Employers' views on the promotion of workplace health and wellbeing: A qualitative study

Background: The evidence surrounding the value of workplace health promotion in positively influencing employees' health and wellbeing via changes to their health behaviours is growing. The aim of the study was to explore employers' views on the promotion of workplace health and wellbeing and the factors affecting these views. Methods: Using a qualitative phenomenological approach, 10 focus groups were conducted with employers selected from a range of industries and geographical locations within Western Australia. The total sample size was 79. Results: Three factors were identified: employers' conceptualization of workplace health and wellbeing; employers' descriptions of (un)healthy workers and perceptions surrounding the importance of healthy workers; and employers' beliefs around the role the workplace should play in influencing health. Conclusions: Progress may be viable in promoting health and wellbeing if a multifaceted approach is employed taking into account the complex factors influencing employers' views. This could include an education campaign providing information about what constitutes health and wellbeing beyond the scope of occupational health and safety paradigms along with information on the benefits of workplace health and wellbeing aligned with perceptions relating to healthy and unhealthy workers

Improving Knowledge and Perception of Cardiovascular Disease Amongst African Americans

The purpose of this project was to evaluate and improve knowledge and perceptions ofcardiovascular disease through culturally sensitive education. African Americans remain disproportionately affected by cardiovascular disease despite advancements in treatment and therapies for this disease over the last few decades. Though there is an abundance of literature highlighting the disadvantage that African Americans have, very little has been done to evaluate the effectiveness of taking a culturally tailored approach to education in order to improve knowledge and perception of CVD in this population. A descriptive, quantitative approach was used for this project. African American patients with or at risk for heart disease were recruited from the St. John’s Well Child and Family Center in Los Angeles, California. These participants completed a 10-item pre-test survey to assess baseline knowledge and perception, and then was given a culturally tailored educational booklet on cardiovascular disease. A 12-item post-test survey was given after the booklet had been completed, and the results were compared to the pre-test survey to evaluate the effectiveness of the intervention. Data analysis of the multiple- choice questions resulted in a mean pre-test score of 46/100 or 46% and a mean post-test score of 76/100 or 76%, indicating increased knowledge of CVD. Data analysis of Likert scale questions assessing for confidence and intent to incorporate heart healthy lifestyle habits and self-perceived improvement in knowledge and perception of CVD following the program intervention revealed an average 66.5% improvement of perception. In conclusion, African American patients at St. John Well Child and Family Center in Los Angeles, California showed improved knowledge and perception of CVD after implementation of a culturally sensitive education booklet and thus could ultimately lower their risk for heart disease

A healthier workplace? Implementation of fruit boxes in the workplace

© The Authors 2016 .Objective: The purpose of this study was to investigate whether making fruit boxes available in the workplace is a successful health promotion strategy. Design: A quasi-experimental study involving three conditions - free fruit, 50c per piece of fruit and 1 per piece of fruit - to investigate the effect of a contribution scheme on employees' fruit purchase/consumption behaviours and willingness to contribute when in the paid conditions. Setting: Perth, Western Australia. Methods: In total, 36 workplaces participated and were randomly assigned to one of the three conditions. The results were analysed using generalised linear modelling. A qualitative follow-up was conducted with workplace representatives 6 weeks after the completion of the trial to investigate how many workplaces implemented the provision of fruit boxes after the trial and the factors influencing the decision to implement fruit boxes. Results: A significant difference in average fruit purchasing/consumption per person was found with respect to condition (p <.001), with businesses in the free condition purchasing/consuming a significantly greater amount of fruit than businesses in the 50c contribution condition or 1 contribution condition. Following the trial, 13 workplaces continued providing their own fruit box, of which 7 were initially in the free condition. Qualitative findings revealed that management support, a receptive culture and sufficient resources were key to the implementation of fruit boxes. Conclusion: Having a fruit box may be a feasible health promotion strategy, and the financial burden of this strategy could be alleviated by asking employees to contribute to the cost of fruit

Th17 plasticity and transition toward a pathogenic cytokine signature are regulated by cyclosporine after allogeneic SCT

