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1.
Isr Med Assoc J ; 22(1): 60-63, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927808

RESUMO

BACKGROUND: In this review, the authors re-examine the role of aspirin in the primary prevention of cardiovascular disease. They discuss the history of the use of aspirin in primary prevention, the current guidelines, and the recent evidence surrounding aspirin use as primary prevention in special populations such as those with moderate cardiovascular risk, diabetes mellitus, and the elderly.


Assuntos
Aspirina/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Fibrinolíticos/uso terapêutico , Aspirina/efeitos adversos , Fibrinolíticos/efeitos adversos , Humanos , Guias de Prática Clínica como Assunto , Prevenção Primária/métodos
2.
Medicine (Baltimore) ; 98(50): e18232, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852085

RESUMO

Transgender people continue to be at high-risk for HIV acquisition, but little is known about the characteristics of their sexual partners. To address this gap, we examined sociodemographic and sexual characteristics of cisgender men who have sex with men (MSM) on pre-exposure prophylaxis (PrEP) reporting transgender sexual partners.A cohort of 392 MSM in southern California in a randomized clinical trial for PrEP adherence were followed from 2013 to 2016. Multivariable generalized estimating equation and logistic models identified characteristics of MSM reporting transgender sexual partners and PrEP adherence.Only 14 (4%) MSM reported having transgender sexual partners. MSM were more likely to report transgender partners if they were African American, had incident chlamydia, reported injection drug-using sexual partners, or received items for sex. Most associations remained significant in the multivariable model: African American (adjusted odds ratio [AOR] 11.20, P = .01), incident chlamydia (AOR 3.71, P = .04), and receiving items for sex (AOR 5.29, P = .04). There were no significant differences in PrEP adherence between MSM reporting transgender partners and their counterpart.MSM who report transgender sexual partners share characteristics associated with individuals with high HIV prevalence. Identifying this group distinct from larger cohorts of MSM could offer new HIV prevention opportunities for this group of MSM and the transgender community.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Prevenção Primária/métodos , Comportamento Sexual , Parceiros Sexuais , Pessoas Transgênero , Adulto , Seguimentos , Infecções por HIV/epidemiologia , Humanos , Incidência , Masculino , Adesão à Medicação , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
3.
Presse Med ; 48(12): 1401-1405, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31699540

RESUMO

Sudden cardiac death represents a major public health issue, with up to 50% of the cardiovascular mortality. Coronary artery disease and dilated cardiomyopathy both represent almost 90% of sudden cardiac death burden. Primary prevention using implantable cardioverter defibrillator relies, in this population, on the left ventricle ejection fraction simple measurement. In this paper, we aim to discuss in which extent a better understanding of competing risk situation may help for a better patient selection and eventually for optimizing primary prevention using implantable cardioverter defibrillator.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardiomiopatia Dilatada/epidemiologia , Cardiomiopatia Dilatada/terapia , Morte Súbita Cardíaca/epidemiologia , Humanos , Seleção de Pacientes , Prevenção Primária/instrumentação , Prevenção Primária/métodos , Risco , Medição de Risco , Fatores de Risco , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/terapia
4.
BMC Public Health ; 19(1): 1417, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666043

