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At least 433 records · Page 24Linked to original sources
PubMed1972

Emergency medical care and care systems in California. Motor vehicle accidents.

Emergency Medical Care and Emergency Medical Care Systems are defined. The need for a distinction between the two is given. Motor vehicle accidents in 58 California counties are analyzed. The status of hospitals serving traffic trauma in California is given with respect to quality of care. The location of California hospitals with respect to the percent of motor vehicle trauma is shown. The importance of time lapse in emergency medical care systems and the reasons for time lapse errors is explored. The need for data processing and systems analysis in California emergency medical care systems is pointed out.

Accidents, Traffic↗
PubMed1968

The smoking study. A report of the attitudes and habits of California physicinas with respect to cigarette smoking.

With funds provided by the California Department of Public Health, on behalf of the Inter-Agency Council on Smoking and Health, the Bureau of Research and Planning of the California Medical Association conducted a large scale study of the professional and personal attitudes and habits of California physicians with respect to cigarette smoking. The project was initiated in the fall of 1966 with a detailed questionnaire mailed to a random sample of California physicians; the analytic phase was begun in the spring of 1967, all aspects of which are not as yet completed.This report contains highlights of the general findings of the study, as well as some detail about differences in attitudes and habits of physicians as they are related to age and medical specialty of respondents.

Adult↗
PubMed1966

Therapeutic abortion. Attitudes and practices of California physicians.

A questionnaire about attitudes and practices regarding therapeutic abortion was sent to 943 diplomates of the American Board of Obstetrics and Gynecology listed in California. In the 748 replies received, certain disparities between the views and practices of the specialists on the one hand and current California statutes on the other were noted. The responses to the questions strongly suggested that current California laws governing the performance of therapeutic abortion are in need of modernization and liberalization if they are to accord with the views and practices of California obstetrician-gynecologists.

Abortion, Therapeutic↗
PubMed1980

Nurse practitioner and physician's assistant clinics in rural California. Part I: issues.

The primary health care needs of at least 26 rural California communities are being served by nurse practitioners (NP's) or physician's assistants (PA's). All of these have physician supervision and support. NP's and PA's have proved to be acceptable and effective. With 230 rural areas in California identified as having unmet health care needs, this type of service is likely to increase and should be supported.NP/PA clinics serve total populations or concentrate on Indians, Chicanos or the poor. Many barriers have been overcome, especially over the past four years, to allow these clinics to flourish and increase in number. The availability of nurse practitioners and physician's assistants has increased due to support to schools and to school policies. Clinic funding has greatly improved; federal funds for general rural clinics, Indians, migrants, family planning and maternalchild health have been greatly supplemented by California state funds. Beginning in 1978, rural NP and PA services can be reimbursed by Medicare and Medi-Cal (California's Medicaid program).Since 1975 state laws have defined PA and NP roles broadly, and these roles are more precisely defined at the local level. Although nurse practitioners and physician's assistants generally cannot prescribe or dispense drugs (a major problem in many clinics), demonstration legislation allows special pilot projects to do both. As remaining funding and legal problems are corrected, NP's and PA's will serve an even greater role in rural areas.

Ambulatory Care Facilities↗
PubMed1984

A statewide approach to health care personnel maldistribution. The California Area Health Education Center System.

An Area Health Education Center (AHEC) system has been established in California to address the maldistribution of physicians and other health care professionals. The AHEC program uses educational incentives to recruit and retain health care personnel in underserved areas by linking the academic resources of university health science centers with local educational and clinical facilities. The medical schools, working in partnership with urban or rural AHECs throughout the state, are implementing educational programs to attract trainees and licensed professionals to work in underserved communities. The California AHEC project entered its fifth year in October of 1983 with the participation of all eight medical schools and the Charles Drew Postgraduate School of Medicine, 35 other health professions schools, 17 independent AHECs and more than 400 clinical training sites. Educational programs are reaching more than 22,000 students and practicing health professionals throughout California. We review the current status of the California AHEC system and use the AHEC programs at Loma Linda University to illustrate the effect this intervention is having.

Area Health Education Centers↗
PubMed1980

Cancer mortality among Mormons in California during 1968--75.

