The Lived Experiences of Folklore Healing Practices as a Health Patterning Modality.

Purpose: The purpose of the study is to understand the meaning of folklore as a health patterning modality and to uncover its unique characteristics in the life-health process. Design: Hermeneutic phenomenological. Method: Max van Manen's methodology was used for this study. The sample was selected from the Afro-Caribbean American community in the United States. The criterion for selection was that participants used folklore healing practices for health and well-being on an ongoing basis. In-depth interviews were done. Purposive sampling with networking was done based on whether the participants used folk healing on a regular basis. Themes of the meaning of folklore healing practices were identified from participants' verbatim data. Findings: The meaning of folklore healing practices was interpreted as phenomena with six interconnected essential themes. Additionally, Barrett's nursing theory of power as knowing participation in change was used to reflect and understand the findings from a nursing perspective. Conclusion: The research findings have implications for nursing science, and the knowledge gleaned from the study may be applied to nursing practice.

Association of kidney function, vitamin D deficiency, and circulating markers of mineral and bone disorders in CKD.

BACKGROUND: Vitamin D (25 hydroxyvitamin D [25(OH)D]) deficiency is common in patients with chronic kidney disease (CKD). Neither the relation of this deficiency to the decrease in glomerular filtration rate (GFR) nor the effects on CKD mineral and bone disorders (MBD) are clearly established. STUDY DESIGN: Cross-sectional analysis of baseline data from a prospective cohort, the NephroTest Study. SETTING & PARTICIPANTS: 1,026 adult patients with all-stage CKD not on dialysis therapy or receiving vitamin D supplementation. PREDICTORS: For part 1, measured GFR (mGFR) using (51)Cr-EDTA renal clearance; for part 2, 25(OH)D deficiency at <15 ng/mL. OUTCOMES & MEASUREMENTS: For part 1, 25(OH)D deficiency and several circulating MBD markers; for part 2, circulating MBD markers. RESULTS: For part 1, the prevalence of 25(OH)D deficiency was associated inversely with mGFR, ranging from 28%-51% for mGFR ≥60-<15 mL/min/1.73 m(2). It was higher in patients of African origin; those with obesity, diabetes, hypertension, macroalbuminuria, and hypoalbuminemia; and during winter. After adjusting for these factors, ORs for 25(OH)D deficiency increased from 1.4 (95% CI, 0.9-2.3) to 1.4 (95% CI, 0.9-2.1), 1.7 (95% CI, 1.1-2.7), and 1.9 (95% CI, 1.1-3.6) as mGFR decreased from 45-59 to 30-44, 15-29, and <15 (reference, ≥60) mL/min/1.73 m(2) (P for trend = 0.02). For part 2, 25(OH)D deficiency was associated with higher age-, sex-, and mGFR-adjusted ORs of ionized calcium level <1.10 mmol/L (2.6; 95% CI, 1.2-5.9), 1,25 dihydroxyvitamin D concentration <16.7 pg/mL (1.8; 95% CI, 1.3-2.4), hyperparathyroidism (1.8; 95% CI, 1.3-2.4), and serum C-terminal cross-linked collagen type I telopeptides concentration >1,000 pg/mL (1.6; 95% CI, 1.0-2.6). It was not associated with hyperphosphatemia (phosphate >1.38 mmol/L). LIMITATIONS: Cross-sectional analysis of the data prevents causal inferences. CONCLUSIONS: 25(OH)D deficiency is related independently to impaired mGFR. Both mGFR decrease and 25(OH)D deficiency are associated with abnormal levels of circulating MBD biomarkers.

Ethnic differences in antenatal care use in a large multi-ethnic urban population in the Netherlands.

