Digital Commons Network^™

Rocky Mountain Highs And Lows: Efforts To Improve Health And Reduce Costs In Denver, Michele J. Orza, Jessamyn Taylor

National Health Policy Forum

In late May–early June 2011, the Forum sponsored a site visit to Denver, Colorado, to observe innovative efforts to improve the health of Coloradans and reduce the cost of health care. The three-day agenda was designed to convey the breadth and interconnectedness of the efforts underway in Denver and to highlight both successes and challenges. The exploration concentrated on how three themes of national interest are unfolding in Denver: building and sustaining a robust and effective safety net in an evolving health care market; improving the health of people and their communities to prevent and reduce the need for health …

Residents' Perceptions Of Social Interaction And Social Activity In An Affordable Assisted Living Facility, Elena Garcia

Honors Scholar Theses

This study is a qualitative study looking at the social interactions and social activities in an assisted living facility, based on the residents’ perceptions. In this study I interviewed 20 residents of an affordable assisted living facility. The participants were male and female, 65 or older, and any ethnicity. Inclusion criteria include: (1) Residing in the assisted living facility at least 6 months and no more than 2 years; and (2) being mentally competent to give informed consent. I recruited the participants based on a list of who was eligible from the facilities administration and then asked the eligible participants …

Bmi Trajectories During The Transition To Older Adulthood: Persistent, Widening, Or Diminishing Disparities By Ethnicity And Education?, Katrina M. Walsemann, Jennifer A. Ailshire

Faculty Publications

Previous research has produced inconsistent results on whether education and ethnic disparities in BMI persist, widen, or diminish over time. We investigate how education and ethnicity, independently and conditionally, influence BMI trajectories during the transition to older adulthood. Employing random coefficient modeling, we analyzed 8 biennial waves of data (1992-2006) from the Health and Retirement Study, a nationally representative longitudinal study of individuals born between 1931 and 1941. After adjusting for health behaviors and health status, education and ethnic disparities in BMI persisted for most groups, but narrowed between high-educated white men and both low-educated Hispanic men and high-educated black …

The College Of Health & Human Services [Annual Report], Wku College Of Health & Human Services, Dr. John Bonaguro, Dean

College of Health & Human Services Publications

No abstract provided.

Massachusetts’ Home Care Programs And Reasons For Discharge Into Nursing Homes, Cathy M. Wong, Nina M. Silverstein

Gerontology Institute Publications

Home and community-based services (HCBS) are a range of long-term care services intended to enable older adults and persons with disabilities to “age in place” in their own homes and communities. Previous studies well document that older adults prefer receiving HCBS rather than institutional care at a nursing home. One study concluded that 84 percent of older Americans, aged 50 years and older, want to remain in their homes for as long as possible. Medicaid is a major source of funding for long term care. Currently, a large proportion of Medicaid funds in most states has been spent on institutional, …

Factors Influencing Receipt Of Outpatient Rehabilitation Services Among Veterans Following Lower Extremity Amputation, Jianxun Zhou, Barbara E. Bates, Jibby E. Kurichi, Pui L. Kwong, Dawei Xie, Margaret G. Stineman

United States Public Health Resources

Objective: To determine patient-, treatment-, and facilitylevel characteristics associated with receiving outpatient rehabilitation services after lower extremity amputation within the Veterans Affairs (VA) system.

Design: Observational study.

Setting: All Veterans Affairs Medical Centers (VAMCs).

Participants: Veterans (N=4165) with lower extremity amputation discharged from VAMCs between October 1, 2002, and September 20, 2004. Interventions: Not applicable.

Main Outcome Measures: Receipt of outpatient rehabilitation services up to 1 year postdischarge. A Cox proportional hazards model was used to determine the adjusted hazard ratio and 95% confidence interval of veterans to receive outpatient services.

Results: …

Acute Impact Of Moderate-Intensity And Vigorous-Intensity Exercise Bouts On Daily Physical Activity Energy Expenditure In Postmenopausal Women, Xuewen Wang, Barbara J. Nicklas

Faculty Publications

This study determined whether performing a single moderate- or vigorous-intensity exercise bout impacts daily physical activity energy expenditure (PAEE, by accelerometer). Overweight/obese postmenopausal women underwent a 5-month caloric restriction and moderate- (n = 18) or vigorous-intensity (n = 18) center-based aerobic exercise intervention. During the last month of intervention, in women performing moderate-intensity exercise, PAEE on days with exercise (577.7 ± 219.7 kcal·d⁻¹) was higher (P = .011) than on days without exercise (450.7 ± 140.5 kcal·d⁻¹); however, the difference (127.0 ± 188.1 kcal·d⁻¹) was much lower than the energy expended …

