Secondary Prevention Measures Research Articles

Utility of telephone text messages in secondary prevention after acute coronary syndrome

Abstract Introduction The recurrence of events in patients after an acute coronary syndrome (ACS) represents a great challenge for the health systems due to its high prevalence, morbidity and mortality, and cost. For this reason, secondary prevention measures with low cost and easy to implement are necessary. The objective is to evaluate the usefulness of telephone text messages (TTM) in the control of risk factors and reduction of events in the first year after an ACS. Methods Single-blind 1:1 randomized clinical trial in consecutive patients discharged with ACS between May 2019 and October 2021 in our center. The intervention group received a monthly TTM for 12 months with the recommendations of the Spanish Society of Cardiology regarding secondary prevention measures. Both groups followed the usual review protocol of our center in a specific ischemic heart disease consultation at 3 and 12 months after discharge. The center lacks cardiac rehabilitation. The objectives of the study at 12 months were: total and cardiovascular death, myocardial infarction, stroke, weight, blood pressure, LDL, HDL, triglycerides, glycosylated hemoglobin, smoking habit, and hours of exercise per week. The evaluator in charge of collecting data after the end of the year was unaware of the assignment group. Results N= 370. The patient profile was the usual one for ACS, with a mean age of around 65 years and 25% diabetic, with no differences in any of the baseline characteristics between both groups. An invasive approach was performed in almost all of the subjects, with percutaneous intervention in three-quarters of the cases and also without significant differences in the type of treatment, percentage of multivessel disease, and left main disease between both groups. Only a lower number of stents per patient was recorded in the control group. There were also no differences in medical treatment between both groups. The results are shown in the table. Conclusions In our study, monthly TTM had no influence on the control of risk factors or clinical events during the first year of follow-up after an ACS, and therefore it is not cost-effective to allocate resources for this purpose.

Smoking cessation after acute myocardial infarction: a Swiss-wide cohort study

Abstract Background Smoking is a major cardiovascular risk factor and of great importance in terms of both primary and secondary prevention. The present study aims to identify patient characteristics associated with smoking cessation within 1 year after acute myocardial infarction (AMI) to inform physician-patient interactions, secondary prevention measures, and public health planning. Methods ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) patients enrolled between 2012 and 2022 in the AMIS Plus registry who were active smokers at the time of the index event were included. At the 1-year follow-up, patients were questioned about their smoking behaviour via telephone interview and were further classified into those who had quit (stoppers) or continued (continuers) smoking. Patient characteristics were collected at the time of the index event and at follow-up and then compared using descriptive statistics. Results From a total of 4523 patients with AMI, 4242 (93.8%) provided information regarding their smoking status at a median follow-up of 395 days (interquartile range 370 to 469) after the index event. Of 1691 (39.9%) active smokers at the time of AMI, 861 (50.9%) reported quitting whereas 830 (49.1%) were still smoking at the 1-year follow-up. Stoppers were younger (57 vs. 58 years, p<0.001), more likely to be male (82.8% vs. 77.7%, p=0.008) and have presented with STEMI (77.0% vs. 71.0%, p=0.005), and less likely to have had a previous AMI (6.6% vs. 13.3%, p<0.001) than continuers. Smoking cessation was more common in patients with a more severe AMI characterised by a greater extent of myocardial injury (in-hospital median peak creatine kinase level 1291 IU/L vs. 1101 IU/L, p=0.012), at least one in-hospital complication (13.9% vs. 9.9%, p=0.01), and participation in a rehabilitation programme (83.7% vs. 68.8%, p<0.001). Stoppers more frequently implemented other favourable lifestyle changes, such as dietary changes (56.2% vs. 45.2%, p<0.001) and increased physical activity (54.6% vs. 37.7%, p<0.001) than continuers. Self-reported weight gain was more prevalent among those who quit smoking (44.0% vs. 19.7%, p<0.001). Conclusions In Switzerland, half of the patients with AMI who were active smokers at the time of AMI, reported to have stopped smoking 1 year after the index event. Smoking cessation was associated with participation in a rehabilitation programme and occurred more often in patients with larger AMI sizes, higher in-hospital complication rates and more frequent implementation of other favourable lifestyle changes after AMI. The significant weight gain after smoking cessation seems to represent a major issue that should specifically be addressed.

