There is a global imperative to respond to the challenge of a growing ‘old-age dependency ratio’ by ensuring the workforce is healthy enough to remain in work for longer. Currently more than half of older workers leave before the default retirement age, and in some countries (e.g. the UK), the time spent in retirement is increasing. At the same time across Europe, there is a gender employment gap, with 14.5% fewer female workers between 55–64 years old, and a large variation in the participation of older women in the workforce (ranging from 30–75%). As older women are under-represented in the workforce, increasing employment in this group has the propensity to go some way towards reducing the old-age dependency ratio to ensure continued economic growth.This review explores the barriers and facilitators to extended working lives in Europe, particularly those that impact on women.International Journal of Aging and Human Development and the International Journal of Aging and Society.A systematic mapping review process was undertaken using four electronic databases, MEDLINE, PsychoINFO, PsychEXTRA via Ovid and AgeLine via EBSCO, using the terms, ‘work’, ‘ageing’, ‘retirement’, ‘pension’, ‘old’, ‘barrier’, ‘extended working life’, ‘gender’ and ‘health and well-being’. Hand searching was also carried out in the The search resulted in 15 English language studies published from 1st January 2005 to the current date that met the inclusion criteria.The key factors that influenced decisions to retire or extend working lives in Europe were health, social factors, workplace factors, and financial security and pension arrangements.Health was found to be the most commonly cited barrier to extended working lives in Europe, and a number of social inequalities to work exist by gender. Structural factors exist, such as the gender pay gap, which disadvantages women, while the nature of work itself differs by gender and can have a negative impact on health. Currently, women tend to exit the labour market earlier than men; however, changes in the state pension age are resulting in women being required to work for as long as men, in most countries. For women to remain healthy at work, workplaces need to consider a range of interventions, including flexible arrangements to both work and retirement to enable women to balance the demands of work with domestic and caring responsibilities that particularly impact on them. People are healthier and live longer today than in previous years, while at the same time they have fewer children than they used to, leading to an increase in the ‘old-age dependency ratio’ . This meTable The lowest retirement ages for women were found in Slovakia, Austria, Poland and Romania, while the highest were found in Denmark, Greece, Iceland and Norway . Also hiWork has been shown to be good for health across all ages , 9. SpecThe European 2020 target is for 75% of the 20–64 year olds to be employed by 2020 . In ordeLooking at the participation in the labour market, there is a gender employment gap which widens through the life cycle, from 8.3 percentage points in the 20–29-year cohort to 14.5 percentage points in the older cohort (55–64 years) . There iOlder workers are mainly employed in manufacturing (14%), human health and social work activities (11%), education (9%) and public administration (9%) and a further 21.6% are self-employed . ChangesGiven the economic imperative to maintain a healthy workforce and increase the number of older workers, this review will draw together the key barriers  and facilitators to extending working lives, with a particular focus on gender.Identifying the research questionIdentifying relevant studiesStudy selectionCharting the dataCollating, summarising and reporting the resultsThe review method was informed by the framework suggested by Arksey and O’Malley  and usedA systematic mapping review process, designed to chart and categorise existing literature in order to identify the main themes and gaps , was usen = 31) within the EU-28 and EEA. Articles were selected based on coverage of factors facilitating or inhibiting extending working lives (EWL). Papers were included from 2005, as a number of retirement policy directives across the EU and nationally have occurred specifically in the last 10 years.The focus of this review was countries  Epub Ahead of Print via Ovid and AgeLine via EBSCO. To support this, hand searching was carried out in the All citations were downloaded into an EndNote library, and duplicates were removed. Initially, the titles and abstracts were screened against the inclusion criteria to identify relevant studies by CEE and a proportion checked by AMC. Following this, the full texts were obtained for those papers marked as included and unsure, and these were screened to obtain the final included list.This process was informed by the paper by Osei-Kwaqi et al. . Followin = 2 [n = 4 [n = 2 [n = 3 [n = 1 [The key characteristics of the 15 included studies in the review are presented in Table n = 2 , 29, UK 2 [n = 4 –33, The 4 [n = 2 , 35, Den2 [n = 3 –38 and G3 [n = 1 , with th3 [n = 1 –42. In f3 [n = 1  study wh3 [n = 1 , 41, thr3 [n = 1 , 39 and 3 [n = 1 , 32–34.THealthSocial factorsWorkplace factorsFinancial security and pension arrangementsThrough the systematic mapping exercise, four main clusters (each of which contained a number of factors) were identified that related to influences on people’s retirement decisions (which vary by occupation and gender) Table :Table 3Sn = 11) of the reviewed studies [The cluster ‘health context’ consisted of four factors: ill health as a barrier to EWL, the negative impact of work on health as a barrier to EWL, positive health benefits of EWLs and the subjective experience of health  as a barrier to EWL. Health was cited in the majority  and countries apart from in two cases. Firstly, a study in the UK found that those with lower educational levels were more likely to need to work for financial reasons, whereas in Germany, the opposite was true as those in lower paid roles were more likely to retire . While iPrimary prevention by means of health promotion; reinforcing healthy lifestyles, counteracting unhealthy lifestyles and improving the physical work environmentSecondary prevention by early detection and treatment of chronic diseasesTertiary prevention through supporting those affected by chronic disease through treatment and rehabilitation .As identified in this review, health is the most frequently cited factor inhibiting EWL and healthier people are found to retire later, which corroborates previous reviews , 43, 44.if used with older workers may benefit their health, well-being and work ability across the life course. These included workplace physical activity interventions and those aimed at risk factors for chronic illness, e.g. smoking, diet and physical inactivity. Similarly, a review in the USA also suggested that workplace-based health and wellness programmes are the key to enabling older workers to extend their working lives [The notion that work itself impacts negatively on health echoes a previous UK policy review of workplace infrastructure . In factng lives . Good prng lives  includedWhile the available evidence from previous reviews and the current review do not allow us to draw specific conclusions about how to improve the health of older women workers to extend working lives, given that they are more likely to be of low socio-economic status and in low paid part-time or temporary jobs, the measures outlined above to reduce work disability could have a proportionately more positive impact on females who are disproportionately clustered in these jobs. Moreover, the key employment-related policies aimed at combatting women’s poverty could subsequently improve their health and facilitate EWL. Such policies include the provision of well-paid parental leave  and the need to extend good quality childcare provision . In addiEducational or employment level was identified in the current review as a barrier and a facilitator to EWL, as in previous reviews , 44. ThiIn respect of the type of work that men and women carry out, women take on more ‘emotion work’ in caring roles. Although this review did not highlight gender differences in unpaid caring roles, an excluded study showed that women take on a significantly higher burden than men . Good quFlexible or partial retirement policies are another potential option to help in the transition from work to retirement . HoweverThis review has highlighted a number of organisational barriers and facilitators to EWL, both physical and psychological, with work-related factors reported in nine out of the 15 papers reviewed , 38–40. Further barriers found in the current review support evidence from previous reviews, which include the barriers as follows: negative or ageist attitudes, particularly in respect of the ability to deal with the demands of a fast-paced and competitive workplace ; and negTo facilitate EWL, Altman  urges thWorkplace factors found to be facilitative of EWL in the current review related to flexible working conditions, working in smaller organisations, effective balancing between resources and demands, the social role of work and voluntary work, as well as making a positive contribution, but also a range of other factors, which are summarised in a number of previous reviews , 45. To Women have been disadvantaged in recent years by changes to the state pension age and the harmonisation of state pension age for men and women, meaning women are forced to work for longer in many European countries including the UK . In factGender has been shown to be a significant predictor of the financial reasons for EWL, and women were more likely to take on bridge employment  for financial reasons than men . This isAddressing the gender pay gap could have a positive impact on the social class of women in Europe, which may reduce their likelihood of working in routine, manual jobs, known to be related to involuntary retirement through disability. Fasang  emphasiswhy older women, in particular, are under-represented and to identify the gaps in the literature.Demographic changes mean that fuller participation in the labour market through EWL is essential; however, older women are an ‘under-represented’ group. As a result, this review has explored the key barriers and facilitators to EWL in Europe and sought to understand The reasons for exiting the labour market are complex and they accumulate over the life course, impacting differently on men and women. Negative impacts of social class on health reduce the opportunity for ‘healthy ageing’, leading to a strong gradient in disability by occupational class, with routine and manual workers more likely to be impacted. Inextricably linked to these socio-economic factors are the impacts of income on retirement choices, and unsurprisingly routine workers, with lower pension entitlements, have fewer options and tend to retire later, unless they have been pushed out through ill health. Within the workplace, physical workload and psychological factors shape retirement choices, particularly in respect of levels of job control, manual work and attitudes towards older workers. Social factors also impact on retirement choices, with push factors associated with wanting to do things outside of work and wanting to enjoy life now, influenced by marital status, and domestic responsibilities.As the reasons for EWL accumulate over the life course and health is the largest contributor to early labour market exit, it is important to focus on the determinants of healthy ageing across the life course  rather than solely focusing on ‘older workers’. In this respect, the literature has highlighted a key gap in the evidence in respect of workplace interventions. The workplace is a key setting for health promotion, and interventions to provide ‘good work’ that promotes health should be a key priority for public health professionals and employers—although more research and intervention evaluations are needed in this area. Improving health in the workplace has the potential to have a greater impact on routine and manual workers and women; two of the groups that are at increased risk of retiring early.without disadvantaging women’s careers. Again, further research is needed; however, given that health is linked to socio-economic position and EWL, policies aimed at reducing the negative impact of discontinuous employment careers are likely to have a positive impact on women, their health, and their ability to extend their working lives.In respect of income and policy changes to statutory pensions, Radl  warns thThis review had underlined the task for policy makers and employers in terms of keeping the workforce not only active in the labour market but also healthy. Many women are now forced to extend their working lives due to policy changes in respect of state pension entitlements, such as the case in the UK. Workplaces must adapt to the needs of older women. To do this, special attention should be paid to the role of individual level factors such as caring responsibilities and macro level factors such as opportunities for training and development and challenging unhelpful social norms and stereotypes. Finally, for women to remain healthier in the workforce for longer, it is essential that their unique needs are protected and the workplace is both aware of these needs and, in response, is flexible in its approach to extending working life.


