The purpose of this quantitative study was to examine to what extent work demands as measured by perceived job stress affected the health-related quality of life (HRQOL) as determined by the number of unhealthy days of registered nurses in the United States. This study was also an investigation of the extent to which other variables such as body-mass index (BMI) and certain lifestyle behaviors affected the HRQOL (number of unhealthy days). The independent variables were perceived job stress, weight (BMI), and lifestyle factors such as tobacco and alcohol use, physical inactivity, and the mindful eating score, and the dependent variable was the HRQOL (measured by the summary index of unhealthy days) of the RNs. This study was guided by the enhanced DRIVE model which describes how individual differences interact with perceived job stress to affect health outcomes. A cross-sectional study design was used and relevant data to answer the research question were collected from 95 participants via a SurveyMonkey survey that was advertised in an e-newsletter from the Nurse Practitioner Association of Continuing Education as well as posted on LinkedIn groups. Logistic regression and Spearman's correlation were used to test the hypothesized associations. There were no statistically significant associations between BMI, alcohol use, smoking, inactivity, and the HRQOL. However, there was a weak correlation between perceived job stress, the mindful eating score, BMI, the total number of unhealthy days and the total number of days that the nurses' daily activities were affected by unhealthy days. The positive social change implication of this study is that, for nurses, awareness of perceived job stress is important in promoting a healthy lifestyle and reducing the risk of chronic diseases.

Obstructive sleep apnea (OSA) is a type of sleep apnea that is common, complicated, and a major contributor to cardiovascular diseases, neurocognitive impairment, and mortality. This disease has additional negative impacts on patients' lives by contributing to daytime sleepiness and low productivity at work as well as absenteeism and work-related injuries. Several studies have been conducted to assess the relationship between cardiovascular exercises and OSA; however, a definite conclusion is lacking. The purpose of this quantitative cross-sectional study was to assess the relationship between cardiovascular exercise participation and OSA by examining the relationship between total cardiovascular exercise participation per week and OSA as well as the relationship between body mass index (BMI) and OSA among adults over normal weight in the United States. Secondary data from the National Sleep Research Resource (NSRR) were used for analyses. Logistic regression was used to test the hypotheses. The Social-Ecological Model (SEM) guided the study. The findings of the study suggested that doing moderate cardiovascular exercise participation per week (0.1 and 200 minutes) had no relationship with OSA while doing higher cardiovascular exercise participation (>200 minutes) per week had relationship with OSA by increasing the odds (AOR = 2.1, CI: 1.048-4.060) of having severe OSA. BMI had no relationship with OSA. Individuals with OSA and a higher BMI could use the findings of this study to participate in an exercise program that might benefit their health and decrease the risk of exacerbated symptoms which could lead to an improved quality of life and decreased burden associated with OSA.

A lack of adherence to antiretroviral therapy (ART) increases the risk of onward human immunodeficiency virus (HIV) transmission and mortality. The purpose of this cross-sectional study based on Andersen's conceptual framework was to test the associations between age, marital status, job/occupational status, education, membership in a peer support group, community, and facility ARV drug refill and alcohol and substance use, and adherence to ART among female sex workers (FSWs) who are 15 years and older in Rivers and Cross Rivers states Nigeria. Data were abstracted from existing program data collected between January 2015 and December 2017 by Heartland Alliance International, Nigeria. Results from chi-square statistics showed that age, job/employment, and marital status were not associated with adherence to ART. Binary logistic regression analyses showed that respondents with senior secondary education were 1.385 times more likely to adhere to ART than other education levels (OR = 1.385, 95% CI = 1.203, 1.593). Respondents who had ARV refill in the facility were 1.737 times more likely to adhere to ART than respondents who had community ARV refill (OR= 1.737, 95% CI: 1.297, 2.326). Also, respondents who were a member of a support group were 6.430 times more likely to adhere to ART compared to those not in a support group (OR= 6.430, 95% CI: 4.682, 8.831). Lastly, respondents who did not abuse alcohol or substance were 1.820 times likely to adhere to ART compared to those who did (OR= 1.820, 95%: CI: 1.356, 2.444). All-inclusive key population policies could aid in lessening the barriers the FSWs face in receiving comprehensive health services as well as endorsing interventions such as alcohol and drug rehabilitation, counseling, and incentives to join peer support groups that could benefit FSWs, their clients, and families.

