Objectives: To assess the intake of milk and alternatives, calcium, and vitamin D in on-reserve First Nations youth in Ontario, Canada; and the relationship of these nutrients to body mass index. To assess the impact of a simple food provision program on the intakes of milk and alternatives among First Nations youth in Kashechewan First Nation and Attawapiskat First Nation, Ontario, Canada. To assess the process of implementing a comprehensive school nutrition education program, as well as its effects on the intake of milk and alternatives, as well as knowledge, intentions, and self-efficacy among First Nations youth in Fort Albany First Nation, Ontario. Methods: Twenty-four hour diet recall data collected by web-based survey between November 2003 and June 2010 (including pre- and post-program) were used to assess intakes. Milk and alternatives, calcium, and vitamin D intakes were described and compared to food and nutrition standards and to intakes in the general population (CCHS cycle 2.2), and related to BMI. Data collected in different years for the same community and season were used to assess yearly effects on milk and alternatives intake (four communities). Data collected in the same year and season but from different communities were used to assess latitudinal effects on milk and alternatives intake (four community pairs). Paired change in intakes was evaluated one week-post snack program implementation in Kashechewan and Attawapiskat, as well as one year post-program in Kashechewan. Change in intakes as well as knowledge, self-efficacy, and intentions were evaluated in Fort Albany after the completion of a comprehensive school-based program. Student (grades 6-8), teacher (from grades K-8), and parent impressions were collected via questionnaires and focus groups. Results: Mean intakes of milk and alternatives, calcium, and vitamin D were below recommendations and levels seen in the general population. No relationship between body mass index and milk and alternatives, calcium, or vitamin D intake was detected. Latitudinal and yearly variation in intakes was detected in the communities under study. Pilot school food provision programs improved intakes in the short-term under close to ideal circumstances, including adequate dedicated personnel and resource support. After one week, calcium intake increased in Kashechewan (p=0.044), while milk and alternatives (p=0.034) and vitamin D (p=0.022) intakes increased in Attawapiskat. Multiple logistical barriers meant that these improvements were not sustained in the long-term. A comprehensive program in Fort Albany was successful in increasing knowledge (p=0.050) and intentions (p=0.010) towards milk and alternatives intake. Students were generally grateful for the snack programs, and especially enjoyed the hands-on lessons in Fort Albany. Teachers in Kashechewan thought that the snack program was very valuable for students and helped with their alertness and attentiveness. In Fort Albany, teachers noted that it was helpful to have an outside person who could devote all of their time to teaching the students about nutrition; they thought that the students gained a whole new perspective about nutrition via the program. Parents in Fort Albany were enthusiastic about the school nutrition program, but noted availability and cost as major barriers to healthy eating. Conclusions: The low milk and alternatives, calcium, and vitamin D intakes seen in the study population parallel results seen in studies of other Canadian Aboriginal populations. Further study is needed to clarify the relationship between milk & alternatives intake and BMI in this population. Latitudinal and yearly variations in intake were identified, and therefore should be accounted for when tailoring interventions to specific First Nations; the needs, opportunities, and barriers in each case may differ significantly. This study demonstrated that school food provision programs were valued by students, parents, and teachers; and were efficacious in improving short-term intakes. Comprehensive programs were shown to improve student knowledge and intentions to make healthy food choices. In order to support long-term effectiveness, the barriers identified through this research, including the need for adequate and sustainable resources, must be addressed.

