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J E Fielding

Publications and source records attributed to J E Fielding.

94 records · Page 6Linked to original sources
PubMedDate not supplied

Structural codes and patient safety: does strict compliance make sense?

The authors of this Comment note recent trends rigidifying the enforcement of building and safety codes for health care facilities and compare the estimated costs (in terms of dollars spent) of those trends with their anticipated benefits (in terms of potential years of human life saved). They estimate that for each potential year of life saved, strict enforcement of the Life Safety Code of the National Fire Protection Association would cost $12.7 to $63.5 million for hospitals and $1.1 to $2.6 million for nursing homes, the latter figure based on Massachusett's experience. These figures are contrasted to the cost of routine kidney dialysis, which is generally acknowledged to be an extremely expensive technology, costing approximately $20,000 per potential year of life saved. The authors suggest that even if strict enforcement of the Code were fully effective (which, given the current structure of the Code, seems doubtful), a portion of the substantial financial resources expended from our limited national health care budget in hewing to the letter of the Code might be better spent on other activities with greater potential yield in improving the quality of life for patients in hospitals and nursing homes.

Accident Prevention↗
PubMedDate not supplied

Worksite hypertension programs: results of a survey of 424 California employers.

More than 30 million American workers 17 years of age or older have some degree of hypertension, and nearly two-thirds of these workers have blood pressure greater than 160/95 mm Hg. Many employer-sponsored hypertension detection and control programs have been reported, but much of the information about these programs is anecdotal and based on perceptions rather than on formal evaluation. To gain an estimate of the number and nature of such programs among California employers, the authors surveyed 424 California organizations with more than 100 employees at one or more sites. Experienced survey researchers conducted 30-minute telephone interviews with key personnel of these firms to probe their companies' health promotion activities, including those devoted to hypertension screening and control. Of the 424 organizations, 43 (10.1 percent) had worksite hypertension programs, and 24 (5.7 percent) were planning to initiate such a program within the following 12 months. But 357 employers neither offered a hypertension program at the time of the survey nor planned to initiate one within the following year. Survey responses indicated that during the 3 years before the survey, the number of worksite hypertension programs among the organizations surveyed had increased by 110 percent. This rapid rate of increase, together with the nearly 50 percent increase in number of programs that employers were planning for the following 12 months, suggest that the number of similar programs in other regions may also be growing at an accelerating rate. The National Heart, Lung, and Blood Institute's strong endorsement of worksite hypertension programs and employers' current interest in health promotion and disease prevention activities should act as a spur for further growth of these programs. For maximum growth, however--especially among smaller companies--active promotion by business and community groups is essential.

California↗
PubMedDate not supplied

A randomized trial of the IMPACT worksite cholesterol reduction program.

To evaluate the incremental effectiveness of a worksite cholesterol control management program when added to an established, comprehensive health promotion program at the worksite, we conducted a randomized, controlled trial including both blue- and white-collar employees at four geographically dispersed worksites. One hundred twenty-seven employees with serum cholesterol levels of 240 mg/dL or greater were assigned to receive an enhanced intervention program (the IMPACT program) while 125 were assigned to a regular screening and referral group, which included a comprehensive worksite health promotion program. One hundred eighteen program and 116 control subjects had one-year follow-up measures recorded. We used venipuncture specimens to obtain standardized baseline and follow-up cholesterol measures. Program subjects experienced a mean decline of 16.6 mg/dL as compared to a decline of 10.0 mg/dL in control subjects. The crude intergroup difference was 6.6 mg/dL (95% confidence internal [CI] = 1.1, 14.3), while the adjusted difference was 6.9 mg/dL (95% CI = 0.5, 14.3). Neither difference was significant at the .05 level. The percentage of program subjects who reduced their cholesterol level to below 240 mg/dL (36%) was significantly greater than the corresponding percentage among control subjects (21%). The enhanced worksite cholesterol control program provided incremental benefit in the percentage of individuals with elevated cholesterol in a population already exposed to a comprehensive worksite health promotion program that includes regular cholesterol screening, referral, and education activities.

Cholesterol↗