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PubMed2005

Linking HIV-infected persons of color and injection drug users to HIV medical and other services: the California Bridge Project.

Our objectives were to describe the strategies and successes in linking out-of-treatment HIV-infected persons of color and injection drug users (IDUs) to a comprehensive HIV care, treatment, and prevention program and other community services. Peer-based outreach staff at 21 sites throughout California provided assessments and referrals to 1453 persons living with HIV but without routine care. A linkage was defined as the receipt of a referred service. Half (49.7%) of persons of color and 41.6% of IDUs received services at a California Early Intervention Program (EIP) site after the date of first contact with peer staff; 58.1% of clients referred to EIP were linked to the program. IDUs were less likely to link to EIP. However, IDU clients were less likely to be referred to EIP, and more likely to be referred and linked to other community programs. Interventions such as the California Bridge Project can effectively link HIV-infected persons from marginalized populations to care, treatment, and prevention services. Programs that address immediate needs such as housing are more appealing to IDUs than programs offering HIV medical care.

Adult↗
PubMed2004

Multispecialty telephone and e-mail consultation for patients with developmental disabilities in rural California.

The University of California (UC), Davis Health System, and California Department of Developmental Services (CDDS) developed the Physician Assistance, Consultation and Training Network (PACT Net) to assist primary-care providers (PCPs) care for patients with developmental disabilities in rural California. This manuscript describes PACT Net, a warm line using phone and e-mail, and its multispecialty panel. A pilot study evaluated whether or not PCPs needed such a consultation service, whether or not it assisted them in providing care, and their overall satisfaction with the service. PCPs were informed on how to request a consultation. Data were collected from patients (demographics), PCPs (satisfaction with preexisting consultation availability and quality, PACT Net consultation reason, preferred mode of contact, duration, and, satisfaction), and specialists (ease, quality of request, and satisfaction). Satisfaction was measured prospectively using a 7-point Likert scale. Data were collected on 30 consultations, 28 by telephone and 2 by e-mail; other data were by combined methods. The average duration of consultation was 47 minutes, and 24 responses occurred within one business day. The top three services requested for consultation were psychiatry (e.g., management of behavioral disturbance), medical genetics (diagnosis), and gastroenterology (miscellaneous). PCPs rated baseline satisfaction with: (1) pre-existing local services at 3.37, (2) timeliness of the PACT Net consultation at 5.45, (3) quality of the communication at 6.3, and (4) overall quality and utility of the consultation at 6.2. Specialists rated the quality of the communication at 6.45, and the ease of the service at 6.46. Phone and e-mail consultation appears satisfactory to PCPs and specialty providers as a way to enhance specialty input to rural patients.

Adolescent↗
PubMed1994

Marked increase in cases of coccidioidomycosis in California: 1991, 1992, and 1993.

Coccidioidomycosis is endemic in California. In an 11-year period from the beginning of 1980 to the end of 1990, an average of approximately 400-500 cases per year were reported to the California State Department of Health Services (CSDHS). In 1990, 441 cases were reported. However, a striking increase in the number of cases was noted in 1991, 1992, and 1993, particularly in the southern San Joaquin Valley counties of Kern and Tulare. In 1992, striking increases were noted in other counties as well. In California there were 1,200 and 4,541 new cases in 1991 and 1992, respectively, that were reported to the CSDHS. The usual rate (5%-7%) of metapulmonary dissemination was noted in these outbreaks, and cases resembling acute adult respiratory distress syndrome that had been noted infrequently in previous outbreaks were conspicuous among the 1991 and 1992 cases. Factors thought to contribute to the extraordinary increases in coccidioidomycosis were a drought of 5 to 6 years' duration; abundant rain in March 1991 and February-March 1992; construction of new buildings; and arrival of new, susceptible individuals to the areas of endemicity.

California↗
PubMed1996

Cancer among American-Samoans: site-specific incidence in California and Hawaii.

