Teaching Zambian traditional birth attendants to monitor growth of infants : evaluation of an education program

The high infant mortality in Zambia is largely attributable to malnutrition. It is exacerbated by the inability of mothers to recognise threats to nutritional status and take corrective action. Advice in ‘Health Centres’ is often inaccessible to mothers. The Traditional Birth Attendants (TBAs) work with pregnant women in local communities, and the purpose of this study was to develop and implement an educationprogram in growth monitoring and nutrition for the TBAs and then to evaluate its effects. Twenty five TBAs from two peri-urban areas of Kitwe were enrolled in this pilot study and eighteen completed the program. The researcher developed and taught a program to the TBAs over ten days. A pretest was given before the teaching program to enable the researcher to obtain information about the knowledge and skills of the TBAs. Following the teaching program the TBAs were re-tested, with the same questionnaire. Focus groups were conducted to enable the TBA to provide information on the teaching materials and the education program. The TBAs then returned to their communities and put into practice the skills and knowledge they had learned for six months. Their practice was monitored by a trained Public Health Nurse. The researcher also surveyed 38 pregnant women about their knowledge of growth monitoring and nutrition before the TBAs went into the field to work with their local communities. The same questionnaire used with the pregnant women was administered to 38 new mothers with children aged 0 to 6 months to gain information of their knowledge and skills following the work of the TBAs. The program was evaluated by assessing the extent to which TBAs knowledge and skills were increased, the knowledge and understanding of a selection of their clients and the rates of malnutrition of infants in the area under study. The results from the research clearly indicated that the teaching program on growth monitoring and nutrition given to the selected group of TBAs had a positive effect on their knowledge and skills. It was found that the teaching developed their knowledge, practical skills, evaluative skills. That they were able to give infants’ mothers sound advice regarding their children’s nutrition was revealed by the mother’s increased knowledge and the decrease in numbers of malnourished children in the study areas at the conclusion of the research. The major outcomes from the study are: that Zambian TBAs can be taught to carry out an expanded role; field experience is a key factor in the teaching program; making advice available in local communities is important; and preliminary data on the Zambian experience were generated. Recommendations are: The pilot program should be expanded with continuing support from the Health Department. Similar educational programs should be introduced into other areas of Zambia with support from the Ministry of Health. That in administering a teaching program: Sufficient time must be allocated to practical work to allow poorly educated women to attain the basic skills needed to master the complex skills required to competently reduce faltering in their communities. The teaching materials to illustrate nutritional principles for feeding programs must be developed to suite locally available foods and conditions. Methods of teaching should suit the local area, for example, using what facilities are locally available. The timing of the teaching program should be suitable for the TBAs to attend. This may vary from area to area, for example it may be necessary to avoid times traditionally given to fetching water or working in the fields. For similar reasons, the venue for the teaching program should be suitable to the TBAs. The teachers should go into the TBAs’ community rather than causing disruption of the TBAs’ day by expecting them to go to the teacher. Data should be collected from a larger group of TBAs and clients to enable sophisticated statistical analysis to complement data from this pilot program. The TBAs should be given recognition for their work and achievement. This is something which they asked for. They do not ask for payment, rather acknowledgment through regular follow up and approbation.

Effects of strength, flexibility and moderate intensity cardiovascular exercise on measures of fitness in sedentary women

