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PubMed1997

Elective cervical discectomy in California: postoperative in-hospital complications and their risk factors.

STUDY DESIGN: A retrospective cohort study of short-term outcomes after elective cervical discectomy in California hospitals. OBJECTIVES: To compare the frequency of elective cervical discectomy across population strata, to determine the frequency of adverse outcomes in the early postoperative period, and to identify risk factors for such outcomes. SUMMARY OF BACKGROUND DATA: Previous cervical discectomy series have been too small to analyze risk factors for early complications, and have originated from centers that may not adequately represent the population. METHODS: Computerized hospital discharge abstracts were obtained from the California Office of Statewide Health Planning and Development. Inclusion and exclusion criteria were applied to identify 10,416 routine discectomies at 257 hospitals in 1990-1991. Several categories of postoperative complications were identified, along with inpatient deaths, early reoperations, and nursing home transfers. Logistic regression was used to estimate the independent effects of patient characteristics on short-term outcomes. RESULTS: After adjustment for age and gender, blacks were 51% and Hispanics were 24% as likely as whites to undergo elective cervical discectomy. Overall, 6.7% of patients had one or more reported postoperative complications: 1.8% had noninfectious surgical complications, 1.8% had infectious complications, 4.0% had other medical complications, and 0.35% had unplanned reoperations before discharge. Fourteen inpatient deaths were reported (0.13%). Congestive heart failure, alcohol/drug abuse, chronic lung disease, previous spine surgery, psychological disorders, and chronic musculoskeletal disorders were independently associated with postoperative complications. Even after adjustment, risk was higher with advancing age, higher among women than among men, and higher after posterior fusion than after discectomy without fusion. CONCLUSIONS: The ethnic disparity in cervical discectomy rates suggests overuse among whites or underuse among minority populations. The complication rates reported here are similar to those synthesized from previous literature, except that the lower incidence of neurologic complications reflects our inability to distinguish preoperative from postoperative deficits. Important comorbidities should be identified and treated, if appropriate, before cervical spine surgery.

Adolescent↗
PubMed1996

Newborn screening for sickle cell disease: 4 years of experience from California's newborn screening program.

PURPOSE: In this article we describe the success of a unique newborn screening program for sickle cell disease and other hemoglobinopathies. We will present and discuss 4 years of experience from the California Newborn Hemoglobinopathy Screening Program. METHODS: Several aspects that ensure the success of the program will be reviewed. These aspects include (a) the use of high-pressure liquid chromatography as the initial screening technique, (b) a confirmatory testing laboratory that incorporates DNA technology and innovative protein analysis using electrospray mass spectrometry, and (c) a complex follow-up strategy that employs regional nurses to track positive results and ensure timely enrollment of infants into treatment systems. RESULTS: Of these 2 million infants screened, 492 were diagnosed with some form of sickle cell disease; 290 (58.9%) were diagnosed with hemoglobin SS, 143 (29.0%) were diagnosed with hemoglobin SC, and 47 (9.5%) were diagnosed with S beta+thalassemia. CONCLUSION: The prevalence and ethnicity data presented here demonstrate the ineffectiveness of targeted screening and justify universal screening. Had targeted screening been performed in California during the past 4 years, 58 nonblack infants with sickle cell disease would have gone undiagnosed, and 6,921 nonblack infants with sickle cell trait would not have been identified.

Anemia, Sickle Cell↗
PubMed1999

Workplace-violence investigations by the California Division of Occupational Safety and Health, 1993-1996.

In response to the growing recognition of violence in the workplace, government agencies who oversee workplace safety are beginning to incorporate security issues into comprehensive safety plans. The California Division of Occupational Safety and Health began conducting inspections for violent events in 1993, and information from these security inspections was collected from January 1993 through January 1997. The inspections were examined by initiating source, industry, type of event, and citations issued and compared with distributions of known victimizations. The factors predicting whether a citation was issued were determined through logistic models. Over 200 inspections were conducted in 11 industries, with retail and health care establishments inspected most frequently. Employee complaints initiated 50.6% of events and accident reports initiated 40.1%. One third of inspections were initiated because of a fatal event, and 27.4% were initiated in response to a physical assault. Citations for security hazards were issued to 23.6% of businesses. Inspections initiated by employee complaints, in response to customer-related security issues, and involving non-fatal assaults were the most frequently cited reasons for inspection. The California Division of Occupational Safety and Health conducted security inspections in a large range of industries and for diverse issues, even though no specific security codes exist.

