RESUMEN
Personalizing risk assessment and treatment decisions for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) rely on pooled cohort equations and increasingly coronary artery calcium (CAC) score. A growing body of evidence supports that elevated CAC scores correspond to progressively elevated ASCVD risk, and that scores of ≥100, ≥300, and ≥1000 denote risk that is equivalent to certain secondary prevention populations. This has led consensus guidelines to incorporate CAC score thresholds for guiding escalation of preventive therapy for lowering low-density lipoprotein cholesterol goals, initiation of non-statin lipid lowering medications, and use of low-dose daily aspirin. As data on CAC continues to grow, more decision pathways will incorporate CAC score cutoffs to guide management of blood pressure and cardiometabolic medications. CAC score is also being used to enrich clinical trial study populations for elevated ASCVD risk, and to screen for subclinical coronary atherosclerosis in patients who received chest imaging for other diagnostic purposes.
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Aspirina , Biomarcadores , LDL-Colesterol , Enfermedad de la Arteria Coronaria , Guías de Práctica Clínica como Asunto , Calcificación Vascular , Humanos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/diagnóstico , Calcificación Vascular/diagnóstico por imagen , Calcificación Vascular/diagnóstico , Aspirina/uso terapéutico , Aspirina/efectos adversos , Aspirina/administración & dosificación , LDL-Colesterol/sangre , Biomarcadores/sangre , Medición de Riesgo , Inhibidores de Agregación Plaquetaria/uso terapéutico , Inhibidores de Agregación Plaquetaria/efectos adversos , Resultado del Tratamiento , Prevención Primaria/normas , Dislipidemias/tratamiento farmacológico , Dislipidemias/sangre , Dislipidemias/diagnóstico , Factores de Riesgo , Valor Predictivo de las Pruebas , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/efectos de los fármacosRESUMEN
BACKGROUND: Clinical practice guidelines (CPGs) synthesize high-quality information to support evidence-based clinical practice. In primary care, numerous CPGs must be integrated to address the needs of patients with multiple risks and conditions. The BETTER program aims to improve prevention and screening for cancer and chronic disease in primary care by synthesizing CPGs into integrated, actionable recommendations. We describe the process used to harmonize high-quality cancer and chronic disease prevention and screening (CCDPS) CPGs to update the BETTER program. METHODS: A review of CPG databases, repositories, and grey literature was conducted to identify international and Canadian (national and provincial) CPGs for CCDPS in adults 40-69 years of age across 19 topic areas: cancers, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, hepatitis C, obesity, osteoporosis, depression, and associated risk factors (i.e., diet, physical activity, alcohol, cannabis, drug, tobacco, and vaping/e-cigarette use). CPGs published in English between 2016 and 2021, applicable to adults, and containing CCDPS recommendations were included. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and a three-step process involving patients, health policy, content experts, primary care providers, and researchers was used to identify and synthesize recommendations. RESULTS: We identified 51 international and Canadian CPGs and 22 guidelines developed by provincial organizations that provided relevant CCDPS recommendations. Clinical recommendations were extracted and reviewed for inclusion using the following criteria: 1) pertinence to primary prevention and screening, 2) relevance to adults ages 40-69, and 3) applicability to diverse primary care settings. Recommendations were synthesized and integrated into the BETTER toolkit alongside resources to support shared decision-making and care paths for the BETTER program. CONCLUSIONS: Comprehensive care requires the ability to address a person's overall health. An approach to identify high-quality clinical guidance to comprehensively address CCDPS is described. The process used to synthesize and harmonize implementable clinical recommendations may be useful to others wanting to integrate evidence across broad content areas to provide comprehensive care. The BETTER toolkit provides resources that clearly and succinctly present a breadth of clinical evidence that providers can use to assist with implementing CCDPS guidance in primary care.
