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PubMed1951

Western equine and St. Louis encephalitis in man, California, 1945-1950.

A large group of etiologic agents, some known and some unknown, produce in man a clinical syndrome now labeled "infectious encephalitis."The separation, from this larger group, of single disease entities which cause similar clinical symptoms is possible, but calls for diagnostic acumen plus supporting laboratory evidence. Two etiologically specific entities, western equine encephalitis and St. Louis encephalitis, are frequently encountered in rather well-defined areas of California, the Central Valley and Imperial Valley; and there is a definite seasonal pattern of occurrence-June through October. There are certain guides that are helpful in differential diagnosis. Establishing a diagnosis on the basis of clinical evidence is difficult. Laboratory studies are of great importance not only for diagnosis in the individual case but for advancement of etiology. Specimens are worthless unless taken at proper intervals and submitted by methods described. It is probable that encephalitides caused by still unknown agents exist in California. The isolation and identification of new encephalitogenic viral agents will depend in large measure upon the submission by physicians of suitable specimens from patients with central nervous system disease in which the cause is obscure.

Animals↗

PubMed1952

The medical aspects of civil defense in California.

Medical care for persons injured in atomic bomb attack or other far-reaching enemy action occupies an important place in civil defense plans that have been set up in California. Preparations have been made on the basis of suppositions as to where attacks might occur and estimates of the number of casualties. State and federal funds have been allocated for aid station equipment, antibiotics, plasma, blankets and litters. In the table of organization, use of all physicians, nurses and hospitals in the state is contemplated. Communities at the center of attacks would borrow facilities and medical personnel from areas not directly affected.County medical societies in California have appointed civil defense committees to work out local plans. Each physician has a part in these plans. If he does not know what his assignment is, be ought to get in touch with his county medical society headquarters immediately.

Antibiotics, Antitubercular↗

PubMed2004

California's Task Force evaluation of issues confronting water reuse.

Water reclamation and reuse have been occurring in California for over a century. The state is arid and semi-arid in large regions and must rely on a variety of water supplies to meet its water demands. Reclaimed water is a potential source to meet a significant portion of new demands expected by 2030. However, there are issues of public health and water quality regulation, cost, public acceptance, institutional and other barriers that must be addressed. The California State Legislature adopted legislation in 2001 to convene the Recycled Water Task Force to advise the state on the opportunities for using reclaimed water in a broad spectrum of applications and in identifying impediments and constraints to increasing the use of reclaimed water. The processes for conducting the Task Force are described to illustrate the actions that were intended to increase the credibility of the Task Force. The recommendations of the Task Force are summarized.

California↗

PubMed1950

Cancer detection centers; the experience to date in California.

Cancer "detection centers" (that is, centers for the examination of presumably well or asymptomatic persons) have been tried out in four different California communities during the last three years. In all instances-as in most other such centers throughout the United States-they have not been successful in restricting examination to well persons.The detection centers in California may therefore be described more accurately as "cancer examination and detection clinics."Three of the four centers have been closed owing to the small yield of cancer cases discovered, plus the fact that the cost of operation exceeded the total available funds of the local branch of the Cancer Society. In addition, it was extremely difficult to obtain and maintain competence on the part of the professional staff in such centers.A more practical approach to the problem of earlier tumor detection would appear to be emphasis on making "every physician's office a detection center," and stressing the annual examination of persons over 40 years of age for tumors in the five common accessible sites. These are the tumors most readily curable today.

California↗

PubMed2004

Cancer occurrence in Southeast Asian children in California.

OBJECTIVES: To estimate misclassification of ethnicity and cancer incidence in Southeast Asian children using the population-based California Cancer Registry. METHODS: Asian race/ethnicity was evaluated using lists of Asian surnames. Average annual incidence rates (per million) for 1988 to 1992 were calculated for non-Hispanic white, black, Hispanic, and Asian children (age <15 years). Proportional incidence ratios (PIRs) for 1988 to 1995 were used to compare Southeast Asian children to non-Hispanic white children. RESULTS: Of the Asian children, 4.2% (30/722) were misclassified by subgroup, predominantly Hmong listed as Laotian. The Asian cancer rate was 134.2 versus 159.2 for non-Hispanic whites. The germ cell tumor rate was higher in Asians (9.9) than in non-Hispanic whites (4.8), but the Wilms tumor rate was two-thirds lower (3.1 vs. 9.2). The rates of Hodgkin lymphoma and central nervous system tumors were lower (2.8 vs. 5.6 and 20.0 vs. 33.8) in Asians than non-Hispanic whites. Compared with non-Hispanic whites, the PIR for Wilms tumor in Southeast Asian children was reduced (PIR = 0.1). Southeast Asian children had increased PIRs for Burkitt lymphoma (PIR = 2.6) and leukemias not classified as acute lymphocytic leukemia or acute nonlymphocytic leukemia (PIR = 3.5). CONCLUSIONS: Accurate race/ethnicity classification of Southeast Asian children is a concern. Marked differences were found in the incidence and PIRs of specific cancers among Southeast Asian children, other Asian children, and other children in California.

