INTERVENTO DI PROMOZIONE DELLA SALUTE SUGLI STILI DI VITA PER IL PERSONALE DIPENDENTE DI UN GRANDE OSPEDALE MILANESE: VALUTAZIONE DELL'EFFICACIA DI UNA TECNICA DI COUNSELING MOTIVAZIONALE BREVE
Creators: name: BARBERI, CLAUDIA ELEONORA
Publisher: name: Universit� degli Studi di Milano
Year: 2017

description: In the last 20 years epidemiological studies in the Western Countries have shown a gradual increase of overweight-obese cases and a similar increase in chronic-degenerative illnesses spread. These conditions cause sick leaves and relevant limitations of working abilities. A growing life expectancy, then, leads to reconsider the senior worker?s position in the job marked, with a working population exposed also to risk factors typical of a non-working-age population.
The Work Health Promotion is the most common way to spread the adoption of healthier habits to reduce illnesses and deaths rate caused by several pathologies, thus contributing to keep a worker more efficient and fit.
In the past years, the different initiatives and projects with the purpose of realizing a better health promotion obtained a limited outcome because they used a prescriptive or just an informative approach. The innovative nature of this WHP project is the new way of taking into account workers? awareness and motivation: patients have to become responsible for their own wellness.
?Ospedale InForma? is a WHP pilot project which aims to spread the consciousness of a healthy lifestyle through leaflets and diffuse the technique of a minimal motivational counselling. 
The first aim of the study is to evaluate if this method could be successful in changing workers? behaviour. Other studies have already used counselling techniques, but without describing them in a clear and precise way, and therefore making it difficult to be repeated. The second aim of this study goes in this direction: set up and define guidelines for future WHP projects in different working realities.
The employers of Fondazione IRCCS C� Granda Ospedale Maggiore Policlinico in Milan have been considered a proper sample for this study regarding: number, availability, supervision, different working positions and shifts.
The project was set up as follows:
Step 1 - Contact the employees in their periodic visit and record the following data: age, sex, job and shifts, BMI, glycaemia, total cholesterol, triglyceride, TYG index [ln (triglyceride * glycaemia /2)] and triglyceride/cholesterol HDL ratio.
Step 2 ? Conduct an interview based on a food questionnaire using the technique of a nutrition motivating minimal counselling and hand out a list of general advices for a correct life style. If necessary, suggest a follow-up after 6 months.
Step 3, 4, 5 ? Improve healthy behaviour through the use of detailed leaflets, healthier dishes introduced in the canteen, healthy food vending machines and providing opportunities and tools for physical activities at work. Use of questionnaires to assess the appreciation of food changes in the canteen. 
The recruitment phase and the first set of interviews were concluded in July 2015.
At the end of this phase, 1002 employees took part in the project, i.e. 75,85% n.855 (85,32%) of them were invited to a follow up after 6 months.
The sample, aged 45 (SD 10,3), is made up of 73,25% of women, 26,65% of men. 44,48% of men and 32,82% of women are overweight-obese.
The most represented jobs are: nurses (33,9%), auxiliaries (15%), medical technicians (14,9%), medical doctors 14,7%. 
Night shift workers are 45% of the sample, day shift are 14,1% and 39,2% are day workers. The biochemical parameters analysed, TyG index and triglyceride/cholesterol HDL ratio, are on average in the standard. 
The NSAS questionnaire outputs showed that eating habits are not different per shift (p=0,9) or age (p=0,504) while they are different per sex (p=0,006) ? better among women - and different per job (p&lt;0,001) ? better among medical technicians and doctors.
In subjects returned for the follow up (n.364), lifestyle habits have improved (p-value&lt;0,0001) as well as the use of antioxidant foods (p-value&lt; 0,0001), even if there was no reduction in BMI (p-value 0,7). 
In follow up, those who have not reached the agreed aim because they have not changed their habits, got the worse questionnaire scores (total score p&lt;0,0001) and antioxidant score (p=0,0013). The analysis of the biochemical parameters shows that, on average, there are no significant statistic differences. 
Those who have not modified their lifestyle got worse values compared to the ones who improved their habits. This is especially true for total cholesterol (p= 0,0296) and triglycerides (p=0,0039). The most feasible behavioural change agreed was an increase of fruit and vegetables consumption (27,13%).
Overall, 51,65% of the employees reached their goal, 17,86% of them partially succeeded in their objective, 30,49% failed it. 69,51% follow-up subjects modified their habits.
Regarding the questionnaire proposed in the canteen, 9 months after the beginning of the project, 70% of people involved modified their habits as a consequence of the given indications and the consequently to indications given and new proposed meals.
The study has limitations related to the absence of a control group, the small number of subjects who presented at follow-up and the small number of subjects with blood tests before and after the realized project.
This study could be defined as a good practice in Health Promotion. The scores obtained through the Dors assessment grid and the motivational minimal counselling technique, together with the changes brought to the working environment, could be signs of healthy changes in workers? lifestyle. 
The structure of the project seems to be easy enough to be used in different workplaces and supplemented by the Healthy Surveillance System. The strong points are: basic and economical measures to evaluate health and lifestyle and the possibility of reproducing the experience with no additional costs. The absence of exclusion criteria could increase the interest in the project, making it useful in different working environments. The study appears to be a valid preliminary contribution to future operative guidelines. 
It could be advisable to proceed with the project as it could become a systematic program to make employees aware of a better lifestyle. Then, a one-year-after follow up could assess the effectiveness of the given suggestions and give useful feedbacks to improve future assistance. 
One possible development of this study would be to evaluate the project?s applicability to other work environments in order to verify its usefulness in creating effective guidelines.