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Virginia Department of Health
Office of the Chief Medical Examiner
MPH Research Project Possibilities
As background, the Office of the Chief Medical Examiner (OCME)

• Is a site for the National Violent Death Reporting System, which collects information on suicide, homicide, unintentional firearm death, legal interventions, and deaths from terrorism.
• Collects information on all homicides in the Commonwealth, and distinguishes those that are related to family and intimate partner violence.
• Coordinates the work of the State Child Fatality Review Team.
• Coordinates the work of the Maternal Mortality Review Team.
• Delivers training and technical assistance to local communities who are conducting child or family violence fatality review.

A fuller description of these fatality review and surveillance programs is provided below, along with a few examples of the kinds of projects that could be developed.

Family and Intimate Partner Homicide
http://www.vdh.virginia.gov/medExam/Violence.htm
Beginning with 1999 deaths, the Office of the Chief Medical Examiner conducts surveillance on all homicides occurring in the Commonwealth, distinguishing those that are related to family and intimate partner violence. Information about homicide-suicide events, largely related to domestic violence, is also collected. This project uses death investigation records and newspaper articles to understand the underlying dynamics related to these preventable deaths. Data are currently available for the seven year period 1999-2005, and include information about the victims, perpetrators, location and premise of injury, method of fatal injury, and the presence of lethality factors. This database could be used for further data analysis.

Maternal Death Review
http://www.vdh.virginia.gov/medExam/MaternalMortality.htm
The Office of the Chief Medical Examiner convenes a statewide fatality review team that examines all deaths to women occurring within one year of the end of the pregnancy, regardless of the cause of death or the outcome of the pregnancy. The purpose of this review is to understand how and why women die and to develop ideas for prevention. Records collected for this review include records on prenatal care and delivery, hospital death records, emergency room visits, other health care providers, medical examiner reports on the death, law enforcement, emergency medical services, and mental health. Three potential projects for interns:

1. Identification of Cases of Pregnancy-Associated Maternal Mortality through Examination of Medical Examiner Case Records
   Three mechanisms are typically employed to identify cases of pregnancy-associated maternal death for review by Maternal Mortality Review Teams. These methods include examination of death certificate check boxes indicating the presence of a pregnancy within three months of death, cause of death codes indicating death was due to the pregnancy itself, or matching of maternal death certificates with fetal death or infant birth certificates.
   
   The established definition of pregnancy-associated death includes deaths that occur within one year of a pregnancy. Death certificate check boxes in Virginia indicate whether or not there was a known pregnancy within 3 months of the death. The purpose of this project is to determine if information obtained in the investigation of a death by the medical examiner’s office, would allow for identification of cases that would be missed by the three traditional methods of case ascertainment.
   
   This project would entail reading medical examiner case files of all women between the ages of 15 and 44 (525 cases for 2006) who have not been identified by traditional methods as having had a pregnancy in the year prior to death to determine if cases are being missed by the current methods. At the end of this project, the intern will report on the numbers of cases identified only through examination of medical examiner records and the usefulness of this method for improving case identification.
2. Maternal Death and Weight Gain During Pregnancy
   As obesity rates among women of childbearing age increase, attention is being focused on the recommendations for the optimal amount of weight to be gained throughout pregnancy. The purpose of this project is to determine the amount of total weight gained during pregnancy among women who died natural pregnancy-associated death.
   
   This project would entail abstracting prenatal records to determine the amount of weight gained during pregnancy for each natural, pregnancy-associated death. At the end of this project, the intern would report on weight gained by the women who died and would be able to compare the amount to the current recommendations for weight gain, to the general population of pregnant women, and among prepregnancy BMI’s for women who died.
3. Assessment of Postpartum Visits
   The Virginia Maternal Mortality Review Team has recommended that prenatal care providers encourage a two week postpartum check up. This project would involve abstracting data from prenatal care records to determine if a postpartum visit is documented and if so, the number of days after delivery the visit took place. At the end of the project, the intern would report on the percentage of women who received postpartum check-ups, the percentage who died prior to the postpartum check-up, and the average number of days between delivery and the postpartum check-up.
   

National Violent Death Reporting System
http://www.vdh.virginia.gov/medExam/NVDRS.htm
Virginia is a state partner in the Centers for Disease Control and Prevention’s National Violent Death Reporting System (NVDRS), known in Virginia as the Virginia Violent Death Reporting System (VVDRS). Using death records from forensic science, medical examiners, law enforcement, and vital records, information is abstracted into a database on all of the following kinds of death: suicide, homicide, unintentional firearm, legal intervention, and terrorist. Data collected includes demographic data, toxicological findings at death, wound type and location, method of fatal injury, cause of death, and circumstances associated with the death. Potential projects include the following:

1. Substance Abuse/Mental Health and Suicide
   Between 2003 and 2006, nearly 25% of suicide victims were noted as having a drug/alcohol problem or tested positive for cocaine (a total of 818 persons). Of these, over half (56%) were also noted as having some mental health problem.
   
