BACKGROUND Effective management of major cardiovascular risk factors is of great importance to reduce mortality from cardiovascular disease(CVD).The Survey of Risk Factors in Coronary Heart Disease(SURF CHD)II study i...BACKGROUND Effective management of major cardiovascular risk factors is of great importance to reduce mortality from cardiovascular disease(CVD).The Survey of Risk Factors in Coronary Heart Disease(SURF CHD)II study is a clinical audit of the recording and management of CHD risk factors.It was developed in collaboration with the European Association of Preventive Cardiology and the European Society of Cardiology(ESC).Previous studies have shown that control of major cardiovascular risk factors in patients with established atherosclerotic CVD is generally inadequate.Azerbaijan is a country in the South Caucasus,a region at a very high risk for CVD.AIM To assess adherence to ESC recommendations for secondary prevention of CVD based on the measurement of both modifiable major risk factors and their therapeutic management in patients with confirmed CHD at different hospitals in Baku(Azerbaijan).METHODS Six tertiary health care centers participated in the SURF CHD II study between 2019 and 2021.Information on demographics,risk factors,physical and laboratory data,and medications was collected using a standard questionnaire in consecutive patients aged≥18 years with established CHD during outpatient visits.Data from 687 patients(mean age 59.6±9.58 years;24.9%female)were included in the study.RESULTS Only 15.1%of participants were involved in cardiac rehabilitation programs.The rate of uncontrolled risk factors was high:Systolic blood pressure(BP)(SBP)(54.6%),low-density lipoprotein cholesterol(LDL-C)(86.8%),diabetes mellitus(DM)(60.6%),as well as overweight(66.6%)and obesity(25%).In addition,significant differences in the prevalence and control of some risk factors[smoking,body mass index(BMI),waist circumference,blood glucose(BG),and SBP]between female and male participants were found.The cardiovascular health index score(CHIS)was calculated from the six risk factors:Non-or ex-smoker,BMI<25 kg/m2,moderate/vigorous physical activity,controlled BP(<140/90 mmHg;140/80 mmHg for patients with DM),controlled LDL-C(<70 mg/dL),and controlled BG(glycohemoglobin<7%or BG<126 mg/dL).Good,intermediate,and poor categories of CHIS were identified in 6%,58.3%,and 35.7%of patients,respectively(without statistical differences between female and male patients).CONCLUSION Implementation of the current ESC recommendations for CHD secondary prevention and,in particular,the control rate of BP,are insufficient.Given the fact that patients with different comorbid pathologies are at a very high risk,this is of great importance in the management of such patients.This should be taken into account by healthcare organizers when planning secondary prevention activities and public health protection measures,especially in the regions at a high risk for CVD.A wide range of educational products based on the Clinical Practice Guidelines should be used to improve the adherence of healthcare professionals and patients to the management of CVD risk factors.展开更多
Background Traditional Chinese medicine (TCM), especially herbal medicine, has been widely used in China and now is also being increasingly used in other countries for the treatment of cardiovascular diseases. Althoug...Background Traditional Chinese medicine (TCM), especially herbal medicine, has been widely used in China and now is also being increasingly used in other countries for the treatment of cardiovascular diseases. Although many studies have demonstrated that certain Chinese herbal products are effective and safe for the treatment of cardiovascular diseases, most of these lack sufficient quality. Therefore, large randomized clinical trials and further scientific research to determine its safety, effectiveness are necessary.QiShen YiQi Dripping Pills (QSYQDP) is a herbal preparation clinically used in the treatment and prevention of coronary artery disease. Preliminary observations have shown its safety and effectiveness. Methods/Design This randomized, controlled trial will recruit 3600 patients with a history of myocardial infarction. Patients will be randomized into two groups by a Centr-Randomized System. One group receives QSYQDP, the other group receive aspirin. This trial protocol will describe eligibility criteria, detailed information on the treatment definition, blinding, endpoints, statistical methods, sample size determination, data management, legal aspects, and the current status of the trial. Discussion This trial is one of the first randomized, controlled clinical trial to evaluate the efficacy and safety of traditional Chinese herbal medicine in the treatment and secondary prevention of coronary artery disease. The results of this study should help to define the role of TCM in modern medical care, as well as to provide the management strategy for CAD patients in China and other countries.展开更多
Cardiovascular diseases are the most common causes of mortality worldwide.They are frequently the reasons for patient hospitalization,their incapability for work,and disability.These diseases represent a significant s...Cardiovascular diseases are the most common causes of mortality worldwide.They are frequently the reasons for patient hospitalization,their incapability for work,and disability.These diseases represent a significant socio-economic burden affecting the medical system as well as patients and their families.It has been demonstrated that the etiopathogenesis of cardiovascular diseases is significantly affected by lifestyle,and so modification of the latter is an essential component of both primary and secondary prevention.Cardiac rehabilitation(CR)represents an efficient secondary prevention model that is especially based on the positive effect of regular physical activity.This review presents an overview of basic information on CR with a focus on current trends,such as the issue of the various training modalities,utilization,and barriers to it or the use of telemedicine technologies.Appropriate attention should be devoted to these domains,as CR continues evolving as an effective and readily available intervention in the future.展开更多
Although the observed progress in the cardiovascular disease treatment, the incidence of new and recurrent coronary artery disease remains elevated and constitutes the leading cause of death in the developed countries...Although the observed progress in the cardiovascular disease treatment, the incidence of new and recurrent coronary artery disease remains elevated and constitutes the leading cause of death in the developed countries. Three-quarters of deaths due to cardiovascular diseases could be prevented with adequate changes in lifestyle, including increased daily physical activity. New evidence confirms that there is an inverse dose-response relationship between physical activity and cardiovascular disease and mortality risk. However, participation in moderate to vigorous physical activity may not fully attenuate the independent effect of sedentary activities on increased risk for cardiovascular diseases. Physical activity also plays an important role in secondary prevention of cardiovascular diseases by reducing the impact of the disease, slowing its progress and preventing recurrence. Nonetheless, most of eligible cardiovascular patients still do not benefit from secondary prevention/cardiac rehabilitation programs. The present review draws attention to the importance of physical activity in the primary and secondary prevention of cardiovascular diseases. It also addresses the mechanisms by which physical activity and regular exercise can improve cardiovascular health and reduce the burden of the disease.展开更多