We explored the quality of life of adults with cerebral palsy without an intellectual disability and the predictors of quality of life.Because cerebral palsy is a disease that manifests in childhood, much of the research into quality of life for those dealing with it focuses on children; there are few studies that evaluate the quality of life of adults with cerebral palsy. Therefore, it is important to consider their perceptions in order to improve their general wellbeing and self-determination.This was a descriptive, cross-sectional study.Quality of life was measured using the GENCAT Quality of Life Scale. Demographic and personal variables were also collected and examined. Participants comprised 75 adults  with cerebral palsy who were members of the National Cerebral Palsy Association of Spain between 2014 and 2015. A linear multivariate model was examined as well.The overall mean score indicator of participants’ quality of life was 103.29, which corresponds to the 56.6th percentile on the GENCAT scale. Examining the level of qualification, we found significant differences in the factors “personal development” and “self-determination,” and those with a university education obtained higher scores than their less-educated counterparts. Having a partner was related to higher quality of life standard scores. After constructing a linear model, it was observed that maintaining sexual relationships was another factor that increased participants’ quality of life.This study highlights the importance of social and romantic relationships to achieve a better quality of life in adults with cerebral palsy who do not have an intellectual disability. Social integration and sexuality education programs should be developed to improve their quality of life. The concept of cerebral palsy (CP) has evolved over time –3; it isThe concept of Quality of Life (QoL) is relatively new in health evaluation. It is difficult to define the concept because it is not a simple notion. Although there is as yet no consensus on defining criteria, most of the international scientific community accepts that it includes the fulfillment of eight basic needs that represent the essence in everyone’s existence: emotional, economic, and physical well-being, interpersonal relationships, personal development, self-determination, social inclusion, and rights . SeveralFor disabled persons, gaining self-determination is paramount as it implies a willingness to take control of one’s own opportunities, decisions, and environmental conditions , 14. ThiDespite some progress having been made, the participation of disabled people locally, regionally, or nationally in the agencies where their life decisions are made is still low; even associations for persons with disabilities generally have administrations that are led by people without those disabilities. It is unknown whether this problem exists because disabled people do not have the qualifications to fulfill these positions or because people’s expectations of disabled individuals are too low. Either way, the qualifications of disabled people are an important factor on the path to self-determination and promoting a better QoL , 21.Although several studies evaluating the QoL of people with CP have been conducted focusing on young people or children –25, mostTherefore, in this study, we analyzed the QoL of adults with CP who did not have an intellectual disability to elucidate relevant sociodemographic factors and predictors.This was a descriptive, cross-sectional study conducted in 2014 and 2015.For this study, we employed a purposive sample comprising adults with CP without intellectual disability (N = 93). General intellectual functioning was defined according to the Wechsler Adult Intelligence Scale (WAIS-IV), adapted to the Spanish population, as individuals with a score of 70 or higher, according to Wechler's classification . InclusiCerebral Palsy Spanish Association and Asturias’ Research Ethics Committee (n° 112/17) approved this specific study. The questionnaire introduction explained the main objective of the study, assured privacy and confidentiality, and briefly described how to correctly complete the questionnaire and informed consent form. A data collection sheet and the GENCAT scale were self-administered by all participants, as we considered it necessary that participants should complete this information independently. Doing so ensured a higher level of accuracy and truthfulness, and simultaneously promoted their rights and freedom of expression as individuals. The instructions to complete the form were provided by the same professional  who was present during the collection period.never or hardly ever,” “sometimes,” “frequently,” and “always or almost always”).The QoL GENCAT scale was used to collect the data . This scIn the GENCAT Scale, different scales according to the type of the studied population exist: general population scale, elderly population scale (aged 50 years and older), disabled people with an intellectual disability scale, and a scale for other groups . We used the “physical disability and mental health problems” scale.Furthermore, we evaluated the factors and life conditions that, according to research, have some impact on QoL , 12, 29.Sociodemographic data was initially gathered using 28 questions. All were shown to 10 professionals  to evaluate their meaning. Once their contributions were collected, only items that had an agreement average above 75 percent were included in the questionnaire. This resulted in 10 final items: age, gender, Gross Motor Function Classification System score, place of residence, adapted home, people with whom they live, qualifications, partnership, active sexual relationship and first sexual relationship. The item “adapted home” refers to installing devices in one’s home that make daily life easier. The item “Gross Motor Function Classification System” , 31 is aThe obtained data were computationally processed using SPSS 20.0 for Windows PC (licensed to the University of Oviedo). To describe quantitative variables, an arithmetic mean was used as a measure of central tendency and standard deviation (SD) and rank were used to measure data dispersion. Total frequencies and percentages were used to describe qualitative variables. The qualitative variables were compared using Pearson’s chi square test. To analyze quantitative variables among two groups, the student t-test for independent samples was applied. If a qualitative variable had more than two categories, an ANOVA was carried out after verification of the normality hypothesis (Kolmogorov Smirnov Test) and a Tukey post-hoc test was performed when the differences were statistically significant. To study the linear relation among quantitative variables, a Pearson correlation was calculated.Finally, a linear multivariate model was designed. The level of statistical significance applied through the whole study was set at p < .05.This study was approved by the ethics committee of the National CP Association and Asturias’ Research Ethics Committee (n° 112/17).p = .001).Participants’ characteristics are presented in It is important to note that the overall mean score indicator of the participants’ QoL was 103.29, which corresponds to the 56.6th percentile on the GENCAT scale . The items with the lowest mean score were “has a satisfactory sexual life”  and “presents with depression symptoms” . Those with higher mean scores were “has good personal hygiene”  and “reports feeling loved by the most important people to him or her” .When analyzing the eight factors that compose QoL and relating them to the different sociodemographic variables we found the following results. A relationship between age and “personal development” was identified. This factor was increased in the youngest participants. It was observed that people who lived in their own residence had a higher level of self-determination than those who lived in a center or group home. However, those who lived with family or at a center obtained higher scores in the “social inclusion” factor than those who lived in their own residence. In addition, those who had their homes adapted obtained higher scores for the “physical wellbeing” factor. Participants who lived with their partner obtained a higher score in the factors “interpersonal relationships,” “personal development,” and “self-determination.” Examining the level of education, we found significant differences in the factors “personal development” and “self-determination.” Moreover, those who currently had a partner obtained higher scores in “interpersonal relationships,” “personal development,” “rights,” and the global QoL index. Finally, participants who maintained sexual relationships had higher scores in “interpersonal relationships,” “personal development,” “self-determination,” and the global QoL index Tables  and 3. HPost-hoc subgroup analyses, presented in To study the possible relationship between sociodemographic variables and the GENCAT scale, we developed a linear model. For this, we included variables that showed p-values lower than .20 derived from the previous analysis  and the variables age and sex. We determined that the “maintenance of sexual relationships” was related to the GENCAT and increased QoL .The aim of this study was to analyze the QoL of adults with CP who did not have an intellectual disability and investigate possible predictors of a higher QoL.The overall mean score indicator of participants’ QoL was 103.29, which corresponds to the 56.6th percentile on the GENCAT scale. This means adults with CP tend to perceive their QoL the same way the general population does. Consistent with this finding, Hergenröder and Blank  reportedWe agree with Davis et al. , who affWith respect to sociodemographic variables, we focused on middle-aged adults with CP (mean = 40.84 years). In other studies, very little information about this age range exists. Most publications were centered on children and adolescents , 33. SomRegarding place of residence, we found it striking that most participants lived in their family home; however, almost half had not had their home adapted. Comparing our results with other studies that investigated the places where adults with CP reside, Blum et al.  showed sRegarding participants’ educational level, the data showed a declining percentage and an inverse proportional relationship with age. The percentages of our study are different from those obtained by Hergenröder and Blank , who conRegarding personal relationships, consistent with other studies, 71.8 percent reported that they were not currently involved in a sexual relationship. In Van der Dussen et al. , 87.5 peThe results of this study must be interpreted within the context of the sample. These findings cannot be extrapolated to other conditions due to the specificity of the sample. Although the participation rate could be considered high, there is a possible overrepresentation of adults classified as level 5 in GMFCS. Further studies involving a larger sample size and including other countries and cultures need to be conducted to strengthen these conclusions. Moreover, it is possible that some participants did not feel comfortable discussing relationships and sexuality with a female researcher . Furthermore, it could be interesting to analyze CP classifications and possible differences depending on the type or distribution . HoweverThe QoL conceptual framework created by Schalock and Verdugo  was a us


