European Prevention Research Articles

‘Social defence’ and the resilience of the domestic war on terror: A genealogy of social security, national security, and defence

Abstract Russia’s invasion of Ukraine has moved attention within International Security back to Great Power Politics and interstate war, and away from phenomena like ‘foreign terrorist fighters’ and lone actor terrorism. Is the War on Terror paradigm receding? This paper argues that counter-radicalisation imaginaries and counter-extremism programming will all remain stubbornly present despite the shift back to interstate war. The resilience of domestic War on Terror policies will stem from their integration within local municipality activity and social policy during the second decade of the 21st century. These policy areas and levels are detached from the international security community, meaning that shifts in attention at the global level will have little effect upon localised national security practices. The paper then interrogates how counterterrorism agendas have so successfully entered the world of social policy and local public administration, using genealogical methods to trace how social security and crime prevention were historically prefaced upon defence. The paper traces the policy paradigm of ‘social defence’ which dominated mid-20th century international organisations, targeting non-criminal juveniles with pre-emptive interventions to prevent ‘dangerous persons’ imperilling society. Effectively, this untold history of crime prevention in Europe demonstrates the profound interlocking of national security, social policy and defence across the 20th century, with implications for the resilience of this triad.

Joining forces to accelerate cancer and NCD prevention in Europe

Abstract JA PreventNCD, a Joint Action to prevent cancer and other non-communicable diseases (NCDs) aims to assist authorities in prioritizing the most effective prevention strategies and policies to reduce the burden of cancer and NCDs, focusing on both personal and societal risk factors. A key objective is to tackle social inequalities by addressing the root causes of NCD risk factors and adopting a life-course approach. Recognizing that health is created by policies in several sectors is key when addressing health determinants, including social and commercial determinants of health. Consolidated efforts across countries will be required to tackle some of these determinants. To achieve the project’s objectives, the JA PreventNCD will build a comprehensive European infrastructure for monitoring risk factors, disease burden, and the impact of policies and interventions. Rigorous evaluation will ensure that the project’s deliverables will have an impact at local, national and EU levels. Three technical work packages address common risk factors for NCDs through actions ranging from policies and structural measures at societal level to interventions targeting individuals. Another set of cross-cutting work packages address monitoring, social inequalities, and health in all policies. More than 100 partners across 25 countries are involved, with almost 100 pilots to be conducted over the course of the project’s four years. One way of ensuring sustainability of the project’s outcomes is the building of a sustainable governance structure through the establishment of an EU Consortium on Cancer Prevention. Furthermore, as a mechanism to ensure high policy relevance of this JA, a Policy Decision Maker’s Forum will be established to engage policymakers and ensure feasibility of the project’s recommended actions. Speakers/Panelists Claudia Habl Austrian National Public Health Institute, Vienna, Austria Ane Fullaondo Biosistemak, Bilbao, Spain Arnfinn Helleve Norwegian Institute of Public Health, Oslo, Norway

The state-of-the-art and barriers for the adoption of personalised prevention in Europe and beyond

Abstract Personalized prevention is a priority of the European Commission’s research agenda, exemplified by the EU-funded project ‘a PeRsonalised Prevention roadmap for the future HEalThcare’ (PROPHET), a coordination and support action of the International Consortium for Personalized Medicine. It aims to bolster health systems in implementing innovative, sustainable, and high-quality personalized strategies to prevent chronic diseases. In this context, a scoping review was conducted to map personalized preventive approaches (PPA) for chronic diseases and obstacles to their adoption worldwide. The review followed the Arksey-O’Malley guidelines and was conducted from January 2017 to December 2023, on PubMed, Web of Science, Scopus, and grey literature. Eligible studies were primary reports and guidelines, while for the barriers to their adoption we included literature reviews. We included 120 documents on approaches and 34 reviews on barriers. Among the former, 251 PPA were identified: 69% on cancer, 21% on cardiovascular diseases, and 10% on neurological, psychiatric, and metabolic diseases. Furthermore, 27% were on primary prevention, using omic biomarkers to predict disease risk and guide preventive strategies; 27% on secondary prevention, using genomics to guide screening programs; 46% on tertiary prevention, using pharmacogenomics or targeted therapies to prevent disease complications. Among the 34 reviews on barriers, the majority were about the lack of clinical utility evidence and research needs, ethical and legal issues, and limited knowledge among health professionals, citizens, and patients. The majority of the barriers (76%) were referred to primary and secondary prevention, consistent with the low rates of existing approaches in these areas. Ongoing efforts show promise for tailoring prevention strategies, but further research and integration are needed to maximize their potential in improving population health and reducing chronic disease burdens on health systems.

