California Department of Health Care Services

Clinically significant fetomaternal hemorrhage (FMH) can have devastating consequences on the newborn infant. Acute FMH close to childbirth can present with hypovolemia, shock, metabolic acidosis, and encephalopathy. Chronic FMH can be associated with congestive heart failure, pulmonary edema, hydrops and hepatomegaly. Early recognition and timely management of FMH are crucial in improving outcomes. This review article summarizes the epidemiology, pathogenesis, diagnosis, management and outcomes of clinically significant FMH. Current knowledge gaps in diagnosis and management of FMH are additionally described.

For centuries, anatomists have charted the folding patterns of the sulci of the cerebral cortex in primates. Improvements in neuroimaging technologies over the past decades have led to advancements in the understanding of the sulcal organization of the human cerebral cortex, yet comparisons to chimpanzees, one of humans' closest extant phylogenetic relatives, remain to be performed in many regions, such as the caudal temporoparietal region (cTPR). For example, while several posterior branches, or rami, of the superior temporal sulcus (STS) have been identified within the cTPR in great apes since the late 1800s, no study has yet comprehensively identified and quantitatively compared these rami across species. To fill this gap in knowledge, in the present study, we defined the three caudal branches of the STS (cSTS) in 72 human and 29 chimpanzee brains (202 total hemispheres) and then extracted and compared the morphological (depth and surface area) properties of these sulci. We report three main findings. First, modern methods replicate classic findings that three rami of the posterior STS are unique to the hominid lineage (i.e., humans and great apes). Second, normalizing for brain size, the cSTS rami were relatively deeper in chimpanzees compared to humans. Third, the cSTS branches were relatively larger in surface area in humans compared to chimpanzees. Finally, we share probabilistic predictions of the cSTS to guide the identification of these sulci in future studies. Altogether, these findings bridge the gap between historic qualitative observations and modern quantitative measurements in a part of the brain that has expanded substantially throughout evolution and that is involved in human-specific aspects of cognition.

ABSTRACT Due to geography, structural, and economic factors, California has been the site of multiple climate crises. Deaf and disabled Californians face especially high health risks in crises, partly due to inaccessible risk communications before, during, and after disasters. California's Offices of Emergency Services (OES) play an important role in ensuring inclusive emergency communication for disabled people. This study examines accessibility of climate‐related risk communications in California's OES for deaf and disabled people and is intended to provide guidance to the cities, counties, and the state to improve risk communication plans for disabled people. Key informants from county ( n = 44) and city ( n = 13) OES offices were surveyed about whether their OES provided accessible emergency communications, had barriers, and had needs to improve accessible communications. Findings reveal that urban OES offices more frequently report using or being aware of accessible communication strategies, while rural offices face challenges due to limited resources and infrastructure. Rural OES have fewer partnerships with deaf‐serving organizations and are less likely to have resources to provide captioning and American Sign Language (ASL) interpreters, compared to urban OES. The study highlights the need for improved training, resource allocation, and policy integration to address accessible communication gaps, especially in rural areas. Recommendations include increased training and funding for rural OES offices, stronger partnerships with disability advocacy groups, and the adoption of universal design principles in climate risk communications. This would ensure that all Californians—regardless of location or ability—receive the information they need to prepare for and respond to climate disasters.

