Preventive Medicine Research Articles

Expectations And Motivations Of Young Occupational Medical Physicians: A Quantitative Survey Of Five German Academies

The aim of this study was to describe the characteristics of future occupational physicians and to evaluate their expectations from and motivations for undertaking postgraduate medical education courses in occupational medicine. This will provide a basis for further increasing the attractiveness of occupational medicine as a discipline in preventive medicine and counteracting the shortage of occupational medical physicians. At five locations in Germany, physicians in postgraduate medical education courses in occupational medicine were asked about their expectations from occupational medicine, their reasons for starting postgraduate medical education courses, and their assessment of these courses. The survey took place between 2018 and 2021. The data were analysed descriptively, and a cluster analysis was applied to identify the types of motives for continuing postgraduate medical education courses in occupational medicine. Of the 233 respondents, the majority were female (68.5%) and the mean age was 43.1 years (SD 7.9 years). The response at the State Chamber of Physicians of Saxony was 50% and at the remaining four academies was between 18% and 23%. The analysis revealed four different types of motives: "career & interest", "work & life balance", "self-employment" and "desire for change". Two-thirds of the participants were in favour of a greater integration of occupational medicine into medical school curriculum. The results suggest that there are different motives that lead physicians to pursue continuing education in occupational medicine. These motives should be considered when recruiting young occupational physicians.

Potential and limitations of secondary prevention of noncommunicable diseases: data from a survey of Russian outpatient physicians

Aim. To identify potential and limitations of secondary prevention of noncommunicable diseases in outpatient clinics of various Russian cities.Material and methods. Outpatient physicians from 16 Russian cities took part in the cross-sectional study. A total of 545 general practitioners took part in the survey. The survey was carried out using a previously prepared questionnaire at the National Medical Research Center for Therapy and Preventive Medicine. It consisted of 11 blocks of questions, including sex and age characteristics, the prevalence of various diseases, adherence to therapy, preferential provision of medications, consultation assistance by hospital-based physicians and coverage of doctors and nursing staff. Answers were offered in several gradations to each question. Depending on the population, cities were divided into 4 following subgroups: population >2 million people (Moscow and St. Petersburg), population of 1-2 million people (Samara, Rostov-onDon, Krasnodar, Krasnoyarsk, Omsk), population of 0,4-1 million people (Vladivostok, Ulyanovsk, Penza, Kursk, Kirov, Tomsk) and population <400 thousand people (Nalchik, Saransk, Ivanovo).Results. In all Russian cities, among men visited a clinic, 37% were people in the age range of 50-60 years. Second place was taken by men aged 60-65 years (30%). Most often, patients present with chronic coronary artery disease (39%), followed by type 2 diabetes (22,6%). Patients present with symptoms of heart failure in 17,7% of cases. Cancer account for 11,5% in the structure of visits. A similar frequency was found for chronic obstructive pulmonary diseases (9,2%). Every third patient is partially adherent to drug correction; partial non-adherence is detected 2 times less, while complete nonadherence is <3%. On average, 67% of doctors from different cities declare 75% achievement of target levels of risk factors, while one in five declare 50% achievement of recommended indicators. In most cases, physicians report minor problems during hospitalization. Every fifth doctor reported no problems, while every tenth respondent noted difficulties in hospitalizing patients. In every second case, partial staffing is noted. Moreover, a comparable trend is observed among doctors and nursing staff. In megacities and small towns the situation is somewhat better compared to cities with a population of 0,4 to 2 million.Conclusion. To optimize the secondary prevention of noncommunicable diseases, a number of measures at the outpatient healthcare level should be taken. This includes educational work on adherence to drug and non-drug treatment correction, expanding coverage of preferential medication provision, improving interaction with hospitalbased doctors and coverage of doctors and nursing staff.

Dr. Fe Del Mundo: The Pioneer Who Transformed Pediatrics and Child Healthcare in the Philippines.

