Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. Abstract. Objective To determine the comparative effectiveness of exercise versus drug interventions on mortality outcomes. Design Metaepidemiological study. Eligibility criteria Meta- analyses of randomised controlled trials with mortality outcomes comparing the effectiveness of exercise and drug interventions with each other or with control (placebo or usual care). The Benefits of Physical Activity. Regular physical activity is one of the most important things you can do for your health. It can help: Control your weight. Data sources Medline and Cochrane Database of Systematic Reviews, May 2. Main outcome measure Mortality. Data synthesis We combined study level death outcomes from exercise and drug trials using random effects network meta- analysis. Results We included 1. Incorporating an additional three recent exercise trials, our review collectively included 3. Acquired immunodeficiency syndrome (AIDS) is defined in terms of either a CD4 + T cell count below 200 cells per CIRCULATION Paths to Discovery: Limitation of Infarct Size and the Open Artery Hypothesis. Research Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study BMJ 2013; 347 doi: http://dx.doi.org/10.1136. Does Diabetes Cause Hair Loss Treatment Diabetes & Alternative Diabetes Treatment 1 Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 2 Division of Diabetes Control, Centers for Disease. Across all four conditions with evidence on the effectiveness of exercise on mortality outcomes (secondary prevention of coronary heart disease, rehabilitation of stroke, treatment of heart failure, prevention of diabetes), 1. No statistically detectable differences were evident between exercise and drug interventions in the secondary prevention of coronary heart disease and prediabetes. Physical activity interventions were more effective than drug treatment among patients with stroke (odds ratios, exercise v anticoagulants 0. Diuretics were more effective than exercise in heart failure (exercise v diuretics 4. Inconsistency between direct and indirect comparisons was not significant. Conclusions Although limited in quantity, existing randomised trial evidence on exercise interventions suggests that exercise and many drug interventions are often potentially similar in terms of their mortality benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes. Introduction. Physical activity has well documented health benefits. Population level cohort studies have shown that people who exercise enjoy a higher quality of life and improved health status compared with those with sedentary behaviours, with subsequent reductions in their risk of adverse outcomes such as admissions to hospital. Randomised controlled trials have shown similarly favourable findings in arthritis,2 cancer,3. Large scale observational studies have also established a clear association between exercise and all cause mortality. Given the overwhelming evidence in support of the health benefits of exercise,1. Global Burden of Disease study has recently ranked physical inactivity as the fifth leading cause of disease burden in western Europe, and as one of the top modifiable risk factors along with smoking. Despite recent calls to encourage physical activity as a strategy to ward off the emerging burden of chronic conditions, including heart disease and diabetes,1. In the United Kingdom, only 1. England meeting recommended levels of physical activity. In contrast, utilisation rates of prescription drugs continue to rise sharply, increasing to an average of 1. England in 2. 01. Abundant evidence from randomised controlled trials shows the mortality benefits of certain drugs such as simvastatin in the secondary prevention of cardiovascular disease,1. United Kingdom. Research on the mortality benefits of exercise, however, remains primarily observational with a limited number of randomised trials in select treatment areas. More importantly, evidence on how physical activity interventions fare compared with drug interventions in reducing the risk of all cause mortality is lacking. We performed a comprehensive review of published meta- analyses on topics with randomised trial evidence on both exercise and drug interventions. For each condition, we combined the data from multiple pairwise meta- analyses in network meta- analyses to assess the geometry of the existing evidence and to determine the comparative effectiveness of drug and exercise interventions in reducing the risk of mortality. Methods. Identification of relevant evidence. We used three steps to identify the relevant body of evidence. Firstly, we searched Medline for meta- analyses of randomised controlled trials evaluating the effectiveness of exercise based interventions on mortality outcomes. Our search strategy included terms for exercise interventions (exercise OR physical activity), mortality outcomes (mortality OR death OR survival), and meta- analysis of randomised controlled trials (randomized OR meta- analysis) in the title, abstract, or keywords (latest search 1. December 2. 