Dissertations / Theses on the topic 'Primary prevention'
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Wurster, Lee Ann. "Shaken baby syndrome: a primary prevention strategy." Connect to resource, 1996. http://rave.ohiolink.edu/etdc/view.cgi?acc%5Fnum=osu1244142835.
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Frauenberg, Sarah. "Aspirin Use for Primary Prevention of Cardiovascular Disease." Diss., North Dakota State University, 2019. https://hdl.handle.net/10365/29207.
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Cardiovascular disease (CVD) is a major cause of morbidity and mortality in the United States and aspirin is a well-known medication strongly associated with CVD prevention. Aspirin has undeniable benefits in the role of secondary prevention of CVD, however, the benefits are ambiguous when associated with primary prevention. The decision to start aspirin for primary prevention becomes complicated due to aspirin?s effect on coagulation and the risk of gastric ulceration. The United States Preventive Services Task Force (USPSTF) has level B recommendations in place regarding the use of low-dose aspirin (81 mg) for primary prevention of CVD. In addition, the American Heart Association (AHA) and American College of Cardiology (ACC) developed a calculator in 2013 to determine a patient?s 10-year CVD risk. The guideline and CVD calculator offer healthcare providers an easy-to-navigate tool to determine proper patient use of aspirin. However, despite the USPSTF guideline, appropriate aspirin use remains suboptimal. Successful adoption of the 2016 USPSTF guideline on aspirin use for primary prevention of CVD by providers in two rural North Dakota communities was the goal of this practice improvement project. The project began with education to providers and staff at the rural clinics regarding the USPSTF guideline and the ACC/AHA calculator. Following the educational session, implementation of the USPSTF guideline occurred for three months. Evaluation was performed through the use of a post-implementation survey. Results of the project demonstrated increased knowledge and usage of the guideline and a positive viewpoint related to implementation of the guideline with the providers in both of the communities having plans to sustain use in future practice. Data were also collected at a health screening fair in one of the rural communities to validate whether patients were taking aspirin per USPSTF guideline. Data gathered from the fair concluded only 59% of patients (41 out of 70) were taking, or not taking, aspirin appropriately according to the USPSTF guideline. Conclusively, primary care providers would be well served by using the ACC/AHA calculator and 2016 USPSTF guideline with all patients 40-79 years of age to determine appropriate use of aspirin for primary prevention of CVD.
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Bou, Samra Sabah. "Tobacco use screening and prevention in primary care setting." free to MU campus, to others for purchase, 2000. http://wwwlib.umi.com/cr/mo/fullcit?p1400023.
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Stewart-Campbell, Rachel Monique. "Perceived Barriers for Implementing Primary Sexually Transmitted Infection Prevention." Scholar Commons, 2012. http://scholarcommons.usf.edu/etd/4409.
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Adolescents continue to be at increased risk for contracting sexually transmitted infections (STI's). This research study describes the perception of barriers that providers in the Tampa Bay area encounter when implementing primary STI prevention programs for adolescents within the community context. This study used semi structured interviews to explore perceived barriers for implementing primary such programs for adolescents in the Tampa Bay area programs. Participants reported faith based institutions/churches and schools as common sectors for presenting a variety of barriers for implementing their program. Perceptions of barriers were described as, the need to tailor program messages and presentations based on restrictions from school officials and parent's opposition to the program; the lack of appropriate places for program activities and distribution of program materials. Other issues that were identified by several participants were lack of political support for programs at the national level and the need for more funding to administer programs.
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Cullimore, John Edward. "Prospects for primary and secondary prevention of cervical adenocarcinoma." Thesis, University College London (University of London), 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.261819.
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Scott, Martha. "The primary prevention of asthma and associated allergic disease." Thesis, University of Southampton, 2013. https://eprints.soton.ac.uk/374749/.
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Bloom, Shelly. "Evaluating a primary prevention program aimed to strengthen developmental assets." Connect to resource, 2010. http://hdl.handle.net/1811/44970.
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Stratelis, Georgios. "Chronic Obstructive PulmonaryDisease : Early detection and prevention in primary care." Doctoral thesis, Linköpings universitet, Allmänmedicin, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-20736.
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Background and aims. Early detection of Chronic Obstructive Pulmonary Disease (COPD) and secondary prevention by means of smoking cessation are the only available methods of stopping the progression of the disease. The overall aim was to examine the possibilities of early detection and prevention of COPD in General Practice. The specific aims were to evaluate a method of detecting COPD at its early stages, to investigate the rate of emphysema in smokers with normal lung function and smokers defined as preclinical COPD, to investigate the effects of performed spirometries and brief smoking cessation advice on smoking habits and to test if concentrations of certain biomarkers in blood, saliva and exhaled breath condensate (EBC) could identify subjects with COPD or non-COPD subjects supposed to be at risk of developing COPD. Methods. The first study evaluated an invitational method, which offered voluntary screening spirometry to a targeted population of smokers 40-55 years old. In the second follow-up study, all smokers with COPD and half of the smokers with normal lung function (NLF) were annually invited for spirometry and brief smoking cessation advice for a duration of 3 years, with half of the smokers with NLF being tested only last year. In the third study, 54 smokers with NLF were examined with High Resolution Computed Tomography (HRCT), with blood samples also being collected from each subject. In study four, 19 subjects categorised as having COPD, 30 non-COPD subjects and 15 healthy non-smoking volunteers were studied by means of spirometry, DLCO, and analysis of biomarkers in EBC, saliva and serum. Results. A total of 512 smokers responded. The prevalence of COPD was 27.5% and was classified as mild in 85% of the sufferers, moderate in 13% and severe in 2%. At year 1, 10% of the smokers with COPD had been continuously abstinent from smoking, compared to 2% of smokers with NLF. The prolonged abstinence rate increased yearly, and at year 3 the smoking cessation rates in smokers with COPD was 25% compared to 7% in smokers with NLF. By visual analysis, HRCT showed signs of emphysema in 43% of the subjects. Emphysema was also associated with low BMI. Higher serum concentrations of lysozyme and lower DLCO were recorded in those with COPD compared to non-COPD subjects. With the exception of chlorine, none of the remaining biomarkers were detected in EBC. Conclusions. By invitational targeted screening, COPD can be easily detected in its mild stages by using spirometry. By becoming diagnosed with COPD, smokers seem to be more motivated to stop smoking, and COPD patients should repeatedly be offered spirometry and smoking cessation advice which may prevent the progression of the disease to a severe disabling form. HRCT may detect smoke related parenchymal lung damage (i.e. emphysema) in symptom-free smokers with normal spirometry. Serum lysozyme and DLCO appeared to be the strongest discriminator between COPD and non-COPD subjects. The use of EBC as a tool to measure exhaled inflammatory biomarkers involved in COPD is as yet uncertain.
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Keen, Barbara. "The role of parents in HIV/AIDS primary prevention education /." Title page, contents and abstract only, 1992. http://web4.library.adelaide.edu.au/theses/09PM/09pmk26.pdf.
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Blomfield, Penelope Ingram. "Prospects for the primary and secondary prevention of cervical cancer." Thesis, University College London (University of London), 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.261777.
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Edmunds, Laurel Devina. "Primary prevention in children at risk of obesity as adults." Thesis, University of Exeter, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.302539.
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Zaman, Sarah. "Primary prevention of death from ventricular tachyarrhythmia following myocardial infarction." Thesis, The University of Sydney, 2014. http://hdl.handle.net/2123/12454.
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Sudden cardiac death (SCD) is the commonest mode of death after acute myocardial infarction (MI). The risk of SCD is significantly higher early after MI (within the first 40 days). Patients at high risk for SCD but who have not yet experienced a life-threatening tachyarrhythmia can be targeted for a primary prevention implantable cardioverter-defibrillator (ICD). However, previous studies assessing ICD implantation early after MI have not yet shown a benefit. This thesis investigated risk stratification of patients early after MI, with a focus on the utility of electrophysiological study (EPS). This was explored in six published manuscripts all with prospective recruitment and assessment of re-vascularised patients with ST-elevation MI (STEMI). Patients underwent early assessment of left ventricular ejection fraction (LVEF) with an EPS performed if LVEF≤40%. An ICD was implanted for a positive, but not a negative EPS. The results provide observational evidence for a benefit of EPS-guided ICD implantation early after MI. In addition, the predictive utility of EPS was found to be critically dependent on the type of programmed stimulation protocol used. Confirmation of the results of this thesis in a randomised trial has the potential to change cardiology guidelines and save a large number of lives.
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Jones, Carol L. "Clinicians' Perceptions of North Carolina's 10-Year Primary Prevention Plan." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2664.
