To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Monitoring is a self-regulatory process involved in making changes to behavior. Monitoring involves a person, group, or organization taking stock of the current situation, comparing this to some goal or reference value, and identifying whether or not there is a discrepancy. Noting a discrepancy can be a reason for taking additional action to ensure goals are achieved or for adjusting or disengaging from the goal. Monitoring can also identify actions required to overcome barriers to goal striving and whether these actions have the intended effects. Given that people often do not monitor their progress, termed “the ostrich problem,” interventions that prompt monitoring can be an effective way to promote changes in behavior. This chapter reviews the evidence that monitoring interventions promote changes in behavior, identifies how monitoring has been conceptualized within theoretical models and existing taxonomies of behavior change techniques, and describes some of the mechanisms by which monitoring promotes behavior change. The chapter concludes that monitoring can be an effective strategy for promoting changes in a range of behaviors and contexts but also that developing monitoring interventions can be complex. A practical guide for the development and application of monitoring strategies is also presented, based on the literature and research evidence on monitoring interventions.
Participation in many behaviors is associated with individuals’ social status and differences in access to resources, which affect their opportunities to engage in these behaviors. For example, behaviors in the health and environmental domain differ between individuals and groups of differing socioeconomic status (SES). While associations between social position and behavior are increasingly recognized and explored, relatively little is known of the mechanisms and processes by which these disparities relate to behavior change. This chapter discusses concepts of inequity relevant to behavior change, highlighting the need for consistent and meaningful operationalizations. The chapter outlines the theoretical frameworks of disparities, emphasizes the important role that multilevel perspectives of socio-structural determinants of disparities play in behavior change, and highlights how behavioral theory can help in understanding disparities in behavior change. Using health behavior examples, mechanisms underlying intervention-generated inequities are identified. If the effects of theory-based determinants on behavior differ by SES, interventions based on these determinants are likely to be differentially effective in groups differing by SES, further contributing to health disparities. Future research on behavior change should include a stronger focus on equity across domains, better document the differential effects on behavior change, and clearly specify the role of inequity in theories of behavior change.
Webb considers that religious experience typically occurs in the setting of a religion as a social institution, and that the subjects of such an experience typically participate in rituals and ceremonies with other people who share some of their beliefs and convictions. He proposes that this social-embedding of religious experiences is significant with regard to their being understood and evaluated, including in connection with their contribution to the meaning of human life.
Images play a crucial role in shaping and reflecting political life. Digitization has vastly increased the presence of such images in daily life, creating valuable new research opportunities for social scientists. We show how recent innovations in computer vision methods can substantially lower the costs of using images as data. We introduce readers to the deep learning algorithms commonly used for object recognition, facial recognition, and visual sentiment analysis. We then provide guidance and specific instructions for scholars interested in using these methods in their own research.
We report electronic medical record interventions to reduce Clostridioides difficile testing risk ‘alert fatigue.’ We used a behavioral approach to diagnostic stewardship and observed a decrease in the number of tests ordered of ~4.5 per month (P < .0001). Although the number of inappropriate tests decreased during the study period, delayed testing increased.
Adolescent dieting and disordered eating (DE) are risks for clinical eating disorders. In this five-wave longitudinal study, we tested gender-specific models linking early risk factors to temporal patterns of DE, considering appearance anxiety as a mediator. Participants were 384 Australian students (age 10 to 13; 45% boys) who reported their purging and skipping meals, experience with appearance-related teasing, media pressure, and appearance anxiety. Parents reported pubertal maturation and height/weight was measured. Gender differences in temporal patterns of DE were found and predictive models were tested using latent-variable growth curve and path models. Boys’ DE was generally stable over time; girls showed stability in purging but an average increase in skipping meals. Peer teasing, media pressure, and pubertal maturation were associated with more elevated initial DE in girls, and pubertal maturation was associated with a steeper increase in DE. For boys, body mass index had a direct positive association with DE. Appearance anxiety was associated with more DE, but there was only one significant indirect effect via anxiety, which was for boys’ pubertal maturation. Findings support the dominant role of social interactions and messages, as well as pubertal maturation, for girls’ DE and the prominence of physical risk factors for explaining boys’ DE.
Individual- and area-level risk factors for suicide are relatively well-understood but the role of macro social factors such as alienation, social fragmentation or ‘anomie’ is relatively underresearched. Voting choice in the 2016 referendum on the UK's membership of the European Union (EU) provides a potential measure of anomie.
To examine associations between percentage ‘Leave’ votes in the EU referendum and suicide rates in 2015–2017, the period just prior to, and following, the referendum.
