Occ Doc in a Box

Stop Workplace Computer Viruses: Use Hand Sanitizer!

2012-02-08T14:51:00.002-06:00

Have head colds spread through your office this year? Worse yet, how about that awful “stomach flu?”

The viruses that cause these miseries easily pass among workers who share office equipment—touch pads and keyboards on scanners, faxes, printers, tablets, and computers. You can’t stop these “computer viruses” by calling the Help Desk. Instead, help your desks by equipping them with hand sanitizer. Make 2012 “The Year of the Sanitizer” where you work!

Alcohol-based hand sanitizer gels effectively reduced workplace colds and coughs in a recent research study. Participants received a 500 ml bottle of gel delivered to their desk, with instructions to cleanse their hands with it five times a day. Compared to workers at a different office not given this intervention, the hand-cleansing group had 55 percent fewer coughs, and 60 percent fewer colds and fevers during the course of a year. The sanitizer users also had significantly less work absence from respiratory illness and from diarrhea (Hubner, 2010).

Soap and water hand washing remains the time-honored cornerstone of good hygiene. These researchers of course still asked people in both groups to continue that habit. The study participants enjoyed better health because of the added convenience the gels offered.
In just seconds, without leaving your computer, you too can kill pesky viruses by the millions. And, other studies have found hand sanitizers remove rhinovirus, a leading cause of colds, even better than soap and water, 80 percent compared to 31 percent (Turner, 2010).

Children live in an even more techno-world than adults, with shared keyboards at school and game controls at home. Remind them to use hand gel at least five times a day—once for each finger. Parents will appreciate this: perfect attendance increased by 20 percent at an elementary school participating in hand gel research, compared to a control setting that did not (Nandrup-Bus, 2011).

At work, school, and home, use computers to spread information—not infections! Pass the sanitizer, please!

References:
1. Nils-Olaf Hübner, Claudia Hübner, Michael Wodny, Günter Kampf and Axel Kramer, “Effectiveness of alcohol-based hand disinfectants in a public administration: Impact on health and work performance related to acute respiratory symptoms and diarrhoea” BMC Infectious Diseases 23 Aug 2010 http://www.biomedcentral.com/1471-2334/10/250

2. R. B. Turner, J. L. Fuls, N. D. Rodgers. “Effectiveness of Hand Sanitizers with and without Organic Acids for Removal of Rhinovirus from Hands” Antimicrobial Agents and Chemotherapy, 2010; 54 (3): 1363 DOI: 10.1128/AAC.01498-09

3. Inge Nandrup-Bus. “Comparative studies of hand disinfection and handwashing procedures as tested by pupils in intervention programs”. American Journal of Infection Control, 2011; 39 (6): 450 DOI: 10.1016/j.ajic.2010.10.023

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Do You Know What I Know?

2011-12-21T14:47:00.002-06:00

Target Audience: Employers and Employees

Gallup polls show 40 percent of Americans report regular attendance at religious services. This time of year, that number soars.

Lately, increasing numbers of Americans pray about their health. Rates have more than tripled in an eight-year span, leaving researchers puzzled about the “. . . primary, overwhelming issue that would have so globally affected people.” (Amy Wachholtz, Director of Health Psychology at U of MA, quoted in NY Times, 6/3/11).

Maybe people pray about their health because they know it helps. In the National Health Interview Survey, almost 60 percent of the 22,000+ participants said they have prayed for their health. These people also saw a physician more frequently, participated more often in vigorous exercise and used more relaxation techniques, support groups, meditation and complimentary and alternative medicine therapies. “People who pray for their health participate in more health promoting behaviors than people who do not pray for their health.” (Harrigan JT, J Relig Health. 2011 Sep;50(3):602-7).

This seems to have remarkable benefit. Dozens of studies have shown that people who regularly attend religious services live longer than their non-religious counterparts; up to a maximum of seven years. The McCullough meta-analysis of 2000 confirmed this strong association. It found a 37 percent reduction in death rates among people who practice their faith, which happens to equal the amount that anti-cholesterol drugs reduce mortality following heart attacks! And, practicing religion nets about ten times more lives saved than these medications do, since about ten times as many people attend religious services as the number of people who have experienced a heart attack.

Religious practice specifically reduces the effects of stress-related illness and cardiovascular disease. It probably does this through several mechanisms. Practitioners make better life choices, adopt healthier lifestyles, cope better, and have more social support. A report this year from Yeshiva University of Manhattan involving nearly 100,000 participants in the Women's Health Initiative found that “People who attend religious services regularly are more likely to have a positive outlook on life and are less likely to suffer from depression . . .Those who attend religious services on a regular basis have a 56 percent higher chance of having an optimistic view of life, and a 27 percent lesser chance of suffering from depression than those who do not” – (summarized by Marco Tosatti 11/16/11, Vatican Insider).

This brings “Occ Doc in a Christmas Box” to the end of my carol-themed series. Like the Mighty King said to the people everywhere: “pray for peace, people everywhere.” Peace begins in your heart, gives you hope, and brings you health of mind and body. I pray that for all of you in the coming year.

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Do You Hear What I Hear?

2011-12-12T11:45:00.005-06:00

Target Audience: Employers and Employees

In this gift-giving season, adults buying MP3 players for children should consider giving them a stop watch, too. About 1 in 5 teens estimate they expose themselves to five or more hours of loud music each day, whereas at maximum volume (100db!), MP3 players can damage hearing with just 90 seconds of daily use.

Teach children the 80/90 rule recommended by audiology researchers at the University of Colorado: you can listen at 80 percent of the maximum volume for up to 90 minutes. If you listen at a higher level, you get less time.

To get them to follow that rule, take them to a website which simulates hearing loss: http://facstaff.uww.edu/bradleys/radio/hlsimulation/.

Listening to sample audio files here may impress them with the need to turn it down. And, it may remind you to not take your own hearing for granted, either. In fact, demonstrating to the kids that you protect your hearing, at home and at work, will impress them the most.

Furthermore, remind them that noise-induced hearing loss has another effect besides deafness. That is, it replaces hearing with tinnitus – the phantom sound of ringing in the ears.

So, get the kids to dial down the vibe. And, protect your own hearing, too. Otherwise, tinnitus may be the subject of the musical question, "Do you hear what I hear?"

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Do You See What I See?

2011-12-07T10:33:00.002-06:00

Target audience: Employers and Employees

My patients often have trouble finding the right words to describe their symptoms. Words may fail when they try to explain pain, numbness, and tingling, for example. Like most doctors, I ask patients to complete pain diagrams to show where their trouble lies, using symbols to represent various kinds of discomfort, and scales to show its severity. A picture is worth a thousand words, at least!

I discussed this recently with my daughter Catherine Loughrin, an optometrist. I wondered how eye doctors solve this problem, since finding the right words for distorted vision seems especially difficult. She helped me find a highly useful, educational, and even entertaining website which I want you to see, even if you have no eye problems yourself.

Vision Simulations lets you customize pictures which show various types and degrees of vision distortions to basically “paint a picture” of your own visual problem. It uses altered photos that represent how each of 13 different eye conditions can affect vision, and then lets you take control from there. To top it off, you can email your finished picture to your own eye care provider. That way, your eye doctor literally can see what you see, and better assess your problem.

Since Christmas approaches, please enjoy this educational, entertaining, and practical gift from Occ Doc in a Box. If it doesn’t “fit,” you can alter it yourself to make it just right! And, you can hum a Christmas carol to yourself all the while, “Do You See What I See?”

http://www.visionsimulations.com/

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Tobacco-free Heroes

2011-11-14T11:05:00.006-06:00

Target audience: Employers and Employees

Everybody needs heroes, although sometimes they seem hard to find. This November 17, Great American Smokeout Day, celebrate a special type of hero you can find everywhere: tobacco-free heroes.

Ex-tobacco users surround us. About one out of every four adults has quit their former use of tobacco. In fact, ex-smokers now outnumber smokers.

Anybody who has ever freed themselves from this addiction has accomplished something heroic. For most, it didn’t come easy; nothing epic ever does. Each found unique motivation to tackle this difficult challenge. Most considered health, finances, and self image as reasons enough. Many did it to honor the requests of worried loved ones. Wanting to provide a better role model for children compelled a remarkable number.

Most needed multiple tries. Tobacco-free heroes learned that quitting is an ongoing journey, not a final destination. Heroes know that arising one more time than falling matters most. They encourage current tobacco users to keep trying to quit and to stay quit.

Seek out tobacco-free heroes by asking people you know if they used to use tobacco. Have them tell you about their quitting journey if so. Maybe no one has asked them about it in years. They will enjoy sharing it.

If you want to quit using tobacco yourself, these stories can help. Realize your own time to do something heroic has come. Each year, about 800 Wisconsinites die from heart attacks and lung cancer brought on by smoking. You can heroically save one of those lives, namely your own.

Consider your individual reasons for wanting to join these heroes. What’s stopping you? With each cigarette you smoke, think about the benefits that would have come from not smoking that cigarette, compared to what you got from it. Make it your last.

Overcoming nicotine addiction requires every advantage to succeed. See your doctor, who has many ways to help you. Set a quit date, and then tell everybody when it will be. Let them support you.

If you talk to a tobacco-free hero and become one yourself, you may help more people than you could ever imagine.

Our world needs more heroes—like you.

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Common Sense About the Common Backache

2011-10-19T13:59:00.003-05:00

Target audience: Employers and Employees

If you have a back, you’ve probably had a backache. I mean the ordinary “I threw my back out” kind. In fact, 70 percent of us will experience backache in the coming year.

I want to chip in my “two cents worth” of common sense about this common problem. In fact, I’ll give you at least a dime’s worth—two cents at a time. But once again, I’m only talking about the ordinary sore back with its typical stiffness and grabbing, achy pain. If your problem includes any “red flags” that I have listed at the end of this column, see your doctor promptly. But for the rest of you, and that’s most of us, take these things to heart:

1. In the short term, your back will hurt. But in the long term, it will turn out fine. Most back pain has no serious cause and leaves the spine undamaged.

2. Your pain will almost certainly improve in a few days to a few weeks. Meanwhile, stay as active as you are able. If you can’t do your normal work, talk with your supervisor about temporary changes to help you through the day. Soon you will handle everything normally again. Try normal activities more slowly and carefully. If something hurts too much today, then try again tomorrow.

3. Exercise, almost any kind, helps. Avoiding activity does more harm than good! Take a walk two or more times a day. If today you can only go 10 minutes each time, then tomorrow try 15, and the next day 20, and so on.

4. You will have good days and bad days. On bad days, be ready with ice, heat, over-the-counter medicine—whatever takes the edge off the pain. And, the simpler the medication the better, like acetaminophen or ibuprofen. Prescription pain medications, while occasionally helpful, run the risk of prolonging the problem by delaying return to normal activity.

5. Even back pain that has no serious cause may return time to time. In fact, it usually does. You can minimize these recurrences by staying fit with healthy, balanced exercise habits that include stretching, strengthening, and cardio. A healthy lifestyle can keep back pain away.

Spines are designed to move. When yours gives you trouble, remember that the sooner you get mobile and active again, the sooner your normal life returns. So fight back! Don’t take back pain lying down!

RED FLAGS
See your doctor promptly to get specific advice about your back pain if any of these things apply:

You are older than 50 or less than 20

Your pain followed forceful trauma such as a car accident or fall from a height

Your pain followed a minor accident or exertion AND you may have weak bones (osteoporosis)

Your back pain causes one or both legs to feel numb, painful, or tingly past knee level (“sciatica”); especially if you have leg muscle weakness

You feel numbness in the groin, or have bladder trouble such as difficulty starting urinary stream or difficulty holding urine

You recently had an infection such as bladder or kidney infection

You presently:
- Feel ill such as with fever, chills, or unexpected weight loss OR
- Awaken from a sound sleep because of back pain

You ever had:
- Any type of cancer OR
- Used IV street drugs OR
- Suppression of your immune system such as from steroids, transplant anti-rejection medications, or positive HIV/AIDS status

Your pain doesn’t improve in two or three weeks

If none of these apply, you may safely follow the Common Sense tips above for up to the first three to four weeks of a back pain episode.

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Back Safety for "Back-to-Schoolers"

2011-09-02T16:25:00.002-05:00

Target audience: Employers and Employees

This year, the National Safety Council has emphasized school safety. You can find excellent resources at their website.

Or just find National Safety Council with a search engine, and look under “news.”

And, remember that safe work practices you learn on your job can help kids, too. We all want children to grow up healthy and productive. Teach them these ergonomic principles so they can avoid back injuries for life.

Homework – Give small children a low table where they can do their homework. If the child’s feet don’t touch the floor, provide a footrest. Position the computer monitor so the top of the screen is at or below the child’s eye level. Or, give them a booster chair to raise them to that level.

Sports – Make sure all equipment fits properly. Help young athletes learn proper form and technique, and stretching exercises appropriate to their age, experience level and specific sport.

Sit up straight – Encourage good posture when watching TV, playing video games or working on a computer. And, limit “screen time!” Young spines need frequent outdoor exercise, especially when children have been cooped up all day in class.

Strengthen bones – Ensure your child gets enough calcium every day. Milk, preferably skim, is essential for healthy bones.

Soak up water like a sponge – That means lots of H2O! Be sure your child avoids high-sugar, caffeinated and carbonated drinks. Encourage children to drink plenty of water. Soda has ingredients that harm growing bones. You can see what cola does to tooth enamel, so picture what it does to bones. High levels of phosphoric acid in sodas interfere with calcium absorption, a problem that could lead to osteoporosis down the road. And, soda drinking may be among the main causes of the current childhood obesity epidemic. Obesity in childhood can lead to adult obesity with bodily aches and pains lifelong!

All-around health – Children should eat a balanced diet low in fats and high in fiber and whole grains, stretch, be physically active every day, and maintain a healthy weight.

Backpacks – Put your child’s fully loaded backpack on the bathroom scale and you will be amazed. Middle and high schoolers tote a ton of textbooks. Make sure your child isn’t expected to carry more than 10 percent of their own body weight in their backpack. Ask them to remove items before school that they won’t need that day. Likewise, they should leave items in their school locker that they won’t need at home. Don’t let the load accumulate!

Encourage them to use both shoulder straps to balance the weight of their backpack. Slinging a heavy bag over just one shoulder unbalances the spine. And, inspect the shoulder straps to ensure they are wide enough and have enough padding to properly spread the weight onto the front of the shoulder. Narrow and thin straps can “bite” into the shoulders and restrict circulation to the arms. Observe where the backpack rests against the child’s back, shortening the straps if the bottom of the backpack is below the level of their belt.

And, don’t give YOURSELF a backache getting kids to school!

Follow the same General Lifting Rules you use at work whenever you lift children, such as preschoolers who are riding along in car seats. Likewise for lifting musical instruments and athletic gear:

Keep your head high, your chin tucked in and your back arched (maintain natural curves).

Keep the child or the item close to your body and stand up straight, lifting with your legs, not your back.

Don’t bend at the waist to lift the child or object.

Avoid twisting while lifting.

Maintain a wide, balanced base of support by positioning your legs apart.

Most importantly, remember to give your school children a hug every morning. Even big kids need hugs to make it through a school day! And you’ll have a better day at work, too!

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The Meaning of Work

2011-08-24T12:42:00.004-05:00

By guest blogger Michelle Hammond, PhD
Target audience: Employees

Perhaps you have heard the following old parable:
One day while wondering, I came across three bricklayers. I asked the first bricklayer what he was doing.
“Laying bricks,” he told me.
I asked the second what he was doing.
“Making a brick wall,” he told me.
I asked the third.
“Building a cathedral,” he explained.

This parable highlights that, often, the meaning we get from our work has as much to do with how we look at our work than the actual tasks we are performing. Although some jobs may be considered more meaningful overall (surgeon, fire-fighters, teachers), all jobs have the potential to be meaningful. In the film It’s a Beautiful Life, in a moment of despair, George Bailey is visited by his guardian angel who provides him with a dismal picture of what the world would be without his contribution to society through his work as a banker. Although we may not have the luxury of such a visit from our guardian angel, it may just be a worthy exercise for us to consider just the same.

There are some health-related reasons to spend some time thinking about what we do at work and the purpose it serves. Individuals who find their work to be meaningful tend have better general physical and mental health and well-being as well as enjoy their work more and are more committed to their organizations.

Although we might always think of it as such, Estelle Morin points out “work is primarily an activity whereby a person inserts himself into the world, exercises his talents, defines himself, actualizes his potential and creates value, which in return gives him a sense of accomplishment and personal effectiveness, and possibly even a meaning to life.”

Are you looking for a little more from your work? Here are some questions for reflection to help you think about meaning you may get from work. They are based on six components of meaning at work.

Social purpose: How does my work contribute to the mission of the organization? Do I think about the bigger picture? How does it contribute to making someone else’s life better, easier, or more fun? How does my work contribute or my organization contribute to my family, my community, or others in need?

Moral correctness: Am I doing work that is morally justifiable in both processes and results? Do I take pride in the principled way in which I complete my job? Am I proud of the moral stance of my workplace? Do my personal values match the values of my workplace?

Achievement-related pleasure: Do I enjoy some or all of the tasks that are part of my job? If not, how what changes can I make to enjoy it more? How can I make use of opportunities to grow and develop myself through the work I do or the programs available through my organization?

Autonomy – How am I able to use my skills and judgments to solve problems and make decisions at work? How can I make use of my strengths or be creative in my work? If I’m in a management position, how do I allow others to use their strengths and creativity? Do I listen to their ideas?

Recognition – Do I receive feedback and recognition about the work I do? Do I ask for feedback? Do I take advantage of opportunities to praise others for the good work they do?

Positive relationships – Do I make interesting contacts or develop good relationships with others through my work? Could I work on the relationships I have with the people I work with? Do I try to connect with people I come across in my work (customers, clients, suppliers, co-workers) in meaningful ways? Have I actually talked to them on a personal level?

If your answers were not as positive as you would like, perhaps their may be some opportunities to look for meaning in your work. All the best as you build your cathedrals! Remember it is built brick by brick!

Morin, E. (2008). The meaning of work, mental health and organizational commitment. IRSST http://www.irsst.qc.ca/-projet-sens-du-travail-sante-mentale-au- work-and-engagement-organizational-0099-1930.html

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How Unfair! Depression and Perceptions of Justice and Fairness

2011-08-12T09:40:00.003-05:00

By guest blogger Michelle Hammond, PhD
Target audience: Employers

We all want to be treated fairly. Fairness at work has been described as the “glue” that holds together workplace relationships, especially relationships between employees and employers. Researchers suggest that we think about fairness in three ways:

Distributive justice refers to the fairness of the outcomes of decisions such as who gets raises and promotions.

Procedural justice is about the way in which the decisions were made such as were the policies fair and equally applied to everyone.

Interactional justice includes the interpersonal treatment around the procedure or change such as information provided and respectful treatment.

All forms of justice are important, but sometimes one type can compensate for the other. For example, your anger at feeling that you should have received a pay raise might be reduced if the decision-maker gave you adequate information and treated you with respect. Workplaces that are perceived to be fair and just benefit from increased job performance, helping behaviors among co-workers, job satisfaction, and loyalty. Injustices, on the other hand, can erode trust and damage relationships.

It makes sense that anxiety and depression might arise from being treated unfairly at work. But an interesting recent study in the U.S. Army entitled “Work Gets Unfair for the Depressed” found that the arrow may point in the opposite direction. In other words, depressive symptoms lead to perceptions of injustice more strongly than the other way around. This means that depressed employees are more likely to experience their workplace as being unfair than their non-depressed counterparts.

There are two “nuggets” to take away from this article. It is important to make sure your workplace policies and practices are fair and just, but also to consider how employees perceive them.

First, we must consider how we are treating depressed employees. There may be a tendency to treat employees with depressive symptoms in ways that lead the depressed employee to experience unfairness and injustice. Are we treating our employees who suffer with depression in unfair ways?

Secondly, as depression may influence how people interpret policies, procedures, and treatment, it is an additional motivation for employers to consider the emotional and physical well-being of their employees. Efforts and programs to improve the employee well-being may also consequently improve perceptions of fairness in the organization.

All the best for creating a fair and just workplace for all!

Lang, J., Bliese, P. D., & Lang, J.W.B. (2011). Work gets unfair for the depressed: Cross-lagged relations between organizational justice perceptions and depressive symptoms. Journal of Applied Psychology, 96, 602-618.

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Service With a Smile: Emotions at Work

2011-07-29T11:13:00.005-05:00

Occ Doc in a Box received a heart-warming Father's Day gift this year. My daughter Michelle proved she is truly a "chip off the old Occ Doc Block" by guest-writing a series for me! And I want to share it with you . . .

Dr. Michelle Hammond earned her PhD in Industrial and Organizational Psychology from Penn State University. She then reversed her ancestors' immigration trend to land a position as Lecturer in Organisational Behaviour at the University of Limerick, Ireland (yes, I said Ireland!) in 2008.

Thanks to Michelle and her husband Pete, my wife Nancy and I now also celebrate Grandfather's and Grandmother's Day, ever since they brought Clara Lilly Hammond into the world last year. Clara has the prettiest auburn curls and blue eyes you have ever seen, as you'd expect of a Limerick Lassie!

-Sláinte, as they say in Ireland (translated: Health!)

Service with a Smile: Emotions at Work
Michelle Hammond, PhD

Target Audience: Employers and Employees

Most of us can agree that good customer service includes being greeted with a friendly smile. Some argue we should even be able to “hear the smile” through the telephone line. But does that “smile” come at a price? The concept of “emotional labor” suggests that sometimes it is tough work to manage the emotions we display, especially when it does not match what feel inside. Even if you are not in the service sector, you might relate to days when you had to refrain from yelling back to an irate customer/co-worker/boss, fight negative emotions when receiving not-so-positive feedback about your performance, or even remain serious when we find something funny at work.

The conflict we experience when we express emotions that are different from what we are actually feeling can be a source of anxiety, depression, and burnout. It can also be bad for the organisation leading to decreased job satisfaction, job performance, and poor customer service. Just consider the former Jet Blue employee Steven Slater, who after a passenger cursed at and shoved, grabbed beer from a beverage cart before deploying the emergency slide and used it to depart the plane. Obviously, the stress of managing emotions got the better of him. Although these negative outcomes can arise, positive outcomes can also happen, such as feelings of accomplishment or connection with another person depending on the strategies we use to manage our emotions.

So how can we manage our emotions and help others to do so?

Rethink how we manage our emotions. When we paste on the smile or grin and bear it (called surface acting) we are much more likely to experience stress than when we actually try to feel the emotions we are trying to display (called deep acting). Customers and employees are also quite good at spotting our fake smiles. Trying to think about what is good in our lives and our jobs can help bring out authentic happiness.

Develop friends at work and encourage employees to become friendly. Even when employees are not able to “control” their customers, having supportive co-workers helps to reduce the negative effects of emotion work. Giving employees adequate opportunities for shared breaks to let off steam, swap “war stories,” or encourage each other can go a long way.

Count to 10 or take a break! Some research suggests that the “raw” emotions we feel only last a short time, and experiencing them past a minute or two is in some way our own choice. Take a break from the situation if you can, or at least take a deep breath before responding.

Name the emotion we are feeling. Sometimes simply naming what we are actually feeling reduces the power it has over us.

Consider emotion-based training in your workplace. Many consulting firms offer training in emotional management or emotional intelligence. After going through good training in emotional intelligence, many people report better relationships both in work and at home.

These are sure strategies to help keep you, your boss, and your customers smiling!

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Employers Save Money When Employees Teach Families Firecracker Safety

2011-07-01T12:09:00.004-05:00

Target audience: Employers and Employees

This month marks a full year back to work for a 26-year-old employee of a local corporation. A firecracker had exploded in his hand at a backyard party when he was 24 and a new employee. Now after two major hand surgeries and months of therapy, he can finally drive a tow motor again.

His very accommodating employer, a client of mine, had provided the health plan that paid for his treatment, and the short-term disability coverage that replaced his wages during two six-month post operative absences. His coworkers covered for his reduced productivity while he performed restricted work before he achieved full duty status.

