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Biomedical subjects

K W Kizer

Publications and source records attributed to K W Kizer.

At least 73 records · Page 4Linked to original sources
PubMed1993

Measles epidemic from failure to immunize.

During 1988 through 1990, California experienced its worst measles epidemic in more than a decade, with 16,400 reported cases, 3,390 hospital admissions, and 75 deaths. More than half of the patients were younger than 5 years; the highest incidence was among infants younger than 12 months. The epidemic centered in low-income Hispanic communities in southern and central California. The major cause of the epidemic was low immunization levels among preschool-aged children and young adults. Rates of complications, admission to hospital, and death were surprisingly high. Outbreak control efforts met with indeterminate success. Problems with these efforts included insufficient funding early in the epidemic and disappointing public response to community-based immunization campaigns. The cost of medical care and outbreak control for the epidemic is conservatively estimated at $30.9 million. Unless the level of immunization in preschool-aged children is increased, this type of epidemic will probably recur.

Adolescent↗
PubMed1993

HIV-1 seroprevalence among women attending sexually transmitted disease clinics in California. California Family of Surveys and Sentinel Surveillance Consortia.

To evaluate the distribution of the human immunodeficiency virus type 1 (HIV-1) epidemic among California women, we analyzed HIV-1 seroprevalence and risk factors among women attending sexually transmitted disease (STD) clinics in 21 local health jurisdictions. Using standardized protocols developed by the Centers for Disease Control, we tested unlinked serum specimens from women attending participating STD clinics in 1989. We analyzed demographic characteristics, HIV risk exposure groups, and results of HIV-1 antibody testing on 17,210 specimens with an overall HIV-1 seroprevalence of 0.57%. Seroprevalence rates were highest for African-American women, women 25 to 29 years of age, injection drug users, and women attending STD clinics in San Francisco. After multiple logistic regression analysis, HIV-1 seropositivity remained highest for these four groups. The rate of HIV-1 infection among women attending STD clinics in California underscores the continued need to make HIV counseling and testing an integral component of routine services for women being evaluated for, or presenting with, sexually transmitted diseases.

Adolescent↗
PubMed1992

Adjustment for smoking, alcohol consumption, and socioeconomic status in the California Occupational Mortality Study.

This paper presents methods for adjusting for smoking, alcohol, and socioeconomic status in death certificate-based occupational mortality surveillance. The methods were applied in the California Occupational Mortality Study, a statewide study of rates based on 180,000 deaths and census estimates of occupations. For each occupation, levels of smoking, alcohol consumption, and socioeconomic status were estimated using National Health Interview Survey and U.S. Census data, and an empirical Bayes procedure was used to improve the stability of smoking and alcohol estimates for small occupations. Expected death rates for occupations were calculated by modeling rates as a function of age, smoking, alcohol, and socioeconomic status with Poisson regression. The effect of adjustment was usually moderate and in the expected direction, and the adjusted mortality ratios were generally closer to 1.0. Full data on agricultural occupations are presented for illustration.

Adolescent↗
PubMed1992

A comparison of HIV-1, HBV, and HTLV-I/II seroprevalence rates of injured patients admitted through California emergency departments.

STUDY OBJECTIVE: To determine the seroprevalence rates of hepatitis B virus (HBV) and human T-lymphotropic virus (HTLV-I/II) and to compare these rates with the HIV-1 seroprevalence rate in a sample of injured patients admitted through ten California emergency departments. DESIGN: Prospective blinded testing for serologic markers for HBV, HTLV-I/II, and HIV-1 on routinely collected blood samples. SETTING: Ten California hospitals were chosen to reflect geographic and demographic diversity. TYPE OF PARTICIPANTS: All injured adult patients who were admitted to a participating hospital through the ED during consecutive three-month periods from June through November 1989. MEASUREMENTS: Serum samples were tested for HIV-1 antibody, HTLV-I/II antibody, and hepatitis B surface antigen (HBsAg) using standard methods. Mann-Whitney U tests, chi 2 tests for independence, sign tests, chi 2 tests for goodness of fit, and logistic regression were used as appropriate. RESULTS: Seroprevalence rates were as follows: HBV, 2.6% (57 of 2,209); HTLV-I/II, 2.0% (46 of 2,262); and HIV-1, 1.4% (31 of 2,264). CONCLUSION: The seroprevalence rate of HBV was slightly higher than that of HIV-1 in this sample of injured patients. Mortality estimates suggest, however, that HBV and HIV-1 pose roughly similar risks to emergency personnel, although the risk of HBV infection can be markedly reduced by vaccination. The data from this and other studies suggest that the ED incidence of HTLV-I/II in United States is low. The relative health risks to emergency personnel from HTLV-I/II appear to be minimal at this time.

