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(1 - 9 of 9)
- Title
- Examining the influence of personal and environmental factors on treatment outcomes in opioid dependent medication-assisted treatment patients.
- Creator
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Placide, Vierne, Unruh, Lynn, Atkins, Danielle, Chisholm, Latarsha, Scott, Blake, University of Central Florida
- Abstract / Description
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Opioid abuse has become a global epidemic and is now a huge public health concern here in the US. Non-medicinal use of opioid prescription drugs is at the forefront of the epidemic and considered the (")gateway(") drug to other illicit opioid use. As opioid prescribing has increased over the last decade in the US, so has opioid-related deaths, surpassing car accidents and suicide as the leading cause of injury-related deaths. Medication assisted treatment (MAT) is fundamental in decreasing...
Show moreOpioid abuse has become a global epidemic and is now a huge public health concern here in the US. Non-medicinal use of opioid prescription drugs is at the forefront of the epidemic and considered the (")gateway(") drug to other illicit opioid use. As opioid prescribing has increased over the last decade in the US, so has opioid-related deaths, surpassing car accidents and suicide as the leading cause of injury-related deaths. Medication assisted treatment (MAT) is fundamental in decreasing opioid abuse overdose and mortality. Therefore, the research study aims to determine if counseling adherence, opioid abstinence, and retention in MATs are influenced by personal characteristics, socio-economic factors, readiness to change, social support, and integrated care. Guided by social cognitive theory, transtheoretical model, and theory of reasoned action, the study will employ a retrospective cohort design utilizing opioid dependent patients from a MAT Program in West Florida. Analysis of three cox regression models indicated for personal factors: an increase in age was associated with patients being more likely to adhere to counseling (p=.001) and retention (p=.034), full-time employment (p=.043) was positively associated with opioid abstinence, whereas part-time employment (p=.037) was positively associated with retention, having insurance (public: p=.000) was positively associated with counseling adherence, opioid abstinence (public: p=.000, private: p=.035) and retention (public: p=.000, private: p=.000). With regards to environmental influences, social support was positively associated with opioid abstinence (p=.022) and integrated care was positively associated with opioid abstinence (p=.027) and retention (p=.000). Examining these factors are necessary to improve treatment adherence and expand MAT programs. Additionally, providing funding is crucial for practitioners to continually create educational intervention strategies to engage patients in treatment, thereby reducing the opioid overdose epidemic. This study extends the literature contributing to understanding personal factors and environmental influences in MATs.
Show less - Date Issued
- 2018
- Identifier
- CFE0007074, ucf:52018
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0007074
- Title
- Interaction between income, health insurance, and self-rated health: A path analysis.
- Creator
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Ashley West, Atalie, Unruh, Lynn, Malvey, Donna, Gau, Jacinta, Martin, Lawrence, University of Central Florida
- Abstract / Description
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The political focus of equitable health outcomes in the United States have long centered on access to medical care. However, there is compelling evidence that access to medical care is only the bare minimum necessary to achieve health, and the true influence of health insurance on health is still unclear. Widely accepted models of health estimate that less than 20% of health outcomes can be attributed to clinical care, while greater than 50% is related to social and economic determinants of...
Show moreThe political focus of equitable health outcomes in the United States have long centered on access to medical care. However, there is compelling evidence that access to medical care is only the bare minimum necessary to achieve health, and the true influence of health insurance on health is still unclear. Widely accepted models of health estimate that less than 20% of health outcomes can be attributed to clinical care, while greater than 50% is related to social and economic determinants of health, with income being the most consistent predictor. As a result, this study investigated whether earned income is related to insurance status on the one hand and self-rated health on the other; whether the association between income and self-rated health is indirectly influenced by the presence of health insurance (-)namely private health insurance; whether there are differences in self-rated health between the privately insured, the publicly insured, and the uninsured; and if duration of uninsurance was inversely associated with self-rated health. As hypothesized, higher income was associated with having health insurance, and in particular private insurance. Among all included predictor variables, higher income and private insurance are the strongest predictors of higher self-rated health, and lower income and Medicaid were the strongest predictors of lower self-rated health. This study affirms that the health of persons with Medicaid is more similar to persons who are uninsured, and the health of persons with private insurance is more similar to those with Medicare. The association between income and self-rated health is indirectly influenced by health insurance. Age and education exerted the strongest overall influence on self-rated health: older respondents had lower self-rated health, and more educated respondents had higher self-rated health. And as uninsurance duration increased, self-rated health decreased. Additional studies are recommended to improve health insurance policy.
