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PurposeLean has shifted over the years from a set of tools to implement to a human-centric approach concerning both hard and soft factors. However, there is a limited research on these soft factors and how they influence companies performance and social outcomes on the one hand and how they enable the hard factors on the other hand. Taking this as a valuable opportunity, the purpose of this paper is to present the key motivating factors and key gaps in the literature as an agenda for future research.Design/methodology/approachA systematic methodology to identifying the literature on social outcomes and factors in Lean is presented. Web of Science, EBSCO, Emerald, Science Direct, Google Scholar and the top journals were searched, and 158 papers were identified.FindingsThe systematic review helped the authors to identify the evolution, current trends, research gaps and an agenda for future research for exploring social outcomes in Lean and the factors mediating them. These factors are grouped and presented.Practical implicationsThe implications of this work include understanding for managers and professionals how both soft and hard factors in Lean are related and that for a sustainable implementation, the whole system must be observed. This work could serve as a valuable resource that depending on the execution of Lean, either positive outcomes will emerge or even negative outcomes, referred to as “The Dark Side”.Originality/valueThis paper presents an extended survey on the factors in Lean mediating both companies’ performance and social outcomes. The authors also believe that this is possibly the most comprehensive systematic literature review on the topic and will set the foundation for various research avenues based on the key findings of this study.

It is critical to ensure climate and energy policies are just, equitable and beneficial for communities, both to sustain public support for decarbonisation and address multifaceted societal challenges. Our objective in this article is to examine the diverse social outcomes that have resulted from climate policies, in varying contexts worldwide, over the past few decades. We review 203 ex-post climate policy assessments that analyse social outcomes in the literature. We systematically and comprehensively map out this work, identifying articles on carbon, energy and transport taxes, feed-in-tariffs, subsidies, direct procurement policies, large renewable deployment projects, and other regulatory and market-based interventions. We code each article in terms of their studied social outcomes and effects, with a focus on electricity access, energy affordability, community cohesion, employment, distributional and equity issues, livelihoods and poverty, procedural justice, subjective well-being and drudgery. Our analysis finds that climate and energy policies often fall short of delivering positive social outcomes. Nonetheless, across country contexts and policy types there are manifold examples of climate policymaking that does deliver on both social and climate goals. This requires attending to distributive and procedural justice in policy design, and making use of appropriate mechanisms to ensure that policy costs and benefits are fairly shared. We emphasize the need to further advance ex-post policy assessments and learn about what policies work for a just transition.

Social Impact Bonds (SIBs) have emerged in recent years as outcome‐based public‐private partnerships (PPP) for the delivery of welfare services, where the payment to the private operator is linked to the achievement of superior social impact. Since the traditional infrastructure‐based PPP approach seems to have failed to achieve higher level of efficiency and, above all, effectiveness, this paper discusses the extent to which the SIB model can represent a reference point to innovate the PPP model by introducing more focus on outcome achievement and social value generation.

PURPOSE: This study focused on self-perceived mate value of young adult survivors of childhood cancer relative to healthy peers. Qualitative studies indicate potential problems surrounding romantic relationships among survivors, but systematic studies are missing.METHODS: One-hundred forty-nine childhood cancer survivors and 149 matched controls completed online questionnaires about their mate value, social comparison strategies (i.e., upward/downward identifying/contrasting strategies), and marital status. Survivors and controls were aged 20-40 (M = 27.8), 55% were female, and survivors had been treated for brain tumors (n = 52; 35%), leukemia (n = 42; 28%), lymphoma (n = 31; 21%), or other solid tumors (n = 24; 16%) at 5-33 years before study participation.RESULTS: Survivors and controls did not differ on overall mate value, but on individual characteristics: Survivors thought they had a better sense of humor (d = 0.36), were more loyal (d = 0.32), had higher social status (d = 0.26), and were more ambitious (d = 0.19), while also considering themselves less sexually adventurous (d = 0.31), less healthy (d = 0.26), having less desire to have children (d = 0.21), and a less attractive face (d = 0.20). Higher mate value was related to being partnered, more upward-identifying, less upward-contrasting, and less downward-identifying strategies. Moreover, less downward-identifying was associated with higher mate value in survivors, but not controls; whereas greater downward-contrasting was associated with higher mate value among controls only (R(2) = 30.8%).CONCLUSIONS: Survivors do not generally view themselves as less valuable (potential) romantic partners, but they evaluate different characteristics either more positively or more negatively. Social comparison strategies offer targetable points of interventions to intervene on negative self-evaluations, potentially enhancing well-being.