National cross-sectional ecological study of 315 English local authority populations. Associations between voting choice in the EU referendum and age-standardised suicide rates, averaged for the years 2015, 2016 and 2017, were examined.
Overall there was a weak, but statistically significant, positive correlation between the local authority-level percentage ‘Leave’ vote in 2016 and the suicide rate 2015–2017: Pearson's correlation coefficient, r = 0.17; P = 0.003. This relationship was explained by populations having an older age distribution, being more deprived and lacking ethnic diversity. However, there was divergence (likelihood ratio test for interaction, χ2 = 7.2, P = 0.007) in the observed associations between London and the provincial regions with Greater London having a moderately strong negative association (r = −0.40; P = 0.02) and the rest of England a weak positive association (r = 0.17; P = 0.004).
Deprivation, older age distribution and a lack of ethnic diversity seems to explain raised suicide risk in Brexit-voting communities. A greater sense of alienation among people feeling ‘left behind’/‘left out’ may have had some influence too, although multilevel modelling of individual- versus area-level data are needed to examine these complex relationships. The incongruent ecological relationship observed for London likely reflect its distinct social, economic and health context.
In Chapter 16, the authors point to the four roles of teachers in vocabulary courses and present research-based suggestions for the effective instruction of vocabulary; they also present a case study that investigated teachers’ perceptions about useful vocabulary, followed by principles required for helping learners with desirable vocabulary learning outcomes.
Depression is among the most common psychiatric disorders seen in primary care. Sexual dysfunction is often present in patients diagnosed with depression, but the temporality of the association is not clear. The aim of the present study is to ascertain sexual dysfunction for men and for women relative to diagnosis of depression in the UK patients' population providing an insight into these conditions.
A case-control design was used to assess the incidence of sexual dysfunction every year in the five year period pre- and post depression diagnosis. Depressed patients (8,221 in UK ffGPRD database) were matched by age, sex and time in the database to non-depressed patients. Significance tests were carried and risk ratios were calculated at each time-point in the 10 year follow-up.
The incidence rate of sexual dysfunction for cases (4.9 events/1000 person-years) and for controls (2.66 events/1000 person-years) were found to be significantly different (p ≤ 0.001). The incidence rate for the individuals sexual disorders (erectile dysfunction, premature ejaculation, and low libido were also significantly different.In addition, the risk ratios for the above conditions calculated by year in the five year period pre- and post diagnosis of depression were statistically significant from the date of diagnosis of depression. Further analysis was also undertaken to explore the observed patterns in the data.
Sexual dysfunction diagnosis differs significantly between cases and controls, particularly after diagnosis of depression. This raises questions regarding management of depression and its effect on sexual dysfunction.
Recent studies suggest an evidence for a “male depressive syndrome” in patients with major depressive disorder.
Because males are markedly overrepresented among suicide victims and the opposite is true for suicide attempters, we investigated the rate and global severity of Gotland Male Depression as measured by the Gotland Male Depression scale in 86 suicide victims (74 males, 12 females), 86 suicide attempters (21 males, 65 females) with current DSM-IV major depressive episode and in 144 normal controls (116 males, 28 females). The rate of Gotland “Male” Depression (total score of 13 or more) was significantly higher in depressed suicide victims (98%) and in depressed suicide attempters (93%) than in normal controls (2%, p=0.00001). Among depressed suicide victims 100% of males and 83% of females have had Gotland “Male” Depression (p=0.02) while the same figures among the depressed suicide attempters were 91% and 94%, respectively (not significant). The total Gotland Male Depression scores were significantly higher in depressive suicide victims (22.26) and depressive suicide attempters (23.23) than in normal controls (4.01, p=0.00001 and p=0.0001, respectively), with significant gender differences only among depressed suicide victims (males: 22.85, females: 18.58, p=0.009) and normal controls (males: 4.33, females: 2.71, p=0.05).
However, since male and female depressed inpatients do not show clinically significant difference in their mean total scores on Gotland scale symptoms (11.99 vs 12.04, Möller-Leimkühler et al, 2004), it would be premature to conclude from our present findings that compared to nonsuicidal female depressives, suicidal female depressives have male-type depression profile.
Little is know about fracture risks in mentally ill adults. We aimed to estimate risks of fracture at any site, and at sites linked with osteoporosis, in this group versus the general population.
We created a population-based cohort using the UK General Practice Research Database (GPRD), with follow-up during 1987-2005. We investigated age and sex-specific fracture risks in psychotic illness (N=4283), non-psychotic affective disorder (N=95,228), and any other psychiatric conditions (N=49,439). Controls were all subjects with no psychiatric code (N=182,851) against which age-stratified relative risks were estimated: 18-44, 45-74, 75+ years. Outcomes were incident cases of fracture at any site, the hip and distal radius.
