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Cleveland Clinic Journal of Medicine Jul 2020
Topics: Aspirin; Atherosclerosis; Humans; Platelet Aggregation Inhibitors; Primary Prevention
PubMed: 32737041
DOI: 10.3949/ccjm.87c.08005 -
Circulation. Arrhythmia and... Feb 2015Racial and ethnic minorities are under-represented in clinical trials of primary prevention implantable cardioverter-defibrillators (ICDs). This analysis investigates... (Comparative Study)
Comparative Study Observational Study
BACKGROUND
Racial and ethnic minorities are under-represented in clinical trials of primary prevention implantable cardioverter-defibrillators (ICDs). This analysis investigates the association between primary prevention ICDs and mortality among Medicare, racial/ethnic minority patients.
METHODS AND RESULTS
Data from Get With The Guidelines-Heart Failure Registry and National Cardiovascular Data Registry's ICD Registry were used to perform an adjusted comparative effectiveness analysis of primary prevention ICDs in Medicare, racial/ethnic minority patients (nonwhite race or Hispanic ethnicity). Mortality data were obtained from the Medicare denominator file. The relationship of ICD with survival was compared between minority and white non-Hispanic patients. Our analysis included 852 minority patients, 426 ICD and 426 matched non-ICD patients, and 2070 white non-Hispanic patients (1035 ICD and 1035 matched non-ICD patients). Median follow-up was 3.1 years. Median age was 73 years, and median ejection fraction was 23%. Adjusted 3-year mortality rates for minority ICD and non-ICD patients were 44.9% (95% confidence interval [CI], 44.2%-45.7%) and 54.3% (95% CI, 53.4%-55.1%), respectively (adjusted hazard ratio, 0.79; 95% CI, 0.63-0.98; P=0.034). White non-Hispanic patients receiving an ICD had lower adjusted 3-year mortality rates of 47.8% (95% CI, 47.3%-48.3%) compared with 57.3% (95% CI, 56.8%-57.9%) for those with no ICD (adjusted hazard ratio, 0.75; 95% CI, 0.67%-0.83%; P<0.0001). There was no significant interaction between race/ethnicity and lower mortality risk with ICD (P=0.70).
CONCLUSIONS
Primary prevention ICDs are associated with lower mortality in nonwhite and Hispanic patients, similar to that seen in white, non-Hispanic patients. These data support a similar approach to ICD patient selection, regardless of race or ethnicity.
Topics: Age Factors; Aged; Aged, 80 and over; Comparative Effectiveness Research; Death, Sudden, Cardiac; Defibrillators, Implantable; Electric Countershock; Ethnicity; Healthcare Disparities; Humans; Medicare; Minority Groups; Primary Prevention; Racial Groups; Registries; Risk Factors; Time Factors; Treatment Outcome; United States
PubMed: 25504649
DOI: 10.1161/CIRCEP.114.001878 -
Epidemiologia E Prevenzione 2015Cancer screening may represent an ideal setting for promoting healthy lifestyle. We conducted a literature review of intervention studies of primary prevention... (Review)
Review
Cancer screening may represent an ideal setting for promoting healthy lifestyle. We conducted a literature review of intervention studies of primary prevention interventions implemented in the context of established screening programmes. We identified 11 trials, 3 of which conducted in Italy. A positive impact of these interventions in favouring the adoption of cancer protective dietary behaviours was observed in all studies. A limited impact was reported for physical activity, while no effect could be observed for interventions aimed to promote smoking cessation. Long term maintenance of the observed behavioural changes and the sustainability overtime of these interventions within population-based programmes should be assessed. To enhance their effectiveness, these health education programmes should include multiple strategies, integrating and combining models of individual, social, and environmental change.
Topics: Clinical Trials as Topic; Diet; Early Detection of Cancer; Health Education; Humans; Italy; Neoplasms; Primary Prevention
PubMed: 26554687
DOI: No ID Found -
BMJ Open Jun 2017It is uncertain whether multiple health behaviour change (MHBC) interventions are effective for the primary prevention of cardiovascular disease (CVD) in primary care. A... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
It is uncertain whether multiple health behaviour change (MHBC) interventions are effective for the primary prevention of cardiovascular disease (CVD) in primary care. A systematic review and a meta-analysis were performed to evaluate the effectiveness of MHBC interventions on CVD risk and CVD risk factors; the study also evaluated associations of theoretical frameworks and intervention components with intervention effectiveness.
METHODS
The search included randomised controlled trials of MHBC interventions aimed at reducing CVD risk in primary prevention population up to 2017. Theoretical frameworks and intervention components were evaluated using standardised methods. Meta-analysis with stratification and meta-regression were used to evaluate intervention effects.
