Rozprawy doktorskie na temat „Health sciences”

Heart failure (HF) is a debilitating clinical syndrome and the end stage of many heart diseases. Despite recent advances in treatment, it is a growing problem with a steadily increasing number of deaths annually. Costs of care have been rising and are projected to continue to do so over the next 20 years. Studies report that health related quality of life (HRQL) in HF adds prognostic information beyond that of traditional demographic and clinical risk factors, however findings vary. This research was conducted on data from The Cardiovascular Health Study (CHS), a large, population based cohort study of community dwelling older adults recruited in 2 annual waves (1989–1990; 1992–1993) and followed through 2009. The data were aligned into a data set that began at participant intake and continued with a maximum 20 year follow up (median 13.56) to examine changes in HRQL in participants newly diagnosed with HF. Changes in self-reported health, life satisfaction, depressive symptoms, physical functioning, and perceived social support were evaluated from the annual study visit immediately before to immediately after new HF diagnosis (N=987). In linear mixed models analysis, depressive symptoms (t(3150) = 3.13, p = .003), self-reported health (t(2968) = 4.85, p < .001), and self-reported physical functioning (t(3139) = 3.16, p = .002) deteriorated more in those diagnosed with HF than in an age/gender matched comparison group over a similar period. In Cox proportional hazard regression, changes in self-reported physical functioning in the year of HF diagnosis and self-reported health prior to diagnosis contributed independently to mortality after adjusting for age, gender, and functional status (walk time). Mortality risk increased 9% for every one-point worsening in physical functioning from before to after diagnosis (HR 1.09, 95%CI 1.02, 1.17) and 17% for every one-point worse self-reported health prior to diagnosis (HR 1.17, 95%CI 1.04, 1.33). Missing data introduced potential selection bias. Understanding the contributors to mortality in HF may help develop interventions and assist in the selection of patient centered treatment options. Assessment of HRQL in routine practice is recommended. Further research is needed to improve the sensitivity of HRQL measures to detect change.

There is a great deal of concern regarding the levels of physical inactivity in people with disability, which is more prevalent than in the general population. Inactivity in individuals with disabilities can lead to higher rates of chronic diseases and obesity and vice versa. Moreover, disability is increasing in middle-aged adults while decreasing among older adults. This purpose of this dissertation was to: 1) evaluate the prevalence of disability across the lifespan, 2) to examine the relationships between disability (DA), physical activity (PA), and factors associated with them, and 3) to look at the trends in these factors to understand the patterns occurring in middle-aged adults compared with older adults.

Data analyzed for this dissertation were collected as part of the Behavioral Risk Factor Surveillance Survey (BRFSS) conducted between 2003 and 2011. Measures included DA, PA, chronic diseases, sociodemographics, health risk behaviors, and health status.

In our first study, we found that respondents categorized as disabled or functionally limited reported less PA, more chronic diseases, and poorer health behaviors than those categorized as able bodied. There was a higher prevalence of DA in the middle-aged and older adults compared to younger adults. Individuals with lower incomes and those with chronic diseases were more likely to be classified as having a disability compared to individuals with higher incomes and individuals without chronic disease. Our second study showed that middle-aged people were less likely to meet physical activity recommendations compared with older adults. Having a DA and being in poor health were strongly associated with not meeting the PA recommendations. In our third study, we found all the age groups showed an increase in functional limitation and DA over time. Further, among all age groups there was an increase in meeting aerobic recommendations over time. Our studies showed that DA and functional limitation are strongly associated with unhealthy behaviors and chronic diseases and poorer health. Moreover, middle-aged and older adults showed similar results in DA and PA recommendations. Given that physical inactivity has the potential to reduce disability, prevent chronic disease and enhance health, greater public health attention to what is warranted.

A college community health improvement plan (CHIP) focusing on the indicators of nutrition and weight status, and physical activity and fitness is designed with the goal of reducing obesity risk, improving health, and preventing chronic disease. The precede proceed model, logic model, innovative care for chronic conditions model, self-care theory, and Bandura’s social cognitive learning theory were used as a research design framework for assessing, planning, and managing sustainability through a two-year college health clinic. The research questions were: what are the current health promotion inputs and activities in terms of environment, ecology, education, and policy and could be supplemented to improve outputs and health outcomes? An integrated review of the literature, observation of the site, regulatory investigation, and focus group sessions were the methods of data collection. The precede-proceed model provided the analytical strategies to assess initiatives and resources, and to determine supplementary initiatives and resources. Results showed that environmental, educational, administrative, and policy resources were available but limited and not well promoted. Conclusions were that health promotion, wellness staffing, and education exist, but are underutilized, under promoted, and funding is necessary. Recommendations include a wellness program, increased activity initiatives, case management, grant funding, and increased community partnerships. The contribution to nursing is to fill a gap-in-practice for health planning in 2-year colleges. The implications for positive social change are improved knowledge, sustained health behaviors, decreased amount of obesity, improved health outcomes and quality of life, decreased chronic diseases, and lower healthcare costs.

