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The Cochrane Database of Systematic... Jan 2019General health checks are common elements of health care in some countries. They aim to detect disease and risk factors for disease with the purpose of reducing... (Meta-Analysis)
Meta-Analysis
BACKGROUND
General health checks are common elements of health care in some countries. They aim to detect disease and risk factors for disease with the purpose of reducing morbidity and mortality. Most of the commonly used individual screening tests offered in general health checks have been incompletely studied. Also, screening leads to increased use of diagnostic and therapeutic interventions, which can be harmful as well as beneficial. It is therefore important to assess whether general health checks do more good than harm. This is the first update of the review published in 2012.
OBJECTIVES
To quantify the benefits and harms of general health checks.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, two other databases and two trials registers on 31 January 2018. Two review authors independently screened titles and abstracts, assessed papers for eligibility and read reference lists. One review author used citation tracking (Web of Knowledge) and asked trial authors about additional studies.
SELECTION CRITERIA
We included randomised trials comparing health checks with no health checks in adults unselected for disease or risk factors. We did not include geriatric trials. We defined health checks as screening for more than one disease or risk factor in more than one organ system.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data and assessed the risk of bias in the trials. We contacted trial authors for additional outcomes or trial details when necessary. When possible, we analysed the results with a random-effects model meta-analysis; otherwise, we did a narrative synthesis.
MAIN RESULTS
We included 17 trials, 15 of which reported outcome data (251,891 participants). Risk of bias was generally low for our primary outcomes. Health checks have little or no effect on total mortality (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.97 to 1.03; 11 trials; 233,298 participants and 21,535 deaths; high-certainty evidence, I = 0%), or cancer mortality (RR 1.01, 95% CI 0.92 to 1.12; 8 trials; 139,290 participants and 3663 deaths; high-certainty evidence, I = 33%), and probably have little or no effect on cardiovascular mortality (RR 1.05, 95% CI 0.94 to 1.16; 9 trials; 170,227 participants and 6237 deaths; moderate-certainty evidence; I = 65%). Health checks have little or no effect on fatal and non-fatal ischaemic heart disease (RR 0.98, 95% CI 0.94 to 1.03; 4 trials; 164,881 persons, 10,325 events; high-certainty evidence; I = 11%), and probably have little or no effect on fatal and non-fatal stroke (RR 1.05 95% CI 0.95 to 1.17; 3 trials; 107,421 persons, 4543 events; moderate-certainty evidence, I = 53%).
AUTHORS' CONCLUSIONS
General health checks are unlikely to be beneficial.
Topics: Adult; Cause of Death; Diagnosis; Disease; Health Promotion; Humans; Morbidity; Primary Prevention; Randomized Controlled Trials as Topic
PubMed: 30699470
DOI: 10.1002/14651858.CD009009.pub3 -
Medicine Sep 2023Transjugular intrahepatic portosystemic shunt (TIPS) can be an effective treatment for cirrhotic patients who develop variceal bleeding and ascites. However, TIPS... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Transjugular intrahepatic portosystemic shunt (TIPS) can be an effective treatment for cirrhotic patients who develop variceal bleeding and ascites. However, TIPS placement is associated with an increased risk of developing hepatic encephalopathy (HE). Recently, there have been efforts to use the typical medical therapies prophylactically in patients undergoing TIPS placement to prevent post-TIPS HE.
METHODS
We conducted literature searches in MEDLINE, Embase, CINAHL, Scopus, and Cochrane to examine studies that use prophylactic medical therapy for preventing post-TIPS HE. A narrative synthesis and grading of recommendations assessment assessment were done for all studies. Meta-analysis was performed for eligible studies using the Mantel-Haenszel method random-effects model. Nine hundred twenty-one articles were screened and 5 studies were included in the study after 2 levels of screening. The medications studied were rifaximin, lactulose, lactitol, L-Ornithine-L-aspartate (LOLA), albumin, and combination therapies.
RESULTS
Narrative results showed that lactulose, lactitol, LOLA and albumin prophylaxis were not associated with reduction in HE occurrence or mortality. A combination of rifaximin and lactulose was found to be associated with lower occurrence of HE, and the results were not different when LOLA was added. Meta-analysis (n = 3) showed that rifaximin treatment was not associated with changes in HE occurrences.
