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PubMed1996

Respiratory health of California rice farmers.

Rice farmers are occupationally exposed to agents that may affect respiratory health, including inorganic dusts and smoke from burning of agricultural waste. To assess respiratory health of this occupational group, we conducted a cross-sectional study, including a self-administered health and work questionnaire, spirometry, and chest radiography among 464 male California rice farmers. Mean age +/- SD was 48.3 +/- 15.2 yr; mean duration of rice farming was 25.7 +/- 14.3 yr. Prevalences for respiratory symptoms were: chronic bronchitis (6.3%), physician-diagnosed asthma (7.1%), and persistent wheeze (8.8%). Chronic cough was reported by 7.1% of respondents and was associated with reported hours per year burning rice stubble. Mean FEV1 and FVC were at expected values. FEV1 was inversely associated with years working in rice storage and use of heated rice dryers. Mean FEF25-75 was 93% of expected and was inversely associated with rice storage activities involving unheated rice driers. ILO profusion scores > or = 1/0 for small irregular opacities were seen in 18 (10.1%) of 178 chest radiographs. Study findings suggest increased asthma prevalence among California rice farmers. Radiologic findings consistent with dust or fiber exposure were increased compared with those of the general population, although no associations with specific farming activities were identified.

Agriculture↗
PubMed1999

A study of twelve Southern California communities with differing levels and types of air pollution. I. Prevalence of respiratory morbidity.

To study possible chronic respiratory effects of air pollutants, we initiated a 10-yr prospective cohort study of Southern California children, with a study design focused on four pollutants: ozone, particulate matter, acids, and nitrogen dioxide (NO2). Twelve demographically similar communities were selected on the basis of historic monitoring information to represent extremes of exposure to one or more pollutants. In each community, about 150 public school students in grade 4, 75 in grade 7, and 75 in grade 10 were enrolled through their classrooms. Informed consent and written responses to surveys about students' lifetime residential histories, historic and current health status, residential characteristics, and physical activity were obtained with the help of the parents. In the first testing season, 3,676 students returned questionnaires. We confirmed associations previously reported between respiratory morbidity prevalence and the presence of personal, demographic, and residential risk factors. Rates of respiratory illness were higher for males, those living in houses with pets, pests, mildew, and water damage, those whose parents had asthma, and those living in houses with smokers. Wheeze prevalence was positively associated with levels of both acid (odds ratio [OR] = 1.45; 95% confidence interval [CI], 1.14-1.83) and NO2 (OR = 1.54; 95% CI, 1.08-2.19) in boys. We conclude, based on this cross-sectional assessment of questionnaire responses, that current levels of ambient air pollution in Southern California may be associated with effects on schoolchildren's respiratory morbidity as assessed by questionnaire.

Acids↗
PubMed1993

Asthma mortality in California, 1960-1989. Demographic patterns and occupational associations.

We analyzed asthma mortality rates in California during the years 1960 to 1989. Sex- and race-specific rates were stratified by age group (0 to 4, 5 to 34, 35 to 64, and 65+ yr) and for all ages directly standardized to the 1970 U.S. age distribution. Observed and expected asthma deaths were also calculated by occupation for the period 1979 to 1981 among persons aged 16 to 64 yr using data from the California Occupational Mortality Study. Asthma mortality rates were strongly associated with increasing age, but no consistent differences were observed between men and women. Mortality rates among blacks under age 65 yr were two to four times the corresponding rate among whites between 1960 and 1989, but this difference was not observed for those over age 65. Asthma mortality rates were calculated for Hispanics and Asians from 1985 to 1989. In this time period the asthma mortality rate ratios for Hispanics were 0.4 to 0.8 compared with the age-stratified rates among whites, 0.1 to 0.2 times the black rates in age categories under 65, and 0.5 times the rate for blacks ages 65 and above. Asthma mortality rates among Asians under 65 yr of age were similar to rates for whites, but for Asians 65 yr of age and over the rate ratios for males and females compared with whites were 1.8 and 1.1, respectively. A decrease of approximately 50% in asthma mortality occurred from 1960 to 1970, and a marked increase occurred between 1975 and 1989.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Health effects of the 2003 Southern California wildfires on children.