Show less - Date Issued
- 2018
- Identifier
- CFE0007308, ucf:52151
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0007308
- Title
- Political, Economic, and Health Determinants of Tuberculosis Incidence.
- Creator
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Rutherford, Ashley, Unruh, Lynn, Rohde, Kyle, Wan, Thomas, Nobles, Matt, University of Central Florida
- Abstract / Description
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The epidemiologic transition has shifted major causes of mortality from infectious disease to chronic disease; however, infectious diseases are again re-emerging as a major global concern (Diamond, 1997; Karlen, 1995; McNeil, 1976). This research aimed to identify potential areas of infectious disease influence that are not health-related in order to help governments and policymakers establish new policies, correct current policies, or further address these issues in order to effectively...
Show moreThe epidemiologic transition has shifted major causes of mortality from infectious disease to chronic disease; however, infectious diseases are again re-emerging as a major global concern (Diamond, 1997; Karlen, 1995; McNeil, 1976). This research aimed to identify potential areas of infectious disease influence that are not health-related in order to help governments and policymakers establish new policies, correct current policies, or further address these issues in order to effectively prevent and combat infectious disease. This study employed a retrospective, cross-sectional, non-experimental design via structural equation modeling (SEM) and examined tuberculosis incidence rates at the country-level. Secondary data from open-source, international databases like World Bank's World Development Indicators, World Governance Indicators, and World Health Organization for the year 2014 was utilized. Results revealed that the latent constructs of political stability, health system indicators, and detection policies directly affected tuberculosis incidence rates; they also exhibited an indirect effect due to covariation. Economic stability did not direct affect tuberculosis incidence, but it indirectly influenced incidence through the covariation of political stability, health system indicators, and detection policies. As a country's political stability increased, tuberculosis incidence decreased. As positive health system indicators increased, tuberculosis incidence decreased. Countries with more Xpert detection policies in place experienced an apparent increase in tuberculosis incidence.
Show less - Date Issued
- 2016
- Identifier
- CFE0006842, ucf:51798
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0006842
- Title
- Rapid Response Teams versus Critical Care Outreach Teams: Unplanned Escalations in Care and Associated Outcomes.
- Creator
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Danesh, Valerie, Neff, Donna, Aroian, Karen, Andrews, Diane, Unruh, Lynn, University of Central Florida
- Abstract / Description
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The incidence of unplanned escalations during hospitalization is undocumented, but estimates may be as high as 1.2 million occurrences per year in the United States. Rapid Response Teams (RRT) were developed for the early recognition and treatment of deteriorating patients to deliver time-sensitive interventions, but evidence related to optimal activation criteria and structure is limited. The purpose of this study is to determine if an Early Warning Score-based Critical Care Outreach (CCO)...
