Temporal trends in low-dose aspirin therapy for primary prevention of cardiovascular disease in European adults with and without diabetes.

AIMS: Aspirin therapy for primary prevention of cardiovascular disease (CVD) is controversial, and guideline recommendations have changed throughout the last decades. We report temporal trends in primary prevention aspirin use among persons with and without diabetes and describe characteristics of incident aspirin users. METHODS AND RESULTS: Using Danish nationwide registries, we identified incident and prevalent aspirin users in a population of subjects ≥40 years without CVD eligible for primary preventive aspirin therapy from 2000 through 2020. Temporal trends in aspirin users with and without diabetes were assessed, as were CVD risk factors among incident users. A total of 522 680 individuals started aspirin therapy during the study period. The number of incident users peaked in 2002 (39 803 individuals, 1.78% of the eligible population) and was the lowest in 2019 (11 898 individuals, 0.49%), with similar trends for subjects with and without diabetes. The percentage of incident users with no CVD risk factors [diabetes, hypertension, hypercholesterolemia, or chronic obstructive pulmonary disease (a proxy for smoking)] decreased from 53.9% in 2000 to 30.9% in 2020. The temporal trends in prevalent aspirin users followed a unimodal curve, peaked at 7.7% in 2008, and was 3.3% in 2020. For subjects with diabetes, the peak was observed in 2009 at 38.5% decreasing to 17.1% in 2020. CONCLUSION: Aspirin therapy for primary prevention of CVD has decreased over the last two decades. However, the drug remained used in individuals with and without diabetes, and a large proportion of individuals started on aspirin therapy had no CVD risk factors.

One sentence summaryThis study investigated the temporal trends in aspirin use for primary prevention of cardiovascular disease in individuals with and without diabetes and found that even though the number of aspirin users has declined, the drug remains prescribed, and individuals even without cardiovascular risk factors were started on aspirin therapy. Lay summary key findingsThe number of aspirin users with and without diabetes for primary prevention of cardiovascular disease has decreased over the last two decades. Nevertheless, individuals with a low burden of cardiovascular risk factors were started on aspirin therapy.Efforts to inform appropriate use of aspirin are needed.

Primary prevention of food allergy in 2021: Update and proposals of French-speaking pediatric allergists.

During the past years, there has been an alarming increase in cases of food allergy and anaphylaxis in ever-younger children. Often, these children have multiple food allergies and food sensitizations, involving allergens with high anaphylactic potential, such as peanuts and nuts, which have a major influence on their quality of life and future. After reviewing the current epidemiological data, we discuss the main causes of the increase in food allergies. We analyze data from studies on the skin barrier and its fundamental role in the development of sensitization and food allergies, data on the tolerogenic digestive tract applied in particular to hen eggs and peanuts, as well as data on the prevention of allergy to cow milk proteins. In light of these studies, we propose a practical guide of recommendations focused on infants and the introduction of cow milk, the management of eczema, and early and broad dietary diversification including high-risk food allergens, such as peanut and nuts while taking into account the food consumption habits of the family.

Origen y evolución del control de salud / Origin and evolution of periodic health check-ups

Los controles periódicos de salud son aquellos cuidados médicos realizados a intervalos regulares, motivados por la necesidad de evaluar la salud en general y prevenir enfermedades a futuro. Se presume que comenzaron a ponerse en práctica durante el siglo XIX para la detección precoz de la tuberculosis y otras enfermedades contagiosas. A principios del siglo XX fueron difundidos los programas de examinación médica en el contexto de la estimación del riesgo de enfermedad y/o muerte previo a la contratación de seguros de vida. El desarrollo tecnológico posterior a la Segunda Guerra mundial fomentó el interés en estas examinaciones periódicas con la implementación de pruebas masivas de rastreo, lo que aumentó de manera considerable de la mano de los servicios de medicina prepaga. En los últimos años se han realizado múltiples esfuerzos por cuantificar los beneficios de estos controles. Si bien existen diversas opiniones respecto a su utilidad, pareciera ser que el enfoque actual del control periódico de salud implica tener en cuenta las necesidades de las personas, el riesgo individual y la relación médico-paciente como eje de la discusión. (AU)

