Patient preference compared with random allocation in short-term psychodynamic supportive psychotherapy with indicated addition of pharmacotherapy for depression.

Depressed patients randomized to psychotherapy were compared with those who had been chosen for psychotherapy in a treatment algorithm, including addition of an antidepressant in case of early nonresponse. There were no differences between randomized and by-preference patients at baseline in adherence and outcome. About half of the early nonresponders refused the additional medication. However, no clear effect of medication addition on ultimate outcome could be demonstrated. In total, 37% of the patients achieved remission. The study suggested that randomization of patients does not induce a great influence on outcome. It might be warranted to continue an initially ineffective psychotherapy for depression, because a considerable number of patients do have a pattern of delayed response

Economic evaluation of a weight control program with e-mail and telephone counseling among overweight employees: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Distance lifestyle counseling for weight control is a promising public health intervention in the work setting. Information about the cost-effectiveness of such interventions is lacking, but necessary to make informed implementation decisions. The purpose of this study was to perform an economic evaluation of a six-month program with lifestyle counseling aimed at weight reduction in an overweight working population with a two-year time horizon from a societal perspective.</p> <p>Methods</p> <p>A randomized controlled trial comparing a program with two modes of intervention delivery against self-help. 1386 Employees from seven companies participated (67% male, mean age 43 (SD 8.6) years, mean BMI 29.6 (SD 3.5) kg/m²). All groups received self-directed lifestyle brochures. The two intervention groups additionally received a workbook-based program with phone counseling (phone; n=462) or a web-based program with e-mail counseling (internet; n=464). Body weight was measured at baseline and 24 months after baseline. Quality of life (EuroQol-5D) was assessed at baseline, 6, 12, 18 and 24 months after baseline. Resource use was measured with six-monthly diaries and valued with Dutch standard costs. Missing data were multiply imputed. Uncertainty around differences in costs and incremental cost-effectiveness ratios was estimated by applying non-parametric bootstrapping techniques and graphically plotting the results in cost-effectiveness planes and cost-effectiveness acceptability curves.</p> <p>Results</p> <p>At two years the incremental cost-effectiveness ratio was €1009/kg weight loss in the phone group and €16/kg weight loss in the internet group. The cost-utility analysis resulted in €245,243/quality adjusted life year (QALY) and €1337/QALY, respectively. The results from a complete-case analysis were slightly more favorable. However, there was considerable uncertainty around all outcomes.</p> <p>Conclusions</p> <p>Neither intervention mode was proven to be cost-effective compared to self-help.</p> <p>Trial registration</p> <p>ISRCTN04265725</p

Occurrence of symptoms in different stages of Duchenne muscular dystrophy and their impact on social participation

Introduction/Aims: As life expectancy improves for patients with Duchenne muscular dystrophy (DMD), new symptoms are likely to arise. This aims of this study are: (1) to explore the prevalence of a broad variety of symptoms in the various stages of DMD (with and without steroid use); (2) to explore the prevalence of common secondary diagnoses; and (3) to evaluate the social participation level of patients with DMD older than 16 y of age; and to explore correlations between social participation and symptoms.Methods A cross-sectional self-report questionnaire, including questions on functional level and health status, as well as a standardized participation scale was distributed among Dutch patients with DMD.Results Eighty-four male patients with a mean age of 22.0 (SD = 10.0) y were enrolled. The most prevalent and limiting symptoms were difficulty coughing (58%), coldness of hands (57%), contractures (51%), stiffness (49%), fatigue (40%), myalgia (38%), and low speech volume (33%). Prevalent secondary diagnoses included cardiac disease (14%), neurobehavioral diagnosis (13%), low blood pressure (13%), and arthrosis (5%). Social participation correlated negatively with coldness of hands (r = - .29; P < .03), decreased intelligibility (r = - .40; P < .003), and chewing problems (r = - .33; P < .02).Discussion The prevalence of a broad spectrum of symptoms and secondary diagnoses is high in patients with DMD, and some of these symptoms are correlated with social participation. Growing awareness of new symptoms and secondary diagnoses among patients, caregivers, and professionals can enhance their recognition, possibly facilitating prevention and early treatment.Neurological Motor Disorder

