What We Have Learned About the Implementation of Whole Health in the Veterans Administration.

As we have advanced the concept of Whole Health (WH) in the Veterans Administration over the past 10 years, we have had the unique advantage of working in a health care system in which a wide range of WH services-ranging from acupuncture to coaching to yoga and Tai Chi to nutrition classes to peer-facilitated empowerment and skill-building groups-are fully covered by the system as part of standard medical benefits. This has given us the opportunity to evaluate both the process and the outcomes of offering this type of Whole Person care on a system-wide scale. This article will review some of the lessons learned from that ongoing evaluation process in the areas of integration of complementary/integrative health approaches as well as health coaching and peer-led groups, WH education, employee well-being, cost impacts, and whole-system transformation. This is not a systematic review, as we will touch on numerous questions and lessons learned rather than dive deeply into the literature seeking the answer to one narrower question. Hopefully the narrative review approach taken here will stimulate further discussion in the field regarding what we are learning and what we can continue to learn from this large scale innovation.

Innovative approaches for understanding seasonal influenza vaccine declination in healthcare personnel support development of new campaign strategies.

OBJECTIVE: The main objectives of our study were to explore reasons for seasonal influenza vaccine acceptance and declination in employees of a large integrated healthcare system and to identify underlying constructs that influence acceptance versus declination. Secondary objectives were to determine whether vaccine acceptance varied by hospital location and to identify facility-level measures that explained variability. DESIGN: A national health promotion survey of employees was conducted that included items on vaccination in the 2009-2010 influenza season. The survey was administered with two other institutional surveys in a stratified fashion: approximately 40% of participating employees were randomly assigned to complete the health promotion survey. SETTING: National single-payer healthcare system with 152 hospitals. PARTICIPANTS: Employees of the healthcare system in 2010 who responded to the survey. METHODS: Factor analysis was used to identify underlying constructs that influenced vaccine acceptance versus declination. Mean factor scores were examined in relation to demographic characteristics and occupation. Multilevel logistic regression models were used to determine whether vaccine acceptance varied by location and to identify facility-level measures that explained variability. RESULTS: Four factors were identified related to vaccine declination and were labeled as (1) "don't care," (2) "don't want," (3) "don't believe," and (4) "don't know." Significant differences in mean factor scores existed by demographic characteristics and occupation. Vaccine acceptance varied by location, and vaccination rates in the previous year were an important facility-level predictor. CONCLUSIONS: Results should guide interventions that tailor messages on the basis of particular reasons for declination. Occupation-specific and culturally appropriate messaging should be considered. Continued efforts will be taken to better understand how workplace context influences vaccine acceptance.

Effect of isoflavones on lipids and bone turnover markers in menopausal women.

OBJECTIVES: The purpose of this analysis was to compare the effects of two dietary supplements derived from red clover to placebo on lipids and bone turnover markers in symptomatic menopausal women. METHODS: The study was a 12-week randomized, double-blind, placebo-controlled trial. Two hundred and fifty-two menopausal women ages 45-60 years experiencing > or =35 hot flashes per week were randomly assigned to Promensil (82 mg total isoflavones), Rimostil (57.2 mg total isoflavones), or placebo. Primary outcome measures were mean absolute changes for HDL-cholesterol, serum osteocalcin, and urinary N-telopeptide. Secondary outcome measures were mean changes of total cholesterol, LDL-cholesterol, the ratio of HDL- to LDL-cholesterol, and triglycerides. RESULTS: Ninety-eight percent of participants completed the 12-week protocol. Women taking Rimostil or Promensil compared to those taking placebo had greater mean increases in HDL-cholesterol; however, this change was small in magnitude (<2 mg/dl) and did not reach significance. There was a significant decrease in triglyceride levels among women taking Rimostil (14.4 mg/dl, P = 0.02) or Promensil (10.9 mg/dl, P = 0.05) compared to those taking placebo. The decrease was primarily among women with elevated baseline triglyceride levels (P for interaction = 0.009). There were no differences in mean changes of total cholesterol, LDL-cholesterol, or the ratio of HDL- to LDL-cholesterol among treatment groups. There were no statistically significant differences among treatment groups for bone turnover markers. CONCLUSIONS: Compared with placebo, both of the supplements containing isoflavones decrease levels of triglycerides in symptomatic menopausal women; however, this effect is small in magnitude.