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Exposure to trauma increases the risk of engaging in detrimental health behaviours such as tobacco and substance use. In response, the United States Substance Abuse and Mental Health Services Administration developed Trauma-Informed Care (TIC), an organisational framework for improving the provision of behavioural health care to account for the role exposure to trauma plays in patients' lives. We adapt TIC to introduce a novel theory of behaviour change, the Trauma-Informed Theory of Individual Health Behavior (TTB). TTB posits that individual capacity to undertake intentional health-promoting behaviour change is dependent on three factors: (1) the forms and severity of trauma they have been and are exposed to, (2) how this trauma physiologically manifests (i.e., the trauma response) and (3) resilience to undertake behaviour change despite this trauma response. We define each of these factors and their relationships to one another. We anticipate that the introduction of TTB will provide a foundation for developing theory-driven research, interventions, and policies that improve behavioural health outcomes in trauma-affected populations.

Job insecurity exerts negative effects on self‐reported health. Using the Spanish Survey of Household Finances for 2011–2014, this paper asks whether and to what extent debt burdens enhance these detrimental health effects. To address potential endogeneity problems surrounding this question, the paper adopts Deb and Trivedi’s (Econometrics Journal, 9, 307–331, 2006) econometric approach. The results show that the negative effect of job insecurity on self‐assessed health is exacerbated if the individual is over‐indebted. Moreover, the role of over‐indebtedness differs between types of debt, with non‐mortgage debts causing larger health losses than mortgage debts. Thus, concerns about job insecurity should not be decoupled from concerns about increasing household indebtedness, and policy measures intended to improve individual welfare should consider both phenomena together.

Prior research links neighborhood immigrant concentration and residential stability to individual health outcomes. It remains unclear how neighborhood social organization extend to family functioning among immigrant families. Expanding the scope of research on neighborhoods and family relationships, this study draws on data from 1417 Latinx families (Myouth age = 10.19 years, SDyouth age = 3.34) to: (1) examine associations between neighborhood immigrant concentration, residential stability, and parent-child warmth and conflict in Latinx families, and (2) test whether associations vary by family generational status. Multilevel mod3els revealed that associations between immigrant concentration and parent-child relationships were contingent on residential stability, and that the association differed according to generational status. In general, stable neighborhoods with larger immigrant populations were associated with more warmth and less conflict for first- and second-generation families relative to foreign-born families. Discussion centers on the conditional role of neighborhood structural characteristics for family relationships among Latinx families and advances directions for future research on neighborhoods and families.

Aim This investigation explored the extent to which nurses' own health is a priority for global National Nursing Associations. Background There is a growing body of evidence linking staff health and well-being and key dimensions of service quality, including patient safety, patient experience and the effectiveness of patient care. Introduction The International Council of Nurses is a federation of more than 130 National Nurses Associations, representing more than 20 million nurses worldwide. Representatives from these Associations attended a Congress in Singapore in 2019 at which a survey was conducted. Methods A convenience sample of 37 leaders of National Nurse Associations from 33 countries and 61 nurse representatives took part in a survey. Results The majority of nurse leaders and participants believed that nurses' own health should be a priority to be addressed, principally because a healthy nurse is better able to provide good patient care. All of the examples offered about how these Associations address nurses' own health were about actions to prompt individual health behaviour change. Discussion The National Nurses Associations did not have a common terminology to talk about nurses' own health. Taking care of one's own health was included as part of the professional role and most nurse leaders thought that working conditions contributed to ill health. Conclusions There is widespread agreement that nurses' own health matters but for most National Nurses Associations it is not a current priority. Implications for nursing policy Going forward nurse health and wellbeing should be a core principle for health services and professional associations, and additional research is needed that demonstrates if improving working environments contributes to nurse retention and recruitment.

Introduction The purpose of this integrative review was to synthesize the literature on women's perceived barriers and facilitators to achieving a vaginal birth after cesarean. Methods A search of Scopus and PubMed databases and relevant citations from 2000 to 2018 was conducted to identify resources meeting inclusion criteria. Conclusion drawing and verification were completed using data displays, data analysis, and comparison. Results Sixteen resources met inclusion criteria. Factors identified by women with a history of cesarean that act as facilitators or barriers to achieving a vaginal birth after cesarean included (1) individual factors (knowledge, body, and psychological), (2) social factors (culture and social support), and (3) systemic factors (perinatal care provider, health system, and financial). Some factors related to barriers and facilitators reflected opposing aspects of the same phenomenon on a continuum. Discussion Enhancing facilitators identified by women, while addressing perceived barriers, may increase access to labor after cesarean for women in the United States. Increasing access to labor after cesarean may subsequently improve women's experiences of care and decrease the US cesarean rate, positively affecting individual health outcomes and overall health of childbearing women in the United States.

