Search Results for 'preventive health'

Preventive health care in elderly people needs rethinking

This sounds like it could be an interesting think-piece. Unfortunately, BMJ no longer gives free access to articles the first year. [this article was subsequently made available to the public for discussion.]

I don’t know what they mean by elderly, the oldest olds? The age group was 70-82. See comments.

BMJ 2007;335:285-287 (11 August), doi:10.1136/bmj.39241.630741.BE1
Analysis by
Dee Mangin, senior lecturer in general practice1, Kieran Sweeney, honorary clinical senior lecturer in general practice2, Iona Heath, general practitioner3

1 Christchurch School of Medicine, University of Otago, Christchurch New Zealand, 2 Peninsula Medical School, Royal Devon and Exeter Hospital, Exeter EX2 5DW, 3 Caversham Group Practice, London NW5 2UP

Dee Mangin, Kieran Sweeney, and Iona Heath argue that, rather than prolonging life, preventive treatments in elderly people simply change the cause of death—the manner of our dying

The first 150 words of the full text of this article appear below.

Summary points

* Single disease models should not be applied to preventive treatments in elderly people
* Preventive treatments in elderly people may select cause of death without the patient’s informed consent
* Preventive use of statins shows no overall benefit in elderly people as cardiovascular mortality and morbidity are replaced by cancer
* A more sophisticated model is needed to assess the benefits and harms of preventive treatment in elderly people

Preventive health care aims to delay the onset of illness and disease and to prevent untimely and premature deaths. But the theory and rhetoric of prevention do not deal with the problem of how such health care applies to people who have already exceeded an average lifespan. In recent years, concerns about equity of access to treatments have focused on ageism. As a result, preventive interventions are encouraged regardless of age, and this can be harmful to the patient and expensive for the health . . .

[Full text of this article via paid subscription only] The full text is now available.
http://www.bmj.com/cgi/content/short/335/7614/285?etoc

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Older, more able

This is an interesting summary of trends in aging in the US. Part of the reason for less disabling aging is the involvement of people in their medical and health decisions [see also Preventive health care in elderly people needs rethinking], technology (from microwave ovens to walkers), smokers died before now and quitters started quitting awhile ago, availability of surgery from eyes to knees, older people exercise more than in the past, changes in attitude towards aging capabilities (changing expectataions of older people by older people and others. Off those rockers!), better availability of foods, etc.

Frank Greve of McClatchy Newspapers says, “The remarkable thing about National Public Radio senior news analyst Daniel Schorr, 91, who only recently gave up tennis, and Landrum Bolling, 94, the globe-trotting director at large for the relief agency Mercy Corps, is the same: They aren’t as remarkable as you’d think they are.

A surprising decline in disability rates among older Americans since the 1980s is enabling millions more to lead longer, richer, spryer lives. … older Americans typically are disability-free for the roughly 10 months of life expectancy that were added from 1992 to 2003.

…According to Dr. Eileen Crimmins, a professor of gerontology and sociology at the University of Southern California, 25 percent of Hispanic and black Americans older than 65 need help with basic tasks. For whites, the rate is 17 percent. Differences in disability rates linked to income and education also persist, Crimmins and others have found, and while women live longer than men, they endure more disabilities. […]

Growing Older May Be Getting Easier, Tuesday 11 December 2007

http://www.truthout.org/issues_06/121107HB.shtml


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George W. Comstock, nonagenarian leader against TB

Dr Comstock Isoniazid (INH) is one of the classic “magic bullets” which revolutionized public health in infectious diseases. Eastern Europe, at least until recently, was still using BCG routinely. Unfortunately, as the articles below describe, once immunized, only X-rays can be used to screen for TB. The YK region still has high rates of TB, although nothing like it was, I believe.

George W. Comstock, 92, Dies; Leader in Fight Against TB
By LAWRENCE K. ALTMAN, Published: July 18, 2007, NY Times

Dr. George W. Comstock, an epidemiologist who made major contributions to the treatment and prevention of tuberculosis and was regarded by many peers as the world’s foremost expert on the disease, died Sunday at his home in Smithsburg, Md. He was 92 and had worked until last week….

In 1957, the United States Public Health Service sought a doctor to study tuberculosis patterns in Alaska, where one of every 30 natives was in a tuberculosis hospital. Dr. Comstock volunteered, saying he saw an opportunity to study preventive treatment.

He conducted a controlled trial in 29 villages near Bethel, Alaska, where tuberculosis was rampant. Members of each household were given the drug INH or a placebo for a year, Dr. Chaisson said.

The study showed the effectiveness of INH in preventing tuberculosis: after a year, INH produced a 70 percent decline in cases of the disease; a follow-up study five years later showed the drug’s benefit had been sustained.

In the trial, Dr. Comstock and his family took INH themselves to convince the participants of his belief in the therapy’s safety, Dr. Chaisson said. After the trial, Dr. Comstock returned and gave INH to those who had received the placebo….

He was a lifelong advocate of public health efforts and expressed disappointment in later years that more doctors were not devoting their services to it. In an interview in 2003, Dr. Comstock said that members of medical school faculties had little contact with public health departments.

[read more]

George W. Comstock, 92; epidemiologist was influential in the treatment of tuberculosis
By Thomas H. Maugh II, LA Times Staff Writer, July 18, 2007

…Comstock was a young commissioned officer in the U.S. Public Health Service after World War II when federal officials were considering a mass vaccination campaign against tuberculosis using the relatively new Bacille Calmette-Guérin vaccine, which is made from an attenuated strain of mycobacterium that produces TB in cows.

He organized a trial of the BCG vaccine in Georgia and Alabama that stretched from 1947 to 1951 and concluded that the vaccine had an efficacy of only 14% in preventing the disease. He argued forcefully that the efficacy was too low to produce widespread benefit and that vaccination would render the Mantoux skin test for detecting TB infections useless by making vaccine recipients permanently positive.

In a country like the United States, with a relatively low incidence of TB, he argued, it was more important to be able to identify those exposed to the mycobacterium and treat them. Federal authorities agreed, and the vaccine was never widely used here….

Comstock frequently quoted Horace Mann’s 1859 commencement address at Antioch College: “Be ashamed to die before you have won some victory for humanity.” Comstock expanded on that theme, noting that “most of us aren’t going to win any big victories, but we can win little ones every day, and they mount up. [read more at…]

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