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This list
includes various Center projects. For more information
regarding these projects, please contact
us.
To view a list of individual projects, just click on the appropriate
category below.
VIOLENCE
Media Literacy as a Violence Prevention Strategy
In
the fall of 2007, we began implementing the
summative evaluation of the curriculum,
Beyond Blame: Challenging Violence in the Media,
which is currently underway in 27 schools
around southern California. The purpose of this
study is to examine the impact of the curriculum
on middle school students. To test the
effectiveness of the curriculum we are employing
an intervention/control design, pre- and
post-testing students on changes in knowledge,
beliefs, attitudes and behaviors. We are also gathering process evaluation
data on integrity, delivery and utilization of
the program intervention. The final phase of
the study, to begin after the summative
evaluation data is analyzed, will assess the
dissemination strategies of the Beyond Blame
curriculum once it is digitized and a website
for it is constructed.
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Epidemiology of Intimate Partner Homicide-Suicide in Los Angeles County
This
study is an extension of an earlier UCLA
study, Incidence and Patterns of Intimate
Partner Homicide, which assembled data from the
Los Angeles County Coroner for 59 cases during
the years 1994-1997. This was formerly a seed
project which is now a small project. Data have
now been collected through 2004, with a total of
over 200 cases. Three local agencies have
collaborated with us on this study: the Los
Angeles County Department of the Coroner, the
Los Angeles Police Department, and the Los
Angeles Office of the Bureau of Alcohol, Tobacco
and Firearms (ATF).
Initial case ascertainment was made using the
California Master Mortality File and coroner
data. First, all suicides of males age 15 or
older were identified in the Master file. Each
suicide was identified in the Coroners database
to determine if it was associated with a
homicide. Homicide records were physically
examined to confirm that the death was
associated with a suicide. After case
identification, corresponding records of the law
enforcement agencies were identified using first
and last name of decedent, and date of
incident. Where information on a weapon
identified at the scene was found additional
information was sought from law enforcement and
ATF. Data were abstracted from paper records by
undergraduate and graduate public health
students.
Data analyses have included univariate analyses
followed by multivariate statistical modeling.
The overall aim of the analyses is the
elucidation of the salient characteristics of
incidents of homicide-suicide. In addition to
the demographic and other personal
characteristics, we are examining the nature of
the perpetrator-victim relationship and other
family dynamics, history of perpetrator-victim
violence, protective orders, perpetrator
arrests, or other law enforcement contacts prior
to the fatal incident, and issues of custody and
follow-up services for surviving children on the
perpetrator or victim(s). In addition, legal
ownership of weapons and purchase dates are
being examined. Findings from this study will
provide valuable information to guide intimate
partner violence prevention and intervention
activities.
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Social and Cultural Factors Associated with Male
Batterers in Mexico and Southern California
Los Angeles, with the largest Mexican population
outside of Mexico City, is highly influenced by
Mexican social and cultural norms. This
project will interview samples of known
batterers and non-batterers in Mexico and the
United States to determine the role of these
factors in abuse. The goal of this project
is to describe the social factors associated
with the development of violent behavior in
Mexican males residing in Mexico and the United
States. The objectives are to identify
risk factors which lead to violence in men, to
describe the effects of this behavior on both
the batterer and his partner, and to identify
differences in characteristics among men
attending a mandated batterer treatment program,
men attending a voluntary program, and men who
are not involved in treatment programs
(controls).
The project will be carried out by lead
investigators in Cuernavaca, Mexico and Los
Angeles, California. In the United States,
only men who report Mexican descent will be
included. The projects will share elements
of the same interview tool, and although each
study will stand alone, results will be compared
between countries.
The specific
aims are:
- To identify the type, frequency and
severity of violence (physical, emotional,
sexual, verbal, and financial) predominantly
committed by men in mandated and voluntary
batterer treatment programs.
- To characterize the reported effects
that the violent behavior has on the
physical and emotional health of both the
women victims and their male aggressors.
- To characterize the social and cultural
variables associated with the development of
violent behavior by the Mexican male.
- To identify the risk factors which
predict the manner in which men express
their violent behavior, including the
initiation and escalation of violent events.
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Suicide in the Workplace
For most work-related fatal injuries, the nature
of the exposure (i.e., task, activity, or duty
combined with specific location) is known.
