Impact and Cost-Effectiveness of a Universal Strategy to Promote Physical Activity in Primary Care: Population-Based Cohort Study and Markov Model.

Impact and cost-effectiveness of a universal strategy to promote physical activity in primary care: population-based Cohort study and Markov model.

Eur J Health Econ. 2013 Apr 10;
Gulliford MC, Charlton J, Bhattarai N, Charlton C, Rudisill C

BACKGROUND: This study aimed to estimate the cost-effectiveness of a universal strategy to promote physical activity in primary care. METHODS: Data were analysed for a cohort of participants from the general practice research database. Empirical estimates informed a Markov model that included five long-term conditions (diabetes, coronary heart disease, stroke, colorectal cancer and depression). Simulations compared an intervention promoting physical activity in healthy adults with standard care. The intervention effect on physical activity was from a meta-analysis of randomised trials. The annual cost of intervention, in the base case, was one family practice consultation per participant year. The primary outcome was net health benefit in quality adjusted life years (QALYs). RESULTS: A cohort of 262,704 healthy participants entered the model. Intervention was associated with an increase in life years lived free from physical disease. With 5 years intervention the increase was 52 (95 % interval -11 to 115) per 1,000 participants entering the model (probability increased 91.9 %); with 10 years intervention the increase was 102 (42-164) per 1,000 (probability 99.7 %). Net health benefits at a threshold of £30,000 per QALY were 3.2 (-11.1 to 16.9) QALYs per 1,000 participants with 5 years intervention (probability cost-effective 64.7 %) and 5.0 (-9.5 to 19.3) with 10 years intervention (probability cost-effective 72.4 %). CONCLUSIONS: A universal strategy to promote physical activity in primary care has the potential to increase life years lived free from physical disease. There is only weak evidence that a universal intervention strategy might prove cost-effective. HubMed – depression


Depression in Terminally Ill Patients: Dilemmas in Diagnosis and Treatment.

J Pain Symptom Manage. 2013 Apr 6;
Asghar-Ali AA, Wagle KC, Braun UK

HubMed – depression


Serotonin and interleukin-6: The role of genetic polymorphisms in IFN-induced neuropsychiatric symptoms.

Psychoneuroendocrinology. 2013 Apr 6;
Udina M, Moreno-España J, Navinés R, Giménez D, Langohr K, Gratacòs M, Capuron L, de la Torre R, Solà R, Martín-Santos R

BACKGROUND: Cytokines and serotonin neurotransmission may play an important role on the development of psychopathological symptoms during interferon (IFN) treatment. The aim of the present study was to investigate the association between IFN-induced depression, anxiety and fatigue and functional genetic variants at the interleukin-6 gene (IL-6) and serotonin transporter gene (SERT). METHODS: 385 consecutive Caucasian outpatients with chronic hepatitis C initiating treatment with IFN-alpha and ribavirin were included. All patients were interviewed at baseline using the Structured Clinical Interview for DSM-IV (SCID-I) and those with a current major depressive disorder or anxiety disorder before starting treatment were excluded. Depression and anxiety were assessed at baseline during the treatment (at 4, 12, 24 and 48 weeks) using the Hospital Anxiety and Depression Scale and fatigue was evaluated using a visual analogue scale. The 5-HTTLPR region of SERT gene and the functional polymorphism located at the promoter region of IL-6 gene (rs1800795) were genotyped. RESULTS: Genotypic distribution was in the Hardy-Weinberg equilibrium for SERT (p=0.41) and for IL-6 (p=0.72) polymorphisms. At baseline we found only a significant effect of IL-6 polymorphism on fatigue symptoms. During antiviral treatment we reported that subjects with CC genotype (IL-6) presented significantly lower changes from baseline in IFN-induced depression (p=0.005) and IFN-induced anxiety (p=0.004). We did not find statistically significant differences on depression (p=0.21) or anxiety (p=0.15) between SS/SL and LL genotypes of SERT. CONCLUSIONS: Genetic variations in the IL-6 gene increase the risk of IFN-induced depression and anxiety. The IL-6 polymorphism was associated with fatigue rates in patients with chronic hepatitis C before treatment. Our study confirms the role of inflammatory mechanisms in IFN-induced psychopathological symptoms. HubMed – depression



Nature’s Anxiety/Depression Treatment – Calm yourself for a minute amidst the chaos and drama. Peaceful kindness is a present you can give that helps, heals and otherwise benefits your friends and …