Influence of Incentive Design and Organizational Characteristics on Wellness Participation and Health Outcomes

Objective: To explore how changing incentive designs influence wellness participation and health outcomes. Methods: Aggregated retrospective data were evaluated using cluster analysis to group 174 companies into incentive design types. Numerous statistical models assessed between-group differences in wellness participation, earning incentives, and over-time differences in health outcomes. Results: Four incentive design groups based on requirements for earning incentives were identified. The groups varied in support for and participation in wellness initiatives within each company. All four design types were associated with improved low density lipoprotein (LDL)(P \u3c 0.01), three with improved blood pressure (P \u3c 0.001), and two with improved fasting glucose (P \u3c 0.03). No incentive plan types were associated with improved body mass index (BMI), but designs predominantly focused on health outcomes (eg, Outcomes-Focused) exhibited a significant increase over time in BMI risk. Conclusion: Incentive design and organizational characteristics impact population-level participation and health outcomes

Development and Validity of a Workplace Health Promotion Best Practices Assessment

Objective: To explore the factor structure of the HERO Health and Well-being Best Practices Scorecard in Collaboration with Mercer (HERO Scorecard) to develop a reduced version and examine the reliability and validity of that version. Methods: A reduced version of the HERO Scorecard was developed through formal statistical analyses on data collected from 845 organizations that completed the original HERO Scorecard. Results: The final factors in the reduced Scorecard represented content pertaining to organizational and leadership support, program comprehensiveness, program integration, and incentives. All four implemented practices were found to have a strong, statistically significant effect on perceived effectiveness. Organizational and leadership support had the strongest effect (β = 0.56), followed by incentives (β = 0.23). Conclusion: The condensed version of the HERO Scorecard has the potential to be a promising tool for future research on the extent to which employers are adopting best practices in their health and well-being (HWB) initiatives

Workplace Well-Being Factors That Predict Employee Participation, Health and Medical Cost Impact, and Perceived Support

Purpose: This study tested relationships between health and well-being best practices and 3 types of outcomes. Design: A cross-sectional design used data from the HERO Scorecard Benchmark Database. Setting: Data were voluntarily provided by employers who submitted web-based survey responses. Sample: Analyses were limited to 812 organizations that completed the HERO Scorecard between January 12, 2015 and October 2, 2017. Measures: Independent variables included organizational and leadership support, program comprehensiveness, program integration, and incentives. Dependent variables included participation rates, health and medical cost impact, and perceptions of organizational support. Analysis: Three structural equation models were developed to investigate the relationships among study variables. Results: Model sample size varied based on organizationally reported outcomes. All models fit the data well (comparative fit index \u3e 0.96). Organizational and leadership support was the strongest predictor (P \u3c .05) of participation (n ¼ 276 organizations), impact (n ¼ 160 organizations), and perceived organizational support (n ¼ 143 organizations). Incentives predicted participation in health assessment and biometric screening (P \u3c .05). Program comprehensiveness and program integration were not significant predictors (P \u3e .05) in any of the models. Conclusion: Organizational and leadership support practices are essential to produce participation, health and medical cost impact, and perceptions of organizational support. While incentives influence participation, they are likely insufficient to yield downstream outcomes. The overall study design limits the ability to make causal inferences from the data

Survival of Infants Born to HIV-Positive Mothers, by Feeding Modality, in Rakai, Uganda

Data comparing survival of formula-fed to breast-fed infants in programmatic settings are limited. We compared mortality and HIV-free of breast and formula-fed infants born to HIV-positive mothers in a program in rural, Rakai District Uganda.One hundred eighty two infants born to HIV-positive mothers were followed at one, six and twelve months postpartum. Mothers were given infant-feeding counseling and allowed to make informed choices as to whether to formula-feed or breast-feed. Eligible mothers and infants received antiretroviral therapy (ART) if indicated. Mothers and their newborns received prophylaxis for prevention of mother-to-child HIV transmission (pMTCT) if they were not receiving ART. Infant HIV infection was detected by PCR (Roche Amplicor 1.5) during the follow-up visits. Kaplan Meier time-to-event methods were used to compare mortality and HIV-free survival. The adjusted hazard ratio (Adjusted HR) of infant HIV-free survival was estimated by Cox regression. Seventy-five infants (41%) were formula-fed while 107 (59%) were breast-fed. Exclusive breast-feeding was practiced by only 25% of breast-feeding women at one month postpartum. The cumulative 12-month probability of infant mortality was 18% (95% CI = 11%–29%) among the formula-fed compared to 3% (95% CI = 1%–9%) among the breast-fed infants (unadjusted hazard ratio (HR)  = 6.1(95% CI = 1.7–21.4, P-value<0.01). There were no statistically significant differentials in HIV-free survival by feeding choice (86% in the formula-fed compared to 96% in breast-fed group (Adjusted RH = 2.8[95%CI = 0.67–11.7, P-value = 0.16]Formula-feeding was associated with a higher risk of infant mortality than breastfeeding in this rural population. Our findings suggest that formula-feeding should be discouraged in similar African settings

