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JACC. Clinical Electrophysiology Jan 2022
Topics: Defibrillators, Implantable; Humans; Primary Prevention; Risk Assessment
PubMed: 35057976
DOI: 10.1016/j.jacep.2021.11.005 -
The Cochrane Database of Systematic... Nov 2017A major determinant in cardiovascular disease (CVD) is stress. As transcendental meditation (TM) is thought to help in lowering negative stress indicators, it may be a... (Review)
Review
BACKGROUND
A major determinant in cardiovascular disease (CVD) is stress. As transcendental meditation (TM) is thought to help in lowering negative stress indicators, it may be a beneficial strategy for the primary prevention of CVD.
OBJECTIVES
To determine the effectiveness of TM for the primary prevention of CVD.
SEARCH METHODS
We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 10); MEDLINE (Ovid) (1946 to week three November 2013); EMBASE Classic and EMBASE (Ovid) (1947 to week 48 2013); ISI Web of Science (1970 to 28 November 2013); and Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment Database and Health Economics Evaluations Database (November 2013). We also searched the Allied and complementary Medicine Database (AMED) (inception to January 2014) and IndMed (inception to January 2014). We handsearched trial registers and reference lists of reviews and articles and contacted experts in the field. We applied no language restrictions.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) of at least three months' duration involving healthy adults or adults at high risk of CVD. Trials examined TM only and the comparison group was no intervention or minimal intervention. We excluded trials that involved multi-factorial interventions. Outcomes of interest were clinical CVD events (cardiovascular mortality, all-cause mortality and non-fatal events) and major CVD risk factors (e.g. blood pressure and blood lipids, occurrence of type 2 diabetes, quality of life, adverse events and costs).
DATA COLLECTION AND ANALYSIS
Two authors independently selected trials for inclusion, extracted data and assessed the risk of bias.
MAIN RESULTS
We identified four trials (four papers) (430 participants) for inclusion in this review. We identified no ongoing studies. The included trials were small, short term (three months) and at risk of bias. In all studies, TM was practised for 15 to 20 minutes twice a day.None of the included studies reported all-cause mortality, cardiovascular mortality or non-fatal endpoints as trials were short term, but one study reported survival rate three years after the trial was completed. In view of the considerable statistical heterogeneity between the results of the studies for the only outcomes reported, systolic blood pressure (I = 72%) and diastolic blood pressure (I = 66%), we decided not to undertake a meta-analysis. None of the four trials reported blood lipids, occurrence of type 2 diabetes, adverse events, costs or quality of life.
AUTHORS' CONCLUSIONS
Currently, there are few trials with limited outcomes examining the effectiveness of TM for the primary prevention of CVD. Due to the limited evidence to date, we could draw no conclusions as to the effectiveness of TM for the primary prevention of CVD. There was considerable heterogeneity between trials and the included studies were small, short term and at overall serious risk of bias. More and larger long-term, high-quality trials are needed.
Topics: Adult; Blood Pressure; Cardiovascular Diseases; Humans; Meditation; Primary Prevention; Stress, Psychological
PubMed: 29140556
DOI: 10.1002/14651858.CD010359.pub3 -
American Family Physician Aug 2019
Review
Topics: Cardiovascular Diseases; Clinical Trials as Topic; Dietary Supplements; Fatty Acids, Omega-3; Fish Oils; Heart Rate; Humans; Lipid Metabolism; Primary Prevention; Secondary Prevention
PubMed: 31414778
DOI: No ID Found -
JACC. Heart Failure Aug 2019
Topics: Cardiomyopathies; Defibrillators, Implantable; Denmark; Heart Failure; Humans; Primary Prevention
PubMed: 31302053
DOI: 10.1016/j.jchf.2019.05.011 -
Journal of the American Heart... Sep 2017Despite numerous advances in the prevention and treatment of atherosclerosis, cardiovascular disease remains a leading cause of morbidity and mortality. Novel and... (Review)
Review
Despite numerous advances in the prevention and treatment of atherosclerosis, cardiovascular disease remains a leading cause of morbidity and mortality. Novel and inexpensive interventions that can contribute to the primary and secondary prevention of cardiovascular disease are of interest. Numerous studies have reported on the benefits of meditation. Meditation instruction and practice is widely accessible and inexpensive and may thus be a potential attractive cost-effective adjunct to more traditional medical therapies. Accordingly, this American Heart Association scientific statement systematically reviewed the data on the potential benefits of meditation on cardiovascular risk. Neurophysiological and neuroanatomical studies demonstrate that meditation can have long-standing effects on the brain, which provide some biological plausibility for beneficial consequences on the physiological basal state and on cardiovascular risk. Studies of the effects of meditation on cardiovascular risk have included those investigating physiological response to stress, smoking cessation, blood pressure reduction, insulin resistance and metabolic syndrome, endothelial function, inducible myocardial ischemia, and primary and secondary prevention of cardiovascular disease. Overall, studies of meditation suggest a possible benefit on cardiovascular risk, although the overall quality and, in some cases, quantity of study data are modest. Given the low costs and low risks of this intervention, meditation may be considered as an adjunct to guideline-directed cardiovascular risk reduction by those interested in this lifestyle modification, with the understanding that the benefits of such intervention remain to be better established. Further research on meditation and cardiovascular risk is warranted. Such studies, to the degree possible, should utilize randomized study design, be adequately powered to meet the primary study outcome, strive to achieve low drop-out rates, include long-term follow-up, and be performed by those without inherent bias in outcome.
