Medicine and Health Sciences Commons^™

Efficiency And Cost Of A Hospital-Based Medical Home: Children With Special Healthcare Needs, Rebecca Olsen

Florida Public Health Review

The current study examined two years of pre-post hospital utilization data (the number of emergency room visits, number of unanticipated hospitalizations, and length of stay (LOS)) among forty-nine medically complex children to determine the efficiency and cost effectiveness of a comprehensive Hospital-Based Medical Home Model. Friedman nonparametric analysis was used to examine the pre-post differences for the non-normal distribution. Each of the cost-effectiveness measures (number of emergency room visits, number of unanticipated hospitalizations, and LOS) were found to be significantly lower post enrollment in the Hospital-Based Medical Home Model.

Suicide Attempts Among Latinas Who Experienced Early Sex Were Largely Mediated By Substance Abuse, Patria Rojas, Sunny Kim, Mario De La Rosa, Wayway M. Hlaing, Theophille Niyonsenga

Florida Public Health Review

The purpose of this study was to describe the role of substance abuse as a mediating factor between early sexual experiences and suicide attempts among adult Latinas. In our study participants (n=158), nearly 15% had attempted suicide and 39% experienced their first sexual encounter at an age of 15 or younger (referred to hereafter as “early sex”). Latinas who experienced early sex were more likely to attempt suicide [OR=2.4, p<0.05], and this relationship was largely mediated by substance abuse. An early sexual debut may indicate an environmental adversity on the child that calls for long term intervention for prevention of substance abuse as well as promotion of psychological well-being later in life.

Exploring The Effect Of Sexual Education On Sexual Health Risk Behaviors: Analysis Of The 2003 And 2007 Youth Risk Behavior Surveys In Florida And Alabama, Shenena Armstrong, Alicestine Ashford, Ivette A. López, C. Perry Brown

Florida Public Health Review

The purpose of this study was to explore the relationship between sexual health education content and sexual health risk behaviors, and the mediating effect of demographic variables. A cross-sectional research design employing secondary data analysis explored these associations in a sample of African American and non-Hispanic White male and female adolescents that took part in the Youth Risk Behavior Survey (YRBS) for the years 2003 and 2007 in the aforementioned southern states. Significant associations were observed between race and reported condom use and alcohol and/or drug use during last intercourse. For both Alabama and Florida, sexual health education was associated …

Health Literacy And Treatment Adherence In Hispanic Hiv-Infected Patients, Maria L. Alcaide, José G. Castro

Florida Public Health Review

This study examined health literacy in Hispanic HIV infected patients attending two large public clinics in Miami, Florida and assessed its association with adherence to antiretroviral medications. We performed a cross-sectional study. Eligible participants were enrolled from the Jackson Memorial Hospital HIV outpatient clinic and the University of Miami AIDS clinical research facility. Data were derived from socio-demographic information, the adult AIDS clinical trial group (AACTG) adherence questionnaire, the short test of functional literacy in adults (STOHFLA), and information about HIV clinical stages. Questionnaires were completed by study participants or by the study coordinator in their preferred language and the …

A Study Of Bus Stop Accessibility: Public Health Students Working In Partnership With The Center For Independent Living, Ellen D.S. López, Susan F. Fesperman, Staci H. Graff, Stephanie Schropp, Sarah T. Catalanotto, Allysha C. Robinson, Zaynab I. Major

Florida Public Health Review

Over 54 million U.S. citizens report living with at least one disability. The Americans with Disabilities Act stipulates legislation that prohibits the discrimination of persons on the basis of disability. Rather than riding the bus in areas that offer a fixed-route bus system, individuals with disabilities often rely on expensive and limited paratransit services, or on family and friends. It has been proposed that with improvements in bus accessibility, riders with disabilities could use the fixed-route system more often and increase their options for independence and community participation. During their 2008 spring semester, participants in the University of Florida College …

