The Los Angeles riots and the medical profession

The study was designed to determine the flow rate necessary to achieve adequate oxygen delivery from self-inflating resuscitation bags. When no reservoir was used the fraction of inspired oxygen (FiO2) was between 0.5 and 0.6 for all flow rates greater than 7 liters/min. When self-inflating bags with oxygen reservoirs were tested, the FiO2 showed a consistent increase with increases in the flow rate from 0 to 15 liters/min flow. A flow rate of 10 liters/min was required to deliver an FiO2 of at least 0.8. Individuals should become thoroughly familiar with the equipment they select for use. Most will find it necessary to provide an oxygen flow of at least 10 to 12 liters/min to provide an oxygen concentration of at least 80%.     

Ophthalmic disorders among the homeless and nonhomeless in Los Angeles

BACKGROUND: Few studies have addressed ocular disorders among the homeless and nonhomeless poor. METHODS: To better understand the health problems of the homeless, ophthalmic disorders were analyzed among 512 homeless and 413 nonhomeless poor individuals receiving vision-screening examinations in Los Angeles. RESULTS: Significantly, more 4- to 17-year-old nonhomeless poor were diagnosed with uncorrected visual acuity worse than or equal to 20/50 without correction (p = 0.001), total refractive errors (p < 0.0005), astigmatism (p = 0.001), and myopia (p < 0.0005) than were a control group of 4- to 17-year-old homeless individuals. More homeless individuals had extraocular muscle imbalance (p < 0.040), but fewer had external eye diseases (p2 = 0.016) than the nonhomeless poor, when age adjusted. In addition, higher rates of glaucoma and cataracts were observed in both homeless and poor nonhomeless populations than in the general population. CONCLUSIONS: Health care professionals should provide vision screenings intended to detect these ocular disorders. Screening and correction of myopia and glaucoma, in particular, can greatly improve the quality of life for those treated.     

Love-styles among Latino community college students in Los Angeles

145 Latino community college students enrolled in Chicano Studies classes in Los Angeles, California were administered a love-attitudes scale. Analysis showed that the mean scores and endorsement patterns were similar to those in earlier research on white-Latino and white-non-Latino students in the United States. Significant gender differences were found. Latino men scored more Ludic and Agapic than women. Researchers might examine the love-styles and ethnic identity in and out of marriage among Latinos, whites, and Asians in southern California.     

Los Angeles airport noise and mortality--faulty analysis and public policy

A well-publicized investigation in Los Angeles showed a higher mortality rate in 1970-1971 among residents in a high-noise area near Los Angeles International Airport than in a low-noise control area. The authors of this report attributed the difference to the effects of jet aircraft noise. A reanalysis of the data did not confirm the original results. Once the confounding effects of age, race, and sex were taken into account by direct and indirect methods of standardization, there was little difference in the mortality experience of the airport and control areas. Adjusted mortality rates due to all causes, cardiovascular diseases, or cerebrovascular disease did not differ appreciably between the two areas and were nearly identical to those of Los Angeles County during 1970.     

