Voluntary Health Insurance Coverage in California, 1961: A Report of the Bureau of Research and Planning, California Medical Association

Almost 7 out of every 10 of the estimated population of 16.2 million persons in California, were covered under some form of voluntary health insurance at the end of 1961. The forms of protection included hospital, surgical, regular medical and major medical expense benefits. The per cent of the civilian population of California covered for surgical benefits was slightly over 66 per cent, while 56 per cent were covered for regular medical expense benefits. Comparable percentages for the United States are approximately 74 per cent (hospital), 69 per cent (surgical), and 51 per cent (regular medical). While the percentage of the State's population covered for hospital and surgical expenses is below that for the United States, it is higher for regular medical expense benefits. The rate of increase in coverage for the different forms of health care protection in California exceeded the rate of population growth during the one-year period ending 1961. The foregoing summary and the information in the accompanying text, does not reflect the total number of persons in California who receive or are eligible for health care services. A large variety of government financed programs on local, state and federal levels either finance or provide such services to an estimated 40 to 50 per cent of the California population, which does not have voluntary health insurance coverage. No current data are available regarding the number of persons who do not desire voluntary health insurance coverage for a variety of personal or financial reasons.     

A century of premedical education

The Flexner Report established guidelines for medical education and made the university the obligate home for medical education. Flexner mandated specific elements necessary for university-based premedical education. With the exception of the MCAT, much less attention has been paid to premedical education and its integration into the scope of medical education than to education within the confines of the medical school. This article reviews the history of premedical education, describes some recent critiques of premedical education, discusses a newer program for premedical education evolving at the University of Illinois at Chicago, and offers some suggestions for the future.     

Clinic-based primary care of frail older patients in California.

We surveyed medical directors of primary care clinics in California to learn how those clinics cared for their frail older patients. Of 143 questionnaires sent, 127 (89%) were returned. A median of 30% of all patient encounters were with persons aged 65 or older, and a median of 20% of older patients were considered frail. A total of 20% of the clinics routinely provided house calls to homebound elderly patients. Of clinics involved in training medical students of physicians (teaching clinics), 70% had at least one physician with an interest in geriatrics, compared with 42% of nonteaching clinics (P less than .005). For frail patients, 40% of the clinics routinely performed functional assessment, while 20% routinely did an interdisciplinary evaluation. Continuing education in geriatrics emerged as a significant independent correlate of both functional assessment and interdisciplinary evaluation. Among the 94 clinics with a standard appointment length for the history and physical examination, only 11 (12%) allotted more than 60 minutes for frail patients. The data suggest that certain geriatric approaches are being incorporated into clinic-based primary care in California but do not provide insight into their content or clinical effects.     

Maternal Mortality in California

During the period August 1957 to December 1966, the Committee on Maternal and Child Care of the California Medical Association and the State Department of Public Health studied 1,219 deaths of women who died during or within 90 days of termination of pregnancy. Twenty-two percent of the deaths reviewed were considered unavoidable. Seventy percent had one or more avoidable factors; of these, 46 percent were attributed to errors in professional judgment, and 16 percent to inadequate prenatal care by the patient herself.Nearly one-third (383) of the 1,219 cases reviewed were deaths from non-obstetric causes. Of the 836 deaths from obstetric causes, 260 were attributed to abortion. Preliminary figures suggest a reduction in criminal abortion deaths corresponding to the increase in therapeutic abortions since 1968.Over one-third of the deaths occurred in Mexican and Negro mothers. Death rate for Negro was triple that for white mothers. Despite the presence of four medical schools in District II (Los Angeles County), maternal death rates were 30 to 50 percent higher than in other districts due to the large urban black and Chicano population. One rural district with a large migratory agricultural population also had high rates.     

