The Effect of a physical activity program on the total number of primary care visits in inactive patients : A 27-month randomized controlled trial

Background: Effective promotion of exercise could result in substantial savings in healthcare cost expenses in terms of direct medical costs, such as the number of medical appointments. However, this is hampered by our limited knowledge of how to achieve sustained increases in physical activity. Objectives: To assess the effectiveness of a Primary Health Care (PHC) based physical activity program in reducing the total number of visits to the healthcare center among inactive patients, over a 15-month period. Research Design: Randomized controlled trial. Subjects: Three hundred and sixty-two (n = 362) inactive patients suffering from at least one chronic condition were included. One hundred and eighty-three patients (n = 183; mean (SD); 68.3 (8.8) years; 118 women) were randomly allocated to the physical activity program (IG). One hundred and seventy-nine patients (n = 179; 67.2 (9.1) years; 106 women) were allocated to the control group (CG). The IG went through a three-month standardized physical activity program led by physical activity specialists and linked to community resources. Measures: The total number of medical appointments to the PHC, during twelve months before and after the program, was registered. Self-reported health status (SF-12 version 2) was assessed at baseline (month 0), at the end of the intervention (month 3), and at 12 months follow-up after the end of the intervention (month 15). Results: The IG had a significantly reduced number of visits during the 12 months after the intervention: 14.8 (8.5). The CG remained about the same: 18.2 (11.1) (P = .002). Conclusions: Our findings indicate that a 3-month physical activity program linked to community resources is a short-duration, effective and sustainable intervention in inactive patients to decrease rates of PHC visits

Process evaluation outcomes from a global child obesity prevention intervention

Background: While it is acknowledged that child obesity interventions should cover multiple ecological levels (downstream, midstream and upstream) to maximize their effectiveness, there is a lack of evaluation data to guide the development and implementation of such efforts. To commence addressing this knowledge gap, the present study provides process evaluation data relating to the experiences of groups implementing the EPODE approach to child obesity prevention in various locations around the world. The aim of this exploratory study was to investigate the barriers and facilitators to program implementation in program sites around the world to assist in developing strategies to enhance program outcomes. Methods: An online survey that included open-ended questions was distributed to the 25 EPODE programs in operation at the time of the survey (May 2012). The survey items asked respondents to comment on those aspects of program implementation that they found challenging and to suggest areas for future improvement. Eighteen programs representing 14 countries responded to the request to participate in the survey, yielding a 72% response rate. The responses were analyzed via the constant comparative method using NVivo qualitative data analysis software.Results: The main concerns of the various EPODE programs were their ability to secure ongoing funding and their access to evidence-based intervention methods and policy advice relating to relationships with third parties. These issues were in turn impacted by other factors, including (i) access to user-friendly information relating to the range of intervention strategies available and appropriate evaluation measures; (ii) assistance with building and maintaining stakeholder relationships; and (iii) assurance of the quality, independence, and transparency of policies and practices. Conclusions: The findings are facilitating the ongoing refinement of the EPODE approach. In particular, standardized and tailored information packages are being made available to advise program members of (i) the various evaluation methods and tools at their disposal and (ii) methods of acquiring private partner support. Overall, the study results relating to the types of issues encountered by program members are likely to be useful in guiding the future design and implementation of multi-level initiatives seeking to address other complex and intractable health-related problems

Body mass index and use and costs of primary care services among women aged 55-79 years in England: a cohort and linked data study.

BACKGROUND: Excess weight is associated with poor health and increased healthcare costs. There are no reliable data describing the association between BMI and the use and costs of primary care services in the United Kingdom. METHODS: Among 69,440 participants in the Million Women Study with primary care records in the Clinical Practice Research Datalink between April 2006 (mean age 64 years) and March 2014, the annual rates and costs of their primary care consultations, prescription medications, and diagnostic and monitoring tests were estimated in relation to their self-reported body mass index (BMI) at recruitment in 1996-2001 (mean age 56 years). Associations of BMI with annual costs were projected to all women in England aged 55-79 years in 2013. RESULTS: Over an average follow-up of 6.0 years, annual rates and mean costs were lowest for women with a BMI of 20 to <22.5 kg/m2 for consultations (7.0 consultations, 99% CI 6.8-7.1; £288, £280-£295) and prescription medications (27.0 prescribed items, 26.0-27.9; £227, £216-£237). Above 20 kg/m2, a 2 kg/m2 higher BMI (a 5 kg change in weight for a woman of average height) was associated with 5.2% (4.8-5.6) and 9.9% (9.2-10.6) higher mean annual consultation and prescription medication costs, respectively. Annual rates and mean costs of diagnostic and monitoring tests were similar for women with different BMIs. Among all women aged 55-79 years in England, excess weight accounted for an estimated 11% (£229 million/£2.2 billion) of all consultation costs and 20% (£384 million/£1.9 billion) of all prescription medication costs, of which 27% were for diabetes drugs, 19% for circulatory system drugs, and 13% for analgesics. CONCLUSIONS: Excess body weight is associated with higher use and costs of primary care services among women in England. Reducing the prevalence of excess weight could improve the health of women and reduce pressures on primary care.Cancer Research UK (grant C570/A16491); Medical Research Council (grant MR/K02700X/1)

