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PubMedDate not supplied

Changes in service availability in california hospitals, 1995 to 2002.

Hospitals face serious financial challenges in the current healthcare marketplace. In response to these challenges, they may alter their service offerings, eliminating services that are perceived as money-losing or adding new services in areas where profitability is expected to be greater. Although research has examined hospital closures, the more subtle phenomenon of hospital service changes has not been systematically studied. This issue is important because different types of hospital service changes could have different effects on hospital financial viability: extensive service closures could contribute to a downward spiral leading to hospital closure, whereas adding new services might help improve a hospital's finances. This article' examines changes in hospital service availability in California general acute care hospitals between 1995 and 2002. Our major findings indicate that many California hospitals made changes in their service offerings during the study period, although few made extensive changes. Altogether, about half of the hospitals in our study population either closed or opened at least one service. Nearly one-fourth of the hospitals in our study population closed one or more services, whereas just under one-third opened one or more new services. However, the vast majority of the hospitals that closed or added a service made only one or two such changes. In addition, few hospitals both closed and opened services. The service closed most frequently was normal newborn labor and delivery (obstetrics), whereas inpatient rehabilitation was the most frequently opened service. Hospitals that made the most service changes tended to be small, rural, and financially troubled at the start of the study period. Among this group of hospitals, service closures were associated with continued financial deterioration, whereas new service openings were associated with improvements in key financial ratios.

California↗
PubMed2006

Pyrethroid illnesses in California, 1996-2002.

This survey summarizes California's recent experience with illnesses related to pyrethroid exposures and augments the data available on pyrethroid inhalation exposure and residue dissipation. We reviewed California Department of Pesticide Regulation (DPR) Pesticide Illness Surveillance Program (PISP) data and DPR Pesticide Use Reporting (PUR) data for 13 pyrethroids used during 1996-2002 and identified 317 illnesses associated with exposure. PUR found a total of 4,629,852 pound (2,100,068 kg) of the 13 active ingredients were applied during the 7 yr. Type II pyrethroids accounted for 1,979,352 (897,820 kg) and 42.7% of the total pounds applied and 220 (69.6%) of the reported illnesses. Cyfluthrin was associated with 122 cases (55% of illnesses related to type II pyrethroids and 38.4% of all pyrethroid illnesses). Agricultural uses accounted for 118 (37.3%) of the reported illness cases, with 116 cases associated with employment. For the 199 cases (62.8%) associated with nonagricultural use, 132 (66.3%) were occupationally related. Overall, approximately equal numbers of illnesses resulted from individual exposures (167 cases) and group exposures (150 cases). The symptom arrays associated with the pyrethroid illnesses included irritant effects or pares- thesias of the eye, skin, or respiratory tract in 269 cases (84.9%). Type II pyrethroids were more frequently associated with isolated irritant symptoms (107 cases) than the type I pyrethroids (26 of 97 cases). Systemic symptoms were reported in 184 illnesses (58% of cases). Isolated systemic effects occurred in 48 cases (15.1%), but systemic effects were also present in 136 (50.6%) of the 269 cases with irritant symptoms. Residue exposures accounted for 158 illnesses (49.8%). Single or multiple violations of pesticide use regulations contributed to exposures in 90 of the 317 illnesses (28.4%); 76 were related to nonagricultural pyrethroid use. We also report results of DPR Worker Health and Safety Branch (WH&S) investigations of three large group illness episodes related to exposure to type II pyrethroids cyfluthrin and lambda-cyhalothrin that involved primarily respiratory irritation symptoms. An inhalation monitoring study found cyfluthrin air levels that approached experimentally established irritant thresholds for airborne cyfluthrin, from which a mean estimated absorbed dosage of 1.311 microg/kg/d was calculated. Although additional data are needed to establish threshold levels for both irritant and systemic symptoms for cyfluthrin and other pyrethroids, these observations suggest that field residues can cause irritant respiratory symptoms. DPR conducted a residue dissipation study in seven orange groves and estimated cyfluthrin residue half-lives. The dissipation rates fell into two distinct decay patterns, with more rapid decay in groves 1-4 (overall average half-life = 4.9 d) and a considerably longer decay in groves 5-7. The half-life for groves exhibiting the slower residue dissipation was not constant. The first two half-lives for groves 5-7 can be approximated; they are 11 and 32d, respectively. The third investigation involved an illness episode in which 11 raisin harvesters developed acute respiratory irritation symptoms when they were exposed to residues of lambda-cyhalothrin, propargite, and sulfur. Gas chromatography analyses of eight dislodgeable foliar residue (DFR) samples verified mean residues of lambda-cyhalothrin (0.43 +/- 0.10 microg/cm2), propargite (0.35 +/- 0.11 microg/cm2), and sulfur (0.31 +/- 0.28 microg/cm2) on the grape leaves. Subsequent investigation confirmed that the lambda-cyhalothrin product, which was not registered for use on grapes, was mistakenly mixed and applied 45 d earlier at 35 times the highest legal rate for any crop. The effects of exposure to average lambda-cyhalothrin DFR levels of 0.43 microg/cm2 have not been previously documented.

