Improving pregnancy prevention in the Austin Independent School District: Student participation in the development of social marketing media

Pregnancy prevention is an important goal of the Austin Independent School District (AISD), but present activity is limited to utilizing a single curriculum. To effectively prevent pregnancy, a diverse range of programs and activities is needed—including media and social marketing. This project (1) reviews literature to identify best practices and characteristics of effective pregnancy prevention programs for AISD, (2) reports on the results of meetings that gathered recommendations for effective channels and media messages for pregnancy prevention among high school students in Central Texas, and (3) presents samples of social marketing media products developed for pregnancy prevention that can be used by AISD.^

Factors influencing participation in individuals with disability: A secondary data analysis

Individuals with disabilities face numerous barriers to participation due to biological and physical characteristics of the disability as well as social and environmental factors. Participation can be impacted on all levels from societal, to activities of daily living, exercise, education, and interpersonal relationships. This study evaluated the impact of pain, mood, depression, quality of life and fatigue on participation for individuals with mobility impairments. This cross sectional study derives from self-report data collected from a wheelchair using sample. Bivariate correlational and multivariate analysis were employed to examine the relationship between pain, quality of life, positive and negative mood, fatigue, and depression with participation while controlling for relevant socio-demographic variables (sex, age, time with disability, race, and education). Results from the 122 respondents with mobility impairments demonstrated that after controlling for socio-demographic characteristics in the full model, 20% of the variance in participation scores were accounted for by pain, quality of life, positive and negative mood, and depression. Notably, quality of life emerged as being the single variable that was significantly related to participation in the full model. Contrary to other studies, pain did not appear to significantly impact participation outcomes for wheelchair users in this sample. Participation is an emerging area of interest among rehabilitation and disability researchers, and results of this study provide compelling evidence that several psychosocial factors are related to participation. This area of inquiry warrants further study, as many of the psychosocial variables identified in this study (mood, depression, quality of life) may be amenable to intervention, which may also positively influence participation.^

The association between classroom characteristics and student physical activity in physical education classrooms

Background. With the rapid rise in childhood obesity, physical activity participation among young children has become the subject of much recent attention. Physical education classes have been specifically targeted as a method of providing opportunities for all children to be active. Unfortunately, student participation in moderate-to-vigorous physical activity during these classes still falls far below the current recommendations. While some research to date has reported the levels of activity among elementary-aged children, research is limited on the relationship between these activity levels and the environmental characteristics that exist within the PE classroom. ^ Purpose. The purpose of this study is to examine the association between specific classroom characteristics and contextual characteristics (lesson context, class size, class location, teacher gender, and teacher encouragement for PA) with elementary aged children's moderate-to-vigorous activity during PE class. ^ Methods. A secondary analysis of 211 3rd, 4th and 5th grade physical education classes amongst 39 elementary schools in Harris County, TX and 35 elementary schools in Travis County, TX was conducted using cross-sectional data from the evaluation of a school-based health program. Lesson context and student activity levels were measured using a direct observation measurement tool. Additionally, these variables were further analyzed against a number of classroom characteristics to determine any significant associations. ^ Results. Overall, elementary PE classes are still participating in low levels of moderate-to-vigorous physical activity averaging only 38% of class time. Additionally, close to 25% of class time is spent in classroom management. Male directed classes spent significantly more time in game activities and female directed classes spent more time in fitness, knowledge, and skill activities. Classes that took place outdoors were more active and spent more time in games than those that took place indoors. Significant correlations were demonstrated between class size and time spent in management context. Time spent in management context was also correlated with time spent sitting and standing. Additionally, positive correlations were demonstrated between time very active and teachers that praised students and encouraged physical activity among their classes.^

Cost analysis of opt-in consent procedures for the Texas statewide immunization information system, ImmTrac

