The know-how is available to reverse the obesity epidemic. Reversing obesity is a societal necessity because it is the predominant contributor to chronic ill health in developed countries and a growing precipitant of illness in middle and low-income countries. In the United States, for example, obesity is the chief driver of health care costs in a country that can no longer afford health care. Although some might advocate population-wide medication use to mitigate the effects of obesity on health, the more direct response is to end obesity. The goal of this paper is explain how mass-scalable obesity containment can be designed, built, and disseminated. Scalable Obesity Solutions (S.O.S.) are discussed from concept through deployment.
James A. Levine
Kimberly S. Peer
Sports medicine professionals are facing new dilemmas in light of the changing dynamics of sport as an enterprise. These changes have considerable ethical implications as sports medicine team members are placed in challenging ethical decision-making situations that often create values tensions. These values conflicts have the potential to threaten and degrade the trust established through the mutual expectations inherent in the social contract between the health care providers and society. According to Starr,1 the social contract is defined as the relationship between medicine and society that is renegotiated in response to the complexities of modern medicine and contemporary society. Anchored in expectations of both society and the medical professions, this tacit contract provides a strong compass for professional practice as it exemplifies the powerful role and examines the deep responsibilities held by health care providers in our society. Although governed by professional boards and organizational codes of ethics, sports medicine professionals are challenged by the conflicts of interest between paternalistic care for the athlete and autonomous decisions often influenced by stakeholders other than the athletes themselves. Understanding how the construct of sport has impacted sports health care will better prepare sports medicine professionals for the ethical challenges they will likely face and, more importantly, facilitate awareness and change of the critical importance of upholding the integrity of the professional social contract.
Thomas H. Kelly and Carl G. Mattacola
The National Institutes of Health's Clinical and Translational Science Award initiative is designed to establish and promote academic centers of clinical and translational science (CTS) that are empowered to train and advance multi- and interdisciplinary investigators and research teams to apply new scientific knowledge and techniques to enhance patient care. Among the key components of a full-service center for CTS is an educational platform to support research training in CTS. Educational objectives and resources available to support the career development of the clinical and translational scientists, including clinical research education, mentored research training, and career development support, are described.
The purpose of the article is to provide an overview of the CTS educational model so that rehabilitation specialists can become more aware of potential resources that are available and become more involved in the delivery and initiation of the CTS model in their own workplace. Rehabilitation clinicians and scientists are well positioned to play important leadership roles in advancing the academic mission of CTS. Rigorous academic training in rehabilitation science serves as an effective foundation for supporting the translation of basic scientific discovery into improved health care. Rehabilitation professionals are immersed in patient care, familiar with interdisciplinary health care delivery, and skilled at working with multiple health care professionals.
The NIH Clinical and Translational Science Award initiative is an excellent opportunity to advance the academic development of rehabilitation scientists.
Promoting bicycling has great potential to increase overall physical activity; however, significant uncertainty exists with regard to the amount and effectiveness of investment needed for infrastructure. The objective of this study is to assess how costs of Portland’s past and planned investments in bicycling relate to health and other benefits.
Costs of investment plans are compared with 2 types of monetized health benefits, health care cost savings and value of statistical life savings. Levels of bicycling are estimated using past trends, future mode share goals, and a traffic demand model.
By 2040, investments in the range of $138 to $605 million will result in health care cost savings of $388 to $594 million, fuel savings of $143 to $218 million, and savings in value of statistical lives of $7 to $12 billion. The benefit-cost ratios for health care and fuel savings are between 3.8 and 1.2 to 1, and an order of magnitude larger when value of statistical lives is used.
This first of its kind cost-benefit analysis of investments in bicycling in a US city shows that such efforts are cost-effective, even when only a limited selection of benefits is considered.
Tamara C. Valovich McLeod, Megan N. Houston and Cailee E. Welch
Concussions resulting from sports and recreational activities are a significant concern in the pediatric population. The number of children and adolescents sustaining sport-related concussions is increasing and, as a result, legislation has been passed in all 50 states to ensure appropriate recognition and referral of pediatric athletes following concussion. The developing brain may make the diagnosis, assessment, and management of concussion more challenging for health care providers and requires the use of specific age-appropriate assessment tools. Concussion management must also include considerations for cognitive and physical rest, a collaborative concussion management team that includes medical and school personnel, and more conservative stepwise progressions for returning to school and to physical activity.