Purpose The purpose of this paper is to identify the most influential determinants of healthcare employees’ problem-solving capabilities and attitudes towards kaizen initiatives, and clarify how these determinants are related to social outcomes. Design/methodology/approach Drawing on the input-process-outcome framework, applied to kaizen initiatives, the determinants of the input and process factors are embodied in hypotheses concerning the direct effects of input and process factors on social outcomes and the indirect effects of input factors on social outcomes resulting from process factors. The hypotheses are tested through multiple regressions using data from 105 kaizen initiatives drawn from two hospitals. Findings Of the 14 determinants investigated, goal clarity, team autonomy, management support, goal difficulty and affective commitment to change (ACC) are the most influential determinants of kaizen capabilities and/or employees’ attitude. Goal clarity, goal difficulty, team autonomy and management support are also found to influence social outcomes directly and/or indirectly through ACC, internal processes and/or an action orientation. Practical implications The results support healthcare practitioners to understand how to establish “focused kaizen” actions to leverage specific determinants that positively influence social outcomes. Originality/value This study provides an original contribution to the literature concerning effective kaizen initiatives in healthcare operations by empirically testing a comprehensive model of the relationship between kaizen initiative determinants and social outcomes. Unlike previous studies, which are mostly anecdotal or focused on one or few determinants, this research adopts a holistic view, and investigates a pluralist set of determinants on social outcomes through a systematic and quantitative approach.

Summary There is increasing need to understand patient outcomes in osteoporosis. This article discusses that fracture in osteoporosis can lead to a cycle of impairment, driven by complex psychosocial factors, having a profound impact on physical function/activity which accumulates over time. More information is required on how treatments impact physical function. Introduction There is increasing need to understand patient-centred outcomes in osteoporosis (OP) clinical research and management. This multi-method paper provides insight on the effect of OP on patients’ physical function and everyday activity. Methods Data were collected from three sources: (1) targeted literature review on OP and physical function, conducted in MEDLINE, Embase and PsycINFO; (2) secondary thematic analysis of transcripts from patient interviews, conducted to develop a patient-reported outcome instrument. Transcripts were re-coded to focus on OP impact on daily activities and physical function for those with and without fracture history; and (3) discussions of the literature review and secondary qualitative analysis results with three clinical experts to review and interpret the importance and implications of the findings. Results Results suggest that OP, particularly with fracture, can have profound impacts on physical function/activity. These impacts accumulate over time through a cycle of impairment, as fracture leads to longer term detriments in physical function, including loss of muscle, activity avoidance and reduced physical capacity, which in turn leads to greater risk of fracture and potential for further physical restrictions. The cycle of impairment is complex, as other physical, psychosocial and treatment-related factors, such as comorbidities, fears and beliefs about physical activity and fracture risk influence physical function and everyday activity. Conclusion More information on how treatments impact physical function would benefit healthcare professionals and persons with OP in making treatment decisions and improving treatment compliance/persistence, as these impacts may be more salient to patients than fracture incidence. Electronic supplementary material The online version of this article (doi:10.1007/s00198-017-3911-9) contains supplementary material, which is available to authorized users.