For homicides, the working relationship is also
generally well understood (e.g., a shooting
involving a clerk at a liquor store during the
course of a robbery). The work exposure
factors associated with self-inflicted injury,
however, are not well known or are poorly
documented in most coroner's reports.
Based on discussions with California county
coroners, self-inflicted fatal injuries are
determined to be work-related on the basis only
of place where injury was inflicted and not on
any known duty, task or activity connected with
work or employment.
The overall
objective of this project is to establish and
understand the multi-factorial nature of
suicides that occur at work. To address
this broad question, the following specific aims
will be addressed:
- To identify and measure the nature of
work-related factors associated with
suicide, classified by a coroner as an
injury-at-work.
- To determine the degree to which these
factors differentiate injury-at-work
cases from those suicides not categorized by
a coroner as injury-at-work.
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An Assessment of Youth Violence Prevention
Activities in USA Cities
UNITY (Urban Networks to Increase Thriving Youth
through violence prevention) is a CDC-funded
cooperative agreement awarded in 2005 to a
partnership comprised of Prevention Institute,
Dr. Deborah Prothrow-Stith of Harvard School of
Public Health, and Billie Weiss from the
University of California at Los Angeles –
Southern California Injury Prevention Research
Center. The goal of UNITY is to strengthen urban
youth violence prevention, build national
support for necessary resources and policies,
and develop tools and framing to ensure
long-term sustainability of youth violence
prevention efforts.
The Southern California Injury Prevention
Research Center conducted an assessment on
current violence prevention activities in a
sample of twelve cities. The sample was selected
to be representative of the range of geographic
locations and rates of fatal youth violence
among the 45 largest cities in the United
States. Telephone interviews were conducted with
the Mayor, Police Chief, Public Health Director,
and School Superintendent, or their designated
representative in each city. Topics covered
included city-wide plans, youth advisory
councils, youth development and violence
prevention programs, violence prevention
coalitions, access to relevant data, and overall
assessment of the city’s efforts.
Key informants identified youth violence as a
serious issue in U.S.A. cities. However, very
few report their city using efforts to prevent
violence before it occurs; resources are
addressing the aftermath of violence.
The Southern California Injury Prevention
Research Center, with funding from The
California Wellness Foundation, created A
Guidebook to Strategy Evaluation: Evaluation
Your City’s Approach to Community Safety and
Youth Violence Prevention.
Documents are available for download via the
citation links below:
Weiss, B.P. (June 2008). An Assessment of Youth
Violence Prevention Activities in USA Cities.
Los Angeles, CA: UCLA Southern California Injury
Prevention Research Center.
Weiss, B.P., Berger, E., & Hatcher, B. (June
2008). A Guidebook to Strategy Evaluation:
Evaluation Your City’s Approach to Community
Safety and Youth Violence Prevention. Los
Angeles, CA: UCLA Southern California Injury
Prevention Research Center.
For more information on UNITY, go to
http://www.preventioninstitute.org/UNITY.html.
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SPORTS
Evaluation of Existing Sports Injury Interventions
and Countermeasures in High School Varsity Football
The highest rates of injury in high school
sports are reported in football. Little is
known about what schools are doing to prevent
these injuries and their effectiveness. We
propose using a multilevel study design to
identify primary, secondary and tertiary
measures in place in local high schools; to
measure whether these interventions affect the
frequency and severity of injury; to compare
treatment protocols across schools; and to
estimate costs of medically treated injuries in
selected sports clinics. We will focus on
two samples of football teams, those under
medical supervision by a local sports clinic and
those not.
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DISASTERS
National Survey of Disaster Experiences and Preparedness
**NEW**
The Department of Homeland Security funded a Center for Excellence called
the National Consortium for the Study of Terrorism and Responses to Terrorism
(NC START) based at the University of Maryland, College Park. Dr. Linda Bourque
received the two sub-awards through NC START as well as two additional grants
from the National Science Foundation to conduct a national household telephone
survey about people's experiences, preparedness and mitigation actions,
and perceptions related to terrorism and disasters. A stratified sample of 3,300
households selected by random digit dialing was interviewed using computer-assisted
telephone interviews. Of the total sample, 1,000 households were selected from areas
considered at high risk of terrorism (Washington, D.C.; New York City; Los Angeles),
and 2,300 households were selected from throughout the
rest of the continental United States.
