Thursday, July 28, 2011

Dr Dingle Clients

Below are some of Dr Dingle's clients

Associated Financial Planners
Australand
Australian Broadcasting Corporation (ABC)
Australian Institute of Banking and Finance
Australian Speakers Bureau
Australian Traditional Medical Society
Australian Veterinary Association of WA
Balya Cancer Self Help and Wellness.
BMS Solutions
Cancer Support Association
CGU Insurance
Chartered Professional Accountants (CPA)
Chifley on the Terrace Hotel
Christ Church Grammar School
City of East Fremantle
City of Fremantle
Clarkson Community School
Colliers International
Colonial Mutual
Conoco Phillips Australasia
Craigie Senior High
CSBP
Custodian Wealth Builders
Deakin Financial Services.
Enjo
Events WA
FESA
Fremantle Hospital and Health Service.
Glyde-In. Community learning Centre
Gooding Pervan
Greenwood Primary School
Hampton SHS
Healthcare Manufacturing Group
Health Protect International
Hospital Environmental Awareness Link.
Institute of Chartered Accountants
John Wollaston Senior High School
Karara Mining Ltd
KFC
Kwinana Industries Education Partnership.
Western Australian Leadership Centre
Lockridge SHS
Marubeni-Itochu Tubulars Oceania Pty Ltd
Meeting Place Community Centre
Melville Council
Micro Enterprises and Individuals
Mortgage Gallery
Mt Lawley SHS
National Council of Jewish Women of Australia.
National Council of Self Insurers
Neways Australia
Packaging Council of Australia.
Parkinson’s Association of WA.
Peel District Education Department Administrators
Pilbara Education District Office
Project Management Institute
Secret Harbour Surf Life Saving Club
Small Business Development Corporation
SOMA
Trades and labour Council.
WA Convention Centre
WACCRM (rural doctors conference)
Water Corporation
West Australian Police Force
West Coast Education District Directors
West coast TAFE
Woodside
Woodvale SHS
Wools of New Zealand
Health -Mor Industries. (USA)
ELKEN (Malaysia)
Deaken Finances (New Zealand)
Newways (Malaysia, Phillipines)
PWD EMS Ltd (Singapore)

Wednesday, July 27, 2011

Vitamin D

Vitamin D is one of the essential nutrients required by the human body. Unlike most vitamins, it is one that we can manufacture on our own, given the right conditions. Despite this, vitamin D is showing up increasingly in populations as the most widespread and critical nutrient deficiency; this deficiency is linked to many diseases and disorders, costing billions of dollars each year. Our changing lifestyles, including increased indoor living and campaigns warning people to stay out of the sun have meant that most people don’t get enough vitamin D. The resulting deficiency is compounded by the consumption of modern and processed foods devoid of any vitamin D.

Vitamin D refers to two biologically inactive precursors: D3, also known as cholecalciferol (made from cholesterol), and D2, also known as ergocalciferol. Vitamin D is the only nutrient that can actually be synthesized by the human body, which technically means that it is not a vitamin. The synthesizing of vitamin D in the body can be achieved through contact with solar ultraviolet B radiation emitted by the sun. Without the presence of this solar radiation the only way to get vitamin D is through diet—hence, it is still classified as a “vitamin.”

It is becoming increasingly common to find low levels of vitamin D in Western populations. Vitamin D uptake from the sun is not affected so much by seasonal changes but by how much time people spend in the sun. People require between 70nmol/L to 100nmol/L of vitamin D and in winter, when people spend less time outdoors, it is difficult to achieve these levels. Furthermore, current sun avoidance advice combined with the dietary habits of the general populous make the situation much worse—the average level in adults is around 25nmol/L - not even half the recommended level. Populations particularly at risk are seniors and infants but also any person spending too much time inside.

In addition to vitamin D obtained through UVB exposure to the sun, this vitamin can be found in foods such as eggs, butter and fortified milk, with the highest levels found in fish. Remember, we evolved as fisher- hunter gatherers and fish used to be an essential part of our nutrition. Vitamin D can also be provided by supplements. Numerous studies have concluded that sensible sun exposure and supplementation are the most effective ways of increasing vitamin D levels.

