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A 4-year, cluster-randomized, controlled childhood obesity prevention study: STOPP.

https://arctichealth.org/en/permalink/ahliterature99038
Source
Int J Obes (Lond). 2009 Apr;33(4):408-17
Publication Type
Article
Date
Apr-2009
Author
C. Marcus
G. Nyberg
A. Nordenfelt
M. Karpmyr
J. Kowalski
U. Ekelund
Author Affiliation
Division of Pediatrics, Karolinska Institutet, Department of Clinical Science, Intervention and Technology, National Childhood Obesity Centre, Stockholm, Sweden. claude.marcus@ki.se
Source
Int J Obes (Lond). 2009 Apr;33(4):408-17
Date
Apr-2009
Language
English
Publication Type
Article
Keywords
Anthropometry
Child
Cluster analysis
Female
Health Promotion - organization & administration
Humans
Longitudinal Studies
Male
Obesity - epidemiology - prevention & control
Overweight - epidemiology - prevention & control
Parents - psychology
Physical Fitness - psychology
Prevalence
Risk Reduction Behavior
School Health Services
Sweden - epidemiology
Abstract
OBJECTIVE: To assess the efficacy of a school-based intervention programme to reduce the prevalence of overweight in 6 to 10-year-old children. DESIGN: Cluster-randomized, controlled study. SUBJECTS: A total of 3135 boys and girls in grades 1-4 were included in the study. METHODS: Ten schools were selected in Stockholm county area and randomized to intervention (n=5) and control (n=5) schools. Low-fat dairy products and whole-grain bread were promoted and all sweets and sweetened drinks were eliminated in intervention schools. Physical activity (PA) was aimed to increase by 30 min day(-1) during school time and sedentary behaviour restricted during after school care time. PA was measured by accelerometry. Eating habits at home were assessed by parental report. Eating disorders were evaluated by self-report. RESULTS: The prevalence of overweight and obesity decreased by 3.2% (from 20.3 to 17.1) in intervention schools compared with an increase of 2.8% (from 16.1 to 18.9) in control schools (P
PubMed ID
19290010 View in PubMed
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The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1--blood pressure measurement, diagnosis and assessment of risk.

https://arctichealth.org/en/permalink/ahliterature151165
Source
Can J Cardiol. 2009 May;25(5):279-86
Publication Type
Article
Date
May-2009
Author
Raj S Padwal
Brenda R Hemmelgarn
Nadia A Khan
Steven Grover
Donald W McKay
Thomas Wilson
Brian Penner
Ellen Burgess
Finlay A McAlister
Peter Bolli
Machael D Hill
Jeff Mahon
Martin G Myers
Carl Abbott
Ernesto L Schiffrin
George Honos
Karen Mann
Guy Tremblay
Alain Milot
Lyne Cloutier
Arun Chockalingam
Simon W Rabkin
Martin Dawes
Rhian M Touyz
Chaim Bell
Kevin D Burns
Marcel Ruzicka
Norman R C Campbell
Michel Vallée
Ramesh Prasad
Marcel Lebel
Sheldon W Tobe
Author Affiliation
Division of General Internal Medicine, University of Alberta, Edmonton, Canada. rpadwal@ualberta.ca
Source
Can J Cardiol. 2009 May;25(5):279-86
Date
May-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antihypertensive Agents - therapeutic use
Blood Pressure Determination - standards
Canada
Clinical Competence
Combined Modality Therapy
Education, Medical, Continuing - standards
Female
Guideline Adherence
Health Promotion - organization & administration
Humans
Hypertension - diagnosis - therapy
Life Style
Male
Middle Aged
Prognosis
Randomized Controlled Trials as Topic
Risk Management
Treatment Outcome
Abstract
To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension.
The diagnosis of hypertension is dependent on appropriate blood pressure measurement, the timely assessment of serially elevated readings, the degree of blood pressure elevation, the method of measurement (office, ambulatory, home) and associated comorbidities. The presence of cardiovascular risk factors and target organ damage should be ascertained to assess global cardiovascular risk and determine the urgency, intensity and type of treatment required.
