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Summary: This article reports on findings that indicate how First Nations musical activities function as cultural determinants of health. Drawing on early findings from a 3-year Australian Research Council funded project titled The Remedy Project: First Nations Music as a Determinant of Health, we detail Australian and Ni Vanuatu First Nations musicians' reported outcomes of musical activity using a First Nations cultural determinants of health framework. The broader findings indicate that our respondents see musical activity as actively shaping all known domains of cultural health determinants, and some surrounding political and social determinants. However, this paper focusses specifically on the political and economic determinants that emerged in analysis as the most dominant subthemes. We argue that this study provides strong impetus for continued investigation and reconceptualization of the place of music in cultural health determinant models. Lay Summary: This article looks at how making and performing music, recording music and listening to music helps the health of First Nations peoples in Australia and Ni Vanuatu. Music is an important part of the lives of First Nations peoples from these places and so research was done to try to understand why it is meaningful. Music can be used as an outlet for personal feelings, and can also be a way that groups of people can express common concerns. First Nations musicians talked about how music makes them feel, and how music is used to strengthen relationships between people, and between people and their culture. Musicians also talked about how music helps them express their political and economic goals. The findings backed up existing First Nations' models of health that say that health for First Nations People's needs to be thought about in a holistic way. The findings also showed that the relationship between music and health needs to be studied more so that we can better understand how it helps maintain links with the past, gives a guide for the present and opens options for the future. Graphical Abstract [ABSTRACT FROM AUTHOR]

How do public health advocates and practitioners encourage policy actors to address the social determinants of health? What strategies can be used to elevate healthy social policies onto government agendas? In this paper, we examine the case of Australia's first national paid parental leave scheme, announced in 2009 after decades of policy advocacy. This scheme provides job-protected leave and government-funded pay at the minimum wage for 18 weeks for eligible primary care givers on the birth of an infant, and has been shown to reduce health inequities. Drawing on documentary sources and interviews (n  = 25) with key policy actors, this paper traces the evolution of this landmark social policy in Australia, focusing on the role of actors, institutions and policy framings in setting the policy agenda. We find that advocates strategically deployed three different framings—for economy, gender equality and health—to drive paid parental leave onto the Government's agenda. They navigated barriers linked to power, gender ideology and cost, shifting tactics along the way by adopting different frames in various institutional settings and broadening their coalitions. Health arguments varied in different institutional settings and, at times, advocates selectively argued the economic or gender equality framing over health. The case illustrates the successful use of strategic pragmatism to provoke action, and raises broader lessons for advancing action on the social determinants of health. In particular, the case highlights the importance of adopting multiple synergistic policy framings to draw support from non-traditional allies and building coalitions to secure public policy change. [ABSTRACT FROM AUTHOR]

Despite the growing rates of obesity and diet-related non-communicable diseases, globally, public health attention has only relatively recently turned to the links between trade agreements and the nutritional risks associated with it. Specific trade agreements appear to have played an influential role in the volume and types of foods entering different countries, yet there is currently no systematic and objective monitoring of trade agreements for their impacts on food environments. Recently, INFORMAS was set up to monitor and benchmark food environments, government policies and private sector actions within countries and globally. One of its projects/modules focuses on trade policy and in particular the food-related aspects of trade agreements. This paper describes the INFORMAS trade protocol, an approach to collecting food-related information about four domains of trade: trade in goods; trade in services and foreign direct investment; domestic supports, and policy space. Specifically, the protocol is tested in Fiji. The development and testing of this protocol in Fiji represents the first effort to set out a framework and process for objectively monitoring trade agreements and their impacts on national food supply and the wider food environment. It has shown that entry into WTO trade agreements contributed to the nutrition transition in Fiji through the increased availability of imported foods with varying nutritional quality. We observed an increase in imports of both healthy and less healthy foods. The application of the monitoring protocol also highlights challenges for data collection associated with each trade domain that should be considered for future data collection and analysis in other low and middle income countries. [ABSTRACT FROM AUTHOR]

This paper highlights two salient challenges at the intersection of tobacco control and macroeconomic policy-making: (i) the use of trade and investment disputes to undermine and/or stall tobacco control legislation and (ii) the inconsistency, and thus unpredictability, of country positions across the two spheres. In the interest of improving international policy coherence, the authors suggest possible solutions to these two challenges at the national and intergovernmental levels. [ABSTRACT FROM AUTHOR]

