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Yes / This study aimed to explore more on contributing factors and prevention of overweight and obesity among Pacific islanders. Methods: Using Cochrane library guideline, four electronic databases, PubMed, Embase, Scopus and CINAHL, were systematically searched from 2010 to 2020. Search strategy included key concepts, free text terms, and database-controlled vocabulary terms to identify articles on determinants and preventative strategies of overweight and obesity in the Pacific countries. A data extraction sheet was developed to extract relevant information required for analysis and theme development for this study. Results: A total of 22 articles were summarized and categorized. Determinants of overweight and obesity identified two themes: environmental related factors 13.6% (3/22) and sociocultural related factors 27.3% (6/22). The preventative strategies of overweight and obesity was categorized into behavioural change 22.7% (5/22), school-related 18.2% (4/22), and policies 50% (11/22). The quality assessment of articles showed “Good” 68.2% (15/22), and “Fair” 31.8% (7/22). Conclusion: This study highlighted two contributing, non-medication factors affecting overweight and obesity are both environmental and socio-cultural issues. Overweight and obesity preventative strategies identified in the Pacific context considered behavioural change, knowledge enhancement, and policy development. Further research should aim at exploring the current preventative strategies in-depth, to appreciate the most feasible and recommended preventative approach within the Pacific society.

Research suggests that the relationship between caregivers and their infants has a significant effect on development and well-being across the lifespan. There is a significant body of research into psychological interventions which focus on this relationship. However, there is only limited research into the impact of antenatal interventions which aim to promote the caregiver-foetus relationship, thus preventing later difficulties in the caregiver-infant relationship. Findings so far suggest that such interventions could be effective, and recommendations have been made for further studies exploring the effect antenatal interventions on the caregiver-foetus relationship. This pilot study explored the impact of a newly developed psychoeducational intervention entitled “Baby World” on the caregiver-foetal relationship. Seventy-nine females and 26 males who were expecting their first child were recruited from an NHS midwife service in London. They were randomly allocated to experimental or control groups. All participants completed questionnaires measuring antenatal attachment, mental health and childhood experiences of caregiving at baseline. Those in the experimental group then attended the Baby World class. All participants then completed the questionnaires for a second time, and then attended the standard antenatal classes. Following attendance at these classes, participants completed the questionnaires for a third time and gave anonymous responses to qualitative questions. Statistical analyses of the quantitative data indicated that the intervention did not have an impact on antenatal attachment. Results did show that antenatal attachment increased over time, whilst anxiety decreased. A significant correlation was found between recollections of maternal caring and antenatal attachment. Qualitative analysis suggested that the intervention did have an impact on aspects of the relationship. In the qualitative responses, the majority of participants wrote that the class had been a positive experience for them, and that it had increased their confidence about being a caregiver. Many of the responses indicated that the class had positively affected their skills in reflective functioning, caregiver sensitivity and attunement, and changed their perspective on how to interact with their infant. The results add to the literature regarding the impact of antenatal interventions on the caregiver-foetus relationship. Further research is needed to explore the impact of the intervention on the relationship more closely, in particular to understand which aspects of the relationship may be affected. There are several limitations of the study, in particular the small sample size and the limited number of expectant fathers who participated. Reasons for these limitations are discussed.

Background: Type 2 diabetes mellitus (T2DM) is a complex health condition that impacts multiple organ systems and contributes to both acute and chronic health problems. In the United States (U.S.), T2DM is a growing health concern with increasing prevalence among both adult and pediatric populations (American Diabetes Association [ADA], 2015; Dea, 2011). Developing a comprehensive plan of care that incorporates a multifaceted treatment and prevention plan is necessary to address this growing health concern and reduce overall morbidity and mortality. Problem: The Edmund Primary Care (EPC) practice data for routine annual diabetic foot exams, annual eye exams, annual urine microalbumin, smoking cessation education and recommendations for pneumococcal polysaccharide do not meet the ADA (American Diabetes Association, 2015) recommendations for patients with T2DM.Design: Quality improvement (QI) project applying the Plan-Do-Study-Act (PDSA) cycle to develop a process change to improve diabetic preventative care measures for hemoglobin A1C, urine microalbumin, diabetic foot exams, and optometry referrals. Setting: A small, nurse practitioner owned, family practice clinic targeting patients 18 years and older with a diagnosis of T2DM.Intervention: A fishbone diagram to conduct a root cause analysis led to identification of key factors contributing to the problem. A comprehensive process change integrating a Diabetic Assessment Flow Sheet (DAFS) and diabetic foot exam sheet was developed to address the problem. Expected Outcome: Increase in rates of completion to at least 90% over eight weeks. Results: Analyzed with run charts demonstrating an increase in rates of completion to 100% for A1C, urine microalbumin, diabetic foot exams, and optometry referrals. A positive percent of change for each measure is as follows: A1C 7%; urine microalbumin 43%; diabetic foot exams 150%; and referrals to optometrist 43%. Significance: This QI project emphasizes the importance of implementing a system to evaluate the quality of care being delivered. It also highlights the usefulness of the PDSA cycle as a method to implementing quality improvement measures in health care. Lastly, this QI project demonstrated the effectiveness of flow sheets in improving the quality of care delivered to patients with T2DM.

