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Articles 361 - 390 of 1660
Full-Text Articles in Other Public Health
Food Accessibility Struggles For College Students With Dietary Restrictions, Ella Schleuning
Food Accessibility Struggles For College Students With Dietary Restrictions, Ella Schleuning
Mahurin Honors College Capstone Experience/Thesis Projects
College is a time when many students experience independence for the first time in their lives. This is the first time they have had to do their laundry on their own, keep their room clean, and maybe most importantly, they are responsible for figuring out where they are going to eat every day, for every meal. The focus of this study is on food accessibility struggles for college students, specifically looking at Western Kentucky University’s (WKU) food on-campus, as well as students with dietary restrictions.
Since college is the first-time students are responsible for their own meals, it can often …
Reimagining Equitable Care: Simulation-Based Education And The Dismantling Of Implicit Bias And Stigma Of Vulnerable Populations In Hospitals, Vanessa Smith
Nursing | Senior Theses
Background: Simulation-based education consists of using high-fidelity mannequins and equipment to provide a safe space for healthcare professionals to practice crucial skills within healthcare. Used within hospitals and schools, simulation most commonly surrounds practicing hands-on skills such as central line insertion, IV insertion, Ultrasound-guided procedures, code blue response, etc. However, a large portion of healthcare that is overlooked is tackling issues within patient-provider relationships. Simulation can help dismantle the negative behaviors and feelings providers push onto patients through the use of standardized patients and role-playing. By using these methods, simulation can reduce providers’ personal implicit biases and the stigma associated …
Microbial Profile And Antimicrobial Resistance Patterns Of Surgical Intra-Abdominal Infections At A Tertiary Hospital In Tanzania A Retrospective Cross-Sectional Study, Abduel Julius Kitua
Microbial Profile And Antimicrobial Resistance Patterns Of Surgical Intra-Abdominal Infections At A Tertiary Hospital In Tanzania A Retrospective Cross-Sectional Study, Abduel Julius Kitua
Master of Surgery
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Among infections of surgical importance, intra-abdominal infections prevail among the most common in surgical patients with considerable morbidity and mortality. The ever-rising microbial resistance to commonly available antibiotics and geographical variations in microbial profile and resistance patterns poses a challenge to the management of these surgical infections of abdominal origin. The aim of this study was to evaluate microbiological characteristics and antibiotic susceptibility of isolates from intra-abdominal infections at a tertiary hospital in Tanzania and how these influence early treatment outcomes.
Outpatient Fall Prevention In Ambulatory Adults 65 Years Old And Over, Dorothy L. Osborne-White
Outpatient Fall Prevention In Ambulatory Adults 65 Years Old And Over, Dorothy L. Osborne-White
Doctor of Nursing Practice (DNP) Scholarly Projects - Archive
Background: In the United States (U.S.), falls are the leading cause of injury among adults 65 and over, resulting in 36 million falls yearly (Moreland et al., 2020). According to the Centers for Disease Control and Prevention (CDC, 2023), one in four older adults experiences a fall each year. Falls are the world's second most prominent cause of accidental deaths (World Health Organization [WHO], 2021). Falls are the leading cause of both fatal and non-fatal injuries among older adults (Moreland et al., 2020).
Methods: A quality improvement project that included a fall bundle was implemented in a primary clinic. A …
Implementing Social Determinants Of Health Data Collection In A Large Urban Pediatric Hospital Setting, Stormee Williams, Kristina Hill, Barry Owen, Forest Melton
Implementing Social Determinants Of Health Data Collection In A Large Urban Pediatric Hospital Setting, Stormee Williams, Kristina Hill, Barry Owen, Forest Melton
Research
No abstract provided.