Dr. Fe del Mundo was a female Filipino pediatrician, humanitarian, and advocate of Filipino children, dedicating her life to seven decades of service. Her programs on maternal and child health, preventive medicine, nutrition, vaccination, and family planning transformed the healthcare landscape in the Philippines. Overcoming adversity, she pursued a road less traveled for women of her time. After training in the United States of America, she returned to the Philippines to take care of sick children during the Second World War and later opened the first pediatric hospital in the country. Her research, inventions, and health programs set the groundwork for the improvement of pediatric and childhood outcomes in the country and the world. She is a woman of many firsts, being a beacon for generations of physicians and women. Her legacy endures through the programs she started, the lives she has saved, the doctors she trained, and the institutions she has founded for the welfare of the children she dearly cared for.

Genomic Medicine: Perspective of the Challenges for the Implementation of Preventive, Predictive, and Personalized Medicine in Latin America

: Genomic information plays an essential role in personalized medicine, with the main objective of determining risk and predisposition to disease, as well as guiding diagnosis, selection, and prioritization of therapeutic options, and even predicting prognosis. Research in the second half of the 20th century allowed genomics to move from the laboratory to clinical practice. The Human Genome Project showed the structure of the genome, the genes, and several of their regulatory pathways, which allowed obtaining exact knowledge about the molecular origin of a growing number of diseases and the development of next-generation sequencing technologies. In the second decade of the 21st century, the decrease in testing costs has allowed genomic medicine to begin to be applied in hospital institutions and outpatient services with a positive impact on public health. However, it has been evidenced that these potential benefits have not been experienced equitably throughout the world. This commentary explores the main challenges and obstacles to the implementation of genomic medicine services in order to expand their use as part of clinical practice in the Latin American context. Finally, six main barriers have been identified: i) high costs and poor access, ii) lack of trained personnel in the genomic field, iii) negative personal and social beliefs, iv) lack of representation of Latin American populations in genomic databases, v) scarce evidence of impact on clinical practice, and vi) lack of understanding of genomic test results by patients and clinicians.

Awareness and Knowledge of the National Healthcare Transformation Program Among Public Health and Preventive Medicine Physicians in Saudi Arabia.

The Health Sector Transformation Program (HSTP) has been established as part of Saudi Vision 2030. Despite the significant progress achieved in previous years, the HSTP addresses multiple challenges. One of these challenges is that the current healthcare model prioritizes treatment over prevention. Therefore, prioritizing preventive healthcare measures is crucial. This study aims to assess the levels of awareness and knowledge among the public health and preventive medicine physicians in Saudi Arabia towards the national healthcare transformation program. In this cross-sectional study, we surveyed public health and preventive medicine physicians in Saudi Arabia. We collected data through a newly developed and validated self-administered questionnaire, which was distributed online. The survey questionnaire consisted of three sections: participants' background characteristics; measurement of public health and preventive medicine physicians' awareness of the HSTP and their confidence in their awareness; and measurement of the physicians' knowledge of the HSTP through six multiple-choice questions. In this study, 307 public health and preventive medicine physicians in Saudi Arabia participated. The mean age ± SD was 33.1 ± 5.1 years, with 54.7% being public health and preventive medicine residents, 33.2% specialists, and 12.1% consultants. Most participants showed high awareness of the HSTP and its strategic objectives. Over two-thirds correctly defined HSTP, value-based healthcare, and the new Model of Care (MOC), while about 50% demonstrated inadequate knowledge regarding Accountable Care Organizations (ACOs) and the "Keep Well" system. Older physicians, consultants, and those with more years of work experience had higher knowledge scores. Regression analysis revealed that job rank significantly influenced public health and preventive medicine physicians' knowledge of the HSTP. This study shows that while public health and preventive medicine physicians are generally aware of HSTP's objectives, they have inadequate confidence in their knowledge, highlighting the need for better information dissemination. Awareness of the MOC is high, but gaps persist in understanding specific components like the "Keep Well" initiatives. The study also found that job rank and experience influence knowledge levels, suggesting the need for broader dissemination of the HSTP concepts.

Concussion Reduction in Division I and II Athletes: Effects of Simple Cervical Spine Exercise Regimen.

