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PubMed1991

Mental health crisis in California.

Over the last 30 years, California dejure (legislated) mental health policy has been based on deinstitutionalization and outpatient care through community mental health systems. But by the end of the 1970s, there was a growing concern over whether deinstitutionalization had successfully occurred, whether community mental health systems had failed and whether mental health systems had ever been adequately funded. In a national study released in 1990, California was named one of four states where mental health delivery has regressed in the past two years. A review of current California mental health policies indicates dejure and defacto policies are not the same. Most mental health dollars are going to state hospitals and community acute inpatient facilities. Budgets for community mental health have been steadily eroded, and the current mental health system is in crisis. Implementation of mental health policy is dependent on intergovernmental financing, and each level of government tries to avoid costs. Definitions of which clients are to be served remain unclear while pressures for more social control mount. Mental health remains segregated from physical health policy-making and continues to operate at a political disadvantage in general fund budget battles.

California↗

PubMed2002

Molecular characterization of expressed DQA and DQB genes in the California sea lion ( Zalophus californianus).

To date, there are no published MHC sequences from the California sea lion (Zalophus californianus), a thriving species that, by feeding high on the marine food web, could be a sentinel for disturbances in marine and coastal ecosystems. In this study, degenerate primers and RACE technology were used to amplify near-full-length (MhcZaca- DQB) and full-length (MhcZaca- DQA) expressed class II MHC gene products from the peripheral blood mononuclear cells of two California sea lions in rehabilitation. Five unique Zaca- DQA sequences and eight unique Zaca- DQB sequences, all encoding functional proteins, were identified in the two animals, indicating the presence of multiple DQ- loci in this species. An additional three Zaca- DQB sequences containing features compatible with pseudogenes or null alleles were also identified. Despite the identification of multiple DQA and DQB sequences, the degree of heterogeneity between them was extremely low. To confirm the limited degree of Zaca-DQ nucleotide variation between individuals, we used denaturing gradient gel electrophoresis to examine putative peptide binding region sequences from the peripheral blood leukocyte-derived RNAs of 19 wild-caught California sea lions from physically distinct populations. The pattern of Zaca-DQ sequence migration was identical between individuals and independent of geographical region. This apparent Zaca-DQ sequence identity between sea lions was confirmed by direct sequencing of individual bands. In combination, these findings raise important questions regarding immunogenetic diversity within this thriving species, and should prompt further research into the existence of a highly polymorphic sea lion class II MHC molecule with sequence features that support traditional peptide binding functions.

Alleles↗

PubMed2001

Microbiological monitoring of marine recreational waters in southern California.

An inventory was conducted to assess the number, type, spatial distribution, and costs of microbiological monitoring programs in southern California marine waters from Point Conception to the US/Mexico International Border. The location of each sampling site was determined using global positioning system (GPS), and estimates of geographic coverage were determined using geographic information system (GIS) techniques. Twenty-one programs conducted 87,007 tests annually at 576 sites in the study area. The largest number of sites was sampled in Orange County, whereas the largest number of analyses was performed in Los Angeles County because monitoring programs in this area focused on daily monitoring. Fifteen of the 21 programs were managed by National Pollutant Discharge Elimination System (NPDES) permitted sewage effluent dischargers who sampled both offshore and shoreline waters and typically tested for three indicator bacteria (total coliform, fecal coliform, and enterococcus). Their combined efforts comprised 82% of all of the microbiological indicator analyses conducted on an annual basis. Five of the remaining monitoring organizations were public health agencies, which typically focus their efforts on testing only total coliforms. Laboratory methodology also varied considerably, with NPDES permittees predominantly utilizing membrane filtration while public health agencies generally used multiple tube fermentation or premanufactured test kits. Nearly three quarters of all the effort expended in southern California occurred along the shoreline as opposed to offshore locations. Two thirds of this shoreline effort was focused on high-use sandy beaches and in proximity to perennial fresh-water outlets (storm drains and creeks). Most sampling occurred at a set of fixed sites that were revisited frequently, but only represented about 7% of the total shoreline. We estimated that roughly $3 million is spent annually on monitoring bathing water quality in southern California, exceeding that spent in any other part of the country.

