Long-term Prevention Programs Research Articles

Direct cord blood LAMP colorimetric phenol red assay for detecting α0-thalassemia (SEA deletion); the validation and post-natal screening in Thailand

Post-natal or newborn screening for thalassemia and hemoglobinopathies is useful for genetic counseling and managing thalassemia in children. We characterized thalassemia genotypes in newborns from the eastern part of Thailand. The results demonstrated a high heterogeneity of thalassemia and hemoglobinopathies with seventeen genotypes. We focused on α0- thalassemia (Southeast Asian [SEA] deletion) in this study. We developed and validated the loop-mediated isothermal amplification (LAMP) colorimetric assay for detecting α0- thalassemia (SEA deletion) using simple direct cord blood sampling compared to genomic DNA. A total of 160 cord blood samples were evaluated with the LAMP assay. The sensitivity and specificity of the LAMP colorimetric assay for α0-thalassemia (SEA deletion) using direct cord blood showed 100% (6/6 x 100) and 98.05% (151/154 x 100) whereas, genomic DNA showed 100% (6/6 x 100) and 100% (154/154 x 100), respectively. Moreover, we demonstrated other simple screening tools for α0-thalassemia with %Hb Bart’s, MCV, and MCH values and found that these parameters were not diagnostic in our samples. The direct cord blood with colorimetric LAMP assay is simple, rapid, and does not require a post-LAMP step compared to conventional PCR. These techniques could be applied in post-natal or large population screening for α0-thalassemia (SEA deletion). Finally, this could support early prevention of complications, early management, genetic counseling for α-thalassemia disease in children, or a long-term prevention and control program of severe thalassemia in Thailand.

Twenty years of epidemiology of acute coronary syndromes in Italy: how cardiovascular epidemiology can guide secondary prevention strategies

Over the last 20 years the epidemiology of acute coronary syndromes (ACS) has significantly changed, affecting both the acute and post-acute phases. In particular, although the progressive reduction in in-hospital mortality, the trend in post-hospital mortality was found to be stable or increasing. This trend was at least in part attributed to the improved short-term prognosis due to coronary interventions in the acute phase, which ultimately have increased the population of survivors at high risk of relapse. Thus, while hospital management of ACS has shown great progress in terms of diagnostic and therapeutic efficacy, post-hospital care has not had a parallel development. This is certainly partly attributable to the inadequacy of post-discharge cardiologic facilities, so far not planned according to the level of risk of individual patients. Hence, it is crucial that patients at high risk of relapse are identified and initiated into more intensive secondary prevention strategies. On the basis of epidemiological data, the cornerstones of post-ACS prognostic stratification are represented on the one hand by the identification of heart failure (HF) at index hospitalization, on the other hand by the assessment of residual ischemic risk. In patients presenting with HF at index hospitalization, the fatal rehospitalization rate increases by 0.90% per year from 2001 to 2011, with a mortality between discharge and the first year which in 2011 was equal to 10%. The risk of fatal readmission at 1 year is therefore strongly conditioned by the presence of HF which, together with age, is the major predictor of new events. The effect of high residual ischemic risk on subsequent mortality shows increasing trend up to the second year of follow-up, moderately increasing over the years until reaching a plateau around the fifth year. These observations confirm the need for long-term secondary prevention programs and implementation of a continuous surveillance in selected patients.

해외사례를 통한 국내 학교폭력 예방대책 탐색 : 노르웨이, 캐나다, 핀란드를 중심으로

The purpose of this study was to explore ways to prevent school violence through oversea cases. This study examined and compared school violence preventive programs in Norway, Canada, and Finland to provide good insight to use in Korea. Data analysis was performed by dividing into three parts: a)legal aspects, b)representative prevention programs, and c)application plans to Korea. The results are as follows. First, school violence is considered as a national problem, and school violence in overseas has been reduced due to active preventive activities. Second, overseas countries are using long-term prevention programs that have shown the effect of reducing school violence. Third, Korea should try to change its perception of school violence in the long run. Then, it becomes easier to use overseas school violence prevention programs.

Changes in physical function of frail elderly females in the one-year long-term care prevention program.

