Indiana recognizes that every Hoosier deserves to live in a safe and supportive environment where he/she can flourish. To this end, the ISDH Office of Womens Health has made a strong commitment to the primary prevention of sexual violence. Primary prevention focuses on stopping first time sexual violence victimization and perpetration. In 2010, the state developed its first comprehensive plan to address sexual violence, entitled Indianas Commitment to Primary Prevention: A State Free of Sexual Violence 2010-2015. This plan provided guidance for advocacy agencies across the Hoosier state to find a role in stopping sexual violence.. In 2015, the ISDH Office of Womens Health, along with nearly 30 community-based and governmental partner agencies, recommitted to ending sexual violence in Indiana. The Sexual Violence Primary Prevention Council (SVPPC) worked together to develop a comprehensive primary prevention plan under which individual advocates, community agencies, coalitions and governmental ...
Heart Failure clinical trial. Clinical trial for CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy: an International Registry (DERIVATE).
Considering the scarcity of health care resources and the high costs associated with cardiovascular diseases, we investigated the spending on cardiovascular primary preventive activities and the prescribing behaviour of primary preventive cardiovascular medication (PPCM) in Dutch family practices (FPs). A mixed methods design was used, which consisted of a questionnaire (n = 80 FPs), video recordings of hypertension- or cholesterol-related general practitioner visits (n = 56), and the database of Netherlands Information Network of General Practice (n = 45 FPs; n = 157,137 patients). The questionnaire and video recordings were used to determine the average frequency and time spent on cardiovascular primary preventive activities per FP respectively. Taking into account the annual income and full time equivalents of general practitioners, health care assistants, and practice nurses as well as the practice costs, the total spending on cardiovascular primary preventive activities in Dutch FPs was calculated.
Definition of Primary prevention in the Legal Dictionary - by Free online English dictionary and encyclopedia. What is Primary prevention? Meaning of Primary prevention as a legal term. What does Primary prevention mean in law?
TY - JOUR. T1 - Primary prevention of cardiovascular disease with statins. T2 - Assessing the evidence base behind clinical guidance. AU - Grundy, Scott M. PY - 2016/2/1. Y1 - 2016/2/1. N2 - Statins and other cholesterol-lowering drugs are increasingly being used for primary prevention of atherosclerotic cardiovascular disease. Three lines of evidence inform the development of therapeutic goals for both drug and lifestyle intervention. This evidence reveals the following principles for cholesterol lowering in primary prevention: (a) the more (lowering), the better for relative risk reduction, (b) the lower, the better for absolute risk reduction, and (c) the earlier, the better for lifetime risk reduction. From these general axioms, treatment can be adjusted to guide therapies in individual patients. There is no one size fits all for primary prevention and simplicity is not the final word for the management of cholesterol disorders; it is useful but cannot be substituted for clinical ...
Description: This workshop will discuss the participatory approach used to develop community-specific primary prevention programs as part of Project Envision, a multi-year community mobilization pilot in New York City. Participants will learn how three community coalitions designed programs that reflect needs assessment findings, are rooted in the principles of primary prevention, and that promote sustainable changes to the social norms which contribute to sexual violence.. Materials:. ...
This study aims to prevent childhood obesity with early life (pregnancy) intensified counselling. The recruited intervention group is pregnant mothers who are at risk to get gestational diabetes. Lifestyle intervention (nutritional and physical activity) begins during pregnancy in maternity clinics and continues in child wellfare clinics until the child is 5 years of age ...
The American Heart Association (AHA) CEO Roundtable today releases Resilience in the Workplace, an evidence review report with practical guidance for employers looking to implement resilience training programs. With two-thirds ...
Congress has used cost-effectiveness analyses in deciding that Medicare should cover selected secondary prevention services, such as screening for breast cancer and colon cancer. But the measure of cost per QALY is routinely ignored in decisions both about treatment for demonstrated disease and about primary prevention of disease. It is ignored, though, in entirely different ways. Medical treatments are paid for even if they are cost-ineffective; in fact, the Medicare program has been blocked from even considering cost-effectiveness in determining whether to cover the costs of treatment. For example, treatment of metastatic lung cancer may cost $800,000 per QALY, but it is typically provided. In sharp contrast, primary preventive services are often withheld even if they are highly cost-effective. For example, the Diabetes Prevention Program, a lifestyle-training program focused on exercise and nutrition that costs only $14,000 per QALY, is covered by only some health insurance plans; Medicare is ...
