The influence of socioeconomic status on the relationship between diabetes and amputations: A systematic review of the literature

This paper synthesizes the current knowledge available regarding the impact of socioeconomic status on diabetes and amputations. In September 2009, searches in the OVID Medline and PubMed databases were performed using keywords associated with race/ethnicity, educational level, insurance status, veteran status, low income, diabetes, and lower extremity amputation. Articles published between 1996 and the search date were used. The pertinent articles were analyzed, summarized, and synthesized. ^ The majority of the articles agreed that African American, American Indian, and Latino minorities experience significantly higher rates of diabetes-related lower extremity amputation (LEA) when compared to whites. Few articles suggested that the disparity experienced by minorities and others of low SES was due to biology; most articles link it to a combination of lower income, lower educational attainment, uninsured or underinsured status, and a greater prevalence of detrimental health behaviors such as smoking. These, in turn, are linked to decreased knowledge of self-care, delayed health care seeking, delayed diagnoses and treatment, discrimination, and low quality health care. Interventions focused on patient education, established regimens of treatment, foot care, and control of diabetes have been shown to be effective, although none have lowered the rate of diabetes-related LEA to rates found in the general population.^

A movement from traditional malarial chemoprophylaxis to the use of intermittent preventive treatment as a method of protection for children diagnosed with sickle-cell disease: A proposal for consideration based on a systematic review of the literature

Approximately 200,000 African children are born with sickle-cell anemia each year. Research has shown that individuals with hemoglobin disorders, particularly sickle-cell anemia, have increased susceptibility to contracting malaria. Currently it is recommended that patients diagnosed with sickle-cell anemia undergo malaria chemoprophylaxis in order to decrease their chances of malarial infection. However, studies have shown that routine administration of these drugs increases the risk of drug resistance and could possibly impair the development of naturally acquired immunity. Clinical trials have shown intermittent preventive treatment (IPT) to be an effective method of protection against malaria. The objective of this report was to review previously conducted clinical trials that study the effects of intermittent preventive treatment on malaria and anemia in infants and children. Based on the review, implications for its appropriateness as a protective measure against malaria for infants and children diagnosed with sickle-cell disease were provided.^ The 18 studies reviewed were randomized controlled trials that focused on IPT’s effect on malaria (7 studies), anemia (1 study), or both (8 studies). In addition to these 16, one study looks at IPT’s effect on molecular resistance to malaria, and another study is a follow-up to a study in order to review IPT’s potential to cause a rebound effect. The 18 th study in this review specifically looks at IPT’s protective efficacy in children with SCA. The studies in this report were restricted to randomized controlled trials that have been performed from 2000 to 2010. Reports on anemia were included to illustrate possible added benefits of the use of IPT specific to burdens associated with SCA other than malaria susceptibility. The outcomes of these studies address several issues of concern involving the administration of IPT: protective efficacy (in reference to age, seasonal versus perennial malaria regions, and overall effectiveness against malaria and anemia), drug resistance, drug rebound effect, drug side-effects, and long-term effects. Overall, these showed that IPT has a significant level of protective efficacy against malaria and/or anemia in children. More specifically, the IPT study evaluating children diagnosed with sickle-cell anemia proved IPT to be a more effective method of protection than traditional chemoprophylaxis. ^

A systematic review of literature on socioeconomic disparities in the prevalence of dental caries

Dental caries, also known as tooth decay, are a disease of the oral cavity that affects the tooth structure and leads to the occurrence of cavities in teeth. Dental caries are one of the leading chronic diseases in the population and are very common in childhood. If not treated appropriately, dental caries have debilitating effect on the oral and general health of individuals. ^ Objectives. The aims of this review are to (1) analyze and elucidate the relationship between the social and economic determinants of health like income, education and race/ethnicity and the prevalence of dental caries and (2) identify and understand the pathways/underlying causes through which these factors affect the occurrence of dental caries. This review will provide a foundation for formulation of better oral health policies in future by identifying the key socio-economic factors and pathways affecting the prevalence of dental caries. Knowledge about these socioeconomic factors could be incorporated in the design of future policies and interventions to achieve greater benefits.^ Methods. This review includes information from all pertinent articles, reviews, surveys, reports, peer reviewed literature and web sources that were published after 2000. The selection criterion includes literature focusing on individuals between the ages of 1 to 65 years, and individuals from different subgroups of community based on income, education and race/ethnicity. The analyses of literature include identifying if a relationship between income/education/race and the prevalence of dental caries exists by comparing the prevalence of dental caries in different socio-economic groups. Also included in this review are articles that are relevant to the mechanisms/pathways through which income/education/race affect the prevalence of dental caries.^ Results. Analyses of available literature suggests that disparities in the prevalence of dental caries may be attributed to differences in income, education and race/ethnicity. Higher prevalence of dental caries was observed in African-American and Mexican-American individuals, and in people with low income and low education. The leading pathways through which the socioeconomic factors affect the prevalence of dental caries are the lack of access to dental care, lack of awareness about good oral hygiene beliefs and habits, oral health, inability to afford dental care, lack of social support to maintain oral health and lack of dental insurance.^ Conclusion. Disparities in the prevalence of dental caries exist in various socio-economic groups. The relationship between socio-economic factors and dental caries prevalence should be considered in the development of future policies and interventions that are aimed at reducing the prevalence of dental caries and enhancing oral health status.^