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Guías de Práctica Clínica como Asunto , Atención Primaria de Salud , Prevención Primaria , Humanos , Atención Primaria de Salud/normas , Prevención Primaria/normas , Canadá , Tamizaje Masivo/normas , Enfermedad Crónica/prevención & control , Persona de Mediana Edad , Adulto , Anciano , Neoplasias/prevención & control , Neoplasias/diagnósticoRESUMEN
This Editorial compares the US Preventive Services Task Force (USPSTF) recommendations with the American Heart Association/American College of Cardiology (AHA/ACC)/multisociety guidelines on statin usage in primary prevention.
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Inhibidores de Hidroximetilglutaril-CoA Reductasas , American Heart Association , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Prevención Primaria/normasAsunto(s)
Tratamiento Conservador/métodos , Manejo de la Enfermedad , Trastornos del Suelo Pélvico , Prevención Primaria/métodos , Adolescente , Adulto , Niño , Tratamiento Conservador/normas , Femenino , Humanos , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Prevención Primaria/normas , Adulto JovenRESUMEN
This Academy of Nutrition and Dietetics Position Paper reports current evidence on pediatric overweight and obesity prevention interventions and discusses implications for registered dietitian nutritionists (RDNs). An overview of current systematic reviews provided evidence-based results from a range of nutrition interventions according to developmental age group (ages 2 to 5, 6 to 12, and 13 to 17 years). Twenty-one current systematic reviews of nutrition interventions demonstrated a beneficial effect of nutrition and physical activity interventions on body mass index measures and no adverse events were identified. RDNs impart nutrition expertise in a wide range of settings to provide comprehensive care for children and adolescents as their nutrition and developmental needs change over time. This Position Paper outlines the current roles of, and proposed directions for, RDNs engaged in pediatric overweight and obesity prevention. Prevention of pediatric overweight and obesity requires comprehensive strategies ranging from policy-level to individual-level interventions in settings that will have the most beneficial impact for children according to their developmental stage. This Position Paper advocates for increased availability of nutrition and food access programs and interventions to reduce risk of pediatric obesity and associated adverse health outcomes both now and for future generations.
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Dietética/normas , Promoción de la Salud/normas , Obesidad Infantil/prevención & control , Prevención Primaria/normas , Academias e Institutos , Adolescente , Niño , Preescolar , Dietética/métodos , Femenino , Promoción de la Salud/métodos , Humanos , Masculino , Política Nutricional , Guías de Práctica Clínica como Asunto , Desarrollo de Programa , Revisiones Sistemáticas como AsuntoRESUMEN
AIMS: Despite the well established role of coronary computed tomography angiography (CCTA) as a diagnostic gatekeeper, the yield of subsequent invasive coronary angiographies (ICA) remains low. We evaluated the adherence of CCTA integration in clinical management and primary prevention therapy. METHODS: We retrospectively analyzed patients referred for ICA after CCTA without known coronary artery disease (CAD) or structural cardiac pathologies. Based on computed tomography (CT) findings, patients were classified as appropriately or inappropriately referred to ICA, equaling Coronary Artery Disease - Reporting and Data System (CAD-RADS) categories 0-2 (<50% stenosis) and 3-5 (>50% stenosis), respectively. CT exams were compared regarding invasive findings and revascularizations. Integration of CT results into primary prevention measures was analyzed and compared to measures taken after ICA. RESULTS: Of 1005 patients referred for ICA, 81 (8.1%) had no obstructive CT findings and therefore no ICA indication. ICA inappropriate patients did not differ in symptom characteristics, but had a significantly lower revascularization rate (3.7% vs. 42.1%, Pâ<â0.0001) compared with patients appropriately referred to ICA. In patients with indication for lipid-lowering therapy after the CCTA statin rate was 53.1% and significantly increased after ICA to 76.4% (Pâ<â0.0001). In CCTA, obstructive findings in proximal-only lesions did not increase the revascularization rate (45.6% vs. 42.1%, Pâ=â0.11) but missed nonproximal relevant stenoses (15.0% vs. 2.5%, Pâ<â0.0001) compared with obstructive findings in all segments. CONCLUSION: The overall rate of inappropriateness was low, but there is relevant statin underutilization in eligible patients due to a lack of CT findings integration. Both ICA referrals and primary preventive therapy could be improved by the implementation of CT results based on CAD-RADS recommendations.