MEDLINE searches were conducted from November 2007 to October 2008 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed full-text articles only.
Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use of echocardiography in hypertensive individuals are outlined. Key messages include continued emphasis on the expedited, accurate diagnosis of hypertension, the importance of global risk assessment and the need for ongoing monitoring of hypertensive patients to identify incident type 2 diabetes.
All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations were required to be supported by at least 70% of task force members. These guidelines will continue to be updated annually.
Notes
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PubMed ID
19417858 View in PubMed
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The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2--therapy.

https://arctichealth.org/en/permalink/ahliterature151164
Source
Can J Cardiol. 2009 May;25(5):287-98
Publication Type
Article
Date
May-2009
Author
Nadia A Khan
Brenda Hemmelgarn
Robert J Herman
Chaim M Bell
Jeff L Mahon
Lawrence A Leiter
Simon W Rabkin
Michael D Hill
Raj Padwal
Rhian M Touyz
Pierre Larochelle
Ross D Feldman
Ernesto L Schiffrin
Norman R C Campbell
Gordon Moe
Ramesh Prasad
Malcolm O Arnold
Tavis S Campbell
Alain Milot
James A Stone
Charlotte Jones
Richard I Ogilvie
Pavel Hamet
George Fodor
George Carruthers
Kevin D Burns
Marcel Ruzicka
Jacques DeChamplain
George Pylypchuk
Robert Petrella
Jean-Martin Boulanger
Luc Trudeau
Robert A Hegele
Vincent Woo
Phil McFarlane
Michel Vallée
Jonathan Howlett
Simon L Bacon
Patrice Lindsay
Richard E Gilbert
Richard Z Lewanczuk
Sheldon Tobe
Author Affiliation
Division of General Internal Medicine, University of British Columbia, Vancouver, Canada. nakhan@shaw.ca
Source
Can J Cardiol. 2009 May;25(5):287-98
Date
May-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antihypertensive Agents - therapeutic use
Blood Pressure Determination - standards
Canada
Case Management - standards
Combined Modality Therapy
Diet, Sodium-Restricted
Female
Health Promotion - organization & administration
Humans
Hypertension - diagnosis - therapy
Life Style
Male
Middle Aged
Patient Education as Topic
Prognosis
Program Evaluation
Randomized Controlled Trials as Topic
Treatment Outcome
Abstract
To update the evidence-based recommendations for the prevention and management of hypertension in adults for 2009.
For lifestyle and pharmacological interventions, evidence from randomized controlled trials and systematic reviews of trials was preferentially reviewed. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. However, for lifestyle interventions, blood pressure lowering was accepted as a primary outcome given the lack of long-term morbidity and mortality data in this field. Progression of kidney dysfunction was also accepted as a clinically relevant primary outcome among patients with chronic kidney disease.
A Cochrane collaboration librarian conducted an independent MEDLINE search from 2007 to August 2008 to update the 2008 recommendations. To identify additional published studies, reference lists were reviewed and experts were contacted. All relevant articles were reviewed and appraised independently by both content and methodological experts using prespecified levels of evidence.
