Scholars since the 19th century have focused on the provision of care in group homes and have demonstrated that structure (that is, the staff, facilities, and equipment), is critical in the delivery of care. The researchers, however, advocate doing for, rather than doing with the clients the activities that address the clients' welfare. The purpose of this study is to investigate how a client-centered approach would affect the quality of care delivered to the mentally challenged individuals (MCIs) in a group home. The study employed the quality-care framework in which the emphasis is on structure (skills), process (efficiency), and outcome (results). The research questions examined operational values underpinning company sanctioned work processes, how personal values underpin work processes of the direct caregivers, configuration of personal values the caregivers believe should be supported in the group home context, and how critical incidents shaped the value set of direct caregivers in regard to care processes. Using structured questionnaires and observing staff as they delivered care to their clients, data were collected from participants who were direct caregivers (n = 7), a facility administrator, and a nurse. The data were coded, categorized, and analyzed for emergent themes. The results of the analysis indicated that there was discord between staff and the organizational leadership. This discord could be improved through increased interaction between the mentioned stakeholders. The results further depicted that client-centered care may have a positive impact on the health of the MCIs that would enable the MCIs to make notable contributions to social change.

The ability to access primary care services within the local community has a direct impact on the health and wellness of the community. Individuals living in rural settings face multiple challenges when attempting to access care. The purpose of this retrospective project was to identify barriers in 2 rural, underserved communities and make recommendations for process changes that could reduce these barriers. Data were gathered from 2 critical access hospitals and 2 rural health clinics located in rural, underserved areas in Iowa. Both hospitals identified access to health services as an issue within their communities. Administrative data were gathered on nonemergent use of the emergency department, which revealed peak use from 10 a.m. to 11 a.m., 12 p.m. to 1 p.m., and 4 p.m. to 5 p.m. Clinic data included patient demographics, staffing and scheduling patterns, and the number of patient visits. One site provided expanded hours, yet very little difference in the number visits to the emergency room for nonemergent care was identified. Both clinic sites reported the need for additional providers to meet the needs of their patients and provide more same-day appointments. Recommendations made to increase access were open scheduling, staggered staff schedules to increase appointments over peak demand times, and use of a dedicated case manager to improve communication and coordination of care. Increased use of technology would allow the provision of care outside the clinic setting, enhance care coordination, and promote patient participation in care. With increased knowledge regarding the barriers facing rural communities when accessing care, process changes can be implemented to reduce barriers. The overall goal is to improve health and wellness through increased access.

Obesity or being overweight is a prevalent health concern around the world. Despite the growing problem in developing countries such as Kenya, there is scant literature available on obesity or being overweight among women in rural Kenya. This research study provides information necessary for bridging the gap in understanding the perceptions, beliefs, and knowledge of obesity among women in rural Kenya. This study used the social cognitive theory (SCT) framework to assist in understanding the impact of obesity or being overweight among women living in rural Kenya. Participants were women aged 20 to 45 recruited from a local church in rural Subukia. Using a phenomenological inquiry, in-depth interviews were conducted. Data obtained were analyzed by open coding. Themes that emerged from data analysis showed that less than half of the study participants had an appropriate knowledge of obesity. Participants desired to have big round bodies, as it was perceived as desirable and as being healthy. However, this perception put these women at increased risk of obesity and associated health risks. Implications for positive social change include the use of study findings by policy makers to develop obesity prevention programs. Such programs may promote obesity awareness and obesity prevention strategies. This promotion may include providing education on topics such as healthy nutrition and the importance of physical activity. Policy makers may develop obesity prevention programs aimed at not only educating, but also empowering rural communities to practice healthy lifestyles based on their cultural and social norms. Such empowerment may encourage the adoption of obesity reducing lifestyles and positive behavior change.

