Medical Advice and Diabetes Self-Management Reported by Mexican-American, Black- and White-Non-Hispanic Adults Across the United States

Background: Diabetes has reached epidemic proportions in the United States, particularly among minorities, and if improperly managed can lead to medical complications and death. Healthcare providers play vital roles in communicating standards of care, which include guidance on diabetes self-management. The background of the client may play a role in the patient-provider communication process. The aim of this study was to determine the association between medical advice and diabetes self care management behaviors for a nationally representative sample of adults with diabetes. Moreover, we sought to establish whether or not race/ethnicity was a modifier for reported medical advice received and diabetes self-management behaviors. Methods: We analyzed data from 654 adults aged 21 years and over with diagnosed diabetes [130 MexicanAmericans; 224 Black non-Hispanics; and, 300 White non-Hispanics] and an additional 161 with ‘undiagnosed diabetes’ [N = 815(171 MA, 281 BNH and 364 WNH)] who participated in the National Health and Nutrition Examination Survey (NHANES) 2007-2008. Logistic regression models were used to evaluate whether medical advice to engage in particular self-management behaviors (reduce fat or calories, increase physical activity or exercise, and control or lose weight) predicted actually engaging in the particular behavior and whether the impact of medical advice on engaging in the behavior differed by race/ethnicity. Additional analyses examined whether these relationships were maintained when other factors potentially related to engaging in diabetes self management such as participants’ diabetes education, sociodemographics and physical characteristics were controlled. Sample weights were used to account for the complex sample design. Results: Although medical advice to the patient is considered a standard of care for diabetes, approximately onethird of the sample reported not receiving dietary, weight management, or physical activity self-management advice. Participants who reported being given medical advice for each specific diabetes self-management behaviors were 4-8 times more likely to report performing the corresponding behaviors, independent of race. These results supported the ecological model with certain caveats. Conclusions: Providing standard medical advice appears to lead to diabetes self-management behaviors as reported by adults across the United States. Moreover, it does not appear that race/ethnicity influenced reporting performance of the standard diabetes self-management behavior. Longitudinal studies evaluating patient-provider communication, medical advice and diabetes self-management behaviors are needed to clarify our findings.

Becoming Other: Virtual Realities in Contemporary Science Fiction

The purpose of this thesis was to explore the boundary between human and other created by virtual worlds in contemporary science fiction novels. After a close reading of the three novels: Surface Detail, Existence, and Lady of Mazes, and the application of contemporary literary theories, the boundary presented itself and led to the discovery of where the human becomes other. The human becomes other when it becomes lost to the virtual world and no longer exists or interacts with material reality. Each of the primary texts exhibits both virtual reality and humanity in different ways, and each is explored to find where humanity falls apart. Overall, when these theories are applied to real life there is no real way to avoid the potential for fully immersive virtual worlds, but there are ways to avoid their alienating effects.

Regional aspects of Miami crime fiction

This thesis argues that forces of literary regionalism and postmodern culture are behind the explosion of crime fiction being written in and about South Florida by a growing number of resident authors. Research included four methods of investigation: 1. A critical reading of many of the novels that make up the sub-genre. 2. A study of the theories of regionalism, postmodernism and the genre of the crime fiction. 3. Interviews with a number of the authors and a prominent Miami book seller. 4. Sociological studies of Miami in terms of historical events and their cultural significance. Today's South Florida crime fiction authors cast their narratives in the old genre of the detective novel where characters are delineated according to traditional definitions of good and evil. Evil characters threaten established order. What makes South Florida crime fiction different from traditional detective fiction is its interest in the exotic, postmodern culture and setting of South Florida. Like the region, the villains are exotic and the order that they threaten is postmodern. There is less of an interest in attributing a larger social meaning to the heroes. Rather, there is an ontological interest in the playing out of good against evil in an almost mythical setting that magnifies economic, environmental and racial issues. There is a unique cultural diversity of the city due to the geographical location of Miami in relationship to Latin America and the Caribbean, and the political forces at work in the region. South Florida's subtropical climate, fragile ecosystem, and elements of frontier life in a cosmopolitan city work to support Miami crime fiction. The setting personifies the unpredictability and pastiche of a postmodern world and may call for a new definition for literature that relies on non-traditional regional characteristics.

Religion & ethnic identity among Mexican youths in Homestead, Florida

Immigrant youth are the fastest growing component of the U.S. population and Mexicans are the largest immigrant group in the U.S. The manner in which they integrate into U.S. society and the ways that they become civically engaged, will greatly determine the nature of civil society in the United States over the next few decades. Moreover, religion is increasingly recognized as an important factor in immigrant adaptation. Based upon fieldwork of participant observation and interviews in Homestead, Florida, this thesis examined the relationship among Mexican youths' identity, religion and civic engagement. I found that if these youths are active in religious practices they will be more likely to identify themselves as part of the dominant group, in this case American society. Religious groups are powerful tools that can help these youth reach the greater community.