Veränderungen des Körpergewichts und Inanspruchnahme ambulanter medizinischer Versorgung: Ergebnisse der MONICA/KORA-Kohorten S3/F3 und S4/F4

Objectives: To test the effects of body weight maintenance, gain, and loss on health care utilisation in terms of outpatient visits to different kinds of physicians in the general adult population.Methods: Self-reported utilisation data were collected within two population-based cohorts (baseline surveys: MONICA-S3 1994/95 and KORA-S4 1999/2001; follow-ups: KORA-F3 2004/05 and KORA-F4 2006/08) in the region of Augsburg, Germany, and were pooled for present purposes. N=5,147 adults (complete cases) aged 25 to 64 years at baseline participated. Number of visits to general practitioners (GPs), internists, and other specialists as well as the total number of physician visits at follow-up were compared across 10 groups defined by body mass index (BMI) category maintenance or change. Body weight and height were measured anthropometrically. Hierarchical generalized linear regression analyses with negative binomial distribution adjusted for sex, age, socioeconomic status (SES), survey, and the need factors incident diabetes and first cancer between baseline and follow-up were conducted.Results: In fully adjusted models, compared to the group of participants that maintained normal weight from baseline to follow-up, the following groups had significantly higher GP utilisation rates: weight gain from normal weight (+36%), weight loss from preobesity (+39%), maintained preobesity (+34%), weight gain after preobesity (+43%), maintained moderate obesity (+48%), weight gain from moderate obesity (+107%), weight loss from severe obesity (+114%), and maintained severe obesity (+83%). Regarding internists, those maintaining moderate obesity reported +107% more visits; those with weight gain from moderate obesity reported +91%. The latter group also had +41% more consultations with other physicians. Across all physicians, mean number of visits were estimated at 7.8 per year for maintained normal weight, 9 for maintained preobesity, 11 for maintained moderate obesity, and 12 for maintained severe obesity. Among those with weight loss, the mean number of visits were 8.7, 10.6 and 10.8 for baseline preobesity, moderate obesity, and severe obesity, respectively. Finally, those with weight gain from normal weight and preobesity reported 9.4 and 9.3 visits, respectively, and those with baseline moderate and follow-up severe obesity reported 13.1 visits (the most overall). Women reported higher GP and other physician utilisation. While all utilisation rates increased with age, GP utilisation was lower in middle to high SES groups.Conclusion: Compared to maintained normal weight over a 7- to 10-year period, maintained overweight, weight gain and weight loss are associated with higher outpatient physician utilisation in adults, especially after baseline obesity. These effects only partly became insignificant after inclusion of incident diabetes or first cancer into the model. Future research should further elucidate the associations between weight development and health care utilisation by BMI status and the mechanisms underlying these associations.Zielsetzung: Es werden Effekte der Erhaltung, Zunahme und des Verlusts von Körpergewicht auf Inanspruchnahme gesundheitsbezogener Versorgung im Sinne ambulanter Besuche bei verschiedenen Ärztegruppen in der erwachsenen Allgemeinbevölkerung untersucht.Methodik: Selbstberichtete Inanspruchnahmedaten wurden im Rahmen zweier Populationskohorten (Baselinesurveys: MONICA-S3 1994/95 und KORA-S4 1999/2001; Follow-ups: KORA-F3 2004/05 und KORA-F4 2006/08) in der Region Augsburg erhoben und für die Analyse gepoolt. Zur Baseline nahmen N=5.147 Erwachsene (vollständige Fälle) im Alter von 25 bis 64 Jahren teil. Über 10 Gruppen, die nach Veränderungen oder dem Erhalt der Body Mass Index- (BMI-) Kategorie definiert wurden, wurde die Anzahl der Besuche bei Allgemeinmedizinern, Internisten und anderen Fachärzten sowie die Gesamtzahl der Arztbesuche beim Follow-up verglichen. Körpergröße und -gewicht wurden anthropometrisch gemessen. Es wurden hierarchische verallgemeinerte lineare Regressionsanalysen mit negativer Binomialverteilung durchgeführt und für Geschlecht, Alter, sozioökonomischen Status, Survey und für zwischen Baseline und Follow-up inzident aufgetretenen Diabetes und inzident aufgetretener erster Krebserkrankung als Bedarfsfaktoren adjustiert. Ergebnisse: In den vollständig adjustierten Modellen hatten im Vergleich zur Gruppe der Teilnehmer, die von Baseline zum Follow-up normalgewichtig geblieben waren, folgende Gruppen eine signifikant höhere Inanspruchnahme von Allgemeinmedizinern: Gewichtszunahme nach Normalgewicht (+36%), Gewichtsabnahme nach Präadipositas (+39%), stabile Präadipositas (+34%), Gewichtszunahme nach Präadipositas (+43%), stabile moderate Adipositas (+48%), Gewichtszunahme nach moderater Adipositas (+107%), Gewichtsabnahme nach schwerer Adipositas (+114%) und stabile schwere Adipositas (+83%). Bezüglich Internisten berichteten Personen mit stabiler moderater Adipositas +107% mehr Besuche, und diejenigen mit einer Gewichtszunahme nach moderater Adipositas +91%. Diese letztere Gruppe zeichnete sich auch durch +41% mehr Besuche bei anderen Fachärzten aus. Über alle Ärzte hinweg wurde die mittlere Anzahl von Besuchen p. a. auf 7,8 bei stabilem Normalgewicht sowie auf 9 bei stabiler Präadipositas, 11 bei stabiler moderater Adipositas und 12 bei stabiler schwerer Adipositas geschätzt. Nach Gewichtsabnahme war die mittlere Anzahl der Besuche 8,7, 10,6 bzw. 10,8 bei initialer Präadipositas, moderater bzw. schwerer Adipositas. Diejenigen mit Gewichtszunahme nach Normalgewicht bzw. Präadipositas berichteten 9,4 bzw. 9,3 Besuche, während diejenigen mit initial moderater Adipositas und schwerer Adipositas zum Follow-up 13,1 Besuche (also insgesamt die meisten). Insgesamt berichteten Frauen über eine höhere Inanspruchnahme von Allgemeinmedizinern und anderen Fachärzten. Während alle Inanspruchnahmeparameter mit dem Alter zunahmen, war die Inanspruchnahme von Allgemeinmedizinern bei mittlerem bis höherem sozioökonomischem Status relativ gering.Fazit: Über einen Beobachtungszeitraum von 7 bis 10 Jahren sind stabiles Übergewicht, Gewichtszunahme und Gewichtsabnahme bei Erwachsenen im Vergleich zu stabilem Normalgewicht mit einer erhöhten ambulanten Inanspruchnahme von Ärzten assoziiert. Dies gilt insbesondere bei initialer Adipositas. Die Effekte waren nur teilweise durch inzidenten Diabetes oder eine inzidente erste Krebserkrankung vermittelt. Zukünftige Studien sollten die Assoziationen zwischen Körpergewichtsentwicklung und der Inanspruchnahme von gesundheitsbezogener Versorgung nach BMI-Status sowie die zugrundeliegenden Mechanismen vertiefend analysieren

