Use of the prevented fraction for the population to determine deaths averted by existing prevalence of physical activity: a descriptive study

Abstract Background: The disease or mortality burdens of unhealthy lifestyle behaviours are often reported. The positive side of the story, the burden that existing levels have averted, is rarely discussed. We present what we believe to be global application of the Prevented Fraction for the Population to obtain estimates of the percentage of premature mortality and number of premature deaths averted by total physical activity levels for 168 countries. Methods: We combined previously published activity prevalence data (2001-2016) and relative risks of mortality in Monte-Carlo simulations to estimate country-specific Prevented Fractions for the Population (percentage of mortality averted) and their 95% confidence intervals. Higher Prevented Fractions indicate a greater proportion of deaths averted due to physical activity. Using mortality data for 40-74 year olds, we estimated the number of premature deaths averted due to activity levels for all adults and by sex. We presented the median and range of the Prevented Fractions globally, by region, and by income classification. Results: The global median Prevented Fraction for the Population was 15.0% (range 6.6-20.5%), conservatively equating to 3.9 million (95% confidence interval: 2.5-5.6) premature deaths averted annually. The African region had the highest median (16.6%, range 12.1-20.5%), the Americas had the lowest (13.1%, range 10.8-16.6%). Low income countries tended to have higher median Prevented Fractions (17.9%, range 12.3-20.5%) than high income countries (14.1%, range 6.6-17.8%). Globally, the median Prevented Fraction was higher for men than women (16.0% (range 7.8-20.7% and 14.1% (range 5.0-20.4%), respectively). Interpretation: Existing physical activity levels have contributed to averting premature mortality across all countries. The Prevented Fraction for the Population has utility as an advocacy tool to promote healthy lifestyle behaviours as, by making the case of what has been achieved, it could demonstrate the value of current investment and services. This may be more conducive to political support.TS, SJS, and SB are funded by the UK Medical Research Council (MC_UU_12015/1 and MC_UU_12015/3). DD is funded by a Future Leader Fellowship by Heart Foundation Australia (No. 101234). At the time of this work, MT was a member of the Centre for Diet and Activity Research (MR/K023187/1), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, National Institute for Health Research (NIHR), and Wellcome Trust, under the auspices of the UKClinical Research Collaboration, is gratefully acknowledged. MT was also funded on the METAHIT project (Medical Research Council grant MR/P02663X/1)

How do GP practices and patient characteristics influence the prescription of antidepressants? A cross-sectional study

BACKGROUND: Under-prescription of antidepressants (ADs) among people meeting the criteria for major depressive episodes and excessive prescription in less symptomatic patients have been reported. The reasons influencing general practitioners’ (GPs) prescription of ADs remain little explored. This study aimed at assessing the influence of GP and patient characteristics on AD prescription. METHODS: This cross-sectional study was based on a sample of 816 GPs working within the main health care insurance system in the Seine-Maritime district of France during 2010. Only GPs meeting the criteria for full-time GP practice were included. The ratio of AD prescription to overall prescription volume, a relative measure of AD prescription level, was calculated for each GP, using the defined daily dose (DDD) concept. Associations of this AD prescription ratio with GPs’ age, gender, practice location, number of years of practice, number of days of sickness certificates prescribed, number of home visits and consultations, number and mean age of registered patients, mean patient income, and number of patients with a chronic condition were assessed using univariate and multivariate analysis. RESULTS: The high prescribers were middle-aged (40–59) urban GPs, with a moderate number of consultations and fewer low-income and chronic patients. GPs’ workload (e.g., volume of prescribed drug reimbursement and number of consultations) had no influence on the AD prescription ratio. GPs with more patients with risk factors for depression prescribed fewer ADs, however, which could suggest the medications were under-prescribed among the at-risk population. CONCLUSIONS: Our study described a profile of the typical higher AD prescriber that did not include heavy workload. In future work, a more detailed assessment of all biopsychosocial components of the consultation and other influences on GP behavior such as prior training would be useful to explain AD prescription in GP’s practice. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12991-015-0041-7) contains supplementary material, which is available to authorized users

253: The effect of statins on the risk of first non-fatal myocardial infarction: A population-based observational study using the PGRx information system

