Margaret Sanders

Prevalence and Correlates of Mental Disorders Among Native American Women in Primary Care

OBJECTIVES We examined the lifetime and the past-year prevalence and correlates of common mental disorders among American Indian and Alaska Native women who presented for primary care. METHODS We screened 489 consecutively presenting female primary care patients aged 18 through 45 years with the General Health Questionnaire, 12-item version. A subsample (n = 234) completed the Composite International Diagnostic Interview. We examined associations between psychiatric disorders and sociodemographic variables, boarding school attendance, and psychopathology in the family of origin. RESULTS The study participants had high rates of alcohol use disorders, anxiety disorders, and anxiety/depression comorbidity compared with other samples of non-American Indian/Alaska Native women in primary care settings. CONCLUSIONS There is a need for culturally appropriate mental health treatments and preventive services.

HPV and cervical cancer prevention counseling with younger adolescents: implications for primary care.

PURPOSE Primary care clinicians will continue to play an important role in cervical cancer prevention, particularly with regard to administration of the newly licensed human papillomavirus (HPV) vaccine and continued administration of Papanicolaou tests. Little is known about the factors that influence cervical cancer prevention counseling, particularly in the adolescent encounter. We conducted a qualitative study to better understand the implications for counseling about cervical cancer prevention by primary care clinicians who care for adolescents. METHODS We conducted in-depth interviews with 37 primary care clinicians in New Mexico to understand the context in which they provide anticipatory guidance about sexual health risks as well as their attitudes about counseling for the forthcoming HPV vaccine. RESULTS Clinicians identified 4 categories of factors related to their counseling experiences with adolescents about HPV: (1) the need to build rapport with adolescent patients, (2) the presumption that adolescent patients engage in high-risk behaviors, (3) the situational delivery and complexity of HPV counseling, and (4) perceptions of clinician and community receptivity to the HPV vaccine. CONCLUSION Our findings show that conditions of the preadolescent and young adolescent visit pose a challenge to the successful integration of counseling about cervical cancer prevention in primary care. Counseling strategies that are designed to emphasize a preventive focus while including parents in the discussion at the time of vaccination and that are appropriate to populations with different cultural values and beliefs will help to enhance communication about cervical cancer prevention and the particular role of the HPV vaccine.

Evaluation for community-based programs: The integration of logic models and factor analysis

PURPOSE To discuss the utility of and value of the use of logic models for program evaluation of community-based programs and more specifically, the integration of logic models and factor analysis to develop and revise a survey as part of an effective evaluation plan. PRINCIPAL RESULTS Diverse stakeholders with varying outlooks used a logic model as a framework to reach agreement on a plan for a state-wide evaluation. This evaluation plan utilized a survey of sixth grade students, administered before and after exposure to a year-long abstinence education program. Components of the logic model were linked to specific survey questions. Exploratory factor analysis was then used to assess whether and how the questions in the survey fit with the constructs of the model; confirmatory factor analysis was used to test the hypothesis that the factors identified in the exploratory analysis were consistently represented in the survey. MAJOR CONCLUSIONS A logic model is a tool that engages stakeholders to link evaluation instruments more closely to specific program objectives. Thus, stakeholders can more closely assess the extent to which project outcomes have been achieved. In addition, use of factor analysis in the evaluation process can help the stakeholders better understand whether evaluation instruments such as a survey adequately assess program effectiveness. Lastly, a logic model process can help to achieve consensus among diverse stakeholders, by allowing them to focus on objectives that are concrete, measurable, and mutually acceptable.

Membrane Receptor Mapping: The Membrane Topography of FceRI Signaling

Ligand binding to membrane receptors initiates cascades of biochemical events leading to physiological responses. Hundreds of proteins and lipids are implicated in signaling networks and programs in genomics and proteomics are continuously adding new components to the signaling “parts lists”. Here, we generate high resolution maps of signaling networks using cytoplasmic face-up membrane sheets that can be labeled with inununogold probes (3–10 nm) and imaged in the transmission electron microscope. Our model system is the mast cell and we focus on mapping the topography of the high affinity IgE receptor, FceRI, its associated tyrosine kinases, Lyn and Syk, and the signaling proteins that propagate signals from these kinases. Crosslinked receptors and their signaling partners segregate during signaling to multiple, dynamic membrane domains, including a transient FceRI-Lyn domain and at least two other distinct domains, one characterized by the presence of receptor, Syk and multiple signaling proteins, but not Lyn (primary signaling domains), and one characterized by the presence of LAT and PLCγl but not receptor (secondary signaling domains). PI 3-kinase associates with both primary and secondary signaling domains and may help to recruit specific signaling proteins through the local remodeling of inositol phospholipids. The lipid raft markers, GM1 and Thy-1, fail to localize in native membrane sheets either with each other or with signaling domains. We introduce new probes to localize multiple signaling molecules on the same membrane sheet and new computational tools to capture and analyze their topographical relationships. In the future, we expect that high resolution maps of signaling networks will be integrated with chemical kinetic analyses, with cell fractionation data and with a range of real-time fluorescence measurements, into mathematical models with power to predict mechanisms that regulate the efficiency, specificity, amplitude and duration of signaling pathways.