Objective: The objective of this study was to understand school administrators’ experience using the Youth Smoking Survey (YSS) school smoking profile to inform and improve future knowledge exchange strategies with schools. Methods: This study employed a two-phase, sequential explanatory mixed method approach. Phase One consisted of a close-ended mail-out questionnaire to 111 school administrators who had not viewed their schools’ feedback report. Phase Two consisted of telephone interviews with consenting questionnaire participants. Results: Of the 111 eligible schools, 71% (N=79) responded to the questionnaire; 29 school administrators participated in the follow-up interviews. Overall, questionnaire respondents rated the feedback report’s layout very positively in terms of clarity and relevancy, but somewhat less positively on timeliness and level of detail (too much). The majority of school administrators (82%) plan to use the feedback report when planning programs, curriculum, or events, and would primarily discuss the report with teachers, students, and parents. While interview participants provided positive feedback regarding the communication quality, relevance, timeliness, and content of the smoking profile, further investigation revealed a weak relationship between these information characteristics and knowledge use (conceptual and instrumental). The weak association could be attributed to the small sample (N=29), the fact that participants had not previously viewed their feedback reports, and did not have adequate time to incorporate the findings into their practice. Conclusions: The findings have contributed to our understanding of the knowledge utilization process of school administrators. Specifically, it examined how end users perceived source and information characteristics in school smoking profile, and the extent conceptual and instrumental knowledge use are associated with the these characteristics. Findings will guide profile revisions and process.

As the Canadian population ages, the burden on our community and health care systems of age-related conditions, such as dementia, is increasing and research in these areas is becoming more critical. Dementia is a major health concern for adults as they age. Although dementia is the most common neurological disease in older adults, headaches are the most common neurological disorder across all ages. Migraines are a common form of headache disorders that affect millions of people worldwide. Both neurological disorders—dementia and migraines—cause significant impairment for the individual and strain on their caregivers, as well as substantial economic impact on society. The relationship between migraines and late-life cognitive health outcomes has not yet been thoroughly explored. Using data from the Manitoba Study of Health and Aging (MSHA), the relationship between migraines and various late-life cognitive health outcomes, including overall dementia, Alzheimer’s disease (AD), vascular dementia (VaD) and cognitive impairment-no dementia (CIND), was examined. As migraines and cognitive impairments are often associated with various comorbid disorders, analyses also investigated the impact of possible associated intervening variables: hypertension, diabetes, stroke, myocardial infarction and other heart conditions. A secondary focus of this project was to examine whether the association between migraines and late-life cognitive health outcomes varied by sex and family history of dementia. Migraines were a significant risk factor for both overall dementia and AD. However, the relationship between migraines and overall dementia appeared to be driven by the significant relationship between migraines and AD. Having a history of migraines was not significantly related to VaD. However, stroke was a statistically significant intervening variable in the relationship between migraines and VaD, indicating that the vascular event, stroke, plays an important part in the migraine-VaD relationship. A history of migraines was not a significant risk factor for CIND. Results could not be stratified by sex because of all participants with migraines, no men developed dementia and only one man developed CIND. Furthermore, despite a lack of significant results from models stratified by family history of dementia, the results are suggestive of possible genetic influences in the relationship between migraines and AD. Overall, this study supports the conclusion that migraines are a significant risk factor for late-life cognitive health, specifically AD. In addition, this study highlights the possibility that vascular events, such as stroke, may play an important role in the relationship between migraines and VaD. Increased understanding of mid-life risk factors for late-life cognitive health outcomes has important implications for researchers and clinicians in the form of interventions, preventative treatments and medications. In addition, this study suggests that there is a need for further research regarding possible genetic influences in the relationship between migraines and AD. As it was unable to be fully addressed in this study, future studies should investigate gender differences among individuals with migraines developing late-life cognitive health outcomes. This research aims to help develop new strategies that could aid in the prevention of cognitive decline, improve quality of life, and increase the likelihood of healthy aging.

Obesity is an accumulation of adipose tissue to the point of negative health outcomes; the association of obesity with type 2 diabetes and cardiovascular disease is particularly profound. Notably, obesity has begun to be associated with impairments in cognitive function; however, the underlying cellular mechanisms are poorly understood. Behavioural studies have demonstrated a link between a high fat diet and impaired hippocampal function, and our aim was to characterize protein level changes in the hippocampus of an obese female rat model. Female rats were fed either a control diet (CD; 10% kcal from fat), or a high-fat diet (HFD; 45% kcal from fat) for 16 weeks. Body weight, food consumption, fasting blood glucose levels, and glucose tolerance were monitored. Upon sacrifice brain, liver, adrenal glands, spleens and fat pads were harvested and analyzed. Plasma leptin and insulin levels were also measured. The distribution of NMDA receptor subunits was examined by using either cell-surface biotinylation, or differential filtration-centrifugation followed by immunoblotting. The feeding protocol induced an obese phenotype in female rats characterized by larger fat pads, spleens and adrenal glands, as well as greater problems handling a glucose load. However, cellular, surface and synaptic expression of NMDA receptor subunits (GluN1, GluN2A & GluN2B) were not significantly altered, which suggests that changes downstream of the receptor may be responsible for the effects of HFD on cognitive behaviour.

