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      Clinical prevention and population health : Curriculum framework for health professions


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          The Clinical Prevention and Population Health Curriculum Framework is the initial product of the Healthy People Curriculum Task Force convened by the Association of Teachers of Preventive Medicine and the Association of Academic Health Centers. The Task Force includes representatives of allopathic and osteopathic medicine, nursing and nurse practitioners, dentistry, pharmacy, and physician assistants. The Task Force aims to accomplish the Healthy People 2010 goal of increasing the prevention content of clinical health professional education. The Curriculum Framework provides a structure for organizing curriculum, monitoring curriculum, and communicating within and among professions. The Framework contains four components: evidence base for practice, clinical preventive services–health promotion, health systems and health policy, and community aspects of practice. The full Framework includes 19 domains. The title “Clinical Prevention and Population Health” has been carefully chosen to include both individual- and population-oriented prevention efforts. It is recommended that all participating clinical health professions use this title when referring to this area of curriculum. The Task Force recommends that each profession systematically determine whether appropriate items in the Curriculum Framework are included in its standardized examinations for licensure and certification and for program accreditation.

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          Actual causes of death in the United States.

          To identify and quantify the major external (nongenetic) factors that contribute to death in the United States. Articles published between 1977 and 1993 were identified through MEDLINE searches, reference citations, and expert consultation. Government reports and complications of vital statistics and surveillance data were also obtained. Sources selected were those that were often cited and those that indicated a quantitative assessment of the relative contributions of various factors to mortality and morbidity. Data used were those for which specific methodological assumptions were stated. A table quantifying the contributions of leading factors was constructed using actual counts, generally accepted estimates, and calculated estimates that were developed by summing various individual estimates and correcting to avoid double counting. For the factors of greatest complexity and uncertainty (diet and activity patterns and toxic agents), a conservative approach was taken by choosing the lower boundaries of the various estimates. The most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400,000 deaths), diet and activity patterns (300,000), alcohol (100,000), microbial agents (90,000), toxic agents (60,000), firearms (35,000), sexual behavior (30,000), motor vehicles (25,000), and illicit use of drugs (20,000). Socioeconomic status and access to medical care are also important contributors, but difficult to quantify independent of the other factors cited. Because the studies reviewed used different approaches to derive estimates, the stated numbers should be viewed as first approximations. Approximately half of all deaths that occurred in 1990 could be attributed to the factors identified. Although no attempt was made to further quantify the impact of these factors on morbidity and quality of life, the public health burden they impose is considerable and offers guidance for shaping health policy priorities.
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            Mortality and morbidity attributable to use of addictive substances in the United States.

            Addiction to tobacco, alcohol, and other drugs inflicts a substantial toll on Americans, measurable in terms of deaths and illnesses, social costs, and economic costs. With approximately 60 million smokers, 14 million dependent on alcohol, and 14 million users of illicit drugs, more than one fourth of Americans over age 15 has a physiological dependence on at least one addictive substance. As a result, nearly 590,000 deaths--about a quarter of all deaths in the United States--are caused by addictive substances: 105,000 from alcohol abuse, 446,000 from tobacco use, and 39,000 from addictive drugs in 1995. The magnitude of addiction's impact on morbidity is also great, causing approximately 40 million illnesses and injuries each year. The economic burden of addiction is estimated at greater than $400 billion every year, including health care costs, lost worker productivity, and crime. Less quantifiable, but equally important, are the social costs to families and communities of addiction. Children of substance-abusing parents are more likely as adults to become plagued by addiction and its related problems. Passive exposure to tobacco smoke affects nonsmokers; drug and alcohol abuse are risk factors for crime and incarceration, family violence, fatal and permanently disabling accidents, birth defects, and divorce. Combined, the effects of tobacco, alcohol, and drugs inflict a greater toll on the health and well-being of Americans than any other single preventable factor.
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              Prevention for the 21st century: setting the context through undergraduate medical education.

              The generation of medical students now being taught will be practicing into the middle of the next century. They will be expected to provide an expanding array of clinical preventive services and be responsible for the health and well-being of entire populations and communities. Although prevention principles are being taught in many contexts, most medical schools do not have adequate curriculum-tracking systems that allow them to track the delivery of education and training in disease prevention and health promotion. The Bureau of Health Professions of the Health Resources and Services Administration (HRSA) and the Association of Teachers of Preventive Medicine have worked on several projects that have culminated in the development of a set of core competencies in preventive medicine for undergraduate medical education. In 1997 they convened a task force of medical educators from a broad array of basic science and clinical disciplines representing major U.S. medical teaching societies. The task force reviewed and updated the 1984 Inventory of Knowledge and Skills Relating to Disease Prevention and Health Promotion so that it would be relevant to faculty in diverse specialty areas and could be integrated throughout the medical curriculum. They then created a list of competencies that are essential from the perspective of each discipline and all disciplines. The article gives the context for teaching preventive medicine, presents the core competencies, and serves as the introduction to a supplement to Academic Medicine on teaching preventive medicine throughout the undergraduate medical curriculum.

                Author and article information

                Am J Prev Med
                Am J Prev Med
                American Journal of Preventive Medicine
                American Journal of Preventive Medicine. Published by Elsevier Inc.
                17 November 2004
                December 2004
                17 November 2004
                : 27
                : 5
                : 471-476
                [a ]American Association of Colleges of Nursing (Allan, Stanley)
                [b ]Association of Physician Assistant Programs (Barwick, Cawley)
                [c ]Community-Campus Partnerships for Health (Cashman, Seifer)
                [d ]Student Health Alliance (Day)
                [e ]American Dental Education Association (Douglass, Timothe)
                [f ]Association of Academic Health Centers (Evans)
                [g ]Association of Teachers of Preventive Medicine (Garr, Riegelman)
                [h ]Association of American Medical Colleges (Maeshiro)
                [i ]American Association of Colleges of Pharmacy (McCarthy, Meyer)
                [j ]National Organization of Nurse Practitioner Faculties (Swenson, Werner)
                [k ]American Association of Colleges of Osteopathic Medicine (Teitelbaum, Wood)
                Author notes
                [* ]Address correspondence and reprint requests to: Richard Riegelman MD, PhD, George Washington University School of Public Health and Health Services, 2300 Eye Street NW, Washington DC 20037 sphrkr@ 123456gwumc.edu
                Copyright © 2004 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.




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