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Biomedical subjects

J E Fielding

Publications and source records attributed to J E Fielding.

At least 19 recordsLinked to original sources
PubMed2001

Effectiveness of altered incentives in a food safety inspection program.

BACKGROUND: The Los Angeles County Department of Health Services revamped its retail food establishment inspection program in 1998 to include, among other novel provisions, the prominent posting of grades. The purpose of the present study is to examine results from the second year of the revamped program to determine the longer-term impact of the program. METHODS: An analysis of program results for Year 1 led to several program refinements: stratification of risk categories, certification of food handlers, and an external fraud hotline. Outcome measures used included routine inspection scores; closure rates; scores from owner-initiated inspections and departmentally initiated inspections; inspection frequencies; compliance with food handler certification requirements; and frequency of use of the external fraud hotline. RESULTS: Inspection scores continued to increase in 1999, while the rate of closures decreased. The owner-initiated inspections also resulted in improved scores, generally maintained on subsequent inspections. Higher risk establishments were inspected more frequently than were lower risk establishments. Over 30,000 food handlers were certified. The external fraud hotline received 16 fraud complaints. CONCLUSIONS: Results indicate that retail food establishments are taking stronger action to assure compliance with food safety practices.

Food Contamination↗
PubMed2001

Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke.

This report presents the results of systematic reviews of effectiveness, applicability, other effects, economic evaluations, and barriers to use of selected population-based interventions intended to reduce tobacco use and exposure to environmental tobacco smoke. The related systematic reviews are linked by a common conceptual approach. These reviews form the basis of recommendations by the Task Force on Community Preventive Services (TFCPS) regarding the use of these selected interventions. The TFCPS recommendations are presented on page 67 of this supplement.

Adolescent↗
PubMed2001

Are older hazardous and harmful drinkers less likely to participate in health-related behaviors and practices as compared with nonhazardous drinkers?

OBJECTIVES: To describe the (1) prevalence of at-risk drinking and participation in health-related behaviors and practices and (2) associations of at-risk drinking with other health-related behaviors and practices among older persons completing a health-risk appraisal for the elderly (HRA-E). DESIGN: Cross-sectional study using data from a self-administered, mailed survey sample. SETTINGS: Persons from three organizations were surveyed: (1) the American Association of Retired Persons; and (2) a large medical group and (3) a community-based senior health center in southern California. PARTICIPANTS: 1,889 persons age 55 years and older. MEASUREMENTS: The HRA-E included items on health characteristics, drinking behaviors (including amount of alcohol use and two alcoholism screening measures: the CAGE (Cut down, Annoyed, Guilty, Eye opener) and Short Michigan Alcoholism Screening Test-Geriatric version (SMAST-G), and participation in selected health-related behaviors and practices. Social drinkers were defined as those who drank fewer than 14 drinks weekly and screened negative on the CAGE (defined as two or more "no" responses) and SMAST-G. Hazardous drinkers drank fewer than 14 drinks weekly and screened negative. Harmful drinkers drank fewer than 14 drinks weekly and screened positive. Possible at-risk drinkers drank 14 or more drinks weekly and screened positive. Least squares regression models were used to assess the effects of hazardous, harmful, and possible at-risk drinking on each of the health-related practices and behaviors. We also conducted these analyses using three other definitions of social, possible at-risk, hazardous, and harmful drinking. RESULTS: Of all respondents, 40% were social drinkers, 3% were harmful drinkers, 2% were hazardous drinkers, and 11% were possible at-risk drinkers. Hazardous, harmful, and possible at-risk drinkers commonly reported driving after drinking or being driven by someone who had been drinking (67%, 76%, and 64% respectively). Harmful and possible at-risk drinkers were more likely than social drinkers to smoke and were less likely to use seatbelts regularly. These findings were observed regardless of how the drinking groups were defined. CONCLUSION: All groups of at-risk drinkers more commonly engaged in selected adverse health-related behaviors and practices than did social drinkers.

Age Factors↗
PubMed2001

Halting the illegal sale of prescription medications in Los Angeles County.

The illegal sale of prescription medications by unlicensed vendors is a widespread practice in Los Angeles County. Many members of ethnic and particularly Latino communities turn to unlicensed vendors because of financial and cultural reasons and/or a lack of access to the U.S. health care system. In response, Los Angeles County Department of Health Services developed a two-part effort to curb the illegal sale of pharmaceuticals. Dramatically increased law enforcement resulted in 280 investigations, 121 arrests, and the confiscation of $4-$4.5 million worth of illegal pharmaceuticals during the first 20 months. The department also has begun outreach efforts to educate those communities most affected by these practices.

