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PubMed1964

COUNTING CALIFORNIA'S SNAKEBITES.

Poisonous snakebites happen in all sections of California, but they are especially frequent in Southern California. An estimated 221 (138 in-patients and 83 out-patients) people were bitten by snakes annually, an incidence of 1.41 bites per 100,000 people. However, the estimated case-fatality rate was less than one-half of one per cent. Of 135 in-patients reported in detail by California hospitals during 1958 and 1959, 123 (91 per cent) were bitten by rattlesnakes, one (1 per cent) by a foreign snake, and 11 (8 per cent) by unidentified poisonous snakes. "Seasonal epidemics" of snakebites occurred, 90 per cent of the bites being inflicted from April through October. Males had higher bite rates than females and Caucasians had higher rates than non-whites. Fifty per cent of the cases were among children and young adults less than 20 years of age. Ninety-nine per cent of the bites were on the extremities-65 per cent on the upper extremities and 34 per cent on the lower extremities. The recommended treatment of poisonous snakebites included incision and suction and the 3 A's (antivenin, antibiotics and antitetanus treatment).

Adolescent↗

PubMed2003

Prevalence and structure of palliative care services in California hospitals.

BACKGROUND: Most Americans die in hospitals where shortcomings in end-of-life care are endemic. Hospital-based palliative care services can improve the care of these patients, yet there are limited data regarding the availability of such services. We sought to determine the prevalence of palliative care services in California hospitals. METHODS: We conducted a cross-sectional survey of a random sample of 25% of all California hospitals. We recorded the percentage of hospitals reporting current or planned palliative care consultation services or inpatient palliative care units. RESULTS: We collected data from 107 (96%) of 112 hospitals. Only 17% of hospitals have a palliative care consult service, and 6% have an inpatient palliative care unit. Nearly all services are multidisciplinary. Twenty percent of hospitals have a contract to provide inpatient hospice beds, 19% have an outpatient-based hospice service affiliated with the hospital, and 74% offer bereavement services. Half of all palliative care services are funded exclusively by the hospital. Thirty-eight hospitals (36%) reported an interest in developing palliative care services. CONCLUSIONS: Few California hospitals currently have palliative care services, though more express interest in developing them. Bereavement and hospice services are more common and offer opportunities for increasing the number of palliative care services in hospitals. Further studies are needed to characterize palliative care services more fully and to assess the quality of care provided by these services.

California↗

PubMed1995

California pediatricians' knowledge of and response to recommendations for universal infant hepatitis B immunization.

OBJECTIVE: To assess California pediatricians' level of agreement with and implementation of universal infant hepatitis B immunization. RESEARCH DESIGN: Mailed questionnaire in the summer and fall of 1993 to a random sample of 1030 California pediatricians to determine whether they universally immunize infants with hepatitis B vaccine. The response rate was 71%. RESULTS: More than 81% said they universally immunize infants against hepatitis B infection; however, 18.3% stated that they do not. Pediatricians were more likely to immunize infants universally against hepatitis B if they (1) agreed with the recommendations (90% vs 54%, P < .01), (2) practiced in a health maintenance organization setting vs private group practice (92% vs 79%, P < .05), or (3) practiced in settings with predominantly low-income patients (89% vs 78%, P = .01). Pediatricians who universally immunize infants against hepatitis B virus were in practice an average of 1.7 years longer than those who do not (13.3 years vs 11.6 years, P = .01). In multivariate analyses, the most powerful predictor of universal immunization was agreement with the recommendations. Among those who disagreed with the recommendations, the most common reasons for disagreement included the following: (1) the long-term efficacy of hepatitis B vaccine is not proved--54%; (2) an additional immunization would make the visits too costly--53%; and (3) three shots would be too much at one visit--53%. CONCLUSIONS: A majority (81.6%) of our sample of California pediatricians universally immunize infants against hepatitis B; however, a significant minority (18.4%) do not agree with the recommendations and do not plan to implement them. Many of their objections are being addressed through combination vaccine development and ongoing research; however, alternative policies and additional research should also be considered.

California↗

PubMed2003

Inpatient surgery in California: 1990-2000.

