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PubMed1999

B notifications and the detection of tuberculosis among foreign-born recent arrivals in California.

OBJECTIVE: To evaluate the effectiveness and limitations of the B notification program for detecting tuberculosis among recent foreign-born arrivals in California. DESIGN: Retrospective cohort study. All foreign-born visa holders with a B notification who arrived in California from January 1992 through September 1995 (n = 27 412) were matched with a listing of foreign-born persons who arrived in the US during the same time period and who were reported to have active tuberculosis in California within one year of their arrival from January 1992 through September 1996 (n = 2547). RESULTS: Overall, 3.5% (95% confidence interval 3.3%, 3.8%) of all persons with a B notification were reported to have active tuberculosis within a year of arrival. Recent arrivals with a B notification and tuberculosis accounted for 38% of all foreign-born cases of tuberculosis reported within one year of arrival. Compared to recent arrivals without a B notification, those with a B notification were more likely to have pulmonary tuberculosis, less likely to have smear-positive pulmonary disease and reported with tuberculosis sooner after their arrival in the US. The B notification program was not able to identify 87% of the smear-positive pulmonary tuberculosis cases in adults, and did not identify 99% of these highly infectious cases among Latin Americans. CONCLUSIONS: Although the evaluation of persons who enter the US with B notifications has a high yield for identifying active tuberculosis cases, it was not able to identify the majority of recent arrivals with the most infectious form of tuberculosis.

Adolescent↗
PubMed1999

Variation in the density of questing Ixodes pacificus (Acari:Ixodidae) nymphs infected with Borrelia burgdorferi at different spatial scales in California.

The density of, and prevalence of infection with Borrelia burgdorferi in, Ixodes pacificus nymphs as well as the density of infected nymphs were compared at 12 properties at a small rural community at high risk for Lyme disease (CHR) and at 12 areas at the University of California Hopland Research and Extension Center (HREC), Mendocino County, California. The mean infection prevalence and density of infected nymphs were 1.7% (range, 0-4.2%) and 0.10 infected nymphs per 100 m2 (range, 0-0.23 per 100 m2) at the HREC, and 12.4% (range, 3.9-41.3%) and 1.83 infected nymphs per 100 m2 (range, 0.29-22.17 per 100 m2) at the CHR. Thus, the mean density of infected nymphs differed 18-fold between CHR and HREC and 76-fold between properties at the CHR. Also, there was up to 10-fold variation in infection prevalence and 16-fold variation in density of infected nymphs between discrete areas within properties at the CHR. The high densities of infected nymphs recorded at the CHR suggest that, despite the low statewide incidence of Lyme disease, the medical community should be alerted that Lyme disease can be highly endemic in rural areas of northwestern California. The prevalence of spirochetal infection was higher for nymphs collected in southern/western, as compared to northern/eastern, exposures at both HREC and CHR. Infection prevalence and nymphal density were negatively associated at the HREC, whereas they tended to be associated positively at the CHR. A positive association was observed between nymphal density and density of infected nymphs when data from CHR and HREC were combined, and when data from the CHR were considered alone, but not for data from the HREC alone.

Animals↗
PubMed2000

Children of working low-income families in California: does parental work benefit children's insurance status, access, and utilization of primary health care?