Strategies for obesity prevention in child care settings: A literature review

Background. Children in the age group of 2-5 years spend substantial amount of time during the day in some kind of childcare setting. These settings are an excellent environmental infrastructure to enhance their nutrition and physical activity behavior and to promote healthy eating and physical activity habits. Due to the steep rise in overweight and obesity among children in the past three decades, it becomes essential to intervene early. There exists a need for literature on a comprehensive and sustainable approach to obesity prevention for younger children in these settings. ^ Methods. Systematic literature search was undertaken using databases like Medline Ovid, Pubmed, Medline Ebsco, and Cochrane Library. Articles published in English as well as English language abstracts of foreign articles were included. The inclusion criteria were as follows: (1) Studies conducted in any part of the world exploring relevant themes and a child care or preschool setting would be included. (2) The interventions promoted physical activity, nutrition/healthy eating/improved diet, reduced television viewing, reduced BMI, changed knowledge and behavior of children and or staff or affected policy/standards/regulations. (3) The population was children in the age group of at least 2 years to 5 years. (4) Articles published in English and English language abstracts for foreign articles would be included. ^ Results. 16 articles were included in the review that consisted of primary interventions in the form of randomized control trials or pre-post interventions were conducted in a preschool or child care or day care setting only. The outcomes pertaining to healthy weight in children were increased vegetable intake, reduced BMI and increased knowledge among others. ^ Conclusion. There is a dearth of data on strong intervention trials in the child care setting. Preschool research studies in the young children that have been conducted are not strong enough. There is a need for more randomized control trials and a well planned evaluation in the preschool age children. There is a need to develop outcome measures that can accurately assess the changes in diet and physical activity in this age group. Child care nutrition and physical activity standards need to be made stringent. ^

A practice-based culminating experience: Writing a HRSA grant application with Texas Organ Sharing Alliance for public education efforts to increase solid organ donation

In November 2010, nearly 110,000 people in the United States were waiting for organs for transplantation. Despite the fact that the organ donor registration rate has doubled in the last year, Texas has the lowest registration rate in the nation. Due to the need for improved registration rates in Texas, this practice-based culminating experience was to write an application for federal funding for the central Texas organ procurement organization, Texas Organ Sharing Alliance. The culminating experience has two levels of significance for public health – (1) to engage in an activity to promote organ donation registration, and (2) to provide professional experience in grant writing. ^ The process began with a literature review. The review was to identify successful intervention activities in motivating organ donation registration that could be used in intervention design for the grant application. Conclusions derived from the literature review included (1) the need to specifically encourage family discussions, (2) religious and community leaders can be leveraged to facilitate organ donation conversations in families, (3) communication content must be culturally sensitive and (4) ethnic disparities in transplantation must be acknowledged and discussed.^ Post the literature review; the experience followed a five step process of developing the grant application. The steps included securing permission to proceed, assembling a project team, creation of a project plan and timeline, writing each element of the grant application including the design of proposed intervention activities, and completion of the federal grant application. ^ After the grant application was written, an evaluation of the grant writing process was conducted. Opportunities for improvement were identified. The first opportunity was the need for better timeline management to allow for review of the application by an independent party, iterative development of the budget proposal, and development of collaborative partnerships. Another improvement opportunity was the management of conflict regarding the design of the intervention that stemmed from marketing versus evidence-based approaches. The most important improvement opportunity was the need to develop a more exhaustive evaluation plan.^ Eight supplementary files are attached to appendices: Feasibility Discussion in Appendix 1, Grant Guidance and Workshop Notes in Appendix 2, Presentation to Texas Organ Sharing Alliance in Appendix 3, Team Recruitment Presentation in Appendix 5, Grant Project Narrative in Appendix 7, Federal Application Form in Appendix 8, and Budget Workbook with Budget Narrative in Appendix 9.^