The maintenance of functional physical fitness across the lifespan depends upon the presence or absence of disease, injury, and the level of habitual physical activity. The prevalence of sedentariness rises with increasing age culminating in 31% of elderly women being classified as leading a sedentary lifestyle. Exercise prescription that involves easily accomplished physical activity may result in the maintenance of mobility into old age through a reduction in the risk of premature death and disablement from cardiovascular disease and a reduction in the risk of falls and injuries from falls. It may be that short bouts of physical activity are more appealing to the sedentary and to those in full time employment than longer bouts, and it may be that short bouts of exercise, performed three times per day, can improve physical fitness. The purpose of this study was therefore to examine the problem: Does exercise session duration, initial cardiovascular fitness, and age group effect changes in functional physical fitness in sedentary women training for strength, flexibility and aerobic fitness? Twenty-three, sedentary women aged between 19 and 54 years who were employed at a major metropolitan hospital undertook six weeks of moderate intensity physical activity in one of two training groups. Participants were randomly allocated to either short duration (3 x 10 minute), or long duration (30 minute), exercise groups. The 3 x 10 minute group (n=13), participated in three, 10 minute sessions per day separated by at least 2 hours, 3 days per week. The 30 minute group (n=10), participated in three 30 minute sessions per week. The total amount of work was similar, with an average of 129 and 148 kcal training day for the 3 x 10 minute and 30 minute groups, respectively. The training program incorporated three walking and stair climbing courses for aerobic conditioning, a series of eleven static stretches for joint flexibility, and isotonic and isometric strength exercises for lower and upper body muscular strength. Measures of functional strength, functional flexibility and cardiovascular fitness were assessed prior to training, and immediately following the six week exercise program. A two way analysis of variance (Group x Time) was used to examine the effect of training and group on the dependent variables. The level of significance, 0.05 was adopted for all statistical tests. Mean hand grip strength showed for both groups no significant change over time for the 3 x 10 minute group (30.7kg to 31.7kg) and 30 minute group (30.2kg to 32.4kg). Leg strength showed a trend for improvement (p=0.098) in both the 3 x 10 minute and 30 minute training groups representing a 15% and 18% improvement, respectively. Combined right and left neck rotation significantly improved in the 3 x 10 minute group (82.8° to 92.0°) and 30 minute group (82.5° to 91.5°). Wrist flexion and extension improved significantly in 3 out of the 4 measurements. Left wrist flexion improved significantly by an average of 7.0% for the 3 x 10 minute and 4.9% for the 30 minute group. Right and left wrist extension improved significantly in the 3 x 10 minute and 30 minute training groups (5.9% and 6.8%, respectively). Hip and spine flexibility improved 3.4cm (35.2cm to 38.6cm) in the 3 x 10 minute group, and 6.6cm (37.4cm to 44.0cm) in the 30 minute group. There was a significant improvement in cardiovascular fitness for both groups representing a 22% improvement in the 3 x 10 minute group (27.2 to 33.2 ml kg min), and a 25% improvement in the 30 minute group (27.5 to 34.4 ml -kg min). No significant difference was shown in the degree of improvement in cardiovascular fitness over six weeks of training for subjects of either low or moderate initial aerobic fitness. Grip strength showed no significant changes over time for either the young-aged (19-35 years) or middle-aged (36-54 years) groups. Leg strength showed a trend for improvement (p=0.093) in the young-aged group (63.5kg to 71.9kg) and middle-aged group (69.3kg to 85.8kg). Neck rotation flexibility improved a similar amount in both the young and middle aged groups representing an improvement of 9.9° and 8.0° respectively. There was significant improvement in two of the four measures of wrist flexibility. Hip and spine flexibility was significantly greater in the young-aged group compared to the middle-aged group (38.5cm and 30.7cm, respectively). There was a significant improvement in hip and spine flexibility over the six week training program representing an increase in reach of 6.5cm for the young age group and 4.9cm for the older group. The middle-aged subjects had significantly lower cardiovascular fitness than their younger peers, scoring 22.8 and 30.7 ml -kg min, respectively. Cardiovascular fitness improved a similar amount in both age groups representing a significant improvement of 23.8% and 28.1% for the younger-aged and middle-aged subjects, respectively. The findings of this study suggest that short bouts of exercise may be equally as effective as longer bouts of exercise for improving the flexibility and cardiovascular components of functional physical fitness in sedentary young and middle aged women. Additionally short bouts of exercise may be more attractive than longer bouts of exercise for the beginning exerciser as they may more easily fit into the busy lifestyle encountered by many people in today's society. Sedentary young and middle-aged women should benefit from static flexibility exercises designed to improve and/or maintain functional flexibility and thus maintain mobility and reduce the incidence of muscular injury. Regular, brisk walking, incorporating some stair climbing, is likely to be beneficial in improving cardiovascular health and perhaps also in improving leg strength, thereby helping to improve and maintain functional physical fitness for both young and middle-aged sedentary women.

Ideal golf swing : an evaluation of its characteristics and the assumptions underlying its acquisition during coaching

The game of golf requires hitting a ball from a range of lies over a range of distances in environments that include many obstacles to be avoided. Each of these different golf shots arc designed to move the ball from the tee to the hole in the least number of strokes. However, the fundamental assumption that seems to underlie the coaching of golf, particularly to novice players, is that acquisition of an ideal basic golf swing is the most important outcome of coaching. Implicit in this view are three further assumptions. The first is that once this ideal basic golf swing is acquired by players, they are able to complete a game of golf in a competent manner even though this requires a range of different shots. The second is that there is a close correspondence between the quality of execution of any golf swing as judged in terms of this ideal swing, and the quality of outcome of the golf shot of which the swing is a part, as judged by where the ball comes to rest. The third assumption is that visual inspection of the golf swing by a coach can reveal inadequacies which can be remedied leading lo improved performance in the game of golf. The research reported in this thesis is an investigation of these assumptions. The rationale underlying coaching of golf was examined by reviewing the golf coaching literature (Chapter 1) and conducting a survey of professional golf coaches (Chapter 2). Results of the literature review and the survey indicated that the major emphasis of golf coaching of novices was on their acquiring what might be described as an ideal basic golf swing. This typically involved identifying components in sequence. Little emphasis was placed during this stage of coaching on what might be described as the complete action of a golf shot which involves hitting a ball to some target location. To examine the assumption that there was a close correspondence between the quality of execution of the golf swing and the quality of the outcome of a golf shot, two studies were conducted. In Chapter 3 the development of a 70-item checklist to be used to evaluate the quality of execution of a golf swing is reported. This checklist was based on a detailed behavioural analysis of the golf swing involving collaboration with relevant experts (i.e., golf coaches, biomechanist, kinesiologist), and information derived from a review of golf coaching materials. Development of the checklist was an iterative process in which earlier versions were used to evaluate sample golf swings, and problems identified during this lest process were used to improve the checklist. The final 70-item checklist comprised of a static component with three parts (left-hand grip; right-hand grip; stance) and a dynamic component with six parts (half backswing; full backswing; half downswing; ball contact; half followthrough; finish position). This version of the checklist was used in a study (reported in Chapter 4) of the relationship between the judged quality of execution of a golf swing and the outcome accuracy of a golf shot. Three groups of golfers with varying ability and experience were required to hit 50 balls with a 9-iron club to a target. Outcome accuracy for each shot was assessed in terms of the distance between the target and the resting location of the ball. Edited videotapes (showing only execution of the golf swing) of the five most, and five least accurate shots produced a sub-sample of these golfers (four professional players; four novice players) were subsequently viewed by three expert coaches. They independently rated using the checklist, the quality of execution of the 80 golf swings in random order without having information about the accuracy of any shot. As expected, the professional golfers completed more accurate golf shots than did the novices, and the golf swings completed by the professionals were rated more highly than those completed by the novices. However, for both groups of golfers the results indicated that there was no clear relationship between the rated quality of execution of golf swings and the outcome accuracy of the shots of which the swing were the initial part. Chapter 5 provides a summary and overview of the research reported in Chapter 1 to 4. It is argued that this research suggests a need for a change of emphasis in golf coaching away from consideration of the golf swing in isolation to consideration of the golf swing as part of a complete action. That is, the quality of execution of a golf swing should not be judged simply in relation to some ideal set of golf-swing components, but rather in relation to how well the completed swing (i.e., the golf shot) achieves the desired aim of propelling the ball from its present location to the target location.

