Self -management factors, influences, and conditions for type 2 diabetes among Black ethnic groups in Miami, Florida and Abidjan, Cote d'Ivoire

The Dahlgren and Whitehead ecological theory provides the framework for a cross-sectional design to compare socio-demographic characteristics, living and working conditions, and lifestyle daily habits as well as cultural and ecological factors among six diabetic multiethnic Black groups in Miami and Abidjan. Approximately 180 Black Americans (African-, Caribbean-, and Haitian-) and 180 Black Africans (Akan, Malinke, and Krou) aged 20 years and older were surveyed. During the preliminary of this study participants' attitudes and behaviors were qualitatively assessed (N=60) and a tool was developed to describe, in the main study (N=360), differences in participants' strength of commitment to diabetes lifestyle self-management. Despite similarities found in terms of age and gender, statistically significant differences were also found within and among groups in terms of living and working conditions, education level, and religion. African American groups were more likely to participate in more diabetes classes than Haitian Americans and Caribbean Americans. However, African Americans were less likely to adhere to daily dietary and weight control regimens. Although, Black African groups reported limited access to equipment, facilities, and financial support they were more likely to follow dietary and weight control recommendations than Black American groups. Overall, African American participants showed the poorest attitudes towards recommended foods, Caribbean American respondents reported the best attitudes and behaviors towards weight control regimens, and the Malinke group had significantly more strength of commitment to successful weight control. Furthermore, Black African groups had significantly more strength of commitment to successful dietary adherence and significantly less support for weight control than Black American groups. ^ Significant differences found within Black groups suggest that understanding each patient's conditions may help healthcare professionals in initiating individualized appropriate counseling before goal setting, and in developing culturally relevant type 2 diabetes management programs. Moreover, significant differences exist in strength of commitment to lifestyle adherence among Black groups in Miami and Abidjan. Cultural, socio-demographic factors and self-management habits may explain differences in participants' outcomes. At the policy level, Black groups should not be approached as a homogenous group and assessment of the vulnerability of each ethnic group may be necessary in the decision-making process.^

Effects of real -time captioning and sign language interpreting on the learning of college students who are deaf or hard of hearing

College personnel are required to provide accommodations for students who are deaf and hard of hearing (D/HoH), but few empirical studies have been conducted on D/HoH students as they learn under the various accommodation conditions (sign language interpreting, SLI, real-time captioning, RTC, and both). Guided by the experiences of students who are D/HoH at Miami-Dade College (MDC) who requested RTC in addition to SLI as accommodations, the researcher adopted Merten’s transformative-emancipatory theoretical framework that values perceptions and voice of students who are D/HoH. A mixed methods design addressed two research questions: Did student learning differ for each accommodation? What did students experience while learning through accommodations? Participants included 30 students who were D/HoH (60% women). They represented MDC’s majority minority population: 10% White (non-Hispanic), 20% Black (non-Hispanic, including Haitian/Caribbean), 67% Hispanic, and 3% other. Hearing loss, ranged from severe-profound (70%) to mild-moderate (30%). All were able to communicate with American Sign Language: Learning was measured while students who were D/HoH viewed three lectures under three accommodation conditions (SLI, RTC, SLI+RTC). The learning measure was defined as the difference in pre- and post-test scores on tests of the content presented in the lectures. Using repeated measure ANOVA and ANCOVA, confounding variables of fluency in American Sign Language and literacy skills were treated as covariates. Perceptions were obtained through interviews and verbal protocol analysis that were signed, videotaped, transcribed, coded, and examined for common themes and metacognitive strategies. No statistically significant differences were found among the three accommodations on the learning measure. Students who were D/HoH expressed thoughts about five different aspects of their learning while they viewed lectures: (a) comprehending the information, (b) feeling a part of the classroom environment, (c) past experiences with an accommodation, (d) individual preferences for an accommodation, (e) suggestions for improving an accommodation. They exhibited three metacognitive strategies: (a) constructing knowledge, (b) monitoring comprehension, and (c) evaluating information. No patterns were found in the types of metacognitive strategies used for any particular accommodation. The researcher offers recommendations for flexible applications of the standard accommodations used with students who are D/HoH.

