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Psychological correlates of negative self-assessedhealthLalage Sanders aa Department of Anaesthetics , University of Wales College of Medicine , Heath Park,Cardiff, CF4 4XW, United KingdomPublished online: 27 Sep 2007.

To cite this article: Lalage Sanders (1989) Psychological correlates of negative self-assessed health, Counselling PsychologyQuarterly, 2:3, 249-259, DOI: 10.1080/09515078908256681

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Counselling Psychology Quarterly, Vol. 2, No. 3, 1989, pp. 249-259

PERCEPTIONS OF HEALTH AND ILLNESS

Psychological Correlates of Negative Self-assessed Health

LALAGE SANDERS Department of Anaesthetics, University of Wales College of Medicine, Heath Park, Cardifi CF4 4 X W , United Kingdom

ABSTRACT The recent growth in the area now subsumed under the title health psychology can be seen to reject real changes in the societal pre-occupation with health promotion. Established models within health psychology have tended to focus on the inrdace between the individual and the health care system. Moreover, as a consequence of employing the tripam’te model of health, illness and sick-role behaviour as separate entities, research has tended to construct barriers between these behaviours. In is necessary to develop psychological models within health psychology rather than use the education model of the medical orthodoxy. This study explored the distinguishing features of a sub-group of women within the sample who were identified as having relatively negative self-assessed health. Data was obtained on their experience of health and illness, their involvement in health-related behaviours (HRB) and their health beliefs. It was shown that this group was more likely to be involved in damaging HRB, but involvement in positive HRB did not difler from the main sample. They tended to anticipate an improvement over time from their present health status which they felt had been influenced by their own behaviour and by their expm’ence of motherhood.

Introduction

Recent years have seen a significant growth of interest in the area which has come to be termed health psychology. The broad sweep of its subject matter ranges from those issues which relate purely to health, to those strictly concerning illness and pathology. There have been researchers working in the field now covered by health psychology for many years. But until recently they presented no unified force. A large part of that work concerned the interface between the medical system and the individual: topics such as doctor-patient communication, anxiety in surgical pa- tients, coping with terminal illness. These issues were usually termed ‘medical psychology’. There was also active academic interest in stress, in pain, and in response to drugs; and although all these had in common a physiological component they were for the most part considered separately. Psychologists were also working in the territory that had been popularised more overtly by the medical sociologists: health behaviour, illness behaviour and sick-role behaviour. Now all these issues can be subsumed under the umbrella of health psychology.

This growth of interest in health psychology reflects very real changes in our

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society. In the past 10 to 15 years health has become a major issue which permeates many aspects of our social lives. There is a new prevailing preoccupation with an active pursuit of health. Health and fitness can be argued to be the new gods of the 1980’s; the number of joggers on our streets, the proliferation of leisure centres and the enormous growth of what may be termed the ‘industry of health’ in general all testify to its growing number of converts. Health as an ideology has pervaded all aspects of our contemporary culture. An interesting indicator of societal values is the advertising industry. Health, fitness and their attributes are the values most commonly used in all forms of advertising. It is not just in the promotion of products which are often considered to be directly related to the improvement of health or fitness through life-style, diet or exercise, (e.g. yoghurt, sportswear), but items which are not ostensibly related to health also invoke images of healthy living as a means of increasing sales. Cola, hairspray and even credit cards have used such images to bolster their sales. Health has become synonymous with beauty, and has consequently developed a powerful selling impact.

As health psychology continues to flourish, it becomes increasingly imperative to ensure that this new enthusiastic impetus for research does not overlook the need for theoretical psychological models rather than drawing on the education model popular with the health professionals and health educationalists. The original health belief model, HBM as proposed by Rosenstock, Hochbaum & associates (Kasl & Cobb, 1966), calculated the probability of an individual engaging in a specific preventive programme as being a function of the perceived threat of the disease, perceived susceptibility to it, and the perceived costs or benefits of taking the action. The model was later modified to include a ‘cue to action’, or trigger. A more recent model, the Dual Process Model (Leventhal et al., 1983) allowed that the individual will react both cognitively and emotionally to health communications arousing fear which, he argues, all such communications do.