For lifestyle modifications to prevent and treat hypertension, restrict dietary sodium to less than 2300 mg (100 mmol)/day (and 1500 mg to 2300 mg [65 mmol to 100 mmol]/day in hypertensive patients); perform 30 min to 60 min of aerobic exercise four to seven days per week; maintain a healthy body weight (body mass index 18.5 kg/m(2) to 24.9 kg/m(2)) and waist circumference (smaller than 102 cm for men and smaller than 88 cm for women); limit alcohol consumption to no more than 14 units per week in men or nine units per week in women; follow a diet that is reduced in saturated fat and cholesterol, and that emphasizes fruits, vegetables and low-fat dairy products, dietary and soluble fibre, whole grains and protein from plant sources; and consider stress management in selected individuals with hypertension. For the pharmacological management of hypertension, treatment thresholds and targets should be predicated on by the patient's global atherosclerotic risk, target organ damage and comorbid conditions. Blood pressure should be decreased to lower than 140/90 mmHg in all patients, and to lower than 130/80 mmHg in those with diabetes mellitus or chronic kidney disease. Most patients will require more than one agent to achieve these target blood pressures. Antihypertensive therapy should be considered in all adult patients regardless of age (caution should be exercised in elderly patients who are frail). For adults without compelling indications for other agents, initial therapy should include thiazide diuretics. Other agents appropriate for first-line therapy for diastolic and/or systolic hypertension include angiotensin- converting enzyme (ACE) inhibitors (in patients who are not black), long-acting calcium channel blockers (CCBs), angiotensin receptor antagonists (ARBs) or beta-blockers (in those younger than 60 years of age). A combination of two first-line agents may also be considered as the initial treatment of hypertension if the systolic blood pressure is 20 mmHg above the target or if the diastolic blood pressure is 10 mmHg above the target. The combination of ACE inhibitors and ARBs should not be used. Other agents appropriate for first-line therapy for isolated systolic hypertension include long- acting dihydropyridine CCBs or ARBs. In patients with angina, recent myocardial infarction or heart failure, beta-blockers and ACE inhibitors are recommended as first-line therapy; in patients with cerebrovascular disease, an ACE inhibitor/diuretic combination is preferred; in patients with proteinuric nondiabetic chronic kidney disease, ACE inhibitors or ARBs (if intolerant to ACE inhibitors) are recommended; and in patients with diabetes mellitus, ACE inhibitors or ARBs (or, in patients without albuminuria, thiazides or dihydropyridine CCBs) are appropriate first-line therapies. All hypertensive patients with dyslipidemia should be treated using the thresholds, targets and agents outlined in the Canadian Cardiovascular Society position statement (recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease). Selected high-risk patients with hypertension who do not achieve thresholds for statin therapy according to the position paper should nonetheless receive statin therapy. Once blood pressure is controlled, acetylsalicylic acid therapy should be considered.
All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 95% consensus. These guidelines will continue to be updated annually.
Notes
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PubMed ID
19417859 View in PubMed
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2009 Canadian Hypertension Education Program recommendations: the scientific summary--an annual update.

https://arctichealth.org/en/permalink/ahliterature151166
Source
Can J Cardiol. 2009 May;25(5):271-7
Publication Type
Article
Date
May-2009
Author
Norman R C Campbell
Nadia A Khan
Michael D Hill
Guy Tremblay
Marcel Lebel
Janusz Kaczorowski
Finlay A McAlister
Richard Z Lewanczuk
Sheldon Tobe
Author Affiliation
Department of Medicine, University of Calgary, Calgary, Canada. ncampbel@ucalgary.ca
Source
Can J Cardiol. 2009 May;25(5):271-7
Date
May-2009
Language
English
Publication Type
Article
Keywords
Antihypertensive Agents - therapeutic use
Attitude to Health
Blood Pressure Determination
Canada
Combined Modality Therapy
Diet, Sodium-Restricted
Female
Health Knowledge, Attitudes, Practice
Health Promotion - organization & administration
Humans
Hypertension - diagnosis - therapy
Life Style
Male
Patient Education as Topic
Program Evaluation
Randomized Controlled Trials as Topic
Severity of Illness Index
Abstract
The present report highlights the key messages of the 2009 Canadian Hypertension Education Program (CHEP) recommendations for the management of hypertension and the supporting clinical evidence. In 2009, the CHEP emphasizes the need to improve the control of hypertension in people with diabetes. Intensive reduction in blood pressure (to less than 130/80 mmHg) in people with diabetes leads to significant reductions in mortality rates, disability rates and overall health care system costs, and may lead to improved quality of life. The CHEP recommendations continue to emphasize the important role of patient self-efficacy by promoting lifestyle changes to prevent and control hypertension, and encouraging home measurement of blood pressure. Unfortunately, most Canadians make only minor changes in lifestyle after a diagnosis of hypertension. Routine blood pressure measurement at all appropriate visits, and screening for and management of all cardiovascular risks are key to blood pressure management. Many young hypertensive Canadians with multiple cardiovascular risks are not treated with antihypertensive drugs. This is despite the evidence that individuals with multiple cardiovascular risks and hypertension should be strongly considered for antihypertensive drug therapy regardless of age. In 2009, the CHEP specifically recommends not to combine an angiotensin-converting enzyme inhibitor with an angiotensin receptor blocker in people with uncomplicated hypertension, diabetes (without micro- or macroalbuminuria), chronic kidney disease (without nephropathy [micro- or overt proteinuria]) or ischemic heart disease (without heart failure).
