Gu Jia-Shi. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 117-148). / Abstracts in English and Chinese. / Title --- p.i / Abstract (English) --- p.iii / Abstract (Chinese) --- p.iv / Acknowledgments --- p.v / Statement of Originality --- p.vi / List of Abbreviations --- p.viii / List of Figures --- p.xi / List of Tables --- p.xiii / Table of Contents --- p.xiv / Chapter Section One : --- Introduction & Literature Review / Introduction & Objective --- p.2 / Introduction / Objective of the present study / Chapter Chapter. 1 --- A Review of Chronic lung disease (CLD) --- p.6 / Chapter 1. --- BPD 226}0ؤ an example of CLD / Chapter 2. --- Pathological change & Clinical presentation / Chapter 3. --- Clinical sequel of CLD infants / Chapter 3.1 --- O2 consumption of CLD infants / Chapter 3.1-1 --- Oxygen consumption / Chapter 3.1-2 --- Oxygen transportation / Chapter 3.1-2a --- Dissolved O2 / Chapter 3.1-2b --- Haemoglobin / Chapter 3.2 --- Energy expenditure of CLD infants / Chapter 3.3 --- Growth rate of CLD infants / Chapter 4. --- Treatment & Management of CLD infants / Chapter 4.1 --- Diuretics / Chapter 4.2 --- Bronchodilators / Chapter 4.3 --- Corticosteroids / Chapter 5. --- "Interpretations of the observed phenomena, why does CLD impair growth?" / Chapter 5.1 --- The traditional view / Chapter 5.2 --- Disagreement with the traditional view / Chapter Chapter 2 --- Measurement of oxygen consumption --- p.20 / Chapter 1. --- Invasive measurement of VO2 / Chapter 1.1 --- Cardiac output / Chapter 1.2 --- Fick method / Chapter 1.3 --- Advantages and Disadvantages of Fick method in estimating VO2 / Chapter 1.4 --- Measurement of cardiac output by thermodilution / Chapter 1.4-1 --- Advantages and Disadvantages of Thermodilution Method / Chapter 2. --- Non-invasive measurement of VO2 / Chapter 2.1 --- Metabolic analyzer---DeltatraćёØII / Chapter 2.2 --- Paramagnetic sensor / Chapter 3. --- Measured and calculated oxygen consumption / Chapter 3.1 --- Difference between mVO2 and cVO2 / Chapter 4. --- Summary / Chapter Chapter 3 --- Hypothesis --- p.34 / Chapter 1. --- Possible explanations for the difference between mV02 & cV02 / Chapter 1.1 --- Measurement variability and Mathematical error / Chapter 1.2 --- Oxygen consumption of the lung / Chapter 1.3 --- VO2pul with lung damage / Chapter 1.4 --- "Neutrophils, Macrophages and oxygen consumption" / Chapter 2. --- Hypothesis / Chapter Section Two : --- Methods & Materials / Chapter Chapter 1 --- Animal Model --- p.41 / Chapter Chapter 2. --- Materials --- p.43 / Chapter 1. --- Animals / Chapter 2. --- Chemicals used for inducing lung damage / Chapter 2.1 --- Acute damage group / Chapter 2.1-1 --- N-nitroso-N-methylurethane (NNNMU) / Chapter 2.1-2 --- Administrations to rabbits / Chapter 2.2 --- Chronic damage group / Chapter 2.2-1 --- Bleomycin (BLM) / Chapter 2.2-2 --- Pulmonary toxicity of Bleomycin / Chapter 2.2-3 --- Administration to animals / Chapter Chapter 3 --- Instruments --- p.50 / Chapter 1. --- Measurement of VO2 and VCO2 226}0ؤDeltatracIÍёØ Metabolic analzyer / Measurement of cardiac outpu´tؤCardiomax II model85 / Chapter Chapter 4 --- Methods --- p.58 / Chapter 1. --- N-nitroso-N-methylurethane (NNNMU) Preparation / Chapter 2. --- Bleomycin Preparation / Chapter 3. --- 2.5% pentobarbitone Preparation / Chapter 4. --- Animal Preparation / Chapter 4.1 --- Control (Normal) group / Chapter 4.2 --- A cute lung damage group / Chapter 4.3 --- Chronic lung damage group / Chapter 5. --- Preparation of the animals for VO2 measurement / Chapter 6. --- Measurement of oxygen consumption / Chapter 6.1 --- VO2wb measurement / Chapter 6.2 --- VO2b measurement / Chapter 7. --- Histopathology / Chapter 8. --- Statistics / Chapter Section Three : --- Results --- p.69 / Chapter 1. --- Healthy (Control) group / Chapter 1.1 --- Pulmonary histology / Chapter 2. --- Acute lung damage group / Chapter 2.1 --- Pulmonary histology / Chapter 3. --- Chronic lung damage group / Chapter 3.1 --- Pulmonary histology / Chapter 4. --- Comparison of the pulmonary oxygen consumption among the three groups / Chapter Section Four : --- Discussion --- p.97 / Chapter Section Five : --- Conclusion --- p.111 / Chapter Section Six : --- Future Studies --- p.114 / Chapter Section Seven : --- Bibliography --- p.118