We recently published our review with the title: “Fucosylated Antigens in Cancer: An Alliance Toward Tumor Progression, Metastasis, and Resistance to Chemotherapy” in Frontiers in Oncology.endothelial to mesenchymal transition” instead of “epithelial to mesenchymal transition.”However, we noticed that there is a mistake in the abstract of the article. Specifically, the abstract mentions “We are submitting this Corrigendum in order to clarify the error and apologize for any confusion by the readers.The correct sentence should read: “Here, we review the relevance of tumor-overexpressed FUTs and their respective synthesized Lewis determinants in critical aspects associated with cancer progression, such as increased cell survival and proliferation, tissue invasion and metastasis, epithelial to mesenchymal transition, endothelial and immune cell interaction, angiogenesis, multidrug resistance, and cancer stemness.”The original article has been updated.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Consider a mosaic image, the edges of the tesseræ being unrelated to pictorial content. Depending upon grout color, the picture is seen as uninterrupted “behind bars” or divided into tiles by “cracks” as in an ancient oil painting. The phenomenology is explored. We serendipitously discovered a visually striking effect that we so far have not heard mentioned before—but we keep asking around.Illusoria Mente; see In a number of experiments , 2012b aConsider the images juxtaposed in craquelure as it often occurs in paintings. These are cracks that are unrelated to the pictorial content;– the picture could disintegrate into mutually unconnected, although related, tiles. Here, we concentrate on the case of grout. The seams may or may not relate to the pictorial content;– the picture could appear as a mosaic, perhaps like a stained glass window. The pieces would indeed be fragments, but “glued together” by the behind a trelliswork so to speak, the lines not appearing as grout, but as an open trellis in front of the picture. There would be an obvious depth relation where the trelliswork and the picture would appear unrelated and mutually disconnected.– the picture could appear as unscathed, running on In our previous work (The following generic forms of visual awareness could conceivably arise:ous work , 2012b, the same picture, and the same mesh, merely depending upon the gray level of the grout. With the black grout, we perceive a “cracked” picture a bit like an old oil painting showing craquelure of the varnish. With the white grout, the picture apparently has an integral surface that runs on behind a trelliswork in front of it. At first blush, the difference is striking. However, with some effort, one is sometimes able to switch between the two appearances. We found that for some observers, the effect is bistable. Some observers are able to voluntarily “flip.”The second and third cases are realized for In cloisonnism in painting, craquelure in aged oil paintings, kintsugi (the repair of broken pottery with gold-colored cement, The finding has various potential applications in visual arts and design, and in art history. Cracks due to technical constraints mosaics,  or artisVarious speculations as to the origin of the effect readily come to mind, but for this short communication we leave it at that.


Objective. To conduct a scoping review to characterize how fever is viewed in anthroposophic medicine (AM) and discuss the scientific validity of these views. Methods. Systematic searches were run in Medline, Embase, CAMbase, and Google Scholar. Material from anthroposophic medical textbooks and articles was also used. Data was extracted and interpreted. Results. Most of the anthroposophic literature on this subject is in the German language. Anthroposophic physicians hold a beneficial view on fever, rarely suppress fever with antipyretics, and often use complementary means of alleviating discomfort. In AM, fever is considered to have the following potential benefits: promoting more complete recovery; preventing infection recurrences and atopic diseases; providing a unique opportunity for caregivers to provide loving care; facilitating individual development and resilience; protecting against cancer and boosting the anticancer effects of mistletoe products. These views are discussed with regard to the available scientific data. Conclusion. AM postulates that fever can be of short-term and long-term benefit in several ways; many of these opinions have become evidence-based (though still often not practiced) while others still need empirical studies to be validated, refuted, or modified. Personal Note and Outline of the Structure of This Article. We were a family with 5 children. Our parents and our family physician treated feverish illnesses with the greatest respect and always managed to make us feel safe and comfortable without suppressing the fever. None of us ever received an antipyretic . The uncritical and widespread use of antipyretics and antibiotics I witnessed as a student and physician therefore seemed a strange and unphysiological interruption of a natural and, from my experience, healthy process. Our physician was an anthroposophist, so I began to enquire: What is anthroposophic medicine? What are its main statements about fever? Do these statements have any scientific basis? The first question will be addressed in Introduction; the results of the second question are presented in Results as statements. Discussion picks up each of these statements and relates them to current scientific literature.In their 2016 editorial “Fever Phobia 35 Years Later: Did We Fail?” . ConsideWhat Is Anthroposophic Medicine (AM)? Anthroposophy is an approach to life that began its development a century ago and has inspired countless ecologic, agricultural, social, educational, economic, pharmaceutical, and therapeutic ventures throughout the world  OR “fever” [All Fields] OR “febrile” [All Fields] OR “Fieber AND anthroposoph∗” [All Fields]). Search B. CAMbase, a German bibliographical database system for complementary and alternative medicine (http://www.cambase.de/), was searched for the words “(Fieber OR Fever) and anthropos” and for “Fieber OR Fever”. Google Scholar was included to find grey literature.Textbooks on anthroposophic medicine –22 were The publication is published in a peer-reviewed journal or is a text-book on anthroposophic medicine.The publication contains views about fever.Inclusion criteria for a written publication to be used for There were no further exclusion criteria.Statements that present the anthroposophic perspective on fever were extracted from the text, coded, sorted, and clustered into generic statements by the author as personal résumé and interpretation. The statements are presented in Search C. Since the author has in the course of time collected a lot of literature in favor of these statements, he concentrated the further search on finding data that put these statements into question. The main of these searches, Search C, was performed in PubMedCentral (PMC) with the words “fever AND ”.59 publications discussed or referenced either studies examining the connection between atopy and children living an “anthroposophic lifestyle” , or stu Viscum album, some of which discussing fever as part of the anticancer action of Viscum album extracts,10 publications discussed or reported the fever-inducing effect of anthroposophic cancer remedies containing8 publications discussed or referenced other or general aspects of AM not directly related to the management of fever,10 publications expressed anthroposophic opinions about fever, including a focus group study of factors that influence vaccination decision-making by parents who visit an anthroposophical child welfare center , 23–30.Search A produced 93 hits from which 87 publications were relevant to fever and AM. Of these see also ,59 publiThe search in Embase did not add any more relevant references.Search B did not add any more relevant references.The leading motif in anthroposophic medicine is that warmth and, in desease, fever are direct manifestations of the “self” working on the body, making the body more an instrument and expression of the “ego,” the “I” (in German “das Ich”) , 25–27.Fever may allow faster and/or more complete resolution of infections , 26–29.Fever may prevent recurrent infection –22, 26.Fever may assist immune maturation in children , 25–27.Fever may protect against developing allergic diseases –22, 26.Fever may help resolve allergic disease –22, 26.Fever offers a unique opportunity for caregivers to provide loving care –22, 26.Fever may facilitate individual development and creativity , 23, 28.Febrile illness may help a developing child take ownership of their body towards a better expression of their unique individuality and to overcome inherited  traits , 26, 28.Febrile illnesses may be protective against cancer , 25, 30.Some febrile illnesses may contribute to curing cancer , 20, 25.Febrile reactions to injecting mistletoe products in cancer treatment may improve treatment outcome , 24, 30.Antipyretics such as acetaminophen and ibuprofen should be used sparingly: only if other means of relieving discomfort fail or if fever needs to be suppressed for other medical reasons , 25–27.The findings were extracted from the text, coded, sorted, and clustered into generic statements by the author, leading to the following thirteen statements. In Search C, in PubMedCentral (PMC) with the words “fever AND ”, led to 445 hits. A scan of these papers and their respective reference lists for evidence speaking against the above statements led to studies indicating that fever may also be detrimental in rare, very particular circumstances –38 that  The leading motif in anthroposophic medicine is that warmth and, in diesease, fever are direct manifestations of the “self” working on the body, making the body more an instrument and expression of the “ego,” the “I” (In German “das Ich”) , 25–27.The discussion is structured around the anthroposophic perspectives on fever as they are stated in thirteen resulting statements listed in  “Fever may allow faster and/or more complete resolution of infections” , 26–29.Case vignette: A publication on the anthroposophic approach to pneumonia reports a 10-year-old girl with a pneumonia that developed from a flue (she had been stressed by fears of entering secondary school and much discussion about this in the family). She was treated without antibiotics and on the 5th day still had fever despite the fact that the coughs were loosening. Examination revealed cold feet and back despite high fever, upon which she was treated with 2 water bottles on her feet and massaged with a silver cream (Argentum 0.4% Ungt.) on her back. On the next day the temperature fell and 2 days later she was free of fever. The subsequent entry into secondary school was unproblematic .This is a notion specific to anthroposophy. It is related to the whole breadth and depth of what human warmth is and can be, including social life and human will, and the