Notes
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PubMed ID
19417857 View in PubMed
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The 2014 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension.

https://arctichealth.org/en/permalink/ahliterature104360
Source
Can J Cardiol. 2014 May;30(5):485-501
Publication Type
Article
Date
May-2014
Author
Kaberi Dasgupta
Robert R Quinn
Kelly B Zarnke
Doreen M Rabi
Pietro Ravani
Stella S Daskalopoulou
Simon W Rabkin
Luc Trudeau
Ross D Feldman
Lyne Cloutier
Ally Prebtani
Robert J Herman
Simon L Bacon
Richard E Gilbert
Marcel Ruzicka
Donald W McKay
Tavis S Campbell
Steven Grover
George Honos
Ernesto L Schiffrin
Peter Bolli
Thomas W Wilson
Patrice Lindsay
Michael D Hill
Shelagh B Coutts
Gord Gubitz
Mark Gelfer
Michel Vallée
G V Ramesh Prasad
Marcel Lebel
Donna McLean
J Malcolm O Arnold
Gordon W Moe
Jonathan G Howlett
Jean-Martin Boulanger
Pierre Larochelle
Lawrence A Leiter
Charlotte Jones
Richard I Ogilvie
Vincent Woo
Janusz Kaczorowski
Kevin D Burns
Robert J Petrella
Swapnil Hiremath
Alain Milot
James A Stone
Denis Drouin
Kim L Lavoie
Maxime Lamarre-Cliche
Guy Tremblay
Pavel Hamet
George Fodor
S George Carruthers
George B Pylypchuk
Ellen Burgess
Richard Lewanczuk
George K Dresser
S Brian Penner
Robert A Hegele
Philip A McFarlane
Milan Khara
Andrew Pipe
Paul Oh
Peter Selby
Mukul Sharma
Debra J Reid
Sheldon W Tobe
Raj S Padwal
Luc Poirier
Author Affiliation
Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Québec, Canada. Electronic address: kaberi.dasgupta@mcgill.ca.
Source
Can J Cardiol. 2014 May;30(5):485-501
Date
May-2014
Language
English
Publication Type
Article
Keywords
Antihypertensive Agents - therapeutic use
Blood pressure
Blood Pressure Determination - standards
Canada
Health Promotion - organization & administration
Humans
Hypertension - diagnosis - drug therapy - prevention & control
Life Style
Patient Education as Topic
Practice Guidelines as Topic
Prognosis
Program Evaluation
Abstract
Herein, updated evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in Canadian adults are detailed. For 2014, 3 existing recommendations were modified and 2 new recommendations were added. The following recommendations were modified: (1) the recommended sodium intake threshold was changed from = 1500 mg (3.75 g of salt) to approximately 2000 mg (5 g of salt) per day; (2) a pharmacotherapy treatment initiation systolic blood pressure threshold of = 160 mm Hg was added in very elderly (age = 80 years) patients who do not have diabetes or target organ damage (systolic blood pressure target in this population remains at
PubMed ID
24786438 View in PubMed
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'About time!' Insights from Research with Pride: a community-student collaboration.

