Primary Prevention Interventions Research Articles

Digital information materials on dementia-an exploratory content analysis

Adiagnosis of dementia places aheavy burden on those affected and their families. Often, difficult decisions must be made. Ideally, people with anew dementia diagnosis make informed decisions together with family members. Digital informational materials can be an important low-threshold resource for making informed decisions. They should provide comprehensive information about dementia, including both primary prevention (risk factors for the onset of dementia) and later treatment options. They should also cover precautionary measures that can make future decisions easier (e.g., advance directives, power of attorney). However, there is currently no comprehensive overview of the various online resources for dementia-related information. This study explores digital informational materials on dementia for different target groups in the German-speaking area using an innovative systematic search strategy. It examines how these materials are structured in terms of risk factors, treatment options, and decision support. This methodological approach is new, so it is described and discussed in detail. The results show that most materials are intended for people with dementia and their families. Treatment measures are often discussed without explaining the risk factors they are meant to address. There is little focus on preventive measures that could support decision-making. The unbalanced presentation could lead to certain measures being difficult to understand (for laypeople) or to misinterpretation of risk factors. Important implications are drawn from these findings.

Swiss national cardiac device registry: changing trends in pacemaker and ICD procedures over the last two decades

Abstract Background The Swiss National Device and Ablation Registry (SwissEPnet) provides a comprehensive database for cardiac pacemaker and ICD procedures. All Swiss centers performing device implantations are obliged to provide their data in this web-based platform. The purpose of this study was to provide an in-depth look at pacemaker and Implantable -defibrillator (ICD) statistics and changing trends over the course of the last 20 years. Methods and Results We analyzed the database of pacemaker and ICD procedures between January 1, 2003, and December 31, 2022. During the study period, a total of 124 458 pacemaker and cardiac resynchronization (CRT) procedures (mean age 77.7 years; 59.7% male) were performed in 73 centers while 29 133 ICDs and CRT-D procedures (mean age 63.63 years; 80.2 % male) were performed in 56 centers in Switzerland. While the number of pacemaker procedures doubled in 20 years and there has been a constant increase in the mean age of patients receiving a pacemaker, the number of ICD procedures has more than tripled and now plateaued with a mean age which remained stable over time. Throughout the study period, the main indications for de novo pacemaker implantations were AV block in 41.7% of patients, followed by sick sinus syndrome combined with tachy-bradycardia syndrome (29.6%) and atrial fibrillation (AF) with slow ventricular conduction (13.7%). The main indication for ICD implantation was primary preventive (66.7%). Since 2016 there has been a decline in primary preventive interventions. Fluoroscopy and procedure durations remained stable over time in pacemaker and ICD procedures. Newer technologies, such as leadless pacemakers and CRT procedures required more fluoroscopy time, but this has also decreased over time. While regular battery changes remained stable (80% in pacemakers, 68% in ICDs), the proportion of DDD and CRT upgrades has increased. The overall reintervention rate due to device-associated infections was 2.4% in pacemaker- and 2.8% in ICD procedures. Since 2013, there has been a steady increase in lead removals/extractions, which were performed mainly due to device-related infections, but also because of lead dysfunctions and worsening electrical parameters. Conclusions In the last 20 years, there was a pronounced increase in the number of pacemaker procedures and a marked increase in the number of ICD procedures which has plateaued now. In younger technologies there is decreasing trend in fluoroscopy time by stable procedure times. Overall, there is a constant increase in mean age of patients receiving a pacemaker, while the mean age of patients receiving an ICD did not change during follow up. Female patients are constantly younger and undergo ICD implantation significantly less often than men. Despite of a stable infection rate, there has been a significant increase in lead removal and extractions in Switzerland.

