Risk, Health, and Physical Enhancement: The Dangers of Health Care as Risk Reduction for Christian Bioethics

2020 ◽  
Vol 26 (2) ◽  
pp. 145-162
Author(s):  
Paul Scherz
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Health Care ◽  
Health Promotion ◽  
Risk Reduction ◽  
Genetic Variants ◽  
Blood Lipids ◽  
The Body ◽  
Individual Risk ◽  
Iatrogenic Effects

Abstract Medicine increasingly envisions health promotion in terms of reducing risk as determined by quantitative risk factors, such as blood pressure, blood lipids, or genetic variants. This essay argues that this vision of health care as risk reduction is dangerous for Christian bioethics, since risk can be infinitely reduced leading to a self-defeating spiral of iatrogenic effects. Moreover, it endangers character because this vision of health is connected to a reductionist vision of the body and an understanding of individual risk that undermines the more communal virtue of solidarity. The essay concludes by discussing how recent Thomistic analyses in favor of physical enhancements illustrate some of the problems that envisioning health care in terms of risk reduction holds for Christian bioethics.

The Impact of Lifestyle Modification on Cardiometabolic Risk Factors in Health-Care Employees With Type 2 Diabetes

2019 ◽  
Vol 33 (5) ◽  
pp. 745-748 ◽  
Author(s):  
Sankalp Das ◽  
Maribeth Rouseff ◽  
Henry E. Guzman ◽  
Chukwuemeka U. Osondu ◽  
Doris Brown ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Health Care ◽  
Health Promotion ◽  
Lifestyle Modification ◽  
Density Lipoprotein ◽  
South Florida ◽  
Care Staff ◽  
Lifestyle Modification Program

Purpose: Diabetes imposes a significant economic burden on employers, particularly when including productivity costs. Given the great interest on multicomponent lifestyle interventions in these individuals, we assessed the short-term and long-term efficacy of a structured lifestyle modification program, My Unlimited Potential, among employees with diabetes of Baptist Health South Florida (BHSF), a large non-for profit health-care system. Design: This is a pre- and post-effectiveness of a workplace health promotion program. Setting: Worksite intervention at BHSF. Participants: The study analyzed the data of 93 employees with diabetes involved in a worksite wellness program after completion of a year long program. Intervention: The intervention was an intense lifestyle modification program that was targeted to the individual needs of the participants. Measures: Cardimetabolic risk factors such as body mass index (BMI), weight, systolic blood pressure, diastolic blood pressure, glycated hemoglobin, total cholesterol, triglycerides, high-sensitivity C-reactive protein, low-density lipoprotein, high-density lipoprotein, and maximal oxygen consumption. Analysis: Paired 2-sample t tests for means and descriptive statistics were used. Results: A mean decrease of 0.6 percentage points was observed in HbA1c values from baseline to 12 months. Weight, BMI, blood pressure, and lipid profile improved significantly after 12 months. Conclusion: This study suggests worksites with existing health promotion programs, and health-care staff can effectively deliver a diabetes prevention program that appears to have a long-term impact on employee health.

scholarly journals RxIALTA: evaluating the effect of a pharmacist-led intervention on CV risk in patients with chronic inflammatory diseases in a community pharmacy setting: a prospective pre–post intervention study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e043612
Author(s):  
Yazid N Al Hamarneh ◽  
Carlo Marra ◽  
Robert Gniadecki ◽  
Stephanie Keeling ◽  
Andrea Morgan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Community Pharmacy ◽  
Risk Reduction ◽  
Tobacco Cessation ◽  
Ldl Cholesterol ◽  
Individual Risk ◽  
Inflammatory Conditions ◽  
Pharmacy Setting