BACKGROUND: The practice environment for surgery is changing. However, little is known regarding the trends or current status of inpatient surgery at a population level. HYPOTHESIS: Inpatient surgical care has changed significantly over the last 10 years. DESIGN: Longitudinal analysis of California inpatient discharge data (January 1, 1990, through December 31, 2000). SETTING: All 503 nonfederal acute care hospitals in California. PATIENTS: All inpatients undergoing general, vascular, and cardiothoracic surgery in California from January 1, 1990, through December 31, 2000, were obtained. MAIN OUTCOME MEASURES: Volume, mean age, comorbidity profile, length of hospital stay, and in-hospital mortality were obtained for inpatient general, vascular, and cardiothoracic surgical procedures performed during the period 1990 to 2000. Rates of change and trends were evaluated for the 10-year period. RESULTS: Between January 1, 1990, and December 31, 2000, 1.64 million surgical procedures were performed. The number of surgical procedures increased 20.4%, from 135,795 in 1990 to 163,468 in 2000. Overall, patients were older and had more comorbid disease in 2000 compared with 1990. Both crude and adjusted (by type of operation) in-hospital mortality decreased from 3.9% in 1990 to 2.75% (P<.001) and 2.58% (P<.001), respectively, in 2000. Length of hospital stay decreased over the period for all operations analyzed. CONCLUSIONS: The total number of inpatient general, vascular, and cardiothoracic surgical procedures has increased over the past decade. Furthermore, our findings indicate that the outcomes of care (eg, in-hospital mortality and length of hospital stay) for patients who undergo general, vascular, and cardiothoracic surgical procedures have improved. However, continued evaluations at the population level are needed.

California↗

PubMed1999

Cancer in California school employees, 1988-1992.

BACKGROUND: Periodic concerns about excesses of cancer among teachers in California schools prompted our examination of cancer incidence in California school employees. METHODS: Records of school employees between 1987-1992 were linked to the California Cancer Registry of incident cases diagnosed 1988-1992. Sex-, race-, and age-adjusted standardized incidence ratios were calculated for specific cancer sites. Analyses stratified by sex, race/ethnicity, and job assignment were also performed. RESULTS: Melanoma of the skin, thyroid cancer, prostate cancer, and female cancers of the breast, uterus, and ovary all occurred more frequently than expected in these school employees. In contrast, cancers of the respiratory system, oral cavity, digestive system, urinary system, and uterine cervix occurred less frequently. CONCLUSIONS: The incidence of cancers thought to be related to hormones and/or higher socioeconomic status appeared elevated while cancers often linked to smoking and/or alcohol intake occurred less frequently in this large cohort of professional school employees.

Adult↗

PubMedDate not supplied

Marginal costs in general acute care hospitals: a comparison among California, New York and Canada.

In the present paper we offer a detailed comparison of hospital costs between California and New York and two Canadian provinces (Ontario and British Columbia) in 1981 and 1985. We find that production technologies differ significantly between the two countries and between California and New York. Marginal costs and their distributions also differ across jurisdictions and across different size hospitals. Marginal cost levels were the lowest in Canadian hospitals for almost all outputs in both years and their distribution was also the tightest. Some very mild scale effects were also present in the acute care production. Hospitals in California experienced for the most part increasing marginal costs for acute care, whereas Canadian hospitals showed the reverse pattern. In New York we find a weak negative scale effect in acute care production. Density estimates conditional on hospital output reinforce these results.

Acute Disease↗

PubMed2002

Use of protective equipment among California farmers.

BACKGROUND: Agriculture is a hazardous industry associated with many occupational injuries and illnesses. We describe California farmers' self-reported exposure to five agricultural hazards and their use of protective equipment. METHODS: A telephone survey of 1,947 California farmers recorded information on occupational exposure, health outcomes and use of protective equipment to lessen risk from exposure to dust, sun, noise, pesticides and tractors. RESULTS: Over 93% of respondents reported using personal protection around pesticides; however, fewer than 1/3 used consistent protection against other hazards. Younger age and male sex were associated with better use of protection from dust, noise, pesticide and tractors, but negatively associated with sun protection. There was no consistent relationship of protective behaviors with cigarette smoking, living on the farm, marital status, or time in non-administrative farmwork. Risk perception was strongly associated with behavior; farmers concerned about specific health problems were much more likely to use protective equipment. CONCLUSIONS: Some farmer characteristics are associated with more safe behaviors, but efforts to encourage protective behaviors on farms should be broadly based in view of a lack of a single risk-taking profile among California farmers.

