Consumers as community support providers: Issues created by role innovation

Using data from a CSP-funded research demonstration project designed to expand vocational services offered by case management teams serving people with serious mental illness, this paper examines the issues created by employing consumers as peer support specialists for the project. Roles and benefits of these positions are analyzed. Challenges experienced by specialists created by serving peers, the structure of the position, the mental health system and the community, and personal issues are analyzed using data from focus groups and the project's management information system. Implications for consumer role definition, supports for role effectiveness, and the structuring of these types of positions are discussed.C.T. Mowbray is Associate Professor, School of Social Work, the University of Michigan, Ann Arbor, Michigan. D.P. Moxley is Associate Professor, School of Social Work, Wayne State University, Detroit, Michigan. S. Thrasher is Assistant Professor, School of Social Work, Wayne State University, Detroit, Michigan. D. Bybee is Adjunct faculty and N. McCrohan is a graduate student in the Department of Psychology, Michigan State University, East Lansing, Michigan. S. Harris is a consultant in East Lansing, Michigan. G. Clover is affiliated with Kent County Community Mental Health Board, Grand Rapids, Michigan.     

A survey of factors related to mental hospital readmissions.

The authors followed up 107 patients selected at random from those discharged from a southern state mental hospital in fiscal year 1972-73. They attempted to differentiate those who were readmitted to the hospital from those who were not on the basis of 52 factors, both personal and environmental, and also compared those who misused alcohol with those who did not. In their sample, 36 of the patients returned to theinstitution, and 71 did not. One of the findings was that in both the total sample and in the nonalcoholic subsample, those readmitted more often received income ffrom sources other than their own employment or the employment of someone in their household. They also tended to be single, separated, or divorced. In both the alcoholic and nonalcoholic subsamples, those readmitted reported more contacts with the community mental health center after their discharge than those not readmitted. In the total sample, the readmitted patients engaged in fewer leisure-time activities and were more likely to report a drinking problem.     

Antibodies and immune profiles of individuals occupationally exposed to formaldehyde: Six case reports

Six patients with multiple subjective health complaints, which have been correlated with chronic exposure to formaldehyde during the course of their education and occupations, were tested for the existence of antibodies (IgE, IgM, and IgG) to formaldehyde (F) conjugated to human serum albumin (F-HSA). In addition, the percentage and absolute numbers of peripheral lymphocyte subpopulations as determined by surface markers were investigated. Antibody titers to F-HSA were present as follows: IgE (2 patients), IgM (3 of 4 tested patients), and IgG (5 patients). Analysis of lymphocyte subpopulations showed T-helper/suppressor (H/S) ratios ranging from 0.8 to 3.3. All 6 patients had elevated Tal cells (antigen memory cells), whereas interleuken 2 receptor positive cells were within expected values. Following formaldehyde exposure, 5 of the patients complained of an initial flulike illness from which they have not completely recovered. The sixth individual had a history of recurrent respiratory infections and surgical removal of hyperplastic ethmoid sinus tissue. The common occurrence of anti-F-HSA antibodies, flulike illness, and Tal cells are interpreted as suggestive of a chronic antigenic stimulation of the immune system in these 6 patients. Further immunological work-up of additional subjects and immune parameters with similar history of formaldehyde exposure and subjective health complaints is warranted.     

Focal intestinal heating with regional abdominal hyperthermia

The effect of regional abdominal heating on the small and large bowel was evaluated in three female research pigs. The BSD Annular Phased Array was used for heating. Blind-end catheters and a free peritoneal probe were surgically attached to small bowel, large bowel, liver, and kidney. Each pig underwent 4-8 heating sessions and was subsequently autopsied. There was no histologic evidence of acute bowel, liver, or kidney damage. There were significant differences in temperatures at the various sites. The average small bowel temperature was significantly higher than predicated by the free peritoneal probe or than seen in the liver or kidney. The large bowel temperatures averaged higher than the free peritoneal probe temperatures, but the difference was not significant. Liver and kidney temperatures approximate whole body temperature due to extensive vascular network. Although the elevated small bowel temperatures may be due in part to different position in relation to isotherms, the frequent occurrence of a large temperature difference suggests focal heating of fluid pockets in the small bowel.     

Inappropriate drinking and secretion of vasopressin after caval constriction in dogs

The object of this study was to determine if chronic thoracic vena caval constriction affected mechanisms regulating water balance, independent of known changes in sodium metabolism in the dog. Fluid and electrolyte balances were determined for 5 days before and 14 days after constriction of the vena cava (n = 5) and in a separate population of time controls (n = 4). Cardiac output was reduced and heart rate was increased in response to chronic caval constriction although blood pressure was maintained at control levels. Water intake and plasma arginine vasopressin (AVP) increased from 31 +/- 4 ml/kg and 1.3 +/- 0.2 pg/ml during the control period to 81 +/- 6 ml/kg and 3.4 +/- 0.6 pg/ml during the period of caval constriction. The caval dogs developed a positive water balance, which preceded the development of a positive sodium balance. This led to a significant fall in plasma osmolality from a control mean of 296 +/- 1 to 284 +/- 4 mosmol/kg during caval constriction and dilutional hyponatremia. Plasma and blood volume increased significantly in response to constriction and were accompanied by formation of 123 +/- 10 ml/kg of ascitic fluid. These results show that water intake and plasma levels of AVP were increased in spite of a fall in plasma osmolality and an increase in vascular volume. These responses cannot be secondary to sodium retention because water was retained in excess of sodium hence hyponatremia. Therefore, chronic caval constriction causes a profound primary disturbance in mechanisms regulating water balance, which may contribute to the formation of edema fluid.