Lipid-lowering prescription patterns after a non-fatal acute coronary syndrome

Abstract Introduction After an acute atherosclerotic cardiovascular event, high-intensity lipid-lowering therapy (LLT) is needed to reduce the risk of recurrence. Moreover, despite 2016/2019 ESC/EAS guidance on lipid management according to risk, several studies indicate that most patients do not attain low-density lipoprotein-cholesterol (LDL-C) goals. The present study aims to describe LLT prescription patterns after a non-fatal acute coronary syndrome (ACS) and identify opportunities for improvement in secondary preventive measures, namely LDL-C control. Methods Retrospective cohort study featuring adults aged 40-80 residing in a Portuguese municipality Portugal, using Electronic Health Records between 2016 and 2022. Selected patients had ≥1 general practice appointment three years before the occurrence of an ACS, which was considered an index date. Sub-analysis was made based on patients’ age (under and high or equal to 65 years), gender, and whether their LDL-C levels were controlled according to gradual upper thresholds of 100 mg/dL in the period before the ACS event and 55 mg/dL at one-year post-ACS. Results Among the 544 selected patients, 270 were younger than 65 years. Females comprised 30% (164 patients) of the total cohort, 27% of the under-65 group, and nearly 38% of the 65 and older group. In younger patients, LDL-C levels were higher at presentation (132 mg/dL) and had a significantly greater decrease during the follow-up period compared to the older group. In the period before the ACS, 71.1% of men and 56.7% of women had no previous prescription of LLT, and younger patients had worse levels of LDL-C control (24.1%) compared to older patients (46.0%). One year post-ACS, the pattern of LLT revealed a substantial drop in patients without any LLT prescription from 66.7% to 13.6% and an increase in high-intensity LLT from 2.4% to 16.5%. Still, moderate-intensity LLT (66%) remained the most frequently used LLT. An increase in LLT potency was observed in the follow-up, although there was a decrease in patients achieving LDL-C control. Previous to the ACS event, 35.3% of men and 34.8% of women had initially controlled LDL-C levels according to defined thresholds, which significantly reduced to 11.3% and 8.5%, respectively, at one-year post-ACS. Conclusion Despite initiating or intensifying LLT after ACS, LDL-C goals were not achieved in approximately 9 out of 10 patients at 1-year follow-up, highlighting that the LLT adjustment was insufficient. Therefore, there is a need for better optimisation of LLT after ACS, unveiling an alarming gap in guideline implementation in clinical practice.

Exploring changes in the distribution of health status in type 2 diabetes over time - methodological aspects for estimating years lost due to disability for Germany

Abstract Knowledge of the severity distribution (SD) of certain diseases is crucial for calculating the years lost due to disability (YLD), as the time spent with a disease is explicitly weighted on the health state level. Depending on the disease, different severity levels are considered. In most cases, the SDs vary from mild, moderate, severe to most severe. This is different in the context of diabetes, where an explicit distinction is made according to the sequelae resulting from the disease progression. In general, these include diabetic neuropathy (with foot ulcers or amputations) and (mild or moderate) vision impairments including blindness due to diabetic retinopathy. These complications cause a considerable loss of quality of life for those affected and high costs for the healthcare system. However, the progression of many of the sequelae can be avoided through (secondary) preventive measures. Estimating the degree of severity is therefore an important indicator of the population affected and in need for care. Due to a lack of data, the Global Burden of Disease Study often uses time-invariant and regionally fixed SDs. Important insights as to the temporal variance of SDs thus remain unnoticed. As part of the BURDEN 2020 pilot project in Germany, SD for diabetes-related complications were estimated from routine health insurance data for the year 2017. In a follow-up project (BURDEN 2.0), these results will also be available for the years 2017 to 2022. If there are any changes in the proportion of individual health conditions, implications can be generated from routine healthcare data of those affected. The SDs overall and according to certain sequelae will be presented over time and discussed. Also, the resulting YLD over time for type 2 diabetes will be examined, including changes in the prevalence of the disease. This makes it possible to analyse and interpret the burden of disease due to diabetes during the years 2017 to 2022.

