African American Women: Surviving Breast Cancer Mortality against the Highest Odds.

Among the country's 25 largest cities, the breast cancer mortality disparity is highest in Memphis, Tennessee, where African American women are twice as likely to die from breast cancer as White women. This qualitative study of African-American breast cancer survivors explores experiences during and post treatment that contributed to their beating the high odds of mortality. Using a semi-structured interview guide, a focus group session was held in 2012 with 10 breast cancer survivors. Thematic analysis and a deductive a priori template of codes were used to analyze the data. Five main themes were identified: family history, breast/body awareness and preparedness to manage a breast cancer event, diagnosis experience and reaction to the diagnosis, family reactions, and impact on life. Prayer and family support were central to coping, and survivors voiced a cultural acceptance of racial disparities in health outcomes. They reported lack of provider sensitivity regarding pain, financial difficulties, negative responses from family/friends, and resiliency strategies for coping with physical and mental limitations. Our research suggested that a patient-centered approach of demystifying breast cancer (both in patient-provider communication and in community settings) would impact how women cope with breast cancer and respond to information about its diagnosis.

Effect of obesity on cardiovascular disease risk factors in African American women.

Obesity is a growing health care concern with implications for cardiovascular disease (CVD). Obesity and CVD morbidity and mortality are highly prevalent among African American women. This pilot study examined the association between obesity and the traditional and emerging CVD risk factors in a sample of African American women. Participants comprised 48 women (27 obese, 21 normal weight) aged 18-45. with no known history of CVD. The women completed demographic and 7-day physical activity recall questionnaires. Height and weight were used to determine body mass index (BMI). Hypertension risk was assessed using the average of two resting blood pressure (BP) measurements. Lipid profile, blood glucose, fibrinogen, high-sensitivity C-reactive protein (hs-CRP), plasminogen activator inhibitor-1 (PAI-1), soluble intercellular adhesion molecule-1 (sICAM-1), and E-selectin (eSel) levels were assessed using fasting blood samples. Laboratory findings were interpreted using the American Diabetes Association (ADA) and Adult Treatment Panel (ATP) III reference guidelines as well as manufacturers' reference ranges for the novel CVD risk factors. The most common traditional risk factors were physical inactivity (72.9%), positive family history of CVD (58.3%), and obesity (56.3%). Obese individuals had elevated systolic BP (p = .0002), diastolic BP (p = .0007) and HDL-cholesterol (p = .01), triglyceride (p = .02), hs-CRP (p = .002), and fibrinogen (p = .01), when compared with normal-weight women. The findings suggest an association between obesity and higher prevalence of both traditional and emerging CVD risk factors in young African American women.

Cost burden of the presenteeism health outcome: diverse workforce of nurses and pharmacists.

OBJECTIVES: To describe presenteeism, its cost burden, and comparative and interactive effects of race/ethnicity in nurses and pharmacists. METHODS: Using 226 self-reports, ordinal logistic regression with marginal/interactive effects modeled 12 presenteeism predictors, contingency tables detected differences/associations, and Human Capital Approach determined cost burden. RESULTS: Presenteeism's prevalence was 52.65% with mean productivity decrement 13.2%. Minorities had lower base presenteeism rates; however, race/ethnicity differences were not significant. Physical symptoms and mental conditions were associated with increased presenteeism likelihood, while decreased likelihood was associated with no medications or lack of resumption of previous medications. Indirect cost burden in 2008 averaged $12,605 per professional for $36 billion nationally. CONCLUSIONS: Prevention of symptoms and conditions impacting cognitions, pain, and perceptions can decrease presenteeism. Minorities' lower rates of presenteeism can be viewed both positively and negatively.

Health risk characteristics of Black female informal caregivers on welfare.

This exploratory study examines differences in health risk characteristics and perceived health by caregiver status in two groups of Black women, 37 informal caregivers and 20 noncaregivers, transitioning from welfare to work. Health risk characteristics were assessed with the Center for Epidemiologic Studies Depression Scale and Healthier People Network Health Risk Appraisal-Version 6. Body mass index (BMI) calculations were based on the standard Centers for Disease Control formula. Perceived health status was assessed using a single-item Cantril ladder. Results show no statistically significant between-group differences in perceived health status, depressive symptoms, frequency of lifestyle behaviors, or BMI. Clinically significant proportions of participants in both groups rated their health as poor or fair; reported mild to severe depressive symptoms; smoked cigarettes; did not perform monthly self-breast exams; were physically inactive, overweight, or obese; and consumed high-fat diets. Black women receiving welfare show increased risk for premature chronic health problems, which warrants development of effective community-based risk-reduction programs.

INSIGHT potentially prevents and treats depressive and anxiety symptoms in black women caring for chronic hemodialysis recipients.

End stage renal disease (ESRD) unduly affects black families in the U.S., including black women who are the family caregivers of affected patients. Nephrology nurses who support chronic hemodialysis recipients may be the first to recognize depressive and anxiety symptoms in this understudied caregiver population. This article describes the risk factors for depression in black women who care for persons receiving chronic hemodialysis therapy and INSIGHT therapy as a potential intervention to reduce depressive symptoms.

Prevalence of cardiovascular risk factors before kidney transplantation.

CONTEXT: Assessing the prevalence of cardiovascular risk factors is an essential step in developing risk profiles and individualizing interventions to reduce the cardiovascular morbidity and mortality of kidney transplant recipients. OBJECTIVE: To examine the prevalence of pretransplant modifiable, potentially modifiable, and nonmodifiable cardiovascular risk factors in patients who received kidney transplants between January 1, 1994, and December 31, 1996. DESIGN: An exploratory, retrospective nested case-control design was employed to assess pretransplant cardiovascular risk factors in kidney transplant recipients with documented posttransplant cardiovascular events (n = 12) and kidney transplant recipients with no documented posttransplant cardiovascular events (n = 66). Data were analyzed using frequencies, unpaired t tests, and chi 2 analyses. RESULTS: Significantly higher means of body mass index values greater than 25 kg/m2 (32.3 +/- 5.8 kg/m2 vs 28.8 +/- 3.4 kg/m2) and serum total cholesterol levels greater than 200 mg/dL (254.5 +/- 5.7 mg/dL vs 242.3 +/- 39.3 mg/dL) were noted in patients with documented cardiovascular events compared to those with no documented cardiovascular events, respectively. Diabetes was more prevalent in patients with documented cardiovascular events (33%); these patients were also predominantly African American men who had a higher prevalence of family and personal histories of cardiovascular disease (17% and 33%).