The study collected information on: household and individual demographic data;
past experience with disasters; respondents; definition of terrorism; cues to prepare; preparedness information
received passively; trust in government organizations; terrorism-related knowledge;
perceived risk; information-seeking and milling; perceived as resilience/self-efficacy;
perceived response effectiveness; preparedness and mitigation actions; and behavioral intentions.
Documents are
available for download via the citation links below:
Kano, M., Wood, M.M., Mileti, D.S., & Bourque, L.B.
(2008). Public Response to Terrorism: Findings
from the National Survey of Disaster Experiences and
Preparedness. Los Angeles, CA: Southern
California Injury Prevention Research Center.
Wood, M.M., Kano, M.,
Mileti, D.S., & Bourque, L.B. (2008).
Questionnaire Specifications: Documentation of the
National Survey of Disaster Experiences and
Preparedness (NSDEP). Los Angeles, CA: Southern
California Injury Prevention Research Center.
Bourque, L.B., Kano, M., Mileti, D.S., & Wood, M.M. (2008). English, Spanish, and Annotated Questionnaires: Questionnaires Used in the National Survey of
Disaster Experiences and Preparedness (NSDEP).
Los Angeles, CA: Southern California Injury
Prevention Research Center.
Video coverage of the
presentation of research findings at the National
Press Club provided by C-SPAN can be viewed via the
link below:
Bourque, L.B. & Milet, D.S. (December 15, 2008).
Public Response to Terrorism in America. A Research
Briefing at the National Press Club, Washington,
D.C.
The PowerPoint slides
presented at the National Press Club can be
downloaded via the link below:
Bourque, L.B. & Milet, D.S. (December 15, 2008).
Public Response to Terrorism in America. A Research
Briefing at the National Press Club, Washington,
D.C.
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Needs Assessment of Emergency Preparedness and
Response Activities in California Schools
School
emergency preparedness is essential to prevent
and minimize the health and social impact of
hazards on the school community, including
children, teachers, staff, their families and
those who live or work near schools. Between
September 2005 and February 2006, a mail survey
was administered to representatives of 200
public school districts and 470 public schools,
grades K through 12, located in 34 of the 58
counties in California. Responses were obtained
from 98 school districts and 157 schools. Data
from the survey were analyzed to describe the
schools’ prior experiences with emergencies and
disasters, the available resources for
preparedness, their current levels of
preparedness, and their needs for improving
preparedness.
Documents are available for download via the
citation links below:
Kano, M. & Bourque, L.B. (January 2007). School
Emergency Preparedness Survey Report: Improving
Coordination Is Vital for School Districts. Los
Angeles, CA: UCLA Southern California Injury
Prevention Research Center.
Kano, M. & Bourque,
L.B. (March 2007). School Emergency Preparedness
Survey Report: A Written Plan is a Good Start,
But Only a Start. Los Angeles, CA: Southern
California Injury Prevention Research Center.
Kano, M. & Bourque, L.B. (July 2007). School
Emergency Preparedness Survey Report: It Takes A
Village To Prepare Schools for Emergencies. Los
Angeles, CA: Southern California Injury
Prevention Research Center.
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Evaluation of Wildfire Evacuation Plans in
California Counties
Timely
evacuation of populations threatened by
wildfires is essential to prevent fatal and
non-fatal injuries from exposure to fire, smoke,
and other secondary hazards. There has been a
paucity of studies that examine the
characteristics of official community evacuation
plans and their potential to minimize damage in
wildfire disasters, especially in densely
populated areas where wildfire may spread to
residential areas. This study will describe and
evaluate official evacuation plans for
California counties at high risk of wildfires.
A content analysis will be performed on
evacuation plans obtained from 58 California
county offices of emergency management using 20
criteria developed by the U.S. Department of
Transportation and the Department of Homeland
Security for an evaluation of catastrophic
hurricane evacuation plans. The evaluation of
plans will be augmented by key informant
interviews with emergency management officials
in the respective counties to identify the
strengths and weaknesses of their current
evacuation plans and their expectations
regarding the public’s response to evacuation
orders. Findings from this study will be
translated into a model template and guidelines
that can be used by emergency management
officials to create or improve their wildfire
evacuation plans. It is anticipated that this
study will provide the basis for developing a
large project involving a broader household
survey on evacuations and the health and social
impact of wildfires in Southern California
communities repeatedly affected by wildfires.
