Norma G. Cuellar

Complementary and alternative medicine (CAM) use by african american (AA) and caucasian american (CA) older adults in a rural setting: a descriptive, comparative study

BackgroundThe use of CAM is at an all time high. There is very little research that compares the use of CAM in elders by ethnicity in rural settings. The purpose of the study was to determine if there was a difference between African American and Caucasian American rural elders on use of CAM and self-reported satisfaction with CAM.MethodsThe design was a descriptive, comparative study of 183 elders who reported the number of CAM used and satisfaction with CAM. A convenience sample was recruited through community service organizations in the state of Mississippi. The availability of elders through the support groups, sampling bias, subject effect, and self-report were limitations of the study.ResultsThe commonest examples of CAM used by rural elders were prayer, vitamins, exercise, meditation, herbs, chiropractic medicine, glucosamine, and music therapy. Significant findings on SES and marital status were calculated. Differences on ethnicity and demographic variables were significant for age, education, and the use of glucosamine.ConclusionsHealth care providers must be aware that elders are using CAM and are satisfied with their use. Identifying different uses of CAM by ethnicity is important for health care practitioners, impacting how health care is provided.

Symptoms of Restless Legs Syndrome in Older Adults: Outcomes on Sleep Quality, Sleepiness, Fatigue, Depression, and Quality of Life

OBJECTIVES: To compare differences in sleep quality, sleepiness, fatigue, depression, and quality of life according to severity of symptoms of restless legs syndrome (RLS) in older adults.

Melatonin pharmacokinetics following two different oral surge-sustained release doses in older adults

Abstract:  Melatonin is increasingly used for the treatment of sleep disorders. Surge‐sustained formulations consisting of combined immediate release and controlled release dosing may mimic the endogenous melatonin physiologic profile. However, relatively little is known about the pharmacokinetic properties of low‐dose (<0.5 mg) and high‐dose (>2 mg) melatonin in a combined immediate release/controlled release dose, especially in older adults who may also exhibit altered melatonin disposition. To assess this, we conducted a randomized, double‐blind, placebo‐controlled study of low‐dose (0.4 mg) and high‐dose (4.0 mg) melatonin (25% immediate release + 75% controlled release) in 27 older adults with insomnia complaints and low endogenous melatonin levels to determine whether melatonin pharmacokinetic properties differ between these two doses. The time to maximum level (1.3 hrs versus 1.5 hrs), elimination half‐life (1.8 hrs versus 2.1 hrs), and apparent total clearance (379 L/hr versus 478 L/hr) did not differ significantly between the low‐ and high‐dose arms, respectively. The maximum concentration was 405 ± 93 pg/mL for the low‐dose arm and 3999 ± 700 pg/mL for the high‐dose arm, both of which are substantially higher than physiologic melatonin levels for this age group. In addition, subjects in the high‐dose arm maintained melatonin levels >50 pg/mL for an average of 10 hrs, which could result in elevated melatonin levels beyond the typical sleep period. Renal and liver function parameters remained stable after 6 wks of treatment. The linear pharmacokinetic behavior of melatonin observed in the elderly can form the basis for future studies exploring a wider range of dosing scenarios to establish exposure–response relationships for melatonin‐mediated sleep outcomes.

CULTURAL COMPETENCE IN THE UNDERGRADUATE NURSING CURRICULUM

More demands are being put on nursing faculty to incorporate content related to cultural competence in the undergraduate curriculum. Adding more content into an already full curriculum and becoming proficient at teaching cultural competence throughout the curriculum are challenging to nursing faculty. In addition, identifying personal bias to ensure that students are prepared to deliver culturally sensitive care requires a certain amount of self-awareness of personal prejudice. The purpose of this article is to present the implementation of the newly developed Blueprint for Integration of Cultural Competence in the Curriculum (BICCC) into an undergraduate nursing curriculum as a framework for teaching cultural competence in an undergraduate nursing curriculum. This will include defining culture and cultural competence as they relate to teaching, presenting educational standards of cultural competence in accrediting agencies, presenting level objectives for learning cultural competent information, describing a curriculum incorporating cultural competence in an undergraduate nursing program, and providing examples of implementation of cultural competence teaching strategies for nursing faculty.

Developing a Blueprint for Cultural Competence Education at Penn

This article describes the structure, process, and outcomes of developing a blueprint for integration of cultural competence education into the curriculum at the University of Pennsylvania, School of Nursing. The overarching framework of Kotter (1995) on leading change and organizational transformation was used as a guide for evaluation of faculty efforts. Within the setting of a research-intensive university, the process consisted of implementing a series of action steps which included appointment of a Director of Diversity Affairs, selection of a Master Teachers Taskforce on Cultural Diversity as catalysts for change; conduction of intensive faculty development programs, dissemination of information about cultural competence education, and use of innovative teaching approaches and student participation in curriculum activities. In addition, a Blueprint for Integration of Cultural Competence in the Curriculum (BICCC) was developed and used as the instrument for faculty surveys for 2 consecutive academic years. Faculty survey findings showed a substantial increase in the number of courses integrating cultural competence content in the programs of study. Successful outcomes of the Penn initiative were due to administrative and faculty support, utilization of a Director of Diversity Affairs, innovative work of the Master Teachers Taskforce on Cultural Diversity, faculty development initiatives, and development of the BICCC as a guiding framework for identifying areas of needed curricular change.

