Psychosocial barriers to self -care among Hispanic women with type 2 diabetes mellitus

This cross-sectional survey-designed study investigated the presence and influence of psychosocial barriers to diabetes self-management practices among Hispanic women with type 2 diabetes mellitus. Women (n = 128) who were diagnosed and being treated for type 2 diabetes were recruited from the Miami-Dade area in South Florida. A Beck Depression Inventory-II, Diabetes Care Profile, Diabetes Knowledge Test, Diabetes Empowerment, Multidimensional Health Locus of Control, and Perceived Stress Scales were administered, along with assessment of diet through a 24-hour recall and anthropometric evaluation by body composition analysis and body mass index computation. ^ Mean (± SD) age for subjects was 50.15 ± 15.93 and age at diagnosis was 42.46 ± 14.69. Mean glycosylated hemoglobin (A 1C) was 8.55 ± 1.39. Diabetes education had not been received by 46.9% of subjects. Psychosocial status had previously been evaluated in only 4 participants. Forty percent of participants were assessed as depressed and 17% moderately to severely so. Depression correlated significantly (p < 0.01) with A1C (r = 0.242), perceived stress (r = 0.566), and self-rated health (r = −0.523). Perceived stress correlated significantly (p < 0.01) with A1C (r = 0.388), understanding of diabetes (r = 0.282), self-rated health (r = −0.372) and diabetes empowerment (r = −0.366). For Cuban women, perceived stress (β = 0.418, p = 0.033) was the only significant predictor of A1C, while among non-Cuban Hispanic women, self-reported health (β = −0.418, p = 0.003) and empowerment (β = 0.432, p = 0.004) were better predictors. The most desirable DM status among the women surveyed (high diet adherence, low exercise barriers, and A1C ≤ 7) was associated with superior self-rated health, more support from family and friends, and greater empowerment. ^ This study revealed the error in considering Hispanics a homogenous entity in treating disease, as their cultural backgrounds and concentration in a community can greatly influence management of a chronic disease like diabetes. The strong correlations found between diabetes-related health indicators and psychosocial factors such as depression and perceived stress suggest that psychosocial assessment of patients must be more strongly advocated in diabetes care. Psychosocial assessment of ethnically diverse diabetic populations is especially vital if greater knowledge is to be gained about their barriers to self-care so that diabetes treatment and thus outcomes are enhanced. ^

Comparison of coronary heart disease risk factors in foreign -born and United States-born Afro Caribbean Americans and African Americans in south Florida

In a cross-sectional study design, risk factors for coronary heart disease (CHD) were evaluated in three groups: 66 Afro Caribbeans (FBCA) living in the US for less than 10 years, 62 US-born Afro Caribbean (USBCA) and 61 African American (AA) adults (18–40 years), with equal numbers of males and females in each group. Socio-demographic, dietary, anthropometric and blood pressure data were collected. Fasting blood glucose, blood lipids and high-sensitivity C-reactive protein (hs-CRP) were determined. ^ The USBCA and AA participants compared to the FBCA participants consumed significantly (p < 0.05) more mean total fat (g) (66.3 ± 41.7 and 73.0 ± 47.8 vs. 52.8 ± 32.3), saturated fat (g) (23.1 ± 14.9 and 24.9 ± 15.8 vs. 18.6 ± 11.5), percent energy from fat (%) (33.1 ± 6.5 and 31.4 ± 6.4 vs. 29.3 ± 6.8), fat servings (1.8 ± 1.2 and 1.5 ± 1.0 vs. 1.2 ± 0.9), dietary cholesterol (mg) (220.4 ± 161.9 and 244.1 ± 155.0 vs. 168.8 ± 114.0) and sodium (mg) (2245.2 ± 1238.3 and 2402.6 ± 1359.3 vs. 1838.0 ± 983.4) and less than 2 servings of fruits per day (%) (86.9 and 94.9 vs. 78.5). These differences were more pronounced in males compared to females and remained after correcting for age. Also, the percentages of USBCA and AA participants who were obese (17.1% and 23.0%, respectively) were significantly (p < 0.05) higher compared to FBCA (7.6%) participants. More USBCA and AA than FBCA individuals smoked cigarettes (4.8% and 6.6% vs. 0.0%) and consumed alcoholic beverages (29.0% and 50.8% vs. 24.2%). The mean hs-CRP level of the AA participants (2.2 ± 2.7 mg/L) was significantly (p < 0.01) higher compared to the FBCA (1.1 ± 1.3 mg/L) and USBCA (1.3 ± 1.6 mg/L) participants. ^ The FBCA participants had a better CHD risk profile than the USBCA and AA participants. Focus should be placed on the ethnic and cultural differences in a population to better understand the variations in health indicators among different ethnic groups of the same race. This focus can provide healthcare professionals and policy planners with the opportunity to develop culturally sensitive programs and strategies for the improvement of health outcomes. ^

