My Wellness Coach: evaluation of a mobile app designed to promote integrative health among underserved populations.

Underserved populations, including those from racial and ethnic groups and with low socioeconomic status, often lack access to mobile apps aimed at reducing health risk factors. This study evaluated the feasibility, acceptability, and preliminary effectiveness of the mobile app, My Wellness Coach (MWC), designed to promote behavior change in seven core areas of integrative health among underserved populations. Patients and staff were recruited from clinic and other settings. Some participants used MWC in a weekly group setting (n = 5); others on their own with support from a coordinator (n = 36). Health outcomes were assessed at baseline and 3 months. Mobile app ratings were collected at 5 weeks and 3 months. Goal setting data were analyzed at 3 months. Most participants (76%) set at least one goal, 71% created action steps for goals, and 29% completed a goal. Patients in the group setting had the highest rate of goal completion (60%) compared to patients (20%) and staff (27%) using the app on their own. Significant (p < .05) changes in pre- and post-test scores were documented for overall wellbeing, global physical health, BMI, vigorous physical activity, and eHealth literacy. Most participants (75%-91%) gave MWC high ratings for impact on behavior change, help seeking, intent to change, attitudes, knowledge, and awareness. This study documented preliminary evidence of the potential benefits of MWC among underserved communities. Future evaluations of Spanish and Android versions and comparisons between group and individual administration will inform implementation strategies for scaling MWC-based interventions to reach underserved communities nationally.

Many underserved populations, including those from diverse racial and ethnic groups and with low income, do not have access to mobile apps to improve health. This study examined whether using the My Wellness Coach (MWC) app was feasible, acceptable, and effective. MWC was designed to promote behavior change in integrative health (Movement, Nutrition, Spirituality, Resilience, Relationships, Sleep, and Environment) among underserved populations. Five participants used MWC in a group setting and 36 participants used MWC on their own with assistance from a coordinator. Participants completed surveys at the beginning of the study and 3 months later. Most participants (76%) set at least one health goal, 71% created action steps for goals, and 29% completed a goal. Participants who used MWC with the weekly group had the highest rate of goal completion (60%). Participants reported significant changes in wellbeing, physical health, body mass index, physical activity, and ability to find and understand electronic health information. Most participants (75%­91%) gave MWC positive ratings. This study provided evidence of the potential benefits of MWC among underserved communities. Future studies with Spanish and Android versions and comparisons between group and individual administration will inform strategies for expanding the reach of MWC-based interventions to underserved communities.

Mobile App Intervention on Reducing the Myeloproliferative Neoplasm Symptom Burden: Pilot Feasibility and Acceptability Study.

BACKGROUND: Myeloproliferative neoplasms (MPNs) are a group of myeloid malignancies associated with significant symptom burden. Despite pharmacological advances in therapies, inadequate management of MPN symptoms results in reduced quality of life. OBJECTIVE: This study aims to determine the feasibility of a 12-week global wellness mobile app intervention in decreasing MPN symptom burden. The University of Arizona Andrew Weil Center for Integrative Medicine's global wellness mobile app, My Wellness Coach (MWC), guides patients to improve their health and well-being through facilitating behavior changes. METHODS: Of the 30 patients enrolled in a 12-week intervention, 16 (53%) were retained through the final assessment. Feasibility was assessed by the ease of recruitment, participant adherence, and mobile app acceptability. App acceptability was measured using the user version of the Mobile Application Rating Scale. MPN symptom burden was measured at baseline and 12 weeks after the intervention. RESULTS: Recruitment was efficient, with the participant goal reached within a 60-day period, suggestive of a demand for such an intervention. Adherence was less than the target within study design (75%), although similar to mobile device app use in other studies (53%). The app was deemed acceptable based on the mean user version of the Mobile Application Rating Scale 3-star rating by participants. Finally, there were statistically significant improvements in several MPN symptoms, quality of life, and total score on the Myeloproliferative Neoplasm Symptom Assessment Form surveys. CONCLUSIONS: Our 12-week intervention with the MWC app was feasible and was associated with a decrease in MPN symptom burden. Further investigation of the MWC app for use as a self-management strategy to reduce the symptom burden in patients with MPN is warranted.

