Health promotion and participatory action research with South Asian women.

PURPOSE: To examine South Asian immigrant women's health promotion issues and to facilitate the creation of emancipatory knowledge and self-understanding regarding health-promoting practices; to promote health education and mobilization for culturally relevant action. METHOD: The study was based on critical social theory; the research model was participatory action research (PAR). Two groups of South Asian women (women from India and of Indian origin) who had immigrated to Canada participated in the project. The qualitative data were generated through focus groups. Reflexive and dialectical critique were used as methods of analyzing qualitative data. The data were interpreted through reiterative process, and dominant themes were identified. FINDINGS: Three themes that were extracted from the data were: (a) the importance of maintaining culture and tradition, (b) placing family needs before self, and (c) surviving by being strong. An issue for action was the risk of intergenerational conflicts leading to alienation of family members. Over a period of 3 years, the following action plans were carried out: (a) workshops for parents and children, (b) sharing of project findings with the community, and (c) a presentation at an annual public health conference. CONCLUSIONS AND IMPLICATIONS: The project activities empowered participants to create and share knowledge, which was then applied toward action for change. Health and health promotion were viewed as functions of the women's relationships to the world around them.

Uprooting and resettlement experiences of South Asian immigrant women.

The purpose of this descriptive qualitative study was to examine and understand the challenges faced by elderly women from India who immigrated to Canada. Ten women were interviewed about their experiences with immigration and resettlement. The analysis of interview data involved iterative process, through which four themes were identified. These themes were isolation and loneliness, family conflict, economic dependence, and setting in and coping. The participants experienced loss because of changes in traditional values and lack of social support. Because the participants could not manage resettlement on their own, personal independence was not very important. Interdependence for the attainment of emotional security and social rewards was more desirable. Health care professionals must take into account the nature of stress and impact of these experiences on health of older immigrant women.

Immigrant nurses' experience of racism.

PURPOSE: To document and describe the experiences of immigrant nurses of colour who have filed grievances concerning their employers' discriminatory practices; and to solicit their views of existing policies and recommendations for equity in professional life. DESIGN AND METHODS: In this descriptive, exploratory study nine immigrant nurses of colour in Ontario, Canada, were interviewed between 1997 and 1998. Data were collected through face-to-face interviews and in focus groups. The discourse theory and methods of van Dijk and Essed were used to analyse the qualitative data. FINDINGS: Recurring themes were: (a) being marginalized and acknowledging and naming the racist experiences; (b) experiencing physical stress and emotional pain; (c) strategizing to cope and survive; (d) recommending policy changes. CONCLUSIONS: All nurses interviewed had experienced reprisals as a result of complaining or filing grievances and unfairness was encountered in the redress process itself. Participants recommended policy initiatives to ensure equity and fair practices in the nursing profession.

Proton pump inhibitor-associated gastric polyps: a retrospective analysis of their frequency, and endoscopic, histologic, and ultrastructural characteristics.

Since 1992 there have been reports of proton pump inhibitors being associated with fundic gland-type gastric polyps. Endoscopic and histologic characteristics and natural history of these polyps have not been clearly defined. We performed a retrospective study of patients on long-term treatment with proton pump inhibitors who developed gastric polyps. Gastric polyps developed in 17 (10 males and 7 females, 7.3%) of the 231 patients who underwent 2 or more upper endoscopies for complicated gastroesophageal reflux disease and who were receiving long-term treatment with proton pump inhibitors. The mean interval of proton pump inhibitor use after which an endoscopy revealed gastric polyps was 32.5 months. In 1 patient, discontinuation of treatment resulted in disappearance of the polyps within 3 months. The polyps recurred 4 months after the treatment was restarted. Endoscopy established that typical polyps were generally small (<1 cm), sessile, multiple, and whitish pink with a mottled partially translucent surface. The polyps were most often present in the proximal/midgastric body. Of the 15 polyps removed endoscopically, 9 were of the fundic gland type, 4 were of the hyperplastic type, and 2 were of the inflammatory type. Eight of 9 polyps with typical endoscopic appearance were of the fundic gland type. None of the polyps contained dysplasia or carcinoma. Long-term use of proton pump inhibitors may be associated with the presence of small gastric fundic gland polyps and hyperplastic polyps. A prospective study is required to establish their incidence, natural history, and clinical significance.

Breast cancer detection practices of south Asian women: knowledge, attitudes, and beliefs.