OBJECTIVE: To examine financial and nonfinancial access to care and utilization of primary health care services among children of working low-income families earning below 200 percent of the federal poverty level in California, and to compare them to children in nonworking low-income families and in families earning over 200 percent of poverty. DATA SOURCES/STUDY SETTING: The 1994 National Health Interview survey weighted to reflect population estimates for California. STUDY DESIGN: This cross-sectional study of 3,831 children under age 19 focuses on financial access, that is, the prevalence and continuity of health insurance coverage; structural access, including the presence of a usual source of care, the predominant care source, its responsiveness to patient's needs, and any indications of delayed or missed care; and utilization of health care measured by the presence of an outpatient doctor's visit and the mean number of visits relative to child health status. DATA COLLECTION: The study uses secondary analysis. FINDINGS: Compared to children of nonworking low-income parents and to nonpoor children, children of working low-income parents were more likely to be uninsured (32.1 percent versus 15.6 percent and 10.3 percent, p = .0001) and to experience disruptions in insurance coverage (p = .0009). These differences persisted after controlling for other covariates in multivariate analyses. Children of working low-income parents did not differ significantly from children of nonworking low-income parents on measures of structural access or utilization, after adjusting for other covariates. However, they differed significantly from nonpoor children on structural access and utilization, and these differences mostly persisted after adjusting for other covariates (odds ratios from 1.5 to 2.9). Similar patterns were observed when children of full-time, year-round working parents with low earnings were compared with the two reference populations. CONCLUSION: Children in working low-income families in California have some of the worst access problems. Even full attachment to the workforce does not guarantee health insurance benefits, access to care, or improved health care use for children of low-income parents. These children are not better off than other low-income children of nonworking parents and are much worse off than nonpoor children. Expansion of health insurance coverage through Healthy Families and Medi-Cal, and attention to nonfinancial barriers to care for working low-income families may help to reduce these disparities.

Adolescent↗
PubMed2000

Organizational systems used by California capitated medical groups and independent practice associations to increase cancer screening.

BACKGROUND: Patients in health maintenance organizations (HMOs) appear to have higher utilization of cancer screening tests than patients with fee-for-service insurance. METHODS: The authors surveyed the medical directors of 174 physician organizations in a California network model HMO to obtain information regarding their organizational structure, implementation of guidelines, and use of systems to increase cancer screening. RESULTS: The majority of independent practice associations (IPAs) and medical groups (IMGs) in this California HMO had guidelines and office systems aimed at improving cancer screening. These activities were reported more frequently for mammography and Papanicolaou (Pap) smears than for colorectal carcinoma screening. IMGs reported using flow sheets more often than IPAs. Chart audits were performed more frequently for mammography (48% for IMGs and 40% for IPAs) and Pap smears (45% and 40%, respectively) than for colorectal carcinoma screening (38% and 30%, respectively). Approximately 50% of IPAs and IMGs reported mailing reminders to patients for mammography and Pap smears, but only a few did so for colorectal carcinoma screening. Annual fecal occult blood testing was believed by most medical directors to be a reasonable strategy for managed care patients (86% of IPAs and 96% of IMGs); however, fewer believed that screening sigmoidoscopy for patients ages 50-70 years was a reasonable expectation (71% and 78%, respectively). CONCLUSIONS: The majority of IPAs and IMGs in this California HMO reported using both guidelines and office systems to improve cancer screening rates. Further research is needed to understand the effect of these systems, as well their complex interactions with competing incentives, on cancer screening in managed care patients.

Adult↗
PubMed2000

Asian gastric cancer patients at a southern California comprehensive cancer center are diagnosed with less advanced disease and have superior stage-stratified survival.

The 5-year overall survival after curative gastrectomy for gastric cancer is markedly different in the West from that in the Far East. Japanese surgeons feel that extended lymphadenectomy contributes to this superior survival, although survival differences may reflect improved staging or less aggressive tumor biology. We analyzed consecutive cases of gastric adenocarcinoma diagnosed and treated at the University of California, Irvine Medical Center from 1989 through 1998 to determine whether patients of Asian descent diagnosed with gastric cancer in Southern California have improved outcome. Fifty-two cases (36%) occurred in patients of Asian descent (39% Vietnamese, 31% Chinese, 13% Korean, 6% Filipino, and 2% Japanese). Only one Asian patient was born in the United States. Non-Asian patients (67% white, 30% Latino, and 3% black) were younger (59 years vs 64 years; P < 0.05) and more likely to have tumors of the gastroesophageal junction (33% vs 4%; P < 0.001). Asian patients were less likely to have distant metastases (24% vs 39%; P = 0.08), were more likely to undergo formal gastrectomy (71% vs 45%; P < 0.01), and were more likely to undergo a curative resection (40% vs 18%; P < 0.01). The overall survival of Asian patients at 3 years was significantly higher than the overall survival of non-Asians (39.4% vs 19.6%, P < 0.05). Asians with regional (node-positive) disease had superior survival (40.2% vs 14.8%, P < 0.05), which can be largely attributed to greater rates of resectability. We conclude that the clinical behavior of gastric cancer in Asians in Southern California differs from that in non-Asians. The increased proportion of resectable disease and improved survival of patients of Asian descent likely reflects less aggressive tumor biology.

