Primary Prevention Interventions Research Articles

Alcohol-Related Behavioral Research and Its Integration into Primary and Secondary HIV Preventive Interventions: A Summing Up.

Alcohol-Related Behavioral Research and Its Integration into Primary and Secondary HIV Preventive Interventions: A Summing Up.

Integrating Health Care Strategies to Prevent Poverty-Related Disparities in Development and Growth: Addressing Core Outcomes of Early Childhood.

Poverty-related disparities appear early in life in cognitive, language, and social-emotional development, and in growth, especially obesity, and have long-term consequences across the life course. It is essential to develop effective strategies to promote healthy behaviors in pregnancy and the early years of parenthood that can mitigate disparities. Primary preventive interventions within the pediatric primary care setting offer universal access, high engagement, and population-level impact at low cost. While many families in poverty or with low income would benefit from preventive services related to both development and growth, most successful interventions have tended to focus on only one of these domains. In this manuscript, we suggest that it may be possible to address both development and growth simultaneously and effectively. In particular, current theoretical models suggest alignment in mechanisms by which poverty can create barriers to parent-child early relational health (i.e., parenting practices, creating structure, and parent-child relationship quality), constituting a final common pathway for both domains. Based on these models and related empirical data, we propose a strength-based, whole child approach to target common antecedents through positive parenting and prevent disparities in both development and growth; we believe this approach has the potential to transform policy and practice. Achieving these goals will require new payment systems that make scaling of primary prevention in health care feasible, research funding to assess efficacy/effectiveness and inform implementation, and collaboration among early childhood stakeholders, including clinicians across specialties, scientists across academic disciplines, and policy makers.

Antihypertensive drug class in combination with lipid lowering treatment for primary prevention of cardiovascular disease in the elderly

BackgroundAntihypertensives and lipid-lowering therapy (LLT) are often used concurrently. ObjectivesTo determine whether there was a difference in clinical outcomes when older patients with LLT were prescribed angiotensin-converting-enzyme-inhibitors (ACE-Is) compared with diuretics. MethodsThis analysis included 648 LLT older users free of cardiovascular disease (CVD) from a trial comparing ACE-I versus diuretic-based therapy. Comparisons were made between LLT+ACE-I (n = 335) and LLT+diuretic groups (n = 313) using multivariable Cox proportional-hazard models. Primary endpoints were all-cause and CVD mortality (in-trial [4.1-year]+post-trial [6.9-year]) and secondary endpoints (in-trial) were the composite of all-cause mortality and first CVD events and its components, CVD mortality and incident diabetes. ResultsThere were no significant differences between the two groups for the primary endpoints over the in-trial plus post-trial follow-up, nor was there a difference for any secondary outcomes over the in-trial follow-up. ConclusionsThe LLT+ACE-I and LLT+diuretic combinations showed similar effects in CVD-free older individuals. Randomised trials are needed to provide conclusive evidence.

The Effect of Physical Exercise on Cognitive Impairment in Neurodegenerative Disease: From Pathophysiology to Clinical and Rehabilitative Aspects.

Neurodegenerative diseases are a group of pathologies that cause severe disability due to motor and cognitive limitations. In particular, cognitive impairment is a growing health and socioeconomic problem which is still difficult to deal with today. As there are no pharmacologically effective treatments for cognitive deficits, scientific interest is growing regarding the possible impacts of healthy lifestyles on them. In this context, physical activity is gaining more and more evidence as a primary prevention intervention, a nonpharmacological therapy and a rehabilitation tool for improving cognitive functions in neurodegenerative diseases. In this descriptive overview we highlight the neurobiological effects of physical exercise, which is able to promote neuroplasticity and neuroprotection by acting at the cytokine and hormonal level, and the consequent positive clinical effects on patients suffering from cognitive impairment.

Understanding Sexual Aggression in UK Male University Students: An Empirical Assessment of Prevalence and Psychological Risk Factors.

