Spirituality among Latinas/os: implications of culture in conceptualization and measurement

Despite growing transnational migration between the United States and Latin American countries, culturally relevant conceptualizations of spirituality among Latinas/os remain lacking in healthcare research. Grounded in Latina feminist theology, this article elucidates cultural values that influence spirituality and describes findings from a study using a new questionnaire to explore spirituality among Latinas in Puerto Rico and the US mainland. Results support the saliency of cultural values such as personalismo and familismo as the context for spiritual perspectives, which may function independently of the Catholic Church structure.     

Diabetes Risks and Health Literacy in Southern African American and Latino Women

Minority women experience health disparities, especially related to diabetes. The purpose of this article is to examine diabetes risk in minority women. A survey design was used to recruit 52 African Americans (AA) and 48 Latina women. Participants described their health, health behaviors, and health literacy. Blood pressure and body mass index were measured. AA women had more diabetes risks than Latinas, and older women had more risks than younger women. All of the women had low health literacy. Women with higher numbers of diabetes risks had lower health literacy. Findings can be used to develop diabetes prevention and education programs.     

The sociocultural context of breast cancer screening among Korean immigrant women

Korean immigrant women, who compose 1 of 6 major subpopulations in Asian Americans in the United States, are reported to have far lower rates of breast cancer screening than do women in general. Despite the sporadically reported cognitive, affective, and environmental constraints to the screening practices, to date, no research has been conducted to investigate the sociocultural contexts within which women in this population seek help for breast health. The purpose of this study is to explore and interpret the sociocultural processes of breast cancer screening among Korean immigrant women using the grounded theory method. Twenty Korean immigrant women, aged between 20 and 81 years, participated in a set of 2 consecutive qualitative interviews conducted in the Korean language. The qualitative data were transcribed and analyzed using the constant comparison technique. "Balancing relationships within a discordant world" is the core concept of the process of breast cancer screening among Korean immigrant women. There are sociocultural discord in perceptions of breast cancer and screening procedures between Asian ways of thinking and Western biomedical premises. The elicited situation-specific theory sheds light on what Western healthcare professionals have missed and what they should consider in caring for culturally diverse populations.     

Life review interviews on the spiritual well-being of terminally ill cancer patients

Goals  The aims of this study were (1) to evaluate the treatment efficacy of life review interviews on the spiritual well-being of terminally ill cancer patients, and (2) to explore any differences in the responses of patients who obtained clinical benefits and those who did not. Materials and methods  Structured life review interviews were conducted with 12 patients in a palliative care unit in Japan. They completed the SELT-M (Skalen zur Erfassung von Lebens qualitat bei Tumorkranken–Modified Version) questionnaire before and after the interviews. The patients were classified into two groups: effective (patients who showed an increase in the SELT-M scores after the intervention) and noneffective groups. Meaningful spoken sentences from the patients’ life reviews were transcribed and correspondence analysis was conducted on the sentences using text mining software. Results  The mean overall QOL score and spirituality subscale score of the SELT-M significantly increased after the life reviews from 2.57±0.61 to 3.58±1.0 (P=0.013) and 2.57±0.61 to 3.14±2.25 (P=0.023), respectively. Three dimensions were extracted from the effective group based on the scores “Positive view of life,” “Pleasure in daily activities and good human relationships,” and “Balanced evaluation of life.” Similarly, three dimensions were extracted from the noneffective group: “Worries about future caused by disease,” “Conflicts in family relationship problems,” and “Confrontation of practical problems.” Conclusion  Life review interviews may be effective in improving the spiritual well-being of terminally ill cancer patients. The potential predictors of treatment success are “positive view of life,” “pleasure in daily activities and good human relationships,” and a “balanced evaluation of life,” while those of treatment failure are “worries about future caused by disease,” “conflicts in family relationships,” and “confrontation of practical problems.” Further intervention trials on patients with predictors of treatment success are promising.     