Leptin and the development of obesity

The focus of this thesis was leptin and its role in the development of obesity and non-insulin-dependent diabetes mellitus (NIDDM). Studies in Psammomys obesus, a polygenic animal model of obesity and NIDDM, showed that ob gene expression and plasma leptin concentration correlated significantly with body weight, percentage body fat and plasma insulin concentration. In addition, plasma leptin concentrations were significantly elevated in insulin resistant Psammomys obesus independent of body weight. Dietary energy restriction from weaning in Psammomys obesus prevented excessive body weight gain, hyperleptinemia and hyperglycemia compared with ad libitum fed animals. Interestingly, 19% of the energy-restricted animals still developed hyperinsulinemia and tended to have increased plasma leplin compared with normoinsulinemic energy-restricted Psammomys obesus. Fasting for 24 hours significantly reduced plasma leptin concentration in lean, insulin-sensitive but not obese, insulin-resistant P. obesus, suggesting a dysregulation in the response of leptin to acute caloric deprivation in these animals. The effects of leptin administration to P. obesus were also investigated. Single daily intraperitoneal injection of 5 mg leptin/kg body weight for 14 days had no significant effect in lean or obese P. obesus. This dose had previously been shown to rapidly and significantly reduce food intake and body weight in ob/ob and wild-type mice, suggesting relative leptin resistance in P. obesus. Acute (8 hour) effects of administration of 5 mg leptin/kg body weight were also investigated. No significant effects on food intake or plasma insulin were detected, however blood glucose concentrations were significantly elevated in obese, glucose intolerant P. obexus, suggesting an exacerbation of insulin resistance in susceptible animals. Treatment of lean, healthy P. obesus with 45 mg leptin/kg body weight/day for 7 days resulted in significant decreases in food intake and percentage body fat, showing that the leptin resistance observed in this species could be overcome by the administration of very large doses of leptin. In another study, leplin was shown to significantly inhibit maximal insulin binding to isolated adipocytes, suggesting that leptin may respresent an important link between obesity and NIDDM. Links between aspects of obesity and NIDDM and polymorphisms in the ob and p3-adrencrgic receptor genes were also investigated in two human populations.

Life events and cognitive processing in sexually dysfunctional individuals

The aim of this study was to make an assessment of the role of the cognitive component in the development of sexual dysfunction. Past studies have largely focused on the impact of particular events on sexual dysfunction and have not assessed the role of the perception of these events. A number of theories on sexual dysfunction have been developed to explain the influence of cognitions, but these have not been empirically tested. This study investigated the role of the cognitive evaluation of sexual experiences among 30 sexually dysfunctional participants and 30 control participants who were matched on age, marital status and biological sex. The Cognitive Aspects of Sexual Dysfunction Measure (CASDM) was constructed to evaluate sexual dysfunction. This measure was designed to tap into the major events in participants’ lives and, more importantly, the participants’ perceptions of these events. The components assessed were the intergenerational (family of origin), individual, current life and relationship aspects of the person’s life. These factors were measured from the responses to questions regarding the participant's cognitions about past experiences, the effect of the past experience on the participant at the lime it occurred and the influence this experience had on the participant's sense of self now, their relationship now and sexual functioning now. The main findings in the intergenerational area were that past experiences were perceived by the sexually dysfunctional group to be having an impact on the self, relationships and their sexual functioning although there were no actual differences between the sexually functional and the sexual dysfunctional participants in the occurrence of the event. For the individual factors, there were differences between the sexually functional and sexually dysfunctional participants in both values and lifestyle, although these were not perceived to be having an impact on the self, relationship and sexual functioning. In the relationship area, anger was the major factor separating the sexually functional and sexually dysfunctional groups. Anger was high among the sexually dysfunctional participants and was perceived to be having an impact on self, the couple’s relationship and their sexual functioning. The importance of all these variables in providing a better understanding of the cognitive factors in sexual dysfunction was discussed. The findings demonstrate the importance of cognitions in influencing sexual functioning. Clinicians should not simply deal with the life experiences of sexually dysfunctional people when attempting to change their behaviour, but should focus on changing cognitions about the behaviours in relation to sexual functioning.