California↗
PubMed1992

Epidemiology of Aeromonas infections in California.

In May 1988, California became the first state to make aeromonas infection a reportable condition, thereby permitting the first population-based study of the epidemiology of infection caused by Aeromonas organisms. Case investigations were carried out on 219 of the 280 patients whose infections were reported during the first year of notification. The overall incidence rate for Aeromonas isolation was 10.6 cases per 1 million population. The gastrointestinal tract was the most commonly reported site from which Aeromonas was isolated (81%), with wounds being the next most common source (9%). Five (2%) of the 219 patients died; all five had serious underlying medical conditions apart from aeromonas infection. No common-source enteric outbreaks were reported. The high rate of gastrointestinal symptoms and isolation of organisms from medically vulnerable patients and the fact that other bacterial enteric pathogens were rarely isolated from symptomatic patients support evidence from previous studies that Aeromonas is an enteric pathogen. The evidence from these case reports in California suggests that aeromonas infections are not an important public health problem and are largely nonpreventable. Thus, public health surveillance is not necessary and mandatory reporting has been discontinued.

Adolescent↗
PubMed1992

Distribution of HIV type 1 infection in childbearing women in California.

The incidence of acquired immunodeficiency syndrome (AIDS) is increasing among California heterosexuals and children. To assess human immunodeficiency virus (HIV)-1 infection in childbearing women, we conducted a blinded serosurvey of newborns. Dried blood specimens taken from 99% of California births during the third quarter of 1988 (n = 135,808) and linked only to maternal demographic categories were tested for HIV-1 antibody by enzyme immunoassay and confirmed by Western blot. Period prevalence of HIV-1 infection was 7.4 per 10,000 childbearing women. Prevalence was highest for Black women and was also elevated for Hispanic and San Francisco Bay Area women. Findings suggest that California Hispanic women will make up an increasing proportion of new AIDS cases.

Adult↗
PubMed1992

Premature mortality related to HIV infection in California 1981-1993.

The number of years of potential life lost (YPLL) before age 65 was used to compare the effects of HIV on premature mortality versus other causes of death in California from 1981 to 1993. Using California AIDS case surveillance data, YPLL associated with HIV rose from 629 in 1981 to 120,721 in 1989, and is projected to reach 188,000 in 1993 (plausible range, 155,000-285,000). In 1989, HIV ranked fourth in YPLL behind all malignant neoplasms, traffic-related motor vehicle accidents, and all heart diseases. By 1993, if current mortality trends continue, HIV is projected to be the leading single cause of YPLL in California ahead of all malignant neoplasms (184,597 in 1989), motor vehicle-related YPLL (163,038 in 1989), and all heart diseases.

Adult↗
PubMed1991

The HIV-1 seroprevalence rate of injured patients admitted through California emergency departments. California HIV-1 Emergency Department Seroprevalence Study Group.

STUDY OBJECTIVES: To measure the HIV seroprevalence of injured emergency department patients in a number of California hospitals and to examine the relationship between ED seroprevalence and local AIDS incidence. DESIGN: Prospective blinded testing for HIV-1 antibody was performed on routinely collected blood samples. SETTING: Ten California hospitals; group 1 included three hospitals from counties of high AIDS incidence (more than 40 cases per 100,000 population), group 2 included three hospitals from counties of intermediate AIDS incidence (20 to 40 cases per 100,000 population); and group 3 included four hospitals from counties of low AIDS incidence (less than 20 cases per 100,000 population). TYPE OF PARTICIPANTS: Eligible patients were all adult trauma victims admitted to a participating hospital through the ED during a consecutive three-month period occurring between June and November 1989. MEASUREMENTS: HIV-1 antibody testing was done using enzyme immunoassay confirmed by immunofluorescence assay. Equivocal results were confirmed by Western blot. Mann-Whitney U test, chi 2 test, and multiple logistic regression were used where appropriate. RESULTS: There were 2,264 patients with adequate blood samples for serologic testing. The seroprevalence rates for hospitals in groups 1, 2, and 3 were significantly different (chi 2 = 8.44, P = .02): Group 1, 2.5% (19 of 756: 95% confidence interval [CI], 1.5% to 3.9%); group 2, 0.9% (10 of 1,078; CI, 0.5% to 1.7%); and group 3, 0.5% (two of 430; CI, 0.06% to 1.7%). CONCLUSION: This study suggests that local AIDS incidence rates do not necessarily predict the seroprevalence rates of injured patients who are admitted through local EDs.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Lifetime Medicaid service utilization and expenditures for AIDS in New York and California.

