Health Tips A to Z

A diet education program must include a nutritional needs assessment, education counseling, and referral as significant.

Educational sessions and materials should include the following information:

• The relationship of nutrition and chronic diseases
• Improving eating patterns
• Relationship of nutrition and proper weight maintenance
• Exercise
• Stress
• Blood Pressure
• Cholesterol
• Diabetes and other chronic diseases.
• Nutritionally accurate information regarding the relationship of health to diet, including cholesterol, fats, fiber, alcohol, carbohydrates, salt, sugar, and vitamin/mineral supplementation.

Methods for identifying healthier foods and incorporating low-calorie, high nutrient foods into eating habits. Guidelines for improving eating habits must be based on or consistent with national recommendations such as The Food Guide Pyramid.

Instructor must be a registered dietitian, registered nurse, or have a baccalaureate degree or higher in health education with training in nutrition. If an allied health professional instructs the program, a consultation and review of the program design by a registered dietitian is recommended.

It is recommended that tobacco cessation programs subscribe to the Code Of Practice for Tobacco Cessation Programs.

Smoking cessation programs must be multi-component with a focus on skills to build beneficial voluntary behavior change practices. Useful techniques include instituting reasons for stopping, understanding the smoking habit, various techniques for stopping and remaining a non-smoker, overcoming the concerns of stopping, short-term objective setting, weight management, stress management, importance of exercise, relationship of alcohol consumption to urges to smoke. Use no aversive or scare tactics.

In programs that use aids such as the “patch” or medications such as “Zyban” appropriate consultation should be available on the usage of these aids.

The instructor ought to have formal training in tobacco cessation from a nationally recognized organization such as American Heart Association, American Cancer Society, American Lung Association, or a nationally recognized commercial program such as Smoke Enders.

Evaluation of success is at times very dubious in smoking cessation programs. Measurement of success must include participation rate, including the number implementing the program, the number completing the program, and the average number per session. Also included, number and percent who stopped smoking at the end of the program, and the number and percent who had not resumed smoking by the end of one year.

Participatory fitness programs ought to include education on benefits of regular exercise and risks of a sedentary lifestyle, its impact on cardiovascular health and diseases, its relationship with weight management and stress management, and aerobic exercise options. Discussion and practice of safe principles of exercise – warm up, cool down, frequency, intensity, duration, flexibility and strength components. The program follows standard procedures by the American College Of Sports Medicine.

Safety precautions should include the following:

• Informed consent prior to starting exercise with clear and complete written and verbal standard procedures of possible risk, purpose of exercise, exercise format to be followed, opportunity for questions, and a signed informed consent with date.
• A screening/assessment of participants to determine if health care assessment is necessary for exercise such as the Physical Activity Readiness Questionnaire (PAR-Q, see forms).
• Measurements of Blood Pressure and resting heart rate are useful assessment information to determine exercise readiness.
• Members who fail screening are medically referred and ought to obtain a written clearance from their physician to exercise.
• The basic content of an aerobic physical activity program should include:

Warm up   5 – 10 minutes
Aerobic exercise   20 – 40 minutes
Cool down   5 – 10 minutes

Exercise instructors should have education and training in exercise physiology, physical education, physical therapy or comparable discipline, or possess a current certification by a nationally recognized sports medicine or exercise association, and be CPR certified.

Program offered is consistent with scientific and medical recommendations for weight loss, reflects a multi-disciplinary approach which offers four components: behavioral, exercise, diet, and maintenance, and is in accordance with the document Guidance For Treatment Of Adult Obesity. It includes:

• Screening to verify that the colleague has no medical or psychological conditions which would make weight loss inappropriate, and to identify the colleague’s level of health risk, classifying participants not only on excess body weight, but also on the basis of associated medical conditions and overriding heath risk.
• Referral for participants who are morbidly obese who would require medical guidance for weight loss.
• Informed consent, explanation of potential physical and psychological risk from weight loss and regain, likely long-term success of program, full cost of the program, credentials of the employee.
• Identification of contributing factors to participant’s weight status, serving as the basis for an individualized weight loss plan which includes the weight goal and plans for nutrition, exercise, and behavioral components.
• Weight goal of participant is reasonable based on personal and family weight history not solely on height and weight charts; initial weight loss goal does not exceed loss of 10% of body weight, 1-2 pounds per week.
• Explanation of unsafe weight loss methods.
• Daily calorie level is adjusted to meet each colleague’s recommended rate of weight loss.
• Daily caloric intake is not less than 1,000 calories; if less, physician monitoring is needed.
• Food plan designed so participants can find foods which meet 100 percent of all the Recommended Daily Allowance (RDA) except for calories. Nutritional supplementation can be used to achieve RDAs, however should not greatly exceed RDAs.
• Nutrition education encouraging permanent healthful eating habits based on The Food Guide Pyramid.
• Participant involved in meal planning and meal selection.

