scholarly journals A Tale of Two Institutions: COVID-19 Positive Rates in Asymptomatic Patients Pre-Screened for Spine Procedures and Surgeries in Los Angeles, California

2021 ◽  
pp. 219256822110574
Author(s):  
Allen S. Chen ◽  
Matthew Brown ◽  
Anush Arekelyan ◽  
Sophie Wennemann ◽  
Nick Shamie ◽  
...  
Keyword(s):  
Public Health ◽  
Los Angeles ◽  
Los Angeles County ◽  
Data Sets ◽  
Global Public Health ◽  
Rt Pcr ◽  
Asymptomatic Patients ◽  
Time Period ◽  
Chi Squared ◽  
Using Data

Study Design Retrospective cohort study. Objectives The coronavirus disease (COVID-19), caused by the severe respiratory syndrome coronavirus 2 (SARS-CoV-2), has created an unprecedented global public health emergency. The aim of the current study was to report on COVID-19 rates in an asymptomatic population prior to undergoing spine procedures or surgeries at two large Los Angeles healthcare systems. Methods Elective spine procedures and surgeries from May 1, 2020 to January 31, 2021 were included. Results from SARS-CoV-2 virus RT-PCR nasopharyngeal testing within 72 hours prior to elective spine procedures were recorded. Los Angeles County COVID-19 rates were calculated using data sets from Los Angeles County Department of Public Health. Chi-squared test and Stata/IC were used for statistical analysis. Results A total of 4,062 spine procedures and surgeries were scheduled during this time period. Of these, 4,043 procedures and surgeries were performed, with a total of 19 patients testing positive. Nine positive patients were from UCLA, and 10 from USC. The overall rate of positive tests was low at .47% and reflected similarities with Los Angeles County COVID-19 rates over time. Conclusions The current study shows that pre-procedure COVID-19 testing rates remains very low, and follows similar patterns of community rates. While pre-procedure testing increases the safety of elective procedures, universal COVID-19 pre-screening adds an additional barrier to receiving care for patients and increases cost of delivering care. A combination of pre-screening, pre-procedure self-quarantine, and consideration of overall community COVID-19 positivity rates should be further studied.

scholarly journals Public Health Efforts Can Impact Adoption of Current Susceptibility Breakpoints, but Closer Attention from Regulatory Bodies Is Needed

2018 ◽  
Vol 57 (3) ◽  
Author(s):  
James A. McKinnell ◽  
S. Bhaurla ◽  
P. Marquez-Sung ◽  
A. Pucci ◽  
M. Baron ◽  
...  
Keyword(s):  
Public Health ◽  
Patient Safety ◽  
Los Angeles ◽  
Antimicrobial Susceptibility ◽  
Los Angeles County ◽  
Susceptibility Testing ◽  
Clinical Care ◽  
Public Health Intervention ◽  
Antimicrobial Susceptibility Testing ◽  
Outreach Program

ABSTRACT Microbiological testing, including interpretation of antimicrobial susceptibility testing results using current breakpoints, is crucial for clinical care and infection control. Continued use of obsolete Enterobacteriaceae carbapenem breakpoints is common in clinical laboratories. The purposes of this study were (i) to determine why laboratories failed to update breakpoints and (ii) to provide support for breakpoint updates. The Los Angeles County Department of Public Health conducted a 1-year outreach program for 41 hospitals in Los Angeles County that had reported, in a prior survey of California laboratories, using obsolete Enterobacteriaceae carbapenem breakpoints. In-person interviews with hospital stakeholders and customized expert guidance and resources were provided to aid laboratories in updating breakpoints, including support from technical representatives from antimicrobial susceptibility testing device manufacturers. Forty-one hospitals were targeted, 7 of which had updated breakpoints since the prior survey. Of the 34 remaining hospitals, 27 (79%) assumed that their instruments applied current breakpoints, 17 (50%) were uncertain how to change breakpoints, and 10 (29%) lacked resources to perform a validation study for off-label use of the breakpoints on their systems. Only 7 hospitals (21%) were familiar with the FDA/CDC Antibiotic Resistance Isolate Bank. All hospitals launched a breakpoint update process; 16 (47%) successfully updated breakpoints, 12 (35%) received isolates from the CDC in order to validate breakpoints on their systems, and 6 (18%) were planning to update within 1 year. The public health intervention was moderately successful in identifying and overcoming barriers to updating Enterobacteriaceae carbapenem breakpoints in Los Angeles hospitals. However, the majority of targeted hospitals continued to use obsolete breakpoints despite 1 year of effort. These findings have important implications for the quality of patient care and patient safety. Other public health jurisdictions may want to utilize similar resources to bridge the patient safety gap, while manufacturers, the FDA, and others determine how best to address this growing public health issue.

