This research comprises an in-depth study to construct a strategic framework for research in Sport and Exercise Medicine at the University of the Free State in Bloemfontein, South Africa. Sport and Exercise Medicine (SEM) is a young academic discipline in South Africa. Internationally, the status, training, research and level of service delivery in SEM are spread out over a broad spectrum, from a well established and highly specialised medical specialty in certain countries, down to relative obscurity with lack of recognition in mainstream medicine and without specialty status in others. Research is the ideal focus area which will advance the status and recognition of SEM in South Africa and elsewhere, as well as increase the evidence base for SEM, both locally and internationally. A need for relevant research in SEM in South Africa has been recognized. The University of the Free State (UFS) has a young SEM programme, which needs to grow and gain local, national and, eventually, international recognition to make a meaningful contribution to the discipline of SEM. Furthermore, the UFS has embarked on a journey to increase its research outputs and status considerably over the next five to ten years. These conditions provide a golden opportunity to establish a research programme of excellence in SEM at the UFS. Against this background, the problem that was addressed is a lack of co-ordinated, publishable research in the Sport and Exercise Medicine (SEM) disciplines at the UFS, despite many opportunities that are presented. In addition, a relative need for strategic research planning in sport sciences in South Africa and internationally has been recognized. The overall goal of the study was therefore to facilitate high quality, published research in SEM with the view to improve the scientific grounding of the discipline. In order to achieve this goal, the specific aim of the study was to do a critical situation-based analysis of Sport and Exercise Medicine and relevant factors in research and research management, with the view to compile a strategic framework for the development of a research programme in SEM at the UFS. Both qualitative and quantitative research methods were utilised in the study and used in complementary fashion. The methods comprised a literature review, semi-structured interviews and a Delphi survey to determine the key components of the eventual strategic framework. All respondents in the empirical part of the study gave informed consent to participate. Pre-testing of the interview guide and the Delphi questionnaire were done by means of pilot studies. These processes were followed to ensure scientific validity, reliability and trustworthiness of the study. The literature review provided relevant insights into aspects of SEM and SEM research; leadership, management and strategic planning; academic research management; principles of research; as well as strategies and policies influencing research at the UFS. With the literature review as foundation, semi-structured interviews were conducted with current academic role players in SEM at the UFS, as well as with research managers at the UFS, to investigate the practical applications of theory and policy in research at the UFS, to identify challenges in research at the UFS, and to obtain the views of current role players on aspects of a multidisciplinary research framework in SEM at the UFS. Thirteen participants were selected for the semi-structured interviews by means of purposive and sequential sampling methods. The questions in the semi-structured interviews comprised seven categories, namely the status, role and place of SEM at the UFS; stakeholders in SEM research; research strategy; challenges in research; skills, knowledge and status of researchers and research leaders; suggested components of a strategic framework in SEM research; and an open category which invited any further relevant comments. Due to their semi-structured nature, the data obtained from interviews were mostly qualitative, but with quantitative elements. The results of the semi-structured interviews were categorised, analysed and collated in tables. These results were used in the context of the literature review, to construct a Delphi questionnaire which was used in a Delphi process with a panel of national and international experts in SEM research and in research management. The Delphi technique is a method for the collection of opinion on a particular topic, particularly the opinions of experts on the topic at hand. It was therefore chosen as an appropriate tool to test the results of interviews with local experts as interpreted according to the literature, on a panel of experts. The participants in the Delphi process were carefully selected to include national and international experts in SEM education and research, as well as policy-makers, leaders and managers in research. The selected international experts were globally representative. The panel consisted of ten experts. The Delphi questionnaire was constructed in accordance with the semi-structured interviews, but categorised in the sequence of the program logic model of the W.K. Kellogg Foundation, on which the final strategic framework was developed. The categories comprised strategic foundations of a research framework in SEM; the role, place and character of research in SEM at a university; inputs and processes required, challenges expected and outputs envisaged; as well as the expected impact or significance of a research programme in SEM at the UFS and possible ways to measure the progress of the programme. The results of the Delphi survey were analysed and the findings presented and discussed. The final outcome of the study, a strategic framework for research in SEM at the UFS, was created by triangulation of the critical analysis of SEM research and other relevant themes in the literature review, the results of the semi-structured interviews, and the results of the Delphi survey. In the final product, the premises, principles, points of departure and required resources for the development of a strategic framework for a research programme in SEM at the UFS were presented. Detailed formulations of inputs, processes and outputs of the programme were put forward, to culminate in a sustainable research programme. In conclusion of the study, final conclusions were drawn, limitations of the study addressed and recommendations made. The researcher believes that this study will make a unique contribution to the research, further development, and ultimately the status of Sport and Exercise Medicine at the University of the Free State and in South Africa. The challenges identified in the study and the complexities of research development have not gone unnoticed. These challenges will be addressed with passion and determination towards the attainment of the ultimate goal which inspired the study.

