National Heart Foundation of Australia: position statement on coronary artery calcium scoring for the primary prevention of cardiovascular disease in Australia.

INTRODUCTION: This position statement considers the evolving evidence on the use of coronary artery calcium scoring (CAC) for defining cardiovascular risk in the context of Australian practice and provides advice to health professionals regarding the use of CAC scoring in primary prevention of cardiovascular disease in Australia. Main recommendations: CAC scoring could be considered for selected people with moderate absolute cardiovascular risk, as assessed by the National Vascular Disease Prevention Alliance (NVDPA) absolute cardiovascular risk algorithm, and for whom the findings are likely to influence the intensity of risk management. (GRADE evidence certainty: Low. GRADE recommendation strength: Conditional.) CAC scoring could be considered for selected people with low absolute cardiovascular risk, as assessed by the NVDPA absolute cardiovascular risk algorithm, and who have additional risk-enhancing factors that may result in the underestimation of risk. (GRADE evidence certainty: Low. GRADE recommendation strength: Conditional.) If CAC scoring is undertaken, a CAC score of 0 AU could reclassify a person to a low absolute cardiovascular risk status, with subsequent management to be informed by patient-clinician discussion and follow contemporary recommendations for low absolute cardiovascular risk. (GRADE evidence certainty: Very low. GRADE recommendation strength: Conditional.) If CAC scoring is undertaken, a CAC score > 99 AU or ≥ 75th percentile for age and sex could reclassify a person to a high absolute cardiovascular risk status, with subsequent management to be informed by patient-clinician discussion and follow contemporary recommendations for high absolute cardiovascular risk. (GRADE evidence certainty: Very low. GRADE recommendation strength: Conditional.) CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: CAC scoring can have a role in reclassification of absolute cardiovascular risk for selected patients in Australia, in conjunction with traditional absolute risk assessment and as part of a shared decision-making approach that considers the preferences and values of individual patients.

Comparison of rural and urban French GPs' activity: a cross-sectional study.

INTRODUCTION: In various countries, a shortage of general practitioners (GPs) and worrying health statistics on risk factors, morbidity and mortality have been observed in rural areas. However, few comparative data are available on GP activities according to their location. The aim of this study was to analyse French GP activities according to their rural or urban practice location. METHODS: This study was ancillary to the Eléments de la COnsultation en médecine GENérale (ECOGEN) study, which was a cross-sectional, multicentre, national study conducted in 128 French general practices in 2012. Data were collected by 54 interns in training during a period of 20 working days from December 2011 to April 2012. GP practice location was classified as rural area, urban cluster or urban area. The International Classification of Primary Care (ICPC-2) was used to classify reasons for encounter, health problem assessments, and processes of care. Univariate analyses were performed for all dependent variables, then multivariable analyses for key variables, using hierarchical mixed-effect models. RESULTS: The database included 20 613 consultations. The mean yearly number of consultations per GP was higher in rural areas (p<0.0001), with a shorter consultation length (p<0.0001). No difference was found for GP sex (p=0.41), age (p=0.87), type of fees agreement (p=0.43), and type of practice (p=0.19) according to their practice location. Urban patients were younger, and there was a lower percentage of patients over 75 years (p<0.001). GPs more frequently consulted at patients' homes in rural areas (p<0.0001). The mean number of chronic conditions managed was higher in rural areas and urban clusters than in urban areas (p<0001). Hypertension (p<0.0001), type 2 diabetes (p=0.003), and acute bronchitis/bronchiolitis (p=0.01) were more frequently managed in rural areas than in urban clusters and areas. Health maintenance/prevention (p<0.0001) and no disease situations (p<0.0001) were less frequent in rural areas. Drug prescription was more frequent in rural areas than in urban clusters and areas (p<0.0001). Multivariable analysis confirmed the influence of a GP's rural practice location on the consultation length (p<0.0001), the number of chronic conditions per consultation (p<0.0001) and the number of health maintenance/prevention situations (p<0.0001), and a trend towards a higher yearly number of consultations per GP (p=0.09). CONCLUSION: French rural GPs tend to have a higher workload than urban GPs. Rural patients have more chronic conditions to be managed but are offered fewer preventive services during consultations. It is necessary to increase the GP workforce and develop cooperation with allied health professionals in rural areas.

