Effectiveness of dietary intervention in children and adolescents with elevated blood pressure

Hypertension is a known risk factor for cardiovascular disease in adults. Essential hypertension in children and adolescents is increasing in prevalence in the United States, and hypertension in children may track into adulthood. This increasing prevalence is attributed to the trends of increasing overweight and obese children and adolescents. Family history and being of African-American/black descent may predispose youth to elevated blood pressure. Interventions targeted to reduce and treat hypertension in youth include non-pharmaceutical interventions such as weight reduction, increased physical activity, and dietary changes and pharmaceutical treatment when indicated. The effectiveness of non-pharmaceutical interventions is well documented in adults, but there are limited studies with regards to children and adolescents, specifically in the arena of dietary interventions. Lifestyle modifications such as dietary interventions are the mainstay of recommended treatment for those children and adolescents with prehypertension or stage 1 hypertension. Given the association of being overweight and hypertension, efficacy of dietary interventions are of interest because of reduced cost, easy implementation and potential for multiple beneficial outcomes such as reduced weight and reduction of other metabolic or cardiovascular derangements. Barriers to dietary interventions often include socioeconomic status, ethnicity, personal, and external factors. The goal of this systematic review of the literature is to identify interventions targeted to children and adolescents that focus on recommended dietary changes related to blood pressure. Dietary interventions found for this review mostly focused on a particular nutrient or food group with the one notable exception that focused on the DASH pattern of eating. The effects of the interventions on blood pressure varied, but overall dietary modifications can be achieved in youth and can serve a role in producing positive outcomes on blood pressure. Increasing potassium and following a DASH diet seemed to provide the most clinically significant results. Further studies are still needed to evaluate long-term effectiveness and to contribute more supporting evidence for particular modifications in these age cohorts.^

Diabetic nephropathy in African-Americans with type 1 diabetes: The new Jersey 725 study

Diabetic nephropathy is the most common cause of end-stage renal disease (ESRD) in the United States. African-Americans and patients with type 1 diabetes (T1D) are at increased risk. We studied the rate and factors that influenced progression of glomerular filtration rate (GFR) in 401 African-American T1D patients who were followed for 6 years through the observational cohort New Jersey 725 study. Patients with ESRD and/or GFR<20 ml/min were excluded. The mean (SD) baseline GFR was 106.8 (27.04) ml/min and it decreased by 13.8 (mean, SD 32.2) ml/min during the 6-year period (2.3 ml/min/year). In patients with baseline macroproteinuria, GFR decreased by 31.8 (39.0) ml/min (5.3 ml/min/year) compared to 8.2 (mean, SD 27.6) ml/min (1.3 ml/min/year) in patients without it (p<0.00001). Six-year GFR fell to <20 ml/min in 5.25% of all patients, but in 16.8% of macroproteinuric patients.^ A model including baseline GFR, proteinuria category and hypertension category, explained 35% of the 6-year GFR variability (p<0.0001). After adjustment for other variables in the model, 6-year GFR was 24.9 ml/min lower in macroproteinuric patients than in those without proteinuria (p=0.0001), and 12.6 ml/min lower in patients with treated but uncontrolled hypertension compared to normotensive patients (p=0.003). In this sample of patients, with an elevated mean glycosylated hemoglobin of 12.4%, glycemic control did not independently influence GFR deterioration, nor did BMI, cholesterol, gender, age at diabetes onset or socioeconomic level.^ Taken together, our findings suggest that proteinuria and hypertension are the most important factors associated with GFR deterioration in African-American T1D patients.^

Changes in sexual behaviors associated with crack cocaine cessation among African Americans in Houston, Texas

