The Wound Healing and Antibacterial Activity of Five Ethnomedical Calophyllum inophyllum Oils: An Alternative Therapeutic Strategy to Treat Infected Wounds.

BACKGROUND: Calophyllum inophyllum L. (Calophyllaceae) is an evergreen tree ethno-medically used along the seashores and islands of the Indian and Pacific Oceans, especially in Polynesia. Oil extracted from the seeds is traditionally used topically to treat a wide range of skin injuries from burn, scar and infected wounds to skin diseases such as dermatosis, urticaria and eczema. However, very few scientific studies reported and quantified the therapeutic properties of Calophyllum inophyllum oil (CIO). In this work, five CIO from Indonesia (CIO1), Tahiti (CIO2, 3), Fiji islands (CIO4) and New Caledonia (CIO5) were studied and their cytotoxic, wound healing, and antibacterial properties were presented in order to provide a scientific support to their traditional use and verify their safety. METHODS: The safety of the five CIO was ascertained using the Alamar blue assay on human keratinocyte cells. CIO wound healing properties were determined using the scratch test assay on human keratinocyte cells. CIO-stimulated antibacterial innate immune response was evaluated using ELISA by measuring ß defensin-2 release in human derivative macrophage cells. CIO antibacterial activity was tested using oilogramme against twenty aerobic Gram- bacteria species, twenty aerobic Gram+ bacteria species, including a multi-drug resistant Staphylococcus aureus strain and two anaerobic Gram+ bacteria species e.g. Propionibacterium acnes and Propionibacterium granulosum. To detect polarity profile of the components responsible of the antibacterial activity, we performed bioautography against a Staphylococcus aureus strain. RESULTS: Based on Alamar Blue assay, we showed that CIO can be safely used on keratinocyte cells between 2.7% and 11.2% depending on CIO origin. Concerning the healing activity, all the CIO tested accelerated in vitro wound closure, the healing factor being 1.3 to 2.1 higher compared to control when keratinocytes were incubated after scratch with CIO at 0.1%. Furthermore, our results showed that CIO exhibit two distinct antibacterial effects: one against Gram+ bacteria by direct inhibition of mitotic growth and another potent effect against Gram- bacteria due to increased release of ß-defensin 2 peptide by macrophages. Interestingly, the needed concentrations of CIO to inhibit bacteria growth and to promote wound healing are lower than concentrations exhibiting cytotoxic effects on keratinocyte cells. Finally, we performed bioautography assay against Staphylococcus aureus to determine polarity profile of the components responsible for CIO antibacterial activity. Our results showed for the five tested CIO that components responsible of the bacterial growth inhibition are the more polar one on the TLC chromatographic profile and are contained in the resinous fraction of the oil. CONCLUSIONS: This study was conducted to evaluate cytotoxicity, wound healing and antibacterial properties of five CIO traditionally used to treat infected wounds. Using cell and bacteria cultures, we confirmed the pharmacological effects of CIO as wound healing and antimicrobial agent. Moreover, we showed that concentration of CIO needed to exhibit therapeutic effects are lower than concentrations exhibiting cytotoxic effects in vitro. For the first time, this study provides support for traditional uses of CIO. These wound healing and antibiotic properties make CIO a valuable candidate to treat infected wounds especially in tropical areas.

Utilisation of Traditional Pacific Healers by mothers and children of the Pacific Islands Families Study.