Adolescent↗

PubMed2004

Fifty years of general anesthesia in California oral and maxillofacial surgery.

In summary, the advances of the last half of the 20th century in general anesthesia delivery by oral and maxillofacial surgeons are the following: 1. Oral and maxillofacial surgeons in training are exposed to significantly more hospital general anesthesia training and in addition spent much of their residency training performing general anesthesia on outpatient dental patients undergoing dentoalveolar surgery. Training programs increased from one year to three years, then to four years and finally, many six-year programs were developed that award the MD degree during or following completion of the residency program. 2. Self-evaluation programs were initiated in the late 1960s and evolved into mandatory in-office evaluation by peer practitioners and later into state-regulated evaluation. These programs began in Southern California and spread to encompass the entire United States. 3. Intravenous ultra-fast acting barbiturate office anesthesia became very refined and several combination drug "balanced" techniques developed. 4. Benzodiazepines, first diazepam then midazolam were introduced and gained wide acceptance by the dental profession. 5. New synthetic narcotic agents were introduced, which give the oral surgeon another pain control and anesthesia supplement. The new agents were short acting but very effective for the period necessary to complete most office surgical procedures. Fentanyl is the prototype for these agents. 6. Monitoring devices were incorporated into practice, and currently all oral surgeons use the pulse oximeter, the electrocardiograph, and blood pressure monitoring devices. All of these monitors are required by the California general anesthesia regulations. 7. Propofol, an entirely new type of intravenous agent, was introduced and is used by more than half of oral surgeons reporting in a survey of drugs used in 2003. Propofol may be used by incremental injection or by continuous infusion incorporating an automatic infusion pump. 8. Sevoflurane, a potent inhalation anesthetic that has many properties of an ideal agent - rapid onset, potent, easily delivered by calibrated vaporizers, rapid emergence, infrequent postoperative nausea, and favorable acceptance by almost all patients about to undergo general anesthesia - is gaining acceptance and use by oral and maxillofacial surgeons.

Anesthesia, General↗

PubMed2005

Access to health care for children and adolescents in working poor families: recent findings from California.

BACKGROUND: Children in working poor families are among the most disadvantaged, yet little is known about barriers to care for these children. OBJECTIVES: We sought to compare health care access and use by children from working poor families with other poor and nonpoor children and consider the extent to which expansions in public health insurance have contributed to increased access in California. METHODS: This was cross-sectional study using data from the 2001 California Health Interview Survey, a representative telephone survey. Using this survey, we were able to include 16,528 children younger than the age of 18 in our analysis. We measured financial and nonfinancial access to health care and service use. RESULTS: Children in working poor families had higher odds of being uninsured (adjusted odds ratio 2.9, 95% confidence interval 2.0, 4.1; adjusted odds ratio 3.7, 95% confidence interval 2.9, 4.8, respectively) compared with children in nonworking poor/TANF and nonpoor families. Disparities in nonfinancial access and use between the working poor and nonworking poor narrowed considerably when controlling for insurance and other covariates. Compared with nonpoor children, disparities in access were wider. The largest disparities in use were in dental care. After controlling for insurance and other covariates, disparities remained. CONCLUSIONS: Despite public insurance expansions, particularly through Healthy Families, disparities in insurance coverage between the working poor and other poor and nonpoor children remain, placing children of the working poor at a disadvantage for access and use. Insurance coverage expansions must be protected and coupled with continued efforts to narrow nonfinancial barriers to care.

Adolescent↗

PubMed2005

Spillover effects of restrictive drug formularies: a case study of PacifiCare in California.

