Program for increasing resident's physical activity at the women's home

Obesity and overweight has reached epidemic proportions in the United States, and the prevalence of overweight and obesity among residents of The Women's Home residents is high. This culminating experience is the result of my practicum at The Women's Home located in Houston, TX. The Women's Home is a rehabilitation center for victims of sexual assault, drug abuse, family violence, or a combination. A needs assessment including focus groups and a literature review was conducted to design a a physical activity intervention for the residents. Results from focus group data showed the resident's average BMI was 32, which is termed clinically obese by American standards. The focus groups determined a strong interest (92%) in engaging in more physical activity to combat their weight problem. As well, they expressed interest in using pedometers as a mechanism to increase physical activity. This planned program, “Every Step Counts”, uses reactivity to pedometers in conjunction with goal setting and increased awareness to increasing steps each day. “Every Step Counts” was developed with support and input from stakeholders, with theoretical constructs and previous evidence based studies. Included in this report are recommendations for implementation, program materials, scope and sequence of program activities, and methods for periodic evaluation.^

Using intervention mapping to develop a community garden program at the women's home

This culminating experience was a practice based intervention conducted by an organization, utilizing an intervention mapping approach for the program planning. It took place summer 2010 through spring 2011 and included incorporating a community garden into the Gusto wellness program at The Women's Home. This organization offers long-term residential care, and therapeutic services. Literature relating to community gardens and nutrition behavior change was reviewed. Short-term objectives included: 1) Conducting a needs assessment using focus groups, 2) Designing gardening program components based on intervention mapping guidelines, 3) Constructing a garden bed at Midtown Community Garden for use of The Women's Home, 4) Planning and implementing gardening education, and 5) Assessing feasibility of the garden program. The target population included 24 residents living at the residential dormitory of The Women's Home at the time of this project. The major variables are intervention mapping constructs including: 1) Needs assessment, 2) Preparing matrices of change objectives, 3) Selecting theory-informed intervention methods and practical strategies, 4) Producing program components and materials, 5) Planning program adoption, implementation, and sustainability, and 6) Planning for evaluation. The specific focus was lack of access to fresh fruits and vegetables (FV) for this population. Focus group responses revealed interest in community garden participation. Matrices of change were developed for lack of FV access based on performance objectives for behavioral and environmental factors and related determinants and theory. Methods and strategies were developed to implement a community garden and encourage participation. Program components included initiating a garden club, networking activities, creating gardening curriculum, and participating at Midtown Community Garden. Adoption and implementation performance objectives were outlined, and many were carried out. Evaluation questions were designed and outcomes of the garden project were discussed. ^ Outcomes of the project included exposure of garden topics and activities for The Women's Home residents, focus group responses revealing an interest in gardening among this population, gardening program components designed based on intervention mapping steps, and a constructed garden bed that was used for planting vegetables and flowers through fall 2010. Limited resources and budget along with a lack of a residential coordinator at The Women's Home were the main limiting factors for this project. Future garden projects can be developed using the intervention mapping process.^

The role of a nursing home administrator's education in influencing quality of care in US nursing homes

Nursing home literature links poor management practices to poor quality of care and resident outcomes. Since Nursing Home Administrators (NHAs) require an array of skills to perform their role, it is important to explore what makes a NHA effective. This research fills a gap in the literature and provides a possible option to improve the quality of care in nursing homes. Purpose of the study. The study examines whether NHAs with advanced education (defined as a Masters degree or more) are associated with better quality of care in licensed nursing homes (NHs). Design and Methods. Data was derived from the CDC’s 2004 National Nursing Home Survey, which is a representative sample of NHs across the US. A Donabedian- inspired structure-process-outcomes study model was created to explain how education relates to quality of care. Quality of care was defined as onsite oral care, employee influenza vaccination rates and staff recognition programs. Statistical analyses included multivariate logistic regression; covariates included facility-level variables used in similar peer-reviewed research but also included select measures from the Area Resource File to control for county-level factors. Results. Descriptive and analytical analyses confirm that NHAs with a Bachelor’s degree, Associate degree or high school diploma perform less well than NHAs with a Masters degree or more. NHAs with advanced education are more likely to have onsite dental care and recognition programs for staff than NHAs with a Bachelor’s degree (or less). Also NHAs with less than graduate education are more likely to provide off-site dental care. Employee vaccination rates are not impacted by education. Adding certification, tenure or years of experience to a NHA with advanced education gives them an advantage. In fact, certification and experience alone do not have a positive relationship to care indicators; however adding these to advanced education produces a significant result. Implications. This research provides preliminary evidence that advanced education for the NHA is associated with better quality of care. If future research can confirm these findings, there is merit in revisiting the qualifications. Education can be a legitimate option to support quality improvement efforts in US nursing homes. ^