Patients with inflammatory conditions are at high risk for cardiovascular (CV) disease. Despite such elevated risk, their CV risk factors are suboptimally managed.ObjectiveTo evaluate the effect of a pharmacist-led intervention on CV risk in patients with inflammatory conditions.MethodsDesignProspective pre–postintervention.Setting17 community pharmacies across Alberta.PopulationAdults with inflammatory conditions (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, gout, systemic lupus erythematosus, psoriasis vulgaris) who had at least one uncontrolled risk factor (A1C, blood pressure, LDL-cholesterol or current tobacco users).InterventionAll patients enrolled in the study received: physical and laboratory assessment, individualised CV risk assessment and education regarding this risk, treatment recommendations, prescription adaptation and prescribing where necessary to meet treatment targets, regular communication with the patient’s treating physician(s) and regular follow-up with all patients every month for 6 months.OutcomesPrimary: change in estimated CV risk (risk of a major CV event in the next 10 years) after 6 months. Secondary: change in individual risk factors (blood pressure, LDL-cholesterol, A1C and tobacco cessation) over a 6-month period.ResultsWe enrolled 99 patients. The median age was 66.41 years (IQR 57.64–72.79), More than half of them (61%) were female and more than three-quarters (86%) were Caucasians. After adjusting for age, sex and ethnicity and centre effect, there was a reduction of 24.5% in CV risk (p<0.001); including a reduction of 0.3 mmol/L in LDL-c (p<0.001), 10.7 mm Hg in systolic blood pressure (p<0.001), 1.25% in A1C (p<0.001). There was a non-significant trend towards tobacco cessation.ConclusionThis is the first study on CV risk reduction in patients with inflammatory conditions in a community pharmacy setting. RxIALTA provides evidence for the benefit of pharmacist care on global cardiovascular risk reduction as well as the individual cardiovascular risk factors in patients with inflammatory conditions.Trial registration numberNCT03152396.

Haematocrit: Relationships with Blood Lipids, Blood Pressure and other Cardiovascular Risk Factors

1994 ◽  
Vol 72 (01) ◽  
pp. 058-064 ◽  
Author(s):  
Goya Wannamethee ◽  
A Gerald Shaper
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Body Mass Index ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Alcohol Intake ◽  
Blood Lipids ◽  
The Other ◽  
The Relationship

SummaryThe relationship between haematocrit and cardiovascular risk factors, particularly blood pressure and blood lipids, has been examined in detail in a large prospective study of 7735 middle-aged men drawn from general practices in 24 British towns. The analyses are restricted to the 5494 men free of any evidence of ischaemic heart disease at screening.Smoking, body mass index, physical activity, alcohol intake and lung function (FEV1) were factors strongly associated with haematocrit levels independent of each other. Age showed a significant but small independent association with haematocrit. Non-manual workers had slightly higher haematocrit levels than manual workers; this difference increased considerably and became significant after adjustment for the other risk factors. Diabetics showed significantly lower levels of haematocrit than non-diabetics. In the univariate analysis, haematocrit was significantly associated with total serum protein (r = 0*18), cholesterol (r = 0.16), triglyceride (r = 0.15), diastolic blood pressure (r = 0.17) and heart rate (r = 0.14); all at p <0.0001. A weaker but significant association was seen with systolic blood pressure (r = 0.09, p <0.001). These relationships remained significant even after adjustment for age, smoking, body mass index, physical activity, alcohol intake, lung function, presence of diabetes, social class and for each of the other biological variables; the relationship with systolic blood pressure was considerably weakened. No association was seen with blood glucose and HDL-cholesterol. This study has shown significant associations between several lifestyle characteristics and the haematocrit and supports the findings of a significant relationship between the haematocrit and blood lipids and blood pressure. It emphasises the role of the haematocrit in assessing the risk of ischaemic heart disease and stroke in individuals, and the need to take haematocrit levels into account in determining the importance of other cardiovascular risk factors.

scholarly journals Development of the First WHO Guidelines for Risk Reduction of Cognitive Decline and Dementia: Lessons Learned and Future Directions

2021 ◽  
Vol 12 ◽  
Author(s):  
Ruth Stephen ◽  
Mariagnese Barbera ◽  
Ruth Peters ◽  
Nicole Ee ◽  
Lidan Zheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Decline ◽  
Risk Reduction ◽  
Individual Risk ◽  
Who Guidelines ◽  
Dementia Risk ◽  
Dementia Prevention ◽  
Multidomain Intervention ◽  
Intervention Trials ◽  
Individual Risk Factors

