Use of a comprehensive program to review religious and personal seasonal influenza vaccination exemption requests by healthcare personnel.

OBJECTIVE: Vanderbilt University Medical Center (VUMC) requires that all faculty and staff receive the seasonal influenza vaccine annually or receive an approved vaccine exemption, either for a medical or deeply held religious or personal belief. We sought to understand the underlying principles behind these exemption requests and their interaction with a multidisciplinary exemption review process. DESIGN: All of the personal and religious exemption requests at VUMC for 3 consecutive influenza seasons from 2015 to 2018 were analyzed, categorizing these requests by 1 of 12 standardized employee categories and 1 of 18 unique reasons for vaccine exemption. SETTING: Tertiary-care academic medical center. PARTICIPANTS: Healthcare personnel (HCP). RESULTS: Among the 3 influenza seasons, 1.1%-2.1% of all VUMC HCP requested religious or personal exemption from vaccination. The frequency of religious and personal exemption approval increased annually from 296 of 452 (65.5%) to 196 of 248 (80.2%) to 283 of 323 (87.6%) over the 3 seasons, representing a statistically significant increase each year. Of the 5 most common reasons against vaccination, 4 were explicitly religious in nature; the most common reason was that the "body is a temple or sacred." Nonclinical staff submitted the most religious and personal exemption requests of any job category, submitting approximately one-third of all requests every year. CONCLUSIONS: These results demonstrate how detailed the personal or religious convictions behind vaccine avoidance can be among HCP and how vaccine avoidance stems from much more than simple misinformation regarding vaccination. The intersection between misinformation and personal or religious beliefs provides a unique opportunity to address HCP opinions toward vaccination in an exemption and appeals process like the one described here.

Expanding mandatory healthcare personnel immunization beyond influenza: Impact of a broad immunization program with enhanced accountability.

OBJECTIVE: Evaluation of a mandatory immunization program to increase and sustain high immunization coverage for healthcare personnel (HCP). DESIGN: Descriptive study with before-and-after analysis. SETTING: Tertiary-care academic medical center. PARTICIPANTS: Medical center HCP. METHODS: A comprehensive mandatory immunization initiative was implemented in 2 phases, starting in July 2014. Key facets of the initiative included a formalized exemption review process, incorporation into institutional quality goals, data feedback, and accountability to support compliance. RESULTS: Both immunization and overall compliance rates with targeted immunizations increased significantly in the years after the implementation period. The influenza immunization rate increased from 80% the year prior to the initiative to >97% for the 3 subsequent influenza seasons (P < .0001). Mumps, measles and varicella vaccination compliance increased from 94% in January 2014 to >99% by January 2017, rubella vaccination compliance increased from 93% to 99.5%, and hepatitis B vaccination compliance from 95% to 99% (P < .0001 for all comparisons). An associated positive effect on TB testing compliance, which was not included in the mandatory program, was also noted; it increased from 76% to 92% over the same period (P < .0001). CONCLUSIONS: Thoughtful, step-wise implementation of a mandatory immunization program linked to professional accountability can be successful in increasing immunization rates as well as overall compliance with policy requirements to cover all recommended HCP immunizations.

Prevalence of IgG antibodies against the severe acute respiratory syndrome coronavirus-2 among healthcare workers in Tennessee during May and June, 2020.

SARS-CoV-2 seroprevalence was low (<1%) in this large population of healthcare workers (HCWs) across the state of Tennessee (n=11,787) in May-June 2020. Among those with PCR results, 81.5% of PCR and antibody test results were concordant. SARS-CoV-2 seroprevalence was higher among HCWs working in high-community-transmission regions and among younger workers. IMPORTANCE: These results may be seen as a baseline assessment of SARS-CoV-2 seroprevalence among HCWs in the American South during a period of growth, but not yet saturation, of infections among susceptible populations. In fact, this period of May-June 2020 was marked by the extension of renewed and sustained community-wide transmission after mandatory quarantine periods expired in several more populous regions of Tennessee. Where community transmission remains low, HCWs may still be able to effectively mitigate SARS-CoV-2 transmission, preserving resources for populations at high risk of severe disease, and these sorts of data help highlight such strategies.

Putting the National Diabetes Prevention Program to Work: Predictors of Achieving Weight-Loss Goals in an Employee Population.