Making the transition to an area of specialist nursing practice is challenging for both the learner and staff who are responsible for education and skill development. This study uses grounded theory methodology to explore the question: "How do nurses learn critical care nursing?"The eight registered nurses who participated in this study were recruited from a range of intensive care settings. The criteria for inclusion in the study included the participant having attained competency within the critical care setting. Data was collected from individual interviews. The findings of this study developed during the coding and comparative analysis process, and subsequently theoretical sampling was used to further explore the identified concepts.This study found that nurses' focus on two main areas during their orientation and induction into critical care nursing practice. These are learning to do (skill acquisition) and learning to be (professional socialisation). The process of transition involves two stages: that of learning to do the tasks related to critical care nursing practice, and the ongoing development of competence and confidence in practice ability. The relationship of the learner with the critical care team is a vital part of the transition to competency within the specialist area.This study identifies factors that influence the learner during transition and also provides an understanding of the strategies used by the learners to attain competency. These findings are applicable to educators and leaders responsible for the education and ongoing learning of nurses within critical care practice. The use of strategies such as simulated learning and repetition are significant in skill acquisition. However attention must also be paid to issues which influence the professional socialisation process, such as the quality of preceptor input during orientation and the use of ongoing mentoring of the learner.

My research explores the lived experience of envy amongst psychotherapists and between psychotherapists in a psychotherapeutic community in New Zealand. It focuses on bringing the experience of envy out of hiddenness and into language.It then explores the understandings and the possibilities of meanings that these experiences have. Previous literature on envy has for the most part discussed the clients' envy for the psychotherapist, and very little has been written about the therapists' envy for the client. My research turns the focus to the psychotherapist as it looks at their envy for each other.As I was interested in the therapists' lived experiences of envy, I chose hermeneutic phenomenology as the methodology to explore these. I drew on the philosophical underpinnings offered by Heidegger, Gadamer and van Manen.What arose from my in-depth conversations with psychotherapists is that while envy is an experienced phenomenon that is for the most part not spoken, the powerful feelings that it evokes have great impact on both those who envy and those who are envied. Envy showed up as arising in a relational context, with perception, time and anxiety as contextual determinants. These, along with the findings of the lived experience of envy as a binding between self and other, as threatening to self and other and as a means of connecting with self and other, are some of the essential points discussed in my thesis.This study provides a starting point for a further exploration of the experience of envy amongst psychotherapists as well as envy's impact on who we are in ourselves and how we are with each other, both personally and professionally.

The analgesic effect of acupuncture is well known. Areas in the brain and higher centres that are activated by acupuncture have been mapped out. Some of these areas are also implicated in the modulation of motor function. In addition to pain relief, acupuncture has been found to increase range of movement in patients with increased muscle tone. There is, however, scant knowledge of the mechanisms underlying this therapeutic effect.

