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 DESIGN: Systematic review of published and unpublished prospective observational studies.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

Exploratory development of a glass ceramic automobile thermal reactor

This report summarizes the design, fabrication and test results obtained for glass-ceramic (CER-VIT) automotive thermal reactors. Several reactor designs were evaluated using both engine-dynamometer and vehicle road tests. A maximum reactor life of about 330 hours was achieved in engine-dynamometer tests with peak gas temperatures of about 1065 C (1950 F). Reactor failures were mechanically induced. No evidence of chemical degradation was observed. It was concluded that to be useful for longer times, the CER-VIT parts would require a mounting system that was an improvement over those tested in this program. A reactor employing such a system was designed and fabricated

The effects on health of a publicly funded domestic heating programme: a prospective controlled study

<b>Objective</b>: To assess the effect of a publicly funded domestic heating programme on self-reported health. <b>Design, setting and participants</b>: A prospective controlled study of 1281 households in Scotland receiving new central heating under a publicly funded initiative, and 1084 comparison households not receiving new heating. The main outcome measures were self-reported diagnosis of asthma, bronchitis, eczema, nasal allergy, heart disease, circulatory problems or high blood pressure; number of primary care encounters and hospital contacts in the past year; and SF-36 Health Survey scores. <b>Results</b>: Usable data were obtained from 61.4% of 3849 respondents originally recruited. Heating recipients reported higher scores on the SF-36 Physical Functioning scale (difference 2.51; 95% CI 0.67 to 4.37) and General Health scale (difference 2.57; 95% CI 0.90 to 4.34). They were less likely to report having received a first diagnosis of heart disease (OR 0.69; 95% CI 0.52 to 0.91) or high blood pressure (OR 0.77; 95% CI 0.61 to 0.97), but the groups did not differ significantly in use of primary care or hospital services. <b>Conclusions</b>: Provision of central heating was associated with significant positive effects on general health and physical functioning; however, effect sizes were small. Evidence of a reduced risk of first diagnosis with heart disease or high blood pressure must be interpreted with caution, due to the self-reported nature of the outcomes, the limited time period and the failure to detect any difference in health service use

Giving urban policy its 'medical': assessing the place of health in area-based regeneration

How does regeneration affect health and how have successive urban policy evaluations sought to measure such impacts? This article draws on a systematic review of national-level evaluation documentation relating to government-funded, area-based regeneration initiatives in the UK since 1980. The review examined whether health impacts had been intended and, if so, how they had been measured. The process and difficulties of conducting the review raise significant questions about policy formulation and evaluation. Is evidence-based policy possible where evaluations are not stored centrally? In short, a model policy development as 'enlightened' or incremental is hard to sustain where a lack of systematic storage of data means that researchers, policy makers and practitioners may struggle to produce clear answers to important policy questions

Do urban regeneration programmes improve public health and reduce health inequalities? A synthesis of the evidence from UK policy and practice (1980–2004)

Objectives: To synthesise data on the impact on health and key socioeconomic determinants of health and health inequalities reported in evaluations of national UK regeneration programmes. Data Sources: Eight electronic databases were searched from 1980 to 2004 (IBSS, COPAC, HMIC, IDOX, INSIDE, Medline, Urbadisc/Accompline, Web of Knowledge). Bibliographies of located documents and relevant web sites were searched. Experts and government departmental libraries were also contacted. Review methods: Evaluations that reported achievements drawing on data from at least two target areas of a national urban regeneration programme in the UK were included. Process evaluations and evaluations reporting only business outcomes were excluded. All methods of evaluation were included. Impact data on direct health outcomes and direct measures of socioeconomic determinants of health were narratively synthesised. Results: 19 evaluations reported impacts on health or socioeconomic determinants of health; data from 10 evaluations were synthesised. Three evaluations reported health impacts; in one evaluation three of four measures of self reported health deteriorated, typically by around 4%. Two other evaluations reported overall reductions in mortality rates. Most socioeconomic outcomes assessed showed an overall improvement after regeneration investment; however, the effect size was often similar to national trends. In addition, some evaluations reported adverse impacts. Conclusion: There is little evidence of the impact of national urban regeneration investment on socioeconomic or health outcomes. Where impacts have been assessed, these are often small and positive but adverse impacts have also occurred. Impact data from future evaluations are required to inform healthy public policy; in the meantime work to exploit and synthesise "best available" data is required

Perceived characteristics of the environment associated with active travel: development and testing of a new scale