Accidents, Occupational↗
PubMed1998

Freedom of choice: Medicaid, managed care, and California family planning clinics.

Access to out-of-plan family planning services for Medicaid beneficiaries enrolled in managed care plans in California has been limited by poor relationships between family planning clinics and contracting managed care plans. Plans either delay or fail to reimburse claims from non-network family planning agencies; family planning staff are unmotivated to identify managed care members through financial screening, to cover costs with other funds, or to refer members back to plan. In addition, plans and clinics fail to coordinate the care of managed care clients by sharing medical records. Based on findings from a pilot project, California will try to facilitate relationships between plans and family planning agencies rather than directly pay out-of-plan claims.

California↗
PubMed2007

Building capacity for HIV/AIDS prevention among Asian Pacific Islander organizations: the experience of a culturally appropriate capacity-building program in Southern California.

This article has two goals: (1) to outline a conceptual model for culturally appropriate HIV prevention capacity building; (2) to present the experiences from a 3-year program provided by Asian Pacific AIDS Intervention Team to Asian Pacific Islander (API) organizations in southern California. The participating organizations were of two types: lesbian, gay, bisexual, transgender, and questioning (LGBTQ) social organizations and social service agencies not targeting LGBTQ. These organizations were selected for participation because of their commitment to HIV/AIDS issues in API communities. An organizational survey and staff observations were used to explore changes in capacity. The organizations were mostly small, targeted diverse populations, served a large geographic area (southern California as a region), and were knowledgeable about HIV. Organizations became more viable (more capacity in human resources, financial, external relations, and strategic management), but also more unstable (large growth in paid staff and board members), and showed more capacity in HIV knowledge environments (especially less stigma and more sensitivity to diverse populations). The results suggest that capacity can expand over a short period of time, but as capacity increases, organizational viability/stability and HIV knowledge environments change, meaning that different types of technical assistance would be needed for sustainability.

California↗
PubMed2006

Knowledge of sexual partner's HIV serostatus and serosorting practices in a California population-based sample of men who have sex with men.

OBJECTIVES: To describe knowledge of primary and secondary sexual partner's HIV serostatus and sexual practices, including serosorting, among men who have sex with men (MSM) living in California. METHODS: Men who self-identified as gay/bisexual in the 2001 California Health Interview Survey, a statewide biennial random-digit-dial survey interviewing more than 50,000 adults on a variety of health topics, were recontacted in 2002 and interviewed by telephone about injection drug use, their own and partner's HIV serostatus, and sexual risk behaviors. RESULTS: Among 220 men who reported a primary partner, 86% [95% confidence interval (CI): 77-92] knew their primary partner's serostatus; 62% (95% CI, 52-70) of the 250 men who reported a secondary partner knew their most recent secondary partner's HIV serostatus. Knowledge of one's most recent secondary partner's HIV serostatus was inversely related to history of injecting recreational drugs (odds ratio, 0.22; P < 0.01), and reporting a primary partner in the past year (odds ratio, 0.37; P < 0.05). Two-fifths (41%) of HIV-positive men and three-fifths (62%) of HIV-negative men engaged in serosorting (serocordant unprotected anal intercourse) with their primary partners, whereas 33% HIV-positive men and 20% HIV-negative men did so with their most recent secondary partners. CONCLUSIONS: This population-based survey documented the extent to which MSM know their partners' serostatus and practice serosorting behaviors. The findings emphasize the need for studies to report serocordant and serodiscordant unprotected anal intercourse separately, as the former presents significant lower risk of HIV transmission.

Adult↗
PubMedDate not supplied

The contribution of hospital volume, payer status, and other factors on the surgical outcomes of scoliosis patients: a review of 3,606 cases in the State of California.