Adenocarcinoma↗
PubMed2000

CALINX (California Information Exchange): a multi-stakeholder statewide initiative to improve healthcare information flows.

Given the diffusion of responsibilities for gathering and reporting healthcare information in a managed care environment, California stakeholders are taking concrete steps to break the deadlock on data and information flows that has characterized the industry for some time. The California Information Exchange (CALINX) was established to facilitate the implementation of the Health Insurance Portability and Accountability Act (HIPAA) standards in California and to create trust for data exchange between trading partners, without which data exchange still will not occur. Strategic directions are set by the chief executives of key associations and organizations representing purchasers, plans, providers, and consumers. Multi-stakeholder workgroups have produced detailed data guidelines for the HIPAA standards along with rules for exchange of key data sets between trading partners. These rules address frequency, timeliness, and accuracy of data submission. Both the data guidelines and the rules have been tested in live demonstration projects, and the results of these projects have been reported to substantiate the business case for implementation. Further incentives are being built into contracts between purchasers and plans, and between plans and providers. CALINX is currently promoting widespread adoption of the data guidelines and rules for exchange with all members of the industry.

California↗
PubMed2001

Changing the health care system: a professional education program for Hispanic leaders in California.

This article reports characteristics and evaluation findings on a program aimed at promoting change in California's health care system by training minority managers and policy specialists. Between 1990 and 1992, 30 Hispanic college graduates enrolled in the University of Southern California's Hispanic Leadership Program. Funded in part by the W. K. Kellogg Foundation, this program led to award of the Master of Health Administration degree and involved students in a series of community workshops. Evaluation took place via alumni surveys and focus groups. Although four individuals failed to complete the program, nearly all others entered careers potentially leading to positions of influence in health care delivery. Graduates indicated that they possessed most of the skills they considered necessary to help improve services to Hispanic people. All had taken concrete action toward this objective. Experience with the program has provided lessons valuable for conducting efforts of this kind, the principal one being that success requires substantial human and material resources. Long-term follow-up will be necessary to assess the program's ultimate impact on California's health care system.

California↗
PubMed2001

Coccidioidomycosis among persons attending the world championship of model airplane flying--Kern County, California, October 2001.

On December 4, 2001, CDC was notified by the United Kingdom (UK) Public Health Laboratory Service (PHLS) of a UK resident aged 72 years who had culture-confirmed coccidioidomycosis (i.e., Valley fever) diagnosed in early December. During October 8-12, the patient had attended the world championship of model airplane flying in Lost Hills, California, located in Kern County in the Central Valley of California, an area where coccidioidomycosis is highly endemic (Figure 1). The patient had influenza-like symptoms on approximately October 25, 1 week after returning from Lost Hills. CDC, in collaboration with UK PHLS and the California Department of Health Services, is conducting an investigation.

Aircraft↗
PubMed2002

Hospital charity care policies and the California health care safety net.

Estimates of charity care expenditures provide a quantitative measure of hospitals' commitment to expanding access to the medically uninsured in their communities but fail to provide information about the subset of uninsured who benefit or the gaps in public insurance programs' coverage that are filled by these charity care programs. This brief provides an overview of a study, conducted for the California HealthCare Foundation, that gathered information on California hospitals' charity care policies. The objective of the study was to identify the eligibility criteria hospitals use for free care and to understand the gaps in Medi-Cal, California's version of Medicaid, and county indigent program coverage that these providers are capable of filling.