His recovery has made everybody happy. But none of it ever had to happen. And if it hadn’t happened, the money could have served a better purpose.

Watch the short but excellent video you will find with this link: http://www.cpsc.gov/cpscpub/prerel/prhtml11/11254.html

Share it with your workforce.

Show it to your children, grandchildren, nieces, nephews, and neighbor kids.

When any of us teach safety to kids, we learn and practice it ourselves. We become at-home Safety Managers. That makes us at-work Safety Practitioners.

Use Independence Day to teach kids about freedom, citizenship, and American exceptionalism. And, firecracker safety.

Admire “the rocket’s red glare” – but from a safe distance.

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Trick Question: What Diabetes Medicine Costs the Most?

2011-06-21T14:24:00.003-05:00

Target audience: Employers

Maybe you’ve heard this one: The costliest diabetes medicine is the one which a doctor prescribes, but the patient fails to take. When a doctor indentifies diabetes needing treatment, but the patient neglects it, the cost of that assessment goes for naught.

Then, spending for future complications skyrockets, while value crashes. “Lean Redesign” considers that WASTE. And, it financially hammers employers and employees alike.

Half the time, Americans use their medicines incorrectly. That adds $150 billion of excess costs annually. Noncompliance increases hospitalizations 10 percent and nursing home admissions 40 percent, needlessly. It wastes $2,000 per patient per year of the cost of physician visits.*

Medication adherence has particular importance for people with diabetes. Studies show that patients who adhere to physician treatment spend 47 percent less than those who comply less well. And, religiously taking diabetes medication was a significant predictor of improved job performance in people with adult-onset diabetes in a recent study. **

Many factors must come together for people to follow prescriptions as they should. The prescriber has responsibility for several, such as:
• selecting the best medicine with fewest side effects
• arranging the most convenient daily dosing schedule
• avoiding interactions with other prescriptions
• motivating the patient.

The responsibility for some factors of course rest entirely with the patient. These include
• wanting to understand the diagnosis and treatment - no denying it!
• fully informing the physician of all other conditions, symptoms, and treatments
• taking personal accountability.

Employers too can improve employees’ adherence to medications, by creating a culture of health, wellness, and vitality. Such a climate promotes wise medical consumerism and self-care. Teach health literacy to your employees, through your usual communication channels. Don’t be shy about explaining it in financial terms. Help employees realize that non-compliance makes them lose money in this “pay me now or pay me later” situation. Truly, an ounce of prevention is worth a pound of cure, and a stitch in time saves nine!

Unfortunately, out-of-pocket costs can form a barrier to obtaining timely treatment. Employers should consider reducing the co-payment for medications necessary to maintain health in the face of chronic diseases, especially diabetes. Negotiate this through your health insurer, pharmacy benefits manager, or directly through a co-pay reimbursement program. However you do it, reducing the co-pay obstacle to diabetes treatment has proven benefits.

Pitney Bowes Corporation proved this in a classic study. By placing all diabetes treatments into the lowest co-pay category (tier 1), they shifted costs from physician services to pharmacy, increasing the rate at which employees refilled their prescriptions. That yielded Pitney Bowes $2.5 million annual savings from lower rates of hospitalization and emergency care. ***

Employers should also encourage every employee to have a primary care physician. Research has demonstrated that physician-connected patients comply with care better, adhere to prescriptions more, and enjoy improved outcomes, than patients who lacked assignment to an individual primary physician.

Sadly, diabetes continues to affect a larger proportion of our nation every year. Fortunately, people with diabetes can remain healthy, employed, and productive at work, with proper medical care. Employers need to ensure every dollar spent on it brings the best value. In the end, this matters far more to employee themselves. But, since your employees matter to you, do all you can to help!

Reference:
*First Report Managed Care, May 2011, Tori Socha, quoting Bruce Sherman, MD, Director of Employers Health Coalition of Ohio
**Loeppke R and Hymel P, “Medication Adherence, Comorbidities, and Health Risk Impacts on Workforce Absence and Job Performance,” JOEM Vol 53, No. 6, June 2011
***Mahoney JJ, Reducing patient drug acquisition costs can lower diabetes health claims,
Am J Manag Care. 2005 Aug; 11(5 Suppl):S170-6 AND Berger J, Economic and clinical impact of innovative pharmacy benefit designs in the management of diabetes pharmacotherapy, Am J Manag Care. 2007 Apr; 13 Suppl 2:S55-8

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How to Optimize Your Medical Surveillance Program

2011-06-10T13:25:00.003-05:00

Target audience: Employers

An employer asked me, “What steps should I take to optimize my medical surveillance program?” Great question! Health surveillance refers to the performance of medical tests on groups of workers who are exposed to hazards, to “be on the lookout” for problems. These particular hazards range from common risks like noise exposure, which causes hearing loss, to exotic ones, like exposure to the metal vanadium, which causes a green tongue and a cough! Single-issue exposures, such as asbestos, may require surveillance. Some multiple and unspecified hazards, such as hazardous waste operations (HAZWOPER), need it, too.

The first step a wise employer takes is to determine what hazards workers face. Industrial hygienists, such as those who may work for your insurer, can then measure the exposure dose. But the employer must first recognize the need to call an industrial hygienist. Systematically review incoming chemicals and new processes to identify those needing further study. Catalog every known and potential hazard. And, proactively ask employees what they notice, how they feel, and what concerns them about their work environment.

Some exposures require medical surveillance and others not. OSHA defines many of these in 29 CFR 1910 (Subpart Z). It lists about two dozen hazards which all require health-related testing. Again the OSHA Noise Standard 1910.95 is the most common of these.

Next, identify who is at risk. Map the areas of exposure on the plant’s floor plan. Then have a hygienist perform testing of these areas, as well as personal monitoring of employees who work in or even pass through these parts of the plant. The hygienist will advise if exposure levels require surveillance.

The scope of this article can’t scratch the surface of how to safely deal with these hazards, or how to perform surveillance for their medical effects. But it will explain the single most important feature of an effective surveillance program.

To learn what that is, let’s again consider noise exposure. It provides a familiar example of how to manage a workplace hazard. The single best way to optimize a surveillance program for noise exposure is to systematically collect audiometric and noise dosimetry data, to systematically use it to find root-cause solutions for noisy areas, and to systematically share it with employees in ways that ensure they follow safe work practices. Hearing conservation programs that don’t work in these systematic ways don’t achieve their highest purpose, namely total prevention, and not mere recognition, of hearing loss. Instead they become mindless exercises in repeated hearing testing. Although they may identify hearing loss in an early stage, screening programs alone won’t prevent it.

Surveillance is different from mere screening because the benefits accrue not just to the individual but to the entire work organization and the employer, too. Surveillance always involves screening, but screening unfortunately does not always lead to surveillance. A surveillance system collects and studies data with a purpose in mind, such as to use it as a “feedback loop” to ensure that employees are properly protected. For example, annual audiograms may identify individuals with standard threshold shifts (STS). A good hearing conservation program requires employees with STS to be retrained in use of hearing protective devices (HPD) and to be re-fit to ensure HPD are used to best advantage. And, the program will study where in the work site the STS occurred, to identify if clusters of STS have developed, to track the incidence rate of STS, and to identify noisy areas that need remediation.

The opportunity to do true surveillance and not just repeated screening is especially important with chemical hazards. Your industrial hygienist can measure the levels of chemical contaminants in the environment, such as through air sampling. Your medical surveillance program can often measure internal levels of the same contaminants, in blood or urine samples from exposed employees. This type of “biological monitoring” assesses the internal dose to which the employee is exposed, which in turn relates to the external environmental dose that the industrial hygienist has measured. And, this can often be done well before these contaminants have any effect on health.

Several types of these “biomarkers” have been identified for various types of chemical hazards. One type, biomarkers of exposure, use direct measurement of the same chemical as in the environment, but in the body rather than in the air. Or they may measure metabolic breakdown products of that chemical. Another type, called biomarkers of effect, measure biochemical changes that occurs in the body as a result to exposure to the chemical.

By screening all exposed employees, and by systematically managing and reporting their data in a true surveillance program, the employer can be sure that employees are “doubly protected.” First they are protected by the safety processes in place at the work site, which are verified by the industrial hygienist. Next employees are protected by measuring the absorbed dose of the chemical, which, if satisfactory, shows that the safety processes, including the individual employee’s work habits, are effectively protecting them.

Hazard surveillance programs that use bio markers allow true preventive medicine. The interventions move far “upstream” rather than simply dealing with disease treatment far “downstream.”

Most employers instinctively understand this in their hearing conservation programs. They identify areas that are excessively noisy. They perform engineering controls to eliminate the source of the noise. When the source can’t be eliminated, they reduce exposure by substituting other processes, by erecting barriers and sound baffles, by using silencers and machine enclosures, by remodeling with acoustical absorbing materials, and by providing isolation in control booths. Employees who are still exposed above the action level are given hearing protection devices, and annual screening audiograms to make sure all these protections are working.

As an employer, you might encounter an exposure with which you are less familiar, such as to one of the chemicals in OSHA 29 CFR 1910 (Subpart Z). Design surveillance for these hazards using the same principles as you do in hearing conservation. As an example, let’s take methylenedianiline (MDA), used as a curing chemical in plastic resins. First, identify where it is used and who is exposed. Take environmental samples to learn levels. Reduce those levels to the extent possible through engineering controls. Consider substitute chemicals or processes. Protect employees from exposure by isolation and containment. Transfer MDA with closed, “no touch” methods to prevent spilling or dispersion. If employees are still exposed above the action level, provide personal protective devices, such as gloves, Tyvec suits, and respirators. Finally, give these exposed employees periodic medical exams and testing.

If you were one of those employees, think of the reassurance you would have from periodic testing for an exposure biomarker. MDA is a chemical that can be measured in urine samples in exposed workers. In a properly designed worksite safety program, these surveillance tests should show zero levels of MDA in the urine of exposed workers. Such workers welcome that reassurance. If levels are increased, this signals a need to re-examine the entire safety process, top to bottom. And it strengthens the employees’ resolve to use personal protective equipment to their best advantage.

On the other hand, consider how a worker feels who has been exposed to this seemingly innocuous substance, which in reality is a known cause of bladder cancer. Waiting for blood to appear in the urine or some other signal of bladder cancer fails to protect employees in that situation. They need a well-designed, bona fide medical surveillance program, directed “upstream” through the use of biomarkers, integrated with industrial hygiene measurements of exposure levels in the work environment in a systematic process that shares results with them. It’s the right thing to do, and that’s the right way to get it done.

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Hangover: More Tragedy Than Comedy

2011-06-03T13:56:00.006-05:00

Last weekend, we all heard the word “Hangover” like never before, owing to the debut of another installment of a film franchise by that name. Hollywood’s latest, but sadly not last, saga of male misbehavior seeks once again to plumb the depths of a bottomless pit. Try as they might, movie makers can’t seem to hit bottom in that sink hole.

Understand, my sour mood here has nothing to do with this film’s merits, or lack thereof. Instead, the general public’s misperception about hangover in general and alcohol abuse particularly, deeply disturbs me. As a safety and health conscious employer, it should bother you even more.

Look at it this way. I performed an Internet search using the word “Hangover”, finding 62,000,000 hits. Narrowing the search to “Hangover Cures” I found a “mere” 7,520,000. Sadly, searching for the heart of the matter, “Hangover Health Risks” produced only 1,410 citations.

It seems the word “Hangover” universally brings chuckles and sneers, not concern or care. Condescending comments follow, not compassion. It brings to mind foggy-headed fraternities, stuporous stadiums and campy deer camps. At most, boozing fraternity brothers might, in moments of sobriety and headache, concede that a hangover is “just the price you pay for having a good time.”

But, why doesn’t “Hangover” make us think of dodging bullets in the forms of traffic near-misses, stumbles and falls, embarrassment, humiliation, saying things that would have been “better left unsaid,” and torn relationships? Grieving parents, damaged childhoods, job loss, brushes with the law, even disability and death can also be “the price you pay for having a good time.”

You may call me a buzz kill. Or you may call me a prophet. Either way I call this reality, and we just have to deal with it. Here are REAL medical accompaniments of hangovers:

Increased risk of accident and injury when intoxicated AND while hung-over, INCLUDING at work the day after a binge.

Increased heart rate and blood pressure for one to two days after a drinking binge, increasing the risk of eventual sustained high blood pressure.

Toxic effects on heart muscle from alcohol, causing rhythm disturbances, most commonly atrial fibrillation, especially following binges. Emergency physicians know the “holiday heart syndrome” well, in which atrial fibrillation develops in patients with hangovers. Binges also increase the chance of cardiomyopathy.

Increased risk of developing fatty liver, with risk of cirrhosis eventually.

Increased risk of acquiring sexually transmitted disease, including HIV, Hepatitis B and C.

Impaired productivity at work including increased absenteeism and lost productive time while at work (presenteeism).

Employers who care about health, safety, and productivity are like salmon swimming up stream. You try to lead your workforce in the right direction, against our culture’s strong current that flows the wrong way: downhill. It is okay to laugh at movies like this, to chuckle at hangover jokes, and to shake your head at absurd home remedies. But all the while, you need tools to push your culture up hill. Please see previous postings from Occ Doc in a Box about binge drinking (12/1/2009) and safe use of prescription pain medications (12/6/2010) to find help.

Now that I have posted this article, I should find at least 1,411 hits the next time I search “Hangover Health Risks.” That closes the lead held by “Hangover Cures” to just over 7.5 million.

I think we have a lot of work ahead.

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Healthy Vision Month

2011-05-27T12:45:00.003-05:00

Target audience: Employers

Two ideas popped out of the Box this month. First, the National Eye Institute recognized May as Healthy Vision Month. Its web site has all sorts of resources, many of which help employers who want to maximize the health, safety and productivity of their associates.

Another idea "caught my eye" at the same time. As you may know, I believe in presenting safety messages in a novel way to employees by asking them to teach safety to their children. Previous blog postings used this technique. Please see "Teaching First Aid to Children" 12/16/09 which features our own First Aid Coloring Book, "Your Teens and Your Prescriptions" 11/10/09, and "Back Safety for Back-To-Schoolers" from 9/15/09. Distribute those materials to employees to drive home safety messages by turning them into safety trainers for their children.

Now you can use items the Healthy Vision Month campaign has developed for children, to reinforce the somewhat humdrum message of eye protection to your workforce. Since everybody cares about kids, whether their own, their extended family's, their neighbors’ or friends’, your employees want to help those children have a safer summer. Distribute the Coloring Pages and Kids Calendars (links are below) at the workplace to let them do that. And since adults will want to provide positive role models for these kids, they will instinctively become safer employees, too.

Your employees will practice better eye safety, both at work and at home, when they know these little "pupils" are watching!

Calendars of Healthy Vision Fun Facts for Kids (PDFs):
http://www.affinityhealth.org/object/occ-doc-box-healthy-vision-calendar1.html
http://www.affinityhealth.org/object/occ-doc-box-healthy-vision-calendar2.html

Coloring Pages (PDF):
http://www.affinityhealth.org/object/occ-doc-box-healthy-vision-coloring.html

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What's On Your Shelf? Part 3

2011-05-17T12:13:00.002-05:00

Target audience: Employers

Continued from last week...

How to Improve
To learn how to improve the connection between personal health and your injury logs, let’s return to “injury icebergs.” Most likely, you already use traditional injury prevention strategies including ergonomics, environmental safety, ongoing employee training, and personal protective equipment. These “melt the iceberg” below the water. And you do worker comp case management, disability prevention, and return-to-work programs to shrink the top. But how do you melt an “illness glacier?”

Everything you do to promote health and manage chronic disease at work will pay benefits in terms of injury and disability prevention. But, to stop this relentlessly advancing glacier, you obviously must go beyond “health promotion” to a true integration of resources. Occupational safety and health, and health promotion, can and must work together. As always, it is about creating a culture of safety and health.

For example, helping employees with obesity is difficult at every workplace, especially if it is a problem viewed in isolation. An extensive review of best practices (Katz, 2005) “found strong support for multi-component interventions aimed at diet, physical activity and cognitive changes but insufficient evidence for diet, physical activity or cognitive changes alone” (Schulte, 2008). It’s not realistic to just have a weight loss contest at work. Effective programs must include things as diverse as the price of healthy vending machine items to the promotion of stair climbing in the office building.

All of these are examples of priorities needed to change your company culture to one of safety and health:

Tobacco cessation programs, smoke -ree workplaces, and a tobacco-free culture in your workplace

Exercise promotion (cardio, strengthening, and stretching), ongoing daily activity, and creation of a culture of vigor and activity

Healthy eating, including education programs, a healthy eating environment in the workplace, and a culture of nutrition

Emotional well-being, including daily stress relieving skills, work/family balance, and a culture of respect for the worth of each person

Wise medical consumerism, especially of preventive resources such as immunization, screening and early detection programs, prenatal and preconception care, biometric testing and health coaching are needed to keep employees well. And, when employees are becoming ill, they need disease management and evidence-based quality care management programs to prevent disability and remain productive.

Safety at home, at work, and during recreation, emphasizing reduction of employees’ risk taking behaviors, is essential in a culture of safety. Education about prudent use of alcohol, buckling the safety belt, wearing a bike or motorcycle helmet or life vest, are all messages that play well with workplace safety promotion. Employees have to “get it” at work, at home, and at play.

These “big picture” solutions are unfortunately far more difficult than a “disease of the month” approach. But, the rewards are huge for those companies that invest the wisest and invest the most. The rewards include not “only” lower injury rates and Worker Comp costs, but better medical claims experience, employee productivity, and corporate success. All must view health “as an investment to be leveraged, rather than a cost to be justified” (Loeppke, 2006).

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What's on Your Shelf? Part 2

2011-05-11T13:23:00.002-05:00

Target audience: Employers

Continued from last week...

HRA Report
The HRA Report gives you a snapshot of what is in your company’s “illness glacier,” as we discussed last week. And, the more employees who participated in the HRA, the more full the snapshot. Look for the items below. At the same time, look at your OSHA log and Worker Comp report to see the size of the problems to which these factors add:

Risk-taking behaviors away from work: Most HRAs include questions about behaviors that reflect a general tendency to take risks. It has been shown that people who tend to “live dangerously” also “work dangerously.” For example, a habit of more than two alcoholic drinks per day, failure to use seatbelts at least 90 percent of the time, or a history of driving under the influence of alcohol are non-occupational risk-taking behaviors that also add to the risk of an occupational injury (Forrester, 1996). Obeying the speed limit when driving has also been shown to be a marker for a lower likelihood of having an occupational injury (Gaines, 2006). Other researchers showed that the risk an alcohol abuser had of an occupational injury related more to their overall risk-taking behavior rather than to the direct affects of alcohol (Dawson, 1994). All of these are common HRA questions, and give you a measurement of how many risk-takers you have.

Emotional distress, job dissatisfaction, job stress, and stressful life events: For decades, researchers have shown that distressed employees are more likely to have workplace accidents and injuries (Niemcryk, 1987, Cooper, 1987, and Shaw, 2006). Your HRA Report tells you about employee stress levels, job and life satisfaction, and gives you a barometer of employee morale. Less stress means fewer injuries. And, injuries that happen to mentally healthy employees have lower disability costs. Depression especially adds to the risk and length of a Worker Compensation case.

Obesity: This has been extraordinarily well studied, including its effect on work injuries, workplace hazards, worker compensation costs, and occupational illnesses. For example:

Carpal tunnel syndrome risk is increased up to twofold by obesity (Ferry, 2000, Nathan, 2002 & 2005, Atroshi, 1999).

Lumbar spine disc disease risk is increased three-fold just by being overweight (BMI >27.5). (Matsumoto, 1998).

Knee arthritis risk is increased fourfold in obese vs. non-obese women (Harris, 2005, Liu, 2007, Schulte, 2008).

Traumatic injuries and musculoskeletal disorders in general are made more common by obesity. (Schulte, 2008).

Worker compensation claims are increased by obesity. There is a linear relationship between BMI and the rate of claims. Employees with BMI >40, compared to recommended-weight employees, had twice as many worker comp claims, 13 times more lost work days, 6 times higher medical costs for worker compensation care, and 10 times higher worker comp and indemnity costs. This was especially true of claims involving the low back, lower extremity, wrist or hand. This includes sprains/strains/contusions, slip/falls, and lifting/exertion. The combination of obesity and high risk occupation was particularly detrimental (Ostbye, 2007).

Occupational asthma is more common in obese workers. Workplace exposures and obesity are both risk factors for asthma, and 15-20 percent of adult asthma is occupational (Schulte, 2008).

Adverse health effects from workplace exposures happen more commonly to obese employees. This includes exposure to heat stress, nervous system toxicants, vibration, and carbon nanotubes. Even the risk of a work-related motor vehicle accident is higher among obese employees (Schulte, 2008).

Work factors can also increase the likelihood of becoming obese. Chronic work stress, shift work, sedentary work, and rated work (“piece work”) have all been shown to increase the chance employees will become obese (Schulte, 2008).

Many conditions are shown to be made more common by the combination of obesity plus other workplace factors. This is true of heart disease, high blood pressure, short-term disability, unscheduled absence, decreased productivity, and involuntary retirement (Schulte, 2008).

Smoking: Increases the risk of dozens of health conditions, including many that are relevant to workplace safety. Studies have shown this for the following.

herniation of cervical and lumbar spinal discs, and lumbar spine disc degeneration (Kaila-Kangas, 2006),

arthritic knee pain (Felson, 2007),

lateral epicondylitis (“tennis elbow”) which was increased three and a half fold (Shiri, 2006),

carpal tunnel syndrome (Nathan, 2002 & 2005)

osteoporosis, plus delayed healing of fractures of bones and of wounds in general.

Inadequate exercise: Inactivity has been shown to be a risk factor for occupational low back problems. It doubles the risk (Feuerstein, 1999). This is true of individuals who lack strength (Cady, 1979) and flexibility (Gaines, 2006). Flexibility deficiency also increases the risk of injury in general (Gaines, 2006).

OSHA Log
To learn how these things have affected you company’s experience, browse your OSHA Log to see if it reflects the conditions listed above. For example, does it show many lifting-related strains? This may reflect lack of employee conditioning. Are there falls from heights, or tow motor mishaps? Risk-taking behavior contributes to these. Your OSHA log is affected not just by the nature of your industry and the safety of your work environment, but also by the health and lifestyle of your employees.

Likewise, this influences the size and number of claims in your Worker Compensation Report. Personal health can be the difference between a “minor injury” which with few medical treatment and disability costs, versus one with major loss. Have seemingly-minor mishaps led to long and costly claims? This can be an effect of anything from unhealthy lifestyle to pre-existing personal medical or psychological conditions.

So what should you do? Check back next week for our conclusion!

What's on Your Shelf?

2011-05-04T12:19:00.003-05:00

Target audience: Employers

Do you know what health conditions make employees more prone to workplace injuries? Do you know how to help prevent injuries in these workers? Over the next few weeks, let’s look at three related documents you may have on your shelf:

Your company’s annual aggregate Health Risk Appraisal (HRA) Report

Your OSHA 300 Work Injury Log

The annual report of your Worker Compensation insurer.

Worker Comp Insurer Annual Report
That last report usually draws the most attention, because it represents a large amount of wasted money. But it’s just “the tip of the iceberg.” The accidents tallied on your OSHA 300 log, plus unrecorded “near misses” and safety breeches, form the 80 percent of the “iceberg” hidden under the water. And, the larger these “injury icebergs” become, the more the danger they could “sink the ship” of your company!

Personal health factors among your employees grow these “icebergs” larger. For example, ill health increases employee susceptibility to workplace accidents and occupational illnesses, expanding the “iceberg” beneath the water level. And these same factors can make recovery from a work related injury or illness more difficult and prolonged, adding to your company’s Worker Comp price tag. The “iceberg” then becomes larger on top.

