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San Diego is located within the geographic distribution of known occurrence of Coccidioides immitis contamination of the soil. Forty-five to fifty-five cases are diagnosed in San Diego hospitals each year. Skin tests were administered to one thousand and twenty-seven ninth grade students in five selected San Diego schools. Coccidioidin 1:100 was administered by Mantoux technique, intradermally. Induration was measured at forty-eight hours. Greater than 5 mm of induration was noted in 9.7% of students tested. Among 378 students who had been lifelong residents of San Diego County, 7% had greater than 5 mm of induration. Coccidioidomycosis is endemic in San Diego but the level of endemicity is rather modest.
San Diego gynecologists were surveyed to determine 1985 prescribing patterns and indications for postmenopausal estrogens. More than 75% of the 103 respondents indicated that they prescribed estrogen for at least 75% of their recently postmenopausal patients, usually for a prolonged period. The dose and duration of estrogen were those recommended to prevent osteoporosis, which was given by all but one physician as a major indication for estrogen use. Only five gynecologists prescribed estrogen without a progestin, which was added primarily to reduce the risk of estrogen-associated endometrial cancer. These data suggest that San Diego gynecologists are well informed about the risks and benefits of estrogen-replacement therapy and are less concerned about the paucity of data concerning long-term progestin use in older women.
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In San Diego County, California, 11 species of ixodid ticks were collected from vegetation and/or from small and large mammals, and/or found parasitizing humans. Adults of the Pacific Coast tick, Dermacentor occidentalis, were the most abundant tick collected from vegetation, with peak numbers occurring during March and April. Adults of the Western black-legged tick, Ixodes pacificus, were the second most abundant, with peaks occurring during February and March. Eight species of ticks were found on mammals, with D. occidentalis being the most abundant. Adults of this tick were found primarily on black-tailed deer, Odocoileus hemionus columbianus. Nymphs occurred mostly on larger rodents, particularly the dusky-footed wood rat, Neotoma fuscipes, while larvae preferred mice. Ixodes pacificus was the second most abundant on hosts. Adults of this tick were found mostly on larger mammals, such as carnivores and deer. Nymphs preferred larger rodents, and larvae primarily mice. Five tick species were found on humans. Adults of I. pacificus, mostly females, were the most prevalent and occurred mostly (80.1%) on individuals during October-March, followed by those of Dermacentor variabilis which were found primarily (95.0%) during April-September. Adults of D. occidentalis were the third most prevalent, being found mostly (96.0%) on humans during January-June. Of the ten species of ticks endemic to California found during the survey, two (Ixodes sculptus and Ixodes woodi), have not been previously recorded from San Diego County.
An empirical study was undertaken in San Diego, California, to test assumptions made by the government and by conservative religious policy advocates that there is a greater incidence of crime in the vicinity of peep show establishments. We asked two questions: (a) Is criminal activity in San Diego particularly acute at peep show establishments compared to surrounding control locations? and (b) Is criminal activity in San Diego disproportionately greater at or near peep show establishments between the hours of 2 a.m. and 6 a.m. compared to other times of the day? The levels of crime activity and the expenditure of police resources were examined by measuring the number of calls-for-service (CFSs) to the police within a 1,000-ft. area on either side of the peep show establishments and comparably-sized control areas beyond the immediate 1,000-foot area. A more focused late-night (2 a.m. to 6 a.m.) analysis was also undertaken. The results showed no reliable evidence of differences in crime levels between the control and test areas, nor was there any evidence of disproportionately greater amounts of crime within the 2 a.m. to 6 a.m. time period in the areas surrounding the peep show establishments. We concluded that San Diego does not have a problem with crime at the peep show establishments generally, nor is there a heightened problem with crime during the 2 a.m. to 6 a.m. period. We discuss the implications of assuming that peep show establishments are associated with negative effects in the community and the possibility of viewpoint discrimination against sex communication.