OBJECTIVE: to determine differences in antenatal care use between the native population and different ethnic minority groups in the Netherlands. DESIGN: the Generation R Study is a multi-ethnic population-based prospective cohort study. SETTING: seven midwife practices participating in the Generation R Study conducted in the city of Rotterdam. PARTICIPANTS: in total 2093 pregnant women with a Dutch, Moroccan, Turkish, Cape Verdean, Antillean, Surinamese-Creole and Surinamese-Hindustani background were included in this study. MEASUREMENTS: to assess adequate antenatal care use, we constructed an index, including two indicators; gestational age at first visit and total number of antenatal care visits. Logistic regression analysis was used to assess differences in adequate antenatal care use between different ethnic groups and a Dutch reference group, taking into account differences in maternal age, gravidity and parity. FINDINGS: overall, the percentages of women making adequate use are higher in nulliparae than in multiparae, except in Dutch women where no differences are present. Except for the Surinamese-Hindustani, all women from ethnic minority groups make less adequate use as compared to the native Dutch women, especially because of late entry in antenatal care. When taking into account potential explanatory factors such as maternal age, gravidity and parity, differences remain significant, except for Cape-Verdian women. Dutch-Antillean, Moroccan and Surinamese-Creole women exhibit most inadequate use of antenatal care. KEY CONCLUSIONS: this study shows that there are ethnic differences in the frequency of adequate use of antenatal care, which cannot be attributed to differences in maternal age, gravidity and parity. Future research is necessary to investigate whether these differences can be explained by socio-economic and cultural factors. IMPLICATIONS FOR PRACTISE: clinicians should inform primiparous women, and especially those from ethnic minority groups, on the importance of timely antenatal care entry.

Complementary and alternative medicine for mental disorders among African Americans, black Caribbeans, and whites.

OBJECTIVES: This study examined racial and ethnic differences in the use of complementary and alternative medicine (CAM) for the treatment of mental and substance use disorders. METHODS: Data were from the National Survey of American Life (NSAL) and the National Comorbidity Survey-Replication (NCS-R). The analytic sample included 631 African Americans and 245 black Caribbeans from the NSAL and 1,393 non-Hispanic whites from the NCS-R who met criteria for a mood, anxiety, or substance use disorder in the past 12 months. Logistic regression was used to examine racial and ethnic differences in the use of any CAM and in the use of CAM only versus the use of CAM plus services in another treatment sector. RESULTS: Thirty-four percent of respondents used some form of CAM. Whites were more likely than blacks to use any CAM, although there was no racial or ethnic difference in CAM use only versus CAM use plus traditional services. A higher proportion of blacks than whites used prayer and other spiritual practices. Among those with a mood disorder, black Caribbeans were less likely than African Americans to use any CAM. CONCLUSIONS: Findings of this study were similar to those of previous studies that examined physical illness in relation to CAM use in terms of its overall prevalence, the predominant use of CAM in conjunction with traditional service providers, and racial and ethnic differences in the use of CAM. The use of prayer was a major factor in differences between blacks and whites in CAM use; however, there were also differences among black Americans that warrant further research.

Birthplace and mortality among insured Latinos: the paradox revisited.

OBJECTIVES: We investigated the Latino paradox in a managed care setting and examined the role of birthplace. METHODS: We evaluated 133,155 non-Latino Whites and 5,237 Latinos (36% born in the United States, 34% in Central and South America, 21% in Mexico, and 8% in the Caribbean Islands) who were enrolled in an integrated healthcare delivery system in northern California. Baseline data were from 1964-1973, and the median followup was 34 years. Main outcome measures were cause-specific and all-cause mortality. RESULTS: In fully-adjusted analyses, and compared with non-Latino Whites, the risk of death from circulatory causes was significantly lower among US-born Latinos (hazard ratio [HR] .79, 95% confidence interval [CI] .66-.93), among Central and South America-born Latinos (HR .76, 95% CI .63-.91), and Caribbean-born Latinos (HR .66, 95% CI .47-0.93). Risk of death by malignant neoplasms was significantly lower among US-born Latinos (HR .68, 95% CI .56-.83). Risk of respiratory death was significantly lower among Central and South America-born Latinos (HR .50, 95% CI .32-.80). All-cause mortality risk was significantly decreased in US-born Latinos (HR .79, 95% CI .71-.87), Central and South America-born Latinos (HR .81, 95% CI .73-.90), and Caribbean-born Latinos (HR .76, 95% CI .63-.93) but not in Mexico-born Latinos. CONCLUSIONS: In our managed care setting, the Latino paradox phenomenon varied by birthplace; it was more evident among US-born Latinos. This subgroup experienced lower circulatory, cancer, and all-cause mortality than did non-Latino Whites, despite higher prevalences of current smoking, obesity, and asymptomatic hyperglycemia.

