Worksite Health Promotion for Low-Wage Workers: A Scoping Literature Review

To determine: (1) What research has been done on health promotion interventions for low-wage workers and (2) What factors are associated with effective low-wage workers’ health promotion

Developing Theory to Guide Building Practitioners’ Capacity to Implement Evidence-Based Interventions

Public health and other community-based practitioners have access to a growing number of evidence-based interventions (EBIs), and yet EBIs continue to be underused. One reason for this underuse is that practitioners often lack the capacity (knowledge, skills, and motivation) to select, adapt, and implement EBIs. Training, technical assistance, and other capacity-building strategies can be effective at increasing EBI adoption and implementation. However, little is known about how to design capacity-building strategies or tailor them to differences in capacity required across varying EBIs and practice contexts. To address this need, we conducted a scoping study of frameworks and theories detailing variations in EBIs or practice contexts and how to tailor capacity-building to address those variations. Using an iterative process, we consolidated constructs and propositions across 24 frameworks and developed a beginning theory to describe salient variations in EBIs (complexity and uncertainty) and practice contexts (decision-making structure, general capacity to innovate, resource and values fit with EBI, and unity vs. polarization of stakeholder support). The theory also includes propositions for tailoring capacity-building strategies to address salient variations. To have wide-reaching and lasting impact, the dissemination of EBIs needs to be coupled with strategies that build practitioners’ capacity to adopt and implement a variety of EBIs across diverse practice contexts

Interview with Maudine "Pat" Thatcher, 1984.

History of the guides at the Institute of Texan Cultures museum from Hemisfair through 1984.INTERVIEW WITH: PAT THATCHER INTERVIEWER: Esther MacMillan DATE: August 1, 1984 PLACE: The Institute of Te xas Cultures (nC) T: Well, this is how I got here . M: All right, Pat, it's quite appropriate for you to be putting your ITC memories on tape today since this is the beginning of your last month here, the first of August. And here is Boss Lady of the Exhibit Floor. And I'd like to go back to the beginning. Dave T.ller, according to Joe Perry, left right after HemisFair closed. And I have this question: And you came right on, is that right? And if that is not right, then you were here all along. Is that it? T: Well, sure, I was here all during HemisFair. M: All right. How did you get the job during HemisFair in the first place? T: It's a very interesting story. Do you want me to tell that story? t4 : Yes, do. T: O.K. I had wanted to get something to do with HemisFair. I wanted to work . It was right after I lost my husband. M: Oh, it was? T: And so I watched the papers and I found a blind ad . And it said, "Hostesses Wanted- -mature women ." So I answered it . I went to the-­I guess it was the First National Bank downtown--and I was interviewed out of about two hundred, maybe. M: Really? T: So when I wrnt in, the Director of the, whi ch I found out later, l THATCHER 2. T: was Bill Robinson, and I sat across the desk, just like I am sitting across from you and he said to me--he said this and that and you know, everything else. And I said, "Vlould you mind just turning over my application and let me talk. I can talk much better than I can write what I can do." M: Oh! T: So he turned it over and we talked. He still wouldn't tell me what the position was or anything about it. M: Oh, you didn't know? T: Nothing about it, absolutely nothing about it. N: How did you know it wasn't a hostess in a dance hall? T: Well, it had to do with something with HemisFair. I~: Oh, it did? T: The ad said, "something to do with HemisFair." I~: Oh, I see. Oh, I didn't know that. T: And so I talked quite a bit to him and told him what I had done and all the things that I could do. And so when I got ready to leave, I said, "I know, don't say, 'We'll call you ... , 11: Did you? T: Uh huh. I said, "I know that story." M: (Laughter) T: So I left. And it was that afternoon, I was on my way out to be a Bluebird out at t·lethodist Hospital; I had my uniform and my shoes in the back of my car; and on the way out there I happened to thi nk, "If he ca 11 s me at home, I won't be there." So I stopped at a friend's house and