Chlamydia trachomatis in older Los Angeles County residents, 1991-1998: implications and recommendations for the detection of sexually transmitted infections in older age groups

OBJECTIVES: This study examined the incidence and implications of reported chlamydia cases in Los Angeles County residents aged 50 and older. DESIGN: Observational study of passive surveillance data submitted to the Los Angeles County Sexually Transmitted Disease Program. SETTINGS: Private and public health facilities in Los Angeles County. PARTICIPANTS: Los Angeles County residents aged 50 and older. MEASUREMENTS: Chlamydia cases were identified from the Los Angeles County Sexually Transmitted Disease Program passive surveillance system reports received from 1991 to 1998. RESULTS: Between 1991 and 1998, 1,421 cases of chlamydia were reported in persons aged 50 and older in Los Angeles County, accounting for 1% of total chlamydia cases. The average annual incidence rate for this period was 9.3 per 100,000, and appeared relatively stable. The mean age +/- standard deviation was 59.0 +/- 9.2 years, with a range of 50 to 96 years. Rates for older women were 1.1 to 3.0 times higher than in older men, similar to rate ratios for 20- to 35-year-olds. Rates among older African Americans appear to be substantially higher than any other older racial/ethnic group. CONCLUSIONS: Our data show that there are no age barriers for sexually transmitted infections. Although this population is highly unlikely to experience adverse reproductive outcomes, transmission to younger sex partners and contribution to the overall chlamydia epidemic are serious concerns. Surveillance and prevention strategies aimed at older persons will be needed as this population continues to grow.     

Demographic and health characteristics of heavy marijuana smokers in Los Angeles County

The demographic, life-style, and self-reported health characteristics of a convenience sample of 207 male and 70 female, non-Hispanic White, heavy marijuana users in Los Angeles County were compared with those of more representative county and national samples. Consistent with other researchers' findings, heavy marijuana users were found to differ significantly in living arrangements, job stability, and income. Heavy marijuana users did not differ in completed education, self-reported physical health, or use of alcohol and cigarettes. Heavy marijuana users were less likely to be married than nonusers, but reported the same number of close friends with whom they interacted more frequently than same-aged comparison groups. Our findings suggest that heavy marijuana users are not homogeneous, and that female users differ significantly from male users.     

Using laboratory surveillance data to estimate engagement in care among persons living with HIV in Los Angeles County, 2009

Poor engagement in HIV care has been associated with delayed access to antiretroviral treatment and increased HIV transmission. Using viral load (VL) results from HIV laboratory surveillance data to conduct longitudinal and cross-sectional analyses, we examined linkage to care, retention in care, and their associated factors in 37,325 persons living with HIV (PLWH) in Los Angeles County (LAC). Linkage to care was considered timely if a VL test result was present ≤3 months of diagnosis. Successful retention in care was defined as having two or more VL test results ≥90 days apart during 2009. Of 6841 persons newly diagnosed with HIV in 2007-2009, 67% were linked to care within 3 months of diagnosis. Factors associated with delayed linkage to care included being African American, Latino, and Asian/Pacific Islander (adjusted hazard ratio [AHR]=0.81; 95% CI=0.75-0.87, AHR=0.83; 95% CI=0.77-0.89, AHR=0.82; 95% CI=0.71-0.94, respectively). Of the 37,325 PLWH, 52% were retained in care during 2009. Factors associated with lack of retention in care included injection drug use (adjusted prevalence ratio [APR]=0.88; 95% CI=0.84-0.93), incarceration at diagnosis (APR=0.56; 95% CI=0.51-0.61), being diagnosed in pre-highly active antiretroviral therapy (HAART) era (APR=0.94; 95% CI=0.92-0.96) or at a public facility (APR=0.97; 95% CI=0.95-1.00), age <45 years (APR=0.87; 95% CI=0.86-0.89), and having concurrent HIV/AIDS diagnoses (APR=0.94; 95% CI=0.92-0.96). This study demonstrates the value of using VL surveillance data to monitor engagement in care among PLWH, and its potential to improve linkage and retention efforts where disparities in care are observed.     

