In the past three years, evidence based medicine emerged as a powerful force in an effort to improve quality and health outcomes, and to reduce cost of care. Computerized physician order entry (CPOE) applications brought safety and efficiency features to clinical settings, including ease of ordering medications via pre-defined sets. Order sets offer promise of standardized care beyond convenience features through evidence-based practices built upon a growing and powerful knowledge of clinical professionals to achieve potentially more consistent health outcomes with patients and to reduce frequency of medical errors, adverse drug effects, and unintended side effects during treatment. While order sets existed in paper form prior to the introduction of CPOE, their true potential was only unleashed with support of clinical informatics, at those healthcare facilities that installed CPOE systems and reap rewards of standardized care. Despite ongoing utilization of order sets at facilities that implemented CPOE, there is a lack of quantitative evidence behind their benefits. Comprehensive research into their impact requires a history of electronic medical records necessary to produce large population samples to achieve statistically significant results. The study, conducted at a large Midwest healthcare system consisting of several community and academic hospitals, was aimed at quantitatively analyzing benefits of the order sets applied to prevent venous thromboembolism (VTE) and treat pneumonia, congestive heart failure (CHF), and acute myocardial infarction (AMI) - testing hospital mortality, readmission, complications, and length of stay (LOS) as health outcomes. Results indicated reduction of acute VTE rates among non-surgical patients in the experimental group, while LOS and complications benefits were inconclusive. Pneumonia patients in the experimental group had lower mortality, readmissions, LOS, and complications rates. CHF patients benefited from order sets in terms of mortality and LOS, while there was no sufficient data to display results for readmissions and complications. Utilization of AMI order sets was insufficient to produce statistically significant results. Results will (1) empower health providers with evidence to justify implementation of order sets due to their effectiveness in driving improvements in health outcomes and efficiency of care and (2) provide researchers with new ideas to conduct health outcomes research.

Several artifacts of federal policy address the connection between health literacy of patients and health outcomes. These laws include The Plain Writing Act, Health Information Technology for Economic and Clinical Health, and the Health Insurance Portability and Accountability Act. Even with this policy structure, little is known about how nurses' knowledge of health literacy may influence patient understanding of medical information and health outcomes. Using Knowles' principles of effective communication, the purpose of this mixed-methods study was to concurrently examine the relationship between nurse knowledge of health literacy and communication techniques used by nurses to identify any causal relationships in the provider-patient-interaction linking health literacy and health outcomes. Quantitative and qualitative data were gathered from 47 registered nurses in south Florida using an online survey. These data were analyzed using descriptive statistics and a content analysis procedure. Descriptive statistics revealed that there is a lack of health literacy knowledge among nurses and nurses rarely or never use Knowles' communication techniques to relay health information to patients. By contrast, content analysis of qualitative data revealed that nurses have a basic understanding of the complexities of health literacy. No correlation existed between a nurse's knowledge of health literacy and the use of appropriate and varied communication techniques when the data sets were merged. This finding suggests that there may be another root cause of low health literacy that requires additional research to fully explore. The positive social change implications stemming from this study include recommendations to policy makers to encourages changes to existing law and policy that supports patient communication training to nurses in order to improve health outcomes for patients.

Objective: To determine who avoids the dentist and declines recommended dental treatment due to cost. Methods: A secondary data analysis was undertaken. Weights were utilized to ensure data were nationally representative. Univariate and bivariate descriptive statistics were calculated and logistic regressions were used to observe the characteristics that were predictive of reporting cost barriers to care. Results: Over 17 per cent of the Canadian population reported avoiding a dental professional due to cost, and 16.5 per cent reported declining recommended dental treatment due to cost. These individuals had a higher prevalence of needing treatment, had more untreated decay, missing teeth, and reported having poor oral health and oral pain often. Having no insurance, lower income, and reporting “poor to fair” oral health were the greatest predictors of reporting cost barriers to care. Conclusions: Individuals who report cost barriers experience more disease and treatment needs than those who do not.