Maak werk van wandelen

Meer dan de helft van de beroepsbevolking voldoet niet aan de Nederlandse Norm Gezond bewegen: minimaal 30 minuten per dag op ten minste 5 dagen per week matig intensief bewegen. Bovendien brengen de meeste werknemers het grootste deel van hun werkdag zittend achter hun computer door. Te weinig beweging verhoogt het risico op tal van chronische ziekten als diabetes en hart- en vaatziekten. Bovendien lijkt inactiviteit geassocieerd met een hoger ziekteverzuim en een lagere productiviteit. Het stimuleren van bewegen is daarom belangrijk. In dit artikel wordt ingegaan op één vorm van bewegingsstimulering: het lunchwandelen. Uit verschillende onderzoeken blijkt dat wandelen tijdens de lunch voor werkgevers en werknemers aantrekkelijk is omdat het in elke werkdag past en weinig geld en moeite kost. Aanjagers, (bijna) fulltime werknemers die bekend zijn in de organisatie en zeer enthousiast over lunchwandelen, kunnen collega’s stimuleren om ook mee te gaan. Door regelmatig activiteiten te organiseren rondom het wandelen kan de aandacht voor deze vorm van bewegen vastgehouden worden. In het artikel worden twee websites genoemd waarop een handleiding en promotiemateriaal voor bedrijven beschikbaar zijn om lunchwandelen makkelijk en succesvol in te kunnen voeren. Vakmedi

Associaties tussen sedentair gedrag en werk-gerelateerde uitkomstmaten: resultaten van een cross-sectioneel onderzoek

In deze verkennende studie is gekeken of er mogelijke relaties zijn tussen zitgedrag (sedentair gedrag) en verschillende werk-gerelateerde uitkomstmaten. Analyses op een cross-sectioneel databestand van ruim 1500 werknemers laten zien dat meer zitten is geassocieerd met een lagere vitaliteit, taakprestatie, productiviteit (alleen in branches met voornamelijk niet-zittend werk), en een hoger verzuim (alleen in branches met voornamelijk zittend werk). Hoewel deze relaties significant zijn, gaat het in alle gevallen om marginale effecten. Er zijn geen significante relaties gevonden tussen zitgedrag en ervaren werkdruk. Geconcludeerd wordt dat de gevonden significante associaties tussen zitgedrag en vitaliteit, taakprestatie, productiviteit en verzuim te klein zijn om hier beleidsmatige consequenties aan te verbinden

Electrically Assisted Cycling: A New Mode for Meeting Physical Activity Guidelines?

PURPOSE: The purpose of this study was to assess the potential of the electrically assisted bicycle (EAB) as a novel tool for meeting the physical activity guidelines in terms of intensity. METHODS: Twelve habitually active adult subjects were requested to cycle a track of 4.3 km at an intensity they would normally choose for commuter cycling, using three different support settings: no support (NO), eco support (ECO), and power support (POW). For estimating the intensity, the oxygen consumption was measured by using a portable gas-analyzing system, and HR was simultaneously measured. The bicycle was equipped with the SRM Training System to measure subjects' power output, pedaling rate, and the cycle velocity. RESULTS: Mean intensity was 6.1 MET for NO, 5.7 MET for ECO, and 5.2 MET for POW. Intensity was significantly lower in POW compared with that in NO. No differences were found between NO and ECO and between ECO and POW. Mean HR was significantly higher in NO compared with that in ECO and POW. The cycling speed with electrical support settings was significantly higher than cycling in the NO condition. Mean power output during cycling was significantly different among all three conditions. Most power outputs were supplied in the NO condition, and the lowest power output was supplied in the POW condition. CONCLUSIONS: Intensity during cycling on an EAB, in all three measured conditions, is sufficiently high to contribute to the physical activity guidelines for moderate-intensity health-enhancing physical activity for adults (cutoff, 3 MET). Further study is needed to conclude whether these results still hold when using the EAB in regular daily life and in subjects with other fitness level