In the United States, the number of major limb amputees is predicted to exceed several million in the coming decades. For those amputees using a prosthesis, their quality of life (QoL) is often modulated by residuum limb problems resultant from its use. Multiple factors preclude quality evidence-based medicine (EBM) research in the field of prosthetics, leading to greater health risk from prosthetic prescription ambiguity. Positive social change is integral to good QoL; studies support administrative healthcare (AHc) as useful to support such, especially in the absence of EBM. This study utilized Veterans Healthcare Administration (VHA) AHc data to discriminate determinants of residual limb skin problem severity (RLSPS), relative to the artificial limb configuration (ALC) used through a retrospective, longitudinal study of a cohort of U.S.Veteran dysvascular amputees. The dataset was derived from multiple archival VHA AHc databases from which 279 Cohort members were identified who underwent amputation surgery during the fiscal year (FY) 2007 were dispensed a prosthesis, and had clinical records through FY 2011. ICD-9-CM and HCPCS codes were used to identify categories of RLSPS and ALC, respectively, with generalized estimating equations modeling to identify likelihood associations of parameters. Derivation of the study cohort dataset was encumbered by data integrity issues and coding system limitations; significant associations were detected for RLSPS with chronic obstructive pulmonary disease, substance use disorder, and major depressive disorder, regardless of the ALC dispensed. The findings support the utility of an amputee-prosthesis AHc database to drive product, policy, and medical decisions toward an improved QoL for this vulnerable population.

Lead exposure during childhood is a significant global public health concern as the potential effects of exposure can result in the need for long-term treatment, diminished productivity in society, and financial strain on the health care system. There is strong evidence of a relationship between lead exposure and attention-deficit/hyperactivity disorder (ADHD); however, there is a gap in the current literature regarding the relationship between lead exposure and specific symptoms of ADHD and the strength of that relationship. The purpose of this meta-analysis was to examine and help quantify this relationship. Cohen's d was used as the standardized mean effect size measure for this study, and allowed for comparison of 2 groups on a specific measure. For the final analysis 20 studies were included that provided a comparison between lead exposure and overall ADHD, inattentive, or hyperactive/impulsive symptoms. The magnitude of the effect size of childhood lead exposure on ADHD symptoms was significant and of medium strength. There was significant variability in the research results for inattentive and hyperactive/impulsive symptoms, and it was hypothesized that this variability may be due to factors related to lead levels and covariates known to affect ADHD symptoms. Study results may contribute to positive social change by providing health care practitioners with a greater understanding of the effect of childhood lead exposure on ADHD symptoms, which they may use to achieve advancements in prevention and treatment. Improved prevention programs for lead exposure and early identification and treatment of related concerns may decrease negative outcomes, as well as the occurrence of ADHD symptoms on a population level, thus improving public health.

Type 2 diabetes mellitus (T2DM) and colorectal cancer (CRC) are 2 chronic diseases with common risk factors related to physical inactivity, obesity, and diet. Literature on T2DM as a risk factor for CRC development and survival in Oman is scarce. Using de-identified archival data provided by Sultan Qaboos University Hospital (SQUH) Oman, a retrospective, case-control, and time-to-event study designs were used to compare odds of developing CRC, and survival rates among adults with and without T2DM. The ecosocial theory provided the theoretical base for this research. Logistic regression was used to examine the odds of developing CRC among 114 cases versus 170 hospital controls. The Cox proportional hazards regression was used to compare survival rates among 228 CRC cases by T2DM status and survival rates by T2DM status across strata of gender, age group, and tumor location and cancer stage. According to the study findings, after having adjusted for potential confounding variables, there was no association between T2DM and odds of developing CRC (OR = 1.49, 95% CI: 0.29-7.68, p = 0.64) or between T2DM and CRC survival rates (HR = 1.07, 95% CI: 0.65 -1.75, p = 0.80). There was also no association between T2DM and CRC survival rates across the strata of potential effect modifiers examined. This research could contribute to positive social change by creating awareness among policy makers that will provide them with information on CRC risk-reduction strategies in the Omani population.

