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PubMed1998

A case-crossover study of intensive racing and training schedules and risk of catastrophic musculoskeletal injury and lay-up in California thoroughbred racehorses.

The objective of this study was to investigate the relationship between intensive racing and training schedules and risk of either catastrophic musculoskeletal injury (CMI) or lay-up from racing in California Thoroughbreds. Thoroughbred racehorses that sustained a CMI during racing or training and either were subsequently euthanized or died on a California racetrack during 1991 and 1992 were studied using a case-crossover study design. Each study subject (case) provided its own self-matched control information in the form of 'typical' exposure frequency, determined or estimated from historic information. Periods of rapid average daily accumulation of high-speed exercise distance were identified for each horse from official race and training histories with a sliding 60-day window. Those window frames containing an average daily rate of distance accumulation exceeding 75th percentile cutoff values were classified as exposed frames followed by 30 days of increased risk, or hazard periods. All remaining days (excluding periods of layoff from racing) were considered non-hazard time at risk. The relative risk (RR) of CMI within 30 days following a period of rapid accumulation of high-speed exercise distance (during a hazard period) was 4.2 (95% confidence interval [CI] = 3.0, 5.8). Of these 214 cases, 84 (39%) were injured during a hazard period whereas on average only 22% of total career time at risk was hazard time for these horses. A second analysis was performed for horses with at least 1 lay-up period from racing of > or = 60 days. RR for a lay-up beginning during a hazard period was estimated for the last lay-up experienced by each horse. The RR for lay-up beginning during a hazard period was 4.8 (95% CI = 2.9, 8.1). Of these 98 cases, 32 (33%) of the lay-ups began during a hazard period whereas on average, only 22% of at-risk time up to last lay-up was hazard time for these horses.

Age Distribution↗
PubMed1998

Risk factors associated with Corynebacterium pseudotuberculosis infection in California horses.

A case-control study was designed using equine medical records from the UC Davis Veterinary Medical Teaching Hospital (VMTH) and data derived through a mailed survey. The objective was to evaluate the associations between horse demographics, horse-management factors, and equine Corynebacterium pseudotuberculosis infection in California. Horses admitted to the VMTH between July 1 1992 and June 30 1994 served as the study base for case identification and simple random sampling of 800 controls. A questionnaire was mailed to the owners of all horses enrolled in the study to collect data on demographics, management and health-related questions. A logistic-regression model containing age, outdoor activity level, other locations in California, insect-control measures, contact with other horses, and summer pasture was developed. The final model was adjusted for the suspected confounding variables admission type, regular teaching hospital patient and breed. Horses of age between 1 and 2 yrs and between 3 and 5 yrs, and horses in contact with other horses or horses on summer pasture had significantly increased odds (p < 0.05) of being diagnosed with C. pseudotuberculosis infection. The results support the hypotheses that the disease predominantly affects young-adult horses of all breeds and both sexes, and that management factors play an important role in occurrence of the disease. Since the existing serological test system is not reliable and destruction of infected animals is not feasible, the most-logical approach for disease prevention is the early identification and isolation of clinical cases and the implementation of management changes like improvement of stable hygiene and insect control and change of pasture practices.

Animals↗
PubMed1999

Sequence comparisons of medium RNA segment among 15 California serogroup viruses.

The complete nucleotide sequences have been determined for the M segment of 12 California (CAL) serogroup bunyaviruses. A method is described here of long reverse transcription-polymerase chain reaction (RT-PCR) that yields the full-length medium (M) RNA genomic segment. A phylogenetic tree was constructed by comparison of the open reading frames (ORFs) in the M RNA segment of 15 CAL serogroup viruses. Three distinct branches were identified and they are represented by the California encephalitis (CE), Melao (MEL), and Trivittatus (TVT) complexes. These groups correspond to those previously established by small (S) RNA genomic sequences. In addition, except for Inkoo virus, the predicted relationship among these viruses agreed with those found by serology.

Encephalitis Virus, California↗
PubMed1986

Potential role of native and exotic deer and their associated ticks (Acari: Ixodidae) in the ecology of Lyme disease in California, USA.

The relationship of native Columbian Black-tailed Deer, two species of exotic deer (Axis and Fallow), and their ticks to the Lyme disease spirochete, Borrelia burgdorferi, was studied in coastal and inland areas of northern California, USA. Spirochetemias were detected in 27% of Black-tailed Deer, 50% of Axis Deer, and 56% of Fallow Deer collected in late fall and winter. Antibody prevalence was 38% in Black-tailed Deer, 24% in Fallow Deer, and 6% in Axis Deer. One to 3 tick species were collected from each species of deer, and 2 tick species were flagged from vegetation; of these, only the Western Black-legged Tick, Ixodes pacificus, was found to contain spirochetes. These findings suggest that all 3 deer species may be important hosts of spirochetes, possibly B. burgdorferi, and reconfirm that I. pacificus is the primary vector of the latter in California.