How co-production can help cancer prevention among people experiencing homelessness: The CANCERLESS experience.

Introduction: People experiencing homelessness (PEH) face many barriers accessing to public services, but patient Navigation (PN) is associated with improvements in a range of health outcomes, including timely access to healthcare for them (Carmichael et al., 2022).
 Target Population: Health and social care professionals and individuals with lived experience of homelessness from Austria, Greece, Spain, and the United Kingdom.
 Population involvement: A series of co-adaptation focus group discussions were conducted with health and social care professionals and individuals with lived experience of homelessness aiming at co-adapting and informing the PN for cancer prevention in Europe.
 Methodology: Focus group discussions were held in field settings and/or online via videoconferencing platforms in four countries (Austria, Greece, Spain, and the U.K.) during December 2021 and January 2022, and were facilitated by a multidisciplinary team of researchers. A total of seven focus group discussions were conducted, with an overall sample size of 56 participants comprising 41 professional key informants and 15 persons currently experiencing homelessness. A structured topic schedule was used to guide the discussion, and to ensure consistency in the cross-national data collection. Focus group discussions were audio-recorded and transcribed verbatim in their respective languages, either manually or using appropriate software. In the first stage of analysis, researchers adopted an inductive thematic approach. Informed by this analytical process, each of the four partner countries then produced a summary of their focus group discussion(s) with the key decisions, outcomes, and themes organised according to this framework.
 Results: The core components of PN programmes for cancer prevention among PEH agreed cross-nationally with all the relevant key participants are (1) Promote cancer awareness and self-management (Facilitate the delivery of cancer education; Promote healthy behaviours and preventative measures; Encourage user involvement in health-related decisions), (2) Identify health needs and barriers (Develop a personalised approach to assessing user need; Seek solutions regarding barriers to care), (3) Co-ordinate access to care (Develop trusting relationships with and facilitate communication between local health and social care providers; Enhance understanding of the needs of PEH among local health and social care providers; Arrange referrals to healthcare services and cancer screening; Co-ordinate and support attendance of appointments), (4) Offer practical assistance (Arrange transportation, mobile phones, clothing, access to hygiene facilities, and storage of medication; Assist with completion of paperwork).
 Lessons learned: Results from the discussions indicate a high level of consistency and cross-national agreement about what the core components of the intervention should be, and how this should be designed and implemented.
 Next Steps: This intervention will be adapted to reflect the country-specifics, to ensure that the PN is appropriate to the four local contexts in which it is piloted.
 
 Bibliography
 Carmichael, C., Smith, L., Aldasoro, E., Gil-Salmerón, A., Alhambra-Borrás, T., Doñate-Martínez, A.,
 Seiler-Ramadas, R. & Grabovac, I. (2022) Exploring the application of the navigation model with
 people experiencing homelessness: a scoping review, Journal of Social Distress and Homelessness. DOI:
 10.1080/10530789.2021.2021363