This dissertation tested a methodological explanation for a double paradox in psychiatric epidemiology: a lower prevalence of major depression in Blacks than Whites in the US, coupled with equal and higher levels of psychological distress in Blacks. The first paradox is a lower prevalence of major depression in Blacks than Whites. The second paradox is the discordant results from comparing Blacks and Whites on depression and distress. These are paradoxes from the vantage points of, respectively, dominant theory and conceptual and empirical understandings of the relationship between disorder and distress. The idea that Blacks in the US express depression and distress more somatically than Whites has been in the literature for decades. If true, it could explain the double paradox. A formal diagnosis of major depression requires endorsing a screening symptom, either sad mood or anhedonia, which are both psychological rather than somatic symptoms. To the extent Blacks express depression more somatically than Whites, depression could be disproportionately undercounted in Blacks due to a lower likelihood of Blacks endorsing a screening symptom, adjusting for underlying levels of depression. Measures of distress share symptom content with the diagnostic criteria for depression but typically do not require endorsing screening symptoms. Thus, if Blacks do somatize depression and distress more somatically than Whites, the depression algorithm may produce a greater undercount of depression in Blacks than Whites, whereas a similar undercount would not occur with distress measures. Accordingly, both paradoxes could be explained. This dissertation has three main parts. In part one, the double paradox is documented in a systematic literature review. Using data from two nationally representative household samples, parts two and three test whether Blacks express depression and distress, respectively, more somatically than Whites, whether this accounts for a lower likelihood of Blacks endorsing a screening symptom, and if (part two only) this explains the Black White depression paradox. The systematic review provides robust evidence of the double paradox. Parts two and three reveal slightly higher levels, respectively, of depression and distress somatization in Blacks than Whites. However, the underlying structure of these small differences provides no evidence of a broad somatization hypothesis in Blacks. Moreover, no evidence is found that the somatization difference inhibits Blacks' endorsement of screening symptoms. One unexpected finding points to subsequent steps to take towards resolving the double paradox.

