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Primary Prevention (primary + prevention)
Selected AbstractsLIFESTYLE-RELATED DISEASES , PERSPECTIVES FOR PRIMARY PREVENTION AND TREATMENT IN ANIMAL MODELS and HUMANSCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 2004Article first published online: 11 JAN 200 No abstract is available for this article. [source] Optimization of Vitamin D Status as an Alternative Strategy for Primary Prevention of Cardiovascular Events in Type 2 Diabetes MellitusJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2010DPhil, Oscar M. P. Jolobe MRCP (UK) No abstract is available for this article. [source] Primary Prevention of Heart Failure in Cardiac PacingPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2006S. SERGE BAROLD No abstract is available for this article. [source] Prophylactic Implantation of Cardioverter Defibrillators in Idiopathic Nonischemic Cardiomyopathy for the Primary Prevention of Death: A Narrative ReviewCLINICAL CARDIOLOGY, Issue 5 2010Cihan Cevik MD, FESC Implantable cardioverter defibrillator (ICD) therapy reduces sudden cardiac death rates and reduces mortality in patients with ischemic heart disease and low ejection fractions. One-third of the deaths in patients with nonischemic cardiomyopathy are sudden. However, the efficacy of ICDs in the primary prevention of death in these patients is less clear. The most common cause of mortality in patients treated with ICDs is heart failure progression. ICD shocks can cause direct myocardial injury, fibrosis, inflammation, and adverse psychological outcomes, and these changes may contribute to the ventricular dysfunction in patients who already have a significantly depressed ejection fraction. We have reviewed the published randomized controlled trials and meta-analysis of prophylactic ICD therapy in the primary prevention of death in patients with nonischemic cardiomyopathy. The individual randomized controlled trials do not report a statistically significant reduction of mortality unless the ICD treatment is added to cardiac resynchronization therapy, but the meta-analysis did show a significant mortality reduction and favored ICD therapy in these patients. Medical management of many study participants was suboptimal, at least based on current guidelines. The patients with non-ischemic cardiomyopathy have good outcomes with medical therapy, and ICD therapy in this relatively low-risk population needs better selection criteria. Copyright © 2010 Wiley Periodicals, Inc. [source] Should We Measure C-reactive Protein on Earth or Just on JUPITER?CLINICAL CARDIOLOGY, Issue 4 2010Ambareesh Bajpai MD Evidence for the role of inflammation in the pathogenesis of atherosclerosis is compelling and has generated interest in high-sensitivity C-reactive protein (hs-CRP) as a marker of cardiovascular risk. Data regarding hs-CRP and cardiovascular risk, though largely consistent, is of unclear clinical relevance. Most recently, the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) trial has led to further debate regarding the utility of hs-CRP. This article provides a comprehensive review of the data regarding cardiovascular risk and hs-CRP with an emphasis on the JUPITER trial and concludes with an evidence-based analysis of the current role of hs-CRP in cardiovascular risk assessment. Copyright © 2010 Wiley Periodicals, Inc. [source] Primary prevention of neural tube defects with folate in Western Australia: the value of the Western Australian Birth Defects RegistryCONGENITAL ANOMALIES, Issue 2 2006Carol Bower ABSTRACT This paper reviews the role of the Western Australian Birth Defects Registry in the primary prevention of neural tube defects. The Registry provides complete and up-to-date information on all neural tube defects (NTD), including terminations of pregnancy. These data have been used to determine a baseline rate of NTD and to monitor trends in NTD over time, when health promotion of folic acid supplement use and voluntary fortification of food with folate were introduced. The register has also been used to investigate NTD in special populations (Indigenous infants in Australia) and as a sampling frame for case control studies. The data derived from these studies have been used to assist in assessing whether mandatory food fortification in Australia is indicated to prevent NTD. [source] Rediscovering bile acid sequestrantsDIABETES OBESITY & METABOLISM, Issue 12 2009D. S. H. Bell Aim: In the recently published The Justification for the Use of statins in Primary prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) mega-trial, rosuvastatin significantly reduced cardiovascular events at the expense of a small but significant increase in the risk of developing type 2 diabetes. The increased risk of new-onset diabetes was in keeping with a recent meta-analysis which suggested that statins, with the possible exception of pravastatin, marginally increase the risk of developing type 2 diabetes. Methods: Although the net effect of rosuvastatin was obviously very positive, we hypothesized that the addition of a bile aid sequestrant to