Child health promotion and health protection practices used by mothers of Mexican descent

Gallagher, Martina The University of Texas Health Science Center at S 2005 해외박사(DDOD)

By 2020, an estimated 1 in 5 children living in the United States will be of Latino descent. The largest subgroup in this growing minority is composed of individuals who are of Mexican origin. The literature shows that due to multiple contextual factors children of Mexican descent generally experience a great number of health disparities. There is a major knowledge gap concerning current health promotion and health protection practices used by mothers of Mexican descent with their children. Understanding how mothers of Mexican origin promote and protect the health of their preschool children is crucial for the creation of culturally specific wellness programs that address health disparities experienced by this vulnerable population. The purpose of this ethnographic study was to explore and describe the child health promotion and protection practices used by low-income, Spanish-speaking Mexican mothers living in San Antonio, Texas. Nine Spanish speaking participants were recruited from a community center in San Antonio, TX. Data collection in the form of ethnographic interviews took place in the participants' homes and during community activities. An adaptation of Spradley's developmental research sequence guided data collection and analysis. The findings indicate that despite significant socioeconomic challenges, these mothers of Mexican origin promoted and protected the health of their preschool children by al cuidado [taking care] and being al pendiente [mindfully aware] of the balance of their children's bodies, minds, and souls. They described a holistic perspective of health where the imbalance of one component would cause disharmony in the overall wellness of the preschool child. This group of mothers saw themselves as solely responsible for ensuring and restoring the balance of their children's bodies, minds, and souls. This balance was viewed as imperative to children's wellness. Child health promotion and protection behaviors used by mothers of Mexican descent were geared towards the maintenance and restoration of the balance of their children's bodies, minds, and souls. The strength of this holistic perspective is not often addressed in health promotion interventions for this population. This new understanding allows for the creation of culturally competent health promotion programs that can build on existing maternal strengths.

Mexican American elders and nursing home transition

Almendarez, Bertha Longoria The University of Texas Health Science Center at S 2007 해외박사(DDOD)

This study explores subjective perceptions of factors influencing Mexican American elders and their families during the process of transition from independent living to nursing homes. Specifically, it describes the processes and outcomes of nursing home transitions among Mexican Americans and the cultural beliefs, traditions and norms influencing them. The Mexican American population is now the largest minority ethnic group in the United States. If demographic trends proceed as projected, the number of athnic minorities entering nursing homes in the next 20 to 30 years will greatly increase as will the need for more culturally sensitive care. Little is known about Mexican Americans and factors preceding transition to nursing homes, how decision-making for admission takes place, what influences adjustment to being in a nursing home, or what perceptions family members have about nursing homes. The theoretical frame of reference orienting this study is a middle range theory on transitions (Meleis, et al., 2000). Among its precepts is that late life is a time of multiple transitions and that these multiple transitions form patterns that can be identified and described. It identifies personal, environmental and societal factors affecting the transition process and its outcomes. This study uses a naturalistic inquiry approach and ethnographic methods to learn from 10 Mexican-American dyads (eider and a family member) about the transition to life in a nursing home and how the decision for admission was made. Five questions provided a semi-structured format for interviews. These were followed as needed by structural or contrast questions to uncover more specifics and to discover the cultural meaning of living in a nursing home. Interview data are augmented by quantitative data obtained from instruments for measuring acculturation, acculturatioe stress, and familism, concepts that are relevant to the Mexican American experience in health care decisions, that were used to describe the sample characteristics. Using the transition theory typology as categories, interview data reveal only two types of transitions: situational and health/illness-related and most transition patterns were multiple and/or sequential. Elders reported declining function, and the inability of family members to provide care as preceding nursing home admission, while family members identified elders' changes in behavior and cognition as well. Minimal process indicators emerged to indicate that elders were making healthy transitions. One pattern of response that did emerge specific to this population was the concept of aguantando, a Spanish term for enduring or withstanding, which was used to describe their outcomes as withstanding or tolerating the situation but not necessarily accepting it. In this sample, children and/or extended family were the decision makers. All family participants agreed that they had no other option and would have rather been able to care for their elders at home. All elders felt they had to accept the admission decision as best for the family although not necessarily for them. The paucity of research with samples including Mexican-American elders supports the need for more studies in this area. Naturalistic inquiry elicits the perspective of the Mexican-American elder regarding factors affecting nursing home transition and adaptation to admission. These findings have implications for education, practice, and policy making. More studies based on the transition model will help to further validate the application of this theory to other ethnic groups. Future research should be considered with a focus on the Mexican American caregiver and the transition from caregiver to supporter of care in the nursing home setting.

