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Southern California's marine monitoring system ten years after the National Research Council evaluation.

In 1990, the National Research Council (NRC) published two in-depth assessments of marine environmental monitoring effectiveness. The first of these, Managing Troubled Waters: The Role of Marine Environmental Monitoring, provided a national perspective and the second, Monitoring Southern California's Coastal Waters, examined the specifics of monitoring design and implementation in a densely populated, highly urbanized coastal region. The reports include explicit recommendations about the need for greater regionalization of monitoring efforts, supported by greater standardization of field, laboratory, and data analysis methods. They also identified the need for centralized data management and for greater flexibility in the language of standard discharge permits, flexibility that would permit discharge agencies to more readily participate in regional monitoring and research programs. Other recommendations identified a need for EPA and NOAA to focus on creating a national monitoring program structured as a network of coordinated local and regional efforts. Finally, the NRC emphasized the need for better reporting and for periodic review of monitoring's relevance to management concerns. In this paper, we use southern California as a test case to assess progress made in implementing the NRC's recommendations. We review progress made on each recommendation and discuss the features of the regulatory and management climate that contributed to or impeded this progress. We also consider whether, and to what extent, the NRC's recommendations remain relevant in the present context.

California↗

Nonfatal fall-related traumatic brain injury among older adults--California, 1996-1999.

In the United States, falls are the second leading cause of traumatic brain injury (TBI) hospitalizations overall and the leading cause of TBI hospitalizations among persons aged > or = 65 years. In 1995, TBIs resulted in an estimated $56 billion in direct and indirect costs in the United States. In California, during 1999, a total of 61,475 hospitalizations from falls were reported among persons aged > 65 years. Risk factors for falling among older persons included arthritis; impairments in balance, gait, vision, and muscle strength; and the use of four or more prescription medications. As part of CDC's program of state-based TBI surveillance, California hospital discharge data were collected and analyzed to describe fall-related TBIs. This report summarizes the results of that analysis, which support previous findings that persons aged > or = 65 years are at risk for hospitalization for a fall and that same-level falls are far more common among persons aged > or = 65 years than falls from a higher level (e.g., a ladder, chair, or stair). Defining the circumstances of fall injuries and recognizing the type of fall leading to TBI hospitalizations among older persons can help health-care providers conduct risk assessment and management of falls in this population.

Accidental Falls↗

Privacy on thin ice? Considering the California Court of Appeal decision in Johnson v. Superior Court.

In Johnson v. Superior Court, the California Court of Appeal determined that a provision of a contract limiting the discovery of the identity of a sperm donor was against public policy and that the privacy interest did not protect against disclosure of this information. Although the court's analysis of the public policy exception to the enforcement of contracts was unnecessary, the opinion properly balances California's and petitioners' interests against an anonymous donor's privacy right.

California↗

Potential impacts of global warming on water resources in southern California.

Global warming will have a significant impact on water resources within the 20 to 90-year planning period of many water projects. Arid and semi-arid regions such as Southern California are especially vulnerable to anticipated negative impacts of global warming on water resources. Long-range water facility planning must consider global climate change in the recommended mix of new facilities needed to meet future water requirements. The generally accepted impacts of global warming include temperature, rising sea levels, more frequent and severe floods and droughts, and a shift from snowfall to rain. Precipitation changes are more difficult to predict. For Southern California, these impacts will be especially severe on surface water supplies. Additionally, rising sea levels will exacerbate salt-water intrusion into freshwater and impact the quality of surface water supplies. Integrated water resources planning is emerging as a tool to develop water supplies and demand management strategies that are less vulnerable to the impacts of global warming. These tools include water conservation, conjunctive use of surface and groundwater and desalination of brackish water and possibly seawater. Additionally, planning for future water needs should include explicit consideration of the potential range of global warming impacts through techniques such as scenario planning.

California↗

Rheumatic fever and rheumatic heart disease; incidence in California.

The statistics quoted in this and other published reports appear to substantiate the impression that rheumatic fever in California, although still an important public health problem which varies widely from one locality to another, is of lower incidence and perhaps of more benign character than in most other parts of the United States. It also appears that in California aortic insufficiency may be of higher relative incidence and occurs more frequently as a clinically diagnosable sequel of rheumatic fever than does classical mitral stenosis. Congenital defects of the heart constitute a large proportion of the cases of organic heart disease in children and young adults in this state.

Adult↗

Congenital syphilis in California.