<strong>Background:</strong><span style="white-space:normal;font-family:;" "=""> Long</span><span style="white-space:normal;font-family:;" "=&quo...<strong>Background:</strong><span style="white-space:normal;font-family:;" "=""> Long</span><span style="white-space:normal;font-family:;" "="">-</span><span style="white-space:normal;font-family:;" "="">term survival in acute coronary syndrome has increased steadily in the last decades. Follow-up studies developed in this patient clearly reveal that they are at risk of suffering a new event, placing them in a new stage, secondary prevention. Assuming this increased risk, the control target of their cardiovascular risk factors become more ambitious. In this field, control of Cholesterol levels, particularly LDL-C, ha</span><span style="white-space:normal;font-family:;" "="">s</span><span style="white-space:normal;font-family:;" "=""> arisen as a priority objective in patients with coronary arterial disease. In this sense, management of </span><span style="white-space:normal;font-family:;" "="">dyslipidemia </span><span style="white-space:normal;font-family:;" "="">guidelines, recently recognise</span><span style="white-space:normal;font-family:;" "="">s</span><span style="white-space:normal;font-family:;" "=""> the role of functional food, highlighting among them </span><span style="white-space:normal;font-family:;" "="">is </span><span style="white-space:normal;font-family:;" "="">the Red Yeast Rice (RYR). The aim of the study is to establish the potential role of functional food, in secondary prevention</span><span style="white-space:normal;font-family:;" "="">,</span><span style="white-space:normal;font-family:;" "=""> while deter</span><span style="white-space:normal;font-family:;" "="">mining its additional capacity to reduce LDL-C in patients that despite optimal classic treatment (maximum tolerated dose of stain plus Ezetimibe) </span><span style="white-space:normal;font-family:;" "="">is</span><span style="white-space:normal;font-family:;" "=""> still out of control objectives. <b>Results and Discussion:</b> 88 patients were included and after 3 months of treatment with RYR, their lipid profiles were compared with the baseline. The variation of T-Col, LDL-C and Trig were statistically significant. A reduction in LDL-C was 10.73</span><span style="white-space:normal;font-family:;" "=""> </span><span style="white-space:normal;font-family:;" "="">mg/dL, which means a 10.93% of additional reduction over the standard therapy the patients were receiving. Concerning security, no relevant side effects were reported when adding RYR, even in a relevant percentage (35.4%)</span><span style="white-space:normal;font-family:;" "="">,</span><span style="white-space:normal;font-family:;" "=""> myalgia disappeared (especially when reduc</span><span style="white-space:normal;font-family:;" "="">ing the </span><span style="white-space:normal;font-family:;" "="">titrating dose </span><span style="white-space:normal;font-family:;" "="">of </span><span style="white-space:normal;font-family:;" "="">the statin). <b>Conclusion:</b> Adding</span><span style="white-space:normal;font-family:;" "=""> RYR in secondary prevention patients in combination with the usual treatment, seems </span><span style="white-space:normal;font-family:;" "="">to be </span><span style="white-space:normal;font-family:;" "="">an effective alternative to optimi</span><span style="white-space:normal;font-family:;" "="">z</span><span style="white-space:normal;font-family:;" "="">e LDL levels and thus get</span><span style="white-space:normal;font-family:;" "="">s</span><span style="white-space:normal;font-family:;" "=""> closer to the target set in the</span><span style="white-space:normal;font-family:;" "=""> </span><span style="white-space:normal;font-family:;" "="">guidelines, without adding relevant side effects, </span><span style="white-space:normal;font-family:;" "="">and </span><span style="white-space:normal;font-family:;" "="">even improving tolerance to the statins.</span>展开更多
Colorectal cancer (CRC) is a common cancer that affects one in three men and one in four women worldwide. Late-stage detection is associated with significantly lower 5-year survival rates. Although it is well establis...Colorectal cancer (CRC) is a common cancer that affects one in three men and one in four women worldwide. Late-stage detection is associated with significantly lower 5-year survival rates. Although it is well established that CRC mortality rates have decreased in the past several decades, adoption of routine screening continues to lag behind screening for other common cancers such as cervical and breast cancer. The decrease in overall rates has been attributed, in part, to improved primary and secondary prevention efforts, including smoking prevention and cessation programs, nutritional counseling, and the use of evidence-based screening protocols, as well as access to better treatment. Despite the increased screening rates, it is estimated that at least one-third of eligible people do not receive appropriate screening. The objective of this review is to describe the current epidemiology of CRC and to demonstrate effective primary and secondary prevention strategies for the primary care provider.展开更多
Objective:To examine whether the combination of Naoxintong Capsule with standard care could further reduce the recurrence of ischemic stroke without increasing the risk of severe bleeding.Methods:A total of 23 Chinese...Objective:To examine whether the combination of Naoxintong Capsule with standard care could further reduce the recurrence of ischemic stroke without increasing the risk of severe bleeding.Methods:A total of 23 Chinese medical centers participated in this trial.Adult patients with a history of ischemic stroke were randomlyassigned ina 1:1ratiousing a blockdesign toreceive eitherNaoxintong Capsule(1.2gorally,twice a day)or placebo in addition to standard care.The primary endpoint was recurrence of ischemic stroke within 2 years.Secondary outcomes included myocardial infarction,death due to recurrent ischemic stroke,and all-cause mortality.The safety of drugs was monitored.Results were analyzed using the intention-to-treat principle.展开更多
Gestational diabetes is typically diagnosed in the late second or third trimester of pregnancy.It is one of the most common metabolic disorders among expectant mothers,with potential serious short-and long-term compli...Gestational diabetes is typically diagnosed in the late second or third trimester of pregnancy.It is one of the most common metabolic disorders among expectant mothers,with potential serious short-and long-term complications for both maternal and offspring health.C-peptide is secreted from pancreatic beta-cells into circulation in equimolar amounts with insulin.It is a useful biomarker to estimate the beta-cell function because it undergoes negligible hepatic clearance and consequently it has a longer half-life compared to insulin.Pregnancy induces increased insulin resistance due to physiological changes in hormonal and metabolic homeostasis.Inadequate compensation by islet beta-cells results in hyperglycemia.The standard oral glucose tolerance test at 24-28 wk of gestation sets the diagnosis.Accumulated evidence from prospective studies indicates a link between early pregnancy C-peptide levels and the risk of subsequent gestational diabetes.Elevated C-peptide levels and surrogate glycemic indices at the beginning of pregnancy could prompt appropriate strategies for secondary prevention.展开更多
<strong>Background:</strong> Cervical cancer has been ranked among the leading causes of deaths among women in Africa. Despite this, priority setting mechanisms used in planning for programmes and interven...<strong>Background:</strong> Cervical cancer has been ranked among the leading causes of deaths among women in Africa. Despite this, priority setting mechanisms used in planning for programmes and interventions that respond to sexual and reproductive health and rights services particularly in cervical cancer prevalence, prevention and treatment have not adequately taken into account research based evidence to respond appropriately. <strong>Methods:</strong> We adapted the Child Health and Nutrition Research Initiative method. A wide range of stakeholders identified potential research areas in an online survey. A technical working group comprising of 67 participants reviewed the questions for modification and removal of out scope questions. Finally, scoring and ranking was done to provide the top ten priorities questions. <strong>Results:</strong> “Cost-benefit analysis of systematic human papillomavirus vaccination compared to the current cost of cervical cancer in public health care systems” scored 27. This was followed by two research questions ranked at 24 points: “assessment of women’s and girls’ knowledge on the importance of early cervical cancer screening,” and “human papilloma virus vaccination and contributions of new technologies to the supply and storage of vaccines, including human papillomavirus vaccine”. <strong>Conclusion:</strong> The study identified 10 priority research questions that can guide the agenda for cervical cancer prevalence, prevention and treatment in the WHO Africa region. The identified priorities will be of use to policy makers, researchers and programmers and other stakeholders who can invest in areas that greatly affect cervical cancer prevalence, prevention and treatment.展开更多