High Prevalence Of Trypanosoma Cruzi Infection In Raccoons (Procyon Lotor) And Associated Risk To Humans In Central Illinois, Esther Onuselogu
High Prevalence Of Trypanosoma Cruzi Infection In Raccoons (Procyon Lotor) And Associated Risk To Humans In Central Illinois, Esther Onuselogu
Masters Theses
Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, remains a neglected tropical disease and a growing health threat in the United States. Raccoons (Procyon lotor) often coexist with humans in urban and suburban areas and serve as reservoir hosts for T. cruzi. While T. cruzi is rare in humans and domestic animals in the U.S., it is common in wildlife species, particularly raccoons and Virginia opossums (Didelphis virginiana). This study aimed to assess the prevalence of T. cruzi infection in the raccoon population of Central Illinois and evaluate the risk of transmission to humans. …
Transforming Children's Oral Health: The Impact Of Oral Healthcare Policies On Virginia Medicaid Dental Health Outcomes., Anita M. Kumar
Transforming Children's Oral Health: The Impact Of Oral Healthcare Policies On Virginia Medicaid Dental Health Outcomes., Anita M. Kumar
Theses and Dissertations
Abstract: Transforming Children's Oral Health: The Impact of Oral Healthcare Policies on Virginia Medicaid Dental Health Outcomes.
Objectives: This dissertation uses Department of Medical Assistance Services (DMAS) administrative files at the individual and provider level from fiscal years (FY) 2011 to 2021 to systematically study the effect of recently implemented oral health policies (EBD guidelines on sealants, CMS updated quality measures, expansion of Medicaid oral healthcare for qualifying pregnant women) on oral health outcomes of Virginia Medicaid-enrolled children.
Methods: The studies employ a difference in differences regression methods (negative binomial, Poisson, and logistic) to examine the effects of oral health …
Examining Stigma In Rural Mental Health Care Settings: A Mixed Methods Approach, Lainie Krumenacker
Examining Stigma In Rural Mental Health Care Settings: A Mixed Methods Approach, Lainie Krumenacker
Murray State Theses and Dissertations
More than half of Americans will be diagnosed with a mental illness in their lifetime (CDC, 2021), yet stigma towards mental health affects both patients and providers. Although programs exist to address stigma, improve cultural competency among providers, and educate families on the importance of support, facilities are often limited on programs they provide due to allocation of resources and funds. Without a shift in treatment and programing, stigma will continue to impact patient care and outcome.
This study explored stigma among mental health providers in rural communities, while exploring potential differences in treatment among patients due to race. Mental …
Advancing School Nursing Practice: A Novel Approach To Screening For Gastrointestinal Disorders In Children, Ashley Bunting, Isabella Cavlan
Advancing School Nursing Practice: A Novel Approach To Screening For Gastrointestinal Disorders In Children, Ashley Bunting, Isabella Cavlan
Nursing | Senior Theses
Background: Currently, mandated health screenings in California schools are limited to vision, hearing, and scoliosis; this leaves several other body systems unmonitored during the crucial years of childhood development. One such system is the gastrointestinal (GI) system, which plays a vital role in the normal growth, nutrition status, development, and overall health of children. Objective: By developing and implementing a GI-specific screening tool in the outpatient school setting, this research aims to increase the detection of GI disorders in children. Not only that, but school nurses can use this novel screening tool to promote early diagnosis, intervention, and …
Nurses Current State Of Knowledge On Prion Disease, Chelsy Grande
Nurses Current State Of Knowledge On Prion Disease, Chelsy Grande
Nursing | Student Research Posters
Human prion disease is a rare and fatal neurodegenerative disorder. Creutzfeldt- Jakob prion disease rapidly progresses, and is caused by prion, an infectious protein that damages the central nervous system (Bailey et al., 2000). The infectious pathogen is different from other infectious diseases as the normal prion protein misfolds, changing the structures and results in an accumulation of cellular prion proteins (Rentz, 2003). There is no cure for Creutzfeldt- Jakob disease, only palliative care to improve their symptoms and provide support as the disease progresses. How much do nurses know and understand about prion disease, and how can this influence …
An Appalachian Perspective On Suicide: A Focus On West Virginia’S Unique Context, Erin Delaney Caswell
An Appalachian Perspective On Suicide: A Focus On West Virginia’S Unique Context, Erin Delaney Caswell
Graduate Theses, Dissertations, and Problem Reports (ETD)
INTRODUCTION: The Appalachian region, spanning 13 states from New York to northern Mississippi, experiences the suicide rates in the United States (U.S.), underscoring a public health crisis exacerbated by persistent socioeconomic challenges. West Virginia (WV), the only state entirely within Appalachia, serves as a focal point for understanding the broader suicide crisis in the region, as WV has the highest suicide rates in the region. Moreover, the state has several unique socioeconomic factors, like increased poverty, lower educational attainment, limited access to healthcare, and a high prevalence of chronic pain and substance that may contribute to elevated rates of suicide. …
A Case Study In Program Evaluation, Lydia Williams
A Case Study In Program Evaluation, Lydia Williams
Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)
The three core functions of public health are assessment, policy development, and assurance, and program evaluation falls under the latter category. A program is incomplete without an in-depth understanding of how well it works and what steps can be taken to make sure there is continuous progress and improvement.
