Abstract Mortality of patients requiring intensive care treatment for greater than 5 days has been shown to be about 20% worldwide. Hyperglycaemia is common in critically ill patients. Strict glucose control with insulin in critically ill patients was shown to reduce mortality and morbidity significantly. Several interrelated mechanisms are involved in the development of “stress hyperglycaemia” in critically ill patients. These include dextrose containing intravenous infusions and total parenteral nutrition; the counter regulatory hormones (catecholamines, cortisol, glucagon and growth hormone) which oppose the effects of insulin; nervous system signaling; increased insulin clearance; and excess production of cytokines that interfere with intracellular insulin signaling pathways. Aim of study: To determine if the cytokines TNFα, IL-6 and adiponectin are significant determinants of insulin resistance in critically ill patients. Methods: The study was a prospective observational study conducted in the intensive care unit (ICU) at the Chris Hani Baragwanath hospital. Forty sequential adult ICU admissions that met with the inclusion criteria were enrolled. Blood specimens were drawn for adiponectin, TNF, and IL-6 at the time of ICU admission, on day 3, day 7 and on discharge from the ICU. Demographic data and clinical data were recorded, and body mass index (BMI) and APACHE II scores were calculated on admission. Blood glucose was measured every 2 to 4 hours, recorded and a mean value was calculated over the 24 hour period. Insulin infusions were started when the blood glucose values exceeded 6.0mmol/l. Administration of insulin was according to a fixed sliding scale. The total amount of insulin administered intravenously over that 24 hour period was recorded. Other factors known to be related to insulin sensitivity, such as inflammation (as indicated by C-reactive protein), vii triglycerides, insulin, C-peptide and cortisol levels were also drawn in addition to the blood drawn for routine investigations. Results: Duration of stay in ICU correlated with severity of illness as assessed by the APACHE II score (r = 0.44, p = 0.004). There was no significant difference in the mean 24 hour plasma glucose concentration throughout the duration of stay in ICU, there were however significant differences in the amount of insulin administered to maintain normoglycaemia. The amount of administered insulin required was found to peak on day 3 and decline thereafter. The main determinant of insulin administered was mean glucose (r = 0.79, p < 0.00001). The measured insulin concentrations on admission correlated with mean plasma glucose (r = 0.41, p = 0.009) and C-peptide (r = 0.45, p = 0.004) levels. The main determinants of mean plasma glucose levels on admission were BMI (r = 0.38, p = 0.013) and serum cortisol (r = 0.41, p = 0.008) levels. Serum triglycerides levels showed a significant difference from admission to discharge, with values increasing from admission levels. Adiponectin levels showed a significant increase from admission to discharge. IL-6 levels showed a significant decrease. TNFα levels did not show statistically significant changes. No statistically significant correlations were found between the levels of TNFα or IL-6 and administered insulin. Adiponectin concentrations showed a negative correlation with amount of administered insulin on discharge (r = -0.457, p = 0.0049). There were significant gender differences in BMI, administered insulin on admission, serum cortisol and C-peptide concentrations, with females having higher values than males. BMI was shown to account for the gender differences in administered insulin and C-peptide levels. viii There were significant differences in IL-6 and TNFα concentrations between the survivors and nonsurvivors, with higher levels being seen in non-survivors. Adiponectin levels were lower in nonsurvivors, but this did not reach statistical significance. Conclusion: Although there was a demonstrable change in insulin sensitivity during the stay in ICU, there was no statistically significant association between the cytokines TNFα or IL-6 and insulin administration. There was a negative correlation between adiponectin concentrations and administered insulin on discharge. This data also demonstrates that mortality is associated with increased levels of proinflammatory cytokines.

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

Thesis (M.S.)--Boston University / The innovation of a day hospital for the long term mentally ill patient brings to light new areas of possible exploration. This study sought to look at what perceptions six patients and a member of the patients' families had concerning day hospitalization and its effects. The patients, all long term mentally ill females, had been actively participating in a specific day hospital program of a large Boston area state hospital. The patients between the ages of thirty and forty-six years of age had been in the hospital for approximately five and one-half months. Previously, they had been hospitalized from nine months to twenty-seven years with a mean of eighteen years and one month [TRUNCATED]

Thesis (M.Sc. (Clinical Psychology)) --University of the North, 1981 / Refer to the document

No description available.

Research Doctorate - Doctor of Philisophy (PhD) / This thesis examines the experiences of parents (both mothers and fathers) with mental illness. Following a tradition of sociology, this thesis is guided by the concepts of ‘generosity’ from Frank and ‘stigma’ from Goffman and ‘risk’ from Lupton. The thesis has gathered data from three sources. In-depth interviews with parents with mental illness are explored to gain an insight into their lived experiences of parenthood and mental illness. The national and state mental health policies on mental illness are analysed in order to assess their applicability to support services for parents with mental illness. The submissions to the Senate Select Committee Inquiry on Mental Health (2006) are also analysed to gain further information about the experiences of parents with mental illness based on a small number of submissions relating to their perspectives. Analysis of the data collected and assimilated in this thesis provides a clear picture of the troubled terrain faced by parents with mental illness. The narratives from the interviews reveal stories of long-term mental health issues for parents with mental illness whose parenting role is largely unsupported. Analysis of this data provides a greater understanding of how parents negotiate their parenting role within the context of socially prescribed notions, limited agency, and limited capacity due to a lack of support services for parents with mental illness. Analysis of mental health policies highlights the disparity between policy and practice. Whilst national mental health policies are now in place, parenthood continues to be overlooked through the continued medicalisation of people with mental illness, and policies that operate under an individualist and economic rationalist discourse.The motivation for this research was to elicit increased understanding and insight into how parental mental illness affects experiences of parenthood. This thesis focuses upon lived experience, social processes, and social policies relating to parents with mental illness. The specific contribution of this research to the sociology of mental health is that it documents for the first time parenthood as lived by parents with mental illness. Finally, it offers theories as to how the gaps in policies and services can be filled to support the ‘silent’ parents whose parenthood is so often unacknowledged the lack of attention paid to their mental illness.

