In response to the increased popularity and use of Traditional/Complementary Alternative Medicine, not only in less-developed countries where it is a first line of contact for the majority of people but also in developed countries, initiation of Integrative Medicine Clinics has been triggered particularly in Western countries. In addition, there are increased opportunities of research and associated criticism on the subject. Whereas such investigations have provided some interesting understandings on how the integrative clinics are managed, surprisingly, many of the investigations have been carried out in developed countries where biomedicine is affordable and accessible for the majority of people. There is a dearth of information about the opportunities and challenges for contemporary and traditional health practices to work together in less-developed countries where accessibility and affordability of modern medicine is a huge challenge. The objective of this thesis then was to offer some exploratory perceptions into how key stakeholders of health in Tanzania recognize the opportunities and challenges that are there for the two health practices to integrate under the National Health System. An ethnographic stance was utilised to explore the views of 35 participants from four regions in Tanzania, among whom were biomedical and traditional practitioners, policy-makers, and religious leaders; researchers of traditional medicine from two national research institutes, participants with multiple roles and clients of the two practices. In-depth, semi-structured interview was the main method of data generation. Data was analysed thematically, from which the study revealed that despite the potential opportunities for the two practices to work together, integration of the two practices cannot take place due to emergence of two schools of thought of traditionalism and modernity that were irreconcilable. Instead cooperation is possible under the framework of Negotiated Order Theory that feeds three processes of Integration and Differentiation, Hybridization of Traditional Medicine and Negotiating Modernity.

[From the introduction]: Experiencing childbirth as a traumatic event is a factor that has been highlighted as contributing to poorer psychological outcomes. Up to 30% of women in the UK experience childbirth as a traumatic event, with many consequently going on to experience some form of anxiety, depression, or post-traumatic stress disorder (PTSD) following childbirth (Slade, 2006; Ayers, 2014). When childbirth presents as a traumatic experience it can impose a profound effect on the lives of mothers, fathers (Nicholls & Ayers, 2007), their children (Allen, 1998) and family and friends (Beck, 2004a; Ayers, Eagle & Waring, 2006). If left untreated the effects can last many years (Forssen, 2012). Consequences of traumatic birth include enduring mental health problems (Forssen, 2012; Beck, 2004a), compromised maternal infant relationships (Nicholls & Ayers, 2007), poorer quality marital relationships (Ayers, Eagle & Waring, 2006) concomitant depression in partners (Nicholls & Ayers, 2007) and can present a challenge to future reproductive decisions (Fenech & Thomson, 2014). This is therefore an important area to research, in order to alleviate some of these difficulties. The causes of traumatic birth are complex and multi-faceted (Simpson & Catling, 2016). Predisposing factors include pre-existing psychological issues (Grekin & O'Hara, 2014) or prior traumatic experiences, such as rape and sexual abuse (Ford & Ayers, 2011). Other risk factors include obstetric emergencies and neonatal complications (Grekin & O'Hara, 2014). Poor care during labour can compound these experiences, or be traumatic in its own right (Ford & Ayers, 2011; Elmir, Schmied, Wilkes & Jackson, 2010; Beck, 2004a). Attachment styles and relationships with partners can influence the likelihood of developing psychological disorders following a traumatic birth, and may influence whether a birth is experienced as traumatic too (Iles, Slade & Spiby, 2011). Women who have experienced a traumatic birth are less likely to have a subsequent pregnancy (Fenech & Thomson, 2014; Gottvall & Waldenstrom, 2002). If these women do become pregnant, they are more likely to request a non-medically indicated caesarean section (Kottmel, Hoesli, Traub, Urech, Huang, Leeners & Tschudin, 2012; Gamble & Creedy, 2001). What is less well known is what other choices women make about pregnancy and birth following a previous traumatic birth.

