The challenge of interdisciplinary collaboration in acute psychiatry: Impacts on the occupational milieu.

This paper, based on a larger ethnographic exploration of the acute inpatient environment for older people with mental illness, describes and provides interpretations of staff perceptions and actions in order to highlight tensions between professional groups which adversely affect opportunities for patients to engage in meaningful occupations. Fieldwork conducted in 1999-2000, supplemented by 20 in-depth interviews with a range of mental health professionals, provides the foundation for suggesting that the extent and nature of occupational engagement is significantly impacted by interdisciplinary relations. The skill of occupational therapists to collaborate with their nursing colleagues in a socially complex environment, and the importance of personal leadership skills among our new graduates are discussed.

Centralized and non-centralized ethics review: a five nation study.

The research ethics review process is now an inherent part of conducting research and a topic of much discussion. On the negative side it has been presented as cumbersome, expensive, time consuming, and potentially a system that does not adequately deal with the concerns it was set up to address. One common, but often controversial, proposal to address some of these concerns has been the institutionalization of centralized systems of review. This paper uses data on the review systems in place in five countries (Australia, Canada, New Zealand, the USA and the U.K.), some with and some without versions of centralized review, to explore issues related to centralization of the review process. It suggests that there are at least three types of systems (fully centralized, dual, and decentralized or multicommittee) in place; all are made up of two, interrelated components (the administrative and ethics review). We suggest that both components need to be considered in discussions about centralized review. Serious consideration of centralization of the administrative component may address many concerns. Centralization of the ethics review may provide a context that deals with other issues and may encourage reviews that more effectively focus on the ethical issues involved.

Doubling the cloak of (in)competence in client/therapist interactions.

Cultural competence is used (often implicitly) to make decisions in human service settings. When therapists make decisions about whether or not a particular service will be offered, they place themselves in a position where their own competence can be judged. Using narrative data on independence and the elderly, we apply Edgerton's idea of the cloak of competence to demonstrate this doubling effect.

Carotenoid-rich bananas: a potential food source for alleviating vitamin A deficiency.

This review article points out that bananas are an important food for many people in the world. Thus, banana cultivars rich in provitamin A carotenoids may offer a potential food source for alleviating vitamin A deficiency, particularly in developing countries. Many factors are associated with the presently known food sources of vitamin A that limit their effectiveness in improving vitamin A status. Acceptable carotenoid-rich banana cultivars have been identified in Micronesia, and some carotenoid-rich bananas have been identified elsewhere. Bananas are an ideal food for young children and families for many regions of the world, because of their sweetness, texture, portion size, familiarity, availability, convenience, versatility, and cost. Foods containing high levels of carotenoids have been shown to protect against chronic disease, including certain cancers, cardiovascular disease, and diabetes. Because the coloration of the edible flesh of the banana appears to be a good indicator of likely carotenoid content, it may be possible to develop a simple method for selecting carotenoid-rich banana cultivars in the community. Research is needed on the identification of carotenoid-rich cultivars, targeting those areas of the world where bananas are a major staple food; investigating factors affecting production, consumption, and acceptability; and determining the impact that carotenoid-rich bananas may have on improving vitamin A status. Based on these results, interventions should be undertaken for initiating or increasing homestead and commercial production.

A dialogue on occupational therapy, culture, and families.

This paper, based on a broad body of relevant data, presents a dialogue that explores and integrates two important concepts: family and culture. An understanding of these concepts is important for enhancing occupational therapy practice, in particular a practice that claims to be client-centered and holistic. The dialogue focuses particularly on issues students involved in the Intercultural Interaction Project, The University of Sydney, Australia, in 2002 identified as important. These include: a lack of understanding of the concept of culture, the confounding of culture and ethnicity, considering culture as an issue only in families from "other" cultural backgrounds, assumptions about the nature of families and therapists' points of reference for making these assumptions, differences in client or family and therapist expectations, and how these expectations affect what happens in therapy and participants' level of satisfaction with the outcomes of the interactions involved. The information suggests that there is a need for a better understanding of how culture influences ideas about families and how to work with them.

Independence as a practice issue in occupational therapy: the safety clause.