Animals↗

PubMed2005

Summer water use by California coastal prairie grasses: fog, drought, and community composition.

Plants in the Mediterranean climate region of California typically experience summer drought conditions, but correlations between zones of frequent coastal fog inundation and certain species' distributions suggest that water inputs from fog may influence species composition in coastal habitats. We sampled the stable H and O isotope ratios of water in non-photosynthetic plant tissue from a variety of perennial grass species and soil in four sites in northern California in order to determine the proportion of water deriving from winter rains and fog during the summer. The relationship between H and O stable isotopes from our sample sites fell to the right of the local meteoric water line (LMWL) during the summer drought, providing evidence that evaporation of water from the soil had taken place prior to the uptake of water by vegetation. We developed a novel method to infer the isotope values of water before it was subjected to evaporation in which we used experimental data to calculate the slope of the deltaH versus deltaO line versus the LMWL. After accounting for evaporation, we then used a two-source mixing model to evaluate plant usage of fog water. The model indicated that 28-66% of the water taken up by plants via roots during the summer drought came from fog rather than residual soil water from winter rain. Fog use decreased as distance from the coast increased, and there were significant differences among species in the use of fog. Rather than consistent differences in fog use by species whose distributions are limited to the coast versus those with broader distributions, species responded individualistically to summer fog. We conclude that fogwater inputs can mitigate the summer drought in coastal California for many species, likely giving an advantage to species that can use it over species that cannot.

California↗

PubMed2000

Comparisons of the polar lipid and pigment profiles of two solar salterns located in Newark, California, USA, and Eilat, Israel.

The whole community pigments and lipids have been examined during a 5-year period in two commercial solar salterns located in the United States and in Israel. There were significant differences in the complexity of the lipid and pigment patterns within the California saltern system, and these differences were not consistent over the sampling period despite examination of ponds with the same salinity. The solar saltern system in Eilat, Israel, showed greater consistency during this sampling period and compared directly with previous studies. The complexity of the saltern in Newark, California, could be explained on the basis of the prevailing weather conditions (cooler and more rainfall) and the nutrient-enriched source water. The Eilat saltern, however, has an oligotrophic water source and has a considerably warmer and drier climate. This difference resulted in more diverse and more complex pigment and lipid patterns and presumably microbial populations in the Newark, California, plant than in the saltern in Eilat, Israel.

Biomass↗

PubMed2005

Baseline susceptibility of persea mite (Acari: Tetranychidae) to abamectin and milbemectin in avocado groves in Southern California.

Persea mite, Oligonychus perseae Tuttle, Baker, and Abatiello, susceptibility to abamectin and milbemectin was evaluated in 2003 to determine baseline susceptibility levels in avocado groves in San Diego and Ventura Counties (California, USA) where more than 70% of the state's avocado production is concentrated. Milbemectin has yet to be used in avocado production in California and abamectin has been available for use since 1999. Baseline susceptibility ratios (in relation to the most susceptible population) of five persea mite field strains to milbemectin varied 2.1- to 2.8-fold at the LC50 and LC90, respectively. The susceptibility of seven field strains to abamectin varied slightly more (2.1- to 3.5-fold) with one strain subjected to seven sprays over the past 4 years showing slight but significant separation of LC50 and LC90's from the most susceptible strain, which is suggestive of the early stages of resistance to this product. Based on these data, baseline susceptibility levels are proposed that might be used to monitor for future persea mite resistance to these chemicals as their use in California avocado production continues.

Animals↗

PubMed2006

Use of the spatial scan statistic to identify geographic variations in late stage colorectal cancer in California (United States).

