An Analysis of Oppression and Health Education for Underserved Populations in the United States: The Issues of Acculturation, Patient-Provider Communication, and Health Education

The oppression of underserved populations is pervasive throughout the history of the United States (U.S.), especially in health care. Brazilian educator Paulo Freire’s controversial ideas about systems of power can be aptly applied to health care. This paper focuses specifically on arguably the most medically underserved group in the U.S. healthcare system, free clinic patients, and analyzes the effects oppression on acculturation and patient-provider communication, and the potential of health education classes to reduce oppression and health disparities in this population. One way in which oppression materializes within the realm of medical and health education is through acculturation. Spanish-speaking free clinic patients are less satisfied with overall interpersonal communication at a free clinic than US born and non-US born English-speaking free clinic patients. Oppression can also be seen in patient-provider communication, specifically, around communicating diagnoses. It is vital for providers and educators to consistently and accurately educate their patients, and to ensure that patients fully understand their diagnoses before concluding an office visit. Reduction of national deaths through preventative health measures, such as health education programming, is an achievable goal. However, one concern in health education classes amongst underserved populations is the underlying power dynamic associated with individuals from a privileged background educating less privileged populations. Engaging health education participants through informal discussions rather than lectures is something that can be applied in future health-related educational settings.    Further examining issues of acculturation, patient-provider communication, and health education classes would help answer Freire’s pedagogical questions and improve health care services for free clinic patients and other underserved populations in the U.S. Keywords: medically uninsured; acculturation; patient-provider communication; health education; US

Imaging Luciferase-expressing Viruses

Optical imaging of luciferage gene expression has become a powerful tool to track cells and viruses in vivo in small animal models. Luciferase imaging has been used to study the location of infection by replication-defective and replication-competent viruses and to track changes in the distribution of viruses in mouse models. This approach has also been used in oncolytic studies as a non-invasive means to monitor the growth and killing of tumor cells modified with luciferase genes. In this chapter, we describe the techniques used for luciferase imaging as have been applied to track replication-defective and replication-competent adenoviruses in mouse and hamster models of oncolysis and virus pharmacology. Although these methods are simple, the process of obtaining accurate luciferase imaging data has many caveats that will be discussed

Investigating the socio-economic impacts of the introduced Asian paddle crab, Charybdis japonica, on New Zealand’s native paddle crab fishery

Despite the body of scientific research that exists on Charybdis japonica since it’s discovery in New Zealand in 2000, an investigation into the socio-economic impacts this introduced species may have was lacking. This study focuses on the potential socio-economic impacts from C. japonica on NZ’s native paddle crab (Ovalipes catharus) fishery. Charybdis japonica has spread steadily throughout the North Island of NZ, predominantly in an area that coincides with the main commercial fishing area for O. catharus (federally managed and defined as ‘PAD1’). Fishers perceptions of change and impacts in the fishery were investigated across the commercial and recreational sectors within this focus area. Qualitative, semi-structured interviews with commercial crab fishers covered three main areas: (1) background information on the O. catharus fishery, (2) perceptions of change in the fishery, (3) knowledge of C. japonica and perceived impact. Surveys with recreational fishers also covered these areas, with additional questions on their perceptions of the value of certain coastal environmental aspects (i.e., safety, cleanliness, biodiversity). Commercial fisheries catch data for the five main O. catharus fishing regions was also analysed to assess if a significant change in catch rates pre- and post- the arrival of C. japonica in NZ had occurred. Results showed significant changes in PAD1, PAD7 and PAD8 fisheries management areas. Given C. japonica has not yet been found in PAD7 and PAD8, catch rate changes within these three areas are likely due to other unmeasured variables. Commercial fishers predominantly suggested C. japonica had not yet had an observable impact on the O. catharus fishery. Recreational fishers that participated in this study had only had a short-term exposure to the fishery (the majority had started fishing for crabs less than a year ago), thus they had limited perceptions of change within the fishery. Commercial and recreational fishers were also tested on their ability to accurately identify the two crab species. Both sectors accurately identified O. catharus 95% of the time and C. japonica 55% of the time from a series of four images, with no statistically significant difference in accuracy between the two sectors. Despite some evidence of self-reported awareness of C. japonica in this study, further sustained public education to enable identification of this introduced species is needed if the public are to be incorporated into the management of this species. Commercial fishers highlighted the potential impact C. japonica may have on the flatfish fishery, an area requiring further investigation. Further research on the impacts C. japonica could have on other species of ecological, social, cultural and economic importance in NZ is required

Hyperbaric Oxygen Therapy for Cancer Patients with Radiation-Induced Tissue Injuries