The effects of age, ethnicity, sexual dysfunction, urinary incontinence, masculinity, and relationship with the partner on the quality of life of men with prostate cancer

Prostate cancer, the leading cause of cancer in men, has positive survival rates and constitutes a challenge to men with its side effects. Studies have addressed the bivaritate relationships between prostate cancer treatment side effects masculinity, partner relationship, and quality of life (QOL). However, few studies have highlighted the relationships among prostate cancer treatment side effects (i.e., sexual dysfunction, urinary incontinence), masculinity, and relationship with the partner together on QOL in men. Most studies were conducted with predominately Caucasian sample of men. Miami is a unique multiethnic setting that hosts Cuban, Columbian, Venezuelan, Haitian, other Latin American and Caribbean communities that were not represented in previous literature. The purpose of this study was to examine relative contributions of age, ethnicity, sexual dysfunction, urinary incontinence, masculinity, and perception of the relationship with the partner on the quality of life in men diagnosed with prostate cancer. Data were collected using self administered questionnaires measuring demographic variables, sexual and urinary functioning (UCLA PCI), masculinity (CMNI), partner relationship (DAS), and QOL (SF-36). A total of 117 partnered heterosexual men diagnosed with prostate cancer were recruited from four urology clinics in Miami, Florida. Men were 67.47 (SD = 8.42) years old and identified themselves to be of Hispanic origin (54.3 %, n = 63). Findings demonstrated that there was a significant moderate negative relationship between urinary and sexual functioning of men. There was a significant strong negative association between men's perceived relationship with partner and masculinity. There was a weak negative relationship between the partner relationship and QOL. Hierarchal multiple regression showed that the partner relationship (β = -.25, t (91) = -2.28, p = .03) significantly contributed overall to QOL. These findings highlight the importance of the relationship satisfaction in the QOL of men with prostate cancer. Nursing interventions to enhance QOL for these men should consider strengthening the relationship and involving the female partner as an active participant.^

The Role of Family/Friend Social Support in Diabetes Self-Management for Minorities with Type 2 Diabetes

This study investigated how ethnicity, perceived family/friend social support (FSS), and health behaviors are associated with diabetes self-management (DSM) in minorities. The participants were recruited by community outreach methods and included 174 Cuban-, 121 Haitian- and 110 African-Americans with type 2 diabetes. The results indicated that ethnicity and FSS were associated with DSM. Higher FSS scores were associated with higher DSM scores, independent of ethnicity. There were ethnic differences in several elements of FSS. DSM was highest in Haitian- as compared to African-Americans; yet Haitian Americans had poorer glycemic control. The findings suggest FSS together with ethnicity may influence critical health practices. Studies are needed that further investigate the relationships among minorities with diabetes, their intimate network (family and friends) and the diabetes care process.

Dietary Intake Of Flavonoids And HDL- And LDL- Cholesterol In Two Black Ethnicities With And Without Type 2 Diabetes

Flavonoids are a class of over 6,500 plant metabolites that have been associated with reduced mortality from cardiovascular disease. A cross-sectional analysis of dietary flavonoids and serum cholesterol in 507 Blacks with and without type 2 diabetes (258 Haitian-Americans and 249 African-Americans) showed differences by ethnicity and diabetes status. Haitian-Americans consumed more of most flavonoids as compared to African-Americans. Individuals with type 2 diabetes consumed less of most flavonoids as compared to those without diabetes. Flavonoids were differentially associated with low-density lipoprotein cholesterol (LDL) and high-density lipoprotein cholesterol (HDL) by diabetes status. Flavanones were associated with lower LDL for participants without diabetes and higher LDL for those with diabetes, independent of ethnicity and adjusted for age, gender, cholesterol medications, daily energy, dietary fat, body mass index (BMI), and smoking. Flavan-3-ols were positively related to LDL while polyflavonoids (theaflavin and polymers, proanthocyanidins) were inversely related to LDL for the group without diabetes only. Higher anthocyanidins and flavan-3-ols and lower polyflavonoids were associated with higher HDL (same adjustments) for those without diabetes, whereas no flavonoids were associated with HDL for individuals with type 2 diabetes.