OBJECTIVES: To identify geographic variations in colorectal cancer by stage at diagnosis in California using a descriptive analysis coupled with a spatial analysis and to discuss methodological considerations concerning the spatial statistical method. METHODS: We analyzed 59,076 colorectal cancer cases diagnosed in California from 1996 to 2000 by logistic regression and by a spatial scan statistic to identify areas with a higher and lower relative risk of late-stage colorectal cancer. RESULTS: In California, 57% of overall cases of colorectal cancer were diagnosed at a late stage. Californians diagnosed with late-stage colorectal cancer were more likely to be Hispanic and living in areas of lower socioeconomic status. The spatial scan identified two areas where the observed number of late-stage cancer was different than the number expected from the distribution in the rest of the state. CONCLUSIONS: Spatial scan analyses can complement descriptive statistics, but results must be interpreted with consideration of factors that affect the ability to detect meaningful differences such as the number of events observed, accuracy in geocoding rural versus urban addresses, and the difficulty of adjusting for covariates.

Aged↗

PubMed2005

Variations in the incidence of postpartum hemorrhage across hospitals in California.

OBJECTIVE: Because postpartum hemorrhage may result from factors related to obstetrical practice patterns, we examined the variability of postpartum hemorrhage and related risk factors (obstetrical trauma, chorioamnionitis, and protracted labor) across hospital types and hospitals in California. METHODS: Linked birth certificate and hospital discharge data from 507,410 births in California in 1997 were analyzed. Cases were identified using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes. Comparisons were made across hospital types and individual hospitals. Risk adjustments were made using 1) sample restriction to a subset of 324,671 low-risk women, and 2) Bayesian hierarchical logistic regression model to simultaneously quantify the effects of patient-level and hospital-level risk factors. RESULTS: Postpartum hemorrhage complicated 2.4% of live births. The incidence ranged from 1.6% for corporate hospitals to 4.9% for university hospitals in the full sample, and from 1.4% for corporate hospitals to 3.9% for university hospitals in the low-risk sample. Low-risk women who delivered at government, HMO and university hospitals had two- to threefold increased odds (odds ratios 1.98 to 2.71; 95% confidence sets ranged from 1.52 to 4.62) of having postpartum hemorrhage compared to women who delivered at corporate hospitals, irrespective of patient-level characteristics. They also had significantly higher rates of obstetrical trauma and chorioamnionitis. Greater variations were observed across individual hospitals. CONCLUSION: The incidence of postpartum hemorrhage and related risk factors varied substantially across hospital types and hospitals in California. Further studies using primary data sources are needed to determine whether these variations are related to the processes of care.

Bayes Theorem↗

PubMed2006

Genotypic and phenotypic characterization of the California 99 (Cal99) variant of infectious bronchitis virus.

The California 99 (Cal99) variant of infectious bronchitis virus (IBV) was first recovered in 1999 from vaccinated broiler chicken flocks in Central California. The S1 hypervariable region of Cal99 genome was most closely related to Arkansas (Ark) serotype viruses. In this study, the complete genome of Cal99 was sequenced, and the structural protein genes were compared with those of commonly used IBV vaccines as well as those of isolates from naturally occurring outbreaks in different parts of the world, to elucidate potential sources of genetic material. Based on sequence comparison, the prototype Cal99 virus is similar to the apathogenic ArkDPI virus, except in the S1 gene and stretches of sequence in the S2 and M structural protein genes, which are more related to Connecticut (Conn) and Massachusetts (Mass) strain viruses, respectively. We speculate that these two fragments came from a Conn and a Mass virus, respectively, and were incorporated into a virus largely derived from ArkDPI. Since Ark, Conn and Mass strains have been simultaneously used as live vaccines in California, both point mutations and recombination among vaccine strains may have contributed to the emergence of the Cal99 variant virus. Analysis of the structural protein genes of six Cal99 isolates demonstrated that viruses of this serotype may differ substantially in the non-S1 structural genes. Finally, we performed a challenge study with Cal99 and demonstrated that the virus causes late-onset respiratory disease, with a severity comparable to that of the M41 IBV challenge strain.

Amino Acid Sequence↗

PubMed1990

Safety effects of relaxing California's clean-record requirement for driver license renewal by mail.

