Health Realization Community Coping Intervention for Somali Refugee Women.

Health Realization (HR) is a strengths-based stress and coping intervention used to promote the use of internal and external coping resources. Our three-arm comparison group trial examined the effects of a culturally adapted Somali HR intervention on coping and mental health outcomes in 65 Somali refugee women post-resettlement. Subjects participated one of three conditions: HR intervention, nutrition attention-control, and evaluation-control. The HR intervention significantly affected multiple dimensions of coping: WAYS-distancing (p = 0.038), seeking social support (p = 0.042), positive reappraisal (p = 0.001); and Refugee Appraisal and Coping Experience Scale-Internal subscale (p = 0.045). The HR intervention also demonstrated improvement in depression symptom ratings (p = 0.079). We discuss findings from the pilot, challenges encountered conducting a three-arm comparison group trial, and implications for further research involving the HR intervention with culturally diverse refugee communities.

Well-Being and Self-Assessment of Change: Secondary Analysis of an RCT That Demonstrated Benefit of Inhaled Lavender and Sleep Hygiene in College Students with Sleep Problems.

CONTEXT: Sleep issues are prevalent and affect health and well-being. The aspects of well-being that are impacted by sleep interventions have not been well studied. OBJECTIVES: To investigate the impact of lavender and sleep hygiene (LSH) compared to sleep hygiene (SH) alone on well-being as measured by the Self-assessment of Change questionnaire (SAC) at post-intervention and two-week follow-up, and secondarily to compare the SAC sleep item to results from standardized sleep surveys. DESIGN: Secondary analysis of a randomized controlled trial (RCT) where one group received a lavender inhalation patch and practiced sleep hygiene (LSH) and the other group received a placebo inhalation patch and practiced sleep hygiene (SH) for five consecutive nights. SETTING: Usual sleep setting. PARTICIPANTS: Seventy-nine college students with self-reported sleep issues. MAIN OUTCOME MEASURES: The SAC was completed at post-intervention and follow-up. RESULTS: Exploratory analysis showed significantly improved well-being for the LSH group at post-intervention for well-being domains of sleep, energy, and vibrancy (P = .01, .03, and .05, respectively) and an overall trend of improved well-being in comparison to the SH group at post-intervention and follow-up. The SAC sleep item showed a similar pattern of change to the standardized sleep surveys with a statistically significant improvement in sleep for the LSH group at follow-up (P = .02). CONCLUSIONS: Findings demonstrate the positive impact of the lavender intervention on three domains of self-assessed well-being are energy, vibrancy, and sleep. SAC results extend and complement prior findings of improved sleep quality.

Wound Care: Multicenter Feasibility Study.

OBJECTIVES: The aims of this study were to determine a sound recruitment strategy for multisite wound studies to address the rising prevalence and incidence of chronic wounds and to identify appropriate adult patient populations with wounds of interest and establish partnerships with their clinicians and clinical services as a model for a multisite wound care feasibility study. DESIGN: A pilot multisite recruitment feasibility study. SETTING: Three wound clinics located in a large, Midwestern metropolitan area. PARTICIPANTS AND INTERVENTION: A convenience sample of 3 staff and 3 patients with lower-extremity wounds from each clinic was interviewed. Medical records of all patients with lower-extremity wounds seen during 1 week at each clinic were reviewed. Outcome measures included characteristics of patients being treated at the 3 wound care clinics (patient demographics and wound characteristics) and wound treatments used. Barriers and opportunities that could be addressed in recruitment and other research strategies were identified. MAIN RESULTS: Barriers and facilitators for future research were identified and varied within and between clinics. Patients reported they were willing to participate in future research, although fewer were willing if the study was blinded. Patients received a variety of treatments within and across clinics. Medical record reviews provided further information about wound clinic patients, wound characteristics, and barriers and facilitators for future study. CONCLUSIONS: Characteristics of wound clinic patients and their wounds were found to vary by site, suggesting tailored recruitment methods by site within multisite wound care studies may be most productive. This study suggests successful recruitment strategies for future wound care intervention research.

Effect of Inhaled Lavender and Sleep Hygiene on Self-Reported Sleep Issues: A Randomized Controlled Trial.

