The key to PLV’s success is a curriculum that has evolved to meet the needs of its female population in order to effectively provide guidance and support to group members. Topics covered by weekly PLV sessions include cardiovascular risk reduction , tobacco use prevention , Cancer Screening and Prevention , Breast Cancer Education , Nutrition and Cancer , and Family Communication, Parenting Skills and Community Resources . I had the pleasure of contacting PLV and recruiting a Consejera to come to the Tijuana clinic to teach a session . This was the first class of our “Mujeres Protegidas” series that covered topics such as female anatomy, menstrual cycles, body perception, and nutrition. A total of 5 women were in attendance, 4 of which were sex workers. The session took place in one of the upstairs rooms of the HFiT clinic that comfortably fit the participants, our PLV Consejera Gloria,square plastic planter and two observers from Flying Samaritans who were hoping to bring a similar program to their clinic in Ensenada. We began the class with a consent form and pre-survey to assess general knowledge on the topics we would be discussing during the class. We then began the discussion on female anatomy utilizing teaching aides provided by Por La Vida.
Our group instructor Gloria went above and beyond to make class enjoyable and very informative for the women. Gloria’s presence made the women feel comfortable and many were willing to share personal stories and experiences. The women were given diagrams of female anatomy and pocket calendars so they could chart their menstrual cycle as well as any reflections for the day. We concluded the class with a healthy snack with recipes to take home to their friends and family. We ended the class with questionnaires assessing how the women felt the day went. 5/5 of the questionnaires expressed high interest level in the topics discussed and that they learned a lot of new information from the day’s session. As part of our women’s health curriculum we also realized the importance of training medical students and maintaining participation in the student-run clinic. We will expand clinic participation through both the HFiT elective and the newly established HFiT student interest group. The HFiT elective includes a didactic course with a curriculum developed by clinical faculty from both UCSD and UABC. The course thread incorporates clinical shadowing. Lectures occur before clinic starts on Saturday and include topics such as health disparities and policy in Mexico, substance abuse in Zona Norte, and medical history taking. At clinic, medical students receive hands on training from attending physicians on how to perform a PAP smear and other gynecological exams. This is a very exciting opportunity since most medical students don’t receive training in this area until 3rd year clerkships. In addition, with our partnership with the Scripps Family Medicine program, we successfully completed an IUD placement workshop on 10/30/13.
Under the instruction of Dr. McKennett, medical students learned more about the different types of contraception and their application. All events were organized by the HFiT student interest group, which will strive to promote awareness and interest in the Tijuana clinic. Below is a picture from UCSD School of Medicine Activity Fair where incoming and current medical students can sign up for the HFiT interest group. Since the initiation of this project, numerous changes have challenged our progress. First of which, the clinic site was move to the Desayunador Salesiano “Padre Chava,” soup kitchen. The new site offers increased space and a large pool of potential patients. Coinciding with the clinic site change, an influx of Haitian migrants arrived in Tijuana. They are seeking refuge in the United States from political unrest in Haiti and the aftermath of Hurricane Matthew. Unable to keep up with the growing number of Haitians arriving at the border, the USA has recently reinstated deportations, a change from a 2010 policy, which accepted all Haitians. Fearing deportation, many Haitians are forced to wait in Tijuana to regroup with family and loved ones. Mexico has done its part in aiding these migrants who have often traveled far distances and put everything at stake to arrive at the border. Padre Chava has been transformed to house Haitians overnight. At one point, the space provided shelter for over 500 people with mattresses overflowing to the street in order to accommodate all the migrants. The women of the HFiT clinic needed an independent space where they could congregate and continue weekly sessions. As a result, a support group of 20 women meets every Saturday at a new clinic space close to the Zona Norte. The women take turns leading discussion in this dynamic group. Many of the women belong to marginalized populations in Tijuana. Similar to the design of the PLV sessions, the premise of this group is empowerment through knowledge. In support of the HFiT women’s group, during the week of February 6th, 2017, the UCSD SOM coordinated a drive to assist in items of basic hygiene and care. Feminine products were donated throughout the week culminating into the final collection at the Winter AC cup. The SOM donated over 100 items through the initiative of the medical students.Despite the changing global health environment that challenged this project, establishing the support services for women in Tijuana allowed me to work directly with the HFiT patient population in the exam room, in the classroom, and on the streets where they worked.
