Nonpharmacological Interventions for Management of Behavioral and Psychological Symptoms of Dementia in Long-Term Care Facilities by Direct Caregivers: A Systematic Review.

Behavioral and psychological symptoms of dementia (BPSD) are a worldwide problem. Estimates indicate approximately 96% of persons with dementia (PWD) exhibit BPSD that are directly associated with long-term care (LTC) placement and approximately one half of these persons experience symptoms classified as severe. BPSD are associated with lost days of work, high turnover, and poor job satisfaction for direct caregivers. Nonpharmacological interventions (NPIs) are effective for management of BPSD when used properly. NPIs are more likely to be used by direct caregivers who are knowledgeable about and have confidence in BPSD effectiveness. Various training techniques promote development of this self-efficacy. The current systematic review synthesizes evidence concerning the use of NPIs for management of BPSD by direct caregivers in LTC settings. Gaps in the literature include evaluation of positive impact of NPIs on PWD and behavior precedent factors. This review emphasizes the need for development and provision of quality NPI education for direct caregivers in LTC settings. [Journal of Gerontological Nursing, 48(7), 18-23.].

Qualitative Descriptive Study of Illegal Behaviors among Those with Gambling Disorder in South Korea: Their Efforts for Recovery and Role of Mental Health Care Providers.

The prevalence of Gambling Disorder among Koreans suggests that it is relatively higher than other countries. This study explored gambling-related crimes and related mental health care needs of those with Gambling Disorder on a case-by-case basis. Participants (n = 6) included men attending Gamblers Anonymous in South Korea with gambling debts and histories of illegal acts. Thematic analysis of qualitative interviews identified themes: (1) Meaning of Gambling Disorder in life, (2) Initiation of illegal acts stemming from Gambling Disorder, and (3) Life after addiction, efforts for recovery, and mental health care needs. Gambling Disorder destroyed lives and created criminal victims thereby threatening familial and community health.

The Impact of Developmental Behavioral Pediatrics in a Population of Children with Down Syndrome.

PURPOSE: Children with Down syndrome (DS) have a unique developmental profile with an increased risk for co-morbid neurodevelopmental diagnoses, including autism spectrum disorder (ASD), anxiety, and attention deficit/hyperactivity disorder (ADHD), among others. A delay in a diagnosis of these conditions can impact the health and psychosocial wellbeing of the child and family. The purpose of this study was to assess identification of secondary co-morbid neurodevelopmental diagnoses within an academic DS specialty Clinic. DESIGN AND METHODS: A retrospective chart review of secondary co-morbid neurodevelopmental diagnoses including children with DS ages 2 to 17 years old, with a visit encounter in a pediatric DS specialty clinic between January 2018 to August 2019 was conducted. Comparisons included diagnoses identified before (T1) and after (T2) inclusion of developmental behavioral specialists as pediatric DS providers. Two sample t-tests, Chi-square test and Fisher's exact t-test were utilized to compare categorical and non-categorical variables. RESULTS: 145 children were identified in T1 of which 51.7% were male. 225 children were seen in T2, 56.0% were male. Increased detection of several co-morbid conditions occurred between T1 and T2 including language disorder (p < 0.0001), intellectual disability (p < 0.0001), and non-specific developmental/behavioral diagnoses (p < 0.0001). CONCLUSION: Developmental/behavioral assessment is integral for detection of co-morbid conditions among a pediatric DS population and prevention of diagnostic overshadowing. PRACTICE IMPLICATIONS: Interprofessional teams, including pediatric nurse practitioners, play a key role in providing health supervision and assessment for a pediatric DS population.

Curbside consultation: A means to promote quality patient care.