Incidentally Detected SARS-COV-2 Among Hospitalized Patients in Los Angeles County, August to October 2020

2021 ◽  
Vol 16 (8) ◽  
Author(s):  
Jennifer Tsai ◽  
Elizabeth Traub ◽  
Kymberly Aoki ◽  
Kelsey Oyong ◽  
Heidi Sato ◽  
...  
Keyword(s):  
Public Health ◽  
Los Angeles ◽  
Emergency Preparedness ◽  
Medical Records ◽  
Confidence Limit ◽  
Los Angeles County ◽  
Resource Planning ◽  
Hospital Discharges ◽  
Hospitalization Rates ◽  
Test Result

We aimed to determine the percentage of COVID-19–associated hospitalizations reported to Los Angeles County (LAC) Public Health that might have been misclassified because of incidentally detected SARS-CoV-2. We retrospectively reviewed medical records from a randomly selected set of hospital discharges reported to LAC Public Health from August to October 2020 for a clinical diagnosis of COVID-19 or a positive SARS-CoV-2 test result. Among the 13,813 discharges from 85 hospitals reported to LAC Public Health as COVID-19–associated hospitalizations from August to October 2020, 346 were randomly selected and reviewed. SARS-CoV-2 detection was incidental to the reason for hospitalization in 12% (95% confidence limit, 9%-16%) of COVID-19 classified hospital discharges. Adjusting COVID-19–associated hospitalization rates to account for incidental SARS-CoV-2 detection could help public health policymakers and emergency preparedness personnel improve resource planning.

Introduction and History of Public Health in Los Angeles County

2012 ◽  
pp. 1-12
Author(s):  
Jonathan E. Fielding ◽  
Jonathan Freedman ◽  
Stephanie N. Caldwell
Keyword(s):  
Public Health ◽  
Los Angeles ◽  
Los Angeles County ◽  
History Of Public Health ◽  
History Of

Evaluating Perceived Emergency Preparedness and Household Preparedness Behaviors: Results from a CASPER Survey in Fairfax, Virginia

2019 ◽  
Vol 14 (2) ◽  
pp. 222-228
Author(s):  
Rennie W. Ferguson ◽  
Shawn Kiernan ◽  
Ernst W. Spannhake ◽  
Benjamin Schwartz
Keyword(s):  
Public Health ◽  
Emergency Preparedness ◽  
Large Scale ◽  
Household Level ◽  
Perceived Preparedness ◽  
Chi Squared ◽  
Public Health Emergency Response ◽  
Household Preparedness ◽  
Using Data ◽  
The Relationship

ABSTRACTObjectives:Using data collected from a Community Assessment for Public Health Emergency Response (CASPER) conducted in Fairfax Health District, Virginia, in 2016, we sought to assess the relationship between household-level perceived preparedness and self-reported preparedness behaviors.Methods:Weighted population estimates and 95% confidence intervals were reported, and Pearson’s chi-squared test was used to investigate differences by group.Results:Examining responses to how prepared respondents felt their household was to handle a large-scale emergency or disaster, an estimated 7.4% of respondents (95% CI: 4.3–12.3) reported that their household was “completely prepared,” 37.3% (95% CI: 31.4–43.7) were “moderately prepared,” 38.2% (95% CI: 31.6–45.2) were “somewhat prepared,” and 14.4% (95% CI: 10.2–20.0) were “unprepared.” A greater proportion of respondents who said that their household was “completely” or “moderately” prepared for an emergency reported engaging in several behaviors related to preparedness. However, for several preparedness behaviors, there were gaps between perceived preparedness and self-reported readiness.Conclusions:Community assessments for public health preparedness can provide valuable data about groups who may be at risk during an emergency due to a lack of planning and practice, despite feeling prepared to handle a large-scale emergency or disaster.