a statin would not only further decrease lipid levels and potentially further decrease cardiovascular events but also protect against the development of diabetes. This is particularly relevant because the bile acid sequestrant, colesevelam, has recently been approved for therapy of diabetes. Results: Colesevelam like other bile acid sequestrants lowers low-density lipoprotein levels by 16% and C-reactive protein by 22% beyond the reductions that occur with statin therapy alone. Bile acid sequestrants confer lipid-lowering, glucose-lowering, and anti-inflammatory benefits, and have been shown to reduce risk of cardiovascular events. Conclusions: Therefore, colesevelam should be the most effective and logical agent to add to a statin in the diabetic and insulin-resistant patient, because in addition to lowering cardiac risk it may prevent the development of diabetes, as well as improving glycaemic control in the established diabetic patient. [source] Primary prevention is better than cureEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2004Peter Driscoll No abstract is available for this article. [source] Primary prevention of eating disorders: characteristics of effective programmes and how to bring them to broader disseminationEUROPEAN EATING DISORDERS REVIEW, Issue 3 2008Uwe Berger Abstract Objective Based upon the observation of advances in the primary prevention of eating disorders (ED), it is summarized that school-based programmes, focusing on risk factors for females with interactive elements, dissonance induction and booster sessions yield significant effects even under strong methodological conditions. However, beyond the presented research findings it remains often unclear, if and how programmes can be brought to a broader dissemination within a community, region or country. Method Introducing the programme PriMa (German school-based programme for the primary prevention of anorexia nervosa (AN) for girls up to the age of 12), we describe the process of programme evaluation (including 1.006 girls from 42 schools in Thuringia, Germany, who participated in a controlled study using a pre-post-design and a 3 months follow-up), programme implementation and development of follow-up programmes, including an intervention for boys and flanking secondary preventive actions (such as a telephone hotline). Results Using standardized measures, the girls in the intervention group of PriMa reported significant improvements in body self esteem, figure dissatisfaction, knowledge and eating attitudes. The teachers, who conducted the programme, felt well qualified and were evaluated significantly positive by their students. Based upon the PriMa evaluation, we established a comprehensive health promotion programme at 60 Thuringian schools within the last 3 years, which could function as a model of a fruitful cooperation between a governmental institution (Thuringian Ministry of Culture) and a research institution (University Hospital Jena). Conclusions Existing programmes have the potential for effective prevention of ED. To confirm these effects under ,real world conditions' within a given community will still be a great challenge that often requires methodological and organizational concessions and compromises. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Primary prevention of risk factors for eating disorders in adolescent girls: Learning from practiceINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 4 2002Catherine Steiner-Adair Abstract Objective This study evaluates the effectiveness and feasibility of a primary prevention program for risk factors for eating disorders in adolescent girls. Method Nearly 500 seventh-grade girls participated in "Full of Ourselves: Advancing Girl Power, Health, and Leadership," and were assessed at baseline, immediately after program completion, and 6 months later on several self-report measures of knowledge, body image, and eating and weight-related behaviors. Results Significant differences were found between participants and controls on measures of knowledge and weight-related body esteem, which were maintained at 6-month follow-up. Eating related behaviors, including skipping meals and dieting, appeared unaffected by program participation. Discussion The program was feasible, safe, and resulted in positive and maintained changes in knowledge and weight satisfaction for adolescent girls. © 2002 by Wiley Periodicals, Inc. Int J Eat Disord 32: 401,411, 2002. [source] Syphilis: An old enemy still lurksJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 2 2006Assistant Professor of Clinical Nursing, FNP Family Nurse Practitioner, L. A. Ferguson MSN Abstract Purpose: To review the problem of increasing cases of syphilis as a communicable disease and to review different presentations of syphilis and to discuss treatment guidelines. Data sources: Extensive review of worldwide scientific literature on the epidemiology, diagnosis, and treatment of syphilis. Conclusions: Syphilis is an infectious sexually transmitted disease, which may have devastating consequences. Previously declining rates have led