Thesis (M.A. (Industrial Psychology))--North-West University, Vaal Triangle Campus, 2007.

Socioeconomic Factors Affecting Infant Sleep-Related Deaths

<p> Both infectious and noninfectious disease agents in wildlife impact human health and accurate research, monitoring, and diagnostic methods are necessary. The objectives of the research reported here were to develop and implement novel methods for bacterial and toxicological disease agent surveillance in wildlife. This dissertation begins with a review of tularemia, an important zoonotic disease to the state of Alaska and the Northern hemisphere. In chapter two, I show the development and implementation of broad-based PCR and quantitative PCR (qPCR) surveillance methods for bacterial DNA in tissue samples; 1298 tissue samples were assayed, numerous potential bacterial pathogens were identified and qPCR detection limits were quantified for various tissue matrices. Chapter three describes an investigation into microbial infection as a source of embryo mortality in greater white-fronted geese (<i>Anser albifrons</i>) in Arctic Alaska. This chapter builds upon our previously developed PCR surveillance techniques by which I demonstrated that bacterial infection is responsible for some greater white-fronted goose embryo mortality in Arctic Alaska. Chapter four describes the development and validation of a cellulose filter paper method for quantifying total mercury in whole blood. I determined that filter paper technology is useful for monitoring total mercury in whole blood, with excellent recoveries (82 - 95% of expected values) and R2 values (0.95 - 0.97) when regressed against the concentration of total mercury in whole blood, the technique generally considered as the "gold standard" for mercury detection. These methods will aid in the accurate detection of disease agents in wildlife as demonstrated by our white-fronted goose work. </p>

<p> There is a great deal of concern regarding the levels of physical inactivity in people with disability, which is more prevalent than in the general population. Inactivity in individuals with disabilities can lead to higher rates of chronic diseases and obesity and vice versa. Moreover, disability is increasing in middle-aged adults while decreasing among older adults. This purpose of this dissertation was to: 1) evaluate the prevalence of disability across the lifespan, 2) to examine the relationships between disability (DA), physical activity (PA), and factors associated with them, and 3) to look at the trends in these factors to understand the patterns occurring in middle-aged adults compared with older adults.</p><p> Data analyzed for this dissertation were collected as part of the Behavioral Risk Factor Surveillance Survey (BRFSS) conducted between 2003 and 2011. Measures included DA, PA, chronic diseases, sociodemographics, health risk behaviors, and health status.</p><p> In our first study, we found that respondents categorized as disabled or functionally limited reported less PA, more chronic diseases, and poorer health behaviors than those categorized as able bodied. There was a higher prevalence of DA in the middle-aged and older adults compared to younger adults. Individuals with lower incomes and those with chronic diseases were more likely to be classified as having a disability compared to individuals with higher incomes and individuals without chronic disease. Our second study showed that middle-aged people were less likely to meet physical activity recommendations compared with older adults. Having a DA and being in poor health were strongly associated with not meeting the PA recommendations. In our third study, we found all the age groups showed an increase in functional limitation and DA over time. Further, among all age groups there was an increase in meeting aerobic recommendations over time. Our studies showed that DA and functional limitation are strongly associated with unhealthy behaviors and chronic diseases and poorer health. Moreover, middle-aged and older adults showed similar results in DA and PA recommendations. Given that physical inactivity has the potential to reduce disability, prevent chronic disease and enhance health, greater public health attention to what is warranted.</p>

<p> Using Heideggerian interpretive phenomenology, this study illuminates the lived experience of an adapted dance program for individuals with Down syndrome and their family members. The overall pattern from both dancers and family members was adapted dance: connecting mind, body and soul. The primary theme from dancer interpretations was expressing a mosaic of positive experiences, and the primary theme from family member interpretations was experiencing pride in their loved ones. The dance program provided dancers an opportunity to express their authentic self while experiencing moments of full embodiment in the connection of their mind, body and soul. While dancers experienced the connection of mind-body-soul, family members recognized the importance of this connection in their loved one. This research is instrumental in advocating for opportunities for individuals with Down syndrome to experience dance as a social, physical and intellectual activity that results in learning and increasing social interactions. The research findings from this study can support future initiatives for dance programs that may influence a population that has limited access to physical activity and dance. The study's teaching strategies, dance activities, class procedures and sequences, and feedback techniques can be used by other professionals who teach individuals with intellectual disabilities.</p>

