Latino cultural beliefs, attitudes, and utilization patterns of mental health services

The purpose of this study was to explore the patterns of utilization of mental health services in the Latino community. Fifty male and female adult Latinos in the general population of San Bernardino County and Riverside County were surveyed. The questionnaire consisted of demographic information and information on beliefs and attitudes about subjects\u27 help seeking behaviors

ARSENIC AND NON-MALIGNANT RESPIRATORY HEALTH OUTCOMES: EPIDEMIOLOGICAL EVIDENCE AND THE NEED FOR INTERVENTIONS IN AMERICAN INDIAN COMMUNITIES

Inorganic arsenic, an established toxicant, has been associated with numerous health outcomes, including cancer of the lung. Evidence on the impact of arsenic exposure on nonmalignant respiratory outcomes, however, is less conclusive as studies examining low-moderate levels (<50 µg/L) of water arsenic exposure are limited. In the US, elevated arsenic disproportionately affects populations relying on private well water, including many American Indian communities. Additionally, these American Indian communities have historically been at an increased risk of tuberculosis. This dissertation aimed to better understand the relationships between arsenic exposure and nonmalignant respiratory health outcomes in a population exposed to low-moderate arsenic from drinking water. We used data from the Strong Heart Study (SHS), a prospective cohort of American Indian adults, and the Strong Heart Water Study (SHWS), a randomized controlled trial aiming to reduce arsenic exposure in American Indian communities. First, we conducted an analysis in 2,132 SHS participants to evaluate associations of arsenic exposure with lung health using urinary arsenic measurements at baseline (1989-1991) and spirometric measurements at Visit 2 (1993-1995). Arsenic exposure was positively associated with restrictive pattern, airflow obstruction, lower lung function, self-reported emphysema and having to stop for breath, independent of smoking and other lung disease risk factors. Second, we evaluated the relationship between a history of active tuberculosis and subsequent lung function in 2,463 SHS participants. We observed that a history of active tuberculosis was associated with airflow obstruction, restrictive pattern, and respiratory symptoms. We found a reduced odds of tuberculosis with increasing arsenic exposure, contrary to our hypothesis, but suggestive evidence of a possible synergistic interaction between arsenic and tuberculosis on worse lung function. Third, we conducted a pilot study, in preparation for the SHWS, of 371 households to identify households with arsenic ≥10 µg/L. Arsenic ≥10 µg/L was found in 26.1% of households and median water arsenic concentration was 6.3 µg/L, ranging from <1 to 198 µg/L. The study also tested and confirmed the effectiveness of a water filtration device to reduce water arsenic in these communities. The long-term efficacy of a community-based arsenic mitigation program in reducing arsenic exposure and preventing arsenic related disease is being tested as part of the SHWS. In conclusion, low-moderate arsenic exposure may contribute to nonmalignant respiratory outcomes, including reduced lung function, respiratory symptoms, and a restrictive lung disease pattern. Our findings support existing knowledge that tuberculosis is a risk factor for long-term respiratory impairment. There is a relatively high burden of arsenic exposure in communities where the SHWS is being conducted, pointing to the continued need for effective interventions at the household level. More research is needed to investigate the association between arsenic exposure and non-malignant respiratory health, as many populations at risk of developing tuberculosis and other respiratory infections are also exposed to arsenic-contaminated water

Predictors of Adherence to Nutrition Recommendations in People With Non- Insulin-Dependent Diabetes Mellitus

The purpose of this study was to determine how the components of psychosocial adjustment to diabetes predict adherence to nutrition recommendations based on self-reported successful completion of contingency contracts. The relationships between the components of psychosocial adjustment and adherence to nutrition recommendations were examined in a convenience sample of patients with non-insulin- dependent diabetes mellitus participating in a contingency contracting intervention with nurses. Patients completed a standardized instrument, the Diabetes Care Profile, at the time they were enrolled into this randomized clinical trial. High and low levels of adherence to nutrition recommendations were identified by a median split of the number of contingency contracts completed for adherence to nutrition recommendations. Subjects who reported higher regimen adherence and a higher support ratio (received more diabetes-specific social support than desired) were significantly less likely to engage in contingency contracting for adherence to nutrition recommendations .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68967/2/10.1177_014572179702300206.pd

Experiencing chronic illness: Cocreating new understandings

This study was conducted as part of a research course in which new partnerships with area citizens and community-driven programs of research were developed. Working together, the teachers, students, and citizens were able to document their practical knowledge through conducting a study of the lived experiences of chronic illness using Heideggerian hermeneutical phenomenology. The pattern, Experiencing Chronic Illness: Cocreating New Understanding, and three themes emerged during the analysis of the data (a) focusing on functional status doesn’t adequately account for the experience of chronic illness, (b) decentering the focus on the treatment of symptoms makes way for equally important discussions of meaning making in the context of chronic illness, and (c) the objectified language of healthcare covers over how chronic illness is experienced