Ethnic differences in food availability at home among 3--5 year old preschoolers attending Head Start centers in 2008

Background. The childhood obesity epidemic has disproportionately impacted the lives of low-income, minority preschoolers and their families. Research shows that parents play a major role as "gatekeepers" who control what food is brought into the home and as role models for dietary practices. Currently, there is limited research regarding ethnic differences in families of low-income preschoolers. ^ Objective. The objective of this study was to look at ethnic differences in food availability at home among the low-income families of Hispanic and African American preschoolers attending Head Start centers in Harris County, Texas. ^ Design/Subjects. Descriptive data on food availability at home between Hispanic and African American families were used and analyzed for this study. Parents or primary caregivers (n = 718) of children enrolled at Head Start Centers in Houston, Texas completed the Healthy Home Survey. ^ Methods. In the Healthy Home Survey, participants were asked to answer open-ended questions regarding various types of foods currently available at home, such as fresh, canned or jarred, dried and frozen fruits; fresh, canned or jarred, and frozen vegetables; salty snacks, sweet snacks, candy, and soda. Descriptive analyses were conducted to identify significant differences between Hispanics and African Americans via a paired t-test to compare the means of variables between the study groups and a Pearson's chi-square or Fischer's exact (if cell size was <5) test calculated for food availability (food types) between ethnicities to determine differences in distributions. ^ Results. Although both Hispanics and African Americans reported having all categories of food types at home, there were statistically significant differences between ethnic groups. Hispanics were more likely to have fresh fruits and vegetables at home than African Americans. At the same time, more African American families reported having canned or jarred fruits and canned green/leafy vegetables than Hispanics. More Hispanic families reported having diet, regular, and both diet and regular sodas available compared to African American families. However, high percentages of unhealthy foods (including snacks and candy) were reported by both ethnicities. ^ Conclusions. The findings presented in this study indicate the implicit ethnic differences that exist in the food availability among low-income families of Hispanic and African American preschoolers. Future research should investigate the associations between food availability and children's weight status by ethnicity to identify additional differences that may exist.^

Patient-centered medical home technology effects on hypertension and diabetes control

Background: Hypertension and Diabetes is a public health and economic concern in the United States. The utilization of medical home concepts increases the receipt of preventive services, however, do they also increase adherence to treatments? This study examined the effect of patient-centered medical home technologies such as the electronic health record, clinical support system, and web-based care management in improving health outcomes related to hypertension and diabetes. Methods: A systematic review of the literature used a best evidence synthesis approach to address the general question " Do patient-centered medical home technologies have an effect of diabetes and hypertension treatment?" This was followed by an evaluation of specific examples of the technologies utilized such as computer-assisted recommendations and web-based care management provided by the patient's electronic health record. Ebsco host, Ovid host, and Google Scholar were the databases used to conduct the literature search. Results: The initial search identified over 25 studies based on content and quality that implemented technology interventions to improve communication between provider and patient. After further assessing the articles for risk of bias and study design, 13 randomized controlled studies were chosen. All of the studies chosen were conducted in various primary care settings in both private practices and hospitals between the years 2000 and 2007. The sample sizes of the studies ranged from 42 to 2924 participants. The mean age for all of the studies ranged from 56 to 71 years. The percent women in the studies ranged from one to 78 percent. Over one-third of the studies did not provide the racial composition of the participants. For the seven studies that did provide information about the ethnic composition, 64% of the intervention participants were White. All of the studies utilized some type of web-based or computer-based communication to manage hypertension or diabetes care. Findings on outcomes were mixed, with nine out of 13 studies showing no significant effect on outcomes examined, and four of the studies showing significant and positive impact on health outcomes related to hypertension or diabetes Conclusion: Although the technologies improved patient and provider satisfaction, the outcomes measures such as blood pressure control and glucose control were inconclusive. Further research is needed with diverse ethnic and SES population to investigate the role of patient-centered technologies on hypertension and diabetes control. Also, further research is needed to investigate the effects of innovative medical home technologies that can be used by both patients and providers to increase quality of communication concerning adherence to treatments.^