Use of health care services for psychological distress by immigrants in an urban multicultural milieu.

OBJECTIVE: Research in the United States tends to attribute low rates of use of mental health services by immigrants to economic barriers. The purpose of our study was to examine this issue in the context of Canada's universal health care system. METHODS: A survey of the catchment area of a comprehensive clinic in Montreal interviewed random samples of 924 Canadian-born individuals and 776 immigrants born in the Caribbean (n = 264), Vietnam (n = 234), or the Philippines (n = 278) to assess their health care use for somatic symptoms, psychological distress, and recent life events. RESULTS: Overall rates of use of medical services in the past year were similar in immigrant (78.5%) and nonimmigrant (76.5%) groups. Rates of use of health care services for psychological distress were significantly lower among immigrants (5.5% compared with 14.7%, P < 0.001). This difference was attributable both to a lower rate of use of specialty mental health services by immigrants (2.5% compared with 11.7%, P < 0.001) and to differential use of medical services for psychological distress (3.5% compared with 5.8%, P = 0.02). When level of psychological distress was controlled, Vietnamese and Filipino immigrants were one-third as likely as Canadian-born residents to make use of mental health services. The lower rate of use by immigrants could not be explained by differences in sociodemographics, somatic or psychological symptoms, length of stay in Canada, or use of alternative sources of help. CONCLUSION: Immigrant status is associated with lower rates of use of mental health services, even with universal health insurance. This lower rate of use likely reflects cultural and linguistic barriers to care.

Strategies to manage hypertension: a qualitative study with black Caribbean patients.

BACKGROUND: The detection of hypertension in black Caribbean populations is good, but its control is thought to be inadequate. AIM: To explore how black Caribbean patients with hypertension understand their condition, and the strategies they use in managing hypertension. DESIGN OF STUDY: Qualitative study using in-depth interviews. SETTING: One general practice in inner-city London. METHOD: Practice records were searched to identify black Caribbean patients with known and treated hypertension. Audiotaped in-depth interviews were conducted with all identified patients and transcripts of the interviews were analysed for thematic content. RESULTS: We interviewed 19 black Caribbean patients with hypertension. Participants reported physical symptoms for elevated blood pressure; a minority relied on symptoms to determine their medicine use. A majority of participants equated 'normal' blood pressure readings with being cured and with no need for prescribed medicine. All participants had been prescribed antihypertension medication, and seven reported taking medication as prescribed. Those who did not, reported diverse and dynamic patterns of medication consumption. Some who had achieved normal blood pressure equated this with being cured and stopped medication, resuming when diagnosed with high blood pressure. Some modified their use of tablets according to bodily symptoms that they felt indicated higher or lower blood pressure. Some stopped or reduced medication because of unwanted effects and almost half of the participants used Caribbean 'bush' remedies. CONCLUSION: These findings suggest that some patients are making reasoned decisions about blood pressure management, drawing on medical information, their own bodily experiences of illness and sociocultural notions and practices. However, this may lead to medication use that diverges from that which is recommended. This study indicates a continued need to address these patients' perspectives and develop and evaluate new strategies to achieve hypertension control in this group.

The relationship of spirituality and health outcomes in Black women with type 2 diabetes.

The purpose of this pilot study was to explore the relationships between spiritual well-being emotional distress, HbA1c values, and blood pressure levels in a convenience sample of 22 Black women with type 2 diabetes. Results revealed significant inverse correlations between diastolic blood pressure (BP) and both total spiritual well-being (r=-.51, P=.02) and religious well-being (RWB) (r=-.55, P=.01). Women with higher RWB scores tended to have lower diastolic BP, as compared to their counterparts with lower RWB scores (z=2.78, P=.005). Emotional distress was positively related to systolic BP (r=.48, P=.03). These finding suggest that holistic care, addressing the spiritual and emotional dimensions, may foster improved BP levels among Black women with type 2 diabetes, thereby potentially reducing their high risk for secondary complications.

