The impact of tightened prescribing restrictions for PBS-subsidised opioid medicines and the introduction of half-pack sizes, Australia, 2020-21: an interrupted time series analysis.

OBJECTIVES: To evaluate the impact of the tightened Pharmaceutical Benefits Scheme (PBS) prescribing rules for immediate release (IR) and controlled release (CR) opioid medicines (1 June 2020), which also eliminated repeat dispensing without authorisation for codeine/paracetamol and tramadol IR and introduced half-pack size item codes for IR formulations. DESIGN, SETTING: Population-based interrupted time series analysis of PBS dispensing data claims for a 10% sample of PBS-eligible residents and IQVIA national opioid medicine sales data (PBS-subsidised and private prescriptions), 28 May 2018 - 6 June 2021. MAIN OUTCOME MEASURES: Mean amount of PBS-subsidised opioid medicines dispensed per day and mean overall amount sold per day - each expressed as oral morphine equivalent milligrams (OME) - overall, by formulation type (IR, CR), and by specific formulation. RESULTS: During the twelve months following the PBS changes, daily PBS-subsidised opioid medicine dispensing was 81 565 OME lower (95% CI, -106 146 to -56 984 OME) than the mean daily level for 2018-20, a decline of 3.8% after adjusting for the pre-intervention trend; the relative reduction was greater for IR (8.4%) than CR formulations (2.6%). Total daily sales of all, IR formulation, and CR formulation opioid medicines did not change significantly after the PBS changes. Repeat dispensing of prescriptions comprised 7.4% of PBS-subsidised opioid dispensing before 1 June 2020, and 1.3% after the changes. Half-pack sizes comprised 8.4% of PBS-subsidised IR opioid medicine dispensing and 2.8% of all opioid medicines sold in the twelve months after the PBS changes. CONCLUSIONS: The introduction of new PBS rules for subsidised opioid medicines was followed by a decline in PBS-subsidised dispensing. Some people may have bypassed the new restrictions by switching to private prescriptions, but our findings suggest that opioid medicine use in Australia declined as a result of the new restrictions.

Age, crash type and the changing patterns of cycling fatalities in Australia between 1991 and 2022.

BACKGROUND: Australia has made significant efforts in recent years to promote cycling. METHODS: Trends in cyclist fatalities in Australia between 1991 and 2022, particularly in those aged 60 years and over, were examined using Poisson regression modelling. RESULTS: Overall, cyclist fatalities decreased by 1.1% annually. However, while there was an annual decline of 2.5% in those aged <60 years, fatalities in the 60+ age group increased by 3.3% annually. Mortality rates also showed an annual decrease of 3.5% for cyclists aged <60 years but remained almost stable in the 60+ age group over the study period. Single vehicle fatalities increased markedly, particularly among the 60+ age group (4.4% annually). DISCUSSION: The observed increase in 60+ fatalities is due to the ageing of the population rather than a rise in cycling popularity as previously thought. The rise in single vehicle fatalities is likely to be related to the increase in the availability and use of dedicated cycling infrastructure.

Updated population-level estimates of child restraint practices among children aged 0-12 years in Australia, 10 years after introduction of age-appropriate restraint use legislation.

OBJECTIVE: Optimal child passenger protection requires use of a restraint designed for the age/size of the child (appropriate use) that is used in the way the manufacturer intended (correct use).This study aimed to determine child restraint practices approximately 10 years after introduction of legislation requiring correct use of age-appropriate restraints for all children aged up to 7 years. METHODS: A stratified cluster sample was constructed to collect observational data from children aged 0-12 years across the Greater Sydney region of New South Wales (NSW). Methods replicated those used in a similar 2008 study. Population weighted estimates for restraint practices were generated, and logistic regression used to examine associations between restraint type, and child age with correct use accounting for the complex sample. RESULTS: Almost all children were appropriately restrained (99.3%, 95% CI 98.4% to 100%). However, less than half were correctly restrained (no error=27.3%, 95% CI 10.8% to 43.8%, no serious error=43.8%, 95% CI 35.0% to 52.7%). For any error, the odds of error decreased by 39% per year of age (OR 0.61, 95% CI 0.46 to 0.81) and for serious error by 25% per year (OR 0.75, 95% CI 0.60 to 0.93). CONCLUSION: The findings demonstrate high levels of appropriate restraint use among children across metropolitan Sydney approximately 10 years after introduction of legislation requiring age-appropriate restraint use until age 7, however, errors in the way restraints remain common. IMPLICATIONS FOR PUBLIC HEALTH: Given the negative impact incorrect use has on crash protection, continuing high rates of incorrect use may reduce effectiveness of legislative change on injury reduction.