In this case study, I developed an evaluation plan for the Lexington-Fayette County Health Department’s (LFCHD) infectious disease outbreak education program. The need for such a program was realized after a MRSA outbreak among a Kentucky high school football team. This case study employed the Center for Disease Control and Prevention …
Financial Strain, Health Behaviors, And Psychological Well-Being Of Family Caregivers Of Older Adults During The Covid-19 Pandemic, Yujun Liu, M. Courtney Hughes, Heng Wang
Financial Strain, Health Behaviors, And Psychological Well-Being Of Family Caregivers Of Older Adults During The Covid-19 Pandemic, Yujun Liu, M. Courtney Hughes, Heng Wang
Faculty Articles, Papers, and Other Scholarship
Objectives
This study aims to examine the change in financial strain, health behaviors, and psychological well-being of family caregivers of older adults during the COVID-19 pandemic and explore the differences in mental health outcomes by gender, race, and relationship status.Methods
Using the 2020 National Health and Aging Trends Study COVID-19 supplement, our sample included 2026 family caregivers of older adults. Structural equation modelingwas conducted.Results
Caregivers with financial strain showed worse mental health than those with no financial strain. Female or adult children caregivers reported significantly less time walking, more financial strain, and a higher level of negative …Healthcare Disparities Among Hypermobile Spectrum Disorder And Hypermobile Ehlers-Danlos Syndrome Patients, Brooke A. Martinez
Healthcare Disparities Among Hypermobile Spectrum Disorder And Hypermobile Ehlers-Danlos Syndrome Patients, Brooke A. Martinez
Honors Undergraduate Theses
Hypermobile Ehlers-Danlos Syndrome (hEDS) is the most common subtype of rare connective tissue disorder called Ehlers-Danlos Syndrome (EDS). Hypermobile Spectrum Disorder (HSD) is a connective tissue disorder that presents itself similarly to hEDS. Both disorders primarily affect individuals assigned to females at birth (AFAB), and symptoms range from joint instability, musculoskeletal pain, dizziness, fatigue, depression, and anxiety. Due to many factors like lack of education or attitudes among medical professionals (MPs), receiving a diagnosis of either of these conditions can be a challenging and grueling journey for patients. An online survey was conducted and distributed over social media platforms to …
Mapping Accessibility To Emergency Care Using Public Transportation, Bach Tran
Mapping Accessibility To Emergency Care Using Public Transportation, Bach Tran
Honors Undergraduate Theses
Intro: Public transit offers various advantages for both communities and individuals in terms of mobility and has the potential to serve as a practical alternative to private motorized transportation. Timely and convenient public transit becomes a lifeline for people who cannot access other types of transportation, especially when it comes to emergency care. Method: We built a private network analysis within ArcGIS Pro using coordinate data from hospitals and stand-alone emergency rooms as designated by the North American Industrial Classification System (NAICS) and public transit data from Orlando, FL. Establishing the accessible time as 30 minutes, we computed and visualized …
Evaluating A High School Mrsa Prevention Program: A Case Study, Jamie Henning
Evaluating A High School Mrsa Prevention Program: A Case Study, Jamie Henning
Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)
MRSA poses a significant health risk to athletes nationwide. This case study examines the application of an online training module to address knowledge gaps regarding Methicillin-resistant Staphylococcus aureus (MRSA) among key decision-makers for high school athletes. It reviews the development and initial evaluation of a web-based training program designed to empower decision-makers with the knowledge to prevent MRSA infection and respond to suspected cases. Program evaluation recommended expanding the training module to wrestling staff with improved evaluation methods while continuing implementation and effectiveness assessment for the football staff. Despite initial data quality limitations, the online training module evaluation offered valuable …
New York City’S Health Governance And Activism From The 1950s To The 1970s, Andres Valcarcel
New York City’S Health Governance And Activism From The 1950s To The 1970s, Andres Valcarcel
Theses and Dissertations
