Primary Prevention Interventions Research Articles

Abstract TP329: Hospital encounters in the 7 days and 30 days before first-ever stroke: An observational study using data linkage

Background/Aim: Up to 20% of people have a hospital encounter in the 30 days before a first ever stroke, suggesting opportunities for better primary prevention. The reasons for these healthcare encounters before stroke have been largely unexplored. We aimed to describe diagnoses in hospital encounters within 7 days and 30 days before a first-ever stroke. Methods: We used a statewide (Tasmania, ~500,000 population) linked dataset comprising emergency department [ED] presentations, hospital admissions and deaths in Australia from 2007-2020. An 8-year look back period was used to identify first ever strokes. ICD 10-AM codes in the principal diagnosis field were used to determine diagnoses in hospital encounters before stroke. We describe the distribution of diagnosis groups for each hospital encounters, separately for ED presentations and hospital admissions, in the 7 days and 30 days before stroke. Results: Out of 4907 first-ever stroke patients, 202 (4.12%) people had 234 hospital admissions within 7 days before stroke and 507 (10.33%) people had 724 hospital admissions within 30 days before stroke. Among 339 (7%) people, there were 351 ED presentations within the 7 days before stroke and among 676 (13.78%) people, there were 765 ED presentations in the 30 days before stroke. In event-level analyses, the most common diagnoses for hospital admissions were dialysis, diseases of circulatory system (e.g. carotid artery stenosis and unruptured cerebral aneurysm), abnormal symptoms or pathological findings (e.g. convulsions and headache), nervous system disorders (e.g. migraine) and respiratory diseases (Table 1). The most common diagnoses for ED presentations were circulatory system disorders, abnormal pathological findings and nervous system disorders in the 7 days and 30 days before stroke. Conclusion: Hospital encounters in the period immediately before stroke are common and associated with a broad range of health conditions. These may represent potentially high-risk groups requiring more intensive primary stroke prevention interventions.

Fully automated coronary artery calcium score and risk categorization from chest CT using deep learning and multiorgan segmentation: A validation study from National Lung Screening Trial (NLST).

The National Lung Screening Trial (NLST) has shown that screening with low dose CT in high-risk population was associated with reduction in lung cancer mortality. These patients are also at high risk of coronary artery disease, and we used deep learning model to automatically detect, quantify and perform risk categorisation of coronary artery calcification score (CACS) from non-ECG gated Chest CT scans. Automated calcium quantification was performed using a neural network based on Mask regions with convolutional neural networks (R-CNN) for multiorgan segmentation. Manual evaluation of calcium was carried out using proprietary software. This study used 80 patients to train the segmentation model and randomly selected 1442 patients were used for the validation of the algorithm. We compared the model generated results with Ground Truth. Automatic cardiac and aortic segmentation model worked well (Mean Dice score: 0.91). Cohen's kappa coefficient between the reference actual and the interclass computed predictive categories on the test set is 0.72 (95% CI: 0.61-0.83). Our method correctly classifies the risk group in 78.8% of the cases and classifies the subjects in the same group. F-score is measured as 0.78; 0.71; 0.81; 0.82; 0.92 in calcium score categories 0(CS:0), I (1-99), II (100-400), III (400-1000), IV (>1000), respectively. 79% of the predictive scores lie in the same categories, 20% of the predictive scores are one category up or down, and only 1.2% patients were more than one category off. For the presence/absence of coronary artery calcifications, our deep learning model achieved a sensitivity of 90% and a specificity of 94%. Fully automated model shows good correlation compared with reference standards. Automating the process could improve diagnostic ability, risk categorization, facilitate primary prevention intervention, improve morbidity and mortality, and decrease healthcare costs.