Recommendations from an expert panel of health professionals regarding a gestational diabetes risk reduction intervention for American Indian/Alaska Native Teens.

BACKGROUND: American Indian/Alaska Native (AI/AN) adolescents are at higher risk for gestational diabetes (GDM), type 2 diabetes, and pregnancy complications than the general population. OBJECTIVE: To inform cultural adaptation of a validated evidence-based intervention (VEBI) originally designed to deliver preconception counseling and diabetes education to non-AI/AN teens with diabetes. DESIGN: Qualitative data were collected using focus group and individual interview methods with health care professionals and experts (n = 16) in AI/AN health, GDM, adolescent health, and/or mother-daughter communication. A semistructured discussion guide elicited responses about provision of care for AI/AN girls at risk for GDM, experience with successful programs for AI/AN teens, comfort of mother/daughter dyads in talking about diabetes and reproductive health and reactions to video clips and booklet selections from the VEBI. All interviews were recorded and transcribed verbatim, and data analysis included inductive coding and identification of emergent themes. RESULTS: Providers felt teens and their moms would be comfortable talking about the VEBI topics and that teens who did not feel comfortable talking to their mom would likely rely on another adult female. Participants suggested including: AI/AN images/motifs, education with a community focus, and avoiding directive language. Concerns included: socioeconomic issues that affect AI/AN people such as: food and housing insecurity, abuse, and historical trauma. CONCLUSIONS: Perspectives from these participants have been used to guide the development of a culturally tailored GDM risk reduction program for AI/AN girls. This program will be available to health care providers who serve the AI/AN population.

Sexually acquired syphilis: Laboratory diagnosis, management, and prevention.

The methods used for the laboratory diagnosis of syphilis include direct detection of Treponema pallidum subspecies pallidum and serologic testing. Serologic testing relies on both nontreponemal and treponemal tests. In newly developed reverse-sequence screening algorithms, treponemal tests are performed before nontreponemal tests. The management of syphilis requires appropriate staging, treatment, and follow-up of patients along with the prompt reporting of infections to public health authorities to assist with prevention and control efforts. Benzathine penicillin G remains the treatment of choice for all stages of syphilis. Screening of populations at higher risk for syphilis is recommended by the US Centers for Disease Control and Prevention, the US Preventive Services Task Force, and the World Health Organization. The second article in this continuing medical education series reviews the testing for and the management of sexually acquired syphilis.

The prevention and control of tuberculosis: an analysis based on a tuberculosis dynamic model derived from the cases of Americans.

BACKGROUND: Tuberculosis (TB), a preventable and curable disease, is claimed as the second largest number of fatalities, and there are 9,025 cases reported in the United States in 2018. Many researchers have done a lot of research and achieved remarkable results, but TB is still a severe problem for human beings. The study is a further exploration of the prevention and control of tuberculosis. METHODS: In the paper, we propose a new dynamic model to study the transmission dynamics of TB, and then use global differential evolution and local sequential quadratic programming (DESQP) optimization algorithm to estimate parameters of the model. Finally, we use Latin hypercube sampling (LHS) and partial rank correlation coefficients (PRCC) to analyze the influence of parameters on the basic reproduction number ([Formula: see text]) and the total infectious (including the diagnosed, undiagnosed and incomplete treatment infectious), respectively. RESULTS: According to the research, the basic reproduction number is computed as 2.3597 from 1984 to 2018, which means TB is also an epidemic in the US. The diagnosed rate is 0.6082, which means the undiagnosed will be diagnosed after 1.6442 years. The diagnosed will recover after an average of 1.9912 years. Moreover, some diagnosed will end the treatment after 1.7550 years for some reason. From the study, it's shown that 2.40% of the recovered will be reactivated, and 13.88% of the newborn will be vaccinated. However, the immune system will be lost after about 19.6078 years. CONCLUSION: Through the results of this study, we give some suggestions to help prevent and control the TB epidemic in the United States, such as prolonging the protection period of the vaccine by developing new and more effective vaccines to prevent TB; using the Chemoprophylaxis for incubation patients to prevent their conversion into active TB; raising people's awareness of the prevention and control of TB and treatment after illness; isolating the infected to reduce the spread of TB. According to the latest report in the announcement that came at the first WHO Global Ministerial Conference on Ending tuberculosis in the Sustainable Development Era, we predict that it is challenging to control TB by 2030.