10.K. Workshop: Evaluating the effectiveness of health promotion and prevention

Abstract The discussion about evidence and the ‘right’ form of evaluation for assessing effectiveness in the field of health promotion and prevention continues to be controversial in the relevant literature. Randomised controlled trials analogous to evidence-based medicine as the ‘gold standard’ of effectiveness research are often rejected as inappropriate for the evaluation of health promotion and prevention interventions because they would not do justice to the complexity of the interventions. In the search for alternatives, system-theoretical approaches for dealing with complexity are reflected. The evaluation of effects moves in the field of tension between simplicity and complexity, which is difficult to map. In the application of impact models, the use of a generic framework model, which roughly represents the intervention logic (‘theory of change’) is recommended. An important implication of evaluating interventions in the field of health promotion and prevention is that effects can not only be measured in numerical ways. To address this, approaches are needed to evaluate interventions also with qualitative research and mixed methods. In order to disseminate evidence-based practices which have been evaluated, evaluation criteria are needed to determine the degree of effectiveness, evidence, and practical applicability. The organisers will share their experiences and perspectives of different methods for evaluating the effectiveness of health promotion and prevention, and discuss the advantages and challenges of approaches with the workshop participants. Three countries (the Netherlands, Finland and Germany) will present different approaches resp. aspects of evaluating health promotion and prevention measures. The different contributions will be discussed and the participants will be invited to share their experiences and successes. With the objective to: • Illustrate the role of health literacy in the evaluation of health promotion and prevention interventions (Germany) • Present a checklist for qualitative research and mixed methods, criteria for an assessment system of interventions as well as first results of the pilot study (Netherlands) • Present the evaluation criteria of evidence-based practices to be selected for the national best practice portal (Finland) • Reflect and discuss the different aspects of evaluation to contribute to a better understanding and implementation of methods to ensure effectiveness in the complex contexts. Key messages • To give insight into new attempts of evaluating effectiveness of health promotion and prevention in Europe. • To reflect and discuss advantages and disadvantages of the different evaluation approaches.

The Association of Cardiovascular Risk Factors and Depression of an adult Austrian Population

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): “Austrian Research Fund (COMET K-project No. 825329)” Introduction Depression has been recognized as a cardiovascular (CVD) risk factor. However, depression is often under-recognized and larger attention should be given to this frequent problem, also in relation to CVD sequelae. There are differences in prevalence of CVD risk factors and CVD care and prevention in Europe. Therefore, it is vital to identify the focus of CVD prevention to implement specific and country-based programs to reduce CVD burden, especially for people with depression. Purpose The aim of this study is to investigate the association between common CVD risk factors hypertension, body mass index (BMI), and smoking with the severity of depression in an adult Austrian population and to characterize sex-related differences. Method This current thesis is a cross-sectional study examining the baseline data of the population from the BioPersMed (Biomarkers of Personalized Medicine) cohort at our Medical University. The initial non-probability recruitment started between 2011 and 2015, resulting in a study population of 1,022 adult men and women who live in the greater Graz area. Three CVD risk factors were examined for this paper and assessed by trained doctors and nurses at baseline: self-reported diagnosis of hypertension, self-reported smoking status, and BMI (kg/m2) by measuring the height and weight of each participant. The PHQ-9 (Patient Health Questionnaire) was analyzed by recording the total score value in three groups. Descriptive statistics, statistical correlation analysis, and an ordinal regression analysis was performed. Results 977 participants were included in the data analysis, with a mean age of 57.3 years. More than half of the participants (56%) were female. Results show a significant association between hypertension and the severity of depression (p<0.01) and between males and all three CVD risk factors, and between females and overweight. People with hypertension and elevated BMI, adjusted for age, sex, diagnosis of depression, and smoking were more likely to fall into a higher level of depression (BMI: increase of 0.033 in the log odds, p<0.5; hypertension: increase of 0.339 in the log odds, p<0.01). Moreover, men were more likely to show a lower level of depression than women (decrease of 0.435 in the log odds, p<0.5). Conclusion This is the first cross-sectional study to examine the association between CVD risk factors and the severity of depression in an adult Austrian population. Further research for causality and longitudinal analyses in a larger sample size are recommended to thoroughly examine and confirm these findings. The results are an important indication for CVD prevention programs in Austria to incorporate specific screening (CVD and Depression) and management of cardiovascular risk factors in their protocols and readapt them according to depression severity.

Practical Decision Algorithms for the Use of the Cardiovascular Polypill in Secondary Prevention in Europe.

