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Expert Review of Cardiovascular Therapy Jun 2018Post-pericardiotomy syndrome is a well-recognized inflammatory phenomenon that commonly occurs in patients following cardiac surgery. Due to the increased morbidity and... (Review)
Review
Post-pericardiotomy syndrome is a well-recognized inflammatory phenomenon that commonly occurs in patients following cardiac surgery. Due to the increased morbidity and resource utilization associated with this condition, research has recently focused on ways of preventing its prevention this condition; primarily using colchicine, NSAIDs and corticosteroids. Areas covered: This systematic review summarizes the three clinical studies that have used corticosteroids for PPS primary prevention in the perioperative period. Due to the heterogeneity amongst these three studies in terms of population (both pediatric and adult patients), surgical procedure, administration regimen and results (only 1/3 studies reporting a positive effect), the effectiveness of corticosteroids remains unproven. Expert commentary: Corticosteroids have shown to be useful in the treatment of PPS but have thus far have shown mixed results as a primary prevention method. Research on patients taking corticosteroids pre-operatively have shown a significant reduction in the risk of developing PPS. Further research is required to determine if corticosteroids are helpful in preventing PPS in patient undergoing cardiac surgery, before any recommendations regarding their use in cardiovascular surgery can be made.
Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents, Non-Steroidal; Cardiac Surgical Procedures; Colchicine; Humans; Pericardiectomy; Postpericardiotomy Syndrome; Primary Prevention
PubMed: 29745734
DOI: 10.1080/14779072.2018.1475231 -
Pediatrics Sep 2020An updated synthesis of research on substance abuse prevention programs can promote enhanced uptake of programs with proven effectiveness, particularly when paired with...
CONTEXT
An updated synthesis of research on substance abuse prevention programs can promote enhanced uptake of programs with proven effectiveness, particularly when paired with information relevant to practitioners and policy makers.
OBJECTIVE
To assess the strength of the scientific evidence for psychoactive substance abuse prevention programs for school-aged children and youth.
DATA SOURCES
A systematic review was conducted of studies published up until March 31, 2020.
STUDY SELECTION
Articles on substance abuse prevention programs for school-aged children and youth were independently screened and included if they met eligibility criteria: (1) the program was designed for a general population of children and youth (ie, not designed for particular target groups), (2) the program was delivered to a general population, (3) the program only targeted children and youth, and (4) the study included a control group.
DATA EXTRACTION
Two reviewers independently evaluated study quality and extracted outcome data.
RESULTS
Ninety studies met eligibility criteria, representing 16 programs. Programs evaluated with the largest combined sample sizes were Drug Abuse Resistance Education, Project Adolescent Learning Experiences Resistance Training, Life Skills Training (LST), the Adolescent Alcohol Prevention Trial, and Project Choice.
LIMITATIONS
Given the heterogeneity of outcomes measured in the included studies, it was not possible to conduct a statistical meta-analysis of program effectiveness.
CONCLUSIONS
The most research has been conducted on the LST program. However, as with other programs included in this review, studies of LST effectiveness varied in quality. With this review, we provide an updated summary of evidence for primary prevention program effectiveness.
Topics: Adolescent; Child; Humans; Primary Prevention; Program Evaluation; Substance-Related Disorders
PubMed: 32769198
DOI: 10.1542/peds.2019-2747 -
Drugs & Aging Aug 2015Statins have been shown to be beneficial in primary and secondary prevention settings; however, their role in the elderly remains a clinical conundrum, given that... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Statins have been shown to be beneficial in primary and secondary prevention settings; however, their role in the elderly remains a clinical conundrum, given that age-related factors could alter the risk-benefit ratio of statin treatment. This study aimed to critically evaluate the efficacy and safety of statins for primary prevention of cardiovascular disease (CVD) in the elderly.
METHODS
We systematically reviewed randomized controlled trials comparing any statins with placebo or usual care for primary prevention of CVD in subjects aged ≥65 years. Relative risks (RRs) using a random effects model were calculated and sensitivity analyses were performed to assess the robustness of findings.
