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1.
Soc Sci Med ; 242: 112568, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31606695

RESUMO

Understanding the drivers of nurses' poor health and the implications for quality of care are important in sustaining a healthy workforce, stimulating professional nursing practice, and ensuring healthy lives while promoting the wellbeing of nurses of all ages. Previous scholarship has identified factors influencing nurses' wellbeing, but have neglected to take a comprehensive approach to assessing the multiple dimensions of nurses' wellbeing and their collective, syndemic effects. Neither have these studies explored the context within which these experiences occur, or how these experiences differ for nurses with multiple marginalized identities in spite of an increasingly diverse workforce. Using the six dimensions of wellness framework, we examined the distinct and interrelated dimensions of nurses' wellbeing that were either enhanced or aggravated by professional practice and how it changed by nurses' race and ethnicity using their situated experiences. The study was conducted using a qualitative research design, which drew on phenomenology and in-depth interviews with Registered and Practical Nurses (n = 70) in two Canadian cities. Of the six dimensions of wellbeing identified, direct care practice enhanced nurses' occupational, intellectual, and spiritual wellbeing, but worsened their physical, emotional and social health. A health gap was found along racial lines, as ethnic minority nurses reported more detrimental effects of direct care nursing on their physical, emotional, occupational, and social wellbeing than their white counterparts. Nurses resorted to institutional structures, social and emotional support from supervisors, coworkers and family members, and engaged in spiritual activities to cope with these adverse health effects. These findings highlight the utility of an adaptable framework in identifying the multiple dimensions and gaps in nurses' wellbeing. Furthermore, our findings echo the urgent need for workplace and safety policies that address issues of diversity and make the work environment safe, equitable and promote nurse productivity and quality care.

2.
J Acad Nutr Diet ; 119(9): 1470-1482, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30940423

RESUMO

INTRODUCTION: Health at Every Size (HAES) is a weight-neutral approach focused on promoting healthy behaviors in people with different body sizes and on enhancing pleasure derived from consuming food to achieve sustainable healthy eating outcomes. However, to the best of our knowledge, there are no studies in the literature assessing the effects of the HAES approach on perceptions of eating pleasure. OBJECTIVE: We qualitatively investigated the perceptions of obese women about eating pleasure before and after a new interdisciplinary, nonprescriptive intervention based on the HAES approach. DESIGN: The intervention was a randomized controlled clinical trial, designated as Health and Wellness in Obesity, conducted over 7 months at University of São Paulo (Brazil). We used a qualitative approach to data construction and analysis of perceptions about eating pleasure. Participants were randomized to either the intervention (I-HAES) group or the control (CTRL) group. The I-HAES group featured individual nutritional counseling, group practice of enjoyable physical activity, and philosophical workshops. The CTRL group was a traditional HAES intervention group (lecture-based model). Focus group discussions eliciting perceptions of pleasure around eating were conducted at baseline and post-study. Focus group transcripts were analyzed by exploratory content analysis. PARTICIPANTS: Forty-three women aged 25 to 50 years with body mass index (measured in kilograms per square meter) between 30 and 39. 9 completed the intervention and the focus groups, with 32 in the I-HAES group and 11 in the CTRL group. RESULTS: Lack of guilt about experiencing pleasure while eating and increased reflection on their own desires increased in participants of both groups after the study. The I-HAES group also displayed a greater sense of autonomy related to eating, increased pleasure in commensality, familiarity with the practice of cooking, and decreased automatic eating. CONCLUSION: HAES-based intervention featuring nutritional counseling, appreciation for physical activity, and philosophical engagement was shown to stimulate pleasure around eating without leading to indiscriminate eating.

