The knowledge and promotion of exercise to older adults with type 2 diabetes by dietitian diabetes educators

The extent to which Registered Dietitians (RD) promote exercise as part of diabetes self-management education to older diabetic adults has not been established. This study explored the exercise-related knowledge, design, and content of educational programs among RDs who were Certified Diabetes Educators (CDEs) and non-CDEs. The Exercise Teaching Questionnaire was completed by 94 CDEs and 73 non-CDEs in Florida, California, and Texas. ^ CDEs had significantly (p < 0.001) higher mean Knowledge, Design, and Content scores (11.8 ± 1.1, 33.5 ± 9.4, 26.9 ± 4.8, respectively) than non-CDEs (11.1 ± 1.6, 29.2 ± 11.1, 22.4 ± 7.4, respectively). However, Knowledge means for both CDEs and non-CDEs were above the 85 percentile. Design and content scale responses showed that while dietitians provided basic information about safety and benefits related to exercise, they frequently reported “never” or only “sometimes” making exercise recommendations. ^ Although these results suggest that RDs are knowledgeable about exercise for older adults with Type 2 diabetes, greater importance should be made on training RDs to promote exercise, perhaps with an emphasis on a comprehensive team approach. ^

Managerial work roles of health care executives in the changing environment of academic medical centers

The current U.S. health care system faces numerous environmental challenges. To compete and survive, health care organizations are developing strategies to lower costs and increase efficiency and quality. All of these strategies require rapid and precise decision making by top level managers. The purpose of this study is to determine the relationship between the environment, made up of unfavorable market conditions and limited resources, and the work roles of top level managers, specifically in the settings of academic medical centers. Managerial work roles are based on the ten work roles developed by Henry Mintzberg, in his book, The Nature of Managerial Work (1973). ^ This research utilized an integrated conceptual framework made up of systems theory in conjunction with role, attribution and contingency theories to illustrate that four most frequently performed Mintzberg's work roles are affected by the two environment dimensions. The study sample consisted of 108 chief executive officers in academic medical centers throughout the United States. The methods included qualitative methods in the form of key informants and case studies and quantitative in the form of a survey questionnaire. Research analysis involved descriptive statistics, reliability tests, correlation, principal component and multivariate analyses. ^ Results indicated that under the market condition of increased revenue based on capitation, the work roles increased. In addition, under the environment dimension of limited resources, the work roles increased when uncompensated care increased while Medicare and non-government funding decreased. ^ Based on these results, a typology of health care managers in academic medical centers was created. Managers could be typed as a strategy-formulator, relationship-builder or task delegator. Therefore, managers who ascertained their types would be able to use this knowledge to build their strengths and develop their weaknesses. Furthermore, organizations could use the typology to identify appropriate roles and responsibilities of managers for their specific needs. Consequently, this research is a valuable tool for understanding health care managerial behaviors that lead to improved decision making. At the same time, this could enhance satisfaction and performance and enable organizations to gain the competitive edge . ^

Examination of the impact of personality, social, and cognitive factors on the co-occurrence of health risk behaviors among multi-problem youth: The utility of an integrative framework

Research has identified a number of putative risk factors that places adolescents at incrementally higher risk for involvement in alcohol and other drug (AOD) use and sexual risk behaviors (SRBs). Such factors include personality characteristics such as sensation-seeking, cognitive factors such as positive expectancies and inhibition conflict as well as peer norm processes. The current study was guided by a conceptual perspective that support the notion that an integrative framework that includes multi-level factors has significant explanatory value for understanding processes associated with the co-occurrence of AOD use and sexual risk behavior outcomes. This study evaluated simultaneously the mediating role of AOD-sex related expectancies and inhibition conflict on antecedents of AOD use and SRBs including sexual sensation-seeking and peer norms for condom use.^ The sample was drawn from the Enhancing My Personal Options While Evaluating Risk (EMPOWER: Jonathan Tubman, PI), data set (N = 396; aged 12-18 years). Measures used in the study included Sexual Sensation-Seeking Scale, Inhibition Conflict for Condom Use, Risky Sex Scale. All relevant measures had well-documented psychometric properties. A global assessment of alcohol, drug use and sexual risk behaviors was used.^ Results demonstrated that AOD-sex related expectancies mediated the influence of sexual sensation-seeking on the co-occurrence of alcohol and other drug use and sexual risk behaviors. The evaluation of the integrative model also revealed that sexual sensation-seeking was positively associated with peer norms for condom use. Also, peer norms predicted inhibition conflict among this sample of multi-problem youth. ^ This dissertation research identified mechanisms of risk and protection associated with the co-occurrence of AOD use and SRBs among a multi-problem sample of adolescents receiving treatment for alcohol or drug use and related problems. This study is informative for adolescent-serving programs that address those individual and contextual characteristics that enhance treatment efficacy and effectiveness among adolescents receiving substance use and related problems services.^

