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PubMed1996

Driving and dementia California's approach to a medical and policy dilemma.

The cognitive impairment that defines dementia is thought to place affected persons at increased risk for unsafe driving. Nevertheless, many persons with dementia continue to drive after the onset of their illness. Since 1988 California physicians have been required to report older persons with Alzheimer's disease and related disorders to their local health departments, information that is then reported to the Department of Motor Vehicles (DMV). To reevaluate how it acts on this information, the DMV convened an interdisciplinary panel of experts and modified its policies regarding drivers with dementia. As revised, the driver's licenses of persons with moderate or advanced dementia will be revoked without further testing. Persons with early or mild dementia will have the opportunity to demonstrate the capacity to drive through a reexamination process. In this manner, the California DMV hopes to balance the need for public safety and with the preservation of personal independence of persons with dementia.

Alzheimer Disease↗
PubMedDate not supplied

Personal exposure to airborne particles and metals: results from the Particle TEAM study in Riverside, California.

The PTEAM Study was the first large-scale probability-based study of personal exposure to particles. Sponsored by the U.S. Environmental Protection Agency (EPA) and the Air Resources Board of California, it was carried out by the Research Triangle Institute (RTI) and the Harvard University School of Public Health (HSPH). HSPH designed and constructed a 4-lpm, battery-operated personal monitor for inhalable particles (PM10) that could be worn comfortably for up to 14 hours by persons from 10 to 70 years old. The monitor was worn for two consecutive 12-hour periods (day and night) during the fall of 1990 by 178 participants representing 139,000 nonsmoking residents of Riverside, California. Nearly identical monitors were employed to collect concurrent indoor and outdoor samples. The monitors were equipped with a different sampling nozzle to collect fine particles (PM2.5). Population-weighted daytime personal PM10 exposures averaged 150 +/- 9 (SE) micrograms/m3, compared to concurrent indoor and outdoor concentrations of 95 +/- 6 micrograms/m3. This suggested the existence of excess mass near the person, a "personal cloud" that appeared related to personal activities. Fourteen of 15 prevalent elements also were evaluated in the personal samples. The two major indoor sources of indoor particles were smoking and cooking; even in these homes, however, more than half of the indoor particles came from outdoors, and a substantial portion of the indoor particles were of undetermined indoor origin. Outdoor concentrations near the homes were well correlated with outdoor concentrations at the central site, supporting the idea of using the central site as an indicator of of ambient concentrations over a wider area. Indoor concentrations were only weakly correlated with outdoor concentrations, however, and personal exposures were even more poorly correlated with outdoor concentrations. Elemental profiles were obtained for environmental tobacco smoke (ETS) (major contributions from potassium and chlorine) and cooking emissions (aluminum, iron, calcium, and chlorine). These profiles can be used in future source apportionment studies.

Adolescent↗
PubMedDate not supplied

Medicaid coverage of maternity care for aliens in California.

The quantity and cost-effectiveness of prenatal care is a critical reproductive health issue as federal and state legislators consider reducing publicly funded services to aliens. An analysis of data from medi-Cal, California's Medicaid program, shows that undocumented and legalized aliens who qualified for coverage under the provisions of federal legislation or the state's expansion of eligibility criteria accounted for 45% of deliveries financed by Medi-Cal in 1991; outlays for these deliveries are estimated at less than 2% of all Medi-Cal payments for that year. Most of these women also received prenatal care covered by Medi-Cal, but more than half were not enrolled in the program until after the first trimester of pregnancy (and thus may not have received adequate prenatal care). Alien women were enrolled for an average of 5-6 months of their pregnancy, whereas nonalien women who qualified for coverage were enrolled for about seven months. California's Proposition 187 would eliminate funding for prenatal care for undocumented aliens, but public outlays for labor and delivery could grow as a result of an increase in poor birth outcomes.

Adolescent↗
PubMed1996

Patient and smoking patterns in northern California American Indian Clinics. Urban and rural contrasts.