Well-being in Residency: Impact of an Online Physician Well-being Course on Resiliency and Burnout in Incoming Residents.

BACKGROUND AND OBJECTIVES: Wellness in residency has come to the forefront of national graduate medical education initiatives. Exponential growth in knowledge and skill development occurs under immense pressures, with physical, mental, and emotional stressors putting residents at burnout risk. The Accreditation Council for Graduate Medical Education requires programs to attend to resident wellness, providing the structure, environment, and resources to address burnout. This study's purpose was to evaluate the Andrew Weil Center for Integrative Medicine online Physician Well-being Course (PWC) with incoming postgraduate year-1 (PGY-1) residents in multiple residencies across a single health care system. The PWC teaches the learner strategies for building resilience, managing stress, identifying signs of burnout, and mindfulness practices including a self-selected daily 10-minute resiliency activity (meditation, gratitude journaling, and finding meaning journaling) for 14 days. METHODS: Incoming PGY-1 residents were enrolled in PWC 1 month prior to 2018 orientation. Validated measures of resiliency, burnout and gratitude were completed pre- and postcourse. We assessed pre/postcourse changes with paired t tests. We asked participants whether they incorporated any wellness behavior changes postcourse. RESULTS: Almost two-thirds of the incoming trainees completed the course (n=53/87, 61%). We found significant improvements (P<.05) for resiliency and burnout (emotional exhaustion, depersonalization). Gratitude did not change. The personal accomplishment burnout scale declined. The most frequently reported wellness behaviors were in the area of sleep, exercise, and diet. CONCLUSIONS: Resiliency, emotional exhaustion, and depersonalization improved, personal accomplishment declined, while gratitude remained the same. This project demonstrates an accessible and scalable approach to teaching well-being to incoming residents.

Professional development in integrative health through an interprofessional online course in clinical settings.

BACKGROUND: Although there is mounting clinical and cost-effectiveness evidence supporting integrative healthcare (IH), a significant knowledge gap hinders widespread adoption by health professionals. INTERVENTION: Foundations in Integrative Health (FIH), a 32-h online competency-based interprofessional course to address this knowledge gap. METHODS: The course was pilot-tested by an interprofessional sample of providers in various clinical settings as professional and staff development. OUTCOME MEASURES: Prior to and following the course, participants completed an IH knowledge test, an IH self-efficacy self-assessment, and validated measures of burnout, wellness behaviors, and attitudes toward IH, interprofessional teams, and patient involvement. Evaluation surveys were administered following each unit and the course. RESULTS: Thirty-one percent of the participants (n = 214/690) completed the course. Pre/post course improvements were found in IH knowledge, IH self-efficacy, attitudes towards IH and interprofessional teams, and several wellness behaviors. The course was positively evaluated with 81% of the participants indicating interest in applying IH principles in their practice and 92% reported that the course enhanced their clinical experience. CONCLUSION: This study demonstrates the outcomes of a multi-site, online IH curriculum offered to a diverse group of health professionals in various clinical settings. This course may allow clinical settings to offer an interprofessional, IH curriculum even with limited on-site faculty expertise.

A Longitudinal Study of Burnout and Well-being in Family Medicine Resident Physicians.

BACKGROUND AND OBJECTIVES: The Accreditation Council for Graduate Medical Education (ACGME) core competencies for residency learning and work environment standards acknowledge high levels of burnout and depression in resident physicians and the critical importance of physician well-being to patient care and effective education. The objective of this study was to follow family medicine resident physicians' well-being throughout residency. METHODS: Family medicine resident physicians from 12 programs completed validated assessments (burnout, depression, perceived stress, satisfaction with life, positive and negative affect, emotional intelligence, mindfulness, gratitude) at residency start, second year start, and graduation. Resident physicians were from the 2011, 2012, and 2013 graduating classes (N=158). RESULTS: Two indicators of burnout (emotional exhaustion, depersonalization) increased between the start of residency and the start of the second year, remaining elevated at graduation. Emotional intelligence was lower at graduation than at the start of residency. In contrast, other measures of well-being (stress, life satisfaction, affect) improved during the second and third years. Depression, mindfulness, and gratitude remained stable. Increased levels of burnout risk at graduation were negatively associated with emotional intelligence, mindfulness, and gratitude. CONCLUSIONS: While the stressful impact of residency is transitory for some measures of well-being, that is not the case for burnout or emotional intelligence. Burnout levels peak after the first year of residency and remain high through graduation. Targeted interventions to identify and address burnout in residency need to be evaluated in future studies.

