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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
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
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
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
Brief interactive lifestyle preventive medicine video education in the primary care clinic: Protocol for a randomized clinical trial
Preventive counseling improves long-term health, but primary care clinicians face time constraints limiting patient education. In a prior emergency department pilot study, a brief passive video trended towards increased patients' willingness to change health behaviors. The current trial, conducted at the primary care clinic, evaluates the feasibility and impact of a short, interactive prevention video delivered during a primary care office visit.
We will conduct a prospective, randomized, non-blinded clinical trial among adult patients presenting to a primary care clinic. Immediately after their appointment, participants will be randomized to receive either the interactive prevention video or usual care. The video maintains engagement through simple in-video questions and adapts content based on patient responses (e.g., skipping smoking cessation for non-smokers). After the encounter, all participants will complete surveys assessing readiness and confidence to initiate lifestyle change including a transtheoretical \"readiness ruler.\" Survey items will be drawn from validated instruments, including the Gillespie & Lenz Readiness and Confidence to Participate in Lifestyle Activities Surveys, the Pittsburgh Sleep Quality Index (PSQI), and select questions from the U.S. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey. Patients will be asked for medical record access and permission for follow-up contact.
The primary outcome is index-visit Lifestyle Readiness and Confidence to Change scores. Secondary outcomes include satisfaction with the clinic visit, intention to change specific lifestyle behaviors, and healthcare use outside the clinic at 30 days and 6 months, as assessed via record review. A 3-12-month follow-up survey will assess self-reported lifestyle changes and new diagnoses.
Analyses will follow intention-to-treat. Ordinal logistic regression will compare primary outcomes between arms, adjusting for Charlson Comorbidity Index, age, sex, gender, and prespecified predictors. Logistic regression will evaluate binary follow-up outcomes. Complete-case analyses will be used, and differential attrition will be reported. We plan to enroll approximately 350 patients.
ClinicalTrials.gov NCT06730737.
Journal Article