Preventive medicine
-
The recently published IMPROVE-IT trial has been hailed as proof that lowering cholesterol reduces the risk of cardiovascular disease (Cannon et al., 2015). Although this study did demonstrate a modest clinical benefit with incremental low-density lipoprotein cholesterol lowering, many physicians tend to ignore the numerous clinical studies which have failed to demonstrate a benefit of cholesterol lowering. This article challenges the cholesterol hypothesis by reviewing these negative studies and our reluctance to acknowledge them. ⋯ The cholesterol-lowering, statin-centric approach to cardiovascular disease prevention may in fact distract us from other beneficial therapies. Dr. Alexander Leaf, former chief of medicine at Massachusetts General Hospital, commented on this paradox and the Lyon Diet Heart Study nearly 15years ago by writing, "At a time when health professionals, the pharmaceutical industries, and the research funding and regulatory agencies are almost totally focused on lowering plasma cholesterol levels by drugs, it is heartening to see a well-conducted study finding that relatively simple dietary changes achieved greater reductions in risk of all-cause and coronary heart disease mortality in a secondary prevention trial than any of the cholesterol-lowering studies to date" (Leaf, 1999).
-
Preventive medicine · Apr 2016
A sequential logit model of caretakers' decision to vaccinate children for the human papillomavirus virus in the general population.
This study explores the predisposing, enabling, and need-based factors associated with parents' or guardians' decision to have their child initiate, continue, and complete the human papillomavirus (HPV) vaccine. ⋯ The decision to initiate and complete HPV vaccination depends on a specific mix of enabling, predisposing, and need-based factors. Our analysis underscores the importance of modeling the vaccination decision in a manner that is consistent with how primary caregivers navigate real-life health care decisions for their children.
-
Preventive medicine · Apr 2016
LetterIdeology versus evidence: Investigating the claim that the literature on e-cigarettes is undermined by material conflict of interest.
A review of the health effects of e-cigarettes (EC) by Pisinger and Dossing concluded that any reassuring the evidence on the contents of e-cigarettes cannot be trusted because 'A substantial number of studies were funded or otherwise supported by manufacturers of ECs' and the relevant literature is influenced by 'severe conflicts of interest' (A). The review also asserts that 'Conflict of interest seems to influence the conclusions of these papers' (BC). These claims have been embraced and magnified by EC opponents. ⋯ Regarding claim 'B', it appears to have been conceived independent of any empirical support. Recently, anti-EC activists and media started to use conflict of interest accusations to disparage the validity of empirical evidence showing that vaping is much safer than smoking. Evidence needs to be considered on its merits rather than from the perspective of preconceived ideological positions.
-
Preventive medicine · Apr 2016
Preventing dementia by promoting physical activity and the long-term impact on health and social care expenditures.
Preventing dementia has been proposed to increase population health as well as reduce the demand for health and social care. Our aim was to evaluate whether preventing dementia by promoting physical activity (PA) a) improves population health or b) reduces expenditure for both health and social care if one takes into account the additional demand in health and social care caused by increased life expectancy. ⋯ Preventing dementia by increasing PA increases life expectancy and can result in decreased spending overall on health and social care, even after additional spending during life years gained has been taken into account. If prevention is targeted at the physically inactive, savings in dementia-related costs outweigh the additional spending in life years gained.
-
Preventive medicine · Apr 2016
The period prevalence of risk behavior co-occurrence among Canadians.
While the benefits of complying with health recommendations is well documented, a considerable proportion of Canadians engage in multiple modifiable risk behaviors. The purpose of this multi-wave longitudinal study was to identify the individual period prevalence and co-occurrence of multiple modifiable risk behaviors, particularly excessive alcohol consumption, physical inactivity, and tobacco use, within a nationally representative sample of Canadians. ⋯ Understanding patterns of modifiable risk behaviors is an initial step in developing and implementing public health interventions. The co-occurrence of these three risk behaviors is a viable concern for one in five Canadians. For these individuals, the likelihood of encountering premature morbidity and mortality is escalated. As the majority of Canadians reported being physically inactive, allocating limited resources towards enhancing leisure-time physical activity levels could have significant population-level implications for improving the health of Canadians.