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PubMed2002

Steroid use among adolescents: findings from Project EAT.

PURPOSE: To explore the prevalence and correlates of using steroids for the purpose of gaining muscle among adolescent males and females. More specifically, the study objectives were to: (a) assess the prevalence of anabolic steroid use in a large population-based sample of adolescent males and females; and (b) identify personal, socio-environmental, and behavioral factors related to the health of adolescents that use anabolic steroids. METHODS: The study population included 4746 middle and high school students from St. Paul/Minneapolis public schools who completed surveys and anthropometric measurements as part of a population-based study of eating patterns and weight concerns among teenagers (Project EAT: Eating Among Teens). Steroid use and a range of socio-environmental, personal, and behavioral factors hypothesized to be correlates of steroid use were assessed. Associations were examined separately among males and females through comparisons of means (unadjusted and adjusted for grade-level and race) for continuous variables, and percentages, and odds ratios for dichotomized variables. RESULTS: Steroid use was more common in males (5.4%, vs. 2.9% of females), non-Caucasians (especially Hmong, a subset of the Asian-American population), and in middle school students (as compared to high school). In males, steroid use was associated with poorer self-esteem and higher rates of depressed mood and attempted suicide, poorer knowledge and attitudes about health, greater participation in sports that emphasize weight and shape, greater parental concern about weight, and higher rates of disordered eating and substance use. Among females, steroid use was less consistent in its associations with other variables, although overall, a similar pattern of results emerged. CONCLUSIONS: Anabolic steroid use in adolescence is associated with poorer health-related attitudes and behaviors and exposure to socio-environmental influences encouraging weight preoccupation. Attention needs to be directed toward youth who may be at increased risk for steroid use within clinical and community-based settings

Adolescent↗
PubMed1997

Psychological dysfunction in Southeast Asian refugees as mediated by sense of coherence.

Investigated Antonovky's (1979, 1987) construct of sense of coherence (i.e., an individual's belief that the world was comprehensible, manageable, and meaningful) as the internal psychological mechanism mediating the effects of external stressors (generalized resistance deficits) and resources on psychological dysfunction (measured by depression, anxiety, and psychosocial dysfunction) in 2,234 Vietnamese, Cambodian, Laotian, Hmong, and Chinese-Vietnamese refugees. Generalized resistance and deficits significantly predicted sense of coherence as well as psychological dysfunction. The amount of variance accounted for increased significantly when the mediating effect of sense of coherence was tested using a path analysis. Sense of coherence significantly reduced the predictive power of generalized resistance and deficits in the psychological dysfunction models. Results support the hypothesized mediating role of sense of coherence. Thus, interventions aiming to enhance Southeast Asian refugees' functioning may gain in effectiveness by targeting and promoting their sense of coherence.

Adolescent↗
PubMed1999

Health of Cambodian refugees.

Cambodian refugees have been entering the United States since 1975, with the largest numbers arriving in the early 1980s. While many adjusted satisfactorily to their new environment, many continue having severe difficulty with the resettlement. Studies show that Cambodians are suffering more physical and mental distress than Vietnamese, Hmong, and Laotians. They are experiencing more financial and social distress, as well. This paper describes a small neighborhood home visiting program established 13 years ago to provide follow-up care for Cambodian refugees seen in a University Medical Center and later serving as a community experience for fourth-year medical students. These close contacts with the Cambodian community indicate that for many, especially those who are aging, both health and adjustment appear to be deteriorating. Chronic illnesses and prolonged severe depression are taking the place of the infectious diseases and the personal health problems, like dental disease, that they brought with them when they resettled in America.

Journal Article↗
PubMed2005

Intervention with linguistically diverse preschool children: a focus on developing home language(s).

