European Prevention Research Articles

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

Stroke prevention in Europe: how are 11 European countries progressing toward the European Society of Cardiology (ESC) recommendations?

PurposeStroke is a leading cause of death and disability, although studies show that 90% of strokes can be prevented. The evidence base for stroke prevention is well established, and this study aimed to investigate how well European countries are adopting the European Society of Cardiology (ESC) guidelines, particularly toward implementation of the recommended best practice in stroke prevention.Materials and methodsWe developed a stroke prevention scorecard – populated with World Health Organization (WHO) data, secondary research, time-series data, and a survey of 550 physicians – to benchmark 11 European countries in the context of the ESC guidelines.ResultsAll countries were found to have policies in place to manage general behavioral risk factors of noncommunicable disease (NCD), but we found that more needs to be done to address cardiovascular disease – specifically, stroke risk factors. Although ten of the countries in this study endorse the ESC cardiovascular clinical guidelines, implementation is lacking. Eight out of the 11 countries received the lowest score in regard to raising awareness around stroke, and 7 countries were found not to have a stroke registry. Among physicians surveyed in primary care it was reported that less than 30% of patients over 40 years old were screened for blood pressure, whereas even fewer were screened for atrial fibrillation; in 10 out of the 11 countries, less than 20% of patients over 65 years old were screened for atrial fibrillation.ConclusionAlthough progress is being made in managing the burden of NCDs, our findings reveal opportunities for improvement in the primary prevention of stroke. Further developments in strategic planning, raising awareness, and monitoring disease are required, as is research on barriers to the implementation of best practice screening of blood pressure and atrial fibrillation in primary care.

Cancer prevention in Europe: how many cancers can be prevented?

Background In Europe, cancer is a major cause of illness and deaths. An estimated 3.4 million new cancer cases were diagnosed in 2012, and this is expected to continue rising to 4.1 in 2030 despite large expenditure being spent on early detection and cancer treatment. Here we sought to assess the potential in cancer prevention by estimating the avoidable numbers and proportions of 17 cancers amenable to prevention in Europe. Method We extracted data from the GLOBOCAN 2012 for cancers of the lip, oral cavity and pharynx, oesophagus, stomach, colorectum, liver, gallbladder, pancreas, larynx, lung, melanoma of skin, breast, cervix uteri, corpus uteri, ovary, kidney and renal pelvis, bladder, acute myeloid leukemia in 40 European countries. These cancers have shown convincing relation to six major cancer risk factors: smoking, alcohol, overweight, physical inactivity, unhealthy diet and solar ultraviolet. We assumed that the lowest observed rate to be attainable throughout Europe. The difference between the age- and gender-specific national cancer incidence rates and the lowest rate observed in 2012 was estimated and defined here as “potentially preventable”. Results 1.5 million cancers or 43% out of all cancers, which were almost equally distributed by sex (48% in males), were potentially preventable. Among men, the proportion was largest in Hungary (57%) and among women, in Denmark (59%). Despite large variation by countries and region, large proportion of preventable cancers was related to large proportion of cancers related to smoking and alcohol drinking (lung, head and neck and bladder cancers). Discussion The potential for cancer prevention in Europe is large; about 4 out of 10 cases could be potentially avoided. Interventions directed at reducing smoking and alcohol use as well as taking up other healthy lifestyle options are key to reduce the cancer burden in Europe.