Fostering positive affective exercise experiences and affect-related competencies for a physically active lifestyle: The FEEL Project – Results of the Pilot-Study

Introduction Interventions for physically inactive individuals often show rather small and unsustainable effects on exercise and sport behavior. This could be because too little consideration is given to affective processes during and after exercise and sport activities (e.g. shame; Hohberg et al., 2022). Furthermore, people are insufficiently enabled to independently regulate their affective well-being through exercise and sport. However, affect regulation competence is central to fostering sustainable exercise and sport behavior (Sudeck et al., 2022). The FEEL program addresses this gap. The 8-week intervention aims to promote positive affective exercise experiences (Ekkekakis et al., 2021), affect regulation competence, well-being and, consequently, exercise and sport. Topics such as affect-based intensity regulation, attention strategies or the individually “suitable” sport activity (Schorno et al., 2022) are addressed in the program and reflected upon based on participants’ experience. Methods The main study, employing a randomized controlled design started in October 2024. Participants are aged 18 to 35 who do not in regularly engage in exercise and sport. The control condition is a functional fitness program. At the SGS Conference, results from the pilot study which was done in Spring 2024 will be presented. Participants of the pilot study (N=20) completed written questionnaires before and after the FEEL program. Afterwards, a focus group discussion (N=5) was conducted to gain insights into the participants experiences. Results The primary outcome, affect regulation competence, showed a large effect from pre- to post-measurements, while affective exercise experiences demonstrated medium to large effects. Similar results were observed in the focus group discussion. Additionally participants also expressed that they valued the safe space atmosphere, the encouragement to reflect on their affect during exercise and sport and the opportunity to experience different activities. Discussion This study explores the potential effects of a multifaceted intervention in primary prevention. It may provide valuable insights into how affective processes and related competencies can be better integrated into exercise and sport programs.

Choice of drug for malaria prevention during pregnancy does not impact infant serological responses to PfEMP-1s

Abstract While sulfadoxine-pyrimethamine (SP) has been the primary intermittent preventive treatment in pregnancy (IPTp) drug, dihydroartemisinin-piperaquine (DP) is being considered as an alternative. DP may lead to lower antimalarial antibodies in the mother, resulting in higher risk of malaria in infancy. We probed cord blood sera collected from women enrolled in a clinical trial of SP vs DP on a protein microarray containing diverse Plasmodium falciparum erythrocyte membrane protein-1s and measure the impact of IPTp drug on proteins associated with malaria disease susceptibility. These results suggest that effective maternal malaria prevention may not alter susceptibility of infants to malaria.

Systematic Review on Chemsex: Advocating for Inclusive Research and Primary Prevention.

Chemsex is a specific practice of sexualized drug use (SDU), linked mainly to the group of men who have sex with men (MSM). This practice has become a public health problem due to the increase in sexually transmitted infections and HIV. However, there are groups and aspects that require greater visibility and research. This study aims to (1) analyze whether the majority of existing studies on chemsex focus on MSM and to what extent studies have addressed other sexual orientations and gender identities; and (2) determine the characteristics and effectiveness of interventions implemented for the prevention and risk reduction associated with chemsex, excluding pre- and post-exposure prophylaxis for HIV. Following PRISMA recommendations, a systematic review was conducted in the Cochrane Library, PubMed/MEDLINE, Scopus and Web of Science databases between April and July 2024. The results were synthesized using a narrative approach and the methodological quality was evaluated of the studies included with the Mixed Methods Appraisal Tool (MMAT) instrument. The first search identified 1314 studies, 14 of them being relevant. The studies analyzed the presence of chemsex and SDU in diverse samples regarding sexual orientation and gender identity. They were plural and addressed multiple aspects that constitute the phenomenon of chemsex. The second search yielded 1985 studies, of which two met the inclusion criteria. No primary or secondary prevention interventions were recorded; however, risk prevention interventions were documented. These interventions demonstrated reductions in chemsex practices, engagement in unsafe sexual behaviors, and substance use. Chemsex reflects complex dynamics within sexually minoritized groups, influenced by gender, sexual orientation, and the collective's inherent insecurities. While risk reduction programs exist, there is a notable lack of primary prevention interventions. Expanding research to include diverse populations and developing inclusive strategies to address this phenomenon is crucial.

Universal parent-focused child sexual abuse prevention: A quasi-experimental protocol.

