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PubMedDate not supplied

Coccidioidomycosis in Tulare County, California, 1991: reemergence of an endemic disease.

In 1991, 1208 cases of coccidioidomycosis were reported to the California Department of Health Services, compared with an annual average of 450 during 1986-90. We conducted a study in Tulare County to define the epidemiology of the disease and identify risk factors for severe disease, focusing on the epidemic period September 1991-December 1991. To identify cases, we used data from the Coccidioidomycosis Serology Laboratory at the University of California, Davis, other laboratories, and the Tulare County Health Department's coccidioidomycosis reporting system. We compared patients who were hospitalized with those who were not to determine risk factors for severe disease. We identified 128 cases of acute coccidioidomycosis diagnosed between 1 September and 31 December 1991 (attack rate 41/100,000); south central Tulare County had the highest attack rate. Thirty-five (27%) case-patients were hospitalized. Male sex (relative risk (RR) 2.5, 95% confidence interval (CI) 1.2-5.0), black people and Asian races (RR 4.8, 95% CI 2.4-9.6), and age > or = 20 years (RR 8.3, 95% CI 1.2-57.4) were univariately significant and remained independently associated with hospitalization in multivariate analysis. The 1991 Tulare County outbreak of coccidioidomycosis was part of a much larger outbreak that began in California during 1991 and continued through 1993. The outbreak was preceded by an unusually rainy spring. Although dust reduction measures during times of increased coccidioidomycosis incidence can help reduce exposure, definitive control awaits the development of a safe, effective vaccine.

Adult↗
PubMedDate not supplied

The interplay of national, state, and local policy in financing care for drug-affected women and children in California.

Recent prevalence studies in California indicate that perinatal alcohol and other drug use remains a serious issue for large numbers of women and their children. In response, national, state and local policymakers have taken steps to address the problem, including increasing funding for treatment services. To gauge the impact of policy attention to this problem, the Center for the Vulnerable Child at Children's Hospital, Oakland, California, surveyed state and local administrators of programs that serve drug-affected women and children in California. Information collected included the scope of program services, indicators of access, and sources of program funding. Surveyed programs were funded through federal, state, county, and foundation sources. Despite new policy and funding initiatives to serve this population, the study found wide gaps between the kinds of services that are believed to be appropriate for drug-affected women and children and the service system that currently exists. Problems in access to care included long waiting times, exclusion of women from programs based on their pregnancy or parenting status, and exclusion of drug-exposed children from programs with medically based eligibility criteria. Program funding sources appeared to impede access, as traditional federal, state, and county funding sources do not support programs that are comprehensive, family-centered, and easily accessible to these women and children. Analysis of the study data suggests that policymakers consider new approaches to promote access to care for these underserved women and children, particularly now as Congress and the states redesign health and social service funding mechanisms and delivery systems.

Adult↗
PubMedDate not supplied

The Addiction Treatment Unit: a dual diagnosis program at the California Medical Facility--a descriptive report.

The Addiction Treatment Unit is a dual diagnosis program which exists in the California Department of Corrections. It is housed in the California Medical Facility in Vacaville, California. Program residents must meet the diagnostic criteria of having a major mental disorder substantiated by a DSM-IV Axis I diagnosis and also meet the criteria for a substance abuse/dependence disorder. All patients are housed in one wing of the facility, which is based on the format of a modified therapeutic community and focuses on the concept of recovery. A multidisciplinary treatment team comprised of a psychiatrist, a psychologist, a social worker and a psychiatric technician delivers clinical interventions, including individual and group therapy as well as medication management. The focus of the drug treatment aspect is an Alcoholics Anonymous/Narcotics Anonymous approach based on 12-Step philosophy. Research involving other therapeutic communities running in prisons is discussed as is the aspect of dual diagnosis programs. Logistical and environmental constraints which pose challenges to running the Addiction Treatment Unit are considered. A summary section reflects on aspects which have been successful, what has not worked or has been changed and upcoming program revisions.

Adult↗
PubMedDate not supplied

CCCSAPR: a new approach to drug policy research in the twenty-first century. California Collaborative Center for Substance Abuse Policy Research.

