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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 -
International Journal of Environmental... Feb 2022The aim of this study was to evaluate the effectiveness of physical activity in the primary prevention of anxiety. A systematic review of randomized controlled trials... (Meta-Analysis)
Meta-Analysis Review
The aim of this study was to evaluate the effectiveness of physical activity in the primary prevention of anxiety. A systematic review of randomized controlled trials (RCTs) was performed. RCTs were searched in seven electronic databases. We included RCTs that assessed either the incidence of anxiety or the reduction of anxiety symptoms which excluded participants with baseline anxiety. Measurements were required to have been made using validated instruments. Objective or subjective (with validated questionnaires) verification of the performance of physical activity was required. Three reviewers carried out the search, selection, data extraction, and risk assessment of Cochrane Collaboration's tool simultaneously and independently, reaching an agreement in their discrepancies by consensus. In addition, a meta-analysis of fixed-effects model was carried out. Three RCTs met inclusion criteria, comprising 350 patients from 3 different countries. A meta-analysis was performed using five comparisons extracted from the selected studies, and the pooled standardized mean difference (SMD) was -0.18 (95% CI: -0.44; 0.07), = 0.158. The heterogeneity was irrelevant, I = 17.7% ( = 0.30). There is no evidence that anxiety can be prevented through physical activity, although the quality of evidence was very low.
Topics: Anxiety; Anxiety Disorders; Exercise; Humans; Primary Prevention; Randomized Controlled Trials as Topic
PubMed: 35162835
DOI: 10.3390/ijerph19031813 -
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 -
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 -
PloS One 2022A significant proportion of cardiovascular disease (CVD) morbidity and mortality could be prevented via the population-based and cost-effective interventions. A...
BACKGROUND
A significant proportion of cardiovascular disease (CVD) morbidity and mortality could be prevented via the population-based and cost-effective interventions. A fixed-dose combination treatment is known as the polypill for the primary and secondary prevention of CVD has come up in recent years.
PURPOSE
In order to provide recommendations for future economic evaluations, this systematic review aimed to review and assess the quality of published evidence on the cost-effectiveness of polypill in primary and secondary prevention of CVD, to identify the key drivers that impact the cost-effectiveness.
METHODS
A systematic review of literature, following the PRISMA guidelines, was undertaken in the electronic databases. Two researchers identified the relevant studies according to inclusion and exclusion criteria. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to quality assessment of included studies. ICERs value adjusted to 2020 United States Dollar using consumer price index (CPI) and purchasing power parity (PPP). Finally, data were summarized via a narrative synthesis.
RESULTS
In total, 24 articles were identified based on the determined inclusion criteria. All studies met more than 50% of the CHEERS criteria. Adjusted incremental cost-effectiveness ratios varied from 24$ to 31000$(2020 US dollar) among the studies. The polypill resulted in the improved adherence and quality of life, at a price equal to or lower than multiple monotherapies. This price is typically below the commonly accepted thresholds or cost saving in both, primary and secondary prevention of CVD. The main identified cost-effectiveness drivers were the polypill price, adherence, age, CVD risk, and drug combination.
CONCLUSIONS
This systematic review found that the polypill seemed to be a cost-effective intervention in primary and secondary prevention of CVD. However, it is necessary to conduct more economic evaluation studies based on the long-term clinical trials with large populations. Also, studies should consider how the polypill interacts with other primary and secondary preventive strategies as a complementary health strategy.
Topics: Cardiovascular Diseases; Cost-Benefit Analysis; Drug Combinations; Humans; Primary Prevention; Quality of Life; Secondary Prevention
PubMed: 35901100
DOI: 10.1371/journal.pone.0271908 -
Journal of Advanced Nursing Oct 2022To evaluate the effectiveness of cardiovascular risk communication strategies to improve understanding and promote risk factor modification. (Review)
Review
AIM
To evaluate the effectiveness of cardiovascular risk communication strategies to improve understanding and promote risk factor modification.
DESIGN
Systematic review with narrative synthesis.