The Safety of Adult Male Circumcision in HIV-Infected and Uninfected Men in Rakai, Uganda

Ron Gray and colleagues report on complications of circumcision in HIV-infected and HIV-uninfected men from two related trials in Uganda, finding increased risk with intercourse before wound healing

Relatively Low HIV Infection Rates in Rural Uganda, but with High Potential for a Rise: A Cohort Study in Kayunga District, Uganda

BACKGROUND: Few studies have been conducted in Uganda to identify and quantify the determinants of HIV-1 infection. We report results from a community-based cohort study, whose primary objectives were to determine HIV-1 prevalence, incidence, and determinants of these infections, among other objectives. METHODOLOGY: Consenting volunteers from the rural district of Kayunga in Uganda aged 15-49 years were enrolled between March and July 2006. Participants were evaluated every six months. A questionnaire that collected information on behavioral and other HIV-1 risk factors was administered, and a blood sample obtained for laboratory analysis at each study visit. PRINCIPAL FINDINGS: HIV-1 prevalence among the 2025 participants was 9.9% (95% CI = 8.6%-11.2%). By the end of 12 months of follow-up, 1689.7 person-years had been accumulated, with a median follow-up time of 11.97 months. Thirteen HIV-1 incident cases were detected giving an annual HIV-1 incidence of 0.77% (95% CI = 0.35-1.19). Prevalence of HSV-2 infection was 57% and was strongly associated with prevalent HIV-1 infection (adjusted Odds Ratio = 3.9, 95% CI = 2.50-6.17); as well as incident HIV-1 infection (adjusted Rate Ratio (RR) = 8.7, 95% CI = 1.11-67.2). The single most important behavioral characteristic associated with incident HIV infection was the number of times in the past 6 months, a participant had sex with person(s) they suspected/knew were having sex with others; attaining statistical significance at 10 times and higher (adjusted RR = 6.3, 95% CI = 1.73-23.1). By the end of 12 months of follow-up, 259 participants (13%) were lost to follow-up, 13 (0.6%) had died, and 2 (0.1%) had withdrawn consent. CONCLUSIONS: Despite relatively low HIV-1 incidence observed in this community, prevalence remains relatively high. In the presence of high prevalence of HSV-2 infection and the behavioral characteristic of having sex with more than one partner, there is potential for increase in HIV-1 incidence

Male circumcision for HIV prevention: current evidence and implementation in sub-Saharan Africa

Heterosexual exposure accounts for most HIV transmission in sub-Saharan Africa, and this mode, as a proportion of new infections, is escalating globally. The scientific evidence accumulated over more than 20 years shows that among the strategies advocated during this period for HIV prevention, male circumcision is one of, if not, the most efficacious epidemiologically, as well as cost-wise. Despite this, and recommendation of the procedure by global policy makers, national implementation has been slow. Additionally, some are not convinced of the protective effect of male circumcision and there are also reports, unsupported by evidence, that non-sex-related drivers play a major role in HIV transmission in sub-Saharan Africa. Here, we provide a critical evaluation of the state of the current evidence for male circumcision in reducing HIV infection in light of established transmission drivers, provide an update on programmes now in place in this region, and explain why policies based on established scientific evidence should be prioritized. We conclude that the evidence supports the need to accelerate the implementation of medical male circumcision programmes for HIV prevention in generalized heterosexual epidemics, as well as in countering the growing heterosexual transmission in countries where HIV prevalence is presently low

Measurement of intergenerational relations/ Mangen

238 hal.; 23 cm

Measurement of intergenerational relations

258 p.; 21 cm

Cost-Effectiveness Analysis of Corneal Collagen Crosslinking for Progressive Keratoconus.

To evaluate the cost effectiveness of corneal collagen crosslinking (CXL) for progressive keratoconus from the healthcare payer's perspective