Sequences of powder cocaine and crack use among arrestees in Los Angeles County

The epidemic of cocaine abuse has led to numerous studies on the substance. While extent of use, characteristics of users, patterns of use, and consequences of dependence are well documented for both powder cocaine and crack, few studies have dealt with the sequence or progression of use between the two forms of cocaine. This paper draws on arrestee data collected from county jails in Los Angeles, California. It identifies four sequences of powder cocaine and crack use and examines each sequence in terms of user characteristics, history of use, dependence, contact with the criminal justice system, and concomitant use of other drugs. Findings not only confirm some already established observations, but also offer new knowledge on powder cocaine and crack abuse. For instance, (a) whereas powder cocaine-initiated users are more likely to progress to crack than to restrict their use to powder cocaine only, crack-initiated users tend more often to use crack only than to progress to powder cocaine; and (b) powder cocaine and crack, when used interchangeably, can interact and reinforce each other, resulting in a higher level of use and dependence on both forms of the substance. This paper contributes to the understanding of powder cocaine and crack use among criminal offenders, in particular, and across the adult population, in general. It also sheds light on prevention, treatment, and social control policies of both cocaine abuse and overall illicit drug use.     

Surveillance of listeriosis in Los Angeles County, 1985-1986. A first year's report

After a large food-borne outbreak of listeriosis in Los Angeles County, California, in 1985, the California State Department of Health Services instituted mandatory reporting of Listeria monocytogenes by clinical laboratories. From September 1, 1985, through August 31, 1986, 94 cases of listeriosis were reported in Los Angeles County for an annual crude incidence rate of 12 cases per million persons. Of the 94 cases, 37 (39%) were in neonates and/or their mothers and 57 (61%) were nonperinatal. The overall case fatality rate was 31%, with a perinatal case fatality of 16% (6 fetal and 23 nonperinatal); this compares with an epidemic perinatal case fatality rate of 32%. No significant differences were observed in age-adjusted, race-specific incidence rates among nonperinatal cases or race-specific incidence rates among perinatal cases. All but 2 of the nonperinatal patients had a known predisposing risk factor for the development of listeriosis, the most common of which was a prior history of steroid therapy. A clustering of cases was not identified. No common food sources were apparent. Patients presenting as perinatal cases were more likely to have ingested Mexican-style cheese, ice cream, and yogurt than those presenting as nonperinatal cases. Improved case ascertainment through mandatory reporting and laboratory-based surveillance will establish meaningful baseline levels of listeriosis.     

Diagnosis of primary HIV-1 infection. Los Angeles County Primary HIV Infection Recruitment Network

BACKGROUND: The optimal approach for diagnosing primary HIV-1 infection has not been defined. OBJECTIVE: To determine the usefulness of symptoms and virologic tests for diagnosing primary HIV-1 infection. DESIGN: Prospective cohort study. SETTING: A teaching hospital in Los Angeles and a university research center in San Diego, California. PATIENTS: 436 patients who had symptoms consistent with primary HIV infection. MEASUREMENTS: Clinical information and levels of HIV antibody, HIV RNA, and p24 antigen. RESULTS: Primary infection was diagnosed in 54 patients (12.4%). The sensitivity and specificity of the p24 antigen assay were 88.7% (95% CI, 77.0% to 95.7%) and 100% (CI, 99.3% to 100%), respectively. For the HIV RNA assay, sensitivity was 100% and specificity was 97.4% (CI, 94.9% to 98.9%). Fever, myalgia, rash, night sweats, and arthralgia occurred more frequently in patients with primary infection (P < 0.05). CONCLUSIONS: No sign or symptom allows targeted screening for primary infection. Although assays for HIV RNA are more sensitive than those for p24 antigen in diagnosing primary infection, they are more expensive and are more likely to yield false-positive results.     