Agriculture↗
PubMed2006

Characteristics of adolescent smoking in high school students in California.

PURPOSE: This pilot study assessed smoking-related behaviors, experiences, and beliefs among a sample of continuation high school students in California to inform dental hygienists about adolescent tobacco use and to assist with the development of effective tobacco cessation intervention strategies. METHODS: After gaining informed consent, we conducted a self-administered questionnaire among 117 adolescent volunteers in rural northern California. The questionnaire assessed demographic variables, lifetime tobacco use, current alcohol use and tobacco use status, early smoking experiences and sensations, factors that might motivate a quit attempt, depression index scores, and other psychosocial variables associated with adolescent smoking. Means and frequencies were generated to evaluate characteristics of tobacco use in this sample of adolescents. Variables of interest were stratified by regular and social smokers. Univariate association of smoking with alcohol use is described by an odds ratio with a 95% confidence interval. Wilcoxon rank sum tests were used to evaluate gender differences among mean depression index scores. RESULTS: Fifty percent of subjects were current smokers, 21% had tried smoking, 5% were former smokers, and 24% had never smoked. Current smokers were 8 times more likely to drink alcohol compared to nonsmokers (OR = 8.0; 95% CI 3.1 - 21.2). Among current smokers, 32% were classified as regular smokers and 18% as social smokers. Sixty-three percent of regular smokers and 42% of social smokers reported smoking within 30 minutes of waking, an indicator of nicotine dependence. Patterns of smoking were variable in rate and frequency ranging from 1 to 30 cigarettes per day. Current female smokers scored higher on the modified Beck Depression Inventory (0-3) than current male smokers (p < 0.001). Oral health issues related to tobacco use, such as gum disease and tooth staining, were identified as factors that might motivate a quit attempt. Frequently reported reasons for use (eg, tension and craving) and reasons for relapse (eg, desire remained high, withdrawal symptoms) were related to nicotine dependence. Fifty-three percent of all smokers had tried to stop smoking but were unsuccessful. Intrapersonal characteristics such as risk-taking, rebellion, and impulsive spending appeared to be related to smoking. CONCLUSION: In this sample of adolescents, smoking patterns were variable and many adolescents experienced symptoms of nicotine dependence. The dental hygiene care appointment provides a unique opportunity to discuss oral health effects of smoking, relate oral changes to smoking, and to deliver a brief smoking cessation intervention.

Adolescent↗
PubMed2006

Dental establishment business activity in California counties at the start of the millennium.

The Bureau of the Census reports for 2002 were used to develop business data for "average" dental establishments in each of the counties in California. On average, between 1997 and 2002, when compared to national information, the number of California statewide dental establishments increased at a greater rate, had a smaller resident population per establishment, reported lower gross receipts, had fewer employees, and paid lower salaries to employees.

California↗
PubMed2006

The California Clinical Data Project: a case study in the adoption of clinical data standards for quality improvement.

The California Clinical Data Project is a statewide initiative to remove barriers to the widespread and effective use of information technology to improve chronic disease care. The project is a case study in the development and widespread adoption of clinical data standards by varied and often competing stakeholders. As an initial step, the project defined precise data standards for the batch reporting of pharmacy claims data and laboratory results data. These uniform standards facilitate the flow of existing electronic clinical information into disease registries and electronic health record systems. Pharmacy and lab results data now are being exchanged electronically with this standard among the largest health plans, medical groups, and clinical laboratories participating in California's pay-for-performance programs. Lessons from this project may apply to the development and adoption of data standards for other states and locales and for the emerging national health information infrastructure.

