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PubMed2000

Birth seasonality in the early Spanish-Mexican colonists of California (1769-1898).

The pattern of birth seasonality in California's early Spanish-Mexican colonists between 1769 and 1898 was reconstructed using genealogical data for progeny of 657 marriages. The monthly distribution of the 3,824 births in this sample shows a strong seasonal pattern, with spring and fall peaks (corresponding to peaks in conceptions during July and February) and a low point in October. This seasonal reproductive pattern is the result of a complicated set of interactions among environmental, physiological, and cultural variables. California's strongly developed winter rainfall pattern and the 19th-century agricultural cycle clearly influenced the seasonal pattern of marriages and births in this agrarian society. Several historical processes interacted with these environmental and economic factors to transform the seasonal birth pattern of the early colonists. Through time the birth pattern becomes less variable and the birth maximum shifts from spring to early winter. This appears to be, at least in part, a result of changes in labor patterns and an increase in average parity. These data suggest a multifactorial explanation for birth seasonality, in which the timing of conceptions and births is influenced by both environmental and socioeconomic factors.

Birth Intervals↗
PubMedDate not supplied

Manifestations of poverty and birthrates among young teenagers in California zip code areas.

CONTEXT: Given that many communities are implementing community-wide initiatives to reduce teenage pregnancy or childbearing, it is important to understand the effects of a community's characteristics on adolescent birthrates. METHODOLOGY: Data from the 1990 census and from California birth certificates were obtained for zip codes in California. Regression analyses were conducted on data from zip code areas with at least 200 females aged 15-17 between 1991 and 1996, to predict the effects of race and ethnicity marital status, education, employment, income and poverty, and housing on birthrates among young teenagers. RESULTS: In bivariate analyses, the proportion of families living below poverty level within a zip code was highly related to the birthrate among young teenagers in that zip code (r=.80, p<.001). In multivariate analyses, which controlled for some of the correlates of family poverty level, the proportion of families living below poverty level remained by far the most important predictor of the birthrate among young teenagers (b=1.54), followed by the proportion of adults aged 25 or older who have a college education (b=-0.80). Race and ethnicity were only weakly related to birthrate. In all three racial and ethnic groups, poverty and education were significantly related to birthrate, but the effect of college education was greater among Hispanics (b=-2.98) than among either non-Hispanic whites (b=-0.53) or blacks (b=-1.12). Male employment and unemployment and female unemployment were highly related to the birthrate among young teenagers in some racial or ethnic groups, but not in others. CONCLUSIONS: Multiple manifestations of poverty, including poverty itself, low levels of education and employment, and high levels of unemployment, may have a large impact upon birthrates among young teenagers. Addressing some of these issues could substantially reduce childbearing among young adolescents.

Adolescent↗
PubMed2000

Update: newborn screening for sickle cell disease--California, Illinois, and New York, 1998.

Sickle cell disease (SCD) is a common single-gene disorder that affects three of every 1000 black newborns and approximately 50,000 persons in the United States. Children affected with SCD are at increased risk for severe morbidity (e.g., severe hemolytic anemia, splenic dysfunction, pain crises, and bacterial infections) and mortality, especially during the first 3 years of life. In 1993, California, Illinois, and New York collectively accounted for approximately 20% of all births to blacks. All three states offer universal newborn screening for hemoglobinopathies. To assess the effectiveness of newborn screening programs for SCD and for receipt of and compliance with early medical interventions (e.g., penicillin prophylaxis and pneumococcal vaccination and other vaccination patterns), a 3-year collaborative follow-up study was conducted from 1995 through 1998 in California, Illinois, and New York. This report summarizes the results of this study, which demonstrate the difficulty in retrospectively finding children who were screened at birth so that data for evaluating program effectiveness can be assessed.

Anemia, Sickle Cell↗
PubMed1975

Patterns of infant and early childhood mortality in the California Project of a collaborative Inter-American Study.