New York City's expansive network of hospitals and preventative health services has an intense history outside of the popular narratives of biomedical and technological advancement. This thesis will discuss the period between the 1950s and 1970s and the various movements and parties that shaped the city's health and hospital system. During this period, New York City's healthcare delivery system became increasingly privatized and commercialized; processes that improved the quality of healthcare yet simultaneously barred the poorest from accessing it. Communities, healthcare workers, and civil rights organizations worked to address perceived faults and extend their agency in health and hospital policy; …
Physical And Mental Health Benefits Of An Intergenerational Yoga Intervention On Individuals And Communities, Crystal Rose Mckinney
Physical And Mental Health Benefits Of An Intergenerational Yoga Intervention On Individuals And Communities, Crystal Rose Mckinney
Cal Poly Humboldt theses and projects
Intergenerational health programming has been shown to elicit positive physical, mental, psychological and social health benefits of all participants due to the educational impact and social engagement of synchronized movement and understanding of other generations. Research continues to show the efficacy of yoga in mind - body - spirit - connection health benefits and is accessible to bodies across the lifespan. People of all ages can benefit from an intergenerational yoga program, particularly in a rural location where there are less opportunities for physical activity participation. The purpose of this project is to apply for Humboldt Area Foundation + Wild …
Perfluorooctanesulfonic Acid Exposure Leads To Downregulation Of 3-Hydroxy-3-Methylglutaryl-Coa Synthase 2 Expression And Upregulation Of Markers Associated With Intestinal Carcinogenesis In Mouse Intestinal Tissues, Josiane Weber Tessmann, Pan Deng, Jerika Durham, Chang Li, Moumita Banerjee, Qingding Wang, Ryan A. Goettl, Daheng He, Chi Wang, Eun Y. Lee, B. Mark Evers, Bernhard Hennig, Yekaterina Y. Zaytseva
Perfluorooctanesulfonic Acid Exposure Leads To Downregulation Of 3-Hydroxy-3-Methylglutaryl-Coa Synthase 2 Expression And Upregulation Of Markers Associated With Intestinal Carcinogenesis In Mouse Intestinal Tissues, Josiane Weber Tessmann, Pan Deng, Jerika Durham, Chang Li, Moumita Banerjee, Qingding Wang, Ryan A. Goettl, Daheng He, Chi Wang, Eun Y. Lee, B. Mark Evers, Bernhard Hennig, Yekaterina Y. Zaytseva
Markey Cancer Center Faculty Publications
Perfluorooctanesulfonic acid (PFOS) is a widely recognized environment pollutant known for its high bio- accumulation potential and a long elimination half-life. Several studies have shown that PFOS can alter multiple biological pathways and negatively affect human health. Considering the direct exposure to the gastrointestinal (GI) tract to environmental pollutants, PFOS can potentially disrupt intestinal homeostasis. However, there is limited knowledge about the effect of PFOS exposure on normal intestinal tissues, and its contribution to GI- associated diseases remains to be determined. In this study, we examined the effect of PFOS exposure on the gene expression profile of intestinal tissues of …
Evaluation Of The Navy Shipshape Program At A Large Navy Military Treatment Facility: A Comprehensive Swot Analysis Approach, Nia Nur Maye
Evaluation Of The Navy Shipshape Program At A Large Navy Military Treatment Facility: A Comprehensive Swot Analysis Approach, Nia Nur Maye
College of Graduate Studies: Theses & Dissertations
The increasing problem of obesity among Navy service members (SMs) is a public health concern that impacts operational readiness and health risks. To combat obesity, the Navy has an official weight management initiative called ShipShape. This project aimed to conduct a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis of ShipShape at a large Military Treatment Facility (MTF) in Portsmouth, Virginia. This program evaluation aimed to identify the internal and external factors that influenced the program's effectiveness to propose suggestions for improvement. Using quantitative and qualitative methods, the evaluation focused on conducting a paired t-test to analyze changes in Body Mass …
Hospital Surge Capacity In Co-Occurring Mass Casualty Incidents, Carolyn Solimine
Hospital Surge Capacity In Co-Occurring Mass Casualty Incidents, Carolyn Solimine