California↗
PubMed2006

The California Cardiac Surgery and Intervention Project: evolution of a public reporting program.

Mandatory public reporting of cardiac surgery outcomes in California was instituted in 2003. To study the impact of the program, the outcomes of coronary artery bypass graft (CABG), valve, and percutaneous coronary intervention (PCI) procedures performed after January 1, 2003 were compared with previous years using the Patient Discharge Database (PDD) of the Office of Statewide Health Planning and Development. Risk-adjusted in-hospital mortality for CABG, CABG plus valve or aneurysm, and valve procedures decreased during 2003 and 2004 compared with 1998 through 2002, and PCI mortality remained unchanged. The average annual procedural volume per hospital decreased 25 per cent (232% +/- 205% to 173% +/- 157%) for CABG and 18 per cent (310% +/- 278% to 253% +/- 235%) for all cardiac surgeries, whereas PCI increased 12 per cent (433% +/- 277% to 492% +/- 356%). During 2003 and 2004, less than one-half of the 120 hospitals performed 200 or more cardiac surgeries per year, and only 25 performed 300 or more. Higher CABG mortality was observed primarily in low-volume programs, but the relationship of volume to risk-adjusted mortality was not significant for any surgical group or for PCI. Identification of outlier status was facilitated by use of 30-day posthospital outcomes (death or reoperation) in addition to in-hospital mortality. This study suggests that the introduction of a mandatory cardiac surgery reporting program in California was associated with improved outcomes.

Angioplasty, Balloon, Coronary↗
PubMed2006

Women's health insurance coverage in California.

Health insurance coverage is a critical resource that facilitates access to the health care system and the array of health services women require across their lifespan. This policy brief provides an overview of the health insurance coverage of nonelderly women in California, based on data from the 2003 and 2001 California Health Interview Surveys (CHIS 2003, CHIS 2001).

Adolescent↗
PubMed1991

Dermatitis among workers cleaning the Sacramento River after a chemical spill--California, 1991.

On July 14, 1991, a train tanker car derailed in northern California, spilling 19,000 gallons of the soil fumigant metam sodium (sodium methyldithiocarbamate) into the Sacramento River north of Redding (Figure 1). The major breakdown product of metam sodium, methylisothiocyanate (MITC), is a known skin irritant at high concentrations (greater than 1%). By July 21, the concentration of MITC in the river, at multiple test sites, measured 20-40 parts per billion (0.01%). On August 6, Shasta County health officials notified the California Department of Health Services (CDHS) of an outbreak of dermatitis among Shasta County jail inmates and crew leaders who had assisted in removing dead fish from the river on July 21-22 in greater than 100 F (greater than 38 C) ambient temperature.

Accidents↗
PubMed1991

Does tobacco advertising target young people to start smoking? Evidence from California.

OBJECTIVE: To evaluate whether tobacco advertising encourages teenagers younger than 18 years to start smoking. DESIGN: Comparison of 1990 California telephone survey data with data from a 1986 national telephone survey (both used a random-digit dialing system); 95% confidence intervals were calculated. To test our hypothesis, we considered whether the perception of advertising was related to age, whether the pattern of market share across age and sex groups followed the pattern of perceived advertising, and whether changes in market share paralleled changes in advertising as perceived by the youngest age group. PARTICIPANTS: There were 24,296 adults and 5040 teenagers. RESULTS: The most advertised brands of cigarettes were Marlboro, according to 33.6% of adults and 41.8% of teenagers, and Camel, according to 13.7% of adults and 28.5% of teenagers--named most often by 12- to 13-year-olds (34.2%). The brands that were purchased most often were Marlboro and Camel. Together these were the brands of choice of 79.9% of males and 85% of females aged 12 through 17 years. Marlboro's market share increased in youths and young adults up to age 24 years and then decreased gradually with age; Camel's market share decreased abruptly with age: it was the brand of choice of 24.5% +/- 5.8% of males aged 12 through 17 years but was chosen by only 12.7% +/- 3.6% of males aged 18 through 24 years; for females, 21.7% +/- 13.7% aged 12 through 17 years chose Camels, while only 5.5% +/- 3.2% aged 18 through 24 years preferred this brand. Both Marlboro and Camel brands had a higher market share in California in 1990 compared with that for the United States in 1986. Of interest is that the market share for Camel increased among the younger smokers but was more evenly distributed for Marlboro. CONCLUSIONS: Perception of advertising is higher among young smokers; market-share patterns across age and sex groups follow the perceived advertising patterns; and changes in market share resulting from advertising occur mainly in younger smokers. Cigarette advertising encourages youth to smoke and should be banned.