Use of child safety seats among Mexican parents in a small south Dade community

The purpose of this study was to determine the use and misuse of child safety seats among Mexican parents. Data were collected via personal interview and by use of the SAFE KIDS BUCKLE UP Child Safety Seat Checklist Form. This study used a descriptive comparative design. The convenience sample consisted of 63 Mexican mothers with at least one child under the age of four (index child). The findings showed that Mexican parents tend to misuse or not use child safety seats. Most parents were not aware of the misuse, and receiving prior information on the use of child safety seats had no bearing on its correct use. Factors influencing nonuse include lack of finances, driving short distances, leaving child safety seat at home, and being unaware of the Florida child restraint law. Findings of this study have implications for how nurses need to educate mothers on car safety and help reduce childhood injuries.

Obesity, Cardiovascular Risk Factors, and Weight Loss in a Population of Adult Mexican Americans

The study of obesity has evolved into one of the most important public health issues in the United States (U.S.), particularly in Hispanic populations. Mexican Americans, the largest Hispanic ethnic subgroup in the U.S., have been significantly impacted by obesity and related cardiovascular diseases. Mexican Americans living in the Lower Rio Grande Valley (the Valley) in the Texas-Mexico border are one of the most disadvantaged and hard-to-reach minority groups. Demographic factors, socioeconomic status, acculturation, and physical activity behavior have been found to be important predictors of health, although research findings are mixed when establishing predictors of obesity in this population. Furthermore, while obesity has long been linked to cardiovascular disease (CVD) risk factors such as hypertension, type 2 diabetes, and dyslipidemia; information on the relationships between obesity and these CVD risk factors have been mostly from non-minority population groups. Overall, research has been mixed in establishing the association between obesity and related CVD risk factors in this population calling attention to the need for further research. Nevertheless, identifying predictors of success for weight loss in this population will be important if health disparities are to be addressed. The overall objective of the findings presented in this dissertation was to attain a more informed profile of obesity and CVD risk factors in this population. In particular, we examined predictors of obesity, measures of obesity and association with cardiovascular disease risk factors in a sample of 975 Mexican Americans participating in a health promotion program in the Valley region. Findings suggest acculturation factors to be one of the most important predictors of obesity in this population. Results also point to the need of identifying other possible risk factors for predicting CVD risk. Finally, initial body mass index is an important predictor of weight loss in this population group. Thus, indicating that this population is not only amenable to change, but that improvements in weight loss are feasible. This finding strengthens the relevance of prevention programs such as Beyond Sabor for Mexican populations at risk, in particular, food bank recipients.

Alienated Selfhood and Heroism: A Poststructuralist Reading of John le Carré’s Spy Fiction Novels

John le Carré’s novels “The Spy Who Came in From the Cold” (1963), “Tinker, Tailor, Soldier, Spy” (1974), and “The Tailor of Panama” (1997), focus on how the main characters reflect the somber reality of working in the British intelligence service. Through a broad post-structuralist analysis, I will identify the dichotomies - good/evil in “The Spy Who Came in From the Cold,” past/future in “Tinker, Tailor, Soldier, Spy,” and institution/individual in “The Tailor of Panama” - that frame the role of the protagonists. Each character is defined by his ambiguity and swinging moral compass, transforming him into a hybrid creation of morality and adaptability during transitional time periods in history, mainly during the Cold War. Le Carré’s novels reject the notion of spies standing above a group being celebrated. Instead, he portrays spies as characters who trade off individualism and social belonging for a false sense of heroism, loneliness, and even death.

Working in a Mexican Classroom: An Autoethnographic Study

This autoethnographical study seeks to develop a deeper understanding of the challenges that are faced by the researcher in adapting to a new cultural and linguistic setting as well as describing the teaching practices that the researcher encounters in a Mexican classroom; data will be collected through the process of reflective journaling as well as the collection of pictures and artifacts.

Post-Revolutionary Post-Modernism: Central American Detective Fiction by the Turn of the 21st Century

Contemporary Central American fiction has become a vital project of revision of the tragic events and the social conditions in the recent history of the countries from which they emerge. The literary projects of Sergio Ramirez (Nicaragua), Dante Liano (Guatemala), Horacio Castellanos Moya (El Salvador), and Ramon Fonseca Mora (Panama), are representative of the latest trends in Central American narrative. These trends conform to a new literary paradigm that consists of an amalgam of styles and discourses, which combine the testimonial, the historical, and the political with the mystery and suspense of noir thrillers. Contemporary Central American noir narrative depicts the persistent war against social injustice, violence, criminal activities, as well as the new technological advances and economic challenges of the post-war neo-liberal order that still prevails throughout the region. Drawing on postmodernism theory proposed by Ihab Hassan, Linda Hutcheon and Brian MacHale, I argued that the new Central American literary paradigm exemplified by Sergio Ramirez’s El cielo llora por mí, Dante Liano’s El hombre de Montserrat, Horacio Castellanos Moya’s El arma en el hombre and La diabla en el espejo, and Ramon Fonseca Mora’s El desenterrador, are highly structured novels that display the characteristic marks of postmodern cultural expression through their ambivalence, which results from the coexistence of multiple styles and conflicting ideologies and narrative trends. The novels analyzed in this dissertation make use of a noir sensitivity in which corruption, decay and disillusionment are at their core to portray the events that shaped the modern history of the countries from which they emerge. The revolutionary armed struggle, the state of terror imposed by military regimes and the fight against drug trafficking and organized crime, are among the major themes of these contemporary works of fiction, which I have categorized as perfect examples of the post-revolutionary post-modernism Central American detective fiction at the turn of the 21st century.