<strong>Background:</strong> The critical need for Health Behaviour Change (HBC) for preventative care has been highlighted by the COVID-19 pandemic. This quality improvement project assessed the effective...<strong>Background:</strong> The critical need for Health Behaviour Change (HBC) for preventative care has been highlighted by the COVID-19 pandemic. This quality improvement project assessed the effectiveness and acceptability of Fountain of Health HBC tools as a minimal intervention for primary and secondary prevention among Canadian clinicians and their patients. <strong>Methods:</strong> Clinicians received HBC education and tools (paper tools and app-based) to assist their patients in setting a S.M.A.R.T (Specific, Measurable, Action-oriented, Realistic, Time-limited) goal at baseline and assessed four weeks later. Primary outcome measures were: 1) patient self-report of success at goal attainment;2) patient self-reported evaluation of change in well-being and health attitudes;and 3) clinician experience and engagement. <strong>Results:</strong> A total of 2184 clinicians received HBC education. Of these, 759 clinicians registered to participate in the project. 961 patients set S.M.A.R.T. HBC goals using either the paper tools (PT) or the app format. Patient data revealed nearly all patients (89% of PT users and 90% of app users) at least partially succeeded in attaining their goal at a four-week follow-up. Most patients (85% of PT and 80% of app users) also reported improvement in their well-being. A significant difference in health beliefs and attitudes was found in both PT (p < 0.001) and app users (p = 0.003). <strong>Conclusions:</strong> HBC is challenging. Educating and providing clinicians with HBC tools as a minimal intervention was found to be a successful health prevention strategy to improve patient well-being and health attitudes, and achieve S.M.A.R.T. goals. Results show HBC tools, education, and support for clinicians are both acceptable and effective for HBC in frontline care. These findings are relevant and timely given greater reliance on virtual care in the wake of the COVID-19 pandemic. Further research with rigorous methodology is needed to implement programs to achieve sustainable HBC to promote health on a large scale.展开更多
Objective: Present a new screening approach for ocular diseases. Method: Transversal, retrospective, single center study that analyzed medical records of patients from a social project on the prevention of blindness a...Objective: Present a new screening approach for ocular diseases. Method: Transversal, retrospective, single center study that analyzed medical records of patients from a social project on the prevention of blindness and amblyopia, which aimed at: 1) Detect the main ocular disorders such as amblyopia, primary angle-closure suspect (PACS);glaucoma suspect (GS);predisposing retinal detachment lesions (PRDL);age-related macular degeneration (AMD), and diabetic retinopathy (DR);2) Perform cataract diagnosis;3) Provide guidance and treatment for allergic conjunctivitis. 4) Prescribe glasses for children until 14 years of age. Participants were examined by a single specialist, holder of a post-doctoral degree in ophthalmology, with 36 years of experience and a sub-specialization in retina and vitreous. All data were analyzed in 2022. Results: The examiner diagnosed 42 cases of PACS, 21 of GS, 8 of PRDL, 14 of AMD, 3 of DR, 40 of cataract and 31 cases of allergic conjunctivitis. Thirty-three participants younger than 14 were prescribed glasses. Other pathologies included retinal detachment, papilledema, corneal ulcer, suspected conjunctival squamous cell carcinoma, retinal vasculitis, strabismus, uveitis, bilateral papilla paleness and lacrimal duct obstruction. Out of the 297 cases examined, 168 participants presented some type of alteration that could compromise their vision. Conclusion: The examiner’s experience and knowledge were decisive factors for the quick diagnosis, advice, screening and/or treatment of several ocular diseases. The social project results reveal that the primary care and/or the screening performed by a specialist are likely to reduce blindness cases.展开更多
AIM: To determine whether the association of β-blockers with endoscopic treatment is superior to endoscopic treatment alone for the secondary prophylaxis of oesophageal variceal bleeding. METHODS: Randomised controll...AIM: To determine whether the association of β-blockers with endoscopic treatment is superior to endoscopic treatment alone for the secondary prophylaxis of oesophageal variceal bleeding. METHODS: Randomised controlled trials comparing sclerotherapy (SCL) with SCL plus β-blockers (BB) or banding ligation (BL) with BL plus BB were identif ied.Main outcomes were overall and 6, 12 and 24 mo rebleeding rates, as well as overall and 6, 12 and 24 mo mortality. Two statistical methods were used: Yusuf-Peto, and Der Simonian and Laird. Inter-trial heterogeneity was systematically taken into account. RESULTS: Seventeen randomised controlled trials were included, 14 with SCL and 3 with BL. Combination β-blocker and endoscopic treatment signif icantly reduced rebleeding rates at 6, 12 and 24 mo and overall [odds ratio (OR): 2.20, 95% conf idence interval (CI): 1.69-2.85, P<0.0001] compared to endoscopic treatment alone. Mortality at 24 mo was signif icantly lower for the combined treatment group (OR: 1.83, 95% CI:1.16-2.90, P= 0.009), as well as overall mortality (OR: 1.43, 95% CI:1.03-1.98, P= 0.03). CONCLUSION: Combination therapy should thus be recommended as the fi rst line treatment for secondary prophylaxis of oesophageal variceal bleeding.展开更多
Ischaemic heart disease(IHD)is a major cause of morbidity and mortality worldwide.While there have been major advances in this field,these patients are still a higher risk subgroup.As such,strategies to mitigate risk ...Ischaemic heart disease(IHD)is a major cause of morbidity and mortality worldwide.While there have been major advances in this field,these patients are still a higher risk subgroup.As such,strategies to mitigate risk and tailor secondary prevention measures are of the utmost relevance.Cardiac rehabilitation(CR),encompassing several domains including exercise training,cardiovascular risk factor optimization,nutritional and psychological assessments,as well as other ancillary interventions has shown to be one of the pillars in the contemporary management of patients with IHD.Indeed,CR is associated with several benefits in this population,ranging from functional capacity to improvements in outcomes.Whilst this,there are still several issues concerning the optimal application of CR which are still not fully ascertained,such as lack of referral and completion,as well as questions related to programme design(particularly among patients with multiple comorbidities).In this review,we aim at presenting a pragmatic overview on the current role of CR in the management of individuals with IHD,while also discussing some of the caveats in the current data,as well as future concepts which could help improve the uptake and personalization of this pivotal time-tested intervention.展开更多
Background: Phase II cardiac rehabilitation (CR) is a class IA indication in patients suffering a cardiovascular event (CV). Current guidelines suggest 36 exercise sessions over a period of 3 months. The main aim of t...Background: Phase II cardiac rehabilitation (CR) is a class IA indication in patients suffering a cardiovascular event (CV). Current guidelines suggest 36 exercise sessions over a period of 3 months. The main aim of this study was to analyze the rate of adherence to a cardiac rehabilitation program and the factors influencing it. Methods: This was a cross-sectional study in 421 secondary prevention patients, who assisted to a Phase-II-CR program between 2007 and 2014. At baseline and program end, patients completed a 6-minute walk test and the Short-Form 36 Health Survey (SF-36). Vital signs and anthropometric measurements were also collected. Adherence was quantified as the percentage of individuals who attended all 36 sessions of the program. Factors considered for affecting adherence included: cardiovascular risk factors (RFs), type of health insurance (public or private), aerobic capacity, and SF-36 score parameters. Results: Adherence to Phase-II-CR was 33%, with no significant differences between men and women. The regression model fully adjusted for age, sex, RFs, type of health insurance and SF-36 score, showed that a SF-36 score <50 on physical health (odds ratio (OR): 11.47;3.99 - 32.99;p < 0.0001) and smoking (OR: 4.41;1.25 - 15.62;p = 0.02) were strong predictors for non-adherence. A trend for better adherence was observed in subjects older than 50 years compared to those aged between 17 and 50 years (37% versus 23%, respectively;p = 0.05). No significant differences were observed in adherence according to RFs clustering. Conclusions: Adherence to Phase-II-CR is low in our population. Patient-related factors, such as SF-36 score and smoking, were the best determinants of Phase-II-CR adherence. Health system-related factors did not influence adherence in this population. Prospective studies are warranted to determine all the factors which may influence adherence to Phase-II-CR programs.展开更多