But think about where icebergs come from in the first place: they are just bits and pieces broken from massive glaciers! Ill health in your work organization, and behaviors that increase the risk of illness, form a massive “glacier” that burdens your company in many ways. One way is that it increases the number and the cost of accidents in your workplace. This causes more “injury icebergs” and makes them larger, top to bottom. Health risks can lead to illness, next to occupational injuries and illnesses, and finally to higher Worker Compensation costs.

To be continued… Check back next week for details on how to make the most of your HRA report!

Pedometers - A Moving Experience!

2011-04-27T14:52:00.003-05:00

Target audience: Employers

I couldn’t sit still while I read this study! Researchers had found that brief stretch breaks, just five minutes, gave office workers measurable improvements in their diabetes and heart disease risks. The more brief energy breaks these sedentary workers took away from their desks, the better their metabolic health became. That included improvements in blood sugar, insulin responsiveness, and blood triglycerides.

Does that really matter? Certainly, knowing that, on average, the more hours per week a person sits, the shorter their life span. (Healy “Breaks in Sedentary Time: Beneficial Association with Metabolic Risks,” Diabetes Care, February 2011).

The best thing about these brief motion breaks is they add up! You can measure how many of these life-saving steps you accumulate in a day by wearing a pedometer.

If you walk less than 5,000 steps per day, you are officially “sedentary.” Bad news for you! This poses a risk to your health and may shorten your life, due principally to diabetes and heart disease.

If you add just 10,000–20,000 steps per week, that is about 5-10 miles per week – one or two miles a day – your metabolic health will improve. Lower blood sugar, lower body insulin levels, and lower triglycerides will prove this.

If you add 30,000 steps per week, that is about 15 miles per week – about two miles a day – your body fat will decrease, you will lose some weight, and LDL “bad” cholesterol will drop.

The American Heart Association advises Americans to add 20,000-30,000 steps per week to their ordinary activity, that is about 10 miles per week – about 1.5 to 2 miles per day – to improve health and offset our nation’s obesity epidemic.

For most average sized people, 2,000 steps equals one mile, which burns 100 calories. Adding just 2,000 steps per day would burn about 10 pounds of body fat in a year!

Ironically, this works even better for obese people. Because they weigh more, heavier people burn more calories with each step than do individuals who weigh less. Obese people can achieve benefits by walking just 2/3–3/4 as many steps as I listed above.

The average American adult gains one to two pounds per year, owing to our bad diets and sedentary lifestyle. Most people can look back to their high school weight and add one to two pounds for every year since graduation, to arrive at their current weight. But, we have a simple cure for this depressing news! For 90 percent of us, just increasing exercise by 100 calories per day, which is 2,000 steps – about one mile – would stop this weight gain. One researcher said it like this: “Relatively small changes in energy intake and expenditure could arrest weight gain.” (Hill Jo, “Using the Energy Gap to Address Obesity,” American Dietetic Association, 2009 November 1/09(11):1848).

Is this easier said than done? Of course! It seems all good things are, and few things matter as much as this. I’ll explain that by paraphrasing what the great author GK Chesterton (1874 – 1936) said about Christianity: “(Diet and Exercise) have not been tried and found lacking. (They) have been found difficult, and left untried.”

It’s time to get a pedometer, and give it a try!

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Returning to work after medical leave? Get your feet back in the door - with pedometers!

2011-04-20T13:34:00.008-05:00

Target audience: Employees

Picture a nice long vacation with your feet in sandals. Now picture the first day back in work boots. As you know, it can surprise you how “out of shape” your legs and feet feel after even a short time away. Those first few work shifts feel longer than you recall.

Perhaps you have been away from work more than a short time, on a medical leave. Physical problems, such as illness, injury, or elective surgery, and even non-physical mental health problems, can cause several weeks to months of absence. Once you finally feel better, and become optimistic about returning to work, stop to consider your humble feet. Are they ready, too?

Long shifts challenge feet and legs, and many jobs require prolonged walking and standing. Mail carriers often walk 7-10 miles per day. Some manufacturing employees do, too, though measuring intermittent indoor walking is harder to do. Often it totals more than one would guess. Warehouse workers may walk as much as mail carriers do, but without realizing it.

I have a reliable way for you to find out if your legs and feet have the stamina you need to return to work successfully. Simply get two inexpensive pedometers. Give one to a co-worker who holds the same job as you, and who works a shift of equal length. Try to find someone of approximately your height. Ask them to wear the pedometer during a work shift, including overtime if that happens commonly. Then use their step count as your goal. Wear the other pedometer around your house, yard, neighborhood, and on errands. Find out if you tolerate as many steps in a day as your co-worker did during a work shift.

Don’t wait until “late in the game” to discover this. As you know, paid leave won’t last forever! Well before yours runs out, use this pedometer method to learn your stamina. If the pedometer shows you have a long way to go, use a calendar to write a walking schedule to get ready. Increase your daily step count with slow, steady progression. You will need one to two weeks to gradually add 2,000 additional steps (about one mile) per day. So, if you must walk 10,000 steps per day (about five miles) but can only comfortably walk 6,000 (about three miles) now, you will need two to four weeks to prepare. If your job requires heavy work boots, wear them during this program. Otherwise, on the first day back, they may feel like a ton!

Of course, during any medical leave from work, you remain under your doctor’s care. Always make your doctor is aware of the physical demands of your job. And get your doctor’s permission to begin your return-to-work walking program. Ask him/her early in the course of your care. That way you will have more time to get ready with this two-pedometer method.

Don’t wait until you’re on your last legs!

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Well Cities Oshkosh "Commencement Address"

2011-03-21T13:17:00.004-05:00

Target audience: Employers

Could your wellness committee or your senior leaders use some spark? Enough already about health care cost containment and ROI, inspire them with some words with more pizzazz! Feel free to borrow any ideas from this short "kick-off" talk I gave to the Well Cities Oshkosh team.

With school graduation season around the corner, consider this a "commencement address" for your company's wellness leaders. Caps and gowns, I leave to you.

Raise your hand if your company expects more work now, with fewer employees, than 10 years ago.

If so, do you agree this makes every one of these hard-working employees more indispensible and less replaceable than 10 years ago? Each person’s contribution has never mattered more!
That reality also makes corporate wellness matter more now than ever. Wellness helps employees arrive at work “alive, awake, alert and enthusiastic!” You need that daily from everybody. You have no spare, extra, or marginal employees anymore, if you ever did. I dare say no one is a slacker anymore, if anybody ever was, because no one’s left to take up the slack.

But, I want you to now raise your hand if you’ve ever experienced a wellness program which, despite high quality and wise design, failed to reach enough people in the organization. Did participation rates remain too low or did family members seemed uninterested, or perhaps participation happened but without real engagement?

Do you agree we all have come today in response to the challenge of widening our wellness reach to engage more people, in meaningful ways? Then look around and you’ll see the solution you sought. Well Cities Oshkosh positions us all to achieve collectively what we can’t individually. Together we will attain wider reach, and better engagement, to improve the health of the Oshkosh community. That way we will help well employees stay well and help ill employees stay employed.

Do you agree we’re wiser to ask 100 people to each do just one thing differently, than to expect one person to change 100 things? Help 100 people change one unhealthy behavior, rather than change 100 behaviors in one person. And, all of us can improve at least one thing! Consider how that’s true of corporations, too. We have at least 100 corporate locations represented here. As we work together, each can perform better in at least one thing, and realize one achievable goal, one at a time.

Do you agree that we can help more people with programs just an inch deep as long as they also stretch a mile wide, rather than a mile deep and an inch wide? Help people with continuous light touches 52 weeks a year by letting them work in a culture of health and wellness, and you have a healthier company, and an initiative that sustains itself. It becomes part of what it means to work here. This approach may touch any one associate only lightly, but it touches all of them, often.

I want you to clearly understand what I mean by a culture of health and wellness. Looking at something you already achieved, namely a culture of safety, helps you understand this best. That culture took years to achieve, but now it touches each employee at your workplace, all the time. Does anyone here work in manufacturing? Please help me here. If I entered your shop floor today dressed just as I am now, how far would I get? Within a minute, wouldn’t any one of your employees stop me to say, “You have to wear ear plugs, and safety shoes, and eye protection, and tuck in your tie!” That culture of safety sustains and enforces itself. So how about if I walked in with a lighted cigarette, or if I smoked at your doorway, or in your parking lot? In a culture of health and wellness, employees let others know, “Hey, we don’t do that here” just like you already trained them to do with safety protection.

If all organizations do this, we create a community of self-sustaining health and wellness, and an ongoing culture of vitality in Oshkosh. This town is about 20 miles wide. If we reach out and join hands we can cover that mileage at least an inch deep with a culture of wellness.

Then consider the uniqueness of each individual, and of each corporation. Then imagine how we won’t cover this town by whitewashing with a broad brush. Instead our corporate partnership we will create a glorious mosaic illustrating how health, wellness and vitality matter in our unique organizations. Oshkosh as a Well City becomes a Wellspring of individual and corporate vitality.

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Which Cancer Screenings When?

2011-03-07T14:21:00.003-06:00

Target audience: Employers

How can you encourage your employees to get their cancer screenings?

DO THIS:
1. Make it personal. Provide targeted messages to men and to women, according to age group. For example, those above 50 years old and those below need different messages. Please see this chart of recommended screenings. And, remind everyone that their own individual family history may require additional screening.

2. Keep it simple. In fact, standard recommendations are simple (see chart).

3. Keep it positive. People find motivation in testimonials about the peace of mind and satisfaction that comes from completing these tests. Completing recommended tests puts the mind at ease, both for the individual and their loved ones. And staying up-to-date gives a feeling of relative control over something that seems "out of control" - namely cancer. Instead of feeling powerless, people who complete screenings and take other cancer-prevention steps (avoiding tobacco and excess alcohol, plus sensible nutrition and exercise) feel they are "doing something!" They feel assertive in a positive way.

4. Talk about cancer prevention, not just cancer detection. Colonoscopy particularly lends itself to the idea of positive preventive thinking. Colonoscopy uniquely prevents cancer, not just detects it. When colonoscopy leads to removal of a polyp, one can have confidence that polyp will never become a cancer. To promote colonoscopy, promote it as a cancer-preventing procedure, not just a cancer-detecting test.

DON’T DO THIS:
1. Don't over-generalize. Men and women need different messages, as do people of different ages. Not everyone needs cancer screening. Emphasize age- and gender-specific recommendations. Don't send messages that mistakenly make people think everyone needs screening every year. And, individualized recommendations from treating physicians always trump blanket recommendations.

2. Don't over-complicate. The worse way is to promote other types of screening that don't have endorsement from national cancer research organizations. Stick to the accepted recommendations such as those in this chart.

3. Don't frighten. Testimonials about how someone found they had cancer on a screening evaluation, and otherwise would not have known it, may actually scare some people away from testing. Surveys show many people actually would "rather not know!" This belief may seem misinformed, but remains a major obstacle. So, emphasize the peace of mind cancer screening brings, and the fact there are ways to prevent, and not just detect, cancer. This less threatening, more welcomed invitation to cancer screening won't frighten people away from participating.

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All in the Family

2011-02-09T12:45:00.003-06:00

Target audience: Employers

My dentist's waiting room displays a sign I enjoy: "Brush only the teeth you want to keep." Like everybody, I want to keep them all! So, how much of your wellness program should incorporate families? Only the parts you want to succeed!

Each component succeeds best when families participate. That goes for health risk appraisals (HRA), exercise promotion, tobacco cessation, alcohol misuse education, home safety, nutrition, depression awareness, stress management, incentive programs, health coaching, resiliency training, medical consumerism, self-care, and more. Wellness is a family affair.

Think of how family support can improve these four key metrics that define wellness program success:

Participation - how many people showed?
Engagement - how well did they complete the process?
Effectiveness - what proportion of participants achieved goals?
Reach - how well did the benefit penetrate the population you hoped to help? Note that Reach puts it all together, incorporating each of the other metrics.

Right now, we are delivering a tobacco cessation intervention, "Call It Quits Plus," to our own organization, made possible by a Mercy Health Foundation grant. Eligibility includes all employees AND spouses, which will increase PARTICIPATION. Our employee smoking rates are much lower than the state average. But, spousal smoking rates are typical. So, we expect larger participation by welcoming them.

This intensive program requires commitment by participants. It centers on medical treatment (prescription medication or over-the-counter nicotine replacement) and a series of group meetings. ENGAGEMENT in this 12-week long process will benefit from the accountability that a spouse adds.

This worksite tobacco cessation method has enjoyed remarkable EFFECTIVENESS, at least ten times higher than that of unassisted "cold turkey" attempts. Effectiveness soars higher for any would-be quitters who have a family "quit smoking buddy."

Yet, ultimately the program REACH will determine its financial outcome. That's because we provide health insurance for employees AND families. In fact, many people seek employment at Affinity to obtain health insurance benefits for their spouse. If we failed to include spouses in our tobacco intervention, we wouldn't reach this needy group, who no doubt generates much of our membership's tobacco-related health care spending.

We need family involvement to maximize the REACH in any intervention. Our financial success depends upon it. I've worked with client companies with enviable programs yet frustration in their claims results, owing to inadequate reach. Invariably, a few costly outliers sour the experience of the whole group if family members remain UN-REACHED!

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UPDATE to Stress and Heart Disease in Women

2010-12-27T09:45:00.003-06:00

Follow-up to blog post from July 22, 2010
Target audience: Employers and Employees

Five months ago, I blogged about a Danish study which found a nearly 50 percent increased heart disease risk among women who reported high work stress. I ended with a quote from the author, who called for more research to “investigate factors that contribute to the perception that work pressure is too high.”

Now I’m happy to report that researchers have completed exactly such a follow up study. But, I’m unhappy to report what that study found.

A recent U.S. report similarly showed that, over ten years of observation, cardiac events happened 40 percent more often to women who had reported “high job strain” early in the study period. Here, researchers used a classic “job strain” definition: a demanding job, often involving time pressure and conflict, coupled with little decision-making authority or opportunity for personal growth. I call that definition a classic, because many earlier studies had used it and found that it correlated strongly to heart disease risk among men.

But this recent study showed an even higher risk of total cardiac events among women who had reported another type of work stress, which the researchers called “active job strain.” The authors had categorized women who reported high-demand work BUT with a higher sense of control and decision making authority as having “active job strain.” Alarmingly, these women had a 60 percent greater risk of heart events, even higher than those who experienced job strain WITHOUT a sense of control and authority.

This seems to show that just having decision-making authority and job control doesn’t offset the heart-injuring effects of high work demands. Instead, these authors point to other data that support physically active lifestyle, social support networks, and a daily “oasis” of time reserved for some form of relaxation, even 10-15 minutes, as important offsets to highly demanding work.

Women working hard at demanding jobs need more than just decision-making authority and control to maintain heart health. They should take good care of themselves, physically, mentally, and spiritually. And, they may need help from the organization and the family to do so.

So, have yourself a Merry Little Christmas and a happy New Year – let your heart be light!

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REFERENCES:
1. Occ Doc in a Box blog July 22, 2010: Stress and Heart Disease in Women

2. Allesoe, K et al “Psychosocial Work Environment and Risk of Ischemic Heart Disease in Women: The Danish Nurse Cohort Study,” Occupational and Environmental Medicine 2010; 67:318-22

3. “Job-stressed women face increased cardiovascular risk” December 15, 2010 MDConsult News, by Bruce Jancin, reporting on presentation by Natalie Slopen, Sc.D., reported at the annual scientific sessions of the American Heart Association, outcomes of The Women’s Health Study, funded by the National Institutes of Health.

Safe Use of Prescriptions at Work

2010-12-06T08:44:00.004-06:00

Target audience: Employers

To work safely, you must respect both edges of the two-edged sword of prescription medication. The right prescription, taken 100 percent as prescribed, can cut the disabling effects of disease, improving work attendance and performance. But taken incorrectly, drugs can cut into workplace safety! This especially matters to commercial drivers, whose safety affects the general driving public. So, the Federal Motor Carrier Safety Administration (FMCSA) has done good work to educate drivers and their employers, most lately with a new website:http://www.fmcsa.dot.gov/rules-regulations/topics/medical/medical-inner.aspx

I like this so much I've modified part of it slightly (see below), to make it useful for educating those who do any type of safety-sensitive work. If you like it too, consider distributing it among your workforce.

I find it ironic that "good guy" prescription medicines, just like "wicked-sister" street drugs, can threaten workplace safety. But since "good drugs" can "go wrong," some companies include extensive testing for prescription medications in employment-related drug screens. For example, medications for anxiety, depression, and pain may get thrown in the same hopper as marijuana and cocaine. Don't make this mistake! This approach doesn't get the job done. Screens that show prescribed medications simply get down-graded to negative, as long as the employee has a legitimate prescription. That doesn’t improve safety. And some employees probably erroneously stop taking medications they ought to take, fearing a positive drug test.

Instead, the better policies I’ve seen require employees to report any prescription to the plant nurse if of a type that could affect work safety. I’m sure this improves safety. This method doesn’t discourage them from taking medications they need. In fact, the nurse can aid compliance, especially to ensure the employee takes it correctly and safely. And nurses protect confidentiality. Companies who lack their own nurse can contract for this service from an agency or clinic. My clinic provides this service.

But, I suspect all companies that take this commendable approach still realize that medications are vastly under-reported. If your company is one, consider sending this document (entitled “FMCSA Medication Safety”) to all employees, with your own short intro paragraph reminding them of this requirement, if your policy requires it. Reassure employees you’re there to help and to protect both their safety and their confidentiality.

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Sixty Seconds With the CEO

2010-08-23T12:09:00.004-05:00

Target audience: Employers

You step into the elevator. Your moment has arrived! Your chief executive officer stands there, alone. You have a sixty second opportunity! And, you desperately need organizational support to solve the brain full of problems you encounter daily. Don’t let this golden moment pass!

I’ve listed talking points for each of several common employee health-related dilemmas you confront as an Occupational Health nurse, wellness coordinator, or manager of Human Resources, Benefits, Safety, or Worker Comp. Use them to enlighten, inform and persuade time-pressured Chiefs!

Wellness
“Hello! Seeing you reminds me of the importance of senior leadership in our wellness program! I just read about how active the executives are in the wellness program at (Dow Corporation, Johnson & Johnson, Citibank, Union Pacific, Quad Graphics, etc.). Those leaders make sure every employee knows that wellness matters at the top! And, it has to here, because, after all:

None of us are getting younger. We have an aging workforce. Our average age is ____!
We do more work now with fewer people than five years ago! That makes everybody’s productivity and health more important. And it makes everybody five years older!
Age will rob our employees of health and productivity, but only if we allow it. It doesn’t have to happen!
By keeping employees healthy we can compete better, with more productivity, and lower benefit costs.
Employee health drives all of our benefit costs. Health insurance, pharmacy, sickness and accident, long-term disability, turnover, early retirement, and lost productive time when at work.

Next time, let’s take the stairs so you and I can talk longer, and keep our own circulation going!”

Worker Comp
“How nice to see you! I was just thinking about all the Lean redesign efforts you’ve spearheaded, to eliminate waste. And I was thinking, what’s a bigger waste than worker comp? I mean, when someone gets hurt, it wastes their own time and money, as well as ours. You have made it a priority to eliminate waste, which means good management of safety, illness and accident prevention, and worker comp has never mattered more. Did you know that:

The single most cost-effective thing we can do in managing worker comp claims is to keep them “medical only.” That means the case only incurs medical costs, and no lost time. It means we accommodate all restrictions and actively get people back to work, avoiding lost time. That greatly lowers next year’s premiums. Lost work day cases increase premiums three to four times more than medical-only claims do.
Doctors are getting better at giving us statements about injured worker restrictions and abilities, instead of just taking workers off work. If managers know that you want these restrictions accommodated, then our claims become “medical only” and our premiums go down.
It really helps when you tell middle-level managers that accommodating restrictions and getting injured employees back to work matters at the top. When you’ve made that a strategic priority, then those managers double their efforts to help people work. I know some of our competitors make that a part of each manager’s performance review.

Well, this elevator has gone down, just like we hope our premiums will. Stay safe!”

Health Plan Benefit Design
“Isn’t our tobacco-free workplace a wonderful improvement? We couldn’t have done it without your leadership! Besides giving us a cleaner workspace, better air, and better image, it also helps employees who have quit tobacco to stay tobacco-free. And it motivates lots of people to finally quit who have always wanted to. Did you know that:

By going smoke free, about 15 percent of smokers in a work group will quit smoking.
But, nicotine addition, like other additions, is a real disease. It needs real medical treatment, so people can successfully quit, and stay quit.
If people just quit cold turkey without help, only 5 percent succeed after a year. But with medications and coaching, that success rate can increase by ten times.
Our health plan benefits need to fully support these people. Otherwise they will try but fail, or succeed but relapse, leaving us the burden of tobacco-related costs. And our tobacco-free workplace policy would remain just another policy, and not a part of our culture of health and wellness.
Health plan money spent on tobacco cessation has a better return on investment than any other preventive service. It leads to more and faster savings than mammograms, colonoscopies, cholesterol testing, and in fact any other kind of screening!
It takes less than 50 cents per member per month to fully support our employees with tobacco cessation benefits.

Well, here’s your stop! Can I call our health plan representative for you, and get this done? That will keep the smoke-free momentum going!”

Stress Management
“It amazes me how calm you look when I know all the big decisions you make. If I were you, my mind would race a mile a minute! I guess staying cool under pressure is part of your job description. Of course, everybody in this organization deals with stress. Did you know that:

Our health risk appraisal shows stress is our most costly health risk. It drives a lot of medical spending, and not just on mental health services. Every condition worsens with stress, whether its back pain, migraines, high blood pressure, or heart disease.
Some of our longest and most difficult-to-manage employee absences owe to stress problems.
We do more work with fewer people than ever before! That means more stress for each individual. And, we can’t afford for any of our teams to lose a key member!
Stress is a workplace risk, kind of like noise exposure. We deal with workplace risks at the source, not downstream. We wouldn’t deal with workplace noise exposure just by buying hearing aids for employees who go deaf. Likewise, we shouldn’t deal with stress by just providing mental health benefits to stressed employees.
One way to deal with stress at the sources is to train managers in stress-free management. And we need to teach both managers and employees constructive communication.

Can I talk to our Employee Assistance Program today about getting that started? They could have it ready for the next Managers’ Retreat you hold. You know, each day that goes by, the stress seems to get worse.”

Safety
“How lucky to see you!” I just have to tell somebody what an employee just told me about how much better he feels since starting treatment for sleep apnea. Like a lot of employees, this fellow has trouble with his weight and carries a lot of it around his neck. His wife had been bugging him to get tested for sleep apnea, because his crazy snoring during the night scares her half to death. Well, he had the test, started treatment, and told me today he wished he had done this five years ago! The trouble is, about 20 percent of our workforce seems to fit his mold. I’m worried we have lots of drowsy people around here who operate hazardous machines and driving trucks and tow motors who probably have sleep apnea but don’t know it. That threatens their health, of course, with high blood pressure and heart disease. But it threatens their safety too, with more workplace accidents. Did you know that:

Truck drivers with untreated sleep apnea have 2-7 times higher crash rates!
Probably 20 percent of truck drivers have untreated sleep apnea.
During the first two years of treatment for sleep apnea, truck drivers have $6,000 lower costs than during the two years before treatment, in total health plan and disability costs.

What’s good for truck drivers would be good for our employees too. Will you endorse a campaign to make employees aware that they need to know about this and see their doctors?”

*****************

Naturally, Occ Doc in a Box recommends “always take the stairs.” But if you catch the CEO headed for the elevator, get your talking points ready and dive in! What a difference a minute can make!

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Are You Making the Most of the Smoke-Free Law?

2010-07-28T13:25:00.004-05:00

Corporations have made great strides toward freedom from tobacco. All Wisconsin residents now breathe more freely because of the July 5th Smoke-Free Workplace Law. BUT, the wisest organizations will go beyond mere compliance with this law to build a corporate culture of health and safety free of the tobacco burden. Theses organizations will enjoy a competitive business advantage because of lower costs and higher productivity.

