Primary Prevention Strategies Research Articles

Breastfeeding as a Primary Care Preventive Strategy towards Improved Child Survival

Breastfeeding as a Primary Care Preventive Strategy towards Improved Child Survival

Male perspectives on intimate partner violence: A qualitative analysis from South Africa.

Intimate partner violence (IPV) affects one in four women globally and is more commonly enacted by men than women. Rates of IPV in South Africa exceed the global average. Exploring the background and context regarding why men use violence can help future efforts to prevent IPV. We explored adult men's perspectives of IPV, livelihoods, alcohol use, gender beliefs, and childhood exposure to abuse through a secondary analysis of qualitative interviews that were conducted in South Africa. The setting was a peri-urban township characterized by high unemployment, immigration from rural areas, and low service provision. We utilized thematic qualitative analysis that was guided by the social ecological framework. Of 30 participants, 20 were residents in the neighborhood, 7 were trained community members, and 3 were program staff. Men reported consumption of alcohol and lack of employment as being triggers for IPV and community violence in general. Multiple participants recounted childhood exposure to abuse. These themes, in addition to culturally prescribed gender norms and constructs of manhood, seemed to influence the use of violence. Interventions aimed at reducing IPV should consider the cultural and social impact on men's use of IPV in low-resource, high-IPV prevalence settings, such as peri-urban South Africa. This work highlights the persistent need for the implementation of effective primary prevention strategies that address contextual and economic factors in an effort to reduce IPV that is primarily utilized by men directed at women.

Sodium Glucose Transporter 2 Inhibitors Versus Metformin on Cardiovascular and Renal Outcomes in Patients With Diabetes With Low Cardiovascular Risk: A Nationwide Cohort Study.

This study investigated whether initial SGLT2 (sodium-glucose cotransporter 2) inhibitor-based treatment is superior to metformin-based regimens as a primary prevention strategy among low-risk patients with diabetes. In this nationwide cohort study, a total of 38 496 patients with diabetes with low cardiovascular risk were identified (age 62.0±11.6 years, men 50%) from January 1 to December 31, 2016. Patients receiving SGLT2 inhibitors-based and metformin-based regimens were 1:2 matched by propensity score. Study outcomes included all-cause mortality, cardiovascular death, hospitalization for heart failure, stroke, and progression to end-stage renal disease. Compared with 1928 patients receiving metformin-based regimens, 964 patients receiving SGLT2 inhibitor-based regimens had similar all-cause mortality (hazard ratio [HR], 0.75 [95% CI, 0.51-1.12]), cardiovascular death (HR, 0.69 [95% CI, 0.25-1.89]), hospitalization for heart failure (HR, 1.06 [95% CI, 0.59-1.92]), stroke (HR, 0.78 [95% CI, 0.48-1.27]), and progression to end-stage renal disease (HR, 0.88 [95% CI, 0.32-2.39]). However, SGLT2 inhibitors were associated with a lower risk of all-cause mortality (HR, 0.47 [95% CI, 0.23-0.99]; P for interaction=0.008) and progression to end-stage renal disease (HR, 0.22 [95% CI, 0.06-0.82]; P for interaction=0.04) in patients under the age of 65. In comparison to metformin-based regimens, SGLT2 inhibitor-based regimens showed a similar risk of all-cause mortality and adverse cardiorenal events. SGLT2 inhibitors might be considered as first-line therapy in select low-risk patients, for example, younger patients with diabetes.

Multi analytical approach to find out the risk factors in terms of single nucleotide polymorphisms in patients with coronary artery disease in Indian Asian Population