The California Collaborative Center for Substance Abuse Policy Research (CCCSAPR) was established in 1997 to provide a nucleus for policy research in addiction and allied fields throughout the nine University of California campuses and allied research endeavors. The primary goal of CCCSAPR is that of providing data on statewide and national substance abuse issues toward the development and maintaining of a coherent substance abuse policy in the state of California. The authors present the history and scope of the Center as a new approach to drug policy research for a new century.

Academies and Institutes↗
PubMedDate not supplied

Drug court effectiveness: a review of California evaluation reports, 1995-1999.

Over the past two decades, drug courts have emerged as a viable alternative for addressing drug cases within the criminal justice system. In California, the Drug Court Partnership Program (DCPP) was created in 1998 and has supported and funded the development of drug courts throughout the State. This article reports on a review of California drug court evaluations through January 2000 conducted as part of an evaluation of the California DCPP. A total of 23 evaluations were collected. Seventeen were reviewed in detail, and six were excluded because they were internal reports rather than evaluations. A standardized review process was initiated which led to a scored rating of the evaluation reports. Results of this review support previous findings that drug court participants may experience reduced rearrest rates by 11% to 14% compared to nonparticipants. The largest reduction in rearrest rates appears among graduates. The graduation rates were between 19% and 54%. Costs and savings associated with drug courts were discussed but no conclusions were possible based on the findings from these evaluations. The evaluation of the effectiveness of drug courts presents unique challenges. This review concludes with a discussion of evaluation methods (e.g. standardizing rate calculations, term definitions) that would strengthen drug court research.

California↗
PubMedDate not supplied

Methamphetamine use and HIV risk among substance-abusing offenders in California.

Recent epidemiological surveys of illicit substance use show a particularly high prevalence of methamphetamine use in the western and southwestern United States-most notably California. Moreover, in their analysis of 1995 Drug Use Forecasting data, Anglin and colleagues (1998) found that methamphetamine was a preferred substance among California arrestees. The present study uses data from 807 state prison inmates in California (32% of whom reported using methamphetamine prior to incarceration) to examine the associations between methamphetamine use and HIV risk behaviors. Methamphetamine users in this sample were significantly more likely than nonusers to have injected drugs during the six months prior to their current incarceration. Among injectors, however, injection-related risks (such as dirty needles and needle sharing, etc.) were not significantly associated with methamphetamine use. However, past six-month sex-related risks were dramatically higher for methamphetamine users. These patterns persisted even after controlling for background differences between the two groups. The results of this study underscore the importance of addressing the higher sex-related HIV/AIDS risk among methamphetamine users undergoing prison-based drug treatment.

Adult↗
PubMed1991

College health services in California.

College health services are an underrecognized segment of California's health delivery system. Higher education institutions in California vary in their arrangements for the provision of health services. Some of the smaller institutions provide nurse triage, first aid, and referral only, whereas other institutions provide 24-hour-per-day/7-day-per-week comprehensive ambulatory and inpatient services. More than 200 full-time equivalent physicians are employed in college health services in California. Patient profiles served by college health services targeted the traditional college student age range. Some institutions, however, have expanded their services to include nonstudent university employees and their dependents. Comparing numbers of outpatient visits and professional staffing requirements to student enrollment showed significant variability between institutions, depending upon the scope of services provided (basic, intermediate, comprehensive) and the type of student population (residential, commuter, mixed).

Adult↗
PubMed1997

Binge drinking among college students: a comparison of California with other states.

California college students (1,864 students from 15 colleges) were compared with students who participated in the Harvard School of Public Health College Alcohol Study, which surveyed 17,592 students in 140 colleges nationwide. California college students, in comparison with the remainder of the nation, were less frequent drinkers; less frequent binge drinkers; exhibited fewer personal problems and risks associated with heavy episodic drinking, including drinking and driving; and reported fewer "secondhand" effects of binge drinking, such as being physically assaulted or experiencing an unwanted sexual advance. Many of these differences appear to be related to the California college students' being older, more likely to be married, and less likely to live on campus than those in the Harvard study. The findings suggest that, in developing programs tailored to local needs, there is significant value in augmenting national surveillance of college student health risk behaviors with the development of regional, state, and local surveillance systems.

Adolescent↗
PubMed1991

Annual average radon concentrations in California residences.