Child sexual abuse (CSA) is a significant public health concern, and there is a lack of universal, evidence-based primary prevention interventions that extend beyond a focus solely on children. Parents remain a consistently underutilized target for primary prevention efforts aimed at mitigating CSA despite their unique relationship and close proximity to their children. CSA risk is not confined to any specific demographic, and its effects on affected children are well-documented, significantly impacting numerous dimensions of their wellbeing. Thus, there is a clear and urgent need to address this gap in prevention strategies. This study will use a quasi-experimental design (target N = 412) to examine potential gains in CSA-related awareness and intentions to use protective behaviors among parents who participate in a universal parent-focused CSA prevention workshop, Smarter Parents. Safer Kids., compared to those who do not. Participants in both the control (n = 206) and experimental group (n = 206) will complete 3 survey assessments: Survey 0 (baseline), Survey 1 (1-month), and Survey 2 (3-month follow-up). The experimental group will participate in a Smarter Parents. Safer Kids. workshop between the Surveys 0 and 1. We will use data collected from the baseline to measure potential mediators of CSA-related awareness and intention to use protective and preventive behaviors. In adjacent efforts to enhance the curriculum's reach with future dissemination and implementation, we will also explore the impact of recruitment materials and strategies on parental engagement. Results of this study will advance efforts to implement parent-focused CSA prevention with a universal audience.

Impact of Long-Term Aspirin Use on Cardiovascular Disease Prevention and Bleeding Risks

Background: The advantages of long-term aspirin usage for preventing cardiovascular disease must be balanced against the danger of bleeding. Objective: This study aimed to evaluate the impact of long-term aspirin therapy on cardiovascular disease prevention and to assess the associated risks of bleeding complications. Methodology: A prospective cohort research comprising 270 adult patients aged 40 and above who were on long-term aspirin treatment was carried out at the University of the Punjab from January 2023 to December 2023. A minimum of six months of aspirin treatment for primary or secondary cardiovascular prevention was necessary to meet the inclusion criteria. With an emphasis on cardiovascular outcomes, bleeding problems, and pertinent laboratory indicators, we gathered data via patient interviews, medical record checks, and laboratory testing. Frequency distributions and t-tests were used in statistical studies to contrast aspirin users with non-users. Results: Among the 270 participants, 25 aspirin users (11.90%) experienced gastrointestinal bleeding (GI Bleeding), while no non-users reported this complication. Additionally, 10 aspirin users (4.76%) had intracranial hemorrhage, whereas no cases were observed in the non-user group. Laboratory analyses revealed that aspirin users had significantly higher platelet counts (230 ± 40 x10^9/L) compared to non-users (210 ± 35 x10^9/L, p = 0.01) and longer prothrombin times (14.2 ± 1.5 seconds) compared to non-users (13.5 ± 1.2 seconds, p = 0.03). Hemoglobin levels were not significantly different between aspirin users (13.2 ± 1.8 g/dL) and non-users (13.8 ± 1.9 g/dL, p = 0.12). Conclusion: Long-term aspirin usage successfully lowers the risk of cardiovascular events, but it also raises the risk of bleeding in the brain and gastrointestinal tract. These results emphasize the need of doing a thorough risk assessment before beginning long-term aspirin medication in patients.

LRP1B mutation is associated with lymph node metastasis in endometrial carcinoma: A clinical next-generation sequencing study.