"New" Social Movements: Alternative Modernities, (Trans)local Nationalisms, and Solidarity Economies

My dissertation is the first project on the Haitian Platform for Advocacy for an Alternative Development- PAPDA, a nation-building coalition founded by activists from varying sectors to coordinate one comprehensive nationalist movement against what they are calling an Occupation. My work not only provides information on this under-theorized popular movement but also situates it within the broader literature on the postcolonial nation-state as well as Latin American and Caribbean social movements. The dissertation analyzes the contentious relationship between local and global discourses and practices of citizenship. Furthermore, the research draws on transnational feminist theory to underline the scattered hegemonies that intersect to produce varied spaces and practices of sovereignty within the Haitian postcolonial nation-state. The dissertation highlights how race and class, gender and sexuality, education and language, and religion have been imagined and co-constituted by Haitian social movements in constructing ‘new’ collective identities that collapse the private and the public, the rural and the urban, the traditional and the modern. My project complements the scholarship on social movements and the postcolonial nation-state and pushes it forward by emphasizing its spatial dimensions. Moreover, the dissertation de-centers the state to underline the movement of capital, goods, resources, and populations that shape the postcolonial experience. I re-define the postcolonial nation-state as a network of local, regional, international, and transnational arrangements between different political agents, including social movement actors. To conduct this interdisciplinary research project, I employed ethnographic methods, discourse and textual analysis, as well as basic mapping and statistical descriptions in order to present a historically-rooted interpretation of individual and organizational negotiations for community-based autonomy and regional development.

Investigating the Outcomes of a Physical Activity Program offered to Older Adults in South Florida and Understanding the Correlates of Completion

Despite the well-known benefits of physical activity, in 2012, only 37.5% of older adults aged 60 years or older met recommended aerobic physical activity levels and 16.1% met muscle-strengthening guidelines. Effective exercise programs can help combat the problem of inactivity but 50% of those who start participating in an exercise program drop out within first few weeks, preventing them from gaining any health benefits. Since fall 2008, the Healthy Aging Regional Collaborative of South Florida has offered EnhanceFitness (EF), an evidence-based physical activity program to older adults. This dissertation compared EF effectiveness at 4-, 8-, and 12-months and examined the factors that were associated with program completion. A paired sample t-test identified changes at 4-months and repeated measures design was used to identify changes from baseline to 4-, 8-, and 12- months. Logistic regression was used to identify correlates associated with completion. Between October 1, 2008 and December 31, 2012, 4,531 older adults (>=60 years) attended one or more EF sessions. Participants showed significant improvement in the number of chair stands performed in 30-seconds with mean change of 1.7, 1.6, and 2.0 respectively at 4-,8-,and 12- months (pp<0.001). Results suggest Black, non-Haitian men were less likely to complete the program when compared to white, non-Hispanic men (OR=0.41, p=0.02). Men who self-reported having at least one risk factor were more likely to complete the program (OR=1.81, p= 0.03). In addition, women who lived in Miami-Dade County (OR=2.13, ppppp<0.01). Effectiveness results revealed that all participants improved on outcome measures. However, improvement is more than double for those who completed recommended sessions (p

The relationship among serum levels of manganese superoxide dismutase and mitochondrial DNA 8-hydroxy-2'- deoxyguanosine, and dietary antioxidants intake in type 2 diabetes