called and THATCHER T: th" mi Ilute I Cd 11 ed, the woman that answered the phone. sai d. "Mrs. Thatcher, don't worry, you have the job." ~I: No kidding! How wonderful. Just like that. T: So I still didn't know what it was. M: You didn't? (Laughter) Oh, for heaven's sake. 3. T: So the first day I came to work was right before the Fair opened. t~: Yeah. T: And oh, it was a busy beehive. You can imagine. r~: I can imagine. T: And they had the party--cocktail party--out on the stones on the Fountain. And it was lovely. Just lovely. M: Here at The Institute. How did you happen to get here if you didn't know where you were going? T: Well, I was told where to report to, you know . M: At The Institute. T: Uh huh. And I used to come down here while this building was being built ; when they built the Skyride; when they built the Hilton Hotel, I'd come down here every so often and I used to see this wall of earth around our building and I couldn't imagine-- "What in the world is that going to be?" I had no idea . M: No. T: So an)'l'lay I got the job and bacame a hostess in the art gallery. M: I don't know what the art gallery is. T: That was "The Sphere of Art in Texa s." It was a modern art show. M: Hhere was it? THATCHER 4. T: In the basement . M: In the basement of The Institute? T: Yes . Oh, it was a beautiful show. Bill Robinson was the Director and so he had all the different artists over Texas in the d·isplay . M: Yeah. T: And it was the most beautiful gallery. They had sculptures, paintings, everywhere. M: Really? T: I have pictures of it. M: I'd like to see that because Joe tells about The Institute opening when the basement was full of rubble . T: Well, it was. But our art show was completed by the time it opened. 11: Well, where was the gall ery then? T: But the gallery was there. By this time the rubble was only in what later became offices and the break room. Yeah, the paintings were hung. M: In what we call the gallery now? T: Yeah, all along the walls. M: And the workmen were still working down there? T: Yes, but not in the gallery. M: That must have been a challenge. T: We had two policemen on duty at all times to protect the pai ntings . We had vi sitors from allover the world and it was very much a success. M: Was it? T: And what used to ti ckl e me was--I 'd see a man and his wife and children and they'd come down the s tairs and he would invariably stay THATCHER 5. T: at the end of the stairs over there and stand there, and I'd go over to him and I'd say, (spoken very sweetly) "Don't you want to go through the gallery?" And he'd say (in a kind of whisper), "Ah, 1 don't like this kind of art. (spoken strongly) 1 don't like this at all." M: Yeah. T: And l' d say, "We 11, 1 tell you what . Let me take you around and show you a few thi ngs and maybe you' 1 1 change your mi nd." M: Really? T: So 1 would . ~1: You did! T: And 1 remember one painting, it was by Casebier (Cecil). ~1 : Yeah . T: At Trinity . M: Was he at Trinity then? T: Yes. And he had a painting almost as big as this wall . M: Yeah. T: And when you first looked at it, it looked like a scene of clouds and mountains, water, so forth and so on. And it ~Ias in acrylics. M: Yeah. T: So, 1 'd say to the man, "Now what does that look like to you?" And he'd say, "Oh, I can tell what that is. That's for real!" And so when he'd get all through with his conversation, I'd say to him, "Well, no really, that's not what it is . It' s modern art . " lind he'd say, "Well, what is it?" And I'd say, "Well, it's a woman lyinl) on a chaise lounge with a pegnoir on, and the sky and the mountains are her boobs." M: (Laughter) THATCHER T: And he'd say , "Well, I'll be damned!" M: Was it true, or did you just make that up? It really was true? T: True. 11: I mean, the picture really was a woman ... 6. T: Yes. Yes. See, that's what modern art is ... you always see different things in it. This is what I used to tell the public. When they didn't like modern art; when you buy what we called in the art gallery at that time--we called it "Candy Box." If it was a still life, that was candy­box art. If it's modern, every time you look into that painting, you ought to be able to find something different. There were several we had, I could go on and on. But this was the idea. Sometimes I would have as many as 200 people listening to me talk and tell about these paintings. M: You're kidding . What kind of training did you have to have for that? T: None. M: You didn't have any? T: I have a gift. I have a gift. That's all I can