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Selected AbstractsHospital Disaster Preparedness in Los Angeles CountyACADEMIC EMERGENCY MEDICINE, Issue 11 2006Amy H. Kaji MD Background There are no standardized measures of hospital disaster preparedness or hospital "surge capacity." Objectives To characterize disaster preparedness among a cohort of hospitals in Los Angeles County, focusing on practice variation, plan characteristics, and surge capacity. Methods This was a descriptive, cross-sectional survey study, followed by on-site verification. Forty-five 9-1-1 receiving hospitals in Los Angeles County, CA, participated. Evaluations of hospital disaster plan structure, vendor agreements, modes of communication, medical and surgical supplies, involvement of law enforcement, mutual aid agreements with other facilities, drills and training, surge capacity (assessed by monthly emergency department diversion status, available beds, ventilators, and isolation rooms), decontamination capability, and pharmaceutical stockpiles were assessed by survey. Results Forty-three of 45 hospital plans (96%) were based on the Hospital Emergency Incident Command System, and the majority had protocols for hospital lockdown (100%), canceling elective surgeries (93%), early discharge (98%), day care for children of staff (88%), designating victim overflow areas (96%), and predisaster "preferred" vendor agreements (96%). All had emergency medical services,compatible radios and more than three days' worth of supplies. Fewer hospitals involved law enforcement (56%) or had mutual aid agreements with other hospitals (20%) or long-term care facilities (7%). Although the vast majority (96%) conducted multiagency drills, only 16% actually involved other agencies in their disaster training. Only 13 of 45 hospitals (29%) had a surge capacity of greater than 20 beds. Less than half (42%) had ten or more isolation rooms, and 27 hospitals (60%) were on diversion greater than 20% of the time. Thirteen hospitals (29%) had immediate access to six or more ventilators. Less than half had warm-water decontamination (42%), while approximately one half (51%) had a chemical antidote stockpile and 42% had an antibiotic stockpile. Conclusions Among hospitals in Los Angeles County, disaster preparedness and surge capacity appear to be limited by a failure to fully integrate interagency training and planning and a severely limited surge capacity, although there is a generally high level of availability of equipment and supplies. [source] On the distribution of wildfire sizesENVIRONMETRICS, Issue 6 2003Frederic Paik Schoenberg Abstract A variety of models for the wildfire size distribution are examined using data on Los Angeles County wildfires greater than 100 acres between 1950 and 2000. In addition to graphs and likelihood criteria, Kolmogorov,Smirnoff and Cramer,von Mises statistics are used to compare the models. The tapered Pareto distribution appears to fit the data quite well and offers some advantages over the untapered Pareto distribution, while alternatives including the lognormal, half-normal, exponential and extremal distributions fit poorly. The size distribution appears to be quite stable over the examination period, though inspection of the transformed wildfire sizes for the tapered Pareto reveals some limited trend in the residuals, indicating a very slight gradual decrease in the average fire size in Los Angeles County over these 50 years. Copyright © 2003 John Wiley & Sons, Ltd. [source] Ground Water Recharge Using Recycled Municipal Waste Water in Los Angeles County and the California Department of Public Health's Draft Regulations on Aquifer Retention TimeGROUND WATER, Issue 4 2009Theodore A. Johnson First page of article [source] HIV, AIDS and human services: exploring public attitudes in West Hollywood, CaliforniaHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2000Robin M. Law Abstract The provision of human services associated with HIV and AIDS has been a controversial issue in Western countries, given the degree of stigma attached to AIDS, and the high level of public concern about the possibility of contracting HIV. Previous research on attitudes to controversial human services has identified some key characteristics associated with negative attitudes and resistant ,not-in-my-backyard' behaviour. Attitudes towards HIV- and AIDS-related services may be affected by other factors as well; in particular, they may be related to self-identified sexual orientation, given the role of HIV and AIDS in the emergence of a strong gay political identity. However, little research has yet been conducted to explore how knowledge and attitudes towards these services in particular localities are associated with a range of