The aim of this study is to identify potential facilitators and barriers for health care professionals to undertake selective prevention of cardiometabolic diseases (CMD) in primary health care. We developed a search string for Medline, Embase, Cinahl and PubMed. We also screened reference lists of relevant articles to retain barriers and facilitators for prevention of CMD. We found 19 qualitative studies, 7 quantitative studies and 2 mixed qualitative and quantitative studies. In terms of five overarching categories, the most frequently reported barriers and facilitators were as follows: Structural (barriers: time restraints, ineffective counselling and interventions, insufficient reimbursement and problems with guidelines; facilitators: feasible and effective counselling and interventions, sufficient assistance and support, adequate referral, and identification of obstacles), Organizational (barriers: general organizational problems, role of practice, insufficient IT support, communication problems within health teams and lack of support services, role of staff, lack of suitable appointment times; facilitators: structured practice, IT support, flexibility of counselling, sufficient logistic/practical support and cooperation with allied health staff/community resources, responsibility to offer and importance of prevention), Professional (barriers: insufficient counselling skills, lack of knowledge and of experience; facilitators: sufficient training, effective in motivating patients), Patient-related factors (barriers: low adherence, causes problems for patients; facilitators: strong GP-patient relationship, appreciation from patients), and Attitudinal (barriers: negative attitudes to prevention; facilitators: positive attitudes of importance of prevention). We identified several frequently reported barriers and facilitators for prevention of CMD, which may be used in designing future implementation and intervention studies.

Background: Selective prevention of cardiometabolic diseases (CMD)—that is, preventive measures specifically targeting the high-risk population—may represent the most effective approach for mitigating rising CMD rates. Objectives: To develop a universal concept of selective CMD prevention that can guide implementation within European primary care. Methods: Initially, 32 statements covering different aspects of selective CMD prevention programmes were identified based on a synthesis of evidence from two systematic literature reviews and surveys conducted within the SPIMEU project. The Rand/UCLA appropriateness method (RAM) was used to find consensus on these statements among an international panel consisting of 14 experts. Before the consensus meeting, statements were rated by the experts in a first round. In the next step, during a face-to-face meeting, experts were provided with the results of the first rating and were then invited to discuss and rescore the statements in a second round. Results: In the outcome of the RAM procedure, 28 of 31 statements were considered appropriate and three were rated uncertain. The panel deleted one statement. Selective CMD prevention was considered an effective approach for preventing CMD and a proactive approach was regarded as more effective compared to case-finding alone. The most efficient method to implement selective CMD prevention systematically in primary care relies on a stepwise approach: initial risk assessment followed by interventions if indicated. Conclusion: The final set of statements represents the key characteristics of selective CMD prevention and can serve as a guide for implementing selective prevention actions in European primary care.

Background The growing number of patients with type 2 diabetes and prediabetes is a major public health concern. Physical activity is a cornerstone of diabetes management and may prevent its onset in prediabetes patients. Despite this, many patients with (pre)diabetes remain physically inactive. Primary care physicians are well-situated to deliver interventions to increase their patients' physical activity levels. However, effective and sustainable physical activity interventions for (pre)diabetes patients that can be translated into routine primary care are lacking. Methods We describe the rationale and protocol for a 12-month pragmatic, multicentre, randomised, controlled trial assessing the effectiveness of an mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED). Twenty-one general practices will recruit 340 patients with (pre)diabetes during routine health check-ups. Patients allocated to the active control arm will receive a Fitbit activity tracker to self-monitor their daily steps and try to achieve the recommended step goal. Patients allocated to the intervention arm will additionally receive the mHealth intervention, including the delivery of several text messages per week, with some of them delivered just in time, based on data continuously collected by the Fitbit tracker. The trial consists of two phases, each lasting six months: the lead-in phase, when the mHealth intervention will be supported with human phone counselling, and the maintenance phase, when the intervention will be fully automated. The primary outcome, average ambulatory activity (steps/day) measured by a wrist-worn accelerometer, will be assessed at the end of the maintenance phase at 12 months. Discussion The trial has several strengths, such as the choice of active control to isolate the net effect of the intervention beyond simple self-monitoring with an activity tracker, broad eligibility criteria allowing for the inclusion of patients without a smartphone, procedures to minimise selection bias, and involvement of a relatively large number of general practices. These design choices contribute to the trial’s pragmatic character and ensure that the intervention, if effective, can be translated into routine primary care practice, allowing important public health benefits. Trial registration ClinicalTrials.gov (NCT05351359, 28/04/2022).