This investigation was to determine if rural origin adversely influenced access to a medical education for rural Kentuckians who applied to Kentucky medical schools. An ancillary purpose of the study was to determine the need for an affirmative action program for rural medical school applicants as a means to improve the distribution of physicians in rural areas. / The sample population was limited to applicants to Kentucky's two medical schools who had graduated from a Kentucky high school. Applicants' county of high school graduation was classified by rural or urban status, population and a defined socioeconomic level that was used to compare accepted and rejected applicants' demographic and socioeconomic backgrounds, academic scores and their choices of undergraduate institutions and majors. / Applicants from the less populated and lower socioeconomic counties were disproportionately representative of the population of those counties. Urban applicants attending out-of-state institutions and urban applicants majoring in mathematics-engineering or physical sciences were accepted for admission to a medical school at significantly higher rates than for all other categories. Applicants' overall and science undergraduate grade-point averages, their overall and science Medical College Admission Test scores and accept or reject status were not found to be statistically independent of the population and socioeconomic level of their home counties (p = 0.0001). Discriminant analysis correctly classified 83 percent of the accepted and rejected applicants using four academic and one demographic indices. / It was concluded that academic achievement and access to a medical education were influenced by the demographic and socioeconomic background of Kentucky medical school applicants. Applicants from the more rural and the less affluent counties experienced inequality in access to a medical education. / The findings support legislation enacted by the 1980 Kentucky General Assembly establishing programs designed to increase both the number of rural medical school applicants and acceptees. Further, they imply that other states with large rural areas and persistent medical shortages should examine access to a medical education for their rural residents. / Source: Dissertation Abstracts International, Volume: 43-07, Section: B, page: 2152. / Thesis (Ph.D.)--The Florida State University, 1982.

A study of nursing and medical technology students in baccalaureate programs in eight universities and medical centers was conducted to attempt to explain the difference in field mode between students and practitioners of allied health. An earlier pilot study reveals that the majority of nursing and medical technology students are field dependent while the majority of practitioners in these areas are field independent. With alpha set at .05, chi-square analysis of the pilot study results reveals the field mode difference to be significant at a p less than .001. / The work of previous investigators indicates that stress producing situations debilitate the recall of learned material for field dependent subjects. Subsequent research was conducted to determine the interactions of field mode according to Witkin's model, general mental ability, and test construction in the evaluation of learning of allied health students. Students were assessed by the Group Embedded Figures Test to determine if they are perceptually field dependent or independent and then classified into high and low mental ability groups based on the total of their Scholastic Aptitude Test scores. Students in each of the resulting four groups were then randomly assigned a general biology examination in either a complex multiple choice format or a short answer free response format. Students also responded to a survey form which assessed their preference for various modes of evaluation and instruction. / With an alpha set at .05, analysis of variance of the subsequent research data reveals a significantly higher performance of high mental ability students than low mental ability students on the general biology examination at a p less than .001. Interactions between field mode, mental ability, and test construction are not significant. Individualized testing formats for allied health students on the basis of field mode or mental ability does not appear to be justified by the subsequent research results. The field mode difference between students and practitioners of allied health may possibly be explained by the fact that students change their field mode from dependent to independent due to exposure to complex testing formats or that through self selection processes, field dependent practitioners may tend to go into less stressful, nontechnical positions. Further research should investigate such possible explanations. / Source: Dissertation Abstracts International, Volume: 41-03, Section: B, page: 0882. / Thesis (Ph.D.)--The Florida State University, 1980.

Source: Dissertation Abstracts International, Volume: 37-07, Section: B, page: 3342. / Thesis (Ph.D.)--The Florida State University, 1976.