Alcohol and homicide: a comparison between Erie County, New York, and Los Angeles County, California

Blood alcohol levels (BALs) were determined for all homicide victims in Erie County, New York, between 1973 and August 1984. These data were compared with similar data for Los Angeles (L.A.) County, California. The overall percentage of victims with blood alcohol levels of 0.01 g% or more was lower in Erie County compared to L.A. County. However, when race and sex were examined as variables in this context, there were interesting differences between the two counties. For instance, there was a higher percentage of Black victims with positive BALS relative to negative BALs in L.A. County, but a higher percentage of White victims with positive BALs relative to negative BALs in Erie County. In Erie County there was a higher percentage of female victims with positive compared to negative BALS, whereas in L.A. County less than half the female victims had positive BALs.     

Alcohol and Homicide: A Comparison between Erie County,New York,and Los Angeles County,California

Blood alcohol levels (BALs) were determined for all homicide victims in Erie County, New York, between 1973 and August 1984. These data were compared with similar data for Los Angeles (L.A.) County, California. The overall percentage of victims with blood alcohol levels of 0.01 g% or more was lower in Erie County compared to L.A. County. However, when race and sex were examined as variables in this context, there were interesting differences between the two counties. For instance, there was a higher percentage of Black victims with positive BALS relative to negative BALs in L.A. County, but a higher percentage of White victims with positive BALs relative to negative BALs in Erie County. In Erie County there was a higher percentage of female victims with positive compared to negative BALS, whereas in L.A. County less than half the female victims had positive BALs.     

Prevention and treatment of travel-related infections in compromised hosts

PURPOSE OF REVIEW: The numbers of international travelers and complexity of their underlying medical conditions continue to increase. Traveling with compromised immunity warrants special consideration regarding the prevention and treatment of travel-related diseases, ideally with the help of a travel medicine specialist. There is a need for careful weighing of the potential health risks in persons with severe immunosuppression, including that related to HIV, use of immunomodulating agents, malignancy and cancer chemotherapy, solid organ and bone marrow transplantation, and asplenia. RECENT FINDINGS: Over the past year, a number of articles and texts have been published addressing the health risks and management strategies for travelers with underlying immune compromise, including the potential interactions between HIV and malaria, and transplant outcomes for those receiving transplants through medical tourism. SUMMARY: Tailored advice and treatment strategies for compromised travelers can help facilitate safe travel for individuals who choose risk-taking travel.     

Prevalence of Childhood Asthma and Associated Morbidity in Los Angeles County: Impacts of Race/Ethnicity and Income

Racial/ethnic and socioeconomic disparities in the prevalence of childhood asthma have been reported nationally but few population-based studies in local and regional settings have been reported. To assess variation in the prevalence of childhood asthma and associated morbidity across race/ethnic and income groups in the Los Angeles County population, we analyzed data on a random sample of 6004 children (≤17 years old) enrolled in a countywide health survey from 09 1999 through 04 2000. The prevalence of childhood asthma was highest in blacks (15.8%), intermediate in whites (7.3%) and Asians (6.0%), and lowest in Latinos (3.9%; p<0.001). These differences persisted after controlling for income, measures of health care access, and other covariates. Asthma prevalence was inversely related to income in all racial/ethnic groups except Latinos from Spanish-speaking households. Among children with asthma, blacks and Latinos were more likely than whites to report asthma-related limitations in physical activity and need for urgent medical services. These findings indicate marked disparities in asthma prevalence and related morbidity in this large urban child population and highlight the importance of efforts to identify high-risk subpopulations for focused prevention and treatment interventions.     

