Development of water insecurity scale for rural households in Cameroon- Central Africa.

Background: Water represents the core of food-energy nexus and is vital for human survival. In developing countries, contaminated water and lack of basic water services undermine efforts to improve nutritional status and related health issues. In the rural areas of Central Africa, a majority of the population lacks access to improved water sources and has to devote considerable efforts to obtain water.Objectives: Using the following definition of water insecurity, i.e. it exists when access to adequate amount of safe and clean water does not occur all the times for the entirety of household members to lead a healthy and active life, the study aimed to develop and test a household-level experiential water insecurity scale for rural households in Central Africa.Methods: The research was conducted in three phases: 1) the formative data collection; 2) the scale development; and, 3) the scale testing. In the third Phase, the scale was tested with 250 women who were water managing person of their households. Statistical analysis included items reduction, reliability, as well as criterion and construct validity assessment. The testing led to a final scale of 17 statements (WATINE-17), covering three domains of water insecurity: 1) psychosocial distress; 2) quantity; 3) quality of water.Results: The scale showed an excellent reliability (Cronbach's alpha = 0.92) and was significantly associated with lower frequency of water intake among women (p = 0.007, concurrent validity). In assessing WATINE-17's predictive validity, it was found that water insecurity was positively related to food insecurity (p < 0.001) and the level of water insecurity was the highest among severely food insecure households [F (3, 246) = 22.469, p < 0.001].Conclusion: The WATINE-17 is able to capture key elements of water insecurity and can be used to monitor and evaluate SDG# 6 and water-related programs, such as WASH, in Central Africa.

A qualitative study examining medical provider advice, barriers, and perceived effectiveness in addressing childhood obesity to patients and families from a low-income community health clinic.

OBJECTIVE: To examine medical provider (n = 16) perceptions in addressing and managing pediatric obesity with a diverse, low-income patient population. METHODS: Semi-structured audio-recorded interviews were performed at three pediatric clinics. Transcripts were reviewed using content analysis and consensus was reached among authors for themes. Themes were grouped into categories including: (1) initiation of weight discussions, (2) advice and perceived effectiveness, and (3) barriers. RESULTS: Most providers reported being comfortable addressing weight and use a variety of methods to initiate conversations; however, many challenges were reported, which include limited time and parent misperceptions of child's weight. A broad range of lifestyle advice was utilized, but preference to discuss physical activity over nutrition was reported. CONCLUSION: Results suggest that successful management of children's weight involves addressing issues at both the parent and the provider levels. Improved nutrition resources or training for providers is suggested; however, time must also be available for individualized counseling. Incorporation of registered dietitians may also reduce the burden.

Beneficioso y Una Prioridad: Latina Women's Perceptions about HIV Testing.

OBJECTIVES: Studies indicate a higher rate of HIV infection among Latinos in the United States, and a pattern of later testing associated with poorer disease management, greater risk of spreading infection, and higher death rates. Thus, it is imperative to generate culturally holistic strategies to improve HIV testing among Latina women. METHODS: We surveyed 182 Latina women in the southeastern US. We cross-tabulated demographic, social, and experiential factors of women who have taken a previous HIV test with women who have not yet been tested. We examined key comparisons between these women in terms of socio-demographic characteristics, sources of information about HIV testing, and responses to questions that identify factors enabling women to take an HIV test. RESULTS: Our results indicate that Latina women perceive HIV testing as worthwhile, beneficial, and a priority for them. They demonstrate the importance of family networks, trusted and bilingual service providers, and known test locations associated with higher percentages of women taking the HIV test. CONCLUSIONS: The results provide input to community health advocates to identify women who need additional support to take an HIV test.

Removing asthma triggers and improving children's health: The Asthma Partnership Demonstration project.

BACKGROUND: Studies have revealed the efficacy of home-based environmental interventions on reduction of asthma symptoms as a strategy for managing asthma in children. A focus on education and behavior change alone is generally too limited to reduce exposure to asthma triggers that exist because of adverse housing conditions. OBJECTIVE: To demonstrate that housing conditions as a focus of a health intervention should be considered more widely as an effective means of addressing serious health problems such as asthma. METHODS: Residences of 41 families of children identified with some of the highest rates of asthma-related hospital visits were assessed for the presence of asthma triggers. RESULTS: The intervention had a positive effect on lessening the effect of the child's asthma on the family's lives and activities. Reductions in frequency of negative effects of children's asthma on sleeping, job or work around the house, and family activity plans, fewer worries or concerns about children getting enough sleep and performing normal daily activities, and fewer adverse effects of children's asthma medications were reported. Reduced use of asthma medication, medication applications, and health visits were noted. Households with return visits had 50% lower hospital bills for childhood asthma treatment. CONCLUSION: Home environment conditions that lead to or exacerbate asthma may be reduced or eliminated by making minor repairs and introducing reasonable cleaning regimens that address sources of asthma triggers. This can produce greater awareness on the part of families about the presence of asthma triggers and motivate future action to address the conditions associated with these triggers.

