1,721,074 research outputs found
Evaluating the Lethal Means of Non-Fatal Suicide Attempts Presenting to Washington State Emergency Departments Before and During the COVID-19 Pandemic
No full textThesis (Master's)--University of Washington, 2022Introduction: During the COVID-19 pandemic, concerns about increasing mental health conditions have emerged due to intersecting stressors associated with COVID-19 morbidity and mortality as well as disease mitigation efforts such as stay-at-home orders, school closures, and social distancing. However, little is known regarding the COVID-19 pandemic’s impact on suicidal behavior in Washington. Methods: This observational longitudinal study utilized 7,765 Washington Emergency Department (ED) visit records from 2019 to 2021 to describe the lethal means utilized for non-fatal suicide attempts and investigate if the utilization of lethal means for suicide attempts has changed during the COVID-19 pandemic. Data on lethal mean utilization were collected from visit records using a novel, automated classification approach leveraging ICD-10 diagnostic codes and clinical free-text fields. Results: Poisoning was the most identified lethal mean among non-fatal suicide attempt visit records during the study period (n = 5833), followed by Other (n = 1010), No Lethal Mean detected (n = 601), Suffocation (n = 356), and Firearms (n = 68). There were a few instances where non-fatal suicide attempt visit counts and proportion of all ED visits increased relative to before the COVID-19 pandemic such as for poisoning (+13.7%, Visit Ratio = 1.23 [1.1, 1.37]), other (+28.8%, Visit Ratio = 1.39 [1.04, 1.86]), and total suicide attempts (+16.3%, 1.26 [1.14, 1.39]) during Winter 2021 (2/21 – 3/20/2021). School age youth (12 – 17 years) appeared to be most impacted as non-fatal suicide attempts accounted for the largest share of ED visits (across all subgroups examined), and they experienced the greatest number of statistically significant elevated visit ratios for suicide attempts during the COVID-19 pandemic (n = 12). Conclusions: This study developed a novel approach to identify the utilization of lethal means for non-fatal suicide attempts using population-based ED data. This approach could be valuable in monitoring real-time changes in population-level suicidal behaviors and evaluating the impact of lethal mean restriction policies
Epidemiology of Violence in Colombia
No full textThesis (Ph.D.)--University of Washington, 2022Armed conflict is a major cause of injury and death worldwide, posing a significant public health problem. In addition to mortality directly resulting from violence, armed conflicts indirectly cause morbidity and mortality through destruction of health infrastructure and diversion of resources, forced displacement, environmental damage to water/sanitation access, and erosion of social and economic security. Colombia’s internal armed conflict began in the 1940s and was uniquely long-lasting, fractious, and geographically dynamic. By leveraging the spatial and temporal heterogeneity of Colombia’s armed conflict, this study examines the spatial trends in violence (Aim 1) and estimates the impact of armed conflict on infant and child survival (Aim 2)
Early Childhood Education and Violence Prevention Across the Life Course and Generations
No full textThesis (Ph.D.)--University of Washington, 2025High-quality early childhood education may buffer against social and structural drivers of interpersonal and self-directed violence. This dissertation examined associations of Head Start—a large-scale early childhood education program for low-income children, launched in 1965 as part of the War on Poverty—and violence-related outcomes within and across generations. Intragenerational analyses found that attending Head Start vs. other childcare was associated with lower handgun carrying and serious fighting risk among Black males. Intergenerationally, there was suggestive evidence that maternal Head Start exposure was associated with lower risk of fighting among Black and Hispanic/Latino male offspring. Collectively, findings suggest that early life investments in the social, economic, and human capital of children and families may be effective and equitable tools to prevent interpersonal violence within and across generations
Association of Facility Level Factors and Outcomes from Hospital-Acquired Pneumonia in Patients with Isolated Severe Traumatic Brain Injury
