Gail Melkus

African-American spirituality: A concept analysis

Culturally competent care for African Americans requires sensitivity to spirituality as a component of the cultural context. To foster understanding, measurement, and delivery of the spiritual component of culturally competent care, this article presents an evolutionary concept analysis of African-American spirituality. The analysis is based on a sample of multidisciplinary research studies reflecting spirituality of African Americans. Findings indicate that African-American spirituality involves quintessential, internal, external, consoling, and transformative attributive dimensions. Findings are considered in relation to previous conceptual analyses of spirituality and suggest that defining attributes of African-American spirituality are both global and culturally prominent. Implications for practice and research are discussed.

Family-Based Interventions for Childhood Obesity: A Review

The purpose of this article is to critically evaluate the evidence related to family-based interventions designed to treat childhood obesity. A MEDLINE, PSYCLIT, and CINAHL search identified articles published between January 1980 and January 2004 relating to family-based interventions. Thirteen studies were included, and all of the interventions used nutrition education, exercise, and behavioral interventions, including behavioral modification, behavioral therapy, or problem solving. Behavioral modification interventions targeted children and parents together or separately and were reported to be successful in improving weight-loss outcomes in both parents and children. Behavioral therapy interventions targeting children and parents together or the parents of children separately improved weight outcomes. Problem-solving interventions that targeted parents of children showed improved weight outcomes for their children. However, when problem solving was used with both parents and children together or children alone, weight outcomes did not improve. A majority of the studies have some methodological weaknesses.

SELF-REPORT OF DEPRESSED MOOD AND DEPRESSION IN WOMEN WITH TYPE 2 DIABETES

The purpose of this cross-sectional analysis (N = 53) was to (a) describe the self-reported prevalence of depressed mood and depression in women with type 2 diabetes; (b) to describe the antidepressive agents and dosages prescribed for depression treatment in women with type 2 diabetes; and (c) to examine differences in diabetes-related health outcomes (physiologic, psychosocial, and health functioning variables) with respect to depressed mood. Forty-four percent of women in this sample reported a depressed mood and 34% of the sample reported a history of depression. The majority of women with a history of depression were taking an antidepressive agent at the time of assessment (94%). Most women were treated with selective serotonin reuptake inhibitors (SSRIs). Women with depressed mood demonstrated poorer psychosocial adjustment and health functioning compared to women without a depressed mood; however, no differences in physiological outcomes were demonstrated. Only 18% of the participants were currently being treated with psychotherapy in conjunction with medication. Further research on this understudied population is indicated.

Obesity in Youth: Implications for the Advanced Practice Nurse in Primary Care

Purpose To discuss the advanced practice nurses diagnosis and management of obesity in youth in primary care. Data Sources Review of current scientific literature, practice guidelines, and a case study. Conclusions Obesity in youth is difficult to manage. Recent research suggests a genetic and environmental etiology associated with impaired glucose tolerance, type 2 diabetes, hypertension, hyperlipidemia, and hypertriglyceridemia. Nutrition education, increasing physical activity, decreasing sedentary behaviors, and behavioral modification have been used with varying success. Management is directed at healthy lifestyle behavior change for youth and their families. Implications for Practice If obesity, impaired glucose tolerance, hypertension, hypercholesterolemia, and hypertriglyceridemia are left untreated, youth may develop type 2 diabetes and coronary artery disease later in life and suffer early morbidity and mortality.

Primary care cancer and diabetes complications screening of black women with type 2 diabetes.

Purpose To determine the frequency with which Black women with type 2 diabetes receive routine primary health care screening for cancer and diabetes complications. Data Sources Pilot study data from a convenience sample of 21 Black women (mean age 46.8 years) with type 2 diabetes. Conclusions Cancer screening consisted of Pap smear, mam‐mography, and colon cancer screening consistent with current American Cancer Society recommendations. Ninety percent reported having had a Pap smear, 86% mammogram and 33% colon cancer screening. Diabetes complications screening was based on the American Diabetes Association care recommendations. Fifty‐five percent received screening eye exams, 40% were screened for renal proteinuria, and 50% received foot examinations and diabetes foot care instruction. Implications for Practice This sample of mid‐life, Black, educated, working women with type 2 diabetes utilize healthcare services and have high rates of primary care cancer screening. Rates of diabetes complications screening are less than optimal. Because Black American women suffer disproportionately high rates of diabetes and related complications, it is imperative that they receive quality diabetes care in an effort to improve health outcomes and decrease premature mortality.