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The cost of domestic and intimate partner violence (DIPV) exceeded $8 billion annually on a national level, and North Carolina spent $307 million on DIPV and DIPV-related mental health care. Studies have shown a correlation between DIPV, mental illness, and substance abuse. North Carolina was found to have higher than normal risk factors for DIPV. In response, the Centers for Disease Control and Prevention partnered with the North Carolina Coalition Against Domestic Violence (NCCADV) to develop the NCCADV 10-year primary prevention plan. This study investigated clinicians' perceptions of the effectiveness of the plan. Phenomenological thought served as the conceptual framework. A purposive sample of 10 clinicians who worked in the region with DIPV clients in the preceding 12 months responded to semistructured interview questions that investigated their perceptions of whether the 10-year plan had a positive influence on victims and if the plan could potentially impact victims' future mental health and substance use behaviors. Interview data were transcribed, open coded, and thematically analyzed with the aid of qualitative software. Study results indicated that these clinicians believed the plan did not impact DIPV clients' current behaviors and was unlikely to have a future impact. A policy recommendation in the form of a position paper resulted from the findings, which recommended the use of mass media that encompass old and new technologies to promote primary prevention efforts by stakeholders and practitioners for the general public. This study has implications for positive social change in that it may provide knowledge to clinicians and stakeholders at the study site that aids them in understanding and preventing DIPV, in addition to promoting an overall increase in public awareness of the negative effects of DIPV.
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BRIGANTI, ROCCO. "Prevention and Protection from child abuse and neglect: a narrative perspective in school-based prevention programs." Doctoral thesis, Università degli Studi di Milano-Bicocca, 2022. http://hdl.handle.net/10281/363765.
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Dalle policies internazionali a quelle nazionali, la ricerca analizza best practices riconosciute, reviews specifiche e diversi approcci metodologici compresi diversi aspetti di analisi e ricerca quantitativa. La ricerca ha visto una dimensione esperienziale importante con differenti opportunità realizzate nel corso del percorso di dottorato, aziendali ed extra aziendali.
In specifico il percorso ha consentito la possibilità di fotografare il fenomeno in tre studi nazionali di impatto del fenomeno di abuso e maltrattamento in collaborazione con Autorità Garante dei Diritti dell’Infanzia e Adolescenza, Terre des Homme, CESVI, Ministeri (Welfare, MIUR, Politiche sociali, Sanità), ISTAT, Ordine degli Assistenti Sociali, Istituto degli Innocenti. L’impatto della prevenzione, o della mancata prevenzione, viene fortemente individuato in una dimensione quantitativa per la prima volta in Italia (2013) e aggiornata nel corso del 2020. In tutti questi studi a evidente metodologia quantitativa ho potuto svolgere ruoli di primissimo piano, dai Comitati Scientifici ai gruppi di ricerca ristretti. La produzione di questi documenti saranno focali nella tesi di dottorato inquadrando il fenomeno in maniera puntuale e associando alla dimensione quantitativa una lettura e analisi qualitativa determinante per promuovere, incrociare e innovare le policies nazionali ed internazionali sul tema.
La tesi “in impostazione” vuole mettere a punto una sorta di manuale spendibile a livello internazionale le cui collaborazioni e connessioni sono già strutturare e impostate, grazie al ruolo di co-chair scientifico di ISPCAN (International Society for Prevention Against Child Abuse and Neglect) e le dirette collaborazioni con David Finkelhor, maggior esponente mondiale relativamente alla ricerca scientifica sul focus dell’elaborato di tesi.
Le criticità incontrate sono legate alla dimensione executive che condiziona in maniera determinante tutti gli aspetti del percorso di dottorato, dalla ricerca all’incrocio strettamente operativo e meno speculativo, imprescindibile. La dimensione executive richiede inoltre, una modalità di approccio multidimensionale, multidisciplinare e, per certi versi, difficilmente circoscrivibile nel dottorato ordinario.
Questo “status” ha rappresentato e rappresenta la fatica maggiore di un percorso invece fortemente motivante e propulsivo sotto tantissimi punti di vista.
4 capitoli che passano dal quantitativo (Dossier AGIA) ad un incrocio quali-quantitativo (Indice di Maltrattamento Regionale) per una chiusura sulla dimensione più educativa. Negli ultimi due capitoli infatti si analizzerà in dettaglio quanto emerso dalla literature review da un punto di vista metodologico e di modello di intervento per poi chiudere, nel capitolo conclusivo, con una specifica analisi del modello dell’organizzazione protagonista del dottorato executive e i propri impatti.From International to National policies, the research analyses recognized best practices, specific reviews and different methodological approaches including various aspects of quantitative analysis and researches. The research has met an important experimental dimension with several opportunities realized during the course of the PhD, corporate and non-corporate. In one specific situation, the path allowed the possibility of map the phenomenon in three National studies on the impact of the phenomenon of child abuse and maltreatment in collaboration with the Autorità Garante per l’Infanzia e l’Adolescenza, Terre des Hommes, CESVI, different Government Authorities (Welfare Minister; MIUR, Social Policies and Health Ministers), Istituto degli Innocenti. The impact of prevention, CNOAS, ISTAT. The impact of prevention, or prevention, is strongly identified in a quantitative dimension for the first time in Italy (2013) and updated during 2020 from Scientific Committees to restricted research groups. The production of these documents will be focal in the doctoral thesis by framing the phenomenon in a precise way and associating the quantitative dimension with a qualitative reading and analysis that is crucial to promote, cross and innovate national and international policies on the subject. The thesis aims to develop a sort of manual that can be used internationally whose collaborations and connections are already structured and set up, thanks to the role of scientific co-chair of ISPCAN (International Society for Prevention Against Child Abuse and Neglect) and direct collaborations with David Finkelhor, the world's leading exponent of scientific research on the focus of the thesis. The critical issues encountered are linked to the executive dimension which decisively conditions all aspects of the PhD program, from research to the strictly operational and less speculative, essential intersection. Furthermore, the executive dimension is a multidimensional, multidisciplinary approach and, in some ways, requires that it can be circumscribed in the ordinary doctorate. This "status" has represented and represents the greatest effort of a path that is strongly motivating and propulsive from many points of view. 4 chapters that pass from official phenomenon mapping to a qualitative-quantitative intersection for a closure on the more educational dimension. In fact, the last two chapters will analyze in detail what emerged from the review literature from a methodological and intervention model point of view and then close, in the final chapter, with a specific analysis of the model of the organization that is the main focus of the executive doctorate and its impacts.
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Autio-Gold, J. (Jaana). "Caries prevention in high-risk preschool children in the United States." Doctoral thesis, University of Oulu, 2005. http://urn.fi/urn:isbn:9514277058.
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Dental caries is a common infectious disease affecting young children living in low-income families in the United States. Efficacious, safe, feasible and cost-effective caries prevention methods for these children are essential. Several studies have shown the efficacy of fluoride varnish and xylitol to improve the oral health of children.
The efficiency of caries prevention programs including the use of fluoride varnish or xylitol chewing gum in early childhood has not been well documented in communities with private dental services. The purpose of this study was to determine the caries prevalence and distribution in the primary dentition, and to evaluate the effectiveness of two prevention programs, including applications of fluoride varnish and the use of xylitol chewing gum in randomized groups of preschool children attending Head Start school programs in Northern Florida.
The caries preventive effect of fluoride varnish in the primary dentition was evaluated in a sample of 4–6 year-old Head Start schoolchildren in Alachua, Florida (n = 142). Caries progression after nine months was analyzed using dmf(s/t) and ds values. A modified caries scoring system, which differentiates between active and inactive carious lesions, was used to evaluate the effect of fluoride on early noncavitated enamel lesions. The effect of xylitol gum was evaluated by measuring the levels of salivary mutans streptococci before and after a three week chewing period in 3–5 year-old children attending the Head Start school in Starke, Florida (n = 61).
This study is in line with earlier reports that caries prevalence is high in Head Start preschool children. This study showed that active noncavitated enamel lesions were common in the primary dentition and that applications of fluoride varnish may offer an effective means of arresting these early enamel lesions. Chewing the xylitol gum reduced the levels of salivary mutans streptococci, thereby possibly reducing the risk for dental caries in these children.
While the detection and monitoring of early enamel lesions is critical in determining effectiveness of prevention therapy, this study suggests that fluoride varnish applications may offer an efficient, non-surgical treatment for decay in children. Also, the prevention program with xylitol may provide an additional method to be used in situations where other prevention methods are difficult to implement.
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Wollmann, Holly. "An economic evaluation of a twelve week workplace primary prevention program." Thesis, University of British Columbia, 2015. http://hdl.handle.net/2429/55154.
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With the majority of Canadians waking hours spent at the workplace place, the financial effects of absenteeism and presenteeism due to chronic disease is increasing. Healthy lifestyle behaviours (such as physical activity, proper nutrition, smoking and alcohol reduction, and mental health management) play in reducing absenteeism and presenteeim rates is crucial. A comprehensive multi-faceted 12 week wellness program (i.e., ACCELERATION) was implemented within a workplace setting to determine its effects on absenteeism and presenteeism. One hour education sessions covered a range of topics from physical activity, proper nutrition, smoking and alcohol cessation to mental health management and stress coping. Weekly one hr exercise sessions conducted with exercise logs to monitor activity/exercise levels at home. The specialized workplace wellness program was designed to examine changes healthy lifestyle behaviours in relation to employee health status, as well as absenteeism and presenteeism costs. An economic evaluation of the ACCELERATION program was created via the distribution of online questionnaires at both baseline and a 3 month follow up. A total of 50 participants, 35 females (43.4 ± 11.5 yr) and 15 males (44.9 ± 10.5 yr) completed the 12 week program. The monetary results from the evaluation reported a reduction in absence days by 54.0% from 1.40 to 0.64 per employee and a cost savings average of $155.79 per employee. Presenteeism was reduced by 17.0% from 29.0% to 12.0% equating to an average cost savings of $420.12 per employee. These results indicate that the ACCELERATION program had a positive effect on employee health costs and is a beneficial health program for the workplace.Education, Faculty of
Kinesiology, School of
Graduate
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Szirmák, Zsófia. "The big five model of personality and primary prevention in adolescence." [S.l. : s.n.], 2005. http://www.diss.fu-berlin.de/2005/232/index.html.
