In 1972, a British charity, Relaxation for Living, was established “to promote the teaching of physical relaxation, to combat stress, strain, anxiety and the tension of modern life, and to reduce fatigue”. This article explores the origins and development of “physical relaxation” techniques and ideologies, starting in the interwar period, and the development of practical, therapeutic, social and cultural frameworks necessary for such an organization to come into being in 1970s Britain. It traces how relaxation was reconstituted as a scientifically-based skill that could be learnt and taught, imbued with therapeutic value for combating and preventing specific physical ailments and enhancing individual health and wellbeing. The article explores how relaxation techniques gained currency among particular demographic and clinical groups, ranging from middle-class, child-bearing women to middle-aged, “coronary-prone” men. This analysis highlights the role that relaxation practitioners played in both creating and responding to demand for individualistic health-management strategies, many of which have shaped contemporary health and wellbeing agendas. This article is published as part of a collection entitled “On balance: lifestyle, mental health and wellbeing”. Annabel, “What a super idea. Where does one go to do that? … But of course, it was just a figure of speech. There was nowhere for him to learn to relax”. In response to this seemingly unmet need, Lloyd, who had been teaching relaxation within National Childbirth Trust (NCT) antenatal classes since 1959, set about to make these techniques more widely available. She established Relaxation for Living as a charity in 1972 “to promote the teaching of physical relaxation, to combat stress, strain, anxiety and the tension of modern life, and to reduce fatigue” —reminisced, her husband had suffered a heart attack in 1969 and was told by his doctor to relax. “We said”, recalled Lloyd in an interview for the women’s magazine fatigue” . UnderpiAs this article will demonstrate, this ideological framework had been established during the early decades of the twentieth century. It led to several fields, including antenatal care, physical education, speech therapy, psychotherapy, yoga and physiotherapy, all incorporating bodily relaxation techniques for therapeutic purposes. The article will highlight the role of key individuals responsible for developing and applying “neuro-muscular” or “physical” relaxation, and the broader medical and social changes and conditions that made possible the establishment of RforL in 1970s Britain. In doing so, it will bring together areas of medical history that have tended to be explored separately, such as women’s health and childbirth, heart disease and stress research, and preventive medicine. It will also draw out ways in which gender steered the differential uptake of therapeutic relaxation practice. With an emphasis on Britain from the interwar period until the early 1970s, it will complement recent scholarship on “stress”, mainly focussed on the United States ”, Lloyd remarked, “is always a matter of compromise and balance. These are not only philosophical concepts, they are physiological facts” : 1.This article will explore how relaxation became a principle strategy for achieving and maintaining “balanced”, healthy lives. It is divided into four sections. The first part outlines the development of “physical” relaxation practices in the interwar period, starting with the work of the Chicago physician Edmund Jacobson (1888–1983). It explains how relaxation ideology was appropriated in Britain, and applied therapeutically to help with specific ailments, nervous illness and for reducing tension in everyday living. The second section analyses the central area in which relaxation practices developed in Britain—for pre- and postnatal, mainly middle-class, women. It highlights the place of obstetrician Grantly Dick-Read (1890–1959) in relaxation history and the relaxation training that constituted and then grew out of antenatal class teaching. The third part explicates how relaxation was drawn into prevailing postwar concerns regarding heart-disease prevention and rehabilitation, particularly for middle-aged working men. The last section details the establishment of RforL as a charity in 1972 and the consolidation of relaxation as a therapy, prophylaxis, art, science, skill and way of life, intimately connected to good health and wellbeing.The methods of therapeutic relaxation taught in the 1970s by RforL were in the most part devised in the interwar years in both Britain and the United States—a period defined by evident and feared hardship and decline . With poThe Chicago physician and psychologist Edmund Jacobson was highly influential in establishing this therapeutic framework and practice. Working on the premise that one cannot be tense and relaxed at the same time, Jacobson devised an elaborate method of muscular relaxation that involved systematically recognizing and releasing all unnecessary bodily tension. “It is physically impossible to be nervous [or tense] in any part of your body, if in that part you are completely relaxed”, he declared : 43. JacPatients learnt his techniques of progressive and differential muscle relaxation through an intense teaching programme involving two or more hours instruction per week plus practise alone of one or two hours each day : 126. ReProgressive Relaxation: A Physiological and Clinical Investigation of Muscular States and their Significance in Psychology and Medical Practice  who, at a similar time, was developing “Autogenic Training”—a relaxation technique based on visualization methods with clear yogic influences . RelaxatIn interwar Britain, the teachings of both Jacobson and Call became influential. Frances Archer (1855–1926), wife of playwright William Archer (1856–1924), was largely responsible for introducing Call’s methods in the British context after learning relaxation exercises directly from her in Massachusetts. Before the First World War, Archer established a “Nerve Training Colony” in King’s Langley, Hertfordshire, where people could go to “recuperate from the hurly-burly of everyday life” . Many reRelaxation in Everyday Life, “intended primarily for the man in the street”, Boome and Richardson, warned readers that although they sought to avoid as far as possible “technical terms and polysyllabic elaborations”, therapeutic relaxation was “not a simple technique to learn”. It required much practice given that “modern civilization and the high speed of present-day living are leading us further and further from fundamental needs and realities” , originally set up in 1956 under the name of the Natural Childbirth Association  reproduced in Dick-Read died in 1959, and a tumultuous period followed for the organization. When Briance was temporarily living in the United States, NCT formally changed its allegiance towards the psychoprophylactic method of Fernand Lamaze (1891–1957), no longer privileging Dick-Read’s teachings. Briance, being fiercely loyal to Dick-Read whose ideology laid the foundation of NCT, was later pushed out of the organization.In the years following Dick-Read’s death, despite the reorientation towards Lamaze’s teachings, NCT instructors taught a far broader range of techniques and learnt from a wide range of approaches, many of which were imparted during regular “study days” for teachers. Lloyd succeeded in developing one of the strongest local branches of NCT, which enjoyed a fair amount of autonomy. She produced a branch newsletter, and established close connections with local medical professionals, in line with NCT’s general policy of working alongside, rather than against the medical establishment in this period : 105. HeBy the 1960s, a number of antenatal teachers, including Lloyd herself, were starting to extend relaxation teachings from the narrow context of childbirth to help women manage their wider experiences of motherhood. As another NCT founder member, Betty Parsons, summed up in her motto: “Relaxation for childbirth, relaxation for life!” . In BirmRelaxation teachings also became available to women through yoga as it spread to the West in the postwar decades. As yoga historian You and Yours and Woman’s Hour and BBC1’s daytime show Pebble Mill at One. In these programmes, relaxation was presented as a tool to help with an array of nervous disorders afflicting the modern-day woman, and an alternative to the widespread use of tranquillisers such as Valium.2In addition, relaxation advice and instruction could readily be found within the growing self-help literature, and accessed through radio programmes and the new medium of domestic television. Many of these programmes primarily targeted women, especially housewives, such as Radio 4’s Therefore, by the time RforL was established in the early 1970s, the demand for therapeutic relaxation, especially among middle-class women, had been firmly established, starting with antenatal care. As a set of techniques and ideologies, therapeutic relaxation then extended into all aspects of managing and bettering modern experiences of motherhood and womanhood more generally. As the next section elucidates, relaxation entered the lives of men through different channels, primarily through developing an association with heart disease prevention and as an antidote to “stress”.Why Rush to Raise Your Blood Pressure, Ruin Your Heart, or Have a Stroke?  