Magister Scientiae (Physiotherapy) - MSc(Physio) / Chronic diseases of lifestyle (CDL) are on a raising trend in the world regardless of age, economic class or geographical location of a population. The mortality rate associated with CDL is alarmingly among the highest globally. Tanzania is not exempted from this development. Literature indicates that physical activity is a health practice that can prevent CDL. It is recommended that medical practitioners should hold the responsibility of counselling patients on physical activity. Some studies outside Africa found an association between doctors’ physical activity patterns and their counselling practices on the same. This study therefore sought to establish whether physical inactivity among medical doctors in Tanzania significantly influenced their counselling practices on physical activity. A cross sectional quantitative survey at the Muhimbili National Hospital and Muhimbili Orthopedic Institute was conducted to derive the required information. A self administered structured questionnaire was voluntarily answered by 144 medical doctors. The Statistical Package for Social Sciences (SPSS) version 17 was used for data capturing and analysis. Descriptive statistics were employed to summarize data and was expressed as means, standard deviation, frequencies and percentages. The students’t-test was used to compare mean physical activity between different groups. Furthermore students’t-test and analysis of variance tests were used to examine association between different variables. Chisquare tests were used to test for associations between categorical variables. Alpha level was set at p< 0.05. Most of the participants in this study were sedentary in their leisure time and only active at work. When their quality of physical activity counselling was assessed, the majority of them were found to be poor physical activity counsellors. A significant association was found between physical activity and age, as well as physical activity and counselling practice (p<0.05). Participants mostly informed their patients about the intensity and duration of exercising more than any other idea of physical activity such as types of exercises, issuing of a written prescription and planning for a follow up. Lack of knowledge and experience about details of physical activity were reasons offered for failure to counsel. Participants also reported the inconvenience of physical activity facility’s schedules, fatigue and tiredness to be their barriers to physical activity participation. Doctors in Tanzania lacked personal initiative to participate in physical activity and consequently lacked the motivation to counsel. Measures around enhancing this health practice should be enhanced by all stakeholders including medical doctors, physiotherapists and patients. The need for short term and long term training in matters related to physical activity are therefore necessary among the practicing doctors and those undergoing training in medical schools. Physiotherapists who are trained in movement science can offer valuable advice/information to medical doctors to ensure that medical doctors acquire physical activity prescription and counselling knowledge. Collaboration between stakeholders in campaigning against sedentary lifestyles should be enhanced. Further reasons for failure to counsel, hindrances to physical activity participation and modern approaches to counselling should be explored. / South Africa

Magister Scientiae (Physiotherapy) - MSc(Physio) / Chronic diseases of lifestyle (CDL) are on a raising trend in the world regardless of age,economic class or geographical location of a population. The mortality rate associated with CDL is alarmingly among the highest globally. Tanzania is not exempted from this development.Literature indicates that physical activity is a health practice that can prevent CDL. It is recommended that medical practitioners should hold the responsibility of counselling patients on physical activity. Some studies outside Africa found an association between doctors’ physical activity patterns and their counselling practices on the same. This study therefore sought to establish whether physical inactivity among medical doctors in Tanzania significantly influenced their counselling practices on physical activity. A cross sectional quantitative survey at the Muhimbili National Hospital and Muhimbili Orthopedic Institute was conducted to derive the required information. A self administered structured questionnaire was voluntarily answered by 144 medical doctors. The Statistical Package for Social Sciences (SPSS) version 17 was used for data capturing and analysis. Descriptive statistics were employed to summarize data and was expressed as means, standard deviation, frequencies and percentages. The students’t-test was used to compare mean physical activity between different groups. Furthermore students’t-test and analysis of variance tests were used to examine association between different variables. Chisquare tests were used to test for associations between categorical variables. Alpha level was set at p< 0.05. Most of the participants in this study were sedentary in their leisure time and only active at work. When their quality of physical activity counselling was assessed, the majority of them were found to be poor physical activity counsellors. A significant association was found between physical activity and age, as well as physical activity and counselling practice (p<0.05).Participants mostly informed their patients about the intensity and duration of exercising more than any other idea of physical activity such as types of exercises, issuing of a written prescription and planning for a follow up. Lack of knowledge and experience about details of physical activity were reasons offered for failure to counsel. Participants also reported the inconvenience of physical activity facility’s schedules, fatigue and tiredness to be their barriers to physical activity participation. Doctors in Tanzania lacked personal initiative to participate in physical activity and consequently lacked the motivation to counsel. Measures around enhancing this health practice should be enhanced by all stakeholders including medical doctors,physiotherapists and patients. The need for short term and long term training in matters related to physical activity are therefore necessary among the practicing doctors and those undergoing training in medical schools. Physiotherapists who are trained in movement science can offer valuable advice/information to medical doctors to ensure that medical doctors acquire physical activity prescription and counselling knowledge. Collaboration between stakeholders in campaigning against sedentary lifestyles should be enhanced. Further reasons for failure to counsel, hindrances to physical activity participation and modern approaches to counselling should be explored.