Background. Childhood immunization programs have dramatically reduced the morbidity and mortality associated with vaccine-preventable diseases. Proper documentation of immunizations that have been administered is essential to prevent duplicate immunization of children. To help improve documentation, immunization information systems (IISs) have been developed. IISs are comprehensive repositories of immunization information for children residing within a geographic region. The two models for participation in an IIS are voluntary inclusion, or "opt-in," and voluntary exclusion, or "opt-out." In an opt-in system, consent must be obtained for each participant, conversely, in an opt-out IIS, all children are included unless procedures to exclude the child are completed. Consent requirements for participation vary by state; the Texas IIS, ImmTrac, is an opt-in system.^ Objectives. The specific objectives are to: (1) Evaluate the variance among the time and costs associated with collecting ImmTrac consent at public and private birthing hospitals in the Greater Houston area; (2) Estimate the total costs associated with collecting ImmTrac consent at selected public and private birthing hospitals in the Greater Houston area; (3) Describe the alternative opt-out process for collecting ImmTrac consent at birth and discuss the associated cost savings relative to an opt-in system.^ Methods. Existing time-motion studies (n=281) conducted between October, 2006 and August, 2007 at 8 birthing hospitals in the Greater Houston area were used to assess the time and costs associated with obtaining ImmTrac consent at birth. All data analyzed are deidentified and contain no personal information. Variations in time and costs at each location were assessed and total costs per child and costs per year were estimated. The cost of an alternative opt-out system was also calculated.^ Results. The median time required by birth registrars to complete consent procedures varied from 72-285 seconds per child. The annual costs associated with obtaining consent for 388,285 newborns in ImmTrac's opt-in consent process were estimated at $702,000. The corresponding costs of the proposed opt-out system were estimated to total $194,000 per year. ^ Conclusions. Substantial variation in the time and costs associated with completion of ImmTrac consent procedures were observed. Changing to an opt-out system for participation could represent significant cost savings. ^

A comparison of labor and delivery management activities in two settings

Similarities and differences in management activities and patient health outcomes between a traditional physician staffed labor and delivery setting and a certified nurse-midwife staffed Birth Center within the same hospital were described. The 950 study subjects, low income, minority women, were classified as low obstetrical risk by a POPRAS score of 25 points or less at time of admission for labor and delivery. The study subjects were similar in demographic, antepartum and intrapartum characteristics; the labor course was problem free for the majority in both settings. There were no remarkable differences in health outcomes between the groups. Management activities varied between settings; these variations were policy related rather than health related. The POPRAS rating system was an accurate predictor for 93% of BC subjects and 85% of LDU subjects. Charge for service was approximately $600 less for BC women; length of stay did not contribute to the difference in charge. Overall, BC respondents to the attitude survey were more satisfied with their labor and delivery experience than L\&DU women. ^

Cross-culture perspectives on fear of HIV disease and AIDS in health care workers

Health care workers have been known to carry into the workplace a variety of judgmental and negative attitudes towards their patients. In no other area of patient care has this issue been more pronounced as in the management of patients with AIDS. Health care workers have refused to treat or manage patients with AIDS and have often treated them more harshly than identically described leukemia patients. Some health care institutions have simply refused to admit patients with AIDS and even recent applicants to medical colleges and schools of nursing have indicated a preference for schools in areas with low prevalence of HIV disease. Since the attitudes of health care workers do have significant consequences on patient management, this study was carried out to determine the differences in clinical practice in Nigeria and the United States of America as it relates to knowledge of a patient's HIV status, determine HIV prevalence and culture in each of the study sites and how they impact on infection control practices, determine the relationship between infection control practices and fear of AIDS, and also determine the predictors of safe infection control practices in each of the study sites.^ The study utilized the 38-item fear of AIDS scale and the measure of infection control questionnaire for its data. Questionnaires were administered to health care workers at the university teaching hospital sites of Houston, Texas and Calabar in Nigeria. Data was analyzed using a chi-square test, and where appropriate, a student t-tests to establish the demographic variables for each country. Factor analysis was done using principal components analysis followed by varimax rotation to simple structure. The subscale scores for each study site were compared using t-tests (separate variance estimates) and utilizing Bonferroni adjustments for number of tests. Finally, correlations were carried out between infection control procedures and fear of AIDS in each study site using Pearson-product moment correlation coefficients.^ The study revealed that there were five dimensions of the fear of AIDS in health care workers, namely fear of loss of control, fear of sex, fear of HIV infection through blood and illness, fear of death and medical interventions and fear of contact with out-groups. Fear of loss of control was the primary area of concern in the Nigerian health care workers whereas fear of HIV infection through blood and illness was the most important area of AIDS related feats in United States health care workers. The study also revealed that infection control precautions and practices in Nigeria were based more on normative and social pressures whereas it was based on knowledge of disease transmission, supervision and employee discipline in the United States, and thus stresses the need for focused educational programs in health care settings that emphasize universal precautions at all times and that are sensitive to the cultural nuances of that particular environment. ^