The California Project of the Inter-American Investigation of Mortality in Childhood was carried out in San Francisco and three surrounding counties in 1969 and 1970. The study found infant death rates of 18.5 per 1,000 live births in San Francisco and 17.2 per 1,000 live births in the three counties. Mortality in the neonatal period (the first 28 days of life) accounted for two-thirds of these deaths. Low birth-weitht played a key role in neonatal mortality, one that was particularly marked during the first day of life. Overall, the study found that 77.7 per cent of the neonatal fatalities and 85.6 percent of those dying in the first day of life weighed 2,500 grams or less at birth. Mortality was also very high among infants of mothers under 20 and over 34 years of age., the risks being especially great in the case of young mothers. Moreover, the vast majority of babies that were born to young mothers and died the first day had very low birth-weights. It is therefore concluded that young mothers ran a relatively high risk of having low birth weight babies prone to dying in the first day of life. This demonstrates a clear need for special measures capable of reducing the health risk faced by both young mothers and their children. Besides providing a more detailed explanation of these points, the authors recommend various specific measures that should be taken and present data obtained by the California Project on other aspects of mortality among infants and preschool children 1-4 years of age

Adolescent↗
PubMed2001

The long-term effects of Medicaid managed care on obstetrics care in three California counties.

OBJECTIVE: To evaluate the long-term effects of Medicaid managed care (MMC) on obstetric service use and program costs in California. DATA SOURCES/STUDY SETTING: Longitudinal administrative data on Medi-Cal enrollment and claims and encounters related to pregnancy and delivery services were gathered from three counties--two long-standing MMC counties and one traditional fee-for-service Medicaid county--in California between 1987 and 1992. STUDY DESIGN: We studied Aid to Families with Dependent Children (AFDC) beneficiaries with live singleton vaginal deliveries with associated hospital stays of 14 days or less. Effects of managed care were examined with respect to prenatal visits, length of stay for delivery, maternal postpartum readmission rates, and total program expenditures. Multivariate analyses examined how the relative effect of managed care on service use and program expenditures in each MMC county evolves over time in comparison to fee-for-service. We controlled for length of Medi-Cal enrollment prior to delivery, data censoring, and individual characteristics such as race and age. PRINCIPAL FINDINGS: Prenatal care use is consistently lower in the MMC counties, although all three counties' prenatal care provision is well below the national standard. Drastic increases in one-day-stay deliveries were found: up to almost 50 percent of deliveries in MMC counties were one-day stays. Program cost savings associated with MMC enrollment are unambiguous. CONCLUSIONS: MMC cost savings might have come at the expense of reduced provision of prenatal care and shorter delivery length of stay. Future studies should verify any possible causal link and the effects on maternal and infant health outcomes.

Aid to Families with Dependent Children↗
PubMed1975

A survey of newborn intensive care centers in California.

Newborn intensive care has come of age in California. Twenty-one newborn intensive care centers and 11 community level units are now approved by Crippled Children Services in California. In 1973 there were more than 6,863 patients admitted to the 20 centers surveyed, over half requiring transport from referring hospitals. This paper provides information on the distribution, admission and occupancy rates, length of stay, costs and admission diagnoses for these high risk infants.

California↗
PubMed1975

California's experience with non-adversary divorce.

California's Family Law Act of 1969, effective January 1, 1970, instituted non-adversary proceedings for divorce, suggested a more equal division of community property and reduced the minimum waiting time for a final divorce decree. A rapid increase in the number of divorces granted in California followed. Analysis revealed that the 1969 Law did not lead to any real increase in marital dissolution among Californians or produce any significant changes in the characteristics of the population filing for divorce. What was seen were certain modifications in behavior on the part of divorcing persons to take advantage of the Law's new provisions.

California↗
PubMed2001

Coordination of health coverage for Medicare enrollees: living with HIV/AIDS in California.