RESULTS
Eight studies (n = 25,952) were included in the meta-analysis. Statins significantly reduced the risks of composite major adverse cardiovascular events (RR 0.82, 95% CI 0.74-0.92), nonfatal myocardial infarction [MI] (0.75, 0.59-0.94) and total MI (0.74, 0.61-0.90). Treatment effects of statins were statistically insignificant in fatal MI (0.43, 0.09-2.01), stroke (fatal: 0.76, 0.24-2.45; nonfatal: 0.76, 0.53-1.11; total: 0.85, 0.68-1.06) and all-cause mortality (0.96, 0.88-1.04). Significant differences were not observed in myalgia (0.88, 0.69-1.13), elevation of hepatic transaminases (0.98, 0.71-1.34), new-onset diabetes (1.07, 0.77-1.48), serious adverse events (1.00, 0.97-1.04) and discontinuation due to adverse events (1.10, 0.85-1.42). The occurrence of myopathy, rhabdomyolysis and cognitive impairment was largely unreported in the included trials.
CONCLUSIONS
From a risk-benefit perspective, there is a role of statins for the primary prevention of major adverse cardiovascular events in elderly patients. Further studies are needed to ascertain the benefits of statins on fatal MI, stroke and all-cause mortality.
Topics: Aged; Cardiovascular Diseases; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Myocardial Infarction; Odds Ratio; Primary Prevention; Randomized Controlled Trials as Topic; Stroke
PubMed: 26245770
DOI: 10.1007/s40266-015-0290-9 -
The Cochrane Database of Systematic... May 2015This is an update of the original review published in 2008. The risk of adverse cardiovascular outcomes is increased with influenza-like infection, and vaccination... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This is an update of the original review published in 2008. The risk of adverse cardiovascular outcomes is increased with influenza-like infection, and vaccination against influenza may improve cardiovascular outcomes.
OBJECTIVES
To assess the potential benefits of influenza vaccination for primary and secondary prevention of cardiovascular disease.
SEARCH METHODS
We searched the following electronic databases on 18 October 2013: The Cochrane Library (including Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Economic Evaluation Database (EED) and Health Technology Assessment database (HTA)), MEDLINE, EMBASE, Science Citation Index Expanded, Conference Proceedings Citation Index - Science and ongoing trials registers (www.controlled-trials.com/ and www.clinicaltrials.gov). We examined reference lists of relevant primary studies and systematic reviews. We performed a limited PubMed search on 20 February 2015, just before publication.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of influenza vaccination compared with placebo or no treatment in participants with or without cardiovascular disease, assessing cardiovascular death or non-fatal cardiovascular events.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures as expected by The Cochrane Collaboration. We carried out meta-analyses only for cardiovascular death, as other outcomes were reported too infrequently. We expressed effect sizes as risk ratios (RRs), and we used random-effects models.
MAIN RESULTS
We included eight trials of influenza vaccination compared with placebo or no vaccination, with 12,029 participants receiving at least one vaccination or control treatment. We included six new studies (n = 11,251), in addition to the two included in the previous version of the review. Four of these trials (n = 10,347) focused on prevention of influenza in the general or elderly population and reported cardiovascular outcomes among their safety analyses; four trials (n = 1682) focused on prevention of cardiovascular events in patients with established coronary heart disease. These populations were analysed separately. Follow-up continued between 42 days and one year. Five RCTs showed deficits in at least three of the risk of bias criteria assessed. When reported (seven studies), vaccination provided adequate immunogenicity or protection against influenza. Cardiovascular mortality was reported by four secondary prevention trials and was significantly reduced by influenza vaccination overall (risk ratio (RR) 0.45, 95% confidence interval (CI) 0.26 to 0.76; P value 0.003) with no significant heterogeneity between studies, and by three trials reporting cardiovascular mortality as part of their safety analyses when the numbers of events were too small to permit conclusions. In studies of patients with coronary heart disease, composite outcomes of cardiovascular events tended to be decreased with influenza vaccination compared with placebo. Generally no significant difference was found between comparison groups regarding individual outcomes such as myocardial infarction.