While volume/outcomes relationships have been shown for several areas of orthopaedics, previous studies have not examined this relationship in the area of scoliosis surgery. The Office of Statewide Planning and Development (OSHPD) California inpatient discharge database was used for a retrospective review of all patients 25 years of age or younger with a diagnosis of scoliosis and a spinal fusion procedure from 1995 to 1999 (n = 3,606). Univariate and multivariate analyses were conducted to determine the effect of various factors on in-hospital mortality, surgical complications, reoperations, and length of stay (LOS). Univariate analyses revealed significant effects of age, sex, illness severity, neuromuscular disease, surgical approach, Medicaid status, and annual hospital volume on outcomes (P < 0.05). After controlling for these factors using multivariate regression, patients insured by Medicaid were found to have a significantly greater odds for complications (P = 0.017) and a significantly increased LOS (P < 0.001) compared with patients with all other sources of payment. Additionally, multivariate regression revealed an inverse relationship between annual hospital volume and likelihood of reoperation, as patients treated at hospitals with annual volumes of 5.1 to 25.0, 25.1 to 50.0, and greater than 50.0 spinal fusions all had approximately half the odds of reoperation (P = 0.042, P = 0.004, and P = 0.028 respectively) as patients treated at hospitals with an annual volume of 5.0 or fewer spinal fusions per year. The current data suggest that being insured with Medicaid in the state of California is associated with poorer outcomes after scoliosis surgery. Additionally, this study documents a volume/outcomes relationship in scoliosis surgery.

Adolescent↗
PubMed2004

Impact of between-hospital volume and within-hospital volume on mortality and readmission rates for trauma patients in California.

OBJECTIVE: Previous research assessing the impact of between-hospital trauma volume (high volume centers vs. low volume centers) and outcomes has been inconsistent. Furthermore, previous research has not considered temporal variations in within-hospital volume (a center having higher than average volume vs. lower than average volume) as a covariate. The objective of this study was to determine the relationship of between-hospital and within-hospital trauma volume and two measures of hospital quality of care. DESIGN: Multivariable, hierarchical, mixed effects, logistic regression analyses of a population-based nonconcurrent cohort from 1995 to 1999. SETTING: Thirty-nine nonfederal California hospitals included in the California Patient Discharge Data Set designated by local Emergency Medical Services authorities as adult trauma centers. PATIENTS: All nonelderly adult trauma patients, 16-64 yrs (n = 54,352), and elderly adult trauma patients, >65 yrs (n = 47,656), admitted with an Injury Severity Score >9. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Severity adjusted in-hospital mortality rate and 30-day trauma-related readmissions were analyzed. Among nonelderly adult patients, higher annual between-hospital trauma volume was not associated with mortality rate (odds ratio, 1.02 for each 100 admissions; 95% confidence interval, 0.99, 1.06) but was associated with higher risk of readmission (odds ratio, 1.19 for each 100 admissions; 95% confidence interval, 1.13, 1.26). Among elderly adult patients, higher annual between-hospital trauma volume was associated with lower mortality (odds ratio, 0.79 for each 100 admissions; 95% confidence interval, 0.71, 0.87) but was not associated with risk of readmission (odds ratio, 0.96 for each 100 admissions; 95% confidence interval, 0.90, 1.04). Higher than average monthly within-hospital trauma volume was associated with higher odds of readmission (odds ratio, 1.11 for a volume deviation of ten patients per month; 95% confidence interval, 1.01, 1.21) among elderly adult patients. CONCLUSIONS: The findings of this study in the context of previous research suggest that relationships between trauma volume and outcomes exist but depend on which patient populations are studied and how the data are analyzed. Furthermore, trauma centers may be subject to the detrimental effects of high temporal volume overextending existing services and capacity. Since this study found that both between-hospital volume and within-hospital volume measures are associated with outcomes, we recommend that both measures be included in future volume-outcome investigations.

Adolescent↗
PubMed2004

Postlicensure surveillance for pneumococcal invasive disease after use of heptavalent pneumococcal conjugate vaccine in Northern California Kaiser Permanente.