PURPOSE/OBJECTIVES: To explore knowledge, attitudes, beliefs, and practices regarding breast cancer detection practices among South Asian women. DESIGN: Descriptive exploratory design. SETTING: Toronto, Ontario, Canada. SAMPLE: 57 South Asian women, age 40 and over, who are first generation immigrants from India and Pakistan and speak one of the four languages identified for the study--Hindi, Punjabi, Gujarati, or Urdu. METHODS: An interview guide was designed specifically for this study. It contained questions regarding knowledge, attitudes, beliefs, and practices about breast self-examination (BSE), clinical breast examination (CBE), and mammogram. In addition, questions assessing the variables of the Health Belief Model and health motivations also were included. The data were obtained during face-to-face interviews in the primary language of the participating woman. The interviews were transcribed and translated into English. FINDINGS: 12% of the participants practiced BSE monthly, 49% had undergone at least one CBE during their lives, and 47% had never had a mammogram. The majority (54%) said they did not know very much about breast cancer. While 21% of the women said detecting cancer early was important, only 5% reported that cancer could be cured. Age, education, or mother tongue showed no statistically significant relationship with the breast health practice scores. However, proficiency with the English language (p = 0.009) and number of years in Canada (p = 0.009) had a significant relationship with the breast health practice scores. The significant explanatory factor for the variable breast health practices was a cue to action (p = 0.009). CONCLUSIONS: South Asian women with minimal knowledge of breast cancer did not engage in breast cancer detection practices. IMPLICATIONS FOR NURSING PRACTICE: This segment of the population of immigrant women needs to be better informed about breast cancer and the benefits of breast cancer detection practices.

Health promotion among immigrant women from India living in Canada.

PURPOSE: To describe the health promoting practices of immigrant women from India and how cultural knowledge, norms, and values influence their behavior. DESIGN: Descriptive using a small convenience sample. METHOD: Using ethnographic methodology, 20 women between the ages of 40 and 70 years living in Canada, 1995-1996, were interviewed individually using open-ended questions. Community get-togethers were also observed. FINDINGS: The sample of women consistently reported that to remain healthy, a good diet, activity, and weight control were important. In addition, prayers, spiritual activities, and good relationships with families helped. CONCLUSIONS: Health professionals should be aware of the special needs of immigrant women to help them promote healthy lifestyles in their cultural context.

Traditional practices of women from India: pregnancy, childbirth, and newborn care.

This article describes maternal and child care practices among women from India. As in all cultures, certain beliefs exist surrounding what facilitates a good pregnancy and its outcome, as well as negative sanctions. These practices continue to influence many immigrant women to whom western practices are either unknown or unacceptable. An understanding of the traditional belief system of such women can case their adaptation into the Canadian and U.S. health care systems.

PIP: An understanding of the traditional practices associated with pregnancy and delivery in immigrant women's countries of origin is essential for US and Canadian health care professionals who attend these women. This article, intended for North American nurses and other health workers, reviews pregnancy, childbirth, and newborn care practices in India. Although most Indian women believe they have little or no control over pregnancy and its outcomes, certain beliefs, customs, and taboos surround pregnancy and the perinatal period. Among the practices discussed in this article are consumption of "hot" versus "cold" foods during pregnancy, reduced food consumption during pregnancy, son preference, uses of herbal medicines, home delivery by a traditional birth attendant, exclusion of men from most aspects of childbirth, the role of extended family, confinement after delivery, delayed onset of breast feeding, and rituals aimed at warding off the "evil eye." An appreciation of these customs helps ensure the provision of appropriate care that facilitates integration of traditional and Western practices.

Is in vivo measurement of size of polyps during colonoscopy accurate?

BACKGROUND: Accurate measurement of polyp size during colonoscopy is important because of the direct correlation of size with colon cancer. Major studies of colorectal neoplasms have measured polyp size differently. It is also well documented that endoscopists underestimate polyp size frequently. The goal of this prospective study was to determine which one of the five methods of estimating polyp size during colonoscopy is most accurate. METHODS: One hundred colon polyps were measured by means of visual estimation, open biopsy forceps methods, linear probe, a ruler immediately after excision, and after fixation in formalin. The size of the polyps measured outside the body immediately after excision was considered the "gold standard" against which all measurements were compared. RESULTS: Forty-seven polyps were 5 mm or less in diameter, 33 polyps were 5.01 mm to 10 mm, and 20 polyps were more than 10 mm in size. For all polyps the mean difference versus the actual size of the polyps was 3.4% for linear probe, 6.4% for visual estimation, and 12.3% for the forceps. CONCLUSION: Measurement of polyp size by linear probe agreed best with the actual polyp size, followed closely by visual estimation. The open biopsy forceps method was the least accurate.

Percutaneous endoscopic gastrostomy: a randomized prospective comparison of early and delayed feeding.