Periodic health check-ups are medical care performed at regular intervals, motivated by the need to assess general health and prevent future diseases. It is presumed that they began to be implemented in the 19thcentury for the early detection of tuberculosis and other contagious diseases, and later spread in the early 20thcentury in the context of estimating the risk of illness and/or death prior to taking out life insurance. The technological development after the World War II encouraged interest in these periodic examinations with the implementation of mass screening tests, which increased considerably with the introductionof prepaid medical services. In recent years, multiple efforts have been made to quantify the benefits of such controls. While there are varying opinionsas to their usefulness, it appears that the current approach to periodic health check-ups is to take into account the needs of individuals, their individual risk, and the doctor-patient relationship at the core of the discussion. (AU)

Training, Attitudes, and Practice (TAP) among healthcare professionals in the Nelson Mandela Bay municipality, South Africa: A health promotion and disease prevention perspective.

BACKGROUND: Healthcare professionals (HCPs) play a pivotal role in ensuring access to quality healthcare of patients. However, their role in health promotion (HP) and disease prevention (DP) has not been fully explored. This study aimed at determining how training, attitude, and practice (TAP) of HCPs influence their practice of HP and DP. METHODS: Data on TAP regarding HP and DP were collected from 495 HCPs from twenty-three hospitals in the study area using a standardized questionnaire. Bivariate, univariate, and multivariate analyses were conducted to describe how the TAP of HCPs influence their HP and DP practices. The analysis was further desegregated at the three levels of healthcare (primary, secondary and tertiary levels). RESULTS: Most of the medical doctors 36.12% (n = 173), registered nurses 28.39% (n = 136), and allied health professionals (AHPs) 11.27% (n = 54) indicated the absence of coordinated HP training for staff in their facilities. Similarly, 32.93% (n = 193) of the HCPs, indicated having participated in HP or DP training. Among those that had participated in HP and DP training, benefits of training were positive behaviour, attributions, and emotional responses. When compared at the different levels of healthcare, enhanced staff satisfaction and continuing professional development for HP were statistically significant only at the tertiary healthcare level. Multivariate analysis showed a likelihood of reduced coordinated HP training for staff among medical doctors (Coef 0.15; 95% CI 0.07-0.32) and AHPs (Coef 0.24; 95% CI 0.10-0.59) compared to nurses. Furthermore, medical doctors (Coeff: 0.66; 95% CI: 0.46-0.94) were less likely to agree that HCPs should model good health behavior to render HP services as compared to nurses. CONCLUSION: Training in HP and DP empowers HCPs with the requisite knowledge and attitude necessary for effective practice. Several HCPs at different levels of care had limited knowledge of HP and DP because of inadequate training. We recommend a strategy aimed at addressing the knowledge and attitudinal gaps of HCPs to ensure effective HP and DP services to patients.

JCL Roundtable. Making prevention a priority.

Clinical lipidology belongs par excellence to the preventive mode of medical practice. This Roundtable brings two long-time advocates of cardiometabolic prevention and a newly minted preventive cardiologist into a discussion that expands their recent JCL editorial on this topic. Atherosclerosis is a single disease process that leads to approximately 25% of deaths in economically advanced nations and a growing fraction of mortality and morbidity in nations with developing and emerging economies. Our discussants suggest that at least 75% of atherosclerotic cardiovascular disease can be prevented. Diet and lifestyle including physical activity are the cornerstones for this effort. Public and private choices about diet-lifestyle are influenced by economics, education (especially in childhood), inequities, technology, misinformation, and trust. Lipid clinics perform well with pharmacologic treatment of lipid disorders and increasingly give attention to hypertension, obesity, and diabetes as needed. Cardiometabolic prevention in the clinic works best through provider teams. Business considerations and exemplary programs are highlighted.