BACKGROUND: This article elaborates on an earlier article about a smoking cessation program conducted in Northern California Indian clinics. Whereas the previous article discussed Indian smoking rates in general, this article compares the smoking patterns of Indians who live in urban and rural settings. The differences between the two populations are described, and the implications of these differences for planning, policy, and education are discussed. METHODS: A self-report questionnaire was administered to 1369 adult Indians seeking health services at 18 American Indian health care clinics in Northern California. Data were collected on demographic characteristics; smoking behaviors; readiness to quit smoking; knowledge, behavior, and attitude; and a social support and "hassles" measures. RESULTS: Urban Indians were more mobile and reported higher smoking rates, a higher level of education, less social support, and more hassles than rural Indians. CONCLUSIONS: Indians living in urban areas continue to experience a high degree of stress. Long-term isolation from reservations and traditional homelands may have contributed to the breakdown of social support systems among urban Indians. These and several other factors should be considered when designing tobacco control programs.

Adult↗
PubMed1996

Prevalence of ocular disorders among 6- and 7-year-olds in Santa Monica, California.

BACKGROUND: Undetected ocular disorders can cause serious problems in a child's mental and social development. METHODS: To investigate relationships between ocular disease, gender and ethnicity in children, vision screening examination data was analyzed from the UCLA Mobile Eye Clinic (MEC), collected from 1985 to 1990 on first graders (69.9 percent 6- and 30.1 percent 7-year-olds) in Santa Monica, California. RESULTS: The sample consisted of 1,469 individuals, of whom 48.1 percent were female and 51.9 percent were male. Ethnicity data was available from 1988 to 1990 on 834 individuals, of whom 46.9 percent were Hispanic, 27.9 percent were White. 11.5 percent were Black, 4.4 percent were Asian, and 9.2 percent were of other races. Significantly more females than males had refractive errors, specifically hyperopia and astigmatism, and uncorrected visual acuity of 20/50 or worse in at least one eye. There were no significant associations of ethnicity or sex with any other disease category. The overall prevalences of other diseases were less than 4 percent. Of the 6- and 7-year-olds studied in Santa Monica, California, 18.5 percent had refractive errors. CONCLUSIONS: Screening for ocular disorders at an early age allows for detection of problems, especially refractive errors, that might affect school performance if uncorrected.

California↗
PubMed1996

Update: mercury poisoning associated with beauty cream--Arizona, California, New Mexico, and Texas, 1996.

During September 1995-May 1996, the Texas Department of Health (TDH), the New Mexico Department of Health (NMDH), and the San Diego County (California) Health Department investigated three cases of mercury poisoning associated with the use of a mercury-containing beauty cream produced in Mexico. The ongoing investigation has found this product in shops and flea markets in the United States located near the U.S.-Mexico border, and a U.S. distributor has been identified in Los Angeles. The cream, marketed as "Crema de Belleza--Manning" for skin cleansing and prevention of acne, listed "calomel" (mercurous chloride [Hg2Cl2]) as an ingredient and contained 6% to 10% mercury by weight. This report presents findings of a continuing investigation by these health departments, the Arizona Dept of Health Services (ADHS), California State Department of Health Services (CSDHS), the Food and Drug Administration (FDA), and CDC.

Adolescent↗
PubMed1996

Sir William Macewen's visit to California as the First Lane Medical Lecturer. A centennial celebration.

1996 marked the centennial anniversary of the 1896 visit to California of William Macewen, MD, Regius Professor of Surgery of the University of Glasgow, Scotland, to give the first Lane Medical Lectures. I describe the origins of this historic lecture series and include photographic records. The progress and development of modern California medicine have been greatly influenced by the personalities who initiated and nurtured this lecture series.

California↗
PubMedDate not supplied

Swimming pool drownings and near-drownings among California preschoolers.