Using decision analysis to select alternate modes of dispensing: An example from Los Angeles County Public Health

2009 ◽  
Vol 7 (2) ◽  
pp. 39
Author(s):  
Sinan Khan, MPH, MA ◽  
Anke Richter, PhD
Keyword(s):  
Public Health ◽  
Los Angeles ◽  
Decision Analysis ◽  
Los Angeles County ◽  
Relative Effectiveness ◽  
Health Maintenance Organization ◽  
Sensitivity Analyses ◽  
Health Maintenance ◽  
Response Planning ◽  
The Many

Objective: To comply with the Center for Disease Control’s mass prophylaxis mandates, many public health jurisdictions must supplement their existing Points of Dispensing (POD)-based system. Because of limited budgets and personnel availability, only one or two alternatives out of the many potential options can be implemented.Design: Multicriteria decision analysis is a powerful tool that allows public health officials to assess the relative effectiveness of alternate modes of dispensing while incorporating the opinions of their multidisciplinary emergency response planning teams.Setting: This process was utilized to analyze the effectiveness of alternate modes of dispensing that could be used to supplement the existing POD system within the Los Angeles County (LAC) Department of Public Health (DPH).Results: The top two options for LAC were prepositioning for civil service and partnership with a major Health Maintenance Organization. These choices were stable under a variety of sensitivity analyses, and the differences in opinion between the agencies and other stakeholders do not change them.Conclusions: The transparency of the model and analysis may allow decision makers and planners in the LAC DPH to garner support for their alternate modes of dispensing plans. By making the decision criteria clear and demonstrating the robustness of the results in the sensitivity analyses, public health partners gain a deeper understanding of the issues and their potential roles. The process can be repeated by any jurisdiction, but definition of “best” will rely on the issues and gaps that are identified with the jurisdiction’s POD plan for mass prophylaxis.

scholarly journals Spatial distribution of tuberculosis incidence in Los Angeles County

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Adam Readhead ◽  
Alicia H. Chang ◽  
Jo Kay Ghosh ◽  
Frank Sorvillo ◽  
Julie Higashi ◽  
...  
Keyword(s):  
Public Health ◽  
Spatial Distribution ◽  
Los Angeles ◽  
Los Angeles County ◽  
Disease Incidence ◽  
The Philippines ◽  
Incidence Rates ◽  
Country Of Birth ◽  
High Incidence ◽  
The U.S

Abstract Background In Los Angeles County, the tuberculosis (TB) disease incidence rate is seven times higher among non-U.S.-born persons than U.S.-born persons and varies by country of birth. But translating these findings into public health action requires more granular information, especially considering that Los Angeles County is more than 4000 mile2. Local public health authorities may benefit from data on which areas of the county are most affected, yet these data remain largely unreported in part because of limitations of sparse data. We aimed to describe the spatial distribution of TB disease incidence in Los Angeles County while addressing challenges arising from sparse data and accounting for known cofactors. Methods Data on 5447 TB cases from Los Angeles County were combined with stratified population estimates available from the 2005–2011 Public Use Microdata Survey. TB disease incidence rates stratified by country of birth and Public Use Microdata Area were calculated and spatial smoothing was applied using a conditional autoregressive model. We used Bayesian Poisson models to investigate spatial patterns adjusting for age, sex, country of birth and years since initial arrival in the U.S. Results There were notable differences in the crude and spatially-smoothed maps of TB disease rates for high-risk subgroups, namely persons born in Mexico, Vietnam or the Philippines. Spatially-smoothed maps showed areas of high incidence in downtown Los Angeles and surrounding areas for persons born in the Philippines or Vietnam. Areas of high incidence were more dispersed for persons born in Mexico. Adjusted models suggested that the spatial distribution of TB disease could not be fully explained using age, sex, country of birth and years since initial arrival. Conclusions This study highlights areas of high TB incidence within Los Angeles County both for U.S.-born cases and for cases born in Mexico, Vietnam or the Philippines. It also highlights areas that had high incidence rates even when accounting for non-spatial error and country of birth, age, sex, and years since initial arrival in the U.S. Information on spatial distribution provided here complements other descriptions of local disease burden and may help focus ongoing efforts to scale up testing for TB infection and treatment among high-risk subgroups.