PURPOSE: This article addresses a series of questions that are critical to planning and implementing effective intervention programs for young linguistically diverse learners with primary language impairment (LI). Linguistically diverse learners in the United States include children whose families speak languages such as Spanish, Korean, Cantonese, Hmong, Vietnamese, or any language other than, or in addition to, English. METHOD: A narrative review of the relevant literature addresses clinical questions including (a) Why support the home language when it is not the language used in school or the majority community? (b) Does continued support for the home language undermine attainment in a second language? (c) Should we support the home language when it includes the code switching or mixing of two traditionally separate languages? and (d) What are some strategies that can be used to support the home language when it is a language that the speech-language pathologist (SLP) does not speak? CONCLUSION: SLPs should provide services to linguistically diverse preschool-age children with LI in a manner that effectively supports the development of the home language. Parent and paraprofessional training along with peer-mediated models of intervention are presented as two possible methods for facilitating the home language in children with LI.

Child, Preschool↗
PubMed2001

Expanding conceptualizations of culturally competent care.

AIM: The aim of the study was to gain an understanding of cultural competence from the perspectives of non-mainstream nurse educators, specifically those of Latin heritage. BACKGROUND/RATIONALE: Although the theoretical concepts of 'cultural diversity' and 'culturally competent care' have been supported and promoted by the largest professional nursing organizations, the practical application of these concepts has often created difficulties for nurse researchers, educators, and clinicians. The lack of progress in teaching and evaluating cultural competence suggested the need to 'center the margins' and explore cultural competence from the margins of one particular non-mainstream nursing group, Latina nurse educators. DESIGN/METHODS: A grounded theory research design was employed. A group of 10 doctoral, prepared, self-identified, Latina nurse educators participated in face- to-face audiotaped interviews. Data collection, analysis, and theoretical sampling decisions occurred concurrently, strengthening theory generation. Institutional review board approval was received for all steps of the study. The major limitation of the study was the omission of student voices. RESULTS/FINDINGS: The analysis suggests that the Latina participants shared the common purpose of teaching students how to think about difference. The teaching practices of this group of Latina educators was based on a belief that 'difference' is not solely about specific cultural groups. For example, content about 'Hmongs' or 'Latinos'. Rather, Latina faculty focused on teaching students how to directly connect with anyone perceived as different from oneself. CONCLUSION: Latina faculty did not distinguish between competent care and culturally competent care; for them, competence necessarily includes cultural competence. They conceptualize the provision of competent care to all persons who are perceived as different, rather than focusing only on those who are perceived as 'culturally' different. These conceptualizations have the potential to shed new light on how nurses and nurse educators think about, develop, and integrate cultural competence into nursing education, practice, and research.

Cultural Diversity↗
PubMed2003

Prevalence of intestinal parasitic infections in northern Vietnam.

We surveyed the prevalence of parasitic infections in the mountainous province of Hoa Binh, north-west Vietnam, involving 526 households of six ethnic groups: Muong, Kinh, Dao, Thai, Tay and Hmong. Eggs or cysts of at least one parasite species were detected in 88% of stool samples (n = 2522). Prevalences of nematodes were high among all ethnic groups: hookworm (52%), Trichuris trichiura (50%) and Ascaris lumbricoides (45%). Ascaris infection appeared to be lower in households owning a latrine, was highest among children and decreased with age. Prevalence of hookworm rose during childhood, remained high until old age, was highest among adult women, but was not linked to anaemia. Eggs of Chlonorchis spp. were found in 126 (5%) individuals (of the Muong, Kinh or Thai groups only). Chlonorchiasis increased with age and was highest among adult men. Taenia eggs were found in three individuals (0.1%). Giardia lamblia was found in all districts and among all groups and the prevalence of infection was estimated at 3%.

Adolescent↗
PubMed2006

Three new alpha-thalassemia point mutations ascertained through newborn screening.

We report three new alpha-thalassemia (thal) point mutations detected during newborn screening for hemoglobinopathies. The first mutation is a single nucleotide deletion (-A) that abolishes the translation initiation codon of the alpha2-globin gene, detected in a newborn of Hmong ethnicity who carried the Southeast Asian alpha(0)-thal deletion (alpha(T)alpha/- -(SEA)). The second mutation, a frameshift caused by a single nucleotide deletion in exon 2 of the alpha1-globin gene [codon 78 (-C)], was detected in a Black/Chinese newborn who also carried the Southeast Asian alpha0-thal deletion (alphaalpha(T)/- -(SEA)). The third mutation was a frameshift in exon 3 of the alpha2-globin gene, codons 113/114 (-C). This mutation was detected in a newborn who carried the 3.7 kb alpha(+)-thal deletion (alpha(T)alpha/-alpha(3.7)).