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Exploratory Study of Disaster Preparedness in
Southern California Immigrant Communities
This
study will explore issues related to disaster
preparedness among underserved, Latino and Asian
immigrant and limited-English proficient (LEP)
communities in Southern California using a
multi-lingual survey. This study builds upon a
qualitative research study conducted in 2007 by
the Asian Pacific American Legal Center (APALC)
in collaboration with the Tomás Rivera Policy
Institute (TPRI) at the University of Southern
California. This study
involved key informant interviews with
government and non-government organizations and
focus groups with Asian and Latino immigrant
community members residing in four Southern
California cities. The study identified formal
and informal disaster-preparedness and -response
networks and resources and how they are prepared
to serve immigrant and LEP populations. It also
identified barriers to disaster preparedness for
these minority communities. The significance of
the qualitative study could be bolstered by a
survey of the same population that replicates
and quantifies its findings. Results from the
survey can be translated into recommended
policies and practices for government and
emergency response organizations to eliminate
disparities in disaster preparedness, response,
relief and recovery, not only in Southern
California but also in areas with similar
demographics throughout the nation. Some of the
project activities will be performed under a
subcontract to APALC, as specified in a separate
project report.
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California Survey of Household Earthquake Preparedness and Mitigation
**NEW**
This study, funded by the California Governor's Office of Emergency
Services, the California Seismic Safety Commission, the Institute for Business and Home Safety,
and the Southern California Association of Governments, will document the current state
of household mitigation and preparedness for disasters in the State of California
with an emphasis on earthquakes. The study will determine the current state of household
mitigation and preparedness for the state as a whole, select racial and ethnic minorities,
and different geographical areas at high risk of earthquakes. The research will also
identify the key processes that lead households to take mitigation and preparedness actions.
Computer-assisted telephone interviews will be conducted with a total of 2,000 households
selected by random-digit-dialing. The sample is equally divided across three strata:
10 northern counties at high risk of earthquakes, 6 southern counties at high risk of earthquakes,
and the rest of the state.
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UCLA Social Science Data Archive of Earthquake Research
**NEW**
Dr. Linda Bourque led an effort to create an electronic data
archive of social science research on earthquakes. The archive was made available to the
public in 2005 by data archivist, Elizabeth Stephenson, through the UCLA Institute for Social
Science Research (ISSR). The collection, which currently includes 18 data sets, 4 of which
are products of Dr. Bourque's own research, represents research conducted since 1971 through the
present. Most of the archived survey data were collected from statistically representative samples of
northern, central and southern California populations. A range of events was studied, including actual
earthquakes, earthquake predictions, and earthquake education and public information campaigns.
Key variables include knowledge, perceptions, preparedness actions, responses to earthquakes
and earthquake predictions, and demographic characteristics. The archive provides free access
to the data sets and their accompanying codebook, questionnaire and specifications. A bibliography
of published and unpublished writings associated with the archived data is also available.
In addition, there is an option for performing on-line analyses of most of the data. This special
collection is a permanent feature of the ISSR Data Archive and will be updated as more data
become available. Its purpose is to preserve data, promote research and education, and inform public policy.
The data archive can be accessed at the link
below:
UCLA Institute for Social Science Research
(ISSR), Social Science Data Archive Earthquake
Survey Data at UCLA
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First Aid in Disaster
Two studies were
conducted to examine the ability of citizens to
perform basic first aid with the notion that
these skills can be
critical in preventing and reducing morbidity
and mortality in the aftermath of disasters.
Data from a population-based household survey
(N=506) of Los Angeles County conducted after
the 1994 Northridge earthquake were analyzed to
test a causal path model predicting
self-reported first aid abilities. Factors that
predicted greater ability to perform first aid
included taking a course in first aid, being
white, being younger, speaking English in the
home (as opposed to other languages), and having
lower income. A related study examined panel
data (N=414) collected from households that were
interviewed as part of the 1994 Northridge
earthquake survey and then re-interviewed three
years later after the El Nino winter of 1997-98.
