How do we measure up? A comparison of lifestyle-related health risk factors among sampled employees in South African and UK companies.

The need to address the growing prevalence of non-communicable diseases through changing the lifestyle behaviours that contribute to them has become a global priority. Settings-based health promotion strategies such as workplace health promotion programmes are growing in an attempt to start meeting this need. In order for settings-based health promotion programmes to be successful, they need to be based on the specific risk profiles of the population for whom they are designed. Workplace health promotion programmes are becoming popular in South Africa, but there are currently few data available about the health risks and lifestyle behaviours of the South African employed population. In order to obtain such data and reward workplace health promotion initiatives, Discovery Health initiated healthy company campaigns in South Africa and the UK. These campaigns took the form of a competition to assess the healthiest companies in each country. Through these campaigns, an extensive data set was collected encompassing UK and South African employees' lifestyle behaviours and health risks. In this article, we used these data to compare self-reported physical activity levels, self-reported fruit and vegetable consumption, calculated BMI, self-reported smoking, mental health indicators, and health screening status of the UK and South African employee samples. We found significant differences across all measures, with the exception of self-reported fruit and vegetable consumption. The findings emphasise the importance of using local data to tailor workplace health promotion programmes for the population for which the programmes have been designed.

The relationship between leadership support, workplace health promotion and employee wellbeing in South Africa.

Leadership support has been identified as an essential component of successful workplace health promotion (WHP) programs. However, there is little research in this area and even less theoretical conceptualization on ways in which leadership support for WHP is related to improved employee wellbeing. In this paper, we developed and tested a model of leadership support for WHP and employee wellbeing outcomes using employer and employee data gathered from 71 South African organizations. A theoretical model based on social exchange theory was developed. It was hypothesized that perceptions of company commitment to health promotion mediates the relationship between leadership support, the provision of WHP facilities and employee wellbeing. A hierarchical structural equation modeling technique was used to test the model. We determined that leaders' support for WHP was important insofar as they also provided health promotion facilities to their employees. No direct relationship was found between leadership support alone and employee wellbeing.

The relationship between workplace environment and employee health behaviors in a South African workforce.

OBJECTIVE: To determine the relationship between the availability of wellness facilities at worksites and self-reported employee health behaviors (physical activity [PA] and nutrition [NUT]). METHODS: Employers (n = 71) and employees (n = 11472) participated in the South African Healthy Company Index survey. The survey included self-reported clinical measures and lifestyle behaviors. A facility score was calculated, ranging from 0 to 100. Hierarchical linear models were used to calculate the relationship between facility scores and whether employees met PA and NUT guidelines. RESULTS: The mean total facility score was 58.5 ± 25.5. The number of facilities at each worksite accounted for 5.4% of the variance in PA among employees (r = 0.054; P = 0.036). Higher facility scores were associated with better NUT habits among employees. CONCLUSIONS: Employers providing wellness facilities are likely to have employees with better PA and NUT habits.

Changes in productivity, psychological wellbeing and physical wellbeing from working in a 'green' building.

BACKGROUND: Based on improvements in indoor environmental quality claims are that 'green' buildings are healthier and promote greater productivity than conventional buildings. However, the empirical evidence over the last decade has been inconclusive, usually with flawed study designs. OBJECTIVE: This study explored whether a 'green' building leads to a healthier, more productive work environment. METHODS: A one-year, longitudinal comparison of two groups of employees of a large commercial bank; a group that moved into a GreenStar-accredited building and a group that stayed in a conventional building, was conducted. Measures of psychological wellbeing, physical wellbeing, productivity, and perceptions of the physical environment were taken before the move, six months later, and one year later. RESULTS: Results indicate that the 'green' building group had significantly increased self-reported productivity and physical wellbeing. The perceptions of the physical work environment indicate that respondents in the 'green' building group experienced significant air quality improvements (specifically, reduced stale air, better ventilation, improved air movement, reduced humidity, and conditions that were not too drafty) but perceived the lighting conditions as dimmer. CONCLUSION: Despite positive findings 'green' building rating tools require amendment to focus on those qualities that actually lead to improved wellbeing and productivity.

The Healthiest Company Index: a campaign to promote worksite wellness in South Africa.

OBJECTIVE: To describe a 2010 initiative to encourage companies in South Africa to adopt workplace health promotion programs. METHODS: Data documenting organizational efforts to improve workers' health were collected from 71 participating employers and 11,472 workers completing health assessments. Organizational and employee health were scored on the basis of responses to the surveys that asked about facilities and programs offered, leadership support for health promotion, and employees' health status. RESULTS: In its first year, the initiative recruited 101 organizations and 71 qualified for the award. Results aggregated across these companies focus on elements constituting organizational and individual health, with specific measures that companies can review to determine whether they and their employees are "healthy." CONCLUSIONS: The Healthiest Company Index provided useful baseline data to support employers' efforts to develop and implement effective and impactful health promotion programs.

The impact of a 'green' building on employees' physical and psychological wellbeing.