The first WHO guidelines for risk reduction of cognitive decline and dementia marked an important milestone in the field of dementia prevention. In this paper, we discuss the evidence reviewed as part of the guidelines development and present the main themes emerged from its synthesis, to inform future research and policies on dementia risk reduction. The role of intervention effect-size; the mismatch between observational and intervention-based evidence; the heterogeneity of evidence among intervention trials; the importance of intervention duration; the role of timing of exposure to a certain risk factor and interventions; the relationship between intervention intensity and response; the link between individual risk factors and specific dementia pathologies; and the need for tailored interventions emerged as the main themes. The interaction and clustering of individual risk factors, including genetics, was identified as the overarching theme. The evidence collected indicates that multidomain approaches targeting simultaneously multiple risk factors and tailored at both individual and population level, are likely to be most effective and feasible in dementia risk reduction. The current status of multidomain intervention trials aimed to cognitive impairment/dementia prevention was also briefly reviewed. Primary results were presented focusing on methodological differences and the potential of design harmonization for improving evidence quality. Since multidomain intervention trials address a condition with slow clinical manifestation—like dementia—in a relatively short time frame, the need for surrogate outcomes was also discussed, with a specific focus on the potential utility of dementia risk scores. Finally, we considered how multidomain intervention could be most effectively implemented in a public health context and the implications world-wide for other non-communicable diseases targeting common risk factors, taking into account the limited evidence in low-middle income countries. In conclusion, the evidence from the first WHO guidelines for risk reduction of cognitive decline and dementia indicated that “one size does not fit all,” and multidomain approaches adaptable to different populations and individuals are likely to be the most effective. Harmonization in trial design, the use of appropriate outcome measures, and sustainability in large at-risk populations in the context of other chronic disorders also emerged as key elements.

scholarly journals Gender responsive health promotion and NCD prevention – challenges and solutions in Kyrgyzstan

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Graeser ◽  
T Djamangulova ◽  
R Aidaralie ◽  
S Matovic-Miljanovic
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Health Promotion ◽  
Health Care Services ◽  
Primary Source ◽  
Preventive Services ◽  
Life Course Perspective ◽  
Common Disease ◽  
Male Population ◽  
Primary Health

Abstract Reaching men is one of the challenges related to targeted health promotion. Societal factors, concepts of masculinities, and gender norms have a strong influence on preventive and health behavior of men. Targeted health promotion and prevention has to consider gender-specific differences in language and information sources to spread preventive messages but often fail to be effective. In Kyrgyzstan, non-communicable diseases account for 80% of mortality, including cardiovascular diseases, and raised blood pressure is the second most common disease for men. The NCD prevention and control project in Kyrgyzstan, funded by the Swiss Agency for Development and Cooperation (SDC), aims to facilitate behavioral change towards healthier lifestyles by taking a gender-responsive approach to support the utilization of NCD related primary health care services for men. The gender-responsive intervention considers gender roles, norms, and inequalities, understands men's health needs, and pattern of preventive behavior to develop interventions. Data from project studies yielded that for men family members were the primary source of information about NCDs, risk factors and prevention. An assets-based approach is taken, building on the male role in a life-course perspective and a positive approach to the role of men as fathers. In 2019, an intervention, combining a school competition for children with a voucher system for preventive services for fathers and male relatives was conducted. In total, 80,416 males were reached and visited primary health facilities for preventive services (which averaged 20% of the male population over 18 years old); 18,364 (23%) men were newly detected with high blood pressure. Medical workers were made available during special hours to provide men with a consultation. During their visits, all men were screened for risk factors and received a consultation based on PEN protocol 1 and 2. Lessons on gender sensitivity have been learned from this experience.

scholarly journals CORRELAÇÃO ENTRE OBESIDADE/SOBREPESO E PRESSÃO ARTERIAL ELEVADA EM ESCOLARES DE UMA CIDADE DO INTERIOR DE SÃO PAULO

