Reducing Metabolic Syndrome Risks for the Hispanic Worker ... · Reducing Metabolic Syndrome Risks...
Transcript of Reducing Metabolic Syndrome Risks for the Hispanic Worker ... · Reducing Metabolic Syndrome Risks...
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Reducing Metabolic Syndrome Risks for the Hispanic Worker:
A Culturally Sensitive Approach
Steven Marks, DNP, RN, APN, COHN-S, FAAOHN
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Who, What, When, Where, Howbut most importantly WHY?
Who - Hispanic workers at Viking Yachts
What Metabolic syndrome When 2015 Where Rural South Jersey How Full management
support
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WHY? Speak in a language they understand
Not just Spanish A life language
Acknowledge their culture Hispanic is not necessarily Mexican Favorite foods Cooking methods Who cooks and shops Ideas about body shape and disease Income
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Metabolic Syndrome
Insulin Resistance
Dyslipidemia
Hypertension
Obesity
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Population at Risk
Hispanic men - According to the American Heart Association (2015)
0
10
20
30
40
50
60
CVDisease
Stroke Pre-diabetes
20132015
% of Population
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Challenges with Target Population
Wage Language Female dominant household Transportation Varying cultural backgrounds
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Literature Review
53 million Hispanic/Latino in US in 2011 Hispanic population at increased risk due to:
Barriers to healthcare Transportation Availability of affordable healthy food choices Differing cultural norms
Body image Health care beliefs
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Literature Review
Latinos en Control study Disease management Interactive cooking sessions Health literacy and education Decreased barriers to care Improved outcomes
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Project
Pre-Intervention Handouts and posters in work area Participant consent Baseline vitals and measurements
BP, Height, Weight, Abdominal Circumference and BMI Baseline labs
Fasting blood sugar, Lipid panel and Hgb A1C Latino Dietary Behavior Questionnaire (LDBQ)
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Project
Intervention Education session
Spanish interpreter Metabolic Syndrome Nutrition
Live cooking session Techniques and tips
Family style meal Female household members invited
Time for questions Healthy Hispanic recipes and food baskets
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Program
Focus Whole grains Grilled foods Lean/inexpensive proteins Minimize processed foods Portion control Spice, not salt
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Metabolic Syndrome
Steven Marks, APN-C
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Metabolic Syndrome
Steven Marks, APN-C
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Sndrome Metablico
Steven Marks, APN-C
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Metabolic Syndrome
High Cholesterol
Overweight
High Blood Sugar
High Blood Pressure
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Sndrome Metablico
Colesterol Alto
Sobrepeso
Azcar en la sangre
Presion Alta
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Hypertension
High blood pressure
The pressure of blood on the artery walls
120/80 Normal
Elevated pressure damages
Eyes
Brain
Heart
Kidneys
5
https://espanol.kaiserpermanente.org/health/care/!ut/p/a0/FchBCsIwEEbhE5Wfooi48wxFNNmU6XRoBpNJsIPS29vu3vcQ8UI0-upCrtUo7w5czcX8loSyp06MN861yayEJyJi-9BSCMFqx8RJjudbE4SmR6efzgg0vftLf8Yg6_gY0Eq5nsp4_wOA0_Lq/
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Hipertensin
Presin arterial alta
La presin de la sangre en las paredes de las arterias
120/80 Normal
La presin elevada daa
Ojos
Cerebro
Corazn
Riones
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https://espanol.kaiserpermanente.org/health/care/!ut/p/a0/FchBCsIwEEbhE5Wfooi48wxFNNmU6XRoBpNJsIPS29vu3vcQ8UI0-upCrtUo7w5czcX8loSyp06MN861yayEJyJi-9BSCMFqx8RJjudbE4SmR6efzgg0vftLf8Yg6_gY0Eq5nsp4_wOA0_Lq/
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Hypertension
Causes
Heredity
Being overweight
Belly fat is worse
Salt in foods
Fast foods
Pre-packaged/boxed foods
Deli meats
Snacks
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http://authoritynutrition.com/wp-content/uploads/2014/01/greedy-overweight-man-eating-junk-food.jpg
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Hipertensin
Causas
Hereditario
Tener sobrepeso
La grasa del estomago es peor
Sal en los alimentos
Comida rpida
Pre-envasados/alimentos en caja
Carnes fras
Comestibles
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http://authoritynutrition.com/wp-content/uploads/2014/01/greedy-overweight-man-eating-junk-food.jpg
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Hypertension
Causes
La hipertensin puede ser el resultado de un exceso de lquido en los vasos sanguneos normales o de la cantidad normal de lquido en vasos sanguneos estrechos, duros u obstruidos.
