Fatalities due to dichloromethane in paint strippers: a continuing problem.

BACKGROUND: Exposure to dichloromethane (DCM or methylene chloride - CH2 Cl2 ) in paint strippers continues to be an avoidable source of morbidity and mortality. DCM has been under regulatory scrutiny by occupational and consumer product agencies since the identification of its carcinogenicity in the mid-1980s. METHODS: We investigated two independent workplace incidents that resulted in three cases of DCM intoxication from paint stripper use. RESULTS: Each incident investigated resulted in a fatality. A third worker suffered obtundation requiring hospitalization and intubation. CONCLUSIONS: The continued occurrence of fatalities and other serious injuries due to DCM-containing paint strippers in the United States calls for a re-evaluation of existing regulatory strategies.

Positive psychology in health care: defining key stakeholders and their roles.

Lifestyle-related diseases have common risk factors: physical inactivity, poor diet, inadequate sleep, high stress, substance use, and social isolation. Evidence is mounting for the benefits of incorporating effective methods that promote healthy lifestyle habits into routine health care treatments. Research has established that healthy habits foster psychological and physiological health and that emotional well-being is central to achieving total well-being. The Happiness Science and Positive Health Committee of the American College of Lifestyle Medicine aims to raise awareness about strategies for prioritizing emotional well-being. The Committee advocates for collaborative translational research to adapt the positive psychology and behavioral medicine evidence base into methodologies that address emotional well-being in nonmental health care settings. Another aim is to promote health system changes that integrate evidence-based positive-psychology interventions into health maintenance and treatment plans. Also, the Committee seeks to ameliorate health provider burnout through the application of positive psychology methods for providers' personal health. The American College of Lifestyle Medicine and Dell Medical School held an inaugural Summit on Happiness Science in Health Care in May 2018. The Summit participants recommended research, policy, and practice innovations to promote total well-being via lifestyle changes that bolster emotional well-being. These recommendations urge stakeholder collaboration to facilitate translational research for health care settings and to standardize terms, measures, and clinical approaches for implementing positive psychology interventions. Sample aims of joint collaboration include developing evidence-based, practical, low-cost behavioral and emotional assessment and monitoring tools; grants to encourage dissemination of pilot initiatives; medical record dashboards with emotional well-being and related aspects of mental health as vital signs; clinical best practices for health care teams; and automated behavioral programs to extend clinician time. However, a few simple steps for prioritizing emotional well-being can be implemented by stakeholders in the near-term.

Community-Engaged Lifestyle Medicine as a Framework for Health Equity: Principles for Lifestyle Medicine in Low-Resource Settings.

Lifestyle risk factors, including tobacco and alcohol use, poor nutrition, and inactivity, comprise the leading actual causes of death and disproportionately affect diverse, lower-income and vulnerable populations. Fundamentally influenced by social determinants of health (including poverty, social linkages, food access, and built environment), these "unhealthy lifestyle" exposures perpetuate and sustain disparities in health outcomes, stealing years of healthy and productive life for minority, vulnerable groups. The authors call for implementation of a health equity framework within lifestyle medicine (LM). Community-engaged lifestyle medicine (CELM) is an evidence-based, participatory framework capable of addressing health disparities through LM, targeting health equity in addition to better health. CELM was developed in 2015 by the University of Texas Rio Grande Valley (UTRGV) Preventive Medicine Residency program to address lifestyle-related health disparities within marginalized border communities. The framework includes the following evidence-based principles: community engagement, cultural competency, and application of multilevel and intersectoral approaches. The rationale for each of these components and the growth of CELM within the American College of Lifestyle Medicine is described. Finally, illustrative examples are provided for how CELM can be instituted at micro and macro levels by LM practitioners.

Reforming Women's Health Care: A Call to Action for Lifestyle Medicine Practitioners to Save Lives of Mothers and Infants.