RESUMO

BACKGROUND: The DREAMS Partnership is an ambitious effort to deliver combinations of biomedical, behavioural and structural interventions to reduce HIV incidence among adolescent girls and young women (AGYW). To inform multi-sectoral programming at scale, across diverse settings in Kenya and South Africa, we identified who the programme is reaching, with which interventions and in what combinations. METHODS: Randomly-selected cohorts of 606 AGYW aged 10-14 years and 1081 aged 15-22 years in Nairobi and 2184 AGYW aged 13-22 years in uMkhanyakude, KwaZulu-Natal, were enrolled in 2017, after ~ 1 year of DREAMS implementation. In Gem, western Kenya, population-wide cross-sectional survey data were collected during roll-out in 2016 (n = 1365 AGYW 15-22 years). We summarised awareness and invitation to participate in DREAMS, uptake of interventions categorised by the DREAMS core package, and uptake of a subset of 'primary' interventions. We stratified by age-group and setting, and compared across AGYW characteristics. RESULTS: Awareness of DREAMS was higher among younger women (Nairobi: 89%v78%, aged 15-17v18-22 years; uMkhanyakude: 56%v31%, aged 13-17v18-22; and Gem: 28%v25%, aged 15-17v18-22, respectively). HIV testing was the most accessed intervention in Nairobi and Gem (77% and 85%, respectively), and school-based HIV prevention in uMkhanyakude (60%). Among those invited, participation in social asset building was > 50%; > 60% accessed ≥2 core package categories, but few accessed all primary interventions intended for their age-group. Parenting programmes and community mobilisation, including those intended for male partners, were accessed infrequently. In Nairobi and uMkhanyakude, AGYW were more likely to be invited to participate and accessed more categories if they were: aged < 18 years, in school and experienced socio-economic vulnerabilities. Those who had had sex, or a pregnancy, were less likely to be invited to participate but accessed more categories. CONCLUSIONS: In representative population-based samples, awareness and uptake of DREAMS were high after 1 year of implementation. Evidence of 'layering' (receiving multiple interventions from the DREAMS core package), particularly among more socio-economically vulnerable AGYW, indicate that intervention packages can be implemented at scale, for intended recipients, in real-world contexts. Challenges remain for higher coverage and greater 'layering', including among older, out-of-school AGYW, and community-based programmes for families and men.


Assuntos
Conscientização , Infecções por HIV/prevenção & controle , Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Prevenção Primária/métodos , Avaliação de Programas e Projetos de Saúde , Adolescente , Adulto , Criança , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Incidência , Quênia , Masculino , Gravidez , Comportamento Sexual , Parceiros Sexuais , África do Sul , Inquéritos e Questionários , Adulto Jovem
5.
Presse Med ; 48(12): 1528-1535, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31767249

RESUMO

The emergence of a viral disease most often results from an imbalance in the interaction between the infectious agent, the host and the environment. After the introduction phase of a viral disease in a territory or a given population and once the first chains of transmission occur, the spread of the disease or its sustainability are possible if the control measures are not implemented or are not sufficiently effective. If it is difficult to anticipate the occurrence and introduction of an emerging viral disease, the following three key elements must be strengthened to limit its impact: (1) anticipation and preparation; (2) research and (3) monitoring and surveillance. Finally, to guarantee that the measures taken are relevant and acceptable to the population, a multidisciplinary approach must be systematically relied upon and re-evaluated on a prospective basis.


Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Surtos de Doenças , Previsões , Viroses/epidemiologia , Doenças Transmissíveis Emergentes/prevenção & controle , Surtos de Doenças/prevenção & controle , Meio Ambiente , Projetos de Pesquisa Epidemiológica , Monitoramento Epidemiológico , Previsões/métodos , Humanos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Controle de Infecções/tendências , Prevenção Primária/métodos , Prevenção Primária/organização & administração , Viroses/prevenção & controle
6.
Clin Ter ; 170(5): e396-e408, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31612199

RESUMO

BACKGROUND: Stroke is the most common cardiovascular disorder after heart disease and one of the major causes of death and disability. Mediterranean diet has proven to be an effective means to prevent cardiovascular diseases and may contribute to the prevention of stroke. This overview aims to analyze all reviews that examine the association between Mediterranean diet pattern and stroke. METHODS: We conducted a literature search on PubMed and Scopus databases, using the keywords "Mediterranean diet" and "Stroke". All studies were selected evaluating the association between the Mediterranean diet and the prevention of stroke and only systematic reviews, meta-analysis and narrative reviews were included. RESULT: 25 eligible articles were included (16 narrative reviews, 9 systematic reviews, 6 systematic reviews with meta-analyses). The authors stated that Mediterranean diet may be a useful means of preventing stroke, especially the 6 meta-analyses highlighted that high adherence to Mediterranean diet was protective against stroke, with a relative risk ranging from 0,64 (95% CI 0,48-0,88) to 0,90 (95% CI 0,87-0,93). Moderate adherence has not shown significant results. CONCLUSION: A high adherence to the Mediterranean diet is inversely associated with stroke risk, and can modify the costs of its management, therefore the prevention policies should implement adherence to this healthy diet.