DATA SOURCES
A comprehensive database search for quantitative and qualitative studies was conducted in five databases, Cumulative Index to Nursing and Allied health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), EMBASE, Applied Social Sciences Index and Abstracts (ASSIA) and Web of Science. The searches were conducted between 1980 and July 2019.
REVIEW METHODS
The systematic review was conducted in accordance with Cochrane review methods. Data were extracted and a narrative synthesis of quantitative and qualitative results was undertaken.
RESULTS
The abstracts of 16,613 articles were assessed and 210 underwent in-depth review, with 31 fulfilling the inclusion criteria. We observed significant heterogeneity across study designs and outcomes. Nine communication strategies were identified including numerical formats, graphical formats, qualitative information, infographics, avatars, game interactions, timeframes, genetic risk scores and cardiovascular imaging. Strategies that used cardiovascular imaging had the biggest impact on health behaviour change and risk factor modification. Improvements were seen in diet, exercise, smoking, risk scores, cholesterol and intentions to take preventive medication.
CONCLUSION
A wide range of cardiovascular risk communication strategies has been evaluated, with those that employ personalized and visual evidence of current cardiovascular health status more likely to promote action to reduce risk.
IMPACT
Future risk communication strategies should incorporate methods to provide individuals with evidence of their current cardiovascular health status.
Topics: Cardiovascular Diseases; Communication; Heart Disease Risk Factors; Humans; Primary Prevention; Risk Factors
PubMed: 35719002
DOI: 10.1111/jan.15327 -
Nutrition, Metabolism, and... Apr 2018To systematically review the latest evidence on established and emerging nutrition-related risk factors for incidence of and mortality from total, ischemic and... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
To systematically review the latest evidence on established and emerging nutrition-related risk factors for incidence of and mortality from total, ischemic and haemorrhagic strokes. The present review was conducted in the framework of the work carried out through 2015 and 2016 for the preparation of the Italian Guidelines for the Prevention and Treatment of Stroke, 8th Edition, by ISO-SPREAD (Italian Stroke Organization and the Stroke Prevention and Educational Awareness Diffusion).
METHODS AND RESULTS
Systematic review of articles focused on primary prevention of stroke published between January 2013 to May 2016 through an extensive search of the literature using MEDLINE/PUBMED, EMBASE and the Cochrane Library. Articles were ranked according to the SIGN methodology while the GRADE system was used to establish the strength of recommendations. As a result of our literature search, we examined 87 meta-analyses overall (mainly of prospective studies), a few isolated more recent prospective studies not included in the meta-analyses, and a smaller number of available randomized controlled trials and case-control studies. Based on the analysis of the above articles, 36 Syntheses of the available evidence and 36 Recommendations were eventually prepared. The present document was developed by organizing the available evidence into three individual areas (nutrients, food groups and dietary patterns) to provide a systematic and user-friendly overview of the available evidence on the relationship between nutrition and primary prevention of stroke. Yet analysis of foods and food patterns allowed translating the information about nutrients in a tool more amenable to use in daily life also in the light of the argument that people eat foods rather than nutrients.
CONCLUSIONS
The present literature review and dietary recommendations provide healthcare professionals and all interested readers with a useful overview for the reduction of the risk of total, ischemic and haemorrhagic stroke through dietary modifications.
Topics: Brain Ischemia; Diet, Healthy; Evidence-Based Medicine; Humans; Incidence; Intracranial Hemorrhages; Italy; Nutritional Status; Nutritive Value; Primary Prevention; Prognosis; Protective Factors; Risk Factors; Risk Reduction Behavior; Stroke; Time Factors
PubMed: 29482962
DOI: 10.1016/j.numecd.2017.12.010 -
Journal of Trauma & Dissociation : the... 2013There has been abundant research targeting the secondary and tertiary prevention and treatment of posttraumatic stress disorder (PTSD), including different forms of... (Review)
Review
There has been abundant research targeting the secondary and tertiary prevention and treatment of posttraumatic stress disorder (PTSD), including different forms of debriefing, treatments for acute stress disorder, and targeted intervention strategies (M. T. Feldner, C. M. Monson, & M. J. Friedman, 2007). However, there remains a scarcity of research pertaining to the primary, pretrauma prevention of PTSD. A systematic review was conducted in order to identify and synthesize all programs aimed at the primary prevention of PTSD to date. A broad search strategy was used, yielding 15,014 studies in 4 languages published between 1915 and 2012. Studies in which a resilience-building intervention was delivered prior to a potentially traumatic event, with data collected regarding psychological well-being, were eligible. A total of 7 studies were identified as meeting these criteria. Currently, there is no solid body of research on the primary prevention of PTSD to justify or guide interventions. The limitations and future directions of research in this domain are discussed.