Show moreThe incidence of unplanned escalations during hospitalization is undocumented, but estimates may be as high as 1.2 million occurrences per year in the United States. Rapid Response Teams (RRT) were developed for the early recognition and treatment of deteriorating patients to deliver time-sensitive interventions, but evidence related to optimal activation criteria and structure is limited. The purpose of this study is to determine if an Early Warning Score-based Critical Care Outreach (CCO) model is related to the frequency of unplanned intra-hospital escalations in care compared to a RRT system based on staff nurse identification of vital sign derangements and physical assessments. The RRT model, in which staff nurses identified vital sign derangements to active the system, was compared with the addition of a CCO model, in which rapid response nurses activated the system based on Early Warning Score line graphs of patient condition over time. Logistic regressions were used to examine retrospective data from administrative datasets at a 237-bed community non-teaching hospital during two periods: 1) baseline period, RRT model (n=5,875) (Phase 1: October 1, 2010 (-) March 31, 2011), and; 2) intervention period, RRT/CCO model (n=6,273). (Phase 2: October 1, 2011 (-) March 31, 2012). The strongest predictor of unplanned escalations to the Intensive Care Unit was the type of rapid response system model. Unplanned ICU transfers were 1.4 times more likely to occur during the Phase 1 RRT period. In contrast, the type of rapid response model was not a significant predictor when all unplanned escalations (any type) were grouped together (medical-surgical-to-intermediate, medical-surgical-to-ICU and intermediate-to-ICU). This is the first study to report a relationship between unplanned escalations and different rapid response models. Based on the findings of fewer unplanned ICU transfers in the setting of a CCO model, health services researchers and clinicians should consider using automated Early Warning score graphs for hospital-wide surveillance of patient condition as a safety strategy.
Show less - Date Issued
- 2015
- Identifier
- CFE0006212, ucf:51093
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0006212
- Title
- Work and Family Conflict: A Comparative Analysis Among Staff Nurses, Nurse Managers, and Nurse Executives.
- Creator
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Raffenaud, Amanda, Unruh, Lynn, Liu, Albert Xinliang, Fottler, Myron, Andrews, Diane, University of Central Florida
- Abstract / Description
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The nursing workforce increasingly faces issues that affect clinical and managerial practice. One such issue is work-family conflict (WFC) and family-work conflict (FWC). Nurses face role strain as they confront the pressures from often competing work-and-family roles. This study assessed WFC/FWC among varying nurse roles: staff nurses, managerial nurses, and nurse executives. A random sample of 5,000 nurses, generated from registered nurses practicing in the state of Florida, was surveyed...
Show moreThe nursing workforce increasingly faces issues that affect clinical and managerial practice. One such issue is work-family conflict (WFC) and family-work conflict (FWC). Nurses face role strain as they confront the pressures from often competing work-and-family roles. This study assessed WFC/FWC among varying nurse roles: staff nurses, managerial nurses, and nurse executives. A random sample of 5,000 nurses, generated from registered nurses practicing in the state of Florida, was surveyed for this research study. Nurses were surveyed on demographics, perceptions regarding the work environment, and perceptions of WFC/FWC. Descriptively, nurses experienced more work-family conflict than family-work conflict. Regression analyses and ANOVAs indicated that staff nurses experienced less work-family conflict than nursing managers (second most) and nursing executives (highest). None of the nurse roles experienced significant levels of FWC. White nurses, compared to non-white nurses, experienced less WFC and FWC. WFC increased with shift length but FWC was not significantly affected by it. Paid leave for childbirth was associated with lower FWC. This study holds significant implication for the nursing workforce. Nurse managers and executives showed significantly higher WFC than staff nurses. This may discourage a nurse from taking on leadership roles or lead to leaving them. In an era where nurse managers and leaders are needed, efforts must be taken to decrease WFC/FWC factors. Nonwhite nurses reported higher levels of both WFC and FWC. This may contribute to tension at the workplace and a difficult family life. Leaders must continue to create platforms for nurses of all races and ethnicities to voice their work and family needs, and to be supported when doing so. Nurses working shifts over 8 hours had higher WFC levels. Although 12-hour shifts have been popular among staff and management, their use should be reevaluated. Finally, paid leave for childbirth is a program worth supporting, as it was a factor in lower FWC.
Show less - Date Issued
- 2018
- Identifier
- CFE0007081, ucf:51997
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0007081
- Title
- The Effect of Registered Nurse Supply on Population Health Outcomes: A Distributed Lag Model Approach.
- Creator
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Sampson, Carla Jackie, Unruh, Lynn, Malvey, Donna, Liu, Albert Xinliang, Neff, Donna, University of Central Florida
- Abstract / Description
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Registered nurses (RNs) are essential to providing care in the healthcare system. To date, research on the relationship between healthcare provider supply and population health has focused on physician supply. This study explored the effect of RN supply on population health outcomes in the U.S. This is a retrospective, cross-sectional study of U.S. counties and county equivalents using national data. Seven population health outcomes (total and disease specific mortalities and low infant birth...
