A Retrospective Chart Review Suggests That Coordinated, Multidisciplinary Treatment for Patients with Anorexia Nervosa Improves Odds of Weight Restoration.

Purpose: The objective of this study was to conduct a secondary data analysis of clinical information documented in the electronic medical record to assess the clinical outcomes of patients who received three different treatment approaches on clinical outcomes for treatment of patients with anorexia nervosa (AN). Patients and methods: Historical electronic medical record (EMR) data on patients aged 6 to 80 years diagnosed with AN seen in a healthcare system between 2007 and 2017 were stratified, according to services received, into three groups: Group A (n = 48) received hospital-based services; Group B (n = 290) saw one or two provider types; Group C (n = 26) received outpatient coordinated multidisciplinary care from three provider types. Clinical outcomes [body mass index for adults (BMI), body mass index percentile (BMI%ile) for pediatric patients] defined AN severity and weight restoration. EMR data were analyzed using a generalized mixed-effects model and a Markov Transition model to examine the odds of weight restoration and the change in odds of weight restoration across the number of provider visits, respectively. Results: Patients receiving coordinated multidisciplinary care had significantly higher odds of weight restoration compared with patients receiving hospital-based services only (OR = 3.76, 95% CI [1.04, 13.54], p = 0.042). In addition, patients receiving care from 1 to 2 providers (OR = 1.006, 95% CI [1.003, 1.010], p = 0.001) or receiving coordinated multidisciplinary care (OR = 1.005, 95% CI [1.001, 1.011], p = 0.021) had significantly higher odds of weight restoration per provider visit day compared with patients receiving hospital-based services only. Conclusion: This retrospective chart review supports the coordinated, multidisciplinary care model for the weight restoration in patients with AN in an outpatient setting.

Sexual Violence in Sport: Expanding Awareness and Knowledge for Sports Medicine Providers.

ABSTRACT: Athletes are vulnerable to sexual violence. Perpetrators of sexual violence may be a trusted coach, a member of the health care team, or a peer. The consequences of sexual violence are wide ranging, resulting in immediate and long-term physical and mental health outcomes that require recognition and comprehensive, multidisciplinary care. Sports medicine providers need to have specific knowledge and skill to care for athletes who experience sexual violence. Several sports organizations (e.g., International Olympic Committee, United States Olympic and Paralympic Committee, the National Collegiate Athletic Association, and the National Athletic Trainers' Association) have developed policies and procedures to prevent sexual violence and help sports medicine specialists provide care and services for athletes affected by sexual violence. Nevertheless, there remains a need for clinical guidelines, screening tools, and education, as well as clinical best practices to address sexual violence in sports medicine.

Sexual violence in sport: American Medical Society for Sports Medicine Position Statement.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the Task Force used an iterative process and expert consensus to finalise the Position Statement. The objective of this Position Statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.

Measuring Adherence to U.S. Preventive Services Task Force Diabetes Prevention Guidelines Within Two Healthcare Systems.

ABSTRACT: Measuring adherence to the 2015 U.S. Preventive Services Task Force (USPSTF) diabetes prevention guidelines can inform implementation efforts to prevent or delay Type 2 diabetes. A retrospective cohort was used to study patients without a diagnosis of diabetes attributed to primary care clinics within two large healthcare systems in our state to study adherence to the following: (1) screening at-risk patients and (2) referring individuals with confirmed prediabetes to participate in an intensive behavioral counseling intervention, defined as a Center for Disease Control and Prevention (CDC)-recognized Diabetes Prevention Program (DPP). Among 461,866 adults attributed to 79 primary care clinics, 45.7% of patients were screened, yet variability at the level of the clinic ranged from 14.5% to 83.2%. Very few patients participated in a CDC-recognized DPP (0.52%; range 0%-3.53%). These findings support the importance of a systematic implementation strategy to specifically target barriers to diabetes prevention screening and referral to treatment.

Sexual Violence in Sport: American Medical Society for Sports Medicine Position Statement.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a position statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the position statement. The objective of this position statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.

Sexual Violence in Sport: American Medical Society for Sports Medicine Position Statement.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the position statement. The objective of this position statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.

Sexual Violence in Sport: American Medical Society for Sports Medicine Position Statement.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the Position Statement. The objective of this Position Statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.

Routine Assessment and Promotion of Physical Activity in Healthcare Settings: A Scientific Statement From the American Heart Association.