[Purpose] This study investigated changes in the physical function of frail elderly females who participated in a long-term care prevention project for ≥1 year. [Participants and Methods] There were 125 females included. Measurement items were body mass index, 5-m maximum gait time, 5-m normal gait time, standing on one leg with eyes open, timed up and go test, and grip strength and measured every six months. [Results] Grip strength decreased significantly after six months and one year compared to that of the start. The other measurements had no significant differences at start, after six months, and after one year. [Conclusion] This study investigated changes in physical functions in the frail community-dwelling elderly females one year after starting in a long-term prevention care program. Consequently, after one year in the program, no change was noted in measurements, such as gait speed, but only grip strength decreased. Likely, the exercise program mainly targeted the lower limb muscles. Therefore, although functions mainly use the lower limbs, such as walking, may be maintained, those using the upper limbs may be affected by aging.

Trends in stroke, cardiovascular disease, and medical expenditure under a community-based long-term stroke prevention program.

Evidence on the effects of preventive measures for noncommunicable disease is urgently needed for low-income and middle-income countries suffering from stroke epidemics along with population aging. We sought to examine the impact of a community-based stroke prevention program on incidences of stroke and ischemic heart disease, mortality from cardiovascular disease, and medical expenditure. Trends in the incidences of stroke and ischemic heart disease were documented in a Japanese rural community, Kyowa, from 1981 through 2015. Trends in mortality from cardiovascular disease and in medical expenditures were compared between Kyowa and its surrounding municipalities from 1981 through 2004. In Kyowa, the age-and-sex-adjusted incidences of stroke and of ischemic heart disease decreased by half (from 4.1 to 1.9 and from 1.5 to 0.7 per year/1000 persons, respectively) over the past 35 years. A similar decreasing trend was observed for the age-and-sex-adjusted mortality from cardiovascular disease, and this decreasing trend occurred earlier than that in the surrounding municipalities. The medical expenditures for cardiovascular disease became lower in Kyowa than in the surrounding municipalities over time. Our study's findings suggest that a community-based stroke prevention program augmented the decline in the incidences of stroke and ischemic heart disease, mortality from cardiovascular disease, and attenuated the increase in medical expenditures for cardiovascular disease.

Protective and high-risk social activities associated with homebound status among older adults in rural Japan

Becoming homebound can be devastating for older adults in rural communities. This study aimed to identify protective or high-risk social activities associated with homebound status among the rural young old (ages 65–74) and the oldest old (ages ≥ 75). We used data from a survey of older adults in a rural community of Japan in 2014. Questions covered sociodemographic characteristics, homebound status (i.e., going out less than once a week), physical and psychological status, and social activities. Using survey data, we conducted logistic regression analysis to identify protective and high-risk social activities associated with homebound status. Of the 1,564 participants, 51.0 % were the oldest old, and the mean age was 75.2 (±7.0) years. The prevalence of homebound status was 10.5 % total: 5.2 % among the young old and 15.7 % among the oldest old and highest among the female oldest old (19.4 %). The main protective social activity for the young and the oldest old was visiting friends’ houses (adjusted odds ratio [AOR] 5.38, 95 % confidence interval [CI] 1.64–17.64 and AOR 3.49, 95 % CI 1.07–11.42, respectively). For the young old, specific high-risk social activities were advising family and friends (AOR 0.07, 95 % CI 0.01–0.62) and activities to support older adults (AOR 0.17, 95 % CI 0.03–0.84). For the oldest old, a protective social activity was participating in long-term care prevention programs (AOR 28.94, 95 % CI 1.90–441.63). To prevent rural older adults from becoming homebound, support should be provided according to protective and high-risk social activities for age groups, with particular attention to safe socialization amid the threat of COVID-19.