It gave me the opportunity to hear personal experiences and understand their concerns and health needs. Overall the expansion of the HFiT clinic has provided medical attention to hundreds of patients often stigmatized by the health care system. This experience enhanced my understanding of humanistic medicine. It allowed me to address the needs of a population that is often overlooked. Spending time to understand primary health concerns will allow more focused medical attention and assist in breaking down the barriers to medical care in Tijuana, Mexico. We must not forget the power of empathy in all relationships: physician to patient, “consejera” to support group, and peerto-peer. Nor should we forget how knowledge can empower individuals to take ownership of their health. It is experiences like these that remind us why we chose the field of medicine. Pomegranate is an ancient fruit and a commodity favored by people worldwide for its unique shape and flavor. Pomegranate peel is a major by-product from the juicing process with rich health-promoting bio-active compounds but remains underutilized or disposed of. The main goal of this dissertation was to study the extraction of functional ingredients from pomegranate peel waste, evaluate their nutritional benefits, and develop value-added nutritional products. A novel green process for antioxidant extraction from wet pomegranate peel was developed. The effects of various extraction conditions on polyphenol yield and quality were investigated, including particle size, time, temperature, and solvent ratios. WPP extraction at 20°C for 6 min with a solvent ratio of 4:1 is recommended as an economic and sustainable process, resulting in 10.53% total phenolic yield with 6.35 g g-1 tannic acid equivalent and 88.93% punicalagin purity. Plant bio-active compounds have demonstrated promising effects in promoting health. Therefore, the hypolipidemic effects of pomegranate peel powder and pomegranate peel extract were researched via Lakeview Golden Syrian hamsters with a high-fat diet. PPP and PPE significantly improve obesity-related indices, including adjusting microbiota composition, increasing the microbiota diversity towards a leaner type, and down-regulating the expression of 2 genes to reduce cholesterol ingestion and LDL uptake. However, further research on potential toxicity was required,square plastic plant pot as adverse plasma LDL-elevating effects were observed at a higher dose of PPP and PPE intake. As functional food fortified with plant bio-active compounds became more popular, the potential of PPE as ingredients for fortified food supplementation was evaluated. A PPEfortified Greek Style yogurt was developed using a top-down formulation method based on USDA dietary guidelines. According to the results from response surface methodology, the optimum formula for a 130 g product consisted of 10.4 g of protein and 77 g of PPE, which could satisfy the polyphenol daily need while maintaining pleasant product properties. An organic acid-based ultrasound-assisted co-extraction process of polyphenol and pectin was investigated for thorough WPP utilization and broader industry applications.
Citric acid was applied for extraction since it’s a common GRAS acid in food applications. Process conditions, including pH, extraction temperature, extraction time, ultrasound intensity, and solvent ratio, were evaluated via Box-Behnken design to study the effects on extraction performance, including polyphenol/pectin yield, antioxidant activity, and pectin characteristics. High methylated pectin yield was as high as 13.99%, which demonstrated that WPP could be utilized as a reliable pectin source. The extraction kinetics were characterized for future industry application guidance. In conclusion, this dissertation demonstrated the potential of pomegranate peel to be utilized as a source of healthy and bio-active compounds. With the depletion of natural resources and growing populations, there is a great motivation for recovering valuable compounds from fruit and vegetable wastes and converting them into functional ingredients as a part of sustainable agricultural practices. Pomegranate is an important California commodity and pomegranate by-products are a large portion of the process. These by-products could be repurposed into valuable compounds, but they are not unutilized or underutilized, ending up in landfills or animal feeds. In this dissertation, physiochemical properties and extraction methods of bio-active compounds in pomegranate peel were comprehensively studied to determine the feasibility of converting these pomaces into healthful food ingredients. The research objectives were to identify the physiochemical characteristics of pomegranate peel and assess different size reduction methods to obtain suitable peel particles for effective extraction by using water as a solvent; evaluate the effects of extraction temperature, time, and water usage on the phenolic yield, phenolic composition, and antioxidant activity to optimize the extraction conditions; study the bio-active properties and nutritional benefits of pomegranate peel powder and extract through animal models; investigate the characteristics of food products developed with pomegranate peel powder and extract; and study the co-extraction mechanism of pectin and polyphenol to improve extract yield and phenolic stability. There are 6 chapters in this dissertation. Chapter 1 includes an introduction, research objectives, and literature review on the processing and waste utilization of pomegranate fruits, with a focus on the current waste management practices and effects of punicalagin, which is the most unique polyphenol in pomegranate. In Chapter 2, the physicochemical properties of pomegranate fruits were investigated to explore the potential of recovering bio-active food ingredients from the inedible fruit peel. Phenolic extraction parameters and effects of wet and dried pomegranate peel were studied, aiming to increase the extraction sustainability with reduced cost. The study in Chapter 3 investigated the potential of developing functional food fortified with a value-added ingredient from pomegranate peel extract, specifically Greek Style Yogurt. Products with different levels of protein content and phenolic content were formulated to study the chemical and sensory properties, which provided solid guidance for future product development. In the research of Chapter 4, the hypolipidemic properties of pomegranate peel and extract were investigated in vivo using hamster models. Currently, no literature is available on the functionality of complete pomegranate peel and extract. In this study, it was found that the pomegranate peel and extract were effective in lowering blood cholesterol in hamsters fed with high-fat diets. The study in Chapter 5 studied the co-extraction mechanism of pectin and polyphenol for improved extract yield and phenolic stability. Ultrasound extraction of pectin and polyphenol in citric acid from pomegranate peel was tested and the corresponding physicochemical properties were evaluated. Unlike most of the research using inorganic acid for extraction, this research utilized GRAS organic acid and provided functional ingredients from fruit by-products without safety concerns. Conclusions and future directions on reutilizing the pomegranate waste as food ingredients are detailed in Chapter 6. Pomegranate belongs to the family Punicaceae. It has been grown since ancient times for its delicious fruit and as an ornamental plant for its red, orange, or occasionally creamy yellow flowers. The estimated global cultivation area for pomegranate is about 300,000 ha, with fruit production of 3.0 million metric tons . Spanish missionaries brought pomegranate to the Americas in the 1500s . Wonderful, a primary cultivar in the U.S., was discovered in Florida and brought to California in 1896. Since then, pomegranate has been grown abundantly in California and Arizona, where mild winters enable the fruits to reach the quality necessary for successful commercial production.