Ročně je dia gnostikováno přes 8 000 nových onemocnění CRC, přibližně 4 000 mužů a žen na toto onemocnění každoročně umírá. Přes probíhající screeningový program bohužel prozatím nelze pozorovat významné zlepšení v zastoupení stadií a tedy časném záchytu CRC. Počet prováděných TOKS v ČR sice dlouhodobě zřetelně roste a s ním i pokrytí tímto screeningovým testem, nicméně celkové pokrytí české populace od 50 let věku v roce 2012 činilo pouze 25,5 %. Nejvyšší pokrytí screeningem CRC prostřednictvím TOKS je v Olomouckém, Zlínském a Ústeckém kraji (přes 28 %), naopak nejnižší je pokrytí v hlavním městě Praze (18 %). Od roku 2008 pozitivita TOKS setrvale a znatelně roste, v roce 2012 dosáhla již 6,9 %. U žen provádějí 13-14 % TOKS praktičtí gynekologové. Závěr: I přes znatelný nárůst účasti populace v posledních letech, na níž se podílí i zapojení praktických gynekologů, bohužel program stále pokrývá pouze čtvrtinu populace. Nezbytným předpokladem úspěchu programu na populační úrovni tak musí být účinná opatření směřující k vyššímu zájmu občanů o preventivní vyšetření, zejm. nově zavedené adresné zvaní k preventivnímu vyšetření. Klíčová slovakolorektální nádory -plošný screening -okultní krev -primární zdravotní péče Práce byla podpořena v rámci projektu 36/14/ /NAP "Vývoj a implementace metodiky hodnocení účinnosti adresného zvaní občanů do onkologických screeningových programů ČR" v rámci programu "Národní akční plány a koncepce" Ministerstva zdravotnictví ČR na rok 2014.This study was supported by the project 36/14/ /NAP "Development and implementation of meth odology for the evaluation of eff ectiveness of personalised invitations of citizens to cancer screening programmes" as part of the programme of the Czech Ministry of Health "National action plans and conceptions".Autoři deklarují, že v souvislosti s předmětem studie nemají žádné komerční zájmy.The authors declare they have no potential confl icts of interest concerning drugs, products, or services used in the study.Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do bi omedicínských časopisů.The Editorial Board declares that the manuscript met the ICMJE "uniform requirements" for biomedical papers. . Screening CRC je živé odborné téma, které je před-mětem intenzivního výzkumu, je charakterizované dynamickým rozvojem a narůstající publicitou. Ve screeningu CRC patří lékařům primární péče významná role, a to nejen v samotném provádění testů, ale také ve správné komunikaci screeningu směrem k občanům. Populační strategie je tak v praxích ambulantních gynekologů a všeobecných praktických lékařů překládána do osobní medicíny, do individuální péče.Eliminace CRC prostřednictvím primární prevence (změn životního stylu, medikamentózní profylaxe) je prozatím v nedohlednu a lékařům v praxi tak nezbývá, než se soustředit na včasný zá-chyt -sekundární prevenci nádorů (screening). Záchyt časných stadií ná-dorů a prekanceróz významně ovlivňuje perspektivu nemocných, jak z hlediska 5letého relativního přežití [3], tak z hlediska kvality...

Cardio-metabolic diseases (CMD; cardiovascular disease, type 2 diabetes, chronic kidney disease) represent a global public health problem. Worldwide, nearly half a billion people are currently diagnosed with diabetes, and cardiovascular disease is the leading cause of death. Most of these diseases can be assuaged/prevented through behavior change. However, the best way to implement preventive interventions is unclear. We aim to fill this knowledge gap by creating an evidence-based and adaptable “toolbox” for the design and implementation of selective prevention initiatives (SPI) targeting CMD. We built our toolbox based on evidence from a pan-European research project on primary-care SPIs targeting CMD. The evidence includes (1) two systematic reviews and two surveys of patient and general practitioner barriers and facilitators of engaging with SPIs, (2) a consensus meeting with leading experts to establish optimal SPI design, and (3) a feasibility study of a generic, evidence-based primary-care SPI protocol in five European countries. Our results related primarily to the five different national health-care contexts from which we derived our data. On this basis, we generated 12 general recommendations for how best to design and implement CMD-SPIs in primary care. We supplement our recommendations with practical, evidence-based suggestions for how each recommendation might best be heeded. The toolbox is generic and adaptable to various national and systemic settings by clinicians and policy makers alike. However, our product needs to be kept up-to-date to be effective and we implore future research to add relevant tools as they are developed.