tell you. I don't know where it comes from . M: But they didn't have to put you through some long drawn out deal. You just walked right in and started doing it. T: Uh huh. M: We 11, I' 11 be ... T: And Bill Rob ins on was amazed. When I said to him one day--I sa id to him in the beginning, I said, "Bill, I'd like to meet these artists." And he said, "Naw, you don't have to--you don't need to meet the ... " He said, "Anybody that can talk like you're talking, you don't need to meet the artists. " THATCHER M: Were you a sole--the only one down there? T: No, we had shifts. Two ladies at a time. M: Oh, you did. 7. T: And that's where I met Selma. Selma was on a diffe rent shift than I was. M: But she was doing the same thing. T : No, no, no. M: Oh. T: No. They were--the rest of them were just hostesses. They'd go around and talk to people, you know, about art and show it to them. But they didn't go into depth because they couldn't do it. They didn't know how to do it. M: Oh, I see. T: So this was why Bill was so--oh, he was just absolutely fascinated. And so as Mr. Baker and Mr. Shuffler would go around through the gallery and they would listen to me and watch me, and Mr. Shuffler kept saying to me, "I want you to write this all down. I want you to write all this down--what you're telling these people, for posterity." So I kept saying, "Well, I can't write and blah, blah, blah." So towards about the last month of the Fair, he got real angry with me. M: Oh? T: He said, I don't care what you--how you write it or anything about it, but I want a record of this." And so, finally I worked real hard at it and the only time I could get it so that it was readable, J would put it in the first person, which J did. And then it flowed. But for me to sit and write, I can't do it. But J can talk. THATCHER 8. M: It's too bad we didn't have a tape recorder then. T: Uh huh. So anyway when the Fair closed, it was one of the most beautiful parties that I've ever been to in my life. And everyone that was anybody in Texas was there. M: Was it all HemisFair or just The Institute? T: Just The Institute. M: Just The Institute. T: And it was held on the back patio and all around.It was beautiful. ~1: Everybody concerned with The Institute during HemisFair? T: Oh. everybody was here. Everybody. And that's the night that John and Nellie Connally were in the receiving line, naturally, and Mrs. Shuffler was standing next to Nellie. And I had mentioned to Mr. Shuffler and Mrs. Shuffler that John Connally was so handsome and he was always so pleasant and always remembered my name. When he'd come through the gallery, he'd always say. "Hello, Mrs. Thatcher, how are you today?" And blah, blah, blah, see. And I would know when he was coming because his aide would come about ten minutes before and I would just look at the aide and I'd say, "Uh huh," nodding my head, and he woul d say, "Uh hUh." And I knew he was comi ng. We 11, I thought John Connally was the best-looking man I had ever seen in my life. And he was just charming and so was she, just darling . And so , one time talked to the aide about him personally. And the aide told me a few stories--he said, "Well, he doe sn 't drink and he doesn't smoke, but he's a hamburger freak ." He said, "We can 't pass a hamburger place without stopping and gettin' John a hamburger." M: Oh, my! THATCHER 9. T: So, that night before the party started, 1 mentioned to Mrs. Shuffler--"You know, 1 don't think 1 can stand to touch him." And so when 1 got in the receiving line, t1rs. Shuffler introduced me to Nellie, you know, formal "How de do." And as 1 went by, Mrs. Shuffler said to me, "You're going to get to touch him." And 1 said, "1 still don't think 1 can stand it." M: (Laughter) T: So when he heard me--he overheard me--so when 1 got to him, he hugged me. M: Oh, isn't that beautiful . T: It was wonderful. Wonderful. So then . .. M: He really was the king pin in getting the whole HemisFair accom-plished. T: Oh, yes. Very definitely. So then, after we closed, ~Jhich was October the sixth, in '68. And Mr. Shuffler asked to see me . 1 went to see him and he said, "Where are you going to be?" At that time they did not know what was going to happen to The Institute. They had no idea about what they were going to do with it. M: Oh . T: Mayor Cockrell, Lila Cockrell, had made the suggestion it would make a wonderful office building ~Jhich made Mr . Shuffler very angry. M: Oh, really. 