Thesis--PlanB (M.S.)--University of Wisconsin--Stout, 2004. / Includes bibliographical references.

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

Context: One to three years after Roux-en-Y gastric bypass (RYGB) surgery, patients demonstrate progressive loss of bone mineral density (BMD) and accelerated bone turnover, especially at weight-bearing sites. Objective: The objective was to measure BMD and bone metabolism in relation to extent of weight lost long-term after RYGB. Design and Setting: This retrospective study was conducted ten years after RYGB in a university laboratory and bone metabolism unit. Patients: Fifty subjects (38 females, 12 males) aged 33-69y were recruited from a university bariatric surgery clinic an average of 10.17±3.45y after RYGB. Main Outcome Measure: The primary outcome measurement was the association of total body weight loss with BMD and serum markers of bone turnover. Results: Patients lost 46.0±20.0 kg ten years post-operatively (p<.01). Percentage total body weight loss (%TBWL) was negatively correlated with BMD (total body: r=-.40, lumbar 1-4: r=-.36, and total hip: r=-.51, all p's<.01) and were positively correlated with serum levels of osteocalcin (r=.40, p<.05). When patients were collapsed into tertiles of %TBWL, weight loss >30% was associated with poorest bone health as indicated by lowest BMD scores at all sites (p<.05) and highest levels of osteocalcin (p<.005). Conclusions: The magnitude of total body weight loss long-term after RYGB may provide insight to patient skeletal health ten years post-surgery. Patients who lost >30% total body weight had low BMD and high levels of bone remodeling at the ten-year mark. Healthcare professionals should be aware the risk of fracture or osteoporosis may be elevated among those who lose >30% total body weight ten years after RYGB. / Contexte: Les patients qui ont subi une chirurgie bariatrique de type Roux- en-Y démontrent, un à trois ans après la chirurgie, une perte progressive de leur densité minérale osseuse ainsi qu'un remodelage accéléré de leurs os, surtout dans les régions où le poids est supporté. Objectif: L'objectif fut de mesurer la densité minérale et le métabolisme des os, en relation avec la perte de poids à long terme après une chirurgie bariatrique de type Roux-en-Y.Désign: Cette étude rétrospective a été conçue dix ans après la chirurgie bariatrique de type Roux-en-Y, dans un environnent de laboratoire universitaire et une unité de métabolisme osseuse. Patients: Cinquante patients (38 femmes, 12 hommes), âgés de 33 à 69 ans, ont été recrutés par une clinique de chirurgie bariatrique universitaire environ 10.17±3.45 ans après avoir subi leur chirurgie bariatrique de type Roux-en-Y.Mesure principale: Le résultat des mesures d'intérêts primaires fut l'association entre la perte de poids totale et la perte de densité minérale osseuse ainsi que les marqueurs de sérum pour le remodelage osseux.Résultats: Les patients ont perdu en moyenne 46.0±20.0 kg au cours des dix années suivants la chirurgie (p<.01). Le pourcentage total de poids perdu (%TBWL) était négativement corrélé avec la densité osseuse (corps complet: r=-.40, lombaires 1-4: r=-.36, et hanches: r=-.51, tous p<.01) et positivement corrélé avec le niveau de sérum d'ostéocalcine (r=.40, p<.05). Quand les patients furent séparés en tiers de %TBWL, la perte de poids >30% était associée avec les pires indices de santé osseuse, dont les moins hauts rangs de densité minérale osseuse dans tous les sites et les niveaux les plus élevés d'ostéocalcine.Conclusions: L'ampleur de la perte de poids totale à long terme après une chirurgie bariatrique de type Roux-en-Y peut fournir des indices par rapport à la santé squelettique, dix ans après la chirurgie. Les patients qui ont perdu >30% de leur poids total initial avaient la plus basse densité minérale osseuse et le plus haut niveau de remodelage osseux, dix ans suivant la chirurgie. Les professionnels de la santé devraient être avertis des risques de fractures ou d'ostéoporose élevés, parmi les patients qui ont une perte de poids totale >30%, dix ans après une chirurgie bariatrique de type Roux-en-Y.

