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PubMed1995

Gender and the primary prevention of suicide mortality.

Primary prevention aims at reducing the incidence of a disorder. The first step in primary prevention involves documenting the magnitude of the problem and identifying risk factors. Consistent with primary prevention practices, we review the national and international epidemiological data on suicide mortality and then discuss the implications these data hold for primary prevention. Our approach is novel because we systematically examine the suicide epidemiology data by gender and culture. Suicide mortality appears to be highest among individuals (e.g., young adult married females in some Papua New Guinea regions; older adult, isolated, White males in the United States) for whom such behavior is culturally sanctioned. Thus, an important target for primary prevention may be local cultures of gender and suicide.

Cause of Death↗
PubMed2005

Modelling the decline in coronary heart disease deaths in England and Wales, 1981-2000: comparing contributions from primary prevention and secondary prevention.

OBJECTIVE: To investigate whether population based primary prevention (risk factor reduction in apparently healthy people) might be more powerful than current government initiatives favouring risk factor reduction in patients with coronary heart disease (CHD) (secondary prevention). DESIGN, SETTING, AND PARTICIPANTS: The IMPACT model was used to synthesise data for England and Wales describing CHD patient numbers, uptake of specific treatments, trends in major cardiovascular risk factors, and the mortality benefits of these specific risk factor changes in healthy people and in CHD patients. RESULTS: Between 1981 and 2000, CHD mortality rates fell by 54%, resulting in 68,230 fewer deaths in 2000. Overall smoking prevalence declined by 35% between 1981 and 2000, resulting in approximately 29,715 (minimum estimate 20 035, maximum estimate 44,675) fewer deaths attributable to smoking cessation: approximately 5035 in known CHD patients and approximately 24,680 in healthy people. Population total cholesterol concentrations fell by 4.2%, resulting in approximately 5770 fewer deaths attributable to dietary changes (1205 in CHD patients and 4565 in healthy people) plus 2135 fewer deaths attributable to statin treatment (1990 in CHD patients, 145 in people without CHD). Mean population blood pressure fell by 7.7%, resulting in approximately 5870 fewer deaths attributable to secular falls in blood pressure (520 in CHD patients and 5345 in healthy people) plus approximately 1890 fewer deaths attributable to antihypertensive treatments in people without CHD. Approximately 45,370 fewer deaths were thus attributable to reductions in the three major risk factors in the population: some 36 625 (81%) in people without recognised CHD and 8745 (19%) in CHD patients. CONCLUSIONS: Compared with secondary prevention, primary prevention achieved a fourfold larger reduction in deaths. Future CHD policies should prioritise population-wide tobacco control and healthier diets.

Adult↗
PubMed2000

Using communicative action in the primary prevention of cancer.

The primary prevention of disease, including cancer, has been a major part of health promotion and health education for decades. However, the long-term results of these strategies have been mixed, and primary prevention as an instrument of cancer control continues to fail to live up to either public or professional expectations. The authors identify and critique two possible factors contributing to this failure and then offer a model for the development and implementation of primary prevention strategies that addresses these factors. The model used is based on Habermas's theory of communicative action and recognizes the importance of a critical dialogue in health education and health promotion. The primary prevention programs currently being conducted by the Cancer Centre for the Southern Interior are presented as an example of the model in action.

British Columbia↗
PubMed1998

Follow-up on primary prevention trials.

Recent primary prevention trials demonstrated that cardiovascular morbidity and mortality benefits are not accompanied by adverse effects on overall mortality and morbidity in cohorts representing plasma cholesterol concentrations observed in the bulk of coronary artery disease. During the past year, further analyses of the West of Scotland Coronary Prevention Study have indicated that benefit requires a 25% reduction of LDL cholesterol and that such treatment is not very expensive when focussed on selected high-risk individuals. The Air Force/Texas Coronary Artery Prevention Study indicated that benefit is seen in individuals with even lower plasma lipid concentration. Although current treatment with lifestyle and lipid modifying drug management is successful in primary prevention, the unpredictable nature of coronary artery disease and the cost of drugs mitigate against direct application of drug management in persons with relatively low risk, but selective treatment should be undertaken in very high-risk settings. Future studies need to examine more specific at risk cohorts, test better targeted lipoprotein modification, test more risk factors and also examine whether changes in vascular function or markers of inflammation will predict a better outcome.

Cholesterol, LDL↗
PubMed2000

Dyslipidemias and the primary prevention of cardiovascular disease: analysis of the FAMUS primary care register.