BACKGROUND: A restrictive drug formulary may influence how physicians treat other, unaffiliated patients, a phenomenon known as the "spillover effect." In a previous study we found significant spillover effects from Maine's Medicaid formulary. OBJECTIVE: To determine whether similar spillover effects exist for private insurers with less restrictive formularies and less dominant market presence. STUDY DESIGN: We treated PacifiCare's formulary changes for proton pump inhibitors (PPIs) as a natural experiment and studied whether these changes spilled onto non-PacifiCare patients in California. Rabeprazole and pantoprazole are the newly preferred PPI products. METHODS: We analyzed the physician-level before-and-after changes in prescribing of rabeprazole and pantoprazole for PacifiCare and non-PacifiCare patients. We also estimated the effect of PacifiCare share of practice on spillover effects using linear regressions. RESULTS: The number of rabeprazole and pantoprazole prescriptions increased simultaneously for non-PacifiCare patients and the increase was positively associated with PacifiCare share of practice. For non-PacifiCare prescriptions, a 10% increase in PacifiCare share of practice led to a 3.3% share increase for rabeprazole and a 1.6% share increase for pantoprazole, respectively (both P < .001). CONCLUSIONS: PacifiCare's PPI formulary changes generated significant spillover effects onto non-PacifiCare patients in California.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMed2004

Rodent-flea-plague relationships at the higher elevations of San Diego County, California.

Rodent-flea-plague relationships were examined at sites located at higher elevations of San Diego County during 1991-2002. The most frequently sampled rodents were the California ground squirrel, Spermophilus beecheyi, and white-footed mice, Peromyscus spp. Higher seasonal mean dependent variables (prevalences of squirrels and indices of O. montana), higher mean amounts of seasonal rainfall, and lower seasonal mean ambient temperatures were found at sites during 1991--1993 compared with 2000--2002. Levels of plague antibody indicate that squirrels seroconverted at most sites during spring/early summer when exposed to infected fleas when cleaning out burrows following hibernation, when interacting more with other squirrels occurred establishing home ranges, and when dispersing juveniles occupied abandoned burrows containing old nests. The majority of squirrels (35/41) were reported seropositive at Heise County Park (elev. 1,281 m) during 1996, 2001, and 2002. This may reflect fewer fleas biting squirrels more often when squirrels spent more time below-ground in order to avoid higher ambient temperatures. In contrast, most squirrels (12/13) were reported seropositive at two higher sites (elev. 1,584 and 1,641 m) on Palomar Mountain during 1993--1996 when there were higher mean dependent variables and amounts of seasonal rainfall compared with 1999--2002. This increased rainfall may have benefited host and flea populations and thus plague transmission. Seasonal indices were usually reduced after dusting squirrel burrows with 2% diazinon dust. Findings also indicated that S. beecheyi is a primary reservoir for plague at the higher elevations of these and other sites in southern California, and that the deer mouse, Peromyscus maniculatus, and other Peromyscus spp. were not major host reservoirs at the sites sampled.

Analysis of Variance↗

PubMed1992

Clinic-based primary care of frail older patients in California.

We surveyed medical directors of primary care clinics in California to learn how those clinics cared for their frail older patients. Of 143 questionnaires sent, 127 (89%) were returned. A median of 30% of all patient encounters were with persons aged 65 or older, and a median of 20% of older patients were considered frail. A total of 20% of the clinics routinely provided house calls to homebound elderly patients. Of clinics involved in training medical students of physicians (teaching clinics), 70% had at least one physician with an interest in geriatrics, compared with 42% of nonteaching clinics (P less than .005). For frail patients, 40% of the clinics routinely performed functional assessment, while 20% routinely did an interdisciplinary evaluation. Continuing education in geriatrics emerged as a significant independent correlate of both functional assessment and interdisciplinary evaluation. Among the 94 clinics with a standard appointment length for the history and physical examination, only 11 (12%) allotted more than 60 minutes for frail patients. The data suggest that certain geriatric approaches are being incorporated into clinic-based primary care in California but do not provide insight into their content or clinical effects.

Aged↗

PubMed2005

Antibody response to Culex tarsalis salivary gland antigens among sentinel chickens in California.