Restless Legs Syndrome in Type 2 Diabetes Implications to Diabetes Educators

Purpose The purpose of this study was to provide a background of restless legs syndrome (RLS), present the prevalence and demographic findings of a descriptive study of type 2 diabetes with RLS, and provide implications to diabetes educators on the management and education of RLS. Methods Participants with type 2 diabetes who met the diagnostic criteria for RLS based on the International RLS Study Group Criteria were recruited from the PENN Rodebaugh Diabetes Center from July 2005 through September 2006. Participants who met inclusion and exclusion criteria were mailed a survey to collect data. Results Of 121 patients with type 2 diabetes, 54 (45%) of the screened sample met the 4 diagnostic criteria for RLS. Of those who met the inclusion and exclusion criteria of the primary study, 18 patients with type 2 diabetes with RLS participated in this study. Along with diabetes, the par- ticipants had a variety of comorbid health conditions including hypertension, neuropathies, rheumatoid arthritis, renal failure, and irritable bowel syndrome. Only one third of the participants were being treated for RLS. Thirty-nine percent of the participants with type 2 diabetes were using insulin to manage their diabetes with other oral agents. Conclusions RLS is a sleep disorder that may affect the management of type 2 diabetes. Diabetes educators must know that sleep disorders can affect long-term health outcomes, and RLS is frequently seen in this cohort of patients.

The effects of periodic limb movements in sleep (PLMS) on cardiovascular disease

Periodic limb movements in sleep (PLMS) are uncontrollable nocturnal movements that occur during sleep and increase with age. Research has implicated PLMS as a contributing factor to the development of cardiovascular disease (CVD). The purpose of this manuscript is to 1) explain the sleep disorder of PLMS and implications on CVD; 2) identify the impact of PLMS on CVD; 3) discuss treatment options for PLMS; 4) present future research needs for PLMS/RLS; 5) provide implications to health care providers to improve the care and health outcomes of persons with PLMS.

Mindfulness Meditation for Veterans—Implications for Occupational Health Providers

Mindfulness meditation (MfM) is a mind-body therapy identified by the National Center for Complementary and Alternative Medicine. Initially taught in a formal classroom setting, MfM is a sustainable intervention with minimal costs that can be used over time. For veterans, after mastery, this technique shows promise in improving health outcomes and quality of life. This article describes MfM, discusses the conceptual framework and evidence-based research for MfM, and identifies the implications of MfM use by health care providers who are caring for war veterans.

Effects of Depression on Sleep Quality, Fatigue, and Sleepiness in Persons With Restless Legs Syndrome

BACKGROUND: Restless legs syndrome is a sleep disorder that is associated with depression and poor sleep quality; it possibly affects sleepiness and fatigue, thereby affecting quality of life. OBJECTIVE: To determine the effect of depression on sleep quality, sleepiness, and fatigue in persons with restless legs syndrome. STUDY DESIGN: Descriptive, comparative study. Data was collected on demographics, depression, sleep quality, sleepiness, and fatigue. Participants were grouped based on depression scores. RESULTS: 40% of the sample reported depressive symptomology. Depressed participants had significantly worse sleep quality (t=4.12, df=40, p<.001) and fatigue (t=3.69, df=46, p=.001). Depression did not affect sleepiness (p=.733). CONCLUSIONS: Persons with restless legs syndrome who are depressed have poorer sleep quality and higher fatigue than nondepressed persons with restless legs syndrome. Few participants are being treated for depression. Health care providers must recognize the impact that depression has on persons with restless legs syndrome and develop innovative nonpharmacological strategies to help with depression.

The Relationship With Iron and Health Outcomes in Persons With Restless Legs Syndrome

Background: Restless Legs Syndrome (RLS) is a sleep disorder cause by inadequate iron metabolism. However, no studies have identified the impact of iron in RLS patients on sleep, depression, fatigue, or quality of life (QoL). Objective: The aims of this secondary data analysis was to determine relationships (a) between serum iron with RLS symptom severity, sleep quality, daytime sleepiness, depression, fatigue, and quality of life (QoL); and (b) based on demographics, specifically age and ethnicity. Method: Data were collected on iron and ferritin concentrations in 48 persons with RLS. Results: Low serum iron levels were measured in 32% of the participants with only 1 person (4%) treated with iron supplementation. General linear models identified age and race as covariants: (a) being White (p = .047) and higher iron levels (p = .019) were independent predictors of higher social functioning; (b) being White (p = .047) and higher iron levels (p = .004) were independent predictors of less sleepiness; (c) younger age (p = .001) and lower iron levels (p = .025) were independent predictors of depression; and (d) younger age (p = .006) and lower iron levels (p = .005) were independent predictors of fatigue. Discussion: Findings from this study show that iron supplementation for persons with RLS not only improves motor and sensory symptoms but might also improve sleep, sleepiness, depression, fatigue, and QoL and should be considered by health care providers for treatment of RLS.