Examining the implementation of the Icelandic model for primary prevention of substance use in a rural Canadian community: a study protocol.

BACKGROUND: The Icelandic Prevention Model (IPM) is a collaborative upstream model that was designed to influence risk and protective factors related to substance use within the community, school, peer and family contexts. By engaging whole communities, the IPM has been found to be effective in reducing youth substance use behaviours across Iceland. As an extension to the IPM's participatory approach, this research will examine how youth involvement can enhance outcomes. In addition, this research will evaluate whether the IPM approach is beneficial for mental health promotion and general youth wellbeing. METHODS: The present research protocol applies the bioecological model within a participatory mixed-method case study design to examine the implementation of the IPM in a rural community in Canada. This study was designed to identify whether the Icelandic substance use prevention model is effective in reducing substance use and promoting mental health and development for Canadian youth. It will also explore how to engage youth within the approach and how this adaptation influences implementation and outcomes. DISCUSSION: The findings from this study will contribute to our understanding of upstream prevention of youth substance use and will be used to support scaling of the IPM across Canada.

Task shifting of cardiovascular risk assessment and communication by nurses for primary and secondary prevention of cardiovascular diseases in a tertiary health care setting of Northern India.

BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality in India. CVDs are to a large extent preventable with the availability of wide range of interventions focusing on primary and secondary prevention. However human resource deficit is the biggest challenge for implementing these prevention programs. Task shifting of the cardiovascular risk assessment and communication to nurses can be one of the most viable and sustainable option to run prevention programs. METHODS: The study was quasi experimental in nature with 1 year follow up to determine the effect of CVD risk assessment and communication by nurses with the help of risk communication package on primary and secondary prevention of CVDs. The study was done in the outpatient departments of a tertiary health care center of Northern India. All the nurses (n = 16) working in selected OPDs were trained in CVD risk assessment and communication of risk to the patients. A total of 402 patients aged 40 years and above with hypertension (HTN) were recruited for primary prevention of CVDs from medicine and allied OPDs, whereas 500 patients who had undergone CABG/PTCA were recruited from cardiology OPDs for secondary prevention of CVDs and were randomized to intervention (n = 250) and comparison group (n = 250) by using block randomization. CVD risk modification and medication adherence were the outcomes of interest for primary and secondary prevention of CVDs respectively. RESULTS: The results revealed high level of agreement (k = 0.84) between the risk scores generated by nurses with that of investigator. In the primary prevention group, there were significantly higher proportion of participants in the low risk category (70%) as compared to baseline assessment (60.6%) at 1 year follow up. Whereas in secondary prevention group the mean medication adherence score among intervention group participants (7.60) was significantly higher than that of the comparison group (5.96) with a large effect size of 1.1.(p < 0.01). CONCLUSION: Nurse led intervention was effective in risk modification and improving medication adherence among subjects for primary and secondary prevention of CVDs respectively. TRIAL REGISTRATION: Trial registration no CTRI/2018/01/011372 [Registered on: 16/01/2018] Trial Registered Retrospectively.

Cardiovascular Risk Reduction by Pharmacists at the Workplace.

PURPOSE OF REVIEW: The burden of cardiovascular disease (CVD) in the USA remains unacceptably high. The associated morbidity and mortality of CVD has important implications on our healthcare system and society. With much of CVD considered preventable an increase emphasis on primary prevention is important. To review the evidence for pharmacists providing CVD primary prevention, particularly as a part of employer-based programs. RECENT FINDINGS: A recent study evaluated the impact of a pharmacist-led 12-month preventative health program in 178 at-risk employees at University of British Columbia (UBC). Cardiovascular Assessment and Medication Management by Pharmacists at UBC (CAMMPUS) resulted in improved Framingham risk scores (FRS) from 11.7 to 10.7 (p = 0.0017), improvement in quality of life (p = 0.023), and medication adherence (p = 0.019). Findings are consistent with improvements observed in other pharmacist-led intervention trials but offer the unique perspective as an employer-based intervention. Pharmacists-led interventions prevent CVD through improvement in health markers and medication adherence. The ability of pharmacists to provide these as part of an employer-sponsored benefit might be favorable as other billing models for pharmacist can be challenging to be justified in a fee-for-service payment structure; further, there is incentive for employers to lower healthcare cost and improve productivity. Future studies defining the impact of pharmacists in this and other settings may have important public health implications.

