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PubMed1995

The California Adult Performance Outcome Survey: preliminary evidence on reliability and validity.

Recent legislation in California mandated the development of an outcome measure suitable for measuring changes in quality of life associated with treatment in the public mental health system. The measure, known as the California Adult Performance Outcome Survey (CAPOS), relies on clinician and client reports of objective and subjective indicators of quality of life. The present study sought to determine whether the clinician-administered CAPOS would agree with that administered by trained research assistants, and whether the CAPOS would agree with an established quality of life measure. A sample of sixty-four severely mentally ill subjects were assessed by their regular mental health provider using the CAPOS. One week later they were assessed by a trained research assistant using the CAPOS and Lehman's Quality of Life Interview (QOLI). For most outcome domains, the CAPOS exhibited moderate to excellent agreement across occasions and raters. Correlations with the QOLI indicated a good degree of overlap among corresponding domains. Outcome measurement procedures for routine use in clinical settings are in their infancy. The CAPOS appears promising in this role because of its brevity, ease of administration, and adequate interrater reliability. The CAPOS affords state and local mental health authorities with an efficient means of tracking key quality of life indicators within the public mental health system.

Activities of Daily Living↗
PubMed1996

The political development of "Program Realignment": California's 1991 mental health care reform.

This article reviews the legislative process that resulted in the most significant reform of California's public mental health system in nearly 25 years. The reform, termed "Program Realignment," decentralized administrative and fiscal control of the mental health system from the state to the county level. The system prior to Program Realignment is discussed here to reveal an already diverse and decentralized county mental health system, fiscal distress, and general dissatisfaction with the system. From these conditions, the objectives of the relevant political actors arose. By tracing the policy development process of Program Realignment, several independent variables are revealed that help explain how and why this legislation came into being and allow generalization of this case to other states' experiences. These independent variables are an urgent need for action within a limited timeframe, a preexisting knowledge base and well-developed policy networks, a spirit of bipartisan cooperation, and the presence of strong leadership. Preliminary evidence suggests that consolidation of fiscal and programmatic authority at the local level has reduced fragmentation of services and increased fiscal flexibility. However, there is concern that the quality of care offered by the state's 59 local mental health programs will become increasingly disparate and that increased financial flexibility may not be used to improve services for clients but to save money for local governments. Lessons from California's experience can alert other states to the pros and cons of this policy approach to providing mental health services and inform policymakers in other states of the steps involved in bringing about such a policy change.

Budgets↗
PubMed1993

Physician advice to quit smoking: results from the 1990 California Tobacco Survey.

OBJECTIVE: To estimate the percentage of California smokers who visit physicians each year and thus determine the extent of the opportunity for physicians to advise their smoking patients to quit; to identify sociodemographic and other characteristics related to smokers' reporting that advice was given; and to look for evidence that physician advice influences quitting behavior. SETTING AND DESIGN: Data were collected as part of the 1990 California Tobacco Survey, a large (n = 24,296) population-based telephone survey. PARTICIPANTS: 9,796 current smokers, including 5,559 daily smokers who had visited a physician in the preceding year. MEASUREMENTS AND MAIN RESULTS: Two-thirds of all smokers had visited a physician in the year before the interview, but only about 50% of Hispanic and Asian smokers had done so. Multivariate analysis showed that advice at the last visit was independently related to older age, higher cigarette consumption, and poorer perceived health. Compared with smokers never advised to quite by a physician, those advised to quit at the last visit were 1.61 (95% confidence interval, 1.31-1.98) times more likely to report a quit attempt in the preceding year and 1.90 (95% confidence interval, 1.45-2.48) times more likely to be preparing to quit; however, those advised previously but not at the last visit showed no more quitting activity than did smokers never advised to quit. CONCLUSION: Physicians have considerable opportunity to reach all demographic subgroups of the population, but the nature of the subgroups advised most (those who are older, have high consumption of cigarettes, or have poor health) suggests that physicians tend to treat such advice as a therapeutic rather than a preventive intervention. Physician advice at the most recent visit encourages patients to think about quitting and probably leads to quit attempts. Thus, it is vital that physicians perform the simple intervention of advising every smoker to quit at every visit.

