Lee, Man Yuen. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 191-215). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Thesis (Ph. D.)--Oregon State University, 2007. / Printout. Includes bibliographical references (leaves 124-140). Also available on the World Wide Web.

published_or_final_version / Nursing Studies / Master / Master of Nursing

The focus of the research study is to explore chronically ill African American, Latino, and White patients' causal attributions of symptoms of depression and factors that predict depression care treatment preferences among these groups. Research has demonstrated that perception of illness impacts what treatments a person will deem appropriate for their mental health problems and from whom they will seek treatment. Research also indicates that certain ethnic groups are more likely to seek treatment for their symptoms of depression in the primary care setting. Yet, it is unclear how they actually perceive their symptoms and what best predicts the treatments that they are likely to consider acceptable. A convenient sample of 109 HIV+ adults, 79 diabetic adults, and 3 adults with both conditions were recruited for this study. Participants had to be receiving services for either HIV, diabetes, or both conditions in one of the three central Austin facilities and be a representative from one of three racial/ethnic groups: African Americans, Latino, and White. Differences were found across ethnicity with regard to causal beliefs and treatment preferences for the symptoms of depression both among the HIV and the diabetic subgroups. Latinos in both groups were more likely than Whites to prefer counseling or a single form of treatment over combined treatment methods. Diabetic Latinos were more likely to prefer counseling for symptoms of depression. HIV seropositive individuals who reported the least number of symptoms of physical illness were more likely to attribute their symptoms of depression to stressful life events, whereas those who reported the greatest number of symptoms of physical illness were more likely to attribute their symptoms of depression to their medical illness. Additionally among the HIV subgroup, individuals who reported high stress tended to predict the preferences for treatment provided by a psychiatrist/psychologist and Whites scored highest on this factor. Finally, differences in depression scores across race/ethnicity were also revealed. The utility of assessing a patient's understanding of symptoms of depression in order to determine how personal illness models impact treatment preferences and knowledge of patient's causal attributions can aid medical social workers and physicians in collaborative management of chronic illness and depression are discussed.

Diabetes affects 25.8 million Americans. Complications related to this growing disease impact public health. One secondary complication of diabetes is changes in skin that can contribute to an increased risk for ulceration. Skin of people with diabetes has not been characterized over time nor has the skin’s acute response to exercise been assessed. The objective of this project was to establish the changes in skin properties over time, within different ambient environments, and after acute exercise. This objective sought to address the central hypothesis that skin will demonstrate decreased stiffness and increased elasticity as a result of acute physical activity. Skin stiffness, compliance, and thickness measurements of the plantar foot were compared across time and environment. Skin stiffness and compliance were also compared before and after treadmill walking. First, three devices were validated. Accuracy of the StepWatch was validated for people using assistive devices. The tissue interrogation device (TID), a novel device that measures tangential skin stiffness, and the myotonometer, which measures skin compliance, were validated using elastomer phantoms. Both were found suitable to measure plantar skin properties. Second, skin properties of 16 persons with and without diabetes were measured over time and environmental condition. Skin was variable across subjects over time, but was stable within subjects over a month, supporting the use of a repeated measures approach to interventional study on the plantar skin in people with diabetes. Previous findings for general skin characteristics were supported including the tendency for persons with diabetes to have a thinner epidermis and a thicker dermis than persons without diabetes. Tangential skin stiffness was determined to be less stiff in people with diabetes when measured in a medial-lateral direction. People with diabetes had lower tissue compliance than those without. Skin properties varied across environmental condition, supporting the consideration of testing environment when evaluating skin. Finally, changes in skin properties were evaluated in 32 persons with diabetes before and after treadmill (TM) walking. Using the TID, skin stiffness (tangential) at the great toe of people with diabetes (663.705±4.796 N/m) and without (647.753±5.328 N/m) were different (p=0.040). Stiffness immediately following TM walking did not differ from pre-walking stiffness, but subsequent trials had increased stiffness. Similar, but not significant responses were noted at the first metatarsal head. Compliance using normal loading increased after walking with statistical differences lasting 30-60 minutes.

Although the benefits of exercise to non-insulin-dependent diabetes mellitus (NIDDM) are well-known, individuals with NIDDM are at risk for macrovascular and microvascular complications associated with an abnormal systolic blood pressure (SBP) elevation during exercise. In order to compare the SBP and rating of perceived exertion (RPE) response between individuals with NIDDM and apparently healthy controls during submaximal exercise, eight individuals representative of each group completed a 10-minute submaximal treadmill exercise trial at 65% of functional capacity. Heart rate, blood pressure and RPE were monitored throughout the trial. Between group comparisons were made for SBP and RPE response, and the frequency of exercise SBP response _> 200 mmHg was investigated. No significant differences were observed in either SBP or RPE response between groups during the submaximal treadmill trials. In addition, none of the subjects from either group achieved a SBP ? 200 mmHg. While this study indicates that exercise at 65% of functional capacity is safe for this particular group of subjects with NIDDM, additional research is warranted to investigate cardiovascular response to exercise in a broader subject pool representative of the entire NIDDM population. / School of Physical Education

The purpose of this study was to determine if there was a difference in physical selfconcept due to level of physical activity or the subject's frame of reference. Participants included female students in two HSC-160 courses and members of the Ball State University women's softball, field hockey, and basketball teams in the fall of 2000. The study was conducted using a demographic questionnaire, the Physical Self-Description Questionnaire (PSDQ), and a physical activity log. Subjects received instructions to complete the PSDQ comparing themselves to either someone more physically fit or less physically fit. Subjects chose one of three physical activity levels, nonparticipant, exercisers, or athlete, based on definitions given on the demographic questionnaire. Results of the study indicated that as the level of physical activity increased, so did physical self-concept scores. Results did not find a significant difference in frame of reference and level of physical activity. / School of Nursing