OBJECTIVES: To compare the effectiveness of lavender (Lavandula angustifolia) and sleep hygiene versus sleep hygiene alone on sleep quantity and sleep quality and to determine sustained effect at two-week follow-up. DESIGN: A randomized controlled trial with investigator blinding and steps taken to blind the participants. SETTING: Participants' usual sleep setting. SUBJECTS: Seventy-nine college students with self-reported sleep issues. INTERVENTIONS: The intervention took place over five nights with baseline, postintervention, and two-week follow-up assessments. Both groups practiced good sleep hygiene and wore an inhalation patch on their chest at night. One group wore a patch with 55 µl of lavender essential oil and the other group wore a blank patch. OUTCOME MEASURES: Sleep quantity was measured using a Fitbit(®) tracker and a sleep diary, and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) and the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance short form. RESULTS: The lavender and sleep hygiene group demonstrated better sleep quality at postintervention and two-week follow-up (PSQI p=0 .01, <0.001 and PROMIS p=0.04, 0.007, respectively). The sleep-hygiene-only group also demonstrated better sleep quality but to a lesser extent (PSQI p=0.02, 0.06 and PROMIS p=0.03, 0.03, respectively). Additionally, a clinical effect was found for the lavender group at postintervention, along with a significant finding for waking feeling refreshed (p=0.01). Sleep quantity did not differ between groups. CONCLUSIONS: Lavender and sleep hygiene together, and sleep hygiene alone to a lesser degree, improved sleep quality for college students with self-reported sleep issues, with an effect remaining at follow-up.

A systematic review of the effect of inhaled essential oils on sleep.

OBJECTIVE: Sleep disturbances are recognized as an important health and public health problem that affects physical, mental, and emotional health and well-being. Inhalation of essential oils may be a safe alternative to pharmaceutical interventions for mild to moderate sleep disturbances. Quantitative human studies on the effect of inhaled essential oils on sleep that were published between 1990 to 2012 were reviewed. METHODS: Ovid Medline, PsychINFO, CINAHL, Science Direct, and PubMed databases were searched to extract articles that evaluated the effect of inhaled essential oils on sleep in humans. RESULTS: The search yielded 15 quantitative studies, including 11 randomized controlled trials that examined hypnotic effects of inhalation of essential oils. A majority of the study findings suggested a positive effect of essential oils on sleep. Lavender was the most frequently studied essential oil. No adverse events were reported. CONCLUSIONS: Inhalation of essential oils may be considered for people with mild sleep disturbances. Further studies with larger samples and stronger methods and endpoints are needed to build on the findings.

A longitudinal study of demographic factors associated with stressors and symptoms in African refugees.

The objectives of this study were to assess differences in premigration, transit, and resettlement stressor exposure and post traumatic stress disorder (PTSD) symptoms as a function of demographic characteristics (i.e., gender, ethnicity, age, time in United States) and to examine the concurrent and longitudinal relations between stressor exposure and PTSD symptoms. The sample consisted of adult (18-78 years) Somali and Oromo refugee men and women (N = 437). Qualitative data regarding participants' self-nominated worst stressors collected at Time 2 (T2) informed the development of quantitative scales assessing premigration, transit, and resettlement stress created using items collected at Time 1 (T1). PTSD symptoms were measured at both T1 and T2. Quantitative analyses showed that levels of stressor exposure and PTSD symptoms differed as a function of refugee demographic characteristics. For example, Oromo, more recent, women, and older refugees reported more premigration and resettlement stressors. Oromo refugees and refugee men reported more PTSD symptoms in regression analyses with other factors controlled. Premigration, transit, and resettlement stressor exposure generally was associated with higher PTSD symptom levels. Results underscore the importance of assessing stress exposure comprehensively throughout the refugee experience and caution against overgeneralizing between and within refugee groups.

A call for change: perspectives on nurses' role in health care reform.

A new generation of nurse activists must follow in the footsteps of nursing pioneers such as Florence Nightingale and Lillian Wald to facilitate health care systems that promote healthy populations.

Use of complementary and alternative therapies in community-dwelling older adults.