BACKGROUNDRisk factors for impairment in psychosexual development and satisfaction among adult survivors of childhood cancer are poorly understood. The authors compared psychosexual outcomes between survivors and healthy controls, and tested whether at-risk survivors can be identified by 1) treatment neurotoxicity or 2) diagnosis.METHODSA total of 144 young adult survivors of childhood cancer and 144 matched controls completed questionnaires regarding psychosexual development, sexual satisfaction, and satisfaction with relationship status. Survivors were aged 20 to 40 years and were 5 to 34 years after diagnosis. Using medical chart data, survivors were divided into non-neurotoxic (48 survivors), low-dose (36 survivors), and high-dose (58 survivors) neurotoxic treatment groups.RESULTSApart from having fewer lifetime sex partners, survivors did not appear to differ from controls. However, survivors of brain tumors and any survivor who received high-dose neurotoxic treatment reported the lowest rates of achieving milestones of psychosexual development, whereas sexual and relationship status satisfaction were found to be related to relationship status. Neurotoxic treatment intensity further distinguished between survivors of brain tumors with and without psychosexual impairment.CONCLUSIONSThe intensity of neurotoxic treatment may be a valuable indicator of risk for psychosexual impairment relative to diagnosis alone. Health care providers should assess romantic/sexual problems among survivors at risk and make referrals if needed. Cancer 2017;123:1869-1876. (c) 2017 American Cancer Society.The results of the current study indicate that adult survivors of childhood cancer do not differ from healthy controls with regard to their psychosexual development, sexual satisfaction, and relationship status satisfaction. However, more intense neurotoxic treatment appears to be associated with a higher risk of psychosexual impairment, and may be a more meaningful risk indicator than diagnostic category alone.

Background Children with cancer experience impaired cardiorespiratory fitness and physical function during and after treatment restricting their possibilities to engage in social activities including sport, leisure activities, and school. The objectives were to determine the effects of classmate-supported, controlled, supervised, in-hospital, physical activity program to preserve cardiorespiratory fitness and physical function from time of diagnosis in children with cancer. Methods National non-randomized controlled trial including schoolchildren aged 6–18 years at diagnosis treated with chemo-/radiotherapy. We included 120 of 128 eligible patients (94%) in the intervention group (62.5% boys, 11.2 ± 3.1 years) from East Denmark and 58 patients in the control group (57% boys, 11.0 ± 3.2 years) from West Denmark. Eight children from the control group withdrew from participation. The groups were comparable in anthropometrics and cancer diagnoses (p > 0.05). The intervention consisted of (i) supervised in-hospital physical activity from diagnosis and throughout intensive treatment, (ii) 90-min general educational session on cancer and therapy in the child’s school class, and (iii) selection of two classmates as ambassadors who took turns to support the child’s physical training during the daytime. The primary outcome was cardiorespiratory fitness (VO2peak, mL/min/kg) at 6 months after diagnosis (sex, age, diagnosis adjusted). Secondary outcomes were sit-to-stand, timed-up-and-go, handgrip strength, and balance test scores. Results Ambassadors were identified for all, and 2542 individual and 621 group training sessions were held. VO2peak deteriorated over time in the control group (− 0.17 [95% CI − 0.32 to − 0.02] per week, p = 0.02), but not in the intervention group (p = 0.14). At 6 months from diagnosis, VO2peak was higher in the intervention group (29.6 ± 5.6 mL/kg/min) than in the control group (22.1 ± 5.6 mL/kg/min) (p = 0.01), and the intervention group had a better physical function at 3 and 6 months (p Conclusions Peer-supported, supervised, in-hospital, physical activity is safe and feasible in children with cancer during treatment. Further, the results suggest that the intervention might mitigate impairments in cardiorespiratory fitness during treatment in children with cancer. Trial registration The study was prospectively registered on the 11 January 2013. Clinicaltrial.gov NCT01772849 and NCT01772862.

Background: After many years of legal struggles for the legalisation of recreational use of cannabis, the Constitutional Court of South Africa ruled in favour of the applicants in September 2018. Although the ruling issued caution regarding the social challenges accompanying this legalisation, it did not address how the country would deal with the societal consequences of this ruling. Aim: The aim of this article was to discuss the social and public health implications of the legalisation of recreational cannabis on South Africa. Methods: Literature review on the social, health and legal impacts of legalisation of cannabis, considering experiences of other countries that have legalised cannabis. Results: The legalisation brings a range of significant negative consequences, which include an expected increase in the number of users and the subsequent undesirable effects on the physical, mental and social health of communities. Conclusion: In terms of financial, infrastructural and human resources, South Africa cannot afford the consequences of the legalisation of recreational cannabis. Poor communities, children and the youth will carry the brunt of the scourge of cannabis use.