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Angiografía por Tomografía Computarizada , Angiografía Coronaria , Enfermedad de la Arteria Coronaria , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Uso Excesivo de los Servicios de Salud , Prevención Primaria , Austria/epidemiología , Angiografía por Tomografía Computarizada/métodos , Angiografía por Tomografía Computarizada/estadística & datos numéricos , Angiografía Coronaria/métodos , Angiografía Coronaria/estadística & datos numéricos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/prevención & control , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Uso Excesivo de los Servicios de Salud/prevención & control , Uso Excesivo de los Servicios de Salud/estadística & datos numéricos , Persona de Mediana Edad , Pautas de la Práctica en Medicina/normas , Prevención Primaria/métodos , Prevención Primaria/normas , Prevención Primaria/estadística & datos numéricos , Derivación y Consulta/normas , Derivación y Consulta/estadística & datos numéricosRESUMEN
AIMS: To compare the population proportion at high risk of cardiovascular disease (CVD) using the Norwegian NORRISK 1 that predicts 10-year risk of CVD mortality and the Norwegian national guidelines from 2009, with the updated NORRISK 2 that predicts 10-year risk of both fatal and non-fatal risk of CVD and the Norwegian national guidelines from 2017. METHODS: We included participants from the Norwegian population-based Tromsø Study (2015-2016) aged 40-69 years without a history of CVD (n=16 566). The total proportion eligible for intervention was identified by NORRISK 1 and the 2009 guidelines (serum total cholesterol ≥8 mmol/L, systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg) and NORRISK 2 and the 2017 guidelines (serum total cholesterol ≥7 mmol/L, low density lipoprotein (LDL) cholesterol ≥5 mmol/L, systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg). RESULTS: The total proportion at high risk as defined by a risk score was 12.0% using NORRISK 1 and 9.8% using NORRISK 2. When including single risk factors specified by the guidelines, the total proportion eligible for intervention was 15.5% using NORRISK 1 and the 2009 guidelines and 18.9% using NORRISK 2 and the 2017 guidelines. The lowered threshold for total cholesterol and specified cut-off for LDL cholesterol stand for a large proportion of the increase in population at risk. CONCLUSION: The population proportion eligible for intervention increased by 3.4 percentage points from 2009 to 2017 using the revised NORRISK 2 score and guidelines.
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Enfermedades Cardiovasculares/prevención & control , Vigilancia de la Población/métodos , Guías de Práctica Clínica como Asunto , Prevención Primaria/normas , Medición de Riesgo/métodos , Adulto , Enfermedades Cardiovasculares/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Noruega/epidemiología , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Factores de TiempoRESUMEN
Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality in the United States (U.S.) and incurs significant cost to the healthcare system. Management of cholesterol remains central for ASCVD prevention and has been the focus of multiple national guidelines. In this review, we compare the American Heart Association (AHA)/American College of Cardiology (ACC) and the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) Cholesterol guidelines. We review the evidence base that was used to generate recommendations focusing on 4 distinct themes: 1) the threshold of absolute 10-year ASCVD risk to start a clinician-patient discussion for the initiation of statin therapy in primary prevention patients; 2) the utility of coronary artery calcium score to guide clinician-patient risk discussion pertaining to the initiation of statin therapy for primary ASCVD prevention; 3) the use of moderate versus high-intensity statin therapy in patients with established ASCVD; and 4) the utility of ordering lipid panels after initiation or intensification of lipid lowering therapy to document efficacy and monitor adherence to lipid lowering therapy. We discuss why the VA/DoD and AHA/ACC may have reached different conclusions on these key issues.