Team illness prevention strategy (TIPS) is associated with a 59% reduction in acute illness during the Super Rugby tournament: a control-intervention study over 7 seasons involving 126 850 player days.

OBJECTIVES: To determine whether a team illness prevention strategy (TIPS) would reduce the incidence of acute illness during the Super Rugby tournament. METHODS: We studied 1340 male professional rugby union player seasons from six South African teams that participated in the Super Rugby tournament (2010-2016). Medical staff recorded all illnesses daily (126 850 player days) in a 3-year control (C: 2010-2012; 47 553 player days) and a 4-year intervention (I: 2013-2016; 79 297 player days) period. A five-element TIPS was implemented in the I period, following agreement by consensus. Incidence rate (IR: per 1000 player days; 95% CI) of all acute illnesses, illness by main organ system, infectious illness and illness burden (days lost due to illness per 1000 player days) were compared between C and I period. RESULTS: The IR of acute illness was significantly lower in the I (5.5: 4.7 to 6.4) versus the C period (13.2: 9.7 to 18.0) (p<0.001). The IR of respiratory (C=8.6: 6.3 to 11.7; I=3.8: 3.3 to 4.3) (p<0.0001), digestive (C=2.5: 1.8 to 3.6; I=1.1: 0.8 to 1.4) (p<0.001), skin and subcutaneous tissue illness (C=0.7: 0.4 to 1.4; I=0.3: 0.2 to 0.5) (p=0.0238), all infections (C=8.4: 5.9 to 11.9; I=4.3: 3.7 to 4.9) (p<0.001) and illness burden (C=9.2: 6.8 to 12.5; I=5.7: 4.1 to 7.8) (p=0.0314) were significantly lower in the I versus the C period. CONCLUSION: A TIPS during the Super Rugby tournament was associated with a lower incidence of all acute illnesses (59%), infectious illness (49%) and illness burden (39%). Our findings may have important clinical implications for other travelling team sport settings.

The Strategic Alliance between Clinical and Molecular Science in the War against SARS-CoV-2, with the Rapid-Diagnostics Test as an Indispensable Weapon for Front Line Doctors.

Our work concerns the actual problem of spread of SARS- CoV-2 outbreak which requires fast and correct as possible answer. In current scenario, the need of rapid answer put away the imperative of proper methodology. We focus on the serogical immunoassay for diagnosis of Covid-19 as an important weapon not only for diagnostic purpose, but also for epidemiologic one. The right equilibrium between high speed, low cost and accuracy is obtained with easy-to-use decentralized point-of-care test as the colloidal gold-based immunochromatographic strip assay which detects IgM and IgG antibodies directed against SARS-CoV-2. As our aim is to evaluate the efficacy of Covid-19 rapid tests and of serological assays in real-life settings, we designed a research protocol aimed to establish how to use correctly these diagnostics, taking into account the different possible clinical and epidemiological scenarios.

Prevention Is Possible: A Brief History of the Origin and Dissemination of the Icelandic Prevention Model.

