Traditional lifestyles, transition, and implications for healthy aging: An Example from the remote island of Pohnpei, Micronesia.

Lifestyle-related, non-communicable diseases, such as diabetes, hypertension, and obesity have become critical concerns in the Pacific islands of Micronesia. We investigated the relationship between the diminution of traditional lifestyle practices and the decline in the health of the population in the State of Pohnpei, Federated States of Micronesia. To assess this, our interdisciplinary team developed two scales, one to rank individuals on how traditional their lifestyles were and one to rank individuals on the healthiness of their lifestyles. Participants' locations were categorized as living on a remote atoll, living on the main island, or as a transitional population. Pohnpeians living in transitional communities (e.g. recently moved from a remote atoll to the main island, or the reverse) ranked lowest on both the tradition and health scales, rather than ranking intermediate between the remote and main island groups as we had hypothesized. As predicted, individuals residing on the remote atolls were living the most traditional lifestyles and also had the healthiest lifestyles, based on our rating system. The higher an individual scored on the tradition scale, e.g. the more traditional life they lived, the higher they scored on the health scale, suggesting the importance of traditional lifestyle practices for maintaining health. These findings have significant implications for promoting health and longevity of Micronesians and other Pacific Island peoples. We suggest the process of transition be recognized as a significant lifestyle and health risk and be given the attention we give to other risk factors that negatively influence our health. Based on our findings, we discuss and recommend the revitalization of particular traditional lifestyle practices, which may advance healthy aging among Pohnpeians.

Patients seek integrative medicine for preventive approach to optimize health.

CONTEXT: Despite the tremendous growth of integrative medicine (IM) in clinical settings, IM has not been well characterized in the medical literature. OBJECTIVE: To describe characteristics and motivation of patients seeking care at an IM clinic. DESIGN, SETTING, AND PARTICIPANTS: Patients from a nine-site practice-based research network participated in this cross-sectional survey. Clinicians documented patients' medical conditions. MAIN OUTCOME MEASURES: Patients provided information on demographics, lifestyle factors, and reasons for seeking care at an IM center. Clinicians documented the medical condition treated and procedures performed at the visit. RESULTS: A total of 4,182 patients (84.5% white; 72.7% college-educated; and 73.4% female) reported their most important reasons for seeking IM. Top-ranked reasons were (1) "to improve health and wellness now to prevent future problems" (83.9%); (2) "to try new options for health care" (76.7%); and (3) "to maximize my health regardless of whether or not my illness is curable" (74.6%). Interestingly, the same top reasons were reported by subgroups of patients who sought IM for wellness, acute care, or chronic illness. Patient reports of lifestyle also demonstrated healthier behaviors than national samples indicate. Patients seeking clinical care at IM centers desire an expanded paradigm of health care, one that seeks to maximize health.

Improving health status of homeless patients at a nurse-managed clinic in the Midwest USA.

Homeless adults have a higher rate of morbidity and mortality than their housed counterparts. Improving the health of homeless adults is a complex problem because of the overlay of individual risk factors, social issues and lack of economic resources. Due to the increased morbidity and mortality rate in homeless adults, it is imperative to develop interventions with demonstrated efficacy that result in improved health outcomes. The purpose of this pre-post pilot study was to compare pre- and post-test scores on specific health outcomes in a group of homeless adults receiving a nurse intervention when utilising a nurse-managed clinic located in the urban core of a Midwestern city in the USA. Between September of 2004 and January 2006, 43 homeless adults completed a health survey at baseline and 2 months later that included measures of health-related quality of life (HRQOL), substance use and health resource use. There was a significant improvement on the post-test scores including substance use, perceived quality and availability of health care, and on two domains of HRQOL: mental health and vitality. This study provides evidence that a nursing intervention can result in improved health outcomes for adult homeless persons.

There's no place like home: a preliminary study of toddler unintentional injury.

This household-based study of 100 parents documents the type and frequency of home toddler unintentional injury and describes parental supervision at the time of injury. Also included is a home assessment for injury-related hazards, parental report of the use of home safety measures, and an 8-week phone survey. The mean number of child injuries was 2.8 (SD = 2.69). Five percent of the injuries required medical attention. Overall, one fifth of the injuries occurred when children were unsupervised. Findings suggest that minor injury may have a developmental component that is different from that of serious injury.

Cultural erosion and biodiversity: canoe-making knowledge in Pohnpei, Micronesia.

Erosion of traditional knowledge and practice is a serious and accelerating problem, but quantitative work on traditional knowledge loss and its importance to biodiversity conservation is lacking. We investigated traditional knowledge of canoe making, a skill heavily dependent on plant biodiversity, on Pohnpei, Federated States of Micronesia, through a survey of 180 island residents. Our results showed that there has been an intergenerational erosion of canoe-making skills. Given current trends, the present generation of Pohnpeians may be the last to retain any knowledge of this traditional craft. We also identified several correlates of knowledge loss-including Western educational level and occupation-that highlight potential avenues for skill conservation via governments, traditional leadership, and schools. These institutions could intervene to emphasize traditional knowledge, which would reinforce institutional contexts in which traditional knowledge and practice is valued. The heightened awareness of the value of biodiversity that is linked to traditional knowledge is key to biological conservation on Pohnpei and can help support local conservation programs.

Health care needs of homeless adults at a nurse-managed clinic.

Up to 55% of the homeless population report health problems. They often use the emergency department (ED) to obtain care when the health needs are not urgent. Nurse-managed clinics have the potential to reduce nonurgent ED use and improve the health of the homeless. The purpose of this study was to establish baseline health data on homeless persons prior to attending a nurse-managed clinic.(1) This study was a cross-sectional, retrospective health survey of homeless clients at a nurse-managed clinic. A total of 110 participants completed a baseline health survey. Of these, 61% reported that prior to coming to the clinic, they used the ED as a source of health care. The most frequent medical diagnoses reported were substance use disorders, depression, back pain, hypertension, and asthma. Providing care for chronic conditions at a nurse-managed clinic has the potential to improve health and reduce use of the ED.

A traditional method of Cinnamomum carolinense preparation eliminates safrole from a therapeutic Pohnpean tea.

Cinnamomum carolinense, locally known as madeu, is a tree endemic to the volcanic mountains of the Island of Pohnpei in the Eastern Carolines of the South Pacific. The bark is harvested from trees and brewed to make a medicinal tea and hot beverage that is regularly consumed. Many species of Cinnamomum contain the known hepatocarcinogen safrole, sparking concern regarding habitual consumption of this beverage. HPLC-PDA analysis confirmed the presence of the carcinogen in alcoholic extracts of Cinnamomum carolinense bark shavings (0.435%, w/w), but safrole was not detected in the tea. The limit of detection and limit of quantitation of safrole were determined to be 1.25 and 3.75 microg/mL, respectively. The traditional preparation method, which boils the bark shavings, degrades the safrole.