Educating Physicians in Family Medicine Residencies About Nonpharmacologic Approaches to Pain: Results of an Online Integrative Course.

BACKGROUND AND OBJECTIVES: Opioid misuse is at an all-time crisis level, and nationally enhanced resident and clinician education on chronic pain management is in demand. To date, broad-reaching, scalable, integrative pain management educational interventions have not been evaluated for effectiveness on learner knowledge or attitudes toward chronic pain management. METHODS: An 11-hour integrative pain management (IPM) online course was evaluated for effect on resident and faculty attitudes toward and knowledge about chronic pain. Participants were recruited from family medicine residencies participating in the integrative medicine in residency program. Twenty-two residencies participated, with 11 receiving the course and 11 serving as a control group. Evaluation included pre/post medical knowledge and validated measures of attitude toward pain patients, self-efficacy for nondrug therapies, burnout, and compassion. RESULTS: Forty-three participants (34.4%) completed the course. The intervention group (n=50), who received the course, improved significantly (P<.05) in medical knowledge, attitude toward pain patients, and self-efficacy to prescribe nondrug therapies while the control group (n=54) showed no improvement. There was no effect on burnout or compassion for either group. The course was positively evaluated, with 83%-94% rating the course content and delivery very high. All participants responded that they would incorporate course information into practice, and almost all thought what they learned in the course would improve patient care (98%). CONCLUSIONS: Our findings demonstrate the feasibility of an online IPM course as an effective and scalable intervention for residents and primary care providers in response to the current opioid crisis and need for better management of chronic pain. Future directions include testing scalability in formats that lead to improved completion rates, implementation in nonacademic settings, and evaluation of clinical outcomes such as decreased opioid prescribing.

Introducing integrative primary health care to an interprofessional audience: Feasibility and impact of an asynchronous online course.

BACKGROUND: Although there is mounting clinical and cost-effectiveness evidence supporting integrative healthcare (IH), a significant knowledge gap hinders widespread adoption by primary care professionals. INTERVENTION: Based on IH competencies developed by an interprofessional team and a needs assessment, a 32-h online interprofessional IH course, Foundations in Integrative Health, was developed. Trainees learn to conduct an IH assessment and how patients are assessed and treated from the diverse professions in integrative primary care. METHODS: The course was pilot-tested with educational program trainees, faculty and clinical staff at graduate level primary care training programs (primary care residencies, nursing, pharmacy, public health, behavioral health, and licensed complementary and IH programs). OUTCOME MEASURES: Prior to and following the course, participants completed an IH knowledge test, an IH efficacy self-assessment, and validated measures of IH attitudes, interprofessional learning, provider empathy, patient involvement, resiliency, self-care, wellness behaviors, and wellbeing. Evaluation surveys were administered following each unit and the course. RESULTS: Almost one-half (n = 461/982, 47%) completed the course. Pre/post course improvements in IH knowledge, IH self-efficacy, IH attitudes, interprofessional learning, provider empathy, resiliency, self-care, several wellness behaviors, and wellbeing were observed. The course was positively evaluated with most (93%) indicating interest in applying IH principles and that the course enhanced their educational experience (92%). CONCLUSION: This study demonstrates the feasibility and effectiveness of a multi-site, online curriculum for introducing IH to a diverse group of primary care professionals. Primary care training programs have the ability to offer an interprofessional, IH curriculum with limited on-site faculty expertise.

Assessing Integrative Psychiatry Curriculum Needs.

