Tertiary Prevention Strategies Research Articles

Global epidemiological trends of trachea, bronchus, and lung cancer in the elderly.

Despite most patients with trachea, bronchus, and lung (TBL) cancer being elderly, epidemiological data specific to this population remain scarce. This study aims to update and delineate the global epidemiological profile of TBL in older adults. An analysis was conducted on data from the Global Burden of Diseases (GBD) 2021 for individuals aged 60 and older. We evaluated the worldwide impact of TBL cancer by socio-demographic index (SDI), gender, and age across 204 countries and territories, including their spatial and temporal trends. The main outcomes comprised age-standardized incidence rates (ASIR), mortality rates (ASMR), disability-adjusted life years (DALY) rates (ASDR), and average annual percent change (AAPC). From 1992 to 2021, the estimated cases of TBL cancer, along with associated deaths and DALYs, increased among the elderly. The ASIR, ASMR, and ASDR all exhibited a declining trend. In 2021, East Asia faced a substantial TBL cancer burden, whereas Western Sub-Saharan Africa exhibited a notable increase over the last thirty years. In 2021, Monaco and Greenland recorded the highest ASIR, ASMR, and ASDR, while Egypt experienced the most significant rise in these rates from 1992 to 2021. The greatest affected age group was those aged 85-89. The TBL cancer burden followed distinct patterns by SDI and sex, with higher SDI regions and females facing a particularly notable increase in burden. From 1992 to 2021, smoking was the leading risk factor for TBL cancer-related deaths and DALYs in older adults, with particulate matter air pollution as a close second. The burden of TBL cancer varies widely across different regions and demographics. More attention should be paid to the elderly in higher SDI regions and females. Recognizing these trends is crucial for enhancing tertiary prevention strategies for TBL cancer and exploring innovative approaches to diagnosis and treatment.

Factors of suicide-related behaviors based on stress-vulnerability model and prevention strategies among nurses: a scoping review.

The objective of this scoping review was to explore, appraise and synthesize the current literature regarding the incidence, factors influencing, and prevention strategies related to suicide risk among nurses. An extensive literature search was conducted using databases such as PubMed, Web of Science, Medline, and Embase from its formation to June 20, 2024, specifically focusing on the suicide-related behaviors of nurses written in Chinese or English. Two researchers independently screened the literature, and disagreements were debated until a consensus was reached. Data extraction was conducted for the studies that were included. The process of data synthesis was carried out using narrative analysis. The study encompassed 40 papers from 15 different countries. This study found that nurses' suicide ideation ranged from 4.3 to 44.58%, while suicide attempts ranged from 2.9 to 12.6%. Based on the stress-vulnerability model, factors influencing nurses' suicide-related behaviors include vulnerability (personality traits, coping styles), stressors (mental disorders, workplace bullying, etc.) and protective factors (social support, resilience, etc.). The strategies for preventing nurse suicide encompass primary prevention (for all nurses), secondary prevention (for nurses at risk of suicide), and tertiary prevention (for nurses who have attempted suicide). The suicide rate among nurses exceeds that of the general population. Mental disorders and workplace bullying are significant stressors that contribute to nurse suicide. Suicide-related behaviors among nurses can be effectively prevented and managed through the implementation of the tertiary prevention strategies. Primary prevention is essential in reducing suicide. Cognitive exercises and schedule shifts reasonably are primary preventive measures tailored for nurses. This study addresses the gaps in influencing factors about suicide-related behaviors among nurses and the strategies for preventing suicide, and provides a complete review of the current situation of nurses' suicide-related behaviors, providing references for the safe management of nurses' suicide.

Prevention of liver cancer in the era of next-generation antivirals and obesity epidemic.

