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.

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.

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.

The experiences of sexual intimacy for partnered older people are little researched. This study, situated in a life course perspective on sexuality, purposively sampled data from 11 in-depth interviews and 41 pieces of correspondence from people between the ages of 75-85 in the United Kingdom. The study used Intuitive Inquiry, a method consisting of five “Cycles”; clarification of topic, literature review and description of initial “lenses”, data collection and summaries, integration of the data with literature to produce the final “lenses” and lastly synthesises of the stages of the study to produce a final interpretation. Data were analysed thematically and phenomenologically providing both breadth and depth. The thematic findings recorded observable acts of sexual intimacy and continuums of participant’s thoughts and feelings. The continuums were organised into five meta-themes: the effects of ageing, the nature of relationships, the family context, seeking assistance and the sexual life story. The phenomenological analysis provided “Being Together” as the essence with the constituents; Maintaining intimacy in changing circumstances, Setting current intimacy across a life course, Concern about what people think, The possibility of sexual intimacy and The spectre of death. In addition to the findings the new contributions to the body of knowledge include; a definition of sexual intimacy in older age, the use of intuitive inquiry as a research method within the UK and a greater understanding in researching sensitive topics with older people. The recommendations highlighted a need for increased professional understanding of older age sexual intimacy and practical interventions to preserve sexual intimacy as part of essential holistic care. Further development of the continuums is planned to develop a tool to aid identification of synchronicity or discord between couples as a potential aid to clinical and therapeutic intervention.

My research explores the lived experience of envy amongst psychotherapists and between psychotherapists in a psychotherapeutic community in New Zealand. It focuses on bringing the experience of envy out of hiddenness and into language.It then explores the understandings and the possibilities of meanings that these experiences have. Previous literature on envy has for the most part discussed the clients' envy for the psychotherapist, and very little has been written about the therapists' envy for the client. My research turns the focus to the psychotherapist as it looks at their envy for each other.As I was interested in the therapists' lived experiences of envy, I chose hermeneutic phenomenology as the methodology to explore these. I drew on the philosophical underpinnings offered by Heidegger, Gadamer and van Manen.What arose from my in-depth conversations with psychotherapists is that while envy is an experienced phenomenon that is for the most part not spoken, the powerful feelings that it evokes have great impact on both those who envy and those who are envied. Envy showed up as arising in a relational context, with perception, time and anxiety as contextual determinants. These, along with the findings of the lived experience of envy as a binding between self and other, as threatening to self and other and as a means of connecting with self and other, are some of the essential points discussed in my thesis.This study provides a starting point for a further exploration of the experience of envy amongst psychotherapists as well as envy's impact on who we are in ourselves and how we are with each other, both personally and professionally.

Making the transition to an area of specialist nursing practice is challenging for both the learner and staff who are responsible for education and skill development. This study uses grounded theory methodology to explore the question: "How do nurses learn critical care nursing?"The eight registered nurses who participated in this study were recruited from a range of intensive care settings. The criteria for inclusion in the study included the participant having attained competency within the critical care setting. Data was collected from individual interviews. The findings of this study developed during the coding and comparative analysis process, and subsequently theoretical sampling was used to further explore the identified concepts.This study found that nurses' focus on two main areas during their orientation and induction into critical care nursing practice. These are learning to do (skill acquisition) and learning to be (professional socialisation). The process of transition involves two stages: that of learning to do the tasks related to critical care nursing practice, and the ongoing development of competence and confidence in practice ability. The relationship of the learner with the critical care team is a vital part of the transition to competency within the specialist area.This study identifies factors that influence the learner during transition and also provides an understanding of the strategies used by the learners to attain competency. These findings are applicable to educators and leaders responsible for the education and ongoing learning of nurses within critical care practice. The use of strategies such as simulated learning and repetition are significant in skill acquisition. However attention must also be paid to issues which influence the professional socialisation process, such as the quality of preceptor input during orientation and the use of ongoing mentoring of the learner.

The analgesic effect of acupuncture is well known. Areas in the brain and higher centres that are activated by acupuncture have been mapped out. Some of these areas are also implicated in the modulation of motor function. In addition to pain relief, acupuncture has been found to increase range of movement in patients with increased muscle tone. There is, however, scant knowledge of the mechanisms underlying this therapeutic effect.

Hypercholesterolaemia (high cholesterol) is a risk factor for atherosclerosis, a major contributor to cardiovascular disease. Much has been written on managing high cholesterol levels including the use of drug therapy and recommendations about beneficial lifestyle changes relating to nutrition and exercise in particular. Despite this, and the need for patients to engage in self management of a condition which may impact invisibly on their health, little is known about how people living with this risk factor actually manage.The purpose of this grounded theory study is to investigate people's process of living with high cholesterol. Eight participants with self reported high cholesterol levels were interviewed and their data analysed using the process of constant comparative analysis, open coding, selective coding and theoretical coding. A substantive theory in the area of patient self-management of high cholesterol levels was generated through the use of this approach. The theory developed was the basic social process of Maintaining Enjoyment of Life, with two supporting categories, Accepting and Getting On With It.Maintaining Enjoyment of Life was central to the participants' process of living with high cholesterol and the recommended health directives. The identification of this basic social process adds to our understanding of the influences on individuals' motivation for behaviour change and adherence to lifestyle changes. The findings of this study provide understanding that issues relating to behaviour change and adherence are not so much about denying that anything is wrong or not taking personal responsibility, but more about trying to hold on to something important, around which the participants' lives revolve. This is Maintaining Enjoyment of Life. By focussing on this basic social process, which is grounded in the participants' data, health professionals could work more effectively towards empowering patients to identify their own individualised strategies for self-management of high cholesterol. In addition, health directives could focus more on process rather than on do(s) and don't(s).