There is increasing public health focus on how corporate practices impact population health and well-being. While the commercial determinants of the climate crisis pose serious threats to human and planetary health, governments largely seek to balance climate action with economic imperatives. Global stakeholders recognize that young people have important voices in influencing climate responses. However, few studies have investigated young people's perceptions of the commercial determinants of the climate crisis. A qualitatively led online survey of n = 500 young Australians (15–24 years) investigated their understanding of corporate responses to the climate crisis, factors that influenced these responses and strategies to respond. A reflexive approach to thematic analysis was used. Three themes were constructed from the data. First, young people perceived that corporate responses to the climate crisis focussed on soft options and lacked meaningful action. Second, they stated that these responses were largely influenced by economic imperatives rather than planetary health, with policy levers needed to implement environmentally responsible corporate practices. Third, young people perceived that systems needed change to create demand for a cleaner environment, leading to improved practices. Young people have a clear understanding of the commercial determinants of the climate crisis and associated threats to population health. They recognize that corporate practices (and consumer demand) will not change without significant policy and structural change. Public health and health promotion stakeholders should work alongside young people to influence decision-makers to address harmful corporate behaviours. [ABSTRACT FROM AUTHOR]

Summary: Despite the potential health benefits of workplace health promotion for employees in sheltered workplaces, participation is often limited. The aim of this study was (i) to understand this limited participation, and (ii) to find opportunities for adapting workplace health promotion, such that it better meets the needs of the target population. A responsive process evaluation of an extensive multi-component workplace health promotion program targeting lifestyle behaviors, financial behaviors, literacy and citizenship, was performed in a large, sheltered workplace in the Netherlands (>3500 employees). To understand the limited participation, interviews with employees (n = 8), supervisors (n = 7) and managers (n = 2), and 10 participant observations were performed. To find opportunities for improving workplace health promotion in the sheltered workplace, 7 dialogs with employees were performed (n = 30). The interview data on the barriers for participation were evaluated through the lens of care ethics, as this allowed to understand the role of various stakeholders in the limited participation, as well as the indirect role of the institutional context. Findings showed that participation in workplace health promotion could increase if it is organized in a way that it encourages employees to work on health together, allow to tailor activities to different needs and capabilities of employees, and connects activities to employees' daily lives. A strength of this study is that the responsive process evaluation focused both on barriers for participation, as well as on opportunities to increase participation. Lay Summary: People who cannot participate in work without adaptations, for example, due to disability, can work in sheltered workplaces. These employees face various health risks, which are prompted by, for example, low income or low (health) literacy. More and more sheltered workplaces provide health promotion programs to improve health of their employees, such as educational workshops about physical exercise and healthy nutrition. However, participation of employees in such programs is limited. In this study, we investigated why participation is limited, and what are possible ways to make workplace health promotion programs that aim to improve health more attractive to employees in a sheltered workplace. We used different methods, such as interviews, group dialogs and participant observations. We concluded that workplace health promotion programs seem to rely too much on the individual employee, who prefers to work on health together with peers. Employees also value that activities in the health program are useful for their daily lives. This increases the relevance of the program for them and makes employees more inclined to participate. [ABSTRACT FROM AUTHOR]

Obesity is a global challenge for healthy populations. It has given rise to a wide range of public health interventions, focusing on supportive environments and lifestyle change, including diet, physical activity and behavioural change initiatives. Impact is variable. However, more evidence is slowly becoming available and is being used to develop new interventions. In a period of austerity, momentum is building to review these initiatives and understand what they do, how they do it and how they fit together. Our project seeks to develop a relatively straightforward systematic framework using readily accessible data to map the complex web of initiatives at a policy, population, group and individual level aiming to promote healthy lifestyles, diet and physical activity levels or to reduce obesity through medical treatments in a city or municipality population. It produces a system for classifying different types of interventions into groupings which will enable commissioners to assess the scope and distribution of interventions and make a judgement about gaps in provision and the likely impact on mean body mass index (BMI) as a proxy measure for health. Estimated impact in each level or type of intervention is based upon a summary of the scientific evidence of clinical and/or cost effectiveness. Finally it seeks, where possible, to quantify the potential effects of different types of interventions on BMI and produce a cost per unit of BMI reduced. This approach is less sophisticated but identifies the areas where more sophisticated evaluation would add value. [ABSTRACT FROM AUTHOR]

