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At least 541 records · Page 30Linked to original sources
PubMed1991

Ambulatory care in the public sector: perinatal care in Los Angeles County.

In planning its response to the increasing demand for perinatal services and the increasing rate of infant mortality and low-birthweight infants the Los Angeles County Department of Health Services faces a formidable set of tasks. Initiatives already in place are attempting to deal with some of the most pressing problems. However, increased services must be made available to enable the increasing number of women to access the system of care, and further outreach is necessary to encourage more women to begin prenatal care early in pregnancy. The county needs to increase the availability of perinatal care services, and these services must respond to the cultural and socioeconomic needs of pregnant women. Financial barriers to care must be eased, and the process of qualifying for Medi-Cal must be simplified. Additional private providers need to be brought into the system, and alternative care providers--such as birthing centers and delivery by midwives--should be expanded for low-risk pregnancies. The DHS has been forced to respond to staggering increases in demands for perinatal care services, and the population pressures and the widening socioeconomic gaps are unlikely to decrease in the near future. These same forces also require the DHS to respond to the increased demand for other health services. The DHS is being required to develop and maintain a complex program of health services without adequate financial resources. The solution to the perinatal care crisis in Los Angeles County and other localities with high rates of poverty cannot be found solely within local governments. It is unrealistic to expect that local taxation can support an increase of this magnitude in the need for care, and increased state and federal support is essential. Other nations, spending far less for health care, produce significantly better results: how much longer will it take this nation to recognize its responsibilities to its most vulnerable citizens?

Adolescent↗
PubMed1993

Outcome of treatment of 686 gunshot wounds of the trunk at Los Angeles County-USC Medical Center: implications for the community.

The Los Angeles County-University of Southern California (LAC-USC) Medical Center, a level I trauma center, has experienced a rapidly increasing incidence of gunshot wounds (GSWs). We sought to enumerate the annual monetary costs and medical consequences of thoracoabdominal gunshot wounds in the epicenter of urban violence. A consecutive series of patients admitted from September 1, 1989 to August 31, 1990 was studied. Their records were coded by trauma nurse reviewers and held in the Trauma Emergency Medical Information System (TEMIS) and Automated Medical Record Abstracting and Reporting System (AMRARS). Diagnoses, procedures, and complications were verified by chart review. An estimate of disability 3 months after discharge was made from the record and reported on a functional activity scale. The total number of patients with GSWs admitted to all of the level I Los Angeles County trauma centers was 2771 during the study period. The total number of patients with major gunshot injuries admitted to LAC-USC Medical Center was 1007. Thoracoabdominal wounds without any head wound component occurred in 686 gunshot patients. Three quarters of the injured patients with truncal gunshot injuries were Hispanic. Total length of stay at the LAC-USC Medical Center for those with truncal wounds was 4666 hospital bed days including 432 ICU bed days, representing a minimum estimated total medical cost of $5,441,334. Annual medical cost of all admissions including rehabilitation, however, could be as great as $12 million for the Medical Center and $53 million for the County of Los Angeles. Thirty percent of patients had MediCal insurance. Payment could not be recovered from another 57% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1979

Automated medical screening in an urban county jail.

A machine-administered, branch-chain automated medical history (AMH) was evaluated as a medical intake screening tool for inmates of a large metropolitan county jail. The reproducibility, validity, sensitivity and specificity of the AMH were measured and found comparable to other previously reported AMH systems. The AMH did not produce intake screening data comparable to that obtained by trained face to face medical interviewers. This, in addition to the time and personnel effort required for administering the AMH while preventing vandalization of the equipment, made the AMH impractical for use in the county jail setting. Physicians used only 21 per cent of the positive AMH responses when they were asked to formulate problem lists from the AMH data. Physicians who used the AMH in clinical settings complained that "the AMH data seem as often wrong as right." The authors observed that the number of true-positive AMH responses was matched by an almost equal number of false-positve and false-negative responses. This may account for the physician's subjective response. If so, this represents a problem to be addressed by future AMH systems. Physicians used only 55.8 per cent of the intake screening information obtained by nurse practitioners. This was also somewhat lower than expected. For this reason, medical historical information in the county jail setting might be most efficiently obtained by the provider who has clinical responsibility for prescribing treatment.