This study aims to investigate the mutation status and protein expression of low-density lipoprotein receptor-related protein 1B (LRP1B) in endometrial cancer, and analyze its association with lymph node metastasis (LNM) in endometrial cancer. Targeted next-generation sequencing (NGS) was conducted on both tumor tissues and paired blood DNA obtained from 94 endometrial cancer patients, followed by comprehensive analysis. Additionally, immunohistochemistry (IHC) was used to explore the correlation between LRP1B protein expression levels, its gene mutation status, and LNM. LRP1B mutation was observed in 19 patients (20.2%). Our results revealed that LRP1B mutation frequencies were significantly different between endometrial cancer with or without LNM (P = 0.038). Multivariate analysis indicated that LRP1B mutation was a favorable predictor (odds ratio 0.09; 95% confidence interval 0.01-0.95; P = 0.045) for LNM in endometrial cancer. Further analysis revealed that combination of LRP1B mutation with clinical variants (LVSI and histological subtype) yielded a higher area under the curve value of 0.871) and patients harboring LRP1B mutated-type were less likely to develop LNM. On integrated analysis, the concordance between LRP1B NGS and LRP1B IHC was 73.3%. This study utilizes targeted NGS to uncover the relationship between LRP1B mutation and LNM status, contributing to the development of primary prevention and proactive treatment strategies.

Methodological Quality and Content of Guidelines on Early Childhood Allergy Prevention: A Systematic Assessment and Content Analysis.

Recommendations on Early Childhood Allergy Prevention (ECAP) are found in Clinical Practice Guidelines (CPG) and Food-Based Dietary Guidelines (FBDG). This synthesis of guidelines aims to compare the methodological quality and content of recommendations in CPGs and FBDGs for ECAP. We searched MEDLINE, the FAO directory of FBDGs and other guideline databases, including the Association of the Scientific Medical Societies in Germany (AWMF), the WHO and the Guideline International Networks database on clinical guidelines (GIN) for CPGs and FBDGs about ECAP and child nutrition. Guidelines had to be published from 2010 onwards, target infants or pregnant/breastfeeding women and contain recommendations on primary preventative interventions to decrease the onset of IgE-mediated allergies, including atopic eczema or asthma. We retrieved a sample of 36 guidelines (23 CPGs, 13 FBDGs) and assessed their methodological quality with the Appraisal of Guidelines for Research and Evaluation tool (AGREE) II. On a subset of recommendations, we performed an in-depth analysis by the type of intervention for direction and strength of recommendation and level of evidence. Descriptive analysis was conducted with SPSS 27. CPGs score higher than FBDGs in most AGREE domains (3, 4, 5 and 6). The 36 guidelines contain 287 recommendations on ECAP, with 70 addressing the introduction of complementary foods and common allergens. We found only slight differences between those recommendations in CPGs and FBDGs. FBDGs on ECAP are of lower quality than CPGs. This does not affect their recommendations on the introduction of complementary foods and common allergens but may compromise their trustworthiness.

Immediate Versus 5-Year Risk-Guided Initiation of Treatment for Primary Prevention of Cardiovascular Disease for Australians Aged 40 Years: A Health Economic Analysis.

Current Australian cardiovascular disease (CVD) prevention guidelines calculate 5-year CVD risk and recommend treatment when risk crosses specific thresholds. This may leave risk factors untreated for people with a low short-term (i.e. 5 years), but high long-term (i.e. lifetime), risk of CVD. We aimed to evaluate the cost effectiveness of intervention for risk factor control at age 40 years (regardless of calculated risk) compared to intervention for risk factor control at the age recommended by contemporary Australian CVD prevention guidelines (when the 5-year CVD risk reaches 10%) across a range of individual risk factor profiles. We used a causal microsimulation model populated with 108 different risk factor profiles, each replicated 10,000 times. Model data were derived from the UK Biobank study and published sources. The primary causal relationships factored in were those of low-density lipoprotein-cholesterol and systolic blood pressure with CVD (defined as myocardial infarction or stroke). The model simulated the ageing of individuals from 40 to 85 years. We calculated years of life lived, quality-adjusted life-years gained, incremental healthcare costs and the incremental cost-effectiveness ratio when low-density lipoprotein-cholesterol and blood pressure were controlled from age 40 years compared to initiation of treatment as recommended by Australian guidelines. The main side effect in the model was an increased risk of type 2 diabetes mellitus from statin use. The trade-off between reduced CVD and increased type 2 diabetes was summarised via quality-adjust life-years. Incremental cost-effectiveness ratios were compared to the Australian willingness-to-pay threshold of AU$28,000 per quality-adjust life-year gained. We adopted a healthcare perspective (2022 AUD) and discounted results at 3% annually. An earlier intervention meaningfully prevented CVD in all but the lowest risk individuals. Intervention at age 40 years versus age when the 5-year CVD risk reaches 10% led to an increase in quality-adjust life-years for 37/54 female individuals and 44/54 male individuals simulated and an increase in years of life lived (i.e. life expectancy) for 46/54 female individuals and 47/54 male individuals simulated. Earlier intervention was also cost effective in 5/54 female individuals and 17/54 male individuals. Current guidelines may result in certain individuals with a lower 5-year, but higher lifetime, risk of CVD being overlooked for earlier cost-effective interventions to prevent CVD.