Update on the omega-3 fatty acid trial landscape: A narrative review with implications for primary prevention.

Residual risk mediated by hypertriglyceridemia among statin-treated individuals is an important clinical and public health challenge. Niacin, fibrates and omega-3 FA are three classes of non-statin agents with demonstrated TG-lowering effects. Randomized controlled trials of niacin and fibrates have been consistently negative, but the trial landscape for two key sources of omega-3 FAs, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) is more complex. Clinical trials evaluating omega-3 FA can be differentiated into those that studied mixed formulations (EPA + DHA) and those that studied EPA alone. Those assessing the impact of mixed formulations have not consistently demonstrated CVD risk reduction, whereas trials of EPA alone have been successful. Two recent trials of mixed formulations - STRENGTH (Long-Term Outcomes Study to Assess Statin Residual Risk with Epanova in High Cardiovascular Risk Patients with Hypertriglyceridemia) and OMEMI (Omega-3 fatty acids in Elderly patients with Myocardial Infarction) - studied contemporarily treated patients with mixed EPA + DHA formulations at higher doses than before and showed no benefit, thus adding valuable information to our overall understanding of this evolving therapeutic class. In this review, we contextualize the findings of STRENGTH and OMEMI within the existing omega-3 FA clinical trial landscape and look ahead to how future trials can inform existing knowledge gaps, particularly with regards to the applicability of these agents within the primary prevention realm.

GLOBAL ENDOCRINOLOGY: Global perspectives in endocrinology: coverage of iodized salt programs and iodine status in 2020.

Iodine deficiency has multiple adverse effects on growth and development. Diets in many countries cannot provide adequate iodine without iodine fortification of salt. In 2020, 124 countries have legislation for mandatory salt iodization and 21 have legislation allowing voluntary iodization. As a result, 88% of the global population uses iodized salt. For population surveys, the urinary iodine concentration (UIC) should be measured and expressed as the median, in µg/L. The quality of available survey data is high: UIC surveys have been done in 152 out of 194 countries in the past 15 years; in 132 countries, the studies were nationally representative. The number of countries with adequate iodine intake has nearly doubled from 67 in 2003 to 118 in 2020. However, 21 countries remain deficient, while 13 countries have excessive intakes, either due to excess groundwater iodine, or over-iodized salt. Iodine programs are reaching the poorest of the poor: of the 15 poorest countries in the world, 10 are iodine sufficient and only 3 (Burundi, Mozambique and Madagascar) remain mild-to-moderately deficient. Nigeria and India have unstable food systems and millions of malnourished children, but both are iodine-sufficient and population coverage with iodized salt is a remarkable 93% in both. Once entrenched, iodine programs are often surprisingly durable even during national crises, for example, war-torn Afghanistan and Yemen are iodine-sufficient. However, the equity of iodized salt programs within countries remains an important issue. In summary, continued support of iodine programs is needed to sustain these remarkable global achievements, and to reach the remaining iodine-deficient countries.

Primary prevention of VTE spans a spectrum.

High mortality from VTE makes primary prevention appealing. Guidelines and assessment tools offer a variety of patient-specific strategies and agents.

Stopping the SARS-CoV-2 surge in the USA-CDC recommendations and ground realities.

As of May 10, 2020, the United States of America (USA) has 1,367,079 cases of SARS CoV-2 and 80,773 deaths associated with the disease. New York alone has more than 333,000 cases and nearly 21,271 deaths. As we are trying to reopen our economies, the biggest risk we face is a surge in the immediate cases of new infections. The second wave of infection in the fall has also been predicted. As per the Center for Disease Control and Prevention's (CDC) latest data set, among the dead from SARS COV-2 in the USA, 80% were 65 years or older. Despite lower percentages of people living in nursing homes and the fact that they represented only 11% of total cases of SARS CoV-2 cases, the maximum death rate has been seen there. A staggering 27,700 people died in long-term facilities in the USA as per the database by the New York Times. These deaths accounted for one-third of the deaths related to SARS CoV-2, making it the most intensively hurt group of al. lThe ground reality is that unfortunately, even now, most of these facilities do not have enough tests that can stop the outbreak. We suggest special targeting of residents of long-term care facilities, and the HCPs involved in these facilities to stop the spread of SARS CoV-2. Extreme measures including the highest testing numbers should be allocated to these facilities and rigorous Infection control measures should be undertaken so that the SARS-CoV-2 virus does not enter and infect the patients in these facilities and if it does, it is limited to the facility.