AIM: This research explores data on the mother's willingness to use, and children's use of Traditional Pacific Healers (TPH) from the first five waves of the Pacific Islands Families study (PIFS). Specific aims were: to report the prevalence of, and describe factors associated with, (1) the willingness of Pacific mothers to use the health services of Traditional Pacific Healers, (2) the use of Traditional Pacific Healers to treat children within the cohort and (3) to assess whether the use of Traditional Pacific Healers was a substitute or a supplement for western medicine. METHODS: Mothers were asked whether they would use a Traditional Pacific Healer if sick (willingness) and how often their child had seen a Traditional Pacific healer in the previous 12 months (use). These questions were asked at multiple measurement waves consisting of 6 week, 4 and 6 year for mothers, and 6 weeks, 1, 2, 4, and 6 year measurement waves for children. RESULTS: At 6 weeks 48% of mothers were willing to use TPH and this decreased to 36% at year 4 and 24% at year 6. Pacific born mothers, Samoan and Tongan mothers, and religious mothers were significantly more willing to use a TPH. Varied patterns of use were observed by children based on ethnicity and measurement wave. Like mothers--use by children declined as they aged. At 6 weeks 18% of children saw a TPH whilst 8% saw a TPH at age 6 years. Mothers amenable to using traditional healers are using them as supplemental to western medicine, rather than as a substitute. CONCLUSIONS: There is a steady reduction observed in mother's willingness and children's use of TPH in the PIFS over time. This raises the question of the whether provision of TPH is sustainable in NZ. There are significant differences in use of TPH by ethnicity. Further research that assesses reasons for visits, treatments provided, and costs may help explain the observed variations shown in this study.

The interface between cultural understandings: negotiating new spaces for Pacific mental health.

This theoretical paper introduces the concept of the "negotiated space", a model developed by Linda Tuhiwai Smith, Maui Hudson and colleagues describing the interface between different worldviews and knowledge systems. This is primarily a conceptual space of intersection in-between different ways of knowing and meaning making, such as, the i Pacific indigenous reference and the dominant Western mental health paradigm of the bio-psycho-social. When developing Pacific models of care, the "negotiated space" provides room to explore the relationship between different (and often conflicting) cultural understandings of mental health and illness. The "negotiated space" is a place ofp urposive re-encounter reconstructing and re-balancing of ideas and values in complementary realignments that have resonance for Pacific peoples living in Western oriented societies. This requires making explicit the competing epistemologies of the Pacific indigenous worldviews and references alongside the bio-psycho-social and identifying the assumptions implicit in the operating logic ofe ach. This is a precursor to being empowered to negotiate, resolve and better comprehend the cultural conflict between the different understandings. This article theorises multiple patterns of possibility of resolutions and relationships within the negotiated space relevant to research, evaluation, model, service development and quality assurance within Pacific mental health.

Culture, language, and health literacy: communicating about health with Asians and Pacific Islanders.

The Asian and Pacific Islander (API) population in the United States is ethnically and linguistically diverse. American API patients in the most disadvantaged subgroups (limited English proficient, low income, low literate, etc) are at risk for having unmet communication needs. Medical education programs and primary care physicians need to address issues of culture, language, and health literacy when they communicate with these patients so that appropriate questions are asked, and accurate information is exchanged between patients and their providers.

Non-fatal injuries among Pacific infants in Auckland: data from the Pacific Islands families first two years of life study.

AIMS: Child injury is the leading cause of mortality and morbidity in developed countries. While Pacific infant death rates are relatively high in New Zealand, little is known about non-fatal injury rates. We seek to describe maternally reported injury in Pacific infants aged between 0-24 months. METHODS: A cohort of Pacific infants born during 2000 in Auckland, New Zealand, was followed. Maternal home interviews were conducted at 6 weeks, 12 months and 24 months postpartum and injury events were recalled. Marginal models using generalized estimating equations (GEEs) were used to analysis the longitudinal data. RESULTS: The inception cohort included 1398 infants at 6 weeks, 1241 infants at 12 months and 1161 infants at 24 months. The age-specific injury incidence per 1000 person-years exposure was estimated at 48 (95% CI: 23, 88) injuries for infants aged 0-6 weeks, 106 (95% CI: 88, 127) injuries for infants aged 7 weeks-12 months and 174 (95% CI: 151, 199) injuries for infants aged 13-24 months. In the multivariable GEE model, older infants (P < 0.001), infants who were male (P = 0.01), born to Pacific Island fathers and non-Pacific Island mothers (P < 0.001), and in higher or unknown income groups (P = 0.01) were significantly more likely to suffer injury events. No significant two-factor interaction with infant age was identified. CONCLUSIONS: Among Pacific infants, non-fatal injury is common and injury incidence rates are considerably higher than national levels. Male infants and those born into ethnically mixed families, where the father was of Pacific Island ethnicity and the mother was non-Pacific, were at increased relative risk of injury and might benefit from specific injury prevention targeting. However, given the high injury incidence levels found, we advocate that investigation and targeting of culturally appropriate prevention strategies for all Pacific families with young children is required to reduce injury rates for Pacific infants in New Zealand.

