American journal of preventive medicine
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Smoking is known to be a major cause of death among middle-aged adults, but evidence on its impact and the benefits of smoking cessation among older adults has remained limited. Therefore, we aimed to estimate the influence of smoking and smoking cessation on all-cause mortality in people aged ≥60 years. ⋯ Smoking remains as a strong risk factor for premature mortality in older individuals and cessation remains beneficial even at advanced ages. Efforts to support smoking abstinence at all ages should be a public health priority.
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In September 2012, the Health Resources and Services Administration funded 12 preventive medicine residency programs to participate in a 2-year project aimed at incorporating integrative medicine (IM) into their residency training programs. The grantees were asked to incorporate competencies for IM into their respective preventive medicine residency curricula and to provide for faculty development in IM. ⋯ Key findings are: (1) IM activities offered to residents increased by 50% during the 2 years; (2) Accessing IM resources already in existence at local grantee sites was the primary facilitator of moving the integration of IM into preventive medicine residencies forward; (3) Among all activities offered residents, rotations were perceived by grantees as by far the most valuable contributor to acquiring IM competencies; (4) Online training was considered a greater contributor to preventive medicine residents' medical knowledge in IM than faculty lectures or courses; (5) Faculty were offered a rich variety of opportunities for professional development in IM, but some programs lacked a system to ensure faculty participation; and (6) Perceived lack of evidence for IM was a barrier to full program implementation at some sites. Grantees expect implemented programs to continue post-funding, but with decreased intensity owing to perceived faculty and curriculum time constraints.
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The Preventive Medicine Residency Program collaborated with the Department of Family Medicine's Program for Integrative Medicine and Health Disparities at Boston Medical Center to create a new rotation for preventive medicine residents starting in autumn 2012. Residents participated in integrative medicine group visits and consults, completed an online curriculum in dietary supplements, and participated in seminars all in the context of an urban safety net hospital. This collaboration was made possible by a federal Health Resources and Services Administration grant for integrative medicine in preventive medicine residencies and helped meet a need of the program to increase residents' exposure to clinical preventive medicine and integrative health clinical skills and principles. The collaboration has resulted in a required rotation for all residents that continues after the grant period and has fostered additional collaborations related to integrative medicine across the programs.
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Few studies have examined the longitudinal associations of fitness or changes in fitness on the risk of developing dyslipidemias. This study examined the associations of (1) baseline fitness with 25-year dyslipidemia incidence and (2) 20-year fitness change on dyslipidemia development in middle age in the Coronary Artery Risk Development in Young Adults Study (CARDIA). ⋯ Our findings demonstrate the importance of cardiorespiratory fitness in young adulthood as a risk factor for developing dyslipidemias, particularly high triglycerides, during the transition to middle age.
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Clinical decision support systems (CDSSs) can help clinicians assess cardiovascular disease (CVD) risk and manage CVD risk factors by providing tailored assessments and treatment recommendations based on individual patient data. The goal of this systematic review was to examine the effectiveness of CDSSs in improving screening for CVD risk factors, practices for CVD-related preventive care services such as clinical tests and prescribed treatments, and management of CVD risk factors. ⋯ CDSSs are effective in improving clinician practices related to screening and other preventive care services, clinical tests, and treatments. However, more evidence is needed from implementation of CDSSs within the broad context of comprehensive service delivery aimed at reducing CVD risk and CVD-related morbidity and mortality.