The nutraceuticals market is vast, encompassing many different products with inconsistent levels of evidence available to support their use. This overview represents a Western perspective of the nutraceuticals market, with a brief comparison with that in China, as an illustration of how individual health supplements increase and decrease in popularity in regional terms. Recent changes in sales patterns, mainly taken from the US market, are summarized and a selection of five newer products, which have not been subject to extensive recent review are profiled: astaxanthin, a carotenoid found in red algae, seafood, salmon and trout, as an antioxidant; cannabidiol, a non-euphoric marijuana ingredient used as mood enhancer and for painful/inflammatory conditions; modified extracts of ginseng used in new indications including dementia and space travel; monk fruit, a non-sugar high intensity sweetener and nigella seed, a popular food ingredient and Asian medicine, which has experienced an extraordinary rise in sales recently. LINKED ARTICLES: This article is part of a themed section on The Pharmacology of Nutraceuticals. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v177.6/issuetoc.

Hepatitis C prevalence in prison populations is much higher than in the community. Effective hepatitis C treatment within this population does not only have a direct individual health benefit, but may lead to substantial community dividend. We reviewed available evidence on hepatitis C treatment in prison settings, with a focus on the European Union/European Economic Area. A systematic review of the literature (PubMed, EMBASE, Cochrane library) was performed and complemented with searches for conference abstracts and grey literature. Thirty-four publications were included reporting on the effectiveness, acceptability and economic aspects of hepatitis C virus treatment models of care to achieve treatment completion and sustained viral response in prison settings. Available evidence shows that hepatitis C treatment in prison settings is feasible and the introduction of direct-acting antivirals will most likely result in increased treatment completion and better clinical outcomes for the prison population, given the caveats of affordability and the need for increased funding for prison health, with the resulting benefits accruing mostly in the community.

Using data from Framingham Heart Study participants interviewed and examined at frequent intervals over much of their adult lifetime, we discover a relationship between smoking and mortality that differs significantly in magnitude from findings in the medical and epidemiological literature. We attribute the finding of smaller deleterious health impacts of smoking to a failure by previous studies to appropriately account for the non- random nature of lifetime smoking patterns and health histories. We provide causal and consistent estimates of the expected longevity consequences of current smoking, smoking cessation, smoking duration, and smoking experience by jointly modeling individual health heterogeneity, by including supply-side factors such as cigarette advertising and prices, and by allowing for permanent and time-varying unobserved heterogeneity in a flexible yet comprehensive multiple equation joint estimation procedure. We simulate our estimated empirical model under a variety of lifetime smoking patterns, and we compare the resulting mortality differences to the epidemiological literature that treats smoking behavior as random. Our results suggest that difference-in-means statistics significantly overstate the expected longevity loss from various patterns of lifetime smoking. For comparison, the (biased) unconditional difference-in-means in age of death between lifelong smokers and nonsmokers is 9.3 years in our research sample, while simulations from our estimated dynamic model suggest the difference is only 4.3 years. Additionally, our results examine the importance of smoking cessation and relapse avoidance.

What if individual psychology took another path than the one guided by the idea of the “Sturm und Drang” of adolescence? What if this path less-traveled led to community-oriented rites of passage that satisfied youth's deep craving for the ancestral wisdom of the Universe … and simultaneously affirmed that parents, too, would continue to grow and contribute as they transited mid-life? This article brings the reader down the path less-traveled to explore navigational aids for future travelers and provides an example of the explosion of community engagement and creativity that can occur when the transitions of adolescence and mid-life, traditionally viewed as crises, become opportunities and assets for fostering individual health and community resiliency, adaptation, and well-being through community-oriented rites of passage.

The number of new psychoactive substances (NPS) has increased significantly, especially within the last 5 years. The EMCDDA conducts risks assessments of such substances, especially in relation to serious adverse events. Examination of the individual health risks of a substance is a fundamental requirement of the process. Based on a number of considerations, the Toxicological Significance Score has been developed to support the risk assessment of NPS by allowing the role of a substance in deaths to be better assessed and classified.

Service recovery is a concept that involves regaining customer satisfaction and loyalty. Although existing studies have addressed its importance, few service recovery methodologies have been developed. Thus, there is a need to develop a systematic framework that can first detect customer status and then provide appropriate recovery recommendations to ensure customer satisfaction. This study develops such a framework in relation to an individual health maintenance practice. While regular moderate exercise is known to promote good health and help prevent disease, the lack of exercise remains a crucial health issue. This study presents a logistic regression model that uses both physiological data (heart rate and blood pressure) and psychological data (ratings of perceived exertion) to detect the effectiveness of an individual's exercise and to provide sports-related service recovery suggestions as needed. To implement and assess this service recovery model, the use of a motion gaming system is proposed.

Purpose Automated delineation of structures and organs is a key step in medical imaging. However, due to the large number and diversity of structures and the large variety of segmentation algorithms, a consensus is lacking as to which automated segmentation method works best for certain applications. Segmentation challenges are a good approach for unbiased evaluation and comparison of segmentation algorithms. Methods In this work, we describe and present the results of the Head and Neck Auto-Segmentation Challenge 2015, a satellite event at the Medical Image Computing and Computer Assisted Interventions (MICCAI) 2015 conference. Six teams participated in a challenge to segment nine structures in the head and neck region of CT images: brainstem, mandible, chiasm, bilateral optic nerves, bilateral parotid glands, and bilateral submandibular glands. Results This paper presents the quantitative results of this challenge using multiple established error metrics and a well-defined ranking system. The strengths and weaknesses of the different auto-segmentation approaches are analyzed and discussed. Conclusions The Head and Neck Auto-Segmentation Challenge 2015 was a good opportunity to assess the current state-of-the-art in segmentation of organs at risk for radiotherapy treatment. Participating teams had the possibility to compare their approaches to other methods under unbiased and standardized circumstances. The results demonstrate a clear tendency toward more general purpose and fewer structure-specific segmentation algorithms.