Primary preventative medicine lacks a consensus on effective concussion prevention strategies for collegiate athletes. Cervical strength has been identified as a potential factor in concussion risk reduction. This study evaluates the impact of a commercially available, portable cervical muscle stretching and strengthening device, NeckX®, on cervical strength, range of motion (ROM), and concussion incidence in collegiate athletes participating in high-concussion-risk sports. A single-arm prospective cohort study was conducted with 162 collegiate athletes from various sports. Participants underwent a 12-week neck exercise protocol using the NeckX® device. Clinical data, including neck strength and ROM, were collected at weeks 0, 6, and 12. Concussion incidence was self-reported by participants and cross-referenced with records from the athletic department. Data were analyzed for significant neck strength and ROM changes throughout the 12-week study. A two-way analysis of variance multiple comparisons with the Tukey-Kramer significant difference test was utilized, using the Holm-Sidak method, with an alpha of 0.05. All athletic teams experienced a significant increase in cervical strength during the 12-week intervention (α = 0.05, p < 0.05). Increases in cervical flexion and extension force were most consistent between teams. Cervical ROM increased significantly in male and female soccer players (α = 0.05, p < 0.05). The overall incidence of head and neck injuries, including concussions, was reduced to 6.60% during the study period, the lowest recorded value in the university's athletic department history. The use of the NeckX® device for 12 weeks was effective in enhancing pericervical muscle strength and ROM while reducing concussion incidence in collegiate athletes participating in high-concussion-risk sports. Interestingly, the positive outcomes were consistent for both males and females, indicating the universal advantages of neck training among collegiate athletes. These findings support existing research on the benefits of cervical strengthening exercises for reducing concussions in collegiate athletes and highlight the convenience and affordability of using this device.

The caregiving role influences Suboptimal Health Status and psychological symptoms in unpaid carers

BackgroundSuboptimal Health Status (SHS) is the physical state between health and disease. This study aimed to fill in the knowledge gap by investigating the prevalence of SHS and psychological symptoms among unpaid carers and to identify SHS-risk factors from the perspective of predictive, preventive and personalised medicine (PPPM).MethodsA cross-sectional study was conducted among 368 participants who were enrolled from Australia, including 203 unpaid carers as cases and 165 individuals from the general population as controls. SHS scores were measured using SHSQ-25 (Suboptimal Health Status Questionnaire-25), whilst psychological symptoms were measured by DASS-21 (Depression, Anxiety and Stress Scale-21). Chi-square was used to measure SHS and psychological symptom prevalence. Spearman correlation analysis was utilised to identify the relationship between SHSQ-25 and DASS-21 scores. Logistic regression analysis was used for multivariate analysis.ResultsThe prevalence of SHS in carers was 43.0% (98/203), significantly higher than the prevalence 12.7% (21/165) in the general population (p < 0.001). In addition, suboptimal health prevalence was higher in female carers (50.3%; 95/189) than females in the general population (12.4%; 18/145). Logistic regression showed that the caregiving role influenced SHS, with carers 6.4 times more likely to suffer from SHS than their non-caring counterparts (aOR = 6.400, 95% CI = 3.751–10.919).ConclusionsUnpaid carers in Australia have a significantly higher prevalence of SHS than that in the general population and experience poorer health. The SHSQ-25 is a powerful tool that can be utilised to screen at-risk individuals to predict their risk of chronic disease development, an essential pillar for shifting the paradigm change from reactive medicine to that of predictive, preventive and personalised medicine (PPPM).

An N-terminal heptad repeat trimer-based peptide fusion inhibitor exhibits potent anti-H1N1 activity

