RESUMO
This pilot study evaluated an innovative diabetes symptom awareness and self-management educational program for Mexican Americans, a fast growing minority population experiencing a diabetes epidemic. Patients with diabetes need assistance interpreting and managing symptoms, which are often annoying and potentially life-threatening. A repeated measures randomized controlled trial was conducted with 72 Mexican Americans aged 25-75 years with type 2 diabetes. Experimental condition participants received eight weekly, in-home, one-on-one educational and behavior modification sessions with a registered nurse focusing on symptom awareness, glucose self-testing and appropriate treatments, followed by eight biweekly support telephone sessions. Wait-listed control condition participants served as comparisons at three time points. Hierarchical linear modeling was used to evaluate the effects of the intervention between- and within groups on psychosocial, behavioral and clinical outcomes. Participants were predominantly female, middle-aged, moderately acculturated and in poor glycemic control. Experimental group participants (n = 39) significantly improved glycemic control, blood pressure, symptoms, knowledge, self-efficacy, empowerment and quality of life. Post intervention focus groups reported satisfaction with the symptom focus. Addressing symptoms led to clinical and psychosocial improvements. Symptoms seem to be an important motivator and a useful prompt to engage patients in diabetes self-management behaviors to relieve symptoms and prevent complications.
Assuntos
Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/terapia , Americanos Mexicanos , Educação de Pacientes como Assunto/organização & administração , Autocuidado , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Poder Psicológico , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: The admission of an infant to the neonatal intensive care unit (NICU) can produce significant stress for mothers and may contribute to a difficult transition following discharge. Past research has primarily focused on Caucasian women. Mexican-Americans are the fastest growing ethnic population in the U.S. with the highest fertility rate; therefore, the purpose of this grounded theory study was to gain a better understanding of the NICU experience for Mexican-American mothers. METHODS: Fifteen women were recruited and data were collected through semi-structured interviews. RESULTS: A theoretical model, taking care of my baby, was developed. The mothers' experiences began with the unexpected event of having an infant admitted to the NICU and played out in a context that fluctuated between being supportive (making meaningful connections) or inhibitive (struggling to mother). The women developed strategies to help them take care of their babies during the NICU stay: balancing responsibilities, leaving part of me with my baby, and watching over. The process concluded in one of two ways: bringing my baby home or losing my baby. CONCLUSION: These findings offer insight for neonatal nurses who provide care for Mexican-American NICU mothers and may help inform their practice. Further research is needed with this growing population to ensure supportive nursing care and influence positive outcomes.
Assuntos
Atitude Frente a Saúde , Unidades de Terapia Intensiva Neonatal , Comportamento Materno/etnologia , Americanos Mexicanos/psicologia , Mães/psicologia , Adulto , Competência Cultural , Feminino , Humanos , Cuidado do Lactente/psicologia , Recém-Nascido , Relações Profissional-Família , Adulto JovemRESUMO
PURPOSE: To explore the experiences of Mexican-American mothers who have had infants in the neonatal intensive care unit (NICU). PARTICIPANTS: A convenience sample of 15 English-speaking, Mexican-American women was interviewed. DESIGN: The study used an exploratory qualitative approach. METHODS: Data collection was conducted through audiotaped, transcribed, semistructured, individual interviews and field notes. The 5 normative cultural values for Latino families-(1) simpatia, (2) personalismo, (3) respeto, (4) familismo, and (5) fatalismo-were used as a sensitizing framework to guide data interpretation. RESULTS: The women's discussions of their NICU experiences clearly reflect the 5 normative Latino cultural values. Positive and negative exemplars of these values are provided as evidence. CONCLUSIONS: These findings can be used to inform nursing care provided for Mexican-American mothers and their infants by assisting nurses to customize care to meet the cultural needs of this population.
Assuntos
Cultura , Terapia Intensiva Neonatal/psicologia , Americanos Mexicanos/psicologia , Mães/psicologia , Enfermagem Neonatal/métodos , Relações Profissional-Família , Adulto , Atitude do Pessoal de Saúde , Competência Cultural , Feminino , Humanos , Entrevistas como Assunto , Pesquisa Metodológica em Enfermagem , Pesquisa Qualitativa , Inquéritos e QuestionáriosRESUMO
ETHNOPHARMACOLOGICAL RELEVANCE: The plant species reported here are traditionally used in Northern Peru for a wide range of illnesses. Most remedies are prepared as ethanol or aqueous extracts and then ingested. The aim of this study was to evaluate the potential toxicity of these extracts. MATERIALS AND METHODS: The toxicity of ethanolic and water extracts of 341 plant species was determined using a brine-shrimp assay. RESULTS: Overall 24% of the species in water extract and 76% of the species in alcoholic extract showed elevated toxicity levels to brine-shrimp. Although in most cases multiple extracts of the same species showed very similar toxicity values, in some cases the toxicity of different extracts of the same species varied from non-toxic to highly toxic. CONCLUSIONS: Traditional preparation methods take different toxicity levels in aqueous and ethanol extracts into account when choosing the appropriate solvent for the preparation of a remedy.
