Functional genomics and metabolomics advance the ethnobotany of the Samoan traditional medicine "matalafi".

The leaf homogenate of Psychotria insularum is widely used in Samoan traditional medicine to treat inflammation associated with fever, body aches, swellings, wounds, elephantiasis, incontinence, skin infections, vomiting, respiratory infections, and abdominal distress. However, the bioactive components and underlying mechanisms of action are unknown. We used chemical genomic analyses in the model organism Saccharomyces cerevisiae (baker's yeast) to identify and characterize an iron homeostasis mechanism of action in the traditional medicine as an unfractionated entity to emulate its traditional use. Bioactivity-guided fractionation of the homogenate identified two flavonol glycosides, rutin and nicotiflorin, each binding iron in an ion-dependent molecular networking metabolomics analysis. Translating results to mammalian immune cells and traditional application, the iron chelator activity of the P. insularum homogenate or rutin decreased proinflammatory and enhanced anti-inflammatory cytokine responses in immune cells. Together, the synergistic power of combining traditional knowledge with chemical genomics, metabolomics, and bioassay-guided fractionation provided molecular insight into a relatively understudied Samoan traditional medicine and developed methodology to advance ethnobotany.

In vitro antibacterial activity of extracts from Samoan medicinal plants and their effect on proliferation and migration of human fibroblasts.

ETHNOPHARMACOLOGICAL RELEVANCE: The prevalence of different types of chronic wounds, due to the ageing population and increase incidence of diseases, is becoming a worldwide problem. Various medicinal plants used in folk medicine have demonstrated wound healing and antimicrobial properties, and some of these species are currently used in commercial preparations. Despite the well-documented and rich tradition of the use of local herbs for the treatment of skin injuries in Samoan folk medicine, their wound healing potential has not yet been systematically studied. AIM OF THE STUDY: Investigation into the in vitro antibacterial activity of ethanol extracts from 14 medicinal plants used in Samoan traditional medicine for the healing of wounds, burns and sores, and their effects on the proliferation and migration of human fibroblasts. MATERIALS AND METHODS: The antibacterial activity of these extracts was tested against pathogens associated with infected skin injuries, using the broth microdilution method. The effect on migration, proliferation and viability of human dermal fibroblasts was evaluated using wound healing scratch assay, cell proliferation assay, and thiazolyl blue tetrazolium bromide cytotoxicity test. RESULTS: The extracts from Cerbera manghas, Commelina diffusa, Kleinhovia hospita, Mikania micrantha, Omalanthus nutans, Peperomia pellucida, Phymatosorus scolopendria, Piper graeffei, Psychotria insularum, and Schizostachyum glaucifolium inhibited the growth of Staphylococcus aureus at the minimum inhibitory concentration (MIC) of ≥4 µg/mL, whereas C. manghas and P. pellucida produced the same MIC against both Escherichia coli and Pseudomonas aeruginosa. Among the antibacterially active species, C. diffusa, K. hospita, P. scolopendria, P. insularum, and S. glaucifolium did not produce toxicity towards the standard line of normal adult human dermal fibroblasts (IC80 > 128 µg/mL). In addition, extracts from Barringtonia asiatica, C. manghas, M. micrantha, O. nutans, P. insularum, and Piper graeffei stimulated significant migration of dermal fibroblasts, while M. micrantha, O. nutans, and P. insularum did not affect cell proliferation at a concentration of 32 µg/mL. CONCLUSIONS: The results suggest that the above-mentioned species of Samoan medicinal plants can be used for the development of new wound healing agents. However, further phytochemical and pharmacological research is needed regarding the isolation and identification of their active constituents.

A qualitative study of the role of Samoan Church ministers in health literacy messages and health promotion in Auckland, New Zealand.