Background Environmental characteristics may be associated with patterns of physical activity. However, the development of instruments to measure perceived characteristics of the local environment is still at a comparatively early stage, and published instruments are not necessarily suitable for application in all settings. We therefore developed and established the test-retest reliability of a new scale for use in a study of the correlates of active travel and overall physical activity in deprived urban neighbourhoods in Glasgow, Scotland. Methods We developed and piloted a 14-item scale based on seven constructs identified from the literature (aesthetics, green space, access to amenities, convenience of routes, traffic, road safety and personal safety). We administered the scale to all participants in a random postal survey (n = 1322) and readministered the scale to a subset of original respondents (n = 125) six months later. We used principal components analysis and Varimax rotation to identify three principal components (factors) and derived summary scores for subscales based on these factors. We examined the internal consistency of these subscales using Cronbach's alpha and examined the test-retest reliability of the individual items, the subscale summary scores and an overall summary neighbourhood score using a combination of correlation coefficients and Cohen's kappa with and without weighting. Results Public transport and proximity to shops were the items most likely to be rated positively, whereas traffic volume, traffic noise and road safety for cyclists were most likely to be rated negatively. Three principal components – 'safe and pleasant surroundings', 'low traffic' and 'convenience for walking' – together explained 45% of the total variance. The test-retest reliability of individual items was comparable with that of items in other published scales (intraclass correlation coefficients (ICCs) 0.34–0.70; weighted Cohen's kappa 0.24–0.59). The overall summary neighbourhood score had acceptable internal consistency (Cronbach's alpha 0.72) and test-retest reliability (ICC 0.73). Conclusion This new scale contributes to the development of a growing set of tools for investigating the role of perceived environmental characteristics in explaining or mediating patterns of active travel and physical activity

Evaluating health effects of transport interventions: methodologic case study

Background: There is little evidence about the effects of environmental interventions on population levels of physical activity. Major transport projects may promote or discourage physical activity in the form of walking and cycling, but researching the health effects of such “natural experiments” in transport policy or infrastructure is challenging. Methods: Case study of attempts in 2004–2005 to evaluate the effects of two major transport projects in Scotland: an urban congestion charging scheme in Edinburgh, and a new urban motorway (freeway) in Glasgow. Results: These interventions are typical of many major transport projects. They are unique to their context. They cannot easily be separated from the other components of the wider policies within which they occur. When, where, and how they are implemented are political decisions over which researchers have no control. Baseline data collection required for longitudinal studies may need to be planned before the intervention is certain to take place. There is no simple way of defining a population or area exposed to the intervention or of defining control groups. Changes in quantitative measures of health-related behavior may be difficult to detect. Conclusions: Major transport projects have clear potential to influence population health, but it is difficult to define the interventions, categorize exposure, or measure outcomes in ways that are likely to be seen as credible in the field of public health intervention research. A final study design is proposed in which multiple methods and spatial levels of analysis are combined in a longitudinal quasi-experimental study

A translational framework for public health research

<p><b>Background</b></p> <p>The paradigm of translational medicine that underpins frameworks such as the Cooksey report on the funding of health research does not adequately reflect the complex reality of the public health environment. We therefore outline a translational framework for public health research.</p> <p><b>Discussion</b></p> <p>Our framework redefines the objective of translation from that of institutionalising effective interventions to that of improving population health by influencing both individual and collective determinants of health. It incorporates epidemiological perspectives with those of the social sciences, recognising that many types of research may contribute to the shaping of policy, practice and future research. It also identifies a pivotal role for evidence synthesis and the importance of non-linear and intersectoral interfaces with the public realm.</p> <p><b>Summary</b></p> <p>We propose a research agenda to advance the field and argue that resources for 'applied' or 'translational' public health research should be deployed across the framework, not reserved for 'dissemination' or 'implementation'.</p&gt

Understanding evidence: a statewide survey to explore evidence-informed public health decision-making in a local government setting

 Background: The value placed on types of evidence within decision-making contexts is highly dependent on individuals, the organizations in which the work and the systems and sectors they operate in. Decision-making processes too are highly contextual. Understanding the values placed on evidence and processes guiding decision-making is crucial to designing strategies to support evidence-informed decision-making (EIDM). This paper describes how evidence is used to inform local government (LG) public health decisions.Methods: The study used mixed methods including a cross-sectional survey and interviews. The Evidence-Informed Decision-Making Tool (EvIDenT) survey was designed to assess three key domains likely to impact on EIDM: access, confidence, and organizational culture. Other elements included the usefulness and influence of sources of evidence (people/groups and resources), skills and barriers, and facilitators to EIDM. Forty-five LGs from Victoria, Australia agreed to participate in the survey and up to four people from each organization were invited to complete the survey (n = 175). To further explore definitions of evidence and generate experiential data on EIDM practice, key informant interviews were conducted with a range of LG employees working in areas relevant to public health.Results: In total, 135 responses were received (75% response rate) and 13 interviews were conducted. Analysis revealed varying levels of access, confidence and organizational culture to support EIDM. Significant relationships were found between domains: confidence, culture and access to research evidence. Some forms of evidence (e.g. community views) appeared to be used more commonly and at the expense of others (e.g. research evidence). Overall, a mixture of evidence (but more internal than external evidence) was influential in public health decision-making in councils. By comparison, a mixture of evidence (but more external than internal evidence) was deemed to be useful in public health decision-making.Conclusions: This study makes an important contribution to understanding how evidence is used within the public health LG context