OBJECTIVES: Although complementary and alternative medicine (CAM) use is becoming increasingly prevalent in the United States, knowledge regarding complementary and alternative therapy use in older adults is limited. The purposes of this study were to (1) assess the prevalence and patterns of CAM use in a probability-based sample of older adults; (2) describe the characteristics of older CAM users; and (3) identify factors associated with complementary and alternative medicine use/nonuse. METHODS: A cross-sectional survey design was used. An age-stratified sample of community-dwelling adults ages>or=65 (N=1200) was randomly selected from the Minnesota Driver's License/Identification Tape using names from the Twin Cities seven-county metropolitan area. The mailed questionnaire included items on demographics, health status, health care utilization, CAM modality use, reasons for use, costs, and complementary and alternative therapy use satisfaction. Descriptive statistics, chi-square tests, and regression analysis were performed. RESULTS: Overall, 62.9% (N=445) of the respondents reported use of one or more complementary and alternative medicine modalities with an average of three modalities (SD+/-1.9, range 1-11). The top five CAM modalities used were nutritional supplements (44.3%), spiritual healing/prayer (29.7%), megavitamins (28.3%), herbal supplements (20.7%), and chiropractic (17.8%). Maintaining health and treating a health condition were the primary reasons for CAM use. The most common conditions treated were arthritis (44.4%) and chronic pain (23.5%). Demographic variables were not significantly different between CAM users and nonusers. CAM users reported more unhealthy days than nonusers did. Overall satisfaction with CAM use was high (80%). Symptoms of a health problem and desire for personal control over health motivated CAM use. The main barriers to CAM use were lack of reason to use and knowledge about CAM. Only 53% of users disclosed CAM use to their primary care providers. CONCLUSIONS: CAM use is common in older adults, especially those with health problems. The widespread use of oral supplements combined with not disclosing CAM use to primary care providers is a concern.

A theoretical framework for using health realization to reduce stress and improve coping in refugee communities.

Refugees have faced extraordinarily stressful situations in their past, and many continue to experience stress daily as they cope with the refugee adjustment experience. A strengths-based, community-focused intervention known as Health Realization (HR) is a promising strategy for nurses to promote positive psychological outcomes in these populations. Although similar in some ways to cognitive therapy, the HR intervention emphasizes the role of thought versus the content of thought. It does not promote actively changing intrusive or negative thoughts but rather promotes an understanding that allows a degree of detachment from thoughts--a shift in consciousness that can provide relief and facilitate healing. An adapted stress and coping model provides a theoretical framework to test the effectiveness of using HR with refugees, which in turn provides a solid foundation for research that can support or refute the existing substantial anecdotal evidence for the use of this intervention in holistic nursing practice.

Somali and Oromo refugee women: trauma and associated factors.

AIM: This paper reports a study identifying the demographic characteristics, self-reported trauma and torture prevalence, and association of trauma experience and health and social problems among Somali and Oromo women refugees. BACKGROUND: Nearly all refugees have experienced losses, and many have suffered multiple traumatic experiences, including torture. Their vulnerability to isolation is exacerbated by poverty, grief, and lack of education, literacy, and skills in the language of the receiving country. METHOD: Using data from a cross-sectional population-based survey, conducted from July 1999 to September 2001, with 1134 Somali and Oromo refugees living in the United States of America, a sub-sample of female participants with clearly identified parenting status (n = 458) were analysed. Measures included demographics, history of trauma and torture, scales for physical, psychological, and social problems, and a post-traumatic stress symptom checklist. FINDINGS: Results indicated high overall trauma and torture exposure, and associated physical, social and psychological problems. Women with large families reported statistically significantly higher counts of reported trauma (mean 30, P < 0.001) and torture (mean 3, P < 0.001), and more associated problems (P < 0.001) than the other two groups. Women who reported higher levels of trauma and torture were also older (P < 0.001), had more family responsibilities, had less formal education (P < 0.001) and were less likely to speak English (P < 0.001). CONCLUSION: These findings suggest a need for nurses, and especially public health nurses who work with refugee and immigrant populations in the community, to develop a more comprehensive understanding of the range of refugee women's experiences and the continuum of needs post-migration, particularly among older women with large family responsibilities. Nurses, with their holistic framework, are ideally suited to partner with refugee women to expand their health agenda beyond the biomedical model to promote healing and reconnection with families and communities.

Adolescent use of complementary therapies.