2/2019 SOLOIST: A Randomized, Double-blind, Placebo-controlled, Parallel-group, Multicenter study to evaluate the effects of SOtagLiflozin on Clinical Outcomes in HemOdynamIcally STable Patients with Type 2 Diabetes POST worsening Heart Failure 1/2019 ILLUMENTE BTK: Stellar 0.014 OTW Drug-coated (paclitaxel-coated) angioplasty (Prx PTA) ballon catheter, provided in diameters ranging from 2-4mm and lenghs up to 150mm 11/2018 AEGIS-II: A Phase 3 Multicenter, Double-blind, Randomized, Placebo-controlled, Parallel group study to investigate the efficacy and safety of CSL112 in subjects with Acute Coronary Syndrome.. 5/2018 APPRAISE ATP: Assessment of Primary Prevention Patients receiving an ICD- Systematic. Evaluation of ATP 5/2018 CONNECT: Care Optimization through Patient and Hospital Engagement Clinical Trial for. Heart Failure 1/2018 CHOCOLATE TOUCH: Study to assess the Drug-Coated Chocolate Touch Balloon Catheters safety and effectiveness compared to an FDA approved drug-coated balloon. 7/2017 ...
The DIAN Trials Unit is nearing the end of its first two secondary prevention trials. It has begun a cognitive run-in period for its next trial, of a tau-based drug, and for a primary prevention study in people as young as 18.. ...
Despite the growing number of options for treating type 2 diabetes, clinicians wanting to prevent the disease in high-risk patients have few good choices. Lifestyle changes that lead to weight loss can prevent diabetes (1, 2) but are difficult to adopt and maintain (3). Drugs used to treat diabetes are often expensive, and testing has only recently begun on their efficacy as primary preventive agents. Two large trials in 2002 showed that metformin (1) and acarbose (4) effectively prevent diabetes in participants with impaired glucose tolerance, but neither drug has been approved by the U.S. Food and Drug Administration (FDA) for prevention and their use has not become part of routine practice ...
臨床研究,如Framingham Heart Study, Coronary Primary Prevention Trial 等發現,「好膽固醇」的水平每提高 0.03 mmol/L,患上心臟病... ...
The Uppsala Longitudinal Study of Adult Men (ULSAM) is a longitudinal, epidemiologic study based on all available men, born between 1920 and 1924, in Uppsala County, Sweden. The origin of this longitudinal study was the "Uppsala Primary Preventive Study", carried out between September 1970 and September 1973. 2,841 men were invited for the investigation, and 2,322 (81.7%) participated ...
The ACCF/AHA Primary Prevention of Cardiovascular Disease Performance Measures Writing Committee (the Writing Committee) was charged to develop performance measures for the prevention of CVD. These performance measures do not specifically address prevention of stroke, although because risk factors for heart disease and stroke overlap, their use should contribute to the prevention of stroke as well. These measures are intended for adults (18 years of age and older) evaluated in the outpatient setting. The Writing Committee designed most of the measures, including all of the lifestyle measures, to begin at age 18 because we recognize that risk for atherosclerosis accumulates over a lifetime and, although it is never too late to make changes to prevent heart disease, the greatest benefit accrues with early lifestyle changes. The relation between cardiovascular risk factors and the extent and severity of coronary atherosclerosis in the teenage years and earlier is well established on the basis of ...
Background: There is conflicting evidence on the use of omega 3 and omega 6 supplementation for the prevention of allergic diseases. We conducted a systematic review evaluating the effectiveness of omega 3 and 6 oils for the primary prevention of sensitization and development of allergic disorders.. Methods: We searched The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, LILACS, PsycInfo, AMED, ISI Web of Science and Google Scholar for double-blind randomized controlled trials. Two authors independently assessed articles for inclusion. Meta-analyses were undertaken using fixed effects modelling, or random effects modelling in the event of detecting significant heterogeneity.. Results: Of the 3129 articles identified, 10 reports (representing six unique studies) satisfied the inclusion criteria. Four studies compared omega 3 supplements with placebo and two studies compared omega 6 supplements with placebo. There was no clear evidence of benefit in relation to reduced risk of ...
