Preventive medicine
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Human Papillomavirus (HPV) infection is a necessary risk factor for cervical cancer. If HPV is no longer spread, no new cervical cancer precursors will occur. The timepoint for control of the HPV infection will therefore be a rate-limiting step for cervical cancer elimination. ⋯ Above age 35, we found an R0 of 0.4. Thus, when younger birth cohorts no longer transmit HPV to women >35 years of age, we predict that the HPV infection will no longer be sustained among the older women. Given adequate resources, campaigns to eliminate HPV that are designed based on the R0 measurements followed by screening to detect and treat pre-existing cervical cancer precursors could achieve accelerated cervical cancer elimination.
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Preventive medicine · Dec 2021
Alcohol and drug offenses and suicide risk among men who purchased a handgun in California: A cohort study.
Firearm access is a risk factor for firearm suicide; substance use may confer additional risk. In this retrospective cohort study, we estimated the associations between prior alcohol and drug charges at the time of handgun purchase and subsequent suicide among men in California. The sample comprised all men who legally purchased a handgun in California in 2001 and who were age ≥ 21 at the time of acquisition (N = 101,377), identified in the California Department of Justice (CA DOJ) Dealer's Record of Sale database. ⋯ Risk was most elevated among those with more recent charges and those with 2 or more charges, and in the time period closest to the purchase. The associations for drug charges and the combination of alcohol and drug charges were not distinguishable from the null. Firearm owners with alcohol offenses may benefit from intervention to reduce firearm access and alcohol use.
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In 2012, United States consensus guidelines were modified to recommend that cervical cancer screening not begin before age 21 and, since 2014, the Health Effectiveness Data and Information Set (HEDIS), a health plan quality measurement too, has included a measure for non-recommended cervical cancer screening among females ages 16-20. Our goal was to describe prevalence over time of cervical cancer screening before age 21 following the 2012 guideline change, and provide information to help understand how rapidly new guidelines may be disseminated and implemented into clinical practice. We used longitudinal clinical and administrative data from three diverse healthcare systems in the Population-based Research to Optimize the Screening Process (PROSPR II) consortium to examine annual trends in screening before age 21. ⋯ The observed steady decline suggests growing adherence to the 2012 consensus guidelines. This trend was consistent across diverse geographic regions, healthcare systems, and patient populations, strengthening the generalizability of the results; however, since we only had 1-2 years of study data prior to the consensus guidelines, we cannot discern whether screening under age 21 was already in decline. Nonetheless, these results provide data to compare with other guideline changes to de-implement non-recommended screening practices.
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Preventive medicine · Dec 2021
Gender gap in health service utilisation and outcomes of depression: A cross-country longitudinal analysis of European middle-aged and older adults.
Research has shown that health service utilisation for depression (HSUD) is less common among men than women. However, most evidence is cross-sectional, and there is limited information about gendered outcomes of depression. This cross-country study assesses gender differences in HSUD and in the persistence of depression by using cross-sectional and longitudinal data. ⋯ Among those without HSUD, depression was more likely to persist among women (45.4%, OR = 0.79, 99%CI = 0.78-0.79). Results suggest that cross-sectional analyses underestimate men's disadvantage in HSUD. Interventions are needed to improve the demand for care and treatment adequacy among men, increasing their perception of need and their mental health literacy.
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Preventive medicine · Dec 2021
Prevention paradox between stroke and multiple potential risk factors using data from a population-based cohort study.
Previous studies have found the prevention paradox in the association between stroke events and a single specific risk factor, indicating that a population-based strategy may be more effective than a high-risk-based strategy for prevention. We tested the hypothesis that the prevention paradox does not apply when focusing on multiple potential risk factors simultaneously. The study cohort included 9051 individuals from Japan aged 40-89 years. ⋯ We found that hypertension was a primary risk factor for stroke incidence, regardless of sex and age. The percentage of patients with a single specific risk of and developed stroke was 46%-63%, while the percentage of patients with 1-3 risk factor(s) was 71-83%. This finding leads to the conclusion that the prevention paradox does not hold when multiple stroke risk factors were associated, suggesting that a high-risk-based strategy that focuses on patients with multiple risk factors may be more effective in preventing strokes.