Putting the National Diabetes Prevention Program to Work: Predictors of Achieving Weight-Loss Goals in an Employee Population.

INTRODUCTION: Differences in eligibility criteria and intervention characteristics have limited the generalizability of findings from studies of worksite translations of the National Diabetes Prevention Program (DPP). The objective of our study was to identify factors associated with achievement of the DPP's 5% weight-loss goal in the Vanderbilt University Medical Center (VUMC) Faculty and Staff Health and Wellness DPP from 2014 to 2017. METHODS: We analyzed data from a DPP worksite translation that adhered to national standards for program quality and intervention fidelity. We compared baseline characteristics and program metrics for participants who did and did not achieve the program's 5% weight-loss goal, and we developed a multivariable logistic regression model to identify independent predictors of achieving this goal. RESULTS: Of the 165 employees enrolled in the DPP from 2014 to 2017, 43.6% (n = 72) met the 5% weight-loss goal. Mean (standard deviation) percentage weight loss for the program was 5.2% (6.0%), or 4.8 (6.0) kg. The median (interquartile range) body mass index at baseline was lower among participants who achieved the 5% weight-loss goal than among those who did not (31.6 [29.4-37.4] vs 34.7 [31.5-39.2], P = .009), and participants who achieved the goal reported more physical activity minutes per week (166.0 [135.2-223.0] min vs 128.5 [83.2-169.8] min, P < .001). Session attendance was greater for participants achieving the 5% weight-loss goal (23 [21-25]) sessions vs 18 [12-21] sessions, P < .001). In the adjusted analysis, physical activity and session attendance remained significant predictors of achieving the 5% weight-loss goal. CONCLUSION: Session attendance and physical activity independently predicted achievement of the 5% weight-loss goal in this worksite translation of the DPP. Strategies designed to improve these metrics may increase DPP success rates.

Sport-related concussion induces transient cardiovascular autonomic dysfunction.

Recent evidence suggests that concussions may disrupt autonomic cardiovascular control. This study investigated the initial effects of concussion on cardiovascular function using three autonomic reflex tests. Twenty-three recreational athletes (12 women, 11 men) were divided into concussed (n = 12) and control (n = 11) groups. Concussed participants performed forced breathing, standing, and Valsalva autonomic tests four times: 1) within 48 h of injury; 2) 24 h later; 3) 1 wk after injury; and 4) 2 wk after injury. The controls performed the same tests on the same schedule. Differences in heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) responses to the tests were continuously measured using finger photoplethysmography and were analyzed using repeated-measures multivariate ANOVAs and ANOVAs. Within 48 h of injury, the concussed group had significantly greater resting SBP (t21 = 2.44, P = 0.02, d = 1.03), HR (t21 = 2.33, P = 0.03, d = 1.01), and SBP responses to standing (t21 = 2.98, P = 0.01, d = 1.24), and 90% SBP normalization times (t21 = 2.64, P = 0.02, d = 1.10) after the Valsalva, but those group differences subsided 24 h later. There was also a significant interaction with the HR responses to forced breathing (F3,60 = 4.13, P = 0.01, ηp2 = 0.17), indicating the concussed responses declined relative to the control's over time. The results demonstrate that concussion disrupted autonomic cardiovascular control, and that autonomic reflex tests are practical means by which to evaluate that dysfunction.

Emergency Preparedness in the Workplace: The Flulapalooza Model for Mass Vaccination.

OBJECTIVES: To explore whether an emergency preparedness structure is a feasible, efficient, and sustainable way for health care organizations to manage mass vaccination events. METHODS: We used the Hospital Incident Command System to conduct a 1-day annual mass influenza vaccination event at Vanderbilt University Medical Center over 5 successive years (2011-2015). Using continuous quality improvement principles, we assessed whether changes in layout, supply management, staffing, and documentation systems improved efficiency. RESULTS: A total of 66 591 influenza vaccines were administered at 5 annual Flulapalooza events; 13 318 vaccines per event on average. Changes to the physical layout, staffing mix, and documentation processes improved vaccination efficiency 74%, from approximately 38 to 67 vaccines per hour per vaccinator, while reducing overall staffing needs by 38%. An unexpected finding was the role of social media in facilitating active engagement. CONCLUSIONS: Health care organizations can use a closed point-of-dispensing model and Hospital Incident Command System to conduct mass vaccination events, and can adopt the "Flulapalooza method" as a best practice model to enhance efficiency.

The benefit of self-testing and interleaving for synthesizing concepts across multiple physiology texts.