Once in the body, vitamin D is either stored in the body’s fat adipocytes or enters the liver. The vitamin D gets broken down in the kidneys for the regulation of calcium and dozens of metabolic functions. The broken-down vitamin D then interacts with vitamin D receptors in the small intestine and on osteoblasts to regulate calcium and phosphorous metabolism. It not only assists calcium uptake in the bones but also works as an immunity modulator. It continues to be metabolised in various tissues and cells for regulating cellular proliferation and differentiation as well as in the functioning of the immune system and macrophages. In addition, circulating concentrations of the broken-down vitamin D may help increase insulin production and alter fat metabolism.
Deficiencies in vitamin D have been linked with a range of problems with the musculoskeletal system including low bone and muscle problems, as well as cardiovascular disease, diabetes and metabolic syndrome, cancer and impacts on the immune system, Parkinson’s Disease, asthma, pain, and pre eclampsia.

Low levels of vitamin D can reduce the amount of calcium uptake in the bones which, over time, can lead to a loss in bone density. Pregnant women with vitamin D deficiency have been found to give birth to children who are at greater risk of being unable to store calcium in their bones, reducing their bone density and increasing the risk of bone fractures. In addition, these children experience higher level of dental caries. Low vitamin D in children will prevent them from reaching their bone mineral density and therefore increase their risk of osteoporosis and fracture later in life. In a study of 206 pregnant women during their second trimester, researchers reported that only 10.5% of the women had adequate levels of vitamin D.

In a study of 23,423 would-be first time mothers, the risk of pre-eclampsia was 27% lower in women who consumed vitamin D supplements with daily doses of 10 to 15 micrograms, compared to women who did not take supplements. Pre-eclampsia, affecting 2% to 3% of all pregnancies is estimated to be responsible for about 60,000 deaths each year worldwide.

Vitamin D deficiency is inversely related to a range of diseases, including respiratory infections such as influenza. In support of these findings, clinical trials have shown that vitamin D supplementation can reduce the risk of reactivation of latent tuberculosis infection. Vitamin D (in particular, D3) stimulates neutrophils, monocytes (natural killer cells) and the epithelial cells lining the lungs and protecting them from infection. So come winter-time and flu season get out and get a bit more sun along with some cod liver oil.

Studies have indicated that vitamin D supplementation may reduce the risk and difficulties associated with autoimmune disorders. In particular, there is strong evidence that vitamin D reduces the risk of multiple sclerosis and type 1 diabetes mellitus, and weaker evidence for rheumatoid arthritis, osteoarthritis, systematic lupus and erythematosusstar. There is no doubt about the link between vitamin D shortage and multiple sclerosis. There is a 41% decrease in MS risk for every 50 nanomoles per liter increase in 1,25-hydroxyvitamin in the blood. Vitamin D deficiency also predisposes to insulin resistance and pancreatic beta cell dysfunction. In a study of 10,366 Finnish children those given 2,000 IU of vitamin D3 per day throughout the first year of life experienced a 78% reduced risk of type 1 diabetes.

Over time, vitamin D deficiency leads to osteopenia, precipitates and exacerbates osteoporosis, which causes the painful bone disease osteomalacia and leads to increased muscle weakness. Notably, vitamin D deficiency is also associated with an increased risk of falling and fractures. Frail older people confined to institutions may sustain fewer hip fractures if given vitamin D. A study of 302 women (average age 77.2) living in Perth, Australia found after 12 months of supplementation significantly more falls in the placebo group than in the vitamin D2 group (62.9% versus 53%, respectively). A study of 124 nursing home residents taking a daily vitamin D supplement of 800IU for five months reduced the number of falls among nursing home-dwelling elderly people by 70%. Lower blood concentrations of vitamin D increase the likelihood of hip fracture among menopausal women by up to 70%.

Numerous studies have shown that vitamin D deficiency is strongly associated with an increased risk in developing cardiovascular disease. Epidemiological studies report that the rates of coronary heart disease, higher rates of diabetes, hypertension and elevated LDL cholesterol, are strongly correlated with decreased vitamin D status. Vitamin D appears to be necessary to maintain adequate apolipoprotein A-I concentrations, the main component of HDL (good) cholesterol.
Vitamin D deficiency increases the risk of “all-cause mortality” and is associated with a 122% increase in the risk of “cardiovascular mortality” compared to the highest average Vitamin D levels. Researchers also found that low levels were linked to higher levels of inflammation markers, such as C-reactive protein (CRP) and interleukin-6 (IL-6), which are important markers for chronic illnesses, including cardiovascular disease (These inflammation markers are a much better predictor of cardiovascular disease than cholesterol levels).