CONCLUSION
In conclusion, a vast majority of medications were not found to be effective post-TIPS HE prophylaxis when used alone. A rifaximin and lactulose combination therapy may be beneficial. Overall, there is significant limitation in the current data and more studies are needed to yield more robust meta-analysis results in the future.
Topics: Humans; Hepatic Encephalopathy; Lactulose; Rifaximin; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Albumins; Primary Prevention
PubMed: 37746955
DOI: 10.1097/MD.0000000000035266 -
Epilepsy & Behavior : E&B Nov 2020Cerebrovascular disease is the most common cause of seizures in adults and the elderly. So far, no drug is recommended as primary prevention of acute symptomatic... (Review)
Review
INTRODUCTION
Cerebrovascular disease is the most common cause of seizures in adults and the elderly. So far, no drug is recommended as primary prevention of acute symptomatic poststroke seizures (ASPSS) or poststroke epilepsy (PSE). This systematic review aimed to evaluate the association between the use of statins after stroke and the risk of developing ASPSS or PSE following cerebral infarct or hemorrhage (primary prevention).
METHODS
We included studies evaluating the poststroke use of statins as primary prevention of ASPSS or PSE, irrespective of stroke type. We excluded uncontrolled studies and studies with prestroke statin use. The main outcome included the occurrence of ASPSS or PSE and the effect of statins by type and dose. The odds ratios (ORs) or hazard ratios (HR) with 95% confidence intervals (CIs) were used as the measures of association between treatment and outcome.
RESULTS
Four studies were included. One study showed a reduced risk of ASPSS after ischemic stroke (OR: 0.25; 95% CI: 0.10-0.59; p = 0.0016). Three studies consistently reported a reduced risk of PSE after ischemic stroke, and one study a reduced risk of PSE after hemorrhagic stroke (HR: 0.62; 95% CI: 0.42-0.90; p = 0.01).
CONCLUSIONS
Data from the literature suggest an association between statin use and a reduced risk of ASPSS after ischemic stroke and a reduced risk of PSE after ischemic and hemorrhagic stroke. Although the certainty of the evidence is low, these findings appear promising and worthy of further investigation.
Topics: Aged; Epilepsy; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Primary Prevention; Seizures; Stroke
PubMed: 32916580
DOI: 10.1016/j.yebeh.2020.107400 -
Heart (British Cardiac Society) Jul 2023Dietary modification is a cornerstone of cardiovascular disease (CVD) prevention. A Mediterranean diet has been associated with a lower risk of CVD but no systematic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Dietary modification is a cornerstone of cardiovascular disease (CVD) prevention. A Mediterranean diet has been associated with a lower risk of CVD but no systematic reviews have evaluated this relationship specifically in women.
OBJECTIVE
To determine the association between higher versus lower adherence to a Mediterranean diet and incident CVD and total mortality in women.
METHODS
A systematic search of Medline, Embase, CINAHL, Scopus, and Web of Science (2003-21) was performed. Randomised controlled trials and prospective cohort studies with participants without previous CVD were included. Studies were eligible if they reported a Mediterranean diet score and comprised either all female participants or stratified outcomes by sex. The primary outcome was CVD and/or total mortality. A random effects meta-analysis was conducted to calculate pooled hazard ratios (HRs) and confidence intervals (CIs).
RESULTS
Sixteen prospective cohort studies were included in the meta-analysis (n=7 22 495 female participants). In women, higher adherence to a Mediterranean diet was associated with a lower CVD incidence (HR 0.76, 95% CI 0.72 to 0.81; I=39%, p test for heterogeneity=0.07), total mortality (HR 0.77, 95% CI 0.74 to 0.80; I=21%, p test for heterogeneity=0.28), and coronary heart disease (HR 0.75, 95% CI 0.65 to 0.87; I=21%, p test for heterogeneity=0.28). Stroke incidence was lower in women with higher Mediterranean diet adherence (HR 0.87, 95% CI 0.76 to 1.01; I=0%, p test for heterogeneity=0.89), but this result was not statistically significant.
CONCLUSION
This study supports a beneficial effect of the Mediterranean diet on primary prevention of CVD and death in women, and is an important step in enabling sex specific guidelines.
