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Primary preventive effects of mineral water Essentuki 17 were investigated on 500 male Wistar rats (body mass 200-250 g). It is demonstrated that oral pretreatment with the above water can prevent the onset of gastroduodenal ulcers. Changes in secretion of gastrin, insulin, glucagon, triiodothyronine and thyroxin support the clinical evidence.
Primary prevention trials are the best method of demonstrating the true value of medical intervention to correct abnormalities of lipid metabolism. A large number of patients must be followed up for a long period and this explains the complexity of the logistic problems which are encountered. However, these trials must conform to the classical guide lines of all clinical trials: an accurate definition of the study population, a principal criterion of adjustment which satisfies the golden rule "One question, one study".
BACKGROUND: Several new strategies for prevention of coronary artery disease have emerged. This review examines the various approaches to primary prevention, and some aspects of secondary prevention. METHODS AND RESULTS: The role of aspirin, beta-blockers, exercise, diets, fish intake, vitamin E, and folic acid are discussed. The potential role of chlamydia in atherosclerosis, the protective effect of alcohol consumption, and the benefits of female sex hormones are also examined. An update on lipid-lowering therapy, and a summary of the recent major clinical trials establishing the use of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors in primary and secondary prevention of coronary artery disease, are provided. CONCLUSIONS: An aggressive approach to medical management of coronary artery disease a substantial reduction in risk.
OBJECTIVES: This study was undertaken to project the population-wide effect of full implementation of the Adult Treatment Panel (ATP) II guidelines of the National Cholesterol Education Program (NCEP). BACKGROUND: The ATP II has proposed guidelines for cholesterol reduction, but the long-term epidemiologic influence of its components has not been fully examined. METHODS: We used a calibrated, validated simulation of the U.S. population, aged 35 to 84 years to estimate the potential for the NCEP guidelines, under varying assumptions, to reduce coronary heart disease morbidity and mortality and overall mortality from the years 2000 to 2020. RESULTS: Primary prevention would yield only about half of the benefits of secondary prevention despite requiring nearly twice as many person-years of treatment. The projected increase in quality-adjusted years of life per year of treatment for secondary prevention was 3- to 12-fold higher than for primary prevention. To yield population-wide epidemiologic benefits equivalent to NCEP recommendations for secondary prevention, primary prevention would require a nearly sixfold increase in the number of persons treated compared with NCEP recommendations. All benefits of universal success of the NCEP primary prevention "screen and treat" guidelines could be achieved by a 11 mg/dl (8%) population-wide reduction in low-density lipoprotein cholesterol levels among persons without preexisting coronary heart disease. CONCLUSIONS: The NCEP guidelines for targeted primary prevention can be a useful component of a rational public health strategy, but only as a complement to the more appealing strategies of secondary prevention and "across-the-board" programs to lower all cholesterol levels.
Discussion of primary prevention has been made difficult by lack of clarity of underlying concepts and assumptions. Is the purpose to prevent diagnosable mental illness or to prevent unhappiness and social incompetence? What are the implications of the assumption that societal stress causes mental illness? Is there a clear distinction made between major and minor mental illness? Except for a few specific conditions there is little evidence that primary prevention has been effective. The authors feel that research and program evaluation in prevention is sorely needed but should be funded separately and with discretion. Scarce mental health funds should not be diverted from direct treatment for this purpose.
The PREVASC study addresses the primary prevention of asthma in infants and small children. The objective of this study is to investigate whether a multifaceted prenatally started intervention strategy in high-risk infants leads to a decrease in the occurrence of (severe) asthma and whether a refinement of the prevention strategy leads to an increase in the adherence to the prevention program. The primary prevention program includes house dust mite impermeable bed coverings, education on breast feeding, hypoallergenic feeding, timing of introduction of solid food and smoking cessation. A total of 888 infants were prenatally included. By the time of inclusion the mothers were 3-7 months pregnant. About 27 infants were excluded from the study and 18 dropped out. Of the remaining 843 infants 535 had a first-degree familial predisposition of asthma (high-risk group), whereas a reference group of 308 (162 boys) infants was not predisposed for asthma in the first-degree (low-risk group). To evaluate the (cost-)effectiveness of the preventive intervention, 222 (118 boys) infants of the high-risk group allocated to the intervention group and 221 (112 boys) allocated to a control group are followed up. The low-risk infants served as controls to evaluate the predictive value of high risk (first-degree familial predisposition of asthma). The infants are followed from the prenatal stage until they reach the age of 6 yr. The remaining 92 high-risk infants were included in an optimized randomized-clinical adherence trial (RCAT). Of these 92 infants, 45 (20 boys) were allocated to an intervention group and 47 (24 boys) to a control group. Until now all infants have been followed for at least 1 yr.