Objective Patients often undertake epilepsy surgery with the expectation that it will lead to improvements in their social situation. Short‐ to medium‐term research consistently points toward improvements in social outcomes; however, no study has mapped out postsurgical social timelines, particularly for longer‐term (>15 years) outcomes. Methods We recruited 39 patients who had undergone anterior temporal lobectomy (ATL) for drug‐resistant temporal lobe epilepsy (TLE) between 1994 and 2002. The cohort (24 females) had a median age of 49 years (range 38‐67), age of habitual seizure onset was 9.5 years (range 0.5‐29 years), and age at surgery was 31 years (range 20‐53). Patients were followed up for a median of 18.4 years postsurgery (IQR = 4.4). Using data obtained from semistructured interviews, we conducted a comprehensive qualitative analysis of patients' self‐reported postsurgical social trajectories. Self‐report questionnaires were used to assess mood and health‐related quality of life (HRQOL) at the time of interview. Results There was a common sequence of social milestone achievement, spanning 20 years postsurgery. Typically, patients first (re)gained their license, then attempted educational and vocational gains, followed by establishing long‐term relationships and finally a family unit. Rare, intermittent seizures postsurgery did not appear to have detrimental effects on social trajectories. Those who experienced a reduction in seizures showed increased likelihood of attaining social milestones compared to those with ongoing seizures. Significance Achieving social milestones after epilepsy surgery may take considerably longer than patients are expecting prior to surgery. The pattern of social milestone outcome resembled a process of psychosocial development. These findings have important implications for presurgical counseling and postsurgical rehabilitation.

Despite the increasing emphasis placed on knowledge management (KM) by the business sector and the common belief that creating, acquiring, sharing, and the use of knowledge enable individuals, teams, and communities to achieve superior performance, within the healthcare context, there is still room from improvements from both the theoretical and empirical perspectives. The purpose of this paper is to outline the contribution of KM process to the social- and economic-related outcomes in the context of health organizations. Given the theoretical approach on the considered concepts and their relationships, a conceptual model and seven research hypotheses were proposed. The empirical data were provided by a cross-sectional investigation including 459 medical and nonmedical employees of Romanian heath organizations, selected by a mixed method sampling procedure. A partial least squares structural equation modeling (PLS-SEM) approach was selected to provide information on the relevance and significance of the first- and second-order constructs, test the hypotheses, and conduct an importance performance matrix analysis. The PLS-SEM estimation showed positive and significant relationships between KM process and quality of healthcare, and organizational-level social and economic outcomes. Moreover, the research results provided evidences for the complex complementary mediation of the quality of healthcare and social-related outcomes on the relationships between KM process and social and economic outcomes. The theoretical and managerial implications are discussed and suggestions for future research are provided at the end of the paper.

Objective Our objective was to explore the association of childhood onset epilepsy (COE) and clinical factors on marital status and fertility in adulthood. Methods We identified a population-based cohort of 307 individuals with COE treated in the Tampere University Hospital district with an inception date of December 31, 1992. A matched reference cohort of 1244 individuals without COE was established as a random sample of the population in the study area through the Population Register Center (PRC). The PRC also provided data on marriages and offspring up to 2018. Fertility and marriage analysis was done by calculating the time until first child and marriage. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated with Cox regression for follow-up spanning up to January 2018. Results Patients with COE had lower fertility rates (32.2% vs 57.3% any offspring, HR = 0.47, 95% CI = 0.38-0.58) and fewer marriages (28.3% vs 49.7% ever married, HR = 0.49, 95% CI = 0.39-0.61) than the referents without COE during 25-year follow-up. The largest impact was in patients with COE who had any disability (10.1% any offspring, HR = 0.20, 95% CI = 0.10-0.41; 6.5% ever married, HR = 0.11, 95% CI = 0.06-0.21), symptomatic etiology of epilepsy (13.1%, HR = 0.18, 95% CI = 0.11-0.31; 12.1%, HR = 0.21, 95% CI = 0.12-0.36), onset of epilepsy before 2 years of age (HR = 0.20, 95% CI = 0.12-0.31; HR = 0.29, 95% CI = 0.18-0.46), and high seizure frequency after start of treatment (HR = 0.13, 95% CI = 0.06-0.28; HR = 0.20, 95% CI = 0.10-0.41). Patients with COE without any disabilities had only slightly lowered fertility (HR = 0.76, 95% CI = 0.61-0.95) and a nonsignificant reduction in marriages (HR = 0.80, 95% CI = 0.64-1.02). Significance COE was associated with a lower chance of finding a partner at adulthood and having fewer children. The extent of such effect varied between patient subgroups.