The impact of parent acculturation on parental fruit and vegetable intake, child fruit and vegetable intake, and child perceived access and availability to fruits and vegetables in the home environment

The purpose of this thesis was to investigate the association between parent acculturation and parental fruit and vegetable intake, child fruit and vegetable intake, and child access and availability to fruits and vegetables. Secondary data analysis was performed on a convenience sample of low-income Hispanic-identifying parents (n = 177) and children from a baseline survey from the Sprouting Healthy Kids intervention. T tests were used to examine the association between parent acculturation status (acculturated or non-acculturated) and fruit intake, vegetable intake and combined fruit and vegetable intake of both the parent and the child. T tests were also used to determine the relationship between parent acculturation and child access and availability to fruits, vegetables, and combined fruits and vegetables. Statistical significance was set at a p level of 0.05. The mean FVI for the parents and children were 3.41 servings and 2.96 servings, respectively. Statistical significance was found for the relationships between parent acculturation and parent fruit intake and parent acculturation and child fruit access. Lower acculturation of the parent was significantly related to higher fruit intake. Counter to the hypothesis, higher acculturation was found to be associated with greater access to fruits for the child. These findings suggest the necessity for not only culturally specific nutrition interventions, but the need for interventions to target behaviors for specific levels of acculturation within a culture. ^

Client Home or Agency Office? How Do We Decide Where to See Our Clients?

Decisions about location of services sometimes appear to be made more on the basis of agency preference than assessment of need. Today the profession has enough experience with service locations that it is possible to develop more clear guidelines for the decision about where work with clients should take place, in the client’s home or nearby community or in the practitioner’s office. This study was conducted with two purposes; 1) to identify at a higher level of evidence the various reasons for seeing clients in their own homes and nearby community setting; and 2) to demonstrate how readily available information can be used to gradually increase the level of evidence by which practice decisions are made.

Editorial: Take Me Home, Down Country Roads

Those of us committed to the tenets of Family Preservation must advocate for increased awareness and attention to the needs of children and their families in rural America. "Country roads" and the rural spaces they traverse have been eulogized by many poets and song writers as ideal places to live. But they may not be ideal for everyone. The past few months, it has become all too evident that rural America is not immune to acts of extreme violence by troubled children. Even though almost 1/3 of American youth live in rural areas, they have been "virtually ignored by mental health service planners and providers"(Cutrona, Halvorson, & Russell, 1996, p. 217). Mental health risk factors such as poverty, parental alcohol abuse, and family instability are on the rise in rural areas, and there has been an increase in suicide attempts, family violence, depression, and alcohol abuse (Cutrona, Halvorson, & Russell, 1996; Petti & Leviton, 1986; National Mental Health Association, 1988). Native Americans are especially concerned about the increases in child abuse and neglect, depression, substance abuse, and suicide in their communities.

Parental Employment and Home Visiting Program Service Delivery

Home visiting programs, which provide in-home services to disadvantaged families with young children, rest on the assumption that poor parents can be reached at home. Increased levels of maternal employment raise questions about this assumption. In this study, longitudinal data collected for a home visiting program evaluation were analyzed to assess whether employment patterns of parents who receive home visiting services reflect employment patterns of other poor mothers between 1995 and 2000. The study also addresses the relationship between maternal employment and home visiting service intensity. To effectively reach home visiting participants, service providers may need to modify service delivery practices.

2011 Home Demonstration Gardens

Themes for the 2011 Home Demonstration Garden Field Days included 1) a storybook garden (vegetables and annual flowers named after characters in classic fairytales), 2) warty pumpkins, 3) new flowers and vegetables, 4) summer squash named after types of cats, 5) pole beans, and 6) sunflowers without pollen for use as cut flowers.