Topics: Male; Humans; Female; Cardiovascular Diseases; Diet, Mediterranean; Prospective Studies; Proportional Hazards Models; Primary Prevention
PubMed: 36918266
DOI: 10.1136/heartjnl-2022-321930 -
Journal of Prevention (2022) Jun 2022Foetal alcohol spectrum disorder (FASD) comprises multiple neurodevelopmental disorders caused by alcohol consumption during pregnancy. With a global prevalence rate of... (Review)
Review
Foetal alcohol spectrum disorder (FASD) comprises multiple neurodevelopmental disorders caused by alcohol consumption during pregnancy. With a global prevalence rate of 7.7 per 1000 population, FASD is a leading cause of prenatal developmental disorders. The extent of physical, mental, and social consequences for individuals with FASD can be vast and negatively affect their social environment, daily life, school, relationships, and work. As treatment for FASD is labour- and cost-intensive, with no cure available, prevention is key in reducing FASD prevalence rates. As most systematic reviews conducted so far have focused on specific FASD risk groups, we investigated the effectiveness of universal FASD prevention and primary preventive strategies. We identified a total of 567 potentially pertinent records through PubMed, Cochrane Library, EBSCO, PubPsych, and DAHTA published from 2010 to May 2020, of which 10 studies were included in this systematic review. Results showed a substantial heterogeneity in the studies' quality, although all preventive measures, except one, proved effective in both increasing knowledge and awareness of FASD, as well as decreasing the risk of an alcohol exposed pregnancy. Limiting factors such as small sample sizes and a lack of behavioural change testing require further studies to support existing evidence for FASD prevention and its implementation, as well as detecting the best course of action for FASD prevention when creating and implementing prevention and intervention approaches.
Topics: Alcohol Drinking; Ethanol; Female; Fetal Alcohol Spectrum Disorders; Humans; Neurodevelopmental Disorders; Pregnancy; Primary Prevention
PubMed: 35286547
DOI: 10.1007/s10935-021-00658-9 -
Stroke Mar 2022The stroke burden continues to grow across the globe, disproportionally affecting developing countries. This burden cannot be effectively halted and reversed without...
The stroke burden continues to grow across the globe, disproportionally affecting developing countries. This burden cannot be effectively halted and reversed without effective and widely implemented primordial and primary stroke prevention measures, including those on the individual level. The unprecedented growth of smartphone and other digital technologies with digital solutions are now being used in almost every area of health, offering a unique opportunity to improve primordial and primary stroke prevention on the individual level. However, there are several issues that need to be considered to advance development and use this important digital strategy for primordial and primary stroke prevention. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines we provide a systematic review of the current knowledge, challenges, and opportunities of digital health in primordial and primary stroke prevention.
Topics: Humans; Internet; Primary Prevention; Smartphone; Stroke
PubMed: 35109683
DOI: 10.1161/STROKEAHA.121.036400 -
Journal of Prevention (2022) Feb 2023Primary prevention of type 2 diabetes mellitus (T2DM) is possible in at-risk populations, and prevention programmes have been shown to be effective in real-world... (Review)
Review
BACKGROUND
Primary prevention of type 2 diabetes mellitus (T2DM) is possible in at-risk populations, and prevention programmes have been shown to be effective in real-world scenarios. Despite this evidence, diabetes prevalence has tripled in recent decades and is expected to reach 700 million patients by 2045, making it one of the leading causes of death globally. This review is aimed at identifying the issues and challenges in the primary prevention of T2DM.
METHODS
Scopus, Web of Science, PubMed and Ovid MEDLINE were systematically searched for published articles. Articles were screened based of inclusion and exclusion criteria. The inclusion criteria were: (1) published in 2010-2020, (2) full original article, (3) written in English, (4) qualitative, mixed-methods article, observational or interventional study. The exclusion criteria were: (1) animal study, (2) in vivo/in vitro study, (3) type 1 diabetes or gestational DM and (4) conference abstract, book chapter, report, and systematic review. Eligible articles were assessed using Mixed Methods Appraisal Tool (MMAT) by three assessors.
