Planning, Development, and Implementation of a University-Led, Low-Cost Employee Wellness Program in a preK-12th-Grade Public School District.

BACKGROUND: A healthy preK-12th-grade school environment is critical to student well-being and success. As role models, school employees play a significant part in creating a healthy environment. Research suggests that employee wellness programs (EWPs) may help school employees adopt healthier lifestyles and, therefore, be healthier, more productive, and serve as healthy role models for students. This article describes the process by which a school district in central Texas partnered with a local university to plan, develop, and implement an affordable EWP. METHODS: A university-led leadership team sought input from employees, including administrators, and conducted a 4-week trial. These resulted in an EWP that provided health risk appraisals, fitness testing, group exercise classes, education seminars, online wellness resources, and blood draws/analysis. RESULTS: During the first 4 years, membership ranged from 107 to 384 (10-37%), and the annual cost of the program ranged from $49 to $116 per participating employee. CONCLUSIONS: University-led EWP programs can support, at a low cost, the health of school employees. Despite low employee engagement, need was demonstrated and feedback was positive. Challenges identified include time demands and lack of principals' support. Future considerations include targeting principals, utilizing the Human Resources Office, and strategically building a culture of health.

Influences on Catered Event Ordering in a University Workplace: Development and Validation of the Understanding Food Ordering Survey.

PURPOSE: To develop and validate an instrument to identify factors that influence what is ordered for catered events for employees at a large university. DESIGN: Themes derived from focus groups were used to develop a survey. SETTING: A large public university in central Texas. SUBJECTS: Twenty-seven administrative assistants who order food participated in focus groups, 138 completed the survey, and 31 completed the survey a second time. MEASURES: One hundred fourteen-question, 5-point Likert scale survey. ANALYSIS: Principal component analyses explored constructs. Confirmatory factor analysis confirmed structure validity. Test -retest analyses assessed reliability. RESULTS: The final survey, the Understanding Food Ordering Survey (UFO), included 19 items within 3 factors; all factor loadings were above 0.3, with no cross-loadings. Three factors explained 55.5% of the variance. Cronbach α values of .846 for social influences from supervisors/coworkers, .838 for restrictions on ordering due to policies/vendors/attendee feedback, .893 for personal views about nutrition, and .831 for the total affirmed reliability. Test-retest reliability was acceptable ( r = 0.780), and paired samples t test indicated no differences between assessments, mean difference = -0.062, standard deviation = 0.29, t (30) = -1.18, P = .247. Structure equation modeling indicated a good fit between the proposed 3-factor model and observed data, with comparative fit index = 0.921 and root means square error of approximation = 0.074. CONCLUSION: Interventions to improve the nutritional quality of foods selected for catering may benefit from addressing contributory factors while considering a top-down approach to changing the workplace culture.

Genesis of an Employee Wellness Program at a Large University.

University employee wellness programs have potential to support positive changes in employee health, thereby improving productivity and mitigating the rise in health care costs. The purpose of this article is to describe a theory-driven approach to systematically planning, developing, and implementing a comprehensive university employee wellness program. Long-term program goals were to improve employee health, well-being, and productivity by focusing on decreasing sedentary behavior, increasing physical activity, improving dietary habits, and reducing stress. An ecological approach was taken to identify levels of influence specific to a university setting: intrapersonal, interpersonal, department/college/division, and university. This framework guided the development of program components and strategies, which were grounded in several health behavior change theories. Input from supervisors and employees was incorporated throughout program development. A 15-week trial run, involving 514 employees, was evaluated to fine-tune services. Participation and feedback were positive, demonstrating that the program was valued. Support from upper administration is evidenced by continued funding. Critical factors to the successful launch of the program included a supportive administration, leverage of existing facilities and equipment, leadership provided by faculty, and service delivery by students.

Validation and reliability testing of the EORTC QLQ-NMIBC24 questionnaire module to assess patient-reported outcomes in non-muscle-invasive bladder cancer.