The main objective of cardiovascular disease (CVD) prevention is to reduce morbidity and mortality. Despite recommendations on evidence-based pharmacological treatment and lifestyle changes, the control of CV risk factors such as hypertension or dyslipidaemia is not optimal. The use of a CV polypill, including guideline-recommended drugs, as a baseline therapy, may contribute to improving risk factors control either by improving the treatment adherence or by the synergistic effect of its components. The CNIC-Polypill is the first CV polypill approved in Europe as an effective strategy for secondary prevention, which contains acetylsalicylic acid, atorvastatin (in two optional doses), and ramipril (in three optional doses) in a single pill. The present practical clinical document aims to provide a guide for patient management after an acute coronary syndrome (ACS) or with chronic CVD (CCVD) with a strategy based on the CNIC-Polypill, also considering the need to add other therapies for a personalized treatment. The most suitable clinical scenarios for the CNIC-Polypill use are discussed: (a) in patients after an ACS at discharge, (b) in patients with CCVD (chronic coronary syndrome, stroke, or peripheral artery disease) with uncontrolled low-density lipoprotein cholesterol (LDL-c) and/or blood pressure levels and (c) in patients with CCVD with well-controlled risk factors to simplify treatment and reduce polypharmacy in the context of CCVD prevention.

Cryptocurrencies and Fraudulent Transactions: Risks, Practices, and Legislation for Their Prevention in Europe and Spain

Cryptocurrencies have been developing very rapidly in recent years, and their use is becoming more and more widespread in different areas. The use of digital currencies for legal uses is advancing along with technological development, but, at the same time, criminal activities are also emerging to take advantage of this boom. The aim of this paper has been, first, to analyze the various ways in which individuals and criminal organizations have taken advantage of the phenomenon of cryptocurrencies to carry out fraudulent activities such as laundering money of illicit origin and, second, to provide an overview of the legal tools that have been developed in this regard in Europe and, more specifically, in Spain to combat these activities. Undoubtedly, cryptocurrencies bring great benefits to the economy, but it is also necessary to know the risks and abuses that have been developed to prevent them.

Kinetic health: ecologies and mobilities of prevention in Europe, c. 1100-1600

ABSTRACT This article coins and deploys the term kinetic health as part of a broader attempt to historicize the mobilities paradigm from the standpoint of past community prophylactics. It uses the example of Galenic or humoral medicine, which for millennia organized individual and group health as a dynamic systems balance among several spheres of intersecting fixities and flows. The radical situatedness it fostered emerges clearly from tracing preventative health interventions among different communities in ‘preindustrial’ Europe, including urban dwellers, miners and armies, whose different motilities both bound people to and released them from their immediate environment. Beyond reframing past practices, kinetic health benefits mobilities studies scholars by interrogating stagist narratives of civilization and modernization in two ways. First, as an analytic, because although humoralism and other medical systems continue to inform present-day approaches to health and disease around the globe, they are often obscured by layers of colonialism and biomedicine. And secondly, as a perch for viewing the long-term ebb, flow and mingling of ideas about ill/health as an assemblage of (social) bodies and their natural and social environments.

Are We Reversing the Trend in Waste Generation: Panel Data Analyses of Municipal Waste Generation in Regard to the Socio-Economic Factors in European Countries

The purpose of this research is to investigate whether there is a decline in the amounts of generated municipal waste that is influenced by the changes which cannot be attributed to the changes in the socio-economic variables and can therefore be ascribed to a changing behaviour and the effectiveness of the policies implemented with the aim of preventing generation of waste. The analyses in this paper cover the data of 30 European countries in the period 2002–2015. The method applied is the panel data analysis of the data on seven socio-economic variables by using both the fixed-effect and the random-effects models. The results of our research show that if we control the model for the socio-economic variables, a decline in the amounts of generated municipal waste can be observed in the period 2011–2015, indicating certain effectiveness of the implemented policies on waste prevention in Europe.