Lung cancer screening: Real screening site data, Vojvodina, Serbia

Abstract Background Lung cancer (LC) is the top cause of cancer-related deaths globally and in Serbia, often diagnosed in advanced stage of disease with when 5-year survival is 10% to 20%. LC screening with low-dose CT (LDCT) can decrease LC mortality and overall mortality. The first pilot LC screening program in Serbia started in the Institute for Pulmonary Diseases of Vojvodina in September 2020. The main objective of this study was to analyze LC patient characteristics according to their screening status. Methods This retrospective study utilized LC hospital registry data from September 2020 to December 2023, including gender, age at diagnosis, settlement area, smoking habits, cancer histological type, TNM classification, disease stage (1-4), and data on participation in LC screening. Group differences were assessed using chi-square and Student’s t-tests, with analyses conducted in SPSS v24.0. Results During observed period from a total of 4649 LC cases 2948 (63.4%) were males, and 73 (1.6%) were included in LC screening. Average age of all LC patients was 66 years, without differences between groups (p = 0.778). Significant differences between groups by gender were find (p = 0.042). Non-screened LC patients were significantly common males compared to females (63.6% vs 36.4%), while among screened difference by gender were lower (52.1% vs 47.9%, respectively). Screened compared to non-screened LC patients have significantly lower percentage of SCLC (9.6% vs 19.1%), and higher percentage of NSCLC (90.4% vs 80.9%), (p = 0.040). According to LC stage, screened compared to non-screened patients were significantly common diagnosed in stage I of disease (45.8% vs 7.8%), and significantly less common in higher LC stages; stage IIIB (11.1% vs 22.5%), and in stage IV (22.2% vs 45.7%), (p < 0.001). Conclusions LC screening with LDCT is proven secondary preventive measure with significant influence on decreasing LC mortality by increasing number of LC patients in early stages of disease. Key messages • Lung cancer screening with low-dose CT significantly increases early-stage diagnoses, improving survival chances. • Population strategies to prevent smoking and screening programs for high-risk groups are needed to reduce lung cancer incidence and mortality rates in Serbia.

Favourable lifestyle changes 1 year after acute myocardial infarction

Abstract Background Acute myocardial infarction (AMI) is a life-threatening event that should be an excellent motivator to adopt a healthy lifestyle. We aimed to evaluate the proportion of patients with AMI who reported favourable lifestyle changes 1 year after AMI. Methods Harnessing a nationwide prospective cohort of patients with AMI in Switzerland, ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) patients enrolled in the AMIS Plus registry between 2012 and 2022 were followed-up 1 year after the event by telephone interview. Favourable lifestyle changes, often addressed in hospitals or rehabilitation programmes were defined as smoking cessation, weight reduction (for overweight patients at index presentation), dietary changes, increased physical activity and stress reduction. Self-reported lifestyle changes were stratified according to AMI type, sex, and age. Results From 7906 AMI patients, 7234 (91.5%) with follow-up data were included. Of these, 5627 (77.8%) were male, 1607 (22.2%) female, 4664 (64.5%) had a STEMI, and 2570 (35.5%) a NSTEMI. At a median follow-up of 397 (interquartile range 371 to 465) days, 861 (50.9%) smokers at the time of the AMI had quit smoking, 1297 (35.0%) overweight patients had lost weight, 2567 (44.8%) patients had implemented nutritional changes, 2415 (41.2%) had increased their physical activity, and 1729 (30.5%) had reduced their stress levels. Patients with STEMI were more likely to stop smoking (53.0% vs. 45.1%, p=0.005), change their diet (46.4% vs. 41.6%, p<0.001), increase their physical activity (43.5% vs. 36.8%, p<0.001), or reduce stress (31.4% vs. 28.7%, p=0.04) compared to NSTEMI patients. Male sex was associated with smoking cessation [52.5% vs. 44.4%; p=0.008; age-adjusted odds ratio (OR), 0.78; 95% confidence interval (CI), 0.61-0.99; p=0.043], dietary change (47.8% vs. 33.7%; p<0.001; age-adjusted OR, 0.67; 95% CI, 0.58-0.77; p<0.001), and an increase in physical activity (43.5% vs. 32.9%; p<0.001; age-adjusted OR, 0.77; 95% CI, 0.67-0.88; p<0.001). However, after adjusting for age, stress reduction was comparable between males and females (30.9% vs. 28.9%; p<0.001; age-adjusted OR, 1.09; 95% CI, 0.94-1.26; p=0.25). Conclusions A substantial proportion of patients with AMI in Switzerland reported favourable lifestyle changes within 1 year after the index event. In general, STEMI as well as male patients were more likely to report multiple favourable lifestyle changes. Nevertheless, there is still room for improvement in terms of secondary prevention measures.

