Kumu hula perspectives on health.

To prepare for research studies that would evaluate the impact of hula as part of a clinical intervention, including cardiovascular disease (CVD) prevention and management programs, kumu hula defined as "culturally recognized hula educators and experts," were interviewed. Investigators sought to elicit their views regarding hula's traditional and contemporary connections to health and well-being, assess the cultural appropriateness of such projects, and suggest ways to maintain hula's cultural integrity throughout clinical intervention programs. Six prominent kumu hula from five different Hawaiian Islands participated in semi-structured key informant interviews lasting between 60 and 90 minutes. Each was asked open-ended questions regarding their attitudes, beliefs, and experiences regarding the connections of hula to health as well as their recommendations on maintaining the integrity of the dance's cultural traditions when developing and implementing a hula-based CVD program. All kumu hula endorsed the use of hula in a CVD intervention program and articulated the strong, significant, and enduring connections of hula to health and well-being. Each kumu hula also recognized that health is the full integration of physical, mental, emotional, and spiritual well-being. When care is taken to preserve its cultural integrity, hula may be an effective integrated modality for interventions designed to improve health and wellness.

Developing a culturally based cardiac rehabilitation program: the HELA study.

BACKGROUND: Heart disease disproportionately affects Native Hawaiians and other Pacific people. In response, researchers proposed and communities endorsed, developing a cardiac rehabilitation (CR) program based on the hula, a Native Hawaiian dance form. The utilization of cultural practices in health interventions can improve outcomes and increase enrollment and retention, but requires sensitivity and understanding. OBJECTIVE: This paper provides the conceptual framework and methods used for integration of multiple communities' perspectives to inform the design of a hula-based CR intervention. METHODS: Specific strategies and processes were established to ensure the equity of scientific-clinical and patient- cultural knowledge and perspectives. Multiple methods were used and a flow diagram defined steps for the intervention development. RESULTS: Patient and cultural consultations provided information about the multidimensional benefits of hula and its use in a CR intervention. Clinical and scientific consultations provided specific guidelines for exercise prescription and patient monitoring. Integrating findings from all consultations identified important direction and requirements. CONCLUSIONS: Community-based participatory research (CBPR) principles guided a complex collaboration of multiple communities; although time consuming, inclusive consultations provided valuable information and relationships.

Interactions of alpha-tocopherol with biomembrane models: binding to dry lecithin reversed micelles.

The state of alpha-tocopherol (Vitamin E) in solutions of dry lecithin reversed micelles dispersed in an apolar medium has been investigated as a function of the Vitamin E to surfactant molar ratio (RVE) at fixed surfactant concentration by FT-IR, 1H NMR and SAXS with the aim to emphasize the role played by anisotropic intermolecular interactions and confinement effects as driving forces of its partitioning between apolar bulk solvent and polar nanodomains and of mutual Vitamin E/reversed micelle effects. It has been found that its binding strength to reversed micelles, triggered by steric and orientational constrains, is mainly regulated by specific interactions between the hydrophilic groups both of Vitamin E and surfactant. Moreover, the RVE dependence of the Vitamin E distribution constant and of the micellar size suggest that the inclusion of increasing amounts of Vitamin E in reversed micelles involves substantial changes in the structural and dynamical properties of the micellar aggregates. The occurrence of mutual effects and the partitioning of Vitamin E between hydrophilic/hydrophobic interfaces and apolar domains allow to infer some important biological implications concerning the capacity of Vitamin E to scavenge free radicals arising from hydrophilic and/or hydrophobic domains, possible variations of its local reactivity respect to that observed in bulk as well as its significant influence on the stability of biomembranes.

Ad hoc survey of hepatitis B vaccination campaign in newborns of HBsAg positive mothers and in 12-year-old subjects in southern Italy.

The ongoing vaccination campaign against hepatitis B (HB) for newborns of hepatitis B surface antigen (HBsAg) positive mothers and for 12-year-old subjects was evaluated in Naples, Italy, an area of relatively high HB endemicity. Subjects were recruited by a random sampling procedure. Among 2060 pregnant women studied, 1887 (91.6%) were screened for HBsAg. HBsAg prevalence was 2.5% (47/1887). Immunoprophylaxis according to the protocol (immunoglobulins within 24 h plus vaccine within 7 days after birth) was administered in 26 (55.3%) out of the 47 newborns of HBsAg positive mothers; vaccination was delayed (later than 7 days after birth) for 14 (29.8%) infants; in the remaining seven newborns (14.9%) were not given immunoglobulins at birth. All infants were vaccinated. Out of the 1000 adolescents sampled 130 (13%) were not found due to an inaccurate census list; 727 (83.3%) of the 870 investigated had received a three-dose HB vaccine series. Overall, the HB vaccination program in Italy is working well. However, further efforts should be made to improve the efficacy and effectiveness of the campaign.