University-based sexual aggression is an international public health issue; however, to date, there have been no formal assessments of the prevalence or psychological indicators associated with the proabuse behaviors of the most common perpetrators at UK universities: heterosexual male students. To facilitate the development of effective primary prevention interventions for domestic students who have sexually harmed, we assess across two empirical studies (Ns = 259 and 295) the psychological risk factors associated with recent sexual aggression amongst two distinct samples of UK male university students. Cumulatively, results highlighted that one in nine participants (11.4%) self-reported recent sexual aggression. These participants could be statistically differentiated from their non-offending peers on various established indicators of general sexual offending, of which logistic regression analyses highlighted atypical sexual fantasies, general aggression, hostility toward women, and rape myth acceptance as being the most reliable predictors. Our data extend the international evidence base by providing the first detailed overview of sexual aggression amongst UK male university students, as well as the psychological risk factors associated with their proabuse behaviors. We discuss the importance of our findings for the development of more effective evidence-based reduction strategies and primary prevention interventions for male students who have sexually harmed.

Implementation of a Depression Screening Tool at the Department of Radiation Oncology

<h3>Purpose/Objective(s)</h3> Depression is a common comorbidity in cancer that has detrimental effects on patient health outcomes and quality of life. Unrecognized depression can impede treatment adherence resulting in disease progression and mortality in cancer patients. Inadequate depression screening and referral practices were observed and verbalized as a concern by internal stakeholders at an academic Radiation Oncology Department (ROD) in Baltimore, Maryland. Thus, the purpose of this Quality Improvement (QI) project was to implement and evaluate the Patient Health Questionnaire (PHQ-9) depression screening tool with subsequent psychosocial referrals for all positive screens. <h3>Materials/Methods</h3> The QI project used the Mobilize-Assess-Plan-Implement-Track (MAP-IT) framework. The QI team implemented four core interventions during the fifteen-week project: Staff education, PHQ-9 screening, provision of mental health resources, and psychosocial referrals for patients with moderate to severe depressive symptoms (PHQ-9 scores of ≥10). A convenience sample of adult cancer patients (≥18 years old) with a confirmed cancer diagnosis and a radiation treatment plan were eligible to participate. Rates of PHQ-9 screening, positive screens, referrals, and social worker follow-up were collected weekly, analyzed, and plotted on run charts. A combination of descriptive statistics, <b>t</b>-tests, and a chi-squared (X²) test examined differences between pre-and post-implementation data for statistical significance. <h3>Results</h3> All targeted staff attended the education session (n = 10), and there was a 100% completion rate for the pre- and post-surveys. Post education, the average score for staff competency significantly increased from 62% to 96% (<i>P</i> = < 0.001; 95% CI [17.5, 57.0]. Post-implementation, PHQ-9 screening compliance increased from 2% baseline to 67% (<i>P</i> = < 0.001, <b>df</b> = 1, n = 145). Of the patients screened, 19% scored above the threshold indicative of a positive screen (n = 27). Subsequently, all positive screens were referred to an Oncology Social Worker (<i>P</i> = < 0.001), and 93% received follow-up care (n = 25). <h3>Conclusion</h3> Routine depression screening and psychosocial referrals among cancer patients receiving radiotherapy in an outpatient setting are feasible when streamlined into the clinical workflow. An integrated care approach with PHQ-9 screening improves the early identification of depression and increases patient access to psycho-oncology care. Registered nurses are in critical positions to perform primary and secondary prevention interventions to reduce the burden of depression. Considerations for future development include a collaborative and stepped care approach to address the unmet psychosocial needs that exist in the oncology population.

Work-relatedness of lateral epicondylitis: Systematic review including meta-analysis and GRADE work-relatedness of lateral epicondylitis.

BackgroundLateral epicondylitis (LE) is a highly prevalent musculoskeletal disorder in workers, often associated with physically demanding work. Knowledge of work‐relatedness of LE is crucial to develop appropriate preventive measures. This study investigates the prospective association between work‐related physical risk factors and LE.MethodsA systematic literature review was conducted in MedLine using PubMed from January 1, 2010 until February 16, 2021. Published reports were included if: (1) LE was clinically assessed, (2) exposure to work‐related physical risk factors was assessed, and (3) associations between LE and work‐related physical risk factors were reported in prospective studies. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation.ResultsIn total, 318 workers with LE from a population of 5036 workers in five studies were included. Meta‐analyses revealed high‐quality evidence for associations between LE and a Strain Index (SI) score >5.1 (odds ratio [OR]: 1.75, 95% confidence interval (CI): 1.11–2.78) and moderate‐quality evidence for forearm rotation >4 h/day or forearm rotation ≥45° for ≥45% time (OR: 1.85, 95% CI: 1.10–3.10). Gripping, flexion and extension of the wrist, and repetitive movements showed no significant associations with LE.ConclusionHigh‐quality evidence was found indicating that a higher SI increased the risk of LE. Moderate‐quality evidence was found for an association between forearm rotation and LE. No associations were found between other physical risk factors and LE. Primary preventive interventions should focus on a reduction of the SI and of high forearm rotation in work.