Children are exposed to food environments that make nutrient-poor, energy-dense food cheap, readily available and heavily marketed; all conditions with potential negative impacts on diet and health. While the need for programmes and policies that improve the status of food environments is clear, greater public support is needed for governments to act. The purpose of this qualitative collective case study was to examine if community engagement in the Local Environment Action on Food (LEAF) project, a community-based food environment intervention in Alberta, Canada, could build public support and create action to promote healthy food environments. Semi-structured interviews with a purposeful sample of 26 stakeholders from 7 communities explored LEAF's impact and stakeholder experiences creating change. Data collection and analysis were iterative, following Charmaz's constant comparative analysis strategy. Participants reported environmental and community impacts from LEAF. Notably, LEAF created a context-specific tool, a Mini Nutrition Report Card, that communities used to promote and support food environment action. Further, analysis outlined perceived barriers and facilitators to creating community-level food environment action, including level of engagement in LEAF, perceived controllability, community priorities, policy enforcement and resources. Findings from this study suggest that community-based interventions, such as LEAF, can help build community capacity and reduce existing barriers to community-level food environment action. Thus, they can provide an effective method to build public awareness, demand and action for healthier food environments. [ABSTRACT FROM AUTHOR]

In this paper, we reflect on and explore what remains to be done to make the concept of supportive environments—one of the Ottawa Charter's five core action areas—a reality in the context of growing uncertainty about the future and accelerated pace of change. We pay particular attention to the physical environment, while underscoring the inextricable links between physical and social environments, and particularly the need to link social and environmental justice. The paper begins with a brief orientation to three emerging threats to health equity, namely ecological degradation, climate change, and peak oil, and their connection to economic instability, food security, energy security and other key determinants of health. We then present three contrasting perspectives on the nature of social change and how change is catalyzed, arguing for an examination of the conditions under which cultural change on the scale required to realize the vision of ‘supportive environments for all’ might be catalyzed, and the contribution that health promotion as a field could play in this process. Drawing on sociological theory, and specifically practice theory and the work of Pierre Bourdieu, we advocate rethinking education for social change by attending more adequately to the social conditions of transformative learning and cultural change. We conclude with an explication of three key implications for health promotion practice: a more explicit alignment with those seeking to curtail environmental destruction and promote environmental justice, strengthening engagement with local or settings-focused ‘communities of practice’ (such as the Transition Town movement), and finding new ways to creatively ‘engage emergence’, a significant departure from the current dominant focus on ‘risk management’. [ABSTRACT FROM PUBLISHER]

Wonju is the first municipality in the Republic of Korea to fund the Healthy City project through municipal revenues from the local tobacco consumption tax. We investigated the process of the local tobacco consumption tax being approved as the main source of financing for the local Healthy City project. We also examined the sustainability and sufficiency of the funding by looking at the pricing policies instituted for cigarettes, smoking prevalence, cigarette consumption and revenues from local tobacco consumption as well as the budgetary allocations among programs in the city. The strong initiative of the mayor of Wonju was one of the factors that enabled the earmarking of the local tobacco consumption tax for the Healthy City Wonju project. He consulted academic counselors and persuaded the municipal government and the City Council to approve the bill. Despite the increasing price of cigarettes in Korea, adequate funding can be sustained to cover the short-term and mid-term programs in Wonju for at least 5 years of the mayor's term, because the smoking rate is persistently high. Analyzing the effects of strong leadership on the part of local authorities and the balance between revenues from the tobacco tax and the prevalence of smoking in the face of anti-smoking policies would be helpful for other countries and communities interested in developing sustainable Healthy Cities projects. [ABSTRACT FROM AUTHOR]