Psychological predictors of posttraumatic stress and depression in firefighters: A 2-year longitudinal study

Background and objectivesDue to high trauma exposure in their job, first responders have an increased chance to develop posttraumatic stress disorder (PTSD) and depression. A challenge in the psychotrauma field is to develop effective preventive strategies for high-risk professionals. The aim of this study was to test which malleable psychological factors (resilience, social support at work, experiential avoidance, repetitive negative thinking (RNT), meaning in life, sense of coherence) predict the development of PTSD and depression symptoms in firefighters. MethodFirefighters (n = 393) were tested at baseline (PTSD, depression and risk factors) and filled out questionnaires in the following 2 years (PTSD and depression). Regression analyses were run testing which set of risk factors best predicted PTSD or depression symptoms at follow-up, when controlling for baseline symptomatology. ResultsLower social support at work and higher experiential avoidance predicted PTSD symptom development, and lower meaning in life and higher RNT predicted depression symptom development. ConclusionsDecreasing experiential avoidance and RNT and promoting social support at work and meaning in life seem promising targets for primary prevention interventions in first responders. Future studies should test whether targeting these risk factors would indeed decrease the development of post-trauma psychopathology in high-risk professionals.

Physical Activity and Neurodegenerative Diseases: Potential Role in Prevention and Therapy

Physical activity and exercise are low-cost interventions in primary and secondary prevention of several noncommunicable disease (e.g. cardiovascular diseases, chronic kidney disease, neurodegenerative and neurovascular disease). In the context of demographic change, the relative and absolute numbers of patients with neurological, especially neurodegenerative disease, will increase. Based on missing causal therapies and high costs, non-pharmacological (e.g. physical activity) approaches for healthy aging are gaining attention. Epidemiological, observational, and randomized controlled studies have shown that physical activity can enhance brain plasticity and improve cognitive vitality over lifespan. However, the underlying neurobiological mechanisms are still largely unknown. Physical activity can influence different risk factors for neurovascular and neurodegenerative diseases (e.g. arterial hypertension, obesity). Moreover, physical activity can induce cellular and molecular changes (level 1) followed by structural and functionals brain changes (level 2) and/or behavioural adaptations (level 3). In this clinical review we summarize the role of physical activity in the prevention and therapy of neurological disease.

Identification of Post-Tuberculosis Lung Function Impairment Early during the Course of Treatment.

Tuberculosis (TB) is a leading cause of morbidity and mortality and an important contributory factor to chronic lung disease. TB-associated permanent lung damage manifests with varying levels of respiratory disability long after TB has been successfully treated, which is a condition known as post-TB lung disease (PTLD). This study assessed whether lung function impairment associated with PTLD occurs early during TB treatment. Using a cross-sectional design, we enrolled newly diagnosed adult TB patients aged ≥18 years who had received anti-TB medication for ≥2 months from a large treatment center in northern Nigeria. We used spirometry and the Global Lung Initiative 2012 reference equations for African Americans to assess and characterize lung function for enrolled participants (N = 94). The median age (range) of participants was 34 (18-72) years. Approximately 5.3% (n = 5) of participants exhibited features of abnormal lung function, 4.2% (n = 4) showed features of obstructive lung abnormality, and 1.1% (n = 1) showed restrictive lung abnormality. Compared with historical patients recruited ≥6 months after TB treatment in the same center, our participants had significantly lower forced expiratory volume in one second and forced vital capacity values. Our findings suggest an opportunity for early intervention for primary and secondary prevention of PTLD to reduce the impact of severe respiratory impairment.

