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PubMedDate not supplied

Hospital nursing benchmarks: the California Nursing Outcomes Coalition project.

The California Nursing Outcomes Coalition (CalNOC) project is an initiative that has become the largest ongoing nursing quality measurement repository in the nation. Launched in 1996 by California nursing leaders concerned with trends in hospital care, CalNOC has created reliable quality benchmark data to define patient safety thresholds in California. This article describes CalNOC's effort, which aligns with the strategy of the National Quality Forum for measuring and reporting healthcare quality. By tracing the evolution of the CalNOC project and its future potential, we hope to encourage other grassroots efforts to build the database repositories needed for healthcare quality measurement in the 21st century.

American Nurses' Association↗
PubMed1998

DNA sequence similarity between California isolates of Cryptosporidium parvum.

We evaluated whether nucleic acid amplification with primers specific for Cryptosporidium parvum followed by automated DNA sequence analysis of the PCR amplicons could differentiate between California isolates of C. parvum obtained from livestock, humans, and feral pigs. Almost complete sequence identity existed among the livestock isolates and between the livestock and human isolates. DNA sequences from feral pig isolates differed from those from livestock and humans by 1.0 to 1.2%. The reference sequence obtained by Laxer et al. (M. A. Laxer, B. K. Timblin, and R. J. Patel, Am. J. Trop. Med. Hyg. 45:688-694, 1991.) differed from California isolates of C. parvum by 1.8 to 3.2%. These data suggest that DNA sequence analysis of the amplicon of Laxer et al. does not allow for differentiation between various strains of C. parvum or that our collection of isolates obtained from various hosts from across California was limited to one strain of C. parvum.

Animals↗
PubMed2004

Diversity and distribution of Frankia strains symbiotic with Ceanothus in California.

Frankia strains symbiotic with Ceanothus present an interesting opportunity to study the patterns and causes of Frankia diversity and distribution within a particular host infectivity group. We intensively sampled Frankia from nodules on Ceanothus plants along an elevational gradient in the southern Sierra Nevada of California, and we also collected nodules from a wider host taxonomic and geographic range throughout California. The two sampling scales comprised 36 samples from eight species of Ceanothus representing six of the seven major biogeographic regions in and around California. The primary objective of this study was to use a quantitative model to test the relative importance of geographic separation, host specificity, and environment in influencing the identity of Ceanothus Frankia symbionts as determined by ribosomal DNA sequence data. At both sampling scales, Frankia strains symbiotic with Ceanothus exhibited a high degree of genetic similarity. Frankia strains symbiotic with Chamaebatia (Rosaceae) were within the same clade as several Ceanothus symbionts. Results from a classification and regression tree model used to quantitatively explain Frankia phylogenetic groupings demonstrated that the only significant variable in distinguishing between phylogenetic groups at the more local sampling scale was host species. At the regional scale, Frankia phylogenetic groupings were explained by host species and the biogeographic province of sample collection. We did not find any significant correspondence between Frankia and Ceanothus phylogenies indicative of coevolution, but we concluded that the identity of Frankia strains inhabiting Ceanothus nodules may involve interactions between host species specificity and geographic isolation.

California↗
PubMed1997

Ehrlichia phagocytophila genogroup rickettsiae in ixodid ticks from California collected in 1995 and 1996.

