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The Lancet. Psychiatry Jul 2018Available treatment methods have shown little effect on the burden associated with mental health disorders. We review promising universal, selective, and indicated... (Review)
Review
Available treatment methods have shown little effect on the burden associated with mental health disorders. We review promising universal, selective, and indicated preventive mental health strategies that might reduce the incidence of mental health disorders, or shift expected trajectories to less debilitating outcomes. Some of these interventions also seem to be cost-effective. In the transition to mental illness, the cumulative lifetime effect of multiple small effect size risk factors progressively increases vulnerability to mental health disorders. This process might inform different levels and stages of tailored interventions to lessen risk, or increase protective factors and resilience, especially during sensitive developmental periods. Gaps between knowledge, policy, and practice need to be bridged. Future steps should emphasise mental health promotion, and improvement of early detection and interventions in clinical settings, schools, and the community, with essential support from society and policy makers.
Topics: Cost-Benefit Analysis; Humans; Mental Disorders; Primary Prevention; Risk Factors
PubMed: 29773478
DOI: 10.1016/S2215-0366(18)30057-9 -
Europace : European Pacing,... Sep 2008Despite substantial advances in prevention and treatment of cardiovascular diseases, sudden cardiac death (SCD) remains a leading cause of death in industrialized... (Review)
Review
Despite substantial advances in prevention and treatment of cardiovascular diseases, sudden cardiac death (SCD) remains a leading cause of death in industrialized countries. Implantable cardioverter defibrillator (ICD) has been demonstrated to be an attractive option for primary prevention of SCD in high-risk patients. This review discusses the progress in the risk stratification for selecting high-risk patients, highlights the clinical trials of primary prevention for SCD, outlines the efficacy of combined use of cardiac resynchronization therapy with ICD, and analyses the cost-effectiveness issue of this device.
Topics: Death, Sudden, Cardiac; Defibrillators, Implantable; Heart Failure; Humans; Primary Prevention; Treatment Outcome
PubMed: 18559335
DOI: 10.1093/europace/eun150 -
Medicina Clinica Oct 2019
Topics: Diabetes Mellitus, Type 2; Europe; Health Behavior; Health Policy; Health Promotion; Healthy Lifestyle; Humans; Primary Health Care; Primary Prevention
PubMed: 31164241
DOI: 10.1016/j.medcli.2019.03.034 -
Schizophrenia Bulletin Jul 2015
Topics: Disease Susceptibility; Humans; Primary Prevention; Schizophrenia
PubMed: 25904722
DOI: 10.1093/schbul/sbv053 -
Zeitschrift Fur Kardiologie Feb 1999In secondary prevention, statins are cost-effective and even more cost-effective than other lipd lowering drugs. Statins are especially favorable in patients with... (Review)
Review
In secondary prevention, statins are cost-effective and even more cost-effective than other lipd lowering drugs. Statins are especially favorable in patients with previous myocardial infarction compared to those with angina pectoris. For secondary prevention of coronary heart disease, statins should be administered generously. In primary prevention, statins are effective but not cost-efficient. Unfavorable results have to be expected especially in premenopausal women, younger patients, and in those with a low risk factor profile. For population based primary prevention, only dietary measures can be advocated; however, apart from a serious lack of compliance their efficiency has not yet been proven. Preventive measures have their own prize; in general they are considered not to prevent coronary heart disease but retard it. Therefore, such therapeutic interventions can be assumed not to reduce but rather to increase the "direct" medical costs. Furthermore, successful prevention of coronary heart disease leads, due to life-prolongation, to an increase in people out of work and in disabled patients due to age and/or disease. Therefore, an increase especially of the "indirect" costs for unemployment, pension, nursing homes, etc. must be expected.
Topics: Coronary Disease; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Primary Prevention
PubMed: 10209828
DOI: 10.1007/s003920050263 -
The Cochrane Database of Systematic... 2001Primary care physicians hold a strategic position in delivering preventive services. However discrepancies exist between evidence based guidelines and practice. (Review)
Review
BACKGROUND
Primary care physicians hold a strategic position in delivering preventive services. However discrepancies exist between evidence based guidelines and practice.
OBJECTIVES
To assess the effects of interventions to improve the delivery of preventive services in primary care.
SEARCH STRATEGY
We searched the Cochrane Effective Practice and Organisation of Care Group specialised register (November 1995; August 1999), MEDLINE (1980 to 1995) and hand searched relevant journals.
SELECTION CRITERIA
Randomised trials, controlled before and after studies, and interrupted time series analyses of interventions to improve preventive services by primary care professionals responsible for patient care.
DATA COLLECTION AND ANALYSIS
Two researchers independently extracted data and assessed study quality.
MAIN RESULTS
Fifty-five studies were included, involving more than 2000 health professionals and 99,000 people, with 83 comparisons between intervention and control groups. Post intervention differences between intervention and control groups varied widely within and across categories of interventions. Most interventions were found to be effective in some studies, but not in others. Five comparisons of group education versus no intervention showed absolute change of preventive services varying between -4% and +31%. Nine comparisons of physician reminders versus no intervention showed absolute change of preventive services varying between 5% and 24%. Fourteen comparisons of multifaceted interventions versus no intervention showed absolute change of preventive services varying between -3% and +64%. Six comparisons of multifaceted interventions versus group education reported absolute changes varying between -31% and +28%. All these comparisons used randomised groups. Ten comparisons of multifaceted interventions versus no intervention used non-randomised groups and showed absolute change of preventive services varying between -5% and +21%. The remaining planned comparisons within categories of interventions contained less than five comparisons.