Familial aggregation, candidate genes and genome scans: Analyzing the role of genetics in stroke

Morrison, Alanna Christine The University of Texas Health Science Center at H 2001 해외박사(DDOD)

The genetic etiology of stroke likely reflects the influence of multiple loci with small effects, each modulating different pathophysiological processes. This research project utilized three analytical strategies to address the paucity of information related to the identification and characterization of genetic variation associated with stroke in the general population. First, the general contribution of familial factors to stroke susceptibility was evaluated in a population-based sample of unrelated individuals. Increased risk of subclinical cerebral infarction was observed among individuals with a positive parental history of stroke. This association did not appear to be mediated by established stroke risk factors, specifically blood pressure levels or hypertension status. The need to identify specific gene variation associated with stroke in the general population was addressed by evaluating seven candidate gene polymorphisms in a population-based sample of unrelated individuals. Three polymorphisms were significantly associated with increased subclinical cerebral infarction or incident clinical ischemic stroke risk. These relationships include the G-protein β3 subunit 825C/T polymorphism and clinical stroke in Whites, the lipoprotein lipase S/X447 polymorphism and subclinical and clinical stroke in men, and the angiotensin I-converting enzyme Ins/Del polymorphism and subclinical stroke in White men. These associations did not appear to be obfuscated by the stroke risk factors adjusted for in the analysis models specifically blood pressure levels or anti-hypertensive medication use. The final research strategy considered, on a genome-wide scale, the idea that genetic variation may contribute to the occurrence of hypertension or stroke through a common etiologic pathway. Genomic regions were identified for which significant evidence of heterogeneity was observed among hypertensive sibpairs stratified by family history of stroke information. Regions identified on chromosome 15 in African Americans, and chromosome 13 in Whites and African Americans, suggest the presence of genes influencing hypertension and stroke susceptibility. Insight into the role of genetics in stroke is useful for the potential early identification of individuals at increased risk for stroke and improved understanding of the etiology of the disease. The ultimate goal of these endeavors is to guide the development of therapeutic intervention and informed prevention to provide a lasting and positive impact on public health.

Maternal perceptions of body image of Mexican-American children

Beckmann-Mendez, Diana Ardith The University of Texas Health Science Center at S 2007 해외박사(DDOD)

With the evolution of the technological age, American society has adopted a lifestyle of convenience and instant access. This lifestyle of convenience combined with inactivity has had a devastating effect on every segment in today's society, and, as a result, obesity has become an epidemic in the United States affecting both adults and children. Mexican-American children in particular have higher rates of obesity than their Hispanic counterparts and other ethnic minorities. Multiple studies have been conducted with various racial and ethnic populations to gain an understanding of the maternal perceptions concerning weight status, body size, and contributing factors in the development of obesity during the childhood years. However, few have focused on Mexican-American mothers. Since mothers are widely recognized as the guardians of young children's health, it is important to gain an understanding of their perceptions of the body images of preschool children. Mothers have a profound influence on their children by serving as role models. However, a need exists to clarify what roles these practices and other cultural phenomena have in promoting or lessening the issue of obesity in children. A mixed methods design was implemented in this study with twofold goal: (a) to describe maternal perceptions of body image in Mexican-American children, and, (b) to determine whether childhood obesity is recognized as a health issue among Mexican-American mothers. Descriptive qualitative data were gathered through semi-structured, ethnographic interviews of Mexican-American mothers. Mothers of children aged 2--5 years (n = 15) were interviewed for their explanatory models surrounding their children's body image and obesity. Quantitative data were collected via a demographics questionnaire and through the use of the Children's Body Image Scale (CBIS). Data gathered from the demographics and the CBIS were used to more fully describe the sample and expand the patterns and themes identified concerning maternal perception of body image of children. Mothers were able to define a healthy child in concordance with established medical/nursing ideals concerning weight and body size. However, an incongruity was discovered between what mothers say and what they do in terms of recognition, treatment, and prevention of childhood obesity and this finding needs to be explored in future research studies.

