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Whole Health Revolution: Value-Based Care + Lifestyle Medicine 整体健康革命:基于价值的医疗+生活方式医学
IF 1.9 Q2 Medicine Pub Date : 2024-04-10 DOI: 10.1177/15598276241241023
Karen S. Johnson, Padmaja Patel
An outdated and burdensome fee-for-service (FFS) reimbursement system has significantly compromised primary care delivery in the US for decades, leading to a dire shortage of primary care workers. Support for primary care must increase from all public and private payers with well-designed value-based primary care payment. Patient care enabled by value-based payment is typically described or “labeled” as value-based care and commonly viewed as distinctly different from other models of care delivery. Unfortunately, labels tend to put individuals in camps that can make the differences seem greater than they are in practice. Achieving the aims of value-based care, aligned with the quintuple aims of health care, is common across many delivery models. The shrinking primary care workforce is too fragile to be fragmented across competing camps. Seeing the alignment across otherwise separate disciplines, such as lifestyle medicine and value-based care, is essential. In this article, we point to the opportunities that arise when we widen the lens to look beyond these labels and make the case that a variety of models and perspectives can meld together in practice to produce the kind of high-quality primary care physicians, care teams, and patients are seeking.
几十年来,过时而繁琐的按服务收费(FFS)报销制度严重影响了美国的初级医疗服务,导致初级医疗工作者严重短缺。所有公共和私人支付方都必须通过精心设计的基于价值的初级医疗支付来增加对初级医疗的支持。以价值为基础的支付方式所提供的患者护理通常被描述或 "贴上 "以价值为基础的护理的标签,通常被视为与其他护理服务模式截然不同。遗憾的是,标签往往会把个人归入不同的阵营,使差异看起来比实际情况更大。实现价值导向型医疗的目标与医疗保健的五重目标相一致,是许多医疗服务模式的共同目标。正在萎缩的初级医疗队伍非常脆弱,不能被相互竞争的阵营分割开来。必须看到生活方式医学和价值医疗等原本独立的学科之间的一致性。在这篇文章中,我们指出了当我们将视角扩大到这些标签之外时所带来的机遇,并证明了各种模式和观点可以在实践中融合在一起,从而产生医生、医疗团队和患者所追求的高质量初级医疗服务。
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引用次数: 0
Health and Wellness Coaching Can Improve Usage of Positive Airway Pressure Therapy in Participants With Obstructive Sleep Apnea and Obesity 健康与保健指导可提高阻塞性睡眠呼吸暂停和肥胖症患者使用气道正压疗法的水平
IF 1.9 Q2 Medicine Pub Date : 2024-04-10 DOI: 10.1177/15598276241244719
Michelle Alencar, Rachel Sauls, Kelly Johnson, Shreya Thakkar, Anthony Carmona, Aaron Morse, Sirish Nakka
Obstructive sleep apnea (OSA) has been tied to chronic conditions, such as obesity. Although continuous positive airway pressure (CPAP) device is an effective treatment, device discomfort impacts treatment adherence. Health and wellness coaching (HWC) can increase weight loss (WL) and adherence across other treatment types. This study aims to determine whether participants undergoing an HWC program improve CPAP device usage and WL compared to control group (CG). Participants were randomly selected to participate in the HWC group in conjunction with standard care. The HWC participants were gender, age, weight, CPAP usage (e.g., hours, days), and race matched to CG participants receiving standard care only. Variables collected include demographics (i.e., age, gender), CPAP device usage, and weight across four time points (baseline, 3-, 6-, and 9-months). Paired samples t-test and Pearson’s coefficient correlation were conducted to determine how outcomes differ between groups. Of 232 participants studied, those in the HWC group significantly increased CPAP usage over time ( P < .001) vs CG (6.5 ± 1.8, and 5.0 ± 2.3 hours, respectively). The HWC group had significantly more weight loss (11.0 ± 14.5 lbs.) than CG (5.7 ± 16.1 lbs.) across the 9-month timeline ( P < .001). This study provides evidence that HWC can improve CPAP adherence and weight loss.
