Public Health Commons^™

The Distribution Of Airborne Coal Dust In Soil Profiles Of Norfolk, Va And Its Implication For Arsenic Loading To These Soils, William Joseph Bounds

OES Theses and Dissertations

Norfolk, Virginia is home to the Northern Hemisphere's largest coal terminal the Lamberts Point Docks. The coal loading process of this terminal creates large amounts of coal dust, which subsequently is distributed throughout the local region by atmospheric transport and deposition. While the coal dust itself poses only minor health hazards, certain trace elements within the coal, particularly arsenic, may pose environmental as well as significant health hazards. Within coal, arsenic occurs primarily in the mineral pyrite. As pyrite in the coal dust is subsequently oxidized via exposure to the atmosphere and/or meteoric water, arsenic may be released to the …

Effects Of Hormonal Changes Throughout The Menstrual Cycle On Joint Laxity In Females, John C. Roberts

Human Movement Studies & Special Education Theses & Dissertations

The objective of this study was to examine the levels of estrogens, progesterone, LH, FSH, estradiol and testosterone and their relation to ACL laxity throughout the menstrual cycle. Subjects were tested at the onset of menses, the first day of ovulation (days 8–17) and day 23 at the mid-luteal phase. A Pearson Product Moment Correlation Coefficient revealed that there were no statistically significant relationships between laxity measurements, of the KT-2000 or radiographic comparisons, and elevated concentrations of any of the hormones. LH was observed in the follicular phase, at the onset of menses, to have a negative correlation with only …

A Longitudinal Study Examining The Stability Of Occupational Stressors Identified By Nursing Home Administrators, Gay Lynne Andrucci-Armstrong

Health Services Research Dissertations

As a result of the ever changing and expanding role of the nursing home administrator in conjunction with the stricter legislation governing nursing facilities over the past decade and the graying of America, a study specific to this population was warranted. The purpose of this study is to determine the relative change in the self-reported occupational stressors of nursing home administrators over a five year period (December 1994 to June 1999) secondary to the increased regulatory climate of the nursing home industry.

This study was carried out in three phases and included all practicing nursing home administrators in Virginia. Phase …

Barrier To Utilization Of Primary Healthcare Resources In Children Two Years Of Age And Under, Ruth A. Waibel

Health Services Research Dissertations

This is a retrospective longitudinal study of health service utilization using the Immunization Practice Data Set obtained from the Center for Pediatric Research, Norfolk, Virginia. Cluster sampling was used to identify a cohort of children (n = 271), aged 0 to 24 months, from the city of Norfolk, Virginia. A two-year abstraction of medical records was used to determine utilization practice patterns for three categories of health: well-baby, acute and chronic care. The purpose of this study was to identify socio-demographic, need, and health system factors associated with under-utilization of primary care services using Aday's model. The proportion of children …

The Effects Of Occupational Ultrasonic Noise Exposure On Hearing In Dental Hygienists: A Pilot Study, Jennifer S. Dunning

Dental Hygiene Theses & Dissertations

The purpose of this case-control study was to determine whether long-term ultrasonic noise exposure via the dental office environment is related to dental hygienists' hearing status. Registered dental hygienists (N = 698) who live in the Hampton Roads area were mailed a Dental Hygiene Work History Questionnaireto determine those meeting the inclusion criteria and willing to participate in the study. Consenting subjects were categorized into one of two groups according to ultrasonic scaler usage rate and matched on age. Persons with known hearing loss due to infection, disease, or congenital defect were excluded from the study. The final sample …

A Health System Analysis Approach To Health Outcomes In Medicare Clients With Chronic Illnesses, Christine A. Elnitsky

Health Services Research Dissertations

Since 1863, outcomes measurement efforts have provided information to health care consumers, administrators, and policymakers in assessing concerns about access, quality and costs. With a growing population of older adults with chronic illnesses, cost-cutting strategies in health delivery systems, and federal endorsement of managed care systems, researchers have begun to evaluate the impact of different delivery system organizations on health. The current study combines two areas of health services research to provide the first published hierarchical analysis of the influence of delivery system factors, and a profile of population and community characteristics and utilization factors, on perceived health outcomes of …

