Follow national guidelines –

Total Cholesterol

Desirable cholesterol   < 200 mg/dl

Borderline cholesterol   200 – 239 mg/dl

High cholesterol   > 240 mg/dl

HDL   

Desirable HDL    > 35 mg/dl

Low HDL    < 35 mg/dl

Refer cholesterol screening participants to medical care as follows –    

Total Cholesterol   

< 200 mg/dl    Recheck cholesterol in five years, when history of coronary heart disease or when two or more CHD risk factors are detected refers to risk reduction program or health professionals, as appropriate.

200 - 239 mg/dl    If history of CHD or if two or more other risk factors are detected, refer to medical care or risk reduction service within two months; if no reported history of CVD or less than two other risk factors, reassess cholesterol status within 1-2 years.

> 240mg/dl    Refer to medical care within two months.

HDL   

> 35 mg/dl   If fewer than 2 risk factors and borderline sum cholesterol, refer to risk reduction service, as appropriate. Reassess HDL in 1-2 years.

Provide the following –    

• the relationship of blood cholesterol, high blood pressure, and other risk factors.    

   o Risk factors include –  high blood pressure 140/90 or higher or on hypertension medication; current cigarette tobacco use; family history of premature CHD; diabetes mellitus; age – male > 45 years, female > 55 years or premature menopause without estrogen replacement therapy.

   o Negative risk factor –  high HDL 60 mg/dl or greater (subtract one risk factor).

   o Risk factors like family history, use of tobacco, high fat or other unhealthy diet, andlack of exercise lead to the development of cardiovascular disease (CVD).

• Definitions and causes of high blood cholesterol and HDL, desirable levels, the meaning and limitations of a single measurement, the cause of variability, and the need for multiple measurements prior to diagnosis.    

• Wide range of treatment options, including diet (e.g., importance of controlling fat intake less than 30% of sum calories from fat, less 10% saturated fats), less than 300 mg. of cholesterol per day, well-balanced diet, weight maintenance or reduction, exercise, and medication.    

• Importance of following prescribed treatment and expert advice.    

National guidelines for blood pressure (BP) protocols –  

• Calibration of blood pressure measuring equipment must be done at least each year.

• Two or more measurements of participant’s blood pressure (BP) must be taken.

• Referral of participants with high blood pressure readings to personal physician for further evaluation.   

Systolic / Diastolic Follow-Up –     

• Normal –    <130 / <85   

   Action –  Recheck in 2 years

• High Normal –    130-139 / 85-90   

   Action –  Recheck in 1 year

Hypertension –     

• Stage 1 (Mild) –    140-159 / 90-99    

   Action –  Confirm within 2 Months.

• Stage 2 (Moderate) –    160-179 / 100-109    

   Action –  Refer to source of care within 1 month.

• Stage 3 (Severe) –    180-209 / 110-119    

   Action –  Refer to source of care within 1 week.

• Stage 4 (Very Severe) –    >210 / >120    

   Action –  Refer to source of care immediately.

Appropriate educational messages –     

• Normal –    <130 systolic and <85 diastolic   

   Action -  No referral. When on treatment, then inform participant that blood pressure (BP) is under good control today and should continue seeing and following treatment program.

• High Normal -    130-139 systolic and/or 85-89 diastolic   

   Action -  Recommend that participant have blood pressure (BP) rechecked within 1 year unless under treatment. Advise participant that the readings are in a high normal range that needs rechecking. In the interim, suggest that among the most effective means to lower blood pressure (BP) is to bring weight into normal range and to exercise.

• High -    >140 systolic and/or >90 diastolic   

   Action –  Refer to doctor for further investigation within 2 months unless the level is within urgent, emergency, or isolated systolic hypertension levels. If already on treatment, advise participant of readings and need to get blood pressure (BP) to a goal of 140/90 or less.

• Isolated Systolic Hypertension –    140-159 systolic and < 90 diastolic in a participant 65 years of age or older.   

   Action -  Advise participant to inform physician of readings at next visit and consider advice regarding weight loss and exercise if appropriate.

• Urgent -    180-209 systolic and/or 110-119 diastolic   

   Action -  Recommend obtaining medical examination within 1 week.

• Emergency -    >210 systolic and/or >120 diastolic   

   Action –  Obtain immediate medical attention.

Provides the following –     

• Written results, referral instructions, and an explanation of blood pressure (BP) levels given to each participant with individualized counseling, including advice about the interval of time advised when the participant ought to be checked again.    

• Utilizes the recommendations in the Fifth Report of the Joint National Committee on Detection, Investigation and Treatment of High Blood Pressure, March 1994.    

• Written and audiovisual materials that are informative, easy to understand, and useful while containing scientifically accurate information.    