Changes in time-activity patterns may influence personal exposure to various environmental factors and affect individual health. However, few studies have investigated the changes in patterns of time spent outdoors. To investigate the trends in outdoor activity in recent decades in China, a retrospective questionnaire was used to examine the amount and pattern of time spent outdoors during the day by 2076 subjects in four geographically distinct rural regions of China. Rural Chinese people spent less time outdoors than they used to because of the economic development, increase in education and changes in working conditions that occurred over time. Outdoor time was the shortest during the school stage of life (Sanya: 3.24-3.61; Shaoxing: 3.35-3.68; Lhasa: 4.37-4.54; Xiuyan: 2.94-3.26 h per day). Subjects in wealthy regions spent less time outdoors during their working stage of life. In the four regions in this study, the average daily times spent outdoors were 3-13% lower for subjects aged 40-59 years and 20-38% lower for those under 40 years compared to subjects aged 60 years and over. Certain health-related issues, such as vitamin D deficiency, will become more prominent in China if this trend continues.

The current 8-year panel study explored changes in marital satisfaction among 614 married middle-aged persons with seventh-grade children. It also examined how individual health (physical health and depressive moods) and role changes (parenting transitions and life stress) were related to trajectories of marital satisfaction and investigated the buffering effect of family cohesion on these associations. Growth curve analyses show an inverted-U shape in marital satisfaction during middle age. This indicates that regardless of the gender or age of the respondents, marital satisfaction among middle-aged adults increased when their children were in the 9th and 12th grade, and then declined when their children were in their sophomore year of college. Declining physical health and an increase in depressive moods were related to a drop in marital satisfaction. Stressful events in midlife had negative effects on marital satisfaction, and family cohesion served as a buffer to mitigate the adverse impact of life stress on marital satisfaction. Overall, these results highlight the role of adolescent children in understanding why marital satisfaction changes among middle-aged parents and emphasize the importance of health and life stress in relation to midlife marital satisfaction. These findings are discussed with life course perspectives and Taiwanese cultural values in relation to familism and academic achievement among children.

Dishonest behavior significantly increases the cost of medical care provision. Upcoding of patients is a common form of fraud to attract higher reimbursements. Imposing audit mechanisms including fines to curtail upcoding is widely discussed among health care policy-makers. How audits and fines affect individual health care providers' behavior is empirically not well understood. To provide new evidence on fraudulent behavior in health care, we analyze the effect of a random audit including fines on individuals' honesty by means of a novel controlled behavioral experiment framed in a neonatal care context. Prevalent dishonest behavior declines significantly when audits and fines are introduced. The effect is driven by a reduction in upcoding when being detectable. Yet upcoding increases when not being detectable as fraudulent. We find evidence that individual characteristics (gender, medical background, and integrity) are related to dishonest behavior. Policy implications are discussed.

The mortality and morbidity associated with melanoma is unquestionable, but its global incidence is greatly outnumbered by that of non-melanoma skin cancer (NMSC). The economic burden of NMSC is significant, falling within the US’ top five most costly cancers 1. In Australia, a high level of skin cancer awareness has been reported 2. Public health campaigns and advice provided by individual health professionals seek to increase knowledge about skin cancer, risk factors and protective sun–safety behaviours. This article is protected by copyright. All rights reserved.

Background To meet the challenges caused by non‐communicable diseases, Norway has established Healthy Life Centres within primary care to encourage a healthy lifestyle. To promote people's health and ensure high‐quality services, user involvement in contemporary health care is regarded as essential. Objective To explore the experience of user involvement among Healthy Life Centre users participating in individual health consultations, followed by physical activity groups and/or diet courses. Methods This was a qualitative study based on twenty semi‐structured individual interviews conducted between September 2015 and May 2016 at a Healthy Life Centre in Norway. Data were analysed using systematic text condensation. Results Being respected and having a trustworthy relationship with the professionals were found to be essential for the service users’ involvement. Building a trustworthy relationship was disrupted for some service users by a lack of relational continuity. This lack of continuity jeopardized the continuation of professionals’ awareness of the service users’ challenges and personal goals. The service users’ preferred levels of user involvement varied. Some service users did not always want to play an active part and instead wanted the professionals, as “experts,” to decide. Conclusions The findings imply that the professionals need to assess each service user's desires for involvement and consider how these can be met. Thus, user involvement cannot be understood without considering the particular setting and each individual service user's preferences for involvement. Relational continuity is needed to maintain the service users’ challenges and goals throughout the services and to promote health behaviour changes. © 2018 The Authors. Health Expectations published by John Wiley & Sons Ltd This is an open access article under the terms of the Creative Commons Attribution License

This paper investigates the effects of a combination of individual health accounts (IHAs) and catastrophic insurance on lifetime income redistribution by examining the variations in end-of-life IHA balances and lifetime out-of-pocket health expenditures. We exploit longitudinal health expenditure data from 2005 to 2007 in Kunshan City, Jiangsu Province of China. We find a high concentration of low IHA balances at the end of life, with most equal to zero. This finding suggests that most IHA balances are used for health expenditures and that the income redistribution effect through the accumulation of IHA balance is limited. However, the results also show a wide variation in lifetime out-of-pocket spending in the form of deductibles and coinsurance, which implies serious inequality in individual financial burden that can lead to a large income redistribution effect.