Deficient or insufficient vitamin D levels have been documented in patients with myocardial infarction, stroke, heart failure, and peripheral arterial disease. A study of 13,331 initially healthy men and women found that low levels of vitamin D may increase the risk of death from all causes by 26% when the lowest and highest average vitamin D levels were compared. In an examination of 1,739 participants in one study, low levels of vitamin D were associated with a 62% increased risk of cardiovascular events like heart attack, heart failure or stroke. The study also found that 28% of subjects had blood levels lower than 15 nanograms per millilitre (ng/mL). Only 10% of the participants had levels in the optimal range above 30 ng/mL.

Low vitamin D levels are linked with the formation of atherosclerosis. When researchers exposed macrophage cells (white blood cells) with and without vitamin D, they found that vitamin D inhibits the uptake of cholesterol by the macrophage cells. When people are deficient in vitamin D, the macrophage cells take in more cholesterol, and they can't get rid of it. The macrophages get clogged with cholesterol and become foam cells, which are one of the earliest markers of atherosclerosis. Macrophage activation is higher in people with diseases such as diabetes, and when found in combination with low vitamin D levels, the macrophages become loaded with cholesterol and eventually stiffen blood vessels and block blood flow.

A number of studies have also shown a link between low vitamin D and diabetes and metabolic syndrome. In a study of 15,088 subjects Vitamin D levels were inversely associated with hypertension, diabetes mellitus and hypertriglyceridemia. Other cross-sectional studies have confirmed the links between vitamin D deficiency and both hypertension and diabetes. One study reported that a daily intake of 800 IU of vitamin D compared with a daily intake of less than 400 IU of vitamin D reduced the risk of type 2 diabetes by one-third. A number of studies have shown a close link between vitamin D deficiency and metabolic syndrome. Vitamin D appears to be necessary to maintain adequate apolipoprotein A-I concentrations, the main component of HDL (good) cholesterol. One study found similar results with the lowest levels of vitamin D being associated with a 31% prevalence of metabolic syndrome, compared to only 10% for people with the highest average levels. The results also showed that vitamin D blood levels were associated with HDL cholesterol levels. Each increase of 10 ng/mL in 25(OH)D was associated with an increase of 3.8 to 4.2 mg/dL in HDL-C. An increase of just 1 mg/dL increment in HDL-C is associated with a 4% to 6% reduction in coronary heart disease risk.

There is now overwhelming evidence that supports increased vitamin D to lower the risk of developing and dying of prostate, breast, colon, ovarian, esophageal, non-Hodgkin's lymphoma and a variety of other lethal cancers. In a 10-year study of 1,179 healthy, postmenopausal women, researchers found that those taking large amounts of vitamin D3 had a 60% or higher chance of not getting cancer compared to their peers. In a review of data from 177 countries, extrapolation of results showed that as many as 50% of breast and colon cancer cases could be prevented by increasing vitamin D intake. According to the study, the median adult intake of vitamin D in the US is only 230 IU per day, versus the researchers' recommended 2000 IU per day. For every increase of 25 nmol/L in people’s blood, there was a 34% cancer risk reduction, with the most common cancers being those of the lung, colon and pancreas.

Vitamin D can protect women with pale skin from breast cancer and it can reduce the risk of pancreatic cancer especially in young men. In fact vitamin D appears to reduce the risk of other cancers as well such as colon-, prostate-, Hodgkin’s Lymphoma and lung cancer. A recent study of vitamin D intakes found increased intakes of the vitamin were associated with a 24% reduction in the risk of developing estrogen and progesterone positive breast tumours.

One explanation for cancers being reduced by vitamin D is vitamin D receptors (VDR). These are found in the tissues of the body and help maintain cellular growth and prevent cells from becoming malignant. Studies on both colon cancer cells and healthy prostate cells have demonstrated protective effects of vitamin D at a cellular level.

Vitamin D deficiency is widespread in developed countries such as the US, UK, Australia, New Zealand and Europe. US studies have found vitamin D deficiency is present in approximately 30% to 60% of the general population. Increasing vitamin D levels just a small amount would outweigh the benefits of most of the medication people take for chronic illness including medication taken for cardiovascular disease.