Assuntos
/métodos , Dieta Mediterrânea , Prevenção Primária/métodos , Acidente Vascular Cerebral/dietoterapia , Acidente Vascular Cerebral/prevenção & controle , Doenças Cardiovasculares/prevenção & controle , Comportamento Alimentar , Humanos , Risco
8.
Medicine (Baltimore) ; 98(39): e17382, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574890

RESUMO

BACKGROUND: Long-term use of aspirin for primary prevention of cancer remains inconclusive, and variation in the effects of aspirin use on cancer outcomes by cancer site, aspirin dose, follow-up duration, or different populations has never been systematically evaluated. METHODS: Seven electronic databases (PubMed, EMBASE, ClinicalTrials.gov, etc) will be searched from inception to September 30, 2019. Randomized clinical trials (RCTs) comparing aspirin versus no aspirin in participants without pre-existing cancer and reporting cancer incidence, and/or cancer mortality outcomes will be selected and assessed for inclusion. The Cochrane's Risk of Bias Tool and the Jadad scale will be used to evaluate the risk of bias and the methodologic quality of the RCTs. Data will be screened and extracted by independent investigators. Total cancer incidence will be defined as the primary clinical endpoint, and total cancer mortality, all-cause mortality, and the risk of major bleeding will be the secondary outcomes. Subgroup analyses based on cancer site, aspirin dose, follow-up duration, or different populations will be conducted. Analyses will be performed using Review Manager 5.3, Comprehensive Meta-Analysis 2.0, and Trial Sequential Analysis (TSA) software. RESULTS: This study will systematically evaluate the effects of long-term aspirin use on total cancer incidence, cancer mortality, all-cause mortality, and the risk of major bleeding. Subgroup analyses will indicate whether the effects of aspirin on cancer outcomes are associated with cancer site, daily dose of aspirin, follow-up duration, or different subgroup of participants. The results will be submitted and published in a peer-reviewed scientific journal. CONCLUSIONS: This systematic review will systematically evaluate the efficacy and safety of long-term use of aspirin for primary prevention of cancer and determine whether there are some potential influencing factors affecting the effects of aspirin on cancer outcomes, thus strengthening the evidence base for the clinical practice and future research of this intervention.


Assuntos
Aspirina/uso terapêutico , Neoplasias/prevenção & controle , Prevenção Primária/métodos , Humanos , Incidência , Metanálise como Assunto , Neoplasias/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisão Sistemática como Assunto , Fatores de Tempo
9.
Arch Cardiovasc Dis ; 112(8-9): 523-531, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471226

RESUMO

This review summarizes the main findings of the French multicentre DAI-PP pilot programme, and discusses the related clinical and research perspectives. This project included retrospectively (2002-2012 period) more than 5000 subjects with structural heart disease who received an implantable cardioverter defibrillator (ICD) for primary prevention of sudden cardiac death, and were followed for a mean period of 3 years. The pilot phase of the DAI-PP programme has provided valuable information on several practical and clinically relevant aspects of primary prevention ICD implantation in the real-world population, which are summarized in this review. This pilot has led to a prospective evaluation that started in May 2018, assessing ICD therapy in primary and secondary prevention in patients with structural and electrical heart diseases, with remote monitoring follow-up using a dedicated platform. This should further enhance our understanding of sudden cardiac death, to eventually optimize the field of preventative actions.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Prevenção Primária/métodos , Morte Súbita Cardíaca/epidemiologia , França/epidemiologia , Humanos , Estudos Multicêntricos como Assunto , Projetos Piloto , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
10.
Rev Port Cardiol ; 38(7): 485-493, 2019 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31530423