A total of 1,246 ixodid ticks collected in 1995 and 1996 from seven California counties were examined for the presence of Ehrlichia phagocytophila genogroup rickettsiae by using a nested PCR technique. Of 1,112 adult Ixodes pacificus Cooley and Kohls ticks tested, nine pools, each containing five ticks, were positive (minimum percentage of ticks harboring detectable ehrlichiae, 0.8%). Positive ticks were limited to four of the seven counties (Sonoma, El Dorado, Santa Cruz, and Orange). In Santa Cruz County, three positive pools were identified at the home of an individual with prior confirmed human granulocytic ehrlichiosis. In El Dorado County, positive ticks were found at sites where cases of granulocytic ehrlichiosis in a horse and a llama had recently occurred. Among 47 nymphal I. pacificus ticks collected in Sonoma County, one positive pool was identified. Fifty-seven adult Dermacentor occidentalis Marx and 30 adult D. variabilis Say ticks, collected chiefly in southern California, were negative. These data, although preliminary, suggest that the prevalence of E. phagocytophila genogroup rickettsiae in ixodid ticks of California may be lower than in cognate vector populations (i.e., I. scapularis Say = I. dammini Spielman, Clifford, Piesman, and Corwin) in the eastern and midwestern United States.

Animals↗
PubMed2004

Molecular population genetics of Cucumber mosaic virus in California: evidence for founder effects and reassortment.

The structure and genetic diversity of a California Cucumber mosaic virus (CMV) population was assessed by single-strand conformation polymorphism and nucleotide sequence analyses of genomic regions 2b, CP, MP, and the 3' nontranslated region of RNA3. The California CMV population exhibited low genetic diversity and was composed of one to three predominant haplotypes and a large number of minor haplotypes for specific genomic regions. Extremely low diversity and close evolutionary relationships among isolates in a subpopulation suggested that founder effects might play a role in shaping the genetic structure. Phylogenetic analysis indicated a naturally occurring reassortant between subgroup IA and IB isolates and potential reassortants between subgroup IA isolates, suggesting that genetic exchange by reassortment contributed to the evolution of the California CMV population. Analysis of various population genetics parameters and distribution of synonymous and nonsynonymous mutations revealed that different coding regions and even different parts of coding regions were under different evolutionary constraints, including a short region of the 2b gene for which evidence suggests possible positive selection.

California↗
PubMed2004

Unsupervised firearm handling by California adolescents.

OBJECTIVE: Relatively little is known about the behavior of adolescents around firearms. The present investigation was undertaken to estimate the proportion of community-residing adolescents who report that they have ever handled a gun without adult knowledge or supervision. METHODS: A random digit dial interview was conducted with 5801 California adolescents as part of the California Health Interview Survey. Respondents were asked whether they have ever held a gun and whether they have ever done so without adult knowledge or supervision. Study design and population weights were applied to these data. In addition, adolescents' reports about the most recent unsupervised handling incident were coded to ascertain what they were doing with the gun as well as with whom and where the incident occurred. RESULTS: One third (33%) of California adolescents report that they have handled a firearm; 5% report that they have done so without adult knowledge or supervision. Half (49%) of all unsupervised handling involved shooting and only 11% occurred in the respondent's home. Several demographic variables (being male, African American, living in a rural area) and risk behaviors (smoking, drinking, being the victim of a gun related threat), as well as having a gun in the home and parents not knowing the adolescent's whereabouts in the afternoon were each associated with unsupervised gun handling. CONCLUSIONS: Unsupervised gun handling is associated with other health risk behaviors. Unsupervised gun handling typically involves shooting the gun and usually occurs with friends, away from the home.

Accidents, Home↗
PubMed2001

Hospitalized fall injuries and race in California.

OBJECTIVE: To compare risks for falls and their consequences among four major race/ethnic groups in California. METHODS: Cases are 104,902 hospital discharges of California residents with a same level fall injury as the principal external cause of injury. Included are all discharges for a first hospitalization for a given injury in any California non-federal hospital from 1995-97. Analysis includes crude and age standardized rates to describe risks, diagnoses, and consequences. RESULTS: Rates per 100 000 for same level hospitalized fall injuries for whites (161) are distinctively higher than for blacks (64), Hispanics (43), and Asian/Pacific Islanders (35). Whites are more likely to have a fracture diagnosis and to be discharged to long term care rather than home, suggesting a poorer outcome or greater severity. Same level falls absorb a large proportion of hospital resources directed to the treatment of injuries. CONCLUSIONS: In a four way comparison among race/ethnic groups, whites are distinguished by their high incidence, rates of fracture, and unfavorable discharge status. Prevention, particularly aimed at whites, has potential to improve health and save treatment resources.

