Month: June 2014

A heads-up on concussion risk

Younger people between 15 and 24 have twice as many emergency room visits as any other age group.

You’ve seen the recent headlines: Contact sports often lead to concussions, with possible long term effects. Earlier this month, former Miami Dolphins quarterback Dan Marino and 14 players became the latest to sue the NFL over concussions. Last year, PBS’ Frontline program League of Denial won a Peabody Award for investigating the NFL’s concussion crisis.

The story does not end with professional or even college sports: Studies show high school athletes are at double the risk of concussion as college players. Experts are also concerned about the cumulative effect of repeated concussion, which has been linked to temporary and permanent changes in the way the brain functions.

Heightened awareness is leading more young athletes to seek medical evaluation for possible concussions.  The State of California has required concussion training for school coaches since Jan. 1, 2013.

Now, a new report by the Los Angeles County Department of Public Health provides a first-ever look at the problem of concussions in the L.A. region—and how rising awareness is leading to more and quicker treatment.

Overall, researchers found that 69,000 people were treated in emergency departments or admitted to hospitals in the county for concussions between 2005 and 2011. During that time, hospitalizations remained steady but the rate of emergency room visits soared by 58%–a finding that public health officials say reflects the public’s growing understanding of concussion symptoms and the importance of seeking medical attention.

By far, the highest rates of emergency visits were for young adults between the ages of 15 and 24. They accounted for nearly 30% of all such visits, almost twice as high as for any other age group. Roughly half of those individuals were hurt while playing football, with another 20% suffering injuries during soccer games. (Falls were the main cause of concussions among all age groups in L.A. County.)

While these findings were not unexpected for this younger age group, researchers were surprised by one unexplained discovery: Females, they found, reported more concussions than men in sports in which both play under similar rules, including basketball and soccer.

“It could be biomechanical, the way females are built versus males,” said Dr. Margaret Shih, director of the public health’s office of health assessment and epidemiology. She said it’s hard to draw a conclusion because women are traditionally more likely to seek medical help than men. “There’s still a lot of research that needs to be done,” she said.

County health officials say they hope their report will lead to heightened awareness not only in our emergency rooms, but on the playing field. And despite the rising numbers of emergency department visits, they think the numbers are still too low.

“I do believe that concussions are underreported,” said Andrea Welsing, director of the injury and violence prevention program for the public health department. She added that pressure to play is still keeping many injured athletes in the game, putting them at risk of further injury.

Although the report will not be distributed in hard-copy form, Welsing said the plan is to launch an e-mail campaign to include parents, coaches, teachers, pediatricians, sports medicine physicians, recreation center personnel and school nurses.

Welsing said the health department is not expecting schools and other youth sports organizations to hire additional medical staff, but rather to train coaches and others to recognize symptoms and realize the importance of taking a player out of the game until he or she can be medically evaluated.

Steven Grech, assistant athletic director for sports medicine and head athletic trainer at California State University, Northridge, said his university has done baseline testing for concussion for all contact sports since 2006.  But the effort became more formalized in 2010, when the NCAA began requiring Division 1 institutions, including CSUN, to have a formal concussion management plan.

The biggest recent improvement at CSUN is in student awareness —the 2010 requirement included student education along with faculty training. Grech said CSUN fosters a culture where players look for symptoms in their teammates and roommates, not just themselves. This is particularly important during the summer, when there are no official team practices but athletes are still playing to stay in shape, Grech said.

“We have kids coming in saying, ‘Hey, I was playing pickup basketball just last night and got hit in the head and I’ve had a headache ever since, I couldn’t sleep last night, I’ve been dizzy,’” Grech said. “We’ve seen an increase in self-reporting over the last four years.”

Posted 6/26/14

Voting’s future: #FixIt

The #LAVote Twitter feed was busy on Election Day, sharing updates and photos from around the county.

After Tuesday’s primary election, Los Angeles County Registrar-Recorder/County Clerk Dean Logan noted the irony of his role the night before: He was using new technology—that is, tweeting—to explain to voters why the county can’t post instant election results on the Internet.

One of his tweets, also posted on the Registrar-Recorder/Clerk’s website : “L.A. County covers a large geographic area.  It will take time for secure transport of ballots to HQ (that’s headquarters in Norwalk) for tabulations.”