Among all mentally ill women, the highest relative risks of fracture at any site were in the youngest age group, whereas the strongest effects in men were with older age. The highest raised risk of any fracture occurred in younger women with psychotic disorders (RR 2.5, CI 1.5-4.3). Hip fracture rates were raised in elderly women and men with psychiatric illness, and were especially high in women (RR 5.1, CI 2.7-9.6) and men (RR 6.4, CI 2.6-16.1) with psychotic disorders at 45-74 years. Data were sparse for estimating relative risk of distal radius fracture, although risk was modestly (but significantly) higher among women with any mental illness in each age group.
These elevated risks are likely to be explained by a range of mechanisms. Further research is needed to elucidate these and to inform the development of targeted interventions.
Population-based evidence is lacking for risk of major birth defect with parental psychopathology, and how effects vary by maternal and paternal diagnosis. We aimed to investigate this risk in offspring of parents admitted for psychiatric treatment in a 26-year national birth cohort.
The study cohort was created using several linked Danish national registers. We identified all singleton live births during 1973-98 (N=1.45m), all parental psychiatric admissions from 1969 onwards, and all fatal birth defects until 1st Jan. 1999. Linkage and case ascertainment were virtually complete. Relative risks were estimated by Poisson regression.
Fatal birth defect risk was elevated with any maternal admission and also with affective disorders specifically, although the strongest effect found was with maternal schizophrenia. The rate was more than doubled in this group compared to the general population (RR 2.34, 95% CI 1.45-3.77); this also represented a significant excess risk versus all other admitted maternal disorders (P=0.018). Risk of death from causes other than birth defect was no higher with schizophrenia than with other maternal conditions. There was no elevation in risk of fatal birth defect if the father was admitted with schizophrenia or any other psychiatric diagnosis.
There are many possible explanations for a higher risk of fatal birth defect with maternal schizophrenia and affective disorder. These include genetic effects directly linked with maternal illness, lifestyle factors (diet, smoking, alcohol and drugs), poor antenatal care, psychotropic medication, and gene-environment interactions. Further research is needed to elucidate the causal mechanisms.
Online learning has become an increasingly expected and popular component for education of the modern-day adult learner, including the medical provider. In light of the recent coronavirus pandemic, there has never been more urgency to establish opportunities for supplemental online learning. Heart University aims to be “the go-to online resource” for e-learning in CHD and paediatric-acquired heart disease. It is a carefully curated open access library of paedagogical material for all providers of care to children and adults with CHD or children with acquired heart disease, whether a trainee or a practising provider. In this manuscript, we review the aims, development, current offerings and standing, and future goals of Heart University.
Using Health and Retirement Study data linked to summary plan descriptions and W-2s, this study reports trends in retirement wealth inequality of older employees 1992–2010. The study identifies and corrects methodological flaws in past research. Retirement wealth is highly unequally distributed; the top lifetime earnings quintile holds half of all retirement wealth, the bottom quintile, only 1%. The top earnings quintile fared better in 2010 than in 1992, whereas bottom-quintile earners fared worse. But retirement wealth inequality mainly reflects inequality within earnings quintiles, resulting from inadequate savings, not outsize accumulations. Systemic flaws reduce median retirement wealth by 84%
This chapter provides an insight into the role of systems science for sustainability assessment. In the first part, we present seven axioms that have been derived from system-theoretical perspectives and show their relevance for sustainability assessment. Following these axioms, we propose a way to structure and analyse systems following four system characteristics: (1) system boundary and interactions with the external environment; (2) purpose, goals, and associated decision-making drivers and criteria for the system; (3) system structure (subsystems, elements, and their interactions), dynamics, and emerging behaviour; and (4) system information, outcomes monitoring, and learning. These four characteristics were applied to study, first, the historical development of the energy system analysis and, second, an Australian urban systems-transformation initiative. The systems-analysis framework presented provides a good basis for putting the elements of a system analysis into their broader context, and designing purposeful interventions. Especially for more transformational change, the alignment of stakeholder values, institutional arrangements, and available knowledge become key leverage points.
Motivation and ability to engage with treatment may deteriorate or falter if a patient is not satisfied with their protocols or provider. Improving patient satisfaction may more effectively strengthen treatment engagement.
1) Determining what patients want from their provider relationship; and 2) identifying means for a provider to effectively assess and evaluate patient satisfaction in relation to treatment engagement.
