A worksite intervention to reduce the cardiovascular risk: proposal of a study design easy to integrate within Italian organization of occupational health surveillance

Abstract

BackgroundDespite the substantial amount of knowledge on effectiveness of worksite health promotion (WHP) in reducing cardiovascular disease (CVD) risk, WHP programs are not systematically applied in Italy. The aim was to design an intervention easy to integrate within the Italian organization of workplace health surveillance.MethodsWe used the “pretest-posttest design”. Workers were employed in multiple occupations and resident in Veneto region, Italy. Occupational physicians (OPs) performed all examinations, including laboratory evaluation (capillary blood sampling and measure of glycaemia and cholesterolemia with portable devices), during the normal health surveillance at worksite. CVD risk was computed based on sex, age, smoking habit, diabetes, systolic pressure and cholesterol level. After excluding those with <40 years of age, missing consent, CVD diagnosis or current therapy for CVD, missing information, CVD risk <5%, out of 5,536 workers 451 underwent the intervention and 323 male workers were re-examined at 1 year. CVD risk was the most compelling argument for changing lifestyle. The counseling was based on the individual risk factors. Individuals examined at posttest were a small fraction of the whole (6% = 323/5,536). In these workers we computed the ratio pretest/posttest of proportions (such as percent of subjects with cardiovascular risk >5%) as well as the exact McNemar significance probability or the exact test of table symmetry.ResultsCVD risk decreased by 24% (McNemar p = 0.0000) after the intervention; in a sensitivity analysis assuming that all subjects lost to follow-up kept their pretest cardiovascular risk value, the effect (−18%) was still significant (symmetry p < 0.0000). Each prevented CVD case was expected to cost about 5,700 euro.ConclusionsThe present worksite intervention promoted favorable changes of CVD risk that were reasonably priced and consistent across multiple occupations.

Efetividade da intervenção educativa no conhecimento de homens relacionado às doenças cardiovasculares

“…(6) Despite the increased interest in this kind of studies, however, not many reports are found in the literature because, when the studies are developed in the work environment, they can be impaired by the existence of a research bias, which interferes in the internal validity of its results. (18) It is highlighted that, like in this study, the possibility of information exchange between the groups is a very frequent bias when the study is developed in industrial companies/ services. (19) Independently of whether information was exchange between the groups, another aspect that should be considered in the comparison of the results with other studies is the difference between the populations, as this study only involved men, while most other studies, mainly international research, which have identified a significant increase in knowledge on risk factors for cardiovascular diseases, were developed with female populations (2,24) or populations with a large share of female participants.…”

“…This can easily happen with educational interventions in the work environment, as the participants naturally share/disseminate information with other colleagues, which can threaten the internal validity of results. 18) In addition, this type of situation is unwanted to assess an intervention, as it reduces the differences observed between the intervention and control groups. 19) Nevertheless, from a Public Health perspective, the fact that the control group benefited from the intervention due to the information exchange is something positive, as these participants also increased their knowledge about the risk factors for CVD, enhancing the prevention of these outcomes.…”

“…(18) Studies that assessed the knowledge on the cardiovascular risk using different types of questionnaires (20,21) and with interventions that took between six (20) and 12 (21) months found a significant increase in the mean knowledge scores. Also, a study in the United States, involving 2,787 participants, showed that the educative intervention can be effective to change knowledge on cardiovascular diseases, even when undertaken for only three months, and that the benefit for knowledge can last beyond 12 month after its end.…”

“…Also, a study in the United States, involving 2,787 participants, showed that the educative intervention can be effective to change knowledge on cardiovascular diseases, even when undertaken for only three months, and that the benefit for knowledge can last beyond 12 month after its end. (22) The interest in research involving workers, aiming to help them improve the health condition and efficiency at work has increased especially in groups from the private sector, (18) and the educative intervention has been appointed as a feasible alternative in the work environment. Hence, the importance of this type of study is highlighted, as the concept of health promotion in the workplace is increasingly gaining relevance, to the extent that both public and private organizations acknowledge that success in the job market can only be achieved with a healthy, qualified and motivated workforce.…”

Factores de Riesgo Cardiovasculares en Trabajadores de una Empresa Productora de Grasas y Aceites Vegetales

“…Los programas de promoción de la salud en el sitio de trabajo pueden modificar factores de riesgo como inactividad física, tabaquismo, hipertensión, dislipidemia, mala alimentación, hiperglucemia y estrés psicológico elevado; y aunque los empleadores consideren que la tarea de mejorar la salud de sus empleados le corresponde a las instituciones de salud, debido a las jornadas de trabajo las personas no pueden asistir a los servicios de atención, el escenario laboral entonces se convertiría en una opción para fomentar estilos de vida saludable (18,19). El diseño de corte transversal en una limitación de esta investigación porque no permite establecer inferencias causales entre las variables estudiadas, aunque si la postulación de hipotesis causales que permitan plantear futuras investigaciones.…”