California↗
PubMed2001

Psychometric properties of the California Critical Thinking Tests.

The evaluation of critical thinking, as with any other measure, must employ instruments that meet appropriate psychometric standards. Therefore, the purpose of this study was to investigate the psychometric properties of the two California Critical Thinking Tests. Two samples of undergraduate students enrolled in a southern comprehensive university took the California Critical Thinking Skills Test (TST) and the California Critical Thinking Dispositions Inventory (TDI). A portion of the participants, who were nursing students, were retested on the TST and TDI two weeks after the initial testing. Some participants also completed the Watson-Glaser Critical Thinking Appraisal (WGCTA). In both samples the TST had neither sufficient psychometric properties to assess individual abilities nor sufficient stability reliability. In particular, the analysis subscale of the TST demonstrated exceptional weakness in all administrations. In contrast, the TDI demonstrated very good reliability estimates in all administrations of the test. The data did not conform to the subscale structure during factor analysis. Whereas the TST needs further refinement, the TDI demonstrated sufficient reliability for use in attitudinal research.

Adolescent↗
PubMed1987

California Federal Savings and Loan Association v. Guerra, 13 January 1987.

The plaintiff employer and other similar employers challenged the constitutionality of a California law that required employers to provide female employees with up to four months unpaid pregnancy leave with reinstatement in the same or a substantially similar job. They claimed that the law was preempted by Title VII of the Civil Rights Act of 1964 because the 1964 Act, as amended by the Pregnancy Discrimination Act of 1978, required absolute neutrality in the treatment of pregnant employees with respect to other employees. Their position was that the California law discriminated in favor of pregnant employees. The Court rejected their claim. It held that the Pregnancy Discrimination Act was "a floor beneath which pregnancy disability benefits may not drop--not a ceiling above which they may not rise," and that the California law shared a common goal with the federal law of providing women with full rights in the workforce without denying them the right to full participation in family life. It ruled that there was nothing in the law that prevented employers from complying with the law and Title VII.

Americas↗
PubMed1976

High risk perinatal care in California.

Rates of perinatal mortality are still too high in California. Mortality and morbidity, particularly for high risk pregnancies, can be reduced by the use of modern technology in the hands of highly trained personnel. New goals for perinatal care have been published by the California Medical Association reflecting these changes. This kind of care is too costly to be developed in all the small obstetric units presently providing services in California. Consolidation of obstetric and neonatal units into fewer hospitals can make it economically possible for these units to meet present-day standards.

California↗
PubMed2003

California children and oral health: trends and challenges.

This paper highlights fundamental elements of the challenge of securing optimal oral health for California's children, now and in the future, and underscores the need for new strategies to reduce the risk of dental disease and expand access to effective services. Developing effective strategies to gain optimal oral health for California children, especially those that are most vulnerable to dental disease and its consequences, requires an appreciation of key dynamic factors that define this challenge and the degree to which these factors are modifiable in the near and long term. Particular attention is directed toward three principal elements: population demographics, levels of dental disease in California children, and factors affecting access to services for vulnerable groups of children. The concluding section addresses the need for strategic action.

California↗
PubMed2003

The demise of the small HMO in California.

On May 25, 2001, the California Department of Managed Health Care served Maxicare, a Los Angeles-based HMO with approximately 250,000 subscribers, a notice of conservatorship. Within the following 16 months, four other small California HMOs either filed for bankruptcy or were put under state conservatorship. The age of the small HMO in California had come to an end.

Bankruptcy↗
PubMed2003

A test of the California competency-based differentiated role model.