Cancer Health Education Preferences Among Miami-Dade County Construction Workers, Alberto J. Caban-Martinez, David J. Lee, Lora E. Fleming, Lourdes Loubriel, Syed M. Ahmed, Aracely Alicea-Clark, John Davis Clark Iii, Evelyn P. Davila

Florida Public Health Review

Construction work is a high-risk, transient occupation. Worksite outreach programs for cancer risk assessment are highly warranted because workers are exposed to both occupational and environmental carcinogens. We examined the feasibility and acceptability of conducting a paired cancer risk assessment and cancer prevention intervention using “lunch trucks” among construction worksites as the delivery mechanism. Among the 57 completed questionnaires from construction workers on a Miami-Dade County construction high-rise apartment building site, there were 50 (88%) males and 29 (51%) white Hispanics. Over 54% of the construction workers were current smokers of cigarettes, 3.5% chewed tobacco, and 19.3% smoked cigars. Of …

Applying Leadership Paradigms To Public Health Challenges

Florida Public Health Review

In the 2008 volume of the Florida Public Health Review we published some student essays in which specific leadership paradigms were applied in theory to tackle some of public health’s most challenging problems. We continue that in effort in 2009 and invite other public health students, faculty, and practitioners from around the state to contribute ideas that foster leadership skills and the development of dynamic leaders.

Whom Can You Trust? Exploring Leadership Addressing Hiv Risk Prevention In African American Women

Florida Public Health Review

Within the last decade African American women have experienced serious increases in HIV diagnoses. Almost 40% of all newly diagnosed HIV-positive women in the United States are black women. Furthermore, black women are 23 times more likely to be diagnosed with AIDS than white women. This paper explores some of the underlying socioeconomic factors for high incidence rates of HIV among African American women—including poverty, racism, and stigma—that contribute to this health disparity and discusses current leadership approaches to addressing this problem. One common leadership approach focuses on adapting CDC intervention programs at a local level, a process that presents …

Applying Leadership To Facilitate Physician-Patient Communication And Promote Health In The Lesbian Community

Florida Public Health Review

Lesbian women experience health inequalities primarily related to their experiences of discrimination, homophobia, and the assumption of heterosexism. This milieu of experiences can lead to an avoidance of routine health care, screening, and non-disclosure of sexual orientation to physicians. Lesbians may participate in some health risk behaviors more than heterosexual women leading to an increase in risks for certain cancers, cardiovascular disease and HIV. Lesbians who discuss their sexual orientation and behavior with their physician report feeling more comfortable, experience better communication, and are more likely to seek routine medical care. Although the medical community has been making a shift …

Using Leadership To Improve Community-Based Obesity Interventions

Florida Public Health Review

Obesity is an enormous health problem facing America in the 21st century. Despite great efforts, health educators have made little progress in meeting the goals laid out in Healthy People 2010. A more contextual, community- based approach is necessary to change the physical and social environment in which people live, work and play. Studies show that residents of neighborhoods that lack pedestrian-friendly features and have high crime rates are less likely to be physically active, an important point for health educators to take into account when designing interventions. Whereas professional health educators have done little in this area, exemplary grassroots …

Hiv Testing Policies In Florida, Jennifer Syvertsen, Hilda Leon, Jeffrey Beal, Marlene Lalota, Sherry Riley, Michael D. Knox

Florida Public Health Review

To combat the HIV/AIDS epidemic, strong policies that promote HIV testing are a primary mechanism for helping public health officials to understand the populations at risk, informing prevention initiatives, and linking infected individuals to the timely care they need. This paper describes HIV testing policies with the goal of improving early diagnosis and treatment of Floridians.