BACKGROUND: Well-developed and well-tested patient-reported outcome measures for non-muscle-invasive bladder cancer (NMIBC) are required. OBJECTIVE: To test and adapt the scale structure and explore the psychometric properties of the European Organisation for Research and Treatment of Cancer (EORTC) questionnaire for NMIBC. DESIGN, SETTING, AND PARTICIPANTS: A total of 433 patients in the Bladder COX-2 Inhibition Trial (BOXIT) completed the EORTC QLQ-C30 and NMIBC questionnaires. BOXIT is evaluating the addition of celecoxib to standard treatment in high- and intermediate-risk NMIBC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multitrait scaling investigated and adapted the questionnaire scale structure and evaluated the reliability and validity of the revised scales, as well as responsiveness to change. RESULTS AND LIMITATIONS: A total of 410 patients (94.7%) (79.3% men, 74.6% high risk) returned baseline forms, and the questionnaire response rate was 88.2%. Multitrait scaling confirmed six scales and five single items. Scales and items demonstrated significant differences between patients with good and poor performance status scores (p<0.001). Men reported better sexual function than women (p<0.001). Scale and single-item module scores were not highly correlated with QLQ-C30 scores (evidence of discriminant validity), and the module was responsive to changes in health over time. International and test-retest data are required. CONCLUSIONS: This study demonstrates the evidence-driven adapted scale structure and psychometric data of the EORTC QLQ-NMIBC24 module to use in clinical trials of patients with high- or intermediate-risk bladder cancer.

Is the Polar F6 heart rate monitor less accurate during aerobic bench stepping because of arm movements?

Because of the well-documented linear relationship between heart rate and oxygen consumption (VO2), heart rate is commonly used to estimate energy expenditure during exercise. However, previous research suggests that heart rate increases without a concomitant rise in VO2 when arm movements are added to exercise. If so, this could impact the accuracy of heart rate monitors in estimating energy expenditure during combined arm and leg exercise. This study compared the cardiorespiratory responses to a bench step aerobics routine performed with and without arm movements and evaluated whether the accuracy of the Polar F6 heart rate monitor in predicting energy expenditure was impacted by the inclusion of arm movements. Thirty-two women performed the same routine with and without arm movements while stepping up and down off of a 15.24-cm bench at a cadence of 128 b·min-1. Heart rate and VO2 increased, whereas oxygen pulse (VO2·heart rate-1) decreased when arm movements were added (p < 0.001). However, the differences between the energy expenditure estimated by the Polar F6 heart rate monitor and the energy expenditure measured by indirect calorimetry were similar during the same aerobic bench stepping routine performed with and without arms (Δ∼2 kCal·min-1, p ≥ 0.05). Results confirm that arm movements during aerobic bench stepping elicit a disproportionate rise in heart rate relative to V[Combining Dot Above]O2. However, results do not support that these movements increase the prediction error in energy expenditure, as the Polar F6 heart rate monitor over predicted energy expenditure when arm movements were involved and when they were not involved.

The impact of seasonality on changes in body weight and physical activity in Mexican-American women.

This 12-month, longitudinal panel study examined seasonal variability in body weight and physical activity in Mexican-American women. Fifty-nine women (20 to 63 years of age) were measured five times at intervals of three months between March 2010 and March 2011. Complete data were collected for all measures at all times on 36 women. Repeated measures multivariate analysis of variance with follow-up univariate repeated measures analysis of variance revealed that body weight increased on average by 1.36 kg (p < .01), with the greatest increase occurring during the fall (+0.80 kg). Changes in vigorous-intensity aerobic activity were statistically significant, with the greatest increase occurring in the spring (+51.99 min/week) and the greatest decline occurring in the fall (-30.11 min/week). Significant changes were observed in muscle-strengthening activity during the summer (-32.38 min/week). Moderate-intensity aerobic activity remained relatively stable. The decline in muscle-strengthening activity during the summer and subsequent decline in vigorous-intensity aerobic activity in the fall likely led to the observed increase in body weight during the fall. Thus, weight management interventions should consider the time of year when Mexican-American women's physical activity declines and include strategies specifically designed to prevent weight gain during the fall season.