Accidental Falls↗
PubMed2005

Trends in the sex ratio of California births, 1960-1996.

STUDY OBJECTIVE: The male sex ratio at birth (or the proportion of male births in a population) has been suggested as a sentinel environmental health indicator. Usually around 51%, the proportion may be dramatically decreased in offspring of persons with chemical exposures. Recent publications from the USA and elsewhere have noted a small but apparently declining male birth proportion, suggesting the effect of some environmental exposures. This paper sought to examine these trends more closely in California's large and diverse population. DESIGN: Using computerised birth certificate data, time trends were examined by multivariate linear and spline regression, controlling for demographic factors. SETTING: California. PARTICIPANTS: About 15 million births from 1960 to 1996. MAIN RESULTS: In the raw data, the male birth proportion is indeed declining. However, during this period, there were also shifts in demographics that influence the sex ratio. Controlling for birth order, parents' age, and race/ethnicity, different trends emerged. White births (which account for over 80%) continued to show a statistically significant decline, while other racial groups showed non-statistically significant declines (Japanese, Native American, other), little or no change (black), or an increase (Chinese). Finally, when the white births were divided into Hispanic and non-Hispanic (possible since 1982), it was found that both white subgroups suggest an increase in male births. CONCLUSION: This analysis shows that the decline in male births in California is largely attributable to changes in demographics.

Adolescent↗
PubMed1994

Targeted HIV seroprevalence among Vietnamese in southern California.

OBJECTIVE: The prevalence of HIV among southern California Vietnamese is unknown. We collected seroprevalence data on targeted Vietnamese in Orange County, California who may be at risk for HIV infection. METHODS: The assumption of elevated risk was based on rates of infection reported among other U.S. groups. Vietnamese (N = 874) from six county sites were tested during 1992: (1) attendees at county HIV/STD clinics and (2) IDU program; (3) male inmates of the county jail and (4) of a juvenile detention centre; (5) males in a driving under the influence of alcohol (DUI) remedial program; and (6) patients for nonpregnancy-related syphilis screening. RESULTS: The number of cases detected and risk factors were: (1) county HIV/STD clinics--5/223 (2.3%), all men who had sex with men; (2) men's jail--1/122 (0.8%), risk factors unknown; (3) juvenile hall--1/145 (0.7%), risk factors unknown; (4) IDU program--0/33; (5) syphilis screening--0/284; and (6) DUI program--0/67. CONCLUSIONS: HIV infection exists among southern California Vietnamese, and men who have sex with men appear to be at a risk for HIV infection similar to others practicing high risk behaviors in the U.S. population. Preventive education needs to be targeted explicitly at these individuals.

Adult↗
PubMed2004

The economic burden of smoking in California.

OBJECTIVE: To develop estimates of the direct and indirect costs of smoking for California in 1999. METHODS: A prevalence based approach was used to estimate the annual costs of smoking. Econometric models were used to estimate the smoking attributable fraction (SAF) for direct costs (hospitalisations, ambulatory care, prescription drugs, home health care, and nursing home services) and indirect costs due to lost productivity from smoking related illness. The models controlled for socioeconomic factors and other risk behaviours. Epidemiological methods were used to estimate the SAF for indirect costs due to lost productivity from premature deaths. The SAFs were applied to total health care expenditures, days lost, and deaths to obtain smoking attributable total costs. RESULTS: In 1999, the total costs of smoking in California were 15.9 billion dollars, 475 dollars per resident, and 3331 dollars per smoker. Direct costs were 8.6 billion dollars (54% of the total), indirect costs due to lost productivity from illness were 1.5 billion dollars (10%), and indirect costs due to premature deaths were 5.7 billion dollars (36%). The cost of smoking was 9.4 billion dollars for men and 6.3 billion dollars for women. There were 43,137 deaths attributed to smoking, representing a total of 535,000 years of life lost. The value of life lost per death averaged 132,000 dollars, or 12.4 years. CONCLUSIONS: California smoking related costs are high. The cost methodology presented is useful for other states and nations interested in estimating their costs of smoking. Cost estimates can be used to evaluate the level of cigarette taxes and other policies related to smoking.