Kids SIPsmartER reduces sugar-sweetened beverages among Appalachian middle-school students and their caregivers: a cluster randomized controlled trial

BackgroundHigh consumption of sugar-sweetened beverages (SSB) is a global health concern. Additionally, sugar-sweetened beverage (SSB) consumption is disproportionately high among adolescents and adults in rural Appalachia. The primary study objective is to determine the intervention effects of Kids SIPsmartER on students’ SSB consumption. Secondary objectives focus on caregivers’ SSB consumption and secondary student and caregiver outcomes [e.g, body mass index (BMI), quality of life (QOL)].MethodsThis Type 1 hybrid, cluster randomized controlled trial includes 12 Appalachian middle schools (6 randomized to Kids SIPsmartER and 6 to control). Kids SIPsmartER is a 6-month, 12 lesson, multi-level, school-based, behavior and health literacy program aimed at reducing SSB among 7th grade middle school students. The program also incorporates a two-way text message strategy for caregivers. In this primary prevention intervention, all 7th grade students and their caregivers from participating schools were eligible to participate, regardless of baseline SSB consumption. Validated instruments were used to assess SSB behaviors and QOL. Height and weight were objectively measured in students and self-reported by caregivers. Analyses included modified two-part models with time fixed effects that controlled for relevant demographics and included school cluster robust standard errors.ResultsOf the 526 students and 220 caregivers, mean (SD) ages were 12.7 (0.5) and 40.6 (6.7) years, respectively. Students were 55% female. Caregivers were mostly female (95%) and White (93%); 25% had a high school education or less and 33% had an annual household income less than $50,000. Regardless of SSB intake at baseline and relative to control participants, SSB significantly decreased among students [-7.2 ounces/day (95% CI = -10.7, -3.7); p < 0.001, effect size (ES) = 0.35] and caregivers [-6.3 ounces/day (95% CI = -11.3, -1.3); p = 0.014, ES = 0.33]. Among students (42%) and caregivers (28%) who consumed > 24 SSB ounces/day at baseline (i.e., high consumers), the ES increased to 0.45 and 0.95, respectively. There were no significant effects for student or caregiver QOL indicators or objectively measured student BMI; however, caregiver self-reported BMI significantly decreased in the intervention versus control schools (p = 0.001).ConclusionsKids SIPsmartER was effective at reducing SSB consumption among students and their caregivers in the rural, medically underserved Appalachian region. Importantly, SSB effects were even stronger among students and caregivers who were high consumers at baseline.Trial registrationClincialtrials.gov: NCT03740113. Registered 14 November 2018– Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03740113.

Cardiovascular risk profile in two cohorts of young apparently healthy South Asian descendants in the Netherlands: still a long way to go!

Cardiovascular disease (CVD) imposes a major healthcare burden on young descendants of South Asian migrants living in the western world. In comparison to the native population, the prevalence is significantly higher and the prevalence of CVD risk factors is increasing rapidly. The cardiovascular risk profile and 10-year risk scores of South Asian descendants were evaluated in two cohorts with a 10-year time difference. Two cross-sectional studies, conducted in 2004 and 2014, focused on asymptomatic South Asian descendants aged 18-59 years were performed. A short questionnaire, BMI, waist circumference, blood pressure, and nonfasting blood tests were obtained. The cohort of 2014 was matched with the cohort of 2004, based on age, gender, and family history of CVD. In 2014, 674 South Asians (44% men, age 38.2 ± 12.0 years) were matched with 674 South Asians (44% men, age 38.3 ± 12.1 years) included in 2004. Notably, hypertension prevalence decreased significantly in 2014 (10.6% vs 23.1% in 2004, P < 0.001), while mean BMI increased (26.1 vs 24.9, P < 0.001). The mean Framingham risk score was lower in 2014 (5.31 ± 6.19%) than in 2004 (6.45 ± 8.02%, P < 0.05). This study demonstrates that South Asian descendants in 2014 have a lower but still high absolute risk for coronary events compared to 2004. Important differences in cardiovascular risk profile exist. Despite improvements, South Asian descendants in 2014 still face a high absolute risk for coronary events compared to 2004, indicating the necessity for continued primary prevention and lifestyle interventions.

A guide to mycetisms: A toxicological and preventive overview.

