The complex challenges facing the sexual assault nurse examiners program in a midwest state are underreporting, late reporting, and poor coordination of care for pediatric victims of child maltreatment with sexual abuse. The main objective of this quality improvement project was the identification of necessary practice-related approaches to care to decrease barriers associated with reporting suspicions of abuse or neglect. An evidence-based, multidisciplinary assessment clinical toolkit that followed clinical components of trauma-sensitive, child-centered screenings triggering a coordinated response to conduct a forensic medical exam within 96 hours of the alleged incident was evaluated. During 3 rounds of surveys following the Delphi technique, 10 members of an expert panel agreed upon critical success indicators were used for the review and final decision for adoption of the toolkit. The final consensus obtained, with an intraclass correlation of 0.924 with a 95% confidence interval, supported implementation of this trauma-informed toolkit which would ensure that medical care and throughput through the system of care addressed the physical and mental needs of the patient and caregivers as well as improvement in the forensic investigative data collection. A child-centered, trauma-sensitive approach to screening and evaluation by healthcare professionals will help decrease the delay to evaluation and to curtail long-term adverse impacts on survivors. This family-based primary prevention effort is a framework for healthcare practitioners to use and includes strategies (i.e., health history, mental health evaluation, family dynamics evaluation) that are child and family centered contributing significantly to positive social change.

Medical and economic costs for obesity are estimated at $147 billion per year, yet less than 1/3 of overweight individuals successfully maintain weight loss. The literature is replete with descriptions of the problem and research on treatments, yet demonstrations of effective loss and maintenance are lacking. Missing is an understanding of the experiences of individuals who successfully maintained healthy weight loss, which could provide insights regarding effective psycho-social interventions. The purpose of this qualitative narrative study was to explore key events and experiences in the lives of former weight cyclers. The primary phenomena of interest included weight cycling and sustained weight loss. Self-determination theory (SDT) and social cognitive theory (SCT) provided the theoretical frameworks to explore concepts like autonomy, mastery, and vicarious learning, which are known to be associated with recovery from other addictions (e.g., smoking cessation, weight loss). Using the tradition of narrative analysis, the stories of 6 formerly obese weight cyclers revealed 5 major themes: structure, strategies, relationship/support, autonomy, and identity as a fat person. Findings support SDT and SCT as meaningful frameworks for understanding how severely obese individuals can attain successful weight maintenance. Findings from this study revealed elements not fully addressed by these theories, such as resilience, the diverse orientations to the problem, and overarching themes common to all participants. Findings can be used to place greater emphasis on psychological components such as autonomy, mastery, and relatedness, which are necessary for successful remission. Findings may contribute to reducing direct and related costs of obesity and improving quality of life for individuals and their families.

The lack of vaccines for emerging and re-emerging diseases highlights technical gaps and indicates a need for innovative approaches to produce new vaccines. Vaccines may be improved by knowledge of host responses to vaccination, disease pathogenesis, and the effect of age and genetics on vaccine outcome. This study's purpose was to quantitatively assess the molecular epidemiology of Francisella tularensis (Ft) and Venezuelan Equine Encephalitis Virus (VEEV). Study results support the Epidemiology Nexus model which holds that association of changes in gene expression to vaccination facilitate understanding the mechanisms of immune development and link public health and disease epidemiology. My research questions assessed the relationship between gene expression following vaccination, the relationship between age and vaccine response, and the association between Human Leukocyte Antigen (HLA) allele and vaccine response. The study was a novel secondary analysis of human data subjected to ANOVA to measure association between treatment and outcome, correlation to measure association of age with vaccine outcome, and Mann-Whitney U tests to measure association of HLA allele with vaccine outcome. Both Ft and VEEV vaccination elicited significant changes in gene expression. A highly positive relationship between age and vaccine outcome was shown for VEEV. The results may affect positive social change by contributing to a growing compendium of evidence of vaccine efficacy mechanisms that may function to assure the public of vaccine safety, combat vaccine hesitancy, and promote vaccine acceptance, as well as contribute mechanistic knowledge to reduce developmental costs of novel vaccines.