Democracy in the healthcare workplace: A critical perspective

A review of existing literature revealed at least two distinct theoretical perspectives or schools of thought which are troubled by problems of the lack of participation in the workplace: Jurgen Habermas' ideal of communicative rationality (1984; 1987); and the field of workplace democracy. Whereas Habermas' ideal of communicative rationality establishes communication as necessary to attain a democratic workplace, the ideal of workplace democracy focuses on a participatory ideal in which conditions of open participation must be fulfilled in order to attain a democratic workplace. This study compared the strengths and weaknesses of the conditions proposed by Habermas with the strengths and weaknesses of the conditions selected to represent the workplace democracy ideal. Two incidents were selected for analysis which occurred within a period of one year within one large healthcare organization. The author was present as a participant-observer to assess these incidents. Each of the conditions for the ideal of communicative rationality and for the workplace democracy ideal was systematically applied to both incidents selected for analysis. The results of the analysis suggested that application of Habermas' theory provided more insight into potential distortions in communication than did the conditions selected to represent workplace democracy. Although the conditions of both models were frequently complementary and even overlapping at times, application of each theory to the same incident produced distinctly different results. ^

A systematic review of organizational workplace wellness programs and their financial and nonfinancial incentives

Workplace wellness programs have revealed immense beneficial results for both the employer and employee. Examples of results include decrease in absenteeism, turnover rate, medical claims and increases in employee satisfaction, productivity, and return on investment. However, the approach taken when implementing requires greater attention since such programs and the financial and/or non-financial incentives chosen have shown to significantly impact employee participation thus the amount of savings the organization experiences. A systematic review was conducted to evaluate the overall effectiveness of workplace wellness programs on employee health status and lifestyle change, recognize the majority types of returns observed by such programs, and identify whether financial or non-financial incentives created a greater effect on the employee. Overall employee health status improvement occurred when participating in wellness programs. The dominant indirect benefit for the organization was employee weight loss leading to a decrease in absenteeism and direct benefits included decreases in medical claims and increases in return on investment. In general, factors such as rate of participation and health status changes were most influenced when a financial incentives was provided in the wellness program. The basis of providing a program with effective incentives resides from efforts made by the employer and their efforts to play a role on every level of the organization regarding planning, implementing, and strategizing the most optimal approach for creating changes for the employees' wellbeing and productivity, thus the organizations overall returns.^

Participation of bcl -2 and bax in epidermal homeostasis and non-melanoma skin cancer

Non-melanoma skin cancer (NMSC) is the most frequently diagnosed form of cancer in United States. As in many other cancers, this slow growing malignancy manifests deregulated expression of apoptosis regulating proteins including bcl-2 family member proteins. To understand the role of apoptosis regulating protein in epidermal homeostasis and progression of NMSC, we investigated keratinocyte proliferation, differentiation and tumorigenesis in bcl-2 and bax null mice. The rate and the pattern of proliferation and spontaneous cell death were the same between the null and the control mice. Both bcl-2 and bax null epidermis showed decreased levels of cytokeratin 14 expression compared to the control littermates. Also, the gene knock out mice showed higher expression of cytokeratin 1 and loricrin in epidermis compared to the control mice. The apoptotic response to genotoxic agent, UV radiation (UVR), was assessed by counting sunburn cells. The bax null keratinocytes showed a resistance to apoptosis while bcl-2 null mice showed an increased susceptibility to cell death compared to the control mice. Moreover, we demonstrated an increase in tumor incidence in bax null mice compared to control littermates in the in vivo chemical carcinogenesis study. Next, we examined the tumor suppressor role of bax protein in NMSC by studying its participation in repair of UVR-mediated DNA lesions. In UVR treated primary keratinocytes from bax deficient mice, the level of CPD remaining was twice that of control cells at 48 hours. Similar results were obtained using embryonic fibroblasts from bax null and bax +/+ embryos, and also with a bax deficient prostate cancer cell line in which bax expression had been restored. However, the repair rate of 6-4 PP was unaffected by the absence of bax protein in all three of above mentioned cell types. In conclusion, bax protein may have a dual function in its role as tumor suppressor in NMSC. Bax may directly or indirectly facilitate DNA repair, or programmed cell death if DNA damage is too severe, thus, in either function, preserving genomic integrity following a genotoxic event. ^