Thesis (Ph. D.)--University OF MICHIGAN.

Currently, effective treatment strategies for patients with severe chronic obstructive pulmonary disease (COPD) are limited. A widely used treatment method is exercise rehabilitation, which has a multitude of benefits on quality of life, improving exercise tolerance and decreasing hospitalizations. However, patients with more severe cases of COPD are unable to train at exercise intensities high enough to significantly improve disease-related skeletal muscle abnormalities such as losses in muscle mass and strength. Our group has recently shown the feasibility and safety of an eccentric (ECC) cycle training intervention in COPD as an alternative modality that can load the muscle four times as much as typical concentric (CON) cycle training at the same metabolic cost (Rocha Vieira, Baril et al. 2011). However, the skeletal muscle adaptations to ECC cycling compared to CON cycling in COPD have not been examined in the literature. In our study, patients were randomized to either an ECC (n=8) or CON (n=7) cycle training group to train for 10 weeks, three times per week for 30 minutes and matched for metabolic cost at 60-80% CON V̇O2peak. Pre and post-training assessments were taken of the patient's body composition, peak muscle strength and muscle fiber type and size by immunolabeling cross-sections of vastus lateralis muscle needle biopsies. Compared to CON training, we found that ECC training resulted in significant increases in lean body mass with an accompanying decrease in body fat mass. Along with this we found that, ECC training resulted in significant increases in muscle strength, whereas CON training did not. At the single fiber level, we found that CON resulted in increases in average fiber size that was principally drive by an increase in type 1 fiber size, however no changes were seen in patients performing ECC training. In both groups no significant changes in fiber type proportions occurred with training. ECC cycling had a moderately greater augmenting effect on lean muscle mass and strength than CON cycling, making it a useful alternative for severe COPD patients due to its high force production at an equivalent metabolic cost, which may prove important in preventing disease related muscle atrophy. / Actuellement, on constate un manque de stratégies de traitements efficaces pour les patientes atteints de maladie pulmonaire obstructive chronique (MPOC) sévère. Une méthode de traitement des plus répandues est l'exercice de réadaptation qui possède de nombreux bienfaits tels que l'amélioration de la qualité de vie, l'augmentation de la tolérance à l'effort et une diminution du nombre d'hospitalisations. Cependant, dans les cas les plus sévères plusieurs patients ne sont pas en mesure de faire de l'exercice à une intensité assez forte pour améliorer les anomalies des muscles squelettiques, une caractéristique importante de la MPOC, comme la perte de la masse musculaire, la force musculaire et un changement des proportions des fibres. Récemment, notre groupe de recherche a démontré la faisabilité et la sécurité d'une intervention en entraînement en cycle de musculation excentrique (EXC) dans les cas de MPOC. En effet, l'exercice excentrique permet d'ajouter 4 fois plus de résistance musculaire que l'entraînement en cycle concentrique (CONC) typique, et ce, au même cout métabolique. Par contre, les adaptations des muscles squelettiques au cycle EXC en comparaison à celles au cycle CONC dans les cas de MPOC n'ont pas été documentées dans les publications. Dans cette étude, les patients ont été randomisés en deux groupes, EXC (n=8) ou CONC (n=7) pour dix semaines d'entraînement, 3x par semaine pour 30 minutes pour un même coût métabolique CONC de 60-80% V̇O2max. Les mesures ont été prises avant et après l'entraînement : la composition corporelle, la force musculaire maximale, une biopsie à l'aiguille du vaste latéral pour l'analyse de l'expression protéinique MHC et pour la grandeur de la fibre musculaire. Les résultats ont démontré qu'en comparaison avec l'entraînement CONC, l'entraînement EXC permet une augmentation significative de la masse corporelle maigre accompagnée d'une diminution de la masse corporelle grasse. De plus, nous avons remarqué que l'entraînement EXC a résulté en une augmentation significative de la force musculaire, mais l'entraînement CONC n'a pas résulté en une augmentation significative de la force musculaire. Néanmoins, l'entraînement CONC a résulté en une augmentation plus grand de la grandeur des fibres en moyen et spécifique à fibres qui expresse le protéine MHC type 1. En les deux groupes, il n'y a pas un changement significatif des proportions des fibres après l'entraînement. L'entraînement EXC a résulté en une augmentation plus grande de la composition corporelle et la force musculaire que l'entraînement CONC. L'entraînement EXC est une alternative utile pour éviter la perte de la masse musculaire dans les patients plus sévère a cause de la diminution de la coûte métabolique et l'augmentation de la force musculaire pendant l'entraînement.