characteristics of local residents, including sensitive information such as sexual orientation and household HIV status, and how these might contribute to the creation of more accepting environments. This paper provides an analysis of a 1994 city-wide survey conducted in West Hollywood, California. This small city has a large and politically-organized gay and lesbian population, as well as significant numbers of residents in other, diverse social groupings, and has experienced high levels of HIV infection and AIDS relative to the surrounding Los Angeles County. Although issues of HIV and AIDS service provision have been well publicized in the city, residents may be expected to hold rather different sets of knowledge about and attitudes to these services, depending on their personal characteristics. Analysis of the survey data reveals that a large proportion of residents of West Hollywood rated HIV and AIDS services as very important, but there were interesting differences among groups. Most notably, variation in knowledge of services and attitudes to services (rating of importance) was particularly associated with age and language, but was less affected by sexual orientation and household HIV status. [source] Residential air exchange rates in three major US metropolitan areas: results from the Relationship Among Indoor, Outdoor, and Personal Air Study 1999,2001INDOOR AIR, Issue 1 2010N. Yamamoto Abstract, We report approximately 500 indoor,outdoor air exchange rate (AER) calculations based on measurements conducted in residences in three US metropolitan areas in 1999,2001: Elizabeth, New Jersey; Houston, Texas; and Los Angeles County, California. Overall, a median AER across these urban areas and seasons was 0.71 air changes per hour (ACH, or per hour; n = 509) while median AERs measured in California (n = 182), New Jersey (n = 163), and Texas (n = 164) were 0.87, 0.88, and 0.47 ACH, respectively. In Texas, the measured AERs were lower in the summer cooling season (median = 0.37 ACH) than in the winter heating season (median = 0.63 ACH), likely because of the reported use of room air conditioners as Houston is typically hot and humid during the summer. The measured AERs in California were higher in summer (median = 1.13 ACH) than in winter (median = 0.61 ACH). Because the summer cooling season in Los Angeles County is less humid than in New Jersey or Texas, natural ventilation through open windows and screened doors likely increased measured AER in California study homes. In New Jersey, AER were similar across heating and cooling seasons, although the median AER was relatively lower during the spring. Practical Implications Adequate ventilation or air exchange rate (AER) for an indoor environment is important for human health and comfort, and relevant to building design and energy conservation and efficiency considerations. However, residential AER data, especially measured by more accurate non-toxic tracer gas methodologies, are at present quite limited worldwide, and are insufficient to represent the variations across regions and seasons within and between homes, including apartments and condominiums in more densely populated urban areas. The present paper presents quantitative and qualitative data to characterize residential AERs in three US urban areas with different climate attributes. [source] A case-control study of the association of the polymorphisms and haplotypes of DNA ligase I with lung and upper-aerodigestive-tract cancersINTERNATIONAL JOURNAL OF CANCER, Issue 7 2008Yuan-Chin Amy Lee Abstract Tobacco smoking is a major risk factor for lung and upper-aerodigestive-tract (UADT) cancers. One possible mechanism for the associations may be through DNA damage pathways. DNA Ligase I (LIG1) is a DNA repair gene involved in both the nucleotide excision repair (NER) and the base excision repair (BER) pathways. We examined the association of 4 LIG1 polymorphisms with lung and UADT cancers, and their potential interactions with smoking in a population-based case-control study in Los Angeles County. We performed genotyping using the SNPlex method from Applied Biosystems. Logistic regression analyses of 551 lung cancer cases, 489 UADT cancer cases and 948 controls showed the expected associations of tobacco smoking with lung and UADT cancers and new associations between the LIG1 haplotypes and these cancers. For lung cancer, when compared to the most common haplotype (rs20581-rs20580-rs20579-rs439132 = T-C-C-A), the adjusted odds ratio (OR) is 1.2 (95% confidence limits (CL) = 0.95, 1.5) for the CACA haplotype, 1.4 (1.0, 1.9) for the CATA haplotype and 1.8 (1.1, 2.8) for the CCCG haplotype, after controlling for age, gender, race/ethnicity, education and tobacco smoking. We observed weaker