Research has demonstrated the many benefits of mindfulness training programmes for individual health and well-being. This study, however, explored whether mindfulness training might have effects on intergroup interaction. We tested the effects of a self-observation-based mindfulness course on several dimensions of acceptance of the other (i.e., non-judgement, non-reaction and observation). An initial study test a mindfulness course training (N = 197). A second study then tested its effect on intergroup relationships (N = 120). A control group was used in both studies, and the subjects were tested before and after the course. Results indicate that participation in the course favoured intergroup acceptance of the other and suggest that mindfulness training represents a useful educational method for reducing social discrimination.

Process safety protects and enhances our individual health, our company's success, and our region's business economy. Companies that handle toxic, flammable, and explosive materials understand the importance of process safety and risk management. So do regulators. So should the community and other stakeholders. Individually, these stakeholders have been working for years to improve process safety performance. Accidents continue to occur. It is time to leverage our resources, knowledge, and skills to all strive for a common goal of great process safety performance. CCPS's Vision 20/20 describes that vision, which calls for effort from individual companies and effort that goes well beyond any individual company, indeed beyond the industries. © 2015 American Institute of Chemical Engineers Process Saf Prog 34: 111–118, 2015

Little attention has been paid to why trends and levels of mortality and morbidity differ in Eastern Europe and few studies have addressed people's own perceptions of their new political system – perceptions which per se may be important for social development. The aim of the present study was to analyse the extent to which trust and economic circumstances affect self-rated health in Poland, Estonia and Russia and how much health differences between the countries can be explained by these factors. A better economy and higher trust were related to better individual health, while economic factors seemed most important for inter-country differences. It is probable that both institutional factors and individual perceptions contribute to people's well-being, but in terms of social policy, an improved welfare system may be the most effective way forward.

An increasing number of institutions of higher education are clustering their health sciences schools into a common unit. Therefore, it is imperative that the individual faculty development units assume new mandates to meet faculty development needs for stakeholders across these disciplines. Critical to providing current and relevant professional development activities is an awareness of the needs of academicians, including common as well as discipline-specific needs. Hence, the aim of this study was to explore the extent to which factors such as discipline, rank, gender, education, and years as an academician impact on perceived needs for faculty development. In February 2012, a cross-sectional survey of the perceived faculty development needs of academicians in the health sciences unit of a Canadian university was conducted using an online assessment tool. A total of 133 out of 1,409 potential participants completed the survey, for a response rate of 9.4%. The findings revealed more similarities than differences in terms of perceived faculty development needs. In addition, differences were found across all health professions schools and in factors such as discipline, academic rank, education, gender, and years as an academician. These findings suggest that faculty development and educational specialists should understand the shared as well as the unique needs of the individual health sciences schools in planning their professional development services.

The concept of health behaviour has become ubiquitous in health-related research and intervention studies, as well as among policymakers. Developed from psychology, it is based on a number of key underlying assumptions that enable it to be integrated in an existing health research paradigm. However, by conceiving individual health behaviour as discrete, stable, homogeneous and measurable, many other aspects of health-related activities, in particular those relating to power and sociality, are excluded. As a consequence, any genuine contribution from medical sociology or related disciplines is, at best, limited. To counter this, it is proposed that reconceptualising what people do in terms of health practices, rather than health behaviour, captures the emergent and contingent properties of people's activities in particular situations. Rather than serving as a direct replacement term, and thus reproducing the same epistemological assumptions, it is argued that its very flexibility and capacity to articulate different theoretical orientations is likely to be its major strength.

We investigate the impact of health on working hours. This is in recognition of the fact that leaving the labour market because of persistently low levels of health status, or because of new health shocks, is only one of the possible responses open to employees. We use the first six waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey to estimate the joint effect of health status and health shocks on working hours. To account for zero working hours, we use a dynamic random effects Tobit model of working hours. We follow Heckman (1981) and approximate the unknown initial conditions with a static equation that utilises information from the first wave of the data. Predicted individual health status is used to ameliorate the possible effects of measurement error and endogeneity. We conclude that overall, lower health status results in fewer working hours and that when they occur, health shocks lead to further reductions in working hours. Estimation results show that the model performs well in separating the time-persistent effect of health status and the potentially more transient health shocks on working hours.

