Reducing office workers' sitting time: rationale and study design for the Stand Up Victoria cluster randomized trial

Background: Excessive time spent in sedentary behaviours (sitting or lying with low energy expenditure) is associated with an increased risk for type 2 diabetes, cardiovascular disease and some cancers. Desk-based office workers typically accumulate high amounts of daily sitting time, often in prolonged unbroken bouts. The Stand Up Victoria study aims to determine whether a 3-month multi-component intervention in the office setting reduces workplace sitting, particularly prolonged, unbroken sitting time, and results in improvements in cardio-metabolic biomarkers and work-related outcomes, compared to usual practice

European shrinking rural areas: Key messages for a refreshed long-term vision.

The paper begins with a discussion of the concept of 'shrinking', and its origins, outside the realm of rural development. Building on this, the paper shows the distribution of shrinking rural areas across Europe. Using both the project's literature review and findings from its eight case studies the socio-economic processes which drive demographic decline in rural areas are then described. A brief account of the evolution of EU interventions to alleviate the effects of shrinking, and some remarks about the current policy/governance landscape follow. We conclude by considering how a better understanding of the problem and process of shrinking may lead to more effective interventions, within the context of a refreshed long-term vision for Rural Europe. The latter needs to fully acknowledge the expanding repertoire of opportunities confronting rural areas as COVID-19 changes in working behaviour, and the geography of economic activity, accelerate, and fulfil, previously incremental shifts in technology and markets

Acute `strokenomics': efficacy and economic analyses of alteplase for acute ischemic stroke

Cerebrovascular disease is the leading cause of adult disability in Western countries and, as such, is associated with a considerable and increasing economic burden. Prevention of disability is preferable to a costly and prolonged period of rehabilitation; however, in this regard, we have only a limited number of acute treatments. Treatment of ischemic stroke with the tissue plasminogen activator alteplase has a considerable and compelling evidence base confirming its clinical efficacy. Good-quality trial data are complemented by years of `real-life' clinical experience. There is limited pharmacoeconomic literature describing the use of alteplase in ischemic stroke, and published data are consistent and broadly supportive of its use in select patient populations. Delivery of stroke and other medical care can differ across countries; however, models based on American, Canadian and European data suggest that following initial monetary investment, net healthcare-associated costs for tissue plasminogen activator-treated patients are less than for untreated contemporaries. Potential savings are driven by reduced disability and associated long-term care costs. At present, robust economic data are only available for the period of 1-year following stroke. Continuing cost savings associated with reduced disability in the longer term make intuitive sense but are yet to be confirmed. A recurring theme in these economic analyses is of reducing healthcare costs associated with the increasing use of thrombolysis. In this regard, it is unfortunate that rates of tissue plasminogen activator utilization remain modest in most centers. This review will discuss the economics of alteplase in acute stroke, making particular reference to the current and projected economic burden of stroke, the evidence base for thrombolysis and published literature on the economics analyses of this therapy