Amino Acid Sequence↗
PubMed1997

Widely varying HIV prevalence and risk behaviours among the ethnic minority peoples of northern Thailand.

We compared HIV prevalence, risk behaviours, and social and sexual norms among nine ethnic minority (Hilltribe) groups in northern Thailand. Communities were selected on the basis of size, ethnicity, development level and geography. Subjects (15-45 years) were stratified by gender and selected by household using two-stage randomization. Forty volunteers were identified in each of 27 villages. Participation was voluntary and informed consent was obtained. HIV infection status was determined using ELISA and Western Blot on saliva samples. Risks for HIV were measured with structured interviews using local languages. Overall HIV prevalence was 23/1080 (2.13%) with an equal male-female ratio. HIV prevalence rates were: Shan 8.75%, Akha 5.0%, Yao 5.0%, Thin 1.25%, Hmong 0.63%, Lahu 0.63%, Lisu 0.63%, Karen 0, and Pa-Long 0. Sex worker use was an HIV risk for men (p = 0.0001), but injecting drug use was not; for women, having been a sex worker was a significant HIV risk (p < 0.0001). HIV rates, social norms and sexual behaviour varied considerably among ethnic groups, as did attitudes toward commercial sex work and use. HIV prevention needs to target the Shan, Akha, and Yao communities, and to focus on reduction of brothel work and use.

Adolescent↗
PubMedDate not supplied

Disability status differentials across fifteen Asian and Pacific Islander groups and the effect of nativity and duration of residence in the U.S.

This study examines disparities in disability status across 15 Asian and Pacific Islander American (API) subpopulations and how nativity and duration in the U.S. influence these differences. Employing three disability questions (work limitations, mobility limitations, and self-care limitations) from the 1990 PUMS, the authors find substantial heterogeneity in disability status across API subgroups: while Japanese American adults have the most favorable outcomes, Other Southeast Asian adults (Laotians, Hmong, and Cambodians), followed by Vietnamese and Pacific Islander adults, suffer from a high risk of disabilities. Many of the disparities in disability status across API subpopulation adults are attributable to differentials in demographic characteristics and SES. The inclusion of an interaction term of age and nativity/duration of residence in the U.S. in multivariate regression analyses demonstrates that the effect of nativity/duration plays a different role across age, net of demographic, and SES risk factors. The overall findings are also consistent with previous studies on the relationship between immigrant health and nativity/duration. That is, immigrants with short duration in the U.S. have superior health status, measured by risk of disability, than longer-term immigrants and their U.S.-born counterparts.

Activities of Daily Living↗
PubMed1995

Characterization of the large deletion in the GALC gene found in patients with Krabbe disease.

Globoid cell leukodystrophy (GLD) of Krabbe disease results from mutations in the galactocerebrosidase (GALC) gene. Previously, we had identified a large deletion in the GALC gene together with a C to T polymorphism at cDNA position 502 in a significant number of cases of infantile Krabbe disease; however, the deletion breakpoint had not been found. In this paper we show that the deletion is approximately 30 kb starting near the middle of the 12 kb intron 10, and includes all of the coding region through exon 17 plus an additional 9 kb. The deletion junction contains a 4 bp direct repeat and is preceded by sequence identified as belonging to the Alu family of interspersed repetitive elements. Using genomic DNA and a PCR-based test to detect normal and deleted sequences at that location, a large number of patients with all clinical types of GLD were analyzed. Of 21 infantile patients found to be heterozygous for the 502T polymorphism reported previously, 15 had the deletion, one could not tested and five, including a Hmong child, did not have the deletion. Sixteen other infantile patients previously tested were found to be either homozygous (10) or heterozygous (6) for the deletion. In addition, five patients with juvenile and adult GLD were found to be heterozygous for the deletion. In every case tested, the deletion was always found on the same allele as the 502T polymorphism. However, other disease-causing mutations have been found on the 502T allele. With careful genotype analysis these families can receive improved genetic information including patient and carrier identification and preimplantation diagnosis.