Evaluating the Impact and Cultural Relevance of LifeKeepers Gatekeeper Training Across Three Training Modalities.

Background: While Gatekeeper Training (GKT) is an accepted component of suicide prevention strategies, there is little evidence about its effectiveness with Indigenous populations and online. Aims: This study examined the effects of LifeKeepers, a novel GKT, comprising three modalities: General, e-learning, and a culturally tailored Māori (New Zealand Indigenous) training. Methods: A total of 5,981 participants completed measures of declarative knowledge, perceived knowledge, and self-efficacy pre- and post-training. Participants rated satisfaction with LifeKeepers, its safety considerations and cultural acceptability post-training. Results: There were statistically significant improvements across all outcome measures (declarative knowledge 1.3 [95% CI 1.3-1.4], perceived knowledge 10.9 [95% CI 10.7-11.1], and self-efficacy 2.5 [95% CI 2.5-2.6]), including across all modalities. More than 90% of participants rated satisfaction, cultural acceptability, and safety considerations highly. Limitations: Without a control group, changes may not be solely due to engagement in LifeKeepers. Conclusions: This study offers preliminary evidence of the immediate effectiveness of LifeKeepers, across its in-person, Indigenous Māori, and e-learning modalities. It addresses a critical literature gap by exploring participants' safety perspectives and strongly supports LifeKeepers as a primary suicide prevention intervention in New Zealand, especially for Indigenous Māori communities. Comparable outcomes for e-learning participants indicate wider accessibility, bolstering suicide prevention efforts.

Primary prevention of type 2 diabetes in the EU: A systematic review of interventional studies

Abstract Background The GBD 2019 study revealed that type 2 diabetes caused over 109.000 deaths and accounted for 5.3 million Disability Adjusted Life Years in the EU, with an estimated annual cost of EUR 300 billion in 2014. Interventions for primary prevention are pivotal in preventing diabetes, providing a structured approach to implementing lifestyle modifications or community-based programs. The objective of this study was to demonstrate the effectiveness of primary prevention interventions to prevent or delay the onset of type 2 diabetes in the EU member states. Methods A systematic review on six databases was conducted for relevant interventional studies carried out in the EU-28. The main outcome of the studies was determined by changes in the incidence of type 2 diabetes. Results The search yielded 18.885 records, of which 18 met the eligibility criteria. The following studies reported significant incidence reduction in the intervention groups: The Finnish Diabetes Prevention Study by individualised lifestyle intervention (HR: 0.614, 95%CI: 0.478-0.789), the Spanish CORDIOPREV Study through increased plant protein intake (HR: 0.64, 95%CI: 0.43-0.96), the Spanish PreDE trial by promoting healthy diet and physical exercise (RR: 0.68, 95%CI: 0.47-0.99), the Norfolk Diabetes Prevention Study with intensive diet-exercise counselling (OR: 0.57, 95%CI: 0.38-0.87), the Spanish PREDIMED and PREDIMED-Reus trials by mediterranean diet supplemented with extra virgin olive oil or mixed nuts (HR: 0.60, 95%CI: 0.43-0.85; HR: 0.49, 95%CI: 0.25-0.97; HR: 0.48, 95%CI: 0.24-0.96), and the Dutch SLIM Study with advices on diet and physical activity (RR: 0.53, 95%CI: 0.29-0.97). Conclusions Significantly decreasing the incidence of diabetes is feasible within primary healthcare settings through intensive lifestyle interventions targeting individuals at high risk. Therefore, it would be beneficial to incorporate these findings into the European guidelines for preventing type 2 diabetes. Key messages • Primary care plays an important role in the prevention of type 2 diabetes. • Well-defined primary lifestyle interventions are capable of slowing the progression from prediabetes to diabetes.