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Love, Thomas. "trends in the Secondary Prevention of Heart Disease in Primary Care." Thesis, University of Dundee, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.500641.
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Bain, Patricia. "Childhood unintentional home injury prevention in the primary health care setting." Thesis, Loughborough University, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.416690.
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Saini, Pooja. "Suicide prevention in mental health patients : the role of primary care." Thesis, University of Manchester, 2015. https://www.research.manchester.ac.uk/portal/en/theses/suicide-prevention-in-mental-health-patients-the-role-of-primary-care(b3f61b67-3baf-4b63-9f68-c9182c30f010).html.
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Background: Primary care may be a key setting for suicide prevention as many patients visit their General Practitioner (GP) in the weeks leading up to their death. Comparatively little is known about GPs’ perspectives on risk assessment, treatment adherence, management of and interactions with suicidal patients prior to the patient’s suicide and the services available in primary care for suicide prevention. Aim: This study aimed to explore primary care data on a clinical sample of individuals who died by suicide and were in recent contact with mental health services in order to: investigate the frequency and nature of general practice consultations; examine risk assessment, treatment adherence and management in primary and secondary care; gain GPs’ views on patient non-adherence to treatment and service availability for the management of suicidal patients. Method: A mixed-methods study design including data from the National Confidential Inquiry on 336 patients who died by suicide, data from 286 patient coroner files, primary care medical notes on 291 patients and 198 semi-structured face–to-face interviews with GPs across the North West of England. We collected data on GPs' views on the treatment and management of patients in the year prior to suicide, suicide prevention generally and local mental health service provision. Quantitative data were analysed using SPSS. Interviews were transcribed verbatim and analysed using a thematic approach. Results: Overall, 91% of individuals consulted their GP on at least one occasion in the year before suicide. GPs reported concerns about their patient’s safety in 27% of cases, but only 16% of them thought that the suicide could have been prevented. The overall agreement in the rating of risk between primary and specialist care was poor (overall kappa = 0.127; p = 0.10). Non-adherence was reported for 43% of patients. The main reasons for non-adherence were lack of insight, reported side effects and multiple psychiatric diagnoses. We obtained qualitative data from GPs on their interpretations of suicide attempts or self-harm, professional isolation and GP responsibilities when managing suicidal patients. Limitations: Our findings may not be generalisable to people who died by suicide and were not under the care of specialist services. GPs recruited for the study may have had different views from GPs who have never experienced a patient suicide. Our findings may not be representative of the rest of the UK although many of the issues identified are likely to apply across services. Conclusion: Suicide prevention in primary care is challenging. Possible strategies for future suicide prevention in general practice include: increasing GP awareness of suicide-related issues and improving training and risk assessment skills; increasing awareness in primary care about why patients may not want treatments offered by focusing on each individual’s situational context; removing barriers to accessing therapies and treatments; and, better liaison and collaboration between services to improve patient outcomes.
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Manj, Jindy. "Crime prevention for primary school aged children, towards a strategy for Nanaimo." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ28442.pdf.
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Stoffregen, Amy. "Utilizing peer drama as primary prevention of dating violence against adolescent females." Connect to resource, 2007. http://hdl.handle.net/1811/28528.
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Thesis (Honors)--Ohio State University, 2007.Title from first page of PDF file. Document formatted into pages: contains 22 p.; also includes graphics. Includes bibliographical references (p. 21-22). Available online via Ohio State University's Knowledge Bank.
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Nes, Bjarne Martens. "Peak oxygen uptake and habitual exercise as a basis for primary prevention." Doctoral thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for sirkulasjon og bildediagnostikk, 2013. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-23793.
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Maksimalt oksygenopptak (VO2peak) er rekna som ein av dei viktigaste prognostiske markørane for framtidig hjarte-/karsjukdom og tidleg død. Ettersom direkte måling av VO2peak er tidkrevjande og kostbart har implementeringa i førebyggjande helsearbeid og klinisk praksis vore begrensa. Både VO2peak og ei rekkje andre sentrale helseparameter, kan betrast ved ei viss mengd fysisk aktivitet i kvardagen, og dagens globale anbefalingar er at alle vaksne bør utføre minst 150 minutt med moderat intensitet eller minst 75 minutt med høg intensitet per veke. Utforminga av anbefalingane inneber at det totale energiforbruket, og dermed helsegevinstane, kan oppnås ved ulike tilnærmingar der kortare varigheit kan kompenserast med høgare intensitet og vice versa. I dette prosjektet nytta me data på direkte målt VO2peak frå 4631 deltakarar i den siste Helseundersøkelsen i Nord-Trøndelag (HUNT 3, 2006-08) til først å utvikle ein prediksjonsmodell for å kunne estimere VO2peak og vidare undersøke om denne modellen kunne predikere framtidig hjerte-/kardødeligheit og død uansett årsak i ein stor befolkning. Me såg vidare på korleis ulike tilnærmingar til dagens anbefalingar for fysisk aktivitet var assosiert med direkte målt VO2peak i utvalet frå HUNT. Hovedfunna i avhandlinga er at VO2peak kan estimerast relativt nøyaktig ved ein regresjonsmodell med lett tilgjengelige variablar som alder, kroppssamansetning, fysisk aktivitetsnivå og kvilepuls og at modellen kan nyttast til å kategorisere personar med låg eller høg direkte målt VO2peak. Denne modellen vart nytta til å estimere VO2peak i eit stort utval friske deltakarar frå HUNT 1 (1984-86) som vart fulgt fram til registrert dødsdato eller slutten av 2010. For kvar 3,5 mL∙kg-1∙min-1 høgare estimert VO2peak var risikoen for død av hjarte- /karsjukdom 21 % lågare for personar av begge kjønn som var under 60 år ved undersøkelsen, medan risikoen uansett dødsårsak var henholdsvis 15 % og 8 % lågare for menn og kvinner. Vidare viser me at grupper som rapporterer fysisk aktivitetsvanar i tråd med dagens anbefalingar, anten ved moderat relativ intensitet over lengre tid eller høg intensitet over kortare tid, i gjennomsnitt hadde tilfredsstillande høg og tilnærma lik VO2peak. Samtidig viser me at eit relativt begrensa antal personar som rapporterte ein tidsbruk under minimum anbefaling, men med svært høg relativ intensitet, også hadde tilsvarande høg VO2peak. Også når tidsbruken eller det samla energiforbruket var konstant fann me at dei som rapporterte høg intensitet hadde høgare VO2peak enn dei som rapporterte låg eller moderate intensitet.Directly measured peak oxygen uptake (VO2peak) is established as an important prognostic marker of cardiovascular disease and premature mortality, but is rarely evaluated for prevention purposes or in primary care settings due to costly and time-consuming procedures. Both VO2peak and several other health parameters can, however, be improved and maintained by regular exercise, and today`s recommendations suggest that all adults should do at least 150 minutes of moderate intensity or 75 minutes or vigorous intensity exercise per week. Hence, the total recommended volume or energy expenditure may be reached by strictly different approaches. In the current thesis, data on directly measured VO2peak in 4631 individuals from the third wave of the Nord-Trøndelag Health Study (HUNT 3, 2006-08), were used to first derive a simple prediction model for VO2peak that potentially could supplement direct measurements in healthcare settings and for research purposes. Next, the clinical utility of this model was examined by its ability to predict all-cause and cardiovascular mortality in a large sample of healthy men and women from the HUNT 1 (1984-86) cohort. Furthermore, we examined how different combinations of intensity and total time spent at habitual exercise were associated with VO2peak in apparently healthy, community dwelling individuals from HUNT 3. The findings in this thesis indicate that VO2peak can be predicted with reasonable accuracy by using easily available clinical and selfreported variables such as age, body composition, self-reported physical activity and resting heart rate, and that the model can be used to correctly classify subjects in the correct tail of the VO2peak distribution. For each metabolic equivalent (i.e. MET, ~3.5 mL∙kg-1∙min-1) higher CRF, the risk of CVD mortality was 21% lower in both men and women who were below 60 years at baseline, while the corresponding risk of all-cause mortality was 15% and 8% lower in men and women, respectively, for each MET higher CRF. Furthermore, we demonstrate that habitual exercise patterns of moderate intensity for a long total duration or vigorous intensity for a relatively short duration, adding up to the total volume as recommended by the health authorities, both were associated with a beneficial VO2peak –level. However, a higher VO2peak was observed among those reporting vigorous intensity compared to low and moderate intensity for a similar time spent, and energy expenditure used during exercise.