The Premedical Student: His Identity: Characteristics of a Cohort of Premedical Students at the University of British Columbia

A prospective study is currently being conducted of students who were freshmen at the University of British Columbia in 1961-1962. Three cohorts are being followed: 136 premedical students, 107 science students, and 136 persons comprising a sample of general arts students. At registration in 1961, the only demographic difference was that the Premedical cohort had a greater proportion of catholics and persons from upper occupational classes. Premedical students generally performed as well in high school as science students and better than general arts students, though the academic potential of science students as measured by achievement and aptitude tests was superior. Premedical students performed better on freshman examinations than the other cohorts, though a significantly larger proportion of science students (84.4%) actually passed into second year than of premedical students (75.0%). A disturbing observation was that by second year the Science cohort had recruited more than enough students to balance its losses, while the Premedical cohort had lost three times as many students as it recruited. The net effect was not much reduced by students who entered directly from senior matriculation or other universities, since these students were about twice as likely to enter the Science cohort as they were to enter the Premedical cohort.     

Meningococcal Disease in California: Epidemiology and Management

Between 1969 and 1975 in California, 1,953 cases of meningococcal disease were reported. For cases reported in 1973, 1974 and 1975, detailed information about chemoprophylaxis of cases and contacts was obtained in addition to demographic and laboratory data. A review of data for the seven years showed a reduction in the case rate from 2.6 to 0.6 per 100,000 population, but this drop was due primarily to a very substantial decline in the military rate from 35.7 to 1.8 per 100,000 population. No reduction was apparent in the case fatality rate. Five groups of associated meningococcal disease cases were identified for a total of nine secondary or coprimary cases among 862 household contacts. Associated cases occurred in 10.4 per 1,000 household contacts—a rate several hundred times greater than that for the general population.The study findings indicate that many physicians are unaware of the following: (1) nonhousehold contacts are at little or no risk of contracting meningococcal disease; (2) prophylaxis should be offered only to household or intimate contacts immediately upon identification of an index case without waiting for test results for meningococcal carriage; (3) valid medical and epidemiologic indications exist for administering prophylaxis to household contacts who are culture negative as well as those who are culture positive; (4) the current drug of choice for prophylaxis is rifampin, but since no drug is completely effective, close medical observation remains the most important factor in the management of household or intimate contacts to meningococcal disease.     

The future of family practice training in California.

Although the number of physicians in California has doubled since 1963, the number of family and general practice physicians has declined. The ratio of office-based primary care physicians to population has also decreased. Graduate medical education is funded largely from patient care revenues, but the low rate of reimbursement for ambulatory care makes training in primary care specialties especially dependent on public support. Medicare, the Veterans Administration, and the University of California provide more than $325 million a year in support of graduate medical education in California. Federal and state grant programs provide $5 million a year for family physician training in the state, but appropriations to these programs have been reduced in real terms. California family practice residencies are disproportionately located at county hospitals, where funding shortfalls make them especially vulnerable to cuts in grant programs. Additional resources will be needed if more family physicians are to be trained.     

Characteristics of medical students who choose primary care as a career: the McMaster experience.

We examined the relation between demographic characteristics and the career choices of medical students who entered McMaster University medical school between 1969 and 1975. In contrast to earlier work, this study found no significant differences in sex, age, marital status at the time of entry into medical school, undergraduate major, whether prerequisite premedical courses had been taken, undergraduate grade point average and academic performance between the graduates who chose primary care and those who chose a specialty. This suggests that many medical school graduates in the 1970s entered primary care by choice rather than by default.     

Hepatic carcinoma with spleen metastasis in a California sea lion from the Gulf of California.

A primary hepatic carcinoma with a neuroendocrine pattern was detected in an adult female California sea lion (Zalophus californianus) found dead on Granito Island in the Gulf of California (Mexico) in January 1996. At necropsy, several light yellow nodules of different sizes were observed on the entire surface of the liver and spleen. Microscopic examination of these nodules using routine haematoxylin-eosin stain, revealed cubic, polyhedral and pleomorphic cells with three to four bizarre mitotic figures per field (40X). An immunohistochemistry test revealed a positive reaction of indirect immunoperoxide to cytokeratin (CK2). This is the first known case of a primary hepatic carcinoma in free-ranging California sea lions from Mexican waters.     

