440 resultados para Smoking prevention


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Background: Gout patients initiating urate lowering therapy have an increased risk of flares. Inflammation in gouty arthritis is induced by IL-1b. Canakinumab targets and inhibits IL-1b effectively in clinical studies. This study compared different doses of canakinumab vs colchicine in preventing flares in gout patients initiating allopurinol therapy.Methods: In this 24 week double blind study, gout patients (20-79 years) initiating allopurinol were randomized (1:1:1:1:1:1:2) to canakinumab s.c. single doses of 25, 50, 100, 200, 300 mg, or 150 mg divided in doses every 4 weeks (50+50+25+25 mg [q4wk]) or colchicine 0.5 mg p.o. daily for 16 weeks. Primary outcome was to determine the canakinumab dose giving comparable efficacy to colchicine with respect to the number of gout flares occurring during first 16 weeks. Secondary outcomes included number of patients with gout flares and C-reactive protein (CRP) levels during the first 16 weeks.Results: 432 patients were randomized and 391 (91%) completed the study. All canakinumab doses were better than colchicine in preventing flares and therefore, a canakinumab dose comparable to colchicine could not be determined. Based on a negative binomial model, all canakinumab groups, except 25 mg, reduced the flare rate ratio per patient significantly compared to colchicine group (rate ratio estimates 25 mg 0.60, 50 mg 0.34, 100 mg 0.28, 200 mg 0.37, 300 mg 0.29, q4wk 0.38; p<=0.05). The percentage of patients with flares was lower for all canakinumab groups (25 mg 27.3%, 50 mg 16.7%, 100 mg 14.8%, 200 mg 18.5%, 300 mg 15.1%, q4wk 16.7%) compared to colchicine group (44.4%). All patients taking canakinumab were significantly less likely to experience at least one gout flare than patients taking colchicine (odds ratio range [0.22 - 0.47]; p<=0.05 for all). The median baseline CRP levels were 2.86 mg/L for 25 mg, 3.42 mg/L for 50 mg, 1.76 mg/L for 100 mg, 3.66 mg/L for 200 mg, 3.21 mg/L for 300 mg, 3.23 mg/L for q4wk canakinumab groups and 2.69 mg/L for colchicine group. In all canakinumab groups with median CRP levels above the normal range at baseline, median levels declined within 15 days of treatment and were maintained at normal levels (ULN=3 mg/L) throughout the 16 week period. Adverse events (AEs) occurred in 52.7% (25 mg), 55.6% (50 mg), 51.9% (100 mg), 51.9% (200 mg), 54.7% (300 mg), and 58.5% (q4wk) of patients on canakinumab vs 53.7% of patients on colchicine. Serious AEs (SAE) were reported in 2 (3.6%; 25 mg), 2 (3.7%, 50 mg), 3 (5.6%, 100 mg), 3 (5.6%, 200 mg), 3 (5.7%, 300 mg) and 1 (1.9%, q4wk) patients on canakinumab and in 5 (4.6%) patients on colchicine. One fatal SAE (myocardial infarction, not related to study drug) occurred in colchicine group.Conclusion: In this large randomized, double-blind active controlled study of flare prevention in gout patients initiating allopurinol therapy, treatment with canakinumab led to a statistically significant reduction in flares compared with colchicine (standard of care), and was well tolerated.

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The 5-year "Solmobile" skin prevention campaigns carried out between 2001 and 2005 by the Swiss League against Cancer met their objectives. About 21'000 visits were recorded throughout Switzerland and 10'000 clinical skin examinations performed. This report briefly summarises the main results of the epidemiological evaluation of these campaigns.