Influenza viruses are susceptible to seasonal influenza, which has repeatedly caused global pandemics and jeopardized human health. Vaccines are only used as preventive medicine due to the extreme mutability of influenza viruses, and antiviral medication is the most significant clinical treatment to reduce influenza morbidity and mortality. Nevertheless, the clinical application of anti-influenza virus agents is characterized by the narrow therapeutic time window, the susceptibility to drug resistance, and relatively limited effect on severe influenza. Therefore, it is of great significance to develop novel anti-influenza virus drugs to fulfill the urgent clinical needs. Influenza viruses enter host cells through the hemagglutinin (HA) mediated membrane fusion process, and fusion inhibitors function antivirally by blocking hemagglutinin deformation, promising better therapeutic efficacy and resolving drug resistance, with targets different from marketed medicines. Previous studies have shown that unnatural peptides derived from Human Immunodeficiency Virus Type 1 (HIV-1) membrane fusion proteins exhibit anti-HIV-1 activity. Based on the similarity of the membrane fusion protein deformation process between HIV-1 and H1N1, we selected sequences derived from the gp41 subunit in the HIV-1 fusion protein, and then constructed N-trimer spatial structure through inter-helical isopeptide bond modification, to design the novel anti-H1N1 fusion inhibitors. The results showed that the novel peptides could block 6-HB formation during H1N1 membrane fusion procedure, and thus possessed significant anti-H1N1 activity, comparable to the positive control oseltamivir. Our study demonstrates the design viability of peptide fusion inhibitors based on similar membrane fusion processes among viruses, and furthermore provides an important idea for the novel anti-H1N1 inhibitors development.

Exposure variables in veterinary epidemiology: are they telling us what we think they are?

This manuscript summarizes a presentation delivered by the first author at the 2024 symposium for the Calvin Schwabe Award for Lifetime Achievement in Veterinary Epidemiology and Preventive Medicine, which was awarded to Dr. Jan Sargeant. Epidemiologic research plays a crucial role in understanding the complex relationships between exposures and health outcomes. However, the accuracy of the conclusions drawn from these investigations relies upon the meticulous selection and measurement of exposure variables. Appropriate exposure variable selection is crucial for understanding disease etiologies, but it is often the case that we are not able to directly measure the exposure variable of interest and use proxy measures to assess exposures instead. Inappropriate use of proxy measures can lead to erroneous conclusions being made about the true exposure of interest. These errors may lead to biased estimates of associations between exposures and outcomes. The consequences of such biases extend beyond research concerns as health decisions can be made based on flawed evidence. Recognizing and mitigating these biases are essential for producing reliable evidence that informs health policies and interventions, ultimately contributing to improved population health outcomes. To address these challenges, researchers must adopt rigorous methodologies for exposure variable selection and validation studies to minimize measurement errors.

A model curriculum in sexual medicine for undergraduate education in Europe

Sexual health has been recognized as an essential component of the overall health and wellbeing. The current article aims, first, to review the current state of sexual health education in undergraduate medical curricula, identifying gaps, needs and challenges. The main part of this paper describes the development and content of an undergraduate sexual medicine curriculum based on a clear concept of the competencies students should learn regarding knowledge, skills and attitudes. The content is based on a biopsychosocial understanding of human sexuality elaborated by international experts from different European countries integrating basic knowledge in biology, psychology, sociocultural and political sciences, preventive medicine, and the various therapeutic approaches to help women, men and couples with sexual health problems on a primary care level. In order to enable students to learn the basic skills of sexual history taking and sexual basic counselling two educational videos were produced. The material presented is part of the European Collaboration in Science and Technology (COST) supported project European Sexual Medicine Network (ESMN). The material provided can serve universities to give the training as a 25-30 hours course equivalent to 1 ECTS.

Building a Prevention Clinic at the Northport VA to Improve Pneumonia Vaccination Numbers

BackgroundPneumonia vaccination rates have increased to >60% over the last 20 years. At the Long Island, NY Northport VA Hospital, pneumonia vaccination data from 2021 showed a vaccination rate of 68.55%. The goal is a Pneumonia vaccination rate of 85%. Pneumonia vaccines prevent invasive pneumococcal disease and pneumococcal pneumonia. We aimed to increase vaccination rates at Northport. MethodsWe established a weekly vaccine and prevention clinic aiming to vaccinate as many veterans as possible. Preventive medicine residents performed outreach, scheduling, vaccine administration, and Brief Action Planning (BAP). Motivational Interviewing techniques were used in outreach calls and clinic visits to encourage behavioral change. ResultsFrom an outreach list of >7,000 patients, 506 patients were contacted and counseled on pneumonia vaccination. 130 patients were scheduled for clinic visits. Of these 130, ninety-one kept their appointments and were seen in the clinic and eighty-seven vaccines were administered, of which 56 were pneumonia vaccines. Data wascollected and analyzed in 2022. DiscussionImplementing a dedicated vaccine and prevention clinic using motivational interviewing techniques in outreach and clinical visits allows for optimized patient vaccinations, enhanced information sharing, increased primary care retention, and increasing the visibility of preventive medicine among patients and colleagues within the VA medical system.