warned that heart disease could soon present mankind with the greatest epidemic it has ever faced . AttemptPragmatic, risk-based, individualistic preventive and therapeutic solutions became favoured in Britain’s “new public health”, especially following the 1962 report by the Royal College of Physicians, which linked smoking to lung cancer . ReflectLancet. The debate, subsequently referred to as the “battle of the knights”, centred on two different understandings of hypertension as either a discrete illness category, “essential hypertension”, or a trait distributed on a continuum  or very anxious, and Jacobson too had referred to “neuro-muscular hypertension”. With reference to high blood pressure, in the nineteenth century this was a condition believed to predominate among women. By the early twentieth century, alongside other psychosomatic conditions that underwent a “sex shift”, it came to be seen as a male disease but was by no means a stable diagnostic category : 289. Asontinuum : 312. Onontinuum . With thYou Must Relax, In the early twentieth century, founders of the “new cardiology” in Britain, such as James Mackenzie (1853–1925) and Thomas Lewis (1881–1945), had recognized the impact of harmful psychological and environmental influences on the functioning of the heart and the wellbeing of the individual . ComparaType A Behavior and your Heart  biological formulation of stress, and the American psychologist Richard Lazarus’ (1922–2002) articulation of “coping” mechanisms, gained traction in the postwar decades and further boosted this rationale. In turn it enabled relaxation training to be marketed as an empowering addition to an individual’s armoury that could strengthen one’s ability to cope in stressful environments. Stressful conditions in themselves were not the problem, rather an individual’s relationship with and to those conditions. n Living  and Do SArteries , advisedThe Stress of Life, contributed considerable scientific credence to pre-existing notions of psychopathology linked to the chronic strain of everyday modern living. Allied to the growing field of psychosomatic medicine, stress became seen as both the cause and the consequence of a host of physical illnesses, including heart disease and hypertension . She also had the support of four trustees: Katharina Dalton, a gynaecologist pioneering research into hormonal imbalance, premenstrual syndrome and the menopause; Madge Moore, a local doctor who specialised in marriage guidance and family welfare; Peter Wilson, who was Honorary Secretary of the British Migraine Association; and John Pringle, a retired bank manager and one of her first private students, who agreed to become Honorary Treasurer.Physiotherapist and health educator Jane Madders was the key inspiration behind the organization’s therapeutic ambitions and practical set up. Madders acted as a technical advisor, leading the training of RforL teachers and later became Chairwoman of the organization. Madders had learnt relaxation techniques during her training in the late 1920s at Chelsea College of Physical Education, although she later recalled that at that time, in 1927, the techniques “were only applied in the physical sense. We never learnt how they could affect our mental states as well” . She hadIn January and February 1972, Madders led a “Training Course in Relaxation Theory and Practice” at the NCT headquarters in London, “for those experienced in relaxation techniques”. It was advertised as a “training course for those wishing to use their knowledge of relaxation for conditions where stress is a contributory factor”. The course, spread over two full days and three evenings, provided practical training sessions and discussion and demonstration of different methods of relaxation; an overview of recent research into relaxation therapy and “recent advances in our understanding of the effect of stress on the physical and biochemical reactions of the body”; the organization of class work and group discussion; counselling, and “relations with the medical profession and other professional bodies”. The course also included a showing of a film and a list of “Useful background reading”, which listed publications by Jacobson, Selye and Lazarus, among other technical articles on behaviour therapy, migraine and pain.Relax–and Enjoy it, for introducing relaxation into everyday life, on Radio 4’s daytime You and Yours programme. It was hugely popular and was repeated on radio the following year alongside a book, Relax: The Relief of Tension Through Muscle Control, written by Madders and published by the BBC together with an associated cassette recording (For Lloyd, this study day greatly influenced how RforL classes were structured and taught. As she reassuringly wrote in her first newsletter to RforL students, attendance at the course meant that “We came away feeling we really knew what we were doing now!” . As wellecording .how to relax” (In the seven months of our official existence, we have received quite a lot of publicity, bringing in enquiries from all over the country and proving the desperate need for our work. The sad thing is that we can actively help so few people; although we are training teachers … our numbers are as nothing when faced with the demand for our services.The foreword to the book, written by the series’ producer, opened with a quote from “one of many letters received” when the relaxation series was broadcast: “For as long as I can remember I’ve been told ‘Relax’, but no one has ever told me how!”. In a similar fashion, Madders opened the introduction to her book with: “ ‘Relax!’ It is likely that someone has said this to you or you have urged someone else to do it and with little effect. Although we are continually being reminded of the ill effects of excessive tension and may well be aware of it in ourselves, we are rarely shown just o relax” . These sThe “desperate need” for relaxation and its development as a means of both counteracting ill-health and promoting wellbeing, grew in tandem. Other organizations such as the Relaxation Society, run by The Revd Geoffrey Harding were in operation at a similar time to when RforL started. As this article has discussed, popular yoga classes routinely included relaxation practice, and a plethora of self-help relaxation books and audio cassettes were in circulation. Relaxation instruction was therefore not as hard to come by as Madders and Lloyd suggested, though there was certainly growing popular demand for courses to learn such techniques within a secular, scientific framework.Neuro-muscular relaxation enables the individual to lower his arousal and is a vital form of health education. As a preventive therapy it can ease the over-burdened N.H.S. Far too many people already suffer from diseases known to have stress in their origins—hypertension, back pain, coronary disease, ulcers, colitis, migraine, depression, insomnia, phobias, tension headaches, tight muscle pains, nervous indigestion. Many more are heading that way and need to be shown how to unwind.Despite the initial concerns over receiving charitable status if relaxation was promoted as both a prophylaxis and remedy, as RforL became further established, prevention remained absolutely essential to the organization’s goals and claims. As Lloyd explained to readers of the NCT Teachers’ Broadsheet in 1979: As well as prevention and therapy for an array of stress-derived illnesses, as the name of the organization signalled, relaxation could and should become embedded in everyday life. As with Jacobson’s differential muscle relaxation techniques and the advice of Boome and Richardson in the 1920s and 1930s, RforL promoted relaxation methods to be used, for example, in the car, at the dentist, at the desk, and in the home. Participants were taught “on-the-spot” techniques that could be adopted until such a time when it was feasible to practise a longer period of restorative “deep relaxation”.Becoming a relaxed person meant becoming a “balanced” person, which in turn would foster a more harmonious environment through enhancing relationships. Whereas “a tight jaw, shoulders and forehead signal messages of tension and others react accordingly, for anxiety is easily caught”, warned Madders, a relaxed person would have the opposite effect: “When a mother is calm the rest of the household simmers down also”. The same principle held true for businessmen and women, teachers and healthcare professionals. For the health and wellbeing of individuals and society at large, relaxation offered a means of achieving “some inner calm in a hectic changing world” . SufferiThe Relaxation Response, which became an international best-seller within weeks. While conducting animal studies on stress and hypertension in the 1960s, which conditioned monkeys to be able to increase and decrease their own blood pressure, he was approached by a group of TM practitioners who claimed their practice enabled them to reduce their blood pressure (The Relaxation Response significantly increased popular awareness of, and demand for learning relaxation techniques with their widely publicized and scientifically legitimated therapeutic