Mayo Clinic proceedings. Innovations, quality & outcomes最新文献

{"title":"Employee Dietary Initiative Improved Chronic Symptoms","authors":"Nancy L. Sudak MD ,&nbsp;Melissa L. Harry MSW, PhD","doi":"10.1016/j.mayocpiqo.2024.03.001","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2024.03.001","url":null,"abstract":"<div><p>With the awareness that the Standard American Diet is a critical contributor to chronic diseases, this initiative aimed to assess the effects of a 28-day dietary challenge health care improvement project on health system employee energy level, sleep quality, gastrointestinal function, ability to concentrate, and aches/pains, including the impact of adherence level, during a period of restricted intake of gluten, dairy, and sugar offered annually from 2021 to 2023. A total of 754 employees completed the pre-challenge survey; analyses included 354 employees who completed both pre-challenge and post-challenge surveys in at least 1 year of this project. Wilcoxon signed rank tests compared presurvey and postsurvey responses to self-reported energy level, sleep quality, gastrointestinal function, ability to concentrate, and aches/pains. Analysis of variance with Tukey’s honestly significant difference tests compared self-reported adherence level with change scores, with η² representing effect size. In each challenge year, the mean rank levels of energy, sleep quality, gastrointestinal function, concentration, and aches/pains improved significantly between pre-surveys and post-surveys (all <em>P</em>&lt;.001). Although an association between significant positive change and diet adherence level was found for all items in at least 1 challenge year, those who mostly or completely adhered to the challenge diet restrictions reported significantly greater positive change in energy levels and gastrointestinal symptoms than those who did not or minimally adhered in all challenge years, with small to medium effect sizes. In conclusion, Essentia Health’s employee challenge appeared to improve self-reported outcomes in 5 symptom domains, with energy levels and gastrointestinal symptoms correlating most favorably to adherence to the challenge. These findings have health and cost implications, which could be confirmed by formal research in employee and other populations.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000110/pdfft?md5=02ce49ae4a6be35062abc86901a38bd2&pid=1-s2.0-S2542454824000110-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140345245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy-Associated Cancer: A Systematic Review and Meta-Analysis","authors":"Ben Walters MBChB ,&nbsp;India Midwinter BSc, MBBS ,&nbsp;Carolyn A. Chew-Graham MBChB, MD ,&nbsp;Kelvin P. Jordan PhD ,&nbsp;Garima Sharma MB ,&nbsp;Lucy C. Chappell MB, BCh, PhD ,&nbsp;Emma J. Crosbie MBChB, PhD ,&nbsp;Purvi Parwani MBBS, MPH ,&nbsp;Mamas A. Mamas BM BCh, DPhil ,&nbsp;Pensée Wu MBChB, MD(Res)","doi":"10.1016/j.mayocpiqo.2024.02.002","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2024.02.002","url":null,"abstract":"<div><p>This study aimed to systematically evaluate and quantify the risk of adverse maternal and neonatal outcomes in patients with pregnancy-associated cancer (PAC). This study was conducted from February 13, 2021, through July 24, 2023. A systematic search of MEDLINE, Embase, Web of Science Core Collection, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials was conducted to identify studies reporting outcomes for patients with PAC. The study was registered on PROSPERO. Two reviewers independently conducted screening, data extraction, and quality assessment. The associations were quantified using random-effects meta-analysis. The initial search produced 29,401 titles and abstracts, after which 147 unique full-text articles were screened, of which 22 articles with 59,190 pregnancies with PAC from 70,097,167 births were included in the meta-analysis. Women with PAC were at significantly increased risk of cesarean deliveries (risk ratio [RR], 1.58; 95% CI, 1.31-1.89), preterm birth (RR, 3.07; 95% CI, 2.37-3.98), venous thromboembolism (RR, 6.76; 95% CI, 5.08-8.99), and maternal death (RR, 41.58; 95% CI, 20.38-84.83). The only outcome with reduced risk was instrumental mode of delivery (RR, 0.67; 95% CI, 0.52-0.87). Pregnancy-associated cancer increases risk of adverse outcomes, including a 7-fold risk of venous thromboembolism and a 42-fold risk of maternal death. Further research is required to better understand the mechanisms leading to these adverse outcomes, especially for women who are not diagnosed until the postpartum period. Affected women should have counseling regarding their increased risk of adverse outcomes.