A testing-based learning strategy is one that relies on the act of recalling (i.e., testing) information after exposure, and interleaving is a strategy in which the learning materials are presented in a serial order (e.g., texts 1, 2, 3, 1, 2, 3, 1, 2, 3) versus a blocked order (e.g., texts 1, 1, 1, 2, 2, 2, 3, 3, 3). Although both learning strategies have been thoroughly investigated, few studies have examined their additive effect with higher-order cognitive tasks such as the ability to identify themes across multiple texts, and none of those did so using physiology information. The purpose of the present study was to compare recall and thematic processing across five different physiology texts. Participants were randomly assigned to learn the texts using one of the following four learning strategies: 1) study-study-study (S-S-S) using a blocked order, 2) S-S-S using an interleaved order, 3) study-test-study (S-T-S) using a blocked order, and 4) S-T-S using an interleaved order. Over the course of the following week, the S-T-S groups had more stable recall of key text ideas compared with the S-S-S groups, and the S-T-S group had more stable recall of thematic information than the S-S-S group when interleaving was used as the presentation order.

Use of B-Mode Ultrasound as a Body Fat Estimate in Collegiate Football Players.

Hyde, PN, Kendall, KL, Fairman, CM, Coker, NA, Yarbrough, ME, and Rossi, SJ. Utilization of B-mode ultrasound as a body fat estimate in collegiate football players. J Strength Cond Res 30(12): 3525-3530, 2016-The purpose of the present study was to validate a 7-site ultrasound imaging protocol to predict the percent body fat (%BF) in a division I football team. Body composition was estimated by ultrasound, 7-site skinfolds, and the 3-compartment-water (3C-W) model of Siri, using bioimpedance spectroscopy to estimate the total body water and air displacement plethysmography (using BODPOD) to determine the body density. Pearson's product-moment correlation analyses were run to determine correlations between ΣUltrasound and the criterion 3C-W, and between the ΣSkinfold and ΣUltrasound. Strong positive correlations were observed between ΣSkinfold and ΣUltrasound (r = 0.984; p < 0.001). Furthermore, a strong positive correlation was observed between ΣUltrasound and %BF from 3C-W (r = 0.878; p < 0.001). Based on the significant correlation analysis, a linear regression equation was developed to predict the %BF from ΣUltrasound, using %BF from the 3C-W model as the dependent variable: %BF = 6.194 + (0.096 × ΣUltrasound); standard error of the estimate (SEE) = 2.97%. Cross-validation analyses were performed using an independent sample of 29 players. The mean observed %BF from the 3C-W model and the mean predicted %BF were 18.32 ± 6.26% and 18.78 ± 6.22%, respectively. The constant error, SEE, and validity coefficient (r) were 0.87%, 2.64%, and 0.91%, respectively. The total error was 2.87%. The positive relationship between ultrasound measurements and the 3C-W model suggests that ultrasound imaging may be a practical alternative to predicting %BF in division I football players.

Self-testing produces superior recall of both familiar and unfamiliar muscle information.

Dozens of studies have found learning strategies based on the "testing effect" promote greater recall than those that rely solely on reading; however, the advantages of testing are often only observed after a delay (e.g., 2-7 days later). In contrast, our research, which has focused on kinesiology students learning kinesiology information that is generally familiar to them, has consistently demonstrated that testing-based strategies produce greater recall both immediately and after a delay. In an attempt to understand the discrepancies in the literature, the purpose of the present study was to determine if the time-related advantages of a testing-based learning strategy vary with one's familiarity with the to-be-learned information. Participants used both read-only and testing-based strategies to repeatedly study three different sets of information: 1) previously studied human muscle information (familiar information), 2) a mix of previously studied and previously unstudied human muscle information (mixed information), and 3) previously unstudied muscle information that is unique to sharks (unfamiliar information). Learning was evaluated via free recall assessments administered immediately after studying and again after a 1-wk delay and a 3-wk delay. Across those three assessments, the read-only strategy resulted in mean scores of 29.26 ± 1.43, 15.17 ± 1.29, and 5.33 ± 0.77 for the familiar, mixed, and unfamiliar information, respectively, whereas the testing-based strategy produced scores of 34.57 ± 1.58, 16.90 ± 1.31, and 8.33 ± 0.95, respectively. The results indicate that the testing-based strategy produced greater recall immediately and up through the 3-wk delay regardless of the participants' level of familiarity with the muscle information.

Expanding mandatory healthcare personnel immunization beyond influenza: Impact of a broad immunization program with enhanced accountability.