Oxidative stress plays a key role in the development of Type 2 Diabetes (T2D). This cross-sectional study examined the relationship among serum levels of manganese superoxide dismutase (MnSOD), 8-hydroxy-2’-deoxyguanosine (8OHdG), dietary antioxidant intakes and glycemic control in African Americans (n=209) and Haitian Americans (n=234) with and without T2D. ^ African Americans had higher BMI (32.8 vs. 29.3 kg/m2), higher energy intake (2148 vs. 1770 kcal), and were more educated as compared to Haitian Americans; all variables were significant at p < .001. Serum levels of 8OHdG and MnSOD for African Americans (1691.0 ± 225.1 pg/ml, 2538.0 ± 1091.8 pg/ml; respectively) were significantly higher than for Haitian Americans (1626.2 ± 222.9, 2015.8 ± 656.3 pg/ml; respectively). 8OHdG was negatively correlated with MnSOD ( r = -.167, p < .001) in T2D. Having T2D was negatively correlated with MnSOD (r = -.337; p < .01) and positively correlated with 8OHdG (r = .500; p < .01). African Americans and Haitian Americans with T2D had fasting plasma glucose (FPG) levels of 143.0 ± 61.0 mg/dl and 157.6 ± 65.5 mg/dl, and A1C of 7.5 ± 1.8 % and 8.4 ± 2.4 %, respectively. African Americans and Haitian Americans without T2D had FPG levels of 95.8 ± 13.2 mg/dl and 98.7 ± 16.9 mg/dl, and A1C of 5.9 ± 0.4% and 6.0 ± 0.5%, respectively. Dietary intakes of vitamin C and vitamin D were negatively correlated with FPG (r = -.21; r = -.19, p < .05) respectively. Carotenoids negatively correlated with A1C (r = -.19, p < .05). Lower levels of MnSOD were associated with lower levels of zinc, r = .10, p < .05, and higher levels of carotenoids r = -.10, p < .05. Higher levels of 8OHdG were associated with lower levels of Vitamin D, r = -.14, p < .01, and carotenoids, r = -.09, p < .05. ^ The results demonstrate greater oxidative mtDNA damage in persons with T2D compared to those without T2D and in African Americans compared with Haitian Americans. The inverse relationship between dietary intake of antioxidants and oxidative stress implies a potential to reduce oxidative stress with diet. ^

Water Governance in Haiti: An Assessment of Laws and Institutional Capacities

The Republic of Haiti struggles to sustainably manage its water resources. Public health is compromised by low levels of water supply, sanitation, and hygiene, and water resources are often contaminated and unsustainably allocated. While poor governance is often blamed for these shortcomings, the laws and institutions regulating water resources in Haiti are poorly understood, especially by the international community. This study brings together and analyzes Haitian water laws, assesses institutional capacities, and provides a case study of water management in northern Haiti in order to provide a more complete picture of the sector. Funded by the Inter-American Development Bank as part of the Water Availability, Quality and Integrated Water Resources Management in Northern Haiti (HA-T1179) Project, this study took place from January-July 2015, with the help of local experts and participating stakeholders. The results indicate that Haiti’s water law framework is highly fragmented, with overlapping mandates and little coordination between ministries at the national level, and ambiguous but unrealistic roles for subnational governments. A capacity assessment of institutions in northern Haiti illustrates that while local stakeholders are engaged, human and financial resources are insufficient to carry out statutory responsibilities. The findings suggest that water resources management planning should engage local governments and community fixtures while supplementing capacities with national or international support.

Influences on immigrant students' perceptions of the chances of making it in the United States

This study examined immigrant minority students' perceptions of race relations and of the chances for social mobility in the United States (U.S.) using cohort samples of West Indian (N=173) and Haitian (N=191) students. The Students' responses collected during the 6th and 7th, 8th and 9th grades were analyzed to determine whether perceptions of racial mistrust, teacher derogation and social mobility varied depending on the student's length of stay in the U.S. or self-concept. Quantitative methodology was applied to data extrapolated from a larger epidemiological longitudinal study consisting of 7, 386 middle school students in Miami (Vega and Gil, 1998). Results show that West Indian and Haitian students' perceptions of racial mistrust, teacher derogation and social mobility were associated more with student's self-concept than length of stay. Students with more favorable self-concepts reported greater optimism toward social mobility than those with less favorable self-concepts. Results also indicate that in the context of parental education and SES that racial mistrust is the strongest predictor of these students' level of optimism towards social mobility.