High-level expression of a cDNA for human granulocyte colony-stimulating factor in Chinese hamster ovary cells. Effect of 3'-noncoding sequences.

We compared the production of recombinant human granulocyte colony-stimulating factor (rhG-CSF) by Chinese hamster ovary (CHO) cells in a transient expression system, using different analogous vectors carrying a human G-CSF-encoding cDNA under the transcriptional control of the murine cytomegalovirus (CMV) major immediate early promoter. Comparison of two transcription units carrying a human (h)G-CSF cDNA deleted of 3'-untranslated (UTR) sequences containing AT-rich elements (ARE) and using 3'-UTR sequences for processing of transcripts from the SV40 early region or from the rabbit beta 1-globin gene showed that use of the sequences from the rabbit beta 1-globin gene resulted in 7- to 12-fold higher levels of rhG-CSF production. Deletion of ARE of hG-CSF cDNA resulted in increased rhG-CSF synthesis when transcription units using 3'-UTR sequences from the rabbit beta 1-globin gene were compared. By contrast, deletion of ARE did not appear to affect rhG-CSF production when 3'-UTR sequences from the SV40 early region were used. The most efficient G-CSF transcription unit, fused to a dihydrofolate reductase (DHFR) marker gene and transfected into a CHO cell line, yielded initial transfectant CHO cell lines secreting up to 21 micrograms rhG-CSF/1 x 10(6) cells in 24 h. After two rounds of DHFR gene amplification, a cell line was isolated that contains approx 12 copies of the vector and produces rhG-CSF at a rate of 90 micrograms/1 x 10(6) cells in 24 h.

Prognostic value of anesthesia type for patients treated for cutaneous melanoma.

BACKGROUND: General anesthesia has been reported to compromise several cell-mediated immune functions. Hence it is plausible that anesthesia could affect the postoperative outcome of cancer patients. OBJECTIVE: To study the influence of the type of anesthesia on survival of 459 patients with localized cutaneous melanoma observed between 1980 and 1991. METHODS: Crude survival proportions were calculated by the methods of Kaplan and Meier. Cox proportional hazards regression analysis was used to estimate the effect on death rates of the type of anesthesia. RESULTS: The 5-year survival proportions were 81% for patients treated under local anesthesia, 71.9% for patients receiving halothane isoflurane or enflurane, and 88.4% for neuroleptanalgesia (P < .05). After multiple adjustment for other prognostic variables (tumor thickness, presence of ulceration, age, sex, cross-sectional profile), using patients treated under local anesthesia as a reference group, the relative risk for general anesthesia with volatile agents was 1.3 (95% CI, 0.84-2.10). CONCLUSION: The type of anesthesia does not seem to affect the survival of patients with cutaneous melanoma, when other prognostic factors are considered.

[Methods for the evaluation of a health intervention in developing countries: the case in the Arsi region, Ethiopia]. / Metodi per la valutazione di un intervento sanitario nei paesi in via di sviluppo: il caso nella regione dell'Arsi, Etiopia.

Since 1989 an evaluation study of the impact of a Primary Health Care (PHC) program is being carried out in Arsi region, Ethiopia. The principal aim of the study is to estimate the mortality rates in those villages mainly involved in PHC activities. A sample of 80 villages will be recruited to allow significant differences in mortality of 20 per thousand between less treated and best treated villages. Considering the absence of routine demographic data, a population census and demographic surveillance of the recruited villages have been carried out. All the activities related to the study are considered together with the principal logistic and methodologic problems.

PIP: The Arsi region in Ethiopia has a population of 2 million who are served by 2 hospitals, 7 health centers (HCs), and 82 health stations (HSs). In 1988, a primary health care program was launched to improve health care by restructuring the instrumentation of HCs, HSs, and health posts HPs, by strengthening maternal-child health (MCH) care with UNICEF support of an expanded program of immunization. In villages, community health agents (CHA) provide primary care for the sick as well as information on hygiene and sanitation in collaboration with traditional birth attendants (TBAs). The health indicators chosen for the study were: overall mortality, child mortality for ages 1-4, sudden illness, utilization of health care, and vaccination coverage. In the first year, child mortality was calculated indirectly by using the technique of Brass. The estimated annual birth rate was 43/1000, the mortality rate was 19/1000, and the child mortality rate was 149/1000. 80 villages with an average population of 1500 each had about 5000 births a year. It was hypothesized that child mortality was 130/1000 in those villages that received minor health care and that a reduction of 20/100 could be achieved if 40 villages were completely covered by health care. Data collection regarding health indicators, sanitation, and household economics was envisioned for late 1989 and 1990 by student interviewers and CHAs. A quarterly demographic bulletin was issued by the Regional Epidemiological Office that monitored field work and checked data for quality. Periodic meetings of CHAs were held for problem-solving. the large nonhomogeneous population and inaccessible terrain posed most of the problems and necessitated a large staff for data collection and continuous supervision.