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The purpose of the study was to investigate the effects of a school‐based prevention program on physical activity, fitness, and obesity. We performed a prospective study in eight Bavarian primary schools (n = 724 children, 8.4 ± 0.7 years) randomized one to one to either an intervention school (IS, n = 427) or a control school (CS, n = 297). Children in IS attended 10 health‐related lessons at school over a period of 1 year. Parents and teachers attended two and three educational health‐related lessons, respectively, and also received 10 newsletters on health issues. Daily physical activity (≥ 60 min/day), physical fitness (six‐item test battery), and anthropometric data were obtained at baseline and after 1 year. Physical activity and physical fitness increased in IS, but it failed to reach significant intervention effects. Nevertheless, a reduction in waist circumference was observed for all children [mean change 1.7 cm; 95% confidence interval (CI) 1.2–2.3; P < 0.001). This effect was more pronounced in overweight children (> 90th percentile, n = 99, mean change 3.2 cm; 95% CI 1.5–4.8; P < 0.001). This easily administered preventative program involving children, parents, and teachers revealed that a generalized approach increasing physical activity will even be favorable in a subgroup of obese children.  相似文献   
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ObjectiveTo evaluate the participants in the Mayo Clinic Biobank for their representativeness to the entire Employee and Community Health program (ECH) primary care population with regard to hospital utilization.Patients and MethodsParticipants enrolled in the Mayo Clinic Biobank from April 1, 2009, to December 31, 2010, were linked to the ECH population. These individuals were categorized into risk tiers (0-4) on the basis of the number of health conditions present as of December 31, 2010. Outcomes were ascertained through December 31, 2011. Hazard ratios (HRs) and 95% CIs for risk of hospitalization, emergency department (ED) visits, and for risk of hospitalization and emergency department (ED) visits were estimated.ResultsThe 8927 Biobank participants were part of ECH (N=84,872). Compared with the entire ECH population, the Biobank-ECH participants were more likely to be female (64.3% vs 54.6%), older (median age, 58 years vs 47 years), and categorized to tier 0 (6.4% vs 24.0%). There were strong positive associations between tier (tier 4 vs combined tiers 0 and 1) and risk of hospitalization (HR, 5.8; 95% CI, 4.6-7.5) and ED visits (HR, 5.4; 95% CI, 4.2-6.8) among Biobank-ECH participants. Similar associations for risk of hospitalization (HR, 8.5; 95% CI, 7.8-9.3) and ED visits (HR, 6.9; 95% CI, 6.4-7.5) were observed for the entire ECH population.ConclusionAlthough the Biobank-ECH participants were older and had more chronic conditions compared with the overall ECH population, the associations of risk tier with utilization outcomes were similar, supporting the use of the Biobank participants to assess biomarkers for health care outcomes in the primary care setting.  相似文献   
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Recent years have seen the implementation of educational programs aimed at developing future orientation and better employability skills, mostly for people new to or returning to the job market. In a field study, we investigated the impact of a 5-day program on reintegration to civilian life on young Israeli combat soldiers' time preferences, gratitude, patriotism, and perceptions of their combat experience. Questionnaires administered before and after the program revealed a positive effect on future orientation but a negative effect on gratitude and perceptions of the combat experience. Although the positive effect on future orientation is in line with the program design, the negative effects found should be taken into consideration when planning or improving similar educational programs.  相似文献   
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The Program for Psychosocial Care and Comprehensive Health for Victims serves, on a yearly basis, an average of 25,000 users in northern Colombia alone. The program is implemented by multidisciplinary teams comprised of psychologists, social workers, and community facilitators, who step in at the individual, family, and community levels. An attempt has been made to determine the effect generated by the timeframe through which professionals have been engaged with the program-filling positions of centrality and betweenness within the networks of information exchange and user referral, including the potential mediating effect from the structure of the egocentric network of implementers in the two aforementioned networks and the moderating effect of the sense of belonging to a team of professionals. Both centrality and betweenness are positional measures describing the location actors occupied within the network structure. Centrality reflects the nominations made and receipt by an actor in a network and is considered an individual indicator of prominence and power. Betweenness shows the times that an actor act as a bridge among two actors in a network and it is considered an indicator of strategic positioning in social networks. An egocentric network is the local structure of relationships that each implementer maintains with his or her direct contacts. In this study, 112 active implementers were included, mostly women (n = 97, 88.2%), who had been working on the program for 16.9 months on average (SD = 14.7). Through conditional process analysis, it has been shown that the time that the implementers have been working on the program and the sense of belonging to the task team are relevant factors that interact with each other toward explaining the level of centrality and betweenness of professionals in the information exchange and user referral networks.  相似文献   