2019 ◽  
Vol 11 (1) ◽  
pp. 51-56
Author(s):  
Marcelo José Alves ◽  
Victor Hugo Santos Zangirolamo ◽  
Carlos Augusto Carvalho Filho ◽  
Everton Alex Carvalho Zanuto ◽  
Diane de Vasconcelos Barrionuevo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Body Mass Index ◽  
Body Weight ◽  
Standard Deviation ◽  
Physical Inactivity ◽  
Pediatric Population ◽  
The Body ◽  
Chronological Age ◽  
Hemodynamic Variables

Currently the Brazilian pediatric population has been exposed to risk factors caused by physical inactivity and poor diet, resulting in an increase in the Body Mass Index (BMI), which can lead to vascular problems even in childhood. The objectivewasto verify the influence of BMIon pressure levels. The sample consisted of 61 children of both sexes, chronological age between six and seven years and regularly enrolled/attending school. These children were evaluated in their hemodynamic variables (systolic -SBP and diastolic –DBP blood pressure), body weight, and height. Mean and standard deviation of participants' ages were 7±0.3 years, SBP had 89.4±10 and DBP of 57±6.9, eutrophic patients had 88.7±1.1 for SBP and 56±5 for DBP,and for those with overweight/obesityof109±5 for SBP and 70.7±8.2 for PAD(p=0.0001).Pearson's correlation for BMI with SBP and DBP was moderate for both, but with beta of 1.53 in linear regression for SBP and 0.96 for DBP. It was concluded thatBMI directly influences systolic and diastolic blood pressure levels and the control of overweight / obesity is necessary at the initial ages of life

scholarly journals The Effect of Oxymel Syrup on Some Cardiovascular Risk Factors in Overweight and Obese People: A Randomized Controlled Trial Study

2021 ◽  
Author(s):  
Marjan Mahdavi Roshan ◽  
Arsalan Salari ◽  
Sogol Emaminejad ◽  
Shirin Parvinroo ◽  
Asieh Ashouri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Controlled Trial ◽  
Test Group ◽  
The Body ◽  
Risk Indicators ◽  
Blood Cholesterol ◽  
Control Group ◽  
Obese People

High blood pressure, diabetes, hyperlipidemia and obesity are risk factors for cardiovascular diseases. With regard to the significant role of a healthy diet in the prevention and even treatment of diseases together with the high cost and side effects of drugs, finding foods effective in the treatment of metabolic disorders has been widely considered. This study aimed to evaluate the effect of oxymel – an Iranian traditional syrup with vinegar base – on cardiovascular risk indicators in obese and overweight people. Candidates were selected based on a set of inclusion criteria and were divided into two groups of control and test. The control group received 250 cc of water, while the test group received 250 cc water containing 30 cc of the oxymel for 30 days. Anthropometric and biochemical indicators were measured at the beginning and end of the study. The results showed that there were no significant changes in the body mass index, waist circumference, hip circumference, waist to hip ratio, HDL, LDL, Triglycerides, systolic and diastolic blood pressure, and blood glucose level. However, weight (P = 0.053) and cholesterol (P = 0.083) decreased relatively significantly in the test group compared to the control group. This study shows that consumption of oxymel has positive cardiovascular effects such as lowering the blood cholesterol level and can contribute to weight loss; however, studies with a larger sample size are recommended.

scholarly journals Association of Established Blood Pressure Loci With 10‐Year Change in Blood Pressure and Their Ability to Predict Incident Hypertension

2020 ◽  
Vol 9 (16) ◽  
Author(s):  
Alaitz Poveda ◽  
Naeimeh Atabaki‐Pasdar ◽  
Shafqat Ahmad ◽  
Göran Hallmans ◽  
Frida Renström ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Genetic Variants ◽  
Association Studies ◽  
Risk Scores ◽  
Genome Wide Association Studies ◽  
Swedish Population ◽  
Long Term Changes ◽  
Traditional Risk Factors