A study was conducted to determine the annual average radon concentrations in California residences, to determine the approximate fraction of the California population regularly exposed to radon concentrations of 4 pCi/l or greater, and to the extent possible, to identify regions of differing risk for high radon concentrations within the state. Annual average indoor radon concentrations were measured with passive (alpha track) samplers sent by mail and deployed by home occupants, who also completed questionnaires on building and occupant characteristics. For the 310 residences surveyed, concentrations ranged from 0.10 to 16 pCi/l, with a geometric mean of whole-house (bedroom and living room) average concentrations of 0.85 pCi/l and a geometric standard deviation of 1.91. A total of 88,000 California residences (0.8 percent) were estimated to have radon concentrations exceeding 4 pCi/l. When the state was divided into six zones based on geology, significant differences in geometric mean radon concentrations were found between several of the zones. Zones with high geometric means were the Sierra Nevada mountains, the valleys east of the Sierra Nevada, the central valley (especially the southern portion), and Ventura and Santa Barbara Counties. Zones with low geometric means included most coastal counties and the portion of the state from Los Angeles and San Bernardino Counties south.

Air Pollution, Indoor↗
PubMed2000

Oxalic acid in PM2.5 particulate matter in California.

Ambient air monitoring for organic acids in PM2.5 was conducted at several locations in California. During the study, it was found that oxalic acid (ethanedioc acid) was the most abundant organic acid found in the PM2.5 fraction. Samples from Azuza (in southern California), San Jose (in the San Francisco Bay area), and Fresno (in central California), a PM2.5 Super Site, were collected in 1999 and analyzed. The results for oxalic acid concentrations during this monitoring effort are presented.

Air↗
PubMed2003

The distribution of particle-phase organic compounds in the atmosphere and their use for source apportionment during the Southern California Children's Health Study.

Atmospheric particulate matter (PM) samples from 12 sites in southern California, collected as part of the Southern California Children's Health Study (SCCHS), were analyzed using gas chromatography/mass spectrometry (GC/MS) techniques. Ninety-four organic compounds were quantified in these samples, including n-alkanes, fatty acids, polycyclic aromatic hydrocarbons (PAH), hopanes, steranes, aromatic diacids, aliphatic diacids, resin acids, methoxyphenols, and levoglucosan. Annual average concentrations of all detected compounds, as well as average concentrations for three seasonal periods, were determined at all 12 sites for the calendar year of 1995. These measurements provide important information about the seasonal and spatial distribution of particle-phase organic compounds in southern California. Also, co-located samples from one site were analyzed to assess precision of measurement. Excellent agreement was observed between annual average concentrations for the broad range of organic compounds measured in this study. Measured concentrations from the 12 sampling sites were used in a previously developed molecular-marker source apportionment model to quantify the primary source contributions to the PM10 organic carbon and mass concentrations at these 12 sites. Source contributions to atmospheric PM from six important air pollution sources were quantified: gasoline-powered motor vehicle exhaust, diesel vehicle exhaust, wood smoke, vegetative detritus, tire wear, and natural gas combustion. Important trends in the seasonal and spatial patterns of the impact of these six sources were observed. In addition, contributions from meat smoke were detected in selected samples.

Air Movements↗
PubMed2005

Exhaust temperature profiles for application of passive diesel particulate filters to solid waste collection vehicles in California.

To reduce public exposure to diesel particulate matter (DPM), the California Air Resources Board has begun adoption of a series of rules to reduce these emissions from in-use heavy-duty vehicles. Passive diesel particulate filter (DPF) after-treatment technologies are a cost-effective method to reduce DPM emissions and have been used on a variety of vehicles worldwide. Two passive DPFs were interim-verified in California and approved federally for use in most 1994--2002 engine families for vehicles meeting min engine exhaust temperature requirements for successful filter regeneration. Some vehicles, however, may not be suited to passive DPFs because of lower engine exhaust temperatures. The purpose of this study was to determine the applicability of two types of passive DPFs to solid waste collection vehicles, the group of vehicles for which California recently mandated in-use DPM reductions. We selected 60 collection vehicles to represent the four main types of collection vehicle duty cycles--rolloffs, and front-end, rear, and side loaders--and collected second-by-second engine exhaust temperature readings for one week from each vehicle. As a group, the collection vehicles exhibited low engine exhaust temperatures, making the application of passive DPFs to these vehicles difficult. Only 35% of tested vehicles met the temperature requirements for one passive DPF, whereas 60% met the temperature requirements for the other. Engine exhaust temperatures varied by vehicle type. Side and front-end loaders met the engine exhaust temperature requirements in the greatest number of cases with approximately 50-90% achieving the required regeneration temperatures. Only 8-25% of the rear loader and roll-off collection vehicles met the engine exhaust temperature requirements. Solid waste collection vehicles represent a diverse fleet with a variety of duty cycles. Low engine exhaust temperatures will need to be addressed for successful use of passive DPFs in this application.