Time trends analysis of statin prescription prevalence, therapy initiation, dose intensity, and utilization from the hospital information system of Jinshan Hospital, Shanghai (2012-2018).

BACKGROUND: Statin remains a mainstay in the prevention and treatment of cardiovascular diseases. Statin utilization has evolved over time in many countries, but data on this topic from China are quite limited. This study aimed to investigate the changing trends of statins prescription, as well as detail the statin utilization through a successive longitudinal study. METHODS: The prescription database was established based on electronic health records retrieved from the hospital information system of Jinshan Hospital, Fudan University from January 2012 to December 2018 in Shanghai, China. The prescription rates and proportions of different statin types and doses among all patients were examined. Sub-analyses were performed when stratifying the patients by age, gender, dose intensity, and preventative intervention. RESULTS: During the study period, a total of 51,083 patients, who were prescribed for statins, were included in this study (mean [SD] age, 59.78 [±13.16] years; 53.60% male, n = 27, 378). The overall statins prescription rate in which patients increased from 2012 (1.24, 95% CI: 1.21-1.27%) to 2018 (3.16, 95% CI: 3.11-3.20%), P < 0.001. Over 90% of patients were given a moderate dose of statins. Patients with a history of coronary and cerebrovascular events (over 32%) were more likely to be prescribed with statins for preventative intervention. Furthermore, our study has witnessed a significant rise in statin therapy in primary and secondary prevention. CONCLUSIONS: In conclusion, statins were frequently prescribed and steadily increased over time in our study period. There were also changes in statin drug choices and dosages. A coordinated effort among the patient, clinical pharmacist, stakeholders and health system is still needed to improve statin utilization in clinical practice in the future.

[Aspirin for primary cardiovascular prevention : the end of an era ?] / Aspirine en prévention cardiovasculaire primaire†: la fin d'une époque†?

Low-dose aspirin in primary prevention of cardiovascular disease is still debated. Recent clinical trials of aspirin vs placebo reported an unfavourable risk-benefit ratio with an increase in major bleedings without reduction on the occurrence of non-fatal cardiovascular events. These studies also highlight that current cardiovascular risk calculators overestimate cardiovascular risk, which is probably related to the improvement in the management of cardiovascular risk factors over the last decades. In accordance with European cardiovascular prevention recommendations, aspirin should not be prescribed for the primary prevention of cardiovascular disease.

L'aspirine à faible dose en prévention primaire des maladies cardiovasculaires (CV) ne fait pas l'unanimité. De nouvelles études parues en 2018 mettent en évidence un rapport risques/bénéfices défavorable avec une augmentation des hémorragies majeures sans effets sur la survenue d'événements CV non mortels. Ces études soulignent également que les calculateurs actuels du risque CV surévaluent celui-ci, et ceci est probablement lié à l'amélioration depuis quelques décennies de la prise en charge des facteurs de risque CV. En accord avec les recommandations européennes de prévention CV, la prescription d'aspirine n'est donc plus recommandée aux adultes sans maladie CV manifeste.

The Use of Oral Anticoagulants in Patients with Atrial Fibrillation in the Emergency Department.