Predictors of early recovery of health status after intensive care

Objective To identify factors predictive of good or poor recovery of health status and health-related quality of life (HRQOL) 90 days after admission to an intensive care unit (ICU).Design and setting Prospective international multicentre study in 19 ICUs participating in the HRQOL substudy of the SAPS 3 project.Intervention The EuroQol questionnaire (EQ) was administered to discharged ICU patients 90 days after admission. A question to compare present health status with that 3 months before ICU admission (same/better/worse) was added.Patients Six hundred and eighteen patients who spent > 24 h in an ICU and survived for 90 days. EQ data and health comparison were available in 559 (90.5%) of them.Measurements and results Patients reported their general level of health to be better (33.8%), the same (31.1%), or worse (35.1%) in comparison with baseline. Recovery was considered to be good for answers “better” or “the same”. Regression analysis showed that transplantation surgery [odds ratio (OR) 0.07, 95% confidence interval (CI) 0.01–0.63], coronary artery bypass surgery without valvular repair (OR 0.39, 95% CI 0.17–0.92) and being admitted to the ICU from a ward or other location (OR 0.55, 95% CI 0.31–0.95) predicted good recovery of health. Predictors of poor recovery (all present at the time of ICU admission) were unplanned ICU admission, hypothermia, serum creatinine level ≥ 2 mg/dl, pH ≤ 7.25 and metastatic cancer.Conclusions More than 60% of ICU patients report good recovery of their health 90 days after ICU admission, depending on their illness and circumstances of ICU admission.Electronic supplementary material Supplementary material is available in the online version of this article at and is accessible for authorized users.The authors wrote this article on behalf of the SAPS 3 Investigators.     

Causal attributions to epidemiological risk factors and their associations to later psychological adjustment among Japanese breast cancer patients

Goals  The objective of this study was to evaluate the causal attributions for breast cancer and their association with the subsequent psychological adjustment. Materials and methods  Sixty-three Japanese patients newly diagnosed with breast cancer were asked by an interviewer about risk factors and explanations for the etiology of breast cancer using a four-point scale. The General Health Questionnaire (GHQ-28) and the Center for Epidemiologic Studies Depression Scale (CES-D) were administered about 2 months later to measure psychological adjustment to the illness. The relationship between each causal attribution and measure of psychological adjustment was assessed with the Spearman rank correlation after adjusting for potential confounders (age, marital status, cancer stage at diagnosis, time between the day of diagnosis and follow-up, and physical symptoms at the follow-up). Main results  Attributions to several explanations, including “stress” and “personal characteristics,” were positively associated with the GHQ-28 measures. Of the attributions to risk factors, “body size” was significantly inversely (r = −0.29) associated and “never having children” was insignificantly and highly inversely (r = −0.77) associated with the GHQ-28 measures, indicating better adjustment to the illness. On the other hand, the attribution to “tobacco” was significantly and positively associated with the GHQ-28 measures (r = 0.34), indicating that the attributions antagonized adjustment to the illness. Conclusion  The current study indicates that forming causal attributions influences the adjustment to the illness in Japanese breast cancer patients and attributions to certain risk factors for breast cancer may contribute to better adjustment.     

Symptoms of PTSD and Major Depression in Latinas Who Have Experienced Intimate Partner Violence

The purpose of this study was to describe symptoms of PTSD and major depression in abused Latinas and to explore the relationships among intimate partner violence (IPV) experiences, these symptoms, and health related quality of life (HRQOL). The rate of PTSD was 69.7%% and of major depressive disorder (MDD) was 57.6%%. The comorbidity of PTSD and MDD was 54.5%%. PTSD and MDD were not consistently correlated with IPV, although some significant relationships were found. PTSD and MDD symptoms were highly correlated with HRQOL. The impact of PTSD and MDD on psychological well-being and functioning in Latinas needs further investigation.     