Applying Mobile Technology to Address Gender-Based Violence in Rural Nigeria: Experiences and Perceptions of Users and Stakeholders

ABSTRACT This paper documents the results of an intervention conducted in Nigeria to test the effectiveness of a mobile phone technology, text4life, in enabling women to self-report gender-based violence (GBV). Women experiencing GBV and other challenges related to sexual and reproductive health and rights were requested to use their mobile phones to text a code to a central server. In turn, the server relayed the messages to trained nearby health providers and civil society organization (CSO) officials who reached out to provide health care and social management services to the callers. Interviews were conducted with some callers, health care providers, and CSO staff to explore their experiences with the device. The interviews and data from the server were analyzed qualitatively and quantitatively. The results indicate that over a 27-month period, 3,403 reports were received by the server, 34.9% of which were reporting GBV. While interviewees perceived that a large proportion of the women were satisfied with the use of text4life, and many received medical treatment and psychological care, the consensus opinion was that many women reporting GBV did not wish to pursue police or legal action. This was due to women’s perceptions that there would be negative cultural and social backlash should they pursue civil punishments for their partners. We conclude that a mobile phone device can be used effectively to report GBV in low-resource settings. However, the device would be more useful if it contributes to equitable primary prevention of GBV, rather than secondary prevention measures.

Barriers to Cardiac Rehabilitation Enrollment and Secondary Prevention Adherence in Patients with Coronary Heart Disease Following Percutaneous Coronary Intervention: A Cross-sectional Survey.

This study aimed to evaluate adherence to secondary prevention measures and to identify barriers to cardiac rehabilitation enrolment among patients with coronary heart disease after percutaneous coronary intervention. An observational cross-sectional survey was conducted through computer-assisted telephone interviews to assess recently treated percutaneous coronary intervention patients at the Prince Sultan Cardiac Center in Saudi Arabia. Out of 104 surveyed patients with coronary heart disease, 85 (82%) were male, with an average age of 59.5 years. The obesity rate was 28% (n = 29), with a high prevalence of comorbidities: 82 (79%), 63 (61%), and 62 (60%) patients had hyperlipidemia, diabetes, and hypertension, respectively. Despite high medication compliance (97%), adherence to secondary prevention measures was low (21%). Adherence to physical exercise and weight monitoring for fluid body build-up was notably poor at 35% and 9%, respectively. Only 11 (10.6%) patients were referred for cardiac rehabilitation, of whom only four (36.4%) attended. Significant barriers such as a lack of staff contact, insufficient physician support, and distance to cardiac rehabilitation facilities were particularly noted by 69% of rural patients. This study underscores the significant cardiac risk factors and low adherence to secondary prevention measures among post revascularization patients with coronary heart disease in Saudi Arabia. Low referral and other organizational barriers, as well as the travel distance to hospital-based cardiac rehabilitation, hinder program enrolment. To improve cardiac rehabilitation accessibility, it is crucial to revise the discharge plans, implement automated referral systems, expand the services across all regions, and utilize alternative delivery models.

Secondary Preventive Management of Kitibha Kushta (Plaque Psoriasis) - A case study

Levels of prevention has been a wide idea concept which includes all the aspects related to health and disease like preventive, curative, promotive and rehabilitative measures. Applicability of this concept in Ayurveda has elaborative understanding in a more simplified manner. Despite leading to both physical and psychological issues, the importance given to skin diseases is always the least. Changing food habits and lifestyle is being the major reason in the current era for increased prevalence of skin diseases especially in young adults. In a way to cope up with fast living culture, people are compromising with their health and well being which needs immediate attention and action. Early diagnosis and complete treatment is the basis of Kushta Chikitsa (treatment of skin diseases) and the same has been highlighted as a secondary preventive measure. One such case is being discussed here which is diagnosed initially and treated as per Ayurveda chikitasa siddhtanta (Ayurvedic treatment principle), considering Dosha (bio-forces of body), Agni(metabolism), Bala (Strength), Ritu (season) etc giving complete relief and self confidence of the patient. This not only prevents the further occurrence of complications due to chronicity but also brings back the faith in Ayurveda treatment modalities. It is high time to make the young minds realize the importance of healthy living, which otherwise can impair the health status of the nation, dragging back its growth and development.

Prevention of Recurrent Myocardial Infarction in an Outpatient Setting

The aim was to study the medical and social characteristics of patients with repeated myocardial infarction (MI), features of the course of the disease, as well as the degree of contribution of cardiovascular disease (CVD) risk factors (RFs) to its development, in order to optimize secondary prevention measures at the primary health care level. Material and methods. Part of the study was carried out on the basis of a retrospective analysis of the outpatient records of all patients registered at the dispensary who had suffered primary MI and recurrent MI. Clinical, laboratory, and instrumental studies were carried out. Results. The study population had both non-modifiable and modifiable risk factors, among which the most common were low levels of physical activity, excess body weight, dyslipidemia and hypertension. The study also revealed gender differences in the prevalence of risk factors for coronary artery disease, which must be taken into account when conducting secondary prevention at the outpatient stage. Clear correlations were revealed between RF, clinical, laboratory, hemodynamic, and morphological, as well as functional parameters in patients with recurrent MI. The most significant correlations in patients with recurrent MI were between the number of complications and the degree of systolic cardiac dysfunction, as well as lipid metabolism disorders. Effective management of patients who have had an MI on an outpatient basis will reduce the risks of recurrent cardiovascular complications and will positively affect the long-term prognosis and clinical endpoints of MI.