Show moreRegistered nurses (RNs) are essential to providing care in the healthcare system. To date, research on the relationship between healthcare provider supply and population health has focused on physician supply. This study explored the effect of RN supply on population health outcomes in the U.S. This is a retrospective, cross-sectional study of U.S. counties and county equivalents using national data. Seven population health outcomes (total and disease specific mortalities and low infant birth weight rate) were the response variables. The predictor variable, RN supply, and some control variables were anticipated to have an asynchronous effect on the seven outcome variables in the hypothesized relationship. Therefore, these variables were examined using three different models: contemporaneous; a three-year lagged; and a distributed lag (both contemporaneous and lagged variables). Quadratic terms for RN and physician supply variables were included. Because the Area Health Resource File (AHRF) outcome variables were skewed toward zero and left censored, Tobit regression analyses were used. Data were obtained from 19 states using historical RN Supply data for 1,472 counties, representing 47% of the total target population of 3,108 U.S. counties and county equivalents. Regions with rural populations(-)the Midwest and Southeast(-)were overrepresented. Higher RN supply is positively related to higher mortality rates from ischemic heart disease, other cardiovascular disease, and chronic lower respiratory disease in the distributed lag models. Higher RN supply is not significantly related to rates of low infant birth weight, infant mortality, or mortality from cerebrovascular disease in any model. Higher RN supply is positively related to total deaths in the contemporaneous and lagged model. The results suggest a counter-intuitive, but non-linear relationship between RN supply and health outcomes. More research is needed to understand these relationships and policies must be devised to reduce the current and growing future RN shortage.
Show less - Date Issued
- 2018
- Identifier
- CFE0007091, ucf:51933
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0007091
- Title
- The Impact of Relational Coordination and the Nurse on Patient Outcomes.
- Creator
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Dejesus, Fanya, Andrews, Diane, Sole, Mary Lou, Neff, Donna, Yan, Xin, Unruh, Lynn, University of Central Florida
- Abstract / Description
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Healthcare quality remains a significant issue due to fragmentation of care in our complex U.S. healthcare systems. While coordination of care is foundational to healthcare quality as well as identified as a National Priority, fragmentation and uncoordinated care continues to afflict our systems. The purpose of this study was to explore the relationship between relational coordination and adverse nurse sensitive patient outcomes, namely hospital acquired pressure ulcers, patient falls with...
Show moreHealthcare quality remains a significant issue due to fragmentation of care in our complex U.S. healthcare systems. While coordination of care is foundational to healthcare quality as well as identified as a National Priority, fragmentation and uncoordinated care continues to afflict our systems. The purpose of this study was to explore the relationship between relational coordination and adverse nurse sensitive patient outcomes, namely hospital acquired pressure ulcers, patient falls with injury, catheter- associated urinary tract infection, and central line-associated blood stream infection. A retrospective correlational survey design using cross sectional data was used to conduct this quantitative study. An electronic relational coordination survey was sent to 1124 eligible registered nurses from 43 nursing units within a 5-hospital magnet-designated healthcare system to gather their perception of the strength of relationship and communication ties of their work team. The nurse practice environment as well as nurse education were control variables. With 406 nurses who completed the survey (36% response rate), findings revealed that the stronger relational coordination ties are amongst the healthcare team, the lower the rate of adverse nurse sensitive patient outcomes as indicated by their inverse relationship. (rs=-.31, p=.050). In a Negative Binomial Regression model, relational coordination was a significant predictor (?-1.890, p=.034) of nurse sensitive patient outcomes whereas nurse education level (p=.859) and nurse practice environment (p=.230) were not. Data affirms that relational coordination, a relationship and communication intensive form of coordination does impact patient outcomes. This research provides significant information to health care leaders and institutions with goals of improving patient care outcomes through enhancement of coordination of care and optimization of healthcare teams.
