Teaching family carers about home based palliative care: Final results from a group education program

Without the considerable support provided by family carers, many patients receiving palliative care would be unable to remain at home. However, family carers typically lack the required information and skills to prepare them for such a role. Pilot work has demonstrated that group education programs for family carers can be readily developed; they are feasible, accessible, and useful. This project sought to build on our pilot research to further examine the effectiveness of a group education program by evaluating the outcomes with a larger number of participants. The program aimed to prepare primary family carers for the role of supporting a relative with advanced, noncurative cancer at home. The psycho-educational program consisted of three consecutive weekly sessions presented in a group format, conducted at six home-based palliative care services across metropolitan and regional Victoria, Australia. The following dependent variables were measured at three time points: carer competence, preparedness, rewards, and information needs. The three time points were: commencement of the program (Time 1), upon completion (Time 2), and two weeks later (Time 3). A total of 156 participants (including the pilot phase) completed Time 1 questionnaires and 96 completed all three time periods (62%). Between Time 1 and Time 2, the intervention had a statistically significant positive effect on preparedness, competence, rewards, and having informational needs met. Outcomes were maintained at Time 3. There was no difference in the effectiveness of the intervention for participants in regional areas compared to participants in metropolitan areas.

This study demonstrated that a group education program to prepare family carers for the role of supporting a dying relative at home was effective. Implications for further research and practice are outlined.

Residential consumption of gas and electricity in the U.S.: The role of prices and income

We study the residential demand for electricity and gas, working with nationwide household-level data that cover recent years, namely 1997-2007. Our dataset is a mixed panel/multi-year cross-sections of dwellings/households in the 50 largest metropolitan areas in the United States as of 2008. We estimate static and dynamic models of electricity and gas demand. We find strong household response to energy prices, both in the short and long term. From the static models, we get estimates of the own price elasticity of electricity demand in the -0.860 to -0.667 range, while the own price elasticity of gas demand is -0.693 to -0.566. These results are robust to a variety of checks. Contrary to earlier literature (Metcalf and Hassett, 1999; Reiss and White, 2005), we find no evidence of significantly different elasticities across households with electric and gas heat. The price elasticity of electricity demand declines with income, but the magnitude of this effect is small. These results are in sharp contrast to much of the literature on residential energy consumption in the United States, and with the figures used in current government agency practice. Our results suggest that there might be greater potential for policies which affect energy price than may have been previously appreciated. (C) 2011 Elsevier B.V. All rights reserved.

Home and Workplace Built Environment Supports for Physical Activity

BACKGROUND: Physical inactivity has been associated with obesity and related chronic diseases. Understanding built environment (BE) influences on specific domains of physical activity (PA) around homes and workplaces is important for public health interventions to increase population PA.

PURPOSE: To examine the association of home and workplace BE features with PA occurring across specific life domains (work, leisure, and travel).

METHODS: Between 2012 and 2013, telephone interviews were conducted with participants in four Missouri metropolitan areas. Questions included sociodemographic characteristics, home and workplace supports for PA, and dietary behaviors. Data analysis was conducted in 2013; logistic regression was used to examine associations between BE features and domain-specific PA.

RESULTS: In home neighborhoods, seven of 12 BE features (availability of fruits and vegetables, presence of shops and stores, bike facilities, recreation facilities, crime rate, seeing others active, and interesting things) were associated with leisure PA. The global average score of home neighborhood BE features was associated with greater odds of travel PA (AOR=1.99, 95% CI=1.46, 2.72); leisure PA (AOR=1.84, 95% CI=1.44, 2.34); and total PA (AOR=1.41, 95% CI=1.04, 1.92). Associations between workplace neighborhoods' BE features and workplace PA were small but in the expected direction.

CONCLUSIONS: This study offers empirical evidence on BE supports for domain-specific PA. Findings suggest that diverse, attractive, and walkable neighborhoods around workplaces support walking, bicycling, and use of public transit. Public health practitioners, researchers, and worksite leaders could benefit by utilizing worksite domains and measures from this study for future BE assessments.

Choice of commuting mode among employees: Do home neighborhood environment, worksite neighborhood environment, and worksite policy and supports matter?

BACKGROUND: Promoting the use of public transit and active transport (walking and cycling) instead of car driving is an appealing strategy to increase overall physical activity.

PURPOSE: To quantify the combined associations between self-reported home and worksite neighborhood environments, worksite support and policies, and employees' commuting modes.

METHOD: Between 2012 and 2013, participants residing in four Missouri metropolitan areas were interviewed via telephone (n = 1,338) and provided information on socio-demographic characteristics, home and worksite neighborhoods, and worksite support and policies. Commuting mode was self-reported and categorized into car driving, public transit, and active commuting. Commuting distance was calculated using geographic information systems. Commuters providing completed data were included in the analysis. Multivariate logistic regression models were used to examine the correlates of using public transit and active commuting.