01. 2). Secondly, for all conditions with evidence on the effectiveness of exercise interventions on mortality outcomes, we identified meta- analyses that evaluated the impact of specific drug interventions on mortality outcomes. We identified the list of relevant drug interventions using clinical practice guidelines, developed by respective European and US clinical specialty organisations (for example, American Heart Association, European Society of Cardiology). In cases where clinical practice guidelines did not give clear guidance around indicated drug treatments, we consulted the US National Library of Medicine’s Medline Plus website (www. For each drug of interest we searched the Cochrane Database of Systematic Reviews to identify the most up to date meta- analysis. In cases where Cochrane reviews did not exist, we searched Medline using terms for drug names, mortality outcomes (mortality OR death OR survival), and meta- analysis of randomised controlled trials (randomized OR meta- analysis). Finally, we developed a separate search strategy in Medline to identify randomised head to head comparisons of exercise versus drug interventions (and their meta- analyses) for all conditions with evidence on the effectiveness of exercise interventions on mortality outcomes. The objective of this search was to capture additional recent trials of exercise versus control intervention that were not included in the meta- analyses evaluating the effectiveness of exercise based interventions on mortality outcomes. This search included terms for exercise interventions (exercise OR physical activity), mortality outcomes (mortality OR death OR survival), and Cochrane Collaboration’s sensitivity and precision maximising terms for randomised controlled trials (latest search 2. May 2. 01. 3). 2. In all three steps we selected the most recent review if more than one eligible meta- analysis was published for a given condition or disease and for each particular intervention. We considered studies embedded within meta- analyses (or single studies identified in the third step) to be eligible for inclusion if they were randomised controlled trials comparing the effectiveness of exercise and drug interventions with another or with control (placebo or usual care) on mortality outcomes. Data extraction. From each eligible trial we extracted the publication year, condition, number of participants, and number of deaths in each trial arm. In cases where mortality outcomes were reported at multiple time points, we selected the longest follow- up duration. One investigator (HN) extracted data and another (Anthony J Damico) checked for accuracy. Evaluation of the geometry of evidence. We developed network diagrams to visualise the geometry of the available evidence. In each network diagram, the size of the nodes was proportional to the number of participants receiving a given intervention (or control), and the thickness of the lines connecting the nodes was proportional to the number of randomised participants in the trials between interventions. We developed two sets of network diagrams. In the first we compared exercise to all identified classes of drugs. In the second we pooled all drug interventions into one group to show the relative size of the patient population included in the trials of exercise versus drug interventions. Statistical analysis. We first qualitatively summarised included trials, describing the types of direct and indirect comparisons. For each direct comparison between two treatments we conducted pairwise meta- analyses using the Der. Simonian- Laird (random effects) method,2. I2 measure. We used rough I2 thresholds of 2. To determine the comparative effectiveness of exercise and drug interventions, we then conducted network meta- analysis, which is a generalisation of indirect comparisons across pairwise meta- analyses. This type of analysis allows for comparing interventions in the absence of head to head trials comparing all the interventions of interest. In cases where both direct (from trials that include a specific pairwise comparison) and indirect (from a network of trials that do not include that comparison) sources of evidence exist, network meta- analysis is capable of simultaneously combining both types of evidence. This analysis preserves the within trial randomised treatment comparison of each trial while combining all available comparisons between treatments. We combined study level relative treatment effects using bayesian Markov chain Monte Carlo methods in Win. BUGS version 1. 4. We used the model developed by Dias and colleagues for the UK National Institute for Health and Care Excellence Decision Support Unit. Our models adopted random effects, taking into account potential heterogeneity by assuming that each treatment was drawn from the same distribution, the mean and variance of which were estimated from the data. We also performed fixed effect analyses under the assumption that no between study heterogeneity existed. Our model selection was based on two criteria. Firstly, we evaluated the deviance information criterion between the two sets of analyses, which favoured random effects models. Secondly, we qualitatively judged the fixed effect model assumption to be too strong given the potential differences in patient populations across drug and exercise trials. HIV/AIDS - Wikipedia, the free encyclopedia. Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV). Even cases that do get seen by a family doctor or a hospital are often misdiagnosed as one of the many common infectious diseases with overlapping symptoms. Thus, it is recommended that HIV be considered in people presenting an unexplained fever who may have risk factors for the infection. They represent approximately 1 in 3. In the United States, as of 2. The risk from sharing a needle during drug injection is between 0. In 2. 00. 7, between 1. HIV is a retrovirus that primarily infects components of the human immune system such as CD4+ T cells, macrophages and dendritic cells. It directly and indirectly destroys CD4+ T cells. Many species of mammals are infected by lentiviruses, which are characteristically responsible for long- duration illnesses with a long incubation period. Upon entry into the target cell, the viral RNAgenome is converted (reverse transcribed) into double- stranded DNA by a virally encoded reverse transcriptase that is transported along with the viral genome in the virus particle. The resulting viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host co- factors. HIV- 1 is the virus that was originally discovered (and initially referred to also as LAV or HTLV- III). It is more virulent, more infective. The lower infectivity of HIV- 2 as compared with HIV- 1 implies that fewer people exposed to HIV- 2 will be infected per exposure. Because of its relatively poor capacity for transmission, HIV- 2 is largely confined to West Africa. During primary infection, the level of HIV may reach several million virus particles per milliliter of blood. The acute viremia is almost invariably associated with activation of CD8+ T cells, which kill HIV- infected cells, and subsequently with antibody production, or seroconversion. The CD8+ T cell response is thought to be important in controlling virus levels, which peak and then decline, as the CD4+ T cell counts recover. A good CD8+ T cell response has been linked to slower disease progression and a better prognosis, though it does not eliminate the virus. This weakens the immune system and allows opportunistic infections. T cells are essential to the immune response and without them, the body cannot fight infections or kill cancerous cells. The mechanism of CD4+ T cell depletion differs in the acute and chronic phases. During the chronic phase, the consequences of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells appear to account for the slow decline in CD4+ T cell numbers. CD4+ T cells in mucosal tissues remain particularly affected. It is also linked to the breakdown of the immune surveillance system of the gastrointestinal mucosal barrier caused by the depletion of mucosal CD4+ T cells during the acute phase of disease. Since the WHO's staging system does not require laboratory tests, it is suited to the resource- restricted conditions encountered in developing countries, where it can also be used to help guide clinical management. Despite their differences, the two systems allow comparison for statistical purposes. A CD4 count of less than 5. A CD4 count of less than 2. Treatment consists of highly active antiretroviral therapy (HAART) which slows progression of the disease. The World Health Organization recommends treating all children less than 5 years of age; children above 5 are treated like adults. In addition to improving current disease, treatment with antiretrovirals reduces the risk of developing additional opportunistic infections. Some evidence has shown a benefit from micronutrient supplements. In 2. 01. 0, an estimated 6. HIV cases and 6. 6% of all deaths (1. The US Centers for Disease Control and Prevention estimated that in 2. Americans were unaware of their infection. Centers for Disease Control and Prevention (CDC) and a CDC task force was formed to monitor the outbreak. Gallo's group called their newly isolated virus HTLV- III. At the same time, Montagnier's group isolated a virus from a person presenting with swelling of the lymph nodes of the neck and physical weakness, two characteristic symptoms of AIDS. Contradicting the report from Gallo's group, Montagnier and his colleagues showed that core proteins of this virus were immunologically different from those of HTLV- I. Montagnier's group named their isolated virus lymphadenopathy- associated virus (LAV). It is thought that several transmissions of the virus from individual to individual in quick succession are necessary to allow it enough time to mutate into HIV. Genetic studies of the virus suggest that the most recent common ancestor of the HIV- 1 M group dates back to circa 1. Early 1. 90. 