Psychometric properties of a modified cultural awareness scale for use in higher education within the health and social care fields.

BACKGROUND: Cultural awareness and cultural competence have become important skills in higher education as populations continue to grow in diversity around the world. However, currently, there are few instruments designed to assess student awareness of the aspects of culture, and the existing instruments need further development and testing for use with different target populations. Therefore, the aim of this study was to test the psychometric properties of a modified version of the Cultural Awareness Scale (CAS) for use in higher education within the health and social care fields. METHODS: A modified version of the CAS was developed, which was tested psychometrically using cross-sectional data. In total, 191 undergraduate students from different health and social care undergraduate programs in Sweden and Hong Kong responded to a call to test the modified instrument. RESULTS: The results showed that the modified CAS is a four-factor measure of cultural awareness and possesses satisfactory internal consistency. Results also support the use of the modified CAS as a generic tool to measure cultural awareness among students in higher education within the health and social care fields. CONCLUSION: The modified CAS showed satisfactory psychometric properties and can be recommended as a generic tool to measure cultural awareness among students in higher education within the health and social care fields. However, further psychometric testing on the effectiveness of the modified CAS as a tool to evaluate the efficacy of cultural awareness interventions is required.

Pharmacodynamics and effectiveness of topical nitroglycerin at lowering blood pressure during autonomic dysreflexia.

STUDY DESIGN: Secondary analysis of prospectively collected observational data assessing the safety of an autonomic dysreflexia (AD) management protocol. OBJECTIVES: To estimate the time to onset of action, time to full clinical effect (sustained systolic blood pressure (SBP) <160 mm Hg) and effectiveness of nitroglycerin ointment at lowering blood pressure for patients with spinal cord injuries experiencing AD. SETTING: US Veterans Affairs inpatient spinal cord injury (SCI) unit. METHODS: Episodes of AD recalcitrant to nonpharmacologic interventions that were given one to two inches of 2% topical nitroglycerin ointment were recorded. Pharmacodynamics as above and predictive characteristics (through a mixed multivariate logistic regression model) were calculated. RESULTS: A total of 260 episodes of pharmacologically managed AD were recorded in 56 individuals. Time to onset of action for nitroglycerin ointment was 9-11 min. Time to full clinical effect was 14-20 min. Topical nitroglycerin controlled SBP <160 mm Hg in 77.3% of pharmacologically treated AD episodes with the remainder requiring additional antihypertensive medications. A multivariate logistic regression model was unable to identify statistically significant factors to predict which patients would respond to nitroglycerin ointment (odds ratios 95% confidence intervals 0.29-4.93). The adverse event rate, entirely attributed to hypotension, was 3.6% with seven of the eight events resolving with close observation alone and one episode requiring normal saline. CONCLUSIONS: Nitroglycerin ointment has a rapid onset of action and time to full clinical effect with high efficacy and relatively low adverse event rate for patients with SCI experiencing AD.

Understanding the reasons why Chinese older people do not wish to tell their life stories.

AIM: To explore the reasons why older Chinese people decline to tell their life stories. BACKGROUND: Promoting the telling of life stories by older people, as part of healthy ageing, may develop their sense of unity and meaning in life. However, not all older adults seem to review their past and tell others about it. Understanding is lacking about how 'healthy' older adults experience the meanings of not telling. DESIGN: A descriptive phenomenology with Giorgi's analysis. METHODS: Data were collected from June 2010-August 2011 through unstructured individual interviews. A potential sample of 36 older people were identified through convenience sampling from 17 daycare and senior centres, of whom 19 participated in this study. RESULTS: Our findings suggest that the reasons why these older people declined to tell their life stories relate to an understanding of the self and to the perception that the older people had of their audience's response and their family's support. Older people seemed to be naturally inclined to reminiscence, but their accumulated personal and interpersonal experiences might have caused them to feel disinclined to talk about what they no longer considered to be important. CONCLUSION: An understanding about the tension existing in cultural/generational narratives of the older people may help health professionals to provide them with a supportive environment for their continuous construction of social identities. This may contribute to their better social health. Equally important is to provide an opportunity for them to share their stories and engage in family and cross-generational dialogues.

Implications for school nursing through interprofessional education and practice.