1 didn't know that. T: And so when 1 talked to him, he said, "Now tell me where you're going to be ." And 1 sa id, "I don't know . I'm going to do a little traveling ," THATCHER 10 . T: And he said, "Well, 1 want to be sure to know where you are--where we can get in touch with you." He didn't say what . Anything about it . 1 was in Chicago when 1 got the call. Mr. Baker called me. M: He di d? T: Uh huh. He called my daughter and my daughter told him where 1 was. So he said, "When can you be here?" And 1 said, "Well, maybe day after tomorrow." He said, "No. Can you be here tomorrow?" M: My word! T: So 1 got a plane out. Oh, it was 'round six o'clock in the evening. M: Did you know why? Still didn't know what kind of job they had planned for you? Good heavens, you've got a lot of faith. T: So 1 got here and 1 didn't unpack my bags, even. Went to bed. Got up and was here in the morning and had this interview with t~r. Baker. And Mr. Baker was a little bit--he did tell me that there would be-- that we would have guides--not like during HemisFair . We would have actual tours for school children. So 1--1 still didn't--it still didn't sink in, you know. So finally, 1 reported for work the next day. M: You were hired but you didn't know what--still didn't know what for. T: No, not exactly. So we had a former guide by the name of Esther who was on the switchboard . And the switchboard was downstairs in the reception hall. And she was doing switchboard . And so Mr. Baker told me that one of my duties would be to learn all about the Texas History of the floor and get ready to talk to the guides and train the guides as to how to give a tour . Well, that was right up my alley. THATCHER 11. M: Sure. · Sure it was. T: So in the meantime, Mr. Baker told me, he said, "Why don't you learn the switchboard so that you can relieve the switchboard operator for lunch or for a break. Which I did. M: Oh . T: Now, remember, this was in January. M: '69. T: '69 . There was no one here except a skeleton crew--staff. Upstairs there were the offices and all were manned and everything, but on the Exh ibit Floor, there was nobody . M: Weren't the exhibits in place? T: Oh, yes. The exhibits were in place. M: But no people. T: No. So Mr . Baker started hiring guides . And at that time our hours were from ten to four weekdays. On Saturdays and Sundays, they were from Twelve-thirty to six. The guides were all college students. And they had time to go after work, or before work, to school. M: Oh. T: One interesting thing about that was, all the monies that were collected in the fountain outside and collected from the fountain inside in the Mexican Culture--that was given as scholarships to the guides. M: Hum. Really. To the guides. T: Uh huh . And they were all young peop le . M: Ah, they were being paid. T: Oh yes. So can remember going out into the Dome and sitting, actually sitti ng on the fl oor and crying . "flow long can I do thi s?" THATCHER 12. M: Oh, really. T: "How can I do this?" So after we got the crew of guides together I started ... M: About how many did you have? T: I had twelve re~ulars, using six men-six women. M: Oh? T: Then I had two alternates. M: Oh. T: So Mr. Baker started hiring all these guides and then the researchers would all come down and give us the lectures like they do now. M: Oh. T: And that's· the way we got started. O.K. The one thing that was very important was, the guides and I had to get out a letter to every principal and every superintendent in Texas schools. M: Texas! Oh! T: So I worked on a composition of a letter and all I needed was Mr. Shuffler's signature that it was all right--a go-ahead. And I can remember one day, I waited and I waited, and I didn't hear anything. At that time his secretary's name was P.J. So I was anxious to get going, you know, because that was a big undertaking. M: Mercy. T: And, incidentally, all those letters were hand-addressed. M: Oh. Oh . T: Thousands . So I went up to the office and as I walked in the office, THATCHER 13. T: in P.J. 