The current lack of a common basis for collecting data on population-level prevention and health promotion interventions causes public health to be relatively invisible within broader health systems, making it vulnerable to funding cuts when there is pressure to reduce spending. Further, the inconsistent use of terms for describing interventions hinders knowledge translation and building an evidence base for public health practice and policy. The International Classification of Health Interventions (ICHI), being developed by the World Health Organization, is a standard statistical classification for interventions across the full scope of health systems. ICHI has potential to meet the need for a common language and structure for describing and capturing information about prevention and health promotion interventions. We report on a developmental appraisal conducted to examine the strengths and limitations of ICHI for coding interventions delivered for public health purposes. Our findings highlight classification challenges in relation to: consistently identifying separate components within multi-component interventions; operationalizing the ICHI concept of intervention target when there are intermediary targets as well as an ultimate target; coding an intervention component that involves more than one ICHI target or action; and standardising what is being counted. We propose that, alongside its purpose as a statistical classification, ICHI can play a valuable role as an 'epistemic hub', to be used flexibly by public health actors to meet a range of information needs, and as a basis for improved communication and exchange. [ABSTRACT FROM AUTHOR]

New trade agreements affect how governments can regulate for health both within health systems and in addressing health protection, promotion and social determinants of health in other policies. It is essential that those responsible for health understand the impacts of these trade negotiations and agreements on policy space for health at a national and local level. While we know more about implications from negotiations concerning intellectual property rights and trade in goods, this paper provides a screening checklist for less-discussed areas of domestic regulation, services, investment and government procurement. As implications are likely to differ on the basis of the organization and structures of national health systems and policy priorities, the emphasis is on finding out key provisions as well as on how exemptions and exclusions can be used to ensure policy space for health. [ABSTRACT FROM PUBLISHER]

The article, a critical essay, presents the notion of an emancipatory promotion of health (EPH), which seeks to relate the field of public health in theoretical and practical terms with the reinvention of utopias and relevant social struggles of our time principally in the Global South, a metaphor designating the peripheral or semiperipheral regions of the modern world-system. This is a relevant topic in the face of the planetary socio-ecological crisis and the debate on economic development, democracy and sustainability at a moment especially critical for the Brazilian reality and other countries. In particular, the contributions of peoples and social movements from rural, forests and water-dominated regions in Brazil to the emancipatory practices of health are discussed. The article is mainly based on two theoretical and methodological references, the Political Ecology and post-colonial approaches. The first focuses its analysis on the intensification of the social metabolism and environmental conflicts in the global capitalist economy, based on an unfair and unsustainable international trade that generates numerous socio-environmental conflicts, mainly in the Global South, that is, the peripheral countries that export agricultural and mineral commodities to richer ones. The second reference broadens and integrates the critique of capitalism with colonialism and patriarchy, understood as the three axes of oppression resulting from the Eurocentric modernity project. The challenge here is to deconstruct and reconstruct through an intercultural dialogue new conceptions of society, economy, nature, development, work and health. Such references help us to understand the importance of indigenous, peasant and Afro-descendant struggles for an emancipatory health promotion. [ABSTRACT FROM AUTHOR]

Guided by the Extended Parallel Process Model, this experiment demonstrates how perceived fairness in health resource policy decisions can influence both the protective action and denial-oriented health threat responses of policy affected individuals. Students from a large urban university in the Midwestern USA (n = 127) read about a purported illness and were told about a vaccination that would soon be available to them through their university. The out-of-pocket cost of vaccination was manipulated (distributive justice), as was the fairness of procedures used to determine this cost (procedural justice). When vaccination was low cost, procedural justice resulted in greater intention to be vaccinated and also diminished reporting of compensatory health behaviors that could purportedly supplant the need for vaccination. Ironically however, procedural justice resulted in lower vaccination intention and exaggerated compensatory health behavior reporting when vaccination was high cost. Crucially, this experiment demonstrates that perceived fairness may encourage both action-oriented and fear control health threat response, and that health promotion behaviors such as vaccination may be affected through interactive relationships of distributive and procedural justice that stem from health policy decisions. [ABSTRACT FROM AUTHOR]

On an urban planet, slums or informal settlements present an increasing challenge for health promotion. The living conditions in complex informal settlements interact with how people navigate through their daily lives and political institutions to shape health inequities. In this article, we suggest that only a relational place-based characterization of informal settlements can accurately capture the forces contributing to existing urban health inequities and inform appropriate and effective health promotion interventions. We explore our relational framework using household survey, spatial mapping and qualitative focus group data gathered in partnership with residents and non-governmental organizations in the Mathare informal settlement in Nairobi, Kenya. All data interpretation included participation with local residents and organizations. We focus on the inter-relationships between inadequate sanitation and disease, social, economic and human rights for women and girls, who we show are most vulnerable from poor slum infrastructure. We suggest that this collaborative process results in co-produced insights about the meanings and relationships between infrastructure, security, resilience and health. We conclude that complex informal settlements require relational and context-specific data gathering and analyses to understand the multiple determinants of health and to inform appropriate and effective healthy city interventions. [ABSTRACT FROM AUTHOR]