The focus of this research is the stress placed on a child when a sibling in the family has a chronic illness or disability, and analysis of what factors may buffer this stress and be associated with well child resilience in the face of family illness. Several major studies from other countries (Cadman, Boyle, & Offord, 1988; Houtzager, Grootenhuis, Caron & Last, 2005; Laufersweiler-Plass, Rudnik-Schoneborn, Zerres, Backes, Lehmkuhl & von Gontart, 2003; Sharpe & Rossiter, 2002; Williams, Williams, Graff, Hanson et al., 2002) suggest that there may be deleterious outcomes for well children in such families, for example higher rates of anxiety, depression, aggressive behaviour and rule breaking behaviour. However there is a lack of clarity about the processes which lead to these negative outcomes. The current study had two major research aims. The first was to describe social, family and personal characteristics of a group of well children with siblings who have a chronic illness or disability. The second aim was to examine relationships between adjustment problems in these well children and factors relating to the family (income, number of children in family, respite availability and utilisation), parents (stress, parenting style, maternal education, access to support) and children (ill child behaviour, amount of care required, well child age, well and ill child participation in social activities). Adjustment in well-children (n=102) was assessed using child self report, child projective and parent rating measures. Parents rated well children with ill siblings as significantly higher in externalising and internalising behaviour than age and gender matched population norms. Children did not rate their behaviour problems higher than norms but did indicate quite high rates of emotional problems on a projective (drawing) test. Parent-rated behaviours of well children were associated with parental, family and ill child variables, including (high) parental stress (daily hassles), (low) family income and (high) ill child internalising and externalising behaviours. Relationships between the well child's perception of having a sibling with a chronic illness or disability and various parent, child and family variables were also explored. Well children who listed more negative (than positive) attributes about having a sibling with a chronic illness were more aggressive and rule breaking in their behaviour. Well children with emotional problems, as assessed by the child family drawings, did not differ significantly from children without emotional problems in any of the parent, child or family variables however both the emotional problems index and the use of scribble drawings were associated with several measures of well child maladjustment. The results were discussed in terms of family systems and resilience theory. Implications for well children and their families including practical applications for existing interventions which target well children, ill siblings and parents were discussed and ideas for future directions for interventions to improve outcomes for well siblings were presented.

The purpose of this research was to explore the phenomenon of resilience as described by consumers of mental health services in Australia who have experienced mental illness. In keeping with Colaizzi's (1978) approach to inquiry, information in this study was gathered through in-depth, semi-structured individual interviews. Information analysis was undertaken using Colaizzi's (1978) seven-step approach, with the inclusion of two additional steps- making this study's analysis a nine step process. Emergent themes were explicated from the findings of this study as follows: Universality; Acceptance; Naming and knowing; Faith, hope and being the fool; Striking a balance; Having meaning and meaningful relationships; and 'Just doing it'. The emergent concept which encapsulated the themes was 'viewing life from the ridge with eyes wide open'. In respect of this concept, participants described resilience was achieved by choosing to walk through the darkness all the while knowing the risks and dangers ahead; Making a decision for life through the hardships. That is, following a moment of enlightenment through 'naming and knowing', participants said they were able to start making decisions and to process what was happening to them by having faith, hope, acceptance, and by 'just getting on with life'. It is suggested that resilient behaviours can be learned and interwoven with life experiences. In this context, there is the potential to guide therapeutic interventions in various clinical and educational settings.

Thesis (Ph.D.)--The Wright Institute (Berkeley), 1981. / Includes bibliographical references.

Female offenders’ experiences within the criminal justice system and the way in which they become involved with the criminal justice system are very different than that of male offenders. Previous research that has been conducted on female offending does show that womens’ contact with the criminal justice system can often be related to histories of abuse and to mental illness, and that these can also be related to subsequent re-contacts with the criminal justice system. Abuse, mental illness and gender, along with control variables (age, aboriginal identity, LSI-OR score), were investigated in a sample of 522 male and female Ontario Provincial offenders. When males and females were compared at the bivariate level using a chi-square comparison, females were found to be significantly more likely to re-contact. Abuse and mental illness were not found on their own to be significantly related to re-contact, but when the relationship between the three variables was examined, mental illness was found to be both significant and positively correlated to both gender and abuse. Examination into the relationship between the variables found a strong relationship between gender and abuse, gender and mental illness, mental illness and abuse as well as strong relationship in the three way interaction between gender, mental illness and abuse. The cross tabulation demonstrated that women who had experienced abuse were identified as being much more likely to be suffering from a mental illness. Logistic regression was used to model the relationship between re-contact, gender, abuse and the risk for re-contact. All possible interactions (as noted above) were included in the model, but the model that best fit the data included only the controls (age, aboriginal identity, LSI-OR score), gender, abuse, mental illness and the interaction between mental illness and gender. Results indicated that there was a significantly higherrisk for re-contact for females with mental illness, compared with men with mental illness or or to men and women without mental illness.. Even though abuse as a single variable or as part of an interaction was not found to be significantly related to re-contact, it is still of importance to note that the chi-square comparisons demonstrated that abuse is significantly related to gender and mental illness, therefore the relationship was still important when looking at the implications of the research. It is recommended that future research further investigate the different needs of male and female offenders and the role that experienced physical, sexual and emotional abuse, mental illness and gender plays in not only offending behaviour, but in the treatment and rehabilitation of offenders within the provincial correctional system.