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Objective: Exercise is Medicine (EIM) is a global initiative encouraging healthcare providers to routinely assess and promote physical activity (PA) among patients. The objective of this study was to evaluate the feasibility, adoption, implementation and effectiveness of EIM from patient, clinician and healthcare staff perspectives using a combination of electronic health record (EHR), survey and interview data., Design: This study used a combination of the Practical Robust Implementation and Sustainability Model (PRISM) and the Learning Evaluation model to implement EIM. Data captured from the EHR, including Physical Activity Vital Sign (PAVS) scores, and data collected from qualitative surveys and interviews were used to evaluate the programme's Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM, which is embedded within PRISM) from provider, staff and patient perspectives., Setting: Five primary care clinics within a large academic health system., Participants: A total of 24 443 patients from all participating clinics had at least one PAVS score during the study period. A total of 17 clinicians completed surveys, and 4 clinicians, 8 medical assistants and 9 patients completed interviews., Results: Implementation fidelity metrics varied widely between components and across clinics but were generally consistent over time, indicating a high degree of programme maintenance. Fidelity was highest during the first 6 months of the COVID-19 pandemic when most visits were virtual. Mean PAVS scores increased from 57.7 (95% CI: 56 to 59.4) to 95.2 (95% CI: 91.6 to 98.8) min per week at 6 months for patients not meeting PA guidelines at baseline and decreased from 253.84 (95% CI: 252 to 255.7) to 208.3 (95% CI: 204.2 to 212.4) min per week at 6 months for patients meeting PA guidelines at baseline. After EIM implementation, clinician-estimated time spent discussing PA with patients increased for 35% of providers and stayed the same for 53%., Conclusion: Overall, this study established EIM's feasibility, adoption, implementation and maintenance in routine primary care practice within a large academic health system. From a population health perspective, EIM is a model to emulate to help primary care providers efficiently address healthy lifestyle behaviours in routine primary care visits., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Allied health professionals are well positioned to assess and support their clients' health literacy (HL); however, they report being deficient in HL knowledge and skills., Objective: To explore allied health students' HL and their perceptions of their roles in supporting clients' HL., Design: A mixed-methods cross-sectional study was undertaken in August 2022 amongst allied health students enrolled in graduate-entry masters programs at the University of Tasmania. Data collected included the Health Literacy Questionnaire (HLQ) ( n = 30) and qualitative telephone interviews ( n = 6)., Results: Allied health students' confidence in the knowledge domain of the HLQ was rated as 28.57 from a maximum possible score of 50. Similarly, the students' confidence in the skills domain of the HLQ was rated as 14.87 from a maximum possible score of 25. Four themes were generated from the qualitative interviews: (1) valuing HL, (2) an innate part of their future roles, (3) contributors to their own HL, and (4) advocacy and their decision to study allied health., Conclusion: This study provides a preliminary insight into the HL of allied health students and highlights the strong perception held by allied health students that supporting clients' HL is a large component of their future roles.

Twenty years after its launch, the most ambitious preventive program implemented at the institutional level in Mexico called PREVENIMSS focuses on new challenges and moves towards relaunching. This paper reviews the foundations and design of PREVENIMSS and its evolution throughout these two decades. The PREVENIMS coverage assessment through national surveys set a relevant precedent in evaluating programs at the Mexican Institute of Social Security. PREVENIMSS has shown progress in preventing vaccine-preventable diseases. However, given the current epidemiological profile, there is still a need to provide more effective primary and secondary prevention of chronic noncommunicable diseases. New digital resources and orientation of PREVENIMSS towards a more comprehensive approach that contemplates secondary prevention and rehabilitation can help to face the growing challenges that the program still faces., (© 2023 Revista Médica del Instituto Mexicano del Seguro Social.)

Environment factors play a crucial implication in human health, with strong evidence suggesting that several biological, chemical, physical and social factors could be possible targets to implement effective strategies for human health promotion. On the other hand, a large gap of knowledge still exists about the implications of environmental factors in terms of functional impairment and disability, while the integration of an environmental-based approach in the therapeutic care of patients affected by disabilities remains still challenging. In this scenario, the One Health approach has been recently introduced in clinical care and aims to optimize health outcomes by recognizing the interconnection between people and the environment. Concurrently, the "Rehabilitation 2030 Initiative" proposed in 2017 by the WHO emphasized the need to integrate environmental-based strategies to promote rehabilitation across different health systems and different nations. However, no previous study underlined the potential implications of the One Health approach in the rehabilitation setting, nor the role of a comprehensive rehabilitation approach focused on environmental factors. Therefore, the aim of this narrative review was to present a comprehensive overview of the data currently available assessing the close relationship between rehabilitation and the environment to provide a different perspective on the comprehensive care of patients affected by disability.

