A Qualitative Study on Preventing Gestational Diabetes in Native Hawaiian and Pacific Islander Adolescent Females: Perspectives from an Expert Panel of Health Care Providers.

The authors examined perspectives of health care providers (HCPs) who serve Native Hawaiian and Pacific Islander (NH/PI) adolescents to inform the adaption of an existing American Indian and Alaska Native-specific gestational diabetes mellitus (GDM) risk reduction and preconception counseling program entitled Stopping GDM, for NH/PI adolescents. Hawai'i-based HCPs (n=14) who care for NH/PI adolescent females volunteered for this expert panel focus group study. These HCP participants served as an expert panel specific to their experiences in providing primary care and reproductive health care/family planning, and their perspectives regarding GDM risk reduction for NH adolescents. Several key themes emerged from these expert panel focus groups: (1) importance of multi-generational family involvement and support; (2) need to address the social determinants of health; (3) strengths-based strategies and recommendations to engage adolescents in a preconception counseling and GDM risk-reduction education program. Findings will inform the adaptation of Stopping GDM into a more holistic, multi-level, strengths-based, culturally tailored GDM risk reduction intervention that fosters empowerment and builds on the resilience of NH/PI communities.

A review of the literature on chiropractic and insomnia.

OBJECTIVE: The purpose of this literature review is to critically review the evidence for chiropractic as a treatment of primary insomnia. METHODS: A search of the following databases up to October 2006 was conducted: PubMed, PEDro, MANTIS, CINAHL, and the specialized register of the Cochrane review group. We also performed hand searching of relevant journals. Randomized clinical trials, clinical trials, and case studies of chiropractic treatment of insomnia were included. It was required that each study used at least one form of standard patient outcome measure. Treatment strategies included manual therapy such as spinal manipulative therapy or muscle relaxation techniques. The review focused on articles published in indexed, peer-reviewed journals. RESULTS: Fifteen studies met the selection criteria. There were no randomized clinical trials specific to chiropractic and insomnia. One study was a survey of opinion for treatment regimens for insomnia, which had low methodological scores. Another study assessed osteopathic cranial manipulation for insomnia, which appeared to have positive effects. Four studies identified physiotherapy treatment and manual therapy. A further 9 studies related to mind-body medical therapies and impaired health status, sleep disorders, and pain in the craniomandibular and cervical spinal regions. CONCLUSION: Some studies have noted improvement in insomnia following manual therapy; however, based on clinical trials, there is minimal evidence of support for chiropractic in insomnia. Further studies with high methodological scores need to be conducted.