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Bonner, Carissa Erin. "Decision making and risk communication about cardiovascular disease prevention in primary care." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/13649.
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Background: Use of absolute risk (AR) guidelines for CVD prevention is suboptimal, resulting in over- and under-treatment. The concept of 'heart age' has been suggested to address barriers to AR, but there is little evidence of its efficacy. Aim: Explore GP and patient experiences of CVD risk assessment, management and communication, and experimentally test the effect of 5-year AR compared to blood pressure, cholesterol, and heart age. Methods: Semi-structured interviews with 25 GPs and 38 patients; think aloud study with 26 patients; two experiments with 144 GPs and 570 patients. Results: Medication decision making was influenced by psychosocial and individual risk factors rather than AR guidelines. GPs used subjective risk assessment strategies, had concerns about communicating AR, and did not prescribe medication based on AR even when provided. Patients disregarded heart age calculators if they received unexpected/negative results. Compared to 5-year AR, heart age increased 2-week recall, but did not improve lifestyle, inflated risk perceptions, and decreased positive emotions/credibility. Discussion: This thesis identifies targets for behavioural intervention, and suggests heart age has little benefit over 5-year AR. Capability and motivation barriers need to be addressed amongst GPs and patients to facilitate an evidence-based, shared decision making approach to CVD prevention.
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Dykstra, Aaron James. "Nutritional Prevention Of Colorectal Cancer: Attitudes And Practices Of Primary Care Providers." Diss., The University of Arizona, 2014. http://hdl.handle.net/10150/332768.
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Colorectal cancer (CRC) is a leading cause of cancer-related deaths around the world. The identification and description of many modifiable and non-modifiable risk factors to CRC has spurred the development of prevention and early detection protocols and recommendations to help reduce CRC incidence and mortality. Measures to manage CRC include diagnostic screenings and lifestyle changes. As rates of screening increase, prevention counseling rates among primary care providers (PCPs) remain low. Barriers to nutrition prevention reported by PCPs are inconsistent across the literature which has led to confusion about the reason for poor nutrition prevention efforts among PCPs. This practice inquiry (PI) addressed the identified practice gap using the Plan-Do-Study-Act (PDSA) quality improvement (QI) model. In the "Plan" phase (Chapter 2), a systematic review of the research literature determined existing nutrition recommendations for CRCs and barriers to implementation by PCPs. Development of several nutrition recommendations for fiber, vitamin D, alcohol, red and processed meats intakes, and dietary patterns were outlined for PCP use in practice. Barriers to nutrition prevention implementation were identified as time, reimbursement, knowledge, and health literacy. To augment findings from the literature, a provider survey was completed (Chapters 3-4). Barriers identified by the participants (n=47) include lack of time, education materials, nutrition knowledge, low health literacy, and lack of patient interest. These findings indicate that several changes are needed to improve the use of CRC prevention guidelines, including additional education and education materials, changes in office policy and additional research to create and analyze the interventions recommended to improve existing nutrition prevention counseling for CRC.
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Johnson, Norman Chris. "A Follow-Up Study of a Primary Prevention Program Targeting Childhood Depression." DigitalCommons@USU, 2000. https://digitalcommons.usu.edu/etd/5576.
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Children have not historically been the subject of research focusing on internalizing disorders (i.e., childhood depression), even though childhood depression continues to be viewed as one of the most prevalent affective problem within this population. Over the past two decades, a small portion of that literature describes prevention efforts in public schools. There has been a growing body of literature centered on childhood depression. However, there are only three studies that report on longitudinal findings that have taken a primary prevention approach.
The present study was a follow-up investigation to delineate the effects of a school-based primary prevention program. The original study utilized a social/ interpersonal and cognitive-behavioral model incorporated into the health education curriculum of the school.
The results of the study suggest that the students continued to report normal to low levels of depressive symptoms at one-year follow-up . The results also suggest that students maintained the social skills gained during the intervention at the one-year followup. In addition, reports of depressive symptomatology slightly declined from posttest to one-year follow-up.
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Maeng, Jae G., and Stephen A. Geraci. "Cardiovirology Clinic for Primary Prevention in HIV Patients: a Quality Improvement Assessment." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/191.
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INTRODUCTION
With effective highly active antiretroviral therapy (HAART), individuals with human immunodeficiency virus (HIV) infection now enjoy life expectancies approaching those of uninfected individuals. Prolonged longevity has increased the prevalence of non-communicable comorbidities within the HIV patient population. HIV is a known independent risk factor for atherosclerotic cardiovascular disease (ASCVD), imparting a 1.5-2 -fold higher incidence of major adverse cardiovascular events (MACE) on infected patients. Deaths from ASCVD have increased as a result, despite a decline in total mortality. The Center of Excellence for HIV/AIDS care established a Cardiovirology Clinic (CvC) focused on providing primary and secondary preventative cardiovascular care to its patients. To date, there are no known data on the efficacy of such an intervention. We sought to define the performance of this care model for primary prevention.
METHODS
Unique CvC patients (n=68) with a treatment delivery window between September 1, 2017 to August 31, 2018 were identified through billing records. All patients were receiving HAART as prescribed by their infectious disease provider. Those with established ASCVD (n=10) were excluded from analysis to limit the study to primary prevention patients. We collected data on ASCVD risk factors (family history of premature ASCVD and personal histories of smoking, diabetes, hypertension [with degree of control], dyslipidemia, drug and alcohol use, and exercise) from the electronic health record. Body-mass index and systolic (SBP) and diastolic (DBP) blood pressures were also collected. Laboratory values including CD4 cell count, HIV-1 viral load, proteinuria, glomerular filtration rate, total cholesterol (TC), triglycerides (TG), and high (HDL) and low density (LDL) lipoprotein were included in the data collection. Estimates of 5-year risk of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or need for major revascularization was calculated using the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) equations.
Patient data were de-identified. Two-tailed, paired T-testing was performed for each factor comparing the initial and most recent follow-up values. Significance was defined as p value <0.05.
RESULTS
Using univariate analysis, reductions in D:A:D risk (relative 32.01%, absolute 1.49%, p
CONCLUSION
In this initial assessment, treated HIV patients appeared to enjoy meaningful reductions in MACE risk through the preventive care they received in this clinic, suggesting that CvCs could be a partial solution to the growing ASCVD morbidity and mortality among HIV-infected individuals. Limitations of this study include a small patient population (n=58) (limiting us to univariate analyses) and short duration of follow up (≤ 1 year). Data collection will continue annually for 4 additional years. With increasing subject numbers, multivariate analyses to determine if components of ASCVD risk reduction show interactions, and which factors, interactions and interventions impart the greatest risk reduction, will be performed in improve the quality of care.
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Nwachuku, Ada Nwachuku. "Type 2 Diabetes Prevention and Management in a Primary Care Clinic Setting." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3314.
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Approximately 8.3% of the U. S. population has type 2 diabetes. Preventing the onset and improving the management type 2 diabetes are crucial for health care professionals. The purpose of this project was to develop and evaluate a type 2 diabetes prevention and management education program in a primary care setting using group medical appointments (GMAs). The chronic care model provided the framework for the study. The education program consisted of information from the Centers for Disease Control on the management of type 2 diabetes to be delivered by clinic staff using a GMA approach, a timeline for implementing the education program, and evaluation strategies for assessing patient health outcomes. Staff participants included 9 females and 1 male. One week after the presentation, staff responded to open-ended questions addressing the plan for prevention and management of type 2 diabetes. Findings indicated that staff unanimously approved the content of the program, thought the program could realistically be implemented, thought the proposed evaluation methods were appropriate, and thought the program would have a positive influence on patient health outcomes. Prevention and management education programs using a GMA approach may be used to reduce incidence and improve management of type 2 diabetes.
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Stewart, Jessica. "School-based primary prevention programmes : outcomes and the factors that affect their success." Thesis, Bangor University, 2018. https://research.bangor.ac.uk/portal/en/theses/schoolbased-primary-prevention-programmes(da7eea0a-1162-4dbd-a697-a39a0e99f2c4).html.
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This thesis explores the use of universal, prevention programmes in primary schools. A systematic literature review examined the effectiveness of universally targeted, schoolbased body-image programmes in children under 12. The review highlighted that approximately half of programmes were successful in reducing body dissatisfaction or improving body satisfaction. Improvements in other associated risk factors were also found. Not all results were maintained at follow-up and the longer-term impact of such programmes was not clear. There were also several methodological concerns that must be considered. An empirical study investigated the use of a bullying programme, KiVa, in Welsh primary schools and the school-level factors that predict outcomes. A mixed-methods approach was used with analysis of pupil survey data and interviews with school staff. KiVa was found to have a positive impact on bullying behaviour which continued as years progressed. School level free-school meal percentage as a proxy for socio-economic deprivation and additional learning needs were found to be predictive of KiVa outcome. Teachers also discussed several within school-factors that they felt affected implementation. The final chapter discusses the implication of the findings for future research and clinical application in relation to other research. Recommendations are made for how schoolbased programmes may be successful implemented within primary schools. Finally, a personal reflection of the research process is considered.