BACKGROUND: There is a paucity of data about cancer among American-Samoans, the largest Pacific Islander group after Hawaiians. This study provides the first data on the incidence and relative risk for all cancers among American-Samoans on the US mainland and in Hawaii. METHODS: The University of Southern California Cancer Surveillance Program and the Hawaii Tumor Registry, two population-based cancer surveillance programmes, provided archival data on American-Samoans residing in Los Angeles Country. California and in Hawaii, respectively. RESULTS: There were significant differences in the incidence and age-adjusted site-specific relative risk of cancers between American-Samoans, Hawaiians, and Anglos (non-Hispanic whites). In Hawaii, American-Samoans diagnosed with cancer compared with Hawaiians had a higher age-adjusted site-specific relative risk for cancers of the nasopharynx (especially males), liver, prostate, thyroid, and blood (especially females) and a lower relative risk for cancers of the colon, rectum (especially males), lung (especially females) and breast. Furthermore, compared with Anglos diagnosed with cancer in Hawaii, American-Samoans had a higher relative risk for cancers of the nasopharynx (especially males), stomach, liver, lung (especially males), corpus uteri, thyroid and blood, and a lower relative risk for cancers of the colon, skin, breast, testes, cervix uteri, bladder (especially males), and lymph nodes. A relatively similar profile of cancer distribution and relative risk was observed among American-Samoans and Anglos diagnosed with cancer in California. CONCLUSIONS: The data provide baseline information which has important implications for future cancer control research and prevention in this population.

Adolescent↗
PubMed1991

Wood rats and kangaroo rats: potential reservoirs of the Lyme disease spirochete in California.

The etiologic agent of Lyme disease, Borrelia burgdorferi Johnson, Schmid, Hyde, Steigerwalt & Brenner, was isolated repeatedly from dusky-footed wood rats, Neotoma fuscipes Baird, and California kangaroo rats, Dipodomys californicus Merriam, in northern California. All animals were collected in a region endemic for Lyme disease but for which the natural reservoir of B. burgdorferi was unknown. Similar attempts to isolate spirochetes from lizards, other species of rodents, jack rabbits, and deer between 1987 and 1991 were unsuccessful. Spirochetes isolated from wood rats and kangaroo rats were antigenically similar to strains of B. burgdorferi that had been isolated previously from the western black-legged tick, Ixodes pacificus Cooley & Kohls, in California. Similar enzootic cycles involving wood rats or kangaroo rats should be sought in other regions of the United States where the reservoirs of this spirochete are unknown.

Animals↗
PubMed1992

First isolation of Borrelia burgdorferi in southern California.

The Lyme disease spirochete, Borrelia burgdorferi Johnson, Schmid, Hyde, Steigerwalt & Brenner, was isolated from the blood of a dusky-footed wood rat, Neotoma fuscipes Baird, in the San Bernardino Mountains of southern California. Antigenic, protein, and molecular analyses demonstrated that the isolate varied slightly from most isolates of B. burgdorferi from northern California and was clearly distinct from other species of Borrelia that are endemic to the state. This is the first reported isolate of B. burgdorferi from southern California and demonstrates that the Lyme disease spirochete is enzootic in mountains near the major human population center of the state.

Animals↗
PubMed1997

Epidemiologic study of Down syndrome in a racially diverse California population, 1989-1991.

The prevalence of Down syndrome was studied among all live births occurring between 1989 and 1991 in the California counties monitored by the California Birth Defects Monitoring Program. Objectives of this study were: 1) to calculate adjusted prevalence rates and quinquennial maternal age-specific risk rates of Down syndrome after adjusting for elective abortion of prenatally diagnosed fetuses; 2) to estimate the impact of prenatal diagnosis and subsequent elective abortion of affected fetuses on the observed prevalence of Down syndrome; and 3) to examine sex ratios among liveborn infants and fetuses with Down syndrome. The racial/ethnic diversity and large size of the population allowed the data to be stratified into five racial categories-Hispanics, whites, Asians, blacks, and others. For the period 1989-1991, the observed prevalence of Down syndrome was 1.13 per 1,000 live births, and the adjusted total prevalence, which took into account the termination of affected pregnancies following prenatal diagnosis, was 1.53 per 1,000 live births. In a comparison of quinquennial maternal age-specific risk rates of Down syndrome by race, Hispanics and whites were the only groups with rates that differed significantly from each other, with Hispanics exhibiting higher rates at maternal ages under 40 years. The overall reduction in live births with Down syndrome in 1989-1991 that could be attributed to prenatal diagnosis and elective abortion of affected fetuses was 25.8%, with a 49.1% reduction being observed at maternal ages > or = 35 years. In 1990-1991, Hispanics had the lowest overall reduction (10.0%), while whites had the highest reduction (46.3%). The male: female ratios among liveborns with Down syndrome were significantly higher than those among all live births, and race had a significant association with sex ratios in both cases and controls. These findings indicate that prenatal diagnosis and elective termination of affected pregnancies has had a substantial impact in reducing the number of liveborns with Down syndrome in the monitored California counties. The effect was greatest for whites and least for Hispanics, with results indicating considerable variation in the use of prenatal diagnostic services among racial/ethnic groups. Estimates of adjusted total prevalence and reduction in live births with Down syndrome in this study should be considered minimal because of some underascertainment of prenatally diagnosed cases.