OBJECTIVE: To describe a significant but poorly understood public health problem, the authors compiled data on swimming pool drownings and near-drownings requiring hospitalization for California children ages 1 to 4. METHODS: Data from death certificates were used to analyze swimming pool drownings, and hospital discharge data were used to analyze near-drownings. RESULTS: Among California preschoolers in 1993, pool immersion incidents were the leading cause of injury death and the eighth leading cause of injuries leading to hospitalization. Rates per 100,000 population were 3.2 for fatalities and 11.2 for nonfatal incidents, with a fatality-to-case ratio of 1:3.5. Total charges for initial hospital stays (excluding physicians' fees) were $5.2 million for 1227 hospital days. CONCLUSIONS: Swimming pools remain a serious hazard for young children. Primary prevention continues to be an important public health goal. Public health officials should support the adoption of laws designed to protect children from drowning and near-drownings.

Age Distribution↗
PubMed1996

Ecology of mosquitoes and lack of arbovirus activity at Morro Bay, San Luis Obispo County, California.

During 1994-95, totals of 17,656 adult females and 111,104 adults reared from field-collected immatures comprising 19 species in 4 genera of mosquitoes were collected from Morro Bay estuary and surrounding environs in San Luis Obispo County, California. Aedes dorsalis was the dominant summer mosquito, whereas Aedes squamiger and Ae. washinoi were abundant during winter and early spring. Host-seeking Culex tarsalis were collected infrequently, even though immatures were collected frequently from freshwater surface pools. Overall, 13,561 adults (386 pools) and 91,547 adults reared from field-collected immatures (3,027 pools) were tested for arboviruses by plaque assay in Vero cell culture. Morro Bay virus, a member of the California serogroup, was isolated from 4 pools of Ae. squamiger reared from field-collected immatures (minimum field infection rate-1.07 per 1,000), verifying the maintenance of this virus by vertical transmission. All remaining pools were negative. Three flocks of 10 sentinel chickens and one group of 5 sentinel rabbits were bled biweekly and tested for arbovirus antibodies with negative results. Neither horizontal nor vertical transmission of western equine encephalomyelitis virus was detected.

Aedes↗
PubMed1997

Effect of California's proposition 187 on the use of primary care clinics.

California's ballot proposition 187, passed by the voters in November 1994, threatened to discontinue undocumented immigrants' eligibility for most health services while mandating that health care professionals report suspected undocumented patients to authorities. Although the proposition has not been put into practice, reports suggest that its passage was associated with a decline in the use of health services by some groups. To assess the effects of the passage of Proposition 187 on the use of primary care services, we surveyed a representative sample of California clinics serving low-income groups (n = 129). Using a mailed questionnaire and phone interviews with clinic directors, we obtained qualitative and quantitative data regarding the effects of the passage of the proposition on clinic use. Among primary care clinics statewide and clinics serving predominantly Latino patients, we detected no significant decline in total monthly visits following the election. Nevertheless, half of clinic directors (51%) thought that the number of clinic visits declined after the passage of Proposition 187, and many directors thought that the deterrent effects of the election persisted for weeks to months after the election. Whereas the number of visits probably declined at some clinics, only a small minority of patients at most primary care clinics could have been deterred from seeking care after the passage of Proposition 187.

California↗
PubMedDate not supplied

Pesticide exposures to children from California's Central Valley: results of a pilot study.

In response to concerns about pesticide use and evidence that contaminants may accumulate in house dust, the California Department of Health Services (DHS) conducted a pilot study of pesticide contamination in rural children's home environments. House dust samples for pesticide analysis were collected from eleven homes, five of which had at least one farmworker (FW) resident. Handwipe samples were collected from one child at each residence (ages 1-3 years). Ten of 33 pesticides tested in house dust were detected. Excluding non-detects, concentrations for diazinon ranged from 0.7-169 ppm in four FW homes and 0.2-2.5 ppm in three non-farmworker (NFW) homes (overall median = 1 ppm), suggesting a difference between FW and NFW homes. Chlorpyrifos ranged from 0.2-33 ppm in three FW homes and < 1 ppm in two NFW homes (overall median < 0.5 ppm). All other pesticides were detected at < 2 ppm at four or fewer homes. The sources of these compounds could not be determined. Co-located samples were considerably different in concentration and loading, indicating intra-household variation. Of nine compounds tested, diazinon and chlorpyrifos were found on the hands of two or three FW children (20-220 ng/hand). Dust ingestion scenarios show child exposures could exceed the United States Environmental Protection Agency Office of Pesticide Program diazinon chronic reference dose (9 x 10(5) mg/kg/day). The results suggested that pesticide residues are present in the home environment of some California children and are likely to contribute to exposures. Additional research is feasible and needed to assess the magnitude and distribution of these risks.