Objective: To determine who avoids the dentist and declines recommended dental treatment due to cost. Methods: A secondary data analysis was undertaken. Weights were utilized to ensure data were nationally representative. Univariate and bivariate descriptive statistics were calculated and logistic regressions were used to observe the characteristics that were predictive of reporting cost barriers to care. Results: Over 17 per cent of the Canadian population reported avoiding a dental professional due to cost, and 16.5 per cent reported declining recommended dental treatment due to cost. These individuals had a higher prevalence of needing treatment, had more untreated decay, missing teeth, and reported having poor oral health and oral pain often. Having no insurance, lower income, and reporting “poor to fair” oral health were the greatest predictors of reporting cost barriers to care. Conclusions: Individuals who report cost barriers experience more disease and treatment needs than those who do not.

In Healthy People 2010, mental health is listed as a major public health concern as evidenced by an alarming increase in the number of individuals who suffer from mental disorders. Mental disorders are a treatable public health condition. However, health disparities in the treatment of mental disorders are evident. The purpose of this study was to examine factors that affected health outcomes of persons with mental disorders. Two specific aims were addressed: Aim 1: to examine the relationships of population characteristics (predisposing factors and enabling resources), health behaviors (health services use and health practice); and health outcomes (physical health status and mental health status); Aim 2: to determine the differences in the usual source of care and health outcomes between individuals with self-reported mental disorders and individuals without mental disorders. This study was a secondary analysis of existing data collected from 2006 Medical Expenditure Panel Survey Household Component Consolidated file. A sample of U.S. civilian non-institutionalized adults (N=622) was grouped according to three self-reported health conditions: mental disorders (MD), physical illnesses (PI) and co-morbid mental disorders and physical illnesses (CM). This sample was predominantly male, White non-Hispanic and married; had a high school diploma, middle to high income, and private insurance; and preferred office-based clinics as the usual source of care, F(2,29)=5.94, p = .007. No statistically significant differences between groups in usual source of care (p=.069) and physical health status (p=.490) but there was a significant difference in mental health status (p=.001). Participants with CM had a poorer mental health status than those with PI and MD, F (2,619) =21.8, p= .000. The mental health status of individuals with PI was significantly better than that of participants with MD. Awareness of disparities in the usual source of care, health services use, and health outcomes among individuals with mental health conditions is imperative if barriers to care are to be eliminated. Innovative interventions pertinent to decreasing barriers to accessing health care and improving the health outcomes among individuals with MD must be tested. Advocating for mental health care policies that reduce health care services disparities among individuals with self-reported MD must be encouraged.

Urban sprawl often has a negative connotation, used as a derogatory label for certain forms and consequences of land development that are seen as environmentally and socially unpleasant. Although sprawl may be seen as offensive, there may be other, far greater and more harmful consequences of sprawl. The literature indicates that rates of negative health outcomes, such as obesity, tend to be higher in more developed areas. However, aside from a few studies, little empirical research looks specifically at the influence of sprawl when it comes to individual health. This research project focuses on sprawl and examines the relationships it has with health behaviors and health outcomes. By analyzing data from the CDC’s 2003 Behavioral Risk Factor Surveillance System (BRFSS), an annual telephone survey of adults that include more than two-hundred self- reported and calculated variables, I investigate the associations between sprawl, physical activity, body weight, and health outcomes using Structural Equation Modeling (SEM). By employing SEM, my research differs from previous research in this field by adding not only additional layers to the evaluation of sprawl and health outcomes, but also allows for the evaluation of associations through various “paths” instead of looking at variables within simpler hierarchical regression models. In addition to direct effects, it also allows for the determination of indirect, or mediated, effects between variables within a path model. Even though no direct relationship between sprawl and health outcomes was revealed, sprawl did show to have a statistically significant indirect effect on health outcomes mediated by physical activity and body weight. Physical activity is also shown to mediate the relationship between sprawl and body weight. Additionally, physical activity reveals both a direct and indirect effect on health outcomes, with its indirect effect being mediated by body weight. Finally, physical activity and body weight are both shown to have statistically significant direct effects on health outcomes. In the concluding chapter I propose a new path model in light of the results of the analyses of data in order to represent the associations between sprawl, physical activity, body weight, and health outcomes more accurately.

