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"Medicine, Preventive."
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Preventive medicine in obstructive sleep apnea—a systematic review and a call to action
Abstract
Study Objectives
The purpose of this systematic review is to evaluate the modifiable risk factors associated with obstructive sleep apnea (OSA) and analyze extant publications solely focused on prevention of the disease.
Methods
Studies focused on prevention strategies for OSA and modifiable risk factors were eligible for inclusion. A detailed individual search strategy for each of the following bibliographic databases was developed: Cochrane, EMBASE, MEDLINE, PubMed, and LILACS. The references cited in these articles were also crosschecked and a partial gray literature search was undertaken using Google Scholar. The methodology of selected studies was evaluated using the 14-item Quality Assessment Tool for Diagnostic Accuracy Studies.
Results
Search resulted in 720 publications examining risk factors and prevention of OSA, as well as lifestyle modifications. Of these, a thorough assessment of the abstracts and content of each of these manuscripts led to the rejection of all but four papers, the latter being included in this systematic review. In contrast, a search regarding “Therapeutics” showed that 23 674 articles on OSA were published, clearly illustrating the imbalance between the efforts in prevention and those focused on therapeutics.
Conclusions
Notwithstanding the importance and benefits of technological advances in medicine, consideration of the needs of people with OSA and its consequences prompts advocacy for the prevention of the disease. Thus, despite the economic interests that focus only on diagnosis and treatment, strategies preferentially aimed at overall avoidance of OSA emerge as a major priority. Thus, public and healthcare provider education, multidimensional prevention, and early diagnosis of OSA should be encouraged worldwide.
Graphical Abstract
Graphical Abstract
Journal Article
Public health explored: 50 stories to change the world
An understanding of public health has never been more important!There has been a growing interest in public health, driven by concerns for social justice and sustainability, but it is currently in the headlines as never before. The failure of governments to get to grips with the Covid-19 pandemic has demonstrated widespread ignorance of the basics of a public health approach to threats to health and well-being.Relevant to all interested individuals but particularly students and professionals within nursing, medicine, social work and public health, this book encourages critical debate and reflection to develop a deep understanding of the complexities of public health issues. It offers 50 powerful stories and sayings around public health that could just change the world! Accompanied by searching questions for discussion and case studies that provide context and link each aphorism to a key event or theme, important messages around public health are extracted and explored.
eBook
Medicalization
This book examines the phenomenon of medicalization and the increasingly large, invasive, and coercive role of medicine in society. Medicine today impinges territory formerly left to families, parents, society, and social and economic policy. Expanding disease definitions and allowing ever-milder conditions to qualify for medicine, 'disease creep', influences public policy and social behavior. Medicalization redirects those experiencing stress, sadness, or distraction to medicine, and impacts how society defines health and wellness. Medicalization in the contexts of diet, lifestyle, education and athletics, growing old, public safety, and mental and physical health, are all explored. Medicalization has adverse consequences both in that it may demonize those who do not go along, and it offers a false promise to remedy non-medical problems with a simple pill. The pharmaceutical industry profits from disease creep, and doctors are complicit in furthering a narrative that relies on medicine. Laws often support a medical approach to societal problems despite notable financial conflicts of interest. Written in a clear and accessible style, Medicalization is a valuable addition to the literature on bioethics, law, health policy, social sciences, and political studies.
eBook
The Application of Preventive Medicine in the Future Digital Health Era
A number of seismic shifts are expected to reshape the future of medicine. The global population is rapidly aging, significantly impacting the global disease burden. Medicine is undergoing a paradigm shift, defining and diagnosing diseases at earlier stages and shifting the health care focus from treating diseases to preventing them. The application and purview of digital medicine are expected to broaden significantly. Furthermore, the COVID-19 pandemic has further accelerated the shift toward predictive, preventive, personalized, and participatory (P4) medicine, and has identified health care accessibility, affordability, and patient empowerment as core values in the future digital health era. This “left shift” toward preventive care is anticipated to redefine health care, emphasizing health promotion over disease treatment. In the future, the traditional triad of preventive medicine—primary, secondary, and tertiary prevention—will be realized with technologies such as genomics, artificial intelligence, bioengineering and wearable devices, and telemedicine. Breast cancer and diabetes serve as case studies to demonstrate how these technologies such as personalized risk assessment, artificial intelligence–assisted and app-based technologies, have been developed and commercialized to provide personalized preventive care, identifying those at a higher risk and providing instructions and interventions for healthier lifestyles and improved quality of life. Overall, preventive medicine and the use of advanced technology will hold great potential for improving health care outcomes in the future.
Journal Article
Slowing ageing by design: the rise of NAD+ and sirtuin-activating compounds
Key Points
Sirtuins are a critical component of evolutionarily conserved longevity pathways. Sirtuins are nicotinamide adenine dinucleotide (NAD
+
)-dependent lysine deacylases that promote longevity and healthy ageing.
Sirtuin-activating compounds (STACs) bind to and allosterically modulate the affinity of SIRT1 for NAD
+
and protein substrates, resulting in increased activity.
Increasing NAD
+
levels through various strategies can enhance the activity of all sirtuins and improve metabolic function and increase longevity.
Sirtuin overexpression and treatment with naturally occurring and synthetic STACs improves metabolic function and increases longevity in mice.
More than 50 clinical trials are currently evaluating the safety and physiological activity of naturally occurring and synthetic STACs for treating human disease.
Sirtuins are NAD
+
-dependent protein deacylases that can reverse various aspects of ageing in model organisms. Trials in non-human primates and humans indicate that sirtuin-activating compounds (STACs) and NAD
+
precursors are safe and effective in treating inflammatory and metabolic disorders, thereby holding great potential to treat various diseases and to extend lifespan in humans.
The sirtuins (SIRT1–7) are a family of nicotinamide adenine dinucleotide (NAD
+
)-dependent deacylases with remarkable abilities to prevent diseases and even reverse aspects of ageing. Mice engineered to express additional copies of SIRT1 or SIRT6, or treated with sirtuin-activating compounds (STACs) such as resveratrol and SRT2104 or with NAD
+
precursors, have improved organ function, physical endurance, disease resistance and longevity. Trials in non-human primates and in humans have indicated that STACs may be safe and effective in treating inflammatory and metabolic disorders, among others. These advances have demonstrated that it is possible to rationally design molecules that can alleviate multiple diseases and possibly extend lifespan in humans.
Journal Article