The effectiveness of a conceptually-based health and wellness course in developing health related factors, exercise self-efficacy and knowledge of health issues and exercise performance among diverse college students

The purpose of the study was to investigate the physiological and psychological benefits provided by a self-selected health and wellness course on a racially and ethnically diverse student population. It was designed to determine if students from a 2-year Hispanic serving institution (HIS) from a large metropolitan area would enhance their capacity to perform physical activities, increase their knowledge of health topics and raise their exercise self-efficacy after completing a course that included educational and activity components for a period of 16 weeks. A total of 185 students voluntarily agreed to participate in the study. An experimental group was selected from six sections of a health and wellness course, and a comparison group from students in a student life skills course. All participants were given anthropometric tests of physical fitness, a knowledge test, and an exercise self-efficacy scale was given at the beginning and at the conclusion of the semester. An ANCOVA analyses with the pretest scores being the covariate and the dependent variable being the difference score, indicated a significant improvement of the experimental group in five of the seven anthropometric tests over the comparison group. In addition, the experimental group increased in two of the three sections of the exercise self-efficacy scale indicating greater confidence to participate in physical activities in spite of barriers over the comparison group. The experimental group also increased in knowledge of health related topics over the comparison group at the .05 significance level. Results indicated beneficial outcomes gained by students enrolled in a 16-week health and wellness course. The study has several implications for practitioners, faculty members, educational policy makers and researchers in terms of implementation of strategies to promote healthy behaviors in college students and, to encourage them to engage in regular physical activities throughout their college years.

A Case Study of Health Tourism in the Jeju Province, South Korea

The United States Census Bureau (2006) reported that in 2005 more than 46 million Americans lacked health insurance, and that by 2019 national spending for health care would exceed $4.5 trillion (Centers for Medicare & Medicaid Services, 2010). Because those numbers are expected to increase, health tourists are seeking better opportunities for low-cost, high-quality treatment in other countries, plus the added benefit of experiencing foreign cultures. Health tourism is a rapidly growing market in both advanced and developing countries. The purpose of this study was to develop an applicable model of health tourism, the Jeju-Style Health Tourism Model, for Jeju Special Self-Governing Province, in the Republic of Korea (South Korea) and to provide other cities and countries with its implications. This study employed a focus group, indepth interviews, and content analysis to discover important factors in developing the model. The results suggested that four major sources must be executed together to maximize the benefits of health tourism development. On a foundation of natural resources, knowledge-based resources were most important (54.5%), followed by artificial resources (25.7%), and expenses-based resources (19.8%).

The effects of health education on student health -related behaviors

During their transitional period from childhood to adulthood, adolescents engage in risk-taking behaviors that become public health concerns. It is important for school health education professionals to design instructional programs that focus on adolescents' developmental needs and foster healthier lifestyles. The goal of health education is to help students acquire health skills that are necessary to succeed in school and in life. This is especially important because the increase in teenagers' risky behaviors can affect their health, well being, and eventually the course of their lives. ^ This study examined the effects of health education on health-related behaviors of public high school students. A multivariate analysis of variance was conducted to determine whether the comprehensive approach based on The Jessors' Problem Behavior Theory (PBT) had a greater impact on adolescents' risk-taking behaviors than the traditional approach. After 18 weeks of health instruction using one of these approaches, the Youth Risk Behavior Survey (YRBS) was administered to measure the level of subjects' self-reported behaviors in six categories of adolescent risky behaviors: the use of tobacco; the use of alcohol and other drugs; engagement in injurious activities; consumption of unhealthy diet; an inadequate level of participation in physical activities; and engagement in risky sexual activities. ^ The results of this study did not support the hypothesis that using the comprehensive health education approach was more influential than the traditional health education approach in improving students' health-risk behaviors. Further research studies based on bio-psychosocial theories are needed to develop and evaluate methods of instruction and delivery of health skills. ^

Examination of Personality, Social and Cognitive Factors on the Co-Occurrence of Health Risk Behaviors among Multi-Problem Youth: The Utility of An Integrative Framework