Fungi are often considered a delicacy and are primarily cultivated and harvested, although numerous species are responsible for intoxication due to toxin content. Foodborne diseases are a significant public health concern, causing approximately 420000 deaths and 600 million morbidities yearly, of which mushroom poisoning is one of the leading causes. Epidemiological data on non-cultivated mushroom poisoning in individual countries are often unrepresentative, as intoxication rarely requires emergency intervention. On the other hand, the lack of specialist knowledge among medical personnel about the toxicological manifestations of mushroom consumption may result in ineffective therapeutic interventions. This work aims to provide an easy-to-consult and wide-ranging tool useful for better understanding the variability of mushroom intoxications, the associated symptoms, and the main treatments for the most severe cases, given the absence of a complete species mapping tool toxic. Moreover, we establish an effective collection network that describes the incidence of mushroom poisonings by reporting the species and associated toxicological manifestations for each case. In conclusion, we highlight the need to establish appropriate primary prevention interventions, such as training the affected population and increasing consultancy relationships between mycological experts and specialised healthcare personnel.

Abstract P110: Biomarkers of Atrial Fibrillation-Related Pathways and Left Atrial Structure and Function in an Overweight and Obese Population

Background: Blood biomarkers of atrial fibrillation (AF)-related pathways can characterize the atrial substrate promoting the development of AF. Exploring associations of blood biomarkers with left atrial (LA) structure and function could enhance our understanding of AF etiopathogenesis and inform AF prevention strategies. Methods: We studied 532 participants of the PREDIMED-Plus trial, a multicenter randomized trial in overweight and obese adults (55-75 years) with the metabolic syndrome in Spain. The trial objective was to test a lifestyle intervention for primary prevention of cardiovascular disease. At baseline, 3 and 5 years after randomization, these participants underwent transthoracic echocardiography and provided blood for serum biomarker measurements [propeptide of procollagen type I (PICP), high-sensitivity (hs) troponin T (hsTnT), hs C-reactive protein (CRP), 3-nitrotyrosine (3-NT), and N-terminal propeptide of B-type natriuretic peptide (NT-proBNP)]. Outcomes of interest included LA peak systolic longitudinal strain (LA PSLS), LA volume index (LAVi), LA function index (LAFi), and LA stiffness index (LASi). We performed cross-sectional and longitudinal analyses to evaluate relationships between log-transformed biomarkers and echocardiographic measurements using multiple linear regression and mixed models: 1) baseline biomarkers and LA outcomes; 2) baseline biomarkers and change in LA outcomes from baseline through year 5; 3) concomitant changes in biomarkers and LA outcomes from baseline to year 5. Results: The participants in this analysis had a mean age of 65 (SD 4.8) years, 40% females, and BMI of 32.2 (SD 3.3) kg/m 2 . At baseline, increased NT-proBNP was associated with worse LAVi (0.78 mL/m 2 , 95% CI 0.04, 1.52), LAFi (-3.61, 95% CI -6.75, -0.46), and LASi (0.02, 95% CI 0.00, 0.04). Higher baseline NT-proBNP was associated with a greater decrease in LA PSLS at year 3 (-0.82%, 95% CI -1.57, -0.06) but not year 5 (-0.01%, 95% CI -0.77, 0.75), and an increase in LASi at years 3 (0.04, 95% CI 0.01, 0.06) and 5 (0.02, 95% CI 0.00, 0.04). Over 5 years, larger elevation in NT-proBNP was associated with more decline in LA PSLS (-0.19%, 95% CI -0.35, -0.02) and more elevation in LAVi (0.28 mL/m 2 , 95% CI 0.10, 0.45) each year. PICP, hsTnT, CRP and 3-NT did not show consistently significant associations with LA outcomes at baseline and through 5 years. Conclusion: In an overweight and obese population, higher NT-proBNP was associated with LA volume enlargement and worsening LA function over 5 years. The implications of these findings for prevention and prediction of AF warrant further investigation.

