Effectiveness of female genital mutilation/cutting education for health professionals: An integrative review.

INTRODUCTION: A plethora of research has identified the lack of educational opportunities for health professionals to support the biopsychosocial and cultural needs of women who have experienced female genital mutilation/cutting (FGM/C). As a result, some women with FGM/C can feel unsupported, discriminated against and fear to communicate their concerns with health providers. The aim of this review is to identify studies that have investigated the effectiveness of FGM/C education for health professionals. METHOD: Toronto and Remington's six-step framework for conducting an integrative literature review was used to identify studies that met the inclusion criteria. Searches were conducted across five primary databases and grey literature, between August and October 2021. The Joanna Briggs Institute critical appraisal tools for quasi-experimental studies was used to critically appraise included studies. The findings of the search were reported using preferred reporting items for systematic reviews and meta-analysis. RESULTS: A total of five studies met the criteria for inclusion. Studies examined education provided to midwives, nurses, obstetricians, gynaecologists, psychosexual counsellors and student nurses, from England, USA, Mali and Kenya. All studies demonstrated that the implementation of FGM/C education was effective in improving learning outcomes (knowledge, attitude and self-efficacy), However, the quality rating of the evidence ranged from very low to moderate and limited inferential analysis reported. CONCLUSION: This review confirms that FGM/C education, which is informed by evidence and developed in collaboration with practicing communities, is an effective way of improving FGM/C knowledge and attitudes among health professionals. STUDY REGISTRATION: Open Science Framework Register 10.17605/OSF.IO/SMJHX.

Try-It-On: Preparing family nurse practitioners to use holistic integrative interventions to reduce opioid prescriptions in chronic pain management.

In the United States, more than 130 people die each day from an opioid overdose. Nonopioid chronic pain management options are necessary in primary care. This educational innovation describes a new curriculum to teach future family nurse practitioner (FNP) prescribers holistic integrative interventions to decrease overprescribing of opioids for chronic pain management. The Modeling and Role Modeling theory and Kirkpatrick Evaluation Model guided the development and implementation of the curriculum innovation using a Try-It-On teaching-learning strategy, which focuses on immersion experience. The focus was to teach students to communicate effectively with patients in an effort to increase patient awareness of the pathophysiology of pain, risks of opioid use, and holistic integrative pain management options. Students learned to manage chronic pain within a holistic focus through immersion within integrative modalities, such as yoga, meditation, mindfulness, and guided imagery. Pre and post participation evaluations documented students' increased comfort level managing patients with chronic pain. Students reported they were much more likely to prescribe holistic integrative modalities after completing the Try-It-On learning modules. Holistic integrative interventions are a viable treatment option and/or adjunct treatment for chronic pain management. In conclusion, using the Try-It-On, teaching-learning strategy provided FNP students with the tools needed to prescribe nonopioid holistic integrative interventions to manage chronic pain.

Cultural safety and midwifery care for Aboriginal women - A phenomenological study.

BACKGROUND: Aboriginal and Torres Strait islander(1) women face considerable health disparity in relation to their maternity health outcomes when compared to non-Aboriginal women. Culture and culturally appropriate care can contribute to positive health outcomes for Aboriginal women. How midwives provide culturally appropriate care and how the care is experienced by the women is central to this study. AIM: To explore the lived experiences of midwives providing care in the standard hospital care system to Aboriginal women at a large tertiary teaching hospital. METHODS: An interpretive Heideggerian phenomenological approach was used. Semi-structured interviews were conducted with thirteen volunteer midwives which were transcribed, analysed and presented informed by van Manen's approach. FINDINGS: Thematic analysis revealed six main themes: "Finding ways to connect with the women", "building support networks - supporting with and through Aboriginal cultural knowledge", "managing the perceived barriers to effective care", "perceived equity is treating women the same", "understanding culture" and "assessing cultural needs - urban versus rural/remote Aboriginal cultural needs". CONCLUSION: The midwives in this study have shared their stories of caring for Aboriginal women. They have identified communication and building support with Aboriginal health workers and families as important. They have identified perceived barriers to the provision of care, and misunderstanding around the interpretation of cultural safety in practice was found. Suggestions are made to support midwives in their practice and improve the experiences for Aboriginal women.

Mango modulates body fat and plasma glucose and lipids in mice fed a high-fat diet.

Consumption of fruits and vegetables has been investigated for their role in the prevention of many chronic conditions. Among the fruits, mango provides numerous bioactive compounds such as carotenoids, vitamin C and phenolic compounds, which have been shown to have antioxidant and anti-inflammatory properties. The present study examined the effects of dietary supplementation of freeze-dried mango pulp, in comparison with the hypolipidaemic drug, fenofibrate, and the hypoglycaemic drug, rosiglitazone, in reducing adiposity and alterations in glucose metabolism and lipid profile in mice fed a high-fat (HF) diet. Male C57BL/6J mice were randomly divided into six treatment groups (eight to nine/group): control (10 % energy from fat); HF (60 % energy from fat); HF+1 or 10 % freeze-dried mango (w/w); HF+fenofibrate (500 mg/kg diet); HF+rosiglitazone (50 mg/kg diet). After 8 weeks of treatment, mice receiving the HF diet had a higher percentage body fat (P = 0·0205) and epididymal fat mass (P = 0·0037) compared with the other treatment groups. Both doses of freeze-dried mango, similar to fenofibrate and rosiglitazone, prevented the increase in epididymal fat mass and the percentage of body fat. Freeze-dried mango supplementation at the 1 % dose improved glucose tolerance as shown by approximately 35 % lower blood glucose area under the curve compared with the HF group. Moreover, freeze-dried mango lowered insulin resistance, as indicated by the homeostasis model assessment of insulin resistance, to a similar extent as rosiglitazone and modulated NEFA. The present findings demonstrate that incorporation of freeze-dried mango in the diet of mice improved glucose tolerance and lipid profile and reduced adiposity associated with a HF diet.