OBJECTIVES: Source case finding in San Diego, California, rarely detects the source for children with tuberculosis (TB) infection or disease. One third of all pediatric TB isolates in San Diego are Mycobacterium bovis, a strain associated with raw dairy products. This study was conducted to determine risk factors for TB infection in San Diego. DESIGN: Case-control study of children </=5 years old screened for TB as part of routine health care visit. Asymptomatic children with a positive (>/=10 mm) Mantoux skin test (TST) were matched by age to 1 to 2 children with negative TST from the same clinic. We assessed risk factors for TB infection through parental interview and chart review. RESULTS: A total of 62 cases and 97 controls were enrolled. Eleven cases and 25 controls were excluded from analysis because of previous positive skin tests. Compared with controls, cases were more likely to have received BCG vaccine (73% vs 7%, odds ratio [OR] 44), to be foreign born (35% vs 11%, OR 4.3), and to have eaten raw milk or cheese (21% vs 8%, OR 3.76). The median time between the most recent previous TST and the current test was 12 months for cases and 25 months for controls. Other factors associated with a positive TST included foreign travel, staying in a home while out of the country, and having a relative with a positive TST. There was no association between contact with a known TB case. In a multivariable model, receipt of BCG, contact with a relative with a positive TST, and having a previous TST within the past year were independently associated with TB infection. CONCLUSIONS: We identified several new or reemerging associations with positive TST including cross border travel, staying in a foreign home, and eating raw dairy products. The strong associations with BCG receipt and more recent previous TST may represent falsely positive reactions, booster phenomena, or may be markers for a population that is truly at greater risk for TB infection. Unlike studies conducted in nonborder areas, we found no association between positive TB skin tests and contact with a TB case or a foreign visitor. Efforts to control pediatric TB in San Diego need to address local risk factors including consumption of unpasteurized dairy products and cross-border travel. The interpretation of a positive TST in a young child in San Diego who has received BCG is problematic.
BACKGROUND: Diabetes risk increases as immigrant populations adopt western lifestyles. We compared the prevalence of fasting hyperglycemia among Filipino women aged 40-79 years in the Philippines, Hawaii, and San Diego. METHODS: Data were obtained from the (1) Philippine National Nutrition Survey (1998), (2) Native Hawaiian Health Research Project (1997-2001), and (3) University of California San Diego Filipino Women's Health Study (1995-1999). Fasting glucose after an 8h fast, blood pressure, and body mass index (BMI) were measured in all three regions; a 75 g oral glucose tolerance test was performed in San Diego and Hawaii. RESULTS: The proportion of Filipinas with BMI > or = 30 kg/m2 was higher in Hawaii (20%) compared to women in San Diego (9.3%) or the Philippines (5.2%, p<0.001). Fasting hyperglycemia prevalence (fasting plasma glucose > or = 126 mg/dl or fasting whole blood glucose > or = 110 mg/dl) did not differ among Filipinas in the Philippines (11.8%), San Diego (14.1%), and Hawaii (14.7%, p = 0.323). Type 2 diabetes prevalence was similar among Filipinas in San Diego (31.6%) and Hawaii (24.9%, p = 0.79). CONCLUSIONS: Despite regional differences in obesity, fasting hyperglycemia was similar among Filipinas in the Philippines, San Diego, and Hawaii and type 2 diabetes prevalence was similar among Filipinas in San Diego and Hawaii.
San Diego Bay is heavily contaminated with metals, but little is known about their biological availability to local marine organisms. This study on 15 elements showed that concentrations of metals associated with sediment increased from the mouth to the back of the Bay while metals in seawater particulates were similar throughout the Bay. Metal bioavailability was assessed over 8weeks following transplant of the local brittlestar, Ophiothrix spiculata (Ophuroidea, Echinodermata), from outside to inside the Bay. Despite a gradient of contamination, brittlestars accumulated similar levels of metals throughout the Bay, suggesting that metal contamination occurred through dissolved metals as well as through the diet. Sediment transplanted in dialysis tubing in the Bay accumulated metals only when placed on the seafloor bottom, indicating greater metal bioavailability near the bottom; the level of accumulation was similar between the mouth and the back of the Bay. The results are consistent with a circulation pattern in which a bottom layer of seawater, enriched with metals, drains from the back to the mouth of the Bay. There was a positive correlation between metal concentration in brittlestars and tidal range, suggesting increased metal exposure due to bay-ocean water exchange. For brittlestar arms the correlation was higher at the mouth than the back of the Bay, indicating greater metal accumulation in arms from dissolved metals in seawater than from ingestion of metal contaminated diet. In contrast, for brittlestar disks the correlation was higher at the back of the Bay, indicative of metal accumulation mainly through the diet. The results highlight the importance of considering bioavailability and physical processes in environmental quality assessments.