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http://kidney.niddk.nih.gov/Spanish/pubs/highblood/index.aspx
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Hipertensin
Causas
La hipertensin puede ser el resultado de un exceso de lquido en los vasos sanguneos normales o de la cantidad normal de lquido en vasos sanguneos estrechos, duros u obstruidos.
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http://kidney.niddk.nih.gov/Spanish/pubs/highblood/index.aspx
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Hypertension
Causes
Smoking
Alcohol
Being male
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http://www.standard.co.uk/incoming/article7847401.ece/binary/original/Smoking%20drinking.jpg
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Hipertensin
Causas
Fumar
Alcohol
Ser hombre
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http://www.standard.co.uk/incoming/article7847401.ece/binary/original/Smoking%20drinking.jpg
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Obesity
Overweight
Fat around the belly is the most dangerous
More than 60% of Hispanics are overweight
Leads to high rates of
Heart disease
Diabetes
Other health problems
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http://img.medscape.com/fullsize/migrated/542/635/mc542635.fig1.gif
https://www.asu.edu/courses/css335/whyconcern.htm
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Obesidad
Obesidad
Grasa al rededor del estomago es mas peligroso
Mas del 60% de hispanos tienen sobrepeso
Conduce a las altas tasas de
Enfermedades del corazn
Diabetes
Otros problemas de salud
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http://img.medscape.com/fullsize/migrated/542/635/mc542635.fig1.gif
https://www.asu.edu/courses/css335/whyconcern.htm
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High Cholesterol
Good/Bad Cholesterol
Bad fats
Saturated fats
Meats, manteca, fried foods, deli meats
Trans fats
Chemically altered
Some commercial fry oils
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http://www.health.harvard.edu/media/content/images/bigstock-Fast-Food-45761026.jpg
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Cholesterol Alto
Colesterol Bueno/Malo
Grasas malas
Grasas saturadas
Carnes, manteca, comida frita, carnes fras
Grasas trans
Alteradas qumicamente
Algunos aceites de frer comerciales
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http://www.health.harvard.edu/media/content/images/bigstock-Fast-Food-45761026.jpg
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High Cholesterol
Good/Bad Cholesterol
Healthy fats
Olive, canola oil, soy and corn oil
Salmon, tuna, trout, mackerel, sardines and herring.
Flaxseed (ground), walnuts, butternuts and sunflower, almonds
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http://www.clevelandclinicwellness.com/food/GoodFats/PublishingImages/TheGoodFats_Introduction_Md.jpg
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Colesterol Alto
Colesterol Bueno/malo
Grasas saludables
Oliva, aceite de canola, aceite de soja y maz
Salmn, el atn, la trucha, mackerel, sardinas y herring.
