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BMJ Open Jun 2017The objective of this meta-analysis of randomised controlled trials (RCTs) is to evaluate the role of primary prevention implantable cardioverter defibrillator (ICD) in... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The objective of this meta-analysis of randomised controlled trials (RCTs) is to evaluate the role of primary prevention implantable cardioverter defibrillator (ICD) in patients with non-ischaemic cardiomyopathy (NICM).
SETTING
A meta-analysis of RCTs performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.
DATA SOURCES
The PubMed, MEDLINE, Embase and Cochrane Central Register of Controlled Trials databases were searched for relevant articles.
PARTICIPANTS
A total of 5 RCTs with 2573 patients with NICM were included.
INTERVENTION
Primary prevention ICD, compared with medical therapy alone.
PRIMARY AND SECONDARY OUTCOME MEASURES
All-cause mortality (primary outcome) and sudden cardiac death (SCD, secondary outcome).
DATA ANALYSIS
Summary estimate HR were constructed using the random-effect DerSimonian and Laird's model. Multiple study-level subgroup analyses were performed, and interaction was tested using random-effect analysis.
RESULTS
Compared with medical therapy alone, ICD placement was associated with lower risk of all-cause mortality (HR 0.79; 95% CI 0.64 to 0.93; p<0.001; I=0%) at a mean follow-up of 4.2 years. The risk of SCD was also lower with ICD placement (RR 0.47; 95% CI 0.30 to 0.73; p=0.001; I=0%) compared with control. On subgroup analyses, there was a suggestion of possible effect modification by age, in which benefit was observed in age group <60 years (HR 0.64; 95% CI 0.47 to 0.89), but not with age ≥60 years (HR 0.82; 95% CI 0.65 to 1.03) (P=0.058), but not with other study-level variables.
CONCLUSIONS
Compared with medical therapy alone, primary prevention ICD therapy in patients with NICM is associated with a significant reduction in all-cause mortality, especially in younger patients. Future dedicated studies are needed to investigate the role of primary prevention ICD in the elderly population.
PROSPEROREGISTRATIONNUMBER
PROSPERO CRD42016052010.
Topics: Age Factors; Cardiomyopathies; Death, Sudden, Cardiac; Defibrillators, Implantable; Humans; Middle Aged; Primary Prevention; Randomized Controlled Trials as Topic
PubMed: 28637742
DOI: 10.1136/bmjopen-2017-016352 -
International Journal of Environmental... Aug 2014Many people at risk of suicide do not seek help before an attempt, and do not remain connected to health services following an attempt. E-health interventions are now... (Review)
Review
Many people at risk of suicide do not seek help before an attempt, and do not remain connected to health services following an attempt. E-health interventions are now being considered as a means to identify at-risk individuals, offer self-help through web interventions or to deliver proactive interventions in response to individuals' posts on social media. In this article, we examine research studies which focus on these three aspects of suicide and the internet: the use of online screening for suicide, the effectiveness of e-health interventions aimed to manage suicidal thoughts, and newer studies which aim to proactively intervene when individuals at risk of suicide are identified by their social media postings. We conclude that online screening may have a role, although there is a need for additional robust controlled research to establish whether suicide screening can effectively reduce suicide-related outcomes, and in what settings online screening might be most effective. The effectiveness of Internet interventions may be increased if these interventions are designed to specifically target suicidal thoughts, rather than associated conditions such as depression. The evidence for the use of intervention practices using social media is possible, although validity, feasibility and implementation remains highly uncertain.