Summary Background: An epidemic of chronic disease in an ageing population obliges us to train medical students to participate in patient and population-centred health systems as members of connected teams with the skills to work in an increasingly pluralistic cultural environment. Context: Like many others, the graduate-entry Sydney Medical Program struggles with teaching population medicine to students who often perceive it to be less relevant than clinical studies. Evaluation found that although students were aware of the importance of population medicine to clinical practice, they felt the existing programme lacked integration with their clinical education and did not develop professional skills. Innovation: Experience told us that clinicians apply the principles of population medicine in every consultation, understanding that individual health outcomes are moderated by the social determinants of health. We applied this knowledge to develop an integrated, community-engaged population medicine curriculum for our students in their final two clinical years. Each student will follow a patient with a chronic health condition in the community over 14 months. They will consider their patient’s experience with chronic disease and its management through a population medicine lens. Students share their learning in tutorial sessions and through online assessment tasks. Implication: A comprehensive evaluation of patient, faculty and student experiences of the programme will allow us to assess whether we have achieved our goal of revealing to students how the application of the principles of population medicine is essential to excellence in daily clinical practice. Early data suggest that students feel positive and excited about this curriculum innovation.

This manuscript provides an introduction to the JSI special issue on The Intersection of Psychology and Globalization. We provide both theoretical and applied rationale for why the discipline of psychology would be well served by entering into the academic discourse on globalization. We present a multifaceted definition of globalization and review extant social science research on globalization that speaks to the psychological implications of globalization. We also discuss Bronfrenbrenner's ecological model as an appropriate theoretical framework to link individual health, behavior and attitudes to macro socioeconomic processes. With this as a backdrop we introduce each of the manuscripts in this special issue with a focus on their specific contributions to developing a theoretical and empirical foundation for understanding and responding to the relationship between psychology and globalization.

This paper suggests new indices of health inequality which may be used when only ordinal information is available on individual health status. We borrow ideas from the literature on the measurement of occupational or residential segregation and show that indices of ordinal segregation which have been recently proposed may be also applied to the measurement of health inequality. We also prove that these indices satisfy four axioms introduced to measure inequality with ordered response health data so that the new indices presented in this paper are consistent with the inequality ordering proposed by Allison and Foster. We also suggest an extension of the family of indices proposed by Abul Naga and Yalcin. Copyright © 2011 John Wiley & Sons, Ltd.

Both male and female peafowl grow crests on top of their head - iridescent blue in males, dull iridescent green and brown in females - but the potential signal function of this plumage ornament is unknown. In this study, peafowl crests were measured in three feral populations, and morphological variation in this ornament was studied in relation to body condition (body mass in relation to tarsus length) and health (white blood cell concentration and ectoparasite load). Prior to the start of the breeding season, male crests are wider with greater pennaceous area, and are more likely to have all feathers grown out compared with female crests. Only crest length changed with measurement date, increasing over time; in males, crest measurements were not related to the extent of train feather development. Crest morphology is a potential signal of individual health and condition in both sexes, but in different ways. In females, the amount of crest plumage grown out to its full extent was related to body condition at the start of the breeding season, whereas in males, the size and pennaceous area of the ornament were related to ectoparasite load. Observations of within-sex agonistic behaviour suggest a possible role for the crest ornament in status signaling in males, because males that engage in more aggressive interactions tend to have wider crests. There was no evidence for a relation between crest morphology and agonistic behaviour in females.

This paper examines environmental and health consciousness, as well as behavioural costs and their effects on the purchase of organic products. The consumption of organic products is regarded as an investment in individual health. The low-cost hypothesis takes environmental attitudes and behavioural costs into account and is applied to organic food consumption. The survey conducted in three German cities in 2006 using self-administered questionnaires (n = 521) does not investigate willingness to pay but rather self-reported behaviour. The results of the regressions using the Heckman correction show that income does not affect the regularity of organic food consumption but that it does influence individual expenditure on organic food. Furthermore, there is an inverted u-shaped relation between age and the purchase of organic products. Although health consciousness has a stronger association with organic food consumption than does environmental concern, the interaction between behavioural costs and health or environmental consciousness shows no effect. Thus, the low-cost hypothesis is not supported.

wall c., glenn s. & poole h. (2011) Experiences prior to diagnosis of non-Hodgkin lymphoma: a phenomenological study. Journal of Advanced Nursing67(11), 2363–2372. Abstract Aim. This paper is a report of a study identifying and describing the essences of patients’ experience during the period leading up to the diagnosis of non-Hodgkin lymphoma. Background. Patient and doctor delays occur during diagnosis of non-Hodgkin lymphoma, and families can affect patients’ help-seeking behaviours. Current guidelines state the need for immediate referral of patients with suspected non-Hodgkin lymphoma symptoms. Methods. A phenomenological approach was used. A purposive sample of 31 patients diagnosed with non-Hodgkin lymphoma was recruited through a hospital and a support group in the United Kingdom. In-depth interviews were tape-recorded, transcribed and then analysed using Colaizzi’s method. Data collection took place over an 18-month period during 2003–2005 and data analysis was completed in 2006. Findings. The overriding theme was: Creating a pathway towards hearing the diagnosis of non-Hodgkin lymphoma. The three themes were as follows: Perceiving individual health and onward movement; Penetrating communication processes and investigations; Advancing towards focusing on the non-Hodgkin lymphoma diagnosis. Patients with non-Hodgkin lymphoma can have a diverse symptom presentation over long periods of time. Their help-seeking behaviours are an interplay of essences, including symptom type, attributions and emotional responses. Patients need tailored information to deal with the uncertainty of their situation at key points during their prediagnosis journey. Conclusion. Nurses should help patients identify and acquire the appropriate information at key points during the diagnosis period as this is a period of great uncertainty. Further research should be conducted into the quality of prediagnosis consultations and the extent to which patients think that their agendums have been met at this time.

