Reviewing the Reviewer: Medical Student Course Feedback as a Marker of Professional Identity Formation.

Professional identity formation refers to the process by which medical trainees develop and internalize their new roles. In this work, we analyze medical student evaluations of teaching (SETs) as a window into students' developing identities as physicians. Our data consisted of 389 open-ended comments written anonymously by first-year (pre-clerkship) students in mid- and end-of-semester evaluations of small group sessions (mandatory attendance) during one full academic year at Yale School of Medicine.

Cognitive Impairment and Cardiovascular Disease: A Comparison of Risk Factors, Disability, Quality of Life, and Access to Health Care.

Objectives: Cognitive difficulties or impairment may be an early step in the development of dementia. Several modifiable risk factors for cardiovascular disease (CVD) may also increase the risk of dementia. The objective of our study was to compare adults with subjective cognitive impairment (SCI), using the Behavioral Risk Factor Surveillance System (BRFSS) cognitive disability measure, with adults who reported CVD.

The impact of key modifiable risk factors on leading chronic conditions.

We studied associations between 7 cardiovascular disease (CVD) risk factors (RFs) and 9 chronic conditions and estimated population-attributable risk. Data (N = 358,218) were from the 2017 Behavioral Risk Factor Surveillance System. Outcomes included asthma, arthritis, chronic obstructive pulmonary disease (COPD), cognitive impairment, CVD, and kidney disease.

Linear association between number of modifiable risk factors and multiple chronic conditions: Results from the Behavioral Risk Factor Surveillance System.

Multiple (≥2) chronic conditions (MCCs) are responsible for a large fraction of healthcare costs. Our aim was to examine possible associations between MCCs and composite measures of behavioral risk factors (RFs). Data were publicly available 2013 Behavioral Risk Factor Surveillance System and included 483,865 non-institutionalized US adults ages ≥18years.

A healthy lifestyle composite measure: Significance and potential uses.

Objectives: Our objective was to create and explore potential uses of a composite "Healthy Lifestyle" measure based on Healthy People 2020 (HP2020) Objectives for behaviors shown to be associated with morbidity and mortality.

Methods: Data were from the 2013 Behavioral Risk Factor Surveillance System (N=412,942) on five modifiable behaviors with HP2020 Objectives (leisure time exercise, eating fruits and vegetables 5 or more times/day, getting ≥7h of sleep/24h, not smoking and not drinking excessively). These indicators were combined to form an all-or-none composite Healthy Lifestyle (HLS) measure.

Polling places, pharmacies, and public health: Vote & Vax 2012.

US national elections, which draw sizable numbers of older voters, take place during flu-shot season and represent an untapped opportunity for large-scale delivery of vaccinations. In 2012, Vote & Vax deployed a total of 1585 clinics in 48 states; Washington, DC; Guam; Puerto Rico; and the US Virgin Islands. Approximately 934 clinics were located in pharmacies, and 651 were near polling places.

Clinical and community delivery systems for preventive care: an integration framework.

Although clinical preventive services (CPS)-screening tests, immunizations, health behavior counseling, and preventive medications-can save lives, Americans receive only half of recommended services. This "prevention gap," if closed, could substantially reduce morbidity and mortality. Opportunities to improve delivery of CPS exist in both clinical and community settings, but these activities are rarely coordinated across these settings, resulting in inefficiencies and attenuated benefits.

Vaccinations and preventive screening services for older adults: opportunities and challenges in the USA.

Vaccinations and disease-screening services occupy an important position within the constellation of interventions designed to prevent, forestall or mitigate illness: they straddle the worlds of clinical medicine and public health. This paper focuses on a set of clinical preventive services that are recommended in the USA for adults aged 65 and older, based on their age and gender. These services include immunisations against influenza and pneumococcal disease, and screening for colorectal and breast cancers.

Developing an integrated strategy to reduce ethnic and racial disparities in the delivery of clinical preventive services for older Americans.

Objectives: To determine the optimum strategy for increasing up-to-date (UTD) levels in older Americans, while reducing disparities between White, Black, and Hispanic adults, aged 65 years and older.