To address the incongruence between the expectations of nursing service and education in California, the Education Industry Interface Task Force of the California Strategic Planning Committee for Nursing developed descriptions to assist employers and educators in clearly differentiating practice and educational competencies. The completion of the Competency-Based Role Differentiation Model resulted in the need to test the model for its utility in the service setting, in education, and for career planning for nurses. Three alpha demonstration sites were selected based on representative geographical regions of California. The sites were composed of tri-partnerships consisting of a medical center, an associate degree in nursing program, and a baccalaureate nursing program. Observers rated senior students and new graduates in medical-surgical units on their behaviors in teacher and leadership care provider and care coordinator roles. The alpha demonstration study results were as expected. That is, senior students practice predominantly at a novice level in teacher and management/leadership care provider functions and new graduates practice predominately at the competent level. New graduates are more likely to take on novice and competent care coordinator roles. The CBRDM may be useful for practice and education settings to evaluate student and nurse performance, to define role expectations, and to identify the preparation necessary for the roles. It is useful for all of nursing as it continues to define its levels of practice and their relationship to on-the-job performance, curriculum development, and carrier planning.

California↗
PubMed1956

Rheumatic fever in Southern California; problems related to diagnosis.

Rheumatic fever occurs in native of Southern California and is a cause of death. The incidence of streptococcosis in Los Angeles is approximately equal to that in three other major cities in the United States where rheumatic fever is known to occur commonly. Manifestations of rheumatic fever may range from mild to severe. It is suggested that a greater percentage of patients in Southern California have symptoms of rheumatic fever that are more mild. Differentiation between prolonged, uncomplicated streptococcosis and rheumatic fever is a major problem. The judicious use of a battery of tests, acute phase reactants, on the same blood sample will frequently help to establish the diagnosis in borderline situations so common to Southern California.

California↗
PubMed1956

The sexual psychopath in California.

In California sexual offenders apprehended by the law are examined by court-appointed psychiatrists to determine whether they are "sexual psychopaths" as defined by California law and need treatment in a mental hospital. This paper outlines the criteria to be used as guides in properly selecting the persons for treatment. In general, sexual offenders fall into four categories. The first group consists of persons who cannot maintain proper control over their sexual impulses but whose acts do not constitute them a menace to the health and safety of others. They are not "sexual psychopaths" and their cases should be handled on their legal merits. The second group embraces persons who have committed a sexual offense on only one occasion and while under the influence of abnormal or unusual environmental stress. They are not considered "sexual psychopaths."The third is made up of persons completely out of step with the social culture. They often have long criminal histories or long histories of social maladjustment. They are impulsive in their behavior and not remorseful of their misdeeds. Sexually deviant acts committed by such individuals are often incidental to their general asocial and amoral behavior. They do not suffer from inability to control sexual impulses. Their offenses should be judged according to the legal merits of the case.True "sexual psychopaths" have deviant menaceful sexual impulses and are not able to control them. The vast majority of these persons are those who have committed sexual offenses against children. The California State Department of Mental Hygiene has a maximum security hospital which is charged with the care and treatment of "sexual psychopaths."

Antisocial Personality Disorder↗
PubMed2003

Teledentistry in rural California: a USC initiative.

Dentistry, in a synergistic combination with telecommunications technology and the Internet, has yielded a relatively new and exciting field that has endless potential. "Teledentistry" emerges from the fusion of dental practice and technology and can take on two forms--real-time consultation and "store and forward." The first entity to put teledentistry into practice was the Army, which, in 1994, successfully undertook consultations between dentists and service personnel located more than 100 miles apart. Since then, various institutions and organizations in the United States and farther afield have practiced teledentistry, with varying degrees of success. The Children's Hospital Los Angeles Teledentistry Project, being run in association with the University of Southern California's Mobile Dental Clinic, seeks to increase and enhance the quality of oral health care that is provided to children living in remote rural areas of California, areas often severely underserved by dental health providers. The project has three phases: Phase I involves the establishment and organization of the teledentistry network; Phase II will introduce technologies to provide orthodontic consultation and treatment; and Phase III will expand the network and provide increased specialty care into further areas of California and beyond, providing services to more children in desperate need of dental health care.

California↗