Introduction In recent years the concept of ‘recovery’ has become increasingly prevalent in both government and health service policy, and in the terminology used by mental health service users. The current study examines the experiences of recovery as described by service users living in a rural / semi-rural population. This is in contrast to the majority of similar studies, which have tended to focus on urban centres where population characteristics, and the services available to service users, differ in many ways. As such, the aim of the current study was to add to the growing theory regarding what constitutes recovery from the viewpoint of service users living in a relatively remote area of the UK. Methodology Eight adult participants, all of whom defined themselves as either recovering or having recovered from significant mental health problems, were interviewed about their experiences using a semi-structured interview. Interviews were audio-recorded, transcribed and analysed for emerging themes using a social constructionist version of Grounded Theory. Data Analysis & Discussion Analysis revealed a consistent set of themes emerging from the participant interviews. These are encapsulated in the concept of reflection and integration, and the dynamic nature of these phenomena over time. Participants made reference to the nature of their problems and the impact they had on relationships, the treatment they had sought and received, and the effects of their experiences on their notions of themselves as individuals. Conclusions The findings of the current study are discussed in the light of existing relevant literature and in relation to current policy initiatives. Comparisons to the emerging theory regarding recovery are drawn, and distinctions made between the existing theory and the findings which appear to be particularly pertinent to the sample population. Suggestions for clinical applications are made. Limitations of the study are also addressed, and areas for potential further research are outlined.

UK Health policy over the past decade has sought to accelerate established trends of moving services for type 2 diabetes into primary care. This has aimed to make services more accessible and to enable patients to benefit from having their diabetes care incorporated into the “generic and holistic” approach of primary care. However, in 2004 the introduction of a new General Medical Services (nGMS) contract signalled a change in primary care by linking clinical targets to financial rewards on a larger scale than ever before. Diabetes is one of nineteen financially incentivised clinical areas under the nGMS contract (2006). This thesis considers how these health policies may have influenced the organisation and experience of providing and receiving care for type 2 diabetes in Scottish primary care settings. It also aims to bridge two usually separate areas of sociological interest: how health professionals interpret and implement policy, and how patients experience and perceive chronic illness and their health care. A multiple case study approach was employed in order to compare and explore the organisation and experience of type 2 diabetes care associated with three general practices of differing size and location. In each case study a period of non participant observation was undertaken and in-depth interviews conducted with health professionals and their type 2 diabetes patients. Analysis of these data shows that multiple factors influence the way diabetes care is organised and experienced in primary care. I argue that the local context of interpersonal relationships of trust, professional identities and role expectations influence both the organisation of care and the way patients interpret that organisation. Moreover, the meanings patients attribute to the local organisation of diabetes care can inform their perceptions of their condition and influence their desire to be involved in diabetes management.

Psychological adjustment to chronic pain has been recently explored within three separate frameworks: a behaviour-focused account of chronic pain acceptance within the broader remit of Acceptance and Commitment Therapy; an emotion-focused approach with various research programs investigating the role of anger, fear, depression and also shame and positive emotions in chronic pain; and a cognitionfocused perspective more recently reframed in terms of illness perceptions as part of a wider model of response to health threats, the Self-Regulatory Model. Although these frameworks have broad areas of overlap, limited research has been directed at integrating acceptance, emotions and illness perceptions into a common, comprehensive account of psychological adjustment to chronic pain. Such an account would be beneficial both for providing a parsimonious approach that would guide further research and for developing pain management interventions that would take advantage of existing research from all three domains. The aim of the present thesis was to explore the possibility of integrating these separate areas by studying the relationships between the main concepts (acceptance, emotions, and illness perceptions) in the context of chronic pain. Based on a review of the relevant conceptual and methodological issues of each domain, a theoretical analysis of the similarities and differences between them was developed, with particular emphasis on the potential of existing models to support an integrative account. This analysis provided specific hypotheses regarding each domain and the interrelationships between them, which were investigated in a longitudinal study on a heterogeneous sample of 265 chronic pain patients using the services of the NHS Lothian Pain Clinic and several patient support organisations. Data were collected via postal and online questionnaires at 3 time points, at 41/2-month intervals (21% attrition rate). Validated questionnaires were used to measure the relevant constructs, with additional questions obtaining information regarding health status, medical history and demographics. The confirmatory analysis (employing a variety of statistical procedures, from correlation to multiple regression, factor analysis, cluster analysis and structural equation modeling) largely confirmed the expected relations within and between domains and was also informative regarding the most suitable data reduction methods. A detailed psychometric analysis of the questionnaires used offered a complementary view on the theoretical and methodological issues involved. An additional exploratory analysis focused on identifying the comparative characteristics of acceptance, emotions, and illness perceptions in predicting health status indicators, controlling for contextual factors such as medical history and demographics. Although no significant longitudinal changes were identified in most parameters (confirming the clinical observation of chronic pain as a stable condition), the longitudinal data allowed an analysis of the stability of the concepts and of the magnitude of their relationships in this patient sample. The analysis of intra- and interpersonal variation via hierarchical longitudinal modeling confirmed the stability of the data, highlighted the necessity of studying variation at both levels, and revealed interesting moderation effects, explained via the proposed concept of ‘discrimination ability’ and several alternative mechanisms. These results can be considered as first steps towards an integrative model of psychological adjustment to chronic pain. It is proposed that the behavioural, cognitive and emotional aspects need further conceptual clarification and these future efforts can be supported by the Cognitive-Affective Model of the Interruptive Function of Pain, within the wider framework of the Self-Regulatory Model.