Crime↗
PubMed2000

Changing the paradigm: planning for ambulatory care expansion in Los Angeles County using a community-based and evidence-based model.

In 1998, Los Angeles County's Department of Health Services (DHS) embarked on a planning process to expand ambulatory care services for the county's 2.7 million uninsured and otherwise medically indigent residents. This planning process was novel in two ways. First, it used a quantitative, needs-based approach for resource allocation to ensure an equitable distribution of safety-net ambulatory care services across the county. Second, it used a new community-based planning paradigm that took into consideration the specific needs of each of the county's eight geographic service planning areas. Together, the evidence-based approach to planning and the community-based decision-making will ensure that DHS can more equitably provide for the needs of Los Angeles County's medically indigent residents.

Ambulatory Care↗
PubMed2000

Core protein phosphorylation modulates pregenomic RNA encapsidation to different extents in human and duck hepatitis B viruses.

To clarify the role of core protein phosphorylation in pregenomic-RNA encapsidation of human and duck hepatitis B viruses (HBV and DHBV, respectively), we have examined the phosphorylation states of different forms of intracellular HBV core protein and the phenotypic effects of mutations in the phosphorylation sites of HBV and DHBV core proteins. We show that HBV core protein is phosphorylated to similar extents in the form of protein dimers and after further assembly in pregenomic RNA-containing capsids. Individual and multiple substitutions of alanine and aspartic acid for serine in the phosphorylation sites of HBV core protein resulted in site-specific and synergistic effects on RNA encapsidation, ranging from 2-fold enhancement to more than 10-fold inhibition. Core protein variants with mutations in all phosphorylation sites exhibited dominant-negative effects on RNA encapsidation by wild-type protein. The results suggest that the presence of phosphoserine at position 162 of HBV core protein is required for pregenomic-RNA encapsidation, whereas phosphoserine at position 170 optimizes the process and serine might be preferable in position 155. Examination of the pregenomic-RNA-encapsidating capacities of DHBV core protein variants, in which four phosphorylation sites were jointly mutated to alanine or aspartic acid, suggests that phosphorylation of DHBV core protein at these sites may optimize pregenomic-RNA encapsidation but that its impact is much less profound than in the case of HBV. The possible mechanisms by which RNA encapsidation may be modulated by core protein phosphorylation are discussed in the context of the observed differences between the two viruses.

Amino Acid Sequence↗
PubMed1999

Community health report cards. Results of a national survey.

INTRODUCTION: The purpose of this research is to examine the state-of-the-art in community health report card development and use in order to increase their effective integration into community health improvement efforts. METHODS: A mailed survey was sent to 115 "report card" communities nationwide. This list was generated through multiple key informants at the national, regional, and state levels. Seventy-four percent (85/115) were eligible for the study. The report cards returned were inventoried for: quality of their data, comprehensiveness, presentation, appropriateness to target audiences, purpose and sponsorship, relevance to policy development, community involvement, comparability, replicability, and other factors. RESULTS: Of the 85 eligible projects, 65 responded. The report cards varied significantly in all areas. Only one half of communities used pre-existing formats or the experience of others to guide this resource-intensive development process. Data collection was the greatest challenge encountered in development. Local health departments, hospitals, and non-profit civic groups were the community groups most likely to be involved in development. CONCLUSION: There is need for infrastructure, technical assistance, and improved, easy-to-use tools to facilitate the report card development process and the sharing of expertise and experience among involved communities. Greater systematization of the process would enhance the reasonableness and sustainability of the effort. Broad community involvement, including support of the local health department, other community agencies, as well as the local business community, may be key to their success.

Community Health Planning↗
PubMed1999

Public health in the twentieth century: advances and challenges.