OBJECTIVE: To assess the direct and indirect effects of the introduction of routine use of pneumococcal conjugate vaccine in infants and toddlers at risk for invasive disease caused by vaccine serotypes and nonvaccine serotypes in vaccinated children and unvaccinated children of the same age. Secondary objectives included determination of the risk of pneumococcal infections in unvaccinated older children and adults in the same population and the impact of vaccine introduction on patterns of antimicrobial resistance. METHODS: Northern California Kaiser Permanente provides integrated comprehensive care to 3.1 million people and has an annual birth cohort of 38,000 infants. Microbiology services use a regional laboratory. Automated laboratory results, immunization records as well as diagnoses for inpatient and outpatient utilization are available from clinical data bases. Beginning in April 2000, the heptavalent pneumococcal conjugate (PNCV7) vaccine was introduced into routine use in the Northern California Kaiser Permanente population. Cases of invasive pneumococcal disease were identified from the automated hospital diagnosis as well as laboratory databases for all individuals, vaccinees and nonvaccinees, inpatient and outpatient. For the purpose of these analyses, pneumococcal invasive disease was defined as a positive culture from a normally sterile site. RESULTS: As of March 2003, 157,471 children had received 1 dose or more of PNCV7, but only 24% of those <2 years of age received all 4 doses as a result of shortages of vaccine. During the last year of observation, no cases of vaccine serotype disease were seen in children <1 year of age compared with an incidence ranging between 51.5 and 98.2 cases per 100,000 person-years (16-34 cases per year) in the years before vaccine introduction. Similar reductions were seen in children <5 years of age. There was no evidence of any concomitant increase in pneumococcal disease caused by nonvaccine serotypes. High level resistance of pneumococci to penicillin fell from a peak of 15% in 2000 to 5% in the first half of 2003. Similar trends were seen for other antibiotics. CONCLUSION: The PNCV7 vaccine is highly effective in reducing the burden of pneumococcal disease in children <5 years of age, and there is evidence of a herd effect as well as a decrease in the antibiotic resistant in strains causing disease. For invasive disease, there is no current evidence of serotype replacement.

Adolescent↗
PubMed2004

Reduced risk of inadequate prenatal care in the era after Medicaid expansions in California.

BACKGROUND: To improve perinatal outcomes in the United States, access to prenatal care was expanded through Medicaid and women were encouraged to enter prenatal care early. OBJECTIVE: The objective of this study was to determine if expanded eligibility for Medicaid increased use of prenatal care and reduced ethnic differences in use of prenatal care. RESEARCH DESIGN: We conducted secondary analysis of California birth certificate data for 1990, 1995, and 1998. SUBJECTS: We studied live-born singleton infants born to black, Asian, Latina, and white women (n = 1,483,951). MAIN OUTCOME MEASURES: Inadequate utilization of prenatal care. RESULTS: The proportion of live-born infants whose mothers had inadequate prenatal care decreased from 20% in 1990 to 14% in 1995 and 12% in 1998. In addition, the proportion of pregnant women with no insurance or who were self-paying fell from 13.1% in 1990 to 4.2% in 1995 and 3.6% in 1998 (P <0.001). Reductions in overall prevalence of inadequate use of prenatal care and ethnic disparities in use of prenatal care were not fully explained by increases in Medicaid coverage. CONCLUSIONS: Since California expanded access to Medicaid-funded prenatal care, there has been a substantial reduction in inadequate use of prenatal care and fewer women have no insurance or are self-paying. To further reduce ethnic disparities in use of health services, new policies must be developed to remove nonfinancial barriers to early and continuous use of prenatal care.

Adolescent↗
PubMed2004

Accommodating ethnic diversity: a study of California hospice programs.