Class of 2017 Abstract / Objectives: To assess access to and quality of primary health care services by individuals receiving meals at a food bank in a rural location using the Primary Care Assessment Tool- Short Form (PCAT-S). Also, to investigate whether individuals with a mental health condition at a rural community food bank receive different care compared to those without a mental health condition. Methods: The PCAT-S, a survey developed by John Hopkins University, was administered to evaluate care at first contact, ongoing care, coordination of care, and comprehensiveness of care. Demographics data (age, gender, health conditions, insurance status, etc.) was also collected. Results: The majority of our participants surveyed lived within an urban zip code (84.8%), had government insurance (81.4%), were male (61.9%), or were Native American (45%). The groups with the highest mean PCAT-S scores were participants with diabetes (mean score= 96.8), participants with no insurance (94.63), and participants who were female (91). The patient populations with the lowest scores were those with less than a high school education (63.11) with serious mental illness (64), or who had bipolar disorder (69). Groups with higher mean PCAT-S scores indicated more involvement with a primary care provider or overall better care within that section of the PCAT-S. Conclusions: Participants with a mental health condition may be receiving less healthcare than those without a mental health condition, especially in the coordination of care between healthcare services, as indicated by lower mean PCAT-S scores. Those living in a rural community, among our population, do not appear to be receiving less healthcare than those in an urban setting.

This study examined beliefs in supernatural causation of both Igbo and Yoruba ethnic groups in Nigeria. The study focuses on the beliefs that treatment of any patient involves exorcism of the invading spirit. A significant number of members of the two ethnic groups believe in the active presence of the spirit world, ancestral spirits, gods, and in reincarnation. Consequently, any illness or misfortune is often attributed to the wrath of the gods or neglect of the spirit world. Content analysis of data gathered through participant observation was the primary means used in the analysis of this study. Subjects were Igbo and Yoruba natives of three age groups. These groups included traditional age, transitional age, and modern age generations. This research found that both Igbo and Yoruba ethnic groups tend to turn to beliefs in supernatural causation during serious illnesses, accidents and deaths. However, as individuals move from traditional age to modern age, they tend to believe less in supernatural causation in Igbo and Yoruba communities, despite the introduction of modern medicine. Specific reasons for the persistence of beliefs in supernatural causation in Igbo and Yoruba communities, despite the introduction of modern medicine, is a topic for further research.

This thesis explores the representation of mental illness and mental incapacity in medieval Irish and Norse-Icelandic saga literature, with a particular focus on the theme of deception in representations of madness. These texts are compared using the methods of literary close reading. It begins (Chapters 1 and 2) with an overview of concepts of madness found in the two bodies of literature (drawing on law texts and poetry as well as the sagas) and the different narrative uses to which these concepts are put. Some general parallels and contrasts are drawn, and the cross-cultural transmission of the concept of the geilt is discussed in this context. Chapter 3 lays the ground for the thesis's analysis of deception in madness narratives by comparing two Irish and Norse-Icelandic narratives about fools and discussing links between the language of mental impairment and the notion of deception. Chapters 4 and 5 explore narrative representations of how deception is used with the aim of rehabilitating the mad person and reconnecting them with society, focusing in particular on the late Middle Irish saga Buile Shuibhne and an episode in the Icelandic family saga Egils saga Skalla-Grímssonar. Chapter 5 concludes with an extended discussion of the role of poetry and memory in representations of mental illness as seen in these two texts. Chapter 6 explores narratives in which deception is used with the purpose of destroying or humiliating the person of unsound mind, here focusing on the late Middle Irish saga Aided Muirchertaig meic Erca and an episode in the Norwegian king's saga Ágrip.