Objective To assess the impact of state laws requiring or encouraging employers to establish “section 125” cafeteria plans that shelter employees' premium contributions from tax.

Objective: In the Netherlands, the Individual Health Care Professions Act (IHCP Act) allows dental students, amongst other non-qualified individuals, to work under certain conditions in a dental practice. The aim of the study was to determine how many dental students have part-time employment in dental practice and which professional tasks they carry out. We also asked the dental students their opinion about the IHCP Act. Material and methods: All the enrolled dental students at the Academic Centre for Dentistry Amsterdam (ACTA) in the Netherlands received a questionnaire by e-mail. Within 1 month, two reminders were sent. Results: The response was 44% (427 students). Of the responding students, 71% had paid employment in addition to their study. Twenty-five per cent of all students worked in a dental practice, usually 8 h a week. Study year and age were positively related to working part-time in dental practice. Activities frequently performed were providing chair side assistance, giving oral hygiene instruction, fluoride applications, scaling and root planning. The self-reported knowledge about the IHCP Act was positively related to study year and working in a dental practice. Hardly any information about the requirements of the IHCP Act with regard to delegation of tasks was provided by the employer. Conclusion: Many Dutch dental students work in a dental practice, taking over a variety of tasks. Although the self-reported knowledge about the IHCP Act was relatively high, many dental students expressed the need for more detailed information about the legal aspects of their tasks.

SUMMARY This paper models the effect that physical activity such as sports participation and active travel, through walking and cycling, has on self-reported health and well-being. The results show that physical activity and active travel mainly have a positive effect on both individual health and well-being. Although, cycling has health benefits, it also appears to involve some disutility, which requires further investigation.

This paper examines the effect of income polarization on individual health. We argue that polarization captures much better the social tension and conflict that underlie some of the pathways linking income disparities and individual health, and which have been traditionally proxied by inequality. We test our premises with panel data for Spain. Results show that polarization has a detrimental effect on health. We also find that the way the relevant population subgroups are defined is important: polarization is only significant if measured between education-age groups for each region. Regional polarization is not significant. Our results are obtained conditional on a comprehensive set of controls, including absolute and relative income.

A primary goal of nutrition research is to optimize health and prevent or delay disease. Biomarkers to quantify health optimization are needed since many if not most biomarkers are developed for diseases. Quantifying "normal homeostasis" and developing validated biomarkers are formidable tasks because of the robustness of homeostasis and of inter-individual diversity. In this paper, we discuss the science, strategies, and technologies for measuring parameters that define individual health. The following concepts are central to define the physiology of the healthy individual: (i) responses to a challenge of homeostasis will be more informative than static homeostatic measures; (ii) processes involved in maintaining homeostasis usually are multi-factorial and require quantitative analyses of the many individual components involved; (iii) health includes a large variation in "normality" and the effects of nutritional interventions may remain hidden in this "diversity of robustness," if incompletely analyzed. Specifically, comprehensive multi-parameter ("omics") analysis may identify key parameters (biomarkers) and lead to a greater understanding of health supporting processes. Perturbation tests that accurately target aspects of the overarching drivers of health (metabolism, oxidation, inflammation, and psychological stress) may be instrumental in creating knowledge for maintaining health and preventing disease through nutrition. © 2009 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Objective: This paper presents the design of the Virtual Olympic Games Framework (VOGF), a computer application designated for athletics, health care, general well-being, nutrition and fitness, which offers multiple benefits for its participants. Background: A special interest in starting the design of the framework was in exploring how people can connect and participate together using existing computer technologies (i.e. gaming consoles, exercise equipment with computer interfaces, devices of measuring health, speed, force and distance and Web 2.0 applications). Method: A stationary bike set-up offering information to users about their individual health and athletic performances has been considered as a starting model. Conclusions: While this model is in the design stage, some preliminary findings are encouraging, suggesting the potential for various fields: sports, medicine, theories of learning, technologies and cybercultural studies. First, this framework would allow participants to perform a variety of sports and improve their health. Second, this would involve creating an online environment able to store health information and sport performances correlated with accessing multi-media data and research about performing sports. Third, participants could share experiences with other athletes, coaches and researchers. Fourth, this framework also provides support for the research community in their future investigations.

We use structural estimation techniques to analyse labour supply effects of changes in economic incentives for individuals who have just finished vocational rehabilitation in Norway. The complicated and sometimes non-convex budget sets for this group of marginal workers are accounted for. We also focus on the limitation in the choice sets this group faces. Parametric bootstrap and simulation techniques are applied to construct confidence intervals for the predicted impacts of changes in the economic environment. The results show that there is a small to moderate effect of changes in economic incentives on the chance of vocational rehabilitation bringing individuals back to employment. We also find that individual health status and local labour market conditions are the most important factors affecting the transition from rehabilitation to work.