OBJECTIVE: Health promotion and health literacy activities within church congregations are not a new concept; however, this has not yet been widely researched in New Zealand. This paper explores the views of Samoan Methodist Church ministers about health-related issues and their role in health promotion and health literacy in their churches. METHODS: This was a qualitative research study with Samoan Methodist Church ministers from Auckland, New Zealand. Ten participants were interviewed face-to-face using a semi-structured approach. A general inductive approach for analysis of qualitative data was utilised. Ethics approval was granted by the University of Auckland Human Participants Ethics Committee. RESULTS: All of the church ministers described a holistic view of health and had a sense of responsibility for the holistic wellbeing of their members. Culture was seen as the main barrier to good health. Most of the ministers identified their role in health promotion as being associated with an external health provider. CONCLUSION: Church ministers are well-respected leaders in the Samoan Church, which helps them play an important role in communicating health-promoting messages and encouraging healthy behaviours. The elders and chiefs are recognised as the cultural leaders in the church; without their support, the cultural barriers to health will be difficult to overcome. Implications for public health: Church ministers are important in health literacy messages and health promotion.

The perspectives of Samoan patients and health professionals about access to renal services in New Zealand.

AIM: Information about Pacific patients' access to renal services is limited. This research aims to describe Samoan patients' access to nephrology services in New Zealand. METHODS: Interviews were conducted with six health professionals and four Samoan patients about access to renal services in 2016. Participants were recruited using the snowball method. Interviews were audio-recorded and transcribed. Field notes were also taken. Data were analysed and coded to identify emerging key themes about how Samoan patients access renal services in New Zealand. RESULTS: Health professionals and Samoan patients' perspectives on pathways for accessing renal services in New Zealand were similar. However, there were differences between perspectives and access. Samoan patients' actual pathways or access to services were often complex involving acute presentations to hospital. Patients moving between New Zealand and Samoa also contributed to these complexities. Miscommunications between patients and health professionals, patients' lack of understanding about chronic kidney diseases, their beliefs and use of traditional medicine also impacted on their pathways to services. CONCLUSION: This study identified factors that affected Samoan patients' access to renal services in New Zealand. Raising awareness of chronic kidney diseases and addressing barriers to accessing services is likely to enable timely interventions and improved outcomes.

Effects of a nationwide strategy to reduce salt intake in Samoa.

OBJECTIVE: Salt reduction is one of the most cost-effective interventions for the prevention of noncommunicable diseases, but there are no studies evaluating the effectiveness of national strategies in low or lower middle income countries. This study aimed to examine the effect of an 18-month nation-wide salt reduction strategy in Samoa. METHODS: Two nationally representative cross-sectional surveys of adults aged 18-64 years, measuring 24-h urinary salt excretion and salt-related knowledge, attitudes and behaviours, were conducted before (2013) and after (2015) the intervention. RESULTS: There were 234 participants at baseline (response rate 47%) and 479 at 18 months (response rate 61%). There was no change in mean population salt intake between 2013 (7.31 g/day) and 2015 (7.50 g/day) (0.19, 95% confidence interval -0.50 to 0.88; P = 0.588). There were significant changes in the proportion of the population who always or often add discretionary salt when eating (-16.2%, P = 0.002), the proportion who understood the adverse effects of salt (+9.0%, P = 0.049) and the proportion using one or more methods to control their salt intake (+20.9%, P < 0.001). A total of 73% reported that they had heard or seen the salt reduction messages. CONCLUSION: With widespread awareness of the salt reduction message and some improvements in salt-related knowledge and behaviours following the intervention, Samoa is now well positioned to implement much-needed structural initiatives or policies to reduce salt in the food supply.

The Feagaiga and Faife'au 'Kids' (FKs): An Examination of the Experiences of Parsonage Children of the Samoan Congregational Denomination in New Zealand.

This article examines the experiences of faife'au 'kids' (clergy children) of the Samoan Congregational Christian Church denomination in New Zealand. The paper investigates the effects the indigenous concept of feagaiga (covenant) has on faife'au kids (FKs) parsonage experiences. Additionally, the Eurocentric concept of 'tagata'ese' (stranger) is also investigated. As part of a master's research study, Talanoa sessions were conducted with eight FKs of the Congregational denomination in New Zealand. Participants were mainly from the Wellington and Auckland regions.