TY - JOUR. T1 - Primary prevention of cancer-related thrombosis. T2 - Special focus on ambulatory patients. AU - Arcopinto, Michele. AU - Cella, Chiara A.. AU - Wesolowski, Robert. AU - Salzano, Andrea. AU - Bossone, Eduardo. AU - Cittadini, Antonio. AU - Baliga, Ragavendra R.. PY - 2014/5/15. Y1 - 2014/5/15. KW - Cancer. KW - Venous thromboembolism. UR - http://www.scopus.com/inward/record.url?scp=84899580186&partnerID=8YFLogxK. UR - http://www.scopus.com/inward/citedby.url?scp=84899580186&partnerID=8YFLogxK. U2 - 10.1016/j.ijcard.2014.03.109. DO - 10.1016/j.ijcard.2014.03.109. M3 - Article. C2 - 24698248. AN - SCOPUS:84899580186. VL - 173. SP - 583. EP - 584. JO - International Journal of Cardiology. JF - International Journal of Cardiology. SN - 0167-5273. IS - 3. ER - ...
Parallel increases in many inflammatory diseases over the last 40 years suggest that common environmental changes are promoting inflammatory immune responses and/or inhibiting the processes that normally keep these in check. One key change during this period has been declining intakes of anti-inflammatory dietary factors, including omega-3 polyunsaturated fatty acids (n-3 PUFA). As allergic diseases often first manifest in early infancy, prevention strategies need to be targeted early, even in utero. This review will examine recent evidence for the use of fish oil during this early period as a primary prevention strategy for allergic disease ...
The epidemic of diabetes and obesity assailing Westernized societies threatens to interact with the prevalent, age-related incidence of aortic disease to increase macrovascular disease burden.3 Primary prevention strategies are critically important; however, as many as one-third of patients with T2DM may be unaware of their disorder-and vascular disease processes that threaten life, limb, and autonomy progress from the earliest phases of the dysmetabolic state.1,2 A better understanding of aortofemoral disease in T2DM is necessary to develop new strategies to address this burgeoning clinical need.. The Ldlr−/− mouse has emerged as one useful model for studying macrovascular injury in response to T2DM.17 When fed HFD, these mice become obese, with concomitant hyperglycemia and dyslipidemia.17 Unlike the Apoe−/− mouse-a model of atherosclerosis in the absence of hyperglycemia and obesity17 Ldlr−/− mice fed the HFD elaborate key features of metabolic syndrome.17 The relationships ...
(1991) Bauer et al. Ther Umsch. Primary prophylaxis by a change of behaviour in the population continues to be the only effective possibility to prevent a further spread of the aids epidemic. The most important presupposition for...
Unobtrusive and easy-to-use sensor devices are used for monitoring the health condition of people interested in adopting a healthier lifestyle. The collect
The California Alliance for Funding Prevention seeks substantive new funding to support prevention strategies, particularly non-clinical, upstream primary prevention that is not currently reimbursed, including the creation of a statewide Wellness Fund.
To receive program updates via e-mail, please send an informal request to: [email protected] Introductory Lecture: Ernest Hawk, Texas, United States. Primary Prevention: Risk factor research aiming for practical ...
This report shares findings from research, policy and practice on prevention in adult safeguarding and presents a wide range of approaches that can help prevent abuse.
OPIS is a think-and-do tank dedicated to making the prevention of intense suffering of sentient beings our highest ethical priority.
Примечание: ОХС - общий холестерин крови. Такие лица нуждаются в настойчивой коррекции риска, а также активном целевом выявлении возможного бессимптомного сердечно-сосудистого заболевания (как правило, атеросклеротического генеза). В этом случае в клинической практике преимущественно применяются следующие неинвазивные методы исследования: электрокардиография (ЭКГ), включая автоматическое суточное амбулаторное мониторирование, ультразвуковые исследования сердца (в т.ч. стресс-эхокардиография, тканевой допплер и др.), магистральных сосудов ...