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Enfermedades Cardiovasculares/prevención & control , Colesterol/sangre , Dislipidemias/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Medicina Militar/normas , Prevención Primaria/normas , Prevención Secundaria/normas , Biomarcadores/sangre , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/mortalidad , Toma de Decisiones Clínicas , Consenso , Monitoreo de Drogas/normas , Dislipidemias/sangre , Dislipidemias/diagnóstico , Dislipidemias/mortalidad , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Factores Protectores , Medición de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos/epidemiología , United States Department of Defense , United States Department of Veterans AffairsRESUMEN
The COVID-19 pandemic altered traditional education models and school nursing practice during the 2020-2021 school year. As schools plan to reopen for the 2021-2022 school year, school nurses must arm themselves with the most recent evidence-based knowledge and tools to promote the health and safety of the school community. Schools will need to continue infection control measures and strategies to support the social emotional needs of students and staff to promote a safe and healthy learning environment on return to school. Partnered with local health departments, school nurses are vital to mitigation measures such as on-site viral testing and vaccination. A successful school year depends on strong nursing leadership.
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COVID-19/prevención & control , COVID-19/psicología , Personal de Enfermería/psicología , Pandemias/prevención & control , Guías de Práctica Clínica como Asunto , Prevención Primaria/normas , Servicios de Enfermería Escolar/normas , Adolescente , Adulto , Actitud del Personal de Salud , COVID-19/epidemiología , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , SARS-CoV-2 , Estados Unidos/epidemiología , VacunaciónRESUMEN
BACKGROUND AND OBJECTIVE: Recommendations for preventing cardiovascular (CV) disease are currently separated into primary and secondary prevention. We hypothesize that relative effects of interventions for CV prevention are not different across primary and secondary prevention cohorts. Our aim was to test for differences in relative effects on CV events in common preventive CV interventions across primary and secondary prevention cohorts. METHODS AND RESULTS: A systematic search was performed to identify individual patient data (IPD) meta-analyses that included both primary and secondary prevention populations. Eligibility assessment, data extraction, and risk of bias assessment were conducted independently and in duplicate. We extracted relative risks (RR) with 95% confidence intervals (95% CI) of the interventions over patient-important outcomes and estimated the ratio of RR for primary and secondary prevention populations. We identified five eligible IPDs representing 524,570 participants. Quality assessment resulted in overall low-to-moderate methodological quality. We found no subgroup effect across prevention categories in any of the outcomes assessed. CONCLUSION: In the absence of significant treatment-subgroup interactions between primary and secondary CV prevention cohorts for common preventive interventions, clinical practice guidelines could offer recommendations tailored to individual estimates of CV risk without regard to membership to primary and secondary prevention cohorts. This would require the development of reliable ASCVD risk estimators that apply across both cohorts.
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Enfermedades Cardiovasculares/prevención & control , Guías de Práctica Clínica como Asunto , Prevención Primaria/métodos , Prevención Primaria/normas , Prevención Secundaria/métodos , Prevención Secundaria/normas , HumanosRESUMEN
First developed in 1990, the Agatston coronary artery calcium (CAC) score is an international guideline-endorsed decision aid for further risk assessment and personalized management in the primary prevention of atherosclerotic cardiovascular disease. This review discusses key international studies that have informed this 30 year journey, from an initial coronary plaque screening paradigm to its current role informing personalized shared decision making. Special attention is paid to the prognostic value of a CAC score of zero (the so called "power of zero"), which, in a context of low estimated risk thresholds for the consideration of preventive therapy with statins in current guidelines, may be used to de-risk individuals and thereby inform the safe delay or avoidance of certain preventive therapies. We also evaluate current recommendations for CAC scoring in clinical practice guidelines around the world, and past and prevailing barriers for its use in routine patient care. Finally, we discuss emerging approaches in this field, with a focus on the potential role of CAC informing not only the personalized allocation of statins and aspirin in the general population, but also of other risk-reduction therapies in special populations, such as individuals with diabetes and people with severe hypercholesterolemia.
