Typhoid fever is a common illness in developing countries, where water and food supplies are often contaminated with the Salmonella typhi bacteria. There are at least 16 million cases of typhoid fever every year, resulting in more than 600,000 deaths. S. typhi has become increasingly resistant to antibiotics, and the current vaccines available confer only 70 percent protection in adults and older children and do not protect young children at all. A new and more effective vaccine, especially one that protects children and adults alike, could offer major public health gains.

Researchers from the National Institute of Child Health and Human Development, led by Feng Ying C. Lin, M.D., M.P.H., evaluated the efficacy of the Vi-rEPA vaccine in more than 11,000 children aged two to five years in Vietnam. Each child received two injections of either Vi-rEPA or an inactive saline placebo, given six weeks apart. The study was double-blind and randomized, thus neither the researchers nor the children knew which injection had been given. Cases of typhoid were diagnosed by identifying the S. Typhi in blood cultures, after a child had experienced 3 or more days of fever.

In the 27 months that followed, S. typhi was identified in 4 of the 5525 children who had received two injections of the Vi-rEPA vaccine and in 47 of the 5566 children who had received two injections of placebo. Thus the vaccine was 91.5 percent effective in protecting against the disease. An additional 771 children received only one injection of either Vi-rEPA or placebo. In this group, 1 child was diagnosed with typhoid fever in the vaccinated group and 8 children were diagnosed in the placebo group (vaccine efficacy, 87.7 percent). No serious adverse reactions occurred due to the vaccination.

Further, among the total number of children with typhoid fever who required hospitalization, none were from the vaccine group.

The results show the efficacy of a typhoid vaccine in young children, for whom no effective vaccine was previously available,” state the authors.

They add, “It is likely that Vi-rEPA will be at least 92 percent protective for persons older than five years of age, including military personnel and travelers to areas in which typhoid is endemic.”

In an accompanying editorial, Richard L. Guerrant, M.D., and Margaret Kosek, M.D., of the University of Virginia comment on the potential uses for an effective typhoid vaccine. They state that if the vaccine is effective in infants “it could play an important part in controlling typhoid fever in areas of endemic disease.”

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One of the most successful member integration programs I’ve seen is being used at the three Skyline Clubs in Virginia. The program was developed by Renata Manning and it’s called the Fitness Edge Program. In essence, people are given a Fitness Edge card and, in order to win their T-shirt and other prizes, they have to get the card checked off in each department of the club. They are given a free introductory clinic or lesson in each area/department, and then their instructor signs off on their card. They have 90 days in which to collect all their signatures.

This program gets them oriented and helps them to meet other new members by registering all new members to participate at once.

Programs like Fitness Edge are also a wonderful way to integrate new staff into your facility so that they can promote all of your different activities.

Staff members who have tried racquetball, tennis, aquatics classes, aerobic classes, basketball, wallyball, etc., are much more likely to promote these activities (or at least speak intelligently about them) to your members.

Staff bonuses for participating in all the activities can include massages, prizes, cash incentives, passing probation, etc. Letting staff (especially full-time staff) try some of your “extra cost” programs (like tanning, massage and weight-loss programs) will help them to sell these services for you.

Bagshaw identifies media coverage of the advantages of lifting weights as a major force behind the growing interest in group strength programs: “It’s hard to pick up a health or fitness magazine without finding something related to the importance of resistance training.” Donna Meyer, the corporate director of group exercise for 24 Hour Fitness and the IDEA 2000 Program Director of the Year, also acknowledges the media’s role in cultivating a more educated client base. “People are taking more control of their health and fitness by learning what programs are of benefit to them and why they are important,” she says.

Minimizes intimidation

“It can be very intimidating trying to fend for yourself on the weight room floor,” notes Bagshaw. Not knowing what resistance exercises to do or how to perform them often prevents patrons from spending adequate time building muscle. But the user-friendly format of muscle conditioning classes changes that.