A pilot program was established in California in 1982 authorizing mail renewal of driver licenses for persons under age 70 lacking clean (accident- and conviction-free) 4-year driving records, but showing clean 2-year records at selection. Such drivers constitute about 14% of California's renewal population, or about 500,000 renewees per year. Eligible drivers whose licenses expired in 1983 were subjects of the present study. Half of them were randomly assigned to a group whose members were sent offers of renewal by mail and the other half were sent standard renewal notices requiring appearance in a field office and successful completion of vision and traffic law tests. Traffic accidents and convictions following the mailout of these documents were tracked for both groups; results presented here cover a 4-year period subsequent to mailout. During this period (a normal license term in California), no significant overall difference was shown between the groups with respect to subsequent convictions or accidents. However, significant detrimental effects on accidents were noted for a subgroup of drivers who had experienced recent traffic violations or accidents which were not on their records at selection. Implications of these results are discussed.

Accidents, Traffic↗

PubMed1985

Agent of Chagas' disease from Honduran vector capable of developing in California insects: implications for cardiologists.

An exotic strain of Trypanosoma cruzi recovered from Triatoma dimidiata from Tegucigalpa, Honduras, was shown by isoenzyme studies to be closely related to the Miles' zymodeme 1 and laboratory reference strain Tehuantepec. It was injected into Swiss random-bred ICR mice. Clean Triatoma protracta nymphs and adults, which had been captured in Winters, California, fed on inoculated mice and were then examined over a 15-month period. Their feces contained multiplying epimastigote and infective trypomastigote forms of T. cruzi. This shows that exotic strains of T. cruzi can develop and survive for long periods in local California vectors. The increasing number of immigrants from Central America who enter California and other states may have public health implications in regard to the introduction of pathogenic strains that are capable of producing cardiomyopathy. Cardiologists who examine patients with cardiomyopathy from Central and South America should rule out Chagas' disease as a cause, since pathogenic T. cruzi strains are present in most Central and South American countries.

Animals↗

PubMed1984

Epidemiological monitoring of environmental lead exposures in California State Hospitals.

Blood lead screening of 8062 state hospital residents in California revealed 143 residents with excessive lead levels (greater than or equal to 30 micrograms/dL). This screening was part of the Childhood Lead Project and was performed in 1978. The purpose of this study was to identify "critical" lead sources in California State Hospitals. Accurate identification is crucial if subsequent abatement programs are to be effective. The strategy involved the following sequence of steps: 1) Selection of cases based on blood lead and erythrocyte protoporphyrin screening. 2) Determination of pica habits and environmental exposures through interviews with ward's staff and/or parents. 3) Measurement of lead levels in environmental samples reflecting exposures. 4) Interpreting these data in order to identify critical lead sources. 5) Reducing exposure to critical lead sources. 6) Following up of cases and controls to validate the effects of this strategy. A group of 36 lead-burdened cases with pica (30-60 micrograms Pb/dL blood) and 36 matched controls (PbB less than 20 micrograms/dL) were selected from among the developmentally disabled residents of two California State Hospitals. These subjects were studied in order to identify the lead sources to which they were exposed and to abate the major ones. Three major lead sources were found in the state hospitals: wall and furniture paints (100-45,400 micrograms Pb/g paint); surface soil (33-570 micrograms Pb/g soil); educational format was presented to all involved staff. The results have indicated a trend towards lower lead intake by the lead-burdened cases. In one of the two hospitals a "lead-free unit" had been established. All the lead-burdened cases were transferred to this unit in August 1981. A few months later the blood lead levels of all the cases dropped below 30 micrograms/dL. Initial epidemiological monitoring indicated where there were preventable hazards, which abatement efforts succeeded in reducing. Further monitoring of such problems is indicated in this and other developmentally-disabled populations.

Adolescent↗

PubMed1982

Biocultural risks in longevity: Samoans in California.