77 Emerging strategies for head & neck cancer prevention

Head and neck squamous cell carcinoma (HNSCC) is a group of malignancies mostly involving the oral cavity, oropharynx, hypopharynx, and larynx. All together they represent the seventh most common cancer diagnosis worldwide. With 890,000 new cases and 450,000 deaths annually per GLOBOCAN estimates, HNSCC accounts for roughly 4.5% of cancer diagnoses and deaths. In the developing world, the incidence of HNSCC is growing with increasing consumption of tobacco (smoked or chewed), alcohol, and areca nut (betel quid). Alcohol and tobacco have a synergistic effect, with the heavy consumption of both increasing HNSCC risk 40-fold. In this context, the risk of second primary tumors in the field of cancerization is high. In developed nations, HPV-related HNSCC surpasses tobacco- and alcohol-related disease. HPV-related HNSCC more commonly affects the oropharynx, hypopharynx, and larynx than the oral cavity, and is associated with a significantly longer survival.Based on this epidemiological facts, different strategies involving primary, secondary and tertiary prevention will be discussed. For prevention of HPV-positive HNSCC, emphasis will be given to vaccination strategies and novel diagnostic biomarkers for early detection. HPV-negative HNSCC are mostly represented by oral cavity cancers. In this particular context, a Working Group of international experts was convened by the International Agency for Research on Cancer (IARC) to review and assess all available evidence on the effectiveness of primary and secondary preventive interventions in reducing the incidence of and mortality from oral cancer. Available evidence will be summarized. Finally, we will address the challenge of unmet oral cancer prevention in the context of oral potentially malignant disorders (OPMD) in terms of oral cancer risk assessment and pharmacological interception approachs.In conclusion, a lot remains to be done to improve the prevention of HNSCC but significant opportunities exist that will hopefully allow in the near future to significantly decrease its morbidity, mortality, and profound impact on patient's quality of life.

Intervention for Primary Prevention of Non-Communicable Diseases.

Intervention for Primary Prevention of Non-Communicable Diseases.

Recombinant Rod Domain of Vimentin Reduces SARS-CoV-2 Viral Replication by Blocking Spike Protein-ACE2 Interactions.

Although the SARS-CoV-2 vaccination is the primary preventive intervention, there are still few antiviral therapies available, with current drugs decreasing viral replication once the virus is intracellular. Adding novel drugs to target additional points in the viral life cycle is paramount in preventing future pandemics. The purpose of this study was to create and test a novel protein to decrease SARS-CoV-2 replication. We created the recombinant rod domain of vimentin (rhRod) in E. coli and used biolayer interferometry to measure its affinity to the SARS-CoV-2 S1S2 spike protein and the ability to block the SARS-CoV-2-ACE2 interaction. We performed plaque assays to measure rhRod's effect on SARS-CoV-2 replication in Vero E6 cells. Finally, we measured lung inflammation in SARS-CoV-2-exposed K18-hACE transgenic mice given intranasal and intraperitoneal rhRod. We found that rhRod has a high affinity for the S1S2 protein with a strong ability to block S1S2-ACE2 interactions. The daily addition of rhRod decreased viral replication in Vero E6 cells starting at 48 h at concentrations >1 µM. Finally, SARS-CoV-2-infected mice receiving rhRod had decreased lung inflammation compared to mock-treated animals. Based on our data, rhRod decreases SARS-CoV-2 replication in vitro and lung inflammation in vivo. Future studies will need to evaluate the protective effects of rhRod against additional viral variants and identify the optimal dosing scheme that both prevents viral replication and host lung injury.

Harnessing global networks to drive country evidence-based reproductive health practices toward universal health coverage

Jhpiego provides contextual evidence-based real-life solutions that contribute to saving lives, improving health, and transforming futures for women, children, and their families living in more than 42 countries. Over its 50 years of existence and a geographic footprint of more than 150 countries, this JHU-affiliated NGO has contributed to the introduction and scale-up of multiple life-saving innovations, has been a dot connector, a trusted partner to many governments and professional and local organizations, and an innovator. In Kenya, Jhpiego has worked for more than 45 years, partnering with KOGS in multiple initiatives, and has contributed to the development and review of multiple evidence-based policies and recommendations at the global, regional, and national levels. Evidence-based practice plays a critical role in improving the quality of reproductive health care. While global recommendations are important, they require adaptation to local contexts for full implementation to be practical. Introduction of heat-stable carbetocin and the scale-up of the E-MOTIVE bundle to manage PPH, respectful care, and mental health in RH, introduction and scale-up of post-pregnancy FP, introduction and scale-up of primary and secondary cervical prevention interventions, the use of blended learning that uses multiple delivery channels, including the use of AI-powered training tools that respond to the needs of health providers, and supporting the quality of services through approved pharmacies, including e-pharmacy.