Absenteeism↗
PubMed1997

Political realities of statewide smoking legislation: the passage of California's Assembly Bill 13.

OBJECTIVE: To prepare a history of the enactment of California Assembly Bill 13 (AB 13), a state law prohibiting smoking in most workplaces passed in 1994, and to discuss its initial impacts. METHODS: Data were gathered from open ended interviews with representatives of voluntary health organisations, local government organisations, and principal legislators involved in the process, as well as observers around the state who could provide insight into the legislative process. Information was also obtained from legislative hearings and debates, public documents, letters and personal communications, internal memoranda, and news reports. RESULTS: The success of local tobacco control legislation in California led to a situation in which some health groups were willing to accept state preemption in order to attract the support of the state restaurant association for a bill. The decision to accept this preemption compromise was made by the state level offices of the voluntary health agencies without consulting the broader tobacco control community within California. In contrast, local tobacco control advocates did not accept this compromise, in part because of their belief that local legislation was a better device to educate the public, generate media coverage, and build community support for enforcement and implementation of clean indoor air and other tobacco control laws. Enactment of AB 13 was associated with a slowing of all local tobacco control legislation, including youth oriented laws. CONCLUSIONS: Because its supporters initially doubted that AB 13 would pass, there was never an effort to reconcile the policy differences between state oriented and locally oriented tobacco control policies. This lack of consensus, combined with the political realities inherent in passing any state legislation, led to a bill with ambiguous preemption language which replaced the "patchwork of local laws" with a "patchwork of local enforcement."

California↗
PubMed1999

Store tobacco policies: a survey of store managers, California, 1996-1997.

OBJECTIVE: To identify store tobacco policies and retailer perception and beliefs that may have contributed to changes in compliance with youth access laws in California. DESIGN: In the winter of 1996-7, a cross sectional, follow up telephone survey was conducted of California store managers whose stores were anonymously surveyed for illegal tobacco sales in the summer of 1996 (that is, 1996 Youth Tobacco Purchase Survey, YTPS). SETTING: A simple random sample of stores from a list of California stores likely to sell tobacco, used in the 1996 YTPS. PARTICIPANTS: 334 managers (77%) of the 434 stores surveyed in 1996 responded to the survey. After eliminating stores that stopped selling tobacco or were under new management or ownership, 320 responses of store managers were included in the analysis. The stores were analysed by type of ownership: chain, which included corporate managed (n = 61); franchise owned (n = 56); and independent (n = 203). MAIN OUTCOME MEASURES: Responses of store managers were linked with the 1996 YTPS outcomes. Manager responses were compared by chi2 tests. Logistic regression analyses were conducted to identify store factors associated with illegal tobacco sales. RESULTS: A lower likelihood of illegal sales rate was associated with the chain stores when compared with the independent stores (odds ratio (OR) = 0.4, 95% confidence interval (CI) 0.2 to 0.9). A lower likelihood of illegal tobacco sales was found in stores that implemented tobacco related activities in the previous year such as changing tobacco displays (OR = 0.5, 95% CI 0.2 to 0.9) or adding new warning signs (OR = 0.7, 95% CI 0.4 to 1.2). Store managers' beliefs that youth were sent to their stores to do compliance checks also resulted in a lower likelihood of illegal sales (OR = 0.7, 95% CI 0.4 to 1.1). CONCLUSIONS: Store tobacco youth access policies, and managers' beliefs about the extent of youth access enforcement in the community, are important in reducing illegal tobacco sales to minors.