This thesis reviews and augments existing evidence surrounding the psychosocial aspects of living with Type 2 diabetes. There is a specific emphasis on the factors which underpin diabetes distress in individuals with Type 2 diabetes, which pertains also to the influence of partners or spouses on psychological adjustment to diabetes. This research develops and presents a conceptual framework of the key determinants of diabetes distress, providing focus and content for an intervention to address distress among couples living with Type 2 diabetes. Chapter 1 introduces the concept of diabetes distress; including prevalence, clinical relevance, and the cognitive, interpersonal and behaviour factors which are believed to drive this condition-specific distress. There is also an emphasis on existing strategies to improve both psychological and medical outcomes in Type 2 diabetes, which identified a need to evolve psychosocial support for individuals who are struggling to manage diabetes. Importantly, this chapter provided a rationale and direction for the studies reported in prospective chapters. Chapter 2 broadens the focus of psychosocial support in diabetes, to consider also the importance of considering partners or spouses in interventions to improve health outcomes in the context of different chronic physical conditions. This systematic review conveys the benefits of partner inclusion in interventions and highlights a number of shortcomings pertaining to couples intervention work. In particular, the review identifies a scarcity of couples intervention work in the context of Type 2 diabetes. The cross-sectional questionnaire study in Chapter 3 captures the predictive influence of illness perception clusters, coping styles, and relationship quality on diabetes distress in individuals with Type 2 diabetes. Of note, this work identifies negative belief and coping patterns which coincide and exacerbate distress, and presents a novel method of distinguishing those most at risk of elevated diabetes distress. Chapter 4 investigates the influence of partners’ diabetes beliefs on diabetes distress over time. This study demonstrates the moderating influence of partners’ illness perceptions on the association between persons with Type 2 diabetes illness perceptions and diabetes distress, and reveals that such effects persist overtime. Furthermore, Chapter 5 explores narratives of diabetes distress among couples living with Type 2 diabetes and among healthcare professionals, by means of individual semi-structured interviews and focus groups. Expanding on the findings of Chapters 3 and 4, this qualitative work compares experiences of distress from the perspectives of individuals with diabetes and those who support them in a personal and professional capacity, in an attempt to understand how communication and interpersonal conflicts might emerge in day to day life. Importantly, Chapter 5 discerns a perceived need for an intervention to reduce diabetes distress in individuals with Type 2 diabetes and their loved ones, and provides direction for the design and implementation of an intervention of this nature. Chapter 6 draws upon existing and primary evidence pertaining to the cognitive, interpersonal, and behavioural factors which underpin diabetes distress, and provides recommendations for the design and implementation of an intervention to address diabetes distress in couples living with Type 2 diabetes. The feasibility study described in Chapter 7 assesses the acceptability, potential effectiveness, and practical implementation of a brief psychoeducational intervention to address diabetes distress in people with Type 2 diabetes and their partners or family members. The findings of Chapter 7 highlight important strengths and shortcomings of providing an intervention of this nature, which are expanded on in the main discussion in Chapter 8. Chapter 8 provides a broad overview of the rationale for this PhD research and reflects on the primary work undertaken to date. Crucially, this discussion chapter provides recommendations on how key strengths of the feasibility study described in Chapter 7 can be enhanced and how observed shortcomings can be addressed in future studies. Finally, there is consideration of how aspects of the intervention described in Chapters 6 and 7 may feasibly be incorporated into existing programmes of diabetes support.

Narcissism refers to persistent feelings of grandiosity, a need for admiration, and a lack of empathy (American Psychiatric Association 2013). The literature has found narcissism to be associated with individuals making decisions for a firm that fulfill their egos rather than maximize firm value. The literature in psychology, however, suggests that when firms face financial distress, narcissism could be a desirable trait in an individual, enabling the CEO to take the necessary risks and make the necessary decisions for the firm to recover. I study the context under which a firm may benefit from a narcissistic CEO. In this study, I use two measures from prior literature (CEO photo prominence in the annual report and a CEO’s use of first-person personal pronouns) to form a combination measure to investigate whether firms in financial distress are more likely to appoint a CEO with more narcissistic traits. I find some evidence to support this hypothesis. I also examine whether the association between narcissism and future firm performance is affected by the economic conditions of a firm and the visibility of the firm. I find results consistent with firm financial distress increasing a narcissistic CEO’s effect on firm performance in low-visibility firms.

The family has been seen as playing an important part in children’s lives and their development. This is because families are seen to be the primary sources of individual development and thus should be seen as the building blocks of communities. Families serve as the main source of emotional, social and material support for most individuals. Thus, stable family environments are acknowledged to provide a fertile environment for children’s wellbeing and for them to grow up to be healthy responsible adults. Most South African children are raised by a single mother or by their maternal grandparents. Research conducted shows that South African Families face many challenges, and these challenges could be the source for high rates of absent fathers. Poverty has been identified to be one of the challenges that affect families in South Africa. Some researchers argue that poverty and inequality continue to undermine the family as an institution by reducing its effectiveness in realizing the roles of its members in society. Therefore poverty puts a burden on families and specifically on the main providers or ‘breadwinners’. Poverty in South Africa is mainly caused by lack of income, which is due to the high unemployment rates with little initiatives to reduce unemployment rates. The research was conducted qualitatively and specifically used narrative inquiry as a method of gathering data. In-depth, one-on-one narrative interviews were conducted in order to gain an in-depth understanding of the consequences of having an absent father and the strategies that young women adopted in order to deal with the consequences. Eight interviews with females aged from 18 – 21 years were conducted in Soweto. The findings reveal that the participants adopted both negative and positive coping strategies. Positive coping strategies include, creative writing, keeping a diary, maintaining a positive attitude, living a different life and speaking to others. Negative coping strategies included withdrawing from others, denial of a need of a father, self-blame, silence and defensive humor. More research is needed on how young people with absent fathers cope, paying into consideration issues of personality, culture and socialization.