Risk factors and outcomes of Candida krusei bloodstream infection: a matched, case-control study.

OBJECTIVES: To investigate the risk factors and outcomes associated with Candida krusei bloodstream. METHODS: We performed a case control study of patients with C. krusei bloodstream infection at the University of Pennsylvania from 1982 to 2010. Controls were without candidemia, and matched to cases on duration of hospitalization and underlying disease. RESULTS: We enrolled 34 cases and 114 matched controls. Most subjects (62%) had hematologic malignancies. In the multivariate model, including a priori the duration of fluconazole use (OR 1.06; 95% CI 1.00, 1.11) and days of neutropenia (OR 1.01; 95% CI 0.98, 1.13), risk factors associated with C. krusei bloodstream infection were splenectomy (OR 11.66; 95% CI 1.04, 130.64), and exposure to antimicrobials with anaerobic activity (OR 5.74; 95% CI 1.76, 18.67). Outcomes of infected patients were poor. Only 32% of case patients survived to hospital discharge, compared to 89% of controls. For 48% death was attributed to C. krusei infection. CONCLUSIONS: C. krusei bloodstream infection occurs most commonly in neutropenic patients with hematologic malignancy. The association with prior fluconazole exposure is less marked than previously described. Splenectomy and the receipt of antimicrobials with anaerobic activity are significant risk factors. The outcome of infected patients remains poor, despite appropriate antifungal therapy.

The effects of regular yoga practice on pulmonary function in healthy individuals: a literature review.

OBJECTIVES: Yoga is a popular form of exercise in the Western world, and yoga's effects on pulmonary function have been investigated previously. The purpose of this article is to review this research systematically and determine if regular yoga training improves pulmonary function in apparently healthy individuals. METHODS: Using the Alternative Health Watch, the Physical Education Index, Medline,(®) and the SPORTdiscus databases; and the keywords yoga, respiration, and pulmonary function, a comprehensive search was conducted that yielded 57 studies. Of these studies selections were made to include only experimental studies written in English, published in peer-reviewed journals after 1980, and investigating the effects of regular yoga practice on pulmonary function in healthy individuals participating in the studies. RESULTS: Yoga improved pulmonary function, as measured by maximum inspiratory pressure, maximum expiratory pressure, maximum voluntary ventilation, forced vital capacity, forced expiratory volume in 1 second, and peak expiratory flow rate, in all (N=9), but 1, study. CONCLUSIONS: Overall, pulmonary function appears to improve with a minimum of 10 weeks of regular yoga practice, and the magnitude of this improvement is related to fitness level and/or the length of time the subjects spend practicing pranayama (i.e., breathing exercises). In other words, greater improvements in pulmonary function are more likely to be seen in less-fit individuals and/or those that engage in longer periods of pranayama. Additional studies examining various yoga practices are warranted to gain a more comprehensive understanding of the effects of yoga techniques on pulmonary functions.

Effects of concurrent respiratory resistance training on health-related quality of life in wheelchair rugby athletes: a pilot study.

PURPOSE: To compare the effects of 9 weeks of training with a concurrent flow resistance (CFR) device versus a concurrent pressure threshold resistance (CPTR) device on health-related quality of life (HRQoL) in wheelchair rugby (WR) athletes. METHOD: Twenty-four male WR athletes (22 with tetraplegia, 1 with a spastic cerebral palsy, and 1 with congenital upper and lower limb deformities) were matched by lesion level, completeness of injury, and rugby classification prior to being randomly assigned to 1 of 3 groups: (1) CPTR (n=8), (2) CFR (n=8), or (3) controls (CON, n=8). Pre/post testing included assessment of HRQoL as measured by the Short-Form Health Survey Version 2.0 (SF-36v2). Manufacturer protocol guidelines for the CFR and CPTR groups were followed for breathing exercises. RESULTS: Sixteen participants completed the study (CPTR=4, CFR=5, CON=7). The Mann-Whitney U rank order revealed significantly greater reductions in bodily pain (P = .038) and improvements in vitality (P = .028) for CFR versus CON. CONCLUSION: Results from this study suggest that training with a CFR device improves some aspects of HRQoL (eg, vitality and bodily pain) in WR athletes. Further research with a larger sample size is needed to examine the impact of these devices on improving HRQoL for wheelchair athletes.