Linaza (molida), nueces, calabaza y girasol, almendras
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http://www.clevelandclinicwellness.com/food/GoodFats/PublishingImages/TheGoodFats_Introduction_Md.jpg
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High Cholesterol
Good Cholesterol
HDL
Bad Cholesterol
LDL
Triglycerides
Excess calories are stored in fat cells as triglycerides
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Colesterol Alto
Colesterol Bueno
HDL
Colesterol Malo
LDL
Triglicridos
El exceso de caloras se almacenan en las clulas grasas como los triglicridos
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Latino stats
High Blood Pressure
29.6% Men
29.9% Women
High Cholesterol
46.2% Men
43.4% Women
Cardiovascular Disease
48.3% Men
32.4% Women
Stroke
2.8% Men
2.0% Women
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Estadsticas de Latinos
Presin alta
29.6% Hombres
29.9% Mujeres
Colesterol Alto
46.2% Hombres
43.4% Mujeres
Enfermedad cardiovascular
48.3% Hombres
32.4% Mujeres
Accidente cerebrovascular
2.8% Hombres
2.0% Mujeres
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Prevention
Eat less fats
Eat more vegetables and fruits
Eat more whole grains
Exercise 30 minutes a day
10 minutes 3 times a day
Take all medication as directed
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Prevencin
Coma menos grasas
Coma mas frutas y vegetales
Coma mas granos integrales
Haga ejercicios 30 minutos por da
10 minutos 3 veces al da
Tome todos los medicamentos segn las indicaciones
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Diabetes
Steven Marks
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Diabetes
La diabetes es la condicin donde el cuerpo no convierte la azcar en energia
Ingerir pruductos naturales contiene menos azcar que los productos fabricdos
Ejemplos de azcar en la dieta serian:
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El contenido de azcar de los alimentosdiabeticos
Banana
4.5
Durazno
3 Vrs 3.5
Fresa
1.5
Red Bull
7 Cucharitas
Te' Casero
Vrs
Te Frio
6 Vrs 14.5
Limonada
Vrs
Tropical
6.5 Vrs 16.5
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El contenido de azcar de los alimentosdiabeticos
Zanahoria - 1
Confites
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El contenido de azcar de los alimentosdiabeticos- Frutas
Pia
2.5
Naranja
6
La naranja contiene mas azcar que la pia
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El contenido de azcar de los alimentosdiabeticosFrutas Vrs Jugos
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Onza
En 8 onzas vaso de naranja contiene cuatro veces mas azcar que una naranja
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El contenido de azcar de los alimentosdiabeticos- Batido
28!!
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El contenido de azcar de los alimentosdiabeticos- Arrollado de Canela
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El contenido de azcar de los alimentosdiabeticos- Cereal
Fruit Loops contiene tres veces mas azcar que el cereal integral!
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Las formas del cuerpo
Las formas de salud
se muestran
en la parte verde
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El Pancreas
El pancreas es el organo que produce insulina
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Sintomas de diabetes
Mucha Sed
Mucha Hambre
Mucha Ganas de Orina
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Gentica
Si mam o pap es diabetico, el riesgo de padacer aumenta
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Prevencin
Aumentar la actividad fisica
Una media hora cada dia
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http://cdn2-b.examiner.com/sites/default/files/styles/image_content_width/hash/8c/7f/8c7f2e159320cf8dca3862ee6694c6fa.jpg?itok=pCvqENP9
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Prevencin
Controlar el Peso
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Prevencin
Ingerir menos azcar Ejemplo:
Jugo
Coca Cola (Gaseosa)
Confites
Pan
Arroz
Pasta
Cereal
Postres
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Prevencin
El arroz blanco y la harina no son saludables
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Granos Integrales
El grano integral incluye:
La cascara
Bran
Los germenes
Germ
La endosperma
Endosperm
Trigo
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Granos Integrales
El cuerpo trabaja mas duro transformando el arroz integral y harina integral en azcar en comparacion con los productos fabricados
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En Conclusin
Contolar el peso teniendo una dieta saludable
Limitar el uso de azcar
Incrementar comidas de granos integrales
Aumentar la actividad fisica
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Nutricin
Steven Marks
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Aspectos Bsicos
La nutricin es la ciencia que estudia cmo el cuerpo hace uso de los alimentos
La dieta es todo lo que come y bebe
Los nutrientes son las sustancias presentes en los alimentos
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Por qu tengo hambre?
Usted necesita energa
T sientes hambre
Se come y el hambre desaparece
Usted ya no tiene hambre
Su cuerpo utiliza la energa y necesita ms
El ciclo se repite de nuevo
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Qu beneficios tiene la comida?
Se convierte en energa para sus actividades diarias
Provee nutrientes
Como para estar contento
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Beneficios del Agua
60% (sesenta) de su peso corporal es agua
El agua es esencial, ya que transporta los nutrientes
Beber agua te hace sentir menos hambre
Beba por lo menos ocho vasos de agua al da
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Vitaminas y Minerales
Vitaminas: ayudan a que el organismo aproveche los elementos suministrados por los alimentos
Minerales: actan en el metabolismo y son esenciales para su buen funcionamiento
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Aspectos Bsicos
Grupos de Comida
Frutas
Vegetales
Granos
Protenas
Productos lcteos
Grasas
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http://www.choosemyplate.gov/print-materials-ordering/MultipleLanguages.html
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Grupos de Comidas
Protena
Su funcin es reparar y construir aminocidos que constituyen todos los tejidos de los msculos, la piel y las uas.