to complacency in prevention and diagnosis. Primary prevention includes education regarding safer sexual practices. Secondary prevention includes early identification via screening and treatment. Implications for practice: Syphilis is a contagious disease that has devastating consequences if not diagnosed and treated. Providers should keep ever vigilant in its identification. Specifically, it should be considered when evaluating all symptom-less dermatological lesions. [source] Non-invasive diagnosis of large oesophageal varices with FibroTest in patients with cirrhosis: a preliminary retrospective studyLIVER INTERNATIONAL, Issue 3 2006Dominique Thabut Abstract: Background and aims: Primary prevention of variceal bleeding with ,-blockers improves survival in patients with large oesophageal varices (LOV). Therefore, cirrhotic patients frequently undergo screening endoscopy. As portal hypertension is related to liver fibrosis, this study aimed to assess the predictive value of FibroTest, a non-invasive marker of liver fibrosis, for the diagnosis of LOV in cirrhotic patients. Methods: Ninety-nine cirrhotic patients had clinical examination, blood sample (liver function tests, platelet count, FibroTest) and upper endoscopy. Measurements of endoscopic and biochemical parameters were made blindly. Sensitivity, specificity, predictive values and area under the receiver operating characteristic curves were assessed for FibroTest, platelet count and Child,Pugh score. The main endpoint was the presence of LOV. Results: Platelet count, prothrombin time, ascites, FibroTest and Child,Pugh class were significantly different among patients with or without LOV. FibroTest had the highest discriminative power with an area under receiver operating characteristics curves of 0.77 (SE=0.06), compared with 0.64 (0.08) and 0.68 (0.08) for platelet count and Child,Pugh score, respectively (P=0.08). A cut-off at 0.80 had a 86% negative predictive value for the diagnosis of LOV (Se=92%, Sp=21%). Conclusion: FibroTest could aid in the diagnosis of LOV and may therefore reduce the indication of endoscopic screening in cirrhotic patients. [source] Management of HIV and AIDS in the African contextORAL DISEASES, Issue 2002R Wood The initial response to the African HIV epidemic was to concentrate on the prevention of new infections. There is now an urgent need to address the health care requirements of large numbers of already infected individuals. The spectrum of disease in the African setting is dominated by tuberculosis, bacterial and protozoan infections. In much of Africa, health services are overwhelmed by the care of terminally ill AIDS patients. In the absence of specific HIV therapy, health care resources are being increasingly utilised, but with little survival benefit for the individual. Resources available for treating patients vary considerably between the richer and poorer countries of the continent. Primary prevention of opportunistic infections and maternal child transmission are at present affordable and cost-effective interventions. Whilst antiretroviral therapies may presently be unaffordable in much of Africa, they represent a modality that can have a major effect on HIV survival. The challenge is to improve the health and longevity of HIV-infected individuals with the rational use of the limited health resources available in Africa today. [source] Ergonomic exposure case studies in Massachusetts fishing vesselsAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue S2 2002Scott Fulmer MS Abstract Background Musculoskeletal disorders may not have been studied as much as greater risks in the dangerous environment of commercial fishing. Primary prevention of risk for these kinds of injuries and illnesses begins by a detailed understanding of what risks are likely to be common in the different fisheries, and how those risks might be reduced. Methods Ergonomic job analyses were conducted on three different types of fishing vessels in Massachusetts: gillnetting, otter trawling, and lobstering. Direct observation was used to link posture to task. Noise measurements, tool analysis, and cycle time measurements were also included. Results Production speed, materials handling, and vessel movement contributed to musculoskeletal stress by affecting observable postural deviation, repetition, and forceful exertions. Conclusions Interventions to reduce ergonomic risk factors might be possible through utilization of below deck space in certain boats, through better technology, or through simple tool adjustments. Am. J. Ind. Med. Suppl. 