Cost-effective and promising interventions relative to mental health of the health workforce and their delivery conditions

Abstract EXPH members and Opinion collaborators Effective interventions to protect mental health of the health workforceare likely to be complex and multi-faceted, addressing modifiable risk factors to be implemented across multiple levels. In the context of the Opinion development, evidence from multiple sources, encompassing best practices, guidelines, toolkits, among others, was reviewed. This allowed for the identification of coordinated integrated approaches. Due to potential stigma and discrimination, efforts in the workplace to support mental health should be accompanied by due consideration of legal and ethical responsibilities. The excess burden of mental health issues in the health workforce is well-described, however assessing cost-effectiveness of interventions to address them remains complex given the challenges in quantifying the impacts to assess (economic, societal, ethical, etc.). Organisational delivery conditions are conceptualized in this Opinion using an implementation science framework, which posits that the success of implementation depends on how its delivery is organised and is context dependent. Contextual factors such workplace culture and leadership can largely influence implementation outcomes, whereas resource constraints and barriers, as well as facilitators are also examined. Specifically, we identified several core conditions for the delivery of mental health services. With respect to the intervention, meeting and adapting to evolving user needs is important, as well as assessing the role of stigma, whilst ensuring those with a history of mental health and/or pre-disposing factors are not targeted. Many delivery conditions focused on the workplace and included ensuring safe space and processes (e.g., for help-seeking) and fostering an environment of trust; training in mental health assessment and key delivery conditions for occupational health practitioners and managers while emphasising that there should be no adverse consequences for help-seeking behaviour; and driving transformation in organisational culture towards one of acceptance of the continuum of mental health issues. To support workplace interventions, a clear and comprehensive regulatory and financial structure and mechanisms of support are required. Attention to public and private sector organisations, including multinational corporations (MCNs) and small- and medium-sized enterprises (SMEs) is needed. These enabling structures should encompass sustainable support for long-term prevention and treatment programs, and research and development of innovative approaches, such as de-stigmatization, care re-organization, regulatory frameworks, and data collection and harmonization.

Changes in Physical and Oral Function after a Long-Term Care Prevention Program in Community-Dwelling Japanese Older Adults: A 12-Month Follow-Up Study.

Background: The aim of this prospective cohort study was to clarify changes in physical and oral function in older adults after completing a 3-month health program combining physical and oral exercise, oral health instruction, and nutritional guidance. Methods: Subjects were 34 women aged at least 70 years (mean age 79.2 years) in Bungotakada City, Oita Prefecture, Japan. Physical and oral function was investigated on the first day (baseline), at the end of the program, and 6 and 12 months after completing the health program. Physical function was measured using handgrip strength test, timed up and go (TUG) test and one-leg standing time test. Oral diadochokinesis test and repetitive saliva swallowing test (RSST) were employed to assess oral function. Results: TUG scores were significantly lower at 6 and 12 months than at baseline in participants aged ≥70 and <80 years. The repetition rate of the monosyllables /pa/, /ta/, and /ka/ was improved at the end of program in participants aged ≥70 and <80 years and increased to more than 6 times/second at 12 months. Conclusions: Our 3-month health program maintained improvements in oral and physical function in older women 1 year after completing the program.

Features of monitoring industrial injuries in Russia and in the countries of the European Union

The statistical reporting system in the Russian Federation, based on the forms and indicators approved by the Federal State Statistics Service, allows monitoring current situation and dynamics of changes in occupational safety and working conditions of employees per industries and types of economic activity of production plants. At the same time, the Russian system of monitoring labor safety protection is ineffective for research, analysis, control, transmission, dissemination and use of information about the causes, circumstances and consequences of occupational injuries on the scale of a plant and a workplace. The comparison of the analysis results in the countries of the European Union and in the Russian Federation shows that focusing on reducing the number of industrial accidents by collecting detailed information allows using this information to identify the main health problems at production sites, as well as developing corrective long-term prevention programs for injuries and diseases. This should be preceded by the theoretical analysis, including development and justification of the structure of the monitoring system, as well as its strategies, goals and objectives that must be solved during implementation.

Relationship between oral and physical function and length of participation in long-term care prevention programs in community-dwelling older Japanese women.