Protenas de origen animal
Carnes
Pescado
Aves
Huevos
Protenas de origen vegetal
Soya y Frutos secos
5 1/2 onzas cada dia
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Grupos de Comidas
Granos
Carbohidratos: Su funcin principal es la de proporcionar energa al organismo
Tipos de carbohidratos: simples y complejos
Los granos enteros son carbohidratos complejos
6 onzas cada dia
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Grupos de Comidas
Vegetales
Contiene fibra, vitaminas y minerales
Fibra es buena para la digestion y estimula la peristalsis
2 tazas cada dia
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Grupos de Comidas
Frutas
Las frutas frescas son ms saludables
Contiene fibra, vitaminas y minerales
Frutas en conserva pueden contener azcar adicional
2 tazas cada dia
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Grupos de Comida
Productos Lcteos
Leche
Yogur
Queso
Mantequilla
2 tazas cada dia
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Grupos de Comidas
Grasas
Limite la cantidad de grasa en su dieta
Las grasas trans son muy malas
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Colesterol
El colesterol es una sustancia en el cuerpo que viene de las grasas
El colesterol bloquea las arterias y causa problemas al corazon
Las grasas saludables son mostradas con la marca verde
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MiPlato
Frutas
Protena
Vegetales
Granos
Leche
Medio plato de frutas y vegetales para la salud
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Porciones
3 onzas de carne igual al tamao de la palma de su mano
1/2 taza de cereal, arroz, pasta o helado, que es igual a 1/2 naranja
una cucharadita de mantequilla, margarina, mayonesa o aceite igual a la punta de su dedo pulgar
una onza igual a un puado (no llena!!)
una cucharada de aderezo para ensalada o mantequilla de man es igual a la mitad de una bola de ping-pong
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https://www.pinterest.com/pin/207095282837751673/
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En Conclusin
Tome mas vegetales, frutas y granos integrales
Medio plato de frutas y vegetales es bueno para la salud
Cambia a leche descremada o baja en grasa (1%)
Beba mucha agua
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Menu Grilled pork on bamboo
skewers Skewers soaked in agave
to mimic sugar cane Fish stew
Fish portions $1.00 each Marinated grilled chicken
thighs $0.99/lb Demonstrated skin
removal and boning to save money
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Menu
Green beans with bacon Frozen beans 4 slices of bacon cooked well
and dried Crumbled to infuse flavor not
fat to dish
Coconut pudding Lower calorie and fat recipe
Tres Leches cake Portion control with mini
muffin tins
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Post Intervention
Repeat Vital signs and measurements
BP, Weight, BMI, Abdominal circumference Lab work
Lipid panel, FBS, HgBA1C LDBQ
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Data Comparison
Pre PostIntervention Group 19.8 24.2Non-intervention Group 23.3 21.7
0
5
10
15
20
25
30
LD
BQ
Sco
re
Mean Total LDBQ Score
Mean total LDBQ score. This chart compares the mean total scores of both the intervention and non-
intervention groups.