A plethora of studies from sub-Saharan Africa indicate that orphaned and vulnerable children are exposed to adverse health, education and other social outcomes. Across diverse settings, conditional cash transfer (CCT) programmes have been successful in improving health outcomes amongst vulnerable children. This study explored the pathways of CCTs' impact on the health of orphans and vulnerable children in rural Ghana. Due to the multi-dimensional nature of CCTs, the programme impact theory was used to conceptualize CCTs' pathways of impact on child health. A qualitative descriptive exploratory approach was used for this study. This study drew on the perspectives of 18 care-givers, 4 community leaders and 3 programme implemen-ters from two rural districts in Ghana. Semi-structured individual interviews were conducted with the participants. Thematic content analysis was conducted on the interview transcripts to pull together core themes running through the entire data set. Five organizing themes emerged from the interview transcripts: improved child nutrition, health service utilization, poverty reduction and social transformation, improved education and improved emotional health and well-being demonstrating the pathways through which CCTs work to improve child health. The results indicated that CCTs offer a valuable social protection instrument for improving the health of orphans and vulnerable children by addressing the social determinants of child health such as nutrition, access to health care, child poverty and education. [ABSTRACT FROM AUTHOR]

Despite evidence that public policy that equitably distributes the prerequisites/social determinants of health (PrH/SDH) is a worthy goal, progress in achieving such healthy public policy (HPP) has been uneven. This has especially been the case in nations where the business sector dominates the making of public policy. In response, various models of the policy process have been developed to create what Kickbusch calls a health political science to correct this situation. In this article I examine an aspect of health political science that is frequently neglected: the raw politics of power and influence. Using Canada as an example, I argue that aspects of HPP related to the distribution of key PrH/SDH are embedded within issues of power, influence, and competing interests such that key sectors of society oppose and are successful in blocking such HPP. By identifying these opponents and understanding why and how they block HPP, these barriers can be surmounted. These efforts to identify opponents of HPP that provide an equitable distribution of the PrH/SDH will be especially necessary where a nation's political economy is dominated by the business and corporate sector. [ABSTRACT FROM AUTHOR]

In this article, we interrogate the policy response of the International Monetary Fund (IMF) to the global financial crisis, and discuss the likely global health implications, especially in low-income countries. In doing so, we ask if the IMF has meaningfully loosened its fiscal deficit targets in light of the economic challenges posed by the financial crisis and adjusted its macro-economic policy advice to this new reality; or has the rhetoric of counter-cyclical spending failed to translate into additional fiscal space for IMF loan-recipient countries, with negative health consequences? To answer these questions, we assess several post-crisis IMF lending agreements with countries requiring financial assistance, and draw upon recent academic studies and civil society reports examining policy conditionalities still being prescribed by the IMF. We also reference recent studies examining the health impacts of these conditionalities. We demonstrate that while the IMF has been somewhat more flexible in its crisis response than in previous episodes of financial upheaval, there has been no meaningful rethinking in the application of dominant neoliberal macro-economic policies. After showing some flexibility in the initial crisis response, the IMF is pushing for excessive contraction in most low and middle-income countries. We conclude that there remains a wide gap between the rhetoric and the reality of the IMF’s policy and programming advice, with negative implications for global health. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various articles within the issue on topics which include applying existing health promotion tools in a new way, the impact of government's austerity measures on health care, and the impact of global financial crisis of 2007/08.