Diabetes knowledge among older adults with diabetes in Beijing, China.

AIMS AND OBJECTIVES: To explore the relationships of demographic and clinical variables and attendance at diabetes educational programmes with diabetes knowledge among a community sample of older Chinese adults with type 2 diabetes residing in Beijing. BACKGROUND: Knowledge of diabetes is an important component of diabetes self-management. Level of education, duration of diabetes, visits to a dietician and diabetes self-management are associated with diabetes knowledge. A few studies have examined these relationships in older Chinese with diabetes. DESIGN: A descriptive correlational study. METHODS: The study was conducted in face-to-face interviews with 108 older adults with type 2 diabetes and an average age of 68 (SD = 8·41) years residing in six residential apartment complexes in Beijing. Along with the assessment of diabetes knowledge and diabetes self-management, assessments of glucose, blood pressure, body mass index (BMI) and waist circumference were obtained. RESULTS: Age and systolic blood pressure were negatively associated with diabetes knowledge. Diabetes knowledge was not related to diabetes self-care activities or glucose level. A regression model with age, education and clinical variables significantly predicted diabetes knowledge, explaining 29% of the variance in knowledge. Participants who had a family history of diabetes, visited traditional Chinese medicine (TCM) doctors and ophthalmologists and attended diabetes educational programmes were more likely to have high scores on diabetes knowledge. CONCLUSIONS: Age, education, a family history of diabetes, visits to TCM providers and ophthalmologists and attending diabetes class are factors associated with increased levels of diabetes knowledge. RELEVANCE TO CLINICAL PRACTICE: Healthcare providers need to provide age-specific, low literacy and family-focused diabetes education programmes and consider integrating principles and holistic perspectives of TCM in diabetes educational programmes for older Chinese with diabetes.

Impact of doulas on healthy birth outcomes.

Birth outcomes of two groups of socially disadvantaged mothers at risk for adverse birth outcomes, one receiving prebirth assistance from a certified doula and the other representing a sample of birthing mothers who elected to not work with a doula, were compared. All of the mothers were participants in a prenatal health and childbirth education program. Expectant mothers matched with a doula had better birth outcomes. Doula-assisted mothers were four times less likely to have a low birth weight (LBW) baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding. Communication with and encouragement from a doula throughout the pregnancy may have increased the mother's self-efficacy regarding her ability to impact her own pregnancy outcomes.

A comparative assessment of early adult life status of graduates of the North Carolina adolescent parenting program.

PROBLEM: What is the comparative impact of a second pregnancy prevention program for teen mothers on those who graduate from the program compared with a sample of young mothers of similar age and social circumstances who did not participate in the program? METHODS: Fifteen program graduates and 20 nonprogram cohorts were surveyed regarding a range of life domains. FINDINGS: Data indicated that program graduates were on a more positive life course: greater primary responsibility for housing and utilities, greater higher education enrollment, more job stability, and greater focus on career goals. CONCLUSION: The differences demonstrate the value of programs designed to assist teen mothers through the challenges of parenting and their own adolescent development. Teen mothers who received these resources became more capable, happier, and confident, which in turn will make them better parents and more empowered to pursue their own personal development.

Psychometric properties of the Chinese version of the SF-36 in older adults with diabetes in Beijing, China.

OBJECTIVE: This study investigated the psychometric properties of the 36-item Short-Form Health Survey (SF-36) (China version) in older Chinese with diabetes living in Beijing, China. METHODS: The SF-36 was administered to community-based sample of 182 older adults with diabetes living in Beijing. Data collection was conducted in face-to-face interviews. Reliability and validity were assessed using internal consistency, convergent and discriminant analyses. Exploratory principal components analyses (PCA) were conducted to compare the sample's response patterns with the hypothesized scale constructs. RESULTS: Item level validation of the scale supported the assumptions of the hypothesized structure. Internal consistency reliability (Cronbach's alpha >.70) of the subscales were acceptable except for the General Health subscale (.67). PCA confirmed general support of the two hypothesized dimensional factors and eight concepts (factors). The physical component summary (PCS) and the mental component summary (MCS) explained 62.26% of the variance and the eight factors components explained 67.39% of the variance. Known-group comparisons of scale scores indicated significantly higher levels of functionality for respondents with no blood pressure, heart, or depressive symptomatology problems. CONCLUSIONS: The Chinese version of the SF-36 showed good reliability and validity and was culturally equivalent. The scale is appropriate for use with older Chinese adults with diabetes.

