Implementation of back to living well, a community-based program for the tertiary prevention of low back pain: a study protocol.

BACKGROUND: The current literature supports the effectiveness of exercise, education, and self-management interventions for the long-term management of persistent low back pain. However, there is significant uncertainty about the implementation of interventions related to barriers, facilitators, and patient's preferences. This study will evaluate the Back to Living Well program implementation from a participant and organizational perspective. More specifically we address the following objectives: 1) identify program barriers and facilitators from participants' perspectives, 2) identify factors related to program, personal and contextual factors that contribute to negative and positive outcomes, and outcome trajectories, 3) identify factors influencing participants' selection of an in-person or e-health program, and 4) evaluate program specific barriers and facilitators from the organization and care delivery perspectives. METHODS: This study will utilize a mixed-method convergent design including a longitudinal cohort strand and a longitudinal qualitative interview strand. The RE-AIM framework will be used to assess program implementation. Participants (n = 90, 1:1: in person or virtual) who choose to register in the program as well as staff (n = 10 to 15) involved in the delivery of the program will be invited to participate. Participants will participate in a 12-week physical activity, education, and self-management program. Implementation outcomes will be measured at 3-, 6-, 12-months, and six months after the end of the follow-ups. Interview scripts and directed content analysis will be constructed based on the Theoretical Domains Framework and the Neuromatrix Model of Pain, Theoretical Domains Framework. Staff interviews will be constructed and analyzed using the Consolidated Framework for Implementation Research. Participants will also complete pain, disability, quality of life and psychological questionnaires, wear an activity tracker at all time points, and complete weekly pain and activity limitation questions using a mobile application. DISCUSSION: The study results will provide evidence to inform potential future implementation of the program. An effective, appropriately targeted, and well implemented exercise program for the long-term management (i.e., tertiary prevention) of LBP could minimize the burden of the condition on patients, the health care system and society. TRIAL REGISTRATION: ClinicalTrials.gov NCT05929846. This (Registration Date: July 3 2023) study has been approved by the Hamilton Integrated Research Ethics Board Project ID#15,354.

Algunas reflexiones sobre la atención de enfermería para la prevención terciaria de complicaciones asociadas al puerperio / Some Some reflections on nursing care for the tertiary prevention of complications associated with postpartum

La prevención incluye medidas destinadas no solo a prevenir la aparición de la enfermedad, sino también a detener su avance y atenuar las posibles consecuencias una vez diagnosticada. El modelo clásico de Leavell y Clark constituye una estrategia de prevención, que en ocasiones se usa en función de los niveles de atención médica y su complejidad; aspecto que trae confusión. En tal sentido, en el presente artículo se pretende reflexionar sobre los principales elementos a tener en cuenta en la prevención terciaria, que es la que se aplica en las unidades de cuidados intensivos, dadas las interrogantes que genera el tema.

Prevention includes measures not only dedicated to prevent the emergence of the disease, but also to stop its advance and attenuate the possible consequences once it is established. The classic pattern of Leavell and Clark constitutes a prevention strategy that is sometimes used associated with the medical care levels and its complexity; aspect that brings confusion. In such a sense, this work aims at reflecting on the main elements to take into account in the tertiary prevention that is implemented in the intensive care units, given the questions that the topic generates.

Primary, secondary and tertiary prevention of food allergy: current practices and future directions.

The incidence of food allergies has risen around the globe, and experts have been exploring methods of preventing such allergies in young children to ease the burden of disease and reduce the morbidity and mortality caused by anaphylaxis to food allergens. Such preventative measures can be categorised as primary, secondary and tertiary prevention, which are discussed in detail in this review. Primary prevention is defined as the prevention of becoming sensitised towards specific allergens. The evidence suggests that avoiding common allergenic foods during pregnancy and breastfeeding is not protective against food allergies, and guidelines recommend weaning from 4 to 6 months of age, with recent studies supporting the early introduction of peanuts at 4 months to prevent peanut allergy. Secondary prevention targets patients who are already sensitised and aims to halt the progression of sensitisation, with evidence for high rates of success and safety in trials of early introduction to milk and peanuts using oral immunotherapy in sensitised infants. Tertiary allergy prevention focuses on reducing the risk of a patient having anaphylaxis, with oral immunotherapy being the most common method of promoting tolerance in allergic children. Several studies have demonstrated successful reintroduction for milk, egg and peanut; however, no such guidelines are recommended for other foods. Finally, dietary advancement therapy in the form of milk and egg ladders has been employed as a method of primary, secondary and tertiary prevention of allergies, particularly in Ireland, the UK and Canada.