Systematic literature review on internet-based interventions to prevent HIV transmission

Objective. To perform a systematic review of the internet based HIV prevention interventions.^ Data Source. Data resources including Ovid Medline, CINAHL (EBSCOhost and Psycinfo) were searched for the relevant articles. Study Selection: Studies were selected if the entire article was in English, Randomized control trial performed after 1998 till current, internet based aimed towards HIV/AIDS prevention. ^ Data Extraction. Each relevant article was coded using a code sheet which consisted of background information, study characteristics, study population information, program details, intervention and results. Data Synthesis: Total of seven relevant articles were coded and the information obtained was incorporated into the evidence tables for comparison.^ Conclusion. Overall the internet based HIV prevention studies have been very successful in recruiting large number of people but has not been able to show effective results due to high attrition. More research needs to be done in the area.^

The role of a nursing home administrator's education in influencing quality of care in US nursing homes

Nursing home literature links poor management practices to poor quality of care and resident outcomes. Since Nursing Home Administrators (NHAs) require an array of skills to perform their role, it is important to explore what makes a NHA effective. This research fills a gap in the literature and provides a possible option to improve the quality of care in nursing homes. Purpose of the study. The study examines whether NHAs with advanced education (defined as a Masters degree or more) are associated with better quality of care in licensed nursing homes (NHs). Design and Methods. Data was derived from the CDC’s 2004 National Nursing Home Survey, which is a representative sample of NHs across the US. A Donabedian- inspired structure-process-outcomes study model was created to explain how education relates to quality of care. Quality of care was defined as onsite oral care, employee influenza vaccination rates and staff recognition programs. Statistical analyses included multivariate logistic regression; covariates included facility-level variables used in similar peer-reviewed research but also included select measures from the Area Resource File to control for county-level factors. Results. Descriptive and analytical analyses confirm that NHAs with a Bachelor’s degree, Associate degree or high school diploma perform less well than NHAs with a Masters degree or more. NHAs with advanced education are more likely to have onsite dental care and recognition programs for staff than NHAs with a Bachelor’s degree (or less). Also NHAs with less than graduate education are more likely to provide off-site dental care. Employee vaccination rates are not impacted by education. Adding certification, tenure or years of experience to a NHA with advanced education gives them an advantage. In fact, certification and experience alone do not have a positive relationship to care indicators; however adding these to advanced education produces a significant result. Implications. This research provides preliminary evidence that advanced education for the NHA is associated with better quality of care. If future research can confirm these findings, there is merit in revisiting the qualifications. Education can be a legitimate option to support quality improvement efforts in US nursing homes. ^

Better together: Addressing maternal and child health outcomes through community health worker continuing education curricula

Background. The incidence of birth defects is a significant public health issue in the United States, adversely affecting the quality of life for parents as well as children born with these defects. Minority populations face a greater burden of birth defects and associated health problems. Prenatal practices can have a large impact on infant health outcomes. Several behaviors during pregnancy, including the intake of folic acid, can greatly influence the likelihood of a child being born with a birth defect. Community Health Workers have been shown to be effective agents at improving prenatal practices, especially when they facilitate support groups that feature pregnant women. ^ Methods. A continuing education curriculum has been created for Community Health Workers that provides content in the area of Maternal and Child Health. Content was selected after conducting a review of relevant literature and theory. Materials for conducting a training for Community Health Workers have been created in addition to materials that were designed for the population with whom the CHWs work. ^ Results. A description of each "key point" of the curriculum and a justification how it relates to the literature of the prevention of birth defects is given here. Additionally, the process of creating the curriculum using the platform delineated in the methods is described. ^ Discussion. Insights for future curriculum development are discussed along with next steps in the process of certifying the curriculum at the state level. A framework for future evaluation of the curriculum is given.^

Hearing aid use and adherence: A systematic review of the literature concerning the socioeconomic and psychological influences on hearing aid use and barriers to use

The current hearing health situation in the United States does not provide adequate support to individuals with hearing loss. More research is needed to give more support to these individuals. By conducting a systematic review of relevant literature from 1990 to present, I identified many factors that influence an individual's use of hearing aids. There are two research questions in this study: 1. Does the provision of screening and access to hearing aids decrease the negative effects of hearing loss? 2. Why is it difficult for people with hearing loss to adapt to and use hearing aids? The population of interest was adults (>18 years old) with hearing loss. Factors that influenced use of hearing aids for this population included age, gender, socioeconomic status, education, perceived severity of hearing loss, cost of hearing aids, screening, perceived benefit, stigmatization, perceived control, cognitive capability, personality, and social support. Research suggests that more efficient screening of at-risk individuals and the provision of better access to these individuals would prevent many of the negative effects of hearing loss.^