The Role of Artificial Intelligence in the Primary Prevention of Common Musculoskeletal Diseases.

Musculoskeletal disorders (MSDs) are a leading cause of disability worldwide, with a growing burden across all demographics. With advancements in technology, conversational artificial intelligence (AI) platforms such as ChatGPT (OpenAI, San Francisco, CA)have become instrumental in disseminating health information.This study evaluated the effectiveness of ChatGPT versions 3.5 and 4 in delivering primary prevention information for common MSDs, emphasizing that the study is focused on prevention and not on diagnosis. This mixed-methods study employed the CLEAR tool to assess the quality of responses from ChatGPT versions in terms of completeness, lack of false information, evidence support, appropriateness, and relevance. Responses were evaluated independently by two expert raters in a blinded manner. Statistical analyses included Wilcoxon signed-rank tests and paired samples t-tests to compare the performance across versions. ChatGPT-3.5 and ChatGPT-4 effectively provided primary prevention information, with overall performance ranging from satisfactory to excellent. Responses for low back pain, fractures, knee osteoarthritis, neck pain, and gout received excellent scores from both versions. Additionally, ChatGPT-4 was better than ChatGPT-3.5 in terms of completeness (p = 0.015), appropriateness (p = 0.007), and relevance (p = 0.036), and ChatGPT-4 performed better across most medical conditions (p = 0.010). ChatGPT versions 3.5 and 4 are effective tools for disseminating primary prevention information for common MSDs, with ChatGPT-4 showing superior performance. This study underscores the potential of AI in enhancing public health strategies through reliable and accessible health communication. Advanced models such as ChatGPT-4 can effectively contribute to the primary prevention of MSDs by delivering high-quality health information, highlighting the role of AIs in addressing the global burden of chronic diseases. It is important to note that these AI tools are intended for preventive education purposes only and not for diagnostic use. Continuous improvements are necessary to fully harness the potential of AI in preventive medicine. Future studies should explore other AI platforms, languages, and secondary and tertiary prevention measures to maximize the utility of AIs in global health contexts.

Preventive medicine in OSA-A systematic review and a call to action.

The purpose of this systematic review is to evaluate the modifiable risk factors associated with OSA and analyze extant publications solely focused on prevention of the disease. 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 grey 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. 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. 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.

Space surgery: a SAGES' white paper.

Space travel is experiencing a renaissance with expanding commercial and international efforts. Space surgery will have growing relevance as mission frequency and distances increase beyond low Earth orbit. This white paper from the SAGES Space Surgery Task Force raises awareness among the SAGES membership regarding the challenges and opportunities surrounding this emerging field that anticipates surgical care in the most extreme, austere environments. Innovation in technology and preventive medicine principles will enhance the effectiveness of space surgical care when the need arises. The impact of advancements in space and terrestrial medicine to support space exploration indicates the need for a surgeon to oversee medical/surgical invasive treatment to ensure astronaut health and mission success. Advanced technology, including semi- and autonomous robotic systems, may be a preferred way to deliver this care in the foreseeable future. There is currently a need to develop training curricula and flight-compatible supplies and technology for physicians that deliver surgical care to this special patient population. The protocols and technology developed to address the unique challenges of space travel will provide value for care in space as well as in extreme, austere terrestrial environments on Earth. Space surgery will continue to evolve as commercial and government programs explore further into space. The SAGES Space Surgery Task Force is favorably positioned to significantly contribute to addressing some capability gaps in delivering surgical care in space.