potential. However, as this article has demonstrated, as with RforL, Benson’s success and the public’s receptivity built on a much longer history.In 1975, the Harvard cardiologist Herbert Benson published pressure . Benson Between 1920 and 1970, significant work had gone into developing therapeutic relaxation as a set of technical skills that had to be taught, learnt and practised and as a framework for everyday living. It had been made relevant to the lives of men and women in distinct ways, and its benefits extendable from the individual to industry, home and state. The major restructuring of the NHS in 1974 did not alter the “health” service’s focus on treating illness and disease. Although relaxation techniques became increasingly practised within clinical settings, such as psychotherapy and physiotherapy, responsibility for maintaining health and enhancing wellbeing lay mainly with individuals. Healthcare consumers primarily had to look outside of the state healthcare system to find and learn techniques such as neuro-muscular relaxation with the hope of preventing and “coping” with a wide range of adverse conditions. In the late 1970s, Thatcherite neoliberal policies accentuated this trend, and relaxation teaching seamlessly entered into the “stress-management” marketplace that burgeoned in the 1980s and beyond.Into the twenty-first century, health and wellbeing strategies, such as the use of mindfulness-based interventions across clinical and non-clinical settings, reverberate strongly with the calls of earlier therapeutic relaxation proponents and structurally build on their pedagogical frameworks . The app


The R&D has been recognized as critical method to take competitiveness by not only companies but also nations with its value creation such as patent value and new product. Therefore, R&D has been a decision maker's burden in that it is hard to decide how much money to invest, how long time one should spend, and what technology to develop which means it accompanies resources such as budget, time, and manpower. Although there are diverse researches about R&D evaluation, business factors are not concerned enough because almost all previous studies are technology oriented evaluation with one R&D technology based. In that, we early proposed R&D business aspect evaluation model which consists of nine business model components. In this research, we develop a simulation model and system evaluating a company or industry's R&D portfolio with business model point of view and clarify default and control parameters to facilitate evaluator's business validity work in each evaluation module by integrate to one screen. Investing in the R&D (Research and Development) has been recognized not only as a key activity of companies and industries for one's sustainability, but also as a tool for expending market share and other purposes , 2. TodaThrough the recognition to patent property as intangible asset, R&D evaluation has been widely studied in various industrial areas. However, almost all researches and studies are technology based evaluation and restricted to single R&D technology while APO noted that innovation shall be viewed from a broad perspective, not merely as technological improvement . With reIn this research, we propose simulation model which is designed for systemize to facilitate a company or industry R&D competitiveness level evaluation in business model aspect with three control parameters and five default parameters.In business model research criteria, standard agreement on definition of business model is not settled while various previous researches have been conducted. Hedman and Kalling offer an outline for conceptual business models and propose it should include “customers and competitors, the offering, activities and organization, resources and factor market interactions.” Osterwalder et al.   defined business model as a “conceptual too containing a set of factors and their relationships and allows expressing the business logic of a specific company” , 6. WithIn this research, we suggest that business model could be comprehended as demonstrating how an organization purchases and sells goods and services as well as obtaining profits in the sense of the above literature reviews and via recent research trend to study the components of business model rather than definition , 8–10.In this research, with respect to recent research trend that concentrates not on definition but on components of business model, we adopted Osterwalder's nine business model components: value proposition, customer segments, channels, customer relationships, key activities, key resources, key partnerships, cost structure, and revenue stream, with four pillars: product, customer interface, infrastructure management, and financial aspects .The simulation model in this research is established based on our former R&D business model evaluation model with four analysis steps: market, growth pattern, competition, and financial. Those have their own factors affecting company's or industry's R&D portfolio value which one can see in As one can see in The growth pattern analysis comes from the idea that market analysis simulates future market pie of analysis target by only linear growth pattern which is not suitable for real growth pattern. The diffusion of innovation theory and other growth pattern studies shows that market or customer growth follows similar technology market pattern .t year BMCc)t( in Equation M)( (business model pie) and calculate ten years future with that:Equation In this research, we utilized industrial CAGR as a recommendation value of analysis of target's CAGR assuming that competitive environment leads benchmarking in one industry to competitors. In that, we assumed one company's R&D components growth would be mirrored by industry's one.To systemize the model, we set up three control parameters, BMC CAGR, log value, and BMC current value, which system user could control manually, and also made recommendation system for two control parameters, BMC CAGR and log value, with the methodologies above.Control parameters are set up by diverse use case diagram of the system. BMC CAGR which controls target's BMC score weight assumes analysis target company has a plan to invest R&Ds which have some specific BMCs, and log value assumes target company expecting own R&D growth trend or long term plan of target while BMC current value considers missing patent data or analyzer's own supervision to BMC weight.Different to two recommendation module adopted parameters, BMC current value is manual input interface control parameter. Equation Default parameters are barrier for control parameters to control extreme inputs from them which could cause unintentional results such as one BMC biased evaluation. Parameters in the simulation model are basically inherited from original model because basic reference data of simulation model comes from patent data in the original model. In that sense, default parameters restrict control parameters range. Firstly, the log value is restricted from −1 to +10 that makes presently possible growth graph. Secondly, we set up BMC weight summation as always 100% by utilizing comparative potion of BMC for BMC weight to compare to another company or industry.Since the simulation model is designed to be systemized, we also developed value effect diagram to analyze control parameter's effect on another parameter, value, and even screen. The simulation model in this research is systemized with JAVA based platform as one can see in Although the model in this research considers diverse aspect and effects, the model has some limitations. Firstly, it could not reflect technical advance of one patent such as 4G telecommunication patent which could make huge advantage to owner. Hence, conversing one patent level evaluation and business model level evaluation would be necessary. Secondly, keywords which we used for this model are text mined from Korea automobile industry patent data. In that, to adopt this model for other industries, executing re-text mining target industry or auto-text mining system would be acceptable. Lastly, it is not suitable to company or industry having not enough patent data such as new established company or not technology oriented companies or industries.Despite the limitations of this research, the model in this research has various potential implementations not only for company but also for industry or country level. Firstly, it could offer comparable value of company R&D activities which support decision making to R&D investment such as when, what, and how much one invest to R&D. The comparable value of R&D also support government to decide what industry or company she invest to maximize future knowledge property value. Furthermore, it could supplement previous technology based one patent level analysis with business model aspect even if one R&D has innovative factors but has no business value.Although this study suggests not only notations for initial assessment model specialized in business model aspect but also simulation model for it, further studies in these criteria such as R&D process assessment and convergence system to technology based evaluation system are necessary because we think it is start-up trial adapting business model to technology based point of view.