AIMS AND OBJECTIVES: To explore the interprofessional collaboration between nursing and social work professionals in their delivery of health services for schoolchildren. BACKGROUND: Interprofessional education has long been recommended as a way to meet the need for effective collaboration in school health service with a view to improving the quality of health care. No local study in Hong Kong has looked specifically at how nursing and social work professionals carry out school health services through interprofessional education and practice. Therefore, an examination was conducted of collaboration on a community-based school caring project. DESIGN: A qualitative design was employed, using semi-structured interviews, field observation and field debriefing. METHODS: Seven nursing students and five social work students were recruited and interviewed in 2011. The transcripts were analysed using qualitative content analysis. RESULTS: Three themes were identified: (1) early identification of children's needs through interprofessional collaboration for health promotion, (2) prompt referral for schoolchildren in need, and (3) comprehensive planning and implementation of school health service. CONCLUSION: The strength of collaborative work between nursing and social work professionals is that it helps to identify and address these complex health needs of children. Healthcare providers are hence able to develop a fuller understanding of children's problems, which in turn enables them to provide appropriate and effective health promotion interventions. RELEVANCE TO CLINICAL PRACTICE: The development of interprofessional education for school health services should be envisaged by the local higher educational institute and policy makers to reduce children's risk-taking behaviours and promote their health and well-being. Health educators and health policy makers can better understand how interprofessional education and collaboration can promote children health service for regional and national policy and practice.

Nurses' perception of time availability in patient communication in Hong Kong.

AIMS: To explore nurses' perceptions of their patient communication in practice and to identify their ways of communicating. BACKGROUND: Nurse theorists and clinicians are aware of the importance of nurse-patient communication in providing patient-centred care. However, barriers remain that prevent nurses from implementing quality/effective communication, and time is often viewed as a critical variable. Continuous emphasis on efficiency contravenes patient-centred care, warranting a re-examination of nurses' perception of time in nurse-patient communication. DESIGN: Focus group interviews were adopted. Thirty-nine registered nurses participated. Interviews were tape-recorded, transcribed and translated, and data were analysed using thematic analysis to identify codes, categories and themes/patterns. RESULTS: Three themes were identified regarding nurses' perception of communication with time: (1) Patterns of communication. (2) Routine scheduled communication vs. meeting individuals' needs. (3) Saving time through communication. Patterns of communication, based on participants' criteria such as the purpose, who initiated it, the nature of communication, expectation to perform, therapeutic value and relation with time were explicated. By integrating communication into routines as intended actions, nurses demonstrate that communication and relationship building with patients take no extra time. Good communication and good relationships help nurses save time. CONCLUSIONS: Nurses' communication behaviour is closely related to their perception of communication. This study suggests the need for a paradigm shift in thinking about communication as requiring time. Additionally, nurses should recognise the value of short, iterative interaction and chit-chat as quality communication for knowing their patients and providing patient-centred care. RELEVANCE TO CLINICAL PRACTICE: Nurses should think beyond time in the discourse of effective nurse-patient communication, as it often relates to manpower. An understanding of how nurses perceive their time availability for nurse-patient communication and their use of time for this aspect contribute to the discourse regarding how to improve patient-centred care.

Metabolic epidemiology of colon cancer: effect of dietary fiber on fecal mutagens and bile acids in healthy subjects.

Because of potential significance of fecal mutagens and secondary bile acids in the pathogenesis of colonic cancer and of inverse association between dietary fiber and colonic cancer risk, the effect of dietary wheat and rye fiber on fecal mutagenic activity and bile acid levels was studied in 15 healthy men and women who were consuming high fat/moderately low fiber diets and excreting high levels of fecal mutagens and bile acids. Each participant provided two 24-h stool specimens and a 3-day diet record while consuming their normal diet (control). All subjects were then asked to consume their normal diet plus 11 g of supplemental fiber per day in the form of whole grain bread for 4 weeks. During the last week of diet intervention, each subject provided two 24-h stool specimens and a 3-day dietary record. Fecal samples collected from both periods were analyzed for bile acids and for mutagens using Salmonella typhimurium strains TA98 and TA100 with and without microsomal activation. The concentration of fecal secondary bile acids was significantly lower during the fiber supplemental period in all subjects. Fiber supplementation also inhibited the fecal mutagenic activity in TA100 and TA98 with and without microsomal activation. Thus, the increased fiber intake in the form of whole wheat and rye bread may reduce the production and/or excretion of fecal mutagens and decrease the concentration of fecal secondary bile acids in humans.

Biochemical epidemiology of colon cancer: effect of types of dietary fiber on fecal mutagens, acid, and neutral sterols in healthy subjects.