The arboviral surveillance program in California depends in part on sentinel chickens to detect western equine encephalomyelitis virus, St. Louis encephalitis virus, and West Nile virus activity. From 2000 through 2002, 1,578 serum specimens from 34 sentinel flocks in northern and southern California were tested for antibodies to Culex tarsalis salivary gland antigens. Sentinel chickens that were seropositive for mosquito salivary gland antigens were more likely to seroconvert to St. Louis encephalitis virus than those seronegative for salivary gland antigens. Flocks with mosquito traps located < 50 feet away had a reduced antibody response to mosquito salivary gland antigens. The use of sentinel chickens and mosquito traps for arboviral surveillance should be standardized to ensure that surveillance data from different sites are comparable and that flocks have comparable opportunities for mosquito exposure. Sentinel chickens should be accessible to potential mosquito vectors to maximize their sensitivity for detecting arboviral activity.

Animals↗

PubMed2005

Clinical, epidemiologic, and environmental surveillance for ehrlichiosis and anaplasmosis in an endemic area of northern California.

Two forms of tick-borne leukocytotropic rickettsioses have been recognized in California since the mid-1990s: human monocytic ehrlichiosis (HME) caused by Ehrlichia chaffeensis and human granulocytic anaplasmosis (HGA) caused by Anaplasma phagocytophilum. Between 1997 and 1999, two cases of HME and four cases of HGA were diagnosed in residents of southern Humboldt County, California. Environmental followup at case-patients' residences revealed dense populations of Ixodes pacificus ticks, particularly in grassy roadside areas. PCR evidence of A. phagocytophilum was detected in approximately 2.0% of I. pacificus; E. chaffeensis was not detected in any of 625 ticks tested. Serologic antibody to A. phagocytophilum was detected in two of 54 participants in a community epidemiologic study; one of these also had antibody to E. chaffeensis. Over 85% of study participants reported finding a tick on themselves in the preceding 12 mo. Residents of southern Humboldt County are at significant risk of tick bites and should take appropriate prevention measures to avoid infection with rickettsia and other tick-transmitted pathogens.

Adolescent↗

PubMed2005

Investigation of human contacts: a Mycobacterium bovis outbreak among cattle at a California dairy.

BACKGROUND: In May 2002, a Mycobacterium bovis outbreak occurred among cattle at a California dairy. We investigated to determine whether persons were infected after working with the cattle or drinking their raw milk. METHODS: We identified persons with potential contact with infected cattle, including dairy workers, their family members, and slaughterhouse workers. Persons were given a tuberculin skin test (TST), and their occupational and milk-drinking habits were recorded. RESULTS: Of 88 potential contacts, 78 (90%) were given a TST; 33 (43%) had positive TST results, of whom 32 were Mexican-born (RR 15.8, 95%CI 2.3-108.8). No persons had active tuberculosis. Eighteen (72%) dairy workers, 11 (27%) family members, and four (33%) slaughterhouse workers had positive TST results. After adjusting for Mexican-birth and age, dairy workers were no more likely to have positive TST results than others (adjusted RR 1.2, 95%CI 0.6-2.1). Forty-one (62%) dairy staff and their family members drank raw milk from the dairy; 21 (51%) had positive TST results and were Mexican-born. All 13 US-born raw milk drinkers had negative TST results. CONCLUSION: A high prevalence of positive TST results was documented among workers at the affected dairy, although results were not independently associated with contact with infected cattle or milk products. Further assessment of California dairy workers should be considered.

Agricultural Workers' Diseases↗

PubMed1992

Human rabies--California, 1992.

On May 8, 1992, an 11-year-old boy died of rabies encephalitis in Fresno County, California. This was the 10th case of human rabies in the United States since 1980 known to be acquired outside the country and the first case reported in California since 1987. This report summarizes the investigation of the case.

California↗

PubMed2005

Agricultural pesticides and lymphoproliferative childhood cancer in California.