   Some questions to explore with the data include:
   • What drugs were abused?
   • What treatments were offered/taken for substance abuse?
   • What treatments were offered/taken for mental health?
   • History/depth of addiction/abuse?
   • Type of mental health issues that co-occur with substance abuse?
   • Interaction of mental health, drugs, and alcohol?
   • What is issue with abuse of prescription drugs?
   • Are different types of drugs being found in different parts of the state?
2. Cocaine and Homicide
   Between 2003 and 2006, nearly 18% of homicide victims tested positive for cocaine at autopsy; this percentage increases to 22% when looking only at cases where no circumstances were known. Combing race/age/gender shows that cocaine use among homicide victims is highest for Black males ages 35-44 (44%), Black female ages 35-44 (47%), Black males ages 45-54 (50%), and Black females ages 45-54 (56%). After the ages of 45-54, cocaine use drops off by one-third. There is clearly some link between cocaine/homicide/race and gender.
   
   Some questions to explore with the data include:
   • In what types of homicides is cocaine present (i.e., homicides related to intimate partner violence compared to homicides related to precipitating crimes)?
   • Are there major differences between the time/day/setting of homicides where cocaine is present?
   • Is the amount of cocaine usage seen in homicide victims “normal” for the race/sex/age groups, or is this an indication of persons at higher risk for homicidal violence?
   • Is cocaine use among homicide victims linked to abuse of other drugs?
3. Cancer and Suicide
   Physical health problems were a factor in 21% of suicides from 2003-2006, especially in older adults. A sample of the type of physical health problems found that cancer was the second most common issue, accounting for more than 18% of all physical health problems (approximately 31 persons per year). Anecdotally, the types of cancer ranged from minor treatable forms to terminal cancers with no hope of treatment or recovery. Preventative cancer screening and awareness could decrease the suicide rate, especially among older persons. (This study might require travel to other district offices to generate enough data).
   
   Some questions to explore with the data include:
   • What types of cancer are factors in suicides (locations of cancer, duration, prognosis)?
   • When did suicide victims learn of their cancer, and what kinds of support were given?
   • Were these cancers that could have been treated successfully with earlier intervention?
   • Is the fear of cancer creating an undue panic in suicide victims? Some victims were never diagnosed, but were sure that they had cancer. Others had treatable forms of cancer.
   • Are suicides related to cancer intertwined with other issues, or is cancer the motivating factor?
4. Economic Status and Suicide and/or Homicide
   Very little in VVDRS is known about socioeconomic status and suicide/homicide. There is some reporting of occupation, but different sources often report wildly different occupations for one victim, and occupations are so vague (for example, “supervisor”) that they are not a good indicators of socioeconomic status. While we know, anecdotally, that suicide and homicide victims are not generally from the upper class, we know little else. Files have a rich amount of information that could possibly be used to estimate status (census block group, GIS, etc.).
   
   Some questions to explore with the data include:
   • Is suicide/homicide a class-based issue?

Needlestick Research - Primary data collection, working with Dr. Spence Harpe.
Needlestick injuries are an important public health issue from an occupational health standpoint.  While this is especially true for health care professionals, it can also be an issue for others (e.g., sanitation workers, custodial staff, etc.).  For those non-healthcare workers, the problem of needlestick injuries may result in part from two factors – the lack of patient knowledge about proper sharps disposal and the lack of availability of sharps disposal containers in public places.  This project would primarily focus on sharps disposal in public spaces.

For more information, click here.

 

Possible MPH Research Project Opportunities with VCU Office of Health Promotion (OHP)
The VCU OHP is inviting  1 in 3 VCU students to take the "American College Health Association National College Health Assessment" (ACHA) survey during the Spring 2008 semester. This is a transition year for both VCU and ACHA. ACHA is piloting a NEW survey tool. Therefore, 5000 of the surveys will be the old survey used since 2002 and 5000 will be the new pilot survey.

 

Possible Project 1.  VCU’s OHP is looking for a statistically smart MPH student  to help analyze some of this data. It will come back from ACHA as two SPSS files. While much of the survey is changing, many of the questions will be the same. ACHA will run reliablity validity tests on the pilot and original. OHP suggests that an MPH student could do the same type of analysis on VCU’s smaller subset of data.

 

Possible Project 2. OHP would like to have someone look at TREND data 2002-2007 on collected VCU data and compare VCU’s local 5 year trends to the national NCHA data for the same years.

 

Interested?  Contact Amanda B. Wattenmaker, MPH, CHES
Virginia Commonwealth University
Office of Health Promotion
University Student Health Services
wattenmakeab@vcu.edu

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