AUTHORS' CONCLUSIONS
In patients with cardiovascular disease, influenza vaccination may reduce cardiovascular mortality and combined cardiovascular events. However, studies had some risk of bias, and results were not always consistent, so additional higher-quality evidence is necessary to confirm these findings. Not enough evidence was available to establish whether influenza vaccination has a role to play in the primary prevention of cardiovascular disease.
Topics: Coronary Disease; Humans; Influenza Vaccines; Influenza, Human; Primary Prevention; Randomized Controlled Trials as Topic; Secondary Prevention
PubMed: 25940444
DOI: 10.1002/14651858.CD005050.pub3 -
BMC Pregnancy and Childbirth Jan 2017Gestational diabetes mellitus (GDM), defined as any degree of glucose intolerance with onset during pregnancy, is increasing worldwide, mostly because obesity among... (Review)
Review
BACKGROUND
Gestational diabetes mellitus (GDM), defined as any degree of glucose intolerance with onset during pregnancy, is increasing worldwide, mostly because obesity among women of reproductive age is continuously escalating. GDM is associated with adverse maternal and fetal outcomes. The aim of this article was to systematically review literature on the effectiveness of nutritional factors before or during pregnancy to prevent GDM.
METHODS
We assessed the primary prevention of GDM through nutritional factors, as diet and supplements. We searched on PubMed, Cochrane Databases and ClinicalTrials.gov from inception to June 2016. Clinical trials and adjusted prospective cohort studies were included.
RESULTS
Eight clinical trials and twenty observational studies assessing the association between dietary factors and primary prevention of GDM were included. Furthermore, six clinical trials and two observational studies related to supplements were also added. Only two nutritional interventions were found to significantly reduce the incidence of GDM, besides the supplements. However, the observational studies showed that a higher adherence to a healthier dietary pattern can prevent the incidence of GDM, especially in high risk population before getting pregnant.
CONCLUSIONS
The results indicate that there may be some benefits of some nutritional factors to prevent GDM. However, better-designed studies are required to generate higher quality evidence. At the moment, no strong conclusions can be drawn with regard to the best intervention for the prevention of GDM.
Topics: Adult; Diabetes, Gestational; Diet, Healthy; Dietary Supplements; Female; Humans; Pregnancy; Prenatal Care; Prenatal Nutritional Physiological Phenomena; Primary Prevention
PubMed: 28086820
DOI: 10.1186/s12884-016-1205-4 -
The Cochrane Database of Systematic... May 2016Viral encephalitis is characterised by diverse clinical and epidemiological features. Seizures are an important clinical manifestation and are associated with increased... (Review)
Review
BACKGROUND
Viral encephalitis is characterised by diverse clinical and epidemiological features. Seizures are an important clinical manifestation and are associated with increased mortality and morbidity. Patients may have seizures during the acute illness or they may develop after recovery. There are no recommendations regarding the use of antiepileptic drugs for the primary or secondary prevention of seizures in patients with viral encephalitis.This is an updated version of the original Cochrane review published in The Cochrane Library 2014, Issue 10.
OBJECTIVES
To assess the efficacy and tolerability of antiepileptic drugs for the primary and secondary prophylaxis of seizures in viral encephalitis. We had intended to answer the following questions.1. Do antiepileptic drugs used routinely as primary prophylaxis for all patients with suspected or proven viral encephalitis reduce the risk of seizures during the acute illness and reduce neurological morbidity and mortality?2. Do antiepileptic drugs used routinely as secondary prophylaxis for all patients who have had at least one seizure due to suspected or proven viral encephalitis reduce the risk of further seizures during the acute illness and reduce neurological morbidity and mortality?
SEARCH METHODS
For the latest version of this review, we searched the Cochrane Epilepsy Group Specialized Register (11 April 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online (CRSO, 11 April 2016), MEDLINE (Ovid 1946 to 11 April 2016), the WHO International Clinical Trials Registry Platform (ICTRP, 11 April 2016), and ClinicalTrials.gov (11 April 2016). We did not impose any language restrictions.
SELECTION CRITERIA
Randomised and quasi-randomised controlled trials in which patients were assigned to a treatment or control group (placebo or no drug).