Tertiary prevention strategies for micrometastatic lymph node cervical cancer: A systematic review and a prototype of an adapted model of care.

PURPOSE: We found a need for balancing the application of clinical guidelines and tailored approaches to follow-up of cervical cancer (CC) patients in the lymph node micrometastatic (MICs) setting. This review aimed to determine the current knowledge of management of MIC-positive CC cases. METHODOLOGY: We addressed prognostic and risk of recurrence monitoring impacts associated with MIC+ cases. The electronic databases for literature and relevant articles were analysed. RESULTS: Fifteen studies, (4882 patients), were included in our systematic review. While the results show that MICs significantly worsen prognosis in early CC. A tertiary prevention algorithm for low volume lymph node disease may stratify follow-up according to the burden of nodal disease and provide data that helps improve follow-up performance. CONCLUSION: MICs worsen prognosis and should be managed as suggested by the algorithm. However, this algorithm must be externally validated. The clinical impact of isolated tumor cells (ITC) remains unclear.

Using Behaviour Change Techniques to characterize patient educational interventions in tertiary individual prevention of work-related skin diseases.

Tertiary Individual Prevention is an interprofessional inpatient rehabilitation programme offered to workers affected by work-related skin diseases. Health educational interventions aiming at changing skin protection behaviour are a pivotal component of the programme. This paper aims at characterizing the content of the educational interventions of the interprofessional inpatient rehabilitation programme and at reporting the mechanisms and functions for behaviour change. We retrospectively analysed existing health educational interventions with document analyses and field observations. The intervention was described using the Template of Intervention Description and Replication (TIDieR). For the intervention content, the Behaviour Change Technique (BCT) Taxonomy (v1) was applied. To characterize the intervention in detail, the BCTs were then mapped to the intervention functions, the COM-B model (Capability, Opportunity, Motivation) and the Theoretical Domains Framework (TDF) from the Behaviour Change Wheel (BCW). The health educational interventions consist of seven components. Five are delivered in a group and two as tailored face-to-face counselling. We identified 23 BCTs in 10 groups. The most common used BCTs are "instruction on how to perform skin protection behaviour," "salience of consequences," "information about skin health," and "demonstration of skin protection behaviour." To initiate the process of behaviour change in skin protection behaviour by the individuals, changes are required in all three behavioural sources (Capability, Opportunity, Motivation) and primarily in the theoretical constructs "behavioural regulation," "skills," and "beliefs about consequences." For this purpose, the five intervention functions "enablement," "training," "education," "modelling," and "persuasion" are used. Health educational interventions to change skin protection behaviour consists of different BCTs, mechanisms of change and intervention functions. This work helps to better understand the mechanisms and means of behaviour change and enables replication in other settings. In the future, the intervention programme should be extended to include BCTs addressing domains for behaviour changes which have not yet been included to maintain the new behaviour in the long-term. Finally, we recommend to report more elements of the rehabilitation programme (e.g. psychological interventions) in a standardized manner by frameworks used in this paper.

In the treatment of work-related skin diseases (WRSD), skin protection behaviour has an important influence in the course of the disease. Health educational interventions as part of an inpatient rehabilitation programme support patients in the process of behaviour change. However, these educational interventions have not been reported in a standardized manner until now. Accurate reporting may contribute to disseminating evidence-based practices because practitioners can better identify strategies for behaviour change, compare the effectiveness in studies and implement an intervention in another contexts. Against this background, it is the aim of this paper to report this intervention using theory-based tools. The educational intervention consists of seven components which are delivered in a group or as tailored face-to-face counselling. The overall aims are to enable, train, and educate patients in changing and improving their skin protection behaviour. Health educators and occupational therapists inform patients about their skin disease, demonstrate, and practice new behaviours and prepare the implementation of new behaviours. Our findings help to better understand the mechanisms and means of behaviour change in the field of WRSD. We also conclude that patients may not receive sufficient educational support in health psychological determinants of behaviour change to implement the new behaviour in the long-term, e.g. to cope with relapses.

Tertiary prevention and treatment of rheumatic heart disease: a National Heart, Lung, and Blood Institute working group summary.