In two decades, the Icelandic prevention model (IPM) has been employed to dramatically reduce rates of adolescent substance use in Iceland. Briefly, the IPM is a multisectoral, community-based, collaborative system where researchers, policy makers, administrative leaders, and practitioners join forces to reduce the odds of adolescent substance use over time. Comparatively, Iceland now ranks among the lowest in adolescent substance use in all of Europe. Since 2005, the IPM has garnered considerable international attention, and several countries or municipalities within them have adapted, or are presently adapting, the model to their needs. In this commentary, we first briefly review the history and formation of the IPM in Iceland from a school-based survey to a fully integrated prevention system. In the second part, we present a short overview of the national consensus building and institutional collaboration that led to the implementation of the model in Chile in Latin America, as a demonstrative example. In this volume of Health Promotion Practice, we also present a series of two practice-based articles that introduce the IPM. The first article, titled "Development and Guiding Principles of the Icelandic Model for Preventing Adolescent Substance Use," introduces the theoretical origins of the model, five guiding principles, and evidence of effectiveness to date. In the second article, titled "Implementing the Icelandic Model for Preventing Adolescent Substance Use," we outline 10 practice-based steps to guide model implementation in other countries. Both articles are available via open access, and both are also available online in Spanish.

Development and Guiding Principles of the Icelandic Model for Preventing Adolescent Substance Use.

Adolescent substance use-the consumption of alcohol, tobacco, and other harmful drugs-remains a persistent global problem and has presented ongoing challenges for public health authorities and society. In response to the high rates of adolescent substance use during the 1990s, Iceland has pioneered in the development of the Icelandic Model for Primary Prevention of Substance Use-a theory-based approach that has demonstrated effectiveness in reducing substance use in Iceland over the past 20 years. In an effort to document our approach and inform potentially replicable practice-based processes for implementation in other country settings, we outline in a two-part series of articles the background and theory, guiding principles of the approach, and the core steps used in the successful implementation of the model. In this article, we describe the background context, theoretical orientation, and development of the approach and briefly review published evaluation findings. In addition, we present the five guiding principles that underlie the Icelandic Prevention Model's approach to adolescent substance use prevention and discuss the accumulated evidence that supports effectiveness of the model. In a subsequent Part 2 article, we will identify and describe key processes and the 10 core steps of effective practice-based implementation of the model.

Implementing the Icelandic Model for Preventing Adolescent Substance Use.

This is the second in a two-part series of articles about the Icelandic Model for Primary Prevention of Substance Use (IPM) in this volume of Health Promotion Practice. IPM is a community collaborative approach that has demonstrated remarkable effectiveness in reducing substance use initiation among youth in Iceland over the past 20 years. While the first article focused attention on the background context, theoretical orientation, evaluation and evidence of effectiveness, and the five guiding principles of the model, this second article describes the 10 core steps to practical implementation. Steps 1 to 3 focus on building and maintaining community capacity for model implementation. Steps 4 to 6 focus on implementing a rigorous system of data collection, processing, dissemination, and translation of findings. Steps 7 to 9 are designed to focus community attention and to maximize community engagement in creating and sustaining a social environment in which young people become progressively less likely to engage in substance use, including demonstrative examples from Iceland. And Step 10 focuses on the iterative, repetitive, and long-term nature of the IPM and describes a predictable arc of implementation-related opportunities and challenges. The article is concluded with a brief discussion about potential variation in community factors for implementation.

Prevention of SARS-COV-2 coronavirus spread at the Auschwitz-Birkenau State Museum in Poland. The most visited Memorial site in the world during the COVID-19 pandemic.

INTRODUCTION: At the Auschwitz-Birkenau State Museum (A-BSM) actions have been undertaken to effectively protect employees and minimise risk of SARS-CoV-2 coronavirus spreading from the beginning of the COVID-19 epidemic. AIM OF THE ARTICLE: The aim was to present the actions, instructions and procedures introduced at the A-BSM to provide information how to deal with pandemic caused by the SARS-CoV-2 coronavirus in institutions taking care of cultural heritage before and after closure of the Museum for visitors and after reopening. MATERIALS AND METHODS: The described activities were developed at the Museum by a specially established Expert Team. RESULTS: Groups of employees and places in which they were most exposed to contact with visitors and, as a consequence, at the highest risk of getting infected, were characterised. The employees were provided with personal protective equipment, and at the Museum site, devices essential for maintaining the microbiological cleanliness of the rooms, were placed. In the next stage, instructions and procedures for particular groups of employees were prepared. Visitors were educated about the need of taking precautions and were allowed to disinfect in several places at the Memorial Site. Steps to reduce attendance at this time has also been taken. Procedures for employees of the A-BSM were developed in such way that they can also be used after reopening of the Museum for visitors. CONCLUSIONS: The actions which ensured the microbiological safety of the A-BSM employees, brought satisfying results. In more than 21 days after closing of the Museum for visitors, no cases of SARS-CoV-2 infection or COVID-19 were found among employees, despite a very high threat.