RATIONALE: In late October 2003, Southern California wildfires burned more than 3,000 km2. The wildfires produced heavy smoke that affected several communities participating in the University of Southern California Children's Health Study (CHS). OBJECTIVES: To study the acute effects of fire smoke on the health of CHS participants. METHODS: A questionnaire was used to assess smoke exposure and occurrence of symptoms among CHS high-school students (n = 873; age, 17-18 yr) and elementary-school children (n = 5,551; age, 6-7 yr), in a total of 16 communities. Estimates of particulate matter (PM10) concentrations during the 5 d with the highest fire activity were used to characterize community smoke level. MAIN RESULTS: All symptoms (nose, eyes, and throat irritations; cough; bronchitis; cold; wheezing; asthma attacks), medication usage, and physician visits were associated with individually reported exposure differences within communities. Risks increased monotonically with the number of reported smoky days. For most outcomes, reporting rates between communities were also associated with the fire-related PM10 levels. Associations tended to be strongest among those without asthma. Individuals with asthma were more likely to take preventive action, such as wearing masks or staying indoors during the fire. CONCLUSIONS: Exposure to wildfire smoke was associated with increased eye and respiratory symptoms, medication use, and physician visits.

Adolescent↗
PubMed1985

Use of ECT in California, 1977-1983.

The author examined the use of ECT in California from 1977 to 1983, a period during which its availability steadily declined. Approximately 1.12 persons per 10,000 population received ECT in 1977-1983, with little variation from year to year. Most ECT was paid for with nonpublic funds by white patients in nongovernmental facilities. The probability of receiving ECT increased with the age of the patient. ECT was quite safe: no fractures were reported, and the mortality rate was 0.2 deaths per 10,000 treatments. Despite restrictive regulation and limited availability, ECT continues to be used in California.

Adolescent↗
PubMed1999

Chart-recorded psychiatric diagnoses in women giving birth in California in 1992.

OBJECTIVE: Although major advances have been made in the diagnosis and treatment of mental disorders in primary care, few population-based investigations have focused on the obstetrical sector. This study examines the occurrence of chart-recorded psychiatric discharge diagnoses among all women delivering in California hospitals in 1992. METHOD: The authors undertook an archival analysis of the California Health Information for Policy Project data set, which consists of linked hospital discharge and birth certificate data for 580,282 deliveries. Frequencies of ICD-9 psychiatric diagnoses were ascertained. RESULTS: Among all women delivering, 1.5% received psychiatric or substance use diagnoses. Of diagnoses recorded, 75% were substance use disorders, 21% were classified generically as "mental disorder of pregnancy," and other psychiatric disorders accounted for 4%. CONCLUSIONS: The occurrence of psychiatric diagnoses in these women is markedly lower than expected, suggesting an underreporting of psychiatric disorders at delivery. Further investigations into the detection of mental disorders in the obstetrical sector are needed.

Adult↗
PubMed2004

Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia.

OBJECTIVE: The objective of this study was to evaluate the relationship between compliance with an antipsychotic medication regimen and risk of hospitalization in a cohort of California Medicaid patients with schizophrenia. METHODS: Compliance behavior was estimated by using a retrospective review of California Medicaid pharmacy refill and medical claims for 4,325 outpatients for whom antipsychotics were prescribed for treatment of schizophrenia from 1999 to 2001. Compliance behavior was estimated by using four different definitions: gaps in medication therapy, medication consistency and persistence, and a medication possession ratio. Patients were followed for one year and had an average of 19.1 dispensing events. Logistic regression models using each compliance estimate were used to determine the odds of hospitalization. RESULTS: Risk of hospitalization was significantly correlated with compliance. With all definitions, lower compliance was associated with a greater risk of hospitalization over and above any other risk factors for hospitalization. For example, the presence of any gap in medication coverage was associated with increased risk of hospitalization, including gaps as small as one to ten days (odds ratio [OR]=1.98). A gap of 11 to 30 days was associated with an OR of 2.81, and a gap of more than 30 days was associated with an OR of 3.96. CONCLUSIONS: This study showed a direct correlation between estimated partial compliance and hospitalization risk among patients with schizophrenia across a continuum of compliance behavior.