Animals↗
PubMed1988

Application of DNA hybridization techniques in the assessment of diarrheal disease among refugees in Thailand.

The epidemiology and etiology of acute diarrheal disease were determined in a Hmong refugee camp on the Thai-Laotian border from April 11 to May 14, 1985. DNA hybridization techniques were used to detect Shigella species, enteroinvasive Escherichia coli, and enterotoxigenic E. coli. A monoclonal enzyme-linked immunosorbent assay was used to detect rotavirus, and standard microbiology was used to detect other enteropathogens. The age-specific diarrheal disease rates were 47 episodes per month per 1,000 children less than five years old and 113 episodes per month per 1,000 children less than one year old. Rotavirus, enterotoxigenic E. coli, Campylobacter, and Cryptosporidium were the predominant pathogens in children less than two years old. The DNA probe hybridized with 94% of 31 specimens identified as enterotoxigenic E. coli by the standard assays and with none of the specimens in which the standard assays were negative. The probe for Shigella and enteroinvasive E. coli hybridized in eight of 10 stools that contained Shigella and four of 314 stools from which Shigella and enteroinvasive E. coli were not isolated. The use of DNA probes allows specimens to be collected in remote areas with a minimum amount of equipment and technical expertise so that they can be easily transported to a central laboratory for further processing.

Acute Disease↗
PubMed2001

Altered levels of Reelin and its isoforms in schizophrenia and mood disorders.

Reelin is a secreted extracellular matrix protein approximately 410 kDa mol. wt that is reduced in brains of patients with schizophrenia, autism, bipolar disorder and major depression. Recent reports also indicate its near absence in sera of some patients with an autosomal recessive form of lissencephaly. Moreover, Reelin is involved not only in normal cortical lamination of the brain during mammalian embryogenesis but is also implicated in cell signaling systems subserving cognition in adult brain. Here, we show that blood levels of Reelin and its isoforms are altered in three psychiatric disorders, namely, schizophrenia, bipolar disorder and major depression. The changes include significant increases in 410 kDa Reelin moiety of 49% in schizophrenic patients (p < 0.022) of four ethnic compositions (Caucasian, Vietnamese, Hmong and Laotian) and non-significant increases in depressed patients by 34% vs control blood. In contrast, 410 kDa Reelin levels decreased by 33% in bipolar blood, albeit non-signficantly, vs. controls. There was a significant increase of 90% (p < 0.0061) in 330 kDa Reelin in Caucasian schizophrenics; the depressed value was elevated by 30% vs. control but non-significantly. Again, in contrast, bipolar 330 kDa value decreased by 31% vs control (p < 0.0480). Finally, all 180 kDa Reelin values varied minimally in schizophrenics vs controls. In contrast, the 180 kDa Reelin values dropped significantly by 49% (p < 0.0117) and 29% (p < 0.0424) in bipolar and depressed patients, respectively, compared with controls. The alterations in blood Reelin values appear to be specific since levels of two other blood proteins, ceruloplasmin and albumin did not vary significantly between all psychiatric subjects and controls. These findings suggest that blood Reelin levels and its isoforms may be used as potential peripheral markers to diagnose presence of several psychiatric disorders and may also serve as targets for future therapeutic interventions.

Adult↗
PubMed2002

Using literature as the framework for a new course.

