The widespread use of highly active antiretroviral therapy (HAART) has resulted in longer lifespans for HIV seropositive women in the United States, during which preventive health care is recommended. Failing to complete recommended cancer screening tests can result in cancer being diagnosed at a later stage with a poorer prognosis. The purpose of the study, based on the ecosocial theory, was to describe the sociodemographic and clinical variables of HIV seropositive women who failed to complete recommended screening tests for breast, cervical, and colorectal cancers, and determine if the presence of hypertension, obesity, diabetes, depression, or tobacco use impacted the completion of these screening tests. The electronic medical records of 142 HIV seropositive women were reviewed. Univariate analysis, bivariate analysis, and logistic regression were conducted to create a model associated with the completion of preventive health care screening tests. For breast cancer, cervical cancer, and colorectal cancer, 69%, 71.8%, and 69.7% failed to complete screening, respectively. Number of years living with HIV infection and HIV stage were associated with breast cancer screening; distance between residence and health care facility, and HIV stage were associated with cervical cancer screening; and age and marital status were associated with colorectal cancer screening. Addressing issues related to the completion of cancer screening tests over the lifespans of HIV seropositive women can result in positive social change by preventing disease and disability, which can negatively impact these women, their families, and their communities.

The Patient Protection and Affordable Care Act (PPACA) expanded access to insurance coverage and health care services for many citizens, and has increased access for women in particular by including preventive reproductive health services as essential health benefits. The current national rates of sexually transmitted infections (STIs), reproductive cancer diagnoses, and unintended pregnancy serve as major areas of concern for women’s health and public health. The present study examined how knowledge of the PPACA influences receipt of preventive reproductive health services among women. Results indicate that higher levels of knowledge of the PPACA are associated with a greater likelihood of receiving cancer and STI screenings, as well as contraceptive counseling, and that increasing contraceptive knowledge, rates of contraceptive counseling, and pap screenings are related to greater use of highly effective contraception. The present study offers support for increased outreach and education efforts, along with additional policy and provider involvement.

Thesis advisor: Judith A. Vessey / This undergraduate thesis explores the underlying problem of interprofessional conflict and the resulting poor communication between physicians and nurses. It establishes the importance of understanding and addressing this subject within the health care community on a basis of reported negative outcomes, including compromised patient safety and quality of care. It also proposes a preventive health model as the most effective approach to describing the problem. An exploration of the antecedents to this interprofessional conflict identifies gender identity as having a significant role in setting the stage for the kind of relationships between nurses and physicians that harbor tension. Gender roles are discussed in the context of the developing professional identities of both physicians and nurses. The discussion further identifies how these social and professional distinctions result in the imposition of hierarchical arrangements that give way to oppressive relationships. The analysis proposes a need for dialogue –a form of primary prevention- regarding the oppressive internalized sexism that appears to have resulted from this hierarchical evolution. / Thesis (BS) — Boston College, 2010. / Submitted to: Boston College. Connell School of Nursing. / Discipline: College Honors Program.

The Annual Wellness Visit (AWV) is a benefit available to Medicare beneficiaries. This benefit has the potential to address many areas of prevention in one focused visit to the primary care clinic, yet it is currently being provided to only 19% of Medicare beneficiaries. This research attempted to examine the extent to which certified health education specialists (CHES) have provided and perceive themselves to be prepared to provide the preventive health services (PHS) within the AWV, along with seven additional preventive counseling services (PCS). A web-based survey assessed the perceived preparedness of health educators, specifically CHES (N=998), to deliver these PHS. The results of these surveys include the development of a single factor internally consistent scale to measure perceived preparedness for the PHS within the AWV. They reveal health educators were least prepared to assist with end-of-life-planning and conduct a basic hearing test. No association was found for education level and perceived preparedness; however, prior experience did account for a significant amount of the variance in perceived preparedness to provide AWV services. Lastly, when compared to historical data regarding physician’s perceived preparedness to provide PCS, health educators were more prepared to counsel on diet and exercise and less prepared to counsel on six other PCS. These results may aid in the understanding of whether CHES perceive they are prepared to provide (PHS) and demonstrate the experience CHES have with each of these PHS.

Bakgrund: Depression är lika vanligt som demens hos äldre, men ofta inte lika studerat eller diskuterat. I dagsläget finns det flertalet olika bedömningsformulär för att finna dessa patienter men depression hos äldre är ofta odiagnostiserat. Konsekvenserna med en depression i sen ålder kan vara mycket ogynnsamma, både för individen och samhället. Allt eftersom den äldre befolkningen kommer att öka så kommer även depression att öka.Syfte: Syftet med denna studie är att undersöka olika metoder för att lindra depressiva symtom hos den äldre befolkningen. Metod: Beskrivande design med litteraturöversikt med systematisk ansats som metod.Resultat: Tolv originalartiklar med kvantitativ experimentell metod inkluderades. Fyra artiklar tog upp självhjälp och hjälp till självhjälp av olika slag som intervention, fyra tog upp fysisk aktivitet som intervention, två tog upp KBT som intervention, en använde samtalsterapi som intervention och två artiklar hamnade under mer än en underrubrik. Nio av artiklarna hade interventioner som visade sig fungera för att lindra depressiva symtom. Slutsats: Att kombinera motion med socialt umgänge, rätt kost och en aktiv vardag kan lindra depressiva symtom i stor utsträckning. Det viktigaste arbetet borde vara att upptäcka och börja sätta in åtgärder i ett tidigt skede, för att förhindra att en depression utvecklas. Detta kan leda till minskat lidande för patienten och minskade kostnader för samhället. / Introduction: Depression is as common as dementia in the elderly, but often not as well studied or discussed. At present, there are several different assessment forms for finding these patients, but depression in the elderly is often undiagnosed. The consequences of a late-age depression can be vary unfavorable, both for the individual and society. As the older population increases, so will depression. Aim: The purpose of this study is to investigate various methods to relieve depressive symptoms in the elderly population. Methods: Descriptive design with literature review with systematic approach as method. Results: Twelve original articles with a quantitative experimental method were included. Four articles addressed self-help and self-help of various kinds as intervention, four took up physical activity as intervention, two took up KBT as intervention, one used conversational therapy as intervention and two articles ended up with more than one sub-heading. Nine of the articles had interventions that were found to work to relieve depressive symptoms. Conclusion: Combining exercise with social interaction, the right diet and an active everyday life can greatly alleviate depressive symptoms. However, the most important work should be to discover and take measures at an early stage, to prevent a depression to develop. This can lead to reduced suffering for the patient and reduced costs for society.