Physical inactivity is one of the most prevalent major health risk factors, with 8 in 10 US adults not meeting aerobic and muscle-strengthening guidelines, and is associated with a high burden of cardiovascular disease. Improving and maintaining recommended levels of physical activity leads to reductions in metabolic, hemodynamic, functional, body composition, and epigenetic risk factors for noncommunicable chronic diseases. Physical activity also has a significant role, in many cases comparable or superior to drug interventions, in the prevention and management of >40 conditions such as diabetes mellitus, cancer, cardiovascular disease, obesity, depression, Alzheimer disease, and arthritis. Whereas most of the modifiable cardiovascular disease risk factors included in the American Heart Association's My Life Check - Life's Simple 7 are evaluated routinely in clinical practice (glucose and lipid profiles, blood pressure, obesity, and smoking), physical activity is typically not assessed. The purpose of this statement is to provide a comprehensive review of the evidence on the feasibility, validity, and effectiveness of assessing and promoting physical activity in healthcare settings for adult patients. It also adds concrete recommendations for healthcare systems, clinical and community care providers, fitness professionals, the technology industry, and other stakeholders in order to catalyze increased adoption of physical activity assessment and promotion in healthcare settings and to contribute to meeting the American Heart Association's 2020 Impact Goals.

Short-Term Elevation of Fine Particulate Matter Air Pollution and Acute Lower Respiratory Infection.

RATIONALE: Nearly 60% of U.S. children live in counties with particulate matter less than or equal to 2.5 µm in aerodynamic diameter (PM2.5) concentrations above air quality standards. Understanding the relationship between ambient air pollution exposure and health outcomes informs actions to reduce exposure and disease risk. OBJECTIVES: To evaluate the association between ambient PM2.5 levels and healthcare encounters for acute lower respiratory infection (ALRI). METHODS: Using an observational case-crossover design, subjects (n = 146,397) were studied if they had an ALRI diagnosis and resided on Utah's Wasatch Front. PM2.5 air pollution concentrations were measured using community-based air quality monitors between 1999 and 2016. Odds ratios for ALRI healthcare encounters were calculated after stratification by ages 0-2, 3-17, and 18 or more years. MEASUREMENTS AND MAIN RESULTS: Approximately 77% (n = 112,467) of subjects were 0-2 years of age. The odds of ALRI encounter for these young children increased within 1 week of elevated PM2.5 and peaked after 3 weeks with a cumulative 28-day odds ratio of 1.15 per +10 µg/m3 (95% confidence interval, 1.12-1.19). ALRI encounters with diagnosed and laboratory-confirmed respiratory syncytial virus and influenza increased following elevated ambient PM2.5 levels. Similar elevated odds for ALRI were also observed for older children, although the number of events and precision of estimates were much lower. CONCLUSIONS: In this large sample of urban/suburban patients, short-term exposure to elevated PM2.5 air pollution was associated with greater healthcare use for ALRI in young children, older children, and adults. Further exploration is needed of causal interactions between PM2.5 and ALRI.

Stepping Back to Move Forward: Evaluating the Effectiveness of a Diabetes Prevention Program Within a Large Integrated Healthcare Delivery System.

OBJECTIVE: To evaluate the short-term effectiveness of the Intermountain Healthcare (IH) Diabetes Prevention Program (DPP) for patients with prediabetes (preDM) deployed within primary care clinics. STUDY DESIGN: A quasi-experimental study design was used to deploy the DPP within the IH system to identify patients with preDM and target a primary goal of a 5% weight loss within 6-12 months of enrollment. STUDY POPULATION: Adults (aged 18-75 years) who met the American Diabetes Association criteria for preDM were included for study. Patients who attended DPP counseling between August 2013 and July 2014 were considered as the intervention (or DPP) group. The DPP group was matched using propensity scores at a 1:4 ratio with a control group of patients with preDM who did not participate in DPP. RESULTS: Of the 17,142 patients who met the inclusion criteria for preDM, 40% had an in-person office visit with their provider. On average, patients were 58 years old, and greater than 60% were women. Based on multivariate logistic regression, the DPP group was more likely to achieve a 5% weight loss within 6-12 months after enrollment (OR = 1.70; 95% CI = 1.29-2.25; p < .001) when compared with the no-DPP group. CONCLUSIONS: Diabetes Prevention Program-based lifestyle interventions demonstrated significant reduction in body weight and incident Type 2 diabetes mellitus when compared with nonenrollees.

A Formative Evaluation of a Diabetes Prevention Program Using the RE-AIM Framework in a Learning Health Care System, Utah, 2013-2015.