Bakgrund: Fysisk inaktivitet och mental ohälsa ökar bland barn och ungdomar i Sverige. Forskning visar att beteenden som barn har ofta fortsätter i vuxen ålder, och att fysisk aktivitet är positivt för både hälsan och studieresultat. Trots detta finns det nästan inga fysioterapeuter i den svenska skolan. Av denna anledning intervjuades de som arbetar i elevhälsoteamet.   Syfte: Syftet med studien är att undersöka hur de professioner som ingår i elevhälsoteam på kommunala grundskolor tänker kring behov av och möjligheter för att inkludera fysioterapeut i elevhälsoteamet. Metod: Kvalitativ design, gjord med intervjuer och analyserad med induktiv ansatts. Urvalet var åtta personer som representerade fyra av de professioner som arbetar inom elevhälsoteamet.   Resultat: Fyra kategorier och tio underkategorier utformades. Kategorierna var: Kunskap om fysioterapi, Elevhälsoteamets uppdrag, behov av kompetens och Styrande faktorer. Dessa kategorier talar om informanternas förkunskap om fysioterapeuter, vad elevhälsoteamet gör idag, vad de ser för kompetensbehov och vad som styr ifall fysioterapeuter skall komma in i skolan.   Slutsatser: Informanterna såg positivt på att ta in fysioterapeuter i skolan. Hinder identifierades i form av ekonomi och lagstadgad styrning. Det finns ett behov av att marknadsföra vad fysioterapeuter kan göra för skolan till de som tar beslut kring elevhälsoteamet. / Background: Physical inactivity and mental illness is growing among children and youths in Sweden. Research shows that the behaviours that children have often continue in adulthood, and that physical activity is good for both general health and academic results. Despite this, there are almost no physiotherapists in Swedish schools. Because of this those who work in the student health team were interviewed.   Aim: The aim of this study is to survey what professions that are included in the student health teams in municipality schools think about the need of and possibilities for physiotherapists to be included in the student health team.   Method: Qualitive design conducted with interviews and analysed with inductive approach. The included participants were eight persons who represented four of the professions that work within the student health team.   Result: Four categories and ten subcategories were formed. the categories were: knowledge of physical therapy, the student health teams mission, need for competence and controlling factors. These categories convey the informant’s knowledge about physiotherapists, what the student health team does today, their need for additional competence and what determines whether physiotherapists can work within schools.   Conclusion: The informants were positive towards possibly having physiotherapists in schools. Hurtles were identified as economic and law. There is a need for physiotherapists to market what they can contribute to the school to those in power over the student health team.

Level of employment of secondary school graduates on the labour market of Liberec region The diploma thesis "Level of employment of secondary school graduates on the labour market of Liberec region" focuses on tree major factors influencing the level of employment of graduates. First is the role of vocational education in the educational system. The thesis tests two hypotheses. First considers vocational education to be superior to general education since graduates learn great deal of hard skills, which they can directly apply while applying for a job. Second hypotheses considers vocational education to be inferior to general education since what the graduates learn during their study does not reflect the needs of employers and they thus prefer the information about the level of education (general education). Second major factor this diploma thesis deals with is the role of social networks in finding first job. The thesis analyses the effectiveness of the social networks on the site of graduates and also on the site of employers. Third factor is the dynamics of the early working stage of graduates and the influence of social and economical forces on regional labour market. The thesis analyses data on the dynamics of employment of graduates in the Czech Republic and especially in the Liberec region.

