Supporting Community-based Healthy Eating and Active Living Efforts in Sustaining Beyond the Funding Cycle.

INTRODUCTION: Considerable research has been done to define, conceptualize, and study sustainability for public health initiatives. New research suggests evaluating sustainability through additional characteristics, like type of intervention or focus of change, may help uncover differences in approaches and resources needed for sustainability. Additionally, available research often misses perspectives from those involved on what is necessary to sustain strategies long term. METHODS: Data collected through community reports and interviews with eight Colorado communities implementing large-scale community-based healthy eating and active living initiatives were used to document strategy characteristics, barriers to sustainability, and community-based perspectives on supports needed for long-term sustainability. Characteristics of implementation were also assessed based on intervention type (program, environment, policy) and to identify similarities and differences in implementation. RESULTS: Policy and environment interventions were sustained more often compared with program interventions. Coalitions or formal committees, community-level coordination, and diverse partnerships were associated with sustainable strategies regardless of intervention type, though primary transition partners varied by intervention type. Loss of a sole champion and shifts in institutional priorities were common barriers for sustainability. Communities requested supports for creative funding and formal coordination, public and political will-building, inclusivity, and advanced evaluation methods to support long-term sustainability. CONCLUSIONS: Findings suggest that community intervention strategies can be highly sustainable, particularly for environment and policy change, and suggest strategies may require similar, yet tailored, partnerships based on intervention type. Additionally, supports requested highlight sophisticated community needs, offering important insights for how providers and funders can best support communities in long-term sustainability efforts. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health.

Heat strain reduction by ice-based and vapor compression liquid cooling systems with a toxic agent protective uniform.

BACKGROUND: The purpose of this study was to compare a vapor compression microclimate cooling system (MCC) and a personal ice cooling system (PIC) for their effectiveness in reducing physiological strain when used with cooling garments worn under the impermeable self-contained toxic environment protective outfit (STEPO). A second comparison was done between the use of total body (TOTAL) and hooded shirt-only (SHIRT) cooling garments with both the MCC and PIC systems. It was hypothesized that the cooling systems would be equally effective, and total body cooling would allow 4 h of physical work in the heat while wearing STEPO. METHODS: Eight subjects (six men, two women) attempted four experiments at 38 degrees C (100 degrees F), 30% rh, 0.9 m x sec(-1) wind, while wearing the STEPO. Subjects attempted 4 h of treadmill walking (rest/exercise cycles of 10/20 min) at a time-weighted metabolic rate of 303 +/- 50 W. RESULTS: Exposure time was not different between MCC and PIC, but exposure time was greater with TOTAL (131 +/- 66 min) than with SHIRT (83 +/- 27 min) for both cooling systems (p < 0.05). Cooling rate was not different between MCC and PIC, but cooling rate while wearing TOTAL (362 +/- 52 W) was greater than with SHIRT (281 +/- 48 W) (p < 0.05). Average heat storage was lower with MCC (39 +/- 20 W x m(-2)) than with PIC (50 +/- 17 W x m(-2)) in both TOTAL and SHIRT (p < 0.05). Also, average heat storage while wearing TOTAL (34 +/- 19 W x m(-2)) was less than with SHIRT (55 +/- 13 W x m(-2)) for both cooling systems (p < 0.05). The Physiological Strain Index (PSI) was lower in MCC-TOTAL (2.4) than MCC-SHIRT (3.7), PIC-SHIRT (3.8), and PIC-TOTAL (3.3) after 45 min of heat exposure (p < 0.05). CONCLUSIONS: Total body circulating liquid cooling was more effective than shirt-only cooling under the impermeable STEPO uniform, providing a greater cooling rate, allowing longer exposure time, and reducing the rate of heat storage. The MCC and PIC systems were equally effective during heat exposure, but neither system could extend exposure for the 4 h targeted time.

TPMG Northern California appointments and advice call center.

Kaiser Permanente (KP) has been developing its use of call centers as a way to provide an expansive set of healthcare services to KP members efficiently and cost effectively. Since 1995, when The Permanente Medical Group (TPMG) began to consolidate primary care phone services into three physical call centers, the TPMG Appointments and Advice Call Center (AACC) has become the "front office" for primary care services across approximately 89% of Northern California. The AACC provides primary care phone service for approximately 3 million Kaiser Foundation Health Plan members in Northern California and responds to approximately 1 million calls per month across the three AACC sites. A database records each caller's identity as well as the day, time, and duration of each call; reason for calling; services provided to callers as a result of calls; and clinical outcomes of calls. We here summarize this information for the period 2000 through 2003.

Upper body cooling during exercise-heat stress wearing the improved toxicological agent protective system for HAZMAT operations.

This study compared endurance in a U.S. Army developmental Occupational Safety and Health Administration Level B personal protective equipment (PPE) system against the toxicological agent protective (TAP) suit, the Army's former standard PPE for Level A and Level B toxic environments. The developmental system consisted of two variations: the improved toxicological agent protective (ITAP) suit with self-contained breathing apparatus (ITAP-SCBA), weight 32 kg, and the ITAP with blower (ITAP-B), weight 21 kg. Both ITAP suits included the personal ice cooling system (PICS). TAP (weight 9.5 kg) had no cooling. It was hypothesized that PICS would effectively cool both ITAP configurations, and endurance in TAP would be limited by heat strain. Eight subjects (six men, two women) attempted three 2-hour treadmill walks (0.89 m/sec, 0% grade, rest/exercise cycles of 10/20 min) at 38 degrees C, 30% relative humidity. Metabolic rate for TAP (222+/-35 W) was significantly less than either ITAP-SCBA (278+/-27 W) or ITAP-B (262+/-24 W) (p<0.05). Endurance time was longer in ITAP-SCBA (85+/-20 min) and ITAP-B (87+/-25 min) than in TAP (46+/-10 min) (p<0.05). Heat storage was greater in TAP (77+/-15 W.m(-2)) than in ITAP-SCBA (51+/-16 W.m(-2)) (p<0.05), which was not different from ITAP-B (59+/-14 W.m(-2)). Sweating rate was greater in TAP (23.5+/-11.7 g/min(1)) than in either ITAP-SCBA (11.1+/-2.9 g/min) or ITAP-B (12.8+/-3.5 g/min) (p<0.05). Endurance in ITAP was nearly twice as long as in PPE with no cooling, even though the PICS, SCBA tanks, and new uniform itself all served to increase metabolic cost over that in TAP. PICS could also be used with civilian Levels A and B PPE increasing work time and worker safety.