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  • 1
    Keywords: COMBINATION ; Germany ; THERAPY ; PATIENT ; treatment ; TRIAL ; HEALTH ; smoking ; EFFICACY ; RATES ; EXCHANGE ; STRATEGIES ; sensitivity ; 1 ; RANDOMIZED-TRIAL ; PROGRAM ; THERAPIES ; LEVEL ; methods ; REPLACEMENT THERAPY ; smoking cessation ; REPLACEMENT ; COSTS ; CESSATION ; QUIT ; outcome ; GENERAL-PRACTITIONERS ; INTERVENTIONS ; BUPROPION ; REIMBURSEMENT ; 3 ; STRATEGY ; A ; EFFECTIVENESS ACCEPTABILITY CURVES ; NORTRIPTYLINE ; AS ; smoking cessation treatment
    Abstract: Background: Evidence from cost-effective smoking cessation programs is scarce. This study determined the cost-effectiveness of 3 smoking cessation strategies as provided by general practitioners (GPs) in Germany. Methods: In a cluster-randomized smoking cessation trial, rates and intervention costs for 577 smoking patients of 82 GPs were followed up for 12 months. Three smoking cessation treatments were tested: (1) GP training plus GP remuneration for each abstinent patient, (2) GP training plus cost-free nicotine replacement medication and/or bupropion hydrochloride for the patient, and (3) a combination of both strategies. Smoking abstinence at 12 months was the primary outcome used to calculate incremental cost-effectiveness ratios and net monetary benefits. Results: Intervention 1 was not effective compared with treatment as usual (TAU). Interventions 2 and 3 each proved to be cost-effective compared separately with TAU. When applying a 95 percent level of certainty of cost-effectiveness against TAU, (sic)9.80 or (sic)6.96, respectively, had to be paid for each additional 1 percent of patients abstinent at 12 months (maximum willingness to pay). That means that in intervention 2, (sic)92.12 per patient in the program must be invested to gain 1 additional quitter (as opposed to (sic)39.10 paid per patient during the trial). In intervention 2, the cost was (sic)82.82, as opposed to (sic)50.04. Neither of these 2 cost-effective treatments proved to be superior to the other. The cost-effectiveness of both treatments was stable against TAU in sensitivity analyses. (The exchange rate from October 1, 2003, was used; (sic)1 = Dollar 1.17.) Conclusions: Both treatments have a high potential to reduce smoking-related morbidity at a low cost. It is highly recommended that they be implemented as a routine service offered by GPs because in many countries, health insurance plans currently do not fund nicotine replacement therapy
    Type of Publication: Journal article published
    PubMed ID: 19204212
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  • 2
    Keywords: CANCER ; RISK-FACTORS ; WOMEN ; CIGARETTE-SMOKING ; CORONARY-HEART-DISEASE ; NURSES HEALTH ; CESSATION ; ELDERLY COHORT ; BRITISH DOCTORS ; CHINESE COHORT
    Abstract: BACKGROUND Smoking is an established risk factor of premature death. However, most pertinent studies primarily relied on middle-aged adults. We performed a systematic review and meta-analysis of the empirical evidence on the association of smoking with all-cause mortality in people 60 years and older. METHODS A systematic literature search was conducted in multiple databases including MEDLINE, EMBASE, and ISI Web of Knowledge and complemented by cross-referencing to identify cohort studies published before July 2011. Core items of identified studies were independently extracted by 2 reviewers, and results were summarized by standard methods of meta-analysis. RESULTS We identified 17 studies from 7 countries. Current smoking was associated with increased all-cause mortality in all studies. Relative mortality (RM) compared with never smokers ranged from 1.2 to 3.4 across studies and was 1.83 (95% CI, 1.65-2.03) in the meta-analysis. A decrease of RM of current smokers with increasing age was observed, but mortality remained increased up to the highest ages. Furthermore, a dose-response relationship of the amount of smoked cigarettes and premature death was observed. Former smokers likewise had an increased mortality (meta-analysis: RM, 1.34; 95% CI, 1.28-1.40), but excess mortality compared with never smokers clearly decreased with duration of cessation. Benefits of smoking cessation were evident in all age groups, including subjects 80 years and older. CONCLUSIONS Smoking remains a strong risk factor for premature mortality also at older age. Smoking cessation is beneficial at any age.