Several epidemiological studies suggest an inverse relationship between fiber intake and colon cancer risk. Animal model studies indicate that this inhibitory effect depends on the source of dietary fiber. Because of the potential significance of certain colonic mutagens and secondary bile acids in the pathogenesis of colon cancer, the effect of types of supplemental fiber on fecal mutagens and bile acids was studied in human volunteers. Seventy-two healthy individuals consuming high-fat/moderately low-fiber diets were screened for fecal mutagenic activity using the Ames Salmonella typhimurium/microsomal assay system. Twenty-one of them were found to excrete high levels of mutagens, and 19 of them were recruited for the diet intervention study. All participants provided two 24-h stool specimens and a 4-day food record while consuming their normal (control) diet. They were then asked to consume the control diet plus 10 g of dietary fiber from wheat bran, oat fiber, or cellulose for 5 wk. After each fiber period, they were asked to consume their control diet. At the end of each fiber and control diet period, each subject provided two 24-h stool specimens. Stool samples were analyzed for bile acids and mutagens using the Ames strains TA98 and TA100 with or without S9 (microsomal) activation. The concentrations of fecal secondary bile acids (deoxycholic acid, lithocholic acid, and 12-ketolithocholic acid) and of fecal mutagenic activity in TA98 and TA100 with and without S9 activation were significantly lower during the wheat bran and cellulose supplementation periods. Oat fiber supplementation had no such effect on these fecal constituents. Thus, the increased fiber intake in the form of wheat bran or cellulose may reduce the production and/or excretion of mutagens in the stools and decrease the concentration of fecal secondary bile acids in humans.

A virtual caravan--A metaphor for home-internationalization through social media: A qualitative content analysis.

BACKGROUND: An internationalized curriculum in nursing education was created in response to the rise of globalization and the need to provide nursing care to people of diverse cultures. Through technology, internationalization at home can facilitate intercultural experiences for more nursing students. OBJECTIVES: The aim of this study is to explore and describe how a virtual course in intercultural communication between students of two universities, through internationalization at home, can support the development of cultural competence. DESIGN: Qualitative research PARTICIPANTS: Junior year nursing students METHOD: Qualitative content analysis of transcribed written and oral presentations during a course on intercultural communication. RESULTS: Four major themes, which are not mutually exclusive, were identified. CONCLUSION: Through this intercultural experience, without leaving home, students uncovered their cultural selves and others based on their own reflective understanding and collaborative discourse with each other and the use of social media for communication. Through experiential intercultural encounters beyond textbook and online materials, they learned to appreciate each other as people with cultural differences yet with much in common, and to recognize their assumptions and the value of subtleties and nuances. They were able to explore solutions within an unfamiliar context through their own efforts and with the support of peers and teachers. This led to a deeper understanding of cultural sensitivity and competence.

Synthesis and structure-activity relationships of oxamic acid and acetic acid derivatives related to L-thyronine.

Aryloxamic acids 7 and 23, (arylamino)acetic acids 29, arylpropionic acids 33, arylthioacetic acids 37, and (aryloxy)acetic acid 41 related to L-triiodothyronine (L-T3) were prepared and tested in vitro for binding to the rat liver nuclear L-T3 receptor and the rat membrane L-T3 receptor. The structure-activity relationships for these compounds are described, with 7f, 23a, 29c, 33a, 37b, and 41 showing excellent potency (IC50's of 0.19, 0.16, 1.1, 0.11, 3.5, and 0.10 nM, respectively) to the nuclear receptor and significantly lower binding affinity to the membrane receptor (IC50's > 5 microM). Some of these compounds, especially in the oxamic acid series 7 and 23, showed an unprecedented potency for methyl-substituted derivatives such as 7f and 23a. Compounds 7f and 23a showed good lipid lowering effects in rats with ED50's of 20 and 5 micrograms/kg po, respectively, and a lack of cardiac side effects in rats at doses as high as 10 and 25 mg/kg po, respectively.

Practices and problems in HANES. Dietary data methodology.

Between April 1971 and June 1974, the first attempt to assess the nutritional status of the non-institutional population of the U.S. was carried out by the DHEW. The survey is known as "HANES" (U.S. Health and Nutrition Examination Survey). Preliminary findings have been released, and further data are expected to be available soon. In this report, dietary collection methods, training and evaluation of interviewers, types of data collected, and data processing procedures of the survey are described, as well as some of the problems encountered.

Relationships between food consumption and dietary intake among healthy volunteers and implications for meeting dietary goals.