On the basis of Church records, detailed cancer and total death rates were determined for an average of 360,000 California Mormons during 1968--75, for an average of 700,000 Utah Mormons during 1970 and 1975, and for a subgroup of active Mormon males known as High Priests and Seventies. For cancer as a whole, the standardized mortality ratio was 68% for all California Mormon males, 83% for all California females, and 50% for active Mormon males in California and Utah compared with 1970 U.S. whites. Age-specific and age-adjusted total mortality rates were substantially lower in Mormons than in 1970 U.S. whites, with the greatest differences occurring between 35 and 65 years of age, where the rates for active Mormon males were reduced by more than 60%. Methodologic issues and sources of error were discussed, and the overall quality of the data was good. Some health-related characteristics of Mormons are also summarized.

Adult↗
PubMed1980

Mortality among California Seventh-Day Adventists for selected cancer sites.

In previous reports concerning cancer among Seventh-Day Adventists (SDA), comparisons were made only with the general population. This report compared California SDA to a sample of non-SDA who were demographically similar to SDA. The study consisted of 17 years of follow-up (1960--76) on 22,940 white California SDA and 13 years of follow-up (1960--72) on 112,725 white California non-SDA. Both groups completed the same base-line questionnaire in 1960. Deaths were ascertained by annual contacts with each study member and by computer-assisted record linkage with the California State death certificate file. Results indicated that, with the exception of colon-rectal cancer and smoking-related cancers, the difference in risk of fatal cancer between SDA and non-SDA was substantially reduced when SDA were compared with a more socioeconomically similar population. The persistence of the low risk for colon-rectal cancer can probably be attributed to some aspect of the diet or life-style of the SDA.

Adult↗
PubMed1993

A model for implementing Healthy People 2000 objectives in African-American communities in California.

Using Healthy People 2000 as the source document, regional task forces were formed at the request of the Health Promotion Section of the California Department of Health Services to set health promotion objectives and recommendations for the state's ethnic populations. The topics chosen by regional African-American task forces were (1) violence and abusive behavior, (2) physical activity and fitness, (3) nutrition, (4) tobacco, (5) educational and community-based programs, (6) cancer, and (7) heart disease and stroke. Objectives were expanded, linked together, and revised to meet felt needs. The regional task forces presented the first draft of the document for review at the Multiethnic Health Promotion Conference held in Sacramento, California, June 11 through 13, 1991. The expanded task force, including conference participants, amended the recommendations and ranked the topic areas in order of priority. The group also responded to the challenge of developing implementation strategies for the recommendations. We discuss the early stages of dissemination and implementation of the agenda among California African-American communities. American Indian, Asian/Pacific Islander, and Latino Task Forces have prepared similar documents, and each document will be used to prepare the Multiethnic Health Promotion Agenda for California. We summarize the process by which the papers were developed and provide detailed analysis of the African-American process.

Black or African American↗
PubMed1993

Lower levels of cigarette consumption found in smoke-free workplaces in California.

OBJECTIVE: We examined the relationship between workplace smoking policies and smoking prevalence and cigarette consumption. METHODS: California residents were questioned by telephone with the 1990 California Tobacco Survey. All respondents (11,704) above age 18 years who were employed indoors were used. Respondents were asked about smoking status, workplace smoking policy, desire to quit, and smoking history. Logistic regression was used to determine the relationship of workplace smoking policy to smoking status, accounting for demographic variables. RESULTS: Prevalence of regular smokers was significantly lower in smoke-free workplaces than in those with no restrictions (13.7% vs 20.6%, P < .001). Continuing regular smokers in smoke-free workplaces smoked fewer cigarettes than those in workplaces with no restrictions (296 vs 341 packs per year, P < .001). More comprehensive smoking policies were associated with smokers more likely to contemplate quitting (P = .014). CONCLUSIONS: Employees in smoke-free workplaces have a lower smoking prevalence and, among continuing smokers, lower cigarette consumption than individuals working where smoking is permitted. We estimate cigarette consumption among employees indoors is 21% below that if there were no smoking restrictions in California workplaces. Furthermore, if all California workplaces were smoke-free, cigarette consumption among employees would be 41% below that if there were no workplace smoking restrictions, approximately a $406 million annual loss in sales to the tobacco industry. This study supports the hypothesis that smoke-free workplace policies are an effective public health measure for decreasing smoking prevalence and cigarette consumption among continuing smokers.

