This thesis is a compilation of literature, and conclusions looking at the relationship between relationship between depression and quality of life in the community based elderly. The literature provided a great deal of information discussion the prevalence of depression in the elderly, and the corresponding need for quality of life.

The Geriatric Depression Scale was used to measure elderly depression, and the Life Satisfaction Index was used to measure quality of life. The two tools are less than 25 items in length promoting the participant's ease in completion. The scoring of the two tools are inverted. A low score on the Depression Scale would indicate a low level of depression, where a high score on the Satisfaction Index would indicate a positive view of quality of life.

The research data will establish the existence of the relationship between depression and quality of life. Even though a statistically significant relationship was established, a low level of predictability was obtained.

During America's history as a nation, the composition of the population has changed from one that was almost totally rural to one that is now predominantly urban. The United States Census Bureau (1990) estimates that 95% of the population in 1790 was rural; today only 25% live in rural areas. In recent years, the size of the rural population has not
declined overall, but is growing more slowly than the suburban population.

The Office of Technology Assessment (OTA, 1991) found that, in general, rural residents tend to be white, native-born, and living in a family headed by a married couple. Rural residents are less likely than urban residents to be employed and to have completed high school. Rural residents have lower incomes than their urban counterparts. Nearly one in four rural citizens lives in poverty, but this rate approaches one out of every two for black families living in rural areas. The 1991 OTA study also showed most rural employment stems from agriculture. This same study found there is a recent trend of locating small manufacturing facilities and other types of light industry in rural areas to take advantage of nonunion environments. However, these companies do not pay much over minimum wage, and benefits such as health insurance are often nonexistent.

The purpose of this study was to describe the knowledge source, knowledge level and attitude of women about to hormone replacement therapy. With this information health care providers can better understand how to assist women to make informed decisions. A literature review was conducted including research on the physiologic effects of hormone replacement therapy, the risks of treatment, and the overall effect of hormone replacement therapy on mortality and life span. Published research related to women’s knowledge and attitude was extremely limited.

The sample used in this study was 30 white married women who belong to a marriage support group at a northwestern Pennsylvania church. The survey used in this study was developed by the researcher. Questions were based on the information in a review of literature. Women were asked to identify the effects of Hormone replacement therapy on physiologic systems. Of a possible 8 correct answers the range was 1 to 5 correct answers with a mean score of 3.6. They were to describe their view of Hormone replacement therapy as beneficial or risky. The study found no participant answered all knowledge questions correctly. The women with the highest scores on knowledge about Hormone replacement therapy also had the most positive attitude.

Further research should be done to verify these results in more diverse populations. Effective ways of educating health care providers and women about hormone replacement therapy need to be developed.

The results of this project is the development of clinical guidelines for the treatment of osteoporosis. Clinical guidelines are a tool for primary care providers to use in planning quality patient care. The guidelines are based on a review of the literature and input from experts in the treatment of osteoporosis.

This study investigated the research questions: How many people have an advance directive? and Do people want their primary care provider to discuss advanced directives during a routine office visit? This nonexperimental, quantitative study used a researcher designed questionnaire. The questionnaire was given to 100 members of a local wellness center who varied in sex, age, marital status and religion. Seventy-nine questionnaires were returned. Twenty-three percent of the research subjects indicated that they had advance directives, which was higher than the 15%-18% reported in the literature for random populations. But, only 43% wanted their primary care provider to discuss advance directives during a routine office visit, well below the 65%-68% reported in the literature for random populations. The results of this study, in contrast to other studies in the literature, showed that these subjects did not want their primary care provider to initiate a discussion of advance directives.

As a result of the human and economic toll associated with musculoskeletal disorders in the workplace, the National Institute for Occupational Safety and Health (NIOSH) declared occupational musculoskeletal disorders to be one of the 10 priority work related conditions (Morbidity and Mortality Weekly Report, 1983).

The push for effectiveness and efficiency in health care has created a need to pursue models of care delivery that focus on outcomes, decrease utilization of clinical resources and promote patient satisfaction. Clinical pathways reflect accumulated knowledge from many disciplines, decrease variations in treatment, promote optimal outcomes and are cost effective.

This project is to develop a clinical pathway to guide the practitioner in the management of lateral epicondylitis in the work setting. The clinical pathway is utilized to address the assessment and treatment of the patient. It serves as a tool to communicate with other health care providers, case managers, employers, and insurance carriers. The pathway is outcome oriented. The goal is to return the employee to regular duty work status, pain free.

The purpose of this research study was to determine if rural health clinics were adequately prepared for pediatric medical emergencies. Preparedness was determined based on availability of minimal basic equipment, medications, and training as identified by the Committee of Pediatric Emergency Medicine guidelines (AAP, 1992). This study focused on rural health clinics in Crawford, Forest, and Venango counties. Eleven clinics participated. It was found that none of the clinics had every piece of equipment, two of 11 (18%) had all medications, and 18% had all the staff with Basic life support certification. The preparedness scores ranged from 35% to 89%, with no clinics reporting all the items recommended for minimal preparedness.

Recommendations included increasing education of primary care providers to better prepare the rural health clinic environment. Further research studies, more published literature, and legislation to establish criteria for minimal equipment, medications, and training were identified to improve preparedness.

This study investigated high school students’ preferences for school-based health services. This non-experimental, quantitative design used a researcher-modified questionnaire. The survey addressed accessibility of services, availability of comprehensive medical services and health education/counseling at school, and identified students’ preferences in those services offered at school. The survey was completed by 117 students at a high school in northwestern, Pennsylvania. Thirty-eight percent stated they should have received health care and did not. Reasons included inconvenient office hours, lack of resources to pay fees, not wanting to see the family doctor, or miss school. These agreed with what is reported in the literature. Students were most interested (60% to 88%) in treatment for minor injuries, illnesses, and having routine physical examinations for sports and working papers. Interest was also high in education on health and nutrition, smoking, drug and alcohol abuse, and weight reduction. Overall, the results of this study agreed with findings in the literature. With the information generated from this study, an initial proposal for a school-based clinic was developed. It included a brief statement of the problem, the results of the needs assessment, statistics showing an increased pattern of usage of health room services, program plan and goals, expected costs, and possible funding sources.