9.G. Workshop: Evaluation of scale-up of health systems interventions: what and how? Lessons for scale-up projects

Abstract Objectives Non-communicable diseases (NCD) are a major challenge for health systems across the globe. Although effective interventions for prevention, detection and control exist, these do not reach all people in need, especially the poor and most vulnerable. Scale-up strategies are developed to increase universal access to those interventions, addressing demand-side and supply-side barriers and to facilitate integration in the health system. While there are useful frameworks to conceptualise and operationalise scale-up of NCD interventions, there is a knowledge gap on what and how to evaluate. This session addresses that knowledge gap, presenting evaluation methods for scale-up from four large multi-country research projects. The objectives are: To increase knowledge on four dimensions of scale-up evaluation: 1) contextualisation of methods; 2) implementation evaluation; 3) cost-evaluation and 4) use of health information systemsTo present methods and results of implementation research on NCDs as an example for other chronic diseasesTo illustrate how contextualisation, implementation and evaluation varies across different stages of scale-upTo stimulate learning by experience through small-group discussion with session participants This workshop provides added value through the four coherent presentations combined with small group interactions on the same topics. It allows the audience to link the case study lessons to their own research and wider application. Format Four different elements of scale-up evaluation are addressed: 1) Contextualisation of evaluation methods from a common framework; 2) Implementation evaluation at operational level; 3) Cost-evaluation of NCD interventions; and 4) Large-scale evaluation through routine health information systems (HIS). Case studies from four large-scale Horizon2020 funded research projects in 14 countries in Europe, Africa and Asia will be presented, each case focusing on one dimension. Cross-cutting themes of adaptation and transferability of methods will also be addressed. After the presentations, there will be an interactive session to promote experience-based learning in small-group discussions. Presentations Self-Management Approach and Reciprocal Learning for Type 2 Diabetes (SMART2D)Scaling-up Packages of Interventions for cardiovascular disease prevention in Europe and Sub-Saharan Africa (SPICES)Scaling-Up NCD Interventions in South-East Asia (SUNI-SEA)The Scale-Up of Diabetes and Hypertension Care (SCUBY) The presentations will provide the introduction to subsequent small-table discussions, around the following questions: How to measure and monitor implementation and outcome of intervention scale-up?How to generate transferrable lessons from cross-country studies?How to conduct cross-setting evaluation of the effect and cost of NCD interventions? Key messages The global scale-up of NCD interventions calls for robust evaluation methods of effect, implementation and cost. Evaluation methods need to be fit to the country context and health information systems.

Scaling-up Packages of Interventions for cardiovascular disease prevention in Europe and Sub-Saharan Africa (SPICES) - implementation evaluation at operational level

Abstract SPICES focuses on the primary prevention of CVDs in vulnerable populations in Europe and Sub-Saharan Africa by raising awareness regarding CVD and its risk factors and by supporting lifestyle behaviour change in primary care and community settings. It is an implementation project employing a mixed methods evaluation approach. The RE-AIM QuEST and CFIR frameworks are used to guide the evaluation of impact on lifestyle and actual CVD risk and describe implementation barriers and explain how implementation context may influence translation to different settings. The presentation will focus on how these frameworks were used in practice and across settings.

Lifestyle Changes Observed among Adults Participating in a Family- and Community-Based Intervention for Diabetes Prevention in Europe: The 1st Year Results of the Feel4Diabetes-Study.

The Feel4Diabetes intervention was a school and community-based intervention aiming to promote healthy lifestyle and tackle obesity and obesity-related metabolic risk factors for the prevention of type 2 diabetes (T2D) among families at risk of developing this disease. The current study aims to present the results on lifestyle behaviors obtained from parents during the first year of the Feel4Diabetes intervention. This multicomponent intervention had a cluster randomized design and was implemented in Belgium, Bulgaria, Finland, Greece, Hungary and Spain over two years (2016–2018). Standardized protocols and procedures were used by the participating centers in all countries to collect data on parents’ lifestyle behaviors (diet, physical activity, sedentary behavior). The Feel4Diabetes intervention was registered at clinicaltrials.gov (registration number: NCT02393872). In total, 2110 high-risk parents participated in the baseline and 12-month follow-up examination measurements. Participants allocated to the intervention group reduced their daily consumption of sugary drinks (p = 0.037) and sweets (p = 0.031) and their daily screen time (p = 0.032), compared with the control group. In addition, participants in the intervention group in Greece and Spain increased their consumption of breakfast (p = 0.034) and fruits (p = 0.029), while in Belgium and Finland they increased their water intake (p = 0.024). These findings indicate that the first year of the Feel4Diabetes intervention resulted in the improvement of certain lifestyle behaviors in parents from high-risk families.