Adolescent↗
PubMed1996

Adequacy of prenatal-care utilization--California, 1989-1994.

A national health objective for the year 2000 is to increase to at least 90% of the proportion of pregnant women who receive prenatal care during the first trimester of pregnancy (objective 14.11). Adequate prenatal care is believed to result in better pregnancy outcomes, including reduced maternal and infant morbidity and mortality and reduced risk for preterm delivery and for low birthweight (<2500 g [<5 lb 8 oz]). However, measures of prenatal-care utilization based on first-trimester initiation of prenatal care address only the timing of prenatal-care initiation and do not include the frequency of visits thereafter, which can provide a more comprehensive measure of prenatal-care utilization. To calculate rates of prenatal-care utilization for California during 1989-1994, the California Department of health Services (CDHS) analyzed data from birth certificates using a more comprehensive measure of prenatal-care utilization. This report presents annual rates of adequate prenatal-care utilization (APNCU) for California during 1989-1994 (the most recent year for which complete data were available), compares these data with the year 2000 objective for prenatal-care utilization, and examines rates of APNCU in California by payment source (for prenatal care) for 1989, 1992, and 1994.

California↗
PubMed1996

Human immunodeficiency virus disease in California. Effects of the 1993 expanded case definition of the acquired immunodeficiency syndrome.

On January 1, 1993, the case definition of the acquired immunodeficiency syndrome (AIDS) in adults and adolescents used for monitoring the AIDS epidemic in California was expanded to include persons infected with the human immunodeficiency virus (HIV) with CD4 T-lymphocyte counts of less than 200 x 10(6) per liter (< 200 per mm3), pulmonary tuberculosis, recurrent pneumonia, or invasive cervical cancer. To assess the implications of this revision on AIDS case reporting in California, we compared cases reported through the end of 1994 based on 1 or more of the 4 new AIDS-defining conditions added in 1993 to cases reported based on pre-1993 AIDS-defining opportunistic infections and cancers. The 4 new conditions included in the 1993 expanded AIDS case definition accounted for a 23% increase in cumulative AIDS cases reported in California by the end of 1993, a 170% increase in the number of cases reported during 1993, and an 88% increase in the number of patients with AIDS living at the end of 1993. The number of cases reported in 1993 (19,629) was 124% more than that reported in 1992 (8,780) and 69% more than that reported in 1994 (11,587). The proportion of cases among women, injection-drug users, and African Americans also increased as a result of this change in the case definition. The expansion of the case definition may have resulted in a peak or plateau in the AIDS incidence in California because of reporting earlier in the HIV disease progression. The expanded case definition has enhanced the usefulness of AIDS surveillance data for targeting secondary prevention efforts, but more behavioral and HIV serosurveys are still needed to adequately target primary HIV prevention efforts.

Acquired Immunodeficiency Syndrome↗
PubMed1996

California's diminished capacity defense: evolution and transformation.

Diminished capacity survives in California as a severely attenuated mens rea defense known as diminished actuality. Some other states have similar limited strict mens rea defenses. The lost advantages of California's former expanded concept of diminished capacity are reviewed. As opposed to the all-or-none insanity defense, mens rea defenses permit the trier of fact to find gradations of guilt but are generally inapplicable unless the elements of a crime are redefined to permit consideration of motivational aspects, as California had done. The change from diminished capacity to a diminished actuality defense was a return to the complex, somewhat artificial legal concept of intent and a resurrection of confusing and antiquated common law definitions. The change was made in response to an unpopular jury verdict and a political climate in which little interest existed or still exists for understanding the reasons behind the commission of any crime. Some of the later restrictions imposed by the California Supreme Court on allowing voluntary intoxication to reduce murder to voluntary manslaughter logically should not apply to mental illness. Knowledge of the complex mens rea issues and the various relevant current defenses is essential for any forensic psychiatrist evaluating defendants in jurisdictions in which such defenses are admissible.

Alcoholic Intoxication↗
PubMedDate not supplied

Year 2000 health status indicators: a profile of California.