The objective of this descriptive, cross-sectional study was to describe curbside consultation, a bidirectional informal discussion with a colleague "expert" concerning patient care, among nurse practitioners. Curbside consultations are valuable, yet little is known about this process use for nurse practitioners. A national convenience sample was recruited using online social media platforms and email. Data were collected in June 2019 via Qualtrics survey software. Web-based survey included 80 questions concerning use and definition of curbside consultation, and followed STROBE guidelines for reporting. Questions also concerned work environment, personal and interpersonal qualities, communication modality and patient engagement. Descriptive and survey item analyses including frequency, percentage, means and standard deviation, Chi-square and Fisher's Exact Test, Pearson's correlation analysis, and one-way independent t-tests. Participants included nurse practitioners (N = 402) in primary (51.2%, N = 206) and specialty care (46%, N = 185). Nurse practitioners reported positive experiences with curbside consultations (96.8%, N = 384) and that reliable access to colleagues was correlated with multiple variables, including practice culture (r = 0.494, p = .001). Most reported (99%, N = 387) patients receive better care with successful curbside consultation. Curbside consultations provide nurse practitioners information access at point-of-care for implementation of evidence-based practice to promote quality patient care. Addition of curbside consultation education is a compelling consideration of nurse practitioner curriculum.

Exploring the use of curbside consultations for interprofessional collaboration and clinical decision-making.

Nurse practitioners utilize curbside consultation, an interprofessional collaboration communication process in which one clinician seeks advice from another, in clinical decision-making practices. Nevertheless, this process is not well-understood. A qualitative design with individual open-ended interviews was used to explore the phenomenon of curbside consultation among nurse practitioners for clinical decision-making. Twenty primary care and specialty nurse practitioners participated. Participants were recruited via purposive sampling from in-patient and out-patient settings in order to reach saturation of themes. Using inductive content analyses, the findings revealed that nurse practitioners made multiple decisions in the course of information-seeking and its application during the curbside consultation process. Motivated by the patient's best interest, nurse practitioners provided advice in the curbside consultation exchange and sought answers to questions encountered in clinical decision-making. Multiple resources were often utilized with curbside consultation frequently evolving into formal consultation. Dynamics of curbside consultation included (a)synchronous approaches including text, e-mail, telephone, or face-to-face processes. Once information was received, nurse practitioners decided whether they (dis)agreed with advice and if validation was necessary. Nurse practitioners utilized curbside consultation for clinical decision-making and means for interprofessional collaboration, thereby increasing clinical competency and promoting quality patient outcomes. Implications of curbside consultation for education and practice require further exploration to enhance outcomes of curbside consultation processes.

COVID outbreak after the 1st dose of COVID vaccine among the nursing home residents: What happened?

The purpose of this study was to assess the effectiveness of Pfizer-BioNTech COVID19 vaccine among nursing home residents by exploring the outcomes of a major COVID-19 outbreak following COVID-19 vaccination in a nursing home located at a metropolitan area of South-Central Texas. 91 residents resided in this nursing home during the outbreak, and 86 residents received the 1st dose of COVID-19 vaccine on January 4th, 2021. A retrospective chart review explored outcomes of this outbreak by accessing the electronic medical records from January 4th, 2021 thru February 28th, 2021. Residents partially vaccinated with COVID-19 vaccine were found less likely to be symptomatic during this outbreak. The risk of SARS-CoV-2 infection was significantly lower among residents who received both doses of the COVID-19 vaccine. Completion of both doses of COVID vaccination for all nursing home residents is essential and can prevent future COVID-19 outbreaks in nursing homes.

Traditional partería providing women's health care in Latin America: A qualitative synthesis.