Background: Although coronary heart disease (CHD) is the most common cause of death worldwide the literature shows a wide variation in the arrangement of cardiac rehabilitation and achieved lifestyle changes. Aim: The...Background: Although coronary heart disease (CHD) is the most common cause of death worldwide the literature shows a wide variation in the arrangement of cardiac rehabilitation and achieved lifestyle changes. Aim: The purpose of this study was to evaluate the effects of intensity (number of patient follow-ups), duration (length of intervention) and content in cardiac rehabilitation programs (CRP) regarding lifestyle changes in patients with CHD. Method: A systematic literature review of articles published in the databases PubMed and CINAHL between 1990 and 2007 was conducted. This resulted in 1120 hits of which 25 articles finally met the set criteria for inclusion. Results: The majority of significant positive results on lifestyle factors were shown among the studies describing high intensity and long duration. Included studies showed a wide variation in content, but four different interventions (informative content, educational content, practical content, behavioral and self care-oriented content) emerged. The group of studies which contained all four interventions focused on most lifestyle factors and achieved the most significant positive results. Conclusion: This systematic literature review shows that CRP should include high intensity, long duration and an intervention content covering information, knowledge, practical training, self care-activity and behavior changes in order to achieve effect on all four lifestyle factors of diet, physical activity and exercise, smoking and stress. Lifestyle changes can be reached in less lifestyle factors, with a longer duration and a variation of intensity of contacts but in combining with an informative and educational content with an additional content of a practical nature or self activity.展开更多
Despite depression being a global mental health disorder,many people with depression do not seek psychiatric help.In particular,it has been reported that only 15.7%of medical students seek treatment.A longer duration ...Despite depression being a global mental health disorder,many people with depression do not seek psychiatric help.In particular,it has been reported that only 15.7%of medical students seek treatment.A longer duration of untreated illness(DUI)leads to clinically poor results.To shorten the DUI,the mental health literacy(MHL)with regard to depression needs to be improved,although it is unclear which MHL components will improve the help-seeking process.Additionally,the existing MHL scale for depression is poorly validated for structural validity.Therefore,the purpose of this study was to develop an MHL scale for depression with verified reliability and validity(particularly structural validity)and verify its relationship with the help-seeking process.For this purpose,we adapted the mixed research method.First,we conducted a systematic literature review on MHL scales for depression to prepare a draft scale with content validity.Second,we conducted semi-structured interviews on MHL with outpatients with depression.Consequently,78 questions on MHL for depression were extracted.Third,to develop our scale,we verified the reliability and validity of these questions with 782 health professional students.The sample size was 780 and data collection was performed by collective survey method.It was conducted in 2018 in Japan.To verify the factor structure,exploratory and confirmatory factor analyses were conducted.We also examined the internal consistency,test-retest reliability,and criterion-related validity.The exploratory factor analysis revealed a three-factor structure(recognition of depression symptoms,helpseeking preferences,and depression onset possibility)with 10 items.According to the confirmatory factor analysis results,the goodness of fit indicators had a good fit.The internal consistency,test-retest reliability,and criterion-related validity had good values.Fourth,the relationship between the MHL of depression and other factors affecting the help-seeking process was examined using structural equation modelling.The same sample size(as above)was applied.All three components of the MHL of depression influenced‘recognition of depression’.In particular,depression onset possibility had the greatest impact on the help-seeking process.Whereas,the MHL of depression had little or no influence on‘intention of consultation’and‘psychiatric consultation’(second and third steps of help-seeking).The largest influence on psychiatric consultation was the recommendation of consultation from others.The multiple correlation coefficients were the recognition of depression,R2=0.33;intention of consultation,R2=0.43;and psychiatric consultation,R2=0.36;and the model was a good fit.This study identified the specific components of the depression MHL that influence the help-seeking process.Subsequently,it is necessary to provide specific MHL education to health professional students,their families,university staff,and teachers.展开更多
In this practicum, the program objective is to improve the health of Joseph’s Storehouse food bank recipients’ community in the Blessing Center (New Hope Free Clinic and Joseph’s food bank), Redlands, California. T...In this practicum, the program objective is to improve the health of Joseph’s Storehouse food bank recipients’ community in the Blessing Center (New Hope Free Clinic and Joseph’s food bank), Redlands, California. The approach is to implement primary prevention and secondary prevention activity to increase knowledge and skills of the clients and their families of how to prevent and control type 2 diabetes through a wellness program in the clinic. The practicum began January 2015 and ended April 2015. 53 food bank recipients (non-diabetic and diabetic) were recruited. A quasi-experimental study design, pre-test/posttest, was used for the study. The impact of the program targeted diverse audience, high risk ethnic groups, and improved knowledge, awareness, management, and positive behavioral change. The study implication for public health promotion specialists is to narrow venues targeting the most vulnerable populations to promote and reduce type 2 diabetes.展开更多
Ischemic stroke(IS) is a severe cerebrovascular disease with a high incidence, mortality, and disability rate. The first-line treatment for IS is the use of recombinant tissue plasminogen activator(r-t PA).Regrettably...Ischemic stroke(IS) is a severe cerebrovascular disease with a high incidence, mortality, and disability rate. The first-line treatment for IS is the use of recombinant tissue plasminogen activator(r-t PA).Regrettably, numerous patients encounter delays in treatment due to the narrow therapeutic window and the associated risk of hemorrhage. Traditional Chinese medicine(TCM) has exhibited distinct advantages in preventing and treating IS. TCM enhances cerebral microcirculation, alleviates neurological disorders, regulates energy metabolism, mitigates infammation, reduces oxidative stress injuries, and inhibits apoptosis, thereby mitigating brain damage and preventing IS recurrence. This article summarizes the etiology, pathogenesis, therapeutic strategies, and relationship with modern biology of IS from the perspective of TCM, describes the advantages of TCM in the treatment of IS, and further reviews the pharmacodynamic characteristics and advantages of TCM in the acute and recovery phases of IS as well as in post-stroke complications. Additionally, it offers valuable insights and references for the clinical application of TCM in IS prevention and treatment, as well as for the development of novel drugs.展开更多