5 pp. / Arizona youth livestock quality assurance and food safety: Trainers reference. Arizona youth livestock quality assurance and food safety: Youth manual. Feeding management for show lambs. Feeding management for show steers. Swine nutrition for show animals. / Illness or injury to a show animal may be preventable by following a few guidelines. Providing a clean and safe environment and properly feeding, watering, and vaccinating animals will help to reduce the risks of experiencing illnesses and injuries. Owners should also learn how to identify signs of health problems, such as sudden changes in behavior or appearance, and prepare a first aid kit for use in the event of an emergency. Also, being familiar with emergency treatment guidelines will help owners protect themselves, prevent further injury to the animal, and properly administer care to the animal if appropriate.

A serious concern in the practice of heat treatment is the effect of surface contamination and the effectiveness of subsequent cleaning on the performance and appearance of the finished products. This study examined the effects of contamination on the appearance, hardness, carbon concentration, and retained austenite percentages in vacuum carburized AISI 9310 steel. The effectiveness of commonly-used cleaning methods was also determined. Seven categories of typical contamination were selected for testing: rust preventative oil, hot and cold cutting fluid, and four levels of oxidation. Samples of AISI 9310 steel were contaminated and then half from each category were cleaned and the other half remained contaminated. All samples were vacuum carburized to a case depth of 0.35wt% carbon at 0.9mm. The properties were experimentally determined post-heat treatment. It was determined that there was no significant difference in the contaminated, cleaned, and non-contaminated samples for any of the hardness, carbon concentration, and percentage of retained austenite measurements. However, most contaminated samples had undesirable appearances after heat treatment. Therefore, when a high quality surface appearance is not necessary or if further surface processing is done on these parts, this study determined that cleaning of AISI 9310 steel is not necessary before vacuum carburization. This implies a potential cost and time savings for heat treatment companies. However, when the customer specifies a clean, lustrous surface, effective cleaning is required before vacuum carburizing.

This study explored social workers perceptions of disproportionality of African American children in the child welfare system, with a particular focus how they felt child welfare agencies, and organization address the specific needs of African American children and families. Along with the types of services social workers felt could be implemented in order to address the concerns amongst African American families. Major findings in the research under represent the perspective of the social workers who work closely with these children and their families. The overall research method that was utilized in this study was qualitative by design. The data collection consisted of 11 face to face interviews with different types of social workers with current and past experiences working with African American children and families, in the child welfare agency. This research called for opinions, experience and personal beliefs from social workers. The survey consist of 13 open/close ended question and demographical questions that were personally asked to each social worker on a one on one bases. The results of this study identified African American children entering and staying in the system at longer rates, poverty, lack of resources in the community, distrust in the government and cultural competency as major contributing factors to disproportionality in the child welfare system. This study displayed a need for social workers to take on more of a strength based approach and remembering to model the NASW code of ethics when working with African American families. Recommendations for future studies include but are not limited to: exploring options to have preventative services for African American families to be offered in their homes or alternatives to easy accessible services and to explore different strategies, tool and techniques in efforts to increase the relationships between the African American families and the social workers.