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000109/pdfft?md5=169a6d692819e0adfc18b447adb93d25&pid=1-s2.0-S2542454824000109-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140137710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluid and Salt Balance Are Things We Often Overlook: Could Our Understanding of Fluid Dynamics Change How We Tackle Heart failure?","authors":"Shriya Sharma MBBS,&nbsp;Rohan Goswami MD","doi":"10.1016/j.mayocpiqo.2024.02.001","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2024.02.001","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000092/pdfft?md5=35819c16ed5d8de713c78d95544ba8f7&pid=1-s2.0-S2542454824000092-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140052820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lifestyle Factors and Cancer: A Narrative Review","authors":"Reya Sharman MD, MPH ,&nbsp;Zoey Harris MD ,&nbsp;Brenda Ernst MD ,&nbsp;Dawn Mussallem DO ,&nbsp;Ashley Larsen MS ,&nbsp;Krisstina Gowin DO","doi":"10.1016/j.mayocpiqo.2024.01.004","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2024.01.004","url":null,"abstract":"<div><p>Lifestyle factors and their impact on cancer prevention, prognosis, and survivorship are increasingly recognized in the medical literature. Lifestyle factors are primarily defined here as diet and physical activity. We conducted a narrative review of the primary published data, including randomized controlled trials and prospective studies, on the impact of primary lifestyle factors on oncogenesis and clinical outcomes in the preventative and survivorship setting. First, we discuss the oncogenic mechanisms behind primary lifestyle factors (diet, physical activity and, within these 2, obesity). Then, we discuss the impact of adherence to lifestyle guidelines and dietary patterns on cancer incidence based on primary data. Owing to the plethora of published literature, to summarize the data in a more efficient manner, we describe the role of physical activity on cancer incidence using summative systematic reviews. We end by synthesizing the primary data on lifestyle factors in the survivorship setting and conclude with potential future directions. In brief, the various large-scale studies investigating the role diet and physical activity have reported a beneficial effect on cancer prevention and survivorship. Although the impact of single lifestyle factors on cancer incidence risk reduction is generally supported, holistic approaches to address the potential synergistic impact of multiple lifestyle factors together in concert is limited. Future research to identify the potentially synergistic effects of lifestyle modifications on oncogenesis and clinical outcomes is needed, particularly in cancer subtypes beyond colorectal and breast cancers.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000080/pdfft?md5=d0ee4432474cab4ebc217bdcc193ca83&pid=1-s2.0-S2542454824000080-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140031383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promise of Lifestyle Medicine for Heart Disease, Diabetes Mellitus, and Cerebrovascular Diseases","authors":"Aleksandra Pikula MD ,&nbsp;Mahima Gulati MD, MSc ,&nbsp;Jonathan P. Bonnet MD, MPH ,&nbsp;Sarah Ibrahim MN, PhD ,&nbsp;Svetlana Chamoun MD, PhD ,&nbsp;Andrew M. Freeman MD ,&nbsp;Koushik Reddy MD","doi":"10.1016/j.mayocpiqo.2023.11.005","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.11.005","url":null,"abstract":"<div><p>The burden of noncommunicable chronic diseases has relevant and negative consequences to persons, health care systems, and economies worldwide. Chronic diseases are the leading cause of disability and mortality and are responsible for 90% of health care expenditure. The most common chronic diseases are diabetes mellitus (DM), cardiovascular disease, and cerebrovascular disease (stroke and vascular cognitive impairment). Modifiable risk factors (MRFs) for these conditions include hypertension, hyperlipidemia, smoking, poor diet, and low-physical activity; with hypertension being the most prevalent MRF. Most MRFs can be successfully targeted through lifestyle medicine (LSM), which is a medical specialty that addresses the root causes of chronic diseases through its primary, secondary, and tertiary preventative approaches. Lifestyle medicine comprises 6 pillars (nutrition, physical activity, sleep health, stress reduction, social connections, and substance use) which through various behavioral approaches, focus on regular physical activity, healthy eating, good quality and quantity sleep, and meaningful social connections coupled with the reduction of stress and substance use. This paper will briefly review the evidence and promise of individual LSM pillars in addressing the underlying MRFs of DM, cardiovascular and cerebrovascular disease (specifically stroke and vascular cognitive impairment). Lifestyle medicine holds a great promise for comprehensive and much improved population health. However, the adoption of LSM at the societal scale requires a multifaceted approach and widespread integration would galvanize a paradigm shift to prevent, treat or reverse chronic diseases from the root causes and achieve health equity.