BACKGROUND: It has been customary to initiate feeding through percutaneous endoscopic gastrostomy (PEG) tubes 24 hours or more after placement of these tubes. Recent changes in practice environment and emphasis on early discharge of hospitalized patients prompted us to evaluate early PEG feeding in a randomized prospective manner. METHODS: Forty-one patients were included in the study. After an informed consent, the patients were randomly assigned to two groups. Groups I (21 patients) received tube feedings 3 hours and Group II (20 patients) received feedings 24 hours after PEG placement. All patients received an Iso-osmolar formula by continuous infusion at 30 ml/hour for the first 24 hours of feeding. The rates were then increased to 70 ml/hour. Residual volumes, tube length, peristomal leakage, and vital signs were checked, and a global assessment was done every 4 hours. Evaluation by a physician was done every 24 hours for 72 hours. If the residual volume was more than 60 ml (significant residual volume), the tube feedings were held for 2 hours. Patients exited the study at 72 hours from the time of procedure. All deaths were recorded to calculate 30-day mortality. RESULTS: One patient (Group 2) died during the study period. Three patients (two in Group 1 and one in Group 2) had a significant residual volume. One patient (Group 1) had local skin infection requiring treatment. None of the patients had any signs of peritonitis or systemic infection. CONCLUSION: Early PEG tube feeding (3 hours after tube placement) is as safe as next day feeding in elderly patients.

Double-lumen esophagus: formation of a new lumen or septation of the existing one?

Presented here are two cases in which two esophageal lumens were identified at endoscopy. One patient had a history of antireflux surgery and both patients had received esophageal dilations. Both patients have done poorly with standard esophageal dilation and are not considered likely to gain from surgery. The mechanism of formation of the second lumen is not certain in Case 1, but in Case 2 a self-contained perforation appears to be the likely mechanism. There is no clear definition of "double-lumen esophagus" in the literature. The term is used at times interchangeably with esophagogastric fistula. We propose that the phrase "double-lumen esophagus" is a morphologic description and should be used only when the two lumens are of nearly equal diameter. The term "fistula" should be used whenever that is the likely mechanism. Hence, Case 1 of our report is the true double-lumen esophagus, while Case 2 is an esophagogastric fistula. Since patients do poorly with standard dilation, newer endoscopic modalities may have a role in the management of these rare but difficult cases.

Sphincter of Oddi dysfunction in patients with intact gallbladder: therapeutic response to endoscopic sphincterotomy.

Increasing evidence exists of the occurrence of sphincter of Oddi dysfunction in patients with an intact gallbladder. Optimal therapy for such patients has not been defined. From 1989 to 1991, 35 patients with sphincter of Oddi dysfunction (abnormal basal sphincter pressure > 40 mm Hg) and an intact gallbladder were identified. The patients with abnormal ductography (except for duct dilation), pancreas divisum, or pancreato-biliary malignancy were excluded. All patients had disabling upper abdominal pain, which was quantified on a 0 = none to 10 = severe pain scale. All patients received standard endoscopic biliary sphincterotomy and were followed up for 4 to 26 months with a mean of 13 months. Initially, 27 of 35 patients (77%) showed at least 50% improvement in the pain score, whereas only 15 of the 27 remained improved throughout the follow-up interval. Patients who were unimproved or had relapses were offered cholecystectomy and 11 patients underwent the procedure. These patients were followed up after cholecystectomy for 2 to 24 months, with a mean of 13 months. Eight of 11 were improved. In summary, the combination of endoscopic sphincterotomy and selective cholecystectomy and minimal medical treatment resulted in a good and excellent response rate of 68%. Better techniques are needed to select patients who will respond to these therapies.

Aortic valve replacement with concomitant open mitral valvotomy--early results and long term followup in 72 consecutive patients.

Experience with 72 consecutive subjects, who underwent aortic valve replacement with open mitral valvotomy is presented. Mean age was 30 years and history of rheumatic fever was forthcoming in 80%. 91.7% patients had aortic regurgitation--with or without aortic stenosis. 45% patients had pulmonary hypertension. Starr Edwards (51.4% and Bjork Shiley valves (45.8%) were commonly used. There were no early deaths. All patients were followed up for 1 to 19 years (mean = 9 years). There were 4 (5.5%) late deaths. 4.1% patients developed mild restenosis of the mitral valve over a mean period of 8 years and 1.04% developed mitral regurgitation mandating mitral valve replacement. A notable feature of this series is the low incidence of thromboembolism-free lives at upto 10 years followup despite receiving only aspirin in place of coumarin anticoagulation. We believe aortic valve replacement and open mitral valvotomy is a worthy alternative to double valve replacement in view of its zero hospital mortality, low late mortality, low incidence of restenosis, low thromboembolic episodes and the avoidance of coumarin anticoagulation.

New nurse faculty: core competencies for role development.

This study originated from the need to define the role competencies for a beginning nurse educator. A survey of full-time faculty and heads of university and community college nursing programs in Ontario showed a high degree of agreement between the two sets of faculty for teacher role, practice, service, personal and professional growth competencies. Significant differences were noted on competencies involving student evaluation, facilitating student's practice, acting as student's advocate, and research. Agreement was noted on the problems created by role ambiguity and role incompetence, particularly for new faculty. This suggests the need for educational preparation and socialization of nurse faculty.