Background 
 Researches have revealed a connection between CAD (coronary artery disease) and genetics, with various biochemical tests established to evaluate its severity. The incorporation of bioinformatics has advanced biomedical research and improved data management efficiency. The current study's objective was to identify risk factors in terms of Single Nucleotide Polymorphisms, associated with CAD in an Indian Asian population, utilizing a combined approach
 Methods
 The present study was completed in two phases: First phase was a literature search for susceptible SNPs and Second comprised of a cross sectional study. In first phase, using bioinformatic techniques like PubMed parser and Natural Language Processing (NLP) and manual search, we tried to find out susceptible polymorphisms to CAD. In second step, Global Screening Array (GSA) (Illumina) was performed in extracted DNA samples of 97cases and 36 controls. Different biochemical tests like Hemogram, Lipids, Fasting Blood Sugar (FBS), LFT, KFT, Vitamin D and HbA1C were also done as per standard protocol.
 Results
 In literature search from 134 studies conducted across several continents and various populations with more a million cases and controls, we could retrieve a comprehensive dataset of 261 susceptible SNPs with pooled Odd’s ratio of 1.196.
 On observing 261susceptible SNPs in our GSA results, we could find 5 SNPs with significant p value including rs187238 of IL-18 gene at chromosome 11, rs731236 and rs2228570 of VDR gene at chromosome 12, rs11556218 of gene IL16 at chromosome 15 and rs5882 of CETP gene at chromosome 16. The earlier studies had reported association of these with several disease conditions and for CAD, pathways related to endothelial damage, susceptibility of vitamin D receptor (VDR) polymorphisms and lowering HDL-cholesterol and ultimately causing CAD. But among Indian population, all only rs5882 has been studied in CAD cases and that too has not shown any association. The polymorphisms regarding VDR gene are also novel in Indian population, further biochemical co-relation done in both cases and controls revealed more percentage of Vitamin D deficient in healthy controls.
 Conclusion
 To conclude, a set of 261 susceptible SNPs for CAD was gathered and out of which association of 5 SNPs in the Indian Asian population was observed. Further, this pool can be validated in different ethnic groups and may provide a valuable screening tool to separate the vulnerable high-risk population where primary prevention strategies can be implemented. We could find, the Vitamin D deficiency may be key reason for developing the disease and further, an alarming condition for seemingly healthy population.

Proteogenomic insights into early-onset endometrioid endometrial carcinoma: predictors for fertility-sparing therapy response.

Endometrial carcinoma remains a public health concern with a growing incidence, particularly in younger women. Preserving fertility is a crucial consideration in the management of early-onset endometrioid endometrial carcinoma (EEEC), particularly in patients under 40 who maintain both reproductive desire and capacity. To illuminate the molecular characteristics of EEEC, we undertook a large-scale multi-omics study of 215 patients with endometrial carcinoma, including 81 with EEEC. We reveal an unexpected association between exposome-related mutational signature and EEEC, characterized by specific CTNNB1 and SIGLEC10 hotspot mutations and disruption of downstream pathways. Interestingly, SIGLEC10Q144K mutation in EEECs resulted in aberrant SIGLEC-10 protein expression and promoted progestin resistance by interacting with estrogen receptor alpha. We also identified potential protein biomarkers for progestin response in fertility-sparing treatment for EEEC. Collectively, our study establishes a proteogenomic resource of EEECs, uncovering the interactions between exposome and genomic susceptibilities that contribute to the development of primary prevention and early detection strategies for EEECs.

Predictive performance of machine learning compared to statistical methods in time-to-event analysis of cardiovascular disease: a systematic review protocol

BackgroundGlobally, cardiovascular disease (CVD) remains the leading cause of death, warranting effective management and prevention measures. Risk prediction tools are indispensable for directing primary and secondary prevention strategies for CVD...

Prevalence of gestational diabetes mellitus in Germany: Temporal trend and differences by regional socioeconomic deprivation.

Gestational diabetes mellitus (GDM) increases the risk for adverse pregnancy outcomes. In 2012, a general screening for GDM was introduced in Germany. The analysis is based on data from the external inpatient quality assurance for obstetrics from the years 2013 to 2021. Women with pregestational diabetes were excluded. GDM was defined either by documentation in the maternity record or by ICD diagnosis O24.4 during hospitalisation. We reported the prevalence stratified by year, maternal age and regional socioeconomic deprivation. The age-standardized prevalence of GDM continuously rose from 4.7 % in 2013 to 8.5 % in 2021. The increase was observed in all age groups. In 2021, this corresponded to 63,563 women with GDM. The prevalence was higher in highly deprived regions than in low deprived regions. A steady increase in GDM prevalence and evidence of health inequalities emphasise the need for primary prevention strategies for GDM.