Ageing research: rethinking primary prevention of skin cancer.

Ageing research: rethinking primary prevention of skin cancer.

Time-Restricted Eating: A Novel and Simple Dietary Intervention for Primary and Secondary Prevention of Breast Cancer and Cardiovascular Disease.

There is substantial overlap in risk factors for the pathogenesis and progression of breast cancer (BC) and cardiovascular disease (CVD), including obesity, metabolic disturbances, and chronic inflammation. These unifying features remain prevalent after a BC diagnosis and are exacerbated by BC treatment, resulting in elevated CVD risk among survivors. Thus, therapies that target these risk factors or mechanisms are likely to be effective for the prevention or progression of both conditions. In this narrative review, we propose time-restricted eating (TRE) as a simple lifestyle therapy to address many upstream causative factors associated with both BC and CVD. TRE is simple dietary strategy that typically involves the consumption of ad libitum energy intake within 8 h, followed by a 16-h fast. We describe the feasibility and safety of TRE and the available evidence for the impact of TRE on metabolic, cardiovascular, and cancer-specific health benefits. We also highlight potential solutions for overcoming barriers to adoption and adherence and areas requiring future research. In composite, we make the case for the use of TRE as a novel, safe, and feasible intervention for primary and secondary BC prevention, as well as tertiary prevention as it relates to CVD in BC survivors.

Commercial Mhealth Apps and Exploitative Value Trade-Offs

"Mobile health (mHealth) apps are becoming progressively important for primary care, disease prevention, and public health interventions. They promise to empower its users by offering them more independence, better access to health services, and more insight into their health status resulting in better informed medical decision-making and lifestyle changes. Disadvantages of mHealth apps often include a lack of privacy protection, a decrease in personal attachment, and the acceptance of a normative conception of health challenging the user’s self-determination. Privacy, attachment, and self-determination are, alongside health, linked to fundamental dimensions of human well-being. Users of mHealth apps can either accept those disadvantages or abstain from using this technology entirely. Users, therefore, have to trade-off fundamental dimensions of well-being to gain a certain health benefit if they want to use commercial mHealth apps. This presentation will clarify the values most relevant in this context, focusing on privacy, self-determination, and attachment. I claim that these values imply fundamental conditions of well-being that should not be undermined, especially in the context of health care. I will argue that the value trade-offs users must engage in are an instance of mutually advantageous agreements by which the provider of the app takes unfair advantage of the user. This renders such agreements exploitative. I will discuss the notion of exploitation that I think applies in this case and explain under what circumstances exploitative agreements that come with the use of commercial mHealth apps oppose the empowerment narrative. "

Recommendations and Associated Levels of Evidence for Statin Use in Primary Prevention of Cardiovascular Disease: A Comparison at Population Level of the American Heart Association/American College of Cardiology/Multisociety, US Preventive Services Task Force, Department of Veterans Affairs/Department of Defense, Canadian Cardiovascular Society, and European Society of Cardiology/European Atherosclerosis Society Clinical Practice Guidelines.