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Data ComparisonPre and Post Intervention Body Measurements and Blood Pressure
Group Measurement Pre M Post M % Change
Intervention Weight 192.25 190.08 -1.13
Abd Circ 41.50 40.46 -2.50
BMI 31.17 30.82 -1.11
Systolic BP 114.77 113.85 -0.80
Diastolic BP 75.85 76.00 0.20
LDBQ Score 19.77 24.23 22.57
Non Intervention Weight 232.53 231.47 -0.46
Abd Circ 46.17 45.33 -1.81
BMI 36.37 36.20 -0.46
Systolic BP 114.00 101.33 -11.11
Diastolic BP 64.67 66.00 2.06
LDBQ Score 23.33 21.67 -7.14
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Data ComparisonPre and Post Intervention Laboratory ValuesGroup Measurement Pre M Post M %
Change
Intervention FBS 102.67 96.83 -5.68HGB A1C 5.91 5.87 -0.71Cholesterol 184.33 183.33 -0.54LDL 114.25 111.36 -2.53Triglyceride 127.08 170.67 34.30
HDL 44.67 40.58 -9.14
Non Intervention FBS 107.00 94.33 -11.84
HGB A1C 6.27 6.13 -2.13Cholesterol 176.00 171.67 -2.46LDL 102.00 111.33 9.15Triglyceride 161.67 112.67 -30.31
HDL 41.67 38.00 -8.80
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Limitations
Short time frame 6 weeks between pre and post intervention
screening
Location and transportation 3 participants got lost and did not attend live
session
Non-intervention group did get education materials
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Clinical Implications
Culturally sensitive education is effective Well received Many education projects can benefit from
cultural awareness Ability to address the specific needs of the
population Not cookie cutter education
Decreased barriers to care Improved health outcomes and decreased cost of
care
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References
American Diabetes Association. (2013). Economic costs of diabetes in the U.S. in 2012. Diabetes Care, 1-14. http://dx.doi.org/10.2337/dc12-2625
American Heart Association. (2013). Statistical fact sheet : 2013. Retrieved from http://www.heart.org/idc/groups/heart-
public/@wcm/@sop/@smd/documents/downloadable/ucm_319572.pdf
American Heart Association. (2015). Statistical fact sheet 2015 update: Hispanics/Latinos & Cardiovascular Diseases. Retrieved from
http://www.heart.org/HEARTORG/General/Heart-and-Stroke-Association-Statistics_UCM_319064_SubHomePage.jsp
Boudreau, D. M., Malone, D. C., Raebel, R. A., Fishman, P. A., Nichols, G. A., Feldstein, A. C., ... Okamoto, L. J. (2009). Health care utilization and costs by metabolic
syndrome risk factors. Metabolic Syndrome and Related Disorders, 7(4), 305-314. Abstract retrieved from PubMed. (Accession No. PMID: 19558267)
Fernandez, S., Olendzki, B., & Rosal, M. C. (2011, April). A dietary behaviors measure for use with low-income, Spanish-speaking Caribbean Latinos with type 2 diabetes: The
Latino Dietary behaviors Questionnaire. Journal of the American Dietetic Association, 111, 589-599. http://dx.doi.org/10.1016/j.jada.2011.01.015
Ford, E. S. (2005, July). Risks for all cause mortality, cardiovascular disease, and diabetes associated with metabolic syndrome. Diabetes Care, 28, 1769-1778.
http://dx.doi.org/10.2337/diacare.28.7.1769
Grundy, S. M., Hansen, B., Smith, Jr, S. C., Cleeman, J. I., & Kahn, R. A. (2004). Clinical management of metabolic syndrome: Report of the American Heart Association/
National Heart, Lung and Blood Institute/ American Diabetes Association: Conference on scientific issues related to management. Arteriosclerosis, Thrombosis
and Vascular Biology, 24, 1-6. http://dx.doi.org/10.1161/01.ATV.0000112379.88385.67
Haynes, D., Pruitt, R., Watt, P., Parker, V., & Price, K. M. (2010). Controlling metabolic syndrome in the Latino population: Support for the current guidelines. Hispanic Health
Care International, 8, 85-92. http://dx.doi.org/10.1891/1540-4153.8.2.85
Huang, P. L. (2009, May-June). A comprehensive definition for metabolic syndrome. Disease Models & Mechanisms, 2, 231-237. http://dx.doi.org/10.1242/dmm.001180
Lennie, T. A. (2006). The metabolic syndrome. Circulation, 114, e528-e529. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.633156
Lindberg, N. M., Stevens, V. J., & Halperin, R. O. (2013, January 28). Weight-loss interventions for Hispanic populations: The role of culture. Journal of Obesity, 2013, 1-6.
http://dx.doi.org/10.1155/2013/542736
Mishra, S., Xu, J., Agarwal, U., Gonzalez, J., Levin, S., & Barnard, N. (2013). A multicenter randomized controlled trial of a plant-based nutrition program to reduce body weight
and cardiovascular risk in a corporate setting: The GEICO study. European Journal of Clinical Nutrition, 1-7.