Positional candidate cloning of the RP10 form of retinitis pigmentosa

Bowne, Sara Juanita The University of Texas Health Science Center at H 2001 해외박사(DDOD)

Retinitis pigmentosa (RP) is a genetically heterogeneous group of retinal degenerations that affects over one million people worldwide. To date, 11 autosomal dominant, 13 autosomal recessive, and 5 X-linked forms of retinitis pigmentosa have been identified through linkage analysis, but the disease-causing genes and mutations have been found for only half of these loci. My research uses a positional candidate cloning approach to identify the gene and mutations responsible for one type of autosomal dominant retinitis pigmentosa, RP10. The premise is that identifying the genes and mutations responsible for disease will provide insight into disease mechanisms and provide treatment options. Previous research mapped the RP10 locus to a 5cM region on chromosome 7q31 between markers D7S686 and D7S530. Linkage and fine-point haplotype analysis was used to reduce and refine the RP10 disease interval to a 4cM region located between D7S2471 and a new marker located 45,000bp telomeric of D7S461. In order to identify genes located in the RP10 interval, an extensive EST map was created of this region. Five EST clusters from this map were analyzed to determine if mutations in these genes cause the RP10 form of retinitis pigmentosa. The genomic structure of a known metabotrophic glutamate receptor, GRMS8, was determined first. DNA sequencing of GRM8 in RP10 family members did not identify any disease-causing mutations. Four other EST clusters (A170, A173, A189, and A258) were characterized and determined to be part of the same gene, UBNL1 (ubinuclein-like 1). The full-length mRNA sequence and genomic structure of UBNL1 was determined and then screened in patients. No disease-causing mutations were identified in any of the RP10 family members tested. Recent data made available with the release of the public and Celera genome assemblies indicates that UBNL1 is outside of the RP10 disease region. Despite this complication, characterization of UBNL1 is still important in the understanding of normal visual processes and it is possible that mutations in UBNL1 could cause other forms of retinopathy. The EST map and list of RP10 candidates will continue to aid others in the search for the RP10 gene and mutations.

Narratives of facing personal mortality in the breast cancer experience of Mexican-American women

Nieto, Beatriz C The University of Texas Health Science Center at S 2005 해외박사(DDOD)

The purpose of this study was to describe the meaning of the lived experience of facing personal mortality in Mexican-American women with Stage IV breast cancer. The concurrent use of Phenomenology and Narrative theory provided the conceptual underpinning for this qualitative study. Narratives of facing personal mortality were explored among nine women diagnosed with Stage IV breast cancer. Each of the women was interviewed for 1 to 1½ hours at a location of their choice, and participant observation supplemented the interview data. Nine richly textured narratives revealed the women's experience of facing personal mortality within the context of living with breast cancer. They also provided a detailed description of each of the participants as person, their experience with breast cancer and with facing personal mortality. A second analysis of the narratives provided an infra-group comparison of facing personal mortality, and three major categories emerged from the narratives. The findings indicate that facing personal mortality, at its most rudimentary understanding, is a subjective and lived experienced. The individual's life intersects at their facing personal mortality experience. The individual's past, present, and future influence the experience of facing personal mortality and how it is manifested and worked through. The most important influences in the participants' life were the love of spouses, children, grandchildren, faith and trust in God, doing their part, and having the will to go on. As nurses, we have the opportunity to have an effect on that intersection as well. These women would benefit from the knowledge and skills of the nurse who is sensitive to their existential concerns, wants, and needs. Therefore, in order to be instrumental in the life of those facing personal mortality, we as nurses need to step up to the challenge and prepare ourselves with the knowledge and skills needed to care for those facing personal mortality. (Abstract shortened by UMI.).