2:10,18, 2002. © 2002 Wiley-Liss, Inc. [source] Comorbid Schizophrenia and Substance Abuse: A Review of Epidemiology and CourseTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 5 2006Joseph Westermeyer MD, PhDArticle first published online: 18 FEB 2010 Over the last dozen years, our knowledge regarding comorbid schizophrenia (SCZ) and substance use disorder (SUD) has evolved in several ways. First, the rate of lifetime comorbid SCZ-SUD appears to have increased another 20,30%, so now about 70,80% of persons with SCZ have lifetime SUD. Second, early remission of SUD has become commonplace among patients with SCZ, perhaps outnumbering the number of SCZ-only patients as well as those with active SCZ-SUD. Third, sustained SUD remission is well demonstrated, though the rates may yet be low. Fourth, research on comorbid SCZ-SUD is filling out our knowledge in many areas, including the characteristics of SCZ patients at risk for SUD, reasons SCZ patients seek out substances, effects of various substances on SCZ course and symptoms, and obstacles to SUD recovery in people with SCZ. The influence of SUD treatment and self-help on epidemiology and course has not been adequately evaluated. Primary prevention and early treatment of SUD in SCZ patients are still relatively neglected, though they offer our greatest hope for enhancing the lives of people with SCZ and improving the cost efficacy of care. [source] Improving survival disparities in cervical cancer between M,ori and non-M,ori women in New Zealand: a national retrospective cohort studyAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2010Melissa McLeod Abstract Objective: M,ori women in New Zealand have higher incidence of and mortality from cervical cancer than non-M,ori women, however limited research has examined differences in treatment and survival between these groups. This study aims to determine if ethnic disparities in treatment and survival exist among a cohort of M,ori and non-M,ori women with cervical cancer. Methods: A retrospective cohort study of 1911 women (344 M,ori and 1567 non-M,ori) identified from the New Zealand Cancer Register with cervical cancer (adenocarcinoma, adenosquamous or squamous cell carcinoma) between 1 January 1996 and 31 December 2006. Results: M,ori women with cervical cancer had a higher receipt of total hysterectomies, and similar receipt of radical hysterectomies and brachytherapy as primary treatment, compared to non-M,ori women (age and stage adjusted). Over the cohort period, M,ori women had poorer cancer specific survival than non-M,ori women (mortality hazard ratio (HR) 2.07, 95% confidence interval (CI): 1.63,2.62). From 1996 to 2005, the survival for M,ori improved significantly relative to non-M,ori. Conclusion: M,ori continue to have higher incidence and mortality than non-M,ori from cervical cancer although disparities are improving. Survival disparities are also improving. Treatment (as measured) by ethnicity is similar. Implications: Primary prevention and early detection remain key interventions for addressing M,ori needs and reducing inequalities in cervical cancer in New Zealand. [source] Psychological abuse between parents: associations with child maltreatment from a population-based sampleCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 6 2008Richard Reading Psychological abuse between parents: associations with child maltreatment from a population-based sample ChangJ. J., TheodoreA. D., MartinS. L. & RunyanD. K. ( 2008 ) Child Abuse & Neglect , 32 , 819 , 829 . Objective This study examined the association between partner psychological abuse and child maltreatment perpetration. Methods This cross-sectional study examined a population-based sample of mothers with children aged 0,17 years in North and South Carolina (n = 1149). Mothers were asked about the occurrence of potentially neglectful or abusive behaviours towards their children by either themselves or their husband/partner in the past year. Partner psychological abuse was categorized as no psychological abuse (reference), husband perpetrates, wife perpetrates or both perpetrates. Outcome measures for psychological and physical abuse of the child had four categories: no abuse (reference), mother perpetrates, father/father-figure perpetrates or both parents perpetrates, whereas child neglect was binary. Adjusted relative risk ratios (aRRRs), adjusted odds ratios and 95% confidence intervals (CIs) were estimated with regression models. A relative risk ratio was the ratio of odds ratios derived from multinomial logistic regression. Results Children were at the greatest risk of maltreatment when parents psychologically abused each other versus no abuse: the aRRR for child psychological abuse by the mother only was 16.13 (95% CI 5.11, 50.92) compared with no abuse, controlling for child age, gender, Medicaid welfare and mother's level of education. Both parents psychologically abuse each other versus no abuse also results in an aRRR of 14.57 (95% CI 3.85, 55.16) for child physical abuse by both parents compared with no abuse. When only the husband perpetrates towards the wife, the odds of child neglect was 5.29 times as much as families with no psychological abuse (95% CI 1.36, 20.62). Conclusions Partner psychological abuse was strongly related to child maltreatment. Children experienced a substantially increased risk of maltreatment when partner psychological abuse was present in the homes. Practice implications This study observed that intimate partner psychological abuse significantly increased risk of child maltreatment. Increased public awareness of partner psychological abuse is warranted. Primary