Preventive interventions are expected to substantially improve the prognosis of patients with primary liver cancer, predominantly hepatocellular carcinoma (HCC) and cholangiocarcinoma. HCC prevention is challenging in the face of the evolving etiological landscape, particularly the sharp increase in obesity-associated metabolic disorders, including metabolic dysfunction-associated steatotic liver disease (MASLD). Next-generation anti-HCV and HBV drugs have substantially reduced, but not eliminated, the risk of HCC and have given way to new challenges in identifying at-risk patients. The recent development of new therapeutic agents and modalities has opened unprecedented opportunities to refine primary, secondary, and tertiary HCC prevention strategies. For primary prevention (before exposure to risk factors), public health policies, such as universal HBV vaccination, have had a substantial prognostic impact. Secondary prevention (after or during active exposure to risk factors) includes regular HCC screening and chemoprevention. Emerging biomarkers and imaging modalities for HCC risk stratification and detection may enable individual risk-based personalized and cost-effective HCC screening. Clinical studies have suggested the potential utility of lipid-lowering, anti-diabetic/obesity, and anti-inflammatory agents for secondary prevention, and some of them are being evaluated in prospective clinical trials. Computational and experimental studies have identified potential chemopreventive strategies directed at diverse molecular, cellular, and systemic targets for etiology-specific and/or agnostic interventions. Tertiary prevention (in conjunction with curative-intent therapies for HCC) is an area of active research with the development of new immune-based neo/adjuvant therapies. Cholangiocarcinoma prevention may advance with recent efforts to elucidate risk factors. These advances will collectively lead to substantial improvements in liver cancer mortality rates.

Workplace Stress Management in Nursing: Addressing Burnout Syndrome and Psychosocial Factors

Introduction: Job stress was identified by the Pan American Health Organization (PAHO) as a relevant public health problem due to its negative impact on workers' health and institutional performance. The prevalence of occupational stress is higher in developing countries, significantly affecting healthcare personnel, especially nurses, due to the nature of their work. Burnout Syndrome (BS) represents an extreme manifestation of chronic stress, characterized by emotional exhaustion, depersonalization and a perception of low personal fulfillment. This phenomenon deteriorates the physical and mental health of workers and reduces the quality of services provided.Development: Job stress arises as a response to the lack of control and ability to cope with constant work demands. Among the associated psychosocial factors are work overload, conflictive relationships and lack of institutional support, accentuated by individual conditions such as gender and seniority. Karasek's Psychosocial Risk Model demonstrated that the balance between demands, control and social support is crucial to mitigate work stress. Modern institutions must address both structural and individual determinants to prevent SB and other harmful effects of stress.Conclusions: SB constitutes a critical problem in nursing, with implications for worker health and institutional efficiency. Primary, secondary and tertiary prevention strategies, together with the development of coping skills and the strengthening of institutional support, are essential. Comprehensive management of occupational stress not only improves the well-being of professionals, but also the quality and sustainability of the health care system

Local Supports to Break the Cycle: A Description of Intersectional Interventions to Address Adverse Childhood Experiences and Drug Overdose.

Adverse childhood experiences (ACEs), substance use disorders (SUDs), and overdose are interconnected issues impacting individuals and communities at multiple levels of the social ecology and across generations. Few studies describe approaches that intentionally and simultaneously address these issues. This paper examines activities of 15 sites across the country that were designed to simultaneously prevent ACEs, SUD, and overdose. This paper describes the work at the intersection as well as gaps and opportunities. Describing ways to implement intersectional programming may assist other organizations in taking similar steps in their communities. From December 2020 through July 15, 2023, funded sites received technical assistance from the National Association of County and City Health Officials and the Centers for Disease Control and Prevention for 18months to support the implementation, adaptation, and/or expansion of evidence-based programs to address ACEs, SUD, and overdose. Activities were coded to identify intersectional interventions that addressed ACEs, SUD, and overdose. Most of the ACEs prevention strategies and overdose prevention priority areas/guiding principles from which communities could choose were represented. Most activities were implemented with caregivers and families and addressed ACEs through interventions to lessen harm or to promote social norms. Primary prevention and coordination of resources were the most used overdose prevention priority area/guiding principle. It is possible to address the intersection of ACEs, SUD, and overdose on a local level. Opportunities to further address the intersection include incorporating more secondary and tertiary prevention strategies, expanding economic supports, and increasing the work focused on equity.