RESULTS
We identified 31 trials (36 484 participants) with a minimum duration of 12 months follow-up. Pooled net change in systolic blood pressure (16 trials) was -1.86 (95% CI -3.17 to -0.55; p=0.01) mm Hg; diastolic blood pressure (15 trials), -1.53 (-2.43 to -0.62; p=0.001) mm Hg; body mass index (14 trials), -0.13 (-0.26 to -0.01; p=0.04) kg/m; serum total cholesterol (14 trials), -0.13 (-0.19 to -0.07; p<0.001) mmol/L. There was no significant association between interventions with a reported theoretical basis and improved intervention outcomes. No association was observed between intervention intensity (number of sessions and intervention duration) and intervention outcomes. There was significant heterogeneity for some risk factor analyses, leading to uncertain validity of some pooled net changes.
CONCLUSIONS
MHBC interventions delivered to CVD-free participants in primary care did not appear to have quantitatively important effects on CVD risk factors. Better reporting of interventions' rationale, content and delivery is essential to understanding their effectiveness.
Topics: Cardiovascular Diseases; Health Behavior; Humans; Primary Health Care; Primary Prevention; Randomized Controlled Trials as Topic; Risk Factors
PubMed: 28619779
DOI: 10.1136/bmjopen-2016-015375 -
Women's Health (London, England) Jan 2016
Topics: Endometrium; Female; Humans; Menorrhagia; Primary Prevention; Women's Health
PubMed: 26767314
DOI: 10.2217/whe.15.71 -
Cancer Prevention Research... Feb 2017In late 2015, the NCI Division of Cancer Prevention convened cancer prevention research experts and stakeholders to discuss the current state of cancer prevention... (Review)
Review
In late 2015, the NCI Division of Cancer Prevention convened cancer prevention research experts and stakeholders to discuss the current state of cancer prevention research, identify key prevention research priorities for the NCI, and identify studies that could be conducted within the NCI Community Oncology Research Program. Goals included identifying cancer prevention research opportunities offering the highest return on investment, exploring the concept of precision prevention and what is needed to advance this area of research, and identifying possible targets for prevention. Four study populations were considered for cancer prevention research: healthy people, those at increased risk for a specific cancer, people with preneoplastic lesions, and children, adolescents, and young adults. Priorities that emerged include screening (e.g., surveillance intervals, tomosynthesis vs. digital mammography), a pre-cancer genome atlas (PreTCGA), HPV vaccines, immunoprevention of noninfectious origins, and overdiagnosis. Challenges exist, as the priority list is ambitious and potentially expensive. Clinical trials need to be carefully designed to include and maximize prospective tissue collection. Exploring existing cofunding mechanisms will likely be necessary. Finally, relationships with a new generation of physician specialists will need to be cultivated to reach the target populations. Cancer Prev Res; 10(2); 99-107. ©2016 AACR.
Topics: Humans; Neoplasms; Primary Prevention
PubMed: 27965286
DOI: 10.1158/1940-6207.CAPR-16-0230 -
International Journal of Cardiology Jul 2024The effects of bempedoic acid on mortality in the secondary prevention setting have not been examined.
BACKGROUND
The effects of bempedoic acid on mortality in the secondary prevention setting have not been examined.
METHODS
We used data from the overall and primary prevention reports of CLEAR - Outcomes to reconstruct data for the secondary prevention population. A Bayesian analyses was employed to calculate the posterior probability of benefit or harm for the outcomes of all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACE). Relative effect sizes are presented as risk ratios (RR) with 95% credible intervals (CrI), which represent the intervals that true effect sizes are expected to fall in with 95% probability, given the priors and model.
RESULTS
In primary prevention, the posterior probability of bempedoic acid decreasing all-cause and cardiovascular mortality was 99.4% (RR: 0.70; 95% CrI: 0.51 to 0.92) and 99.7% (RR: 0.58; 95% CrI: 0.38 to 0.86) respectively. In secondary prevention, the posterior probability of bempedoic acid increasing all-cause and cardiovascular mortality was 96.6% (RR: 1.15; 95% CrI: 0.99 to 1.33) and 97.2% (RR: 1.21; 95% CrI: 1.00 to 1.45) respectively. The probability of bemepdoic acid reducing MACE in the primary and secondary prevention settings was 99.9% (RR: 0.70; 95% CrI: 0.54 to 0.88) and 95.8% (RR: 0.92; 95% CrI: 0.84 to 1.01) respectively.
CONCLUSION
In contrast to its effect in the primary prevention subgroup of CLEAR - Outcomes, bempedoic acid resulted in a more modest MACE reduction and a potential increase in mortality in the secondary prevention subgroup. Whether these findings represent true treatment effect heterogeneity or the play of chance requires further evidence.