Objective The impact of childhood differentiated thyroid carcinoma (DTC) on psychosocial development has not yet been studied. The aim of this study was to evaluate the achievement of psychosocial developmental milestones in long-term survivors of childhood DTC. Design and methods Survivors of childhood DTC diagnosed between 1970 and 2013 were included. Reasons for exclusion were age 35 years at follow-up, a follow-up period n = 30). A comparison group non-affected with cancer (n = 508) and other childhood cancer survivors (CCS) were also used to compare psychosocial development. To assess the achievement of psychosocial milestones (social, autonomy and psychosexual development), the course of life questionnaire (CoLQ) was used. Results We included 39 survivors of childhood DTC (response rate 83.0%, mean age at diagnosis 15.6 years, and mean age at evaluation 26.1 years). CoLQ scores did not significantly differ between survivors of childhood DTC and the two non-affected groups. CoLQ scores of childhood DTC survivors were compared to scores of other CCS diagnosed at similar ages (n = 76). DTC survivors scored significantly higher on social development than other CCS, but scores were similar on autonomy and psychosexual developmental scales. Conclusions Survivors of childhood DTC showed similar development on social, autonomy, and psychosexual domains compared to non-affected individuals. Social development was slightly more favorable in DTC survivors than in other CCS, but was similar on autonomy and psychosexual domains.

Bente Arboe,1,2 Maja Halgren Olsen,2 Jette Soenderskov Goerloev,1 Anne Katrine Duun-Henriksen,2 Christoffer Johansen,2,3 Susanne Oksbjerg Dalton,2 Peter de Nully Brown1 1Department of Hematology, Copenhagen University Hospital, Rigshospitalet, 2Unit of Survivorship Research, The Danish Cancer Society Research Center, 3Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark Background: Autologous stem cell transplantation (ASCT) is the standard treatment for patients with relapsed diffuse large B-cell lymphoma (DLBCL) or transformed indolent lymphoma (TIL). The treatment is mainly considered for younger patients still available for the work market. In this study, social outcomes after ASCT in terms of return to work (RTW) are described.Patients and methods: Information from national administrative registers was combined with clinical information on patients, who received ASCT for relapse of DLBCL or TIL between 2000 and 2012. A total of 164 patients were followed until RTW, disability or old-age pension, death, or December 31, 2015, whichever came first. A total of 205 patients were followed with disability pension as the event of interest. Cox models were used to determine cause-specific hazards. Results: During follow-up, 82 (50%) patients returned to work. The rate of returning to work in the first year following ASCT was decreased for patients being on sick leave at the time of relapse (hazard ratio [HR] 0.3 [0.2;0.5]) and increased for patients aged ≥55 years (HR 1.9 [1.1;3.3]). In all, 56 (27%) patients were granted disability pension. Being on sick leave at the time of relapse was positively associated with receiving a disability pension in the first 2 years after ASCT (HR 3.7 [1.8;7.7]). Conclusion: Patients on sick leave at the time of relapse have a poorer prognosis regarding RTW and have a higher rate of disability pension. Furthermore, patients >55 are more likely to RTW compared to younger patients. These results indicate an unmet need for focused social rehabilitation. Keywords: social outcomes, chemotherapy, relapse treatment, disability pension, epidemiology

Corporate social responsibility has been seen by corporations as a practice to adopt as an act of philanthropy. There have been attempts to expand the role of social responsibility to business problems however there has never been an attempt to consider the strategic alignment of social outcomes to strategy. This article analyses the role of strategy by providing a review of strategy using Whittington's generic strategies model and expanding the same model to incorporate a social strategy model that supports the anecdotal idea that social responsibility can be potentially strategic. The paper centres its argument within the Indian context.