Epidemiology of major trauma and trauma deaths in Los Angeles County

The aims of this study were to identify differences in the centre of buoyancy (CB) and centre of mass (CM) locations of male and female collegiate swimmers, and to assess the influence that buoyancy has on freestyle kicking performance. Sixteen female collegiate swimmers (mean +/- s: age 19.1 +/- 1.2 years) had significantly more adipose tissue (20.2 +/- 4.4%) than 15 male collegiate swimmers (19.9 +/- 1.0 years, 12.6 +/- 3.8%). The ratio of the sum of abdominal and suprailiac skinfolds to the thigh skinfold was significantly greater for the males (2.07 +/- 0.37) than the females (1.31 +/- 0.32), implying that females had proportionately more fatty tissue caudally than males. The distance d between the centres of buoyancy and mass was significantly larger for the males (0.79 +/- 0.43 cm) than the females (0.16 +/- 0.34 cm). Both points were more caudal in the female subjects (59.9 +/- 0.7% and 59.8 +/- 0.7% of body height respectively) than in the male subjects (61.7 +/- 0.8% and 61.2 +/- 0.9% respectively). These data suggest that the difference in d may be attributed to the difference in the location of the centre of buoyancy, because the centre of mass difference was not significant and was characterized by a smaller effect size. The amount and distribution of adipose tissue accounted for a significant proportion of variance in d (R2 = 0.25 and 0.29 respectively). Males had a significantly higher proportional kick time, defined as the ratio of times to complete a 22.9 m sprint when kicking and swimming respectively, than females (1.57 +/- 0.09 and 1.51 +/- 0.13 respectively). This shows that the male swimmers kicked proportionally more slowly than the female swimmers. However, the distance d did not account for a significant proportion of variance in the proportional kick time. Therefore, our results do not support the notion that skilled male swimmers are at a performance disadvantage in terms of natural buoyancy characteristics.     

Personal constitution and health status among Chinese elderly in Taipei and Los Angeles

Ligation of the ductus arteriosus in utero produces fetal and neonatal pulmonary hypertension and alterations in the hemodynamic responses to nitric oxide and endothelin-1 in fetal and newborn lambs. To determine whether fetal pulmonary hypertension alters the expression of the genes of the nitric oxide and endothelin-1 pathways, seven fetal lambs (123-126-d gestation) underwent ligation of the ductus arteriosus. Near-term (138-139-d gestation), total lung RNA, and protein were prepared from control and ductal ligation fetal lambs for RNase protection assays and Western blotting. Ligation of the ductus arteriosus was associated with decreased expression of endothelial nitric oxide synthase mRNA and protein, and the alpha1 and the beta1 subunits of soluble guanylate cyclase protein; and with increased expression of phosphodiesterase V mRNA. Ligation of the ductus arteriosus was also associated with increased expression of preproendothelin-1 mRNA and with decreased expression of endothelin B receptor (ET(B)) mRNA. These results suggest that there is coordinated regulation of genes of the nitric oxide pathway, which would decrease nitric oxide and cGMP concentration, thereby decreasing pulmonary vasodilator activity. There is also coordinated regulation of genes of the endothelin-1 pathway, which would increase endothelin-1 concentration and limit ET(B) receptor activation, thereby increasing pulmonary vasoconstrictor activity. These alterations in gene expression would increase fetal pulmonary vascular resistance, contributing to the development of pulmonary hypertension after birth.     

CYP2D6 phenotype-genotype relationships in African-Americans and Caucasians in Los Angeles

CYP2D6 genotyping (CYP2D6*3, CYP2D6*4, CYP2D6*5, CYP2D6*13, CYP2D6*16 alleles and gene duplications) was previously performed on 1053 Caucasian and African-American lung cancer cases and control individuals and no significant difference in allele frequencies between cases and control individuals detected. We have carried out additional genotyping (CYP2D6*6, CYP2D6*7, CYP2D6*8, CYP2D6*9, CYP2D6*10, CYP2D6*17 alleles) and debrisoquine phenotyping on subgroups from this study to assess phenotype-genotype relationships. African-Americans showed significant differences from Caucasians with respect to frequency of defective CYP2D6 alleles, particularly CYP2D6*4 and CYP2D6*5. The CYP2D6*17 allele occurred at a frequency of 0.26 among 87 African-Americans and appeared to explain higher average metabolic ratios among African-Americans compared with Caucasians. CYP2D6*6, CYP2D6*8, CYP2D6*9 and CYP2D6*10 were rare in both ethnic groups but explained approximately 40% of higher than expected metabolic ratios among extensive metabolizers. Among individuals phenotyped with debrisoquine, 32 out of 359 were in the poor metabolizer range with 24 of these (75%) also showing two defective CYP2D6 alleles. Additional single strand conformational polymorphism analysis screening of samples showing large phenotype-genotype discrepancies resulted in the detection of three novel polymorphisms. If subjects taking potentially interfering drugs were excluded, this additional screening enabled the positive identification of 88% of phenotypic poor metabolizers by genotyping. This sensitivity was comparable with that of phenotyping, which identified 90% of those with two defective alleles as poor metabolizers.     

