Internal medicine residency training for unhealthy alcohol and other drug use: recommendations for curriculum design

<p>Abstract</p> <p>Background</p> <p>Unhealthy substance use is the spectrum from use that risks harm, to use associated with problems, to the diagnosable conditions of substance abuse and dependence, often referred to as substance abuse disorders. Despite the prevalence and impact of unhealthy substance use, medical education in this area remains lacking, not providing physicians with the necessary expertise to effectively address one of the most common and costly health conditions. Medical educators have begun to address the need for physician training in unhealthy substance use, and formal curricula have been developed and evaluated, though broad integration into busy residency curricula remains a challenge.</p> <p>Discussion</p> <p>We review the development of unhealthy substance use related competencies, and describe a curriculum in unhealthy substance use that integrates these competencies into internal medicine resident physician training. We outline strategies to facilitate adoption of such curricula by the residency programs. This paper provides an outline for the actual implementation of the curriculum within the structure of a training program, with examples using common teaching venues. We describe and link the content to the core competencies mandated by the Accreditation Council for Graduate Medical Education, the formal accrediting body for residency training programs in the United States. Specific topics are recommended, with suggestions on how to integrate such teaching into existing internal medicine residency training program curricula.</p> <p>Summary</p> <p>Given the burden of disease and effective interventions available that can be delivered by internal medicine physicians, teaching about unhealthy substance use must be incorporated into internal medicine residency training, and can be done within existing teaching venues.</p

Towards a sedentary society: trends in adolescent sport practice in Switzerland (1993-2002).

The rate of overweight and obese children and adolescents is rapidly increasing in developed countries. Although a decrease in sport practice may be one of the several factors implicated, data on recent trends are scarce. This article presents the trends in sport practice among Swiss adolescents between 1993 and 2002, comparing data from two surveys

Secular trends in legal and illegal substance use among 16 to 20 year old adolescents in Switzerland.

Data targeting trends in legal and illegal substance use by adolescents are scarce. Using the data from two similar large national surveys run in 1993 and 2002, this paper assesses secular trends in rates of substance use among 16-20-year-old Swiss adolescents. Self-reported regular use of tobacco, alcohol misuse, regular cannabis use (01 occasion over last 30 days) and lifetime use of psychoactive medication, LSD, ecstasy, cocaine and heroine were assessed through identical questions using an anonymous self-administered questionnaire. 9268 (1993) and 7428 (2002) high school students and apprentices were included in the analyses. There is a higher proportion of regular smokers among apprentices than among students (p &lt;0.001). Between 1993 and 2002 the increase in regular tobacco consumption was significant among both female and male apprentices (p &lt;0.001) but not among students. Between 1993 and 2002 alcohol misuse significantly increased in all four groups (p &lt;0.001). It is more prevalent among males than among females (p &lt;0.001) and higher among apprentices than among students (p &lt;0.001). Regular use of cannabis has increased in the four groups (p &lt;0.0001). It is higher among males than among females (p &lt;0.001), while it is largely the same among students and apprentices. While the increase in ecstasy use is highly significant in all four groups (p &lt;0.001), the increase in LSD and cocaine use is significant among apprentices only (p &lt;0.001). Use of LSD, ecstasy and cocaine is more prevalent among males than among females (&lt;0.001) and higher among apprentices than among students (p &lt;0.001). The secular increase in psychoactive substance use among older Swiss adolescents calls for the implementation of effective strategies both from individual and public health viewpoints

Role of high normal gamma-glutamyltransferase level in identifying heavy alcohol use in young men.

The objective of the current study was to determine the predictive value of high normal gamma-glutamyltransferase (GGT) level as an indication of heavy drinking in young men. In a sample of 577 men attending a one-day army recruitment process mandatory for all Swiss men at age 19 years, GGT level was evaluated as the dependent variable for each of eight dichotomous classifications of individuals on the basis of meeting cut-off criteria for five indexes of alcohol use, two indexes of alcohol-related problems, and one index of body mass. The sensitivity, specificity, and predictive values of GGT level in identifying subjects as either heavy drinkers or being overweight were determined. Compared with findings for their counterparts, GGT level was higher in subjects reporting consumption of more than 14 drinks per week (20.5 +/- 7.81 vs. 18.9 +/- 7.60, P &lt;.05), in those reporting being drunk at least once during the past 30 days (20.3 +/- 7.80 vs. 18.3 +/- 7.43, P &lt;.001), and in individuals with body mass indexes &gt;or=25 kg/m(2) (25.8 +/- 10.84 vs. 18.3 +/- 6.59, P &lt;.001). At a GGT level cut-off of 20 U/l, the sensitivity, specificity, and positive and negative predictive values of either being a heavy drinker or overweight were 48.2%, 70.2%, 67.7%, and 51.2%, respectively. Exclusion of subjects with body mass indexes of &gt;or=25 kg/m(2) revealed similar results. High normal GGT level in young men is indicative of heavy alcohol use or being overweight; when present, subjects should be screened further for potential concomitant drinking problems