From crisis to chronic: a comparative analysis of Long COVID impact in Italy and the United States

Abstract Background The aftermath of COVID-19 is bringing about socio-economic consequences, such as diminished quality of life (QoL), decreased productivity, and considerable healthcare expenditures. Despite the emerging acknowledgment of a clinical syndrome following COVID-19 disease, known as Long COVID (LC), notable research gaps persist. This study aims to assess the epidemiological and economic impact of LC in both Italy and the United States (US). Methods This ecological analysis comprises epidemiologic and economic data from 2020 to January 2023, regarding working-age individuals (18-64 years). An Italy/US incidence rate ratio (eIRR) was estimated to compute LC cases in each country. The product between the value of a year spent in good health, individual Quality-Adjusted Life Year (QALY) loss, and LC cases yielded total lost QoL. Temporary productivity loss (TPL) was calculated through the Human Capital Approach. All estimates were deemed significant at a p-value less than 0.05. Results Up to date, the eIRR was 0.78 [0.43 - 0.91] implying 22% fewer LC cases in Italy with respect to the US. Total LC cases were 11 [8.7 - 13.5] and 1.8 [0.9 - 2.1] million in the US and Italy, respectively. The relative QALYs loss was 1.5 [0.8 - 3.1] and 0.2 [0.1 - 0.9] million. Reduced QoL cost roughly $189 [164 - 214] billion in the US and €6 [1 - 11] billion in Italy. TPL amounted to $37 [21 - 57] billion in the US and €2.8 [1.2 - 7.4] billion in Italy. Americans aged 30-39 years showed the largest income loss (26.6%), while in Italy it occurred in the age group 50-64 years (38%). Conclusions LC places a substantial burden in Italy and the US, impacting both the productivity of the working-age population and influencing the younger generation, who constitute the future workforce. Our study underpins the necessity for comprehensive health policies, programs, and interventions alongside effective tertiary prevention strategies to tackle the challenges posed by LC. Key messages • According to this analysis, both countries show significant productivity and quality-adjusted life years loss due to LC among working age individuals. • Steering the formulation of evidence-based sounding health policies to address LC burden, among working age individuals, both in Italy and in the US.

Targeting HPV for the prevention, diagnosis, and treatment of Cervical Cancer.

Despite advances in screening and prevention, cervical cancer (CC) remains an unresolved public health issue and poses a significant global challenge, particularly for women in low-income regions. Human papillomavirus (HPV) infection, especially with the high-risk strains, is a primary driver of cervical carcinogenesis. Emerging evidence indicates that integrating HPV testing with existing approaches, such as cervical cytology and visual inspection, offers enhanced sensitivity and specificity in CC screening. HPV infection-associated biomarkers, including HPV E6/E7 oncogenes, p16^INK4a, DNA methylation signatures, and non-coding RNAs, offer valuable insights into disease progression and the development of personalized interventions. Preventive and therapeutic vaccination against HPV, along with tertiary prevention strategies such as the use of antiviral and immune-modulating drugs for HPV-related lesions, show great clinical potential. At the mechanistic level, single-cell RNA sequencing analysis and the development of organoid models for HPV infection provide new cellular and molecular insights into HPV-related CC pathogenesis. This review focuses on the crucial roles of HPV in the prevention, diagnosis, and treatment of CC, with particular emphasis on the latest advancements in screening and disease intervention.

Enhancement of Psychosocial Competence and Well-Being of Chinese High School Students under the COVID-19 Pandemic: Tin Ka Ping P.A.T.H.S. Project in Mainland China

Mental health problem is a growing problem in mainland China and the situation has worsened under the COVID-19 pandemic. Besides focusing on tertiary and secondary prevention strategies, there is an urgent need to enhance the well-being of adolescents through primary prevention programs. During the pandemic, a positive youth development program entitled “Tin Ka Ping P.A.T.H.S. Program” was implemented in schools in mainland China. In 2022/23 academic year, students were invited to write a weekly diary on their experience about the program after completion of the program (N = 2,337). Qualitative evaluation showed that 98.2% of the students perceived the program was beneficial to their well-being in different domains. Specifically, students perceived the program enhanced their sense of community, school and academic adjustment, interpersonal relations (family relations and peer relations), and intrapersonal competence (including optimism, resilience, positive coping with stress, spirituality, life meaning and cherishing one’s life). In conjunction with other quantitative and qualitative evaluation findings, the triangulated findings strongly suggest Tin Ka Ping P.A.T.H.S. Program is a promising program that enhances the psychosocial competence and quality of life of adolescents.

Secondary and Tertiary Prevention for Adolescent Dating Violence: A Systematic Review.

