VHL Community:

AN OBESITY INTERVENTION PROGRAM FOR HISPANIC ADOLESCENTS

Mon, 20 Feb 2012 12:11:41 GMT

Title: AN OBESITY INTERVENTION PROGRAM FOR HISPANIC ADOLESCENTS Abstract: Purpose/Aims: The purpose of the study was to evaluate the feasibility, acceptability and preliminary efficacy of a theory-based healthy eating and activity intervention (Sabor con Salud Latino para los Niños [SSLN]). Relationships between self-efficacy, peer and parent social support and acculturation as key factors associated with eating and activity behaviors in Hispanic youth were explored. Background: Obesity in Hispanic youth has reached alarmingly high levels, increasing the risk of type 2 diabetes, hyperlipidemia, hypertension, and cardiovascular disease. In Mexican American children ages 6-11 years, 41.7% are overweight and obese, 24.7% are obese and 19.6% have a Body Mass Index (BMI) greater than the 97th percentile (Ogden et al., 2010). While personal, behavioral, and environmental factors contribute to these high rates, emerging literature suggests acculturation, self-efficacy and social support are key influences. Methods: The one-group, pre- and post-test, quasi-experimental design used a community-based participatory research (CBPR) method to test the feasibility, acceptability, and preliminary efficacy of the 8-week intervention. Social Cognitive Theory (SCT) was used to guide the intervention. Measurements included an analysis of recruitment, retention, participant satisfaction, observation of intervention sessions, paired t-tests, effect sizes, and bivariate correlations between study variables (acculturation, nutrition and physical activity [PA] knowledge, attitude and behaviors, perceived confidence and social support) and outcome variables (BMI z-score, waist circumference and BP percentile). Results: Findings showed the SSLN program was feasible and acceptable. Seventeen participants (10 females and 7 males) aged 11-14 years enrolled in the study. SSLN completers (n=16) attended 88.1% of the sessions. Retention strategies such as texting reminders for class, raffle prizes and phone calls to parents increased attendance and strengthened communication between parents, adolescents and the SSLN Instructors. Participants reported that the curriculum was fun (M = 4.63, SD = .72) and they learned about nutrition (M = 3.81, SD = 1.42) and PA (M = 4.25, SD = 1.13). The preliminary effects on adolescent nutrition and PA behaviors showed mixed results with small-to-medium effect sizes for nutrition knowledge and attitude, PA and sedentary behavior. Correlation analysis among acculturation and study variables was not significant. Positive associations were found between perceived confidence in eating and nutrition attitude (r = .61, p < .05) and nutrition behavior (r = .62, p < .05), perceived confidence in exercise and nutrition behavior (r = .66, p < .05), social support from family for exercise and PA behavior (r = .67, p < .01) and social support from friends for exercise and PA behavior (r = .56, p < .05). Implications: These findings suggest a culturally specific healthy eating and activity program for adolescents was feasible and acceptable and warrants further investigation, since it may fill a gap in existing obesity programs designed for Hispanic youth. The positive correlations suggest further development and testing of the theoretical model.

A CASE STUDY OF MIDWIFERY in MANITOBA

Mon, 20 Feb 2012 12:11:38 GMT

Title: A CASE STUDY OF MIDWIFERY in MANITOBA Abstract: Background. In 2000, midwifery was regulated in the Canadian province of Manitoba. Since the inception of the midwifery program, little research has been done to analyze the utilization of regulated midwifery services. Currently, many women are denied access to midwifery care due to the shortage of midwives in Manitoba. Key components of the original implementation plan for midwifery have not met projected targets, including a lower than projected number of midwives and midwifery births. Furthermore, a lack of successful educational programs and lack of funded positions have contributed to the shortage of midwives. Purpose. The purpose of this study is (1) To describe the utilization of midwifery health care services in Manitoba from 2000/2001 to 2009/2010 and; (2) To explore factors influencing the utilization of regulated midwifery services in Manitoba. Conceptual Model. The Behavioral Model of Health Services will be used to conceptualize factors that impact the utilization of midwifery services in Manitoba. The goal of this framework is to demonstrate how predisposing, enabling, and need factors are interrelated in regards to health care utilization. A feminist framework will be applied in this study to draw on the insights and struggles of the midwifery profession in Manitoba. The relevance of a feminist framework in midwifery is to examine the issues and practices of a situation in relation to how they influence women’s lives and experiences. Methods. This study will use a case study design. The unit for analysis or the single case to be studied is regulated midwifery services in Manitoba. Both qualitative and quantitative methods of data collection will be used. The case study evidence will be derived from three sources; documents, administrative data and interviews. The quantitative analysis will be done using population-based administrative data from the Manitoba Centre for Health Policy, to study the utilization of midwifery care in Manitoba between 2001/02 to 2009/10 (e.g., trends in number of midwives, proportion of births attended by midwives, geographic distribution of midwifery services). Document analysis (e.g., reports, minutes, archived documents) and the long interview method with key informants will be used to gather the qualitative data in this case study. Interviews will be audiotaped and transcribed; content analysis will be used to identify themes arising from the data. Implications. In spite of scientific evidence that supports the midwifery model of care, there remains an inherent struggle to justify and sustain the profession globally. Although Canada has implemented a direct entry midwifery model, other areas of the world including the U.S. also have a nurse midwifery model. The findings will have implications for maternal/child health professionals to work at improving collaborative efforts to facilitate access to midwifery services for women who would like the choice of midwifery care.