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Rapport de synthèse : But de l'étude : Les accidents domestiques représentent un problème significatif en médecine pédiatrique. Le but de cette étude est de mieux comprendre les mécanismes et causes des brûlures afin de pouvoir cibler la prévention. Méthode : Il s'agit d'une étude prospective d'une durée d'une année, d'Août 2004 à Août 2005. Les patients ayant consulté pour des brûlures à l'Hôpital de l'Enfance de Lausanne (HEL) ou au CHUV ont été répertoriés. Le mécanisme et les circonstances des brûlures ont été analysées, de même que l'environnement et les données psycho-sociales. Résultats : huitante-neuf patients ont été inclus dans l'étude, âgés de 2 mois à 15 ans. Septante-huit pour cent des patients avaient moins de 5 ans. Plus de la moitié étaient des garçons. Les brûlures par échaudement prédominaient. Nous n'avons pas pu mettre en évidence d'incidence augmentée de brûlures chez des patients de familles immigrées ou de niveau social bas. Dans la majorité des cas, un adulte était présent au moment de l'accident. Conclusion : Si l'on devait établir un profil type de l'enfant à risque de se brûler dans notre région, il s'agirait d'un garçon âgé de 15 mois-5ans, se brûlant en se versant une tasse de liquide chaud sur la main, à son domicile, en présence de l'un ou de ses deux parents. Le message de prévention devrait donc s'adresser directement aux parents, toutes nationalités et niveau social confondus afin de leur expliquer les dangers de brûlures présents au quotidien à leur domicile. A chaque contrôle, les pédiatres devraient parler des accidents domestiques aux parents. En insistant sur les dangers que représentent les tasses de café, la porte du four et la plaque de la cuisinière, qui sont des éléments du quotidien et qui méritent une attention à chaque utilisation. Les brûlures chez le petit enfant pourraient ainsi être fortement réduites.

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A simulation model of the effects of hormone replacement therapy (HRT) on hip fractures and their consequences is based on a population of 100,000 post-menopausal women. This cohort is confronted with literature derived probabilities of cancers (endometrium or breast, which are contra-indications to HRT), hip fracture, disability requiring nursing home or home care, and death. Administration of HRT for life prevents 55,5% of hip fractures, 22,6% of years with home care and 4,4% of years in nursing homes. If HRT is administered for 15 years, these results are 15,5%, 10% and 2,2%, respectively. A slight gain in life expectancy is observed for both durations of HRT. The net financial loss in the simulated population is 222 million Swiss Francs (cost/benefit ratio 1.25) for lifelong administration of HRT, and 153 million Swiss Francs (cost/benefit ratio 1.42) if HRT is administered during 15 years.

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BACKGROUND: Secondary prevention programs for patients experiencing an acute coronary syndrome have been shown to be effective in the outpatient setting. The efficacy of in-hospital prevention interventions administered soon after acute cardiac events is unclear. We performed a systematic review and meta-analysis to determine whether in-hospital, patient-level interventions targeting multiple cardiovascular risk factors reduce all-cause mortality after an acute coronary syndrome. METHODS AND RESULTS: Using a prespecified search strategy, we included controlled clinical trials and before-after studies of secondary prevention interventions with at least a patient-level component (ie, education, counseling, or patient-specific order sets) initiated in hospital with outcomes of mortality, readmission, or reinfarction rates in acute coronary syndrome patients. We classified the interventions as patient-level interventions with or without associated healthcare provider-level interventions and/or system-level interventions. Twenty-six studies met our inclusion criteria. The summary estimate of 14 studies revealed a relative risk of all-cause mortality of 0.79 (95% CI, 0.69 to 0.92; n=37,585) at 1 year. However, the apparent benefit depended on study design and level of intervention. The before-after studies suggested reduced mortality (relative risk [RR], 0.77; 95% CI, 0.66 to 0.90; n=3680 deaths), whereas the RR was 0.96 (95% CI, 0.64 to 1.44; n=99 deaths) among the controlled clinical trials. Only interventions including a provider- or system-level intervention suggested reduced mortality compared with patient-level-only interventions. CONCLUSIONS: The evidence for in-hospital, patient-level interventions for secondary prevention is promising but not definitive because only before-after studies suggest a significant reduction in mortality. Future research should formally test which components of interventions provide the greatest benefit.

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For persons without cardiovascular disease, the benefit of aspirin in primary prevention has been controversial until the recent publication of several major randomized controlled trials. Since then, several medical societies recommend that clinicians discuss aspirin prevention with adults at high cardiovascular risk. Patients with low cardiovascular risk are unlikely to benefit from aspirin, as potential harms (hemorrhagic strokes, gastrointestinal bleedings) may outweigh benefits. Aspirin should be recommended in primary prevention only in patients with a 10-year cardiovascular risk > or = 10% or in diabetic patients aged > or = 40 years with a concomitant cardiovascular risk factor, after assessing contraindications for aspirin and individual's preferences for the risks and benefits associated with aspirin.