Adolescent dating violence (ADV) is a pervasive public health issue associated with numerous social, psychological, and physical health consequences. Thus, programs are often implemented to prevent ADV and promote healthy relationships. Although there is a growing body of literature on primary ADV prevention strategies (i.e., prevention), little is known about secondary (e.g., early intervention) and tertiary (e.g., manage and reduce impact once occurring) ADV prevention approaches. This systematic review, guided by Cochrane Review methodology, summarizes available evidence on secondary and tertiary ADV preventive interventions. The search had no date restriction and was conducted in eight databases in November 2022. Studies published in English and/or Spanish were included if they described the development, implementation, and/or evaluation of a secondary and/or tertiary preventive intervention for ADV. After screening the titles and abstracts of 3,645 articles, 31 articles were included in this study, reporting on 14 secondary, 3 primary/secondary, 6 secondary/tertiary, and 1 tertiary ADV preventive intervention. The included studies highlighted that available secondary ADV prevention strategies are quite effective in preventing ADV victimization and perpetration, and that the effects may be strongest for teens with a higher risk of being involved in an abusive relationship. The only included study that reported on a tertiary intervention was a program development study. Based on the lack of tertiary prevention strategies available for ADV, clinical interventions focusing on treating and reducing negative consequences after ADV are needed.

Burden of six major types of digestive system cancers globally and in China.

Digestive system cancers constitute a significant number of cancer cases, but their burden is not uniform. As Global Cancer Observatory (GLOBOCAN) 2022 has recently updated its estimates of cancer burden, we aimed to investigate the burden of six major digestive system cancers both worldwide and in China, along with geographical and temporal variations in cancer-specific incidence and mortality. We extracted data on primary cancers of the esophagus, stomach, colorectum, liver, pancreas, and gallbladder from the GLOBOCAN database for 2022. Age-standardized incidence and mortality rates were calculated and stratified by sex, country, region, and human development index (HDI). We used the 2022 revision of the World Population Prospects (United Nations) to obtain demographic data for various age groups in China from 1988 to 2012 and used the joinpoint model and the average annual percentage change (AAPC) to analyze cancer incidence trends in China. In 2022, the estimated global incidence of digestive system cancers reached 4,905,882, with an estimated 3,324,774 cancer-related deaths. Colorectal cancer was most prevalent in terms of incidence and mortality. There was a significant correlation between the burden of gastrointestinal cancers and country HDI. From 1988 to 2012, the incidence of esophageal, gastric, and liver cancers declined in China, whereas colorectal and pancreatic cancer incidences continued to increase. By 2050, colorectal and liver cancers are projected to remain the leading cancer types in China in terms of incidence and mortality, respectively. Digestive system cancers remain a significant public health challenge globally and in China. Although progress has been made in the prevention and control of some cancers, the burden of digestive system cancers persists. The implementation of tertiary prevention strategies must be intensified to reduce the incidence and mortality of digestive system cancers, mitigating their impact on public health.

Educating patients about health helps slow the progression of chronic kidney disease in the eastern region of India

Abstract Background: Chronic kidney disease (CKD) poses a well-documented burden, necessitating patient awareness of the importance of healthy lifestyle modifications to mitigate co-morbidities and mortality risks. Objective: This study aimed to assess the effectiveness of education-based conservative management in mitigating disease progression among CKD patients in the eastern region of India. Materials and Methods: A total of 248 CKD patients receiving outpatient department and inpatient department care at the nephrology and dialysis department of Belle Vue Clinic, Kolkata, West Bengal, India, were included in the study. Comprehensive data encompassing demographic details, socioeconomic status, clinical co-morbidities, and conservative management interventions via patient education were examined. The study compared the rise in creatinine levels with adherence to five key factors: dietary restrictions, medication compliance, follow-up appointments with physicians, management of co-morbidities, and adherence to lifestyle modifications. Each strategy was graded on a scale of 0, 1, or 2 based on compliance, with 0 indicating minimal or no compliance, 1 indicating moderate compliance, and 2 indicating strong compliance. Results: In this study, several factors were linked to elevated creatinine levels among CKD patients, including being in the middle-age range, male gender, living predominantly in urban areas, and working in business or service occupations. Additionally, a higher prevalence of co-existing conditions such as diabetes mellitus and hypertension was noted among CKD patients, along with documented instances of polycystic kidney disease, obstructive uropathy, and renal cell carcinoma. After educating CKD patients, those who scored 8–10 on compliance exhibited a decrease in creatinine elevation (0.35 mg/dL) among 120 cases from January 2022 to June 2023. Conversely, those with scores ranging from 5 to 7 (81 cases) showed moderate creatinine elevation (1.24 mg/dL), while those with scores of 0–4 (47 cases) demonstrated higher levels of creatinine elevation (5.48 mg/dL). Conclusion: This study concludes that the conservative management of CKD patients educates individuals about primary prevention of the disorder and provides a comprehensive understanding of secondary and tertiary prevention strategies. This cost-effective approach significantly impacts physical, mental, social, and psychological adjustment behaviors.