Behaviours common among youth (e.g., inconsistent condom use, substance use) place them at increased risk for sexually transmitted infections (STIs). Despite decades of prevention efforts, STIs in youth continue to be a major public health challenge in Canada. Factors affecting school-based intervention success or failure have yet to be explained; contextual factors external to the individual, yet to be defined; and the involvement of youth in the design and evaluation of curriculum interventions, remains poorly documented.A three-phase exploratory study was conducted in two Prince Edward Island schools to describe: (a) factors youth identify as being important to facilitate their ability to take control of their sexual health behaviour, (b) what these youth perceive their needs to be in terms of sexual health education, (c) how they perceive newly developed curriculum resources, and (d) what can be learned about their participation in a curriculum development process.In Phase I, 15 girls and 13 boys participated in focus groups (n=8) and engaged in participatory activities (e.g., reflective writing, role-play, drawing) in order to identify their sexual health education needs and to contribute to the form and content of educational resources to be developed. In Phase II, curriculum experts assisted with refining the youth-generated materials so that they might become resources for use in schools. Eventually this process led to a set of resources (e.g., vignettes, sexual-risk assessment activities, and games) that promote STI/HIV prevention. In Phase III, 22 of the 28 participants from Phase I participated in focus groups (n=4) to evaluate the curriculum resources refined in Phase II. Inductive analyses of data (thematic and content analysis) from student focus groups were undertaken. Youth described positive and negative influences (factors at the intrapersonal, interpersonal, organizational, and community levels) on their ability to take control of sexual health behaviour. The findings from this study offer insight into the social composition of sexual risk that needs to be considered in future intervention studies. A tailored approach to the development of sexual health curriculum resources for youth may improve school-based intervention success toward preventing STIs in this high-risk group. / Certains comportements courants adoptés par les adolescents (l'usage irrégulier du condom ou la consommation d'alcool et de drogues, par ex.) augmentent le risque de contracter une infection transmissible sexuellement (ITS). Malgré les efforts déployés depuis des décennies en matière de prévention au Canada, les ITS continuent de poser un grand défi pour la santé publique au sein de cette population. Les facteurs responsables de la réussite ou à l'échec des interventions en milieu scolaire sont mal connus; les facteurs contextuels (extérieurs à l'individu) restent à définir; enfin, la participation des jeunes à la conception et à l'évaluation des programmes scolaires a fait l'objet de peu d'analyses.Nous avons mené dans les écoles de l'Île-du-Prince-Édouard une étude exploratoire en trois volets qui visait à décrire: a) les facteurs jugés importants par les adolescents afin de favoriser leur propre responsabilisation en matière de santé sexuelle; b) les besoins qu'ils expriment en matière d'éducation sur le sujet; c) leurs perceptions à l'égard des ressources pédagogiques récentes; d) ce qu'on peut apprendre sur leur participation à la conception de programmes scolaires sur le sujet.Dans le cadre du volet I, 15 jeunes filles et 13 jeunes garçons ont pris part à des groupes de discussion (n=8) ainsi qu'à des activités participatives (exercice de réflexion par écrit, jeu de rôles, dessin) dans le but de définir leurs besoins en matière de santé sexuelle et de déterminer le format et le contenu de ressources pédagogiques éventuelles. Dans le volet II, des pédagogues ont contribué à peaufiner le matériel produit par les jeunes en vue de son utilisation en milieu scolaire. Cette démarche a conduit à la production d'un ensemble de ressources axées sur la prévention des ITS et du VIH (par. ex., sketches, activités d'évaluation du risque, jeux). Dans le volet III, 22 adolescents parmi les 28 qui avaient participé au premier volet ont évalué dans le cadre de nouveaux groupes de discussion (n=4) le matériel pédagogique conçu au cours du volet II. Nous avons procédé à une analyse inductive des données recueillies (analyse thématique et analyse de contenu). Les participants ont décrit l'incidence positive ou négative d'un ensemble de facteurs (de nature intrapersonnelle, interpersonnelle, organisationnelle et sociale) sur leur capacité de se responsabiliser. Nos conclusions jettent un éclairage sur la nature sociale du risque sexuel, une dimension qui demandera à être approfondie dans des recherches subséquentes. La conception de matériel pédagogique adapté aux besoins des jeunes pourrait accroître le succès des interventions en milieu scolaire en matière de prévention des ITS au sein de ce groupe à risque élevé.