BACKGROUND: Studies have confirmed ethnic disparities in the use of hospice services and identified barriers that minorities face in accessing care. OBJECTIVES: We sought to determine whether hospices provide services that might affect minority participation. RESEARCH DESIGN: We surveyed California hospices to determine whether programs use diverse health care providers and volunteers, offer translation, diverse spiritual care, or outreach materials and whether they plan to expand such services. Linking the data to the California Office of Statewide Health Planning and Development annual home care and hospice survey and 2000 US Census, we used multivariate linear regression to evaluate the relationship of program characteristics (profit status, size, chain/freestanding status, urban/rural location, and proportion of nonwhite residents) to services that might affect minority participation. SUBJECTS: One hundred of 149 programs that we surveyed responded. RESULTS: Many programs offer translation (81%), diverse providers (63%) and volunteers (64%), and culturally diverse spiritual services (52%). Few (21%) were conducting outreach, but 23/25 programs expanding services reported plans to improve outreach. In multivariate models adjusted for program size, chain status, profit status, urban/rural location, proportion of nonwhite residents, we found that larger hospices and those in ethnically diverse zip codes were more likely to offer such services. Larger hospices are more likely to report expanding such services. CONCLUSIONS: Many hospices are making efforts to accommodate ethnically diverse patients, but a substantial number are not. Culturally appropriate care and outreach should be addressed in efforts to improve the acceptability and experience of hospice care among minorities.

California↗
PubMed2006

Patient-delivered partner therapy for chlamydial infections: attitudes and practices of California physicians and nurse practitioners.

OBJECTIVE: The objective of this study was to examine California clinicians' use of and attitudes toward patient-delivered partner therapy (PDPT) to treat sexual partners of patients infected with chlamydia. STUDY DESIGN: In 2002, a stratified random sample of primary care physicians and nurse practitioners completed a mailed, self-administered survey. Weighted frequencies were calculated to assess partner management practices, including PDPT, and attitudes toward PDPT. Multivariate models were constructed to determine independent predictors of PDPT use. RESULTS: Of 708 physicians and 895 nurse practitioners, approximately half (47% and 48%, respectively) reported that they use PDPT usually or always. Over 90% agreed that PDPT protects patients from reinfection and provides better care for patients with chlamydia. However, providers reported concerns that PDPT may result in incomplete care for the partner, may be dangerous without knowing the partner's medical or allergy history, is an activity the practice may not get paid for, and may get them sued. Obstetrics/gynecology and family practice physicians were more likely than internal medicine physicians to report routine use of PDPT. Concerns about adverse outcomes of PDPT were associated with less PDPT use. CONCLUSIONS: Although the proportion of California healthcare providers routinely using PDPT is comparatively high, further study is warranted to examine the circumstances under which this partner management strategy is used.

Adult↗
PubMed2004

The epidemiology of HIV among Mexican migrants and recent immigrants in California and Mexico.

For Mexican migrants and recent immigrants, the impact of migration from Mexico to California has the potential to lead to an increased risk for HIV infection. Until recently, the prevalence of HIV in Mexico and among Mexican migrants in California appeared to be stable and relatively low. Recent studies have raised new concerns, however, that the HIV epidemic may expand more aggressively among this population in the coming years. Unfortunately, the insufficient amount of data available within recent years makes it difficult to fully assess the potential for rapid spread of the HIV epidemic among this population. Consequently, there is a critical need for an ongoing binational surveillance system to assess prevalence and trends in HIV/STD/TB disease and related risk behaviors among this population both in Calfornia and within this population's states of origin in Mexico. This enhanced epidemiologic surveillance system should provide improved data on the subpopulations at the highest risk for HIV/STD/TB, such as men who have sex with men, and should provide the opportunity to evaluate the impact of migration on the transmission dynamics, risk behaviors, and determinants of behavior on each side of the border. It is essential that this potential threat be assessed and that intervention programs are developed and implemented to combat this possible escalation in the HIV epidemic.

Agriculture↗
PubMed1979

Cross-neutralization study of seven California group (Bunyaviridae) strains in homoiothermous (PS) and poikilothermous (XTC-2) vertebrate cells.

Antigenic relationships among seven California group strains were studied by a plaque-reduction neutralization test (PRNT). Cross-reactions occurred in most cases but three subgroups were noted: (1) the major serogroup contained the viruses of California encephalitis, LaCrosse, Snowshoe Hare and Trahyna (including the Lumbo strain) whereas (2) Jamestown Canyon and (3) Trivittatus viruses were distinct. There was no significant difference between the PRNT results in mammalian (PS) cells incubated at 37 degrees C and amphibian (XTC-2) cells incubated at 28 degrees C. Trivittatus virus failed to produce plaques in XTC-2 cells.