Topics: Humans; Primary Prevention; Psychological Theory; Psychotherapy; Stress Disorders, Post-Traumatic
PubMed: 23796172
DOI: 10.1080/15299732.2012.753653 -
Revista Panamericana de Salud Publica =... Nov 2013To analyze health promotion and primary prevention strategies in the global fight against chronic noncommunicable diseases (NCDs) and to reflect on the challenges of... (Review)
Review
OBJECTIVE
To analyze health promotion and primary prevention strategies in the global fight against chronic noncommunicable diseases (NCDs) and to reflect on the challenges of overcoming these diseases.
METHODS
In this systematic literature review, studies were analyzed on health programs identified by the Brazilian Health Ministry as the main global community intervention initiatives: the North Karelia Project, in Finland; the Stanford Three-Community Study, Stanford Five-City Project, Minnesota Heart Health and Pawtucket Heart Health Program, in the United States; the CINDI project, in Europe and Canada; CARMEN in South America; Mirame, in Chile; and Tianjin, in China. The LILACS, Medline, and SciELO databases were searched, as well as the Brazilian Health Ministry, Pan American Health Organization, and World Health Organization websites. Only original articles analyzing primary data were included. The outcomes evaluated in the studies were cholesterol, blood pressure, obesity, physical activity level, tobacco use, dietary habits, and other risk factors for NCDs.
RESULTS
Seventeen studies were selected. The North Karelia Project, Three Community Study, and Five-City Multifactor Risk Reduction Project contributed to decrease tobacco use, cholesterol levels, and blood pressure levels. The Minnesota Heart Health Program and the Pawtucket Heart Health Program had moderate success in reducing the risk factors for NCD. The CINDI and CARMEN programs demonstrated the importance of integrated actions for decreasing the main risk factors. The Mirame project, which focused on educational interventions for school children, reached 30,000 students in 2001 without requiring a large financial investment. The Tianjin project was able to reduce salt intake, prevalence of arterial hypertension, and obesity by restructuring primary health care services.
CONCLUSIONS
These successful experiences in community health improvement may serve as models for the implementation of more effective health policies, aiming at the development of actions that integrate health promotion and primary prevention of the main risk factors for NCDs.
Topics: Adult; Brazil; Child; Chronic Disease; Community Health Services; Global Health; Health Education; Health Policy; Health Promotion; Health Status Indicators; Humans; Primary Health Care; Primary Prevention; Risk Factors; Risk Reduction Behavior
PubMed: 24553762
DOI: No ID Found -
Preventive Cardiology 2010The benefits of statins on prevention of coronary heart disease in women without heart disease have not been clarified. The authors systematically reviewed all the... (Meta-Analysis)
Meta-Analysis Review
The benefits of statins on prevention of coronary heart disease in women without heart disease have not been clarified. The authors systematically reviewed all the published literature on primary prevention trials and found 6 primary prevention trials to date with sex-specific data on mortality and coronary heart disease events in women. The summary risk ratio for primary prevention of all-cause mortality was 0.90 (95% confidence interval, 0.60-1.35; P=.61) and for any coronary heart disease event was 0.78 (95% confidence interval, 0.64-0.96; P=.02). This review reveals that statin therapy along with diet and exercise in moderately hyperlipidemic women without a previous history of cardiovascular disease is of significant benefit in preventing coronary heart disease events but of no proven benefit in preventing all-cause mortality.
Topics: Coronary Artery Disease; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Incidence; Multivariate Analysis; Primary Prevention; Risk; Statistics as Topic; Women's Health
PubMed: 20377811
DOI: 10.1111/j.1751-7141.2009.00059.x