Haller Dagmar M, Pfarrwaller Eva, Cerutti Bernard, Gaspoz Jean-Michel
Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Adolescent and Young Adult Program, Department of Community, Primary Care and Emergency Medicine and Department of Pediatrics, Geneva University Hospitals, Geneva, Switzerland.
BMJ Open. 2016 Oct 18;6(10):e011936. doi: 10.1136/bmjopen-2016-011936.
INTRODUCTION: Health-compromising behaviours are often acquired in adolescence. Alongside broader public health interventions, preventive interventions within primary care have the potential to encourage long-lasting behaviour change by tailoring messages to each individual. The aim of this study is to determine the effectiveness of primary care interventions in reducing the 3 main cardiovascular risk behaviours (smoking, low physical activity and unhealthy diet) in adolescents aged 10-19 years. It is also to identify successful initiatives and ingredients for such success that could be replicated in primary care. METHODS AND ANALYSIS: This systematic review of the literature and meta-analysis will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The following databases will be searched for articles published between January 1990 and December 2016: MEDLINE, EMBASE, PsychINFO, CINAHL, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, ISRCTN registry. Our search will focus on randomised and cluster randomised controlled trials of interventions conducted in primary care practices to reduce the 3 main cardiovascular risk behaviours in adolescents aged 10-19 years, compared with active (information leaflet, etc) or passive (usual care, etc) control conditions. The primary outcomes will be smoking, physical activity and diet, measured either objectively or by self-report. Secondary outcomes such as body mass index or insulin resistance will also be examined. 2 reviewers will independently screen articles, extract relevant data and assess study quality using the Cochrane risk of bias tool. A meta-analysis will be considered if the number of studies is sufficient and outcomes are sufficiently homogeneous. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria will be used to assess the quality of the evidence. ETHICS AND DISSEMINATION: This systematic review will add to our knowledge on the prevention of cardiovascular disease early in life and these findings will be disseminated through peer-reviewed publications and presentations at relevant conferences. STUDY REGISTRATION NUMBER: PROSPERO CRD42016028045.
引言：危害健康的行为往往在青少年时期养成。除了更广泛的公共卫生干预措施外，初级保健中的预防性干预措施有可能通过为每个人量身定制信息来鼓励持久的行为改变。本研究的目的是确定初级保健干预措施在减少10至19岁青少年的3种主要心血管风险行为（吸烟、缺乏体育活动和不健康饮食）方面的有效性。同时还要确定可在初级保健中复制的成功举措及其成功要素。 方法与分析：本系统文献综述和荟萃分析将遵循系统评价和荟萃分析的首选报告项目（PRISMA）建议。将检索以下数据库中1990年1月至2016年12月发表的文章：医学文献数据库（MEDLINE）、荷兰医学文摘数据库（EMBASE）、心理学文摘数据库（PsychINFO）、护理学与健康领域数据库（CINAHL）、考克兰对照试验中心注册库、美国国立医学图书馆临床试验注册平台（ClinicalTrials.gov）、国际标准随机对照试验编号注册库（ISRCTN registry）。我们的检索将集中于在初级保健机构中进行的干预措施的随机对照试验和整群随机对照试验，这些干预措施旨在减少10至19岁青少年的3种主要心血管风险行为，并与积极对照（信息传单等）或消极对照（常规护理等）条件进行比较。主要结局将是吸烟、体育活动和饮食，通过客观测量或自我报告来衡量。体重指数或胰岛素抵抗等次要结局也将进行检查。两名评审员将独立筛选文章、提取相关数据并使用考克兰偏倚风险工具评估研究质量。如果研究数量足够且结局足够同质，则将进行荟萃分析。推荐分级评估、制定与评价（GRADE）标准将用于评估证据质量。 伦理与传播：本系统综述将增加我们对早期预防心血管疾病的认识，这些研究结果将通过同行评审的出版物以及在相关会议上的报告进行传播。 研究注册号：国际前瞻性系统评价注册库（PROSPERO）CRD42016028045。
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