Accidents, Occupational↗

PubMed1989

Cholinesterase activity depression among California agricultural pesticide applicators.

Cholinesterase activity measurements for 542 California agricultural pesticide applicators under medical supervision during the first 9 months of 1985 were analyzed. Twenty-six workers, 4.8% of the sample, had cholinesterase values at or below the California threshold values for removal from continued exposure to cholinesterase-inhibiting pesticides (60% of baseline for red blood cell cholinesterase and 50% of baseline for plasma cholinesterase activity). Eight of these 26 workers, 31.5%, had pesticide-related illnesses. Pesticides most frequently associated with cholinesterase depressions exceeding California threshold values included mevinphos (Phosdrin), oxydemeton methyl (Metasystox-R), methomyl (Lannate), and acephate (Orthene); these pesticides included organophosphates in toxicity categories I and II and one carbamate in toxicity category I.

Agricultural Workers' Diseases↗

PubMed1991

Investigation of a fatality among parathion applicators in California.

Staff of the California Department of Health Services investigated the death of a parathion applicator in California that was thought to be pesticide-related. A crew of eleven workers (including six sprayers, three mixer/loaders, one mixer/sprayer and one foreman) had been applying 0.125% parathion spray to almond orchards for approximately three weeks. On the day of the fatality, a sprayer rapidly developed symptoms of salivation, sweating, and convulsions after a half-day of work. Despite aggressive medical treatment, the worker died within one hour of his initial symptoms. Significant laboratory results for the decreased case included: parathion residue on the inner and outer garments worn by the worker, parathion in the post-mortem gastric contents, and elevated urinary metabolites consistent with acute parathion intoxication. Interviews with the work crew revealed that three of the 10 workers had complaints of headaches, vomiting, and/or sore throat; yet, subsequent plasma and red cell cholinesterase tests of the co-workers did not show any significant depressions in comparison with pre-season baseline values. This worker death is consistent with prior reports of parathion-related sprayer/applicator intoxications and is the first worker-related parathion death in California since 1972. Substitution of pesticides with less toxic active ingredients or the elimination of parathion is recommended.

Adult↗

PubMed2003

Food fortification with folic acid and twinning among California infants.

This study sought to determine whether a change in twinning prevalence was associated with mandatory folic acid fortification. As of January 1998, it became mandatory in the United States that grain products be fortified with folic acid. The effectiveness of this fortification for neural tube defects has been explored, but other possible implications of fortification has not. We computed the prevalence of twinning among more than 2.5 million California births occurring from 1990 to 1999. The prevalence of twin births in California increased over the last decade with increases observed among most maternal race/ethnic, age, and parity groupings. Unadjusted prevalence measures did not reveal substantial increases in twinning prevalence among these groupings after the fortification period relative to the period immediately preceding it. Analyses that simultaneously adjusted for age, parity, race/ethnicity, sexes of twin pair (as a measure of zygosity), year of birth, and fortification period also did not reveal an association between fortification and twinning. Our results do not suggest a change in twinning prevalence associated with folic acid fortification of the US food supply among women delivering in California.

California↗

PubMed2001

Paleoepidemiolgical patterns of trauma in a prehistoric population from central California.

Skeletal trauma was investigated in a large collection of human remains from central California (N = 162 aged and sexed adults). Lesions investigated included cranial and long bone fractures, projectile wounds, and dislocation. Long bone fractures were found in 10.5% of individuals; overall, incidence by element was 2.3%. In addition, cranial injuries were found in 4.4% of complete adult crania. Projectile wounds were seen unambiguously in four individuals (with embedded obsidian fragments) and strongly suggested in two other individuals with partially healed lesions. Finally, one case of traumatic hip dislocation was also observed. In both incidence and patterning of injuries, this population is similar to other archeological groups from California. This evidence further supports earlier reports indicating that interpersonal aggression was quite common in prehistoric California.

Adolescent↗

PubMed2003

Recent trends and racial/ethnic differences in the incidence and treatment of ductal carcinoma in situ of the breast in California women.