Albumin provides the vital scaffolding for growth and tissue repair and supports oncotic blood pressure and hemodynamics. In hemodialysis patients, albumin aids with fluid removal by drawing excess fluid from edematous tissues back into the blood where it can then be removed by a dialyzer. The hyperglycemia seen in dialysis patients with Type II diabetes progressively damages kidney glomeruli, which permits albumin seepage into the urine, thus lowering serum albumin. The conceptual framework underpinning this research is the van't Hoff theory of osmotic pressure. Under this framework, the solute-solvent relationship largely contributes to the osmotic movement of fluid. The purpose of this study was to determine if albumin levels differed in Hispanics on dialysis with and without diabetes and if potential differences existed over time. Differences in diabetes incidence in Hispanics suggest albumin levels may be dissimilar. Albumin physiology is abundant in the literature; how and to what magnitude albumin levels are affected in patients with diabetes is unclear. This quantitative, retrospective cohort study employed ANOVA, Repeated Measures t tests, Spearman Correlation, and regression analysis to evaluate potential associations between the research variables. Data were extracted from CMS-2728 forms to amass the final cohort (N = 827). Differences in albumin levels at the first 2 intervals were observed (Baseline 1.29 -± 0.49 mg/dL, F = 2.28, p < .032; 3 months 0.47 -±0.41 mg/dL, F = 1.62, p < .004). Covariables (hypertension, peripheral vascular disease, and infections) were controlled for but showed inconclusive results. Lower serum albumin in Hispanic dialysis patients with diabetes provides the impetus for developing ethnic-specific albumin therapies, thus promoting positive social change.

Premature mortality resulting from the growing global burden of noncommunicable diseases (NCDs) is a contemporary development challenge. Low-income and lower-middle-income countries are disproportionately affected, with the poorest in society considered the most vulnerable. A paucity of literature exists on how leadership practices at the implementation level relate to ensuring readiness for NCD services. The purpose of this study was to investigate whether any relationship exists between leadership practices at the county level and readiness for NCD services in Kenya. Path-goal and adaptive leadership theories were used to guide this quantitative correlational study, using secondary data from a 2013 Service Availability and Readiness Assessment survey. Correlation and multiple linear regression tests were used to determine the strength and direction of any relationship between the independent variable of leadership practices (annual work planning, therapeutic committees, and supportive supervision), and the dependent variable of NCD readiness (county readiness score). The results indicated a statistically significant relationship between therapeutic committee (p = .002) and supportive supervision practices (p = .023) and NCD readiness. Leadership practices also had a statistically significant predictive relationship with NCD readiness (p = .009). This study may be significant to county health leaders in relation to their efforts to ensure proximal access to quality NCD services in Kenya. The results of this study may help to promote the development of capacity-building programs targeting health leadership and prioritization of actions to ensure access to NCD prevention and treatment services at the county level in Kenya.

Poor completion rates in the radiation therapy associate's degree program offered through a community college did not meet the standards set by the college and damaged the program's reputation. The relationship between admission criteria and program completion was not known. The purpose of this study was to determine if there were any relationships between the admission criteria (GPA in prerequisite courses, interview scores, writing sample scores, and preadmission testing scores) and students' completion of a radiation therapy associate's degree program. This correlational study used 2 stages of Tinto's retention theory: (a) recruitment and admission to college and (b) pre-entry assessment and placement. Retrospective data, collected from an accredited radiation therapy program offering a 2-year degree, provided a sample size of 70 anonymous student records. The point biserial coefficient was used to analyze the data. The results yielded a significant, moderate, positive relationship between the interview score and student completion. No other significant relationships were found. The professional development program that was derived from the study sought to teach program directors about interview skills and tactics. The ability to identify at-risk students in the admission process is expected to contribute to social change by improving completion rates; improving satisfaction among students, faculty, employers; and ultimately improving the quality of patient care.

Obesity is currently viewed as one of the most important health concerns in the United States. Researchers have minimally investigated perspectives surrounding obesity within the African-American female population. This lack of research presented a gap in knowledge concerning the perceived social, environmental, and cultural influences of obesity within this population. The research questions asked African-American females about their views toward these influences. This research was guided by tenets of the social cognitive theory and the transtheoretical model for behavioral change. Thirteen African-American females participated in the interviews. The data collected were reviewed and coded using word frequencies and themes. Findings included recurring themes of cultural influences, social disparities, and the lack of access to healthy food sources and health providers. Positive social change could result from this research to help enlighten public health professionals and community planners to understand the perspectives of African-American women's belief systems surrounding obesity. The information delivered by this research could possibly empower the participants to address the issues within their communities with civic leaders and policy makers to create and sustain needed change.