However both these models are primarily concerned with interaction between the individual and the health care system, and as such do not easily lend themselves to more general applications within health psychology. The literature review undertaken by Kasl & Cobb (1966), over 20 years ago organised the then existing literature into three areas, termed health behaviour, illness behaviour and sick-role behaviour. Whilst this trichotomy had obvious organisational advantages for their review it appears to have erected barriers between the study of these three branches of behaviour which are still found today. This model has generated problems of its own, and effectively masked important areas which should themselves be the object of investigation. Is it possible to see these three types of behaviour as separate and discrete entities? Is it not more likely that, for example, there will be some form of interaction between the way an individual behaves when healthy and when ill? Is it not reasonable to suggest that past experiences of health and illness will affect the way in which individuals will perceive their own health status, their health related behaviour and their health beliefs? In order to understand the processes involved in all areas of behaviour, it is necessary to consider the possibility of interaction between them. At a time when our society is pre-occupied with promoting health, it is important to explore the way in which health, both as a notion and as experience,

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Psychological correlates of Negative Self-assessed Health 25 1

is perceived by individuals. The study reported here explored whether health as subjectively evaluated affected either an individual’s involvement in health-related behaviour or their health beliefs.

In order to explore this possibility it was necessary first to define the three areas under investigation: somatic concern, health-related behaviour and health beliefs.

Somatic Concern

The first area of interest was the individual’s experience of health and ill-health. Harris & Guten (1979) categorised their subjects into three health conditions, Good, Moderate and Poor in order to ascertain whether the nature and dimensions of health behaviour varied by health condition. This categorisaiion was achieved from responses to three questions. Repondents were asked if they were currently experi- encing symptoms, if they had had to seek medical advice or curtail ordinary activities recently, and lastly to rate their own health on the three point scale. This measure to establish health condition was fairly crude and did not distinguish the symptomatic from the asymptomatic very effectively. Research on symptom interpretation (for example Robinson, 1971; Pennebaker, 1982; Granfield, 1979; Telles & Pollack, 1981 and Robinson & Granfield, 1986) have all indicated the degree of varibility in reaction to and detection of symptoms. Thus in this research respondents were asked about their subjective experience of and attitudes to health and ill-health, in order to achieve a reasonable measure of what was termed ‘somatic concern’.

Health-related Behaviour

Whilst health behaviour originally referred to preventive health measures in recent years a wider spectrum of behaviour has been covered by this title. Perhaps the broadest definition was that used by Graham (1985) who included such activities as housework because they are part of the maintenance of the health of the family. Whilst this definition avoids the imperialism of the medical orthodoxy, its broad scope covers behaviours which may not necessarily be construed by the individuals concerned as primarily promoting health. Harris & Guten (1979) adopted the term health protective behaviour as behaviour performed by a person in order to promote, protect or maintain their health. This had the merit of incorporating those behaviours which may not be considered by the medical orthodoxy as beneficial to health but which the individual concerned believes to be health-promoting. Their research, and that of a British team, Pill & Stott (1986) who used the same methodology, showed that there is a body of activities which forms a social representation of health protective behaviours.

The present research adopted the term health-related behaviours, partly to avoid the negative connotations of ‘protect’ which implies there is something from which to protect, and partly to avoid the use of double negatives in discussing

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behaviours like smoking. Thus health-related behaviour (HRB) may be defined as any behaviour which an individual believes will affect health.

Health Beliefs

If there is an interaction between health experience and health-related behaviour it is likely that an important mediating variable will be the type of beliefs that people hold about their own health, and about health as a concept. Any theory advanced to explain such an interaction would have to take health beliefs into account. The term health beliefs often occurs in the literature, but frequently refers only to beliefs about illness and its causation, for example Blaxter (1983) and Stimson (1974). Thus here the term health belief may be considered similar to a ‘social representa- tion of health’ (Herzlich, 1973), that is the ideas, categories and types of language which are generally employed to distinguish both health and illness. Therefore the aim of this research was to seek evidence of interaction between individuals’ levels of somatic concern, their involvement in health-related behaviours, and their beliefs about health. This report is primarily concerned with those individuals who have a relatively high level of somatic concern, and thus examines the health psychological correlates of a negative self-assessed health status.