OBJECTIVE: Evaluation of a mandatory immunization program to increase and sustain high immunization coverage for healthcare personnel (HCP). DESIGN: Descriptive study with before-and-after analysis. SETTING: Tertiary-care academic medical center. PARTICIPANTS: Medical center HCP. METHODS: A comprehensive mandatory immunization initiative was implemented in 2 phases, starting in July 2014. Key facets of the initiative included a formalized exemption review process, incorporation into institutional quality goals, data feedback, and accountability to support compliance. RESULTS: Both immunization and overall compliance rates with targeted immunizations increased significantly in the years after the implementation period. The influenza immunization rate increased from 80% the year prior to the initiative to >97% for the 3 subsequent influenza seasons (P < .0001). Mumps, measles and varicella vaccination compliance increased from 94% in January 2014 to >99% by January 2017, rubella vaccination compliance increased from 93% to 99.5%, and hepatitis B vaccination compliance from 95% to 99% (P < .0001 for all comparisons). An associated positive effect on TB testing compliance, which was not included in the mandatory program, was also noted; it increased from 76% to 92% over the same period (P < .0001). CONCLUSIONS: Thoughtful, step-wise implementation of a mandatory immunization program linked to professional accountability can be successful in increasing immunization rates as well as overall compliance with policy requirements to cover all recommended HCP immunizations.

Factors Associated With Physician Empowerment and Well-being at an Academic Medical Center.

OBJECTIVE: This study reports an institutional approach to rapidly measure burnout and gather physicians' opinions on workplace factors that empower well-being. METHODS: In July 2017, physicians at Vanderbilt University Medical Center were invited to participate in a two-question survey measuring self-reported burnout and providing an opportunity to describe structures that empower well-being. Free-text responses were analyzed and a linear regression model assessed factors associated with well-being. RESULTS: A total of 1135 physicians responded (43.3% response rate) with a mean well-being score of 56 (scale 0 to 100). Higher scores were associated with clinical fellow status (P = 0.002), male sex (P = 0.008), less allocation of time to clinical care (P < 0.001), and not commenting on "leadership" and "autonomy" in the free-text response. CONCLUSIONS: Brief surveys collecting perspectives on well-being can help employers identify high-risk groups and provide a roadmap for institutional change.

Feasibility Assessment of a New Surveillance Tool for Respiratory Protective Devices Used in U.S. Healthcare.

BACKGROUND: Respiratory protective devices (RPDs) are used for infection prevention in healthcare settings during routine patient care and public health emergencies. In recent years, healthcare systems have experienced shortages of RPDs during outbreaks of infectious diseases, in part due to a lack of information about their availability. New tools to track RPD inventories may improve accessibility during an emergency. Investigators at Vanderbilt University have identified four major themes that influence RPD use for infection prevention: hospital preparedness, responsiveness to airborne pathogens, potential exposure outcomes, and infection control practices related to respirator effectiveness. Based on these findings, an RPD surveillance tool (RST) was developed to collect and share near real-time data about RPD supplies in healthcare facilities. The objective of this study was to conduct a feasibility assessment of this RST. METHODS: The new online surveillance tool was implemented at four large, urban, acute care U.S. hospitals in January 2014; data was collected about RPD inventory, tracking systems, hospital characteristics, and utility of gathered information. RESULTS: The RST was implemented successfully and without difficulty at hospitals that had 78 to 90 percent occupancy rates. Participating hospitals reported that the RST (1) provided value for benchmarking their RPD supply, (2) promoted understanding about RPD accessibility among hospital systems engaged in infection control, and (3) served as a means to assess RPD program quality. CONCLUSION: Implementation of this newly developed RST is feasible and appears to have utility in U.S. hospitals for tracking and understanding RPD use for routine healthcare delivery and public health emergencies.

Modifiable Healthy Lifestyle Behaviors: 10-Year Health Outcomes From a Health Promotion Program.

INTRODUCTION: Previous studies have examined the impact of healthy lifestyle choices on health-related outcomes; however, given their fragmented, often cross-sectional nature, assessing the relative impact of daily modifiable behaviors on overall long-term outcomes, particularly for a diverse working adult population, remains challenging. METHODS: Relationships between ten self-reported healthy lifestyle behaviors and health outcomes during the subsequent 9 years in a cohort of 10,248 participants enrolled during 2003 in a voluntary workplace wellness program were assessed. Cox proportional-hazards models computed hazard ratios (HRs) for lifestyle characteristics associated with time to one of seven self-reported chronic diseases or death. Data were collected between 2003 and 2012 and analyzed between 2014 and 2016. RESULTS: Behaviors that most significantly affected future outcomes were low-fat diet, aerobic exercise, nonsmoking, and adequate sleep. A dose-response effect was seen between dietary fat intake and hypertension, obesity, diabetes, heart disease, and hypercholesterolemia. After dietary fat intake, aerobic exercise was the next most significant behavior associated with development of outcomes. Compared with sedentary participants, those who exercised 4 days per week were less likely to develop new-onset diabetes (HR=0.31, 95% CI=0.20, 0.48); heart disease (HR=0.46, 95% CI=0.27, 0.80); and hypercholesterolemia (HR=0.61, 95% CI=0.50, 0.74). Low-fat diet and adequate sleep were more significant than commonly promoted healthy behaviors, such as eating a daily breakfast. CONCLUSIONS: Modifiable lifestyle behaviors targeted in health promotion programs should be prioritized in an evidence-based manner. Top priorities for workplace health promotion should include low-fat diet, aerobic exercise, nonsmoking, and adequate sleep.

