Preventive medicine
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Preventive medicine · Jul 2021
Metabolically healthy obesity increases the prevalence of stroke in adults aged 40 years or older: Result from the China National Stroke Screening survey.
Debate over the cardio-cerebrovascular risk associated with metabolically healthy obesity (MHO) continues. In this study we investigated the association of MHO with the risk of stroke among 221,114 individuals aged 40 years or older based on data from the China National Stroke Screening and Prevention Project (CNSSPP), a nationally representative cross-sectional study, during 2014 to 2015. Different metabolic health and obesity phenotypes were defined according to the Adult Treatment Panel III (ATP III) criteria, where obesity was defined as a body mass index (BMI) ≥28 kg/m2. ⋯ Furthermore, obesity and metabolic abnormalities had an additive interaction for stroke risk with an attributable proportion (AP) of 14.0% in females. BMI played a partial mediating role with the proportion of the effect (PE) at 11.1% in the relationship between metabolic abnormalities and stroke. This study strengthens the evidence that management and interventions in the MHO population may contribute to the primary prevention of stroke.
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Preventive medicine · Jul 2021
Is it ethical to incentivize mammography screening in medicaid populations?- A policy review and conceptual analysis.
Mammography screening is controversial, as screening decisions are preference-sensitive: equally well-informed women do not universally get mammograms. Offering financial incentives for screening risks unduly influencing the decision-making process and may undermine voluntariness-yet incentives are being used in 4 US states (Arizona, Indiana, Kentucky, Michigan) under Section 1115 waivers. These initiatives are especially problematic in Medicaid populations who typically have lower health literacy and face the potential threat of disenrollment if they opt out. ⋯ CMS and US states should therefore review variations and prevent unjustifiable practices, such as incentivizing 35-year-old women. Large incentives should be offered only if accompanied by robust studies. Incentives for using evidence-based mammography decision-aids, instead of mammography completion, better realize the intended goals.
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Preventive medicine · Jul 2021
Development and validation of a risk prediction model for high-risk adenomas at the time of first screening colonoscopy among screening aged Canadians.
The aim of this study was to develop a risk prediction model for high risk adenomas (HRAs) detected at screening colonoscopy based on readily available participant information. The cohort consisted of 3035 participants aged 50 to 74 years with no history of cancer who underwent a primary screening colonoscopy at a centralized colon cancer screening centre between 2008 and 2016. A multivariable logistic regression model was created using CRC risk factors identified from prior research. ⋯ Our model has moderate predictive ability, with strengths in being able to rule out those with an absence of HRAs on screening colonoscopy. Maximizing screening efficiency through improved risk prediction can enhance resource allocation. Ultimately, this model has the potential to improve patient care by reducing unnecessary colonoscopies, limiting this invasive procedure to those most likely to have significant findings.
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Preventive medicine · Jul 2021
Health-related behaviors and health insurance status among US adults: Findings from the 2017 behavioral risk factor surveillance system.
Health insurance coverage has increased overtime in the US. This study examined the associations between health insurance status and adoption of health-related behaviors among US adults. Using data collected through the 2017 Behavioral Risk Factor Surveillance System on health insurance coverage and type of insurance, we examined four health-related behaviors (i.e., no tobacco use, nondrinking or moderate drinking, meeting aerobic physical activity recommendations, and having a healthy body weight) and their associations with health insurance status. ⋯ Adults with public insurance were 7% more likely to report no tobacco use than adults who were uninsured. Additionally, adults with private insurance were 8% and 7% more likely to report no tobacco use and meeting physical activity recommendations, respectively, but 10% less likely to report nondrinking or moderate drinking than adults with public insurance. In conclusion, we found significant associations existed between having health insurance coverage and engaging in some health-related behaviors among US adults.
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Preventive medicine · Jul 2021
Public guns, private violence: The association of city-level firearm availability and intimate partner homicide in the United States.
This city-level study examines the association of federally licensed firearm dealers (FFLs) and measures of illegal firearm availability with the risk of intimate partner homicide. Annual data for a sample of 286 large cities in the United States were collected for the years 2010-2019, incorporating city-level information on the number of gun-perpetrated homicides, the rate of licensed firearm dealers, and guns reported lost or stolen. All data were compiled and analyzed in 2020. ⋯ Results indicate that a higher rate of licensed firearm dealers was associated with a higher risk of intimate partner homicide, although more pronounced in states with lower-than-average existing gun ownership. This association was robust to different analytical methods and alternate ways of capturing illegal guns. A supplementary analysis using unique data from The Trace further supports the argument that FFL presence is a risk factor for intimate partner firearm homicide specifically, but not necessarily firearm homicide characterized by other motives.