Animals↗
PubMed1989

The large viral RNA segment of California serogroup bunyaviruses encodes the large viral protein.

Reassortant bunyaviruses derived from two members of the California serogroup (La Crosse/original and Tahyna/181-57) viruses were used to demonstrate that the large Mr viral protein (L) is encoded by the L RNA segment. Radiolabelled viral proteins were analysed by discontinuous SDS-PAGE. The L protein of La Crosse virus was observed to migrate ahead of its Tahyna virus counterpart when electrophoresed through a 5% acrylamide resolving gel. Among the reassortant viruses, the L protein phenotype segregated with the viral L RNA segment. After confirming the genotype of the viruses used in this study, it was concluded that the L RNA species of California serogroup viruses codes for the L protein, the presumed viral polymerase.

Animals↗
PubMed2001

Land use and stream nitrogen concentrations in agricultural watersheds along the central coast of California.

In coastal California nitrogen (N) in runoff from urban and agricultural land is suspected to impair surface water quality of creeks and rivers that discharge into the Monterey Bay Sanctuary. However, quantitative data on the impacts of land use activities on water quality are largely limited to unpublished reports and do not estimate N loading. We report on spatial and temporal patterns of N concentrations for several coastal creeks and rivers in central California. During the 2001 water year, we estimated that the Pajaro River at Chittenden exported 302.4 Mg of total N. Nitrate-N concentrations were typically <1 mg N l(-1) in grazing lands, oak woodlands, and forests, but increased to a range of 1 to 20 mg N l(-1) as surface waters passed through agricultural lands. Very high concentrations of nitrate (in excess of 80 mg N l(-1)) were found in selected agricultural ditches that received drainage from tiles (buried perforated pipes). Nitrate concentrations in these ditches remained high throughout the winter and spring, indicating nitrate was not being flushed out of the soil profile. We believe unused N fertilizer has accumulated in the shallow groundwater through many cropping cycles. Results are being used to organize landowners, resource managers, and growers to develop voluntary monitoring and water quality protection plans.

Agriculture↗
PubMed2001

Pesticides are involved with population declines of amphibians in the California Sierra Nevadas.

Several species of frogs and toads are in serious decline in the Sierra Nevada Mountains of California. These species include the threatened red-legged frog ( Rana aurora ), foothill yellow-legged frog ( R. boylii ), mountain yellow-legged frog ( R. muscosa ), Cascades frog ( Rana cascadae ), western toad ( Bufo boreas ) and Yosemite toad ( B. canorus ). For many of these species current distributions are down to 10% of historical ranges. Several factors including introduced predators, habitat loss, and ultraviolet radiation have been suggested as causes of these declines. Another probable cause is air-borne pesticides from the Central Valley of California. The Central Valley, especially the San Joaquin Valley, is a major agricultural region where millions of pounds of active ingredient pesticides are applied each year (http://www.cdpr.ca.gov/dprdatabase.htm). Prevailing westerly winds from the Pacific Coast transport these pesticides into the into the Sierras.

Animals↗
PubMed2006

A dietary risk assessment of the pyrethroid insecticide resmethrin associated with its use for West Nile Virus mosquito vector control in California.

An outbreak of human illnesses associated with West Nile Virus (WNV) occurred in New York City in 1999. Since then, it has gradually spread westwards, reaching northern California for the first time in 2005. WNV is transmitted by several mosquito species and birds serve as the main reservoir. Several control measures have been used, targeting both the aquatic larvae and the adult mosquitoes. In the latter case, roosting birds in trees are sprayed with pyrethroid insecticides because these are highly toxic to mosquitoes, but have low avian toxicity. A request was made to use a resmethrin-containing insecticide during the month of October 2005 in California. Because resmethrin was not registered for use on growing crops, concerns were raised about potential crop contamination. Therefore, an expedited dietary risk assessment was conducted on resmethrin. Developmental toxicity in the rat (NOELs of 25 or 40 mg/kg/day) was used as the acute endpoint and dietary exposure was assessed using the DEEM-FCID computer program. Only crops growing above ground during October were considered. Margins of Safety (MOS) were found to be above 100, the level generally considered to be sufficient to protect public health when using an animal NOEL.

Animals↗