Considering the evidence, there is an overwhelming agreement between vitamin D researchers that current recommendations of 200 IU per day for children and adults up to 50 years of age for vitamin D need to be increased to 800 IU to 1000 IU vitamin D3. Numerous studies have shown supplementation to be effective in raising blood levels of Vitamin D levels with no evidence of intoxication reported in either the short- or long-term trial.

Sensible sun exposure (or UVB irradiation) along with supplements are required to satisfy the body's vitamin D requirement. To achieve adequate levels of vitamin D we need to get one to two hours of sensible sun exposure a day. This should be during the morning or late afternoon. While it is prudent to avoid too much sun it is important to remember that the costs of vitamin D deficiency far outweigh the cost of skin cancer and some sun may also be necessary to reduce skin cancers. Remember, we did evolve in the sun but maybe not the hot midday sun, especially for those with fair skin.

Obesity causes cancer

According to the American Institute for Cancer Research, more than 100,000 cancer cases in the U.S. are linked to excess body fat - most of them are preventable. Obesity accounts from between around 50 to10 % of various types of cancer.

49% of endometrial cancers (20700 cases per year)
35% of esophageal cancers (5800 cases per year)
28% of pancreatic cancers ( 11900 cases per year)
24% of kidney cancers ( 13900 cases per year)
21% of gallbladder cancers (2000 cases per year)
17% of breast cancers (33000 cases per year)
9% of colorectal cancers (13200 cases per year)

Fat cells used to be thought of as inert stores of calories. We now know that fat is a complex and multifaceted organ system. Recent theory suggests that we put on increased weight over winter as a part of our immune system response to assist in the protection against bacteria and viruses. Short term inflammation is essential for our response to toxic invaders. However, in obese people fat becomes a major producer of inflammatory and chronic inflammation is closely linked with most (if not all ) forms of chronic illness including cancer. Additionally, in obese people, the adipose cells have the incredible capacity to increase their diameter 10- to 15- fold. The enlarged adipose size results in greater production of regulatory factors and unbalances the normal metabolic pathways, resulting in systemic chronic inflammation.

Recent research has found that infiltration of macrophages (white blood cells which are part of the immune system) in subcutaneous adipose tissue is greatly increased in obese people by up to 50% of cell content compared to 10% in lean subjects. The small number of macrophages in lean subjects are also category M2 whereas the recruited macrophages in obese persons are of category M1. M1 are responsible for the production of pro inflammatory cytokines (messengers) such as Interleukin 6 (IL6), Tumor Necrosis Factor alpha (TFNα) and monocyte-chemoattractant protein-1 (MCP-1). All of which have been linked with increased risk of cancer and have shown to be responsible for the activation of factors know to be active in several tumour types in humans.

Recent research has also demonstrated a close a link between inflammation and tumour growth. Including studies showing increased weight gain significantly associated with increased death rates for all cancers. Other studies have also demonstrated that dietary and genetic obesity strongly enhances the development of cancers in laboratory animals.

The research is now overwhelming. Obesity is a major and avoidable cause of many cancers.

Also check out my blog on What is cancer

Tuesday, July 12, 2011

milk and calcium myths

Milk Myths

I grew up in the 1960s, when every kid in Australia was given a free bottle of milk just before morning tea at school. I thought it was great. Now, 50 years on, maybe it was a big mistake. Today I see many people with allergies and reactions to milk; chronic illness related to milk is skyrocketing. Even the smallest amount of milk now causes me to have lots of mucus. Despite advertising claims, cow’s milk, as we know it, is not a healthy drink. Not only is it not a great source of calcium for bones but also there is mounting scientific evidence that consuming processed dairy has negative health consequences from colic in kids to breast cancer.

Milk is not the food it used to be. It is so highly processed that it no longer resembles the milk our ancestors consumed thousands of years ago. Today a cow (a Friesian cow) gives 25 litres per day compared to just a few litres daily that cows produced centuries ago. Modern farming practices have extended the milking period to 305 days per year (1). Pasteurization was necessary 100 years ago due to poor hygiene but today it destroys the enzymes that make milk easy to digest, particularly for infants. All milk, including human milk, comes with a rich array of nutrients, including 20 or more enzymes to help digest itself—such as lactase to digest lactose. Homogenisation forces the particles of fat through a series of sieves to mix it with water, just so cream does not settle on top. It then becomes difficult for the body to determine whether it is fat or water. Normally the two don’t go together.