Administration, Oral↗
PubMed1997

An overview of plague in the United States and a report of investigations of two human cases in Kern county, California, 1995.

Plague was confirmed in the United States from nine western states during 1995. Evidence of Yersinia pestis infection was identified in 28 species of wild or domestic mammals. Thirteen of the plague positive species were wild rodents; 15 were predators/carnivores. Yersinia pestis was isolated from eight species of fleas. Seven confirmed cases of human plague were reported in 1995 (New Mexico 3; California 2; Arizona and Oregon 1 each). Five of the seven cases were bubonic; one was septicemic and one a fatal pneumonic case. Months of onset ranged from March through August. In California, during 1995, plague was recorded from 15 of the 58 counties. Over 1,500 animals were tested, of which 208 were plague positive. These included 144 rodents and 64 predators/carnivores. Two confirmed human cases (one bubonic and one fatal pneumonic) occurred, both in Kern County. Case No. 1 was reported from the town of Tehachapi. The patient, a 23 year-old male resident, died following a diagnosis of plague pneumonia. The patient's source of plague infection could not be determined precisely. Field investigations revealed an extensive plague epizootic surrounding Tehachapi, an area of approximately 500-600 square miles (800-970 square kilometers). Case No. 2 was a 57 year-old female diagnosed with bubonic plague; she was placed on an antibiotic regimen and subsequently recovered. The patient lives approximately 20 miles (32 km) north of Tehachapi. Field investigations revealed evidence of a plague epizootic in the vicinity of the victim's residence and adjacent areas. Overall results of the joint field investigations throughout the entire Kern county area revealed a high rate of plague positive animals. Of the numerous samples submitted, 48 non-human samples were plague positive.

Adult↗
PubMed1997

Small group reform in a competitive managed care market: the case of California, 1993 to 1995.

State-level insurance reforms designed to make health insurance more accessible for small businesses and their employees have become common in the 1990s. This study examines the effects of small group reform legislation enacted in California in 1993. Using survey data on health benefits in small firms, we look at changes in health insurance coverage that occurred between spring 1993 (just before reform) and spring 1995. Our results indicate that insurance became slightly more affordable and, among businesses with three to nine employees, employer provision increased more than 10 percentage points. Provision was unchanged among larger-sized businesses, however. Managed care penetration increased considerably. We argue that California's competitive health insurance market, which already was dominated by managed care, represented a favorable environment for small group reform. In this context, the modest growth in insurance provision highlights the limited potential of incremental reforms for expanding insurance coverage.

California↗
PubMed1997

Ranging of male Oropsylla montana fleas via male California ground squirrel (Spermophilus beecheyi) juveniles.

We asked if fleas more frequently remain on those California ground squirrels (Spermophilus beecheyi) that are likely to emigrate from their natal nest. In Camp Ohlone, Alameda County, California, juvenile male squirrels were infested with more fleas (Oropsylla montana) than were juvenile females, and juveniles of both sexes were infested with more fleas (O. montana and Hoplopsyllus anomalus) than adults. There was no difference between the adult sexes in the number of fleas. The disproportionate infestation of male juveniles was accounted for almost exclusively by male O. montana. Greater activity on the part of juvenile males did not account for this difference; the activity of male and female juveniles was very similar. As yearlings, male squirrels established home ranges at greater distances from the natal burrow than did females. Remaining on ranging male squirrels might help male fleas find nonsibling mates in new nests, whereas female fleas might tend to stay in the natal nest in order to assure their progeny of its resources. Flea behavior, modified by characteristics of the host that are sex-specific and predictive of future traits, such as the tendency to range, may thus determine the nature and extent of infestations in juvenile squirrels.