Objetivo: Determinar la asociación entre la periodontitis y el sedentarismo en adultos de los Estados Unidos entre los años 2013-2014. Materiales y métodos: Estudio analítico, observacional, transversal y retrospectivo, se utilizó la información de 3333 adultos de 30 a 78 años, de la encuesta Nacional de Examen de Salud y Nutrición NHANES 2013-2014 de los Estados Unidos. Se evaluó la periodontitis como presencia y ausencia y el sedentarismo se compuso de horas en la televisión, horas en la computadora y horas de actividad sedentaria. Asimismo, como variables intervinientes se tuvo género, edad, nivel educativo, ingreso, condiciones médicas, medidas de prevención, diabetes, discapacidad, visita al dentista, consulta odontológica, salud bucal, nutrición, consumo de tabaco, seguro de salud. Se obtuvieron estadísticas descriptivas de las variables mencionadas. Se analizó la comparación de la periodontitis con las covariables mediante las pruebas Chi Cuadrado y T-student. Asimismo, se realizó un análisis multivariado mediante la regresión de Poisson con varianza robusta, donde se calcularon las razones de prevalencia. Además se incluyeron los intervalos de confianza (IC 95%). Resultados: Se encontró una asociación entre la variable periodontitis y el sedentarismo, en la dimensión horas en la computadora (RP=1.57 I.C. = 1.23 -2.02, RP: 1.56, 95% IC 1.24-1.96) y horas en la televisión (RP=1.62 I.C. = 1.27 -2.06, RP: 1.58, 95% IC 1.27-1.98). Se encontró que aquellos adultos de 30 a 78 años de edad, que pasan menos de 2 horas en la computadora (RP=1.57 I.C. = 1.23 -2.02), más de 2 horas; pero menos de 4 horas (RP=1.56 I.C. = 1.24 -1.96), tienen mayores probabilidades de presentar periodontitis. Asimismo, las personas que pasan menos de 2 horas en la televisión (RP=1.62 I.C. = 1.27 -2.06) y más de 2 horas; pero menos de 4 horas (RP=1.58 I.C. = 1.27 -1.98), también tienen probabilidades de presentar periodontitis. Conclusiones: Existe asociación entre la periodontitis y el sedentarismo en la dimensión horas en la computadora y horas en la televisión. / Objective: To determine the association between periodontitis and sedentary lifestyle in adults in the United States between the years 2013-2014. Materials and Methods: Analytical, observational, cross-sectional, retrospective, retrospective study, data from 3333 adults aged 30 to 78 years, from the 2013-2014 NHANES National Health and Nutrition Examination Survey of the United States were used. Periodontitis was assessed as presence and absence and sedentary lifestyle was composed of hours on TV, hours on the computer, and hours of sedentary activity. Likewise, intervening variables were gender, age, educational level, income, medical conditions, preventive measures, diabetes, disability, dental visit, dental consultation, oral health, nutrition, tobacco use, health insurance. Descriptive statistics were obtained for the variables mentioned. Comparison of periodontitis with the covariates was analyzed using Chi-square and T-student tests. Likewise, a multivariate analysis was performed using Poisson regression with robust variance, where prevalence ratios were calculated. Confidence intervals (95% CI) were also included. Results: An association was found between the variable periodontitis and sedentary lifestyle, in the dimension hours on the computer (PR=1.57 C.I. = 1.23 -2.02, PR: 1.56, 95% CI 1.24-1.96) and hours on television (PR=1.62 C.I. = 1.27 -2.06, PR: 1.58, 95% CI 1.27-1.98). It was found that those adults 30 to 78 years of age, who spend less than 2 hours on the computer (PR=1.57 C.I. = 1.23 -2.02), more than 2 hours; but less than 4 hours (PR=1.56 C.I. = 1.24 -1.96), are more likely to present periodontitis. Likewise, people who spend less than 2 hours on television (PR=1.62 C.I. = 1.27 -2.06) and more than 2 hours; but less than 4 hours (PR=1.58 C.I. = 1.27 -1.98), are also likely to present periodontitis. Conclusions: There is an association between periodontitis and sedentary lifestyle in the dimension of hours on the computer and hours on the television. / Tesis