DATA COLLECTION AND ANALYSIS
One review author (SP) searched the publications by title, abstract and keywords, and decided on their suitability for the review. For any studies where their suitability was unclear, the co-authors (CR, BM) were consulted. The co-authors (CR, BM) independently evaluated the selected studies. Since there were no included studies, we carried out no data analysis.
MAIN RESULTS
We did not find any randomised or quasi-randomised controlled trials that compared the effects of antiepileptic drugs with placebo (or no drug) for the primary or secondary prevention of seizures in viral encephalitis. We identified two studies from the literature search where different antiepileptic drugs were used in patients with viral encephalitis, however both failed to meet the inclusion criteria.
AUTHORS' CONCLUSIONS
There is insufficient evidence to support or refute the routine use of antiepileptic drugs for the primary or secondary prevention of seizures in viral encephalitis. There is a need for adequately powered randomised controlled trials in patients with viral encephalitis to assess the efficacy and tolerability of antiepileptic drugs for the primary and secondary prophylaxis of seizures, which is an important clinical problem.
Topics: Anticonvulsants; Encephalitis, Viral; Humans; Primary Prevention; Secondary Prevention; Seizures
PubMed: 27209627
DOI: 10.1002/14651858.CD010247.pub3 -
Journal of Affective Disorders Nov 2021Primary prevention has the potential to modify the course of depression, but the consistency and magnitude of this effect are currently undetermined. (Review)
Review
BACKGROUND
Primary prevention has the potential to modify the course of depression, but the consistency and magnitude of this effect are currently undetermined.
METHODS
PRISMA and RIGHT compliant (PROSPERO:CRD42020179659) systematic meta-review, PubMed/Web of Science, up to June 2020. Meta-analyses of controlled interventions for the primary prevention of depressive symptoms [effect measures: standardized mean difference (SMD)] or depressive disorders [effect measure: relative risk (RR)] were carried out. Results were stratified by: (i) age range; (ii) target population (general and/or at-risk); (iii) intervention type. Quality (assessed with AMSTAR/AMSTAR-PLUS content) and credibility (graded as high/moderate/low) were assessed. USPSTF grading system was used for recommendations.
RESULTS
Forty-six meta-analyses (k=928 individual studies, n=286,429 individuals, mean age=22.4 years, 81.1% female) were included. Effect sizes were: SMD=0.08-0.53; for depressive symptoms; RR=0.90-0.28 for depressive disorders. Sensitivity analyses including only RCTs did not impact the findings. AMSTAR median=9 (IQR=8-9); AMSTAR-PLUS content median=4.25 (IQR=4-5). Credibility of the evidence was insufficient/low in 43 (93.5%) meta-analyses, moderate in two (4.3%), and high in one (2.2%): reduction of depressive symptoms using psychosocial interventions for young adults only, and a combination of psychological and educational interventions in primary care had moderate credibility; preventive administration of selective serotonin reuptake inhibitors (SSRIs) for depressive disorders in individuals with a stroke had high credibility.
LIMITATIONS
Intervention heterogeneity and lack of long-term efficacy evaluation.
CONCLUSIONS
Primary preventive interventions for depression might be effective. Among them, clinicians may offer SSRIs post-stroke to prevent depressive disorders, and psychosocial interventions for children/adolescents/young adults with risk factors or during the prenatal/perinatal period.
Topics: Adolescent; Adult; Child; Depression; Female; Humans; Male; Primary Health Care; Primary Prevention; Selective Serotonin Reuptake Inhibitors; Young Adult
PubMed: 34375224
DOI: 10.1016/j.jad.2021.07.101 -
International Journal of Cardiology Jan 2021Rheumatic heart disease (RHD) remains endemic in less-resourced regions and countries and results in high medical and non-medical costs to households, health systems,... (Review)
Review
BACKGROUND
Rheumatic heart disease (RHD) remains endemic in less-resourced regions and countries and results in high medical and non-medical costs to households, health systems, and society. This scoping review maps out the available evidence on the economic impact of RHD and its antecedents and suggests future research priorities.