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000031/pdfft?md5=58d78cea9d5fe151634311a29262b548&pid=1-s2.0-S2542454824000031-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139985022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Series of Minimally Invasive Robotic-Assisted Resection of Cardiac Papillary Fibroelastoma: The Mayo Clinic Experience","authors":"Ali Ahmad MD ,&nbsp;Edward A. El-Am MD ,&nbsp;Piotr Mazur MD, PhD ,&nbsp;Elias Akiki MD ,&nbsp;Ahmed A. Sorour MD ,&nbsp;Reto D. Kurmann MD ,&nbsp;Kyle W. Klarich MD ,&nbsp;Arman Arghami MD, MPH ,&nbsp;Phillip G. Rowse MD ,&nbsp;Richard C. Daly MD ,&nbsp;Joseph A. Dearani MD","doi":"10.1016/j.mayocpiqo.2024.01.001","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2024.01.001","url":null,"abstract":"<div><p>Papillary fibroelastomas (PFEs) are small, slowly growing benign cardiac tumors with clinically significant risk of embolization. Surgical excision is the definitive treatment of symptomatic PFE and is conventionally performed through a median sternotomy. In this study, we report a series of 12 patients, who underwent robotic-assisted PFE removal at the Mayo Clinic. PFE involved the mitral valve, left atrium, and tricuspid valve. No major complications occurred after the procedure, and most patients were discharged 4 days after the surgery. On follow-up, 1 patient demonstrated pericarditis.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000018/pdfft?md5=fd8dda6c79e48af2268a31af1219db9b&pid=1-s2.0-S2542454824000018-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139942255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Exercise in Statin-Associated Muscle Symptoms Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","authors":"Laura A. Mangone MS ,&nbsp;Oh Sung Kwon PhD ,&nbsp;Blair T. Johnson PhD ,&nbsp;Yin Wu PhD ,&nbsp;Linda S. Pescatello PhD","doi":"10.1016/j.mayocpiqo.2024.01.003","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2024.01.003","url":null,"abstract":"<div><h3>Objective</h3><p>To provide a synthesis of randomized controlled trials (RCTs) investigating statin-associated muscle symptoms (SAMS) in adults who underwent exercise training intervention.</p></div><div><h3>Patients and Methods</h3><p>We systematically searched 5 electronic databases for placebo-controlled RCTs through January 31, 2023. We included short-term and long-term exercise interventions that compared the efficacy and safety of exercise+statin vs exercise+placebo in healthy adults and reported SAMS preintervention and postintervention. Publication bias and methodological study quality assessments were performed.</p></div><div><h3>Results</h3><p>Five of 454 potentially qualifying RCTs met the inclusion criteria, all short-term exercise RCTs. Participants were predominantly physically inactive young to middle-aged (M=37.2 y) men (57%), 252 (49%) who were on statin therapy, and 271 (53%) on placebo. Of the 3 RCTs providing qualitative SAMS results, 19 (9%) out of 220 participants reported SAMS on exercise+statin and 10 (4%) out of 234 reported SAMS on exercise+placebo. There was no difference between exercise+statin vs exercise+placebo for maximal oxygen consumption (<em>d</em>=−0.18; 95% CI, −0.37 to 0.00; <em>P</em>=.06) or creatine kinase after short-term exercise (<em>d</em>=0.59; 95% CI, −0.06 to 1.25; <em>P</em>=.08). Participants in the exercise+statin group reduced low-density lipoprotein cholesterol vs exercise+placebo (<em>d</em>=−1.84; 95% CI, −2.28 to −1.39; <em>P</em>&lt;.001). Most of the RCTs exhibited low levels of risk of bias (<em>k</em>=4, 80%) and achieved moderate methodological study quality (75.0%±5.2%).</p></div><div><h3>Conclusion</h3><p>Self-reported SAMs tended to be 5% greater after short-term exercise in statin users compared with placebo, although this difference did not achieve statistical significance. There remains an important need for placebo-controlled RCTs investigating the prevalence of statin-induced SAMS during exercise training.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000043/pdfft?md5=c5586b14864a68487b513e07604c35db&pid=1-s2.0-S2542454824000043-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139898575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Health Clearance Outcomes for Cardiovascular Surgery","authors":"Miao Xian Zhou DMD ,&nbsp;Christopher F. Viozzi MD, DDS ,&nbsp;Ondřej Heneberk ,&nbsp;Sarah K. Lee DDS ,&nbsp;Kyle W. Klarich MD ,&nbsp;Thomas J. Salinas DDS","doi":"10.1016/j.mayocpiqo.2024.01.002","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2024.01.002","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the risk of morbidity and mortality in patients receiving dental extractions before planned cardiovascular surgery (CVS) and examine factors that may affect the chance of oral health clearance.