The global experience of digital health interventions in COVID-19 management.

Digital health interventions are globally playing a significant role to combat coronavirus disease 2019 (COVID-19), which is an infectious disease caused by Severe Acute Respiratory Syndrome coronavirus 2. Here, we present a very brief overview of the multifaceted digital interventions, globally, and in India, for maintaining health and health-care delivery, in the context of the Covid-19 pandemic.

Evidence-Based Public Health Provided Through Local Health Departments: Importance of Academic-Practice Partnerships.

OBJECTIVES: To determine the extent to which US local health departments (LHDs) are engaged in evidence-based public health and whether this is influenced by the presence of an academic health department (AHD) partnership. METHODS: We surveyed a cross-sectional stratified random sample of 579 LHDs in 2017. We ascertained the extent of support for evidence-based decision-making and the use of evidence-based interventions in several chronic disease programs and whether the LHD participated in a formal, informal, or no AHD partnership. RESULTS: We received 376 valid responses (response rate 64.9%). There were 192 (51.6%) LHDs with a formal, 80 (21.6%) with an informal, and 99 (26.7%) with no AHD partnership. Participants with formal AHD partnerships reported higher perceived organizational supports for evidence-based decision-making and interventions compared with either informal or no AHD partnerships. The odds of providing 1 or more chronic disease evidence-based intervention were significantly higher in LHDs with formal AHD partnerships compared with LHDs with no AHD partnerships (adjusted odds ratio = 2.3; 95% confidence interval = 1.3, 4.0). CONCLUSIONS: Formal academic-practice partnerships can be important means for advancing evidence-based decision-making and for implementing evidence-based programs and policies.

Simulated impacts and potential cost effectiveness of Communities Putting Prevention to Work: Tobacco control interventions in 21 U.S. communities, 2010-2020.

In 2010, the Centers for Disease Control and Prevention (CDC) funded communities to implement policy, systems, and environmental (PSE) changes under the Communities Putting Prevention to Work (CPPW) program to make it easier for people to make healthier choices to prevent chronic disease. Twenty-one of 50 funded communities implemented interventions intended to reduce tobacco use. To examine the potential cost-effectiveness of tobacco control changes implemented under CPPW from a healthcare system perspective, we compared program cost estimates with estimates of potential impacts. We used an existing simulation model, the Prevention Impacts Simulation Model (PRISM), to estimate the potential cumulative impact of CPPW tobacco interventions on deaths and medical costs averted through 2020. We collected data on the costs to implement CPPW tobacco interventions from 2010 to 2013. We adjusted all costs to 2010 dollars. CPPW tobacco interventions cost $130.5 million across all communities, with an average community cost of $6.2 million. We found $735 million in potentially averted medical costs cumulatively from 2010 through 2020 because of the CPPW-supported interventions. If the CPPW tobacco control PSE changes are sustained through 2020 without additional funding after 2013, we find that medical costs averted will likely exceed program costs by $604 million. Our results suggest that the medical costs averted through 2020 may more than offset the initial investment in CPPW tobacco control interventions, implying that such interventions may be cost saving, especially over the long term.

Treating eating disorders in the real world - MaiStep: A skill-based universal prevention for schools.

