<p> This study examined the relationship between acculturation and obesity in foreign-born Asians residing in the United States. Two proxies were used to measure level of acculturation: years of United States residency and English language use and proficiency. Hypothesis 1 predicted that acculturation measured as number of years of residence will positively predict obesity. Hypothesis 2 predicted that acculturation measured as English language preference and proficiency will positively predict obesity.</p><p> The study used data from the 2009 California Health Interview Survey. Study participants met two inclusion criteria: foreign born and Asian. Point Biserial was run to determine whether or not there was a correlation.</p><p> Results showed a weak relationship between obesity and both variable used to measure acculturation. Additional exploratory analysis was performed to determine whether or not there was a relationship between obesity and acculturation for each Asian ethnicity. Results of this exploratory analysis were mixed. </p>

<p> The impact of hypertension as human's age is debilitating and could affect any individual as they grow older. Hypertension is a silent killer that must be taken very seriously because it has claimed the life of 7.6 million people in 2005 worldwide. The purpose of this research study was to raise a global awareness and the characteristics of people who are more likely to have hypertension. Demographically, this research project focuses on those patients 60 years of age or older who are overweight, with an emphasis on the Black Community. The dataset used in this project was a cross-sectional, descriptive secondary data obtained from the National Ambulatory Medical Care Survey (NAMCS), part of the Center for Disease Control and Prevention (CDCP). </p><p> The results of the study for the hypothesis suggests that African Americans 60 years and older have a higher rate of hypertension compared with other races 60 years and older in the United States. Furthermore, the study also validates that there is a relationship between higher body mass index and hypertension. The higher body mass index a person has the greater their chances of having hypertension.</p>

<p>Incivility is a low-level form of violence that has been found to threaten safety and has gained increasing attention from healthcare leaders. Incivility at work causes distractions and threatens the culture of safety. Locations providing mental health services are among such high-risk areas. The purpose of this study was to evaluate the effectiveness of a nurse leader&rsquo;s educational approach to improve civility in the mental health (MH) nursing workplace using assertiveness training with role-play. </p><p> The civility score in this study was measured by staffs&rsquo; perceptions of eight items: respect; conflict resolution; cooperation; anti-discrimination; value differences; diversity acceptance; personal interest; and reliability of team members. In this study, the principal investigator (PI), a MH nurse leader, prepared and implemented a six-month plan of evidence-based actions intended to improve civility and to strengthen the sense of community. </p><p> Role-play exercises were included in assertiveness training sessions. Personalized brochures that summarized information and future direction for improving civility were prepared and distributed. </p><p> Civility awareness and assertiveness were reinforced by sharing literature, facilitating discussions, and practicing occasional role-plays to problem-solve past and current incivilities as they surfaced. Follow-up measurements showed a rapid and sharp increase in civility, with improved scores for each of the eight items. These findings support continued use of assertiveness training with role-play as an effective approach for improving civility in a culturally diverse MH nursing staff. Limitations of this study are discussed. </p>

<p> Sickle cell disease (SCD) is a major healthcare and societal problem that affects millions of people worldwide. Sickle cell pain is the hallmark feature of SCD and includes manageable and unmanageable persistent pain that affects every aspect of an individual's life. Most of the research on pain in SCD has focused on children with acute vaso-occlusive episodes. Consequently, significant gaps exist in our knowledge of the occurrence and characteristics of manageable and unmanageable persistent pain in adults with SCD. </p><p> The specific aims of this study in a sample of adults with SCD were to: 1) determine the occurrence of persistent SCD pain and compare those with manageable and unmanageable persistent SCD pain on demographic and clinical characteristics, as well as, pain-related measures; 2) compare those with manageable and unmanageable persistent SCD pain on coping strategies; and 3) determine which factors influence quality of life (QOL) in these patients. </p><p> One hundred and three patients who were &ge;18 years with SCD completed questionnaires on demographic, clinical, and pain characteristics, as well as, the Pain Catastrophizing Scale (PCS), the Duke Religious Index (DRI), and the Medical Outcomes Study Short-Form (SF-36). Patients were divided into those with manageable (average pain intensity &le;5) and unmanageable pain (average pain intensity >5) based on established cutpoints. Final analyses were done on 94 patients. </p><p> Seventy percent of patients had manageable pain and 30% had unmanageable pain. Patients with unmanageable pain reported higher ratings for all of the items on the Pain Quality Assessment Scale (PQAS); were more likely to be taking only a short-acting opioid; reported less relief from analgesic medications, and reported significantly lower SF-36 scores. Significant negative correlations were found between pain catastrophizing and religiosity/spirituality, and physical and mental health. Several variables were found to have an influence on QOL. These findings suggest that persistent pain in adults with SCD is a significant problem. More research needs to evaluate how adults with SCD cope with persistent pain and its impact on their QOL.</p>