Factors associated with not breastfeeding exclusively among mothers of a cohort of Pacific infants in New Zealand.

AIMS: This study investigated the association between not breastfeeding exclusively (among mothers of a cohort of Pacific infants in New Zealand) and several maternal, sociodemographic, and infant care factors. METHODS: The data were gathered as part of the Pacific Islands Families (PIF) Study. Infant feeding information was obtained through interviews with mothers (6 weeks post-birth) and from hospital records for 1247 of the 1365 biological mothers. RESULTS: Factors significantly associated with not exclusively breastfeeding at hospital discharge included smoking, unemployment prior to pregnancy, years in New Zealand, not seeing a midwife during pregnancy, caesarean delivery, and twin birth status. Factors significantly associated with cessation (before 6 weeks post-birth) of exclusive breastfeeding (for mothers who initially breastfed exclusively) included smoking, employment prior to pregnancy, being in current employment, high parity, dummy use, not receiving a visit from Plunket, infant not discharged at the same time as the mother, infant not sharing the same room as the parent(s) at night, regular childcare, and having a home visit for the infant from a traditional healer. CONCLUSIONS: Aside from smoking, different factors were associated with initiation and maintenance of exclusive breastfeeding. Identification of risk factors should assist targeting women who are at heightened risk of not breastfeeding exclusively.

Voicing the strengths of Pacific Island parent caregivers of children who are medically fragile.

Research is deficient regarding the strengths of Pacific Island parents of children who are medically fragile. The purpose of this qualitative ethnographic study was to explore the strengths of Pacific Island parents of these children. Audiotaped interviews were analyzed using Text Smart and peer review. The core theme reflecting strength was positive energy. Participants believed that parents needed to have the ability to handle emotional feelings, solve problems, connect with their spirituality, find meaning, take care of themselves, use family support, use community support, use a positive attitude, be resourceful, meet a challenge, interact with nature, and focus on the present. Themes were affirmed by the literature with the exception of interacting with nature, which may be indigenous to the population's cultural orientation.

Addressing the cancer control needs of Pacific Islanders: experience of the Pacific Islander Cancer Control Network.

PURPOSE: This paper describes the accomplishments of the Pacific Islander Cancer Control Network (PICCN). PICCN's objectives fall under two broad categories: increasing cancer awareness and enhancing cancer control research among Samoans, Tongans, and Chamorros. METHODS: PICCN established an infrastructure for addressing the goals that include the University of California, Irvine; the UCI Chao Family Comprehensive Cancer Center; and community-based organizations (CBOs) in areas where large numbers of Pacific Islanders live. Activities that increase cancer awareness include assessing existing cancer education materials, developing new culturally-sensitive materials, and distributing the materials in a culturally-sensitive manner. Activities that enhance cancer control research include training Pacific Islander investigators and providing them with mentors to help with the development of research projects. RESULTS: During the four project years, PICCN has conducted more than 180 cancer awareness activities in its six study sites: Carson, CA; San Mateo, CA; San Diego, CA; Salt Lake City, UT; American Samoa; and Guam. PICCN members have also participated in conferences and lead discussions about the importance of clinical trials for Pacific Islanders. In addition, the Network has trained nine Pacific Islander investigators (three individuals from each ethnic group) in its cancer control academy. Finally, PICCN investigators are conducting pilot research projects that will answer important questions regarding the cancer control needs of these Pacific Islanders and set the stage for interventions aimed at addressing the needs. CONCLUSION: PICCN is advancing the national goal of eliminating cancer-related health disparities through its cancer awareness and research activities for Pacific Islanders.