<p>An important factor in the rise of health care costs is the structure and performance of health care markets. This is an area in which policy can be particularly effective. Health care markets are characterized by complex interactions between consumers, physicians, insurers, facilities, and government agencies. Physicians, insurers, and facilities operate under a mix of objectives and governance structures. The many varieties of objectives, and governance structures can be broadly categorized as for-profit, not-for-profit, and governmental. </p><p> In the three chapters that follow I construct a theoretical framework to analyze hospital behavior and use a 30 year panel of data on Californian hospitals to assess the validity of the models and to identify the impact of governance structure on behavior. Chapter II addresses firm objectives. I find that firms have a continuum of weighting allocations, with for-profit firms placing greater weight on profit, government firms placing greater weight on social objectives, and not-for-profit firms locating in a middle ground. All three types of governance structures display overlap in their objectives. </p><p> In Chapter III, I identify patterns in hospital entry and exit. Like most manufacturing industries, entering hospitals are significantly smaller than incumbent hospitals and exiting hospitals are significantly smaller than surviving hospitals. The patterns of entry and exit for hospitals vary systematically with both governance structure and geographic diversification. </p><p> In Chapter IV, I develop a model of hospital entry that explains heterogeneous entry size and firm survival. I find entry size to be a relatively important factor in firm survival. In general entering on a larger scale increases the probability of survival. Despite this fact many firms enter relatively small. The model that I develop resolves small entry as a rational choice for uncertain firms. </p>

<p> Public health reporting is an important source of information for public health investigation and surveillance, which are necessary for the prevention and control of disease. There are two important problems with the current public health reporting process in the United States: (a) the reporting specifications are unstructured and are communicated with reporting facilities using nonstandard public health department Web sites and (b) most reporting facilities transmit reports to public health entities using manual and paper-based processes. Our research focuses on the development and evaluation of new strategies to improve the public health reporting process by addressing these problems. </p><p> To improve the communication of public health reporting specifications by public health authorities, we: (a) examined the business process of a laboratory complying with the reporting requirements, (b) evaluated public health department Websites to understand the problems faced by reporting facilities while accessing the reporting specifications, (c) identified the content requirements of a knowledge management system for public health reporting specifications, (d) designed the representation of the public health reporting specifications, and (e) evaluated the content and design using a prototype web-based query system for public health reporting specifications. </p><p> To improve the transmission of case reports from healthcare facilities to public health entities, we: (a) described public health workflow associated with the management of case reports, (b) identified the content of a case report to meet the needs of public health authorities, (c) modeled the case report using Health Level Seven (HL7) v2.5.1, and (d) evaluated the electronic case reports by comparing the timeliness, completeness of information content, and the completeness of the electronic reporting process with the paper-based reporting processes.</p><p> We demonstrated a model for public health reporting specifications using a prototype web-based query system. The evaluation conducted with users from laboratories, healthcare facilities, and public health entities showed that the proposed model met most of the users' needs and requirements. We also identified variation in the reporting specifications, some of which could be standardized to improve reporting compliance.</p><p> We implemented HL7 v2.5.1 case reports from Intermountain Healthcare hospitals to the Utah Department of Health. The electronic reports transmitted from the Intermountain hospitals were more timely (median delay: 2 days) than the paper reports sent from other clinical facilities (median delay: 3.5 days) but less timely than the paper reports from Intermountain laboratories (median: 1 day). However, the evaluation of the completeness of data elements needed for public health triage prior to investigation showed that electronic case reports from Intermountain hospitals included more complete information than paper reports from Intermountain laboratories. Even though the paper reports from Intermountain laboratories were more timely, the incomplete reports may delay investigation. There are informatics opportunities and public health needs to improve both electronic laboratory reporting and electronic case reporting.</p>