Prenatal and postnatal anxiety in Mexican women giving birth in Los Angeles.

Examined psychosocial factors related to pre- and postnatal anxiety in 291 pregnant Mexican women (aged 15–38 yrs). Ss completed the State-Trait Anxiety Inventory and questions designed to assess variables such as preferred characteristics of health care providers. Higher prenatal anxiety was associated with less desire for an active role during labor, lower assertiveness, higher pain expectation at delivery, lack of support from family members other than the husband, and preferences for health care providers who are female and Latino. All Ss preferred health care providers who provided good medical explanations and who were knowledgeable, friendly, and sympathetic. Postnatal anxiety was significantly lower than prenatal anxiety. Negative attitudes toward the baby and number of complications during labor and delivery were related to postnatal anxiety adjusted for prenatal anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual assault history and physical health in randomly selected Los Angeles women.

Associations of sexual assault history with multiple measures of physical health were examined among 1,610 randomly selected women living in Los Angeles, California. Sexually assaulted women were more likely than nonassaulted women to report poor health perceptions, functional limitation, several chronic diseases, medically explained somatic symptoms, and medically unexplained somatic symptoms. Sexual assault was associated with increased risk of symptoms in a variety of organ systems rather than solely reproductive or sexual symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of community attitudes towards suicide in Windsor and Los Angeles.

Administered a Suicide Opinion Questionnaire (SOQ; G. Domino et al, 1980) to 103 community adults in Windsor, Canada, and 103 in Los Angeles, California. Samples were matched as to gender, age, and occupational status. Significant differences were obtained on 5 of the 8 SOQ scales, with Windsor Ss showing greater endorsement of agreement on the Mental Illness, Cry for Help, and Right to Die scales and lesser endorsement of agreement on the Religion and Moral Evil scales than Los Angeles Ss. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determinants of regular source of care among homeless adults in Los Angeles

OBJECTIVES: The authors explore the determinants of having a regular source of care in a community-based probability sample of homeless adults in Los Angeles. Results from this study should be more representative than those from previous studies of the homeless that are clinic- or shelter-based. In addition to those factors found to be barriers to regular sources of care in the general population, we hypothesized that psychosocial characteristics of the homeless and the homeless lifestyle would negatively impact their likelihood of having a regular source of care. METHODS: The authors conducted a multiple logistic regression to predict regular source of care among the homeless, using an adaptation of the Behavioral Model of health services utilization as an analytic framework. RESULTS: Fifty-seven percent of the sample reported that they had a regular source of care. Of those with a source of care, 30% reported a hospital outpatient department; 25% reported a community or homeless clinic; 23% reported a hospital emergency room; 14% reported a government clinic; and 9% reported a private physician's office as their source of care. Some factors found to be barriers to having a regular source of care in the general population (male, Hispanic, young age) also were barriers among homeless adults. Additional barriers in this sample included homelessness-related characteristics such as competing needs, long-term homelessness, and social isolation. Chronic mental illness and chronic substance dependence were not related to having a source of care among the homeless. Characteristics that increased the likelihood of having a regular source of care in the general population (poor health status, Medicaid) were not related to having a regular source of care among the homeless. CONCLUSIONS: In a context of limited resources, the distribution of regular source of care among the homeless appears to be highly inequitable. Although some of the characteristics identifying those with a regular source of care suggest differential patterns of behavior across subgroups, others suggest differential advantage in access to care and a lack of fit between the needs of the homeless and the organization of health services.     