阻塞性睡眠呼吸暂停(OSA)与肥胖等慢性疾病有关。虽然持续气道正压(CPAP)装置是一种有效的治疗方法,但装置的不适感会影响治疗的坚持性。健康与保健指导(HWC)可以提高体重减轻(WL)和其他治疗类型的依从性。本研究旨在确定与对照组(CG)相比,接受 HWC 计划的参与者是否能改善 CPAP 设备的使用和 WL。参与者被随机选入 HWC 组,同时接受标准护理。HWC 参与者的性别、年龄、体重、CPAP 使用情况(如小时数、天数)和种族与仅接受标准护理的 CG 参与者相匹配。收集的变量包括四个时间点(基线、3 个月、6 个月和 9 个月)的人口统计学特征(即年龄、性别)、CPAP 设备使用情况和体重。研究人员进行了配对样本 t 检验和皮尔逊系数相关性检验,以确定组间结果的差异。在所研究的 232 名参与者中,HWC 组与 CG 组相比,CPAP 使用时间明显增加(P < .001)(分别为 6.5 ± 1.8 小时和 5.0 ± 2.3 小时)。在 9 个月的时间里,HWC 组的体重减轻幅度(11.0 ± 14.5 磅)明显高于 CG 组(5.7 ± 16.1 磅)(P < .001)。本研究提供了 HWC 可以提高 CPAP 依从性和减轻体重的证据。
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引用次数: 0
Group-Based Interventions in Lifestyle Medicine 以小组为基础的生活方式医学干预措施
IF 1.9 Q2 Medicine Pub Date : 2024-04-10 DOI: 10.1177/15598276241242340
Viet T. Tran, Elizabeth M. Vaughan, Stephanie Kim, Craig A. Johnston
Group-based interventions in health care have demonstrated a positive influence on patient outcomes by strengthening patient-healthcare professional relationships and providing an avenue for patient empowerment through shared experiences and belongingness. Groups have been shown to enhance social and psychological support, improve self-management behaviors, and encourage peer-support. However group settings also present challenges, such as discomforts in sharing within a group context and managing diverse group dynamics. We outline the efficacy and dynamics of group-based activities in health care settings. This includes key behavioral components of groups, such as creating a safe, supportive, and cohesive environment in group activities where confidentiality is paramount. By recognizing principles for group and moderator behaviors, individuals are more likely to maximize the potential of these interventions.
医疗保健中以小组为基础的干预措施通过加强患者与医疗保健专业人员之间的关系,以及通过分享经验和归属感为患者提供一个增强能力的途径,对患者的治疗效果产生了积极的影响。事实证明,小组活动可以加强社会和心理支持,改善自我管理行为,鼓励同伴互助。然而,小组活动也会带来一些挑战,例如在小组环境中分享时的不适感以及管理不同的小组动态。我们概述了医疗机构中以小组为基础的活动的功效和动态。这包括小组的关键行为要素,例如在小组活动中创造一个安全、支持和团结的环境,同时将保密性放在首位。通过认识小组和主持人行为的原则,个人更有可能最大限度地发挥这些干预措施的潜力。
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引用次数: 0
Nutritional Supplements for Healthy Aging: A Critical Analysis Review 促进健康老龄化的营养补充剂:批判性分析评论
IF 1.9 Q2 Medicine Pub Date : 2024-04-09 DOI: 10.1177/15598276241244725
Matthew W. Kaufman, Sarah DeParis, Marily Oppezzo, Cheri Mah, Megan Roche, Levi Frehlich, Michael Fredericson
Background: Healthy aging is defined as survival to advanced age while retaining autonomy in activities of daily living, high societal participation, and good quality of life. Sarcopenia, insomnia, cognitive impairment, and changes in sensation can be key hinderances to healthy aging, but nutritional supplements may abate their impact. As research advances, an updated review on their efficacy on age-related conditions is warranted. Results: Sarcopenia can be mitigated through proper protein intake, supplements like creatine, and in certain situations Branched-Chain Amino Acids and Vitamin D, in adults over 65. Melatonin supplementation has moderate evidence for improving sleep, while valerian root lacks evidence. Magnesium, tart cherry, and kiwifruits have shown promising impacts on sleep in limited articles. Magnesium, Vitamin D, and B vitamin supplementation have been shown to improve cognition in those with mild cognitive impairment and Alzheimer’s disease but require further study prior to recommendation. The Age-Related Eye Disease Study supplement combination is routinely recommended to reduce risk of progression to advance stages of age-related macular degeneration. Alpha-Lipoic Acid and Folate have been investigated for their roles in mitigating age-related hearing losses. Conclusions: Nutritional supplements and lifestyle changes may mitigate disabilities across multiple domains of age-related illnesses and promote healthy aging.