BackgroundDespite demonstrated positive effects in a number of clinical trials, the evidence is lacking as to the impact of statins on the risk of first myocardial infarction (MI) in real life settings.ObjectivesTo assess the impact of real life statin utilization on the risk of first non-fatal MIMethodsCase-control methodology using the pharmacoepidemiological information system PGRx. Data on comorbidities, risk factors and medications were obtained from medical records and patient telephone interviews. General practices (n=371) and cardiology centres (n=60) across France were employed in the study. Cases were patients with the first MI ≤ 1 month before the date of recruitment (n=2238). Controls were patients seen by a general practitioner (GP) with no restriction as to the reasons of consultation (n=2238), matched to MI cases on gender, age, frequency of visits to a doctor, date of recruitment and personal history of non-cardiovascular chronic disease. Statin exposure was defined as any utilisation in the two-year prior to date of MI in cases or recruitment date in controls. Adjusted odds ratios (OR) of the risk of first MI was estimated by multiple conditional logistic regression models. Comparative effectiveness and propensity to use of individual statin molecules were assessed.ResultsThe use of statins was associated with a lower MI risk (adjusted OR 0.67 [95% CI 0.56 - 0.79] for current use (within 2 months before the index date) and 0.73 [0.62 0.86] for any use within 24 months). Among individual statins, rosuvastatin was associated with the lowest MI risk (adjusted OR 0.49 [0.35 - 0.68] for any use in 24 months preceding the index date) followed by simvastatin (0.62 [0.46 - 0.84]).ConclusionsIn this first major population-based observational study we reproduced the results observed in recent meta-analyses accounting for real life compliance and population variability. The results could be of interest and applicable to other industrialised countries as the observed risk reduction was constant across MI risk levels

The safety of agomelatine in standard medical practice in depressed patients : a 26‐week international multicentre cohort study

© 2020 The Authors. Human Psychopharmacology: Clinical and Experimental published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Objective: The present observational cohort study documented the safety of agomelatine in current medical practice in out-patients suffering from major depressive disorder. Method: The 6-month evolution of agomelatine-treated patients was assessed with a focus on safety (emergent adverse events, liver acceptability), severity of depression using the Clinical Global Impression Severity (CGI-S) score, and functioning measured by the Sheehan Disability Scale (SDS). Results: A total of 8453 depressed patients from 761 centres in 6 countries were analysed (female: 67.7%; mean age: 49.1 ± 14.8 years). Adverse events reported were in accordance with the known safety profile of agomelatine. Cutaneous events were reported in 1.7% of the patients and increased hepatic transaminases values were reported in 0.9 % of the patients. The incidence of events related to suicide/self-injury was 1.0%. Two completed suicides, not related to the study drug, were reported. CGI-S total scores and SDS sub-scores improved and numbers of days lost or underproductive decreased over the treatment period. Conclusions: In standard medical practice, agomelatine treatment was associated with a low incidence of side effects. No unexpected events were reported. A decrease in the severity of the depressive episode and improved functioning were observed.info:eu-repo/semantics/publishedVersio

La carte Vitale permet de prédire l'antibiorésistance à l'échelon individuel

International audienc

Chronic Eczematous Eruptions of the Elderly Are Associated with Chronic Exposure to Calcium Channel Blockers: Results from a Case–Control Study

It has been suggested that chronic eczematous eruptions of the elderly could be associated with chronic drug exposure. To determine the drugs associated with these eruptions, we conducted a case–control study on 102 cases and 204 controls. Cases were consecutive patients older than 60 years presenting with an eczematous eruption that had evolved continuously or recurrently for more than 3 months without a reliable cause. Two controls were matched to each case on age, sex, in/outpatient origin, and center. Information about drug exposure was obtained from patients and their pharmacists. Drug use for more than 3 months within the year preceding the eruption was compared between cases and controls. An association was found between calcium channel blockers (CCB) and eczema, with a matched OR (odds ratio) of 2.5 (95% CI (confidence interval): 1.3–4.6). To ascertain the course of patients after CCB withdrawal, two ancillary studies were performed on 74 patients with eczematous eruptions from our department before the case–control study period, and on 101 patients registered in the French “Pharmacovigilance” database. Healing of these eruptions after CCB withdrawal occurred in 83 and 68% of these cases, respectively. The long-term use of CCB is a risk factor for chronic eczematous eruptions of the elderly

Characterization of the Molecular Determinants of Primary HIV-1 Vpr Proteins: Impact of the Q65R and R77Q Substitutions on Vpr Functions

Although HIV-1 Vpr displays several functions in vitro, limited information exists concerning their relevance during infection. Here, we characterized Vpr variants isolated from a rapid and a long-term non-progressor (LTNP). Interestingly, vpr alleles isolated from longitudinal samples of the LTNP revealed a dominant sequence that subsequently led to diversity similar to that observed in the progressor patient. Most of primary Vpr proteins accumulated at the nuclear envelope and interacted with host-cell partners of Vpr. They displayed cytostatic and proapoptotic activities, although a LTNP allele, harboring the Q65R substitution, failed to bind the DCAF1 subunit of the Cul4a/DDB1 E3 ligase and was inactive. This Q65R substitution correlated with impairment of Vpr docking at the nuclear envelope, raising the possibility of a functional link between this property and the Vpr cytostatic activity. In contradiction with published results, the R77Q substitution, found in LTNP alleles, did not influence Vpr proapoptotic activity

CMS physics technical design report : Addendum on high density QCD with heavy ions

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