Developing an Evidence-Based Primary Cancer Prevention Repository: insights from the PIECES project

Abstract Introduction Up to 40% of cancer cases could be avoided through effective primary prevention. However, cancer prevention tends to be fragmented across Europe, leading to geographical health differences. The dissemination and scale-up of effective primary cancer prevention interventions may address this. Although effective cancer prevention programs exist, finding them and their materials (especially regarding implementation) can be challenging. Repositories of evidence-based interventions provide insight into “what is out there” and can support dissemination within and across national borders. The PIECES project aims to develop and disseminate a repository of evidence-based primary cancer prevention programs adaptable to European contexts, with information to aid adaptation and implementation across countries. Methods The development of the PIECES repository has been informed by established repositories such as NCI’s Evidence-Based Cancer Control Programs. The project team developed a scoring sheet with a selection of items that could be included in the repository. All participants rated each item on relevance and applicability and provided comments and suggestions. A final framework, including a set of minimal requirement items, was agreed upon during three online consensus building meetings. Results We created a repository of evidence-based primary cancer prevention interventions targeting modifiable risk factors suitable for implementation in European healthcare settings. This 22-item repository provides information about an intervention’s logic model, implementation practices, and appraisal of published evidence of effectiveness. Conclusions This repository is innovative as it includes practical information and tools to facilitate implementation. While initially built to serve the PIECES project, the repository is designed to be a valuable tool for European policymakers, researchers, and implementers. Lessons learned from this process will inform future developers. Key messages • A comprehensive cancer prevention intervention repository avoids “reinventing the wheel” and allows for more efficient use of existing interventions by building upon the best available evidence. • The ongoing efforts of the PIECES project represent a significant contribution to reduce cancer prevention disparities and to facilitate the adoption of evidence-based interventions in Europe.

A review on efficacy of polygenic risk score information on behavioral change and clinical outcomes

Abstract Background Polygenic Risk Score (PRS) represents a promising advancement in personalized medicine, enabling the inherited risk assessment for disease outcomes based on the effect of various common genetic variants. The utilization of PRS information to promote the adoption of healthier behaviors has witnessed an increase interest in recent years, but its full potential still needs to be fully addressed. Methods This systematic review aims to assess the efficacy of disclosing PRS information on individuals’ engagement in risk-reducing interventions. CENTRAL database has been searched up to December 2023 to identify randomized controlled trials (RCTs) comparing the disclosure of PRS results, with scenarios where other or no information is provided. We performed a preliminary meta-analysis on the mean difference of clinical and psychological outcomes between the two arms. Results Out of 4419 results, we included 12 studies. Trials focused on primary (83%), secondary (8%) and tertiary (8%) preventive interventions. As for the possible diseases predicted by the PRS, cardiovascular diseases (33%) were the most common (n = 4), along with cancers (33%), diabetes (25%) and metabolic disease (8%). PRS result disclosure was compared to standard care (n = 7), no information provided (n = 4), and family risk (n = 1). By pooling data from four comparable studies, we report a reduction in the mean difference for LDL cholesterol in the intervention group of -6.39mg/dL (95%CI -10.09, -2.70, I²=0%, p < 0.001). No significant changes were observed for systolic and diastolic blood pressure, and weight, in 3 studies and 4 analyzed studies, respectively. An increase in anxiety levels was observed towards the PRS group in 4 studies (SMD 0.24, 95%CI 0.02, 0.46, I² = 66%, p = 0.03). Conclusions Preliminary analysis show small or no effects of PRS disclosure on intermediate health or psychological outcomes. Larger trials assessing the potentiality of PRS disclosure are still needed. Key messages • From the analysis of twelve preventive trials on the efficacy of PRS on behavior change, we report a positive effect on LDL cholesterol reduction. • Larger well conducted trials are needed to integrate PRS-based information into future preventive strategies.