Meningkatkan Minat Wanita Usia Subur (WUS) Untuk Melakukan Pemeriksaan IVA Melalui Pemberian Buku Saku

Cervical cancer is caused by HPV or Human Papilloma Virus. There are 32,469 cases per year of cervical cancer in Indonesia, with a mortality rate of 18,279 people. Efforts that can be made to increase WUS's interest in conducting IVA examinations are through health promotion activities about IVA examinations. Health promotion is one of the primary prevention that can be done to prevent cervical cancer. The primary prevention strategy that can be done is by providing health education about cervical cancer. The method chosen is to use a pocket book. Pocket books are educational information media with words that are easy to understand, illustration images that are in accordance with attractive designs so as to make WUS understand and understand material about cervical cancer. Pocket books can be taken home and read independently by WUS, so it will cause WUS interest in conducting IVA examinations.

Comorbid Patients with Abdominal Obesity and High Risk of Atrial Fibrillation: Correction of Modifiable Risk Factors as a Strategy of Primary Prevention (Prospective Study)

Aim. To assess whether correction of modifiable risk factors is efficient to prevent atrial fibrillation (AF) in comorbid patients with abdominal obesity and premature atrial contractions.Materials and Methods. We enrolled 889 comorbid patients with abdominal obesity and premature atrial contractions, aged from 58 to 72 years (average age 66.4 ± 0.7 years). The duration of follow-up was 3 years. All patients underwent correction of potentially modifiable risk factors of AF (normalisation of body weight, blood pressure, blood glucose and lipid levels, cessation of smoking, elimination of physical inactivity) until their target values were achieved. Endpoints included maintenance of sinus rhythm or registration of AF. After the follow-up, all patients could be divided into two groups: 578 (65.02%) patients with incomplete correction of risk factors, 95 (10.69%) patients who achieved target values, and 216 (24.29%) without risk factor correction.Results. Within the first two years of follow-up, the frequency of AF did not differ significantly and was 85.29%, 94.32%, and 93.47% respectively. In patients who achieved target values of potentially modifiable risk factors for > 1 year, the ratio of actual to predicted development of AF during the 2nd and 3rd year of follow-up was 57.58% and 14.29%, respectively.Conclusion. In comorbid patients with abdominal obesity and premature atrial contractions, reduction of AF was observed exclusively in patients with successful correction of all potentially modifiable risk factors for ≥ 2 years.

Associated Factors of Early Breastfeeding Initiation and Exclusive Breastfeeding in South Africa: Evidence From the South African Demographic and Health Survey

Background and aims: Breastfeeding is the most desirable nutritional source for 0‒6 month-old infants. The initiation of early and exclusive breastfeeding is essential as a robust primary health prevention strategy for many children. This study aimed to examine the prediction of factors associated with early breastfeeding initiation and exclusive breastfeeding in South Africa. Methods: The required data were extracted from the South African Demographic and Health Survey 2016. A total of 3548 respondents were included in the analysis. A multivariable logistic model was applied in the analysis to examine factors associated with breastfeeding practices. Results: About 63.3% of the respondents imitated breastfeeding within 1 hour of birth, and 31.2% were exclusively breastfed during the first 6 months. The results demonstrated that maternal age (Odds ratio [OR]=2.49, 95% CI=1.61‒3.86, P<0 .001), antenatal care (OR=0.80, 95% CI=0.67‒0.95, P=0.009), postnatal care (AOR=0.82, 95% CI=0.68‒0.99, P=0.036), and a child’s health check before leaving the hospital (AOR=0.69, 95% CI=0.56‒0.86, P<0.001) were significantly associated with low initiation of breastfeeding. Maternal age (AOR=0.44, 0.28‒0.69, P=0.001), birth order (AOR=1.71, 95% CI=1.37‒2.14, P=0.001), and child’s health check (AOR=0.63, 0.41‒0.96, P=0.033) were significantly associated with non-exclusive breastfeeding. Conclusion: A low proportion of women practice delayed breastfeeding initiation. Hence, the findings revealed that exclusive health education and counselling should be provided for mothers before, during, and after pregnancy for greater changes in the direction of the relationship between mothers’ breastfeeding initiation and performance.