BACKGROUND: Research on incorporating integrative medicine (IM) into medical training is increasing. Programs and organizations around IM have been established, but there has not previously been a needs assessment focused on integrating IM into psychiatry training. OBJECTIVES: The results of a needs assessment of training directors and faculty, focused on interest and priorities for developing an IM curriculum for psychiatry training programs, are described. METHODS: Psychiatry Training Directors and faculty were invited to participate in a detailed electronic survey. Areas of inquiry included (a) IM content areas to include in training; (b) IM approaches to specific medical conditions; (c) existing IM content; (d) importance, interest, and strategies for IM training; and (e) availability of wellness programs for trainees. RESULTS: Thirty-six respondents from psychiatry training programs completed the survey. Of the training programs represented by the respondents, 50% indicated that they currently had IM content in their curriculum; only 11.8% of them rated their programs' existing IM content as sufficient. Content areas rated most highly for inclusion in a psychiatry IM curriculum included sleep health, motivational interviewing, and self-care. Respondents indicated incorporating IM into the psychiatry training curriculum (47%) or as an elective (44%) as the desired implementation strategy, with experiential onsite activities demonstrating IM topics (67%) and online modules supplemented by local faculty (58%) as the 2 most desirable learning formats. Significant barriers identified were time constraints, lack of faculty expertise in IM, current lack of curricular requirements for IM competencies, and budgetary limitations. CONCLUSION: Responses to the survey suggest that faculty need support and additional education in implementing IM training. A standardized, online curriculum could help meet that need. Our results also indicate that wellness programs for residents are currently inadequate; bolstering them could help address burnout and increase the knowledge psychiatrists have of IM modalities. The types of institutions represented by faculty interested in further developing IM offerings vary considerably, as do their current efforts to integrate IM into training programs.

Pharmacy Competencies for Interprofessional Integrative Health Care Education.

Objective. To address the gap in evidence-based knowledge among pharmacy students and practicing pharmacists regarding complementary and integrative health approaches due to insufficient education and a lack of standardized training. Methods. The National Center for Integrative Primary Healthcare (NCIPH) developed 22 pharmacy competencies linked to a set of 10 interprofessional "metacompetencies" in integrative health care. Results. The NCIPH pharmacy competencies are well-aligned with the current educational standards and Center for the Advancement of Pharmacy Education (CAPE) outcomes for pharmacy programs. Therefore, the NCIPH competencies may provide a foundation for the incorporation of interprofessional integrative health care education into pharmacy curricula. Conclusion. The NCIPH pharmacy competencies in integrative health care, linked to the interprofessional "metacompetencies," are aligned with educational standards and outcomes, and may serve as a basis for pharmacy curriculum.

Pediatric Integrative Medicine in Residency Program: Relationship between Lifestyle Behaviors and Burnout and Wellbeing Measures in First-Year Residents.

It is widely recognized that burnout is prevalent in medical culture and begins early in training. Studies show pediatricians and pediatric trainees experience burnout rates comparable to other specialties. Newly developed Accreditation Council for Graduate Medical Education (ACGME) core competencies in professionalism and personal development recognize the unacceptably high resident burnout rates and present an important opportunity for programs to improve residents experience throughout training. These competencies encourage healthy lifestyle practices and cultivation of self-awareness, self-regulation, empathy, mindfulness, and compassion—a paradigm shift from traditional medical training underpinned by a culture of unrealistic endurance and self-sacrifice. To date, few successful and sustainable programs in resident burnout prevention and wellness promotion have been described. The University of Arizona Center for Integrative Medicine Pediatric Integrative Medicine in Residency (PIMR) curriculum, developed in 2011, was designed in part to help pediatric programs meet new resident wellbeing requirements. The purpose of this paper is to detail levels of lifestyle behaviors, burnout, and wellbeing for the PIMR program’s first-year residents (N = 203), and to examine the impact of lifestyle behaviors on burnout and wellbeing. The potential of the PIMR to provide interventions addressing gaps in lifestyle behaviors with recognized association to burnout is discussed.

Integrative Medicine in Residency: Feasibility and Effectiveness of an Online Program.