A Study Of The Factors That Impact Female Military Beneficiaries Obtaining Preventive Health Services, Cynthia Andrea Chargois

Health Services Research Dissertations

The purpose of this study was to determine what factors predict whether female military retirees or the female beneficiary of a military retiree, ages 40 to 64, will obtain preventive health services, specifically, Pap smears, mammograms, and clinical breast examinations. Based on the findings of the study, it is suggested that it may be important for the Department of Defense to broaden their scope of interest to include those areas that are most prominent in affecting female military retirees or the female beneficiary of a military retiree, particularly those 40 to 64, in obtaining preventive health services.

The study comprised …

Childhood Obesity And Its Relationship To Sedentary Behavior Patterns Vs. Other Independent Risk Factors Of Obesity Among Navy Dependent Adolescents, Shaye Lauren Arluk

Human Movement Studies & Special Education Theses & Dissertations

Background According to data gathered in the NHANES 1999 survey 14% of American children are now classified as obese, a 60% increase in prevalence from the NHANES II survey in 1976. Multiple research studies have looked at the role of dietary intake, heredity, and physical activity participation as independent risk factors of obesity with mixed results. However, sedentary behavior patterns, which have markedly increased in the past ten years, have not been extensively studied in relation to childhood obesity. The goal of this study was to focus on the relationship between various sedentary behaviors and childhood obesity.

Methods Two descriptive …

Validation Of Passive Air Sampling Monitors Onboard United States Navy Submarines, Larry A. Mcfarland

Community & Environmental Health Theses & Dissertations

An operating submarine creates a unique air quality mixture of compounds that result from a combination of human metabolism, construction materials, materials brought onboard and compounds created through the interaction of ship systems. A comprehensive study of submarine atmospheres is ongoing during deployments of U.S. Navy nuclear submarines. As part of the overall effort, a paired air sampling comparison field validation was conducted to compare the air sampling effectiveness of passive diffusive monitors compared to more traditional active air sampling methods when sampling for acrolein, formaldehyde and ozone in the enclosed submarine atmosphere. Acrolein monitors containing 2-hydroxymethylpiperidine (HMP) impregnated glass …

The Pediatric Breathing Survey, Linda J. Galloway

Health Services Research Dissertations

To ensure culturally-sensitive assessments, the researcher designed a Pediatric Breathing Survey (PBS) to measure quality of life for African-American children. The purpose of this study was to test whether the PBS is a reliable and valid instrument. Comparisons of group differences on race, income and parent's level of education based on parent responses to the questionnaires were conducted. More specifically, differences in Health Related Quality of Life (HRQOL) between Caucasian and African-American children were examined. The researcher-designed instrument was compared to Juniper's Pediatric Asthma Quality of Life Questionnaire. The sample consisted of parents of 84 school-aged children diagnosed with asthma. …

Explanatory Power Of The Behavior Model Of Utilization For Pediatric Asthma Health Care In An Urban Managed Care Setting, Kathie Marie Sawyer Zimbro

Health Services Research Dissertations

The Behavior Model of Utilization played a key role in explaining health services use for pediatric members with asthma in one urban, regional managed care company. The critical role the asthma management program played in promoting the health and well-being of enrolled members was elucidated. Information gleaned from this empirical study can be used to encourage appropriate resource utilization, formulate pediatric asthma health policy, and deliver cost-effective, quality health care. More importantly, managed care company administrators and clinicians can demonstrate the value of their efforts by achieving measurable improvements in the health and well-being of children in the communities they …

Identification Of Violence In The Home - Pediatric And Parental Reports, Bonnie D. Kerker, Sarah Mccue Horwitz, John M. Leventhal, Stacey Plichta, Phillip J. Leaf

Community & Environmental Health Faculty Publications

Objectives: To compare the rates of domestic violence reported by mothers with those identified by physicians, to compare the rates of harsh discipline practices reported by mothers with the rates of abuse identified by physicians, and to examine the relationship between reported domestic violence and harsh discipline practices.

Design: Interviews with parents and pediatricians to compare pediatric detection of domestic violence and child abuse with parental reports of domestic violence and harsh discipline practices.

