The level of burden experienced by caregivers of patients diagnosed with Alzheimer's disease is high. Studies that examine this burden by taking into account cultural and spiritual differences are limited, particularly with regard to minority populations. The purpose of this study was to investigate the burden and challenges faced by minority caregivers providing in-home care to Alzheimer's patients. Guided by social support theory, a phenomenological study design was used with semi-structured interviews of 12 caregivers to examine their perspectives on the burden and challenges they face, including their lived experiences, cultural and spiritual values, and interaction with health professionals. Thematic analysis in an inductive way was used to analyze the collected qualitative data. The results of the analyses of the collected data showed that cultural and spiritual values are important in making decisions, as caregivers in minority populations face daily challenges in terms of limited social support and resources. The findings of this study suggest that public health interventions aimed at alleviating the burden on Alzheimer's caregivers need to take into account differences in cultural and spiritual values. Findings also show that there is a need for social support programs that reduce the burden on caregivers in general and on the minority population in particular. The findings of this study may drive positive social change by helping public health workers design and implement programs that consider differences in the cultural and spiritual values of minority populations while garnering the resources to provide the needed social support and alleviate the burden faced by the family member caregivers.

Closure of community hospitals directly impacts the health of rural populations and indirectly affects economic growth and access to medical services. The purpose of this doctoral project was to assess the causes and impacts of hospital closures on rural communities. The practice-focused question addressed the implications of hospital closures on individuals and families in rural communities. A systematic review of the literature, based on conflict theory, addressed populations that lack health care facility resources. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided the selection of 8 journal articles for review. The inclusion criteria for articles encompassed the impact of closure of health care facilities on the rural community and if the information about the causes of closure of health care facilities provided recommendations about hospital closure. The John Hopkins Nursing Evidence-Based Practice Rating Scale framework was used to determine the level and quality of evidence of the journal articles selected for review. Findings indicated that hospital closure has a negative effect on rural residents' health due to prolonged travel time for patients to access care, deterioration of health when access is not possible and increased expenses for services from remote locations. Loss of jobs due to hospital closure results in loss of income and decreased access to affordable care for community members. Findings from this project may be used to promote social change for regional and national stakeholders as the project raises awareness of the need to be diligent in preserving and enhancing health services in rural areas.

Worldwide, millions of children 5 years of age and older suffer with nocturnal enuresis, also known as nighttime bedwetting. Nocturnal enuresis is a chronic elimination disorder that while usually benign, too often results in the child being emotionally and physically abused. Efforts to design effective treatments with low relapse rates have thus far been thwarted by the array of organic and psychosocial variables related to its development. Guided by the 5-factor theory of personality, this cross-sectional study investigated whether a parent's personality characteristics significantly predict effective treatment for a child's nocturnal enuresis. Effective treatment was defined as having no relapses of symptoms in the 6 months following initial treatment success. A convenience sample of parents (n = 165) was recruited from the online social network Facebook and other online educational and support forums for parents seeking information on enuresis. Participants completed the NEO-FFI-3 to measure their personality characteristics, and logistic regression analyses were used to determine if parental personality characteristics, parental history of childhood enuresis, and/or the child's gender were significant predictors of effective treatment for a child's enuresis. None of these factors were found to significantly predict effective treatment for enuresis. This study promotes positive social change by identifying the need for an integrated biopsychosocial approach to treating children with enuresis with effective evidence-based treatments. These treatments are expected to result in fewer children exposed to the high rates of abuse and the development of psychosocial disorders often associated with nocturnal enuresis

The problem addressed in this phenomenological study is how culture and acculturation can potentially influence gestational weight during pregnancy, leading to overweight and obesity among immigrant Latinas. To understand the possible influence of culture and acculturation on the diet, exercise, and weight of pregnant immigrant Latinas, the experiences of immigrant Latinas who had undergone a pregnancy in Mexico and were pregnant in California were examined. The ecological model theory was applied as a framework for exploring the participants' experiences regarding nutrition, physical activity, and weight gain. Semistructured interviews with 10 qualified participants were conducted. Data analysis entailed an inductive approach based on the following phases of qualitative data analysis: data reduction, data display, and conclusion and verification. Clustered responses were presented around the major themes. Six major themes were derived from the data. These were: (a) bicultural lifestyles; (b) personal adjustments relating to pregnancy and prenatal care; (c) low levels of social and relational support; (d) adjustments regarding diet, nutrition, food security, and access; (e) changes in the form and extent of physical activity in the United States; and (f) rapid weight gain experienced during pregnancies undergone in the United States. Social change implications include encouraging public health professionals, health educators, and community health workers to focus on the importance of culture and acculturation on the health of Latinas in order to ensure positive infant and maternal health outcomes.