Topics: Depression; Depressive Disorder; Humans; Internet; Primary Prevention; Suicidal Ideation; Telemedicine; Suicide Prevention
PubMed: 25119698
DOI: 10.3390/ijerph110808193 -
Occupational Medicine (Oxford, England) Jul 2020
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Occupational Health Services; Pandemics; Pneumonia, Viral; Primary Prevention; SARS-CoV-2
PubMed: 32347933
DOI: 10.1093/occmed/kqaa075 -
Circulation Journal : Official Journal... Jun 2024
Topics: Humans; Aged, 80 and over; Primary Prevention; Defibrillators, Implantable; Aged; Age Factors
PubMed: 38763734
DOI: 10.1253/circj.CJ-24-0310 -
Cardiovascular Therapeutics Jun 2017Implantable cardioverter defibrillators (ICDs) have proved their favorable outcomes on survival in selected patients with cardiomyopathy. Although previous meta-analyses... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Implantable cardioverter defibrillators (ICDs) have proved their favorable outcomes on survival in selected patients with cardiomyopathy. Although previous meta-analyses have shown benefit for their use in primary prevention, the evidence remains less robust for patients with nonischemic cardiomyopathy (NICM) in comparison to patients with coronary artery disease (CAD).
OBJECTIVES
To evaluate the effect of ICD therapy on reducing all-cause mortality and sudden cardiac death (SCD) in patients with NICM.
DATA SOURCES
PubMed (1993-2016), the Cochrane Central Register of Controlled Trials (2000-2016), reference lists of relevant articles, and previous meta-analyses. Search terms included defibrillator, heart failure, cardiomyopathy, randomized controlled trials, and clinical trials.
STUDY SELECTION
Eligible trials were randomized controlled trials with at least an arm of ICD, an arm of medical therapy and enrolled some patients with NICM. The primary endpoint in the trials should include all-cause mortality or mortality from SCD.
DATA EXTRACTION
Hazard ratios (HRs) for all-cause mortality and mortality from SCD were either extracted or calculated along with their standard errors.
DATA SYNTHESIS
Of the 1047 abstracts retained by the initial screen, eight randomized controlled trials were identified. Five of these trials reported relevant data regarding patients with NICM and were subsequently included in this meta-analysis. Pooled analysis of HRs suggested a statistically significant reduction in all-cause mortality among a total of 2573 patients randomized to ICD vs medical therapy (HR 0.80; 95% CI, 0.67-0.96; P=.02). Pooled analysis of HRs for mortality from SCD was also statistically significant (n=1677) (HR 0.51; 95% CI, 0.34-0.76; P=.001).
CONCLUSION
ICD implantation is beneficial in terms of all-cause mortality and mortality from SCD in certain subgroups of patients with NICM.
Topics: Adult; Aged; Cardiomyopathies; Death, Sudden, Cardiac; Defibrillators, Implantable; Electric Countershock; Female; Humans; Male; Middle Aged; Odds Ratio; Primary Prevention; Prosthesis Design; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 28129469
DOI: 10.1111/1755-5922.12253 -
The American Journal of Tropical... May 2021Plague, a fleaborne rodent-associated zoonosis, is a neglected disease with most recent cases reported from east and central Africa and Madagascar. Because of its low... (Review)
Review
Plague, a fleaborne rodent-associated zoonosis, is a neglected disease with most recent cases reported from east and central Africa and Madagascar. Because of its low incidence and sporadic occurrence, most of our knowledge of plague ecology, prevention, and control derives from investigations conducted in response to human cases. Long-term studies (which are uncommon) are required to generate data to support plague surveillance, prevention, and control recommendations. Here we describe a 15-year, multidisciplinary commitment to plague in the West Nile region of Uganda that led to significant advances in our understanding of where and when persons are at risk for plague infection and how to reduce morbidity and mortality. These findings provide data-driven support for several existing recommendations on plague surveillance and prevention and may be generalizable to other plague foci.
Topics: Ecology; Epidemiological Monitoring; Humans; Incidence; Longitudinal Studies; Plague; Primary Prevention; Risk Factors; Uganda; Yersinia pestis
PubMed: 33939638
DOI: 10.4269/ajtmh.20-1381 -
Cleveland Clinic Journal of Medicine Jul 2020
Topics: Aspirin; Humans; Platelet Aggregation Inhibitors; Primary Prevention
PubMed: 32737042
DOI: 10.3949/ccjm.87c.08006 -
Advances in Nutrition (Bethesda, Md.) May 2019With the high burden of cancer worldwide, primary prevention has been identified as a key cancer control strategy to reduce this burden. Diet and nutrition are important...