Greenness mitigate cause-specific mortality associated with air pollutants in ischemic and hemorrhagic stroke patients: An ecological health cohort study

BackgroundAir pollution is one of the most serious environmental risks to mortality of stroke. However, there exists a noteworthy knowledge gap concerning the different stroke subtypes, causes of death, the susceptibility of stroke patient, and the role of greenness in this context. MethodsWe analyzed data from an ecological health cohort, which included 334,261 patients aged ≥40 years with stroke (comprising 288,490 ischemic stroke and 45,771 hemorrhagic stroke) during the period 2013–2019. We used Cox proportional hazards models with time-varying exposure to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the associations of annual average fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) with both all-cause and cause-specific mortality. Additionally, we conducted analyses to examine the effect modification by greenness and identify potential susceptibility factors through subgroup analyses. ResultIn multivariable-adjusted models, long-term exposure to PM2.5 and NO2 was associated with increased risk of all-cause mortality (HR: 1.038, 95% CI: 1.029–1.047 for PM2.5; HR: 1.055, 95% CI: 1.026–1.085 for NO2, per 10 μg/m3, for ischemic stroke patients; similar for hemorrhagic stroke patients). Gradually increasing effect sizes were shown for CVD mortality and stroke mortality. The HRs of mortality were slightly weaker with high versus low vegetation exposure. Cumulative exposures increased the HRs of pollutant-related mortality, and greater greenness decreased this risk. Two subtypes of stroke patients exhibited diverse patterns of benefit. ConclusionIncreasing residential greenness attenuates the increased risk of mortality with different patterns due to chronic air pollutants for ischemic and hemorrhagic stroke, offering valuable insights for precise tertiary stroke prevention strategies.

Genetic counseling for hearing loss today

Genetic counseling for hearing loss today originated from decoding the genetic code of hereditary hearing loss, which serves as an effective strategy for preventing hearing loss and constitutes a crucial component of the diagnostic and therapeutic framework. This paper described the main principles and contents of genetic counseling for hearing loss, the key points of counseling across various genetic models and its application in tertiary prevention strategies targeting hearing impairment. The prospects of an AI-assisted genetic counseling decision system and the envisions of genetic counseling in preventing hereditary hearing loss were introduced. Genetic counseling for hearing loss today embodies the hallmark of a new era, which is inseparable from the advancements in science and technology, and will undoubtedly contribute to precise gene intervention!

The Role of the School Nurse in Addressing Climate-Associated Illnesses: Air Quality.

Climate change is having an unprecedented influence on human health. Children's allergies and respiratory problems are increasing because of rising pollen levels and air pollution. School nurses are well positioned to prevent and treat allergies, asthma, and other respiratory conditions. Due to their consistent presence with the school setting, nurses can promote health, wellness, and academic productivity by addressing poor indoor and outdoor air quality. The purpose of this article is to increase understanding of how air quality affects the health of school-age children and to provide school nurses with primary, secondary, and tertiary prevention strategies for ensuring clean and healthy learning environments. This is the second in a series of articles aimed at raising awareness among school nurses about climate-associated illnesses and equipping them with the resources they need to protect students' health.

