Biomedical subjects
J E Fielding
Publications and source records attributed to J E Fielding.
Successes of prevention.
Despite the intuitive--and historically persistent--appeal of preventive medical measures, latter-day skeptics find less cause for continued optimism. The failure of expectations is only partly a confusion of definitions. An examination of what is prevented, and by whom, suggests new professional as well as political strategies, and anticipates new dilemmas.
Managing public health risks: the swine flu immunization program revisited.
In this Comment, the Massachusetts Commissioner of Public Health views the federal government's 1976-77 Swine Flu Immunization Program, which was sharply criticized by Dr. Cyril Wecht in a recent Article in this journal, as a classic example of a public policy decision made under conditions of stress and uncertainty. Once the responsible government officials had made a public commitment to immunize the entire populace of the United States, he contends, they found it very difficult to reformulate the program in response to changing information concerning its relative costs and benefits. Dr Fielding offers suggestions for avoiding in the future some of the problems that surrounded the Swine Flu Program and for preventing further erosion of public confidence in essential preventive medicine programs.
Quantifying the need for hospital beds.
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Firearms and gun control: a public-health concern.
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Health promotion--some notions in search of a constituency.
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Comprehensive health care and motor-vehicle safety.
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PSRO: an educational force for improving quality of care.
The major purpose of the PSRO program is to improve the quality of medical care. Peer review is expected not only to detect problems but to analyze causes, and to develop, implement, and evaluate corrective programs. Such peer-review efforts are in themselves educational. In addition, educational programs focusing on identified deficiencies must be organihe educational efforts of local health facilities and organizations of all types is urged. Although PSRO's will not specifically underwrite continuing health-care education, they should provide a community-wide means for integrating patient-care review with continuing medical education.
Components of the PSRO review system in short-stay hospitals.
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Health care for the economically disadvantaged adolescent.
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Getting smarter and maybe wiser.
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Development of a health risk appraisal for the elderly (HRA-E).
The purpose of this project is to develop a health risk appraisal for the elderly (HRA-E) and test its application in both medical and nonmedical settings. The HRA-E system consists of a questionnaire and software for computer-generation of personalized reports to participants, 55 years and older, and their physicians. Items in the questionnaire cover a comprehensive range of content domains relevant to health promotion in the elderly. The goal of the HRA-E system is to prevent functional decline. Samples of eligible subjects from the American Association of Retired Persons (AARP), a group practice, and a senior center were extended invitations to participate. Those responding affirmatively to the invitation were given a questionnaire and evaluation form. Each person who returned the questionnaire received his or her personal report and a second evaluation form. Four months after receiving their reports, respondents were questioned about behavior changes during the interim. Preliminary findings, based on 1895 respondents, indicate that nearly all participants found the questionnaire easy to complete and were pleased with its overall length. In addition, most participants read their reports, and many planned to take action, based on report recommendations. In the next phase of this project, the intent is to refine the questionnaire, extend the intervention protocols for longitudinal application, and evaluate its impact on health-related behaviors, medical care utilization, and functional decline.
Questions employers need to ask about preferred arrangements.
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Quality in worksite health promotion: who is responsible?
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Adolescent pregnancy in the United States: a review and recommendations for clinicians and research needs.
Adolescent pregnancy, often unplanned and unwanted, has a negative impact on the physical, emotional, educational, and economic condition of the pregnant teenager. Forty percent of the one million adolescents who became pregnant in 1986 chose abortion, and, of the remainder, 61% were unmarried. Teenage mothers in greater numbers and at younger ages are opting to keep and raise their children. In 1987 over $19 billion in federal monies were expended on families begun when the mother was a teenager. The preferred approach to this problem is prevention of teenage pregnancy rather than abortion, with emphasis on sex education and access to family planning information and contraceptive devices for both females and males. Sex education in schools is presented in widely varying formats; in fact, prevention of pregnancy may not even be presented. Family planning clinics are subject to the whims and biases of the funding agencies. Clinicians have an important role in providing guidance for teenage patients and their parents, but can also influence school and community leadership to ensure that all teenagers receive sound sex education in school programs and that family planning agencies are permitted to counsel teenagers and provide contraceptive devices.
Frequency of health risk assessment activities at U.S. worksites.
Data from the National Survey of Worksite Health Promotion Activities include information about health risk assessment (HRA) activities available at private sector worksites in the United States. HRA activities were found at 29.5% of all worksites. Of those worksites, 24% provided HRA questionnaires and 77.4% provided periodic health/physical examinations. Screening tests provided as part of the health/physical exams included blood pressure screening (55.4%), cancer screening (19.5%), blood tests for cholesterol (28.3%) and sugar (39%), and tests of physical fitness (15.1%). In most cases, the frequency increased as worksite size increased, regional variations were small, and there was significant variation among different industry types. HRA activities were overrepresented at worksites where the majority of workers were women, over 30 years of age, not blue collar, and not represented by a union. On-site health personnel increased the likelihood of the presence of HRA activities. At 85% of the worksites with HRA activities all permanent employees were eligible. The full costs of screening were paid by 87.9% of the worksites, activities were held on company time at 74.5%, and time off to participate was available at 78.2% of worksites. The most commonly mentioned benefit of HRA activities was improved employee health (47.1%). Other health promotion activities frequently found in association with HRA activities were smoking cessation (54.1%), care and prevention of back pain (50.8%), and stress management (49.6%).
The promotion of physical activity in the United States population: the status of programs in medical, worksite, community, and school settings.
While the medical care encounter is considered an ideal situation in which patients are encouraged to increase their physical activity levels, very little research has been conducted in this setting. In fact, with the exception of the physical activity components of cardiac rehabilitation programs, few formal physical activity programs are available in medical care settings. Although the workplace is currently the focus of the greatest interest by those persons who implement physical activity programs, there is little precision in defining what constitutes a worksite physical activity program. A number of researchers and authors, using program experience rather than empirical findings, have described what they believe to be the important components of successful worksites health promotion and physical education programs. The greatest variety of physical activity programs are found in community settings. They are offered by a number of nonprofit private organizations, nonprofit public agencies, and for-profit organizations. While relatively little research has been done concerning changes in the community environment, it is clear that such changes can effect community participation. Community campaigns to increase physical activity have been studied, and it appears that they clearly affect residents' interest and awareness in physical activity, but they do not have a major effect on behavioral changes in the short term. It appears that a major opportunity to influence favorable physical activity in the United States is being missed in schools. A large majority of students are enrolled in physical education classes, but the classes appear to have little effect on the current physical fitness levels of children and, furthermore, have little impact on developing life-long physical activity skills.