Metabolic syndrome and its component conditions of hypertension, obesity, and insulin resistance are on the increase in United States. Metabolic syndrome substantially increases the risk of cardiovascular disease and type 2 diabetes (T2D). To date, no published study has examined the relationship between psychological traumas from physical and/or sexual assault in childhood and metabolic syndrome or its components. This study, using the psychoneuroimmunology (PNI) model, investigated associations between psychological trauma (physical/sexual abuse) in childhood and metabolic syndrome in adulthood using data from the Midlife in the United States II (MIDUS-II) study. This research was undertaken to investigate whether a history of psychological trauma was associated with an elevated risk for metabolic syndrome. Chi-square test and logistic regression were used to investigate the respective associations. Metabolic syndrome was the dependent variable, assault in childhood was the independent variable, and the relevant covariates included in the logistic regression model were age, gender, cigarette and alcohol consumption, and ethnicity. While there was no significant association between assault in childhood and metabolic syndrome (p = 0.146), there were significant associations between metabolic syndrome and age group (p =< 0.026). In the adjusted logistic regression model, the only covariate that showed significant association with metabolic syndrome was Age Group 2 (41-55; p = 0.016). Also significant was the association between sexual assault in childhood and high blood pressure (p = 0.041). The results of this study suggest that clinicians may wish to watch for evidence of abuse, given the potential for future health impacts.

This qualitative study examined the phenomenology of advanced breast cancer (ABC) among 7 female participants between the ages of 20 and 45. Oral data were collected to extract participants' interpretations of their spiritual and psychosocial experiences of living with ABC. Findings suggest that these women experienced a dichotomous relationship with regard to their bodies and their relationships with others; this served as a means of making sense of their experiences and as a coping mechanism. Positive psychology and the theory of reasoned action and planned behavior provided the theoretical framework for examining the role of social reinforcements, beliefs, and attitudes and intentions on the health behavior of pre-menopausal African American women with ABC in Northern and Southern Delaware. Additionally, the theoretical framework provided answers to the overarching questions of how pre-menopausal African American women with advanced breast cancer applied meaning-making and spirituality to find purpose in their diagnosis. Inductive analysis of their narrative data suggested a set of themes: the body as a medical object, the body as a feminine object, honesty in relationships, missed opportunities from healthcare professionals, from wounded to mended, and the joy of purposeful living. The participants reported that an intimate relationship with God helped them feel supported in a way that family and friends could not. The findings in this study support potential spiritual and meaning-making interventions as well as promote a more positive quality of life for pre-menopausal women living with advanced breast cancer.-¬-¬-¬

Autism spectrum disorders (ASD) constitute life-long neurodevelopmental conditions. Globally, ASD risk for males remains 2 to 4 times greater than for females. Critical exposure mechanisms, their timing on ASD risk, and associations with the ASD gender differential remain elusive. The purpose of this study was to describe the relationship between preconception, pregnancy, recalled lactation practice, and infant traits, on ASD risk and the gender differential of ASD. A recently published temporal framework was adapted to study effects of maternal smoking and vitamin use, and recalled lactation practice on offspring ASD diagnosis with adjustment for preconception health and infant breathing traits. A retrospective case-control analysis using 733 child data records from U.S. autism registry characterized child gender-stratified relationships of 9 study variables. Logistic regression results showed prior maternal smoking, male gender, and maternal recollection of lactation practices were associated with offspring ASD diagnosis. Exposure factors associated with ASD did not differ by child gender or maternal vitamin use. Infant respiratory distress at birth was a covariate and collinearly related to obstetric risks. Maternal smoking was antecedent to respiratory distress and lactation practice. Study limitations included incomplete responses without repeated measures for recalled lactation practice and maternal diet variables. The implications for positive social change include a better understanding of reproductive, preconception, and prenatal risk factors of ASD. The study results have implications for reproductive health, smoking cessation programs, family planning, and prenatal care for women of reproductive age.