Setting: Community-based pediatric practices in the 13-town greater New Haven, Conn, area.

Participants: Of the 23 practices invited, 19 agreed to participate. Of the 2006 parents …

Factors Associated With Asthma Readmissions In Children's Hospitals, Maria Acedo Kronenburg

Health Services Research Dissertations

Asthma is the most common chronic illness of childhood. Pediatric asthma hospitalization rates and costs of care have risen in recent years. Readmissions, an adverse outcome often used to monitor quality of care, may account for the increase in asthma hospitalization rates. This research examined selected hospital and patient risk factors related to asthma readmissions, using Donabedian's framework for structure, process, and outcomes to assess the quality of care for children with asthma. Outcome measures included readmission for asthma within one year of initial hospitalization, readmission within 30 days, and multiple readmissions within one year. Structure factors measured were insurance …

Factors Which Affect Post-Hospital Resource Use And Patient Health Outcomes Among Taiwanese Older Adults, Chouh-Jiaun Lin

Health Services Research Dissertations

The purpose of this study was to explore relationships among population characteristics, patient post-hospital resource use and patient health outcomes in terms of the Andersen health behavioral model. An additional purpose of this study was to examine a discharge planning screening instrument used in a large urban hospital in Taiwan to determine if it predicts resource use and patient outcomes. A longitudinal research design was adopted for this study. Data were collected from the general medicine departments of an 800-bed university teaching hospital. Out of 109 patients who were interviewed, 78 participants qualified (participation rate = 71.6%).

The majority of …

The Accuracy Of Nitrous Oxide Passive Dosimeters As Compared With An Infra-Red Spectrographic Reference Method, Susan Allen

Community & Environmental Health Theses & Dissertations

Nitrous oxide is a gas often used in dental, surgical and veterinary operations as an anesthetic agent. Employees stationed in proximity of fugitive gas emissions may potentially suffer adverse health effects from chronic exposure to this agent. Passive dosimeters can be worn in the breathing zone of potentially affected personnel during exposure periods, then later analyzed to quantify nitrous oxide exposure. This study sought to establish the accuracy of several commercially available passive monitoring devices for nitrous oxide by comparison against an infra-red spectrophotometric reference method.

A Study Of The Knowledge And Attitudes Of Physicians Toward Victims Of Spouse Abuse, Ramani N. Garimella

Health Services Research Dissertations

The purpose of this study is to measure the knowledge and attitudes of physicians toward victims of spouse abuse. All 150 practitioners in the specialities of emergency medicine, family medicine, obstetrics-gynecology and psychiatry, in a large area general hospital are included in the sampling frame; 76 responded (RR = 51%). Knowledge and attitudes were measured using the Physician Survey on Spouse Abuse. Rosenberg's Tripartite Model of Attitude formed the theoretical basis for this study. Participants were 72% male, 90% white, 88% currently married, with a mean age of 44 years (SD = 7.99). Mean years in practice was 14.61 (SD …

Classification Of Participants Into Two Health Resource Utilization Groups By The Health Enrollment Assessment Review (Hear) Survey, Jody W. Donehoo

Health Services Research Dissertations

The study examined the ability of the Health Enrollment Assessment Review (HEAR) survey instrument to classify participants into one of two groups according to utilization of health resources anticipated in the following year. Developed by the U.S. Air Force, the HEAR survey is used worldwide by the Department of Defense for enrollees in TRICARE Prime, the military's adaptation of the HMO model of managed care. Individual HEAR reports are prepared for survey participants and their primary care providers in TRICARE Prime. Although it is currently administered worldwide to a majority of the 8.4 million health care beneficiaries of the Department …

Benchmarking Financial Operations Using The Premier Operations Outlook Database, Margaret M. Thompson

Community & Environmental Health Theses & Dissertations

Acute-care hospitals have come under increased pressure to reduce costs while increasing the quality of providing care. Historically, increasing costs of providing care has had the greatest impact on the reduction of operating margins necessary to expand capital and for repayment of debt. Facilities can benchmark internal historical data to identify areas where costs have increased and are able to explain the factors that contribute to the increases. One of the challenges facing hospitals in their efforts to reduce operating costs is how, what, and where, do they obtain comparative data to benchmark the cost of operating medical facility to …