Aim To examine the association between the crack cocaine cessation and risky sexual behaviors. Design and setting Between June 2002 and March 2005, a sample of African-American residents of Houston, Texas who were using crack at the time of enrollment participated in a cohort study to evaluate per outreach interventions to reduce HIV risk behaviors. The sample for this study consisted of 351 women and men who completed structured surveys at baseline and at six months about socio-demographic characteristics, drug use, and sexual behaviors. Multivariate logistic regression was used to analyze the association between crack cessation and risky sexual behaviors at follow-up, while controlling for confounding characteristics. Measurements Crack cessation was defined as reporting no crack use in the 30 days prior to the follow-up interview. Possible associated factors included unprotected sex, having multiple sex partners, trading sex for money/drugs, crack use, and socio-demographic variables. Findings At the six-month follow-up interview, 21% of participants reported that they had not used crack in the previous 30 days. For women, crack cessation was significantly associated with having only one sex partner at follow-up; for men, crack cessation was significantly associated with being single, separated, or divorced at baseline, having only one sex partner at follow-up, and initiating protected sex by follow-up. Conclusion These findings support previous research indicating that crack use is associated with unprotected sex and multiple sexual partners, as men and women who ceased crack use were less likely to engage in these risky sexual behaviors. Findings demonstrate that treatment for crack use could have a meaningful effect on risky sexual behaviors and HIV/STI prevention.^

The illness experiences of African Americans residing in an inner city community, Houston, Texas

This dissertation documents health and illness in the context of daily life circumstances and structural conditions faced by African American families living in Clover Heights (pseudonym), an inner city public housing project in the Third Ward, Houston, Texas. Drawing from Kleinman's (1980) model of culturally defined health care systems and using the holistic-content approach to narrative analysis (Lieblich, Tuval- Mashiach, & Zilber, 1998) the purpose of this research was to explore the ways in which social and health policy, economic mobility, the inner city environment, and cultural beliefs intertwined with African American families' health related ideas, behaviors, and practices. I recruited six families using a convenience sampling method (Schensul, Schensul, & LeCompte, 1999) and followed them for fourteen months (2010–2011). Family was defined as a household unit, or those living in the same residence, short or long-term. Single, African American women ranging in age from 29–80 years headed all families. All but one family included children or grandchildren 18 years of age and younger, or children or other relative 18 years of age and older. I also recruited six residents with who I became acquainted over the course of the project. I collected data using traditional ethnographic methods including participant-observation, archive review, field notes, mapping, free-listing, in-depth interviews, and life history interviews. ^ Doing ethnography afforded the families who participated in this project the freedom to construct their own experiences of health and illness. My role centered on listening to, learning from, and interpreting participants' narratives, exploring similarities and differences within and across families' experiences. As the research progressed, a pattern concerning diagnosis and pharmacotherapy for children's behavioral and emotional problems, particularly attention-deficit hyperactivity disorder (ADHD) and pediatric bipolar disorder (PBD), emerged from my formal interactions with participants and my informal interactions with residents. The findings presented in this dissertation document this pattern, focusing on how mothers and families interpreted, organized, and ascribed meaning to their experiences of ADHD and PBD. ^ In the first manuscript presented here, I documented three mothers' narrative constructions of a child's diagnosis with and pharmacotherapy for ADHD or PBD. Using Gergen's (1997) relational perspective I argued that mothers' knowledge and experiences of ADHD and PBD were not individually constructed, but were linguistically and discursively constituted through various social interactions and relationships, including family, spirituality and faith, community norms, and expert systems of knowledge. Mothers' narratives revealed the complexity of children's behavioral and emotional problems, the daily trials of living through these problems, how they coped with adversity and developed survival strategies, and how they interacted with various institutional authorities involved in evaluating, diagnosing, and encouraging pharmaceutical intervention for children's behavior. The findings highlight the ways in which mothers' social interactions and relationships introduced a scientific language and discourse for explaining children's behavior as mental illness, the discordances between expert systems of knowledge and mothers' understandings, and how discordances reflected mothers' ‘microsources of power’ for producing their own stories and experiences. ^ In the second manuscript presented here, I documented the ways in which structural factors, including gender, race/ethnicity, and socioeconomic status, coupled with a unique cultural and social standpoint (Collins, 1990/2009) influenced the strategies this group of African American mothers employed to understand and respond to ADHD or PBD. The most salient themes related to mother-child relationships coalesced around mothers' beliefs about the etiology of ADHD and PBD, ‘conceptualizing responsibility,’ and ‘protection-survival.’ The findings suggest that even though mothers' strategies varied, they were in pursuit of a common goal. Mothers' challenged the status quo, addressing children's behavioral and emotional problems in the ways that made the most sense to them, specifically protecting their children from further marginalization in society more so than believing these were the best options for their children.^