Quantitative food frequency questionnaires and 5-day food records were used to explore relationships between food consumption and nutrient intake among 65 healthy volunteers who were willing to participate in a dietary fiber intervention study. Spearman's correlation coefficient was calculated between the nutrient intake and the frequency of consumption of each food item, as well as the amount consumed per month. Percentage of calories from fat was related to frequency of consumption and amount of consumption, respectively, of bacon (r = .48, .49), frankfurters and sausage (r = .45, .45), and french fries and fried potatoes (r = .43, .39). Frequency and amount, respectively, of consumption of fruits were most highly correlated with intake of vitamin A (r = .45, .46), vitamin C (r = .44, .48), and dietary fiber (r = .43, .43). We conclude that specific food consumption amounts and/or frequency of eating foods such as legumes, fruits, and whole-grain or bran-rich cereals should be recommended to assist individuals in meeting dietary goals.

Diet and serum lipids in vegan vegetarians: a model for risk reduction.

The lipid levels and dietary habits of 31 Seventh-Day Adventist vegan vegetarians (aged 5 to 46 years) who consume no animal products were assessed. Mean serum total cholesterol (3.4 mmol/L), low-density-lipoprotein cholesterol (1.8 mmol/L), and triglyceride (0.8 mmol/L) levels were lower than expected values derived from the Lipid Research Clinics Population Studies prevalence data. Mean high-density-lipoprotein cholesterol (1.3 mmol/L) was comparable to expected values. Analysis of quantitative food frequency data showed that vegans had a significantly lower daily intake of total energy, percentage of energy from fat (31% vs 38%), total fat, saturated fat, monounsaturated fatty acids, cholesterol, and protein and a significantly higher intake of fiber than a sample of matched omnivore controls. Vegans' food intake was also compared with expected values, matched for sex and age, derived from the second National Health and Nutrition Examination Survey and Continuing Survey of Food Intakes by Individuals 24-hour recall data. The vegan diet was characterized by increased consumption of almonds, cashews, and their nut butters; dried fruits; citrus fruits; soy milk; and greens. We conclude from the present study that a strict vegan diet, which is typically very low in saturated fat and dietary cholesterol and high in fiber, can help children and adults maintain or achieve desirable blood lipid levels.

Determination of enantiomers in ephedrine mixtures by polarimetry.

Enantiomeric purities have been measured with precisions that are equivalent to those obtained from chiral chromatography by a simple ligand substitution reaction into the first coordination sphere of Cu(II)-tartrate complexes. The model systems are binary mixtures of the ephedrines. Ligand exchange reactions are done in bulk aqueous media. The detector is polarimetry. Multivariate regression analyses of optical rotation data measured at five wavelengths are used to prepare calibration and prediction models for binary mixtures of the enantiomers.

Fecal mutagens from subjects consuming a mixed-western diet.

Because of potential significance of fecal mutagens (presumptive carcinogens) in the pathogenesis of colon cancer, feces from 99 healthy subjects from the New York metropolitan area were studied. The diet histories indicate that all participants were consuming a mixed-western diet which is high in total fat and low in fiber. Fecal samples that were incubated under anaerobic conditions at 37 degrees C for 96 h or frozen without incubation, were extracted with hexane: peroxide-free diethyl ether (1:1), partially purified on a silica Sep-pak cartridge and assayed for mutagenicity using the Salmonella typhimurium/mammalian microsome system. Aliquots of fecal samples incubated anaerobically showed a higher frequency of mutagenic activity (per cent samples showing activity) in strains TA98 and TA100 with and without microsomal (S9) activation. In addition, the mutagens requiring S9 activation, were more frequently inactivated when the fecal samples were frozen immediately after defecation and transported to the laboratory. Compared with hexane: ether, extraction of fecal samples with acetone increased the mutagenic activity mostly with TA98 with S9 activation. The HPLC fractionation of hexane: ether extract with methanol: water gradient using reverse phase C-18 column and UV detector at 254 nm indicated that the mutagenic activity (TA98 with S9 activation) is concentrated in several peaks. This is the first demonstration of HPLC profile of fecal samples that are active in TA98 with S9 activation. HPLC profile of fecal extracts and mutagenic activity of these extracts in strains TA98 and TA100 suggest the presence of several types of mutagens in the feces of healthy subjects consuming a high-fat, low-fiber mixed-western diet.

Metabolic epidemiology of colon cancer: fecal mutagens in healthy subjects from rural Kuopio and urban Helsinki, Finland.