OBJECTIVES: This study evaluated whether the rates of lymphoproliferative malignancies among children are elevated in areas of intensive agricultural pesticide use in the state of California in the United States. METHODS: The study included all newly diagnosed, statewide cases of childhood lymphoma and acute lymphoblastic leukemia in 1988-1994 among children aged <15 years. Of the 2642 cases (over 6.6 million children in California and 46 million child-years of observation) during this period, 2570 (97.3%) could be successfully geocoded for the analyses. An a priori classification of the >850 chemical agents reported in use during the study was developed by assigning the agents to eight chemical groupings of interest and identifying seven individual high-use agents with high potential toxicity. Rate ratios for neighborhood (block group) levels of pesticide use were estimated with a Poisson regression and adjustment for age, race and ethnicity, and gender. RESULTS: The rates of childhood lymphoma and leukemia were not generally higher in high pesticide-use areas. Those of Hodgkin's disease, although based on small numbers (N=258), were slightly elevated in the areas with the highest use of several pesticide groupings. CONCLUSIONS: The generally null results in this study systematically examining the risk relationships for residential proximity to agricultural pesticide use stand in contrast to existing epidemiologic literature suggesting elevated childhood cancer risks from reported household pesticide use. These differences may be due to different chemical agents or to differences in indoor versus outdoor exposure potential or both. Future studies should use refined methods that better characterize the exposure potential for children to these agents.

California↗

PubMed2005

Changes in the newborn delivery practice and neonatal outcomes as financing changed in Los Angeles County and Orange County, California.

The objective of this investigation was to study changes in newborn delivery during a period of extensive changes in financing mechanisms in Los Angeles County (LAC) and Orange County (OC), California. California hospital discharge data (1990-1999) were used for the analyses. The Herfindahl-Hirschman Index (HHI) was calculated to measure the distribution of newborn deliveries among hospitals. Birth outcomes, including cesarean section rates, in-hospital deaths, interhospital transfers, and selected neonatal morbidities, were assessed. A total of 2,351,209 newborn deliveries in 124 hospitals were recorded. The number of newborn babies delivered per year decreased by 21% during the study period. A dramatic decline in the number of deliveries (up to 80%) was seen in all four LAC county hospitals. The cesarean section rate increased for Medi-Cal patients during the study period, compared with no change in the rate for privately insured patients. The newborn interhospital transfer rate for patients in LAC remained unchanged. The newborn in-hospital mortality rates for both LAC and OC decreased during the study period.

California↗

PubMed1992

Cysticercosis: first 12 months of reporting in California.

Cysticercosis, a sometimes fatal ailment caused by larvae of the pork tapeworm Taenia solium, became a reportable disease in California in 1989. During the first year, from 1 April 1989 through 31 March 1990, 134 cases were reported to the California Department of Health Services. All of the 112 patients for whom laboratory diagnostic test data were obtained had neurocysticercosis. Nearly all (117) of the 127 patients whose race and ethnic background were known had a Hispanic background, and most of the 112 patients whose country of birth or prior residence was known had immigrated from T. solium-endemic countries. However, three of 11 patients born in the United States said they had never traveled outside the country, and it appears possible that indigenous transmission has been occurring. These findings affirm that neurocysticercosis should be included in the differential diagnosis of neurologic symptoms in patients who have immigrated from or traveled to T. solium-endemic countries, and also in those who have been in close contact with immigrants from endemic countries.

Adolescent↗

PubMed1992

Protection from environmental tobacco smoke in California. The case for a smoke-free workplace.

OBJECTIVE: To determine the extent of exposure of nonsmoking indoor workers to environmental tobacco smoke (ETS) according to type of work-site smoking policy, work area, workplace size, and demographic characteristics. DESIGN AND PARTICIPANTS: Participants included 7162 adult, nonsmoking, indoor workers who were interviewed as part of the 1990 California Tobacco Survey. Respondents were asked whether anyone had smoked in their work area within the past 2 weeks. RESULTS: An estimated 2.2 million California nonsmokers were exposed to tobacco smoke at indoor work sites in 1990. Nonsmoker exposure to ETS was 9.3% for those working in a smoke-free worksite, 23.2% for those working where there was only a work-area restriction, 46.7% for those working where there was a policy that did not include the work area, and 51.4% for those working where there was no work-site smoking policy. After adjustment for type of work area (eg, office, open area), workplace size, and demographic factors, it was determined that nonsmokers working where there was only a work-area ban were 2.8 times more likely to be exposed to ETS than those working in a smoke-free work site. In workplaces with no policy or a policy not covering the work area, nonsmokers were over eight times more likely to be exposed to ETS than those who worked in a smoke-free work site. Nonsmokers who were 18 to 24 years of age, male, or Hispanic, and those with less than a high school education had more exposure to ETS. CONCLUSION: These results indicate that adequate protection of nonsmokers from ETS exposure requires a smoke-free work site.

Adolescent↗