Examining the communication and relationship between the healthcare professional and the American Indian patient Accordion Closed
Amber Poleviyuma, Darold Joseph, Roger Nosker
A qualitative review of the literature demonstrates that not all healthcare is equal; Native Americans receiving health care do not always comprehend their healthcare experience and experience with healthcare professionals. As found in one study, dissatisfaction was based on the interpersonal communication between the provider and American Indian patient. (Garroutte, 2004, p. 2241). Furthermore, obstacles such as medical literacy, language barriers, and cultural differences influence interactions between healthcare professionals and American Indian patients. Although, there is plenty of literature on healthcare professionals communicating with the patient, literature focusing specifically on American Indians is minimal. Accordingly, addressing such health disparities is crucial for American Indian patients and Healthcare providers. Ineffective communications, limited health illiteracy, have an adverse effect on the Native American patient’s ability to benefit from and comply with medical treatment. Patient education by the community for its members through events, publications, and multimedia, and expanded effort by medical providers and healthcare organizations may improve healthcare outcomes. Provision of communications trainings on cultural competence for healthcare professionals may be advantageous in improving patient-provider communication. Implementation of such measures could help bridge the existing gap which negatively impacts health outcomes for the Native American patient.
Exploring the binding between sGC and titin Accordion Closed
Savannah Laughter, Candice Benally, Matthew Gage
Soluble guanylate cyclase (sGC) is a heterodimeric protein essential in the initiation of several nitric oxide (NO) initiated physiological responses. sGC converts guanosine triphosphate (GTP) to cyclic guanosine monophosphate (cGMP), which then triggers a variety of responses, including repair and regeneration of tissue during wound healing, angiogenesis, cell motility, cell survival, vasodilation and endothelial cell proliferation. Decreased levels of sGC are linked to hardening and narrowing of the arteries (atherosclerosis), aging and loss of memory. In humans, two alpha (α) and two beta (β) subunits have been identified. The most studied isoform of sGC is the a1b1 isoform, which has two homologous subunits. Each subunit contains four functional domains: N-terminal H-NOX, Per Arnt Sim (PAS), coiled-coil and C-terminal catalytic domains. The H-NOX domain of the α1 subunit contains a 69 amino acid intrinsically disordered region (IDR) at the N-terminus whose function is currently undetermined. IDRs have no defined structure but maintain function in a flexible state. Recent studies in the Gage lab suggest that this region may interact with an E3 ligase and the muscle protein titin, suggesting this region may be involved in localization and degradation. The possible interaction between the two proteins soluble guanylate cyclase (sGC) and the muscle protein titin is currently being investigated in this study. Size exclusion chromatography, native page gels, and CD spectroscopy are the potential methods to investigate the potential binding between the IDR of the α1 subunit of sGC and titin.
Uranium exposure levels in sheep bones Accordion Closed
Carl Haskie, Andee Lister, Jani Ingram
Uranium milling has been conducted on the Navajo Nation from the 1940s to the late 1980s. There are over 500 contaminated mining sites still left abandoned on the Navajo Nation (“Addressing Uranium Contamination on the Navajo Nation | Superfund | Pacific Southwest | US EPA”, n.d., p. xx). Uranium is a natural occurring element that can cause increased cancer risk and liver damage. Uranium-238 has a half-life of 4.47 billion years (“Uranium | Radiation Protection Program | US EPA”, n.d., p. xx). Sheep graze almost everywhere on the reservation and that poses a threat because sheep is a traditional source of food for the Navajos. The project I am working on will focus on the amount of uranium concentration found in sheep bone from Leupp, AZ and Cameron, AZ. Before running my samples through the ICP-MS I prep my samples by pounding the bone into a fine powder, than incinerating and than putting the bone through a digestive step. To find these concentrations, I will be using an instrument called the Inductively Coupled Plasma- Mass Spectrometer (ICP-MS). The ICP-MS measures the amount of certain trace elements found in each sample of sheep bone in this which case is uranium. By comparing sheep from Leupp,AZ and Cameron, AZ we are hoping the uranium concentration is not relatively high.
Prevalence of obstetrical hemorrhage at Flagstaff Medical Center Accordion Closed
Ashleigh Goodell, Cynthia Beckett
PICOT: For pregnant and newly delivered women, does the use of an evidence based guideline for obstetrical hemorrhage versus individual physician management influence early identification in women suffering from hemorrhage?
Evidence: Literature review from Cochran, CINAHL, and Medline using search terms “obstetrical hemorrhage,” “postpartum hemorrhage,” “etiology of hemorrhage,” “prevention,” and “control,” resulted in 22 articles. Ten were selected for this project.
Strategy: Gain knowledge through literature review and working with Terry Smith, Perinatal clinical educator, on a retrospective chart review for the past twelve months.
Practice Change/Intervention: This project explores how the implementation of an obstetric hemorrhage guideline can provide optimal response of the multidisciplinary team. A protocol will help in identifying when patients are at risk of hemorrhage and detecting the stage of hemorrhage and primary treatment goals.
Evaluation: Compare data collected prior to the implementation of the obstetric hemorrhage guideline of practice to data collected after. Determine the effectiveness / efficacy of the evidence based practice (EBP) change. Plan to implement guideline Fall 2014.
Outcomes: With the creation of evidence-based protocols, prompt recognition and response of the interdisciplinary team, and a more vigorous quality review procedure, the number of obstetric hemorrhages within our community (FMC) should be reduced.
