Does self-monitoring reduce blood pressure? Meta-analysis with meta-regression of randomized controlled trials

Introduction. Self-monitoring of blood pressure (BP) is an increasingly common part of hypertension management. The objectives of this systematic review were to evaluate the systolic and diastolic BP reduction, and achievement of target BP, associated with self-monitoring. Methods. MEDLINE, Embase, Cochrane database of systematic reviews, database of abstracts of clinical effectiveness, the health technology assessment database, the NHS economic evaluation database, and the TRIP database were searched for studies where the intervention included self-monitoring of BP and the outcome was change in office/ambulatory BP or proportion with controlled BP. Two reviewers independently extracted data. Meta-analysis using a random effects model was combined with meta-regression to investigate heterogeneity in effect sizes. Results. A total of 25 eligible randomized controlled trials (RCTs) (27 comparisons) were identified. Office systolic BP (20 RCTs, 21 comparisons, 5,898 patients) and diastolic BP (23 RCTs, 25 comparisons, 6,038 patients) were significantly reduced in those who self-monitored compared to usual care (weighted mean difference (WMD) systolic −3.82 mmHg (95% confidence interval −5.61 to −2.03), diastolic −1.45 mmHg (−1.95 to −0.94)). Self-monitoring increased the chance of meeting office BP targets (12 RCTs, 13 comparisons, 2,260 patients, relative risk = 1.09 (1.02 to 1.16)). There was significant heterogeneity between studies for all three comparisons, which could be partially accounted for by the use of additional co-interventions. Conclusion. Self-monitoring reduces blood pressure by a small but significant amount. Meta-regression could only account for part of the observed heterogeneity

Citizens Show Strong Support for Climate Policy, But Are They Also Willing to Pay?

To what extent citizens are willing not only to support ambitious climate policy, but also willing to pay for such policy remains subject to debate. Our analysis addresses three issues in this regard: whether, as is widely assumed but not empirically established, willingness to support (WTS) is higher than willingness to pay (WTP); whether the determinants of the two are similar; and what accounts for within-subject similarity between WTS and WTP. We address these issues based on data from an original nationally representative survey (N=2500) on forest conservation in Brazil, arguably the key climate policy issue in the country. The findings reveal that WTP is much lower than WTS. The determinants differ to some extent as well; regarding the effects of age, gender, and trust in government. The analysis also provides insights into factors influencing how much WTS and WTP line up within individuals, with respect to age, education, political ideology, salience of the deforestation issue, and trust in government. Our findings provide a more nuanced picture of how strong public support for climate change policy is, and a starting point for more targeted climate policy communication

Ageing science, health care and social inclusion of older people

In this paper we present preliminary findings from a study of the social, ethical and cultural aspects of ageing science and medicine. The paper draws on a collaborative, ongoing project between life scientists and sociologists, funded by the Economic and Social Research Council's (ESRC) New Dynamics of Ageing Programme1 and the ESRC Centre for the Economic and Social Aspects of Genomics2. The sociological element of this project involves participant observation and interviews with expert scientists who specialise in ageing and age-related diseases, both in the UK and the US, as well as interviews with sceptics of ageing science and medicine. There has been much critique of how ageing science is anti-ageing, reinforcing the ageism prevalent in Western culture. Our specific objective in this paper is to suggest how biogerontology can contribute to the social inclusion of older people, particularly in relation to health care. We discuss how agesim is endemic to some aspects of health care, and go on to show how the ways that biogerontology is reconceptualising what it is to age, and to be old, can help reinclude ageing and the aged in health-care education, policy and practice