3.
BMJ Open ; 9(1): e023558, 2019 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-30782708

RESUMO

INTRODUCTION: A wide range of water-related problems contribute to the global burden of disease. Despite the many plausible consequences for health and well-being, there is no validated tool to measure individual- or household-level water insecurity equivalently across varying cultural and ecological settings. Accordingly, we are developing the Household Water Insecurity Experiences (HWISE) Scale to measure household-level water insecurity in multiple contexts. METHODS AND ANALYSIS: After domain specification and item development, items were assessed for both content and face validity. Retained items are being asked in surveys in 28 sites globally in which water-related problems have been reported (eg, shortages, excess water and issues with quality), with a target of at least 250 participants from each site. Scale development will draw on analytic methods from both classical test and item response theories and include item reduction and factor structure identification. Scale evaluation will entail assessments of reliability, and predictive, convergent, and discriminant validity, as well as the assessment of differentiation between known groups. ETHICS AND DISSEMINATION: Study activities received necessary ethical approvals from institutional review bodies relevant to each site. We anticipate that the final HWISE Scale will be completed by late 2018 and made available through open-access publication. Associated findings will be disseminated to public health professionals, scientists, practitioners and policymakers through peer-reviewed journals, scientific presentations and meetings with various stakeholders. Measures to quantify household food insecurity have transformed policy, research and humanitarian aid efforts globally, and we expect that an analogous measure for household water insecurity will be similarly impactful.

4.
Appetite ; 136: 114-123, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30641158

RESUMO

Although there is increased focus on behavior change programs targeting parents to promote healthy child feeding, success of these programs has been limited. To close this gap, we sought to understand parents' goals for child feeding and their motivations, abilities, and contextual environment that challenged or enabled goal achievement, with a focus on parents' own childhood food experiences. We conducted semi-structured qualitative interviews (n = 21) with low-income parents of at least one child aged 3-11 years in three semi-rural counties in upstate New York to explore their emic perspectives on child feeding goals and practices. Transcripts were coded by at least two researchers using the constant comparative approach. Emergent themes were identified and interpreted in the context of the Motivation-Ability-Opportunity framework. Low-income parents articulated and were clearly motivated to achieve both nutrition- and psychosocial-oriented goals. Salient psychosocial goals (e.g., family meals to promote family relationships, help child feel secure), often led to different child feeding practices than indicated by parents' nutrition-oriented child feeding goals (e.g., nutritious diet, healthful relationship with food). Sometimes these psychosocial goals were in conflict with the nutrition-oriented goals; for example, some parents gave into child food preferences to avoid conflict or hesitated to introduce changes in diets of overweight children to preserve child self-esteem. Prominent contextual barriers included child preferences, life disruptions, and the inflexible time and financial restrictions of poverty. Parents exhibited awareness and motivation to achieve healthy eating goals but success was often thwarted by the salience of psychosocial goals that often motivated less-healthy practices. Thus, behavior change programs should acknowledge the value and relevance of both types of goals and help parents develop strategies to address the tensions between them.

5.
Int Health ; 11(3): 163-165, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30576501

RESUMO

Water insecurity massively undermines health, especially among impoverished and marginalized communities. Emerging evidence shows that household-to-household water sharing is a widespread coping strategy in vulnerable communities. Sharing can buffer households from the deleterious health effects that typically accompany seasonal shortages, interruptions of water services and natural disasters. Conversely, sharing may also increase exposure to pathogens and become burdensome and distressing in times of heightened need. These water sharing systems have been almost invisible within global health research but need to be explored, because they can both support and undermine global public health interventions, planning and policy.


Assuntos
Características da Família , Saúde Global , Abastecimento de Água/estatística & dados numéricos , Humanos
6.
Soc Sci Med ; 220: 12-21, 2018 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-30390470

RESUMO

Community sanitation interventions increasingly leverage presumed innate human disgust emotions and desire for social acceptance to change hygiene norms. While often effective at reducing open defecation and encouraging handwashing, there are growing indications from ethnographic studies that this strategy might create collateral damage, such as reinforcing stigmatized identities in ways that can drive social or economic marginalization. To test fundamental ethnographic propositions regarding the connections between hygiene norm violations and stigmatized social identities, we conducted 267 interviews in four distinct global sites (in Guatemala, Fiji, New Zealand, USA) between May 2015 and March 2016. Based on 148 initial codes applied to 23,278 interview segments, text-based analyses show that stigmatizing labels and other indices of contempt readily and immediately attach to imagined hygiene violators in these diverse social settings. Moral concerns are much more salient at all sites than disease/contagion ones, and hygiene violators are extended little empathy. Contrary to statistical predictions, however, non-empathetic moral reactions to women hygiene violators are no harsher than those of male violators. This improved evidentiary base illuminates why disgust- and shame-based sanitation interventions can so easily create unintended social damage: hygiene norm violations and stigmatizing social devaluations are consistently cognitively connected.