Adolescent↗
PubMed1991

Neospora-like protozoan infection as a major cause of abortion in California dairy cattle.

Ninety-five aborted bovine fetuses received from California dairies over a 4.5-year period had histologic lesions of focal encephalitis. Protozoa that reacted with Neospora caninum antiserum were detected in the brain of 88 of these fetuses and in the heart of 1 fetus. Sarcocystis spp schizonts were seen in the vascular endothelium of 1 fetus. It was concluded that a Neospora-like cyst-forming coccidian may be a major cause of abortion in California dairy cattle.

Abortion, Veterinary↗
PubMed1990

Seroepidemiologic survey of antibodies to Ehrlichia equi in horses of northern California.

The prevalence of antibodies to Ehrlichia equi in horses from the foothill regions of northern California and from the Sacramento valley (non-foothill area) was determined, using an indirect fluorescent antibody test. Horses from foothill regions had a higher prevalence of seropositivity (10.4%) and higher titer (1:10 to 1:80) than did those from non-foothill regions (3.1%; titer less than or equal to 1:10). Fifty percent of healthy horses on a foothill farm enzootic for E equi had titer to E equi, suggesting that infection with E equi can be subclinical. Six veterinarians surveyed from northern California diagnosed clinical E equi infection in 38 horses during 1985-1986 based on clinical signs of infection and observation of E equi inclusion bodies in neutrophils on blood smears.

Animals↗
PubMed1990

Prevalence of trichomoniasis among California beef herds.

Sixty cow-half herds of more than 50 cows each were randomly selected for a prevalence survey of bovine trichomoniasis in California. Herd size, as judged by the number of bulls, ranged from 1 to 210 bulls (median = 8; mean = 59 +/- 15.8). Preputial smegma was collected from 729 bulls (median = 6 bulls/herd) and cultured for Tritrichomonas foetus. Of 57 herds from which samples were collected, 9 (15.8%) had at least one infected bull. Of the 729 bulls from which samples were cultured, 30 (4.1%) were infected. Correcting for sensitivity of the diagnostic test yielded a prevalence of 5.0%. Infection rates for bulls greater than 3 years old and less than or equal to 3 years old were 6.7% and 2.0%, respectively (P less than 0.025). Median herd sizes were 14 bulls (range, 6 to 114) for infected herds and 7 (range, 1 to 210) for uninfected herds. These findings suggest that trichomoniasis is common in California beef herds. Because several bulls less than 4 years old were infected, we suggest that control measures stressing replacement of older bulls with younger ones should be combined with diagnostic procedures in those younger replacements, to ensure that they are not already infected.

Age Factors↗
PubMed1990

Reducing tobacco consumption in California. Development of a statewide anti-tobacco use campaign.

Cigarette smoking continues to be the leading preventable cause of death in California and the United States. Although substantial progress has been made over the past 25 years, there is growing recognition of the need for large-scale efforts to reduce tobacco use. Given their central roles in implementing public health programs and their ability to reach many of the groups most at risk of tobacco use uptake and tobacco-related disease, state health agencies have an important challenge before them. This article describes the development and operation of a statewide, publicly funded anti-tobacco use campaign currently undertaken by the California Department of Health Services under the auspices of the state's Tobacco Tax and Health Promotion Act of 1988 (Proposition 99), which increased excise taxes on cigarettes by 25 cents per pack sold in the state. A discussion of problems in implementation and operation being incurred may be relevant to the planning of similar campaigns elsewhere.

