Preventive medicine
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Preventive medicine · Dec 2021
Randomized Controlled TrialAdherence with protocol medication use and mortality from unrelated causes in a prevention trial.
Several studies have shown that non-adherence to medication use is associated with lower use of preventive services and increased mortality. We aimed to study the relationship between initial adherence to medication use and mortality in the Prostate Cancer Prevention Trial (PCPT). The PCPT randomized men age 55 and over to a finasteride or placebo arm. ⋯ Hazard ratios (HRs) at 5 years were 1.62 (95% CI: 1.37-1.91), 1.55 (95% CI: 1.30-1.83) and 1.49 (95% CI: 1.25-1.76) for Models I-III. HRs at ten years were lower but still statistically significant. Non-adherence to taking protocol medications was associated with increased mortality from unrelated conditions.
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Preventive medicine · Dec 2021
Randomized Controlled TrialEfficacy of a school-based physical activity and nutrition intervention on child weight status: Findings from a cluster randomized controlled trial.
Despite the benefits of factorial designs in quantifying the relative benefits of different school-based approaches to prevent unhealthy weight gain among students, few have been undertaken. The aims of this 2 × 2 cluster randomized factorial trial was to evaluate the impact of a physical activity and nutrition intervention on child weight status and quality of life. Twelve primary schools in New South Wales, Australia randomly allocated to one of four groups: (i.) physical activity (150 min of planned in-school physical activity); (ii.) nutrition (a healthy school lunch-box); (iii.) combined physical activity and nutrition; or (iv.) control. ⋯ There were no significant effects of the nutrition or physical activity intervention on child BMI scores or child quality of life, and no significant synergistic effects of the two interventions combined. Future research assessing the longer-term impact of both intervention strategies, alone and combined, is warranted to better understand their potential impact on child health. TRIAL REGISTRATION: Australian Clinical Trials Registry ACTRN: ACTRN12616001228471.
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Preventive medicine · Dec 2021
Clinical TrialGroup prenatal care and improved birth outcomes: Results from a type 1 hybrid effectiveness-implementation study.
To compare birth outcomes for patients receiving Expect With Me (EWM) group prenatal care or individual care only, we conducted a type 1 hybrid effectiveness-implementation trial (Detroit and Nashville, 2014-2016). Participants entered care <24 weeks gestation, had singleton pregnancy, and no prior preterm birth (N = 2402). Mean participant age was 27.1 (SD = 5.77); 49.5% were Black; 15.3% were Latina; 59.7% publicly insured. ⋯ Post-hoc analyses indicated EWM patients utilizing the integrated information technology platform had lower risk for low birthweight infants (RR 0.47, 95% CI 0.24, 0.86) than non-users. Future research is needed to understand mechanisms by which group prenatal care improves outcomes, best practices for implementation, and health systems savings. Trial registration: ClinicalTrials.govNCT02169024.
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Preventive medicine · Dec 2021
Changes in the body mass index and blood pressure association across time: Evidence from multiple cross-sectional and cohort studies.
Although body mass index (BMI) is considered a key determinant of high blood pressure, its importance may differ over time and by age group. We utilised separate data sources to investigate temporal changes in this association: 23 independent (newly sampled), repeated cross-sectional studies (Health Survey for England (HSE)) at ≥25 years (1994-2018; N = 126,742); and three British birth cohorts at 43-46 years (born 1946, 1958, and 1970; N = 18,657). In HSE, associations were weaker in more recent years, with this trend most pronounced amongst older adults. ⋯ A weaker association between BMI and blood pressure may partly offset the public health impacts of increasing obesity prevalence. However, despite sizable increases in use of antihypertensive medication, BMI remains positively associated with SBP in all ages. Our findings highlight the need to tackle non-medical factors such as population diet which influence both BMI and blood pressure, and the utility of using multiple datasets to obtain robust inferences on trends in risk factor-outcome associations across time.
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Preventive medicine · Dec 2021
Risk factors for multiple metabolic syndrome components in obese and non-obese Japanese individuals.
Many studies have reported that even non-obese individuals have multiple metabolic syndrome (MetS) components, such as hypertension, hyperglycemia, and lipid abnormalities have a higher cardiovascular disease mortality rate and incidence. However, the risk factors for multiple MetS components in non-obese individuals have not been sufficiently clarified. This study compared risk factors, including overall lifestyle habits, for multiple MetS components possession between obese and non-obese individuals. ⋯ The odds ratio of each risk factor, with the exception of walking speed and eating speed, tended to be higher in non-obese individuals than in obese individuals. The only risk factor specific to obese individuals was lack of regular exercise. These results suggest that almost all risk factors for possession of multiple MetS components were common to both obese and non-obese individuals, and the risk level of each risk factor tended to be higher in non-obese individuals.