Animals↗
PubMed1992

A comparison of HIV-1, HBV, and HTLV-I/II seroprevalence rates of injured patients admitted through California emergency departments.

STUDY OBJECTIVE: To determine the seroprevalence rates of hepatitis B virus (HBV) and human T-lymphotropic virus (HTLV-I/II) and to compare these rates with the HIV-1 seroprevalence rate in a sample of injured patients admitted through ten California emergency departments. DESIGN: Prospective blinded testing for serologic markers for HBV, HTLV-I/II, and HIV-1 on routinely collected blood samples. SETTING: Ten California hospitals were chosen to reflect geographic and demographic diversity. TYPE OF PARTICIPANTS: All injured adult patients who were admitted to a participating hospital through the ED during consecutive three-month periods from June through November 1989. MEASUREMENTS: Serum samples were tested for HIV-1 antibody, HTLV-I/II antibody, and hepatitis B surface antigen (HBsAg) using standard methods. Mann-Whitney U tests, chi 2 tests for independence, sign tests, chi 2 tests for goodness of fit, and logistic regression were used as appropriate. RESULTS: Seroprevalence rates were as follows: HBV, 2.6% (57 of 2,209); HTLV-I/II, 2.0% (46 of 2,262); and HIV-1, 1.4% (31 of 2,264). CONCLUSION: The seroprevalence rate of HBV was slightly higher than that of HIV-1 in this sample of injured patients. Mortality estimates suggest, however, that HBV and HIV-1 pose roughly similar risks to emergency personnel, although the risk of HBV infection can be markedly reduced by vaccination. The data from this and other studies suggest that the ED incidence of HTLV-I/II in United States is low. The relative health risks to emergency personnel from HTLV-I/II appear to be minimal at this time.

California↗
PubMed1998

Medical care at the California AIDS Ride 3: experiences in event medicine.

STUDY OBJECTIVE: Providing medical care at special events is a growing area of concern of emergency physicians. Little information has been published on events in which participants outnumber spectators. We describe such an event at which the medical encounters far outnumbered any previously published report. METHODS: The California AIDS Ride 3 bicycle ride took place June 1-8, 1996, and covered 547 miles of highway between San Francisco and Los Angeles. One hundred five volunteer staff members provided medical care. Extensive patient encounters were recorded on a one-page form; all other encounters were recorded as hash marks by the provider. Two physicians reviewed the medical records and categorized each encounter. RESULTS: Of the 25,379 patient encounters recorded over the 8 days of the event, 509 were triaged as greater severity (requiring an examination by a physician); 31% of these involved heat-related illnesses. Fifty-five patients required transport to local emergency departments by the local EMS systems; 7 of these patients required hospital admission. CONCLUSION: The California AIDS Ride 3 required more medical personnel and resulted in more patient encounters than any similar event previously described. We describe the medical care team and patient encounters to facilitate planning for medical care at future class 3 events.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Coordinated teamwork in California industrial rehabilitation.

This article describes a case study of an industrially produced hand injury that exemplifies the coordination and teamwork involved in vocational rehabilitation in the California Workers' Compensation system. This patient required multiple tendon and nerve transplant operations done with microsurgical techniques, hand therapy for functional and sensory retraining, job analysis, vocational evaluation, labor market survey, work-hardening experience, and an on-the-job training program to effect a successful outcome. An overview of the current status of the California Workers' Compensation system and current insurance perspectives are discussed.

Accidents, Occupational↗
PubMed1998

Hospital vascular surgery volume and procedure mortality rates in California, 1982-1994.