The present study aimed to clarify the relationship between community-dwelling older women's participation period in community-based exercise programs and their oral and physical functioning. From May to September 2019, we recruited 205 older women (mean age: 77.6 ± 5.5years) who had joined weekly long-term care prevention programs such as community-based exercise programs that included oral and physical exercises, in Hiroshima Prefecture, Japan. Physical function was evaluated using a handgrip strength test, a Timed Up & Go test, a one-leg standing test, and a 30-s chair stand test. Tongue pressure, oral diadochokinesis, and Dysphagia Risk Assessment for the Community-dwelling Elderly were measured to evaluate oral functioning. After adjusting for clinical factors (i.e., age, BMI, hypertension, diabetes, stroke, heart disease, joint disease, osteoporosis, remaining teeth, denture use, oral wetness, history of dental examinations in the last year, use of interdental brush and/or dental floss), we compared the oral and physical function parameters of participants from varying program engagement periods using propensity score matching. A significant increase in mean handgrip strength was found in people who had been participating for ≥ 5years compared with those who had been participating for < 5years (p = 0.01). Furthermore, repetition of the monosyllable/ka/was significantly greater for people in the ≥ 5years group compared with those in the < 5 years group (p = 0.03). Long-term participation in an exercise program is positively associated with handgrip strength and tongue motor function in independent older women.

Predictors of emergency medical services utilization after different preventive counseling programs in paroxysmal atrial fibrillation patients after catheter ablation

Abstract Background Catheter ablation (CA) is known to reduce atrial fibrillation (AF) burden, but even after CA patients (pts) may remain symptomatic and seek for emergency care. Purpose To identify predictors of emergency medical services (EMS) utilization after different preventive counseling programs in paroxysmal AF pts after CA. Methods This is a secondary analysis of a randomized controlled trial in AF pts after CA (radiofrequency or cryoballoon) assessing the effects of a long-term preventive counseling program encompassing remote support. Pts were randomized into 3 groups in 1:1:1 ratio. During hospitalization for CA pts from all groups received single-session preventive counseling with focus on their individual cardiovascular risk factors profile. After discharge, pts from Group 1 received remote preventive counseling by phone and pts from Group 2 by email every two weeks for the first 3 months after enrollment (a total of 6 sessions). Group 3 received usual care. At baseline and at 12 months of follow-up, pts underwent assessments of their demographic parameters (age, sex, education level, marital status, and socioeconomic status) and psychological status (stress level using a 10-point visual analogue scale [VAS] and anxiety and depression by the Hospital Anxiety and Depression Scale [HADS]; transthoracic echocardiography, ECG and 24-hour ECG monitoring. A multivariate regression analysis of seeking for EMS was performed with patients' baseline parameters as independent variables. Results A total of 135 pts aged 35 to 80 years were enrolled (mean age 57.3±9.1 years, 51.8% men). Over 1 year of follow-up, 53 study participants called the ambulance (which made up for 90 calls) with no significant differences between the study groups. Age (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1–2.9; P=0.010), stress level ≥7 points (OR 3.2, 95% CI 1.4–7.5; P=0.007), left ventricular (LV) ejection fraction ≤62% (OR 2.6, 95% CI 1.1–6.1; P=0.024); and left atrial (LA) diameter ≥42 mm (OR 3.6, 95% CI 1.5–8.5; P=0.003) were independent predictors of an EMS call. Conclusions Age, perceived stress level, reduced LV function and LA size were independent predictors of EMS utilization after CA regardless of preventive counseling interventions. Funding Acknowledgement Type of funding source: None

New technologies for intensive prevention programs after myocardial infarction: rationale and design of the NET-IPP trial.

Current health care data reveal suboptimal prevention in patients with coronary artery disease and an unmet need to develop effective preventive strategies. The New Technologies for Intensive Prevention Programs (NET-IPP) Trial will investigate if a long-term web-based prevention program after myocardial infarction (MI) will reduce clinical events and risk factors. In a genetic sub study the impact of disclosure of genetic risk using polygenic risk scores (PRS) will be assessed. Patients hospitalized for MI will be prospectively enrolled and assigned to either a 12-months web-based intensive prevention program or standard care. The web-based program will include telemetric transmission of risk factor data, e-learning and electronic contacts between a prevention assistant and the patients. The combined primary study endpoint will comprise severe adverse cardiovascular events after 2years. Secondary endpoints will be risk factor control, adherence to medication and quality of life. In a genetic sub study genetic risk will be assessed in all patients of the web-based intensive prevention program group by PRS and patients will be randomly assigned to genetic risk disclosure vs. no disclosure. The study question will be if disclosure of genetic risk has an impact on patient motivation and cardiovascular risk factor control. The randomized multicenter NET-IPP study will evaluate for the first time the effects of a long-term web-based prevention program after MI on clinical events and risk factor control. In a genetic sub study the impact of disclosure of genetic risk using PRS will be investigated.