Although entirely preventable, rheumatic heart disease (RHD), a disease of poverty and social disadvantage resulting in high morbidity and mortality, remains an ever-present burden in low-income and middle-income countries (LMICs) and rural, remote, marginalised and disenfranchised populations within high-income countries. In late 2021, the National Heart, Lung, and Blood Institute convened a workshop to explore the current state of science, to identify basic science and clinical research priorities to support RHD eradication efforts worldwide. This was done through the inclusion of multidisciplinary global experts, including cardiovascular and non-cardiovascular specialists as well as health policy and health economics experts, many of whom also represented or closely worked with patient-family organisations and local governments. This report summarises findings from one of the four working groups, the Tertiary Prevention Working Group, that was charged with assessing the management of late complications of RHD, including surgical interventions for patients with RHD. Due to the high prevalence of RHD in LMICs, particular emphasis was made on gaining a better understanding of needs in the field from the perspectives of the patient, community, provider, health system and policy-maker. We outline priorities to support the development, and implementation of accessible, affordable and sustainable interventions in low-resource settings to manage RHD and related complications. These priorities and other interventions need to be adapted to and driven by local contexts and integrated into health systems to best meet the needs of local communities.

Primary, secondary and tertiary prevention of Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs.

Relative Energy Deficiency in Sport (REDs) is common among female and male athletes representing various sports at different performance levels, and the underlying cause is problematic low energy availability (LEA). It is essential to prevent problematic LEA to decrease the risk of serious health and performance consequences. This narrative review addresses REDs primary, secondary and tertiary prevention strategies and recommends best practice prevention guidelines targeting the athlete health and performance team, athlete entourage (eg, coaches, parents, managers) and sport organisations. Primary prevention of REDs seeks to minimise exposure to and reduce behaviours associated with problematic LEA. Some of the important strategies are educational initiatives and de-emphasising body weight and leanness, particularly in young and subelite athletes. Secondary prevention encourages the early identification and management of REDs signs or symptoms to facilitate early treatment to prevent development of more serious REDs outcomes. Recommended strategies for identifying athletes at risk are self-reported screening instruments, individual health interviews and/or objective assessment of REDs markers. Tertiary prevention (clinical treatment) seeks to limit short-term and long-term severe health consequences of REDs. The cornerstone of tertiary prevention is identifying the source of and treating problematic LEA. Best practice guidelines to prevent REDs and related consequences include a multipronged approach targeting the athlete health and performance team, the athlete entourage and sport organisations, who all need to ensure a supportive and safe sporting environment, have sufficient REDs knowledge and remain observant for the early signs and symptoms of REDs.

Consensus on the tertiary prevention of primary liver cancer.

To effectively prevent recurrence, improve the prognosis and increase the survival rate of primary liver cancer (PLC) patients with radical cure, the Chinese Society of Hepatology, Chinese Medical Association, invited clinical experts and methodologists to develop the Consensus on the Tertiary Prevention of Primary Liver Cancer, which was based on the clinical and scientific advances on the risk factors, histopathology, imaging finding, clinical manifestation, and prevention of recurrence of PLC. The purpose is to provide a current basis for the prevention, surveillance, early detection and diagnosis, and the effective measures of PLC recurrence.

Primary, Secondary, and Tertiary Prevention of Congenital Cytomegalovirus Infection.

Cytomegalovirus infection is the most common congenital infection, affecting about 1% of births worldwide. Several primary, secondary, and tertiary prevention strategies are already available during the prenatal period to help mitigate the immediate and long-term consequences of this infection. In this review, we aim to present and assess the efficacy of these strategies, including educating pregnant women and women of childbearing age on their knowledge of hygiene measures, development of vaccines, screening for cytomegalovirus infection during pregnancy (systematic versus targeted), prenatal diagnosis and prognostic assessments, and preventive and curative treatments in utero.

[Research Progress on the Application of Intervention Mapping in Tertiary Prevention of Cancer].

Intervention mapping (IM) is a framework for formulating theory-and evidence-based health education projects with participatory approaches from ecological perspectives.The intervention program designed via IM plays a role in reducing the exposure of cancer risk factors,increasing cancer prevention behaviors,and promoting early cancer screening and rehabilitation of cancer patients.This study summarizes the characteristics,implementation steps,and application status of IM in tertiary prevention of cancer,aiming to provide reference for the application of IM in the health education projects for cancer in China.

Tenofovir versus entecavir for tertiary prevention of hepatocellular carcinoma in chronic hepatitis B infection after curative therapy: A systematic review and meta-analysis.