An Estimate of Attributable Cases of Alzheimer Disease and Vascular Dementia due to Modifiable Risk Factors: The Impact of Primary Prevention in Europe and in Italy

Background: Up to 53.7% of all cases of dementia are assumed to be due to Alzheimer disease (AD), while 15.8% are considered to be due to vascular dementia (VaD). In Europe, about 3 million cases of AD could be due to 7 potentially modifiable risk factors: diabetes, midlife hypertension and/or obesity, physical inactivity, depression, smoking, and low educational level. Aims: To estimate the number of VaD cases in Europe and the number of AD and VaD cases in Italy attributable to these 7 potentially modifiable risk factors. Methods: Assuming the nonindependence of the 7 risk factors, the adjusted combined population attributable risk (PAR) was estimated for AD and VaD. Results: In Europe, adjusted combined PAR was 31.4% for AD and 37.8% for VaD. The total number of attributable cases was 3,033,000 for AD and 873,000 for VaD. In Italy, assuming a 20% reduction of the prevalence of each risk factor, adjusted combined PAR decreased from 45.2 to 38.9% for AD and from 53.1 to 46.6% for VaD, implying a 6.4 and 6.5% reduction in the prevalence of AD and VaD, respectively. Conclusion: A relevant reduction of AD and VaD cases in Europe and Italy could be obtained through primary prevention.

Facilitating Factors and Barriers to the Use of Emerging Technologies for Suicide Prevention in Europe: Multicountry Exploratory Study.

BackgroundThis study provides an analysis on the use of emerging technologies for the prevention of suicide in 8 different European countries.ObjectiveThe objective of this study was to analyze the potentiality of using emerging technologies in the area of suicide prevention based on the opinion of different professionals involved in suicide prevention.MethodsOpinions of 3 groups of stakeholders (ie, relevant professionals in suicide field) were gathered using a specifically designed questionnaire to explore dimensions underlying perceptions of facilitating factors and barriers in relation to the use of emerging technologies for suicide prevention.ResultsGoal 1 involved facilitating factors for the use of emerging technologies in suicide prevention. Northern European countries, except for Belgium, attach greater relevance to those that optimize implementation and benefits. On the other hand, Southern European countries attach greater importance to professionally oriented and user-centered facilitating factors. According to different stakeholders, the analysis of these facilitating factors suggest that professionals in the field of social work attach greater relevance to those that optimize implementation and benefits. However, professionals involved in the area of mental health, policy makers, and political decision makers give greater importance to professionally oriented and user-centered facilitating factors. Goal 2 was related to barriers to the usability of emerging technologies for suicide prevention. Both countries and stakeholders attach greater importance to barriers associated with resource constraints than to those centered on personal limitations. There are no differences between countries or between stakeholders. Nevertheless, there is a certain stakeholders-countries interaction that indicates that the opinions on resource constraints expressed by different stakeholders do not follow a uniform pattern in different countries, but they differ depending on the country.ConclusionsAlthough all countries and stakeholders agree in identifying resource constraints as the main barrier to the use of emerging technologies, factors facilitating their use in suicide prevention differ among countries and among stakeholders.

P629Undertreatment of female patients in lipid-lowering for secondary prevention in Europe, Canada, South Africa, Middle East and China: results of the Dyslipidemia International Study (DYSIS)

P629Undertreatment of female patients in lipid-lowering for secondary prevention in Europe, Canada, South Africa, Middle East and China: results of the Dyslipidemia International Study (DYSIS)

The Cost of Arbovirus Disease Prevention in Europe: Area-Wide Integrated Control of Tiger Mosquito, Aedes albopictus, in Emilia-Romagna, Northern Italy.

Aedes albopictus (tiger mosquito) has become the most invasive mosquito species worldwide, in addition to being a well-known vector of diseases, with a proven capacity for the transmission of chikungunya and dengue viruses in Europe as well as the Zika virus in Africa and in laboratory settings. This research quantifies the cost that needs to be provided by public-health systems for area-wide prevention of arboviruses in Europe. This cost has been calculated by evaluating the expenditure of the plan for Aedes albopictus control set up in the Emilia-Romagna region (Northern Italy) after a chikungunya outbreak occurred in 2007. This plan involves more than 280 municipalities with a total of 4.2 million inhabitants. Public expenditure for plan implementation in 2008–2011 was examined through simple descriptive statistics. Annual expenditure was calculated to be approximately €1.3 per inhabitant, with a declining trend (from a total of €7.6 million to €5.3 million) and a significant variability at the municipality level. The preventative measures in the plan included antilarval treatments (about 75% of total expenditure), education for citizens and in schools, entomological surveillance, and emergency actions for suspected viremias. Ecological factors and the relevance of tourism showed a correlation with the territorial variability in expenditure. The median cost of one antilarval treatment in public areas was approximately €0.12 per inhabitant. Organizational aspects were also analyzed to identify possible improvements in resource use.