Chronic dental disease is acknowledged to be the most prevalent preventable chronic disease in children and is disproportionately higher for Hispanic children who are part of the nation's largest minority group (Crall & Edelstein, 2001; Flores et al., 2002; Barker & Horton, 2008). In spite of efforts to provide access to dental services, parents make the ultimate decision if and when to take their child to the dentist. Management of this chronic condition lessens pain, improves attendance at school, improves concentration, and improves grades (Dental Health Foundation, 2006; Percy, 2008). Successful management is dependent upon identifying the barriers Hispanic parents face in seeking dental care for their children. Culturally appropriate instruments are key in identifying barriers that parent's face to advance what is known about the oral health needs of Hispanic children (Ramos-Gomez et al., 2005). A convenience sample (N = 322) of primarily Hispanic parents and guardians (94.3%) were recruited from two clinics in Los Angeles which provide care to underserved communities in Southern California. The purpose of the first phase of the study was to determine the cultural equivalence of translated measures of oral health factors (i.e., oral health beliefs, parental dental anxiety, access to dental care, perceived discrimination, and pediatricians' role in seeking dental care) based on the Behavioral Model for Vulnerable Populations that were combined to develop The Children's Oral Health Survey (COHS) used in the second phase of the study. The purpose of the second phase was to determine the factors that influence utilization of oral health services in Hispanic children. Findings from this research found gender to be a significant predictor of dental care utilization for children. In comparison to parents who had one child, parents with more than one child were more likely to take at least one child for dental visits. More importantly, parents who thought their children were treated with respect by dental staff was significant in influencing utilization of oral health services. Findings from this research using the translated instruments suggested that Hispanic parents may not understand the questions and therefore demonstrates that a tool that is culturally developed would better identify the oral health issues of Hispanic parents.

Objectives: First, to identify the core Electronic Health Records (EHR) functionalities available to physicians who work in private and public health care facilities in Trinidad and Tobago and the extent to which physicians are using each function. Second, to understand the rate of adoption of Electronic Health Records in private and public hospitals/clinics, and finally, to identify the barriers to adoption of Electronic Health Records in private and public hospitals/clinics in Trinidad and Tobago. Background: The two largest public hospitals in Trinidad and Tobago, Port of Spain General Hospital and San Fernando General Hospital, utilized paper medical records. In Trinidad and Tobago, there is little known about the EHR functions available and being used, adoption rates, and barriers to adoption of EHR in the private and public sectors. Method: Electronic Health Records (n = 130) questionnaires were sent to number of health care practices in the private and public facilities in the five regions of Trinidad and Tobago, in order to understand availability and use of EHR, adoption rates, and barriers to the use of EHR. Results: The most commonly available function for the private and public physicians was Health Information and Data with respective scores of 58% and 29%. Sixty-three percent of the private physicians who adopted EHR reported using the Result Management and Order Management functions. The public physicians who had adopted EHR reported they were not utilizing the Decision Support, Result Management, and Order Management functions. There was no statistical difference between private and public physicians for the available and used functions. A total of 53 private and 19 public physicians responded to the survey (55% response rate). Thirteen (25%) private physicians reported adopting EHR and 2(11%) public physician reported adoption of EHR. Private and public physicians cited start-up cost and technical limitations of systems as the barriers to their practices' adoption of EHR. Conclusion: Findings showed the same availability and use of core functionalities, as well as adoption rate among the private and public facilities, and slightly fewer barriers in the private practices. A larger sample is merited to understand if there is any statistically significant difference between the two groups.

The purpose of this project was to create a cardiac rehabilitation nutrition education program with relevant nutrition topics. This program aimed to educate cardiac rehabilitation participants about Eating Heart Healthy as it relates to various topics leading to successful lifestyle changes. Therefore, this program may be used as a secondary prevention tool for post-cardiac event patients.