Adolescent↗
PubMed2000

Spit (smokeless) tobacco use by high school baseball athletes in California.

OBJECTIVE: To describe the prevalence, patterns, and correlates of spit (smokeless) tobacco (ST) use in a sample of high school baseball athletes in California. DESIGN: This cross sectional study was a survey of 1226 baseball athletes attending 39 California high schools that were randomly selected from a list of all publicly supported high schools with baseball teams. At a baseball team meeting, athletes who agreed to participate and had parental consent completed the study questionnaire. To enhance the accuracy of self reported ST use status, a saliva sample was collected from each subject. The questionnaires and saliva samples were coded and salivary cotinine assay was performed on a random subsample of 5% of non-users who also were non-smokers. Biochemical assay indicated that 2% tested positive for cotinine inconsistent with self reported ST non-use. RESULTS: Overall, 46% had ever used ST and 15% were current users. Odds ratios and 95% confidence intervals (CI) suggested that, among high school baseball athletes, age, living in a rural area, being white, smoking cigarettes, drinking alcohol, not knowing about the adverse effects of ST, perceiving little personal risk associated with ST use, and believing that friends, role models, teammates, and same age baseball athletes in general used ST, increased the likelihood of being an ST user. CONCLUSION: The findings indicate that considerable experimentation with ST products occurs among high school baseball athletes in California, and many are current users. ST interventions targeting this population are needed to stop the transition from experimental ST use to tobacco dependence. Correlates of ST use for consideration in future intervention studies are identified.

Adolescent↗
PubMed2005

Effect of ethnicity and gender on the incidence of venous thromboembolism in a diverse population in California in 1996.

There have been very few studies that have describe the epidemiology of first-time venous thromboembolism (VTE) in a large, ethnically diverse population. The California Discharge Data Set was used to identify a cohort of cases with incidentVTE in 1996. Cases associated with traditional provoking risk factors were identified and the remaining cases were labeled as idiopathicVTE. Direct standardization using census information was performed to compare incidence rates across races, gender, and gender within race. There were 21,002 cases with incident VTE in 1996, a crude incidence of 90 events per 100,000 adults. Thirty percent of all VTE events were pulmonary embolism. The directly standardized incidence per 100,000 California adults was 93+/-1.7 (+/-95% CI) in women, 85+/-1.7 in men, 103+/-2.1 in Caucasians, 138+/-6.5 in African- Americans, 61+/-2.8 in Hispanics and 29 +/- 2.4 in Asian-Pacific Islanders (p<0.001 for all inter-group comparisons). After adjusting for misclassification of race, the incidence of VTE per 100,000 was 104 in Caucasians, 141 in African-Americans, 55 in Hispanics, and 21 in Asian/Pacific-Islanders. The incidence of idiopathic VTE was significantly lower among both Hispanics and Asian/Pacific-Islanders (p<0.001) than Caucasians or African-Americans. African-Americans were more likely, and Hispanics less likely, to be diagnosed with idiopathic pulmonary embolism compared to Caucasians. The 28 day case-fatality rate among cases with idiopathic VTE was 2%, and it was significantly higher among African-Americans (4.1%) compared to Caucasians (1.8%, p<0.001). There are important differences in the incidence of total and idiopathicVTE and in the proportion of events diagnosed as pulmonary embolism among each of the major racial/ethnic groups in California. Further research is needed to explain these observed differences among the different racial/ethnic groups.

Adolescent↗
PubMed2006

Work hours and self-reported hypertension among working people in California.

