RESUMEN
INTRODUCTION: Integrative medicine (IM) is by its very definition patient centric: "It reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches." Best methods for teaching IM in residency have not been well described. METHODS: An IM curriculum for preventive medicine (PM) residents was thoughtfully developed and iteratively revised using Kern's six-step approach. The centerpiece of this curriculum was to have learners work collaboratively within teams on projects that would facilitate IM-focused care within primary care practices. Before embarking on specific IM-related projects, residents immersed themselves within the practices to understand the needs of the community. RESULTS: Forty-eight PM residents have participated in the curriculum in the last 3 years, and 27 unique physician preceptors served as mentors for the projects. Both residents and preceptors enjoyed working on the projects, and both groups considered the work to be a valuable educational pursuit. Common IM content areas covered by the projects dealt with interprofessional collaboration, health promotion, and population-based prevention. Although there were challenges associated with implementation of the projects, overcoming these enhanced the PM residents' confidence and ability to serve as agents of change. CONCLUSIONS: An IM curriculum was successfully incorporated into a PM residency program. The focus on serving the community, or a population health approach, may not be the most common approach in IM, but it worked effectively to enhance the IM knowledge and skills of PM residents.
Asunto(s)
Curriculum/normas , Medicina Integrativa/educación , Médicos/normas , Enseñanza/normas , Competencia Clínica , Humanos , Internado y Residencia , Atención Primaria de SaludRESUMEN
OBJECTIVE: To examine the relationship between increased physical activity in adolescence and adult weight status. DESIGN: Cohort study based on data from the National Longitudinal Study of Adolescent Health. SETTING: In-home interviews. PARTICIPANTS: A total of 3345 adolescents in grades 8 to 12 with body mass index (calculated as weight in kilograms divided by height in meters squared) data available at baseline and 5 years later. Main Exposures Days per week of curricular and extracurricular physical activity. MAIN OUTCOME MEASURE: Overweight status (body mass index > or =25) 5 years after baseline. RESULTS: Increasing participation in certain extracurricular physical activities and physical education decreased the likelihood of young adulthood overweight. Regarding extracurricular physical activities, the likelihood of being an overweight adult was reduced most (ie, 48%) by performing certain wheel-related activities (ie, rollerblading, roller skating, skateboarding, or bicycling) more than 4 times per week. Each weekday that adolescents participated in physical education decreased the odds of being an overweight adult by 5%, with participation in all 5 weekdays of physical education decreasing the odds by 28%. In general, physical activity predicted normal-weight maintenance better than weight loss. CONCLUSION: These data underscore the important role that school-based and extracurricular physical activity play in reducing the likelihood of transitioning to overweight as young adults.
Asunto(s)
Conductas Relacionadas con la Salud , Actividad Motora , Sobrepeso/epidemiología , Adolescente , Adulto , Índice de Masa Corporal , Estudios de Cohortes , Femenino , Encuestas Epidemiológicas , Humanos , Estudios Longitudinales , Masculino , Sobrepeso/prevención & control , Educación y Entrenamiento Físico/estadística & datos numéricos , Prevalencia , Estados Unidos/epidemiologíaRESUMEN
The American College of Preventive Medicine (ACPM) this position statement is intended to guide physicians in counseling children and adolescents to prevent overweight. Rigorous reviews of the published literature have found insufficient evidence to permit the development of formal recommendations by the US Preventive Services Task Force and others. However, numerous public health and physician organizations have developed recommendations on the basis of expert opinion, professional judgment, and the available scientific evidence. This article presents the position of the ACPM in light of these ambiguities. The ACPM will review and modify its recommendations as new scientific evidence emerges.