Anxiety, depression, and substance use disorders are some of the frequently occurring mental illnesses among Canadian children and adolescents that can result in debilitating short and long terms outcomes. The rise in readmission rates for recipients of mental illness in Saskatchewan, coupled with the high incidences of suicide-related deaths, necessitates a patient outcome evaluation for predictors of readmission to youth counseling services among adolescents. The purpose of this secondary data analysis study was to explore the associations between anxiety, depression, substance use disorder, individual counseling, family counseling, group counseling, and the outcome of readmission within 1 year following discharge from youth counseling programs. Age, gender, and socioeconomic status were tested for interactions between the independent and dependent variables. The social ecological model of health behavior was used in understanding the study findings. Data from the Saskatoon Health Region Addiction and Mental Health Information System database were used for chi-square and multiple binary logistic regression analyses. Findings showed a statistically significant association between anxiety and readmission (p = 0.046, odds ratio =. 707). The association for anxiety was modified by age (p = 0.038). Depression showed a strong association with readmission (p = 0.001, odds ratio = 1.722) even after examining for effect modification. Additional prospective cohort studies over a long period of time are needed for at risk youth. The potential positive social change impact of this study is better outcome and overall quality of life of program participants; both of which can be achieved through investments in resources to reduce readmission to youth community counseling program.

The foundation of modern-day emergency medical service (EMS) systems began in 1966, based on hospital medical care. Demand for evidence to support prehospital practices that have been in existence for the past half-century has continued to grow; yet, researchers have not adequately explored the relationship between the medical certification level of emergency first responders and the amount of time an ambulance spends on the scene. The purpose of this quantitative study was to examine and compare ambulance scene times for emergency responses when basic life support (BLS) certified first responders or advanced life support (ALS) first responders are first on the scene, and whether the level of first responder training reduces the time spent on the scene by a paramedic ambulance. A final research question dealt with whether there is a relationship between how long the first responder is on the scene and the amount of time an ambulance spends at the scene of an emergency. The publicly available archival data used for the study were from a community that had BLS and ALS first responders. Data analysis involved t-tests of the hypotheses for the first 2 research questions and a linear regression analysis of the hypotheses for the third research question. The findings showed that there is a clear difference in ambulance scene times based on the certification level of the first responders. Advanced life support first responders significantly reduced the scene time of ambulances when they arrived at the scene prior to the ambulance. Positive social change could result from this study if understanding the impact that ALS first responders have on ambulance scene times leads EMS planning managers to deploy resources more strategically, thus improving the efficiency of the public safety system and saving lives.

Many researchers have alluded to the inequity in distribution of HIV preventive services in South Africa (SA). Other researchers have demonstrated that socio-demographic factors are main determinants of distribution of preventive services like voluntary counseling and testing (VCT) in SA. VCT is a primary HIV prevention tool through which infected persons enter the treatment, care, and support programs; identifying the impact of socio-demographic determinants (SDDs) on VCT uptake in SA could help direct VCT services to areas and individuals that need them most. The research question in this study examined what and how SDDs impact the uptake of VCT in SA using the integrated theory of health behavior change (ITHBC) as its theoretical framework. A quantitative study with a cross-sectional design using secondary data from a population-based survey by the John Hopkins Education and Health SA (2012) was conducted. In a multivariate logistic regression analysis, SDDs like province, settlement, employment, races, and age were statistically significant while marital status, education, and SES (socio-economic status) did not have statistically significant impact on VCT uptake. This study demonstrated that Black, unemployed men of low to medium SES between the ages of 15-49 years living in peri-urban and urban-informal areas of all provinces but especially Eastern Cape, Northern Cape, and North West provinces of SA had the lowest VCT uptake. This study advocates policies and programs to improve VCT distribution and accessibility in places and individuals with lowest uptake. Improved uptake will help reduce new HIV infection, HIV-associated morbidity, and mortality; as well as ensure equity, equality, and social justice in the distribution of HIV preventive services in SA.