Its not the years in your life that count. Its the life in your years." Abraham Lincoln. Implantable cardioverter defibrillators (ICDs) have one fundamental function the prevention of sudden unexpected arrhythmic cardiac death.. As Americans age and more baby boomers become "eligible" for a primary prevention ICD, it is important to ensure that treatments are appropriately and effectively applied to this growing segment of the population. Yet, enrollment of patients older than age 65 years in major primary prevention ICD trials is limited. A surprising 28% of Americans suitable for an ICD by conventional criteria are over age 79 years.1 Over 40% of primary prevention ICDs in the United States are placed in patients ≥70 years old. A review of over 115,000 Medicare patients in the National Cardiovascular Database ICD Registry revealed a mean age of 75 years at the time of ICD implantation, a trend that did not change between 2006 and 2010.2,9 Implantation rates are similar in other ...
Results 900 patients (87% men, mean age 64±10 years) were included in the analysis. During a median follow-up of 669 days (IQR 363-1322 days), 150 patients (17%) died and 191 (21%) patients received appropriate device therapy. 114 (13%) patients died without prior appropriate therapy. Stratification of the risk for death without prior appropriate therapy resulted in risk categorisation of patients as low, intermediate or high risk. NYHA ≥III, advanced age, diabetes mellitus, left ventricular ejection fraction ≤25% and a history of smoking were significant independent predictors of death without appropriate ICD therapy. 5-year cumulative incidence for death without prior appropriate therapy ranged from 10% (95% CI 6% to 16%) in low-risk patients to 41% (95% CI 33% to 51%) in high-risk patients. ...
Our study found that in both older women and men with HF and reduced LVEF, implantation or prescription of a primary prevention ICD on discharge was associated with improved survival. Relative to those not receiving an ICD, those receiving (or prescribed) an ICD had similarly improved survival in both women and men, with no significant sex-based interactions. These HRs are similar to those seen overall in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT; HR for mortality in ICD versus placebo groups, 0.77), which, among the landmark randomized clinical trials of primary prevention ICDs, most closely resembles the population studied here.1. Despite the survival benefits of primary prevention ICDs in patients with HF demonstrated in randomized clinical trials, benefit in the subgroup of women from these trials has not been definitively proved.7-9 This uncertainty on survival benefit may be one of several contributing factors to the lower rates of ICD referral and implantation in eligible ...
This paper describes the design of the West of Scotland Coronary Prevention Study WOSCOPS which is a primary prevention trial involving men aged 45-64 yr with raised plasma cholesterol levels. The principal aim is to test the hypothesis that reduction of serum cholesterol by treatment with pravastatin a competitive inhibitor of 3-hydroxy-3-...
The limitations of what physical therapists can differ from country to country. In Japan, physical therapists are national licensed health care professionals who can help patients improve or restore their mobility. Most Japanese physical therapists provide care for people in health care facilities, …
The online aspirin bleeding risk calculator tool, created by Dr. Vanessa Selaks team (Auckland University), helps estimate a patients own 5-year risk of a cardiovascular disease (CVD) event and the risk of a major bleed for primary prevention patients with and without aspirin.1,2 This enables the clinician to show the patient estimates of the benefits and harms of taking aspirin.. The tool informs and helps patients decide on taking aspirin, as it is a decision that only they can make. It takes into account if the patient is on medications and/or has co-morbid health conditions that can influence bleeding and CVD events.. It is based on a New Zealand cohort of 245,028 patients. The data may not be relevant to patients in countries outside of New Zealand.. References:. ...
This is a large, randomized trial of a Lyme disease primary prevention program for passengers on ferry boats going to Nantucket Island for the period from Memorial Day until Labor Day. Boats are randomized to experimental or control interventions.. The experimental intervention is a performance-based educational program on Lyme disease prevention, and uses supplemental materials. An entertainment troupe delivers the intervention using comedy, theater, and vaudevillian techniques. The entertainers present three shows in different locations on the boat. Each show is about 10 minutes and covers the severity and likelihood of acquiring Lyme disease and the benefits of tick avoidance and search and removal behaviors. When people on experimental boats enroll in the study they receive the following free materials: a wallet-sized tick ID card, a laminated shower card with tick-removal instructions, a map showing tick habitats, a tick-feeling card, and an educational pamphlet. Control boats do not have ...