prevention should include education about the seriousness of partner psychological abuse in families. Domestic violence and child welfare agencies must recognize the link between partner psychological abuse and child maltreatment and work together to develop effective screening for each of these problems. [source] Primary prevention of allergy: avoiding risk or providing protection?CLINICAL & EXPERIMENTAL ALLERGY, Issue 2 2008E. Hamelmann Summary Primary prevention strategies of allergy so far have been aimed to fight allergy causes, by avoiding risk factors and inhibiting their mechanisms of action. The results of trials testing food or airborne allergen avoidance as a prevention strategy were, however, rather disappointing. A reverse approach for primary prevention of allergies aims to facilitate exposure to protecting factors which promote the induction of immunologic tolerance against innocuous antigens. These factors are associated with farming environment and a ,traditional lifestyle', but identification of these factors is quite difficult. Major candidates include food-borne microbes, helminths or their components, which are able to stimulate mucosal immunity, particularly in the gut. Similarly, new preventive and therapeutic strategies are being tested to induce specific food-allergen oral tolerance through the ingestion of progressively increasing doses of the offending food. This shifting of allergy prevention research from avoidance to tolerance induction will hopefully allow us to reverse the epidemic trend of allergy diseases. [source] Primary prevention of neural tube defects with folate in Western Australia: the value of the Western Australian Birth Defects RegistryCONGENITAL ANOMALIES, Issue 2 2006Carol Bower ABSTRACT This paper reviews the role of the Western Australian Birth Defects Registry in the primary prevention of neural tube defects. The Registry provides complete and up-to-date information on all neural tube defects (NTD), including terminations of pregnancy. These data have been used to determine a baseline rate of NTD and to monitor trends in NTD over time, when health promotion of folic acid supplement use and voluntary fortification of food with folate were introduced. The register has also been used to investigate NTD in special populations (Indigenous infants in Australia) and as a sampling frame for case control studies. The data derived from these studies have been used to assist in assessing whether mandatory food fortification in Australia is indicated to prevent NTD. [source] Patient and Physician Determinants of Implantable Cardioverter Defibrillator Use in the Heart Failure PopulationCONGESTIVE HEART FAILURE, Issue 4 2010Sanders H. Chae MD Recent studies report surprisingly low rates of implantable cardioverter defibrillator (ICD) placement for primary prevention against sudden cardiac death among patients with heart failure and left ventricular systolic dysfunction. Reasons for the low rates of utilization are not well understood. The authors examined ICD implantation rates at a university-based tertiary care center and used multivariable analysis to identify independent factors associated with ICD utilization. The ICD implantation rate for 850 eligible patients was 70%. Forty-seven (18%) patients refused implantation; women were twice as likely to refuse compared to men (8% vs 4%, P=.013). Race was not associated with utilization. On multivariable analysis, independent predictors of implantation included having a heart failure specialist (odds ratio [OR], 8.13; P<.001) or general cardiologist (OR, 2.23; P=.13) managing care, age range 70 to 79 (OR, 0.55; P<.001) or 80 and older (OR, 0.26; P<.001), female sex (OR, 0.49; P<.001), QRS interval (OR, 1.016; P<.001), diastolic blood pressure (OR, 0.979; P=.011), cerebrovascular disease (OR, 0.44; P=.007), and dementia (OR, 0.13; P=.002). Our registry of patients with cardiomyopathy and heart failure reveals that high rates of utilization are possible. Factors closely associated with ICD utilization include type of physician coordinating care, age, and comorbidities. Congest Heart Fail. 2010;16:141,146. © 2010 Wiley Periodicals, Inc. [source] FS05.1 Treatment of hand eczemaCONTACT DERMATITIS, Issue 3 2004Niels K Veien Hand eczema is a common skin disease that often becomes chronic, and treatment of the disease is often challenging. Skin protection is of great importance for the prevention of hand eczema and is a fundamental aspect of the treatment of hand eczema. Emollients have been shown to be successful in the primary prevention of hand eczema as well as in reducing eczema activity. Topical corticosteroids are still the mainstay of treatment, but randomised controlled trials of their efficacy are needed. A combination of tacrolimus and topical corticosteroids may reduce the risk of steroid-associated side-effects. UV-therapy and Grenz rays can also suppress hand eczema. Systemic treatment with immunosuppressants such as cyclosporine and methotrexate show promising results, and acitretin may suppress keratotic hand eczema. Treatment possibilities for hand