AIM: To identify practices, beliefs, and potential gaps in knowledge about partería tradicional in Latin America. BACKGROUND/INTRODUCTION: Partería tradicional (lay midwifery) refers to ancestral knowledge used by laypersons, mainly parteras tradicionales (lay midwives), to provide health care to women and children. This care, initiated prior to formalization of health care continues today. Descriptions of the intergenerational oral transmission of partería tradicional knowledge and practice in Latin America exist without related synthesis. METHODS: Qualitative synthesis of the literature, including publications in Spanish, English, and Portuguese indexed in public databases over the previous 22 years concerning partería tradicional. Identification of categories, themes, and bias reporting via PRISMA processes, using the Thomas and Harden's approach and the Noblit and Hare's methodological recommendations. RESULTS: Partería tradicional themes included "ancestral knowledge," "destiny and a spiritual calling," "woma's heritage," and "a means for providing health care." DISCUSSION: Parteras tradicionales are key providers of health care for rural and urban marginalized communities. Limited knowledge and understanding of this practice impacts interactions between parteras tradicionales, midwives, and nurses. An interchange of knowledge is fundamental for care congruent with culture and the humanization of women's reproductive health. CONCLUSIONS AND POLICY IMPLICATIONS: Communities with unresolved health care needs benefit via collaboration between formal health practices and partería tradicional. A compelling need for inquiry to preserve the art of partería tradicional exists internationally. Parteras tradicionales must be considered when formulating health care policy, thereby enhancing their historic role among the most vulnerable populations in Latin America: protecting, caring, and addressing health care needs.

Outcomes of Depression Screening for Adolescents Accessing Pediatric Primary Care-Based Services.

PURPOSE: Assess outcomes of depression screening among adolescents accessing pediatric primary care-based services. These findings will contribute to development of clinical protocols for depression screening and intervention in primary care settings. DESIGN AND METHODS: Retrospective chart review conducted via electronic medical records at a pediatric primary care-based clinic to extract PHQ-9 data for adolescents screened from 1/17/2018 to 4/18/2018. De-identified data included age, gender, ethnicity, provider, PHQ-9, and referral/follow-up/medication status. RESULTS: Data included 1213 adolescents of whom N = 600 were depressed without additional comorbidities; 96 adolescents had PHQ-9 scores >5. Descriptive analyses by age, gender, ethnicity, referral type, follow-up, and provider services identified targeted primary care-based interventions for depression and referral. Depression screening occurred primarily at well child visits. 82.5% of those with PHQ-9 scores >5 were not currently receiving treatment. Overall, referrals by physicians (45.8%) and nurse practitioners (42.9%) were equivalent with more referrals for adolescents with moderate-severe depression. Nurse practitioners provided more counseling than physicians among adolescents with mild to moderate depression. CONCLUSIONS: Adolescent mental health necessitates an enhanced continuum of care. Primary care-based interventions provided by pediatric nurse practitioners are imperative to address adolescent mental health needs. Findings provide practical means to incorporate protocols for depression enhancing primary care-based mental health access. PRACTICE IMPLICATIONS: Need for incorporation of practical modalities for depression assessment and follow up as recommended by American Academy of Pediatrics. Future study for comparison of methods (phone/text reminder, follow up appointment, online resource reminder, telehealth), indicated to enhance follow-up care for adolescents experiencing depression.

Psychosocial Factors Associated with Paternal Perinatal Depression in the United States: A Systematic Review.

Paternal perinatal depression can occur in approximately one out of ten fathers. However, research within this population is limited. A previous systematic review suggested that United States had higher rates of paternal perinatal depression compared to other countries. Therefore, this systematic review identified psychosocial factors for depression during the perinatal period in fathers who live in the United States. A literature search was conducted from multiple databases using keywords and MeSH terms to retrieve articles up to the year 2019. Twenty five articles were included in this review. A social-ecological framework was applied to identify psychosocial factors associated with paternal depression. Individual factors include prior history of depression, having maladaptive cognitive coping styles, fathers who self-identified as African-American or Hispanic, parenting stress, substance use, and history of criminal conviction. Interpersonal factors include lack of social support, quality of relationship with the mother of the baby, coparenting conflict, quality of current and childhood relationships with their own parents, and maternal depression. Community factors include frequent daily experiences with racism, and limited access to transportation and housing. These findings underscore the importance of assessing depression and developing father-inclusive interventions that address the psychological needs of fathers.

Social Support and Perinatal Depression: The Perspectives of Mexican-American Adolescent Mothers.