Research has identified a number of putative risk factors that places adolescents at incrementally higher risk for involvement in alcohol and other drug (AOD) use and sexual risk behaviors (SRBs). Such factors include personality characteristics such as sensation-seeking, cognitive factors such as positive expectancies and inhibition conflict as well as peer norm processes. The current study was guided by a conceptual perspective that support the notion that an integrative framework that includes multi-level factors has significant explanatory value for understanding processes associated with the co-occurrence of AOD use and sexual risk behavior outcomes. This study evaluated simultaneously the mediating role of AOD-sex related expectancies and inhibition conflict on antecedents of AOD use and SRBs including sexual sensation-seeking and peer norms for condom use. The sample was drawn from the Enhancing My Personal Options While Evaluating Risk (EMPOWER: Jonathan Tubman, PI), data set (N = 396; aged 12-18 years). Measures used in the study included Sexual Sensation-Seeking Scale, Inhibition Conflict for Condom Use, Risky Sex Scale. All relevant measures had well-documented psychometric properties. A global assessment of alcohol, drug use and sexual risk behaviors was used. Results demonstrated that AOD-sex related expectancies mediated the influence of sexual sensation-seeking on the co-occurrence of alcohol and other drug use and sexual risk behaviors. The evaluation of the integrative model also revealed that sexual sensation-seeking was positively associated with peer norms for condom use. Also, peer norms predicted inhibition conflict among this sample of multi-problem youth. This dissertation research identified mechanisms of risk and protection associated with the co-occurrence of AOD use and SRBs among a multi-problem sample of adolescents receiving treatment for alcohol or drug use and related problems. This study is informative for adolescent-serving programs that address those individual and contextual characteristics that enhance treatment efficacy and effectiveness among adolescents receiving substance use and related problems services.

Relation of health related hardiness to health perception and psychosocial adaptation in adult hispanics with chronic hepatitis C

The purpose of this study was to investigate the role of hardiness in health perception and psychosocial adaptation in adult hispanics with chronic hepatitis C (n = 32). The Health Related Hardiness Scale and the Psychosocial Adaptation to Illness Scale were administered to 32 adult hispanics diagnosed with chronic heptitis C at a gastroenterology center. The results indicate that a comparison of subjects with low and high hardiness scores did not reveal significant differences on any of the PAIS domains (health care orientation, sexual relationships, psychological distress, vocational, domestic and social environments). Furthermore, hardiness subscales of control and committment did not have any influence on patient's psychosocial adaptation nor in its domains. However, a comparison of subjects with low and high challenge scores indicates that those with low challenge had lower total psychosocial adaptation scores (M = 5.55, SD = 2.13) than subjects with high challenge scores (M = 4.24, SD = .67) ,t = (1, 30) = 2.34, p < 0.05. Differences were also found for the domains of health care orientation, psychological distress, social and vocational environment. Lastly, there were significant differences on perceived health rating (poor, fair, and good) for the total hardiness score (F = (2,29) =5.49, p < 0.05), control (F =(2,29) = 4.09, p < 0.05), committment (F=(2,29) = 3.76, p < 0.05) and challenge (F=(2,29)= 4.92, p < 0.05). Thus, those patients who rated their health as poor had lower hardiness levels. Findings have implications for promoting hardiness for better health perception and in certain aspects of psychosocial adaptations in adult hispanics with chronic hepatitis C.

The Efficacy of San Lazaro and His Manifestations: Divine Mediators of Health Within Miami's Cuban-American Santeria Community.

This study explored the origins, evolution and influence of the tradition of San Lázaro as it currently pertains to the Cuban-American Santeria community in Miami. The main argument of the study is that in the context of the contemporary religious culture of Santeria in Miami, San Lázaro is a hybrid spirit. Many manifestations of healing entities have come to merge in the person of this spirit. Though practitioners identify with specific manifestations of this spirit, the processes of transmigration have blurred the lines of deep-rooted faiths and created a fusion of meanings from disparate traditions, making San Lázaro an ambivalent personality. San Lázaro’s ambivalence is the very quality that makes him such an important Orisha. As a deity whose personalities demonstrates the combination of a diversity of qualities, including those that contradict each other, San Lázaro is deployed in a very broad range of healing context, making him a versatile Orisha. This study clarified the contrasting qualities this deity embodies and traces the socio-historical context in which the deity acquires the layers of meanings it is currently associated with. Drawing on interviews with Lázaranian worshipers [Lázarenos] in Miami and engaging in Bourdieu’s concept of Habitus, the study provided a window into the nature of the tradition of San Lázaro and how its usage is linked with the African heritage of the worshipers.

Health Literacy and Medicare Recipient's Knowledge of Health Insurance Options

Health literacy is a major problem for the aging population (Parker, Ratzan, & Lurie, 2003). The significance of this study was to access the relationship between health literacy and knowledge of Medicare to determine ways in which seniors can effectively navigate their healthcare insurance.