Attitude of Health Personnel↗
PubMed2002

Increasing cervical cancer screening among underserved women in a large urban county health system: can it be done? What does it take?

BACKGROUND: Further reduction in avoidable cervical cancer morbidity and mortality may require system-wide, integrated approaches implemented in the public health facilities serving the nation's indigent and minority women. OBJECTIVES: Report on the evaluation of a 5-year demonstration project testing a multicomponent (provider, system, and patient) intervention to increase cervical cancer screening among women who receive their health care through the Los Angeles County Department of Health Services, the second largest County Health Department in the nation. MATERIALS AND METHODS: A longitudinal nonequivalent control group design was utilized. Data were collected during a baseline (no intervention) year and 2.5 years of intervention. A large hospital, one feeder Comprehensive Health Centers (CHC), and three of the health center's feeder Public Health Centers (PHC) received the intervention. Another hospital, CHC and its three feeder PHCs (matched on size, patient characteristics, and range of services provided) served as comparison sites. Independent random samples of patients 18 years and older were drawn annually at each site (n = 18,642). The outcome measure was a receipt of a Papanicolaou smear during a 9-month period. RESULTS: At the Hospital and CHC levels a statistically significant intervention effect was observed after controlling for baseline screening rates and case mix. No intervention effect was observed at the PHCs. CONCLUSION: An intensive multicomponent intervention can increase cervical cancer screening in a large, urban, County health system serving a low-income minority population of under screened women. Retention of program elements in the postresearch phase, and the difficulties and importance of conducting this type of research, is described.

Adult↗
PubMedDate not supplied

Penicillinase-producing Neisseria gonorrhoeae in Dade County, Florida: evidence of core-group transmitters and the impact of illicit antibiotics.

In 1985, 2,455 cases of infection due to penicillinase-producing Neisseria gonorrhoeae were reported from Dade County, Florida. These cases represent the largest concentration of PPNG infections reported to date in the United States. A zip code-based geographic analysis of morbidity caused by gonorrhea and PPNG identified a core area where the percentage of all gonorrhea cases due to PPNG was 31-36%. This percentage decreased in a radial pattern outward from the central core. A prospective study of patients presenting to the Dade County central clinic with gonorrhea found that men infected with PPNG were more likely to have medicated themselves with illicit antibiotics than were patients infected with penicillin-sensitive N. gonorrhoeae (odds ratio, 3.6; 95% confidence interval, 1.9-6.8). Of all self-medicated patients, 42% obtained antibiotics via illicit over-the-counter purchase at pharmacies in the hyperendemic area. In contrast to previous reports, PPNG infection was not associated with either narcotic- or prostitution-related activities. The results show that PPNG is endemic in Dade County and is arrayed in a core distribution. Antibiotic abuse may have played an important role in the Miami epidemic and in the establishment of PPNG as an endemic strain.

Adolescent↗
PubMedDate not supplied

Trends in sexually transmitted diseases in homosexually active men in King County, Washington, 1980-1990.

Trends in sexually transmitted diseases (STDs) in homosexually active men were analyzed in King County, Washington, from 1980 to 1990. New-problem visits to the public STD clinic declined from 4142 in 1980 to 509 in 1988 (-88%), then rose to 937 (+84%) in 1989, and 527 in the first half of 1990. Cases of gonorrhea in homosexually active men treated at the STD clinic plus private sector cases of rectal gonorrhea in men fell from 955 in 1982 to 33 in 1988 (-97%), then rose to 102 in 1989 (+209%). Similar trends were observed for several other STDs. Of 109 Neisseria gonorrhoeae isolates from homosexual or bisexual men in 1988 to 1989, 46 (42%) belonged to 3 auxotype/serovar classes; one of these was a penicillinase-producing strain (PPNG), the first appearance of PPNG in substantial numbers in homosexually active men in King County. The remaining 58% of isolates were distributed among 20 strains. These data imply substantial reductions in the frequency of high-risk sexual behavior in homosexually active men in King County over most of the 1980s, followed by an increased frequency of unsafe behavior after 1988. Maintenance of sexual safety may require increased educational effort and societal support as time passes.