associations between the LIG1 haplotypes and UADT cancers. Our findings suggest the LIG1 haplotypes may affect the risk of lung and UADT cancers. © 2007 Wiley-Liss, Inc. [source] Impact of reproductive factors and lactation on breast carcinoma in situ riskINTERNATIONAL JOURNAL OF CANCER, Issue 1 2004Kathleen Meeske Abstract Incidence rates for breast carcinoma in situ (CIS) have increased markedly over the past 20 years. Breast CIS, detected primarily on mammography, now represents 30,45% of all screened detected breast cancers. We conducted a large population-based case-control study to evaluate the impact of reproductive factors and lactation on breast CIS risk. Case subjects were newly diagnosed with breast CIS at ages 35,64 years between March 1, 1995 and May 31, 1998 (n = 567), resided in Los Angeles County and were born in the United States. Control subjects (n = 614), identified through random digit dialing, fulfilled the same eligibility criteria and were required to have had at least one screening mammogram in the 2-year period before their interview. Women with a positive family history of breast cancer had a 2-fold increase in breast CIS risk. Parous women were at reduced risk relative to nulligravid women (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.46,1.00). Among nulliparous women, pregnancy was unrelated to breast CIS risk. Among parous women, risk declined with each additional term pregnancy (p -trend = 0.003). No associations were found with age at first term pregnancy, induced abortion or miscarriage. Long duration of breast-feeding (,24 months) was associated with increased risk (OR = 2.00, 95% CI = 1.11,3.60). The observed effects of family history and pregnancy on breast CIS risk are consistent with those observed for invasive breast cancer. The results for breast-feeding are contrary to what has been observed in studies of invasive breast cancer. © 2004 Wiley-Liss, Inc. [source] Transnational Twist: Pecuniary Remittances and the Socioeconomic Integration of Authorized and Unauthorized Mexican Immigrants in Los Angeles County,INTERNATIONAL MIGRATION REVIEW, Issue 1 2005Enrico A. Marcelli Annual U.S.-Mexico pecuniary remittances are estimated to have more than doubled recently to at least $10 billion - augmenting interest among policymakers, financial institutions, and transnational migrant communities concerning how relatively poor expatriate Mexicans sustain such large transfers and the impact on immigrant integration in the United States. We employ the 2001 Los Angeles County Mexican Immigrant Residency Status Survey (LAC-MIRSS) to investigate how individual characteristics and social capital traditionally associated with integration, neighborhood context, and various investments in the United States influenced remitting in 2000. Remitting is estimated to have been inversely related to conventional integration metrics and influenced by community context in both sending and receiving areas. Contrary to straight-line assimilation theories and more consistent with a transnational or nonlinear perspective, however, remittances are also estimated to have been positively related to immigrant homeownership in Los Angeles County and negatively associated with having had public health insurance such as Medicaid. [source] Treatment of Uncorrected Refractive Error Improves Vision-Specific Quality of LifeJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2006Anne L. Coleman MD OBJECTIVES: To evaluate the benefit of eyeglasses and magnifiers in elderly patients with uncorrected refractive errors. DESIGN: A single-center, randomized, prospective, controlled trial (September 2001 to August 2003). SETTING: Los Angeles County, California. PARTICIPANTS: One hundred thirty-one community-dwelling persons aged 65 and older who had habitual distance visual acuity of 20/32 or worse and whose distant visual acuity, near visual acuity, or both could be improved with eyeglasses, a magnifier, or both by two lines of acuity or more. INTERVENTION: Sixty-six were randomized to receive a prescription and voucher for free eyeglasses, a magnifier, or both immediately, and 65 were randomized to receive a prescription and voucher after the 3-month follow-up visit (the control group). MEASUREMENTS: Primary outcome was vision-specific functioning as measured using the 25-item National Eye Institute,Visual Functioning Questionnaire (NEI-VFQ). Secondary outcomes were distance and near visual acuity and overall functioning as measured using the Rosow-Breslau function questionnaire. RESULTS: In the intention-to-treat analysis of 3-month follow-up data, participants who received the eyeglasses prescription and voucher immediately had greater improvement in NEI-VFQ composite scores than the control group (P<.01). They also had greater improvement in perceptions of their general vision (P<.01), distance visual acuity (P=.03), near visual acuity (P=.04), and mental health (P=.02). CONCLUSION: Correction of uncorrected refractive error, one of the leading causes of visual impairment in older people, improved the vision-specific quality of life of community-dwelling older persons. [source] Income-Related Differences in the Use of Evidence-Based Therapies in Older Persons with Diabetes Mellitus in For-Profit Managed CareJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2003Arleen F. Brown MD OBJECTIVES: To determine whether income influences evidence-based medication use by older persons with diabetes mellitus in managed care who have the same prescription drug benefit. DESIGN: Observational cohort design with telephone interviews and clinical examinations. SETTING: Managed care provider groups that contract with one large network-model health plan in Los Angeles County. PARTICIPANTS: A random sample of community-dwelling Medicare beneficiaries with diabetes mellitus aged 65 and older covered by the same pharmacy benefit. MEASUREMENTS: Patients reported their sociodemographic and clinical characteristics. Annual household income (,$20,000 or <$20,000) was the primary predictor. The outcome variable was use of evidence-based therapies determined by a review of all current medications brought to the clinical examination. The medications studied included use of any cholesterol-lowering medications, use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) for cholesterol lowering, aspirin for primary and secondary prevention of cardiovascular disease, and angiotensin-converting enzyme (ACE) inhibitors in those with diabetic nephropathy. The influence of income on evidence-based medication use was adjusted for other patient characteristics. RESULTS: The cohort consisted of 301 persons with diabetes mellitus, of whom 53% had annual household income under $20,000. In unadjusted analyses, there were lower rates of use of all evidence-based therapies and lower rates of statin use for persons with annual income under $20,000 than for higher-income persons. In multivariate models, statin use was observed in 57% of higher-income versus 30% of lower-income respondents with a history of hyperlipidemia (P = .01) and 66% of higher-income versus 29% of lower-income respondents with a history of myocardial infarction (P = .03). There were no differences by income in the rates of aspirin or ACE inhibitor use. CONCLUSION: Among these Medicare managed care beneficiaries with diabetes mellitus, all of whom had the same pharmacy benefit, there were low rates of use of evidence-based therapies overall and substantially lower use of statins by poorer persons. [source] Comparing adults in Los Angeles County who have and have not been homelessJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 6 2001Michael R. Cousineau This study compares the formerly homeless with those who have not been homeless on several characteristics, based on a telephone survey of the general adulate population. The study was conducted in Los Angeles County. Researchers estimate how many and what percentage of adults (aged 18 or older) have been homeless in the past 5 years and the types of places people stayed while they were homeless. An estimated 370,000 adults have experienced homelessness within the past 5 years, 5.7% of the adult population (95% confidence interval [CI] 5.2,6.2). A third were literally homeless (in a shelter, street, or car). Just over half (56%) stayed with a friend or relative while homeless. Nine percent had a mixed experience. Compared to those who were not homeless, the formerly homeless are disproportionately poor, African American, not in the job market, on public assistance, and in poor health. There are few differences when comparing place of birth, citizenship status, or length of residence in Los Angeles County. Yet many homeless have been able to achieve some economic stability. Implications for the development of intervention and prevention programs are discussed. © 2001 John Wiley & Sons, Inc. [source] Sexual Homicide: A Spatial Analysis of 25 Years of Deaths in Los AngelesJOURNAL OF FORENSIC SCIENCES, Issue 5 2007Isaac T. Van Patten Ph.D. Abstract: Although it has been frequently studied over the last 100 years, empirical studies of sexual homicide are lacking. The majority of the existing studies have been descriptive in nature. In this study, we consider the spatial geometry of sexual homicide and the impact of time and distance on case solvability. An analysis of sexual homicides (n = 197) from 1980 to 2004 for Los Angeles County was conducted. Offender and victim journey to encounter site, journey