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At least 19 recordsLinked to original sources
PubMed1979

Social workers in primary prevention: action and ideology in mental health.

Primary prevention and a public health model have been among the distinguishing innovations of the community mental health movement. Social work practice, however, has historically been involved in community intervention and environmental manipulation to offset social and psychological jeopardy. Given a long tradition of commitment to activity and techniques which are now hailed as mental health's "third revolution," this study explores the role of social work in primary prevention. Data are from a survey of three community mental health centers in which professional staff completed the Gottesfeld Critical Issues of Community Mental Health questionnaire, a time-distribution form, and a prevention questionnaire. In addition, all staff working in primary prevention were interviewed in depth. The total sample of this study of mental health professionals was 84. This study points to some interesting contradictions found between social work action and ideology in primary prevention. Also, social workers are compared with other professionals in order to isolate some primary prevention tasks and attitudes that appear unique to each.

Community Mental Health Services↗
PubMed1992

[Primary prevention trial. Methodological problems].

Primary prevention trials are the best method of demonstrating the true value of medical intervention to correct abnormalities of lipid metabolism. A large number of patients must be followed up for a long period and this explains the complexity of the logistic problems which are encountered. However, these trials must conform to the classical guide lines of all clinical trials: an accurate definition of the study population, a principal criterion of adjustment which satisfies the golden rule "One question, one study".

Clinical Trials as Topic↗
PubMed1979

Primary prevention in perspective.

Discussion of primary prevention has been made difficult by lack of clarity of underlying concepts and assumptions. Is the purpose to prevent diagnosable mental illness or to prevent unhappiness and social incompetence? What are the implications of the assumption that societal stress causes mental illness? Is there a clear distinction made between major and minor mental illness? Except for a few specific conditions there is little evidence that primary prevention has been effective. The authors feel that research and program evaluation in prevention is sorely needed but should be funded separately and with discretion. Scarce mental health funds should not be diverted from direct treatment for this purpose.

Adult↗
PubMed1992

Implications of recent results of long term multifactorial primary prevention of cardiovascular diseases.

Multifactorial primary prevention trials for reduction of cardiovascular diseases have engendered disappointing results because beneficial in-trial prevention has not been obtained consistently even when risk factor levels have been significantly improved. In addition, long term follow up studies, including post-trial periods, have revealed diminished or disappeared differences in risk factor levels between treated and control groups; total and coronary mortality differences have also been reduced or the death rates have even been increased during the post-trial period of treated group over those of control subjects in a study with a consistent coronary risk reduction during the intervention period. Reasons for this enhanced coronary mortality cannot be pointed out but drug treatment, especially beta-blocking agents in mild hypertension, should be studied more carefully. Despite this discouraging mortality finding multifactorial prevention with simultaneous reduction of several coronary risk factors sounds useful provided that pharmacological prevention could be selected to give more benefit than harm.

Antihypertensive Agents↗
PubMed1992

An evaluation of a secondary school primary prevention program on violence in intimate relationships.

A large-scale primary prevention program for wife assault and dating violence was evaluated, employing a measure of attitudes, by means of the London Family Court Clinic Questionnaire on Violence in Relationships. The target audience comprised all students in four high schools. A brief intervention, including a large group presentation on wife assault and dating violence, followed by classroom discussion facilitated by community professionals was instituted. Attitudes, knowledge and behavioral intentions were assessed prior to intervention, immediately afterward, and at five to six weeks postintervention, in a stratified classroom level random sample of the participants. Significant positive attitude, knowledge, and behavioral intention changes were found at posttest, and the majority of these were maintained at delayed follow-up. Striking sex differences were found, with females consistently showing better attitudes than males. A 'backlash' effect was noted among a small number of males after the intervention. It was hypothesized that this group may already be involved in abusive behavior and require secondary, rather than primary, prevention. Students reported a high level of awareness of and experience with violence in their own and their friends' dating and family relationships, and overwhelmingly endorsed primary prevention of relationship violence in the schools.

Adolescent↗
PubMed2026

Polygenic Risk Identifies Older Adults Who May Benefit From Aspirin for the Primary Prevention of Ischemic Stroke.