Creating Pathways To Participatory Research

Florida Public Health Review

Many disciplines, including Public Health, have recognized the importance of participatory research methods in creating change in communities. The ability of participatory research to create change- particularly in behaviors- is what makes it such a promising area of research in health promotion. Whereas the value of participatory research is recognized, a “disconnect” exists in that the support mechanisms for this research are not in place. In fact, many researchers are encouraged to forgo the use of participatory research methods via the policies or biases of tenure and promotion committees, funding agencies and institutional review boards. These entities may claim to …

Improving Folic Acid Consumption In Women At Risk For Neural Tube Defects In Florida, Jessica C. Bishop-Royse, Elizabeth Jensen, Melanie Simmons

Florida Public Health Review

Two providers who participated in the Florida VitaGrant program, a site providing early childhood services to primarily Mexican Hispanic families (Site A) and a site providing home visiting services to pregnant women and families with infants (Site B), are presented as alternative models for improving folic acid levels in reproductive aged women in Florida. Site A distributed multivitamins and education in the context of health education provided to women in a group setting, once a month. Site B provided the services primarily through home visits of varying frequency. Folic acid knowledge and consumption were measured at program initiation and at …

Leadership Approaches To Providing Quality Hiv Prevention Care For Older Adults

Florida Public Health Review

Americans continue to face risks associated with human immunodeficiency virus (HIV). One population that receives little attention concerning HIV is that of older adults. Approximately 20% of all HIV cases are among adults aged 50 and older. Older adults and younger populations are at risk for HIV; however, few programs are in place to reduce the incidence of HIV among this priority population. Many cases of HIV among older adults go unnoticed because health care professionals perceive older adults as asexual. Many physicians and other health professionals, including health educators, are uncomfortable in discussing sexual histories with older adults, so …

Primary Care Use Among Hiv Positive Inpatients At An Inner City Public Hospital: The Impact Of Crack Cocaine Use, Toye H. Brewer, Lisa R. Metsch, Marsha Mullings, Gabriel Cardenas, Margaret Pereyra

Florida Public Health Review

We studied factors associated with HIV care utilization in symptomatic HIV-positive crack-using and non-using patients at a public hospital in Miami, Florida. A bedside survey conducted with 89 HIV-positive crack-users and 93 HIV-positive non-users examined health care knowledge, perceived health status, drug use, and HIV care patterns. A multi-nominal model was utilized to calculate the adjusted odds ratio (AOR) of three levels of care: currently receiving care (having seen an HIV provider in the past 4 months), having dropped out of care (having seen an HIV provider at least once but not in the past 4 months), and never having …

What Floats Your Boaters? – A Commentary, Mary Martinasek

Florida Public Health Review

Florida has over one million registered boaters not including the plethora of canoes and other paddle craft for which registration is not required. Whereas wearing a seatbelt in a car is regulated by law and has become a routine practice for the majority of Floridians, wearing a personal floatation device (PFD) while boating is neither mandatory nor routine. Florida has ranked first annually among states in boating fatalities since 2003, and accounted for 10.9% of the total number of U.S. boating deaths in 2006. This commentary argues for making PFD use mandatory in an environment where the social norm is …

Obstetrical Screening Practices Of Nurse-Midwives And Nurse Practitioners, Laura Ann Abney

UNF Graduate Theses and Dissertations

With the continued growth in the numbers of nurse practitioners and certified nurse-midwives, more and more women will receive prenatal care from advanced practice nurses. The purpose of this research was to assess the routine screening practices of advance practice nurses providing prenatal care and to compare those practices with current guidelines. The study focused on five areas of prenatal screening: bacterial vaginosis, group B streptococcus, gestational diabetes, maternal serum markers, and fetal movement monitoring. The interaction model of client health behavior by Cheryl Cox, specifically professional-technical competencies, part of the client-professional element of the model, provided the theoretical framework …

Effects Of An Educational Intervention On Hospital Acquired Urinary Tract Infection Rates, Sharon Lanier Smith