A systematic review of published meta-analyses, systematic reviews, and literature reviews between 1996 and 2016 was conducted across three databases (Medline, PsycINFO, CINAHL). Using variations of the search terms patient; satisfaction; medication, medical and psychiatric treatment; and engagement/adherence, a total of 1667 articles were identified. After removing duplications, 1582 articles were independently screened for eligibility (e.g. conceptual focus, methodological limitations) by two research assistants, resulting in the final inclusion of 50 meta-analysis, systematic review, or literature review articles that focused on predictors or barriers to patient satisfaction and/or predictors or barriers affecting engagement/adherence.
Barriers and predictors of patient satisfaction centered on two fundamental domains:
– relationship with Provider (sub-factors: multicultural competence, shared decision making, communication skills, continuity of care, empathy) and;
Eight treatment engagement/adherence barrier and predictor domains were identified, specifically treatment regimens; illness beliefs, emotional/cognitive factors; financial and logistic; social support; symptom/illness characteristics; demographics and patient-provider relationship.
Key findings highlight actions psychiatrists and other clinical providers may consider in addressing barriers and highlighting promoters to improve patient satisfaction and overall engagement and adherence.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Identifying early risk factors for the development of social anxiety symptoms has important translational implications. Accurately identifying which children are at the highest risk is of critical importance, especially if we can identify risk early in development. We examined continued risk for social anxiety symptoms at the transition to adolescence in a community sample of children (n = 112) that had been observed for high fearfulness at age 2 and tracked for social anxiety symptoms from preschool through age 6. In our previous studies, we found that a pattern of dysregulated fear (DF), characterized by high fear in low threat contexts, predicted social anxiety symptoms at ages 3, 4, 5, and 6 years across two samples. In the current study, we re-evaluated these children at 11–13 years of age by using parent and child reports of social anxiety symptoms, parental monitoring, and peer relationship quality. The scores for DF uniquely predicted adolescents’ social anxiety symptoms beyond the prediction that was made by more proximal measures of behavioral (e.g., kindergarten social withdrawal) and concurrent environmental risk factors (e.g., parental monitoring, peer relationships). Implications for early detection, prevention, and intervention are discussed.
Cognitive-behavioral therapy (CBT) for tobacco cessation is an evidence-based, yet underutilized intervention. More research is needed to understand why some treatment-seekers are ‘no-shows’ for the initial visit.
Examine factors associated with participant no-shows among smokers scheduled for group CBT.
Tobacco smokers (N = 115) were recruited from the community, screened, and if eligible, scheduled to begin group-based CBT plus nicotine replacement therapy. At the screening, participants reported their recruitment source, demographics, smoking history, and contact information. We computed the distance to the study site using the address provided. Regression analyses tested predictors of participant no-shows for the initial visit.
Eligible participants were mostly recruited via flyers (56%), female (58%), African American (61%), middle-aged (Mage = 49 years), averaged 16 cigarettes per day, and resided 8 miles away from the study site. The overall initial visit no-show rate was 56%. Bivariate analyses indicated that respondents who were recruited online, younger, and lived further away from the site were more likely to be no-shows. Younger age significantly predicted failure to attend in the multivariable model.
Findings highlight potential barriers to participation in a group-based intervention, and have implications for pre-intervention engagement strategies and modifications that may increase reach and uptake.
This meta-analysis investigated the overall effects of glossing on L2 vocabulary learning from reading and the influence of potential moderator variables: gloss format (type, language, mode) and text and learner characteristics. A total of 359 effect sizes from 42 studies (N = 3802) meeting the inclusion criteria were meta-analyzed. The results indicated that glossed reading led to significantly greater learning of words (45.3% and 33.4% on immediate and delayed posttests, respectively) than nonglossed reading (26.6% and 19.8%). Multiple-choice glosses were the most effective, and in-text glosses and glossaries were the least effective gloss types. L1 glosses yielded greater learning than L2 glosses. We found no interaction between language (L1, L2) and proficiency (beginner, intermediate, advanced), and no significant difference among modes of glossing (textual, pictorial, auditory). Learning gains were moderated by test formats (recall, recognition, other), comprehension of text, and proficiency.
The practice of asceticism may represent a rupture with the world, but in the early medieval West it notably encouraged the establishment of “small worlds,” to use the expression of Wendy Davies to describe the numerous, largely cloistered groups that came to replace the social and political institutions of the ancient world. The structure of these small monastic worlds was defined, in the first place, by a way of life regulated according to written norms and by the establishment of well-defined, hierarchically organized complexes of space. Several contributions to this volume demonstrate that this twofold process, characteristic of the history of Western monasticism, emerged only gradually. It took centuries for religious experience to become equated with a disciplined way of life, let alone a single monastic rule, and for the conception and establishment of a topography specific to the requirements of monastic living to develop.