BACKGROUND AND OBJECTIVES: Online curricular interventions in residency have been proposed to address challenges of time, cost, and curriculum consistency. This study is designed to determine the feasibility and effectiveness of a longitudinal, multisite online curriculum in integrative medicine (IMR) for residents. METHODS: Residents from eight family medicine programs undertook the 200-hour online IMR curriculum. Their medical knowledge (MK) scores at completion were compared to a control group from four similar residency programs. Study and control groups were comparable in baseline demographics, and MK scores. Course completion, MK scores, and course evaluations were assessed. RESULTS: Of 186 IMR residents, 76.9% met completion requirements. The IMR group showed statistically significant higher MK scores at residency completion, the control group did not (IMR: 79.2% vs. CONTROL: 53.2% mean correct). Over three-fourths of IMR participants (range 79-92%) chose the top two rating categories for each course evaluation item. In an exit survey, ability to access the curriculum for 1 additional year and intention to utilize IM approaches after residency were the highest ranked items. CONCLUSIONS: The demonstrated feasibility, effectiveness, and positive evaluations of the IMR curriculum indicate that a multisite, online curricular intervention is a potentially viable approach to offering new curriculum with limited on-site faculty expertise for other family medicine residencies.

Barriers to Condom Use: Results for Men and Women Enrolled in HIV Risk Reduction Trials in Outpatient Drug Treatment.

HIV transmission often occurs through heterosexual high-risk sex. Even in the era of HIV combination prevention, promoting condom use, and understanding condom barriers, remain priorities, especially among substance-dependent individuals. Men and women (N=729) in outpatient drug treatment participated in a five-session gender-specific risk reduction group or one-session HIV Education group. Condom barriers (Motivation, Partner-related, Access/Availability, Sexual experience) were assessed at baseline and 6-month follow-up. Completing either intervention was associated with fewer motivation and partner-related barriers. Among women, reductions in motivation and sexual experience barriers were associated with less sexual risk with primary partners. Condom barriers are important to gender-specific HIV prevention; given limited resources, brief interventions maximizing active components are needed.

Interprofessional Competencies in Integrative Primary Healthcare.

In October 2014, the National Center for Integrative Primary Healthcare (NCIPH) was launched as a collaboration between the University of Arizona Center for Integrative Medicine and the Academic Consortium for Integrative Health and Medicine and supported by a grant from the Health Resources and Services Administration. A primary goal of the NCIPH is to develop a core set of integrative healthcare (IH) competencies and educational programs that will span the interprofessional primary care training and practice spectra and ultimately become a required part of primary care education. This article reports on the first phase of the NCIPH effort, which focused on the development of a shared set of competencies in IH for primary care disciplines. The process of development, refinement, and adoption of 10 "meta-competencies" through a collaborative process involving a diverse interprofessional team is described. Team members represent nursing, the primary care medicine professions, pharmacy, public health, acupuncture, naturopathy, chiropractic, nutrition, and behavioral medicine. Examples of the discipline-specific sub-competencies being developed within each of the participating professions are provided, along with initial results of an assessment of potential barriers and facilitators of adoption within each discipline. The competencies presented here will form the basis of a 45-hour online curriculum produced by the NCIPH for use in primary care training programs that will be piloted in a wide range of programs in early 2016 and then revised for wider use over the following year.

En octubre de 2014, se inauguró el Centro nacional de atención primaria integral de salud (National Center for Integrative Primary Healthcare, NCIPH) como una colaboración entre el Centro de medicina integral de la Universidad de Arizona y el Consorcio académico de salud y medicina integral, y fue subvencionado con fondos de la Administración de Recursos y Servicios de Salud. El objetivo principal del NCIPH es desarrollar un conjunto básico de competencias de asistencia sanitaria integral (SI) y programas educativos que abarquen los espectros de formación y práctica en atención primaria interprofesional y se integren en última instancia en la educación en atención primaria. Este artículo detalla la primera fase de la iniciativa del NCIPH, que se centra en el desarrollo de un conjunto de competencias compartidas en asistencia sanitaria integral para las disciplinas de atención primaria. Se describe un proceso de desarrollo, perfeccionamiento y adopción de 10 "metacompetencias" a través de un proceso de colaboración en el que participa un equipo interprofesional heterogéneo. Los miembros del equipo representan al personal de enfermería, las profesiones médicas de atención primaria, farmacia, salud pública, acupuntura, naturopatía, quiropráctica, nutrición y medicina de la conducta. Se ofrecen ejemplos de las subcompetencias específicas de cada disciplina en fase de desarrollo en cada una de las profesiones participantes, junto con los resultados iniciales de la evaluación de los posibles obstáculos y los facilitadores de la adopción dentro de cada disciplina. Las competencias que se presentan aquí constituirán la base de un plan de estudios en línea de 45 horas elaborado por el NCIPH para su uso en programas de formación en atención primaria que se pondrán a prueba a principios de 2016 y serán posteriormente revisados para la generalización de su uso el año siguiente.