INTRODUCTION: Differences in eligibility criteria and intervention characteristics have limited the generalizability of findings from studies of worksite translations of the National Diabetes Prevention Program (DPP). The objective of our study was to identify factors associated with achievement of the DPP's 5% weight-loss goal in the Vanderbilt University Medical Center (VUMC) Faculty and Staff Health and Wellness DPP from 2014 to 2017. METHODS: We analyzed data from a DPP worksite translation that adhered to national standards for program quality and intervention fidelity. We compared baseline characteristics and program metrics for participants who did and did not achieve the program's 5% weight-loss goal, and we developed a multivariable logistic regression model to identify independent predictors of achieving this goal. RESULTS: Of the 165 employees enrolled in the DPP from 2014 to 2017, 43.6% (n = 72) met the 5% weight-loss goal. Mean (standard deviation) percentage weight loss for the program was 5.2% (6.0%), or 4.8 (6.0) kg. The median (interquartile range) body mass index at baseline was lower among participants who achieved the 5% weight-loss goal than among those who did not (31.6 [29.4-37.4] vs 34.7 [31.5-39.2], P = .009), and participants who achieved the goal reported more physical activity minutes per week (166.0 [135.2-223.0] min vs 128.5 [83.2-169.8] min, P < .001). Session attendance was greater for participants achieving the 5% weight-loss goal (23 [21-25]) sessions vs 18 [12-21] sessions, P < .001). In the adjusted analysis, physical activity and session attendance remained significant predictors of achieving the 5% weight-loss goal. CONCLUSION: Session attendance and physical activity independently predicted achievement of the 5% weight-loss goal in this worksite translation of the DPP. Strategies designed to improve these metrics may increase DPP success rates.

Modifiable Healthy Lifestyle Behaviors: 10-Year Health Outcomes From a Health Promotion Program.

INTRODUCTION: Previous studies have examined the impact of healthy lifestyle choices on health-related outcomes; however, given their fragmented, often cross-sectional nature, assessing the relative impact of daily modifiable behaviors on overall long-term outcomes, particularly for a diverse working adult population, remains challenging. METHODS: Relationships between ten self-reported healthy lifestyle behaviors and health outcomes during the subsequent 9 years in a cohort of 10,248 participants enrolled during 2003 in a voluntary workplace wellness program were assessed. Cox proportional-hazards models computed hazard ratios (HRs) for lifestyle characteristics associated with time to one of seven self-reported chronic diseases or death. Data were collected between 2003 and 2012 and analyzed between 2014 and 2016. RESULTS: Behaviors that most significantly affected future outcomes were low-fat diet, aerobic exercise, nonsmoking, and adequate sleep. A dose-response effect was seen between dietary fat intake and hypertension, obesity, diabetes, heart disease, and hypercholesterolemia. After dietary fat intake, aerobic exercise was the next most significant behavior associated with development of outcomes. Compared with sedentary participants, those who exercised 4 days per week were less likely to develop new-onset diabetes (HR=0.31, 95% CI=0.20, 0.48); heart disease (HR=0.46, 95% CI=0.27, 0.80); and hypercholesterolemia (HR=0.61, 95% CI=0.50, 0.74). Low-fat diet and adequate sleep were more significant than commonly promoted healthy behaviors, such as eating a daily breakfast. CONCLUSIONS: Modifiable lifestyle behaviors targeted in health promotion programs should be prioritized in an evidence-based manner. Top priorities for workplace health promotion should include low-fat diet, aerobic exercise, nonsmoking, and adequate sleep.

Relationship between physical inactivity and health characteristics among participants in an employee-wellness program.

OBJECTIVE: To characterize factors associated with physical inactivity among employees with access to workplace wellness program. METHODS: We examined data on physical inactivity, defined as exercise less than once a week, from the 2010 health risk assessment completed by employees at a major academic institution (N = 16,976). RESULTS: Among employees, 18% of individuals reported physical activity less than once a week. Individuals who were physically inactive as compared with physically active reported higher prevalence of cardiovascular diseases (adjusted odds ratio [AOR], 1.36 [1.23 to 1.51]), fair or poor health status (AOR, 3.52 [2.97 to 4.17]), and absenteeism from work (AOR, 1.59 [1.41 to 1.79]). Overall, physically inactive employees as compared with physically active employees reported more interest in health education programs. CONCLUSION: Future research is needed to address barriers to physical inactivity to improve employee wellness and potentially lower health utility costs.

Pancreatitis caused by rheolytic thrombolysis: an unexpected complication.

Two patients developed acute pancreatitis after mechanical thrombolysis with use of the AngioJet system. Patient 1 had undergone a remote complex revascularization of the lower extremities and presented with acute ischemia after thrombosis of his composite distal bypass. Patient 2 presented with superior vena cava (SVC) syndrome and had thrombosis of the SVC and innominate veins. Despite dissimilar presentations, both patients had renal insufficiency, were treated with mechanical and chemical thrombolysis, and had extensive thrombus burden. The pathophysiology of acute pancreatitis in this setting is believed to be secondary to massive hemolysis in the presence of chronic renal insufficiency. This phenomenon should be considered in patients whom develop abdominal pain after mechanical thrombolysis.