This study examined healthcare providers’ adherence to the national Tuberculosis guidelines (NTG) during the diagnosis and treatment of TB in Addis Ababa, Ethiopia using a descriptive, cross-sectional study design. Data were collected from 233 medical records using checklists. Adherence of healthcare providers to the NTG during the diagnosis of TB was 60.9% (n=67) for female and 56.1% (n=69) for male TB patients. However, 91.8% (n=101) female and 90.2% (n=111) male TB patients had been prescribed the correct numbers of anti-TB pills, complying with the NTG recommendations. There was an over-diagnosis of smear negative pulmonary Tuberculosis (PTB) as only 2.6% (n=2) of the 76 smear negative PTB patients were diagnosed correctly. Healthcare providers’ compliance with the NTG could be enhanced by providing appropriate in-service education, maintaining accurate records of all TB patients and providing supportive supervision to identify and address shortcomings.

M.A. (Psychology) / Numerous amounts ofliterature has confirmed the positive correlation that exists between exercise and psychological well-being. With the increased interest in the associated psychological factors ofpain, the present study was undertaken to investigate the effects of chronic pain on rheumatoid arthritic and osteoarthritic patients, with the overall aim of reducing, and alleviating these factors. The psychological factors studied were depression, effects ofthe impact ofarthritis, for example, on the independent, physical and psychosocial aspects oftheir lives, as well as coping. It was hypothesized that by engaging in an aquatic exercise program there would be a reduction/alleviation ofpain, which in tum would demonstrate a reduction in the psychological components ofpain. Evidence was found to support the hypothesis, due to the fact that, after exposure to the aquatic therapy program, subjects demonstrated a reduction in pain followed by a reduction in depression, slight improvement in coping with their arthritis, and the impact of arthritis was partially alleviated. The need for a larger sample group, as well a longer period of investigation will be needed for future research.

D.Litt. et Phil. (Psychology) / It is an accepted fact that the incidence of coronary heart disease has reached endemic proportions in South Africa. One of the fastest growing clinical populations in this domain is that of the coronary artery bypass patient. As a result the facilities catering to the biomedical needs of this population are amongst the most sophisticated in the world. However, facilities for the effective psychosocial rehabilitation of these patients are relatively scarce. When they are addressed they tend to focus essentially on secondary emotional factors impeding reintegration back into society. A sadly neglected psychosocial factor and independent risk factor is that of the Type A behaviour pattern. Extensive research in this area has not only found this behaviour pattern to be detrimental to effective rehabilitation but has also found it to be instrumental in the reocclusion of grafted blood vessels resulting in an elevated re-operation rate as well as putting these patients at risk for a potentially fatal coronary event. In an attempt to address this problem a rehabilitation group intervention program adapted for South African conditions was launched. This program was based on the Recurrent Coronary Prone Prevention Project intended for the treatment of post-myocardial infarct patients in San Francisco. Essentially the aim of the project was to ascertain whether this intervention could be applied effectively to the coronary artery bypass population and whether its duration could significantly shortened so as to be more economically viable given the limited economic resources characteristic of the health care services in this country. The modified programme was administered to a group of 13 post-coronary artery bypass graft patients at two local cardiac rehabilitation centres. A second group of 10 patients at these same centres served as a no-treatment waiting list control group, while simultaneously undergoing an aerobic exercise and cardiovascular counselling programme. Results of the study indicate the modified programme to be highly successful in modifying Type A behaviour and its components within the South African context in the post coronary artery bypass patient samples exposed to it. Comparisons of the experimental and control groups after the intervention showed statistically significant differences on the majority of measures. Thus it was- concluded that the modified programme has the potential to be an invaluable aid in the treatment of .this population in South Africa. Presently, however, this sample is being monitored longitudinally in order to ensure that the treatment benefits remain.

This study examined the relationship between Bandura' s theory of self-efficacy and the rehabilitation outcome of spinal cord injured persons. The study elicited selfefficacy expectations from fifteen subjects on three occasions: admission and two and four weeks later. Patients rated how they expected to perform six weeks after admission on fifteen rehabilitation behaviors. Patients' ratings were compared to actual performance ratings made by the medical staff on the Barthel Index. Results reveal that subjects' predictions two weeks and four weeks after admission were accurate (r = .74, < .01; r = .89, p < .001, respectively). Findings support the limited applicability of Bandura's theory of spinal cord injury rehabilitation. Recommendations for future research include examining variables which enhance self-efficacy and using a larger, more homogeneous sample.

Modern advances in technology have allowed for an increase in the precision with which we are able to measure, record, and affect behavior. These developments suggest that the domains in which behavior analysis might contribute are considerably broader than previously appreciated, for instance the area of behavioral medicine. One way the field of behavior analysis can begin to address problems in behavioral medicine is with biosensor technology, like surface electromyography (sEMG). For sEMG technology to be useful in behavioral medicine, specifically recovery from total knee arthroplasty, a reference value (the maximum voluntary individual contraction-MVIC) must be established. The MVIC value allows for the comparison of data across days and may allow the programming of contingencies. However, current MVIC methods fall short. Study 1 compares MVIC values produced by a participant given the typical instruction only method with two alternative methods: instruction + feedback, and instruction + feedback in a game context. Across 10 participants both feedback conditions lead to higher MVIC values then the instruction only condition. Study 2 applies the MVIC techniques developed during Study 1 to an exercise procedure. Using an MVIC value as the criteria for feedback Study 2 compares the same three conditions, however this time assessing for the conditions under which exercise performance is optimal. Across all 9 participants the instruction + feedback in a game context lead to the participant ‘working harder' and 8 out of 9 participants exceeded the MVIC value more often during this condition then in the other two conditions.