Life stress and cervical squamous intraepithelial lesions in women with human papillomavirus and human immunodeficiency virus.

OBJECTIVE: Human immunodeficiency virus (HIV)-infected women are at risk for cervical intraepithelial neoplasia (CIN) and cancer due to impaired immunosurveillance over human papillomavirus (HPV) infection. Life stress has been implicated in immune decrements in HIV-infected individuals and therefore may contribute to CIN progression over time. The purpose of this study was to determine whether life stress was associated with progression and/or persistence of squamous intraepithelial lesions (SIL), the cytologic diagnosis conferred by Papanicolaou smear, after 1-year follow-up among women co-infected with HIV and HPV. METHOD: Thirty-two HIV-infected African-American and Caribbean-American women underwent a psychosocial interview, blood draw, colposcopy, and HPV cervical swab at study entry. Using medical chart review, we then abstracted SIL diagnoses at study entry and after 1-year follow-up. RESULTS: Hierarchical logistic regression analysis revealed that higher life stress increased the odds of developing progressive/persistent SIL over 1 year by approximately seven-fold after covarying relevant biological and behavioral control variables. CONCLUSIONS: These findings suggest that life stress may constitute an independent risk factor for SIL progression and/or persistence in HIV-infected women. Stress management interventions may decrease risk for SIL progression/persistence in women living with HIV.

Vitamin D deficiency in pregnant women from a non-European ethnic minority population--an interventional study.

OBJECTIVE: To determine the vitamin D status of pregnant women from non-European ethnic minorities in South Wales. DESIGN: Prospective study. SETTING: Llandough Hospital, Cardiff, South Wales. SAMPLE: One hundred and sixty pregnant women from a non-European ethnic minority population in South Wales. METHODS: Biochemical screening of vitamin D status was carried out at the first antenatal visit. Women found to be deficient in vitamin D were subsequently supplemented and vitamin D status was rechecked at delivery. MAIN OUTCOME MEASURE: Vitamin D status at delivery. RESULTS: Eighty of 160 women had a vitamin D level below 8 ng/mL at their first antenatal visit and were treated with oral vitamin D. Factors that could influence vitamin D status such as religion, fluency in English and dressing habits did not appear to have any effect, although a higher proportion of women who had lived in Britain for longer than three years had subnormal vitamin D levels. In 58 of those checked at delivery, the mean plasma vitamin D level increased from 6 to 11 ng/mL although the mean parathyroid hormone level was unchanged. CONCLUSION: In view of the high incidence of subnormal vitamin D levels in women from ethnic minorities, we recommend biochemical screening of these women in early pregnancy, with subsequent supplementation where indicated.

Home-based therapies for the common cold among European American and ethnic minority families: the interface between alternative/complementary and folk medicine.

BACKGROUND: Most studies of alternative/complementary medicine use in children have focused on children with chronic illness and have not addressed the more common form of complementary medicine: popular home-based interventions and therapies for common low-morbidity sickness episodes. Also, there has often been a distinction between alternative/ complementary medical practices used by the general population and those used by members of ethnic minority groups and commonly referred to as folk medicine or ethnomedicine. OBJECTIVE: To describe the home-based therapies and practices that parents from diverse ethnocultural backgrounds use to treat the common cold in their children. METHOD: Interviews with mothers of children coming for care at a number of clinics and physicians' offices. Included were mothers from European American, African American, Puerto Rican, and West Indian-Caribbean heritages. RESULTS: Mean number of home-based remedies for the common cold did not differ among ethnic groups (controlling for maternal age, maternal education, number of children, and health insurance status). There were differences among groups regarding the frequency of use of specific remedies. CONCLUSIONS: Home-based remedies for colds in childhood are commonly used. Many of the treatments are complementary to biomedical treatment (ie, antipyretics, over-the-counter cold remedies, fluids). Very few are potentially hazardous if taken in moderation. Mothers from ethnic minorities use similar amounts of homebased interventions when compared with mothers from the majority culture.

Development of a culturally appropriate food guide for pregnant Caribbean immigrants in the United States.