背景:健康老龄化的定义是,在保持日常生活自理能力、较高的社会参与度和良好的生活质量的同时,还能存活到晚年。肌肉疏松症、失眠、认知障碍和感觉变化可能是阻碍健康老龄化的主要因素,但营养补充剂可以减轻它们的影响。随着研究的不断深入,有必要对营养补充剂对老年相关疾病的疗效进行最新评述。结果:对于 65 岁以上的成年人来说,通过摄入适当的蛋白质、肌酸等营养补充剂,以及在某些情况下补充支链氨基酸和维生素 D,可以缓解 "肌肉疏松症"。褪黑素补充剂在改善睡眠方面有中等程度的证据,而缬草根则缺乏证据。在有限的文章中,镁、酸樱桃和猕猴桃对睡眠有良好的影响。镁、维生素 D 和 B 族维生素补充剂已被证明可改善轻度认知障碍和阿尔茨海默氏症患者的认知能力,但在推荐之前还需要进一步研究。老年性眼病研究》常规推荐补充剂组合,以降低老年性黄斑变性发展到晚期的风险。阿尔法硫辛酸和叶酸在减轻老年性听力损失方面的作用已得到研究。结论营养补充剂和生活方式的改变可减轻多种老年相关疾病的残疾,促进健康老龄化。
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引用次数: 0
From the President's Desk: The Strategic Plan for the American College of Lifestyle Medicine 2024-2026. 来自主席台:美国生活方式医学学院 2024-2026 年战略计划》。
IF 1.9 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-04-05 DOI: 10.1177/15598276241242349
Beth Frates
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引用次数: 0
Impact of Lifestyle Medicine Interventions on the Management of Systemic Hypertension in Primary Care: A Canadian Randomized Controlled Trial 生活方式医学干预对基层医疗机构系统性高血压管理的影响:加拿大随机对照试验
IF 1.9 Q2 Medicine Pub Date : 2024-04-04 DOI: 10.1177/15598276241242013
Elisa Marin-Couture, Julie-Alexandra Moulin, Anne-Sophie Thibault, Paul Poirier, Jean-Pierre Després, Anette Gallant, Vincent Lamarre, Natalie Alméras, Isabelle Lemieux, Christian Chabot, Maria-Cecilia Gallani, Marie-Eve Piché, Benoit J. Arsenault, Angelo Tremblay, Jean-Sébastien Paquette, Caroline Rhéaume
The study aimed to evaluate the feasibility of implementing lifestyle interventions in primary care settings with hypertensive patients and their effect on blood pressure, body composition, cardiometabolic markers, and antihypertensive drug use. Sixty participants diagnosed with stage 1 hypertension were randomly assigned to 4 groups: (1) Standard medical care (control), (2) Physical activity protocol, (3) Dietary Approach to Stop Hypertension (DASH) diet, and (4) Combination of physical activity protocol and DASH diet. Participants received counseling from family physicians, nurses, kinesiologists, and registered dietitians. Various assessments were conducted before (T0) and after (T6) the interventions, including 24-h ambulatory blood pressure monitoring, blood and urine tests, anthropometric measurements, computed tomography to measure adipose tissue, submaximal exercise test to estimate maximal oxygen consumption and health questionnaires. Fifty-one (51) participants (51/57, 89%) completed the program. All interventions reduced blood pressure indices between T0 and T6, except the combined interventions group. Body composition and cardiometabolic parameters were improved in all groups, except for the control group. In total, 28% of participants (7/23) reduced or stopped their antihypertensive medications at T6. The results suggest that structured lifestyle interventions are feasible in primary care and improve blood pressure and cardiometabolic parameters in patients with stage 1 hypertension.