Maternal and infant characteristics associated with human milk feeding in very low birth weight infants.

This study identified maternal and infant characteristics predicting human milk (HM) feeding in very low birth weight (VLBW) infants whose mothers (n = 184) participated in a study of lactation counseling and initiated milk expression. Data were collected prospectively, by maternal interview and medical record review. During hospitalization, 159 (86%) infants received at least 50% HM proportion of feedings in the first 2 weeks of life, and 114 (62%) received some HM until the day of hospital discharge. Analysis showed plan to breastfeed was the strongest predictor of initiation and duration of HM feeding. Greater than 12 years of education, respiratory distress syndrome, Apgar score >6, and female gender were significant predictors, and no perinatal hypertensive disorder, white race, and mechanical ventilation were marginal predictors of HM feeding. Women with a high-risk pregnancy should be provided education about the benefits of breastfeeding for infants who are likely to be born prematurely.

Using the family to combat childhood and adult obesity.

The purpose of this article is to emphasize the value of the family as a source of behavior change, particularly with respect to attaining achievable goals of weight loss and regular physical activity for youth and their families. We present a review of the literature, providing support for the value of the family in influencing children to form good diet and exercise behaviors and as a source of support and motivation for individuals seeking to lose or control their weight and to start and maintain a physically active lifestyle. Recognizing the importance of family behavior in the development of weight control and weight loss activities is essential. Future work should focus on identifying measurable parameters of family-level weight control behaviors and ways to apply those parameters to help create new interventions that use the strengths of the family for achieving weight control goals.

Social support for exercise and dietary habits among college students.

An assessment inventory (the Friend/Peer Support-Health Eating Physical Activity Scale-FPS-HEPAS) was developed to measure social influence patterns of college student physical activity and food consumption habits. Principal components analysis of 50 items with two referent sets (friends and peers) produced two scales with common factors: encouragement to exercise, avoidance of high fat/salty foods, support for dieting and/or exercise to lose weight, and criticism about exercise behavior. The Friend Support scale also included a factor relating to criticism of eating foods high in fat or salt. The Peer Support scale included two subscales relating to exercising together and food intake to gain weight. Overall, females reported receiving greater support for their diet and exercise actions than did males. They reported getting more encouragement to exercise, practice good dietary habits, and watch their weight from friends and peers than did males. Gender differences in terms of composition of friends and peers also were found. Females received significantly higher levels of support for exercise, good dietary habits, weight loss, and higher criticisms about their exercise habits when their peer groups were at least half or mostly all male. By contrast, male students report their highest levels of support when their peers were mostly or all female.

Positive and negative affect and health functioning indicators among older adults with chronic illnesses.

Emotional states have been linked with physical and mental health outcomes. In this study the role of positive and negative affect was investigated as determinants of health functioning for a community-dwelling sample of 153 older adults (age 60 or older) with chronic illnesses. High positive affect and low negative affect were found to be associated with lower levels of symptom distress, fewer depressive symptoms, higher daily activity scores, and higher perceived physical and mental health-related quality of life. These results have important clinical implications for the use of positive and negative affect as an indicator of life functioning among older adults. The relationship of positive and negative affect to reported health functioning found in this study suggests that measuring affect can provide a valuable means for understanding how individuals view their mental health as well as their symptoms of illness.

Human milk consumption and full enteral feeding among infants who weigh

OBJECTIVE: Establishing enteral feeding is an important goal in the care of very low birth weight infants. In such infants, receipt of >/=50 mL/kg per day human milk during hospitalization has been associated with shorter time to full enteral feeding. The objective of this study was to determine whether high proportions (>/=50%) of human milk during feeding advancement are associated with shorter time to full enteral feeding and improved feeding tolerance. METHODS: This was a prospective cohort study of very low birth weight infants (n = 127) who were grouped into low (<50%; n = 34) and high (>/=50%; n = 93) human milk consumption groups according to their human milk proportion of enteral feeding during the time of feeding advancement. The primary outcomes of interest were ages at which 100 and 150 mL/kg per day enteral feedings were achieved. RESULTS: The high human milk group reached 100 mL/kg per day enteral feeding 4.5 days faster than the low human milk group. The high human milk group reached 150 mL/kg per day enteral feeding 5 days faster than the low human milk group. After adjustment for gestational age, gender, and respiratory distress syndrome, times to reach 100 and 150 mL/kg per day were significantly shorter for those in the high human milk group. Infants in the high human milk group had a greater number of stools per day; other indicators of feeding tolerance were not statistically different. CONCLUSION: In infants who weighed

Development and psychometric testing of the relocation self-efficacy scale.