Cancer, secondary to cardiovascular disease, is the leading cause of death worldwide (Centers for Disease Control and Prevention, n.d.). Radiation is a standard cancer therapy, however it can cause fibrosis of blood vessels, the breakdown of soft tissue, and subsequently lead to necrosis. When caring for cancer patients, it is imperative to consider the lasting effects interventions pose on their long-term health. Hyperbaric oxygen therapy (HBOT) is a healing treatment consisting of administering 100% oxygen to the body in a pressurized chamber; in turn, HBOT facilitates capillary regrowth, blood flow restoration, and increased efficiency of wound healing time. The efficacy of hyperbaric oxygen therapy in improving the healing time of radiation-induced tissue injury in adults, compared to those not receiving the therapy, was examined. A literature search was conducted using the databases CINAHL and PubMed. The search encompassed the years 2019 to 2024 and included the search terms: hyperbaric oxygen therapy, injury, radiation, and cancer. Inclusion criteria involved articles that identified the uses of HBOT when treating post-radiation injuries for breast, head, neck, and pelvic cancers. Exclusion criteria included articles that did not fit the age group or highlighted alternative treatment modalities. Twelve peer-reviewed articles met the search criteria. The literature found that individuals receiving HBOT for radiation-induced complications reported increased quality of life, decreased pain, and minimal side effects shortly after therapy. Based on the findings, there is strong support that this treatment modality can reduce the healing time of tissue injuries compared to those not utilizing HBOT

First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review.

BACKGROUND: The dose of mifepristone approved by most government agencies for medical abortion is 600 mg. Our aim was to summarize extant data on the effectiveness and safety of regimens using the widely recommended lower mifepristone dose, 200 mg, followed by misoprostol in early pregnancy and to explore potential correlates of abortion failure. STUDY DESIGN: To identify eligible reports, we searched Medline, reviewed reference lists of published reports, and contacted experts to identify all prospective trials of any design of medical abortion using 200 mg mifepristone followed by misoprostol in women with viable pregnancies up to 63 days' gestation. Two authors independently extracted data from each study. We used logistic regression models to explore associations between 15 characteristics of the trial groups and, separately, the rates of medical abortion failure and of ongoing pregnancy. RESULTS: We identified 87 trials that collectively included 120 groups of women treated with a regimen of interest. Of the 47,283 treated subjects in these groups, abortion outcome data were reported for 45,528 (96%). Treatment failure occurred in 2,192 (4.8%) of these evaluable subjects. Ongoing pregnancy was reported in 1.1% (499/45,150) of the evaluable subjects in the 117 trial groups reporting this outcome. The risk of medical abortion failure was higher among trial groups in which at least 25% of subjects had gestational age >8 weeks, the specified interval between mifepristone and misoprostol was less than 24 h, the total misoprostol dose was 400 mcg (rather than higher), or the misoprostol was administered by the oral route (rather than by vaginal, buccal, or sublingual routes). Across all trials, 119 evaluable subjects (0.3%) were hospitalized, and 45 (0.1%) received blood transfusions. CONCLUSIONS: Early medical abortion with mifepristone 200 mg followed by misoprostol is highly effective and safe

Policy and Social Factors Influencing Diabetes among Pima Indians in Arizona, USA

The Pima Indians have the highest rate of type 2 diabetes in the world. While biomedical studies have identified a genetic variable associated with the high prevalence of diabetes among Pima Indians, genetics is only one factor that encompasses an individual’s risk for developing a disease. Information on the social factors relating to the development of type 2 diabetes amongst this population is necessary. The purpose of this analysis is to review policy, social and historical factors associated with diabetes among Pima Indians. Governmental policies have affected this population’s ability to eat a diet native to their culture. For example, the damming of the Gila River in the early 1920s resulted in diet and lifestyle changes, reducing traditional low fat, high fiber intake and physical activity, among the Pima population. U.S. Department of Agriculture (USDA) policies in place in the 1970s and 1980s did not allow Native Americans, the Pima included, to get farm help such as agricultural loans in times of need. These policies led to many Pima finding sedentary jobs, if they could find work at all, and adopting unhealthy lifestyles. While genetic factors have shown to be important predictors of diabetes incidence, the historical and social factors that changed US Pima Indians’ lifestyles are significant factors which have contributed to the high prevalence of diabetes among this group. In order to address the high rates of diabetes among the Pima Indians, it is vital that emphasis be placed upon culturally appropriate interventions. U.S. government agencies, tribal leaders, and community elders would benefit from working together to establish healthier food sources, encourage physical activity, and utilize existing community networks to spread information on diabetes prevention and management practices. Future studies on diabetes among Pima Indians would include more policy, social and historical factors, develop programs with reflection of these factors, and evaluate the programs. Keywords: Pima Indians, type 2 diabetes, Native American policies, social factors, US