OBJECTIVE: The award-winning book The Spirit Catches You and You Fall Down,(1) a true story of the collision between two cultures (American and Hmong) with heartrending consequences for the patient, the patient's family, and the medical professionals who care for them, has been favorably reviewed(2) and used to stimulate teaching of cultural diversity, ethics, and professionalism to students and residents. We used it as a required text for a new Patient Doctor Society (PDS) course for 184 first- and second-year medical students. This report describes the scope and contexts in which the book was used to meet specific course goals. DESCRIPTION: PDS is a required 90-hour introduction to medical interviewing, which integrates ethics, communication, clinical reasoning, cultural diversity, humanities, spirituality, integrative medicine, nutrition, and behavioral science. To provide a common experience among these diverse topics, faculty members were asked to use examples from the book to achieve their learning objectives. A required faculty development session illustrated strategies for effectively using the text. Focusing on chapter 13 ("Code X"), dramatic portrayals of differences in beliefs about end-of-life care and clinician-family communication, facilitated the introduction of methods including point-of-view writing, role-plays, and faculty-facilitated discussions as techniques for meeting course objectives. At PDS orientation, we used the same chapter, and had faculty members lead small groups of students using the teaching techniques they acquired. About 90% of students read the book prior to orientation. Students favorably reviewed this three-hour session. For the ethics session, unfacilitated small groups of students were asked to identify and discuss the ethical issues in chapter 11 ("The Big One"), which describes a major turning point in the health care provided to the text's central character, Lia. Each group presented its "moral diagnosis" and ethical arguments for resolution. Class discussion then focused on the diverse views presented, to emphasize the importance of justifying decisions and to practice using tools of ethical analysis. In the communication skills workshop, we excerpted dramatic readings from the book. Faculty members played the roles of the author, the patient's mother, and one of Lia's physicians. The interaction became a dialogue to illustrate the points of view of the participants. The dialogue was used to stimulate discussion about potential pitfalls in physician-patient communication and understanding. In a medical humanities session, excerpts from the book were compared with poetry explicating themes of physician arrogance and humility. DISCUSSION: The Spirit Catches You and You Fall Down provides a context appropriate to teaching students how to listen to, and learn from patient stories. The story will be reintroduced in the pediatrics clerkship. Caution will be exercised to (1) avoid overexposure to the text, (2) counteract the potential to interpret the story too narrowly, and (3) assure that faculty become familiar with the text and its uses. We intend to track outcomes in knowledge, skills and attitudes for each content area, and observe the degree that the book facilitates achievement of objectives. We will follow several cohorts of students to verify longitudinally the learning effects observed.

Cultural Diversity↗
PubMed1983

Health service utilization by Indochinese refugees.

In this article the utilization of medical services by Indochinese refugees is examined. A representative sample of the refugee population in one resettlement site provides basic data on health service utilization behaviors. The analysis focuses on the situational and attitudinal determinants of hospital contact, physician contact, and the volume of utilization of both services. The findings indicate that length of residence and ethnicity are important predictors of utilization behaviors. The most recently arrived refugees and the Hmong are low utilizers of physician and hospital services. A regression analysis of situational and attitudinal variables shows that effects of length of residence and ethnicity do not diminish when the effects of the other variables are considered. Although the results are similar to previous utilization studies, they do suggest that Indochinese refugees require more information about United States health services to utilize them properly.

Asia, Southeastern↗
PubMedDate not supplied

The postpartum experience for southeast Asian women in the United States.

PURPOSE: To examine the meaning of postpartum experiences for Southeast Asian women living in the United States. STUDY DESIGN AND METHODS: Phenomenology. Open-ended interviews were conducted with 19 women; audio-taped interviews were transcribed and analyzed for recurrent themes. RESULTS: Women identified culturally specific treatments they needed to use following the birth of an infant. These treatments are meant to delay aging and to prevent chronic ailments, and include stringent dietary measures and prolonged rest periods. Because childbirth signifies a paramount event in the life of a woman belonging to the Cambodian, Vietnamese, or Hmong cultures, she is accorded a great deal of assistance from female relatives. Three themes were discovered through this research: Prolonged Rest, Regaining Balance in the Body, and the Affiliation of Women. The themes give meaning to childbirth experiences and future well-being in the community. CLINICAL IMPLICATIONS: The childbirth experience in Southeast Asian cultures is saturated with great status, particularly in the family and community. In addition, postpartum cultural traditions of Southeast Asian women comprise deep meaning for healthy aging. Through this study, nurses can gain a more in-depth appreciation of the underlying meanings of postpartum practices for Southeast Asian women.