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Saaristo, T. (Timo). "Assessment of risk and prevention of type 2 diabetes in primary health care." Doctoral thesis, Oulun yliopisto, 2011. http://urn.fi/urn:isbn:9789514297113.
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Abstract Type 2 diabetes is one of the fastest increasing lifestyle diseases globally. Its cure is not yet possible, but there is firm evidence from scientific studies that it can effectively be prevented by lifestyle changes. There is limited evidence-based information on the prevention of diabetes in practice. This dissertation offers new desirable information on the issue. The aim of this dissertation study was to describe the prevalence of risk factors for type 2 diabetes and hidden glucose disorders predicting the development of diabetes in the Finnish adult population, and to analyse whether the risk for developing diabetes could be reduced by simple lifestyle counselling. Furthermore, the ability of the Finnish Diabetes Risk Score (FINDRISC) to detect glucose disorders leading to diabetes and undiagnosed diabetes was analysed. In the dissertation data from large Finnish population surveys (the FINRISK 2002 glucose tolerance survey and the FIN-D2D 2004−2005 survey) were analysed. In addition, a prospective design and large-scale intervention were included. We found that obesity and glucose disorders are very common in the Finnish middle-aged population. Prevalence of obesity was 24% for men and 28% for women, that of abnormal glucose metabolism 42% for men and 33% for women, and that of undiagnosed diabetes 9% for men and 7% for men. One quarter of individuals aged 45−64 years were at high risk for diabetes. Lifestyle interventions were offered to more than 10,000 high-risk individuals, 3,379 men and 6,770 women. Of the men, 43% were also at high risk for cardiovascular morbidity and 42% at high risk for cardiovascular mortality estimated through the FRAMINGHAM and SCORE risk engines, respectively. The FINDRISC, originally developed for predicting the risk of development of type 2 diabetes, also predicted the prevalence of diabetes in the population. The effect of lifestyle interventions on weight and its association with glucose tolerance was evaluated in individuals at high risk for diabetes in a one-year follow-up. In total 17.5% of them lost ≥ 5% weight. Their relative risk for diabetes decreased 69% compared with the group that maintained their weight. This study shows that FINDRISC predicts prevalent type 2 diabetes. A significant proportion of middle-aged Finnish population has a glucose disorder including undiagnosed type 2 diabetes. Lifestyle interventions in primary health care may promote weight loss, which decreases the risk of diabetesTiivistelmä Diabetes on yksi nopeimmin lisääntyvistä elintapasairauksista maailmassa. Sitä ei vielä voida parantaa, mutta tieteellisissä tutkimuksissa on kiistattomasti osoitettu, että sitä voidaan tehokkaasti ehkäistä elintapamuutoksilla. Diabeteksen ehkäisystä käytännössä on hyvin niukasti tutkimustietoa. Tämä väitöskirja tuo kaivattua lisätietoa aiheesta. Väitöstutkimuksen päätavoitteena oli selvittää diabeteksen riskitekijöiden ja piilevien diabetesta ennakoivien sokerihäiriöiden yleisyyttä suomalaisessa aikuisväestössä. Tämän ohella tavoitteena oli selvittää voidaanko yksinkertaisella elintapaneuvonnalla vähentää sellaisten henkilöiden sairastumisvaaraa, joilla oli suuri riski sairastua diabetekseen. Lisäksi arvioitiin diabetesriskitestin kykyä tunnistaa ennakoivat sokerihäiriöt ja aiemmin tunnistamaton diabetes. Tutkimuksessa käytettiin laajoja suomalaisia väestötutkimusaineistoja: FINRISKI-2002 -tutkimusta, sen alaotosta ja D2D-väestötutkimusta 2004–2005. Mukana oli myös pitkittäisasetelma ja laajamittainen interventio. Tutkimuksen perusteella huomasimme, että lihavuus ja sokerihäiriöt ovat hyvin yleisiä keski-ikäisillä suomalaisilla. Merkittävästi lihavia (BMI ≥ 30 kg/m2) oli 24 % miehistä ja 28 % naisista ja poikkeava sokeriaineenvaihdunta oli 42 %:lla miehistä ja 33 %:lla naisista. Tunnistamaton diabetes oli 9 %:lla miehistä ja 7 %:lla naisista. Suuressa diabetekseen sairastumisvaarassa oli neljäsosa 45−64-vuotiaista. Interventioon otettiin yli 10 000 suuressa diabeteksen sairastumisriskissä olevaa henkilöä, 3 379 miestä ja 6 770 naista. Miehistä 43 % oli suuressa sairastumisvaarassa myös sydän- ja verisuonisairauteen ja 42 % suuressa kuolemanvaarassa Framingham- ja SCORE-riskilaskureilla arvioituna. Tyypin 2 diabeteksen sairastumisriskin arviointiin kehitetty Riskitesti ennusti hyvin myös diabeteksen esiintymistä väestössä. Elintapainterventioiden vaikutusta painoon ja sokeriaineenvaihduntaan analysoitiin vuoden seurannassa sellaisilla henkilöillä, joilla oli suuri diabetesriski. Paino laski 5 % tai enemmän 17,5 %:lla, jolloin sairastumisriski diabetekseen väheni 69 % verrattuna ryhmään, jonka paino ei muuttunut. Tutkimuksen perusteella lihavuus, sokerihäiriöt ja tunnistamaton diabetes ovat yleisiä keski-ikäisessä väestössä. Riskitesti on hyvä työkalu myös diabeteksen seulonnassa. Perusterveydenhuollossa tarjottavalla elintapaneuvonnalla voidaan saada aikaan laihtuminen, joka vähentää sairastumisvaaraa diabetekseen
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Simmons, Rebecca Kate. "Reducing the burden of type 2 diabetes : public health aspects of primary prevention." Thesis, University of Cambridge, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.611898.
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Ansved, Julia, and Maja Lingerhed. "Ethiopian nurses' work with primary prevention : a minor field study in Addis Ababa." Thesis, Sophiahemmet Högskola, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-2332.
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Background One central task within nursing is health promotion, which can be done at different levels. Primary prevention aims to promote health and protect against illness by preventing problems before they occur. HIV is still a worldwide issue, yet Ethiopia is one country where efforts at preventing the spread of the virus have had positive results. Aim This study aimed to describe how nurses in Addis Ababa, Ethiopia, work with primary prevention to minimise the spread of HIV. Method The study was conducted as a qualitative field study at a hospital in Addis Ababa. Semi-structured interviews were held with seven nurses at four different units. Content analysis was used to analyse the data. Result The nurses mentioned various efforts of preventing HIV, where the main findings describe the different hands-on methods at their unit as well as the nurses’ frequent work with health education and information. An additional finding outlines the setting in which the nurses carry out their preventive work. Conclusion In conclusion, the nurses worked in a variety of ways to prevent the spread of the virus to themselves and to their patients. Screening was an important effort to minimise the exposure to other non-infected individuals. Health education and information were quoted by the majority of the nurses, but it was impacted by the awareness that the patients already exhibited. The findings show the multitude of efforts attempted at all units, which highlight the significant presence and value of health promotion within nursing.
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Armstead, Terra. "The Opioid Epidemic: Assessment of Primary Prevention Interventions in Muskingum County Public Schools." Otterbein University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1596204955483026.
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Monker, Jo-Ann (Jo-Ann Lynne) Carleton University Dissertation Psychology. "An Evaluation of the cumulative effects of participation in a primary prevention program." Ottawa, 1996.
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Dohnhammar, U. E. "Prescribing for prevention in primary care : exploring patients' views on risk management medicines." Thesis, University of Liverpool, 2016. http://livrepository.liverpool.ac.uk/3004195/.
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Prevention of disease is a key strategy in the NHS, contributing to cost-effective health care and lower morbidity and mortality through early identification and management of risk factors in large populations. However, effects of increased prescribing, in the form of a growing burden of treatment for patients and challenges associated with polypharmacy, have prompted criticism from medical practitioners as well as scholars from the biomedical and social scientific fields. Whilst a growing evidence base guides prescribing, factors in the social world also influence how medicines are used. Patients’ views on medicines are recognised as important for a good outcome of treatment, but they are not very well known with regards to risk management prescribing and polypharmacy. The research presented in this thesis draws on critical examinations of societal influences on large-scale prescribing, and focuses on cardiovascular (CVD) risk management in primary care. This approach allowed me to explore the use of medicines in a setting where prescribing is common but also involves challenges in terms of the balancing of beneficial and harmful effects for populations and individuals. General influences on patients’ expectations of prescribed medicines were addressed in a review and synthesis of medical and social scientific literature describing beliefs, views and experiences. An update of the national clinical guidance on CVD risk assessment and modification of blood lipids offered an opportunity to review how CVD risk and the benefit and harm from statins were represented in a lay context; UK newspapers. In the empirical part of the research, I explored patients’ understanding of their own use of medicines in CVD risk management. My findings produced a thematic structure describing how patients conceptualise a diagnosed CVD risk and make sense of the recommended risk management treatments. Central influences on patients’ views are a simplified representation of CVD risk as a distinct condition with particular consequences for the individual, anticipation of defined effects from medicines, and a personalised understanding of health information which leads to individual responsibility for engaging with risk management. To propose implications of my findings, I discuss them in relation to three current policy reports on disease prevention and prescribing. My study adds knowledge about a central part of modern primary care, based on suggestions of how the currently dominating approach in CVD prevention might shape people’s perspective of medicines.