This thesis was designed to test the relationship between parents' health attitudes and beliefs and utilization of preventive health services of their children. Four measures of health attitudes and beliefs (HAB) were examined in this study, they were: 1) Interest in and concern with health; 2) Skepticism about physicians; 3) Tendency to consult physicians; and 4) Efficacy. Preventive care utilization included well-child care and immunization.

Health literacy affects caregivers' ability to engage in preventive health care behaviors for themselves and their children. Studies suggest that health literacy among low income families needs improvement, and this possibly contributes to disparities in preventive health care rates. Additionally, parents and caregivers may not be able to provide or seek preventive health care for their children because of lack of knowledge and skills to do so effectively. This study designed and piloted an intervention that delivered to parents of young children, 1) health literacy information in an experiential manner, and 2) practical skills to engage their families in healthy lifestyle choices, with the decisions for healthy lifestyle choices being based on the health knowledge provided in the intervention. Specifically, the intervention focused on diet/nutrition, physical activity, sleep hygiene, parenting skills, and mental wellness. The intervention was successful at improving diet/nutrition knowledge at least one month post-intervention and more immediate changes were found for participants' overall beliefs about diet/nutrition, children's vegetable consumption, and parents' fruits and vegetable consumption. Immediate improvements were also found for factual knowledge about physical activity, sleep, and the relationship between mental health and stress. Additionally, the intervention was successful at improving general knowledge and beliefs about sleep, knowledge about the relationship between sleep and health, and knowledge about common childhood sleep problems at least one month post-intervention. The intervention also reduced participants' bedtime interactions with children that are indicative of sleep problems at least one month post-intervention. Future research should conceptualize the intervention as a multiple health behavior intervention and reflect this in the evaluation.

The study was designed to identify current levels of corporate health promotion and nutrition activities and to highlight the need for continued health promotion activities, in particular nutrition education, throughout corporate America.Five hundred surveys were mailed to the Fortune 500 companies throughout the United States. One hundred and twenty-one were completed, yielding a 24% sample for analysis.The wellness/health promotion activities reported to be a part of corporate wellness programs included exercise, nutrition education, CPR training, stress management and intramural sports. It appeared that size of the corporation influenced the nutrition promotion provided at the worksite. There appeared to be no difference between CEO support or lack of support to the wellness/health promotion program and the variety of health promotion activities. It was apparent that having a nutrition consultant resulted in greater and more varied nutrition health promotion activities at the worksite, and that in the future, America's Fortune 500 companies will need to hire a nutrition professional to disseminate nutrition and health promotion information at the worksite. / Institute for Wellness

<p>In this dissertation, I discuss two important factors in individuals' decision-making processes: subjective expectation bias and time-inconsistent preferences. In Chapter I, I look at how individuals' own subjective expectations about certain future events are different from what actually happens in the future, even after controlling for individuals' private information. This difference, which is defined as the expectation bias in this paper, is found to have important influence on individuals' choices. Specifically, I look into the relationship between US elderly's subjective longevity expectation biases and their smoking choices. I find that US elderly tend to over-emphasize the importance of their genetic makeup but underestimate the influence of their health-related choices, such as smoking, on their longevity. This finding can partially explain why even though US elderly are found to be more concerned with their health and more forward-looking than we would have concluded using a model which does not allow for subjective expectation bias, we still observe many smokers. The policy simulation further confirms that if certain public policies can be designed to correct individuals' expectation biases about the effects of their genes and health-related choices on their longevity, then the average smoking rate for the age group analyzed in this paper will go down by about 4%.</p><p>In Chapter II, my co-author, Hanming Fang, and I look at one possible explanation to the under-utilization of preventive health care in the United States: procrastination. Procrastination, the phenomenon that individuals postpone certain decisions which incur instantaneous costs but bring long-term benefits, is captured in economics by hyperbolic discount factors and the corresponding time-inconsistent preferences. This chapter extends the semi-parametric identification and estimation method for dynamic discrete choice models using Hotz and Miller's (1993) conditional choice probability approach to the setting where individuals may have hyperbolic discounting time preferences and may be naive about their time inconsistency. We implement the proposed estimation method to US adult women's decisions of undertaking mammography tests to evaluate the importance of present bias and naivety in the under-utilization of mammography, controlling for other potentially important explanatory factors such as age, race, household income, and marital status. Preliminary results show evidence for both present bias and naivety in adult women's decisions of undertaking mammography tests. Using the parameters estimated, we further conduct some policy simulations to quantify the effects of the present bias and naivety on the utilization of preventive health care in the US.</p> / Dissertation

Thesis (M.P.A.)--Kutztown University, 1996. / Source: Masters Abstracts International, Volume: 45-06, page: 2937. Abstract precedes thesis as [3] preliminary leaves. Typescript. Includes bibliographical references (leaves [3]).