The use of Rate of Perceived Exertion (RPE) by those with Diabetes Mellitus participating in physical activity has not been clearly addressed. The American College of Sports Medicine has suggested that RPE may be used with diseased populations, including those with Non-insulin Dependent Diabetes Mellitus (NIDDM), but no specific guidelines for RPE use have been established for this population. The purpose of this study was to compare the RPE during graded exercise for the individuals with NIDDM and apparently healthy individuals. Specific comparisons of the RPE at the ventilatory threshold and at 60% and 80% of maximal oxygen uptake were made.Seven subjects with NIDDM were paired with seven apparently healthy CONTROLS of similar age, weight, and gender. All subjects performed a maximal graded exercise test (GXT) on a motor driven treadmill per Bruce Ramp protocol. Rate of perceived exertion was taken every minute using Borg's 6-20 point scale (Borg 1973). All subjects were given the same instructions for use of the RPE scale and were queried by the same technician. An analysis of variance was performed with a significance level set of ps0.05. Statistical analysis revealed no significant differences between the two groups for all demographic variables measured including age, weight, height, body mass index (BMI) and percent body fat. No significant difference was seen for maximal exercise data including RER, RPE, V02, and heart rate. Maximal V02 was 31.1 ± 8.2 ml•kg-lmin-l SD for the NIDDM group and 38.7 ± 11.6 for the CONTROL group when expressed in weight relative terms. Maximal heart rates for the NIDDM and CONTROL groups were 176.9 ± 17.9 bpm and 176.4 ± 8.8 bpm respectively. Ventilatory threshold (VT), heart rate at VT and percentage of VO2 at which VT occurred were not significantly different between groups.No statistically significant differences were seen between the NIDDM or the CONTROL group for RPE at the selected intensities. RPE at the VT was 13.0 ± 3.6 and 12.3 ± 1.8 for the NIDDM and CONTROL groups respectively. RPE at 60% of functional capacity was 13.3 ± 3.5 for the NIDDM group and 12.0 ± 1.7 for the CONTROL group. Likewise, no statistical difference was seen at 80% of functional capacity. The NIDDM group RPE was 16.1 ± 2.5 and the CONTROL group rating was 15.9 ± 2.0, respectively. Under the terms of this study those individuals with NIDDM perceived exertion similarly to the CONTROL group. / School of Physical Education

Diabetes has become a nationwide epidemic affecting 18.2 million Americans, and the incidence is expected to increase 122% by the year 2025. The dyslipidemia associated with type 2 diabetes—low HDL-C; high TG; and small, dense LDL-C—contributes to the 2 to 4 times greater risk of individuals with diabetes to have a major cardiovascular event. Niacin, a B vitamin, and aerobic exercise have been shown separately to favorably alter the lipid profile. The present study examined a combination therapy of Niaspan®, an extended-release formulation of niacin, and 16 weeks of aerobic exercise in 23 individuals with type 2 diabetes. The dosage of Niaspan® began at 500 mg/day and increased 500 mg/day every 4 weeks up to a maximum dose of 2000 mg/day. Subjects were advised to gradually progress their frequency, intensity, and duration of aerobic exercise until they were expending at least 1500 kilocalories by week 8. Subjects were instructed to make no changes to their diet or diabetes medication regimen. Lipoproteins and subfractions and selected measures of physical fitness were examined before and after the 16 week intervention. Following the 16 week intervention period, there were significant changes (p<0.05) in HDL-C (+28%), TG (-19%), VLDL-C (-12%), and LDL-C (-9%). There were also significant changes in the larger, more buoyant subfractions HDL2 (+48%), VLDL2 (-15%) and LDL1 (-48%). Other subfractions that are smaller and more dense also changed favorably: HDL3 (+24%) and LDL4 (-15%). Although there was no significant weight loss in this population as a result of the intervention, there were significant changes in submaximal heart rate (124.9±17.6 vs. 116.7±16.3 bpm) and resting systolic (136.8±17.5 vs. 128.3±13.8 mmHg) and diastolic (80.3±12.5 vs. 73.2±9.8 mmHg) blood pressure, adaptations that occur with improvement in physical fitness. There were no changes in fasting plasma glucose or glycosylated hemoglobin, contradicting any deterioration in glucose control. Therefore, the combination of Niaspan® and aerobic exercise is effective at altering the lipid profile in individuals with type 2 diabetes. In addition, this intervention is safe in that it does not adversely affect glucose control. / School of Physical Education, Sport, and Exercise Science

Previous studies reported that noncompliance to diabetes treatment may result in a series of health complications. To further understand patients’ noncompliance to meal plans, a study on meal planning strategy was developed. Through a survey Certified Diabetes Educators determined which meal planning strategies were the most effective in encouraging patients’ compliance to meal plan according to age groups (18 and under, 19 to 49, 50 to 70, and 71 and above) and recency of diagnosis (newly- and non-newly diagnosed) with Type 2 diabetes. Results identified that nutrition labels had the greatest mean rating for effectiveness in age groups 18 and under, 19 to 49, and 50 to 70; and healthy food choices had the greatest mean rating for effectiveness with age group 71 and above. / Department of Family and Consumer Sciences