Systematic review of current trends of cardiovascular disease (CVD) and association between health insurance coverage and CVD mortality among women aged 60--65 in Texas in 2000--2011

Cardiovascular disease (CVD) is highly preventable, yet it is a leading cause of death among women in Texas. The primary goals of this research were to examine past and current trends of CVD, as well as identify whether there is an association between the insurance coverage and mortality from CVD among women aged 60–65 in Texas between 2000 and 2011. ^ The systematic review of the research is based on the guidelines and recommendations set by the Centre for Reviews and Dissemination for conducting reviews in health care. Over 47 citations of peer-reviewed articles from Ovid MEDLINE and PubMed databases and five websites were identified, of which 7 studies met inclusion criteria for the first systematic review to examine the trends of CVD in Texas. Ten citations of peer-reviewed articles from Ovid MEDLINE and PubMed databases and five web sites were reviewed for the second systematic review (to study the association between insurance coverage and cardiovascular health among Texas women 60–64 years of age), of which 3 studies met inclusion criteria and were included in the research. The results of the study highlighted key gaps in the existing literature and important areas for the further research, as well as determined directions for future public health CVD prevention programs in Texas. ^ Based on the conducted research, the major determinants of premature mortality among women attributed to cardiovascular disease are based on individual level characteristics, more specifically sex, age, race/ethnicity, and education. The results indicate that African American and non-Hispanic white women are more likely to have higher CVD mortality rates than Hispanic women due to higher prevalence of cardiac risk factors. The data also shows higher levels of mortality from CVD in the southeastern United States, with Texas ranking as the third state with the highest prevalence of CVD among women. According to the Texas Department of State Health Services, there are approximately 56,000 deaths caused by CVD annually in Texas, which represents about one death every ten minutes. Coronary artery disease and stroke were the causes of 31.2 percent of all female deaths in Texas in 2009, meaning that approximately 68 women die from any form of cardiac disease in Texas each day. ^ The data of the reviewed studies indicate that women' lack of health insurance was significantly associated with a higher prevalence of cardiovascular disease. The uninsured women were more likely to be unaware of their risk factors and more likely to have undiagnosed diabetes—a co-morbidity factor of CVD. One of the studies also reports strong correlation between state rates of uninsured and lower rates of preventive care. Given these strong correlations, those who were chronically uninsured were at a higher risk of mortality than the insured, due to prolonged periods of time without basic access to preventive and medical care. ^ Suggested recommendations to decrease CVD mortality rates in Texas are consistent with the existing literature and include state policy development that addresses elimination of health disparities, consideration of potential benefits of universal health coverage by the legislative policymakers, and maintenance of solid partnerships between public health agencies and hospitals to educate on, diagnose, and treat CVD among the female population in Texas. ^

Risk and protective factors associated with depression among racial and ethnic mothers of adolescents