Several diseases can be prevented either by primary prevention, such as immunisation or behavioural counselling, or secondary prevention such as screening. The new clinical recommendations include screening of abdominal aortic aneurysm among male smokers and ex-smokers aged between 65 and 75 years and the extension of breast cancer screening by mammography for women aged between 40 and 49 years, as well as screening for diabetes among patients with hypertension or dyslipidemia.
In the United States and many Western nations, increasing prevalence of osteoporotic fracture is contributing to the health care system burden, and costs and needs for medical services are predicted to increase significantly by the beginning of the 21st century. Recent reports investigating developmental changes in skeletal mass of adolescent girls and young women under different experimental or ecological conditions support the contention that modification of environmental factors, especially dietary calcium and physical activity, can favorably modulate bone mass and bone density compared to controls. The peripubertal period, starting as early as 10 years of age, seems to be most responsive to modification of environmental/lifestyle factors, whereas potential gains of bone mass during late adolescence and early adulthood, although smaller, may be more readily achieved through improved dietary calcium intakes and regular exercise programs. Scientific evidence in support of these beneficial effects on bone is presented as part of the rationale for prevention of osteoporotic fractures. Also discussed is the need for a national policy to prevent osteoporosis through primary prevention strategies focused at young girls prior to puberty. The goal would be for every prepubertal girl, over the next decade, to achieve peak bone mass (and density) of the spine, hips and other bones by age 20, i.e., early adulthood. A second target group for national policy should be women in their 20s. Attainment of the goal to gain 3-5% additional bone mass during this decade would prolong the time before the fracture threshold range (low bone mass) is reached in the postmenopausal decades.
The efficacy of primary prevention of mental disorders has been debated over the years. The debate is complicated by ideology, semantic confusion, methodological difficulties and a paucity of good evaluative studies. This paper reviews newer concepts of primary prevention and mental health promotion, methodological issues, model programs, and inherent ethical concerns. Further evaluative studies and an increased contribution of psychiatrists to the primary prevention debate are recommended as necessary steps in further evolution of the field.
A particularly important question for primary prevention of CHD is when to initiate cholesterol-lowering drugs in patients at risk. The two most important factors to consider are the serum LDL cholesterol level and the absolute risk, based on the presence or absence of other risk factors. The intensity of therapy can be modified according to the other risks at play. For example, diabetes mellitus is a particularly powerful risk factor for morbidity and mortality from CHD. Therefore, middle-aged or elderly diabetic patients can reasonably be treated as if they already have established CHD. Other risk factors are less dangerous, but when a patient has several such factors, intensive cholesterol-lowering therapy often is indicated. Except for patients at highest risk, a 3- to 6-month trial of nondrug therapy is warranted in an effort to achieve the target of therapy without drugs or with low doses of drugs. If patients are appropriately selected for therapy, cholesterol management for primary prevention of CHD should rival secondary prevention in reducing the burden this disorder imposes on society.