Maternal and infant mortality are fundamental indicators of a society's health and wellness. These measures depict a health crisis in the United States. Compared with other rich countries, women in the United States more frequently die from pregnancy or childbirth, and infants are less likely to survive to their first birthday. Most of these deaths are preventable; disproportionately affect diverse, low-income groups; and are perpetuated by social and health care inequities and subpar preventive care. Lifestyle medicine (LM) is uniquely positioned to ameliorate this growing crisis. The article presents key prescriptions for LM practitioners to build health and health equity for women. These prescriptions, summarized by the acronym PURER, include action in the areas of (1) practice, (2) understanding/empathy, (3) reform, (4) empowerment, and (5) relationship health. The PURER approach focuses on partnering with diverse female patients to promote resilience, promoting social connection and engagement, facilitating optimal family planning and advocating for culturally responsive, equitable health care systems. Through PURER, LM practitioners can help women and partners resiliently overcome the harmful challenges of discrimination and stress characterizing present-day American life. Over time, the equitable and collective practice of LM can help ameliorate the health care barriers undermining the health of women, families, and society.

Positive Psychology in Lifestyle Medicine and Health Care: Strategies for Implementation.

Prevention and treatment of lifestyle-related diseases are realized through leading a healthy lifestyle. Activities supporting positive psychology can facilitate healthy behaviors and improve physiological health. Adding such activities to clinical care promotes attainment of the physical, social, and emotional elements of health, as defined by the World Health Organization-leading to (1) prolonged lifespan and quality of life, (2) lowered costs of care, and (3) reduced rates of provider burnout. A key challenge remains the translation of positive psychology-based practices into practical, implementable strategies by health care providers. An essential step is collaboration of positive psychology and health care researchers and practitioners to develop standards, terms, and measures and arrive at evidence-based clinical approaches addressing total well-being. The first Summit on Happiness Science in Healthcare enabled national experts and stakeholders in lifestyle medicine, medical education, health care administration, psychology, and community welfare to convene and identify best practices for practical implementation of positive psychology science into health care. This article draws on the summit discussions to address the gap between positive psychology theory and practical implementation in health care. We briefly summarize the positive psychology-health outcomes relationship and present key strategies needed to bridge this gap.

Biopsychosocial determinants of opioid use disorder (OUD) and implications for maternal and child health research: A scoping review.

BACKGROUND: Opioid use disorder (OUD) is on the rise among women of reproductive age in the United States, contributing to a marked increase in the incidence of adverse consequences on maternal and child health (MCH). There is a dearth of literature on the biopsychosocial determinants of OUD in MCH populations and their role in the current opioid epidemic. The aim of this study is to examine the epidemiology of OUD in the United States and develop a biopsychosocial research model of OUD among women of reproductive age. METHODS: Utilizing a scoping review methodology, a systematic search strategy was implemented using MEDLINE/PubMed, Integrated Library searches, and Google Scholar. Scholarly/peer-reviewed articles published up to July 2017, in English, and restricted to populations in the United States were eligible for inclusion. A qualitative synthesis of the selected studies was performed to summarize study findings. RESULTS: Multiple factors play a role at every level of the biopsychosocial model (BPSM) in OUD-from molecular (genetic, epigenetic), cellular-tissue, organ system, the person (psycho-affective, cognitive, and behavioral), to relation-ship-based (family, peers), community environment, healthcare-related, and policy levels. CONCLUSION: Important research gaps persist at every level and highlight the need for multiple-level biopsychosocial research to enhance our understanding of the nature, extent, distribution, etiology, and consequences of OUD among women of reproductive age. Our biopsychosocial model of OUD can be used to guide innovative MCH epidemiology research.

Health insurance literacy and awareness of the Affordable Care Act in a vulnerable Hispanic population.

OBJECTIVE: The Patient Protection and Affordable Care Act (ACA) has allowed millions of Americans to obtain coverage. However, many, especially minorities, remain uninsured. With mounting evidence supporting the importance of health insurance literacy (HIL), the purpose of this cross-sectional study is to examine the association between HIL and ACA knowledge. METHODS: We conducted 681 in-person interviews with participants at a community health event along the Texas-Mexico border in 2015, after the conclusion of the ACA's second enrollment period. To assess HIL, we used the Health Insurance Literacy Measure, reflecting consumers' confidence to choose, compare, and use health insurance. We assessed ACA knowledge through the following question: "How much would you say you know about this health reform law?" Logistic regression was used to examine the association between HIL and ACA knowledge after controlling for several covariates. RESULTS: Almost 70% of participants knew nothing/very little about the ACA. Multivariate analyses revealed that no/very little ACA knowledge was associated with low levels of confidence "choosing health insurance plans" (OR:0.55; 95%CI:0.40-0.75) (full sample) and "comparing plans" (OR:0.56; 95%CI:0.32-0.96) (U.S.-born sub-sample). CONCLUSION: No/little ACA knowledge is associated with lower levels of HIL. PRACTICE IMPLICATIONS: Promoting HIL is an essential step towards improving healthcare access.

