Transformative Learning Intervention: Effect on Functional Health Literacy and Diabetes Knowledge in Older African Americans

This study evaluated the effect of a transformative learning intervention on functional health literacy and diabetes knowledge in older African Americans. Twenty participants from senior community centers completed a six session intervention and three health literacy tests. Participants’ verbal responses affirmed the positive influence of the TL principles

Perceptions Of Sexuality By African American Patients On Hemodialysis

ABSTRACT PERCEPTIONS OF SEXUALITY BY AFRICAN AMERCIAN PATIENTS ON HEMODIALYSIS by MERRY STEWART May 2010 Advisor: Dr. Ramona Benkert Major: Nursing Degree: Doctor of Philosophy Sexuality is central to who we are as sentient beings and transcends physical sex acts. Sexuality concerns are reported as common for individuals receiving hemodialysis; yet, sexuality-related research for this population has been limited to a focus on altered physical sexuality. Little is known about the effects of hemodialysis on perceptions of personal identity, family-social roles as men or women, and intimate relationships. African Americans make up a disproportionate percentage of chronic hemodialysis patients and may be at greater risk for altered sexuality. The purpose of this qualitative descriptive study was to explore African Americans\u27 perceptions of sexuality since being on dialysis. A middle-range model, the Sexuality Adaptation Model (SAM), derived from Roy\u27s Adaptation Model provided a guiding theoretical framework. Semi-structured interviews were conducted with 19 African American men (n = 12) and women (n = 7) who were receiving hemodialysis treatment (mean age = 49.95 years). Eight participants (seven men, one woman) were married, or in steady relationships. The range of dialysis years for the participants ranged from 1 to 10 years (M = 4.16, SD = 3.08). For male participants, a strong endorsement of traditional masculinity ideology was found to promote adaptive behaviors that minimized an altered sense of who I am as a man. In contrast, female participants\u27 perceptions of sexuality were found to be influenced by multiple meanings of their identity as Black women. Most partnered men expressed greater concerns regarding the effects of hemodialysis on diminished physical sexuality and altered partner relationships, whereas women participants were primarily concerned about their altered personal sexuality identities and roles as a mother. The rollercoaster effects of loss of time, energy, independence, and negative dialysis center environment was suggested to erode perceptions of sexuality among the majority of study participants. Informal mutual support groups were reported to contribute to positive perceptions of sexuality. The application of the SAM facilitated relevant descriptions of participants\u27 perceptions of sexuality and supported the investigator\u27s assertion that a holistic approach is needed to guide research and clinical interventions related to sexuality concerns

Opening up evidence-based policy: exploring citizen and service user expertise

[Abstract not available

The Association Between Parent Engagement and Child Outcomes in Social Skills Training Programs: Discovering the Secret Agent Society in Partnership

Previous research in clinical, community, and school settings has demonstrated positive outcomes for the Secret Agent Society (SAS) social skills training program. This is designed to help children on the autism spectrum become more aware of emotions in themselves and others and to ‘problem-solve’ complex social scenarios. Parents play a key role in the implementation of the SAS program, attending information and support sessions with other parents and providing supervision, rewards, and feedback as their children complete weekly ‘home mission’ assignments. Drawing on data from a school-based evaluation of the SAS program, this study examined whether parents’ engagement with these elements of the intervention was linked to the quality of their children’s participation and performance. Sixty-eight 8-14 year olds (mean age 10.7) with a diagnosis of autism participated in the program. The findings indicated that ratings of parental engagement were positively correlated with children’s competence in completing home missions and with the quality of their contribution during group teaching sessions. However, there was a less consistent relationship between parental engagement and measures of children’s social and emotional skill gains over the course of the program

Implementation, Evalution and Maintenance of a Social-Emotional Skills Training Program for Children with an Autism Spectrum Disorder in a Specialist School Setting

Socialization difficulties in children with an Autism Spectrum Disorder (ASD) are often associated with peer rejection and impaired academic achievement. Schools might appear to offer an ideal setting for social-emotional skills (SES) instruction. However, common challenges to successful implementation of school-based programs include inadequate staffing and resourcing, and a lack of ASD-specific staff training. This paper describes how barriers to program implementation were overcome in a project evaluating the Secret Agent Society (SAS) SES training intervention within Autism Spectrum Australia (Aspect) specialist classes. Questionnaire data was collected from school staff over a one-year period. Findings supported the effectiveness of the adoption process used, and suggest that SAS was feasible and acceptable to school staff