Virginia's Pfiesteria Monitoring Program: Water Quality, Roger K. Everton, Wick T. Harlan, Jonathan W. Priest, Mark S. Alling

Virginia Journal of Science

During the summer and early fall of 1998, 34 estuarine stations in Virginia were sampled for Pfiesteria like organisms (PLOs) and associated water quality conditions. Stations were sampled either bimonthly (20 stations) or monthly (14 stations) from June to October 1998. At each station, a set of live and Lugol' s preserved samples were collected for presumptive counts of PLOs and water quality conditions were determined. Water quality parame­ters measured included standard field parameters, nutrients (total, dissolved, and particulate), chlorophyll a, and conventional water quality indicators. Although PLOs were relatively low in 1998 as compared to 1997, presump­tive PLO counts …

Measurement Of Hospital Performance: Environmental And Organizational Factors Associated With Cost, Debra Kay Dierksmeier Anderson

Health Services Research Dissertations

As U.S. health care expenditures top the $1 trillion mark, there is increased interest in measuring the performance of health care providers. For bottom line oriented payors such as government and business, the focus is on measuring cost. As hospitals account for over one-third of health care expenses, hospital cost per admission is a common measure of performance.

Many environmental and organizational factors come into play in determining hospital cost per admission. This research examines several of these factors, using Raymond Zammuto's model of organizational effectiveness assessment. Using Zammuto's framework, this research looks at the relationship of social, physical, and …

Devolpment Of A Scale To Assess Home Health Care Aides' Ability To Recognize Depression In Older Adults, Tina M. Nerney

Community & Environmental Health Theses & Dissertations

Depression afflicts 20% to 40% of people 65 and older. Depression in older adults is frequent and chronic. The challenge of a hospital stay and the knowledge of having a long term disability may increase the risk for a depressive episode. In today's health care environment older adults are being released from hospitals after a short length of stay and are frequently dependent on home health services for assistance with activities of daily living. Home health care aides are given the responsibility of providing these services to the older adult in the home environment and need to be aware of …

The Effects Of A Maternal Childhood Lead-Poisoning Education Program On Knowledge, Health Beliefs, And Compliance, Sylvia Elaine Johnson

Health Services Research Dissertations

The purpose of this study is to determine the effects of two educational intervention methods on participant's knowledge, health beliefs and prevention behavior as they relate to childhood lead poisoning. The two educational methods being used in the study are personal instruction by the investigator and a 12-minute video developed by the American Academy of Pediatrics on childhood lead poisoning. Information contained in both educational tools is identical. In particular, this study seeks to determine if one educational intervention was more effective than the other. The final purpose of the study is to test the Health Belief Model by examining …

Coping Processes Used By Mothers Of Triplets, Susan Mullen Kaplan

Health Services Research Dissertations

The purpose of the study was to identify and describe the coping processes used by mothers of triplets. Using a descriptive design, interpersonal comparisons of 92 mothers of triplets attending a national meeting of families of higher order multiples were made. Variables, in addition to sociodemographic characteristics, included coping processes, levels of depression, perceived availability of social support, and current stress levels. Coping processes were measured using the Ways of Coping Questionnaire (Folkman & Lazarus, 1988), derived from their cognitive-phenomenological theory of stress and coping. Level of depression was measured using the Zung Self-rating Depression Scale (Zung, 1965). Perceived availability …

Passage Or Pathology: Current Attitudes Toward Women's Aging In The Literature Of Menopause, Kaaren Gearhart Ancarrow

Institute for the Humanities Theses

Menopause is currently portrayed in the medical literature as a pathological 11 process resulting from "hormone deficiency." However, feminist writers contend that the climacteric is part of the normal female aging process and oppose the medicalization of menopause and the consequent inevitable hormone replacement therapy (HR T) promoted by the hegemonic medical and pharmaceutical industries. This paper explores the historical development of these two paradigms of menopause and their manifestations in samples of three classes of contemporary literature on the subject: gynecological textbooks, popular advice books written by physicians, and women's accounts. Five major themes are investigated using quantitative and …