Electronic Theses & Dissertations (2024 - present)
The COVID-19 pandemic has brought sweeping disruption and changes across healthcare systems. Examining how these changes have impacted surge capacity and capabilities is necessary to plan for future co-occurring surge-creating events in hospital Emergency Departments (EDs) and Intensive Care Units (ICUs). While there is extensive research on patient surge management, no study has looked at how the presence of a prolonged surge would impact the healthcare system’s ability to handle a concurrent acute patient surge. This study seeks to demonstrate the need for comprehensive planning for co-occurring patient surges in New York State using hospital capacity data from Health and …
Workplace Stress Of Special School Teachers At Three Schools In Bali Province, Made Adhyatma Prawira Natha Kusuma, Agnes Ayu Biomi, Luh Putu Wulandari Artha
Workplace Stress Of Special School Teachers At Three Schools In Bali Province, Made Adhyatma Prawira Natha Kusuma, Agnes Ayu Biomi, Luh Putu Wulandari Artha
Preventia: The Indonesian Journal of Public Health
Workplace stress is often seen as a threat or a problem that comes from the work environment. Stress is a feeling resulting from the interaction between the individual and the work environment. Work stress can happen to anyone at any time, including special school teachers. This research aims to describe the workplace stress of special school teachers at three schools in the Bali Province. This research was conducted in October-December 2022. Researcher used quantitative research method with cross-sectional design and descriptive approach. Data collection is carried out using the Copenhagen Psychosocial Questionnaire-III and the Occupational Diagnosis Survey from the Ministry …
Factors Associated With Reproductive Health Knowledge Among Vocational School Students In Padang, Wilda Tri Yuliza, Meti Yanti, Alkafi Alkafi, Gusni Rahma
Factors Associated With Reproductive Health Knowledge Among Vocational School Students In Padang, Wilda Tri Yuliza, Meti Yanti, Alkafi Alkafi, Gusni Rahma
Preventia: The Indonesian Journal of Public Health
The Ministry of Health of the Republic of Indonesia in 2022 reported that 35.3 persen of women and 31.2 persen of men aged 15-19 have limited or no awareness of reproductive health. The rise of vocational students who are often caught in raids with several cases including sexual deviations is a fatal impact of the lack of reproductive health knowledge on adolescence. The purpose of this study is to find out the factors associated with reproductive health knowledge among vocational students in Padang City. A cross-sectional quantitative research was conducted in July-September 2023 among 538 students at SMK in Padang, …
A Position Analysis Of Bpjs Claims Administration Officers And Verifiers (Case Study: Jambi Province Regional Mental Hospital), Hanisah Hanisah, Asmaripa Ainy, Iwan Stia Budi
A Position Analysis Of Bpjs Claims Administration Officers And Verifiers (Case Study: Jambi Province Regional Mental Hospital), Hanisah Hanisah, Asmaripa Ainy, Iwan Stia Budi
Preventia: The Indonesian Journal of Public Health
The high coverage rate of handling partially rejected claim financing reaching 7.34% of the total 19,476 cases in the Outpatient Unit of the Jambi Provincial Mental Hospital (RSJD) in 2022, is closely related to the quality of human resources (HR) in this case, the claims officer and the suitability of what is done with the job description, job specifications and standard operating procedures (SOP) that have been made. This study aimed to analyze the position of administrative officers and claim verifiers in the outpatient unit of the Jambi Provincial Mental Hospital. This research used a qualitative method. Information was collected …
High-Risk Individuals And Naloxone Use: Implications For Thn Programs In Rural Appalachian Communities, Victor Garcia, Lisa Mccann, Erick Lauber, Christian Vaccaro, Melissa Swauger, Alex Daniel Heckert
High-Risk Individuals And Naloxone Use: Implications For Thn Programs In Rural Appalachian Communities, Victor Garcia, Lisa Mccann, Erick Lauber, Christian Vaccaro, Melissa Swauger, Alex Daniel Heckert
Journal of Appalachian Health
Introduction: Take-home naloxone (THN) is being made available across rural Appalachia to curb opioid overdose fatalities. Despite this initiative, some opioid users do not possess naloxone, and if they do, do not administer it to others.