Youth mental health and exposome

Abstract Mental health is a complex Public Health challenge, especially youth. A better understanding of factors that contribute to youth mental health and reduce the burden of youth mental health conditions such as executive and emotional functioning is needed to develop primary and secondary prevention interventions. One of the main challenges for better understanding mental health of youth is the complexity and diversity of exposures that individuals experience throughout their lifetime. There is a wide range of factors in the environment, and individuals are exposed to different combinations of external factors depending on their location, occupation, and lifestyles. These factors include physical (e.g., noise and indoor and outdoor air), chemical and social factors (e.g., neglect and abuse, relationship conflicts) based on the exposome framework. The exposome is a guiding framework for the multi-country study EARLY involving Albania, Belgium, Germany, Israel, Moldova, Portugal, Romania, Serbia, Spain, and Switzerland. EARLY is one of the first projects to theoretically explore and empirically investigate youth mental health in line with the exposome framework. We aim to identify factors influencing youth mental health with validated exposure measures. An exploratory list of measures was collected in Albania, Belgium, Germany, Israel, Moldova, Portugal, Romania, Serbia, Spain, and Switzerland. The measures vary widely. Besides the variation, there is still a lack of standardized methods for measuring environmental exposures. Limitations of measures affect reliability and validity. Therefore, an overview of available assessment methods and steps toward improving measures will be discussed in this talk. Speakers/Panelists Karin Boode GGD GHOR Nederland, Utrecht, Netherlands Peter Van Den Hazel INCHES, Ellecom, Netherlands

Promoting Mental Health and Well-Being Among Adolescent Young Carers in Europe: A Cross-National Randomized Controlled Trial Study.

This cross-national study focuses on adolescents who provide care and support to family members or significant others. Current evidence regarding their mental health and solutions to strengthen it is limited and mostly available in a few countries. The aim of this study is to evaluate the results of a primary prevention intervention for improving the mental health and well-being of adolescent young carers (AYCs) aged 15-17 years in six European countries. The intervention was based on a psychoeducational program and tools adapted from the Discoverer, Noticer, Advisor, and Values (DNA-V) model. We designed a randomized controlled trial with 217 AYCs participating in the study, either in the intervention or control group. Quantitative and qualitative data were collected via questionnaires at baseline, post-intervention, and a 3-month follow up. The results were mixed, as positive improvements in primary (i.e., psychological well-being and skills) and secondary (school/training/work functioning) outcomes were shown by the experimental group but, in most cases, they were not statistically significant. The qualitative data supported positive claims about the intervention and its appropriateness for AYCs. The study implementation during the peak of the COVID-19 pandemic forced the consortium to adapt the design and may have influenced the results. More long-term studies are needed to assess similar mental health programs with this hard-to-reach target group.

Economic Evaluation of Prevention Interventions for Child Sexual Exploitation or Child Sexual Abuse: A Systematic Review.

Child sexual abuse, including sexual exploitation, is a global issue, affecting 8% to 31% of girls and 3% to 17% of boys worldwide. This systematic review aims to synthesize economic evidence on the cost-effectiveness of community interventions to prevent child sexual abuse/exploitation to inform decision-making. A systematic search was conducted on eight databases for studies published until April 2023. Gray literature was searched using Google. The inclusion criteria were economic evaluation of interventions targeted at children, perpetrators/offenders, or professionals addressing child sexual abuse/exploitation. There was no limitation by country, but an English language abstract was required for non-English articles. Studies without a specific focus on child sexual abuse/exploitation, such as physical, emotional, and domestic violence-related abuse, were excluded. All costs were adjusted to US$ 2023. Reporting quality assessment was conducted using the Consolidated Health Economic Evaluation Reporting Standards 2022 checklist. Of 5,180 screened articles, 17 were included in the final synthesis, with most from the United States and focused on tertiary prevention delivered to offenders. While the intervention components varied across studies, all demonstrated promising and cost-effective results. The findings highlight a small but growing body of economic evidence for child sexual abuse/exploitation interventions. The existing economic evaluation evidence is dominated by tertiary prevention, which focuses on offenders and child victims and highlights the need for more research and action on primary and secondary preventative interventions for general and at-risk populations.