Kidney cancer following occupational exposure to trichloroethylene: clinical case series and review of the literature

This case study describes the clinical, medical and administrative management of kidney cancer secondary to occupational exposure to trichloroethylene, a chlorinated solvent classified as a known carcinogen by the International Agency for Research on Cancer. Data were collected from the computerized records of all patients treated by the occupational medicine department of Montpellier University Hospital for kidney cancer following occupational exposure to trichloroethylene. The study included five patients aged between 36 and 64 years. Clinical characteristics (histology, stage at diagnosis and disease course) were variable. The patients had all been exposed to trichloroethylene before the year 2000, with a mean delay to diagnosis of 31 years. Kidney cancer is a frequent pathology, often discovered by chance, even at metastatic stages. Knowledge of occupational risks enables us to set up primary and secondary prevention measures (early detection), as well as a specific medical and social care pathway.

A Quality Improvement Project On The Introduction Of A Nurse-Led, Patient Self-Monitored Blood Pressure Telehealth Platform

Abstract Background Telehealth is a strategy for health and wellbeing promotion. Hypertension is a modifiable risk factor in vascular health. Timely, reliable and accessible identification of this risk is important. Working within an interdisciplinary ambulatory neurovascular hub, a nurse-led model of service provided the opportunity to effectively identify and modify this risk through the secondary prevention measure of hypertension management. Methods An interdisciplinary neurovascular service quality improvement group, the “Stroke Big Room”, evaluated service models and telehealth platforms for patient-self monitoring of hypertension. The telehealth “Florence” platform was introduced. An accompanying Patient Information Leaflet was developed with the Communications Team within the Trust. Patients with a blood pressure of 130/80mmHg and a confirmed diagnosis of minor stroke or transient ischaemic attack were offered the “Flo” platform. Results A 20-patient sample found: 50% required no treatment change, 30% were commenced on antihypertensive treatment and 20% required antihypertensive dose increase. In the 2023/24 financial year, 285 patients participated in the Flo platform. Conclusion Timely identification and modification of hypertension is a reversible risk factor for neurovascular disease. A nurse-led service for the provision of, education on and support in use of a telehealth monitoring platform is an effective approach. This service model allows for effective secondary prevention treatment in a rapid and accessible way. The telehealth platform “Flo” was accessible to patients on the basis of patient reported outcome measures. As a result of the use of the platform, pharmacotherapeutic interventions occurred in 50% of participants in this telehealth programme.

Using System Dynamics for Local Authority Public Health practice in England

A key function of local authority public health teams in England is to undertake a regular health needs assessment of their population. This involves forecasting, among other things, prevalence and incidence of long term conditions and health care service demand. Over the last few years, Kent County Council Public Health has adopted the use of system dynamics modelling (SDM) to not only do this but generate scenarios to simulate the impact of different interventions across different cohorts defined by age groups and diagnosable conditions. These include “no conditions” as well as understand the combined effects of different interventions, demographic changes and wider health determinants. Risk factors, such as smoking, diet and physical activity, were calculated using local linked data for the incidence of single conditions, progression toward complex needs and levels of morbidity including frailty. These were used to create the dynamics of the model. Incidence, prevalence and mortality for each cohort were projected over 25 years with “do nothing” and “Better Health” scenarios. The size of the “no conditions” cohort increased, and the other cohorts decreased in size. The impact of the interventions on life expectancy at birth and healthy life expectancy was significant. SDM heavily influenced local authority commissioning decisions for health improvement services redesign such as smoking cessation, weight management as well as other secondary prevention measures such as hypertension management and cardiovascular disease screening delivered by General Practice and other health service partners.

Role of L-carnitine in Cardiovascular Health: Literature Review.

Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide. Secondary preventive measures, like anti-platelet medications, B-blockers, and angiotensin-converting enzyme (ACE) inhibitors, have been found to dramatically lower the risk of cardiovascular disease. However, prolonged usage of these drugs has been linked to multiple adverse impacts. Hence, finding more efficient treatments, especially dietary strategies for long-term use in daily life, is advantageous for primary prevention and treatment. L-carnitine, a naturally occurring amino acid derivative normally synthesized in the liver and kidney, is believed to have a considerable influence on cardiovascular health. L-carnitine can enhance both contractile performance and structural integrity of the cardiac muscle by maintaining efficient energy production and reducing oxidative stress. This literature review aims to address several pressing questions regarding the role of L-carnitine in cardiovascular health: what are the physiological functions of L-carnitine, particularly in relation to cardiovascular health; how effective and safe is L-carnitine supplementation in the management of various cardiovascular diseases, primarily ischemic heart disease, heart failure, and peripheral vascular disease; what are the underlying mechanisms through which L-carnitine exerts its cardioprotective effects; what controversies exist in the current research; and finally, what should be the future directions? Through this comprehensive analysis, the review aims to enrich our understanding of L-carnitine's role in cardiovascular health, providing a robust foundation for future academic and clinical endeavors. PubMed, Embase, and Google Scholar have been used to search the following keywords: L-carnitine, cardiovascular health, mitochondrial function, and L-carnitine side effects. Then, using the existing search engine formats, some keyword combinations were used to find the related articles included and every possibility, including using every first keyword combination with another keyword, using every keyword in every place at each given box, etc. Around 308 articles were reviewed using this process, including systemic reviews, meta-analysis studies, randomized controlled trials, and literature review articles. Inthe end, after leaving the pure articles related to the topic as 35 articles, which are attached below with direct citation, the majority of them were very fresh articles, as recent as 2010, and back words, except just one paper related to the impact of L-carnitine post-myocardial infarction, as its data provided us with a positive and promising impact of L-carnitine in this field. L‑carnitine seems to have a pivotal role in cardiovascular health due to its energy metabolism, anti-oxidative stress, and endothelial role. The safety and effectiveness of L-carnitine administration remain an issue for scientific investigation. One of the major concerns is that the intestinal metabolism of L-carnitine generates trimethylamine-N-oxide (TMAO), a compound that has been linked with faster atherosclerosis progression.

Parental and child's psychosocial and financial burden living with an inherited metabolic disease identified by newborn screening.

Newborn screening (NBS) is one of the most effective measures of secondary prevention. While the benefit of NBS on the clinical long-term outcomes of children with inherited metabolic diseases (IMD) has been demonstrated, the potential burden of families living with an early diagnosed and treated child with an IMD has not been thoroughly investigated. The aim of this longitudinal questionnaire-based study on 369 families living with a child with an IMD was to investigate the psychosocial and financial burden following a true-positive NBS. The reported psychosocial burden differed between children and their parents, and was associated with the child's age, diagnosis, and treatment. At younger ages, parent-reported burden was higher for the parents than for the individual child, while it increased for children and decreased for parents as the child grew older. Furthermore, psychosocial burden increased if the child required a strict dietary treatment and was at risk of metabolic decompensation. Regardless of diagnosis and treatment, the developmental delay of their child independently increased the parental psychosocial burden. Financial burden was reported by 24% of all families, and was higher in low-income families and in families whose children required dietary treatment. In conclusion, a substantial psychosocial and financial burden was revealed for children and their families after true-positive NBS. Since this burden is likely to have a negative impact on the long-term individual health benefits of NBS, this study underlines the importance of regularly assessing the psychosocial and financial needs of these families.

Vaccination in latent papillomavirus infections: An experimental randomized, prospective, open-label, controlled trial