It's not what you say but the way that you say it: an fMRI study of differential lexical and non-lexical prosodic pitch processing.

BACKGROUND: This study aims to identify the neural substrate involved in prosodic pitch processing. Functional magnetic resonance imaging was used to test the premise that prosody pitch processing is primarily subserved by the right cortical hemisphere.Two experimental paradigms were used, firstly pairs of spoken sentences, where the only variation was a single internal phrase pitch change, and secondly, a matched condition utilizing pitch changes within analogous tone-sequence phrases. This removed the potential confounder of lexical evaluation. fMRI images were obtained using these paradigms. RESULTS: Activation was significantly greater within the right frontal and temporal cortices during the tone-sequence stimuli relative to the sentence stimuli. CONCLUSION: This study showed that pitch changes, stripped of lexical information, are mainly processed by the right cerebral hemisphere, whilst the processing of analogous, matched, lexical pitch change is preferentially left sided. These findings, showing hemispherical differentiation of processing based on stimulus complexity, are in accord with a 'task dependent' hypothesis of pitch processing.

Bipolar depression: clinically missed, pharmacologically mismanaged.

Bipolar affective disorders are common and frequently debilitating mental illnesses. Diagnostic criteria mean they are defined by the presence of pathological mood elevation, but research shows greater disease burden is inflicted by depressive phases (bipolar depression) both in terms of duration and impact of symptoms. Despite this there is consistent evidence for the underdiagnosis of bipolar depression and its misdiagnosis as a unipolar disorder, with significant subsequent impact on medication management. There is currently less robust evidence for the appropriate pharmacological approach in such individuals than in unipolar depression, and fewer guidelines for clinicians. Despite this there is clear and growing evidence that 'treatment as usual' of depressive symptomatology is ineffective at best, harmful at worst, and that there is little role for the use of antidepressants. Both mood stabilizers and antipsychotics demonstrate efficacy, and whilst there are emerging data on intraclass differences, more research is needed, particularly concerning bipolar II disorder. Present treatment strategies are limited by insufficient large randomized control trials, an inadequate understanding of the neuropathology of bipolar illnesses and a lack of tailored medications. Better clinical training, understanding and recognition of this common condition are essential.

Effects of respiratory resistance training with a concurrent flow device on wheelchair athletes.

BACKGROUND/OBJECTIVE: To determine the effect of respiratory resistance training (RRT) with a concurrent flow respiratory (CFR) device on respiratory function and aerobic power in wheelchair athletes. METHODS: Ten male wheelchair athletes (8 with spinal cord injuries, 1 with a neurological disorder, and 1 with postpolio syndrome), were matched by lesion level and/or track rating before random assignment to either a RRT group (n = 5) or a control group (CON, n = 5). The RRT group performed 1 set of breathing exercises using Expand-a-Lung, a CFR device, 2 to 3 times daily for 10 weeks. Pre/posttesting included measurement of maximum voluntary ventilation (MVV), maximum inspiratory pressure (MIP), and peak oxygen consumption (V(O2peak)). RESULTS: Repeated measures ANOVA revealed a significant group difference in change for MIP from pre- to posttest (P < 0.05). The RRT group improved by 33.0 cm H2O, while the CON group improved by 0.6 cm H2O. Although not significant, the MW increased for the RRT group and decreased for the CON group. There was no significant group difference between V(O2peak) for pre/posttesting. Due to small sample sizes in both groups and violations of some parametric statistical assumptions, nonparametric tests were also conducted as a crosscheck of the findings. The results of the nonparametric tests concurred with the parametric results. CONCLUSIONS: These data demonstrate that 10 weeks of RRT training with a CFR device can effectively improve MIP in wheelchair athletes. Further research and a larger sample size are warranted to further characterize the impact of Expand-a-Lung on performance and other cardiorespiratory variables in wheelchair athletes.