Full text linkThesis (Master's)--University of Washington, 2015Introduction Traumatic brain injury (TBI) is a major public heath problem and leading cause of death and disability worldwide. While secondary brain injuries are known to worsen mortality in TBI, very little literature exists on the role of hospital-acquired infections in isolated TBI. Among adults with isolated severe TBI, we describe the cumulative incidence of hospital-acquired pneumonia and analyze the association between hospital characteristics and the development of hospital-acquired pneumonia. Methods We examined data from the National Trauma Databank (NTDB), excluding children, patients with non-isolated TBI, and patients hospitalized for less than one week. We describe clinical and demographic characteristics of patients, stratified by facility characteristics and the presence of hospital acquired pneumonia. We used multivariable Poisson regression to analyze the association between hospital characteristics and the development of hospital-acquired pneumonia. Results 20,604 patients were included in our analysis. The cumulative incidence of hospital-acquired pneumonia was 17.3%. Among patients that developed hospital-acquired pneumonia, the cumulative mortality was 18.2%. On multivariate analysis, compared to small hospitals (<200 beds), patients at medium hospitals (201-400 beds) had a 28% reduced risk of hospital-acquired pneumonia (Relative risk 0.72, 95% CI: 0.53 - 0.96) and patients at large hospitals (>400 beds) had a 34% reduced risk of hospital-acquired pneumonia (Relative risk 0.66, 95% CI: 0.49 - 0.88). Conclusion Hospital-acquired pneumonia is common in patients with isolated severe TBI, and larger hospitals conferred a decreased risk for the development of hospital-acquired pneumonia. Future research should aim to explore the mechanism of the impact of facility characteristics on infectious complications, examine the utility of pneumonia prevention measures in the TBI population, and determine the impact of in-hospital infectious complications on patient-level outcomes in isolated severe TBI
Bariatric surgery in women of child-bearing age, timing between an operation and birth, and associated perinatal complications
Full text linkThesis (Master's)--University of Washington, 2016-06University of Washington Abstract Bariatric surgery in women of child-bearing age, timing between an operation and birth, and associated perinatal complications Brodie Parent, MD Chair of the Supervisory Committee: Dr. Ali Rowhani-Rahbar, MD, PhD, Assistant Professor Department of Epidemiology Importance: Metabolic changes after maternal bariatric surgery may impact subsequent fetal development. Many relevant perinatal outcomes have not been studied in this postoperative population, and the risks associated with short operation-to-birth (OTB) intervals have not been well-examined. Objective: 1) To assess perinatal complications in postoperative mothers (‘POMs’) compared to mothers without operations (non-operative mothers, ‘NOMs’). 2) To examine the association of the OTB interval with perinatal outcomes. Design: Population-based retrospective cohort study from 1980-2013. Data were collected from birth certificates and maternally-linked hospital discharge data. Setting: Hospitals in Washington State Participants: a) All POMs and their infants (n=1,859); b) a population-based random sample of NOMs and their infants, frequency-matched by delivery year (n=8,437). Exposures: a) Bariatric operation prior to birth or b) categories of OTB intervals. Main Outcomes and Measures: Prematurity, neonatal intensive-care-unit (NICU) admission, congenital malformation, small for gestational age (SGA), birth injury, low APGAR score (≤8), and neonatal mortality. Poisson regression was used to compute relative risks (RR) and confidence intervals (CI), with adjustments for maternal body mass index, delivery year, socioeconomic status, age, parity, and co-morbid conditions. Results: Compared to infants from NOMS, infants from POMs had a higher risk for prematurity (14% vs. 9%, RR 1.6, 95% CI 1.3-1.9), NICU admission (15% vs. 11%, RR 1.3, 95% CI 1.1-1.4), SGA status (13% vs. 9%, RR 1.9, 95% CI 1.7-2.3), and low APGAR scores (18% vs. 15%, RR 1.2, 95% CI 1.1-1.4). Compared to infants from mothers with a ≥4 year OTB interval, infants from mothers with a ≤2 year interval had higher risks for prematurity (RR 1.5, 95% CI 1.0-2.2), NICU admission (RR 1.5, 95% CI 1.1-2.3), and SGA status (RR 1.51, 95% CI 0.94-2.42). Conclusions and Relevance: Infants of mothers with a previous bariatric operation had a greater likelihood of perinatal complications, compared to infants of non-operative mothers. Operation-to-birth intervals <2 years were associated with higher risks for prematurity, SGA status, and NICU admission, compared to longer intervals. These findings are relevant to bariatric surgeons, obstetricians, and their patients, and could inform decisions regarding the optimal timing between an operation and conception. Supplementary material included: Figure 1, 2 and 3: Flow diagram, epidemiologic birth trends, and forest plot of risk estimates Supplemental Tables 1 and 2: risks associated with operation-to-birth interval