Adolescent↗
PubMed2005

Access to specialty mental health services among women in California.

OBJECTIVE: The Anderson behavioral model was used to investigate racial and ethnic disparities in access to specialty mental health services among women in California as well as factors that might account for such disparities. METHODS: The study was a cross-sectional examination of a probability sample of 3,750 California women. The main indicators of access to services were perceived need, service seeking, and service use. Multivariate models were constructed that accounted for need and enabling and demographic variables. RESULTS: Significant racial and ethnic variations in access to specialty mental health services were observed. African-American, Hispanic, and Asian women were significantly less likely to use specialty mental health services than white women. Multivariate analyses showed that Hispanic and Asian women were less likely than white women to report perceived need, even after frequent mental distress had been taken into account. Among women with perceived need, African-American and Asian women were less likely than white women to seek mental health services after differences in insurance status had been taken into account. Among women who sought services, Hispanic women were less likely than white women to obtain services after adjustment for the effects of poverty. Need and enabling factors did not entirely account for the observed disparities in access to services. CONCLUSIONS: Additional research is needed to identify gender- and culture-specific models for access to mental health services in order to decrease disparities in access. Factors such as perceived need and decisions to seek services are important factors that should be emphasized in future studies.

Adolescent↗
PubMed1975

California: Sacramento County's experience with community care.

Since 1969 treatment of the mentally ill in California has shifted from the use of large state institutions to reliance on community-based programs. The author describes the shift, the legislation precipitating it, and the public controversy surrounding the closing of state mental hospitals. The Sacramento County Mental Health Services handled the change to community care by contracting with the School of Medicine of the University of California at Davis to provide the necessary leadership and service programs; a crisis intervention approach was used.

California↗
PubMed1983

The impact of deinstitutionalization on California's state hospital population.

Deinstitutionalization has dramatically reduced the state psychiatric hospital population in California from 37,000 in 1955 to only 2,500 at the present time. In 1980 and 1982 the California Department of Mental Health conducted two surveys to assess demographic characteristics, psychiatric diagnosis, health status, and behavioral traits of state hospital patients. The results indicate that most patients are young, male, and diagnosed as schizophrenic and frequently engage in dangerous behaviors. The various patient subpopulations exhibited few differences in diagnostic distribution, although Hispanics did have a significantly higher rate of substance use. The author posits that the current hospital population constitutes a "hard core" of patients who may be difficult to place in community treatment facilities.

Adolescent↗
PubMed1989

Public mental health funding in California, 1959 to 1989.

Actual expenditures for local mental health services in California from 1959 to 1989 are analyzed to determine trends in state funding of services. As the locus of authority for mental health services shifted from state to county governments, the relative share of state budget appropriations devoted to mental health steadily dwindled. Since 1973 the public mental health budget has declined by 11.8 percent, and in most years the percentage of state general funds allocated to mental health has decreased. Programs for the developmentally disabled, which are similar in scope and mission to those for the mentally ill but are both funded and directed by the state, have received consistently higher levels of funding. California's practice of decentralizing operating authority for mental health programs while retaining responsibility for funding is seen as detrimental to the quality of public mental health services.

Budgets↗
PubMed1999

Availability and performance of psychiatric acute care facilities in California from 1992 to 1996.