Significant improvements were seen in the mothers’ FFFS scores for “The 4th factor: illness and worries” (p = 0.016) and in the median CDQ scores for one of 18 items after STSSE (p = 0.01). Although additional studies with larger sample sizes will be necessary before these findings are generalizable, the positive changes seen in both parents and children as a result of STSSE are promising.The objective of this study was to evaluate the effectiveness of simultaneous training for children with autism spectrum disorder (ASD) and their parents, with a focus on social skills enhancement (STSSE) by evaluating behavioral changes in children with ASD and changes in family functioning. STSSE was conducted on 17 children of elementary school age with ASD and their parents. Changes in scores on the social skills scale for education , the child behavior checklist, the Feetham Family Functioning Survey (FFFS), and the confidence degree questionnaire for families (CDQ) were used to assess the effectiveness of STSSE. Improvements were seen for “Communication Skills” on the children’s SS-scale ( In adIn Japan, only a few reports have discussed parent training (PT). One of the most effective PT programs was developed more than 20 years ago at the University of California, Los Angeles (UCLA). This PT program and has been used in numerous countries for changing parenting behaviors among parents of children with attention deficit hyperactivity disorder (ADHD) . In ordeet al. [et al. [et al. [However, PT does have some limitations. For example, it has not been shown to have a significant effect on behaviors of children with ASD, particularly in terms of externalizing problems. Therefore, a mainstream treatment approach in which children undergo direct training in social skills, problem solving, and anger management has been developed ,10,11,12et al.  reported [et al.  and Solo [et al. , parentsTherefore, in the present study, simultaneous training for children with ASD and their parents with a focus on social skills enhancement, which combines SST for high-functioning children with ASD of elementary school age and their parents, was applied in small groups of four to five members. STSSE, the primary focus of which is helping children with ASD acquire social skills, is unique in that it is both an SST program for children and a PT program for parents. STSSE uses a variety of behavioral principles to help enhance the social functioning of children with ASD. An STSSE course, which is simultaneously carried out for children with ASD and their parents, comprises 10 consecutive sessions and can be completed within six months. Parental sessions focus on helping parents gain an understanding of their child’s social skills, including the areas in which they may be lacking, and on assisting their child in adapting to both the home and school environment.In a previous study, maternal well-being was measured using both adverse maternal outcomes—such as depression and parenting stress—and favorable maternal outcomes—such as life satisfaction and overall psychological well-being ; howeverTherefore, the purpose of this study was to evaluate the effectiveness of STSSE for children with ASD and their parents by evaluating behavioral changes in children with ASD and changes in family functioning, including both parents and other family members.Explanatory leaflets regarding STSSE were distributed to the families of children with ASD at the outpatient clinic of Osaka University Hospital; 17 children and their mothers were subject to the study. All children were diagnosed with ASD in the outpatient clinic according to Diagnostic and Statistical Manual of Mental Disorders (5th edition) guidelines. All children were aged from seven years eleven months to ten years ten months, and nine had comorbid ADHD. Informed consent was obtained from all children and parents before the study began.To evaluate the effectiveness of STSSE, parents were instructed not to start any new or change any ongoing medications or interventions for their children during the program. Parents who had previous PT experience or showed serious psychological conditions, including a history of child abuse, or children with cognitive deficit  lower than 60) were carefully excluded by the research team, which consisted of the attending doctors, a nurse, and psychologists. The attendance rate among the 17 children and their parents in the STSSE sessions was 90%. When these children and parents could not be present in some sessions, they were supplemented with the content and material of the missed sessions individually.The participants’ demographic data are shown in etc., in order to select appropriate candidates.The clinical characteristics of the children who participated in the study are shown in STSSE was conducted for small groups of 4 to 5 participants by a registered nurse and clinical psychologists trained in the original SST procedures. Each group member was selected in order of application. A single STSSE course comprised 10 consecutive sessions and was completed within six months. Each session lasted 90 min and was held every 1 to 2 weeks. To maintain the quality of STSSE, two researchers assisted the leader, monitored the contents of each session, and recorded the parents’ remarks and reactions. The records of each session were analyzed and discussed by the researchers, child neurologists, clinical psychologists, and a registered nurse.The STSSE content used in this study was formulated based primarily on the original report of SST programs that described “recognition and understanding of emotion; theory of mind; and executive functions/real life-type problem solving” . The chiet al. [In reference to the programs developed for parents of children with ASD by Butter et al. , some neet al. ,26.The content and points of intervention for the 10 sessions comprising a course are shown in et al. [The effectiveness of STSSE was assessed using the following four scales: social skills scale for education  , child bet al. , and theThe SS-scale scoring system consists of the following four factors, each scored on a four-point Likert scale: “Group Behavior Skills”; “Self-Control Skills”; “Friends and Relationships Skills”; and “Communication Skills” . Since tThe CBCL is a scale designed to evaluate child behavioral problems . Responsa-score” and the “b-score” is calculated as the “d-score”. The d-score represents the discrepancy between perceived and desired family functioning, with a lower d-score indicating better family functioning.In the FFFS, family functioning is defined as activities and relationships, including growth, safety, socialization, economic stability, and education, among and between individuals, the family, and the environment that enable a family to maintain itself and meet the needs of family members. The FFFS is designed to evaluate family functioning ,30 by aset al. [This scoring system comprises 18 items  that weret al.  to incorThe mothers’ comments at the end of each session were recorded and analyzed.All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethical Review Board of Osaka University Hospital (project identification code: 10007-5).p < 0.05 was considered to indicate statistical significance.Data were analyzed using SPSS 20.0 for Windows . All scores were compared using the Wilcoxon signed-rank test. p = 0.029; Increases were seen in all SS-scale scores for education after STSSE. In particular, significant increases were seen in the scores for “Communication Skills”   . No signChanges in FFFS scores are shown in p = 0.019)”, significant improvement was seen in the d-score for “The 4th factor: Illness and worries” (p = 0.016). In addition, improvements were seen in the following sub-categories: “Q2: Consultation and concern for relatives (excluding a partner)” (p = 0.52); “Q9: Using a medical institution and receiving health consultation” (p = 0.10); and “Q11: Worries about a child” (p = 0.39) (Among the two factors making up “Relationship between family and subsystem ( = 0.39) . In addip = 0.64) and “Relationship between family and subsystem” (p = 0.51); however, these differences were not significant   .The median CDQ score increased for three of the 18 items after PTSS; however, no significant differences were observed .In general, the comments of the mothers suggested the usefulness of STSSE. Most mothers reported that their child had more emotional control as a result of the joint SESSE activities, which required paying attention, expressing their emotions in words, and using suitable language when communicating with others . FurtherIn this study, “Communication Skills” among children with ASD, which included “Hearing”, “Speaking”, “Assertion”, and “Talking”, showed significant improvement following STSSE. Some mothers of children who showed improvement made comments such as “My son has begun saying things to me like ‘this dinner is really good’,” and “My daughter was able to raise her hand and answer a question at school.” Since “Hearing”, “Speaking”, “Assertion”, and “Talking” can be used to evaluate the ability of an individual to draw conclusions, the improvement in these sub-items suggest that STSSE made it possible for children to use communication skills more effectively at school. Some parents reported that their children’s communication skills acquired through “Rehearsal”, “Modeling”, and “Homework” were also utilized at school. Teachers were informed of the content of the skill-training program together with a handout, and that their