Background. Human papillomavirus refers to one of the most common sexually transmitted infections with the majority of viruses in the host being transient carriers, the so-called latent forms of papillomavirus infection. Persistence of cancer-associated human papillomavirus is fraught with cervical intraepithelial neoplasia, and subsequent cervical cancer. Measures for secondary prevention of cervical cancer in latent forms of papillomavirus infection are yet to be developed, which predetermined the present study.Objectives. To increase the effectiveness of secondary prevention of cervical cancer by improving the algorithm for managing latent forms of papillomavirus infection in women. Methods. A randomized controlled trial enrolled 152 patients diagnosed with a latent papillomavirus infection. Patient examination and data analysis were carried out at clinical trial centers of the Department of Obstetrics, Gynecology and Perinatology of Kuban State Medical University (Russia) in 2020–2024. The trial involved patients aged 18 to 35 years. Patients were divided into 2 groups using the sealed code envelope method: Group I (comparison group) (n = 74) — microbiological sanitation of the cervicovaginal zone (as indicated) and observation for 36 months with annual control of viral load, colposcopy and oncocytology; Group II (study group) (n = 78) — microbiological sanitation of the cervicovaginal zone (as indicated) and administration of quadrivalent recombinant human papillomavirus vaccine (types 6, 11, 16, 18) (3 doses intramuscularly: second and third doses were administered 1 and 3 months after the first one). Each patient was analyzed for the effectiveness of preventive therapy according to the dynamics of indicators: colposcopy, cytology (Papanicolau staining), and molecular biological analysis (polymerase chain reaction). The indicators were evaluated after 12, 24, and 36 months. Statistical analysis of the results was carried out using IBM SPSS Statistics 26 (IBM, USA) variation statistics programs.Results. Vaccination with a quadrivalent recombinant vaccine against human papillomavirus of types 6, 11, 16, 18 against the background of correction of dysbiotic vaginal and cervical disorders in latent forms of papillomavirus infection in women was revealed to cause a 9.3-fold decrease (compared to the study group) in realization of latent persistence of viruses into subclinical (25.7 % in group I vs. 9.0 % in group II) and clinical forms of papillomavirus infection (cervical intraepithelial neoplasia) — 12.1 % in group I vs. 1.3 % in group II, to reduce the persistence of human papillomavirus and the appearance of their new genotypes, the viral load of highly oncogenic types of human papillomavirus (1.9 times —3.2 ± 2.4 geq/ml in group I versus 1.7 ± 2.1 geq/ml in group II).Conclusion. The trial has shown that human papillomavirus vaccination is associated with a reduced risk of realization of latent forms of papillomavirus infection into clinical forms as cervical intraepithelial neoplasia and, consequently, cervical cancer, thereby being considered promising for secondary prevention of this pathology.

Adherence to Secondary Prevention Measures after Acute Myocardial Infarction and Its Impact on Patient Outcome-A Nationwide Perspective.

Objectives: Secondary prevention is crucial for reducing morbidity and mortality in patients following acute myocardial infraction (MI). However, adherence to cardiac rehabilitation (CR) and pharmacotherapy remains suboptimal despite strong guideline recommendations. This study investigated the adherence to CR, dual antiplatelet therapy (DAPT), and statins following acute MI and evaluated their impact on patient outcomes from a nationwide perspective in Austria. Methods: In this national observational study, all patients diagnosed with acute MI, defined as STEMI or NSTEMI, between April 2011 and August 2015 in Austria were included. Patient characteristics and comorbidities were derived from the Austrian national health insurance system using ICD-10 codes. Adherence to CR, high-intensity statins, and DAPT was assessed based on health insurance records and pharmacy prescription submissions. Cox Regression hazard analysis was used to explore the impact of non-adherence to CR on mortality. Results: Among 16,518 acute MI patients, only 13.4% adhered to the recommended CR programs, which was associated with a significantly lower risk of mortality (adjusted hazard ratio [HR] 0.73; 95% CI: 0.54-0.98; p = 0.036). In contrast, 66.4% of 23,240 patients did not comply with high-intensity statin therapy, correlating with an increased mortality risk (adjusted HR 1.16; 95% CI: 1.06-1.25; p < 0.001). Furthermore, among 22,331 patients analyzed for DAPT adherence, only 29.3% followed the guidelines, yet this adherence was linked to a 21% reduction in mortality over the observation period (adjusted HR 0.79; 95% CI: 0.72-0.88; p < 0.001). Conclusions: This nationwide study reveals alarmingly low adherence to CR and secondary preventive medications among acute MI patients, which is significantly linked to higher mortality rates. Enhanced efforts to promote awareness and adherence are crucial, involving structured referrals and personalized follow-ups to improve patient outcomes. Addressing these gaps through comprehensive healthcare strategies could substantially enhance cardiovascular health.

Advances in Cardiac Telerehabilitation for Older Adults in the Digital Age: A Narrative Review

Abstract The population of older adults is growing worldwide, and cardiovascular disease (CVD) remains their leading cause of death. Cardiac rehabilitation (CR) is an effective secondary prevention measure that has been shown to improve quality of life and exercise function, along with reducing recurrence, rehospitalization, and disability risks among older adults. However, CR participation rates are very low, at &lt;50% of CVD patients, due to transportation issues, travel costs, and long distances to rehabilitation centers, among numerous other reasons. Recently, a novel CR model, cardiac telerehabilitation (CTR), has been suggested to address many of the barriers otherwise encountered in implementing traditional center-based CR (CBCR) programs and subsequently increasing patient participation rates. CTR is a part of telemedicine, involving the provision of personalized telehealth services via wireless devices, such as smartphones, wearables, and video consultations, which can remotely monitor patients and provide objective feedback to those unable or unwilling to participate in traditional CBCR. This article reviews CTR importance, safety, efficacy, cost-effectiveness, and implementation to draw attention to such programs for older adults, enhance secondary prevention, and provide a reference basis for future users.