The Health Professions Council of South Africa requires all Health Practitioners to complete accredited learning opportunities, and provide proof thereof, for the purpose of updating their knowledge and acquire new skills. Continuing Professional Development is the chosen model, which has a goal of holistic development of practitioners. The Department of Family Medicine, University of the Free State, provides such opportunities through Refresher Courses, which covers common fields of interest over a period of three years. The goal of this study was to find reasons and possible solutions for the perceived lack of interest in these Refresher Course learning opportunities and to determine how the Department of Family Medicine could adapt their education strategy to meet the needs of General Practitioners. A cross-sectional study design was chosen, by which a questionnaire was posted to randomly chosen participant in the Free State Province. The needs and preferences of General Practitioners regarding their continuous development were queried and factors influencing their usage of learning opportunities were assessed. The study revealed that General Practitioners still prefer a lecture form of presentation in large or small groups. They prefer the current format to continue, but find it difficult to leave their practices unattended. There is a slight movement towards training opportunities on computer. Thus, although the current format should not change, the Department of Family Medicine should consider strategies to accommodate those who find it difficult to attend.

The objective of this Master's thesis was to quantify the effects of repetitive arm motion-induced shoulder fatigue on perceptual characteristics related to shoulder proprioception in a healthy group of male and female adults. Through three simple perceptual tasks, our protocol aimed to assess healthy adults' senses of force, rhythm, and posture in a non-fatigued condition, and in a fatigued condition following an upper-extremity repetitive pointing task (RPT). Repetitive motion-induced fatigue revealed an increase in anterior-posterior center of pressure (CoP) range of motion and displacement, but no change in force matching accuracy, nor in the ability to maintain a particular rhythm during a repetitive arm task. Since our study involved relatively low efforts, compensations from unfatigued muscles possibly explain subjects' ability to preserve certain task characteristics. We do not fully understand the mechanisms by which repetitive arm motion-induced fatigue may impair postural stability, but it is possible that these mechanisms could involve changes in other systems, occurring with global fatigue. More studies are needed to shed light into that question. / Le but de ce projet de maîtrise était de mesurer les effets de la fatigue musculaire sur les caractéristiques perceptives liées à la proprioception dans un groupe de femmes et d'hommes en bonne santé. Par trois simples tâches perceptives, notre protocole visait à évaluer la perception de la force, du rythme, et de la posture dans un état non-fatigué, et dans un état fatigué suite à un mouvement répétitif. La fatigue, provoquée par des mouvements répétitifs, à révélé une augmentation antéro-postérieur de l'amplitude de mouvement et du déplacement du centre de pression, mais aucun changement dans la capacité d'égaler une force, ni dans la capacité de maintenir un rythme particulier au cours d'une tâche répétitive. Puisque notre étude a nécessité des efforts relativement faibles, la préservation de certaines caractéristiques de ces tâches peut être expliquée par l'assistance d'autres muscles non fatigués. Nous ne comprenons pas entièrement les mécanismes par lesquels la fatigue, causée par les mouvements répétitifs du membre supérieur, peut nuire à la stabilité posturale, mais il est possible que ces mécanismes pourraient impliquer des changements dans d'autres systèmes. D'autres études seront nécessaires pour répondre à cette question.

Introduction: In years 1994 to 1997, the Kateri Memorial Hospital Center in conjunction with the Kahnawake Education Center, and the Kahnawake Schools Diabetes Prevention Project developed an elementary school diabetes prevention curriculum. The curriculum aimed to increase knowledge of type 2 diabetes, healthy eating and active lifestyles of the children with the long term goal of preventing obesity and diabetes among the Kanien'kehá:ka (Mohawk) population of Kahnawake, Quebec. The curriculum consisted of three units: nutrition, fitness, and lifestyles and diabetes, divided into 10, 45-minute lessons for grades 1 through 6. The Kahnawake Diabetes Prevention Project has been involved with one of the longest diabetes prevention school based curricula; it has been implemented in Kahnawake elementary schools for 15 years. Objectives: To evaluate the implementation of the Kateri Memorial Hospital Center health education curriculum in the years 2010/2011 and 2011/2012, and to further explore the barriers and the facilitators of the health education curriculum from the perspectives of teachers, parents, curriculum authors and school administrators. Subjects and Methods: This study adopted a community-based participatory approach. The participants of this study were selected from four groups of people including teachers, parents, curriculum authors and school administrators. The design of this study was qualitative descriptive combined with a cross-sectional survey. Questionnaires were distributed to classroom teachers in the Kahnawake elementary schools. The qualitative portion was undertaken using talking circles with parents, curriculum authors and teachers. Semi-structured interviews were conducted with school principals to understand current issues with the curriculum and to develop recommendations for future changes and implementation. Descriptive statistics were applied to analyze the questionnaire results such as the number of curriculum lessons taught, the number of teachers who implemented the curriculum and the number of students who received the curriculum. The talking circles and the semi-structured interviews were audio-recorded, and transcribed verbatim. Thematic textual analysis was performed to identify emerging themes. Results: The findings showed that participants perceived the health education curriculum as important to the children to increase knowledge regarding health behaviours to prevent Type 2 diabetes. The strengths of the curriculum included factors involving a positive school environment and certain aspects of delivery and curriculum content. Weaknesses included lack of administrative support, instructional time and time management issues, a lack of Mohawk cultural representation, and outdated or missing resource materials. Recommendations addressed curriculum content, cultural integration, methodology development and administrative support to revitalize the curriculum and its delivery. Conclusion: To our knowledge, this project was the first study exploring the barriers and facilitators of this 15-year-old diabetes prevention curriculum. The results obtained from this project provide knowledge on the challenges and the strengths faced with a health education curriculum from different perspectives. The findings will be used to make recommendations for revision, development and implementation of a new health education curriculum. / Introduction: Dans les années 1994 à 1997, le Centre Hospitalier de Kateri Memorial en collaboration avec le Centre de l'Education de Kahnawake ont développé un cursus de la prévention de diabète pour les écoles élémentaire. L'intervention vise à augmenter les connaissances et changer l'environnement physique et les normes sociales des écoles et de la communauté par la promotion de l'alimentation de bonne santé et la mode actif de vie avec l'objectif de longue durée de prévenir l'obésité et le diabète chez la population de Kanien'kehá:ka. Le programme consiste de trois unités: la nutrition, le fitness et les modes de vie, et le diabète, divisé de cours en 10 et 45 minutes pour chaque classe de 1 à 6. Le projet de prévention du diabète de Kahnawake a été impliqué dans un des plus anciens programmes de prévention du diabète en milieu scolaire; il a été mis en œuvre dans les écoles élémentaire de Kahnawake pour 15 ans. Objectifs: D'évaluer la mise en œuvre du programme d'éducation à la santé de l'hôpital de Kateri Memorial dans les années 2010/2011 et 2011/2012, et d'explorer les obstacles et les facilitateurs de la programme du point de vue des enseignants, des parents, des auteurs du programme et les administrateurs scolaires. Objets et méthodes: Cette étude adopte une approche communautaire participative. La population cible de cette étude est sélectionné parmi les trois sous-groupes de personnes dont les enseignants, les parents, les auteurs du programme et les administrateurs scolaires. Le design de cette étude était descriptive qualitative combinée avec une enquête transversale. Les questionnaires ont été distribués aux enseignants d'écoles élémentaires à Kahnawake. La partie qualitative a été menée à l'aide des cercles de discussion avec les parents, les auteurs et les enseignants. Les entrevues semi-structurées ont été réalisées avec les administrateurs des écoles pour mieux comprendre les enjeux actuels avec le programme d'études et d'élaborer des recommandations pour des futurs changements. Les statistiques descriptives ont été appliquées pour analyser les résultats du questionnaire, comme le nombre de leçons du programme enseigné, le nombre d'enseignants qui a implémenté le programme et le nombre d'étudiants qui ont reçu le curriculum. Les cercles de discussion et les entrevues semi-structurées ont été audio-enregistrées et transcrites textuellement. L'analyse textuelle thématique a été réalisée afin d'identifier les thèmes émergents. Résultats: Les résultats ont démontré que les participants perçoivent le programme d'éducation à la santé important pour les enfants à accroître les connaissances sur les comportements de santé pour prévenir le diabète de type 2. Les points forts du programme comprenaient des facteurs impliquant un environnement scolaire positif et certains aspects de la prestation et le contenu du programme. Faiblesses comprenaient le manque de soutien administratif, le temps d'enseignement et les problèmes de gestion du temps, un manque de représentation culturelle Mohawk, et des ressources obsolètes ou manquantes. Recommandations adressées contenu du programme l'intégration culturelle, le développement de la méthodologie et de soutien administratif afin de revitaliser le programme et sa livraison.Conclusion: À notre connaissance, ce projet a été la première étude à explorer les obstacles et les facilitateurs de ce programme de 15 ans de prévention du diabète. Les résultats obtenus à partir de ce projet apportent des connaissances sur les défis et les atouts face à un programme d'éducation sanitaire à partir de perspectives différentes. Les résultats serviront à formuler des recommandations pour la révision ou l'élaboration d'un nouveau programme d'éducation sanitaire.

Canadian women are twice as likely to be severely obese compared to men, are more likely to be physically inactive, and comprise the majority of patients undergoing bariatric treatment for severe obesity. Physical activity (PA) is one of the strongest predictors of successful long-term weight management and is a recommended adjunct to bariatric surgery. However, patients often do not increase levels of PA following surgery and physical inactivity among severely obese women remains poorly understood. Twelve women (mean age 47±9 years), who had undergone bariatric surgery in the last two years, were interviewed to explore perceptions of barriers and facilitators to PA. Thematic analysis resulted in development of three key, interrelated themes: the physical body, appraisal of the physical and social self, and the exercise environment. Barriers to PA included weight-restricted mobility, side effects of surgery, body dissatisfaction, compromised psychological health, competing responsibilities, a lack of exercise self-efficacy and social support, reduced access to accommodating facilities, lack of exercise knowledge, as well as northern climate. Participants reported post-surgical weight loss, weight and health maintenance, enjoyment, body image, supportive active relationships, as well as access to accommodating facilities and exercise knowledge as facilitators and motivators for adoption and maintenance of PA. Suggested appropriate PA counselling strategies and programming for healthcare providers and exercise professionals working with this unique population are discussed. Keywords: physical inactivity; women; severe obesity; weight loss surgery / Les femmes canadiennes ont deux fois plus de chance de souffrir d'obésité morbide en comparaison aux hommes et elles constituent la majorité des patients devant subir une chirurgie bariatrique. L'activité physique (AP) est un des indices les plus important pour une gestion adéquate et long terme du poids et devrait être employée comme complément à la chirurgie bariatrique. Toutefois, les femmes n'augmentent souvent pas leur niveau d'AP suite à une chirurgie bariatrique. L'inaction physique parmi les femmes obèses est un phénomène mal compris. Douze femmes (âge moyen de 47±9 ans) qui ont subi une chirurgie bariatrique dans les deux dernières années ont été interviewées pour étudier leur perception à propos des obstacles et des facilitateurs de l'activité physique. Une analyse thématique a résulté dans le développement de trois thèmes : physique, psychosocial et structurel, s'informant et se renforçant mutuellement. Les femmes ont discuté du fait que les barrières physiques de l'activité physique sont le poids restreignant la mobilité, la réduction d'énergie et les effets secondaires de la chirurgie. Les participantes ont également parlé des obstacles psychosociaux suivants : l'insatisfaction au niveau corporel, le manque d'auto-efficacité, le manque de soutien social, le manque de motivation ainsi que la fragilité du bien-être psychologique. Les barrières structurelles comprenaient quant à elles un manque d'installation et d'équipement adapté pour les obèses, un manque de soutien au niveau de l'information et le climat nordique. Nos résultats aident les professionnels de la santé à comprendre quelques défis des femmes souffrant d'obésité morbide qui veulent un traitement de chirurgie bariatrique en adoptant et maintenant simultanément un style de vie physiquement actif. Des stratégies efficaces d'AP et de mise en place de programmes pour ce type spécifique de patients doivent toucher simultanément les trois thèmes clés d'obstacles compte tenu de leur interaction complexe et de leur impact sur le comportement de l'individu par rapport à l'AP. Mots clés : exercice, femme, problèmes de santé, obésité, perte de poids opération