Preventive medicine
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Preventive medicine · Sep 1997
ReviewThe nocebo phenomenon: concept, evidence, and implications for public health.
The nocebo hypothesis proposes that expectations of sickness and the affective states associated with such expectations cause sickness in the expectant. The nocebo phenomenon is a little-recognized facet of culture that may be responsible for a substantial variety of pathology throughout the world. However, the extent of the phenomenon is not yet known, and evidence is piecemeal and ambiguous. This paper reviews the concept of nocebo and its association with the placebo phenomenon, gives examples of evidence for the nocebo phenomenon, and suggests public health implications.
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A useful way to summarize the placebo-nocebo theme is to consider the tension and interaction between conviction and responsibility. With the conviction of the mainstream biomedical paradigm prevalent today, it would be tempting to say to Dr. Engel's patient: "That question is nonsense. ⋯ Engel was both true to his convictions and responsible for providing the highest standard of care by understanding the patient's convictions and needs for comfort. The biopsychosocial concept provides a blueprint to bring the old-fashioned medical art of "humanness" to modern scientific care. Identifying the interactions of the problem, the person, and the totality of resources permits a focus on therapeutic strategies to promote placebo effects and prevent the consequences of nocebo.
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Preventive medicine · Sep 1997
Comparative StudyValidity of self-reported hypertension in the National Health and Nutrition Examination Survey III, 1988-1991.
The National Health and Nutrition Examination Survey (NHANES) is the main data source for hypertension surveillance. However, because of a gap of almost 10 years between each NHANES, self-reported data from annual surveys need to be examined as an alternative data source. This study analyzes the validity of self-reported hypertension in a national sample of non-Hispanic whites, non-Hispanic blacks, and Mexican-Americans. ⋯ Self-reported hypertension may be used for surveillance of hypertension trends, in the absence of measured blood pressure, among non-Hispanic whites and non-Hispanic black women and persons with a medical visit in the past year. Validation should be repeated with each NHANES.