Epidemiology and control of monkeypox outbreak in Houston, Texas

BackgroundIn the 2022–2023 global outbreak, the United States and state of Texas recorded a total of 31,277 and 3,085 confirmed monkeypox (Mpox) cases respectively as of November 2023. This study aims to investigate the demographic characteristics and risk factors of Mpox outbreak in Houston and document the epidemiologic control measures implemented with their outcomes. MethodsHouston Health Department received reports of suspected Mpox cases via electronic case reports and laboratory reports from healthcare providers within Houston. These were then investigated and reclassified as either positive or negative using DNA polymerase chain reaction tests. All the reported cases received between May 2022 and January 2023 were included in this study using convenient sampling methods. Descriptive statistics using frequency distribution was used to analyze the sociodemographic, clinical features and travel history of the cases. A two-sided Chi-squared test was used to determine association between Mpox test results and risk factors with significant level set at P < 0.05. Other infection control measures such as community engagement, health education, tracking and contact tracing, vaccination, referrals and laboratory sample logistics support were implemented by the health department. ResultsOut of the total of 1,625 suspected persons investigated for Mpox, 724 (44.6%) tested positive. Among the 724 confirmed cases, male was 700 (96.7%), females 20 (2.8%), transgender male 1 (0.1%), transgender female 3 (0.4%). Age groups 30–39 years constituted 43.6%, 18–29 years 27.4%, 40–49 years 18.2%, 50–59 years was 8%. Race distribution of positive cases was Whites 43.4%, African American 38.7%, Asian 1.4%. Risk factors with P < 0.05 included male gender, age groups 30–39 years and 40–49 years, travel history to Mpox endemic areas, recent sexual contact with known or suspected Mpox cases, human immunodeficiency virus seropositivity. Identifying as gay and bisexual were also statistically significant risk factors for Mpox infection. ConclusionThe timely implementation of primary and secondary prevention measures targeted at the most at-risk populations was very effective at curtailing the spread of Mpox infection within the city of Houston.

Years of potential life lost due to hepatitis B with or without Delta agent in the Kyrgyz Republic

Recent studies indicate that a marked percentage of chronic viral hepatitis B patients is coinfected with hepatitis D virus known to accelerate the progression of liver disease and contribute to unfavourable disease outcome. Data on premature mortality assessed by the Lost Years of Potential Life (LYPL) indicator, provide the most accurate social burden estimate for such coinfection able to contribute to strengthening viral hepatitis control measures. The aim of the study was to conducting comparative LYPL analyses due to acute and chronic hepatitis B infection without and with delta agent in the Kyrgyz Republic in the years 2014–2018. Materials and methods. LYPL magnitude was calculated using the number of recorded deaths in the reporting form of the 2014–2018 National Statistics Committee «C51-Distribution of deaths by sex, age groups and causes of death». Results. In 2014–2018, 145 cases of death of patients with viral hepatitis B without (HB) and with a delta agent (D) were registered in the Kyrgyz Republic. Of these, 66% (96/145) of patients died from hepatitis B, of which a third (32/96) had an acute disease course. And among those who died from hepatitis D (19/49), acute course was registered in 39%. LYPL for the 145 deceased patients totaled 3766 years, of which 63% (2365 years) were due to HB. Despite that only 35% of patients (51/145) died from acute forms of such hepatitides, their LYPL accounted for 52% (1968) of total years lost that decreased by 4.5-fold for 2014–2018 due to AHB (6.3‰ and 1.41‰, 2014 and 2018, respectively) but increased by 1.1-fold due to AHD (2.7‰ and 3.1‰, 2014 and 2018, respectively). Chronic hepatitis B vs CHD resulted in 1.6 times higher LYPL magnitude (1108 and 691, respectively). At the same time, LYPL due to CHB dynamically increased by 2.6 times, whereas due to CHD — by 6.3 times. Сonclusion. The high LYPL level due to hepatitis B and D infection related to pediatric cases evidence about a heavy burden of such diseases in the Kyrgyz Republic. The data obtained prove that it is necessary to increase adherence of adult population to hepatitis B vaccination and examine children at the site of infection, regardless of vaccination history. Abruptly increased LYPL due to chronic hepatitis cases requires strengthening secondary prevention measures and ensuring timely access to specialized care at infection sites. It is also necessary to evaluate epidemiological surveillance after fatal viral hepatitis.