Despite using identical evidence to support practice guidelines for lipid-lowering treatment in primary prevention of cardiovascular disease (CVD), it is unclear to what extent the 2018 American Heart Association/American College of Cardiology/Multisociety, 2016 US Preventive Services Task Force (USPSTF), 2020 Department of Veterans Affairs/Department of Defense, 2021 Canadian Cardiovascular Society, and 2019 European Society of Cardiology/European Atherosclerosis Society guidelines differ in grading and assigning levels of evidence and classes of recommendations (LOE/class) at a population level. We included 7262 participants, aged 45 to 75 years, without history of CVD from the prospective population-based Rotterdam Study. Per guideline, proportions of the population recommended statin therapy by LOE/class, sensitivity and specificity for CVD events, and numbers needed to treat at 10 years were calculated. Mean age was 61.1 (SD 6.9) years; 58.2% were women. American Heart Association/American College of Cardiology/Multisociety, USPSTF, Department of Veterans Affairs/Department of Defense, Canadian Cardiovascular Society, and European Society of Cardiology/European Atherosclerosis Society strongly recommended statin initiation in respective 59.4%, 40.2%, 45.2%, 73.7%, and 42.1% of the eligible population based on high-quality evidence. Sensitivity for CVD events for treatment recommendations supported with strong LOE/class was 86.3% for American Heart Association/American College of Cardiology/Multisociety (IA or IB), 69.4% for USPSTF (USPSTF-B), 74.5% for Department of Veterans Affairs/Department of Defense (strong for), 93.3% for Canadian Cardiovascular Society (strong), and 66.6% for European Society of Cardiology/European Atherosclerosis Society (IA). Specificity was highest for the USPSTF at 45.3% and lowest for European Society of Cardiology/European Atherosclerosis Society at 10.0%. Estimated numbers needed to treat at 10 years for those with the strongest LOE/class were ranging from 20 to 26 for moderate-intensity and 12 to 16 for high-intensity statins. Sensitivity, specificity, and numbers needed to treat at 10 years for assigned LOE/class varied greatly among 5 CVD prevention guidelines. The level of variability seems to be driven by differences in how the evidence is graded and translated into LOE/class underlying the treatment recommendations by different professional societies. Efforts towards harmonizing evidence grading systems for clinical guidelines in primary prevention of CVD may reduce ambiguity and reinforce updated evidence-based recommendations.

428Prevalence and forms of Intimate Partner Violence in WLWHA and HIV negative women in Umuahia

Abstract Background Intimate Partner Violence (IPV) is the range of sexually, psychologically and physically coercive acts used against adult and adolescent women by a current or former male partner. IPV is the commonest form of violence against women and one of the most pervasive human rights abuses against women. The UN reported that 1 in 3 women had experienced physical/sexual violence at some point in their lives and 2 in 3 victims of intimate partner homicide are women. This study is aimed at determining the prevalence and forms of IPV affecting WLWHA and HIV negative women in Umuahia, Nigeria. Methods A comparative cross-sectional study involving 200 WLWHA and 200 HIV negative women in Umuahia using systematic random sampling method. An interviewer-administered questionnaire was deployed for data collection. Data analysis was done using IBM SPSS. Results A total of 115 (57.5%) WLWHA compared to 73 (36.5%) of the HIV negative women had suffered from any form of IPV. Furthermore, a higher proportion of WLWHA suffered emotional (50.0%), physical (39.0%) and sexual (28.5%) IPV, compared to 31.5%, 17.5% and 12.0% respectively for HIV negative women. Conclusion IPV occurs in both groups of women but much higher in WLWHA. Primary prevention interventions aimed at prevention and reduction should be instituted especially amongst WLWHA. Health care settings should be equipped to ensure a comprehensive response whenever IPV is detected. Keywords Intimate Partner Violence, Prevalence, Forms.

430Predictors of Intimate Partner Violence amongst WLWHA and HIV negative women in Umuahia

Abstract Background Intimate Partner Violence (IPV) is the range of sexually, psychologically and physically coercive acts used against adult and adolescent women by a current or former male partner. IPV is the commonest form of violence against women and one of the most pervasive human rights abuses against women. The UN reported that 1 in 3 women had experienced physical/sexual violence at some point in their lives and 2 in 3 victims of intimate partner homicide are women. This study is aimed at determining the predictors of IPV amongst WLWHA and HIV negative women in Umuahia, Nigeria. Methods A comparative cross-sectional study involving 200 WLWHA and 200 HIV negative women in Umuahia using systematic random sampling method. An interviewer-administered questionnaire was deployed for data collection. Data analysis was done using IBM SPSS. Results Predictors of IPV amongst WLWHA included partner involvement in concurrent relationship and having childhood exposure to domestic violence while those amongst HIV negative women included coerced first sex, woman earning more than her partner, partner frequent use of alcohol and partner use of either or both cigarette and marijuana. Conclusion Predictors of IPV differed amongst both groups of women. Primary prevention interventions aimed at prevention and reduction should be instituted especially amongst WLWHA. Health care settings should be equipped to ensure a comprehensive response whenever IPV is detected. Keywords Intimate Partner Violence, Predictors, WLWHA.

