A Community-Based Cultural Adaptation Process: Developing a Relevant Cooking Curriculum to Address Food Security for Burundian and Congolese Refugee Families.

Refugee-specific nutrition and cooking curricula addressing dietary acculturation barriers to food security are limited. A cooking curriculum was culturally adapted for Burundian and Congolese refugees to address their unique dietary acculturation experiences. A four-phase curriculum adaptation process (information gathering [literature review, researcher informed, and formative interviews; n = 18], preliminary adaptation design [data incorporation and steering committee; n = 5], pilot testing [n = 10 youth/adult dyads], and refinement) was applied to the existing evidence-based iCook 4-H curriculum using a five-strategy (peripheral, evidential, linguistic, constituent-involving, and sociocultural) cultural adaptation framework. A multiphase, two-cycle coding analytic process was completed within NVivo 12, followed by direct content analysis. Seventeen adaptations were made to the iCook curriculum, derived from varying combinations of four data sources (literature review, researcher informed, priority population, and steering committee), applying all five cultural adaptation strategies. A majority of the curriculum adaptations were derived from two or more data sources (71%) and were categorized within multiple adaptation strategies (88%). This study provided a community-based cultural adaptation process that could be used with various populations to address unique barriers and facilitators to food security. This innovative model addresses cultural needs while simultaneously aiming to improve health habits of refugee communities.

Food Acquisition Behaviors and Perceptions of Food Pantry Use among Food Pantry Clients in Rural Appalachia.

Rates of food insecurity vary highly across and within regions in the U.S., with rural Appalachia having higher rates compared to the rest of the country, leading parts of the population to rely on food pantries as a source of food. This article explores how food pantries fit into a broader scope of food acquisition strategies of rural Appalachian households and aims to contextualize this with an understanding of how food pantry users perceive their food pantry use. Semi-structured interviews (n=20) were conducted with food pantry users in Eastern Tennessee, followed by a survey for collection of demographic data. NVivo 11.4 software was used for thematic analysis and theory formulation. In addition to pantry use, participants reported reliance on grocery stores, and reciprocal, informal, food-sharing social networks to get food. Lack of transportation, insufficient food quantity, and other factors depleted participants' food resources. Food stretching, refusing to waste food, acceptability of food pantry food, and money-saving strategies enhanced participants' food resources. Food pantries are a consistent, but not the only food source for those who use them. Food pantry users are savvy with their resources and employ multiple strategies to maintain their food supply despite high levels of food insecurity.

Feasibility and Acceptability of Implementing a Culturally Adapted Cooking Curriculum for Burundian and Congolese Refugee Families.

Pika Pamoja (Cook Together) is an eight-session cooking curriculum for Burundian and Congolese refugee families, culturally adapted from the evidence-based iCook 4-H curriculum to address dietary acculturation barriers to and facilitators of food security. The goal of this study was to determine the feasibility and acceptability of implementing Pika Pamoja. Researchers and a multilingual community aid implemented Pika Pamoja in a pre-post pilot intervention with randomized control (n = 5)/treatment (n = 5) dyads (youth/mother). Feasibility (recruitment/retention, implementation, fidelity testing, and assessment procedures) and acceptability (process and program evaluations) measures were collected. All 10 dyads (control and treatment) were retained throughout the study. All fidelity measures were 91% or above. The final youth assessment instrument included scales for cooking skills (α = 0.93), cooking self-efficacy (α = 0.90), openness to new foods (α = 0.81), and eating (α = 0.68), playing (α = 0.90), and setting healthful goals (α = 0.88) together as a family. The final adult instrument included scales for cooking, eating, and playing together (α = 0.68), kitchen proficiency (α = 0.89), and food security (α = 0.79). Participant feedback was uniformly positive. Based on these results, Pika Pamoja was feasible to implement and was accepted by the priority population. Larger scale studies to measure the effectiveness of Pika Pamoja to increase food security among refugee families are needed.

Barriers and Facilitators to Food Security among Adult Burundian and Congolese Refugee Females Resettled in the US.

Sub-Saharan African refugees in the US have reported food security rates seven times below the national average. Dietary acculturation issues may be a contributing factor. Criterion-specific sample (n = 18) was recruited using network then snowball sampling methods. Semi-structured interviews were facilitated with the aid of a culturally and linguistically appropriate interpreter. An iterative, two cycle coding analytic process was completed within NVivo 11 by two coders who sought inter-rater reliability. Codes were organized into hierarchical maps and coding matrices for direct content analysis, and pattern and theme detection. Saturation was achieved and validated with an additional two interviews. Participants were primarily Burundian (67% vs. 33% Congolese), married (72%), held no high school degree (72%), unemployed (56%) and reported limited English proficiency (72%). Barriers and facilitators to food security across all levels of the Socio-Ecological Model (SEM) were noted. Emerging themes included difficulty with language, cooking, and shopping; transportation; social network support; orientation services; reliance on nutrition assistance programs; limited culturally relevant food and land access; and program policy miscomprehension. The complex relationship between dietary acculturation barriers and facilitators at various SEM levels demonstrates the need for a multi-level intervention to improve food security among refugees.

"I Had One Job and That Was To Make Milk".