Adult↗
PubMed2005

Increasing response rates in a survey of Medicaid enrollees: the effect of a prepaid monetary incentive and mixed modes (mail and telephone).

OBJECTIVES: We sought to evaluate the effect of pairing a mixed-mode mail and telephone methodology with a prepaid US 2.00 dollars cash incentive on response rates in a survey of Medicaid enrollees stratified by race and ethnicity. RESEARCH DESIGN: Sampling was conducted in 2 stages. The first stage consisted of a simple random sample (SRS) of Medicaid enrollees. In the second stage, American Indian, African American, Latino, Hmong, and Somali enrollees were randomly sampled. A total of 8412 enrollees were assigned randomly to receive a mail survey with no incentive or a US 2.00 dollars bill. RESULTS: The response rate within the SRS after the mail portion was 54% in the incentive group and 45% in the nonincentive group. Response rates increased considerably with telephone follow-ups. The incentive SRS response rate increased to 69%, and the nonincentive response rate increased to 64%. Differences between incentive conditions are more pronounced after the first mailing (P < 0.01); almost all differences remained significant (P < 0.05) after the completion of the mail mode. The inclusion of the US 2.00 dollars incentive had similar effects on response rates and cost across the different racial and ethnic strata, except for Latino enrollees. CONCLUSIONS: A mixed-mode mail and telephone methodology is effective for increasing response rates in a Medicaid population overall and within different racial and ethnic groupings. The effectiveness of this strategy can be enhanced, in terms of response rate and cost, by including a US 2.00 dollars prepaid incentive.

Ethnicity↗
PubMedDate not supplied

Maternal depression and anxiety and infant development: a comparison of foreign-born and native-born mothers.

Studies that investigate infant and/or child development in families of depressed or anxious mothers do not include samples of foreign-born non-English-speaking mothers. This article describes a pilot study investigating infant development, maternal depression, and anxiety in comparison samples of native-born and foreign-born mothers and children from Vietnam, Laos (Hmong), and the Democratic Republic of Congo. Maternal depression and anxiety were measured with the Hopkins Symptom Checklist-25, and the developmental status of children 0-25 months of age was measured with the Denver II. Foreign-born mothers were more anxious than native-born mothers. Non-English-speaking foreign-born mothers were clinically depressed (1.83) and moderately anxious (1.62). Infants of native-born mothers and English-speaking foreign-born mothers performed better on the Denver II than children of foreign-born non-English-speaking mothers. Infants and toddlers of non-English-speaking mothers appear to be at high risk for delays during their first 25 months of life. Public health nurses need to advocate for appropriate interpreter services and mental health resources for non-English-speaking mothers of young children. Developmental screening should reflect cultural variations in parental expectations of how and when children meet developmental milestones. Replication studies and investigation about the long-term development of this high-risk group of children are needed.

Adult↗
PubMed1987

Susceptibility to human cutaneous leishmaniasis and HLA, Gm, Km markers.

A relationship between markers related to the immune response (HLA system, Gm and Km immunoglobulin allotypes) and susceptibility to cutaneous leishmaniasis was investigated in a population of Hmong refugees who had recently settled in French Guiana. Two approaches were used: 1) case/control comparisons of the marker phenotype distribution to detect possible associations; 2) multiple-case family studies to search for marker-linked genes. When the distribution of HLA-A, B, C, antigens and Gm, Km allotypes was compared between patients and controls, only a significant decrease of HLA-Cw7 antigen among leishmaniasis patients was detected (p = 0.01). No interaction between any two of these markers and the disease was found. On the other hand, neither an HLA, Gm or Km susceptibility gene could be demonstrated in the informative sets of affected siblings. These results are discussed with respect to those reported in other infectious diseases.

Disease Susceptibility↗