<p> Autism is a rapidly increasing global health concern. In the United States, many families and individuals with autism find it difficult to access treatment for this condition because it is commonly excluded from health insurance plans. Apprehension about passing autism health insurance legislation includes concerns regarding the impact on small businesses. Many businesses advocates and law makers have expressed concern that passing an autism health insurance mandate will cause small businesses to close or to stop offering health insurance plans to their employees. In an effort to substantiate these concerns, this study provides an analysis of publicly available data on small business closures and small business health insurance plans to determine if a relationship exists between passing an autism health insurance mandate and a change in the number of small business closures or the percentage of small businesses that offer health insurance plans to their employees.</p><p> The methodology for this study includes testing of Pearson&rsquo;s <i> r</i> correlation models, semipartial correlation models and analysis of variance (ANOVA) models. Findings indicate there is insufficient evidence to conclude that a relationship exists between enacting an autism health insurance mandate and an increase in the number of small business closures. In addition, findings indicate there is insufficient evidence to conclude that a relationship exists between enacting an autism health insurance mandate and a decrease in the percentage of small businesses offering health insurance to their employees. </p>

<p> This study identified a leadership competency model for developing healthcare executives in Mexico based on the National Center for Healthcare Leadership (NCHL) Model. Eleven chief executive officers and chief medical officers were interviewed. They considered 86% of the National Center for Healthcare Leadership (NCHL) competencies as very important or vital and perceived a gap in the performance of these competencies. They also identified additional vital competencies beyond the scope of the NCHL's model. Participants also reported that leadership development and succession planning programs were lacking. Recommendations are to design a leadership development program using the NCHL model as a framework and further customizing the approach per the organization's unique mission, vision, strategy, values, and circumstances. The NCHL is offered as a general strategy for leader development that could be useful in the Mexican private healthcare industry, based on some "best practices" in the design and implementation of the leadership programs.</p>

<p> This study examined the human needs of 445 adults admitted to hospital with the primary medical diagnosis of Type 2 Diabetes Mellitus [ICD-9CM 250.0-9] and compared the pattern of nursing diagnoses (human needs) with those of 5321 patients having Type 2 DM but admitted to hospital for other reasons and with the 78,480 inpatients with no DM. Length of hospital stay, intensive care unit use and discharge dispositions were examined, controlling for race, poverty, marital status and age, to determine if the nursing diagnosis variables were distinctive for any of the three patient groups. A subset of 14 nursing diagnoses was identified from the literature on the care of Type 2 DM to determine how they varied among the three groups. The 61 nursing diagnoses were also fitted in regression models to explain variances in patient length of stay and to explore patient diabetes status. A multinomial logistic (logit) regression model that included the predictor variables of patient age, race, marital status, socioeconomic position (insurance type), and sex was used to predict patient discharge disposition. </p><p> This study was a secondary analysis of data collected over a three-year period by nurses in the daily assessment and care of their hospitalized patients. Donabedian's structure, process, and outcome model of quality of care provided the conceptual framework for this study. The statistical software SAS (9.3) was used for the analysis. </p><p> Nursing diagnosis use pattern did not consistently distinguish patients with type 2 diabetes mellitus from other patients. Patient information gathered by nurses in the provision of care to their patients is qualitative in nature -with holistic perspective independent of International Classification of Diseases codes. Nursing diagnosis was related to patient length of stay. The number of different nursing diagnoses was the most important predictor of patient length of stay in a model that included patient age, sex, marital status and socioeconomic position. </p><p> Patient race, age, and socioeconomic position were predictive of patient discharge disposition (discharge to own home, discharge to home with home health services, discharge to nursing homes, or discharge to other healthcare facility) but not substantially related to patient length of stay. This methodological study has helped address two related questions in the negative; when the disease is known are the needs of the patient known and when the needs of the patient are known, is the disease known?</p>