Summary 1Comparative studies of ageing address the evolutionary lability of the rate of ageing as an indication of potential for, and constraints on, the extension of life span. 2Experimental studies on ageing have focused on damage induced by reactive oxygen species (ROS) and other stresses, and on the mechanisms to prevent or repair this damage. Research on animal models has revealed genes with large effects on life span. However, the relevance of some animal models to human ageing is unclear and it is not known whether evolved differences in ageing involve such major gene effects. 3Studies on the demography of populations of vertebrates in the wild show that animals suffer from senescence in nature. Variation in the rate of ageing is consistent with evolutionary theory in that senescence is delayed in populations that suffer relatively low extrinsic mortality. 4Populations of longer-lived individuals suffer a higher proportion of ageing-related mortality, and thus stronger selection against early ageing. The presence of ageing-related deaths in these populations suggests a lack of suitable mechanisms that would further extend life span. 5Similar patterns of ageing-related mortality in wild and captive or domesticated populations indicate that most ageing-related death is caused by intrinsic factors, such as tumours and cardiovascular failure, rather than increasing vulnerability to extrinsic causes of mortality. 6Studies of several wild populations of long-lived birds suggest that ageing-related mortality is often catastrophic, with individuals maintaining high levels of condition until shortly before their demise. 7Comparative studies of many species suggest connections between early development and the pattern of ageing later in life, consistent with laboratory studies on variation within individual species. The physiological connections across the life span are not well understood. 8Comparative studies have provided important insights into the ageing process. However, we still lack information on important issues, including the causes of death in natural populations, the relationship of within- and between-population variation in the rate of ageing, the genetic basis of variation in rate of ageing in natural populations, and detailed longitudinal studies of individual health and reproductive success in relation to age at death.

Patients with type 2 diabetes experience hypoglycaemia less frequently than those with type 1 diabetes. Some protection against hypoglycaemia is afforded by the relatively intact glucose counter-regulatory pathways that characterize the pathophysiology of early type 2 diabetes. To some extent, this protection explains why hypoglycaemic episodes in intensively treated individuals with type 2 diabetes, when they occur, are rarely severe. As diabetes progresses and therapy intensifies to achieve recommended glycaemic goals, hypoglycaemia frequency and severity increase. Thus, when it comes to instituting intensive therapy, fear of hypoglycaemia may contribute to health-care providers' 'clinical inertia'. Because maintaining glycaemic control is so important to both public and individual health, many new therapies and technologies have been developed. This manuscript reviews and considers whether these advancements in therapy make glycaemic goals easier to achieve by minimizing hypoglycaemia. Putting the hypoglycaemia experienced by type 2 diabetes patients into appropriate clinical perspective, the impact of recent progress made in pharmacotherapy, drug delivery systems, and BG monitoring on hypoglycaemia incidence is largely positive. The extent to which this progress can effect improvement over traditional therapies will, however, depend upon patient (and provider) education, motivation and behaviour change.

Background: The current study extends the use of linear enamel hypoplasia (LEH) to examine the historical changes in living conditions encountered by Aboriginal people at Yuendumu who were born between 1890 and 1960. LEH provides health information beyond written records and gives insight into the relationship between individual health and living conditions during initial and ongoing contact with Europeans. Materials and Methods: The dental casts of 446 people, collected as part of the University of Adelaide longitudinal study of growth and development, were recorded for the presence of hypoplastic defects. Defects were recorded according to the Development Defects of the Enamel (DDE) standards and assigned to developmental units based on their crown position. Results: The frequency of LEH on the permanent dentitions increased five-fold from the 1890-1929 birth cohort to the 1955-1960 cohort. LEH also affected earlier developing enamel units. Deciduous defects did not show a strong temporal trend but overall prevalence was comparable to other disadvantaged groups. Conclusion: The changes in permanent LEH frequency and age distribution correspond to altered living conditions with the worst hypoplasia recorded after settlement of Aboriginal people at Yuendumu. Prior to that period LEH was comparable to precontact Australian populations indicating that resettlement had a dramatic impact on childhood morbidity.

The term "plastic surgeon" is oddly uninformative, although it seems likely that most people know what plastic surgeons do. How well can a sample of individuals encountered on the street describe what geriatricians do? To answer this question, we strolled through downtown Baltimore's Inner Harbor, armed with a video camera and picture identification cards to ask the following question: "What is a geriatrician?" Two of us (PA, JY), from the Johns Hopkins Division of Geriatric Medicine and Gerontology, surveyed a convenience sample of people aged 18-80. To further enhance this survey, a video of the interviews was produced (available in online version of article). We entered this exercise having recently joined the ranks of geriatricians-prepared to improve the health and quality of care of our elderly patients. Our naive excitement at entering this noble specialty was trampled by the reality that virtually no one we interviewed knew what a geriatrician was. Answers like, "somebody who works for Ben and Jerry's ice cream" were amusing but at the same time typical and sobering. This simple survey reveals a distressing gap in the public's knowledge of the field of geriatrics and the need for better understanding of its importance to public health and individual health. After all, if people do not know what a geriatrician is, how can they support the growth of geriatrics or seek care from us?