In Search Of Wellness: Allied Health Professionals' Understandings Of Wellness In Childhood Disability Services, Lauren Breen, Helen Wildy, Sherry Saggers, Jeannine Millsteed, P Raghavendra

Research outputs 2011

Purpose. Wellness approaches are not routine in childhood disability services, despite theoretical and empirical support and an increasing demand for them from health consumers and disability activists. We aimed to investigate how health professionals define or understand wellness and its practice in the context of childhood disability. Method. A qualitative, interpretive approach was taken. Semi-structured interviews were conducted with 23 health professionals (allied health therapists and managers) providing early intervention and ongoing therapy within four Australian childhood health and disability services. Years of experience providing services to children with disabilities and their families ranged from 6 months to 30 years …

The Relationship Of Race And Social Integration On The Health Status Of Older Adults In An Urban City, Thomas T. Jordan

Dissertations, Theses, and Capstone Projects

Durkheim argues that an individual is more vulnerable to self-destruction the more s/he is detached from the collective. This dissertation will explore the relative impact of social integration on older adults who have transitioned into their new roles in the social structure in relationship to their physical (obesity) and psychological (stress) health status. Additionally, the dissertation examines how social integration varies in its impact from one racial group to another, and how such variations influence the health status of the older adults who are members of these groups.

This dissertation employs data from the Brookdale Center for Healthy Aging and …

Self-Rated Health Status And Cardiorespiratory Fitness As Predictors Of Mortality In Men, Jennifer Gander, Duck-Chul Lee, Xuemei Sui, James R. Hébert, Steven P. Hooker, Steven N. Blair

Faculty Publications

Self-rated health (SRH) and cardiorespiratory fitness (fitness) are independent risk factors for all-cause mortality. The purpose of this report is to examine the single and joint effects of these exposures on mortality risk. The study included 18 488 men who completed a health survey, clinical examination and a maximal exercise treadmill test during 1987–2003. Cox regression analysis was used to quantify the associations of SRH and fitness with all-cause mortality. There were 262 deaths during 17 years of follow-up. There was a significant inverse trend (p_trend <0.05) for mortality across SRH categories after adjustment for age, examination year, body mass index, physical activity, smoking, alcohol consumption, abnormal ECG, hypertension, hypercholesterolaemia, cardiovascular disease, diabetes and cancer. Adjustment for fitness attenuated the association (p value =0.09). The authors also observed an inverse association between fitness and mortality after controlling for the same covariates and SRH (p_trend = 0.006). The combined analysis of SRH and fitness showed that fit …

Survival Analysis With Censored Outcomes, Henry T. Robertson

All ETDs from UAB

This dissertation is arranged in the three-paper format. The unifying theme of the dissertation is estimating longevity in terms of years of life lost (YLL). The papers are presented in order of increasing methodological focus. The first paper, No compelling evidence that sibutramine prolongs life in rodents despite providing a dose-dependent reduction in body weight, was published in the International Journal of Obesity in 2010. Although sibutramine reduced food intake and body weight, it had no association with longevity. The conclusions were based on data from a 2-year toxicology trial required by the FDA. Although this paper was largely applied …

The Relationship Of Financial Performance, Quality Indicators, And The Role Of Nurse Executives In Virginia Nursing Homes, Jeany V. Murphy

Health Services Research Dissertations

Problem statement. The dynamic nature of the healthcare industry has triggered changes in nurse executive functions. The job has expanded into entrepreneurial roles to be able to provide the most cost effective services while maintaining good quality outcomes for the residents. The new responsibility requires a different set of knowledge and competencies that is usually achieved through advanced education. It is not known whether nurse executives in long term care in Virginia possess the skills to influence both the financial and quality outcomes of the facility.

Methods. This descriptive research study examined the relationship of the nurse executives' technical, human, …

Chhs December/January E-Newsletter, Dr. John Bonaguro, Dean, Vashon S. Wells, Editor, Wku College Of Health & Human Services

College of Health & Human Services Publications

No abstract provided.