The effects of caffeine in women during aerobic-dance bench stepping.

People of all ages and fitness levels participate regularly in aerobic-dance bench stepping (ADBS) to increase fitness and control body weight. Any reasonable method for enhancing the experience or effectiveness of ADBS would be beneficial. This study examined the acute effects of a single dose of caffeine on physiological responses during ADBS in women. When compared with a placebo, neither a 3- nor a 6-mg/kg dose of caffeine altered physiological responses or rating of perceived exertion (RPE) in 20 women (age 19-28 y) of average fitness level, not habituated to caffeine, while they performed an ADBS routine. Since neither dose of caffeine had any effect on VO2, VCO2, minute ventilation, respiratory-exchange ratio, rate of energy expenditure, heart rate, or RPE during ADBS exercise, it would not be prudent for a group exercise leader to recommend caffeine to increase energy cost or decrease perception of effort in an ADBS session. Furthermore, caffeine ingestion should not interfere with monitoring intensity using heart rate or RPE during ADBS.

The physiological effects of caffeine in women during treadmill walking.

Although the effects of caffeine ingestion on athletic performance in men have been studied extensively, there is limited previous research examining caffeine's effects on women of average fitness levels participating in common modes of physical activity. The purpose of this study was to determine the effect of 2 levels of caffeine dosage on the metabolic and cardiorespiratory responses to treadmill walking in women. Subjects were 20 women (19-28 years of age) of average fitness, not habituated to caffeine. Each subject was assigned randomly a 3-mg x kg(-1) dose of caffeine, 6-mg x kg(-1) dose of caffeine, and placebo for 3 trials of moderate steady-state treadmill walking at 94 m x min(-1) (3.5 mph). Steady-state rating of perceived exertion (RPE), heart rate (HR), respiratory exchange ratio (RER), weight-relative VO2, %VO2max reserve (%VO2R), and rate of energy expenditure (REE) were measured during each trial. Repeated measures analysis of variance revealed that a 6-mg x kg(-1), but not a 3-mg x kg(-1) dose of caffeine increased VO2 (p = 0.04), REE (p = 0.03), and %VO2R (p = 0.03), when compared to the placebo. Caffeine had no effect on RPE, HR, or RER. No significant differences were observed between the placebo trials and the 3-mg x kg(-1) dose trials. Although a 6-mg x kg(-1) dose of caffeine significantly increased REE during exercise, the observed increase (approximately 0.23 kcal x min(-1)) would not noticeably affect weight loss. Because caffeine had no effect on RPE, it would not be prudent for a trainer to recommend caffeine in order to increase a woman's energy expenditure or to decrease perception of effort during mild exercise. These data also demonstrate that caffeine intake should not interfere with monitoring walking intensity by tracking exercise heart rate in women.

The effects of caffeine on athletic agility.

Caffeine has been shown to improve sprint time, anaerobic power, and reaction time, all integral aspects of agility. The purpose of this study was to determine whether an acute caffeine dose would enhance agility and anaerobic power. Sixteen subjects participated in a randomized, double-blind experiment and performed the proagility run and the 30-second Wingate test 60 minutes after ingestion of caffeine (6 mg.kg(-1)) or placebo. No significant change was observed in the proagility run after caffeine ingestion compared with placebo. Also, no significant change was observed in peak power, mean power, or percent power decrease. Agility is an integral component of athletic skill and any reasonable method for enhancing agility would benefit active individuals. However, results from this study indicate that a 6 mg.kg(-1) dose of caffeine does not impact agility as measured by the proagility run test or power output as measured by the 30-second Wingate test in recreationally active young adult males who are not habituated to caffeine.

The metabolic cost of hatha yoga.