Assessment of the overall risk of atherosclerotic cardiovascular disease(ASCVD)is the first step in managing dyslipidemia and is an important reference for the target and intensity of treatment.Recently,different guid...Assessment of the overall risk of atherosclerotic cardiovascular disease(ASCVD)is the first step in managing dyslipidemia and is an important reference for the target and intensity of treatment.Recently,different guidelines and consensuses on the management of this condition have successively recommended further risk stratification among patients with ASCVD,and a new“extreme risk”category has been proposed to identify patients who may obtain greater benefit from more intensive lipid-lowering therapy.The definition and terminology of extreme risk varies among different guidelines and consensuses;however,they all recommended an aggressive lipid-lowering therapeutic approach and/or a more stringent low-density lipoprotein cholesterol target for patients at extreme risk.Regardless of the definitions,this general approach may have a remarkable effect on the treatment of this condition in clinical practice.To help clinicians and patients to better understand the new strategy for the secondary prevention of ASCVD,this review provides a summary highlighting the necessity of further risk stratification among ASCVD patients,how patients at extreme risk can be identified,and the potential impact of applying the new“extreme risk”category in clinical practice.展开更多
文摘BACKGROUND Effective management of major cardiovascular risk factors is of great importance to reduce mortality from cardiovascular disease(CVD).The Survey of Risk Factors in Coronary Heart Disease(SURF CHD)II study is a clinical audit of the recording and management of CHD risk factors.It was developed in collaboration with the European Association of Preventive Cardiology and the European Society of Cardiology(ESC).Previous studies have shown that control of major cardiovascular risk factors in patients with established atherosclerotic CVD is generally inadequate.Azerbaijan is a country in the South Caucasus,a region at a very high risk for CVD.AIM To assess adherence to ESC recommendations for secondary prevention of CVD based on the measurement of both modifiable major risk factors and their therapeutic management in patients with confirmed CHD at different hospitals in Baku(Azerbaijan).METHODS Six tertiary health care centers participated in the SURF CHD II study between 2019 and 2021.Information on demographics,risk factors,physical and laboratory data,and medications was collected using a standard questionnaire in consecutive patients aged≥18 years with established CHD during outpatient visits.Data from 687 patients(mean age 59.6±9.58 years;24.9%female)were included in the study.RESULTS Only 15.1%of participants were involved in cardiac rehabilitation programs.The rate of uncontrolled risk factors was high:Systolic blood pressure(BP)(SBP)(54.6%),low-density lipoprotein cholesterol(LDL-C)(86.8%),diabetes mellitus(DM)(60.6%),as well as overweight(66.6%)and obesity(25%).In addition,significant differences in the prevalence and control of some risk factors[smoking,body mass index(BMI),waist circumference,blood glucose(BG),and SBP]between female and male participants were found.The cardiovascular health index score(CHIS)was calculated from the six risk factors:Non-or ex-smoker,BMI<25 kg/m2,moderate/vigorous physical activity,controlled BP(<140/90 mmHg;140/80 mmHg for patients with DM),controlled LDL-C(<70 mg/dL),and controlled BG(glycohemoglobin<7%or BG<126 mg/dL).Good,intermediate,and poor categories of CHIS were identified in 6%,58.3%,and 35.7%of patients,respectively(without statistical differences between female and male patients).CONCLUSION Implementation of the current ESC recommendations for CHD secondary prevention and,in particular,the control rate of BP,are insufficient.Given the fact that patients with different comorbid pathologies are at a very high risk,this is of great importance in the management of such patients.This should be taken into account by healthcare organizers when planning secondary prevention activities and public health protection measures,especially in the regions at a high risk for CVD.A wide range of educational products based on the Clinical Practice Guidelines should be used to improve the adherence of healthcare professionals and patients to the management of CVD risk factors.
文摘Background Traditional Chinese medicine (TCM), especially herbal medicine, has been widely used in China and now is also being increasingly used in other countries for the treatment of cardiovascular diseases. Although many studies have demonstrated that certain Chinese herbal products are effective and safe for the treatment of cardiovascular diseases, most of these lack sufficient quality. Therefore, large randomized clinical trials and further scientific research to determine its safety, effectiveness are necessary.QiShen YiQi Dripping Pills (QSYQDP) is a herbal preparation clinically used in the treatment and prevention of coronary artery disease. Preliminary observations have shown its safety and effectiveness. Methods/Design This randomized, controlled trial will recruit 3600 patients with a history of myocardial infarction. Patients will be randomized into two groups by a Centr-Randomized System. One group receives QSYQDP, the other group receive aspirin. This trial protocol will describe eligibility criteria, detailed information on the treatment definition, blinding, endpoints, statistical methods, sample size determination, data management, legal aspects, and the current status of the trial. Discussion This trial is one of the first randomized, controlled clinical trial to evaluate the efficacy and safety of traditional Chinese herbal medicine in the treatment and secondary prevention of coronary artery disease. The results of this study should help to define the role of TCM in modern medical care, as well as to provide the management strategy for CAD patients in China and other countries.
基金Masaryk University,No.MUNI/A/1294/2019Ministry of Health,Czech Republic–Conceptual Development of Research Organization,No.65269705.
文摘Cardiovascular diseases are the most common causes of mortality worldwide.They are frequently the reasons for patient hospitalization,their incapability for work,and disability.These diseases represent a significant socio-economic burden affecting the medical system as well as patients and their families.It has been demonstrated that the etiopathogenesis of cardiovascular diseases is significantly affected by lifestyle,and so modification of the latter is an essential component of both primary and secondary prevention.Cardiac rehabilitation(CR)represents an efficient secondary prevention model that is especially based on the positive effect of regular physical activity.This review presents an overview of basic information on CR with a focus on current trends,such as the issue of the various training modalities,utilization,and barriers to it or the use of telemedicine technologies.Appropriate attention should be devoted to these domains,as CR continues evolving as an effective and readily available intervention in the future.
基金supported by the Portuguese Foundation for Science and Technology,(UID/DTP/04045/2013)by the European Regional Develop-ment Fund,through COMPETE 2020(POCI--01--0145-FEDER--006969)+4 种基金funded by the European Regional Development Fund,through NORTE 2020(NORTE--01--0145--FEDER--000016)The European Regional Development Fund through the Operational Competitiveness Programthe Foun-dation for Science and Technology(FCT)of Portugal support the research unit CIAFEL within the projects FCOMP--01--0124--FEDER--020180(References FCT:PTDC/DES/122763/2010)and UID/DTP/00617/2013supported by the Portuguese Foundation for Science and Technology(REF:UID/BIM/04501/2013)FEDER/Compete2020 funds
文摘Although the observed progress in the cardiovascular disease treatment, the incidence of new and recurrent coronary artery disease remains elevated and constitutes the leading cause of death in the developed countries. Three-quarters of deaths due to cardiovascular diseases could be prevented with adequate changes in lifestyle, including increased daily physical activity. New evidence confirms that there is an inverse dose-response relationship between physical activity and cardiovascular disease and mortality risk. However, participation in moderate to vigorous physical activity may not fully attenuate the independent effect of sedentary activities on increased risk for cardiovascular diseases. Physical activity also plays an important role in secondary prevention of cardiovascular diseases by reducing the impact of the disease, slowing its progress and preventing recurrence. Nonetheless, most of eligible cardiovascular patients still do not benefit from secondary prevention/cardiac rehabilitation programs. The present review draws attention to the importance of physical activity in the primary and secondary prevention of cardiovascular diseases. It also addresses the mechanisms by which physical activity and regular exercise can improve cardiovascular health and reduce the burden of the disease.