Sustained diabetes risk reduction after real life and primary health care setting implementation of the diabetes in Europe prevention using lifestyle, physical activity and nutritional intervention (DE-PLAN) project

BackgroundReal life implementation studies performed in different settings and populations proved that lifestyle interventions in prevention of type 2 diabetes can be effective. However, little is known about long term results of these translational studies. Therefore, the purpose of this study was to examine the maintenance of diabetes type 2 risk factor reduction achieved 1 year after intervention and during 3 year follow-up in primary health care setting in Poland.MethodsStudy participants (n = 262), middle aged, slightly obese, with increased type 2 diabetes risk ((age 55.5 (SD = 11.3), BMI 32 (SD = 4.8), Finnish Diabetes Risk Score FINDRISC 18.4 (SD = 2.9)) but no diabetes at baseline, were invited for 1 individual and 10 group lifestyle counselling sessions as well as received 6 motivational phone calls and 2 letters followed by organized physical activity sessions combined with counselling to increase physical activity.Measurements were performed at baseline and then repeated 1 and 3 years after the initiation of the intervention.ResultsOne hundred five participants completed all 3 examinations (baseline age 56.6 (SD = 10.7)), BMI 31.1 (SD = 4.9)), FINDRISC 18.57 (SD = 3.09)). Males comprised 13% of the group, 10% of the patients presented impaired fasting glucose (IFG) and 14% impaired glucose tolerance (IGT). Mean weight of participants decreased by 2.27 kg (SD = 5.25) after 1 year (p = <0.001). After 3 years a weight gain by 1.13 kg (SD = 4.6) (p = 0.04) was observed. In comparison with baseline however, the mean total weight loss at the end of the study was maintained by 1.14 kg (SD = 5.8) (ns). Diabetes risk (FINDRISC) declined after one year by 2.8 (SD = 3.6) (p = 0.001) and the decrease by 2.26 (SD = 4.27) was maintained after 3 years (p = 0.001). Body mass reduction by >5% was achieved after 1 and 3 years by 27 and 19% of the participants, respectively.Repeated measures analysis revealed significant changes observed from baseline to year 1 and year 3 in: weight (p = 0.048), BMI (p = 0.001), total cholesterol (p = 0.013), TG (p = 0.061), fasting glucose level (p = 0.037) and FINDRISC (p = 0.001) parameters. The conversion rate to diabetes was 2% after 1 year and 7% after 3 years.ConclusionsType 2 diabetes prevention in real life primary health care setting through lifestyle intervention delivered by trained nurses leads to modest weight reduction, favorable cardiovascular risk factors changes and decrease of diabetes risk. These beneficial outcomes can be maintained at a 3-year follow-up.Trial registrationISRCTN, ID ISRCTN96692060, registered 03.08.2016 retrospectively

Lack of control of hypertension in primary cardiovascular disease prevention in Europe: Results from the EURIKA study

BackgroundThe prevalence of and factors associated with uncontrolled hypertension and apparent resistant hypertension were assessed in the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA; NCT00882336). MethodsEURIKA was a cross-sectional observational study including patients being treated for the primary prevention of cardiovascular disease in 12 European countries. Patients were assessed if they were being treated for hypertension (N=5220). Blood pressure control was defined according to European guidelines, with sensitivity analysis taking account of patients' age and diabetes status. Associated factors were assessed using multivariate analysis. ResultsIn the primary analysis, a total of 2691 patients (51.6%) had uncontrolled hypertension. Factors significantly associated with an increased risk of having uncontrolled hypertension included female sex (odds ratio [OR]: 2.29; 95% confidence interval [CI]: 1.93–2.73), body mass index (BMI; OR per kg/m2: 1.03; 95% CI: 1.01–1.04), and geographic location. A total of 749 patients (14.3%) had apparent resistant hypertension. Factors significantly associated with an increased risk of having apparent resistant hypertension included BMI (OR per kg/m2: 1.06; 95% CI: 1.04–1.08), diabetes (OR: 1.28; 95% CI: 1.06–1.53), use of statins (OR: 1.36; 95% CI: 1.15–1.62), serum uric acid levels (OR: 1.16; 95% CI: 1.09–1.23), and geographic location. Similar results were seen in sensitivity analyses. ConclusionsOver 50% of patients treated for hypertension continued to have uncontrolled blood pressure and 14.3% had apparent resistant hypertension. Positive associations were seen with other cardiovascular risk factors.

Eurobarometer: an effective tool for tobacco prevention in Europe

Eurobarometer: an effective tool for tobacco prevention in Europe

Maintenance of risk reduction during 3-year follow up in prevention of type 2 diabetes by lifestyle intervention in primary health care setting: Diabetes in Europe Prevention using Lifestyle, physical Activity and Nutritional intervention (DE-PLAN) project

Maintenance of risk reduction during 3-year follow up in prevention of type 2 diabetes by lifestyle intervention in primary health care setting: Diabetes in Europe Prevention using Lifestyle, physical Activity and Nutritional intervention (DE-PLAN) project

The Policy Context of Depression and Suicide Prevention in Europe. Results of the Joint Action Situation Analysis

Fight against depression and suicide in Europe: evidence-based tools partly utilised. Results of JA situation analysis Gyorgy Purebl, Tamas Kurimay Semmelweis University of Medicine, Budapest, Hungary Introduction According to the WHO GBD Study depression will be the second most frequent cause of disability by 2020. Although many activities and research have been done against depression, and devidence-based therapies are also available, depression remains a top health concern with increasing significance. Aims Joint Action of Mental Health and Well-being Workpackage 4 aims to develop a framework for action at the level of policies, infrastructures and interventions for prevention and treatment of depression and suicide. The first step is the data collection about the best practices in the participating countries. Method Comprehensive assessment was conducted for evaluating the utilisation of evidence-based tools: 1.) systematic review of scientific publications and policy documents in the field, 2.) assessment of best practices 3.) situation analysis in national frameworks. The evaluation do not focus only to scientific and clinical excellence but also management and activity on policy level. Data collection is conducted with the help of the JA WP4's key stakeholders. Results The preliminary data of the evaluation revealed that although many evidence-based tools are available, there are considerable differences in their utilisation, and many of them are not enacted into a policy context in the different participating countries. The final data will be presented in more details. Conclusion Although combating depression and suicide is a significant need in public health, evidence-based tools are partly exploited in the practice. In the next phase of JA an action framework will be developed, for tackling the obstacles of dissemination of evidence-based practices in Europe, with the invocation of policy context.

Low rates of both lipid-lowering therapy use and achievement of low-density lipoprotein cholesterol targets in individuals at high-risk for cardiovascular disease across Europe.