The epidemic of gang-related homicides in Los Angeles County from 1979 through 1994

OBJECTIVE: To determine trends in gang homicides and the population at greatest risk for homicide by reviewing all gang-related homicides in Los Angeles County, California, from January 1979 to December 1994. DESIGN: Homicide files of the Los Angeles Police Department and the Los Angeles County Sheriff's Department from 1979 to 1994 involving violent street gang activity were reviewed. Gang files were reviewed for demographic data, weapons used, homicides by drive-by shootings, and times and geographic areas of occurrence. SETTING: Los Angeles County from January 1, 1979, to December 31, 1994. MAIN OUTCOME MEASURES: Age, race, and sex of gang-related homicide victims; frequency of weapon use; and the change in gang-related homicide rates during the study period. RESULTS: A total of 7288 gang-related homicides occurred in Los Angeles County from 1979 through 1994; 5541 of these homicides occurred in Los Angeles Police Department and Los Angeles County Sheriff's Department jurisdictions. During the study period, the proportion of all homicides that were gang related increased from 18.1% to 43.0% (P < .001). Of the 5541 gang-related homicide victims, 4580 (85.6%) were aged 15 to 34 years, 93.3% were African American or Hispanic, 5157 (93.2%) were male, 3559 (64.2%) were gang members, and 1408 (25.4%) occurred during drive-by shootings. Firearms were used in an increasing proportion of homicides, from 71.4% in 1979 to 94.5% in 1994. Homicides by semiautomatic handguns dramatically increased during the study period. Gang-related homicide rates for African-American males aged 15 to 19 years increased from 60.50 per 100,000 population per year in 1979 to 1981 to 192.41 per 100,000 population per year in 1989 to 1991. CONCLUSIONS: Gang-related homicides in Los Angeles County have reached epidemic proportions and are a major public health problem. To prevent gang violence, the root causes of violent street gang formation must be alleviated, the cycle of violent street gang involvement must be broken, and access to firearms must be limited.     

A survey of hospital postpartum and postabortion rubella vaccination policies in Los Angeles County, 1992

OBJECTIVE: To determine the proportion of Los Angeles County (LAC) hospitals offering obstetrical services that have postpartum and postabortion rubella vaccination policies. DESIGN: A survey was sent to the infection control practitioners (ICPs) of all operational acute care hospitals (N = 133) in LAC in 1992. A remainder and second survey was mailed to ICPs who did not respond to the first mailing. RESULTS: Of 75 hospitals with obstetrical departments, 56 (75%) responded. Thirty-four (61%) of the 56 respondent hospitals had post-partum rubella vaccination policies. Of the 34 hospitals with policies, 30 (88%) accepted only a written record of rubella seropositivity as proof of immunity, 30 (88%) screened women with unknown immunity status before hospital discharge, and 32 (94%) vaccinated susceptible women before hospital discharge. Of the 32 hospitals that performed induced abortions, only two (6%) provided screening and vaccination services for these women. CONCLUSION: Only 61% of hospitals in LAC offering obstetrical services had postpartum rubella vaccination policies while only minimal screening and vaccination occurred in association with abortion services. Widespread implementation of postabortion screening and vaccination, and more stringent compliance with Advisory Committee on Immunization Practices recommendations for postpartum screening and vaccination in hospitals offering obstetrical services would reduce the number of rubella-susceptible women who have been missed by other prevention strategies.     

Health status of and access to health services by residents of urban encampments in Los Angeles

This paper reports findings from a survey of 134 homeless people living in 42 urban encampments in central Los Angeles. These data, of concern to public health officials, include the physical conditions in the camps, the health status of residents, their use of drugs and alcohol, and their access to and use of health care services such as substance abuse treatment. Many encampment residents report poor health status; over 30 percent report chronic illnesses, and 40 percent report a substance abuse problem. Although outreach efforts have had success in bringing HIV and tuberculosis screening services to encampments, residents report significant barriers to using primary health care and drug and alcohol treatment services. Public hospitals and clinics remain the major source of primary medical care for homeless people living in encampments. Outreach and case management continue to be critical components of improved access to health care for homeless people.     

Stockholm and Los Angeles: A cross-cultural study of the communication of suicidal intent.