Air Pollutants↗
PubMed2006

Air quality modeling in the South Coast Air Basin of California: what do the numbers really mean?

This study evaluates air quality model sensitivity to input and to model components. Simulations are performed using the California Institute of Technology (CIT) airshed model. Results show the impacts on ozone (O3) concentration in the South Coast Air Basin (SCAB) of California because of changes in: (1) input data, including meteorological conditions (temperature, UV radiation, mixing height, and wind speed), boundary conditions, and initial conditions (ICs); and (2) model components, including advection solver and chemical mechanism. O3 concentrations are strongly affected by meteorological conditions and, in particular, by temperature. ICs also affect O3 concentrations, especially in the first 2 days of simulation. On the other hand, boundary conditions do not significantly affect the absolute peak O3 concentration, although they do affect concentrations near the inflow boundaries. Moreover, predicted O3 concentrations are impacted considerably by the chemical mechanism. In addition, dispersion of pollutants is affected by the advection routine used to calculate its transport. Comparison among CIT, California Photochemical Grid Model (CALGRID), and Urban Airshed Model air quality models suggests that differences in O3 predictions are mainly caused by the different chemical mechanisms used. Additionally, advection solvers contribute to the differences observed among model predictions. Uncertainty in predicted peak O3 concentration suggests that air quality evaluation should not be based solely on this single value but also on trends predicted by air quality models using a number of chemical mechanisms and with an advection solver that is mass conservative.

Air Pollution↗
PubMedDate not supplied

The California 500: medical care at a NASCAR Winston Cup race.

BACKGROUND: Stock car racing is America's fastest-growing professional sport. With more than 5.5 million paid admittances and another 148 million watching the 34-race NASCAR Winston Cup series on television, emergency physicians are increasingly called upon to organize medical support for such events. Currently, little reliable information is available to assist in determining what specific personnel and equipment are necessary to optimally support a race event. OBJECTIVE: To characterize the spectrum of presenting injuries and illnesses at a NASCAR Winston Cup event. METHODS: This study was a retrospective review of all patients presenting to nine on-site first aid stations from June 19 to 22, 1997, for the inaugural California 500 race weekend at California Speedway in Fontana, California. Staffing of the nine first aid stations was provided by 20 paramedics, 25 emergency nurses, five emergency physicians, nine advanced life support (ALS) ambulances with two crew members each, and a medically configured helicopter with flight crew. RESULTS: Of the 923 patients seen, 38 were drivers/crew, 230 were track employees, and 644 were spectators. One hundred thirty-six of the patients were treated in the two infield facilities, while 787 were treated in the grandstand first aid stations. Patients seen per hour peaked just before the start of the race at 73 patients seen. Of the ten patients transported to the hospital, three required admission. No deaths occurred. CONCLUSION: These data may assist individuals planning medical support for large motorsports venues.

Accidents↗
PubMedDate not supplied

Differences between children and adults: implications for risk assessment at California EPA.

The California legislature enacted a law requiring the California Environmental Protection Agency (Cal/EPA) Office of Environmental Health Hazard Assessment (OEHHA) to evaluate whether our risk assessment methodologies are adequately protective of infants and children. In addition both OEHHA and the California Air Resources Board must examine whether the Ambient Air Quality Standards set for criteria air pollutants and the health values developed for air toxics are adequately protective of infants and children. We have initiated a program to look at potential differences in response to toxicants between children and adults. We are evaluating this issue from the perspective of exposure differences as well as toxicokinetic and toxicodynamic differences between children and adults. Data on specific chemicals are rather limited. As a result, we will be pooling information to determine whether there are generic differences between children and adults that may be applicable to risk assessment in general or to risk assessment of specific classes of compounds. This paper discusses the rationale for approaching the issue of determining whether our risk assessment methods are adequate for infants and children and includes a discussion of some of the available information on both qualitative and quantitative differences in response to toxicants between children and adults or immature and mature laboratory animals. We provide examples of differences between children and adults in absorption, metabolism, and excretion of toxicants as well as qualitative differences in toxic response.