BACKGROUND: The rapid increase in the incidence of ductal carcinoma in situ (DCIS) of the breast in the U.S. has been associated with the widespread adoption of screening mammography. Little is known regarding the incidence and treatment of DCIS in women of racial/ethnic groups other than white and black. The current investigation examined recent trends and racial/ethnic differences in the incidence and treatment of DCIS in California. METHODS: All cases of DCIS diagnosed in women age > or = 40 years in California between 1988-1999 were included. Age-adjusted incidence rates for white, black, Hispanic, and Asian-Pacific Islander women were calculated using the 2000 U.S. female population as the standard. The estimated annual percent change (EAPC) in the rates was calculated using least squares regression. RESULTS: The average annual age-adjusted incidence of DCIS (1988-1999) was 45.3 per 100,000 in white women, 35.0 in black women, 30.9 in Asian-Pacific Islander women, and 21.8 in Hispanic women. Although a steady increase in the incidence of DCIS was noted in all racial/ethnic groups over the study period, Asian-Pacific Islander women were found to have experienced the steepest increase (EAPC = 9.1%), particularly in the age group 50-64 years (EAPC = 12.0%). The DCIS incidence was reported to increase with age in white, black, and Hispanic women, but remained fairly constant after the age of 50 years in Asian-Pacific Islanders. The proportion of women with DCIS treated with mastectomy decreased from 53% in 1988 to 32% in 1999. Younger women and Asian-Pacific Islander women reportedly were more likely to undergo mastectomy. CONCLUSIONS: Considerable differences by race/ethnicity and age were observed in DCIS incidence and the change in the incidence in California between 1988 and 1999. Further information is needed to determine whether these differences are because of differential utilization of screening mammography or biologic characteristics of DCIS lesions.

Adult↗

PubMed2005

Characterization and PCR-based detection of benzimidazole-resistant isolates of Monilinia laxa in California.

Monilinia laxa is a pathogen of brown rot of stone fruit and almond in California, causing blossom blights and fruit rots. In this study, low-level resistance to the benzimidazole fungicides benomyl and thiophanate-methyl was detected in field isolates of M laxa collected from stone fruits and almonds in California. Low-resistant (LR) isolates grew in potato dextrose agar (PDA) plates amended with benomyl and thiophanate-methyl at 1 and 5 microg ml(-1), respectively, but not in plates amended with benomyl at 5 microg ml(-1) or thiophanate-methyl at 50 microg ml(-1). The benzimidazole LR isolates were characterized by temperature sensitivity and the DNA sequence of the beta-tubulin gene. The LR isolates showed high-temperature sensitivity, being sensitive to 1 microg ml(-1) of benomyl at 28 degrees C but resistant at 8-24 degrees C. Analysis of the DNA sequence of the beta-tubulin gene showed that the LR isolates had a point mutation at the amino-acid position 240, causing substitution of leucine by phenylalanine. Based on the point mutation, a pair of allele-specific PCR primers was developed for rapid detection of LR isolates of M laxa. In addition, a pair of PCR primers specific to M laxa was developed on the basis of the differences in the DNA sequence of the intron 6 of beta-tubulin gene from M laxa, M fructicola and other fungal species. The primer pair amplified the expected 376-bp DNA fragment from all M laxa isolates tested, but not from 14 other fungal species isolated from stone fruit and almond crops. The restriction endonuclease BsmA I recognized the sequence GTCTCC in the PCR products from sensitive (S) isolates only, but not the GTTTCC sequence in the PCR products from LR isolates. The endonuclease digested the 376-bp PCR products from S isolates to produce two bands (111 and 265 bp) on agarose gels. Thus, both allele-specific PCR and the PCR-restriction fragment length polymorphism (PCR-RFLP) methods could be useful for rapidly detecting benzimidazole-resistant isolates of M laxa from stone fruit and almond crops in California.

Ascomycota↗

PubMed2002

Congenital malformations in offspring of Vietnamese women in California, 1985-97.