UNF Graduate Theses and Dissertations

In today's hospital environment, good care has become synonymous with positive patient outcomes. Marring this landscape is the alarming rate of hospital acquired (nosocomial) infections. Urinary tract infection (UTI) is one of the most common hospital acquired infections. The major cause associated with these infections is the use of indwelling urinary catheters. Bacteria invade the lower urinary tract by ascending through or around the catheter. Morbidity associated with urinary catheter-associated UTI can be minimized by prudent decisions concerning catheter usage and good catheter care. The principle route of dispersal of nosocomial infections is likely from patient-to-patient via transiently contaminated hands …

The Effect Of Leadership Skill-Building On Nurse Leader Behaviors, Barbara Drummond-Huth

UNF Graduate Theses and Dissertations

Patient outcome data are an important factor in healthcare. Reports by the Institute of Medicine between 1999 and 2001, as well as recent research by Linda Aiken and her colleagues have added more emphasis to measures that can be taken to improve patient outcomes. Because of the role they play in healthcare facilities, nurse leaders are in a position to take the lead in improving patient outcomes. There is evidence to suggest that nurse leaders' transformational leadership behaviors are associated with positive patient outcomes.

The purpose of this project was to identify the effect of transformational leadership skill-building training on …

The Relationship Between Preexisting Gastroesophageal Reflux Disease In Lung Transplant Recipients And The Development Of Post-Transplant Bronciolitis Obliterans, Heidy Abuan David-Robinson

UNF Graduate Theses and Dissertations

Lung transplant is a treatment modality for patients with end stage lung disease. Bronchiolitis obliterans syndrome (BOS) is the number one cause of morbidity and mortality in patients the first year after lung transplant. There are many risk factors which have been identified to increase the risk of BOS including acute rejection, lymphocytic bronchitis, medication non-compliance, bacterial or viral infections, older donor age, extended ischemic time, donor antigen-specific reactivity, human leukocyte antigen (HLA) mismatch, underlying disease and gastroesophageal reflux disease (GERD).

Advanced practice nurses can help in the primary prevention of BOS through the assessment and treatment of pre-transplant patients …

New Nurse Residency - An Evidence Based Approach, Alice M. Nied

UNF Graduate Theses and Dissertations

Nurse educators believe that their graduates are well-prepared for entry level positions in nursing. In the acute healthcare setting, new graduates are placed on virtually every type of nursing unit, including critical care. Employers have developed formal orientations to familiarize new graduate nurses new with the institution and its policies and procedures and to teach the things employers believe new RNs need to know but do not, either because they were never taught the material or they have not retained it.

The purposes of this project were to (a) examine the evidence relative to a disconnect between nursing education and …

Effects Of Dietary And Exercise Interventions On The Incidence Of Metabolic Syndrome, Ricky Mccoy Kirby

UNF Graduate Theses and Dissertations

Metabolic syndrome is a serious health problem in the United States. The presence of metabolic syndrome significantly increases the risk of developing type II diabetes and cardiovascular disease by producing a prothrombic state. The prothrombic state that results from the clustering of several independent cardiovascular risk factors within one individual increases the risk of micro and macro vascular changes and eventually to end organ damage.

There is considerable evidence to support the serious nature of this medical condition. Medications used to treat the hypertension, diabetic, and dyslipidemia components of metabolic syndrome can be a significant drain on the monthly budget …

Dietary Interventions To Reduce Metabolic Syndrome In An Uninsured Population: An Evidence-Based Approach, Michele Smith Bednarzyk

UNF Graduate Theses and Dissertations

Recent studies show that more than one-third of U.S. adults (over 72 million people) were obese in 2005–2006. This includes 33.3% of men and 35.3% of women. Obesity is a primary factor in the development of metabolic syndrome, a condition that places individuals at high absolute risk of mortality and morbidity. The use of a nutritionally balanced diet aimed at weight reduction has the potential to decrease the prevalence of obesity, therefore reducing the incidence of metabolic syndrome and its consequences.