BACKGROUND: Primary prevention of cardiovascular disease with a pharmacological approach to dyslipidemias is controversial. Little is known about the clinical management by general practitioners in this area. OBJECTIVES: To evaluate the patterns of treatment of patients in primary prevention who were entered in the FAmily Medicine, Université de Sherbrooke (FAMUS) register and to calculate the probability of their receiving a hypolipidemic agent according to the presence of various risk profiles. PATIENTS AND METHODS: Descriptive study based on the FAMUS prospective primary care register. Data from patients in primary prevention (those who had not sustained a cardiovascular event) were extracted and analyzed. MAIN RESULTS: Of the 52,505 patients in the register, 48, 190 were identified as being in primary prevention. Of these, 22,250 (46.2%) had a complete lipid profile on record, and 2300 had received a prescription for a hypolipidemic agent (4.8%). Patients under pharmacological treatment had significantly higher lipid values. The adjusted relative risk of being treated with a hypolipidemic agent was 1.3 for smokers, 1.3 for diabetic patients, 2.0 for those with a positive family history of premature cardiovascular disease, 2.2 for hypertensives and 3.3 for men over 45 years of age or women over 55 years, compared with patients who were not taking lipid-lowering medications. The number of risk factors was even more strongly associated with the probability of being treated. CONCLUSION: Overall, few patients in primary prevention in the register were treated with a pharmacological agent. The presence of associated risk factors in this study was an important predictor for treatment, suggesting that patients in primary prevention are being evaluated globally as a function of all of their risk factors, not just their lipid and lipoprotein levels. Further attention, nonetheless, needs to be directed to the segment of the population with multiple risk factors whose lipoprotein profile is unknown or who are not being treated to guideline target levels.

Adult↗
PubMed1983

Primary prevention of tobacco smoking.

Sixth-grade students (N = 56) were assigned randomly to one of four experimental conditions: pretest and primary prevention; primary prevention; pretest; and neither pretest nor primary prevention. In eight group sessions, primary prevention students learned facts, problem solving, decision making, self-instructions and interpersonal skills to help keep them from using tobacco. All students completed posttests and a six-month follow-up. Compared with untrained controls, trained students had greater knowledge of smoking, more perspectives on tobacco problems, better linkages between problems and solutions, more insights on the consequences of nonsmoking decisions and greater nonverbal and verbal competence in tobacco use situations. Follow-up data showed trained students with stronger commitments to tobacco abstinence, more frequent refusals of tobacco, and less smoking than controls. Midway through seventh grade, 8% of trained students and 37.5% of controls had smoked in the most recent month.

Child↗
PubMed2004

Clopidogrel added to aspirin versus aspirin alone in secondary prevention and high-risk primary prevention: rationale and design of the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial.

BACKGROUND: Clopidogrel is a more potent antiplatelet agent than aspirin, resulting in greater clinical efficacy in patients with atherothrombotic disease. Furthermore, the combination of clopidogrel plus aspirin has been demonstrated to be superior to aspirin alone in the treatment of patients with acute coronary syndromes and after coronary stenting. Whether dual antiplatelet therapy is superior to aspirin monotherapy for high-risk primary prevention and secondary prevention is unknown. METHODS AND RESULTS: The Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) study was designed to evaluate the efficacy and safety of clopidogrel plus aspirin versus placebo plus aspirin in patients with established coronary, cerebral, or peripheral arterial disease or in patients with multiple risk factors for atherothrombosis who have not yet sustained an ischemic event. This randomized, international, multicenter, double-blinded, placebo-controlled study has finished enrolling patients worldwide. A total of 15,603 patients will be followed long term. The primary end point will be the composite of vascular death, myocardial infarction, or stroke. Rates of severe bleeding will also be compared between the two arms of the study. CONCLUSIONS: This large-scale trial of patients at high risk for atherothrombotic events will allow determination of the value of a strategy of adding clopidogrel to the current standard of care, including low-dose aspirin, for a wide spectrum of patients with atherothrombosis.

Arteriosclerosis↗
PubMed2004

History of the concept of 'levels of evidence' and their current status in relation to primary prevention through lifestyle interventions.

Primary prevention is a major option to reduce the burden of chronic disease in populations. Because lifestyle interventions have proved to be effective, lifestyle recommendations including nutritional advice are made abundantly. However, both their credibility and their effectiveness are often considered not to be high. Therefore, scientific evidence should form the basis of recommendations and, as in clinical medicine, a rational approach should be followed for the evaluation of evidence. In this paper, the development and current concepts of 'levels of evidence' as they are applied in clinical medicine are outlined and their impact on evidence-based recommendations is discussed. Next, the question is raised as to how far the existing schemes are applicable to the evaluation of issues pertaining to primary prevention through lifestyle changes. Current schemes were developed mainly for clinical research questions and therefore place major emphasis on randomised controlled trials as the main and most convincing evidence in the evaluation process. These types of study are rarely available for lifestyle-related factors and might even not be feasible to obtain. Arguments are advanced to support the notion that a modification of currently existing 'levels of evidence' as developed for clinical research questions might be necessary. Thereby, one might be able to accommodate the specific aspects of evidence-related issues of recommendations for primary prevention through lifestyle changes, like dietary changes.

Diet↗
PubMed2002

[Primary prevention of malignant tumors].