The Premedical Education of the First-Year Class in Canadian Medical Schools: 1965-66

The premedical academic records of the 1965-66 entering class of Canadian medical students were analysed. Ninety-six per cent of the class had taken their preparation in a Canadian institution, while 80% had taken it in the same university as the medical school in which they enrolled. Forty per cent entered without a degree, the remainder having at least a bachelor''s degree in arts or science.Thirty-six per cent of all courses taken by these students in their premedical education were in the physical sciences, 22% in the biological sciences and 41% in the social sciences and humanities. One-third of the students had taken no course in the behavioural sciences and another third had taken only one course.Analysis of the level of performance of the entering class showed that 10% had obtained an A average, 49% a B average, 41% a C average and 3% a D average. The grades of these students were higher generally in the natural sciences than in the social sciences or humanities.It was concluded that it could be questioned whether medical students received a premedical preparation which met the philosophy of a “broad, liberal education”.     

Inferring Geographic Isolation of Wolverines in California Using Historical DNA

ABSTRACT Delineating a species' geographic range using the spatial distribution of museum specimens or even contemporary detection-non-detection data can be difficult. This is particularly true at the periphery of a species range where species' distributions are often disjunct. Wolverines (Gulo gulo) are wide-ranging mammals with discontinuous and potentially isolated populations at the periphery of their range. One potentially disjunct population occurred in the Sierra Nevada Mountains, California, USA, and appears to have been extirpated by the 1930s. Many early 20th century naturalists believed that this population was connected to other populations occurring in the Cascade Range of northern California, Oregon, and Washington, USA, but a recent analysis of historical records suggests that California wolverines were isolated from other populations in North America. We used DNA extracted from museum specimens to examine whether California wolverines were isolated. Both nuclear and mitochondrial DNA data indicate that California wolverines were genetically distinct from extant populations, suggesting long-term isolation. We identified 2 new control region (mitochondrial DNA) haplotypes located only within California. We used these data and referenced sequences from the Rocky Mountains, USA, to make inferences regarding potential wolverine translocations into California. In addition, we used these genetic data to make inferences about wolverine conservation throughout western North America.     

The medical aspects of civil defense in California

Medical care for persons injured in atomic bomb attack or other far-reaching enemy action occupies an important place in civil defense plans that have been set up in California. Preparations have been made on the basis of suppositions as to where attacks might occur and estimates of the number of casualties. State and federal funds have been allocated for aid station equipment, antibiotics, plasma, blankets and litters. In the table of organization, use of all physicians, nurses and hospitals in the state is contemplated. Communities at the center of attacks would borrow facilities and medical personnel from areas not directly affected.County medical societies in California have appointed civil defense committees to work out local plans. Each physician has a part in these plans. If he does not know what his assignment is, be ought to get in touch with his county medical society headquarters immediately.     

Diagnosis and seroprevalence of leptospirosis in California sea lions from coastal California

The sensitivity and specificity of the microscopic agglutination test (MAT) as a method for detection of exposure to Leptospira spp. in California sea lions (Zalophus californianus) were determined. Sera came from individuals that demonstrated clinical signs of renal disease, had lesions suggestive of leptospirosis at necropsy, and had visible leptospires in silver stained kidney sections as positive controls. Sera from unexposed captive individuals were used as negative controls. The test was 100% sensitive at 1:3,200 for confirming renal infection and 100% specific at negative < 1:100 for detection of Leptospira interrogans scrovar pomona antibodies by MAT in California sea lions. Leptospira interrogans serovar pomona was used as a screening serovar because it has been isolated previously from the kidneys and placentas of California sea lions, and there appears to be cross-reactivity between serovar pomona and other serovars. Sera from 225 free-ranging California sea lions presented to one of three participating California (USA) coastal marine mammal rehabilitation centers in 1996 were then evaluated for antibodies to serovar pomona using the MAT. The overall seroprevalence was 38.2% (86/225), although the prevalence varied among locations from 100% (38/38) in animals at the Marine Mammal Care Center (Fort MacArthur, California, USA) to 0% (0/14) at SeaWorld California (San Diego, California). At The Marine Mammal Center (Sausalito, California) [prevalence 27.8% (48/173)], the majority of seropositive animals were subadults and adults, and males were 4.7 times more likely to be seropositive to serovar pomona than females. When combining results from all three centers, subadult and adult animals were more likely to be seropositive than pups and juvenile sea lions, and the highest proportion of seropositive animals presented during the autumn months. Serum elevations of blood urea nitrogen, creatinine, phosphorus, and/or calcium were associated with seropositivity to serovar pomona. We found no association between potassium or sodium levels and seropositivity.     