Adolescent↗
PubMed2004

Full time adult credential students' instructional preferences at California State University, Long Beach: pedagogy orandragogy?

This study investigated the instructional preferences of full time adult credential students after they took a live course called Principles of Adult Education at California State University, Long Beach (CSULB) in the fall semester of 2002. These full time adult credential students had been working on their adult teaching credentials to meet the competencies specified by the California Commission on Teacher Credentialing. The course introduced students to Andragogy developed by Malcolm Knowles out of the andragogical model developed by Lindeman (1926). The study used Principles of Adult Learning Scales (PALS), advanced by Gary Conti in 1983 to measure instructional preferences. Data were collected from 30 (100% of 30) full time adult credential students enrolled in a live course to determine their instructional preferences of helping adults learn. The results of the study showed in most cases these adult learning professionals taught adult students andragogically; in some cases they taught adult students pedagogically.

California↗
PubMed2003

Molecular differentiation and diversity among the California red oaks (Fagaceae; Quercus section Lobatae).

A recent epidemic of Phytopthora (Sudden Oak Death) in coastal woodlands of California is causing severe mortality in some oak species belonging to the red oak (Lobatae) group. To predict the risks of spread of this disease, an understanding of the relationships among California's red oak species and of their population genetic structure is needed. We focus here on relationships among the four species of red oak. Whereas morphological distinction of Quercus wislizeni and Quercus parvula can pose problems, Quercus kelloggii and Quercus agrifolia in pure forms are easily distinguishable from one another and from Q. wislizeni and Q. parvula in the field. However, hybrids among all species combinations are known to occur in nature and these can confound data from ecological studies. Our results revealed greatest differentiation of the deciduous Q. kelloggii, with only weak AFLP fragment differentiation of the three remaining evergreen species. The molecular data suggest a closer affinity of Q. agrifolia with Q. wislizeni and Q. parvula contrary to earlier suggestions that its origins are likely to have been with northern deciduous oaks probably through a common ancestor with Q. kelloggii. Interior and coastal populations of Q. wislizeni separated in dendrograms based on phenetic and genetic distances suggesting probable isolation in different glacial refugia. The position of Q. parvula remains ambiguous, having a closer affinity with interior populations of Q. wislizeni and with Q. agrifolia, than with coastal populations of Q. wislizeni. Mean population differentiation in Q. wislizeni was 0.18, which is somewhat higher than the average for other oak species, suggesting that range fragmentation has occurred in the past, resulting in a metapopulation structure. Our results provide evidence that introgression among these species may be causing reticulation, further confounding species separation. Whereas Phytopthora has been reported on Q. agrifolia, Q. parvula and Q. kelloggii, it has not yet been detected in natural populations of Q. wislizeni. The species relationships that our molecular data show suggest that this is more likely a result of escape due to ecological tolerances than to genetic differences.

California↗
PubMed2004

Increasing hip fracture incidence in California Hispanics, 1983 to 2000.

BACKGROUND: Hip fracture incidence in non-Hispanic whites (NHW) has decreased nationwide for the past 20 years. Little is known regarding hip fracture incidence among Hispanics, the largest, fastest growing minority in the United States. OBJECTIVE: To assess the change in standardized hip fracture incidence from 1983 through 2000 in California Hispanics relative to other racial groups. DESIGN: Hospitalizations for individuals older than 55 years with hip fracture requiring repair in acute care hospitals. Annual population estimates based on US Census Bureau estimates. Incidence standardized to national gender-age strata. Change in annual incidence calculated by weighted linear regression with robust variance estimates. RESULTS: 372,078 hip fractures were identified. Age-adjusted annual incidence of hip fractures declined by 0.74% per year among women (655 to 568 per 100,000), but was unchanged among men (247 to 238 per 100,000). Among NHW women, the standardized annual incidence fell by 0.6% (4.0 fractures per 100,000) per year. Annual incidence among Hispanic women increased 4.9% (11.1 fractures per 100,000) per year. Annual incidence among Hispanic men increased by 4.2% (4.5 fractures per 100,000) per year and among NHW men by 0.5% (1.2 fractures per 100,000) per year. No significant change occurred among black or Asian women or men. CONCLUSIONS: Among California women, hip fracture incidence has doubled among Hispanics since 1983, while remaining unchanged or declining in other groups. Greater attention should be given to identification of individuals at risk for hip fracture and initiation of preventive measures in Hispanic populations.