The phonological analysis of bilingual Creole/English children living in South Florida

The purpose of this study was to gather normative data regarding the phonological system of bilingual Creole-English children ages three and five and to compare performance to norms for English speaking children. The forty participants lived in Miami and represented low socio-economic groups. Participants were assessed using the Goldman-Fristoe Test of Articulation-2 and a Haitian Creole Picture Naming Assessment. The results indicated that the percentage of correct phonemes in Creole (M=91.6) were not significantly different when compared to the correct production of the same phonemes in English (M=92.8). Further analysis revealed that the accuracy of all phonemes was higher for the five-year (M= 90.8) as compared to the three-year-olds (M= 85) in Creole. In English, the five-year-olds performed better than the three-year-olds participants. These findings revealed patterns of phonological development in bilingual Creole/English Children similar to patterns reported in other bilingual children. This information is essential in the evaluation and treatment of this population.

Tittmann and the 'Tiger Car' : competing conceptions of modernity in Haiti, 1946-50

The purpose of this project was to address the lack of scholarship on mid-twentieth century Haitian history and illustrate its significance. It employs primary and secondary sources in shaping a Gramscian historical narrative. Ideas of "everyday resistance" and internal and external politics are also be of significance to this work. In mid-twentieth century Haiti, the black-nationalist rhetoric of noirisme became the dominant political ideology. Blackness was amorphous and its application to politics was dependent upon class. In proclaiming blackness the average Haitian was attacking the class schism that beleaguered the island. Yet for the elite noirismewas a conduit to modernity and a useful tool for muting the division between rich and poor. With the election of Dumarsais Estimé in 1946, dialogue between the U.S. government, the Haitian elite, and the masses, relative to definitions of modernity played out within the new political reality of noirisme.

A Fraternidade como categoria política: princípio anunciado na educação brasileira

This dissertation has had the goal of understanding and discussing how the fraternity category is presented in the main Brazilian education laws after the promulgation of the 1988 Federal Constitution. The systematization of a theoretical base about the fraternity category in its relation with de Brazilian education regulatory landmarks has allowed the proposition of elements of this category. The process of building the theoretical references of this research was written from a historical recuperation of the French Revolution, taking into account the triad of its main principles, “liberty, equality, and fraternity”, as civic and political values. Likewise, the Haitian Revolution was considered because of the symbolic role this revolution played on the concretization of the triad through the slave and black people’s struggle whose aims were both participation in the colony’s power positions and in the abolishing of slavery. The modernity and post modernity issues, as well as the concepts of citizenship and human rights, are also took as theoretical references in order to identify characteristics and connections of each one of those themes and concepts with the fraternity as a political category. This analysis has allowed the elaboration and systematization of the fraternity category and its constitutive elements: the universality which is directly connected to the local and regional issues; the mondialization as a counter-argument to the globalization which is seen exclusively in its economic dimension; the participative democracy as alternative way to the representative democracy; the “alteridade” (a kind of altruism) due to its specific way to recognize the other one as someone pretty much like me; and the diversity which consider the multicultural perspective and the necessity of building unity. It was possible to identify that the first two elements of the triad, liberty and equality, were the most import ones over the so called modernity period when the triad was put in the second place or only in its religious dimension. The post modernity, in turn, has brought to light the fraternity due to its constitutive elements. It was also possible to highlight the citizenship as a modernity landmark and the human rights as an idea marked by the fraternity and directly linked with the post modernity. From this theoretical frame it was made an analysis of the legal instruments that organize and regulate the Brazilian education: the 1998 Federal Constitution; the Statute for Children and Adolescents; the National Brazilian Education Law; and the National Education Plan. All these legal instruments were discussed based on their relation with the fraternity as a political category and through the identification of its main constitutive elements. The methodological way was put into practice mainly through the qualitative dimension, especially the Bardin’s content analysis. The dissertation has permitted to emphasize that the fraternity as political category was not a forgotten principle in the Brazilian education legislation, but a principle not formally and textually declared yet.