IMPROVE,a community-based exercise intervention versus support group to improve functional and health outcomes among older African American and non-Hispanic White breast cancer survivors from diverse socioeconomic backgrounds: Rationale,design and methods

BackgroundAfrican Americans (AA) and socioeconomic status (SES) disadvantaged older breast cancer survivors (BCS) are more likely to experience poor functional and health outcomes. However, few studies have evaluated the putative beneficial effects of exercise on these outcomes in older racial minority and SES-disadvantaged BCS.MethodsThis is a mixed-methods study that includes a randomized-controlled trial, “IMPROVE”, to evaluate a group-based exercise intervention compared to a support group program in older BCS, followed by post-intervention semi-structured interviews to evaluate the intervention. The trial aims to recruit 220 BCS with 55 in each of four strata defined by race (AA versus Non-Hispanic Whites) and SES (disadvantaged vs. non-disadvantaged). Participants are ≥65 years old and within five years of treatment completion for stage I-III breast cancer. Participants are randomized to a 52-week, three sessions/week, one-hour/session, moderate intensity aerobic and resistance group exercise intervention, (n = 110) or a 52-week, one hour/week, support group intervention [attention-control arm], (n = 110). The first 20 weeks of both programs are supervised and the last 32 weeks, unsupervised. The primary outcome is the change in Short Physical Performance Battery (SPPB) Scores at 20 weeks from baseline, between the two arms. Secondary outcomes include change in SPPB scores at 52 weeks, change in body composition and biomarkers, at 20 and 52 weeks from baseline, between arms.DiscussionResults of the trial may contribute to a better understanding of factors associated with recruitment, and acceptability, and will inform future exercise programs to optimally improve health outcomes for older BCS.     

Developing culture-specific interventions for Latinas to reduce HIV high-risk behaviors.

Latina women are among the fastest-growing segments of the U.S. population to become infected with HIV. Health care providers must use culture-specific HIV prevention strategies and must address cultural roles and values of the Latin community to empower Latinas to reduce high-risk behaviors. Some Latinas adhere to their cultural traditions that place the female subservient to the male in the sexual relationship. A review of the literature reveals that skills-building, a group participatory tool that engages the individual to examine high-risk behaviors and provides methods to make behavior changes, and nurse counseling, which focuses on an individual's specific risk behaviors, are more effective modes of reducing high-risk behaviors in women than an information-only intervention.     

HBV-related health behaviors in a socio-cultural context: Perspectives from Khmers and Koreans

PurposeThe aim of this study is to explore factors influencing health and health care within the sociocultural context of Cambodian Americans (CAs or Khmers) and Korean Americans (KA) and to examine intergroup similarities and differences between CAs and KAs, focusing on hepatitis B virus (HBV) and liver cancer prevention behaviors.MethodsThe study used a qualitative design guided by the revised Network Episode Model (NEM) and informed by ethnographic analysis. Focus group interviews with key informants among CA community health leaders (CHLs, n = 14) and individual interviews with key informants of KA CHLs (n = 9) were audiotaped and transcribed.ResultsThree categories that influenced HBV and liver cancer prevention emerged from both CAs and KAs: the socio-cultural, individual, and behavioral. Four additional subcategories (sub-themes) of sociocultural were identified as socio-history, socio-medicine, socio-linguistic, and socio-health resources. Both CAs and KAs, however, have low levels of knowledge and significant misunderstandings about HBV infection.ConclusionsThe study identifies and compares the social-cultural determinant for HBV and liver cancer and highlights the factors of education, intercultural communication, and interactions within socio-cultural contexts of CA and KA subgroups. In general, conceptual overlaps are apparent between Khmers (from now on, the terms, CA and Khmer, will be used interchangeably) and Koreans except for the sub-theme of socio-history. However, differences in concept-specific attributes point to the need to account for differing conceptualizations and implications of specific ethnic groups' sociocultural contexts, and to design contextually-relevant outreach and educational interventions for targeted AAPI subgroups.     