Perinatal depression is estimated to affect one in seven pregnant women. As such, social support has been shown to impact the mental health of women during the perinatal period. The purpose of this qualitative descriptive study was to examine the types of social support received by pregnant and parenting Mexican-American adolescent mothers and their perceptions of how it can influence perinatal mental health. Deductive content analysis was used to analyze the data using emotional, instrumental, and informational support as primary categories. Positive and negative aspects of the adolescent's social network were also included to understand how individuals impact their mental health. A convenience sample of 20 perinatal Mexican-American adolescents were interviewed. Emotional support, such as encouragement and affirmation, as well as instrumental support, via financial assistance and help with infant care, were primarily sought from significant others, which consisted of family members and their partner. Having strained relationships with their significant others primarily contributed to emotional distress. Health care providers were often sought out for informational support concerning perinatal depression. However, some adolescents were unable to establish rapport with their health care provider, making it difficult to inquire about pertinent mental health information. Study findings suggest that identifying support needs and expectations is an important component of facilitating positive mental health outcomes for Mexican-American adolescent mothers. Future efforts to promote mental health and prevent perinatal depression among Mexican-American adolescent mothers should consider integrating a strong focus on social support.

Mobile Health, Information Preferences, and Surrogate Decision-Making Preferences of Family Caregivers of People With Dementia in Rural Hispanic Communities: Cross-Sectional Questionnaire Study.

BACKGROUND: Mobile health (mHealth) technology holds promise for promoting health education and reducing health disparities and inequalities in underserved populations. However, little research has been done to develop mHealth interventions for family caregivers of people with dementia, particularly those in rural Hispanic communities, who often serve as surrogate decision makers for their relatives with dementia. OBJECTIVE: As part of a larger project to develop and test a novel, affordable, and easy-to-use mHealth intervention to deliver individually tailored materials in rural Hispanic communities, in this pilot study, we aimed to examine (1) characteristics of people with dementia and their family caregivers in rural Hispanic communities, (2) caregivers' preferences for types and amounts of health information and participation in surrogate decision making, and (3) caregivers' mobile device usage and their desire for receiving information via mobile devices. METHODS: This was a cross-sectional survey. A convenience sample of 50 caregivers of people with dementia was recruited from rural health care facilities in Southwest Texas during 3 weeks of April 2017 to May 2017 via word-of-mouth and flyers posted at the facilities. RESULTS: More women than men were in the patient group (χ21=17.2, P<.001) and in the caregiver group (χ21=22.2, P<.001). More patients were on Medicare and Medicaid; more caregivers had private insurance (P<.001 in all cases). Overall, 42% of patients did not have a power of attorney for their health care; 40% did not have a living will or advance directive. Caregivers were interested in receiving all types of information and participating in all types of decisions, although on subscales for diagnosis, treatment, laboratory tests, self-care, and complementary and alternative medicine, their levels of interest for decision-making participation were significantly lower than those for receiving information. On the psychosocial subscale, caregivers' desire was greater for surrogate decision-making participation than for information. Caregivers did not differ in their interests in information and participation in decision making on the health care provider subscale. All but 1 caregiver (98%) owned a mobile phone and 84% had a smartphone. Two-thirds wanted to receive at least a little dementia-related information via a smartphone or tablet. The amount of dementia-related information caregivers wanted to receive via a mobile device was significantly greater for women than for men (U=84.50, P=.029). Caregivers who owned a tablet were more likely to want to receive dementia-related information via a mobile device than those who did not own a tablet (U=152.0, P=.006). CONCLUSIONS: Caregivers in rural Hispanic communities were interested in receiving a wide range of information as well as participating in making decisions for their relatives with dementia. There is much need for effective mHealth interventions that can provide information tailored to the needs and preferences of these caregivers.

"We Don't Want to be Judged": Perceptions about Professional Help and Attitudes Towards Help-Seeking among Pregnant and Postpartum Mexican-American Adolescents.

