Journal of health science & education最新文献

Background: Community health workers, promotoras, have been identified as effective change agents of their community members' health behaviors and health status. However, few studies have examined the effects of delivering an intervention on the promotoras themselves.

Objectives: This study assessed whether promotoras delivering a healthy lifestyle intervention for adults improved their health behaviors and health status from baseline to 6- and 12-months post-baseline.

Methods: Volunteer promotoras were trained to promote healthy lifestyles including physical activity through workshops and free group exercise classes throughout their communities. Twenty completed all required trainings and delivered at least one class during the period between baseline and 12-month assessments. The promotoras were measured on the following variables: Systolic and diastolic blood pressure, waist circumference, weight, and height. Additionally, they reported their health behaviors and status including moderate-to-vigorous physical activity, beverage consumption, sleep duration, and depressive symptoms.

Results: Repeated measures ANOVAs showed statistically significant decreases from baseline to 6 months for systolic blood pressure (p ≤ 0.05), diastolic blood pressure (p ≤ 0.001) and body mass index (p ≤ 0.05). Changes in self-reported measures were not statistically significant although trends were observed with increases in water consumption.

Conclusions: Findings from this study suggest positive effects associated with delivery of a PA intervention. This is one of the first studies to focus on a cohort of promotoras to examine health outcomes from delivering a healthy lifestyle intervention. It is important to further explore these impacts on the community health workers as they have become increasingly essential to the health of some communities.

The relationship between HIV knowledge and testing behavior is poorly understood among young Chinese-, Korean-, and Vietnamese-American women. This study assesses: (1) levels of HIV/AIDS knowledge, (2) lifetime and annual prevalence of HIV testing, and (3) whether higher levels of HIV knowledge were associated with increased likelihood of testing after controlling for HIV risk behaviors. Fifty-one percent reported lifetime HIV testing (n=117); among those tested, 53% were tested within the past year. A significant and positive association between scores on the HIV Knowledge Questionnaire (HIV KQ-45) and HIV testing was identified. This association was no longer statistically significant after controlling for sexual risk behaviors. Participants were most knowledgeable about HIV symptoms (88.6%) and least knowledgeable about treatment options (56.8%). Future studies should further characterize cultural factors affecting these women's sexual practices, as well develop culturally adapted HIV educational interventions to increase HIV knowledge and testing rates.

Objective: To assess early care and education professionals' breastfeeding knowledge and practices before and after an e-learning program.

Participants: Early care and education professionals from New Hampshire (U.S.A.) licensed child care programs were invited to complete a pre-assessment followed by a 90-minute e-learning breastfeeding program. Three months post-training, participants were invited to complete the post-assessment.

Analysis: McNemar tests were used to assess changes from pre-post-assessment for dichotomous variables. McNemar-Bowker tests were used to determine differences from pre-post for variables with more than two categories. When the McNemar-Bowker test was significant, a multiple comparison correction (Bonferroni) was used.

Results: 114 participants completed the e-learning program and pre-post assessment. Results showed significant improvement from pre-post in 10 of 15 breastfeeding knowledge questions related to health of baby, mother and child care centers, economics, and environmental impact. There were significant changes from pre-post in 24 of 50 breastfeeding practice questions in handling breast milk, promoting breastfeeding, and supporting mothers.

Conclusions and implications: This study indicates improvement in early care and education professionals' breastfeeding knowledge and practices; however, opportunities exist to design targeted initiatives to further strengthen practices that support breastfeeding families in the child care environment.

Background: Using personal experience stories as teaching tools, clinical narratives are an effective means for sharing the art of nursing practice and provide insight into nurses' critical thinking and clinical proficiency. Using clinical narratives to assess curriculum effectiveness provides important insights into changed practice and learning beyond the classroom.

Aim: This article provides an example of using clinical narratives in the evaluation of the Department of Veterans Health Affairs Office of Nursing Services (ONS) Evidence Based Practice Curriculum (EBPC).

Methods: As part of a larger mixed-method evaluation of the EBPC, clinical narrative methods were employed to describe one incident where participants (n=3) applied at least two of three evidence based practice components (best available evidence; clinical expertise; patient preference).

Results: Examination of clinical narratives demonstrated successful application of key components of evidence based practice and an integration into individual nursing practice beyond data obtained from other evaluation methods.

Conclusions: Incorporating rich clinical narratives into a rigorous mixed-method program evaluation protocol provides insights beyond information uptake, satisfaction, efficacy, or competency assessment scores.

Background: Individuals with Down syndrome (DS) are at high risk for autism spectrum disorder (ASD) with ~20% of individuals meeting diagnostic criteria for ASD. Despite the high risk, there is no research documenting early signs of ASD in infants with DS or potential prodromal ASD-associated behaviors.