https://arctichealth.org/en/permalink/ahliterature131754
Source
Health Promot Int. 2012 Sep;27(3):372-81
Publication Type
Article
Date
Sep-2012
Author
Kira A Abelsohn
Jessica M Ferne
Kyle A Scanlon
Broden L Giambrone
Sivan B Bomze
Author Affiliation
The 519 Church Street Community Centre, Toronto, Canada. kira.abelsohn@gmail.com
Source
Health Promot Int. 2012 Sep;27(3):372-81
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Community Health Services
Community-Based Participatory Research
Cooperative Behavior
Female
Health Promotion - organization & administration
Healthcare Disparities
Homosexuality
Homosexuality, Female
Homosexuality, Male
Humans
Male
Ontario
Students
Universities
Abstract
Research with Pride (RwP) was a community-student collaborative initiative to promote and build capacity for community-based research exploring health and wellness in lesbian, bisexual, trans and queer (LGBTQ) communities. The event took place at University of Toronto's Dalla Lana School of Public Health (DLSPH) in September 2009, and engaged over 100 students, community members and academic researchers in a full day of discussion, learning and networking. RwP was initiated by a group of graduate students in Health Promotion who identified a gap in resources addressing LGBTQ health, facilitating their further learning and work in this area. By engaging in a partnership with a community service organization serving LGBTQ communities in downtown Toronto, RwP emerges as a key example of the role of community-student partnerships in the pursuit of LGBTQ health promotion. This paper will describe the nature of this partnership, outline its strengths and challenges and emphasize the integral role of community-student partnerships in health promotion initiatives.
PubMed ID
21880613 View in PubMed
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Academic practice-policy partnerships for health promotion research: experiences from three research programs.

https://arctichealth.org/en/permalink/ahliterature259816
Source
Scand J Public Health. 2014 Nov;42(15 Suppl):88-95
Publication Type
Article
Date
Nov-2014
Author
Charli C-G Eriksson
Ingela Fredriksson
Karin Fröding
Susanna Geidne
Camilla Pettersson
Source
Scand J Public Health. 2014 Nov;42(15 Suppl):88-95
Date
Nov-2014
Language
English
Publication Type
Article
Keywords
Administrative Personnel - psychology
Community-Institutional Relations
Cooperative Behavior
Health Personnel - psychology
Health Promotion - organization & administration
Health Services Research - organization & administration
Humans
Program Evaluation
Research Personnel - psychology
Sweden
Abstract
The development of knowledge for health promotion requires an effective mechanism for collaboration between academics, practitioners, and policymakers. The challenge is better to understand the dynamic and ever-changing context of the researcher-practitioner-policymaker-community relationship.
The aims were to explore the factors that foster Academic Practice Policy (APP) partnerships, and to systematically and transparently to review three cases.
Three partnerships were included: Power and Commitment-Alcohol and Drug Prevention by Non-Governmental Organizations in Sweden; Healthy City-Social Inclusion, Urban Governance, and Sustainable Welfare Development; and Empowering Families with Teenagers-Ideals and Reality in Karlskoga and Degerfors. The analysis includes searching for evidence for three hypotheses concerning contextual factors in multi-stakeholder collaboration, and the cumulative effects of partnership synergy.
APP partnerships emerge during different phases of research and development. Contextual factors are important; researchers need to be trusted by practitioners and politicians. During planning, it is important to involve the relevant partners. During the implementation phase, time is important. During data collection and capacity building, it is important to have shared objectives for and dialogues about research. Finally, dissemination needs to be integrated into any partnership. The links between process and outcomes in participatory research (PR) can be described by the theory of partnership synergy, which includes consideration of how PR can ensure culturally and logistically appropriate research, enhance recruitment capacity, and generate professional capacity and competence in stakeholder groups. Moreover, there are PR synergies over time.
The fundamentals of a genuine partnership are communication, collaboration, shared visions, and willingness of all stakeholders to learn from one another.
PubMed ID
25416579 View in PubMed
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[A cardiovascular health promotion program for 9-12 year old children and the community of Saint-Louis du Parc/Quebec].

https://arctichealth.org/en/permalink/ahliterature202967
Source
Sante Publique. 1998 Dec;10(4):425-45
Publication Type
Article
Date
Dec-1998
Author
L. Renaud
J. O'Loughlin
G. Paradis
S. Chevalier
Author Affiliation
Régie régionale de Montréal-Centre, Québec.