Research has shown that people with physical disabilities are at risk for developing secondary health conditions. Many of these secondary health conditions may be reduced by engaging in physical activity, yet people with physical disabilities are less likely to participate in physical activity. Information gaps remain regarding facilitators and barriers to physical activity. The purpose of this phenomenological study was to understand the experiences with physical activity among adults with a spinal cord injury (SCI). Research questions asked were about exercise experiences, barriers and facilitators, and the role of the natural and social environment. The theoretical framework used was the theory of planned behavior, in which attitudes and perceived advantages and disadvantages to performing a behavior are considered. In-depth interviews were conducted with 10 adults, 18 years of age and older, who have an SCI that requires the use of a wheelchair. Interviews were transcribed verbatim and analyzed thematically by identifying key phrases, determining recurring phrases, and grouping codes into themes. NVivo, a qualitative software, aided in the analysis. The participants in this study faced many obstacles, including physical and social barriers. Despite these barriers, participants recognized the importance of physical activity and identified factors that encouraged exercise. The implications for positive social change from this research include a better understanding among healthcare professionals working with people with disabilities and disability advocates of the experiences people with an SCI have when exercising and the potential to minimize the barriers to physical activity in an effort to reduce related secondary health conditions.

Low health literacy is a problem the U.S. faces and, like health care itself, is a complex issue stemming from patient demographics and the healthcare providers being very diverse. Tools have been developed to mitigate the risks of low health literacy, however, without formal policy. The purpose of this qualitative case study was to explore and compare commonalities in health literacy best practices of organizations that are recognized as leaders in health literacy and are addressing low health literacy in their communities. By comparing the organizations' abilities to implement standards of plain language and health literacy tools/guidelines, best practice and policy recommendations could be made to various organizations regardless of level (local, state, federal, or nonprofit). The theoretical framework was based on the Evans and Stoddart framework of determinants of health and the health behavioral theories. The conceptual framework was based on health literacy best practices and policy. The research questions focused on how organizations implement health literacy tools/guidelines, the impact of health literacy best practices on policy development and addressing health literacy through formal policy. The qualitative multiple case study used open-ended interview questions via telephone conferencing, with 13 participants from health literacy organizations. The analysis was done by coding and bracketing the responses manually and with NVivo software. Results indicate that health literacy policy development and involvement exists but it is not derived from the health literacy best practices. The implications for positive social change for this study impacts the patient (individual), community, organization, and society through best practices and recommendations for policy development.

The goal of diabetes education programs (DEPs) is to improve patients' pattern-management habits for those with type 2 diabetes (T2D), though participation in DEPs is lower than expected due to low physician referral rates. This retrospective study examined secondary data of 162 T2D patients who had been referred to a DEP in a community center in RI to determine whether the source of referral affected patient attendance, participation persistence, and outcomes. Self-referred (n = 62) and physician-referred (n = 100) groups were analyzed for possible associations among the aforementioned variables. Chi-square (p = .04) and logistic regression (p = .04) indicated that the referral source for a DEP does have an effect on participation rates, while logistic regression showed that odds for self-referred patients to participate were 1.97 times higher. Multiple linear regression found no difference between the referral source and the number of sessions patients completed, though covariate analysis showed that age (p = .02) contributes to the model. Multiple linear regression showed no difference between the number of sessions attended and changes in hemoglobin A1c (HbA1c) levels. It is important to note that those who completed the program and reported pre- and post-program HbA1c levels (n = 7) all reported improved outcomes. This highlights the limitation of the small sample size (n = 7), which increased the possibility of a Type II error. This community center DEP model can serve as a blueprint, highlighting the importance of diabetes education and leading to positive social change by improving referral and participation rates and resulting in fewer complications, a decreased disease burden, and an improved quality of life.

An increased exposure to the sexual content of traditional mass media (i.e., television, magazines, movies, music) affects real life sexual behaviors among adolescents. Engaging in online risk behaviors such as sharing/posting sexual content using social networking sites, cellphones, smartphones, IPads, or other new media devices has become common among adolescents. The purpose of this quantitative, correlation study, based upon the theory of reasoned action and three pre-existing national surveys, was to determine whether significant associations exist between attitudes, intentions, and behaviors related to online risk behaviors and real life sexual behaviors among African American female adolescents in Metro Atlanta. Data were collected from 111 African American female adolescents residing in the Metro Atlanta. Statistical analyses included the Pearson r correlation, phi coefficient correlation, and logistic regression tests. According to study results, there were no significant relationships between attitudes and behaviors concerning online risk behaviors and real life sexual behaviors, age and attitudes of online risk behaviors, or relationship status and online risk behaviors. However, a significant relationship was found between age and engaging in online risk behavior. The positive social change implications include further insight for those working in the area of adolescent sexual health prevention and promotion. The findings can be used to better understand the impact of online risk behaviors on adolescent sexual health and how new media platforms can be effectively used to tailor prevention programs and campaigns.