Ecological indicators for system-wide assessment of the greater everglades ecosystem restoration program

Developing scientifically credible tools for measuring the success of ecological restoration projects is a difficult and a non-trivial task. Yet, reliable measures of the general health and ecological integrity of ecosystems are critical for assessing the success of restoration programs. The South Florida Ecosystem Restoration Task Force (Task Force), which helps coordinate a multi-billion dollar multi-organizational effort between federal, state, local and tribal governments to restore the Florida Everglades, is using a small set of system-wide ecological indicators to assess the restoration efforts. A team of scientists and managers identified eleven ecological indicators from a field of several hundred through a selection process using 12 criteria to determine their applicability as part of a system-wide suite. The 12 criteria are: (1) is the indicator relevant to the ecosystem? (2) Does it respond to variability at a scale that makes it applicable to the entire system? (3) Is the indicator feasible to implement and is it measureable? (4) Is the indicator sensitive to system drivers and is it predictable? (5) Is the indicator interpretable in a common language? (6) Are there situations where an optimistic trend with regard to an indicator might suggest a pessimistic restoration trend? (7) Are there situations where a pessimistic trend with regard to an indicator may be unrelated to restoration activities? (8) Is the indicator scientifically defensible? (9) Can clear, measureable targets be established for the indicator to allow for assessments of success? (10) Does the indicator have specificity to be able to result in corrective action? (11) What level of ecosystem process or structure does the indicator address? (12) Does the indicator provide early warning signs of ecological change? In addition, a two page stoplight report card was developed to assist in communicating the complex science inherent in ecological indicators in a common language for resource managers, policy makers and the public. The report card employs a universally understood stoplight symbol that uses green to indicate that targets are being met, yellow to indicate that targets have not been met and corrective action may be needed and red to represent that targets are far from being met and corrective action is required. This paper presents the scientific process and the results of the development and selection of the criteria, the indicators and the stoplight report card format and content. The detailed process and results for the individual indicators are presented in companion papers in this special issue of Ecological Indicators.

Dimensions of gender relations and reproductive health inequity perceived by female undergraduate students in the Mekong Delta of Vietnam: a qualitative exploration

Introduction Increasing evidence indicates that gender equity has a significant influence on women’s health; yet few culturally specific indicators of gender relations exist which are applicable to health. This study explores dimensions of gender relations perceived by female undergraduate students in southern Vietnamese culture, and qualitatively examines how this perceived gender inequity may influence females’ sexual or reproductive health. Methods Sixty-two female undergraduate students from two universities participated in eight focus group discussions to talk about their perspectives regarding national and local gender equity issues. Results Although overall gender gaps in the Mekong Delta were perceived to have decreased in comparison to previous times, several specific dimensions of gender relations were emergent in students’ discussions. Perceived dimensions of gender relations were comparable to theoretical structures of the Theory of Gender and Power, and to findings from several reports describing the actual inferiority of women. Allocation of housework and social paid work represented salient dimensions of labor. The most salient dimension of power related to women in positions of authority. Salient dimensions of cathexis related to son preference, women’s vulnerability to blame or criticism, and double standards or expectations. Findings also suggested that gender inequity potentially influenced women’s sexual and reproductive health as regards to health information seeking, gynecological care access, contraceptive use responsibility, and child bearing. Conclusion Further investigations of the associations between gender relations and different women’s sexual and reproductive health outcomes in this region are needed. It may be important to address gender relations as a distal determinant in health interventions in order to promote gender-based equity in sexual and reproductive health.