Acute Ischaemic Stroke in Patients Treated with Direct Oral Anticoagulants: Potential Causes, Clinical Characteristics, and Short-Term Outcomes.

Direct oral anticoagulants (DOAC) are the first-line treatment for primary and secondary acute ischaemic stroke (AIS) prevention in patients with nonvalvular atrial fibrillation (NVAF), but a significant percentage of patients develop AIS despite being treated with DOAC. As the number of DOAC-treated patients is growing, so is the number of patients with AIS on DOAC. The aim of the study was to assess the incidence of AIS with prestroke DOAC treatment among patients hospitalised in the University Hospital in Kraków, to analyse the clinical characteristics of AIS occurring in patients on DOAC, and to identify potential causes of treatment ineffectiveness in this group. In the study, we included all patients hospitalised in the Department of Neurology of the University Hospital in Kraków within one year (July 2022 to June 2023) with the diagnosis of AIS. The group was divided into two subgroups of patients with and without prestroke DOAC treatment. Based on medical files, we retrospectively analysed the profile of cardiovascular risk factors, stroke severity (assessed with National Institutes of Health Stroke Scale, NIHSS), use of causative stroke treatment and short-term outcomes (defined as NIHSS score, modified Rankin scale (mRS) score at discharge, in-hospital mortality, and secondary intracerebral haemorrhage among patients treated with mechanical thrombectomy, MT). Within the DOAC-treated subgroup, we looked for potential causes of AIS occurring despite DOAC treatment (valvular AF, poor adherence to treatment, underdosing, other prothrombotic conditions, aetiology of stroke other than thromboembolic, and drug-drug interactions). In the study, we included 768 AIS patients. 109 (14.2%) had a history of prestroke DOAC treatment. A potential cause of DOAC treatment failure was identified in the majority of them (n = 63, 57.8%). Patients with prestroke DOAC treatment had worse functional condition before stroke and higher stroke severity on admission but similar short-term outcomes and similar short-term effects of treatment with MT. DOAC (+) and DOAC (-) patients had different profiles of cardiovascular risk factors and different factors associated with short-term outcome. Conclusions and Clinical Implications. A potential cause of AIS occurring in DOAC-treated patients can be identified in most cases and in many of them prevented.

Stroke prevention strategies in Africa: a scoping review protocol.

The objective of this scoping review is to map the existing strategies on methods and interventions for primary and secondary stroke prevention in Africa. Stroke is among the leading causes of disability globally. African nations have higher stroke mortality and case fatality rates than the industrialized world, leading to significant social and financial costs, which necessitates efficient preventative methods. Despite the high prevalence of stroke in Africa, the scope of stroke-prevention strategies in Africa is unknown. Consequently, mapping diverse approaches to preventing stroke in Africa could provide direction for future research into stroke prevention in Africa. This review will incorporate studies that report methods or strategies used for stroke prevention in Africa. All primary and gray literature will be considered for inclusion. No language or date restrictions will be applied. The JBI methodological framework for scoping reviews will be adopted for this scoping review. A 3-step search strategy consisting of an initial limited search, a full search, and a screening of the reference lists of all included articles will be undertaken. Databases such as CINAHL, Scopus, PubMed, PEDRo, DORIS, Global Health, Web of Science, and Open Access Thesis and Dissertations will be searched. All search results will be screened, and relevant data extracted by 2 independent reviewers. The findings will be presented in the final scoping review and illustrated in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Figshare https://doi.org/10.6084/m9.figshare.21679904.v1.