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Aterosclerosis/prevención & control , Calcio/análisis , Vasos Coronarios/química , Guías de Práctica Clínica como Asunto , Prevención Primaria/normas , Aterosclerosis/diagnóstico , Aterosclerosis/epidemiología , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Vasos Coronarios/diagnóstico por imagen , Diabetes Mellitus/epidemiología , Humanos , Hipercolesterolemia/epidemiología , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Literatura de Revisión como Asunto , Medición de Riesgo/métodos , Factores de RiesgoRESUMEN
The 2021 guidelines primary panel selected clinically relevant questions and produced updated recommendations, on the basis of important new findings that have emerged since the 2016 guidelines. In patients with clinical atherosclerosis, abdominal aortic aneurysm, most patients with diabetes or chronic kidney disease, and those with low-density lipoprotein cholesterol ≥ 5 mmol/L, statin therapy continues to be recommended. We have introduced the concept of lipid/lipoprotein treatment thresholds for intensifying lipid-lowering therapy with nonstatin agents, and have identified the secondary prevention patients who have been shown to derive the largest benefit from intensification of therapy with these agents. For all other patients, we emphasize risk assessment linked to lipid/lipoprotein evaluation to optimize clinical decision-making. Lipoprotein(a) measurement is now recommended once in a patient's lifetime, as part of initial lipid screening to assess cardiovascular risk. For any patient with triglycerides Ë 1.5 mmol/L, either non-high-density lipoprotein cholesterol or apolipoprotein B are the preferred lipid parameter for screening, rather than low-density lipoprotein cholesterol. We provide updated recommendations regarding the role of coronary artery calcium scoring as a clinical decision tool to aid the decision to initiate statin therapy. There are new recommendations on the preventative care of women with hypertensive disorders of pregnancy. Health behaviour modification, including regular exercise and a heart-healthy diet, remain the cornerstone of cardiovascular disease prevention. These guidelines are intended to provide a platform for meaningful conversation and shared-decision making between patient and care provider, so that individual decisions can be made for risk screening, assessment, and treatment.
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Enfermedades Cardiovasculares/prevención & control , Dislipidemias/terapia , Adulto , Apolipoproteínas B/sangre , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Suplementos Dietéticos , Ácido Eicosapentaenoico/análogos & derivados , Ácido Eicosapentaenoico/uso terapéutico , Ezetimiba/uso terapéutico , Femenino , Conductas Relacionadas con la Salud , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Inhibidores de PCSK9/uso terapéutico , Embarazo , Complicaciones del Embarazo , Prevención Primaria/normas , Medición de Riesgo , Prevención Secundaria/normasRESUMEN
Growing evidence suggests current water, sanitation, and hygiene interventions do not improve domestic hygiene sufficiently to improve infant health, nor consider the age-specific behaviors which increase infection risk. A household playspace (HPS) is described as one critical intervention to reduce direct fecal-oral transmission within formative growth periods. This article details both the design and development (materials and methods), and testing (results) of a HPS for rural Ethiopian households. Design and testing followed a multi-sectoral, multistep participatory process. This included a focus group discussion (FGD), two user-centered and participatory design workshops in the United Kingdom and Ethiopia, discussions with local manufacturers, and a Trials by Improved Practices (TIPs) leading to a final prototype design. Testing included the FGD and TIPs study and a subsequent randomized controlled feasibility trial in Ethiopian households. This multi-sectoral, multistage development process demonstrated a HPS is an acceptable and feasible intervention in these low-income, rural subsistence Ethiopian households. A HPS may help reduce fecal-oral transmission and infection-particularly in settings where free-range domestic livestock present an increased risk. With the need to better tailor interventions to improve infant health, this article also provides a framework for future groups developing similar material inputs and highlights the value of participatory design in this field.