The new definition of the term sudden infant death syndrome (SIDS) and the criteria introduced in San Diego for the subclassification of cases have been used to re-classify the first 100 consecutive cases of sudden and unexpected infant deaths that were registered with the German SIDS study (GeSID). Although there are 30 different variables that have to be considered in the general and stratified sections of the San Diego definition, it is practical, in particular, as an international standard to perform scientific studies. The comparison of the San Diego definition and the classification used for GeSID shows similarities in the methods but differences in the criteria used. Nevertheless, the numbers of cases classified as SIDS and borderline SIDS are similar (San Diego n=69, GeSID n=74). The SIDS IA criteria of the San Diego definition were not fulfilled by any case because metabolic screening and vitreous chemistry were not included in the GeSID investigation scheme. An important advantage of the San Diego definition is the introduction of the category of unclassified sudden infant death, which includes cases for which no autopsy was performed. This demonstrates that such cases cannot be classified as SIDS. In conclusion, we recommend the universal acceptance and use of the San Diego SIDS definition.
OBJECTIVES: To describe the epidemiology of active disease caused by Mycobacterium tuberculosis in San Diego County from 1989 to 1993 and to identify the specific subgroups for whom the impact of the disease was most pronounced. METHOD: The authors reviewed all 1860 reports of verified tuberculosis (TB) cases included in the surveillance database maintained by the San Diego County Health Department's TB Control Program. Data were analyzed by age, gender, ethnicity, nativity, HIV co-infection, major site of infection, and drug resistance. RESULTS: Between 1989 and 1993. San Diego County witnessed a greater increase (77.7%) in the number of incident TB cases than the state of California as a whole (22.8%) or the United States (9.9%). The local resurgence of TB was reflected in increasing case counts among specific subpopulations--immigrants from countries with high endemic rates of TB (62.5% of the new cases), U.S.-born members of minority groups, the elderly, and young adult males. CONCLUSIONS: Tuberculosis cases in San Diego County have increased each year since 1989, with certain population subgroups exhibiting more dramatic increases in case rates than those reported nationally. San Diego County is one of the principal entry points for the western United States and a popular travel destination. These factors have led to a dramatic increase in the incidence of TB in the county. A range of tailored surveillance, treatment, and control strategies--some of which have already been implemented--will be needed to control the spread of the disease.
Stormwater discharges from Chollas Creek, a tributary of San Diego Bay, have been shown to be toxic to aquatic life. The primary objective of this study was to provide the linkage between in-channel measurements and potential impairments in the receiving waters of San Diego Bay. This study addressed this objective within the context of four questions: (1) How much area in San Diego Bay is affected by the discharge plume from Chollas Creek during wet-weather conditions?; (2) How much of the wet-weather discharge plume is toxic to marine aquatic life?; (3) How toxic is this area within the wet-weather discharge plume?; and (4) What are the constituent(s) responsible for the observed toxicity in the wet-weather plume? The stormwater plume emanating from Chollas Creek was dynamic, covering areas up to 2.25 km2. Approximately half of the plume was estimated to be toxic to marine life, based upon the results of purple sea urchin (Strongylocentroutus purpuratus) fertilization tests. The area nearest the creek mouth was the most toxic (NOEC = 3 to 12% plume sample), and the toxicity decreased with distance from the creek mouth. The toxicity of plume samples was directly proportional to the magnitude of plume mixing and dilution until, once outside the plume margin, no toxicity was observed. Trace metals, most likely zinc, were responsible for the observed plume toxicity based upon toxicity identification evaluations (TIEs). Zinc was also the constituent identified from in-channel samples of Chollas Creek stormwater using TIEs on the storms sampled in this study, and in storms sampled during the previous storm season.
