A Summer Health Program for African-American High School Students in Baltimore, Maryland: Community Partnership for Integrative Health.

CONTEXT: Physical inactivity, poor nutrition, and chronic stress threaten the health of African-American youth in urban environments. Conditions often worsen in summer with diminished access to healthy foods and safe venues for physical activity. OBJECTIVE: A public-private partnership was formed to develop and evaluate an integrative health intervention entitled "Mission Thrive Summer" (MTS). METHODS: The MTS setting was an urban farm and adjacent school in a low-income community in Baltimore, Maryland. The intervention included farming, nutrition education, cooking, physical activity, yoga, mindfulness, and employment. Mixed-methods outcomes evaluation was conducted. Quantitative measures included accelerometry and self-reported health behaviors, using the Child and Adolescent Mindfulness Measure, Perceived Stress Scale, Physical Activity Questionnaire for Adolescents (PAQA), CDC Youth Risk Behavior Survey, and Block Kids Food Screener (BKFS). Outcomes were compared pre- and post-intervention using paired t-tests. Qualitative evaluation was based on participant and parent interviews. PARTICIPANTS: In total, 36 African-American 9th- and 10th-grade students joined MTS (17 in 2013, 26 in 2014, and 7 participating both years). RESULTS: In total, 88% of participants completed MTS. Accelerometry revealed that participants took 7158 steps and burned 544 calories per day during MTS. Participants experienced statistically significant improvements in self-reported physical activity (PAQA) and dietary habits (BKFS). Surveys did not detect changes in stress or mindfulness (P > .05). Qualitative data demonstrated new knowledge and skills, increased self-efficacy, health behavior change, and program enjoyment. CONCLUSIONS: MTS was feasible among African-American high school students in Baltimore. Mixed-methods outcomes evaluation provided preliminary evidence of health behavior change during the summer and at follow-up.

Spice MyPlate: Nutrition Education Focusing Upon Spices and Herbs Improved Diet Quality and Attitudes Among Urban High School Students.

PURPOSE: To determine whether an experiential nutrition education intervention focusing on spices and herbs ("Spice MyPlate") is feasible and improves diet quality and healthy eating attitudes among an urban and predominantly African-American sample of adolescents more than standard nutrition education alone. DESIGN: A nonrandomized controlled trial compared standard nutrition education in U.S. Department of Agriculture MyPlate guidelines (control group) with standard nutrition education plus adjuvant Spice MyPlate curriculum (intervention group). Data were collected at baseline and after 3, 6, and 10 weeks. SETTING: Study setting was two public high schools in Baltimore, Maryland. SUBJECTS: A total of 110 students in grades 9 to 12 participated. INTERVENTION: The 6-week school-based intervention conducted during health class focused on cooking using spices and herbs to eat healthier diets according to MyPlate. MEASURES: Dietary intake reported on 3-day food records and healthy eating attitudes questionnaires was analyzed. ANALYSIS: Differences in diet quality and healthy eating attitudes between study groups were estimated by t-tests, Wilcoxon-Mann-Whitney tests, and covariate-adjusted regression models. RESULTS: Spice MyPlate was feasible and there were modest but significant improvements (p ≤ .05) in the Spice MyPlate group compared with control in whole grains (31.2 g/wk) and protein foods (13.2 ounces per week) intake, and attitudes toward eating vegetables, whole grains, lean protein, and low-fat dairy. CONCLUSIONS: Although randomized trials are needed, experiential nutrition education focusing on spices and herbs may help urban and predominantly African-American adolescent populations eat healthier diets.

Effectiveness Guidance Document (EGD) for acupuncture research - a consensus document for conducting trials.

BACKGROUND: There is a need for more Comparative Effectiveness Research (CER) to strengthen the evidence base for clinical and policy decision-making. Effectiveness Guidance Documents (EGD) are targeted to clinical researchers. The aim of this EGD is to provide specific recommendations for the design of prospective acupuncture studies to support optimal use of resources for generating evidence that will inform stakeholder decision-making. METHODS: Document development based on multiple systematic consensus procedures (written Delphi rounds, interactive consensus workshop, international expert review). To balance aspects of internal and external validity, multiple stakeholders including patients, clinicians and payers were involved. RESULTS: Recommendations focused mainly on randomized studies and were developed for the following areas: overall research strategy, treatment protocol, expertise and setting, outcomes, study design and statistical analyses, economic evaluation, and publication. CONCLUSION: The present EGD, based on an international consensus developed with multiple stakeholder involvement, provides the first systematic methodological guidance for future CER on acupuncture.

Physician Perspectives on Comparative Effectiveness Research: Implications for Practice-based Evidence.