A small percentage of patients with sickle cell disease (SCD) have experienced an increase in life span by 10 years, while others with the same disease continue to die prematurely. The purpose of the study was to evaluate whether or not regional location was a barrier to care for adults with SCD in relation to emergency department visits and health outcomes at 16 and 21 years after the approval of hydroxyurea therapy as treatment. Secondary data were sourced and a retrospective quantitative correlational design was used to examine the effect of hydroxyurea treatment approval on emergency department visits and mortality (dependent variables) with changes in the regions for Northeast, Midwest, South, and West (independent variables). Insurance status, age, gender, and income level (covariables) were employed to describe the population. Chi-Square analysis was used to examine the association of the variables and sample sizes provided by the HCUP datatsets; Nationwide Inpatient Sample (NIS) 2006 (n=67,214), NIS 2011 (n=80,040), Nationwide Emergency Department Sample (NEDS) 2006 (n=164,698), and NEDS 2011 (n=215,296). The results of the analysis revealed a significant association between regional location, emergency department visits, and deaths among SCD patients. The implications for social change include improvements in health and health outcomes regionally, with adult SCD education for health care providers and patients on SCD treatment protocols. Adults with SCD might possibly benefit from this study with improvements in health and health outcomes for all regions once the barrier to care and specific areas are identified.

Twenty-four young adults, ages 18 to 30, from Cache Valley were studied to determine the incidence of lactose malabsorption. Lactose malabsorption was determined by a two-hour oral lactose tolerance test. The criteria for a malabsorber was a flat glucose curve in which there was a rise in serum glucose less than 20 mg. per 100 ml. above the fasting level. Four of the subjects were found to be lactose malabsorbers. The incidence of lactose malabsorption was determined to be 16.67 per cent. A 95 per cent confidence interval for this study indicated that the actual percentage could be expected to be between 1.76 and 31.58 per cent with 75 per cent confidence. Two of the subjects determined to be lactose malabsorbers developed gastrointestinal symptoms associated with lactose intolerance: abdominal cramping, flatulence and/or diarrhea. The daily milk intake varied greatly among both lactose absorbers and malabsorbers subjects.

Facilitating nutritional improvement in schools is an important strategy for reversing the alarming trends of overweight and undernourishment currently observed among children in the United States. Compared to national recommendations, many people in the United States under-consume nutrient-dense foods, such as fruits and vegetables. The objective of this study was to determine if various school-based interventions can increase fruit and vegetable consumption among 75 fourth-graders. Interventions included fruit and vegetable challenges, offering a new variety of fruit, and classroom nutrition education. To assess intake, photographs of students' school lunch trays were taken pre- and post-consumption and then analyzed to determine consumption. Differences in mean intake across time were examined and paired t-test analyses were used to assess if observed differences were statistically significant. Compared to baseline intakes, the variety intervention significantly increased mean fruit and vegetable consumption (p<0.001). The 'challenges' also increased intakes, however, the increase was not consistently significant (p=0.014 to 0.824). The education intervention was not associated with significant increases (p=0.642). Thus, schools should be encouraged to offer new varieties of fruits and vegetables.

Socioeconomic status strongly impacts food choices and eating patterns of both adults and children. Low-income individuals tend to eat diets high in calories and fat, and low in nutrient dense foods such as fruits and vegetables. Barriers such as cost, access, availability, and knowledge are commonly reported reasons for limited intake of fruits and vegetables. Low-income individuals are more likely to experience food insecurity, which can also limit the consumption of nutrient dense foods. As a result, low-income individuals are at an increased risk for obesity and chronic diseases. Farmers’ market incentives were found to significantly increase food security status among program participants and although fruit and vegetable consumption among those participants did increase, the change was not statistically significant for fruit and most types of vegetables. However, mean carotenoid levels were found to increase among participants who received an 8-week intervention that included weekly farmers’ market incentives. Data collected through qualitative interviews indicates that farmers’ market incentives helped participants overcome barriers associated with poor fruit and vegetable intake. Furthermore, parents expressed value in the opportunity for children to select, purchase, prepare, and consume fruit and vegetables purchased at the farmers’ market. However, qualitative and quantitative data suggest that farmers’ market incentive programs would have greater participation if individuals were not required to match their federal nutrition assistance benefits. Further research should be conducted using a completely randomized design and larger sample sizes to determine changes in fruit and vegetable intake among participants of farmers’ market incentive programs. The combination of nutrition education and farmers’ market incentives should be investigated to determine if program participants would further benefit from a combination of two intervention strategies.