A population-based cross-sectional study examining homicides among community-dwelling older adults in Victoria, Australia: A study protocol.

BACKGROUND: There is a need for both descriptive and analytical evidence on the factors associated with older adult homicide. The current landscape is insufficient because most published research is confined to the United States, and contains insufficient data about the homicide context. This study protocol describes the proposed method for examining the characteristics and factors associated with older adult homicide in the Australian state of Victoria, using data generated for the criminal and coronial investigation into these deaths stored in the Victorian Homicide Register (VHR). Outcomes will support practitioners, policy makers and other key stakeholders to strengthen prevention strategies to reduce the risk of future homicides among older Victorians. METHODS: This study will comprise a single-jurisdiction population-based cross-sectional design to analyse consecutive cases of homicide among community-dwelling older adults in Victoria, Australia for the period 2001 to 2015. All homicides of adults aged 18 years and older, and where the Coroner's investigation is completed at data extraction will be included. Variables will be selected in accordance with elements of the social-ecological model (i.e., individual, interpersonal, incident, and community). This will include: socio-demographic characteristics; presence of mental or physical illness; deceased-offender relationship; nature of any abuse between the deceased and offender; incident location and weapon used; the presence of alcohol or drugs; and criminal justice outcomes. Homicide rates per 100,000 population will be calculated for older adults (aged 65 years and older) and younger adults (aged 18-64 years), and compared as rate ratios using Poisson regression. Descriptive statistics and cross-tabulation will be generated for factors associated with homicide for older compared to younger adults. Homicide typologies based on deceased-offender relationship and motive will be explored within group and family homicides will be compared between older and younger adults.

Attention, response inhibition, and hoarding: A neuropsychological examination.

Background and aims: The prominent cognitive-behavioral model of hoarding posits that information processing deficits contribute to hoarding disorder. Although individuals with hoarding symptoms consistently self-report attentional and impulsivity difficulties, neuropsychological tests have inconsistently identified impairments. These mixed findings may be the result of using different neuropsychological tests, tests with poor psychometric properties, and/or testing individuals in a context that drastically differs from their own homes. Methods: One hundred twenty-three participants (hoarding = 63; control = 60) completed neuropsychological tests of sustained attention, focused attention, and response inhibition in cluttered and tidy environments in a counterbalanced order. Results: Hoarding participants demonstrated poorer sustained attention and response inhibition than the control group (CPT-3 Omission and VST scores) and poorer response inhibition in the cluttered environment than when in the tidy environment (VST scores). CPT-3 Detectability and Commission scores also indicated that hoarding participants had greater difficulty sustaining attention and inhibiting responses than the control group; however, these effect sizes were just below the lowest practically meaningful magnitude. Posthoc exploratory analyses demonstrated that fewer than one-third of hoarding participants demonstrated sustained attention and response inhibition difficulties and that these participants reported greater hoarding severity and greater distress in the cluttered room. Discussion and conclusions: Given these findings and other studies showing that attentional difficulties may be a transdiagnostic factor for psychopathology, future studies will want to explore whether greater sustained attention and response inhibition difficulties in real life contexts contribute to comorbidity and functional impairment in hoarding disorder.

Differences in participant characteristics and observed child restraint use between population-based and restraint fitting service samples.