Fecal mutagenic activity and dietary pattern of rural and urban Finnish population groups with distinct risk for the development of colon cancer were studied in a low-risk population in rural Kuopio and an intermediate-risk population in urban Helsinki. The average daily intake of protein and fat was the same in the two groups but the frequency of consumption of whole-grain cereals and whole-grain bread, as well as the amount of fiber from the bread were higher in Kuopio as compared to Helsinki. Fecal samples collected for 2 days were incubated under anaerobic conditions at 37 degrees C for 96 h, extracted with hexane: peroxide-free diethyl ether, partially purified on a silica Sep-Pak cartridge, and assayed for mutagenic activity using the Salmonella typhimurium/mammalian microsome system. The fecal mutagenic activity was observed with the tester strains TA98 and TA100 with and without microsomal activation in both the population groups. The percentage of samples showing fecal mutagenic ratio greater than 3 with TA98 and TA100 with microsomal activation, was higher in volunteers from Helsinki than in Kuopio.

Induced circular dichroism study of the aqueous solution complexation of cello-oligosaccharides and related polysaccharides with aromatic dyes.

Acetobacter xylinum, grown in the presence of low levels of the water-soluble dye Calcofluor White ST produces a pellicle of cellulose that has no detectable crystallinity. Biological factors of this sort are probably more important than physical factors in controlling the higher order structures of celluloses. Circular dichroism (CD) is induced by complexes that are formed by specific interactions between chiral oligosaccharides and dye molecules. Using CD, equilibrium constants were measured for the association reactions between various dyes with a series of cello-oligosaccharides (n = 2-6), methylcellulose, hydroxypropylcellulose (HPC), amylose, cyclomalto-oligosaccharides (cyclodextrins), and the linear malto-oligosaccharides (n = 3-7). Possible structural features of the complexes are discussed. Dyes that are capable of binding to the higher cello-oligomers in aqueous solutions are the same dyes that modify the solid structure of bacterial cellulose. An analogy between the binding of water-soluble dyes to cello-oligosaccharides and the binding of the cellulose-degrading enzyme, cellobiohydrolase I, to cellulose is discussed.

Gender-related factors influencing perceptions of homosexuality.

There is a long history linking gender role conformity to perceived homosexuality. However, the lack of a systematic theoretical model hinders the elucidation of the interrelationships among gender stereotypes, conformity to gender stereotypes, and perceived homosexuality, as well as other factors which may mediate these relationships. The purpose of the present study was to propose such a model by combining theories of gender stereotype formation and maintenance with research investigating perceptions of homosexuality. Specifically, this study examined college students' perceptions of gender role characteristics in male and female adult target persons and these students' perceptions of the likelihood that the targets were homosexual. Path analysis demonstrated that the sex and occupation of the target person were significantly related to perceived masculinity, femininity, and homosexuality of the target person. Furthermore, individual differences in these relationships were observed, indicating that the sex and gender role characteristics of the participant influenced perceptions of the gender role attributes and homosexuality of the target person.

Cue-responding during simulated routine nursing care: a mixed method study.

BACKGROUND: Failure of nurses to recognize, acknowledge, and/or explore patient cues/concerns may result in patients' unrecognized psychosocial and information needs that could have untoward consequences. With the continuous evidence of the need for nurses to improve their communication, a greater emphasis is needed in the undergraduate nursing curriculum on training students in such skills. OBJECTIVE: This study is to explore the cue-responding behaviors of nursing students during their routine care of patients in a simulated setting. DESIGN: A mixed methods approach. PARTICIPANTS: Senior year students. METHOD: Data was collected by video-taping the students' cue-responding behavior performance, through individual debriefing interviews, and from the student-patient actors' written comments and the focus group. RESULTS: Of the 110 cues in the conversation, 47% were acknowledged, only 12% were explored, and 53% were responded to with distancing behavior. Students' cue-responding behavior was a negative 21.8% with more cues being responded to through distancing behaviors than were acknowledged. Their pattern of communication was characterized by a focus on task completion, the use of predominately close-ended questions, and the giving of explanations and information based on unchecked assumptions. CONCLUSIONS: Learning from their individual video-taped performance and debriefing with facilitators helped the students to not only develop a deeper level of self-awareness and reflection but also caused them to think more about time, the culture of nursing, and the tension between task-focused and patient-centered care. They came to value cue-responding in communication as one way of learning about communicating with patients. Focusing on cue-responding in communication also provided us with insights on the students' understanding of communication and the need for educators to re-emphasize person-centered communication and to deal with issues that go beyond technical skills. Future research is critical to examine its transferability to practice with continuous coaching and role modeling for students in clinical settings.