Late life insulin resistance and Alzheimer's disease and dementia: The Kuakini Honolulu heart program.

INTRODUCTION: Recent findings outline negative effects of brain insulin signaling on memory due to hyperinsulinemia. We investigated the association between insulin resistance (IR) with AD and dementia. METHODS: Later life Japanese men (N = 1544, mean age = 79.9 years) with normal cognitive function were followed from exam 4 to 5 of the Kuakini Honolulu Asia Aging Study. Subjects underwent physical exams, blood draws, and neuropsychological testing. IR status was determined at exam 4 using the McAuley and HOMA indices. Subjects with prevalent diabetes and dementia were excluded. Incident dementia and AD cases were determined at exam 5. RESULTS: IR was associated with decreased odds of AD and dementia using both IR indices. Carriers of the APOE ε4 allele had 15% increased odds of AD and dementia. DISCUSSION: Our findings provide insight regarding possible inverse relationship between IR and AD in elderly Japanese men, and support biologic studies showing short term hyperinsulinemia improves memory and cognitive function.

Dynamic Cerebral Autoregulation Assessment Using Extracranial Internal Carotid Artery Doppler Ultrasonography.

Transcranial Doppler ultrasonography of the middle cerebral artery (MCA) is frequently used to assess dynamic cerebral autoregulation (dCA); however, this is difficult in patients with poor temporal bone windows. In the study described here, we investigated the agreement and sensitivity of dCA indices determined from the extracranial internal carotid artery (ICA) and those determined from the MCA. Measurements for 32 stroke patients and 59 controls were analyzed. Measurement of the mean flow correlation index (Mx) and transfer function analysis based on spontaneous blood pressure fluctuation were simultaneously performed for the extracranial ICA and MCA. The mean values of Mx and phase shift did not significantly differ between the ICA and MCA (mean difference: Mx = 0.01; phase shift of very low frequency [VLF] = 0.7°, low frequency [LF] = 3.3° and high frequency = 4.5°), but the gains in VLF and LF in the ICA were significantly lower than those in the MCA (mean difference: gain of VLF = -0.13, gain of LF = -0.10). The intra-class correlation coefficient between the dCA indices of the ICA and MCA was favorable in Mx (0.76) and the phase shift of VLF (0.72). The area under the receiver operating characteristic curve for stroke diagnosis did not differ among the dCA indices. We conclude that dCA assessed from the ICA is as effective as that from the MCA, but the results are not interchangeable.

Recruitment of Asians and Pacific Islanders with Type 2 Diabetes into a Clinical Research Trial of Enhancing Diabetes Self-Management.

The objective of the study was to evaluate strategies and barriers to recruiting Asians and Pacific Islanders (API) with type 2 diabetes, into clinical trials. Descriptive statistics and content analysis were utilized to analyze reasons for non-participation. A "talk story" interview method was employed to recruit participants and uncover reasons for non-participation. A total of 1891 potential participants were identified and 340 declined participation. Eighty who declined were randomly selected to provide their reasons for non-participation. Socioeconomic issues faced by this population, such as earning wages to meet basic needs and care giving took precedence over altruistic participation in research.

Diabetes knowledge and self-management effects on physiological outcomes in type 2 diabetes.

PURPOSE: The purpose of this study was to determine whether Asian Pacific Islanders with type 2 diabetes who have better knowledge and self-management would have better baseline hemoglobin A1c (HbA1c) and total cholesterol values. Signicant relationships were found among (a) general diet on HbA1c (p < .030), (b) medications on HbA1c (< .009), and (c) diabetes knowledge on HbA1c (p < .001). Participants with active self-management regimens were expected to demonstrate better laboratory values than those who did not implement self-management. However, persons with knowledge may for other reasons still lack self-management. PRACTICAL IMPLICATIONS: Future studies comparing baseline results to post-additional education sessions may yield better comparisons.

Perceptions related to diet and exercise among Asians and Pacific Islanders with diabetes.

The purpose of this study was to explore the perceptions of Asians and Pacific Islanders (API) with Type 2 diabetes related to diet and exercise. A descriptive content analysis was conducted on verbalized responses from 15 participants in focus groups who were asked "What role does your culture play in what, when, and how much you eat?" and "If and/or how much you exercise and what type of exercise you do?" The participants recorded responses were transcribed verbatim and analyzed for themes utilizing the social ecological framework.The families, environment, and the local culture in Hawai'i greatly affect the dietary and physical activities of the participants. Psychosocial themes related to diet included depression, denial, and lack of self control. Physical activities were impacted by motivation and awareness of complications of diabetes. Family upbringing, social events, food portions and variety, and reciprocity contributed to eating behaviors of the participants. Family values in sports and role expectations of gender influenced physical activities.This study identified social ecological influences on health behavior among Asians and Pacific Islanders. The findings suggest various efforts for physicians and other health care providers to assist API in taking care of their diabetes.

Generational differences in registered nurse turnover.