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Fletcher, William S. "An accident centred approach to primary safety strategy development for vehicles." Thesis, Loughborough University, 2000. https://dspace.lboro.ac.uk/2134/7255.
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This thesis addresses the development of a methodology to determine primary safety strategy with respect to the choice of appropriate technological solutions to the problem of accidents in cars. In motorised societies in the 1990s, road accidents are a major cause of loss of life, injury and property damage. Motor manufacturers have increasingly been concerned with reducing the effects of accidents and have recently been developing technologies to attempt to reduce the number of accidents on the roads. Traditionally, these technologies have been transferred from other domains into vehicles, (principally from aerospace). Two problems however exist with this approach. Firstly, developing solutions on the basis of what is technologically feasible may ignore the requirements of the drivers in terms of systems that would actually be of benefit whilst driving. In part, this is due to an incomplete understanding of the reasons why drivers have accidents in cars. Secondly, motor manufacturers are faced with an ever increasing number of potential systems that they may develop and eventually implement in cars. Currently, they have no methodology to determine which of these systems, if any, should be researched or developed further. This thesis addresses both of these issues. Firstly, a large scale questionnaire survey was conducted using a population of recently accident involved drivers drawn from the insurance group of a major motor manufacturer. The survey was designed to obtain information from drivers pertaining to the reasons for the occurrence of their accident. This information was more detailed than had previously been gained from drivers after they have been involved in accidents in cars. This data was built upon in the second study of the thesis, which used real life accident data to develop a methodology to determine safety strategy for a motor manufacturer. Focus groups using a variety of employees of the motor manufacturer were employed to correlate accident scenarios with a series of functionally defined accident countermeasures. When combined with quantitative data from the questionnaire survey, assessments of the overall efficacy of the countermeasures could be deduced. From this, an outline strategy for primary safety system development was deduced.
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Hendrikx, Tijn. "Catch Atrial Fibrillation, Prevent Stroke : Detection of atrial fibrillation and other arrhythmias with short intermittent ECG." Doctoral thesis, Umeå universitet, Allmänmedicin, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-100497.
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Background: Atrial fibrillation (AF) is the most common arrhythmia in the adult population, affecting about 5% of the population over 65 years. Occurrence of AF is an independent risk factor for stroke, and together with other cardiovascular risk factors (CHADS2/CHA2DS2- VASc), the stroke risk increases. Since AF is often paroxysmal and asymptomatic (silent) it may remain undiagnosed for a long time and many AF patients are not discovered before suffering a stroke. Aims: To estimate the prevalence of previously undiagnosed AF in an out-of-hospital population with CHADS2 ≥1, in patients with an enlarged left atrium (LA) and of total AF prevalence in sleep apnea (SA) patients, conditions that have been associated with AF. To compare the efficacy of short intermittent ECG with continuous 24h Holter ECG in detecting arrhythmias. Methods: Patients without known AF recorded 10−30 second handheld ECG (Zenicor-EKG®) registrations during 14−28 days at home, both regular, asymptomatic registrations twice daily and when having cardiac symptoms. Recordings were transmitted through the in-built SIM card to an internet-based database. Patients with palpitations or dizziness/presyncope referred for 24h Holter ECG were asked to additionally record 30-second handheld ECG registrations during 28 days at home. Results: In the out-of-hospital population with increased stroke risk, previously unknown AF was diagnosed in 3.8% of 928 patients. Comparing AF detection in patients with an enlarged LA versus normal LA showed that eleven of 299 patients had AF. Five of these had an enlarged LA (volume/BSA). No statistical difference in AF prevalence was found between patients with enlarged and normal LA, 3.3% and 3.2% respectively, (p = 0.974). AF occurred in 7.6% of 170 patients with sleep apnea, in 15% of patients with sleep apnea ≥60 years, and in 35% of patients with central sleep apnea. AF prevalence was also associated with severity of sleep apnea, male gender and diabetes. Comparing the efficacy of arrhythmia detection in 95 patients with palpitations or dizziness/presyncope with continuous 24h Holter and short intermittent ECG, 24h Holter found AF in two and AV-block II in one patient, resulting in 3.2% relevant arrhythmias detected. Short intermittent ECG diagnosed nine patients with AF, three with PSVT and one with AV-block II, in total 13.7% relevant arrhythmias. (p = 0.0094). Conclusions: Screening in the out-of-hospital patient population (mean age 69.8 years) yielded almost 4% AF, making it seem worthwhile to screen older patients with increased stroke risk for AF with this method. Screening patients with LA enlargement (mean age 73.1 years) did not result in higher detection rates compared with the general out-of-hospital population. AF occurred in 7.6% of patients with sleep apnea, (mean age 57.6 years) and was associated with severity of sleep apnea, presence of central sleep apnea, male gender, age ≥60 years, and diabetes. Short intermittent ECG is more effective in detecting relevant arrhythmias than 24h Holter ECG in patients with palpitations or dizziness/presyncope.
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Hebden, Lana. "Prevention and Management of Weight Gain in Young Adulthood." Thesis, The University of Sydney, 2014. http://hdl.handle.net/2123/11946.
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Over the last few decades, prevalence of excess body weight has escalated among populations. Addressing this ‘obesity epidemic’ requires strategies for preventing population weight gain, particularly among groups with above average risk, such as young adults. The overarching aim of this research was to develop and evaluate a lifestyle program for the prevention and management of weight gain in young adults. Existing randomised controlled trials (RCTs) were systematically reviewed to identify characteristics of effective programs for young adults. These included self-monitoring of weight-related behaviours, tailoring feedback to be personally relevant, providing an initial consultation with subsequent support, increasing physical activity and reducing dietary energy density. Findings from this review informed the development of a mobile phone-based program which was piloted in a RCT with N=52 young adults. Participants achieved some short-term positive changes in their weight, diet and physical activity, although not significantly different from controls. Process findings from this pilot, including a preference for set weight targets, personalised regular contact, and support with planning meals and activity schedules, informed TXT2BFiT (‘Text to be fit’), a multi-component, nine-month, mobile phone-based program aimed at assisting young adults with managing their weight and weight-related dietary and physical activity behaviours. Efficacy of the TXT2BFiT program was tested in a primary RCT with a preliminary sample of N=118 young adults, found to be effective for reducing participants’ body weight, total energy intake, and frequency of energy-dense takeaway meals. Future research will test efficacy of the TXT2BFiT program among the target sample (N=352). If demonstrated to be effective, with wide reach regardless of socio-demographic profile, it may provide an equitable, cost-effective solution for the prevention and management of weight gain in young adults.
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Gavine, Anna J. "The primary prevention of violence in secondary school pupils in the West of Scotland." Thesis, University of St Andrews, 2014. http://hdl.handle.net/10023/6544.
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Violence is a leading cause of morbidity and mortality amongst young people. Public health approaches are now being increasingly utilised to reduce the risk of young peoples' involvement in violence. One such programme is Medics Against Violence (MAV), which aims to reduce pro-violent attitudes and enhance empathy in secondary school pupils. This thesis aims to investigate whether this approach can be effective in tackling youth violence in secondary school pupils. A mixed-methods approach was adopted to conduct both an outcome and process evaluation of MAV. Four schools took part in the outcome evaluation, which examined whether there was a change in attitudes towards violence or empathy in pupils receiving the MAV programme. The process evaluation consisted of focus groups with school pupils, and open-ended questionnaires and semi-structured interviews with MAV volunteers. There was a small but significant reduction in pro-violent attitudes immediately post-intervention. However, this was not sustained at three months and there was no significant increase in empathy scores. Pupils generally demonstrated anti-violent attitudes, although were more likely to support the use of reactive violence. The pupils appeared to enjoy and generally engage well with the programme. In particular, the use of real footage, interviews with those affected by violence and the Glasgow setting provided a sense of realism for the pupils. Moreover, pupils valued the opportunity to discuss the issues raised by MAV with the volunteers. Volunteers felt engagement was occasionally an issue in the most affluent areas. However, some volunteers adapted the programme to focus on victimisation prevention in the most affluent schools. Further development is therefore needed in terms of establishing who the programme is aimed at (i.e. potential victims or perpetrators), focusing on reactive violence and increasing the sustainability of its effects.
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Clinch, Amy. "A community psychology approach to preventing violent extremism : gaining the views of young people to inform primary prevention in secondary schools." Thesis, University of Birmingham, 2011. http://etheses.bham.ac.uk//id/eprint/3197/.