increasingly autonomous and differentiated relationship that animals have had to warmth throughout evolution. This topic goes far beyond the scope of this article. It is, however, worth mentioning that human “warmth,” the most powerful personality trait in social judgment, is enhanced by physical warmth , 44. “FThe positive attitude of anthroposophic physicians with regard to fever has support from the evolutionary point of view. Fever is a highly conserved evolutionary host response with survival and salutary benefit. Fever is one component of the acute phase response, which is a complex physiological reaction to disease or injury, and elicits cytokine mediated rise in core temperature, generation of acute phase reactants, and activation of a number of physiologic, endocrinologic, and immunological effects . Even thBut if fever really were so important, would we not have genetic models of animals or humans who are unable to produce fever and have worse outcomes? There may be such models on the horizon: In a study showing that early and strong immune responses are associated with control of viral replication and recovery in Lassa virus-infected Cynomolgus monkeys, the authors noted absence of significant fever in nonsurvivors despite high levels of IL-6 . In anot Klebsiella pneumoniae, the lung [ “Fever may prevent recurrent infection” –22, 26. “Fever may assist immune maturation in children” , 25–27.The improved immune function during febrile temperatures has to be weighed up against metabolic costs and potential damage to sensitive organs such as the brain, possibly the fetus , 32, andthe lung . Thus, ithe lung . Neverththe lung . A very the lung . “FeverIn analogy to the loss of memory performance when sleep is disturbed, AM proposes that interrupting the fever phases may impair disease resolution and long-term immunity. Anthroposophic physicians report that patients, especially children, often stop having recurrent infections after experiencing an acute febrile illness without use of antipyretics or antibiotics –22, alth “Fever may protect against developing allergic diseases” –22, 26. “Fever may help resolve allergic disease” –22, 26.The findings that the risk of islet autoantibody seroconversion and subsequent development of type 1 diabetes was associated with respiratory infections during the first 6 months of life (a time at which the children are often not yet able to develop fever and when height of fever is correlated with severity of disease ), but no “Fever offers a unique opportunity for caregivers to provide loving care” –22, 26.These are topics that deserve future research. There is controversial evidence that use of acetaminophen in the first year of life and in later childhood is associated with an increased risk of asthma, rhinoconjunctivitis, and eczema in children and adults , 70. How “Fever may facilitate individual development and creativity” , 23, 28. “Febrile illness may help a developing child take ownership of their body towards a better expression of their unique individuality and to overcome inherited  traits” , 26, 28.Some children with autism appear to become more socially adept during and after a febrile infection , 79. Suc “All I would suggest is that the future had begun to register a new design in my blood, and that the fever marked the beginnings of its struggle for awareness” [ “Fever may be protective against cancer” , 25, 30.Biographical accounts of the role of acute febrile illnesses in facilitating developmental steps and helping to find new individual creativity are aspects of fever that have yet to become subject to scientific investigation. Johann W. von Goethe, for example, suffered several severe acute febrile illnesses and felt he came through each time with new impulses . Laurensareness” . In anthareness” , 26–28 tareness” , 26–29. areness” . Howeverareness” . No suchFrom an anthroposophic point of view, health arises in an actively maintained, ongoing, and dynamic balance between polarities, each of which represents a pathological direction. Living nature manifests itself everywhere within polar opposite forces, which are working together in rhythmical alternations . One suc Some febrile illnesses may contribute to curing cancer , 20, 25.From an anthroposophic point of view, many illnesses can be assessed in terms of their relationship to the “inflammatory” and “hardening” poles: childhood cancers such as leukemias and embryonic tumors are more related to the “inflammation” pole whereas the common solid tumors of the adult develop in a more “hardening” context. Life processes that lose their organic connection with their antagonists may become isolated and move towards the direction of “hardening”: this may lead to microcalcification, autoimmune processes, or even cancer as a consequence of loss of immune surveillance. These “hardening” processes can trigger more or less helpful “inflammatory” counterregulations. While chronic inflammation can lead to sclerosis and cancer , there iAnthroposophic physicians may at times actually attempt to support and elicit fever, particularly in cancer treatment. Metabolic processes and biochemical reaction rates across numerous cellular functions of immune cells are increased at temperatures that simulate naturally occurring fever, for example, leucocyte proliferation, maturation, and activation, neutrophil and monocyte motility, migration, phagocytosis and pinocytosis, T cell expansions, activation and cytotoxic activity, antibody production, dendritic cell antigen processing  and pres “Febrile reactions to injecting mistletoe products in cancer may improve treatment outcome” , 24, 30.This question was the starting point of a fascinating story of cancer research and personal courage in the course of which surgeon Coley (re)discovered that erysipelas  can lead to complete cancer remission. Of the 1200 documented patients he treated with Coley-Toxin 270 patients with nonoperable, often metastasized, cancer reportedly went into complete remission , 98. In Viscum album L.) for cancer treatment was first suggested by Steiner, who emphasized that fever induction was essential for the success [ Viscum album extract usually only induces fever in the first weeks [The use of mistletoe . The re success , 112–114 success , 115. Itst weeks . Chronotst weeks . Interesst weeks . These c “Antipyretics such as acetaminophen and ibuprofen should be used sparingly: only if other means of relieving discomfort fail or if fever needs to be suppressed for other medical reasons” , 25–27.Mistletoe injection products have been shown to increase quality of life , 118–120Although many mainstream hospitals and practices have not yet translated this into practice , there iBeyond suppressing the benefits of fever, pharmacological antipyresis has its own risks: a review financed by ibuprofen distributors  could noThe suppression of the acute phase reaction symptoms and the slightly euphorizing effect of antipyretics is likely to increase interaction with other people and the rate and duration of viral shedding, as has been shown in human volunteers  and ferrUsing antipyretics to relieve symptoms may not always be straightforward: in a placebo controlled study paracetamol did not increase well-being or fluid intake but suppressed the urge to rest  . AnotherAnthroposophic physicians rarely resort to antipyretics but are aware, firstly, that fever can be the sign that the body is reacting against something going seriously wrong, such as meningitis or pyelonephritis. Second, just as the normal and necessary blood pressure reaction to exertion can be dangerous for some, so can fever, and there are situations in that it may be maladaptive and deleterious as reflected by naturally occurring cold-seeking behavior in such cases. A brain that has just been damaged by hypoxia may benefit from hypothermia . In someAnthroposophic medicinal products are prescribed by approximately 30,000 physicians in 18 of the 27 EU member states and in 67 other countries throughout the world . CaregivPatients beginning fever due to an acute infection usually feel cold and shiver despite rising temperature. In this case they need to be warmed until they feel warm all the way into the extremities. This reduces (1) the work of increasing body temperature, (2) the uncomfortable chills, and (3) maybe even the risk of febrile seizures; there are no studies on this to date. Note that this does not apply to exceptional situations such as brain injury, in which case cooling may be advantageous. In anthroposophic households, fine wool or cotton nightwear and cotton sheets are used to maximize “breathing” capacity; cheap synthetic fibers often lead to heat congestion. Plenty of warm teas  and, if hungry, easily digestible food (soups and fine porridges for the younger children) are recommended in this phase. Once the plateau of fever has been reached, heat can be gently released so as to prevent sweating, yet avoiding chills. The caregivers should be able to judge the warmth, breathing, color, and circulation of the patient. Cold feet need attention. Attention must also be paid to the excretory capacity of the body in terms of urine, stools, and sweat. An atmosphere of peace and quiet, free of electronic media and social stress, is seen as conductive to a good and salutogenic course of the illness. Caregivers who interpret febrile illnesses as opportunities for bonding, for cuddly times, and for stories read or told, gentle massages, songs sung, beautiful candle-light surroundings, and warm bonding can engender a lasting feeling of trust, thankfulness, and fond memories in their patients, be they young or old. Various forms of internal and external applications can be learned by parents and carers to help patients through the course of an infection. The most common applications are compresses using lemon , ginger (on kidney/chest area), mustard (on chest), or quark (on chest), depending on the need and constitution of the patient. Enema can relieve discomfort, constipation, and dehydration  . Anthrop Fever is a self-regulated phenomenon and does not, in a normal healthy patient with an acute infection, cause harm of itself. Going through a feverish illness may contribute to individual development and long-term health and should be accompanied in a way that fosters salutogenic competencies. Since it is self-regulated, there is no temperature above which the natural fever of acute infections must be lowered per se in normal children [ should be reserved for the cases in which the fever is endangering the patient, such as in severe sepsis or brain injury, where cooling is advantageous, or causing distress and malaise and alternative ways of easing their suffering fail or seem inadequate. Beware of the underlying causes of fever and carefully accompany fever instead of suppressing it. Other views with regard to the long-term benefits of fever still await empirical confirmation, negation, or differentiation through further research.Scoping the available literature and views within the anthroposophic medical community led to thirteen opinion statements about fever. Many of these views are now well substantiated scientifically and slowly finding their way into the practice of mainstream medicine : Fever ichildren . AntipyrIt is important for anthroposophically inclined practitioners, carers, and patients to be aware of the fact that the scientific investigation of the effects of febrile infections on short- and long-term health and development in humans is only beginning and that many salutogenic effects , 97–105