The chronic nature of the nursing workforce shortage in the United States is a continuing concern. As the nationwide gap between supply and demand grows, it remains unknown what impact turnover will have on nursing, access to care, and efforts to improve quality and safety of health care. It also remains unclear whether the recent turnover trends among new graduate registered nurses differ from past generational cohorts of new nurses. The aims of this study were to identify the reasons why registered nurses turnover by generational cohort (Veterans, Baby Boomers, and GenXMs) and to compare the length of time nurses were employed in their first five nursing positions by generational cohort. The findings suggest the three generational cohorts displayed similar reasons for leaving nursing positions with relocation, career advancement, and personal/family reasons reported most frequently. Except for the first nursing position, significant generational effects were found in the length of time Veterans, Baby Boomer, and GenXMs stayed employed in their nursing positions. It remains unknown why the GenXMs displayed a significantly shorter length of employment time in their second, third, fourth, and fifth nursing positions. The decline in length of employment time displayed in both the Baby Boomers and GenXMs may be an issue of concern requiring future research.

Factors influencing osteoporosis preventive behaviours: testing a path model.

AIM: This paper is a report of a study to test a model of certain factors influencing people engaging in osteoporosis preventive behaviours, and to estimate the direct and indirect effects of personal and social factors on whether people engage in those behaviours. BACKGROUND: Osteoporosis preventive behaviours, including exercise and calcium intake, help decreasing the risk of developing osteoporosis. Reasons for engaging in osteoporosis preventive behaviours are complex and influenced by personal and social factors. Years of education, self-efficacy, knowledge of osteoporosis, social support and social capital have been indicated to increase people engaging in osteoporosis preventive behaviours; but age has been shown to decrease those behaviours. METHODS: The proposed model was developed using Social Cognitive Theory and a conceptual framework for addressing the social context of health behaviour. A correlational cross-sectional study was carried out in 2005, using questionnaires and a convenience sample of 243 participants. Data analysis included descriptive statistics, correlation techniques and path analysis. RESULTS: Self-efficacy was a better predictor of engaging in osteoporosis preventive behaviours than were the other variables. Social capital had a statistically significant direct and indirect effect on osteoporosis preventive behaviours. The modified path model showed good fit with the data. CONCLUSION: The associations between personal and social factors extend our knowledge from previous studies and increase our understanding of the complex relationships among the study variables. The model provides guidance for future nursing practice, research, and education programs related to osteoporosis prevention.

Culturally tailored diabetes education program for Chinese Americans: a pilot study.

BACKGROUND: The prevalence of type 2 diabetes among Chinese Americans is rising, and cultural and socioeconomic factors prevent this population from achieving optimal diabetes management. OBJECTIVES: To assess the feasibility and acceptability of a culturally appropriate diabetes management program tailored to Chinese Americans with type 2 diabetes and the preliminary outcomes of the intervention. METHOD: Forty eligible subjects were recruited from the community to participate in this 10-session program developed by integrating Chinese cultural values into an established Western diabetes management program. Feasibility and acceptability of the program were evaluated by the percentage of participants meeting the course objectives and satisfaction with the program. Outcomes measures included the Diabetes Quality-of-Life (DQOL) survey, body weight, blood pressure, and HbA1c levels measured before, after, and 3 months after the intervention. RESULTS: Thirty-three participants completed all 10 sessions and the outcome measurements. Attrition rate was 17.5%. The majority of the participants understood the course content (75%) and identified and demonstrated various diabetes management skills (70% and 82.5%, respectively). All participants who completed the program were "very satisfied" with the program. With regard to the outcome variables, 43.6% of the participants lost more than 5 pounds and most had a reduction in blood pressure at 3 months after completion of the program. Mean HbA1c decreased from 7.11 to 6.12 postintervention. Significant improvements on the DQOL also were reported. DISCUSSION: Culturally tailored diabetes management may be effective in Chinese Americans with type 2 diabetes. Further study, with a larger sample size and a control group, is recommended.

Ideal body image and health status in low-income Pacific Islanders.

UNLABELLED: Purpose of this descriptive study was to examine the relationship between ideal body image and family support in Pacific Islander. The subjects were 120 residences (65 with diabetes and 55 without diabetes) of a housing project in Hawaii. Data were collected by interview using the following questionnaires: The Family Behavior Checklist, the Modified Body Image Questionnaire, the Diabetes Knowledge Scale, and demography. Variables of primary interest included the subjects' ideal body image, serum level of glycosylated hemoglobin, hypertension, family support behaviors, ethnicity, and knowledge of diabetes. Findings indicated that the majority of subjects perceived receiving family support in the diet regimen, but not in the areas of glucose self-monitoring, exercise, or medication. The subjects' knowledge level regarding diabetes scored low. Subjects perceived that families lacked knowledge of diabetes. Metabolic control significantly correlated with present age, sources of health insurance, presence of diabetes, and the feeling of ideal body image according to non-Western culture. Subjects had different standards of ideal body image depending on whether they identified with a Western culture or with a non-Western culture. CONCLUSIONS: Presence of hypertension and diabetes were associated multiple environmental factors (e.g. family support, knowledge of diabetes and number of children per household) as well as cultural value (e.g. ideal body image). Findings provide diabetes educators with information regarding the ideal body image among low-income Pacific Islanders. It implies the importance of assessing the individual's perceptions of ideal body image according to his or her cultural values prior to developing regimens for diabetes or hypertension.