Preventing Harmful Internet Use-Related Addiction Problems in Europe: A Literature Review and Policy Options.

Internet use-related addiction problems are increasingly being recognized on a European scale due to international health organizations considering gaming addiction. In April 2013, the American Psychiatric Association recognized Internet Gaming Disorder in the fifth Diagnostic and Statistical Manual of Mental Disorders, and in April 2018, the World Health Organization included Gaming Disorder in the eleventh International Classification of Diseases. However, findings on these problems within this period are lacking in Europe, and a preventive approach is missing globally. A detailed critical literature review was conducted using PsycINFO and Web of Science in this five-year period. A total of 19 studies were reviewed and problems identified were: generalized Internet addiction and online gaming and gambling addictions across seven European countries (i.e., Spain, Germany, France, Italy, Greece, The Netherlands, and Denmark). The individuals with problematic use were found to be educated adolescents, usually young males with comorbid disorders, and gaming and gambling disorders were implicated in the most severe cases. Cognitive behavioral therapy was the main treatment, sometimes combined with a systemic approach for adolescents. Prevalence, high-risk populations, and factors contributing to these addiction problems are discussed, and a set of policy options are developed for this region. The implications for early detection, diagnosis, treatment, and prevention in Europe are considered.

Secular trends in the initiation of therapy in secondary fracture prevention in Europe: a multi-national cohort study including data from Denmark, Catalonia, and the United\xa0Kingdom

SummaryThis paper demonstrates a large post-fracture anti-osteoporosis treatment gap in the period 2005 to 2015. The gap was stable in Denmark at around 88–90%, increased in Catalonia from 80 to 88%, and started to increase in the UK towards the end of our study. Improved post-fracture care is needed.IntroductionPatients experiencing a fragility fracture are at high risk of subsequent fractures, particularly within the first 2 years after the fracture. Previous studies have demonstrated that only a small proportion of fracture patients initiate therapy with an anti-osteoporotic medication (AOM), despite the proven fracture risk reduction of such therapies. The aim of this paper is to evaluate the changes in this post-fracture treatment gap across three different countries from 2005 to 2015.MethodsThis analysis, which is part of a multinational cohort study, included men and women, aged 50 years or older, sustaining a first incident fragility fracture. Using routinely collected patient data from three administrative health databases covering Catalonia, Denmark, and the United Kingdom, we estimated the treatment gap as the proportion of patients not treated with AOM within 1 year of their first incident fracture.ResultsA total of 648,369 fracture patients were included. Mean age 70.2–78.9 years; 22.2–31.7% were men. In Denmark, the treatment gap was stable at approximately 88–90% throughout the 2005 to 2015 time period. In Catalonia, the treatment gap increased from 80 to 88%. In the UK, an initially decreasing treatment gap—though never smaller than 63%—was replaced by an increasing gap towards the end of our study. The gap was more pronounced in men than in women.ConclusionDespite repeated calls for improved secondary fracture prevention, an unacceptably large treatment gap remains, with time trends indicating that the problem may be getting worse in recent years.

Suicide Prevention in the European Region.

Although the majority of the world's suicides occur in Asia, suicide and self-harm are major concerns in Europe as well. Suicide accounts for 1.4% of the total number of deaths in Europe, with rates highest among those aged over 70 and also high among those aged 45-59 years. Europe accounts for six of the top ten countries with the highest suicide rates internationally. Although rates of suicide attempts and self-harm are not consistently recorded, evidence from hospital-based studies and school-based surveys highlight their extent and scale. Numerous countries in Europe have developed national suicide prevention strategies and action plans. Some of the suicide prevention activities in Belgium, Estonia, Finland, Scotland, France, Germany, Romania, Russia, Sweden, Ukraine, and Italy are summarized. In the chapter we also highlight novel suicide prevention projects funded by the EU which have advanced our understanding of suicide risk and have developed the evidence base for what works to prevent suicide. Examples include the European Alliance Against Depression (EAAD), Saving and Empowering Young Lives in Europe (SEYLE), Suicide Prevention Through Internet and Media Based Mental Health Promotion (SUPREME), and Reduction of Suicides and Trespasses on Railway Property (RESTRAIL). Future challenges and opportunities for suicide prevention in Europe are also discussed.