该研究旨在评估在基层医疗机构对高血压患者实施生活方式干预的可行性及其对血压、身体成分、心脏代谢指标和降压药物使用的影响。60 名确诊为高血压 1 期的参与者被随机分配到 4 个小组:(1)标准医疗护理(对照组);(2)体育锻炼方案;(3)饮食疗法(DASH);(4)体育锻炼方案和饮食疗法(DASH)组合。参与者接受了家庭医生、护士、运动师和注册营养师的咨询。在干预前(T0)和干预后(T6)进行了各种评估,包括 24 小时动态血压监测、血液和尿液化验、人体测量、计算机断层扫描测量脂肪组织、亚极限运动测试估算最大耗氧量以及健康问卷调查。51名参与者(51/57,89%)完成了计划。除综合干预组外,所有干预措施都降低了 T0 和 T6 之间的血压指数。除对照组外,所有干预组的身体成分和心脏代谢指标均有所改善。在 T6 阶段,共有 28% 的参与者(7/23)减少或停止了降压药的服用。结果表明,结构化生活方式干预在初级保健中是可行的,并能改善一期高血压患者的血压和心脏代谢指标。
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引用次数: 0
Lifestyle Medicine Approach to Wound Management 伤口管理的生活方式医学方法
IF 1.9 Q2 Medicine Pub Date : 2024-04-04 DOI: 10.1177/15598276241242026
Jengyu Lai
Chronic wounds impact 4.5% of the US population, necessitating a comprehensive understanding of their types and underlying mechanisms. Diabetic foot ulcers (DFUs), prevalent in 25% of individuals with diabetes, contribute significantly to lower limb amputations. The pathophysiology involves neuropathy, peripheral arterial disease, impaired immunity, glycemic control, and mechanical stress. Lifestyle medicine emerges as a pivotal aspect of care, offering both prevention and treatment by integrating plant-predominant nutrition, physical activity, stress management, avoidance of harmful substances, restful sleep, and social connectedness. These interventions impact gene interactions, immune function, and tissue regeneration, playing a crucial role in chronic wound management. The standard of care involves a multidisciplinary approach, emphasizing infection and vascular management, pressure offloading, conducive wound healing environments, and lifestyle adjustments. As diabetes prevalence rises, a proactive integration of lifestyle interventions is crucial, offering a promising avenue to alleviate the growing healthcare burden associated with chronic wounds.
