This study examined negative reception to caregiving by a chronically ill spouse and the impact on the caregiving and the caregiver spouse. Quantitative and qualitative methodology were used. Audiotaped interviews using the Caregiver Impact Inventory (CII) (Miller, 1993) provided data on caregivers' perceptions of negative reception to caregiving by a chronically ill spouse. Perceptions of Caregiving (Oberst, 1991), Caregiver Burden Scale (Oberst, 1991), Caregiver Strain Index (Robinson, 1983), and Rosenberg Self-Esteem (Rosenberg, 1965), were implemented. Eight respondents indicated (CII) that negative reception to caregiving by a chronically ill spouse had a significant impact on the thoughts and feelings, and self-esteem of the caregiver. Caregiver spouses responded by reserving or withholding caregiving responses. The caregiver spouses indicated that moderate levels of threat, general stress and benefit (POC), moderate levels of burden (CBS), moderate levels of strain (CSI) and low-moderate self-esteem were experienced.

<p> In this qualitative study, I explored the phenomenon of positive growth in maternal caregivers of children who have undergone a kidney transplant. Semistructured interviews were conducted with seven mothers who shared narrative accounts of their experience. Through a phenomenological analysis of the interview data, the fundamental structure of positive growth in caregivers of transplant children was illuminated. Both negative themes and trauma and positive themes and growth were found to contribute to maternal caregiver positive growth.</p><p> Participants revealed that being a caregiver for a transplant child is an endless quest that entails layers of loss, and with each loss there is the need to start anew. The experience of loss and renewal is recursive and at times seemingly endless. Thus, the overarching theme describing positive growth in transplant caregivers was a &ldquo;journey of endless beginnings.&rdquo; There were three metathemes: encountering loss, transitioning through loss, and reconciling loss. Six themes composed the first leg of the journey, which was laden with trauma; however, months before and after the child&rsquo;s transplant a transitional period unfolded. Three major themes made up this pivotal point: the secondchance search, transplantation as the gift of life, and facing posttransplant loss. It was at this juncture that profound connections with others were made, leading to the possibility for caregivers to transcend their trauma and have the opportunity to experience positive growth. The third leg of the journey, comprising six themes, entailed additional losses but also presented a time of renewal where caregivers reconciled ongoing losses, embraced new ways of being, and experienced lasting positive change.</p>

Inference techniques had traditionally been based on modus ponens, modus tollens, syllogism and contraposition. In this dissertation, we look at inference based on subset containment, supported by the power set theory and mathematical relations. Two distinct groups of relational products definitions were compared here, the triangle relational products of Bandler and Kohout (called BK-products in the literature) and their B- and K- modifications suggested by DeBates and Kerre. The type of inference studied here belongs to a category called interval-valued inference as opposed to point-based inference and is based on the "Checklist Paradigm" of Bandler and Kohout. / One crucial factor in using the relational products is the choice of the connectives. T-norms and t-conorms had been used for the AND and OR connective in one of the relational product definitions as opposed to the traditional MAX and MIN counterpart. However, there are an infinite number of t-norms and t-conorms that could be used and it is difficult to know which is the most suitable. / To avoid this situation, interval-valued approximate inference templates were abstracted from these relational products definitions. These templates were instantiated using a meta theory called the checklist paradigm in which the bounds of logical connectives can be found, giving rise to interval-valued approximate fuzzy relational inference structures. The class of upper and lower bounds of the connectives provide the intervals of the computation. / A simulator was built using the activity structures methodology to evaluate these fuzzy relational inference structures in a complete medical domain dealing with multiple context. The conceptual structure of the complete domain was based on the structures of a medical knowledge base system, CLINAID. The simulation was performed using fuzzy input data, crisp input data, computation with and without paradox in three different scenarios: body systems identification, disease diagnosis (deterministic) and disease diagnosis (stochastic). / We defined inference bands for the inference structures and introduced new performance metrics to measure the inference structures that we had instantiated from the templates. The performance of the inference structures based on these metrics were reported. / Source: Dissertation Abstracts International, Volume: 56-11, Section: B, page: 6241. / Adviser: Ladislav Kohout. / Thesis (Ph.D.)--The Florida State University, 1995.