Leaf extract of Kentut (Paederia foetida L.) as a preventive measure against interleukin-6 expression in the liver of mice in a sepsis model injected with Escherichia coli

Kentut leaves (Paederia foetida L.) are a type of medicinal plant that can be used as a preventative medicine against sepsis. This plant contains secondary metabolite compounds such as alkaloids, flavonoids, triterpenoids, saponins, and other active compounds. This research aims to determine the influence and effective dosage of Kentut leaf extract as a preventive measure against IL-6 expression in the livers of mice in a sepsis model injected with E. coli. The method used was a Completely Randomized Design (CRD). The study involved 24 white male mice divided into 6 groups. Data analysis was performed using One Way ANOVA. The average values of IL-6 expression in the mouse livers for each group are as follows: KN at 7.09%±0.06; K+ at 26.36%±0.02; K- at 72.60%±0.05; PI (100mg/kgBW) at 71.04%±0.04; PII (300mg/kgBW) at 62.22%±0.02; and PIII (500mg/kgBW) at 40.92%±0.01. The research results indicate that there is an influence of kentut leaf extract as a preventive measure against IL-6 expression in the livers of mice in the sepsis model injected with E. coli, with a significance value of 0.000 or p-value 0.005. The effective dosage of kentut leaf extract as a preventive measure against IL-6 expression is the PIII dosage of 500mg/kgBW. The anti-inflammatory mechanism in sepsis is thought to be caused by the presence of flavonoids, alkaloids, phenolic acids, and terpenoid compounds. The most likely anti-inflammatory mechanism is believed to involve flavonoids inhibiting cyclooxygenase (COX) and lipoxygenase (LOX) enzymes involved in the synthesis of inflammatory mediators such as prostaglandins and leukotrienes, which can trigger IL-6 production.

N.A. Semashko on the management of preventive measures to preserve and improve the health of citizens (to the 150th anniversary of his birth)

On September 21, 2024, the medical community celebrates the 150th anniversary of the birth of Nikolai Aleksandrovich Semashko, an outstanding manager of Russian healthcare, a scientist and teacher in the field of social hygiene. The results of his work in creating a new healthcare system in difficult conditions, one of the main principles of which is prevention, is highly appreciated by the World Health Organization and is known all over the world. To study the main directions of the prevention of various diseases over the first half of the twentieth century, there were analyzed the scientific works of N.A. Semashko, located in the electronic scientific libraries eLibrary, CyberLeninka, Scopus, Web of Science, the Central Scientific Medical Library, and the Russian State Library. N.A. Semashko considered prevention a priority in the activities of not only health professionals, but also other state and public organizations, as well as the citizens themselves in maintaining and strengthening their health. For its implementation, he recommended using various approaches, including improving the activities of sanitary organizations and medical institutions, developing dispensaries, the district principle of work, involving sanitary inspectors in joint activities with doctors and conducting health education of the population. Conclusions. Justified by N.A. Semashko in scientific works and the main directions of preventive medicine implemented in practice contributed to the elimination of epidemics, a decrease in the level of morbidity and mortality of the population, and therefore this experience should be taken into account and used in modern conditions.

The Longevity Med Summit: insights on healthspan from cell to society.

In recent years, there has been a paradigm shift with regards to ageing, challenging its traditional perception as an inevitable and natural process. Researchers have collectively identified hallmarks of ageing, nine of which were initially proposed in 2013 and expanded in 2023 to include disabled macroautophagy, chronic inflammation, and dysbiosis, enhancing our understanding of the ageing process at microscopic, cellular, and system-wide levels. Strategies to manipulate these hallmarks present opportunities for slowing, preventing, or reversing age-related diseases, thereby promoting longevity. The interdependence of these hallmarks underscores the necessity of a comprehensive, systems-based approach to address the complex processes contributing to ageing. As a primary risk factor for various diseases, ageing diminishes healthspan, leading to extended periods of compromised health and multiple age-related conditions towards the end of life. The significant gap between healthspan and lifespan holds substantial economic and societal implications. The inaugural Longevity Med Summit (4-5 May 2023, Cascais, Portugal) provided an international forum to discuss the academic and industry landscape of healthy longevity research, preventive medicine and clinical practice to enhance healthspan.