Respirator Use in a Hospital Setting: Establishing Surveillance Metrics.

Information that details use and supply of respirators in acute care hospitals is vital to prevent disease transmission, assure the safety of health care personnel, and inform national guidelines and regulations. OBJECTIVE: To develop measures of respirator use and supply in the acute care hospital setting to aid evaluation of respirator programs, allow benchmarking among hospitals, and serve as a foundation for national surveillance to enhance effective Personal Protective Equipment (PPE) use and management. METHODS: We identified existing regulations and guidelines that govern respirator use and supply at Vanderbilt University Medical Center (VUMC). Related routine and emergency hospital practices were documented through an investigation of hospital administrative policies, protocols, and programs. Respirator dependent practices were categorized based on hospital workflow: Prevention (preparation), patient care (response), and infection surveillance (outcomes). Associated data in information systems were extracted and their quality evaluated. Finally, measures representing major factors and components of respirator use and supply were developed. RESULTS: Various directives affecting multiple stakeholders govern respirator use and supply in hospitals. Forty-seven primary and secondary measures representing factors of respirator use and supply in the acute care hospital setting were derived from existing information systems associated with the implementation of these directives. CONCLUSION: Adequate PPE supply and effective use that limit disease transmission and protect health care personnel are dependent on multiple factors associated with routine and emergency hospital practices. We developed forty-seven measures that may serve as the basis for a national PPE surveillance system, beginning with standardized measures of respirator use and supply for collection across different hospital types, sizes, and locations to inform hospitals, government agencies, manufacturers, and distributors. Despite involvement of multiple hospital stakeholders, regulatory guidance prescribes workplace practices that are likely to result in similar workflows across hospitals. Future work will explore the feasibility of implementing the collection and reporting of standardized measures in multiple facilities.

Relationship between physical inactivity and health characteristics among participants in an employee-wellness program.

OBJECTIVE: To characterize factors associated with physical inactivity among employees with access to workplace wellness program. METHODS: We examined data on physical inactivity, defined as exercise less than once a week, from the 2010 health risk assessment completed by employees at a major academic institution (N = 16,976). RESULTS: Among employees, 18% of individuals reported physical activity less than once a week. Individuals who were physically inactive as compared with physically active reported higher prevalence of cardiovascular diseases (adjusted odds ratio [AOR], 1.36 [1.23 to 1.51]), fair or poor health status (AOR, 3.52 [2.97 to 4.17]), and absenteeism from work (AOR, 1.59 [1.41 to 1.79]). Overall, physically inactive employees as compared with physically active employees reported more interest in health education programs. CONCLUSION: Future research is needed to address barriers to physical inactivity to improve employee wellness and potentially lower health utility costs.

Health risk factor modification predicts incidence of diabetes in an employee population: results of an 8-year longitudinal cohort study.

OBJECTIVE: To understand risk factor modification effect on Type 2 diabetes incidence in a workforce population. METHODS: Annual health risk assessment data (N = 3125) in years 1 through 4 were used to predict diabetes development in years 5 through 8. RESULTS: Employees who reduced their body mass index from 30 or more to less than 30 decreased their chances of developing diabetes (odds ratio = 0.22, 95% confidence interval: 0.05 to 0.93), while those who became obese increased their diabetes risk (odds ratio = 8.85, 95% confidence interval: 2.53 to 31.0). CONCLUSIONS: Weight reduction observed over a long period can result in clinically important reductions in diabetes incidence. Workplace health promotion programs may prevent diabetes among workers by encouraging weight loss and adoption of healthy lifestyle habits.

Seven-year trends in employee health habits from a comprehensive workplace health promotion program at Vanderbilt University.

OBJECTIVE: To assess long-term changes in health risks for employees participating in Vanderbilt University's incentive-based worksite wellness program. METHODS: Descriptive longitudinal trends were examined for employees' health risk profiles for the period of 2003 to 2009. RESULTS: The majority of risk factors improved over time with the most consistent change occurring in physical activity. The proportion of employees exercising one or more days per week increased from 72.7% in 2003 to 83.4% in 2009. Positive annual, monotonic changes were also observed in percentage for nonsmokers and seat belt usage. Although the largest improvements occurred between the first two years, improvements continued without significant regression toward baseline. CONCLUSIONS: This 7-year evaluation, with high participation and large sample size, provides robust estimates of health improvements that can be achieved through a voluntary incentive-based wellness program.