Age Distribution↗
PubMed2006

Salmonella spp., Vibrio spp., Clostridium perfringens, and Plesiomonas shigelloides in marine and freshwater invertebrates from coastal California ecosystems.

The coastal ecosystems of California are highly utilized by humans and animals, but the ecology of fecal bacteria at the land-sea interface is not well understood. This study evaluated the distribution of potentially pathogenic bacteria in invertebrates from linked marine, estuarine, and freshwater ecosystems in central California. A variety of filter-feeding clams, mussels, worms, and crab tissues were selectively cultured for Salmonella spp., Campylobacter spp., Escherichia coli-O157, Clostridium perfringens, Plesiomonas shigelloides, and Vibrio spp. A longitudinal study assessed environmental risk factors for detecting these bacterial species in sentinel mussel batches. Putative risk factors included mussel collection near higher risk areas for livestock or human sewage exposure, adjacent human population density, season, recent precipitation, water temperature, water type, bivalve type, and freshwater outflow exposure. Bacteria detected in invertebrates included Salmonella spp., C. perfringens, P. shigelloides, Vibrio cholerae, Vibrio parahaemolyticus, and Vibrio alginolyticus. Overall, 80% of mussel batches were culture positive for at least one of the bacterial species, although the pathogens Campylobacter, E. coli-O157, and Salmonella were not detected. Many of the same bacterial species were also cultured from upstream estuarine and riverine invertebrates. Exposure to human sewage sources, recent precipitation, and water temperature were significant risk factors for bacterial detection in sentinel mussel batches. These findings are consistent with the hypothesis that filter-feeding invertebrates along the coast concentrate fecal bacteria flowing from land to sea and show that the relationships between anthropogenic effects on coastal ecosystems and the environmental niches of fecal bacteria are complex and dynamic.

Animals↗
PubMed2004

Class II multiformity generated by variable MHC- DRB region configurations in the California sea lion ( Zalophus californianus).

In light of the immunological importance of molecules encoded within the major histocompatibility complex ( MHC), there are numerous studies examining the variability of these genes in wildlife populations. An underlying assumption in many of these studies is that MHC diversity invariably arises from a high level of allelic variation at a single gene locus, leading to widespread descriptions of thriving species with apparently limited MHC polymorphism. Indeed, in a previous study we failed to find sequence features compatible with traditionally diverse peptide-binding functions in MHC class II ( DQA and DQB) genes in California sea lions and therefore expanded the search for polymorphism to the DRA and DRB genes. Our results show that, in contrast to Zaca-DQA, -DQB, and - DRA, Zaca-DRB has sequence features compatible with antigen binding and presentation. In fact Zaca-DRB constitutes a gene family, comprising at least seven loci, each of which exhibits limited variability, and which are present in variable configurations between individuals. This unusual mechanism for generating MHC DRB diversity is similar to that observed in the rhesus macaque, but has not been reported in any other species. The identification of a novel system of class II MHC variability in the California sea lion justifies new studies into the organizational basis of immunogenetic diversity in other marine species, and its role in infectious disease susceptibility.

Animals↗
PubMed2002

Fire management of California shrubland landscapes.

Fire management of California shrublands has been heavily influenced by policies designed for coniferous forests, however, fire suppression has not effectively excluded fire from chaparral and coastal sage scrub landscapes and catastrophic wildfires are not the result of unnatural fuel accumulation. There is no evidence that prescribed burning in these shrublands provides any resource benefit and in some areas may negatively impact shrublands by increasing fire frequency. Therefore, fire hazard reduction is the primary justification for prescription burning, but it is doubtful that rotational burning to create landscape age mosaics is a cost effective method of controlling catastrophic wildfires. There are problems with prescription burning in this crown-fire ecosystem that are not shared by forests with a natural surface-fire regime. Prescription weather conditions preclude burning at rotation intervals sufficient to effect the control of fires ignited under severe weather conditions. Fire management should focus on strategic placement of prescription burns to both insure the most efficient fire hazard reduction and to minimize the amount of landscape exposed to unnaturally high fire frequency. A major contributor to increased fire suppression costs and increased loss of property and lives is the continued urban sprawl into wildlands naturally subjected to high intensity crown fires. Differences in shrubland fire history suggest there may be a need for different fire management tactics between central coastal and southern California. Much less is known about shrubland fire history in the Sierra Nevada foothills and interior North Coast Ranges, and thus it would be prudent to not transfer these ideas too broadly across the range of chaparral until we have a clearer understanding of the extent of regional variation in shrubland fire regimes.