In academic medicine, the growing importance of disease prevention and health promotion poses new challenges. Besides diseases, the focus must also be on health resources and competences in order to promote health and to prevent diseases or their prolonged manifestation. These aspects must already be integrated into medical education in order to equip future professionals. With the aim of integrating health promotion and disease prevention more strongly in the curriculum and strengthening the interdisciplinary collaboration between physicians and other health care professionals, a prototypical longitudinal model curriculum is being developed for students of medicine and educational science with a focus on health pedagogy at Augsburg University. Students learn about health promotion strategies in the University setting, gain initial interdisciplinary experience and then plan and implement health promotion initiatives for their fellow students in smaller projects as peers. The intention is to make the university setting more health-promoting for as well as by students.The model curriculum is intended to provide other university locations with "good practice" examples that can then be locally adapted and integrated into the respective curricula., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Context: The Presence for Racial Justice project leverages the Stanford Presence 5 framework to present anti-racism communication practices that promote clinician trust-building for Black patients in primary care. With the racial/ethnic disparities in COVID-19 infection rates, an assessment of Black patients' perspectives around COVID-19 care is required to promote health equity in current and future health crises. Objective: To compile clinician communication strategies for promotion of patient understanding and agency concerning Black patients' perceptions of COVID-19 vaccine, treatment and testing. Study design: Qualitative study employing inductive and deductive thematic analysis. Setting: Four primary care clinics primarily serving Black patients in Oakland, CA; Rochester, NY; Leeds, AL; and Memphis, TN. Population Studied: 37 Black patients, recruited through convenience sampling by their primary care clinician for 45-minute semi-structured audio-recorded interviews. Outcome Measures: Emergent themes around Black patient perceptions and motivations for seeking/delaying COVID-19 vaccine, treatment, and testing, and their ideal medical guidance on COVID-19 care. Results: Due to historic mistreatment of Black patients within the healthcare system, medicine, and research, there is a high prevalence of mistrust amongst the Black patient interviewees towards the safety, efficacy, and equitable distribution of the COVID-19 vaccine compared to existing vaccines. Patients feared racial discriminatory treatment and intended to wait for the general population, authority figures, and White patients to receive the vaccine first. Many patients believed personal protective behaviors (e.g., mask wearing, staying home, taking supplements) would be more effective than receiving the COVID-19 vaccine. They expressed a preference for receiving COVID-19 medical care in the comfort of their homes due to high costs and risks of maltreatment, death, and loneliness. Conclusion: Black patients hinged their vaccination decisions on having enough time to observe vaccine rollout and discussion with their clinicians. Relating new medical interventions (ie., COVID-19 vaccine) to accept medical approaches (ie., Flu vaccine) and being aware of historical distrust in medicine can inform clinician efforts to empower and provide excellent care for Black patients moving forward., Competing Interests: Authors report none., (2021 Annals of Family Medicine, Inc.)

Background: The American Psychological Association reports that Generation Z are suffering mentally and physically more than any other group. Purpose: Measure the effects of a 16-week, online college-level "Complementary Therapies in Health Course" through the lens of the biopsychosocial-spiritual model on measures of health and aspects of well-being in college students. Methods: A mixed method, controlled, repeated measures study delivered in an online synchronous college-level health course. The course curriculum included the science and practice of compassion, happiness, mindfulness, meditation, yoga, service, gratitude, longevity, movement, and more. Results: 42 students 18-23 participated. A significant between subjects cross-over effect demonstrating improvements in the intervention group and deterioration in the control group was found using the Self Compassion Scale (p < 0.005), Self-Compassion subscale of Judgment (p < 0.001), Spiritual Well-being Scale (p < 0.047), and the Pemberton Happiness Index (p < 0.007). The Self Compassion Scale also revealed a within subjects significant effect (p < 0.001). Qualitative data revealed improvements in compassion, feelings of happiness, sleep, exercise and health habits, gratitude, mindfulness, spiritual feelings, and more. Discussion: Health education predicated on the biopsychosocial-spiritual model is efficacious. Translation to Health Education Practices: A whole person, complementary health approach to education programming has widespread, positive effects on college students.

