Why certain systematic reviews reach uncertain conclusions

No abstract available

Journal of another plague year

Recent years have seen a catalogue of plagues and sundry other contagions. Hard on the scaly heels of avian flu follows global warming, swine flu, obesity, and now the economic plague. This litany of woes has affect’d me deeply, as these few entries from my diary this past year shew. Rose early to enjoy reading the latest bill of mortality of estate agents in the Parish of St Giles, which show’d again a monthly increase. The Bankers, too, have this past year been struck low, and it transpires that their understanding of the term "Bank" has left much to be desired; they have been sinking our shillings in miscellaneous crackpot schemes in the Colonies that few understand, and fewer profit from: to wit, hedge funds, subprime mortgages, Ponzi schemes, plans to build golden stairways to the moon, and God knows how many other feeble minded schemes

Reducing social inequalities in smoking: can evidence inform policy? A pilot study

Objective: To assess the potential contribution of evidence from existing systematic reviews of effectiveness to answering the question: what works in reducing social inequalities in smoking? Data source: The Cochrane Library (2002/4). Study selection: Systematic reviews of the effectiveness of community based tobacco control interventions, and all the primary studies included in one of these reviews. Data extraction: Reviews and primary studies were assessed for intent to assess the social distribution of intervention effects, information about the social inclusiveness or targeting of interventions, baseline sociodemographic data collected on participants, and estimates of effect size stratified by sociodemographic variables. Data synthesis: Only one review aimed to examine outcomes stratified by sex, age or socioeconomic status, and these aims were only achieved with respect to sex. Sociodemographic data about participants were frequently collected in primary studies, but not used to compare intervention effects between social groups. Conclusions: There may be scope for using existing research more effectively to contribute to evidence based policy to reduce social inequalities in smoking—by explicitly seeking stratified outcome data in new systematic reviews, by re-analysing original datasets, and/or by meta-analysis of individual participant data

Better homes, better neighbourhoods

Abstract not availabl

Assessing the health impact of local amenities: a qualitative study of contrasting experiences of local swimming pool and leisure provision in two areas of Glasgow

Study objective: To assess the health impacts of local public swimming pool and leisure provision. Design: Retrospective qualitative study using focus groups. Reports from two areas with contrasting experience of provision of a public swimming pool (opening and closure) were compared within the context of general reports about health and neighbourhood. Setting: Two deprived neighbourhoods in south Glasgow. Participants: Local adult residents of mixed ages, accessed through local community groups. Main results: In both areas the swimming pool was reported as an important amenity that was linked to health and wellbeing. However, few residents reported regular use of the pool for physical activity. Use of the pool facility for social contact was directly linked to reports of relief of stress and isolation, and improved mental health. Pool closure was one in a series of amenity closures and area decline and was used to represent other area changes. Health impacts were strongly linked to the pool closure. The pool opening was associated with local area regeneration, similar but less prominent links between swimming pool provision and health were reported. Health benefits of social contact were diffuse and linked to other local amenities as well as the new pool facility. Conclusions: Although theoretically linked to increased physical activity, the health benefits conveyed by the swimming pool may be more closely linked to the facilitation of social contact, and a supervised facility for young children. The use of qualitative work to investigate area based change provides rich contextual data to strengthen and explain the reported health impacts

Influence of psychological coping on survival and recurrence in people with cancer: systematic review

OBJECTIVE: To summarise the evidence on the effect of psychological coping styles (including fighting spirit, helplessness/hopelessness, denial, and avoidance) on survival and recurrence in patients with cancer. DESIGN: Systematic review of published and unpublished prospective observational studies. MAIN OUTCOMES MEASURES: Survival from or recurrence of cancer. RESULTS: 26 studies investigated the association between psychological coping styles and survival from cancer, and 11 studies investigated recurrence. Most of the studies that investigated fighting spirit (10 studies) or helplessness/hopelessness (12 studies) found no significant associations with survival or recurrence. The evidence that other coping styles play an important part was also weak. Positive findings tended to be confined to small or methodologically flawed studies; lack of adjustment for potential confounding variables was common. Positive conclusions seemed to be more commonly reported by smaller studies, indicating potential publication bias. CONCLUSION: There is little consistent evidence that psychological coping styles play an important part in survival from or recurrence of cancer. People with cancer should not feel pressured into adopting particular coping styles to improve survival or reduce the risk of recurrence. [References: 42