The health and well-being of individuals is related to their activity-travel patterns. Individuals who undertake physically active episodes such as walking and bicycling are likely to have improved health outcomes compared to individuals with sedentary auto-centric lifestyles. Activity-based travel demand models are able to predict activity-travel patterns of individuals at a high degree of fidelity, thus providing rich information for transportation and public health professionals to infer health outcomes that may be experienced by individuals in various geographic and demographic market segments. However, models of activity-travel demand do not account for the attitudinal factors and lifestyle preferences that affect activity-travel and mode use patterns. Such attitude and preference variables are virtually never collected explicitly in travel surveys, rendering it difficult to include them in model specifications. This paper applies Bhat’s (2014) Generalized Heterogeneous Data Model (GHDM) approach, whereby latent constructs representing the degree to which individuals are health conscious and inclined to pursue physical activities may be modeled as a function of observed socio-economic and demographic variables and then included as explanatory factors in models of activity-travel outcomes and walk and bicycle use. The model system is estimated on the 2005-2006 National Health and Nutrition Examination Survey (NHANES) sample, demonstrating the efficacy of the approach and the importance of including such latent constructs in model specifications that purport to forecast activity and time use patterns. / text

Aims of the study–to investigate the associations between school bullying, psychological injuries in the family and health outcomes among students. Methods Questionnaire information on bullying by methods of D. Olweus, Norwegian scientist. The psychological state was measured by the sense of coherence, self-esteem, loneliness, happiness, and communication skills. Health outcomes were headache, stomach ache, back pain, anxiety, etc. Family injuries were stress in the family, domestic violence, crisis. Totally 588 students were investigated among all the 670 studying in X Kaunas gymnasium. Response rate 87.8%. Results. Totally 138 (23.6%) were involved in the bullying process, among them 76 (12.9%) were bullied frequently, 46(7.8%) were bullies and 16 (2.7%) were involved in the two-way bullying process. The prevalence of frequent bullying among boys was 58 (24.1%) and among girls 34 (9.8%) (p<0.0001), among 5-9 grades it was 72 (18.3%) and among 10-12 grades 20(10.3%) (p=0.012). Though the prevalence of bullies was more often among 10-12 grades-29 (14.9 %) than 5-9 grades 33 (8.4%, p=0.015). 11.8% of students suffered from severe conflicts in the family and permanent tension. Crises (divorces, death or incurable disease of the close family member, severe financial problems) were met by 15.1%. Stress at home 6 times increased the risk of low sense of coherence, 8 times the risk of poor self-rated health, while frequent bullying 4 times in the 5-9 grades group. Though the... [to full text]

Clostridium difficile colitis (CDC) is associated with a higher risk of acute death among hospitalized ulcerative colitis (UC) patients. However, the risk of colectomy with CDC in these patients has varied across studies. No study has assessed the long-term health impact of CDC in UC patients. Therefore, the present study evaluated the impact of CDC on five-year health outcomes of hospitalized UC patients based on Ontario health administrative data. No overall association was observed between CDC and five-year risks of colectomy or death in overall cohort. However, patients who were discharged from hospital without undergoing colectomy demonstrated marginally higher five-year risks of colectomy and hospital re-admission. Mortality risk and length of stay during index hospitalization were also higher in patients with CDC. Analysis of a parallel cohort of UC patients derived using a published case definition corroborated most of these results, but demonstrated a higher five-year mortality risk with CDC.

Clostridium difficile colitis (CDC) is associated with a higher risk of acute death among hospitalized ulcerative colitis (UC) patients. However, the risk of colectomy with CDC in these patients has varied across studies. No study has assessed the long-term health impact of CDC in UC patients. Therefore, the present study evaluated the impact of CDC on five-year health outcomes of hospitalized UC patients based on Ontario health administrative data. No overall association was observed between CDC and five-year risks of colectomy or death in overall cohort. However, patients who were discharged from hospital without undergoing colectomy demonstrated marginally higher five-year risks of colectomy and hospital re-admission. Mortality risk and length of stay during index hospitalization were also higher in patients with CDC. Analysis of a parallel cohort of UC patients derived using a published case definition corroborated most of these results, but demonstrated a higher five-year mortality risk with CDC.