METHOD
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. We identified articles through systematic electronic database search supplemented by expert knowledge of unpublished literature. Studies were included if they collected empirical RHD-related costing data as a primary or secondary objective and if the data were collected from 2000 onward. Main quantitative findings by intervention, costing perspective, and location were charted, and a standardized quality assessment tool was used to appraise included studies.
RESULTS
The index search identified 2519 electronic records and two grey-literature graduate theses. Six full texts were included in the review. Primary prevention costs were modest, while secondary and especially tertiary prevention were more costly. Most estimates were of health sector costs and for tertiary interventions. Only two studies described RHD-related costs in non-high-income countries. Most studies were of adequate methodological quality.
CONCLUSION
Research into the costs of RHD has mostly been done in wealthy countries. Costs from the household perspective, which are particularly important in countries with limited public healthcare finance, are lacking. To inform advocacy and guide implementation of the 2018 World Health Assembly resolution on RHD, high-quality, local cost estimates will be needed from a range of representative, RHD-endemic countries.
Topics: Global Health; Health Care Costs; Humans; Income; Primary Prevention; Rheumatic Heart Disease
PubMed: 32920073
DOI: 10.1016/j.ijcard.2020.09.020 -
The American Journal of Cardiology Nov 2014The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in... (Review)
Review
The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults was based on a systematic review of randomized trials with atherosclerotic cardiovascular disease (ASCVD) outcomes and meta-analyses of these trials published through 2011. With evidence of an ASCVD risk reduction benefit greatly outweighing the potential for adverse effects, the guideline recommends statin therapy for primary prevention in those with ≥7.5% 10-year ASCVD risk and consideration of statin therapy in those with 5% to <7.5% 10-year ASCVD risk. Subsequent meta-analyses of the statin trials support these recommendations and have additionally found a reduction in total mortality in lower-risk subjects. Additional evidence from imaging trials and epidemiologic studies suggests that initiation of statin therapy earlier in the course of ASCVD could have the potential to more effectively prevent age-related progression of atherosclerosis. Given the high levels of suboptimal risk factors in adults and the safety and availability of low-cost generic statins, a consideration of all the available evidence strongly supports earlier intervention for the primary prevention of ASCVD. In conclusion, earlier initiation of statin therapy has the potential to have a large long-term impact on the heavy burden of cardiovascular disease in the aging populations.
Topics: Cardiovascular Diseases; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Primary Prevention; United States
PubMed: 25205631
DOI: 10.1016/j.amjcard.2014.07.076 -
European Journal of Public Health Aug 2017Healthy ageing and health promotion (HP) actions for older people have become an important health sector priority. At the same time, the application of economic... (Review)
Review
BACKGROUND
Healthy ageing and health promotion (HP) actions for older people have become an important health sector priority. At the same time, the application of economic evaluation methods in the field of health interventions in order to support allocative decision processes is of growing importance. The aims of the review were to analyze what the existing evidence is on cost-effectiveness of HP and/or primary prevention (PP) programmes for older people whilst providing deeper insight into methodological aspects of such studies, their overall quality and issues related to practical implementation of results.
METHODS
Systematic review of contemporary evidence (2000-15). Studies' eligibility criteria included target population 65 years old or older; interventions classified as HP or PP; a full economic evaluation conducted. The search strategy included five electronic databases and Internet websites of institutions or projects related to the topic. Quality assessment of the studies was based on the 'Drummond checklist'.
RESULTS
After screening 6450 records, 29 papers were included, the vast majority of which (22) focus on fall prevention strategies. In this area, there are examples of good and moderate quality studies which confirm the cost-effectiveness of diverse physical activity interventions in fall prevention. The existing studies are characterized by huge differences in the methods applied as well as overall quality which limits the comparability and generalizability of the results.
CONCLUSIONS
There is a need for development and implementation of economically driven studies, with methods adjusted to particular character of HP and/or PP strategies for older population.
Topics: Aged; Cost-Benefit Analysis; Health Promotion; Health Services for the Aged; Humans; Primary Prevention
PubMed: 28371813
DOI: 10.1093/eurpub/ckx030