文摘<strong>Background:</strong><span style="white-space:normal;font-family:;" "=""> Long</span><span style="white-space:normal;font-family:;" "="">-</span><span style="white-space:normal;font-family:;" "="">term survival in acute coronary syndrome has increased steadily in the last decades. Follow-up studies developed in this patient clearly reveal that they are at risk of suffering a new event, placing them in a new stage, secondary prevention. Assuming this increased risk, the control target of their cardiovascular risk factors become more ambitious. In this field, control of Cholesterol levels, particularly LDL-C, ha</span><span style="white-space:normal;font-family:;" "="">s</span><span style="white-space:normal;font-family:;" "=""> arisen as a priority objective in patients with coronary arterial disease. In this sense, management of </span><span style="white-space:normal;font-family:;" "="">dyslipidemia </span><span style="white-space:normal;font-family:;" "="">guidelines, recently recognise</span><span style="white-space:normal;font-family:;" "="">s</span><span style="white-space:normal;font-family:;" "=""> the role of functional food, highlighting among them </span><span style="white-space:normal;font-family:;" "="">is </span><span style="white-space:normal;font-family:;" "="">the Red Yeast Rice (RYR). The aim of the study is to establish the potential role of functional food, in secondary prevention</span><span style="white-space:normal;font-family:;" "="">,</span><span style="white-space:normal;font-family:;" "=""> while deter</span><span style="white-space:normal;font-family:;" "="">mining its additional capacity to reduce LDL-C in patients that despite optimal classic treatment (maximum tolerated dose of stain plus Ezetimibe) </span><span style="white-space:normal;font-family:;" "="">is</span><span style="white-space:normal;font-family:;" "=""> still out of control objectives. <b>Results and Discussion:</b> 88 patients were included and after 3 months of treatment with RYR, their lipid profiles were compared with the baseline. The variation of T-Col, LDL-C and Trig were statistically significant. A reduction in LDL-C was 10.73</span><span style="white-space:normal;font-family:;" "=""> </span><span style="white-space:normal;font-family:;" "="">mg/dL, which means a 10.93% of additional reduction over the standard therapy the patients were receiving. Concerning security, no relevant side effects were reported when adding RYR, even in a relevant percentage (35.4%)</span><span style="white-space:normal;font-family:;" "="">,</span><span style="white-space:normal;font-family:;" "=""> myalgia disappeared (especially when reduc</span><span style="white-space:normal;font-family:;" "="">ing the </span><span style="white-space:normal;font-family:;" "="">titrating dose </span><span style="white-space:normal;font-family:;" "="">of </span><span style="white-space:normal;font-family:;" "="">the statin). <b>Conclusion:</b> Adding</span><span style="white-space:normal;font-family:;" "=""> RYR in secondary prevention patients in combination with the usual treatment, seems </span><span style="white-space:normal;font-family:;" "="">to be </span><span style="white-space:normal;font-family:;" "="">an effective alternative to optimi</span><span style="white-space:normal;font-family:;" "="">z</span><span style="white-space:normal;font-family:;" "="">e LDL levels and thus get</span><span style="white-space:normal;font-family:;" "="">s</span><span style="white-space:normal;font-family:;" "=""> closer to the target set in the</span><span style="white-space:normal;font-family:;" "=""> </span><span style="white-space:normal;font-family:;" "="">guidelines, without adding relevant side effects, </span><span style="white-space:normal;font-family:;" "="">and </span><span style="white-space:normal;font-family:;" "="">even improving tolerance to the statins.</span>
文摘Colorectal cancer (CRC) is a common cancer that affects one in three men and one in four women worldwide. Late-stage detection is associated with significantly lower 5-year survival rates. Although it is well established that CRC mortality rates have decreased in the past several decades, adoption of routine screening continues to lag behind screening for other common cancers such as cervical and breast cancer. The decrease in overall rates has been attributed, in part, to improved primary and secondary prevention efforts, including smoking prevention and cessation programs, nutritional counseling, and the use of evidence-based screening protocols, as well as access to better treatment. Despite the increased screening rates, it is estimated that at least one-third of eligible people do not receive appropriate screening. The objective of this review is to describe the current epidemiology of CRC and to demonstrate effective primary and secondary prevention strategies for the primary care provider.
基金Supported by the Shanghai Municipal Commission of Science and Technology,China(No.STCSM 14401970300)。
文摘Objective:To examine whether the combination of Naoxintong Capsule with standard care could further reduce the recurrence of ischemic stroke without increasing the risk of severe bleeding.Methods:A total of 23 Chinese medical centers participated in this trial.Adult patients with a history of ischemic stroke were randomlyassigned ina 1:1ratiousing a blockdesign toreceive eitherNaoxintong Capsule(1.2gorally,twice a day)or placebo in addition to standard care.The primary endpoint was recurrence of ischemic stroke within 2 years.Secondary outcomes included myocardial infarction,death due to recurrent ischemic stroke,and all-cause mortality.The safety of drugs was monitored.Results were analyzed using the intention-to-treat principle.
文摘Gestational diabetes is typically diagnosed in the late second or third trimester of pregnancy.It is one of the most common metabolic disorders among expectant mothers,with potential serious short-and long-term complications for both maternal and offspring health.C-peptide is secreted from pancreatic beta-cells into circulation in equimolar amounts with insulin.It is a useful biomarker to estimate the beta-cell function because it undergoes negligible hepatic clearance and consequently it has a longer half-life compared to insulin.Pregnancy induces increased insulin resistance due to physiological changes in hormonal and metabolic homeostasis.Inadequate compensation by islet beta-cells results in hyperglycemia.The standard oral glucose tolerance test at 24-28 wk of gestation sets the diagnosis.Accumulated evidence from prospective studies indicates a link between early pregnancy C-peptide levels and the risk of subsequent gestational diabetes.Elevated C-peptide levels and surrogate glycemic indices at the beginning of pregnancy could prompt appropriate strategies for secondary prevention.
文摘<strong>Background:</strong> Cervical cancer has been ranked among the leading causes of deaths among women in Africa. Despite this, priority setting mechanisms used in planning for programmes and interventions that respond to sexual and reproductive health and rights services particularly in cervical cancer prevalence, prevention and treatment have not adequately taken into account research based evidence to respond appropriately. <strong>Methods:</strong> We adapted the Child Health and Nutrition Research Initiative method. A wide range of stakeholders identified potential research areas in an online survey. A technical working group comprising of 67 participants reviewed the questions for modification and removal of out scope questions. Finally, scoring and ranking was done to provide the top ten priorities questions. <strong>Results:</strong> “Cost-benefit analysis of systematic human papillomavirus vaccination compared to the current cost of cervical cancer in public health care systems” scored 27. This was followed by two research questions ranked at 24 points: “assessment of women’s and girls’ knowledge on the importance of early cervical cancer screening,” and “human papilloma virus vaccination and contributions of new technologies to the supply and storage of vaccines, including human papillomavirus vaccine”. <strong>Conclusion:</strong> The study identified 10 priority research questions that can guide the agenda for cervical cancer prevalence, prevention and treatment in the WHO Africa region. The identified priorities will be of use to policy makers, researchers and programmers and other stakeholders who can invest in areas that greatly affect cervical cancer prevalence, prevention and treatment.
