Evaluation of a very brief pedometer-based physical activity intervention delivered in NHS Health Checks in England: The VBI randomised controlled trial.

BACKGROUND: The majority of people do not achieve recommended levels of physical activity. There is a need for effective, scalable interventions to promote activity. Self-monitoring by pedometer is a potentially suitable strategy. We assessed the effectiveness and cost-effectiveness of a very brief (5-minute) pedometer-based intervention ('Step It Up') delivered as part of National Health Service (NHS) Health Checks in primary care. METHODS AND FINDINGS: The Very Brief Intervention (VBI) Trial was a two parallel-group, randomised controlled trial (RCT) with 3-month follow-up, conducted in 23 primary care practices in the East of England. Participants were 1,007 healthy adults aged 40 to 74 years eligible for an NHS Health Check. They were randomly allocated (1:1) using a web-based tool between October 1, 2014, and December 31, 2015, to either intervention (505) or control group (502), stratified by primary care practice. Participants were aware of study group allocation. Control participants received the NHS Health Check only. Intervention participants additionally received Step It Up: a 5-minute face-to-face discussion, written materials, pedometer, and step chart. The primary outcome was accelerometer-based physical activity volume at 3-month follow-up adjusted for sex, 5-year age group, and general practice. Secondary outcomes included time spent in different intensities of physical activity, self-reported physical activity, and economic measures. We conducted an in-depth fidelity assessment on a subsample of Health Check consultations. Participants' mean age was 56 years, two-thirds were female, they were predominantly white, and two-thirds were in paid employment. The primary outcome was available in 859 (85.3%) participants. There was no significant between-group difference in activity volume at 3 months (adjusted intervention effect 8.8 counts per minute [cpm]; 95% CI -18.7 to 36.3; p = 0.53). We found no significant between-group differences in the secondary outcomes of step counts per day, time spent in moderate or vigorous activity, time spent in vigorous activity, and time spent in moderate-intensity activity (accelerometer-derived variables); as well as in total physical activity, home-based activity, work-based activity, leisure-based activity, commuting physical activity, and screen or TV time (self-reported physical activity variables). Of the 505 intervention participants, 491 (97%) received the Step it Up intervention. Analysis of 37 intervention consultations showed that 60% of Step it Up components were delivered faithfully. The intervention cost £18.04 per participant. Incremental cost to the NHS per 1,000-step increase per day was £96 and to society was £239. Adverse events were reported by 5 intervention participants (of which 2 were serious) and 5 control participants (of which 2 were serious). The study's limitations include a participation rate of 16% and low return of audiotapes by practices for fidelity assessment. CONCLUSIONS: In this large well-conducted trial, we found no evidence of effect of a plausible very brief pedometer intervention embedded in NHS Health Checks on objectively measured activity at 3-month follow-up. TRIAL REGISTRATION: Current Controlled Trials (ISRCTN72691150).

[Trends in the pharmaceutical profile of intentional drug overdoses seen in the emergency room]. / Evolution des médicaments utilisés dans les intoxications médicamenteuses volontaires examinées aux urgences.

OBJECTIVES: The aim of the study was to investigate trends in substances used for acute self-administered drug overdoses (SADO). METHOD: Review of all SADO emergency room visits over two 1-year periods during 1992-1993 (P1) and 2001-2002 (P2). RESULTS: We compared 804 SADO episodes in P1 with 830 in P2. Patient characteristics did not differ significantly during the two periods (predominance of women: 66 vs 69%; mean age: 33 +/- 12 vs 37 +/- 13.5 years). Psychotropic drugs predominated in both periods (78 and 77%), but the prevalence of benzodiazepines declined (67 to 55%; p < 0.01) and that of antidepressants increased (9.5 to 15%; p < 0.01). Bromazepam was the ben-zodiazepine used most often during both periods (P1: 30% and P2: 35%), but the use of aprazolam increased (from 6 to 17%; p < 0.01). Among the antidepressants, the use of tricyclics decreased (from 43 to 14%; p < 0.01) and that of selective serotonin reuptake inhibitors increased (31 to 71%; p < 0.01). The proportion of benzodiazepine-related drugs increased over time (8.1 to 14%: p < 0.01). The other therapeutic classes remained quite similar to each other between P1 and P2, except for anti-inflammatories (P1: 1.3%, P2: 2.7%; p = 0.01). Among the analgesics, paracetamol alone or combined with other agents predominated (68 and 64% respectively), but use of opiate analgesics was fre-quent during the later period (2.7 vs 22%; p < 0.01). CONCLUSION: The trend of the different pharmacological families used in SADO seen in the emergency room has not fundamentally changed over the past decade. However, qualitative changes within the drug classes require emergency physicians to update their knowledge of toxicology.

Change in profile of acute self drug-poisonings over a 10-year period.

All acute, deliberate, drug-poisoning-related emergency department visits over two periods of one year, 1992-1993 (P1) and 2001-2002 (P2), were reviewed to investigate trends in substances used for acute self drug-poisonings over a 10-year period. For P1 and P2 respectively, 804 and 830 episodes of acute self drug-poisonings were compared. For the two studied periods, psycholeptic drugs predominated (78 and 77%); however, benzodiazepines declined (67 to 55%; P <0.01) and antidepressants increased (9.5 to 15%; P <0.01). Moreover, the type of antidepressant changed markedly with a decrease of the imipraminic antidepressants (48.4 to 10.7%) and an increase of selective serotonin reuptake inhibitors (31.2 to 74%). The proportion of benzodiazepine-related drugs increased with time (7.9 to 14.1%). The proportion of analgesics was 5.4% for P1 and 7.3% for P2; paracetamol, alone or associated to other compounds, remained the most incriminated. Nevertheless, opioids were more often mentioned during the later period (11.6 to 24.5%). The trend of the different pharmacological families used in acute self drug-poisonings is not fundamentally different over a 10-year period. However, there are some qualitative modifications, which are important for readjusting the emergency physician's toxicological knowledge and public health actions.