Coronary Heart Disease (CHD) accounts for almost 20% of all deaths in the United States and is a leading cause of premature death and disability. The cost for this disease includes not only lost work years, but billions of health care dollars. Women account for almost half of the deaths from CHD and rates for the death of young women have risen 30% from 1988 to 1998. For the two-thirds of women who survive the initial coronary event, the risk of future events and disability increases. Cardiac rehabilitation (CR) is a multi-disciplinary program designed to reduce this risk. Unfortunately, only 25% of eligible women attend the program. Few studies have analyzed the factors that influence women's CR enrollment choices making a careful examination of these factors particularly relevant. The purpose of this study was to qualitatively explore the factors associated with a woman's decision to enroll, or not enroll, in CR from the perspectives of the patient and her support person. Twenty-five women (15 enrolled in CR, 10 not enrolled in CR) and 24 matched support persons (one person's supporters refused to participate) were interviewed using a semi-structured format from September, 1999 to January, 2001. Questions addressed the beliefs, affect, social referents, past experiences/habits, and facilitating/constraining conditions related to CR enrollment choices. Support persons were asked to respond to these questions from their perception of their loved one's attitudes, beliefs and health care seeking behaviors. Information from the interviews was transcribed verbatim, entered into NUD*IST, and coded using the components of the Expanded Theory of Reasoned Action (Triandis, 1977) as a framework. Descriptive analyses was done on basic demographic information, including perceptions of health and depression. There were specific factors identified in each of the primary categories of affect, beliefs, facilitating/constraining factors, and social referents and information. The key findings indicated that a lack of information on CR, feelings related to the perceived necessity of CR, transportation, finances, and accessibility were primary factors in enrollment behavior. Overall agreement between the cardiac female and her support person existed in most categories, except affect, where a minimum number of emotions was stated by the supporter. Cardiologists are a preferred source for CR information and they and primary care physicians need to increase the amount of positive support they provide to post-coronary event women. Emphasis on the necessity of attending CR as well as solutions for transportation and finances may increase enrollment. More research should be completed on the context of depression related to CR, importance of factors identified as having an impact on CR decision making, and the role of support persons in the enrollment choices of women. / Graduation date: 2002

Access to abstract permanently restricted to Ball State community only / Access to thesis permanently restricted to Ball State community only / School of Physical Education, Sport, and Exercise Science

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Nursing Studies / Master / Master of Nursing

Although effective anti-tuberculosis agents have been available for over thirty years, tuberculosis (TB) is still a global health concern and the incident rate in Hong Kong remains high. Directly Observed Therapy, Short-course (DOTS) strategy, in combination with patient education are proved to be more effective in reducing TB incidence than the DOTS strategy alone. However, there is a lack of evidence based protocol to guide nurses through the implementation of health education for TB patients. This dissertation is a translational nursing research aims at developing an evidence-based health education guideline for nurses to deliver health education to TB patients to improve treatment adherence. The objectives are to gather evidence on the effectiveness of nursing health education in promoting treatment adherence among TB patients, conduct quality assessment of the reviewed articles, develop evidence-based health education protocol for TB patients, assess the implementation potential of the innovation and discuss its implementation and evaluation plan. In this dissertation, a systematic review of 8 relevant and up-to-date research papers was performed and a guideline was then generated based on the extracted data. The guideline consists of 3 components: effective individual health education, essential elements for health education booklet and training for nurses. The implementation potential of the guideline is considered to be high while the implementation and evaluation plan of the guideline are also discussed. With the implementation of the evidence-based protocol on TB health education, the treatment adherence of the TB patients is expected to be increased. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Background: Individuals with autism spectrum disorders (ASD) are characteristically deficient in social awareness and communication skills, while displaying repetitive behaviours. Because of this, integration of individuals with ASD into society is often difficult as people do not know how to respond to their atypical behaviour. Particularly in Asian cultures, this vulnerable group is often subjected to stigmatization. However, recent literature has highlighted some benefits of assistive animal intervention (AAI) for individuals with ASD, which may improve their ability for social interaction. This review examines the effects of AAI in terms of service dogs for individuals with ASD. Methods: Journal articles were identified through a systematic review on psycINFO, Pubmed, Scholars Portal and Web of Knowledge. Additional searches were conducted for inclusion of grey literature and doctoral theses in the review. Results: Of the 170 studies initially found, 7 were selected; 3 cohort studies, 3 case-control studies, and 1 cross-sectional study. Reported outcomes included increased social reciprocity, decreased behavioural problems and decreased stress in individuals with ASD. Despite these positive outcomes, they should be taken with caution, as the designs of the seven studies included in this review show methodological weaknesses, such as small sample sizes and possible information bias from data collection. Conclusions: Additional research focused on varying age groups with ASD, longitudinal studies and standardized outcome measures are required for further research. What this review suggests though is that there is a need to address social services gaps for various disability groups, not just for those with ASD. Some legislative measures are in place in Hong Kong to support the accessibility of assistance dogs in public; however, since there are so few in Hong Kong, their exposure is not enough to gain widespread acceptance. Expansion of assistance dog services to serve other disability groups may help to enhance their quality of life. / published_or_final_version / Public Health / Master / Master of Public Health

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The leading cause of long-term disability among adults in industrialized countries is stroke. Exploration of the brain mechanisms involved during recovery from stroke is likely to yield information that can be used to promote better functional outcome. After focal motor cortical infarcts, reorganization of movement representations in the remaining motor cortex has been linked to both spontaneous recovery and recovery induced by rehabilitative training. However, the mechanisms and nature of cortical reorganization remain poorly understood. The central hypothesis of these dissertation studies is that synaptogenesis and structural reorganization in the cortex near the lesion are linked to spontaneous partial recovery and the beneficial effects of motor rehabilitative training after stroke-like injury. This was tested in a rat model of focal cortical ischemia by both behavioral and neuroanatomical measures in perilesion cortex. In separate studies, it was found that motor rehabilitative training on a skilled reaching task using the impaired forelimb after a unilateral ischemic lesion improved forelimb functional outcome and facilitated synaptogenesis in perilesion cortex. In addition, this improved functional recovery was disrupted by focal protein synthesis inhibition in perilesion cortex, suggesting the structural plasticity in this area plays an important role in regained function. Finally, it was also hypothesized that a therapy that enhances the efficacy of motor rehabilitation also enhances synaptic structural plasticity in perilesion cortex. Cortical electrical stimulation (CS) during motor rehabilitation has previously been shown to improve the efficacy of rehabilitation. Increased density of axodendritic synapses in perilesion cortex was found in rats that received cortical electrical stimulation of perilesion cortex during rehabilitation compared to rehabilitation alone, and the synaptic density was positively correlated with post-rehabilitation reaching performance. These findings suggest that CS-induced functional improvements may be mediated by synaptic structural plasticity in stimulated cortex. Together these studies indicate that, after a cortical lesion in rats, motor rehabilitation alone or in conjunction with other efficacious therapies can greatly enhance synaptic structural plasticity in perilesion cortex. Furthermore, these studies suggest that rehabilitation induced improvements in functional outcome are dependent upon the structural and functional integrity of the reorganized perilesion cortex.