Community-Engaged Lifestyle Medicine: Building Health Equity Through Preventive Medicine Residency Training.

Vulnerable populations in the U.S. experience persistent disparities in chronic disease and associated lifestyle-based risk factors. Because of environmental, cultural, and health systems barriers affecting vulnerable populations, lifestyle medicine interventions may miss those at highest risk for chronic disease. Numerous reports suggest that graduate medical education (GME) inadequately prepares physicians to promote healthy lifestyles and health equity in vulnerable groups. General Preventive Medicine/Public Health (GPM/PH), the medical specialty dedicated to health promotion and disease prevention in populations, can fill this gap. However, virtually no published reports describe health equity-oriented GPM/PH residency programs. The authors describe implementation of the novel Community-Engaged Lifestyle Medicine at the University of Texas Rio Grande Valley GPM/PH residency program between 2017 and 2018. Community-Engaged Lifestyle Medicine applies community engagement principles to lifestyle medicine practice, training residents in multilevel, intersectoral approaches promoting behavior change and health equity. Community-Engaged Lifestyle Medicine is described in the context of health equity and the local border community, along with associated curricular objectives and experiences. In 2017, the authors assessed first-year Community-Engaged Lifestyle Medicine process outcomes, fidelity to health equity mechanisms, and feasibility in a GPM/PH residency, by mapping Community-Engaged Lifestyle Medicine activities to American Council of Graduate Medical Education and the American College of Lifestyle Medicine competencies. The Community-Engaged Lifestyle Medicine framework was successfully implemented in 2017, meets all American Council of Graduate Medical Education competency domains, and demonstrates fidelity to mechanisms of community engagement, health equity, and the practice of lifestyle medicine. Community-Engaged Lifestyle Medicine represents a feasible and valid framework to promote health equity via GPM/PH and GME training and practice.

Community-engaged interventions on diet, activity, and weight outcomes in U.S. schools: a systematic review.

CONTEXT: Community engagement literature suggests that capacity-building approaches and community partnership in health intervention design, delivery, and analysis improve outcomes. School communities influence childhood diet and activity patterns affecting lifelong obesity risk. This systematic review's purpose is to assess whether incorporating community engagement principles in school-based interventions influences weight-related outcomes. EVIDENCE ACQUISITION: Obesity-prevention interventions (published January 2000-2011) in diverse U.S. schools, meeting a minimum threshold of community engagement and targeting weight-, diet- or activity-related outcomes were identified in MEDLINE, PsycINFO, and CINAHL (December 2010-March 2011). Two reviewers scored community engagement performance on 24 metrics of capacity building and partner involvement along four research stages. Outcome performance was calculated as percentage of targeted primary and/or secondary outcomes achieved. EVIDENCE SYNTHESIS: Sixteen studies were included, targeting anthropometric (n = 12); dietary (n = 13); and activity (n = 10) outcomes in schoolchildren (mean age=10.7 years). Studies averaged 46% of targeted outcomes (95% CI = 0.33, 0.60) and met 60% of community engagement metrics. Positive correlations existed between community engagement performance and all-outcome performance (r = 0.66, 95% CI = 0.25, 0.87) and secondary-outcome performance (r = 0.67, 95% CI = 0.22, 0.89), but not primary-outcome performance (r = 0.26, 95% CI = -0.27, 0.67). Number of outcomes met was not correlated with number of outcomes targeted, number of partners, or study size. Specific qualitative and quantitative trends suggested that capacity-building efforts, engagement in needs assessments and results dissemination, and durable partnerships positively influence outcomes. CONCLUSIONS: Results suggest that meaningful partnership of diverse school communities within obesity prevention interventions can improve health outcomes.