This study examines the quality of entry translation in Dorland's Medical Dictionary (DMD) containing mistranslation and maltranslation. This embedded-case study used DMD human-based and website mistranslation leading to maltranslation. The purposively selected data were 111 tropical medicine related the entries and its definition inserted in the "Kamus Kedokteran Dorland Edisi 31" and the website translated by Google Translate. The translation techniques and assessment of the quality were processed in a Focus Group Discussion. The rational how a mistranslation raised maltranslation was based on the basic medical science when a doctor examined, diagnosed, treated, promoted and prevented diseases for the benefit of patients. Findings show that 111 entries made up of 158 human-based translated sentences are composed of 2816 units of translation, and the 162 Google Translate sentences for 3054 units. There are 18 translation techniques in human-based translation, 16 in Google Translation, 80 mistranslations leading to 57 maltranslations causing incorrect diagnosis, mistreatments, and misdirection of health promotion and prevention of disease. Of 40 tokens, maltranslation occurs 32 times and human-based translation 25 times, implying low quality of the translation that requires improvement of the definition, word entries, and sentences in the website.

Background: Promotion of healthy behaviour is increasingly highlighted worldwide as a way to improve public health, prevent disease incidence, and decrease long-term costs for healthcare. In Sweden the National Board of Health and Welfare (NBHW) used the well-established format of national guidelines to facilitate a more widespread use of approaches for promotion of healthy lifestyle habits in healthcare. Aims and objectives: The aim of this case study was to explore the tensions between public health knowledge and the tenets of evidence-based medicine (EBM) in the creation of national guidelines on lifestyle habits. Methods: Based on data from interviews with guideline professionals and the collected documents of the national guidelines, we examine how NBHW negotiated the conflicts between public health knowledge and the format of national guidelines. An analytical model based on approaches from the sociology of standardisation is used to explore the ramifications of these negotiations. Findings: In line with findings in the sociology of standardisation, we show how conflicts between public health knowledge and the format of national guidelines result in both having to yield on certain points. This, we claim, results in compromise, but perhaps also compromised notions of validity and causality. Discussion and conclusion: This case offers important learning about the general compatibility of public health and currently dominant methods of EBM. Important crossroads are outlined, concerning how validity and causality are configured in public health guidelines and how these require extensive epistemological deliberation.

Longevity health sciences and mental health are fields of public health and of preventive and integrative medicine. The antagonism between health construction and human pathology is substantiated by two opposite fundamental pathways: the health-longevity tetrad versus the aging-disease cascade. It is necessary that the current paradigm of contemporary medicine be replaced by the advanced paradigm of future medicine. A societal cost-benefit rate is decisive for health-longevity promotion. This is why the WHO public health strategy keeps forwarding the societal medical target into the global health-longevity field.

Reducing HIV transmission is a critical goal worldwide, prompting new strategies to slow the spread of the virus. This paper describes the theoretical underpinnings of the Comprehensive Harm Reduction Protocol (CHRP) and the process of its implementation in one large urban HIV clinic and two smaller rural primary care clinics. Patients enrolled in CHRP complete the Risk Diagnostic Questionnaire (RDQ), self-reporting HIV transmission risk behavior at most clinic visits. Clinicians review RDQs to trigger dialogue using motivational interviewing and the stages of health behavior change to reduce high-risk behaviors (drug use, alcohol use, or high-risk sexual behavior). In the ongoing evaluation study, CHRP patients receive two provider-only visits before being randomized to continue with provider brief prevention messages only or to receive additional intensive counseling with a risk-reduction specialist following the provider visit. If outcome data support one or both interventions, CHRP could be a useful model for widespread adoption. Observations from the implementation of this protocol are presented in order to facilitate the adoption of this protocol in interested clinics. Later, results of the evaluation of the implementation of the protocol may have value in developing prevention policy in HIV treatment clinics.