7.
J Natl Med Assoc ; 2018 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-30420078

RESUMO

BACKGROUND: Little is known about how pre-resettlement experiences affect refugees' uptake of cancer screenings. The objective of this study was to characterize Somali Bantu and Karen experiences with cancer and cancer screenings prior to and subsequent to resettlement in Buffalo, NY in order to inform engagement by health providers. METHODS: The study was grounded in a community-based participatory research approach, with data collection and analysis guided by the Health Belief Model and life course framework. Interviews were transcribed, independently coded by two researchers, and analyzed using an immersion-crystallization approach. We conducted 15 semi-structured interviews and six interview-focus group hybrids with Somali Bantu (n = 15) and Karen (n = 15) individuals who were predominantly female (87%). RESULTS: Cancer awareness was more prevalent among Karen compared to Somali Bantu participants. Prior to resettlement, preventative health care, including cancer screening, and treatment were unavailable or inaccessible to participants and a low priority compared with survival and acute health threats. There, Somali Bantu treated cancer-like diseases with traditional medicine (heated objects, poultices), and Karen reported traditional medicine and even late-stage biomedical treatments were ineffective due to extent of progressed, late-stage ulcerated tumors when care was sought. A fatalistic view of cancer was intertwined with faith (Somali Bantu) and associated with untreated, late-stage cancer (Karen). Karen but not Somali Bantu reported individuals living with cancer were stigmatized pre-resettlement due to the unpleasant manifestations of untreated, ulcerated tumors. Now resettled in the U.S., participants reported obtaining cancer screenings was challenged by transportation and communication barriers and facilitated by having insurance and interpretation services. While Somali Bantu women strongly preferred a female provider for screenings, Karen women felt cancer severity outweighed cultural modesty concerns in terms of provider gender. SIGNIFICANCE: Our findings suggest the need for culturally-relevant cancer education that incorporates the life course experiences and addresses logistical barriers in linking individuals with screening, to be complemented by trauma-informed care approaches by healthcare providers.

8.
Int J Health Policy Manag ; 7(7): 630-644, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29996583

RESUMO

BACKGROUND: Despite increased access to treatment and reduced incidence, vertical transmission of HIV continues to pose a risk to maternal and child health in sub-Saharan Africa. Performance-based financing (PBF) directed at healthcare providers has shown potential to improve quantity and quality of maternal and child health services. However, the ways in which these PBF initiatives lead to improved service delivery are still under investigation. METHODS: Therefore, we implemented a longitudinal-controlled proof-of-concept PBF intervention at health facilities and with community-based associations focused on preventing vertical transmission of HIV (PVT) in rural Mozambique. We hypothesized that PBF would increase worker motivation and other aspects of the workplace environment in order to achieve service delivery goals. In this paper, we present two objectives from the PBF intervention with public health facilities (n=6): first, we describe the implementation of the PBF intervention and second, we assess the impact of the PBF on health worker motivation, key factors in the workplace environment, health worker satisfaction, and thoughts of leaving. Implementation (objective 1) was evaluated through quantitative service delivery data and multiple forms of qualitative data (eg, quarterly meetings, participant observation (n=120), exit interviews (n=11)). The impact of PBF on intermediary constructs (objective 2) was evaluated using these qualitative data and quantitative surveys of health workers (n=83) at intervention baseline, midline, and endline. RESULTS: We found that implementation was challenged by administrative barriers, delayed disbursement of incentives, and poor timing of evaluation relative to incentive disbursement (objective 1). Although we did not find an impact on the motivation constructs measured, PBF increased collegial support and worker empowerment, and, in a time of transitioning implementing partners, decreased against desire to leave (objective 2). CONCLUSION: Areas for future research include incentivizing meaningful quality- and process-based performance indicators and evaluating how PBF affects the pathway to service delivery, including interactions between motivation and workplace environment factors.