TY - JOUR. T1 - The best usage of aspirin in primary prevention - Indication, dosage and ethnic issues. AU - Lin, Chung Sheng. AU - Sheu, Wayne H H. AU - Chern, Chang Ming. AU - Wu, Chau Chung. AU - Ho, Low Tone. AU - Hsu, Chung Y.. AU - Hsu, Tsui Lieh. AU - Lo, Yuk Keung. AU - Chen, Ming Fong. PY - 2007/2. Y1 - 2007/2. N2 - Aspirin is a well-known drug applied in clinical therapy. However, results of aspirin researches and clinical trials are different from traditional therapeutical guidelines. Some new conclusions emerged. Aspirin takes in a prevention role in some diseases, such as cardiovascular (CV) events, diabetes, and metabolic syndrome. However, how to apply aspirin in primary prevention still needs more discussion. In this article, we discuss the effect of aspirin in the field of cardiology, stroke, diabetes and pharmacology. We also discuss the dosage and appropriate usage of aspirin in Taiwans population. The content of this article included the view points of the benefit of aspirin ...
For patients taking statins for prevention of cardiovascular disease (CVD), extended care with nurse-led cardiovascular risk-factor counseling improves statin adherence and reduces anxiety, with improvements seen in low-density lipoprotein cholesterol for primary prevention patients.
With the publication of MADIT II in 2002 and SCD-HeFT in 2004, primary device implant indications have expanded; and with the COMPANION trial in 2005 supporting the benefit of biventricular devices, the number of ICD implants has increased further. Since these trials, data on implant patterns in a large group of patients from multiple centers has not been reported. The Advancements in ICD Therapy (ACT) prospective implant registry is a non-consecutive patient study developed to track such a group undergoing device implantation. Data on device and lead performance, arrhythmic events and mortality are tracked.. Methods: Over a 19 month period from November 2004.to June, 2006, 5454 devices were implanted at 286 centers in 38 states in the United States. Patients where enrolled within 2 weeks of implant. Patients are being followed for a period of 2 years at 6 month intervals with device interrogations performed at each visit. Primary prevention patients are those who met MADIT II, SCD-HeFT or ...
The program focuses on primary preventive measures: encouraging Americans to take aspirin if they are found to be at risk for heart disease, get their high blood pressure under control, manage blood cholesterol levels, and stop smoking.. "Cardiovascular disease is a big problem and Million Hearts is a big solution," says Thomas Frieden, M.D., director of the CDC.. If the program is successful, Dr. Frieden estimates that 10 million more Americans will get their high blood pressure under control; 20 million more Americans will be treating their high cholesterol effectively; 4 million fewer Americans will smoke; and consumption of artificial trans fat will be cut by half and sodium consumption by 20 percent.. "I am confident we can save a million hearts," Dr. Frieden says.. Always talk with your health care provider to find out more information.. ...
The USPSTF recommends initiating low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years.
The American Heart Association evaluated the results of large cohort studies and primary and secondary prevention trials. Large observational studies have shown that consumption of antioxidant-rich foods or supplements reduces the risk of coronary artery disease. The largest of these cohort studies is the Nurses Health Study, in which 85,000 participants were followed for approximately eight years. The risk of coronary disease was lowest among women with the highest intake of vitamin E. None of the studies reviewed found a link between disease risk and consumption of vitamin C. Even though observational studies support a relationship between disease risk and consumption of dietary antioxidants, evidence from randomized trials on primary prevention is lacking. However, results from secondary prevention trials have been more supportive. For example, the Cambridge Heart Antioxidant Study showed that the risk of myocardial infarction was reduced up to 77 percent in patients who took high dosages of ...
To assess the value of the latest recommendations, it is worth considering what new evidence has emerged since those issued in 2009. In that year, the Antithrombotic Trialists (ATT) Collaboration reported a collaborative meta-analysis of individual-patient data from 6 primary prevention trials of 95 000 persons, which included a detailed assessment of how the cardiovascular benefits and bleeding risks compared in different prognostic groups (3). The latest recommendations from the USPSTF consider 5 more primary prevention trials of about 25 000 persons, most of whom were at low risk for CVD. The relative risk estimates for nonfatal MI (22% reduction), stroke (no significant effect), mortality (no significant effect), and serious gastrointestinal bleeding (58% increase) were almost identical to those reported by the ATT. Perhaps not surprisingly, the ATT and USPSTF both find that aspirin yields small cardiovascular benefits (that is, a reduction in nonfatal MI) and small bleeding risks (serious ...