Class of 2007 Abstract / Objectives: To identify differences between patients diagnosed with a serious mental illness who test positive for cocaine and/or methamphetamine compared to patients who test positive or other abused substances. Methods: This retrospective study of clinical data obtained through a community mental health agency that provides outpatient services for patients with a serious mental illness. The study population was divided into two subgroups: positive cocaine and/or methamphetamine drug screen versus other positive drug screens and were compared over a 12- month period for the frequency and types of positive drug screens and blood alcohol levels, days of court-ordered treatment, the number of psychiatric hospitalizations and length of stay, primary psychiatric diagnosis, and the cost of care for services provided. Results: More females were in the “cocaine/methamphetamine” group versus more males in the “other substances of abuse” group, (p < 0.01). A higher proportion of patients diagnosed with psychotic disorders tested positive for “other substances” than for “cocaine and methamphetamine” (p < 0.01) and the “cocaine/methamphetamine” group had significantly more mood and anxiety disorders than the other group (p < 0.05). The frequency of patients testing positive for marijuana, methadone, and other opiates was higher in the “other substance abuse” group (p < 0.001). Patients in the “cocaine/methamphetamine” group had higher rates of polysubstance abuse (p < 0.001). The most commonly abused substance was cocaine (53.8%). Conclusions: Regular drug screening for substances of abuse and utilization of drug treatment programs should be recommended for SMI patients to improve their care and treatment outcomes.

Thesis advisor: Juliet B. Schor / Fragrances in consumer products have become a contested topic in daily life. Workplace fragrance policies problematize fragrances, which, for many people, are normal aspects of consumer products. This mixed-method dissertation focuses on employees in a large non-industrial workplace with a fragrance-free policy. It examines employee reactions to a policy that requests behavioral changes based on claims that everyday consumption of fragranced products may be harmful to employee health. In order to develop an understanding of how and to what extent fragrances and indoor air quality are problematized in the workplace, I engage a number of different constructs from environmental and consumer sociology. The dissertation expands upon constructs of contested illness (Brown, Kroll-Smith, & Gunter, 2000; Phillimore, Moffatt, Hudson, & Downey, 2000; Shriver & Webb, 2009); framings of environments in bodies (Kroll-Smith & Kelley, 2008); lay assessments of health impacts (Burton-Jeangros, 2011; Collins, 2010; Heikkinen, Patja, & Jallinoja, 2010; O'Sullivan & Stakelum, 2004; Scammell, Senier, Darrah-Okike, Brown, & Santos, 2009) and understandings of the role of scents in social life (Largey & Watson, 1972; Low, 2006; Synnott, 1991). My findings show that a majority of participants understand fragrance impacts through an individual health frame, as an allergy, that locates the problems associated with fragrance within the bodies of specific individuals who exhibit symptoms due to fragrance exposures. While this orientation has had positive impacts on the implementation of the policy and reducing corresponding impacts on those who are Fragrance Sensitive, the degree to which fragrances have been problematized is limited by understandings of fragrance impacts as allergies. The limiting framework of fragrance sensitivity as allergy has practical efficacy because it helps employees to connect with the idea that fragrances cause health issues for some individuals. However, it also stymies assessments and connections to potential broader environmental health impacts of fragrances in part because allergens such as pollen are generally viewed as benign and only problematic to the anomalous individuals who experience reactions. Limitations of the framework are reinforced by established moral and cultural assessments of good and bad fragrances and the appropriate use of fragrances (Low, 2006; Synnott, 1991). This dissertation examines what happens when people are confronted with information that the industrial traces associated with their consumption practices - in this case wearing and using fragranced products on their bodies and in their work environments - may be contributing to negative health outcomes for their coworkers. This study is the first to analyze the social dimensions of the use of synthetic fragrances in connection to environmental health impacts in the context of everyday life. The findings have relevance for other organizations considering regulation of fragrances as well as for efforts to use health rationales to encourage changes in consumption practices. / Thesis (PhD) — Boston College, 2017. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Sociology.