BACKGROUND AND AIM: Atrial Fibrillation is the leading cause of embolic stroke, yet less than half of high-risk patients with atrial fibrillation are on adequate stroke prevention with oral anticoagulants. Guidelines for the primary prevention of stroke recognize the emergency department as a location for physicians to identify atrial fibrillation and initiate anticoagulants. We sought to compare anticoagulant prescription rates in patients with atrial fibrillation in various provider settings to identify opportunities for improvement in cardioembolic stroke prevention. METHODS: A retrospective cohort study of 436 patients with atrial fibrillation presenting to the emergency department from 2014 to 2018 was performed. Baseline characteristics, stroke risk, and rates of anticoagulant prescription were compared across 3 groups: (1) patients discharged from the emergency department, (2) patients admitted under observation status, and (3) patients admitted to inpatient hospital service. RESULTS: Among 436 patients (47% women, 51% Hispanic), we identified 105 in the emergency department cohort, 131 in the observation cohort and 200 in the inpatient cohort. The average CHA2DS2-VASc score was 2.5 in the emergency department cohort, 2.6 in the observation cohort and 3.3 in the inpatient cohort. Anticoagulants were prescribed for high-risk patients (CHA2DS2-VASc score ≥ 2) in 17.5% (7/40) of the emergency department cohort compared to 73% (38/52, P< .0001) of the observation cohort and 80% (82/103 P< .0001) of the inpatient cohort. CONCLUSION: Patients with atrial fibrillation are more likely to be prescribed anticoagulants if admitted to inpatient or under observation status compared to the emergency department.

Moving Upstream From the Individual to the Community: Addressing Social Determinants of Health.

School nurses are often the primary health professional promoting children's health-and address not just individuals, but communities. This article, featuring the key principle of community/public health, is the first in a series focusing on The Framework for 21st Century School Nursing Practice™ and presents a case study on asthma and air quality issues comparing the more traditional individual approaches to health (labeled downstream and midstream) with population-level approaches (labeled upstream). Through collaboration with key community stakeholders, school nurses can successfully implement policies and programs to address social determinants of health and, in turn, improve the health of the entire community. As we look to advance school nursing and support best practices, concentrating on population-level, upstream approaches align with recommendations outlined in the Framework for 21st Century School Nursing Practice™.

A Scoping Review of Foci, Trends, and Gaps in Reviews of Tobacco Control Research.

INTRODUCTION: The burden of disease associated with tobacco use has prompted a substantial increase in tobacco-related research, but the breadth of this literature has not been comprehensively examined. This review examines the nature of the research addressing the action areas in World Health Organization's Framework Convention on Tobacco Control (FCTC), the populations targeted and how equity-related concepts are integrated. METHOD: A scoping review of published reviews addressing tobacco control within the primary prevention domain. We searched PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Educational Resources Information Centre, and PsycInfo from 2004 to 2018. RESULTS: The scoping review of reviews offered a "birds-eye-view" of the tobacco control literature. Within the 681 reviews meeting inclusion criteria, there was a strong focus on smoking cessation targeting individuals; less attention has been given to product regulation, packaging, and labeling or sales to minors. Equity-related concepts were addressed in 167/681 (24.5%); few were focused on addressing inequity through structural and systemic root causes. CONCLUSION: This analysis of foci, trends, and gaps in the research pursuant to the FCTC illustrated the particular action areas and populations most frequently addressed in tobacco control research. Further research is needed to address: (1) underlying social influences, (2) particular action areas and with specific populations, and (3) sustained tobacco use through the influence of novel marketing and product innovations by tobacco industry. IMPLICATIONS: This scoping review of the breadth of tobacco control research reviews enables a better understanding of which action areas and target populations have been addressed in the research. Our findings alongside recommendations from other reviews suggest prioritizing further research to support policymaking and considering the role of the tobacco industry in circumventing tobacco control efforts. The large amount of research targeting individual cessation would suggest there is a need to move beyond a focus on individual choice and decontextualized behaviors. Also, given the majority of reviews that simply recognize or describe disparity, further research that integrates equity and targets various forms of social exclusion and discrimination is needed and may benefit from working in collaboration with communities where programs can be tailored to need and context.