PURPOSE: The purpose of this qualitative study is to understand how depression is recognized, as well as perceptions of professional help and attitudes concerning perinatal depression among pregnant and postpartum (perinatal) Mexican-American adolescents. DESIGN AND METHODS: This qualitative descriptive study used deductive and inductive content analysis to analyze data. Categories and subcategories describing the mental health literacy of perinatal Mexican-American adolescents concerning perinatal depression are presented. A convenience sample of 20 perinatal Mexican-American adolescents between the ages of 15 and 19 years were interviewed. Participants were recruited from parenting classes across urban high-schools in Southwestern United States. RESULTS: Adolescents expressed difficulties in recognizing perinatal depression. Depressive symptoms were identified through self-appraisals or the appraisal of others. Establishing rapport with empathetic health care providers facilitated trust among adolescents. Fear of judgement was the most common response and prevented help-seeking. Lack of trust, normalization of depression, and reluctance with disclosing symptoms were also indicated by participants. CONCLUSIONS: Stigma concerning perinatal depression was identified as a barrier for help-seeking among participants who were already experiencing criticism due to their pregnancy status. The quality of interactions with health providers may hinder or facilitate adolescents from professional help-seeking. PRACTICE IMPLICATIONS: Active engagement and collaboration with Mexican-American adolescents are indicated in identification and treatment of perinatal depression. Integration of mental health services in primary care settings is suggested to facilitate help-seeking for perinatal depression. Mental Health First Aid may be utilized to improve knowledge and decrease stigma concerning perinatal depression among Mexican-American adolescents.

Outcomes of Depression Screening Among Adolescents Accessing School-based Pediatric Primary Care Clinic Services.

PURPOSE: Implementation of routine Patient Health Questionnaires (PHQ-9) screening among adolescents aged 12-18year, accessing school-based pediatric primary care clinic services for identification of adolescents at potential risk for Major Depressive disorder (MDD). DESIGN AND METHODS: Retrospective chart review (N=256 cases) documented PHQ-9 depression screening outcomes among adolescents accessing school-based pediatric primary care clinic services for episodic illness and wellness visits. Data analyses included descriptive statistical methods. RESULTS: Chart review included 137 (53.5%) females and 119 (46.5%) males. PHQ-9 depression screening was identified for 56.3% (n=144) of charts with scores ≥10 for 12.5% (n=18) among those screened. Mental health referrals were made for 83.3% (n=15) with PHQ-9 scores ≥10. Dysthymia related concerns were reported among 20.1% (n=29) of which 55.2% (n=16) received mental health referrals. Female adolescents reported more sleep problems (χ2=9.174, p=0.002) and tiredness (χ2=6.165, p=0.013) than males. The 15-18year age group (χ2=5.443, p=0.020) was more likely to experience sleep problem and low self-esteem than 12-14year age group (χ2=5.143, p=0.023). CONCLUSION: Implementation of PHQ-9 depression screening protocol identified MDD among adolescent accessing pediatric school-based primary care clinic services facilitating referrals to mental health providers, potentially improving morbidity and mortality among adolescents. PRACTICE IMPLICATIONS: MDD is common among adolescents and associated with functional impairments and increased morbidity and mortality. Due to its high prevalence, it is imperative to improve screening and treatment access in this population via school-based clinics.

Identifying Health Promotion Needs Among Dominican-American Adolescents.

PURPOSE: Immigration from the Dominican Republic to the United States has grown rapidly. Yet, although adolescent pregnancy and obesity are common concerns among Hispanics, little is known specifically about Dominican adolescent health. This study was undertaken to assess Dominican-American adolescents' health concerns and their perceptions about their health promotion needs. DESIGN AND METHODS: Dominican-American adolescents (N=25) were recruited in a pediatric clinic in New York City which primarily serves a Dominican population. Eligibility criteria included age 13-21years, self-identifying as Dominican ethnicity, and able to speak and read English. They completed a questionnaire, with demographic questions and questions about their risk behaviors including sexual and substance use. After completing the questionnaire, they participated in a semi-structured interview addressing their health education experiences and suggestions for such programs. Quantitative data were analyzed using frequencies to provide a demographic and behavioral profile. Qualitative data were analyzed using thematic analysis. RESULTS: Twenty-five adolescents, ages 13-21years, (female N=19, male N=6) participated in the study. Most were in school (92%) and were sexually experienced (68%). Programmatic preferences included in-person programs rather than online. They spontaneously addressed the importance of cultural issues, and the need to address several issues in addition to sexuality, including obesity and substance use. CONCLUSIONS: Programming for this population should address a broad conceptualization of health, and incorporate Dominican cultural issues. PRACTICE IMPLICATIONS: Nurses working with adolescents of Dominican origin, should provide health education that incorporates the specific needs of this population, including culturally congruent face-to-face interventions.

