Two central themes were assessed in this thesis involving children with cancer. First, the relationship between the child's medical functioning and their overall quality of life (QOL). Second, how the child's illness and subsequent QOL related to parental mental health and parenting behaviours. These themes were explored using the Risk and Resilience model developed by Wallander et al. (1989b). Study one involved children diagnosed with acute lymphoblastic leukaemia (ALL), the most common form of childhood cancer. Results showed that the child's medical functioning (e.g., time since diagnosis) did not relate to the child's QOL, but did relate to parental mental health. Furthermore, child QOL was significantly related to both parental mental health (depression) and parenting behaviours (endorsement of force). In an attempt to explore these themes in greater detail, Study two involved two groups of cancer survivors, those with ALL or tumours of the central nervous system (CNS). Medically, these groups have different prognoses, treatments, and long-term consequences. Results showed that those with poorer medical functioning, i.e., CNS tumours, had poorer QOL than both the ALL group and population norms, confirming the relationship between the child's medical and psychological adaptation. Furthermore, the child's adaptation was strongly related to both parental mental health and parenting behaviours, again providing evidence for the relationship between child and parent functioning. The results of both studies in this thesis go some way to demonstrate the wide-ranging effects that cancer can have on both the child and family. The child's QOL can be compromised by the illness. Moreover, cancer has a detrimental effect on the family life, from pervasive feelings of depression and worry, to longterm concerns about child-rearing. This thesis has shown that those children with CNS involvement, and their families, are particularly at-risk. To conclude, a section outlining clinical interventions which can help reduced the impact of childhood cancer on the family are discussed.

This thesis examines the multi-disciplinary literature on menopause, develops and evaluates an intervention to prepare mid-aged women for the menopause transition. The literature review suggests that the intervention should aim to increase knowledge of menopause, counter overly negative attitudes, and promote health-enhancing behaviours, framed in a biopsychosocial perspective. Forty-five-year-old women registered at five general practices were targeted for the research. One hundred and seventy-eight women were sent baseline questionnaires assessing knowledge and beliefs about the menopause, and a number of healthrelated beliefs and behaviours. Sixty per cent (N=106) of the women responded. Overall, health-related behaviours were not inter-correlated, nor were health beliefs strong predictors of health behaviours. A number of relationships were found which have implications for health services for mid-aged women. The women appeared to have a low level of awareness of empirically derived information about menopause. Beliefs about menopause were complex and multi-faceted, and not necessarily congruent. Intention to use hormone replacement therapy was related to a disease model of menopause, depressed mood and a poorer sense of personal control over the experience of menopause. An as-sociation between smoking and earlier menopausal changes was found. A complex relationship between lack of exercise, greater body mass index, low self-esteem and perceived barriers to regular exercise was also evident. Fifty women subsequently participated in a health education intervention in the form of two small group sessions. Fiftyone women acted as control. The post-intervention assessment was carried out three months later, and the follow-up assessment a year later. A third group of women (N=44) was contacted for the first time at follow-up, to control for the effects of completing questionnaires by the first control group. Knowledge improved and fewer negative beliefs were expressed after the intervention. The proportion of smokers in the intervention group decreased, as did the proportion of women intending to use hormone replacement therapy, though these changes did not reach statistical significance due to the sample size. These changes were maintained at the 1-year follow-up. These outcome measures were unchanged for the control group. The results are discussed with reference to previous findings for mid-aged samples. The implications for further research are drawn. A range of suggestions for further development of health promotion services for mid-aged women are made.

Introduction There is a paucity of knowledge regarding adolescent's preferences for care. The health related problems they face have implications for individuals and nations. Objectives To determine the health problems and needs of adolescents, their knowledge, use of, and preferences for health related services and service providers. Study design A descriptive study involving a two-stage probability sample. An interview schedule was designed for data collection. Setting Eight randomly selected main-stream high schools in Stoke-on-Trent, England. Subjects One hundred and eleven males and 142 females aged 14 and 15 years between 1 st April and 30th June 1994. Results The adolescents had unmet problems and needs relating to lifestyle and risk-taking behaviour, sexual and reproductive health, and emotional problems, influenced by socio-economic and legislative factors. Services were used primarily for physical problems. Knowledge of the location and opening times of two local contraceptive services for adolescents was poor (10/253,4%). Factors they associated with confidentiality were identified. Preferences for service providers varied with the nature of the problem. The girls were more likely to give advice to peers regarding substance abuse, and issues relating to sexual and reproductive health, and expressed a greater preference for advice from peers on these issues. The services the adolescents wanted to see provided were appropriate to their needs and reflected a holistic concept of health. Conclusions • The Health of the Nation targets will not be met unless these problems and needs are addressed. • Potential intervention points for health promotion are being missed. • Local services must be widely advertised. • Adolescents need specific reassurance from service providers that their care will be confidential. • Positive actions adolescents are prepared to take need reinforcing. • Peer counselling programmes might be expected to have a greater positive impact on girls. • Adolescents' opinions regarding service provision must be taken into account.