Despite the common prevalence of urologic diseases, studies have demonstrated that the general public often has little knowledge or insight into the field of urology or the role of an urologist. In this study, we investigated the context, frequency, and accuracy of urologic conditions on the television series "Grey's Anatomy." We reviewed episodes from the first 15 seasons. Episodes with urologic references were then screened and the urologic conditions, outcomes, and treatments were recorded. We identified a total of only 21 urologic events across 15 seasons and 342 episodes of "Grey's Anatomy." A total of 52% (11/21) of the conditions were related to external male genitalia. The portrayal of these conditions and the associated treatments were considered to be medically accurate within reason 62% (13/21) of the time. There is significant room for improvement to increase the portrayal of common urologic conditions and malignancies to improve the public's awareness and perception of our specialty.

The Ontario Community Outreach Program for Eating Disorders is a pilot training project within the eating disorder programs at the University Health Network--Toronto General Hospital (TGH) and the Hospital for Sick Children. This system provides ongoing training, consultation, and research evaluation in areas ranging from prevention through to tertiary care, in the hopes of increasing the capacity of practitioners to respond to the healthcare pressures of those experiencing eating disorders. A total of 3,315 health care practitioners and educators in Ontario participated in community-based training workshops. A pre-post analysis of participants' self-report evaluations was conducted using chi-square analyses. The findings revealed that there was a statistically significant increase in participants' (a) knowledge of eating disorders and of body image issues and (b) level of comfort to either treat clients with eating disorders or teach a curriculum on body image. The contribution of the training program to the development of a provincial network of specialized eating disorder services, designed to promote the public's access to timely and appropriate care for the full spectrum of eating disorders, are discussed., (2005 by Wiley Periodicals, Inc.)

The academic discipline of kinesiology is relatively new (1960s) and is devoted to the study of human movement. The knowledge base and subject of study continues to develop and now includes inquiry regarding the impact of physical activity on health, society, and quality of life. The purpose of this course content evaluation was to identify kinesiology students' views on the addition of public health content in the curriculum. A lecture addressing the background history of public health, with supported reading, was given to forty students enrolled in an upper level Bachelor of Kinesiology-health course. Students were advised of the inclusion of this topic on the final exam and that their responses would be used to inform future direction of the course material. Students were asked to provide their opinion, through a written response to the question: Does public health belong in the Faculty of Kinesiology? A content analysis was employed and seven themes were identified from students' responses. The themes highlighted professional experience, enhanced leadership, and health promotion and physical activity's contribution to health. In summary, students positively evaluated the inclusion of public health within the kinesiology curriculum and perhaps this is not surprising given the scoring associated with the question. Despite this limitation, students provided insightful responses worthy of reflection that should be considered in a dialogue about the inclusion of public health content in the kinesiology curriculum.

Discussions about the goals of medicine and health care have significantly increased through the last decade of the past century. This was determined by the highly increased extent of health care, scarce health care resources, fundamental changes of health care technologies and well-established market relationships in health care. For a long time medicine attempted to achieve three main goals: to save and prolong life, fight and prevent diseases, reduce pain and sufferings. In the result of development of medicine the previous goals became rather problematic. Technological progress of medicine of the second half of the 20th century has implemented the believing, that medicine is able to prolong the life of human without restrictions. Ageing population has started expecting from medicine not only the saving of life and health enhancement, but also prolonging of life, since the mentioned is tended to be more socioeconomic, not medical, problem. Nowadays discussion about the goals of health care comes from the doubts, if the questions for medicine really have medical background. Often the society tries to escape from number of social problems medicalizing them. Spiritual and social problems of human are often supposed to be as medical ones, thus it is crucial to separate the main goals of medicine, which represent its values and targets, from the secondary ones, related to social or individual welfare, crime, dilemmas of poverty or morality. The aim of the article is to reveal the key values of medicine and health care, which determine the goals of medicine and health care.

Unlabelled: This self-directed learning module highlights consideration and treatment of individuals with long-term spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the challenges of chronic disease prevention, diagnosis, therapeutic options, and the resultant impact on the person with long-term SCI. With cardiovascular disease becoming a leading cause of mortality in this population, risk factor modification through weight, lipid, and glucose control becomes more important. Likewise, bowel dysfunction increases with duration and severity of SCI. Conservative and surgical management options are discussed. Musculoskeletal repetitive trauma injuries occur commonly in long-term SCI but can be prevented with appropriate lifestyle or equipment modifications. These and other conditions occurring in the person with long-term SCI are closely related to psychosocial function with resultant social isolation, depression, and substance abuse. Thus, identification and surveillance of these comorbidities are addressed, with an emphasis on prevention., Overall Article Objective: To summarize the unique medical, psychosocial, and functional needs of the individual with long-term SCI., (Copyright 2002 by the American Academy of Physical Medicine and Rehabilitation)