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Résumé Objectifs : Alors que de nombreuses études suggèrent que l'exposition au tabagisme passif représente un danger pour la santé des non-fumeurs, la plupart des études s'intéressant aux effets néfastes du tabagisme passif sur la santé respiratoire de sujets adultes étaient des études transversales. Les résultats d'études longitudinales restent rares et controversés. Le but de notre étude était de mesurer les effets d'une exposition antérieure au tabagisme passif sur l'évolution journalière de quatre catégories de symptômes respiratoires dans une étude journalière incluant des adultes n'ayant jamais fumé. Méthodes : Dans le cadre de l'étude SAPALDIA (Swiss study on air pollution and lung diseases in adults), nous avons mené une étude de cohorte prospective et multicentrique. 1421 adultes n'ayant jamais fumé étaient suivis durant deux ans sur la base de questionnaires journaliers remplis durant une à six périodes de quatre semaines répartis sur deux années (1992-1993). Nous avons ensuite déterminé le risque relatif (RR) de développer ou de s'amender de symptômes respiratoires en association avec une exposition antérieure au tabagisme passif. Résultats : Dans un échantillon d'adultes n'ayant jamais fumé, nous avons trouvé une association entre une exposition antérieure au tabagisme passif et une évolution péjorée de tous les symptômes respiratoires étudiés, montrant un risque relatif de 1.09 à 1.21 de développer les symptômes respiratoires, et un risque relatif de 0.91 à 0.83 de s'amender de ces symptômes. Une exposition au tabagisme passif sur la place de travail était associée à une diminution de la durée des intervalles libres sans symptômes bronchitiques (RR 1.33) et asthmatiques (RR 1.27), alors qu'une exposition uniquement en-dehors de la place de travail était associée avec un allongement de la durée des épisodes avec symptômes respiratoires des voies aériennes hautes ou basses (RR 0.78-0.77). Conclusion : Nos résultats suggèrent que l'exposition au tabagisme passif a des effets néfastes sur la dynamique journalière symptômes respiratoires, et que l'importance et le type d'effet sont influencés par le lieu d'exposition.

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The overall aim of the project has been to assess the extent to which data on the frequency of occurence of STDs [Sexually transmitted diseases] might be useful in the monitoring and evaluation of AIDS prevention programmes. The objectives have been to answer the following questions: (a) Can measures of STD occurence be used as an outcome measure of AIDS/HIV preventive efforts ? In particular: -> which diseases might be useful ? -> in what ways could they be used ? (b) If measures of STD occurence can be used in this way, is existing surveillance data in Western Europe adequate for the purpose ? If not why not ? (c) What do data from existing STD surveillance systems tell us about the success or failure of AIDS prevention to date ? (d) What needs to be done in order taht STD surveillance data in the countries of Western Europe could be used for this purpose ? [Authors, p. 4]

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CONTEXT: In the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly - Pivotal Fracture Trial (HORIZON-PFT), zoledronic acid (ZOL) 5 mg significantly reduced fracture risk. OBJECTIVE: The aim of the study was to identify factors associated with greater efficacy during ZOL 5 mg treatment. DESIGN, SETTING, AND PATIENTS: We conducted a subgroup analysis (preplanned and post hoc) of a multicenter, double-blind, placebo-controlled, 36-month trial in 7765 women with postmenopausal osteoporosis. Intervention: A single infusion of ZOL 5 mg or placebo was administered at baseline, 12, and 24 months. MAIN OUTCOME MEASURES: Primary endpoints were new vertebral fracture and hip fracture. Secondary endpoints were nonvertebral fracture and change in femoral neck bone mineral density (BMD). Baseline risk factor subgroups were age, BMD T-score and vertebral fracture status, total hip BMD, race, weight, geographical region, smoking, height loss, history of falls, physical activity, prior bisphosphonates, creatinine clearance, body mass index, and concomitant osteoporosis medications. RESULTS: Greater ZOL induced effects on vertebral fracture risk were seen with younger age (treatment-by-subgroup interaction, P = 0.05), normal creatinine clearance (P = 0.04), and body mass index >or= 25 kg/m(2) (P = 0.02). There were no significant treatment-factor interactions for hip or nonvertebral fracture or for change in BMD. CONCLUSIONS: ZOL appeared more effective in preventing vertebral fracture in younger women, overweight/obese women, and women with normal renal function. ZOL had similar effects irrespective of fracture risk factors or femoral neck BMD.