Selective entrainment of gamma subbands by different slow network oscillations

Theta oscillations (4–12 Hz) are thought to provide a common temporal reference for the exchange of information among distant brain networks. On the other hand, faster gamma-frequency oscillations (30–160 Hz) nested within theta cycles are believed to underlie local information processing. Whether oscillatory coupling between global and local oscillations, as showcased by theta-gamma coupling, is a general coding mechanism remains unknown. Here, we investigated two different patterns of oscillatory network activity, theta and respiration-induced network rhythms, in four brain regions of freely moving mice: olfactory bulb (OB), prelimbic cortex (PLC), parietal cortex (PAC), and dorsal hippocampus [cornu ammonis 1 (CA1)]. We report differential state- and region-specific coupling between the slow large-scale rhythms and superimposed fast oscillations. During awake immobility, all four regions displayed a respiration-entrained rhythm (RR) with decreasing power from OB to CA1, which coupled exclusively to the 80- to 120-Hz gamma subband (γ2). During exploration, when theta activity was prevailing, OB and PLC still showed exclusive coupling of RR with γ2 and no thetagamma coupling, whereas PAC and CA1 switched to selective coupling of theta with 40- to 80-Hz (γ1) and 120- to 160-Hz (γ3) gamma subbands. Our data illustrate a strong, specific interaction between neuronal activity patterns and respiration. Moreover, our results suggest that the coupling between slow and fast oscillations is a general brain mechanism not limited to the theta rhythm

Hippocampal Respiration-Driven Rhythm Distinct from Theta Oscillations in Awake Mice

So. [South] Pacific - Bora BoraVolume 22, Page 6Colo

A family of hyperpolarization-activated channels selective for.

Proton (H + ) channels are special: They select protons against other ions that are up to a millionfold more abundant. Only a few pro- ton channels have been identified so far. Here, we identify a fam- ily of voltage -gated ?pacemaker ? channels, HCNL1, that are exquisitely selective for protons. HCNL1 activates during hyperpo- larization and conducts protons into the cytosol. Surprisingly, pro- tons permeate through the channel ?s voltage -sensing domain, whereas the pore domain is nonfunctional. Key to proton perme- ation is a methionine residue that interrupts the series of regularly spaced arginine residues in the S4 voltage sensor. HCNL1 forms a tetramer and thus contains four proton pores. Unlike classic HCN channels, HCNL1 is not gated by cyclic nucleotides. The channel is present in zebrafish sperm and carries a proton inward current that acidifies the cytosol. Our results suggest that protons rather than cyclic nucleotides serve as cellular messengers in zebrafish sperm. Through small modifications in two key functional do- mains, HCNL1 evolutionarily adapted to a low-Na + freshwater en- vironment to conserve sperm ?s ability to depolarize