Physicians, therapists, staff and patients who were employed or receiving care in a primary care practice were asked about their direct experience with the site. Using ethnographic research methods, informants' points of view were elicited through interviews and their comments were examined using domain analysis. Two physicians were interviewed on 5 occasions, 5 therapists between 2 to 4 times, 5 patients twice, an office manager on 3 occasions and 1 nurse twice for a total of 40 interviews. The interviews ranged between 30 to 75 minutes (50 minute average) and took place over an eighteen-month period. Six categorical themes were identified: Characteristics of the Environment; Characteristics of Therapists; The Referral Process; Characteristics of Collaboration; The Psychotherapy Process; and Social Considerations. This study, the first ethnographic investigation of Family Systems Medicine, generated 5 principal conclusions. First, several marked dissimilarities between Family Systems Medicine as depicted in the professional literature and by informants emerged. Second, although the bio-psycho-social model promotes innovative awareness of social issues in health care, informants demonstrated status-quo knowledge. Third, certain aspects of the physician-therapist relationship--which includes an employee-employer arrangement--likely impedes collaboration. Fourth, patients emphasized the relevance of several issues (e.g., central location and prestige by association) that have heretofore been casually discussed in the literature. And, fifth, several problems associated with the use of ethnographies in a for-profit setting were identified. Finally, based upon a review of the findings, 4 major theoretical assertions are proposed: (1) Central location significantly reduces underutilization of health care; (2) Clinical outcomes are significantly enhanced due to / therapists' direct association with physicians ("prestige by association"); (3) Family therapists are not ideally suited to provide biopsychosocial care; and (4) The employee-employer relationship between therapists and physicians impedes collaboration. / Source: Dissertation Abstracts International, Volume: 56-07, Section: B, page: 3674. / Major Professor: Thomas Edward Smith. / Thesis (Ph.D.)--The Florida State University, 1995.

Six factual series were unobtrusively telephoned to fifty-one U.S. academic health sciences libraries and hospital libraries. Previous unobtrusive studies of reference services in public and academic libraries have shown that the accuracy of short answers to factual queries is approximately 55 percent. In this study, the majority of the queries, 63 percent, were answered accurately. Referrals to another library or information source were provided for 25.2 percent of the queries. Eleven answers, 3.6 percent, were inaccurate, and no answer was provided for 7.8 percent of the queries. / No significant relationship was found between the accuracy of answers and either the type of health sciences library, the region in which the library was located, the size of the monograph collection or the number of subscriptions. There was a correlation between budget and the accuracy of answers provided. While no significant correlation was found between the accuracy of answers and the total number of library staff, there was a correlation between the number of accurate answers provided and the presence of at least one staff member with a master's degree in library and information science. There was a significant correlation between employing a librarian certified by the Medical Library Association and the accuracy of answers provided by the library. / Although some referrals were to unspecified libraries or individuals, the majority were to specific sources for which the librarian provided a name, address and/or telephone number. If these "helpful referrals" are counted with accurate answers as correct responses, they account for 76.8 percent of the answers. / Four libraries answered all queries accurately. In a follow-up survey, five libraries (9.8 percent) stated that accurate answers were not provided because they did not own the appropriate source. Staff related problems were given as reasons by 17.6 percent of the libraries, while 25.5 percent indicated that library policy prohibited providing answers to the public. / Source: Dissertation Abstracts International, Volume: 50-03, Section: A, page: 0565. / Major Professor: Gerald Jahoda. / Thesis (Ph.D.)--The Florida State University, 1989.

An exploratory study of perceptions about the appropriateness of different types of family involvement was conducted with respect to two groups: family members of individuals with head injuries and head injury rehabilitation professionals. Following an exhaustive review of the literature, the Family Involvement Questionnaire (FIQ) was constructed. The FIQ consists of sixty items representing various types of family involvement, grouped into the following categories: Input, Information/Education, Treatment, Advocacy, Contact, and Counseling/Support. The statistical properties of the instrument were tested and the FIQ was found to be a valid and reliable instrument. / Families and Professionals (n = 134) from each of four post acute head injury rehabilitation centers were asked to complete the FIQ. Both family and professional responses indicated that both groups agreed that family members should be given the opportunity to participate in most of the activities described in the items. Families, however, regarded a wider range of activities as appropriate than did professionals and families' mean responses were higher than professionals' responses. / The items and categories of items receiving high ratings and/or rankings by both groups were described. The types of involvement considered most appropriate by both groups included receiving information/education, family provision of background or other information, participation in all aspects of discharge planning, family notification of health or behavioral problems, receipt of instruction in how to treat/respond to clients and family advocacy regarding quality of care. / Degree of agreement between families and professionals on the appropriateness of different types of family involvement was addressed by determining the association between the two groups' responses. Family and professional mean scores on all six of the categories of items were positively correlated, with the strongest correlations occurring on the Input, Information/Education, Treatment and Advocacy categories. An item by item comparison of family and professional means revealed substantial differences in perceptions about the appropriateness of family involvement in counseling, access to the client, issues having to do with sexuality, active participation in actual treatment or treatment planning, family access to documentation and notification of schedule changes and minor health or behavioral problems. Using independent t-tests, with significance levels adjusted for multiple repetitions, several factors which may have accounted for some of the within group variability were examined. Recommendations for clinical practice, management and research were offered. / Source: Dissertation Abstracts International, Volume: 52-01, Section: B, page: 0143. / Major Professor: E. Jane Burkhead. / Thesis (Ph.D.)--The Florida State University, 1990.