Communities with large Caribbean immigrant populations in Boston, Mass, have alarmingly high rates of both infant mortality and low-birth-weight infants. Although the federally funded Special Supplemental Food Program for Women, Infants, and Children (WIC) has been shown to increase infant birth weight and reduce fetal mortality, observations made in this study show that pregnant Caribbean immigrants who enrolled in WIC did not receive comprehensive, culturally appropriate nutrition counseling. Public health nutritionists and other health care providers used the Basic Four food group model as the basis for their dietary recommendations. The Basic Four model, however, is culturally biased and does not accommodate the food habits of the Caribbean immigrant. Furthermore, it does not adequately address the needs of pregnant women who are either lactose malabsorbers or vegetarians. Using ethnographic and nutrition science research methods, two culturally appropriate food guides were developed to accommodate the food practices of pregnant women from Haiti and the English-speaking Caribbean. The guides group foods into three categories: growth, protection, and energy. The guides not only include cultural foods but allow for the Recommended Dietary Allowance (RDA) for calcium to be met by nondairy sources and the RDA for protein to be met by vegetable sources. This study suggests that the Basic Four system is an inadequate model for Caribbean immigrants and that it is possible and necessary to construct culturally appropriate food guides that meet the US RDAs.

Development of a culturally appropriate food guide for pregnant Caribbean immigrants in the United States

Communities with large Caribbean immigrant populations in Boston, Mass, have alarmingly high rates of both infant mortality and low-birth-weight infants. Although the federally funded Special Supplemental Food Program for Women, Infants, and Children (WIC) has been shown to increase infant birth weight and reduce fetal mortality, observations made in this study show that pregnant Caribbean immigrants who enrolled in WIC did not receive comprehensive, culturally appropriate nutrition counseling. Public health model as the basis for their dietary recommendations. The Basic Four model, however, is culturally biased and does not accomodate the food habits of the Caribbean immigrant. Furthermore, it does not adequately address the needs of pregnant women who are either lactose malabsorbers or vegetarians. Using ethnographic and nutrition science research methods, two culturally appropriate food guides were developed to accomodate the food practices of pregnant women from Haiti and the English-speaking Caribbean. The guides group food into three categories: growth, protection, and energy. The guides not only include cultural foods but allow for the Recommended Dietary Allowance (RDA) for calcium to be met by nondairy sources and the RDA for protein to be met by vegetable sources. This study suggests that the Basic Four system is an inadequate model for Caribbean immigrants and that it is possible and necessary to construct culturally appropriate food guides that meet the US RDAs. (AU)

Infant feeding practices by ethno-cultural grouping.

PIP: This study attempts to assess infant breastfeeding practices among 200 low income families in New York City and in New Jersy, and to measure differences in feeding practices among 5 different ethno-cultural groups, U.S. Blacks, West Indians, Puerto Ricans, Haitians, and Hispanics. 58.5% of mothers were not born in the U.S., but the majority, or 77.5% had lived in the U.S. for more than 5 years. Only 6% of families reported an annual income above $10,000. 29% of mothers in the entire study group attempted breastfeeding, the majority being West Indian mothers (64%), followed by Puerto Ricans (34%), Hispanics (33%), Haitians (21%), and U.S. Blacks (15%). Average duration of breastfeeding was highest among Hispanics, with 10.2 weeks, and lowest among Haitians, with 2.3 weeks. 94.5% of mothers had used an artificial formula feeding in conjunction or as a substitute for breastfeeding during the first 4 months of infancy, the most widely used milk feeding being Similac, 41.5%, followed by ordinary cow's milk, 31%; less than 10% of families were using formula feeding beyond 6 months of age. 1/3 of mothers reported using iron supplements in addition to the iron already contained in some formulas. 17 infants had diets deficient in iron intake; those infants were fed an iron-poor formula, and half of them presented evidence of iron deficiency anemia. Introduction of solid foods differed little among the various ethnic subgroups. This study corroborates other published reports in indicating that there is a growing interest in breastfeeding among the lower socioeconomic population. Still, education on proper nutrition for infants is lacking within the same group, and infant feeding counseling programs should be sensible to such lack of professional guidance.^ieng