Social outcomes, in particular intangible social outcomes, are generally difficult to achieve in the construction industry due to the predominantly episodic, fragmented and heavily regulated nature of construction that presupposes a tendency towards mainstream construction processes and design. The Western Australian ‘Percent for Art’ policy is recognized for stimulating social outcomes, by creating richer and more aesthetically pleasing social environments through the incorporation of artwork into public buildings. A case study of four Percent for Art projects highlights the role of the Artwork Selection Committee in incorporating artwork into construction. A total of 20 semi-structured interviews were conducted with committee members and policy officers. Data analysis involved a combination of pattern coding and matrix categorization, and resulted in the identification of the committee’s three key elements of collaborative communication, democratic decision-making and project champions. The findings suggest these key elements foster the interaction, communication and relationships needed to facilitate feedback, enhance relationships, create cross-functional teams and lower project resistance, which are all necessary to overcome constraints to social outcomes in construction. The findings provide greater insight into the mechanisms for achieving social outcomes and a basis for future discussion about the processes for achieving social outcomes in the construction industry.

The purpose of this paper is to understand the transition from technological innovation to social innovation by analysing insights from the biomedical context. Specifically, the study investigates how entrepreneurs manage such a transition focusing on their motivations and awareness about social innovation. The study adopts a qualitative approach, in the form of multiple case studies of Italian firms that produce and use 3D printing in the biomedical field. Data was collected through in-depth interviews with entrepreneurs, backed by available documentary evidence and observation. This study points to the need for further investigation providing researchers with new information about the transition from technology innovation to social innovation. The transition has been studied from an exploratory perspective, considering 3D printing as a recent phenomenon in the biomedical field. Main results refer to social benefits resulting from the transition of technological innovation to social innovation, particularly focusing on the origin of such a transition.

Importance Identifying associations between preschool-aged children’s electronic media use and their later well-being is essential to supporting positive long-term outcomes. Objective To investigate possible dose-response associations of young children’s electronic media use with their later well-being. Design, Setting, and Participants The IDEFICS (Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants) study is a prospective cohort study with an intervention component. Data were collected at baseline from September 1, 2007, through June 30, 2008, and at follow-up from September 1, 2009, through May 31, 2010, in 8 European countries participating in the IDEFICS study. This investigation is based on 3604 children aged 2 to 6 years who participated in the longitudinal component of the IDEFICS study only and not in the intervention. Exposure Early childhood electronic media use. Main Outcomes and Measures The following 6 indicators of well-being from 2 validated instruments were used as outcomes at follow-up: Peer problems and Emotional problems subscales from the Strengths and Difficulties Questionnaire and Emotional well-being, Self-esteem, Family functioning, and Social networks subscales from the KINDLR (Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents–Revised Version). Each scale was dichotomized to identify those children at risk for poorer outcomes. Indicators of electronic media use (weekday and weekend television and electronic game [e-game]/computer use) from baseline were used as predictors. Results Associations varied between boys and girls; however, associations suggested that increased levels of electronic media use predicted poorer well-being outcomes. Television viewing on weekdays or weekends was more consistently associated with poorer outcomes than e-game/computer use. Across associations, the likelihood of adverse outcomes in children ranged from a 1.2- to 2.0-fold increase for emotional problems and poorer family functioning for each additional hour of television viewing or e-game/computer use depending on the outcome examined. Conclusions and Relevance Higher levels of early childhood electronic media use are associated with children being at risk for poorer outcomes with some indicators of well-being. Further research is required to identify potential mechanisms. Adverse health outcomes of sedentary behavior, which is characterized by a low energy expenditure while in a sitting or reclining posture,1 are increasingly acknowledged in children and adolescents.2- 4 A growing body of evidence suggests that sedentary behaviors may be detrimental even at a very young age.5 Electronic media use incorporating television viewing and use of computers and electronic games (e-games) is one type of sedentary behavior. Evidence suggests that electronic media use (mainly in the form of television viewing, which is the most widely studied electronic media behavior) may be particularly detrimental to health outcomes during childhood and into adulthood.2,6 Psychological and social well-being (hereinafter referred to as well-being) as a potential outcome of young children’s contemporary lifestyle behaviors, particularly electronic media use, is not well investigated. A clear definition of well-being in the health behavior literature that reflects the multidimensional nature of this concept is lacking.7 Nonetheless, well-being can be reasonably conceptualized as constituting positive and adverse psychological and social attributes and behaviors, such as emotional symptoms, prosocial behavior, self-control, and externalizing problems. Poorer levels of well-being during early childhood are associated with later outcomes, such as depression and hostile and aggressive behavior.8- 10 Conversely, good levels of well-being during early childhood may support positive behavioral, social, and academic outcomes during later childhood.11,12 Some evidence suggests that higher levels of electronic media use may be detrimental to well-being during early childhood.5 However, the evidence supporting these associations is extremely limited and largely inconclusive. A particular dearth of information on dose-response associations of electronic media use with well-being exists,5 and this information is necessary to inform targets for interventions, public health programs, and policy. Longitudinal studies are needed to identify such associations from early childhood to later childhood. The aim of this study was to investigate possible dose-response associations of young children’s electronic media use with their well-being 2 years later.