Do you want Occ Doc in a Box to show you how your company can do this? Start with this link which takes you Outside the Box to Affinity's SlideShare page. There I've posted a Power Point slide guide. Then, check out my video on YouTube, which gives some insights on the electronic cigarette.

As important as this information is, it's only the beginning. More to come! So keep your eyes on this Box!

Stress and Heart Disease in Women

2010-07-22T15:41:00.003-05:00

Target audience: Employers

Many studies have linked job stress and excessive work demands with heart disease, but mainly in men. Recent research has proved this happens to women, too.

Danish researchers studied the work-stress levels of 12,000 women through 15 years of follow-up. 580 of them developed heart disease during that time, including angina, heart attack, and other problems with coronary circulation. And, about 60 percent of participants reported their work pressure was too high.

The researchers analyzed the association between high work stress in the early years of the study, and the eventual development of heart problems during the 15 years of follow-up. They found that women who had experienced a high degree of work-place pressure had:

a nearly 50 percent increased risk of developing heart disease;
a 25 percent increased risk among those who felt their job pressure was even just “a little too high”;
a 70 percent increased heart attack rate in women who indicated the highest levels of job pressure.
The strongest associations between very high work pressure and heart disease were found among women younger than 51 at baseline.
These relationships remain significant, even when other cardiovascular risks were taken into consideration, such as smoking, high cholesterol and blood sugar levels, high blood pressure, and lack of physical activity.

The authors concluded, “It is important further to investigate factors that contribute to the perception that work pressure is too high, as it may include different aspects of work demands as well as aspects of not being able to control the work load.”

Source: Allesøe, K et al “Psychosocial Work Environment and Risk of Ischemic Heart Disease in Women: The Danish Nurse Cohort Study”; Occupational and Environmental Medicine 2010; 67:318-22

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Gender Differences In Negative Emotions Under Stress

2010-07-15T11:18:00.004-05:00

Target audience: Employers

Women and men have different types of stress-related psychological disorders. Women under stress have:

greater rates of depression
increased rates of some types of anxiety disorders.

But men under stress have:

a greater likelihood to crave alcohol when under stress
higher rates of alcohol-use disorders.

These differences seem obvious to many. It is important to know, though, that they are borne out in research. Research subjects were given three types of “imagery scripts” – stressful, alcohol related, and neutral/relaxing. When women were presented with the stressful story, they reported higher levels of sadness and anxiety than men. But for the men, emotional arousal was linked to increases in alcohol craving. “In other words, when men are upset, they are more likely to want alcohol.” This related to the fact that at baseline, the men tended to drink more than women on average. “Men’s tendency to crave alcohol when upset may be a learned behavior or may be related to known gender differences in reward pathways in the brain, and this tendency may contribute to the risk for alcohol-use disorders.” Researchers also concluded that women are more likely than men to focus on their negative emotional states, such as to think about them over and over again. On the other hand, men were more likely to seek a distraction away from their internally negative emotions in order to not think about them. In this research, men had a greater blood pressure response to stress, but didn’t report greater sadness or anxiety.

Reference: Hong et al, “Gender Differences and Response to Emotional Stress: An Assessment Across Subjective, Behavioral and Physiological Domains in Relations to Alcohol Craving,”Alcoholism: Clinical and Experimental Research July 2008

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Are Some People "Stress-Proof"?

2010-07-08T14:12:00.002-05:00

Target audience: Employers

Some people appear to be resilient even under difficult conditions. But others react with a range of physical and mental disorders when chronically stressed. Research shows that this has to do with the way the brain and the body adapt to stress, which has a genetic basis. Inheritance determines about 62 percent of the variability in levels of the stress hormone cortisol in one person compared to another.

Researchers recently demonstrated this by measuring cortisol levels in the saliva of research subjects, who were “stressed” by role-playing in simulated job interviews. Each test subject underwent an interview by a panel of three straight-faced judges, and then had to perform mental arithmetic tasks out loud. They were reprimanded if they made a mistake, and had to give five minutes of dialog to convince the interviewers to “hire” them.

Saliva samples were collected before and after these experiments. In addition to measuring cortisol in the saliva, cells were tested to characterize the type of gene the individual carried, for a growth factor responsible for development and differentiation of brain cells. Animal research has shown that this particular protein drops under chronic stress.

This research showed that certain gene profiles were associated with a higher cortisol reaction to these simulated stressful situations. And, this finding was directly opposite in women versus men. That is, for women a certain genotype was associated with a lower (healthier) cortisol response, whereas men with the same genotype had a higher (unhealthier) cortisol level. And, another genotype that was associated with lower cortisol levels in men was associated with the highest cortisol levels in women. Although the researchers couldn’t say why a certain gene was associated with an opposite stress response between men and women, the point was the severity of the stress reaction had a genetic basis in both genders.

Overall, males showed a greater stress response to this simulated social stress testing. Other research suggests these excessive stress responses are associated with higher risks of diabetes, high blood pressure, and heart disease. On a broader level, this research suggests that some people are genetically more “stress-proof” than others.

Reference: Levin et al, “Association Between Avpr 1A Promoter Region Polymorphisms and Prepulse Inhibition” Psychoneuroendocrinology 2009; doi: 10.1016

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Will Your Business See Success In... The Stress Contest?

2010-06-30T10:42:00.003-05:00

Target audience: Employers

Market competitors oppose one another like armies on a battlefield. Throughout military history, victory has gone to the healthiest army. So, too, in business competition, healthy workforces triumph with lower costs and higher productivity.

Now a stress epidemic erodes employee health, both physical and emotional. Your “employee army” lives an increasingly stressful life, at work and home. How will YOU lead them through this storm of stress, more effectively than your competition? It is no longer enough to provide EAP, wellness, and mental health benefits. All your competitors have those, too. What can your organization uniquely give employees to withstand stress, and bring you success in THE STRESS CONTEST?

Stay tuned to this blog as Occ Doc in a Box presents strategies for employers battling stress! First, let's study stress, our enemy, to learn what it has done, what it may do next, and how we can outsmart it. I've assembled some of the latest research in our War Room…

Stress and Productivity
According to the American Institute of Stress (AIS), a non profit organization that serves as a stress information clearing house, job stress:

Affects about one-third of workers in the United States.

Causes 12 percent of employees to have called in sick due to job stress in any given year.

Causes about 1 million work absences per day.

Costs 300 billion dollars per year as a result of
-- accidents
-- absenteeism
-- medical costs
-- worker compensation
-- other expenses.

Causes 60-80 percent of on-the-job accidents, with double-digit increases in worker compensation premiums between highly stressed workers compared to low stress.

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Allergy Attack versus Medicine Head!

2010-05-12T18:59:00.003-05:00

Don't let seasonal allergies affect safety at work

Target audience: Employees and Employers

Recent research at a heavy manufacturing plant proved four important things about seasonal allergies:

1. During their bad seasons, allergy sufferers have more work injuries, more Worker Compensation claims, less ability to concentrate and to work without mistakes, and rate their own work performance as being worse. Absenteeism, Worker Comp, and group health claims increase!

2. The worse their symptoms got, the worse these risks and impairments became.

3. And, when allergy sufferers used sedating antihistamines (allergy medicines that cause drowsiness), their impairment and their risks didn’t improve.

4. BUT, when allergy sufferers used non-sedating medications, their work performance improved dramatically and was nearly as good as people who had no allergy. Their risk of work injury also dropped to normal!

It is nice when research matches common sense! If you have ever suffered from severe runny nose, watery eyes, and sneezing from allergies, then you know you can’t work as effectively and safely as you’d like. And, if you ever had “medicine head” from taking antihistamines that made you drowsy, you also know that makes it hard to work, especially to work safely. But, if you use an allergy medicine that does not cause drowsiness, you remain alert, make fewer mistakes, and work safely and effectively.

So, the take home message is “READ THE BOX!” If you use an over-the-counter allergy medicine, read the warning label before you take it! If it says it may cause drowsiness, you should not take it and go to work within 6-12 hours, depending on the product. Find and use something else to keep allergy troubles away while you work, for the safety and you and your co-workers.

Certain over-the-counter medicines are great for working people. These include loratadine (Claritin type) and cetirizine (Zyrtec type). You can buy these over the counter, including inexpensive generic or “store brands.” Ask your provider what’s best for you. Your doctor could also prescribe various other allergy medicines if needed, which likewise do not cause drowsiness. More severe allergies may require these prescriptions.

And, remember to tell your doctor what you do at work. That helps your provider choose the best and safest medicine for you. Again, the key is finding the right medicine. If your allergies are anything more than minor, treating them improves your safety, but you need the right medicine to help you feel better AND work better.

Be safe! Stay happy! Don’t fall victim to “ALLERGY ATTACK or MEDICINE HEAD!”

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Teaching First Aid to Children - A Special Christmas Gift

2009-12-16T17:48:00.002-06:00

TO: My Readers
FROM: Occ Doc in a Box

Please enjoy this "Second Edition" of Teaching First Aid to Children (click to download). It offers fun AND education for the whole family! It gives children 15 first aid jingles they can learn and understand, with pictures to color. And, adults get 15 simple first aid lessons they can teach, while learning themselves.

It comes 20 years after I produced the "First Edition," which was a coloring book for young visitors to the emergency department. My 9-year-old son provided the original illustrations. The new edition includes those "classic" cartoons, accompanied by updated and expanded lessons for adults.

I hope it helps you and your children enjoy a safe, healthy, and injury-free 2010!

Merry Christmas from Occ Doc in a (Gift) Box!

The Perfect Gift for the Trucker on Your List

2009-12-08T12:24:00.004-06:00

Healthy for them, free for you!

Target audience: Employers and Employees

If you're searching for the ideal stocking stuffer for your favorite trucker, you've come to the right place! Our completely unique and totally FREE Commercial Driver Health Education book is just the thing. This one-of-a-kind pamphlet is chock full of health tips every driver needs. It emphasizes practical strategies for surviving the unhealthy and stressful demands of "life on the road." We've selected tips that help drivers maintain medical certification they need under Department of Transportation rules. Topics include Fighting Fatigue, Recognizing Sleep Apnea, Exercise and Nutrition While Travelling, Visual Health, and more!

Download this PDF file from our Web site to print or distribute as you desire. And, here's a special offer for employers who have a fleet of drivers: between now and Dec. 25, we will take your order for up to 100 copies free!

Keep watching our blogspot this holiday season to see more ways I become Occ Doc in a Christmas Gift Box!

Find our Commercial Driver Health Education booklet here:
http://www.affinityhealth.org/object/services-specialty-occupational-driver-health.html

Or from the Affinity Occupational Health web page, http://www.affinityhealth.org/page/services-specialty-occupational, look in our "Health Library" at the bottom of the right hand column.

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Why do ladies extend their pinkies when holding drinks?

2009-12-01T11:03:00.003-06:00

Target audience: Employers and Employees

You can spot a classy lady at a party by the way she holds her beverage container. Whether it’s a fancy champagne flute or a can of beer, a woman of sophistication keeps her pinkie extended straight, with only the thumb and three fingers on the glass. Puzzled by this nuance for years, I’ve finally figured out why. The sophisticated woman is showing everyone she is counting her drinks! The three fingers on the glass show she’s limiting herself to a three-drink maximum. That’s because four drinks in 24 hours, for a woman, is a binge!

If you watch a gentleman drink, you’ll find further proof of my theory. A man who holds his drinking glass with his thumb and all four fingers shows that he knows to limit himself to four servings, as five drinks in 24 hours, for a man, would be a binge!

I know that all of you blog readers are ladies and gentlemen, and understand the definition of a drinking binge: Four or more drinks for a woman, five or more drinks for a man, in 24 hours equals a binge. And you understand that a “binge” differs from a “bender.” Whereas a three-day-long drunken “bender” is accomplished only by extreme misuse of alcohol, a simple binge can occur almost accidentally. Most people who drink alcohol do so socially and in moderation. Moderate drinking is defined as one to two drinks in 24 hours, and not more than 14 in a week. But, even normally moderate drinkers could surprise themselves by reaching binge level simply by having a cocktail before dinner, a couple of glasses of wine with the meal, then an after dinner drink. Because this can happen fairly easily, ladies and gentlemen should use the pinkie up/pinkie down drink counting method I have described!

But, portion size can undo this drink counting method, just as portion size can do in dieting. When counting drinks, remember that each of these is a serving of alcohol:

12 ounces of beer
5 ounces of wine
1 ½ ounces of spirits

Some people find the idea of consuming four or five drinks inconceivable! To other people, that seems like nothing at all. But, it doesn’t matter how it seems. What matters is, what it does. Without a doubt, even a single binge does bad things for your health. Accidental injury risk increases, not only behind the wheel of a car, but also on a snowmobile, a motorcycle, in a boat, or on the basement stairs. Binges cause next-day blood pressure to be higher and heart rates faster. Work accident risks are greater even 24 hours after a binge. Work productivity drops for 24 hours after a binge, and the likelihood of work absence increases. That means lost production and missed opportunities for the work organization. And, that amount of alcohol equals a lot of calories, of a type which are hard for the body to metabolize. Those calories deposit directly into the liver, causing a condition with the unglamorous name of fatty liver. Repeated binges can make that progress all the way to cirrhosis.

Safe use of alcohol is a “numbers game” as in how many drinks, what size, and how often. Here’s a great web site with online calculators and interactive tools to help ensure you and loved ones have the information you need to use alcohol wisely if you choose to drink:
http://www.rethinkingdrinking.niaaa.nih.gov/

Occ Doc in a Box encourages you to enjoy all your celebrations safely and in moderation. And ladies, keep those pinkies pointed!

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Your One-Stop Respirator Information Shop

2009-11-24T16:21:00.002-06:00

Target audience: Employers

Respirator manufacturers and safety equipment vendors can be great sources of knowledge. But an employer who purchases their products may also want to cross-reference non-commercial resources. This is one of the many ways the National Institute for Occupational Safety and Health (NIOSH), a division of the Centers for Disease Control (CDC), assists business.

NIOSH has just released a Respirator Trusted-Source Information Page, with plenty of useful information on it in the form of text, photos, and tables. Consider this a reliable public resource to identify NIOSH-approved respirators, how to obtain products, and how to use them. The page will be dynamic, and information will be added as it becomes available. Content will address each of the sections listed below:

Section 1: NIOSH-Approved Respirators – What are they, How can they be identified, Where can I get them? Understanding the types of respirators; Identifying NIOSH-approved products; and Outlets for purchasing products

Section 2: Use of NIOSH-Approved Respirators - How to implement the use of respirators in the workplace and use them appropriately.

Section 3: Ancillary Respirator Information - Commonly asked Questions and Answers (Fact Sheets), Respirator Myths, Science of Respirator Function and Performance, Respiratory Protective Devices Not Approved by NIOSH

The Respirator Trusted-Source Information Page may be viewed at:
www.cdc.gov/niosh/npptl/topics/respirators/disp_part/RespSource.html

And, a cost-saving tip today from out of the Box: when seeking the periodic medical approval that OSHA requires your employees have before using a respirator, start with a questionnaire, rather than a full exam. Your local Occupational Health Clinic should give you the money-saving option of reviewing questionnaires from your employees, and then notifying you which employees can be approved with that information alone. Only employees who need full medical evaluation would then be given an appointment. Do this by distributing the OSHA Mandatory Medical Questionnaire to your employees:

http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=978

But, pre-fill it with the required information about work conditions and the respirator itself (“respirator usage.”). The place for that information is Part B of the OSHA questionnaire. It may be easier for you to complete this separately for each type of respirator-requiring job, and attach that to the questionnaire.

Please find a separate Part B section here, which you can use to do that:
http://www.affinityhealth.org/object/services-specialty-occupational-blog-respirator-form-2009-11-24.html

After employees complete their confidential health sections, they should then send them directly to the clinic.

This approach complies with the OSHA Respirator standard and protects confidentiality of health information. And, it may reduce the number of full exams you need to obtain by 50 percent.That way, both you AND your employees can be helped to breathe a little easier!

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Your Teens and Your Prescriptions

2009-11-10T14:38:00.004-06:00

Don't Let Good Kids (or Good Meds) Go Bad!

Target Audience: Employers and Employees

You probably know of prescription pain killers such as OxyContin, Vicodin, and Percocet. You should know that these meds can be good and useful, because “life brings many painful things.” And though we doctors have “pills for ills and drugs for bugs” we often don’t have a cure for chronic pain. We commonly use medications like these to control pain whenever possible and prudent.

And you certainly know teenagers. You were one yourself. All kids are good kids, though no one is good in every way. For example, most teenage boys are about 10 minutes away from doing something stupid, if given the chance. And, among the common stupid things teens may do is “borrowing” the prescription pain meds of adults, to take in abusive ways. I’m writing to tell you how to prevent these good kids (and good meds) from going bad.

This happens commonly. Among 12th graders in Wisconsin, 22.9 percent say they have taken painkillers such as OxyContin, Percocet, or Vicodin without a doctor’s prescription. I live in Wisconsin in Outagamie County, where we have great health care, fine schools and where “all the children are above average.” Our prevalence of teen prescription abuse is even higher than the state’s average, with almost 25 percent of high school seniors admitting to it.*

High availability of health care services may make prescription abuse more likely among teens. That’s because more adults in such areas have been prescribed chronic pain meds, and probably correctly so. But that makes it easier for teens to “borrow” them, with or without the adult’s knowledge.

And make no mistakes about it; good meds go very bad when misused, even becoming lethal. Seizures, overdoses, and respiratory depression causing breathing to stop are real hazards of inappropriate use. And these “worst case scenarios” can happen easily, especially if other medications or alcohol are also misused.

It is so easy to misdirect prescriptions that it is becoming part of teen sub-culture. For example, a new phenomenon known as the “pharming” or “bowling” party features different kinds of prescription drugs mixed together in a bowl or a bag (also called “trail mix”). Teenage party-goers pass it, taking pills by the handful. They often don’t know what drugs they are taking or how they will affect their mind or body, nor would emergency medical responders in the event that they need to treat a teen and counteract the drug’s effect.

While these “bowling” parties are extreme examples of “getting high,” it’s interesting that, unlike with other forms of adolescent drug use, the desire to feel good or get high ranks much lower as a motivator for most prescription drug misuse. More often, teens turn to prescription drugs to help manage their daily lives—for example, to lower stress and anxiety, boost their mood or increase performance. Being a teenager is more complicated now than ever. Like adults, some teens think prescriptions will help them keep going. They may discover it’s easy and free to lift them from the home medicine cabinet. All teens need support from good role models like parents, grandparents, coaches, teachers, and their own doctors. Unfortunately many mistakenly get the message that adults solve their own problems with prescriptions, alcohol and other substances. Here are ways to be a “difference maker” and protect the teens in your lives from misusing prescription pain killers:

If you are a parent:

Set limits and let teens know you will be disappointed. Talking to teenagers works! When important adults communicate the risks, abuse by teens declines. Parents, grandparents, relatives, adult friends, coaches, and activity leaders are all very important influencers of teen behavior.
Model good behavior. Watch how you use medicines in front of teens. Teens learn by example. Use your own medicines responsibly. Take them EXACTLY as prescribed.
“Denormalize” the behavior. While 1 in 5 teens abuse prescription drugs, that means 4 in 5 do not. “Everybody DOESN’T do it!”
Debunk common myths:
-- Prescriptions aren’t always safe. When prescription pain meds are abused, they are just as dangerous as street drugs.
-- They can be just as addictive.
-- It’s not okay to misuse these drugs, even “once and a while.” Experimenting with drugs is NOT a normal part of growing up!

Even if you are not a parent:

Most people don’t keep track of their medications.
Monitor all medications in the home—prescription and OTC medicines.
Safely store medicines out of children’s reach and sight. Consider locking them up.
Get rid of old or unused medicines. Returning them to a pharmacy for disposal is best.**
Don’t take any prescription pain pill when you will be driving or on duty at work, unless and until specifically approved to do so by your doctor. Even if the doctor didn’t say you COULDN’T take it that way, don’t assume you can. You should always ask directly, “Can I take this and still go to work?” Find out first!

If you want more information (and I really hope you do!), look at the excellent Power Point review of the subject on the web page of the National Council on Patient Information and Education's (NCPIE) 24th annual observance of "Talk About Prescriptions" Month (TAP Month).
http://www.talkaboutrx.org/rxmonth2009_maximizing.jsp#article

And, I’ve included five fliers from the CDC, which give great summaries.

Talking to Your Teens About Prescription Drug Abuse
http://www.affinityhealth.org/object/services-specialty-occupational-blog-teens-PDF1.html

Maximizing Your Role as a Teen Influencer
http://www.affinityhealth.org/object/services-specialty-occupational-blog-teens-PDF2.html

Why Teens Turn to Prescription Drugs
http://www.affinityhealth.org/object/services-specialty-occupational-blog-teens-PDF3.html

Warning Signs and Symptoms of Prescription Drug Abuse
http://www.affinityhealth.org/object/services-specialty-occupational-blog-teens-PDF4.html

6 Myths About Teens and Prescription Drug Abuse
http://www.affinityhealth.org/object/services-specialty-occupational-blog-teens-PDF5.html
---------------------------------------------------------------

*2007 Wisconsin Youth Risk Behavior Survey (YRBS)
http://dpi.wi.gov/sspw/yrbsindx.html

**Adapted from NCPIE

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Healthy Vending Machines

2009-10-27T11:44:00.001-05:00

Target audience: Employers

Promoting good workplace nutrition – one coin at a time!

Finances are tight lately. Maybe your wellness budget has been shrinking. You need health promotion ideas that are low-cost, yet wide-reaching with high yield.

Consider that times are tight for employees, too. They may have less “lunch money” than in the past, and may be dining at the company vending machines more. The days of meeting at local restaurants are on hold.

Now consider the lowly food vending machine at your work place. Maybe it’s time to use it to better advantage. Does it reflect the idea that your company is committed to health and vitality? And, that working “alive, awake, alert and enthusiastic!” is helped by good nutrition?

A vending machine that displays healthy and inviting choices visibly projects your company’s culture of wellness and health. It can be a showcase for the message that your organization cares about the health of all members. These machines display their wares 24/7, not only to those who use them, but even to passers by. A “trophy case” of good nutrition choices sends a health promotion message that is low-cost, wide-reaching, yet high-yield. That’s timely considering both your budget and that of employees!

Click here for a PDF that provides step-by-step remedies for unhealthy vending machines. It comes from the CDC’s “Lean Works” initiatives, which you can browse at http://www.cdc.gov/leanworks/build/environmental.html.

If you meet with your vendor and review this guide, additional ideas will flourish. Food vendors are becoming very familiar with these requests, and they may offer surprisingly good and low-cost suggestions. One I saw was placement of all the healthy choices to the right and unhealthy to the left, with a sign challenging customers to “Make the Right Choice!” And, increasing the price of unhealthy options, to underwrite the cost of the healthier choices, almost guarantees more healthy items will be chosen.

Hey, times are tough. Everybody has to do their part. Even the snack machine!

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Fainting After Shots

2009-10-21T14:10:00.003-05:00

Target audience: Employers and Employees

It's flu shot season! That's not necessarily anybody's favorite time of year. But, most people are happy to undergo the minor discomfort of a needle poke to be spared the misery of influenza. For some people though, any shot can be a challenge all by itself, especially for people who faint at the sight, the feel, and sometimes even just the thought of a needle! This common problem happens every day in medical offices, emergency departments, and flu shot clinics.

Doctors classify this phenomenon as "vasovagal syncope." But, it's not a disease or an abnormal condition in these situations. In fact, a normal cardiovascular reflex underlies vasovagal syncope. In certain people this reflex is simply exaggerated for unknown reasons, and can cause them to faint during medical procedures. They usually experience warning signs first, like weakness, a cold sweat, buzzing in the ears, blurred vision, and an unwell sensation. It can happen to men and women of any age, though it is probably most common among adolescent females. Among many people who have fainted with childhood shots, the tendency continues life-long. It is especially likely when shots and other medical procedures are needed in people who already feel faint from dehydration or illness.