Source
Sante Publique. 1998 Dec;10(4):425-45
Date
Dec-1998
Language
French
Publication Type
Article
Keywords
Cardiovascular Diseases - etiology - prevention & control
Child
Child Health Services - organization & administration
Community Health Services - organization & administration
Health Promotion - organization & administration
Humans
Organizational Objectives
Poverty
Program Evaluation
Quebec
Risk factors
Urban Health Services - organization & administration
Abstract
This article presents a programme for cardiovascular health for 9 to 12 years old children, called "Healthy Heart" Saint-Louis du Parc and carried out in low socioeconomic and multiethnic part of Montreal, Quebec, Canada. These five years programme targets were more both spheres: school and community (leisure centre, ethnocultural centre, groceries and other places). We develop the objectives, the conceptual models underlying to the programme, the perspective of work, the infrastructure of the programme: its staff and financing, the partnerships and the structure organising. Then we present the various interventions carried out along the period and so a description of many evaluations. At last, we discuss about the programme continuation.
PubMed ID
10065008 View in PubMed
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Accelerating the workplace health agenda.

https://arctichealth.org/en/permalink/ahliterature142056
Source
Healthc Pap. 2010;10(3):33-7
Publication Type
Article
Date
2010
Author
Louise Lemieux-Charles
Author Affiliation
Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Source
Healthc Pap. 2010;10(3):33-7
Date
2010
Language
English
Publication Type
Article
Keywords
Canada
Health facilities
Health Promotion - organization & administration
Humans
Occupational Health
Abstract
Lowe and Chan's proposal for the development of common work environment metrics is long overdue. The authors' healthy work environment (HWE) framework is evidence based and illustrates the relationships between HWEs and organizational-level outcomes in a succinct yet comprehensive manner. The challenges we face in implementing their framework are related not so much to a fear of change but to a willingness to engage with multiple stakeholders and levels of government in coordinating our efforts. To date, we have lacked, at the policy level, a belief that HWEs can reduce operating costs, improve human resource utilization and, ultimately, lead to higher-quality patient care. We need a framework that will allow us to compare organizational performance in the area of health human resources in the same manner as we compare organizational outcomes in other areas. Such comparisons would allow us to further our understanding of the relationships among care providers, workplaces and organizational outcomes.
PubMed ID
20644350 View in PubMed
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Achieving cardiovascular health through continuing interprofessional development.

https://arctichealth.org/en/permalink/ahliterature190531
Source
Can J Public Health. 2001 Jul-Aug;92(4):I10-6
Publication Type
Article
Author
D M Kaufman
J. McClaran
M. Toombs
S. Beardall
I. Levy
A. Chockalingam
Source
Can J Public Health. 2001 Jul-Aug;92(4):I10-6
Language
English
Publication Type
Article
Keywords
Behavior Therapy - education
Canada
Cardiovascular Diseases - prevention & control
Education, Medical, Continuing
Health Behavior
Health Care Coalitions
Health Promotion - organization & administration
Humans
Life Style
Patient care team
Patient Participation
Public Health
Abstract
In order to achieve cardiovascular health for all Canadians, the ACHIC (Achieving Cardiovascular Health in Canada) partnership advocates that health promotion for healthy lifestyles be incorporated into practice, and that the consistent messages and professional skills required to motivate patients and the public be acquired through interprofessional education and development. Professional education specialists are essential members of health care promotion teams with expertise to develop educational interventions that impact behaviours of health professionals and subsequent patient outcomes. Continuing medical education (CME) is in evolution to continuing professional development (CPD), and then to continuing inter-professional development (CID). Providers of health promotion, public health, and health care can work with health educators to complete the cascade of learning, change in practice, and improvement in patient outcomes. The Canadian health care system can empower Canadians to achieve cardiovascular health, the most important health challenge in the 21st century.
PubMed ID
11962121 View in PubMed
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