Ethnic differences in choices of health information by cancer patients using complementary and alternative medicine: an exploratory study with correspondence analysis.

This study examined patterns in the use of health information among Caucasian, Japanese, and non-Japanese Asian Pacific Islander cancer patients in Hawaii and explored the relation of ethnicity and educational level to choices of health information sources. Information from 140 cancer patients, most of whom were users of complementary and alternative medicine (CAM), was analyzed using correspondence analysis. Three clusters of health information pertinent to the three ethnic groups emerged from the data. The results of this study revealed that Caucasian patients preferred objective, scientific, and updated information obtained through medical journals or newsletters from research institutions, telephone information services, and the internet. Japanese patients relied on media and commercial sources including television, newspapers, books, magazines and CAM providers. Non-Japanese Asians and Pacific Islanders used information sources involving person-to-person communication with their physicians, social groups, and other cancer patients. A higher educational level was closely related to a cluster of health information stressing objective, scientific and updated information, while a lower educational level was associated with interpersonally communicated information. The three ethnicity-specific patterns of health information use remained relatively stable at different educational levels, implying that the effect of patients' ethnicity overrides their educational level in shaping their choices of health information. The results of this study indicate the importance of recognizing cancer patients' culturally developed world views when understanding their health information-seeking behavior. For medical practice, these findings indicate the need for healthcare providers to assist cancer patients to obtain accurate health information in a culturally sensitive way.

The Pacific Islander Cancer Control Network's role in cancer awareness, research and training.

PURPOSE: The Pacific Islander Cancer Control Network (PICCN) is one of the 18 Special Populations Networks recently established by the National Cancer Institute (NCI) to address the cancer control needs of America's medically under-served populations. The PICCN focuses on three Pacific Islander groups: Samoans, Guamanians/Chamorros, and Tongan Americans. The program provides an infrastructure for collaboration between an academic institution, the University of California, Irvine; an NCI designated cancer center, the Chao Family Comprehensive Cancer Center; community-based organizations; and other agencies concerned with the health of Pacific Islanders. METHODS: The PICCN's objectives include improving cancer awareness, enhancing recruitment to clinical trials, increasing the number of cancer control investigators, and encouraging more research among these Pacific Islanders. The activities that increase cancer awareness include assessing existing cancer education materials aimed at Pacific Islanders, working with the NCI's Cancer Information Service to modify existing materials, developing new culturally-sensitive materials, and distributing the materials in a culturally-sensitive manner. PRINCIPAL FINDINGS: The PICCN enhances recruitment of Pacific Islanders to clinical trials by establishing relationships with cancer centers, making them aware of existing cancer center studies, and developing culturally appropriate recruitment materials when necessary. The network plans to increase the number of Pacific Islander investigators and encourage more research among Pacific Islanders by identifying potential investigators, informing them about existing cancer control training opportunities, developing a new training opportunity, and providing mentors to help with the development of pilot projects and RO1 applications. CONCLUSION: Through these efforts, the PICCN is addressing the goal of eliminating health disparities among ethnic and racial minorities in this country.

Differences in treatment patterns for localized breast carcinoma among Asian/Pacific islander women.