OBJECTIVE: To compare characteristics and restraint use between a population-based and fitting service sample of child restraint users. METHOD: Characteristics of the two samples were compared using chi-squared tests. Differences in errors in restraint use observed in the two samples were modeled using logistic regression. RESULTS: There were significant differences in child age (p < 0.001), and restraint types (p < 0.001) between the two samples, with more younger children in the fitting service sample. Controlling for differences in restraint type, the odds that adult participants were female were 61% less in the fitting service sample than in the population-based sample (OR 0.39, 95%CI 0.21-0.71). The odds that adult participants perceived a large risk associated with restraint misuse (OR 3.62, 95%CI 1.33-9.84), had a household income in the highest bracket (OR 3.89, 95%CI 1.20-12.62) and were living in areas of highest socioeconomic advantage (OR 2.72, 95%CI 1.22-6.06) were approximately three times higher in the fitting service sample. Overall, more participants had errors in restraint use in the population-based sample (p = 0.021). However, after controlling for restraint type, securing errors were three times more likely (OR 3.34, 95%CI 1.12-10.2), and serious installation errors were almost twice as likely (OR 1.91, 95% CI 1.09-3.39) in the fitting service sample. CONCLUSIONS: While less resource intensive, convenience and/or fitting service samples may be less representative than population-based samples. Given the need for efficiency, methods that combine randomized population-based invitations to participate in restraint fitting check day events across geographically representative areas may be useful for ongoing surveillance of child restraint use.

Improving population-level refractive error monitoring via mixture distributions.

INTRODUCTION: Sampling and describing the distribution of refractive error in populations is critical to understanding eye care needs, refractive differences between groups and factors affecting refractive development. We investigated the ability of mixture models to describe refractive error distributions. METHODS: We used key informants to identify raw refractive error datasets and a systematic search strategy to identify published binned datasets of community-representative refractive error. Mixture models combine various component distributions via weighting to describe an observed distribution. We modelled raw refractive error data with a single-Gaussian (normal) distribution, mixtures of two to six Gaussian distributions and an additive model of an exponential and Gaussian (ex-Gaussian) distribution. We tested the relative fitting accuracy of each method via Bayesian Information Criterion (BIC) and then compared the ability of selected models to predict the observed prevalence of refractive error across a range of cut-points for both the raw and binned refractive data. RESULTS: We obtained large raw refractive error datasets from the United States and Korea. The ability of our models to fit the data improved significantly from a single-Gaussian to a two-Gaussian-component additive model and then remained stable with ≥3-Gaussian-component mixture models. Means and standard deviations for BIC relative to 1 for the single-Gaussian model, where lower is better, were 0.89 ± 0.05, 0.88 ± 0.06, 0.89 ± 0.06, 0.89 ± 0.06 and 0.90 ± 0.06 for two-, three-, four-, five- and six-Gaussian-component models, respectively, tested across US and Korean raw data grouped by age decade. Means and standard deviations for the difference between observed and model-based estimates of refractive error prevalence across a range of cut-points for the raw data were -3.0% ± 6.3, 0.5% ± 1.9, 0.6% ± 1.5 and -1.8% ± 4.0 for one-, two- and three-Gaussian-component and ex-Gaussian models, respectively. CONCLUSIONS: Mixture models appear able to describe the population distribution of refractive error accurately, offering significant advantages over commonly quoted simple summary statistics such as mean, standard deviation and prevalence.

Epidemiology of Homicide in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis.