Response of the child with autism to preferred prosody during instruction

It has been found that incorporating preferences leads to improvements in target skills for children with autism. No studies have been found, however, that assess the preferences of children for prosody of teacher instruction. Prosody has been defined by fluency of speech, modification of pitch and stress of syllables. This research assessed the preference for, and effectiveness of, prosody of instruction by teachers of children with autism. The preferences of children with autism for monotone, conversational and enthusiastic voice prosodies were assessed. The children's teachers made recording of their own voice reading a story passage in the three selected prosodies. The children with autism were requested to listen to these recordings and select a preferred prosody over thirty three trials. Chi square analyses were conducted to determine the significant preferences from these trials. The selections of prosody of the children with autism were compared with the selections of typical children of the same age. Significant preferences were found for three children with autism and seven typical children. The three children with autism with significant preferences were observed in their classrooms. Teachers were cued with flashcards to use the different prosodies and the children's responses were recorded. An additional twenty instructions were recorded in which the teachers were not given a cue for voice prosody Chi square and Fisher's exact tests indicated that children's preferences did not influence their responses to prosody during classroom instruction. In other words the response in class was not related to prosody preference. Overall children were more likely to not respond to the monotone prosody. The enthusiastic and conversational prosodies were equally effective. Therefore it was concluded that continued and varied use of enthusiastic and conversational prosodies during classroom instruction would be effective for children with autism. It was recommended that future research focus on evaluating the effectiveness of variety of prosody for children with autism.

Multi-type maltreatment : relationships between familial characteristics, maltreatment and adjustment of children and adults

This thesis examines the nature, extent and impact of multiple forms of maltreatment (multi-type maltreatment) from within a developmental victimological framework. The interrelationships between sexual abuse, physical abuse, psychological maltreatment, neglect, and witnessing family violence are assessed. The role of family variables in predicting maltreatment and the relative contribution of child maltreatment and family variables to adjustment are evaluated. Risk factors for multi-type maltreatment, and the relationship between multi-type maltreatment and adjustment are explored. The major theories of child development are reviewed. As well as exploring the relevance of developmental theories to understanding the impact of child maltreatment, factors influencing the emergence of child psychopathology are reviewed from a developmental psychopathology perspective. Ecological and developmental perspectives on how child maltreatment translates into the behavioural and emotional adjustment problems of children are integrated in the Child Maltreatment: Risk and Protection Model. After exploring some of the relevant conceptual issues, the literature on the prevalence and impact of each maltreatment type is reviewed, and the literature on multi-type maltreatment critiqued. Methodological and ethical concerns with the conduct of research in the field of child maltreatment using direct assessment of children led to the need for an instrument to assess parent perceptions of each of the types of abuse and neglect, as well as adult retrospective reports. Data are presented from two cross-sectional questionnaire-based studies using the Parent and Adult versions of the Family and Life Experiences Questionnaire which was designed to assess perceptions of children's experiences of sexual abuse, physical abuse, psychological maltreatment, neglect and witnessing family violence. Problems with the isolated focus of research on single forms of child maltreatment are addressed by the inclusion of each of these forms of child maltreatment within a single research design. Respondents for both studies were volunteers recruited from counselling agencies, medical, community health, child care and fitness centres and a first year psychology course. Parents (N=50) described their perceptions of primary school children's family characteristics, experiences of maltreatment and adjustment. Children's behavioural adjustment (internalising and externalising), sexual behaviours, emotions, self-esteem, gender identity, family adaptability and cohesion, parental traditionality, parental sexual punitiveness, interparental relationship satisfaction, and demographic characteristics are assessed in the study of Parents' perceptions. A large degree of overlap between the different types of abuse and neglect was found, with a high proportion of parents describing children's experiences of multiple forms of child maltreatment. Using both maltreatment and family characteristics to predict internalising behaviour problems, neglect and family cohesion were the only unique predictors. Family adaptability and cohesion were the only unique predictors of externalising behaviour problems. Physical and sexual abuse were not predicted from family characteristics; neglect was predicted, but no variables provided unique prediction. Unique predictors of psychological maltreatment were family cohesion, parental sexual punitiveness and divorce. Divorce was the only variable with significant unique prediction of the child witnessing family violence. Family background and family functioning were found to predict some forms of maltreatment, but to also be important factors mediating the adjustment of children, independent of maltreatment. The results are interpreted within an ecological framework, integrating risk factors for maltreatment with experiences of abuse and neglect and subsequent adjustment in childhood. Retrospective reports of adults' (N=175) own childhood family characteristics, experiences of maltreatment, and reports of their current adjustment are also studied. Included with the adult version of the FLEQ were the Trauma Symptom Checklist-40, Rosenberg's Self-esteem Scale, and the Family and Adaptability and Cohesion Evaluation Scale-II. Similar results were found in the in the Adult Study. As hypothesised, adult retrospective reports of the five different types of child maltreatment were found to be highly intercorrelated. Family characteristics predicted maltreatment and adjustment scores and discriminated between single and multi-type maltreatment. Maltreatment scores also predicted adult adjustment. As the number of maltreatment types increased, there was an increase in the number of adjustment problems reported. Alternate hypotheses regarding the possible operation of mediating and moderating processes in the relationships between family characteristics, maltreatment and the adjustment of adults were assessed. Finally, the results of these investigations are discussed and interpreted in the light of extant findings previously reviewed. Data from the two major empirical studies are used to demonstrate the overlap between different child maltreatment categories, and the extent and impact of multi-type maltreatment. The results show that children are vulnerable to more than one type of maltreatment. Individuals who experience a number of different forms of maltreatment had greater adjustment problems than those experiencing only one or two different types of abuse or neglect. Dysfunctional families place children at risk of child maltreatment. Negative family characteristics lead to adjustment problems in children and adults. The type of maltreatment having the most damaging effect on children was neglect, and in the long-term, sexual abuse. A multi-dimensional approach to prevention and intervention needs to be adopted, based on the co-morbidity of maltreatment types, and the likelihood of children experiencing further abuse or neglect of a different type. Dysfunctional family dynamics which place children at risk of multi-type maltreatment, and mediate the effects of maltreatment on adjustment, need to be specifically targeted with support and family intervention strategies. Risk-assessment measures used by Child Protection workers must include adequate knowledge of the inter-relationships between maltreatment types, and the particularly negative impact on adjustment of experiencing many forms of abuse or neglect. Suggestions for future clinical and research work in the area of child maltreatment are developed. The importance of assessing all forms of maltreatment when examining the relationships of maltreatment to adjustment is emphasised. It is recommended that prevention and intervention strategies acknowledge the interrelationships between maltreatment types.