Adult↗
PubMedDate not supplied

Evidence of thorough reporting of sexually transmitted diseases in a southern rural county.

BACKGROUND AND OBJECTIVES: Private physicians outside the South have been found to report half or fewer of the sexually transmitted diseases that they diagnose. The authors studied whether this is also true in a Southern rural county. STUDY DESIGN: Reports of gonorrhea and chlamydia infection from private physician practices in a rural North Carolina county were compared with laboratory records of positive test results. The proportions reported through 8 months of passive surveillance were compared with the proportion reported during 2 months of active weekly telephone surveillance. RESULTS: A total of 72% of all positive gonorrhea test results and 55% of all chlamydia test results were reported through passive surveillance. The proportions increased to 88% and 79%, respectively, with active surveillance. A separate system of multiple checks ensured complete reporting of syphilis that was not affected by surveillance type. CONCLUSIONS: A relatively high proportion of sexually transmitted diseases diagnosed by private physicians was reported in this rural county. Potential reasons included physician awareness of reporting requirements, delegation of reporting to clinical staff, and personal acquaintance with the health department staff.

Chlamydia Infections↗
PubMed1999

Clinical presentation and treatment of a Salmonella bredeney epidemic in Shelby County, Alabama.

BACKGROUND: Numerous residents of Shelby County, Alabama, were infected with Salmonella when a restaurant unknowingly served food tainted with the bacterium. Because of the similarity in symptoms caused by other gastrointestinal pathogens and the variability in time of presentation, an outbreak such as this could be confused with one of another pathogenic origin. The pathogen identified, Salmonella bredeney, is a particularly rare cause of food poisoning. It makes up only 0.1% of the Salmonella isolates identified by the Centers for Disease Control and Prevention (CDC) each year. METHODS: We analyzed patient presentations through chart review and combined this information with that obtained from the state laboratories in Montgomery and the Shelby County Health Department. RESULTS: Symptoms were mostly gastrointestinal and ranged greatly in severity. The total number of patients affected in this incident exceeded 170, making it the largest epidemic of its kind in the recent history of Alabama. CONCLUSIONS: The outbreak in Shelby County was caused by an exceedingly rare species of Salmonella. At this time, it is the only outbreak of S bredeney reported in MEDLINE-accessible literature since 1983.

Adult↗
PubMed2004

Income, income inequality, and cardiovascular disease mortality: relations among county populations of the United States, 1985 to 1994.

OBJECTIVES: Despite the major contribution of cardiovascular disease (CVD) to total mortality, and reports demonstrating strong relations between income and CVD, the joint relations of population-level income and income inequality with CVD mortality are not well described. This study was undertaken to describe relations among population-level income, income equality, and mortality due to cardiovascular disease, coronary heart disease, and stroke. METHODS: County income distributions were determined from 1990 census data, and CVD mortality rates were obtained from the Compressed Mortality File. Relations among income, income inequality, and CVD mortality were examined in stratified and Poisson regression analyses. RESULTS: County income was inversely related and income inequality was directly related to CVD, coronary heart disease, and stroke mortality. Relations were strongest for stroke. Relations of stroke mortality with income inequality were strongest in low-income populations. CONCLUSIONS: The CVD mortality experiences of county populations are related to both income and income distribution in a complex, disease-dependent manner. The authors' findings are especially relevant to the Southeast, a region of high income inequality, low income, and high stroke mortality.

Adult↗
PubMed1997

Geographic issues in the analysis of a county-wide survey.

Surveys are used by county public health departments to obtain data for purposes such as risk factor inventories and program planning. Geographic data are often collected from respondents in order to make sub-county estimates and to ensure that the sample is representative of the population. This article addresses geographic issues that arise in analyzing such surveys including: (1) the assignment of respondents to geographic units, (2) the number of respondents necessary per unit, (3) geographically appropriate questions, and (4) geographic definitions. Data from a county-wide survey that highlight these issues are presented and suggestions for improvements are made.

Adult↗
PubMed1999

Mobilizing a mass HIV counseling and testing program in Chautauqua County.