A randomized clinical trial of an HIV-risk-reduction intervention among low-income Latina women

BACKGROUND: HIV infection has increased within the Latina community more than in any other ethnic or racial group within the United States. Latinas comprise only 13% of the U.S. population, yet they account for 20% of the cumulative reported cases of AIDS. OBJECTIVES: The purpose of the study was to evaluate a randomized culturally tailored intervention to prevent high-HIV-risk sexual behaviors for Latina women residing in urban areas. METHODS: Mexican and Puerto Rican women (18-44 years of age; N = 657) who were sexually active during the previous 3 months were recruited and randomized into intervention and control groups. The intervention, facilitated by bilingual, bicultural, trained Latina women, consisted of culturally tailored sessions on understanding their bodies, HIV/AIDS and sexually transmitted diseases, condoms (myths and use), negotiating safer sex practices, violence prevention, and partner communication. Bivariate and multivariate analyses assessed changes from baseline. RESULTS: The intervention improved HIV knowledge, partner communication, risk-reduction behavioral intentions, and condom use, and decreased perceived barriers to condom use. DISCUSSION: The efficacy of a culturally-sensitive intervention to reduce HIV/AIDS-risk behaviors in Latina women was demonstrated in the current study.     

Update: Toward image-guided robotic surgery: determining the intrinsic accuracy of the daVinci-S robot

Early in 2006, Intuitive Surgical (Sunnyvale, CA, USA) released their next generation robotic surgery system, the daVinci-S. While the S is an update on the daVinci surgical system it has significantly different structures. This led to the belief that there might be differences in the accuracy and precision of the daVinci-S as compared to the daVinci “classic”. In a previous study, we measured the accuracy of the daVinci “classic” to be 1.02 mm throughout its work volume (Kwartowitz et al. in Int J Comput Assist Radiol Surg 1:159–165, 2006) In this study we evaluated the accuracy of the daVinci-S using the same protocol as was used for the daVinci “classic”. The localization error is found to be 1.05 mm, which is essentially the same as the measured error for the daVinci “classic”. It is concluded that the daVinci-S is an appropriate localizer for a robotic image guided surgery (RIGS) system.     

What do laypersons consider as a good death

Goals  This study was designed to understand laypersons’ attitude of good death. Materials and methods  A 53-item Good-Death Questionnaire (GDQ) was generated by applying “good-death principles” and past research on good death in Chinese people. Main results  A total of 184 adults completed the questionnaire. The Cronbach’s alpha for the GDQ was 0.96. Factor analysis produced five factors: autonomy and choice, wish fulfillment, death preparation, spiritual support and afterlife, and symptom control. Elderly people had higher scores in “autonomy” than people aged ≤40 (52.71 ± 5.94 vs. 56.71 ± 3.82, P = 0.012). Chaplains had higher scores in “death preparation” than volunteers (76.09 ± 4.44 vs. 70.46 ± 6.49, P = 0.011) and higher scores in “spiritual support” than volunteer and farmers–workers–businessmen (32.97 ± 2.49 vs. 28.08 ± 5.06 and 29.69 ± 5.05, P = 0.002). People with Buddhist religious belief had higher scores in “spiritual support” than people without religious belief (31.10 ± 3.99 vs. 25.73 ± 3.13; P < 0.001). Religious devotion was positively related to “death preparation” and “spiritual support.” People who had witnessed death had lower scores of “autonomy and choice” than the inexperienced (55.41 ± 4.81 vs. 57.06 ± 3.85; P = 0.032). Conclusions  Our results identified some major characteristics of good-death attitude among laypersons. Religious devotion has a positive impact on the attitude of good death.     

A qualitative assessment of upper quarter dysfunction reported by physical therapists treated for breast cancer or treating breast cancer sequelae

Purpose  

As survival rates for breast cancer improve, long-term effects of treatment are receiving increasing attention, including upper quarter impairments and functional limitations. The purpose of this study was to assess, through qualitative means, the long-term effects of breast cancer treatment on upper quarter function as reported by those with expertise in upper quarter dysfunction. Participants were physical therapists who were either breast cancer survivors (“survivors”) or those who specialized in treatment of individuals post-breast cancer (“treaters”).     