Assuntos
Infecções por HIV/prevenção & controle , Pessoal de Saúde/economia , Pessoal de Saúde/psicologia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Reembolso de Incentivo , Adulto , Atitude do Pessoal de Saúde , Pré-Escolar , Feminino , Infecções por HIV/transmissão , Pessoal de Saúde/estatística & dados numéricos , Humanos , Lactente , Estudos Longitudinais , Masculino , Serviços de Saúde Materno-Infantil , Motivação , Moçambique , Reorganização de Recursos Humanos/estatística & dados numéricos , Poder (Psicologia) , Gravidez , Serviços de Saúde Rural , Inquéritos e Questionários
9.
Prev Med Rep ; 10: 144-149, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29755933

RESUMO

Obesity is socially stigmatized in the U.S., especially for women. Significant research has focused on the role that the social and built environments of neighborhoods play in shaping obesity. However, the role of obesity in shaping neighborhood social structure has been largely overlooked. We test the hypothesis that large body size inhibits an individual's engagement in his or her neighborhood. Our study objectives are to assess if (1) body size (body mass index) interacts with gender to predict engagement in one's neighborhood (neighborhood engagement) and (2) if bonding social capital interacts with gender to predict neighborhood engagement independent of body size. We used data collected from the cross-sectional 2011 Phoenix Area Social Survey (PASS), which systematically sampled residents across four neighborhood types (core urban, urban fringe, suburban, retirement) across the Phoenix Metopolitian Area. Survey data was analyzed using logistic regression for 804 participants, including 35% for whom missing data was computed using multiple imputation. We found that as body size increases, women-but not men-have reduced engagement in their neighborhood, independent of bonding social capital and other key covariates (objective 1). We did not observe the interaction between gender and bonding social capital associated with neighborhood engagement (objective 2). Prior scholarship suggests obesity clusters in neighborhoods due to processes of social, economic, and environmental disadvantage. This finding suggests bi-directionality: obesity could, in turn, undermine neighborhood engagement through the mechanism of weight stigma and discrimination.

10.
Int J Health Policy Manag ; 7(12): 1130-1137, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30709088

RESUMO

BACKGROUND: Primary healthcare facility managers (PHFMs) occupy a unique position in the primary healthcare system, as the only cadre combining frontline clinical activities with managerial responsibilities. Often serving as 'street-level bureaucrats,' their perspectives can provide contextually relevant information about interventions for strengthening primary healthcare delivery, yet such perspectives are under-represented in the literature on primary healthcare strengthening. Our objective in this study was to explore perspectives of PHFMs in western Kenya regarding how to leverage human resource factors to improve immunization programs, in order to draw lessons for strengthening of primary healthcare delivery. METHODS: We employed a sequential mixed methods approach. We conducted in-depth interviews with key informants in Kakamega County. Emergent themes guided questionnaire development for a cross-sectional survey. We randomly selected 94 facility managers for the survey which included questions about workload, effects of workload on immunization program, and appropriate measures to address workload effects. Participants provided self-assessment of their general motivation at work, their specific motivation to ensure that all children in their catchment areas were fully immunized, and recommendations to improve motivation. Participants were asked about frequency of supervisory visits, supervisor activities during those visits, and how to improve supervision. RESULTS: The most frequently reported consequences of high workload were reduced accuracy of vaccination records (47%) and poor client counseling (47%). Hiring more clinical staff was identified as an effective remedy to high workload (69%). Few respondents (20%) felt highly motivated to ensure full immunization coverage and only 13% reported being very motivated to execute their role as a health worker generally. Increasing frequency of supervisory visits and acting on the feedback received during those visits were mostly perceived as important measures to improve program effectiveness. CONCLUSION: Besides increasing the number of staff providing clinical care, PHFMs endorsed introducing some financial incentives contingent on specified targets and making supervisory visits meaningful with action on feedback as strategies to increase program effectiveness in primary healthcare facilities in Kenya. Targeting health worker motivation and promoting supportive supervision may reduce missed opportunities and poor client counseling in primary healthcare facilities in Kenya.