Findings included that 24% of the interviewees
had received first aid training since the first
interview. Those who had recently received
training reported greater first aid skills and
were more likely to report actual and expected
utilization of those skills compared to those
who were not recently trained or never trained.
These studies highlighted the importance of
first aid training, skill evaluation and skill
retention among members of the public.
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TRAFFIC
AND TRANSPORTATION
The Effectiveness of Rumble Strips in Reducing Motor
Vehicle Crashes on Rural Highways and Freeways
This
study was designed to estimate the effectiveness
of both centerline and shoulder rumble strips in
reducing the incidence of motor vehicle injury
crashes. This would be accomplished by
assembling a multi-state database that is large
enough to allow detailed analyses and precise
estimation of effects. Data would be obtained
from police crash report databases and state
highway department records, and collected from
study sites by research staff. The results of
this study would allow state and federal
policymakers to better anticipate benefits of
the incorporation of rumble strips into highway
construction and reconditioning projects, and
would enable valid cost-benefit analyses to be
conducted.
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Helmets and Spinal Injuries: Dispelling the Myth and
Enhancing Helmet Laws
Although
helmets on motorcyclists and scooter operators
have been shown to be effective in reducing
mortality and severe head injury in crashes,
some researchers and a vocal minority of
anti-helmet groups have persisted in claims that
wearing a helmet in a motorcycle crash increases
the risk of physical injury to the neck. The
basis for their claim has been anecdotal
observations and biomechanical speculation. The
objective of this project was to examine
analytically new information from a large
database on the hypothesis of increased risk of
physical injury to the neck, trunk and spine
from wearing helmets in crashes.
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Adult Skateboard Injuries: A New Emerging Problem in
Recreation
This
project was a cooperative study by investigators
from UCLA and Scripps Memorial Hospital, La
Jolla. Little is known about skateboard
related injuries in adults despite an extensive
medical literature on these injuries in children
and adolescents dating to the 1970’s. Although
most of the injuries described in earlier
research were non-life threatening, health and
safety professionals began the call for
restrictions on use of skateboards including
requirements for protective equipment. The
findings of the CPSC show over 281,900 medically
treated injuries based on a national
surveillance network. The literature on
skateboarding injuries over the past 10 years
has continued to emphasize the pediatric
population, yet recent observations in one large
trauma center has suggested that the injury
problem is no longer confined to children or
adolescents but to adults as well. The purpose
of this project was to fill the void in critical
epidemiological and clinical information on a
new and growing subgroup of injured
skateboarders. To this end, we obtained
information from the U.S. National Trauma Data
Bank and compared these data to that derived
from the Scripps Memorial Hospital Trauma
Service for 2000-2006 to describe and compare
analytically details of the demographic,
exposure, injury features and severity as well
as clinical treatment parameters for adult
injured skateboarders.
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Pedestrian Collision Injuries
As a response to the Southern California Injury
Prevention Research Center’s call for new
researchers to become involved in injury
research, this project used geographic
information systems (GIS) and spatial data
analyses to evaluate socio-geographic
inequalities in pedestrian-motor vehicle (PMV)
collisions across the city of Los Angeles. It
was hypothesized that low-income and non-white
groups are at higher risk of being involved in
PMV collisions than are white and high-income
groups because urban-environmental hazards
(e.g., traffic congested intersections, poorly
maintained and enforced crosswalks, etc.) are
often located in neighborhoods where
disadvantaged groups reside. This project
addressed items identified on the CDC’s Injury
Research Agenda (i.e., transportation-related
injury prevention and control) with an
innovative analytical framework and methodology,
and provided insights into the risks of injury
that underrepresented and disadvantaged groups
face in urban environments.
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COMMUNITY
OUTREACH
TRAUMATIC
BRAIN INJURY (TBI)
Mild Traumatic Brain Injury Outcomes
Few studies have provided detailed information
on the demographic characteristics, external
causes and outcomes of representative groups of
persons hospitalized with mild traumatic brain
injury (MTBI). A longitudinal multi-cohort
study in San Diego, California is examining the
epidemiology of MTBI to address interrelated
questions about outcome, occurrence, risk
prediction and treatment needs for mild brain
injured adults. Analyses will identify
specific sequelae of mild brain injury, show the
relation between particular precursors and
predictors and the outcomes of MTBI and
ascertain risk factors for mild brain injury.