Health care workers are finding themselves in an era of change with regard to service rendering. Health care workers need to be prepared for these changes during their training. The most important change in the transformation process of health care is the focus on primary health care and associated community-orientated and community-based services. To ensure that the training of prospective speech therapists and audiologists (the health care workers) is applicable with regard to preparing for service, the curriculum must be such that the expected outcome will be achieved through the education and training students receive. There are, however, also changes with regard to training in the policies and regulations of higher education that must be adhered to. In order to adapt to all the changes in health care service and the changes in policies and regulations for training, it is necessary to change and adapt the strategies for training too. Training and service rendering can only be effective if it meets with the requirements of the relevant professional board, health care bodies and the regulating bodies of higher education. The requirements of health care and education and the associated changes, however, necessitate a review of curricula for education and training programmes. When a new curriculum has to be developed or an existing curriculum is reviewed, the process is to be conducted according to specific steps and various factors need to be attended to. If these steps are defined and the factors that influence the education and training together with the requirements regarding content, the education and training process and the desired outcomes are described, it is called a framework for the programme. The research problem defined, was that no guidelines or framework existed according to which a curriculum for a training programme for speech therapy and audiology could be adapted, revised or developed. This led to the formulation of the research question, namely: What should be included in a framework for an undergraduate education and training programme to ensure that the training programme meets the requirements of the above mentioned bodies? The main purpose of this study was to make a contribution to health care in South Africa by making a contribution to the education and training of a group of health care workers. The goal was to compile a framework for undergraduate education and training programmes for speech therapy and audiology. In order to achieve the goal, a comprehensive literature study was conducted to study curriculum development, existing curricula and the requirements of relevant bodies. A concept framework was developed and verified by an empirical study through the application of the Delphi technique. The data were processed and analysed and the final product, a framework for the training programme for undergraduate speech therapy and audiology, was established. The literature study served as the basis of this investigation. The Delphi technique was applied to verify the concept framework that had been developed on the basis of the literature study. The concept framework initially consisted of 183 statements, describing aspects and elements of the curriculum design process and content of the curriculum. Each statement was to be judged according to a three-point rating scale, namely essential, desirable and irrelevant. The criterion for reaching consensus was predetermined, namely 75% of the number of ratings on any of the items in the questionnaire had to correspond. The panel of experts (eight) that took part in the Delphi process included heads of departments of the various training institutions in South Africa, an educational expert and an expert representative of the Professional Board for Speech, Language and Hearing Therapy. A pilot study to determine the validity and reliability of the research instrument (the questionnaire) had been conducted before the research instrument was sent to the participants in the Delphi process. With the completion of round three, consensus on the items in the Delphi questionnaire was on 96.77%. Stability was also reached in round three, as the items on which consensus was not reached, showed the same responses with regard to rating since round one. The Delphi process was therefore ended after round three and the final framework was compiled based on the results of the Delphi investigation, in other words, the responses of the participants. The framework is of great value for programme development, as professionspecific information and requirements of stakeholders are contained within the framework, thereby facilitating the task of experts in educational development involved with programme development for speech therapy and audiology. It is recommended that the programme be used by institutions as a guideline for the development of innovative undergraduate training programmes for speech therapy and audiology. It can also be used for revising and/or evaluating existing training programmes, as well as for the accreditation of a training programme. The content elements of the framework may be adapted and changed, if and when the requirements of the relevant professional board and the requirements of health care services and education change, as well as according to changes in the needs of students and needs of the community.