Obesity is epidemic among Black adolescent females, and adolescent obesity often leads to adult obesity. Previous research suggests that there may be an interaction between physical activity and dietary fruit and vegetable intake on body mass index (BMI) in obese adolescent females in general, but it was unclear whether the same pattern is evident in Black adolescent females, who, on average, tend to have low levels of physical activity and fruit and vegetable intake. Bandura's social learning theory implies the possibility that adolescent females might model their behaviors on the behavior of others in their high school years, including physical activity and dietary behaviors. The primary research question for this quantitative, retrospective, cross-sectional study asked whether there is a statistically significant interaction between dietary fruit and vegetable intake and physical activity on the BMI of Black adolescent females. In this study, data from 1,211 Black female adolescents in the Center for Disease Control Youth Risk Behavior Survey database were analyzed using multiple linear regression statistics. BMI was the dependent (outcome) variable, physical activity was the independent (predictor) variable, and fruit and vegetable intake was the moderator variable. Physical activity had a significant negative association with BMI while intake of fruits and vegetables showed no significant association with BMI. Unlike previous research that was not focused specifically on Black adolescent females, Fruit and vegetable intake did not significantly moderate the relationship between physical activity and BMI. This study has positive social change implications for practitioners designing obesity prevention programs for Black female adolescents, which should focus on increasing physical activity levels towards controlling BMI, leading to a healthier life for Black female adolescents.

Assistive technology may delay cognitively impaired elders' need for long-term institutionalization, and the promote independence. Its use is on the rise, yet the gap between the needs of the cognitive impaired elderly and what developers of the assistive technologies design, manufacture, and implement, remains to be filled. Using Inayatullah's 6-pillar approach, as the guide to the future of assistive technology, the purpose of this qualitative study was to explore how assistive technologies may fulfill the daily functional needs of the cognitively impaired elderly with Alzheimer's or other dementia by 2037. Data were collected from a focus group of 10 seniors at a senior center in a large mid-Atlantic city, as well as survey data from with 5 family members of the cognitively impaired elderly and 16 technology developers from an engineering society. These data were coded according to the thematic content analysis and causal layered analysis. The future triangle analysis served as a second layer of analysis. Findings indicated that the most desirable outcome for 2037 is that of the "happy retiree," characterized by flourishing cultural and financial opportunities, and the least desirable is that of the "struggling pensioner" characterized by monetary gains of the social elite at the expense of the poor and working class. The most expected outcome, though, is the "caring robot" that is characterized by the use of technology and artificial intelligence to promote equitable social and health care benefits to aging citizens. Positive social change may be achieved through recommendations to state, local, and national policy makers that support the improvement in the elders' well-being, the delay of hospitalization, and greater support for the duties of family members, and greater caretaker independence.

Age-related macular degeneration (AMD) is a chronic, irreversible disease that robs individuals of vision, quality of life, and independence. It is the leading cause of blindness in industrialized countries. Sleep-disordered breathing (SDB) is a condition characterized by repeated episodes of apnea and/or hypopnea, insomnia, short sleep duration, and/or sleep disturbances (snoring, gasping, etc.). Because SDB has been shown to cause chronic hypoxia resulting in oxidative stress on the retina, it has been proposed that SDB may be associated with AMD. Based on the life course theory of chronic disease, this quantitative, cross-sectional study used data from the 2005-2008 National Health and Nutrition Examination Survey to study whether there was an association between SDB and AMD, including neovascular AMD and geographic atrophy in adults 40 years and older. Descriptive statistics and logistic regression analyses were used. The results suggest that AMD is associated with diagnosed sleep disorders, including sleep apnea and insomnia, as well as sleep apnea symptoms of gasping snoring, snorting, and stopping breathing. The findings of this study highlight the importance of diagnostic screening and therapeutic intervention to treat SDB. Early diagnosis and therapy for SDB could address not only the comorbidities associated with SDB, but could also prevent or slow the progression of AMD. In turn, this would yield lower rates of vision loss, reduced comorbidities associated with vision loss, and reduced impact of AMD on the health care system and social and financial costs to society.