This thesis reports a shared journey within a personal one. I intended to understand help-seeking motivation in family members of compulsive hoarders. I learned something about myself. An integrative review of family experience of hoarding revealed themes of quality of life; shattered families; rallying around and lack of support, which was the central theme. This begged the question: What sources of help do family members of compulsive hoarders seek and why? A family-group collaborative design was proposed but developments in recruitment produced a situation of recruiting and being recruited simultaneously by a co-researcher expert by experience engaged in help-seeking. Negotiations around the collaborative workings of the project produced a cycle of action and reflection similar to co-operative inquiry. Analysis consisted of a free association exercise conducted by both co-researchers and dialogical narrative analysis by me alone. Results were triangulated with field notes including reports of interviews with other family members. Findings from these exercises included a focus on my co-researcher's role within the family and within the research team; identity; relationships within and outwith the family and tolerance of uncertainty. My co-researcher's prolonged and wide-ranging help-seeking led to her discovering that hoarding had been included in the fifth edition of Diagnostic and Statistical Manual of the American Psychiatric Association (APA) (DSM-5), and this opened the possibility of treatment. Initially stating she preferred to focus on large scale projects as a way of avoiding her family situation, exploration of the experience from a different perspective unexpectedly allowed for a re-appraisal of the situation and its effects despite little change in circumstances. "The answer is in the exploration", as Tracy put it during analysis. At the end of this project, I found myself not ready to let go. I also found myself unsure about my own identity. I explore why through autoethnographic writing, examining how the same processes which inadvertently benefited my co-researcher helped me to develop a new story for myself in relation to my status as a registered mental health nurse transitioning from psychosocial practitioner to mental health nurse academic. Building on our work together, this work has produced further arguments for the use of autoethnographic methods in mental health research and has made a case for flattened structures and slow approaches in research relationships and by extension in other mental health work. In addition, we have uncovered a helpful bespoke response to compulsive hoarding in a relative which employs aspects of research and therapy. In considering these issues I suggest a model for mental health nurse practice, education and research which understands evidence-based practice as a situated, narrative exercise with a broad range of influences from other disciplines and a requirement to proceed from a critical standpoint.

Background Despite recent progress in enhancing the accessibility of HIV-related health services worldwide, opportunities to diagnose patients are often missed due to genuine barriers at different levels. The aim of this study is to explore the factors that affect the uptake of HIV testing by young people in Saudi Arabia. Methods A sequential mixed methods design was used to reveal the factors that influenced HIV testing among young people aged 17-25 years. In terms of the quantitative strand of the study, a descriptive cross-sectional design was applied to identify the relevant and context-specific factors that influenced HIV testing among Umm- Al Qura University students. The students were selected using a convenience sampling technique. Self-completed online questionnaire was used. The questionnaire consisted of 52 items: 12 items for HIV/AIDS-related knowledge, 3 items for risk perception, and 37 items for attitudes toward HIV testing. For the qualitative strand of the study, semi-structured interviews were used to gather the perspectives of healthcare professionals working in the field of HIV/AIDS in the country. Results Three hundred and ninety four participants completed the questionnaire: 116 (29.4%) male and 278 (70%) female. 50.5% of the participants were aged from 20 to 22 years, 34.8% were 17-19 years and 14.7% were aged between 23-25 years. Only 20 (6%) participants had previously been tested for HIV. The main reasons for not being tested for HIV were: exposure to HIV was considered unlikely (48%), the HIV test was not offered (36%), and a lack of awareness of the locations of HIV testing centres (16%). With regard to HIV/AIDS-related knowledge, the male participants scored higher than the females as the mean score for males was (M = 6.4, SD = 2.4) while for females it was (M = 5.7, SD = 2.5); however, this difference was not significant. In terms of risk perception, female participants had lower levels of risk perception than male participants, with the mean score for males being (M = 11.7, SD = 2.5) and (M = 10.5, SD = 2.4) for females; this difference was statistically significant p < 0.01. The female participants showed slightly more positive attitudes towards HIV testing than male participants: the mean score for males was (M = 108.14, SD = 17.9) and was (M = 111.32, SD = 17.3) for females. However, this difference was not significant. Healthcare professionals who were interviewed indicated stigma, an HIV/AIDS knowledge gap and fear of the consequences of a positive result as the main factors hindering the uptake of the HIV test. Conclusions Knowledge, attitudes and HIV risk perception are critical factors that inform the decision to undertake HIV testing. However, socio-cultural constraints constitute a significant additional burden that hinders the efforts to scale up the HIV testing uptake in Saudi Arabia.