Discrepancy in reporting is a frequent phenomenon in psychotherapy research and its presence indicates added information to take into account when assessing youth functioning (De Los Reyes, 2011; Hawley & Weisz, 2003). There is a need to further understand patterns in youth psychotherapy to protect from risk of treatment failure or deterioration. Our study aimed to explore informant discrepancy and its relation to key therapeutic constructs as well as youth functionality over time within youth outpatient mental health populations who use the Y-OQ and TSM in routine outcome monitoring and as clinical support measures. Using an outpatient mental health sample, regular Y-OQ and TSM data from n=157 youth ages 12-18 and their primary caregivers was assessed. Informant discrepancy was measured using initial total Y-OQ scores from both the youth and primary caregiver. Therapeutic constructs were measured using the TSM domains of primary caregiver distress, therapeutic alliance, and youth motivation. Change in functioning throughout the course of treatment was measured by the primary caregiver and youth Y-OQ total scores at each session. Results indicated that informant discrepancy predicted primary caregiver distress as well as change in youth functioning over time as perceived by the primary caregiver. Consistent with previous research, higher discrepancy between was associated with higher primary caregiver distress and predicted poorer youth functioning throughout the course of treatment. Implications and conclusions are discussed.

Purpose: As a group, adults who stutter (AWS) are vulnerable to experiencing distress and other negative psychological health outcomes. However, not all AWS experience elevated levels of distress, and little is known about why some people are resilient while others struggle to cope. In the current study, stuttering was conceptualized as a type of concealable stigmatized identity (CSI). The purpose of this study was to determine if stigma-identity constructs that contribute to variability in distress among groups of people with other types of CSIs also contribute to psychological health outcomes among AWS. The specific stigma-identity constructs that were examined include salience (the extent that a person thinks about stuttering), centrality (how much a person defines themselves by stuttering), concealment (the extent that a person attempts to keep stuttering a secret from others), and disclosure (the frequency in which a person tells others about stuttering). Methods: A sample of 505 AWS completed an online survey that included measures of salience, centrality, concealment, disclosure, demographics, self-rated stuttering severity, psychological distress, and adverse impact of stuttering on quality of life. Correlational and hierarchical regression analyses were performed to (1) determine the extent that stigma-identity constructs explain variability in psychological health outcomes among AWS and (2) identify unique relationships between each of the stigma-identity constructs and psychological health outcomes. Additionally, self-rated stuttering severity was investigated as a potential moderator of the relationships between stigma-identity constructs and psychological health outcomes. Results: Together, the stigma-identity constructs accounted for a significant proportion of the variability in distress (~25%) and adverse impact of stuttering on quality of life (~30%) among AWS. Salience, centrality, and concealment were positively associated with and predictive of distress and adverse impact of stuttering on quality of life after controlling for demographics and neuroticism. Further, self-rated stuttering severity moderated the relationship between centrality and adverse impact of stuttering on quality of life. Specifically, high centrality was only associated with more adverse impact of stuttering on quality of life among people with moderate and high self-rated stuttering severity. Disclosure did not have a consistent reliable relationship with either psychological health outcome. Conclusions: The results from this study provide evidence that it is both appropriate and useful to conceptualize stuttering as a type of CSI. That is, variability in psychological health outcomes among AWS can be explained to a large extent by individual differences in the ways people think about and behave in relation to their stuttering identity. Speech-language pathologists should be aware of the relationships that salience, centrality, and concealment have with psychological health outcomes among AWS and should consider the implications for stuttering intervention.