Because Medicare does not cover a large part of the health care that its enrollees living with HIV/AIDS require, they need other coverage to supplement Medicare. Medicaid is a major source of that supplemental coverage. In California, Medicare enrollees with HIV/AIDS who were also enrolled in Medi-Cal (California's Medicaid program) had total payments from both programs of $177 million, or an average of $28,956 per person in the fee-for-service-system in 1998. Of that total, Medicare paid for 38 percent, mainly for inpatient visits and ambulatory care, while Medi-Cal paid 62 percent, mainly for prescription drugs. For these dual enrollees, many of Medicare's benefit gaps--including a large share of prescription drugs, nursing facility services and home care--are being filled by Medi-Cal. Data in this Medicare Brief indicate that the incremental cost to the federal government of filling gaps in the Medicare benefits package would be considerably less than the full cost of the additional benefits. Through Medicaid and other programs, the federal government is already paying a substantial part of public program expenditures for dual enrollees with HIV/AIDS. Other issues to consider are how the dual Medicare-Medicaid funding streams affect the programs' cost efficiency, and from the perspective of Medicare enrollees and providers, how well the dual programs coordinate to meet the needs of people with HIV/AIDS and other chronic conditions.

California↗
PubMed2002

Outbreak of Salmonella serotype Kottbus infections associated with eating alfalfa sprouts--Arizona, California, Colorado, and New Mexico, February-April 2001.

On March 12, 2001, the California Department of Health Services (CDHS) identified a cluster of Salmonella Kottbus isolates with indistinguishable pulsed-field gel electrophoresis (PFGE) patterns. During February 1-May 1, CDHS identified 23 patients with S. Kottbus infections in several California counties and an additional patient from Arizona. This report summarizes the results of the investigation of this outbreak, which identified cases in four states and implicated alfalfa sprouts produced at a single facility.

Adolescent↗
PubMed2002

Absolute minimum. California announces its decision on nurse-staffing ratios, and other states watch and wait for the ripples to come their way.

After two years of wrangling, California hospitals learned how many patients the state government believes one nurse should care for safely. The announcement last week could well reverberate nationally. The ratio of one nurse to six patients in medical-surgical units is twice the number of patients supported by the state's nurse association and four fewer than that supported by the California Healthcare Association.

California↗
PubMed2002

Survey of urological laparoscopic practices in the state of California.

PURPOSE: In the interest of maintaining our surgical domain we performed a survey aimed at establishing laparoscopic practice patterns as they pertain to urological disease. MATERIALS AND METHODS: Surveys were mailed to 2,902 surgeons in California who were listed with the American College of Surgeons, including 2,175 general surgeons, 510 urologists and 217 obstetricians-gynecologists. RESULTS: A total of 442 complete responses (15.2%) were tallied. Of urologists and of nonurologists 54% and 11% performed no laparoscopy, while 12% and 80%, respectively, devoted at least 5% of their time to laparoscopic surgery. Urologists and nonurologists performing no laparoscopy were older than those performing a significant volume (p < 0.05). Of urologists 16% thought that they were trained adequately during residency to perform laparoscopic surgery compared with 30% of nonurologists. Of the urologists who performed hand assisted laparoscopy, 50% tended to use it as a means of gaining familiarity with these techniques. These urologists performed more laparoscopic surgery than other urologists. While 80% of laparoscopy cases were community based, academic urologists are actively interested in laparoscopic surgery. The 2 most important reasons cited for performing laparoscopy were more rapid recovery and decreased morbidity. The leading laparoscopic procedures according to incidence for urologists performing laparoscopic surgery were diagnostic procedures (12.9%), varicocelectomy (12.1%), adrenalectomy (9.7%), pelvic lymphadenectomy (8.9%), and simple nephrectomy and renal cyst decortication (8.1% each). The leading laparoscopic cases according to the number of available cases per urologist were colposuspension-bladder neck suspension (1.06), donor nephrectomy (0.77), pelvic lymphadenectomy (0.52), varicocelectomy (0.48) and orchiopexy (0.45). Urologists performed more urological laparoscopy cases than nonurologists. CONCLUSIONS: Urological laparoscopic practice in California remains in its infancy. It is imperative that exposure should be increased in residency training programs.

