Using Art as a Medium for First Nations Youth to Express Their Pain: A Two-Eyed Seeing Qualitative Study

BACKGROUND: First Nations (FN) youth in Canada have the highest rates of pain-related conditions (ear, dental, headaches) yet may be least likely to be treated for them. Untreated pain has an arresting impact on growth and development and is detrimental to the achievement of life goals. In recent research conducted by the Aboriginal Children’s Hurt & Healing Initiative (ACHH), community participants reported that First Nation children are stoic and are reluctant to talk about their pain (Latimer & Rudderham, 2013). Clinicians are trained to assess pain based on overt signs of expression (cry, facial grimace, ability to describe) however if you do not present your pain this way it may reduce the chance of proper assessment and treatment.

OBJECTIVES: Using a Two-Eyed Seeing qualitative perspective (best of Indigenous and Western knowledge) the purpose of this research was to provide FN youth with the method of art making to determine how they express their pain.

DESIGN/METHODS: Youth from four FN communities, in three Maritime Provinces were invited to participate in art workshops facilitated by internationally renowned Mi’kmaq artist Alan Syliboy. The workshop began with a conversation circle about pain experiences and then proceeded to the art making. A FN documentary cinematographer captured the workshops and the results are documented in art and film. Three team members independently themed the data using thematic analysis and the inter-rater reliability was >85%.

RESULTS: 39 youth aged 10-18 years participated in 4 community-based conversation and art sessions. The themes for the sessions were themed using the four dimensions of the Medicine Wheel. While the overwhelming theme discussed in the conversation sessions was physical pain, when provided the nonverbal, art mode of expression, the youth painted emotional pain more frequently than physical, spiritual and mental pain. There was overlap between the four themes but 70% of the artwork prominently illustrated emotional pain with 54% overlapping with physical, 30% mental and 31% spiritual.

CONCLUSION: These results present a more complicated issue regarding the integration of the different types of pain, intertwined together. The finding that when asked-youth primarily discussed physical pain but given the opportunity, more frequently painted emotional pain may shed new light on the degree to which emotional pain is a factor for these youth. The artwork and accompanying narratives are powerful and have implications for understanding the complexity of assessing the different dimensions of pain in a culturally meaningful manner and for clinician education purposes. A sample of the artwork is attached.

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Rapid imaging of olfaction by functional MRI (fMRI): identification of presence and type of hyposmia

PURPOSE

Our goal was to develop a rapid, simple, near-real-time method of functional MRI (fMRI) to measure brain activation in response to olfactory stimuli, to use it to identify patients with smell loss (hyposmia), and to differentiate their types of hyposmia.

METHOD

fMRI was obtained in 16 patients with Type I hyposmia (who could detect but not recognize odors), 5 patients with Type II hyposmia (who could both detect and recognize odors, albeit with less than normal acuity), and 2 volunteers with normal olfactory acuity by use of a rapid echo planar imaging technique in which one coronal brain section from the anterior cortical region was studied and a single olfactory stimulus was used. Actual scanning time performed by a variation of methods previously published required 26 s. Three patients with Type I hyposmia were treated with theophylline 250-500 mg for 4-6 months and were studied before and after treatment.

RESULTS

Brain activation in response to olfactory stimuli was demonstrated using a new, rapid, and simple fMRI technique. Patients with Type I hyposmia had less activation than patients with Type II hyposmia. Both patient groups had less activation than normal volunteers. Activation in patients with Type I hyposmia was essentially absent from regions of the middle frontal, orbitofrontal, and temporal cortex and was totally absent in regions of inferior frontal, insular, and cingulate cortex. Activation in patients with Type II hyposmia was greatest in the middle frontal cortex and the orbitofrontal cortex bilaterally and was present in regions of inferior frontal, temporal, and cingulate cortex. Each patient with Type I hyposmia treated with theophylline had improved smell function to Type II hyposmia and after treatment demonstrated activation in inferior frontal and cingulate cortex bilaterally, whereas before treatment, no activation in these regions was apparent.

CONCLUSION

We describe a simple, rapid technique that can be used in a practical clinical setting to identify patients with hyposmia and to differentiate patients with different types of olfactory loss. These studies confirm the presence and classification of patients with Type I and Type II hyposmia. Results of this study suggest that regions of the frontal cortex may act to guide or direct olfactory signals to other brain areas such as temporal and cingulate regions. Although these latter regions are involved with olfactory recognition, their role in olfactory memory, olfactory meaning, and attention needs to be considered.

Taste memory induces brain activation as revealed by functional MRI

PURPOSE

Our goal was to use functional MRI (fMRI) to measure brain activation in response to imagination of tastes in humans.

METHOD

fMR brain scans were obtained in 31 subjects (12 men, 19 women) using multislice FLASH MRI and echo planar imaging (EPI) in response to imagination of tastes of salt and sweet in coronal sections selected from anterior to posterior temporal brain regions. Activation images were derived using correlation analysis, and ratios of areas of brain activated to total brain areas were calculated. Total activated pixel counts were used to quantitate regional brain activation.