cooperation may also form the basis of the behavioral changes shown in the study results.In contrast, no significant improvements were seen in the CBCL scores in this study. Although the direct aim of STSSE is the acquisition of social skills, a behavioral improvement was anticipated as well; however, based on CBCL scores, no behavioral improvement was seen in emotional control, coping, and peer relationships skills. Nonetheless, the improvement seen in communication skills may have resulted in reduced somatic complaints, suggesting that the children became able to express their mental state, including stress, anxiety, and conflict issues, more easily than before. In this study, some mothers of children who showed an improvement in expression of their mental state made comments such as, “My son does not bite his fingernails as much,” and “When I made a feelings sheet, the word “sad” began appearing from my child.” On the other hand, some mothers thought problems worsened; however, as shown in d-score for “Relationship between family and subsystem” in the FFFS was improved after STSSE. This result suggests that strengthened support from a partner may be associated with increased life satisfaction and psychological well-being for mothers of children with ASD [The with ASD . By virtIn the STSSE course, mothers were recommended to share the materials and experiences obtained in the sessions with their partner, especially those regarding their children’s ASD-related characteristics. Most of the mothers reported that they practiced the same session with their partner at home and found time to talk about how to care for their children. Fewer children  who had parents with one of the negative parenting risk factors  showed clinically significant improvements compared with those whose parents did not have a negative parenting risk factor . It is cAs shown in We developed and introduced an STSSE program based on the previously reported parent program, PTSS, primarily for children with ASD and their parents. STSSE differed from our original PTSS in the following aspects: STSSE, which was applied to child-parent pairs simultaneously, provides a chance for children and their parents to meet and talk together, feel sympathy for one another, and enhance their own self-esteem. In addition, STSSE places a greater focus on acquisition of social skills compared with PTSS.This program did have some limitations. First, in this study, no improvement in externalizing behavior was observed in high-functioning children with ASD during the follow-up period; however, improvements were seen in social skills and peer relationships and, thus, externalizing problems may be alleviated in the long term. Alternatively, programs targeting younger children may be necessary, since earlier intervention for children with ASD has been associated with a better prognosis . Second,This research evaluated the effectiveness of our newly developed STSSE by analyzing changes in mothers’ FFFS and CDQ scores and children’s SS-scale scores. Positive changes were seen in both parents and children; although these results are promising, an additional study with a larger sample size will be needed before they can be generalized to other populations.


Family reunification was the most common reason (34%) for resettlement in Sweden in 2013. About one-fifth of the population is foreign-born. This study used mixed methods to evaluate a culturally tailored clinical health-promotion intervention. The intervention was conducted by licensed clinicians and a local coordinator. Sessions were five-weeks long, two hours a week. The quantitative data cover results from 54 participants, mainly Arabic and Somali-speaking, who participated in 10 groups. The participants’ perceived health improved significantly over the three measures. They also shared that their health significantly improved according to moderate effect size. The qualitative data, analyzed using revised content analysis, reflected one general theme: “the intervention is an investment in perceived improved health”, and four categories: “perceived increased health literacy”, “strength, empowerment and security”, “finding a new lifestyle”, and “the key to entry into Swedish society is language”. An intervention focusing on the prevention of ill-health, on health as a human right, and on empowerment, and aimed at female newcomers, has practical implications. In recent years, human migration has changed, with the process of globalization, in number and nature. Migration is influenced by various factors that include the seeking of asylum and personal safety, the quest for economic improvement, and family reunification . In receThe Swedish Public Health Report 2009) shows that the prevalence of physical and mental ill-health among immigrants is double those of the Swedish-born population . In ligh shows thAccording to a theoretical approach by Silove , events The research questions were: How do participants assess their health prior to, at the end of, and six months after the end of the lifestyle course? How do the participants view their participation in the course?This study is part of a larger study designed to assess self-perceived health and well-being among newly-arrived women who immigrated as relatives, before and after they participated in the intervention .In this article we use a definition of health similar to that used in earlier publications, which perceive health as “a dynamic, active process of maintaining a personal and social state of balance and well-being” ,17.PartiThis is a participatory approach—that is, the participants are invited to engage in a dialogue with the multidisciplinary team and ask questions about health, lifestyle and prevention. Furthermore, this approach generates a group dynamic that results in peer recommendations, which may be more effective than individual dialogue.The participants were seated in a classroom setting. Arabic and Somali-speaking women were the most common participants. Each intervention was dedicated to a single language group. The course lasted for five weeks, with a two-hour meeting on the same day and time each week. The last session was extended to 2.5 h to allow for a diploma ceremony for participants who attended at least four of the five sessions. Regarding the curriculum’s pedagogical technique, the multidisciplinary team was sensitive to the participants’ educational level. Each lesson was developed and designed to be clear and simple: the two hours were divided into one for health information, followed by a short break for some free refreshments, and one for dialogue and feedback about the relevance of the information presented. Generally, participants were given a hand-out containing PowerPoint presentations including Swedish-language illustrations, which provided opportunities to learn practical health-related Swedish vocabulary. During the course, the ability to laugh and a sense of humour were an advantage, according to clinical experience .The approach focused on nutrition and public health, physical activity, the female body, contraception and health, stress and coping. The curriculum of the intervention, based on Silove’s theoretical approach, started with focus groups and interviews, by students supervised by the first author, with key local people in order to receive relevant needs content in every session for each language group ,19,20. TOur clinical experience is that newcomers may lack a sense of “belonging” with respect to Swedish authorities  and may therefore avoid such authorities. To avoid stigma and social isolation, the sessions and follow-ups were held in a neutral place, that is, at the site of the courses in Swedish for adult immigrants in Södertälje. Södertälje is 30 kilometers south of Stockholm. At the end of 2013, Södertälje had a population of 91,072 originating from 40 countries and speaking 80 languages, and about 35 per cent of the population were foreign-born . The data on 10 groups with five weekly sessions (n = about 10 participants/group) were collected from 28 August 2012 to 26 November 2013, as four more groups in Spring 2014 could not be followed up after six months, as the project finished on 30 June 2014. Those who did not respond to the first, second or third follow-up notices are referred to as drop-outs even though they completed the intervention. Other results are reported elsewhere.The project, which started in 28 August 2012 and ended on 30 June 2014, included 277 participants, from Södertälje (145) and Angered (132), which is on the west coast of Sweden close to Gothenburg. In this article we have chosen to report the results of the follow-up survey for the effective participants in Södertälje who attended all three data collections . For practical and language-related reasons we did not use an instrument but included a few questions from Sweden’s national public health survey, “Health on Equal Terms” which also foreign-born had answered before . The valThe five main open narrative questions were: (1) If a female relative or friend came to Sweden to live here, what content would be needed for her in a lifestyle course (intervention)? (2) How did you feel before the lifestyle course? (3) How do you feel today? (4) How has the lifestyle course influenced you? and (5) What more do you need to feel integrated in the Swedish society?The information, quantitative and qualitative questions were translated into Arabic and Somali by a translator and back-translated orally  by an aut-test was performed to determine