Melba Sheila D'Souza

Women’s well-being and reproductive health in Indian mining community: need for empowerment

This paper is a qualitative study of women’s well-being and reproductive health status among married women in mining communities in India. An exploratory qualitative research design was conducted using purposive sampling among 40 selected married women in a rural Indian mining community. Ethical permission was obtained from Goa University. A semi-structured indepth interview guide was used to gather women’s experiences and perceptions regarding well-being and reproductive health in 2010. These interviews were audiotaped, transcribed, verified, coded and then analyzed using qualitative content analysis. Early marriage, increased fertility, less birth intervals, son preference and lack of decision-making regarding reproductive health choices were found to affect women’s reproductive health. Domestic violence, gender preference, husbands drinking behaviors, and low spousal communication were common experiences considered by women as factors leading to poor quality of marital relationship. Four main themes in confronting women’s well-being are poor literacy and mobility, low employment and income generating opportunities, poor reproductive health choices and preferences and poor quality of martial relationships and communication. These determinants of physical, psychological and cultural well-being should be an essential part of nursing assessment in the primary care settings for informed actions. Nursing interventions should be directed towards participatory approach, informed decision making and empowering women towards better health and well-being in the mining community.

Do Perceptions of Empowerment Affect Glycemic Control and Self-Care Among Adults with Type 2 Diabetes?

Background: The Arab adult with T2DM is understudied with less known facts about the perception of empowerment and its relationship with self-care and glycemic control. Purpose: The purpose of this study was to determine the extent to which perception of empowerment by Arab adults living with Type 2 Diabetes Mellitus (T2DM) was associated with better glycemic control and self-care management. Methods: A cross-sectional descriptive study was led among 300 Arab adults living in Oman with T2DM in an outpatient diabetes clinic. The Diabetes Empowerment Scale (DES), glycosylated haemaglobin (HbA1c) and Body mass index was assessed. The DES was found to be valid and reliable for the population. ANOVA, Regression analysis, and Structural equation modeling was used for analysis. Results: The composite score and three subscales of DES were a significant and strong predictor of good glycemic control among Omani adults with T2DM (p<0.001). Age, education, duration of DM, prior DM education program and medications were significantly associated with DES. Conclusion: Diabetes nurse educators engaged in the care of adults with T2DM should assess self-empowerment and tailor interventions to increase empowerment for better glycemic control. Patient empowerment plays an essential role in maintaining self-care behaviours and HbA1c.

Health Related Quality of Life among Omani Men and Women with Type 2 Diabetes

The aim of this study was to explore predictors of health related quality of life (HRQoL) among men and women with type 2 diabetes. This cross-sectional descriptive study consisted of a random sample of 300 adults with type 2 diabetes in a selected public hospital. Euro-QoL and Revised Summary of Diabetes Self-Care Activities scales were used to collect data between January and June 2010. Schooling and ability to manage positively were highly significant predictors of quality of life (QoL) among women as compared to men. Age, prevention of activities of daily living and knowledge/management of diabetes were significant predictors of Health state among women as compared to men. Findings demonstrate that 30.6% (versus 35.7%) of the variance in the total QoL and 14% (versus 23%) of the variance in health state could be explained by personal and clinical characteristics among women and men, respectively. The study underlines the importance for nurse educators to assess HRQoL among men and women and to develop effective self-care management strategies based on personal and clinical characteristics.

Effectiveness of patient navigator interventions on uptake of colorectal cancer screening in primary care settings

AIM Colorectal cancer is the fourth most common type of cancer in the world and every year it is responsible for 610,000 deaths worldwide. The aim of this review was to examine the effectiveness of patient navigator interventions towards enhancing uptake of colorectal cancer screening in primary care settings. METHODS Electronic databases such as PubMed, CINHAL, Google Scholar and SCOPUS were searched to retrieve articles reporting on primary studies applying any patient navigator intervention to promote uptake of colorectal cancer screening in eligible patients. The search yielded 292 articles and 15 met the inclusion criteria. RESULTS All 15 studies were conducted in urban settings located in the USA. The findings of the review show that patient navigator interventions can increase colorectal cancer screening rates in diverse primary care settings. Patient navigator interventions were most effective in patients who belong to minority groups and enhanced uptake of colorectal cancer screening with rates ranging 11-91%. CONCLUSION There is a need for further studies to examine the effectiveness of patient navigator interventions in rural populations and other countries. Such studies will help us to clearly characterize the effectiveness of patient navigator interventions.

Foot care behaviors among adults with type 2 diabetes

AIM The aim of the study was to determine factors influencing foot care behaviors among adults with type 2 diabetes. METHODS A correlational descriptive study was conducted with a random sample of 160 adults with type 2 diabetes from the public hospital between April and July 2014. RESULTS Just over 15% of the sample had a history of foot ulcers and almost 42% had numbness/tingling and pain in their feet. Positive foot care behaviors were correlated with higher income, higher educational attainment, lower body weight, positive attitude and higher awareness of diabetes and its management. CONCLUSION Targeting type 2 diabetes people with low level of education, low income and overweight may help to enhance their foot care and reduce foot complications in similar populations, Implications. Those most at risk of foot problems should be targeted for education to increase their awareness of ways to prevent and to manage foot problems.