RESULTS
A total of 11 articles were selected for qualitative synthesis from the initial 620 articles. The issues and challenges seen in T2DM primary prevention followed three themes: healthcare program (sub-themes: lack of resources, community partnership, participation, health literacy), health provider (sub-themes: lack of implementation, health care staff, collaboration, availability), individual (sub-themes: awareness, communication, misbehaviour, family conflict).
CONCLUSION
Factors relating to healthcare programmes, health providers, and individual issues are the main challenges in T2DM primary prevention. By establishing sustainable preventative initiatives that address these issues and challenges in the primary prevention of T2DM, a reduction in T2DM prevalence could be achievable.
Topics: Humans; Diabetes Mellitus, Type 2; Risk Factors; Diabetes Mellitus, Type 1; Primary Prevention
PubMed: 36129587
DOI: 10.1007/s10935-022-00707-x -
BMJ Open Respiratory Research Aug 2023Current evidence on the effectiveness of SARS-CoV-2 prophylaxis is inconclusive. We aimed to systematically evaluate published studies on repurposed drugs for the... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Current evidence on the effectiveness of SARS-CoV-2 prophylaxis is inconclusive. We aimed to systematically evaluate published studies on repurposed drugs for the prevention of laboratory-confirmed SARS-CoV-2 infection and/or COVID-19 among healthy adults.
DESIGN
Systematic review.
ELIGIBILITY
Quantitative experimental and observational intervention studies that evaluated the effectiveness of repurposed drugs for the primary prevention of SARS-CoV-2 infection and/or COVID-19 disease.
DATA SOURCE
PubMed and Embase (1 January 2020-28 September 2022).
RISK OF BIAS
Cochrane Risk of Bias 2.0 and Risk of Bias in Non-Randomised Studies of Interventions tools were applied to assess the quality of studies.
DATA ANALYSIS
Meta-analyses for each eligible drug were performed if ≥2 similar study designs were available.
RESULTS
In all, 65 (25 trials, 40 observational) and 29 publications were eligible for review and meta-analyses, respectively. Most studies pertained to hydroxychloroquine (32), ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) (11), statin (8), and ivermectin (8). In trials, hydroxychloroquine prophylaxis reduced laboratory-confirmed SARS-CoV-2 infection (risk ratio: 0.82 (95% CI 0.74 to 0.90), I=48%), a result largely driven by one clinical trial (weight: 60.5%). Such beneficial effects were not observed in observational studies, nor for prognostic clinical outcomes. Ivermectin did not significantly reduce the risk of SARS-CoV-2 infection (RR: 0.35 (95% CI 0.10 to 1.26), I=96%) and findings for clinical outcomes were inconsistent. Neither ACEi or ARB were beneficial in reducing SARS-CoV-2 infection. Most of the evidence from clinical trials was of moderate quality and of lower quality in observational studies.
CONCLUSIONS
Results from our analysis are insufficient to support an evidence-based repurposed drug policy for SARS-CoV-2 prophylaxis because of inconsistency. In the view of scarce supportive evidence on repurposing drugs for COVID-19, alternative strategies such as immunisation of vulnerable people are warranted to prevent the future waves of infection.
PROSPERO REGISTRATION NUMBER
CRD42021292797.
Topics: Adult; Humans; COVID-19; Pandemics; SARS-CoV-2; Angiotensin Receptor Antagonists; Hydroxychloroquine; Ivermectin; Angiotensin-Converting Enzyme Inhibitors; Primary Prevention
PubMed: 37640510
DOI: 10.1136/bmjresp-2023-001674 -
Preventive Medicine Jul 2015Anxiety disorders are the most prevalent psychiatric disorders in primary care and have significant social, economic, and interpersonal costs. Primary care is an ideal... (Review)
Review
OBJECTIVE
Anxiety disorders are the most prevalent psychiatric disorders in primary care and have significant social, economic, and interpersonal costs. Primary care is an ideal setting to prevent the appearance of anxiety disorders. The aim of this study was to evaluate the efficacy and cost-effectiveness of primary prevention interventions in anxiety disorders in the adult population receiving primary health care.
METHODS
A literature search was carried out in four databases-PubMed, PsycInfo, Cochrane, and Web of Science-from January 1980 to November 2013. Clinical trials and systematic reviews published in English and non-English languages and that evaluated the efficacy and/or cost-effectiveness of interventions of primary prevention for anxiety in primary care in the general adult population were included. Risk of bias was assessed by the Cochrane Risk Bias Tool and Overview Quality Assessment Questionnaire.