Applications of Chinese Dietary Pattern Prescriptions in the Long-term Management of Cerebrovascular Diseases

Stroke is one of the major causes of death and disability worldwide. Proper diet is an important primary prevention strategy in the long-term management of cerebrovascular diseases. The currently popular MD, DASH, MIND, and Japanese dietary patterns all have significant significance in research on the prevention and treatment of cerebrovascular diseases. Due to the vast geographical area and dietary differences, there is currently a lack of comprehensive epidemiological research on dietary patterns and cerebrovascular diseases in China and a unified definition of dietary patterns. This article summarizes the characteristics of the above four dietary patterns and combines them with modern Chinese nutrition theory and epidemiological research evidence. Explore dietary patterns that are suitable for Chinese residents and provide reference for Chinese general practitioners in formulating dietary prescriptions for the long-term management of cerebrovascular diseases.

Abstract 2199: Low-carbohydrate diet score and risk of bladder cancer: Findings from the Singapore Chinese Health Study

Abstract Background. Bladder cancer is a leading tumor of urinary tract with annually 570,000+ new cases and 200,000+ deaths worldwide. In the United States, the current incidence rate of bladder cancer is 15.8 per 100,000 population with more than 82,000 new cases and more than 16,000 deaths each year. Although smoking is established as a major risk factor for bladder cancer development, accounting for 30-50% cases, the role of other modifiable risk factors, including dietary in bladder cancer remains unclear. Low-carbohydrate diet (LCD) is a dietary pattern to restrict carbohydrate and to favor protein and/or fat intakes that has recently been well-accepted for weight loss. While its short-term effect to support the weight loss has been popular, its long-term effect on chronic diseases, including cancer, needs to be elucidated. In the current analysis, we sought to determine the association between LCD scores and bladder cancer risk in the Singapore Chinese Health Study (SCHS), an ongoing prospective cohort study consisting of more than 63,000 Chinese Singaporeans, 45- 74 years of age at baseline enrollment period 1995-1998. Methods. Total, animal-based and plant-based LCD scores were derived from the baseline dietary survey data, representing summed intake of carbohydrates, fats and proteins from all dietary, animal- and plant-food sources, respectively. Bladder cancer cases were ascertained using cancer registry. Cox proportional hazard regression model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for different LCD score levels with risk of bladder cancer. Results. By December 31, 2015, or after 17.6 years of follow-up, 250 bladder cancer cases were developed within the SCHS. Total LCD score was marginally associated with increased risk of bladder cancer (HRQ4vs.Q1=1.43, 95% CI: 0.98-2.09, Ptrend = 0.06). Animal-based LCD score was significantly associated with risk of bladder cancer. The HRs and respective 95% CIs of bladder cancer for quartiles 2, 3, and 4, compared with the lowest quartile, were 1.09 (0.76-1.56), 1.17 (0.81-1.70), and 1.53 (1.09-2.17) (Ptrend=0.01). The positive association was only present in men, ever smokers, never drinkers and individuals without history of type 2 diabetes (All P’sheterogeneity>0.05). Conclusions. In a prospective cohort study of more than 63,000 Chinese Singaporeans, we found that animal-based LCD score, representing a diet with lower carbohydrate and higher animal fat and protein, was significantly associated with increased risk of bladder cancer. Dietary modification is therefore suggested as an effective strategy for primary prevention of bladder cancer. Citation Format: Yen Thi-Hai Pham, Renwei Wang, Aizhen Jin, Woon-Puay Koh, Jian-Min Yuan, Hung N. Luu. Low-carbohydrate diet score and risk of bladder cancer: Findings from the Singapore Chinese Health Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2199.

Role of Breast Cancer Risk Estimation Models to Identify Women Eligible for Genetic Testing and Risk-Reducing Surgery.

Hereditary breast and ovarian cancer (HBOC) syndrome is responsible for approximately 10% of breast cancers (BCs). The HBOC gene panel includes both high-risk genes, i.e., a four times higher risk of BC (BRCA1, BRCA2, PALB2, CDH1, PTEN, STK11 and TP53), and moderate-risk genes, i.e., a two to four times higher risk of BC (BARD1, CHEK2, RAD51C, RAD51D and ATM). Pathogenic germline variants (PGVs) in HBOC genes confer an absolute risk of BC that changes according to the gene considered. We illustrate and compare different BC risk estimation models, also describing their limitations. These models allow us to identify women eligible for genetic testing and possibly to offer surgical strategies for primary prevention, i.e., risk-reducing mastectomies and salpingo-oophorectomies.