The research study was undertaken to determine the needs of Heads of Department in the School of Medicine, UFS; management models available to them; and the factors impacting on their academic environment. The rationale for the study can be found in the need expressed by Heads of Department to manage their departments in the new academic setting. The aim of the study was to create and establish a management model for experienced as well as new Heads of Department in the School of Medicine, measured against the background of good management practices. This aim was achieved by performing a literature study regarding the needs of Heads of Department; factors influencing their academic environment, and the composition of available management and leadership models that could apply to Heads of Department in the School of Medicine. Heads of Department are appointed in the academic environment with the primary focus on their educational achievements. Throughout the process it was demonstrated that this is still relevant and needs to be part of the appointment process of Heads of Department in the School of Medicine. It was also indicated throughout this study that there is an increasing expectation from Heads of Department to take on sole responsibility for the management of their departments. In the light of these developments, it was important to consider solving this problem for them, and also to establish a management model for Heads of Department, thus empowering them to manage their departments in the future. The research took the form of a descriptive, explanatory survey comprising a literature review, a questionnaire survey and a Delphi process. The literature study covered a few aspects, including assessing the possible needs of Heads of Department, exploring factors impacting on their environment, as well as the difference between management and leadership, and the difference between various management models that may be applicable to management in an academic setting such as a Medical School. The second part of the empirical study was a Delphi process, which involved six experts from the areas of management, health management, and education. The overall goal and objective was to make a significant contribution to the managerial needs of Heads of Department, and to establish a management model, thus empowering Heads of Department to manage their departments in the future. A quantitative approach with open-ended questions was followed. The Delphi technique also focussed on these areas through statements in order to measure the experts' feelings about these areas. As part of the Delphi process, the experts had to participate in two rounds. The main findings from the questionnaire to Heads of Department, the Delphi technique, and information obtained via the literature study enabled the researcher to make a recommendation on a management model for Heads of Department, UFS. The management model had to be flexible, individualized, relevant, and adaptable. It had to include the seven main areas of management, namely strategic management; office administration, postgraduate education and training; undergraduate teaching research, academic administration, and service delivery. The recommendations on the clinical management model were extensively detailed, as these will also form the basis of an implementation plan for implementing the management model in the School of Medicine, UFS. In summary, the researcher is of the opinion that the overall goal and objectives of the study were addressed and realised, and that meaningful recommendations were made. The PRIME model was established as a management model for Heads of Department, School of Medicine, UFS, offering an ultimate solution to the managerial problems of Heads of Department. The management model is in line with the needs of the Heads of Department, legislation, and the policy documents referred to in earlier chapters. In addition, recommendations were also made on future research; the possible implementation in other Medical Schools; and the use of the PRIME model. The researcher realises the limitations of the study, which are discussed in detail. Although a number of limitations were listed, the majority of these could be seen as minor limitations and they do not have an impact on the final outcome of the study. It is recommended that the study be followed by a research process and the possibility of utilising certain principles of the PRIME model in other Medical Schools in South Africa in order to assist them with the managerial problems they might be experiencing. The aim of the model is not to address all the issues in detail, but to provide a model for academic management of departments based on the needs indicated, and the academic management models available for such management. It is the researcherâs opinion that the PRIME model for the management of academic departments will contribute significantly to the overall management of academic health, the best possible utilisation of resources, and the improvement of health services at large. Furthermore, the researcher believes that this study has achieved all these aspects. It is in line with the current trend to improve quality within health services, and it is ultimately about improving the lives of Heads of Department in the academic sphere. The thesis also provides an extensive and comprehensive reference source for Heads of Department on leadership, management, needs, management models available; and factors that have an impact on the academic environment. As a management model, the PRIME model aims to create a win-win situation for the Heads of Department, their departments, and management and authorities. With this PRIME model, we can reach for the stars!