2010 Home Demonstration Gardens

Themes for the 2010 Home Demonstration Garden Field Days were several newer cultivars of annual flowers (zinnia, four o’clocks, gazania, gaillardia, petunia, coleus, and vinca), a blooming quilt block, eggplant cultivars (including an inedible eggplant), and a compost trial.

2011 Home Demonstration Gardens

Themes for the 2011 Home Demonstration Garden Field Days included 1) a storybook garden (vegetables and annual flowers named after characters in classic fairytales), 2) warty pumpkins, 3) new flowers and vegetables, 4) summer squash named after types of cats, 5) pole beans, and 6) sunflowers without pollen for use as cut flowers.

Comparative effectiveness, safety and acceptability of medical abortion at home and in a clinic: a systematic review

OBJETIVO: Comparar la efectividad, la seguridad y la aceptación de los abortos médicos practicados en el domicilio con aquellos realizados en la clínica. MÉTODOS: Se realizó una búsqueda sistemática de ensayos clínicos controlados aleatorizados y de estudios de cohortes prospectivos, comparando los abortos médicos realizados en el domicilio y en la clínica. Se realizaron búsquedas en el Registro Central de Cochrane de Ensayos Controlados, EMBASE, MEDLINE y Popline. Los resultados de interés principales fueron el fracaso para abortar completamente, los efectos secundarios y la aceptabilidad. Se calcularon las tasas de probabilidad y sus intervalos de confianza (IC) del 95%. Se reunieron los cálculos aproximados utilizando un modelo de efectos aleatorios. RESULTADOS: Nueve estudios cumplieron los criterios de inclusión (n=4522 participantes).Todos fueron estudios de cohortes prospectivos que utilizaron mifepristona y misoprostol para inducir al aborto. El aborto completo se consiguió en el 86- 97% de las mujeres que se sometieron a un aborto en el domicilio (n=3478) y entre el 80% y el 99% de aquellas mujeres que se sometieron a un aborto en una clínica (n = 1044). Los análisis agrupados de todos los estudios no mostraron diferencias en las tasas de aborto completo entre los grupos (tasa de probabilidad=0,8; IC del 95%: 0,5-1,5). Las complicaciones graves del aborto fueron poco frecuentes. El dolor y los vómitos duraron 0,3 días más en aquellas mujeres a las que se les administró misoprostol en el domicilio, en comparación con las que recibieron el tratamiento en la clínica. Las mujeres que optaron por un aborto médico en el domicilio mostraron un mayor grado de satisfacción, que las llevaría a elegir el método de nuevo y recomendárselo a una amiga, que aquellas mujeres que abortaron en la clínica. CONCLUSIÓN: El aborto en el domicilio es seguro siempre que el lugar cuente con las condiciones incluidas en los estudios. Los estudios de cohortes prospectivos por país no han mostrado diferencias en cuanto a efectividad o aceptabilidad entre abortos médicos en el domicilio y en la clínica.

Educational orientation regarding vocabulary and literacy access : Evaluating the impact of an intervention program designed to promote early learning at home

El estudio evalúa el impacto de un programa de promoción del desarrollo lingüístico y cognitivo para niños de 5 años implementado según dos modalidades: una que implicó acciones de alfabetización familiar en los hogares de los niños (modalidad intensiva) y otra que incluyó la participación de los niños en las salas de jardín de infantes (modalidad extensiva). La evaluación del impacto se realizó por medio de un diseño pre-test ? post-test. Se tomaron pruebas de vocabulario receptivo (VR), producción de categorías (PC) y escritura a una muestra de 214 niños participantes de la modalidad intensiva, 69 participantes de la modalidad extensiva y un grupo control de no participó del programa (49 niños). Los resultados mostraron que la participación en la modalidad intensiva implicó un mayor incremento en las habilidades infantiles de VR, PC que en la modalidad extensiva. A su vez ambas modalidades experimentales mostraron un mayor incremento en las variables examinadas respecto de las observadas en el grupo control. No se detectaron efectos de la escolaridad de la madre y la asistencia previa al jardín. Los resultados mostraron correlaciones significativas entre todas las variables analizadas y el valor predictivo de los puntajes en VR a principio de año respecto de los puntajes en VR y escritura a fin de año.