Application of Mathematical Modeling in Public Health Decision Making Pertaining to Control of COVID-19 Pandemic in India

Introduction: The COVID-19 is highly infectious and possibility of spread is more, it is expecting to see large number of cases in the coming days. There is need for effective public health measures at community level including those recommended for containment and buffer zones. To achieve this, there is need for evidence based decision making at all level. Mathematical modeling can be important tool to achieve this. The objective of this research article is to sensitize public health decision makers at Centre, State and District level about application of Mathematical Modeling in decision making for prevention and control of COVID-19. Methodology: BAILEY’S MODEL was applied on secondary data for COVID -19. In this model, the removal rate is calculated which is the percentage of removed persons in the infected population. Further, regression analysis has been done, to show the linear relationship between the total infection rate and the total recovery rate. Linking of this model with decision making has been described. Findings: BAILEY’S MODEL described that when the number of infected is equal to the number of removed patients, the coefficient will reach 100% threshold and the epidemic will be extinguished. In this article as per the Regression Analysis (Linear) of Bailey’s Relative Removal Rate (BMRRR), COVID 19, India, it is observed that the trend reached to 100 in the month of mid of September, 2020. So it may be interpreted that at that point of time, the number of infected will be equal to the number of removed patients, and that’s why the coefficient will reach 100% threshold. Conclusion: This a very good model to support analysis and interpretation of State/District data (whenever numbers of cases are high) and it will also help in relevant decision making in control activities of COVID 19 Pandemic. This will further help government to take long-term disease prevention and intervention programs. How to cite this article:Kumar A, Roy R. Application of Mathematical Modeling in Public Health Decision Making Pertaining to Control of COVID-19 Pandemic in India. Epidem Int 2020; 5(2): 23-26. DOI: https://doi.org/10.24321/2455.7048.202013

High toxoplasmosis seroprevalence among young pregnant women in Medea, Algeria.

Toxoplasmosis is a parasitic disease with worldwide distribution and a major public health problem. In fact, the zoonotic pathogen Toxoplasma gondii infects humans and almost all warm-blooded animals. One of the most common sources of human T. gondii infection is the ingestion of tissue cysts in raw or undercooked meat. The current epidemiological study was carried out in Medea (Algeria), from January to June 2017, using Enzyme Linked Immunosorbent assay (ELISA). Antibodies against T. gondii were determined in sera of more than one thousand pregnant women. The different age groups were: 15-20, 20-25, 25-30, 30-35, 35-40 and 40-45. Among 1,012 pregnant women analyzed, 252 (25%) were found seropositive, 49 among them showed a IgG+/IgM+ profile, and 760 (75%) were seronegative exhibiting IgG-/IgM-. Toxoplasmosis prevalence's were 44.5% and 39.5% in 15-20 and 20-25 age categories, respectively. A long-term prevention program is needed and strategies should be focused on the serodiagnosis of toxoplasmosis, especially in pregnant women. Since the consumption of raw or undercooked meat is not a part of the culinary culture in that area of study, cat exposure remains the principal factor of human infection.

A mathematical model for the novel coronavirus epidemic in Wuhan, China.

We propose a mathematical model to investigate the current outbreak of the coronavirus disease 2019 (COVID-19) in Wuhan, China. Our model describes the multiple transmission pathways in the infection dynamics, and emphasizes the role of the environmental reservoir in the transmission and spread of this disease. Our model also employs non-constant transmission rates which change with the epidemiological status and environmental conditions and which reflect the impact of the on-going disease control measures. We conduct a detailed analysis of this model, and demonstrate its application using publicly reported data. Among other findings, our analytical and numerical results indicate that the coronavirus infection would remain endemic, which necessitates long-term disease prevention and intervention programs.