Implications Of Lifecourse Epidemiology For Research On Determinants Of Adult Disease, Sze Yan Liu, R N. Jones, M Maria Glymour

Department of Public Health Scholarship and Creative Works

Many diseases commonly associated with aging are now thought to have social and physiologic antecedents in early life. Understanding how the timing of exposure to early life risk factors influences later-life health may illuminate mechanisms driving adult health inequalities and identify possible points for effective interventions. Recognizing chronic diseases as developing across the lifecourse also has implications for the conduct of research on adult risk factors for disease. We review alternative conceptual models that describe how the timing of risk factor exposure relates to the development of disease. We propose some expansions of lifecourse models to improve their relevance for …

Editor’S Farewell, Irvin Sam Schonfeld

Publications and Research

No abstract provided.

Surrogate Screening Models For The Low Physical Activity Criterion Of Frailty, Sandrah P. Eckel, Karen Bandeen-Roche, Paulo H.M. Chaves, Linda P. Fried, Thomas A. Louis

Johns Hopkins University, Dept. of Biostatistics Working Papers

Background and Aims. Low physical activity, one of five criteria in a validated clinical phenotype of frailty, is assessed by a standardized questionnaire on up to 20 leisure time activities. Because of the time demanded to collect the interview data, it has been challenging to translate to studies other than the Cardiovascular Health Study (CHS), for which it was developed. Considering subsets of activities, we identified and evaluated streamlined surrogate assessment methods and compared them to one implemented in the Women’s Health and Aging Study (WHAS).

Methods. Using data on men and women ages 65 and older from the CHS, …

Chronic Pain And Pain Management Among Older Veterans, Juyoung Park

Florida Public Health Review

The aim of the study was to examine chronic pain in older veterans (65+) and the pain treatment that they received at the Veteran Medical Center. Using a cross-sectional research design, a survey was administered to 107 older veteran participants with self-reported chronic pain recruited from outpatient centers of the Veterans Administration Medical Center: Pain Management Center, Geriatric Clinic, Arthritis Treatment Center, Mental Health Clinic, and Primary Care Clinic. Severity of pain, functional status, depression, spirituality, social support, and social network were assessed, and demographic data were collected. A majority of the participants (92.5%, n = 99) reported having had …

Program Evaluation Of A Community-Based Door-Through-Door Medical Escort Service, Lauren A. Martin

Gerontology Institute Publications

This report summarizes the program evaluation findings of a Boston-based organization’s Medical Escort program. This “door-through-door” service strives to provide medical transportation, physical assistance, and emotional support to elders on their way to the doctor’s office, during medical appointments and on the way back home again. By offering added assistance the program attempts to remove environmental barriers associated with access to health care. This evaluation combines previously collected program statistics with surveys (32) from program volunteers and phone interviews (78) with recipients.

Perceived Stigma Among Patients Receiving Antiretroviral Treatment: A Prospective Randomised Trial Comparing An M-Dot Strategy With Standard-Of-Care In Kenya, Susan Kaai, Sandra Bullock, Avina Sarna, Matthew Chersich, Stanley Luchters, Scott Geibel, Kishorchandra Mandaliya, Marleen Temmerman, Naomi Rutenberg

Population Health, East Africa

HIV and AIDS remain highly stigmatised. Modified directly observed therapy (m-DOT) supports antiretroviral treatment (ART) adherence but little is known about its association with perceived stigma in resource-constrained settings. In 2003, 234 HIV-infected adults enrolled in a two-arm randomised trial comparing a health centre-based m-DOT strategy with standard self-administration of ART. Data on perceived stigma were collected using Berger's HIV stigma scale prior to starting ART and after 12 months. This was a secondary analysis to examine whether perceived stigma was related to treatment delivery. Perceived stigma scores declined after 12 months of treatment from a mean of 44.9 (sd=7.6) …

The Future Health Care Workforce Of Older Americans, Richard G. Stefanacci Do, Mgh, Mba, Christine A. Arenson Md, Barney S. Spivack Md, Facp, Agsf, Cmd

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Hp Newsletter March 2010 Dowload Full Pdf

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Annual Report, Western Kentucky University College Of Health & Human Services, Dr. John Bonaguro, Dean, Wku College Of Health & Human Services

College of Health & Human Services Publications

No abstract provided.

Consumer-Directed Health Insurance Vs. Managed Care: Analysis Of Health Care Utilization And Expenditure Incurred By Employees In A Rural Area, Cecilia M. Watkins, J. White, D. Duncan, D. Wyant, T. Nicholson, J. Khubchandani, C. Lakshminarayana

Public Health Faculty Publications

Consumer-Directed Health Plans (CDHPs) are proposed as an option to control healthcare costs. No research has addressed their applicability in rural settings. This study analyzes three years (2003–2005) of healthcare expenditure and utilization incurred by two employers and a national carrier providing data from a rural state, Kentucky. The study included two measures of expenditures (health care and prescription drugs) and three measures of utilization (physician visits, hospital admissions, and hospital inpatient days). In general, the CDHP successfully controlled the growth of medical costs. These findings suggest that CDHPs may be a viable alternative benefit structure for rural employers.

