RESUMEN
BACKGROUND: There is evidence for e-Health interventions for full-blown depression. Little is known regarding commonly untreated subthreshold depression in primary care. This randomized controlled multi-centre trial assessed reach and two-year-effects of a proactive e-Health intervention (ActiLife) for patients with subthreshold depression. METHODS: Primary care and hospital patients were screened for subthreshold depression. Over 6 months, ActiLife participants received three individualized feedback letters and weekly messages promoting self-help strategies against depression, e.g., dealing with unhelpful thoughts or behavioural activation. The primary outcome depressive symptom severity (Patient Health Questionnaire;PHQ-8) and secondary outcomes were assessed 6, 12 and 24 months. RESULTS: Of those invited, n = 618(49.2 %) agreed to participate. Of them, 456 completed the baseline interview and were randomized to ActiLife (n = 227) or assessment only (n = 226). Generalised estimation equation analyses adjusting for site, setting and baseline depression revealed that depressive symptom severity declined over time, with no significant group differences at 6 (mean difference = 0.47 points; d = 0.12) and 24 months (mean difference = -0.05 points; d = -0.01). Potential adverse effects were observed at 12 months, with higher depressive symptom severity for ActiLife than control participants (mean difference = 1.33 points; d = 0.35). No significant differences in rates of reliable deterioration or reliable improvement of depressive symptoms were observed. ActiLife increased applied self-help strategies at 6 (mean difference = 0.32; d = 0.27) and 24 months (mean difference = 0.22; d = 0.19), but not at 12 months (mean difference = 0.18; d = 0.15). LIMITATIONS: Self-report measures and lack of information on patients' mental health treatment. DISCUSSION: ActiLife yielded satisfactory reach and increased the use of self-help strategies. Data were inconclusive in terms of depressive symptom changes.
RESUMEN
When a behavior is monitored, it is likely to change, even if no change may be intended. This phenomenon is known as measurement reactivity. We investigated systematic changes in accelerometer-based measures over the days of monitoring as an indicator of measurement reactivity in an adult population. One hundred seventy-one participants from the general population (65% women; mean age = 55 years, range: 42-65 years) wore accelerometers for 7 consecutive days to measure sedentary behavior and physical activity (PA). Latent growth models were used (a) to investigate changes in accelerometer wear time over the measurement days and (b) to identify measurement reactivity indicated by systematic changes in sedentary time (ST), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Over the measurement days, participants reduced accelerometer wear time by trend (rate of change [b] = -4.7 min/d, P = .051, Cohen's d = .38), increased ST (b = 2.4 min/d, P = .018, d = .39), and reduced LPA (b = -2.4 min/d, P = .015, d = .38). Participants did not significantly reduce MVPA (P = .537). Our data indicated that accelerometry might generate reactivity. Small effects on ST and LPA were found. Thus, the validity of accelerometer-based data on ST and LPA may be compromised. Systematic changes observed in accelerometer wear time may further bias accelerometer-based measures. MVPA seems to be less altered due to the presence of an accelerometer.
Asunto(s)
Acelerometría/normas , Ejercicio Físico , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Conducta SedentariaRESUMEN
Results of brief smoking counseling program implemented in pregnancy counseling centers are presented. Counseling was provided in 28 of 39 pregnancy counseling centers. A total of 693 out of 719 pregnant women invited to participate in the program during the study period of 6 months agreed to participate. Among the participants, 30.5% were smokers. Proactive approaches can reach a high proportion of the target population.
Asunto(s)
Consejo Dirigido/estadística & datos numéricos , Promoción de la Salud/estadística & datos numéricos , Educación del Paciente como Asunto/estadística & datos numéricos , Embarazo/estadística & datos numéricos , Prevención del Hábito de Fumar/estadística & datos numéricos , Fumar Tabaco/prevención & control , Adolescente , Adulto , Femenino , Alemania , Humanos , Persona de Mediana Edad , Mujeres Embarazadas , Evaluación de Programas y Proyectos de Salud , Resultado del Tratamiento , Adulto JovenRESUMEN
Aim: There is limited knowledge about the reaching of socioeconomic disadvantaged groups for prevention measures. Results of proactive contacting are presented for a 2-step cardiopreventive health examination programme (CHP) in 2 job centres in Northern Germany. Methods: The duration of the programme extended over a period of 10 weeks. All clients aged between 40 and 65 years were included. Phase 1consisted of a self-administered computer-based assessment, and if medical staff were present, blood pressure measurement and/or blood samples were taken. Participants without a history of cardiovascular diseases, interventional/surgical blood vessel procedures, diabetes and a body-mass-index ≤35 kg/m2 were invited to a specialised examination centre (phase 2). Logistic regression analysis was used to test predictors for participation in both phases. Variables were age, gender and for phase 2 the distance between participants' residence addresses and the address of the examination centre, cardiovascular risk factors, subjective health and socio-demographics. Results: 344 of the 1 049 invited job centre clients participated in the assessment. Women were more likely to participate than men. A number of 253 participants were invited for blood pressure measurement and blood sample taking. Participation of 209 persons was positively associated with age. A number of 138 participated in phase 2. Participation decreased with increasing distance between the participant's residence address and the address of the examination centre. Smokers, persons with less than 10 years of schooling and those who did not report an elevated level of blood lipids were less likely to participate. Conclusion: Blood pressure measurements and taking of blood samples in job centres were found to be highly accepted. The burden on potential participants to reach preventive measures should be minimised.
Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Solicitud de Empleo , Tamizaje Masivo , Selección de Paciente , Poblaciones Vulnerables , Adulto , Conducta Cooperativa , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores SexualesRESUMEN
AIM: The aim of this study was to test the feasibility of a web-based programme provided by paediatric practices for counselling parents to reduce second-hand smoke exposure of their children. METHODS: Accompanying persons of children were systematically screened concerning tobacco smoking at their home in 2 Swiss paediatric practices. They were invited for programme participation if they or their partners smoked at home regularly. The web-based programme provided at least 1 computer-tailored counselling letter. Upto 3 additional counselling letters could be requested online by the participants over a period of 3 months. The letters were tailored according to the indoor smoking behaviour of the parents and considered individual barriers and resources for the establishment of a smoke-free home. Additionally, further information and advice could be requested on the programme website. Feasibility indicators were the participation rate, programme use, and programme evaluation by the participants. RESULTS: 3 055 (82.3%) of 3 712 accompanying persons of children in the paediatric practices were screened concerning tobacco smoking at their home. 96 (56.8%) of 169 eligible persons participated in the programme. 68 (70.8%) of the 96 programme participants could be reassessed at post assessment. 9 (15.0%) of 60 participants who provided a valid e-mail address requested more than one counselling letter. The counselling letters and the web-based programme were evaluated positively by the programme participants. CONCLUSION: Systematic screening combined with the provision of individually tailored counselling letters for parents to reduce second-hand smoke exposure of their children was feasible in paediatric practices. Possible strategies to in-crease the use and reach of the programme are -discussed.
Asunto(s)
Consejo Dirigido/estadística & datos numéricos , Exposición por Inhalación/prevención & control , Exposición por Inhalación/estadística & datos numéricos , Pediatría/estadística & datos numéricos , Contaminación por Humo de Tabaco/prevención & control , Contaminación por Humo de Tabaco/estadística & datos numéricos , Adulto , Niño , Salud Infantil , Preescolar , Consejo Dirigido/organización & administración , Estudios de Factibilidad , Femenino , Alemania , Promoción de la Salud/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Padres , Embarazo , Fumar , Suiza/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: The aim of this study is to test the acceptance and efficacy of an individualised text messaging (SMS)-based intervention to support smoking cessation in apprentices of vocational schools. METHODS: The SMS program MyWay, which generated individualised text messages to support smoking cessation based on an online assessment and a weekly SMS assessment, was developed. The text messages were based on the Transtheoretical Model of Behavior Change and sent to the programme participants over a period of 3 months. The programme was tested in 62 school classes at 6 vocational schools in Bremen, Germany, where 1 086 apprentices participated in an online assessment addressing demographic and smoking related variables. RESULTS: A total of 415 persons (38%) fulfilled the inclusion criteria "daily cigarette smoking", "ownership of a cell phone" and "regular use of text messaging". Of these, 210 persons (51%) participated in the programme. A 6-month follow-up telephone interview for the evaluation of the SMS programme and the assessment of smoking-related variables could be conducted in 125 (60%) of the 210 programme participants. Compared to the baseline assessment, the smoking prevalence (7-day-point prevalence abstinence, 11%) and the intention to stop smoking (p<0.01) were higher at the 6-month follow-up. Furthermore, cigarette craving was lower at 6-month follow-up among persons who still smoked at this point in time (p<0.01). CONCLUSIONS: In comparison to other smoking cessation services, this intervention approach allows us to reach a substantial part of smokers in vocational schools. The text messaging programme is promising for the support of smoking cessation in young adults.
Asunto(s)
Servicios de Salud Escolar/estadística & datos numéricos , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/estadística & datos numéricos , Prevención del Hábito de Fumar , Fumar/epidemiología , Envío de Mensajes de Texto/estadística & datos numéricos , Educación Vocacional/estadística & datos numéricos , Adolescente , Adulto , Femenino , Alemania/epidemiología , Humanos , Estudios Longitudinales , Masculino , Prevalencia , Estudiantes/estadística & datos numéricos , Resultado del Tratamiento , Adulto JovenRESUMEN
Little is known about tobacco smoking and health risk drinking among apprentices at vocational schools. The aim of this study was to determine the proportions of subjects who smoke or drink alcohol in a risky way, their preparedness to stop smoking, and the proportions of smokers and risk drinkers according to occupational groups and general school education. The methods included a survey of all apprentices in their first year of vocational training and all trainees in a course of preparation for occupation in a north-eastern region of Germany. All vocational schools of the study region participated. At the time of the survey, 77.9% of the apprentices were present. Among them, 99.8% (N=1 124) filled in questionnaires. The data revealed that among the total sample 61.2% were daily or less than daily current smokers. Among adults, 8.2%, among those at age 17 or younger 12.9% had a mean daily consumption of more than 12 grams (females) or more than 24 grams (males) of pure alcohol. These proportions were 12.6-18.0% among apprentices of blue collar occupations and 2.8-6.5% among apprentices of white collar or health occupations. Among subjects who had left school without graduation, 85.0%, and among those with the highest school education 36.9% were current smokers. It is concluded that vocational schools are a suitable and essential setting to reach a high risk population concerning tobacco smoking or unhealthy alcohol consumption.
Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Fumar/epidemiología , Estudiantes/estadística & datos numéricos , Adolescente , Adulto , Comorbilidad , Escolaridad , Femenino , Alemania/epidemiología , Humanos , Masculino , Prevalencia , Factores de Riesgo , Adulto JovenRESUMEN
AIM: There is limited research about the acceptance of population-based prevention activities, offered systematically and directly at home. Screening data about smoking behaviour in families with children younger than 3 years were used. We examined associations between family variables (education, employment, number of children in the household), the "proportion of persons on social welfare" (PPSW) in the population aged 15-65 years and the following dependent variables: participation rate in a systematic screening, proportion of smokers within the sample of screened families and participation rate in counselling. METHODS: For postal and personal contacts reporting data of children aged < 3 years, resident in Stralsund (due date 01.06.2008, N=1 298) were used. A total number of 827 families participated in the screening. The counselling was offered if at least 1 adult had smoked at least 1 cigarette per day in the last 4 weeks. Associations between family variables, PPSW and dependent variables were analysed using multilevel statistics. RESULTS: The higher the PPSP the lower is the probability for participation in the screening (odds ratio=0.982; 95% confidence interval=0.970-0.996). There was at least one adult smoker in 425 (51.4%) of these 827 families participating in the screening. The counselling was offered in 425 families, whereby 65.9% (280) participated. There was no association between family variables, PPSW and participation in the counselling. CONCLUSION: Differences in participation in the screening procedure are low: a high proportion of families in districts with a high PPSW took part. Even in districts with a PPSW rate of more than 30%, 71.3% of the families were successfully contacted. There is the recommendation to offer prevention measures in social< deprived city areas in a more proactive way considering the association between the prevalence of smoking in families and the proportion of PPSW.
Asunto(s)
Empleo/estadística & datos numéricos , Promoción de la Salud , Instituciones Residenciales/estadística & datos numéricos , Prevención del Hábito de Fumar , Fumar/epidemiología , Bienestar Social/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Escolaridad , Composición Familiar , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Medición de Riesgo , Distribución por Sexo , Factores Socioeconómicos , Adulto JovenRESUMEN
BACKGROUND: To strengthen the position of physicians regarding problematic use and dependence of prescripted drugs a manual was issued by the German Medical Association in 2007.â A study among participants in a training to qualify in "primary addiction treatment" was conducted. The utilisation of the manual, its relevance for routine care and self-estimated changes in drug prescription were examined. METHODS: All 542 participants in training courses between 1.9.2008 and 31.12.2009 were asked about participation in a survey 12 weeks later. A number of 267 took part in this investigation. RESULTS: A proportion of 60,7â% among GPs that received the manual dealt with them beyond the training course. From 178 physicians, who confirmed the provision of drug prescription, a number of 56 stated changes in their drug prescription. A higher probabilty for changes in drug prescription was given in case of a high percentage of new informations that could be culled from the manual. CONCLUSION: The interest for the manual beyond the training course and the amount of self-estimated changes in drug prescription should encourage to use this within training measures in a systematic way.
Asunto(s)
Manuales como Asunto , Medicamentos bajo Prescripción , Psicotrópicos , Trastornos Relacionados con Sustancias/rehabilitación , Adulto , Actitud del Personal de Salud , Estudios Transversales , Curriculum , Educación Médica Continua , Femenino , Medicina General/educación , Alemania , Humanos , Entrevistas como Asunto , Masculino , Medicina , Persona de Mediana Edad , Pautas de la Práctica en Medicina , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/prevención & controlRESUMEN
BACKGROUND: The effectiveness of brief interventions on smoking cessation together with regular visits to the general practitioners (GP) has been proven. Nevertheless, the guidelines for smoking cessation are not currently implemented sufficiently. A lack of financial resources, time, and consulting abilities prevent GPs from offering systematic advice on smoking cessation. This study examine 1) to what extent GPs ask their patients to provide information about their smoking habits and to what extent they document this, 2) how willing, and 3) how confident GPs are to offer all smoking patient counselling, and 4) which factors influence their level of confidence. METHODS: From August 2005 until May 2006, a questionnaire was sent to all 1 247 GPs in Brandenburg. In all 68 practices was excluded for several reasons (closed practice, death, not providing primary care) a total of 54.0% (n=637) of the GPs took part. RESULTS: 30.0% of the GPs documented the smoking status of their patients during the first consultation. 12.9% had already offered advice to all their smoking patients, while 27.6% were not willing to offer advice to all smoking patients. The average confidence of GPs to offer all smoking patients advice on smoking cessation was 4.1 (SD=2.6) on scale of 1 to 10 (1=not at all confident and 10=very confident). The confidence of non-smoking GPs to offer an advice was higher in comparison with smoking GPs. CONSEQUENCES: To motivate GPs to offer advice on smoking cessation, it seems necessary to change some conditions. This includes programms, initiated by professional medical associations, to help colleagues stop smoking. Further studies should indicate whether the inclusion of practice colleagues in screening and regular updates of the patient's smoking status increase the number of regular counselling.
Asunto(s)
Rol del Médico , Cese del Hábito de Fumar , Actitud del Personal de Salud , Competencia Clínica , Documentación , Medicina Familiar y Comunitaria , Femenino , Alemania , Investigación sobre Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Guías de Práctica Clínica como Asunto , AutoeficaciaRESUMEN
AIM: So far, the chances for tobacco prevention are not currently implemented sufficiently in general practices. The involvement of practice nurses (PN) could contribute to reach more patients. This study investigated the characteristics of PN which could be relevant for the implementation of counselling offers. METHODS: A total of 216 general practices was randomly selected from all general practitioners registered for primary care in a defined region in West Pomerania. The participation rate was 69% (n=151). A total of 209 PN participated in a training and 94.3% filled in the questionnaire. RESULTS: The data indicated a smoking prevalence rate of 30.3% among PN. Their motivation, to offer counselling measures in general practices was higher on average than the confidence to realise such interventions. There was no association between characteristics of PN such as age, number of work years in the practice, hours worked per week or smoking status and motivation or confidence measures. CONCLUSION: There is a need for proactive interventions to decrease the smoking prevalence among PN. Furthermore, it should be examined which skills and knowledge are essential for PN nurses to manage new tasks with a high level of confidence.
Asunto(s)
Actitud del Personal de Salud , Adhesión a Directriz/estadística & datos numéricos , Promoción de la Salud/estadística & datos numéricos , Enfermeras Practicantes/estadística & datos numéricos , Cese del Hábito de Fumar/estadística & datos numéricos , Fumar/epidemiología , Adulto , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenAsunto(s)
Atención a la Salud/normas , Trastornos Relacionados con Sustancias/prevención & control , Alcoholismo/epidemiología , Alcoholismo/prevención & control , Alcoholismo/psicología , Alemania/epidemiología , Humanos , Relaciones Profesional-Paciente , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicologíaAsunto(s)
Prescripciones de Medicamentos/estadística & datos numéricos , Trastornos Relacionados con Sustancias/diagnóstico , Analgésicos/administración & dosificación , Estimulantes del Sistema Nervioso Central/administración & dosificación , Humanos , Hipnóticos y Sedantes/administración & dosificación , Relaciones Médico-Paciente , Guías de Práctica Clínica como Asunto , Trastornos Relacionados con Sustancias/terapiaRESUMEN
BACKGROUND: Smoking behavior among couples is often similar. PURPOSE: The aim of the study was to examine the relationship between the partner's smoking status and the intention to stop smoking of the index person. METHOD: Cross-sectional data of 1,044 patients in a random sample of 34 general medical practices in northeastern Germany were analyzed. RESULTS: Among smokers with a non-smoking partner (SNP), more intended to quit smoking in the next six months (37.0% vs. 31.4%), compared to smokers with a smoking partner (SSP). Also, more SNP intended to quit in the next four weeks (4.7% vs. 2.7%) compared to SSP. SNP were more active in the use of self-change strategies than SSP. CONCLUSION: The data confirm that the partner's smoking status is related to the intention to quit smoking. Interventions should address the different needs of both smokers with a smoking partner and those with a non-smoking partner.
Asunto(s)
Composición Familiar , Intención , Cese del Hábito de Fumar/psicología , Adolescente , Adulto , Anciano , Medicina Familiar y Comunitaria , Femenino , Alemania , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Motivación , Autoeficacia , Apoyo Social , Tabaquismo/psicología , Tabaquismo/rehabilitación , Adulto JovenRESUMEN
AIM: The present work aimed at evaluating the radiological mid-term results of femoral components of different materials in an identically designed total knee system. METHOD: 31 knees with zirconium femoral components and 32 standard femoral components were evaluated about 4 years following surgery using the Roentgenographic Evaluation and Scoring System of the Knee Society. RESULTS: In both groups, the implant position was correct. There was a statistically significant higher rate of radiolucent lines in zones 1 and 4 at the tibia site in the zirconium group. CONCLUSION: Our clinical results disagree with the results of biomechanical studies of the same type of prosthesis. However, there are some findings from animal studies showing that zirconium ions may inhibit the mineralisation of osteoid, which could be an explanation for the higher rate of radiolucent lines seen in the present study.
Asunto(s)
Cerámica , Prótesis de la Rodilla , Niobio , Complicaciones Posoperatorias/diagnóstico por imagen , Vitalio , Circonio , Adulto , Anciano , Análisis de Falla de Equipo , Femenino , Fémur/diagnóstico por imagen , Fémur/cirugía , Estudios de Seguimiento , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Oseointegración/fisiología , Diseño de Prótesis , RadiografíaRESUMEN
AIM: This study gives an overview about the collaboration of general practitioners (GP) with professionals in outpatient care and in addiction treatment sites. The goal of the study is to examine whether characteristics of the GP and distances to various specialised professionals have an effect on the referral of patients to GPs, primarily in the pilot study of nine "Medical practices for addiction". METHOD: A random sample of 330 general practices was drawn from the records of the association of the Compulsory Health Insurance. The participation rate was 75.8%. RESULTS: There was a high level of networking between general practitioners (GP) and professionals in outpatient care and in addiction treatment sites. The greater the distance to a "Medical practice for addiction", the lower was the chance of referral. There was no influence of distance concerning referral and other specialised outpatient professionals. CONCLUSIONS: Only part of the general population benefits from the pilot study. Aspects such as accessibility and well proven habits of the GPs concerning referral, should be considered to a greater extent for future collaboration among addiction care systems.