Exploring the associations between adverse childhood experiences (ACEs) and adolescent cancer risk behaviours in the ALSPAC cohort

BackgroundSome modifiable risk factors for cancer originate during adolescence. While there is evidence indicating relationships between adverse childhood experiences and health risk behaviours generally, little is known about how childhood adversity influences the engagement of adolescents in cancer risk behaviours. This study aimed to determine the relationship between adverse childhood experiences and adolescent cancer risk behaviours.MethodsData were collected prospectively from birth to age 18 years on children born to mothers enrolled into the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort study. Multivariable linear regression models assessed relationships of a composite exposure measure comprised of adverse childhood experiences (total number of childhood adversities experienced from early infancy until age 9 years) with multiple cancer risk behaviours. The latter was expressed as a single continuous score for tobacco smoking, alcohol consumption, obesity, unsafe sex, and physical inactivity, at ages 11, 14, 16 and 18 years. Analysis was carried out on the complete case and imputation samples of 1,368 and 7,358 participants respectively.ResultsAll adolescent cancer risk behaviours increased in prevalence as the adolescents grew older, except for obesity. Each additional adverse childhood experience was associated with a 0.25 unit increase in adolescent cancer risk behaviour (95% CI 0.16–0.34; p < 0.001). Individually, parental substance misuse (β 0.64, 95% CI 0.25–1.03, p < 0.001) and parental separation (β 0.56, 95% CI 0.27–0.86, p < 0.001) demonstrated the strongest evidence of association with engagement in adolescent cancer risk behaviour.ConclusionChildhood adversity was associated with a greater degree of engagement in adolescent cancer risk behaviours. This finding demonstrates the need for targeted primary and secondary prevention interventions that reduce engagement across multiple cancer risk behaviours for children and adolescents who have experienced adversity in childhood, such as parental substance misuse and separation, and reduce exposure to adversity.

Global Burden of Alzheimer's Disease and Other Dementias Attributed to High Fasting Plasma Glucose from 1990 to 2019.

Burden of Alzheimer's disease (AD) and other dementias have grown rapidly over the decades, and high fasting plasma glucose (HFPG) was one of the well-established risk factors. It is urgently needed to estimate the global burden of AD and other dementias attributable to high fasting plasma glucose between regions, countries, age groups, and sexes to inform development of effective primary disease prevention strategies and intervention policies. The burden of AD and other dementias attributable to HFPG was estimated based on a modeling strategy using the Global Burden of Disease Study 2019 dataset. The disease burden and time trend globally and by region, country, development level, age group, and sex were evaluated. The number of AD and other dementias-related deaths attributable to HFPG increased from 42,998.23 (95% uncertainty interval, UI: 4459.86-163,455.78, the year of 1990) to 159,244.53 deaths (95% UI 18,385.23-583,514.15, the year of 2019). The age-standardized death rate increased from 1.69 (95% UI 0.18-6.54) in 1990 to 2.24 (95% UI 0.26-8.24) in 2019. The burden was higher in more developed regions. The burden in women was double that in men, that HFPG-attributable AD and other dementias caused 99,812.79 deaths (95% UI 9005.67-387,160.60) in women and 59,431.74 deaths (95% UI 5439.02-214,819.23) in men, with age-standardized death rate of 2.27 (95% UI 0.20-8.79) per 100,000 population in women and 2.20 (95% UI 0.20-8.00) in men. Findings from the current study emphasizes the urgent requirement for targeted interventions in high-development regions, as well as the importance of proactive measures in middle-development countries in protection of AD and other dementias. The gender disparity necessitates the integration of gender-specific considerations in targeted approaches in prevention of AD and other dementias.

French healthcare students and antibiotics: are they ready to promote their appropriate use?