Methods for recovery of microorganisms and intact microbial polar lipids from oil-water mixtures: laboratory experiments and natural well-head fluids.

Most of the world's remaining petroleum resource has been altered by in-reservoir biodegradation which adversely impacts oil quality and production, ultimately making heavy oil. Analysis of the microorganisms in produced reservoir fluid samples is a route to characterization of subsurface biomes and a better understanding of the resident and living microorganisms in petroleum reservoirs. The major challenges of sample contamination with surface biota, low abundances of microorganisms in subsurface samples, and viscous emulsions produced from biodegraded heavy oil reservoirs are addressed here in a new analytical method for intact polar lipids (IPL) as taxonomic indicators in petroleum reservoirs. We have evaluated the extent to which microbial cells are removed from the free water phase during reservoir fluid phase separation by analysis of model reservoir fluids spiked with microbial cells and have used the resultant methodologies to analyze natural well-head fluids from the Western Canada Sedimentary Basin (WCSB). Analysis of intact polar membrane lipids of microorganisms using liquid chromatography-mass spectrometry (LC-MS) techniques revealed that more than half of the total number of microorganisms can be recovered from oil-water mixtures. A newly developed oil/water separator allowed for filtering of large volumes of water quickly while in the field, which reduced the chances of contamination and alterations to the composition of the subsurface microbial community after sample collection. This method makes the analysis of IPLs (or indirectly microorganisms) from well-head fluids collected in remote field settings possible and reliable. To the best of our knowledge this is the first time that IPLs have been detected in well-head oil-water mixtures.

Measuring raft size as a function of membrane composition in PC-based systems: Part 1--binary systems.

This work applied two steady-state fluorescence techniques to detect nanoscopic membrane domains in a binary dimyristoylphosphocholine (DMPC)-cholesterol system and a ternary dioleoylphosphocholine (DOPC)-dipalmitoylphosphocholine (DPPC)-cholesterol system. A polarity-induced spectral shift in the emission spectra of 1-myristoyl-2-[12-[(5-dimethylamino-1-naphthalenesulfonyl)amino]dodecanoyl]-sn-glycero-3-phosphocholine (DAN-PC) in combination with a Förster resonance energy transfer (FRET) assay agreed with the phase diagrams that have been published for these systems and were observed to be useful tools in the detection of membrane heterogeneities. The DAN-PC/dehydroergosterol (DHE) FRET pair was found to be best suited for use with these steady-state techniques because of their differential partitioning between phases, although a high acceptor concentration was needed to obtain accurate measurements. In the binary system, this high probe concentration was found to be perturbing, but in more representative ternary systems, the high probe concentration no longer disrupted the phase behavior of the system. This FRET pair allowed for the calculation of nanometer-scale domain sizes in model ternary systems, using the two steady-state fluorescence techniques along with a clear and straightforward model.

Measuring raft size as a function of membrane composition in PC-based systems: Part II--ternary systems.

The heterogeneity of cell membranes, specifically the presence of lipid rafts, has been hypothesized to play a role in a large number of cellular processes. Although extensive work has been carried out to show the function of lipid rafts in these processes, the characterization of lipid rafts has proven to be extremely difficult. It is known that raft size is relevant to the function of cellular processes and that raft coalescence may be a driving factor for these processes; however, it remains unclear what factors influence raft size and coalescence in natural cell membranes. In this work, we study two ternary model phospholipid and cholesterol systems using two steady-state fluorescent techniques to detect and characterize membrane domains. Domain size is determined through the use of a model to relate experimental Förster resonance energy transfer (FRET) measurements to domain size. Domains in the range of 3-15 nm were detected in a dioleoylphosphatidylcholine-dipalmitoylphosphatidylcholine-cholesterol (DOPC-DPPC-Chol) system, while only a very small region containing domains was detected in a 1-palmitoyl-2-oleoyl-phosphatidylcholine-dipamitoylphosphatidylcholine-cholesterol (POPC-DPPC-Chol) system. In addition, the polarity-dependent emission maximum shift of the acceptor 1-myristoyl-2-[12-[(5-dimethylamino-1-naphthalenesulfonyl)amino]dodecanoyl]-sn-glycero-3-phosphocholine (DAN-PC) was used to detect the type of liquid phase(s) present in the membrane. It was found that, even in the case in which no two-phase coexistence was observed (POPC-DPPC-Chol), two liquid phases are present, although not necessarily in coexistence. These steady-state fluorescent techniques provide a method for detecting the presence of very small domains in model membranes and provide previously inaccessible detail about the phase behavior of these two systems.

On the front line of primary health care: the profile of community health workers in rural Quechua communities in Peru.

OBJECTIVE: To describe the profile of community health workers--health promoters, traditional birth attendants and traditional healers--in rural Quechua communities from Ayacucho, Peru. METHODS: Basic quantitative and qualitative information was gathered as part of a community health project implemented between 1997 and 2002 in 40 Andean communities with information from questionnaires, personal interviews and group discussions. RESULTS: The majority of current community health workers are men with limited education who are primarily Quechua speakers undertaking their work on a voluntary basis. Health promoters are mostly young, male, high school graduates. There exists a high drop-out rate among these workers. In contrast, traditional healers and traditional birth attendants possess an almost diametrically opposite profile in terms of age, education and drop-out rates, though males still predominate. At the community level the health promoters are the most visible community health workers. CONCLUSION: It is very important to consider and to be aware of the profile of community health workers in order to provide appropriate alternatives when working with these groups as well as with the indigenous population, particularly in terms of culture, language and gender issues.