Assuntos
Pessoal de Saúde/psicologia , Programas de Imunização/organização & administração , Administração de Recursos Humanos/métodos , Atenção Primária à Saúde/organização & administração , Carga de Trabalho/psicologia , Atitude do Pessoal de Saúde , Estudos Transversais , Pessoal de Saúde/estatística & dados numéricos , Humanos , Quênia , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos
11.
Hum Resour Health ; 14(1): 60, 2016 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-27717388

RESUMO

BACKGROUND: Performance-based incentives (PBIs) have garnered global attention as a promising strategy to improve healthcare delivery to vulnerable populations. However, literature gaps in the context in which an intervention is implemented and how the PBIs were developed exist. Therefore, we (1) characterized the barriers and promoters to prevention of vertical transmission of HIV (PVT) service delivery in rural Mozambique, where the vertical transmission rate is 12 %, and (2) assessed the appropriateness for a PBI's intervention and application to PVT. METHODS: We conducted 24 semi-structured interviews with nurses, volunteers, community health workers, and traditional birth attendants about the barriers and promoters they experienced delivering PVT services. We then explored emergent themes in subsequent focus group discussions (n = 7, total participants N = 92) and elicited participant perspectives on PBIs. The ecological motivation-opportunity-ability framework guided our iterative data collection and thematic analysis processes. RESULTS: The interviews revealed that while all health worker cadres were motivated intrinsically and by social recognition, they were dissatisfied with low and late remuneration. Facility-based staff were challenged by factors across the rest of the ecological levels, primarily in the opportunity domain, including the following: poor referral and record systems (work mandate), high workload, stock-outs, poor infrastructure (facility environment), and delays in obtaining patient results and donor payment discrepancies (administrative). Community-based cadres' opportunity challenges included lack of supplies, distance (work environment), lack of incorporation into the health system (administration), and ability challenges of incorrect knowledge (health worker). PBIs based on social recognition and that enable action on intrinsic motivation through training, supervision, and collaboration were thought to have the most potential for targeting improvements in record and referral systems and better integrating community-based health workers into the health system. Concerns about the implementation of incentives included neglect of non-incentivized tasks and distorted motivation among colleagues. CONCLUSIONS: We found that highly motivated health workers encountered severe opportunity challenges in their PVT mandate. PBIs have the potential to address key barriers that facility- and community-based health workers encounter when delivering PVT services, specifically by building upon existing intrinsic motivation and leveraging highly valued social recognition. We recommend a controlled intervention to monitor incentives' effects on worker motivation and non-incentivized tasks to generate insights about the feasibility of PBIs to improve the delivery of PVT services.


Assuntos
Atitude do Pessoal de Saúde , Infecções por HIV/prevenção & controle , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Motivação , Administração de Recursos Humanos/métodos , Remuneração , Serviços de Saúde Rural , Adulto , Agentes Comunitários de Saúde , Feminino , Grupos Focais , Humanos , Masculino , Tocologia , Moçambique , Enfermeiras e Enfermeiros , Pesquisa Qualitativa , Recompensa , População Rural , Voluntários
12.
AIDS Care ; 28(6): 778-94, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26883903

RESUMO

Despite significant biomedical and policy advances, 199,000 infants and young children in sub-Saharan Africa (SSA) became infected with HIV in 2013, indicating challenges to implementation of these advances. To understand the nature of these challenges, we sought to (1) characterize the barriers and facilitators that health workers encountered delivering prevention of vertical transmission of HIV (PVT) services in SSA and (2) evaluate the use of theory to guide PVT service delivery. The PubMed and CINAHL databases were searched using keywords barriers, facilitators, HIV, prevention of vertical transmission of HIV, health workers, and their synonyms to identify relevant studies. Barriers and facilitators were coded at ecological levels according to the Determinants of Performance framework. Factors in this framework were then classified as affecting motivation, opportunity, or ability, per the Motivation-Opportunity-Ability (MOA) framework in order to evaluate domains of health worker performance within each ecological level. We found that the most frequently reported challenges occurred within the health facility level and spanned all three MOA domains. Barriers reported in 30% or more of studies from most proximal to distal included those affecting health worker motivation (stress, burnout, depression), patient opportunity (stigma), work opportunity (poor referral systems), health facility opportunity (overburdened workload, lack of supplies), and health facility ability (inadequate PVT training, inconsistent breastfeeding messages). Facilitators were reported in lower frequencies than barriers and tended to be resolutions to challenges (e.g., quality supervision, consistent supplies) or responses to an intervention (e.g., record systems and infrastructure improvements). The majority of studies did not use theory to guide study design or implementation. Interventions addressing health workers' multiple ecological levels of interactions, particularly the health facility, hold promise for far-reaching impact as distal factors influence more proximal factors. Incorporating theory that considers factors beyond the health worker will strengthen endeavors to mitigate barriers to PVT service delivery.