RESUMO

INTRODUCTION AND OBJECTIVE: Lipoprotein(a) [Lp(a)] is an independent cardiovascular risk factor but is closely associated with other similar risk factors that are manageable with appropriate treatment and guidance. We aimed to study the impact of using combined therapy for managing Lp(a) levels in patients at high cardiovascular risk but without major adverse cardiovascular events, in primary prevention. METHODS: We conducted a retrospective observational study in 516 patients randomly selected from a group of 1677 patients who attended cardiovascular risk and metabolism consultations between 1995 and 2015. The disorders observed and therapies used were classified into nosological and pharmacological groups, respectively. Cardiovascular risk was calculated based on the Framingham risk score, the European Society of Cardiology's SCORE and the American College of Cardiology's ASCVD Risk Estimator, and changes in patients' lifestyle were assessed. RESULTS: Significant differences (p<0.001) were found in almost all metabolic variables, except fasting insulin and C-peptide. Lp(a) levels were also significantly reduced (p<0.001). Carotid intima-media thickness improved, decreasing from 2.90 mm to 1.40 mm; however, there was no reduction in the number of cases of vascular stenosis. Of patients with hepatic steatosis (85.5%), 40.7% presented hepatomegaly, but liver function was only altered in a few patients (14.5%). Lipid-lowering therapy, especially statins, significantly decreased Lp(a), benefiting from synergy with other treatments. CONCLUSIONS: Lp(a) is a key overall indicator of vascular risk and should be considered a therapeutic target. Besides a healthy lifestyle, primary prevention should include combined drug therapies to address all cardiovascular risk factors and to delay the atherosclerotic process.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Hipolipemiantes/uso terapêutico , Lipoproteína(a)/sangue , Prevenção Primária/métodos , Adulto , Idoso , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
11.
Lancet ; 394(10199): 685-696, 2019 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-31448740

RESUMO

Ischaemic heart disease has a multifactorial aetiology and can be prevented from developing in populations primordially, and in individuals at high risk by primary prevention. The primordial approach focuses on social determinants of health in populations: political, economic, and social factors, principally unplanned urbanisation, illiteracy, poverty, and working and living conditions. Implementation of the UN Sustainable Development Goals can lead to major improvements in cardiovascular health, and adequate health-care financing and universal health care are important for achieving these goals. Population-level interventions should focus on tobacco control, promotion of healthy foods (fruits, vegetables, legumes, and nuts), curbing unhealthy foods (saturated fats, trans fats, refined carbohydrates, excessive salt, and alcohol), promotion of physical activity in everyday living, and control of ambient and indoor pollution. At the individual level, identification of people at high multifactorial risk and guideline-driven management of hypertension, LDL cholesterol, and diabetes is required. Strategies to improve adherence to healthy lifestyles and drug therapies are essential and can be implemented at health system, health care, and patient levels with use of education, technology, and personalised approaches. Improving quality of medical education with a focus on ischaemic heart disease prevention for physicians, nurses, allied health workers, and the public is required.


Assuntos
Isquemia Miocárdica/prevenção & controle , Prevenção Primária/métodos , Causalidade , Assistência à Saúde/normas , Exercício , Saúde Global , Humanos , Guias de Prática Clínica como Assunto , Medição de Risco , Fatores de Risco , Fatores Socioeconômicos
12.
Rev Saude Publica ; 53: 54, 2019 Aug 15.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31432911

RESUMO

Guidelines emphasize the importance of approaching substance use by adolescents, particularly in primary health care. However, there are problems with its incorporation. The objective of this study was to present the training stages on the theme for professionals in primary health care. Researchers conducted logistic structuring, content elaboration and evaluation of difficulties before and after training. Sixty percent of professionals involved in the care of adolescents in a medium-sized city participated in the study. More than half of them stated having difficulties in the approach, mainly theoretical limitations and short consultations. After the training, the professionals informed whether they felt more prepared, but practical difficulties remained.


Assuntos
Educação Continuada , Atenção Primária à Saúde/organização & administração , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Serviços de Saúde do Adolescente , Adulto , Brasil , Usuários de Drogas , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Prevenção Primária/métodos
13.
BMJ ; 366: l4697, 2019 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-31434641