To determine the metabolic and heart rate (HR) responses of hatha yoga, 26 women (19-40 years old) performed a 30-minute hatha yoga routine of supine lying, sitting, and standing asanas (i.e., postures). Subjects followed identical videotaped sequences of hatha yoga asanas. Mean physiological responses were compared to the physiological responses of resting in a chair and walking on a treadmill at 93.86 m.min(-1) [3.5 miles per hour (mph)]. During the 30-minute hatha yoga routine, mean absolute oxygen consumption (Vo(2)), relative Vo(2), percentage maximal oxygen consumption (%Vo(2)R), metabolic equivalents (METs), energy expenditure, HR, and percentage maximal heart rate (%MHR) were 0.45 L.min(-1), 7.59 ml.kg(-1).min(-1), 14.50%, 2.17 METs, 2.23 kcal.min(-1), 105.29 b.min(-1), and 56.89%, respectively. When compared to resting in a chair, hatha yoga required 114% greater O(2) (L.min(-1)), 111% greater O(2)(ml.kg(-1).min(-1)), 4,294% greater %Vo(2)R, 111% greater METs, 108% greater kcal.min(-1), 24% greater HR, and 24% greater %MHR. When compared to walking at 93.86 m.min(-1), hatha yoga required 54% lower O(2)(L.min(-1)), 53% lower O(2)(ml.kg(-1).min(-1)), 68% lower %Vo(2)R, 53% lower METs, 53% lower kcal.min(-1), 21% lower HR, and 21% lower %MHR. The hatha yoga routine in this study required 14.50% Vo(2)R, which can be considered a very light intensity and significantly lighter than 44.8% Vo(2)R for walking at 93.86 m.min(-1) (3.5 mph). The intensity of hatha yoga may be too low to provide a training stimulus for improving cardiovascular fitness. Although previous research suggests that hatha yoga is an acceptable form of physical activity for enhancing muscular fitness and flexibility, these data demonstrate that hatha yoga may have little, if any, cardiovascular benefit.

Metabolic cost of aerobic dance bench stepping at varying cadences and bench heights.

To determine the metabolic and cardiovascular responses of aerobic dance bench stepping (ADBS) at commonly used cadences and bench heights, 30 women (19-47 years of age) performed a graded maximal treadmill test and four 8-minute submaximal ADBS routines. Subjects followed identical videotape sequences of basic ADBS movements at cadences of 125 and 130 beats.min(-1) at bench heights of 6 and 8 in. Physiological measurements were taken during each minute of each test. Mean values calculated from the last 3 minutes were used for data analysis. Although there were no physiological differences between ADBS at the 2 cadences, there were significant physiological differences between ADBS at the 2 bench heights. On average, a 2-in. increase in bench height, increased heart rate, VO2, and rating of perceived exertion by 10 beats.min(-1), 3.09 ml.kg(-1) min(-1), and 1.53, respectively. In conclusion, it appears that bench height is more of a factor than cadence in increasing metabolic cost of ADBS. Results from this study provide information about the energy cost of ADBS at the common bench heights and cadences used in this study and, therefore, may be used to help aerobic participants select the proper bench height and cadence combination to control body weight and develop cardiorespiratory fitness safely and effectively.

A review of fluid replacement for workers in hot jobs.

Prolonged work in hot environments leads to progressive water and electrolyte loss from the body. The rate of sweating varies among individuals and depends on the environmental conditions, but in protective clothing and very hot environments rates can reach 2.25 L/hour. Because hypohydration will impair work performance and increases the risk of heat injury, consumption of fluids is necessary to prevent dehydration and enhance performance. Much of the research on rehydration has been conducted in athletic settings. The purpose of this review is to interpret the existing research literature on hydration in a way that is useful to industrial hygienists and safety experts. The authors hope to provide industrial hygienists and safety professionals with scientific bases for making recommendations regarding beverage availability and hydration practices. Although water is a very common beverage, some previous research has reported that drinks containing low to moderate levels of electrolytes and carbohydrates may provide some significant advantages in industrial situations. In general these studies seem to support the use of electrolyte-carbohydrate beverages as a supplement to water or as a replacement for water.