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Epidemiology
and Costs of Mild Traumatic Brain Injury in Non-Hospitalized
Patient Populations
Jess Kraus,
MPH, PhD
Federico Vaca, MD, MPH
Paul Hsu, MPH, PhD
While
the negative consequences of traumatic brain injuries have
been well-documented, growing evidence suggests that mild
traumatic brain injuries (MTBI) also lead to negative outcomes.
Often called concussions, mild head injuries, minor head trauma,
etc., are a very common neurologic disorder and occur when
there is a sudden jolt or blow to the head, resulting in temporary
confusion or disorientation, possible transient memory loss,
and even momentary loss of consciousness. Generally, the affected
person will seek care at an emergency department (ED) and
then be discharged. About one in four do not receive any medical
attention. Furthermore, according to CDC reports to congress,
the number of MTBI cases seen in emergency rooms has almost
doubled between 1991 and 1996, while hospitalizations have
dropped by more than half between 1980 and 1994, implying
that total non-hospitalized cases of mild traumatic brain
injuries are substantially increasing. Longer-term outcomes
including depression, personality changes and/or mood disorders,
problems sleeping, and alcohol/substance abuse have all been
noted in the literature.
This longitudinal
study seeks to examine the incidence, costs, and consequences
of those suffering a mild traumatic brain injury and who were
not subsequently hospitalized. Participants were enrolled
through the emergency departments or trauma centers of five
Southern California hospitals, located in three different
counties, and received follow-up interviews at three and six
months. At the same time, a “control” group of
other injuries were also enrolled and followed to ensure that
any outcomes were as a result of the brain injury and not
simply any injury, etc. The results of this research will
further clarify the epidemiology of this type of injury and
perhaps lead to practical, clinical guidelines in the future.
Publications are being prepared and the study results will
be available soon.
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Evaluation
Study of Beyond Blame: Challenging Violence in the Media
Teri Webb
PhD
Lucille Jenkins MPH
The goal
of this study is to assess whether or not a comprehensive
media literacy intervention mitigates the negative effects
of exposure to media violence and reduces the risk for aggression
and violence among middle school children. To achieve this
goal a multiphase evaluation study of the violence-prevention
media literacy curriculum entitled, Beyond Blame: Challenging
Violence in the Media is currently underway. The Center for
Media Literacy developed this curriculum in 1995 and is partnering
with the SCIPRC in all phases of this study. For more information
about the Center for Media Literacy, visit their website at
www.medialiteracy.org.
The pilot intervention
was implemented in two middle schools in Los Angeles, a K-8
school in Orange County, and a seventh-grade school in the
San Fernando Valley during the 2005-2006 school year. The
study included six intervention classrooms (N=245) and one
control classroom (N=16). The results of the pilot study look
promising as a majority of the intervention students (90.2%)
reported an increase in pre-to post-test knowledge scores
compared to only 18.8% of control students.
Due to the fact
that the curriculum materials were dated and the discipline
of media literacy has evolved significantly over the last
decade, we revised the curriculum. Currently, Beyond Blame
is made up of 10 lessons organized around the five core concepts
and key questions of media literacy, which are engaged to
interrogate contemporary representations of violence on television,
in movies, music and video games.
The impact evaluation
will involve school districts in the San Gabriel and San Fernando
Valleys, Los Angeles Unified and the Archdiocese of Los Angeles,
and be implemented during the winter semester 2007. The specific
aims of this phase of the study are to implement Beyond Blame
on a large scale (N=1125) employing a quasi-experimental research
design to assess the effects of the curriculum on middle school
students. In schools predominately serving minority students,
the study will compare classrooms led by intervention teachers
to those led by control teachers. Outcome measures will be
assessed by questionnaires administered one week before the
intervention (pretest), one-week immediately after the intervention
(posttest), and at two follow-up periods for each group. Pre-
and post-test outcome measures will cover knowledge, attitudes,
beliefs, behaviors and critical thinking skills.