In October 1997, the staff of the New York State Department of Health's Anonymous HIV Counseling and Testing Program were mobilized to assist the Chautauqua County Department of Health to respond to an unprecedented demand for HIV counseling and testing. This demand followed the release of the name of an HIV-infected individual who was suspected of infecting 13 young women in Chautauqua County. This article reviews essential elements of New York's efforts to assist Chautauqua County in meeting increased demands for HIV counseling and testing services during the emergency response. New York's experience can help inform other jurisdictions that may encounter similar public health emergencies in the future.

AIDS Serodiagnosis↗
PubMed1999

Outreach and enrollment challenges: increasing participation in Child Health Plus in Onondaga County, New York.

Title XXI of the Social Security Act, the State Children's Health Insurance Program (CHIP), was signed into law as part of the Balanced Budget Agreement in August 1997. The program provides $24 billion to states over a five-year period to provide health insurance to uninsured children in low-wage, working families with incomes too high to qualify for Medicaid and too low to afford private coverage. Based on interviews with participating insurers in Fall 1998, total enrollment of children in Child Health Plus in Onondaga County, New York is approximately 5,250. However, there are still approximately 10,000 uninsured and potentially eligible children in Onondaga County. In order to ensure the success of Child Health Plus and enroll these uninsured children, the State and County governments, communities, and plans participating in the program must be committed to effective outreach and ease of enrollment.

Child↗
PubMed2000

County commissioners as a key constituency for public health.

Local government elected officials are an important constituency for public health as they represent all citizens in their cities and counties, make policy decisions that affect the public's health, and allocate funding to support public health activities. This article describes efforts to determine the current knowledge and perspective of county commissioners regarding factors that affect local governmental decision making, particularly involving public health. Interview findings indicate that county commissioners are influenced by what their constituents consider important. The article suggests actions that public health managers can take to increase local elected officials' understanding of public health.

Community-Institutional Relations↗
PubMedDate not supplied

Establishing a dental practice in a rural, low-income county health department.

Historically, county health departments have not been responsible for providing dental care to needy citizens. However, as the need for dental care among indigent and low-income citizens has grown health departments are being called on to provide these necessary services. This article describes one local board of health's effort to establish a dental program within a large rural county. The board of health directed the local county health department to purchase and operate a mobile dental clinic, build a permanent dental facility, recruit a dental staff, and most important, provide the financial resources to pay for the program.

Dental Clinics↗
PubMed2003

Demographic characteristics of hospitalized patients with alcoholic liver disease and pancreatitis in los angeles county.

BACKGROUND: This study sought to identify demographic characteristics of hospitalized patients with alcoholic liver disease (ALD) in Los Angeles County for the purpose of implementing new preventive and educational programs. Another specific aim of the study was to characterize demographic and comorbid differences between patients with ALD and patients with pancreatitis, another alcohol-related disease. METHODS: Analyses were performed on discharge data from all nonfederal short-stay hospitals within Los Angeles County, released for the year 1999 by the Office of Statewide Health Planning and Development. Repeated hospital stays for ALD by the same patients were deleted from the data analysis based on individual identification numbers. For the analysis of medical costs of ALD, repeated hospital stays were included. RESULTS: Primary diagnosis of ALD accounted for 1.2% of total deaths among hospitalized patients and was the eighth most common cause of death among diseases examined. Moreover, the fatality rate of primary ALD among ALD hospital visits was the second highest, behind septicemia. ALD was most prevalent in the middle-aged (45-65 years old) and low- to middle-income men. The age-standardized hospitalization rate of ALD was highest in Hispanic men (61.1 per 100,000 per year), whereas that of chronic pancreatitis, another common complication of alcohol abuse, was most prevalent in African American men. CONCLUSIONS: Middle-aged Hispanic men with low- to middle-income status were identified as a high-risk group for ALD in Los Angeles County. These data will guide us to develop a new strategy for future preventative and educational programs for ALD.

Adolescent↗
PubMed2006

Increased reported cases of tuberculosis among children younger than 5 years of age, Maricopa County, Arizona, 2002-2003.