The protein, fat, carbohydrate, and fluid content of the meal plan meet safety recommendations:

Protein   Between 0.8 and 1.5 grams of protein per kilogram of intention body weight, but no more than 100 grams of protein a day.
Fat   10 – 30% calories as fat.
Carbohydrate   At least 100 grams per day.
Fluid   At least one liter of water daily.

• Exercise component ought to be a important portion of the program and be both didactic and experiential.
• Participant is appropriately screened for exercise using a assessment questionnaire such as the Par-Q Readiness Assessment (see forms). Instruction on recognizing untoward responses to exercise.
• Participants work towards 30-60 minutes of exercise 5-7 days per week.
• No appetite suppressant prescription drugs.
• Maintenance plan available for continued backing.
• Weight control programs should be conducted by a registered dietitian or by degreed health professionals with training in nutrition with consultation by a registered dietitian.
• Trained lay leaders may help  if supervised by nutrition professional.

Note: There’s an interactive version of Guidance for the Treatment of Adult Obesity at e-Guidance for the Treatment of Adult Obesity.

A program is required to support appropriate interpretation of blood lipid evaluation results, including a caution that a single measurement neither excludes nor establishes a diagnosis of their blood cholesterol.

Follow national guidelines:

Total Cholesterol
Desirable cholesterol   < 200 mg/dl
Borderline cholesterol   200 – 239 mg/dl
Hypercholesterolemia   > 240 mg/dl

HDL
Desirable HDL    > 35 mg/dl
Low HDL    < 35 mg/dl

Refer blood lipid evaluation participants to health care as follows:

Total Cholesterol
< 200 mg/dl    Recheck cholesterol in five years, if history of coronary heart disease or if two or more CHD risk factors are detected refers to risk reduction program or health professionals, as appropriate.
200 - 239 mg/dl    If history of CHD or if two or more other risk factors are detected, refer to healthcare or risk reduction service within two months; if no reported history of CVD or less than two other risk factors, reassess cholesterol status within 1-2 years.
> 240mg/dl    Refer to medical within two months.

HDL
> 35 mg/dl   If fewer than 2 risk factors and borderline total cholesterol, refer to risk reduction service, as appropriate. Reassess HDL in 1-2 years.

Offer the following:
• The relationship of blood lipids, high Blood Pressure (BP), and other risk factors.
   o Risk factors include: elevated Blood Pressure (BP) 140/90 or higher or on hypertension medication; current tobacco use; family history of premature CHD; diabetes mellitus; age – male > 45 years, female > 55 years or premature menopause without estrogen replacement therapy.
   o Negative risk factor: high HDL 60 mg/dl or greater (subtract one risk factor).
   o Risk factors such as family history, smoking, high fat or other unhealthy diet, and lack of exercise lead to the development of cardiovascular disease (CVD).
• Definitions and causes of elevated blood lipids and HDL, desirable levels, the meaning and limitations of a single measurement, the cause of variability, and the need for multiple measurements prior to diagnosis.
• Wide range of treatment options, including diet (e.g., significance of controlling fat intake less than 30% of total calories from fat, less 10% saturated fats), less than 300 mg. of cholesterol per day, well-balanced diet, weight maintenance or reduction, exercise, and medication.
• Importance of following prescribed treatment and professional advice.

Appropriate medical or allied health professional trained in measurement of Blood Pressure, referral protocols, and delivering educational messages to colleague conducting Blood Pressure programs. These programs are required to follow national instructions.

• National instructions for Blood Pressure (BP) protocols:
   o Calibration of Blood Pressure (BP) quantifying equipment
   be done at least each year.
   o Two or more measurements of colleague’s Blood Pressure must be taken.
   o Referral of participants with elevated Blood Pressure readings to personal physician for further assessment.