During the evening, Logan and other county officials kept the Twitter generation entertained with updates and photos of bright red boxes of paper ballots security-sealed and ready for transport.  Logan loves the real-time dialogue with constituents, but pleads for patience from those among the county’s 4.8 million registered voters who may blame reporting delays on county staff.

Secure transport of ballots doesn’t begin until the polls close. “Once that’s done, the counting process is fast — but we have to get them to Norwalk,” he said. (Still, as of Wednesday, thousands of “provisional” and last-minute absentee ballots remained to be counted.)

Both tired and exhilarated on Wednesday morning, Logan said it might be a long time before voters can cast their vote online or get instant election results.  That’s hard to explain to a public that’s used to doing everything online, from paying bills to voting for the next American Idol.

“What it really comes down to is the value of the history of the secret ballot,” Logan said.  He explained that while an online activity such as banking is a secure transaction, it still requires that the identity of the individual be linked to the account so the bank knows who you are. At the polls, the voter signs in so he or she can’t vote more than once, but once the paper ballot is placed in the box it can no longer be connected to any individual voter.

But Logan is more confident that the county can streamline the current voting process to better serve the demands of a new generation of voters in other ways. “We’re looking at modernizing the voting systems,” he said. Tuesday’s startlingly low voter turnout, he said, is one more indicator of a voting process that is “at the end of its life cycle.” (Only 13.1% of eligible county residents voted, the lowest turnout in the state.)

Last year, the county launched a massive updating of the voting apparatus to be more user-friendly, with updated equipment to be available at the polls in 2016, part of a broader effort that includes research into the future needs of an increasingly large and complex population.

And on Wednesday, the county passed an ordinance—initiated by Supervisor Zev Yaroslavsky —that will require candidates to file their campaign finance reports electronically, with the goal of eliminating the slow, labor intensive data entry process and providing quicker, more complete access to the public.

By the November 4 general election, Logan said, campaign donor information will be available online for all candidates. While optional electronic filing has existed for several years, he said, only 50% of L.A. County candidates have been filing online.   Some information was only accessible on paper at Norwalk headquarters.

“And some candidates have done a hybrid, sometimes electronically, sometimes paper,” he said. “The first step is to make that an even playing field. All of the candidates will be filing in the same manner.”

He adds that it’s not enough to post campaign finance information: the county plans to make sure it’s presented in a searchable, user-friendly format.  (One minor downside:   Because the information will be entered online by the candidate’s campaign management, errors or violations will be publicly visible before the county has a chance to see the entry and notify the campaign of the problem.)

Logan called the move significant because “it’s one step in updating the whole process.” The goal of the county, he asserts, is “transparency, security and accountability.”

Logan said his department also is looking at new ways to bring younger voters to the polls, including the opportunity to vote at any polling place, rather than having to make it to a designated polling location during voting hours.

And the poll worker pool needs to be expanded beyond the current demographic, which skews heavily toward older people and retirees. “There is not the population available that’s willing to put in a day’s work for what is essentially a civic volunteerism act,” he said. “Some do it for the stipend, which I think is $175, but there are certainly areas of this county where that’s not an incentive.”

Logan says the department will carefully consider each update to the system.  “People are now used to getting information on a real-time basis and our system isn’t designed for that,” he acknowledged. “But we need to make sure we’re not duplicating [problems] with a newer version of the old process.  We need to make sure there’s value added, and a flexibility to change with the times.”

Posted 6/5/14

A stowaway on Expo 2

I had a chance to ride the rails last week, going behind the scenes of one of L.A.’s most eagerly anticipated transit projects.

The vehicle transporting me was a bouncing truck, not a sleek light rail train. But my imagination was moving full speed ahead as I traveled a major chunk of the Expo Line Phase 2 route now taking shape beside the 10 Freeway. (I even shot some iPhone footage along the way. I’m probably not going to be winning any cinematography Oscars, but I hope you’ll click on the above link to share a condensed and accelerated video version of my off-road voyage.)

When completed next year, and opened to the traveling public in 2016, Expo will be an urban transportation godsend: a chance to bring some predictability and personal choice back to what’s become, over the past decade, the increasingly soul-crushing experience of just trying to get across town.

