Preventive medicine
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Preventive medicine · Oct 2022
ReviewThe cognitive dissonance discourse of evolving terminology from colonial medicine to global health and inaction towards equity - A Preventive Medicine Golden Jubilee Article.
We discuss the evolution of terminology, beginning with colonial medicine and ending with global health. We describe how global health's definition evolved to include language on autonomy, power, and health equity. Specifically, we studied the websites of the twenty-five‑leading national (N = 5), multilateral (N = 5), philanthropic (N = 5), non-governmental organizations (N = 5) in research, health service delivery, and advocacy, and academic institutions (N = 5) within global health to understand their history, places of critical operations, budget, organizational structure, leadership, mission, policies, and representation of the global south. ⋯ We underscore that the epistemological-praxis disconnect creates organizational psychology akin to cognitive dissonance within individuals, particularly among practitioners from the global south. This dissonance perpetuates inequity across global health organizations uniquely structurally impedes decolonization by and in the institutions that promote global health, and undermines the achievement of current goals across the global health system. To truly decolonize global health, researchers must measure and study changes in how organizations operationalize their goals, structures, policies, and administrative processes to address equity and social justice across all sectors of the global health system.
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Preventive medicine · Oct 2022
The association of smoking cessation with mortality from pneumonia among middle-aged and elderly community residents: The Japan Collaborative Cohort (JACC) study.
Several studies have shown that smoking is a significant risk factor for pneumonia, but it is uncertain to what extent smoking cessation reduces the risk. This study aimed to investigate whether and to what extent smoking cessation is associated with reduced risk of mortality from pneumonia in a Japanese, prospective, community-based cohort. We examined 94,972 individuals (mean age, 57 years; women, 57%) who provided valid responses to a lifestyle questionnaire including questions about smoking. ⋯ Multivariable hazard ratios (95% confidence intervals) compared with the current smokers were 1.02 (0.72-1.45) for 0-1 year of smoking cessation at baseline, 0.92 (0.70-1.22) for 2-4 years, 0.95 (0.74-1.21) for 5-9 years, 0.71 (0.53-0.96) for 10-14 years, 0.63 (0.48-0.83) for 15 years or more, and 0.50 (0.36-0.70) for never-smokers. Although smoking increases the risk of pneumonia mortality, the present study showed that the risk of pneumonia mortality decreased with years of smoking cessation, eventually improving to levels similar to those of non-smokers for 10 years or more. Continued smoking cessation may be effective in preventing pneumonia deaths.
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Preventive medicine · Oct 2022
Changes in time spent walking and disability-free life expectancy in Japanese older people: The Ohsaki Cohort 2006 Study.
An increase in time spent walking is significantly associated with lower risks of mortality and disability. This study aimed to investigate the association between changes in time spent walking and disability-free life expectancy (DFLE) in community-dwelling older people. Thirteen-year follow-up data from a cohort study of 7105 Japanese older adults (age ≥ 65 years) in 2006 were analyzed. ⋯ The 2-year difference in DFLE did not change after the participants were stratified by body mass index, motor function, cognitive function, and history of diseases. Increase in time spent walking is associated with longer DFLE in Japanese older people. Encouraging simple physical activity such as walking at the population level could increase life-years lived in good health.
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Preventive medicine · Oct 2022
What explains racial/ethnic inequities in the uptake of differentiated influenza vaccines?
We investigated the role of individual, community and vaccinator characteristics in mediating racial/ethnic disparities in the uptake of differentiated influenza vaccines (DIVs; including high-dose, adjuvanted, recombinant and cell-based vaccines). We included privately-insured (commercial and Medicare Advantage) ≥65 years-old community-dwelling health plan beneficiaries in the US with >1 year of continuous coverage and who received ≥1 influenza vaccine during the study period (July 2014-June 2018). Of 2.8 million distinct vaccination claims, 60% were for DIVs; lower if received in physician offices (49%) compared to pharmacies/facilities (74%). ⋯ These disparities disappeared for whites, but not for non-whites, after controlling for community and vaccinator characteristics. We found an alarming level of inequity in DIV vaccine uptake among fully insured older adults that could not be fully explained by differences in sociodemographic, medical, community, and vaccinator characteristics. New strategies are urgently needed to address these inequities.
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Preventive medicine · Oct 2022
Using multiple imputation by super learning to assign intent to nonfatal firearm injuries.
The number of nonfatal firearm injuries in the US by intent (e.g., due to assault) is not reliably known: First, although the largest surveillance system for hospital-treated events, the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample (HCUP-NEDS), provides accurate data for the number of nonfatal firearm injuries, injury intent is not coded reliably. Second, the system that reliably codes intent, the CDC's National Electronic Injury Surveillance System - Firearm Injury Surveillance Study (NEISS-FISS), while large enough to produce stable estimates of the distribution of intent, is too small to produce stable estimates of the number of these events. Third, a large proportion of cases in NEISS-FISS, notably in early years of the system, are coded as of "undetermined intent." Trends in the proportion of nonfatal firearm injuries by intent in NEISS-FISS thus depend on whether these cases are treated as a distinct category, or, instead, can be re-classified through imputation. ⋯ Trends in the number of nonfatal firearm injuries by intent, 2006-2016, derived in our two-step process, are relatively flat. Multiple imputation strategies recovered intent distribution trends that differed from trends derived using methods that are not designed to account for the multiple complex relationships of missingness present in NEISS - FISS data. When applied to NEISS - FISS, MISL imputation produces plausible distributional estimates of firearm injury by intent.