The efficacy of secondary prevention programs with remote support in coronary heart disease patients with abdominal obesity

To assess the impact of 2 preventive counselling programs with subsequent remote support in CHD patients with concomitant obesity. A prospective randomized parallel-group study in 120 stable CHD patients hospitalized for elective coronary revascularization who were from 40 to 65 years old and had concomitant obesity. Patients were randomized (1:1:1) into 3 groups (n=40 each). Before discharge, Groups 1 and 2 received a single-session comprehensive counselling with focus on diet followed by remote counselling by phone (Group 1) or via text messages (Group 2). Remote counselling was delivered weekly (Months 1-3) and then monthly (Months 4-6). Group 3 received only standard advice from their attending physicians. The patients were followed for 12 months with assessment of adiposity measures, self-reported dietary patterns, physical activity (IPAQ questionnaire), smoking status, blood pressure (BP), fasting blood glucose, lipids and C-reactive protein (CRP) levels, as well as of clinical events. At 1 year of follow-up, the patients from both intervention groups showed a marked improvement of several risk factors including obesity: the body mass index was reduced by 1.48±0.13 kg/m² in Group 1 and by 1.53±0.18 kg/m² in Group 2; the waist circumference went down by 7.62±0.49 and by 7.41±0.74 cm, respectively; the height-normalized fat mass decreased by 4.66±0.40 kg and 5.98±0.63 kg, respectively (all P values are &lt;0.01 vs corresponding changes in the control group). These changes were coupled with more healthy dietary patterns and less sedentary lifestyles in both intervention groups: the proportion of patients with low activity level fell from 87.5% to 2.5% in Group 1 and from 80% to 10% in Group 2 (both p values &lt;0.01 vs control). In Group 1, BP decreased by 18.08±2.20 mmHg (systolic) and 8.56±1.61 mmHg (diastolic); both р values &lt;0.01 vs Group 3. In Group 2 systolic BP dropped by only 11.95±2.50 mmHg (non-significant) and diastolic BP by 6.33±1.52 mmHg (р&lt;0.05 vs control). The proportion of smokers went down from 30% to 5% in Group 1 and from 22.5% to 0% in Group 2 (both p values &lt;0.01 vs control). The fasting glucose levels decreased by 0.21±0.20 mmol/L in Group 1 and by 0.48±0.25 mmol/L in Group 2 (&lt;0.01 vs control, both), but there were no meaningful improvements in blood lipids or CRP. Long-term (6 months) secondary prevention programs incorporating remote support technologies result into sustained improvement of key secondary prevention indicators in obese CHD patients, irrespective of the support modality (by phone or via electronic messaging).

P6214How to improve long-term prevention in young patients after myocardial infarction - the IPP-Y study

Abstract Background Patients who experienced myocardial infarction (MI) at a young age are of special medical and socioeconomic interest; cardiovascular risk factor control to prevent recurrent events is crucial in this specific cohort. Objectives The purpose of the study was to evaluate long-term risk factor control in young MI-patients in clinical practice and investigate the effects of a modern intensive prevention program in a prospective randomized trial. In a genetic substudy it was analyzed if prevention effects were depending on individual genetic risk. Methods Patients who had MI at age of ≤45 years were revisited after a mean period of 5.7±4.0 years to evaluate long-term risk factor control. Furthermore a 12-months intensive prevention program in young MI-patients (IPP-Y), coordinated by non-physician prevention assistants and including personal teachings, telephone contacts, clinical and telemetric control of risk factors, was compared to usual care in a randomized trial. Primary endpoint of the randomized trial was prevention success, defined as improvement of one of the risk factors smoking, LDL cholesterol or physical inactivity without deterioration of the others. As the opposite prevention failure was defined as deterioration of one of the risk factors without improvement of the others. Genetic risk was assessed by polygenetic risk scores, based on 163 SNPs. Results Only a minority of the 277 young patients after MI achieved guideline-recommended risk factor targets at long-term follow-up visits: mean body mass index was 29.9±5.1 kg/m2, just 14.8% had a body mass index &lt;25 kg/m2. More than one third (38.3%) were persistent or recurrent smokers. Mean LDL cholesterol level was 94±38 mg/dl, only 27.1% of the patients achieved LDL cholesterol levels &lt;70 mg/dl. However, the long-term prevention program IPP-Y led to a higher rate of the primary endpoint prevention success (IPP-Y: 49% vs. UC: 27%, p&lt;0.05) and a lower rate of prevention failure (IPP-Y: 15% vs. UC: 38%, p&lt;0.05) compared to usual care after 12 months (see figure). Telemetric control of risk factors as part of the prevention program was used by 71.4% of the patients. In the genetic subanalysis prevention effects were found in both, patients with high genetic risk as well as patients with low genetic risk assessed by polygenetic risk scores (p=0.79 high vs. low genetic risk). Effects of IPP-Y during 12 months Conclusions To our knowledge this is the first study on young patients with MI that demonstrates insufficient long-term risk factor control in clinical practice and significant effects of an intensive prevention program. Prevention effects were independent from individual genetic risk. Acknowledgement/Funding This work was supported by the Stiftung Bremer Herzen, Bremen, Germany and the Stiftung Bremer Wertpapierbörse, Bremen, Germany