Asunto(s)
Técnicos Medios en Salud/estadística & datos numéricos , Atención Ambulatoria/estadística & datos numéricos , Médicos de Familia/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/rehabilitación , Alemania/epidemiología , Humanos , Trastornos Relacionados con Sustancias/diagnósticoRESUMEN
AIMS: The Alcohol Use Disorders Identification Test (AUDIT) is a common screening instrument. This study analyses if response categories of the AUDIT might be dichotomized without affecting the psychometric properties of the questionnaire. METHODS: Participants between 18 and 65 years were recruited from general practices in two northern German cities. In total, 10,803 screenings were conducted (refusal rate: 5.9%). For those who were screened positive, the Munich-Composite International Diagnostic Interview (M-CIDI) was used for identification of 12-month Alcohol Use Disorders and at-risk consumption (exceeding 20/30 g per day). Abstinent subjects and screening positives without diagnostic interview were excluded from the analysis, leaving a sample of 7,112 subjects. ROC-Curves were calculated separately for each item in order to identify an optimal cut-off value. Finally, a version of the AUDIT based on dichotomized items was compared to the original version and its short-form, the AUDIT version based on three questions dealing with consumption AUDIT-C. RESULTS: As an optimal cut-off value for items on consumption, drinking at least once a week, having more than 1-2 drinks per occasion, and drinking 6 or more drinks in one sitting at least once a month were identified. For all questions on alcohol-related problems or dependence symptoms, having 'ever occurred' differed best between subjects with and without Alcohol Use Disorders or at-risk consumption. Sensitivity and specificity of the dichotomized version of the AUDIT did not differ from the original version, and both full versions performed superior compared to the AUDIT-C. CONCLUSION: Data indicate that the AUDIT response categories may be dichotomized without affecting its validity.
Asunto(s)
Alcoholismo/epidemiología , Evaluación Preclínica de Medicamentos/métodos , Adolescente , Adulto , Anciano , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Prevalencia , Curva ROCRESUMEN
We investigated whether voluntary exercise and concurrent antidepressant treatment (tianeptine; 20 mg/kg/day; 4 weeks) exert synergistic effects on the mouse hypothalamic-pituitary-adrenocortical (HPA) axis. Animals had access to a running wheel, were treated with the antidepressant, or received both conditions combined. Control mice received no running wheel and no drug treatment. Exercise resulted in asymmetric changes in the adrenal glands. Whereas sedentary mice had larger left adrenals than right ones, this situation was abolished in exercising animals, mainly due to enlargement of the right adrenal cortex. However, antidepressant treatment alone was ineffective whereas the combination of antidepressant treatment and exercise resulted in an enlargement of both adrenal cortices. In these respective conditions, the levels of tyrosine hydroxylase (TH) mRNA expression in the left and right adrenal medullas varied greatly in parallel to the changes observed in the adrenal cortex sizes. TH mRNA expression in the locus coeruleus of exercising mice was significantly increased irrespective of concomitant tianeptine treatment. Corticotrophin-releasing factor mRNA levels in the hypothalamic paraventricular nucleus were decreased after voluntary exercise but were unaffected by tianeptine. Exercise, particularly in combination with tianeptine treatment, resulted in decreased early morning baseline plasma levels of corticosterone. If animals were exposed to novelty (i.e. a mild psychological stressor), a decreased response in plasma corticosterone levels was observed in the exercising mice. By contrast, after restraint, a mixed physical and psychological stressor, exercising mice showed an enhanced response in plasma corticosterone compared to the controls; a response which was even further boosted in exercising mice concomitantly treated with tianeptine. Under either condition, plasma adrenocorticotrophic hormone levels were not different between groups. Thus, voluntary exercise impacts substantially on HPA axis regulation. Concurrent tianeptine treatment results in synergistic actions, mainly at the adrenal level, affecting both its structure and function.