The purpose of the project was to increase awareness about alpha-1 antitrypsin deficiency (AATD) in chronic obstructive pulmonary disease (COPD), particularly among those with a familial history of genetic factor AATD; an additional goal was to understand its relationship to COPD. COPD is the third leading cause of death in the United States, with more than half of COPD patients experiencing significant disabilities. Major causes for COPD include smoking, air pollution, secondary smoke, upper respiratory infections, hereditary factors, occupational factors, environmental factors, and socioeconomic factors. Genetic factors, however, also play a significant role in early onset COPD and in those who smoke and have the genetic factor related to COPD (AATD), symptoms are more severe and exacerbations more frequent. Undiagnosed AATD can result in under treatment and lack of planning for preventing COPD onset and exacerbation in these patients. COPD clients of a local pharmacy (n =31) were invited to complete a Likert survey and given materials on COPD exacerbation prevention and information on AATD. Results indicated that 38.7% of respondents had early onset symptoms, positive family history, and no improvement in symptoms with smoking cessation. The results support that targeting those family members with COPD and providing information on genetic factors for this condition could decrease the frequency and severity of exacerbations. This is in keeping with the health belief model that guided this study in that a perceived risk for harm has the potential to improve the use of preventative health measures in individuals.

Globally the diabetes epidemic is a major health challenge. Associated with the diagnosis of diabetes is the morbidity and premature mortality stemming from the complications of the disease. It was identified that approximately 50% of clients who attended a diabetes centre in an outer western metropolitan region of Sydney were not completing diabetes education. A strategy employed to overcome this was the introduction of a 2 ½ hour group diabetes education program called the Ongoing Education System (OES), for persons with Type 2 diabetes, that enabled completion of education at this one session. However, debate occurred among health professionals at the Wentworth Diabetes Service (WDS) as to the effectiveness of the OES as compared to the traditional individual education sessions. (one-on-one education). The purpose of this study was to compare the outcomes of two modes of diabetes education for completing education for clients with Type 2 diabetes , namely individual education (Treatment A) and the OES group education (Treatment B). The findings overall revealed no difference in the outcomes of participants who received individual education and those who received the OES at completion of education as well as at 6 and 12 month post education. A secondary finding of this study was the significant influence gender and age exerted on the outcomes of the education programs. One significant implication from the findings for both the person diagnosed with Type 2 diabetes and the health care organisation is that the OES provides a cost effective alternative to individual education that encourages clients to complete diabetes education thereby enabling the person to achieve an optimal quality of life. In addition this study provides research evidence for the benefit of current practice in diabetes education. / Doctor of Philosophy (PhD)