Assuntos
Competência Clínica , Infecções por HIV/prevenção & controle , Pessoal de Saúde/psicologia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez , Serviços Preventivos de Saúde , África ao Sul do Saara , Criança , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , Soropositividade para HIV/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Motivação , Gravidez
13.
Chronic Illn ; 9(2): 145-55, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23585634

RESUMO

OBJECTIVES: This article reports on results of a qualitative study of social supports and institutional resources utilized by individuals living with diabetes in a high-poverty urban setting. The goal was to examine how access to social capital among low-income populations facilitates and impedes their self-efficacy in diabetes self-management. METHODS: Semi-structured interviews were conducted with 34 patients with diabetes from a safety net primary care practice in Buffalo, New York. RESULTS: Facilitators and barriers to successful self-management were identified in three broad areas: (1) the influence of social support networks; (2) the nature of the doctor-patient relationship; and (3) the nature of patient-health care system relationship. Patients' unmet needs were also highlighted across these three areas. DISCUSSION: Participants identified barriers to effective diabetes self-management directly related to their low-income status, such as inadequate insurance, and mistrust of the medical system. It may be necessary for patients to activate social capital from multiple social spheres to achieve the most effective diabetes management.


Assuntos
Automonitorização da Glicemia , Diabetes Mellitus/terapia , Relações Médico-Paciente , Pobreza , Apoio Social , Automonitorização da Glicemia/economia , Assistência à Saúde , Diabetes Mellitus/economia , Empatia , Feminino , Humanos , Seguro Saúde , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , New York , Educação de Pacientes como Assunto , Pesquisa Qualitativa , Confiança
14.
Chronic Illn ; 9(1): 43-56, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22679244

RESUMO

OBJECTIVES: This study explores the perceptions, attitudes, and beliefs that inform how people live with diabetes in a high poverty, ethnically diverse neighborhood with a growing population of refugees. The specific research objective was to examine participants' explanations of how their diabetes began, understandings about the illness, description of symptoms, as well as physical and emotional reactions to the diagnosis. METHODS: Qualitative design using semi-structured interviews. The transcripts were analyzed using an immersion-crystallization approach. RESULTS: Thirty four individuals diagnosed with diabetes for at least 1 year participated. The sample included 14 refugees (from Somalia, Sudan, Burma, or Cuba), eight Puerto Ricans, six non-Hispanic Caucasians, six African-Americans, and two Native Americans. Three broad themes were identified across ethnic groups: (a) the diagnosis of diabetes was unexpected; (b) emotional responses to diabetes were similar to Kubler-Ross's stages of grief; (c) patients' understanding of diabetes focused on symptoms and diet. CONCLUSIONS: Patients were frequently stunned by the diagnosis of diabetes, and expressed emotions associated with the stages of grief including denial, anger, bargaining, depression, and acceptance. Our findings suggest that clinicians might consider addressing the patients' emotions or grief reaction as an early priority to promote acceptance as a first step to self-management.


Assuntos
Atitude Frente a Saúde , Diversidade Cultural , Diabetes Mellitus/psicologia , Áreas de Pobreza , Adaptação Psicológica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ira , Atitude Frente a Saúde/etnologia , Grupos de Populações Continentais/psicologia , Negação (Psicologia) , Depressão , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/economia , Diabetes Mellitus/etnologia , Feminino , Pesar , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , New York , Projetos Piloto , Pesquisa Qualitativa , Refugiados/psicologia , Adulto Jovem
15.
Int J Circumpolar Health ; 70(4): 396-406, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21884655