Adolescent↗
PubMed1986

In California, voluntary mass prenatal screening.

A statewide program in California to detect neural tube and other birth defects may revive enthusiasm for mass prenatal screening. Participation in the program is voluntary, but all expectant mothers are asked to sign a statement of "informed consent/refusal." So far California's program seems to be working well, but questions for the future include the level of participation, the possibility that normal fetuses will be aborted, the kinds of information given to women, and the elusive nature of free choice.

California↗
PubMed1989

Free-standing birth centers in California. Program and medical outcome.

During 1985, 25 free-standing birth centers (FSBCs) were operating in California. All had a written or verbal backup agreement with a hospital that averaged six minutes away from the center. Seventy-four percent of the deliveries in these centers were attended by obstetricians, 6% by certified nurse-midwives, less than 1% by family physicians and 19% by a team of physicians and midwives. Between 1979 and 1985, over 10,000 women were admitted in labor in California FSBCs. Medical outcome data were collected for 1984 and 1985. The medical outcome for births in these centers demonstrates that FSBCs, while existing under the aegis of an "alternative" philosophy, are associated with a low cesarean section rate, low neonatal mortality and no neonatal mortality.

California↗
PubMed1989

Mortality from unintentional injuries in California, 1985.

In 1985 unintentional injuries were the fourth leading cause of death among California residents, causing 10,380 deaths. They were the leading cause of potential life lost, accounting for 278,109 years lost. This was more than twice the number of years lost due to heart disease and 1 1/2 times the number lost due to cancer. Motor vehicle traffic accidents were the leading cause of unintentional injury deaths, accounting for half (5,158) the deaths. The next two leading causes were poisoning (especially for men aged 25 to 44 years) and falls (especially among persons aged 75 and older). Drowning was second to motor vehicle accidents as a cause of death in children aged 1 to 14 years. California's age-adjusted injury mortality rates in 1985 were lower in coastal and urban counties than in inland and rural counties, and these rates were generally lower in counties having organized systems of trauma care.

Accidents↗
PubMed1989

Pharmacist-managed drug therapy in California hospitals.

To assess the effect of state legislation expanding the scope of pharmacy practice in health-care institutions, California hospitals were surveyed in 1982 and 1986 about pharmacists' regulation of drug therapy. Questionnaires were mailed to pharmacy directors at all hospitals in the state. The survey form explained that in pharmacist-regulated drug therapy, the pharmacist, under order or authorization of the prescriber, requests laboratory tests and initiates or adjusts drug dosage to obtain the desired therapeutic response; the questions were based on this definition. The response rates were 51.4% (292 of 568) in 1982 and 56.2% (329 of 585) in 1986. For the responding hospitals of most sizes and types, the percentage having pharmacist regulation of drug therapy increased; the largest increase was in the for-profit chain hospitals. In 1986, pharmacists were involved in regulating maintenance dosages in more than half of the responding hospitals (from 52% of hospitals with 50 or fewer beds to 86% of hospitals with 400-499 beds). The responses indicated that at least 50% of patients receiving aminoglycoside or warfarin therapy or total parenteral nutrition had their maintenance dosages regulated by pharmacists. The two surveys indicate that between 1982 and 1986 pharmacists became more involved in regulating drug therapy in California hospitals.

California↗
PubMed1989

Marketing smokeless tobacco in California communities: implications for health education.

In the first phase of a 5-year research project aimed at curtailing smokeless tobacco use among youth, we examined the marketing of smokeless tobacco within California. Observational data were collected from almost 200 retail stores located near high schools and colleges in 14 California counties. Interviews were conducted with over 100 school personnel and youth leaders in 13 counties and with seven retailers from 4 counties. Overall, 81% of the stores in the sample carried smokeless tobacco, and even in urban areas most stores (71%) had these products for sale. Urban stores were more likely to have materials promoting them (e.g., posters, displays, coupon offers). Almost all (98%) stores that carried smokeless tobacco sold moist snuff. Most (78%) school personnel and youth leaders, especially in urban areas, were aware of advertisements for it, particularly on television and in magazines. Rogers' theory regarding the diffusion of innovations was the basis of the discussion of our results. The implications of marketing for the development of health education programs are examined.

Adolescent↗