Because migration is such a widespread phenomenon, studies of the effects of accompanying life change on the health and well-being of the migrant have special significance in areas like California that support large migrant communities. Previous studies have shown that increased weight and elevated blood pressure may be linked to changes in diet, exercise habits, and the altered sociocultural milieu of the migrant. Among Samoans, a Pacific Island population of Polynesian descent, these changes appear to be particularly prominent in segments of the population that have moved to the environment of Hawaii, which epidemiologic studies have characterized as "intermediate-modern.' Preliminary findings from a survey of weight, height, blood pressure, fasting glucose levels, and mortality records among Samoans living in California indicate that individuals living under more highly urbanized conditions exhibit even more pronounced changes. Adult weight among Samoans in California (San Francisco) greatly exceeds that of their counterparts in Hawaii and Samoa. Elevated blood pressures are also seen, though the extent to which this is associated with excessive weight gain is unclear. The number of individuals with high (greater than or equal to 160 mg/dl) fasting plasma glucose levels would be consistent with a population in which the prevalence of diabetes is many times higher than in the U.S. population. Although mortality patterns are difficult to determine for this population, available records suggest an excess mortality from cardiovascular diseases of all types among adult Samoans under age 50. Further investigations will attempt to link biobehavioral changes in the migrants' lifestyle to these observed patterns of risk.

Adult↗

PubMed1986

Migration and biocultural adaptation: Samoans in California.

The consequences of migration for the Samoan population of California are discussed within the context of other studies focusing on Samoan native and migrant populations in Samoa and Hawaii. The social, cultural and economic characteristics of California Samoans are described and data are presented for body morphology, blood pressure, psychosocial stress and social support, general morbidity patterns and mortality rates for 1978-1982. Although the nature of disease risks appear profound in this population, particularly patterns of extreme obesity and psychosocial stress, mortality rates for heart disease and stroke are less than might be expected among other American groups. Such unexpectedly low mortality rates may represent the relatively healthy experience of older cohorts of migrants, or be a result of proportionally few individuals having lived long enough in California to develop cardiovascular and other chronic disease that have lengthy natural histories. We postulate that at present Samoan social structure, particularly the high status that accrues with aging in traditional Samoan society, may act as a buffer for the risk factors we observed and their expected outcomes. If so, the U.S.-born Samoans who are currently passing through childhood and early adult years with progressively less awareness of Samoan values of family and social structure will exhibit the same risks we describe here, but lack the available social buffers that currently exist for their parents.

Acculturation↗

PubMed1987

Rotavirus gastroenteritis in southern California.

The epidemiology of rotavirus infections in Southern California was analyzed over a three year period, from January 1, 1981 through December 31, 1983. Data was available from patients seen at the University of California Irvine Medical Center (UCIMC), in addition to referral testing provided to the community in Orange County. Over the 3 yr period the laboratory performed 1172 rotavirus assays. Out of these, 345 were positive for an overall positive rate of 29.4%. The 643 stool specimens from UCIMC corresponded to 508 patients, of which 31.1% (158/508) were positive for rotavirus. The majority of patients with a positive rotavirus test were under 1 yr of age (117/158), with only ten cases found in the 2-15 yr old group. The distribution of the positive rotavirus tests was similar for the female and male population. Approximately 70% of the positive results occur during October through December, with the month of November having the highest incidence. The distribution of positive rotavirus tests did not appear to correlate with either the coldest or the driest month of the year in Southern California.

Age Factors↗

PubMed2004

The state of ED on-call coverage in California.

The ED provides initial treatment, but failure of specialists to respond unravels the safety net. To assess the scope of problems with on-call physicians in California. A mailed anonymous survey to all CAL/ACEP physician members (1876) asking patient, physician and ED demographics, specialist availability for consultation, insurance profile, and availability of follow-up care. 608/1876 physicians responded (32.4%), representing 320/353 California EDs (90.6%). The seven specialties in which the greatest proportion of EDs reported trouble with specialty response were: plastic surgery (37.5%), ENT (35.9%), dentistry (34.9%), psychiatry (26.0%), neurosurgery (22.9%), ophthalmology (18.4%) and orthopedics (18.0%). 71.6% of responder EDs reported that their medical staff rules required ED on-call coverage. However, the percentage of responders who stated that hospitals paid each specialty for call was low: neurosurgery (37.3%), orthopedics (34.4%), ENT (17.9%), plastic surgery (15.1%) and ophthalmology (13.1%). On-call problems were more acute at night (77.2%) or on weekends (72.4%). Patient insurance negatively affected (69.9%) willingness of on-call physicians to consult for at least a quarter of patients. Regarding follow-up, 91% reported some trouble, whereas 64% reported a problem at least half the time. Surgical sub-specialists are the most problematic on-call physicians. Insurance status has a major negative effect on ED and follow-up care. The on-call situation in California has reached crisis proportions.