REVIEWER'S CONCLUSIONS
There is currently no solid basis for assuming that a particular intervention or package of interventions will work. Effective interventions to increase preventive activities in primary care exist, but there is considerable variation in the level of change achieved, with effect sizes usually small or moderate. Tailoring interventions to address specific barriers to change in a particular setting is probably important. Multifaceted interventions may be more effective than single interventions, because more barriers to change can be addressed. Future research should analyse barriers to change and interventions to implement preventive services in more detail, to clarify how interventions relate to specific barriers. Since more complex interventions are likely to be more effective but also more costly, economic evaluations should also be included.
Topics: Humans; Practice Patterns, Physicians'; Primary Health Care; Primary Prevention; Randomized Controlled Trials as Topic
PubMed: 11279688
DOI: 10.1002/14651858.CD000362 -
Sexual Abuse : a Journal of Research... Mar 2017The extensive and sometimes profoundly damaging effects of sexual violence and large numbers of victims necessitate dedicated attention to primary prevention efforts....
The extensive and sometimes profoundly damaging effects of sexual violence and large numbers of victims necessitate dedicated attention to primary prevention efforts. Few studies have examined the scope of current prevention activities or their fit with empirical research into effective prevention strategies. The current article presents findings from a survey of primary prevention activities in non-Māori and bicultural communities within Aotearoa New Zealand. Forty-four respondents representing 42 agencies responded to a comprehensive survey that canvased types of sexual violence primary prevention activities undertaken, sexual violence primary prevention programs, and barriers and supports to sexual violence prevention work. Consistent with findings from previous international surveys, the focus of primary prevention work in New Zealand was on sexual violence education and increasing awareness. Findings are discussed in the context of the sexual violence prevention literature and what works in prevention more broadly to help identify promising initiatives as well as gaps in current practices. Recommendations for advancing sexual violence primary prevention research are also provided.
Topics: Humans; New Zealand; Primary Prevention; Sex Offenses; Surveys and Questionnaires
PubMed: 25930201
DOI: 10.1177/1079063215583852 -
Progress in Cardiovascular Diseases 2016Cardiovascular disease (CVD) remains the leading cause of death for women. Given the overall prevalence of CVD and its risk factors in women, primary prevention is an... (Review)
Review
Cardiovascular disease (CVD) remains the leading cause of death for women. Given the overall prevalence of CVD and its risk factors in women, primary prevention is an important focus. In 2013, the American College of Cardiology and the American Heart Association released guidelines for men and women on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk (ASCVD) in adults based on randomized-controlled trials. Fixed and appropriate intensity of a statin based on calculation of an individual's risk of ASCVD or in diabetics or those with severely elevated low-density lipoprotein cholesterol patients for primary prevention is recommended rather than cholesterol level goals. A more recent consensus statement regarding the role of non-statin therapies has been released, but like the prior guidelines released in 2013, there were no sex-specific recommendations. An evidence-based approach to ASCVD prevention should be used in women.
Topics: Cardiovascular Diseases; Female; Humans; Hyperlipidemias; Hypolipidemic Agents; Practice Guidelines as Topic; Primary Prevention; Quality Improvement; United States
PubMed: 27481045
DOI: 10.1016/j.pcad.2016.07.008 -
Gesundheitswesen (Bundesverband Der... Feb 2017Nudging as a means of influencing human behaviour has received increasing attention by policy makers, including those in the field of public health. Nudges are generally... (Review)
Review
Nudging as a means of influencing human behaviour has received increasing attention by policy makers, including those in the field of public health. Nudges are generally understood as specific aspects of a choice architecture that make certain behaviours more likely to occur without mandating them through binding rules, and without relying on economic incentives. Following the example of the United States and Great Britain, the German government has established a working group tasked with advising the federal government on the use of nudging and other behavioural interventions in policy making. The working group's inception in February 2015 inspired a lively public debate. While numerous opportunities for the use of nudging in primary prevention and health promotion in Germany exist, the concept has not yet been widely used in practice. We discuss the basic theoretical concepts of nudging, relating the underlying ideas to the terminology used in prevention and health promotion. In addition, we present typologies and practical examples for nudging interventions, and discuss criticisms raised in the academic and public debate. Finally, we discuss implications for research and policy, highlighting how nudging and related approaches can be used to strengthen primary prevention in Germany.
Topics: Choice Behavior; Germany; Health Behavior; Health Promotion; Internationality; Models, Organizational; Primary Prevention; Social Control, Formal
PubMed: 28226384
DOI: 10.1055/s-0042-121598 -
Nature Reviews. Neurology Sep 2016The increasing global stroke burden strongly suggests that currently implemented primary stroke prevention strategies are not sufficiently effective, and new primary... (Review)
Review
The increasing global stroke burden strongly suggests that currently implemented primary stroke prevention strategies are not sufficiently effective, and new primary prevention strategies with larger effect sizes are needed. Here, we review the latest stroke epidemiology literature, with an emphasis on the recently published Global Burden of Disease 2013 Study estimates; highlight the problems with current primary stroke and cardiovascular disease (CVD) prevention strategies; and outline new developments in primary stroke and CVD prevention. We also suggest key priorities for the future, including comprehensive prevention strategies that target people at all levels of CVD risk; implementation of an integrated approach to promote healthy behaviours and reduce health disparities; capitalizing on information technology to advance prevention approaches and techniques; and incorporation of culturally appropriate education about healthy lifestyles into standard education curricula early in life. Given the already immense and fast-increasing burden of stroke and other major noncommunicable diseases (NCDs), which threatens worldwide sustainability, governments of all countries should develop and implement an emergency action plan addressing the primary prevention of NCDs, possibly including taxation strategies to tackle unhealthy behaviours that increase the risk of stroke and other NCDs.
Topics: Global Health; Humans; Primary Prevention; Stroke
PubMed: 27448185
DOI: 10.1038/nrneurol.2016.107