Recommendations: The use of an obstetric hemorrhage guideline will allow for early identification, prevention, and improved outcomes for pregnant and newly delivered women.
An evidence-based approach to healthcare literacy Accordion Closed
Amber Howard, Cynthia Beckett
PICOT: In Elderly Navajo patients does creating a pictorial label for their medications versus the usual standard of text label instructions help health complications such as rehospitalization?
Evidence: A literature search from Cochrane, CINAHL, and Medline, using search terms “medication reconciliation,” “health literacy,” and “coronary heart disease in Native Americans,” resulted in 27 articles. Ten articles were selected to guide this project.
Strategy: Gain knowledge through literature review, observation, interviews, and discussions on the challenges of elders understanding discharge medications.
Practice Change/Intervention: This project explores how healthcare workers can improve patient comprehension of medication literacy in the elderly Native American population, with a focus on Navajo. Develop and implement a culturally sensitive and specific process using pictorials to assist elderly patient understanding of when to take medications. Work with Navajo interpreters to create a process specific to this population.
Evaluation: Determine how many patients are being readmitted to the hospital because of medication issues. Elders will verbalize when to take their medications using the pictorials.
Outcomes: Establish a standardized process for using pictorials for all patients with low health literacy levels to assist in the patients understanding of when to take their medications.
Recommendations: More tribally specific research is needed on health literacy and medication compliance for patients. Other pictorials may need to be developed to help patients understand what the medications are for as well as for when to take them.
The lived experience of suicide in underrepresented college students Accordion Closed
Iris Beno, Vicki Black
Suicide among Native Americans is a growing concern on the Indian reservations. On the reservation, suicide rates are twice as high for Indian youth compared to Caucasian American youth. This topic is hard to address and discuss by Native Americans; because suicide is rarely discussed, research is needed to learn how to address and reduce rates of suicide. A Native American research team performed a recent study informally by looking upon their own family members and friends as references, to gain an idea of how problematic suicide is in the Native communities. The data that was collected was based on the lived experiences of Native Americans, and with this data they want to learn how to identify and understand the underlying problem. When a greater understanding and solutions are made, the results will be shared with the Native American communities.
Cancer prevention outreach within the Hopi, Navajo and Urban Native American communities Accordion Closed
Ashley Young, Marissa Adams
The mission of the Community Outreach Program of the Partnership for Native American Cancer Prevention (NACP) is to partner with tribal communities using the Community-Based Participatory Research (CBPR) model. Within CBPR, the Outreach is guided by an Advisory Board. Our focus has been to increase the knowledge of Cancer prevention through a culturally sensitive way. Cancer is the second leading cause of death among the Native American and Alaska Native tribes (“AI/AN Populations”, 2013). Within the state of Arizona, the top 5 cancer in the Native American populations are: Prostate, Female Breast, Colon and Rectum, Kidney and Renal Pelvis, and Corpus and Uterus (“U.S. Cancer Stats.”, 2013). To fulfill our mission, we have prepared Cancer 101 PowerPoint presentations, a Digital Story that focuses on the encouragement of a mammography screening, and a Sarcoma Fact Sheet that has been distributed throughout our Native American Communities. During outreach events, community members were reminded and encouraged to get their health screenings done; many community members were unaware of screening guidelines. The programs that we provide have made a positive impact in the communities by reminding community members of all ages that cancer can be prevented though living a healthy and active lifestyle in addition to following screening guidelines.
Transglutaminase 2 expression in macrophages in response to Toxoplasma gondii infection and stress Accordion Closed
Adam Bradley, Fernando Monroy
Macrophages are phagocytes distributed throughout the body and contribute to tissue healing and homeostasis. They participate in innate and adaptive immune responses. Macrophages remove foreign molecules including infectious agents. Toxoplasma gondii is an intracellular protozoan parasite that can survive within macrophages by altering the macrophage proteolytic and inflammatory pathways. The end products of stress (epinephrine [EPI], nor-EPI, and corticosterone [CORT]) are widely accepted to be immunosuppressive in part by altering the function of macrophages. However, stress seems to promote inflammation in diseases such as inflammatory bowel disease, rheumatoid arthritis and psoriasis which are associated with increase secretion of nor-EPI and its effects on macrophages. Macrophages express transglutaminase 2 (TG2), a multifunctional enzyme that contributes to inflammatory response. Its participation in colon cancer and Crohn’s disease is well documented. The role of TG2 during infection is unknown as well as the stress-induced increase in inflammation. The goal of our study was to determine if TG2 expression was affected by T. gondii infection and the stress product nor-EPI. Our hypothesis was that T. gondii infection will induce decreased TG2 expression and its expression should increase in the presence of nor-EPI. To test our hypothesis we cultured mouse RAW264.7 macrophages that were exposed to T. gondii in the presence or absence of nor-EPI. Macrophage RNA was collected at 3 and 8 hr post-infection and used to determine expression of TG2 and the macrophage pro-inflammatory cytokine interleukin (IL)-1β. Our results show that both mouse macrophages and the intestinal epithelial cell line MODE-K expressed TG2. Expression of TG2 was induced by nor-EPI while T. gondii infection seemed to decrease its expression. When both infection and nor-EPI were combined we observed the highest expression of TG2. The cytokine IL-1b was suppressed by nor-EPI and induced by infection. We observed that the stress hormone CORT was better at inducing TG2 than nor-EPI. In this study I report a decrease in TG2 expression by infection and its expression was increased in the presence of stress products. This neuro-immune crosstalk may be important in situations where stress and infection occur to exacerbate inflammatory diseases.