BACKGROUND: For very-low-birth-weight (VLBW) infants, breastfeeding may no longer be an immediate option. Mothers often turn to mechanically expressing their milk with a breast pump to provide their infants human milk. Research aim: This study aimed to describe mothers' experiences expressing milk for their VLBW infants in a level 3 neonatal intensive care unit. METHODS: Qualitative, phenomenological methods were used to better understand the milk expression experiences of 17 mothers of VLBW infants. In-depth interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using Colaizzi's seven-step protocol, and themes were identified to illustrate the lived experience of the mothers. RESULTS: Five global themes emerged from interviews with mothers. However, this article focuses on one global theme, "I had one job and that was to make milk," and the supporting subthemes: (1) "I was heartbroken," (2) "Pumping is a full-time thing," and (3) "I literally sacrificed nights." CONCLUSION: This study provides insight into the complex experience that mothers in the southeastern United States undergo when expressing milk for their VLBW infants.

A diabetes self-management education class taught by pharmacy students.

OBJECTIVE: To assess the impact of pharmacy students teaching a diabetes self-management education (DSME) class on their competence and confidence in providing diabetes education. DESIGN: Pharmacy students enrolled in a service-learning elective first observed pharmacy faculty members teaching a DSME class and then 4 weeks later organized and taught a DSME class to a different group of patients at a student-run free medical clinic. ASSESSMENT: Student performance as assessed by faculty members using a rubric was above average, with a mean score of 3.3 on a 4.0 scale. Overall, student confidence after teaching the group DSME class was significantly higher than before teaching the class. CONCLUSION: Organizing and teaching a DSME class improved third-year pharmacy students' confidence and diabetes knowledge and skills, as well as provided a valuable service to patients at a free medical clinic.

Long-term outcome of radiofrequency ablation for intraoral microcystic lymphatic malformation.

OBJECTIVE: To determine long-term outcome of radiofrequency (RF) ablation of microcystic lymphatic malformation (LM) of the oral cavity for control of recurrent infection and bleeding. DESIGN: Institutional review board-approved retrospective study, SETTING: Tertiary pediatric medical center, PATIENTS: Twenty-six patients with intraoral microcystic LM were treated with RF ablation from August 2002 through August 2010. INTERVENTION: Radiofrequency ablation of intraoral LM. MAIN OUTCOME MEASURES: Postoperative stay, diet, pain; control of bleeding and/or infection; recurrence; and indication for retreatment. RESULTS: The most common complaints necessitating initial RF ablation were recurrent infection (n=10 [37%]) and bleeding (n=9 [33%]). The most common problems requiring further ablation were bleeding (n=11 [41%]) and cosmetic deformity not affecting function (n=8 [31%]). Fourteen patients (55%) were discharged home on postoperative day (POD) 3; the remaining 11 (45%) were discharged home on POD 4. Thirteen patients (52%) resumed oral diet immediately on the day of the procedure. Ten patients (38%) began eating on POD 1, and virtually every patient was on full oral intake at discharge. Fourteen patients (55%) required only acetaminophen for pain control, 11 (41%) required acetaminophen with codeine, and 1 (4%) required oxycodone. The mean follow-up time was 47 months after treatment. At the most recent clinic evaluation, 13 patients (50%) were symptom free, 8 (31%) were stable and improved without need for future treatment, and 5 (19%) required further treatment. One-half of patients in the study group underwent more than 1 RF procedure for recurrence. The number of RF ablations in this series were 1 procedure (n = 13), 2 procedures (n = 7), 3 procedures (n = 2), 4 procedures (n = 2), and 6 or 7 procedures (n = 2). CONCLUSIONS: Radiofrequency ablation is an effective treatment for localized, superficial microcystic LM in the oral cavity. Pediatric patients tolerate the treatment with rapid postoperative recovery and minimal complications. The majority of patients required a short hospital stay for observation of the airway. Virtually every patient resumed oral diet by the time of discharge. Radiofrequency ablation is the treatment of choice at Children's Hospital Boston (CHB) for patients who present with symptomatic, superficial, and localized intraoral microcystic LM. For lesions involving deeper structures, multimodal treatments including surgical and sclerotherapy may be necessary.

Decreasing procedural pain over time of left prefrontal rTMS for depression: initial results from the open-label phase of a multi-site trial (OPT-TMS).

BACKGROUND: There is much interest in whether daily left prefrontal repetitive transcranial magnetic stimulation (rTMS) over several weeks may become a clinically useful antidepressant treatment. Although rTMS appears largely safe, many patients report that this procedure is somewhat painful, which may restrict its ultimate appeal and utility. We analyzed interim results from the open-label phase of a multi-site randomized trial of rTMS as a treatment for depression to investigate whether the procedural pain of left prefrontal rTMS changes over time. METHODS: Patients with unipolar depression who had failed to respond during at least three weeks of the sham-controlled double-masked rTMS were then offered three more weeks (15 sessions) of open-label rTMS. Retrospective pain ratings and state emotional factors from 20 subjects were assessed using visual analog scales (VAS) recorded on computers before and after each treatment (289 sessions). RESULTS: Over the 15 treatment sessions, subjective reports of the painfulness of rTMS decreased 48% from baseline. This reduction, although greatest in the first few days, continued steadily (average 2.11 points per session) over the 3 weeks of treatment. The analysis found a significant effect for rTMS-session (p<0.0001) on rTMS-procedural pain over and above changes in subjective emotional states. CONCLUSION: The procedural pain of left, prefrontal rTMS decreases over time, apparently independently of other emotional changes. Since rTMS scalp pain may decline over time, physicians and patients may decide to continue treatment despite initial discomfort. These observational data can be better tested once the data from the blinded phase of the trial becomes available.