Studied the communication of suicidal intent in 50 consecutive cases of confirmed suicide selected from coroner's records in both Stockholm, Sweden, and Los Angeles, California. Using the "psychological autopsy" method, intensive interviews were conducted with a close friend or relative of the decedent approximately 2 mo. after the suicide. Results indicate that at least 60% of the victims in both cities had made direct verbal threats prior to taking their lives,while more than 80% had voiced direct or indirect threats. Responses to the suicidal communications were generally maladaptive. Cross-cultural differences in the data, and the need for better understanding of suicide dynamics among laymen are discussed. (20 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genetic polymorphism of CYP2D6 and lung cancer risk in African-Americans and Caucasians in Los Angeles County

The well described genetic polymorphism of the CYP2D6 gene influences response to a wide variety of therapeutic agents metabolized by the CYP2D6 enzyme product. CYP2D6 also appears to play a role, along with other cytochrome P450 enzymes, in the metabolic activation of the tobacco specific nitrosamine, NNK, as well as metabolism of nicotine to cotinine. While impaired activity of CYP2D6 was strongly protective against lung cancer in some studies, primarily based on phenotyping, the literature is conflicting. The molecular basis of CYP2D6 deficiency is now well understood, enabling the use of genotyping to classify individuals. We therefore examined whether lung cancer risk is reduced by the presence of four CYP2D6 alleles associated with impaired activity due to an inactivating mutation--CYP2D6*4, CYP2D6*3, CYP2D6*5 and CYP2D6*16--among 341 incident cases of lung cancer and 710 population controls of Caucasian or African-American ethnicity in Los Angeles County, California. We did not confirm a strong association between the presence of these inactivating alleles and lung cancer risk [odds ratio (OR) = 0.90, 95% confidence interval (CI) 0.60-1.35 for Caucasians], although there was a small decreased risk among the African-Americans (OR = 0.66, 95% CI 0.38-1.14). Among smokers, when the data are stratified according to lifetime smoking history, there is a suggestion of an association limited to Caucasian smokers of <35 pack-years, the median for all smokers in these data (OR = 0.49, 95% CI 0.23-1.04). However, among African-American smokers, who smoke less than Caucasians, the association did not differ between smoking categories. We also examined the possible role of additional copies of the CYP2D6 gene, which lead to enhanced CYP2D6 activity, in increasing lung cancer risk. Among controls the prevalence of having more than two copies of the CYP2D6 gene and no inactivating alleles was 4.3% for Caucasians and 4.9% for African-Americans. Relative to subjects with an inactivating allele, those with an additional copy of the CYP2D6 gene and no inactivating alleles may be at increased risk of lung cancer, particularly for adenocarcinoma (OR = 3.61, 95% CI 1.08-11.7 for African-Americans and OR = 2.20, 95% CI 0.69-6.0 for Caucasians). Our data suggest that the CYP2D6 genetic polymorphism is not the strong risk factor for lung cancer suggested by some studies of phenotype, but may play a minor role.     

Development of neurosurgery in southern California and the Los Angeles county/University of Southern California Medical Center

We reported a case of successful treatment of bilateral pulmonary metastasis from rectal cancer with high-dose 5'-DFUR plus MMC combination chemotherapy. A woman born in 1948 showed a recurrence in the bilateral lung about 29 months after low anterior resection. High-dose 5'-DFUR plus MMC combination chemotherapy was started in March, 1991. The chest X-ray examination 8 weeks after beginning this therapy showed a remarkable decrease in the size of the pulmonary metastatic foci and CEA decreased in the same way. The dose of 5'-DFUR was reduced after 5 courses, and then CEA increased. No remarkable side effect was encountered and the patient could be safely treated at an outpatient clinic. During this therapy no recurrence has been detected, and we performed a resection of the bilateral pulmonary metastasis by median sternotomy in October, 1991. The above findings suggested that this was an effective and safe therapy for pulmonary metastasis from colon cancers and could be a neo-adjuvant chemotherapy for surgical resection of pulmonary metastasis.