's office, Mr. Shuffler was coming out of his and there were two men standing waiting for him. And he was just putting on his hat. And I said, "Pardon me, Mr. Shuffler." I said, "All I need is an O.K. on my little letter. Please, may I have it." And he reared up and he sa i d, "Mrs. Thatcher, I will have you know that I am a very busy man." And I said, "Well, I'm busy, too." And I turned around and I walked out. Well, by this time I was so disgusted, you know. Here we had all this work to do and couldn'tget an "0 . K." quickly enough to do it . So anyway, I want down and sat downstairs and I thought, "Well, you know, I don't 1 i ke thi s." And I was jus t about ready to walk out. M: Hmm . T: I thought, you know, "If they're not going to pay any attention to what I '01 trying to tell 'em .. . " M: Sure. T: In a few minutes P.J. came down and said, "Mrs. Thatcher, please don't be upset," she said, "because he's one of the most wonderful people to work for." She said, "I know sometimes he can be very curt, but. .. ," she said, "he truly, truly is a very wonderful person." And she said, "You'll learn his dispos ition ." That's the way she put it. So she left and I'm still a little bit piqued about it . Finally about half an hour later. he came down and apologized to me . M: He did? T: And he threw the letter across the desk and he said. "There's your letter--now get going . " There was only one little mistake in it . And I'm sure that that is all in his library . I'm sure all these THATCHER T: things that 1 'm telling you .. . M: Yeah . 14. T: So anyway, we struggled and we found lots of things that we tried to do were wrong, but some of the nice things were these ... The first time we had, let's see, I think there were about 200 came from the School for the Blind in Austin. Now mind you, none of us had ever given a tour to the blind. So the only thing I told the guides was, I said, "Well, we're going to have to get our feet wet, and we are going to have to learn to do this." And I said, "One thing we know-­that the blind--if they can touch--they can see." So that's when I did my little thing with the flag in the intro area--the big Texas flag. If you turn your back to it, it has something to do with your hair . And you rub your hand on the steel, and you get a sensation--well, you can make it hum. So we would do that to the blind and deaf. M: Yeah. T: And they loved it. M: For goodness ... now the big ... T: The big electric flag. M: And you turn your back to it . T: Uh huh. And you rub it like this up on the top or on the sides, and it will--we call it--over the years--we've called it our play toy. M: For goodness sake. T: So then we taught all the guides how to give tours. Now in the interim all of these guides--there were l ots of funny things that went on--there were lots of romances- - M: Oh, were there? THATCHER T: There were lots of weddings . . . M: Really? 15. T: Uh huh . And we had a very good time. And one little guide that I had, Letitia was her name; Letitia came in and when I saw her-- she was selected as running for the Queen of Fiesta. M: Oh. T: And she was so intrigued with the exhibit floor, she asked me, she said, "How do you get a job working here?" And I said, "Ho, ho, ho, that's easy, you know." Well, anyway, that's a long story, too. In getting back to her, when she instituted her way of giving a tou r- -she was bilingual--she would walk and she would hold her hand face up, she'd say, "I'm speaking in English ." This way, palm down, "I'm speaking in Spanish." to the children. It worked beautifully. M: Ohl T: And she's the one who started what we did with the fountain in the Mexican Culture, "The Wishing Fountain." She would have the children all turn their backs and pitch their penny over their right shoulder into the fountain--and if you told your wish it didn't come true. And then, as they pitched their pennies, she would say, "Arriba", which in Spani sh means, "Up and Away We Go." M: Oh, cute. T: And that has been, over the years, we've been doing thi s and still do it. M: She was a natural, wa sn 't she? T: Yes. So many of them were such wonderful young people. They were lovely . THATCHER M: Were they all college students? T: Uh huh. And one thing that I can remember that was funny, very funny, was we had a guide, a young man, and even though he was young he was balding on the top of his head . So one day he said to me, 16. "Mrs. Thatcher, do you think I'd look good in a wig?" And I said, "Well, Jay, I imagine . Why not? If you're self-conscious about that little bald spot. Why not?" So he came in, and at that time you knnw, all young men wore long hair. ~1: Yeah . T: This wig was long and it was horrible . ~1: Oh, dear! T: But anYViay, he got over in the tepee and he was tal ki ng to some children and he played like he scalped himself . M: (Laughter) T: That wig came off and it was a roar! M: Oh, how funny! T: And then we had another little girl, Kathy, who was not quite five feet tall . She was tiny-boned and a tiny young lady . And \~e had a beautiful chest back in the Italian Culture and it was