Multiple claims and some empirical findings suggest that 'green' buildings should be healthier (psychologically and physically) and promote greater productivity than conventional buildings. The empirical evidence in this regard over the last decade or so has been inconclusive suggesting either that the studies are flawed or that there are specific aspects of green buildings that promote wellbeing and productivity and others that do not. This study looks at a longitudinal comparison of two groups; a group that moved into South Africa's first GreenStar-accredited building and a group that did not. Measures were taken before the move and six months later. Results demonstrated that the 'green' building did not produce significantly better physical or psychological wellbeing, or higher perceived productivity. These results are discussed in relation to suggestions for what design features to focus on that may produce significant results.

Brief interventions for patients presenting to the Psychiatric Emergency Service (PES) with major mental illnesses and at-risk drinking.

The presentation for care in psychiatric emergency setting provides an opportunity to assist individuals with mental health disorders and problems related to alcohol use. The purpose of this pilot study was to determine whether clinician-administered brief alcohol interventions are effective in reducing alcohol consumption in patients who screen positive for at-risk drinking in the psychiatric emergency setting. A total of 390 PES patients were screened; 87 (schizophrenia/bipolar disorder, n = 34; depression/anxiety, n = 53) met criteria for the study and received a brief alcohol intervention. Both groups dropped their drinking by approximately 7 drinks/week over the 6-months of the study (P < .05). The results of this study suggest that individuals with mental illnesses who drink at risk levels may benefit from a short, targeted brief alcohol intervention directed at changing their alcohol-related behavior and that, delivery of these interventions is feasible in a psychiatric emergency setting.

State mental health policy: implementation of computerized medication prescribing algorithms in a community mental health system.

This column describes a Michigan initiative to implement medication prescribing algorithms for schizophrenia, bipolar disorder, and major depression. The algorithms were incorporated into the electronic medical records system of a four-county community mental health system. Guideline adherence of 30 providers who treated nearly 3,000 patients was measured at mid- and endpoints of the first year. They were adherent for about a third of their patients in the first six months (32%) and more than half in the second (52%). Scores on scales measuring providers' perceptions of algorithm ease of use and usefulness were in the midrange at both time points.

Improving integrated general medical and mental health services in community-based practices.

The historical fragmentation of physical and mental health services has impeded efforts to improve quality and outcomes of care for persons with mental disorders. However, there is little information on effective strategies that might reduce fragmentation and improve integrated services within non-academic, community-based healthcare settings. Twenty-three practices from across the U.S. participated in a learning community meeting designed to identify barriers to integrated care and strategies for reducing such barriers. Barriers were initially identified based on a quantitative survey of organizational factors. Focus groups were used to elaborate on barriers to integrated care and to identify strategies for reducing barriers that are feasible in community-based settings. Participants identified key barriers, including administrative (e.g., lack of common medical records for mental health and general medical conditions), financial (e.g., lack of reimbursement codes to bill for mental health and general medical care in the same setting), and clinical (e.g., lack of an integrated care protocol). Top strategies recommended by participants included templates (i.e., for memoranda of understanding) to allow providers to work across practice settings, increased medical record security to enable a common medical record between mental health and general medical care, working with state Medicaid agencies to establish integrated care reimbursement codes, and guidance in establishing workflows between different providers (i.e., avoid duplication of tasks). Strategies to overcome barriers to integrated care may require cooperation across different organizational levels, including administrators, providers, and health care payers in order for integrated care to be established and sustained over time.

Screening psychiatric emergency department patients with major mental illnesses for at-risk drinking.

OBJECTIVE: This study determined the prevalence of at-risk drinking in a psychiatric emergency service and compared the characteristics and functioning of at-risk drinkers with schizophrenia or bipolar disorder with those of at-risk drinkers with depression or anxiety disorders. METHODS: Adult patients who entered the psychiatric emergency service and met study criteria were surveyed. RESULTS: A total of 148 participants had schizophrenia or bipolar disorder, and 242 had depression or anxiety. Twenty-three percent of the group with schizophrenia or bipolar disorder and 22 percent of the group with depression or anxiety drank more than the recommended limits. The group with schizophrenia or bipolar disorder reported experiencing significantly more consequences from drinking than the depression or anxiety group. Both groups reported significant depression in the prior few days. CONCLUSIONS: This study demonstrated the importance of assessing alcohol use and depression among all patients in psychiatric emergency services.

Routine use of the Beck Scale for Suicide Ideation in a psychiatric emergency department.