In recent years, Twitter has been applied to monitor diseases through its facility to monitor users’ comments and concerns in real-time. The analysis of tweets for disease mentions should reflect not only user specific concerns but also disease outbreaks. This requires the use of standard terminological resources and can be focused on selected geographic locations. In our study, we differentiate between hospital and airport locations to better distinguish disease outbreaks from background mentions of disease concerns.Our analysis covers all geolocated tweets over a 6 months time period, uses SNOMED-CT as a standard medical terminology, and explores language patterns (as well as MetaMap) to identify mentions of diseases in reference to the geolocation of tweets. Contrary to our expectation, hospital and airport geolocations are not suitable to collect significant portions of tweets concerned with disease outcomes. Overall, geolocated tweets exposed a large number of messages commenting on disease-related news articles. Furthermore, the geolocated messages exposed an over-representation of non-communicable diseases in contrast to infectious diseases.Our findings suggest that disease mentions on Twitter not only serve the purpose to share personal statements but also to share concerns about news articles. In particular, our assumption about the relevance of hospital and airport geolocations for an increased frequency of diseases mentions has not been met. To further address the linguistic cues, we propose the study of health forums to understand how a change in medium affects the language applied by the users. Finally, our research on the language use may provide essential clues to distinguish complementary trends in the use of language in Twitter when analysing health-related topics. The increase in life expectancy through better health of the world population has mainly been achieved through advancements in the fields of medicine, biology and microbiology . HoweverModern sources of data such as search engine queries  and onliGiven the richness of this source, we take advantage of the rapid availability of data, textual features and geolocation provided from Twitter. We focus on the full range of illnesses, including infectious and non-communicable diseases, to determine the scope of disease mentions in social media. The origin of the tweets is given special attention to contrast hospital geolocated tweets with those from airports. Furthermore, we address the linguistic cues, provided by the users, when health is discussed. By comparing both infectious and non-infectious diseases, we hope to discover if language and/or locations features can be used to uniquely characterise these categories. This research is based on the hypothesis that large-scale social media data can provide new insights about the health state of the population through the analysis of language and with a focus on location.Twitter is a prime news medium where a wide range of illnesses are discussed. This enables the detection of different patterns in the discussion of selected diseases, and as a consequence allows linking of worldwide events with such disease mentions.Considering the location plays an important role in determining the relevant health mentions and in monitoring specific areas for their distribution of health mentions. As a primary assumption, we expected that a hospital location would inflate the number of disease mentions, given the purpose of the location.Different language styles could be predominant when communicating different illnesses; knowing the language patterns could help to identify non-explicit mentions of a given disease. Furthermore, different language patterns may be attributed to different locations.Our research is based on the following assumptions: In the health domain, there is an increased interest in the use of social media analytics. The first exploitation of Twitter in this regard was performed by  to improGiven this, there is still research to be conducted regarding how the proximity to disease-prone locations influences Twitter users, especially at a language level. In addition, these findings could elucidate on what and how information is shared. There is also a lack of research regarding the identification of multiple diseases from tweets, although, this is partially addressed by topic modelling approaches , 33.Following the same principles described above, the analysis of language could be used to distinguish non-communicable disease mentions in tweets from infectious disease mentions. For example, it is expected that users apply a different language when being concerned about cancer and food poisoning. So far, Twitter has been used to analyse specific disease outbreaks, which required to capture specific mentions of disease. By contrast, we observe in this study the full spectrum of disease terms to better analyse the language use of disease mentions on Twitter for the outbreak or trend development of different disease types.Furthermore, we use the geolocation to differentiate Twitter use for hospital visitors in contrast to airports. In our primary assumption, we expected that Twitter use in hospitals is focused on specific disease mentions, whereas the use of Twitter at airports could form an indicator for the early detection of communicable diseases. Certainly, the geolocation restricts the amount of Twitter data and the use of medical terminology for the identification of disease mentions may not necessarily reflect the mention of diseases in the daily common language in the use of Twitter. However, monitoring the full amount of data published through Twitter should give sufficient input to analyse the questions addressed above.The collected Twitter data amounts to 58’751’297 tweets gathered between the 26th of October 2016 and the 27th of March 2017. This was performed using the Twitter application program interface (API)  by colleWith this partition of the data, we can focus on identifying the differences that location poses on the frequency and language for distinct illnesses. In particular, the targeted locations that constitute “disease hot spots” due to their nature. Increases in international travel are raising concerns regarding travel-associated illnesses , and hosClinical terms have been collected from the Systematized Nomenclature of Medicine – Clinical Terms , the refTweets contain a variety of special characters, therefore, we applied five modifications to increase the performance of the pattern identification: (1) the disease term, if present, was normalised into “DISEASE”; 2) usernames, defined by words immediately preceded by the symbol @, were replaced by “@username”; (3) URLs were replaced by “URL”; (4) the @ symbol was replaced by “at” when not succeeded or preceded by a word; and (5) the remaining punctuation symbols have been removed. Subsequently, each tweet was tokenized and a Part-of-Speech (POS) tag was assigned to each token. These steps were performed using the TweetTokenizer and the POS tagger from Python’s Natural Language Tool Kit (NLTK) package , as well usernameThe disease terminology collected for this research includes polysemous terms mainly due to the presence of synonyms for some of the illnesses. Although the consideration of synonyms allows for a more appropriate representation of the layman language used on Twitter, it can also lead to the dubious semantics of the terms, rendering the tweet unusable for monitoring the health status of the population sample. To address this issue, we apply Named Entity Recognition (NER) techniques. With this, we try to classify entities (i.e. disease names is this case) contained in each tweet. Given that disease terms are not common entities in NER tools provided by popular services such as Stanford NER  and GATEThe retrieval and filtering of the clinical terms amounted to 21’080 disease names and 19’813 synonyms. Both numbers differ due to the lack of synonyms for some disease terms.The full analysis of all 58’751’297 with regards to disease mentions and geolocation produced the following result: 242 messages are within the 3 km radius of airports, 132 occur near hospitals, and the remaining 10’242 are assigned to the geolocated collection. From the 132 messages within the 0.2 radius from hospitals, 3 are simultaneous within 3 km of airports. In total, 10’613 potentially relevant tweets have been identified, i.e. containing a disease mention that could be normalised to the disease terms.Given the contrast between the number of hospital locations and airport locations, the smaller number of retrieved messages occurring near hospitals suggest that: (1) the proximity to hospitals does not induce a significant number tweets covering disease mentions; and (2) there seems to be only a small number of users (with geolocation activated) tweeting near hospitals.Further analysing the complete set of 10’613 tweets, 493 disease terms and synonyms have been identified in the data set, with 302 present in more than 1 message. As a first step, we utilised tweets in each collection to determine the distribution of the disease terms. For the hospital and airport tweets, results are shown in Figs. The results show that 21 disease terms are common to all collections, which include“viral hepatitis”, “always sleepy”, “heart failure”, “kidney stone”, “brain damage”, “mosquito bite”, among others. “Knocked out”, “Lassa fever”, “heart disease”, “substance abuse”, “mental disorder”, and “culture shock” are present in high frequency in both collections. The term ‘human immunodeficiency virus” (HIV), the most frequent in the airport collection, is absent in the geolocated and hospital collections. Upon further inspection, it was found that these messages were created by an organisation, which raises awareness of stigma, to share information about HIV related news.Additionally, we compare the least frequent terms in all collections. For the geolocated sample, 383 terms appear in less than 10 messages. In the airport collection, 50 terms have a frequency below 10. The hospital collection has 55 terms with a frequency lower than 5. Considering the three samples, “multiple myeloma” is the only term common to all. Upon further inspection of the low frequency tweets, it was clear that personal statements were vastly more common than the presence of news titles, especially in the geolocated collection. For the airport and hospital collections this occurs to a lesser extent.These results suggest that less mentioned terminology, in our dataset, is correlated with an increase in personal messages, which are useful to monitor the population’s health, and more frequent term occurrences are inflated due to the repetitiveness of news article titles. However, term specificity is another important factor. Disease terms such as “acute laryngopharyngitis”, “metabolic acidosis”, “segmental vitiligo”, and “plantar fasciitis” use specialised terminology of which the