scholarly journals 542. Los Angeles County Acute Care Regional Antibiogram Suggests Changing Landscape of MDRO Threats Between 2015 and 2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S258-S259
Author(s):  
James McKinnell ◽  
Chelsea Foo ◽  
Kelsey OYong ◽  
Janet Hindler ◽  
Sandra Ceja ◽  
...  
Keyword(s):  
Public Health ◽  
Los Angeles ◽  
Acute Care ◽  
Los Angeles County ◽  
Multivariable Analysis ◽  
Multidrug Resistant ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Level Data ◽  
Facility Level

Abstract Background National surveillance for multidrug-resistant organisms (MDRO) are limited by narrow geographic sampling, few hospitals, and failure to account for local epidemiology. A Los Angeles County (LAC) regional antibiogram was created to inform public health interventions and provide a baseline for susceptibility patterns countywide. We present data to compare the 2015 and 2017 LAC regional antibiogram. Methods We conducted a cross-sectional survey of cumulative facility-level antibiograms from all hospitals in LAC; 83 hospitals (AH) and 9 Long-term Acute Care (LTAC). For 2015, submission was voluntary, 2017 data were collected by public health order. Non-respondents were contacted by phone and in person. Isolates from sterile sources were pooled. Countywide susceptibility was calculated by weighting each facility’s isolate count by its reported susceptibility rate with minimum–maximim observed (2015) and Interquartile range (IQR) for 2017. Change from 2015 mean susceptibility is reported. Results Seventy-five (75) facilities submitted antibiograms for 2015 and 86 facilities for 2017. Among non-respondents in 2017, two facilities could not provide an adequate antibiogram and 4 were specialty hospitals with too few cultures to create an antibiogram. Regional summmary tables are presented in Tables 1–4. Klebsiella pneumoniae (n = 50 hospitals/19,382 isolates) % S to meropenem was 97% (IQR 94–100%), no change from 2015. Pseudomonas aeruginosa (PA) (n = 52 hospitals/17,770 isolates)% S to meropenem was 84% (IQR 74–93%), no change from 2015. Susceptibility to Acinetobacter baumannii (AB) was reported by 48 hospitals, including 1,4361 isolates,% S to meropenem was 39% (IQR 25–75%), 14% lower than 2015. Streptococcus agalactiae (n = 13 hospitals/647 isolates)% S to clindamycin was 43% (IQR 13–59%), a 22% increase from 2015. Conclusion LAC regional antibiograms identified stable patterns of antimicrobial resistance for most pathogens, but concerning results with AB and PA. Analysis of highly drug-resistant pathogens such as AB and PA would be improved with patient-level data to generate a combination antibiogram. We favor presenting IQR %S as done for 2017. Ongoing analysis will include multivariable analysis of observed changed S controlling for hospital characteristics. Disclosures All authors: No reported disclosures.

scholarly journals Genetic Analysis of Invasive Aedes albopictus Populations in Los Angeles County, California and Its Potential Public Health Impact

PLoS ONE ◽  
2013 ◽  
Vol 8 (7) ◽  
pp. e68586 ◽  
Author(s):  
Daibin Zhong ◽  
Eugenia Lo ◽  
Renjie Hu ◽  
Marco E. Metzger ◽  
Robert Cummings ◽  
...  
Keyword(s):  
Public Health ◽  
Los Angeles ◽  
Genetic Analysis ◽  
Aedes Albopictus ◽  
Los Angeles County ◽  
Health Impact ◽  
Public Health Impact ◽  
Potential Public Health
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