Abstract 4805: Identifying neighborhood hot spots of HPV-associated cancers for targeted interventions of HPV vaccination uptake in underserved communities of South Florida

Abstract Background: Although the incidence of cervical cancer in the US has declined, the incidences of other HPV-associated cancers are on the rise. HPV vaccination is an important primary prevention strategy for reducing the burden of HPV-associated cancers. In South Florida (population over 6 million), the percentage of adolescents aged 13-15 years who completed the recommended HPV vaccine series is 54%, which lags significantly behind the Healthy People 2030 target of 80%. In addition, vaccination disparities exist in South Florida by races/ethnicities and sexes, with non-Hispanic black males having the lowest rate at 27%. To address HPV cancer disparities, we performed a geospatial analysis on the incidence of HPV-associated cancers by sex and races/ethnicity to identify communities in South Florida with high incidence of HPV-associated cancer to target interventions that may improve HPV-vaccine uptake via community outreach and engagement. Methods: The average annual (2010-2019) incidence of HPV-associated cancers in women (cervical, oropharyngeal, vulva, vaginal, and anal) and men (oropharyngeal, penile, and anal) were calculated for Hispanics, Non-Hispanic Whites (NHWs) and Non-Hispanic Blacks (NHB) at the census tract level across South Florida using data from the Florida Cancer Data System (FCDS), the state incident cancer registry. Geospatial hot spot analyses were used to identify clusters of census tracts with high HPV cancer incidence by sex and race/ethnicity. Socioeconomic and cervical screening data of the hot spots were analyzed to identify other neighborhood risk conditions that may be associated with high HPV cancer risk. Results: For Hispanics and NHBs in South Florida, census tract hot spots for male and female HPV cancers appear to overlap in low-income neighborhoods; however, hot spots for NHW males are mostly in medium to higher income areas and do not overlap with hot spots observed for NHW females, likely given that NHW females generally report higher cervical screening rates. Conclusion: There is a positive association between male and female HPV cancer incidence in Hispanic and NHB communities of South Florida, justifying the need for increased HPV vaccination and screening programs in these neighborhoods. While increasing cervical screening rate in the hot spot neighborhoods is urgent for cervical cancer control, increasing gender-neutral HPV vaccination uptake in these communities will not only reduce the incidences of male HPV cancers but also help to accelerate cervical cancer elimination by reducing HPV infection. Citation Format: Ming Lee, Sara Parrott, Rebecca Kaiser, Ridhi Vyas, Danielle Gabuzda, Arianna Vazquez, Daniela Flores Quetant, Nancy Elliott, Valerie Bethel, Amanda Rivera, Brandon Mahal, Raymond Balise, Elizabeth Franzmann, Erin Kobetz. Identifying neighborhood hot spots of HPV-associated cancers for targeted interventions of HPV vaccination uptake in underserved communities of South Florida [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4805.

Abstract 2215: Effects of a high-fiber, high-fruit and -vegetable, low-fat dietary intervention on rectal tissue bacteria