NOVEL METHODS EXAMINING STRESS, REST AND GROWTH IN NICU VULNERABLE INFANT POPULATIONS

Mon, 20 Feb 2012 12:11:34 GMT

Title: NOVEL METHODS EXAMINING STRESS, REST AND GROWTH IN NICU VULNERABLE INFANT POPULATIONS Abstract: Purpose: To describe novel methods used to investigate stress reactivity, growth and rest in preterm infants randomized to a music intervention while quantifying noise levels in the neonatal intensive care unit (NICU). Background: Innovative techniques are available to study the sensitive balance of the hypothalamic-pituitary-adrenal axis and neuroendocrine system function among infants in NICU who are at risk for increased stress, poor rest and decreased growth. Music has the unique ability to reduce stress, enhance rest and promote growth. Due to characteristic challenges of these babies, minimal research has been conducted in these areas as it is impractical to obtain large quantities of blood commonly needed to test biomarkers for stress and growth. Further, equipment for evaluating rest and noise is often cumbersome around the tubes, wires and monitors attached to tiny babies. Methods: We conducted a randomized controlled blinded multi-center pilot study to examine a structured music intervention over a seven day period. Using Urn Randomization, eligible preterm infants (N=19) were randomized to: 1) a music or 2) sham intervention based on high versus low degree of perinatal stress identified on standardized instruments, namely, the Perceived Stress Scale (PSS) reported by mothers and the Clinical Risk Index for Babies (CRIB). The Neurobiologic Risk Score (NBRS) was used to score infant biophysiologic stress over the NICU stay. Growth variables of weight gain in grams and serum insulin and IGF-1 were obtained before and after the one week study period. Hours of rest were quantified by actigraphy and validated with the Newborn Behavioral Observation (NBO) tool. NICU environmental noise decibels and frequencies were analyzed with portable noise dosimeters. Stress reactivity was examined at timed intervals before and after a stressor blood stick with salivary cortisol strips collected pre and post the one week intervention. Analyses: Descriptive statistics and two-sample independent t-tests were used to examine the data and determine group differences in stress, weight gain, rest, Insulin, and IGF-1. Results: The data suggests that stress scores (PSS, CRIB, and NBRS) were similar between the two groups. Compared to the controls, the music group was found to have lower salivary cortisol levels during the stress reactivity tests, a higher number of sleep bouts, lower activity counts, increased Insulin and IGF-1, and lower lengths of stay. Implications: Lingual cortisol strips offered a non-invasive method of obtaining cortisol levels to examine stress reactivity. Actigraphy provided a means of quantifying rest that was validated by the NBO tool and nurses notes. Noise dosimeters were shown to be useful for assessing NICU noise. In sum, clinical scientists need innovative ways to examine variables that impact health outcomes of at-risk infants cared for in the NICU. Funding: 1) NIH/NINR-T32 NR007077 Health Disparities and Vulnerable Populations Research Training Program. 2) Oppenheimer Complimentary Alternative, Integrative Medicine Grant. 3) American Association of Critical Care Nurses Clinical Care Grant.

RISKING UNINTENDED PREGNANCY, HIV AND STIs AMONG METHAMPHETAMINE-USING WOMEN

Mon, 20 Feb 2012 12:11:31 GMT

Title: RISKING UNINTENDED PREGNANCY, HIV AND STIs AMONG METHAMPHETAMINE-USING WOMEN Abstract: Purpose: To describe the contextual factors and perceptions of methamphetamine-related behaviors that influence sexual risk for unintended pregnancy, HIV and sexually transmitted infections (STI) among methamphetamine-using women. Background: Among methamphetamine users, the gender ratio is equal between women and men, but women start using at a slightly younger age and have more complex psychosocial problems due to childhood traumas. As a potent long-acting stimulant, methamphetamine's neurobiological effects last for eight to twelve hours, during which users describe euphoria, increased energy, decreased appetite, and enhanced sexual desire. Research has identified an independent association of the drug and sexual activity and likelihood for sexual encounters to occur while under the influence of methamphetamine. Descriptive studies report high frequency of risky sexual behaviors that are practiced by heterosexual users, including: unprotected vaginal intercourse, receptive anal intercourse, and sexual encounters with multiple intimate or anonymous partners. Methamphetamine use poses gender-specific risks for women who become regular users of the drug, especially related to sexual risk for pregnancy, HIV, and sexually transmitted infections. Method: Passive recruitment was conducted by flyer placement in southern California drug treatment facilities, WIC sites, and a maternal-fetal medicine practice seeking participation by pregnant or postpartum women who used methamphetamine during a portion of their pregnancy. Eligible candidates were 18 years of age or older, English speaking, and claimed methamphetamine was their primary drug of choice. A sample of 17 participants self-identified as White, Hispanic, mixed race Hispanic and Asian, ranged in age from 18 to 37 years of age; four were married, and all were unemployed. Under the protection of a Certificate of Confidentiality, one or two audio taped, semi-structured interviews were conducted regarding their lives before pregnancy, methamphetamine use, and their experience of pregnancy. Using Constructivist Grounded Theory and the symbolic interactionism for understanding meaning-making, simultaneous data collection and analysis was conducted. Findings: The women reported initiation to methamphetamine averaging at 15.8 years of age and half of the sample had a first pregnancy by the age of 16. They had minimal knowledge of and exposure to reproductive education or services; thus, they chose not to use contraception and voiced no concern for sexual risk with multiple partners. From their description of sexual behaviors surrounding methamphetamine use, a core category, Risking unintended pregnancy, HIV, and STI emerged with four categories of factors that contribute to understanding the participants’ sexual risk-taking: seeking sexual satisfaction, gambling with sexuality, fulfilling intrapersonal needs, and using sex as a commodity. Implications: The process contributes to understanding the complex relationship between methamphetamine and sexuality among female users. The findings point to the need for early timing of supportive interventions, including psychological counseling with adolescents regarding adverse childhood traumas, introduction to reproductive services, contraceptive education, and ongoing availability of appropriate resources into adulthood. Further research with a broader population of methamphetamine users remains critical.