<p> The efficiency and efficacy of the U.S. healthcare system has been in question for decades. We spend more per capita than any other industrialized nation while consistently realizing inferior health outcomes for our population as a whole when compared with many industrialized nations. In 1965, the proportion of U.S. gross domestic product (GDP) attributed to healthcare was approximately 6%. Today, the share of GDP spent on healthcare by the United States is almost 18%. This number is 5% higher than the next two countries, the Netherlands and France (spending 12.0% and 11.8% of their GDP on healthcare respectively) according to the Organization for Economic Co-operation and Development (OECD). The proportion of GDP spent on healthcare in 2020 is estimated to reach 20%, with the nation's increasing healthcare expeditors reducing resources available for other worthy government programs, eroding wages, and undermining the competitiveness of U.S. industry. </p><p> This dissertation explores longitudinal outcome data for Malcolm Baldrige National Quality Award recipients in healthcare in the dimensions of patient outcomes (mortality, complications and patient safety), as well as hospital financial and efficiency measures (average length of stay, expense per discharge and profitability). Source data from Truven Health Analytics (formerly Thomson Reuters) are used to evaluate changes in level, immediacy/latency and trend in the years prior to versus the years after becoming a Malcolm Baldrige National Quality Award recipient. In support of the hypothesis, being a recipient of the Malcolm Baldrige National Quality Award in healthcare explains slight enhancements in clinical outcomes, while hospital financial and efficiency measures all showed overwhelmingly positive operating results.</p>

<p> The purpose of this quantitative meta-analytic study was to investigate the prescribing medication practices of primary care providers among elderly patients 65 years of age and older. Two statistical analyses were conducted on approximately 3 million geriatric patients in a variety of health care settings throughout the United States. The first meta-analysis involved 26 peer-reviewed studies that compared the prescribing medication practices of primary care providers among geriatric patients in the United States with the prescribing practice recommendations of the Beers Criteria. The second meta-analysis involved 8 peer-reviewed studies that compared the prescribing medication practices in America of physicians who received training in geriatric medicine with physicians who received training in general medicine. The predictor variable (i.e., independent or observed variable) was the prescribing medication practices of primary care providers. The outcome variable (i.e., dependent or expected variable) was the prescribing practice recommended by the Beers Criteria. The third variable was the moderating variable of physician training in geriatric medicine. The first findings revealed that primary care providers in the United States prescribed potentially inappropriate medications to geriatric patients. The second findings indicated that physicians without training in geriatric medicine prescribed more potentially inappropriate medications than those with training in geriatric medicine. Serious health care dilemmas among the geriatric population are high incidences of inappropriate dispensation of prescriptions by primary care providers. Inappropriate prescriptions are common in geriatric clinical settings among primary care providers who function in a fragmented medication prescription system and who lack training in geriatric medicine.</p>

<p> This thesis examines the role of limited English proficiency (LEP) as a contributing significant barrier to the mental health access for Chinese living in America. The literature purports that language barriers do present significant challenges to providing timely and effective mental health services worldwide. Additionally, studies highlight two reoccurring themes on the mental health of Chinese Americans, including their underutilization of mental health services and the premature termination of treatment in comparison to other nonminority clients. Using the 2009 dataset from the California Health Interview Survey (CHIS) 2009 Adult Questionnaire, data was analyzed and it was concluded that a relationship exists between mental health status and language proficiency. Further study is necessary to determine where it may be best for health professionals to invest their efforts in the mental health care of this deserving population. It would behoove organizations, communities, and health care leaders to peer deeper into the interconnected relationship between mental health utilization and language proficiency.</p>