Substantial advances in public health methods, practice, and the health of the public have occurred in the twentieth century. Some of the contributions most notable for their impact on mortality and longevity are vaccine development and widespread use, smallpox eradication, large reductions in communicable disease epidemics, and the rise and decline of several serious chronic diseases. Many methodological advances have facilitated better understanding of disease processes and opportunities for control. Epidemiological methods have advanced, but studies often ignore the determinants of health at the community level and above, leading to simplistic formulations of multiple risk factors contributing to chronic and other diseases and injuries. Occupational and environmental health developed as disciplines in this century, making significant contributions to current and future population health. The health care system became more organized, technologically sophisticated, and costly. New tools to assess health and the burden of ill health, to improve the effectiveness of interventions, and to measure economic effects of alternative investments promise greater efficiency and effectiveness for public health. An increasingly fragmented public health infrastructure must confront unprecedented challenges including dramatic global population growth, increased aging of the population associated with enhanced longevity, and possible irreversible changes in key environmental health determinants.

Health Care Reform↗
PubMed1996

The ecology of work and health: research and policy directions for the promotion of employee health.

This article identifies new research and policy directions for the field of worksite health in the context of the changing American workplace. These directions are viewed from an ecological perspective on worksite health and are organized around three major themes: (1) the joint influence of physical and social environmental factors on occupational health, (2) the effects of nonoccupational settings (e.g., households, the health care system) on employee well-being and the implications of recent changes in these settings for worksite health programs, and (3) methodological issues in the design and evaluation of worksite health programs. Developments in these areas suggest that the field of worksite health may be undergoing a fundamental paradigm shift away from individually oriented wellness programs (provided at the worksite and aimed primarily at changing employees' health behavior) and toward broader formulations emphasizing the joint impact of the physical and social environment at work, job-person fit, and work policies on employee well-being.

Accidents, Occupational↗
PubMed1994

Immunization status of children of employees in a large corporation.

OBJECTIVE: To assess immunization levels for children of employees of a large corporation. DESIGN: A mail survey of a random sample of employees on the immunization history of one child per family. SETTING: US employees of Johnson & Johnson. PARTICIPANTS: 1500 employees with children born between 1984 and 1991. MAIN OUTCOME MEASURES: Coverage rates for recommended vaccines at different ages up to 6 years. MAIN RESULTS: Only 45.2% and 55.3% of the study children at ages 2 and 6 years were current for all recommended immunizations (65.1% and 70.3%, respectively, excluding the Haemophilus influenzae type b vaccine). Using the minimum standard required by many states for school entry, the coverage level at age 6 years was 90.4%. Factors associated with higher immunization rates at age 2 years were the corporate health plan (choices), higher pay level, greater parental formal education, white race, and knowing when to initiate immunization. Lower immunization rates at age 2 years were associated with delayed receipt of the first dose of diphtheria, tetanus, and pertussis vaccine, use of city or county clinics, employee-reported barriers of difficulty leaving work, and provider access problems, but not cost of services. After adjusting for the effects of other variables through logistic regression, race, pay level, and plan choice were no longer significant. Modeling with the remaining variables predicted rates of adequate immunization at age 2 years from 15% to 81%. CONCLUSION: Even in this relatively affluent group with good insurance (including immunizations), preschool immunization rates did not reach public health goals. Changing modifiable factors, such as knowing when to initiate immunization, enabling parents to leave work more easily, and improving provider access, might improve preschool immunization rates.

Child↗
PubMed1994

Evaluation of the IMPACT blood pressure program.

To evaluate the incremental effectiveness of a work-site blood pressure control program, we conducted a randomized, controlled trial at four work sites with established health promotion programs. Workers with blood pressures of 140/90 mm Hg or higher were eligible. Eighty subjects were assigned to receive a referral to a community physician, monthly 10-minute work-site counseling sessions including blood pressure readings, and personalized mailings, whereas 79 control subjects received only a physician referral. Results for 74 intervention and 71 control subjects were obtained after 1 year. As compared with control subjects, intervention subjects experienced average declines of 8.5/3.9 mm Hg. Adjusted for age, sex, and baseline blood pressure, the decreases were 7.6 mm Hg for systolic and 2.4 mm Hg for diastolic blood pressure. These results suggest that counseling of high-risk persons and personalized mailing programs can have an incremental benefit in controlling blood pressure.

Counseling↗
PubMed1994

An evaluation of Duke University's LIVE FOR LIFE health promotion program on changes in worker absenteeism.

The effect of an employer-sponsored health promotion program on worker absenteeism is examined over a 4-year period in a group of 4972 Duke University hourly employees. Program participants experienced an average of 4.6 fewer absentee hours in the third year of program availability than did nonparticipants, after controlling for baseline absenteeism, gender, race, education, and age. These results suggest that employer-sponsored health promotion initiatives can have a favorable influence on absenteeism.

Absenteeism↗