CULTURE OF OPPRESSION IN AFRICAN-AMERICANS WITH HEART FAILURE.

African-Americans are disproportionately affected and have a greater incidence of heart failure compared to other populations. Current literature identifies many contributory factors, among which is the role of culture. Culture, defined to include socioeconomic status and the historical and sociological experience of African-Americans, may play a pivotal role in how clients manage their symptoms of heart failure. This study attempts to explain how culture contributes to the lack of successful management of heart failure among African-Americans using the framework of Hofstede's cultural dimensions of power distance and individualism.

Fulbrighter's journey.

This article provides a synopsis of a Fulbright scholar's journey to Jordan, filled with challenges, opportunities, and life-changing experiences. The author received a Fulbright lecturing award for 2011-2012 for the Jordan University of Science and Technology School of Nursing. This manuscript discusses the experience of teaching graduate students in nursing in the Middle East, collaborating with Muslim professors on research projects, and organizing a fundraiser that provided financial support for refugees and disadvantaged students at the university.

Sugar-Sweetened Beverages Contribute Significantly to College Students' Daily Caloric Intake in Jordan: Soft Drinks Are Not the Major Contributor.

Sugar sweetened beverages (SSBs) are caloric-dense and associated with poor diet quality which may result in weight gain and obesity. Obesity is an independent risk factor for several chronic diseases. This study aimed to (1) assess the consumption level of SSBs among college students in Jordan and (2) examine the relationship of consumption level to body weight. The current study is a cross-sectional study conducted on 967 college students (55.3% males and 44.7% females). Consumption of SSBs was assessed using validated questionnaires. SSBs were classified into four major categories (hot drinks, fruit drinks, energy drinks, and soft drinks). Anthropometric measurements of the participants including body weight, height, and waist circumferences were recorded. Male students consumed more calories from SSBs compared to female students (p = 0.016). The mean contribution of SSBs to daily energy intake among college students was 480 kcal with the highest contribution from sugar sweetened hot drinks and fruit drinks. A significant positive relationship was found in BMI (p = 0.006) and waist circumference (p = 0.030) for participants consuming calories from SSBs. In conclusion, beverages with added sugar contribute substantially to the daily energy intake of college students in Jordan.

Are there gender differences in the reasons why African Americans delay in seeking medical help for symptoms of an acute myocardial infarction?

OBJECTIVES: To identify gender differences in delay time and the reasons why African Americans delay in seeking medical care for symptoms of acute myocardial infarction (AMI). DESIGN: Cross-sectional. SETTING: Five hospitals in the San Francisco and East Bay areas. PATIENTS: Sixty-one African American men and women diagnosed with an AMI. MAIN OUTCOME MEASURES: Prehospital delay time. RESULTS: Median delay time was longer for women compared to men (4.4 hours vs 3.5 hours), although the difference was not significant. Single women delayed longer than single men (P = .03), and women who were alone when symptoms began delayed longer than women with someone (P = .03). Women who received advice to seek help or call 911 upon symptom onset had shorter delays compared to women who were not advised to call 911 (P = .01). Men at home delayed longer than men who experienced their symptoms outside the home (P = .01). Men with emergency room insurance delayed longer than men without emergency room insurance (P = .03), and men who took an ambulance to the hospital had shorter delay times than men who took other means of transportation (P = .04). CONCLUSION: Women compared to men often delay seeking treatment for an AMI, which further increases their risks. Our findings suggest specific characteristics that can serve as a profile to those African Americans most likely to delay seeking treatment for AMI.

Factors associated with prolonged prehospital delay of African Americans with acute myocardial infarction.

BACKGROUND: Delays in seeking treatment for signs and symptoms of acute myocardial infarction are longer for African Americans than for whites. OBJECTIVE: To determine factors associated with prolonged delay and the extent to which perceived racism influences prehospital delay in African Americans with acute myocardial infarction. METHODS: Sixty-one African Americans with acute myocardial infarction were interviewed within 1 month of hospital admission. Delay times were calculated on the basis of the interviews. Independent t tests and chi(2) tests were used to determine factors associated with prolonged delays. RESULTS: Median delay was 4.25 hours and did not differ significantly between women and men (4.42 vs 3.50 hours). Most patients (69%) experienced their initial signs and symptoms at home, often witnessed by family members or friends (70%). Delay was longer for insured patients than for uninsured patients (4.45 vs 0.50 hours). Single, widowed, or divorced patients had longer delay times than did married patients (5.33 vs 2.50 hours), and patients with diabetes delayed longer than did those without diabetes (7.29 vs 3.50 hours). Perceived racism did not differ significantly between patients who delayed seeking treatment and those who did not. CONCLUSIONS: Median delay times were substantially longer than the recommended time of less than 1 hour, reducing the benefit from reperfusion therapies. Education and counseling of patients and their families should be a major strategy in optimizing patients' outcomes and decreasing the time to definitive treatment.

Accustomed to enduring: experiences of African-American women seeking care for cardiac symptoms.

OBJECTIVE: Understand the meaning of delayed treatment seeking in African-American women with unstable angina and myocardial infarction. METHODS: Phenomenologic analysis of in-depth interview data and field notes on 12 African-American women hospitalized with unstable angina or myocardial infarction. RESULTS: Women's interpretation of and response to symptoms were informed by experiences of marginalization and their self-understanding as people who were strong and who had endured life's hardships. When hospitalized, some women experienced trivialization of their complaints by clinicians and a focus on technological procedures over respectfully attending to their concerns, which provided further disincentives to seeking care. Three major themes emerged: misrecognition and discounting of symptoms, enduring, and influence of faith. CONCLUSIONS: Experiences of marginalization shape responses to symptoms, care-seeking behavior, and interpretation of subsequent care experiences for African-American women with cardiac disease, who may experience different symptoms as well as interpret them differently than members of other groups.

Women and heart disease: missed opportunities.

One woman dies of cardiovascular disease (CVD) every minute in the United States. CVD is the primary cause of mortality in US women, substantially affecting the lives of African American women compared to other ethnic groups. In a national survey conducted by the American Heart Association, 87% of women surveyed failed to cite heart disease as a major threat to their health. These misperceptions may lead women to underestimate their risk for CVD, resulting in a delay in seeking medical care, thus increasing their morbidity and mortality rates. Professional association guidelines and Internet resources for women and their health care providers are available to address the risk factors of smoking, diabetes mellitus, obesity, hypertension, hyperlipidemia, and physical inactivity. Unless women are informed and educated about these risk factors, they are unable to modify their lifestyles, be proactive in their health care, or reduce their cardiovascular risks.