Fortunately, there is a nearly sure-fire solution to this vexing, embarrassing, and potentially dangerous problem. It starts by telling the person who is going to give you the shot, that you fainted from a shot previously. Obviously, the right time to tell this is BEFORE they give your shot! Ask if you may lie down WHILE you receive the shot. Don't wait until you're on the verge of black out! And, elevating your legs while lying down to receive the shot nearly guarantees you won't become faint. Drinking plenty of water on the day of the shot also reduces the risk.

But, it's also important to realize that the vasovagal reaction can also happen in a delayed fashion, up to 15 minutes later. Rarely, it can even be longer. That is why the CDC’s Advisory Committee on Immunization Practices in 2006 recommended that all recipients of all vaccines be observed for 15 minutes after vaccination (MMWR 2006;55[RR15]:1-48). Even if you've never had a faint after a shot, it is a good practice to sit or lie down at the health care facility for 15 minutes after receiving the vaccine. A research study showed that fainting happens in less than five minutes in 49 percent of cases, and less than 15 minutes in 80 percent.

If shots have caused you to faint in the past, please don't be embarrassed or feel that it's your fault. It's a normal reaction which simply happens more easily to you. The important thing is to not avoid essential preventive health measures, like flu shots, for fear of fainting. The problem can be solved. But mass immunization at a flu shot clinic needs a special strategy, because your condition requires a few simple preventive steps. Speak up before you get the shot. Ask to lie down, and don't be in any hurry to leave. That's the best way for you to avoid the flu, and fainting too!

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Pharmacy Frugality: How to save money on your prescriptions

2009-10-19T10:55:00.004-05:00

Part 3 of 3

Target audience: Employers and Employees

A final tip for saving money on your prescriptions (continued from last week):

Brand-Name Cost Savings – Finally, I have a tip to reduce the price of name brand (non-generic) medications. Look into the "patient assistance program" and "drug discount cards" of the manufacturer of the prescription you take. All of the major drug companies have these, although they may not cover every medication they make. Most require that you meet financial eligibility requirements. These requirements are less stringent for the discount cards than the patient assistance programs. These can provide a large discount ranging from 20 percent all the way to "free." You can easily learn if you and your medicine are eligible by using a very handy web site. A non-profit group called Rx Assist has a searchable database that makes a great clearinghouse for information about these programs: http://www.rxassist.org/default.cfm

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Pharmacy Frugality: How to save money on your prescriptions

2009-10-13T10:09:00.004-05:00

Part 2 of 3

Target audience: Employers and Employees

More options for saving money on your prescriptions (continued from last week):

“Lower Tier” = Lower Cost, on Drug Formularies and Preferred Drug Lists
Health plans make lists of preferred medications, ranking them in two to three categories or “tiers.” Physicians and pharmacists, both internal and external to the health care plan, create the lists using the best value options. Co-pays are lower for drugs they list on lower tiers. If your doctor recommends a medication that’s not on your plan’s preferred list, or on a higher tier, ask if there is another choice. If you can use an equally effective drug from a lower tier, your co-pay will be lower. Again, you should follow your doctor’s advice, but the only way to know is to ask!

Fund your Flexible Spending Account (FSA)
Ask your company’s Human Resources Benefits department how you can create an FSA. These are pre-tax employee benefit plans, also known as Cafeteria Plans, Pre-Tax Plans, or Section 125 Plans. You fund them by designating a certain amount of money you want directed from each paycheck into your account. There are two advantages in using this money to pay for your medicines, or even just your co-payments:

First, this money isn’t taxed. The income you redirect to your FSA is not subject to the 7.65% FICA tax, the 15%-39% federal tax nor the average 5-7% state tax. Total tax savings will vary from individual to individual based on the employee's income tax levels. But, there is no tax liability on this money for anyone. Not when you contribute through payroll contribution, not when you are reimbursed for your eligible expenses and not when you file your income tax return. These funds remain tax-free.

Second, all the money you will be contributing during the plan year is available right away. You can access the total amount you have elected to contribute in the coming plan year throughout the course of the year, regardless of the contribution level at the time a claim is submitted for reimbursement. You don’t need to first “build up” the account. It’s like an interest-free loan you make to yourself.

The medical reimbursement account maximum is $5,000 per tax year. However, there are efforts in Congress to lower this to $2,500.* Still, that is a considerable amount of money that can be used for medications, co-payments, and other health care expenses.

You can use the pre-tax funds to pay eligible expenses for your spouse, dependents as well as yourself. Your contribution can be used for any qualified medical expenses you or your dependents receive during the course of the plan year, whether planned expenses or not. You may use the funds for predictable expenses such as orthodontia and vision care or for unexpected office visits, emergencies, dental crowns, prescriptions, etc.

And, since January 2, 2004, certain over-the-counter medications (e.g., antacids, allergy medications, pain relievers, cold medicine) are now eligible for reimbursement under FSA. They do not, however, currently qualify as deductible medical expenses on your U.S. tax return. In order for over-the-counter drug costs to be reimbursable under the plan, items must be purchased for personal use or for use by a spouse or dependent, and the over-the-counter drug must alleviate or treat personal injury or sickness.

To submit over-the-counter drug expenses, the receipt must clearly identify the name of the product/drug, the name of the provider/merchant, the purchase date, and the amount paid. A receipt stating “Pharmacy” as the description is not acceptable; nor is it acceptable to submit the packaging in lieu of a receipt.

It’s very important, though, to carefully determine the amount of money you want withheld from each paycheck. That’s because whatever you don’t use by the end of the year will be lost forever! Your employer can’t return unused funds to you. Whatever you don’t spend will be wasted. Fortunately, the year’s cost of a daily medicine is easy to estimate. Most pharmacies can run a computer report for you of all of last year’s expenses. If nothing changes about your medicines, those costs will probably continue. You can elect that much money to be deferred into your FSA, and then start spending it right away to keep your prescriptions refilled.

Mail Order – Many health plans arrange discounts with mail order pharmacies. And these contracts allow purchase of larger supplies, three months for example, with co-pay savings.

Pharmacy Chain Generic Discount Programs – You may have heard of "big box" chain store pharmacies with cut-rate discounts on certain generic medications. They offer 30-day supplies for four dollars, for example. These deals give customers big savings, but only apply to certain generic products. To get these deals, first ask your doctor if your medication can be generic. Then see if yours is on the store's discount list. To do this, enter the name of the store and "generic discount list" in an Internet search engine. You could also search the web site of the pharmacy chain you want (disclaimer – Occ Doc in a Box gives no commercial endorsements!).

REMEMBER – As Occ Doc in a Box has said many times before, the most expensive prescription may be the one you don’t buy! If your doctor has prescribed a medicine, but you don’t take it or stop it too early, you may have lost most of the value of that medical appointment. And your condition may be untreated, won’t improve, and may worsen. Since medications can be costly, talk with your doctor, your pharmacist, and your HR Benefits representative so you can stay on your medicine and still be FRUGAL AT THE PHARMACY!

* If you want to take action to protect FSA from new limitations go to http://savemyflexplan.org/

Check back next week for a final tip, plus a printer-friendly version of the entire three-part article!

Pharmacy Frugality: How to save money on your prescriptions

2009-10-07T12:52:00.005-05:00

Part 1 of 3

Target audience: Employers and Employees

PHARMACIST TO CUSTOMER: “Do you have any questions about your prescription?”
CUSTOMER TO PHARMACIST: “No. Thanks.”

This polite five-second exchange occurs hundreds of times a day at most retail pharmacy counters around the country. Unfortunately, some of those same customers are involved in this common dialog, too:

DOCTOR TO PATIENT: “The prescription hasn’t controlled your condition as well as I expected. Are you taking it every day?”
PATIENT TO DOCTOR: “No. It was too expensive, so I eventually stopped buying it. I’ve got to pay my bills, you know!”

I have an idea! Next time a pharmacist wants to know if you have any questions, ask “How can I make my medication more affordable?” And, ask your doctor, too!

They can probably help you save money by exploring these and other options:

Over-the-Counter (OTC) Medications
It’s worth asking your doctor if an OTC medication will work as well. Some gastro-esophageal reflux disease (GERD) drugs, allergy medications, and anti-inflammatory drugs have OTC options, for example. Sometimes the doctor can recommend a higher does of an OTC drug, which will make it as effective as a prescription. But only the doctor should decide this, so you must ask first. It would be foolhardy to “play doctor” yourself! OTC medications are easier to access and are less expensive, but they should be taken just as seriously and cautiously as prescription drugs.

Generic Drugs
Ask your doctor or pharmacist if your medication is available in generic form. All but the newest medications, those still under patent, can be bought in generic varieties. You can be confident they will work as well, because all FDA-approved, generic medications, both prescription and over-the-counter (OTC) must:

contain the same active ingredients in the same amounts as branded products
have undergone the same quality and safety reviews
show equal effectiveness

In some situations, your doctor may decide that only the brand name product is right for you, and ought to be able to tell you why that’s a better idea. Otherwise, go generic!

Cash and Carry
Most often, pharmacy charges are submitted to insurance, leaving you with just a co-payment. But sometimes, it’s cheaper to pay out of pocket and not submit the cost to insurance at all. That’s because most plans will only pay for a month’s supply at a time. But a larger supply, three months for example, usually costs much less per dose. So, it may save money to pay full price once for a three-month supply of your daily medicine, rather than paying the monthly co-payments three times. For example, a $10 or $20 per month co-pay over three months may total more than the full cost of a three month supply. If your prescription is generic, this is probably true. If so, you can save money and make fewer trips to the drug store!

Pill Splitting
Ask the doctor or pharmacist if you can have a double strength tablet to then split into single doses, which saves money. But, DO NOT SPLIT PILLS UNLESS SPECIFICALLY ADVISED! It can be dangerous with some medications. But many can be safely split, so ask about this economical option.

Check back next week for more "Pharmacy Frugality" tips on using your health plan options to your greatest advantage.

U.S. Chamber of Commerce Pandemic Flu Guide Receives Approval from Occ Doc in a Box!

2009-09-22T10:51:00.004-05:00

You may feel swamped by "flu news." If you have been searching for useful business information about seasonal flu and novel H1N1 ("swine") flu, I recommend this document, released Sept. 18. It includes a list of 10 action items for business, beginning on page 8 of 16, that you'll fine especially to-the-point and practical. You can download it here: http://www.uschamber.com/issues/index/defense/pandemic_influenza.htm.

Or, navigate to it from the Chamber's web site, where you will notice other links to practical information: http://www.uschamber.com/.

To this advice, I add emphasis that soap and water, and hand sanitizers, are serious medicine! Good hygiene is not only endorsed by your grandmother, but is also Occ Doc in a Box-approved to lower not just the individual risk of flu, but especially the risk of spread throught the work organization.

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Back Safety for "Back-to-Schoolers"

2009-09-15T11:32:00.002-05:00

We all want children to grow up healthy and productive. Many of the same rules you follow to avoid backaches at work apply to kids, too. Teach them these ergonomic principles so they can avoid musculoskeletal injuries for life.

Homework – Give small children a low table where they can do their homework. If the child’s feet don’t touch the floor, provide a footrest or box for the feet. Position the computer monitor so the top of the screen is at or below the child’s eye level. Or, give them a booster chair to raise them to that level.

Sports – If your child is involved in sports, make sure all equipment, including helmets, pads and shoes, fits properly. Be sure young athletes are taught proper form and technique, and stretching exercises appropriate to their age, experience level and specific sport.

Sit up straight – Encourage good posture when watching TV, playing electronic games or working on a computer. And, keep all those activities limited! Young spines need frequent exercise, especially outdoors, and especially in children who have been in school all day.

Strengthen bones – Ensure your child gets enough calcium every day. The calcium in milk is essential for healthy bones and reduces the risk of joint and muscle-related injuries.

Drink right – That means lots of H2O! Be sure your child avoids high-sugar, caffeinated and carbonated drinks. Rather, encourage children to drink plenty of water. Soda has several ingredients that are bad for growing bones, including high levels of phosphoric acid, which can interfere with calcium absorption – a problem that could lead to osteoporosis down the road. And, soda drinking may be among the main causes of the current childhood obesity epidemic. Obesity in childhood can mean bodily aches and pains lifelong!

All-around health – Children should eat a balanced diet low in fats and high in fiber and whole grains, stretch, be physically active every day, and maintain a healthy weight.

Backpacks – Put your child’s fully loaded backpack on the bathroom scale and you will be amazed. Middle schoolers especially tote a ton of textbooks. Make sure your child isn’t expected to carry more than 10 percent of his or her own body weight in the backpack. Ask your child to remove items before school that he or she won’t need that day. Likewise, your kids should leave items in their school locker at the end of the day if they won’t be needed at home. Don’t let the load accumulate!

Encourage them to use both shoulder straps to balance the weight. A heavy backpack slung over just one shoulder unbalances the spine. And, inspect the should straps to ensure they are wide enough and have enough padding to properly spread the weight onto the front of the shoulder. Narrow and thin straps can “bite” into the shoulders and restrict circulation to the arms. Observe where the backpack rests against the child’s back, shortening the straps if the bottom of the backpack is below the level of their belt.

And, don’t give YOURSELF a backache getting kids to school!

Remember the General Lifting Rules whenever you lift children, such as preschoolers who are riding along in car seats. Likewise for lifting musical instruments and athletic gear:

Keep your head high, your chin tucked in and your back arched (maintain natural curves).
Keep the child or the item close to your body and stand up straight, lifting with your legs, not your back.
Don’t bend at the waist to lift the child or object.
Avoid twisting while lifting.
Maintain a wide, balanced base of support by positioning your legs apart.

And, give your school children a hug every morning. Even big kids need hugs to make it through a school day! And you’ll have a better day at work, too!

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How to Help Others Quit Tobacco: Part 2

2009-09-02T13:51:00.003-05:00

Target Audience: Employers and Employees

The “Five A’s” from last week's blog post give you a starting point to use to help someone quit tobacco. For people who are ready to quit, this is a roadmap to success. But for people who aren’t ready, as discussed in the “Third A – Assess” a different approach is needed. That approach is called “The Five R’s.” It’s designed to motivate tobacco users who aren’t ready yet. Maybe they have been demoralized by previous failures, or fear the “unknown” life ahead of them without the tobacco they’ve used for years, or are simply misinformed. Here’s how you can help:

Relevance
Don’t you think tobacco has a lot to do with your problem with your (health/finances/children/spouse/job/parents/self esteem) that you’ve told me about before?

Encourage them to consider quitting by making it personally relevant to their current situation, being as specific as possible. Connect it to what you already know has been on their mind lately, such as their health, appearance, family or social situation (i.e., having children in the home), family history or other risk for disease, their age, and gender. You don’t have to say much. Often, the less said the better. But by even briefly connecting their tobacco use to the here-and-now, you can provide strong motivation.

Risks
What will happen to you if you keep using tobacco? What will happen to your (family/friends/children)?

Let them do the talking. It’s best to hear what worries them instead of telling them what you think their worries should be. But remind them the only way to eliminate those risks is to quit completely, not just cut down or switch brands.

Rewards
Once you quit, what good things will happen to you and your (family/friends/children)?

Now, you might want to do the talking! Remind them of the many benefits that will come, especially those that matter most to them in their particular situation. For example:

Improved health
Improved sense of smell
Save money
Better self-image
Home, car, clothing, breath will smell better
Can stop worrying about quitting
Set a good example for children
Have healthier babies and children
Eliminate worry about exposing others to smoke
Feel better physically
Perform better in physical activities
Reduced wrinkling/aging of skin
Food will taste better

Roadblocks
So, what’s standing in your way?
What has to change before you will try?
What worries you about trying to quit?
How do the risks of continuing tobacco compare with your worries about quitting?

Now, let them do the talking. Just listen. Maybe they fear withdrawal symptoms, failure, putting on weight, lack of support, depression, and loss of the enjoyment of tobacco. Acknowledge all of their fears as legitimate, but remind them there are solutions for each of these.

Repetition
I’ve learned it’s a mistake to try to do too much at once with people who need more time. Don’t try to talk through all of the “Five R’s” in one sitting. Come back to where you left off some other time. That lets them know you are sincere and committed to helping them.

Each time, raise the issue gently and respectfully. Know that they are trying. And, know that tobacco use is a powerful physical and psychological addiction that is difficult to quit. Tobacco users need your compassion, support and understanding while they’re struggling to free themselves from it.

Tobacco users all deal with two fears – the fear of quitting and the fear of continuing. They may need your help. Don’t be afraid to try!

REFERENCES:

Fiore MC, et al. (2000). Clinical Practice Guideline: Treating Tobacco Use and Dependence. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service.

Centers for Disease Control and Prevention. Cigarette Smoking Among Adults—United States, 2006. Morbidity and Mortality Weekly Report [serial online] 2007; 56(44):1157–1161 [accessed 2007 Nov 8].

National Cancer Institute,
http://www.cancer.gov/cancertopics/factsheet/tobacco/cessation#r12
Filozof C, Fernandez Pinilla MC, Fernandez-Cruz A. Smoking cessation and weight gain. Obesity Reviews 2004; 5(2):95–10

DiClemente, CC, Prochaska, JO, et al. (1991) The Process of Smoking Cessation: An Analysis of Precontemplation, Contemplation, and Preparation Stages of Change. Journal of Consulting and Clinical Psychology, 59(2):295-304.

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How to Help Others Quit Tobacco: Part 1

2009-08-25T17:12:00.003-05:00

Target Audience: Employers and Employees

“I noticed you smoke. Would you like to quit?” I ask that question in my clinic several times a day. Like most doctors, I’m trained to gently but directly raise this issue with each patient who uses tobacco.

Suppose you don’t use tobacco, but you’re concerned about someone who does. Maybe you want to help them, even though you’re not a doctor. And, you don’t want to come across as pushy, nosey, judgmental or offensive. Where do you begin?

Do what we doctors do! We use an approach know as the “Five A’s and the Five R’s,” which was developed by the U.S. Public Health Service in 2000. I’ve modified it here for non-doctors. It’s quick, effective and easy to remember. And if you do it correctly, you won’t offend or embarrass the person you are trying to help.

Ask
Would you like to stop using tobacco?

If the person you care about is like most tobacco users, they probably wish they could quit. More than 80 percent say they do (Gallup Poll, 2001). And each year, about 45 percent of tobacco users make an attempt to quit (CDC, 2007). Most won’t mind if you ask, as long as they know you genuinely care.

Advise
Because I care about you, I think you should stop. Just cutting down isn’t enough.

As your spouse/friend/co-worker/family member I’m worried about tobacco and its effect on your health/finances/children/self image . . . I know you are too.

Tobacco users know they should stop, but know it won’t be easy. It’s important for them to know that someone who cares wants to help. Personalize your message by connecting it to your relationship with them.

Assess
Are you ready to try quitting in the next 30 days?
How likely is it you will set a quit date by then?
Can you pick a number between 0 and 10 to tell me how likely it is?

Many tobacco users have been contemplating quitting for some time and are ready to begin planning. If the person you’re trying to help gives you a number 7 or higher, they’re ready! But if they say 6 or less, they aren’t there yet. They may be in a stage we call “Pre-contemplation.”

This is a crucial difference in terms of what to say next. You can begin to “Assist” (next step) people who are ready (7 or higher). But those who aren’t ready (6 or less) shouldn’t be given advice or assistance about how to quit. Instead they should be given help to get them ready. Don’t badger them into trying now, but don’t give up on them either. For such a person, you should skip the next two “A’s” and go to the “Five R’s” (see next week’s post).

Assist people who are ready to try
Can I help you get your own quitting coach?
And, can I help you pick a quit date?
Can I help you tell other people when it will be, so they can help too?
Let’s talk about times when you’ve tried to quit in the past. Where will the challenges be this time, and how can we prepare for them?
If we do all this, I know you’ll succeed.

At this point, by far the most effective way to assist is to make use of telephone coaching. Confidential and effective coaching is available at no cost or obligation. If the person you’re trying to help is ready, encourage them to call a coaching program.

Anyone anywhere can use the national tobacco-free help line at 1-800-QUIT NOW. They will receive free live assistance from trained professionals.

Northeast Wisconsin has the added benefit of an award-winning telephone coaching program from Affinity Health System, called Call It Quits. Anyone can make use of this community service by calling (920) 738-2230 or 1-800-362-9900 or e-mail to callitquits@affinityhealth.org.

These aren’t “hot lines” that you call once you’re desperate. Instead they are “help lines” that help people prepare, take action, and then maintain this life improvement. And coaching helps the most if it is included from the very beginning.

Telephone coaches usually call back on the quit date, and regularly thereafter. Many send additional help in the mail. They can help callers learn about prescription and non-prescription medications that help control cravings, to decide what’s best for them. And this can be done at no cost and no obligation.

One great thing about the convenience of a trained and qualified telephone coach is that you won’t have to be the coach yourself! Still, you may want to discuss with the person you’re trying to help certain things which universally seem to be a challenge:

Weight gain – this can happen, but the average is less than 10 pounds (National Cancer Institute, 2007). It’s far healthier to gain ten pounds than to remain a tobacco user. And when quitting tobacco is part of a healthier lifestyle with regular exercise and better diet, the weight can be lost.

Nicotine cravings – medications are highly effective. For example, over-the-counter nicotine patches, gum or lozenges, and prescription Chantix or bupropion are all proven to boost success rates by reducing craving. And, people who use tobacco less heavily tend to have fewer cravings.

Temptations – reduce them by removing tobacco products from the home and work area. To get ready to quit, avoid using tobacco in places like the car where the user will still have to spend a lot of time once they’ve quit. And remind them, “Not one more puff (or chew).”

Alcohol – this can lead to tobacco relapse, so limit or quit alcohol too. Smoke-free restaurants and bars are a great advantage.

Fellow tobacco users – learn how to ask them for help and consideration. Practice “scripts” the quitter can use to ask them to not use tobacco in their presence. And remember, there is an 80 percent chance each of them wants to quit, too! One might become a “quitting buddy.”

Stress – now is the time to learn effective and healthy ways of dealing with stress, without tobacco. Exercise, positive thinking, music, prayer, meditation, assertiveness and other coping skills are essential.

Arrange
Can you and I talk regularly about how this is going?

Meet again soon after the quit date, and every few weeks after that. Congratulate the person you’re helping if they’ve been able to quit. If they relapsed, remind them it is still a victory that they tried. Review the relapse to learn lessons that will help the next attempt, and promptly start again.

Join us next week for the “Five R’s”!

Why BMI?

2009-08-12T13:58:00.005-05:00

Hello from the Box! If corporate wellness is among your responsibilities, you are probably familiar with body mass index (BMI) measurement, the most widely used method of weight assessment in health risk appraisals (HRA). As common as it is, it’s still a foreign concept to many employees. This week’s article provides an easily understood explanation of BMI. Consider using it to educate employees about this important and costly employee health issue.

Why BMI?
Why should you (and you employer) care?

Target Audience: Employers and Employees

“How much should I weigh, Doc?” I’m asked that daily in the clinic. I always use a body mass index (BMI) table to answer this classic question. In fact, I keep a BMI table in every exam room. How much a person should weigh depends upon how tall they are, among other things. So, I show the patient their BMI on the table, and then we discuss goals.

The first goal I give every grown adult is this: don’t gain more weight! That is, except when speaking with that rare thin person whose BMI is too low, and with pregnant women. For the rest of us, it’s amazing to think about how adding a couple pounds a year will accumulate. Since the time we finished high school, many of us have done exactly that (or worse!). To start getting better now, we first have to stop getting worse.

Next, I personalize my advice. I might need to know my patient’s body fat percentage. This is to see if their high BMI is due to excess body fat, which it usually is, or instead from an unusually large amount of muscle, which is the reason much less often. I may need to measure their waistline, to know if their body fat is accumulating in the abdomen, where it does the most harm. And I need to know about other health risks they have, like high blood pressure, blood sugar, cholesterol and triglycerides. That's because these risks increase the bad effects of a high BMI. And I need to know if they have any chronic diseases, such as diabetes, which their BMI problem may have already caused.