RESULTS

Activation was present in each section in all subjects after imagination of each tastant. Activation was similar in response to imagination of either salt or sweet and was quantitatively similar to that previously reported in response to imagination of odors of banana and peppermint. Activation was similar in both men and women as opposed to previous results of odor memory in which activation in men was greater than in women. However, subjective responses of intensity of imagined tastes were significantly greater than those previously obtained for odor memory and were consistently, albeit not significantly, greater in women than in men, similar to results previously reported for odor memory. Brain regions activated in response to taste imagination were consistent with regions previously described as involved with actual taste perception in both humans and animals. Regional brain localization for salt and sweet memories could not be differentiated.

CONCLUSION

These studies indicate that (a) tastes can be imagined, (b) brain regions activated for taste imagination are consistent with regions previously described for actual taste perception, and (c) similar to odor memory for banana and menthone, regional brain localization for salt or sweet taste memories could not be differentiated.

Selective induction of mucosal immune responses to 2-acetylaminofluorene

Mucosal vaccination with chemical carcinogens coupled to enterotoxins such as cholera toxin (CT) can elicit carcinogen-specific immunoglobulin secretion into the intestinal lumen. The present study examines the ability of several related bacterial enterotoxins and their subunits to act as adjuvants or carrier proteins in stimulating an intestinal secretory IgA (S-IgA) response to 2-acetylaminofluorene (AAF). Using Thiry-Vella loops in rabbits, CT, cholera toxin B subunit (CTB) and the recombinant B subunit of the heat labile enterotoxin from E. coli (rLTB) were all found to be effective carrier proteins and adjuvants for eliciting S-IgA anti-AAF. However, marked differences in the ratio of mucosal S-IgA to serum IgG production were observed. CT elicited the highest luminal S-IgA anti-AAF titers as well as the highest ratio of intestinal S-IgA/serum IgG when used as an adjuvant. Conversely, rLTB elicited a high serum IgG anti-AAF titer but only a modest intestinal S-IgA response. Dialysis studies using monoclonal IgA versus IgG anti-AAF on opposing sides of a semipermeable membrane demonstrated the potential importance of the intestinal S-IgA/serum IgG ratio. A high "intestinal" IgA/"serum" IgG ratio abolished carcinogen transfer to the "serum" side of the membrane, while a low ratio enhanced transfer. Thus, to generate an active mucosal immune response capable of blocking carcinogen absorption, the carrier protein or adjuvant should be selected to optimize the intestinal S-IgA/serum IgG ratio.

Perinatal factors associated with the respiratory distress syndrome

Perinatal factors related to the incidence of respiratory distress syndrome were analyzed by the multiple logistic regression statistical method in 263 mothers and their 298 offspring delivered between 24 and 35 weeks' gestation in a 1-year period in a regional referral perinatal center. The risk of respiratory distress syndrome in white infants rose with decreasing gestational age (p less than 0.0001) while prolonged rupture of membranes of greater than 24 hours in the absence of maternal infection (28% of cases) was highly protective (p less than 0.0001). Compared with vaginal delivery, cesarean delivery without labor increased the risk of respiratory distress syndrome (p = 0.03). The administration of tocolytic drugs was unrelated to the incidence of respiratory distress syndrome, but corticosteroid therapy given at least 72 hours before delivery was protective (p = 0.03). Male and female infants were equally at risk for respiratory distress syndrome as were black and white infants, but other races had a lower incidence (p = 0.004). Infants with respiratory distress syndrome were on mechanical ventilators longer than those with other respiratory illnesses.

Influence on immunoreactive folate-binding proteins of extracellular folate concentration in cultured human cells

The influence of extracellular folate concentration on cellular levels of the folate transport protein and its soluble product was studied directly in cultured human nasopharyngeal carcinoma (KB) cells. As determined by radioimmunoassay, levels of the folate transport protein and the soluble folate-binding protein were 58 +/- 17 (mean +/- SD) and 5 +/- 2 pmol/mg cell protein, respectively, in KB cells maintained in standard medium (containing 2,300 nM folic acid). These levels significantly increased to 182 +/- 34 and 26 +/- 6 pmol/mg cell protein, respectively, in KB cells serially passaged in low folate medium (containing 2-10 nM 5-methyltetrahydrofolate). Increases in folate-binding protein levels occurred more rapidly in KB cells serially passaged in very low folate medium containing less than 2 nM folate and were prevented by the addition of 100 nM 5-methyltetrahydrofolate or 0.1-1 microM 5-formyltetrahydrofolate to this medium. When KB cells which had been passaged in low folate medium were passaged back into either standard medium or low folate medium supplemented with reduced folates, the levels of both folate-binding proteins fell linearly towards the levels in KB cells continuously maintained in standard medium. The folate transport protein was identified in and underwent similar changes in human and mouse mammary tumor cells. These studies indicate that the folate transport system is probably regulated by the extracellular folate concentration through changes in intracellular metabolite levels.

Burn injury in infants and young children

Scalding, most often self-precipitated, is the most common cause of burn injuries in children. Flame burns are much less common but are more severe and have a higher mortality than do scalds. Most burns in this age group are small, but affect areas functionally and cosmetically sensitive to burn injury. Abused infants and toddlers have a much higher mortality than do unabused children. Younger children have a higher mortality after serious burns than do older children. Common infections include otitis media, viral gastroenteritis and viral infections of the upper part of the respiratory tract, many of which are established prior to injury. Hyperthermia and leukocytosis are common and may be misleading as indicators of infection. Fluid needs are greater than predicted by the Parkland formula. Hypertension is uncommon and resolves spontaneously.