Perceived Barriers to and Facilitators of Hypertension Management among Underserved African American Older Adults.

OBJECTIVE: To understand the perceived barriers to and facilitators of hypertension self-management among underserved African American older adults in a southeastern clinic. DESIGN: Qualitative descriptive. SETTING: Urban cardiovascular health clinic in a southeastern state. PARTICIPANTS: 28 African Americans diagnosed with hypertension. METHODS: Interview questions were focused on knowledge of hypertension management and barriers and facilitators to hypertension self-management. Thematic content analysis was applied. RESULTS: Patients reported increased hypertension knowledge after attending the clinic. All patients reported knowledge of the severe consequences of uncontrolled hypertension. Perceived barriers to hypertension management included lack of money, lack of motivation to exercise, and fear of injury from exercising. Perceived facilitators of hypertension management included weight loss, unexpected diagnosis of hypertension, family members with hypertension and diabetes, and social support. CONCLUSIONS: Findings suggest that perceived barriers and facilitators influence a patient's decision to manage hypertension. Findings suggest the importance of health literacy and patient-provider communication at this particular clinic. Possible factors in the social environment may influence hypertension management. This study adds to the literature by understanding the perceived barriers to and facilitators of hypertension management of an underserved sample in a southeastern clinic. The results suggest a need for the redesign and transformation of future hypertension education strategies aimed at this clinic sample.

Factors influencing medication compliance among hypertensive older African American adults.

OBJECTIVE: The purpose was to gain an indepth understanding of the factors influencing hypertension medication compliance among hypertensive older African Americans. DESIGN: Qualitative descriptive. In depth semistructured interviews were conducted with 28 patients. Interviews were recorded, transcribed, and analyzed by the Colaizzi-style method. SETTING: Patients at a cardiovascular clinic in the Southeast. PATIENTS: 28 African American males and females aged > or = 55 with controlled and uncontrolled hypertension were recruited and interviewed. RESULTS: Stroke Heart Attack and Prevention Program (SHAPP) patients reported self-efficacy, patient-provider communication, and social support contributed to their hypertension regimen compliance. Patients reported higher self-efficacy contributed to their hypertension control. Patients also reported that open communication with the SHAPP nurses and social support from their family, friends, and coworkers provided emotional support, information and guidance to assist them in being compliant with their hypertension management regimen. CONCLUSIONS: Our results can inform SHAPP providers and staff about patients' hypertension medication compliance, can improve patient-provider communication in other SHAPP clinics, and can aid in future patient hypertension management. Our results also suggest the importance of self-efficacy, patient-provider communication, and social support in hypertension regimen compliance.

Adult-derived stem cells and their potential for use in tissue repair and molecular medicine.

This report reviews three categories of precursor cells present within adults. The first category of precursor cell, the epiblast-like stem cell, has the potential of forming cells from all three embryonic germ layer lineages, e.g., ectoderm, mesoderm, and endoderm. The second category of precursor cell, the germ layer lineage stem cell, consists of three separate cells. Each of the three cells is committed to form cells limited to a specific embryonic germ layer lineage. Thus the second category consists of germ layer lineage ectodermal stem cells, germ layer lineage mesodermal stem cells, and germ layer lineage endodermal stem cells. The third category of precursor cells, progenitor cells, contains a multitude of cells. These cells are committed to form specific cell and tissue types and are the immediate precursors to the differentiated cells and tissues of the adult. The three categories of precursor cells can be readily isolated from adult tissues. They can be distinguished from each other based on their size, growth in cell culture, expressed genes, cell surface markers, and potential for differentiation. This report also discusses new findings. These findings include the karyotypic analysis of germ layer lineage stem cells; the appearance of dopaminergic neurons after implantation of naive adult pluripotent stem cells into a 6-hydroxydopamine-lesioned Parkinson's model; and the use of adult stem cells as transport mechanisms for exogenous genetic material. We conclude by discussing the potential roles of adult-derived precursor cells as building blocks for tissue repair and as delivery vehicles for molecular medicine.

Clonogenic analysis reveals reserve stem cells in postnatal mammals. II. Pluripotent epiblastic-like stem cells.

Undifferentiated cells have been identified in the prenatal blastocyst, inner cell mass, and gonadal ridges of rodents and primates, including humans. After isolation these cells express molecular and immunological markers for embryonic cells, capabilities for extended self-renewal, and telomerase activity. When allowed to differentiate, embryonic stem cells express phenotypic markers for tissues of ectodermal, mesodermal, and endodermal origin. When implanted in vivo, undifferentiated noninduced embryonic stem cells formed teratomas. In this report we describe a cell clone isolated from postnatal rat skeletal muscle and derived by repetitive single-cell clonogenic analysis. In the undifferentiated state it consists of very small cells having a high ratio of nucleus to cytoplasm. The clone expresses molecular and immunological markers for embryonic stem cells. It exhibits telomerase activity, which is consistent with its extended capability for self-renewal. When induced to differentiate, it expressed phenotypic markers for tissues of ectodermal, mesodermal, and endodermal origin. The clone was designated as a postnatal pluripotent epiblastic-like stem cell (PPELSC). The undifferentiated clone was transfected with a genomic marker and assayed for alterations in stem cell characteristics. No alterations were noted. The labeled clone, when implanted into heart after injury, incorporated into myocardial tissues undergoing repair. The labeled clone was subjected to directed lineage induction in vitro, resulting in the formation of islet-like structures (ILSs) that secreted insulin in response to a glucose challenge. This study suggests that embryonic-like stem cells are retained within postnatal mammals and have the potential for use in gene therapy and tissue engineering.