OBJECTIVE: The acute care psychiatric hospital industry has been challenged by managed care, government policies, and marketplace competition to control rising costs. This study examined changes in the availability and performance of acute care psychiatric delivery facilities in California between 1992 and 1996. METHODS: A retrospective longitudinal research design was used. Data on facilities, licensed psychiatric beds, discharged patients, days of care, occupancy, average length of stay, licensure, and type of ownership for the years 1992, 1994, and 1996 were purchased from the California Office of Statewide Health Planning and Development. Data were analyzed using numerical description and percent-change calculations. RESULTS: Between 1992 and 1996 licensed beds, days of care, and average length of stay decreased in acute psychiatric facilities and services, while psychiatric discharges and facility occupancy increased. The for-profit sector and the specialty acute care sector experienced large decreases in facilities, licensed beds, days of care, and average length of stay. The generalist sector-general psychiatric units licensed within acute general hospitals-and not-for-profit facilities experienced large increases in discharges. CONCLUSIONS: Challenges to institution-based services for the mentally ill population now extend beyond the state hospital system to include community-based acute care psychiatric hospital services. Recent declines in the for-profit, acute care psychiatric hospital specialty sector and the success of the generalist and not-for-profit sectors demonstrate the lack of uniform responses to environmental pressures. However, changes in federal Medicare reimbursement policy enacted in the Balanced Budget Act of 1997, as well as competition from alternative providers, are likely to result in further closures of all types of acute care psychiatric facilities over the next few years.

California↗
PubMed1999

Adequacy of prenatal care among women with psychiatric diagnoses giving birth in California in 1994 and 1995.

OBJECTIVE: Although poor prenatal care is detrimental to maternal and infant health, few studies have assessed the adequacy of prenatal care among women with psychiatric diagnoses. This investigation examined the association between chart-recorded psychiatric and substance use diagnoses at the time of delivery and adequacy of prenatal care among all women delivering babies in California hospitals during 1994 and 1995. METHODS: The authors undertook an archival analysis of data from the California Health Information for Policy Project (CHIPP), which consists of linked hospital discharge and birth certificate data for 1,094,178 deliveries in 1994 and 1995. The associations between International Classification of Diseases, 9th Revision, Clinical Modification psychiatric and substance abuse diagnoses and level of prenatal care were examined. Logistic regression analyses were conducted to assess the association between maternal diagnostic category and inadequate prenatal care while controlling for payment source, age, education, race, marital status, and parity (previous births). RESULTS: Women who received psychiatric and substance use diagnoses demonstrated significantly increased risk of inadequate prenatal care compared with women without those diagnoses. CONCLUSIONS: Psychiatric diagnoses were associated with an increased risk of inadequate prenatal care; the association between psychiatric and substance use diagnoses and poor prenatal care persisted even after the analysis controlled for known risk factors. Future investigations will need to elucidate the processes of prenatal care for women with psychiatric disorders so that preventive interventions can be developed.

Adult↗
PubMedDate not supplied

Occurrence of low birthweight and preterm delivery among California infants before and after compulsory food fortification with folic acid.

OBJECTIVES: Studies suggest that folic acid intake influences the occurrence of low birthweight and preterm delivery. Since 1998, there has been compulsory fortification of flour and other grains with folic acid in the U.S. The objective of this study was to investigate the frequencies of low birthweight and preterm delivery after mandatory folic acid fortification among approximately six million California births. METHODS: The authors investigated prevalences of low birthweight and preterm delivery before and after compulsory fortification among 5,916,630 singleton California live births that occurred from January 1990 through December 2000. RESULTS: The unadjusted prevalences of very low birthweight, low birthweight, and preterm delivery did not substantially vary across birth years. That is, substantial decreased prevalences during the fortification period relative to the period preceding it were not observed. However, analyses that simultaneously adjusted for maternal age, parity, race/ethnicity, education, year of birth, and fortification period revealed the following relative risk ratios (RR) and 95% confidence intervals (CI): RR = 0.91, CI 0.88, 0.94 for very low birthweight, RR = 0.94; 95% CI 0.93, 0.96 for low birthweight, and RR = 0.96; 95% CI 0.94, 0.97 for preterm delivery. CONCLUSION: Findings indicate small reductions in prevalences of these outcomes associated with the timing of fortification of the U.S. food supply.