PURPOSE: Little is known about the long-term growth and outcomes of vascular surgery procedures over time. Trends in the use of three major vascular surgery procedures by a general population-lower extremity arterial bypass (LEAB), carotid endarterectomy (CEA), and abdominal aortic aneurysm repair (AAA)-are described. The extent to which these procedures are being performed in low-, moderate-, and high-volume hospitals is examined. METHODS: California hospital discharge records for LEAB, CEA, AAA, lower extremity angioplasty, coronary angioplasty, and coronary bypass surgery (CABG) were studied in all non-federal hospitals between 1982 and 1994. The data were age- and sex-adjusted to describe procedure growth. In-hospital mortality rates for LEAB, CEA, and AAA are related to overall hospital procedure volume, using logistic regression to control for risk factors and time trends. RESULTS: Growth in the number of vascular procedures performed in California was modest between 1982 and 1994, with no age-adjusted growth. Lower extremity angioplasty grew considerably in the 1980s and has since plateaued. Annual in-hospital death rates declined for all procedures except ruptured AAA. Comparing the two 5-year periods of 1982-1986 and 1990-1994, in-hospital death rates decreased from 4.2% to 3.3% for LEAB, from 9.2% to 6.2% for unruptured AAA, and from 1.6% to 1.0% for CEA (p < 0.0001). The odds of dying for patients treated in high-volume hospitals for LEAB and CEA procedures compared with patients treated in hospitals performing fewer than 20 procedures in a year were 66.7% (p = < 0.0001) and 66.1% (p < 0.0001), respectively. For patients with ruptured and unruptured AAA procedures, the odds of dying in hospitals with at least 50 AAA procedures in a year were 49.1% (p < 0.0001) and 83.8% (p = 0.016), respectively, compared with the odds of dying in low-volume hospitals. CONCLUSIONS: In-hospital mortality rates for CEA, LEAB, and unruptured AAA have been significantly decreasing over time. Mortality is inversely related to hospital volume and directly related to patient age and emergency status. Mortality trends over time for ruptured AAA remains unchanged; however, mortality is less in high-volume hospitals. Coronary angioplasty (PTCA) has not had an impact on rates for LEAB.

Age Factors↗
PubMed1999

Cigar smoking in California: 1990-1996.

BACKGROUND: Cigars have been heavily promoted in recent years. The nature and extent of the resultant increase in cigar smoking needs to be understood before the public health implications can be assessed. METHODS: Data are from population-based surveys conducted in California adults (> or = 18 years) in 1990 (n = 24,296) and 1996 (n = 24,266). Trends in current (every day or some days) cigar use are described for demographic subgroups and by cigarette smoking status. RESULTS: Current cigar use has doubled in California, from 2.5% in 1990 to 4.9% in 1996. In 1996, fewer than 5% of cigar smokers smoked cigars daily; essentially all of the increase was from nondaily use in those under 45 years of age of both genders, particularly in 18- to 24-year-olds. Among males, increased cigar use was observed in all racial/ethnic groups except Asians, and was observed in those with higher educational attainment and higher incomes. In both years, current and former cigarette smokers had higher rates of cigar use than never smokers, but the increase in current cigar smoking was observed regardless of cigarette smoking status. In 1996, daily cigar smokers were more likely to be former cigarette smokers than nondaily cigar smokers. CONCLUSION: If more people begin to smoke cigars daily, or if cigar use leads young people to initiate cigarette smoking or leads former cigarette smokers to relapse to cigarette smoking, the recent trends in cigar use may have public health implications.

Adolescent↗
PubMed2003

Meeting the reproductive health care needs of adolescents: California's Family Planning Access, Care, and Treatment Program.

PURPOSE: To examine the effect of the California Office of Family Planning's Family Access, Care, and Treatment Program (Family PACT), which was established in 1997 to provide comprehensive, reproductive health services for low-income adolescents and adults. Program evaluation was used to measure access to services, develop a profile of users, identify service utilization patterns, and assess the sensitivity of the health care system to the needs of adolescents. METHODS: Data sources include baseline data on California's previously established family planning services, enrollment, and claims data for the first 4 years of Family PACT, client exit interviews, and on-site observations. RESULTS: Adolescents represented 21% of all clients served by Family PACT in fiscal year 2000-2001 (FY 2000-2001). Adolescent clients served increased from 100,000 in FY 1995-1996 to more than 260,000 in FY 2000-2001(161% increase). The proportion of males has increased from 1% to 11%. In FY 2000-2001, Hispanics comprised 50% of adolescent clients, followed by 32% white, 9% African-American, and 6% Asian, Filipino, or Pacific Islander. Over one-half were aged 18 or 19 years, 42% were aged 15 to 17 years, and 5% were aged younger than 15 years. Contraceptive methods most often dispensed were barrier methods (55% for females, 72% for males), oral contraceptives (44%), contraceptive injections (16%), and emergency contraceptives (7%); 57% received sexually transmitted infection screening. CONCLUSIONS: By linking eligibility determination to the delivery of services, removing cost barriers, increasing the numbers and types of providers offering publicly funded services, and ensuring confidentiality, greater numbers of adolescents obtained needed reproductive health care, thus ensuring an opportunity to reduce unintended pregnancies and sexually transmitted infections.

Adolescent↗
PubMed1997

A study of HIV seroprevalence in a group of homeless youth in Hollywood, California.