Abortion, Induced↗
PubMed1997

Temporal trends and factors associated with survival after Pneumocystis carinii pneumonia in California, 1983-1992.

The authors investigated quarterly trends in survival after the diagnosis of Pneumocystis carinii pneumonia for 19,607 patients in California in the decade from January 1, 1983, through December 31, 1992. Subjects included all cases for whom P. carinii pneumonia was the initial (and only) acquired immunodeficiency syndrome (AIDS)-defining diagnosis as reported to the California human immunodeficiency virus/AIDS surveillance registry. There was a period of rapidly improving survival from approximately June 1986 until April 1988, coincident with the widespread introduction of antiretroviral therapy (zidovudine) and the institution of P. carinii pneumonia prophylaxis (with cotrimoxazole and pentamidine). There was no evidence, however, of meaningful improvements in survival for these patients after that period. The association of several covariates (risk transmission group, gender, race/ethnicity, certainty of P. carinii pneumonia diagnosis, age, region of residence, availability of CD4 count, and level of CD4 count) were also studied both by proportional hazards regression and by recursive partitioning (i.e., tree-based) survival analysis. The availability of a CD4 count (regardless of its level) was the single factor most strongly associated with survival (median survival 36 months among those with and 14 months among those without reported CD4 counts, p < 0.05). Data from this large, population-based surveillance registry of AIDS in California suggest that, despite earlier improvements in survival after the diagnosis of P. carinii pneumonia, the long-term survival of these patients remains poor (39% alive 2 years after diagnosis) and that no improvement in survival has occurred since 1988.

AIDS-Related Opportunistic Infections↗
PubMed1981

Advances in American forensic sciences. California's role.

The forensic sciences in the United States, specifically forensic medicine, have benefited primarily from the advances made by the New York Medical Examiner Office pioneers and the philosophy developed in the Massachusetts medicolegal structure as begun in 1877. California's pioneering role is directly related to the development of criminalistics which in turn served as a stimulus for the improvement and development of forensic medicine in that state. Historically many private practitioners were involved in general criminalistics in California before the system of state criminalistic laboratories and criminal investigations was well established. Any report on the growth of the forensic sciences must include mention of the earlier pioneers including Heinrich, Kirk, Kytka, Crossman, Abernethy, Pinker, Helsel, and Noxley. A review of the current state of the art in the forensic sciences is presented, as is a review of the contributions of California to the development of American forensic sciences.

California↗
PubMed2004

Clinical faculty tracks and academic success at the University of California Medical Schools.

PURPOSE: To describe the five faculty series for medical school faculty in the University of California (UC) system, their criteria for advancement, associated challenges, and the different ways they are used by each school. METHOD: During 2001-02, the associate dean for academic affairs at each UC medical school was interviewed for information on the number of faculty in each academic series, the role of each series, and problematic issues associated with them. The averaged merit and promotion results for each series for 1999-2002 at the University of California, Davis, School of Medicine, were examined. RESULTS: The two clinical faculty series showed the most variability among the UC campuses for number of faculty, and strategy for appointment and advancement. The percentage of faculty in the Clinical X series varied from 8% to 39% at the five campuses. All campuses agreed that faculty in the Clinical X series must participate in applied or translational clinical investigation or educational investigation, and disseminate their work. All campuses required that the Ladder-Rank and In-Residence faculty devote the majority of their time to hypothesis-driven research. At University of California, Davis, the two clinical series had the highest approval rates for merits and promotion actions. The Ladder-Rank series had the highest denial rate for merits and promotion. CONCLUSIONS: Clinical series in the UC system are used differently at the five medical schools. Appointing junior faculty in series with minimal expectations as a "safe starting place" is favored for building long-term faculty. Faculty in all series tend to do well in the academic review process, indicating that these series define distinct expectations. Clinical faculty's accomplishments are increasingly understood, valued, and rewarded.

California↗
PubMed1994

Application of airborne gamma spectrometric survey data to estimating terrestrial gamma-ray dose rates: an example in California.