whether the participants showed changes in their perceived health directly after and after six-month follow-up. Effect sizes (Cohen’s d) were calculated in order to verify improvement. An effect size of 0.2 is assumed to be small, 0.5 to be average and values over 0.80 to be large. Only p-values under 0.05 are reported in the results. Socio-demographic characteristics and lifestyle questions were described by means, standard deviations and frequencies.Quantitative data acquired from the three measurements were analyzed by producing descriptive statistics using SPSS 22.0  for Windows. This analysis included the computing of mean values and standard deviations of all Likert items included. We used Spearman analyses to identify the strengths of associations between ranked (non-parametric) questions. A An inductive approach was used for the qualitative data, as is advisable when previous knowledge is lacking, which was the case in this study . The datThe study was approved by the Stockholm Regional Ethical Review Board (No. 2012/1302-31/5). Each questionnaire was marked with a code (a number) and this code was used at the measuring dates instead of the participant’s name and could not be linked to how they responded to various questions. The participants were informed in advance, orally and by information sheet, about the purpose of the study and the follow-up. They gave their written or oral (when illiterate) consent to participate and were free at any time to terminate their participation without prejudice. To reduce the risk of exposing an already vulnerable group, the analysis and the presentation of results were performed on the group level and the quotations used are not identified by language group. For ethical considerations, a recorder was not used.The intervention involved six Arabic-speaking groups, two Somali-speaking groups and two groups that spoke several mixed languages. Each of the 10 groups consisted of 3 to 13 participants .A total of 144 female and 1 male participated in the lifestyle course in Södertälje. Of the total 145 participants, 54 answered questions before and directly after and at the sixth-month follow-up, three measures. One hundred and one of the participants answered questions before and directly after. Their responses will be published elsewhere. Forty participants (28.6%) were dropouts for the second and third measures. There were no significant differences regarding age, education level and work experience between the participants who participated in all three measurements and the rest. The typical reasons for dropping out at the six-month follow-up were competing activities, such as introductory courses for employment at the same time and reduction of the accompanying financial support payments if the person did not attend, relocation to another municipality, pregnancy or simply dropping out.Sociodemographic mean data among the 54 participants are presented in t = −3.673, p < 0.001; −3.236, p < 0.002, respectively) and the effect size was moderate. The participants showed significantly higher perceived health during the last follow-up and the effect size was moderate . According to at least p<.05).It was common that the participants slept about 6–8 hours a night on all three measures, but nearly half  had nightmares before the lifestyle course and about the same  had similar amounts direct after the course and at the six-months follow-up, respectively .There was one general theme “The intervention is an investment in perceived improved health” and four categories: “Perceived increased health literacy”; “Strength, empowerment and security”; “Finding new ways of life”; and “The key to entry into Swedish society the language”.The content of the information provided at the last follow-up after six-months by the participants of the intervention was considered relevant and new for the participants. The participants mentioned that it was important for them as newcomers to have this new knowledge and they pass on this information to family members at home and also in their home country.Great information. I feel better now. I have sought help for my back pain problems”.“The information that I should check my breasts. It was good that women should examine themselves. Nutrition information also gave me new information”.“It was good information, so I think today that I feel good by focusing on sleep and exercise. Today, I know where I can go to get more information about something happening”.“I have learnt a lot from the nurse, who I will call in different situations when needed. Have told my relatives and given the phone numbers ”.“The course gave the participants new perspectives which reduced their perceived stress. They had the strength to deal with their challenges in new ways, they became motivated and they felt more self-confident and energetic—that is, they felt better than before the course. They could cope with future work options, studies and family and could better help their families feel physically better.Before the course I was stressed. I was thinking too much. It would be better to have this lifestyle course at the time when you are new (in the first six months) in Sweden”.“I feel good now, but I had mental problems before. I have gained an understanding of my disease. Previously, I had no information about stress”.“I felt bad before the course, but the course made me stop and think about what I could do to help myself”.“That I could raise questions about pregnancy, food and weight. Today I think more about health and exercise”.“I think that the course gave me a “mental lift”. I’ve gotten better and will feel better mentally”.“I feel good, because I think more about my health and myself. (Have four children) I’ve started a course to lose weight”.“The participants related their new lifestyles to health promotion and health literacy, considered themselves to have developed stronger will-power and felt that the relaxation session meant that “the soul could rest”. They were regularly monitoring their diet and had changed their eating habits in terms of both nutrition and eating times, and were also monitoring their contraception measures and coping strategies. The course resulted in new perspectives, which influenced their lifestyle as they felt their health improved. After the intervention some participants had begun training which later led to traineeships and, eventually, permanent employment in healthcare. They expressed a willingness to learn more.I go on walks, which I did not do before—it is a new habit. Also, the children and the family have been told about what I learned. I do not cook the same food all the time and I try not to sit too long. I have become calmer”.“I’ve developed, got new contacts (meeting other participants), I am thinking more about my body and have become calmer; I study and I now plan special time for the children and the family”.“I’m pregnant and feel tired and unwell, but I think about what I learned about pregnancy and relaxation. It was good. I feel more confident now, earlier I was worried. I have had inflammation in a toe. I was worried it was a clot. I feel more confident now and don’t worry”.“I get a lot of exercise. There are different kinds of contraception in Sweden, where I now have access to primary care and ways to promote health”.“Before I had no friends here, but now I feel my life has become more normal. I get together with relatives and friends and I am less scared. I want to succeed with my education (needed for a job) and bringing up my children”.“The participants discussed how knowing Swedish would better equip them to communicate their symptoms and needs when they seek primary care. Otherwise, misunderstandings could easily occur. To be dependent on an interpreter was not always good because understanding is important if they are going to describe how they feel. Newcomers should be encouraged to learn the language to express their opinions in the new country. They searched for way to interact with Swedes. Additionally, the role of women in Sweden and in their home countries was quite different, which increased demands on them and they wanted to know more about human rights issues.Language is the most important thing. The more we learn, the better we feel. We need more contact with Swedes, but where can we find opportunities? We rush from school to practice and then home and to our children who need to be cared for. There is a lot of pressure on us. In our country all women were housewives”.“I live with a Swedish man, but I want to know more about Swedish legislation—for example, about social issues and how agencies work”.“The intervention attracted interest in learning more about gynecological health, breast cancer prevention, parenting, prevention of physical punishment, first aid, weight loss, rights regarding access to healthcare for asylum seekers, information about dental care, relationship problems, mental health, nutrition, and Swedish traditions and habits.…… I’m curious about Swedish traditions. I think it would be interesting to discuss more about the culture clashes and child rearing. I have seen how many people in my culture have difficulty setting limits for their children. It doesn’t need to be wrong, but we need to get to know each other and each other’s habits, havediscussions. So there can be a balance – getting to know each other is important”.“I want to know more about children’s health and how to talk to them, in a good way (not being angry)”.