Sudden Infant Death disparities: A systematic review on health education and policy recommendations for decreasing Sudden Infant Death in the African-American community

Objective: To perform a systematic review of the literature on SIDS and SUID deaths concentrated in the African-American community, describe health education and policy recommendations and recommend a new approach that may aid in decreasing the disparity of infant mortality in the African-American community. ^ Methods: The PubMed database was systematically searched to identify relevant articles for final review and analysis. Using the CASP 2006 system to critique literature, twelve articles were found that met inclusion and exclusion criteria. ^ Results: Evidence in the literature confirmed there was a current disparity among African Americans' infant mortality rates in comparison to other US ethnic groups. The underlying reasons for these disparities included the following maternal and infant characteristics: mothers younger than eighteen, having more than one live infant, having a high school education or less, never been married, and have infants born preterm or with low birth weight. Maternal smoking, substance abuse, and breastfeeding did not have a significant impact on infant sleep environments among African Americans. ^ Conclusion: Tailored health education programs at the community level, better access to pre-pregnancy and prenatal care, and increased maternal perception of risk that is relevant to the infants sleeping environment are all possible solutions that may decrease African American infant mortality rates.^

Deprivation of Education in Urban Areas: A Basic Profile of Slum Children in Delhi, India

This paper showed the basic educational status of slum children between 5 and 14 years old. The attendance ratio of slum children is much lower than that of children in Delhi as a whole. Parental perception of education and financing education are the major constraints. Even if children are attending schools, the majority of them are over-aged. There are both demand and supply side reasons for discouraging slum children from attending schooling. As opposed to school-based surveys in previous literature, children in slums are more likely to go to government schools rather than low-fee paying private schools. Some policies are suggested.

Determinants of political tolerance : a literature review

This paper reviews the current literature on political tolerance with particular reference to its individual- and aggregate-level determinants. Individual-level determinants such as authoritarianism, education, contact, and threat perception are found to have robust effects on tolerance. What are less known are the mediating factors that enhance or reduce these effects. In recent years, increasing attention has been directed toward the impact of contextual factors on threat and contact effects.

Contemplative Education CenterStage: Training the Mindful Performer

In the late 20th century and early 21st century, contemplative education/studies courses, concentrations, and initiatives have emerged in the academy. Although there has been significant discussion of postsecondary courses and programs that have integrated contemplative views and practices in the literature, there have been few studies of contemplative curricula and pedagogy in higher education. Additionally, there have been even fewer inquiries of the influence of contemplative education on performing arts training within conservatories and college and university departments. The aim of this qualitative study was two-fold: (1) to describe, interpret, and appraise the impact of contemplative education on the curricula of an interdisciplinary conservatory level performing arts program, MFA Contemporary Performance, at Naropa University; and (2) to disclose, compare, and analyze MFA student perceptions of the influence of contemplative education on their professional and personal development. The following questions guided this study: (1) How do faculty and students characterize contemplative education within the MFA in Theater: Contemporary Performance Program? (2) How does contemplative education impact the intended and operational curricula of courses within the MFA Contemporary Performance Program? (3) How do graduate students perceive the effects of contemplative education, offered by the MFA Contemporary Performance Program, on the development of their communication abilities, presence-in-performance, sociolinguistic perspectives, and aesthetic perspectives? Based on the research methodology of educational criticism and connoisseurship, this investigation provides a vivid description and interpretation of the intended and operational curricula of three core courses within the MFA program. These curricula were examined through five dimensions: intentional, curricular, pedagogical, structural, and evaluative. In order to shape our understanding of the contemplative and performative nature of the curricula, the significant and subtle qualities of the courses were further captured by preparation, context-building, reflective, showing, and closing conventions. Since the courses were grounded in postmodern view, they were evaluated according to Doll's criteria of richness, recursion, relations, and rigor for the evaluation of postmodern curricula. MFA first- and second-year students primarily characterized contemplative education as body/mind training for performance and personal development, sitting meditation, and cultivation of mindfulness and awareness. Student perceptions of the impact of contemplative education on the development of their communication abilities, presence-in-performance, sociolinguistic perspectives, and aesthetic perspectives, throughout the course of their two-year training, are presented in a dimensional analysis. The research reveals eight different themes that intersect the three core curricula and interviews with MFA students and faculty. These thematics include inclusivity, nowness, silence, improvisation, goodness, heart, training, and space. The beginning letter of each theme combines to form the acronym, insights. The framework of insights connects and illuminates the most potent aspects of MFA Contemporary Performance values and training.