Bandura's concept of "self-efficacy" has been hypothesized to influence coping behavior and associated cognitions in a variety of health-related areas. This study examined the interrelationships among the variables of self-efficacy, pain tolerance, anxiety, coping self-statements, and pain ratings. / At three sessions, 58 college students (29 male and 29 female) were administered state anxiety measures and a self-efficacy questionnaire on which they predicted their perceived ability to cope with a cold pressor pain task. Subjects then underwent the cold pressor task to pain tolerance, immediately after which they completed the Coping Statements Inventory (measuring positive and negative self-statements) and a pain rating scale. / Self-efficacy, pain tolerance, self-statements, and pain ratings were found to be significantly interrelated (p $<$.05). Specifically, higher self-efficacy was associated with fewer negative self-statements, higher pain tolerance, and lower pain ratings. Positive self-statements, on the other hand, were found to be unrelated to self-efficacy and pain tolerance. Additionally, high self-efficacy subjects had significantly higher pain tolerance and significantly lower state anxiety (at session 3) than low self-efficacy subjects. Subjects who dropped out of the study were found to have significantly higher pain ratings than those subjects who remained in the study. / The results of this study were consistent with Bandura's self-efficacy theory. The findings indicate that persons with higher self-efficacy make fewer maladaptive negative coping cognitions and have a higher ability to cope with a painful situation. These persons also perceive the situation to be less painful and experience less state anxiety over time. The data suggest that the effectiveness of pain treatments may be increased by directing attention toward the assessment and enhancement of patients' perceptions of ability to cope with pain. / Source: Dissertation Abstracts International, Volume: 50-03, Section: B, page: 1123. / Major Professor: Jack May. / Thesis (Ph.D.)--The Florida State University, 1988.

The September 1985 earthquakes in Mexico resulted in impacts on the health and well-being of a population and thus provided an opportunity for gaining insights into the little-studied epidemiology of natural disasters. The intent of this research was to examine patterns of morbidity, health care utilization, and relocation trends in the disaster zone of Mexico City during a nine-month period following the earthquake and to provide direction for relief efforts in the aftermath of a similar catastrophe elsewhere Based on a multistage sampling plan, 504 households from twenty-eight randomly selected camps, or twenty-two percent of camp households, were surveyed eight months after the earthquake. Information at the individual level was gathered for 2,427 persons within the disaster zone at the time of the earthquake, or twenty percent of approximately 12,000 camp residents Although less than one percent of the study population was injured, the injured and non-injured differed significantly with respect to age and height of residence relative to ground level. A rate of 74.1 injuries per 1000 persons was determined among the 60+ age group while 5.3 per 1000 was observed in children 6-14 years. Results of logistic regression indicated that age was significant in predicting injury. The injured tended to have been positioned on ground level or on the third floor or higher of a structure. Trauma to the lower extremities was observed with high frequency Although fear accounted for most perceived illnesses at the time of the earthquake, medical care was sought instead for chest pains, high blood pressure, and respiratory conditions Local medical institutions provided emergency care for all cases for which attention was received. No mention was made of foreign medical relief groups While a destroyed dwelling prompted relocation of a household, choice of a temporary settlement was influenced significantly by solidarity of the pre-earthquake neighborhood During the relief period (two weeks-two months after the disaster), households moved most often and nearer the former residence when compared to other phases Results emphasized the need for a working disaster plan in urban areas and that aid be directed by neighborhood. Further research was proposed for disaster-specific epidemiologic methods, statistical generation of movement patterns, and post-disaster behavioral issues / acase@tulane.edu