Traditional preparations of kava (Piper methysticum) inhibit the growth of human colon cancer cells in vitro.

BACKGROUND: Epidemiological studies indicate there is low incidence of colon cancer in the South Pacific islands, including Fiji, West Samoa, and Vanuatu. Cancer incidence has been shown to be inversely associated with kava (Piper methysticum G. Forst.) ingestion. Hypothesis/Purpose: Kava prepared traditionally will inhibit the growth of human cancer cells. This investigation entails preparation and analysis of kava extracts and study of the growth inhibitory activity of the extracts, alone and combined with hibiscus. STUDY DESIGN: We will prepare kava as in Micronesia - as a water extract, high in particulate content, alone or combined with sea hibiscus (Hibiscus tiliaceus L.) - and examine the components and growth inhibitory activity. METHODS: We obtained ground kava prepared in the traditional way from lateral roots and sea hibiscus mucilage and sap from different sources in Micronesia, and prepared water extracts (unfiltered, as well as filtered, since in traditional use the kava beverage contains a high particulate content) and partitions. We used the MTT assay to determine the growth inhibitory activity of the preparations on colon and breast cancer cells and nonmalignant intestinal epithelial cells. LC-MS analysis was used to examine the components of the kava and sea hibiscus extracts and partitions. RESULTS: Traditional preparations of kava inhibit the growth of breast and colon cancer cells. Among the kava preparations, the order of decreasing activity was Fiji(2), Fiji(1), Hawaii; the unfiltered preparations from Fiji were more active than the filtered. Phytochemical analysis indicated that filtering reduced most kavalactone and chalcone content. For example, for Fiji(2), the ratio of dihydromethysticin in filtered/unfiltered kava was 0.01. Thus, for the extracts from Fiji, growth inhibitory activity correlates with the content of these compounds. Unfiltered and filtered kava from Fiji(1) were more active on malignant than nonmalignant intestinal epithelial cells. Since kava is prepared in Micronesia by squeezing the extract through sea hibiscus bark, we assayed the growth inhibitory activity of combinations of kava and sea hibiscus sap and found that sea hibiscus enhanced the growth inhibitory effect of kava. CONCLUSION: Our results show that traditional kava, alone or combined with sea hibiscus, displays activity against human cancer cells and indicate it will be worthwhile to develop and further analyze these preparations to prevent and treat colon and other cancers. Our findings suggest it is important to examine the activity of plants in the form that people consume them.

Salt intake and iodine status of women in Samoa.

The objective of this study was to determine iodine nutrition status and whether iodine status differs across salt intake levels among a sample of women aged 18-45 years living in Samoa. A cross-sectional survey was completed and 24-hr urine samples were collected and assessed for iodine (n=152) and salt excretion (n=119). The median urinary iodine concentration (UIC) among the women was 88 µg/L (Interquartile range (IQR)=54-121 µg/L). 62% of the women had a UIC <100 µg/L. The crude estimated mean 24-hr urinary salt excretion was 6.6 (standard deviation 3.2) g/day. More than two-thirds (66%) of the women exceeded the World Health Organization recommended maximum level of 5 g/day. No association was found between median UIC and salt excretion (81 µg/L iodine where urinary salt excretion >=5 g/day versus 76 µg/L where urinary salt excretion <5 g/day; p=0.4). Iodine nutrition appears to be insufficient in this population and may be indicative of iodine deficiency disorders in Samoan women. A collaborative approach in monitoring iodine status and salt intake will strengthen both programs and greatly inform the level of iodine fortification required to ensure optimal iodine intake as population salt reduction programs take effect.

"Healing is a Done Deal": Temporality and Metabolic Healing Among Evangelical Christians in Samoa.