Previous studies of association of ABO phenotypes with gonorrhoea have shown contradictory results. Despite the interdependencies, none have examined the combined effect of ABO, Lewis and Secretor phenotypes. Furthermore, none have used genotyping to confirm phenotyping. This study is ground-breaking in this regard, and illustrates how such an association study should be performed. STUDY DESIGNS AND METHODS: The study examined 175 individuals who tested positive for gonorrhoea, and 211 individuals who tested negative for gonorrhoea. Strain typing was not performed. The following blood grouping methods were performed on the study participants: ABO phenotyping Lewis phenotyping, and genotyping of selected samples Secretor genotyping Chi-square and p values were used to examine whether or not there is an association of ABO, Lewis and Secretor blood group related molecules with gonorrhoea infection. RESULTS: Neither random statistical analysis of data sets, nor statistical analysis of data sets arranged by blood group, yielded a statistically significant association of ABO, Lewis and Secretor phenotypes and genotypes with Neisseria gonorrhoeae that could not be refuted when the data was disaggregated for ethnicity. The study did show a statistically significant difference in the incidence of the partial secretor phenotype (26.7%) in the gonorrhoea positive population and the incidence of the partial secretor phenotype (15.4%) in the gonorrhoea negative population, when all ethnic groups were analysed together. However, when the data was disaggregated for ethnicity, the p values were no longer statistically significant. CONCLUSION: There is no association of ABO, Lewis and Secretor phenotypes and genotypes with Neisseria gonorrhoeae. Nevertheless, this study still has merit, because, to the author's knowledge, it is the first time a study of these human blood groups with a disease has been performed correctly.

It has been said that within a secondary care setting, surrounded by medical influences, it is difficult for midwives to keep birth normal. This qualitative study has been conducted to answer the question: "What are midwives' experiences of keeping birth normal within a secondary care setting?" van Manen's (1990) hermeneutic thematic analysis was the method used to analyse the data generated from this study. Eight "core" or hospital-based midwives were interviewed. The interviews were tape recorded and transcribed into text and were analysed to come to a deeper understanding of the research question. There are three data chapters that reveal the themes that emerged from the data: "Being a midwife 'is' keeping birth normal", "Stepping back and stepping in" and "Interacting with the doctor". The findings of the study revealed that seeing, knowing, and believing in normal birth leads to an embodied sense of "being" that infuses the way midwives practise. This knowledge needs to be passed on to junior midwives. Midwives judge when to use technology and intervention and the appropriate timing of intervention. The Relationships between medical practitioners and midwives is a key to keeping birth normal. Ultimately, it is through teamwork that normal birth is safeguarded. The midwives in this study demonstrate a quiet yet determined courage to constantly question the decisions that might take away from the "normal" experience. They do not say that intervention is not necessary, but question the appropriate use of intervention. This questioning keeps normal birth a possibility.

For almost three decades 'holistic health care' has been a widely invoked term. It is called upon as an antidote to mechanistic science, as justification for the use of alternative therapies, as instruction to good practice and even as a boundary marker in establishing professional identity. In the service of these intentions it has assumed various meanings. The first aim of this study is to identify from the literature, the illusion of shared meaning that saturates this term and to expose the implications of this lack of clarity. The elusive nature of the meanings attributed to holism and the problem of determining an appropriate method of pursuing these meanings is addressed. A particular understanding of conceptual analysis and practical reasoning are defended as adequate tools. The group of ideas from which the term holism can be distinguished, individualism, dualism and reductionism, form the context of the examination of understandings of wholeness. Eight distinctions of wholeness are examined and the common conceptual feature of 'purpose' is suggested. This requires considerable justification which is provided by an exploration of the notion of 'partness'. Recourse to the seminal work of Smuts (1926) is sought and the derivation of the idea of holism from evolution theory is explored. A key understanding explored is the nature of emergent properties and their role in the holistic doctrine, 'the whole is more than the sum of the parts'. Employment of the word holism in social science, philosophy, and biology is examined and a number of fallacies about holism exposed. With a somewhat clearer understanding of holism, and a working notion of wholeness, theories of health are discussed as contenders for a philosophical basis for 'holistic health care'. While several show some congruence, it is argued that the Foundations Theory of Health can be shown to demonstrate the characteristics of work for wholeness identified in this work. The conclusion that holistic health care is in essence working creatively with incipient wholes, is explained and justified by a discussion about how a health worker might become more holistic in her practice.