“I also have to learn more about Swedish culture, to help me feel good and get a job. It is also important to get out in nature”.“Stress reduction in the relationship between a man and a woman”.“The present study raises a number of significant questions, and provides implications and recommendations for policymakers, clinical work and research. The results give support to a study  among neThe results have connection with Silove’s five dimensions model . The maiThe participants were not identified patients and the aim of the intervention was not care-giving. However, this study as well as earlier Swedish studies ,15 demonThe study has strength in that it is prospective, used established questions from the Public Health Report  and cultThe questions used had not been tested for reliability and validity for this target group, as that would have required additional time and data. The main methodological limitations of this study are the absence of a control group and the convenience sample, implying selection bias, because we could not control who came as participants. Therefore, we could not conclude that the significant changes in perceived health were a result of the lifestyle course. The target group was relatively small and involved mainly two languages  and they had different educational background. Moreover, the questions may have been misunderstood, and the fact that participants have had more or less experience in answering questionnaires may have influenced bias of data. Their knowledge of metric distance, equivalence—for instance, distance on an ordinal scale—may vary, depending on factors such as their educational level and the experience they may have had with such questions in their culture. This knowledge is needed when planning the design.The target group is less settled than the general population, which had impacts on the numbers of dropouts, but the number dropouts was in line with other prospective studies ,15 and tA limitation of the qualitative data is that we communicated through a professional interpreter and due to that, could not analyze latent data . The resA relatively short and culturally tailored intervention (lifestyle course), with clinically interdisciplinary health professionals, a local coordinator, a process evaluator, and a professional interpreter, strengthens the prerequisites for increased health literacy among new-coming female women from countries outside the EU. Women’s health is a human right and healthy new arrivals will be productive members in the society.This intervention should be included in a reception community-based health promotion and accompanied by regular evaluation and quality improvement. This intervention should also be introduced to other social and economic disadvantaged groups at risk for illness in the general population.Even though the study has limitations mentioned above, this short intervention for unidentified patients has sufficient evidence to assert that is promising tool worthy of further implementation.


A postal questionnaire was sent to 1000 randomly selected households issued a routine “Boil Water” notice. Findings were then compared to a previous study that explored drinking water behaviour during a “Boil Water” notice issued after serious floods. Consumers affected by the routine incident showed a significant preference for official water company information, whereas consumers affected by the natural disaster preferred local information sources. Confusion over which notice was in place was found for both incidents. Non-compliance was significantly higher for the natural disaster (48.3%) than the routine incident (35.4%). For the routine incident, compliance with advice on drinking as well as preparing/cooking food and brushing teeth was positively associated with receiving advice from the local radio, while the opposite was true for those receiving advice from the water company/leaflet through the post; we suggest this may largely be due to confusion over needing boiled tap water for brushing teeth. No associations were found for demographic factors. We conclude that information dissemination plans should be tailored to the circumstances under which the advice is issued. Water companies should seek to educate the general public about water notices and which actions are safe and unsafe during which notice, as well as construct and disseminate clearer advice on brushing teeth and preparing/cooking food.When public health is endangered, the general public can only protect themselves if timely messages are received and understood. Previous research has shown that the cause of threats to public health can affect risk perception and behaviours. This study compares compliance to public health advice and consumer behaviour during two “Boil Water” notices issued in the UK due to a routine incident During ” notice .Typically, risk communication is broken down into four elements: message, source, transmitter and receiver . It is w versus routine incidents [Different information channel preferences have been found for naturalncidents  and diffncidents . During ncidents ,11, radincidents , email oncidents . Of crucncidents . Brodie ncidents  found thncidents . Some stncidents ,18, whilncidents  and negancidents . Studiesncidents .Typically, non-compliance with ‘Boil Water’ advice ranges between 9% and 20% ,21, wherReturning to the issue of trust, citizen advisory groups, health professionals, safety professionals, scientists and educators are consistently considered trustworthy or credible sources of information on environmental risk, except that those associated with an industry or believed to have a monetary interest are suspect sources ,32. OverWhile consumers normally put great trust in information from physicians and other health professionals , in someOf the four elements of risk communication, this paper primarily focuses on the effects of sources, transmitters and receivers upon consumer compliance to health advice. Through quantitative analysis, we show how different information sources and demographic characteristics affect consumer behaviour during the two water incidents. Undoubtedly, the message content also contributes to consumer understanding and behaviour. However, during the incidents in this study, the message content was a variable that we were unable to control for as both incidents involved a great number of sources and transmitters with a huge number of messages. In order to address issues such as how the linguistic framing of water advice might affect consumer compliance, we conducted a separate qualitative analysis of the water advice reported by the media during the natural disaster incident . versus natural disaster incidents result in differences in consumers’ compliance with advice, use of information sources, recall of advice received and their satisfaction with the information.No previous studies have directly compared behaviour during routine water notices with behaviour during natural disaster water notices. We aim to show how the causes and circumstances of routine incidentscryptosporidium oocysts were detected and a routine, precautionary “Boil Water” notice was issued to 258,000 people for ten days. In contrast, in summer 2007, the UK experienced its worst ever floods [At the Pitsford water treatment works in Northamptonshire in June 2008, a routine incident occurred after a rabbit entered the works . Low levr floods . The MytThis section will outline the methods used to study the routine “Boil Water” incident at Pitsford. To ensure comparability, the same study design was employed here as in our previous study of the natural disaster incident at the Mythe water treatment work . It shouA postal questionnaire study was sent to 1000 households affected by the routine incident in February 2009 (8 months after the incident). We obtained postcodes for affected areas from the Drinking Water Inspectorate. The Royal Mail Postcode Address File was then used to provide full addresses within these postcodes, from which 1000 were selected using a random number generator. Any business or school addresses were substituted for a further randomised selection of residential addresses.Ethical approval was granted by the King’s College London Social Sciences, Humanities and Law Research Ethics Sub Committee.The postal questionnaire surveyed respondents’ uses of unboiled and boiled tap water, the advice that they remember receiving and the information sources that they consulted. Mainly close-ended questions were employed, which were a combination of yes/no questions, ranking questions, and “tick only one” and “tick as many as apply” multiple choice questions. The questionnaire was piloted twice on undergraduate students from King’s College London (N = 50), and minor revisions were made to wordings. The final questionnaire was sent out with a detailed project description and a stamped, addressed return envelope. A reminder was sent four weeks later to those who had not yet replied.For ranking questions, where participants ticked rather than ranked options, a single tick was coded as rank one, whereas multiple ticks were given the same rank . Where participants first ranked options but then ticked one further option, the tick was coded as their lowest rank. On “tick only one” questions, multiple ticks were coded as inconclusive, with the exception of the water advice recollection question where multiple ticks were coded as “believed more than one advice was in place” so that uncertainty could be accounted for. For information source questions where respondents ticked “other’ or “website” but