OBJECTIVES: To examine the health status of Californians using a set of 18 health status indicators (HSIs) corresponding to goals set forth in Healthy People 2000 and to develop a health status profile for use in research and surveillance, policy development program planning, and program evaluation. METHODS: Federal, state, and county data were used to evaluate California's performance on 18 indicators of health status related to mortality, disease incidence, and health risks. RESULTS: By 1994, California had achieved Year 2000 objectives associated with seven HSIs and significant declines in mortality associated with two other HSIs. Nationally, California was ranked among the states with the lowest rates for infant mortality, lung cancer, female breast cancer, and syphilis but among states with the highest rates for homicide, AIDS, measles, tuberculosis, late prenatal care, childhood poverty, and poor air quality. CONCLUSIONS: California's experience may provide a useful model for other state and local health agencies monitoring the health status of populations using HSIs associated with Year 2000 objectives.

Adolescent↗
PubMedDate not supplied

Primary care physicians' satisfaction with quality of care in California capitated medical groups.

CONTEXT: Managed care and capitation have placed new responsibilities on primary care physicians, including formally acting as "gatekeepers" for specialty services and tests. Previous studies have not examined whether primary care physicians who provide services to patients under many coverage arrangements feel differently about caring for patients covered under capitation vs those covered through more traditional forms of insurance. An understanding of whether California primary care physicians feel that they deliver a different level of quality to capitated patients could help signal whether variations in care for patients with different coverage forms are evolving. OBJECTIVE: To evaluate whether primary care physicians in California capitated groups report different satisfaction levels with quality of care for patients in their overall practice than for patients covered by capitated contracts and to examine whether physicians' satisfaction with capitated care quality is influenced by the characteristics of the practice setting. DESIGN: Cross-sectional questionnaire. SETTING: A total of 89 California physician groups with capitated contracts. PARTICIPANTS: A total of 910 primary care physicians (80% response rate). MAIN OUTCOME MEASURE: Satisfaction with 4 aspects of quality of care provided to patients covered by capitated contracts vs patients overall. RESULTS: Physicians reported lower satisfaction with all 4 aspects of care for patients covered by capitated contracts than for patients in their overall practice: 71% were very or somewhat satisfied with relationships with capitated patients (compared with 88% for overall practice), 64% were very or somewhat satisfied with the quality of care they provided to capitated patients (compared with 88% for overall practice), 51% were very or somewhat satisfied with their ability to treat capitated patients according to their own best judgment (compared with 79% for overall practice), and 50% were very or somewhat satisfied with their ability to obtain specialty referrals (compared with 59% for overall practice) (P< or =.001 for all comparisons). Being in a medical group practice (vs an independent practice association) and having a larger percentage of capitated patients were independently associated by multivariate analysis with higher levels of satisfaction with capitated quality of care (P< or =.005). CONCLUSION: These California primary care physicians were less satisfied with the quality of care they deliver to patients covered by capitated contracts than with the quality of care they deliver to patients covered by other payment sources. However, those in medical group practices and with a higher percentage of capitated patients were more satisfied with capitated care. National expansion of capitation should be accompanied by efforts to ensure that the satisfaction of practicing physicians with the care they deliver does not decline.

Attitude of Health Personnel↗
PubMed1998

The role of diversity in the health care needs of California.

Socioeconomic, racial, and ethic diversity influence many facets of health care, including access to health services, the morbidity and mortality of disease, and the process of training health care professionals. California has an increasingly diverse population, and it is essential that the University of California medical schools carefully address the role of diversity in medical education and in education for the many other professionals who have a key role in the provision of care and services to Californians. In this paper, we provide evidence in support of the belief that the University of California system must train a physician workforce that reflects the racial, ethnic, and socioeconomic characteristics of California's population in order to provide equitable health care to all segments of the state's people.

Attitude of Health Personnel↗
PubMed1993

Isolations of Jamestown canyon virus (Bunyaviridae: California serogroup) from mosquitoes (Diptera: Culicidae) in the western United States, 1990-1992.