After-Hours Care↗

PubMed2006

Survey of California emergency departments about practices for management of suicidal patients and resources available for their care.

STUDY OBJECTIVE: To determine the resources available and current practices for the treatment of patients with suicidal ideation or attempts in California emergency departments (EDs). METHODS: We conducted a mail and e-mail survey of the directors of all 346 EDs in the state of California. Data collected included identification of hospital and respondent, type of hospital, presence of separate psychiatric ED, total number of ED patients and number of ED patients with suicidal ideation or attempts who were treated per week, mental health personnel on call to evaluate suicidal patients, criteria for patient disposition, available disposition options, delays in patient care, changes desired in the ED treatment of suicidal patients, and adequacy of community resources for suicidal patients. RESULTS: Two hundred twenty-three of 346 (64.5%) ED directors responded to the survey. Overall, the mean estimate of the proportion of ED visits by suicidal patients was 1.7%. Though evaluation of patients with suicidal ideation by a mental health professional was the usual practice, 51 respondents (23%) reported that they occasionally send patients with suicidal ideation home without such an evaluation, and 8.5% reported this was done more than 10% of the time. No single type of mental health professional, including psychiatrist, social worker, county or private psychiatric evaluation team, psychiatric nurse, or psychologist, was available for evaluation of suicidal patients in more than 50% of respondent EDs. In the majority of EDs, psychiatric evaluations were performed by either mobile county or private psychiatric evaluation teams or social workers on call to the ED. Psychiatrists were reported to evaluate the majority of suicidal patients in only 10% of EDs. Only 27% of respondents had the ability to admit patients to a psychiatric service at their hospital. When patients needed to be transferred, the estimated mean wait for these transfers was 7 hours. Seventy-one percent of respondents reported needing improved access to mental health personnel for evaluation of suicidal patients; 61% reported needing improved access to mental health personnel for patient disposition. CONCLUSION: In California EDs, there are limited mental health services for suicidal patients. Regional solutions to emergency and nonemergency mental health problems are needed, including improved access to mental health personnel for ED evaluation, disposition, and follow-up of suicidal patients and community mental health resources for patient referrals.

Adolescent↗

PubMed2004

Coronary heart disease mortality for six ethnic groups in California, 1990-2000.

PURPOSE: To investigate ethnic variations in coronary heart disease death in California, the authors examined total and CHD-specific mortality among non-Hispanic white (white), Hispanic, non-Hispanic black (black), Chinese, Japanese, and Asian Indian Americans. Deaths were identified in the California Mortality Database and population information was derived from the 1990 and 2000 censuses. METHODS: Age-standardized death rates per 100,000 population were calculated for ages 25 to 84 years from 1990 to 2000. Proportional mortality ratios (PMRs) for each sex and age group were calculated by dividing the proportion of deaths due to CHD in each ethnic group by the proportion of deaths due to CHD in the total population. RESULTS: Blacks had the highest all-cause age-standardized death rates among men (1614) and women (1014). Blacks had the highest CHD death rates among men (272) and women (190). PMRs for CHD were highest in Asian Indian men (161) and women (144), reflective of the higher percentage of CHD deaths compared with all cause deaths in this group. All sex-ethnic groups showed a decline in all cause and CHD mortality compared with the period between 1985 and 1990, except Asian Indian women, who experienced a 16% increase in all cause mortality and 5% increase in CHD mortality. CONCLUSIONS: There is considerable heterogeneity in CHD mortality among ethnic subgroups, and additional research is needed to guide treatment and prevention efforts. Blacks and Asian Indians in California are identified as particularly high risk populations.

Adult↗