BACKGROUND: With greater numbers of older adults relocating to independent living communities (ILCs), there is an increasing need to determine whether factors such as self-efficacy can facilitate relocation adjustment. However, no relocation self-efficacy instrument is available. OBJECTIVES: To develop and test an instrument measuring older adults' self-efficacy to relocate to an ILC. METHOD: A 101-item initial instrument representing facets of relocation self-efficacy was developed based on the literature on self-efficacy and relocation and on qualitative interviews with a sample of women who had relocated to ILCs. The instrument was content validated by a panel of experts, reduced to 65 items, and then evaluated by a convenience sample of 166 community-dwelling older adults who planned to move to an ILC. The sample ranged in age from 65 to 91 years (M = 76.59 years, SD = 6.02 years); most were female (63%), Caucasian (96%), college educated (59%), and married (62%). Assessment of the scale included calculation of internal consistency reliability, test-retest reliability, item and scale correlation coefficients, and principal components factor analysis with varimax rotation to evaluate construct validity, scale structure, and item response range. In addition, convergent validity of the Self-Efficacy Relocation Scale (SERS) was evaluated by assessing correlations with measures of positive relationships (Positive Relations With Others Scale) and environmental mastery (Environmental Mastery Scale). RESULTS: The final SERS consists of 32 items in three factors: Engagement Efficacy, Daily Living Efficacy, and Transition Management Efficacy. These three factors explained 68% of the sample variance. Cronbach's alpha for the total scale was .97; alpha for the three factors was .96, .96, and .91, respectively. As anticipated, convergent validity was supported by moderate positive correlations between the three SERS factors and the Positive Relations With Others Scale and Environmental Mastery Scale. DISCUSSION: Identifying older adults at risk for difficulty in adjusting to relocation prior to moving to an ILC by using a measure of relocation self-efficacy has important implications for their health and life satisfaction. This study suggests that the SERS may be useful in identifying such individuals and alerting healthcare professionals to initiate early interventions to facilitate positive relocation adjustment. Further testing of the SERS with heterogeneous socioeconomic, marital, ethnic, and racial samples is needed.

The relationships among health functioning indicators and depression in older adults with diabetes.

A common health problem among the elderly with diabetes is the onset of depressive symptoms that can adversely affect self-care and control of diabetes. The study examined the relationships of gender, race, comorbid conditions, symptom distress, and functional status with depression in a sample (N = 55) of older adults with diabetes. Most participants were female and black; mean age was 73 years. Gender and symptom distress were the strongest predictors of depression, accounting for 53% of the variance in depression. Although the sample was reasonably high functioning with only moderate levels of symptom distress, these findings serve as an important reminder for nurses that even moderate levels of symptom distress may be an indicator of depressive symptomatology among older diabetic adults.

Cultural adaptation resources for nutrition and health in new immigrants in Central North Carolina.

This paper presents results of a study that was conducted for the purposes of describing available human services resources relating to nutrition, physical health, and behavioral health for new and recent immigrants (predominantly Mexican immigrants, but groups from Southeast Asia and continental Africa as well) in Guilford County, NC. Sixty-five service providers were determined to represent cultural adaptation resources providing either direct and/or ancillary assistance to limited English proficient immigrants. Seventeen direct assistance providers specialized in food and nutrition programs, but only 2 had targeted programs for addressing food scarcity, insecurity, and nutritional deficiencies in immigrant households. Four of 15 direct physical health services providers had clinical care or specialty programs for immigrants. Finally, 5 of 16 direct behavioral health care providers offered mental health treatment and counseling services adapted specifically for targeted immigrant groups. These findings highlight the limited development of the existing human services network to increase its capacity to provide nutrition and health related services to a growing community of diverse immigrant groups. These descriptive results underscore a need for additional local level or community based resources to be directed towards increasing the community's ability to provide essential human services to population groups not yet language proficient and acculturated to "American community standards."

Lactation counseling for mothers of very low birth weight infants: effect on maternal anxiety and infant intake of human milk.