Die Critical-lllness-Polyneuropathie (CIP), eine Erkrankung des peripheren Nervensystems nach einer schweren intensivmedizinisch behandlungspflichtigen Erkrankung, ist bereits seit dem 19. Jahrhundert bekannt und lässt sich nur sehr schwer von einer Critical-Illness- Myopathie, die im gleichen Kontext auftreten kann, unterscheiden. Erschwert wird die Situation dadurch, dass beide Funktionsstörungen kombiniert auftreten können. Auf Grund der Weiterentwicklung in der Medizin ist in den letzten 2 Jahrzehnten eine Häufigkeitssteigerung zu verzeichnen mit der Forderung geeignete Maßnahmen zu finden, die häufig schwerwiegenden Folgeerscheinungen zu mindern. Mit Entwicklung eines bestimmten neurorehabilitativen Behandlungsregimes ergeben sich die Fragen, welche CIP Patienten profitieren, ergeben sich prognoserelevante Faktoren und welche Art und Dauer der Neurorehabilitation vorgehalten werden muss. In der vorliegenden Arbeit wurden retrospektiv die Entlassungsbriefe der Patienten mit einer CIP der Abteilung für neurologisch-neurochirurgisch Frührehabilitation der Jahre 2004-2008 ausgewertet. Die Beurteilung der Fähigkeitsstörungen erfolgte mit dem Frührehabilitations-Barthel-Index nach Schönle, dem Barthel-Index sowie dem FIM und das Handicap wurde mit der 8-stufigen Glasgow-Outcome-Scale bewertet. Zusätzliche Parameter waren das Alter und Geschlecht, die Ursache der CIP, die Zeit von Erkrankungsbeginn bis zur Aufnahme, die Behandlungsdauer, Komplikationen sowie die Entlassungsart. 200 Patienten, 67,5% Männer und 32,5% Frauen konnten ausgewertet werden. Eine Häufung des Erkrankungsbildes fand sich bei Patienten ab dem 60. Lebensjahr. Eine Ursachenpräferenz fand sich nicht, wobei im Wesentlichen kardiale, respiratorische und gastrointestinale Erkrankungen vorgefunden worden waren. Alle Patienten konnten, nach einer durchschnittlichen Behandlungsdauer von 40 Tagen, von der Frührehabilitationsbehandlung profitieren. So konnten 34% in weiterführende rehabilitative Behandlungsstufen und 17,5% der Patienten gebessert nach Hause entlassen werden. Die Sterblichkeit mit 11% muss der besonderen Schwere des Krankheitsbildes angelastet werden. Dies wird durch die Feststellung gestützt, dass die Komplikationsrate mit über 60% während der rehabilitativen Behandlung sehr hoch lag. Hervorzuheben ist, dass sich herausarbeiten ließ, dass sich eine längere Behandlung positiv auf die Behandlungsergebnisse, auch bei schwer Betroffenen auswirkte. Die auslösende Ursache scheint keinen wesentlichen Einfluss auf das outcome zu haben. Männer profitieren bei der Wiedererlangung motorischer Fähigkeiten etwas besser als Frauen. Die älteren Patienten zeigen gute Verbesserungen bei körperlichen Funktionsstörungen. Bezogen auf die kognitiven Fähigkeiten muss aber das Alter als negativer Prädiktor angesehen werden. Der Grad der Behinderung hat einen deutlichen Einfluss auf die Behandlungsdauer und Behandlungsergebnisse. Demgegenüber stellt eine primäre Intensivpflicht einen negativen Prädiktor, auch wenn auch diese Patienten von der Rehabilitation profitieren. / The Critical-lllness-Polyneuropathie (CIP) is an illness of the peripheral nervous system after a severe illness with intensive care treatment. It is known since the 19th century and cannot be distinguished easyly from the Critical Illness Myopathie which can appear in the same context. The situation is complicated by the fact that both dysfunctions can appear combined. Because of the advances in the medicine the frequency of the CIP has increased in the last 2 decades. The question is which patients profits from a certain neurorehabilitativen treatment, which factors are relevant for the prognosis and which kind and duration of the neurorehabilitation must be reproached.

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