RESUMO

OBJECTIVES: This paper documents an exceptional research partnership developed between the Vuntut Gwitchin Government (VGG) in Old Crow, Yukon, with a group of scientists to examine northern food security and health as part of a larger, multidisciplinary International Polar Year (IPY) research program. We focus on the elements that enabled a successful community-researcher relationship. Study design. The VGG led the development of the research and acted as Principal Investigator on the IPY grant. The multidisciplinary collaboration spanned the physical, biological and health sciences, including issues related to food security. METHODS: The food security and health component of this research was carried out using a series of complementary methods, including focus groups, structured interviews, a household questionnaire, an interactive workshop, community meetings, transcript analysis and a caribou flesh exposure assessment. RESULTS: Results from the food security component are informing local and regional adaptation planning. The legacy of the research collaboration includes a number of results-based outputs for a range of stakeholders, a community-based environmental monitoring program, long-term research relationships and improved community capacity. CONCLUSIONS: The type of collaboration described here provides a useful model for new types of participatory health research with northern communities.


Assuntos
Pesquisa Participativa Baseada na Comunidade , Índios Norte-Americanos , Mudança Climática , Grupos Focais , Abastecimento de Alimentos , Pesquisa sobre Serviços de Saúde , Humanos , Territórios do Noroeste , Inquéritos e Questionários
16.
Environ Res ; 111(6): 881-7, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21700277

RESUMO

The contamination of traditional foods with chemical pollutants is a challenge to the food security of Aboriginal Peoples. Mercury levels are generally low in terrestrial animals; however renal mercury levels have been shown to change over time in the Porcupine Caribou Herd, the principal food source for the Vuntut Gwitchin First Nation of Old Crow in Yukon, Canada. Seventy-five Porcupine Caribou muscle, sixty-three kidney and three liver samples were analyzed for total mercury. Average concentrations were 0.003, 0.360 and 0.120mg/kg wet weight total mercury for muscle, kidney and liver, respectively. Consumption data of caribou muscle, kidney and liver were collected from twenty-six adults in Vuntut Gwitchin households. Women of child-bearing age (n=5) consumed a median of 71.5g/person/day of caribou muscle and 0.0g/person/day kidney but consumed no liver; median consumptions for all other adults (women aged 40+ and all men, n=21) were 75.8, 3.2 and 2.5g/person/day for meat, kidney and liver, respectively. Median dietary exposures to total mercury from caribou tissues were estimated to be 0.138µg/kg body weight for women of child-bearing age and 0.223µg/kg body weight for other adults. Caribou tissues were found to contribute high levels of important nutrients to the diet and pose minimal health risk from mercury exposure.


Assuntos
Contaminação de Alimentos , Índios Norte-Americanos , Carne/análise , Mercúrio/toxicidade , Adulto , Animais , Dieta , Exposição Ambiental , Feminino , Humanos , Rim/química , Fígado/química , Masculino , Músculo Esquelético/química , Rena , Medição de Risco , Adulto Jovem , Yukon
17.
Int J Circumpolar Health ; 70(3): 286-300, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21631967

RESUMO

OBJECTIVES: This study sought to evaluate food consumption patterns in the context of food security in two Yukon First Nations communities. STUDY DESIGN: Twenty-nine members of Vuntut Gwitchin households in Old Crow and 33 members of Tlingit households in Teslin participated in individual interviews. METHODS: Food frequency questionnaires were used to quantify traditional food consumption throughout the spring 2007 and winter 2008 and to identify potential temporal trends through a comparison with data from the early 1990s. Additional questions, including the Health Canada Household Food Security Survey Module, sought to assess food security concerns in each community. RESULTS: Overall frequency of traditional food consumption did not change in either community from the 2 time-point analyses. There was, however, a difference in frequency of consumption of certain groups of foods, and this highlighted the degree to which environmental variability affects the availability of foods. CONCLUSION: The importance of traditional foods in the diet of Yukon First Nations has not changed over the past 15 years. However, limited availability of food species, access to harvesting equipment and decrease in available time to go out on the land to harvest are food security challenges facing households today.


Assuntos
Dieta , Abastecimento de Alimentos , Grupos Populacionais , Adulto , Idoso , Regiões Árticas , Canadá , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
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