• Relationship of high blood pressure and other risk factors, such as family history, tobacco use, high fat and unhealthy diet, lack of exercise, in the development of cardiovascular illness, including stroke, kidney illness, heart attack, and other diseases.

• Definition and causes of high blood pressure.

• Importance of following prescribed treatment.

• Blood pressure (BP) measurements – at least two blood pressure measurements taken during the screening episode, using a mercury sphygmomanometers or regularly calibrated aneroids.    

• Blood pressure treatment status – ascertain whether the participant is under a doctor’s care, on any medication, on a prescribed diet, or any other type of treatment for hypertension.    

• Blood cholesterol measurement – total cholesterol and HDL-cholesterol taken either using a properly tested and maintained table top blood analyzer providing immediate feedback to the client, or sending blood to a laboratory providing feedback using a method that is as effective as immediate feedback.    

• Cholesterol treatment status – ascertain whether the patron is under a doctor’s care, on any medication, on a prescribed diet, or any other type of treatment for high cholesterol.    

• Obesity – utilize an accepted method for estimating obesity. for example assess participants height and weight and use the 1959 Metropolitan Life Height/Weight charts or use Body Mass Index.    

   o Identify people  20% or more above their ideal weight.

• Tobacco use status – assess whether the participant currently smokes cigarettes, whether the client has quit or never smoked, and the number of cigarettes smoked/day.    

• Exercise habits – screening questions could  be limited to frequency and duration exercise. Do participants exercise in a moderately vigorous fashion at least three times per week for 30 minutes or more.    

• Diabetes – whether the customer has diabetes, and whether or not it is currently under control. A blood glucose might  be also done via finger stick and desk top analyzer. A few manufactures make available cassettes which include cholesterol and glucose measurements.

• Cerebrovascular illness or occlusive PVD – ascertain if the patron has had a stroke or other type of capillary illness.

• Family history of cardiovascular illness – ascertain whether any of the participants’ parents or siblings had a heart attack or sudden death due to heart illness before age 55.

• Coronary heart illness – ascertain when the client has had a heart attack or other kind of coronary heart illness.

• Stress – participant’s assessment of stress in work and/or personal life. A series of well-tested and validated questions reviewing  levels of stress are available from the Employee Health Program.

• Participant release form (see forms) – A release form is required in which the participant authorizes the program to draw blood for testing to send information to the participant’s medical care provider if medical risks are identified, and to obtain information from the provider about diagnosis and prescribed treatment.

• Participant interest survey – if an assessment of interest has not been accumulated previously, the screening activity must assess levels of interest in programs such as –  weight control, tobacco use cessation, fitness or exercise, stress management, nutrition, self-care, cholesterol control.

• Health education messages – the screener must review with the participant his/her identified health risks and what they mean to the participant’s overall health, and give the participant a written record of the blood pressure, total cholesterol, and any other physiological measures taken.

• Referral of participants for treatment – participants with elevated risks must be referred to appropriate sources of diagnosis and possible treatment following nationally or locally recognized guidelines for such referral.

Demographic information ought to include location of the screening, worksite, client’s name, address, social security number, home and work phone numbers, sex, race, birthdate, relevant job information (e.g., hourly or salaried), department number, and work shift.

They should have expertise in content areas, planning, promotion, administration, examination, and ability to grow a program and tailor the program to the workplace.   

Program providers should have a quality assurance program for evaluating  the effectiveness of service personnel, to assess satisfaction of participants, and for personnel training and continuing education.   

An overall policy statement must be available from directors and program providers addressing the following issues –  

• assurance of confidentiality of health data,
• referral to health and medical care for at-risk participants,
• follow-up with referred participants and those at-risk,
• program examination on process and outcomes,
• organization of the worksite for promotion of wellness and changes in corporate culture.

A clear contract or letter of agreement for services should be provided.

The purpose of the incentive is to encourage workers to adopt positive behaviors or maintain an existing positive behavior.

Everyone who achieves a goal or maintains a behavior ought to receive something. A lot of organizations also provide incentives merely for participating in events.

Stay away from being the “best” or doing the “most.” Encouraging people  to be the best or doing the most promotes excessive behavior, discourages others, and creates elitism.    

The best designed incentive programs are ones which are based on achieving objectives that are attainable by most person. Recognition, acknowledgment by top management, or special privileges are examples of great intangible incentives.   

Incentive ideas –    

• Free or Low-Cost –     

   o Certificates

   o Movie passes

   o Recognition in worker newsletter

   o Mugs

   o Water bottles

   o Commendation from management

   o T-shirts

   o Hats

• Moderate Cost –     

   o Entertainment tickets

   o Sweatshirts

   o Waist packs

   o Subscriptions to health magazines

   o Health and fitness books

   o Videos

• High Cost –     

   o Week-end getaways

   o Dinner for two

   o Clocks

   o Watches

• Others –     

   o Cash

   o Gift certificates

Utilizing posters, newsletter articles, and flyers are excellent means of promoting the program. Other promotional methods to consider are e-mail and announcements at staff meetings. Ask wellness committee members to recruit participants.