Assuntos
Artemia/efeitos dos fármacos , Plantas Medicinais/toxicidade , Animais , Relação Dose-Resposta a Droga , Etanol/química , Dose Letal Mediana , Medicina Tradicional , Peru , Plantas Medicinais/química , Medição de Risco , Solventes/química , Testes de Toxicidade , Água/químicaRESUMO
OBJECTIVES: Nasal nitric oxide (nNO) is a reliable non-invasive screening test for primary ciliary dyskinesia (PCD), but the recommended technique, exhalation against resistance (ER), requires cooperation limiting its use in young children. Our objectives were to determine whether easier non-velum closure techniques have the ability to discriminate PCD and longitudinal reproducibility. STUDY DESIGN: We conducted a case-control study evaluating 5 breathing techniques (ER, breath hold, tidal breathing mouth open, tidal breathing mouth closed, and humming) for measuring nNO in patients with PCD compared with control subjects (cystic fibrosis [CF], non-PCD non-CF bronchiectasis, and healthy). A subgroup repeated measurements 1 month later. Sensitivity, specificity, and intraclass correlation coefficient of each nNO technique were determined. RESULTS: We tested 85 children (20 PCD, 32 CF, 14 broncheoctasis, and 19 healthy), aged 5 to 18 years (mean age, 11.5 years); 52% of children were male. All breathing techniques discriminated patients with PCD from control subjects with high specificity (>90%), 100% sensitivity, and intraclass correlation coefficient >0.8. nNO output cutoff values for diagnosing PCD varied with techniques (ER, 59 nL/min; breath hold, 61 nL/min; tidal breathing mouth open, 37 nL/min; tidal breathing mouth closed, 30 nL/min; humming, 41 nL/min). CONCLUSION: Non-velum closure techniques are reproducible and valid to discriminate PCD; however, they generally yield lower values than ER.
Assuntos
Testes Respiratórios/métodos , Transtornos da Motilidade Ciliar/diagnóstico , Óxido Nítrico/metabolismo , Adolescente , Bronquiectasia/metabolismo , Estudos de Casos e Controles , Criança , Pré-Escolar , Fibrose Cística/metabolismo , Feminino , Humanos , Estudos Longitudinais , Masculino , Sensibilidade e EspecificidadeRESUMO
AIM: The plant species reported here are traditionally used in Northern Peru to treat bacterial infections, often addressed by the local healers as "inflammation". The aim of this study was to evaluate the minimum inhibitory concentration (MIC) of their antibacterial properties against gram-positive and gram-negative bacteria. MATERIALS AND METHODS: The antimicrobial activity of ethanolic and water extracts of 141 plant species was determined using a deep-well broth microdilution method on commercially available bacterial strains. RESULTS: The ethanolic extracts of 51 species inhibited Escherichia coli, and 114 ethanolic extracts inhibited Staphylococcus aureus. In contrast, only 30 aqueous extracts showed activity against Escherichia coli and 38 extracts against Staphylococcus aureus. The MIC concentrations were mostly very high and ranged from 0.008 to 256 mg/ml, with only 36 species showing inhibitory concentrations of <4 mg/ml. The ethanolic extracts exhibited stronger activity and a much broader spectrum of action than the aqueous extracts. Hypericum laricifolium, Hura crepitans, Caesalpinia paipai, Cassia fistula, Hyptis sidifolia, Salvia sp., Banisteriopsis caapi, Miconia salicifolia and Polygonum hydropiperoides showed the lowest MIC values and would be interesting candidates for future research. CONCLUSIONS: The presence of antibacterial activity could be confirmed in most species used in traditional medicine in Peru which were assayed in this study. However, the MIC for the species employed showed a very large range, and were mostly very high. Nevertheless, traditional knowledge might provide some leads to elucidate potential candidates for future development of new antibiotic agents.
Assuntos
Antibacterianos/farmacologia , Escherichia coli/efeitos dos fármacos , Extratos Vegetais/farmacologia , Plantas Medicinais/classificação , Staphylococcus aureus/efeitos dos fármacos , Antibacterianos/isolamento & purificação , Países em Desenvolvimento , Medicina Tradicional , Testes de Sensibilidade Microbiana , Peru , Extratos Vegetais/isolamento & purificação , Plantas Medicinais/química , Plantas Medicinais/crescimento & desenvolvimentoRESUMO
OBJECTIVE: To determine the microbiological yield of induced sputum (IS) samples compared with conventional airway samples, spontaneously expectorated sputum and throat swabs, in children with cystic fibrosis (CF) attending an outpatient clinic. STUDY DESIGN: Ninety-five children with CF (75 able to spontaneously expectorate sputum) were included in this prospective cross-sectional comparative study. After obtaining expectorated sputum or throat swabs samples, IS was obtained by performing the sputum induction procedure using an eFlow device (PARI, Starnberg, Germany). CF bacterial culture results were compared between the two procedures. RESULTS: Differences in culture results between samples were observed in 25 of 94 (27%) patients. IS had a significantly higher yield for CF pathogens, with 80% of the differences being due to detection of additional organisms in IS samples. Overall, SI was well tolerated, but 12 of 95 cases had a >20% postinduction decline in forced expiratory volume in 1 second. The whole SI procedure took 30 to 85 minutes of clinic time, and its estimated additional cost was $150 (US)/patient. CONCLUSIONS: Induced sputum has a higher microbiological yield compared with the conventional samples in children with CF, even in patients capable of expectorating sputum spontaneously. Although sputum induction is safe and tolerable, it is time-consuming and expensive in routine clinical settings.
Assuntos
Fibrose Cística/microbiologia , Escarro/microbiologia , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
Various populations experience health disparities related to risk factors such as gender, race or ethnicity, educational level, income level, and geographic location. These populations often experience barriers to access and utilization of services, which can lead to adverse health outcomes. Health promotion interventions developed within the context of communities represent resources that may offer protection to these populations. The purpose of this article is to describe the evolution of a conceptual model for the study of health disparities. The model, based on a review of literature, was developed to guide 19 pilot studies funded by the Texas-New Mexico P20 Southwest Partnership Center for Nursing Research on Health Disparities. Reflection on these studies, their respective methodologies, and findings resulted in a revised model to guide further studies of communities experiencing health disparities.