RESUMO

OBJECTIVE: To assess effects of increasing omega-3, omega-6, and total polyunsaturated fatty acids (PUFA) on diabetes diagnosis and glucose metabolism. DESIGN: Systematic review and meta-analyses. DATA SOURCES: Medline, Embase, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, and trials in relevant systematic reviews. ELIGIBILITY CRITERIA: Randomised controlled trials of at least 24 weeks' duration assessing effects of increasing α-linolenic acid, long chain omega-3, omega-6, or total PUFA, which collected data on diabetes diagnoses, fasting glucose or insulin, glycated haemoglobin (HbA1c), and/or homoeostatic model assessment for insulin resistance (HOMA-IR). DATA SYNTHESIS: Statistical analysis included random effects meta-analyses using relative risk and mean difference, and sensitivity analyses. Funnel plots were examined and subgrouping assessed effects of intervention type, replacement, baseline risk of diabetes and use of antidiabetes drugs, trial duration, and dose. Risk of bias was assessed with the Cochrane tool and quality of evidence with GRADE. RESULTS: 83 randomised controlled trials (mainly assessing effects of supplementary long chain omega-3) were included; 10 were at low summary risk of bias. Long chain omega-3 had little or no effect on likelihood of diagnosis of diabetes (relative risk 1.00, 95% confidence interval 0.85 to 1.17; 58 643 participants, 3.7% developed diabetes) or measures of glucose metabolism (HbA1c mean difference -0.02%, 95% confidence interval -0.07% to 0.04%; plasma glucose 0.04, 0.02 to 0.07, mmol/L; fasting insulin 1.02, -4.34 to 6.37, pmol/L; HOMA-IR 0.06, -0.21 to 0.33). A suggestion of negative outcomes was observed when dose of supplemental long chain omega-3 was above 4.4 g/d. Effects of α-linolenic acid, omega-6, and total PUFA on diagnosis of diabetes were unclear (as the evidence was of very low quality), but little or no effect on measures of glucose metabolism was seen, except that increasing α-linolenic acid may increase fasting insulin (by about 7%). No evidence was found that the omega-3/omega-6 ratio is important for diabetes or glucose metabolism. CONCLUSIONS: This is the most extensive systematic review of trials to date to assess effects of polyunsaturated fats on newly diagnosed diabetes and glucose metabolism, including previously unpublished data following contact with authors. Evidence suggests that increasing omega-3, omega-6, or total PUFA has little or no effect on prevention and treatment of type 2 diabetes mellitus. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017064110.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/prevenção & controle , Gorduras Insaturadas na Dieta/uso terapêutico , Prevenção Primária/métodos , Prevenção Secundária/métodos , Adulto , Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Suplementos Nutricionais , Jejum/sangue , Ácidos Graxos Ômega-3/uso terapêutico , Ácidos Graxos Ômega-6/uso terapêutico , Ácidos Graxos Insaturados/uso terapêutico , Feminino , Hemoglobina A Glicada/análise , Humanos , Insulina/sangue , Resistência à Insulina , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Expert Rev Cardiovasc Ther ; 17(9): 633-643, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31382819

RESUMO

Introduction: While the clinical merits of aspirin in secondary cardiovascular disease (CVD) prevention remain undisputed, its role in primary prevention is controversial. Recently, three trials of primary prevention reported neutral net benefit results or evidence of harm for aspirin in patients with no overt CVD. Areas covered: This article aims to inform clinical practitioners by appraising the current body of evidence on the use of aspirin for primary CVD prevention, ranging from general pharmacology to clinical outcomes and future directions. Expert opinion: Based on meta-analyses incorporating latest trials in the field of primary prevention, the modest reduction in ischemic events with aspirin, if any, is offset by a modest increase in nonfatal bleeding. Improved control of CVD risk factors and broader use of statins may have reduced the thrombotic complications of atherosclerosis, thus limiting the opportunity for aspirin to prevent clinical CVD events in the contemporary era. As such, decision-making about aspirin for primary prevention is challenging even when selected patients are considered and involves careful weighing of risks and benefits. Ongoing investigations conducted in patients with cancer could rapidly modify the current perception of the unfavorable benefit-risk ratio of aspirin in patients with no overt CVD.