Modelling the distribution of a threatened habitat: the California sage scrub

Aim Using predictive species distribution and ecological niche modelling our objectives are: (1) to identify important climatic drivers of distribution at regional scales of a locally complex and dynamic system – California sage scrub; (2) to map suitable sage scrub habitat in California; and (3) to distinguish between bioclimatic niches of floristic groups within sage scrub to assess the conservation significance of analysing such species groups. Location Coastal mediterranean‐type shrublands of southern and central California. Methods Using point localities from georeferenced herbarium records, we modelled the potential distribution and bioclimatic envelopes of 14 characteristic sage scrub species and three floristic groups (south‐coastal, coastal–interior disjunct and broadly distributed species) based upon current climate conditions. Maxent was used to map climatically suitable habitat, while principal components analysis followed by canonical discriminant analysis were used to distinguish between floristic groups and visualize species and group distributions in multivariate ecological space. Results Geographical distribution patterns of individual species were mirrored in the habitat suitability maps of floristic groups, notably the disjunct distribution of the coastal–interior species. Overlap in the distributions of floristic groups was evident in both geographical and multivariate niche space; however, discriminant analysis confirmed the separability of floristic groups based on bioclimatic variables. Higher performance of floristic group models compared with sage scrub as a whole suggests that groups have differing climate requirements for habitat suitability at regional scales and that breaking sage scrub into floristic groups improves the discrimination between climatically suitable and unsuitable habitat. Main conclusions The finding that presence‐only data and climatic variables can produce useful information on habitat suitability of California sage scrub species and floristic groups at a regional scale has important implications for ongoing efforts of habitat restoration for sage scrub. In addition, modelling at a group level provides important information about the differences in climatic niches within California sage scrub. Finally, the high performance of our floristic group models highlights the potential a community‐level modelling approach holds for investigating plant distribution patterns.     

Antibodies to selected disease agents in translocated wild turkeys in California

Wild turkeys (Meleagris gallopavo) trapped within California (n = 715) or imported into California from other states (n = 381) from 1986 to 1996 were tested for exposure to certain disease agents. Prevalence of antibody to Mycoplasma gallisepticum, Mycoplasma meleagridis, Salmonella pullorum, Salmonella typhimurium, Newcastle disease virus, and avian influenza virus was low (0-4%) for wild turkeys trapped within California. With the exception of antibody prevalence to M. meleagridis of 33%, the same was true for wild turkeys imported into California from other states. Antibody prevalence to Mycoplasma synoviae was 8-10% for both groups.     

NTD prevalences in central California before and after folic acid fortification

BACKGROUND: In many regions, NTD prevalences were already declining prior to folic acid fortification. This study examined whether the declining prefortification (1989–1996) NTD prevalences continued into the postfortification period (1998–2003) in selected California counties. METHODS: This population‐based study used vital statistics data and birth defects registry data that were actively ascertained from medical records. The study population included all live births and stillbirths delivered in central California counties from 1989 to 2003. Cases included deliveries with NTDs during the same time period. RESULTS: For all NTDs combined, the slopes indicated that NTD prevalence was decreasing by 7.5 (slope: ?7.5; 95% CI: ?12.4, ?2.5) cases per 100,000 deliveries per year before fortification, whereas NTD prevalence was no longer decreasing after fortification. Comparison of the difference in the two slopes indicated that the postfortification slope exceeded the prefortification slope by 12.6 (95% CI: 2.6, 22.6) cases per 100,000 deliveries per year. CONCLUSIONS: Annual NTD prevalences in central California did not continue to decrease after implementation of folic acid fortification. Birth Defects Research (Part A) 2008. © 2008 Wiley‐Liss, Inc.     