Prenatal insomnia and childbirth-related PTSD symptoms: A prospective population-based cohort study

BackgroundCertain populations are at high risk of experiencing a traumatic event and developing post-traumatic stress disorder (PTSD). Yet, primary preventive interventions against PTSD are lacking. It is therefore crucial to identify pre-traumatic risk factors, which could be targeted with such interventions. Insomnia may be a good candidate, but studies on civilians are sparse. Furthermore, the mechanisms at stake in the relationship between pre-traumatic insomnia and PTSD symptoms are unclear. MethodsThis prospective population-based cohort study (n = 1,610) examined the relationship between insomnia symptoms at 32 weeks of pregnancy and childbirth-related PTSD (CB-PTSD) symptoms at eight weeks postpartum. Postnatal insomnia symptoms, prenatal psychological symptoms (depression, anxiety, PTSD, fear of childbirth), subjective birth experience (SBE) and birth medical severity were included as covariates in the analyses, which were based on a Piecewise Structural Equation Modelling approach. ResultsThe relationship between prenatal insomnia and CB-PTSD symptoms was mediated by negative SBE and postnatal insomnia symptoms. All relationships involving insomnia symptoms had small or very small effect sizes. LimitationsThis study used self-report questionnaires. Postnatal insomnia and CB-PTSD symptoms were concurrently measured. ConclusionPrenatal insomnia symptoms may impair the ability to cope with a difficult birth experience and contribute to postnatal insomnia, a risk factor for CB-PTSD. Thus, prenatal insomnia symptoms may be a promising target for CB-PTSD primary preventive interventions, although other prenatal psychological symptoms could also be considered. Even beyond the perinatal context, future studies on pre-traumatic insomnia and PTSD should include post-traumatic insomnia as a covariate.

An International Spatial Analysis of Welfare Spending’s Influence on Measles

BACKGROUND: National welfare policies have the potential to influence population health. Yet, no research has investigated the influence that welfare spending levels have on primary prevention interventions.&#x0D; &#x0D; METHODS: This study uses generalized linear mixed model Bayesian analysis to explore how welfare spending influences the relationship between measles counts and measles vaccination rates at a national level. Furthermore, models include random effects to account for the nested structure of countries within regions. A conditional autoregressive model was also developed to test for the influence of spatial relationships among the variables of interest.&#x0D; &#x0D; RESULTS: Analysis of the Bayesian Information Criterion (BIC) indicated that the non-spatial model (BIC=19743.090) was preferred over the spatial model (BIC = 24225.730). The final model found that both the first dose of measles vaccine (B = -0.835, 95% Cr. I. = -0.975, -0.699), public social protection (B = -0.936, 95% Cr. I. = -1.132, -0.744), and their interaction (B = -0.239, 95% Cr. I. -0.319, -0.156) had a negative influence on national measles counts.&#x0D; &#x0D; CONCLUSIONS: This finding indicates that welfare spending may enhance primary prevention interventions, like measles vaccination.

Waste Electrical and Electronic Equipment: Impacts of working conditions on health in Benin

BACKGROUND AND AIM: E-waste workers are exposed to various health problems not clearly defined because practicing in the informal sector. In Benin, the burden of morbid conditions among e-waste workers is not known. This study aims to evaluate the impact of working conditions on their health in Cotonou, Benin. METHODS: A cross-sectional and analytical study was conducted from November 2019 to October 2020 in Cotonou, using a stratified random sampling technique. The collectors, repairers and recyclers of e-waste were interviewed using a digital questionnaire on a tablet using the KoboCollect application. Binary logistic regression was performed using the stepwise degressive method to identify factors associated with the health status. RESULTS:The study population consisted of 161 subjects, including one female. The mean age was 30 ± 10 years with extremes of 14 and 63 years. The majority (60.25%) were aged 25-49 years. The subjects worked in poor conditions and six out of ten (62.73%) did not wear any personal protective equipment. The prevalence of health conditions was 44% [36.4% - 52.1%]. The risk factors associated with the occurrence of a health condition were activities exposing to respiratory risks; lack of personal protection; membership in the reclaimer category; membership in the recycler category; exposure to adverse working conditions and low daily income. CONCLUSIONS:The high prevalence of health conditions among e-waste workers in Cotonou, highlights the importance of addressing their health problems and implementing public health interventions in both primary and secondary prevention. KEYWORDS: working conditions, health, environment, e-waste, Benin