Human Immunodeficiency Virus (Hiv)/Hepatitis B Virus (Hbv) Risk Perception Related To Needlestick Injuries At A Medical School In Norfolk, Virginia, Ronald B. Hartman

Community & Environmental Health Theses & Dissertations

A limited number of studies have been conducted to assess the perceptions of risk of medical students and residents for acquiring Human Immunodeficiency Virus (HIV) or Hepatitis B Virus (HBV) via percutaneous (needlestick) injuries while performing clinical training. The purpose of this study is to investigate these perceptions of risk, and to determine whether there is an association between a high perception of risk and a low incidence of needlestick injury. The method of investigation was a four-page survey questionnaire. The instrument was investigated for reliability by use of a pilot study with a small group of medical students and …

A Test Of An Alternate Calibration Matrix For Niosh Method 7300, Robert T. Vitek

Community & Environmental Health Theses & Dissertations

The purpose of this study was to determine if the analytical results (when determining cadmium, lead, and zinc concentrations) for air sample filters prepared and analyzed according to N:OSH Method 7300, differ significantly, from those obtained when the instrument is calibrated using EPA Method 200.7 acid matrix standards. The null hypothesis was that no statistically significant difference, measured at the 95% confidence level, would exist between results obtained from the two calibration standards. Careful standard and sample preparation, the use of an internal standard, and the application of working standard and working internal standard correction factors served to isolate the …

The Effects Of Risk Management Program Implementation On Worker Safety Knowledge, John C. Donnelly

Community & Environmental Health Theses & Dissertations

This study examined the effect of the implementation of a risk management program tool on worker safety knowledge in a composite building material fabrication facility whose workers suffered from an increasingly high injury (incidence) rate in recent years. Risk assessment codes (RACs) and job safety analyses (JSAs) were the primary tools used to introduce workers to the concept of risk. Because employee involvement is a crucial element in JSA development. employee input was frequently solicited throughout JSA development.

The study instrument consisted of a pre-test and post-test survey, to which an experimental and control group were subjected. The instrument was …

Affective Reactions, Social Support And Willingness To Self-Disclose To Hiv Seropositive Individuals: Impact Of Sexual Orientation And Responsibility For The Infection, Susan Paige Sherburne

Psychology Theses & Dissertations

An attributional model of controllability suggests that perceptions of someone's controllability of an event lead to anger and rejection, whereas perceptions of uncontrollability lead to pity and helping. This study examined the impact of an HIV victim's sexual orientation and "responsibility" for infection on subjects' affective responses, self-disclosure to the person, social support, and liking and trust for the person. Subjects received messages from their "partner" (a confederate) stating that he had just learned he was HIV positive. The message either stated that he was heterosexual or homosexual, and that he had either only one partner or many partners. Subjects …

Patient Satisfaction Among Users Of The After Hours Program, Helen L. Larocco

Community & Environmental Health Theses & Dissertations

The problem of increasing health care costs and decreasing access to health care services is a major crisis in the U.S. today. One factor contributing to the rising cost of health care is the inappropriate use of emergency rooms, (ERs). In response to escalating costs a local health care corporation implemented a telephone triage program called the After Hours Program, (AHP). The goal of the program was to reduce inappropriate utilization of emergency rooms, and to educate patients to recognize and treat specific health problems independently, i.e., home treatment.

A program evaluation was completed in which different dimensions of patient …

A Comparison Of The Utilization Of Health Services In The Presence Or Absence Of Prescriptive Drug Insurance In A Managed Care Environment, Martha Groblewski

Health Services Research Dissertations

This study tested if the availability of third party payment for prescriptive drugs as part of employer sponsored health insurance was associated with a change in the utilization of four types of health services in an independent practice association (IPA). The study employed the individual determinants component of the Andersen-Newman theoretical framework for health services utilization. Groups of employees in companies that offered health insurance identical in all ways except for the presence or absence of the prescriptive rider were included in the study which resulted in a population of 122 companies (89 with prescriptive rider insurance and 33 without …