BACKGROUND: Empirical research investigating older adult homicide is sparse and rarely accumulated for greater insights. This systematic review and meta-analysis quantifies the prevalence and characteristics of homicide victimization among older adults (65 years and older) compared with younger adults (18-64 years). METHOD: We searched Cumulative Index to Nursing and Allied Health Literature, Cochrane, Criminal Justice Abstracts, EMBASE, MEDLINE, ProQuest, PsycINFO, Scopus, and Web of Science for studies published before December 31, 2018 (International Prospective Register of Systematic Reviews registration: CRD42017054536). Included were English-language, original, peer-reviewed studies describing the homicide of older adults. Excluded were studies not meeting age criteria, residence as an institution, or with insufficient outcome variables. The review included 39 studies; 17 were included in the meta-analysis. Data were extracted via open access or from study authors. Heterogeneity was assessed through study-level random effects estimates. RESULTS: Pooled homicide rates per 100,000 population were 2.02 (95% CI [1.23, 3.33]) for older adults (n = 35,325) and 3.98 (95% CI [2.42, 6.53]) for younger adults (n = 607,224; rate ratio = .51, 95% CI [0.37, 0.70], p < .001). Proportion estimates for older adults: victim female 46.3%, location home 71.4%, offender familiar 25.2%, compared to stranger, 24.2%, motive argument 36.1%, compared to felony 30.8%, and weapon firearm 24.5%. Older adults were significantly different to younger adult victims (p = <.001) for female (OR = 2.5, 95% CI [2.02, 3.10]), home (3.87, 95% CI [3.45, 4.35]), stranger (1.81, 95% CI [1.66, 1.98]), argument (0.33, 95% CI [0.28, 0.39]), felony (2.78, 95% CI [2.58, 2.99]), and firearm (0.38, 95% CI [0.36, 0.40]). CONCLUSIONS: Homicide against older adults differs from younger adults and warrants specific research and tailored prevention strategies.

Mesoderm-derived PDGFRA+ cells regulate the emergence of hematopoietic stem cells in the dorsal aorta.

Mouse haematopoietic stem cells (HSCs) first emerge at embryonic day 10.5 (E10.5), on the ventral surface of the dorsal aorta, by endothelial-to-haematopoietic transition. We investigated whether mesenchymal stem cells, which provide an essential niche for long-term HSCs (LT-HSCs) in the bone marrow, reside in the aorta-gonad-mesonephros and contribute to the development of the dorsal aorta and endothelial-to-haematopoietic transition. Here we show that mesoderm-derived PDGFRA+ stromal cells (Mesp1der PSCs) contribute to the haemogenic endothelium of the dorsal aorta and populate the E10.5-E11.5 aorta-gonad-mesonephros but by E13.5 were replaced by neural-crest-derived PSCs (Wnt1der PSCs). Co-aggregating non-haemogenic endothelial cells with Mesp1der PSCs but not Wnt1der PSCs resulted in activation of a haematopoietic transcriptional programme in endothelial cells and generation of LT-HSCs. Dose-dependent inhibition of PDGFRA or BMP, WNT and NOTCH signalling interrupted this reprogramming event. Together, aorta-gonad-mesonephros Mesp1der PSCs could potentially be harnessed to manufacture LT-HSCs from endothelium.

Child restraint headrest and belt routing design features and their association with child passenger behavior and restraint misuse.

OBJECTIVES: Ergonomic design of child restraint systems (CRS) may facilitate optimal travel behavior and crash protection of child passengers during motor vehicle trips. However there have been few studies examining the relationship between CRS design and child passenger travel behavior. The aim of this study was to examine whether associations between CRS design features and child passenger behavior exist during real-world, everyday vehicle trips. METHODS: Video from a naturalistic driving study (NDS) was analyzed in this study. Families drove an instrumented study vehicle for approximately two weeks with at least one child aged between one and eight years traveling in their own forward-facing (FF) CRS or belt positioning booster (BPB). Video for one child passenger was randomly selected from each trip for analysis. Video was coded for five-second epochs at nine time points (5%, 17%, 25%, 30%, 50%, 53%, 75%, 89% and 95% of trip length). Two types of child passenger travel behaviors were identified by manual review of the video and audio recordings: (i) optimal/suboptimal head position and (ii) correct/incorrect use of the internal harness/shoulder belt. Video screenshots were used to characterize CRS design features. Random effects logistic regression models were used to examine the associations between specific CRS design features and the travel behaviors of interest, whilst accounting for clustering of data by child and trip. RESULTS: Suboptimal head position was associated with the absence of a height adjustable headrest and a narrow headrest wing width in FFCRS. Incorrect harness use in a FFCRS was associated with the absence of an adjustable headrest, in addition to headrest features such as wing width and depth. In BPBs, a reduction in suboptimal head position was associated with the absence of a sash belt guide, however no restraint design features were associated with incorrect shoulder belt use. CONCLUSIONS: Some CRS design features may influence undesirable child passenger travel behavior. These early findings support enhanced and user-centric CRS design as a likely important mechanism to improve child passenger safety.