Once the program is kicked off you could want to provide an incentive for any worker who recruits another worker to any of the program offerings.

• How many worksites have done the program?

• What types of worker population was the program offered?

• What educational materials are used?

• Will the program meet the needs of employees?

• What are the techniques used to help change behaviors?

• Does the program help individuals  move through stages of readiness to make health behavior changes?

• How do you market the program to employees?

• What follow-up do you provide?

• How do you make referrals for medical care or other supportive services employees may need?

• How do you know the program works?

• How do you measure participant satisfaction?

Small and medium size worksites do not typically have a wellness professional on staff. When your worksite is in this category, you’ll need to contract with providers outside your corporation.

Large companies have several choices. They can hire a staff solely for the wellness program, they can contract with outside wellness providers, or they can use a combination of internal staff and outside providers.

When choosing  a provider some key questions in the areas of staff, program structure, process, and effectiveness need to be addressed. Each of these key questions is discussed in the following sections.

Wellness Business Staff

Health professionals become wellness professionals when they are trained in the full range of wellness activities. Wellness professionals are generalists who come from a broad variety of backgrounds and schooling.

They might be nurses, dietitians, health educators, counselors, exercise physiologists, or have other backgrounds. But also to their main training, they know something about all wellness topics, including use of tobacco, stress, exercise, and nutrition.

They also know how to engage and support people  in making and sustaining health improvements and have good people  skills.

Normally, wellness professionals at worksites fall into three wide categories, wellness screeners, wellness counselors, and wellness instructors.

• Wellness screeners introduce workers to the program, take health measurements, collect health-related information, provide initial counseling, and help workers define for themselves what they need and want in a wellness program.

• Wellness counselors work with staff members after the screening to help them create and carry out a plan to reduce their risks and improve their health.

• Wellness instructors teach courses and minigroups on different health topics.

A wellness program in a small corporation could be staffed by a single staff person who fills all three roles. Larger worksites will use different individuals  to fill these roles.

When selecting  staff or selecting  among wellness companies, ask the following questions –

• Do prospective employees have a range of health backgrounds that’ll provide appropriate specialistise in the topics to be addressed?

• Have prospective workers functioned well as wellness screeners, wellness counselors, and/or wellness instructors?

• Will this staff include individuals  from the racial and ethnic backgrounds found in your staff member population?

• is each staff member comfortable with the range of backgrounds found in your staff member population, and able to communicate effectively with the various social and educational levels of your employees?

• Do staff members have a warm, but specialist, counseling style when interacting with employees?

Some organizations choose to follow a National Health Observances calendar which offers advantages. the materials developed by these various national health organizations are very credible. the materials are generally high quality and available free or at a nominal cost.

The company benefits from additional publicity that occurs in various media throughout the community related to the national observance. for planning suggestions you could want to utilize the HOPE Publications Wellness Resource Planning Guide available for free at this Web site.

An HRA seeks to identify precursors associated with premature death or serious disease and quantifies the probable impact for each individual.

An HRA instrument is derived from an understanding of the at a illness. Based on this understanding, useful prediction instruments can be constructed to assess the health risks of an individual. Individuals with a higher number of health risks tend to have more serious medical problems over time.

Drawing attention to their health risks can help customers reduce risk factors which lead to the onset of unnecessary illness and subsequent premature death.

The questionnaire covers lifestyle habits (like tobacco use, seat belt use, and exercise) and physical measures (like cholesterol, blood pressure levels, height, and weight).

For accuracy, it is vital to obtain direct measures of blood pressure, cholesterol and HDL-cholesterol. the HRA also provides recommendations and indicates what risks are modifiable. Kinds of measures to assess health risks are discussed under Screening Programs.

The impact of a health risk (assessment|appraisal} is much greater when it is given in-person, with immediate feedback to the patron. This also provides an opportunity to invite the patron’s participation in continuing health counseling and to gain their written consent to do pro-active outreach to them.

A health age may be computed based on the individual answers to the questionnaire and physiologic factors. the health age might indicate the individual to be younger or older than their chronological age.

HRA programs are one the most prolific kinds of wellness activities utilized by organizations. Continuing research on HRAs is examining the efficacy of this tool.

Among the big advantages of this tool is that it can provide an aggregate group report of a company and could be utilized as an analysis tool.

Detailed information is available from the Society of Prospective Medicine (www.spm.org/desc.html) who publishes a handbook on HRAs.