Pitit se rìches malere [Children are the wealth of the poor]: The Influence of Gender and Power on Choice and Uptake of Long Acting Contraceptives

Background: Haiti has the highest maternal mortality rate in the Latin American and Caribbean region. Despite the fact that Haiti has received twice as much family planning assistance as any other country in the western hemisphere, the unmet need for contraception remains particularly high. Our hypothesis is that unsuccessful efforts of family planning programs may be related to a misconstrued understanding of the complex role of gender in relationships and community in Haiti. This manuscript is one of four parts of a study that intends to examine some of these issues with a particular focus on the influence of uptake and adherence to long acting contraceptive (LAC) methods.

Methods: We conducted a three-month community-based qualitative assessment through 20 in-depth interviews in Fondwa, Haiti. Participants were divided into 4 groups of five: female users, female non-users, men and key community stakeholders.

Results: Based on the qualitative interviews, we found that main barriers included lack of access to family planning education and services and concerns regarding side effects and health risks, especially related to menstrual disruption and fears of infertility. Women have a constant pressure to remain fertile and bear children, due not only to social but also economic needs. As relationships are conceived as means for economic provision, the likelihood of uptake of irreversible methods (vasectomy and tubal ligation) was restricted by loss of fertility. Consequently, the discourse of family planning, though self-recognized in their favor, assumes women can afford not to bear children. This assumption should be questioned given the complexities of the other social determinants at play, all which affect the reproductive decisions made by Haitians.

Conclusions: Overall, our study indicated awareness surrounding contraception in the Haitian Fondwa community. Combining the substantial impact of birth spacing with the elevated yet unmet need for contraceptives in the area, it is necessary to address the intricacies of gender issues in order to implement successful programing. In Haiti not being able to bear a child poses a threat to economic and social survival, possibly explaining a dimension of the low uptake of LACs in the region, even when made available. For this reason, we believe IUDs (Intrauterine Devices) provide a suitable alternative, allowing the couple to comprehend all of the factors involved in decision making, thus decreasing the imbalances of power and knowledge prior to considering an irreversible alternative.

Peroxisome Proliferator-Activated Receptor-γ Coactivator 1-α (PPARGC1A) Genetic Associations with Type 2 Diabetes in Three Ethnicities

Genetic heterogeneity, lifestyle factors, gene-gene or gene-environment interactions are the determinants of T2D which puts Hispanics and populations with African ancestry at higher risk of developing T2D. In this dissertation, the genetic associations of PPARGC1A polymorphisms with T2D and its related phenotypes (metabolic markers) in Haitian Americans (cases=110, controls=116), African Americans (cases=120, controls=124) and Cuban Americans (cases=160, controls=181) of South Florida were explored. Five single nucleotide polymorphisms of gene PPARGC1A were evaluated in each ethnicity for their disease association. In Haitian Americans, rs7656250 (OR= 0.22, pp=0.03) had significant protective association with T2D but had risk association in African Americans for rs7656250 (OR=1.02, p=0.96) and rs4235308 (OR=2.53, p=0.03). We found that in Haitian American females, both rs7656250 (OR=0.23, pp=0.03) had protective association with T2D. In African American females, rs7656250 (OR=1.14, p=0.78) had risk association whereas in males, it had significant protective effect (OR=0.37, p=0.04). However, the risk association exhibited by rs4235308 was stronger in African American females (OR=2.69, p=0.03) than males (OR=1.16, p=0.72). In Cuban Americans, only rs7656250 showed significant risk association with T2D (OR=6.87, p=0.02) which was stronger in females alone (OR=7.67, p=0.01). We also observed significant differences among correlations of PPARGC1A SNPs and T2D phenotypes. Positive correlation was observed for log Hs-CRP with rs3774907 (pp=0.03) in Cuban Americans respectively. Correlation of log A1C with rs7656250 (p=0.02) was positive in Cuban Americans while it was negative for rs3774907 in Haitian Americans (ppPPARGC1A correlations with T2D and its phenotypes among the three ethnicities studied (ii) the associations of PPARGC1A SNPs showed significant effect modification by sex. The findings suggest that variations in effects of PPARGC1A gene polymorphisms among three ethnicities and between sexes may have biomedical implications for the development of T2D as well as the phenotypes related to T2D.