Primary prevention represents an effective instrument in the battle against tumour diseases. Prevention is aimed to lower the mortality for this disease by means of reduction of the cancer incidence. Our article reviews the main fields of primary prevention, namely the principles of proper nutrition and regimen. Effects of balance in energy and related nutrients, essential components of the diet, types of meals together with problems of food processing and storage are discussed from the view of the cancer prevention. Each chapter brings applicable preventive recommendations. Smoking is considered as a risks factor not only for tumours, but also for other serious diseases. Other carcinogenic factors and possible preventive measures are referred in the last chapter. Though we know that the primary cancer prevention requires active approach of the whole society, we are certain that medical professionals in every day contact with patients can highly improve the public informedness. The article submits substrate for such discussions.

Diet↗
PubMedDate not supplied

[Guidelines for the elaboration of programs for the primary prevention of cardiovascular diseases. The Working Group for Primary Cardiovascular Prevention].

This paper, elaborated by consensus between experts from Scientific Societies and the Health Administration, is aimed at providing general guidelines for the elaboration and prompting of cardiovascular disease primary prevention programmes, through individual risk factors screening and control. It is expected to be helpful for primary care professionals. After reviewing the rationale and logistics of the programmes starting in the Spanish context, an outline for the risk screening and assessment of the individuals attending the health services is set out. The strategies for high risk individuals control and the periodic health examination of low risk subjects are developed, emphasizing the multifactorial approach. Lastly operational criteria for the management of each risk factor taking simultaneously into account the whole risk picture, embracing definition criteria and consensus recommendations, are stated.

Adult↗
PubMed2000

[Determinants of interest in primary preventive screening].

BACKGROUND: Primary prevention care requires active approach not only from the health professionals but also from all individuals of the target population. People themselves have to be interested for their own health, for the preventive examinations, for their life-style. However, the health supporting activities based on the voluntary interest are most frequently exploited by people who actually do not need it, and people of the high risks stay apart. The aim of the study was to identify major differences among those who are interested in the preventive examinations and who are not, and answer the question whether those who declare their interest are the needful and primarily aimed population. METHODS AND RESULTS: Within the preventive project, 4353 parents of school-aged children in Brno were examined using a special questionnaire. Beside interest in examination, following criteria were questioned and analysed: age, education level, economical standard, subjective evaluation of health, occurrence of concrete health problems, family health history, adequacy of the body weight (according reported height and weight), dietary habits, alcohol consumation, smoking habits, recreation-sport activities, and selected subjective perceptions. Differences based on concern about examination were evaluated by the comparison of studied parameters in groups formed according the "interest" and also using the logistic regression analysis. We found that the dominating determinant of concern about the preventive examination was the interest of the family partner (harmony of interests). In the group of persons who declared their "interest", higher education level, worse subjective evaluation of health, higher occurrence of concrete health problems, and higher incidence of selected diseases in the family were more frequently reported. Obversely, the number of smokers was lower in this group. Incidence of overweight persons differed according to their sex--meanwhile more overweight women were among the "interested group", more overweight men were among the "not interested". Women in the "interested" group consumed alcohol less frequently, men in this group were often more active in sports. Dietary habits as well as economical standard did not differ among the two groups. CONCLUSIONS: Though the differences among groups with different concern about examination were statistically different, they were not very pronounced. It cannot be confirmed that the preventive examination is exploited preferably by people without major risk factors, those socio-demographically or otherwise specific, or generally those to whom the proposal of examination was not aimed.

Attitude to Health↗
PubMed1997

Primary prevention of coronary heart disease: role of cholesterol control in the United States.

The benefit of cholesterol-lowering drug therapy in patients with existing coronary heart disease (CHD) is well established through clinical trials. Prevention of recurrent coronary morbidity and mortality in CHD patients is called secondary prevention. In contrast, primary prevention is delaying or preventing altogether new-onset-CHD. There are three categories of primary prevention: high-risk, moderate-risk, and long-term (life-time). A recent clinical trial has documented benefit of cholesterol-lowering drugs for prevention of coronary morbidity and mortality and total mortality in hyper-cholesterolemic, middle-aged men. This trial lends support for including aggressive cholesterol reduction in high-risk primary prevention. However, for such therapy to be cost effective at present-day prices of cholesterol-lowering drugs, only those patients in the higher ranges of risk can be selected for treatment. This leaves a large number of people at moderately high risk for premature CHD because of high cholesterol levels. These persons deserve increased professional attention to risk reduction. In general the nondrug approach is indicated. The latter approach includes eliminating other risk factors, e.g. cigarette smoking and hypertension, and reducing serum cholesterol levels by decreased intakes of saturated fatty acids, cholesterol, and excess total calories. Some moderate-risk patients may require low doses of cholesterol-lowering drugs to achieve the goals for cholesterol reduction. Finally, public health strategies need to be developed for applying the same nondrug approach for the general population for reducing the overall incidence of CHD.

Coronary Disease↗
PubMed1980

Toward a clarification of primary prevention.

The ambiguity of the concept of primary prevention and a vague fear that primary prevention may violate civil liberties are two of the important barriers blocking the implementation of primary prevention. Progress toward overcoming these barriers may be possible by distinguishing between the different but overlapping meanings of primary prevention. In this paper four models of primary prevention are proposed to aid definitional accuracy and to help identify and avoid those types of preventive interventions which threaten civil liberties.

Adaptation, Psychological↗