BACKGROUND: Many studies have examined racial/ethnic differences in treatment for localized breast carcinoma, but to the authors' knowledge few have included Asian/Pacific Islander (API) women. METHODS: The population-based study included API and non-Hispanic white women diagnosed with localized invasive breast carcinoma in the Greater San Francisco Bay Area during 1994 (n = 1772). Multiple logistic regression was used to assess the association between race/ethnicity and type of surgery, radiation therapy following breast-conserving surgery (BCS), and hormone therapy for estrogen receptor-positive tumors while adjusting for demographic, medical, and census block-group socioeconomic characteristics. RESULTS: API women were significantly more likely to undergo mastectomies than white women (58% vs. 42%). This difference remained for Chinese and Filipino women after multivariate adjustment (odds ratio vs. whites [OR] = 2.4, 95% confidence interval [95% CI] = 1.4-4.2; OR [95%CI] = 1.8[1.0-3.1], respectively). Chinese women were also more likely than white women to not receive adjuvant therapy, be it radiation after BCS or hormone therapy for estrogen receptor-positive disease. Other API women did not differ from white women in adjuvant therapy use. CONCLUSIONS: This population-based study identified differences in treatment for localized breast carcinoma by race/ethnicity that were not explained by differences in demographic, medical, or socioeconomic characteristics. These results underscore the importance of looking at treatment patterns separately for API subgroups and support the need for research into cultural differences that may influence breast carcinoma treatment choices.

Native Hawaiian traditional healing: culturally based interventions for social work practice.

Developing cultural competence is a key requirement for social workers in the multicultural environment of the 21st century. However, the development of social work interventions that are syntonic with specific cultural groups is a great challenge. Interventions that are based on the traditional healing practices of a particular culture ensure cultural relevance and consistency with its values and worldview. This article discusses the importance of culturally based interventions within a cultural competence framework and offers examples of such interventions used with Native Hawaiians. Two interventions are discussed, targeted to the micro (direct practice) level and macro (community practice) level of practice. Culturally based social work interventions may be most appropriate for client systems within a particular culture; however, some methods, such as ho'oponopono, have been successfully used with clients from other cultures as well.

Nutrition in pregnancy in the Wellington region.

The diets of 115 pregnant women in the Wellington region were assessed for nutrient intake using 24 h dietary recall. Assessment was performed in both the second and third trimester. Women came from three ethnic groups, European (61), Maori (29) and Pacific Islanders (25). Comparisons of nutrient intake were made between these groups. The overall energy intake was similar between the groups (range 4.8-19.7 MJ/d) but Maori (p less than 0.05) and Pacific Islanders (p less than 0.02) had a significant decrease in energy intake from second to third trimester. Pacific Islanders consumed significantly more starch (121 g/d, p less than 0.05) whereas Maori women consumed significantly more sucrose (86 g/d, p = 0.0002). The mean intake in Pacific Islanders contained significantly less calcium (882 mg/d, p = 0.0002) and zinc (9.0 mg/d, p = 0.014). Forty-four percent Europeans, 28% Maori and 51% Pacific Islanders had an estimated iron intake below the minimum safe intake for pregnancy. However dietary iron intake did not relate to the presence of anaemia nor whether iron supplements were given.

Prenatal cranial haemorrhages in 47 Pacific Islander infants: is traditional massage the cause?

Intracranial haemorrhage is usually a very rare occurrence in the fetus before the onset of labour but we have identified major, mostly subdural, prenatal intracranial haemorrhages in 47 infants of immigrant Pacific Islander parentage. Forty-four infants have been stillborn and the numbers from 1983 to 1986 were sufficient to account for the stillbirth rate for Pacific Islanders in Auckland being approximately 60% higher than rates for Europeans or Maoris. Two of three liveborn infants survived with neurological sequelae. Similar haemorrhages may be the cause of a congenital hydrocephalus in Pacific Islanders. A bleeding disorder can be excluded in most cases, as can trauma from accidents or assaults. Trauma during attempts at cephalic version of breech presentations by traditional methods could explain why 53% of deliveries were breech and other pathological and clinical features. Advice at antenatal clinics about possible dangers of traditional massage has coincided with a reduction in the incidence of haemorrhages since 1986.