Comparative effectiveness research (CER) is defined by the Institute of Medicine as "the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care." The goal of CER is to provide timely, useful evidence to healthcare decision makers including physicians, patients, policymakers, and payers. A prime focus for the use of CER evidence is the interaction between physician and patient. Physicians in primary practice are critical to the success of the CER enterprise. A 2009 survey suggests, however, that physician attitudes toward CER may be mixed-somewhat positive toward the potential for patient care improvement, yet negative toward potential restriction on physician freedom of practice. CER methods and goals closely parallel those of practice-based research, an important movement in family medicine in the United States since the 1970s. This article addresses apparent physician ambivalence toward CER and makes a case for family medicine engagement in CER to produce useful practice-based evidence. Such an effort has potential to expand care options through personalized medicine, individualized guidelines, focus on patient preferences and patient-reported outcomes, and study of complex therapeutic interventions, such as integrative care. Academic medical researchers will need to collaborate with experienced family physicians to identify significant practice-based research questions and design meaningful studies. Such collaborations would shape CER to produce high-quality practice-based evidence to inform family and community medicine.

El Instituto de Medicina (Institute of Medicine) ha definido la investigación de eficacia comparativa (IEC) como "la generación y síntesis de datos que comparan los beneficios y perjuicios de métodos alternativos con los que prevenir, diagnosticar, tratar y monitorizar una enfermedad o con los que mejorar la atención proporcionada". El objetivo de la IEC consiste en proporcionar datos útiles y oportunos a los responsables de la toma de decisiones sanitarias, incluidos médicos, pacientes, diseñadores de políticas y pagadores. Uno de los principales puntos del interés del uso de la IEC es la interacción entre el médico y el paciente. Los médicos de atención primaria son esenciales para el éxito de las iniciativas sobre IEC. No obstante, según una encuesta de 2009, es posible que la actitud de los médicos hacia la IEC sea mixta (algo positiva por el potencial de mejora en lo que a la atención al paciente se refiere, aunque negativa a consecuencia de la posible restricción de la libertad de práctica del médico). Existe un paralelismo entre los métodos y objetivos de la IEC y los de la investigación basada en la práctica clínica (practice-based research, PBR), un importante movimiento en la medicina general en Estados Unidos desde los años setenta. Este artículo aborda la aparente ambivalencia hacia la IEC y defiende la implicación de la medicina general en la IEC, con el fin de producir datos útiles a partir de la práctica clínica. Dicho esfuerzo tiene el potencial de ampliar las opciones de atención sanitaria mediante una medicina personalizada, directrices individualizadas, un enfoque hacia las preferencias del paciente y los resultados notificados por este, y el estudio de intervenciones terapéuticas complejas, como la asistencia sanitaria integrada. Los investigadores médicos universitarios tendrán que cooperar con médicos de atención primaria experimentados para identificar interrogantes de la investigación basada en la práctica y diseñar estudios que resulten relevantes. Dichas colaboraciones darán forma a la IEC y le permitirán producir, a partir de la práctica clínica, datos de gran calidad y notificarlos a la medicina general.

The use of biofield therapies in cancer care.

Biofield therapies form a subcategory of the domain of energy therapies, as defined by the National Center for Complementary and Alternative Medicine. Specific biofield therapies addressed in this article include Therapeutic Touch, Healing Touch, Polarity Therapy, Reiki, and Qigong. This article will identify core concepts in biofield therapies, review controlled trials of the use of biofield therapies with patients with cancer, describe the process of biofield therapies implementation in one cancer center, and suggest research to benefit not only patients with cancer but also family members and oncology professionals.

Effectiveness of CancerGuides a study of an integrative cancer care training program for health professionals.

PURPOSE: To determine how CancerGuidesâ, an integrative cancer care training program, would affect participants' perception of their professional skills, their mood, use of self care and mind-body modalities, and the acceptance of integrative cancer care at their institutions. STUDY DESIGN: Qualitative and quantitative measures were used during the training program and at 6-month follow-up. A focus group met before and after the training, and individual interviews of focus group participants were done at follow-up. METHODS: The week-long program consisted of lectures that provided information on integrating conventional and complementary therapies into individualized programs of cancer care. Small group sessions used mind-body techniques to allow participants to understand the dilemmas faced by cancer patients. A self-report survey was administered at the training program and at 6-month follow-up. The survey included questions on the personal and professional use of modalities and on participants' sense of how well they met the course objectives. Qualitative questions addressed self-care, changes in clinical practice, and the acceptance of integrative therapies by their institutions. The Profile of Mood States was administered before and after the training. RESULTS: Six months after the training, there was a significant increase in the use and/or recommendation of complementary and alternative medicine modalities in clinical practice and a significant increase in the personal practice of these modalities. Participants' perceived level of skill for all of the course objectives was significantly increased following the training and was maintained at 6-month follow-up. There were significant reductions in the Anger-Hostility and Tension-Anxiety subscale scores of the Profile of Mood States questionnaire. In response to qualitative questions, participants reported positive changes in patient care and in their clinical practices at 6-month follow-up. The subset of participants in the focus group interviews reported similar improvements. Thirty-five percent of those responding at follow-up reported an increase in acceptance of integrative cancer therapies at their institutions, and 77% reported making positive changes in self-care. CONCLUSIONS: Cancer-Guides provided training that allowed participants to enhance personal self-care, to interact more effectively with their patients, and to develop programs of integrative cancer care.