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Diseño de Equipo/normas , Composición Familiar , Salud del Lactante/normas , Prevención Primaria/métodos , Prevención Primaria/normas , Saneamiento/métodos , Saneamiento/normas , Adolescente , Niño , Preescolar , Etiopía , Femenino , Grupos Focales , Guías como Asunto , Humanos , Lactante , Recién Nacido , Masculino , Población Rural , Reino UnidoRESUMEN
OBJECTIVE: There is a relationship between pesticide exposure and farmworkers' health. Well-conducted evaluations can provide an insight into how to develop and implement more effective interventions to prevent farmers and farmworkers' exposure to pesticides. This review aimed to summarize the literature on the effectiveness of interventions to promote pesticide safety and reduce pesticide exposure among farmers and farmworkers. METHODS: A comprehensive search on PubMed, Embase, ISI Web of Science, Scopus, Science Direct, Agricola, NIOSHTIC, and Agris databases was performed to identify relevant studies published from 2000 to 2019. Randomized controlled trials (RCTs) and quasi-experimental studies assessing the effectiveness of interventions on a variety of outcomes related to pesticide exposure were considered. The searches were restricted to articles written in English. The methodological quality of included reviews was appraised using the Effective Public Health Practice Project quality assessment tool (EPHPP). RESULTS: The initial search led to 47912 records, 31 studies of which including nine RCTs and twenty-two quasi-experimental studies met the criteria. The majority of the included studies focused on the educational/ behavioral approach. The studies that applied this approach were effective in improving the participants' knowledge and attitude; however, these interventions were less effective in terms of making changes in participants' behaviors and their risk of exposure to toxic pesticides. Multifaceted interventions were moderately effective in terms of improving farmers' and farmworkers' behaviors and reduction in exposure to toxic pesticides. We did not find any studies that had evaluated the effectiveness of engineering/technological, and legislation/enforcement interventions. CONCLUSIONS: Although the majority of studies were based on an educational/behavioral approach and did not assess the effect of interventions on objective measures, the results of this review highlight the significant effectiveness of educational programs and some potential key elements of these interventions. These findings may inform policymakers to develop interventions to reduce pesticide exposure among farmers and farmworkers.
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Enfermedades de los Trabajadores Agrícolas/prevención & control , Agricultores/estadística & datos numéricos , Exposición Profesional/prevención & control , Plaguicidas/toxicidad , Prevención Primaria/normas , Enfermedades de los Trabajadores Agrícolas/epidemiología , Enfermedades de los Trabajadores Agrícolas/etiología , Agricultores/educación , Agricultores/psicología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Exposición Profesional/estadística & datos numéricos , Prevención Primaria/métodos , Ensayos Clínicos Controlados Aleatorios como AsuntoAsunto(s)
COVID-19 , Control de Enfermedades Transmisibles , Densidad de Población , Prevención Primaria/normas , Número Básico de Reproducción , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/transmisión , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/organización & administración , Control de Enfermedades Transmisibles/estadística & datos numéricos , Exactitud de los Datos , Interpretación Estadística de Datos , Transmisión de Enfermedad Infecciosa/prevención & control , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Humanos , Incidencia , Medición de Riesgo , Factores de Riesgo , SARS-CoV-2/aislamiento & purificación , Índice de Severidad de la EnfermedadRESUMEN
Los trastornos de la conducta alimentaria (TCA) han adquirido relevancia en la pediatría chilena. Su tratamiento debe ser realizado, de preferencia, por equipos multidisciplinarios especializados o con alto grado de capacitación en la problemática. Sin embargo, los pediatras generales tienen un rol fundamental tanto en la prevención como en la pesquisa temprana de estas patologías. El objetivo de esta publicación es proporcionarles recomendaciones prácticas sobre las intervenciones que pueden llevar a cabo durante la atención de adolescentes, para la prevención de los TCA, la pesquisa precoz y evaluación de quienes ya los presentan, y su derivación oportuna a tratamiento especializado.