RESULTS
No high-quality research was identified that studied primary prevention of anxiety disorders in the adult population in the primary care setting. The few studies that exist focus on the child-adolescent population or on other types of interventions, usually as secondary prevention.
CONCLUSION
This study emphasizes the need for the development of high-quality clinical trials on the prevention of anxiety disorders in primary care.
Topics: Anxiety Disorders; Humans; Mental Health; Primary Health Care; Primary Prevention
PubMed: 25456801
DOI: 10.1016/j.ypmed.2014.10.015 -
JAMA Nov 2022It is uncertain whether hormone therapy should be used for the primary prevention of chronic conditions such as heart disease, osteoporosis, or some types of cancers.
Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Persons: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.
IMPORTANCE
It is uncertain whether hormone therapy should be used for the primary prevention of chronic conditions such as heart disease, osteoporosis, or some types of cancers.
OBJECTIVE
To update evidence for the US Preventive Services Task Force on the benefits and harms of hormone therapy in reducing risks for chronic conditions.
DATA SOURCES
PubMed/MEDLINE, Cochrane Library, EMBASE, and trial registries from January 1, 2016, through October 12, 2021; surveillance through July 2022.
STUDY SELECTION
English-language randomized clinical trials and prospective cohort studies of fair or good quality.
DATA EXTRACTION AND SYNTHESIS
Dual review of abstracts, full-text articles, and study quality; meta-analyses when at least 3 similar studies were available.
MAIN OUTCOMES AND MEASURES
Morbidity and mortality related to chronic conditions; health-related quality of life.
RESULTS
Twenty trials (N = 39 145) and 3 cohort studies (N = 1 155 410) were included. Participants using estrogen only compared with placebo had significantly lower risks for diabetes over 7.1 years (1050 vs 903 cases; 134 fewer [95% CI, 18-237]) and fractures over 7.2 years (1024 vs 1413 cases; 388 fewer [95% CI, 277-489]) per 10 000 persons. Risks per 10 000 persons were statistically significantly increased for gallbladder disease over 7.1 years (1113 vs 737 cases; 377 more [95% CI, 234-540]), stroke over 7.2 years (318 vs 239 cases; 79 more [95% CI, 15-159]), venous thromboembolism over 7.2 years (258 vs 181 cases; 77 more [95% CI, 19-153]), and urinary incontinence over 1 year (2331 vs 1446 cases; 885 more [95% CI, 659-1135]). Participants using estrogen plus progestin compared with placebo experienced significantly lower risks, per 10 000 persons, for colorectal cancer over 5.6 years (59 vs 93 cases; 34 fewer [95% CI, 9-51]), diabetes over 5.6 years (403 vs 482 cases; 78 fewer [95% CI, 15-133]), and fractures over 5 years (864 vs 1094 cases; 230 fewer [95% CI, 66-372]). Risks, per 10 000 persons, were significantly increased for invasive breast cancer (242 vs 191 cases; 51 more [95% CI, 6-106]), gallbladder disease (723 vs 463 cases; 260 more [95% CI, 169-364]), stroke (187 vs 135 cases; 52 more [95% CI, 12-104]), and venous thromboembolism (246 vs 126 cases; 120 more [95% CI, 68-185]) over 5.6 years; probable dementia (179 vs 91 cases; 88 more [95% CI, 15-212]) over 4.0 years; and urinary incontinence (1707 vs 1145 cases; 562 more [95% CI, 412-726]) over 1 year.
CONCLUSIONS AND RELEVANCE
Use of hormone therapy in postmenopausal persons for the primary prevention of chronic conditions was associated with some benefits but also with an increased risk of harms.
Topics: Female; Humans; Advisory Committees; Chronic Disease; Estrogens; Fractures, Bone; Hormone Replacement Therapy; Hormones; Postmenopause; Primary Prevention; Progestins; Prospective Studies; Quality of Life; Risk Assessment; United States; Urinary Incontinence; Venous Thromboembolism
PubMed: 36318128
DOI: 10.1001/jama.2022.18324