Several important gaps exists in information on the health care resources used by people with AIDS, including patterns of outpatient care, differences between populations at risk of the disease, and services paid for by Medicaid. To address the shortage of information in these areas, this study examined average Medicaid expenditures and service use for the time period a person has AIDS. The study population was Medicaid enrollees with AIDS in New York and California who died between October 1985 and September 1986. The study focused on the differences between the two states and between four groups that were proxies for at-risk populations: children, women, drug-using men, and non-drug-using men. Mean lifetime Medicaid expenditures were about $30,000 in New York and $20,000 in California. Inpatient use was higher and outpatient service use was lower in New York than in California after controlling for risk group, diagnosis, and Medicaid eligibility group (a proxy for income level). In California, women had higher expenditures and inpatient use than men. In New York, women and drug-using men had higher expenditures and use of inpatient and outpatient services (except home health care) than the non-drug-using men. Children in New York had higher expenditures and hospital use than adults but similar outpatient service use. Multivariate analyses suggest that differences between risk groups were largely attributable to differences in diagnosis and income level (as measured by Medicaid eligibility group).

Acquired Immunodeficiency Syndrome↗
PubMed1991

Safety belts and public health. The role of medical practitioners.

Medical practitioners have helped the public become aware of the importance of health-promoting life-style changes such as getting more exercise and abstaining from smoking. They can likewise help their patients protect themselves from the threat of automobile crash injury. Safety belt use remains too low, and increased use offers unusual potential for averting death and disability. Various characteristics associated with a failure to use safety belts can be used to help identify patients at high risk of traffic injury. These include male sex, persons who are ethnic minorities, young people, poor people, those with low educational levels, and persons with negative attitudes to seat belt use. Various methods and resources are available to help practitioners provide appropriate safety belt advice to patients, although the specific resources available vary from place to place. At a minimum, patients need to be told that a proper use of occupant protection can at least double the chances of avoiding death or severe injury in an automobile crash.

Adult↗
PubMed1990

Reducing tobacco consumption in California. Development of a statewide anti-tobacco use campaign.

Cigarette smoking continues to be the leading preventable cause of death in California and the United States. Although substantial progress has been made over the past 25 years, there is growing recognition of the need for large-scale efforts to reduce tobacco use. Given their central roles in implementing public health programs and their ability to reach many of the groups most at risk of tobacco use uptake and tobacco-related disease, state health agencies have an important challenge before them. This article describes the development and operation of a statewide, publicly funded anti-tobacco use campaign currently undertaken by the California Department of Health Services under the auspices of the state's Tobacco Tax and Health Promotion Act of 1988 (Proposition 99), which increased excise taxes on cigarettes by 25 cents per pack sold in the state. A discussion of problems in implementation and operation being incurred may be relevant to the planning of similar campaigns elsewhere.

Adolescent↗
PubMed1990

Benzene, benzo(a)pyrene, and lead in smoke from tobacco products other than cigarettes.