Mexican Adolescents' Self-Reports of Parental Monitoring and Sexual Communication for Prevention of Sexual Risk Behavior.

PURPOSE: Assess perceptions of parental monitoring and sexual communication for sexual health promotion among adolescents who are Mexican. DESIGN AND METHODS: Adolescents (N=153, n=85 females, n=68 males) between 14years (n=80) and 15 years (n=73) were recruited at a public high school in Monterrey in the state of Nuevo Leon, Mexico. All participants were living with a parent(s). Descriptive statistical analyses were conducted to assess sociodemographic characteristics of the group. Chi-square analyses were conducted to identify potential group differences among the adolescents by age, gender and sexual activity regarding responses to each item of the Spanish Version Parental Monitoring and Sexual Communication Scale (a=0.88). RESULTS: Eleven percent of adolescents self-reported sexual activity. Significant group differences by age, gender and sexual activity were identified concerning parental monitoring and sexual communication including: less parental monitoring with older age (14 versus 15 year olds); more parental monitoring for females than males; less monitoring for sexually active adolescents; greater sexual communication for males than females, and among adolescents who were sexually active. CONCLUSIONS: An assessment of adolescents' perceptions of parental monitoring and sexual communication is useful for development of strategies concerning sexual health promotion in Mexico. PRACTICE IMPLICATIONS: The Spanish Version Parental Monitoring and Sexual Communication Scale can be used for assessment and modification of interventions for adolescent populations in Mexico. Information obtained from this assessment can be used to assist parents to enhance positive outcomes for parental monitoring and sexual communication with their children.

Adaptation of the contraceptive self-efficacy scale for heterosexual Mexican men and women of reproductive age.

AIM: Development of a Spanish Version Contraceptive Self-efficacy Scale for use among heterosexual Mexican populations of reproductive age inclusive of 18-35years. BACKGROUND: Methods of family planning have decreased in Mexico which may lead to an increase in unintended pregnancies. Contraceptive self-efficacy is considered a predictor and precursor for use of family planning methods. METHODS: Cross-sectional, descriptive study design was used to assess contraceptive self-efficacy among a heterosexual Mexican population (N=160) of reproductive age (18-35years). Adaptation of a Spanish Version Contraceptive Self-efficacy scale was conducted prior to instrument administration. RESULTS: Exploratory and confirmatory factorial analyses identified seven factors with a variance of 72.812%. The adapted scale had a Cronbach alpha of 0.771. A significant correlation between the Spanish Version Contraceptive Self-efficacy Scale and the use of family planning methods was identified. CONCLUSIONS: The Spanish Version Contraceptive Self-efficacy scale has an acceptable Cronbach alpha. Exploratory factor analysis identified 7 components. A positive correlation between self-reported contraceptive self-efficacy and family planning method use was identified. This scale may be used among heterosexual Mexican men and women of reproductive age. The factor analysis (7 factors versus 4 factors for the original scale) identified a discrepancy for interpretation of the Spanish versus English language versions. Interpretation of findings obtained via the Spanish versión among heterosexual Mexican men and women of reproductive age require interpretation based upon these differences identified in these analyses.

Assessment of Mental Health Literacy among Perinatal Hispanic Adolescents.