Can Age or Height Define Appropriate Thresholds for Transition to Adult Seat Belts? An Analysis of Observed Seat Belt Fit in Children Aged 7-12 Years.

This study aimed to investigate associations between demographic, anthropometric and vehicle factors and the fit of adult seat belts in children aged 7-12 years in passenger vehicles. Seat belt fit was assessed by inspection of 7-12-year-old children in their own cars. Logistic regressions examined associations between anthropometric and vehicle factors on achieving good seat belt fit. There were 40 participants included in the analysis, with 16 (40%) having good overall belt fit. The odds of achieving good overall seat belt fit increased by 15% (OR 1.15, 95% CI 1.04-1.27) with every centimeter increase in height and increased by 5% with every one-month increase in age (OR 1.045, 95% CI 1.001-1.10). Controlling for vehicle factors, neither age or height was significantly associated with overall good belt fit, and the discriminatory power of models including these metrics to predict good belt fit was 73% (AUC 0.73, 95% CI 0.55-0.91) and 74% (AUC 0.74, 95% CI 0.58-0.91). The results suggest that taller and older children have a better chance of achieving a good seat belt fit. However, with variations in seat geometry between vehicles, no single simple metric clearly defines an appropriate transition to the adult seat belt.

Subjective experiences of bicyclists being passed by motor vehicles: The relationship to motor vehicle passing distance.

BACKGROUND: Feeling unsafe when riding a bicycle is a key barrier to cycling participation. To better understand the experiences of cycling on-road, this study aimed to explore the relationship between cyclists' subjective experiences and the lateral passing distance of motor vehicles. METHODS: An on-road observational study was conducted in Victoria, Australia. Participants had a custom device installed on their bicycle that measured the lateral passing distance of motor vehicles and included a handlebar mounted "panic button" that participants could press when they felt that a passing event was too close or unsafe. A random effects logistic regression model was used to investigate the relationship between cyclist sex, motor vehicle type and infrastructure characteristics, and button press events. RESULTS: A total of 217 button press events were recorded (1.2 % of all passing events) from 60 participants. For events with a passing distance closer than 100 cm, 10.4 % of these events had a recorded button press. The adjusted odds of a button press event were over three-fold higher when the rider was passed by a truck, compared to when the rider was passed by a sedan. The predicted probability of a button press event was higher in events occurring in road environments with no bike lane and no parked cars (1.9 %) compared to no bike lane with parked cars (1.2 %), a bike lane with no parked cars (0.9 %) and a bike lane with parked cars (0.7 %). CONCLUSIONS: The study identified important links between cyclists' subjective experience of unsafe events, motor vehicle types and infrastructure characteristics. Greater emphasis needs to be placed on capturing subjective experiences to inform and advance the development and implementation of safe and comfortable cycling infrastructure.

Induction of muscle-regenerative multipotent stem cells from human adipocytes by PDGF-AB and 5-azacytidine.