• Systolic/Diastolic Follow-Up:
   o Normal:   <130 / <85
      Action: Recheck in 2 years
   o High Normal:   130-139 / 85-90
      Action: Recheck in 1 year

• Hypertension:
   o Stage 1 (Mild):   140-159 / 90-99
      Action: Confirm within 2 Months.
   o Stage 2 (Moderate):   160-179 / 100-109
      Action: Refer to source of care within 1 month.
   o Stage 3 (Severe):   180-209 / 110-119
      Action: Refer to source of care within 1 week.
   o Stage 4 (Very Severe):   >210 / >120
      Action: Refer to source of care immediately.

• Appropriate educational messages:
   o Normal:   <130 systolic and <85 diastolic
      Action: No referral. If on treatment, then inform colleague that Blood Pressure (BP) is under great control today and should continue seeing and following treatment program.
   o High Normal:   130-139 systolic and/or 85-89 diastolic
      Action: Recommend that participant have Blood Pressure rechecked within 1 year unless under treatment. Advise participant that the readings are in a high normal range that needs rechecking. In the interim, suggest that one of the most effective means to reduce Blood Pressure is to bring weight into normal range and to exercise.
   o High:   >140 systolic and/or >90 diastolic
      Action: Refer to physician for further evaluation within 2 months unless the level is within urgent, emergency, or isolated systolic hypertension levels. If already on treatment, advise attendant of readings and need to get Blood Pressure to a goal of 140/90 or less.
   o Isolated Systolic Hypertension:   140-159 systolic and < 90 diastolic in a colleague 65 years of age or older.
      Action: Advise attendant to inform physician of readings at next visit and consider advice regarding weight loss and exercise if appropriate.
   o Urgent:   180-209 systolic and/or 110-119 diastolic
      Action: Recommend obtaining medical care evaluation within 1 week.
   o Emergency:   >210 systolic and/or >120 diastolic
      Action: Obtain immediate healthcare attention.

• Provides the following:
   o Written results, referral instructions, and an explanation of Blood Pressure (BP) levels given to each attendant with individualized counseling, including advice about the interval of time recommended when the attendant ought to be checked again.
   o Utilizes the recommendations in The Fifth Report Of The Joint National Committee on Detection, Assessment and Treatment of High Blood Pressure (BP), March 1994.
   o Written and audiovisual materials that are informative, easy to understand, and useful while containing scientifically accurate information.
   o Relationship of elevated Blood Pressure and other risk factors, such as family history, smoking, high fat and unhealthy diet, lack of exercise, in the development of cardiovascular disease, including stroke, kidney disease, heart attack, and other diseases.
   o Definition and causes of elevated Blood Pressure.
   o Importance of following prescribed treatment.

Health risk evaluation programs must be carried out on a one-on-one basis by trained healthcare professionals. Health risk measures must include the following:

• Blood Pressure (BP) measurements – at least two Blood Pressure (BP) measurements taken during the screening episode, using a mercury sphygmomanometers or regularly calibrated aneroids.
• Blood Pressure (BP) treatment status – ascertain whether the participant is under a doctor’s care, on any medication, on a prescribed diet, or any other sort of treatment for hypertension.
• Blood cholesterol measurement – total cholesterol and HDL-cholesterol taken either using a properly tested and maintained table top blood analyzer offering immediate feedback to the client, or sending blood to a laboratory offering feedback using a method that is as effective as immediate feedback.
• Cholesterol treatment status – determine whether the client is under a doctor’s care, on any medication, on a prescribed diet, or any other type of treatment for elevated blood lipids.
• Obesity – utilize an accepted method for estimating obesity. For example evaluate participants height and weight and use the 1959 Metropolitan Life Height/Weight charts or use Body Mass Index.
   o Identify people 20 percent or more above their ideal weight.
• Smoking status – evaluate whether the attendant currently smokes cigarettes, whether the client has quit or never used tobacco, and the number of cigarettes used tobacco/day.
• Exercise habits – screening questions may be limited to frequency and duration exercise. Do participants exercise in a moderately vigorous fashion at least three times per week for 30 minutes or more.
• Diabetes – whether the client has diabetes, and whether or not it is currently under control. A blood glucose may be also done via finger stick and desk top analyzer. Several manufactures make available cassettes which include blood lipid and glucose measurements.
• Cerebrovascular disease or occlusive PVD – ascertain if the client has had a stroke or other kind of blood vessel disease.
• Family history of cardiovascular disease – ascertain whether any of the participants’ parents or siblings had a heart attack or sudden death due to heart disease before age 55.
• Coronary heart disease – evaluate if the client has had a heart attack or other sort of coronary heart disease.
• Stress – colleague’s assessment of stress in work and/or personal life. A series of well-tested and validated questions assessing levels of stress are available from the Worker Health Program.
• Participant release form (see forms) – A release form is needed in which the attendant authorizes the program to draw blood for testing to send information to the attendant’s medical care provider if medical care risks are identified, and to obtain information from the provider about diagnosis and prescribed treatment.
• Participant interest survey – if an assessment of interest has not been gathered previously, the evaluation activity must assess levels of interest in programs such as: weight management, smoking cessation, fitness or exercise, stress management, diet, self-care, cholesterol control.
• Health education messages – the screener must review with the colleague his/her identified health risks and what they mean to the colleague’s central health, and give the colleague a written record of the Blood Pressure, total cholesterol, and any other physiological measures taken.
• Referral of participants for treatment – participants with elevated risks must be referred to appropriate sources of diagnosis and possible treatment following nationally or locally recognized standard procedures for such referral.

Demographic information must include location of the screening, worksite, client’s name, address, social security number, work and home phone number, sex, race, birthdate, relevant job information (e.g., hourly or salaried), department number, and work shift.

Health Tip – Audio Version – “Tough gymnastics”
Health Tip – Healthy Next Step – Childhood Sports Injuries and Their Prevention: A Guide for Parents with Ideas for Kids (National Institute of Arthritis and Musculoskeletal and Skin Diseases)

Gymnastics is far from risk-free. Researchers who looked at national data on kids say gymnastics results in about 27,000 injuries a year that wind up in emergency rooms.

The most common – 44 percent – were strains and sprains, most commonly in gymnasts ages 12 to 17. Fractures and dislocations were diagnosed about 30 percent of the time, most commonly in gymnasts ages 6 to 11.

Lara McKenzie at Nationwide Children’s Hospital in Columbus, Ohio:

“We may be able to prevent and reduce the number of gymnastics-related injuries if we were to establish a uniform set of rules and regulations for gymnasts, trainers and coaches.’’

The study was in the American Academy of Pediatrics’ journal Pediatrics. One researcher received funds from a training program supported by the National Institutes of Health.

Health Tip courtesy of the U.S. Department of Health and Human Services.

Last revised: April, 07 2008

Health Tip – Audio Version – “One cigarette, two hearts”
Health Tip – Healthy Next Step – Smoking (National Institute of Environmental Health Sciences)

If you’re pregnant, smoking can hurt two hearts.

Smoking increases the risk of lung cancer and heart disease in adults. And research suggests babies of moms who smoke have a higher risk of congenital heart defects, which are abnormalities in the structure of the heart found at birth.

The study in the journal Pediatrics found septal heart defects – a tiny hole inside the heart – were more common among infants whose mothers smoked around the time they conceived. And the more Mom smoked, the higher the risk.

Sadia Malik with the University of Arkansas for Medical Sciences suggests:

“Since half the pregnancies in the U.S. are unplanned, by not smoking, you ensure the health of your unborn child.”

The study was supported by the Centers for Disease Control and Prevention and the National Institutes of Health.

Health Tip courtesy of the U.S. Department of Health and Human Services.

Last revised: April, 08 2008

Program directors or providers should have a background in wellness programming and a professional health-related degree or certification. They should have expertise in content areas, planning, promotion, administration, assessment, and ability to grow a program and tailor the program to the worksite.

Program providers ought to have a quality assurance program for evaluating the performance of service personnel, to evaluate satisfaction of participants, and for personnel training and continuing education.

An overriding policy statement ought to be available from directors and program vendors discussing the following concerns: assurance of confidentiality of health data, referral to medical care for at-risk participants, follow-up with referred participants and those at-risk, program assessment on process and outcomes, employer of the workplace for promotion of wellness and changes in corporate culture. A clear contract or letter of agreement for services ought to be given.