RESULT: The majority of participants reported commuting by driving (88.9%); only 4.9% used public transit and 6.2% used active modes. After multivariate adjustment, having transit stops within 10-15 minutes walking distance from home (p=0.05) and using worksite incentive for public transit (p<0.001) were associated with commuting by public transit. Commuting distance (p<0.001) was negatively associated with active commuting. Having free or low cost recreation facilities around the worksite (p=0.04) and using bike facilities to lock bikes at the worksite (p<0.001) were associated with active commuting.

CONCLUSION: Both environment features and worksite supports and policies are associated with the choice of commuting mode. Future studies should use longitudinal designs to investigate the potential of promoting alternative commuting modes through worksite efforts that support sustainable commuting behaviors as well as the potential of built environment improvements.

Integrating Land Use Planning and Transportation: Policy formulation in the Belfast Metropolitan Area

Much of the interest in sustainable cities relates to the inexorable rise in the demand for car travel and the contribution that certain urban forms and land-use relationships can make to reducing energy consumption. Indeed, this demand is fuelled more by increased spatial separation of homes and workplaces, shops and schools than by any rise in trip making. This paper evaluates recent efforts to integrate land-use planning and transportation policy in the Belfast Metropolitan Area by reviewing the policy formulation process at both a regional and city scale. The paper suggests that considerable progress has been made in integrating these two areas of public policy, both institutionally and conceptually. However, concerns are expressed that the rhetoric of sustainability may prove difficult to translate into implementation, leading to a further dislocation of land-use and transportation.

Risk versus National Pride. Conflicting discourses over the construction of a High Voltage Power Station in the Athens Metropolitan Area for demands of the 2004 Olympics

This paper first explores the conflictual discourses employed by government agencies, citizens’ initiatives, and environmental organizations over the construction of a High Voltage Power Station (KYT) for demands of the 2004 Olympic Games, as presented in media reports and movement literature over a period of one year. Having in mind recent criticisms targeting the lack of empirical evidence in Ulrich Beck’s risk theorization, this exploration is of distinct importance. Secondly, it takes into account that both the defensive character of societal action and mistrust to expert authorities have been confirmed as prevalent characteristics of both the Greek and the general risk social context. The paper attempts to re-evaluate and/or complement existing perspectives of societal activism in general and environmental mobilizations in particular within the confines of the Greek social context. As a tentative conclusion, it is suggested that the risk perspective offers a novel prism for the examination of societal activism without confining it to the characteristics of individual national contexts.

Dynamics and Function of Langerhans Cells In Vivo: Dermal Dendritic Cells Colonize Lymph Node Areas Distinct from Slower Migrating Langerhans Cells

Langerhans cells (LCs) are prominent dendritic cells (DCs) in epithelia, but their role in immunity is poorly defined. To track and discriminate LCs from dermal DCs in vivo, we developed knockin mice expressing enhanced green fluorescent protein (EGFP) under the control of the langerin (CD207) gene. By using vital imaging, we showed that most EGFP(+) LCs were sessile under steady-state conditions, whereas skin inflammation induced LC motility and emigration to lymph nodes (LNs). After skin immunization, dermal DCs arrived in LNs first and colonized areas distinct from slower migrating LCs. LCs reaching LNs under steady-state or inflammatory conditions expressed similar levels of costimulatory molecules. Langerin and EGFP were also expressed on thymic DCs and on blood-derived, CD8alpha(+) DCs from all secondary lymphoid organs. By using a similar knockin strategy involving a diphtheria toxin receptor (DTR) fused to EGFP, we demonstrated that LCs were dispensable for triggering hapten-specific T cell effectors through skin immunization.

Higher incidence of childhood-onset type 1 diabetes mellitus in remote areas: a UK regional small-area analysis

Aims/hypothesis: We investigated the association between the incidence of type 1 diabetes mellitus and remoteness (a proxy measure for exposure to infections) using recently developed techniques for statistical analysis of small-area data.

Subjects, materials and methods: New cases in children aged 0 to 14 years in Northern Ireland were prospectively registered from 1989 to 2003. Ecological analysis was conducted using small geographical units (582 electoral wards) and area characteristics including remoteness, deprivation and child population density. Analysis was conducted using Poisson regression models and Bayesian
hierarchical models to allow for spatially correlated risks that were potentially caused by unmeasured explanatory variables.

Results: In Northern Ireland between 1989 and 2003, there were 1,433 new cases of type 1 diabetes, giving a directly standardised incidence rate of 24.7 per 100,000 personyears. Areas in the most remote fifth of all areas had a significantly (p=0.0006) higher incidence of type 1 diabetes mellitus (incidence rate ratio=1.27 [95% CI 1.07, 1.50]) than those in the most accessible fifth of all areas. There was also a higher incidence rate in areas that were less deprived (p<0.0001) and less densely populated (p=0.002). After adjustment for deprivation and additional adjustment for child population density the association between diabetes and remoteness remained significant (p=0.01 and p=0.03, respectively).

Conclusions/interpretation: In Northern Ireland, there is evidence that remote areas experience higher rates of type 1 diabetes mellitus. This could reflect a reduced or delayed exposure to infections, particularly early in life, in these areas.