BACKGROUND: U.S. suicide rates are estimated to be 11 per 100,000 people, and improved screening in emergency departments may reduce suicide rates. METHOD: This study examined the relationship between clinician rating of suicide ideation and Beck Scale for Suicide Ideation (BSI) scores when clinicians had access to the BSI results and whether BSI scores and/or clinician ratings of suicidality are associated with patient disposition from the psychiatric emergency department. RESULTS: Of 735 patients, 665 (90%) had documentation of suicide ideation in the chart; 246 (37%) were rated as suicidal; 487 (66%) patients completed the BSI forms; 300 patients (62%) scored positive on the BSI. Logistic regression analysis for BSI scores and clinician ratings of suicidality showed similar results, except clinicians were more likely to rate males as suicidal, while BSI scores did not vary according to sex. Hospitalization occurred more often for patients with mood disorder who had positive BSI scores, while hospitalization occurred more often for patients with a diagnosis of bipolar disorder or schizophrenia who were rated by clinicians as suicidal. CONCLUSIONS: There were important demographic and diagnostic differences revealed by logistic regression analysis of BSI scores and clinician-rated suicidality, and these differences may be associated with disposition for patients presenting with suicide ideation.

Clinical equivalence of generic clozapine.

OBJECTIVE: To determine if mental health service utilization increases when patients are converted to generic clozapine. METHOD: About 125 patients taking clozapine in a community mental health clinic were switched from Novartis Clozaril to generic clozapine (Mylan Pharmaceuticals). Serum clozapine levels were obtained 2 weeks before, and 2 weeks after, the switch to generic clozapine. The number of outpatient visits, emergency room visits, and hospitalizations in the year prior to the switch were compared to those in the year following the switch, to determine service utilization. RESULTS: Psychiatric emergency room visits decreased, but clozapine serum levels, inpatient hospital days, partial hospital admissions, and outpatient psychiatrist visits did not change after the switch to generic clozapine. CONCLUSIONS: There were no significant increases in mental health service utilization after the conversion to Mylan generic clozapine. The switch to Mylan generic clozapine was cost effective, as the reduction in pharmacy costs was not offset by increased utilization costs.

A multiple-goal, multilevel model of feedback effects on the regulation of individual and team performance.

When working as a member of a team, individuals must make decisions concerning the allocation of resources (e.g., effort) toward individual goals and team goals. As a result, individual and team goals, and feedback related to progress toward these goals, should be potent levers for affecting resource allocation decisions. This research develops a multilevel, multiple-goal model of individual and team regulatory processes that affect the allocation of resources across individual and team goals resulting in individual and team performance. On the basis of this model, predictions concerning the impact of individual and team performance feedback are examined empirically to evaluate the model and to understand the influence of feedback on regulatory processes and resource allocation. Two hundred thirty-seven participants were randomly formed into 79 teams of 3 that performed a simulated radar task that required teamwork. Results support the model and the predicted role of feedback in affecting the allocation of resources when individuals strive to accomplish both individual and team goals.

A survey of psychiatrists' attitudes toward treatment guidelines.

We developed a survey to look at psychiatrists' attitudes toward psychotropic prescribing guidelines, specifically the Texas Medication Algorithm Project (TMAP) algorithms. The 22-page survey was distributed to 24 psychiatrists working in 4 CMHC's; 13 completed the survey. 90% agreed that guidelines should be general and flexible. The majority also agreed that guidelines should define how to measure response to a specific agent; fewer agreed guidelines should specify dosage, side effect management, or augmentation strategies. Psychiatrists were familiar with TMAP; none referred to it in their practice. In spite of this, psychiatrists' medication preferences were similar to those suggested by guidelines.

Assessing conformance to medication treatment guidelines for schizophrenia in a community mental health center (CMHC).

The feasibility of implementing current medication treatment guidelines in a community mental health clinic was examined in this cross-sectional and retrospective study. Specifically, two issues were addressed: 1) could we identify a set of clinical guidelines whose utilization could be monitored with a routine medical chart review; and 2) were the requisite data for such a review available in the medical records. An examination of three sets of published guidelines revealed 5 specific guidelines that could be operationalized and monitored. Records were reviewed for a random sample of two-thirds of all patients currently diagnosed with schizophrenia and schizoaffective disorder (n = 309). Information was collected from the medical record on patient demographics, diagnosis, duration of illness, symptoms and side effects, and medication information. Rates of conformance to the 5 guidelines ranged from a high of 97% to a low of 43%. The use of current guidelines to improve treatment in community clinics appears to be limited by the deficiencies in the medical record and the structure of the guidelines themselves. Standardized progress notes and computerized prescribing programs will improve conformance, and permit the rapid and accurate assessment of conformance to guidelines in community clinics.

A comparison of guidelines for the treatment of schizophrenia.

Although the clinical and administrative rationales for the use of guidelines in the treatment of schizophrenia are convincing, meaningful implementation has been slow. Guideline characteristics themselves influence whether implementation occurs. The authors examine three widely distributed guidelines and one set of algorithms to compare characteristics that are likely to influence implementation, including their degree of scientific rigor, comprehensiveness, and clinical applicability (ease of use, timeliness, specificity, and ease of operationalizing). The three guidelines are the Expert Consensus Guideline Series' "Treatment of Schizophrenia"; the American Psychiatric Association's "Practice Guideline for the Treatment of Patients With Schizophrenia"; and the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. The algorithms are those of the Texas Medication Algorithm Project (TMAP). The authors outline the strengths of each and suggest how a future guideline might build on these strengths.