Cormac G. Ryan, Patricia Schofield and Denis J. Martin
Negative views of older adults can lead to suboptimal care. For older adults with persistent low back pain (LBP), promotion of physical activity by health care professionals is important. Health care professionals’ views of older adults are influenced by their training. This study aimed to compare recommendations for physical activity for managing persistent LBP offered by students in physiotherapy and occupational therapy to an older person vs. a younger person. In a cross-sectional online survey, participants (N = 77) randomly received a vignette of either a 40-yr-old or 70-yr-old patient with persistent LBP. Other than age, the vignettes were identical. There was no difference between the younger and older vignettes in the likelihood of participants making overall appropriate physical activity recommendations—63% vs. 59%, OR (95%CI) = 1.19 (0.48–2.99), p = .71—although there was a trend toward age bias on recommendations specific to daily activity. Postqualification education may be where ageist views need to be addressed.
Roberta Bgeginski, Diogo A. DeSousa, Bruna M. Barroso, Janete Vettorazzi, Michelle F. Mottola, Felipe B. Schuch and José Geraldo L. Ramos
The Physical Activity Readiness Medical Examination (PARmed-X) for Pregnancy aims to facilitate the communication between the health care provider, the fitness professional and the pregnant woman. The purpose of the current study was to test the psychometric properties of the Brazilian Portuguese version of the PARmed-X for Pregnancy.
Reliability and validity of psychometric properties of the Brazilian Portuguese version of the PARmed-X for Pregnancy were tested in 107 women recruited from the Hospital de Clínicas de Porto Alegre. Participants completed the first page of the instrument twice with a minimal interval of 1 week for test-retest reliability analysis. The absolute and relative contraindications to exercise on page 2 of the document were completed by the obstetrician.
Results indicated good evidence of construct validity. The isolated items in the PARmed-X document presented a large heterogeneity in kappa coefficients ranging from very low estimates to perfect estimates. The overall indication of prescription of physical activity, nonetheless, presented a good kappa coefficient of 0.749.
The Brazilian Portuguese version of the PARmed-X for Pregnancy can be applied as a valid tool for medical screening by health care providers to help inform safe exercise prescription during pregnancy.
Abigail Sherman Katz and Nicolaas Petrus Pronk
Physical activity is regarded an important health behavior. Routine doctor visits, dentist visits, and willingness to seek phone advice from a nurse are considered important care-seeking behaviors (ie, behaviors that reflect the way in which people seek and access health care delivery resources available to them). Employers promote physical activity as well as care-seeking behavior to protect and promote health, optimize productivity, and manage health care costs. The purpose of this study was to investigate the association between physical activity and 3 care-seeking behaviors among a sample of 5500 employed adults.
Data were obtained from employee health assessments. Logistic regression was used to test the relationship between physical activity and care-seeking behavior.
Physical activity was positively associated with all 3 measures of care-seeking behavior: doctor visits (P < .001), dentist visits (P < .001), and willingness to seek phone advice from a nurse (P < .05). For individuals reporting chronic conditions, physical activity was negatively associated with doctor visits for the condition (P < .05) and positively associated with self-perceived health (P < .001).
Physical activity is associated with important care-seeking behaviors for employees with and without chronic conditions.
Charles H. Tator
There has been a remarkable increase in the past 10 years in the awareness of concussion in the sports and recreation communities. Just as sport participants, their families, coaches, trainers, and sports organizations now know more about concussions, health care professionals are also better prepared to diagnose and manage concussions. As has been stated in the formal articles in this special issue on sport-related concussion, education about concussion is one of the most important aspects of concussion prevention, with the others being data collection, program evaluation, improved engineering, and introduction and enforcement of rules. Unfortunately, the incidence of concussion appears to be rising in many sports and thus, additional sports-specific strategies are required to reduce the incidence, short-term effects, and long term consequences of concussion. Enhanced educational strategies are required to ensure that individual participants, sports organizations, and health care professionals recognize concussions and manage them proficiently according to internationally recognized guidelines. Therefore, this paper serves as a “brief report” on a few important aspects of concussion education and prevention.
Abhinav Singh and Bharathi Purohit
Regular physical activity is well recognized as an important lifestyle behavior for the development and maintenance of individual and population health and well-being. This study was conducted to evaluate physical activity, sedentary lifestyle, and obesity among Indian dental health professionals.
Global Physical Activity Questionnaire was used to assess physical activity among 324 dental health care professionals. Metabolic equivalents (MET) were used to express the intensity of physical activities. Obesity was recorded corresponding to Body Mass Index. Individuals were considered in high risk group to develop obesity if energy expenditure was < 600 MET min/week.
Total physical activity measured in mean MET minutes per week was 625.6, 786.3, 296.5, and 296.5 for third year, final year, interns, and faculty, respectively (P ≤ .05). Obesity was observed in 22.4% of third-year students, 16.3% of final-year students, 20.4% of interns, and 40.8% of faculty members (P ≤ .001).
The sedentary lifestyle of dental health care professionals is a major threat to the present and future health of the professionals by which the entire community could be prone to an epidemic of chronic disease.