I was moved—and not only in the literal sense—to see all the years of hard work, planning and construction transforming into something so real and so powerful. The long-held dream of being able to make it from downtown L.A. to 4th Street in Santa Monica in 46 minutes flat is now emerging fast from steel, sweat and stone.

I saw stations rising in Palms and at Westwood Boulevard. Long stretches of sound walls were already in place. About four miles of track have been installed, with 10 additional miles coming soon to complete the roundtrip journey of Expo Phase 2 from Culver City to Santa Monica.

On the morning of my off-road tour, from Bagley Avenue to Military Avenue in West Los Angeles, electrical crews were racing their construction counterparts to put up the network of power poles that will move Expo’s trains. Knots of workers were busily installing pavers on the platform of the Westwood Boulevard station. Elevator towers were up at the Palms Station, ready for the contractor to install glass and machinery. And heavy, laser-equipped machines were preparing to tamp down rock ballast between rail ties.

It was a fascinating trip into L.A.’s past, present and future. We traveled past the modern Lycée Français de Los Angeles; past an area known as Motor Yard where generations of taggers, unfortunately, have left an inch-thick residue of graffiti for our teams to clean up; through an old freight train tunnel under the 10 Freeway that will soon see a new generation of trains gliding through.

To our right, for some of the trip, rumbled the 10 Freeway—moving uncharacteristically smoothly on this morning but inevitably heading toward the gridlock that will be the Expo Line’s best advertisement when Phase 2 opens. As we passed the Westwood Boulevard station, another symbol of motoring frustration, the 405 Freeway, was visible to the west.

It was an amazing vantage point, and I wish that every Angeleno who’s ever cursed a Sig Alert could have been along for the ride. Short of that, I hope that the video above will spur your imagination and awaken the sense that something better is coming down the tracks for Los Angeles.

Expo 2’s making tracks to Santa Monica from Culver City. Photo/Expo Construction Authority

Posted 6/18/14

County’s $840 million reform plan

The county, which pays millions annually for health care for retirees and their dependents, will save substantially in the years ahead.

In a move expected to save hundreds of millions of dollars in the decades to come, the Los Angeles County Board of Supervisors on Tuesday approved historic reforms in the way it pays for county retirees’ health care insurance.

County officials said the changes could save $840 million over the course of the next 30 years. Under the plan—which applies to those hired after July 1, not to current workers—the county will reduce the subsidies it provides for retirees to purchase health care insurance. The changes approved by the board also require retirees who are eligible for Medicare to enroll in the federal program; the county subsidy will be applied to a Medicare supplement plan.

The savings are projected be considerable. Currently, the county pays up to $1,953.41 a month to subsidize health care benefits for a retiree and his or her family. Under the new plan, a retiree under the age of 65 would receive an individual monthly subsidy of up to $918.46, which will be reduced to $370.89 once the retiree reaches 65 and can be covered under Medicare. The new plan is based only on individual coverage, but retirees can still purchase insurance for their dependents at their own expense.

“This represents one of the most significant improvements to our retiree health care benefit since the 1980s. It reduces our unfunded liability by 20%,” said William T Fujioka, the county’s chief executive officer. “It speaks to our board’s fiscal responsibility and fiscal discipline, and it’s a move that will help ensure our future financial viability.”

Fujioka said the support of county labor groups had helped make the new retiree health plan a reality.

“They were with us 100%,” Fujioka said. “We went to the table and negotiated this change, and they joined us in presenting this change to our L.A. County retirement board. As a consequence, we got a unanimous vote.”

The county currently pays about $487.8 million a year for retiree health care—with that obligation coming off the top of the budget each year, before other programs are funded.

Taking action now ensures the health of the retiree benefit in the years ahead, Supervisor Zev Yaroslavsky said.

“These reforms allow Los Angeles County to continue its leadership role in providing fair and responsible benefits to retirees, in contrast to troubles that have affected many other jurisdictions across the country,” Yaroslavsky said.  “Without these changes, our health care program would have faced severe challenges going forward. As it is, we are doing the right thing for future generations of L.A. County employees and taxpayers.”

Posted 6/17/14

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