A diagnosis of cancer, regardless of type or site, raises much fear and loss of control for patients and their spouses. While being married is associated with lower mortality from a wide range of illnesses, including cancer, the quality of marital interactions and the relationship is the stronger predictor of health outcomes, rather than marital status. When people are faced with their greatest life challenges, they attach great importance to the behavior of their intimate partner, with trust being a key component of relationship quality, thus lending stability, and emotional and practical support. The purpose of this study was to examine vulnerable cancer patients with pain and their partners. The quality of the patient/partner relationships and the partners' coping styles were evaluated as mediators in a Structural Equation Model (SEM) latent path analysis with the outcome measures of quality of life for the individuals. Stress, coping and outcome theory guided the questions for the study. Much of the previous dyadic research that has been done on couples when one member has a diagnosis of cancer has centered on disease specific populations. This study was the first to examine the couples' relationships from a symptom defining population. Therefore, a broad range of ages, patients with different cancer diagnoses and both genders in the roles of patients and caregivers was the population studied. Coping was explored as a dyadic process that includes transactional appraisal of stressors that mediates the subsequent effects on quality of life outcomes. Multivariate analysis was used to determine covariates to be included in the SEM based on a review of the literature. There was no evidence of coping as a mediator. The participants in this study had good quality relationships, and this did serve as a positive mediator on the outcomes for the patient. Recommendations for future research and nursing practice, including the use of a single item global assessment of relationship quality, that nurses can incorporate in their practice is discussed.

This study evaluated two distinct aspects of social functioning (specifically, social support and social constraint) in an attempt to increase understanding of its bidirectional relationship with distress after cancer diagnosis. Participants in this intensive longitudinal study were all recently diagnosed, first primary cervical or head/neck cancer survivors (n=47). Data collection involved a comprehensive baseline assessment and 30-day period of daily assessment (n=37) of key variables (i.e., social support, social constraint, and distress). Data were analyzed using unconditional and conditional multilevel linear models. None of the variables changed significantly over the 30-day period. On a typical day, social constraint and distress were predictive of one another (ps < .001). Social support and distress did not demonstrate a bidirectional relationship (ps > .05). In the context of cancer adjustment and survivorship, future interventions for distress should consider targeting social constraint and interventions for social constraint should consider targeting distress.

Romantic disengagement is a disturbingly prevalent yet understudied cause of marital distress and dissolution. Existing research on disengagement has been primarily descriptive and limited by reliance on retrospective reports from already disengaged spouses. Theoretically informed prospective research to elucidate the process through which some spouses become increasingly disengaged from their partners over time is necessary to facilitate clinical intervention efforts. Thus the purpose of this research was to propose a theoretically informed model of the process of romantic disengagement and then to perform preliminary tests of pieces of the model. The model was tested in a sample of 103 married couples assessed six times over their first seven years of marriage. Pieces of the model that were tested included (1) the implication that avoidant and disengaging behaviors toward one's partner, particularly during times of need or increased stress (such as marital conflict interactions), are indicators of a process of romantic disengagement, (2) that predispositional and contextual factors interact to predict a spouse's greater tendency to behave avoidantly during couple interactions, and (3) that spouses tendency to be more avoidant with his or her partner later in marriage will be greater to the extent that avoidance is reinforced early in marriage. First, I examined whether avoidant behavior during marital conflict contributes to a process of romantic disengagement as evidenced by declines in trust and intimacy and declines in marital satisfaction. Consistent with hypotheses, I found higher conflict avoidance was associated with declines in trust and intimacy and declines in marital satisfaction. Second, I tested two predispositional (i.e., spouses' attachment avoidance and avoidant coping style) and two contextual factors (spouses' role during support interactions, and the partner's negative affect) that were expected to interact to predict whether spouses behave avoidantly during specific couple interactions. I found mixed support for hypotheses depending on spouse and interaction type. Specifically, during conflict interactions, husbands and wives with higher attachment avoidance, and wives with more avoidant coping styles, behaved more avoidantly to the extent that their partners were higher in negative affect. During supportive transactions, husbands with more avoidant coping styles were more disengaged to the extent that their wives were higher in negative affect. Third, I tested my hypothesis that a spouse will be more avoidant with his or her partner later in marriage to the extent that avoidance is reinforced early in marriage. I found partial support for this hypothesis. Husbands' disengagement during conflict interactions interacted with improved mood post-interaction to predict husbands' disengagement across interactions at 7 years of marriage. In summary, this research presents an integrated theoretical model of romantic disengagement and provides preliminary support for aspects of the model.