The transition from hospital to home can be complicated, leaving family caregivers in stressful situations that they may not know how to handle. The burden that is placed on these individuals has led researchers to focus on the public health implications of caregiving in hopes of identifying at-risk caregivers. This quantitative analysis identified what relationships exist between caregiver compassion fatigue among family caregivers and training or education received per the Caregiver Advise Record and Enable (CARE) Act and if education influences readmission rates. A purposive sample of 385 family caregivers participated in this study. The Care Transitions Measure (CTM-15), the Caregiver Reaction Scale (CRS), and the LACE (length of stay, acuity of admission, comorbidities, and emergency department visits) index were used to explore the relationship between caregiver education received, caregiver compassion fatigue, and rates of readmission. The results of this study did not support a significant relationship between the education that caregivers receive according to the CARE Act and readmission rates of the care receiver when utilizing the CTM-15 and the LACE index but it did support a relationship between the caregiver's compassion fatigue and the amount of training the caregivers receive from the CARE Act in some areas of the CRS. While research continues to identify flaws in the caregiver transition, the CRS and CTM-15 show a significant relationship in some areas of the CRS, identifying some caregivers are better educated prior to leaving the hospital and with a potential reduction in compassion fatigue.

Obesity remains a public health concern among persons with mental illness resulting from the interaction of a combination of factors such as genetic, medication, effects of their symptoms, social, and environmental factors. Obesity complications account for increased mortality and morbidity, reduced life expectancy, and quality of life in persons with mental illness. The management of obesity is challenging and predicting the ability of mental health professionals to advise patients on weight management behavior is important to improve patients' overall well-being. The social cognitive theory constructs knowledge, expectations, situational perception, self-efficacy, and goal setting were utilized in predicting Weight Management Advice Behavior (WMAB) among psychiatry professionals. WMAB described the ability of professionals to effectively offer advice on managing weight. A cross-sectional study design was used, in which data were collected using a validated instrument. A sample size of 134 was used and the collected data were analyzed using simple and multiple linear regression, logistic regression and MANOVA. Self-efficacy, goal setting, knowledge, and situational perception were found to have a significant association with WMAB individually. Only self-efficacy (p < .001), goal setting (p < .001), knowledge (p < .001), and situational perception (p < .05) were independent predictors of WMAB among psychiatry healthcare professionals. There were significant differences among the professional groups with regards to knowledge, self-efficacy, goal setting, situational perception, and expectations. The study findings will bring about positive social change by informing the advice of professionals, reducing obesity and alleviating its burden among people with mental illness.

In 2013, approximately 232,340 women were diagnosed with breast cancer, and an estimated 39,620 women would die as a result of breast cancer. Stage I breast cancer can often be treated, but Stage IV breast cancer presents more difficulties in treatment, as it spreads to the bones, liver, or other areas of the body. Consequently, women with Stage IV breast cancer have very low 18 month and 5-year survival rates. According to some statistics, 79.5% of the United States population claim to be Christian. Much of this segment of the population uses faith to guide most aspects of their lives, including issues pertaining to their health. The purpose of this study was to explore how women integrated faith into their lived experience of combating cancer. This mixed method phenomenological study examined the perceived attributions for survival among a group of 32 breast cancer survivors of various ages and cancer stages in the tristate area of Kentucky, Indiana, and Ohio. Faith related attributions for survival were more commonly reported among women who also reported affiliation to Christianity than women who did not express religious affiliation; however, faith related attributions often also incorporated the restorative effects of standard medical procedures. The implications for positive social change in this study includes the potential inclusion of faith in developing culturally appropriate strategies for treatment and recovery of many illnesses, including cancer.

The Special Supplemental Women, Infants, and Children (WIC) Program is one of many United States Department of Agriculture's (USDA) food subsidy programs that serves 8.6 million participants, deemed nutritionally at risk. WIC is designed to influence nutritional and health behaviors to a population least capable of functioning. The purpose of this study was to identify if participation in WIC's nutrition education activities and restricted use of food subsidy benefits had a post-factorial effect on their nutritional behaviors. This study provides data on Bronfenbrenner's social ecological influences and how it impacts on long-term behavioral change. A quantitative causal-comparative design utilizing a convenience sampling method compared responses to a survey on nutritional habits of women shoppers at a Walmart retailer in an urban southeastern metropolitan city. The study population included women aged 18-50 years with one or more child who had or were currently receiving WIC (n = 63) compared with controls (n = 32) who also met the aforementioned criteria, yet did not receive WIC. Analyses of a Wilcoxon signed rank test supported an association between participation in WIC and an influence on participants' food purchase habits, while evidence from a linear equation for repeated measures between groups did not support a common variable for what influenced purchases between cases and controls. This study provides insight for future study regarding WIC's effectiveness to promote long-term health for its participants. It may also lend to discussion by USDA officials to consider programmatic review and change of other food subsidy programs which conceivably could impact the diets of more than 49 million Americans.