OBJECTIVES: Although tuberculosis (TB) rates in the United States among children younger than 5 years old (2.8/100,000 in 2003) have been declining, Maricopa County, Arizona, reported an increase from 4.1/100,000 in 2002 to 9.0/100,000 in 2003. We investigated factors associated with this increase. METHODS: We reviewed county TB clinic records of pediatric patients (younger than 5 years old) and their probable adult sources, interviewed parents or guardians of pediatric TB patients and examined changes in clinic procedures. RESULTS: We verified 11 pediatric TB cases in 2002 and 25 in 2003 (n = 36). A total of 31 (86%) patients were born in the United States, and 28 (78%) had at least 1 foreign-born parent. There were 19 children (53%) identified from an adult TB contact investigation. Of children with identified sources (n = 24, 67%), 23 (96%) had probable household transmission; 20 (83%) had a foreign-born relative from a TB-endemic country as the probable source. Seven (50%) of 14 adult sources investigated had a delayed TB diagnosis. In 2003, increased TB clinic staffing, more frequent pediatric TB clinics and on-site gastric aspirates for TB diagnosis contributed to 55% more children being evaluated for TB. CONCLUSIONS: Close interaction with family members and delayed diagnoses were the primary means of TB transmission to children. The increase in pediatric TB likely reflects improved clinic diagnostic capacity and may indicate a more accurate baseline rate for Maricopa County. Programmatic improvements in TB control and targeted outreach to high-risk immigrant populations may increase pediatric and adult source case detection and reduce Mycobacterium tuberculosis transmission.

Arizona↗
PubMed1995

Impact of pollution and place of residence on atopic diseases among schoolchildren in Telemark County, Norway.

For estimation of the prevalence, degree of severity, and association with outdoor pollution, a questionnaire on asthma and other atopic diseases was distributed to the parents of 4666 7-13-year-olds, comprising all the children in 36 schools in Telemark County, Norway, including 37% of the schoolchildren in the county. The response rate was 94%. In a validity study employing clinical evaluations, the questionnaire-based diagnosis of asthma was found to have a sensitivity of 0.96 and a specificity of 0.88. The lifetime prevalence of asthma in Telemark was 9% (boys 11.3%, girls 6.6%; p < 0.001). There was no significant difference in the lifetime prevalence of asthma by pollution zone; 8.3% in heavily, 9.3% in moderately, and 9.2% in minimally polluted zones. The asthma prevalence was significantly higher (14.2%; p < 0.05) among boys in the coastal area of the county than in the mountainous area (8.9%). Both of these areas were in the minimal pollution zone. Of asthma cases, 67% were categorized as mild, 29% as moderate, and 4% as severe. The lifetime prevalence was 17.8% (boys 21.3%, girls 14.2%; p < 0.001) for allergic rhinitis, 13.2% (boys 11.4%, girls 15.2%; p < 0.001) for atopic eczema, and 29.6% (boys 31.7%, girls 27.4%; p < 0.01) for overall atopic disease (asthma, allergic rhinitis, eczema). These findings are not compatible with the hypothesis that outdoor pollution is associated with the lifetime prevalence of asthma in school-age children. The results also show that less than 0.5% of schoolchildren suffer from severe asthma.

Adolescent↗
PubMed1994

Injury and the role of alcohol: county-wide emergency room data.

The purpose of this study is to describe variables associated with injury in an emergency room (ER) sample that is representative of an entire U.S. county. A probability sample (n = 3717) of ER patients from the county hospital, 3 of the 6 community hospitals, and the three health maintenance organization hospitals in a single Northern California county were breath-analyzed and interviewed at the time of the ER visit. Injured were most likely to consume only 1 or 2 drinks within < 1 hr of injury occurrence. Twenty-three percent reported feeling drunk at the time of the event, and of these, 45% felt the event would not have happened if they had not been drinking. Breathalyzer reading, feeling drunk at the time of the event, and quantity-frequency (Q-F) of usual drinking were found to be predictive of admission to the ER with an injury, whereas breathalyzer reading, Q-F, and being injured in someone's home were predictive of reporting drinking prior to injury. Although feeling drunk at the time of the event and usual drinking patterns are predictive of injury occurrence, drinking prior to the event may not entail large quantities of alcohol consumed, but relatively small amounts consumed in close proximity to the injury event. These alcohol consumption variables may vary, however, depending on the type, cause, and severity of injury.

Accidents↗