These finding in turn are necessary to assemble
a composite index of key factors related to
outcomes and to improve prediction, intervention
strategies and treatment parking for patients
and their families.
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Frequency, Types of Outcomes and Rehabilitation
Needs Assessment for Mild Traumatic Brain Injury
It is well established that older persons
recover more slowing from brain injuries than
their younger counterparts, even when the injury
is of similar severity. Although there
have been thousands of reports in the research
literature on mild traumatic brain injury (MTBI),
few have addressed this problem in the elderly
and almost none have been concerned with
specific outcomes following MTBI.
Epidemiological evidence shows that persons aged
15-24 and over age 65 have the highest incidence
of MTBI; yet follow-up studies of the
consequences of injuries in older persons are
almost nonexistent. The few reports that
are available have had very small sample sizes,
large losses to follow up, and lacked
specificity of outcome to the elderly
differential from normal aging. hence,
this project has, as its main objective, the
determination of age-specific consequences of
MTBI, especially those related to physical
complaints, memory and cognitive deficits,
impairments or disabilities (including social
factors such as work or leisure activities), and
indicators of unfilled rehabilitation treatment
needs. In addition, the cost of these
consequences is unknown and therefore, secondary
objectives of this project will be to measure
it and the quality of life following MTBI.
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Outcomes of Mild Traumatic Brain Injury
The current state of epidemiologic research in
mild traumatic brain injury (MTBI) demonstrates
uncertainty about essential characteristics of
the injury and the path to recovery. Few
studies have provided detailed information on
the demographic characteristics, external
causes, and outcomes of representative groups of
persons with MTBI. Little epidemiologic
data are available on risk factors or other
circumstances pertaining to exposure by
individuals with MTBI. This project will
evaluate important neurological, cognitive,
behavioral, social, or adjustment impairments
that may occur after MTBI, comparing outcomes
from a brain-injured cohort admitted to the
hospital to those from an other-injury cohort
and a non-hospitalized slight head-injured
cohort gathered at the same time. Also to
be examined are the contributions to long-term
recovery from MTBI due to pre-injury factors
such as socioeconomic status, pre-injury
behaviors, social characteristics, and potential
confounders such as alcohol use. Results
of this study will be used to design individual
and family post-injury counseling as well as
general community education efforts.
Three specific aims to be evaluated by this
study are:
- To identify, describe and measure
neurological and behavioral sequelae six
months post-injury in a well-defined
medically diagnosed MTBI cohort and to
compare these findings in another cohort of
persons with slight head injury.
- To identify, describe and measure
economic and social risk factors in the
occurrence of mild brain injuries.
- To identify patterns of service and
rehabilitation needs after discharge between
the cohort of MTBI, a cohort of persons with
injuries of comparable severity to regions
other than the brain, and a cohort of
persons with slight head injury who are seen
but not admitted to a hospital.
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Gender and Traumatic Brain Injury
It has long been observed that some patients
with moderate or severe brain injury survive and
are discharged with "good" recovery. But,
the factors related to good recovery are largely
still unknown. The U.S. Brain Injury
Association and Brain Trauma Foundation
published Guidelines for the Management of
Severe Head Injury. One section dealt with
prognosis and evaluated carefully the published
literature on the subject of prognostic factors
and TBI. Age, Glasgow Coma Scale score,
papillary diameter and light reflex,
hypotension, and CT scan features were
identified as factors related to outcome
following injury. These factors allow for
probabilistic estimates of survival yet in
aggregate they are not deterministic. In
fact, no single study has examined all factors
simultaneously and many factors are acknowledged
confounders with one another. The overall
objective of this project is to address the role
of an additional factor in prognostic outcome of
TBI, namely gender. Hence this project has
two specific aims; one methodological and one
evaluative:
-
To develop
and pilot test a protocol for the collection
of gender specific TBI data across multiple
international medical centers
-
Using
pooling data, to determine if gender is
differentially related to poor outcomes
following TBI, controlling for several known
factors.
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Biomechanical/Forensic Study of Fatal Head Trauma
The Los Angeles County Office of the Coroner (LACCO)
must routinely assess injury diagnoses to
determine the cause of death. In this
project, we will review five years of fatalities
among children aged five and under in which
severe head and intracranial injury was present.
