Commentary on the Culture of Prevention.

Despite significant progress in prevention science over the past 30 years in developing evidence-based interventions and policies, there has not been equal success in attracting support from policymakers and gaining acceptance by communities. In recognition of this gap, the editors of Prevention Science put out a call to scientists to help clarify and define the concept of a "culture of prevention." Such a culture would influence the creation of an infrastructure for implementing and sustaining the most effective strategies informed by research. The journal call stated a culture of prevention was a "general orientation or readiness of a group of people… to address problems by using a preventive, rather than a reactive approach." This commentary examines the concept demonstrated in the array of papers presented here in which the "culture of prevention" is applied in different contexts-occupational safety and health, substance use, school, governmental, community, around problem behaviors, and violence. It is important to note that the papers represent perspectives and experiences from several countries, including some cross-national experiences providing an international framework. While a final definition awaits further research, the commentary summarizes important elements that might constitute that evolving definition and pave the way for the implementation of more effective prevention programming.

Delayed diagnosis of homozygous sickle cell disease in Jamaica

In a retrospective study of symptomatically referred patients with homozygous sickle cell (SS) disease, only 26 percent were diagnosed by two years of age. Since 61 percent of subjects in a neonatally defined cohort developed symptoms specific to sickle cell disease by this age, it is clear that the diagnosis is frequently overlooked or not transmitted to the parents. The greatest mortality from SS disease occurs in the first two years of life and early diagnosis of SS disease is essential for the institution of prophylactic programmes to prevent morbidity and mortality from acute splenic sequestration, pneumococcal septicaemia, and aplastic crisis. In the majority of children despite the occurrence of specific symptoms, the diagnosis of underlying haemoglobinopathy is not made early enough for effective intervention. Neonatal screening is the preferred option but if this is impractical, education of health care workers could promote earlier diagnosis of SS disease.(AU)