The target group for this research was mothers. This group was selected partly to control for some of the variance in these issues which is known to be associated with sex and age. Moreover in the dominant social structure of our society it is generally mothers who are responsible for many health decisions concerning their family, from selection of the family diet to the decision, in the presence of symptoms, to seek competent medical advice.

Method

Respondents

A quota was established to reflect broadly the socio-economic profile of the country, the only inclusion criterion being that each woman should have at least one chld under 16 years. The 150 women interviewed in this study were all resident in and around Cardiff and were contacted by one of three methods: through social contact points, (e.g. evening classes, schools, play groups and leisure centres), through other respondents or through door-to-door enquiry.

Procedure

Each respondent was interviewed twice, at an interval of approximately 7 days, the two interviews covering four topics. These interviews were nearly always conducted in the respondents own home, although the Home Liaison Unit of a primary school was used for the nine mothers contacted through that agency. No attempt was made to obtain objective data on the health of these women. The aim was to understand their health as perceived by them.

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Psychological correlates of Negative Self-assessed Health 253

The first interview used a structured schedule and covered three topics: demographic features, the level of somatic concern, and involvement in health- related issues. In the section termed somatic concern respondents were asked about their health, their experience of illness and the extent to which they worried about their bodily symptoms, and the frequency with which they resorted to medication. During this part of the interview the women were asked to rate first their present health, and then their childhood health on a labelled six-point scale, (ranging from ‘excellent’ to ‘very poor’). The comparison between the two was explicity discussed. The section on health-related issues covered involvement in positive health- promoting behaviours, both preventive medicine, (cervical smears and dental examinations), and life-style behaviours, (exercise and healthy eating), and weight- control and tobacco and alcohol consumption. Respondents were also asked if they would describe themselves as fit.

At the second interview the women were encouraged to talk about their health beliefs, to compare directly their own present health as they perceived it, with that of other mothers of their own age, of their past selves of 10 years before, and of their anticipated future selves, 10 years on. By this means it was possible to elicit from them the course of their health status over time as perceived by the women themselves. They were also encouraged to discuss and make explicit the reasoning behind their decisions on their comparisons. Thus data were obtained on the types of factors which they believed to influence health status.

From the data on somatic concern it was possible to identify those women who could be considered to take a relatively negative view of their adult health, and then compare them with the rest of the sample in order to examine other factors by which they might be distinguished. Thus 50 women were identified, who unlike the rest of the sample, explicitly stated that their present health was poorer than their childhood health. The results presented below concern this sub-group and the ways in which they differ from the rest of the sample.

Results

Socio-demographic Factors

This group showed no significant differences in socio-demographic details. These women were not distinguishable from the rest of the sample by marital nor employment status, by the number nor the ages of their children, by their own age nor their socio-economic class. From this it may be concluded that the perception of a deterioration in health since the days of their childhood is not associated with easily identifiable external characteristics nor social circumstances.

Somatic Concern

The overall picture from the data shows that these women displayed higher general levels of somatic concern, painting a poorer picture of their own health compared to the rest of the sample. Thus they were clearly distinguishable by their higher levels

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of somatic concern on many of the variables in this section other than the one used to identify them.

In answer to the direct question ‘Would you say that you are healthy?’ only 70% replied ‘yes’ compared to 93% of the main sample, ( x = 12.3, ptO.001). In response to the check-list of ailments, the women in this group indicated that they suffered these symptoms more regularly than the rest of the sample. Whilst the mean number of ailments suffered by the main sample either ‘constantly’ or ‘frequently’ was 1.83, the figure for the sub-group was 3.3. This was a significant difference for both these categories, (for ‘constantly’ F= 4.2, p <0.05, for ‘fre- quently’ F=13.6, ptO.001). It would seem reasonable to conclude that this relatively high occurrence of symptoms was associated with the impression of a deterioration in their health since childhood. A higher percentage of this group, 42016, than of the main sample, 26%, reported that they had suffered a serious illness in adulthood, although this difference failed to reach significance, (p>0.05). But fewer of them recalled a serious illness in their childhood, 6% compared to 24% of the main sample (x=8.8, pt0.05). Significantly more of them reported that they were aware of something which made them ill, 60% compared to 39%, (x=5.1,p<O.O5). And eight women in the sub-group described themselves as migraine sufferers compared to only three in the main sample.

