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 Mexican-Americans; 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 one-third 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.

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.

The Modern State and the Re-Creation of the Indigenous Other: The Case of the Authentic Sámi in Sweden and the White Man’s Indian in the United States of America.

The present study comparatively examined the socio-political and economic transformation of the indigenous Sámi in Sweden and the Indian American in the United States of America occurring first as a consequence of colonization and later as a product of interaction with the modern territorial and industrial state, from approximately 1500 to 1900. The first colonial encounters of the Europeans with these autochthonous populations ultimately created an imagery of the exotic Other and of the noble savage. Despite these disparaging representations, the cross-cultural settings in which these interactions took place also produced the hybrid communities and syncretic life that allowed levels of cultural accommodation, autonomous space, and indigenous agency to emerge. By the nineteenth century, however, the modern territorial and industrial state rearranges the dynamics and reaches of power across a redefined territorial sovereign space, consequently, remapping belongingness and identity. In this context, the status of indigenous peoples, as in the case of Sámi and of Indian Americans, began to change at par with industrialization and with modernity. At this point in time, indigenous populations became a hindrance to be dealt with the legal re-codification of Indigenousness into a vacuumed limbo of disenfranchisement. It is, thus, the modern territorial and industrial state that re-creates the exotic into an indigenous Other. The present research showed how the initial interaction between indigenous and Europeans changed with the emergence of the modern state, demonstrating that the nineteenth century, with its fundamental impulses of industrialism and modernity, not only excluded and marginalized indigenous populations because they were considered unfit to join modern society, it also re-conceptualized indigenous identity into a constructed authenticity.

Development and evaluation of a geographic information system based method to estimate flooding susceptibility in an area of Broward County, Florida

The objective of this study was to develop a GIS-based multi-class index overlay model to determine areas susceptible to inland flooding during extreme precipitation events in Broward County, Florida. Data layers used in the method include Airborne Laser Terrain Mapper (ALTM) elevation data, excess precipitation depth determined through performing a Soil Conservation Service (SCS) Curve Number (CN) analysis, and the slope of the terrain. The method includes a calibration procedure that uses "weights and scores" criteria obtained from Hurricane Irene (1999) records, a reported 100-year precipitation event, Doppler radar data and documented flooding locations. Results are displayed in maps of Eastern Broward County depicting types of flooding scenarios for a 100-year, 24-hour storm based on the soil saturation conditions. As expected the results of the multi-class index overlay analysis showed that an increase for the potential of inland flooding could be expected when a higher antecedent moisture condition is experienced. The proposed method proves to have some potential as a predictive tool for flooding susceptibility based on a relatively simple approach.

The modern state and the re-creation of the indigenous other: The case of the authentic Sami in Sweden and the white man's Indian in the United States of America

The present study comparatively examined the socio-political and economic transformation of the indigenous Sámi in Sweden and the Indian American in the United States of America occurring first as a consequence of colonization and later as a product of interaction with the modern territorial and industrial state, from approximately 1500 to 1900. ^ The first colonial encounters of the Europeans with these autochthonous populations ultimately created an imagery of the exotic Other and of the noble savage. Despite these disparaging representations, the cross-cultural settings in which these interactions took place also produced the hybrid communities and syncretic life that allowed levels of cultural accommodation, autonomous space, and indigenous agency to emerge. By the nineteenth century, however, the modern territorial and industrial state rearranges the dynamics and reaches of power across a redefined territorial sovereign space, consequently, remapping belongingness and identity. In this context, the status of indigenous peoples, as in the case of Sámi and of Indian Americans, began to change at par with industrialization and with modernity. At this point in time, indigenous populations became a hindrance to be dealt with the legal re-codification of Indigenousness into a vacuumed limbo of disenfranchisement. It is, thus, the modern territorial and industrial state that re-creates the exotic into an indigenous Other. ^ The present research showed how the initial interaction between indigenous and Europeans changed with the emergence of the modern state, demonstrating that the nineteenth century, with its fundamental impulses of industrialism and modernity, not only excluded and marginalized indigenous populations because they were considered unfit to join modern society, it also re-conceptualized indigenous identity into a constructed authenticity.^

Middle -class immigrant identities: Dominican-Americans in South Florida

Identity studies of immigrants are complex because of multiple influences affecting identity reconstruction during immigration and acculturation: nationality, socio-cultural differences, occupations, education, spatial and geographic locations, age, gender, and personal attributes. Most immigrant identity studies deal with lower-income immigrants, who do not have the resources of middle- and upper-middle-class immigrants. South Florida is “home” to many middle-class immigrants, including Dominican-Americans. This dissertation interviewed sixty-six Dominican immigrants in South Florida, in order to determine their reconstructed identities after immigration/resettlement and to discover what influences contributed to these changes in identities. ^ The research design of this dissertation utilized an inductive, qualitative model, with the “grounded theory” method of data collection, categorization, and analysis. Participants were selected by a snowball sampling and interviewed with an informal questionnaire. Results were transcribed, categorized, tabulated, and analyzed for conclusions and theorization on immigrant identity. ^ The dissertation addressed numerous influences relating to identity reconstruction: the differing circumstances of immigration, the unique resources of middle- and higher-class immigrants, the nurturing environment of South Florida for immigrants with education and professional skills, and the boundary protection offered by suburban spaces. The interviewees displayed a wide range of age, length of residence in the United States, reasons for immigration, entry ports, settlement, relocations, occupations, and claimed identities. Identity was cross-tabulated with the various influences, as a means of invalidating certain influences and indicating possible trends. ^ The dissertation concluded that middle-class immigrant identities are diverse and multiple, as are the related influences. None of these immigrants had become totally assimilated, nor have they retained dual, non-overlapping attachments or frames of reference. Instead, many of the immigrants seemed to have developed or negotiated two or more identities, according to need, context, and personal interest. A cosmopolitan community such as South Florida seems to have encouraged such multiplicity of identity. However, rather than forming free-flowing identities, most of these immigrants eventually developed diverse and hybrid identities that have bounded attachments to various networks, groups, and places in South Florida. ^

Elementary classroom teachers' knowledge of tort liability for negligence

The purpose of this research study was to investigate the legal knowledge of Florida's public elementary classroom teachers in the area of tort liability for negligence. A second purpose of the study was to assess the knowledge of school law in the area of negligence according to specific variables to determine if significant differences in knowledge existed among groups of teachers classified by: years of teaching experience, whether or not teachers took a school law course or inservice, college degree held and whether or not teachers had administrative experience. A validated survey instrument consisting of 22 scenarios based on decided court cases in the United States was utilized. These cases included court decisions ranging from 1938–1994, and represented the categories of duty and standard of care, proper instruction, proper supervision, proper maintenance, field trips, and post-injury treatment. ^ A random sample of 420 elementary classroom teachers were sent the survey instrument to complete, and a total of 309 surveys were returned producing a return rate of 77%. The results of this research study revealed that the overall level of legal knowledge of public elementary classroom teachers in the State of Florida produced a mean percent correct of 53%. The range of scores varied from 18%–82%, with the approximate average of correct answers of 12 out of 22. The category of proper instruction produced the lowest mean percent correct of 35%, and the area of post-injury treatment yielded the highest mean percent correct of 78%. ^ The findings of this study emphasize the necessity of preparing teachers regarding their legal rights, duties and responsibilities. The need for teachers to receive training at the preservice and inservice levels has become clear by this study. ^