Socio-Ecological Interactions Promote Outbreaks of a Harmful Invasive Plant in an Urban Landscape

Urban landscapes often harbour organisms that harm people and threaten native biodiversity. These landscapes are characterized by differences in socioeconomic context, habitat suitability and patch connectedness. Identifying which spatial differences enable outbreaks of pests, pathogens and invasive species will improve targeted control efforts. We tested hypotheses to explain the distribution and demography of puncturevine Tribulus terrestris, a human-dispersed invasive plant in Boise, a city in the western United States. We hypothesized an increase in puncturevine infestations near low-valued properties with a high proportion of bare ground, the species\u27 preferred microhabitat, that are well connected on the urban road network. To test these hypotheses, we collected data on the abundance, emergence and persistence of reproductive plants in transects spanning \u3e100 km of our study city. We then used hierarchical Bayesian models to evaluate the impacts of spatial covariates on puncturevine distribution and demography. Bare ground cover consistently increased abundance, emergence and persistence of puncturevine, indicating the overarching importance of suitable establishment sites for this invasive species. Property value had the strongest impact on puncturevine abundance and was the most important main effect in the model for puncturevine emergence. In both models, lower-valued properties had a higher risk of puncturevine occurrence. The effects of road network connectivity depended on bare ground cover, with the highest predicted abundance and emergence of puncturevine in patches with low connectivity on the road network and high bare ground cover. Understanding these relationships will require data that can disentangle seed dispersal from establishment limitations

Overlapping Agencies: The Collision of Cancer, Consumers, and Corporations in Richard Powers’s Gain

Richard Powers\u27s 1998 novel Gain establishes a complicated relationship between its two main characters, a corporation called Clare International and suburban mom named Laura Bodey. Readers, assuming the malignity of such corporations, mistake the hints Laura encounters that Clare is responsible for her ovarian cancer for facts. Such readings overlook the science of ovarian cancer as well as how Powers depicts Laura\u27s relation to her disease. I analyze Laura\u27s understudied half of the novel, framing it as a cancer narrative that reworks conventions of that genre. In placing her cancer in broad social and environmental contexts, Powers eschews the individualist strain that characterizes many illness narratives. In so doing, the novel demands engagement with consumer agency and bodily frailty in the face of corporate dominance

Broad Repertoire of T Cell Autoreactivity Directly from Islets of Donors with Type 1 Diabetes (T1D)

Type 1 diabetes (T1D) is an autoimmune disease characterized by the infiltration of lymphocytes into the insulin-producing β-cells in the pancreas. We have isolated live T cells sorted or grown directly from the isolated, handpicked islets of human donors with T1D. We received ~500 islet equivalent EQ of variable purity (10-90%) from 12 donors with T1D (disease duration 0.42-20 years) and from seven control donors and two donors with type 2 diabetes (T2D). A total of 321 T cell lines and clones were derived from the islets of donors with T1D (3 lines from the 9 control donors). These are 131 CD4+ lines and clones, 47 CD8+ lines and 143 lines that contain both CD4+ and CD8+ T cells. From 50 lines and clones examined to date, we have determined the autoreactivity of 19 and have seen a broad repertoire of T cell autoreactivity in the islets, including characterized targets and post-translationally modified targets. Autoreactivity of CD4+ T cell lines was to three different peptides from glutamic acid decarboxylase 65 (GAD; GAD115-127, GAD274-286, GAD555-567), proinsulin76-90, and to chromogranin A or proinsulin expressed by DR4+DQ8+ B cells transduced with lentivirus containing constructs with the open reading frames corresponding to whole autoantigens. Reactivity to modified peptides included the glucose-regulated protein 78 and islet amyloid polypeptide with arginine to citrulline modifications (GRP78292-305(Arg-Cit297) and IAPP65-84(Arg-Cit 73, 81)), deaminations (IA-2545-562(Gln-Glu 548, 551, 556), and to several insulin hybrid peptides. These autoreactive CD4+ T cell lines and clones secreted only pro-inflammatory cytokines (IFN-γ, TNFα) upon peptide stimulation. For CD8+ T cells from islets, from one donor with T1D, we saw binding of a pool of HLA-A2 pentamers loaded with insulin B10-18, IA-2797-805 and insulin specific glucose-6-phosphatase catalytic subunit related protein, IGRP265-273. These results have implications for the development of successful prevention and reversal therapeutic strategies in T1D