We examined the applicability of radioelement data from the National Aerial Radiometric Reconnaissance, an element of the National Uranium Resource Evaluation, to estimate terrestrial gamma-ray absorbed dose rates, by comparing dose rates calculated from aeroradiometric surveys of uranium, thorium, and potassium concentrations with dose rates calculated from a radiogeologic data base and the distribution of lithologies in California. Gamma-ray dose rates increase generally from north to south following lithological trends, with low values of 25-30 nGy h-1 in the northernmost 1 x 2 degrees quadrangles between 41 and 42 degrees N to high values of 75-100 nGy h-1 in southeastern California. Lithologic-based estimates of mean dose rates in the quadrangles generally match those from aeroradiometric data, with statewide means of 63 and 60 nGy h-1, respectively. These are intermediate between a population-weighted global average of 51 nGy h-1 reported in 1982 by UNSCEAR and a weighted continental average of 70 nGy h-1, based on the global distribution of rock types. The concurrence of lithologically and aeroradiometrically determined dose rates in California, with its varied geology and topography encompassing settings representative of the continents, indicates that the National Aerial Radiometric Reconnaissance data are applicable to estimates of terrestrial absorbed dose rates from natural gamma emitters.

Background Radiation↗
PubMed2001

BSN by 2010. A California initiative.

The Association of California Nurse Leaders has developed an initiative to require the baccalaureate in nursing as the credential for entry into practice as a registered nurse by the year 2010 in the state of California. When nursing is compared to other healthcare professions, such as pharmacy, physical therapy, and occupational therapy, it becomes obvious that educational requirements for nurses must be updated. Nursing leaders have developed a 10-year action plan to change the entry-level educational requirements for California nurses.

California↗
PubMed2002

The California experiment: alternatives for minimum nurse-to-patient ratios.

In making policy, it is ideal to study a problem, test solutions, and then implement the best solution. In California there is legislation regarding nurse staffing that requires implementation of a solution before the problem has been accurately stated and before alternative solutions have been tested. Assembly Bill 394 directs the California Department of Health Services to establish "minimum, specific, and numerical licensed nurse-to-patient ratios by licensed nurse classification and by hospital unit" and have these ratios in place January 1, 2002. This law is scheduled for implementation before there is specific evidence of optimal staffing levels for various patient populations. The author presents a comprehensive literature review of activities related to nurse staffing in the United States, provides data related to existing patient classification systems in California, and suggests an alternative to staffing ratios to protect consumers.

California↗
PubMed2004

Licensed caregiver characteristics and staffing in California acute care hospital units.

PURPOSE: Concerns about declining quality of care and nurse staffing shortages led to legislation mandating minimum nurse-to-patient ratios in the state of California. Although research finds that better registered nurse (RN) staffing results in higher quality of care, little evidence exists on which to base specific nurse-patient ratios. The authors describe the results of a California survey characterizing licensed caregivers, identifying staffing levels by unit type, and describing how staffing levels vary across hospital types. METHODS: A stratified random sample of general acute care hospitals was surveyed to collect cross-sectional data on hospitals' nursing workforce and staffing practices and to assess the impact of potential patient-to-nurse staffing ratios. All academic medical centers; rural, private, and city/county hospitals; and hospitals affiliated with a large group-model health maintenance organization (HMO) were eligible for inclusion. RESULTS: Eighty hospitals were surveyed, representing all major metropolitan areas in the state. Acute care hospitals in California have diverse nursing staffs with variations in education, experience, and employment status. Considerable variations in skill mix were identified, with the proportion of RNs ranging from 30% to 84%, depending on the unit type surveyed. CONCLUSIONS: As states struggle with an anticipated critical shortage of RNs, these results have several implications for health and education policy. Future studies of this type will be needed to evaluate the impact of anticipated changes in the regulation of nurse staffing.

California↗
PubMed2004

Nurse staffing and hospital ownership in California.

OBJECTIVE: The purpose of this study is to describe the relationship between nurse staffing and owner type or specific corporate owner in California acute care hospitals. BACKGROUND: Little empirical data exist regarding nurse staffing as it relates to owner type or specific corporate owner. With minimum staffing ratios scheduled to be implemented in January 2004, this study provides baseline data for evaluating the impact of minimum staffing ratios in California. METHODS: The study design is descriptive and cross-sectional. Data used in this study are for short-term general hospitals that reported to the California Office of Statewide Health Planning and Development database for fiscal years ending in 1997 through 1999. Six regression models were estimated using pooled data from the 3 years of data. RESULTS: The most consistent significant findings are: increased patient days or patient discharges predict increased registered nurse (RN) hours; lower RN wages predict increased RN hours; higher technology scores predict increased RN hours; and in 1998 there was an across-the-board decrease in RN hours. Other significant findings include that for-profit hospitals and for-profit systems had fewer RN productive hours for medical-surgical nursing, and select corporate owners, unrelated to profit status, had consistently fewer RN productive hours for medical-surgical nursing. CONCLUSIONS/IMPLICATIONS: For-profit hospitals and systems behaved differently in the healthcare market environment of the late 1990s. Select nonprofit systems were also using significantly less RN staffing. Other findings support the implication that as technology sophistication increases, there will be a need for increased RN hours to manage the advanced technology. This runs counter to the argument that increasing technology will decrease the need for RN hours. Finally, as discharges go up, the need for RN hours increases.