In Nigeria, childhood tuberculosis (TB), a debilitating and deadly disease, is highly prevalent and case reporting is poor due to weak health systems. Globally, children account for at least 10 percent of the TB burden, yet they remain neglected in TB prevention and control efforts. Research studies integrating family and community-centered strategies have been recommended by stakeholders to address the paucity of current local prevention and management strategies for childhood TB. This observational cross-sectional study explored the relationship between caregivers' quality of life (QOL), gender, and socioeconomic status (SES) and the incidence of TB in children aged 0-14 years. Using the abbreviated version of World Health Organization's (WHO) QOL tool, the WHOQOL-BREF, data were collected individually in a face-to-face setting from caregivers (n = 47) whose children had been diagnosed with TB in Bauchi State, Northeastern Nigeria, over a 5-year period. Data were collected in the same manner from another set of caregivers of children without TB (n = 47) within the same period and setting. Results from logistic regression indicated a statistically significant relationship (p < .001) between the caregivers' QOL and the occurrence childhood TB. However, the caregivers' gender and SES were not significantly related to the incidence of childhood TB. This finding underscores the need to identify the factors that positively impact the QOL of caregivers of childhood TB cases. It also reflects the importance of integrating QOL interventions as part of TB control programs seeking to improve childhood TB reporting. This can mitigate the disease burden in vulnerable age-groups living in resource limited settings, thereby contributing to positive social change in the society.

Although Grenada has an extensive health care infrastructure and cervical cancer screening rates are relatively high, Grenada also has a disproportionate rate of morbidity and mortality from cervical cancer. The aim of this study was to explore factors that contribute to these disproportionate rates in Grenada. Using a phenomenological qualitative approach, Andersen's behavioral model of health care utilization and a systems based model for assessing care were used as a guide to explore Grenadian women's follow-up experiences with Pap test and cervical cancer screening. Purposive sampling was used to recruit 8 women for semi-structured in-depth interviews. Data were collected on enabling, need, process and quality factors and coded using apriori and open strategies. Results showed that communication strategies used by private practitioners and good interpersonal relationships with nurses enabled follow-up whereas inadequate treatment services, delays in the receipt of test results, and lack of trust in the government clinics were hindrances. This research identified gaps in the follow-up system and is, therefore, significant for the Grenada Ministry of Health to inform planning and restructuring in order to increase system effectiveness. Implications of positive social change include broadening the knowledge base and skill sets of nurses, highlighting strengths of the public system, and identifying target areas for resource allocation. These changes can result in increased workforce efficiency, improved accessibility and quality, a more user-friendly follow-up process and, thus, reduced morbidity and mortality from cervical cancer.

Chronic kidney disease (CKD) is preventable and reversible in the early stages with upstream strategies; however, the number of individuals diagnosed with end-stage renal disease (ESRD) is increasing annually. Although researchers have documented the physiological and psychological stressors associated with hemodialysis (HD), little is known about the effects of in-center HD on the recipients in DeKalb County, Georgia. This study described the experiences of 10 African American HD patients who dialyze in DeKalb County. Using a phenomenological approach, the interviews were transcribed and then analyzed for significant quotes and recurrent themes relevant to receiving HD in DeKalb County. The health belief model was used to identify the perceptions and susceptibilities that formed the lived experiences of the participants. Results showed that 70% of the patients had been diagnosed with hypertension and/or diabetes and that 50% had never heard of ESRD prior to diagnosis. All 10 patients reported never knowing that hypertension and/or diabetes was a major cause of ESRD. The study sought to find common themes related to the perceived threat of ESRD by the participants. This study can be used to implement positive social change by instituting upstream strategies to decrease the prevalence of ESRD or slow the progression of CKD in this population, heightening awareness of this disease in minority communities, and implementing a sustainable health behavior plan to decrease the prevalence of the disease.