California↗
PubMed2002

Inventory of ocean monitoring in the Southern California Bight.

Monitoring of the ocean environment in southern California, USA, has been conducted by a diverse array of public and private organizations with different motivations, working on a variety of spatial and temporal scales. To create a basis from which to integrate information from these diverse programs, we conducted an inventory of ocean monitoring activities in the Southern California Bight to address the following questions: (1) How much money is being expended annually on marine monitoring programs? (2) Which organizations are conducting the most monitoring? (3) How are resources allocated among the different types of monitoring programs? This inventory focused on programs existing, or those expected to be in existence, for at least 10 years and that were active at any time between 1994 and 1997. For each program identified for inclusion in this study, information was collected on the number of sites, sampling intensity, parameters measured, and methods used. Levels of effort were translated into cost estimates based upon a market survey of local consulting firms. One hundred fourteen marine monitoring programs, conducted by 65 organizations and costing US $31 million annually, were identified. Most of the effort (81 programs, 65% of samples, 70% of costs) was expended by ocean dischargers as part of their compliance with National Pollutant Discharge Elimination System (NPDES) permit requirements. Federal programs (11 programs, 25% of samples, 10% of total expenditures) expended more than state or local government programs. More than one quarter of monitoring expenditures were conducted to measure concentrations and mass of effluent inputs to the ocean. The largest effort expended on receiving water monitoring was for measuring bacteria, followed by sediments, fish/shellfish, water quality, and intertidal habitats. The large level of expenditures by individual agencies has presented opportunities for integrating small, site-specific ocean monitoring programs into regional- and national-scale monitoring and assessment programs.

Animals↗
PubMed2005

A quantitative tool for assessing the integrity of southern coastal California streams.

We developed a benthic macro-invertebrate index of biological integrity (B-IBI) for the semi-arid and populous southern California coastal region. Potential reference sites were screened from a pool of 275 sites, first with quantitative GIS landscape analysis at several spatial scales and then with local condition assessments (in-stream and riparian) that quantified stressors acting on study reaches. We screened 61 candidate metrics for inclusion in the B-IBI based on three criteria: sufficient range for scoring, responsiveness to watershed and reach-scale disturbance gradients, and minimal correlation with other responsive metrics. Final metrics included: percent collector-gatherer + collector-filterer individuals, percent non-insect taxa, percent tolerant taxa, Coleoptera richness, predator richness, percent intolerant individuals, and EPT richness. Three metrics had lower scores in chaparral reference sites than in mountain reference sites and were scored on separate scales in the B-IBI. Metrics were scored and assembled into a composite B-IBI, which was then divided into five roughly equal condition categories. PCA analysis was used to demonstrate that the B-IBI was sensitive to composite stressor gradients; we also confirmed that the B-IBI scores were not correlated with elevation, season, or watershed area. Application of the B-IBI to an independent validation dataset (69 sites) produced results congruent with the development dataset and a separate repeatability study at four sites in the region confirmed that the B-IBI scoring is precise. The SoCal B-IBI is an effective tool with strong performance characteristics and provides a practical means of evaluating biotic condition of streams in southern coastal California.

Animals↗
PubMed2005

Large woody debris and land management in California's hardwood-dominated watersheds.

Although large woody debris (LWD) has been studied extensively in conifer-dominated watersheds, relatively little is known about LWD in hardwood-dominated watersheds. Field surveys of 32 hardwood-dominated stream reaches in northern coastal California revealed that levels of LWD varied with land ownership and that living trees strongly influenced debris jam formation. Almost half of the channel-spanning debris jams, which stored the most wood and were most likely to form a pool, were formed behind a key piece that was still living. These living key pieces might provide greater longevity and stability than would otherwise be expected from hardwood LWD. Compared to streams on private land, streams on public land had significantly greater LWD loading and debris-jam frequency. Land management practices that remove wood from streams might be contributing to the degradation of salmonid habitat in California's hardwood-dominated watersheds.