The eight-week nutrition education program consists of three modules: general dietary guidelines, dietary factors associated with heart disease, and food selection and preparation. Each lesson includes research-based curriculum, in-class activities, take home activities, and supplemental handouts to foster multiple learning styles. Evaluation forms for each session and the program overall were included.

Background: Electronic personal health records (ePHRs) are consumer-centric tools that enable consumers to securely access, manage and share their health information with health care providers. Although the potential for ePHRs to improve healthcare is significant, there is no available evidence on health care professionals' use of ePHRs for their own health management. Nurses have a tremendous opportunity to assist and educate patients in ePHRs. Research has shown that ePHR adoption among patients were influenced by perceived usefulness and ease of use using the technology acceptance model (TAM). This study expanded the TAM adding perceived data privacy security protections and health promoting role models for the ePHR acceptance model.

Purpose: This study examined (1) characteristics associated with ePHR use by nurses: health, technology experience, and attitudes about privacy of electronic health information, (2) psychometric properties of the measures in the research model, (3) association of ePHR acceptance constructs: perceived usefulness, ease of use, data privacy and security protections, and health promoting role model with ePHR use, and (4) moderating effects of nurses characteristics: age, chronic illness and/or medication use, providers use of electronic personal health record (EHR) on the relationships between ePHR acceptance constructs and ePHR use.

Methods: Registered nurses working in hospitals and members of the nursing informatics community (NIC) completed an anonymous online survey in the Fall of 2013 (n=847). Differences between groups were examined using t-tests and χ² tests. The associations between nurses' characteristics and ePHR use were examined via multiple logistic regression models that also held constant possible confounding covariates and interaction terms.

Results: Less than half (41%) of the hospital nurses were ePHR users. The odds of ePHR use was significantly greater among those with chronic medical conditions/medication use (OR=1.64, 95% CI=1.06-2.53) and those whose health care providers used EHRs (OR=3.62, 95% CI=2.45-5.36) controlling for age, marital status, current positions and specialty area. ePHR use was more common among NIC nurses (72%). The odds of ePHR use was also increased among NIC nurses with providers that used EHRs (OR=5.99, 95% CI=1.40-25.61), but users were 70% less concerned about privacy of health information online than nonusers (OR=0.32, 95% CI=0.14-0.70) controlling for ethnicity, race and practice regions. The majority of both ePHR users and nonusers would grant access to their primary care providers. However, fewer ePHR users in both nursing groups granted permission to designated family members or friends, other care providers who care for them, or pharmacists to view ePHRs than nonusers who answered hypothetically. Sufficient reliability for usefulness, ease of use, and privacy and security protections, and health promoting role model scales were found (all Cronbach alphas>0.70). Three constructs contributed significantly to ePHR use after adjusting nursing group, age, chronic illness and medication use, and health care providers use of EHR (usefulness, OR=0.87, 95% CI=0.85-0.89; data privacy and security protection, OR=1.04, 95% CI=1.01-1.07; and health promoting role model, OR=1.07, 95% CI=1.04-1.11). Significant interactions existed between perceived data privacy and security protections and providers EHR use, and between perceived health promoting role model and age on ePHR use (p<0.05).

Conclusion: The study findings suggest practical insights for nurses. With the experience of using ePHRs, nurses can leverage use of ePHRs for patient education on chronic illness and medication management. Nurses in NIC can also play an important role in practical ePHR design to enhance functionality and security in ePHR with their specialties in nursing informatics.

Obesity often arises from poor diet and lack of exercise. Food deserts, in particular, cause people to develop poor eating habits because of the limited healthy food options and availability to cheap fast food chains. People affected by food deserts are usually found in communities of color and low-income areas. The purpose of the study was to identify whether Fontana residents are willing to adopt healthier lifestyles based on the perceptions about their own health and the health of the community. Mixed method research was utilized for the study. The participants in the study included adult residents of both sexes and all ethnic backgrounds from the City of Fontana. Those participants ranged in ages from 18 and above. The data results proved some significance between Fontana residents' will to adopt healthier lifestyles and their perceptions on personal and community health. The bivariate correlation tests indicated a statistical significance between the tested variables despite their small correlations and large unshared variances. The ANOVA tests aided with proving the validity of the proposed hypotheses. Based on the data findings, the null hypothesis was rejected and alternative hypothesis was accepted. For future research on getting residents to be more proactive about their health and that of the community, shorter and simpler surveys were advised.