Adult↗
PubMedDate not supplied

Multiple-race mortality data for California, 2000-2001.

OBJECTIVES: To examine mortality rates and quality of race reporting for multiple-race individuals in California using the new multiple-race data available on the death certificate. METHODS: Death date were drawn from California vital statistics for 2000 and 2001. Denominator data were drawn from the 2000 census Modified Race Data Summary File. The authors calculated mortality rates and relative standard errors for multiple-race individuals as a whole and by county, and for the three largest reported multiple-race groups (African American and white, American Indian/Alaska Native and white, and Asian and white). RESULTS: Decedents reported to be of more than one race were disproportionately young, Hispanic, male, and never-married. Age-adjusted mortality rates for multiple-race groups were approximately one-sixth as high as rates for single-race individuals. There was substantial variability in rates for multiple-race decedents according to county of residence. CONCLUSIONS: Mortality rates for multiple-race people were implausibly low, and death certificates for multiple-race individuals were geographically clustered. Race reporting on death certificates will need to be improved before accurate death rates can be calculated for those of multiple races.

Adolescent↗
PubMed2003

The "experimenting agency". The California Youth Authority Research Division.

During the 1960s and 1970s, the California Youth Authority embarked on a series of randomized field trials to test interventions for juvenile and young adult offenders. This article examines the institutional and political reasons why rigorous tests were adopted for such interventions as the Community Treatment Program. It also describes the effect these trials had on the agency and on California justice, as well as how the experimental method eventually became less often used in the Youth Authority. The authors explore some general reasons why this happened.

Adolescent↗
PubMed2006

Disarming batterers through restraining orders: the promise and the reality in California.

Laws that prohibit persons under a domestic violence restraining order from purchasing or possessing a firearm are a primary way to keep guns out of the hands of batterers. In July 2005, the California Attorney General's Task Force on the Local Criminal Justice Response to Domestic Violence issued a report called Keeping the Promise: Victim Safety and Batterer Accountability. The report focused, in part, on the extent to which California's domestic violence restraining order system succeeds in disarming batterers. Restraining orders are the principal means by which the criminal justice system can accomplish this objective. The Task Force found that criminal justice agencies and the courts performed poorly in this area. The report strongly recommended that a more strategic, collaborative use of laws already on the books could significantly improve performance, without much additional expense. What follows is a summary of those finding and recommendations.

Advisory Committees↗
PubMed1996

Systemic adenovirus infection associated with high mortality in mule deer (Odocoileus hemionus) in California.

Seventeen counties in northern California experienced epizootics of high mortality in the mule deer (Odocoileus hemionus) population during the latter half of 1993. Thirteen deer submitted to the California Veterinary Diagnostic Laboratory System as part of this natural die-off had systemic adenovirus infection. Pulmonary edema was present in all 13 deer. Erosions, ulceration, and abscessation of the upper alimentary tract occurred in 7/13 deer. Four of 13 deer had hemorrhagic enteritis. All 13 deer had widespread systemic vasculitis with endothelial intranuclear inclusions. Fluorescein isothiocyanate-labeled antibody directed against bovine adenovirus type 5 bound to antigen in endothelial cells. Adenovirus was identified by transmission electron microscopy within the nuclei of endothelial cells in 6/6 deer examined. An adenovirus was isolated from lung homogenates of one deer that were cultured on black-tailed deer pulmonary artery endothelial cells. With the exception of the intranuclear inclusions evident on histologic evaluation, gross and histologic changes were similar to those described for bluetongue virus infection and epizootic hemorrhagic disease virus infection in white-tailed deer. Nine additional deer were emaciated and had pharyngeal abscesses with focal vasculitis, which may represent the chronic affects of previous nonfatal adenovirus infection.

Adenoviridae↗