Modern milk has been sold to millions of people around the world based on its supposed benefits in building healthy bones. The research shows that milk has, at best, questionable benefits for preventing osteoporosis and bone fractures and is in fact linked with many forms of chronic illness including cancer, cardiovascular disease, multiple sclerosis, diabetes type 1, Parkinson’s disease, gut disorders and allergies.

Calcium for bones?

Findings from long-term studies have cast doubt on the value of consuming the large amounts of dairy and calcium currently recommended. In particular, high calcium intake does not actually appear to lower a person’s risk for osteoporosis (2). There is evidence that the recommended levels in the West are too high, with countries such as India, Japan and Peru having an average daily calcium intake around 300 milligrams (mg) per day, less than half that in the Western world, and no increase in the incidence of bone fractures (3). If increased dairy consumption leads to reduced osteoporosis and fracture rates, then multi-country epidemiologic studies would show that countries with the highest dairy consumption, such as Australia, New Zealand, the U.S. and U.K., would have the lowest osteoporosis and fracture rates yet this is not the case. Although the consumption of dairy products in the United States is among the highest in the world, osteoporosis and fracture rates are simultaneously high (4,5).

Other areas of research also support this finding. A comprehensive literature review found that of 57 evidence-based scientific studies of dairy foods’ effects on bone health, “53% were not significant, 42% were favourable and 5% were unfavourable. Of 21 stronger-evidence studies, 57% were not significant, 29% were favourable and 14% were unfavourable” (6). In other words, despite the huge amount of money the dairy industry invests in research, there are many studies showing that milk has no benefit and that it has potentially negative effects.

In one study, a low intake of calcium (less than one glass of milk daily) was not associated with a significantly increased risk of any fracture, osteoporotic fracture or hip fracture and no significant relationship was observed by age for low milk intake and hip fracture risk (7). There was also no difference in risk of fracture or osteoporosis between men and women. In the Harvard Nurses’ Study of 77,761 mostly white women aged 34-59 who were followed over a 12-year period, those who drank little or no milk compared to the high milk drinkers (three glasses or more) had no reduction in risk of hip or arm fracture (8). The bottom line is that the studies do not support what we are constantly told by the dairy industry, media, governments and dieticians. So why do we keep getting told this message? If it was so clear cut to warrant a health message from the government you would expect all the research to support it. Not only is this not the case but there is also plenty of research to show the complete opposite.

It is simplistic to think that the calcium in our diet goes straight to our bones. The “calcium balance” is where the calcium intake from food is compared to the amount of calcium lost through excretion and unabsorbed mineral in sweat, faeces and urine. The remaining amount, whether positive or negative, is the calcium balance (9). If a person’s calcium balance is positive, there is an excess of calcium in the body, a proportion of which goes directly to increasing bone mineral density (10). If, however, a person’s balance is negative, more calcium is lost than is consumed, and therefore calcium from bone mineral must be reabsorbed into the bloodstream to provide the difference (10). This causes a lowering of bone mineral density and therefore is a factor in the onset of osteoporosis and fracture risk in later life 10. The amount of calcium that is absorbed and retained in the body from dairy products is about 30% of the total calcium consumed (9).

A number of factors help explain this discrepancy. First, calcium absorption is inversely related to the amount of calcium consumed in the diet, with low levels of calcium intake resulting in the most efficient absorption rates (11). This phenomenon may be partly responsible for the fact that many non-dairy-consuming societies around the world have few adverse health effects (such as osteoporosis and fracture) even with relatively low calcium intake (12).

Dairy products contain significant levels of protein, fat (in cheese, cream, butter and full cream products), sugar (in flavoured milks and yoghurts), sodium and phosphorous, all of which reduce the bioavailability of the calcium it contains. The presence of proteins has been demonstrated to have a negative influence on calcium absorption. Protein in milk causes an increase in urinary calcium excretion (13). Some dairy products, especially processed cheeses, clearly increase the urinary excretion of calcium as a result of their increased sodium, sulfur-containing amino acid, and phosphorus content (14). Interestingly, high-fat dairy products such as cheese, butter, chocolate and ice cream have also been found to be acid-forming foods (like protein and alcohol) (15,16), and so the question is raised: how effective are dairy products at ensuring bone health and are there other, more effectual dietary alternatives?