vast majority of the population is unaware. This may suggest the frequency of 1 for these terms. On contrary, terms such as “bee sting” and “mosquito bite”, although appearing in 5 messages, use informal terminology more characteristic of Twitter’s users.For the second step, we consider all collections as a single dataset. For the remaining of the paper, we will focus on terms with an occurrence frequency above 199; this subset corresponds to ∼ 50% of the Twitter data collection hence we believe it to be appropriate for further analysis and it provides a reasonable amount of messages for each disease mention. Additionally, we utilised this threshold given the high volume our data and to guarantee readability throughout the paper. All the terms found correspond to the diseases’ clinical terminology, i.e. the terms are not synonyms. The filtering of terms with more than three words reduced the complexity hence their presence in the data set, given that we expect simple English to be preferentially used in Twitter. The disease terms range from clear health-related terms  to clinically less relevant terms (e.g. “knocked out”). All messages with a disease term have been further analysed to determine the distribution of terms and the use of language in the tweets. The results of this analysis are partly presented in Table Considering the disease terms “knocked out” and “culture shock”, the messages may use the terms in a non-clinical sense. The first term can be interpreted and often be used in the sense of elimination , and “culture shock” is mostly used as a company name (e.g. “Cool new socks! Made in Chicago USA! at Culture Shock - Clothing and Records URL”). Similarly, “cat ear” clinically corresponds to a malformation of the inner ear ; howeverOur analysis and findings reveal that there is a strong presence and influence of news articles and their distribution on the use of medical language when properly analysing Twitter feeds. The majority of disease terms occur frequently in tweets with reference to specific news articles or explicitly repeat the article title. As a conclusion, news media are the source explicit disease term mentions and their frequency form a systematic bias to disease mentions and have to be excluded when analysing Twitter feeds for surveillance. This also shows that Twitter users give high relevance to news media; this phenomenon could receive particular relevance when determining the impact of campaigns (exposed as specific news events) that target given diseases (e.g. awareness campaigns). Furthermore, a short-term peak in the frequency of a disease term aligned with the increase in related news articles can be exploited as an indicator for changes in public concerns, perceptions, and opinions for an illness, or could be removed as an obvious distraction from the surveillance analysis.For all 10’613 messages  website  and GoogThese findings suggest that attributing a location may reduce the capability of identifying disease outbreaks mainly relating to the high volume of news media content. In addition, the presence of news media hinders the content analysis of Twitter with the goal of monitoring the health state of a population.Our POS analysis with regards to the disease mentions shows that the most frequent POS patterns are singular nouns , and singular proper nouns . To a lesser degree, we identified adjectives , verbs in base form , and prepositions or subordinating conjunctions . For the majority of the disease terms, the preferential POS is an NNP or NN, a few exceptions are “knocked out” which is assigned an IN, as the second most frequent term, and “kidney disease” which is attributed a VB also as the second most frequent term. Due to the nature of the disease term, it was expected a high presence of nouns or proper nouns for selected diseases (e.g. “Lassa fever”), hence, the results suggest that the term could be used with its clinical meaning. Furthermore, in previous sections, we addressed the high presence of news articles which is a likely indicator that the term is used in a clinical context. However, it is applied to give reports regarding the disease and not to express personal statements from the users.Considering the POS patterns generated through the previously mentioned method, overall, the results suggest a strong presence of NNP. This predominance of nouns has already been addressed in the literature  and it wThe frequency of each pattern is correlated with the number of messages related to news articles. These tweets contain the same news title, thus, the high frequency of given patterns in disease terms such as “Lassa fever” and “female genital mutilation”. A similar behaviour can be seen with “culture shock”, albeit, in this case, it is related to the standard pattern used for advertising the product of a company. In contrast, terms such as “substance abuse”, “brain damage” and “spinal cord injury” are present in patterns with similar frequencies. These are similarly linked to news articles, however, the titles and news stories contain more diversity and are also repetitive, therefore, contributing to the frequency of the patterns. In addition, the results also suggest that similar patterns, within each disease term, tend to occur with similar frequencies.MetaMap was able to identify disease terms in 3’489 tweets from the initial 10’618 messages containing the terminology. In the hospital collection, Metamap reached a score of 4.04 and identified terms in 44 messages from the total of 132 messages. A total of 45 terms such as “eating disorder”, “brain damage”, and “substance abuse” were not identified. Considering the airport collection, MetaMap achieved an average relevance score of 25.49 and was able to identify the terms contained in 183 messages out of 242 messages. A total of 23 terms were not identified, these include terms such as “bee sting”, “shell shock”, “Lassa fever” and “bipolar disorder”. In the geolocated collection, the average relevance score was 3.36 and MetaMap was able to identify the terms in 3’272 messages of a total of 10’242. Similarly to the airport and hospital collections, issues regarding the identification of terms in the tweets were verified. For example, despite representing the most frequent term “knocked out” was also the term most difficult to identify to MetaMap. The same occurs with “Lassa fever” and “culture shock”. Considering the agreement between MetaMap’s term identification and the actual terminology, the score is of 0.62 (the terms contained in 2’044 tweets are representative of the terminology present in the 3’272 messages in which MetaMap can identify a UMLS concept). As an example, we detail the specific case of the term “knocked out”. This term is present in 103 of the 3’272 tweets identified by MetaMap, however, it is never identified by MetaMap as “knocked out”; the algorithm identifies other disease terms in these 103 messages.The results suggest a trade-off between the use of complex and colloquial terminology. Although more frequent in Twitter, health-related layman terms can pose significant challenges and require the application of domain-specific semantic disambiguation tools. In addition, we suspect the characteristics of the messages (e.g. short length and possible disregard for grammar rules) may have increased the difficulty for MetaMap’s algorithm. This is further supported by cases where the same terminology was found in some tweets and not in others, despite being referenced in both.In this paper, we tested an approach to determine the presence of linguistic patterns associated with diseases and we explored the representation value of a geolocated Twitter sample. We analysed the full body of Twitter feeds with geolocation over a period of 5 months. Using SNOMED clinical terms, we verified a higher presence of non-communicable diseases compared to infectious diseases. The division of the data showed that hospital and airport locations do not contribute to the increase in the number of disease mentions, contrary to our expectation.We also identified questionable interpretations for selected disease terms, exposing non-medical interpretations of the medical term . The findings originating from our data exploration suggest a high presence of news article titles or mentions in the messages which indicate that current events have a strong influence on the disease’s frequency. An example is “Lassa fever”, the majority of the messages correspond to news stories originating from regions affected by an outbreak in late 2016/early 2017. This finding provides an alternative way to explore the news content provided by Twitter, mainly through the determination of the degree of concern of users and through the gathering of outbreak information from local news providers, thus, suggesting its utility for disease monitoring. However, our findings also suggest that Twitter is not only used as a medium to share personal statements but also to disseminate news articles. Furthermore, it suggests that users give high relevance and interest to news media.Regarding the POS tagging, the majority tweets expose noun or proper noun use of the disease term which corresponds to our expectations and previous findings in the scientific literature. For the POS patterns, the high presence of news articles may have hindered the identification of linguistic patterns as the ones identified may solely relate to the news articles and not individual statements regarding health conditions. To address this, an additional step to remove tweets related to news articles could be implemented to exclusively analyse personal tweets. The results from the NER suggest that despite being useful to identify tweets containing the correct clinical terminology and providing semantic disambiguation, further developments are needed to better handle the unique style of the Twitter messages. To further address the linguistic cues, we propose the study of health forums to understand how a change in medium affects the language applied by the users. Furthermore, these insights can provide new information on the complexity of language when discussing health.Using a collection of more than 58 million tweets, we used and determined language patterns, and contrasted the use of Twitter between airport locations (with a larger number of feeds) against the hospital location . As an outcome, we determined that these locations are not suitable for the collection of significant portions of tweets concerned with disease outcomes. Additionally, we verified a high presence of discussion regarding non-communicable diseases.This study is based on the premise that users utilise Twitter as a medium to share concerns regarding illnesses and that hospital and airport locations would be preferential for the discussion of certain diseases or diseases in general. This was not verified, in contrast, we found the predominance and influence of news articles. To closely monitor disease outbreaks, personal statements mentioning illnesses or symptoms are desired. However, our findings can also be applied to measure the degree of concern expressed by the users, although not strictly indicative of an outbreak it can be used use to determine if additional public health measures should be implemented.