Addressing the "other" health literacy competencies--knowledge, dispositions, and oral/aural communication: development of TALKDOC, an intervention assessment tool.

Most health literacy assessments evaluate literacy skills including reading, writing; numeracy and interpretation of tables, graphs, diagrams and charts. Some assess understanding of health systems, and the ability to adequately apply ones skills to specific health-related tasks or demands in health situations. However, to achieve functional health literacy, the ability to “obtain, process, and understand basic health information and services needed to make appropriate health decisions,” other health literacy dimensions should be assessed: a persons knowledge and attitudes about a health issue affects his or her ability to and interest in participating in his or her own care. In patient care settings, the abilities to listen, ask questions and check ones understanding are crucial to making appropriate decisions and carrying out instructions. Although literacy is a skill associated with educational attainment and therefore difficult to change in a short time, health education interventions can address health literacy domains such as knowledge, attitudes and oral communication skills. For this reason, an instrument that can assess these constructs is a valuable part of a health educators toolbox. The authors describe the development and process and outcomes of testing a novel instrument targeted to assess HPV and cervical cancer health literacy competencies, TALKDOC, including its validation with the Health Activities Literacy Scale.

Interdisciplinary health education and career choice in rural and underserved areas

Purpose  To assess the association between an educational rural health interdisciplinary programme (RHIP) and subsequent practice in US rural and underserved locations.

Perceived parenting ability and systemic sclerosis.

OBJECTIVE The purpose of this study was to compare perceived parenting abilities in mothers with systemic sclerosis (SSc) based on the subtype of SSc and age group of their children, and to examine how the degree of pain, fatigue and functional ability relates to parenting ability. METHODS In this cross-sectional survey, 74 mothers with SSc, who had children aged 18 years or younger living at home with them, completed a series of questionnaires online or on paper. The questionnaires included the Parent Disability Index (PDI) and surveys regarding demographic information, pain (visual analogue scale), fatigue (Multidimensional Assessment of Fatigue) and functional ability (Health Assessment Questionnaire). RESULTS An analysis of variance revealed that the mean age of the mother (F(2,71)  = 7.9; p < 0.01), mean PDI score (F(2,68)  = 5.4; p < 0.01) and mean pain score (F(2,71)  = 4.0; p = 0.02) were each associated with the age group of the children. The univariate analysis of variance results showed that dichotomized pain (F(1,69)  = 13.3; p < 0.01), fatigue (F(1,69)  = 18.9; p < 0.01) and disability (F(1,69)  = 9.8; p < 0.01) were each associated with the PDI score. The multivariate analysis of variance results showed that dichotomized pain (F(1,68)  = 7.5; p < 0.01) and fatigue (F(1,68)  = 12.7; p < 0.01) were associated with the PDI. CONCLUSION Mothers with SSc report difficulty with parenting, which can be related to the severity of the symptoms. The findings suggest that interventions to reduce pain and fatigue may improve perceived parenting ability.

The HEAL, Phase II Project: Enhancing Features of an Electronic Medical Record System to Improve Adherence to Asthma Guidelines

This article describes the implementation of an enhanced electronic medical record (EMR) system in three community health care centers in the Greater New Orleans area of Louisiana. This report may aid efforts directed at the implementation of enriched tools, such as decision support, in an EMR with the goal of improving pediatric asthma outcomes.

Successes and Opportunities to Adopting Evidence-Based Practices to Improve Asthma Care in New Orleans

Pediatric asthma is a multifactorial disease, requiring complex, interrelated interventions that target children, families, schools, health care providers, and communities. This article describes components of the Head-off Environmental Asthma in Louisiana (HEAL), phase II project, a collaboration between community and medical facilities for children with asthma in New Orleans. HEAL phase II extends and builds on the lessons learned from HEAL I, a post-Katrina research project, an observational study directed by Tulane University Health Sciences Center and the New Orleans Department of Health. HEAL phase II offers an opportunity to understand, from a health system’s perspective, how factors associated with the health care setting, patient-family, health care provider, asthma education, and community work together to create optimal conditions that support pediatric asthma care in New Orleans. In this context, this article will discuss factors contributing to health disparities in asthma; the need for a mul...

Participation Patterns of Ethnic Groups of Children Enrolled in Head Start Programs

Participation in activities is essential to the development of skills and social relationships. Children from different ethnic backgrounds living in poverty often experience limited access to participation opportunities. Sixty parents of children (20 Caucasian, 20 Hispanic, 20 Native American) enrolled in Head Start programs completed the Assessment of Preschool Children’s Participation. Significant differences in skill development activities were found between ethnic groups and between genders. No differences were found in other areas of participation. To effectively promote the participation of children from different ethnic groups living in poverty, occupational therapists need to collaborate with parents within their cultural context.