Eating disorders are difficult to treat and often associated with morbidity and mortality. Universal prevention approaches are increasingly focusing on enhancing skills, but few eating disorder programs are available for under-15-year-olds. This study aimed to develop and examine a school-based universal prevention program ('MaiStep') for adolescent boys and girls. A three-arm randomized controlled trial with baseline, post-intervention and 12-month follow-up was conducted with 1654 adolescents (M = 13.35, SD 0.76). 'MaiStep' was delivered by psychologists in the first intervention group (IG1) and teachers in the second intervention group (IG2), and compared to an active control group (ACG). Primary outcomes were eating disorder-related risk factors measured with scales of the Eating Disorder Inventory-2 (e.g. 'drive for thinness', 'interoceptive awareness'), cognitions and affect related to the body (Body Shape Questionnaire, BSQ-8), and behaviors (Body Image Avoidance Questionnaire, BIAQ). The total sample (N1) was divided into a healthy subsample (N2) and a sample fulfilling DSM-5 criteria for a subthreshold eating disorder (N3) measured with the self-report Structured Inventory for Anorexic and Bulimic Syndromes (SIAB-S). Significant improvements in 'interoceptive awareness' (EDI-2) and lower BIAQ scores emerged in N1 at post-intervention and at 12-month follow-up (F(4; 3038) = 3.068, p = .016, ηpart2 = 0.004 and F(4; 2900) = 2.993, p = .018, ηpart2 = 0.004) and in N2 at post-intervention and at 12-month follow-up (F(4; 2812) = 3.147, p = .014, ηpart2 = 0.004 and F(4; 2684) = 3.674, p = .005, ηpart2 = 0.005). The healthy subsample N2 additionally showed significantly lower scores on 'drive for thinness' (EDI-2) and on the BSQ-8c at post-intervention (F(2; 1446) = 3.091, p = .046, ηpart2 = 0.004 and F(2; 1453) = 3.505, p = .030, ηpart2 = 0.005) but not at 12-month follow-up. No significant results emerged for N3. The positive findings of improved 'interoceptive awareness' (EDI-2) and reduced body image avoidance (BIAQ) indicate that broad disseminated universal prevention under the age of 15 is possible. Trial registration MaiStep is registered at the German Clinical Trials Register (DRKS00005050).

Evidence-based prevention programs targeting youth mental and behavioral health in primary care: A systematic review.

The objectives of this systematic review were to: 1) identify evidence-based youth (i.e., infancy, pre-school age, school age, and adolescence) mental and behavioral health disorder preventive interventions conducted in or offered by primary care settings, and 2) describe these interventions' characteristics, efficacy, and clinical involvement. Randomized controlled trials that targeted the prevention of mental or behavioral health outcomes for youth and had a connection to primary care were included. The PRISMA guidelines were utilized for two phases: 1) searching PubMed, EMBASE, PsycInfo, CINAHL, and Cochrane databases in January 2017; and 2) searching United States Preventive Services Task Force (USPSTF) Systematic Reviews in November 2017. The two phases revealed 504 and 58 potential articles, respectively. After removal of duplicates, screening of abstracts, and full-text reviews, 19 interventions (infancy: n = 2, pre-school age: n = 3, school age: n = 6, adolescence: n = 8) were included: 1) 10 interventions described in 17 articles from the databases, and 2) 9 interventions described in 11 articles from the USPSTF reviews. The included interventions capitalized on primary care settings as a natural entry point to engage youth and families into interventions without requiring a large amount of clinic involvement. Commonalities of efficacious interventions and recommendations for future research are discussed. The authors encourage primary care providers, mental and behavioral health providers, and/or public health researchers to continue developing and testing preventive interventions, or adapting existing interventions, to be implemented in primary care.

The public health importance of scabies in community domiciliary care settings: an exploratory cross-sectional survey of Health Protection Teams in England.

Scabies is a contagious skin infection commonly occurring in institutions such as care homes. However, a large proportion of vulnerable people in England receive domiciliary care in the community and their experience of scabies has not been described. We undertook a pragmatic cross-sectional survey of Health Protection Teams (HPTs) in England to determine the burden of scabies related to domiciliary care. Fifteen cases or outbreaks were notified to HPTs between January 2013 and December 2017. Although a relatively uncommon event for individual HPTs, they were complex to manage and required the co-ordination of multiple stakeholders. Diagnosis was often delayed and required several clinical consultations. A lack of guidance led to difficulties establishing stakeholder roles and responsibilities and sources of funding for treatment. The stigmatisation of scabies sometimes affected the quality of care provided to patients, such as use of excessive personal protective equipment. Our study demonstrates that scabies is an issue of public health importance for domiciliary care service providers and users, and research is required to better understand the impacts of the disease and to develop evidence-based guidance. More generally, there is a need for simpler treatment regimens and methods of diagnosing scabies.