to body disposal site, and journey-after-crime trips were examined. Descriptive and bivariate analyses were performed to examine victim, offender and case characteristics. Using logistic regression models both time factors and offense geometries were found to be significant predictors in case solvability. Simpler geometries are significantly more likely to be solved than cases with complex geometries and the longer a case remains unsolved the less likely it is that it will be closed. The results provide support for some of the findings from earlier descriptive studies and extend our understanding of the spatial geometry of sexual homicide. [source] The effectiveness of nonprofit lead-organization networks for social service deliveryNONPROFIT MANAGEMENT & LEADERSHIP, Issue 4 2010Bin Chen Public agencies increasingly contract with nonprofit organizations to lead community-based networks for social service delivery. We explore the role that partnership characteristics play in the effectiveness of these networks. Using data on children and family services in Los Angeles County, we consider the impact of both the motivations for forming partnerships and the nature of the resulting partnerships on perceived outcomes for clients, interorganizational relationships, and organizational learning. We find that client outcomes and interorganizational relationships are enhanced when partnerships are formed to meet certain programmatic and organizational goals. Organizational learning, however, is affected only when partnerships are formed to enhance organizational legitimacy. Partners selected because they share common vision increase effectiveness, while those selected because there are few alternative partners decrease effectiveness. Finally, when partnerships use an interorganizational coordination mechanism, client outcomes are improved. The managerial implications of these impacts for the nonprofit sector are developed. The results lend considerable support to the role of partnership motivation and partner selection in the effectiveness of nonprofit lead-organization networks, and specificity about the nature of that role. [source] West Coast study of childhood brain tumours and maternal use of hair-colouring productsPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 3 2002Elizabeth A Holly Summary The immature nervous system of the fetus is characterised by rapid cell growth and division and is particularly vulnerable to carcinogens and mutagens. Several epidemiological studies have reported an increased risk for childhood brain tumours (CBT) associated with exposure to N-nitroso compounds (NOC). Hair-colouring products (hair ,dyes') that contain NOC-related aromatic amines have shown mutagenicity in vitro and carcinogenic properties in vivo. The potential public health impact of the relationship between hair dye use and carcinogenesis has prompted epidemiological research, given that a large proportion of American women have used hair dyes. A large population-based case,control study was conducted on the west coast of the USA to investigate risk factors for CBT including exposure to NOC. Eligible CBT patients (<20 years of age and diagnosed between 1984 and 1991) were identified from cancer registries in Los Angeles County, the San Francisco Bay Area in California and the Seattle area in Washington state. A total of 540 biological mothers of these children were interviewed, and 801 control subjects who were frequency matched to the CBT patients on birth year and sex were obtained using random digit dialling. Mothers were asked details about personal use of hair dyes during the index pregnancy including frequency of use, trimester of use and type of dye used. Results from age- and sex-adjusted unconditional logistic regression analyses showed no association between risk for CBT and use of hair dyes 1 month before and/or during pregnancy nor during specific trimesters. A nearly twofold increased risk for CBT was associated with single-interval use during the 1 month before pregnancy, but the confidence interval (CI) was imprecise and the estimate was not different from unity (OR = 1.9, 95% CI [0.5, 7.0]). Exclusive use of permanent dye, temporary dye or hair darkeners was not associated with risk for CBT. A twofold increased risk (OR = 2.0, 95% CI [0.83, 4.7]) was observed with exclusive use of semi-permanent dye during the month before or during pregnancy. Exclusive use of semi-permanent dye during the month before pregnancy and/or first trimester also was associated with an elevated risk for CBT, again not different from unity and with an imprecise CI (OR = 2.5, 95% CI = [0.58, 10.3]). There was no evidence of an association between risk for CBT by histological subtypes and use of hair dyes during