Rosal, M., Ockene, I. S., Restrepo, A., White, M. J., Borg, A., Olendzki, B., ... Reed, G. (2011, April). Randomized trial of a literacy-sensitive, culturally tailored diabetes self-
management intervention for low-income Latinos. Diabetes Care, 34, 838-844. http://dx.doi.org/10.2337/dc10-1981
References
American Diabetes Association. (2013). Economic costs of diabetes in the U.S. in 2012. Diabetes Care, 1-14. http://dx.doi.org/10.2337/dc12-2625
American Heart Association. (2013). Statistical fact sheet : 2013. Retrieved from http://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319572.pdf
American Heart Association. (2015). Statistical fact sheet 2015 update: Hispanics/Latinos & Cardiovascular Diseases. Retrieved from http://www.heart.org/HEARTORG/General/Heart-and-Stroke-Association-Statistics_UCM_319064_SubHomePage.jsp
Boudreau, D. M., Malone, D. C., Raebel, R. A., Fishman, P. A., Nichols, G. A., Feldstein, A. C., ... Okamoto, L. J. (2009). Health care utilization and costs by metabolic syndrome risk factors. Metabolic Syndrome and Related Disorders, 7(4), 305-314. Abstract retrieved from PubMed. (Accession No. PMID: 19558267)
Fernandez, S., Olendzki, B., & Rosal, M. C. (2011, April). A dietary behaviors measure for use with low-income, Spanish-speaking Caribbean Latinos with type 2 diabetes: The Latino Dietary behaviors Questionnaire. Journal of the American Dietetic Association, 111, 589-599. http://dx.doi.org/10.1016/j.jada.2011.01.015
Ford, E. S. (2005, July). Risks for all cause mortality, cardiovascular disease, and diabetes associated with metabolic syndrome. Diabetes Care, 28, 1769-1778. http://dx.doi.org/10.2337/diacare.28.7.1769
Grundy, S. M., Hansen, B., Smith, Jr, S. C., Cleeman, J. I., & Kahn, R. A. (2004). Clinical management of metabolic syndrome: Report of the American Heart Association/ National Heart, Lung and Blood Institute/ American Diabetes Association: Conference on scientific issues related to management. Arteriosclerosis, Thrombosis and Vascular Biology, 24, 1-6. http://dx.doi.org/10.1161/01.ATV.0000112379.88385.67
Haynes, D., Pruitt, R., Watt, P., Parker, V., & Price, K. M. (2010). Controlling metabolic syndrome in the Latino population: Support for the current guidelines. Hispanic Health Care International, 8, 85-92. http://dx.doi.org/10.1891/1540-4153.8.2.85
Huang, P. L. (2009, May-June). A comprehensive definition for metabolic syndrome. Disease Models & Mechanisms, 2, 231-237. http://dx.doi.org/10.1242/dmm.001180
Lennie, T. A. (2006). The metabolic syndrome. Circulation, 114, e528-e529. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.633156
Lindberg, N. M., Stevens, V. J., & Halperin, R. O. (2013, January 28). Weight-loss interventions for Hispanic populations: The role of culture. Journal of Obesity, 2013, 1-6. http://dx.doi.org/10.1155/2013/542736
Mishra, S., Xu, J., Agarwal, U., Gonzalez, J., Levin, S., & Barnard, N. (2013). A multicenter randomized controlled trial of a plant-based nutrition program to reduce body weight and cardiovascular risk in a corporate setting: The GEICO study. European Journal of Clinical Nutrition, 1-7.
Rosal, M., Ockene, I. S., Restrepo, A., White, M. J., Borg, A., Olendzki, B., ... Reed, G. (2011, April). Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income Latinos. Diabetes Care, 34, 838-844. http://dx.doi.org/10.2337/dc10-1981
-
Questions?
Steven Marks, DNP, RN, APN, COHN-S, FAAOHNEmail: [email protected]
mailto:[email protected]
Reducing Metabolic Syndrome Risks for the Hispanic Worker: A Culturally Sensitive ApproachWho, What, When, Where, Howbut most importantly WHY?WHY?Metabolic SyndromePopulation at RiskChallenges with Target PopulationLiterature ReviewLiterature ReviewProjectProjectProgramSlide Number 12MenuMenuPost InterventionData ComparisonData ComparisonData ComparisonLimitationsClinical ImplicationsSlide Number 21Questions?