Expressive writing as a presurgical stress management intervention for breast cancer patients.

This study evaluated whether expressive writing (EW) was an effective stress management intervention for breast cancer patients. Women were recruited at the end of neoadjuvant chemotherapy and assigned to write about their cancer experience (EW group; n = 24) or neutral topics (neutral writing [NW] group; n = 25). Women were asked to write for 20 minutes a day for a total of four writing sessions that were completed over a 7-day period. Participants were reassessed approximately 3 days before and 2 weeks after surgery. The intervention did not significantly decrease women's distress, perceived stress, sleep disturbance, or pain. There was some evidence that the EW group used more sleep medication at the presurgical assessment than the NW group. Social constraints moderated the effect of the intervention. Among women with high social constraints, the EW group reported lower average daily pain than the NW group. Among women with low social constraints, the EW group reported higher average daily pain than the NW group. EW was not broadly effective as a stress management intervention for women with breast cancer. These data do not support the use of EW as a presurgical mind-body complementary medicine program for this population.

Sense of control and diabetes mellitus among U.S. adults: a cross-sectional analysis.

BACKGROUND: Little is known about the influence of psychosocial factors on diabetes mellitus. The aim of this study was to improve understanding of the association between two psychosocial factors- sense of control and social support- and diabetes mellitus. METHODS: The authors analyzed data from 2,592 U.S. households in the 1995 survey of the Aging, Status, and the Sense of Control study. Logistic regression analyses were conducted to examine whether sense of personal control and social support were associated with DM and whether gender, race, and Hispanic ethnicity modified these associations. RESULTS: After adjusting for age, obesity, and socioeconomic position, a one point increase in sense of control (i.e., a stronger sense of control) was associated a significant reduction in risk of diabetes mellitus (odds ratio = 0.67, 95% confidence interval: 0.47, 0.95). A weak social support system was associated with a non-significant risk of diabetes (odds ratio = 1.32, 95% confidence interval: 0.93, 1.89). No effect modification was detected. CONCLUSION: Sense of control deserves greater attention as a predictor of diabetes mellitus. Further studies of the contribution of psychosocial factors to diabetes mellitus should assess the temporal nature of this relationship.

Can education policy be health policy? Implications of research on the social determinants of health.

Research on the social determinants of health has demonstrated robust correlations between several social factors, health status, and life expectancy. Some of these factors could be modified through policy intervention. National-level public policies explicitly based on population health research are in various stages of development in many Western countries, but in spite of evident need, seemingly not at all in the United States. Because research shows such a strong association between education and good health, we offer evidence to show that at least two pressing problems in American society, namely the uneven distribution of educational attainment and health disparities linked to socioeconomic position, may be ameliorated through policy initiatives that link quality early childhood care, child development programs, and parental training in a seamless continuum with strengthened K-12 education.

The unrealized potential of prenatal care. A population health approach.

To review the scientific evidence behind the traditional view that prenatal care improves pregnancy outcomes. The literature published in English between 1965 and 2002 was searched for relevant studies and opinions on prenatal care outcomes. As search engine we used the MEDLINE bibliographic database, employing a combination of keywords, including pregnancy, prenatal care and outcomes. Editorials, proceedings of meetings and reviews, were included in the analysis. This review was not intended to be a systematic or exhaustive review of the literature on prenatal care. The significant heterogeneity of the retrieved papers made any aggregation impossible. In each of the reviewed studies we assessed the methodologic aspects and validity of conclusions, using established criteria for the evaluation of prenatal interventions. Our processing of editorials and other personal opinions was conducted with the intention to draw the line between statements based on scientific evidence and speculative, emotional or traditional concepts. Outcomes research related to prenatal care is marred by methodologic flaws and conceptual problems. While traditional prenatal protocols are based on an individual-centered medical care system, the outcomes are measured using population-based parameters. Interventions capable of improving maternal and neonatal outcomes at the population level are more likely to be social and economic rather than health interventions case by case.