The aim of this study was to deepen understanding of the relationship between autonomy and integrity in interactions between patients and individual health care workers in real-life care situations.The data reported here are from a 6- and 12-month follow-up of the teaching of ethics to health care professionals working with older people. The data collection method used was participant observation. Health professionals' caring behaviour in everyday situations was observed from the point of view of patients' autonomy and integrity. Theoretical frameworks relating to autonomy and integrity were used to analyse the data.The structural framework was useful for identifying the two concepts and their relationship in everyday situations. The data suggest that the two concepts are ethically complex. Autonomy is grounded in respect for patients' ability to choose, decide and take responsibility for their own lives. Autonomy varies within and between individuals and is dependent on context and on those involved. It stresses the intrinsic value of patients, which marks their worth independently of others. Integrity, however, is bound to patients' very existence, no matter what their physical and mental conditions, and must be respected regardless of their ability to act autonomously.The concepts of autonomy and integrity appear to presuppose one another and to be indivisible if older adult patients' dignity is to be maintained. This implies that when patients' autonomy is supported their integrity is protected and, consequently, their dignity upheld.

Background Epilepsy is a common medical condition affecting many children in mainstream education. The practice of local secondary schools and the health service with regard to pupils with epilepsy was examined. The extent to which these children had activities at schools restricted and the schools’ perception of the health service with regard to epilepsy was explored. Method A structured interview was conducted with selected staff members from mainstream secondary schools in East Midlands region, UK. Results Fourteen out of 17 schools participated. Fifty-seven children were identified from a total pupil population of 14 534. Seven schools used the DOH/DfEE (The Department of Health/Department for Education and Employment) ‘Supporting Pupils with Medical Needs’ publication as a resource. No schools created individual health care plans for children with epilepsy. Six out of seven schools reported appropriate provision for children during swimming activities. The commonest restriction was related to computer use. Nine schools stated a need for more training for staff members with regard to seizure management. Conclusions Schools rely heavily on obtaining medical information from non-medical sources. Individual health care plans for children with epilepsy are not commonly undertaken. Few children had any restriction or special provision placed upon them because of their epilepsy except in the area of computer use. Further action is needed to consider how the system for providing for such children can be improved so that each child's individual health needs can be satisfactorily met.

This study investigated how parents' preferred level of control in treatment decision-making is related to their personal health care involvement and to their decision to use complementary therapies (CTs) for their child. One hundred-eighteen parents of pediatric oncology patients completed an anonymous CT survey. The Krantz Health Opinion Survey (KHOS) was used to determine parents' preferred involvement in personal health care, and the Control Preferences Scale for Pediatrics (CPS-P) measured preferred role in pediatric treatment decision-making. Unlike previous studies of adult cancer patients, most parents preferred active or collaborative decision-making. The KHOS and CPS-P were significantly correlated, indicating that parents' preferred role in children's treatment decisions was related to their own personal health care involvement. Forty-six percent of parents used CTs for their child, and 33% began using a new CT after diagnosis. The hypothesized relationship between CT use and parents' own health care involvement was partially supported. Preference for control in decision-making was not associated with CT use. These findings provide validation for the newly developed CPS-P and indicate that parents' decisions to use CT for their child are related in part to individual health care preferences.

In this paper we address the importance of distributive preferences in the social valuation of quality-adjusted life years (QALYs). We propose a social welfare function that generalises the functions traditionally used in the health economic literature. The novelty is that, depending on the individual health gains, this function can represent either preferences for concentrating or preferences for spreading total gain or both together, an issue which has not been addressed until now. Based on an experiment, we observe that this generalisation provides a suitable approximation to the sampled social preferences. Copyright © 2001 John Wiley & Sons, Ltd.

Serial anthropometric data were obtained during the first year of life of six nursery-reared infant gorillas in the Columbus (Ohio) Zoo. Two of the infants are likely to be monozygotic twins as determined by DNA analysis. Growth curves were fitted to serial measures of cephalo-thoracic-abdominal length, arm length, leg length, head circumference, upper arm circumference, and weight from each gorilla, to describe individual patterns of variation in skeletal growth and body composition. Growth in skeletal measures tended to be curvilinear to varying degrees over the first year of life. Body composition varied more than skeletal measures throughout the first year as a consequence of individual health status. Individual growth and body composition variations appear to reflect both genetic and environmental influences in this small sample of captive infant gorillas.

Objectives. In the present study we investigate the relevance of the monitoring-blunting concept to the realm of health behaviour, and to health promotion and disease detection behaviour in particular. Design. The study is correlational in character, supplemented with some qualitative data. Methods. Sixty participants of varying sex, age and educational level filled out the Threatening Medical Situations Inventory, measuring the monitoring and blunting coping style, and the newly developed Health Promotion-Detection Questionnaire, intended to measure the tendencies to exhibit health promotion and disease detection behaviours. In addition, they answered a few open questions concerning their health. Results. It emerged that disease detection behaviour is positively related to age, and it is more often carried out for health reasons than health promotion behaviour. The monitoring coping style is significantly, though modestly, related to both health promotion and disease detection. The latter relation still holds when we controlled for age and gender. No relations with blunting were found, except for individual health behaviours. Conclusion. The results of the present study encourage further investigation of the role of coping styles in the performance of different types of health behaviours. Hereby, the further distinction between health strivings of the approach and the avoidance type may prove useful.