Not only did the subgroup report a higher incidence of ill-health but signifi- cantly more of them stated that they had taken some form of medication in the 24 hours prior to the interview, 40% compared to 19% (x=6.6,p<0.05). In line with this apparent tendency to take medication, significantly more of this group affirmed that they worried about their health, 38% compared to 20% (x=4.7, pt0.05).

Taken as a whole these results indicate that not only did these women evaluate their present health as poorer than the way they recalled their childhood health, but that as a sub-group of the main sample they were reporting more incidents of ill- health. Thus these women can be termed the Somatic Concern ( S C ) group as they demonstrated overall relatively higher level of somatic concern than did the rest of the sample.

Before examining the ways in which the SC women differed from the rest of the sample in health-related behaviour and health beliefs it is necessary first to present the data for the whole sample in each case in order to describe the types of responses that the interview schedule generated.

Health-related behaviour: the whole sample, (n = 150)

These data indicate that approximately three quarters of the sample were involved in at least one of the positive behaviours covered by the interview. Of the responses to the preventive medicine section 77% of respondents reported that they had undergone a cervical smear test within the last 3 years, and 76% claimed that they visited the dentist every 6 months. There was no evidence to suggest an association between these two forms of behaviour. Indeed there were only two respondents who had neither regularly visited the dentist nor had a recent cytology test. Thus

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Psychological correlates of Negative Selj-assessed Health 255

although both behaviours can be subsumed under the title of preventive medicine the lack of association in the responses would indicate that for prospective participants there may be little commonality between the two.

The data on life-style behaviours showed that 74% of respondents reported undertaking some form of regular exercise, and 67% claimed to take health into consideration when selecting their diet. This latter figure does not include those whose dietary selection was influenced only by a desire to lose weight. Weight-loss was an important consideration for many of the respondents. Sixty six percent of the sample declared themselves to be over the weight they wanted to be, and 21% wanted to lose over a stone in weight. Three percent of the sample felt they were under-weight, leaving only 31% who were content with their present weight. In reply to the questions on tobacco consumption, half the sample had never been smokers, and a further 17% had given up. Thirty three per.cent of the sample were smokers at the time of the interview, only 19% admitting to smoking more than 10 cigarettes daily. Asked about their drinking habits, 2% were total abstainers, and 38% were occasional drinkers, (twice a month or less). There was no evidence of association between smoking and drinking patterns.

When asked if they would describe themselves as fit, only 28% replied ‘yes’, a further 34% using the qualifier ‘reasonably’. This must be constrasted with the responses when asked if they would describe themselves as healthy. Here 85% affirmed they were healthy, and a further 10% used the qualifier. Thus only 5% of the sample did not consider themselves healthy whilst 38% did not think of themselves as fit. This is evidence of the distinctiveness of the two notions. It can be seen from these replies (as given in Table I) that apparently although it is possible to be healthy but not fit, it is not possible to be fit but not healthy.

TABLE I. Self-assessments of health and fitness. Whole sample (n = 150)

reasonably not healthy healthy healthy Total

42 fit 42 reasonably fit 44 6 1 51 not fit 42 9 6 57

Total 128 15 7 150

- -

In response to the question asking whether they did anything to maintain or improve their health, 61% of the sample answered in the affirmative, some citing more than one activity. The frequency of the differing types of activities cited by those respondents are given in the Table 11.

It can be seen that exercise, choosing a healthy diet and weight-control between them accounted for 96% of the responses. This is very pertinent and a key to an understanding of what constitutes the social representation of HRB.