</p></div><div><h3>Patients and Methods</h3><p>A retrospective medical record review was performed of patients who underwent dental screening before CVS from January 1, 2015, to December 31, 2021, at a major medical institution. A total of 496 patients met the inclusion criteria and were divided into 2 groups. Group 1 patients were cleared to advance to planned CVS (n=390). Group 2 patients were not cleared for surgery and subsequently underwent dental extractions before planned CVS (n=106).</p></div><div><h3>Results</h3><p>Six patients (5.7%) experienced postoperative complications after dental extraction that resulted in an emergency room visit. No deaths occurred after dental extraction before CVS. However, 4 patients died within 30 days of CVS, 3 from Group 1 (0.77%) and 1 from Group 2 (0.94%). Dental extraction before planned CVS showed a borderline significant association with death based on unadjusted (<em>P</em>=.06) and age-adjusted analysis (<em>P</em>=.05). Patients who reported seeing a dentist routinely had a significantly higher chance of oral health clearance (<em>P</em> &lt;.001). No differences were noted between the 2 groups with regard to age, sex, or 30-day hospital readmission rate.</p></div><div><h3>Conclusion</h3><p>Patients who had dental extractions completed before planned CVS may be at an increased risk of mortality. Further studies are needed to examine this relationship. Emphasis should be on prioritization of routine dental visits before planned CVS.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S254245482400002X/pdfft?md5=0c853ec792958279280c8bf7548799db&pid=1-s2.0-S254245482400002X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139743832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Foundations of Lifestyle Medicine and its Evolution","authors":"David Lippman MD ,&nbsp;Mariah Stump MD, MPH ,&nbsp;Erica Veazey MD ,&nbsp;Sley Tanigawa Guimarães MD ,&nbsp;Richard Rosenfeld MD, MPH, MBA ,&nbsp;John H. Kelly MD, MPH ,&nbsp;Dean Ornish MD ,&nbsp;David L. Katz MD, MPH","doi":"10.1016/j.mayocpiqo.2023.11.004","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.11.004","url":null,"abstract":"<div><p>Lifestyle Medicine (LM) is a rapidly growing discipline that focuses on the role of lifestyle factors in preventing, managing, and reversing chronic disease. At this point in the field’s evolution, there is strong evidence that the 6 pillars of LM—a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connections—are central in the creation and maintenance of health. Previous publications, many of them randomized controlled studies and meta-analyses, have solidified the evidence base for the use of the 6 pillars within the field of LM. As data emerged, so did its governing body, the American College of Lifestyle Medicine (ACLM), and with it a rich history began to unfold. Several articles have been written on the early history of the ACLM and the growth of the field; however, this review article explores the history and foundation of LM, aiming to provide a comprehensive understanding of its relevance and impact on health care. It underscores landmark studies that have defined the field and provides a road map detailing national and global barriers and areas of potential future growth.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000759/pdfft?md5=a1b46d38f00271da8f9afd56d05f08be&pid=1-s2.0-S2542454823000759-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139503379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Burden of Chronic Disease","authors":"Karen Hacker MD, MPH","doi":"10.1016/j.mayocpiqo.2023.08.005","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.08.005","url":null,"abstract":"<div><p>Chronic diseases like diabetes, heart disease, stroke, and cancer have been and continue to be some of the major causes of worldwide morbidity and mortality. A transition between infectious and noncommunicable diseases occurred in the early 1900s as a result of improved public health and has persisted ever since. Now, as individuals live longer, the prevalence and cost of chronic disease continue to grow. The estimated cost of chronic disease is expected to reach $47 trillion worldwide by 2030. Individual lifestyle and behaviors and community factors play important roles in the development and management of chronic diseases. Many of these conditions (diabetes, heart disease, and respiratory diseases) are preventable, and their leading risk factors are physical inactivity, poor nutrition, tobacco use, and excessive alcohol. Unfortunately, the investment in prevention remains small compared with treatment, both from a lifestyle perspective and a social determinants of health perspective. Given the future trajectory of chronic disease, innovation in technology and pharmaceuticals with a concomitant investment in prevention will be required. Our future depends on it.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000577/pdfft?md5=bd9f441ee6b6f735f943a50213617df8&pid=1-s2.0-S2542454823000577-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139505446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}