    Type of Publication: Journal article published
    PubMed ID: 22688992
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  • 3
    Keywords: RECEPTOR ; tumor ; FACTOR RECEPTOR ; Germany ; SYSTEM ; DISEASES ; PATIENT ; TUMOR-NECROSIS-FACTOR ; mechanisms ; ASSOCIATION ; polymorphism ; ALPHA ; cytokines ; ASSAY ; PLASMA ; AGE ; OBESITY ; NECROSIS-FACTOR-ALPHA ; INVOLVEMENT ; CEREBROSPINAL-FLUID ; BODY ; RECEPTORS ; TNF-ALPHA ; FACTOR-ALPHA ; MASS INDEX ; CYTOKINE ; WEIGHT ; IMMUNE-SYSTEM ; LEVEL ; ASSAYS ; PLASMA-LEVELS ; BMI ; NECROSIS ; SLEEP ; LEPTIN LEVELS
    Abstract: Background: Narcolepsy is a disabling sleep disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis. Recent studies suggest that the immune system might play a pathogenic role pointing to a possible involvement of inflammatory cytokines. Methods: We investigated a sample of 30 patients with narcolepsy in comparison with 120 sex- and age-matched and 101 sex-, body mass index (BMI)-, and age-matched randomly selected normal controls. In these groups, plasma concentrations of tumor necrosis factor alpha(TNF-alpha) and its soluble receptors p55 and p75 ( soluble TNF receptor [sTNF-R] p55 and sTNF-R p75) were measured using commercial enzyme-linked immunosorbent assays. Results: The narcoleptic patients showed a significantly higher BMI compared with controls of the same age. Soluble TNF-R p75 levels were consistently elevated in the narcoleptic patients compared with their sex- and age-matched (P = .001) as well as sex-, BMI-, and age-matched counterparts (P =. 003). Female narcoleptic patients exhibited higher sTNF-R p55 levels compared with their sex- and age-matched controls (P =. 01), but this difference disappeared when comparing patients with sex-, BMI-, and age-matched normal controls. Tumor necrosis factor alpha levels did not differ significantly between groups. Conclusion: Narcoleptic patients show increased plasma levels of sTNF-R p75, suggesting a functional alteration of the TNF-alpha cytokine system, further corroborating a possible pathogenic role of the immune system in this sleep disorder
    Type of Publication: Journal article published
    PubMed ID: 16983052
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  • 4
    Keywords: CANCER ; SURVIVAL ; tumor ; Germany ; human ; THERAPY ; DISEASE ; EPIDEMIOLOGY ; POPULATION ; PATIENT ; prognosis ; LYMPHOMA ; NUMBER ; AGE ; SURVEILLANCE ; UNITED-STATES ; OUTCOMES ; TRENDS ; STATES ; ADULT ; ADULTS ; RE ; THERAPIES ; ELDERLY-PATIENTS ; PERIOD ANALYSIS ; rituximab ; non-Hodgkin lymphoma ; LEVEL ; analysis ; methods ; technique ; USA ; EMPIRICAL-EVALUATION ; MEDICINE ; UP-TO-DATE ; LOW-GRADE ; non Hodgkin lymphoma ; neoplasm ; ARCH ; ACTIVE ANTIRETROVIRAL THERAPY ; CHOP CHEMOTHERAPY
    Abstract: Background: Non-Hodgkin lymphoma (NHL) is the most common hematologic malignant neoplasm in adults. We use the novel technique of period analysis to disclose the most recent trends in survival among adults diagnosed as having NHL on the population level with minimum delay. Methods: We estimated trends in 5-and 10-year relative survival in patients 15 years or older diagnosed as having NHL in the United States between 1990 and 2004 using data from the Surveillance, Epidemiology, and End Results (SEER) program. We also estimated survival by age, location and histologic type of the tumor, sex, and race to further elucidate trends in survival in this disease. Results: Overall, 5-year relative survival increased from 50.4% to 66.8%, and 10-year relative survival increased from 39.4% to 56.3% between 1990-1992 and 2002-2004. Improvements were most pronounced in patients younger than 45 years (+ 26.8 and + 27.1 percentage points for 5- and 10-year survival, respectively), but improvements were seen in all age groups, in both sexes, in both nodal and extranodal disease, and in both lowgrade and high-grade disease. Improvements in prognosis were less in black patients than in white patients, especially in younger black patients. Conclusions: Our period analysis discloses a strongly improved outlook for patients diagnosed as having NHL in recent years. Changes in treatment of the disease and a decrease in the number of human immunodeficiency virus-related NHL cases attributable to highly active antiretroviral therapy are probably primarily responsible for these improvements
    Type of Publication: Journal article published
    PubMed ID: 18332290
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  • 5
    Keywords: exercise ; GLYCEMIC CONTROL ; MISSING DATA ; METAANALYSIS ; OLDER-ADULTS ; MULTIPLE IMPUTATION ; CARDIOVASCULAR-DISEASE MORTALITY ; ALL-CAUSE ; CLINICAL-RESEARCH ; WALKING DECREASED RISK
    Abstract: BACKGROUND Physical activity (PA) is considered a cornerstone of diabetes mellitus management to prevent complications, but conclusive evidence is lacking. METHODS This prospective cohort study and meta-analysis of existing studies investigated the association between PA and mortality in individuals with diabetes. In the EPIC study (European Prospective Investigation Into Cancer and Nutrition), a cohort was defined of 5859 individuals with diabetes at baseline. Associations of leisure-time and total PA and walking with cardiovascular disease (CVD) and total mortality were studied using multivariable Cox proportional hazards regression models. Fixed- and random-effects meta-analyses of prospective studies published up to December 2010 were pooled with inverse variance weighting. RESULTS In the prospective analysis, total PA was associated with lower risk of CVD and total mortality. Compared with physically inactive persons, the lowest mortality risk was observed in moderately active persons: hazard ratios were 0.62 (95% CI, 0.49-0.78) for total mortality and 0.51 (95% CI, 0.32-0.81) for CVD mortality. Leisure-time PA was associated with lower total mortality risk, and walking was associated with lower CVD mortality risk. In the meta-analysis, the pooled random-effects hazard ratio from 5 studies for high vs low total PA and all-cause mortality was 0.60 (95% CI, 0.49-0.73). CONCLUSIONS Higher levels of PA were associated with lower mortality risk in individuals with diabetes. Even those undertaking moderate amounts of activity were at appreciably lower risk for early death compared with inactive persons. These findings provide empirical evidence supporting the widely shared view that persons with diabetes should engage in regular PA.
    Type of Publication: Journal article published
    PubMed ID: 22868663
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