Comparison of Injury Severity and Resource Utilization in Pediatric Firearm and Sharp Force Injuries
No full textThesis (Master's)--University of Washington, 2019Importance: Pediatric firearm injuries are a serious and growing public health problem. Firearm injuries have a high case-fatality, but we lack a full knowledge of their injury severity and healthcare utilization compared to other penetrating injuries, especially among critically injured children. Objective: Describe resource utilization, injury severity, and short-term clinical outcomes for pediatric firearm injuries and compare those to non-firearm penetrating sharp force injuries in children. Design: Retrospective cohort study utilizing the National Trauma Data Bank (NTDB) data years 2007-2016. Setting: Multicenter database study. Participants: Encounters for firearm injury or cut/pierce injury in children 17 years or younger. Exposure: Firearm injury encounters were compared to cut/pierce injury encounters. Outcomes: Intensive care unit (ICU) admission, hospital and ICU length of stay (LOS), and injury severity score (ISS). Results: We identified 25,155 encounters for firearm injuries and 21,270 encounters for cut/pierce injuries. The majority of firearm injuries and cut/pierce injuries were suffered by males (85.8% vs. 74.6%) and adolescents aged 15-17 (74.8% vs. 51.2%). A greater proportion of those with firearm injuries were African-American (61.3%) than those with cut/pierce injuries (31.1%). A greater proportion of firearm injuries (30.5%) than cut/pierce injuries (12.8%) were admitted to the ICU. Firearm injuries resulted in a higher mean Injury Severity Score (ISS), longer mean hospital and ICU length of stay (LOS) compared to cut/pierce injuries. Firearm injuries accounted for 126,027 hospital days and 39,255 ICU days while cut/pierce injuries accounted for 58,705 hospital days and 8,353 ICU days. After adjusting for age, sex, year, and hospital, firearm injuries were 2.3 (95% CI: 2.1-2.5) times more likely to require ICU admission and were associated with higher ISS scores compared to cut/pierce injuries, even among critical injuries. Multinomial logistic regression demonstrated higher risk of prolonged hospital (RRR 4.11 95%CI: 3.46-4.89) and ICU LOS (RRR 2.16 95%CI: 1.91-2.45) for firearm injuries compared to cut/pierce injuries. Conclusions and Relevance: Pediatric firearm injuries carry a greater injury severity and health care utilization compared to other penetrating injuries even among critical injuries, demonstrating that mechanism of injury is an important consideration in pediatric penetrating trauma. This highlights the importance of public health measures to reduce the risk of pediatric firearm injuries
Adolescent Nonfatal Firearm Injury Trends at a Level I Trauma Center in King County, WA, 2011-2021
No full textThesis (Master's)--University of Washington, 2024Background: Firearm-related harm is a critical and growing public health problem in the United States, particularly among adolescents. Leveraging multiple data sources can provide a more complete assessment of nonfatal firearm injuries at the local-level, as national-level data may mask variations in firearm injury incidence by and within states. Methods: This retrospective cohort study used data from a Level I Trauma Center in King County, Washington (WA) and the Gun Violence Archive (GVA) to examine adolescent nonfatal firearm injury trends and explore how well trauma registry data are captured in the GVA. We calculated incidence rates per 100,000 population for each year of the study period and by intent, race, age, and sex. Events of gun violence in the GVA were matched to trauma registry data using probabilistic linkage methods.
Results: Nonfatal firearm injury incidence rates increased among our sample from 2011 to 2021 (2.65 per 100,000 persons versus 3.38 per 100,000 persons); we observed the highest rate in 2019 (3.71 per 100,000 persons). The majority of nonfatal firearm injuries during the study period were sustained by adolescents who were aged 18-19 (51.8%), Black or African American (56.4%), and male (84.8%). Approximately 42% of trauma registry cases were probabilistically matched to cases in the GVA; assault-related cases, those involving Black adolescents, and those among patients aged 15-17 were captured at a higher proportion in the matched data.
