Class of 2010 Abstract / OBJECTIVES: The purpose of this study was to determine the number of inpatient discharges and burden of illness due to testicular cancer with data from the national database Healthcare Cost and Utilization Project (HCUP). METHODS: This retrospective study looked at hospital discharge records to obtain information regarding the inpatient burden of illness of testicular cancer patients. The study looked at procedures, co-­‐morbidities, hospital characteristics, case-­‐mix control, and the Deyo-­‐Charlson to see how they were associated with the charges, length of stay, and inpatient mortality. Also included in the study was information regarding patient age, method of payment, and hospital type and size. A linear multivariate regression was performed to estimate determinates of hospital costs. RESULTS: During the 5-­‐year time frame of the study, 28,985 inpatient admissions with testicular cancer were identified. For the overall sample, the average total charges per hospitalization were $29,857. For the 717 patients that died while receiving inpatient treatment, the associated charges averaged $73,800, more than double that associated with the overall sample. The gamma regression of charges for the overall sample showed an association between increased charges and age, length of stay, number of procedures, all admission years in reference to 2002, admission to a large-­‐sized hospital in reference to a small hospital, admission to an urban hospital in reference to a rural hospital, admission to a teaching in reference to a nonteaching hospital and the Deyo-­‐Charlson score. CONCLUSIONS: Testicular cancer is on the rise worldwide and is associated with a high inpatient burden of illness.

According to Mechanic (1967), the layman has usually assumed that the psychiatric professional is the unbiased expert on who is, or is not, mentally ill. In addition, the psychiatric professional has also usually assumed that his labeling decisions are based upon an unbiased scientific examination of the available information. However, Mechanic, and other sociological observers of the mental illness labeling process, have recently questioned whether these assumptions are legitimate. In fact, these observers have found that the professional’s labeling decisions are apparently heavily biased in favor of mental illness. Mechanic (1967), recounting his experience at two state institutions, reported that once a person is presented for institutionalization, seldom if ever does the psychiatrist dis- agree, although the psychiatrist’s “reasons” for hospitalization may be based on different premises than the public’s. Scheff (1964a, 1964b) found that when psychiatrists work within a court commitment setting, they tended to presume the existence of mental disorder. In a detailed examination of actual court procedures and psychiatrists’ pre- commitment patient interviews, his evidence indicated that the psychiatrists’ investigations appeared biased and presumed the existence of disorder. The psychiatrists frequently chose arbitrary evidence upon which to base their decisions- -evidence that involved elaborate psychiatric straining and interpretation. Often they decided to commit the person in question even where no evidence could be found. Their offhand remarks suggested pre- judgment of the case, and the interviews were conducted with such marked haste and carelessness that they only lasted on the average about ten minutes. As one of the psychiatrist’s states: The petition cases are pretty automatic. If the patient’s own family wants to get rid of him you know there is something wrong (Scheff, 1964a, p. 410). Coffman (1961) has noted that psychiatrists usually seek only that information that is consistent with their opinions through a process he has called “discrediting”. Within the mental hospital with which he was associated, the patient’s records and history were carefully searched to provide justification for the patient’s label, while any evidence of health was usually ignored. On the other hand, Gove (1970) has disputed the veracity of these observations. He has presented evidence that psychiatric professionals do not routinely label people as mentally ill, and do not commit every person they examine to a mental institution. Gove has also questioned the scientific adequacy of the methods employed by Mechanic and Scheff. Unfortunately, Gove’s rebuttal was based upon a review of the literature, and most, if not all, of the studies in his review were not originally directed toward the question of possible professional bias. In the writer’s opinion, an adequate test of the legitimacy, or illegitimacy, of Mechanic’ (1967), Scheff’s (1964a, 1964b), or Goffman’s (1961) observations has not yet been made. If professional bias does exist in the mental illness labeling process, then two primary factors might account for Mechanic’s, Scheff’s, and Goffman’s observations. First, an individual’s work setting may be associated with various situational expectancies that might influence one’s diagnostic judgment. For example, the situational expectancies of the psychiatric professional, operating within his typical work setting, might be biased in favor of the probable appearance of a mentally ill person. If one expects to interview a mentally ill person, then one’s diagnostic judgment of that person’s mental status might be affected. Second, the psychiatric professional’s training and experience might foster an increased inclination to view people as mentally ill--a greater inclination than the non-professional. If the professional is less inclined to tolerate deviance than the non-professional, then the professional’s diagnostic judgments should be more likely to lead to the mental illness label. The primary goal of this dissertation will be to examine these two factors--situational expectancies and tolerance of deviance--and their role in the mental illness labeling process. Bias in the application of the mental illness label may be traceable to the effects of these two factors. / This thesis was digitized as part of a project begun in 2014 to increase the number of Duke psychology theses available online. The digitization project was spearheaded by Ciara Healy.

Class of 2007 Abstract / Objectives: To explore the economic burden of illness and outcomes associated with in-patient related cases of asthma. Methods: This retrospective database study used Healthcare Cost and Utilization Project’s National Inpatient Survey to investigate the total number of discharges, length of stay and health care costs of patients with a primary diagnosis of asthma based on gender, payer and level of income. Data was analyzed using a non-parametric z-test to determine if results were significant. Results: A total of 418,789 patients (164,045 male, 251,264 female, 3,479 missing) were admitted with the category diagnosis of asthma in 2004. Females had a longer mean length of stay, higher mean charges and higher aggregate charges than males. These apparent differences were found to be significant. Medicaid had a larger number of total discharged and higher aggregate charges. Both these outcomes were found to be significant when compared to all other payers, expect there was no significance between Medicaid and Medicare in regards to aggregate charges. Medicare had a longer mean length of stay and higher mean charges which were found to be significant when compared to all other payers. Not low median income had more discharges, longer mean length of stay and higher mean and aggregate charges compared to low median income. These apparent differences were found to be significant. Conclusions: Being of female gender, or part of a government funded program (Medicaid or Medicare) or having an income of $36,000+ would result in higher discharge rates, longer mean length of stay and higher mean and aggregate charges in respect to asthma hospitalizations.

