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High rates of injury, particularly those for back injuries, at an offshore petroleum unit were addressed through an intensive wellness program initiated in 1991. The number of all types of injuries, including back injuries, decreased between 1991 and 1995. The number of back injuries decreased from nine in 1987 to four in 1992 and was zero in 1993. Although there are inadequate data to provide power for a significant result, other criteria suggest a causal relationship. The results are consistent with the few published studies that suggest a decrease in the number of injuries in association with exercise and perhaps with modification of psychosocial risk factors. Calculations suggest a cost savings of over $800,000 and a return on investment of $2.51, as well as avoidance of pain and injury.

This article describes the reasons given by employees for choosing between an indemnification -type health insurance plan (Blue Cross/Blue Shield) and a health maintenance organization (group health plan). A population of 1,003 matched pairs was determined and questionnaires were sent to 1,861 individuals remaining in the company, with a response rate of 74%. Many of the reasons listed as important for joining one or the other plan were alike for both groups. However, the members of the group health plan felt that preventive care and regular checkups were more important than did the Blue Cross/Blue Shield members. The latter group felt that free choice of physician was very important, whereas the subscribers to the group health plan did not place such importance on this factor. Both groups were satisfied with their care, although there were some expected differences.

Cardiovascular disease is the major cause of death in American adults. The chief form of cardiovascular disease is coronary heart disease (CHD). Prevention of CHD depends on the identification of risk factors in asymptomatic individuals. The American Heart Association recommends that all adults be examined periodically for the presence of silent cardiovascular disease and coronary risk factors. The major risk factors for CHD are smoking, high blood pressure, and high blood cholesterol. Additional factors associated with CHD are high blood triglycerides, reduced levels of high-density lipoproteins, diabetes mellitus, obesity, sedentary lifestyle, and certain behavioral characteristics. Available data suggest that the predominance of CHD among Americans can be attributed to these risk factors, and increasing evidence indicates that appropriate modification of these factors will markedly reduce coronary risk. The purpose of this report is to identify the risk factors, indicate their relation to coronary disease, and recommend an approach to their detection in adults during periodic health examinations.