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.

The control of proliferation, differentiation and survival of normal and malignant haemopoietic cells is under the control of a wide range of different factors. These include cell:cell interactions, immune regulatory factors, hormonal influences, and local environmental influences. However, the way in which these factors combine to regulate the dynamics of the leukaemic cell are poorly understood. One of the main problems in conducting these experiments is the logistical difficulty in comparing multiple variables. For example, to design an experiment to simulate and study a biological system that involves 13 factors each at 3 different levels requires 1,594,323 experimental runs. Taguchi methods, on the other hand, use orthogonal arrays to create smaller, less costly experiments that have a high rate of reproducibility. A study involving 13 factors at 3 different concentrations can be conducted with only 27 experimental runs. The use of Taguchi methods in the discipline of life scienceis in its very early stages, as very limited number of experiments in this field have been designed and analysed according to the Taguchi methodology. This study was thus set to investigate the suitability of Taguchi methods to study a biological problem with multiple factors involved and poorly understood mechanisms.

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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.

The World Health Organization estimates that 22 million children worldwide aged <5 years are overweight and highlights tackling childhood obesity as an urgent priority. Childhood obesity is rising to epidemic proportions in the developing world, reflecting changing physical activity levels and dietary intakes, adding a significant public health burden to countries where undernutrition remains common. Interventions to prevent childhood obesity have had disappointing results, because the science and aetiology of obesity is poorly understood and prevention programmes have not targeted appropriate behaviours nor adequately engaged communities being studied. The origins of obesity appear simple, excess energy intake and/or low energy levels expended on physical activity, leading to chronic energy imbalance. However, the problem is more complex with underlying societal, behavioural and genetic causes of energy imbalance remaining unclear. Obesity is driven by individual, household and community factors: research to date has concentrated on individual factors with almost no significant focus on higher level influences on obesity. Findings from studies in developed countries are unlikely to be applicable to rural African settings where there is an increasing transition from a state of undernutrition to that of overnutrition. Few data exist on the prevalence of child and adolescent obesity from low and middle income countries like South Africa. This thesis aimed to determine the prevalence of overweight and obesity in children and adolescents (aged 7-15 years) within this population and to identify possible risk factors. Participants and Methods The study was cross-sectional and involved collecting primary data in local schools. A total of 1,519 subjects were recruited from three age groups (approximately 500 from each age group 7, 11 and 15 years). Participants were recruited from school grades 1, 5 and 9 corresponding to the ages 7, 11 and 15 years respectively. The study comprised two parts, a main cross-sectional study and a further study including a sub-sample of the participants. In the main cross-sectional study anthropometric measurements (height, weight, mid-upper arm circumference and body fat) were performed on all the participants and a lifestyle questionnaire administered (questions related to water collection, travel to school, TV watching and sport participation). The study took place in a demographic surveillance area and data collected from participants was linked with their household/community data to allow analysis of variables associated with overweight/overfat status. 150 participants were randomly selected from the main study (50 from each age group 7, 11 and 15 years) and invited to take part in a sub-sample study which included objective measurement of physical activity (7 days accelerometry) and dietary assessment (2 x 24 hour multiple pass recall assessments) on each participant. Main Findings Prevalence of overweight and obesity was higher in girls than boys and was highest in the oldest age groups for females. Using the Cole/IOTF BMI for age reference combined overweight and obesity was 23% in grade 9 females compared to only 6% in boys in the same grade (p<0.01). The lifestyle questionnaire revealed high levels of water collection, active commuting and TV watching.