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Health is an adaptive state unique to each person. This subjective state must be distinguished from the objective state of disease. The experience of health and illness (or poor health) can occur both in the absence and presence of objective disease. Given that the subjective experience of health, as well as the finding of objective disease in the community, follow a Pareto distribution, the following questions arise: What are the processes that allow the emergence of four observable states—(1) subjective health in the absence of objective disease, (2) subjective health in the presence of objective disease, (3) illness in the absence of objective disease, and (4) illness in the presence of objective disease? If we consider each individual as a unique biological system, these four health states must emerge from physiological network structures and personal behaviors. The underlying physiological mechanisms primarily arise from the dynamics of external environmental and internal patho/physiological stimuli, which activate regulatory systems including the hypothalamic-pituitary-adrenal axis and autonomic nervous system. Together with other systems, they enable feedback interactions between all of the person's system domains and impact on his system's entropy. These interactions affect individual behaviors, emotional, and cognitive responses, as well as molecular, cellular, and organ system level functions. This paper explores the hypothesis that health is an emergent state that arises from hierarchical network interactions between a person's external environment and internal physiology. As a result, the concept of health synthesizes available qualitative and quantitative evidence of interdependencies and constraints that indicate its top-down and bottom-up causative mechanisms. Thus, to provide effective care, we must use strategies that combine person-centeredness with the scientific approaches that address the molecular network physiology, which together underpin health and disease. Moreover, we propose that good health can also be promoted by strengthening resilience and self-efficacy at the personal and social level, and via cohesion at the population level. Understanding health as a state that is both individualized and that emerges from multi-scale interdependencies between microlevel physiological mechanisms of health and disease and macrolevel societal domains may provide the basis for a new public discourse for health service and health system redesign.

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fang evolution in Tertiary forms, where, un-and ribs of modern reptiles, p. 201-310. In: Biolderstandably, the dentition is seldom pre-ogy of the Reptilia, Vol. I. C. Gans (ed.). Acad. served. Press. KARDONG, K. V. 1974. Kinesis of the jaw apparatus during the strike in the cottonmouth snake, Agkistrodon pisczuorus. Forma et funcio 7:327-354.-. 1975. Prey capture in the cottonmouth snake We gratefully acknowledge the support of (Agkzstrodon pisciuorus). J. Herp. 9: 169-175. NSF Grants DEB 78-10831 and PChI-8022980 KLAUBER, L. M. 1972. Rattlesnakes: Their habits, (to JAR). We are indebted to M. Rand, L. Kloslife histories, and influence on mankind. Univ. Calterman, R. Storm and R. Forbes for providing if. Press. many of the specimens used in this study. We PREGILL, G. K. 1977. Axial myology of the racer are particularly grateful to K. V. Kardong for Coluber constrictor with emphasis on the neck rehis incisive criticisms of the manuscript.

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Aims:To identify and compare, family support needs following an acquired brain injury (ABI) in metropolitan and regional/remote areas in order to inform the development of a state-wide family peer support network. Design: Mixed methods design including postal survey and focus groups. Results: The survey was completed by 194 family members who provide support to an adult with ABI. Focus groups included 43 participants (29 family members, 14 people with ABI). Thematic analysis of open-ended survey responses and focus group transcripts revealed 15 areas of needed support. Although all themes were identified by both geographic groups, regional/remote participants commented more frequently on the need for coordinated, accessible and tailored services. A strong focus was placed on the need for counselling and emotional support, as well as family support groups from both major city and regional/remote participants. Each support was reviewed to identify those which could be augmented through peer-supports, including: emotional support; family support groups; ABI information; family social activities; help to navigate the system; early supports (within the first year of ABI); and self-advocacy training. Conclusions: Results highlight a need for ongoing supports for the entire family following ABI in both metropolitan and regional/remote regions of SA (South Australia). Support themes can inform the development of family-centred services, including the role of peer-support networks.

BackgroundChronic disease is a major global challenge. However, chronic illness and its care, when intruding into everyday life, has received less attention in Asia Pacific countries, including Australia, who are in the process of transitioning to chronic disease orientated health systems.AimThe study aims to examine experiences of chronic illness before and after the introduction of Australian Medicare incentives for longer consultations and structured health assessments in general practice.MethodsSelf-help groups around the conditions of diabetes, epilepsy, asthma and cancer identified key informants to participate in 4 disease specific focus groups. Audio taped transcripts of the focus groups were coded using grounded theory methodology. Key themes and lesser themes identified using a process of saturation until the study questions on needs and experiences of care were addressed. Thematic comparisons were made across the 2002/3 and 1992/3 focus groups.FindingsAt times of chronic illness, there was need to find and then ensure access to 'the right GP'. The 'right GP or specialist' committed to an in-depth relationship of trust, personal rapport and understanding together with clinical and therapeutic competence. The 'right GP', the main specialist, the community nurse and the pharmacist were key providers, whose success depended on interprofessional communication. The need to trust and rely on care providers was balanced by the need for self-efficacy 'to be in control of disease and treatment' and 'to be your own case manager'. Changes in Medicare appeared to have little penetration into everyday perceptions of chronic illness burden or time and quality of GP care. Inequity of health system support for different disease groupings emerged. Diabetes, asthma and certain cancers, like breast cancer, had greater support, despite common experiences of disease burden, and a need for research and support programs.ConclusionCore themes around chronic illness experience and care needs remained consistent over the 10 year period. Reforms did not appear to alleviate the burden of chronic illness across disease groups, yet some were more privileged than others. Thus in the future, chronic care reforms should build from greater understanding of the needs of people with chronic illness.

Health care systems cannot afford to avoid, and should actively embrace the critiques of social theory and analyses in the transformations of health systems to improve chronic care. Creative tensions between empirical and intellectual critique, and a synthetic middle ground are likely to lead to more realistic and innovative approaches spanning the nature of chronicity and the transformation of Primary Care.