The Convergence of Science and Culture: Developing a Framework for Diabetes Education in Tribal Communities

In an unprecedented effort to address the epidemic of diabetes in tribal communities, the Diabetes Education in Tribal Schools project brought together a group of individuals from eight tribal colleges and three federal agencies to develop a diabetes prevention curriculum for American Indian and Alaska Native school children. The curriculum incorporates Western and Native science with culturally responsive teaching techniques. Both the project and its evaluation process have reached beyond conventional bounds to acknowledge fundamental issues of tribal culture, history and health and the integration of science, culture, and community. This article will discuss the challenges and rewards of the inter-cultural dynamics of the project’s development process, the tribal community context within which the curriculum will be implemented, and the necessary convergence of science and culture, requisite for education in this population and the elimination of diabetes-related health disparities

So That the People May Live (Hecel Lena Oyate Ki Nipi Kte): Lakota and Dakota Elder Women as Reservoirs of Life and Keepers of Knowledge about Health Protection and Diabetes Prevention

Around the world, Type 2 diabetes is on the rise, affecting adults and youth from societies in the throes of industrialization. Over time, uncontrolled diabetes can leave in its wake people facing renal failure, blindness, and heart disease, and communities daunted by new, chaotic phenomena. Westernized lifestyles are a recognized explanation for the escalating prevalence. The web of causation, however, may be broader and thicker, woven by complex interactions with environmental, sociological, and historical roots. The purpose of this participatory ethnographic study was to document, understand, and support Lakota and Dakota elder women’s beliefs and knowledge about health protection and diabetes prevention. In-depth interviews were conducted with nine elder women to learn: (1) about the factors attributable to diabetes, (2) about related narratives addressing health protection and diabetes prevention, and (3) how knowledge about health protection is shared. The elders saw diabetes as an outside, unnatural disorder, the contributing influences of which are external as well as internal. They offered narratives about chaos, restitution, testimony, and quests for cures and meaning. The elders connected health to traditional values and ways, the land, and memory. Reservoirs of wisdom reside in the knowledge systems of tribal elders who remember when diabetes was unknown. Health leaders at local and national levels would be wise to respect and draw upon this knowledge for guidance in program planning and policy development

Using Quantitative and Qualitative Methods to Pretest the Publication Take Charge of Your Diabetes: A Guide for Care

Quantitative and qualitative methods used to pretest the guidebook Take Charge of Your Diabetes: A Guide for Care are presented in this paper. Questionnaires were used as the quantitative method (completed by 59 diabetes educators and 301 people with diabetes) and focus groups were used as the qualitative method (3 groups composed of 22 black men and women with diabetes) to examine the relevance, purpose, content, and presentation of the Guide. Findings from between-methods triangulation supported the relevance, clarity Of messages, identification of groups that would be most likely to benefit, readability, understandability, and credibility of the Guide. Specific areas that needed modification were identified. Each evaluation method provided unique data; for example, quantifiable data on intention to change behavior was provided from one method and a recommendation that diversity be maintained was provided from the other method, The relative strengths and limitations of combining quantitative and qualitative approaches are described.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68540/2/10.1177_014572179602200608.pd

Professional Development

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68715/2/10.1177_014572179301900204.pd

Large meta-analysis of genome-wide association studies identifies five loci for lean body mass

Lean body mass, consisting mostly of skeletal muscle, is important for healthy aging. We performed a genome-wide association study for whole body (20 cohorts of European ancestry with n = 38,292) and appendicular (arms and legs) lean body mass (n = 28,330) measured using dual energy X-ray absorptiometry or bioelectrical impedance analysis, adjusted for sex, age, height, and fat mass. Twenty-one single-nucleotide polymorphisms were significantly associated with lean body mass either genome wide (p < 5 x 10(-8)) or suggestively genome wide (p < 2.3 x 10(-6)). Replication in 63,475 (47,227 of European ancestry) individuals from 33 cohorts for whole body lean body mass and in 45,090 (42,360 of European ancestry) subjects from 25 cohorts for appendicular lean body mass was successful for five single-nucleotide polymorphisms in/ near HSD17B11, VCAN, ADAMTSL3, IRS1, and FTO for total lean body mass and for three single-nucleotide polymorphisms in/ near VCAN, ADAMTSL3, and IRS1 for appendicular lean body mass. Our findings provide new insight into the genetics of lean body mass

A Stream is Always Giving Life: Communities Reclaim Native Science and Traditional Ways to Prevent Diabetes and Promote Health

Rare in Indian country just sixty years ago, type 2 diabetes mellitus is now woven into the fabric of losses in tribal communities across North America. Westernized lifestyles, with coincident obesity and physical inactivity, are powerful risk factors for this relatively new disease of civilization. The web of causation is thicker and wider than obesity and physical activity alone, intertwined by historical, economic, environmental, and sociological roots. As diabetes-related morbidity, disability, and mortality continue to increase in communities around the globe, many tribal elders recall when diabetes was almost unknown. They remember being taught how to stay healthy, lessons that were part of their traditional ecological knowledge, a symbolic and informational knowledge that is grounded in cultural values and practices, and refined through generations of observation, experimentation, and adaptation. In these conversations, the elders\u27 traditional ecological knowledge richly illustrates the cultural capital that supported their survival and helped maintain the health of their communities even when they had to face challenging times

Validation of an Armband to Measure Daily Energy Expenditure in Older Adults

BACKGROUND. Objective methods to measure daily energy expenditure in studies of aging are needed. We sought to determine the accuracy of total energy expenditure (TEE) and activity energy expenditure (AEE) estimates from the SenseWear Pro armband (SWA) using software versions 6.1 (SWA 6.1) and 5.1 (SWA 5.1) relative to criterion methods in free-living older adults. METHODS. Participants (n = 19, mean age 82.0 years) wore a SWA for a mean ± SD 12.5 ± 1.1 days, including while sleeping. During this same period, criterion values for TEE were assessed with doubly labeled water and for resting metabolic rate (RMR) with indirect calorimetry. AEE was calculated as 0.9 TEE – RMR. RESULTS. For TEE, there was no difference in mean ± SD values from doubly labeled water (2,040 ± 472 kcal/day) versus SWA 6.1 (2,012 ± 497 kcal/day, p = .593) or SWA 5.1 (2,066 ± 474 kcal/day, p = .606); individual values were highly correlated between methods (SWA 6.1 r = .893, p < .001; SWA 5.1 r = .901, p < .001) and demonstrated strong agreement (SWA 6.1 intraclass correlation coefficient = .896; SWA 5.1 intraclass correlation coefficient = .904). For AEE, mean values from SWA 6.1 (427 ± 304 kcal/day) were lower by 26.8% than criterion values (583 ± 242 kcal/day, p = .003), and mean values from SWA 5.1 (475 ± 299 kcal/day) were lower by 18.5% than criterion values (p = .021); however, individual values were highly correlated between methods (SWA 6.1 r = .760, p < .001; SWA 5.1 r = .786, p < .001) and demonstrated moderate agreement (SWA 6.1 intraclass correlation coefficient = .645; SWA 5.1 intraclass correlation coefficient = .720). Bland–Altman plots identified no systematic bias for TEE or AEE. CONCLUSIONS. Acceptable levels of agreement were observed between SWA and criterion measurements of TEE and AEE in older adults