HIV/AIDS in childbearing Hispanic/Latinas: an emerging crisis

The purpose of this article is to describe possible reasons for the increase in HIV/AIDS among childbearing Hispanic/Latinas and to discuss the implications for maternal child nurses. The median age of Hispanic/Latinas is 27 years compared to 36 years for all other races combined. Hispanic/Latinas have the highest birth rate among all women in the United States; they also have a five times greater rate of HIV/AIDS infection compared to non-Hispanic White women. Most commonly, Hispanic/Latina women first discover their HIV status when they receive prenatal care. Gender and cultural roles, poverty, lack of health insurance, poor health literacy, limited English proficiency, and low educational level all contribute to this emerging crisis. Educating Hispanic/Latina women about prevention methods, early testing/counseling, and treatment options is a first step in decreasing the suffering and devastation associated with HIV/AIDS among childbearing Hispanic/Latinas and their families.     

Depression in general intensive care unit survivors: a systematic review

Purpose  To critically review data on the prevalence of depressive symptoms in general intensive care unit (ICU) survivors, risk factors for these symptoms, and their impact on health-related quality of life (HRQOL). Methods  We conducted a systematic review using Medline, EMBASE, Cochrane Library, CINAHL, PsycINFO, and a hand-search of 13 journals. Results  Fourteen studies were eligible. The median point prevalence of “clinically significant” depressive symptoms was 28% (total n = 1,213). Neither sex nor age were consistent risk factors for post-ICU depression, and severity of illness at ICU admission was consistently not a risk factor. Early post-ICU depressive symptoms were a strong risk factor for subsequent depressive symptoms. Post-ICU depressive symptoms were associated with substantially lower HRQOL. Conclusions  Depressive symptoms are common in general ICU survivors and negatively impact HRQOL. Future studies should address how factors related to individual patients, critical illness and post-ICU recovery are associated with depression in ICU survivors.     

Needs assessment for next generation computer-aided mammography reference image databases and evaluation studies

Introduction  

Breast cancer is globally a major threat for women’s health. Screening and adequate follow-up can significantly reduce the mortality from breast cancer. Human second reading of screening mammograms can increase breast cancer detection rates, whereas this has not been proven for current computer-aided detection systems as “second reader”. Critical factors include the detection accuracy of the systems and the screening experience and training of the radiologist with the system. When assessing the performance of systems and system components, the choice of evaluation methods is particularly critical. Core assets herein are reference image databases and statistical methods.     

Design and rationale for a randomized trial of a theory- and technology- enhanced physical activity intervention for Latinas: The Seamos Activas II study

IntroductionLatina women report disproportionately high rates of physical inactivity and related chronic health conditions. Physical activity (PA) efforts to date have shown modest success in this at-risk population; thus, more effective interventions are necessary to help Latinas reach national PA guidelines and reduce related health disparities. This paper describes the design, rationale, and baseline findings from the Seamos Activas II intervention.Methods/DesignThe ongoing RCT will test the efficacy of the Seamos Saludables PA print intervention vs. a theory-and technology-enhanced version (Seamos Activas II). The purpose of the study is to increase the percentage of Latinas meeting the national PA guidelines compared to the prior trial, improve biomarkers related to disease, and extend generalizability to a broader and more representative population of Latinas (i.e. Mexican/Mexican-Americans). Intervention refinements included further targeting key constructs of Social Cognitive Theory, and incorporating interactive text message-based self-monitoring strategies. The primary outcome is change in minutes per week of MVPA measured by ActiGraph GT3X+ accelerometers at 6- and 12-months. Secondary PA outcomes assessed by the 7-Day PA Recall will be used to corroborate findings.ResultsParticipants (N = 199) are Latinas 18–65 years (mean = 43.8) of predominantly Mexican origin (89%). At baseline, objectively measured MVPA was 39.51 min/week (SD = 71.20, median = 10) and self-reported MVPA was 12.47 min/week (SD = 22.54, median = 0).Participants reported generally low self-efficacy and higher cognitive vs. behavioral processes of change.ConclusionAddressing interactivity and accountability through text messaging, and more rigorously targeting theoretical constructs may be key to helping Latinas achieve nationally recommended PA levels and thereby reducing health disparities.