Routine serologic tests for syphilis (as required by California law governing prenatal examination) and penicillin therapy during pregnancy for infected mothers have been major factors in the prevention of congenital syphilis in California during the past ten years. In 1940 one of each 822 infants had the disease, as indicated by morbidity reports of congenital syphilis in infants under the age of one year. In 1950 the ratio was one in 8,148. To determine why congenital syphilis continues to occur, a study of the 134 cases reported over a two-year period was made with the cooperation of local health officers and practicing physicians. It showed that in 76 per cent of cases the mother did not consult a physician prior to delivery or reported so late in pregnancy that the infant was born before adequate penicillin therapy could be given. In another 15 per cent syphilis developed in the mother during pregnancy after a negative reaction to a prenatal serologic test. The other 9 per cent of cases were due to various factors, such as infectious relapse or reinfection in previously adequately treated mothers. The study indicated that most cases occur in the lower socioeconomic population groups. Seventy-four per cent of cases were in infants delivered in county hospitals.

California↗

Tuberculosis control in California mental hospitals.

Diagnosis, the first step in tuberculosis control, is accomplished in the mental hospitals of California by x-ray examination of all patients annually and of new or returning patients on admission. This routine has been carried on since 1937. Tuberculous patients with active disease are segregated in one of three specially staffed and equipped units at the Patton, Sonoma and Napa hospitals. Those in whom disease is likely to recur are likewise segregated for special care and observation. Those in whom disease is inactive or not definitely diagnosed are not segregated but are observed by physicians of the Bureau of Tuberculosis Control of the California Department of Public Health in collaboration with the staffs of the institutions. Since the establishment of this program the proportion of new or previously unrecognized cases of tuberculosis has been reduced from 0.83 per cent, a year after the program was begun, to 0.37 per cent, while recurrence or progression of previously recognized disease has been reduced from 12.3 per cent at the first survey to 5 per cent at the most recent. Overcrowding in all hospitals has been the chief obstacle to the success of the program.

California↗

Poliomyelitis vaccine; epidemiologic observations on the safety and effectiveness in California in 1955.

During the past year California has participated with other states in a nationwide field evaluation of the safety and effectiveness of poliomyelitis vaccine. Among 227,000 children who received Cutter vaccine, and the household contracts of these children, the incidence of poliomyelitis was higher during the early postvaccinal period than in comparable age groups of the population at large. Among 238,000 children who received poliomyelitis vaccine made by other manufacturers early in 1955 no increase in poliomyelitis was observed in the inoculated children or their household contacts. Subsequent observation on over 500,000 additional children vaccinated in California alone since September 1955 with vaccine that was made under revised safety standards has uncovered no evidence of unsafe vaccine. In children who received a single inoculation of vaccine prior to the onset of the poliomyelitis season in 1955 the incidence of paralytic poliomyelitis was about 60 per cent less than in unvaccinated children. Among those who received two inoculations an 85 per cent reduction was observed. The average reduction in paralytic poliomyelitis for the entire vaccinated group was approximately 75 per cent. Data thus far on children vaccinated since September 1955 with poliomyelitis vaccine made by methods now approved indicate that a similar overall effectiveness is still being maintained.

California↗

Psychiatric services in general hospitals: a report of the Northern California Psychiatric Society's committee on the need for psychiatric services in general hospitals.

A study made by a special committee appointed for the purpose by the Northern California Psychiatric Society found that a real need exists for local psychiatric services in general hospitals of the Northern California area. Such services can be provided readily-and in some communities are already available. A broad segment of the population looks to the general hospital to provide diagnosis and care and so enable the patient's prompt recovery from psychiatric disorders. The study further emphasizes the importance of such factors as a competent psychiatric chief, adequate staff and personnel and good planning in organizing inpatient and outpatient facilities and integrating treatment so that all the functions of the hospital are available to psychiatric patients. Granted these special considerations, the services can be provided more easily than many physicians, including some psychiatrists and administrators, suppose.

California↗

Alcoholism; the chronological background leading to California's present program.

An ancient problem is receiving modern attention in California. In this paper, the author briefly reviews the historical background that has made possible newer attitudes and study approaches to the problem of alcoholism. The chain of circumstances (and its welders) leading to California's broadly programmed attack upon alcoholism and its related complications is described.

Alcoholism↗

Attitudes of California dermatologists toward Worker's Compensation: results of a survey.

A survey-questionnaire on Worker's Compensation sent to 492 California dermatologists produced 268 replies, a recovery rate of 54 percent, representing approximately 10 percent of the practicing dermatologists in the United States. A total of 75 percent replied they treat Worker's Compensation patients; most of the 25 percent who replied they do not gave strong reasons for refusing to assume the care of these patients. The answers to the questionnaire given by the 201 California dermatologists who treat Worker's Compensation patients are tabulated and discussed. Although there exists considerable misunderstanding among physicians, insurance companies and employers on many aspects of Worker's Compensation, the situation is not without hope for improvement. Better knowledge of work procedures, more availability of precise information on the ingredients of work contactants and cooperation among the interested parties should improve the quality of care for these patients in the future.