The specific factors that influence student-athletes to enroll in Utah colleges were studied at Utah State University, Iieber State College, University of Utah, Westminster College, Brigham Young University, and College of Southern Utah. The intercollegiate sports surveyed were football, basketball, track and field, wrestling, and baseball. Factors influencing student-athletes to attend certain institutions varied :f'rom one athlete to another. Academic programs, level of competition, amount of financial aid, reputation of the athletic programs and institutions, as well as general facts of the programs were evaluated prior to selecting certain financial aid awards. Recruiting coaches were found to be very influential on the student-athletes and were responsible for dispensing the most helpful information to them. Most student-athletes were receiving some financial aid and were actively recruited by representatives of athletic departments.

Male castrated rats treated with testosterone or estradiol were given a diet containing 9, 18, or 50 per cent protein. Total lipids, lipid classes and fatty acid composition of lipid classes were determined. Estradiol treated rats grew slower, smaller and consumed less diet. Their liver weights were larger when compared to their body weights. Moisture content of liver remained unaffected by sex hormones, but increased with the high level of protein in the diet. Both testosterone and estradiol affected lipid metabolism; in general, the estrogenic influence was more pronounced and more predictable. Estradiol administration increased total lipids, free and esterified cholesterol and phospholipids in serum. Liver triglyceride level was decreased and free fatty acids and phospholipids were increased. An effect of sex hormone on the percentage composition of serum and liver fatty acids was apparent. Estradiol dosed rats maintained higher proportions of myristic and strearic acids in the serum cholesterol esters than that of the other fatty acids. It also increased the level of stearic and oleic acids and decreased the level of myristic, palmitic and linoleic acids in serum phospholipids. Oleic acid concentration was increased while linoleic acid concentration was decreased in serum triglycerides of estradiol treated rats. The liver cholesterol ester fatty acid patterns remained unchanged by sex hormone treatement. Liver phospholipid fractions contained a lower percentage of oleic acid in estradiol treated groups. Testosterone and estradiol treated rats had a higher proportion of myristic, stearic and linoleic acids and lower proportion of oleic acid in liver triglycerides than did the control rats. Dietary content of protein did not change serum lipid values significantly. The high level of dietary protein decreased oleic acid concentration in liver phospholipids and triglycerides.

Protein recovery and coagulation properties of five commercial and fractionated milk clotting enzymes were studied. The fractionated enzymes were Sephadex G-100 fractions of the commercial enzymes. Milk clotting activity of each fraction was tested using Berridge substrate. All fractions from each preparation which had milk clotting activity as measured with the Formagraph were collected and pooled. These samples and the original enzyme preparations were used to coagulate milk. Percent of protein lost in whey was determined by Kjeldahl. Coagulation was followed using a spectrophotometer monitoring changes in apparent absorbance at 600 nm. Curd protein yields using the five original enzyme preparations were compared with each other. Also, protein lost in whey from the five original preparations were compared with those using the isolated fraction. There was a significant difference among the original enzymes in protein lost in whey. There were also significant differences between some of the commercial enzyme preparations and their fractionated preparations. Gel filtration through Sephadex G-100 improved bovine rennet and calf rennet/porcine pepsin mixture more than the other three enzyme preparations. Calf rennet, Mucor miehei protease and modified M. miehei protease showed no significant reduction in protein lost to whey after fractionation. Protein loss using original calf rennet, bovine rennet and modified M. miehei protease were not significantly different from each other. M. miehei protease and calf rennet/porcine pepsin mixture were not significantly different from each other, but, the two groups were significantly different from each other. There were noticeable differences in coagulation curves of the five original enzymes. Coagulation properties of commercial and fractionated enzyme were different in all five pairs.