This article reports findings from interviews that explored the meanings occupational therapists attach to independence as a value and a therapeutic goal in interactions with elderly clients. Through a historical review of the literature, we trace the changing use of this term and identify two analytically distinct concepts associated with it: independence as self-reliance in activity and independence as autonomy, self-determination, or choice. We show how the latter has emerged in contemporary service contexts to represent an ideal of client-centered practice for persons with chronic disabilities, such as frail elderly clients. Using a "critical incident" interview approach with 12 Australian occupational therapists, we identified the therapists' explicit and implicit understandings of independence as a value concept and practice issue. Our findings suggest that a mismatch often exists between idealized and practice-based talk about independence and that therapists narrativize this opposition around what we call "the safety clause." That is, therapists invoke concerns about safety and duty of care as a caveat to implementing their independence ideals and justifying the retention of professional control. We identify key issues that therapists need to address if the rhetoric of independence-related client-centered practice is to be achieved in reality.

A participatory assessment of dietary patterns and food behavior in Pohnpei, Federated States of Micronesia.

Non-communicable diseases are escalating rapidly within the Pacific region, including Pohnpei, Federated States of Micronesia. A shift in dietary patterns from indigenous, high fiber, healthy local food to energy-dense, imported food with low nutritional value, and increased sedentary lifestyles are expediting this process. Essential to counteract this trend is an understanding of how people make food decisions. This participatory assessment utilized a quantitative and qualitative approach to capture diet patterns and knowledge, attitudes, beliefs and practices of food consumption. A structured 7-day food frequency questionnaire (FFQ) was used to quantify the diets of 293 adult Pohnpeian women attending an island-wide education/disability screening program. An ethnographic approach, including in-depth interviews, informal focus groups and observations documented food behavior practices and contributed to the design of the FFQ. Of those responding to the FFQ, 96% reported eating rice frequently (3-7 days/week) whereas 75% reported eating locally grown carbohydrate foods frequently. Factors associated with culture change, including availability, affordability, convenience, and status of food items were found to determine food decisions. Food-based, culturally sensitive and innovative strategies that utilize existing resources are required to promote local food production and consumption. Prevention programs with an information, education and communication (IEC) approach are needed to provide accurate and available health and nutrition knowledge and to increase the demand for local foods. Behavior modification requires the continued collaboration of the national, state, and community organizations that partnered on this research to strategize programs in order to target individual food choices and to transform the environment to support these decisions.

Pacific issues of biodiversity, health and nutrition.

Neglect of traditional food systems has led to serious nutrition and health problems throughout the Pacific Islands. At the same time, there is concern about the loss of traditional knowledge, customs and culture related to local foods, and of biodiversity. However, there is still a great diversity of nutrient-rich local food crops in the Pacific, along with considerable knowledge about these foods, their methods of production, harvesting, storage, and preparation. An integrated approach is needed in order to make a meaningful impact on increased production, marketing/processing and use of local food crops and foods for better health and nutrition, requiring greater collaboration between the health sector and agencies in other sectors. Priorities for action include: documentation and assessment of traditional food systems, including analysis of local foods and crop varieties for their nutrient content; innovative means of increasing awareness of the values of local foods among the general public and policy makers; conservation of rare varieties of crops and food trees and protection of the environment; and an increased focus on small-scale processing and marketing of local foods. Overriding all of this is the urgent need to mainstream consideration of these important issues into relevant national and regional policies. The rubric "Biodiversity for Health and Nutrition" incorporates all of these issues and provides a framework within which all partner agencies can be involved.

If Ethics Committees were Designed for Ethnography.

WHERE DID THE ETHICS REVIEW PROCESS go wrong for qualitative research, and how can we make it right, or at least better? This paper begins with an excerpt from an ethnography of attempting to attend an ethics review-related workshop, which exemplifies that the ethics-review process is based on epistemological assumptions aligned with positivistic research, and does not fit the qualitative research process. We suggest that a new format for ethics review, based on assumptions associated with qualitative research and ethnography, might be a better fit. In this model the researcher becomes the expert and the committee the learner or ethnographer. In this process the ethics review process is guided by four core open-ended questions that facilitate a fuller and richer exchange of information. The second part of this paper presents strategies that may lessen the risks associated with the unknown or emergent aspects of qualitative research. These strategies include a dual consent process and the co-opting of journal editors or thesis review boards to review ethical considerations prior to publication or sign off, and a renewed focus of ethics training.

Carotenoid content of pandanus fruit cultivars and other foods of the Republic of Kiribati.