the index pregnancy or the month before conception. Together with results from previous studies, these results provide no consistent evidence of an association between risk for CBT and use of hair dyes during pregnancy. [source] The Public Health Nursing Practice Manual: A Tool for Public Health NursesPUBLIC HEALTH NURSING, Issue 2 2004M.S.N./ M.P.H., Sharon D. Sakamoto R.N. Abstract Public health nursing is recognized as an important and critical component of the public health workforce, and today, it makes up the largest single category of public health professionals, according to the U.S. Department of Health and Human Services. Preparation of generalist public health nurses with the knowledge base, skills, and training to effectively respond to public health challenges is essential. The County of Los Angeles Department of Health Services, Public Health Nursing Section, in response to this need, implemented the Public Health Nursing Practice Manual to provide public health nurses with interventions and guidelines to articulate their role and practice as outlined by the framework of the Public Health Nursing Practice Model developed by Los Angeles County. Identification and development of new methods to support the practice of nursing is imperative in facilitating a more sophisticated and expanded level of practice, as well as providing a means of improving, protecting, and enhancing the quality of health for all people. The Public Health Nursing Practice Manual is an effective tool to monitor performance improvement and provide standardization of the generalist public health nurse practicing in Los Angeles County. [source] Paramedic and Emergency Medical Technicians Views on Opportunities and Challenges When Forgoing and Halting Resuscitation in the FieldACADEMIC EMERGENCY MEDICINE, Issue 6 2009Corita R. Grudzen MD Abstract Objectives:, The objective was to assess paramedic and emergency medical technicians (EMT) perspectives and decision-making after a policy change that allows forgoing or halting resuscitation in prehospital atraumatic cardiac arrest. Methods:, Five semistructured focus groups were conducted with 34 paramedics and 2 EMTs from emergency medical services (EMS) agencies within Los Angeles County (LAC), 6 months after a policy change that allowed paramedics to forgo or halt resuscitation in the field under certain circumstances. Results:, Participants had an overwhelmingly positive view of the policy; felt it empowered their decision-making abilities; and thought the benefits to patients, family, EMS, and the public outweighed the risks. Except under certain circumstances, such as when the body was in public view or when family members did not appear emotionally prepared to have the body left on scene, they felt the policy improved care. Assuming that certain patient characteristics were present, decisions by paramedics about implementing the policy in the field involve many factors, including knowledge and comfort with the new policy, family characteristics (e.g., agreement), and logistics regarding the place of arrest (e.g., size of space). Paramedic and EMT experiences with and attitudes toward forgoing resuscitation, as well as group dynamics among EMS leadership, providers, police, and ED staff, also play a role. Conclusions:, Participants view the ability to forgo or halt resuscitation in the field as empowering and do not believe it presents harm to patients or families under most circumstances. Factors other than patient clinical characteristics, such as knowledge and attitudes toward the policy, family emotional preparedness, and location of arrest, affect whether paramedics will implement it. [source] Detection of Undiagnosed Diabetes and Prediabetic States in High-risk Emergency Department PatientsACADEMIC EMERGENCY MEDICINE, Issue 5 2009Michelle A. Charfen MD Abstract Background:, Diabetes is often not diagnosed until complications appear, and one-third of those with diabetes may be undiagnosed. Prediabetes and diabetes are conditions in which early detection would be appropriate, because the duration of hyperglycemia is a predictor of adverse outcomes, and there are effective interventions to prevent disease progression and to reduce complications. Objectives:, The objectives were to determine the prevalence of diabetes mellitus and prediabetes in emergency department (ED) patients with an elevated random glucose or risk factors for diabetes but without previously diagnosed diabetes and to identify which at-risk ED patients should be considered for referral for confirmatory diagnostic testing. Methods:, This two-part study was composed of a prospective 2-year cohort study, and a 1-week cross-sectional survey substudy, set in an urban ED in Los Angeles County, California. A