Aim: This preliminary case-control study described ASD-associated behaviors in infants with DS contrasted to typically developing (TD) infants.

Patients and methods: The Autism Observation Scale for Infants (AOSI) was used to describe ASD-related behaviors in 18 infants with DS (7-18 months) and 18 TD infants (9-14 months).

Results: Thirty nine percent (7 out of 18) of infants with DS in our sample were designated "at risk" for ASD on the AOSI with 100% of infants with DS demonstrating at least one feature of ASD. In contrast, only 11% (2 out of 18) of TD infants were designated "at risk" for ASD on the AOSI. Social and communication impairments appear to represent early signs of elevated ASD-associated behavior in infants with DS.

Conclusions: Early signs of ASD-associated behavior appear present and detectable in infants with DS. These early signs mirror findings of other populations at risk for ASD with social communication as the primary behavioral impairment to signal elevated risk for the emergence of ASD. This study contributes to the refinement of the DS behavioral phenotype and identifies important next steps to help improve the identification, diagnosis, and treatment of ASD in DS.

Introduction: The Veterans Health Administration (VHA) registered nurse (RN) Transition to Practice (TTP) program is a 1-year comprehensive, standardized curriculum taught for entry-level nurses to assist them in transitioning to VA-trained, competent, professional RNs. The TTP program includes revised modules on Evidence-Based Practice (EBP) clinical decision making. The revised curriculum emphasizes EBP as a problem-solving approach to clinical decision making rather than a project-based approach to implement practice changes. The goal of this quality improvement project was to evaluate the content, delivery, and outcomes of a revised Evidence-Based Practice Curriculum (EBPC) for use in the VHA RN TTP program.

Methods: Focus groups were conducted with TTP coordinators, who teach the program and facility EBP content experts from 32 VHA Medical Centers. All attended a three-day face-to-face training at a central location. Qualitative data were managed and analyzed with a rapid assessment process.

Discussion: Leaders within and outside of organizations are commonly believed to affect the success of implementing and sustaining any program or initiative through their influence on organizational climate, leadership processes, and leadership alignment across multiple levels of leadership. Our findings were in line with other research showing that leaders should prioritize EBP and fuel it with resources to create sustainable change.

Conclusions: In conclusion, the EBPC was reviewed very favorably by all who planned to use it in their facilities in teaching the content to practicing registered nurses. Future evaluation will focus on the degree to which faculty use the program, how they use the modules, and what feedback nurses provide after exposure to EBPC.

Preparing lay Community Health Ambassadors (CHA) to assess, document and monitor physical activity using standardized instruments can be daunting. Administering some instruments needs specialized training. System for Observing Play and Recreation in Communities (SOPARC) is a standardized instrument requiring extensive training. The question guiding this project was: Can lay Community Health Ambassadors (CHA) be trained to administer SOPARC at Racial and Ethnic Approaches to Community Health (REACH) physical activity fitness sites? This manuscript presents the process undertaken to train Community Health Ambassadors (CHAs) and some preliminary results. Preliminary results are that fifty-six (56) Community Health Ambassadors (CHAs) representing four (4) community partner groups were certified in the SOPARC training. These CHAs successfully documented pre/post data for 20 different physical activity sites. Additionally, the results support the premise that Community Health Ambassadors are a viable liaison in community health delivery.

Background: Among ESRD patients, obesity may improve dialysis-survival but decreases likelihood of transplantation, and as such, obesity prevalence may directly affect growth of the dialysis population.

Objective: The objective of this study was to assess BMI trends in the ESRD population as compared to the general population.

Materials and methods: Incident adult ESRD patients were identified from the United States Renal Data System from 01/01/1995-12/31/2010 (n=1,458,350). Data from the Behavioral Risk Factor Surveillance System (n=4,303,471) represented the US population. Trends in BMI, obesity classes I (BMI of 30-34.9), II (BMI of 35-39.9), and III (BMI ≥ 40), were examined by year of dialysis initiation. Trends in BMI slope were compared between the ESRD and US populations using linear regression.

Results: Mean BMI of ESRD patients in 1995 was 25.2 as compared to 29.4 in 2010, a 16.7% increase, while the US population's mean BMI increased from 25.3 to 27.2, a 7.5% increase. BMI increase among the ESRD population was significantly more rapid than among the US population (β: 0.16, 95% CI: 0.14-0.18, p<0.001).

Conclusions and recommendations: Mean BMI among the ESRD population is increasing more rapidly than the US population. Given decreased access to kidney transplantation among ESRD patients with obesity, future research should be directed at controlling healthcare expenditures by identifying strategies to address the obesity epidemic among the US ESRD population.