BACKGROUND: Low-dose aspirin is no longer recommended for routine primary prevention in older adults due to bleeding risks outweighing vascular benefits. We hypothesized that an integrative polygenic score (iPGS) could identify a subgroup of older individuals who derive net benefit from aspirin for the primary prevention of ischemic stroke. METHODS: We performed post hoc analysis of the ASPREE randomized, placebo-controlled trial (Aspirin in Reducing Events in the Elderly) of daily 100-mg aspirin, in 12 031 genotyped participants of European ancestry aged >70 years without prior cardiovascular disease. The iPGS was derived from >1.2 million variants and evaluated both continuously and by quintiles. Cox models assessed associations between polygenic risk, ischemic stroke, and major bleeding events, and tested the interaction between the iPGS and treatment allocation, with adjustment for baseline lifestyle and clinical covariates. RESULTS: The mean age of participants was 75.1 years, and 54.9% were women. Over a median of 4.6 years, 187 ischemic strokes and 373 major bleeds occurred, including 101 intracranial bleeds (46 hemorrhagic strokes). Each 1-SD increase in the iPGS was associated with higher incident ischemic stroke risk (hazard ratio, 1.39 [95% CI, 1.20-1.62]). An interaction between the continuous iPGS and aspirin allocation was observed for ischemic stroke (P=0.04) but not major bleeding. In the highest iPGS quintile, aspirin reduced ischemic stroke by 51% (hazard ratio, 0.49 [95% CI, 0.28-0.85]) without significantly increasing major bleeding (hazard ratio, 1.15 [95% CI, 0.71-1.88]). No benefit was observed in the overall cohort or in lower-risk quintiles. CONCLUSIONS: Among older adults, high polygenic risk identifies individuals who may experience substantial stroke reduction with aspirin, with no excess bleeding. These findings raise the possibility that genomic risk stratification may enable targeted aspirin use for the primary prevention of ischemic stroke. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01038583.

Humans↗
PubMed1977

Primary prevention in community mental health centers: a survey of current activity.

About half of the current activity in consultation and education services of community mental health centers can be classified as primary prevention. Using a framework that distinguishes between institutional-level interventions (caretaker training and program consultation) and individual-level interventions (dealing with developmental or situational crises) data are presented from 43 community mental health centers on (a) specific target populations that are tapped by primary-prevention activities and (b) content of the activities. Illustrative activities are described and explanations of current trends are posited. Current programming trends in primary prevention reflect the "state of the art" today and the findings in this paper have implications for the future promotion of primary prevention activity.

Community Mental Health Services↗
PubMed2026

Eligibility of real-world patients for aspirin primary prevention trials in cardiovascular disease.

BACKGROUND: Evidence for the net benefit of aspirin for primary prevention of cardiovascular disease (CVD) is finely balanced, leading to variation in guideline recommendations internationally. External validity of randomised clinical trial (RCT) evidence may therefore be of particular importance. The aim of this study is to characterise real-world patients according to their eligibility for guideline-cited aspirin RCTs for primary CVD prevention. METHODS: Eligibility criteria from 14 RCTs were applied to a linked primary care/hospital discharge dataset of people&#x2009;&#x2265;&#x2009;40 years without CVD. Proportions eligible for each trial were calculated, and characteristics of eligible and ineligible patients compared for each trial, including Cox regression analysis of event rates for major adverse cardiovascular events (MACE), major bleeding events, and non-cardiovascular mortality. RESULTS: Of 570,211 included patients (300,500 [52.7%] women, 336,877 [59%]&#x2009;<&#x2009;60 years), the median proportion ineligible for 14 RCTs was 90.7% (range 42.5-99.4%) and 24.0% of patients were ineligible for all RCTs. On average, trial-ineligible populations were younger (median age trial-ineligible 57.8 vs trial-eligible 62.6 years, p&#x2009;=&#x2009;0.008) and a lower proportion had hypertension (23.9% vs 50.9%, p&#x2009;=&#x2009;0.004), diabetes (6.4% vs 11.5%, p&#x2009;=&#x2009;0.015), or a regular statin prescription (11.8% vs 26.7%, p&#x2009;=&#x2009;0.001). Trial-ineligible populations had a higher hazard of MACE compared to trial-eligible in four RCTs and lower in ten (hazard ratio [HR] range across all RCTs 0.45 [95%CI 0.40-0.51] to 2.78 [95%CI 2.61-2.96]). Hazards of bleeding events in the trial-ineligible were lower than the trial-eligible in eight RCTs and higher in four (HR range across all RCTs 0.63 [95%CI, 0.59-0.66] to 1.69 [95%CI, 1.53-1.86]), and time-varying hazards of non-CVD death were consistently lower in four RCTs and higher in five (HR range across all RCTs and time points 0.29 [95%CI 0.24-0.36] to 11.42 [95%CI 9.91-13.17]). CONCLUSIONS: Compared with trial-ineligible populations within the same age and sex strata, RCTs recruited people of varying CVD risk but often excluded people at high risk of bleeding or non-CVD death, highlighting that many trials may overestimate the net benefit of aspirin for primary prevention.

Humans↗
PubMed1992

The Lipid Research Clinics Coronary Primary Prevention Trial. Results of 6 years of post-trial follow-up. The Lipid Research Clinics Investigators.