Of the many of Information and Communication Technology (ICT) products, electronic games are considered as having great potential for improving health and social outcomes. This chapter considers the factors that may be involved in facilitating health and social outcomes and also those factors that might be considered risk factors by reviewing studies that have shown both positive and detrimental effects on people’s physical and mental health. The authors also debate some research questions that remain unanswered and suggest guidelines for practitioners, researchers, and game designers. This work was supported by the Portuguese Foundation of Science and Technology (FCT) under the grant PTDC/PSI-PSO/099985/2008.

Introduction: Contemporary HIV-related theory and policy emphasize the importance of addressing the social drivers of HIV risk and vulnerability for a long-term response. Consequently, increasing attention is being given to social and structural interventions, and to social outcomes of HIV interventions. Appropriate indicators for social outcomes are needed in order to institutionalize the commitment to addressing social outcomes. This paper critically assesses the current state of social indicators within international HIV/AIDS monitoring and evaluation frameworks. Methods: We analyzed the indicator frameworks of six international organizations involved in efforts to improve and synchronize the monitoring and evaluation of the HIV/AIDS response. Our analysis classifies the 328 unique indicators according to what they measure and assesses the degree to which they offer comprehensive measurement across three dimensions: domains of the social context, levels of change and organizational capacity. Results and discussion: The majority of indicators focus on individual-level (clinical and behavioural) interventions and outcomes, neglecting structural interventions, community interventions and social outcomes (e.g. stigma reduction; community capacity building; policy-maker sensitization). The main tool used to address social aspects of HIV/AIDS is the disaggregation of data by social group. This raises three main limitations. Indicator frameworks do not provide comprehensive coverage of the diverse social drivers of the epidemic, particularly neglecting criminalization, stigma, discrimination and gender norms. There is a dearth of indicators for evaluating the social impacts of HIV interventions. Indicators of organizational capacity focus on capacity to effectively deliver and manage clinical services, neglecting capacity to respond appropriately and sustainably to complex social contexts. Conclusions: Current indicator frameworks cannot adequately assess the social outcomes of HIV interventions. This limits knowledge about social drivers and inhibits the institutionalization of social approaches within the HIV/AIDS response. We conclude that indicator frameworks should expand to offer a more comprehensive range of social indicators for monitoring and evaluation and to include indicators of organizational capacity to tackle social drivers. While such expansion poses challenges for standardization and coordination, we argue that the complexity of interventions producing social outcomes necessitates capacity for flexibility and local tailoring in monitoring and evaluation.

Health-related quality of life (HRQoL) is increasingly recognized as a key outcome in both clinical and research settings in the pediatric population with end-stage renal disease (ESRD). This review aims to: (1) summarize the current knowledge on HRQoL and socioprofessional outcomes and (2) provide strategies for incorporation of HRQoL assessment into clinical practice. Studies report that pediatric patients with ESRD have significantly lower HRQoL scores compared with children with other chronic diseases. Patients treated by dialysis are at particularly high risk for impaired HRQoL. Furthermore, patients more often have impaired neurocognitive functioning and lower academic achievement. Important determinants of impaired HRQoL include medical factors (i.e., receiving dialysis, disabling comorbidities, cosmetic side effects, stunted growth), sociodemographic factors (i.e., female gender, non-Western background) and psychosocial factors (i.e., noneffective coping strategies). Contrary to the situation in childhood, adult survivors of pediatric ESRD report a normal mental HRQoL. Despite this subjective feeling of well-being, these patients have on average experienced significantly more difficulties in completing their education, developing intimate relationships, and securing employment. Several medical and psychosocial strategies may potentially improve HRQoL in children with ESRD. Regular assessment of HRQoL and neurocognitive functioning in order to identify areas in which therapies and interventions may be required should be part of standard clinical care.