PURPOSE: Interest in alternative/complementary therapies (A/CTs) is on the rise, yet little is known about adolescents' use of A/CTs. The study purpose was to examine A/CT utilization patterns among a clinic-based sample of adolescents. METHODS: A cross-sectional survey of 401 adolescents, aged 12-18 years, was conducted in one Midwest urban adolescent ambulatory clinic in 2002. RESULTS: Overall, 68.1% of the adolescents reported using one or more A/CT; most commonly, herbal medicines (27.2%), massage therapy (26.7%), and megavitamins (21.7%). Use by friends and family was the primary influence for adolescent A/CT use; lack of familiarity was the greatest reason for nonuse (53.9%). Alleviation of physical pain (66.3%) was the most common desired health outcome. Few adolescents (13.8%) disclosed A/CT use to their health care providers. Insurance coverage was provided for 10.2% of the therapies and out-of-pocket costs averaged 67 dollars/month. Age, race/ethnicity, having a health condition, taking medications, health responsibility, and work status were associated with overall A/CT use in bivariate analyses. Of these, only associations between A/CT use and race/ethnicity and health responsibility remained statistically significant after adjusting for the other variables. CONCLUSIONS: Use of A/CTs was common among these adolescents, yet very few disclosed their use to health care providers. Providers must ask about A/CT use to gain a more complete understanding of health practices among adolescents in clinical settings. Future research is needed to better understand representative patterns of A/CT use.

Sexual abuse history, risk behavior, and sexually transmitted diseases: the impact of age at abuse.

OBJECTIVE: The objective of this study was to examine the relationship between age at onset of sexual abuse, risk behaviors, and a diagnosis of sexually transmitted disease (STD) in a clinic-attending adolescent population. METHODS: Bivariate analyses were used to test association among age at onset of sexual abuse, risk behaviors, and STD diagnosis (n = 2175). Relationship between sexual abuse and STD acquisition was assessed by regression analysis. RESULTS: More females than males reported sexual abuse, 26.75% and 5.4%, respectively. Abuse at or before 10 years of age was associated with more lifetime and recent partners. History of abuse was associated with higher rates of STD tests. In regression analysis, for males and females, the odds of having an STD were 2.5 times greater if abuse occurred at 10 years or younger. CONCLUSION: Sexual abuse at a younger age is associated with more sexual risk behaviors and is a risk factor for STDs.

Staphylococcus aureus and wounds: a review of tea tree oil as a promising antimicrobial.

Antibiotic-resistant bacteria continue to be a major health concern worldwide. In particular, Staphylococcus aureus, both methicillin-resistant and -sensitive, are of concern in their ability to cause difficult skin and underlying tissue infections. Melaleuca alternifolia oil (tea tree oil), an essential oil, has demonstrated promising efficacy in treating these infections. Tea tree oil has been used for centuries as a botanical medicine, and has only in recent decades surfaced in the scientific literature as a promising adjunctive wound treatment. Tea tree oil is antimicrobial, anti-inflammatory, and has demonstrated ability to activate monocytes. There are few apparent side effects to using tea tree oil topically in low concentrations, with contact dermatitis being the most common. Tea tree oil has been effective as an adjunctive therapy in treating osteomyelitis and infected chronic wounds in case studies and small clinical trials. There is a need for larger clinical trials to further examine efficacy of tea tree oil as an adjunctive wound therapy, as well as improved guidelines for developing plant-based medicines.

Trauma and coping in Somali and Oromo refugee youth.

PURPOSE: To describe war-related trauma history, immigration factors, problems, and coping of Somali and Oromo refugee youth. METHODS: Analysis of a subset of participants (N = 338) aged 18-25 years from a population-based survey of Somali and Oromo refugees conducted in 2000-2002. Data included trauma history, life situation, and scales for physical (Cronbach alpha =.69), psychological (alpha =.56), and social problems (alpha =.69). Data were analyzed using Chi-square and Mann-Whitney U tests. RESULTS: Average emigration age was 14.8 years, with 4.2 years in transit and 2.0 years in the United States; 60% reported plans to return home to live. Two-thirds (66%) had less than a high school education, 49% had English language problems, 49% were employed (38% female vs. 57% male); 70% were single, with Somali females more likely than Oromo to be partnered and mothers (39% vs. 19%). There were significant ethnicity/gender differences for all problem scales. More females reported feeling alone (24% vs. 61%, p <.001). Youth with symptoms of posttraumatic stress syndrome reported more traumatic events (mean number of events: 28 vs.16). Trauma history was strongly associated with physical, psychological, and social problems. Most frequent strategies to combat sadness were praying (55.3%), sleeping (39.9%), reading (32.3%), and talking to friends (27.8%). CONCLUSIONS: Many young Somali and Oromo immigrants to the United States experience life problems associated with war trauma and torture, but many others are coping well. The findings suggest a need to develop age-appropriate strategies to promote the health of refugee youth to facilitate their successful adaptation to adult life in the United States.