Prevalence of Depressive Symptoms in the Whole Spectrum of Cognitive Aging: Findings from the HELIAD Community Study

AbstractBackgroundDepressive symptoms embody a risk factor for developing age‐related cognitive impairment, while they belong to the most common non‐cognitive symptoms of dementia. The conundrum of the prevalence of depressive symptoms in older adults in the Mediterranean region, but also worldwide is vividly reflected in reported prevalence rates ranging from 7.7% in a study from Malaysia and Australia to 81.1% in India. The present study aimed to shed light on the prevalence of mild, moderate and severe depressive symptoms in the entire spectrum of cognitive aging based on a cohort of randomly selected older adults from municipal rosters of two locations in Attica and central Greece.MethodsBased on a thorough neurological and neuropsychological assessment, the diagnoses of mild cognitive impairment, Alzheimer’s dementia (AD) or dementia caused by other diseases (non‐AD) were established in participants of the Hellenic Epidemiological Longitudinal Investigation of Aging and Diet (HELIAD). The presence of depressive symptoms was tapped with the 15‐item Geriatric Depression Scale (GDS). Scores between 0‐4 point to the absence of depression, while scores between 5‐8, 9‐11, 12‐15 are compatible with mild, moderate and severe depressive symptoms, respectively. Statistical analyses were based on Pearson’s Chi‐squared test and pairwise proportions tests.ResultsThe prevalence of depressive symptoms in the total sample (n = 1937 participants; mean age 73,84 SD: 5,427, females: 1148) was 19.5% (mild 13.1%, moderate 3.8%, severe 2.5%). The prevalence of depressive symptoms in older adults without cognitive impairment was 18%, in patients with MCI 27%, in AD 25% and in non‐AD 23.5%. The differences in the distribution of depressive symptoms of different severity across the four groups reached statistical significance (chi‐squared = 28.957, df = 9, p‐value<0.001). The prevalence of moderate to severe depressive symptoms reached its maximum in AD (11.3%) and its lowest in people without cognitive impairment (5.4%).ConclusionsAlmost one out of five older adults suffered from depressive symptoms, with the prevalence and severity increasing significantly in cases of cognitively impaired individuals. These observations highlight the urgent need for raising awareness regarding the presence of depressive symptoms in older adults and improving primary, secondary and tertiary preventive strategies.

Anterior cruciate ligament injury occurrence, return to sport and subsequent injury in the Australian High Performance Sports System: A 5-year retrospective analysis

ObjectivesTo report anterior cruciate ligament (ACL) injury occurrence, return to sport (RTS) timeframes and ACL subsequent injuries recorded in the Australian High Performance Sports System according to athlete sex. MethodsACL injury data of injured athletes were prospectively collected by the treating sports and exercise physicians and physiotherapists within the Australian High Performance Sports System between January 1, 2015 and May 31, 2020. RTS time frames for ACL injuries and the proportion of subsequent ACL injuries were calculated. The RTS time was compared between sexes, age groups and ACL injury categories using the Mann-Whitney U test and the Kruskal-Wallis test. ResultsA total of 132 ACL injuries were reported in 108 athletes (77 female, 31 male). ACL injuries accounted for 6.4% of all reported knee injuries, with almost half (48.5%) of the ACL injuries reported to occur during training. Median RTS time was 369 days (IQR = 273–487), with RTS times reducing with increasing age (X2 (Zbrojkiewicz et al., 2018) = 11.781, p = 0.008). The presence of concurrent knee pathology did not significantly affect the RTS timeframes. ACL injuries were most frequently reported in netball, winter sports, basketball, field hockey and gymnastics. One quarter of the ACL reported (n = 34, 25.8%) were subsequent to a prior ACL injury, with the majority of these injuries occurring to the ipsilateral knee (n = 26) as opposed to contralateral knee (n = 6). ConclusionsDespite ACL injuries accounting for a small proportion of all knee injuries reported in the Australian High Performance Sports System, more than a quarter are subsequent to a previous ACL injury. Shorter RTS times were observed in older athletes; however, considerable periods of time-loss occur as a consequence of ACL injuries. Effective primary prevention, rehabilitation processes, and ongoing tertiary prevention strategies are warranted in this population.

Oral cancer: licensed to kill?

Oral squamous cell carcinoma (OSCC) is a lethal disease of global significance. Having previously demonstrated a rising incidence and worsening mortality in a retrospective analysis of 9,887 OSCC patients diagnosed in Queensland, Australia, the authors of this paper re-analysed patient cohort data to determine the cause of death. Overall, 5,859 patients died: 3,585 (61.2%) from a cancer related episode in the head and neck, 796 (13.6%) from cancer outside the head and neck region, and 1,478 (25.2%) from a non-cancer related cause. Improved understanding of the cause of death offers important opportunities to enhance contemporary care provision, including more accurate prediction of mortality outcomes, recognition of patients whose pre-existent comorbidities limit the efficacy of intensified treatment modalities, and the delivery of better post-treatment screening and tertiary preventive strategies.