Asunto(s)
Antidepresivos Tricíclicos/farmacología , Sistema Hipotálamo-Hipofisario/efectos de los fármacos , Condicionamiento Físico Animal/fisiología , Sistema Hipófiso-Suprarrenal/efectos de los fármacos , Tiazepinas/farmacología , Corteza Suprarrenal/anatomía & histología , Corteza Suprarrenal/efectos de los fármacos , Corteza Suprarrenal/fisiología , Análisis de Varianza , Animales , Conducta de Elección , Ritmo Circadiano/efectos de los fármacos , Corticosterona/sangre , Hormona Liberadora de Corticotropina/genética , Hormona Liberadora de Corticotropina/metabolismo , Sistema Hipotálamo-Hipofisario/metabolismo , Locus Coeruleus/efectos de los fármacos , Locus Coeruleus/metabolismo , Masculino , Ratones , Ratones Endogámicos C57BL , Tamaño de los Órganos , Núcleo Hipotalámico Paraventricular/efectos de los fármacos , Núcleo Hipotalámico Paraventricular/metabolismo , Sistema Hipófiso-Suprarrenal/metabolismo , ARN Mensajero/análisis , Factores de Tiempo , Tirosina 3-Monooxigenasa/genética , Tirosina 3-Monooxigenasa/metabolismoRESUMEN
BACKGROUND: General practitioners can reach large number of smokers. Their good interpersonal relationship with patients promises successful guidance with regard to smoking. However, little is known about the accessibility of smokers to intervention in general practice and about the motivation to abandon smoking. There is a lack of information concerning the GPs' perceived responsibility for smoking counselling. The goal of the study is to examine to what extent smokers can be advised in general practice and how GPs' assess the practicability of such counselling. METHODS: The sample consisted of consecutive general practices patients. A random sample of 39 GPs was drawn and 34 took part in the study. Of 3434 patients, 99.7 % participated in the screening procedure. Inclusion criteria (age 18 to 70 years, admitted smokers), were met by 551 subjects. The participation rate was 81.4 % (n = 449). All GPs received a single training session. Counselling was tailored to the motivation to quit. More than 60 % of the patients were not motivated to stop smoking. RESULTS: Following the study design, 87.8 % of all smoking patients were counselled by GPs. A total of 79.3 % among the GPs considered the intervention to be practicable. CONCLUSIONS: Despite a low motivation to quit smoking in the general practice, 80 % of the smoking patients can be reached by interventions. Furthermore, since the agreement of the GPs concerning practicability was almost 80 %, measures should be initiated to promote counselling for all smokers within the scope of medical consultation.
Asunto(s)
Medicina Familiar y Comunitaria/métodos , Medicina Familiar y Comunitaria/estadística & datos numéricos , Promoción de la Salud/métodos , Promoción de la Salud/estadística & datos numéricos , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/estadística & datos numéricos , Adolescente , Adulto , Anciano , Consejo/métodos , Consejo/estadística & datos numéricos , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Relaciones Médico-PacienteRESUMEN
Gangliosides induce a selective and complete modulation of CD4 from the surface of T cells. CD4 down-modulation occurs by CD4 endocytosis. This process is independent of serine phosphorylation of the cytoplasmic tail of CD4 and does not require the association between the tyrosine protein kinase p56lck and the cytoplasmic tail of CD4. Ganglioside-induced CD4 endocytosis is accompanied by the loss of p56lck activity associated with CD4. Sequential immunoprecipitation analysis using an anti-CD4 antibody and an anti-p56lck antiserum showed that this is caused by the dissociation of the enzyme from the cytoplasmic tail of CD4. The kinetics of p56lck dissociation after ganglioside treatment is identical to that of CD4 endocytosis, suggesting that p56lck is displaced in the process of endosome formation. The results indicate that CD4 endocytosis alone can cause the dissociation of the p56lck complex without the requirement for CD4 phosphorylation.