Background Genome‐wide association studies have identified >1000 genetic variants cross‐sectionally associated with blood pressure variation and prevalent hypertension. These discoveries might aid the early identification of subpopulations at risk of developing hypertension or provide targets for drug development, amongst other applications. The aim of the present study was to analyze the association of blood pressure‐associated variants with long‐term changes (10 years) in blood pressure and also to assess their ability to predict hypertension incidence compared with traditional risk variables in a Swedish population. Methods and Results We constructed 6 genetic risk scores (GRSs) by summing the dosage of the effect allele at each locus of genetic variants previously associated with blood pressure traits (systolic blood pressure GRS (GRS SBP ): 554 variants; diastolic blood pressure GRS (GRS DBP ): 481 variants; mean arterial pressure GRS (GRS MAP ): 20 variants; pulse pressure GRS (GRS PP ): 478 variants; hypertension GRS (GRS HTN ): 22 variants; combined GRS (GRS com b ): 1152 variants). Each GRS was longitudinally associated with its corresponding blood pressure trait, with estimated effects per GRS SD unit of 0.50 to 1.21 mm Hg for quantitative traits and odds ratios (ORs) of 1.10 to 1.35 for hypertension incidence traits. The GRS comb was also significantly associated with hypertension incidence defined according to European guidelines (OR, 1.22 per SD; 95% CI, 1.10‒1.35) but not US guidelines (OR, 1.11 per SD; 95% CI, 0.99‒1.25) while controlling for traditional risk factors. The addition of GRS comb to a model containing traditional risk factors only marginally improved discrimination (Δarea under the ROC curve = 0.001–0.002). Conclusions GRSs based on discovered blood pressure‐associated variants are associated with long‐term changes in blood pressure traits and hypertension incidence, but the inclusion of genetic factors in a model composed of conventional hypertension risk factors did not yield a material increase in predictive ability.

scholarly journals Derivation and Application of a Tool to Estimate Benefits From Multiple Therapies That Reduce Recurrent Stroke Risk

Stroke ◽  
2020 ◽  
Vol 51 (5) ◽  
pp. 1563-1569 ◽  
Author(s):  
Adam Richards ◽  
Nicholas J. Jackson ◽  
Eric M. Cheng ◽  
Robert J. Bryg ◽  
Arleen Brown ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Reduction ◽  
Stroke Risk ◽  
Care Delivery ◽  
Recurrent Stroke ◽  
Individual Risk ◽  
Stroke Risk Factors ◽  
Multiple Stroke ◽  
Individual Risk Factors ◽  
Delivery Models

Background and Purpose— Lowering blood pressure and cholesterol, antiplatelet/antithrombotic use, and smoking cessation reduce risk of recurrent stroke. However, gaps in risk factor control among stroke survivors warrant development and evaluation of alternative care delivery models that aim to simultaneously improve multiple risk factors. Randomized trials of care delivery models are rarely of sufficient duration or size to be powered for low-frequency outcomes such as observed recurrent stroke. This creates a need for tools to estimate how changes across multiple stroke risk factors reduce risk of recurrent stroke. Methods— We reviewed existing evidence of the efficacy of interventions addressing blood pressure reduction, cholesterol lowering, antiplatelet/antithrombotic use, and smoking cessation and extracted relative risks for each intervention. From this, we developed a tool to estimate reductions in recurrent stroke risk, using bootstrapping and simulation methods. We also calculated a modified Global Outcome Score representing the proportion of potential benefit (relative risk reduction) achieved if all 4 individual risk factors were optimally controlled. We applied the tool to estimate stroke risk reduction among 275 participants with complete 12-month follow-up data from a recently published randomized trial of a healthcare delivery model that targeted multiple stroke risk factors. Results— The recurrent stroke risk tool was feasible to apply, yielding an estimated reduction in the relative risk of ischemic stroke of 0.36 in both the experimental and usual care trial arms. Global Outcome Score results suggest that participants in both arms likely averted, on average, 45% of recurrent stroke events that could possibly have been prevented through maximal implementation of interventions for all 4 individual risk factors. Conclusions— A stroke risk reduction tool facilitates estimation of the combined impact on vascular risk of improvements in multiple stroke risk factors and provides a summary outcome for studies testing alternative care models to prevent recurrent stroke. Registration— URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00861081.

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