California↗
PubMed2002

Alcohol coverage in California newspapers: frequency, prominence, and framing.

The purpose of this study was to investigate the nature and extent of alcohol coverage in California newspapers by examining the frequency, positioning, and framing of alcohol-related articles. A content analysis assessed the frequency and nature of alcohol references in news content drawn from a random sample of nine California newspaper issues from September 1997 to June 1998. The study findings indicate that alcohol is mentioned at least once a day in daily newspapers with more frequent mention in smaller newspapers. Alcohol is most often discussed in relation to trauma or in the context of promoting alcohol consumption. Articles on trauma and driving while intoxicated receive more prominence than other stories mentioning alcohol. Despite the relative frequency of alcohol content in trauma news, these stories are rarely framed with any sort of health context. Public health advocates should work toward increasing the frequency and improving the framing of alcohol in newspaper coverage.

Alcohol Drinking↗
PubMed2002

Flea, rodent, and plague ecology at Chuchupate Campground, Ventura County, California.

Chuchupate Campground in Ventura County, California, was closed to the public for 18 years (1982 to 2000) because of uncontrolled vector fleas and persistent plague antibody titers in rodents. The primary purpose of this study was to clarify the plague ecology of Chuchupate Campground by identifying involved rodents and their vector fleas and by determining many of their ecological parameters: abundance, flea and host preferences and diversities, and flea seasonality. Rodents and fleas were identified to species, some fleas were tested for Yersinia pestis, and rodent bloods were analyzed for the presence of antibodies to Y. pestis. During this study, 20 flea species were identified from 10 rodent and one lagomorph species collected. Five species of rodents were seropositive for plague during 13 of the 17 years in which plague testing was conducted. A likely reservoir species was not determined, but evidence of plague resistance was discovered in Merriam's chipmunks (Tamias merriami) and dusky-footed woodrats (Neotoma fuscipes). The "susceptible" rodent and flea complexes at Chuchupate are the California ground squirrel (Spermophilus beecheyi) and its fleas, Oropsylla montana and Hoplopsyllus anomalus, Merriam's chipmunk and its flea, Eumolpianusfornacis, and the dusky-footed woodrat and its flea, Orchopeas sexdentatus. Host preference, diversity, and seasonality of fleas are discussed, as well as the pivotal role of woodrat houses and nests as foci for hosts, fleas, and plague.

Animals↗
PubMed2002

Use of liquid deltamethrin in modified, host-targeted bait tubes for control of fleas on sciurid rodents in northern California.

The efficacy of liquid deltamethrin was evaluated for controlling fleas on golden-mantled ground squirrels, Spermophilus lateralis, and chipmunks, Tamias amoenus and T. senex. A host-targeted bait tube was modified to deliver insecticide to visiting rodents during a seven-week trial conducted in the Southern Cascade Mountains of northern California. A single deltamethrin treatment with one replenishment of bait provided effective flea control on rodents within one week of deployment of bait tubes. A second treatment accompanied by two bait replenishments during the following two-week period maintained effective control throughout the seven-week period, even though all bait tubes were removed from the site after three weeks. Our results suggest that the use of modified bait tubes treated with liquid deltamethrin can provide an effective, economical, and efficient means of controlling vector fleas on the primary disease amplifying rodent hosts in this plague endemic region of California.

Animals↗
PubMed2002

Human rabies--California, 2002.

On March 31, 2002, a man aged 28 years residing in Glenn County, California, died from rabies encephalitis caused by a rabies virus variant associated with the Mexican free-tailed bat (Tadarida brasiliensis) (Figure). This report summarizes the investigation by the Glenn County Health Department (GCHD) and the California Department of Health Services (CDHS). Persons who observe abnormal behavior in any wildlife species should contact animal control or animal rescue agencies immediately and should avoid approaching or handling these animals.