The objective of this descriptive-exploratory study was to examine the HIV seroprevalence rate among a sample of homeless youth in Hollywood, California. A total of 96 respondents (age 14-24) were administered a questionnaire and had their blood drawn to test for the presence of HIV antibodies, during nightly street outreach activities conducted by Covenant House California. The HIV seroprevalence rate was 11.5% for the sample. Chi-square analysis showed strong correlation between HIV status and sexual risk behavior but not for HIV status and drug-related risk behavior.

Adolescent↗
PubMed1998

Primary care physicians' screening of adolescent patients: a survey of California physicians.

PURPOSE: To determine how often primary care physicians screen adolescents for important risk factors and to determine how rates of screening vary by physicians' specialty and practice setting, patients' age, and type of risk factor. METHODS: A stratified random sample of 343 California physicians who are Board certified in pediatrics, family practice, or internal medicine, and physicians in these specialties who specialized in adolescent medicine were surveyed about their screening practices using a mailed questionnaire. Subjects were asked the percentage of routine comprehensive physical examination during which they personally queried or screened each age group of adolescents (11-14 years old and 15-18 years old) for each of the following risk factors: high blood pressure, alcohol use, cigarette use, sexual activity, and drug use. RESULTS: The frequency with which primary care physicians reported actually screening younger and older adolescents for the various risks were approximately: 93% and 96% for high blood pressure, 70% and 84% for alcohol use, 74% and 82% for drug use, 67% and 83% for sexual activity, and 76% and 86% for smoking, respectively. For all risk factors, providers screened older adolescents more frequently than younger adolescents (p < 0.01). Finally, screening rates varied by specialty (p < 0.01) but not by practice setting. CONCLUSIONS: This study found that California physicians frequently screen adolescents for a variety of risk factors. However, the reported rates may not be consistent with published guidelines. Interventions may need to be developed which focus on improving primary care physicians' adolescent-specific screening practices.

Adolescent↗
PubMed1995

The California Hospital Outcomes Project: using administrative data to compare hospital performance.

BACKGROUND: The California Hospital Outcomes Project was created by an act of the state legislature in 1991. The California Office of Statewide Health Planning and Development (OSHPD) publishes annual reports on risk-adjusted hospital outcomes for medical, surgical, and obstetric patients. These outcomes indicators were chosen: in-hospital mortality within 30 days (acute myocardial infarction [AMI]), reported post-operative complications (diskectomy, delivery), post-operative length of stay (diskectomy), and readmission within 6 weeks (delivery). Project reports are based on discharge abstracts submitted by hospitals and edited by OSHPD. For each outcome, two risk adjustment models were used to estimate expected and risk-adjusted hospital outcome rates, along with p values representing the likelihood that the observed number of adverse outcomes occurred by chance. RESULTS: The first hospital outcomes report was distributed to hospitals in June 1993 and released to the public in December 1993. The total number of hospitals labeled as "better than expected" was 14 for AMI, 5 for cervical diskectomy, and 25 for lumbar diskectomy. The second hospital outcomes report was distributed to hospitals in June 1995. RESPONSE AND CONCLUSIONS: Letters submitted for 168 hospitals in response to the 1993 report demonstrated that hospitals had studied and used project results to evaluate their coding practices and quality of care. Media coverage of the 1993 report was balanced but sometimes critical of OSHPD's failure to identify "worse" hospitals. In response to providers' concerns, OSHPD has undertaken a validation study to explore whether differences in coding, unmeasured risk factors, or processes of care explain the reported differences in risk-adjusted outcome rates.

California↗
PubMedDate not supplied

Psychological distress following urban earthquakes in California.

During and following a disaster caused by a natural event, human populations are thought to be at greater risk of psychological morbidity and mortality directly attributable to increased, disaster-induced stress. Drawing both on the research of others and that conducted at the Center for Public Health and Disaster Relief of the University of California-Los Angeles (UCLA) following California earthquakes, this paper examines the extent to which research evidence supports these assumptions. Following a brief history of disaster research in the United States, the response of persons at the time of an earthquake was examined with particular attention to psychological morbidity; the number of deaths that can be attributed to cardiovascular events and suicides; and the extent to which and by whom, health services are used following an earthquake. The implications of research findings for practitioners in the field are discussed.

Adolescent↗
PubMed2001

Effect of emissions control programs on visibility in southern California.