Descriptive epidemiology of Australian football injuries presenting to sports medicine clinics

Sports injury prevention has been the focus of a number of recent public health initiatives due to the acknowledgement that sports injuries are a significant public health problem in Australia Whilst Australian football is one of the most popular participation sports in the country, only very limited data is available about football injuries The majority of sports injury data available for this sport is from hospital emergency departments and elite-level injury surveillance Overall there is a paucity of data from treatment settings other than hospitals In particular, there is a lack of information about the injuries sustained by community-level, junior and recreational Australian football participants. One good potential source of football injury data is sports medicine clinics. Analysis of injury presentations to sports medicine clinics was undertaken to provide a detailed description of the epidemiology of Australian football injuries that present to this treatment setting and to determine the implications for injury prevention in this sport. In addition, the data from sports medicine clinics was compared with existing sources of Australian football injury data to determine how representative sports medicine clinic data is of other football injury data sources and to provide recommendations for future injury surveillance n Australian football. The results contained in this thesis show that Australian football is the sport most associated with injury presentation at sports medicine clinics. The majority of injured Australian football players presenting to sports medicine clinics are community-level or junior participants which suggests that sports medicine clinics are a good source of information on the injuries sustained by sub-elite football participants. Competition is the most common context in which Australian football players presenting to sports medicine clinics are injured. The major causes of injuries to Australian football players are being struck by another player, collisions and overuse. Injuries to Australian football players predominantly involve the lower limb. Adult players, players who stopped participating immediately after noticing their injury and players with overuse injuries are the most likely to sustain a more severe injury (i.e. more than four weeks before a full return to football participation and a moderate/significant amount of treatment expected). The least experienced players (five or less years of participation) are more likely to require a significant amount of treatment than the more experienced players. The prevention of lower limb injuries, injuries caused by body contact and injuries caused by overuse should be a priority for injury prevention research in Australian football due to the predominance of these injury types in the pattern of Australian football injuries Additionally, adult players, as a group, should be a focus of injury prevention activities in Australian football due to the association between age and injury severity. Overall, the pattern of Australian football injuries presenting to sports medicine clinics appears to be different than reported by club-based and hospital emergency department injury surveillance activities. However, detailed comparison of sports medicine clinic Australian football data with other sources of Australian football injury data is difficult due to the variable methods of collecting and reporting injury information used by hospital emergency department and club-based injury surveillance activities. The development of a standardised method for collecting and reporting injury data in Australian football is strongly recommended to overcome the existing limitations of data collection in this sport. In summary, sports medicine clinics provide a rich source of Australian football injury data, especially from the community and junior levels of participation. The inclusion of sports medicine clinic data provides a broader epidemiological picture of Australian football injuries. This broader understanding of the pattern of Australian football injuries provides a better basis for the development of injury prevention measures in this sport.

Liver fat metabolism, obesity and diabetes in Psammomys obesis

Defects in fat metabolism are central to the aetiology and pathogenesis of obesity and type II diabetes. The liver plays a central role in these disease states via its regulation of glucose and fat metabolism. In addition, accumulation of fat within the liver has been associated with changes in key pathways of carbohydrate and fat metabolism. However a number of questions remain. It is hypothesised that fat accumulation within the liver is a primary defect in the aetiology and pathogenesis of obesity and type II diabetes. Fat accumulating in the liver is the result of changes in the gene expression of key enzymes and proteins involved with fat uptake, fat transport, fat oxidation, fat re-esterification or storage and export of fat from the liver and these changes are regulated by key lipid responsive transcription factors. To study these questions Psammomys obesus was utilised. This polygenic rodent model of obesity and type II diabetes develops obesity and diabetes in a similar pattern to susceptible human populations. In addition dietary and environmental changes to Psammomys obesus were employed to create different states of energy balance, which allowed the regulation of liver fat gene expression to be examined. These investigations include: 1) Measurement of fat accumulation and fatty acid binding proteins in lean, obese and diabetic Psammomys obesus. 2) Characterisation of hepatic lipid enzymes, transport protein and lipid responsive transcription factor gene expression in lean, obese and diabetic Paammomys obesus. 3) The effect of acute and chronic energy restriction on hepatic lipid metabolism in Psammomys obesus. 4) The effect of sucrose feeding on the development of obesity and type II diabetes in Psammomys obesus. 5) The effect of nicotine treatment in lean and obese Psammomys obesus, 6) The effect of high dose leptin administration on hepatic fat metabolism in Psammomys obesus. The results of these studies demonstrated that fat accumulation within the liver was not a primary defect in the aetiology and pathogenesis of obesity and type II diabetes. Fat accumulating in the liver was not the result of changes in the gene expression of key enzymes and proteins involved in hepatic fat metabolism. However changes in the mRNA level of the transcription factors PPAR∝ and SREBP-1C was associated with the development of diabetes and the gene expression of these two transcription factors was associated with changes in diabetic status.