Despite increasing interest, little is known about the beliefs and views of the public in relation to the use of economic incentives as a means to promote healthy eating. This study explores views of ethnically and socioeconomically diverse shoppers regarding acceptability of economic incentives to promote healthier food purchases, and factors likely to affect the success of such schemes. Six focus groups (n = 36 participants; 14 Māori, 12 Pacific, 10 non-ethnic specific low income), were held in Auckland, New Zealand, in October 2009. A general inductive approach was used to identify common themes. The single most important reported food purchasing influence was cost. Focus group participants viewed the concept of economic incentives to promote healthy eating positively, as long as such schemes provided worthwhile incentives, and were simple and convenient to use. The preferred option for delivery was a pre-loaded electronic swipe card. Fruit and vegetables were the food group most participants said they would like to see incentivized. There was marked variability in the incentive amount thought sufficient to promote participation in such a scheme. Our findings suggest economic incentives hold promise as a means to promote healthier household food purchases, and their effectiveness should be evaluated using robust, randomized trials. [ABSTRACT FROM AUTHOR]

This article explores the dearth of coverage of the social determinants of health by the Canadian mainstream media. It is argued that this neglect is primarily a reflection of political and economic societal structures that has been associated with increasing corporate control of the mainstream media. Applying a critical political economy lens, it is argued that the barriers to having the Canadian mainstream media report on the social determinants of health are so numerous that it may indeed be ‘time to call it a day' in regard to having them assist in the dissemination of social determinants of health findings. Recognizing this reality should spur the development of alternative means of communicating with the public in order to develop a citizens’ movement to create health-promoting public policy. Recent dissemination efforts related to the Social Determinants of Health: The Canadian Facts provide an example of how this might be accomplished. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the economic performance of 10 nutrition interventions. The interventions included Mediterranean Diet, Intensive Lifestyle Change (nutrition and physical activity) to Prevent Diabetes, Reduced Fat Diet for persons with IGT, Nutritional Counselling in GP (GP, general practice/ primary care), Nurse Counselling in GP, Oxcheck Nurse Health Checks in GP, Gutbusters Workplace (for men), Talking Computer, Multi Media 2 fruit 5 veg Campaign and the FFFF (Fighting Fit, Fighting Fat) Media Campaign. Markov models were constructed in order to estimate economic performance expressed as cost per QALY (quality adjusted life year) gained. Data from original clinical trial reports were used to populate the models, supplemented by the wider literature where required. Performance of the Mediterranean Diet and Intensive Lifestyle Change to Prevent Diabetes interventions could be estimated with most certainty and both were highly cost-effective interventions, at AU $1020 (US $760, £410) and AU $1880 (US $1410, £750) per QALY gained, respectively. The media campaign interventions appear highly cost-effective at A U $46 (US $34, £18) for '2 fruit 5 veg' and AU $5600 (US $4200, £2200) per QALY gained for FFFF,, but are associated with considerable uncertainty, and may be dominated under certain assumptions. Several interventions were cost-saving under plausible sets of assumptions, whereas a small number were potentially dominated. All interventions subject to economic evaluation appeared cost-effective relative to societal norms. Nutrition interventions can constitute a highly efficient component of a strategy to reduce the growing disease burden linked to over/poor nutrition. There is an urgent need for high-quality trial data from which economic performance of nutrition interventions can be modelled. [ABSTRACT FROM AUTHOR]

The author discusses the aspects of the health of the ecosystems, which is the most significant element of the health and wellbeing of the population. It mentions that the World Health Organization (WHO) recognizes the natural ecosystems, which is the planet's life-support systems for human being and other life forms. Moreover, it notes that human activity threatens the natural functions of the world and the ability of the ecosystems to sustain future generations can no longer be ignored.

Health has moved up on the political agendas of most governments around the globe. The interdependence of economic, environmental and social conditions and health is increasingly understood. In turn, the experiences in health promotion with building healthy public policies become more important. Future “health in all policies” efforts, however, need to consider changing political contexts. There is some scope to review the focus on GDP when measuring economic development, and how health promotion considers both the opportunities and responsibilities of industry as part of healthy public policies. [ABSTRACT FROM PUBLISHER]

Mental and behavioural disorders account for about one-third of the world's disability due to all ill health amongst adults, with unipolar depressive disorders set to be the world's number one cause of ill health and premature death in 2030, affecting high- and low-income countries alike. There is a range of evidence-based cost-effective interventions that can be implemented in parenting, at schools, at the workplace and in older age that can promote health and well-being, reduce mental disorders, lead to improved productivity and increase resilience to cope with many of the stressors that are facing the world. These facts need to be better communicated to policy makers to ensure that the silent burden of impaired mental health is adequately heard and reduced. [ABSTRACT FROM PUBLISHER]