What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure? : An Individual Patient Data Meta-analysis

Background To identify those characteristics of self-management interventions in patients with heart failure (HF) that are effective in influencing health-related quality of life, mortality, and hospitalizations. Methods and Results Randomized trials on self-management interventions conducted between January 1985 and June 2013 were identified and individual patient data were requested for meta-analysis. Generalized mixed effects models and Cox proportional hazard models including frailty terms were used to assess the relation between characteristics of interventions and health-related outcomes. Twenty randomized trials (5624 patients) were included. Longer intervention duration reduced mortality risk (hazard ratio 0.99, 95% confidence interval [CI] 0.97–0.999 per month increase in duration), risk of HF-related hospitalization (hazard ratio 0.98, 95% CI 0.96–0.99), and HF-related hospitalization at 6 months (risk ratio 0.96, 95% CI 0.92–0.995). Although results were not consistent across outcomes, interventions comprising standardized training of interventionists, peer contact, log keeping, or goal-setting skills appeared less effective than interventions without these characteristics. Conclusion No specific program characteristics were consistently associated with better effects of self-management interventions, but longer duration seemed to improve the effect of self-management interventions on several outcomes. Future research using factorial trial designs and process evaluations is needed to understand the working mechanism of specific program characteristics of self-management interventions in HF patients.

Sustainability or climate change? An ecocritical analysis of Ian McEwan’s Solar :

This essay is an ecocritical literary analysis of the novel Solar. The aim is to investigate the effect on the reader of the main characters, place, symbols and satire with focus on climate change and sustainability. The protagonist Michael Beard, a despicable, selfish antihero, consumes everything and everybody whereas Tom Aldous, the heroic character, is devoted to a life of sustainability. Beard represents the greedy capitalistic Western consumer society and its male leaders who close their eyes to the warnings of a changing climate, and Aldous represents the sustainable and alternative lifestyle. Humor and ridicule exhibits the weaknesses and greed of mankind in a satirical way. Symbols like cancer and the Co2 emitting transport system symbolize overconsumption and a stressed globe. The effect on the reader is a reflection about the ongoing struggle between climate change and sustainability and the demand for a change towards a sustainable lifestyle.