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Background: Guidelines of the Diagnosis and Management of Heart Failure (HF) recommend investigating exacerbating conditions, such as thyroid dysfunction, but without specifying impact of different TSH levels. Limited prospective data exist regarding the association between subclinical thyroid dysfunction and HF events. Methods: We performed a pooled analysis of individual participant data using all available prospective cohorts with thyroid function tests and subsequent follow-up of HF events. Individual data on 25,390 participants with 216,247 person-years of follow-up were supplied from 6 prospective cohorts in the United States and Europe. Euthyroidism was defined as TSH 0.45-4.49 mIU/L, subclinical hypothyroidism as TSH 4.5-19.9 mIU/L and subclinical hyperthyroidism as TSH <0.45 mIU/L, both with normal free thyroxine levels. HF events were defined as acute HF events, hospitalization or death related to HF events. Results: Among 25,390 participants, 2068 had subclinical hypothyroidism (8.1%) and 648 subclinical hyperthyroidism (2.6%). In age- and gender-adjusted analyses, risks of HF events were increased with both higher and lower TSH levels (P for quadratic pattern<0.01): hazard ratio (HR) was 1.01 (95% confidence interval [CI] 0.81-1.26) for TSH 4.5-6.9 mIU/L, 1.65 (CI 0.84-3.23) for TSH 7.0-9.9 mIU/L, 1.86 (CI 1.27-2.72) for TSH 10.0-19.9 mIUL/L (P for trend <0.01), and was 1.31 (CI 0.88-1.95) for TSH 0.10-0.44 mIU/L and 1.94 (CI 1.01-3.72) for TSH <0.10 mIU/L (P for trend=0.047). Risks remained similar after adjustment for cardiovascular risk factors. Conclusion: Risks of HF events were increased with both higher and lower TSH levels, particularly for TSH ≥10 mIU/L and for TSH <0.10 mIU/L. Our findings might help to interpret TSH levels in the prevention and investigation of HF.

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While the development of early psychosis intervention programs have improved outcome of such disorders, primary prevention strategies are still out of reach. The elaboration, over the last 15 years, of scales and criteria to identify populations at high risk for psychosis is a real progress, but their low specificity is still a major obstacle to their use outside of research projects. For this reason, even if "ultra high risk", subjects present with real psychiatric disorders and sometimes significant decrease in functioning level, the fact that only a small proportion will eventually develop full blown psychosis will probably lead to the rejection of a "psychosis risk syndrom" from the future DSM-V classification.

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OBJECTIVES: To investigate the effect of a change in second-hand smoke (SHS) exposure on heart rate variability (HRV) and pulse wave velocity (PWV), this study utilized a quasi-experimental setting when a smoking ban was introduced. METHODS: HRV, a quantitative marker of autonomic activity of the nervous system, and PWV, a marker of arterial stiffness, were measured in 55 non-smoking hospitality workers before and 3-12 months after a smoking ban and compared to a control group that did not experience an exposure change. SHS exposure was determined with a nicotine-specific badge and expressed as inhaled cigarette equivalents per day (CE/d). RESULTS: PWV and HRV parameters significantly changed in a dose-dependent manner in the intervention group as compared to the control group. A one CE/d decrease was associated with a 2.3 % (95 % CI 0.2-4.4; p = 0.031) higher root mean square of successive differences (RMSSD), a 5.7 % (95 % CI 0.9-10.2; p = 0.02) higher high-frequency component and a 0.72 % (95 % CI 0.40-1.05; p < 0.001) lower PWV. CONCLUSIONS: PWV and HRV significantly improved after introducing smoke-free workplaces indicating a decreased cardiovascular risk.