But the conversation always comes back to BMI. That’s because when working toward a goal, it’s easier to track your weight than your body fat percentage or your waist size. After all, just about everybody has a scale at home. So I use the table to show them how their BMI will come down to a healthier range with slow and steady weight loss.

Although many people seek a doctor’s advice about their weight, most people tend to care about it not so much for health reasons. Instead, they just want to look their best. But fashion trends and celebrities’ physical appearances don’t have much to do with health. On the other hand, BMI does!

Medical researchers have studied this repeatedly. And almost always, scientists use BMI as their preferred measurement. They’ve shown time after time, that the higher the BMI climbs above 25, the greater the chance of developing any one of many diseases.

That’s especially true when the person has both a high BMI and a larger waistline (35” or more for women and 40” or more for men). This combination can signal central obesity. It increases the chance of diabetes, high blood pressure, heart attack, sleep apnea, high cholesterol, stroke, gallbladder disease, reflux of acid from the stomach (GERD), and several types of cancer.

But having a high BMI alone, even without high body fat or central obesity, increases the risk of other important conditions, too. These include low back pain, arthritis in the knees and hips, and heel pain from so-called “heel spurs.” And, although these problems seem less serious than a heart attack for example, they are much more common, especially among working people.

So, to stay healthy, and not just to look good, we should all pay attention to BMI. And, since employers pay the bills when employees become unhealthy, they should pay attention, too. To a good employer, it’s not for “show.” It’s for “dough!”

Research has shown time and again that BMI predicts costs. For example, when two populations of working people are compared, and one group has an average BMI of 18.5-25 and the other greater than 40, all else being equal, the high BMI group will have:

medical and pharmacy costs almost 70 percent higher (reference 1)
twice as many Worker Comp cases, with 10 times higher Worker Comp costs (reference 2)

And, BMI is such a strong predictor of costs that, for each number BMI drops between 45 and 25, there is an average reduction of medical expense of 4 percent and pharmacy spending of 7 percent. Again, that’s the average difference for EACH unit of BMI, and there are 20 units between 45 and 25 (reference 3). Every little bit matters! Back to what I said earlier, it’s unfortunate how a couple pounds a year adds up as the years pass. Likewise, as the average BMI in a work organization ticks upward, so do its costs.

This means that, both for us as individuals and as a work organization, the numbers matter. A high BMI number is important even for a person who doesn’t look particularly heavy. That’s because an obesity epidemic has changed our country over the last 25 years. Looking around to see how we compare with others is a bad thing to do, for many reasons. One is that what “looks normal” nowadays may be very unhealthy, and very expensive. It’s about health, and it’s about the cost of ill health. It’s not about looks, or about making anybody feel inadequate. It’s just the way it is.

So, to improve individual health, first don’t get any worse. Then set realistic goals that can be reached in a slow and steady fashion. And, exactly the same approach is needed for the whole corporation. First, don’t let the average BMI of the population get any worse. Then little by little, help employees so the average BMI can comes down.

Please use this BMI table to see what your BMI is now. Then move your finger along the row that corresponds to your height, and consider the possibilities. If your BMI is too high, how many pounds do you need to lose to reduce BMI by just one unit? That’s enough to start improving your health, and it may be a realistic goal. Then consider what would happen if all of us who have a high BMI did that. We’d have a healthier company, and a healthier country! Little by little we can do better. First though, let’s stop getting worse!

References:
1) Edington et al, “The relationship between NHLBI Weight Guidelines and Current Medical Costs in a Manufacturing Population,” American Journal of Health Promotion 17(3):183-189, 2003.

2) Ostbye et al, “Obesity and Workers’ Compensation,” Archives of Internal Medicine, Vol 167, April 23 2007.

3) Edington et al, “Association of Healthcare Costs with Per-Unit Body Mass Index Increase” Journal of Occupational and Environmental Medicine: July 2006 - Volume 48 - Issue 7 - pp 668-674

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Could You Have Sleep Apnea Without Knowing It?

2009-08-05T10:34:00.003-05:00

(Lessons from Truck Drivers)

Target audience: Employers and Employees

A True Story from My Office
“Doc, I’m glad you made me have that test. Now I feel better than ever. I just didn’t realize how tired I really was!”

A truck driver told me that. He had seen me for his Department of Transportation (DOT) required certification exam. That was his parting comment as we exchanged a hearty handshake, and he left with his certificate, satisfied.

Although we were seeing eye-to-eye by then, things didn’t start that way. I had surprised him a month earlier when I required him to have a sleep study to screen for sleep apnea.

I had explained how this very common condition causes people to momentarily but repeatedly stop breathing while asleep, disrupting normal sleep cycles. He understood that, and admitted his wife once mentioned she noticed pauses in his snoring pattern while he slept.

Then I covered the connection between untreated sleep apnea and health conditions, including how it can lead to high blood pressure, heart failure, and even sudden death. He said he’d heard that, too, and knew his own blood pressure had been borderline.

I went on to say that, because sleep apnea sufferers never reach deeper levels of sleep, they are prone to excessive daytime drowsiness, which could lead to falling asleep at the wheel. That’s where he stopped agreeing with me. More accurately, he clammed up. He pled the 5th, so to speak. But, to his credit, he went along with my request, as a professional driver should, albeit reluctantly.

His test confirmed severe sleep apnea. He started nightly use of a CPAP machine, and noticed results right away. “I should have done this years ago!” he told me. Ironic, I thought. I should have started requiring these tests years ago.

Sleep apnea isn’t new. But requiring tests for it, in people who don’t feel they have it, is new. This has created no small amount of controversy, particularly among truck drivers, who are under scrutiny because of the obvious public safety implications of their job.

A Sad Story
There are more than 5,000 deaths due to large truck crashes in the U.S. annually. Somewhere between 7 percent and 20 percent of these crashes are due to truck drivers falling asleep behind the wheel. Their job is very demanding and would be stressful for anyone. But it’s a killer for someone with untreated sleep apnea, which may increase crash risk by two to seven times. And it is estimated that 17 percent to 28 percent of truck drivers have that condition. (Reference: Parks, 2009).

Still, those same statistics mean most truck drivers don’t have sleep apnea. And, most truck drivers finish long careers without ever being in any accident. So, how can doctors decide which drivers need to go through this inconvenient and expensive process, simply to remain eligible to drive a truck?

The Tale of the Tape/the Battle of the Bulge/Contents Under Pressure
The answer is: by using a tape measure, a scale, and a blood pressure cuff. This answer was given to us when experts gathered to answer these difficult questions. In 2006, a joint task force of three major professional groups was formed: The American College of Occupational and Environmental Medicine, the American College of Chest Physicians, and the National Sleep Foundation. One of their tasks was to decide how doctors could identify drivers who ought to have sleep apnea screening, even among drivers who didn’t think they were drowsy. Their consensus was to require the screening test if two out of the following three criteria were met:

Body mass index of 35 or greater

Neck circumference of 17” or greater in male drivers and 16” in females.

High blood pressure that was either new, uncontrolled, or requiring two or more medicines to control(Source: Hartenbaum et al, 2006)

So, these are the three things I look for when I evaluate a truck driver. These are what led me to ask the driver I described earlier to have a sleep study. And I was right, he had sleep apnea.
So, how often am I right? In this situation, at least nine times out of ten!

The Proof of the Pudding (It’s in the Eating!)
I know those odds from my own experience, and from talking to colleagues. But more importantly, I know this because two recent studies have put this approach to the test, and found it is remarkably good at predicting sleep apnea. The first study found that 98.4 percent of truck drivers who had at least two of the three indicators listed above proved to have sleep apnea when tested (Talmadge, 2008). In the second study, it was 100 percent (Parks, 2009). I know of few other medical decision-making rules that work as well as this one.

The Moral of the Story
The moral depends on who you are. If you are a truck driver, staying alive requires that you can stay awake. The moral for you is to discuss sleep apnea with your own doctor, and have the test if they or your DOT medical examiner recommends.

If your work is not as safety-sensitive as that, talk to your doctor if you are concerned about feeling tired or sleepy. The “Epworth Sleepiness Scale” below gives you a way to measure that. And, know your body mass index (click here for a BMI calculator http://www.nhlbisupport.com/bmi/ ).

Ideally, it should be about 19-25. If it is over 25, set a realistic goal of gradually lowering it. If it is 35 or greater, you may be at risk for sleep apnea and not know it. Talk to your doctor, especially if your neck measures 17 or more inches around; 16 inches if you are female. If your blood pressure is a problem, you may also be at increased risk, if either BMI or neck circumference is increased.

The “Rest” of the Story
I expect to see my truck driver patient next year, knowing that in the meantime, he will continue to use his bedside CPAP device to keep breathing normally in his sleep, even when on the road. And I believe he is a safer, more alert truck driver because he is now treating a condition that was putting him at risk of drowsy driving, even though he didn’t know it.

When I see him then, he will be better rested than when I met him. And I rest easier meanwhile!

References:
1) Parks, Philip D. MD, MPH, et al, “Screening for Obstructive Sleep Apnea during Commercial Driver Medical Examinations”

Journal of Occupational and Environmental Medicine (JOEM): March 2009 - Volume 51 - Issue 3 - pp 275-282

2) Talmage, James B. MD; et al, “Consensus Criteria for Screening Commercial Drivers for Obstructive Sleep Apnea: Evidence of Efficacy”

JOEM: March 2008 - Volume 50 - Issue 3 - pp 324-329

3) Hartenbaum, N, et al, “Sleep Apnea and Commercial Motor Vehicle Operators: Statement from the Joint Task Force”

JOEM Sept 2006 Vol 48, No. 9 Supplement

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How tired are you? Click here for the Epworth Sleepiness Scale.

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Eight Ways Employers Can Communicate with Doctors to Improve Worker's Compensation Care

2009-07-27T08:16:00.004-05:00

(Tips from a doctor!)

Target audience: Employers

Part 2 of 2

5) Ensure the physician has obtained relevant records from prior treatment of pre-existing conditions. If a work accident has occurred, and a pre-existing condition is present, then the physician will need to decide if an aggravation has occurred. To decide this correctly, the doctor will need not only a good incident description, but also records of prior treatment of the pre-existing condition. This is too important to rely only upon what the employee can remember. Make sure your Worker Compensation insurer has asked the employee where previous treatment was done, and asked them to authorize the current doctor to receive those records. Once the physician has both the records AND the incident report, they can consider:

Was the incident reported promptly?
-- If so, aggravation is more likely.
-- If not, aggravation is less likely.

How much time passed after the incident, until the employee sought treatment or accommodation?
-- If no delay, aggravation is more likely.
-- If delayed, aggravation is less likely.

Were the signs and symptoms of the pre-existing condition changed after the incident, comparing previous medical records to current?
-- If yes, aggravation is more likely.
-- If not, aggravation is less likely.

Is additional treatment and/or accommodation being sought since the incident, beyond what was needed prior to it?
-- If yes, aggravation is more likely.
-- If not, aggravation is less likely.

And, did the employee have a pre-placement medical exam? If so, have it reviewed to see if the condition was present prior to employment.

6) If a condition developed gradually during employment, give specifics to the physician about the job. Job descriptions matter most in cases that began without an accident. The physician needs to determine if ongoing workplace exposure caused or at least added to such conditions. You must give doctors a history of the job assignments your employee had before they reported the problem (not just what they have done since). And you need to provide specific information about their duties. Methods include:

Written functional job description

BRIEF job video. Edit to about three minutes. Supply it to the doctor as a DVD.

Ergonomic analysis, done by insurance rep or therapist for example

Measurements of:
-- Weights handled
-- Forces required (push, pull, squeeze)
-- Duration of effort
-- Frequency of effort
-- Job cycle and rest cycle
-- Task rotation sequence

Review of OSHA log regarding occurrence of other occupational disease cases on this particular job

Job history
-- Length of employment
-- Duration of current assignment
-- Number of hours worked prior to problem onset (time cards, service records)
-- Any work changes that immediately preceded the onset of trouble (new equipment/process/assignment)

7) Get to know the doctor’s office staff. Make a list of all the doctors who have treated your recent Worker Comp cases. Call each office. Ask the name of the person who coordinates Worker Comp communication. This person may be a nurse or a medical record technician. Introduce yourself to them and exchange basic information about preferred communication routes. Making this simple connection early can prove to be highly valuable in future cases.

8) Write to the primary care doctors of your employees. The goal here is to make doctors aware of your company. Don’t limit it to doctors who are treating Worker Compensation injuries. Instead the idea is to proactively let doctors know what your company can offer to help them care for your employees who are also patients of theirs. Here’s how:

Create a brief but attractive single-page description of your company, the work environment, on-site health-related resources, your wellness program, and relevant policies such as Worker Comp and FMLA.

Then provide it to the account representatives of your health plans. Ask them to have it sent to the primary care providers (PCPs) to whom your employees are assigned. Ask them to send it ONLY to PCPs who currently have employees of your company assigned to their practices*. And ask them to mail it with a cover letter that lists for that doctor the names of each of your employees who are assigned to their practice.

NOTHING GETS THE ATTENTION OF A DOCTOR LIKE THE NAMES OF PATIENTS THEY KNOW. The name of your company may not mean anything to the doctor, but the names of their patients will! When they see that patients of theirs work for you, then they will pay attention to your company. And, your information may help them provide better care of their patients. That’s what matters to every doctor!

* Here’s a way to specify your request to the health plan account rep, to avoid the mistake of sending a letter to a physician who hasn’t seen one of your employees yet, even if technically assigned to them: “Please have the health plan run a report by member (per employer group) for a particular time frame (3, 6, or 9 months for example) of any claims received or paid. Send our company letter to the doctors of those members, with the names of the members who had a claim.”

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Eight Ways Employers Can Communicate with Doctors to Improve Worker's Compensation Care

2009-07-15T13:21:00.006-05:00

(Tips from a doctor!)
Target audience: Employers

Part 1 of 2

If you haven’t noticed that doctors don’t seem to listen when you talk about an employee’s Worker’s Comp injury, it’s probably because you’ve never even been given the CHANCE to talk to a doctor about an employee’s Worker’s Comp injury! On behalf of the whole grand profession, please accept my professional apologies for our apparent stubbornness. But apologies won’t solve this dilemma, I’m afraid. That’s because doctors deal with certain realities that simply make glib and candid conversations inappropriate.

Here are priorities that sometimes make doctors seem deaf to your concerns:

Confidentiality is a value. It’s not only a law; this isn’t just about HIPAA. It’s about earning and maintaining the trust of our patients. After all, without trust there is no therapeutic alliance between healer and patient, and there won’t be much success with medical treatment.
Patient advocacy is a basic role. Every doctor first looks out for their patient. After all, that’s what you want when you see your own doctor.
Doctors know their duty, but only THEIR duty. They tend to avoid areas they don’t understand.

So, how can employers help doctors understand the complex circumstances of Worker’s Comp cases, outside of the tidy four walls of doctors’ offices? The Occ Doc in a Box wants you to help doctors “think outside the box” using these Eight Ways. And, these strategies respect the issues listed above, so doctors will listen to what you have to say.

1) Let your employees do the talking for you. Doctors will always listen more to what their patients say than to what employers tell them. So, educate and motivate your employees! Then they will TALK THE TALK FOR YOU, saying things like these to their doctors:

“We always have light duty. I’m sure they will find something safe for me, if you’ll write what I’m able to do.”
“When do you think I will be able to do my usual job? My company wants me to get back to it as soon as you think I should. So do I.”
“If you don’t think I need a prescription, don’t write one. They can give me Tylenol or ibuprofen, and we have ice bags at work, if you think that’s just as good.”

BUT your employees won’t TALK THE TALK unless they know YOU WILL WALK THE WALK. So, keep your promises, and consistently help all employees who have injuries.

If this seems like a “pipe dream” to you, then at least require your employee to give the doctor a short page of your talking points, like those three above. Then the doctor will see these at the same time as they are seeing your employee.

2) Have someone attend Worker’s Comp appointments. Either a professional case management nurse, or your company nurse, worker comp/safety professional, area manager, or supervisor should meet the employee in the waiting room.

Tell the receptionist you want to meet the doctor, in the presence of the employee/patient, after the exam.
Write that on the back of your business card; ask the receptionist to hand it to the doctor before they see the patient, then take a seat. DON’T EXPECT TO BE IN THE EXAM ROOM DURING THE EXAMINATION.
Once you are brought to the room, your role will be to provide information about the work environment, job duties and on-site resources.
-- Ask to see the Return to Work form right away, and decide if it is likely the restrictions can be accommodated.
-- If you spot a restriction that would be impossible to accommodate, it is fine to ask the doctor “Is that item a medical necessity? Or could we do this instead . . .?” Then, accept their decision.

The process I’ve outlined above should be done only after your employee has signed an authorization for you to speak with their doctor. Ask your Worker’s Comp insurer to provide you with a HIPAA-compliant form to have ready when the need arises.

3) Inform the physician promptly of the status of the case (disputed versus conceded). Present the doctor with the facts about the incident, but don’t drag them into arguments about “what really happened.” The physician won’t be able to resolve such issues anyway; you must. Particularly, deal with “hearsay” yourself. Simply make the physician aware of case status. If the case is disputed, the physician can decide if the timing of tests and surgery is elective, and postpone such until the dispute is resolved. Urgent tests and surgery will be scheduled regardless, but the patient will be helped to make certain that the requirements of their private health plan are met, so back-up insurance is available.

4) Provide a good incident description. If there was an accident that started the problem, then the physician will need to decide if there is a direct cause-and-effect relationship between the injury the patient has and the mechanism of the accident. If able, attach digital photos to your report, which are truly “worth a thousand words."

Stay tuned for the remaining four tips in the next blog post!

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10 Ways Employers Can Help Injured Employees Avoid Obstacles to Recovery

2009-07-10T08:21:00.006-05:00

1) Listen to employees when they have bodily complaints that they think are important. Don't brush them off.

2) Reassure employees that their aches and pains are legitimate, without always requiring them to first be “legitimized” by a doctor.

3) Give employees structured options for expressing frustrations, safety concerns, interpersonal differences, anxieties etc. BESIDES filing a Worker Comp claim! Examples – safety committee, EAP, grievance mechanism.

4) Place workers in appropriate jobs, not into those in which they are destined to fail (example – demoting a senior employee to a heavy, entry level job they haven’t done since they were young).

5) After each Worker Comp appointment, ask the employee how their doctor or therapy visit went. Were they satisfied? Was a thorough evaluation done? Was the employee told what to expect about how things would go? Are next steps clear? If not, help the employee find out who to call to fix these things.

6) When your injured employee describes their treatment plan to you, have the following checklist in mind. If any of these areas seem neglected, partner with your Worker Comp insurer to solve the problem.

Is the treatment plan as brief and straightforward as reasonable?
Are needed tests or treatments being done in a timely manner? Are unnecessary delays solved or avoided?
Is a single doctor in charge? Or is it confusing which doctor is the captain of the ship?
Has the employee been told what to expect? Have they been coached on how long it takes most people to recover from this type of injury or surgery? Do they understand what results are expected from their treatment, and when?
Are they allowed to remain close to their working life? Are appropriate accommodations being made so they can stay at work, and as close to their home department as able?
Have they received understandable medical information about their injury? Do they know what the problem is? Have they been directed to appropriate information resources, like web sites, books, and/or health educators?

7) Provide alternate work right away to accommodate their restrictions, then be ready to begin a transition toward regular duty once it has been ok’ed.

8) Keep the employee involved with the company as time passes in the course of their treatment. They should remain active in all dimensions of worklife that they can still do, including social. They must remain a welcomed member of the team, and not an outcast. “Absence makes the case grow longer . . .”

9) Reward the employee for each step they make toward full recovery, publically acknowledge their effort, reassure them that a safe workplace will be provided, ensure any safety issues that lead to a work injury in the first place are now corrected.

10) Create a Culture of Care in which co-workers support the injured employee as they return to work. It’s good corporate citizenship, and it benefits everyone!

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My Favorite OSHA Record-Keeping Rule: It Should Be Yours, Too!

2009-07-01T08:32:00.003-05:00

Suppose an employee named Joe comes to Human Resources and tells you, "This new job is making my back sore. I can keep doing it, but I just don't want my back to get worse." Good point you think; you don't want that either. So you ask Joe to see me.

After a careful examination, suppose I find Joe has just a minor back problem, which doesn’t require a prescription, physical therapy, or anything like that. But I don't want Joe’s problem to get worse either. What should I do? Should I restrict Joe’s activity, hoping that will help?

Of course, I’ll write restrictions whenever necessary, such as when a condition limits the patient’s capacity to work. Or, if an injury is unstable and would be worsened by unrestricted work, then I’ll assign restrictions 24/7. But in Joe’s case, his problem is minor and he is still capable of doing his job. Restrictions seem like overkill, and aren’t a “root cause” solution either. But do I have any other choice, if I want to prevent future trouble?

Suppose while I’m pondering what to do, Joe hands me a letter you sent along, and I read: “Dear Doctor: please keep in mind that, if you find only a minor musculoskeletal discomfort, and you find that our employee is fully able to perform all routine job functions, we will work with him to modify his tasks as needed to prevent a more serious condition from developing. For example, we may temporarily limit duties or make temporary re-assignment, and may develop a work hardening schedule, while solving any ergonomic problems that may have led to the problem. None of this will require you to restrict our employee’s activity.”

Brilliant! I can reassure Joe that I think his back is OK, and that you’ll help it stay that way. And I can do that without “blindly” imposing limitations when I don’t think they are really necessary. Taking you on your word, I allow him to return to full duty, and to see me again “as needed.”

So, what would motivate you to take such a wise approach? There are many good reasons; your desire to help employees, to have a safer work environment, to prevent problems before they start, and to do the right thing. But here’s another. In this case, doing the right thing for Joe did a good thing for you too: YOU AVOIDED AN OSHA RECORDABLE INJURY. If I had been given no choice but to write restrictions, this case would have become OSHA recordable. But since you presented a better option, the case I described above, at least so far, was NOT OSHA RECORDABLE.

This is made possible by my FAVORITE part of the OSHA 29 CFR Part 1904 “Recording and Reporting of Occupational Injuries and Illnesses” standard. Buried within its thousands of paragraphs, there is a LITTLE KNOWN and UNDERUTILIZED provision which employers can and should apply in cases like the one I’ve described. I wish it were used more often, because it works to the benefit of EVERYONE.

As always, there is a right way and a wrong way to do anything. Here, it may be the right thing to do but only when it’s done EXACTLY right. To fully understand, read this explanation OSHA provides in the FAQ section of its Recordkeeping Policies and Procedures Manual (CPL 02-00-135):

Question 7-19. Does the employer have to record a work-related injury and illness if an employee experiences minor musculoskeletal discomfort, the health care professional determines that the employee is fully able to perform all of his or her routine job functions, but the employer assigns a work restriction to the injured employee?

Answer: As set out in Chapter 2, I., F. of the Recordkeeping Policies and Procedures Manual (CPL 2-00.135) a case would not be recorded under section 1904.7(b)(4) if (1) the employee experiences minor musculoskeletal discomfort, and (2) a health care professional determines that the employee is fully able to perform all of his or her routine job functions, and (3) the employer assigns a work restriction to that employee for the purpose of preventing a more serious condition from developing. If a case is or becomes recordable under any other general recording criteria contained in section 1904.7, such as medical treatment beyond first aid, a case involving minor musculoskeletal discomfort would be recordable.

As you can see, this ONLY applies if the problem is minor. And, it ONLY applies to musculoskeletal discomforts, not to lacerations or head injuries for example. And, a health care professional (not just the plant manager for example) must decide that the individual is still capable of full duty work. And, there must be no other factor which makes it otherwise recordable, such as the presence of a fracture or the need for a prescription, for example. THEN AND ONLY THEN can employers avoid recordability by taking it upon themselves to modify the work assignment appropriately for the sake of prevention, even though the health care provider hasn’t required it.