Intervenția preventivă a depresiei la copii, adolescenți şi adulți

Depression is a common mental disorder associated with increased morbidity and mortality. Depressive disorders usually occur around the age of 20. However, symptoms may appear earlier, even during childhood. Depressive episodes can be repetitive or chronic, affecting the individual's entire life. Primary prevention of unipolar depressive disorder is a potential strategy to stop or at least reduce the severity or delay the onset of a disorder. Primary preventive interventions are an ideal, modern and future approach that can have many benefits both in terms of population health and economic.

Alcohol-related Behavioral Research and its Integration into Primary and Secondary HIV Preventive Interventions: Introduction.

The purpose of this paper is to provide a brief introduction to and description of the contents of this special issue of AIDS and Behavior. The article begins with a description of the rationale for the special issue and the origin of its compilation. This background information is followed by a brief description of the main articles that are included in the special issue, which is structured by Gaist and Stirrat's [4] definitions of types of behavioral and social science research for HIV-AIDS research. The "bookend" article to this introduction is by Robert Freeman and identifies future directions for research and clinical practice that the special issue articles' content suggests.

The Psychology of Sustainability and Sustainable Development: Advancing Decent Work, Inclusivity, and Positive Strength-Based Primary Preventive Interventions for Vulnerable Workers.

This study discusses the contribution of the psychology of sustainability and sustainable development to the wellbeing of vulnerable workers. The psychology of sustainability and sustainable development is a current area of the research study in the field of sustainability science. It deals with sustainability as a framework to recognize and integrate the value of the psychological approach in the construction of processes linked to sustainable development. Accordingly, the psychology of sustainability and sustainable development could provide sustainable development processes for the employment of vulnerable workers. The contribution starts with the definition of the coordinates of a sustainable development process for vulnerable workers, anchoring it to the principles of decent work and inclusivity. Subsequently, positive variables involved in the sustainable development processes and their relationship with decent work and inclusivity are discussed. Moreover, positive healthy organizations are introduced as work environments capable to take care of the wellbeing, also, of vulnerable workers. Lastly, the applications of positive strength-based primary preventive interventions for vulnerable workers are analyzed. Perspectives for further research studies and interventions are also examined.

Applying the RE-AIM implementation framework to evaluate fall prevention interventions in community dwelling adults with cognitive impairment: a review and secondary analysis

BackgroundCognitive impairment (CI) is a risk factor for falls due to environmental or living settings, balance, gait and vision impairments, as well as medications. While previous systematic reviews have focused on the effectiveness of fall prevention programs in adults with cognitive impairment, very limited information is available on their implementation. This review examines what aspects of fall prevention interventions for community-dwelling adults with CI have been reported using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to support successful implementation.MethodsWe examined the included studies from our systematic review, which searched 7 databases for primary and secondary fall prevention interventions involving community-dwelling adults ≥50 years with mild to moderate CI. Reviewers screened citations and extracted data for study characteristics and the 5 dimensions (62 criteria) of the RE-AIM framework.ResultsTwelve randomized or clinical controlled trials (RCTs/CCTs) consisting of 8 exercise interventions, 3 multifactorial interventions, and 1 medication treatment were included in the review. Only 4 of 62 criteria were reported by all 12 included studies and 29 criteria were not reported by any of the studies. Five of the included studies reported on 20 or more of the 62 possible RE-AIM criteria and 3 of these studies self-identified as “feasibility” studies. While Reach was the best-reported construct by the included studies, followed by Effectiveness and Implementation, the criteria within the Adoption and Maintenance constructs were rarely mentioned by these studies. In general, there was also wide variation in how each of the criteria were reported on by study authors.ConclusionBased on the reporting of RE-AIM components in this review, we are unable to make connections to successful intervention components and thus practice-based recommendations for fall prevention in those with CI. The lack of detail regarding implementation approaches greatly limits the interpretation and comparisons across studies to fully inform future research efforts.