then provided additional information, answers were re-coded so that e.g., “television” includes listening, phoning and visiting websites of television channels/programmes whereas “website” includes internet-only sources. Open-ended questions were quantified where possible; e.g., home ownership was translated into the binary categories “yes, home owner” and “no, not home owner”. For all questions, non-responses were coded as missing data and inconclusive replies were largely excluded from analysis.Data were entered into Microsoft Access 2007 and then cross-checked against the original responses. For statistical analysis, data were transferred into SPSS version 16. Once the data had been transferred into SPSS, they were validated a second time. As some respondents did not fully answer some questions, the sample size varies between questions.apriori that non-compliance with water advice would be higher for the natural disaster event compared to the routine incident. In addition, we predicted that demographic factors , drinking water preferences, and use of information sources could have had an effect on participants’ perceptions and behaviours; however, as no formal hypotheses were defined apriori for the impact of demographics, drinking water preferences and use of information sources, statistical outcomes for these variables should be interpreted solely as indicators of the potential strength of association. Quantitative analysis is mainly descriptive. Inferential analysis was carried out using Chi-Square, Mann-Whitney, ANOVA, and Linear Regression. For all analyses with multiple predictor variables, only those variables that were significant at the p < 0.2 level in single predictor models were included in the multiple predictor models. The least significant variable was then removed from the model until all predictor variables were significant at the p < 0.2 level. The value of the model in predicting each dependent variable was then derived from the tests of between subjects’ effects in the corrected model. Throughout, the level of significance was set at 5% and only responses with at least 10 responses were included as dependent variables.As the routine incident only affected the drinking water, that is, other resources such as traffic, communications and electricity were unaffected, we hypothesised This section outlines the key findings from the study of the routine incident, and compares results to the findings from the “Boil Water” notice stage of the natural disaster study .In total, 173 completed questionnaires were returned from consumers who receive mains water from Pitsford water treatment works. Eleven respondents stated that they had not been issued with the “Boil Water” notice. These were excluded from analysis, yielding a sample size of 162 participants. This routine incident response rate of 17.3% is comparable to the 19.5% rate for the natural disaster.We compared the demographic characteristics of the routine respondents with those for the disaster participants, to check for sampling bias . Overallp = 2.1 × 10−9 (2-tailed)).As Participants were also asked to rank the information sources in order of how useful they had found each source for the entire incident. For the routine incident, the water company was ranked highest , whereas for the natural disaster, local radio was ranked highest (53.4%) [The vast majority of routine incident consumers reported receiving water advice . However, there was a lot of confusion regarding which notice was in place . Quite sWe queried how clear the tap water advice was and how well-informed routine incident consumers had felt: 65.0% (n = 104/160) thought the advice was “clear” or “very clear” and 90.1% (n = 145/161) felt “informed” or “very informed”. In comparison with the natural disaster , more roFor the routine incident, advice from the water company/leaflet through the post was positively associated with clear advice and feeling informed; no other information source displayed any association . In the Routine incident respondents were asked to specify their use of unboiled and boiled tap water . Some covs. 70.7%) and overall ingestion compliance (64.6% vs. 51.7%) was significantly better for the routine incident, as confirmed by Chi-Square . For the routine incident, advice from the local radio was positively associated with compliance with ingestion advice, whereas advice from the water company/leaflet through the post was associated with less compliance .As i.e., the incident triggered a routine response) and the second by the 2007 floods.Following the 2007 floods in the UK, the Pitt Review predicted a marked increase in extreme weather and with it natural disaster incidents ; these pInformation source use differed between the two incidents, and the use of information sources was significantly higher for the routine incident. Here, the water company was the most accessed information source and it was also ranked as the most useful. For the natural disaster, on the other hand, the water company and the local radio were used in almost equal measure, but the local radio was ranked as the most useful . We founPrevious routine incident studies have found that between 9% and 20% of respondents drink unboiled tap water despite the “Boil Water” notice ,18,21. FBoth the greater satisfaction with water advice and the notably lower degree of non-compliance for the routine event may be attributable to the fact that Anglian Water’s communication campaign included vans with hailers and information points in the streets. In contrast, the floods of 2007 often impaired many communication methods. The natural disaster incident may have triggered a higher than normal need for geographic-specific information , but it The discrepancy in satisfaction and non-compliance highlights the need for water companies to establish themselves as the primary information source for all water incidents, so that in case of a future incident, whether it be a natural disaster one or a routine one, media and other agencies refer to their advice. It should also be pointed out that for the routine event it was the local radio that was associated with higher ingestion compliance with advice, whereas the water company/leaflet had the opposite effect. Thus, the role of local media as an additional and effective way to disseminate emergency health advice is clear and it is therefore vital that efforts to keep them continuously up-dated during an event are prioritised. It is also essential that all sources of information are instructed to clarify that the need to boil the water extends to all ingestion activities.Even though it is the legal responsibility of the water company to provide temporary water supplies during a water supply failure, Knapton and Rundblad  found th et al.’s [The finding that 41.4% of routine incident consumers believed that there was more than one simultaneous notice echoes the early stages of the natural disaster when a “Do Not Drink” notice was in place (35.2%). These parallel results from the routine incident reinforce Rundbladet al.’s . Recall  et al.’s [Interestingly, a recent study on perceptions about water contaminants found that in an incident-free context, boiling and chilling tap water to drink was highly unfavoured . In addiet al.’s  suggestiuse (rather than specific actions such as drink) were common. As a result, the reporting of the water advice could actually have lessened the public’s motivation to comply with that advice and to take personal responsibility for their own safe water behaviours. There are, to our knowledge, no studies of linguistic techniques in media reports during routine water events.Additionally, Knapton and Rundblad  found thIn the present study of the routine incident, we found no impact of demographic factors on compliance with water advice. It should be noted that whilst there were also no associations between demographics and behaviour for the “Boil Water” notice period of the natural disaster incident, our earlier study did find that whether a person was in paid employment or not was significantly associated with use of unboiled water for ingestion purposes during the “Do Not Drink” notice period . These fAssessing current knowledge of public compliance to water notices is complicated by the various methodologies of previous studies. Whilst some have measured use of unboiled water ,21, otheResponse rates for both the present study and our previous natural disaster study were just below 20%. In the past, surveys of compliance with water notices that were sent out shortly after the incident have yielded response rates of around 65% . HoweverPrevious studies have shown that the greater the time gap between an event and data collection regarding that event, the greater the negative effect on recall accuracy . Largely


Since the discovery of HAM/TSP, little progress has been made on developing treatments. As HAM/TSP usually progress slowly, it can take a long time to evaluate disease activity and decide on a course of treatment. Therefore, there is a dire need for biomarkers capable of predicting the rate of disease progression and “surrogate end-points” that enable new treatments to be assessed more rapidly and with greater accuracy in clinical trials. However, in order to validate surrogate end-points, it is necessary to conduct large-scale, randomized clinical trials – a very difficult feat for such a rare disease. Here we present a recent study on candidate prognostic biomarkers for HAM/TSP and discuss future research directions.