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The thesis presents a person-centred ethnographic study of individuals' experiences following first-episode psychosis as they received treatment and support from the OPUS early intervention programme in Copenhagen, Denmark. It describes individuals' struggles to come to terms with overwhelming experiences during their psychosis, and their engagement in identity work as they reconstructed individual life projects. Examining individual-society relations, it is a study of health and social policy in practice, from an existential and cultural phenomenological perspective. The researcher took an active membership role - as evaluator - in the programme, and fifteen key informants described their situations and experiences during in-depth interviews and through written narratives. The longitudinal design allowed for individuals' changes in attitudes and life circumstances to be described, and for a dialogical approach. The study explores the community intervention programme from the recipients' perspectives, examining individual processes of transformation in the event of serious psychiatric diagnosis. It describes their social roles in their relationship to treatment staff, their views on medication, and the workings of the therapeutic interventions through psycho-education, multiple-family groups, and social skills training groups. Processes of recovery are analysed as symbolic healing. The OPUS organisation, as well as the general Danish welfare system and the labour market, determined the life choices available to these individuals and their possibilities for social integration. Informants' experiences of mental illness and mental healthcare constituted existential crises in which their senses of ontological security were suspended as their lives were disrupted. -While some informants chose a strategy of 'sealing over' their experiences others 'integrated' them in various ways: either by dogmatically endorsing one particular explanation or by combining different systems of explanation from the cultural repertoire in a creative analytical and theory-building work of bricolage. Re-establishing a sense of biographical continuity - connecting the individual's past, present and future - was crucial to each person's sense of self and experience of recovery.

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Efforts to control and eradicate infectious disease have concentrated on the provision of childhood vaccination. Unfortunately, the uptake of childhood vaccination continues to vary and infectious diseases continue to cause differential morbidity and mortality. Limited research has assessed the factors that underlie the uptake of vaccination. The present research undertakes an analysis of the patterns and determinants of vaccination uptake within the Portsmouth and South East Hampshire Health Authority, located in the south of England. In so doing, the research employs different analytical approaches, from the traditional ecological analysis through descriptive mapping and multivariate regression, to the innovative multi-level analyses. The ecological analysis shows a distinct geography to the uptake of vaccination which reflects characteristics of socioeconomic deprivation. Further analysis through multilevel modelling, emphasizes two influences on the uptake of vaccination. First, parental characteristics, which affect their role as decision maker and their ability to overcome certain time-space constraints to attend. Second, the ways in which the service is provided, including the influence of the health professional as adviser and provider of vaccination and the initiatives employed to improve uptake. These findings have implications for the future provision of childhood vaccination. Specifically, the research provides the opportunity to identify and target children unlikely to complete their vaccination schedule and the need to improve and standardise health professional knowledge and advice to parents.

This thesis assesses the participation of the medical profession in the development of the structure of the health system in Mexico between 1917-1988. The thesis considers that the major variable that influenced the development of the health system was the participation of the State as its most important financer, provider and regulator. The shaping of the health system in turn determined the mode of participation of doctors. The period is divided in three subperiods: 1917-1943; 1944-1970 and 1971-1988. The first describes the efforts of the profession to gain control over the demand for health services which remained private after the end of the 1917 Revolution. The second describes the way in which the State intervened in the redefinition of the health system, the achievement of the legal control of professions and the way in which medical work began to be determined by the constraints of institutions despite doctors' efforts to defend their autonomous status. Finally, the third period is characterised by a crisis of the economic and political system with repercussions in the definition of the educational and health policy, and the way doctors were faced these conditions. The thesis also points out the major changes during the period in four of the most important characteristics of the medical profession: professional organization, education, employment and geographical distribution. An analysis is finally presented where theoretical elements are used to interpret the historical events that characterized the participation of the Mexican medical profession in the development of the health system.