Among the risk factors for hypertension, stress, especially work stress, has drawn increasing attention. Another potential work-related risk factor for hypertension identified in the past few years is work hours. This article presents an analysis of work hours and self-reported hypertension among the working population in the state of California. The data set used for this study comes from the Public Use File of the 2001 California Health Interview Survey. The logistic regression analysis shows a positive association between hours worked per week and likelihood of having self-reported hypertension. Compared with those working between 11 and 39 hours per week, individuals working 40 hours per week were 14% (95% CI: 1.01 to 1.28) more likely to report hypertension, those who worked between 41 and 50 hours per week were 17% (95% CI: 1.04 to 1.33) more likely to report hypertension, and those who worked >or=51 hours per week were 29% (95% CI: 1.10 to 1.52) more likely to report hypertension after controlling for various potentially confounding variables, including demographic and biological risk factors and socioeconomic status. This analysis provides evidence of a positive association between work hours and hypertension in the California working population.

Adult↗
PubMed2005

Residential proximity to naturally occurring asbestos and mesothelioma risk in California.

RATIONALE: Little is known about environmental exposure to low levels of naturally occurring asbestos (NOA) and malignant mesothelioma (MM) risk. OBJECTIVES: To conduct a cancer registry-based case control study of residential proximity to NOA with MM in California. METHODS: Incident MM cases (n = 2,908) aged 35 yr or more, diagnosed between 1988 and 1997, were selected from the California Cancer Registry and frequency matched to control subjects with pancreatic cancer (n = 2,908) by 5-yr age group and sex. Control subjects were selected by stratified random sampling from 28,123 incident pancreatic cancers in the same time period. We located 93.7% of subjects at the house or street level at initial diagnosis. Individual occupational exposure to asbestos was derived from the longest held occupation, available for 74% of MM cases and 63% of pancreatic cancers. Occupational exposure to asbestos was determined by a priori classification and confirmed by association with mesothelioma. MAIN RESULTS: The adjusted odds ratios and 95% confidence interval for low, medium, and high probabilities of occupational exposures to asbestos were 1.71 (1.32-2.21), 2.51 (1.91-3.30), and 14.94 (8.37-26.67), respectively. Logistic regression analysis from a subset of 1,133 mesothelioma cases and 890 control subjects with pancreatic cancer showed that the odds of mesothelioma decreased approximately 6.3% for every 10 km farther from the nearest asbestos source, an odds ratio of 0.937 (95% confidence interval = 0.895-0.982), adjusted for age, sex, and occupational exposure to asbestos. CONCLUSIONS: These data support the hypothesis that residential proximity to NOA is significantly associated with increased risk of MM in California.

Adult↗
PubMed1975

Current and emerging models of residential psychiatric treatment, with special reference to the California situation.

The author reviews the steps that have led to the progressive deemphasis of psychiatric hospitalization in California and surveys the empirical basis for rejecting the usefulness of hospitalization. He discusses the four alternative residential models that have emerged in California as substitutes for state mental hospitals--general hospital psychiatric units, board and care homes, private psychiatric facilities available through vendor contracts, and convalescent hospitals. The author also touches briefly upon some important problems, including the possible fate of public general hospital psychiatric units, community mental health services, and the commitment law in California.

California↗
PubMed1991

The negligible effects of California's 1982 reform of the insanity defense test.

OBJECTIVE: The authors' goal was to determine whether changing the insanity test in California in 1982 actually affected use of the insanity defense. METHOD: They gathered information on all individuals who entered the insanity plea (N = 1,300) and all those acquitted by reason of insanity (N = 665) in seven counties in California 3 years before and 3 years after the change in the test of insanity. They focused on whether California's revision of the insanity test affected the number and rate of insanity pleas, the number and rate of insanity acquittals, the characteristics of individuals using the defense, the target offenses, and the length of stay of insanity acquittees. RESULTS: The reform did not affect the rate of insanity pleas or acquittals, the characteristics of those using the defense, or their length of confinement. CONCLUSIONS: Although the reform had no direct effects on the use of the insanity defense, the authors hypothesize that an indirect change in criminal sentencing practices led to a decrease in the number and rate of insanity pleas and acquittals.

California↗