BACKGROUND: Kiribati, a remote atoll island country of the Pacific, has serious problems of vitamin A deficiency (VAD). Thus, it is important to identify locally grown acceptable foods that might be promoted to alleviate this problem. Pandanus fruit (Pandanus tectorius) is a well-liked indigenous Kiribati food with many cultivars that have orange/yellow flesh, indicative of carotenoid content. Few have been previously analysed. AIM: This study was conducted to identify cultivars of pandanus and other foods that could be promoted to alleviate VAD in Kiribati. METHOD: Ethnography was used to select foods and assess acceptability factors. Pandanus and other foods were analysed for beta- and alpha-carotene, beta-cryptoxanthin, lutein, zeaxanthin, lycopene and total carotenoids using high-performance liquid chromatography. RESULTS: Of the nine pandanus cultivars investigated there was a great range of provitamin A carotenoid levels (from 62 to 19,086 microg beta-carotene/100 g), generally with higher levels in those more deeply coloured. Seven pandanus cultivars, one giant swamp taro (Cyrtosperma chamissonis) cultivar and native fig (Ficus tinctoria) had significant provitamin A carotenoid content, meeting all or half of estimated daily vitamin A requirements within normal consumption patterns. Analyses in different laboratories confirmed high carotenoid levels in pandanus but showed that there are still questions as to how high the levels might be, owing to variation arising from different handling/preparation/analytical techniques. CONCLUSIONS: These carotenoid-rich acceptable foods should be promoted for alleviating VAD in Kiribati and possibly other Pacific contexts where these foods are important. Further research in the Pacific is needed to identify additional indigenous foods with potential health benefits.

Carotenoid and vitamin content of Karat and other Micronesian banana cultivars.

We previously found high carotenoid levels in Karat and other Micronesian bananas, indicating potential importance for alleviating vitamin A deficiency and other nutritionally related health problems in the Federated States of Micronesia. Past work focused on carotenoid and mineral analyses, whereas here we investigated 16 cultivars (most not previously analysed) for a broader micronutrient profile, including seven vitamins. Karat carotenoid levels were higher than in previous analyses, confirming Karat as exceptionally carotenoid-rich. We identified an additional 10 carotenoid-rich cultivars, expanding the range having potential for alleviating vitamin A deficiency. A striking finding is the high riboflavin level in Karat, including high levels of uncharacterized flavonoids. Niacin and alpha-tocopherol are at levels that may contribute importantly to dietary intake within normal patterns of consumption. These data present a more complete basis for promoting the nutritional benefits of these banana cultivars where they are consumed in the Pacific, and potential benefits for promoting elsewhere.

Insights on food and nutrition in the Federated States of Micronesia: a review of the literature.

BACKGROUND: Nutrition-related disorders, including vitamin A deficiency (VAD) and chronic diseases, are serious problems in the Federated States of Micronesia (FSM). Many suggest that these disorders are new problems related to dietary and lifestyle changes. In the past four decades, imported foods, such as white rice, flour, sugar, refined foods and fatty meats, have increasingly replaced local foods in the diet. AIM: A literature review was conducted to understand underlying issues related to dietary change and obtain insights for nutrition research and interventions. METHOD: Published and unpublished papers from different disciplines were reviewed and collated for information on food and nutrition in FSM. Topics covered were historical background, local foods, infant and child feeding, dietary assessment, and nutritional status. Particular focus was on information and data relating to VAD, the primary topic that led to the review of the literature. CONCLUSIONS: FSM, a tropical country of abundant agricultural resources, has suffered a great loss in production and consumption of local foods. Inconsistent external and internal government policies and food aid programmes have contributed to the problem. Further research on the nutrient content of local foods and factors affecting production, acquisition and consumption is needed, as well as a broad, well-planned, intersectoral intervention aimed at dietary improvement for all age groups in the population.

Pacific pandanus fruit: an ethnographic approach to understanding an overlooked source of provitamin A carotenoids.

Commonly recommended plant sources of provitamin A, such as dark green leafy vegetables, are not acceptable in many population groups. The objective of this study was to identify other indigenous foods that may be effectively promoted to alleviate vitamin A deficiency (VAD) and to gather information relevant to identification, production, acquisition, and consumption of foods relevant to a food-based VAD prevention strategy in the Federated States of Micronesia. An ethnographic study on edible pandanus cultivars, involving key informant interviews and observation was carried out. Analyses revealed a great range in carotenoid content. Several orange-coloured pandanus cultivars, all highly acceptable, contained high levels of carotenoid, almost meeting daily requirements in usual consumption patterns, whereas light yellow-coloured cultivars contained low levels. Availability has decreased substantially in recent years due to increased consumption of imported foods and general neglect of indigenous foods. High-carotenoid pandanus should be promoted for general enjoyment and health benefits.