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TABLE 11. Activities for improving or maintaining health. Whole sample (n= 150)

Exercise 74 Diet 23 Weight-control .13 Not smoking 3 Regular rest 1 Medical checkup 1

The SC Group (n=50)

Having thus established the types of response generated by the section of the interview schedule on HRB for the whole sample, it is possible to examine the way in which the responses of the SC group differed from the rest. The distinguishing features of the SC group in the data on HRB concerns only negative or damaging behaviours, and not the positive health maintenance or improvement behaviours. The SC women did not differ from the rest of the sample in their involvement in preventive medicine, and were no more or less likely to exercise or to select a diet on health considerations.

However, significantly more of the SC women were over their desired weight, 80% as compared to 60% of the rest of the sample, ( x = 6 . 0 , ~(0.05). Moreover, there were proportionately more of the SC women who smoked over 10 cigarettes daily, 30% compared to 14% of the rest of the sample, (x=4.5,p<0.05). Both of these issues, reducing weight and reducing or giving up tobacco can be considered to hinge on self-control. Both of these courses of behaviour involve a perceived element of self-denial, unlike the more positive behaviours involved in promoting health.

When asked whether they would consider themselves fit significantly more of the SC women answered in the negative than did the rest of the sample, 60% compared to 27%, ( x = 16.21,ptO.OOl). More of them responded in the negative to the question of fitness than did to the question of healthiness; it would seem that these women as a group perceived fitness as being more unobtainable than health. Respondents were also asked if there were activities they would like to engage in to promote their health. More of the SC women replied in the affirmative to this, 84% compared to 67%, (x=4.0, p=0.05).

In summary the responses of this group, although not differing from the rest of the sample for involvement in positive health promoting activities, were character- ised by an element of wistfulness. The SC women were more inclined to consider themselves unfit, to want to lose weight and to be able to do things to improve their health. At the same time they were no more involved in these activities, and yet more likely to be involved in at least one damaging activity (heavy smoking).

Health Beliefs: the whole sample (n = 150)

In making a direct comparison between their perceptions of their own health status

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Psychological correlates of Negative Self-assessed Health 257

and that of other mothers of their own age, 44% indicated that their status was equivalent. When asked to compare their present health status with that of 10 years prior to interview the majority 52% considered it had deteriorated. However, when asked to anticipate their future health status 10 years hence the responses were more evenly divided, although a slight majority expected no change (Table 111).

TABLE 111. Perceived comparative health status. Whole sample (n= 150)

better same worse

Comparison: with others 52 65 33 with past 45 27 78 with future 47 58 -45

Somatic Concern Group (n=SO)

The self-evaluations of their own relative health status did not differ significantly from the main sample when comparing themselves with others, or with their health of 10 years previously. However there was a tendency for more of these women to expect an improvement in their health over the next 10 years. When they were asked for the reasoning behind the relative allocations of health status that they had given, these women tended to be more forthcoming in their discussion than the rest of the sample.

Two reasons were cited frequently. The first reason was their own behaviour, citing either an inadequate involvement in health promoting activities , (exercise and careful selection of diet) , or their continued involvement in damaging behaviours, (smoking or being over-weight). The second but more frequently cited reason concerned the detrimental effect of motherhood which they believed they had experienced. It must be recalled at this point that there were no differences in the structure of the families of these women, either in the number or the ages of their children. The difference then must be seen to lie in their perception of their experience of motherhood as in some way deterimental to their health.

Discussion

It is clear that the SC group, identified by this one measure of negatively evaluated adult health, comprised women who had generally raised levels of somatic concern in comparison with the rest of the sample. It must be stressed that this negative evaluation is only relative; none of the sample was chronic sick or disabled, all were fulfilling the requirements of their social roles as mothers.

It must also be recalled that these women did not differ from the rest of the sample in the degree to which they were involved in positive HRB. They were just

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as likely to be, for example, taking regular exercise as were the rest. The distingu- ishing feature for this group concerned weight-control and smoking, negative HRB. This, in combination with the element of wistfulness identified in their responses to the HRB questions may well be directly related to an element of self-control. It is however, important to distinguish this from the theory of Health Locus of Control. HLOC theory in this context could not explain the apparent willingness of these women to be involved in positive HRB. If their negative HRB is explained in terms of Health Locus of Control theory they must be considered to have an external locus of control. But if they are seen as ‘externals’ who do not believe that they can influence their own health through their own actions, it becomes impossible to explain why they are as likely as the rest of the sample to be involved in active health promotion through life-style and preventive medicine. Rather then this tendency to be involved in negative HRB, along with the apparent wish to be able to do things to promote their health may be better understood as correlated with high levels of somatic concern. What may have seemed to have been a relatively poor experience of health may have militated against these respondents motivation when a proposed behaviour requires a high degree of resolve.