Background: In 2022, stroke shifted from the fourth to the fifth leading cause of death in the U.S. as COVID-19 temporarily took its place. Despite this change, stroke remains a significant cause of mortality and long-term disability in the U.S. This study analyzes trends in in-hospital mortality among stroke-related hospitalizations in California from 2016 to 2022, with a particular focus on the pandemic years. Methods: This retrospective analysis utilized patient discharge data from the California Department of Health Care Access and Information, screening nearly 25 million inpatient events for stroke-related ICD-10-CM diagnosis codes (I60-I63) among individuals 20 and older. Multivariate logistic regression (MLR) analysis assessed the impact of the pre- and post-COVID-19 periods on in-hospital mortality, adjusting for confounders such as age, gender, race and ethnicity, geographic regions, and payer source. Results were interpreted using Adjusted Odds Ratios (AOR). Results: The study identified 590,801 stroke-related hospitalizations and 66,096 in-hospital deaths (11.2%). Initially, the age-and-sex-adjusted in-hospital mortality rate decreased from 28.88 per 100,000 in 2016 to 27.38 in 2019. However, with the onset of COVID-19 in 2020, the rate increased to 27.94, peaking in 2021 at 30.78 during the pandemic's height. In 2022, the rate slightly declined to 28.30 but remained above pre-pandemic levels. Similar trends from 2016 to 2022 were observed in age-adjusted rates for males, which increased from 27.77 to 29.73, and for females, which decreased from 29.91 to 26.98. The gap between male and female mortality rates widened significantly during the pandemic, with male mortality peaking in 2021 with a difference of 3.75. MLR analysis revealed a 22.6% increase in in-hospital mortality during the post-COVID period compared to the pre-COVID period (AOR=1.23, p<0.001). Additionally, male mortality was 25.3% higher than female mortality (AOR=1.25, p<0.001). Racial disparities were also noted, with Asians having a 53.9% higher prevalence of stroke compared to Whites (AOR=1.54, p<0.001), followed by Blacks at 38.8%. Conclusion: The COVID-19 pandemic significantly impacted in-hospital stroke mortality rates in California, particularly during the peak in 2021. The study highlights the differential impact on males, who experienced higher mortality increases, and the pronounced racial disparities, with Asians and Blacks showing higher prevalence rates compared to Whites.

Prior authorization criteria for Federal Drug Administration (FDA) approved immunotherapeutics, among the class of anti-amyloid monoclonal antibodies (mAbs), established by state drug formulary committees, are tailored for adults with late-onset Alzheimer's disease. This overlooks adults with Down syndrome (DS), who often experience dementia at a younger age and with different diagnostic assessment outcomes. This exclusion may deny DS adults access to potential disease-modifying treatments. To address this issue, an international expert panel convened to establish adaptations of prescribing criteria suitable for DS patients and parameters for access to Centers for Medicare & Medicaid Services (CMS) registries. The panel proposed mitigating disparities by modifying CMS and payer criteria to account for younger onset age, using alternative language and assessment instruments validated for cognitive decline in the DS population. The panel also recommended enhancing prescribing clinicians' diagnostic capabilities for DS and initiated awareness-raising activities within healthcare organizations. These efforts facilitated discussions with federal officials, aimed at achieving equity in access to anti-amyloid immunotherapeutics, with implications for national authorities worldwide evaluating these and other new disease-modifying therapeutics for Alzheimer's disease.

To assess demographics and outcomes up to 3 years of age among children with cytomegalovirus (CMV) infection in California neonatal intensive care units (NICUs) during 2010-2021. The California Perinatal Quality Care Collaborative (CPQCC) collects data on all very low birth weight (VLBW, birth weight ≤ 1500 g) and acutely ill infants with birth weight > 1500 g across 92% of NICUs in California. VLBW infants and those with neurological conditions are referred to a statewide high-risk infant follow-up (HRIF) program. CMV infection was defined as a positive culture or PCR identified during the NICU hospitalization. During 2010-2021, CMV reporting rates averaged 3.5/1000 VLBW infants (n = 205) and 1.1/1000 infants >1500 g (n = 128). Among all 333 infants with CMV, 314 (94%) were discharged home alive, 271 (86%) were referred for HRIF and 205 (65%) had ≥1 visit. Whereas infants born to mothers <20 years of age had highest CMV reporting rates and those born to Hispanic mothers comprised 49% of all infected infants, they had the highest loss of follow-up. At the 12-month visit (n = 152), 19 (13%) infants with CMV had bilateral blindness and 18 (12%) had hearing loss. At the 24-month visit, 5 (5%) of 103 had severe cerebral palsy. Among infants admitted to the NICU, those with CMV diagnoses may over represent infants with more severe CMV disease and outcomes. The CPQCC and HRIF program findings may help inform implementation of surveillance for congenital CMV infection in other U.S. states and guide strategies to reduce disparities in access to services.