1489-P: Ten-Year Follow-Up of Diabetes Incidence in the DE-PLAN (Diabetes in Europe—Prevention Using Lifestyle, Physical Activity, and Nutritional Intervention) Project in Catalonia

To assess the long-term effectiveness of a pragmatic public healthcare strategy to prevent type 2 diabetes within primary care setting. In the extended follow-up of the DEPLANCAT project, we explored whether the originally-achieved risk reduction remains after discontinuation of active lifestyle intervention. Middle-aged men (n=184) and women (n=368) with Finnish Diabetes Risk Score (FINDRISC)>14 and/or prediabetes (WHO rules for fasting or 2-h glucose) were allocated not randomly but sequentially to standard care control (CG) or intensive lifestyle intervention (IG) group. After a median of 4.2 y of active intervention, participants who were still free of diabetes were further followed-up without any additional specific intervention for a median of 5.8 y (median total follow-up of 10.01 y) via computerized health-care records or direct personal contact with invitation to 2h-glucose retest. The primary outcome was the development of diabetes. During the active intervention, diabetes was diagnosed in 124 participants (22.5%): 63 (28.8%) in the CG and 61 (18.3%) in the IG. After 10 y, 27 people (4.9%) had died. Among the remaining 401 individuals, 34 diabetes diagnoses were traced using the health-care records. Additionally, among the 191 people (47.6%) who agreed to blood re-test (66 in the CG and 125 in the IG) 16 new cases were found. During the post-intervention follow-up the total number of new cases of diabetes was 16 in the CG and 34 in the IG. The absolute incidences of diabetes during the overall follow-up were 6.1 (95% CI 5.2-6.9) and 5.1 (4.4-5.8) per 100 person-years, respectively (p=0.019 log-rank). The corresponding HR was 0.59 (0.43-0.81) with a relative risk reduction of 16.6%. The NNT to prevent one case of diabetes was 10. Intensive lifestyle intervention in a primary care setting substantially reduces diabetes incidence among high-risk individuals. Risk reduction can persist for at least 10 years. Disclosure F. Barrio: None. B. Costa: None. F. Cos: None. J. Cabre: None. A. Martinez: None. S. Mestre: None. C. Castell: None. J. Lindstrom: None. Funding Institute of Health Carlos III, Spanish Ministry of Health and the European Regional Development Fund (PI14/00122, PI14/00124); La Marató de TV3 Foundation (73-201609.10); Spanish Diabetes Society; Department of Health, Generalitat de Catalunya; Pla Estratègic de Recerca i Innovació en Salut (SLT002/16/00045, SLT002/16/00154, SLT002/16/00093)

Cardiovascular Disease Prevention in Europe and Sub-Saharan Africa

Cardiovascular Disease Prevention in Europe and Sub-Saharan Africa

Cancer Prevention Europe.

The case for cancer prevention in Europe is the same as for all other parts of the world. The number of cancers is increasing, driven by demographic change and evolution in the exposure to risk factors, while the cost of treating patients is likewise spiralling. Estimations suggest that around 40% of cancers in Europe could be prevented if current understanding of risk and protective factors was translated into effective primary prevention, with further reductions in cancer incidence and mortality by screening, other approaches to early detection, and potentially medical prevention. However, the infrastructure for cancer prevention tends to be fragmented between and within different countries in Europe. This lack of a coordinated approach recently led to the foundation of Cancer Prevention Europe (Forman et al., 2018), a collaborative network with the main aims of strengthening cancer prevention in Europe by increasing awareness of the needs, the associated required resources and reducing inequalities in access to cancer prevention across Europe. This article showcases the need for strengthening cancer prevention and introduces the objectives of Cancer Prevention Europe and its foreseen future role in reducing the European cancer burden.

1.C. Round table: The Digital Transformation of health, care and prevention in Europe. EU and WHO action and Countries’ experiences

1.C. Round table: The Digital Transformation of health, care and prevention in Europe. EU and WHO action and Countries’ experiences