OBJECTIVE: Although it is well documented that breastfeeding promotes health and development of very low birth weight (VLBW) infants, lactation initiation among mothers of VLBW infants is low. Mothers are anxious about the health of their children, and medical staff may be reluctant to promote breastfeeding out of concern for increasing that anxiety. Therefore, the purpose of this study was to examine whether mothers of VLBW infants who initially planned to formula feed were different in terms of their level of anxiety and maternal stress compared with mothers who had planned to breastfeed their infants. The aims of this study were to (1) determine whether counseling mothers of VLBW infants who had initially planned to formula feed on the benefits of breast milk would increase their stress and anxiety levels, (2) assess whether mothers who initially had not planned to breastfeed changed their plans after counseling to provide breast milk, and (3) measure the amount of breast milk expressed by mothers who initially planned to formula feed. Their results were compared with those of mothers of VLBW infants who initially planned to breastfeed. METHODS: Initial plan to breastfeed (initial breastfeed group [IBG]; n = 115) or formula feed (initial formula feed group [IFG]; n = 81) was determined before counseling. All participants received counseling on infant health benefits, collection and storage of breast milk, and breast pump procurement. Maternal anxiety was measured using the State-Trait Anxiety Inventory (STAI), which was administered to mothers before and after counseling and every 2 weeks until infant discharge. Maternal stress was measured after counseling with the Parental Stressor Scale: NICU. Infant breast milk intake was measured throughout hospitalization. An exit questionnaire that pertained to the perceived benefits and efforts of expressing milk was administered close to the time of infant discharge. RESULTS: After lactation counseling, 100% of the IBG and 85% of the IFG initiated breast milk expression (used the electric breast pump in the hospital) for a total lactation initiation rate of 94%. After adjustment for the mothers who initiated milk expression but did not provide any breast milk, the lactation initiation rate for the entire group was 84%. Non-Hispanic black mothers and Non-Hispanic white mothers initiated milk expression at similarly high rates (95% vs 93%). Also, milk expression initiation was similar for low-income and non-low-income mothers (95% vs 92%). IFG and IBG STAI and Parental Stressor Scale: NICU scores were not significantly different, and there were no significant differences between groups in the change in anxiety after counseling. In addition, the mean difference scores (after counseling - before counseling) for STAI anxiety "state" were not significantly different between groups, even when controlling for "trait" anxiety. State anxiety declined during the first 6 weeks of infant hospitalization in a similar manner for both groups. Maternal trait but not state anxiety scores were inversely correlated with total infant breast milk intake. Breast milk intake (mL/kg per day) was greater in the infants of mothers in the IBG compared with the IFG at each week during the first month and for their entire hospital stay. Infant breast milk intake increased from weeks 1 to 3 in both groups and continued to rise in the fourth week for the IBG. However, breast milk intake declined at week 4 for the IFG. IBG infants received breast milk for 83% of the total fed hospital days (days that feedings were given) compared with 44% of total fed days for the IFG. The proportion of enteral intake that was breast milk was also greater for the IBG compared with IFG during the first 4 weeks and for the total hospitalization. However, the mothers in IFG were able to provide at least 50% of their infants' enteral intake for the first 3 weeks, 48.8% for the fourth week, and 32.8% of the enteral intake for the entire hospitalization. Infants of low-income women received significantly lower amounts of breast milk than did infants of non-low-income mothers. Race and income accounted for 36% of the variance in breast milk intake. Of the 184 mothers who initiated breast milk expression, 72 (39%) completed the exit questionnaire. Infant health benefits were the most common reasons cited by both groups for expressing milk. The most common reasons that both groups reported for ceasing milk expression were (1) low milk supply, (2) returning to work or school, and (3) inability to pump as often as needed. Almost all of the mothers reported that pumping was worth the effort (IBG 100%, IFG 87%), and 100% said that they were glad that the staff helped them with milk expression. CONCLUSION: Counseling mothers of VLBW infants increases the incidence of lactation initiation and breast milk feeding without increasing maternal stress and anxiety.

In-home continuing care services for substance use affected families.

The role of in-home work with substance use affected family members has great potential for addressing family and personal issues that are often not well addressed by continuing care interventions that involve limited contact with the family and the impact alcohol and other drug "abuse" has on the family environment. This article reviews the importance of involving the family in the recovery process and offers comparative advantages of an in-home visitation approach for assisting the substance user with maintaining substance use avoidance, reintegrating with the family, and addressing unresolved family issues affecting children and spousal relationships.