“Many people are intimidated [to]do exercises alone in the weight room, because they feel very exposed, like they might do an exercise incorrectly and look silly,” observes Cleland. “In a group situation, it’s a lot easier to blend into the crowd. Everyone’s too busy working on their own technique to bother watching others.”

Promotes safe and effective exercise

Training under the guidance of a fitness instructor promotes safety because members are more likely to perform exercises correctly — both in classes and on their own. “In muscle conditioning classes, participants get accurate information and ideas for exercises they can perform later when working out alone,” points out Prolo. Learning how to perform the exercises properly reduces the risk of accidents and/or injury, an obvious plus for both fitness clientele and facilities.

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How it Works: The key to Propecia’s success is that it inhibits the androgens responsible for baldness. When finasteride is present, dihydrotestosterone range decreases, so this procedure is maintained until the DHT (dihydrotestosterone) stages have reduced enough that hair advancement can start to occur, and the effects of routine male baldness can be minimized. Finasteride lessens the effect of dihydrotestosterone on the hair follicles and, as a consequence, strengthens the roots which keeps the hair from thinning or falling out.

DOSAGE: Available in the form of a tablet, Propecia should be used right away after proper consultation with a licensed dermatologist. The prescribed dose of this drug is based on the extent of baldness or other health issues. The usual dosage of propecia is 1 mg. daily. It is important to maintain the dosage schedule for Propecia unless your doctor advises it. It must be used according to specific instructions and for specific issues. You must observe some special care instructions when using cheap Propecia. It is important to avoid excess dosages, and it is ideally used at a set, regular time.

Compare Propecia Price: Some of the most common side effects of propecia are lower libido, erectile dysfunction and less ejaculatory volume. Side effects of Propecia are not common and they are often hard to determine. Additional side effects of the drug include skin rash, tender breasts, respiratory problems and testicular complaints.

Dubbed “Chalk Talks,” the quarterly meetings focus on goal setting and achieving short-term successes, as opposed to long-term annual goals traditionally measured by a scoring system. “We felt that goal setting is a superior tool in developing staff performance because [goals are made] specific, measurable, attainable, realistic and tangible,” explains club manager Paula Potter.

Potter says both staff and managers agree that the Chalk Talks are less intimidating than traditional performance reviews, particularly because each meeting carries less weight than an annual evaluation, and employees come away with clear, more progressive direction.

Additionally, staff is encouraged to provide management with feedback and voice any concerns related to their position.

To reward employees who meet quarterly goals, the club has established an appreciation fund that honors staff with functions like rock climbing outings, parties and individual rewards like movie tickets. According to Potter, the program is a success because it’s based on a simple formula: “When managers are providing constant feedback and direction, it leads to happy, motivated, productive employees… and, when our staff are happy, they give better customer service.”

AEDs at work

Courts Plus Health and Fitness Centre, an Elmhurst Park District Facility, in Elmhurst, Ill., has had an AED since August1996. Says Pamela J. Stoike, manager of fitness and racquet sports at Courts Plus, “We purchased the AED for a number of reasons. In addition to my duties as the full-time manager of fitness and racquet sports, I am also a licensed paramedic. As a result, I knew that AED technology was available, and that AEDs were very easy to use. So easy to use that the lay person (someone with no medical training) could successfully use the device without a lot of advanced training and knowledge.”

Stoike also states that having an AED is about raising the standard of care within fitness facilities. “AEDs have the potential to save many lives, and [they] are already proving that lives are being saved,” she says.

Courts Plus knows that AEDs can save lives firsthand, since one was used at the facility to save a member. This past year, a 43-year-old man collapsed on the track. Staff members began two-person CPR and, when the AED arrived, they attached the pads to the man. The AED immediately advised a shock. After the second shock, the man had a pulse. At that time, the paramedics arrived and transported him to the hospital.