The central paradigm linking disadvantaged social status and mental health has been the social stress model (Horwitz, 1999), the assumption being that individuals residing in lower social status groups are subjected to greater levels of stress not experienced by individuals from higher status groups. A further assumption is that such individuals have fewer resources to cope with stress, in turn leading to higher levels of psychological disorder, including depression (Pearlin, 1989). Despite these key assumptions, there is a dearth of literature comparing the social patterning of stress exposure (Hatch & Dohrenwend, 2007; Meyer, Schwartz, & Frost, 2008; Kessler, Mickelson, & Williams, 1999; Turner & Avison, 2003; Turner & Lloyd, 1999; Turner, Wheaton, & Lloyd, 1995), and the distribution and contribution of protective factors, posited to play a role in the low rates of depression found among African- and Latino-Americans (Alegria et al., 2007; Breslau, Aguilar-Gaxiola, Kendler, Su, Williams, & Kessler, 2006; Breslau, Borges, Hagar, Tancredi, Gilman, 2009; Gavin, Walton, Chae, Alegria, Jackson, & Takeuchi, 2010; Williams, & Neighbors, 2006). Thus, this study sought to describe both the distribution and contribution of risk and protective factors in relation to depression among a sample of African-, European-, and Latina-American mothers of adolescents, including testing a hypothesized mechanism through which social support, an important protective factor specific to women and depression, operates. ^ Despite the finding that the levels of depression were not statistically different across all three groups of women, surprising results were found in describing the distribution of both risk and protective factors, in that results reported among all women who were mothers when analyzed masked differences within each ethnic group when SES was assessed, a point made explicit by Williams (2002) regarding racial and ethnic variations in women's health. In the final analysis, while perceived social support was found to partially mediate the effect of social isolation on depression, among African-Americans, the direct effect of social isolation and depression was lower among this group of women, as was the indirect effect of social isolation and perceived social support when compared to European- and Latina-American mothers. Or, put differently, higher levels of social isolation were not found to be as associated with more depression or lower social support among African-American mothers when compared to their European- and Latina-American counterparts. ^ Women in American society occupy a number of roles, i.e., that of being female, married or single, mother, homemaker or employee. In addition, to these roles, ethnicity and SES also come into play, such that the intersection of all these roles and the social contexts that they occupy are equally important and must be taken into consideration when making predictions drawn from the social stress model. Based on these findings, it appears that the assumptions of the social stress model need to be revisited to include the variety of roles that intersect among individuals from differing social groups. More specifically, among women who are mothers and occupy a myriad of other roles, i.e., that of being female, married or single, African- or Latina-American, mother, homemaker or employee, the intersection of all the roles and the social contexts that women occupy are equally important and must be taken into consideration when looking at both the types and distribution of stressors across women. Predictions based on simple, mutually exclusive categories of social groups may lead to erroneous assumptions and misleading results.^

Edouard Glissant e o legado de William Faulkner

Este trabajo se propone analizar el intertexto que une al escritor Edouard Glissant con William Faulkner a través de dos obras: el ensayo Faulkner, Mississipi (1996) y la novela Sartorius (1999). En el primer texto, el autor enfatiza cuestiones presentes en su propia obra novelesca: la genealogía, la relación con el espacio de la plantación, el mestizaje, la (i)legitimidad de derechos con respecto a la posesión de la tierra, la opacidad. En el segundo, traza una línea genealógica de un personaje perteneciente a una etnia africana imaginaria, haciéndolo llegar hasta las plantaciones del sur de los Estados Unidos; paralelamente, presenta la línea genealógica de los Sartoris. En esta dirección, busco mostrar cómo el proyecto literario de Glissant dialoga con la obra de Faulkner, indagando e inventariando las mismas problemáticas con respecto al transplante de poblaciones y su inserción en el espacio de las plantaciones, tanto en el sur de los Estados Unidos como en las islas del Caribe. En las obras de ambos escritores puede percibirse el mismo vértigo trágico que persigue a los personajes, conduciéndolos a la locura, el sufrimiento y la muerte

Edouard Glissant e o legado de William Faulkner

Este trabajo se propone analizar el intertexto que une al escritor Edouard Glissant con William Faulkner a través de dos obras: el ensayo Faulkner, Mississipi (1996) y la novela Sartorius (1999). En el primer texto, el autor enfatiza cuestiones presentes en su propia obra novelesca: la genealogía, la relación con el espacio de la plantación, el mestizaje, la (i)legitimidad de derechos con respecto a la posesión de la tierra, la opacidad. En el segundo, traza una línea genealógica de un personaje perteneciente a una etnia africana imaginaria, haciéndolo llegar hasta las plantaciones del sur de los Estados Unidos; paralelamente, presenta la línea genealógica de los Sartoris. En esta dirección, busco mostrar cómo el proyecto literario de Glissant dialoga con la obra de Faulkner, indagando e inventariando las mismas problemáticas con respecto al transplante de poblaciones y su inserción en el espacio de las plantaciones, tanto en el sur de los Estados Unidos como en las islas del Caribe. En las obras de ambos escritores puede percibirse el mismo vértigo trágico que persigue a los personajes, conduciéndolos a la locura, el sufrimiento y la muerte