INTRODUCTION: Evaluation of interventions can help to close the gap between research and practice but seldom takes place during implementation. Using the RE-AIM framework, we conducted a formative evaluation of the first year of the Intermountain Healthcare Diabetes Prevention Program (DPP). METHODS: Adult patients who met the criteria for prediabetes (HbA1c of 5.70%-6.49% or fasting plasma glucose of 100-125 mg/dL) were attributed to a primary care provider from August 1, 2013, through July 31, 2014. Physicians invited eligible patients to participate in the program during an office visit. We evaluated 1) reach, with data on patient eligibility, participation, and representativeness; 2) effectiveness, with data on attaining a 5% weight loss; 3) adoption, with data on providers and clinics that referred patients to the program; and 4) implementation, with data on patient encounters. We did not measure maintenance. RESULTS: Of the 6,862 prediabetes patients who had an in-person office visit with their provider, 8.4% of eligible patients enrolled. Likelihood of participation was higher among patients who were female, aged 70 years or older, or overweight; had depression and higher weight at study enrollment; or were prescribed metformin. DPP participants were more likely than nonparticipants to achieve a 5% weight loss (odds ratio, 1.70; 95% confidence interval, 1.29-2.25; P < .001). Providers from 7 of 8 regions referred patients to the DPP; 174 providers at 53 clinics enrolled patients. The mean number of DPP counseling encounters per patient was 2.3 (range, 1-16). CONCLUSION: The RE-AIM framework was useful for estimating the formative impact (ie, reach, effectiveness, adoption, and implementation fidelity) of a DPP-based lifestyle intervention deployed in a learning health care system.

Incidental Risk of Type 2 Diabetes Mellitus among Patients with Confirmed and Unconfirmed Prediabetes.

OBJECTIVE: To determine the risk of type 2 diabetes (T2DM) diagnosis among patients with confirmed and unconfirmed prediabetes (preDM) relative to an at-risk group receiving care from primary care physicians over a 5-year period. STUDY DESIGN: Utilizing data from the Intermountain Healthcare (IH) Enterprise Data Warehouse (EDW) from 2006-2013, we performed a prospective analysis using discrete survival analysis to estimate the time to diagnosis of T2DM among groups. POPULATION STUDIED: Adult patients who had at least one outpatient visit with a primary care physician during 2006-2008 at an IH clinic and subsequent visits through 2013. Patients were included for the study if they were (a) at-risk for diabetes (BMI ≥ 25 kg/m2 and one additional risk factor: high risk ethnicity, first degree relative with diabetes, elevated triglycerides or blood pressure, low HDL, diagnosis of gestational diabetes or polycystic ovarian syndrome, or birth of a baby weighing >9 lbs); or (b) confirmed preDM (HbA1c ≥ 5.7-6.49% or fasting blood glucose 100-125 mg/dL); or (c) unconfirmed preDM (documented fasting lipid panel and glucose 100-125 mg/dL on the same day). PRINCIPAL FINDINGS: Of the 33,838 patients who were eligible for study, 57.0% were considered at-risk, 38.4% had unconfirmed preDM, and 4.6% had confirmed preDM. Those with unconfirmed and confirmed preDM tended to be Caucasian and a greater proportion were obese compared to those at-risk for disease. Patients with unconfirmed and confirmed preDM tended to have more prevalent high blood pressure and depression as compared to the at-risk group. Based on the discrete survival analyses, patients with unconfirmed preDM and confirmed preDM were more likely to develop T2DM when compared to at-risk patients. CONCLUSIONS: Unconfirmed and confirmed preDM are strongly associated with the development of T2DM as compared to patients with only risk factors for disease.

Pre-exercise screening: role of the primary care physician.

Participation in regular physical activity is associated with a multitude of benefits including a reduction in chronic disease and premature mortality, and improved quality of life. All segments of society need to collaborate with one another in an effort to promote active lives. The Israeli "Gymnasium Law" requires pre-exercise evaluation prior to exercise participation in a health club. Recently that law was modified to allow for participant pre-screening with the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+). This change reflects the evidence that the risk of catastrophic events (e.g. heart attack) during moderate intensity physical activity is low, and the likelihood of detecting heart disease in asymptomatic adults is low. This change will likely reduce the number of individuals who require physician evaluation. The American College of Sports Medicine (ACSM) recently updated their recommendations for pre-exercise evaluation. The ACSM guidelines have replaced risk factor assessment, with an algorithm that first stratifies based on current physical activity level, then by the presence of chronic disease, and/or signs and symptoms of chronic disease, and last by desired exercise intensity. The goal of these efforts is to reduce barriers to regular physical activity, by eliminating unnecessary medical evaluations. All adults should be encouraged to be physically active.

Concurrent Validity of a Self-Reported Physical Activity "Vital Sign" Questionnaire With Adult Primary Care Patients.