Health effects of housing improvement: systematic review of intervention studies

OBJECTIVE: To review the evidence on the effects of interventions to improve housing on health. DESIGN: Systematic review of experimental and non-experimental housing intervention studies that measured quantitative health outcomes. DATA SOURCES: Studies dating from 1887, in any language or format, identified from clinical, social science, and grey literature databases, personal collections, expert consultation, and reference lists. MAIN OUTCOME MEASURES: Socioeconomic change and health, illness, and social measures. RESULTS: 18 completed primary intervention studies were identified. 11 studies were prospective, of which six had control groups. Three of the seven retrospective studies used a control group. The interventions included rehousing, refurbishment, and energy efficiency measures. Many studies showed health gains after the intervention, but the small study populations and lack of controlling for confounders limit the generalisability of these findings. CONCLUSIONS: The lack of evidence linking housing and health may be attributable to pragmatic difficulties with housing studies as well as the political climate in the United Kingdom. A holistic approach is needed that recognises the multifactorial and complex nature of poor housing and deprivation. Large scale studies that investigate the wider social context of housing interventions are required. [References: 42

Systematic reviews of health effects of social interventions: 1. Finding the evidence: how far should you go?

Study objective: There is little guidance on how to identify useful evidence about the health effects of social interventions. The aim of this study was to assess the value of different ways of finding this type of information. Design: Retrospective analysis of the sources of studies for one systematic review. Setting: Case study of a systematic review of the effectiveness of interventions in promoting a population shift from using cars towards walking and cycling. Main results: Only four of the 69 relevant studies were found in a "first-line" health database such as Medline. About half of all relevant studies were found through the specialist Transport database. Nine relevant studies were found through purposive internet searches and seven relevant studies were found by chance. The unique contribution of experts was not to identify additional studies, but to provide more information about those already found in the literature. Conclusions: Most of the evidence needed for this review was not found in studies indexed in familiar literature databases. Applying a sensitive search strategy across multiple databases and interfaces is very labour intensive. Retrospective analysis suggests that a more efficient method might have been to search a few key resources, then to ask authors and experts directly for the most robust reports of studies identified. However, internet publications and serendipitous discoveries did make a significant contribution to the total set of relevant evidence. Undertaking a comprehensive search may provide unique evidence and insights that would not be obtained using a more focused search

Promoting walking and cycling as an alternative to using cars: systematic review

Objectives: To assess what interventions are effective in promoting a population shift from using cars towards walking and cycling, and to assess the health and distributional effects of such interventions. Data sources: Published and unpublished reports in any language identified from electronic databases, bibliographies, websites and reference lists. Review methods: Systematic search and appraisal to identify experimental or observational studies with a prospective or controlled retrospective design that evaluated any intervention applied to an urban population or area by measuring outcomes in members of the local population. Results: 22 studies met the inclusion criteria. We found some evidence that targeted behaviour change programmes can change the behaviour of motivated subgroups, resulting (in the largest study) in a modal shift of around 5% of all trips at a population level. Single studies of commuter subsidies and a new railwy station have also shown modest effects. The balance of best available evidence about publicity campaigns, engineering measures and other interventions suggests that they have not been effective. Participants in trials of active commuting experienced short-term improvements in certain health and fitness measures, but we found no good evidence about the health effects of any effective population-level intervention. Conclusions: The best available evidence of effectiveness is for targeted behaviour change programmes, but the social distribution of their effects is unclear and some other types of intervention remain to be rigorously evaluated. We need a stronger evidence base for the health impacts of transport policies, preferably based on properly conducted prospective studies

Systematic reviews of health effects of social interventions: 2. Best available evidence: how low should you go?

Study objective: There is little guidance on how to select the best available evidence of health effects of social interventions. The aim of this paper was to assess the implications of setting particular inclusion criteria for evidence synthesis. Design: Analysis of all relevant studies for one systematic review, followed by sensitivity analysis of the effects of selecting studies based on a two dimensional hierarchy of study design and study population. Setting: Case study of a systematic review of the effectiveness of interventions in promoting a population shift from using cars towards walking and cycling. Main results: The distribution of available evidence was skewed. Population level interventions were less likely than individual level interventions to have been studied using the most rigorous study designs; nearly all of the population level evidence would have been missed if only randomised controlled trials had been included. Examining the studies that were excluded did not change the overall conclusions about effectiveness, but did identify additional categories of intervention such as health walks and parking charges that merit further research, and provided evidence to challenge assumptions about the actual effects of progressive urban transport policies. Conclusions: Unthinking adherence to a hierarchy of study design as a means of selecting studies may reduce the value of evidence synthesis and reinforce an "inverse evidence law" whereby the least is known about the effects of interventions most likely to influence whole populations. Producing generalisable estimates of effect sizes is only one possible objective of evidence synthesis. Mapping the available evidence and uncertainty about effects may also be important