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.     

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.     

Homeless youths and young adults in Los Angeles: prevalence of mental health problems and the relationship between mental health and substance abuse disorders

Although understanding of the subsistence patterns, service utilization, and HIV-risk behaviors of homeless youths and young adults in increasing, relatively little is known about the epidemiology of mental health problems in this group or the relationships between mental health problems and substance use. This study measured symptoms of depression, low self-esteem, ADHD, suicidality, self-injurious behavior (SIB), and drug and alcohol use disorder in a sample of homeless youth and young adults living in Hollywood, CA. Results indicated extremely high prevalences of mental health problems as compared with corresponding rates of mental health problems found among housed youths in previous studies. Prevalence of mental health problems differed by age and ethnicity. African Americans were at lower risk of suicidal thoughts and SIB than were those of other ethnicities. Older respondents and females were at increased risk of depressive symptoms, and younger respondents were at increased risk of SIB. Previous history of sexual abuse and/or assault was associated with increased risk of suicidality and SIB. Risk factors for drug abuse disorders included ethnicity other than African American, homelessness for 1 year or more, suicidality, SIB, depressive symptoms, and low self-esteem. Risk factors for alcohol abuse disorder included male gender, white ethnicity, homelessness for 1 year or more, suicidality, and SIB. Extremely high rates of mental health problems and substance abuse disorders in this sample suggest the need for street-based and nontraditional mental health services targeted toward these youths and young adults.     

Microsporidiosis in HIV-positive children in Madrid (Spain)

A prospective study was carried out to determine the prevalence rates of microsporidiosis and other enteroparasites in HIV-positive children in the Madrid area. HIV-positive pediatric patients from three hospitals were enrolled in the study. A total of 293 samples (158 stool and 127 urine) were collected from 83 children whose mean age was 6.3 years and had a mean CD4 count of 504.7/mm3 (range 1-2,220/mm3), 48 of whom suffered diarrhea at the time of the study. Microsporidia identification was investigated in stool and urine samples using Weber's chromotrope-based stain, IIF and PCR species-specific tests. Enteric parasites were identified in 32.5% of the children. Cryptosporidium sp. was the most common parasite encountered (14.4%), followed by Blastocytis sp. (9.6%) and Giardia duodenalis (8.4%). Microsporidia was only found in the stools of one child (1.2% of total and 2% of those with diarrhea) and Enterocytozoon bieneusi was demonstrated by PCR. The patient was 10 years old, presented non-chronic diarrhea and his CD4 count was 298/mm3. These data differ from those previously reported by us in HIV-positive adults (13.9%) in the same area, although this group showed more severely depressed CD4 lymphocyte counts than children. New epidemiological studies should be carried out to elucidate whether additional risk factors exist between these groups.     

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.     

Los Angeles County after the 1992 civil disturbances: Degree of exposure and impact on mental health.

The impact of the 1992 Los Angeles (LA) civil disturbances on psychosocial functioning was assessed as part of a larger project investigating the views and attitudes of residents in LA County. Random digit dialing methodology identified a household probability sample of 1,200 adults (age 18 or older) from LA County. Respondents completed a telephone interview 6 to 8 months after the disturbances. Respondents' degree of exposure to the disturbances, mental health impact of the disturbances, and mental health effects of chronic versus acute exposure to violence were assessed. Consistent with hypotheses, the impact of the disturbances was the worst in the South Central communities. Higher rates of posttraumatic stress disorder (PTSD) (both diagnostic level and subclinical symptomatology) were found among respondents who reported disturbance-related experiences. Exposure to an acute event (i.e., the disturbances) was predictive of current PTSD symptomatology after controlling for demographics, lifetime trauma, and other types of stressful events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inbreeding patterns in the Gredos Mountain Range (Spain)

The relationships among the frequency of consanguineous marriages, inbreeding coefficient, period, village size, and altitude are analyzed for three rural valleys belonging to the Sierra de Gredos (central Spain). These valleys occupy an area of about 30 x 80 km2, and the average total number of inhabitants for the period 1877-1970 was 58,621. Information about a sample of 23,744 weddings celebrated between 1875 and 1974 was obtained from 48 village parish registers. The mean inbreeding level up to second cousins for the whole area was 0.0012. A high percentage of inbreeding variation (83%) can be explained by each village's census size, resulting in a different interslope consanguinity pattern consisting of higher inbreeding levels in most northern localities in the Gredos mountains. This north-south geographic trend is consistent with results on blood polymorphisms from the same area (Mesa et al. 1994).     

34th Annual Congress of the American Society of Clinical Oncology. 16-19 May 1998, Los Angeles, USA. Breast cancer (II)

The objective of this cross-sectional study was to investigate the prevalence of abdominal symptoms and the abdominal medical history among sewage workers. 142 male sewage workers and 137 male referents in 11 Swedish municipalities were addressed with a questionnaire about abdominal symptoms, medical history, occupational history and life style factors. The sewage workers suffered less from nausea [adjusted odds ratio (adjOR) = 0.18, 95% confidence interval (Cl) 0.04-0.84] than the referents. There was no significant difference in the three months prevalence of diarrhoea (adjOR = 1.7, 95% Cl = 0.79-3.4), dyspepsia (adjOR = 0.85, 95% Cl = 0.49-1.5) or irritable bowel syndrome (adjOR = 1.4, 95% Cl = 0.53-3.5). The sewage workers were affected more often by peptic ulcers during their present jobs than the referents, although the increased risk was not significant (adjOR = 1.4, 95% Cl = 0.31-6.1). The odds ratios were adjusted for age, use of tobacco products and alcohol consumption. The conclusion of this study was that sewage workers are less affected by nausea than comparable referents.     