No description available.

The employment of metaphors in drawing meaning from our experiences is an indispensable ingredient in most patient narratives. More specifically, they are essential to the conceptual system we reference to understand and respond to the disruptions brought upon by chronic illness. Through an analysis of patient narratives penned by a group of contemporary American authors, this study identifies trends in how patients can use metaphor to “bridge” the gap between their lives pre and post diagnosis, a process that in many cases presents vulnerability as a viable remedy for alleviating the alienation and diminished self-image so often impacting the lives of patients with lifelong disorders. / Includes bibliography. / Thesis (M.A.)--Florida Atlantic University, 2018. / FAU Electronic Theses and Dissertations Collection

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Many clients with severe mental health problem, live in the community with their relatives. Research in the area has indicated that exacerbation of psychotic symptoms in clients is strongly associated with the emotional atmosphere in the family. The presence of high expressed emotion has been linked with relapse. However, recent research suggests that it is the causal attributions which relatives make to explain the illness symptomatology, which is most predictive of relapse. Relatives viewing clients' symptoms as being controllable by the client has been associated with hostility in relatives. Little has been said in the literature about the subjective experiences of clients. The present study investigated the causal attributions which clients and relatives made to explain the manifestation of the illness. Causal attributions made to explain positive symptoms, negative symptoms and behavioural problems were examined and compared. Clients! perception of their relationship with a key relative and their affective state was measured. Participants knowledge about schizophrenia, and relatives levels of distress were also examined. The clients in the present study were men under fifty with a diagnosis of schizophrenia. Key relatives also participated. A cross sectional correlational and comparative methodology was employed. A mixture of quantitative data and qualitative information was generated. A key finding was that the nature of attributions made was determined by symptom category. Positive Symptoms were deemed to be the least controllable symptom and Behavioural Problems were considered the most controllable. Relationships existed between the attributions made by clients and relatives. Depression in clients was related to them attributing their illness to personal factors, and a reporting negative feelings about there relationship with a key relative. Findings are discussed in relation to literature, research and clinical practice.

This study explores the process of psychological adjustment to multiple sclerosis. Fourteen participants who were given a definite diagnosis of multiple sclerosis between five and forty years prior to the study and who experienced the relapse-remitting form of the disease were interviewed face to face using a semi structured interview schedule. Grounded theory was used to analyse the interviews and to build a theoretical account of the process of psychological adjustment to multiple sclerosis. The results suggest a model of adjustment in which some individuals with multiple sclerosis move from a stance of denial to a position of acknowledgement in response to the progress of the disease. Reaching acknowledgement allows individuals to adopt an active coping stance which can protect against negative psychological consequences. This adjustment process takes place against an overall process in which individuals experience multiple sclerosis as a progression through a series of different disease phases. Findings suggest that individuals also have to adjust within the social context. Role adjustment and communication were found to be central issues in the family adjustment process. Communication was also central to adjustment in the wider social context. Participants' service use suggests that they also undertake an adjustment from reliance on medical approaches to seeking out self help and alternative approaches. It is argued that this service use process reflects the individual adjustment process. The findings are critically evaluated and compared to existing models of adaptation to chronic illness. The clinical and service implications are discussed. A critical discussion of the methodology is presented and implications for further research are explored.

Thesis (M.S.)--Boston University

This study investigated the relationship between intensity of grief and coping patterns of parents of individuals affected by psychotic disorders. The study investigated the intensity of grief in a sample of parents of individuals with psychotic disorders in Western Australia to determine if the results replicate international studies. It further examined if the characteristics of the psychotic disorders of children, had an impact on the grief reactions of parents and if the disorder had a measurable impact on the nature of the relationship between parents and children. The study also identified specific coping strategies that parents consider as being most helpful to them in dealing with their grief, the relationship between intensity of grief and coping patterns of respondents and gender differences in grieving and coping strategies. The research findings suggest that there is measurable grief in a cross section of parents of individuals with psychotic disorders in Western Australia with many similarities to studies done internationally. The findings also suggest that this grief increases in intensity from the time of first diagnosis and peaks at 1-2 years after diagnosis and again 20 years after diagnosis. There was a strong association between past behaviours related to grief reactions and present feelings related to grief. To the best of my knowledge, these findings have not been reported before. IV Certain characteristics of the disorder of children had an impact on the grief reactions of the parents. Higher levels of grief were reported in parents whose children needed frequent assistance with personal care and children with a late onset of the disorder. / There was a positive correlation in parents who had a close relationship with the child before the onset of the disorder and following onset of the disorder suggesting that the disorder did not affect the relationship. To the best of my knowledge, these findings have not been reported before. While this research has replicated other studies, it has also researched coping strategies that have not been identified before. Although cognitive coping strategies were most frequently used by parents and subjectively found to be more helpful, parents using predominantly behavioural methods of coping showed less intensity in their grief. Parents oscillated between approaching the feelings of grief and distracting themselves from them, which highlighted the idiosyncratic nature of coping. Although there were no gender differences in the intensity of grief, there were distinct differences in coping strategies used by fathers and mothers. These findings have important implications for social work practice and policy development within the mental health settings of Western Australia.