Terminally differentiated murine osteocytes and adipocytes can be reprogrammed using platelet-derived growth factor-AB and 5-azacytidine into multipotent stem cells with stromal cell characteristics. We have now optimized culture conditions to reprogram human adipocytes into induced multipotent stem (iMS) cells and characterized their molecular and functional properties. Although the basal transcriptomes of adipocyte-derived iMS cells and adipose tissue-derived mesenchymal stem cells were similar, there were changes in histone modifications and CpG methylation at cis-regulatory regions consistent with an epigenetic landscape that was primed for tissue development and differentiation. In a non-specific tissue injury xenograft model, iMS cells contributed directly to muscle, bone, cartilage, and blood vessels, with no evidence of teratogenic potential. In a cardiotoxin muscle injury model, iMS cells contributed specifically to satellite cells and myofibers without ectopic tissue formation. Together, human adipocyte-derived iMS cells regenerate tissues in a context-dependent manner without ectopic or neoplastic growth.

At what stages of licensing do graduated driver licensing systems reduce crashes? Example from Queensland, Australia.

Evaluations of new graduated licensing systems (GLS) commonly examine pre-post young driver crash rates relative to another driver group. This comparison approach is important to account for other influences on crashes over time, but has limited ability to determine which GLS components are most effective and at what stage during the licensing process. We previously identified declines in young driver crashes in Queensland, Australia, following introduction of a new GLS in 2007. The objective of the current research was to conduct complementary modelling to identify at what points through the licensing process had particular GLS policies contributed to reductions. Crash trends were explored for learner and provisional drivers under the new GLS versus previous system for three time periods relative to the month of acquiring a provisional licence: the preceding learner period, the first month of provisional licensure (when crashes typically peak), and the overall provisional period. Interrupted time series analyses were conducted for the log ratio of crashes per 10,000 licensed (learner and provisional) drivers with the total number of licensed drivers as an offset. The greatest declines were found in the first month of licensure, with indications that a longer learner period, higher supervised driving hours, and a new provisional night-passenger restriction were key contributors to provisional crash reductions. There was also some indication that a restriction on all phone use reduced crashes during the learner period. We conclude that time series analysis focusing on licensing stage, rather than calendar time only, offers a complementary approach to analysing GLS effectiveness by better identifying where and how changes impact crashes.

Determinants of object choice and object attachment: Compensatory consumption in compulsive buying-shopping disorder and hoarding disorder.

BACKGROUND AND AIMS: Individuals who meet criteria for compulsive buying-shopping disorder (i.e., acquiring problems only) or hoarding disorder (i.e., acquiring and discarding problems) may acquire possessions to compensate for unmet belonging needs, but may do so in different ways. Those with compulsive buying-shopping disorder may acquire objects that they believe will relieve the distress associated with unmet belonging needs (e.g., objects that distract or comfort), whereas those with hoarding disorder may acquire objects that they believe achieve belonging needs (e.g., objects that have interpersonal connotations). Accordingly, this study examined whether a belongingness threat would drive individuals who excessively acquire possessions to choose a human-like object (person-shaped tea holder) or a comfort item (box of chamomile tea). METHODS: One hundred seventy-five participants (57 self-reported excessive acquiring only; 118 self-reported excessive acquiring and difficulty discarding) recalled a time when they either felt supported or unsupported by a significant other before choosing an object to take home with them. Participants rated how anthropomorphic and comforting the objects were as well as how attached they became to their chosen object. RESULTS: Unsupported individuals were more likely to acquire the comfort item than supported individuals; however, individuals with both acquiring and discarding problems were more likely to acquire the human-like item than those with an acquiring problem only. Comfort and anthropomorphism ratings predicted object choice and attachment. DISCUSSIONS AND CONCLUSION: The current findings extend the Compensatory Consumer Behavior Model to include what factors determine strategy choice and object attachment.

Suicide by crashing into a heavy vehicle: Professional drivers' views.