Purpose: Research findings on risk factors that contribute to opioid overdose are presented. These factors, identified in a sample of 16 overdose cases, are (1) early onset age of opioid use; (2) progressive opioid use; (3) a transition from pain medication to heroin and fentanyl; (4) fears of being arrested at a naloxone intervention if first responders are contacted, and (5) limited knowledge of …
Interest Of Public Health Science Students Of State University Of Malang To Work In Remote Areas, Borders, And Islands, Sapto Adi, Dian Mawarni, Dita Ratna Fauzia
Interest Of Public Health Science Students Of State University Of Malang To Work In Remote Areas, Borders, And Islands, Sapto Adi, Dian Mawarni, Dita Ratna Fauzia
Preventia: The Indonesian Journal of Public Health
The health workforce distribution in Indonesia still needs to be balanced, especially in border areas and islands (DTPK), with no exception for public healthcare workers. This study aimed to determine the interest of public health science students in working in remote areas and the factors associated with the interest of public health science students to work in remote areas. This study design was cross-sectional, and a total sampling method was used. The subjects were final-year students majoring in Public Health Science at the State University of Malang. The dependent variable was the interest of public health science students to work …
Contraceptive Methods In Diabetic Women Referring To Government Diabetes Clinics In Northern Iran, Roya Mansour-Ghanaei, Yalda Donyaei-Mobarrez, Kobra Abouzari-Gazafroodi
Contraceptive Methods In Diabetic Women Referring To Government Diabetes Clinics In Northern Iran, Roya Mansour-Ghanaei, Yalda Donyaei-Mobarrez, Kobra Abouzari-Gazafroodi
Makara Journal of Health Research
Background: Unwanted pregnancies in diabetic women can endanger the mother and the fetus. The present study was conducted to determine contraceptive methods for diabetic women referred to government diabetes clinics in the north of Iran.
Methods: A total of 153 diabetic women referred to government clinics in Guilan were included in this cross-sectional study. A questionnaire made by the researcher regarding personal and social information and information related to contraceptive methods was administered. Data were analyzed analytically using SPSS version 19.
Results: The findings of the present study revealed that 87.6% of diabetic women used contraceptive methods, …
Factors Associated With Postacute Covid-19 Syndrome Among Patients In Malaysia, Ahtheemathurra Ballasingam, Farida Islahudin, Siti Azdiah Abdul Aziz, Mohd Makmor-Bakry
Factors Associated With Postacute Covid-19 Syndrome Among Patients In Malaysia, Ahtheemathurra Ballasingam, Farida Islahudin, Siti Azdiah Abdul Aziz, Mohd Makmor-Bakry
Makara Journal of Health Research
Background: Post-acute COVID-19 is known to affect multiple organs. It is essential to determine factors that affect post-acute COVID-19 syndrome and medications needed by patients for optimized care.
Methods: A prospective cohort study was conducted among patients recruited by stratified sampling from two COVID-19 hospitals in Malaysia. Patients were followed up for 6 months using a standard questionnaire to identify demographics, symptoms, medications taken, and factors associated with post-acute COVID-19 syndrome.
Results: A total of 388 were successfully followed up. The most frequently reported symptom was respiratory symptoms (N = 168, 43.30%), of which cough (N = …
Physical Therapy Professionals’ Opioid Knowledge And Attitudes In A Midwestern State: A Cross Sectional Survey, Steven G. Kinney, John D. Kiesel
Physical Therapy Professionals’ Opioid Knowledge And Attitudes In A Midwestern State: A Cross Sectional Survey, Steven G. Kinney, John D. Kiesel
Internet Journal of Allied Health Sciences and Practice
Purpose: To determine perspectives towards opioid use, knowledge on managing an opioid overdose, and awareness towards individuals who use opioids of Indiana physical therapy (PT) professionals. Methods: An online questionnaire was disseminated to PT professionals in Indiana from various practice settings. This questionnaire included two standardized measures, the Opioid Overdose Knowledge Scale (OOKS) and the Opioid Overdose Attitude Scale (OOAS). An additional 12 questions regarding the role of PT and other groups in the opioid crisis as well as opioid education were included. These questions were developed by discussion between investigators as well as feedback from another rehabilitation professional. Descriptive …
Childcare License Not Necessary, Jean C. Brannum
Childcare License Not Necessary, Jean C. Brannum
Capstones
Most childcare centers need a license to operate, but many states have loopholes that allow fitness center daycares to forego traditional licensing. The variation in rules lets some kids play in dangerous situations.