Abstract Introduction. Emerging evidence suggests that the bacteria residing in colon and rectal tissue are plausibly associated with colorectal cancer (CRC). Prior studies investigated the effects of dietary interventions on the fecal microbiome but few assessed colorectal tissue microbiome endpoints. We investigated the effects of a high-fiber, high-fruit and -vegetable, low-fat dietary intervention on the rectal tissue microbiome in the Polyp Prevention Trial (PPT). Methods. PPT is a 4-year randomized clinical trial, with specific goals including consuming: 1) ≥ 18g of fiber per 1,000 kcal/day; 2) ≥ 3.5 servings of fruits and vegetables per 1,000 kcal/day; and 3) <20% of kcal/day from fat. We extracted DNA from rectal biopsies using the AutoGen Animal Tissue DNA Extraction Kit and sequenced the V4 region of the 16S rRNA gene to characterize the bacteria in biopsies collected at baseline and the end of years 1 and 4 (N=233 in intervention arm and N=222 in control arm). We estimated effects of the intervention on rarefied alpha diversity and a priori-selected presence and relative abundance (presented as percentages summing to 100) of 10 bacteria most strongly historically associated with CRC presence using repeated-measures linear mixed-effects models. We also explored intervention effects on presence/abundance of all bacteria (with Bonferroni correction for multiple testing) and stratified the analysis among intervention arm participants who adhered to 75% of the dietary goals (super compliers) over the 4 years (N=48) and comparable participants in the control arm (N=64). Results. The intervention did not statistically significantly modify rectal tissue alpha diversity. Compared to the control arm, relative abundance of a priori-selected Porphyromonas (absolute difference-in-difference (DiD) at T1 vs. T0 = -0.24 and T4 vs. T0 = -0.12; P=0.004) and Prevotella (absolute DiD at T1 vs. T0 = -0.40 and at T4 vs. T0 = -0.32; P=0.01) were more strongly decreased in the intervention arm. Other bacteria selected for exploratory analyses were not statistically significantly modified by the intervention after accounting for multiple testing. Among super compliers and comparable control arm participants, the findings were similarly weak. Conclusion. Overall, our findings did not strongly support that a high-fiber, -fruit, and -vegetable, and low-fat diet intervention influences rectal tissue microbiome diversity nor the abundance of most bacteria, except for two oral-originating bacteria that were previously associated with CRC presence. It is possible that dietary exposures over longer periods of time (than 4 years) may more strongly influence the tissue microbiome. Future intervention studies, including tissue samples collected throughout the colon and rectum among larger, diverse study populations for longer periods of time are warranted to inform potential primary prevention strategies for CRC. Citation Format: Doratha Armenthus Byrd, Maria Gomez, Stephanie Hogue, Ana Ortega-Villa, Yunhu Wan, Andrew Warner, Bin Zhu, Casey Dagnall, Kristine Jones, Belynda Hicks, Paul Albert, Gwen Murphy, Rashmi Sinha, Emily Vogtmann. Effects of a high-fiber, high-fruit and -vegetable, low-fat dietary intervention on rectal tissue bacteria [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2215.

Mechanism of regulation of KIF23 on endometrial cancer cell growth and apoptosis

ObjectiveThe global incidence of endometrial cancer, a malignant tumor in females, is on the rise. It is one of the most common gynecological cancers. Early-stage endometrial cancers can often be treated successfully with uterine extirpation. However, those diagnosed at a later stage have a poor prognosis and encounter treatment challenges. Therefore, additional research is necessary to develop primary prevention strategies for high-risk women and improve survival rates among patients with endometrial cancer. Hence, gene therapy targeting KIF23 shows promise as an advanced strategy for the treatment of endometrial cancer.MethodsImmunohistochemistry, Western blotting, and PCR were used to examine the expression of KIF23 and its associated pathway factors in endometrial cancer tissue (specifically Ishikawa and SNGM cells, respectively). We investigated the functional roles of KIF23 using CCK-8, colony-forming proliferation assays, Transwell migration assays, and xenotransplantation in mice.ResultsImmunohistochemistry analysis showed variations in the expression levels of KIF23 between endometrial cancer tissue and normal endometrium tissue. KIF23 downregulated BAX and caspase-3 protein expression while upregulating BCL-2 protein expression. Additionally, knocking out KIF23 inhibits endometrial cancer cell proliferation and migration while promoting cell death. Mechanistically, our study provides evidence that KIF23 promotes endometrial cancer cell proliferation by activating the ERK and AKT/PI3K pathways, while simultaneously inhibiting programmed cell death in endometrial cancer.ConclusionOur study provides evidence to support the inhibition of endometrial cancer by KIF23 knockdown. This offers valuable insights for future research on potential therapeutic strategies for this type of cancer.Graphical

Environmental Interventions for Preventing Atopic Diseases.