Edouard Glissant e o legado de William Faulkner

Este trabajo se propone analizar el intertexto que une al escritor Edouard Glissant con William Faulkner a través de dos obras: el ensayo Faulkner, Mississipi (1996) y la novela Sartorius (1999). En el primer texto, el autor enfatiza cuestiones presentes en su propia obra novelesca: la genealogía, la relación con el espacio de la plantación, el mestizaje, la (i)legitimidad de derechos con respecto a la posesión de la tierra, la opacidad. En el segundo, traza una línea genealógica de un personaje perteneciente a una etnia africana imaginaria, haciéndolo llegar hasta las plantaciones del sur de los Estados Unidos; paralelamente, presenta la línea genealógica de los Sartoris. En esta dirección, busco mostrar cómo el proyecto literario de Glissant dialoga con la obra de Faulkner, indagando e inventariando las mismas problemáticas con respecto al transplante de poblaciones y su inserción en el espacio de las plantaciones, tanto en el sur de los Estados Unidos como en las islas del Caribe. En las obras de ambos escritores puede percibirse el mismo vértigo trágico que persigue a los personajes, conduciéndolos a la locura, el sufrimiento y la muerte

Dionne Brand, Austin Clarke, and Tessa McWatt: Blackening Canada

This project analyzes contemporary black diasporic writing in Canada, arguing that Dionne Brand, Austin Clarke and Tessa McWatt evince a unique form of double-consciousness in their writings. Their work transforms African-American double-consciousness by locating it simultaneously within both the black diaspora and the practice of Canadian multiculturalism. The objective of this project is to offer a critical framework for situating these writers within the legacy of both Black Atlantic and Canadian cultural production. These writers do not aim to resolve their double-consciousness but rather dwell within that contradictory doubleness and hyphenation, forcing nation and diaspora to contend with one another in a discomfiting and unsettling dialogue. These authors employ the absences of the black diaspora to imagine new forms of black cultural production, multicultural citizenship and national identity. Their works produce a grammar of diasporic double-consciousness that locates the absented origins of diaspora within Canada. Brand’s depiction of temporality and Clarke’s tracing of movement explore the continuities between nation and diaspora while re-membering neglected aspects of the history of black Canada, such as the life and death of Albert Johnson. McWatt extends this blackening of nation by depicting coalitions between diasporic, indigenous, raced and sexed subjects. These authors transform hegemonic Canadian narratives of nation by dwelling in the hyphen, while their evocation of memory, absence, trauma, and desire gives blackness new meaning and legitimacy.

Death Threat Letters: Allegories of American Authorship in the Age of Terrorism

This dissertation examines novels that use terrorism to allegorize the threatened position of the literary author in contemporary culture. Allegory is a term that has been differently understood over time, but which has consistently been used by writers to articulate and construct their roles as authors. In the novels I look at, the terrorist challenge to authorship results in multiple deployments of allegory, each differently illustrating the way that allegory is used and authorship constructed in the contemporary American novel. Don DeLillo’s Mao II (1991), first puts terrorists and authors in an oppositional pairing. The terrorist’s ability to traffic in spectacle is presented as indicative of the author’s fading importance in contemporary culture and it is one way that terrorism allegorizes threats to authorship. In Philip Roth’s Operation Shylock (1993), the allegorical pairing is between the text of the novel and outside texts – newspaper reports, legal cases, etc. – that the novel references and adapts in order to bolster its own narrative authority. Richard Powers’s Plowing the Dark (1999) pairs the story of an imprisoned hostage, craving a single book, with employees of a tech firm who are creating interactive, virtual reality artworks. Focusing on the reader’s experience, Powers’s novel posits a form of authorship that the reader can take into consideration, but which does not seek to control the experience of the text. Finally, I look at two of Paul Auster’s twenty-first century novels, Travels in the Scriptorium (2007) and Man in the Dark (2008), to suggest that the relationship between representations of authors and terrorists changed after 9/11. Auster’s author-figures forward an ethics of authorship whereby novels can use narrative to buffer readers against the portrayal of violent acts in a culture that is suffused with traumatizing imagery.

Spanish colonial literature in South America,

Bibliography: p. 585-650.

The leopard's claw : a thrilling story of love and adventure from a European castle through the West African jungle, disclosing a deep insight into the quality and spiritual influence of African social institutions and conditions, and revealing a profound psyschic [sic] interpretation of African inner life, all clustered about the mysterious function and significance of the leopard's claw /

Mode of access: Internet.

Spanish America in song and story, selections representing Hispano-American letters from the conquest to the present day,

Mode of access: Internet.

The faithful slave /

Local copy lacks cover and begins with p. [1]