Women Leaders Resolving Conflict in Higher Education: A Feminist Epistemological Perspective

In an American postsecondary context, conflict is inherent (Gianneschi & Yanagiura, 2006; Valian, 1999). Successful navigation of conflict in the academy is vital for those who aspire to leadership positions (Nadler & Nadler, 1987; Walters, Stuhlmacher, & Meyer, 1998). Presently, however, women face significant barriers to achieving success in higher education administration, including gender expectations for conflict resolution behavior (Bartunek, 1992; Bowles, Babcock, & McGinn, 2005; Gayle, Preiss, & Allen, 2002). While a considerable body of literature exists for understanding gender negotiation, it remains rooted in a masculine paradigm (Kolb & Putnam, 2006; Shuter & Turner, 1997), and, as such, established theories lack a feminist epistemological perspective. Consequently, my primary research question is, How do women leaders experience and perceive conflict in the higher education work environment? I conduct a qualitative study that examines workplace conflict experiences of 15 women leaders from diverse personal and professional backgrounds. Hartsock's (1983) three-tiered gender-sensitive analysis of power, updated to include multicultural perspectives, serves as my theoretical framework. It is a lens through which I evaluate theories, finding multicultural organizational, higher education conflict, and gender negotiation theories most applicable to this study. The framework also creates the foundation upon which I build my study. Specifically, I determine that a feminist research method is most relevant to this investigation. To analyze data obtained through in depth interviews, I employ a highly structured form of grounded theory called dimensional analysis. Based on my findings, I co-construct with study participants a Feminist Conflict Process Theory and Flowchart in which initially the nature of the relationship, and subsequently the level of risk to the relationship, institution, or self, is evaluated. This study supports that which is observed in the conflict resolution practitioner literature, but is unique in its observation of factors that influence decisions within a dynamic conflict resolution process. My findings are significant to women who aspire to serve in leadership positions in higher education, as well as to the academy as a whole, for it expands our knowledge of women's ontological and epistemological perspectives on resolving conflict in postsecondary education.

Everything in di Dark Muss Come to Light: A Postcolonial Investigation of the Practice of Extra Lessons at the Secondary Level in Jamaica's Education System

Despite the vast research examining the evolution of Caribbean education systems, little is chronologically tied to the postcolonial theoretical perspectives of specific island-state systems, such as the Jamaican education system and its relationship with the underground shadow education system. This dissertation study sought to address the gaps in the literature by critically positioning postcolonial theories in education to examine the macro- and micro-level impacts of extra lessons on secondary education in Jamaica. The following postcolonial theoretical (PCT) tenets in education were contextualized from a review of the literature: (a) PCT in education uses colonial discourse analysis to critically deconstruct and decolonize imperialistic and colonial representations of knowledge throughout history; (b) PCT in education uses an anti-colonial discursive framework to re-position indigenous knowledge in schools, colleges, and universities to challenge hegemonic knowledge; (c) PCT in education involves the "unlearning" of dominant, normative ideologies, the use of self-reflexivity, and deconstruction; and (d) PCT in education calls for critical pedagogical approaches that reject the banking concept of education and introduces inclusive pedagogy to facilitate "the passage from naïve to critical transitivity" (Freire, 1973, p. 32). Specifically, using a transformative mixed-methods design, grounded and informed by a postcolonial theoretical lens, I quantitatively uncovered and then qualitatively highlighted how if at all extra lessons can improve educational outcomes for students at the secondary level in Jamaica. Accordingly, the quantitative data was used to test the hypotheses that the practice of extra lessons in schools is related to student academic achievement and the practice of critical-inclusive pedagogy in extra lessons is related to academic achievement. The two-level hierarchical linear model analysis revealed that hours spent in extra lessons, average household monthly income, and critical-inclusive pedagogical tents were the best predictors for academic achievement. Alternatively, the holistic multi-case study explored how extra-lessons produces increased academic achievement. The data revealed new ways of knowledge construction and critical pedagogical approaches to galvanize systemic change in secondary education. Furthermore, the data showed that extra lessons can improve educational outcomes for students at the secondary level if the conditions for learning are met. This study sets the stage for new forms of knowledge construction and implications for policy change.