In this review, we detail the exposome (consisting of environmental factors such as diet, microbial colonization, allergens, pollutants, and stressors), mechanistic and clinical research supporting its influence on atopic disease, and potentiation from climate change. We highlight contemporary environmental interventions and available evidence substantiating their roles in atopic disease prevention, from observational cohorts to randomized controlled trials, when available. Early introduction to allergenic foods is an effective primary prevention strategy to reduce food allergy. Diverse dietary intake also appears to be a promising strategy for allergic disease prevention, but additional study is necessary. Air pollution and tobacco smoke are highly associated with allergic disease, among other medical comorbidities, paving the way for campaigns and legislation to reduce these exposures. There is no clear evidence that oral vitamin D supplementation, prebiotic or probiotic supplementation, daily emollient application, and antiviral prophylaxis are effective in preventing atopic disease, but these interventions require further study. While some environmental interventions have a well-defined role in the prevention of atopic disease, additional study of many remaining interventions is necessary to enhance our understanding of their role in disease prevention. Alignment of research findings from randomized controlled trials with public policy is essential to develop meaningful public health outcomes and prevent allergic disease on the population level.

Sex-dependent effect of socioeconomic status on cardiovascular event risk in a population-based cohort of patients with type 2 diabetes.

Socioeconomic status (SES) factors often result in profound health inequalities among populations, and their impact may differ between sexes. The aim of this study was to estimate and compare the effect of socioeconomic status indicators on incident cardiovascular disease (CVD)-related events among males and females with type 2 diabetes (T2D). A population-based cohort from a southern European region including 24,650 patients with T2D was followed for five years. The sex-specific associations between SES indicators and the first occurring CVD event were modeled using multivariate Fine-Gray competing risk models. Coronary Heart Disease (CHD) and stroke were considered secondary outcomes. Patients without a formal education had a significantly higher risk of CVD than those with a high school or university education, with adjusted hazard ratios (HRs) equal to 1.24 (95%CI: 1.09-1.41) for males and 1.50 (95%CI: 1.09-2.06) for females. Patients with <18000€ income had also higher CVD risk than those with ≥18000€, with HRs equal to 1.44 (95%CI: 1.29-1.59) for males and 1.42 (95%CI: 1.26-1.60) for females. Being immigrant showed a HR equal to 0.81 (95%CI: 0.66-0.99) for males and 1.13 (95%CI: 0.68-1.87) for females. Similar results were observed for stroke, but differed for CHD when income is used, which had higher effect in females. Socioeconomic inequalities in CVD outcomes are present among T2D patients, and their magnitude for educational attainment is sex-dependent, being higher in females, suggesting the need to consider them when designing tailored primary prevention and management strategies.

Primary Prevention of Cardiovascular Disease in Women.

Cardiovascular disease (CVD) remains a leading cause of mortality in women, necessitating innovative primary prevention strategies. Contemporary guidelines on primary prevention of CVD highlight the increasing prevalence of CVD risk factors and emphasize the significance of female-specific risk enhancers that substantially augment the future risk of CVD. These risk factors occur throughout a woman's life cycle, such as hormonal contraception, hypertensive disorders of pregnancy, and menopause, all of which confer an added layer of risk in women beyond the conventional risk factors. Despite this, current methods may not fully capture the nuanced vulnerabilities in women that increase their risk of CVD. In this review, we highlight gender-specific risk enhancers and subsequent prevention as well as strategies to improve primary prevention of CVD in women.

Transformational narrative changes as a community-level approach to the prevention of adverse childhood experiences and substance use.

There is increasing scientific evidence linking substance use, childhood adversity, and social determinants of health. However, little research has considered the evaluation of community-level strategies to reduce substance use by increasing awareness and implementation of evidence-based strategies for preventing adverse childhood experiences (ACEs). This article lays out the conceptual framework for a $2.9 million demonstration project designed to raise awareness of the impact of ACEs on substance use, including primary prevention strategies. Communities used transformational narrative change-with an emphasis on the voices of those most impacted by ACEs and substance use-to highlight the importance of addressing social determinants of health along with primary prevention strategies. The conceptual background highlighted in this article informed media, public health, and local efforts in the three accompanying articles and invited commentary. These findings may help inform future efforts to promote community-level strategies and strengthen the evidence-base for transformational narrative change efforts.