The purpose of this study was to explore the nature and process of supervision of occupational therapists as it occurs in New Zealand. There has recently been an increased focus on supervision by the profession. This study is therefore timely in seeking to describe the phenomenon of supervision. The study had eleven participants with some of the participants agreeing to be interviewed in both capacities those of supervisee and supervisor; this resulted in interviews with eight supervisees and five supervisors. Grounded theory was chosen as the methodology for the study. This methodology ensures that the voices of the participants are heard and that the study remains focused on their understandings and the meanings that they make of the process of supervision. Grounded theory allows for the generation of a conceptual model of the experience. By using the constant comparative method of data analysis a core concept of participating in supervision emerged.Participating in supervision describes a process that is heavily dependent on the quality of the supervisory relationship. It identifies the factors that bring supervisees to supervision and places emphasis on supervisory relationships that allow supervisees to explore the concept of me as a therapist. It highlights the benefits in therapists gaining an understanding of the wider picture in which they practice. It emphasises the significance of contextual factors such as supervision contracts and training, and highlights the issues raised by the type of power the supervisor holds. Positional power was seen by participants to be detrimental to the outcome of supervision whereas social power was seen to empower supervisees and allow a deeper relationship to develop. The trust in such relationships enabled issues to be raised without fear of consequence, or threat to competence. Supervisors were tasked to build on supervisees' strengths but to also challenge supervisees' actions and plans.Supervisees entered supervision believing that they would grow as therapists. For some this was possible and they were able to make the most of supervision. Supervision gave them a safe place to go and to explore what was happening, it was affirming. It empowered them to integrate knowledge, skills and behaviours such that they came away with insights. Importantly supervisees felt inspired. For others, poor relationships and structures resulted in guarding. They felt the need to protect themselves and they began fighting shy of supervision. There was obvious avoidance and frustration with supervision. This study takes us a step closer to understanding the place and value of supervision in occupational therapy in New Zealand.

Obesity is a global epidemic that is associated with several adverse health consequences. In addition, there is also a growing prevalence of obesity in pregnancy. Maternal obesity places the fetus in an abnormal in utero condition that can produce alterations in development leading to permanent programming of physiological systems. Obesity is also associated with cognitive dysfunction, which calls for investigations into its effects on the hippocampus, a brain area involved in learning and memory. Long-term potentiation (LTP), a neurophysiological correlate for learning and memory, can be examined in hippocampal slices. This study aimed to fill in the gap in literature regarding the effect of obesity on hippocampal synaptic plasticity in female rats, and maternal obesity effects on offspring hippocampal synaptic plasticity. Female Sprague-Dawley rats were fed either a control diet (CD), or a high-fat diet (HFD; 40% of calories from saturated fat) for 16 weeks. Impaired glucose tolerance and greater retroperitoneal fat pad weight indicated an obese phenotype in HFD rats; as well, the modified diet led to impaired LTP: CD rats had 10% more potentiation in amplitude, and 11% more potentiation in slope than HFD rats. Offspring were weaned onto control diet at post-natal day 21. Reduced success rates for achieving LTP, and lowered magnitudes of mean LTP in the offspring, strongly suggest that maternal obesity may have compromised hippocampal synaptic plasticity, and warrants further study.

The current study utilizes a life course approach in its exploration of the connection between life stage and psychological well-being, within the context of cancer caregivers. Further the study explores this connection in light of four possible mediating unmet needs factors that is unmet work or financial needs, unmet health care needs, unmet information needs and unmet future concerns needs as well as the extent to which these factors differ within each group. The study utilizes data from The Cancer Support Person’s Unmet Needs Survey (SPUNS) conducted by Campbell et al. in which a random, stratified sample of 1128 cancer survivors and their immediate caregivers, selected from the Cancercare Manitoba Cancer Registry, were surveyed (2009). The sample for the current study included 789 support persons selected for the study by the survivor for whom they cared. The study revealed that caregivers in midlife exhibited higher levels of unmet needs in work/ financial as well as future concerns life aspects. It is the expectation that the results of this study will enable practitioners to better support and fill the needs of caregivers allowing for improved quality of life and quality of care.