Somali and Oromo refugees: correlates of torture and trauma history.

OBJECTIVES: This cross-sectional, community-based, epidemiological study characterized Somali and Ethiopian (Oromo) refugees in Minnesota to determine torture prevalence and associated problems. METHODS: A comprehensive questionnaire was developed, then administered by trained ethnic interviewers to a nonprobability sample of 1134. Measures assessed torture techniques; traumatic events; and social, physical, and psychological problems, including posttraumatic stress symptoms. RESULTS: Torture prevalence ranged from 25% to 69% by ethnicity and gender, higher than usually reported. Unexpectedly, women were tortured as often as men. Torture survivors had more health problems, including posttraumatic stress. CONCLUSIONS: This study highlights the need to recognize torture in African refugees, especially women, identify indicators of posttraumatic stress in torture survivors, and provide additional resources to care for tortured refugees.

Sampling in difficult to access refugee and immigrant communities.

We evaluated sampling strategies and trust-building activities in a large multiphase epidemiologic study of torture prevalence in populations that were difficult to locate and enroll. Refugee groups under study were Somalis from Somalia and Oromos from Ethiopia who were living in Minneapolis and St. Paul, Minnesota, in 1999-2002. Without a complete sampling frame from which to randomly recruit participants, we employed purposive sampling methods. Through comparative and statistical analyses, we found no apparent differences between our sample and the underlying population and discovered no effects of recruiting methods on study outcomes, suggesting that the sample could be analyzed with confidence. Ethnographic trust and rapport-building activities among investigators, field staff, and immigrant communities made it possible to obtain the sample and gather sensitive data. Maintaining a culture of trust was crucial in recovering from damaging environmental events that threatened data collection.

Complementary therapies and healing practices: faculty/student beliefs and attitudes and the implications for nursing education.

The purpose of this study was to describe the knowledge and attitudes of nursing faculty and students (BSN and MS) regarding complementary/alternative therapies (C/AT) and their integration into nursing practice. Implications for curricular and faculty development were also identified. A cross-sectional survey (n = 170) of graduating BSN students (n = 73) and MS and PhD students (n = 47) and faculty (n = 50) was conducted in a university-based nursing program. The self-administered questionnaire contained 134 forced choice items. Questions assessed attitudes and knowledge about training in, personal use of, perceived barriers to, and intent to integrate C/AT into clinical practice. Over 95 percent of the students and faculty agreed that clinical care should integrate the best of conventional and C/AT practices. Few had received formal C/AT education; the highest number had received some education about massage, music, prayer/spiritual healing, and therapeutic/healing touch. They desired more education but not necessarily the skills to perform these therapies themselves. Faculty and students expressed positive attitudes about incorporating C/AT into curricula and nursing practice. Current knowledge lags behind interest, however, suggesting a situation ripe for change. The most important perceived barrier to incorporation was lack of evidence. Curricular change is needed to fully integrate C/AT in nursing programs at all levels; faculty development and nursing research is needed to facilitate these changes.

Adolescent health in the Caribbean: a regional portrait.

OBJECTIVES: This study assessed youth health in the Caribbean Community and Common Market countries and describes the prevalence of health-related factors. METHODS: We used a self-administered classroom questionnaire; questions addressed general health, health care, nutrition, sexual history, drug use, mental health, violence, family characteristics, and relationships with others. RESULTS: Most youths reported good health; however, 1 in 10 reported a limiting disability or significant health problems. Violence was a pervasive concern. Of those who reported history of sexual intercourse, many reported that their first intercourse was forced, and nearly half reported that they were aged 10 years or younger when they first had intercourse. CONCLUSIONS: Although most young people are healthy, problems indicate the importance of monitoring trends and designing effective youth health programs.