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For the past forty years, the Pima Indians living in the Gila River Indian Community have been among the most consistently studied diabetic populations in the world. But despite many medical advances, the epidemic is continuing and prevalence rates are increasing. Diabetes among the Pima is the first in-depth ethnographic volume to delve into the entire spectrum of causes, perspectives, and conditions that underlie the occurrence of diabetes in this community. Drawing on the narratives of pregnant Pima women and nearly ten years’ work in this community, this book reveals the Pimas’ perceptions and understanding of type 2 and gestational diabetes, and their experience as they live in the midst of a health crisis. Arguing that the prenatal period could offer the best hope for curbing this epidemic, Smith-Morris investigates many core values informing the Pimas’ experience of diabetes: motherhood, foodways, ethnic identity, exercise, attitude toward health care, and a willingness to seek care. Smith-Morris contrasts gripping first-person narratives with analyses of several political, economic, and biomedical factors that influence diabetes among the Pimas. She also integrates major theoretical explanations for the disease and illuminates the strengths and weaknesses of intervention strategies and treatment. An important contribution to the ongoing struggle to understand and prevent diabetes, this volume will be of special interest to experts in the fields of epidemiology, genetics, public health, and anthropology. Click here for a Facilitator’s Guide to Diabetes among the Pima
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Introduction. Pima Indians living in the United States (U.S.) have the highest prevalence of type 2 diabetes mellitus in the world. Their Mexican counterparts, living a traditional lifestyle in the mountain of Sonora, Mexico, have at least five times less diabetes than the U.S. Pima Indians. The effects of a traditional lifestyle in reducing type 2 diabetes risk factors and the association of factors to type 2 diabetes were evaluated in a sample of 1211 genetically related Pima Indians living different lifestyles (224 from Mexico and 887 from U.S.). Subsets of these populations were used to address specific questions. First, differences in insulin resistance between subjects with normal glucose tolerance (194 Mexican versus 449 U.S. Pima) were evaluated. Second, the effect of physical activity and obesity explaining differences in metabolic syndrome prevalence were evaluated in 224 and 447 Mexican and U.S. Pima Indians. Third, factors associated with type 2 diabetes were evaluated in each Pima Indian population (224 from Mexico and 887 from U.S.). Methods. Demographic, physical, biochemical, and lifestyle factors were measured in 1996 in a cross-sectional study of Pima Indians 20 years of age or older living in Maycoba, Sonora Mexico and contrasted to results from a sample of U.S. Pima Indians participating in an ongoing epidemiological study that used similar methods and selection criteria. Insulin resistance was estimated by both fasting insulin and homeostasis model assessment-insulin resistance (HOMA-IR). Metabolic syndrome was defined using the Third Report of the National Cholesterol Education Program's Adult Treatment Panel III (NCEP III) criteria. Body mass index (BMI) was calculated by dividing weigh in kilograms by the square of height in meters (Kg/m2). Physical activity was measured using a questionnaire developed for the U.S. Pima Indians and adapted to the Mexican Pima Indian population. Type 2 diabetes was defined according to the 1999 WHO criteria after an oral glucose tolerance test. Multiple linear regression analysis was used to answer the first question (related to differences in insulin resistance) and multiple logistic regressions analysis to answer the second (related with differences in metabolic syndrome) and third questions (related to factors associated with type 2 diabetes). Results. Insulin resistance was much lower in the Mexican Pima Indians than in genetically related U.S. counterparts, even after controlling for differences in obesity, age and sex. In addition, the unadjusted prevalence of metabolic syndrome was 24.1% and 56.6 % in the Mexican and U.S. Pima Indians, respectively. However, most of the difference in metabolic syndrome prevalence was explained by differences in obesity and physical activity. Furthermore, in Mexican Pima Indians, type 2 diabetes was independently associated with age, fasting insulin, and waist circumference. In the U.S. Pima Indians, type 2 diabetes was associated with with age, sex, fasting insulin, total cholesterol, blood pressure and physical activity. Conclusion. The findings underscore the importance of lifestyle in the prevention of type 2 diabetes risk factors, such as insulin resistance and metabolic syndrome, even in individuals with high propensity to develop diabetes.
Cardiovascular, respiratory, and related conditions cause more than 40 percent of all deaths globally, and their substantial burden is rising, particularly in low- and middle-income countries (LMICs). Their burden extends well beyond health effects to include significant economic and societal consequences. Most of these conditions are related, share risk factors, and have common control measures at the clinical, population, and policy levels. Lives can be extended and improved when these diseases are prevented, detected, and managed. This volume summarizes current knowledge and presents evidence-based interventions that are effective, cost-effective, and scalable in LMICs.
We are what we eat. That old expression seems particularly poignant every time we have our blood drawn for a routine physical to check our cholesterol levels. And, it's not just what we eat that affects our health. Whole ranges of behaviors ultimately make a difference in how we feel and how we maintain our health. Lifestyle choices have enormous impact on our health and well being. But, how do we communicate the language of good health so that it is uniformly received-and accepted-by people from different cultures and backgrounds? Take, for example, the case of a 66 year old Latina. She has been told by her doctor that she should have a mammogram. But her sense of fatalism tells her that it is better not to know if anything is wrong. To know that something is wrong will cause her distress and this may well lead to even more health problems. Before she leaves her doctor's office she has decided not to have a mammogram-that is until her doctor points out that having a mammogram is a way to take care of herself so that she can continue to take care of her family. In this way, the decision to have a mammogram feels like a positive step. Public health communicators and health professionals face dilemmas like this every day. Speaking of Health looks at the challenges of delivering important messages to different audiences. Using case studies in the areas of diabetes, mammography, and mass communication campaigns, it examines the ways in which messages must be adapted to the unique informational needs of their audiences if they are to have any real impact. Speaking of Health looks at basic theories of communication and behavior change and focuses on where they apply and where they don't. By suggesting creative strategies and guidelines for speaking to diverse audiences now and in the future, the Institute of Medicine seeks to take health communication into the 21st century. In an age where we are inundated by multiple messages every day, this book will be a critical tool for all who are interested in communicating with diverse communities about health issues.
International experts from world-renowned medical schools comprehensively review for practicing clinicians and scientists alike the latest understanding of the epidemiology, causation, and consequences of diabetes and obesity. The authors discuss in detail their diagnosis, clinical manifestations, complications, and best practices for diagnosis and treatment. They also review the history and epidemiology of these conditions, explain their genetics and pathophysiology, and illuminate their known mechanisms and interactions. State-of-the-art survey-chapters critique current approaches (lifestyle and pharmacological) to the treatment of these conditions.