Randomised controlled trial and economic evaluation of a task-based weight management group programme.

BACKGROUND: Obesity is a rising global threat to health and a major contributor to health inequalities. Weight management programmes that are effective, economical and reach underprivileged groups are needed. We examined whether a multi-modal group intervention structured to cater for clients from disadvantaged communities (Weight Action Programme; WAP) has better one-year outcomes than a primary care standard weight management intervention delivered by practice nurses (PNI). METHODS: In this randomised controlled trial, 330 obese adults were recruited from general practices in London and allocated (2:1) to WAP (N = 221) delivered over eight weekly group sessions or PNI (N = 109) who received four sessions over eight weeks. Both interventions covered diet, physical activity and self-monitoring. The primary outcome was the change in weight from baseline at 12 months. To indicate value to the NHS, a cost effectiveness analysis estimated group differences in cost and Quality-Adjusted Life-Years (QALYs) related to WAP. RESULTS: Participants were recruited from September 2012 to January 2014 with follow-up completed in February 2015. Most participants were not in paid employment and 60% were from ethnic minorities. 88% of participants in each study arm provided at least one recorded outcome and were included in the primary analysis. Compared with the PNI, WAP was associated with greater weight loss overall (- 4·2 kg vs. - 2·3 kg; difference = - 1·9 kg, 95% CI: -3·7 to - 0·1; P = 0·04) and was more likely to generate a weight loss of at least 5% at 12 months (41% vs. 27%, OR = 14·61 95% CI: 2·32 to 91·96, P = 0·004). With an incremental cost-effectiveness ratio (ICER) of £7742/QALY, WAP would be considered highly cost effective compared to PNI. CONCLUSIONS: The task-based programme evaluated in this study can provide a template for an effective and economical approach to weight management that can reach clients from disadvantaged communities. TRIAL REGISTRATION: ISRCTN ISRCTN45820471 . Registered 12/10/2012 (retrospectively registered).National Institute for Health Research Health Technology Assessment (project number 09/127/34

Injectable biomaterial induces regeneration of the intervertebral disc in a caprine loaded disc culture model †

Back pain is the leading cause of disability with half of cases attributed to intervertebral disc (IVD) degeneration, yet currently no therapies target this cause. We previously reported an ex vivo caprine loaded disc culture system (LDCS) that accurately represents the cellular phenotype and biomechanical environment of human IVD degeneration. Here, the efficacy of an injectable hydrogel system (LAPONITE® crosslinked pNIPAM-co-DMAc, (NPgel)) to halt or reverse the catabolic processes of IVD degeneration was investigated within the LDCS. Following enzymatic induction of degeneration using 1 mg mL−1 collagenase and 2 U mL−1 chondroitinase ABC within the LDCS for 7 days, IVDs were injected with NPgel alone or with encapsulated human bone marrow progenitor cells (BMPCs). Un-injected caprine discs served as degenerate controls. IVDs were cultured for a further 21 days within the LDCS. Tissues were then processed for histology and immunohistochemistry. No extrusion of NPgel was observed during culture. A significant decrease in histological grade of degeneration was seen in both IVDs injected with NPgel alone and NPgel seeded with BMPCs, compared to un-injected controls. Fissures within degenerate tissue were filled by NPgel and there was evidence of native cell migration into injected NPgel. The expression of healthy NP matrix markers (collagen type II and aggrecan) was increased, whereas the expression of catabolic proteins (MMP3, ADAMTS4, IL-1β and IL-8) was decreased in NPgel (±BMPCs) injected discs, compared to degenerate controls. This demonstrates that NPgel promotes new matrix production at the same time as halting the degenerative cascade within a physiologically relevant testing platform. This highlights the potential of NPgel as a future therapy for IVD degeneration

The severity of pandemic H1N1 influenza in the United States, from April to July 2009: A Bayesian analysis

Background: Accurate measures of the severity of pandemic (H1N1) 2009 influenza (pH1N1) are needed to assess the likely impact of an anticipated resurgence in the autumn in the Northern Hemisphere. Severity has been difficult to measure because jurisdictions with large numbers of deaths and other severe outcomes have had too many cases to assess the total number with confidence. Also, detection of severe cases may be more likely, resulting in overestimation of the severity of an average case. We sought to estimate the probabilities that symptomatic infection would lead to hospitalization, ICU admission, and death by combining data from multiple sources. Methods and Findings: We used complementary data from two US cities: Milwaukee attempted to identify cases of medically attended infection whether or not they required hospitalization, while New York City focused on the identification of hospitalizations, intensive care admission or mechanical ventilation (hereafter, ICU), and deaths. New York data were used to estimate numerators for ICU and death, and two sources of data - medically attended cases in Milwaukee or self-reported influenza-like illness (ILI) in New York - were used to estimate ratios of symptomatic cases to hospitalizations. Combining these data with estimates of the fraction detected for each level of severity, we estimated the proportion of symptomatic patients who died (symptomatic case-fatality ratio, sCFR), required ICU (sCIR), and required hospitalization (sCHR), overall and by age category. Evidence, prior information, and associated uncertainty were analyzed in a Bayesian evidence synthesis framework. Using medically attended cases and estimates of the proportion of symptomatic cases medically attended, we estimated an sCFR of 0.048% (95% credible interval [CI] 0.026%-0.096%), sCIR of 0.239% (0.134%-0.458%), and sCHR of 1.44% (0.83%-2.64%). Using self-reported ILI, we obtained estimates approximately 7-96lower. sCFR and sCIR appear to be highest in persons aged 18 y and older, and lowest in children aged 5-17 y. sCHR appears to be lowest in persons aged 5-17; our data were too sparse to allow us to determine the group in which it was the highest. Conclusions: These estimates suggest that an autumn-winter pandemic wave of pH1N1 with comparable severity per case could lead to a number of deaths in the range from considerably below that associated with seasonal influenza to slightly higher, but with the greatest impact in children aged 0-4 and adults 18-64. These estimates of impact depend on assumptions about total incidence of infection and would be larger if incidence of symptomatic infection were higher or shifted toward adults, if viral virulence increased, or if suboptimal treatment resulted from stress on the health care system; numbers would decrease if the total proportion of the population symptomatically infected were lower than assumed.published_or_final_versio

Changes in Alcohol Consumption During a Stop-Smoking Attempt and Differences Between Smokers Using Nicotine Replacement and Smokers Using Varenicline.