Role of leptin receptors in the development of obesity

The focus of this dissertation was leptin and the leptin receptor, and the role of these genes (OB and OB-R) in the development of obesity and type 2 diabetes in humans and Psammomys obesus, a polygenic rodent model of obesity and type 2 diabetes. Studies in humans showed that circulating leptin concentrations were positively associated with adiposity, and independently associated with circulating insulin and triglyceride concentrations. Analysis of two leptin receptor sequence polymorphisms in a Caucasian Australian population and a population of Nauruan males, with very high prevalence rates of obesity, showed no associations between sequence variation within the OB-R gene and obesity- or diabetes-related phenotypic measures. In addition, these two OB-R polymorphisms were not associated with longitudinal changes in body mass or composition in either of the populations examined. A unique analysis of the effects of multiple gene defects in the Nauruan population, demonstrated that the presence of sequence alterations in both the OB and OB-R genes were associated with insulin resistance. Psammomys obesus is regarded as an excellent rodent model in which to study the development of obesity and type 2 diabetes in humans. Examination of circulating leptin concentrations in Psammomys revealed that, as in humans, leptin concentrations were associated with adiposity, and independently associated with circulating insulin concentrations. This animal model was utilised to examine expression of OB-R, and the regulation of expression of this gene after dietary manipulation. OB-R is known to have several isoforms, and in particular, OB-RA and OB-RB gene expression were examined. OB-RB is the main signalling isoform of the leptin receptors. It has a long intracellular domain and has previously been shown to play an important role in energy balance and body weight regulation in rodents and humans. OB-RA is a much shorter isoform of OB-R, and although it lacks the long intracellular domain necessary to activate the JAK/STAT pathway, OB-RA is also capable of signalling, although to a lesser degree than OB-RB. OB-RA is found to be expressed almost ubiquitously throughout the body, and this isoform may be involved in transport of leptin into the cell, although its role remains unclear. OB-RA and OB-RB were both found to be expressed in a large number of tissues in Psammomys obesus. Interestingly, obese Psammomys were found to have lower levels of expression of OB-RA and OB-RB in the hypothalamus, compared to lean animals. This finding raises the possibility that decreased leptin signalling in the brain of obese, hyperleptinemic Psammomys obesus may contribute to the leptin resistance previously described in this animal model. However, the primary defect is unclear, as alternatively, increased circulating leptin concentrations may lead to down-regulation of leptin receptors. The effect of fasting on leptin concentrations and gene expression of OB-RA and OB-RB was also examined. A 24-hour fast resulted in no change in body weight, but a reduction in circulating leptin concentrations, and an increase in hypothalamic OB-RB gene expression in lean Psammomys. In obese animals, fasting again did not alter body weight, but resulted in an increase in both circulating leptin concentrations and hypothalamic OB-RB gene expression. In the liver, fasting resulted in a large increase in OB-RA gene expression in both lean and obese animals. These results highlighted the fact that regulation of leptin receptor gene expression in polygenic models of obesity and type 2 diabetes is complex, and not solely under the control of circulating leptin concentrations. Sucrose-feeding is an established method of inducing obesity and type 2 diabetes in rodents, and this experimental paradigm was utilised to examine the effects of longer term perturbations of energy balance on the leptin signalling pathway in Psammomys obesus. Addition of a 5% sucrose solution to the diet of lean and obese Psammomys resulted in increased body weight in both groups of animals, however only obese Psammomys showed increased fat mass and the development of type 2 diabetes. The changes in body mass and composition with sucrose-feeding were accompanied by decreased circulating leptin concentrations in both groups of animals, as well as a range of changes in leptin receptor gene expression. Sucrose-feeding increased hypothalamic OB-RB gene expression in obese Psammomys only, while in the liver there was evidence of a reduction in OB-RA and OB-RB gene expression in both lean and obese animals. The direct effects of sucrose on the leptin signalling pathway are unclear, however it is possible to speculate that the effect of sucrose to decrease leptin concentrations may have been involved in the exacerbation of obesity and the development of type 2 diabetes in obese Psammomys, From these studies, it appears that sequence variation in the OB and OB-R genes is unlikely to be a major factor in the etiology of obesity in human populations. The ability to examine regulation of expression of these genes in Psammomys obesus, however, has demonstrated that the effects of nutritional modifications on leptin receptor gene expression need closer attention. The role of the OB and OB-R genes in metabolism and the development of type 2 diabetes also warrants further examination, with particular attention on the differential effects of dietary modifications on leptin receptor gene expression across a range of tissues.