AimsTo analyse the treatment and control of dyslipidaemia in patients at high and very high cardiovascular risk being treated for the primary prevention of cardiovascular disease (CVD) in Europe.Methods and ResultsData were assessed from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA, ClinicalTrials.gov identifier: NCT00882336), which included a randomly sampled population of primary CVD prevention patients from 12 European countries (n = 7641). Patients’ 10-year risk of CVD-related mortality was calculated using the Systematic Coronary Risk Evaluation (SCORE) algorithm, identifying 5019 patients at high cardiovascular risk (SCORE ≥5% and/or receiving lipid-lowering therapy), and 2970 patients at very high cardiovascular risk (SCORE ≥10% or with diabetes mellitus). Among high-risk individuals, 65.3% were receiving lipid-lowering therapy, and 61.3% of treated patients had uncontrolled low-density lipoprotein cholesterol (LDL-C) levels (≥2.5 mmol/L). For very-high-risk patients (uncontrolled LDL-C levels defined as ≥1.8 mmol/L) these figures were 49.5% and 82.9%, respectively. Excess 10-year risk of CVD-related mortality (according to SCORE) attributable to lack of control of dyslipidaemia was estimated to be 0.72% and 1.61% among high-risk and very-high-risk patients, respectively. Among high-risk individuals with uncontrolled LDL-C levels, only 8.7% were receiving a high-intensity statin (atorvastatin ≥40 mg/day or rosuvastatin ≥20 mg/day). Among very-high-risk patients, this figure was 8.4%.ConclusionsThere is a considerable opportunity for improvement in rates of lipid-lowering therapy use and achievement of lipid-level targets in high-risk and very-high-risk patients being treated for primary CVD prevention in Europe.

E17. The prevention of breast cancer

A highly effective and increasingly common approach to reducing the incidence of and mortality from heart disease and stroke is the use of preventive therapy in highrisk individuals. The use of statins in people with high cholesterol levels and anti-hypertensives in those with high blood pressure has helped to reduce the death rate from heart disease by more than half and that from strokes by more than two thirds [1]. Breast cancer is by far the commonest cancer in women, with an estimated 1.4 million new cases every year, and it is an ideal candidate in which to begin to utilise this strategy for cancer prevention. Two drugs, tamoxifen and raloxifene, are licensed for preventive therapy in the United States. Both have been shown to reduce incidence by approximately 40%, but in a head-to-head comparison tamoxifen was about 25% more effective [2]. However, as these drugs are now off patent there seems to be no direct way for them to be licensed for prevention in Europe, although the National Institute for Health and Care Excellence (NICE) has now recommended their use for high-risk women in the UK, and they can be prescribed off-label. More recently two other selective oestrogen receptor (ER) modifiers (SERMs), lasofoxifene and arzoxifene, have been investigated in large prevention trials in which the primary outcome was the prevention of fractures in osteoporotic women. Both appear to be at least as effective as tamoxifen in breast cancer risk reduction, but lasofoxifene also showed large reductions in heart disease and fracture rates [3], making it an ideal candidate for preventive therapy. All of these drugs have recently been evaluated with extended follow-up in an individual patient overview [4]. The result shows a 55% reduction in ERpositive cancer in the 5 years of active treatment, but also a 42% reduction in the next 5 years, as a result of “carryover” benefits after treatment cessation (Figures 1 and 2). An important unanswered question is the duration of the carryover effect, as this enhances the benefits; however, side effects largely do not show a carryover, leading to a larger benefit/harm ratio. On the other hand, no reduction in ER-negative tumours has occurred, and in fact a marginally increased (14%, P = 0.09) incidence was seen (Figure 3). This may reflect tumours which would have appeared earlier as ER-positive tumours in the absence of treat

O192 Clinical reality of coronary prevention in Europe: A comparison of EUROASPIRE II, III and IV surveys

O192 Clinical reality of coronary prevention in Europe: A comparison of EUROASPIRE II, III and IV surveys