The disease of the dependancy in Bosnia and Herzegovina in the postwar period are in the expansion, and the fact is that nobody of the competents can expose the correct data about the extension of this occurrence. The reason to this is that in the health care institutions are evident only those dependents who attend to treatment, and the police evident only the catched breachers of law--the producers and the dispersals of the drug. The periodical researches which are performed among the different population groups do not give unfortunately, also besides the setted endeavour, the right insight into this problematics. Besides the fact that the production and distribution of tobacco and alcohol are legal, cannot be neglected their lost effect onto the health by the excessive and longterm consummation, so to them as the psycoactive substances should dedicate the adequative attention. The treatment consequence of the disease dependance is longterm and expansive, often with uncertain outcome, especially in narcomen the dependence (the percentage of the recovery from 0.5-4.0%), so the basis of the struggle against the dependancy disease is the prevention affirmation of the healthy styles of living--without tobacco, alcohol and drugs. Many theoretics, the authors of the scientific papers from these field prevention share to three levels--the primary, secondary and tertial ones, but the public-health care approach only the primary three levels the primary prevention considers the right prevention which is the dam of the disease occurrence and the damage, the rest two levels infact are the diagnostics, treatment and the rehabilitation and not the aim is to them the reduce of damage, so much and if is this is possible. Of course, should not neglect the great difference in costs in the levels of the prevention: the methadone therapy and the commune for the treatment and the rehabilitation of the dependents encircle the small number of the dependence and cost hundred times more than the primary preventive programmes, which address to the unavoidableness of the performance of the strategy of the primary preventions against the disease of the dependancy.
In the primary prevention of coronary heart disease (CHD), the effect of aspirin and statins is well documented in several controlled randomized trials. For aspirin the results can be transferred into clinical practice due to its low price; for the more expensive statins, however, serious economic problems exist. In contrast to secondary prevention these drugs do not reach cost-efficiency in primary prevention; due to their high prices for the criteria of the randomized controlled studies values >60 000 or >100 000 [US dollars/YLS] are gained. Data from England and Scotland indicate that according to the inclusion criteria of the WOSCOPS- and AFCAPS/TexCAPS studies almost 20 and 60%, respectively, of the adult population had to be treated with a statin. Results of newer studies may even increase these numbers. These costs cannot be covered by any health care system. Primary prevention of CHD with statins reveals paradigmatically that for financial reasons evidence-based medicine can no longer be transferred into clinical practice. The limited resources of all health care systems make rationing with treatment allocation only to the high risk groups necessary. The American, European and German guidelines propose a > or =2% annual risk of CHD as the limit, for financial reasons the Britisch recommendations favor a limit of 3%; in order to save >50% of the costs. Despite the financial restraints of the German health care system, the limit of > or =2% annual risk of CHD as proposed by the German Cardiac Society may be realistic when the different preventive measures are applied following a step-by-step plan based on the costs. According to the Procam algorithms, persons without diabetes mellitus or familiar disposition, who in case of nicotine abuse have given up smoking and if hypertensive have blood pressure values within the therapeutic range, statins are only to be given under the following conditions: LDL-cholesterol > or =175 or > or =190 mg/dl, for a HDL-cholesterol < or =35 or < or =45 mg/dl, or triglyceride levels > or =200 or > or =175 mg/dl, respectively. Diabetics without CHD have the same risk as non-diabetics with CHD. Therefore, in diabetics the same measures should be taken for primary prevention as in non-diabetics for secondary prevention. Evaluation of cost-efficiency indicates that intensive blood sugar control as well as intensive antihypertensive treatment and application of statins are all cost-effective in primary prevention of diabetics.
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Endothelial dysfunction is the final common pathway in the pathogenesis of preeclampsia. Future therapeutic modalities aimed at preventing or treating preeclampsia should either reduce the extent of (or even prevent) endothelial cell dysfunction (primary prevention) or should reduce the consequences of endothelial cell dysfunction (secondary and tertiary prevention). Relevant potential and promising directions for further research will be discussed. Part I of this review concerns the primary prevention of preeclampsia. The etiology of preeclampsia is still unknown. The 4 hypotheses that are the most popular currently are the placental ischemia hypothesis, the immune maladaptation/spiral artery-decidual ¿toxin' hypothesis, the VLDL (very low density lipoproteins)/TxPA (toxicity preventing activity) hypothesis, and the genetic hypothesis. For the near future only the disturbed VLDL/TxPA balance and the imbalance between free radicals and scavengers appear to be amenable for clinical research purposes.