Methods: Data were analyzed from the 2008 Behavioral Risk Factor Surveillance System, quantifying the proportion of older Americans UTD with influenza and pneumococcal vaccinations, mammograms, Papanicolaou tests, and colorectal cancer screening. A comparison of projected changes in UTD levels and disparities was ascertained by numerically accounting for UTD adults lacking 1 or more clinical preventive services (CPS).

Clinical preventive services for older adults: the interface between personal health care and public health services.

Healthy aging must become a priority objective for both population and personal health services, and will require innovative prevention programming to span those systems. Uptake of essential clinical preventive services is currently suboptimal among adults, owing to a number of system- and office-based care barriers. To achieve maximum health results, prevention must be integrated across community and clinical settings.

Routine checkups don't ensure that seniors get preventive services.

Background: A small number of preventive services are recommended for all adults ages 65 years and older. It is well established that the combined delivery or being “up to date” on these measures is low. However, the effect of routine checkups on being up to date is not known.

The Vote and Vax program: public health at polling places.

Although influenza-associated illness is a major cause of hospitalizations and death among older Americans, only half of adults aged 50 or older-for whom influenza vaccinations are recommended-receive an annual influenza vaccination. National elections, which draw a large number of older voters, take place during influenza vaccination season and represent an untapped opportunity for large-scale delivery of vaccinations. In 2006, the Robert Wood Johnson Foundation launched a program to evaluate the feasibility of delivering influenza vaccinations near polling places.

Delivery of preventive services to adults aged 50-64: monitoring performance using a composite measure, 1997-2004.

Objective: Population-based rates for the delivery of adult vaccinations or screenings are typically tracked as individual services. The current approach is useful in monitoring progress toward national health goals but does not yield information regarding how many U.S.

Expanding the delivery of clinical preventive services through community collaboration: the SPARC model.

Background: Population-based rates of adult vaccinations and cancer screenings are low, with less than 40% of older adults up to date with routinely recommended prevention services. Delivery rates are lower still in poor and minority communities.

Context: During the past 10 years, Sickness Prevention Achieved through Regional Collaboration (SPARC), a New England-based nonprofit agency, has developed a promising model for increasing community-wide delivery of prevention services.

Routine preventive services for older women: a composite measure highlights gaps in delivery.

Background: We used a composite measure to examine the delivery of routine clinical preventive services to U.S. women aged 50-64 years and > or =65 years in 2004.

Receipt of preventive services by elders based on composite measures, 1997-2004.

Background: The receipt of routine vaccinations and cancer screening is typically tracked separately. Monitoring trends in this way does not measure the overall protection conferred by these services on a target population.

Design: Telephone surveys were conducted in 1997, 2002, and 2004 as part of the Behavioral Risk Factor Surveillance System.

Putting prevention in its place: the shift from clinic to community.

Despite widespread insurance coverage for adult vaccinations, cancer screening, and cardiovascular disease prevention measures, most U.S. adults are not up to date with these routine services.

Are older adults up-to-date with cancer screening and vaccinations?

Introduction: Public health organizations in the United States emphasize the importance of providing routine screening for breast cancer, cervical cancer, and colorectal cancer, as well as vaccinations against influenza and pneumococcal disease among older adults. We report a composite measure of adults aged 50 years and older who receive recommended cancer screening services and vaccinations.

Methods: We analyzed state data from the 2002 Behavioral Risk Factor Surveillance System, which included 105,860 respondents aged 50 and older.

Validation of self-reported pneumococcal vaccination in behavioral risk factor surveillance surveys: experience from the sickness prevention achieved through regional collaboration (SPARC) program.

Behavioral risk factor surveillance system (BRFSS) is the primary surveillance tool for the ongoing measurement of state-specific delivery of pneumococcal polysaccharide vaccine. This study is the first validity assessment of self-reported pneumococcal vaccination status in a population-wide BRFSS survey. A subset of respondents to the sickness prevention achieved through regional collaboration (SPARC) BRFSS survey, which was conducted from June to September 1997 in a four-county area were assessed.