Concurrent
with the impact evaluation, a process evaluation will be conducted
to assess issues such as coverage, integrity, delivery and
utilization of the program intervention. The goal of the process
evaluation is to ascertain as much information as possible
about how the curriculum is being implemented to help to account
for individual and classroom variability in outcome measures.
Thus research questions addressed here include: How much of
the 10-lesson curriculum do the teachers actually teach in
their classrooms, how many students are engaged in the learning
process, how well do teachers deliver the lesson plans to
their students, and, overall, how satisfied are teachers and
students with the curriculum?
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Helmets,
Spinal Cord Injuries and Motorcycle Crashes
Jess Kraus
A.A. Afifi
Leanne Streja
One argument used
by anti-helmet groups is that wearing helmets increases cervical
spinal cord injuries because of the added weight to the head
and neck. The objective of this study was to determine the
estimated risk of total and cervical spinal cord injury associated
with helmet use in motorcycle crashes. Using the National
Trauma Database of 14,500 relevant hospitalizations, odds
ratios of spinal cord injury with and without helmet use were
derived. Helmets were found to be cervical spinal cord injury
sparing and this finding persisted after controlling for age,
alcohol use, gender and type of vehicle crash. Publications
are being prepared and the study results will be available
soon.
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Needs
Assessment of Emergency Preparedness and Response Activities
in California Schools
Linda
B. Bourque PhD
Megumi Kano DrPH
Schools
are not immune to the natural, technological and human-induced
hazards that pose threats to the health and safety of the
population at large. School emergency preparedness is essential
to prevent and minimize the impact of hazards on the school
community, including children, parents, teachers, staff and
the surrounding community. During 2002-2003, we conducted
an exploratory study of emergency preparedness in public schools
in 12 purposively selected school districts in Los Angeles
County. This study is a survey assessment of emergency preparedness
in a larger sample of public schools and school districts
in California. Survey data are collected using mailed questionnaires
and telephone follow-up. The objectives are to describe the
current state of school district and school site preparedness
for emergencies and disasters in California, and to identify
the areas of preparedness that need further improvement.
Survey responses
were collected from a total of 98 school districts and 157
school sites from throughout California. The survey respondents’
interest in this topic was high, such that about 40% of the
district and school site respondents, respectively, volunteered
to participate in future follow-up telephone interviews. Study
results 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: UCLA Southern California Injury Prevention
Research Center.
Kano,
M. & Bourque, L.B. (March 2007). School Emergency Preparedness
Survey Report: It Takes A Village To Prepare Schools for Emergencies.
Los Angeles, CA: UCLA Southern California Injury Prevention
Research Center.
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The
Effectiveness of Rumble Strips in Reducing Motor Vehicle Crashes
on Rural Highways and Freeways
Jess Kraus, MPH,
PhD (co-lead)
Federico Vaca, MD, MPH (co-lead)
Paul Hsu, MPH, PhD
A rumble strip
is a band of texturing that consists of grooves that are raised
or pressed into the road surface perpendicular to the direction
of travel, usually applied on the shoulder or the centerline
of rural roads and highways. Driving over a strip produces
both a tactile vibration and an audible “rumble”,
serving as a warning that a driver is leaving the travel lane
or roadway. While numerous states are incorporating rumble
strips into their highway engineering and construction programs,
relatively little data exist to verify their effectiveness
on reducing the negative consequences of inattentive and drowsy
driving.
This study
is in the process of assembling a multi-state database from
police crash reports and state highway department records.
Motor vehicle crash rates along a road segment will be compared
before and after rumble strip installation. In addition, crash
rates along a matching road segment with no installation will
also be compared during the same time periods to account for
possible confounding through policy changes, technological
advances, vehicle safety improvements, etc. The results will
allow state and federal policymakers to better evaluate the
benefits and effectiveness of rumble strips, and enable valid
cost-benefit analyses to be conducted.
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