Adult↗
PubMed2002

The California Tobacco Control Program and potential harm reduction through reduced cigarette consumption in continuing smokers.

Harm reduction for continuing smokers has been suggested as a public health priority. We evaluated whether tobacco control programs might reduce cigarette consumption among current smokers through strategies aimed primarily at protecting nonsmokers from secondhand smoke (SHS). Data were from adult (18+ years) respondents to multiple (1990, 1992, 1996, 1999), large, cross-sectional, population-based surveys of smoking behavior, conducted to evaluate the California Tobacco Control Program. Adult daily smoking prevalence decreased from 15.9 +/-0.4%(+/-95% confidence interval) of the California adult population in 1990 to 13.0 +/-0.3% in 1999. Concurrently, moderate-to-heavy daily smoking (>or= 15 cigarettes/day) decreased from 10.3 +/-0.4% in 1990 to 7.4 +/-0.3% in 1999, and heavy daily smoking (>or= 25 cigarettes/day) from 3.4 +/- 0.2% in 1990 to 1.9 +/- 0.1% in 1999. Decreased daily smoking was observed in all demographic subgroups except young adults. Among college graduates, the daily smoking prevalence in 1999 was 6.4 +/- 0.4%, a level previously observed only among U.S. physicians. In 1999, nearly 30% of current smokers did not smoke daily, and more than 60% said they now smoked less than previously. In 1999, self-reported cigarette consumption was inversely related to believing SHS is harmful to nonsmokers, having a smoke-free workplace, and living in a smoke-free home. In California, tobacco control strategies that educated the population about SHS and resulted in smoking restrictions may have led continuing smokers to smoke less, which should reduce the harm from smoking to the public health in the long term.

Adolescent↗
PubMed1991

Lead use in California industry: its prevalence and health implications.

An estimated 230,000 workers were reported to work in lead-using activities as a result of a 1986 statistical survey of employers in California. However, 68% of these workers worked in activities of relatively low hazard. This included 114,000 workers engaged in electronic soldering. Over 1800 workers were reported to work in battery manufacture, a relatively high-hazard activity, but with consistent monitoring and protection. In contrast, over 4300 workers were involved in radiator repair activities, a high-hazard activity with inconsistent monitoring and protection. Over 8% of construction workers were reported to work in lead-using processes. This sector is exempt from federal Occupational Safety and Health Administration (Fed/OSHA) and California Occupational Safety and Health (Cal/OSHA) lead standards, yet some of the most hazardous activities (welding, grinding, and cutting, etc.) occurred here. Comparison of projections from the National Occupational Hazard Survey of potential lead exposure in California with these survey results suggests consistent and reliable assessment of the major sources of potential occupational exposure to lead.

California↗
PubMed2003

Sharps-related injuries in California healthcare facilities: pilot study results from the Sharps Injury Surveillance Registry.

BACKGROUND AND OBJECTIVES: In 1998, the California Department of Health Services invited all healthcare facilities in California (n = 2,532) to participate in a statewide, voluntary sharps injury surveillance project. The objectives were to determine whether a low-cost sharps registry could be established and maintained, and to evaluate the circumstances surrounding sharps injuries in California. RESULTS: Approximately 450 facilities responded and reported a total of 1,940 sharps-related injuries from January 1998 through January 2000. Injuries occurred in a variety of healthcare workers (80 different job titles). Nurses sustained the highest number of injuries (n = 658). In hospital settings (n = 1,780), approximately 20% of the injuries were associated with drawing venous blood, injections, or assisting with a procedure such as suturing. As expected, injuries were caused by tasks conventionally related to specific job classifications. The overall results approximate those reported by the Centers for Disease Control and Prevention's National Surveillance System for Health Care Workers and the University of Virginia's Exposure Prevention Information Network. CONCLUSION: These data further support findings from previous studies documenting the complex and persistent nature of sharps-related injuries in healthcare workers. In the future, mandated reporting using standardized forms and consistent application of decision rules would facilitate a more thorough analysis of injury events.

Adult↗