With the high burden of cancer worldwide, primary prevention has been identified as a key cancer control strategy to reduce this burden. Diet and nutrition are important modifiable factors that may alter the risk of developing cancer, because several dietary components including alcohol consumption, fruit and vegetable intake, and dietary fiber have been shown to significantly impact cancer risk. Consequently, a number of organizations have developed cancer prevention guidelines that highlight the importance of nutrition (and related factors including body size and physical activity) to reduce the risk of cancer. However, there are barriers to the uptake of these guidelines, particularly with respect to diet and nutrition including awareness, communication, and other factors that influence eating behavior. Improved knowledge translation (KT) of recommendations may help facilitate uptake. The purposes of this narrative review are: 1) to examine issues and challenges related to KT of diet and nutrition evidence in the context of cancer prevention, including public awareness and attitudes towards cancer prevention, engagement in cancer prevention strategies, and effects of KT on diet-cancer preventive behaviors; 2) to discuss examples of effective and ineffective KT of diet and nutrition evidence; and 3) to provide recommendations for improving KT to help move the field of diet, nutrition, and cancer prevention forward. Evidence shows that adherence to nutrition recommendations for cancer prevention significantly reduces the risk of cancer; however, engagement in nutrition-based preventative behaviors is low. Skepticism and confusion around evidence linking diet and nutrition with cancer may arise, in part, through ineffective media KT; the primary source of health information for many people. Simple, tailored, targeted KT communication strategies aimed at increasing the general public's awareness, attitudes, and engagement in cancer preventive behavior should be emphasized to encourage cancer control.
Topics: Diet; Health Behavior; Health Promotion; Humans; Neoplasms; Nutritional Sciences; Primary Prevention; Translational Research, Biomedical
PubMed: 30915435
DOI: 10.1093/advances/nmy089 -
Current HIV/AIDS Reports Mar 2015In light of the 2 million HIV infections that occur globally each year, there is a need to optimize strategies that integrate biomedical and behavioral approaches to HIV... (Review)
Review
In light of the 2 million HIV infections that occur globally each year, there is a need to optimize strategies that integrate biomedical and behavioral approaches to HIV prevention. Post-exposure prophylaxis (PEP) immediately after acute high-risk exposures and pre-exposure prophylaxis (PrEP) for those who engage in recurrent high-risk behaviors are promising bio-behavioral approaches to decreasing HIV transmission. Guidelines have recommended PEP for occupational and non-occupational exposures for over 15 years, but uptake of PEP has been limited, partly as a result of insufficient awareness of this intervention among persons at highest risk for acquiring HIV. However, since the publication of large randomized clinical trials demonstrating the efficacy of PrEP, and the dissemination of guidelines endorsing its use, there is a renewed focus on bio-behavioral prevention. Numerous studies have recently assessed the acceptability of bio-behavioral prevention programs among diverse populations or described experiences implementing these programs in "real-world" settings. As research and clinical data informing optimal utilization of PEP and PrEP are rapidly accumulating, this review provides a timely summary of recent progress in bio-behavioral prevention. By contextualizing the most noteworthy recent findings regarding PEP and PrEP, this review seeks to inform the successful implementation of these promising prevention approaches.
Topics: Anti-Retroviral Agents; HIV Infections; Humans; Post-Exposure Prophylaxis; Pre-Exposure Prophylaxis; Primary Prevention
PubMed: 25600106
DOI: 10.1007/s11904-014-0253-5 -
Cleveland Clinic Journal of Medicine Jul 2020
Topics: Aspirin; Atherosclerosis; Humans; Platelet Aggregation Inhibitors; Primary Prevention
PubMed: 32737041
DOI: 10.3949/ccjm.87c.08005