This study examined the stimulating factors for prolactin (PRL) and growth hormone (GH). One aim of the study was to establish an anatomical basis for a proposed releasing factor for PRL, vasoactive intestinal peptide (VIP). Ames dwarf mice, which manifest a spontaneous mutation which, when present in homozygous form (df/df), results in absence of PRL and GH, were used in the present study. Immunoreactive VIP and growth hormone releasing hormone (GHRH) were examined and compared between brains of normal and PRL and GH-deficient dwarf mice in order to see whether there is a response of VIP and GHRH neurons to the absence of target hormones, PRL for VIP and GH for GHRH The anatomical source of the hypophysial portal VIP, and the response of the hypothalamic VIP-containing neurons to PRL deficiency was investigated. VIP immunoreactivity was detected in parvocellular paraventricular nucleus neurons. Groups of VIP-containing neurons in the parvocellular paraventricular nucleus project to the median eminence, which contains portal blood vessels that transport hypophysiotropic factors to the pituitary gland. VIP immunoreactivity was also located in axon terminals in both the external and internal zone of the median eminence. Immunoreactive VIP in the cortex, amygdala, bed nucleus of the stria terminalis, and in the suprachiasmatic nucleus were qualitatively comparable between normal and dwarf mice. Qualitative increases in the fiber immunostaining in the external layer of the median eminence and perikaryal immunoreactivity in PVN of the dwarf mouse were detected. The presence of median eminence-afferent VIP neurons in the paraventricular nucleus and fiber immunostaining in the external layer of the median eminence suggest that parvocellular paraventricular neurons may be involved in PRL regulation Studies of the stimulatory factor GHRH in mice have been hampered by the lack of antiserum directed against the mouse-specific peptide. GHRH-containing cell bodies were found to be primarily concentrated in the arcuate nucleus. In addition, new localizations of GHRH-containing cell bodies were demonstrated, such as in the medial preoptic area, anterior hypothalamic area, and in the area lateral to anterior hypothalamic area. It is not known whether these neurons participate in GH regulation. In addition, GHRH-immunoreactive perikarya in the hypothalamic ventromedial nucleus of dwarf mice were noted. Whether these neurons project to median eminence is not known. The number of the GHRH-containing cell bodies in the dwarf arcuate nucleus was increased compared to the number in normals. The increased number of cell bodies was located in the ventral and medial areas of the arcuate nucleus. (Abstract shortened by UMI.) / acase@tulane.edu

In this dissertation, I estimate the effect of medical malpractice on health care delivery in the United States. In particular, I focus on the effect of medical malpractice on physician behavior and health outcomes of the patients. The National Practitioner Data Bank (NPDB) has been combined with the Nationwide Inpatient Sample (NIS). Malpractice claims frequency and severity are used as measures of medical malpractice risk in each state While estimating defensive medicine in obstetrics, physician behavior is modeled as a fixed effects logit. Results suggest that a higher degree of malpractice risk increases the probability of C-section delivery. Overall, there is no evidence of defensive medicine. In fact, marginal benefit of additional resource use is higher than its marginal cost While analyzing the effect of medical malpractice on physician behavior and health outcomes for AMI patients, I find that an increase in medical malpractice risk leads to a reduction in resource use and improvement in health outcome for patients with less severe medical conditions. For patients with more severe medical conditions, medical malpractice is associated with a reduction in health expenditure and no increase in mortality. Therefore, I find no evidence of defensive medicine for AMI patients While analyzing the effect of medical malpractice risk on health outcomes for patients suffering from for five common medical conditions, I find that an increase in claims frequency improves mortality for patients suffering from stroke, hip fracture, pneumonia, or CHF. Medical malpractice does not affect mortality for patients suffering from GI hemorrhage. Severity of medical condition of the patient is an important factor in determining the effect of medical malpractice on health outcomes The policy implications are that medical malpractice serves its purpose as a deterrent to less than optimal care. Overall, we find that medical malpractice improves health outcomes for a majority of medical conditions. Reducing medical malpractice risk may reduce this benefit. This means that reforms aimed at reducing medical malpractice risk faced by physicians and hospitals could lead to a decline in the quality of care provided / acase@tulane.edu