Drawing on fieldwork in independent Samoa, in this article, I analyze the temporal dimensions of evangelical Christian healing of metabolic disorders. I explore how those suffering with metabolic disorders draw from multiple time-based notions of healing, drawing attention to the limits of biomedicine in contrast with the effectiveness of Divine healing. By simultaneously engaging evangelical and biomedical temporalities, I argue that evangelical Christians create wellness despite sickness and, in turn, re-signify chronic suffering as a long-term process of Christian healing. Positioning biomedical temporality and evangelical temporality as parallel yet distinctive ways of practicing healing, therefore, influences health care choices.

Perceived social and media influences on tobacco use among Samoan youth.

BACKGROUND: Tobacco use among young Pacific populations continues to undermine efforts to reduce the escalating rates of non-communicable disease in the region. Reducing tobacco use to less than 5 percent by 2025 is now a World Health Organisation (WHO) mandated target for the Pacific region. Yet, little is known about the drivers to uptake of tobacco use among young people in the Pacific. Family and peers are expected to be important in this process, but similarly, tobacco marketing may also play an important role. The tobacco industry has been highly adaptive to the changing media environment across the Pacific Islands. The aim of this study was to develop an understanding of the social cultural and media drivers to tobacco uptake and use among young Samoans to contribute to the design of effective tobacco control intervention. METHODS: We examined high school students (aged 16 and 17 years) perceptions of tobacco use in their community, access and use of media channels and the extent to which they are cognizant of both pro and anti-tobacco imagery across a range of media. Data was collected through in-depth semi-structured interviews. A thematic analysis of the interview data identified common and divergent beliefs, attitudes and behaviours surrounding tobacco use and the influence of the media. RESULTS: Family is critically important for representing normative tobacco use in Samoa. The use of media, in particular digital media, was found to be conditioned by parental views on the use of media in the home. Media access remains highly regulated within more traditional households. Loyalty to traditional cultural practices (Fa'a Samoa) underpinned views on the limited influence of media on social norms around tobacco use. Parents were thought to have the greatest influence on youth smoking. Tobacco use was viewed as a personal, or family issue, and not a problem that was amendable to change at a societal level. CONCLUSION: In order to develop effective and culturally relevant tobacco control policies, the public health community must consider social norms around tobacco use as well as patterns of media use among young Samoans.

Samoan Philosophy of Nursing: a basis for culturally proficient care and policy.

AIM: To explore nurses' perspectives about the Samoan Philosophy of Nursing, and determine its feasibility for nursing care of Samoans internationally. BACKGROUND: This philosophy is the conceptual cultural framework for nursing law, practice, education and research in Samoa, and was developed by Samoan nurses who recognized the need for guidance to deliver quality, culturally competent and proficient health care. DESIGN: A mixed method study, employing a questionnaire and ethnographic methods. METHOD: The Samoan Philosophy of Nursing Questionnaire sought demographic data and aspects about the philosophy from 95 registered nurse clinicians, administrators and educators throughout Samoa during 2012. Descriptive statistics were used for data analysis. Additionally, 19 focus groups (5-6 participants each) and 19 in-depth interviews were held to further explore these aspects, as well as participant observations. Descriptive statistics were used to analyse quantitative data, and Spradley's ethnographic method was adopted for analysing the qualitative data. FINDINGS: Of 95 questionnaires analysed, 70% of participants reported using the philosophy all the time, and 30% most of the time. They placed a high satisfaction rate, value and importance on this philosophy. From the ethnography, six major themes emerged: valuable framework of learning; conceptual framework for holistic assessment; benchmark for regulating and monitoring practice improving interaction and culturally proficient practice; potential use for Samoans overseas; and maintaining quality health and the dignity of people. CONCLUSION: This first-time study evaluated the Samoan Philosophy of Nursing and adds to nursing knowledge. Findings confirmed its usefulness as a culturally based conceptual framework to facilitate, regulate and monitor education, research and practice for sustainable health outcomes in Samoa, and for Samoans living abroad. IMPLICATIONS FOR NURSING POLICY AND EDUCATION: It is important that Samoans living abroad receive culturally proficient care, but this requires the support of policymakers, nurse leaders and educators so that nurses internationally can access and competently utilize relevant aspects of this philosophy in practice.