慢性伤口影响着 4.5% 的美国人口,因此有必要全面了解其类型和潜在机制。糖尿病足溃疡(DFUs)在 25% 的糖尿病患者中普遍存在,是导致下肢截肢的重要原因。其病理生理学涉及神经病变、外周动脉疾病、免疫受损、血糖控制和机械应力。生活方式医学是护理的一个重要方面,它通过整合以植物为主的营养、体育锻炼、压力管理、避免有害物质、充足睡眠和社会联系,提供预防和治疗。这些干预措施会影响基因相互作用、免疫功能和组织再生,在慢性伤口管理中发挥着至关重要的作用。护理标准涉及多学科方法,强调感染和血管管理、压力卸载、有利伤口愈合的环境以及生活方式调整。随着糖尿病患病率的上升,积极整合生活方式干预措施至关重要,这为减轻与慢性伤口相关的日益沉重的医疗负担提供了一条大有可为的途径。
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引用次数: 0
Lifestyle Medicine’s Role in Common Hormonal Disorders: A Case-Based Discussion 生活方式医学在常见荷尔蒙紊乱中的作用:基于病例的讨论
IF 1.9 Q2 Medicine Pub Date : 2024-04-04 DOI: 10.1177/15598276241242012
Mahima Gulati
Hormonal disorders like PCOS (Polycystic Ovary Syndrome), autoimmune thyroid disease (AITD) including Hashimoto’s thyroiditis, male hypogonadism are commonly encountered in clinical practice in the US and worldwide, with rising frequency. These typically affect patients during young or middle age, compared with other common chronic illnesses like type 2 diabetes, hypertension, atherosclerotic cardiovascular disease, where onset may usually be in middle or older age. Multiple studies point to the role of disordered lifestyle health behaviors as contributory to these endocrinopathies, and conversely therapeutic lifestyle changes leading to improvement in signs, symptoms, biochemical markers, and sequelae of these conditions. This article presents 3 different real life case studies of the conditions enlisted above and documents the positive impact of lifestyle improvements on their disease condition. Therapeutic lifestyle behaviors are an extremely useful and important component of management of these familiar endocrinologic disorders, and clinicians need to routinely counsel their patients about healthy lifestyle interventions when treating these common syndromes.
多囊卵巢综合症(PCOS)、自身免疫性甲状腺疾病(AITD)(包括桥本氏甲状腺炎)、男性性腺功能减退症等荷尔蒙紊乱疾病在美国和全球的临床实践中都很常见,而且发病率越来越高。与2型糖尿病、高血压、动脉粥样硬化性心血管疾病等其他常见慢性疾病相比,这些疾病的患者通常在中青年时期发病。多项研究指出,紊乱的生活方式和健康行为是导致这些内分泌疾病的原因,反之,改变生活方式可改善这些疾病的体征、症状、生化指标和后遗症。本文介绍了上述病症的 3 个不同的真实案例研究,并记录了改善生活方式对疾病状况的积极影响。治疗性生活方式行为是治疗这些人们熟悉的内分泌失调症的一个非常有用和重要的组成部分,临床医生在治疗这些常见综合征时,需要对患者进行健康生活方式干预方面的常规咨询。
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引用次数: 0
Empowering Medical Students: Unveiling the Benefits of Nutrition Seminars and Plant-Based Diets in Medical School Education 增强医科学生的能力:揭示营养研讨会和植物膳食在医学院教育中的益处
IF 1.9 Q2 Medicine Pub Date : 2024-04-03 DOI: 10.1177/15598276241242732
Fanny Huang, Deena Sukhon, Jessica R. Cummings, Nikita Lee, Elizabeth Carlson, Michelle Jankowski, Virginia Uhley
Background: Whole-food, plant-based (WFPB) dietary patterns can be used as a lifestyle modification to lower blood pressure and lose weight. This study aimed to observe the effects of WFPB dietary patterns and improve nutrition education in medical school. Methods: Forty-six medical students participated in the four-week Plant Plunge challenge, which consisted of a pre- and post-challenge health screening, weekly nutrition seminars, and the personal challenge to eat more WFPB. Afterward, an anonymous survey was sent to participants to analyze nutrition education quality in medical school. Results: The Wilcoxon Signed Rank test indicated statistically significant improvement in weight and blood pressure (BP) (N = 33). The median (interquartile range) difference in weight from pre- to post- was −.9 (−2.2, .0, P < .0461) pounds, whereas the differences in systolic and diastolic BP were −5.0 (−9.0, −.5, P < .049) and −7.0 (−11.0, −2.0, P < .0037) mmHg, respectively. Participants were significantly more likely to advocate for the integration of nutrition information into the medical school curriculum ( P = .0162). Conclusions: Short-term lifestyle modifications with WFPB dietary patterns help reduce weight and BP. Incorporating nutrition seminars in medical education may improve long-term patient outcomes.