BACKGROUND: Participants in the Lipid Research Clinics Coronary Primary Prevention Trial, a randomized, cholesterol-lowering trial comparing cholestyramine (N = 1907) vs placebo (N = 1899) treatment in 35- and 59-year-old asymptomatic hypercholesterolemic men, conducted between 1973 and 1983, were followed up annually from 1985 until 1989. Post-trial treatment was not provided. METHODS: Eleven predefined hypotheses pertaining to possible benefits and adverse effects of in-trial cholestyramine treatment were tested by standard statistical comparisons of the two original Coronary Primary Prevention Trial treatment groups (cholestyramine and placebo). RESULTS: Similar increasing proportions of cholestyramine and placebo used cholesterol-lowering drugs post-trial. After 13.4 years of in-trial plus post-trial follow-up, there were 13 (143 vs 156) fewer deaths in the cholestyramine group than in the placebo group. Although not statistically significant, the mortality hazard ratio (0.89) was similar to that in other cholesterol-lowering trials. This trend, a result of reduced coronary heart disease mortality, occurred despite a post-trial narrowing of the in-trial cholestyramine-placebo difference in coronary heart disease incidence from 32 (155 vs 187) to 16 (268 vs 284). The cholestyramine and placebo groups had similar 13.4-year mortality rates from cancer, other medical causes, and trauma and similar cancer incidence rates. However, 13.4-year incidences of benign colorectal tumors (50 vs 34), cancer of the buccal cavity and pharynx (eight vs two), gallbladder disease (68 vs 53), and gallbladder surgery (58 vs 40) were nonsignificantly increased in the cholestyramine group. CONCLUSION: Overall, 6 years of post-Coronary Primary Prevention Trial follow-up have not provided conclusive evidence of benefit or long-term toxicity of cholestyramine treatment beyond that evident at the cessation of the trial.

Cause of Death↗
PubMed1992

A coronary primary prevention study of Scottish men aged 45-64 years: trial design. The West of Scotland Coronary Prevention Study Group.

This paper describes the design of the West of Scotland Coronary Prevention Study (WOSCOPS) which is a primary prevention trial involving men aged 45-64 yr with raised plasma cholesterol levels. The principal aim is to test the hypothesis that reduction of serum cholesterol by treatment with pravastatin [a competitive inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase--a regulatory enzyme in cholesterol synthesis] over an average period of 5 yr will lead to a reduction in fatal and non-fatal myocardial infarction. A trial population of approx. 6500 men have been randomized in equal numbers to treatment with placebo or pravastatin. At the time of randomization, these men have no evidence of previous myocardial infarction. All subjects are given smoking and dietary advice throughout the study. The principal endpoints are: (i) coronary heart disease death plus non-fatal myocardial infarction, (ii) coronary heart disease death, and (iii) non-fatal myocardial infarction.

Cholesterol↗
PubMed1992

[Primary prevention in mental health programs. Possible or impossible? Now or later?].

The point in discussion is: Does any possibility exist of having primary prevention actions included in mental health plans and programs of the countries pertaining to the Latin-American and Caribbean region? On the one hand, such actions are becoming more and more necessary if the higher mental health demands are taken into account--which exceed the offer of services at a secondary preventive level. On the other hand, recent literature has been accumulating scientific evidence bringing rational basis for interventions at a primary preventive level. Mental health workers--if adequately trained--may find a fruitful field for action in assistance and research as well.

Humans↗
PubMed1975

Family mental health maintenance: a new approach to primary prevention.

The authors describe an approach to primary prevention in which indirect services are redefined to include community services aimed at promoting mental health and preventing emotional and mental disorders. At the Peninsula Hospital Community Mental Health Center such services are family-focused and include consultation, education, collaboration with other agencies, and early intervention with children and families with special needs. The authors describe some of the programs that have been developed and discuss how mental health Centers can conceivably, under contract, develop such community services for health maintenance organizations and other prepayment plans that provide comprehensive health maintenance and medical care.

Adolescent↗
PubMed1992

Beta-adrenergic antagonists for primary prevention of gastrointestinal hemorrhage in patients with cirrhosis and esophageal varices.

The use of beta-adrenergic antagonists for primary prevention of gastrointestinal hemorrhage in patients with cirrhosis and esophageal varices is discussed. In five controlled trials, patients with cirrhosis and endoscopically proven esophageal varices were treated with either propranolol or nadolol in doses to reduce heart rate by 20-25% or in doses to decrease hepatic vein pressure by 25% of basal levels or to a level of less than 12 mm Hg. In two of three studies, investigators found that propranolol significantly reduced frequency of initial bleeding in patients with esophageal varices. In one of two studies, nadolol significantly decreased the risk of variceal bleeding in patients with cirrhosis; in the other study, a significant difference in the frequency of initial bleeding was found only among patients who were compliant with therapy. Only one of the five studies showed a significant difference in survival between the treatment group and the placebo group. Adverse effects of therapy included dizziness, fatigue, cardiac insufficiency, Raynaud's phenomenon, and risk of bleeding associated with propranolol withdrawal. Therapy with a nonselective beta-adrenergic antagonist should be considered for primary prevention of gastrointestinal hemorrhage in patients with cirrhosis and suspected or documented large varices; however, abrupt discontinuation of the medication is associated with risk of bleeding.