The incidence of skin cancer in San Diego is one of the highest in the nation. Research has documented that excessive unprotected exposure to ultraviolet (UV) radiation over time significantly increases a person's risk for developing various types of skin cancer. Our study investigated the amount of sun exposure and the practice of sun protection among San Diegans and examined factors thought to be associated with these behaviors. In April 1994, a random sample of 864 San Diego residents was surveyed by telephone. Because most survey questions specifically asked about sun exposure and sun protection when tanning versus recreating, the analyses were presented separately for recreators (i.e., those who spent time in the sun during the hours of 8:00 am and 6:00 pm for recreation last summer; n = 786) and tanners (i.e., those who spent at least 10% of their time in the sun to get a tan last summer; n = 464), a subset of recreators. Study results indicated that on average, 27% of the tanners' time in the sun last summer was spent getting a tan, and tanners reported using sunscreen about 50% of the time on both their face and body. In terms of sun protection while recreating, survey respondents reported using sunscreen on their face approximately 40% of the time compared to approximately 30% of the time on their body. Correlates of sun exposure and sun protection for both tanners and recreators included demographic characteristics, susceptibility factors, attitudes, and knowledge. The findings from this study support the need for education on skin cancer prevention. The practical implications of these findings are discussed in terms of appropriate community skin cancer prevention interventions. Medical Subject Headings (MeSH): skin cancer, sunlight, behavior.
Sediments of San Diego Bay (SDB) are known to contain elevated levels of polychlorinated biphenyls (PCBs). While numerous efforts have been made to monitor the spatial or temporal trends of contamination in SDB, no studies have been directed toward measurements of water column contamination. We measured PCB concentrations in the water column of SDB with an in situ sampling system. Except for one sample collected near the bay mouth, all other samples contained higher PCB concentrations than the 30-day average discharge limit established by the California Ocean Plan. The highest concentrations of water column PCBs occurred in the Central Bay, consistent with the previous findings that sediments in the Central Bay contained higher PCB levels than those in the North and South Bays. Based on the water volume of 2.2 x 10(8) cm3 at a lower water level, it was estimated that approximately 1,000 g of PCBs is transported out of SDB via tidal exchange annually. This indicates that water column transport driven by tidal exchange is a viable mechanism reducing PCB contamination within SDB.
Infant mortality in San Diego County (USA) in 1988 was 6.9 per 1000 live births. This rate had remained unchanged since 1980. It rose to 8.3 in 1989 and fell to 7.0 in 1990. This study describes the results of an investigation into the causes of infant mortality during 1985. A total of 333 infant deaths were recorded. Nearly half the neonatal deaths were related to perinatal causes and more than half the post-neonatal deaths were attributed to the Sudden Infant Death Syndrome. Two-thirds of all infant deaths occurred in the neonatal period. The contribution of factors in the maternal background and those related to care during labour, as well as postnatally, is described.
Trace element contents of scalp hair from randomly selected, ethnically homogeneous subjects of Darjeeling (India) were compared with those of the residents of San Diego, California (U.S.A.). The differences between mean concentrations of Ca, Mg, Cu, Na and Cd in the two groups were not significant, and the concentrations of K, Fe, Mn and Zn were significantly higher (P less than 0.01), and that of Al was significantly lower (P less than 0.01), in hair of the residents of Darjeeling. Concentrations of lead in four of the Darjeeling hair samples were very high (greater than 30 micrograms g-1) and in the remaining samples the mean concentration was similar to San diego hair samples. In two mentally retarded Darjeeling subjects, abnormally high values of aluminum (50 and 70 micrograms g-1) and iron (155 and 196 micrograms g-1) were observed. The mean aluminum concentration (2.4 micrograms g-1) in the remaining Darjeeling hair samples was significantly lower than the mean aluminum concentration (10.6 micrograms g-1) in the San Diego hair samples (P less than 0.01). The mean manganese concentration in Darjeeling hair was 20 times higher than the mean manganese content in San Diego hair samples.