Animals↗
PubMed2001

A river might run through it again: criteria for consideration of dam removal and interim lessons from California.

Resource managers are increasingly being challenged by stakeholder groups to consider dam removal as a policy option and as a tool for watershed management. As more dam owners face high maintenance costs, and rivers as spawning grounds for anadromous fish become increasingly valuable, dam removal may provide the greatest net benefit to society. This article reviews the impact of Endangered Species Act listings for anadromous fish and recent shifts in the Federal Energy Regulatory Commission's hydropower benefit-costs analysis and discusses their implications for dam removal in California. We propose evaluative criteria for consideration of dam removal and apply them to two case studies: the Daguerre and Englebright Dams on the Yuba River and the Scott and Van Horne Dams on the South Eel River, California.

Animals↗
PubMed2001

Design and performance of a channel reconstruction project in a coastal California gravel-bed stream.

A 0.9 km-reach of Uvas Creek, California, was reconstructed as a sinuous, meandering channel in November 1995. In February 1996, this new channel washed out. We reviewed project documents to determine the basis for the project design and conducted our own historical geomorphological study to understand the processes operating in the catchment and project reach. The project was designed using a popular stream classification system, based on which the designers assumed that a "C4" channel (a meandering gravel-bed channel) would be stable at the site. Our historical geomorphological analysis showed that the reach had been braided historically, typical of streams draining the Franciscan Formation in the California Coast Ranges, with episodic flows and high sand and gravel transport. After the project washed out, Uvas Creek reestablished an irregular, braided sand-and-gravel channel, although the channel here was narrower than it had been historically, probably due to such factors as incision caused by gravel mining. Our study casts doubt on several assumptions common in many stream restoration projects: that channel stability is always an appropriate goal; that channel forms are determined by flows with return periods of about 1.5 years; that a channel classification system is an easy, appropriate basis for channel design; and that a new channel form can be imposed without addressing the processes that determine channel form.

California↗
PubMed2005

Invasive annual grasses indirectly increase virus incidence in California native perennial bunchgrasses.

In California valley grasslands, Avena fatua L. and other exotic annual grasses have largely displaced native perennial bunchgrasses such as Elymus glaucus Buckley and Nassella pulchra (A. Hitchc.) Barkworth. The invasion success and continued dominance of the exotics has been generally attributed to changes in disturbance regimes and the outcome of direct competition between species. Here, we report that exotic grasses can also indirectly increase disease incidence in nearby native grasses. We found that the presence of A. fatua more than doubled incidence of infection by barley and cereal yellow dwarf viruses (B/CYDVs) in E. glaucus. Because B/CYDV infection can stunt E. glaucus and other native bunchgrasses, the indirect effects of A. fatua on virus incidence in natives suggests that apparent competition may be an additional mechanism influencing interactions among exotic and native grasses in California. A. fatua's influence on virus incidence is likely mediated by its effects on populations of aphids that vector B/CYDVs. In our study, aphids consistently preferred exotic annuals as hosts and experienced higher fecundity on them, suggesting that the exotics can attract and amplify vector populations. To the best of our knowledge, these findings are the first demonstration that exotic plants can indirectly influence virus incidence in natives. We suggest that invasion success may be influenced by the capacity of exotic plant species to increase the pathogen loads of native species with which they compete.

Animals↗
PubMed2006

Going beyond the kidney disease outcomes quality initiative: hemodialysis access experience at Kaiser Permanente Southern California.