文摘<strong>Background:</strong> The critical need for Health Behaviour Change (HBC) for preventative care has been highlighted by the COVID-19 pandemic. This quality improvement project assessed the effectiveness and acceptability of Fountain of Health HBC tools as a minimal intervention for primary and secondary prevention among Canadian clinicians and their patients. <strong>Methods:</strong> Clinicians received HBC education and tools (paper tools and app-based) to assist their patients in setting a S.M.A.R.T (Specific, Measurable, Action-oriented, Realistic, Time-limited) goal at baseline and assessed four weeks later. Primary outcome measures were: 1) patient self-report of success at goal attainment;2) patient self-reported evaluation of change in well-being and health attitudes;and 3) clinician experience and engagement. <strong>Results:</strong> A total of 2184 clinicians received HBC education. Of these, 759 clinicians registered to participate in the project. 961 patients set S.M.A.R.T. HBC goals using either the paper tools (PT) or the app format. Patient data revealed nearly all patients (89% of PT users and 90% of app users) at least partially succeeded in attaining their goal at a four-week follow-up. Most patients (85% of PT and 80% of app users) also reported improvement in their well-being. A significant difference in health beliefs and attitudes was found in both PT (p < 0.001) and app users (p = 0.003). <strong>Conclusions:</strong> HBC is challenging. Educating and providing clinicians with HBC tools as a minimal intervention was found to be a successful health prevention strategy to improve patient well-being and health attitudes, and achieve S.M.A.R.T. goals. Results show HBC tools, education, and support for clinicians are both acceptable and effective for HBC in frontline care. These findings are relevant and timely given greater reliance on virtual care in the wake of the COVID-19 pandemic. Further research with rigorous methodology is needed to implement programs to achieve sustainable HBC to promote health on a large scale.
文摘Objective: Present a new screening approach for ocular diseases. Method: Transversal, retrospective, single center study that analyzed medical records of patients from a social project on the prevention of blindness and amblyopia, which aimed at: 1) Detect the main ocular disorders such as amblyopia, primary angle-closure suspect (PACS);glaucoma suspect (GS);predisposing retinal detachment lesions (PRDL);age-related macular degeneration (AMD), and diabetic retinopathy (DR);2) Perform cataract diagnosis;3) Provide guidance and treatment for allergic conjunctivitis. 4) Prescribe glasses for children until 14 years of age. Participants were examined by a single specialist, holder of a post-doctoral degree in ophthalmology, with 36 years of experience and a sub-specialization in retina and vitreous. All data were analyzed in 2022. Results: The examiner diagnosed 42 cases of PACS, 21 of GS, 8 of PRDL, 14 of AMD, 3 of DR, 40 of cataract and 31 cases of allergic conjunctivitis. Thirty-three participants younger than 14 were prescribed glasses. Other pathologies included retinal detachment, papilledema, corneal ulcer, suspected conjunctival squamous cell carcinoma, retinal vasculitis, strabismus, uveitis, bilateral papilla paleness and lacrimal duct obstruction. Out of the 297 cases examined, 168 participants presented some type of alteration that could compromise their vision. Conclusion: The examiner’s experience and knowledge were decisive factors for the quick diagnosis, advice, screening and/or treatment of several ocular diseases. The social project results reveal that the primary care and/or the screening performed by a specialist are likely to reduce blindness cases.
文摘AIM: To determine whether the association of β-blockers with endoscopic treatment is superior to endoscopic treatment alone for the secondary prophylaxis of oesophageal variceal bleeding. METHODS: Randomised controlled trials comparing sclerotherapy (SCL) with SCL plus β-blockers (BB) or banding ligation (BL) with BL plus BB were identif ied.Main outcomes were overall and 6, 12 and 24 mo rebleeding rates, as well as overall and 6, 12 and 24 mo mortality. Two statistical methods were used: Yusuf-Peto, and Der Simonian and Laird. Inter-trial heterogeneity was systematically taken into account. RESULTS: Seventeen randomised controlled trials were included, 14 with SCL and 3 with BL. Combination β-blocker and endoscopic treatment signif icantly reduced rebleeding rates at 6, 12 and 24 mo and overall [odds ratio (OR): 2.20, 95% conf idence interval (CI): 1.69-2.85, P<0.0001] compared to endoscopic treatment alone. Mortality at 24 mo was signif icantly lower for the combined treatment group (OR: 1.83, 95% CI:1.16-2.90, P= 0.009), as well as overall mortality (OR: 1.43, 95% CI:1.03-1.98, P= 0.03). CONCLUSION: Combination therapy should thus be recommended as the fi rst line treatment for secondary prophylaxis of oesophageal variceal bleeding.
文摘Ischaemic heart disease(IHD)is a major cause of morbidity and mortality worldwide.While there have been major advances in this field,these patients are still a higher risk subgroup.As such,strategies to mitigate risk and tailor secondary prevention measures are of the utmost relevance.Cardiac rehabilitation(CR),encompassing several domains including exercise training,cardiovascular risk factor optimization,nutritional and psychological assessments,as well as other ancillary interventions has shown to be one of the pillars in the contemporary management of patients with IHD.Indeed,CR is associated with several benefits in this population,ranging from functional capacity to improvements in outcomes.Whilst this,there are still several issues concerning the optimal application of CR which are still not fully ascertained,such as lack of referral and completion,as well as questions related to programme design(particularly among patients with multiple comorbidities).In this review,we aim at presenting a pragmatic overview on the current role of CR in the management of individuals with IHD,while also discussing some of the caveats in the current data,as well as future concepts which could help improve the uptake and personalization of this pivotal time-tested intervention.
文摘Background: Phase II cardiac rehabilitation (CR) is a class IA indication in patients suffering a cardiovascular event (CV). Current guidelines suggest 36 exercise sessions over a period of 3 months. The main aim of this study was to analyze the rate of adherence to a cardiac rehabilitation program and the factors influencing it. Methods: This was a cross-sectional study in 421 secondary prevention patients, who assisted to a Phase-II-CR program between 2007 and 2014. At baseline and program end, patients completed a 6-minute walk test and the Short-Form 36 Health Survey (SF-36). Vital signs and anthropometric measurements were also collected. Adherence was quantified as the percentage of individuals who attended all 36 sessions of the program. Factors considered for affecting adherence included: cardiovascular risk factors (RFs), type of health insurance (public or private), aerobic capacity, and SF-36 score parameters. Results: Adherence to Phase-II-CR was 33%, with no significant differences between men and women. The regression model fully adjusted for age, sex, RFs, type of health insurance and SF-36 score, showed that a SF-36 score <50 on physical health (odds ratio (OR): 11.47;3.99 - 32.99;p < 0.0001) and smoking (OR: 4.41;1.25 - 15.62;p = 0.02) were strong predictors for non-adherence. A trend for better adherence was observed in subjects older than 50 years compared to those aged between 17 and 50 years (37% versus 23%, respectively;p = 0.05). No significant differences were observed in adherence according to RFs clustering. Conclusions: Adherence to Phase-II-CR is low in our population. Patient-related factors, such as SF-36 score and smoking, were the best determinants of Phase-II-CR adherence. Health system-related factors did not influence adherence in this population. Prospective studies are warranted to determine all the factors which may influence adherence to Phase-II-CR programs.