Advances in lung cancer treatment among older adults require a risk-benefit analysis for health professionals, patients, and family members to assess increased survival and health-related quality of life (HRQL). The purpose of this study was to assess the effect of lung cancer treatment with surgery or tumor ablation on HRQL domains. A lung cancer quality of life model guided the study. The research design was a quantitative ancillary study in which 70 participants were recruited from those who had already consented to undergo a randomized clinical trial of lung cancer treatment. Data consisted of repeated administrations (baseline, 1- and 3-months) of the lung cancer symptom scale. Participants indicated their physical function, symptomatic distress, and overall quality of life experience on an analogue response card. Although randomization in a clinical trial ensures equal groups at baseline, self-selection and loss to follow-up in this comparative survey led to significant differences between the 2 treatment groups in age (p = .049) and average symptomatic distress (p = .007). Statistical analyses were performed using generalized estimating equations assuming a negative binomial distribution. There were no significant effects from treatment with surgery or tumor ablation on HRQL (physical symptoms, symptomatic distress, and overall quality of life experience) at 1-month (p = .7794, p = .6395, p = .9318) and 3-months (p = .2616, p = .1345, p = .5217) based on Holm-Bonferroni correction (p = .016). The findings indicate that among older adults with lung cancer there is no advantage in selecting surgery or tumor ablation in terms of effect on HRQL. The study may contribute to positive social change by providing lung cancer treatment-specific risk-benefit information affecting patient HRQL, which may be useful to providers, patients, and family members.

Through the creation of the Indian Health Service in 1955, the health status of American Indian and Alaska Native (AI/AN) has improved; however, AI/AN women of reproductive age still have some of the poorest health outcomes of all populations. This study aimed to examine effective interventions that seek to improve the health of AI/AN women during pregnancy, and immediately postpartum (up to 12 months post delivery). This study addressed the research question: What effect does parental competence have on early parenting and/or infant/toddler outcomes? The life course conceptual framework was used to demonstrate how life experiences impact current health. The methodology followed the preferred reporting items for systematic reviews and meta-analyses statement. A literature review from 1993-2015 using derivatives for race and pregnancy was conducted. Inclusion and eligibility were determined using a priori criteria and application of the population, intervention, comparator, outcome, and study design(s) approach. Study quality was assessed using the Cochrane risk of bias tool and an expert review panel. A meta-analysis was conducted to determine the impact of parental competence through parenting knowledge and self-efficacy. The findings of this study suggest that evidence based interventions focused on: reducing multiple risky maternal health behaviors, through education and treatment options (creating positive social change at the individual, family, and societal levels); increasing access to prenatal care early in pregnancy, through community based participatory research (creating change at the societal level); and supporting parental competence, through training (creating change at the organizational level), will promote positive birth outcomes in AI/AN women.

Improving maternal health has been a challenge for developing nations with very high rates of maternal mortality. Sub-Saharan Africa, particularly Sierra Leone, has some of the highest maternal mortality rates in the world. In an attempt to improve on this, the Sierra Leonean government enacted free maternal healthcare services in 2010. The Sierra Leone Free Healthcare Initiative (SLFHCI) provides free healthcare for pregnant women, lactating mothers, and children under 5 years old. This research explored the impact of the free healthcare on hospital deliveries. The determinant of health model was used to evaluate the effectiveness of the SLFHCI program, and a quantitative study design was used to analyze 1,200 samples of secondary data. Five research questions aimed to determine how the pre and postimplementation periods of the SLFHCI program impacted the rate of antenatal services usage, hospital deliveries, low birth weight deliveries, very low birth weight deliveries, and preterm deliveries. Descriptive statistics, chi-square tests, and logistic regression were used to analyze data. The results indicated improvements in antenatal visits, hospital deliveries, low birth weight deliveries, and preterm deliveries after adjusting for covariates. The results suggest that the SLFCHI program is an effective strategy for preventing low birth weight and preterm deliveries and for improving antenatal visits and hospital deliveries. The knowledge gained from this research could provide a roadmap for improving overall maternal care in Sierra Leone and other affected countries. Strategies to improve the quality of the SLFHCI intervention are worthy of further investigation