日本で望まれる機械安全に関する法規制及び社会制度の考察

An advantage of Japan is that high-quality safety management and production technologies have been implemented at worksites by workers, managers and production engineers. If European technologies and social systems for safety of machinery are appropriately implemented on the basis of these capabilities, a new technology and social system framework based on Japan's own onsite capabilities may be created. This study examined the laws, regulations, and social systems that are favorable for safety of machinery in Japan. In maximizing onsite capabilities for safety management, the following four activities were presumed important: (1) the positioning of safety as an investment for new value creation, not a cost; (2) the sharing of a strong sense of ownership and common values for building a safe workplace among involved individuals; (3) the changes in strategies from prevention of recurrence to proactive prevention and from considering the number of accidents to considering the severity of accident; and (4) the consideration of unexpected problems. In addition to the aforementioned activities, the basic principles of machine safety and accident prevention in Europe were considered particularly important for spreading and promotion among corporate executives and machine designers. These principles are the (1) risk reduction strategies provided by the International Organization for Standardization (ISO 12100); (2) conformity assessments that use a modular approach and marking aimed at conveying information about declarations of conformity; (3) validity confirmation when using a machine based on marking information; and (4) feedback regarding disaster information for the design and manufacturing stages of a machine. Language: ja

Priorities and challenges for skin cancer prevention in Europe

The incidence, mortality, and survival rates of melanoma vary significantly across Europe, likely related to persistent inequalities between European countries in the areas of skin cancer early detection, case registration, and prevention. To enhance the planning of prevention strategies for skin cancer in Europe, we solicited the direct opinion of European experts in the field of dermato-oncology on the main obstacles, needs, and priorities for the reduction of the skin cancer burden on this continent. We surveyed European dermatologists with leading positions in European and international organizations active in skin cancer prevention by means of written, single-choice and multiple-choice questionnaires. Fifty-two dermatologists from 32 European countries completed the survey (response rate 80%). Fewer respondents in Eastern Europe compared with Western Europe reported the presence of governmental (12 vs. 46%) or nongovernmental (35 vs. 65%) initiatives for skin cancer prevention. Most respondents in Eastern (73%) and Western Europe (69%) reported the existence of national cancer registries, but the confidence in the accuracy of melanoma registration was low. Public and professional education for early detection were top priorities for skin cancer campaigns across Europe and the perceived obstacles were similar in both regions: the lack of a national program of public education, insufficient public authority initiatives, and insufficient training of physicians on skin cancer. Our survey highlighted several areas requiring intervention for skin cancer prevention and found that the main issues and obstacles appear to be similar across Europe, creating the premise for coordinated, pan-European action.

Cancer prevention in Europe

In the coming years, European death rates because of cancer will further decline, but the overall number of cases will increase, mostly as a consequence of the ageing of the population. The target for cancer prevention in Europe will remain a healthy diet and control of obesity in addition to a decrease in smoking. A healthy diet model in European countries is the traditional Mediterranean diet, which is based on abundant and variable plant foods, high consumption of cereals, olive oil as the main (added) fat, low intake of (red) meat and moderate consumption of wine. The Mediterranean diet is associated with a reduced risk of cardiovascular disease and cancer. The biological mechanisms for cancer prevention associated with the Mediterranean diet have been related to the favourable effect of a balanced ratio of omega 6 and omega 3 essential fatty acids and high amounts of fibre, antioxidants and polyphenols found in fruit, vegetables, olive oil and wine. The Mediterranean diet also involves a 'Mediterranean way of drinking', that is, regular, moderate consumption of wine mainly with food. This pattern of drinking increases longevity, reduces the risk of cardiovascular disease and does not appreciably influence the overall risk of cancer. However, heavy alcohol drinking is associated with digestive, upper respiratory tract, liver and breast cancers; therefore, avoidance or restriction of alcohol consumption to two drinks/day in men and one drink/day in women is a global public health priority.

Harmonizing evidence based infection prevention in Europe

Harmonizing evidence based infection prevention in Europe

The Future of Research on Evidence-based Developmental Violence Prevention in Europe – Introduction to the Focus Section

Across Europe, there is an increasing demand for good evidence that can inform policies aimed at reducing violence against and among children and adolescents. However, there is still a paucity of high-quality research on effective prevention of bullying and violence, and researchers from different parts of Europe rarely discuss their findings. The focus section of this issue of the International Journal of Conflict and Violence brings together work by prominent prevention scholars from across Europe, who show that significant progress is being made. The introduction presents nine recommendations about how prevention research could be further strengthened in Europe.