The purpose of this project was to investigate whether individual nutrition counseling would improve the outcomes of patients with …

The Experiences Of Women Who Live With An Implantable Cardioverter-Defibrillator (Lcd), Jenea Mary Smith

UNF Graduate Theses and Dissertations

The implantable cardioverter defibrillator (lCD) is the most effective treatment available for terminating potentially life-threatening ventricular fibrillation and ventricular tachycardia. The lCD detects and attempts to correct these arrhythmias by pacing, cardioversion, and defibrillation thereby providing lifesaving therapy to patients at risk for sudden cardiac death. Currently, 150,000 Americans receive ICDs each year. Although most lCD recipients are men, more women are now qualifying for insertion (Stutts, Cross, Conti, & Sears, 2007).

Despite its established health benefits, lCD implantation is accompanied by psychological factors which merit research attention. This study investigated the experiences of women who live an lCD. The …

The Effect Of Electronic Feedback On Anesthesia Providers' Timely Preoperative Antibiotic Administration, Jonathan Pabalate

UNF Graduate Theses and Dissertations

The growing presence of electronic anesthesia record keeping and perioperative informatics systems is contributing to a database of valuable information that can significantly improve patient care and patient outcomes. Efforts such as the National Surgical Quality Improvement Project and the Surgical Care Improvement Project have analyzed quality measures that directly correlate to patient outcomes. Several of these quality indicators are influenced by the performance of anesthesia providers’ activities in the perioperative period. These programs promote timely administration of preoperative antibiotics. One of their guidelines states that preoperative antibiotic should be given within an hour prior to surgical incision. Surgical site …

Effects Of Provider Education On Documentation Compliance In The O.R., Brenda Kingdon

UNF Graduate Theses and Dissertations

Knowledge of The Joint Commission's National Patient Safety Goals and an effective provider cooperative practice involving communication and teamwork are essential for the delivery of safe and compliant patient care in the surgical setting. The purpose of this study was to assess the impact of an educational intervention for physicians and nurses designed to increase documentation of compliance with national patient safety standards. As events of noncompliance have impacted patient safety at the hospital where this project was conducted, measures were needed to assess barriers to compliance with standards of practice and to focus educational session plans on identified knowledge-base …

The Effect Of Moral Distress On Nursing Retention In The Acute Care Setting, Cynthia L. Cummings

UNF Graduate Theses and Dissertations

This descriptive study explored the relationship between moral distress, professional stress and intent to stay in the hospital setting. The study involved 234 nursing participants and was conducted via an online survey over a 90 day period. The survey tool consisted of 51 items taken from known moral distress, professional stress and intent to stay tools. The items were divided into frequency and intensity of occurrence. Various statistical measures were utilized to conclude that moral distress and professional stress factors were significant (p

Effects Of Community Of Practice And Knowledge Translation Strategies On Nurse Practitioners' Knowledge And Practice Behavior, Helen M. Holman

UNF Graduate Theses and Dissertations

Background: Emerging evidence suggests that interactive CE activities will have the most effect in terms of knowledge and practice. Using technology to provide interactivity via computer-based applications is as effective an educational strategy as traditional education formats.

Methods: A randomized controlled trial was conducted to test the effectiveness and satisfaction of educational activities provided within an online community of practice(CoP) on nurse practitioner (NP) knowledge and practice behavior. The online interactive website combined certified continuing education, professional forum, Ask-the-Experts, national guideline links, patient education tools, and professional resources. A Two-Group Control Group design was used. Study participants were assessed on …

Perceptions About The Impact Of Global Medical Travel On Poorer Populations In India, Blair Gifford, Sinyoung Park, Sharmila Anand

Department of Health Administration Faculty Publications

There is anecdotal evidence that the increasing focus on global medical travel health services for foreigners in India is likely to exacerbate the different levels of access to health services between India’s wealthy and poor populations. However, surveyed physicians (n=177) at three hospitals in New Delhi indicated positive attitudes to global medical travel, especially in regards to global medical travel’s effects on poorer populations. Overall, these results appear to be the result of respondents’ support of the economic development, new medical technologies, and increased medical training that comes from the health infrastructure investments needed to attract foreign patients.