文摘Background: Although coronary heart disease (CHD) is the most common cause of death worldwide the literature shows a wide variation in the arrangement of cardiac rehabilitation and achieved lifestyle changes. Aim: The purpose of this study was to evaluate the effects of intensity (number of patient follow-ups), duration (length of intervention) and content in cardiac rehabilitation programs (CRP) regarding lifestyle changes in patients with CHD. Method: A systematic literature review of articles published in the databases PubMed and CINAHL between 1990 and 2007 was conducted. This resulted in 1120 hits of which 25 articles finally met the set criteria for inclusion. Results: The majority of significant positive results on lifestyle factors were shown among the studies describing high intensity and long duration. Included studies showed a wide variation in content, but four different interventions (informative content, educational content, practical content, behavioral and self care-oriented content) emerged. The group of studies which contained all four interventions focused on most lifestyle factors and achieved the most significant positive results. Conclusion: This systematic literature review shows that CRP should include high intensity, long duration and an intervention content covering information, knowledge, practical training, self care-activity and behavior changes in order to achieve effect on all four lifestyle factors of diet, physical activity and exercise, smoking and stress. Lifestyle changes can be reached in less lifestyle factors, with a longer duration and a variation of intensity of contacts but in combining with an informative and educational content with an additional content of a practical nature or self activity.
文摘Despite depression being a global mental health disorder,many people with depression do not seek psychiatric help.In particular,it has been reported that only 15.7%of medical students seek treatment.A longer duration of untreated illness(DUI)leads to clinically poor results.To shorten the DUI,the mental health literacy(MHL)with regard to depression needs to be improved,although it is unclear which MHL components will improve the help-seeking process.Additionally,the existing MHL scale for depression is poorly validated for structural validity.Therefore,the purpose of this study was to develop an MHL scale for depression with verified reliability and validity(particularly structural validity)and verify its relationship with the help-seeking process.For this purpose,we adapted the mixed research method.First,we conducted a systematic literature review on MHL scales for depression to prepare a draft scale with content validity.Second,we conducted semi-structured interviews on MHL with outpatients with depression.Consequently,78 questions on MHL for depression were extracted.Third,to develop our scale,we verified the reliability and validity of these questions with 782 health professional students.The sample size was 780 and data collection was performed by collective survey method.It was conducted in 2018 in Japan.To verify the factor structure,exploratory and confirmatory factor analyses were conducted.We also examined the internal consistency,test-retest reliability,and criterion-related validity.The exploratory factor analysis revealed a three-factor structure(recognition of depression symptoms,helpseeking preferences,and depression onset possibility)with 10 items.According to the confirmatory factor analysis results,the goodness of fit indicators had a good fit.The internal consistency,test-retest reliability,and criterion-related validity had good values.Fourth,the relationship between the MHL of depression and other factors affecting the help-seeking process was examined using structural equation modelling.The same sample size(as above)was applied.All three components of the MHL of depression influenced‘recognition of depression’.In particular,depression onset possibility had the greatest impact on the help-seeking process.Whereas,the MHL of depression had little or no influence on‘intention of consultation’and‘psychiatric consultation’(second and third steps of help-seeking).The largest influence on psychiatric consultation was the recommendation of consultation from others.The multiple correlation coefficients were the recognition of depression,R2=0.33;intention of consultation,R2=0.43;and psychiatric consultation,R2=0.36;and the model was a good fit.This study identified the specific components of the depression MHL that influence the help-seeking process.Subsequently,it is necessary to provide specific MHL education to health professional students,their families,university staff,and teachers.
文摘In this practicum, the program objective is to improve the health of Joseph’s Storehouse food bank recipients’ community in the Blessing Center (New Hope Free Clinic and Joseph’s food bank), Redlands, California. The approach is to implement primary prevention and secondary prevention activity to increase knowledge and skills of the clients and their families of how to prevent and control type 2 diabetes through a wellness program in the clinic. The practicum began January 2015 and ended April 2015. 53 food bank recipients (non-diabetic and diabetic) were recruited. A quasi-experimental study design, pre-test/posttest, was used for the study. The impact of the program targeted diverse audience, high risk ethnic groups, and improved knowledge, awareness, management, and positive behavioral change. The study implication for public health promotion specialists is to narrow venues targeting the most vulnerable populations to promote and reduce type 2 diabetes.
基金supported by the National Natural Science Foundation of China (No. 82174112)the Science and Technology Project of Haihe Laboratory of Modern Chinese Medicine (No. 22HHZYSS00015)。
文摘Ischemic stroke(IS) is a severe cerebrovascular disease with a high incidence, mortality, and disability rate. The first-line treatment for IS is the use of recombinant tissue plasminogen activator(r-t PA).Regrettably, numerous patients encounter delays in treatment due to the narrow therapeutic window and the associated risk of hemorrhage. Traditional Chinese medicine(TCM) has exhibited distinct advantages in preventing and treating IS. TCM enhances cerebral microcirculation, alleviates neurological disorders, regulates energy metabolism, mitigates infammation, reduces oxidative stress injuries, and inhibits apoptosis, thereby mitigating brain damage and preventing IS recurrence. This article summarizes the etiology, pathogenesis, therapeutic strategies, and relationship with modern biology of IS from the perspective of TCM, describes the advantages of TCM in the treatment of IS, and further reviews the pharmacodynamic characteristics and advantages of TCM in the acute and recovery phases of IS as well as in post-stroke complications. Additionally, it offers valuable insights and references for the clinical application of TCM in IS prevention and treatment, as well as for the development of novel drugs.
文摘Assessment of the overall risk of atherosclerotic cardiovascular disease(ASCVD)is the first step in managing dyslipidemia and is an important reference for the target and intensity of treatment.Recently,different guidelines and consensuses on the management of this condition have successively recommended further risk stratification among patients with ASCVD,and a new“extreme risk”category has been proposed to identify patients who may obtain greater benefit from more intensive lipid-lowering therapy.The definition and terminology of extreme risk varies among different guidelines and consensuses;however,they all recommended an aggressive lipid-lowering therapeutic approach and/or a more stringent low-density lipoprotein cholesterol target for patients at extreme risk.Regardless of the definitions,this general approach may have a remarkable effect on the treatment of this condition in clinical practice.To help clinicians and patients to better understand the new strategy for the secondary prevention of ASCVD,this review provides a summary highlighting the necessity of further risk stratification among ASCVD patients,how patients at extreme risk can be identified,and the potential impact of applying the new“extreme risk”category in clinical practice.