USPSTF 2016 recommendations on statin use for primary prevention of CVD Clinical Question:What are the benefits and harms of statin treatment for dyslipidemia in adults 21 years and older?Bottom Line:The United States Preventive Services Task Force (USPSTF) now recommends that adultswithout a history of cardiovascular disease (CVD) use a low- to moderate-dose statin for the…
A new genetic test could help predict which individuals will develop coronary heart disease among those with similar conventional risk factors. The length of the terminating structures of chromosomes, telomeres, can be used to predict cardiovascular mortality in middle-aged men, according to a study from Leicester in the UK which analysed blood samples collected for the West of Scotland Primary Prevention Study, (WOSCOPS). Nilesh Samani gave Helen Morant the details ...
Findings of the ASPREE trial show no benefit, at all, of aspirin in primary prevention of disability-free survival, cardiovascular events and death, or all-cause death in healthy elderly people.
Cerebro/cardiovascular (CV) death accounts for approximately 30% of total deaths in Japan and therefore it is important to establish a preventive treatment for CV events from the point of public health. The guidelines proposed by a joint study group centering on the Japanese Circulation Society, recommend administration of aspirin to patients with multiple risk factors for primary prevention of arteriosclerotic diseases. In addition, the 2002 AHA guidelines recommend use of aspirin in patients with a 10% or higher 10-year risk of CV events. However, these descriptions are founded on randomized, comparative study results and epidemiological data obtained outside Japan, while no epidemiological data are available in Japan that would allow prediction and selection of patients who could benefit from primary prevention with aspirin. Although the benefit of aspirin for secondary prevention has been proven in Japanese patients, the benefits of primary prevention are still controversial ...
Organized by Dr. Michael Ozner, the Cardiovascular Disease Prevention Symposium is an annual gathering of visionary cardiologists focused on conquering heart disease. Topics included PCSK9 to reduce cholesterol, benefits of fish oil and biomarkers of coronary artery disease.
Three major trials of aspirin for primary prevention of cardiovascular events, viewed together, suggest its benefits are largely outweighed by the bleeding risk, according to a leading Harvard specialist. The results from the three studies should be considered in the context of findings from statin trials, according to Professor Paul Ridker, from the Centre for Cardiovascular Disease Prevention at the Brigham and Womens Hospital in Boston. Primary prevention specialist mulls the latest evidence
Cardiovascular disease is the one the major causes of death among in the indian population. Use of aspirin is known to play an important role in reducing the risk of CVD as well as CRC .. Recently, Use of Aspirin has been once again guidelined, to be used as a primary prevention of Cardiovascular Disease and Colorectal Cancer. For quite some time, there has been ongoing debate regarding the utility of this important in a younger age group. While this issue is still resolved in the guidelines, the general usage and utility of this drug in other groups has been reconfirmed with clarifications.. On April 12th, 2016, U.S. Preventive Services Task Force has issued the Recommendation Statement on Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: ...
The rate of myocardial infarctions, strokes, and heart disease-related deaths in persons at high risk may be reduced by about 30%.
This study is assessing the efficacy of aspirin in preventing cardiovascular events in patients with type 2 diabetes mellitus. The primary endpoint is the
Despite the considerable efforts and funds devoted to cancer research over several decades, cancer still remains a mainly lethal disease. Cancer incidence and mortality have not declined at the same rate as other major causes of death, indicating that primary prevention remains a most valuable approach to decrease mortality. There is general agreement that environmental exposures are variously involved in the causation of the majority of cancer cases and that at least half of all cancers could be avoided by applying existing etiologic knowledge. There is disagreement, however, regarding the proportion of cancer risks attributable to specific etiological factors, including diet, occupation and pollution. Estimates of attributable risks are largely based today on unverified assumptions and the calculation of attributable risks involves taking very unequal evidence of various types of factors and treating them equally. Effective primary prevention resulting in a reduction of cancer risk can be ...