The sexual psychopath in California

In California sexual offenders apprehended by the law are examined by court-appointed psychiatrists to determine whether they are "sexual psychopaths" as defined by California law and need treatment in a mental hospital. This paper outlines the criteria to be used as guides in properly selecting the persons for treatment. In general, sexual offenders fall into four categories. The first group consists of persons who cannot maintain proper control over their sexual impulses but whose acts do not constitute them a menace to the health and safety of others. They are not "sexual psychopaths" and their cases should be handled on their legal merits. The second group embraces persons who have committed a sexual offense on only one occasion and while under the influence of abnormal or unusual environmental stress. They are not considered "sexual psychopaths."The third is made up of persons completely out of step with the social culture. They often have long criminal histories or long histories of social maladjustment. They are impulsive in their behavior and not remorseful of their misdeeds. Sexually deviant acts committed by such individuals are often incidental to their general asocial and amoral behavior. They do not suffer from inability to control sexual impulses. Their offenses should be judged according to the legal merits of the case.True "sexual psychopaths" have deviant menaceful sexual impulses and are not able to control them. The vast majority of these persons are those who have committed sexual offenses against children. The California State Department of Mental Hygiene has a maximum security hospital which is charged with the care and treatment of "sexual psychopaths."     

Vicariance and dispersal across Baja California in disjunct marine fish populations

Abstract.— Population disjunctions, as a first step toward complete allopatry, present an interesting situation to study incipient speciation. The geological formation of the Baja California Peninsula currently divides 19 species of fish into disjunct populations that are found on its Pacific Coast and in the northern part of the Gulf of California (also called the Sea of Cortez), but are absent from the Cape (Cabo San Lucas) region. We studied the genetic makeup of disjunct populations for 12 of these 19 fish species. Phylogeographic patterns for the 12 species can be separated into two major classes: a first group (eight species) showed reciprocal monophyly and high genetic divergence between disjunct populations. A second group (four species) displayed what appeared to be panmictic populations. Population structure between Pacific Coast populations, across the Punta Eugenia biogeographic boundary, was also evaluated. While dispersal potential (inferred by pelagic larval duration) was a poor predictor of population structure between Gulf of California and Pacific populations, we found that population genetic subdivision along the Pacific Coast at Punta Eugenia was always positively correlated with differentiation between Pacific and Gulf of California populations. Vicariant events, ongoing gene flow, and ecological characteristics played essential roles in shaping the population structures observed in this study.     

Voluntary Health Insurance Coverage in California, 1952 to 1963—Report of the Bureau of Research and Planning

More than seven out of every ten of an estimated civilian population of 17.3 million people in California were covered under some form of voluntary health insurance at the close of 1963.Between 1952 and 1963, the number of Californians covered for hospital expenses increased from 5.7 million to 12.3 million; for surgical expenses from 5.4 million to 11.6 million; and for regular medical expenses from 3.0 million to 10.1 million.The percentage covered by health insurance also rose significantly: for hospitalization, from 51.3 to 71.0 per cent; for surgical, from 48.2 to 67.1 per cent; and for regular medical from 27.2 to 57.9 per cent. The rate of increase in hospitalization coverage was slightly higher in California than in the total U.S.; however, the per cent of persons covered remains lower. For surgical coverage, both the rate of increase and the per cent covered are lower in California. For regular medical, growth rates in California and in the U.S. were similar, however the over-all per cent covered is significantly higher in California.Major medical coverage, which has shown the fastest growth rate, covered only 0.4 per cent of the U.S. population in 1952 and 17.1 per cent by the end of 1963. Comparable figures for California are not available.     

Antibodies against Leptospira interrogans in California sea lion pups from Gulf of California

One hundred and twenty-five serum samples from California sea lion (Zalophus californianus californianus) pups, and one from an adult female from eight reproductive rookeries located in seven islands in the Gulf of California (Mexico), were collected during the 1994-96 reproductive seasons. These were tested for antibodies to 19 serovars of Leptospira interrogans using a Microscopic Agglutination Test (MAT). Forty-one samples (32%) had antibody levels from 1:20 to 1:320 to one or more serovars. The most frequently detected serotypes were Leptospira interrogans hardjo (n = 13), cynopteri (8), ballum (6), and szwajizak (5). Serovars with the highest prevalence were Leptospira interrogans hardjo and serjoe (1:320), ballum (1:160), and cynopteri, girppotyphosa, and tarassovi (1:80). Based on these results, exposure of sea lions to L. interrogans serovar hardjo seems to be relatively common among colonies located in the islands of the Gulf of California in contrast with those located on the Pacific coast, where the most frequently detected serovar is L. interrogans serovar pomona.