Protease inhibitors and cardiovascular disease: analysis of the Los Angeles County adult spectrum of disease cohort

Since protease inhibitors (PIs) were first introduced in 1995, research has shown that use of PIs greatly improves rates of survival, while slowing HIV disease progression. However, there are concerns that use of PIs may be associated with an increased risk of cardiovascular disease (CVD). To examine the relationship between PI use and CVD among HIV-infected patients, a large retrospective/prospective observational study was conducted. The study population was a clinic-based population seeking HIV treatment services between 1990 and 2000 at several sites in Los Angeles County. CVD was defined as ischemic heart disease/coronary artery disease (ICD-9 codes 410-414, 428, and 429.7) and cerebrovascular disease/stroke (ICD-9 codes 430-438). Multiple imputation was performed on missing data, and survival analysis was performed on the imputed datasets using an extended Cox Proportional Hazards Model. The 5,667 HIV-infected individuals contributed 15,550 person-years of follow-up. Eighty incident cases of CVD were identified. Use of PIs (hazard ratio (HR)=6.22 [95% CI: 3.13-12.39], p-value <0.001) and time-dependent non-PI use (HR 3.18 [1.99-5.09], p<0.001) were associated with CVD. Clinicians should monitor treatment of HIV-infected patients for adverse CVD events, and consider alternate forms of drug therapy and CVD-preventing drugs, particularly for those with a personal or family history of CVD.     

Prevalence of unprotected sex among men with AIDS in Los Angeles County, California 1995-1997.

OBJECTIVE: To determine the prevalence of unprotected sex among men with AIDS in Los Angeles County. DESIGN: Cross-sectional study. METHODS: All men aged > or = 18 years who were newly reported to the local health department with AIDS and completed a standardized interview between January 1995 and June 1997 were included in the study. Men were classified as having unprotected sex if they reported one or more sex partners during the past year with whom they had vaginal or anal sex and did not always use a condom. RESULTS: Of 617 men interviewed, 29% reported unprotected sex in the past year. The prevalence of unprotected sex was highest among men < 30 years of age (43%) and those who had first learned of their HIV-positive status < 12 months prior to interview (44%). In all, 323 (52%) men reported one or more male sex partners in the past year. Of these, 22% reported unprotected insertive anal sex and 27% unprotected receptive anal sex. One or more female partners in the past year was reported by 131 (21%) men. Of these, 53% reported unprotected vaginal sex and 18% unprotected anal sex. CONCLUSIONS: The findings highlight the importance of early HIV detection efforts, coupled with targeted and sustained HIV prevention services for those who test positive, to prevent ongoing transmission of the virus.     

Time since immigration and health services utilization of Korean-American older adults living in Los Angeles County

The aim of this study was to characterize ambulatory healthcare utilization of older Korean Americans and its association with length of time since immigration. It was hypothesized that older Korean Americans who were recent immigrants would use outpatient physician visits less often than early immigrants. The data are from the 2000 Korean-American Health Survey, which assessed the health status and medical needs of Korean Americans living in Los Angeles County. The dependent variable was the number of visits to a physician for check-up or consultation. Multivariate regression modeling was used to assess the influence of length of time since immigration on the dependent variable controlling for predisposing, enabling, and need variables for a sample of 208 Koreans Americans aged 65 and older. Results indicated that high school education in Korea and health insurance status were significant predictors of number of visits to a physician during the previous year (P<.05). The main variable of interest, the number of years living in the United States, approached significance at P=.09. It was concluded that enabling variables such as education and health insurance significantly influenced use of healthcare services in the older Korean-American population. The lack of studies regarding older minority populations and their access to healthcare further highlight theneed not only to characterize the access of these often-vulnerable populations, but also to generate interest for further studies.     

Measles surveillance in five major US cities: Chicago, Houston, Los Angeles, Miami, and New York

Endemic measles, if it occurs in the United States, will likely be found in cities, because large populations are required to sustain transmission and importations of measles virus are most frequent in cities. We investigated measles surveillance systems in 5 cities (Chicago, Houston, Los Angeles, Miami, New York City) during 1995-1999. The passive reporting of a measles case activated the systems to look for more cases and to intervene to prevent more cases. During 1995-1999, 1363 suspected measles cases were investigated. Only 58 of these were confirmed as measles (0.24 cases/100000 people), and the majority (57%) of confirmed cases were imported or linked to an importation. Most (83%) suspected cases that met the case definition had a complete case investigation, including a laboratory test for measles. We conclude that surveillance in these 5 cities shows no evidence of endemic measles transmission.     

