Why is prevention so difficult and slow?

Recognizing the preventive quality in the adoption of innovations: The case of third-party ownership photovoltaic systems in Finland

This study explores the role of the preventive quality of innovations on their adoption intention. The preventive quality of innovations is a distinctive feature of innovations that is directed towards avoiding a future, possibly harmful event. Empirically grounded in third-party ownership of photovoltaic systems in Finland, this study examines data collected from an online survey measuring respondent intention to adopt. A series of hypotheses theoretically grounded in the Diffusion of Innovations theory and the preventive quality of innovations were tested through Partial Least Squares Structural Equation Modeling with SmartPLS4. Findings for the overall sample reveal that the preventive quality and the relative advantage of innovations influenced adoption intention positively. Findings highlight the preventive quality of innovations as a construct that acts as the greatest contributor to the dependent variable.

COVID-19 and the selection problem in national cause-of-death statistics

The World Health Organization has issued international instructions for certification and classification (coding) of the coronavirus disease (COVID-19) as cause of death. Central to these instructions is the selection of the underlying cause of death for a public health preventive purpose. This article focuses on two rules for this selection: (1) that a death due to COVID-19 should be counted independently of pre-existing conditions that are suspected of triggering a severe course of COVID-19 and (2) that COVID-19 should not be considered as due to anything else. The article argues that observance of the first rule may not always lead to an optimal selection from a preventive point of view and that in the future the ascertainment of an animal source of the coronavirus (SARS-CoV-2) would make it possible to reconceptualize 'COVID-19' and create a zoonotic classification code by means of which a factor of a greater preventive value could be selected than what is currently possible.

Health and evolution

Darwinian medicine may shed new light on the notion of health and many current health problems. In this paper, health, as an ability to realize one's own welfare, is compared with health as an ability—either being developed or actually present—to perform a reproductive function of one's species. It is argued that knowledge about the conditions for health in the latter sense may enhance our efforts to promote health in the former sense.

Time-related issues with application to health gains and losses

Time-related aspects of health have attracted increasing interest, and it has become evident that many medical situations concern the exchange of present-day costs for future benefits. Traditional decision analytic paradigms weigh the probability of outcomes and the value of outcomes. Such analyses are incomplete if they do not consider the time of the outcome as well. The concept of diminishing value over time is positive discounting. Time discounting processes and effects have a potentially large impact on clinical decision making. Therefore, characteristics of discounting should be taken into consideration. Discounting processes are variable with individuals and also within different contexts such as gains and losses. No single model can be expected to describe time-related decisions within health. A more diversified use and critical appraisal of these concepts in medicine become more important as we attempt to refine decision models. A summary of valuation factors in medical decision making is presented: (a) long-term decisions are very sensitive to discount rates; (b) discount rates are greater for gains than for losses; (c) discount rates vary by domain, by outcome, by individuals over time, and by level of certainty; (d) individual preferences may reverse themselves over time; (e) the doctor uses expected value; the patient is risk aversive; (f) over a lifetime perspective, a flat or even negative discount rate will result in choices that minimize lifetime disability.

The Swedish SF-36 Health Survey III. Evaluation of criterion-based validity: results from normative population

Assumptions of the variation in SF-36 scale scores were tested in relation to external criteria in 8930 respondents comprising the Swedish norming population. Physical health scales were strongly associated with age, while small differences were found for the Mental Health scale across age groups. Females reported poorer health than males, particularly in ages between 30-40 and over 70. Worse health profiles were associated with social risk factors (unemployment, divorce, etc.). The disability pension rate was strongly related to reduced Physical Functioning and increased Bodily Pain. The use of medical care was reflected in general health scores (i.e., the lower the scale score, the higher the care consumption). Self-reported physical and psychological symptoms were selectively related to SF-36 scales. All SF-36 scales, except Mental Health, were more strongly related to ratings of health satisfaction than to global quality of life. Combinations of the SF-36 well-being scales explained a substantial part of the variance of these ratings. In conclusion, the performed criterion-validity tests support the cross-cultural stability of the SF-36.

Circumstances around the fall in a multinational hip fracture risk study: a diverse pattern for prevention. MEDOS Study Group). Mediterranean Osteoporosis Study

Hip fracture is a major public health problem, but with a potential for prevention. Data from a European multicentre study on hip fracture epidemiology with a case control design, the MEDOS study, were used to describe and analyse circumstances around falls associated with hip fracture. The study includes 2185 fracture cases age > 50 years from 14 centres in southern Europe: Portugal, Spain, France, Italy, Greece and Turkey. Information was collected by a standardized and validated questionnaire translated into six languages and administered by trained interviewers. Circumstances around the fall were categorized according to: (1) place, age group and time of day; (2) functional disability; (3) drug consumption including alcohol; and (4) environmental factors. Possibilities for prevention were also analysed. High risk falls were identified using seven reasonably well-established risk factors, and similarly eight risk factors were used to identify high risk fallers. Selected trains of events were also studied. A pattern of great diversity was found both among the fallers and the environment in which they fell and fractured the hip. Those with more than one factor involved constituted only 14.7% of female and 19.7% of male fractures. A majority of cases were not physically disabled before the fall. A majority (66.5%) fell and fractured their hip indoors and only 4.3% outside in darkness. Cardiovascular and cerebrovascular comborbidity were observed with 4.9 and 7.8%, of falls respectively. Falls in a stairway comprised 11% of falls. The correlation between the number of the risk factors of the faller and in the environment was 0.07 and there was no difference between males and females. The pattern of causality behind falls that cause hip fracture and therefore of prevention comprises many sometimes small groups and intricate time sequence. The results suggest that global preventive strategies could presently not be implemented. Instead, the pattern of prevention should include different target groups and be country and site specific. For the high risk group of institutionalized patients prevention can be implemented without delay.