Attitude of Health Personnel↗

Algerian ivy dermatitis; a California disease.

A hitherto unrecognized cause of contact dermatitis in California is the widely cultivated plant known as Algerian ivy. This plant, which grows in California (and its close relative, English ivy) causes a dermatitis which is similar to although milder than that caused by poison oak. Dermatitis from this cause occurs most frequently when persons who have become sensitive to it by previous contact trim the plant back in the spring after its seasonal spurt of growth. For persons whose occupations require repeated contact with the plant, dermatitis from this cause is an occupational hazard. Dermatitis from this plant is easily diagnosed by means of a simple patch test. In a series of 12 cases the only effective treatment was with corticosteroid agents.

California↗

Tetanus in California; epidemiology and a review of 232 cases.

A study was made of records of the 232 reported cases of tetanus in California, from 1953 through 1958. Cases occurred in 30 of California's 58 counties. Two-thirds of the patients lived in suburban and urban areas. Two-thirds of the cases occurred in persons over the age of 20 years. The incidence was twice as high in males as in females. Forty-seven per cent of the patients died, with the highest death rates being in persons over the age of 40 years.Sixty-three per cent of the injuries associated with these 232 cases occurred in the home environment and 17 per cent at the place of employment.Ninety-one per cent of the patients had never been immunized with tetanus toxoid, or if they had been immunized, had not received the booster injections necessary to maintain effective immunity. Nine per cent gave a history of having had one or more injections of tetanus toxoid within five years.

California↗

VIROLOGY. A REPORT OF PRESENTATIONS FEATURED AT THE 94TH ANNUAL SESSION OF THE CALIFORNIA MEDICAL ASSOCIATION.

With virology as the theme of its three general meetings, the 94th Annual Session of the California Medical Association was addressed by outstanding experts on various aspects of this engaging subject. The following report of highlights of the speakers' presentations was written at the editor's behest by Warren Levinson, M.D., a postdoctoral fellow at the Virus Laboratory, University of California, Berkeley.

California↗

Cirrhosis mortality in California--a trend.

The recorded California death experience attributable to cirrhosis of the liver for the period 1910-1957 was collected and analyzed. The analysis clearly demonstrated a progressive increase in age-adjusted death rates for the past thirty-five years, paralleled by a constantly decreasing average age at death. Increasingly, California citizens are dying of cirrhosis of the liver at younger ages. At a time when diagnosis and treatment of cirrhosis of the liver are at their highest points of clinical interest and concern, this analysis suggests that other morbid forces are at work in the production of liver cirrhosis that must be ferreted out by clinicians and epidemiologists.

Biometry↗

Introduction and potential establishment of Aedes albopictus in California in 2001.

Aedes albopictus was discovered in Los Angeles, California, in June 2001 in a maritime cargo container from China containing a shipment of a commercial plant product known as "Lucky Bamboo" (Dracaena spp.). To keep the plants alive during the ocean transit, they were shipped in 5-8 cm of water, providing an excellent habitat for Ae. albopictus. Mosquito infestations were subsequently detected at 15 nursery distributors of Dracaena in 2 northern and 4 southern California counties. The distribution of the Ae. albopictus infestations was limited to the vicinity of those nursery distributors with documented infestations. Infestations persisted for more than 5 months near some of the nurseries, and eggs were found in ovitraps until mid-November 2001 up to 1,000 m from the original infestation sites. Overwintering Ae. albopictus populations were discovered in April, July, and August 2002 at original infestation sites in Chino, San Bernardino County, and Monterey Park and Rowland Heights, Los Angeles County, respectively. Specimens were found at some sites of overwintering populations until October 2002.

Aedes↗

Human death associated with bat rabies--California, 2003.

Rabies is a rapidly progressive, incurable viral encephalitis that is, with rare exception, transmitted by the bite of an infected mammal. On September 14, 2003, a previously healthy man aged 66 years who resided in Trinity County, California, died from rabies approximately 6 weeks after being bitten by a bat. This report summarizes the investigation by the Trinity and Shasta County Health Departments and the California Department of Health Services (CDHS). Persons should avoid direct contact with bats; however, if such contact occurs, the exposed person should visit a health-care provider immediately, and the exposure should be reported to local public health officials.

Aged↗