Esophageal and Gastric Varices↗
PubMed1976

An instrument for differentiating programs in prevention--primary, secondary and tertiary.

Prevention programs in mental health have been developed slowly, in part due to an inadequate understanding of primary, secondary, and tertiary prevention. This paper describes an instrument developed to identify critical dimensions to consider in differentiating among prevention programs, and to help clarify the complex issues underlying the design of such programs.

Community Mental Health Services↗
PubMed1992

The case for unstable angina pectoris as a primary end point in primary prevention studies.

Coronary artery disease (CAD) primary end point definitions used in previous prevention trials are reviewed, as well as trends over time for CAD mortality, incidence and hospital discharges to see if new primary end points should be considered. CAD mortality has shown a dramatic decline in the U.S. in the last 20 years, whereas the decrease in the incidence of acute myocardial infarction (AMI) is less consistent. The decline in CAD incidence and mortality has been attributed to changes in lifestyle and increased medical/surgical intervention. Hospital discharge rates for CAD have risen during the past decade. In addition, although the rate of discharge for AMI appears to have stabilized, the rates for angina, and more dramatically for unstable angina, have increased. Unstable angina made up 4% of CAD discharges in 1980, and increased to 25% of CAD discharges in 1989. Because of these trends, future trials that rely solely on AMI as a primary end point will not reflect the actual experience with CAD presentation in the U.S. Given the greater availability of methods to diagnose unstable angina more accurately, and because of its high risk pathology, it is concluded that unstable angina should receive serious consideration as a primary end point in future primary prevention trials.

Adult↗
PubMed2025

Lp(a) testing for the primary prevention of cardiovascular disease in high-income countries: a cost-effectiveness analysis.

BACKGROUND AND AIMS: Cost-effectiveness of Lipoprotein(a) [Lp(a)] testing is not established. We aimed to evaluate the cost-effectiveness of Lp(a) testing in the cardiovascular disease (CVD) primary prevention population from healthcare and societal perspectives. METHODS: We constructed and validated a multi-state microsimulation Markov model for a population of 10,000 individuals aged between 40 and 69 years without CVD, selected randomly from the UK Biobank. The model evaluated Lp(a) testing in individuals not initially classified as high-risk based on age, diabetes status, or the SCORE-2 algorithm. Those with an Lp(a) level &#x2265;105&#xa0;nmol/L (50&#xa0;mg/dL) were treated as high risk (initiation of a statin plus blood pressure lowering). The Lp(a) testing intervention was compared to standard of care. The primary analyses were conducted from the Australian and UK healthcare perspectives in 2023AUD/GBP. A cost adaptation method estimated cost-effectiveness in multiple European countries, Canada, and the USA. RESULTS: Among 10,000 individuals, 1,807 had their treatment modified from Lp(a) testing. This led to 217 and 255 quality-adjusted life years gained in Australia and the UK, respectively, with corresponding incremental cost-effectiveness ratios of 12,134 (cost-effective) and -3,491 (cost-saving). From a societal perspective, Lp(a) testing saved $85 and &#xa3;263 per person in Australia and the UK, respectively. Lp(a) testing was cost-saving among all countries tested in the cost adaptation analysis. CONCLUSIONS: Lp(a) testing in the primary prevention population to reclassify CVD risk and treatment is cost-saving and warranted to prevent CVD.

Humans↗
PubMed1992

Primary prevention trial of oral cancer in india: a 10-year follow-up study.

Oral cancer is caused by chewing and smoking of tobacco. To assess the feasibility of primary prevention of oral cancer, two cohorts were studied in base-line surveys and then followed up annually for 10-yr in Ernakulam district of Kerala state. The intervention cohort consisted of 12212 tobacco users aged 15 yr and over, who were exposed to a concentrated program of education against tobacco use. The control cohort was a non-concurrent cohort of 6075 tobacco users studied using similar methods but with a minimal amount of advice against tobacco use. The stoppage of tobacco use increased and the incidence rate of leukoplakia decreased significantly and substantially in the intervention cohort compared to the control cohort. The decrease in the incidence of leukoplakia was indicative of the decrease in the risk of oral cancer since the two were intimately related. This study demonstrated feasibility of primary prevention of oral cancer.

Adult↗