Show less - Date Issued
- 2015
- Identifier
- CFE0005939, ucf:50823
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0005939
- Title
- The influence of perceived organizational support, perceived coworker support (&) debriefing on work-related compassion satisfaction, burnout, and secondary traumatic stress in Florida public safety personnel.
- Creator
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Miller, Anastasia, Unruh, Lynn, Zhang, Ning, Wharton, Tracy, Liu, Albert Xinliang, University of Central Florida
- Abstract / Description
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The purpose of this study was to examine the relationships between perceived organizational support, perceived coworker support, and debriefing on the one hand, and compassion satisfaction, burnout, and secondary traumatic stress on the other hand in Florida law enforcement, fire, emergency medical services, and dispatch public safety workers. In order to explore the relationships between these constructs, the research questions examined the relationships of the work environment of Florida...
Show moreThe purpose of this study was to examine the relationships between perceived organizational support, perceived coworker support, and debriefing on the one hand, and compassion satisfaction, burnout, and secondary traumatic stress on the other hand in Florida law enforcement, fire, emergency medical services, and dispatch public safety workers. In order to explore the relationships between these constructs, the research questions examined the relationships of the work environment of Florida public safety by administering surveys gauging perceived organizational support, perceived coworker support, psychological resilience, and debriefing activities that the personnel participate in. The Professional Quality of Life: Compassion Satisfaction and Compassion Fatigue Version 5 was also sent out to establish the self-reported levels of compassion satisfaction, burnout, and secondary traumatic stress. The study found that there were differences in the levels of compassion satisfaction, burnout, and secondary traumatic stress between the public safety fields. It also found that there was a positive relationship between the presence of perceived organizational support, perceived coworker support, psychological resilience, and debriefing activities on at least one of the constructs of compassion satisfaction, burnout, or secondary traumatic stress within the different public safety fields. This study furthers the literature by being the first study to compare the four different public safety fields in the state of Florida and with regards to those constructs.
Show less - Date Issued
- 2016
- Identifier
- CFE0006357, ucf:51533
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0006357
- Title
- Is Conflict a Factor in a Population's Quality of Life? A Comparative Study of University Students in the Palestinian Territories and Jordan.
- Creator
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Asi, Yara, Unruh, Lynn, Ramirez, Bernardo, Liu, Albert/Xinliang, Sadri, Houman, University of Central Florida
- Abstract / Description
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As nearly one third of the world's population lives in an area that is in some way touched by war, researchers have long been interested in the varied impacts of conflict on civilians. Many indicators, measuring both physical and mental constructs, have been assessed in war-torn populations from around the world, one of which is health-related quality of life (HRQoL). The occupied Palestinian Territories (oPt) are one region in which copious research on health indicators has been undertaken...
Show moreAs nearly one third of the world's population lives in an area that is in some way touched by war, researchers have long been interested in the varied impacts of conflict on civilians. Many indicators, measuring both physical and mental constructs, have been assessed in war-torn populations from around the world, one of which is health-related quality of life (HRQoL). The occupied Palestinian Territories (oPt) are one region in which copious research on health indicators has been undertaken in an effort to understand how long-term conflict manifests itself in noncombatant populations. However, existing studies focus primarily on indicators within the Palestinian population itself that impact HRQoL, and not on the extent to which the presence of the conflict and its consequences disturb physical and mental health outcomes compared to areas without conflict. The purpose of this study is to evaluate the impact of long-term conflict by comparing HRQoL in the oPt and the neighboring country of Jordan, as well as to assess how demographic factors such as socioeconomic status and household size can moderate or aggravate this impact. The potential mediating factors of insecurity and perceived stress will also be assessed. This study found that the presence of conflict was not the most significant predictor of low HRQoL. The mitigating factor of a traditional foundation of mental resilience in Palestinian culture is addressed as a potential explanation for this result. The implications of this study are wide-ranging, particularly in their ability to contribute to healthcare policy recommendations in war-affected areas, and to bolster our understanding of the health status and needs of those living in these areas.
Show less - Date Issued
- 2015
- Identifier
- CFE0005574, ucf:50233
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0005574
