Stephen A' Dawkins,MD,MPH,BSHS,FACOEM

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Practical Wellness

• Dr. Stephen A. Dawkins
• ACIG Fall Conference
• September 15, 2005

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Agenda

• What is Practical Wellness?
• Four Areas of Focus 1. Weight 2.
  Exercise 3. Medical Care 4. Stress
• Questions and Answers

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Weight

• What is the proper weight?
• How do you calculate proper weight?
• What is BMI?

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Facts About Weight

• 2/3 of US adults are overweight (excess body
  weight compared to standards)
• 30.5 of US adults are obese (abnormally high
  proportion of body fat)
• A person may be overweight without being obese
• BMI (Body Mass Index) weight (kg)/height in
  meters squared (m2) and is gender neutral
• 300,000 death occur yearly due to obesity
• Less than half of US adults have a healthy body
  weight
• From 1960 to 2000, the prevalence of
  obesity/overweight have increased
• Obesity/overweight increase to age 60, then
  decline
• Obesity/overweight is associated with an increase
  in diabetes, hypertension, high cholesterol,
  cancer and increased mortality

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Practical Weight Management

• Eat just enough (portion control)
• Eat less as you get older (you
  need less food)
• 3. To lose weight, use more calories than you
  ingest (food intake must match activity)

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Exercise

• What qualifies as exercise?-30 minutes activity
  that makes you breathe heavy-muscles use it or
  lose it-challenge your balance-stretch

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Facts About Exercise

• Less than 1/3 of US adults get regular exercise
• Decreases the risk of dying from CAD
• Reduces the risk of developing diabetes,
  hypertension and colon cancer
• Start slowly to build up an exercise program to
  develop acclimatization and endurance.
• Some medicines may alter your heart rate,
  especially beta blockers.
• Exercise requires hydration. Drink plenty of
  fluids.

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Practical Exercise

• Some exercise is better than none.
• One should exercise at all ages.
• Daily exercise should total 30 minutes/day, but
  may be in separate time blocks.

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Medical Issues

• Preventive Care-intuitively we understand that
  preventive care is less expensive, and more
  effective than problem treatment (ex. prenatal,
  NO vaccines)
• Annual Exams-questions when, content, what if
  asymptomatic

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Mens Health

• Colon Health-2nd leading cause of ca death-93
  of cases occur after 50yo-risk increases with
  age-hemoccult-colonoscopy-sigmoidoscopy-barium
  enema-biomarkers-familial polyposis-screening
  begins _at_ 50yo-IBD or polyps screen earlier

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Mens Health

• Prostate Disease-BPH, prostatitis, cancer-sx
  hematuria, urinary flow changes, pain-tests
  PSA, digital exam, urinalysis, transrectal
  ultrasound, prostate biopsy, MRI, CT, urodynamic
  tests-digital exam should begin at age 40

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Womens Health

• Breast Disease-2nd leading cause of ca death in
  women-diagnosis rates are increasing-death
  rates are decreasing-13.2 of women born today
  will be dx with breast ca-breast ca rates
  increase with age-yearly mammograms-monthly
  self exams-screening v. diagnostic exams-MRIs
  for implant rupture-biomarkers-h/o bilat.
  Mastectomy may no longer require mammograms

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Womens Health

• Cervical Disease-45,000 women affected-0.76
  risk of developing-0.26 risk of
  dying-preventable-curable if detected
  early-PAP smear-associated with HPV

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Chronic Diseases

• Hypertension
• Diabetes
• Lung Disease
• Colon Disease
• Neurologic Problems
• Heart Disease
• Circulatory Diseases

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Emerging Issues

• Cord Blood
• Stem Cells
• Cloning

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What is Job Stress?

• The harmful physical and emotional response that
  occurs when the requirements of the job do not
  match the capabilities, resources, or needs of
  the worker.
• responsibility without authority

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Research on Job Stress

• 40 of workers report that their job is very or
  extremely stressful--Northwestern Life survey
• ¾ of employees believe workers have more
  on-the-job stress than a generation
  ago--Princeton Survey Research Associates study
• Problems at work are more strongly associated
  with health complaints than are any other life
  stressor, even over financial or family
  issuesSt. Paul Fire and Marine Insurance study

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What are the important determinants of job stress?

• Worker characteristics
• Working conditions

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What are the important determinants of job stress?