Pediatric Integrative Medicine in Residency (PIMR): Description of a New Online Educational Curriculum.

Use of integrative medicine (IM) is prevalent in children, yet availability of training opportunities is limited. The Pediatric Integrative Medicine in Residency (PIMR) program was designed to address this training gap. The PIMR program is a 100-hour online educational curriculum, modeled on the successful Integrative Medicine in Residency program in family medicine. Preliminary data on site characteristics, resident experience with and interest in IM, and residents' self-assessments of perceived knowledge and skills in IM are presented. The embedded multimodal evaluation is described. Less than one-third of residents had IM coursework in medical school or personal experience with IM. Yet most (66%) were interested in learning IM, and 71% were interested in applying IM after graduation. Less than half of the residents endorsed pre-existing IM knowledge/skills. Average score on IM medical knowledge exam was 51%. Sites endorsed 1-8 of 11 site characteristics, with most (80%) indicating they had an IM practitioner onsite and IM trained faculty. Preliminary results indicate that the PIMR online curriculum targets identified knowledge gaps. Residents had minimal prior IM exposure, yet expressed strong interest in IM education. PIMR training site surveys identified both strengths and areas needing further development to support successful PIMR program implementation.

Sub-nanometer flattening of 45 cm long, 45 actuator x-ray deformable mirror.

We have built a 45 cm long x-ray deformable mirror (XDM) of super-polished single-crystal silicon that has 45 actuators along the tangential axis. After assembly, the surface height error was 19 nm rms. With use of high-precision visible-light metrology and precise control algorithms, we have actuated the XDM and flattened its entire surface to 0.7 nm rms controllable figure error. This is, to our knowledge, the first sub-nanometer active flattening of a substrate longer than 15 cm.

Increasing resident recruitment into family medicine: effect of a unique curriculum in integrative medicine.

INTRODUCTION: Healthcare reform is highlighting the need for more family practice and other primary care physicians. The Integrative Medicine in Residency (IMR) curriculum project helped family medicine residencies pilot a new, online curriculum promoting prevention, patient-centered care competencies, use of complementary and alternative medicine along with conventional medicine for management of chronic illness. A major potential benefit of the IMR program is enhanced recruitment into participating residencies, which is reported here. METHODS: Using an online questionnaire, accepted applicants to the eight IMR pilot programs (n = 152) and four control programs (n = 50) were asked about their interests in learning integrative medicine (IM) and in the pilot sites how the presence of the IMR curriculum affected their ranking decisions. RESULTS: Of residents at the IMR sites, 46.7% reported that the presence of the IMR was very important or important in their ranking decision. The IMR also ranked fourth overall in importance of ranking after geography, quality of faculty, and academic reputation of the residency. The majority of IMR residents (87.5%) had high to moderate interest in learning IM during their residency; control residents also had a high interest in learning IM (61.2%). CONCLUSIONS: The presence of the IMR curriculum was seen as a strong positive by applicants in ranking residencies. Increasing the adoption of innovative IM curricula, such as the IMR, by residency programs may be helpful in increasing applications of competitive medical students into primary care residencies as well as in responding to the expressed interest in learning the IM approach to patient care.

CAM and energy psychology techniques remediate PTSD symptoms in veterans and spouses.