The Use of Diazepam and of Cocaine in Combination with Other Drugs by Los Angeles County Probationers

The use and abuse of other drugs by Los Angeles County probationers who use diazepam or cocaine has been studied. The results indicate that although diazepam is frequently used alone, it is more often used in combination with other drugs, particularly phencyclidine, opiates, and methadone. The results also indicate that most cocaine users do not use other drugs in combination with their cocaine, but when another drug is used it is most likely phencyclidine, an opiate, or a sedative hypnotic.     

How the 2008 stock market crash and seasons affect total and cardiac deaths in Los Angeles County

Various stressors trigger cardiac death. The objective was to investigate a possible relation between a stock market crash and cardiac death in a large population within the United States. We obtained daily stock market data (Dow Jones Industrial Average Index), death certificate data for daily deaths in Los Angeles County (LA), and annual LA population estimates for 2005 through 2008. The 4 years death rate curves (2005 through 2008) were averaged into a single curve to illustrate annual trends. Data were "deseasonalized" by subtracting from the daily observed value the average value for that day of year. There was marked seasonal variation in total and cardiac death rates. Even in the mild LA climate, death rates were higher in winter versus summer including total death (+17%), circulatory death (+24%), coronary heart disease death (+28%), and myocardial infarction death (+38%) rates (p <0.0001 for each). Absolute coronary heart disease death rates have decreased since 1985. After accounting for seasonal variation, the large stock market crash in October 2008 did not affect death rates in LA. Death rates remained at or below seasonal averages during the stock market crash. In conclusion, after correcting for seasonal variation, the stock market crash in October 2008 was not associated with an increase in total or cardiac death in LA. Annual coronary heart disease death rates continue to decrease. However, seasonal variation (specifically winter) remains a trigger for death and coronary heart disease death even in LA where winters are mild.     

Unprotected Sex of Homeless Women Living in Los Angeles County: An Investigation of the Multiple Levels of Risk

This research uses multi-level modeling to investigate the context of unprotected sex of homeless women. Based on interviews with 429 randomly selected women living in temporary shelter settings in Los Angeles, this project investigates multiple levels of influence on unprotected sex with particular partners. Previous studies have investigated condom use of homeless women primarily at the individual level. This project investigates unprotected sex at the level of the partnership, the individual woman, and her social network. Homeless women who believe in the efficacy of condoms to prevent HIV infection, believe that they have low susceptibility to HIV and have a greater proportion of their non-sex partner social network ties with whom they speak about HIV are less likely to engage in unprotected sex. Women are more likely to engage in risky sexual behavior in relationships in which they have high commitment to their partner and experience physical violence.     

Prevalence of intestinal parasitic infections in patients with acquired immunodeficiency syndrome in Brazil.

OBJECTIVES: To evaluate the prevalence of intestinal parasitic infections and to investigate the possible associations of clinical status and laboratory findings with the different parasites found in stool samples. METHODS: Each patient was provided with one standard fecal collection vial containing 10% formalin for detecting ova, larvae, and cysts. To detect Cryptosporidium parvum and Isospora belli, the acid-fast Kinyoun stain and fluorescent auramine-rhodamine stain were used. RESULTS: A total of 200 patients with acquired immunodeficiency syndrome participated in this study; 40% were infected with at least one pathogenic species. The total prevalence of parasites was 16% for Giardia lamblia, 13% for Entamoeba coli, 7% for Cryptosporidium parvum, 3.5% for Endolimax nana, 2.5% for Ascaris lumbricoides, 2.5% for Strongyloides stercoralis, 2% for Isospora belli, and 0.5% for Blastocystis hominis. Results showed that diarrhea was significantly associated with cryptosporidiosis, giardiasis, and isosporiasis. However, no association was observed between the CD4+ cell counts and the manifestation of any particular parasite. CONCLUSIONS: The data support the value of standard fecal examinations in human immunodeficiency virus-infected patients, even in the absence of diarrhea, since these examinations easily can be performed, with low costs, and frequently disclose treatable conditions.