The purpose of this study was to verify the efficiency of McDowell's leisure counseling model for potential use with cardiac rehabilitation and intervention programs in effecting leisure attitudes, work attitudes, work self-concept, leisure self-concept and leisure satisfaction. To test the effectiveness of McDowell's model, an experimental research design, utilizing a pretest-posttest control group design, was used. The independent variable was counseling and the dependent variables, stated as alternative research hypotheses, were a positive effect on leisure self-concept, work self-concept, leisure attitudes, work attitudes and leisure satisfaction. Over a three month period, 24 adult subjects from an Adult Fitness Intervention Program volunteered for leisure counseling and were randomly assigned to one of two groups after which treatment was also randomly assigned. A test for homogeneity of regression revealed the subjects to be representative of the population on all variables except Work Self-Concept. In the study, a client typically was married, middle-aged, white-collar male worker. To measure the dependent variables, five instruments designed to be used with McDowell's model were used. The data obtained from the leisure counseling sample was first subject to a test for homogeneity of regression after which hypotheses one, two, three and five, were subjected to an analysis of covariance. The findings of the analysis of data allowed for the rejection of the null hypotheses and the acceptance of the research hypotheses for hypotheses two and five. For hypotheses one and three, the researcher failed to reject the null hypothesis, and rejected the research hypothesis. An interpretation of these findings suggested that leisure counseling using McDowell's model can affect one's leisure self-concept and leisure satisfaction. From the study it was concluded that for the sample studied McDowell's leisure counseling model can be said to have positively increased the clients' leisure self-concept and leisure satisfaction on a short term basis. It was also concluded that leisure counseling as a component of cardiac rehabilitation/intervention programs using McDowell's model was said to be neither effective or ineffective for the sample studies. These results must account for the fact that the research methodology was not able to identify the possible reactive effect of the pretest. / Ed. D.

Twenty subjects were audio and video taped during their exercise leadership examination. The tapes were used to code the interactions that occurred between the exercise leaders and the participants in the simulated cardiac rehabilitation exercise session using an interaction analysis system developed specifically for this physical activity setting group. The system identified interactions that could occur during the warm-up, stimulus, and cool-down phases of the session. The tapes were coded using the Datamyte 801 Observational Recorder. The phases of the sessions were coded individually. A frequency count was made as the interaction categories occurred. The frequencies were converted into rates of interaction (f•min⁻¹) for comparison. The mean rates of interaction were low for the phases and overall (warm-up= .38/min; stimulus= .59/min; cool-down= .29/min; total= .46/min). The individual subject's rates of interaction were all less than 1 interaction per minute (minimum= .28/min; maximum= .72/min). Related t-tests across category facets between phases showed the instruction and explanation facets in the warm-up phase differed significantly from the same facets in the stimulus phase. The compliance facet differed significantly in the stimulus phase from the compliance facet in the other two phases. The monitor facet in the stimulus phase differed significantly from the monitor facet in the cool-down phase. There was no significant differences across facets between the warm-up and cool-down phases. Higher rates of interaction occurred more frequently in the stimulus phase. The coding showed the differences in the interactions of the exercise leaders in the different phases in the simulated exercise session. The low rates of interaction suggest that the exercise leaders may have been reactive to the specific examination situation in which these data were collected. / M.S.

Expiratory muscle strength training (EMST) is a resistance exercise targeting the expiratory musculature that has predominated rehabilitation research for cough and swallowing. While there have been consistent improvements in expiratory muscle strength with EMST, and promising findings in cough and swallowing, there remains a substantial gap in our understanding of the physiologic adaptations associated with training and how to optimize rehabilitative outcomes. This dissertation consists of two studies aimed at refining EMST protocols for cough and swallowing rehabilitation. Chapter 1 is an introduction that provides an overview of exercise prescription principles, outlines what is known related to exercise protocols and EMST outcome measures, and finally describes the current research gaps and dissertation aims. Chapter 2 focuses on quantifying the relationship between resistive load and ratings of perceived exertion (RPE) during EMST, examines variability in RPE in healthy adults, and compares RPE using two respiratory devices. In Chapter 3, we examine the impact of modifying exercise parameters on physiologic adaptations and RPE, while also beginning to establish links between EMST, cough, and swallowing by assessing task specificity. Chapter 4 synthesizes the research findings into the greater scientific literature, discusses the clinical implications of this work, outlines limitations, and suggests avenues for future research.

Psychology / M.A. (Clinical Psychology)

This study investigated factors influencing the quality of data for the Tuberculosis (TB) control programme in Oshakati District in Namibia. A quantitative, cross-sectional descriptive survey was conducted using 50 nurses who were sampled from five departments in Oshakati State Hospital. Data was collected by means of a self-administered questionnaire. The results indicated that the majority (90%) of the respondents agreed that TB training improved correct recording and reporting. Sixty percent of the respondents agreed that TB trainings influenced the rate of incomplete records in the unit, while 26% of the respondents disagreed with this statement. This indicates that TB trainings influence the quality of data reported in the TB programme as it influences correct recording and completeness of data at operational level. Participants’ knowledge on TB control guidelines, in particular the use of TB records to, used to capture the core TB indicators influenced the quality of data in the programme. The attitudes and practises of respondents affected implementation of TB guidelines hence, influencing the quality of data in the programme. The findings related to the influence of the quality of data in the TB programme and its effect to decision-making demonstrated a positive relationship (p=0.0023) between the attitudes of study participant on the use of data collected for decision-making. Knowledge, attitudes and practice are the main factors influencing the quality of data in the TB control programme in Oshakati District. / Health Studies / M.A. (Public Health)