INTRODUCTION: No tool currently used by primary health care providers to assess physical activity has been evaluated for its ability to determine whether or not patients achieve recommended levels of activity. The purpose of this study was to assess concurrent validity of physical activity self-reported to the brief (<30 sec) Physical Activity "Vital Sign" questionnaire (PAVS) compared with responses to the lengthier (3-5 min), validated Modifiable Activity Questionnaire (MAQ). METHODS: Agreement between activity reported to the PAVS and MAQ by primary care patients at 2 clinics in 2014 was assessed by using percentages and κ coefficients. Agreement consisted of meeting or not meeting the 2008 Aerobic Physical Activity Guidelines for Americans (PA Guidelines) of the US Department of Health and Human Services. We compared self-reported usual minutes per week of moderate-to-vigorous physical activity among patients at a primary care clinic in 2014 who reported to PAVS and to MAQ by using Pearson correlation and Bland-Altman plots of agreement. RESULTS: Among 269 consenting patients who reported physical activity, PAVS results agreed with those of MAQ 89.6% of the time and demonstrated good agreement in identifying patients who did not meet PA Guidelines recommendations (κ = 0.55, ρ = 0.57; P < .001). Usual minutes per week of moderate-to-vigorous physical activity reported to PAVS had a high positive correlation with the same reported to MAQ (r = 0.71; P < .001). CONCLUSION: PAVS may be a valid tool for identifying primary care patients who need counseling about physical activity. PAVS should be assessed further for agreement with repeated objective measures of physical activity in the patient population.

Predictive Validity of an Adult Physical Activity "Vital Sign" Recorded in Electronic Health Records.

BACKGROUND: Few have examined predictive relationships between physical activity (PA) and health using electronic health records (EHRs) of patient-reported PA. OBJECTIVE: Assess initial predictive validity of the Physical Activity "Vital Sign" (PAVS) recorded in EHRs with BMI and disease burden. METHODS: EHRs were from November 2011 to November 2013 (n = 34,712). Differences in not meeting Physical Activity Guidelines (PAG) were tested using chi-square analysis between being normal weight versus overweight/obese, and scoring below versus above the 50th percentile of the Charlson Comorbidity Index (CCI). Repeated measures logistic regression was used to determine odds of BMI and CCI classifications according to responses to the PAVS as not meeting PAG. RESULTS: Patients who did not meet PAG according to the PAVS were more likely than normal weight patients to have a higher BMI (BMI 25.0-29.9, OR = 1.19, P = .001; BMI 30.0-34.9, OR = 1.39, P < .0001; BMI 35.0-39.9, OR = 2.42, P < .0001; BMI ≥ 40, OR = 3.7, P < .0001) and also higher disease burden (above 50th percentile for CCI, OR = 1.8, P < .0001). CONCLUSIONS: The strong association of the PAVS found with patient BMI and moderately-strong association with disease burden supports initial predictive validity of the PAVS recorded in EHRs. PA recorded in EHRs may be vastly useful for assessing patient disease and cost burdens attributed independently to PA behavior.

Validity of two brief primary care physical activity questionnaires with accelerometry in clinic staff.

BACKGROUND: To date, no physical activity (PA) questionnaires intended for primary care have been compared against a criterion measure of PA and current (2008) aerobic PA recommendations of the American College of Sports Medicine/American Heart Association (ACSM/AHA). AIM: This study evaluated preliminary evidence for criterion validity of two brief (<1 min) PA questionnaires with accelerometry, and their ability to identify if individuals meet ACSM/AHA PA recommendations. METHODS: 45 health clinic staff wore an accelerometer for seven consecutive days and afterwards completed two brief PA questionnaires, the Physical Activity Vital Sign (PAVS), and the Speedy Nutrition and Physical Activity Assessment (SNAP). Agreement and descriptive statistics were calculated between the PAVS or SNAP and accelerometry in order to measure each questionnaire's ability to quantify the number of days participants achieved ⩾ 30 min of moderate-vigorous PA (MVPA) performed in bouts of ⩾ 10 continuous minutes. Participants with <5 days of ⩾ 30 bout-min of MVPA were considered insufficiently active according to PA recommendations. FINDINGS: There was a significant positive correlation between number of days with ⩾ 30 bout-min MVPA and the PAVS (r = 0.52, P < 0.001), and SNAP ( r= 0.31, P < 0.05). The PAVS had moderate agreement with accelerometry for identifying if individuals met or did not meet PA recommendations (κ = 0.46, P < 0.001), whereas SNAP had poor agreement (κ = 0.12, P < 0.05). CONCLUSIONS: This study provides preliminary evidence of criterion validity of the PAVS and SNAP with accelerometry and agreement identifying if respondents meet current (2008) ACSM/AHA aerobic PA recommendations. The PAVS and SNAP should be evaluated further for repeatability, and in populations varying in PA levels, age, gender, and ethnicity.