Effectiveness of tertiary prevention on quality of life and control of risk factors in patients with ischemic coronary heart disease

Determine the effectiveness of cardiac rehabilitation (CR) as a tertiary prevention strategy in the quality of life and control of risk factors of patients with ischemic coronary heart disease (ICC) of the National Cardiovascular Institute (INCOR) of EsSalud- Lima during the year 2018. A retrospective cohort of 280 patients with a diagnosis of CCI was studied who, after medical, interventional, or surgical treatment, were referred to the INCOR CR program for tertiary prevention (PT) in 2018. The program was developed according to the institutional guide for eight weeks with exercise sessions and educational, psychological, nutritional, and recreational workshops. At the beginning and at the end of this, the QLMI-2 quality of life test was applied, and anthropometric, laboratory, and risk factor control measurements were performed. Quality of life levels at the end of CR showed a statistically significant improvement in the emotional, social, physical, and global dimensions (p < 0.001). The same behavior was observed for the nutritional variables of weight, abdominal circumference, and BMI (p < 0.001). Physical capacity showed a statistically significant improvement in the aspects of muscle strength (12.2%), physical activity (38.0%), and functional capability (25.4%) (p < 0.001). The result was not homogeneous for the biochemical metabolic variables, where glycosylated hemoglobin, glycemia, and lipid profile did not show significant improvement, except for HDL, which raised its levels statistically significantly (p < 0.001). CR is effective as a central strategy to perform tertiary prevention in patients with ICC since it notably improves quality of life and coronary risk factors.

Alberta Childhood Cancer Survivorship Research Program.

Adverse outcomes after childhood cancer have been assessed in a range of settings, but most existing studies are historical and ascertain outcomes only after 5-year survival. Here, we describe the Alberta Childhood Cancer Survivorship Research Program and its foundational retrospective, population-based cohort of Albertan residents diagnosed with a first primary neoplasm between the ages of 0 and 17 years from 1 January 2001 to 31 December 2018. The cohort was established in collaboration with the Alberta Cancer Registry and Cancer in Young People in Canada program and has been linked to existing administrative health databases and patient-reported outcome questionnaires. The cohort comprised 2580 survivors of childhood cancer, 1379 (53.4%) of whom were 5-year survivors. Approximately 48% of the cohort was female, 47% of the cohort was diagnosed between 0 and 4 years of age, and the most frequent diagnoses were leukemias (25.4%), central nervous system tumors (24.0%), and lymphomas (14.9%). Detailed treatment information was available for 1741 survivors (67.5%), with manual abstraction ongoing for those with missing data. By the study exit date, the median time since diagnosis was 5.5 years overall and 10.4 years for 5-year survivors. During the follow-up time, 82 subsequent primary cancers were diagnosed, 20,355 inpatient and 555,425 ambulatory/outpatient events occurred, 606,773 claims were reported, and 437 survivors died. The results from this research program seek to inform and improve clinical care and reduce cancer-related sequelae via tertiary prevention strategies.

Current Clinical Concepts: Exercise and Load Management of Adductor Strains, Adductor Ruptures, and Long-Standing Adductor-Related Groin Pain.

Adductor-related groin pain is a common problem in sports. Evidence-based management of athletes with adductor strains, adductor ruptures, and long-standing adductor-related groin pain can be approached in a simple yet effective and individualized manner. In most cases, managing adductor-related pain in athletes should be based on specific exercises and loading strategies. In this article, I provide an overview of the different types of adductor injuries, from acute to overuse, including their underlying pathology, functional anatomy, diagnosis, prognosis, mechanisms, and risk factors. This information leads to optimal assessment and management of acute to long-standing adductor-related problems and includes primary, secondary, and tertiary prevention strategies that focus on exercise and load-based strategies. In addition, information on different options and contexts for exercise selection and execution for athletes, athletic trainers, and sports physical therapists in adductor injury rehabilitation is provided.