Preventing Diabetes in the Workplace: Effects of Coaching and Monetary Incentives.

OBJECTIVE: Prevention of diabetes demonstrated in the diabetes prevention program has not been thoroughly evaluated in workplace settings. METHODS: Glycemic control was assessed by glycated hemoglobin (HbA1c) and its impact on 5-year incidence of diabetes and prediabetes prevalence, in wellness program participants (WPP) of (Group A, with) or (Group B, without) health coaching and monetary incentives. RESULTS: HbA1c fell in Group A WPP (5.52 ±â€Š0.60 vs 5.58 ±â€Š0.36 SD, P = 0.04) as did prediabetes. Incident diabetes was less than expected (24 vs 74, P < 0.001). HbA1c increased in Group B WPP (5.37 ±â€Š0.40 SD vs 5.58 ±â€Š0.54, P < 0.001) and prediabetes increased from 28 to 36 (P < 0.001). CONCLUSIONS: Health coaching and monetary incentives improved glycemic control over 5 years, an improvement not observed in WPP without these interventions.

A thermal stress treadmill walk for clinic evaluation of candidates for hazardous materials (HazMat) duty.

UNLABELLED: U.S. guidance for examining hazmat workers recommends stress testing be considered when heat stress is expected. However, the most common stress test-Bruce protocol treadmill electrocardiography (BPTE) wearing gym clothes-creates little thermal stress. OBJECTIVE: Evaluate a novel thermal stress treadmill walk (TSTW). METHODS: Body temperatures and heart rates during BPTE in 93 current and potential hazmat workers wearing gym clothes were compared with later values in 35 of these subjects while they were wearing thermally-restrictive "sauna suits" during a 45-min TSTW. Physiological strain index (PSI) was calculated from temperature and heart rate changes and compared with PSI values from hazmat simulations and climatic chamber exercises. RESULTS: Tympanic temperature (TT) rose 0.5°C (SD 0.5) during BPTE lasting 12.4 min (SD 2.9). PSI reached 6.0 (SD 1.3). TT rose 1.0°C (SD 0.5) during TSTW, p < .01. PSI averaged 6.6 (SD 1.9) in 29 subjects who completed TSTW, versus 5.7 (SD 5.7) in the 6 subjects who did not. Ingested thermistor temperatures increased more than did TT during TSTW, yielding PSI of 7.0 (SD 1.5), equal to PSI values from climatic chamber exercises, i.e., 7.0 (SD 1.0). CONCLUSION: TSTW increased body temperature and PSI in 29 of the 35 subjects who completed it to levels matching those of operational simulations in climatic chambers and during hazmat exercises. This TSTW may be useful for evaluating candidates for hazmat duty.

Prolonged respiratory illness after single overnight continuous positive airway pressure humidification: endotoxin as the suspect.

A patient developed a prolonged respiratory illness after a single overnight use of tap water to humidify air supplied by a constant positive airway pressure (CPAP) device, which she had previously used for six years without difficulty. During those years, she used only distilled water for this purpose, as instructed by her sleep specialist. Analysis of the well water supplying her home showed no microorganisms, metals or other analytes likely to have caused her illness, but endotoxin was found at concentrations well above that recommended by the U.S. Pharmacopeia, as a maximum in water which may be inhaled as an aerosol.

Nurse practitioner services: three-year impact on health care costs.

OBJECTIVE: In 2005, our initial analysis of the impact on health care costs (HCC) of providing on-site Nurse Practitioner (NP) services showed favorable results. METHODS: We measured the effects of the NP program on HCC in two ways. Method 1 compared actual HCC for 2005 to 2007 versus projected HCC, the latter based on medical payments in 2002 to 2004, before the NP intervention. Method 2 was a microanalytic comparison of the HCC of nine Major Diagnostic Categories responsible for 88.5% of all conditions treated by the NP from July 2005 to December 2006. RESULTS: Annualized cost of the NP program was $124,750. Savings in HCC using the first method were $1,089,466 per year, yielding a benefit-to-cost ratio of 8.7 to 1. Savings in HCC using the second method reflected a ratio of 2.0 to 1. In addition, method 1 reflects HCC savings which may be due to the addition of a 24/7 Nurse Help Line. CONCLUSIONS: This 3-year analysis confirms our preliminary findings that an on-site NP has a favorable benefit-to-cost function. Longer-term analyses are needed to confirm these findings.

Inguinal phlegmon and positive serology for syphilis after penile bite laceration: true, true and unrelated.

Among many causes of penile injury, sexual activity is infrequently reported. The present case involved delay in recognition, which led to development of a phlegmon near major vascular structures. Positive serologic evidence of syphilis was an incidental finding.

Severe illness in furniture makers using a new glue: 1-bromopropane toxicity confounded by arsenic.

OBJECTIVE: To describe the illnesses of four workers with high concentrations of serum bromide after exposure to glue containing 1-bromopropane (1-BP). METHODS: We reviewed all available clinical records, examined the workers, and obtained additional urinary arsenic values. We used standard autoanalyzer and other routine methods for blood and urinalysis. RESULTS: All four workers had symptoms and abnormal physical findings when hospitalized, remaining symptomatic with abnormal examinations 3 months later. Milder symptoms persisted in two workers, 8 years after their initial illnesses. Both have returned to work. Follow-up was unavailable for the other two workers. CONCLUSIONS: Severe illness occurred in four gluers after 1-BP exposures associated with elevated levels of serum bromide. All had elevated urinary arsenic concentrations, the source of which remains unknown, but which confound interpretation of the abnormal bromide levels and clinical findings present during the acute illnesses.