Benzene, benzo(a)pyrene (BaP), and lead in mainstream smoke from cigars, roll-your-own (RYO) cigarette and pipe tobaccos were sampled to evaluate their potential health significance. Results with reference cigarettes were consistent with published values, providing support for the methodology employed. The emissions of benzene and BaP, expressed as mass emitted per gram of tobacco consumed, were similar for all products evaluated; for benzene, the mean values for cigars, RYO cigarette and pipe tobaccos were 156 +/- 52, 68 +/- 11, and 242 +/- 126 micrograms/g, respectively. Mean values for BaP were 42 +/- 7 and 48 +/- 4 ng/g for cigars and RYO cigarette tobacco, respectively. Lead values were below the limit of reliable quantitation in all cases. The mean benzene concentrations in a puff ranged from 1 to 2 x 10(5) micrograms/m3 for cigars, RYO cigarette and pipe tobaccos. For BaP, the puff concentration averaged about 60 micrograms/m3 for cigars and RYO cigarette tobacco. The results suggest that smoking cigars, pipes or RYO cigarettes leads to potential exposures which exceed the No Significant Risk levels of benzene and BaP set pursuant to California's Proposition 65. These tobacco products are now required to bear a health hazard warning when sold in California. We recommend that this be adopted as national policy.

Benzene↗
PubMed1990

Elevated blood lead in California adults, 1987: results of a statewide surveillance program based on laboratory reports.

California medical laboratories that test for blood lead are required to report results exceeding 1.21 mumols/L (25 micrograms/dl). Between April and December 1987, the California Department of Health Services received 3,077 blood lead reports from 34 laboratories for 1,293 civilian, non-institutionalized adults. Approximately 1 percent of all reports exceeded 3.87 mumols/L (80 micrograms/dl), 7 percent exceeded 2.42 mumols/L (50 micrograms/dl), and 21 percent exceeded 1.93 mumols/L (40 micrograms/dl). Individuals tested were overwhelmingly male (94 percent), disproportionately Hispanic surnamed (44 percent), and most often residents of Los Angeles County (81 percent). Workers in lead smelting, battery manufacturing, and brass foundries accounted for nearly 80 percent of reports. Construction, radiator repair, pottery and ceramics manufacturing, and gun firing ranges accounted for the remainder. All adults with reports of greater than or equal to 2.90 mumols/L who were contacted reported on occupational exposure. Approximately half were not in routine medical monitoring programs. Despite OSHA standards, elevated blood lead with the potential for serious acute and chronic lead poisoning in California adults remains a significant public health and major occupational health concern.

Adolescent↗
PubMed1990

Maternal serum alpha-fetoprotein screening activities of state health agencies: a survey.

Maternal serum alpha-fetoprotein (MSAFP) screening has been demonstrated to be cost-effective on a population basis and is becoming standard practice. The American Society of Human Genetics has twice published policy statements to define the essential elements of a quality screening program. The present study reviewed the impact of these policy statements on state public-health agencies with respect to regulation or provision of MSAFP screening in their jurisdictions. With a few exceptions, states have not elected to play a major role in provision or regulation of this test. There is need to address issues of funding, standards, and data collection in a collaborative effort, if policy statements on genetic services are to be translated into effective state population screening.

Congenital Abnormalities↗
PubMed1990

Selenium. Nutritional, toxicologic, and clinical aspects.

Despite the recent findings of environmental contamination, selenium toxicosis in humans is exceedingly rare in the United States, with the few known cases resulting from industrial accidents and an episode involving the ingestion of superpotent selenium supplements. Chronic selenosis is essentially unheard of in this country because of the typical diversity of the American diet. Nonetheless, because of the growing public interest in selenium as a dietary supplement and the occurrence of environmental selenium contamination, medical practitioners should be familiar with the nutritional, toxicologic, and clinical aspects of this trace element.

Animals↗
PubMed1990

HIV antibody seroprevalence among prisoners entering the California correctional system.

A cross-sectional blind study was conducted in the spring of 1988 to estimate the extent of human immunodeficiency virus (HIV) infection among inmates entering the California correctional system. Of the 6,834 inmates receiving entrance physical examinations during the study period, 6,179 (90.4%) had serum tested for the presence of HIV antibodies after routine blood work was completed and personal identifiers were removed. Seroprevalence was 2.5% (95% confidence interval, 2.1% to 3.0%) among the 5,372 men tested and 3.1% (95% confidence interval, 2.1% to 4.5%) among the 807 women tested. Seroprevalence was more than twice as high among men arrested in the San Francisco Bay Area as in those arrested elsewhere in the state. The regional differences in HIV seroprevalence observed among entering inmates mirror infection rates reported among intravenous drug users from the same regions.

California↗