I believe OSHA is wise to allow this because it helps employees. In situations like this, the root cause of the problem is a mismatch between the employee’s musculoskeletal condition and the demands of the job. Artificially limiting the employee’s activity by ordering medical restrictions would be a one-sided solution. A more balanced approach is encouraged by this OSHA provision, in which attention is directed to the job itself, to the benefit of the employee. And, why limit what the employee is allowed to do, at work and when away from work, when their minor discomfort can be resolved by job modification? I always remind employees that MY restrictions need to be followed all day, every day. But modifications you make to the jobs at your workplace apply only there. Better to change the work than change the worker!

I also believe this is one of OSHA’s wiser provisions because it helps employers to do the right thing. For one, an employer can encourage early reporting of discomfort without worrying this will inflate the number of recordable cases. In fact, early reporting can result in FEWER recordable cases, if preventive action is taken early. And, this OSHA provision supports employers who use work hardening programs for new hires, for employees returning to work after prolonged absences, and for employees newly assigned to certain tasks. Think of how common that last scenario is in this economy, in which layoffs result in veteran employees returning to entry-level jobs. Such employees who develop minor musculoskeletal discomfort while on work hardening can, after proper health care provider assessment and agreement, be temporarily re-assigned, then re-introduced to the task using a more gradual schedule, without incurring a new case on the OSHA 300 log.

Employers have to be very, very careful when dealing with issues of OSHA recordability. Record keeping rules can’t be “gamed.” After all, the OSHA 300 log is the main data source for workplace safety in our country. Major fines can be levied upon employers who are out of compliance. Still, there are many legitimate reasons an employer may want to avoid unnecessarily recording an incident. And, the case above illustrates this little known and often over-looked option which accomplishes that.

That’s why Occ Doc in a Box recommends you study this part of the OSHA Record Keeping Standard. It may become your favorite part, too!

********************

Below are excerpts from two other OSHA references to this provision, and hyperlinks that take you to the source documents

http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=DIRECTIVES&p_id=3205#chapter2

Record Type: Instruction
• Directive Number: CPL 02-00-135
• Title: Recordkeeping Policies and Procedures Manual
• Information Date: 12/30/2004
• Standard Number: 1904; 1913.10

Chapter 2.
ENFORCEMENT POLICIES AND PROCEDURES
I –F
Restricted Work. An employee's work is considered restricted when, as a result of a work-related injury or illness, (A) the employer keeps the employee from performing one or more of the routine functions of his or her job (job functions that the employee regularly performs at least once per week), or from working the full workday that he or she would otherwise have been scheduled to work, or (B) a physician or other licensed health care professional recommends that the employee not perform one or more of the routine functions of his or her job, or not work the full workday that he or she would otherwise have been scheduled to worked. The new rule continues the policy established under the old rule that a case is not recordable under section 1904.7(b)(4) as a restricted work case if the employee experiences minor musculoskeletal discomfort, a health care professional determines that the employee is fully able to perform all of his or her routine job functions, and the employer assigns a work restriction to that employee for the purpose of preventing a more serious condition from developing

http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=FEDERAL_REGISTER&p_id=16960

Settlement Agreement: Occupational Injury and Illness Recording and Reporting - 66:66943-66944

Federal Registers - Table of Contents

• Publication Date: 12/27/2001
• Publication Type: Notice
• Fed Register #: 66:66943-66944
• Standard Number: 1904
• Title: Settlement Agreement: Occupational Injury and Illness Recording and Reporting

DEPARTMENT OF LABOR
Occupational Safety and Health Administration
Settlement Agreement: Occupational Injury and Illness Recording and Reporting

AGENCY: Occupational Safety and Health Administration (OSHA), Department of Labor.
ACTION: Notice of settlement agreement.
SUMMARY: The Occupational Safety and Health Administration (OSHA) has entered into a settlement agreement with the National Association of Manufacturers (NAM) to resolve NAM's legal challenge to OSHA's revised regulations in 29 CFR part 1904, Recording and Reporting Occupational Injuries and Illnesses. As part of the agreement, OSHA agreed to publish a copy of the OSHA-NAM settlement agreement in the Federal Register within 30 days.
DATES: The settlement agreement was completed on November 16, 2001.
C. A case is not recordable under 1904.7(b)(4) as a restricted work case if the employee experiences minor musculoskeletal discomfort, a health care professional determines that the employee is fully able to perform all of his or her routine job functions, and the employer assigns a work restriction to that employee for the purpose of preventing a more serious condition from developing.

The Not-So-Lazy Days of Summer

2009-06-19T10:47:00.006-05:00

Remember when summer vacation meant you got to sleep late? No longer the case, I’ll bet! More likely, you NEVER get to sleep late, and probably don’t get to bed when you should either. As you know, we are a sleep-deprived nation!

Everybody who works shifts, or who employ shift workers, knows this. Now add this to your knowledge of the subject:
(Source: Tepas DI, “Sleep Patterns of Shift Workers,” Occupational Medicine – State of the Art Reviews, Vol 5 no. 2)

As you can see, PM shifts (that is, working from afternoon into evening) are associated with the most sleep. That’s true whether worked as a permanent shift or while part of a rotation. And night shifts are the worst, as we all know. Besides the fact night shift workers average the least sleep, you can also see from the above table that they must “make up” lost sleep more than other workers, on days away from work.

But, it appears they don’t make up the sleep deficit very well. Permanent night shift workers average only 20 minutes more sleep on days off than do day and PM workers, even though night shift workers average about an hour less sleep on work days. Remember, deficits accumulate: if you need 8 hours but only average 7, then by the end of the week you are an entire night short on sleep!

Employers who are savvy to this do what they can to encourage employees to come to work well-rested. Here are a few tips your schedulers should know:

The time off between the end of one shift and the beginning of the next one should be at least 11 hours. Remember that rule even when scheduling early morning meetings!

Limit eight-hour shifts to a maximum of seven in a row, and 12-hour shifts to four or five in a row.

Those tips come from CIRCADIAN, a fatigue-risk management system. Please see these links for more of their advice. And get to bed on time tonight! http://ohsonline.com/articles/2009/06/08/workers-need-11-hours-off-between-shifts.aspx

http://ohsonline.com/Articles/2009/06/08/Workers-Need-11-Hours-Off-Between-Shifts.aspx?p=1

It's Hot in This Box

2009-06-10T16:34:00.004-05:00

Finally, summer seems to be coming. This afternoon, your “Occ Doc in a Box” is blogging with an electric fan running!

Actually, it’s not that hot. I’m just not used to it. Ironically, that’s what makes workers in the upper Midwest particularly vulnerable to heat-related illnesses, like heat cramps, heat exhaustion and heat stroke. This includes your employees!

People like us who aren’t acclimated to heat through the year are more prone to problems when summer finally comes. Heat-related illness happens in hot places where you’d expect. California, Florida, and North Carolina accounted for 57 percent of all heat stroke deaths, with North Carolina having the highest annualized rate, among agricultural workers. But Wisconsin gets hot and humid fast and its sudden heat waves are especially dangerous. A single heat wave in July of 1999 caused a total of 21 deaths in Wisconsin.

In a few weeks though, I’ll become acclimated. “Acclimatization" means temporary adaptation of the body to work in the heat that occurs gradually when a person is exposed to it. Acclimatization peaks in most people within four to fourteen days of regular work for at least two hours per day in the heat. Until then, I’ll play it safe, and so should you and your employees.

While sipping ice water and loosening my tie, I found this absolutely fabulous Web site from CalOSHA that provides a fantastic electronic toolkit to help you and your employees prevent heat-related illness. This eTool is easy to use and “has it all.” Check it out now before your workplace starts to swelter!
http://www.dir.ca.gov/dosh/etools/08-006/index.htm

Improve Safety Motivation and Compliance

2009-06-04T09:53:00.003-05:00

Help employees be safe so no one's sorry!
(Continued from last week)
Target audience: Employers

How can you improve safety motivation and compliance among employees with special psychological needs?
Make use of the tools available to you.

Employee Assistance Program. Make a formal referral to the EAP if you suspect safety may be compromised by emotional issues, stressful life situations or poor adaptation to stress.

Drug and alcohol policy. Make sure employees and supervisors are fully aware of the program, its importance in accident prevention, and how to apply it in “reasonable suspicion” cases BEFORE and accident happens.

Talk to your staff. Find opportunities to speak with unsafe employees about “unmet hierarchical needs” – for example, are they protesting bad conditions, or demoralized by a bad environment?

Medical fitness for duty exam. When an employee’s unsafe behavior seems to have a medical cause, refer to an Occupational Medicine specialist for an exam. You will receive information limited to what you “need to know” to accommodate their needs. They will receive information and guidance about how their medical status affects their job safety. Sometimes this leads to the discovery of health conditions they didn’t know they had, or had neglected. Things I’ve found include “Wrong Job Syndrome,” unreported angina, undiagnosed dementia, concealed gambling addiction, mislabeled arthritis, hidden psychiatric illness (depression, bipolar depression, personality disorder).

A Better Safety Climate

2009-05-27T15:11:00.002-05:00

Help employees be safe so no one's sorry!

(Continued from last week)

Target audience: Employers

3. Construct a Better Safety Climate
Before we can begin discussing how to construct a better safety climate, let’s get some definitions straight:

Reactive Supervisor – One who only responds to accidents and near-misses. Their focus is on the severity of the hazard (how bad things were or could have been), rather than risk it will happen again. Focus is more on “things” than people.

Unsafe employee – One who fails to recognize hazards and hazardous actions and understand the consequences; tends to focus on the belief that an accident is “not that likely to happen.”

Proactive Supervisor – One who also controls risks by changing “things” and people and processes to prevent accidents. For example, one focus is on follow-up to training programs to assess if employees are actually carrying out safe work practices. If not, why? Do the environment and/or process need improvement?

Safe employee – One who recognizes hazards and hazardous behaviors in advance, and responds to possibility of an accident. Like the boss, they are proactive.

Vrendenburgh AF “Organizational Safety: Which management practices are most effective in reducing employee injury rates?” Journal of Safety Research 33 (2002) 259-276

To construct a better safety climate, keep these points in mind:

Supervisors need to model preventive behaviors.
Proactive supervisors lead to safe (proactive) employees provided managers give clear, internally consistent (e.g. safety over speed) and easily understood messages or “safety scripts.” Reactive supervisors lead to unsafe employees. (So do supervisors who are proactive but unclear!)

Zohar D, “Climate as a social-cognitive construction of supervisory safety practices: Scripts as a proxy of behavior patterns”, Journal of Applied Psychology 2004 vol 89 no 2, 322-333

Management needs to create and support integrated work teams.
In some workplaces, social interaction at work has been shown to be the strongest predictor of who will be injured. Remarkably, how well someone gets along with coworkers may be the most important safety behavior. It can matter more than personal fitness, size or strength. “Loners” or “outsiders” are often the employees at most risk. They need integration into your work team.

For example, a Tampa VA Hospital study showed poor social relationships among staff nurses were the strongest predictor of who would be injured, and the length of their injury disability. One illustration was that these social “outsiders” were less likely to find help when needed to lift a difficult patient. This was a prospective study, in which participants were followed for several years, to see who would report a work injury. Personal attributes were not predictive, like strength, age, size.

Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement, Patient Safety Center of Inquiry, Tampa FL, Veterans Health Administration and Department of Defense, Oct. 2001, p. 11

Another example involved a 1988 Boeing Aerospace study in which employees most likely to report injury were those who indicated a poor relationship with their supervisor. Personal attributes were not predictive. This was also a prospective study.

Bigos et al, “A prospective study of work perceptions and psychosocial factors affecting the report of back injury,” Spine 16:1-6, 1991.

Human Resources should include safety history when interviewing candidates.
A Vredenburgh study showed certain front-end hiring and promotion practices predicted lower future injury rates. These included examining an individual’s safety record in their previous position, seeking information about safety performance in prior jobs, and hiring based on the applicant’s safety consciousness. When information wasn’t available, HR departments that asked questions like these achieved lower injury rates: “Please describe the types of accidents or near misses you have had in your current or previous jobs; Please provide an example of when you had to call a co-worker’s attention to a possible violation of a safety regulation?”

What doesn’t work? Unfortunately, a number of things, including training alone, like body mechanics with no assistive devices, and selection based on biometrics (height, weight, BMI), age, and sometimes even physical fitness (employees who are more fit are expected by coworkers to do more work, which increases risk).

Check back next week to learn how you can improve safety motivation and compliance among employees with special psychological needs!

Hierarchy of Needs Effect

2009-05-19T10:09:00.002-05:00

Help employees be safe so no one's sorry!

(Continued from last week)

Target audience: Employers

2. Take Advantage of Hierarchy of Needs Effect (Abraham Maslow): Once basic needs are met, people strive to meet higher needs. But, they won’t move on to higher needs unless the basics are satisfied first. In order, these needs are first Physiological, then Security, then Social, then Ego, and last, Self-Actualization.

Employees who are striving to meet their highest needs (achievement, importance, excellence, recognition) perform the best and are the best “safety stewards.” But first, they must satisfy lower level (e.g. pay, bodily comfort) and middle level needs (safe environment, group membership, belonging, and team spirit).

I’ve seen several examples of this in action.

Safety committee operations – If the workplace meets basic physiological needs (fair pay, adequate temperature and housekeeping, reasonable breaks, control of obvious environmental hazards), then employees are interested in the social and team efforts of participating in safety improvements. Committees are then effective. Otherwise they aren’t.

First aid training – A high level of interest is indicated by employees in safe and reasonably comfortable workplaces, because it appeals to their team spirit and citizenship. That satisfies Maslow’s Higher Level Needs. But, these are unappealing in inherently unsafe environments, where basic needs are unmet. The same is true of blood donation drives.

On-site exercise facility – Employees who want to “better themselves” are attracted to these, but only if basic needs are first met. Workers in unsafe, back-breaking jobs won’t use an employer-provided exercise facility for that reason.

Check back next week for information on how to construct a better safety climate.

The Hawthorne Effect - An Illustration

2009-05-13T10:13:00.006-05:00

(Continued from last week)
Target audience: Employers

Last week, we explained the Hawthorne Effect and its benefits to employee productivity and safety. Here is an example of the Hawthorne Effect in action, and the positive impact it had on employees and the organization’s bottom line.

Example: I participated in a hospital lift-reduction program. In addition to ergonomic improvements in the patient handling process, Hawthorne principles were included in the pilot project done on a selected inpatient unit. For example, employees were involved in several activities, including:

A needs assessment was conducted by the safety committee, involving managers and staff.
The hospital conducted a workplace walk-through, which was visible to staff.
Employees engaged in study meetings with the insurer to explore best practices and to review available tools that could assess patient lifting needs and algorithms that align with various needs.
Large group brainstorming meetings were held with staff. Certain assessment tools, algorithms, and lifting equipment were selected by vote.
Capital equipment purchase of lifting equipment was done, with vendor in-services for all staff.
Assessment tools and algorithms were presented at an employee education day.
Multiple employee observation studies were done by committee members, looking at feasibility of the process, and employee compliance.
Employee satisfaction surveys were also done along the way. These showed good acceptance.

Outcomes: The pilot resulted in a reduction of $175,550 in Worker Comp costs in 12 months.

Help employees be safe so no one's sorry!

2009-05-06T16:34:00.003-05:00

A physician's perspective on simple psychology to help people work safer.

Target audience: Employers

Those of you in HR and Safety have an advantage over me. That is, you get to work with people before they get hurt. I see them in the clinic after they’ve been injured. By then, the stress of having an injury and being in a Worker Comp situation can make their psychological and social situation complicated!

But, we all can understand that the psychology of preventing injuries has to do with familiar aspects of human nature. Here are some management psychology methods I’ve seen which make sense to me. Try them out if you haven’t already. Then perhaps fewer of your employees will have to meet me in the clinic, after an injury!

1. Take advantage of The Hawthorne Effect*: Individual behaviors improve when the subjects know they are being observed.
The Hawthorne Effect is named for research done by Dr. Elton Mayo (Harvard Business School Psychologist) in a 1924-32 study at Hawthorne Illinois Plant of Western Electric. While studying productivity and efficiency, he made a variety of changes, one at a time, in the working conditions of a group of female electrical assemblers. To his surprise, regardless of what it was he manipulated, worker production seemed to continually improve.

He discovered a simple reason for this: the workers were happy to receive attention from the researchers who expressed an interest in them. When these women were singled out from the rest of the factory workers, it raised their self-esteem. When they were allowed to have a friendly relationship with their supervisor, they felt happier at work. When he discussed changes in advance with them, and allowed them a form of participation, they felt like part of the research team. Elton Mayo had secured the group’s cooperation and loyalty. This explains why productivity rose even when the changes he made seemed negative. For example, it rose even after he took away their rest breaks!

When people spend a large portion of their time at work, they want a sense of belonging, of being part of something bigger than themselves. When they get it, they are more effective.

This effect has been described as the reward you reap when you pay attention to people. The mere act of showing people that you're concerned about them usually spurs them to better job performance.

Moral: Include the Hawthorne Effect in any efforts to improve employee performance, both in production and in safety behavior. When they know that 'somebody upstairs cares,’ (and that somebody upstairs is watching!) employees change behaviors for the better!

* Modified from document by Envision Software, Incorporated Tampa, Florida

Check back next week for an example of the Hawthorne Effect in action!

Conclusion to Smoke-Free Workplace Policies

2009-04-29T10:53:00.003-05:00

(Continued from last week)

February, 2008: A study from the city of Rome, Italy, reported that smoke-free workplace laws there were immediately followed by reductions of heart attack rates greater than 10 percent, both in smokers and non-smokers. This followed an earlier report from the northern Italian Piedmont region showing this and other public health improvements after a national workplace smoking ban.

(Cesaroni G, Forastiere F, “Effect of the Italian Smoking Ban on Population Rates of Acute Coronary Events,” Circulation. 2008;117:1183-1188. Barone-Adesi F, Vizzini L, “Short-term effects of Italian smoking regulation on rates of hospital admission for acute myocardial infarction.” Eur Heart J 2006;20:2468--72.)

January 2, 2009: In a follow-up study from Pueblo, Colorado, researchers found that the heart attack reduction improved to 41 percent over the first three years of the ban. Heart attack rates still hadn’t changed in other Colorado cities that didn’t have workplace smoking bans.

(Bartecchi C, Alsever RN, Nevin-Woods C, “ Reduced Hospitalizations for Acute Myocardial Infarction After Implementation of a Smoke-Free Ordinance --- City of Pueblo, Colorado, 2002—2006” MMWR January 2, 2009 / 57(51);1373-1377)

Today: We will all live and work in better health if we can breathe clean air!

More Proven Smoke-Free Workplace Policies

2009-04-22T12:45:00.002-05:00

(Continued from last week...)

September, 2007: The nation of Scotland reported a 17 percent drop in heart attacks, which began immediately after the country enacted a full workplace smoking ban. This reduction occurred both in people who smoked and people who didn’t.

(Haw SJ, Gruer L. Changes in exposure of adult non-smokers to secondhand smoke after implementation of smoke-free legislation in Scotland: national cross sectional survey. BMJ 2007;335:549--52.)

October, 2007: The nation of Ireland experienced a 14 percent drop in heart attack admissions in the year following its smoke-free workplace law. This reduction occurred both in people who smoked and those who didn’t.

(Edmund Cronin MD, European Society of Cardiology 2007 meeting in Vienna)

Check back next week for the conclusion to this series - proof that smoke-free work environments save lives!

More Proven Smoke-Free Workplace Policies

2009-04-15T09:47:00.002-05:00

(Continued from last week...)

September, 2006: Heart attack rates dropped 27 percent in Pueblo, Colorado, during the first 18 months after the city enacted a full workplace smoking ban. This reduction occurred both in people who smoked and people who didn’t. No such reduction occurred in comparison cities in Colorado that didn’t have a ban.
(Bartecchi C, Alsever RN, Nevin-Woods C, et al. Reduction in the incidence of acute myocardial infarction associated with a citywide smoking ordinance. Circulation 2006;114:1490—6)

July, 2007: Bowling Green, Ohio, which enacted smoke-free laws in 2002, experienced public health improvements that began immediately and were more obvious as time passed. The largest improvement was in heart attack hospitalizations, where rates were decreased significantly by 39 percent after one year and by 47 percent after three years following the implementation of the ordinance.
(Khuder SA, Milz S, “The impact of a smoking ban on hospital admissions for coronary heart disease” Preventive Medicine Journal, 2007 Jul;45(1):3-8.)\

Check back next week for more proof that smoke-free work environments save lives!

Newsflash: Lives are saved by smoke-free workplace policies!

2009-04-08T14:49:00.002-05:00

For about 8 years, I’ve worked to help people avoid second-hand smoke in their jobs. Although hardly anyone disagrees with the fact that second-hand smoke is a workplace health risk, it seems a lot of people don’t agree with me that every worker deserves protection. By every worker, I include those in the hospitality, beverage, food, and bowling industries, for example. There’s the rub! Still, enough people agree about this that many places now have laws providing this protection.

But in the past, those who disagreed with these workplace health policies raised a challenge that I thought was valid. It went like this: “Granted, tobacco smoke is bad. But you have no proof that it helps anyone to enact laws banning it from indoor workplaces.”

Notice, I said this was a challenge that I “thought” was valid. Today I’m happy to report this challenge is no longer a valid complaint! There is now proof that lives are saved immediately once smoke-free workplace laws take effect. The evidence has been steadily mounting the past few years. Let’s see how the story has unfolded in terms of just one of the many benefits of smoke-free laws, namely heart attack prevention:

April, 2003: Heart attack rates dropped 40% in Helena, Montana, during the six months the city had a full workplace smoking ban. This reduction occurred both among people who smoked and people who didn’t. When the city’s ban was replaced by a state-wide law that allowed smoking in designated areas, the improvement in heart attack rates disappeared! Heart attack rates returned to pre-ban levels!

(Sargent RP, Shepard RM, and Glantz SA, “Reduced incidence of admissions for myocardial infarction associated with public smoking ban: before and after study,” British Medical Journal 2004; 328:977-980).

Check back next week for more proof that a smoke-free workplace saves lives!

Top 10 Health Investment Tips of Time and Money: Tips #9 and 10

2009-04-01T12:09:00.004-05:00

Health Tips to Survive the Economic Recession: Top Ten Ways to Stay Healthy and Get Wealthy By Being Wise! (Final two tips, continued from last week...)

9) Prevent accidents at home and at play.

Home accidents are common, can be tragic, and cost money. Spend your money on home safety instead. Falls are the most serious type of home accident. Prevent them by throwing away that old and rickety ladder. Replace it with a new one that is safe and solid. It will cost less than the co-pay from an emergency room visit for a broken arm! Put up secure handrails in stairways and use them. Fix broken steps. Use a night light. Don’t tolerate throw rugs that may slip and slide. Promptly salt or sand your slippery, icy steps this winter. And, Christmas lights that you can hang while both your feet are on the ground are just as festive as the ones your crazy neighbor puts on his rooftop!

And, you must play it safe! Use a bike helmet, and make sure your kids do, too. Be a safe boater, jet skier, water skier, snow boarder, down hill skier – whatever your pastime is. If you hunt, do it from the ground. If you insist on climbing a tree, get a good deer stand; spend money if you have to! Use it correctly and stay clipped to the safety line. Deer hunters are hurt far more often by faulty tree stands than by firearms. But, that gun you’re carrying can obviously devastate a fellow hunter. Whenever you have your hands on a gun this deer season, you are obligated to be wide awake, stone-cold sober and thinking of safety first.

10) Get your recommended health screenings.

Don’t miss the preventive screenings that are recommended for your age and gender. Men need to begin annual prostate cancer screening with an exam and blood test (PSA) by their doctor by age 50 (45 for African-Americans and for those with a family history). Women need to start annual mammography at age 40. And, everyone by age 50 needs colorectal cancer screening (colonoscopy, or sigmoidoscopy/barium enema plus fecal occult blood testing).

A word about colonoscopy: it can prevent, not just detect, colon cancer. It can find and remove pre-cancerous polyps. Once removed, a polyp has no chance of becoming a cancer. An ounce of prevention is worth a pound of cure, and it costs a whole lot less!