Age Factors↗
PubMed1996

Dental public health in California: a view of the future.

This article has described two recent successful initiatives that have utilized the unique knowledge and skills of dental public health specialists--the enactment of California's new fluoridation law and the first oral health needs assessment of California children--as examples of the types of activities in which practitioners of this specialty of dentistry are engaged on a day-to-day basis. It has also underscored how dental public health can be considered not only a specialty of dentistry, but also a specialty of the broader field of public health, as a result of its mission to assure, promote and protect the oral health of communities. We believe that assuring the oral health of Californians and the nation is far too large an undertaking for any one group or organization. The individual orientation of dental clinicians and the community orientation of dental public health practitioners will both be needed, as will be the collaboration of many other individuals and organizations, if we are to look forward to the 21st century as one in which barriers to oral health are overcome, oral diseases become distant memories, and Americans can look forward to a lifetime of oral health.

Adolescent↗
PubMed1998

Population growth and air quality in California.

Demographers are often interested in the environmental impacts of population growth. I examine the impact of growth specifically on air quality in California. In recent decades, California has suffered from notoriously polluted air and has experienced rapid population growth. Despite the population growth, air quality actually has improved since the early 1980s due to aggressive regulatory efforts. Using data for 56 counties, I analyze the contribution of population growth to trends in atmospheric emissions of five regulated pollutants from 1980 to 1990, controlling for trends in per capita income and regulatory efforts. The analysis is disaggregated by source of emissions and demonstrates that population growth is strongly associated with some sources of emissions but not with others. Thus, the overall impact of population growth depends upon the composition of production and consumption activities in each county. I also explore whether the trend in number of households predicts better than the trend in number of persons, and whether the impact of population growth depends upon the age structure or source of growth (immigration or domestic increase). Generally, these alternative specifications of population do not improve the models of atmospheric emissions.

Air Pollution↗
PubMed1998

Mortality among children with sickle cell disease identified by newborn screening during 1990-1994--California, Illinois, and New York.

Sickle cell disease (SCD) is an autosomal recessive disorder characterized by production of abnormal (sickle) hemoglobin, resulting in anemia, susceptibility to pneumococcal and other infections, pain, stroke, and multiple organ dysfunctions. The most common types include hemoglobin SS (homozygous) disease, sickle cell-hemoglobin C disease, and the sickle beta-thalassemia syndromes. A randomized controlled trial published in 1986 indicated that daily oral penicillin prophylaxis reduced the incidence of serious infection in young children with SCD and led to widespread adoption of newborn screening programs for SCD. To study the effectiveness and utilization of prevention programs among large populations of infants with SCD, several newborn screening programs in the United States are now attempting to determine rates of complications and actual use of early medical interventions (e.g., penicillin prophylaxis and pneumococcal vaccination). This report focuses on recent mortality in California, Illinois, and New York. In California and Illinois, mortality from all causes among black children born during 1990-1994 with SCD was slightly less than overall mortality for all black children born in the same time period.

Black People↗
PubMedDate not supplied

A survey for Salmonella by drag swabbing manure piles in California egg ranches.

A cross-sectional study was conducted between August 1995 and November 1996. Sixty California egg-producing ranches were chosen at random; 39 ranches agreed to participate in the study. The surface of the manure pile in one house on each ranch was sampled by drag swabbing. The drag swabs were tested for Salmonella using a most probable number procedure that had a detection level of one to five Salmonella per drag swab. In 12 ranches (32.4%), the drag swabs were negative for Salmonella; the remaining had Salmonella counts in the range of 1 to over 1700 per swab. Twenty-two different serotypes were found. Salmonella heidelberg and Salmonella cerro represented the majority of the typed isolates. Salmonella enteritidis (SE) was found on only one ranch. This study found SE to be rare in California egg ranches, which implies that these ranches are not a major source of S. enteritidis.

Animals↗