Topics: American Heart Association; Blood Pressure; Cardiovascular Diseases; Endothelium, Vascular; Humans; Insulin Resistance; Meditation; Primary Prevention; Risk Factors; Risk Reduction Behavior; Secondary Prevention; Smoking; Smoking Cessation; Treatment Outcome; United States
PubMed: 28963100
DOI: 10.1161/JAHA.117.002218 -
Ciencia & Saude Coletiva Mar 2020In Medicine, it is critical "to offer 100% of what is needed and avoid 100% of what is not needed." Unfortunately, this primary issue is challenging, and generally, more... (Review)
Review
In Medicine, it is critical "to offer 100% of what is needed and avoid 100% of what is not needed." Unfortunately, this primary issue is challenging, and generally, more than required is offered, and everything that is unnecessary is not avoided. This is a nonsystematic review with a teaching objective that reviews the general issue in primary care and suggests ways to avoid overuse and shortcomings concerning preventive, diagnostic, therapeutic, and rehabilitative interventions. Knowing not to do is science and art that is hardly taught and practiced less. The overuse that harm are an almost daily part of clinical practice in prevention, diagnosis, treatment, and rehabilitation. It is essential to promote "the art and science of not doing".
Topics: Community Medicine; Diagnostic Techniques and Procedures; Family Practice; Health Services Misuse; Humans; Physician-Patient Relations; Primary Prevention; Rehabilitation; Therapeutics; Unnecessary Procedures
PubMed: 32267426
DOI: 10.1590/1413-81232020254.30082019 -
Public Health Research & Practice Jun 2024Skin cancer is highly preventable through primary prevention activities such as avoiding ultraviolet radiation exposure during peak times and regular use of sun... (Review)
Review
OBJECTIVES
Skin cancer is highly preventable through primary prevention activities such as avoiding ultraviolet radiation exposure during peak times and regular use of sun protection. General practitioners (GPs) and primary care nurses have key responsibilities in promoting sustained primary prevention behaviour. We aimed to review the evidence on skin cancer primary prevention activities in primary care settings, including evidence on feasibility, effectiveness, barriers and enablers.
STUDY TYPE
Rapid review and narrative synthesis.
METHODS
We searched published literature from January 2011 to October 2022 in Embase, Medline, PsychInfo, Scopus, Cochrane Central and CINAHL. The search was limited to skin cancer primary prevention activities within primary care settings, for studies or programs conducted in Australia or countries with comparable health systems. Analysis of barriers and enablers was informed by an implementation science framework.
RESULTS
A total of 31 peer-reviewed journal articles were included in the review. We identified four main primary prevention activities: education and training programs for GPs; behavioural counselling on prevention; the use of novel risk assessment tools and provision of risk-tailored prevention strategies; and new technologies to support early detection that have accompanying primary prevention advice. Enablers to delivering skin cancer primary prevention in primary care included pairing preventive activities with early detection activities, and access to patient resources and programs that fit with existing workflows and systems. Barriers included unclear requirements for skin cancer prevention counselling, competing demands within the consultation and limited access to primary care services, especially in regional and remote areas.
CONCLUSIONS
These findings highlight potential opportunities for improving skin cancer prevention activities in primary care. Ensuring ease of program delivery, integration with early detection and availability of resources such as risk assessment tools are enablers to encourage and increase uptake of primary prevention behaviours in primary care, for both practitioners and patients.
Topics: Humans; Skin Neoplasms; Primary Health Care; Primary Prevention; Australia
PubMed: 38316050
DOI: 10.17061/phrp34012401 -
BMC Pediatrics Sep 2021
Topics: Child; Humans; Primary Health Care; Primary Prevention; Secondary Prevention
PubMed: 34496790
DOI: 10.1186/s12887-021-02787-w -
European Heart Journal Mar 2024Knowledge of quantifiable cardiovascular disease (CVD) risk may improve health outcomes and trigger behavioural change in patients or clinicians. This review aimed to... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
Knowledge of quantifiable cardiovascular disease (CVD) risk may improve health outcomes and trigger behavioural change in patients or clinicians. This review aimed to investigate the impact of CVD risk communication on patient-perceived CVD risk and changes in CVD risk factors.
METHODS
PubMed, Embase, and PsycINFO databases were searched from inception to 6 June 2023, supplemented by citation analysis. Randomized trials that compared any CVD risk communication strategy versus usual care were included. Paired reviewers independently screened the identified records and extracted the data; disagreements were resolved by a third author. The primary outcome was the accuracy of risk perception. Secondary outcomes were clinician-reported changes in CVD risk, psychological responses, intention to modify lifestyle, and self-reported changes in risk factors and clinician prescribing of preventive medicines.
RESULTS
Sixty-two trials were included. Accuracy of risk perception was higher among intervention participants (odds ratio = 2.31, 95% confidence interval = 1.63 to 3.27). A statistically significant improvement in overall CVD risk scores was found at 6-12 months (mean difference = -0.27, 95% confidence interval = -0.45 to -0.09). For primary prevention, risk communication significantly increased self-reported dietary modification (odds ratio = 1.50, 95% confidence interval = 1.21 to 1.86) with no increase in intention or actual changes in smoking cessation or physical activity. A significant impact on patients' intention to start preventive medication was found for primary and secondary prevention, with changes at follow-up for the primary prevention group.
CONCLUSIONS
In this systematic review and meta-analysis, communicating CVD risk information, regardless of the method, reduced the overall risk factors and enhanced patients' self-perceived risk. Communication of CVD risk to patients should be considered in routine consultations.
Topics: Humans; Cardiovascular Diseases; Risk Factors; Communication; Smoking Cessation; Exercise; Primary Prevention
PubMed: 38243824
DOI: 10.1093/eurheartj/ehae002 -
JACC. Clinical Electrophysiology Feb 2018
Topics: Death, Sudden, Cardiac; Defibrillators, Implantable; Hospitalization; Humans; Primary Prevention; Shock
PubMed: 29749946
DOI: 10.1016/j.jacep.2017.10.012