Norm-based comparison of SF -12 physical and mental health scale scores for a sample of employees of Broward County

In the new health paradigm, the connotation of health has extended beyond the measures of morbidity and mortality to include wellness and quality of life. Comprehensive assessments of health go beyond traditional biological indicators to include measures of physical and mental health status, social role-functioning, and general health perceptions. To meet these challenges, tools for assessment and outcome evaluation are being designed to collect information about functioning and well-being from the individual's point of view.^ The purpose of this study was to profile the physical and mental health status of a sample of county government employees against U.S. population norms. A second purpose of the study was to determine if significant relationships existed between respondent characteristics and personal health practices, lifestyle and other health how the tools and methods used in this investigation can be used to guide program development and facilitate monitoring of health promotion initiatives.^ The SF-12 Health Survey (Ware, Kosinski, & Keller, 1995), a validated measure of health status, was administered to a convenience sample of 450 employees attending one of nine health fairs at an urban worksite. The instrument has been utilized nationally which enabled a comparative analysis of findings of this study with national results.^ Results from this study demonstrated that several respondent characteristics and personal health practices were associated with a greater percentage of physical and/or mental scale scores that were significantly "worse" or significantly "better" than the general population. Respondent characteristics that were significantly related to the SF-12 physical and/or mental health scale scores were gender, age, education, ethnicity, and income status. Personal health practices that were significantly related to SF-12 physical and/or mental scale scores were frequency of vigorous exercise, presence of chronic illness, being at one's prescribed height and weight, eating breakfast, smoking and drinking status. This study provides an illustration of the methods used to analyze and interpret SF-12 Health Survey data, using norm-based interpretation guidelines which are useful for purposes of program development and collecting information on health at the community level. ^

Obesity Indicators by Race/Ethnicity for Diagnosis of Cardiometabolic Diseases for a US Representative Sample of Adults

Background: Obesity, a growing epidemic, is a preventable risk factor for cardiometabolic diseases. Obesity and cardiometabolic diseases affect Hispanics and African Americans more than non-Hispanic Caucasians. This study examined the relationship among race/ethnicity, obesity diagnostic measures (body mass index, waist circumference, subscapular and triceps skinfold thickness), and cardiometabolic risk factors (hyperglycemia, high, non-high-density lipoprotein cholesterol, low, high-density lipoprotein cholesterol, and hypertension) for adults across the United States. Methods: Using data from two-cycles of the National Health and Examination Survey (NHANES) 2007-2010, and accounting for the complex sample design, logistic regression models were conducted comparing obesity indicators in Mexican Americans, other Hispanics, and Black non-Hispanics, with White non-Hispanics and their associations with the presence of cardiometabolic diseases. Results: Differences by race/ethnicity were found for subscapular skinfold thickness and hyperglycemia. Waist circumference and subscapular skinfold were positively associated with the presence of hyperglycemia; dyslipidemia, and hypertension across race/ ethnicity, adjusting for age, gender, smoking, physical activity, education, income to poverty index, and health insurance. Race/ ethnicity did not influence the association of any obesity indicators with the tested cardiometabolic diseases. All obesity measures except triceps skinfold were associated with hyperglycemia. Conclusions: We suggest that subscapular skinfold thickness be considered as an inexpensive non-intrusive screening tool for cardiometabolic risk factors in an adult US population

Perceived Stress and Self‑rated Health of Haitian and African Americans with and without Type 2 Diabetes

Background: Blacks have a higher incidence of diabetes and its related complications. Self-rated health (SRH) and perceived stress indicators are associated with chronic diseases. The aim of this study was to examine the associations between SRH, perceived stress and diabetes status among two Black ethnicities. Materials and Methods: The cross-sectional study included 258 Haitian Americans and 249 African Americans with (n = 240) and without type 2 diabetes (n = 267) (N = 507). Recruitment was performed by community outreach. Results: Haitian-Americans were less likely to report ‘fair to poor’ health as compared to African Americans [OR=0.58 (95% CI: 0.35, 0.95), P = 0.032]; yet, Haitian Americans had greater perceived stress than African Americans (P = 0.002). Having diabetes was associated with ‘fair to poor’ SRH [OR=3.14 (95% CI: 2.09, 4.72),P < 0.001] but not perceived stress (P = 0.072). Haitian-Americans (P = 0.023), females (P = 0.003) and those participants having ‘poor or fair’ SRH (P < 0.001) were positively associated with perceived stress (Nagelkerke R2=0.151). Conclusion: Perceived stress associated with ‘poor or fair’ SRH suggests that screening for perceived stress should be considered part of routine medical care; albeit, further studies are required to confirm our results. The findings support the need for treatment plans that are patient-centered and culturally relevant and that address psychosocial issues.