Says Stoike, “I am happy to report that he is doing quite well and is back at the club working out. Needless to say, he is quite grateful that our facility had an AED, and that he was given this second chance. As you can probably tell, I highly recommend the use of AEDs in fitness facilities.”

Although the Cooper Fitness Center in Dallas, Texas, doesn’t have a dramatic story to tell, it still has an AED, and recommends that other facilities have one, as well. Says Heather Henderson, program director, “The Cooper Fitness Center wants to provide a quick and efficient response to all emergencies. The AED allows our employees to do this. We follow the guidelines set forth by the American Heart Association, which strongly supports AEDs in public facilities. But, most importantly, it gives our members a feeling of safety.”

The survey is a spin-off of a larger report from Partnership for Prevention, which includes public policy recommendations based on the nine leading causes of premature death. As reviewed in the report, the top nine causes are tobacco use, poor diet/sedentary living, alcohol abuse, infectious diseases, toxic agents, firearms, sexual behaviors, motor vehicle accidents and illicit drug use.

Using a nationally representative sample, researchers interviewed 1,000 American adults. When asked, “What do you think are the leading causes of premature death in the United States?” only 23 percent of those surveyed correctly identified cigarette smoking as the No. 1 cause of premature death in this country.

Roughly 2 million people die each year in the United States. According to government reports, as many as a half of these deaths are preventable.

Smoking is estimated to cause approximately 400,000 annual deaths, constituting almost 40 percent of all preventable U.S. deaths each year. While consumers may associate cheap cigarettes primarily with lung cancer, emphysema and other lung diseases, smoking is also a major cause of cardiovascular disease (including heart disease and stroke), impotence, and cancers of the mouth, tongue and esophagus. Cigarette smoking also contributes to cervical, colorectal and kidney tumors, blindness and hearing loss.

Sixty percent of those surveyed believed that motor vehicle accidents, illicit drugs or firearms topped the list of the leading causes of premature death. Yet, the mortalities from these causes combined make up less than 10 percent of the approximately 1 million preventable yearly deaths.

“Americans are confused about what’s really killing them” said Partnership for Prevention’s president Ashley Coffield, MPA. “Highly publicized issues like violence and AIDS tend to shape the public’s consciousness about health hazards,” she added.

As this and other studies suggest, popular media coverage is often a poor gauge of public health realities.

For example, an ACSH evaluation of health reporting by the widely respected TV newsmagazine “60 Minutes” revealed a mediocre overall performance in accuracy, objectivity and fairness.

“Americans rely on television, newspapers and magazines for much of their health information,” said Dr. Gilbert Ross, ACSH’s medical director. “That’s why it’s so critical that the media get their stories straight. Trusted shows like ’60 Minutes’ have a responsibility to provide accurate and balanced information to the public, which they’re not doing well now,” Dr. Ross said.

Commenting on the Partnership for Prevention survey, Ross stated, “It’s clear from this survey and others that despite what the tobacco industry says, most Americans are not aware of the real causes of premature death, especially smoking.”

The Aralia program provides many of its services in a 4,800-square-foot facility in Nortel’s Brampton Centre office in Toronto. There is a warm, welcoming reception area with soothing videos of outdoor scenery, motivating health and wellness phases etched in the glass entryway and comfortable reading chairs. A massage therapist helps reduce stress in quiet, private rooms with relaxation videos and audiotapes, dimmed lighting and biofeedback equipment. The facility also contains a wellness library with more than 700 resources, as well as the services of 15 staff members, including a medical consultant, physiotherapists, nurses, a dietitian and a back care specialist. This positive blending of medical and wellness services creates a unique and comprehensive approach to employee health and well-being.

Other program components are provided outside of the Wellness Centre. They include a 16,000-square-foot fitness facility, indoor rock-climbing walls, outdoor volleyball and basketball courts, and a 2.1-km walking trail with five exercise stations.