Value-based insurance design (VBID) has mostly been used in improving medication use and adherence for certain conditions or patients, but its outcomes remain uncertain when applied to other services and to all health plan enrollees. To determine the association of participation in a California Public Employees' Retirement System (CalPERS) VBID program with its enrollees' health care spending and utilization. A retrospective cohort study with difference-in-differences propensity-weighted 2-part regression models was performed in 2021 to 2022. A VBID cohort was compared with a non-VBID cohort both before and after VBID implementation in California in 2019 with 2 years' follow-up. The study sample included CalPERS preferred provider organization continuous enrollees from 2017 through 2020. Data were analyzed from September 2021 to August 2022. The key VBID interventions include (1) if selecting and using a primary care physician (PCP) for routine care, PCP office visit copayment is $10 (otherwise, PCP office visit copayment is $35 as for specialist visit); and (2) annual deductibles reduced by a half through completion of the following 5 activities: annual biometric screening, influenza vaccine, nonsmoking certification, second opinion for elective surgical procedures, and disease management participation. The primary outcome measures included annual per member total approved payments for multiple inpatient and outpatient services. The 2 compared cohorts of 94 127 participants (48 770 were female [52%]; 47 390 were younger than 45 years old [50%]) had insignificant baseline differences after propensity-weighting adjustment. The VBID cohort had significantly lower probabilities of inpatient admissions (adjusted relative odds ratio [OR], 0.82; 95% CI, 0.71-0.95), and higher probabilities of receiving immunizations (adjusted relative OR, 1.07; 95% CI, 1.01-1.21) in 2019. Among those with positive payments, VBID was associated with higher mean total allowed amounts for PCP visits in 2019 and 2020 (adjusted relative payments ratio, 1.05; 95% CI, 1.02-1.08). There were no significant differences for inpatient and outpatient combined totals in 2019 and 2020. The CalPERS VBID program achieved desired goals for some interventions with no added total costs in its first 2 years of operation. VBID may be used to promote valued services while containing costs for all enrollees.

Purpose:To examine racial/ethnic differences in dietary behaviors, diet quality, body mass, and the perceived availability of healthful foods in one's neighborhood among mothers from low-income California households.Methods:Cross-sectional telephone surveys of mothers from randomly sampled households with incomes ≤185% federal poverty level in 2018 and 2019 using a validated 24-h dietary recall assessment. Dietary outcomes were cups of fruits and vegetables, ounces of sugar-sweetened beverages, teaspoons of added sugars, and kilocalories consumed the previous day. Diet quality was assessed by calculating Health Eating Index-2015 scores. Supplemental survey items assessed mothers' weight and height. Body mass index (BMI) was calculated with a BMI of 30 or higher considered obese. Perceived availability of fresh fruits and vegetables and healthy foods in general within one's neighborhood was recorded.Results:The analytic sample of 9200 mothers was 66.3% Latina, 17.3% white, 12.6% African American, and 3.8% Asian American, Native Hawaiian, or Pacific Islander (AANHPI). African American mothers consumed the fewest cups of fruits and vegetables and the most teaspoons of added sugars, reported poor diet quality, and had the highest obesity rate, 54.7% versus 46.9% for Latinas, 39.9% for whites, and 23.5% for AANHPIs. Accordingly, a greater proportion of African Americans reported limited availability of fresh fruits and vegetables and healthy foods in general in their neighborhood.Conclusion:Findings are interpreted in light of recent calls for broader approaches to address health disparities, including strategies that focus on inequalities in racial/ethnic socioeconomic status and systemic racism.