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.     

Lifetime comorbidity among anxiety disorders and between anxiety disorders and other mental disorders in adolescents

We examine the lifetime comorbidity among anxiety disorders, and between anxiety disorders and other mental disorders, in a large (n = 1,507) community sample of high school students on whom extensive diagnostic data were available. Three diagnostic groups were formed: those with a lifetime anxiety disorder (n = 134); those with a nonanxiety disorder (n = 510); and those who had never met criteria for a mental disorder (n = 863). The intra-anxiety comorbidity rate was relatively low (18.7%), and was strongly associated with being female (92%). The lifetime comorbidity between anxiety and other mental disorders (primarily MDD) was substantial (73.1%) and was not associated with being female.     

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)     

Estimated intake of PCDDs, PCDFs and co-planar PCBs in individuals from Madrid (Spain) eating an average diet

The estimated intake of PCDD/Fs and co-planar PCBs associated with an average diet consumed in Spain was investigated. The estimated total average intake for PCDDs and PCDFs from an average spanish diet was found to be 142 pg I-TEQ/day (2.4 pg I-TEQ/Kg b.w./day, for a 60 Kg person). PCDDs provided almost 80% of the total dioxin equivalents. This represents the upper bound estimate. If concentrations less than the LOD are taken as equal to zero, then the estimated average intake would be 81 pg I-TEQ/day which is the lower bound estimate. Data reported are in good agreement with those reported for other countries.     

Relationship commitment and its implications for unprotected sex among impoverished women living in shelters and low-income housing in Los Angeles County.

Objective: To examine how relationship commitment among impoverished women is associated with their frequency of unprotected sex. Design: Cross-sectional analyses were conducted on survey data from a probability sample of 445 women initially sampled from shelters and low-income housing in Los Angeles County. Main Outcome Measure: Frequency of unprotected sex in a typical month was derived as the product of 2 items: how often the woman had sex with her partner in a typical month and how often a male condom was used. Results: For both sheltered and housed women, relationship commitment predicted more frequent engagement in unprotected sex with their partner, even after controlling for the type of relationship (primary vs. casual). However, this association could not be accounted for by perceived partner monogamy, ability to refuse unwanted sex, perceived HIV susceptibility, and condom use self-efficacy. Among housed women only, never asking the partner to use a condom partially accounted for more frequent engagement in unprotected sex among women with stronger relationship commitment. Conclusion: Results emphasize the importance of relationship commitment issues in HIV prevention interventions with impoverished women, and the need for a better understanding of relationship commitment and its influence on condom use in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric disorders and sexual risk among adolescents in mental health treatment.

Objective: To examine the relationship between psychiatric disorders and sexual behaviors among adolescents receiving mental health treatment. Adolescents in mental health treatment have been found to have higher rates of HIV risk behavior than their peers, but data concerning the relationship between psychopathology and risk are inconsistent and limited. Method: Eight hundred and forty adolescents (56% female, 58% African American, mean age = 14.9 years) and their parents completed computerized assessments of psychiatric symptoms via the Computerized Diagnostic Interview Schedule for Children (Shaffer, 2000a, 2000b). Adolescents also reported on sexual risk behaviors (vaginal/anal sex, condom use at last sex) and completed urine screens for a sexually transmitted infection (STI). Results: Adolescents meeting criteria for mania, externalizing disorders (oppositional defiant, conduct, and attention-deficit/hyperactivity disorders), or comorbid for externalizing and internalizing disorders (major depressive, generalized anxiety, and posttraumatic stress disorders) were significantly more likely to report a lifetime history of vaginal or anal sex than those who did not meet criteria for any psychiatric disorder (odds ratio [OR] = 2.0, 2.3, and 1.9, respectively). Adolescents meeting criteria for mania were significantly more likely to have 2 or more partners in the past 90 days (OR = 3.2) and to test positive for a STI (OR = 4.3) relative to adolescents who did not meet criteria for a psychiatric disorder. Conclusions: The presence of internalizing and externalizing disorders, especially mania, suggests the need for careful screening and targeting of adolescent sexual behavior during psychiatric treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

An examination of the prevalence of mental disorders among the elderly in the community.

Administered the Older Americans Resources and Services multidimensional functional assessment questionnaire to a multistage statewide area probability sample of 2,146 noninstitutionalized Virginians 60 yrs of age and older. Findings indicate that the vast majority of Ss in the community possessed the cognitive capacity and psychological resources necessary to manage the tasks of living independently. Only a relatively small proportion experienced psychological dysfunction, and these rates closely approximated those suggested by literature reviews. Overall, health self-ratings, education, and income were positively correlated with psychological well-being for nearly all psychological status measures. Age, sex, race, and marital status were related only to certain psychological disorders. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric disorders in homeless persons--Anglo-American studies of epidemiology and management]

Bleeding from gastro-oesophageal varices is a serious medical emergency associated with high morbidity and mortality. Recent advances in treatment include the use of safer vasoactive agents, endoscopic injection of cyanoacrylate, endoscopic variceal ligation and radiological porto-systemic shunt. This article will discuss these new therapies and suggest an integrated approach to the management of variceal haemorrhage.     

Features of episodes of mental disorders in chronic renal insufficiency (clinico-morphologic study)

The authors studied the traits of psychotic attacks in 40 patients with terminal stages of chronic renal insufficiency. They were expressed in atypical delirious, delirio-amentive and amentive conditions. 8 cases were studied morphologically. The pathological process in the brain was characterized as toxico-dyshomeostatic encephalopathy. The pathogenesis of such disorders is discussed.     

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.