Objective: Every profession has its own safety and health risks. In addition to the risk of being involved in a "normal" road crash, professional heavy vehicle drivers are at risk of becoming victims of people attempting suicide by crashing into their vehicles. Road suicides are not that rare, at least not in Finland, where they represent about 12% of all fatal road crashes. The purpose of this study was to survey professional heavy vehicle drivers about their experiences, views and opinions regarding road suicides.Methods: The sample included heavy vehicle drivers (N = 863) randomly recruited from a transport workers' union.Results: About 18% of the respondents reported a suspected suicide attempt of a motor vehicle driver crashing into their vehicle, with 15% of these (i.e.2.8% of the whole sample) also reporting a resulting crash. More than half of the respondents reported personally knowing another professional driver who had experienced a crash caused by a suicidal driver. Almost 80% of the drivers reported being afraid that someone would attempt suicide by crashing into their vehicle; however, thinking about such a possibility produces a level of anxiety in less than half of all respondents. Most respondents agreed about the challenges of avoiding a crash if somebody deliberately drives their car towards their vehicle.Conclusion: Heavy vehicle drivers perceive road suicides as an occupational risk in their profession. We discuss possible preventive measures against suicide attempts by crashing into a heavy vehicle.

Estimated stroke risk, yield, and number needed to screen for atrial fibrillation detected through single time screening: a multicountry patient-level meta-analysis of 141,220 screened individuals.

BACKGROUND: The precise age distribution and calculated stroke risk of screen-detected atrial fibrillation (AF) is not known. Therefore, it is not possible to determine the number needed to screen (NNS) to identify one treatable new AF case (NNS-Rx) (i.e., Class-1 oral anticoagulation [OAC] treatment recommendation) in each age stratum. If the NNS-Rx is known for each age stratum, precise cost-effectiveness and sensitivity simulations can be performed based on the age distribution of the population/region to be screened. Such calculations are required by national authorities and organisations responsible for health system budgets to determine the best age cutoffs for screening programs and decide whether programs of screening should be funded. Therefore, we aimed to determine the exact yield and calculated stroke-risk profile of screen-detected AF and NNS-Rx in 5-year age strata. METHODS AND FINDINGS: A systematic review of Medline, Pubmed, and Embase was performed (January 2007 to February 2018), and AF-SCREEN international collaboration members were contacted to identify additional studies. Twenty-four eligible studies were identified that performed a single time point screen for AF in a general ambulant population, including people ≥65 years. Authors from eligible studies were invited to collaborate and share patient-level data. Statistical analysis was performed using random effects logistic regression for AF detection rate, and Poisson regression modelling for CHA2DS2-VASc scores. Nineteen studies (14 countries from a mix of low- to middle- and high-income countries) collaborated, with 141,220 participants screened and 1,539 new AF cases. Pooled yield of screening was greater in males across all age strata. The age/sex-adjusted detection rate for screen-detected AF in ≥65-year-olds was 1.44% (95% CI, 1.13%-1.82%) and 0.41% (95% CI, 0.31%-0.53%) for <65-year-olds. New AF detection rate increased progressively with age from 0.34% (<60 years) to 2.73% (≥85 years). Neither the choice of screening methodology or device, the geographical region, nor the screening setting influenced the detection rate of AF. Mean CHA2DS2-VASc scores (n = 1,369) increased with age from 1.1 (<60 years) to 3.9 (≥85 years); 72% of ≥65 years had ≥1 additional stroke risk factor other than age/sex. All new AF ≥75 years and 66% between 65 and 74 years had a Class-1 OAC recommendation. The NNS-Rx is 83 for ≥65 years, 926 for 60-64 years; and 1,089 for <60 years. The main limitation of this study is there are insufficient data on sociodemographic variables of the populations and possible ascertainment biases to explain the variance in the samples. CONCLUSIONS: People with screen-detected AF are at elevated calculated stroke risk: above age 65, the majority have a Class-1 OAC recommendation for stroke prevention, and >70% have ≥1 additional stroke risk factor other than age/sex. Our data, based on the largest number of screen-detected AF collected to date, show the precise relationship between yield and estimated stroke risk profile with age, and strong dependence for NNS-RX on the age distribution of the population to be screened: essential information for precise cost-effectiveness calculations.

Suicide by crashing into a heavy vehicle: Focus on professional drivers using in-depth crash data.