Purpose: Health-related issues are widely covered in news agencies by medical and health journalists. The quantity, format and quality of their coverage influence the general public as well as policymakers and professions. Current studies and observations suggest that news agencies are more dominated by medical topics (disease, symptoms, epidemiology, treatment and medicines) than general public health issues (risk prevention, health protection, education and promotion). This study explores the causes of the current situation in Iran and generates solutions for supporting health-promoting media that may also prove beneficial for other countries. Design/methodology/approach: A qualitative study was conducted to explore the coverage of health-related topics in selected news agencies. Stakeholders, including health journalists, health professionals and public relations staff at the Iranian Ministry of Health and Medical Education were interviewed. Data were collected until data saturation was reached. The transcripts of all the 17 interviews conducted were analyzed using conventional content analysis. Findings: Four groups of causes were identified, including individual factors, organizational factors, socioeconomic factors and the different nature of medicine and public health. The participants proposed several solutions that were classified into three categories, including the empowerment of stakeholders through capacity development, organizational change and mutual communication and culture change. Originality/value: Creating health-promoting media is a complex but urgent task, and providing a comprehensive and deep understanding of the dynamic interdependencies of the multiple factors at play in it and developing and implementing the most effective interventions for it requires a systematic approach.

Objective: To determine whether physician specialty was associated with differences in the quality of primary care practice and patient satisfaction in a large, group model HMO., Data Sources/study Setting: 10,608 patients ages 35-85 years, selected using stratified probability sampling from the primary care panels of 60 family physicians (FPs), 245 general internists (GIMs), and 55 subspecialty internists (SIMs) at 13 facilities in the Kaiser Permanente Medical Care Program of Northern California. Patients were surveyed in 1995., Study Design: A cross-sectional patient survey measured patient reports of physician performance on primary care measures of coordination, comprehensiveness, and accessibility of care, preventive care procedures, and health promotion. Additional items measured patient satisfaction and health values and beliefs., Principal Findings: Patients were remarkably similar across physician specialty groups in their health values and beliefs, ratings of the quality of primary care, and satisfaction. Patients rated GIMs higher than FPs on coordination (adjusted mean scores 68.0 and 58.4 respectively, p<.001) and slightly higher on accessibility and prevention; GIMs were rated more highly than SIMs on comprehensiveness (adjusted mean scores 76.4 and 73.8, p<.01). There were no significant differences between specialty groups on a variety of measures of patient satisfaction., Conclusions: Few differences in the quality of primary care were observed by physician specialty in the setting of a large, well-established group model HMO. These similarities may result from the direct influence of practice setting on physician behavior and organization of care or, indirectly, through the types of physicians attracted to a well-established group model HMO. In some settings, practice organization may have more influence than physician specialty on the delivery of primary care.

This article presents the methods and results of two surveys aiming to contribute to the development of partnerships between doctors and teachers in primary school. The first study, carried out with a sample of elementary school teachers, shows the interest they have in health promotion at school, their desire to see national education doctors become involved in health education, and their misunderstanding of the role of national education doctors and nurses, especially in training and participation in school projects. The second study, carried out among a sample of national education doctors, shows their felt sense of "friction" between the individual medical approach within which they were trained and for which they are known and solicited, and the public health approach that they would like to develop. To ameliorate the partnership, the inspector of national education, as the responsible party for educational policies within his district, is the necessary "link" between doctors, school directors and teachers.

The urgency of the analyzed issue is due to the study of the basic issues of medical ecology: the dynamics of demographic indicators, the correlation of somatic and reproductive public health, depending on the influence of physical factors of the urban environment on public health on the basis of medical and geographic mapping. The article aims at the analysis of the environmentally determined disorder of the urbanized territory. The leading approach to the study of the issue of medical ecology is a medical and geographical mapping, which allows identifying the most affordable and common areas of multi-component medical and environmental maps. While analyzing the impact of various aspects of the environment on human health, the priority is given to risk factors that directly lead to the emergence of diseases. The contents of the article may be useful to justify the choice of the rational approach to public health as a redistribution mechanism to reallocate the space of ecological niches.