Introduction: Little is known about effects of smoking cessation on alcohol consumption. Varenicline reduces enjoyment of smoking and cigarette consumption and may also reduce enjoyment and consumption of alcohol. We conducted the first prospective examination of the effects of stopping smoking on alcohol enjoyment and consumption and compared clients using varenicline and nicotine replacement treatment (NRT). Methods: Audit of records from clients undergoing routine smoking cessation treatment in three stop-smoking services in London, United Kingdom. The sample comprised smokers who consume alcohol and underwent smoking cessation treatment with either varenicline (N = 230) or NRT (N = 62). Alcohol enjoyment and consumption were reported before and on the target quit day (TQD) and 1 and 4 weeks post-TQD. Results: Participants reduced their alcohol consumption in week 1 of their quit attempt (15.0-12.7 units per/week, p = .001).In heavy drinkers, the change remained significant at 4 weeks (32.2-24.8 units per/week, p = .004). The type of medication used had no significant impact on the change. Smokers treated with varenicline versus NRT were more likely to report reduced enjoyment of alcohol on TQD (20% vs. 10%, respectively, p < .001) and at 4 weeks post-TQD (20% vs. 6%, respectively, p = .014). Results were similar for abstainers and those who did not manage to stop smoking. Conclusion: Making a stop-smoking attempt is accompanied by a reduction in drinking. The finding has implications for policies concerned with effects of stopping smoking on alcohol use. Varenicline may affect enjoyment of drinking, but its potential to alter drinking behavior is small. Implications: The finding that smokers making a quit attempt reduce their alcohol consumption has practical implications for treatment providers who are concerned about the possible effects of smoking cessation on alcohol drinking. Although varenicline may reduce alcohol enjoyment compared to NRT, it does not appear to have a significant impact on alcohol consumption.This work was supported by a grant from Alcohol Research UK (SG 13/14 191)

Pulpal response of dogs primary teeth to an adhesive system or to a calcium hydroxide cement Resposta pulpar de dentes decíduos de cães a um sistema adesivo ou ao cimento de hidróxido de cálcio

The aim of this study was to evaluate the pulpal response of dogs primary teeth to an adhesive system or to a calcium hidroxide cement after mechanic exposure of the pulp. Three mongrel dogs were used and ten class V cavities were prepared on their teeth. A mechanic pulp exposure was produced with a sterile exploratory probe in the central portion of each cavity and bleeding was controlled with dry sterile cotton pellets. Enamel, dentin and the site of the pulp exposure of five teeth were etched with 35% phosphoric acid followed by the application of an adhesive system (Scotchbond Multi-Purpose - 3M). In the other five teeth, calcium hydroxide cement (Hydro C - Dentsply) was applied on the site of the pulp exposition before application of the adhesive system (Scotchbond Multi-Purpose - 3M). All teeth were restored with a resin composite (Z-100 - 3M). After 7, 30 or 45 days the dogs were anesthetized and perfused with saline followed by a solution of neutral buffered formalin. Maxilla and mandible were sectioned into three parts and placed in a solution for demineralization. Following bone demineralization, all teeth were cut, trimmed, embedded in paraffin and longitudinally cut. Then, the teeth were stained with hematoxilin and eosin and observed under a light microscope. The results obtained with the treatments proposed in this study showed the presence and persistence of an inflammatory response of different intensities at the three experimental periods. There was no variation in the inflammatory response regarding the different treatments performed.<br>O objetivo deste estudo foi de avaliar a resposta pulpar de dentes decíduos de cães à um sistema adesivo ou a um cimento de hidróxido de cálcio após exposição mecânica da polpa. Foram utilizados três cães sem raça definida, e nestes foram realizados dez preparos cavitários classe V. Uma exposição pulpar mecânica foi produzida com uma sonda exploradora esterilizada, na porção central de cada cavidade. A hemorragia foi controlada com "bolinhas" de algodão esterilizadas. O esmalte, dentina e local da exposição pulpar de cinco dentes foram condicionados com ácido fosfórico a 35%, seguido da aplicação de um sistema adesivo (Scotchbond Multi-Uso - 3M). Nos outros cinco dentes, um cimento de hidróxido de cálcio (Hydro C - Dentsply) foi aplicada no local da exposição pulpar antes da aplicação do mesmo sistema adesivo. Todos os dentes foram restaurados com uma resina composta (Z-100 - 3M). Após 7, 30 ou 45 dias os cães foram anestesiados e perfundidos com solução salina seguida de uma solução de formalina neutra tamponada. A maxila e a mandíbula foram seccionadas em três partes e estocadas em uma solução para desmineralização. Após a desmineralização óssea, todos os dentes foram cortados, incluídos em parafina e seccionados longitudinalmente. A seguir todos os dentes foram corados com hematoxilina e eosina e observados em microscópio de luz. Os resultados demonstraram a presença e persistência de uma resposta inflamatória de diferentes intensidades nos três períodos experimentais. Não houve variação na resposta inflamatória pelos diferentes tratamentos propostos