• NIOSH holds that working conditions is the
  primary factor resulting in job stress
• These stressors have a direct influence on
  employee safety and health
• Individual characteristics simply strengthen or
  weaken this influence

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NIOSH Model of Job Stress
INDIVIDUAL AND SITUATIONAL FACTORS
RISK OF INJURY AND ILLNESS
STRESSFUL JOB CONDITIONS
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What types of work conditions lead to stress?
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Work Conditions Leading to Stress

• Design Tasks

• Heavy workload
• Infrequent breaks
• Long work hours
• Shiftwork
• Routine tasks that have little inherent meaning
  and that provide little sense of control

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Work Conditions Leading to Stress

• Design of Tasks
• Management Style

• Lack of participation by workers in decision
  making
• Poor communication within the organizationstrong
  rumor mill
• Lack of family friendly policies

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Work Conditions Leading to Stress

• Design of Tasks
• Management Style
• Interpersonal Relationships

• Poor social environment
• Lack of support from co-workers or supervisors
• Isolation

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Work Conditions Leading to Stress

• Design of Tasks
• Management Style
• Interpersonal Relationships
• Work Roles

• Conflicting or uncertain job expectations
• Too much responsibility, i.e., wearing too many
  hats

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Work Conditions Leading to Stress

• Design of Tasks
• Management Style
• Interpersonal Relationships
• Work Roles
• Career Concerns

• Job insecurity
• Lack of opportunity for growth, advancement, or
  promotion
• Rapid changes for which workers are unprepared

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Work Conditions Leading to Stress

• Design of Tasks
• Management Style
• Interpersonal Relationships
• Work Roles
• Career Concerns
• Environmental Conditions

• Overcrowding
• Excessive noise
• Air pollution
• Ergonomic issues

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What are the physiologic responses to stress?
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The fight or flight response

• A measureable biologic response involving the
  parasympathetic and sympathetic pathways of the
  nervous system
• As the body prepares to defend itself, hormones
  are released causing increased pulse, deeper
  respirations, muscle tension, and overall
  sharpened senses

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The Physiologic Response

• Long term stress keeps the body in a constant
  state of activation ultimately leading to fatigue
  and damage to the body
• Over time the body is unable to adequately repair
  itself and natural immunity is compromised
• The body is now at increased risk of injury
  and/or a multitude of disease states

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What are some of the early warning signs of job
stress?

• Headache
• Sleep disturbances
• Difficulty concentrating
• Short temper
• Upset stomach
• Job dissatisfaction
• Low morale
• Disturbed relations with family and friends

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The Result

• Increased absenteeism
• Tardiness
• Decreased productivity

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The Outcome

• Healthcare expenditures are 50 greater for
  workers who report high levels of stressJournal
  of Occupational and Environmental Medicine
• Workers who must take time off because of stress,
  anxiety, or a related disorder will be off the
  job for approximately 20 daysBureau of Labor
  Statistics

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What can be done?

• NIOSH suggests two models to manage stress based
  on the prevailing underlying determinantsworker
  characteristics vs. work conditions

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Model A Stress Management

• Employee Assistance Program
• Provides counseling for employees for both work
  and personal issues
• Advantages- easy to implement and relatively low
  cost
• Disadvantages- short term effect the work
  environment is often ignored

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Model B Organizational Change

• Addresses direct ways to reduce stress by first
  identifying the stressful aspects of the job and
  designing/implementing strategies to reduce these
  stressors
• Advantages- deals with the root cause
• Disadvantages- implementation may be difficult if
  it effects work routines, production schedules,
  or changes the overall organizational structure
  of the company

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Model B Organizational Change

• NIOSH contends that top priority should be given
  to this model
• Integration of the two models is regarded as the
  best overall approach to prevent stress in the
  workplace

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What is a healthy organization?

• NIOSH has identified specific characteristics
  that promote a healthy, low-stress work
  environment resulting in higher rates of
  productivity

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Healthy Organization Characteristics

• Recognition of employees for good performance
• Opportunities for career development and
  advancement
• Organizational culture that values the individual
  worker
• Management actions that are consistent with
  organizational values

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Healthy Organizations

• This is a direct challenge to the prevailing
  belief by many employers that stressful working
  conditions are a necessary evil as pressures
  mount for companies to have increased
  productivity and profitability.

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More information

• NIOSH Publications Dissemination,
• 800-35-NIOSH
• http//www.cdc.gov/niosh
• The Encyclopaedia of Occupational Health and
  Safety, 4th edition, Vol. 1, Chapter 5 and Vol.
  2, Chapter 34

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