Addressing the contradiction between discourse and practice in health promotion

The main theme of this thesis is the contradiction between discourse and practice in health promotion. Many health promoters continue to exert power-over the community through top-down programming whilst at the same time using an emancipatory discourse. The thesis has addressed this contradiction in three parts. The first part determines how the emancipatroty discourse has evolved and eplores the role of social movements in the development of contemporary health discourses and their influence on the legitimisation of empowerment. Central to this discourse is the empowerment of communities. To understand the role of this concept the thesis provides an interpretation of the different meanings of power and community, and the different levels of analysis of empowerment in the context of health promotion programming. The second part identifies the nature of health programming and the dominance of top-down, and to a much lesser extent, bottom-up approaches. The thesis argues that these two approaches are not, and do not have to be, mutually exclusive. To address this issue the thesis presents a new methodology is situated within a framework developed for the accomodation of empowerment goals within health promotion programmes. The study also identifies the organisational areas of influence on the processs of community empowerment and it is these which are used for the assessment of this concept. Both the framework and the methodology address the contradiction in health promotion by making community empowerment operational within a programme context. The third part of the thesis supports the rationale for the design of the methodology with field work in rural Fijian communities. The findings are presented as a composite case study to highlight the experiences of implementing the methodolgy and the main themes that emerged during the field work. the final chapter of the thesis brings together the central themes of the study and draws from these and 'emergent agenda' as a way forward for health promotion research and practice.

Adolescent girls in physical education and sport : an analysis of influences on participation

This study investigates the influences on participation in physical activity of thirty adolescent girls from a metropolitan secondary school in Victoria. It seeks to understand how they perceived, experienced and explained their involvement or non involvement in both competitive and non competitive physical activity during four years of their secondary schooling. Participants experienced physical education as both a single sex group in Years 7 and 9 and a coeducational group in Years 8 and 10. They were exposed to a predominantly competitive curriculum in Years 7 to 9 and a less structured, more social, recreational program in Year 10. These experiences enabled them to compare the differences between class structures and activity programs and identify the significant issues which impacted on their participation. Large Australian population studies have revealed that fewer girls participated in sport and regular physical activity than boys. An important consequence is that girls miss out on the health benefits associated with participating in physical activity. Other research has found adolescence is the time that girls drop out of competitive sport. However, an important issue is whether girls who drop out of competitive sport cease to be involved in any physical activity. There are some studies which have reported good participation rates by adolescent girls in non competitive, recreational forms of physical activity and the possibility exists that they may drop out of competitive and into non competitive physical activity. This study primarily utilises a qualitative approach in contrast to previous studies which have largely relied upon the use of surveys and questionnaires. Whilst quantitative research has provided useful information about the bigger picture, there are limitations caused by reliance on the researchers' own interpretations of the data. Additionally there is no opportunity for any clarification and explanation of findings and trends by the respondents themselves. The current study utilized qualitative individual and collective interviews in three stages. Questions were asked in the broad areas of coeducation and single sex classes, preferences for competitive or recreational activity and body image issues. Some quantitative information focusing on nature and extent of current activity patterns was also gathered in the first stage. Thirty Year 10 girls participated in individual first interviews. Nine selected girls then took part in the second (individual) and third (collective) interview stages. Results revealed three groups based on the nature of physical activity involvement: [1] competitive activity group, [2] social activity group and [3] transition group. The transition group represented those who were in the process of withdrawing from competitive sport to take up more non competitive, recreational activity. The most significant difference between groups was skill level. On the whole those entering adolescence with the highest skill levels, such as those in the competitive group, were the most confident and relished competing against others. The social group was low in skill and confidence and had predominantly negative experiences in physical education and sport because their deficiencies were plainly visible to all. Similarly, a lack of skill improvement relative to those of 'better performers' affected the interest and confidence levels of those in the transition group. Boys' domination in coeducational classes through verbal and physical intimidation of the less competent and confident girls and exclusion of very competent girls was a major issue. Social and transition group members demonstrated compliance with boys' power by hanging back and sitting out of competitive activities. Conversely, the competitive group resisted boy's attempts to dominate but had to work hard to demonstrate their athletic capabilities in order to do so. Body image issues such as the skimpy physical education and sport uniform along with body revealing activities such as swimming and gymnastics, heightened feelings of self-consciousness and embarrassment for most girls. When strategies were adopted by social and transition group members to avoid any body exposure or physical humiliation, participation levels were subsequently affected. However, where girls felt confident about their physical abilities and body image, they were able to ignore their unflattering uniforms and thus participation was unaffected. Specific teaching practices such as giving more attention to boys, for example by segregating the sexes in mixed classes to focus attention on boys, reinforced stereotypical notions of gender and contributed to the inequities for girls in physical education. The competitive group were frustrated with having to prove themselves as capable as boys in order to receive greater teacher attention. The transition group rejected teacher's attempts to coerce them into participating in the inter school sports program. The social group believed that teachers viewed and treated them less favourably than others because of their limited skills. Girls were not passive in the face of these obstacles. Rather than give up physical activity they disengaged from competitive sport and took up other forms of activity which they had the confidence to perform. These activity choices also reflected their expanding social interests such as spending time with male and female friends outside school and increased demands on their time by study and part time work commitments. This study not only highlighted the diversity and complexity of attitudes and behaviours of girls towards physical activity but also demonstrated that they display agency in making conscious, sensible decisions about their physical activity choices. Plain Language Summary of Thesis Adolescent girls in physical education and sport; An analysis of influences on participation by Julia Whitty Submitted for the degree of Master of Applied Science Deakin University Supervisor: Dr Judy Ann Jones This study investigates the influences on participation in physical activity of thirty adolescent girls from a metropolitan secondary school in Victoria in order to understand how girls' perceived, experienced and explained their involvement or non involvement in both competitive and non competitive physical activity. Qualitative individual and collective interviews were conducted. Questions focussed on attitudes about coeducation and single sex classes, preferences for competitive or recreational activity and feelings about body image. Some quantitative information about the nature and extent of current activity patterns was also gathered in the first stage. Thirty Year 10 girls participated in individual first interviews. Nine selected girls then took part in the second (individual) and third (collective) interview stages. Results revealed three clearly different groups based on the nature of physical activity involvement (1) Competitive, (2) Social and (3) Transition (those in the process of withdrawing from competitive sport to take up more non competitive, recreational activity). The major difference between groups was skill level. Those entering adolescence with the highest skill levels were more competent and confident in the coeducational and competitive sport setting. Other significant issues included boys' domination, body image and teaching behaviours and practices.