convenience sample was enrolled of 528 ED patients without previously diagnosed diabetes with either 1) a random serum glucose , 140 mg/dL regardless of the time of last food intake or a random serum glucose , 126 mg/dL if more than 2 hours since last food intake or 2) at least two predefined diabetes risk factors. Measurements included presence of diabetes risk factors, ED glucose, cortisol, insulin and glycosylated hemoglobin (HbA1c), and 2-hour oral glucose tolerance test results, administered at 6-week follow-up. Results:, Glycemic status was confirmed at follow-up in 256 (48%) of the 528 patients. Twenty-seven (11%) were found to have diabetes, 141 (55%) had prediabetes, and 88 (34%) had normal results. Age, ED glucose, HbA1c, cortisol, and random serum glucose , 140 mg/dL were associated with both diabetes and prediabetes on univariate analysis. A random serum glucose , 126 mg/dL after 2 hours of fasting was associated with diabetes but not prediabetes; ED cortisol, insulin, age , 45 years, race, and calculated body mass index (BMI) were associated with prediabetes but not diabetes. In multivariable models, among factors measurable in the ED, the only independent predictor of diabetes was ED glucose, while ED glucose, age , 45 years, and symptoms of polyuria and polydipsia were independent predictors of prediabetes. All at-risk subjects with a random ED blood glucose > 155 mg/dL had either prediabetes or diabetes on follow-up testing. Conclusions:, A substantial fraction of this urban ED study population was at risk for undiagnosed diabetes and prediabetes, and among the at-risk patients referred for follow-up, the majority demonstrated diabetes or prediabetes. Notably, all patients with two risk factors and a random serum glucose > 155 mg/dL were later diagnosed with prediabetes or diabetes. Consideration should be given to referring ED patients with risk factors and a random glucose > 155 mg/dL for follow-up testing. [source] A population-based description of glioblastoma multiforme in Los Angeles County, 1974,1999CANCER, Issue 12 2005Indro Chakrabarti M.D., M.P.H. Abstract BACKGROUND There have been reports that the incidence rates of brain tumors have increased over the past few decades, but most have considered all brain tumors together. The authors analyzed the pattern of glioblastoma multiforme (GBM) occurrence in Los Angeles County, California to shed light on the incidence and descriptive epidemiology of this type of brain tumor. METHODS Data were obtained from the Los Angeles County Cancer Surveillance Program. Incidence rates were analyzed by gender, race, age at diagnosis, period of diagnosis (1974,1981, 1982,1988, or 1989,1999), and socioeconomic status (SES). In addition, data were stratified according to anatomic subsite. A multivariate model describing changes in rates by each of these variables was constructed. RESULTS Age-specific incidence rates (ASIR) rose sharply after age 30 years. The peak ASIR was at age 70,74 years in males and at age 75,79 years in females. The age-adjusted incidence rate (AAIR) of GBM increased from 1974 to 1999 by an estimated 2.4% per year among males and 2.8% per year among females. Overall, males had a 60% increased risk of brain tumors compared with females. Males had a higher incidence of GBM compared with females at each anatomic subsite except the posterior fossa. The largest male:female ratio occurred in the occipital lobes. Non-Latino whites had the highest incidence rates (2.5 per 100,000) followed by Latino whites (1.8 per 100,000), and blacks (1.5 per 100,000). After 1989, compared with the period before magnetic resonance imaging (MRI) was available, there was an increase in GBM incidence rates among those with of higher SES that was most pronounced in females. The incidence of GBM was highest for frontal lobe tumors and for tumors that involved two or more lobes (overlapping tumors), followed by tumors in the temporal and parietal lobes. In the multivariate analysis, year of diagnosis, SES, gender, race (Latino but not black), site, and age at diagnosis all were important predictors of incidence rate. CONCLUSIONS GBM incidence increased in Los Angeles County over the last 30 years and especially after 1989, suggesting that the introduction of MRI may have contributed to the increase. Individuals older than age 65 years experienced the greatest increase in incidence over time. Older age, male gender, higher SES, and non-Latino white race increased the risk of GBM. Previously unreported incidence rates for GBM among Latino whites were significantly lower than among non-Latino whites but were intermediate between non-Latino whites and blacks. Cancer 2005. © 2005 American Cancer Society. [source] | |||||||||||||||||||||||||