Assuntos
Aspirina/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Hemorragia/induzido quimicamente , Aterosclerose/tratamento farmacológico , Tomada de Decisões , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Seleção de Pacientes , Prevenção Primária/métodos
15.
Malar J ; 18(1): 270, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395048

RESUMO

BACKGROUND: Malaria preventive measures, including long-lasting insecticide-treated bet nets (LLINs), indoor residual spraying (IRS), and controlling mosquito breeding sites, are key measures to achieve malaria elimination. Still, compliance with these recommended measures remains a major challenge. By applying a novel and comprehensive model for determinants of malaria prevention behaviour, this study tests how individual perceptions influence the intentions to use malaria preventive measures and explores strategies that stimulate their consistent use. METHODS: The study was carried out in the sectors of Ruhuha and Busoro, Rwanda during October and November 2017, and these were conducted into two phases. Phase one involved a questionnaire survey (N = 742), whereas Phase two employed a qualitative approach that included nine focus group discussions, seven key informant interviews, and three in-depth interviews. RESULTS: The findings of the quantitative study showed that participants very often use LLINs (66.6%), accept IRS (73.9%), and drain stagnant water in case of presence (62%). The intentions to use malaria preventive measures were consistently driven by perceived severity, perceived self-efficacy, perceived response efficacy, and subjective norms, and hindered by perceived barriers. The intentions were also positively associated with the actual use of LLINs, acceptance of IRS, and drainage of stagnant water. There is no evidence that either not having enough LLINs (ownership of at least one bed net in the household, here referred to as availability) or having sufficient LLINs (having one LLIN per two people in the household, here referred to as accessibility) moderated the relationship between behavioural intentions and actual use of LLINs. The qualitative study indicated that participants believed malaria risk to be high and perceived a high mosquito density. They also believed that repetitive malaria episodes are caused by the perceived low effectiveness of anti-malaria medications. Lack of LLINs increased the perceived added value of LLINs, and together with the increased malaria burden increased the perceived response efficacy. Participants highlighted the need to continuously mobilize and engage community members especially those who do not use LLINs when having one, and those who do not accept the spraying activities. CONCLUSION: Malaria prevention interventions should target individual perceptions to enhance consistent use of malaria preventive measures. Three strategies to improve consistent use and acceptance of these measures are highlighted: (1) ensure access to LLINs and regular spraying activities, (2) community mobilization and (3) citizen engagement in malaria prevention activities.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Malária/prevenção & controle , Percepção , Prevenção Primária/métodos , Adulto , Feminino , Humanos , Malária/psicologia , Masculino , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , Ruanda
16.
Ther Umsch ; 76(2): 65-70, 2019 08.
Artigo em Alemão | MEDLINE | ID: mdl-31429395

RESUMO

Skin cancer - prevention and therapy Abstract. Skin cancers are increasing in western countries. Prevention consists mainly of primary (UV- protection) and secondary (early detection) prevention. Family physicians are often the first contact persons to evaluate the dignity of skin lesions of high-risk patients and help to perform the diagnosis. If skin cancer is detected early, surgical removal is highly likely to achieve complete cure and reduce the financial burden due to malignant skin tumors. Great progress has been made in the local and systemic therapy of skin tumors in recent years.


Assuntos
Prevenção Primária/métodos , Prevenção Secundária/métodos , Neoplasias Cutâneas , Humanos , Neoplasias Cutâneas/prevenção & controle
17.
Public Health Genomics ; 22(1-2): 25-35, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31330524

RESUMO

BACKGROUND/AIMS: Familial hypercholesterolaemia (FH) is a common genetic disorder that, if untreated, predisposes individuals to premature coronary heart disease. As most individuals with FH remain undiagnosed, new approaches to detection are needed and should be considered a priority in public health genomics. Universal screening of children for FH has been proposed, and this study explores public perspectives on the acceptability of this approach. METHODS: A one-day deliberative public forum was held in Perth, WA, Australia. Thirty randomly selected individuals were recruited, with self-reported sociodemographic characteristics used to obtain discursive representation. Participants were presented with information from a variety of perspectives and asked to discuss the information provided to identify points of consensus and disagreement. The data collected were analysed using thematic analysis. RESULTS: Of the 17 participants at the forum, 16 deemed universal screening of children for FH to be acceptable. Fifteen of these 16 believed this was best performed at the time of an immunisation. Participants proposed a number of conditions that should be met to reduce the likelihood of unintended harm resulting from the screening process. DISCUSSION/CONCLUSION: The outcomes of the forum suggest that establishing a universal screening programme for FH in childhood is acceptable to the general public in WA.