This article explores the scope of ‘religion-psy dialogue’ in the mid-twentieth century, via a case study from Japan: Kosawa Heisaku, a Buddhist psychoanalyst based in Tokyo. By putting this case study in brief comparative perspective, with the conversation that took place in 1965 between Paul Tillich and Carl Rogers, the article discusses both the promise and the pitfalls of the modern and contemporary world of ‘religion-psy dialogue’, alongside the means by which specialists in a variety of fields might investigate and hold it to account. What do I do with my distress? This dilemma and its consequences are deeply familiar to psychotherapy. They are also somewhere near the heart of many forms of religious experience. Who am ‘I’ in the first place? Where in my past, in my relationships, in my habits of behaviour, in my character, should I look for the cause of this distress or for my inability to solve it by myself? Who is this distress turning me into? And is this distress ‘mine’ alone? Or is it also a judgement against my society, or my conditions of work – perhaps the whole culture that surrounds me?The evolution of what Nikolas Rose calls the psy disciplines – primarily psychiatry, psychology and psychotherapy – across the twentieth century incorporated a steady shift towards these sorts of wide-ranging, multi-causal approaches to distress, notably though not exclusively in post-Freudian psychoanalytic, Jungian, Existential and person-centred movements. A similar shift occurred, though for different reasons, within religious traditions like Buddhism – both in Asia and in the West – and Christianity: a fresh willingness to extend religious notions of suffering into the medical and the everyday, and to interpret ‘healing’ more broadly: to include, for example, recovery from, or the religious contextualization of mental illness, addiction and family breakdown. And so we see now books and talks and celebrity figures from the worlds of Buddhism and Christianity making liberal use of psychological terminology, theorizing and case studies. We find pastoral counselling provided across a range of religious traditions, by religious professionals or – increasingly – people with a dual professionalism spanning religion and psychotherapy or counselling. And we encounter the championing of broad benefits for mindfulness meditation, ranging across the personal and inter-relational, the cardiac and neurological, and finally the spiritual and the ethical.No-one familiar with the introspective, highly psychological writings of the Christian theologian Augustine of Hippo, or the ‘moral therapy’ precursors to scientific psychiatry could argue that dialogue between the religious and the ‘psy’ is somehow uniquely a modern phenomenon. And yet it is in the modern era that we find traditions, individuals, institutions, theories, and practices labelled as ‘religious’ or ‘psy’ being brought quite self-consciously into contact with counterparts across very real  professional and hermeneutic divides.Through self-inspection, self-problematization, self-monitoring and confession, we evaluate ourselves according to the criteria provided for us by others. Through self-reformation, therapy, and the calculated reshaping of speech and emotion, we adjust ourselves by means of the techniques propounded by experts of the soul. Rose, , p. 11To then add religion or spirituality into the mix both complicates matters and raises the stakes. Here, are two powerful but rather malleable sources of epistemic and moral authority – religious obligation or faith, and psychological health or well-being – coming together, and capable of producing ideas and practices and ways of being in the world that may hold enormous sway over people while all but defying objective critique. Encompassing in conceptual scope, deeply personal and complex in its everyday reality – ideas, images, and propositions blending with symbol, myth, emotion, faith, presumed unconscious content, and meditative states – religion-psy dialogue seems to resist adequate description, critique and evaluation via any single meta-language.These points of contact, and the social-historical forces that foster them, matter greatly in the present day because of the broad range of ways in which they are capable of influencing everyday life. Since the 1960s, sociologists and social critics like Philip Rieff and Christopher Lasch, followed more recently by Nikolas Rose and Jan De Vos, have worried about the increasingly pervasive political and cultural power of the psy disciplines. Rose has been particularly concerned about a late twentieth-century trend away from traditional, external modes of surveillance and coercion towards more internalized forms, which feel as though they have been freely chosen by us for our own good:and psychologically beneficial; important analogies across intrapersonal, interpersonal and transpersonal forms of relating  case study approach has the advantage of being less likely to miss the specific historical, cultural and personal dynamics of each instance of dialogue, reminding us that beyond this rather abstract term – ‘religion-psy dialogue’ – lies no concrete reality, but rather a series of discrete realities, which nevertheless also possess important and informative overlapping features.The smash of the plate reverberates around the kitchen. In the silence that follows the little boy looks up to see his father’s fury building. Then out it comes, torrents of recrimination: Why did he do that to a precious plate? Why the hell can this boy never concentrate?The boy apologizes, means it, but on and on it goes with his father’s anger, until the boy can’t help but shout back: It was a mistake! And I’ve tried to apologize! What more do you want?!But the boy’s mother, too, is in the room: People are people, my love, and though what you did was truly wrong, never forget that I know you. And I know you can’t help it with things like this – no matter how hard you try.A sigh escapes the boy’s mouth, his shoulders drop. He dissolves into tears: Thankyou mother. Thankyou … I really am sorry. I won’t do it again.A young Kosawa Heisaku offered this ‘parable’, as he called it, to his readers in the mid-1930s as a way of helping them to appreciate the difference between two sorts of human guilt .The parable may well have had origins in the Kosawa family home. Heisaku was born the ninth of ten children, in a village in Kanagawa prefecture where his family owned rice fields. His father, Takatarō – ‘hawk-boy’ – ran a small bank and dealt in tobacco on the side Takeda, . Beyond ie (household) system, the first son mattered by far the most in terms of family name and inheritance. Heisaku’s existence was, at least in this social sense, neither here nor there. His eldest brother’s name – 宗栄: Sōei – meant religious glory or honour. Heisaku – 平作 – meant ‘normal crop’.Growing up, father and son had relatively little to do with one another. Nine siblings were formidable competition, and the eldest – a girl – was already twenty years old when Heisaku came along, by which time fatherhood for Takatarō may have lost much of its charm. To make matters worse, under Japan’s Other than Kosawa’s early wish to become Prime Minister, which he attributed to the influence of his father’s politics, there is little evidence that Takatarō attended to or shaped the young boy directly in any meaningful way. Kosawa later recalled Takatarō reserving most of his attention instead for the third son of the family, Saburō, who appears to have suffered with behavioural problems. Kosawa resolved to become a psychiatrist one day partly so that he could better understand people like Saburō – how they came to be the way they were, and what might be done about it.yume bunseki). He recalled his father once complaining to him about the cost of Heisaku’s lengthy hospital treatment for a detached retina while in his mid-20s. Despite this being a serious condition, and doubtless a frightening experience, the only fatherly comments that stayed with Kosawa were that one family member shouldn’t be allowed  to destroy the rest. Even as Takatarō lay dying, there was no let up. Kosawa was by this point a fully qualified medical doctor, pursuing a specialism at one of the country’s most prestigious universities. His father simply asked him how long he intended to keep messing around ‘at school’ . Kosawa, for his part, tried to bring what he could of his medical know-how to prolonging his father’s life. He was unsuccessful, and may even have blamed himself for his father’s early death in 1931.Takatarō’s influence on Kosawa was largely indirect, but formidable nonetheless. He plainly scared his son, who found him overbearing, unpredictable, stubborn and fundamentally selfish .Kosawa was by no means out of the ordinary here. He grew up in a society many of whose men rhapsodized rather than really knew their mothers Napier, , and whoKosawa’s early relationships with his father and mother seem to have shaped his attitudes towards both Buddhism and mental health, and to have inspired his interest in seeing the two placed together in a single, salvific system – albeit with Buddhism and psychoanalysis still retaining separate goals and languages and institutions of their own. Helping to set this emerging conversation in train was a Buddhist monk of the Jōdo Shinshū (Shin) sect by the name of Chikazumi Jōkan. Kosawa met Chikazumi while he was at Higher School in northern Japan, encountering via him a highly devotional, emotional form of Buddhism in which intra-familial relationships were understood as furnishing the individual with transpersonal salvific opportunity. Chikazumi came to this realization while lying in bed one day, critically ill, and hearing his father by his bedside quietly wishing his son’s troubles upon himself. It became a moment of conversion: an encounter with compassion so strong and pure that all at once it broke him out of the small, citadel mentality of a young university intellectual, showing him instead a truer, more vital vision of himself – as weak, vulnerable and loved Iwata, .Namu-Amida-Butsu: ‘Hail to Amida Buddha’ – in order to be saved. This wasn’t some magical formula. Rather, it was an honest and profoundly generative recognition of weakness, such that the very term ‘weakness’ lost its typical, negative connotations.The proximate source of this love and compassion was his father. Their ultimate source, for human beings, was the quasi-monotheistic figure of the cosmic Buddha ‘Amida’ – the Buddha of Infinite Light. The thirteenth-century founder of Shin Buddhism, a man by the name of Shinran, had insisted that the limits of human nature and the boundless compassion of Amida were such that a person needed only to recite a short prayer – The voice with which I call Amida BuddhaIs the voice with which Amida Buddha calls to me.For Chikazumi, and soon for Kosawa, the full force of his home life coming into play alongside a new-found devotionalism, modern Japanese family relationships were the means by which Amida’s mercy broke into mundane, linear time, and into mundane, human lives , and on that basis much fruitful conversation can happen between the religion and psy spheres, Tillich’s and Kosawa’s cosmologies nevertheless understand the human as something else, or more. So for all their usefulness as bridging concepts between the religious and the psy, ideas like ‘grace’ should not have distinct meanings folded into them as though such things do not matter. Second, in Kosawa’s and Tillich’s cosmologies human limitations extend to our ability to formulate  Hirota, .4Critics of particular instances of religion-psy dialogue have been quick to offer related cautions. We need some way of distinguishing in meditation, argues one, between psychological insights  and spiritual insights . We need to avoid religion-psy ‘dialogue’ devolving into the former simply serving the latter – as a provider of high-sounding, inspirational alternative terminologies for what is basically psychology, effectively masking a slide into agnosticism.everyone is heir to the very same constitutional weaknesses, so there can – or at least should – be no tyranny of ‘strong’ over ‘weak’. In practice, of course, there was the serious risk of a religious reading glossing, even enabling, the harmful effects described in a social reading. Kosawa was criticized on precisely these grounds by some of his young psychoanalytic trainees.Lastly, there is a concern about what kinds of people some forms of religion-psy dialogue helps to create. Kosawa, in his own day, was accused of literally ‘drinking’ his clients: thriving on their tales of distress and even playing the saviour to some extent – unable, despite his theorizing to the contrary, to imagine himself rather than Amida Buddha as the source of a person’s felt acceptance. An American critic, though not especially well informed about Japan, offered the provocative criticism that whereas psychoanalysis in the United States sought to free the individual from the fetters of society, people like Kosawa actively sought to tighten them. If one stands back and seeks to read, at a purely social level, Kosawa’s therapy, then reliant as it was on encouraging an individual to really experience their frailty, inadequacy, and deep need of others it might indeed fit such concerns. Read, however, at a religious or philosophical level, there might seem to have rather more going on: on this reading, For Kosawa Heisaku, the fruits of religion-psy dialogue emerged in two simple questions: what is insight, and what does it cost? Good questions, which seem likely to remain with us for some time yet. And there is much to welcome, from this point of view, in the increasing interaction between the religion and psy professions, institutions, ideas and practices – even orientations within individuals. Finding ways to hold such interaction to account, by understanding its sources, claims, motivations and possible implications, is an important task, in which a range of academic and non-academic specialisms have roles to play. This article has sought to sketch out a social-historical and transcultural approach, as just one of many potential angles on this complex modern and contemporary phenomenon.No potential conflict of interest was reported by the author.This work was supported by the Japan Society for the Promotion of Science; Wellcome Trust and British Academy.Christopher Harding is a lecturer in Asian History at the University of Edinburgh. He works on the cultural history of modern India and Japan, with a particular interest in religion, spirituality, and mental health.