According to the United States (U.S.) Census Bureau, Hispanics are the fastest growing ethnic minority in the U.S. As such, Hispanic females have the highest birth rate (35 per 1000) among adolescents between the ages of 15 and 19 years. Despite high fertility rates, there is limited mental health information among Hispanic adolescents during the perinatal period. Perinatal depression is a major concern as it poses health risks for both the mother and infant. Adverse outcomes such as preterm birth, low infant birth weight, and poor maternal-infant attachment may result from perinatal depression. However, less than half of Hispanic adolescent mothers who experience perinatal depression receive treatment. Previous research identified low mental health literacy (MHL) as one of the primary reasons for the limited use of mental health services among ethnic minorities. This study assessed the MHL of pregnant and postpartum Hispanic adolescents (n = 30) using a modified MHL scale. Implications for nursing practice are discussed to help improve mental health outcomes among pregnant and postpartum Hispanic adolescents.

Psychosocial Risk Factors for Perinatal Depression among Female Adolescents: A Systematic Review.

Perinatal depression is a health concern among pregnant and postpartum adolescents as it may negatively impact fetal development and result in complications such as preterm delivery, low infant birth weight, and poor maternal-infant attachment. The purpose of this systematic review is to examine psychosocial risk factors for depression among adolescents during pregnancy and postpartum. A literature search was conducted from five databases from 1995 to 2016. A total of 17 studies matched the inclusion criteria. Lack of social support, perceived stress, prior history of depression, and a history of sexual or physical violence were most frequently identified as potential risk factors for perinatal depression. Additional risk factors include the adolescent's perception of her pregnancy, family criticism, self-efficacy, self-esteem, substance use, parental stress, community violence, anxiety, and African-American ethnicity. Research and clinical implications are indicated for adolescents at risk for perinatal depression.

The Meaning of Weight: A Big Way of Life for Rural Mexican-American Adolescent Men and Caregivers.

OBJECTIVE: To describe the meaning of body weight among rural Mexican-American adolescents (RMAA) and an influential person (IP) of their social network. DESIGN AND SAMPLE: This is qualitative descriptive study. Convenience sampling was used to recruit RMAA seeking care at a rural primary care-based clinic. Content analysis was used to identify categories and subcategories. Fifteen male adolescents and 14 IPs were interviewed (n = 29). MEASURES: Individual interviews were conducted using a semi-structured questionnaire. RESULTS: Participants described body weight through family norms, body size, and history of heart disease or diabetes. Cultural scripts were used to describe weight gain, judgment of size, and resource limitations. CONCLUSIONS: Health care providers must evaluate cultural scripts associated with body size to develop interventions that are derived from the meaning ascribed to weight status rather than simply based on evidence-based standards. ClinicalTrials.gov Identifier: NCT01387646.

Retrospective chart review of obesity and episodic and chronic illness among rural Mexican-American adolescents accessing rural health clinic services.

Obesity impacts the physical and psychological health of children and adolescents, and is a risk factor for development of episodic and chronic illness. Rural Mexican-American adolescents are at risk for obesity and associated chronic illnesses.The study used a retrospective chart review of data collected routinely in a rural health clinic setting from 1 January 2005 to 31 December 2010 to assess incidence of overweight/obesity status and episodic or chronic illness among Mexican-American adolescents aged 12-18 years. Analyses included body mass index, age, gender, and episodic or chronic illness diagnoses. Two hundred twelve charts were audited; women (n = 114, 53.8%), men (n = 98 46.2%); normal (n = 105, 49.5%), overweight/obese (n = 107, 50.5%). There were more female normal (n = 61, 53.5%) vs. overweight/obese (n = 53, 46.5%). More male overweight/obese (n = 54, 55.1%) than normal weight (n = 44, 44.9%). Age at first documented overweight/obesity status occurred in early adolescence (median = 13 years, mode = 12 years). Chronic illness incidence was higher among men than women, and overweight/obese vs. normal weight adolescents and in sub-categorizations by weight and specific illness. Incidence of episodic illness was higher among women than men, with variation by weight and specific illness. Disproportionately high incidence of episodic or chronic illness and overweight/obesity identified among rural Mexican-American adolescents compels intervention modification to improve effectiveness.