BACKGROUND: Little is known about reproductive outcome risks for Vietnamese women delivering infants and fetuses in the U.S. METHODS: Using data from a large population-based registry, we explored risks of selected congenital malformation phenotypes in offspring of Vietnamese women in California. Data were derived from the California Birth Defects Monitoring Program, a population-based active surveillance system for collecting information on infants and fetuses with congenital malformations using multiple source ascertainment. Approximately 3.4 million births (liveborn and stillborn) occurred during the ascertainment period, 1985-97. Information on maternal race/ethnic background was obtained from California birth certificate and fetal death files. Vietnamese women delivered 45,453 births and 1,257,853 births were delivered to non-Hispanic white women. RESULTS: The overall prevalence of structural congenital malformations was 1.92 among Vietnamese and 2.63 among non-Hispanic whites per 100 births and fetal deaths. Grouping by 20 3-digit malformation codes of the International Classification of Diseases-Ninth Revision revealed relative risks of 0.8 or less for spina bifida, eye, upper alimentary, genital, urinary, musculoskeletal, "other" limb, and "other" musculoskeletal anomalies, and relative risks of 1.3 or more for anencephaly and chromosomal anomalies. Grouping by the more specific 4-digit malformation codes revealed 50, among 178, malformation groupings with associated relative risks of >or=1.3 or <or=0.8. Seventeen relative risk estimates suggested elevated risks for Vietnamese births, and 33 estimates suggested lowered risks for Vietnamese, relative to non-Hispanic white births. Simultaneous adjustment for maternal age, plurality, and child sex, did not substantially alter observed risks. CONCLUSIONS: These data contribute to a relatively sparse literature about an important subgroup of the U.S. population, but can not elucidate whether increased or decreased risks among Vietnamese are related to potential underlying genetic susceptibilities, to cultural, social, or political differences that could modify exposures, or to the many potential combinations between susceptibilities and exposures.

California↗

PubMed1995

Lead levels in the household environment of children in three high-risk communities in California.

To assess environmental lead contamination in the household environment of children in high-risk areas of California, three urban locations were surveyed by the California Department of Health Services. Plant, soil, and dust lead levels were measured and a questionnaire was administered. This survey estimates that 3 million homes in California (27%) may have exterior paint lead levels > or = 5000 ppm, and 1.3 million homes (12%) may have interior paint lead levels > or = 5000 ppm. The highest concentrations of lead in paint were found on exterior surfaces and, for homes built between 1920 and 1959, on trim. Age of housing was the best predictor of lead in soil and dust; homes built before 1920 were 10 times more likely to have soil lead levels > or = 500 ppm compared to post-1950 homes. Most of the variability in dust lead levels could not be explained by factors measured in this survey. Sources of lead in the home were more highly correlated with lead dust concentration levels than they were with lead dust loading levels. Households with members reporting a lead job were twice as likely to have high dust lead levels compared to households with no one reporting a lead job. The significant differences in dust lead concentration levels between communities were not reflected in differences in dust lead loading levels. Measuring dust lead loading levels does not appear to be a meaningful sampling method for risk assessment in the context of prioritizing abatement.

California↗

PubMed1994

Assessment of the reproductive and developmental toxicity of pesticide/fertilizer mixtures based on confirmed pesticide contamination in California and Iowa groundwater.

Pesticides and fertilizers, as used in modern agriculture, contribute to the overall low-level contamination of groundwater sources. In order to determine the potential of pesticide and fertilizer mixtures to produce reproductive or developmental toxicity at concentrations up to 100 x the median level found in groundwater, we prepared and studied two mixtures of pesticides and a fertilizer (ammonium nitrate). One mixture containing aldicarb, atrazine, dibromochloropropane, 1,2-dichloropropane, ethylene dibromide, and simazine plus ammonium nitrate was considered to be a representative of groundwater contamination in California (CAL). The other, containing alachlor, atrazine, cyanazine, metolachlor, metribuzin, and ammonium nitrate, simulated groundwater contamination in Iowa (IOWA). Each mixture was administered in the drinking water of either Swiss CD-1 mice during a Reproductive Assessment by Continuous Breeding study or pregnant Sprague-Dawley rats (gd 6-20) at three dose levels (1x, 10x, and 100x) where 1x was the median concentration of each pesticide component as determined in the groundwater surveys in California or Iowa. Unlike conventional toxicology studies, the purpose of this study was to evaluate the health effects of realistic human concentrations. Thus, the testing concentrations are probably well below the maximally tolerated dose. Propylene glycol was used as the solubilizer for the pesticides in drinking water formulations in both studies. In the reproductive study, neither mixture caused any clinical signs of toxicity, changes in food or water consumption, or body weight in either F0 or F1 mice at doses up to 100x the median groundwater concentrations. There were no treatment-related effects on fertility or any measures of reproductive performance of either the F0 or the F1 generation mice exposed to either CAL or IOWA at up to 100x. Similarly, measures of spermatogenesis, epididymal sperm concentration, percentage motile sperm, percentage abnormal sperm, and testicular and epididymal histology were normal. In the developmental study, CAL- or IOWA-exposed females did not exhibit any significant treatment-related clinical signs of toxicity. No adverse effects of CAL or IOWA were observed for measures of embryo/fetal toxicity, including resorptions per litter, live litter size, or fetal body weight. CAL or IOWA did not cause an increased incidence of fetal malformations or variations. In summary, administration of these pesticide/fertilizer mixtures at levels up to 100-fold greater than the median concentrations in groundwater supplies in California or Iowa did not cause any detectable reproductive (mice), general, or developmental toxicity (rats).

