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Obesity, physical activity, and
the urban environment: public health research needs
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An experiential
interdisciplinary quality improvement education
initiative
-
Preventive medicine in emergency centres: an opportunity
of partnership for emergency physicians and primary care
physicians
-
Cutting
costs through prevention
-
American Cancer
Society guidelines on nutrition and physical activity
for cancer prevention: reducing the risk of cancer with
healthy food choices and physical activity
-
The
impact of a decision aid about heart disease prevention
on patients' discussions with their doctor and their
plans for prevention: a pilot randomized trial
Obesity, physical activity, and
the urban environment: public health research needs
Persistent trends in overweight and obesity have
resulted in a rapid research effort focused on built
environment, physical activity, and overweight. Much of
the focus of this research has been on the design and
form of suburbs. It suggests that several features of
the suburban built environment such as low densities,
poor street connectivity and the lack of sidewalks are
associated with decreased physical activity and an
increased risk of being overweight. But compared to
suburban residents, inner city populations have higher
rates of obesity and inactivity despite living in
neighborhoods that are dense, have excellent street
connectivity and whos streets are almost universally
lined with sidewalks.
The
authors suggest that the reasons for this apparent
paradox are rooted in the complex interaction of land
use, infrastructure and social factors affecting inner
city populations. They believe that certain disparities
among urban and suburban populations in obesity and
overweight, physical activity and research focus have
emerged and that these need to be addressed.
Lopez RP, Hynes HP.
Environ Health. 2006 Sep 18;5(1):25
October
2006 Index
An
experiential interdisciplinary quality improvement
education initiative
Prathibha Varkey and colleagues conducted a pilot study
that supports the feasibility and potential benefits of
interdisciplinary quality improvement education. Seven
learners, including 2 preventive medicine fellows, 2
family medicine residents, 1 internal medicine resident,
and 2 master's-level nursing students participated in an
experiential 4-week quality improvement rotation at a
major academic medical center. Together they worked on a
quality improvement project that resulted in enhanced
medication reconciliation in a preventive medicine
clinic. In their pilot study learner knowledge measured
on the QI Knowledge Application Tool increased from an
average of 2.33 before the start of the rotation to 3.43
(P = .043) by the end of the rotation. At the
conclusion, all learners said they were confident or
very confident that they could make a change to improve
health care in a local setting. The authors recommend
that further research be conducted to explore strategies
to implement the same pilot on a larger scale, and to
examine the impact on patient outcomes.
Varkey
P, Reller MK, Smith A, Ponto J, Osborn M. Am J Med
Qual. 2006 Sep-Oct;21(5):317-22
October
2006 Index
Preventive medicine in emergency centres: an opportunity
of partnership for emergency physicians and primary care
physicians
Whereas
preventive interventions for primary care physicians are
well established, the preventive interventions in
emergency departments have been only partially and
recently evaluated. The authors believe that emergency
departments represent an opportunity for preventive
medicine. Given that the vulnerable population that
comes to emergency departments frequently have risk
factors and risk behaviors that need to be addressed,
the visit provides unique opportunities. The authors
further state that the concept of "teachable moment" and
the studies recently performed seem to confirm this
hypothesis. This article reviews the current preventive
interventions recommended in emergency departments and
discusses the rationale to implement preventive medicine
in emergency departments and some of the limits of this
process.
Guessous
I, Cornuz J, Hugli OW, Yersin B. Rev Med
Suisse. 2006 Aug 9;2(75):1854-8
[Article
in French] Centre interdisciplinaire des urgences, CHUV,
1011 Lausanne.
Idris.Guessous@chuv.ch
October
2006 Index
Cutting costs through prevention
The
article examines a model, developed by MDVIP, for
delivering cost-effective preventive medicine that is
not possible in traditional primary care practices.
Successful preventive care demands an in-depth
assessment of health risk factors, appropriate
screenings, and planning for long-term wellness goals
based upon individual medical needs. The author believes
that in today's healthcare climate, the only way to
offer comprehensive, quality service is by dramatically
reducing practice size to no more than 600 patients,
affording physicians the time needed to provide
proactive medical care. The data in this article show
that with this model, patients have reduced hospital
visits, shorter lengths of stay, and reduced costs. This
model is commonly referred to as "concierge" medicine,
of which MDVIP-affiliated physicians constitute 25
percent of the estimated 300 concierge practices
nationally.
Goldman
E. J Med
Pract Manage. 2006 Jul-Aug;22(1):41-4
MDVIP,
Inc., NW, Suite 100, Boca Raton, FL 33787, USA.
egoldman@mdvip.com
October
2006 Index
American Cancer
Society guidelines on nutrition and physical
activity for cancer prevention: reducing the risk of
cancer with healthy food choices and physical activity
The American Cancer
Society (ACS) publishes Nutrition and Physical Activity
Guidelines to serve as a foundation for its
communication, policy, and community strategies and
ultimately, to affect dietary and physical activity
patterns among Americans. These Guidelines, published
every 5 years, are developed by a national panel of
experts in cancer research, prevention, epidemiology,
public health, and policy, and as such, they represent
the most current scientific evidence related to dietary
and activity patterns and cancer risk. The ACS
Guidelines include recommendations for individual
choices regarding diet and physical activity patterns,
but those choices occur within a community context that
either facilitates or interferes with healthy behaviors.
Community efforts are essential to create a social
environment that promotes healthy food choices and
physical activity. Therefore, this committee presents
one key recommendation for community action to accompany
the four recommendations for individual choices to
reduce cancer risk. This recommendation for community
action recognizes that a supportive social environment
is indispensable if individuals at all levels of society
are to have genuine opportunities to choose healthy
behaviors. The ACS Guidelines are consistent with
guidelines from the American Heart Association and the
American Diabetes Association for the prevention of
coronary heart disease and diabetes, as well as for
general health promotion, as defined by the Department
of Health and Human Services' 2005 Dietary Guidelines
for Americans.
Kushi LH, Byers T, Doyle
C, Bandera EV, McCullough M, Gansler T, Andrews KS, Thun
MJ. CA Cancer J Clin. 2006 Sep-Oct;56(5):254-81.
October
2006 Index
The impact
of a decision aid about heart disease prevention on
patients' discussions with their doctor and their plans
for prevention: a pilot randomized trial
Low utilization of
effective coronary heart disease (CHD) prevention
strategies may be due to many factors, but chief among
them is the lack of patient involvement in prevention
decisions. The authors undertook this study to test the
effectiveness of an individually-tailored, computerized
decision aid about CHD on patients discussions with
their doctor and their plans for CHD prevention. The
researchers conducted a pilot randomized trial in a
convenience sample of adults with no previous history of
cardiovascular disease to test the effectiveness of an
individually-tailored, computerized decision aid about
CHD prevention against a risk factor list that patients
could present to their doctor. The authors believe that
their study confirms patients limited knowledge about
their CHD risk and effective risk reduction options and
provides preliminary evidence that an
individually-tailored decision aid about CHD prevention
might be expected to increase patients discussions about
CHD prevention with their doctor and their plans for CHD
risk reduction. They further recommend that these
findings should be replicated in studies with a larger
sample size and patients at overall higher risk of CHD.
Sheridan SL, Shadle J,
Simpson RJ, Pignone MP. BMC Health Serv Res. 2006
Sep 27;6(1):121
October
2006 Index