Male veterans and their spouses (N = 218) attending one of six-week-long retreats were assessed for posttraumatic stress disorder (PTSD) symptoms pre- and postintervention. Participants were evaluated using the PTSD checklist (PCL), on which, a score of >49 indicates clinical symptom levels. The mean pretest score was 61.1 (SD ± 12.5) for veterans and 42.6 (SD ± 16.5) for spouses; 83% of veterans and 29% of spouses met clinical criteria. The multimodal intervention used Emotional Freedom Techniques and other energy psychology (EP) methods to address PTSD symptoms and a variety of complementary and alternative medicine (CAM) modalities for stress reduction and resource building. Interventions were delivered in group format as well as individual counseling sessions. Data were analyzed for each retreat, as well as for the six retreats as a whole. Mean post-test PCL scores decreased to 41.8 (SE ± 1.2; p < .001) for veterans, with 28% still clinical. Spouses demonstrated substantial symptom reductions (M = 28.7, SE ± 1.0; p < .001), with 4% still clinical. A follow-up assessment (n = 63) found PTSD symptom levels dropping even further for spouses (p < .003), whereas gains were maintained for veterans. The significant reduction in PTSD symptoms is consistent with other published reports of EP treatment, though counter to the usual long-term course of the condition. The results indicate that a multimodal CAM intervention incorporating EP may offer benefits to family members as well as veterans suffering from PTSD symptoms. Recommendations are made for further research to answer the questions posed by this study.

Resident wellness behaviors: relationship to stress, depression, and burnout.

BACKGROUND AND OBJECTIVES: Stress in medical education has been well documented, often with the primary focus on negative factors such as depression and burnout. Few studies have attempted to assess well-being mediating behaviors. This study describes the relationship between wellness behaviors and measures of well-being at the start of family medicine residency. METHODS: Using an online questionnaire, first-year family medicine residents (n=168) completed standardized measures exploring perceived stress, depression, satisfaction with life, and burnout. A lifestyle wellness behavior measure was developed for the study. RESULTS: Average reported perceived stress levels were consistent with ranges found for medical students and residents. Twenty-three percent of residents scored in a range consistent with depression risk. In terms of burnout risk, 13.7% scored in the high emotional exhaustion range and 23.8% in the high depersonalization range. Two thirds reported high life satisfaction. Higher depersonalization and less time in nurturing relationships were associated with greater likelihood of medication use for sleep, mood, and anxiety in females. Higher alcohol use was associated with increased levels of perceived stress, burnout, and depression. The two wellness behaviors most associated with higher well-being were restful sleep and exercise. CONCLUSIONS: At the start of residency, well-being measures are consistent with findings in medical school. Restful sleep and exercise were associated with more positive well-being. Future longitudinal data analysis will help clarify the effect of residency training in well-being and lifestyle behaviors. Identification of protective factors and coping mechanisms could guide residencies in incorporating support services for residents.

Advances in Integrative Nanomedicine for Improving Infectious Disease Treatment in Public Health.

INTRODUCTION: Infectious diseases present public health challenges worldwide. An emerging integrative approach to treating infectious diseases is using nanoparticle (NP) forms of traditional and alternative medicines. Advantages of nanomedicine delivery methods include better disease targeting, especially for intracellular pathogens, ability to cross membranes and enter cells, longer duration drug action, reduced side effects, and cost savings from lower doses. METHODS: We searched Pubmed articles in English with keywords related to nanoparticles and nanomedicine. Nanotechnology terms were also combined with keywords for drug delivery, infectious diseases, herbs, antioxidants, homeopathy, and adaptation. RESULTS: NPs are very small forms of material substances, measuring 1-100 nanometers along at least one dimension. Compared with bulk forms, NPs' large ratio of surface-area-to-volume confers increased reactivity and adsorptive capacity, with unique electromagnetic, chemical, biological, and quantum properties. Nanotechnology uses natural botanical agents for green manufacturing of less toxic NPs. DISCUSSION: Nanoparticle herbs and nutriceuticals can treat infections via improved bioavailability and antiinflammatory, antioxidant, and immunomodulatory effects. Recent studies demonstrate that homeopathic medicines may contain source and/or silica nanoparticles because of their traditional manufacturing processes. Homeopathy, as a form of nanomedicine, has a promising history of treating epidemic infectious diseases, including malaria, leptospirosis and HIV/AIDS, in addition to acute upper respiratory infections. Adaptive changes in the host's complex networks underlie effects. CONCLUSIONS: Nanomedicine is integrative, blending modern technology with natural products to reduce toxicity and support immune function. Nanomedicine using traditional agents from alternative systems of medicine can facilitate progress in integrative public health approaches to infectious diseases.