Using the head injury diagnoses, we will
reconstruct the biomechanical pathway for cranial
injuries and compare this pathway to the stated
histories. With the input of biomechanical
and forensic professionals, we will identify
inconsistencies between diagnoses, biomechanical
mechanism of these injuries, and the stated
histories to determine if any of these cases
present the potential for child abuse.
The ultimate goal of this project is to identify
patterns of cranial injury and reported history,
both fatal and non-fatal, that may indicate the
need for further investigation of abuse.
This information will be of great value to
agencies which examine causes of death or that
must quickly assess the correlation between
caretaker's reports and the injuries diagnosed.
Infant Death Review committees, which routinely
examine circumstances surrounding pediatric
deaths, are an example. These teams are
usually well equipped to examine agency response
to deaths, but rarely have the biomechanical
expertise to determine inconsistencies between
forensic findings and reported histories.
Healthy People 2010 has identified increased
activity of Infant Death Review teams as a
priority, and this study will provide a
demonstrated protocol to introduce biomechanical
forces into the investigation of intracranial
injuries.
This project
will review the case series of fatalities to
children under the age of five in Los Angeles
County who had intracranial trauma among their
diagnoses. The specific aims of this
project are:
-
To identify the forensic pathology of
cranial injuries.
- To describe the biomechanical
circumstances of cranial impact necessary to
create the injuries.
- To determine if the recorded
history of the cause and/or activities
surrounding the death are consistent with
the injuries sustained.
- To determine if there are patterns of
cranial injury which are inconsistent with
reported non-contact injury (which suggest
the potential for abusive injury).
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PEDIATRICS
Co-Sleeping and Sudden Unexpected Deaths in Infancy
(SUDI)
Co-sleeping is one of the most debated risk
factors for Sudden Infant Death Syndrome (SIDS)
and may lead to other injury deaths, such as
suffocation. Although organizations such as the
American Academy of Pediatrics (AAP) recommend
against co-sleeping, other health organizations
and practitioners are advocates, arguing that if
practiced safely, co-sleeping has important
health benefits for mothers and their infants.
Few studies on the benefits and risks associated
with co-sleeping have been conducted in the
United States.
Most studies on co-sleeping have examined risk
of SIDS, the leading contributor to
post-neonatal death. However, many infants die
from suffocation and undetermined causes each
year. A complete understanding of the risks
associated with co-sleeping requires examining
these outcomes. Furthermore, it is suspected
that a diagnostic shift began in the late
1990’s, such that deaths once classified as SIDS
are increasingly categorized to other causes.
Yet few studies have documented how coroners
classify the manner and cause of infant deaths
and the effects of diagnostic shifts on
case-control study results are not well known.
Anecdotally, it is apparent that diagnoses vary
between and even within coroners offices because
of differences between agencies’ protocols and
the degree to which protocols are carried out by
medical examiners. For instance, even without
clear evidence of suffocation, co-sleeping may
lead some investigators to call a death
accidental suffocation rather than SIDS.
The goal of this study is to examine the
relationship between co-sleeping and Sudden
Unexpected Deaths in Infancy (SUDI) using a
population-based case-control in California. The
term Sudden Unexpected Deaths in Infancy (SUDI)
was developed to encompass all sudden deaths to
infants, including deaths classified as SIDS,
undetermined, accidental suffocation, and
homicide.
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OTHER
Morbidity and Mortality Associated with Acute
Injuries Following Chiropractic Manipulation of the
Cervical Spine
Chiropractic
manipulation frequently causes transient minor
side effects, and, less commonly, serious events
resulting in neurological sequelae and stroke.
Valid estimates of the frequency of such acute
events and the morbidity and mortality
associated with them are currently lacking,
however. This project will use diagnostic and
E-code data from hospital discharge and death
certificate records from California to identify
acute injuries, including posterior cervical
artery circulation stroke and deaths associated
with health-care delivery. These data will then
be linked to subjects’ hospital records and
medical examiners’/coroners’ reports to
specifically identify acute injuries associated
with chiropractic procedures. These data,
coupled with population-based chiropractic
utilization data, will be used to estimate the
risk of acute injuries and death associated with
chiropractic manipulation of the cervical
spine. Findings may be used by patients and
health-care providers and policymakers in aiding
informed decision-making and in the development
of evidence-based guidelines for chiropractic
care.
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