Preventive medicine
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A useful way to summarize the placebo-nocebo theme is to consider the tension and interaction between conviction and responsibility. With the conviction of the mainstream biomedical paradigm prevalent today, it would be tempting to say to Dr. Engel's patient: "That question is nonsense. ⋯ Engel was both true to his convictions and responsible for providing the highest standard of care by understanding the patient's convictions and needs for comfort. The biopsychosocial concept provides a blueprint to bring the old-fashioned medical art of "humanness" to modern scientific care. Identifying the interactions of the problem, the person, and the totality of resources permits a focus on therapeutic strategies to promote placebo effects and prevent the consequences of nocebo.
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Preventive medicine · Sep 1997
Comparative StudyValidity of self-reported hypertension in the National Health and Nutrition Examination Survey III, 1988-1991.
The National Health and Nutrition Examination Survey (NHANES) is the main data source for hypertension surveillance. However, because of a gap of almost 10 years between each NHANES, self-reported data from annual surveys need to be examined as an alternative data source. This study analyzes the validity of self-reported hypertension in a national sample of non-Hispanic whites, non-Hispanic blacks, and Mexican-Americans. ⋯ Self-reported hypertension may be used for surveillance of hypertension trends, in the absence of measured blood pressure, among non-Hispanic whites and non-Hispanic black women and persons with a medical visit in the past year. Validation should be repeated with each NHANES.
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Epidemiologic surveys have revealed accelerated increases in adenocarcinoma but less rapid increases in squamous cell carcinoma of the lung among cigarette smokers in recent decades. Changes in the makeup of cigarettes and corresponding changes in smoke composition along with nicotine-compensating smoking patterns, such as the frequency of puff drawing and depth of inhalation, are suggested to have contributed to the observed epidemiologic profiles of these major histologic types of lung cancers. ⋯ The product changes, the smokers' dependence on nicotine which governs their smoking patterns, and the modified smoke chemistry support the hypothesis that differences in PAH and TSNA exposure may be linked to the observed different incidences of squamous cell cancer and adenocarcinoma of the lung.
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Since 1953, the sales-weighted average "tar" and nicotine yields of commercial cigarettes in developed countries have significantly declined. However, the risk for chronic obstructive pulmonary disease (COPD) and for cancer of the lung has not decreased; adenocarcinoma incidence even continues to rise faster than the rate of squamous cell carcinoma of the lung. Undiminished risk of cigarette smokers for COPD and lung cancer is largely due to more intense smoking and deeper inhalation of the smoke of "low-yield" cigarettes and to significant changes in the smoke yields of certain lung carcinogens. ⋯ The way people smoke and the total number of cigarettes consumed daily determine the uptake, i.e., the administered dose of nicotine, other toxic, and genotoxic smoke constituents. It is important to communicate this to consumers rather than letting the smokers believe that they are truly smoking a cigarette of lower smoke yields when they choose "light" or "ultralight" products.