What is good for the bone

While protein has a negative effect on calcium availability, magnesium and potassium, which are found in high concentrations in plants we eat as food, have been recognized as having a largely positive influence (17). These minerals appear to decrease the rate of bone attrition and urinary excretion of calcium from the body when present in moderate quantities. Milk has a poor calcium-to-magnesium ratio and contains low concentrations of potassium, while plant sources have a much higher concentration. Potassium appears to buffer the effects of acidic foods by protecting against calcium loss from the renal acid load of protein (6).

Vitamin D, derived primarily from sunlight, certain oils (including cod liver oil) and fortified foods (including dairy products), is the major nutritional factor affecting calcium absorption (4). Scientific studies have repeatedly shown that inadequate vitamin D levels result in impaired calcium absorption in the body (4,9). The role of vitamin D in milk is also found to significantly lower the risk of fracture (5). Many people in Western populations are now recognised as being deficient in vitamin D (see my earlier article on the topic).

The adequacy of non-dairy centred diets to support bone health has been demonstrated by a recent study conducted in Spain among adolescent males. It reported that a Mediterranean-type intervention diet based on fresh fruits and vegetables, olive oil, fish and legumes provided the same amount of dietary calcium as the subject’s usual (baseline) diet, although the food sources of that calcium varied significantly. The intervention diet also resulted in a significant increase in calcium absorption and retention, while significantly reducing the amount of calcium excreted in urine. This may be partially attributed to the lowered potential renal acid load of the diet, particularly from a high intake of fruit and vegetables (19,20). Therefore, the study concludes, the adoption of a Mediterranean-style diet low in dairy can assist in maximising peak bone mass and preventing osteoporosis without milk or other dairy products (21).

Perhaps the most important part of the bone mass equation is a healthy mixture of minerals from unprocessed plant foods and physical activity, particularly weight-bearing exercises (22,6).
In response to learning these facts about milk, many people ask me, “But where can we get our calcium?” No other animal on the planet experiences bone problems at the rates humans do. Most other animals get calcium from their normal, often vegetarian diet. Our primate cousins, even those such as the gorilla which are much heavier and stronger than us, get all the calcium they need from unprocessed plant foods and cows get theirs from grass and have an excess of calcium.

So where should we be getting our calcium?

References

1. Maruyama et al. 2010
2. Papadimitropoulos et al. 2002
3. Babbar et al. 2006
4. Lanou et al. 2005
5. Feskanich et al. 2003
6. Weinsier and Krumdieck 2000
7. Kanis et al. 2005
8. Roba 2005
9. Allen 1982
10. Atkinson et al. 2008
11. Gallagher et al. 1979
12. Jackson et al. 2001
13. Beresteijn et al. 1990
14. Heaney et al. 1982
15. Alexy et al. 2008
16. Buclin et al. 2001
17. Tucker et al. 1999
18. Allen 1982
19. New 2003
20. Remer 2000
21. Seiquer et al. 2008
22. Black et al. 2002

Wednesday, July 6, 2011

what makes a good workplace wellness program

Organizing and running a WW program is not just about getting a speaker (like me) into motivate people for a day or two. They need real long term planning. Unfortunately the majority of WW programs that companies invest in are half-baked with little or no valid research to suggest that they will work. In this blog I have presented some guidelines from my research to help you get started. They need to be comprehensive, well planned and well thought out. From a survey of 89 organisations in Missouri private sector worksites with 250 or more employees that offered a worksite health promotion program, it was concluded that “the number of programs offered does not appear to be as important as depth of level of intervention. Have a smaller but more concentrated program rather than trying to run lots of smaller projects.

To facilitate long term behaviour change and achievement of organizational goals, it was recommended that programs should attempt to include the following four levels of intervention:
• I) Communication/Awareness.
• II) Screening/Assessment
• III) Education/Lifestyle Programs
• IV) Behaviour Change Support Systems

In support of this the Glaxo Wellcome corporation identified critical success factors for the success of their Health and Wellness program as
• Senior management support
• Contracting
• Focus
• Longitudinal programming
• Stages of readiness for change model
• Integration with other health programs
• Integrated data analysis
• Feedback/continuous improvement
• Employee surveys
• Continuous marketing

A 12 month study to determine the effectiveness of workplace stress management programs was carried out among five hundred and one participants. Full intervention participants showed a more rapid reduction in negative responses to stress than did participants from the other groups. Full-intervention subjects also reported fewer days of illness than subjects in the other groups. These results indicated that a work-site program that focuses on a complete program can significantly reduce illness and healthcare utilization.