empty and she would get in that and she'd raise the lid just enough and she'd say , "Help'.' in a soulful voice, "Help" when a tour would go by. M: (Laughter) T: And these were some of the things, you know, young people how they i nnova te. M: How wonder ful! But there must have been inspiration from you. T: Our esprit~~~~!2~ was something else. I only fired three guides THATCHER T: in the whole time. M: How long did this go on? T: From '69 until the Maguires came in '76. M: That's seven years. That long? With paid guides. T: Uh huh. 17. t1: I asked somebody about that the other day and whoever it was di dn' t know when the volunteer deal started. Oh, did the Maguires not want that kind of service? Is that why ... ? T: The Maguires, when they came, they wanted more community involve­ment. Which is very fine. M: Uh huh. T: So that was w~y they closed down the guide program and instituted the volunteers. M: While you still had these guides, these paid guides under your wing, did you have to train them on historical facts? T: I train

Developing Theory to Guide Building Practitioners’ Capacity to Implement Evidence-Based Interventions

Public health and other community-based practitioners have access to a growing number of evidence-based interventions (EBIs), and yet EBIs continue to be underused. One reason for this underuse is that practitioners often lack the capacity (knowledge, skills, and motivation) to select, adapt, and implement EBIs. Training, technical assistance, and other capacity-building strategies can be effective at increasing EBI adoption and implementation. However, little is known about how to design capacity-building strategies or tailor them to differences in capacity required across varying EBIs and practice contexts. To address this need, we conducted a scoping study of frameworks and theories detailing variations in EBIs or practice contexts and how to tailor capacity-building to address those variations. Using an iterative process, we consolidated constructs and propositions across 24 frameworks and developed a beginning theory to describe salient variations in EBIs (complexity and uncertainty) and practice contexts (decision-making structure, general capacity to innovate, resource and values fit with EBI, and unity vs. polarization of stakeholder support). The theory also includes propositions for tailoring capacity-building strategies to address salient variations. To have wide-reaching and lasting impact, the dissemination of EBIs needs to be coupled with strategies that build practitioners’ capacity to adopt and implement a variety of EBIs across diverse practice contexts

The systemic inflammome of severe obesity before and after bariatric surgery

INTRODUCTION: Obesity is associated with low-grade systemic inflammation. The 'inflammome' is a network layout of the inflammatory pattern. The systemic inflammome of obesity has not been described as yet. We hypothesized that it can be significantly worsened by smoking and other comorbidities frequently associated with obesity, and ameliorated by bariatric surgery (BS). Besides, whether or not these changes are mirrored in the lungs is unknown, but obesity is often associated with pulmonary inflammation and bronchial hyperresponsiveness. OBJECTIVES: We sought to: (1) describe the systemic inflammome of morbid obesity; (2) investigate the effects of sex, smoking, sleep apnea syndrome, metabolic syndrome and BS upon this systemic inflammome; and, (3) determine their interplay with pulmonary inflammation. METHODS: We studied 129 morbidly obese patients (96 females; age 46 ± 12 years; body mass index [BMI], 46 ± 6 kg/m2) before and one year after BS, and 20 healthy, never-smokers, (43 ± 7 years), with normal BMI and spirometry. RESULTS: Before BS, compared with controls, all obese subjects displayed a strong and coordinated (inflammome) systemic inflammatory response (adiponectin, C-reactive protein, interleukin (IL)-8, IL-10, leptin, soluble tumor necrosis factor-receptor 1(sTNF-R1), and 8-isoprostane). This inflammome was not modified by sex, smoking, or coexistence of obstructive sleep apnea and/or metabolic syndrome. By contrast, it was significantly ameliorated, albeit not completely abolished, after BS. Finally, obese subjects had evidence of pulmonary inflammation (exhaled condensate) that also decreased after BS. CONCLUSIONS: The systemic inflammome of morbid obesity is independent of sex, smoking status and/or comorbidities, it is significantly reduced by BS and mirrored in the lungs