Nearly 80,000 immature and adult mosquitoes in three genera were collected in high-elevation (> 1,000 m) areas of California (68,229), Nevada (3,721), Oregon (5,918), and Washington (1,629) during 1990-1992 and tested for virus as adult males or females in 1,799 pools. Collections comprised primarily alpine Aedes in the Aedes communis (De Geer) group of the subgenus Ochlerotatus. Thirteen strains of Jamestown Canyon (JC) virus were recovered by plaque assay in Vero cell culture from three members of the Ae. communis group: 10 from Aedes tahoensis Dyar, 2 from Aedes cataphylla Dyar, and 1 from Aedes hexodontus Dyar. All isolates came from collections made in Alpine, Sierra, Tulare, or Tuolumne counties in the Sierra Nevada of California. Vertical transmission of JC virus in all three mosquito species was demonstrated by the isolation of virus from adult males or females reared from field-collected larvae or pupae. The prevalence of infected Ae. tahoensis was significantly higher in field-collected adult females than in reared adult males and females in Alpine County, which indicated that JC virus was being amplified by horizontal transmission. This study further incriminated Ae. tahoensis, Ae. cataphylla, and Ae. hexodontus as natural vectors of JC virus in California and greatly extended the known geographical range of this virus in the Sierra Nevada.

Altitude↗
PubMed1991

Isolation of Jamestown Canyon virus from boreal Aedes mosquitoes from the Sierra Nevada of California.

More than 28,000 mosquitoes in four genera were collected from high elevation (greater than or equal to 1,000 m) areas of California during 1988-89 and tested for virus by plaque assay in Vero cells. Viruses were serogrouped by enzyme immunoassay and serotyped by cross-neutralization. Six strains of Jamestown Canyon virus in the California serogroup were isolated from three species of boreal Aedes in the Aedes communis group of the subgenus Ochlerotatus. All isolates were from mosquitoes collected in Alpine County at approximately 2,300 m elevation in the Sierra Nevada. These included one virus from a pool of male Aedes cataphylla collected in immature stages, which is evidence for vertical transmission; four viruses from adult female Ae. communis (sens. lat.); and one virus from adult female Aedes hexodontus. These are the first isolations of viruses from boreal Aedes mosquitoes in California and the first reported isolations of Jamestown Canyon virus from Ae. cataphylla or Ae. hexodontus.

Aedes↗
PubMed1987

Resistance of California ground squirrels (Spermophilus beecheyi) to the venom of the northern Pacific rattlesnake (Crotalus viridis oreganus): a study of adaptive variation.

Recent studies have documented natural resistance to snake venom in a number of diverse mammalian species. The present paper documents for the first time variation in such resistance within one single species, the California ground squirrel (Spermophilus beecheyi). This species is a frequent prey of the northern Pacific rattlesnake (Crotalus viridis oreganus) in certain habitats. Venom resistance was tested directly in two populations of ground squirrels by injection of 1-40 mg/kg venom doses. One population was obtained from a habitat with a high rattlesnake density; the other population came from a rattlesnake-free habitat. Dramatic differences in the response to venom between these populations were manifested, based on a variety of criteria, such as mortality, necrosis and healing time. Resistance to venom was also examined by LD50 tests in groups of mice pre-injected with ground squirrel sera from three rattlesnake-adapted California populations and a non-adapted Arctic population (S. parryii) from snake-free central Alaska. The California ground squirrel sera were 3.3-5.3 times more effective in the in vivo neutralization of venom than the sera from Arctic ground squirrels. Moreover, the level of protection by the sera as reflected by the LD50 values was highly correlated (P less than 0.005) with the level of in vitro squirrel serum-venom binding as quantified by radioimmunoassay (RIA). A subsequent RIA revealed that binding levels of sera from 14 California ground squirrel populations correlated significantly (P less than 0.025) with local rattlesnakes densities; i.e. sera pools from populations sympatric with rattlesnakes exhibited the highest binding, whereas populations living in habitats where rattlesnakes are rare or absent typically exhibited the lowest binding levels, several of which approximated the Arctic control. Taken together, these results demonstrate intraspecific variation that is probably the result of differential natural selection due to northern Pacific rattlesnakes. This intraspecific variation should be taken into consideration when testing for natural resistance in wild-caught species.

Adaptation, Physiological↗