The Latinx population in the United States is disproportionately affected by HIV. Our community-based participatory research partnership developed, implemented and evaluated a Spanish-language peer navigation intervention designed to increase HIV testing and condom use among social networks of immigrant Spanish-speaking Latinx gay, bisexual and other men who have sex with men (GBMSM) and transgender women (TW). We randomized 21 social networks of Latinx GBMSM and TW, ages 18-55 years, to the intervention, known as "HOLA," or a waitlist control group. Social network participants (n = 166) completed structured assessments at baseline and 12-month follow-up (24 months after baseline). Follow-up retention was 95%. Individual in-depth interviews with a sample of participants documented their intervention-related experiences, needs, and priorities to inform future research. At follow-up, "HOLA" participants reported increased HIV testing (adjusted odds ratio = 8.3; 95% CI = 3.0-23.0; P < 0.0001). All study participants reported increased condom use; there was no significant difference between HOLA and waitlist control participants. In-depth interviews identified critical intervention elements and impacts and community needs and priorities. The "HOLA" intervention is effective for increasing HIV testing among Latinx GBMSM and TW, an initial step within the HIV prevention and care continua, and may be adaptable to promote pre-exposure prophylaxis uptake.

In 2007, the American College of Sports Medicine, with endorsement from the American Medical Association and the Office of the Surgeon General, launched a global initiative to mobilize physicians, healthcare professionals and providers, and educators to promote exercise in their practice or activities to prevent, reduce, manage, or treat diseases that impact health and the quality of life in humans. Emerging from this initiative, termed Exercise Is Medicine, has been an extensively documented position stand by the American College of Sports Medicine that recommended healthy adults perform 150 min of moderate dynamic exercise per week. The purpose of this article is to demonstrate the foundation for this global initiative and its exercise prescription for health and disease prevention has roots that began in antiquity more than two millennia ago. Individuals and concepts to remember are that Susruta of India was the first "recorded" physician to prescribe moderate daily exercise, Hippocrates of Greece was the first "recorded" physician to provide a written exercise prescription for a patient suffering from consumption, and the global influence of Galen from Rome combined with his recommendation on the use of exercise for patients in the management of disease prevailed until the 16th century. Historically intertwined with these concepts was exercise being advocated by select physicians to minimize the health problems associated with obesity, diabetes, and inactivity.

This paper investigates mindfulness as a case study of a "subjective turn" in education reflecting a postsecular age. The practice of mindfulness originates in an ancient Buddhist teaching prescribed as part of the path to enlightenment. In spite of its origins, it is becoming widespread within diverse secularly conceived social and educational settings. The paper offers a historical review of this phenomenon and analyzes why and how mindfulness has become the spearhead within a burgeoning "contemplative turn" in education. The thesis suggested is that "normal education" follows "normal science", yet science itself is now being shaken by its own venturing into the "dangerous" waters of the religious experience. The paper reflects critically on the prices and merits of mindfulness in education as a practice shaped by its becoming measurable. It locates these processes as depicting the postsecular age's blurring of boundaries between religiosity/secularity/education, subject/object, and science/healing/education.

As in other Western countries in the Netherlands during the first half of the twentieth century, large numbers of school children were sent to holiday camps or "health colonies" to gain weight and recover strength. At first this large-scale hygienic enterprise was led by teachers, who wanted to "save" poor, undernourished children by providing a "healthy refuge" from the city. A few weeks of sunshine and fresh air at the seaside or in the woods was supposed to promote health and happiness and to improve morals. However, from 1920, stimulated by government subsidies, the colonies came under the authority and control of the medical profession. Consequently, criteria for admission were narrowed to purely medical reasons, particularly the prevention of tuberculosis, and the aims of the "treatment" to physical improvement. In the process of medicalization of ordinary children's lives the intermediate category of "weakness" (between healthy and ill) seems to have played an important role, justifying a massive philanthropic effort long after tuberculosis had stopped being a serious threat. Paediatricians created a somatic culture around the child's body, which was replaced by a psychiatric culture around children's emotions. This shift was stimulated by a second wave of medicalization focusing on mental health. Finally, a critical counter-discourse, nourished by psychoanalysis and the improved health condition of children, dispelled the illusion that sunshine and fresh air were medicine. (Contains 2 figures and 69 footnotes.)