California↗
PubMed1996

California encephalitis in Alabama.

Arthropod-borne virus (arbovirus) infections in humans are primarily central nervous system infections, but other clinical manifestations include febrile illness and fever with hemorrhagic diathesis. In the genus Bunyavirus there are several viruses that cause disease in humans, especially in North America; these include LaCrosse, Jamestown Canyon, trivittatus, and snowshoe hare viruses. The disease seen mainly in children is California encephalitis (usually of the LaCrosse subtype); this infection is widespread in the United States but is most prevalent in the upper Midwest, especially in rural areas. We present the first reported case of California encephalitis in rural Alabama; the patient was a 7-year-old boy who came to us with fever and seizures in the summer of 1994. This report stresses the importance of including California encephalitis in the differential diagnosis when children have fever and altered sensorium after exposure to mosquitoes during summer months.

Alabama↗
PubMed1997

Incidence of non-fatal workplace assault injuries determined from employer's reports in California.

Although fatal work-related assault assault injury rates are routinely reported in the United States, reports of non-fatal injuries are not routinely examined. Non-fatal workplace assault injuries can be reported through many agencies. One of the most common reporting mechanisms in California is the Employer's Report of Occupational Illness and Injury. Employer's Reports filed from October 1, 1994 through January 31, 1995 in the state of California were the source of workplace assault information for this study. All reports indicating an assault-related injury were identified and characterized by gender and occupation of the victim, type of assault and weapon used, and industry. Annual rates were determined based on the number of estimated annual reports and the civilian working population. The estimated annual rate of workplace assault injuries for California based on Employer's Reports is 72.9 per 100,000 workers, which is approximately 50 times the fatal rate. Rates differed by industry, with retail, hospital, transportation and police workers exhibiting the highest rates. Assaults were predominantly Type I, which involve criminal activity, and Type II, which involve an assault by a client, patient, or inmate. The rates of non-fatal work-related assault injury are much greater and have different characteristics than fatal injuries. These non-fatal injury patterns need to be considered when estimating the burden of assault injuries on businesses, and can help identify the most effective prevention strategies.

Absenteeism↗
PubMed2004

Comorbidity of select anxiety and affective disorders with alcohol dependence in southwest California Indians.

BACKGROUND: Native Americans, overall, have the highest prevalence of alcohol dependence of any US ethnic group. In several large national surveys, alcohol dependence has been significantly associated with higher rates of anxiety and affective disorders (comorbidity). However, the frequencies of these disorders and their comorbidity with alcohol dependence in Native American populations are relatively unknown. METHODS: Demographic information and DSM-III-R diagnoses were obtained by using the Semi-Structured Assessment for the Genetics of Alcoholism developed for the Collaborative Study on the Genetics of Alcoholism from 483 Southwest California Indian adults residing on contiguous reservations. The Semi-Structured Assessment for the Genetics of Alcoholism allowed differentiation of each anxiety and affective disorder into one of three types: independent of substance use, concurrent with alcohol use, and concurrent with drug use. RESULTS: Sixty-six percent of the men and 53% of the women sampled had a lifetime diagnosis of alcohol dependence. Fourteen percent of the sample had a lifetime independent anxiety disorder, and 14% of the sample had a lifetime independent affective disorder. Alcohol- and/or drug-concurrent major depression occurred in 8%, and other alcohol- and/or drug-concurrent anxiety and affective disorders each occurred in less than 1.1% of the sample. No significant comorbidity was found between alcohol dependence and independent agoraphobia, social phobia, or major depressive disorder. CONCLUSIONS: In this Southwest California Indian sample, rates of anxiety and affective disorders were substantially similar to those reported in the National Comorbidity Survey; however, comorbidity of independent disorders with alcohol dependence was not as pervasive as in the National Comorbidity Survey. Rates of concurrent anxiety and affective disorders were low. These data support the hypothesis that despite high rates of alcohol dependence, Southwest California Indians do not have higher rates of anxiety and affective disorders or comorbidity of these disorders with alcohol dependence than those reported in large surveys of non-American Indian populations.

Adolescent↗