Animals↗

PubMedDate not supplied

Minors' access to single cigarettes in California.

OBJECTIVE: As the cost of a pack of cigarettes continues to increase, minors may resort to purchasing single cigarettes ("loosies"), but no clear data on their rate of access to singles are available. This study examined the availability of singles to minors by gender, age, and ethnicity. DESIGN: In a factorial experiment, 36 minors of different sexes, ages, and ethnic groups each attempted to purchase a single cigarette once in half of a group of 72 randomly selected stores in middle-class California communities, for a total of 1,271 single cigarette purchase attempts. RESULTS: Minors were able to purchase singles 7.9% of the time, with this access rate being significantly higher (16.2%) for older (16-year-old) minors. Minors were typically charged 15 cents for the single, and singles were sold by 28 of the 72 (38.9%) stores. CONCLUSIONS: Minors have considerable access to single cigarettes in middle-class, California communities, despite California laws banning their sale. Minors' rate of access to singles in poorer communities and in states that lack legislation against selling them is probably significantly higher. Because singles facilitate cigarette purchases by minors who lack money, any legislation that increases the cost of a pack of cigarettes must also explicitly ban the sale of singles.

Adolescent↗

PubMed1992

Acute pesticide morbidity and mortality: California.

The California Pesticide Illness Surveillance Program collects, investigates, abstracts, and records reports received from physicians. A minority of the reports are received through the county health officers who are notified by physicians under a state requirement for reporting pesticide-caused conditions. Most of the cases are identified by review of workers' compensation records. All the cases identified are investigated by the agricultural commissioners of the counties where exposure occurred. The investigation reports are reviewed and abstracted by staff of the Worker Health and Safety Branch of the California Department of Pesticide Regulation, California Environmental Protection Agency (Cal/EPA). The crucial determination is assessment of the degree of relationship between the exposure and subsequent disease: definite, probable, possible, unlikely, or unrelated. In most years, the number of cases investigated has been between 2,500 and 3,000. Excluding antimicrobials, the number of cases found after investigation to have a definite, probable, or possible relationship with pesticide exposure has ranged from 970 (in 1989) to 1,372 (in 1988). Cases involving antimicrobials rarely were reported prior to 1987. In that year, surveillance staff began reviewing workers' compensation records personally, with the specific goal of identifying antimicrobial cases. Since then, antimicrobials have been found to account for 746-813 cases annually, primarily involving splashes and squirts to the eye and inhalation of fumes or vapors. Numbers of case reports from agricultural situations have varied irregularly, driven by small numbers of episodes concerning multiple individuals. Variability in numbers of cases involving the skin has depended almost entirely on variation in numbers of field worker dermatitis. The most common situation for field worker dermatitis has been summer work in table grapes grown in the southern San Joaquin valley. In the two years since reentry intervals for the acaricide propargite were lengthened, there have been no more major clusters of field worker dermatitis. Although the cases collected by the surveillance program are predominantly occupational, because of dependence on workers' compensation for case identification, most recorded deaths are nonoccupational. Nonoccupational fatalities include suicides, mistaken ingestion of pesticides (especially if stored in food containers), and entry into structures being fumigated. Occupational deaths are less common and more varied. The circumstances of each reported occupational death are summarized above.

California↗