Adult↗
PubMed2002

Vaginal birth after cesarean birth--California, 1996-2000.

In 2000, of all births in the United States, 23% were cesarean, approximately 37% of which were repeat cesarean births (i.e., births to women who had a previous cesarean birth). Approximately 60% of cesarean births might be by elective repeat cesarean delivery (ERCD). Because cesarean birth is associated with higher maternal morbidity than routine vaginal birth, two of the national health objectives for 2010 are to reduce the cesarean birth rate among women at low risk to 15% of women who are giving birth for the first time (objective no. 16-9a) and to 63% of women with previous cesarean births (objective no. 16-9b). A key strategy to reduce the repeat cesarean birth rate is to promote vaginal birth after cesarean (VBAC) as an alternative to ERCD. Achieving the national health objective for 2010 will require increasing the VBAC rate to 37%. During 1989-1999, VBAC rates in the United States increased from 19% in 1989 to 28% in 1996 and then decreased to 23% in 1999. This report summarizes an analysis of California's VBAC rates during 1996-2000, which indicates that the VBAC rate in California decreased by 35%, from 23% in 1996 to 15% in 2000. Strategies to improve VBAC rates might include educating women about the risks for complications and benefits of VBAC, ensuring careful selection of VBAC candidates, developing guidelines for management of labor, and educating health-care providers about reducing VBAC risks.

California↗
PubMed2003

Plasma cholinesterase levels of mountain plovers (Charadrius montanus) wintering in central California, USA.

Declines of over 60% in mountain plover (Charadrius montanus) populations over the past 30 years have made it a species of concern throughout its current range and a proposed species for listing under the U.S. Endangered Species Act. Wintering mountain plovers spend considerable time on freshly plowed agricultural fields where they may potentially be exposed to anticholinesterase pesticides. Because of the population status and wintering ecology of plovers, the objectives of our study were to use nondestructive methods to report baseline plasma cholinesterase (ChE) levels in free-ranging mountain plovers wintering in California, USA, and to assess whether sampled birds showed signs of ChE inhibition related to anticholinesterase chemical exposure. We compared plasma ChE activity for mountain plovers sampled from the Carrizo Plain (an area relatively free of anticholinesterase pesticide use) with similar measures for plovers from the Central Valley (where anticholinesterase pesticides are widely used). Analyses for ChE inhibition indicated that none of the plovers had been recently exposed to these chemicals. However, mean ChE levels of plovers from the Central Valley were significantly higher (32%) than levels reported for plovers from the Carrizo Plain. This result differs from our original assumption of higher exposure risk to mountain plovers in the Central Valley but does suggest that some effect is occurring in the ChE activity of mountain plovers wintering in California.

Animals↗
PubMed2003

Relationship of hospital volume to outcome in cardiac surgery programs in California.

There are more than 120 cardiac surgery programs in California. More than half perform less than 200 coronary artery bypass graft (CABG) procedures per year. This study queried the state of California discharge abstract database to analyze the relationship between annual procedural volume and outcomes of all 119 nonfederal hospitals performing cardiac surgery during 1997 through 1999. Unadjusted in-hospital mortality for CABG surgery was 3.91 per cent (923 of 23,619) in hospitals performing fewer than 200 procedures per year and 2.09 per cent (496 of 23,704) in hospitals performing > or = 500 procedures annually (P = 0.001 by Chi-square). Similar findings were noted for CABG + valve and/or aneurysm and for valve procedures. Risk-adjusted CABG data obtained from 78 of 119 hospitals found that a significant difference persisted between a volume of < 200 and > or = 200 procedures per year (P = 0.03 by t test). There was wider variation in outcome among lower-volume hospitals. However, many low-volume providers had excellent results. It is concluded that although volume is clearly related to outcome patient-related factors and process variables may be more important. Performance improvement programs should be developed to improve communication between providers with differing outcomes.

California↗