In 1996, as part of Kaiser Permanente Southern California's participation in the Medicare End-Stage Renal Disease Managed Care Demonstration Project, a multidisciplinary continuous quality improvement (CQI) committee was formed, which included nephrologists, vascular surgeons, interventional radiologists, care managers, a renal quality-improvement nursing director, and renal program administrators. The goal of this report was to analyze the impact of this CQI program on hemodialysis outcomes within the organization. Kaiser Permanente is a national, integrated, nonprofit, staff model health maintenance organization with 8 million members. The southern California region has 3.1 million members and currently manages the health care of 3,700 hemodialysis patients, 300 peritoneal dialysis patients, and 1,000 kidney transplant patients. Thirty-one vascular surgeons and 29 interventional radiologists provide for their hemodialysis access needs. The Kidney Disease Dialysis Outcomes Quality Initiative (K/DOQI) guidelines were adopted, as well as measures to perform more venous transpositions and less common arteriovenous fistulas (AVFs) before graft placement. The outcomes assessed included incidence and prevalence of AVFs, grafts, and catheters; replacement access with AVFs; and combined AVF and graft thrombosis episodes per patient per year. Primary AVF incidence rates increased from 27% in 1997 to 88% in 2003. AVF prevalence rates increased from 30% in 1997 to 62% in 2003. Replacement access which is an AVF increased from 26% in 1998 to 58% in 2003. Yearly thrombosis episodes/patient decreased from 0.62 in 1998 to 0.34 in 2003. Catheter usage as of 2003 comprised an incidence of 65% and prevalence (> or =90 days) of 13%, which was essentially unchanged from 1999, despite improvements in fistula usage and thrombosis rate. The rate of AVF prevalence can be increased dramatically, exceeding the 40% K/DOQI recommendation, by using the CQI process. Increased prevalence of AVF is associated with a lower yearly incidence of thrombosis episodes/patient. Reducing excessive catheter usage appears to be a more difficult problem.

Aged↗
PubMed2005

Gastric adenocarcinoma among Hmong in California, USA, 1988-2000.

BACKGROUND: This study examined gastric adenocarcinoma incidence, mortality, and tumor characteristics in the Hmong population of California, 1988-2000. Many Hmong relocated to the United States at the conclusion of the Vietnam War. Resettlement difficulties encountered by Hmong have included socioeconomic and healthcare issues. Hmong are wary of Western medicine and would resort to it as the last option, which may delay the diagnosis and treatment of diseases such as cancer. METHODS: Data from the California Cancer Registry were used to calculate incidence and mortality rates for Hmong, and were compared to these in Asian Pacific Islanders (API) and non-Hispanic whites (NHW). The population at risk was estimated through linear interpolation, using data from the 1990 and 2000 decennial censuses. RESULTS: Hmong experienced incidence and mortality rates of gastric adenocarcinoma several times higher than those of API and NHW. More than 97% of Hmong patients chose no treatment, compared to only 25.6% of API and 30.3% of NHW patients. Hmong were more likely to be diagnosed with cancer at later stages but at better histologic grades than API and NHW. CONCLUSIONS: Further investigations into Helicobacter pylori, Epstein-Barr virus, acid reflux, and dietary practices of Hmong living in the United States are needed before any firm conclusion can be made, as these risk factors may impact gastric cancer development. Hmong should also be encouraged to use traditional and Western medicines simultaneously, provided that traditional healthcare practices do not interfere with biomedicines.

Adenocarcinoma↗
PubMed2005

Incidence of male breast cancer in california, 1988-2000: racial/ethnic variation in 1759 men.

Breast cancer among males is rare, accounting for less than 1% of all breast cancers in the United States. Although it is rare, it can cause significant morbidity and mortality. We analyzed data from 1759 California males whose diagnosis of breast cancer was made between 1988 and 2000 and reported to the population-based California Cancer Registry. Cases were primary, microscopically confirmed in situ and invasive breast cancer. Age-adjusted incidence rates per 100,000 men were highest in Blacks (1.65), intermediate in whites (1.31) and lowest in Hispanics and Asian/Pacific Islanders (0.68, 0.66, respectively). Age at diagnosis differed by race (p = 0.001) with blacks diagnosed at an earlier age than whites or Asians/Pacific Islanders. Stage at diagnosis also differed by race (p = 0.001) with blacks more likely to be diagnosed at distant stage. Further investigation showed that blacks and Hispanics were more likely to be diagnosed with tumors 5 cm in diameter or greater. The proportion of men having surgery following a diagnosis of breast cancer also varied by race/ethnicity (p = 0.001) with blacks least likely to have surgery following diagnosis. Understanding racial/ethnic variation in male breast cancer may provide clinical and etiologic implications for breast cancer in different populations.

Adult↗