The Relationship Between Body Image And Body Mass Index In Attendees At A Health Fair, Millie S. Olds

Master of Public Health Program Student Publications

The purpose of this study was to examine the relationship between body image and body mass index (BMI) in attendees at a health fair. BMI and body image was also compared between races, ages and genders. It was hypothesized that there would be discrepancies between perceived body image and weight status, as measured by BMI. Sixty-two participants at a health fair in Cincinnati completed a survey about perceived body image and had their height and weight measured and BMI calculated later. Results suggested a positive relationship between BMI and body image. Participants with a higher BMI identified themselves with a …

Unmet Medical Need Of Underserved Population In A Safety-Net Organization, Leslie Clem

Master of Public Health Program Student Publications

Background: Safety net providers serve a large proportion of America’s uninsured and low income population. The purpose of this study is to determine if differences in unmet medical needs exist between the provisional and clinic populations, age groups, and sex and race categories. This research study provides information about the population that receives services from Good Neighbor House, a non-profit social service organization in Dayton, Ohio.

Methods: GNH created a survey to assess the unmet medical need of their clients. The instrument contains questions about routine medical care, unmet medical care in the last 12 months, medical bills, and demographic …

Resting Energy Expenditure Changes With Weight Loss: Racial Differences, Xuewen Wang, Tongjian You, Leon Lenchik, Barbara J. Nicklas

Faculty Publications

It is controversial whether weight loss reduces resting energy expenditure (REE) to a different magnitude in black and white women. This study was to determine whether changes in REE with weight loss were different between black and white postmenopausal women, and whether changes in body composition (including regional lean and fat mass) were associated with REE changes within each race. Black (n= 26) and white (n= 65) women (age= 58.2±5.4 years, 25< BMI< 40 kg·m⁻²) completed a 20-week weight loss intervention. Body weight, lean and fat mass (total body, limb and trunk) via dual energy X-ray absorptiometry, and REE via indirect …

Table Of Contents

Michigan Journal of Public Health

No abstract provided.

Indigenous And Mestizo Mexican Migrant Farmworkers: A Comparative Mental Health Analysis, William Donlan, Junghee Lee

School of Social Work Faculty Publications and Presentations

Mexican-origin migrant farmworkers using: (a) lifetime prevalence of culture-bound syndromes, (b) self-rated emotional/mental health, (c) depression measured by PHQ-9, (d) stress level. Demographic and psychosocial variables were examined by ethnicity and gender using Chi square and independent t-tests. Logistic and linear regression models were constructed for mental health variables. Indigenous participants reported significantly higher stress compared to mestizos, and indigenous women reported significantly higher stress compared to all groups. Prevalence of culture-bound syndromes and mean PHQ-9 severity score was highest for indigenous females. Mean self-rated emotional/mental health was lowest among indigenous females. Controlling for main effects and other interactions, (a) …

The Latina/O Mental Health Paradox Or Racial/Ethnic Disparities? Depression Among New Immigrants To The U.S, Sandra Iveth Ramirez

Open Access Theses & Dissertations

The Latino/a Mental Health Paradox states that the foreign-born immigrants have better mental health outcomes when compared with native-born groups of various ethno-racial backgrounds, with the gap in mental stress minimizing overtime. The objective of this study is to examine whether Latina/os immigrants suffer an ethno-racial disparity in mental health or if they have favorable mental health outcomes as predicted by the Paradox. Expanding on the Latina/o Mental Health Paradox, rather than comparing Latina/o immigrants with native-born, this study will compare depression among recently legalized Latina/os with recent legalized European immigrants.

Psychological Care For Persons Of Diverse Religions: A Collaborative Continuum, Glen Milstein, Anne Marie Yali

Publications and Research

The purpose of this paper is to describe to psychologists and other clinicians a continuum of mental health care for persons of diverse religions. The continuum delineates boundaries between clinical care provided by mental health professionals and religious care provided by clergy, as well as describes pathways of collaboration across these boundaries. A prevention science based model of Clergy Outreach and Professional Engagement (COPE) is offered to guide this collaboration. The model describes a continuum that moves from the care already present in religious communities, through professional clinical care provided in response to dysfunction and returns persons to their own …