Refracting custom in Western Sahara's quest for statehood

This article argues that distinctions made by local actors between different legal and normative orders within a broad field of custom should receive greater analytical attention. Local distinctions within custom have sometimes been overlooked in scholarly emphasis on other distinctions, such as between custom and state law, or between custom and religious law. The significance of local distinctions within custom comes to the fore in the case of the liberation movement from Western Sahara, a disputed territory partially annexed by Morocco in 1975. In exile in Algeria, Western Sahara's liberation movement has set up a state-like government that seeks international recognition as a state. In support of its efforts at state-making, the liberation movement has drawn on a longstanding local distinction within custom to produce a distinction between a‘rāf, construed as tribal laws to be erased, and ‘ādāt, construed as customary cultural heritage to be elevated

Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Background The mental health of children and young people (CYP) is a major UK public health concern. Recent policy reviews have identified that service provision for CYP with mental health needs is not as effective, responsive, accessible or child-centred as it could be. Following on from a previous National Institute for Health Research (NIHR) study into self-care support for CYP with long-term physical health needs, this study explored self-care support’s potential in CYP’s mental health. Objectives To identify and evaluate the types of mental health self-care support used by, and available to, CYP and their parents, and to establish how such support interfaces with statutory and non-statutory service provision. Design Two inter-related systematic literature reviews (an effectiveness review with meta-analysis and a perceptions review), together with a service mapping exercise and case study. Setting Global (systematic reviews); England and Wales (mapping exercise and case study). Participants (case study) Fifty-two individuals (17 CYP, 16 family members and 19 staff) were interviewed across six sites. Main outcome measures (meta-analysis) A measure of CYP’s mental health symptomatology. Data sources (literature reviews) MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, All Evidence-Based Medicine (EBM) Reviews, Applied Social Sciences Index and Abstracts (ASSIA) and Education Resources Information Center (ERIC). Review methods Titles and abstracts of papers were screened for relevance then grouped into studies. Two independent reviewers extracted data from studies meeting the inclusion criteria. A descriptive analysis and meta-analysis were conducted for the effectiveness review; descriptive analyses were conducted for the perceptions review. These analyses were integrated to elicit a mixed-methods review. Results Sixty-five of 71 included studies were meta-analysable. These 65 studies elicited 71 comparisons which, when meta-analysed, suggested that self-care support interventions were effective at 6-month [standardised mean difference (SMD) = −0.20; 95% confidence interval (CI) −0.28 to −0.11] and 12-month (SMD = −0.12; 95% CI −0.17 to −0.06) follow-ups. However, judged against Cochrane criteria, the studies were mostly low quality. Key elements of self-care support identified in the perceptions review were the acquisition of knowledge and skills, peer support and the relationship with the self-care support agent; CYP also had different perceptions from adults about what is important in self-care support. The mapping exercise identified 27 providers of 33 self-care support services. According to the case study data, effective self-care support services are predicated on flexibility; straightforward access; non-judgemental, welcoming organisations and staff; the provision of time and attention; opportunities to learn and practise skills relevant to self-care; and systems of peer support. Conclusions Mental health self-care support interventions for CYP are modestly effective in the short to medium term. Self-care support can be conceptualised as a process which has overlap with ‘recovery’. CYP and their families want choice and flexibility in the provision of such interventions and a continued relationship with services after the nominal therapy period. Those delivering self-care support need to have specific child-centred attributes. Future work Future work should focus on under-represented conditions (e.g. psychosis, eating disorders, self-harm); the role of technology, leadership and readiness in self-care support; satisfaction in self-care support; the conceptualisation of self-care support in CYP’s mental health; and efficacy and cost-effectiveness

Age- and gender-specific risk of death after first hospitalization for heart failure

<p>Abstract</p> <p>Background</p> <p>Hospitalization for heart failure (HF) is associated with high-in-hospital and short- and long-term post discharge mortality. Age and gender are important predictors of mortality in hospitalized HF patients. However, studies assessing short- and long-term risk of death stratified by age and gender are scarce.</p> <p>Methods</p> <p>A nationwide cohort was identified (ICD-9 codes 402, 428) and followed through linkage of national registries. The crude 28-day, 1-year and 5-year mortality was computed by age and gender. Cox regression models were used for each period to study sex differences adjusting for potential confounders (age and comorbidities).</p> <p>Results</p> <p>14,529 men, mean age 74 ± 11 years and 14,524 women, mean age 78 ± 11 years were identified. Mortality risk after admission for HF increased with age and the risk of death was higher among men than women. Hazard ratio's (men versus women and adjusted for age and co-morbidity) were 1.21 (95%CI 1.14 to 1.28), 1.26 (95% CI 1.21 to 1.31), and 1.28 (95%CI 1.24 to 1.31) for 28 days, 1 year and 5 years mortality, respectively.</p> <p>Conclusions</p> <p>This study clearly shows age- and gender differences in short- and long-term risk of death after first hospitalization for HF with men having higher short- and long-term risk of death than women. As our study population includes both men and women from all ages, the estimates we provide maybe a good reflection of 'daily practice' risk of death and therefore be valuable for clinicians and policymakers.</p