Cancer and diabetes are the second and seventh leading causes of death in the United States, respectively (Kochanek et al., 2017). When including prediabetes and the entire cancer continuum, both diseases affect over 150 million individuals in the United States each year (Bullard et al., 2018; Siegel et al., 2019). Furthermore, there exists an alarming rise in patients presenting with both type 2 diabetes and obesity-related cancers concurrently, as both diseases share similar risk factors (Vigneri et al., 2009). An aging adult population, physical inactivity and unhealthy eating habits are continuing to rise, and the prevalence of individuals with obesity-related cancers and type 2 diabetes are expected to increase in a parallel manner. Cancer and type 2 diabetes are projected to increase over the next 30 years by greater than 45%. (Smith et al., 2009; Rowley et al., 2017). Exercise can serve as a modifiable risk factor for multiple chronic diseases, including cancer and diabetes (Booth et al., 2012). Additionally, exercise can optimize the disease prognosis by subduing the physical and psychological hardships that often accompany a diseased state (Pederson et al., 2006). Despite the various health benefits and its role in the primary prevention of chronic disease, studies have found as many as 95% of US adults are considered physically inactive by the US Department of Health and Human Services (Troiano et al., 2008). Even more troublesome, patients of these particular populations also fail to participate in regular physical activity despite its positive effect on disease management and prognosis. It is estimated that as little as 10% of the cancer community is active during their treatment and 60% of the diabetes community are physically inactive in the United States (Garcia et al., 2014; Centers for Disease Control and Prevention, 2017). However, these rates are expected to be inaccurate as many studies quantify physical activity through self-reported questionnaires and are likely overestimated by patients (Schrack et al., 2017). The relationships that exist between physical activity and multiple chronic diseases are extensively investigated worldwide. Such studies are often in well-funded, controlled, and tightly regulated interventions. Though effective at providing quality research and credible outcomes, the interventions fail to accurately represent the challenges and expected outcomes of cancer patients and individuals with diabetes participating in a community based intervention. Additionally, large high-quality clinical trials make it difficult to translate research interventions into routine clinical practice, as real-world health care systems often do not have extensive funds to provide exquisite care. Our study, a community-based intervention with limited funding, sought to bridge this gap in the research. This 10-week exercise intervention focused on the physiological, physical, and psychological changes of 157 cancer survivors and 67 non-insulin dependent type 2 diabetes patients. Subjects participated in comprehensive biweekly exercise sessions that included aerobic, resistance, and flexibility training. All participants were evaluated on cardiometabolic risk factors, anthropometric measurements, physical functioning, and psychological well-being prior and succeeding the intervention. Multiple findings were identified concerning retention trends, and changes in psychological health, anthropometric profiles, cardiometabolic risk factors, and physical functioning among both groups. The diabetes group underwent improvements in HbA1c and Quality of Life (QOL). The cancer group experienced improvements in physical functionality, fatigue, and insomnia. Factors that determined program retention within the cancer group were also determined. Our findings help to demonstrate the expected outcomes of an exercise trial in a community-setting. These outcomes will provide further insight on how to create exercise programs that are most effective for individuals with diabetes and cancer patients in a community setting with limited resources.

BACKGROUND: Periodontal disease is a major chronic disease worldwide and one of the most prevalent oral pathologies. Some factors that may lead to periodontal disease include poor nutrition, chronic illness, poor lifestyle choices, smoking, and excessive alcohol consumption. Previous studies have also revealed a biological link between diabetes or obesity and periodontal health status. Because physical activity can reduce the risk of diabetes and obesity, it would follow that physical activity may also lead to improved periodontal health. However, to date, there has been limited research on the effects of physical activity on periodontal disease risk. Our investigation answers the following question: Do people who are more physically active have better periodontal health than those who are inactive? OBJECTIVE: The purpose of our research initiative was to evaluate the prevalence of periodontal disease among people who are physically inactive versus those who are physically active using data from NHANES. METHODS: In this study, we utilized the publicly available NHANES 2011-2012 datasets of 9756 observations before exclusions. Our study included individuals (30-80 years of age) consisting of 49.4% male and 50.6% female who provided demographic data, periodontal and dentition examination data, and self-reported smoking and physical activity data (Table 3). There were a total of 3327 observations meeting our inclusion criteria. Weighted prevalence estimates and odds ratios (OR) were calculated for physical activity adjusted by age, gender, race, education level, and economic status. Physical activity was categorized by domains of transportation physical activity, occupation physical activity, leisure time physical activity, and sedentary behavior. Physical activity was also categorized into a dichotomous total amount of physical activity by adding the three major physical activity domains. RESULTS: We observed higher rates of periodontal disease in men, in older adults, smokers, and individuals with diabetes mellitus. We also observed that individuals with higher total physical activity and leisure time physical activity and lower amount of total sedentary activity had lower periodontal disease rates. After adjusting for confounders, lower sedentary time was associated with lower periodontal disease rates (OR 1.18; 95% CI (Confidence Interval) 1.01,1.38; p=0.0416), but total physical activity and leisure time was not significantly associated with periodontal disease (OR 1.00; 95% CI 0.79,1.28; p=0.98) (OR 1.14; 95% CI 0.81,1.61; p=0.42) (Table 5). CONCLUSION: Our findings indicate sedentary time is associated with higher rates of periodontal disease. Future prospective longitudinal studies and strategies are needed to investigate implications further and define the magnitude of the association between physical activity and periodontal disease.