The story of fable : a narrative analysis of the experience of four registered nurses in their first year of practice

This research explores the transition from student to registered nurse from the perspective of the new graduate. This interpretive study uses narrative analysis as the methodology. Individual stories were collected and processed using the method of core story creation and emplotment (Emden 1998). Four newly registered nurses were invited to share stories related to how they were experiencing their role. Participants were encouraged to tell their stories in response to the open question 'what is it like to be a registered nurse?' In the final step of the analysis one honest and critical story has been crafted (Barone 1992) using a process termed emplotment thus disclosing the themes that allow the stories to be grasped together as a single story (Polkinghorne 1988, Emden 1998). The final story of 'Fable' gives insight into the ways in which newly registered nurses experience their role. Becoming a registered nurse is not easy however, Fable finds that nursing is more than just a job and describes many rewarding experiences. It is hoped that the outcomes of this research will be valuable to students, graduates, nurse academics and the profession of nursing generally by enhancing understandings of the relationship between the graduate and the actual employment experience.

Meaning of home : a comparison of the meaning of home as identified by samples of Victorians with, and without, an intellectual disability

This phenomenological study of the meaning of home from the perspectives of people with and without an intellectual disability sought to identify, (a) any common ‘essence’ of meaning held by and, (b) the nature of any differences of perception between, the groups. Purposive samples of 18 people with an intellectual disability and 21 non-disabled people were surveyed using a semi-structured interview to ascertain their experiences of home and 'non-homes'. Inductive analysis of the data revealed a shared understanding of the meaning of home at a fundamental level. This shared meaning of home was found to comprise: the ability to exert control over an area; having a personalised space; feeling content with the living situation; a sense of familiarity with the setting; a set of behaviours and routines usually only enacted when at home; common names and uses for rooms; socialising at home with others; the importance of a positive social atmosphere in the home; and, recognition of places as non-homes because they lacked one or more of these attributes. Further analysis revealed the essence of home is its experience as the place where stress is most reduced or minimised for the individual. The study demonstrates that the concept of stress is superordinate to previously identified concepts considered fundamental to home such as privacy, control and non-homes. Major differences between the two samples were largely differences of degree with people who have an intellectual disability reporting the same fundamental attributes of home as people who do not have an intellectual disability, but in a less elaborated form. Principal among these differences of degree was the notion of control over the home and its derivative elements which encompassed the whole dwelling including its setting for people without an intellectual disability but was very restricted for people with an intellectual disability being largely confined to the person's bedroom. Socialising in or from the home was also very limited for people with an intellectual disability in comparison with that experienced by non-disabled informants with the former group conveying an impression of leading significantly socially isolated lives at home. The major implications of this study are related to the meaning of home per se, to residential service provision to people with an intellectual disability, and to future research.

Nursing and being nursed from patients' perspectives : an ethnographic study

The research was commenced to understand why patients submissively accept compliance in the nursing relationship. To understand this phenomenon, an anthropological perspective about nursing was sought through ethnographic processes, utilising The Ethnographic Research Cycle and The Developmental Research Sequence as detailed by James Spradley (1980). Ethnographic methods of fieldwork and participant observation were undertaken over a three month period in a district nursing service in a rural area of Victoria, Australia. There are three over arching aims. The first is to record information at risk of being lost, hence the ethnography is an archival record describing insiders' perspectives of nursing practice. Description brings into view broad contextual issues that shape nursing practice, the daily routines and cultural norms of nursing, whilst also giving voice to patients' experiences about being nursed. The early part of the thesis is descriptive of the mundanity of nursing practice and of being a patient as these interactions are of fundamental significance in giving meaning to people's lives. Secondly the inquiry seeks to capture the meaning patients attach to nursing. Further description continued to uncover perspectives of nursing that were layered to present an integrated whole that still acknowledges the integrity of individuals and structures that make up that whole. As the cultural picture gained detail, the expected norms of being a nurse and a patient became evident, revealing how culture gives shape to nursing and being nursed. Notions of time and space were found to be constructs of being a patient which shape the illness experience. They are not necessarily within a patient's control, nonetheless, there is a norm and deviation from this norm has consequences for patients. Thirdly, the ethnography conveys the expected behaviour for a person who becomes a patient, to make known the implicit meanings, norms of behaviour and unwritten rules that a patient needs to understand as they pass through various stages of the health care system. In conclusion, the ethnography consistently reveals the underlying conflict between what nurses believe they do and the meaning attached to the experience of being nursed. For example, some nurses practice with patients' values as central to practice; others believe they care, yet observation and patient conversations suggest that they do not. The ethnography revealed that society expects nurses to elicit and reinforce compliance. Similarly, the power of culture shapes the experience of patients as the desire to be accepted, as a personal need, and as a means of having their nursing needs met, means that patients will invariably be passively compliant. The consequence is that nurses have a dominant power differential over patients, therefore, if nursing is to continue to describe practice as humanistic and caring, they ought to actively seek to be aware of patients' values and be motivated to accept these as central to practice.