背景:全食物、植物性(WFPB)膳食模式可作为生活方式的一种调整,用于降低血压和减轻体重。本研究旨在观察 WFPB 饮食模式的效果,并改善医学院的营养教育。研究方法46 名医科学生参加了为期四周的 "植物大跃进 "挑战,其中包括挑战前和挑战后的健康检查、每周一次的营养研讨会以及吃更多 WFPB 的个人挑战。之后,我们向参与者发送了一份匿名调查,以分析医学院的营养教育质量。调查结果显示Wilcoxon Signed Rank 检验表明,体重和血压(BP)的改善具有统计学意义(N = 33)。前后体重差异的中位数(四分位数间距)为-.9(-2.2,.0,P < .0461)磅,而收缩压和舒张压的差异分别为-5.0(-9.0,-.5,P < .049)和-7.0(-11.0,-2.0,P < .0037)毫米汞柱。参与者更倾向于主张将营养信息纳入医学院课程 ( P = .0162)。结论:采用 WFPB 饮食模式进行短期生活方式调整有助于减轻体重和降低血压。在医学教育中纳入营养讲座可改善患者的长期治疗效果。
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引用次数: 0
Prevalence of Vegetarianism and Lifestyle Correlates in a National Study 一项全国性研究中的素食主义流行率和生活方式相关因素
IF 1.9 Q2 Medicine Pub Date : 2024-04-03 DOI: 10.1177/15598276241243296
Shelly S. Bakst, Dolev Karolinsky
Introduction: Vegetarianism in its various forms has gained global recognition in part because of the notion that it is healthier; however, associations between plant-based diets and selected lifestyle practices in Israel have yet to be clarified. Methods: A population-based sample consisting of 1396 Israeli adults was collected via telephone survey, between the years 2013-2014. Differentiation between self-defined and actual vegetarians was initially verified (based on food intake). Next, “actual” vegetarian status was studied in relation to demographics and health behaviors. Results: Approximately 5% (N = 65) of respondents (5.8% Jews and 3.0% Arabs) were “self-defined” vegetarians; but only about half (N = 33) adhered to genuine vegetarian diets. By contrast, nearly 2% (N = 26) of those self-identified as non-vegetarians were “actual” vegetarians; thus, 4.4% (N = 59) of the sample were verified “vegetarians.” And while socio-demographic features did not meaningfully capture differences by vegetarianism status, “actual” vegetarians were significantly more likely than non-vegetarians to be physically active (OR = 1.7), use nutritive supplements (OR = 2.4) and read food product labels (OR = 1.9; all P < .01). Conclusions: Aggregately, “actual” vegetarian participants were more inclined to have healthier lifestyle practices relative to their non-vegetarian counterparts. Forthcoming research using larger samples should however exploit constant assessment measures to validate the link between vegetarianism and health-promoting correlates.
导言:各种形式的素食主义在全球范围内得到认可,部分原因是素食主义更健康;然而,在以色列,以植物为基础的饮食与特定生活方式之间的关系尚待澄清。研究方法通过电话调查收集了 2013-2014 年间 1396 名以色列成年人的人口样本。首先核实了自我定义的素食者和实际素食者之间的区别(基于食物摄入量)。接下来,研究了 "实际 "素食者身份与人口统计学和健康行为的关系。研究结果约 5%(N = 65)的受访者(5.8% 犹太人和 3.0% 阿拉伯人)是 "自我定义的 "素食者;但只有约一半(N = 33)的受访者坚持真正的素食。相比之下,近 2%(N = 26)自我认定为非素食者的人是 "真正的 "素食者;因此,样本中有 4.4%(N = 59)是经过验证的 "素食者"。虽然社会人口学特征不能有效反映素食者身份的差异,但 "实际 "素食者比非素食者更有可能参加体育锻炼(OR = 1.7)、使用营养补充剂(OR = 2.4)和阅读食品标签(OR = 1.9;均为 P < .01)。结论总体而言,"实际 "素食者比非素食者更倾向于采用更健康的生活方式。不过,即将进行的研究应使用更大的样本,利用恒定的评估措施来验证素食主义与促进健康的相关因素之间的联系。
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引用次数: 0
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American Journal of Lifestyle Medicine
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