Inactivity reduces insulin action. Energy surplus causes similar reductions to insulin action. Unless energy intake is reduced to match low energy expenditure during inactivity, a concurrent energy surplus may account for the lower insulin action. This study evaluated the effect of inactivity (sitting) with and without energy surplus on insulin action. Fourteen young (26.1 ± 4.5 years (M ± SD)), lean (23.7 ± 7.1% fat), fit (VO 2peak = 49.1 ± 3.3 ml*kg -1 *min -1 ) men (n=7) and women (n=7) completed each of 3, 24-hour conditions: an active condition (i.e. high energy expenditure with energy intake matched to expenditure) = ACTIV; (2) reduced energy expenditure (inactivity) with no reduction in energy intake (i.e. energy surplus) = INACTIV; (3) inactivity with energy intake reduced to match low energy expenditure = INACTIV LO-CAL. Insulin action was measured during a glucose infusion the following morning. Data were analyzed using linear mixed-effects models with planned contrasts. Compared to ACTIV, insulin action, defined as whole-body rate of glucose disappearance ( R d ) scaled to steady-state plasma insulin, was reduced 39% in INACTIV ( p < 0.001) and by 18% in INACTIV LO-CAL ( p = 0.07). Insulin action was also higher in INACTIV LO-CAL compared to INACTIV ( p =0.04). These results suggest that 1 day of sitting elicits large reductions in insulin action. Energy surplus accounts for half of the decline in insulin action, suggesting other factors are involved in the metabolic response to inactivity.

ABSTRACTPreoperative Activity Level and Outcomes in Older ¨Adult Cardiac Surgery Patients: A Pilot StudyDon Howard Sorensen Jr.College of Nursing, BYUMaster of SciencePurpose: To assess the relationship between preoperative physical activity levels and health related quality of life on intra- and post-hospital outcomes following scheduled cardiothoracic surgery in older adults.Rationale/Background: Adults age 50 and older tend to accumulate more sedentary time and are less physically active. Sedentary behavior is linked with early morbidity and death and may predispose patients to postoperative complications. Preoperative activity levels and its relationship to surgical outcomes is an underexplored area. Insight on this topic could influence how to optimize interventions prior to surgery to improve outcomes. Methods: Seven participants were fitted with an ActiGraph GT3X+ accelerometer to measure preoperative activity levels for 1 week and complete the RAND Short Form-36 health-related quality of life tool. This process was then supposed to be repeated during the first and last weeks of cardiac rehabilitation (rehab). This information, along with demographics, was then correlated with information pulled from the Society of Thoracic Surgeons database on post-surgical outcomes and the 6-minute walk tests (6MWT) done during rehab. Results: The only statistically significant result was participants who experienced some type of intra-hospital complication also scored low in emotional wellbeing (r = -0.928, p = 0.003) as reflected in the quality of life score. Other findings with p values > 0.05 but <<> 0.1 were noted as œareas needing further exploration. Such areas for further exploration included: participants who spent more time in light physical activity reported less role limitations due to physical health (r = 0.864, p = 0.059), higher preoperative activity levels related to higher postoperative 6MWT (r = 0.830, p = 0.082), increased body mass index related to a decrease in postoperatively 6MWT (r = -0.869, p = 0.056). Implications: Exploring the relationship between preoperative activity levels and post-surgical outcomes could provide insight optimizing interventions before surgery to improve surgical success and rehab outcomes.

京都大学 / 新制・課程博士 / 博士(経済学) / 甲第24825号 / 経博第672号 / 新制||経||304(附属図書館) / 京都大学大学院経済学研究科経済学専攻 / (主査)教授 矢野, 剛, 教授 西山, 慶彦, 教授 諸富, 徹 / 学位規則第4条第1項該当 / Doctor of Economics / Kyoto University / DFAM