T-helper 17 (Th17) cells have been widely implicated as drivers of autoimmune disease. In particular, Th17 cytokine plasticity and acquisition of an interleukin-17A(+)(IL-17A(+)) interferon gamma(IFN gamma)(+) cytokine profile is associated with increased pathogenic capacity. Donor Th17 polarization is known to exacerbate graft-versus-host disease (GVHD) after allogeneic stem cell transplantation (allo-SCT); however, donor Th17 cytokine coexpression and plasticity have not been fully characterized. Using IL-17 "fate-mapping" mice, we identified IL-6-dependent Th17 cells early after allo-SCT, characterized by elevated expression of proinflammatory cytokines, IL-17A, IL-22, granulocyte-macrophage colony-stimulating factor, and tumor necrosis factor. This population did not maintain lineage fidelity, with a marked loss of IL-17A and IL-22 expression late posttransplant. Th17 cells were further segregated based on IFN gamma coexpression, and IL-17A(+)IFN gamma(+) Th17 displayed an enhanced proinflammatory phenotype. Th17 cytokine plasticity and IFN gamma production were critically dependent upon donor-derived IL-12p40, and cyclosporine (CsA) treatment regulated this differentiation pathway. This observation was highly concordant with clinical samples from allo-SCT recipients receiving CsA-based immune suppression where although the IFNgnegative- Th17 subset predominated, IFN gamma(+)-Th17 cells were also present. In sum, Th17 polarization and ensuing differentiation are mediated by sequential inflammatory signals, which are modulated by immunosuppressive therapy, leading to distinct phenotypes within this lineage

Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial: a double-blind, active and placebo-controlled study.

BACKGROUND: The treatment of ischaemic stroke with neuroprotective drugs has been unsuccessful, and whether these compounds can be used to reduce disability after recurrent stroke is unknown. The putative neuroprotective effects of antiplatelet compounds and the angiotensin II receptor antagonist telmisartan were investigated in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial. METHODS: Patients who had had an ischaemic stroke were randomly assigned in a two by two factorial design to receive either 25 mg aspirin (ASA) and 200 mg extended-release dipyridamole (ER-DP) twice a day or 75 mg clopidogrel once a day, and either 80 mg telmisartan or placebo once per day. The predefined endpoints for this substudy were disability after a recurrent stroke, assessed with the modified Rankin scale (mRS) and Barthel index at 3 months, and cognitive function, assessed with the mini-mental state examination (MMSE) score at 4 weeks after randomisation and at the penultimate visit. Analysis was by intention to treat. The study was registered with ClinicalTrials.gov, number NCT00153062. FINDINGS: 20,332 patients (mean age 66 years) were randomised and followed-up for a median of 2.4 years. Recurrent strokes occurred in 916 (9%) patients randomly assigned to ASA with ER-DP and 898 (9%) patients randomly assigned to clopidogrel; 880 (9%) patients randomly assigned to telmisartan and 934 (9%) patients given placebo had recurrent strokes. mRS scores were not statistically different in patients with recurrent stroke who were treated with ASA and ER-DP versus clopidogrel (p=0.38), or with telmisartan versus placebo (p=0.61). There was no significant difference in the proportion of patients with recurrent stroke with a good outcome, as measured with the Barthel index, across all treatment groups. Additionally, there was no significant difference in the median MMSE scores, the percentage of patients with an MMSE score of 24 points or less, the percentage of patients with a drop in MMSE score of 3 points or more between 1 month and the penultimate visit, and the number of patients with dementia among the treatment groups. There were no significant differences in the proportion of patients with cognitive impairment or dementia among the treatment groups. INTERPRETATION: Disability due to recurrent stroke and cognitive decline in patients with ischaemic stroke were not different between the two antiplatelet regimens and were not affected by the preventive use of telmisartan.Clinical TrialComparative StudyJournal ArticleMulticenter StudyRandomized Controlled TrialResearch Support, Non-U.S. Gov'tErratum in :Lancet Neurology, 2008; 7; 985info:eu-repo/semantics/publishe

Promoting regulation via the inhibition of DNAM-1 after transplantation

Donor T cells play pivotal roles in graft-versus-host disease (GVHD) and graft-versus-leukemia (GVL) effects following bone marrow transplantation (BMT). DNAX accessory molecule 1 (DNAM-1) is a costimulatory and adhesion molecule, expressed mainly by natural killer cells and CD8(+) T cells at steady state to promote adhesion to ligand-expressing targets and enhance cytolysis. We have analyzed the role of this pathway in GVHD and GVL. The absence of DNAM-1 on the donor graft attenuated GVHD in major histocompatibility complex (MHC)-mismatched and MHC-matched BMT following conditioning with lethal and sublethal irradiation. In contrast, DNAM-1 was not critical for GVL effects against ligand (CD155) expressing and nonexpressing leukemia. The effects on GVHD following myeloablative conditioning were independent of CD8(+) T cells and dependent on CD4(+) T cells, and specifically donor FoxP3(+) regulatory T cells (T-reg). The absence of DNAM-1 promoted the expansion and suppressive function of T-reg after BMT. These findings provide support for therapeutic DNAM-1 inhibition to promote tolerance in relevant inflammatory-based diseases characterized by T-cell activation