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BackgroundDentists in the United States frequently prescribe opioids for dental-related pain, although evidence shows superior efficacy of nonopioids for pain management. A national sample of US dentists was interviewed to understand the barriers and facilitators to opioid prescribing.MethodsSemistructured one-on-one telephone interviews were conducted with dentists sampled from the 6 regions of The National Dental Practice-Based Research Network. Responses were coded into the domains of the Capability, Opportunity and Motivation Model of Behavior. Potential behavior change interventions were identified for targeted themes.ResultsSeventy-three interviews were qualitatively analyzed. Most of those interviewed were general dentists (86.3%) and on average (SD) were in practice for 24.3 (13.0) years. Ten themes were identified within the Capability, Opportunity and Motivation Model of Behavior. Dentists’ knowledge of opioid risk, ability to identify substance use disorder behavior, and capability of communicating pain management plans to patients or following clinic policies or state and federal regulations were linked with judicious opioid prescribing. Dentists reported prescribing opioids if they determined clinical necessity or feared negative consequences for refusing to prescribe opioids.ConclusionsDentists’ opioid decision making is influenced by a range of real-world practice experiences and patient and clinic factors. Education and training that target dentists’ knowledge gaps and changes in dentists’ practice environment can encourage effective communication of pain management strategies with patients and prescribing of nonopioids as first-line analgesics while conserving opioid use.Practical ImplicationsIdentified knowledge gaps in dentistry can be targets for education, clinical guidelines, and policy interventions to ensure safe and appropriate prescribing of opioids.  相似文献   
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BackgroundSchool sealant programs (SSPs) increase sealant prevalence among children lacking access to oral health care. SSPs, however, are substantially underused. From 2013 through 2018, the Centers for Disease Control and Prevention funded 18 states for SSP activities in high-need schools (≥ 50% free and reduced-price meal program participation). From 2019 through 2020, the authors assessed SSPs' impact in reducing caries and how states expanded SSPs. The authors also discuss potential barriers to expansion.MethodsFor Aim 1, the authors used a published methodology and SSP baseline screening and 1-year retention data to estimate averted caries over 9 years attributable to SSPs. For Aim 2, the authors used state responses to an online survey, phone interviews, and annual administrative reports.ResultsUsing data for 62,750 children attending 18.6% of high-need schools in 16 states, the authors estimated that 7.5% of sound, unsealed molars would develop caries annually without sealants and placing 4 sealants would prevent caries in 1 molar. Fourteen states reported SSP expansion in high-need schools. The 2 most frequently reported barriers to SSP expansion were levels of funding and policies requiring dentists to be present at assessment or sealant placement.ConclusionsThe authors found that SSPs typically served children at elevated caries risk and reduced caries. In addition, the authors identified funding levels and policies governing supervision of dental hygienists as possible barriers to SSP expansion.Practical ImplicationsIncreasing SSP prevalence could reduce caries. Further research on potential barriers to SSP implementation identified in this study could provide critical information for long-term SSP sustainability.  相似文献   
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目的探索差异化培养方案在北京协和医院眼科临床医学博士后学员培养中的实施效果。方法选取2018—2020级北京协和医院眼科临床医学博士后学员为评估对象。根据学员的教育背景和能力水平,制订差异化培养方案和进阶式手术培训体系,横向比较分析临床医学博士后学员与同年级其他学员的理论考核成绩,纵向比较分析临床医学博士后学员连续3年理论与技能综合评估成绩及发展趋势,并通过核心胜任力模型分析学员3年间在职业素养、沟通合作、病人照护、知识技能、教学能力和终生学习6个维度的纵向发展趋势。结果第1年、第3年临床医学博士后学员的理论考核成绩较同年级其他学员高,临床医学博士后学员的理论与技能综合水平逐年提高,第3年临床医学博士后学员6个维度的核心胜任力均得到有效发展。结论差异化培养方案可有效提升临床医学博士后学员的综合水平,为培养高层次复合型医学精英人才作出了积极有益的探索。  相似文献   
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新型冠状病毒肺炎疫情凸显了复合型医学人才缺乏的现状,纵观世界医学教育发展史,高层次复合型医学人才的培养愈发紧迫。锚定加快建设世界重要人才中心和创新高地的战略目标,本文以浙江大学医学教育为例,聚焦与探索新时代高层次复合型临床医学人才的培养模式,包括:(1)优化"非医本科、八年一贯、两段完整"的医学博士培养模式,创新临床医学课程体系;(2)创建临床医学博士后培养体系,整合优质人才和医疗资源的结构与布局,打造高品质学科交叉背景的师资队伍和创新策源地,不仅强化住院医师岗位胜任力和前沿交叉领域开拓潜力,而且保障高层次复合型临床医学人才的可持续发展。培养模式、课程体系、师资队伍和临床教学基地系列改革建设,迭代创新服务于面向世界科技前沿、面向经济主战场、面向国家重大需求、面向人民生命健康的新时代复合型高层次人才强国的战略。  相似文献   
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