Foot care education and platelet derived growth factor on wound healing in foot ulcers among adults

Aim: The aim of the study was to evaluate the combined efficacy of foot care education and recombinant human platelet-derived growth factor (rhPDGF) on the wound healing in foot ulcers among adults with type 2 diabetes (T2D). Subjects and Methods: A randomized control trial and a factorial design were used in this study in a 500-bedded private teaching hospital with four major surgical units in 2013. A sample size of 50 adults with T2D was selected in each of the three groups; the combined intervention (foot education and rhPDGF), the medication intervention (rhPDGF), and the control group (CG) (Betadine gel). A standard clinical practice guideline was adopted for the three groups at baseline, 15 th day, and 30 th day. A modified Bates-Jensen wound assessment tool was used to assess the wound healing. Results: Combined efficacy of foot care education and rhPDGF resulted in complete closure of wound with a mean time of 15.91 days compared to the medication intervention (rhPDGF) and the CG in foot ulcers. There was better wound healing characteristics among adults with T2D exposed to the foot care education and rhPDGF compared to the use of rhPDGF and Betadine. Conclusion: Combined efficacy of foot care education with PDGF improved the total wound healing and ensured better wound characteristics in lower extremity foot ulcers among adults with T2D.

Need for interprofessional collaborative practice: Lafora disease

A 19-year adolescent presented to a specialist hospital with a 5-year history of Lafora disease (LD) or progressive myoclonic epilepsy. LD (EPM2) resulting from a homozygous missense mutation in EPM2B (NHLRC1) was confirmed. Symptomatic management was done using conventional anti- epileptics and anti-myoclonics. Understanding the nature of prenatal screening and genetic alliance are an important for advocating genetic testing and genetic counseling. This framework is necessary for a transdisciplinary, preventive genetic services, and likely gene therapy.

Barriers to Colorectal Cancer Screening in Primary Care Settings: Attitudes and Knowledge of Nurses and Physicians

Objective: Healthcare providers (HCPs) play a critical role in reducing colorectal cancer (CRC) related morbidity and mortality. This study aimed at exploring the attitudes and knowledge of nurses and physicians working in primary care settings regarding CRC screening. Methods: A total of 142 HCPs (57.7% nurses and 42.3% physicians) participated in a cross-sectional survey. Data were collected using a Self-administered Questionnaire. The participants were clinically experienced (mean = 9.39 years; standard deviation [SD] = 6.13), regularly taking care of adults eligible for CRC screening (62%) and had positive attitudes toward CRC screening (83.1%). Most participants (57%) had low levels of knowledge about CRC screening (mean = 3.23; SD = 1.50). The participants were most knowledgeable about the recommended age for initiating screening (62.7%) and the procedures not recommended for screening (90.8%). Results: More than 55% did not know the frequency of performing specific screening procedures, the upper age limit at which screening is not recommended, and the patients at high-risk for CRC. There were no significant differences between nurses′ and physicians′ attitudes and knowledge. The participants′ perceptions about professional training (odds ratio [OR] = 2.17, P = 0.003), colonoscopy (OR = 2.60, P = 0.014), and double-contrast barium enema (OR = 0.53, P = 0.041), were significantly associated with knowledge about CRC screening. Conclusions: The inadequate knowledge levels among nurses and physicians may be one of the barriers affecting CRC screening. Enhancing HCPs knowledge about CRC screening should be considered a primary intervention in the efforts to promote CRC screening and prevention.

Examining the Risk Factors among Omani Women: Risk Assessment and Their Implications

Osteoporosis is common among postmenopausal women, giving rise to morbidity and diminishing the quality of life. There is lack of information about the risk factors of osteoporosis among local Omani women. To explore the risk factors of Osteoporosis among Omani Women using a Modified Fracture Risk Assessment Tool. This is an exploratory research design using a simple random sampling. A pilot study was conducted among 35 local Omani women from the Muscat region, who completed the validated and reliable Modified Fracture Risk Assessment Tool (MFRAT). Bone Mineral Density (BMD) was measured among 11 women at moderate-high risk based on MFRAT. The data was analyzed using inferential statistics. Fourteen Omani women were at moderate-high risk for Osteoporosis fracture due to premenopausal, Vitamin D Deficiency, increased parity, increased lactation period and sedentary lifestyle. Among these five women revealed low BMD and required early intervention and support. Determinants of Osteoporosis can be elicited among premenaopausal Omani women with a specific risk assessment tool. There is a need to construct a cultural sensitive risk assessment tool for Omani women for early screening and detection of Osteoporosis. Nurses can identify, provide intervention and education for Omani women at-risk of fracture.