Also available are a Zen garden for quiet reflection, a private “blood pressure alcove” for stress reduction, a spirituality room where employees of all faiths can worship during the work day, and even a “food choices board” in the cafeteria to encourage healthy meal selections. It’s all part of Aralia’s mission to optimize the potential of Nortel’s employees by enabling them and their family members to assume greater responsibility for their health and well being.

The program also includes popular classes on relaxation training, finding joy in your life, parenting, eldercare and personal fitness training. These varied offerings have produced significant cost savings for Nortel. The company has saved more than $1.90 in health care expenses for every $1 spent on wellness — a ratio that is very high by Canadian standards because Canada’s system of socialized medicine covers medical expenses that in the U.S. are picked up by corporations. This win-win situation has resulted in more satisfied employees and improved productivity.

Known as CPR for Managers, or Critical success factors Progress Review, the program identifies factors, such as budgetary goals and customer service, that are measured both in terms of commitment (following through on what you’ve agreed to do) and growth (opportunities for improvement in personal performance as well as contribution to the department or club).

Managers are first asked to develop their own critical success factors and then submit them to the general manager for review. A bonus system, paid quarterly, is in place to reward those who meet the success objectives.

According to general manager Greg Lappin, helping managers understand where the majority of their energies should be focused has helped put them more at ease. “It really helped clearly define their top priorities,” Lappin says. “[And] tying the bonus plan to a few measurable factors was a big plus.” Lappin says CPR for Managers is successful also because it helps him to hold department heads accountable in a fair manner that promotes consistency and equality.

Researchers from Harvard School of Public Health, Harvard Medical School, and Brigham and Women’s Hospital in Boston examined the relationship between levels of physical activity and occurrence of coronary heart disease and stroke among women with diabetes mellitus. They found that “among diabetic women, boosted physical activity, is associated with substantially reduced risk for cardiovascular disease.”

The study included 5,125 female nurses who were part of the larger Nurses’ Health Study. All participants had type 2 diabetes — the more common form of diabetes in which the body produces insulin but does not use it properly — and all had no prior history of heart attack or stroke. The nurses completed a questionnaire about medical history, lifestyle and physical activity at the time of entry and then every two years thereafter. They also conducted two sets of analyses. First, they examined the long-term effects of moderate to vigorous activities, and second, they looked at the specific effects of regular walking. The study started in 1980 and ended in 1994.

During the fourteen years of follow-up, the researchers documented 225 new cases of CAD and 98 new cases of stroke. For the long-term effects, there was a strong association between physical risk and activity of cardiovascular events, with the risk of coronary heart disease and stroke decreasing as the level of physical activity increased. Indeed, “diabetic women who spent 4 hours per week performing moderate or vigorous exercise had an approximately 40% lower risk for cardiovascular disease than those who did not,” the authors noted. A similar reduction in risk was also found for stroke.

Looking specifically at the effects of regular walking, the authors reported strong evidence that “regular walking, especially brisk walking, is associated with lower risk for coronary heart disease and stroke among diabetic women.”

The authors made it clear, however, that the findings from this observational study do not mean that there is a cause-and-effect relationship. In other words, they cannot conclude that an increase in exercise is directly responsible for a reduction in cardiovascular events. Such a statement would require that prospective randomized clinical trials be conducted to allow the researchers to control which subjects would exercise and which would not, and then measuring the changes that result.

Nevertheless, the authors concluded that “[b]y using more detailed and repeated measurements of physical activity over 14 years of follow-up, our study provides strong evidence that increased physical activity, including such moderately intense exercise, may substantially reduce incidence of stroke and coronary heart disease among diabetic persons.”

“Because walking is accessible and relatively safe and can be easily incorporated into daily routines, it is a form of exercise that is practical and suitable for most diabetic patients, especially elderly persons. Nevertheless, optimal planning and precautions are needed in any exercise program for diabetic patients so that exercise-induced hypoglycemia and other complications can be minimized,” they added.

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