Assuntos
Comportamento do Consumidor , Doença das Coronárias/prevenção & controle , Hiperlipoproteinemia Tipo I , Programas de Rastreamento , Percepção Social , Adulto , Austrália , Criança , Feminino , Humanos , Hiperlipoproteinemia Tipo I/diagnóstico , Hiperlipoproteinemia Tipo I/epidemiologia , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/psicologia , Prevenção Primária/métodos , Opinião Pública
18.
Indian Heart J ; 71(2): 113-117, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31280821

RESUMO

Aspirin is one of the oldest and most commonly used cardiovascular drugs. Despite there being high-quality evidence supporting the use of aspirin for patients with known cardiovascular disease, a definitive consensus regarding its use for patients at risk for cardiovascular disease (and without established cardiovascular disease) has never been reached. Many randomized control trials have produced conflicting results, and consequently, society guidelines have issued differring recommendations. Three major trials were published in 2018, which supplement the existing data on aspirin's role in primary prevention and provide further guidance on this contentious issue. This article reviews the history of aspirin through the last two decades, with special emphasis on these new trials.


Assuntos
Aspirina/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Prevenção Primária/métodos , Humanos
19.
BMC Womens Health ; 19(1): 88, 2019 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269928

RESUMO

BACKGROUND: Women with gestational diabetes have low diet quality. We evaluated the effectiveness of a group-based lifestyle modification program for improvement of dietary quality in women with previous gestational diabetes predominantly within their first postnatal year. METHODS: Women were randomised to intervention (n = 284) or usual care (n = 289). Dietary data was collected at baseline and twelve months using a food frequency questionnaire and recoded into the Australian Recommended Food Score (ARFS). Mixed model analyses investigated the intervention effect on ARFS (per-protocol-set (PPS) excluded women without the minimum intervention exposure). RESULTS: Baseline mean total ARFS was low (31.8 ± 8.9, maximum score = 74) and no significant changes were seen in total ARFS (Cohen's D = - 0.06). 2% reduction in alcohol for intervention (0.05, 0.26) compared with - 1% for usual care (Odds ratio: 0.68; 95%CI 0.46, 0.99). Dairy ARFS sub-category significantly improved (low fat/saturated fat foods) in the intervention group over time compared with usual care for the PPS analysis (dairy + 0.28 in intervention (95%CI 0.08, 0.48) compared with + 0.02 in usual care (95%CI -0.14, 0.18) (group-by-treatment interaction p = 0.05, Cohen's D = 0.14)). CONCLUSIONS: Engaging with the intervention improved aspects of diet quality that aligned with minimum intervention exposure, but the total diet quality remains low. Further research is needed to improve diabetes prevention program engagement. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ANZCTRN12610000338066 , April 2010.


Assuntos
Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Gestacional/dietoterapia , Dieta/estatística & dados numéricos , Cuidado Pós-Natal/métodos , Prevenção Primária/métodos , Adulto , Austrália , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Gestacional/prevenção & controle , Feminino , Humanos , Estilo de Vida , Gravidez
20.
Orthop Nurs ; 38(4): 244-250, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31343628

RESUMO

Cognitive impairment is a recognized predictor of acute delirium, particularly in the postoperative period. Estimates of up to 24% of patients experiencing delirium and its associated cognitive impairment during any orthopaedic procedure have been reported, with higher rates for those patients undergoing hip fracture repair. Primary prevention is the most effective strategy to maintain cognition and prevent delirium. The purpose of this article is to provide evidence-based recommendations to prevent acute delirium using bundles of care. Bundles of care are a set of 3-5 independent, evidence-based interventions that, when implemented together, result in significantly better outcomes than when implemented individually. The bundle consists of ongoing assessment of cognition, continuing orientation, and early mobilization and socialization.


Assuntos
Cognição/fisiologia , Delírio/prevenção & controle , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Humanos , Programas de Rastreamento/métodos , Procedimentos Ortopédicos/métodos , Prevenção Primária/métodos , Fatores de Risco
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