French healthcare students are required to carry out primary prevention interventions as part of the Healthcare Service by Healthcare Students (HSHS). The purpose of this study was to explore students' perceptions of preparedness to address the public's concerns about antibiotic use and how their perceptions changed after implementing their intervention. A questionnaire was sent twice during the 2020-2021 academic year to 920 multidisciplinary healthcare students (nursing, medicine, physiotherapy, pharmacy and midwifery students) enrolled in the HSHS in Franche-Comté (HSHS-FC). This study included 870/920 students (94.6%). Medical and pharmacy students were the most concerned about the issue of antimicrobial resistance. Before enrollment in the HSHS-FC, 463 of the 870 students included (53.2%) reported having sufficient knowledge about antibiotics to lead preventive interventions, reaching 87.9% (58/66) for pharmacy students. Despite this relative lack of knowledge, 77.2% of students felt confident to promote the appropriate use of antibiotics in the healthcare service context. This rate ranged from 68.0% (17/25) for midwifery students to 93.9% (62/66) for pharmacy students. Irrespective of the topic of the intervention, students significantly improved their knowledge and ability to promote antibiotic use after training in the HSHS-FC. Theoretical prerequisites and a feeling of concern vary widely depending on the curriculum. The HSHS-FC promotes multidisciplinary collaboration and can contribute to improving students' knowledge. The support of an expert in antimicrobial resistance may be necessary to validate the content of the interventions proposed by the students.

Primary prevention of prescription stimulant misuse in first-year college students

Objective: Eight percent of college students report past year prescription stimulant misuse (nonmedical use of stimulants defined as taking stimulants in a manner other than prescribed). Despite this high prevalence rate, primary prevention efforts are lacking on college campuses. Participants and Methods: A prescription stimulant misuse primary prevention intervention targeting first-year college students was developed, refined, and pilot tested. Existing substance use treatment (motivational interviewing) and time management (cognitive behavioral therapy for adult ADHD) techniques were integrated into the novel brief prevention intervention. Focus groups provided feedback to help refine the prevention intervention. Following refinements, 484 first-year college students were randomly assigned to condition (327 treatment, 157 control) and followed for 3 months. Results: Participants rated the intervention as satisfactory. After controlling for time invariant covariates, condition significantly predicted prescription stimulant misuse. There was a lower rate of past 3-month prescription stimulant misuse reported in the intervention group (4.9%) compared to the control group (11.5%). Academic expectancies remained stable in the intervention group yet increased in the control condition over time. Time management skill ratings remained stable in both groups. Changes in academic expectancies, yet not time management skills, were a partial mediator of the prevention efficacy in prescription stimulant misuse at 3-month follow-up. Conclusions: These results provide preliminary support for the acceptability and efficacy of a brief primary prevention intervention for college student prescription stimulant misuse. Changes in positive prescription stimulant expectancies, yet not time management skills, appear to be potential targets for future preventive efforts.

RELATIONSHIPS BETWEEN CEREBRAL VASCULOPATHIES AND MICROINFARCTS IN COMMUNITY-BASED OLDER ADULTS

Abstract Cerebral microinfarcts are associated with cognitive impairment and dementia. Less is known about the relationships of various vasculopathies (arteriolosclerosis and cerebral amyloid angiopathy (CAA) with microinfarcts. This case-control study examined the associations of the vasculopathies with microinfarcts in 842 older adults in the Adult Changes in Thought (ACT) autopsy data. Arteriolosclerosis was assessed by histological examination using the H&amp;E stain; CAA was assessed using the Congo red histochemical stains; and microinfarcts was ascertained by blinded board-certified neuropathologists. Multivariable-adjusted logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CI) for the presence of cerebral microinfarcts associated with the two cerebral vasculopathies. Cerebral microinfarcts were present in 417 (49.5%) participants. Mild, moderate, and severe arteriolosclerosis was present in 13.2%, 43.9%, 29.7% of participants with microinfarcts, and 28.9%, 40.0%, and 12.5% of participants without microinfarcts, respectively. ORs (95% CIs) for microinfarcts associated with moderate and severe arteriolosclerosis were 2.15 (1.45-3.17) and 4.59 (2.88-7.33), respectively. Mild, moderate, and severe CAA was present in 18.0%, 17.5%, and 3.6% of participants with microinfarcts, and 18.1%, 16.5%, and 2.4% of participants without microinfarcts, respectively. ORs (95% CIs) for microinfarcts associated with moderate and severe CAA were 0.97 (0.65-1.44) and 1.37 (0.59-3.21), respectively. Cerebral microinfarcts were common in older adults and were associated with a higher prevalence of arteriolosclerosis, but not with CAA. Our study underscores the need for additional studies to better understand this complex relationship to develop interventions for primary prevention of cognitive impairment.