Entecavir (ETV) and Tenofovir disoproxil fumarate (TDF) are the first-line drugs for the treatment of chronic hepatitis B virus (HBV). However, the impact of these two antiviral agents on the outcome of HBV-related hepatocellular carcinoma (HCC) after curative therapy remains to be explored. The purpose of the present study was to compare the effect of ETV and TDF on recurrence and mortality after curative treatment for HBV-related HCC. A comprehensive literature search of multiple electronic databases was conducted from 2000 to January 2022 for studies comparing ETV and TDF for HBV-related HCC patients after curative therapy. The adjusted hazard ratios (aHR) were pooled using a random-effects model. A total of nine studies with 5298 patients were included in the final meta-analysis. TDF was associated with a lower risk of HCC recurrence [aHR 0.73, 95% confidence interval (CI) 0.65-0.81] compared to HCC. TDF reduced the risk of late recurrence compared to ETV (aHR 0.58, 95% CI 0.45-0.76) but not early recurrence (aHR 0.88, 95% CI 0.76-1.02). The mortality risk was also lower with TDF compared to ETV (aHR 0.62, 95% CI 0.50-0.77). TDF was associated with a lower risk of recurrence and mortality than ETV after resection or ablation of HBV-related HCC. Further prospective randomized controlled studies are warranted to validate these results.

[The consensus on tertiary prevention of primary liver cancer (2022 version)].

In order to effectively prevent recurrence, improve the prognosis and increase the survival rate of primary liver cancer (PLC) patients with radical cure, the Chinese Society of Hepatology, Chinese Medical Association organized the relevant experts to develop the consensus on tertiary prevention of PLC (2022 version), which based on domestic and international research progress on the risk factors, pathological and clinical features, prevention of recurrence of PLC, combined with the present actual situation in China. The purpose is to provide a current basis for the prevention, surveillance, early detection and diagnosis, the effective measures of PLC recurrence.

Análise do perfil clínico e epidemiológico dos pacientes atendidos em um serviço terciário de dermatologia / Analysis of the clinico-epidemiological profile of patients attended in a tertiary dermatology service / Análisis del perfil clínico y epidemiológico de los pacientes atendidos en un servicio terciario de dermatología

OBJETIVO: Este artigo analisou o perfil epidemiológico e clínico dos pacientes atendidos em um serviço terciário de Dermatologia no município de Ponta Grossa-PR no período de 2016 a 2018. MÉTODOS: Trata-se de um estudo descritivo, exploratório, transversal e de abordagem quantitativa com dados coletados do prontuário médico. RESULTADOS: A maioria dos pacientes atendidos (I) era do sexo feminino; (II) com mais de 50 anos; (III) realizaram somente uma consulta, (IV) não foram submetidos a exames adicionais; e (V) apresentavam comorbidades, sobretudo, dermatológicas; o segmento corporal com maior número de lesões dermatológicas foi a cabeça; o grupo diagnóstico mais comum foi a afecção dos anexos cutâneos e o diagnóstico mais frequente foi a ceratose actínica. CONCLUSÃO: O estudo é fundamental para demonstrar quais são os pacientes e as doenças dermatológicas comumente encaminhadas para o serviço especializado, o que pode direcionar ações de prevenção primária, secundária e terciária.

OBJECTIVE: This article analyzed the epidemiological and clinical profile of patients treated at the outpatient Dermatology clinic, during 2016-2018, located in the municipality of Ponta Grossa-PR. METHODS: This is a descriptive exploratory, cross-sectional study with a quantitative approach, with data collected from the medical records. RESULTS: Most of the patients examinated: (I) were female; (II) over 50 years old; (III) attended to a single consultation; (IV) were not submitted to additional exams; and (V) had comorbidities, especially dermatological; the head was the most affected body segment; the most common diagnostic group was cutaneous annexes affections and the most frequent diagnosis was actinic keratosis. CONCLUSION: The study is fundamental to demonstrate who are the patients and which are the dermatological diseases commonly referred to the specialized service, which can guide primary, secondary and tertiary prevention actions.

OBJETIVO: Este artículo analizó el perfil epidemiológico y clínico de los pacientes atendidos en un servicio terciario de Dermatología en el municipio de Ponta Grossa-PR en el período de 2016 a 2018. MÉTODOS: Se trata de un estudio descriptivo, exploratorio y transversal con un enfoque cuantitativo con datos recogidos de las historias clínicas. RESULTADOS: La mayoría de los pacientes atendidos (I) eran mujeres; (II) tenían más de 50 años; (III) tenían una sola consulta, (IV) no se sometieron a exámenes adicionales; y (V) presentaban comorbilidades, principalmente, dermatológicas; el segmento corporal con mayor número de lesiones dermatológicas fue la cabeza; el grupo diagnóstico más común fue la afección de apéndices cutáneos y el diagnóstico más frecuente fue la queratosis actínica. CONCLUSIÓN: El estudio es fundamental para demostrar cuáles son los pacientes y las enfermedades dermatológicas que se derivan habitualmente al servicio especializado, lo que puede dirigir las acciones de prevención primaria, secundaria y terciaria.