Needs and experiences of Samoan breast cancer survivors in Southern California.

OBJECTIVE: Breast cancer rates are increasing among Samoan and other Pacific Islander women, yet studies of their social support needs are nearly non-existent. The purpose of this paper is to report on the cultural dimensions of social support among Samoan breast cancer survivors in Southern California. METHODS: Data for this paper came from a larger one-and-a-half year study of the social support needs of Samoan breast cancer survivors and their family and friends. In-depth, retrospective, qualitative interviews were conducted with a purposeful sample of 20 Samoan survivors who were recruited from an existing social support program as well as the general community. RESULTS: We documented important informational needs and behaviors, social support needs and experiences, and spirituality issues for the Samoan breast cancer survivors. CONCLUSIONS: Our findings underscore the need for culturally-specific social support services for Samoans, as well as the necessity of community-based participatory research to define and explore social support and other survivorship needs in this understudied population. Recommendations from the community report-back, stressed the importance of expanding community Samoan cancer social support groups through collaborations with Samoan leaders and churches.

Toxic hepatitis after consumption of traditional kava preparation.

Liver toxicity from the use of kava dietary supplements has been reported, but little is known about the side effects of traditional kava preparations. We present a case study of a tourist who developed serious toxic liver disease after consumption of kava beverages in traditional Samoan kava ceremonies.

Variability in content of the anti-AIDS drug candidate prostratin in Samoan populations of Homalanthus nutans.

Homalanthus nutans, used by Samoan healers to treat hepatitis, produces the antiviral compound 12-deoxyphorbol 13-acetate, prostratin (1). Prostratin is being developed as an adjuvant therapy to clear latent viral reservoirs, the major obstacle to eradication of HIV-AIDS within the human body. A validated reversed-phase HPLC method was developed to assay concentrations of 1 in H. nutans. A survey of four distinct populations on two different Samoan islands revealed significant variability in content. The stem tissue (range 0.2-52.6 microg/g 1), used by healers in indigenous therapies,gave a higher median concentration of prostratin (3.5 microg/g) than root or leaf tissues (2.9 and 2.5 microg/g, respectively).The high variability and skewness of these data indicate that cultivar selection for drug production will be important for this species. The reversed-phase HPLC assay will allow plants to be selected for agricultural development and genetic analysis by identifying those individuals above and below a 95% confidence interval for the median concentration.

Cancer disparities in indigenous Polynesian populations: Maori, Native Hawaiians, and Pacific people.

Polynesia consists of several islands that are scattered across a vast triangle in the Pacific, and include New Zealand, Hawaii, and the Pacific islands. There are reported differences in the types of cancer and epidemiologies seen among communities in these islands, the reasons for which are diverse and complex. In this Review, we describe patterns of cancer incidence, mortality, and survival in indigenous populations compared with populations of European origin in Polynesia, and highlight the limited available data for Pacific populations. Additionally, we document the current knowledge of the underlying biology of cancers in these populations, and report risk factors that differ between ethnicities, including smoking, viral infections, and obesity. Disparities in measures of health are highlighted, as are evident differences in knowledge of tumour biology and cancer management between majority and minority populations.

Reduced half-life of holocarboxylase synthetase from patients with severe multiple carboxylase deficiency.

Multiple carboxylase deficiency is a clinical condition caused by defects in the enzymes involved in biotin metabolism, holocarboxylase synthetase (HLCS) or biotinidase. HLCS deficiency is a potentially fatal condition if left untreated, although the majority of patients respond to oral supplementation of 10-20 mg/day of biotin. Patients who display incomplete responsiveness to this therapy have a poor long-term prognosis. Here we investigated cell lines from two such HLCS-deficient patients homozygous for the c.647T>G p.L216R allele. Growth of the patients' fibroblasts was compromised compared with normal fibroblasts. Also the patient cells were not sensitive to biotin-depletion from the media, and growth rates could not be restored by re-administration of biotin. The molecular basis for the HLCS deficiency was further investigated by characterisation of the p.L216R protein. The HLCS mRNA was detected in MCD and normal cell lines. However, protein and enzyme activity could not be detected in the patients' cells. In vitro kinetic analysis revealed that enzyme activity was severely compromised for recombinantly expressed p.L216R and could not be increased by additional biotin. Furthermore, the turn-over rate for the mutant protein was double that of wildtype HLCS. These results help provide a molecular explanation for the incomplete biotin-responsiveness of this p.L216R form of HLCS.