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The previous government developed guidelines for schools detailing primary prevention approaches that could be used to reduce risk and promote resilience in young people against extremist groups (DCSF, 2009). A community psychology approach is utilized in this research to gain the views of young people in one Local Authority (LA) about the most effective ways to implement the DSCF (2009) guidelines and build resilience locally. The guidelines will be adapted on the basis of the results so that implementation within the LA is relevant to local needs. Focus groups were designed using the structure of the Supply and Demand Model (Meah and Mellis, 2006) of radicalisation and were held with Year 9 students (n=22) from three secondary schools within the LA. A thematic analysis approach was taken to analyse the data gathered. The students developed their own thoughts about effective strategies to prevent violent extremism, which included: developing an environment that facilitates a sense of belonging in school; and providing opportunities for positive multi-cultural experiences. Students had concerns about approaches that encourage debates on current affairs (DCSF, 2009) because they felt this would create hostility in school. It was felt by participants that preventative approaches should focus on primary schools because secondary aged students already have established, fixed ideas. The utility of the Supply and Demand model (Meah and Mellis, 2006) as a risk and resilience framework for violent extremism is discussed.
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Dane, Andrew V. "Program integrity in primary and early secondary prevention, preserving what works across diverse settings." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/MQ28705.pdf.
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Kenton, Nicole. "A model of volunteer progression, supporting and sustaining volunteerism in a primary prevention project." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ65200.pdf.
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Kuiper, Sandra. "Family history of asthma prognostic impact in infants and cost-effectiveness of primary prevention /." [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Universiteit Maastricht [host], 2007. http://arno.unimaas.nl/show.cgi?fid=7930.
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Mouton, Jeannie. "Disabled persons : predictors for the risk of contracting HIV/AIDS and primary prevention strategies." Thesis, Stellenbosch : Stellenbosch University, 2003. http://hdl.handle.net/10019.1/53394.
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On t.p.: Master of Arts (Clinical Psychology)Thesis (MA)--Stellenbosch University, 2003.
ENGLISH ABSTRACT: Progress has been made in the approach to combating the spread of HIV/AIDS with regards to the Department of Health's presentation of the HIV/AIDS/STD Strategic Plan for South Africa. However, deep concem exists with regards to specific marginalized groups such as disabled persons within the South African sector threatened by the spread of HIV/AIDS. The aim of this paper was to review published academic papers on the specific ways in which disabled people are at risk for contracting HIV/AIDS, and the existence of primary prevention programmes designed and specifically aimed at the disability sector. The roles of non-governmental and other organisations were also looked at. The first section of the review focused on high-risk behaviour among disabled persons for contracting HIV/AIDS. Existing literature covered mainly areas of intellectual disability and psychiatric disability. Disabled persons struggle with the same issues of good education, workers' rights, gender equality, health care and social support and well-being as the general population. These issues are however exacerbated by struggles unique to those living with a disability. Inadequate public and social support increase disabled people's vulnerability to issues such as poverty, lack of resources, and inadequate education, heightening their risk of contracting HIV/AIDS. The second section of the review discusses the area of primary prevention, explaining why prevention programmes should be tailormade for specific needs such as those of disabled persons. Examples of prevention programmes from the literature are looked at, as well as a prevention initiative launched in South Africa.
AFRIKAANSE OPSOMMING: Vooruitgang is gemaak op die gebied van die voorkoming van die verspreiding van MIVNIGS met die bekendstelling van die Departement van Gesondheid se MIVNIGS/STD Strategiese Plan vir Suid-Afrika. Daar is wel steeds kommer oor spesifieke gemarginaliseerde groepe, soos gestremde persone, binne die Suid- Afrikaanse sektor wat bedreig word deur die verspreiding van MIVNIGS. Die doel van die studie was om 'n oorsig te kry van akademiese materiaal wat gepubliseer is oor die spesifieke wyses waarop mense met 'n gestremdheid in gevaar verkeer om MIVNIGS op te doen, asook primêre voorkomingsprogramme wat spesifiek ontwerp en gemik is op die gestremde sektor. Daar is ook gekyk na die rol van nie-regerings- en ander organisasies. Die eerste deel van die studie fokus op hoë risiko gedrag van gestremde persone wat hulle in gevaar mag stel vir die opdoen van MIVNIGS. Bestaande literatuur handel meestaloor die areas van intellektuele gestremdheid en psigiatriese siektes. Gestremde persone moet dieselfde uitdagings oorkom as diegene in die algemene populasie, soos byvoorbeeld die gebrek aan goeie onderwys, arbeidsregte, diskriminasie op grond van geslag, gesondheidssorg, asook sosiale steun en algemene welsyn. Gestremde persone se kwessies word egter vererger deur sekere uitdagings wat uniek is aan 'n lewe met 'n gestremdheid. Gestremde persone ontvang meestalonvoldoende publieke en sosiale steun wat dikwels armoede, gebrek aan hulpbronne en onvoldoende opvoeding tot gevolg het. Laasgenoemde verhoog gestremde persone se kanse om MIVNIGS op te doen. Die tweede deel van die studie bespreek primêre voorkomingsprogramme en waarom dit noodsaaklik is om voorkomingsprogramme te ontwerp wat uitsluitlik gemik is op spesifieke populasies. Daar word dan ook gekyk na voorbeelde van primêre voorkomingsprogramme in die literatuur, asook 'n voorkomingsinisiatief wat in Suid-Afrika geloods is.
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Calhoun, McKenzie L., L. Brian Cross, and Rhonda M. Cooper-Dehoff. "Clinical Utility of Beta-Blockers for Primary and Secondary Prevention of Coronary Artery Disease." Digital Commons @ East Tennessee State University, 2013. https://doi.org/10.1586/erc.13.16.
Full textAbstract:
Evaluation of: Bangalore S, Steg PG, Deedwania P et al. β-Blocker use and clinical outcomes in stable outpatients with and without coronary artery disease. JAMA 308(13), 1340–1349 (2012).
The number of myocardial infarctions (MIs) in population remains high and this event is a significant predictor of mortality. Information in the literature points to a reduction in mortality, reinfarction and sudden death in first year, especially in patients with high risk, if β-blockers (BBs) are used after MI. In a perspective study, Zuckerman et al. have determined outcome following pharmacotherapy after acute MI in older adults. It is apparent that a number of matters require consideration in evaluation of the effectiveness of BBs. It seems that not all patients benefit equally from treatment with BBs but such an intervention reduces mortality. It is also important to recognize that the beneficial effects of BBs should not be considered in isolation since the biological system is too complex to manipulate with the use of a single class of drugs.
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Vuong, Kylie. "Transforming melanoma prevention: The development, validation and efficacy of model-generated risk predictions in Australian primary care." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17876.
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Personalised model generated risk predictions that incorporate several risk factors may motivate people to increase sun protection. The aim of the thesis is to evaluate and build the quality of the evidence for melanoma risk prediction models, contribute to knowledge of melanoma risk factors for inclusion in risk prediction models, and evaluate their effectiveness as preventive tools inclinical practice. Chapter 1 presents an overview of the epidemiology and role of melanoma risk prediction models in prevention. Chapter 2 presents the results of a systematic review of melanoma risk prediction models. The systematic review identified 28 melanoma risk prediction models. However, there was limited reporting of model development and performance measures, and few studies were externally validated or prospectively evaluated in clinical settings. Chapter 3 evaluates occupational sun exposure and melanoma risk to improve understanding of whether this risk factor should be considered for inclusion in risk prediction models by use of two population based case control studies. There was no association between occupational sun exposure and melanoma risk overall or according to anatomical site. Chapters 4 and 5 presents the development and validation of two melanoma risk prediction models, one using self assessed risk factors and the other using clinicallyassessed risk factors. Chapter 6 presents the results of a pragmatic randomised controlled trial, in which 272 Australian general practice patients were randomly allocated to receive (1) real time personalised model generated risk predictions based on self assessed risk factors and tailored prevention advice, or (2) generic prevention advice. There were no statistically significant differences between intervention and control patients in sun protection practices (p=0.13). However average risk patients in the intervention group appeared to show greater sun protection at 6 weeks (mean difference=0.23, on a scale of 1 to 5; 95% confidence interval: 0.01 to 0.45; p=0.04). This thesis adds high quality evidence relevant to the prevention of me lanoma from the development and validation of model generated risk predictions to their implementation and efficacy in clinical practice and is likely to have an impact on preventative care in Australia and internationally.
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Jamison, James. "Identifying strategies to inform interventions for the secondary prevention of stroke in UK primary care." Thesis, University of Cambridge, 2018. https://www.repository.cam.ac.uk/handle/1810/284939.