Eating disorders (ED) have become relevant in Chilean pediatrics. Their treatment must be prefe rably carried out by multidisciplinary teams with specialty or a high degree of training in the pro blem. However, general pediatricians have a fundamental role both in the prevention and in the early detection of these pathologies. The purpose of this publication is to provide them with practical recommendations on interventions that can be carried out during adolescent care for the prevention of ED, the early detection and evaluation of those who already have them, and their timely referral to specialized treatment.
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Humanos , Adolescente , Pediatría/métodos , Pediatría/normas , Rol del Médico/psicología , Trastornos de Alimentación y de la Ingestión de Alimentos/diagnóstico , Trastornos de Alimentación y de la Ingestión de Alimentos/etiología , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Trastornos de Alimentación y de la Ingestión de Alimentos/terapia , Pediatras/normas , Pediatras/psicología , Grupo de Atención al Paciente , Examen Físico/métodos , Examen Físico/normas , Relaciones Médico-Paciente , Prevención Primaria/métodos , Prevención Primaria/normas , Derivación y Consulta , Chile , Factores de Riesgo , Diagnóstico Precoz , Diagnóstico Diferencial , Anamnesis/métodos , Anamnesis/normasRESUMEN
We present the adaptation for Spain of the updated European Cardiovascular Prevention Guidelines. In this update, greater stress is laid on the population approach, and especially on the promotion of physical activity and healthy diet through dietary, leisure and active transport policies in Spain. To estimate vascular risk, note should be made of the importance of recalibrating the tables used, by adapting them to population shifts in the prevalence of risk factors and incidence of vascular diseases, with particular attention to the role of chronic kidney disease. At an individual level, the key element is personalised support for changes in behaviour, adherence to medication in high-risk individuals and patients with vascular disease, the fostering of physical activity, and cessation of smoking habit. Furthermore, recent clinical trials with PCSK9 inhibitors are reviewed, along with the need to simplify pharmacological treatment of arterial hypertension to improve control and adherence to treatment. In the case of patients with type 2 diabetes mellitus and vascular disease or high vascular disease risk, when lifestyle changes and metformin are inadequate, the use of drugs with proven vascular benefit should be prioritised. Lastly, guidelines on peripheral arterial disease and other specific diseases are included, as is a recommendation against prescribing antiaggregants in primary prevention.
Presentamos la adaptación para España de la actualización de las Guías Europeas de Prevención Vascular. En esta actualización se hace mayor énfasis en el abordaje poblacional, especialmente en la promoción de la actividad física y de una dieta saludable mediante políticas alimentarias y de ocio y transporte activo en España. Para estimar el riesgo vascular, se destaca la importancia de recalibrar las tablas que se utilicen, adaptándolas a los cambios poblaciones en la prevalencia de los factores de riesgo y en la incidencia de enfermedades vasculares, con particular atención al papel de la enfermedad renal crónica. A nivel individual resulta clave el apoyo personalizado para el cambio de conducta, la adherencia a la medicación en los individuos de alto riesgo y pacientes con enfermedad vascular, la promoción de la actividad física y el abandono del hábito tabáquico. Además, se revisan los ensayos clínicos recientes con inhibidores de PCKS9, la necesidad de simplificar el tratamiento farmacológico de la hipertensión arterial para mejorar su control y la adherencia al tratamiento. En los pacientes con diabetes mellitus 2 y enfermedad vascular o riesgo vascular alto, cuando los cambios de estilo de vida y la metformina resultan insuficientes, deben priorizarse los fármacos con demostrado beneficio vascular. Por último, se incluyen pautas sobre enfermedad arterial periférica y otras enfermedades específicas, y se recomienda no prescribir antiagregantes en prevención primaria.