Social vulnerability and surgery outcomes: a cross-sectional analysis

BackgroundPost-operative complications present a challenge to the healthcare system due to the high unpredictability of their incidence. Socioeconomic conditions have been established as social determinants of health. However, their contribution relating to postoperative complications is still unclear as it can be heterogeneous based on community, type of surgical services, and sex and gender. Uncovering these relations can enable improved public health policy to reduce such complications.MethodsIn this study, we conducted a large population cross-sectional analysis of social vulnerability and the odds of various post-surgical complications. We collected electronic health records data from over 50,000 surgeries that happened between 2012 and 2018 at a quaternary health center in St. Louis, Missouri, United States and the corresponding zip code of the patients. We built statistical logistic regression models of postsurgical complications with the social vulnerability index of the tract consisting of the zip codes of the patient as the independent variable along with sex and race interaction.ResultsOur sample from the St. Louis area exhibited high variance in social vulnerability with notable rapid increase in vulnerability from the south west to the north of the Mississippi river indicating high levels of inequality. Our sample had more females than males, and females had slightly higher social vulnerability index. Postoperative complication incidence ranged from 0.75% to 41% with lower incidence rate among females. We found that social vulnerability was associated with abnormal heart rhythm with socioeconomic status and housing status being the main association factors. We also found associations of the interaction of social vulnerability and female sex with an increase in odds of heart attack and surgical wound infection. Those associations disappeared when controlling for general health and comorbidities.ConclusionsOur results indicate that social vulnerability measures such as socioeconomic status and housing conditions could affect postsurgical outcomes through preoperative health. This suggests that the domains of preventive medicine and public health should place social vulnerability as a priority to achieve better health outcomes of surgical interventions.

ACPM Position Statement: Air Pollution and Environmental Justice

The American Lung Association's “State of the Air” 2023 report reveals almost 36% of Americans live with unhealthy levels of air pollution. Studies link air pollution with acute respiratory symptoms and exacerbation of respiratory and cardiovascular diseases. Differential air pollution exposures between white and non-white communities are significant components of environmental injustices. Even during the COVID-19 lockdown, when the United States experienced significant decreases in polluting activities, these differences persisted. The American College of Preventive Medicine's Science and Translation Committee conducted a nonsystematic literature review to explore initiatives addressing air pollution as a key component of environmental justice, the state of the science regarding health impacts, and evidence supporting mitigations to reduce those impacts. We recommend advocacy for cleaner energy sources and increasing green space; and increasing research, surveillance, and education and training on linkages between air pollutants and health. We recommend preventive medicine physicians raise awareness about increased risks of cardiovascular disease, cancer, asthma, and reduced lung function with air pollution exposure. Preventive medicine physicians may also educate patients and other practitioners about exposures, and how “conventional” disease prevention strategies may have unintended consequences; and influence healthcare leaders to improve efficiency and reduce emissions. We also recommend physicians utilize social determinants of health (SDOH) Z-Codes to capture environmental factors. Private payers should incorporate pollution exposure data into SDOH risk-adjustments for Medicare Advantage programs. Medicaid agencies should develop provider recommendations for pediatric populations, and states should finance in-home interventions for asthma.

Calls to action on lung cancer management and research.

Lung cancer, the leading cause of cancer-related deaths globally, remains a pressing health issue despite significant medical advances. The New York Lung Cancer Foundation brought together experts from academia, the pharmaceutical and biotech industries as well as organizational leaders and patient advocates, to thoroughly examine the current state of lung cancer diagnosis, treatment, and research. The goal was to identify areas where our understanding is incomplete and to develop collaborative public health and scientific strategies to generate better patient outcomes, as highlighted in our "Calls to Action." The consortium prioritized 8 different calls to action. These include (1) develop strategies to cure more patients with early-stage lung cancer, (2) investigate carcinogenesis leading to lung cancers in patients without a history of smoking, (3) harness precision medicine for disease interception and prevention, (4) implement solutions to deliver prevention measures and effective therapies to individuals in under-resourced countries, (5) facilitate collaborations with industry to collect and share data and samples, (6) create and maintain open access to big data repositories, (7) develop new immunotherapeutic agents for lung cancer treatment and prevention, and (8) invest in research in both the academic and community settings. These calls to action provide guidance to representatives from academia, the pharmaceutical and biotech industries, organizational and regulatory leaders, and patient advocates to guide ongoing and planned initiatives.