The results concerning the health beliefs of this group, especially their relative evaluations of health status are of particular interest in understanding the way in which they perceive health. The only way in which these comparisons differed significantly from the rest of the sample was in their expectation of improvement. This would suggest that the women in this group are not without optimism in spite of their current negative evaluations. Given the reason they tended to use to explain their own health status, namely motherhood, it may well be that in anticipating an improvement they were taking into consideration the expected diminution of the demands of that role as children grow up. It is, of course impossible from these data to be certain which (if either), is causative: the experience of motherhood these women had undergone, or their raised levels of somatic concern. It would seem reasonable to suggest however that these two factors are closly linked in these women’s beliefs concerning health.

It should also be noted that the SC women were no more likely than the rest of the sample to rate themselves as less healthy than other mothers when asked to make that explicit comparison. They should not therefore be considered to believe themselves to have inferior health status to their peers. The high levels of somatic concern expressed, along with the overall picture of a poorer experience of health, indicates that these women may have believed that their experience is common amongst their contemporaries. Although the SC women may seem to the observer to be experiencing poorer health than the others, they themselves did not appear to be any more ready to think this to be the case than were the other respondents. It is apparent that even when the source of the data is subjective accounts, there is still a possible mismatch between comparative health status as subjectively and objectively evaluated.

In summary the women identified as having raised levels of somatic concern have been shown to have distinguishable features both in their HRB and in their health beliefs. It is thus possible to identify certain health psychological correlates of

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Psychological correlates of Negative Self-assessed Health 259

a negative self-assessed health. The results from this study provide support for the hypothesis that there must be an interaction between the three areas within health psychology, namely somatic concern, HRB and health beliefs. This also supports the contention that to consider any of these areas in isolation may serve to prevent an understanding of the dynamics involved. This suggests that health psychology must take the whole of an individual’s psychology of health into account. As this branch of the discipline grows, it must be hoped that it will generate satisfactory theoretical models which incorporate all these components.

References

BLAXTER, M. (1983) The causes of disease, Social Science and Medicine, 17, pp. 59-69. GRAHAM, H. (1985) Caringfor thefamily (Health Education Council Report). GRANRELD, A. (1979) The frequent consulter in pnmaly medical care (Unpublished Ph.D. thesis). HARRIS, D.M. & GUTEN, S. (1979) Health protective behaviour, an exploratory study, Journal of

HERZLICH, C. (1973) Health and nlness (London, Academic Press). KASL, S. & COBB, S. (1966) Health behaviour, illness behaviour and sick-role behaviour, Archives of

LEVENTHAL, H., SAFER, M. & PANAGIS, D. (1983) Impact of communications on the self-regulation of

PENNEBAKER, J.W. (1982) The Psychology ofPhysica1 Symptoms (New York, Springer-Verlag). PILL, R. & STOTT, N. (1986) Looking after themselves, Health Educarion Research and Practice, 1, pp.

ROBINSON, D. (1971) The Process of Becoming IZl (London, Routledge & Kegan Paul). ROBINSON, J.O. & GRANRELD, A. (1986) The frequent consulter in primary medical care, Journal of

SWSON, G.V. (1974) Obeying doctors orders: a view from the other side, Social Science and

TELLES, J.L. & POLLACK, M.H. (1981) Feeling sick: the experience and legitimation of illness, Social

Health and Social Behaviour, 20, pp. 17-29.

Environmental Health, 12, pp. 246-266, 53 1-541.

health beliefs, decisions and behaviours, Health Education Quarterly, 10, pp. 3-29.

11 1-1 19.

Psychosomatic Research, 30( 5 ) , pp. 589-600.

Medicine, 8, pp. 97-104.

Science and Medicine, 15(A), pp. 243-251.

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