eczema, indications and side effects will be discussed. [source] The metabolic syndrome in type 2 diabetes: When does it matter?DIABETES OBESITY & METABOLISM, Issue 6 2006J. Wong Aims:, Young adults with type 2 diabetes (T2Dm) present the clinician with the problem of when to start therapies for the primary prevention of vascular disease and how to identify those at most vascular risk. We examine whether the metabolic syndrome (MetS) can be a useful clinical tool to stratify vascular risk in this context. Methods:, Data were collected from 5928 subjects with T2Dm, and subjects were categorized as having MetS by World Health Organization criteria (body mass index criteria modified for Asians using >23 kg/m2). The prevalence of macrovascular disease was examined by MetS status and age. Results:, The overall MetS prevalence was 72.3%. MetS was associated with an increased prevalence of ischaemic heart disease (IHD) (17.2% MetS vs. 11.6% no MetS, p < 0.0001), coronary artery bypass graft (7.6 vs. 4.7%, p < 0.0003), peripheral vascular disease (PVD) (4.7 vs. 3.7%, p = 0.08) and stroke (6 vs. 3.9%, p = 0.002) across all age groups. MetS subjects had an IHD prevalence equivalent to that seen in subjects who were one decade older without MetS. The most significant impact of MetS was for the age group of 40,49 years with much lesser impact seen with progressively increasing age [odds ratio (OR) = 2.1 for IHD in MetS compared with no MetS at age 40,50 years, p < 0.05; falling progressively to OR = 1.5 at age >70 years, p > 0.05]. Similar trends were seen for coronary artery by-pass graft (CABG) and PVD. There was a strong relationship between the number of MetS risk factors and IHD prevalence (r = 0.99, p = 0.0001). Conclusions:, These data suggest that MetS is particularly useful in stratifying vascular risk in younger T2Dm patients and in those with a high number of MetS components. For patients with MetS, especially those with a full house of MetS risk factors, commencing risk-lowering interventions 10 years earlier than their MetS-free counterparts could be considered. [source] Treatment of diabetic nephropathy in its early stagesDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 2 2003Giacomo Deferrari Abstract Diabetic nephropathy is one of the most frequent causes of end-stage renal disease (ESRD), and, in recent years, the number of diabetic patients entering renal replacement therapy has dramatically increased. The magnitude of the problem has led to numerous efforts to identify preventive and therapeutic strategies. In normoalbuminuric patients, optimal glycemic control (HbA1c lower than 7.5%) plays a fundamental role in the primary prevention of ESRD [weighted mean relative risk reduction (RRR) ,37% for metabolic control versus trivial renoprotection for intensive anti-hypertensive therapy or ACE-inhibitors (ACE-I)]. In the microalbuminuric stage, strict glycemic control probably reduces the incidence of overt nephropathy (weighted mean RRR ,50%), while blood pressure levels below 130/80 mmHg are recommended according to the average blood pressure levels obtained in various studies. In normotensive patients, ACE-I markedly reduce the development of overt nephropathy almost regardless of blood pressure levels; in hypertensive patients, ACE-I are less clearly active (weighted mean RRR ,23% versus other drugs), whereas angiotensin-receptor blockers (ARB) appear strikingly renoprotective. Once overt proteinuria appears, it is uncertain whether glycemic control affects the progression of nephropathy. In type 1 diabetes, various anti-hypertensive treatments, mainly ACE-I, are effective in slowing down the progression of nephropathy; in type 2 diabetes, two recent studies demonstrate that ARB are superior to conventional therapy or calcium channel blockers (CCB). In clinical practice, pharmacological tools are not always used to the best benefit of the patients. Therefore, clinicians and patients need to be educated regarding the renoprotection of drugs inhibiting the renin-angiotensin system (RAS) and the overwhelming importance of achieving target blood pressure. Copyright © 2003 John Wiley & Sons, Ltd. [source] Socio-economic status, obesity and prevalence of Type 1 and Type 2 diabetes mellitusDIABETIC MEDICINE, Issue 6 2000J. M. M. Evans Summary Aims ,The influence of socio-economic status on the prevalence of Type 1 and Type 2 diabetes mellitus, and on obesity, was explored using routinely collected healthcare data for the population of Tayside, Scotland. Methods ,Among 366 849 Tayside residents, 792 and 5474 patients with Type 1 and Type 2 diabetes, respectively, were identified from a diabetes register. The Carstairs Score was used as a proxy for socio-economic status. This is a material deprivation measure derived from the UK census, using postcode data for four key variables. Odds ratios for diabetes prevalence, adjusted for age, were determined for each of six deprivation categories (1 , least deprived, 6/7 , most deprived). The mean body mass index (BMI) in each group was also determined, and the effect of deprivation category