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Stroke is a significant contributor to the global burden of disease in adults. With the risk of recurrent stroke high, preventative medicines aimed at risk factor reduction are the method of choice for addressing the challenge of increased morbidity and mortality and improving patient outcomes. Research in stroke has shown that adherence to medication is problematic and survivors face considerable practical and physical barriers to taking prescribed medicines. Understanding these challenges can inform the development of strategies to improve medication taking behaviour through delivery of interventions in the primary care setting. This thesis aims to identify potential strategies to inform interventions to improve medication taking in stroke. The research: identified key barriers and facilitators of medication adherence for the secondary prevention of stroke - firstly from within the primary care setting and then from the perspective of an online stroke forum; explored the appropriateness of the online forum as a method of data collection for conducting qualitative research compared with a traditional qualitative interview approach; investigated medication taking among community stroke survivors to characterise patients who receive help with medicines and estimate the proportion who have unmet needs and miss medicines; and examined attitudes from across the stroke spectrum towards a novel approach to medication taking for secondary prevention (i.e. fixed-dose combination polypill). Findings showed that survivors face considerable barriers to medicine taking, but that facilitators, particularly the caregiver role, can encourage good medication taking practice. The online forum has potential as a source of data to understand stroke survivors' behaviour, and a novel strategy to taking stroke medicines has promise. These findings enhance current thinking around medicine taking behaviour in stroke and can inform the development of effective interventions to improve medication taking practices and address nonadherence among stroke survivors. Implications for clinical practice are discussed, and recommendations are provided for future research.
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Tan, John Wei-Liang. "Induction of tolerance to egg in egg allergic children and children at high risk of egg allergy." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17343.
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The prevalence of food allergy has increased in recent years, placing a significant burden on individuals and families. Egg is the leading cause of IgE-mediated food allergy in infancy and early childhood in Australia, recently estimated to affect 9% of infants in an urban Australian setting. Although the natural history of egg allergy in childhood is resolution and acquisition of tolerance by teenage years in 60-75% of egg allergic infants, the burden of disease is significant in the childhood years. Previously, it was widely believed that strict avoidance of food allergens in early infancy was protective against sensitisation to food allergens, particularly in children with a genetic predisposition to atopy. For several decades, Australian, European and American Colleges of Immunology, Allergy and Paediatrics recommended avoidance of common allergic foods such as egg, wheat, nuts and fish as a method of primary prevention of food allergy. Despite these guidelines of avoidance, the incidence of food allergy has continued to increase over the last two decades. This increase in prevalence of food allergy, along with emerging evidence that early introduction of “allergenic” foods may be protective rather than sensitizing, has led to a change in guidelines for infant weaning in Australia (ASCIA), Europe (ESPGHAN) and the American Academy of Pediatrics (AAP). However, evidence from randomised controlled trials is required to substantiate early introduction of allergenic foods. The first objective of this thesis was to investigate if dietary introduction of egg into infants at risk of allergy between 4-6 months would reduce sensitization to egg. We conducted a randomized controlled trial involving infants with at least one first-degree relative with allergic disease. Infants with a skin prick test to egg white (EW-SPT) <2mm were randomized at 4 months of age to receive whole egg powder or placebo (rice powder) until 8 months of age, whilst excluding all other forms of egg in their diet. Diets were then liberalized in both groups when infants were 8 months old. The primary outcome was EW-SPT ≥3mm at age 12-months. 319 infants were recruited and randomised, 165 to the egg arm and 154 to the placebo arm. 14 infants reacted to egg within one week of introduction (despite EW-SPT <2mm at entry) and were excluded from the study. 254 infants (83%) were assessed at 12 months of age. Loss to follow up was similar between both intervention and placebo groups. Sensitization to EW at 12 months was 20% and 11% in infants randomized to placebo and egg respectively (OR=0.46, 95%CI 0.22-0.95, p=0.03, Chi-Square test). The absolute risk reduction was 9.8% (95%CI: 8.2% to 18.9%) with a number needed to treat of 11 (95%CI: 6 to 122). IgG4 to egg proteins and IgG4/IgE ratios were higher in infants who were randomized to egg (p<0.0001 for each) at 12 months. There was no effect on the proportion of children with probable egg allergy (placebo 13, egg 8). The results of this thesis demonstrates that introduction of whole-egg powder into the diets of high-risk infants reduced sensitization to egg white and induced egg-specific IgG4 (indicating immunomodulation). However 8.5% of infants randomized to egg were not amenable to primary prevention via early introduction at between 4-6 months. The results of this study mirror other recently published studies investigating early introduction of egg (STAR, STEP, PETIT), peanut (LEAP) and 6 allergenic foods (EAT). The results of the above-mentioned studies and our BEAT study will significantly contribute to the emerging body of evidence which supports early introduction of allergenic foods as primary prevention of food allergy. Children with a known food allergy, including egg allergy, have been traditionally advised to avoid all forms of the food to which they are allergic. This includes trace amounts and small amounts of modified protein in heat-treated or baked goods. It was believed, but never scientifically substantiated, that strict avoidance of food allergens would increase the likelihood and hasten the attainment tolerance to egg. Heating or enzymatic degradation can reduce the allergenicity of many proteins in part by eliminating conformational epiptopes. This is true for egg allergens, particularly ovalbumin, where heating the egg substantially changes the tertiary structure of the allergens, usually by eliminating conformation but not linear epitopes. It has been noted that some egg allergic children can tolerate baked egg but not whole egg. Apart from an oral food challenge, there is currently no other easy and reliable method of predicting if an egg allergic child will be able to tolerate baked egg without experiencing a clinical allergic reaction. There is also growing suggestion that tolerance to baked egg may hasten the outgrowing of egg allergy, although there is currently no firm evidence to support this. This second aim of this thesis was to examine the suitability of skin prick testing (SPT) to baked egg and ovomucoid in egg allergic individuals to predict the outcome of baked egg food challenges. One hundred and thirty-four egg allergic patients had SPT performed to ovomucoid and baked muffin prior to having a baked egg food challenge. Ninety of 134 patients (63%) passed the baked egg challenge. Of the 53 who reacted,
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Kypridemos, Christodoulos. "Modelling the effectiveness and equity of primary prevention policies in England : a stochastic dynamic microsimulation for the joint prevention of non communicable diseases." Thesis, University of Liverpool, 2016. http://livrepository.liverpool.ac.uk/3006786/.
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Introduction: Cardiovascular disease and cancers are the main causes of premature death and disability in England. This thesis uses a microsimulation modelling methodology to examine and quantify the effectiveness and equity of existing primary prevention policies and feasible alternatives. Methods: I created and validated IMPACT_NCD, a dynamic stochastic microsimulation model from first epidemiological principles, to simulate the life course of synthetic individuals under counterfactual scenarios. First, I used the model to quantify the contribution of statins to the observed decline in total cholesterol in England. Then, I examined a national screening programme known as 'NHS Health Checks'. Afterwards, I estimated the effectiveness and equity of the national salt reduction strategy. Finally, I studied two proposed policies for the tobacco 'endgame'; a total sales ban, and a sales ban restricted to those born in or after 2000. Results: The model suggested that statins contributed only about a third of the observed total cholesterol decline in England since 1991-92. Their impact on reducing socioeconomic inequalities in total cholesterol was generally positive, contrary to what was anticipated. NHS Health Checks may prevent or postpone about 19,000 cases of cardiovascular disease by 2030; however, population wide structural policies could be three times more effective and generally more equitable. IMPACT_NCD estimated that the national salt reduction strategy may have prevented or postponed about 52,000 cases of cardiovascular disease and 5000 cases of gastric cancer since 2003. Additional legislative policies from 2016 onwards could further prevent or postpone approximately 20,000 more cases by 2030, while reducing inequalities. Finally, a total ban on sales of tobacco products could prevent or postpone about 90,000 cases of cardiovascular disease, 79,000 cases of lung cancer, and tremendously reduce health inequalities by 2045. The age restricted ban could have small benefits overall within the simulation horizon. Conclusions: Increasing the structural elements of existing policies or complementing them with new structural policies might maximise their effectiveness and equity. Simulation modelling is valuable for the evaluation of existing policies and the design of new fit for purpose policies that will take into account the complex nature and dynamics of the populations.
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Docobo, Jose Miguel. "Community policing as the primary prevention strategy for Homeland Security at the local law enforcement level." Thesis, Monterey, California. Naval Postgraduate School, 2005. http://hdl.handle.net/10945/2289.
Full textAbstract:
CHDS State/LocalApproved for public release, distribution is unlimited
In the wake of September 11, 2001, local law enforcement agencies throughout the country find themselves struggling to identify their responsibilities and define their future role in the effort against terrorism in our homeland. At a time when law enforcement organizations are competing for limited funds and resources, agencies will have to look at how to adapt existing policing philosophies and strategies, such as community-oriented policing, to address the issue of homeland security. The goal of terrorism is centered in creating an atmosphere of fear in society to achieve a philosophical goal. Terrorism is about the impact of its violence on society. This requires the application of the basic concepts of law enforcement: protection and prevention to terrorism. As a result of the events of September 11, 2001, law enforcement agencies have had to assimilate homeland security strategies into their existing responsibilities for combating crime and maintaining social order. This thesis will identify how homeland security prevention and deterrence responsibilities efforts can be effectively integrated into local law enforcement's existing community policing framework. This thesis will also study attempt to identify the extent to which local law enforcement agencies in the state of Florida have adopted community-policing efforts into their homeland security strategy.
Chief Deputy, Hillsborough County Sheriff's Office, Tampa, FL