Investigating collagen hydration with micro computed tomography

Amurao, Maxwell Leland Ramirez The University of Texas Health Science Center at S 2008 해외공개박사

In the human body, the most abundant simple molecule is water, and the most abundant complex molecule are proteins. It therefore stands to reason that protein-water interactions are both commonplace and important. The Stoichiometric Hydration Model (SHM) describes the interaction of water with collagen and its effects on collagen (and protein) structure. Micro Computed Tomography is used to expound on molecular hydration relationships for microscopic protein structures consistent with the SHM. Tendon samples are particularly suitable for study because it is composed of a symmetric and repetitive occurrence of collagen molecules, having nearly 100% collagen content, with the collagen molecules and fibrils aligned along the tendon long axis providing directional symmetry. This dissertation focuses on investigating collagen hydration with three-dimensional micro-CT (3D-micro-CT) dilatometry by addressing three specific aims. The first specific aim was to quantify the accuracy and precision of geometric measurements obtained from 3D-micro-CT to establish its use for dilatometry. The second specific aim was to use micro-CT imaging to relate changes in relative length, relative diameter, relative volume, density and differential density of bovine tendons to the molecular hydration properties of the collagen molecule. The third specific aim was to investigate the effect of glucose induced molecular changes---covalent crosslinking versus glucose bridges---resulting from glucose immersion in-vitro, as well as the combination of mechanical stress and glucose in-vivo. The following conclusions were obtained from the series of studies conducted: (1) The 3D-micro-CT dilatometry methodology used in this dissertation provided sufficiently precise and accurate measurements of tendon diameter, length, volume, density and differential density. (2) The unique approach using micro-CT dilatometry presented an independent method to support the presence of monolayer hydration coverage for collagen in its native state. (3) The measured dilatometric changes in native extensor tendons consistently supported the Stoichiometric Hydration Model. (4) The dominant source of dilatometric effects for glucose-immersed tendon samples in-vitro was the formation of hydrogen-bonds between glucose and collagen molecules that created glucose "spacers" in the collagen structure. Increased mechanical compression caused the formation of glucose bridges that replaced Ramachandran single water bridges. (5) Glucose-bridges also replaced single water bridges in-vivo due to the combined action of glucose and periodic mechanical stress on the tendon. Mechanical force caused the formation of a tightly bound, immobilized glucose-bridge such that concentration of free glucose is reduced in the tendon. (6) Glucose-bridge formation in-vivo is age-related, increasing up to a point determined by the maximum glucose bridge factor ( Sgb = 0.50) which was determined both empirically and theoretically. In summary, investigating collagen hydration with micro-CT provided robust supporting evidence for the Stoichiometric Hydration Model, and generated new insights on the effects of glucose on the collagen molecule consistent with the SHM.

The relationship between depression and unwanted sexual contact in adolescent females

Gerardi, Margit B The University of Texas Health Science Center at S 2007 해외박사(DDOD)

The overall purpose of the dissertation study was to explore the nature of female adolescents' experiences of unwanted sexual contact and the prevalence of depressed mood or clinically diagnosed mood disorder. Specific aims of the present study were to assess the prevalence of unwanted sexual contact, depression, and posttraumatic stress experience in 200 late adolescent females seeking routine health care services in an outpatient setting. The researcher also sought to investigate the relationship between the presence of depression and a history of unwanted sexual contact and the relationship between the presence of posttraumatic stress experience and a history of unwanted sexual contact. Lastly the researcher wanted to assess the influence of individual, intrapersonal, and environmental factors on the development of depression in late adolescents experiencing unwanted sexual contact. Findings in this study revealed both statistically significant and non-significant relationships. Hypothesis one stated that late female adolescents experiencing unwanted sexual contact were more likely to experience depression than those not experiencing sexual violence. This hypothesis was accepted. Hypothesis two stated that late female adolescents experiencing unwanted sexual contact will be more likely to report greater severity of depression than those not experiencing sexual violence. This hypothesis was accepted. Hypothesis three stated that individual, intrapersonal, and environmental factors influence the development of adolescent depression after unwanted sexual contact. The hypothesis was partially accepted. Individual and intrapersonal factors influenced the development of adolescent depression after unwanted sexual contact. Environmental factors did not significantly influence the development of adolescent depression after unwanted sexual contact. In conclusion, it is imperative to screen not only for unwanted sexual contact but also depression in adolescence. Depression has been identified in this study as co-morbid factor associated with unwanted sexual contact and also associated with increased risk for such negative outcomes to adolescents such as high-risk sexual behaviors and potential impairment in relationship formation.

