The Design of a Multi-component Intervention to Promote Screening Mammography in an American Indian Community: The Native Women's Health Project.

BACKGROUND: Breast cancer is an important public health issue among American Indian/Alaska Native (AI/AN) women in the US. This article describes the design and implementation of a culturally sensitive intervention to promote breast health among AI/AN women through a hybrid model that incorporates clinical and community-based approaches. This is one of the first studies using this model addressing breast cancer disparities among AI/AN populations in the US. METHODS: The Theory of Planned Behavior was used as the guiding framework of the intervention and Community Based Participatory Research was the primary vehicle for the intervention planning and implementation. Three preliminary studies took place that aimed to identify qualitatively and quantitatively what deterred or encouraged AI women to get past or future mammograms. The research results were shared with community members who, through a prioritization process, identified the theoretical focus of the intervention and its corresponding activities. The priority population consisted of AI women ages 40-74, with no recent mammogram, and no breast cancer history. RESULTS: The intervention centered on the promotion of social modeling and physician recommendation. The main corresponding activities included enhancing patient-physician communication about screening mammography through a structured dialogue, receipt of a breast cancer brochure, participation in an inter-generational discussion group, and a congratulatory bracelet upon receipt of a mammogram. Environmental and policy related changes also were developed. CONCLUSION: Creating a theory-based, culturally-sensitive intervention through tribal participatory research is a challenging approach towards eliminating breast cancer disparities among hard-to-reach populations.

American Indian Diabetes Beliefs and Practices: Anxiety, Fear, and Dread in Pregnant Women With Diabetes.

Diabetes among American Indian (AI) people is a health disparities condition that creates excessive morbidity and mortality. This research delineated culturally constructed models of type 2 diabetes among 97 pregnant women in two large AI nations in Oklahoma. The data analysis of explanatory models of type 2 diabetes revealed the participants' intense anxiety, fear, and dread related to the condition. The sample was further stratified by combinations of diabetes status: 1) absence of type 2 diabetes (n = 66), 2) type 2 diabetes prior to pregnancy (n = 4), and 3) gestational diabetes (n = 27). Patients were interviewed regarding perceptions of the etiology, course, and treatment of diabetes. The research incorporated an integrated phenomenologic and ethnographic approach using structured and semi-structured interviews to yield both quantitative and qualitative data. General findings comprised three main categories of patients' concerns regarding type 2 diabetes as an illness: 1) mechanical acts (i.e., injections), 2) medical complications, and 3) the conceptual sense of diabetes as a "severe" condition. Specific findings included significant fear and anxiety surrounding 1) the health and well-being of the unborn child, 2) the use of insulin injections, 3) blindness, 4) amputation, and 5) death. Paradoxically, although there was only a slight sense of disease severity overall, responses were punctuated with dread of specific outcomes. The latter finding is considered consistent with the presence of chronic diseases that can usually be managed but present risk of severe complications if not well controlled.

Perceptions and Concerns Regarding Diabetes Mellitus During Pregnancy Among American Indian Women.

Diabetes among American Indian (AI) people is a. condition that creates excessive morbidity and mortality and is a significant health disparity. This research delineated culturally constructed models of diabetes mellitus (DM) among 97 pregnant women in 2 large AI Nations to Oklahoma. Analysis of data revealed intense anxiety, fear, and dread related to DM during pregnancy. The sample was stratified by DM status: (a) absence of DM (n = 66), (b) DM prior to pregnancy (n = 4), and (c) gestational (n = 27). Structured and semistructured interviews elicited patient culturally based explanatory models (EMs) of etiology, course, and treatment. The research incorporated an integrated phenomenologic and ethnographic approach and yielded both quantitative and qualitative data. General findings comprised the following main categories of patients' concerns regarding DM as an illness: (a) care-seeking behaviors, (b) medical management, (c) adherence and self-management, (d) complications, and (e) the conceptual sense of DM as a "severe" and feared condition. Many findings varied according to acculturation status, but all included significant fear and anxiety surrounding (a) the health and well-being of the unborn child, (b) the use of insulin injections, (c) blindness, (d) amputation, and (e) death, but with (f) a paradoxically lowered anxiety level about diabetes severity overall, while at the same time expressing extreme dread of specific outcomes. The latter finding is considered consistent with the presence of chronic conditions that can usually be managed, yet still having risk if severe.

American Indian Diabetes Prevention Center: Challenges of a Health Equity Quest.

American Indians are classified by the federal government as a "health disparities population" with significant excess morbidity and mortality caused by diabetes and its many complications. The National Institute on Minority Health and Health Disparities of the National Institutes of Health has created a national program titled "Centers of Excellence" whose primary goal is the elimination of health disparities. This article describes the American Indian Diabetes Prevention Center at the University of Oklahoma Health Sciences Center, College of Public Health, in terms of its intellectual foundations rooted in a biocultural analytic model and operationalized by an interdisciplinary functioning staff. Challenges are described in terms of the monumental task of impacting health disparity conditions and in the exigencies of research collaborations with American Indian Nations located in rural areas remote to the University's health sciences urban-based hub.

Dose-dependent effects of acute exercise on PKC levels in rat heart: is PKC the heart's prophylactic?

UNLABELLED: Epidemiological studies have demonstrated that chronic exercise is cardioprotective, and recent evidence from our laboratory suggests a key role for protein kinase C (PKC)-dependent pathways, at least in part, as a cellular basis for this response. However, the dose-response relationship linking exercise volume and the time course of isoform-specific PKC activation are poorly understood. AIM: The purpose of this investigation was to determine the effects of acute exercise of varying durations on PKC subcellular distribution and phosphorylation in the rat left ventricle. METHODS: Adult (5 months) male Fischer-344 more rats were subjected to a single bout (OB) or 7 days (SB) of treadmill running (n = 6/group; 23 m min-1, 20 min), and compared with sedentary controls (SED; n = 8). Hearts were isolated immediately after [early window (EW); n = 3/group] or 24 h after the last exercise bout [late window (LW); n = 3/group] in OB and SD, respectively. Total PKC and subcellular distribution for the alpha, delta, epsilon, betaI, and betaII isoforms, as well as phosphorylated (phospho-) PKC epsilon (pSer729), PKC alpha (pSer657) and PKCdelta (pThr507) levels were assessed by western blotting. Protein kinase C epsilon and PKC alpha mRNA levels were assessed by real time polymerase chain reaction. RESULTS: Following OB, PKCbetaI protein levels were reduced, while total phospho-PKC epsilon (pSer729), PKC alpha (pSer657) and PKC delta (pThr507) levels were increased during EW (P < 0.05). Interestingly, total PKC delta (31%) and membrane-associated PKC alpha (24%) levels decreased from EW to LW (P < 0.05). In contrast, SB yielded chronic increases in total PKC epsilon (80.5%) levels and PKC delta (20.0%) levels (P < 0.03), with reversal of effects on phospho-PKC epsilon (Ser729), phospho-PKC alpha (Ser657) and phospho-PKC delta (Thr507) levels observed with OB. Reductions in total phospho-PKC alpha (Ser657) persisted at SB (26.1%; P < 0.02). Interestingly, mRNA levels for PKC epsilon were significantly increased following SB while PKC alpha mRNA levels were reduced, respectively. CONCLUSION: These data suggest that divergent patterns of PKC activation occur following OB and SB at both the transcriptional and translational levels. That similar patterns of PKC translocation are observed in experimental models of ischaemic preconditioning and genetic PKC manipulation provide evidence for a dose-dependent cardioprotective phenotype induced by physical activity.