Top 10 Health Investment Tips of Time and Money: Tips #7 and 8

2009-03-25T11:33:00.002-05:00

Health Tips to Survive the Economic Recession: Top Ten Ways to Stay Healthy and Get Wealthy By Being Wise! (continued from last week...)

7) Limit your soft drink (including diet soda) intake.

What’s the single unhealthiest thing in the average American diet? Without a doubt, it’s soda. Sweetened sodas contain high fructose corn syrup, which is clearly linked to an increased risk of diabetes. It is an unnatural sugar, which stimulates a prolonged insulin response by the body. Over time, this “dulls” the body’s ability to respond normally to its own insulin. Then a condition called “insulin resistance” begins. This leads to another set of problems called “metabolic syndrome.” This is a pre-diabetic condition which also increases the risk of heart disease and stroke. Studies have shown that people who average just ONE can of soda a day have an almost 50 percent greater chance of developing metabolic syndrome than people who average less than one soda a day. Considering that a 12 oz. can of sweetened soda has the equivalent of almost 10 teaspoons of sugar, this shouldn’t be a surprise. But how’s this for a surprise? Even diet sodas increase the risk of metabolic syndrome! Apparently their artificial sweeteners “sharpen the sweet tooth” and make people eat more sweets. So, drink less soda – a LOT less. It should be only an occasional treat or reward, like dessert.

In the long run, the healthiest beverage is also the drink that is free and available everywhere – good old H2O!

8) Talk to your physician about aspirin therapy.

Has your doctor advised you to take an aspirin, or a baby aspirin, every day to reduce your risk of heart attack or stroke? Then, you'd better take your aspirin! As simple as it sounds, aspirin is among the most effective preventive treatments known to science, for those people in need. If your doctor hasn’t advised you about this, then ask your doctor if you should take it, particularly if you’ve ever had a heart problem or stroke. But let your doctor decide. A doctor who knows you will know what’s best for you!

Top 10 Health Investment Tips of Time and Money: Tips #5 and 6

2009-03-18T10:53:00.004-05:00

Health Tips to Survive the Economic Recession: Top Ten Ways to Stay Healthy and Get Wealthy By Being Wise! (continued from last week...)

5) Drink responsibly and in moderation.

Question: What do you call it when a man consumes five servings of alcohol in a day, or a woman consumes four servings? Answer: a DRINKING BINGE.
To some people, that seems like a lot of alcohol. To others, it sounds like nothing! But it doesn’t matter how it “sounds” to you, what matters is what it really is. And, it really is a serious health risk! People who have drinking binges aren’t necessarily alcoholics. And an occasional binge is not the same as a “bender.” But regardless, it is a strain on your health! That amount of alcohol is enough to increase accident risks, both on that day AND the next. It is enough to increase blood pressure, cause heart rhythm irregularities, and stress the liver. The binge drinking definition (five or more drinks for a man, four or more for a woman) comes from research that shows this much alcohol is too much for the body to safely handle.

If you choose to drink, you must do so only moderately, generally not more than two drinks in a day. As many people know, moderate drinking can be healthy. But binge drinking is definitely dangerous. And most people don’t know that it’s only a fine line between healthy moderate drinking and dangerous binge drinking. That extra beer or two will cost you more than just what you pay the bartender.

6) Decrease your risk for diabetes.

How easy is it to get diabetes? Very easy! In fact, if for some reason you WANTED to get diabetes, you would be almost guaranteed to get it if you follow these “Four Easy Steps”:

• Have relatives with diabetes (most of us do)

• Get older (all of us do that!)

• Don’t get enough exercise (and who does?)

• Eat the ordinary American diet (too many calories and too much sugar).

So, what do you do if you DON’T want diabetes? You have to avoid the Four Easy Steps! Obviously, the first two are things you can’t do anything about. So, to avoid diabetes, you MUST change the only two things on the list that can be changed: DIET and EXERCISE. Eat fruits and vegetables every day. Exercise and be active. It’s what you do every day that matters. Take the stairs, walk around the parking lot, kick a soccer ball around the back yard with your kids, bike to work, dance, jog, and push your vacuum cleaner around to fast and jazzy music. Do whatever it takes! You don’t want diabetes!

Check back next week for more of the Top 10 Tips!

Top 10 Health Investment Tips of Time and Money: Tips #3 and 4

2009-03-11T10:02:00.000-05:00

Health Tips to Survive the Economic Recession: Top Ten Ways to Stay Healthy and Get Wealthy By Being Wise! (continued from last week...)

3) Take your medication as directed.

Prescription medicines can be expensive. But, the most costly prescription may be on one that you DON’T buy! That is the one your doctor prescribes, but which you fail to take! You MUST take your prescriptions exactly the way they are written, 100%! Not “usually” or “most of the time.” Not 50%, 75%, or even 90%. They need to be used 100% the way your doctor advised. If your doctor’s advice is unclear, ask questions and don’t leave the office until you fully understand the answers. If you sense a problem later that worries you or that makes it hard to take them 100% correctly, talk to the pharmacist! It’s free! If the store window is too busy, ask for a time you can return, or a time the pharmacist can call you. But don’t stop or skip medicines! Your doctor prescribed them for a good reason. If you disagree with your doctor, get a second or a third opinion. Find two doctors who agree, and choose the doctor you like best. Then follow that doctor’s orders, 100%!

4) Have a plan to handle emergent and non-life threatening medical needs.

It’s 3 a.m. Who do you want to take your call? If you or a family member is sick or injured, you need to decide what to do very quickly and in a stressful situation. If the situation seems dangerous to life or limb (chest pain, uncontrollable bleeding, stroke symptoms, seizure, etc.) then call 911. If it isn’t that kind of situation, call Affinity NurseDirect (1-800-362-9900). Sound simple? That’s what you need in a time like that, namely a simple plan of attack. Mistakes in those situations can be costly, either of money, or of health. Make the call, get advice, do it right the first time. Don’t guess.

Check back next week for more of the Top 10 Tips!

Health Tips to Survive the Economic Recession: Top Ten Ways to Stay Healthy and Get Wealthy By Being Wise!

2009-03-04T11:50:00.000-06:00

Becoming ill has become very, very, expensive these days. So, staying well is more important than ever. Being healthy has always been important. But now, you must keep your body and mind healthy if you want your finances to be healthy, too.

But, like many things, it’s easy to be penny wise and dollar foolish. If you try to save your money by spending nothing on maintaining your health, you will lose your health and your money too. Staying healthy requires an investment of a little of your time and a little wisely-spent money. This will pay you BIG returns. It can be the wisest investment you can make!

Here are Dr. Harrison’s “TOP 10 HEALTH INVESTMENT TIPS OF TIME AND MONEY”:

1) Learn how to access your company’s Employee Assistance Program (EAP).

Learn how to access your company’s EAP. It costs you nothing. On the other hand, stress, depression, relationship problems, alcohol or other substance use problems can be very, very expensive. The mind and body are continuously connected. Mental health issues like these can lead to physical illness, and every type of physical illness is made worse by these mental health conditions. If you are in need, EAP is by far the most economical and accessible resource you could find.

2) If you use tobacco, quit.

If you use tobacco, you must quit. Even if it hasn’t made you sick yet, it costs a bundle to use tobacco, almost $2,000 a year for a pack-a-day smoker. Once it makes you sick (and it will) your treatment could cost tens if not hundreds of thousands of dollars. But trying to quit cold turkey, without help, rarely gets the job done. Only 3-5% of cold turkey attempts work. Nicotine addiction is simply too powerful, and it is far too deadly a problem, to not deal with in the most effective way possible.

Most employers offer tobacco cessation assistance; see if there is a program coming up at work. It may be free.

Learn what your health plan offers for cessation coverage, such as for medicines and programs, which are far more effective than trying to quit without help.

And, you can always use Call It Quits telephonic coaching (800-362-9900) or the Wisconsin Tobacco Quit Line (800-QUITNOW) free.

So, what’s stopping you from getting help to quit tobacco? Whatever the reason, compare it to this: lung cancer is almost always fatal (5 year survival rate less than 10%) and almost always preventable (90% of cases are due to smoking). Considering that every smoker has a 10-20% chance of getting this entirely fatal, entirely preventable, and entirely tragic disease, what’s stopping you from quitting right now?

Check back next week for more of the Top 10 Tips!

Need help with sore elbows? Follow the "palm up/elbow in" rule!

2009-02-25T14:36:00.000-06:00

Sore elbows are among the most common “aches and pains” of working-aged people. Of all the different types of elbow troubles, tennis elbow (lateral epicondylitis) is the most common. About one out of every 30 people will go to their doctor for help with this condition in their lifetime. Many more than that have the problem but find other ways to live with it.

Although Tennis Elbow can of course be caused by playing tennis, it more commonly develops simply as “a part of life.” This is because of an aging process that affects the tendon on the outside of the elbow, which anchors important muscles that are used with day-to-day gripping activities. This tendon is no different from those in other parts of the body, in that as it ages it loses some of its spring, flexibility and elasticity. As it grows stiffer, it develops small cracks on its surface. These cracks heal poorly, which causes elbow pain as the muscle and tendon are heavily used. Sometimes, the pain can start suddenly, such as with a work injury. More commonly, it simply comes over time. Then, it might be discovered at work, even if it was not caused by work.

Regardless of the cause of your sore elbows, the “palm up/elbow in” rule is wise advice. This rule tells you the proper position of your hands and elbows when lifting or carrying. What it means is, try NOT to lift or carry heavy items with the palms down and the elbows out. If you are lifting an object, it is always better for your elbows if you can slide your hand beneath it, and then scoop it so that your elbows are kept close to your body. Try to avoid lifting and carrying with an overhand grip, especially when the object is at arm’s length. It might be necessary to first get items in your work area positioned closer. You may need to step onto a ladder to keep items close, or slide them toward you before lifting. Sometimes this can’t be done, but when it is practical, working with the “palm up/elbow in” helps prevent and control sore elbows.

Like every other part of a working person’s body, the elbows feel better when the whole body is healthy. “Cardio” exercise improves circulation into the arms if done most days. On the other hand, circulation into the arms is hindered by smoking, which causes arteries to spasm and hardens them. Less circulation means slower healing of minor injuries that happen in the work day, and a greater chance of tennis elbow.

Warming and stretching the muscles, such as those of the forearms, helps prevent painful conditions, including elbow pain. Strengthening exercises help keep muscles well-matched to the requirements of work and leisure activities. Personal trainers and fitness coaches can help develop exercise programs that are balanced among cardio, stretching, and strengthening.

So, keep these ideas in mind to keep your elbows happy! Especially, whenever you have the choice, lift with your “palm up/elbow in,” not “palm down/elbow out.” It’s a handy tip!

Protect Your Skin on the Job

2009-02-18T14:52:00.000-06:00

Sometimes it takes a “thick skin” to work anywhere! How do you protect your skin from the following hazards?

Water – It may seem surprising to think of water as a skin hazard, but either too much OR too little water can affect your skin.
-- Some industrial jobs expose hands and feet to wet work. Soggy work boots or wet gloves cause the outer layer of the skin to become “water-logged.” If this happens repeatedly, this outer layer of the skin can actually dissolve. Then the skin loses its ability to hold moisture within its deeper layers. That affects the softness and flexibility of skin, making it stiff and swollen. And, because the outer layer is the skin’s main line of defense against chemicals, water-logged skin can be more easily penetrated by other chemicals and become irritated.
-- Frequent hand washing is required in many jobs. Excessive hot water and soap washes off the natural skin oils, making the skin dry out and become irritated. That causes dry, red, rough, “dish pan” hands.
-- This is particularly a problem for people with personal, pre-existing skin problems, like eczema and atopic dermatitis. Wet work is frequently not well tolerated by people with these conditions. That’s especially true in winter months, when the humidity of the air is reduced by heating furnaces. On the other hand, hot summer months with high humidity lead to impairment of the skin’s ability to sweat normally, and the development of a rash called “prickly heat.” This is a red, pin-point itchy rash especially under the arm pits and other skin folds.
-- Another way in which water can affect the skin is through live steam burns and hot water burns.

Alkalies (caustics) – Sodium hydroxide and potassium hydroxide are frequently used in cleaning pulp vats and pipelines that contain pulp slurries. While these do a good job cleaning your equipment, they can be highly dangerous to the skin. Caustics ruin the fat and oil (lipids) in the skin, damage skin proteins, and drive water out of skin tissues. This leads to chemical burns that often have a brown over-lying scab. Alkaline burns are more serious than acids burns. The alkalies penetrate more deeply and combine themselves with skin lipids and proteins, whereas acids tend to stay more external and wash off more easily. Calcium hydroxide, often added to cellulose pulp in paper mills, also has an alkaline characteristic and can cause burns of that type.

Acids – Sulfuric and hydrochloric (muriatic) acids are used also for line cleaning and deliming in paper mills. These are corrosive to the skin although they do not penetrate as deeply as the alkalies.

Chlorine – The most serious risk from chlorine is inhalation burn of the lungs. It is also very irritating to the eyes. However chlorine gas can also irritate the skin when it combines with surface moisture. Chlorine gas plus moisture on the skin results in hydrochloric acid which “bathes” the skin. However, if someone has developed skin burns from chlorine, the greater risk is that they may also have had an inhalation injury.

Biocides – Various substances are used as anti-slime, anti-bacterial, and anti-fungal agents. The type known as isothiazolines are particularly common as they prevent mold and decay in paper and calcium oxide/calcium carbonate slurries. In most (although not all) people, biocides of that type can cause a skin rash called contact dermatitis. This is from a hypersensitivity or allergic mechanism. It looks exactly like poison ivy with redness, blisters, skin peeling and weeping. If someone has become sensitized to the biocides, even a very small amount of re-exposure can cause the same reaction. A similar type of allergic contact dermatitis can occur with other chemicals including glues, bonding agents (bisphenol A, epichlorohydrin, epoxy resins and acrylic monomers). Paper products that are treated with ink drying agents (colophony rosin) can also cause allergic skin reactions. Likewise, some individuals have allergies to metals (nickel and chromium) which cause similar contact dermatitis. Hardened metal objects such as tools can, in sensitive individuals, cause a skin rash.

Oils – Machinery oils, if in frequent contact with the skin, can cause a type of acne from plugging of skin oil glands.

To protect your skin on the job, following accepted safety measures is the most important thing. Read MSDS and follow the manufacturer’s recommendations for personal protective equipment. Several different types of protective gloves are available, but it is important to choose a type that is recommended by the manufacturer for the product you will be handling. For example, latex gloves are easily penetrated and perforated by certain oils and solvents. Insure that the insides of gloves are clean. Cotton glove liners are very useful for this purpose. Putting your hand inside of a glove that has been contaminated can be as bad as no glove at all; therefore a clean glove with a clean liner is the best practice.

When your hands get dirty, wipe and wash them off immediately. However, when doing routine skin washing, don’t use water that is hotter than needed or more soap than is necessary. Excessive hot water and soap robs the outer layer of the skin of its natural oils, leaving it red and irritated. This is particularly a problem in the winter when humidity levels are lower. For the same reason, moisturize your hands after washing. Use a non-fragranced hand cream. In general, the thicker the cream, the better it will protect the hands. Thin, white, “vanishing creams” are more likely to sting if the skin is red or cracked. Ointments like petroleum jelly won’t.

If your skin comes in contact with hazardous chemicals, immediately rinse them off, and continue rinsing while someone else gets you the help you need.

If you think you’ve had a rash develop in the course of your work, be sure to report it promptly to your occupational health nurse.

Can the Soda; Soak Up Water Like a Sponge!

2009-02-11T10:28:00.000-06:00

You’ve probably seen reminders to drink plenty of water during hot summer months. Hard working (and hard playing) people need to avoid summertime dehydration. But you may wonder why not drink soda instead of water? What’s the difference? Both are wet!

It’s true that any drinkable fluid is better than no fluids at all. But, there are important reasons why water is the “preferred beverage.” Obviously, water has no sugar, no acid, and no calories. It is naturally what your body needs.

Soda, on the other hand, is very “unnatural.” All carbonated beverages are strongly acidic. This is bad news for your teeth and your bones. The acid is caused by the carbonation itself. And, acids are frequently added such as phosphoric and citric acids. Whereas pure water has a pH of 7.00 (neutral) common sodas have pH ranging from Root Beer’s 4.61 to Pepsi’s 2.49. By comparison, battery acid has a pH of 1.00. Sodas are very, very acidic. Sodas are the strongest acids that you will ever put in your mouth!

You can imagine what acids do to your teeth. Soda’s acidity attacks the enamel directly. And, sugar in sweetened sodas (and sports drinks) combines with bacteria in your mouth to form more acid. There are 16 teaspoons of sugar in a 20 ounce bottle of regular soda. That’s a LOT of sugar, and a lot of calories. That makes a LOT of acid. This causes an “acid attack” on your teeth. This is particularly bad if your habit is to sip soda through the day. Each sip starts an acid attack that lasts twenty minutes. These acid attacks weaken your tooth enamel and cause cavities, stains, and softened dental roots.

And, more bad news, current research shows that sodas can soften your bones, too! The National Institutes of Health reported 4/26/08 on research from the University of Connecticut Center for Osteoporosis. They found that drinking soda and carbonated beverages was associated with lower bone mass in children. Colas, which contain phosphoric acid, were particularly of concern. The body has to waste calcium when it has to counter balance increased levels of phosphoric acid in the blood stream. If there isn’t enough calcium in the diet, the body will take calcium from the bones to cushion the blood stream from the effects of too much phosphoric acid.

Sodas then are bad for the teeth and maybe bad for the bones. But wait; there’s even more bad news! Drinking at least one soda per day is associated with a significantly higher risk of developing metabolic syndrome. This is a condition associated with obesity, and increased risk of diabetes, heart disease and stroke.

Metabolic syndrome is defined by the presence of three or more of the following factors:

waistline of 35” or more for women and 40” or more for men
fasting blood sugar of 100 or higher or a known diagnosis of diabetes
blood pressure 135 over 75 or higher or a known diagnosis of high blood pressure
triglyceride level of 150 or higher
HDL (good) cholesterol levels less than 50 in women and less than 40 in men.

What do these five random things have in common? Each of them is a sign that the body is losing its normal ability to respond to its own insulin. This “insulin resistance” also shows up in something you may have read about, called “central obesity.” This refers to the apple shape some people have, which can be a marker for insulin resistance and metabolic syndrome. Insulin resistance can eventually lead to diabetes, heart attack, and stroke.

The study that connected soda drinking with metabolic syndrome found the condition was 48 percent more likely in participants who drank one or more 12-ounce soft drinks per day compared to those who averaged less than one per day. And, the more soda a person averaged, the higher their metabolic syndrome risk was. This was true even after adjusting for dietary intake of saturated and trans-fats, fiber, and total calories, as well as smoking and exercise. So, the effect seemed to be strongly related to the soda consumption itself.

Want more bad news? This was true whether the soda was regular or diet! The researchers were surprised by that. The metabolic syndrome risk from sweetened sodas, especially those which contain the notorious “high fructose corn syrup” was already suspected. But, the link to diet soda was something of a surprise. The authors believed that perhaps diet sodas increase your “sweet tooth,” so that when you drink diet soda, you may want to eat sweeter foods. This can promote insulin resistance. However it didn’t matter if the sodas were caffeinated or uncaffeinated.

It seems to be no coincidence then that our nation of soda lovers is in an obesity epidemic and a diabetes epidemic, while it has increased its consumption of soda drinks steadily over the past three decades. Look at the size of the soft drink containers, for example. A bottle of pop in the 1950s was 6.5 ounces. Today, 20-ounce bottles are common, and 64-ounce “big cups” are sold at the convenience stores. These have more than five cans of soda in a single serving! By comparison, how often do you see people drinking that much water or milk?

So, this summer, whether you are working hard or laying hard out, be like Sponge Bob. Soak up the water! But can the pop!

--Brian Harrison, MD

References:
1) Wisconsin Dental Association (http://www.wda.org/)
2) “Soft Drinks Linked to Metabolic Syndrome Risk” by Crystal Phend, Med Page Today 7/23/07 (http://www.medpagetoday.com/)
3) “Cola May Be Bad To The Bones” by HealthDay News 4/26/08 (http://www.nml.nih.gov/)

Get Your Eyes Checked for Safety

2009-02-04T16:35:00.001-06:00

No, not checked like that! A real eye check includes:

Tests of your vision
A painless test for glaucoma (“the sneak thief of sight”)
A dilated eye exam (drops to widen the pupil, for the doctor to see your retina)
--during your twenties, you should have this full exam at least twice
--during your thirties, at least three times
--during forties, at least four times
--after age fifty, every one or two years
Have the exam even more often if you have special risks, such as:
--Diabetes which is a leading cause of blindness, and requires an annual exam
--Previous eye trauma or eye surgery
--Family history of glaucoma
--African American descent, which increases glaucoma risk.

Good eye health is an important part of work place safety! Think about people whizzing around the plant on tow motors. These drivers need good vision for good public safety, just like drivers on the streets do. For example, the Department of Transportation requires that truck drivers be able to see 20/40 in each eye, or better, and have 70 degrees of side vision in each eye. Safe tow motor driving requires good vision too. If you drive a tow motor, your side vision ought to be good enough that when you are in your car, looking straight ahead through the windshield, you should be still able to see things pass by through the side windows, without needing to turn your head or your gaze. If you can’t see as well as that, then have a full exam by your eye care provider.

To keep your good vision, protect your eyes at work. Everyday in the US, more than 2,000 people suffer eye injuries at work. Temporary or permanent vision loss will happen in up to 10 percent of these people. And, about 90% of these injuries could have been prevented with proper eye protection.

The best defense is good preparation! When starting a job, anticipate hazards it may cause, such as flying objects (bits of metal or glass), moving tools, dust and other particles, chemicals, and harmful radiation. Then eliminate these hazards as well as you are able before starting the task. Use machine guards, work screens, splash guards, and other engineering controls to best advantage. Keep your distance! And, use proper eye protection. Never use a carpentry hammer to strike anything other than nails or other hardened steel. Never hit a chisel without eye goggles.

Wear safety eye wear whenever there is a chance of an eye injury. Even if you are just passing through an eye hazard area, protective eye wear must be worn.

Use the right type of eye wear. Side shields are needed wherever flying particles, flying objects, or dust might contaminate your eyes. But, this isn’t enough if you are working with chemicals; you will then need goggles. If welding, always lower the welding visor, no matter how brief the welding job or how quick you think you are with your tools. Less than one second of welding flash will cause severely painful flash burns. And, you won’t know you burned your eyes until several hours later. That will mean a trip to the doctor, sometimes even the Emergency Department in the middle of the night. Very inconvenient – and very painful!

If you, a co-worker, or a family member suffers an eye injury, proper first aid can save valuable time and possibly prevent vision loss. When working with chemicals, whether at work or at home, always know where eye washing can be done. It is best to have a first aid kit with a commercial bottle of eye wash at home and at work. If chemicals splash into the eye, immediately flush it with water or any other drinkable liquid that is immediately available. Hold the eye under a faucet or shower, or pour water into the eye with a clean container. Keep the eye open and as wide as possible while flushing. Continue flushing for at least 15 minutes. Remember, the solution to pollution is dilution!

The key is to flush immediately. Don’t stop to remove a contact lens; just begin flushing over the lens immediately, it may even wash out. Eye drops are no substitute! This takes gallons of water, not just a few drops of contact lens solution.

Seek immediate medical treatment after 15 or more minutes of flushing. Also, seek treatment if any specks in the eye do not wash out. If anyone is struck on the eye, seek medical attention if there is reduced vision, black eye, or continuing pain. See a doctor at once if anything cuts or punctures the eye, especially a flying particle.

A special threat to eye safety this time of year comes from cars that won’t start in cold weather! Every year, people loose vision from sulfuric acid burns from car batteries. Make sure you know exactly what you are doing if you are jumping a car battery, or call a professional.

Want to know more about eye safety, eye problems, and taking care of your site? Go to http://www.preventblindness.org/, especially go to “Vision Learning Center.”

And don’t forget to get your eyes checked! As you can see, I did!

-Brian D. Harrison, MD