Topics: Aged; Female; Humans; Male; Middle Aged; Cardiovascular Diseases; Dicarboxylic Acids; Double-Blind Method; Fatty Acids; Primary Prevention; Secondary Prevention; Treatment Outcome
PubMed: 38643794
DOI: 10.1016/j.ijcard.2024.132074 -
Journal of General Internal Medicine Jul 2019
Review
Topics: Evidence-Based Medicine; Humans; Primary Prevention; Time Factors; Treatment Outcome
PubMed: 31062228
DOI: 10.1007/s11606-019-05032-4 -
BMC Health Services Research Sep 2016The use of e-health and m-health technologies in health promotion and primary prevention among older people is largely unexplored. This study provides a systematic... (Review)
Review
BACKGROUND
The use of e-health and m-health technologies in health promotion and primary prevention among older people is largely unexplored. This study provides a systematic review of the evidence on the scope of the use of e-health and m-health tools in health promotion and primary prevention among older adults (age 50+).
METHODS
A systematic literature review was conducted in October 2015. The search for relevant publications was done in the search engine PubMed. The key inclusion criteria were: e-health and m-health tools used, participants' age 50+ years, focus on health promotion and primary prevention, published in the past 10 years, in English, and full-paper can be obtained. The text of the publications was analyzed based on two themes: the characteristics of e-health and m-health tools and the determinants of the use of these tools by older adults. The quality of the studies reviewed was also assessed.
RESULTS
The initial search resulted in 656 publications. After we applied the inclusion and exclusion criteria, 45 publications were selected for the review. In the publications reviewed, various types of e-health/m-health tools were described, namely apps, websites, devices, video consults and webinars. Most of the publications (60 %) reported studies in the US. In 37 % of the publications, the study population was older adults in general, while the rest of the publications studied a specific group of older adults (e.g. women or those with overweight). The publications indicated various facilitators and barriers. The most commonly mentioned facilitator was the support for the use of the e-health/m-health tools that the older adults received.
CONCLUSIONS
E-health and m-health tools are used by older adults in diverse health promotion programs, but also outside formal programs to monitor and improve their health. The latter is hardly studied. The successful use of e-health/m-health tools in health promotion programs for older adults greatly depends on the older adults' motivation and support that older adults receive when using e-health and m-health tools.
Topics: Aged; Global Health; Health Promotion; Healthy Lifestyle; Humans; Internet; Mobile Applications; Motivation; Primary Prevention; Telemedicine
PubMed: 27608677
DOI: 10.1186/s12913-016-1522-3 -
Rural and Remote Health 2016Unintentional injuries (injuries for which there is no evidence of a predetermined intent) are one of the leading causes of death worldwide, particularly in low- and... (Review)
Review
INTRODUCTION
Unintentional injuries (injuries for which there is no evidence of a predetermined intent) are one of the leading causes of death worldwide, particularly in low- and middle-income countries (LMICs). Although evidence demonstrates unintentional injuries are preventable it is a public health challenge for many LMICs such as the Solomon Islands. Occupational therapists are well placed to contribute to injury prevention, as they have specialised skills to analyse the accessibility and safety of the environments within which people conduct their daily occupations. While the role of occupational therapy in unintentional injury prevention is well known in high-income countries, it is unfamiliar in LMICs, especially in the Solomon Islands. This integrative review aimed to explore the incidence of common unintentional injuries, and the burden in the Solomon Islands; and explore the potential role of occupational therapy in unintentional injury prevention in the Solomon Islands, based on current activities in LMICs.
METHOD
Articles were reviewed from six databases (Medline, CINAHL, OTDBase, OT Seeker, Scopus and PsychInfo). Five articles met the inclusion criteria for the first objective and 15 articles met the inclusion criteria for the second objective. These articles were thematically analysed where themes and codes associated with the research objectives were extracted and analysed.
RESULTS
Unintentional injuries in the Solomon Islands reported in the literature included ocular trauma, falls from fruit trees and coconut palms, and road traffic crashes. Burden of injury reported was mostly associated with loss of productivity. Occupational therapists undertook rehabilitative, biomechanical, neurodevelopmental and educational roles in LMIC, focusing on tertiary and secondary injury prevention.
CONCLUSIONS
This integrative review suggests that there is limited information regarding injury in the Solomon Islands. However, evidence is available in LMICs to suggest that occupational therapy services can play a potential significant role in unintentional injury prevention, demonstrating a need for establishing injury prevention within the occupational therapy role in the Solomon Islands.
Topics: Accidents, Occupational; Developing Countries; Female; Humans; Male; Melanesia; Occupational Therapy; Primary Prevention; Wounds and Injuries
PubMed: 27764951
DOI: No ID Found