Suicide prevention in India

India accounts for nearly 18 % of the global population but approximately 28 % of global suicides. Similar to many countries around the world, suicide in India is known to result from a complex interplay of social, economic, and personal factors. To address this important issue, India released its first national suicide prevention strategy in 2022. The strategy follows the WHO-recommended model of a multisectoral approach to suicide prevention, incorporating a mix of primary prevention interventions (focusing on whole populations), secondary prevention interventions (targeting 'high-risk' individuals), and tertiary prevention interventions (aimed at individuals affected by suicide). This paper delves into the details of these primary, secondary, and tertiary prevention interventions and explores how they apply to the Indian context, while arguing for the need to prioritize primary prevention interventions, at least in the short term, to reduce suicides.

Evidence for a Negative Loss Spiral between Co-Worker Social Support and Burnout: Can Psychosocial Safety Climate Break the Cycle?

Previous research suggests that co-worker social support predicts burnout, but this relationship may be far more complex, with the potential for a reciprocal cycle of loss. Leading research on loss spirals has explicitly called for more research on interindividual factors such as social support and, by extension, how interventions that operate on these interpersonal resources could play a role in primary and secondary prevention (i.e., intervening in cycles of loss). In this study, we explore the reciprocal relationship between burnout and co-worker social support, with psychosocial safety climate (PSC) as an upstream predictor and moderator of this relationship. Using hierarchical linear modelling (N = 380 frontline healthcare workers, nested within N = 63 teams) on longitudinal data, we found a reciprocal relationship between burnout and co-worker support, which was both triggered and moderated by PSC. These findings provide initial evidence for a social support-burnout loss spiral, wherein individuals with poor co-worker support are more likely to become burnt-out, and in this depleted state they are subsequently less likely to reach out for those social supports when available, which would, in turn, lead to further burnout. This social support-burnout loss spiral is exacerbated when working in a low-PSC context, as the environment does not send positive safety signals about resource scarcity and replenishment. Therefore, PSC may be a potential target for intervention both in primary prevention (i.e., stopping the loss spiral in the first instance) and in secondary intervention, as high PSC signals to workers already in the burnout-support loss cycle when it is safe to reinvest resources or engage in recovery behavior.

Assessment of Adverse Childhood Experiences, Adverse Professional Experiences, Depression, and Burnout in USPhysicians.

To assess associations of adverse childhood experiences (ACEs) and adverse occupational experiences (AOEs) with depression and burnout in US physicians. We performed a secondary analysis of data from a representative sample survey of US physicians conducted between November 20, 2020, and March 23, 2021, and from a probability-based sample of other US workers. The ACEs, AOEs, burnout, and depression were assessed using previously published measures. Analyses included data from 1125 of the 3671 physicians (30.6%) who received a mailed survey and 6235 of 90,000 physicians (6.9%) who received an electronic survey. The proportion of physicians age 29-65 who had lived with a family member with substance misuse during childhood (673 of 5039[13.4%]) was marginally lower (P <.001) than that of workers in other professions (448 of 2505 [17.9%]). The proportion of physicians age 29-65 who experienced childhood emotional abuse (823 of 5038 [16.3%]) was similar to that of workers in other professions (406 of 2508 [16.2%]). The average physician depression T-score was 49.60 (raw score ± SD, 6.48±3.15), similar to the normed US average. The AOEs were associated with mild to severe depression, including making a recent significant medical error (odds ratio [OR], 1.64; 95% CI, 1.33 to 2.02, P<.001), being named in a malpractice suit (OR, 1.30; 95% CI, 1.07 to 1.59, P=.008), and experiencing one or more coronavirus disease 2019-related AOEs (OR, 1.76; 95% CI, 1.56 to 1.99, P<.001). Having one or more ACEs was associated with mild to severe depression (OR, 1.58; 95% CI, 1.38 to 1.79, P<.001). The ACEs, coronavirus disease 2019-related AOEs, and medical errors were also associated with burnout. Assessing ACEs and AOEs and implementing selective primary prevention interventions may improve population health efforts to mitigate depression and burnout in physicians.