<p> <b>Background:</b> Commonly used response scales in patient-reported outcome (PRO) measures include the visual analogue scale, 11-point numeric rating scale, 5-point numeric rating scale, 5-point verbal rating scale, and 5-point verbal-numeric rating scale. Although prior studies have explored the interpretation of response scale labels and compared scores resulting from the response scale, many questions remain.</p><p> <b>Purpose:</b> To identify sets of verbal descriptors interpreted with the least variation and to explore whether the response scales provide interval level data and whether the scales are interchangeable.</p><p> <b>Methods:</b> Subject recruitment and screening was through an online drug-drug interaction service (MediGuard.org). Via an online survey platform, subjects used a scale (0 = lowest possible and 10=highest possible) to assign interpretation scores to verbal descriptors. Repeated measures analysis of variance informed the test interval data between scores. Subjects also completed repeated administrations of four symptom-specific item stems with different response scales.</p><p> Ordinal regression informed the analysis of scores assigned to verbal descriptors, comparison of probabilities of responding in given categories across scales, and prediction of response category on one scale conditional on observed response on another scale. Cut-points informed tests for interval level data.</p><p> <b>Results:</b> The sample (n=350) comprised 223 females and 127 males with a mean (SD) age of 56.9 (12.1) years. Number of health conditions per subject ranged from 1 to 12 (median = 5). Age, sex, level of education, and number of health conditions were associated with the interpretation of verbal descriptors. Scores assigned to "poor," "fair," "good," "very good," "excellent," "somewhat," "sometimes," and "quite a bit," had the largest variation. The probability of responding in the same categories on the different response scales was significantly different across scales before and after collapsing categories. No scale yielded interval level data. The 11-NRS data tended more towards interval level than the data from other scales.</p><p> <b>Conclusions:</b> Using different response scales with verbal descriptors in non-randomized studies may introduce bias. Differential item functioning and subgroup analyses should be investigated in the development and use of these response scales. The scales are not interchangeable. Compared with other scales the 11-NRS produced data approaching interval level. Collapsing categories entails significant probabilities of misclassification.</p>

<p> Obesity in the United States should be of great concern to all Americans. The rates of obesity among children and adolescents have been on the rise, demonstrating the need for action now. Obesity at a young age can lead to obesity into adulthood, thereby also increasing the risk of health issues such as the development of high blood pressure and diabetes. Many factors go into play when dealing with obesity, yet the factors that will be considered in this study are the effects of decrease activity and the impact of BMI of a child or teen. Another factor that will be consideed in this study is the consumption of sugar sweetened beverages and how this also affects a child or teens BMI.</p>

<p> This dissertation examines the factors that will affect nursing home quality of care using several national data sources on market regulation, county demographic characteristics, market structural and the characteristics of different types of long-term care providers in 2010. </p><p> The first study examines how nine different measures of nursing home care quality respond to the greater levels of local market competition from these alternative providers of long-term care, as well as other nursing homes. Findings reveal that faced with greater competition from assisted living facilities, nursing homes are left to care for more disabled, less healthy patients. Although the nursing home's staff-to-bed ratios rise in response, other measures of care quality decline, such as more process- and outcome-based measures. Competition from home health agencies likewise has mixed effects on nursing home care quality, and competition from other nursing homes in a market tends to decrease care quality. These finding suggest that care quality in nursing homes may continue to erode as the market for alternative, community-based long-term care services expands. </p><p> The second study examines the Medicare regulation effects on nursing home quality controlling for the whole long-term care market competition structure. In many local markets nursing homes now compete with assisted living facilities for residents, yet most previous studies of the effects of Medicaid nursing home reimbursement policies on care quality have analyzed nursing homes in isolation, ignoring the presence of nearby competitor firms, and how state regulation of assisted living facilities might also affect care quality in nursing homes. This study uses a richer model specification that accounts for a much broader range of state long-term care regulations as well as the structure of a nursing home's local market. Findings reveal that a higher Medicaid reimbursement rate leads to significant improvements in nine different aspects of nursing home quality, while state certificate-of-need programs for nursing homes lead to a decline in several (but not all) dimensions of it. A large presence of assisted living beds in a local market also tends to reduce nursing home quality, and state regulations regarding assisted living facilities indirectly affect nursing home care quality by altering the nature of local market competition. Overall, these results suggest that state laws related to all long-term care providers, not just nursing homes, are important determinants of nursing home care quality.</p>