Improvement of physical and oral function in community-dwelling older people after a 3-month long-term care prevention program including physical exercise, oral health instruction, and nutritional guidance.

ObjectiveThere is limited evidence about the most appropriate way to improve physical and oral function in older people. The aim of this study was to clarify the effectiveness of a long‐term care prevention program combining physical exercise, oral health instruction, and nutritional guidance among community‐dwelling older people.Materials and methodsWe included 43 older people aged at least 65 years (seven men and 23 women; mean age 75.3 years) in Bungotakada City, Japan. The 3‐month program involved a weekly intervention. Physical and oral function was investigated on the first day of the program (i.e., baseline) and at the end of the program (i.e., after 3 months). Physical function was examined using measures such as handgrip strength, timed up‐and‐go test, and one‐leg standing time with eyes open. An oral diadochokinesis test was used to assess oral function.ResultsMean maximum handgrip strength increased significantly in older people aged ≤74 years (younger participants) and those aged ≥75 years (older participants) after 3 months compared with the baseline. The timed up‐and‐go test duration was significantly lower in older participants after the program. Repetition of the monosyllables pa and ka and the repetitive saliva swallowing test was significantly improved in both groups. The dysphagia risk assessment for the community‐dwelling elderly score was significantly lower in younger participants after 3 months.ConclusionParticipation in a 3‐month program combining physical exercise, oral health instruction, and nutritional guidance may contribute to improvement or maintenance of oral and physical function in older people.

Effects of an intensive long-term prevention programme after myocardial infarction – a randomized trial

Long-term risk factor control after myocardial infarction (MI) is currently inadequate and there is an unmet need for effective secondary prevention programmes. It was the aim of the study to compare a 12-month intensive prevention programme (IPP), coordinated by prevention assistants and including education sessions, telephone visits and telemetric risk factor control, with usual care after MI. Three hundred and ten patients were randomized to IPP vs. usual care one month after hospital discharge for MI in two German heart centres. Primary study endpoint was the IPP Prevention Score (0-15 points) quantifying global risk factor control. Global risk factor control was strongly improved directly after MI before the beginning of the randomized study (30% increase IPP Prevention Score). During the 12-month course of the randomized trial the IPP Prevention Score was improved by a further 14.3% in the IPP group ( p < 0.001), while it decreased by 11.8% in the usual care group ( p < 0.001). IPP significantly reduced smoking, low-density lipoprotein cholesterol, systolic blood pressure and physical inactivity compared with usual care ( p < 0.05). Step counters with online documentation were used by the majority of patients (80%). Quality of life was significantly improved by IPP ( p < 0.05). The composite endpoint of adverse clinical events was slightly lower in the IPP group during 12 months (13.8% vs. 18.9%, p = 0.25). A novel intensive prevention programme after MI, coordinated by prevention assistants and using personal teachings and telemetric strategies for 12 months, was significantly superior to usual care in providing sustainable risk factor control and better quality of life.

A Study on Long-Term Care Prevention Programs for Community-Dwelling Frail Elderly Subjects:

A Study on Long-Term Care Prevention Programs for Community-Dwelling Frail Elderly Subjects: