American journal of preventive medicine
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Dietary guidelines, especially those designed to prevent the diseases of dietary excess, are a relatively new phenomenon in the United States. National dietary guidelines have been promulgated based on scientific reasoning and indirect evidence. In general, weak evidentiary support has been accepted as adequate justification for these guidelines. ⋯ Using guidelines against dietary fat as a case in point, an analysis is provided that suggests that harm indeed may have been caused by the widespread dissemination of and adherence to these guidelines, through their contribution to the current epidemic of obesity and overweight in the U. S. An explanation is provided of what may have gone wrong in the development of dietary guidelines, and an alternative and more rigorous standard is proposed for evidentiary support, including the recommendation that when adequate evidence is not available, the best option may be to issue no guideline.
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To document the growing use in the United States of health impact assessment (HIA) methods to help planners and others consider the health consequences of their decisions. ⋯ These completed HIAs are useful for helping conduct future HIAs and for training public health officials and others about HIAs. More work is needed to document the impact of HIAs and thereby increase their value in decision-making processes.
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Randomized Controlled Trial
Telephone intervention to promote diabetic retinopathy screening among the urban poor.
Participation in diabetic retinopathy screening is suboptimal. The Vision is Precious study (2001-2005) tested the hypothesis that a tailored telephone intervention in urban minority diabetes populations, offered in English or Spanish, would result in greater screening for retinopathy than a standard print intervention. ⋯ A limited telephone intervention can improve significantly participation in retinopathy screening in a minority, low-income population. This intervention influenced risk perceptions about diabetes complications. Further research is needed to develop effective risk communications to prevent the complications of diabetes.
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Prostate cancer is the leading cancer in U.S. men, and the third leading cause of cancer deaths. Principal screening tests for detection of asymptomatic prostate cancer include digital rectal examination (DRE) and measurement of the serum tumor marker, prostate-specific antigen (PSA). There are risks and benefits associated with prostate cancer screening. Randomized controlled trials of screening by DRE and PSA are limited to two previously published studies. Two other large-scale randomized controlled trials are currently in progress. ⋯ The American College of Preventive Medicine concludes that there is insufficient evidence to recommend routine population screening with DRE or PSA. Clinicians caring for men, especially African-American men and those with positive family histories, should provide information about potential benefits and risks of prostate cancer screening, and the limitations of current evidence for screening, in order to maximize informed decision making.
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Video games provide extensive player involvement for large numbers of children and adults, and thereby provide a channel for delivering health behavior change experiences and messages in an engaging and entertaining format. ⋯ Research is needed on the optimal use of game-based stories, fantasy, interactivity, and behavior change technology in promoting health-related behavior change.