0s colonial cities were notable due to their high prevalence of prostitution and genital ulcers, to the degree that, as of 1. Kinshasa were thought to have been prostitutes, and, as of 1. By 1. 96. 2, Haitians made up the second largest group of well- educated experts (out of the 4. By 1. 97. 8, the prevalence of HIV- 1 among homosexual male residents of New York City and San Francisco was estimated at 5%, suggesting that several thousand individuals in the country had been infected. They will not only be unable to work, but will also require significant medical care. It is estimated that as of 2. AIDS orphans. Unemployment in people with HIV/AIDS also is associated with suicidal ideation, memory problems, and social isolation; employment increases self- esteem, sense of dignity, confidence, and quality of life. A 2. 01. 5 Cochrane review found low- quality evidence that antiretroviral treatment helps people with HIV/AIDS work more, and increases the chance that a person with HIV/AIDS will be employed. This causes a slower growth of the tax base, an effect that is reinforced if there are growing expenditures on treating the sick, training (to replace sick workers), sick pay and caring for AIDS orphans. This is especially true if the sharp increase in adult mortality shifts the responsibility and blame from the family to the government in caring for these orphans. This additional expenditure also leaves less income to spend on education and other personal or family investment. In 2. 01. 1, the BBC reported that some churches in London were claiming that prayer would cure AIDS, and the Hackney- based Centre for the Study of Sexual Health and HIV reported that several people stopped taking their medication, sometimes on the direct advice of their pastor, leading to a number of deaths. He had been diagnosed during 1. He was diagnosed as HIV positive on August 3. Further tests within 2. Ashe had AIDS, but he did not tell the public about his diagnosis until April 1. LIFE magazine said the photo became the one image . By 2. 00. 3 seven had contracted HIV, and two died from complications related to AIDS. Some countries or jurisdictions, including some areas of the United States, have laws that criminalize HIV transmission or exposure. Three of the most common are that AIDS can spread through casual contact, that sexual intercourse with a virgin will cure AIDS. In 2. 01. 4, some among the British public wrongly thought you could get HIV from kissing (1. Operation INFEKTION was a worldwide Soviet active measures operation to spread the claim that the United States had created HIV/AIDS. Surveys show that a significant number of people believed . This research includes behavioral health interventions such as sex education, and drug development, such as research into microbicides for sexually transmitted diseases, HIV vaccines, and antiretroviral drugs. Other medical research areas include the topics of pre- exposure prophylaxis, post- exposure prophylaxis, and circumcision and HIV. References^ abcd. Department of Health & Human Services. Retrieved June 1. Guide for HIV/AIDS Clinical Care. AIDS Education and Training Center Program. Retrieved November 2. World Health Organization. Retrieved June 1. Modern infectious disease epidemiology concepts, methods, mathematical models, and public health (Online- Ausg. Encyclopedia of public health. Retrieved 1. 1 February 2. Retrieved 1. 1 February 2. Rom ; associate editor, Steven B. Environmental and occupational medicine (4th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. ISBN 9. 78- 0- 7. Centers for Disease Control and Prevention. Archived from the original on February 4, 2. Retrieved May 2. 3, 2. Retrieved March 1. Retrieved 1. 1 February 2. Journal of Internal Medicine. Cold Spring Harbor perspectives in medicine. Report on the global AIDS epidemic. Retrieved June 1. Retrieved 1. 4 February 2. Retrieved 1. 4 February 2. AIDS at 3. 0: A History. Geneva: World Health Organization. ISBN 9. 78- 9. 2- 4- 1. Tarrytown, NY: Marshall Cavendish. ISBN 9. 78- 0- 7. Chapter 1. 18.^ abcdefghijklmnopq. Vogel, M; Schwarze- Zander, C; Wasmuth, JC; Spengler, U; Sauerbruch, T; Rockstroh, JK (July 2. Primary HIV/AIDS care: a practical guide for primary health care personnel in a clinical and supportive setting (Updated 4th ed.). ISBN 9. 78- 1- 7. Reeders & Philip Charles Goodman, ed. ISBN 9. 78- 3- 5. Lecture Notes: Medical Microbiology and Infection. John Wiley & Sons. ISBN 9. 78- 1- 1. Topics in HIV medicine : a publication of the International AIDS Society, USA. American family physician. Chapter 1. 69.^Mittal, R; Rath, S; Vemuganti, GK (Jul 2. Saudi Journal of Ophthalmology. Retrieved June 1. In Bradley WG, Daroff RB, Fenichel GM, Jankovic J. Bradley's Neurology in Clinical Practice: Expert Consult . Philadelphia, PA: Elsevier/Saunders. Department of Health and Human Services. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. American family physician. Current opinion in HIV and AIDS. Antibiotic Essentials 2.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. Archives
December 2016
Categories |