Hypercholesterolaemia (high cholesterol) is a risk factor for atherosclerosis, a major contributor to cardiovascular disease. Much has been written on managing high cholesterol levels including the use of drug therapy and recommendations about beneficial lifestyle changes relating to nutrition and exercise in particular. Despite this, and the need for patients to engage in self management of a condition which may impact invisibly on their health, little is known about how people living with this risk factor actually manage.The purpose of this grounded theory study is to investigate people's process of living with high cholesterol. Eight participants with self reported high cholesterol levels were interviewed and their data analysed using the process of constant comparative analysis, open coding, selective coding and theoretical coding. A substantive theory in the area of patient self-management of high cholesterol levels was generated through the use of this approach. The theory developed was the basic social process of Maintaining Enjoyment of Life, with two supporting categories, Accepting and Getting On With It.Maintaining Enjoyment of Life was central to the participants' process of living with high cholesterol and the recommended health directives. The identification of this basic social process adds to our understanding of the influences on individuals' motivation for behaviour change and adherence to lifestyle changes. The findings of this study provide understanding that issues relating to behaviour change and adherence are not so much about denying that anything is wrong or not taking personal responsibility, but more about trying to hold on to something important, around which the participants' lives revolve. This is Maintaining Enjoyment of Life. By focussing on this basic social process, which is grounded in the participants' data, health professionals could work more effectively towards empowering patients to identify their own individualised strategies for self-management of high cholesterol. In addition, health directives could focus more on process rather than on do(s) and don't(s).

This study uncovers the experience of being ethical from the perspective of pre-registration nursing students. Using the qualitative methodology of phenomenology, specifically that outlined by van Manen, it seeks to show how students act ethically within everyday practice.Ethics is vital to any health related profession and the growing complexity of New Zealand's health care system requires more responsibility for ethical decision making in nursing care. Providing nursing care is an ethically charged undertaking and despite ethics taking an increasingly important place in nursing education few studies show the contextual nature of ethical practice from the perspective of students. This study aims to partly redress this situation.In this study I have interpreted the experiences of twelve pre-registration students. Using seventeen stories shared by the student participants, my personal understandings and literature, the meaning of being ethical has been illuminated. Three themes emerged from the interpretation. These include 'keeping things 'nice'', 'being true to yourself' and 'being present'. This thesis asserts that the overarching theme within these themes is that of 'being constrained and enabled'. Being constrained shows the experiences of students as they live through the tensions of being and doing as they strive to be ethical. Being enabled shows the experience of self-determination. Finally the study maintains that the shaping of ethical practice for undergraduate students may be enhanced when their reality is positioned and valued within educational processes.

Advance directives (ADs) convey consumers' wishes about accepting or refusing future treatment if they become incompetent. The issue of making a particular AD, more commonly referred to as a living will, is the focus of this thesis. The typical direction of the living will is that life-sustaining activities such as the provision of mechanical ventilation should be withheld so that a person may die what is hoped to be a 'peaceful death'. Clearly the whole basis of the thinking behind the recognition of ADs is that patients' wishes should prevail. ADs have been championed by some as a means of preserving both dignity and autonomy at the end of life in the face of increasing medical advances in technology to preserve life indefinitely. ADs are seen as a means of promoting peace of mind in will-makers, of allowing carers and family to honour the person's wishes and of stimulating communication between all involved parties.While at present there is no statutory right for people in New Zealand to make ADs, it is considered they have rights to do so in common law as consumers of health and disability services in this country. Little is known about the views of New Zealanders making ADs or their justification for doing so. This small qualitative study, using a discourse analysis approach after Potter and Wetherell (1987), aimed to investigate how the participants justified making ADs. Six people were interviewed and the transcriptions were analysed identifying three dominant interpretative repertoires and three corresponding subject positions.The findings indicated that the participants positioned themselves: as independent self-determining individuals who knew when they were ready to make ADs after witnessing undesirable deaths of close family members; as judges of knowing when inappropriate treatments lead to undignified deaths; and as concerned parents who want to relieve their families of uncertainty in the future when making surrogate end-of-life decisions for them. Witnessing a prolonged family member's death in the past was a contributing factor to the participants making ADs. The participants' recall of these events led them to make their wishes known in advance so that their families, in turn, would not have to go through a similar experience at the terminal stages of their lives. The overarching motivations for formalising ADs was to avoid having life artificially prolonged by receiving life-sustaining treatments as well as the desire to die a dignified death.This study highlights the need for healthcare professionals to value the importance of advance planning with well adults before they lose the capacity to give informed choices at the end of life. The taking of a values history as part of this advance planning may inform family and healthcare professionals about peoples' general values and at the same time confirm and record end-of-life choices for future reference.