Purpose: The purpose of this study was to explore how an exclusive sample of women’s national football team coaches described how they implement careful coaching while facing social and organizational pressure to win medals. Method: To consider coaches’ negotiations, we drew on Noddings’ concept of caring. Using an interpretive research paradigm, we conducted in-depth interviews with five Swedish women’s national football team coaches. An abductive approach was used to simultaneously process the theoretical framework of “ethics of care” and the empirical data. Results: The coaches unanimously adopted a holistic perspective to coaching. The coaching strategies they described included promoting players’ development, well-being, and sustainable elite performance; listening to the players’ voices and engaging in dialogue; and creating a positive environment and promoting fair play. Conclusions: These findings demonstrate that the women coaches, despite performance pressure, adopt caring coaching in the form of Noddings’ pedagogical modelling, dialogue, and confirmation strategies, and provide an example of how coaches can adopt caring, holistic, and athlete-centred coaching while working at the highest level of competitive sport and achieving competitive success. Coaches at the upper echelons of sport are responsible for serving the interests of both the stakeholders they represent and the athletes they coach  of the participant … Athletes are expected to analyse, think and make important decisions.  actions” that include giving time, being there, engaging in dialogue, showing sensitivity, and empowering athletes Jones, . In contCare(ful) coaching is not only about caring coaching practices; according to Hardman et al. , it alsoTo explore how women coaches describe how they implement careful coaching while facing social and organizational pressure to win medals, we drew on Noddings’, 2012b eFor Noddings , caring Noddings  further This study follows the qualitative methodology of interpretive description . All interviews were audio-recorded, transcribed professionally, and checked for accuracy by the authors. Where possible, the research team members interviewed the study participants in the coaches’ mother tongue; otherwise, the English language was used. Where necessary, the transcripts were translated into English.Data analysis began with the aim of understanding the coaches’ career development. During this process, the two authors of this article recognized that the Swedish coaches spoke of coaching as a caring activity, a description that differed from the bulk of coaching literature that demonstrates authoritarian and controlling coaching, yet followed an emerging body of research presenting evidence of caring, holistic, and athlete-centred coaching  to handle elite players’ challenging behaviour; (2) to promote fair play; (3) to promote elite players’ development; (4) to see every player as a human being; (5) to listen to and take care of the players’ needs; (6) not to risk players’ health; and (7) to have a good dialogue with the players. Fifthly, the two authors discussed, compared, and contrasted the seven categories in relation to the concept of “caring”. It was in this step that the seven tentative categories were combined into the three coaching strategy categories of (a) promoting development, well-being, and sustainable elite performance; (b) listening to the players’ voices and having dialogue; and (c) creating a positive environment and promoting fair play (research question 2). No data related to the aim of the study were excluded as a result of a lack of a suitable category or fitting into more than one category. The underlying meaning of the three categories was formulated into the theme of “Holistic perspective of every person and managing performance expectations”. This theme reflects research question 1 and thus the coaches’ approach to coaching. This overarching theme represents the thread of the underlying meaning , through the meaning units, keywords, or key phrases and the categories on an interpretative level . In addition to the characteristics presented in The overarching theme, “Holistic perspective of every person and managing performance expectations”, represents the women’s approach to coaching (as per research question 1). The coaches unanimously agreed that they see their players as both players and humans, and their coaching decisions as based on moral insight and caring. The coaches described that it is important to them to give players a sense of being present, being willing to listen, and conveying interest in the players. According to Noddings , this opThe step from being responsible for a club team to being in charge of a national team is huge. Here you are alone … It requires more preparation. I get these players that I don’t know that much, and I don’t meet very often … Preparations have become even more important. I have gone more on gut feeling before [in club teams] … but I have realized that it is not possible to go on gut feeling, it’s so short-sighted and result-driven. Other concerns that I have had are: how do I make it as good as possible, how do I get the players to understand the policy we have and what we accept and don’t accept?In the case of the Swedish women coaches, however, the above results demonstrate a holistic approach to coaching, despite performance result expectations. This negotiation was possible because the coaches clearly understood their context and role, and the expectations placed on them. Mary, for instance, stated: “… My main job is to prepare and win the next game. That is how it is”. In a similar way, Carolyn said, “When you step up to the highest level in the national team, then it’s results … then it’s more like life or death”. In this statement, Carolyn refers to both the security of her coaching position and her players’ change in play and qualifying for or remaining on national teams. Thus, through their coaching they must influence player-performance to satisfy the results-based demands to ensure the players’ playing and coaches’ job security. Such security is, however, only possible if players and coaches are healthy  and well. Given that the coaches spoke of the high demands they face, and that they have limited time to get to know the players, they need to plan their activities well in order to achieve “good” and sustainable national team activities. Susan said:Susan’s statement reinforces that national team positions are different from club-based positions. National team coaching positions are about greater pressure, greater responsibility, and more difficult working conditions because coaches do not see their players on a regular basis and thus they have fewer opportunities to get to know the players. Lastly, national team positions are less secure for both players and coaches.The first category, “Promoting development and well-being”, contextualizes how the women coaches are faced with results-based expectations, yet, despite these pressures, focus on the holistic development of players, and their health and well-being. In this regard, the coaches’ knowledge of holistic player development is significant. The second category, “Listening to the players’ voices and having dialogue”, includes creating a dialogue with and listening to the players  by drawing out the best in each other. The statement illustrates how a coach models caring communication, while all players should help and support each other and thus themselves be involved in a caring practice . Then I stepped up and apologized for him, that we had not talked about this. I expect everyone here to adhere to my philosophy. This is an important thing and I decide on values, you could say. … we are not taking any free kicks because we’re better than that. For if something is free and we’re “taking” a free kick and she gets injured, then I can truly go back and say that I don’t like it and then I cannot do this. We play tough but we take no free kicks.In football, fair play is a fundamental part of the game and represents the positive benefits of playing by the rules and respecting others FIFA, . The coaMary’s statement is not an isolated quote about fair play and moral standards; the women coaches clearly outlined that they stand for fair play in general and do not want to risk players’ health. Mary’s integrity exemplified an ability to think and act in relation to particular values  and caring at the right time, for the right reasons, and with the right feelings . The findings also demonstrate that the coaches provide confirmation to the players through building trust as well as encouraging players’ moral development. However, our data demonstrate that because the women did not regularly see their players at the national team level, they were limited in establishing opportunities for the players to collaboratively practise care and contribute to their national team community.At present, although calls for caring, holistic, and athlete-centred coaching are common, only a few empirical examples exist of how elite or national team coaches manage the negotiation of results-based expectations and holistic athlete development (exceptions are Annerstedt & Lindgren, To ensure research credibility, we adopted a number of strategies, such as aiming to include all women’s national football team coaches in Sweden to participate in the study, which we achieved, and following a strict analytic procedure. As for methodological limitations, our findings are based on a small and exclusive sample of coaches. Therefore, the findings can only be transferred to similar groups of coaches. Future studies about caring coaching in national football team situations should include male coaches, which could enrich our understanding of ethics of care and potentially add a gender perspective. Another possible limitation of the study was that the interviews focused on several aspects. It is important to note that had specific questions been asked about careful coaching, the women coaches’ responses may have included additional aspects of how they manage the players carefully and holistically.