Connectedness in the nurse-patient relationship

Miner-Williams, Denise The University of Texas Health Science Center at S 2005 해외박사(DDOD)

The purpose of this study was to explore and describe the nurse-patient relationship in which connectedness is experienced (NPR-C) from both nurse and patient perspectives in order to produce grounded theory to help to better understand the nurse-patient relationship (NPR). Two questions were asked: "What are patient and nurse descriptions of the NPR in which connectedness is experienced?" and "What are descriptions of the consequences of the NPR in which connectedness is experienced?". Using grounded theory methods, participants were asked if they had experienced a meaningful NPR. Semi-structured interviews were conducted with 15 people, nurses and patients (including family members). In addition, most participants were followed up with telephone or email contacts for an opportunity to contribute more. In the process, 25 stories were shared; 15 from the nurse perspective, and 10 from the patient perspective. The resulting grounded theory has two core variables, meeting the need and meaningfulness, and delineates the process of NPR-C. Connectedness in the nurse-patient relationship is a type of nurse-patient encounter in which needs of the spirit are met with the help of a spiritually competent nurse. It takes place in a milieu of openness and trust in which there is exchange, spiritual guidance by the nurse, and an interpretation of its meaningfulness resulting in an impact on one's life, healing, strength, and/or growth. This grounded theory validated concepts of presence, caring, meaning, and spirituality in nursing literature. However, significant progress has been made with this theory. Primarily is the understanding of how NPR-C fits into the NPR as a sub-concept which refines the meaning of holistic nursing. It identifies the concepts and attributes of needs of the spirit and spiritual competence. This research synthesizes many concepts concerning NPR-C into a parsimonious model which gives understanding of its phases and critical attributes. The study provides an important means of practical incorporation of spirituality into nursing care with the establishment of the primacy of relationship in meeting spiritual needs. It has implications for retention in that findings indicate that nurses who engage in NPR-C are willing to remain in high-turnover units because of the engendered satisfaction.

Genetic alterations associated with prostate cancer progression

Chu, Lisa Wey-Lan The University of Texas Health Science Center at H 2001 해외박사(DDOD)

Prostate cancer is the second most commonly diagnosed cancer among men in the United States. In this study, evidence is presented to support the hypothesis that specific chromosomal aberrations (involving one or more chromosomal regions) are associated with prostate cancer progression from organ-confined to locally advanced tumors and that some aberrations seen in high frequency in metastatic tumors may also be present in a subset of primary tumors. To determine the appropriate approach to address this hypothesis, I have established a modified CGH protocol by microdissection and DOP-PCR for use in detecting chromosomal changes in clinical prostate tumor specimens that is more sensitive and accurate than conventional CGH methods. I have successfully performed the improved CGH protocol to screen for genetic changes of 24 organ confined (pT2) and 21 locally advanced (pT3b) clinical prostate cancer specimens without metastases (N0M0). Comparisons of tumors by stage or Gleason scores following contingency table analysis showed that seven regions of the genome differed significantly between pT2 and pT3b tumors or between low and high Gleason tumors suggesting that these regions may be important in local prostate cancer progression. These included losses on 6p21–25, 6q24–27, 8p, 10q25–26, 15q22–26, and 18cen–q12 as well as gain of 3p13–q13. Multivariate analyses showed that loss of 8p (step1) and loss of 6q25–26 (or 6p21–25 or 10q25–26) (step 2) were predictive of pathologic stage or Gleason groups with 80% accuracy. Additional 5–7 steps in the multivariate model increased the predictive value to 91–95%. Comparison of the CGH data from the primary prostate tumors of this study with those obtained from published literature on metastases and recurrent tumors showed that the clinically more aggressive stage pT3b tumors shared more abnormalities in high frequency with metastases and recurrent tumors than less aggressive stage pT2 tumors. Furthermore, loss of 11cen–q22 was shared only between the primary tumors and metastases while gain of Xcen–q13 and loss of 18cen–q12 were in common between primary and recurrent tumors. These analyses suggest that the multistage model of prostate cancer progression is not linear and that some early primary tumors may be predisposed to metastasize or evolve into recurrent tumors due to the presence of specific genetic alterations.