A new method for the analysis and display of the effect of emissions controls on visibility is applied to conditions in southern California. An advanced mechanistic air quality model that represents airborne particles as a source-oriented external mixture first is used to track emissions source contributions to the size distribution and chemical composition of airborne particles at Claremont, CA, under heavy smog conditions. The resulting description of the aerosol is used in a Mie scattering calculation to determine the magnitude and particle size dependence of light scattering and absorption in the atmosphere. The resulting light scattering and absorption coefficient values are supplied to an image processing-based visibility model that creates full color representations of the appearance of the local terrain in the presence of the specified level of air pollution based on satellite-generated landscape images. By linking these models, a direct connection is established between source emissions and resulting visual air quality. The composite modeling system then is used to studythe effectthat different emissions control strategies would have on visibility in southern California. An aggressive program of 92 specific emissions control measures that include primary particle controls plus controls on reactive gases that act as secondary aerosol precursors would more than double visual range at Claremont under the 1987 historical conditions studied. Synthetic landscape images show that the mountains to the north of Claremont that are not visible at a range of 10 km under base-case conditions would be visible if the emissions controls described above were applied.

Absorption↗
PubMed2002

Organic matter in central California radiation fogs.

Organic matter was studied in radiation fogs in the San Joaquin Valley of California during the California Regional Particulate Air Quality Study (CRPAQS). Total organic carbon (TOC) concentrations ranged from 2 to 40 ppm of C. While most organic carbon was found in solution as dissolved organic carbon (DOC), 23% on average was not dissolved inside the fog drops. We observe a clear variation of organic matter concentration with droplet size. TOC concentrations in small fog drops (<17 microm) were a factor of 3, on average, higher than TOC concentrations in larger drops. As much as half of the dissolved organic matter was determined to have a molecular weight higher than 500 Da. Deposition fluxes of organic matter in fog drops were high (0.5-4.3 microg of C m(-2) min(-1)), indicating the importance of fog processing as a vector for removal of organic matter from the atmosphere. Deposition velocities of organic matter, however, were usually found to be lower than deposition velocities for fogwater, consistent with the enrichment of the organic matter in smaller fog drops with lower terminal settling velocities.

Air Movements↗
PubMed2003

Tiered approach for identification of a human fecal pollution source at a recreational beach: case study at Avalon Bay, Catalina Island, California.

Recreational marine beaches in California are posted as unfit for swimming when the concentration of fecal indicator bacteria (FIB) exceeds any of seven concentration standards. Finding and mitigating sources of shoreline FIB is complicated by the many potential human and nonhuman sources of these organisms and the complex fate and transport processes that control their concentrations. In this study, a three-tiered approach is used to identify human and nonhuman sources of FIB in Avalon Bay, a popular resort community on Catalina Island in southern California. The first and second tiers utilize standard FIB tests to spatially isolate the FIB signal, to characterize the variability of FIB over a range of temporal scales, and to measure FIB concentrations in potential sources of these organisms. In the third tier, water samples from FIB "hot spots" and sources are tested for human-specific bacteria Bacteroides/Prevotella and enterovirus to determine whether the FIB are from human sewage or from nonhuman sources such as bird feces. FIB in Avalon Bay appear to be from multiple, primarily land-based, sources including bird droppings, contaminated subsurface water, leaking drains, and runoff from street wash-down actvities. Multiple shoreline samples and two subsurface water samples tested positive for human-specific bacteria and enterovirus, suggesting that at least a portion of the FIB contamination is from human sewage.

Animals↗
PubMed2004

Modeling the oxidative capacity of the atmosphere of the south coast air basin of California. 1. Ozone formation metrics.

Metrics associated with ozone (O3) formation are investigated using the California Institute of Technology (CIT) three-dimensional air-quality model. Variables investigated include the O3 production rate (P(O3)), O3 production efficiency (OPE), and total reactivity (the sum of the reactivity of carbon monoxide (CO) and all organic gases that react with the hydroxyl radical). Calculations are spatially and temporally resolved; surface-level and vertically averaged results are shown for September 9, 1993 for three Southern California locations: Central Los Angeles, Azusa, and Riverside. Predictions indicate increasing surface-level O3 concentrations with distance downwind, in line with observations. Surface-level and vertically averaged P(O3) values peak during midday and are highest downwind; surface P(O3) values are greater than vertically averaged values. Surface OPEs generally are highest downwind and peak during midday in downwind locations. In contrast, peaks occur in early morning and late afternoon in the vertically averaged case. Vertically averaged OPEs tend to be greater than those for the surface. Total reactivities are highest in upwind surface locations and peak during rush hours; vertically averaged reactivities are smaller and tend to be more uniform temporally and spatially. Total reactivity has large contributions from CO, alkanes, alkenes, aldehydes, unsubstituted monoaromatics, and secondary organics. Calculations using estimated emissions for 2010 result in decreases in P(O3) values and reactivities but increases in OPEs.

Air Pollutants↗