explored by analysis of covariance, adjusting for age and sex. Results ,The prevalence of Type 2 diabetes, but not Type 1 diabetes, varied by deprivation. People in deprivation category 6 and 7 were 1.6-times (95% confidence interval 1.4,1.8) more likely to have Type 2 diabetes than those least deprived. There was no relationship between deprivation and BMI in Type 1 diabetes (P = 0.36), but there was an increase in BMI with increasing deprivation in Type 2 diabetes (P < 0.001; test of linearity P < 0.001). Conclusions ,The study confirms the relationship between deprivation and the prevalence of Type 2 diabetes. There are more obese, diabetic patients in deprived areas. They require more targeted resources and more primary prevention. [source] Early detection and intervention in first-episode schizophrenia: a critical reviewACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2001T. K. Larsen Objective: To review the literature on early intervention in psychosis and to evaluate relevant studies. Method: Early intervention was defined as intervention in the prodromal phase (primary prevention) and intervention after the onset of psychosis, i.e. shortening of duration of untreated psychosis (DUP) (secondary prevention). Results: We found few studies aimed at early intervention, but many papers discussing the idea at a more general level. We identified no studies that prove that intervention in the prodromal phase is possible without a high risk for treating false positives. We identified some studies aimed at reducing DUP, but the results are ambiguous and, until now, no follow-up data showing a positive effect on prognosis have been presented. Conclusion: Early intervention in psychosis is a difficult and important challenge for the psychiatric health services. At the time being reduction of DUP seems to be the most promising strategy. Intervention in the prodromal phase is more ethically and conceptually problematic. [source] Commentary on Larney (2010): A call to action,opioid substitution therapy as a conduit to routine care and primary prevention of HIV transmission among opioid-dependent prisonersADDICTION, Issue 2 2010SANDRA A. SPRINGER No abstract is available for this article. [source] Primary prevention of eating disorders: characteristics of effective programmes and how to bring them to broader disseminationEUROPEAN EATING DISORDERS REVIEW, Issue 3 2008Uwe Berger Abstract Objective Based upon the observation of advances in the primary prevention of eating disorders (ED), it is summarized that school-based programmes, focusing on risk factors for females with interactive elements, dissonance induction and booster sessions yield significant effects even under strong methodological conditions. However, beyond the presented research findings it remains often unclear, if and how programmes can be brought to a broader dissemination within a community, region or country. Method Introducing the programme PriMa (German school-based programme for the primary prevention of anorexia nervosa (AN) for girls up to the age of 12), we describe the process of programme evaluation (including 1.006 girls from 42 schools in Thuringia, Germany, who participated in a controlled study using a pre-post-design and a 3 months follow-up), programme implementation and development of follow-up programmes, including an intervention for boys and flanking secondary preventive actions (such as a telephone hotline). Results Using standardized measures, the girls in the intervention group of PriMa reported significant improvements in body self esteem, figure dissatisfaction, knowledge and eating attitudes. The teachers, who conducted the programme, felt well qualified and were evaluated significantly positive by their students. Based upon the PriMa evaluation, we established a comprehensive health promotion programme at 60 Thuringian schools within the last 3 years, which could function as a model of a fruitful cooperation between a governmental institution (Thuringian Ministry of Culture) and a research institution (University Hospital Jena). Conclusions Existing programmes have the potential for effective prevention of ED. To confirm these effects under ,real world conditions' within a given community will still be a great challenge that often requires methodological and organizational concessions and compromises. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Plasma antioxidative activity during atorvastatin and fluvastatin therapy used in coronary heart disease primary preventionFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 1 2004Jan Kowalski Abstract We estimated the effect of atorvastatin and fluvastatin on plasma antioxidative activity used in coronary heart disease (CHD) primary prevention. Anti-oxidative activity of blood plasma was determined by Bartosz et al. method [Curr. Top. Biophys. (1998)22:11,13], based on reduction of preformed cation radical of 2,2,azinobis(3-ethylbenzothiazoline-6-sulphonic acid) by blood plasma. The study comprised 35 patients with CHD risk who were randomly divided into two groups. The atorvastatin group comprised 17 patients who were administered the drug orally in a daily dose of 10 mg and the fluvastatin group consisted of 18 patients on an oral dose of 40 mg once daily. The control group comprised 12 healthy subjects with no drug administration. Blood samples were collected from cubital vein before and after 6-week therapy. Significantly (P < 0.05) increased , in comparison with the initial values , antioxidative activity of blood plasma was found in atorvastatin and fluvastatin groups after 6-week therapy. Moreover, the increase in antioxidative plasma activity in atorvastatin group was significantly higher in comparison with the fluvastatin group. The results of our study have demonstrated that atorvastatin and fluvastatin have an additional mechanism independent of the effect on cholesterol concentration. Thus, we presume that administration of these statins in CHD risk patients may have a beneficial effect. [source] Nutrition and pharyngeal cancer: Results from a case-control study in SpainHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2002Ana Escribano Uzcudun MD Abstract Background Oropharyngeal and hypopharyngeal cancer is increasing all over the world, frequently affecting more and more women and younger individuals and not only the typical 50- to 60-year-old heavy smoker and drinking man. In addition, 5-year overall survival rate remains poor (30% to 40% in most series), despite advances in treatment. Therefore, it is crucial to understand as accurately as possible the risk factors for these malignancies to improve primary prevention. Methods We report the results from a case-control study of pharyngeal cancer risk factors conducted in Spain involving 232 consecutive patients who were gender- and age-matched with 232 controls. Data were collected by interviewer-administered personal interview. Results Our results show that low intake of fruit, fruit juice, uncooked vegetables, dietary fiber,containing foods (legume and cereals), fish, milk, and dairy products is an independent risk factor for pharyngeal cancer and that high consumption of meat and fried foods also increases the risk once data are adjusted for tobacco smoking and alcohol drinking. Conclusions Although findings for fruit, juice, and uncooked vegetables are in accordance with those from other authors and can be explained on a biologic basis, the relationship between pharyngeal cancer and dietary excess of saturated fatty acids needs experimental investigation. Findings for milk, dairy products, and fish also warrant more detailed epidemiologic research because of conflicting data reported in the literature and because of the reportedly ambiguous role of retinol in human cancers. No conclusive explanations for the protective effect of dietary fiber,containing foods can be put forward today. Our results are uniquely attributable to oropharyngeal and hypopharyngeal cancers because of the small size of our nasopharyngeal cancer subsample. © 2002 Wiley Periodicals, Inc. Head Neck 24: 830,840, 2002 [source] Barriers and strategies affecting the utilisation of primary preventive services for people with physical disabilities: a qualitative inquiryHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2006Thilo Kroll PhD Abstract Individuals with physical disabilities are less likely to utilise primary preventive healthcare services than the general population. At the same time they are at greater risk for secondary conditions and as likely as the general population to engage in health risk behaviours. This qualitative exploratory study had two principal objectives: (1) to investigate access barriers to obtaining preventive healthcare services for adults with physical disabilities and (2) to identify strategies to increase access to these services. We conducted five focus group interviews with adults (median age: 46) with various physically disabling conditions. Most participants were male Caucasians residing in Virginia, USA. Study participants reported a variety of barriers that prevented them from receiving the primary preventive services commonly recommended by the US Preventive Services Task Force. We used a health services framework to distinguish structural,environmental (to include inaccessible facilities and examination equipment) or process barriers (to include a lack of disability-related provider knowledge, respect, and skilled assistance during office visits). Participants suggested a range of strategies to address these barriers including disability-specific continuing education for providers, the development of accessible prevention-focused information portals for people with physical disabilities, and consumer self-education, and assertiveness in requesting recommended services. Study findings point to the need for a more responsive healthcare system to effectively meet the primary prevention needs of people with physical disabilities. The authors propose the development of a consumer- and provider-focused resource and information kit that reflects the strategies that were suggested by study participants. [source] | ||||||||||||||||||||||||||||||||||||||||||||||