Conclusion: The rate of nonfatal firearm injuries among King County adolescents who were captured in the trauma registry increased between 2011 and 2021. These findings indicate the need for local evidence-based policy changes and targeted interventions for adolescents at the highest risk of nonfatal firearm injury in King County, particularly individuals who are Black, male, and aged 18-19
Epidemiology of Chronic Pseudomonas Lung Infections in Cystic Fibrosis Adolescents and Adults
Full text linkThesis (Master's)--University of Washington, 2015Rationale: Chronic Pseudomonas aeruginosa lung infection is common and associated with significant morbidity and mortality in cystic fibrosis. Whether recent advances in care have affected the frequency of this chronic infection is unknown. Objectives: Determine if there was a significant change in the incidence of developing chronic Pseudomonas aeruginosa infection among adolescents and adults with cystic fibrosis between 2003 and 2012. Methods: The retrospective cohort consisted of individuals with cystic fibrosis followed in the CF Foundation Patient Registry who were 13 years of age and older without chronic Pseudomonas aeruginosa at baseline. Multivariable regression models accounting for within patient correlation were used to assess the change in incidence of developing chronic Pseudomonas aeruginosa infection between 2003 and 2012. Measurements and Main Results: During the ten-year observation period, 15,504 individuals were followed for a median of 5 (IQR 2-9) years. The incidence of developing chronic Pseudomonas aeruginosa decreased from 14.3% in 2003 to 6.4% in 2012. After adjusting for potential confounding, there was a significant decrease in the relative risk of developing chronic Pseudomonas aeruginosa infection compared to 2003 (P value test of trend < 0.001). Relative to 2003, the risk of developing chronic Pseudomonas aeruginosa infection in 2012 was 0.33 (95% CI: 0.30-0.37). Conclusions: Among individuals with cystic fibrosis, a significant decrease in the incidence of developing chronic Pseudomonas aeruginosa infection between 2003 and 2012 was observed. Whether this change in incidence results in changes in clinical outcomes warrants further exploration
Differences by Victim Race and Ethnicity in Race and Ethnicity Motivated Violent Bias Crimes: A National Study
Full text linkThesis (Master's)--University of Washington, 2018Background. Over 80% of bias motivated violent victimization is motivated by race or ethnicity and over 50% of bias victimization occurs in Non-Hispanic Whites (NHW). Our aim was to determine the risk and health impacts of race/ethnicity motivated violent victimization by victim race/ethnicity. Methods. We examined data from the National Crime Victimization Survey (2003-2015) to estimate violent victimization risk by victim race/ethnicity and type of bias motivation (race/ethnicity or other). We examined incident and offender characteristics for race/ethnicity motivated victimization by victim race/ethnicity. Results. The risk of race/ethnicity motivated violent victimization was greater for Non-Hispanic Blacks (NHB) and Hispanics than for NHWs (IRR=1.4; 95% CI: 1.0-2.0, and IRR=1.6; 95% CI: 1.2-2.1). Violent incidents for NHB victims more frequently resulted in injury or medical care. Nearly 40% of NHB victims reported difficulties at school or work related to the incident where only 21.5% of NHWs and 11.7% of Hispanic victims reported similar problems. Roughly 37% of NHB victims identified a NHW offender and 45% of NHW victims identified a NHB offender. Hispanic victims identified NHB or NHW offenders in over 70% of incidents. Conclusions. Although literature suggests that NHWs account for the majority of bias victimizations, the risk of non-fatal violent victimization motivated by race/ethnicity is greater for Non-Hispanic Blacks and Hispanics. Crimes perpetrated against NHBs are likely more severe and victim/offender racial incongruity is common. Findings provide empiric evidence on race/ethnicity-related structural disadvantage with adverse health consequences
Incidence, Longitudinal Trajectory, and Hemodynamic Implications of Cardiac Dysfunction Following Traumatic Brain Injury
Full text linkThesis (Ph.D.)--University of Washington, 2017-06Traumatic brain injury (TBI) is a major public heath problem and leading cause of death and disability worldwide. While hemodynamic instability is common following TBI and associated with increased mortality, few studies have evaluated the function of the heart following TBI. Understanding the role of cardiac dysfunction following TBI represents a major gap in the literature. To address this, the primary aims of the dissertation in isolated moderate-severe TBI patients were: 1) To determine the incidence, longitudinal course, and admission risk factors for systolic dysfunction, 2) To determine the early hemodynamic profile in patients who develop systolic dysfunction, and 3) To examine the association of early myocardial workload and in-hospital mortality. In aim #1, we conducted a prospective cohort study using transthoracic echocardiography (TTE) to determine the incidence of systolic dysfunction within 24 hours following moderate-severe TBI, compared to mild TBI (control group); in addition, we examined the longitudinal course of systolic function over the first week of hospitalization following moderate-severe TBI. In aim #2, we conducted a secondary analysis of the prospective cohort study described in aim #1; we used multivariable linear mixed models to examine the early hemodynamic profile that is associated with the development of systolic dysfunction following moderate-severe TBI. In aim #3, we conducted a retrospective cohort study using the National Trauma Databank (NTDB) to examine the association of the admission rate-pressure product (RRP) with in-hospital mortality following severe TBI. Completion of these aims has helped to uncover a new link between the brain and heart following TBI, and will lead to future studies aiming to personalize hemodynamic management to improve outcomes following TBI
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