Woman and midwives: position, problems and potential.

OBJECTIVE: to describe and analyse birthing models in a number of countries, particularly Samoa and China, that have been the focus of my recent research; to discuss how cultural frameworks, colonisation and ideas of what is 'modern' influence the nature, place of birth and its attendant. IMPLICATIONS FOR PRACTICE: midwives need to reflect on their practice and consider broader health policy and how it affects health systems. They also need to understand the social, economic, historical and cultural context of practice, including the influence of gender inequality and attitudes to women and themselves as midwives.

Pacific Islanders' perspectives on heart failure management.

OBJECTIVE: To identify the health beliefs, attitudes, practices, and social and family relations important in heart failure treatment among Pacific Islanders. METHODS: Four focus groups were convened with 36 Native Hawaiians and Samoans with heart failure and their family caregivers. Thematic data analysis was used to categorize data into four domains: health beliefs and attitudes, preferred health practices, social support systems, and barriers to heart failure care. RESULTS: Common coping styles and emotional experiences of heart failure in this population included avoidance or denial of illness, hopelessness and despair, and reliance on spiritual/religious beliefs as a means of support. Among study participants, more Samoans preferred to be treated by physicians whereas more Native Hawaiians preferred traditional Hawaiian methods of healing. Two types of social support (informational and tangible-instrumental) were identified as important in heart failure care. Barriers to heart failure care included poor knowledge of heart failure, lack of trust in physicians' care, poor physician-patient relations, finances, dietary changes, and competing demands on time. CONCLUSION: The recruitment, retention, and adherence of Pacific Islanders to heart failure interventions is affected by an array of psychosocial and socio-cultural factors. PRACTICE IMPLICATIONS: Interventions might be improved by offering participants accurate and detailed information about heart failure and its treatment, engaging the extended family in providing necessary supports, and providing tools to facilitate physician-patient relationships, among others, within the context of a larger socio-cultural system.

Cultural considerations in developing church-based programs to reduce cancer health disparities among Samoans.

OBJECTIVES: We examined receptivity to developing church-based cancer programs with Samoans. Cancer is a leading cause of death for Samoans, and investigators who have found spiritually linked beliefs about health and illness in this population have suggested the Samoan church as a good venue for health-related interventions. DESIGN: We interviewed 12 pastors and their wives, held focus groups with 66 Samoan church members, and engaged a panel of pastors to interpret data. All data collection was conducted in culturally appropriate ways. For example, interviews and meetings started and ended with prayer, recitation of ancestry, and an apology for using words usually not spoken in group setting (such as words for body parts), and focus groups were scheduled to last five hours, conferring value to the topic and allowing time to ensure that cancer concepts were understood (increasing the validity of the data collected). RESULTS: We found unfamiliarity with the benefits of timely cancer screening, but an eagerness to learn more. Church-based programs were welcome, if they incorporated fa'aSamoa (the Samoan way of life) -- including a strong belief in the spiritual, a hierarchical group orientation, the importance of relationships and obligations, and traditional Samoan lifestyle. This included training pastors to present cancer as a palagi (White man) illness versus a Samoan (spiritual) illness, about which nothing can be done, supporting respected laity to serve as role models for screening and witnesses to cancer survivorship, incorporating health messages into sermons, and sponsoring group education and screening events. CONCLUSION: Our findings inform programming, and our consumer-oriented process serves as a model for others working with minority churches to reduce cancer health disparities.