Doctor of Philosophy / Grossarth-Maticek and Eysenck (1988) demonstrated that personality type as measured by the 70-item Grossarth-Maticek Personality Stress Inventory (GMPSI), predicts mortality and its cause with remarkable accuracy. Further, various forms of autonomy training, such as bibliotherapy and short individual treatment that were designed to reduce the toxic personality features (such as emotional dependence) effectively improved long-term health outcomes. However, several aspects of their theory and research were either insufficiently explicated or require further investigation. For example, the researchers did not thoroughly investigate the psychometric properties of the inventory, and they did not sufficiently examine the mechanisms that may mediate the personality-health relationship. Further, the autonomy training was inadequately described, and perhaps could have been briefer and had the same impact. Three studies were run to investigate these issues further. Study 1 (Chapter 2) investigated the internal consistency, test-retest reliability and convergent, discriminant and concurrent validity of the GMPSI in 312 first-year students, using a variety of statistical techniques (e.g., structural equation modeling, confirmatory factor analysis, and simple correlations). In addition, the psychometric properties of this scale were compared to those of three revised versions of the scale, which were theorised to be psychometric improvements of the original version from basic principles. The revised versions contained reverse-worded items (of different types) to monitor and disrupt acquiescence response sets, and/or an extended response scale to improve internal consistency and stability. Psychometric effects of reverse-wording and the extended response scale on scale reliability were examined via the analysis of construct reliability estimates, personality subscale model fit of congeneric measurement models (a form of structural equation modeling), and test-retest reliability estimates. The original version of the scale appeared to be the most reliable and valid scale of the four versions. This improved reliability of the original version was not an artifact of an acquiescence response set, because this form of responding was not prevalent in the reverse-worded versions. In contrast, it appeared that the incorporation of reverse-wording degraded the internal consistency of the scale as participants appeared to respond to the positive and negative-worded items as if they were measurements of independent constructs, rather than measurements of constructs on opposite ends of a particular dimension. Predicted correlations between the GMPSI and concurrent validity measures offered support for Grossarth-Maticek's theory, and suggest that the GMPSI is an effective and reliable tool for the measurement of these personality types. However, experimental evidence supporting the link between personality, mediating mechanisms and disease is required to further substantiate these findings. The second and third studies (Chapters 3 and 4, respectively) were investigations of the utility of an information pamphlet discussing stress, assertiveness and relaxation, in improving GMPSI personality type stress responses in a student and a community sample (Studies 2 and 3 respectively), and provided an opportunity to investigate the mechanisms mediating the personality-health relationship via experimental manipulation. Specifically, Study 2 investigated the effectiveness of the pamphlet in improving personality scores, mood, coping strategies, health behaviours, and salivary cortisol levels (measured at pre-treatment, 1-month post-treatment and 5-months post-treatment) in 200 first-year university students. Further, two modes of administration of the pamphlet were compared: pure selfadministration versus instruction accompanied by self-administration. Group differences in mood and cortisol reactivity to a visualisation stress task were also assessed. Very few significant differences were found between the two pamphlet administration forms. Both pamphlet forms were effective in improving mood states, some lifestyle habits (e.g., exercise), and salivary cortisol responses to the acute stress task compared to the control group. The strength of these effects ranged from small to medium, and all significant differences were between pre-treatment and the 1-month post-treatment session. The failure to observe differences at the 5-months post-treatment session may have been due to inadequacies of the treatment, or low statistical power for detecting effects from the final session due to the large attrition rate that had occurred by this session. Overall, while large treatment effect sizes were not found, the results could be construed as "clinically" significant when taking into account the low costs of implementing an information pamphlet in the larger community, and the potential benefits on individuals' stress responses and health behaviours. Study 3 aimed to investigate the treatment effects of the same self-administered pamphlet in 77 participants from the general community, who varied largely in age (19 - 77 years). Treatment and control groups were compared in terms of treatment compliance, cortisol levels, health behaviours, personality scores, perceived stress, mood, and coping styles (measured at pre-treatment, 2 weeks posttreatment, 3 months post-treatment, and 6 months post-treatment). In addition, group differences in cortisol reactivity to an acute cognitive stress task were examined. Home visits were arranged for each session to reduce sample attrition. Further, an intervention evaluation form was administered at each post-treatment session to verify and maintain treatment involvement. Several significant treatment effects were observed, including changes in personality scores and non-productive coping strategies, and the strength of these effects ranged from medium to very large. Most participants reported that they found the information pamphlet very appealing and helpful. In addition to the examination of intervention effects in the second and third studies, a path model that aimed to identify direct and mediating relationships between personality and concurrently measured disease was examined for the two samples (Chapter 5). This path model was based on a new integrative theory of personality-disease, which was developed. Eysenck's (1991) proposed personality-disease model formed the foundation of this new theory, and elements of several other generic personality-disease models were also incorporated. This theory was empirically tested using path analysis on the student and community data separately. Common pathways in the two models were then tested for invariance. Overall, most paths proposed by the integrative model were identified in one or both samples; thus, the model was generally supported. All common direct paths were statistically invariant (i.e., equivalent) in the two samples. While personality did not appear to directly predict illness, several significant indirect pathways were identified by which personality appears to affect disease incidence, such as via perceived stress, mood, coping styles, and physical risk factors. These findings appear to support Grossarth-Maticek's theory that personality affects disease incidence via stress responses, as well as other generic approaches (i.e., the personality-induced hyperreactivity model and the stress moderator model) that emphasise the stress-moderating effects of personality on health. However, support for the dangerous behaviours model was not found, which posits that certain personality dispositions seek risky behaviours (e.g., poor health behaviours such as smoking and alcohol consumption) that fit their personality. The final Chapter 6 directly compares the results of these three studies, and discusses their practical and theoretical significance in terms of Grossarth-Maticek's theory and research, views of critics, and other personality-health perspectives and research. In summary, the current studies appear to suggest that the GMPSI is a reliable and valid scale for the measurement of particular personality traits. Further, there appears to be evidence to suggest that personality traits can be changed by an intervention pamphlet. This information pamphlet also appears to be effective in significantly improving responses to stress, and these effects are more prominent in high-risk groups (i.e., subjects with extreme personality trait scores). Moreover, there is some evidence to suggest that personality may have direct effects on several mechanisms involved in the development of disease. Overall, this thesis demonstrates the importance of recognising the role of personality and stress in disease prevention and prediction by providing independent evidence for the benefits of treatment and mechanisms by which benefits may occur.