Objective: Road traffic suicides typically involve a passenger car driver crashing his or her vehicle into a heavy vehicle, because death is almost certain due to the large mass difference between these vehicles. For the same reason, heavy-vehicle drivers typically suffer minor injuries, if any, and have thus received little attention in the research literature. In this study, we focused on heavy-vehicle drivers who were involved as the second party in road suicides in Finland. Methods: We analyzed 138 road suicides (2011-2016) involving a passenger car crashing into a heavy vehicle. We used in-depth road crash investigation data from the Finnish Crash Data Institute. Results: The results showed that all but 2 crashes were head-on collisions. Almost 30% of truck drivers were injured, but only a few suffered serious injuries. More than a quarter reported sick leave following their crash. Injury insurance compensation to heavy-vehicle drivers was just above €9,000 on average. Material damage to heavy vehicles was significant, with average insurance compensation paid being €70,500. Three out of 4 truck drivers reported that drivers committing suicide acted abruptly and left them little opportunity for preventive action. Conclusions: Suicides by crashing into heavy vehicles can have an impact on drivers' well-being; however, it is difficult to see how heavy-vehicle drivers could avoid a suicide attempt involving their vehicle.

The relationship between impact speed and the probability of pedestrian fatality during a vehicle-pedestrian crash: A systematic review and meta-analysis.

BACKGROUND: Pedestrians struck in motorised vehicle crashes constitute the largest group of traffic fatalities worldwide. Excessive speed is the primary contributory factor in such crashes. The relationship between estimated impact speed and the risk of a pedestrian fatality has generated much debate concerning what should be a safe maximum speed limit for vehicles in high pedestrian active areas. METHODS: Four electronic databases (MEDLINE, EMBASE, COMPENDEX, and SCOPUS) were searched to identify relevant studies. Records were assessed, and data retrieved independently by two authors in adherence with the PRISMA statement. The included studies reported data on pedestrian fatalities from motorised vehicle crashes with known estimated impact speed. Summary odds ratios (OR) were obtained using meta-regression models. Time trends and publication bias were assessed. RESULTS: Fifty-five studies were identified for a full-text assessment, 27 met inclusion criteria, and 20 were included in a meta-analysis. The analyses found that when the estimated impact speed increases by 1 km/h, the odds of a pedestrian fatality increases on average by 11% (OR = 1.11, 95% CI: 1.10-1.12). The risk of a fatality reaches 5% at an estimated impact speed of 30 km/h, 10% at 37 km/h, 50% at 59 km/h, 75% at 69 km/h and 90% at 80 km/h. Evidence of publication bias and time trend bias among included studies were found. CONCLUSIONS: The results of the meta-analysis support setting speed limits of 30-40 km/h for high pedestrian active areas. These speed limits are commonly used by best practice countries that have the lowest road fatality rates and that practice a Safe System Approach to road safety.

How much space do drivers provide when passing cyclists? Understanding the impact of motor vehicle and infrastructure characteristics on passing distance.

BACKGROUND: Understanding factors that influence the distance that drivers provide when passing cyclists is critical to reducing subjective risk and improving cycling participation. This study aimed to quantify passing distance and assess the impact of motor vehicle and road infrastructure characteristics on passing distance. METHODS: An on-road observational study was conducted in Victoria, Australia. Participants had a custom device installed on their bicycle and rode as per their usual cycling for one to two weeks. A hierarchical linear model was used to investigate the relationship between motor vehicle and infrastructure characteristics (location, presence of on-road marked bicycle lane and the presence of parked cars on the kerbside) and passing distance (defined as the lateral distance between the end of the bicycle handlebars and the passing motor vehicle). RESULTS: Sixty cyclists recorded 18,527 passing events over 422 trips. The median passing distance was 173 cm (Q1: 137 cm, Q3: 224 cm) and 1085 (5.9%) passing events were less than 100 cm. Relative to sedans, 4WDs had a reduced mean passing distance of 15 cm (Q1: 12 cm, Q3: 17 cm) and buses had a reduced mean passing distance of 28 cm (Q1: 16 cm, Q3: 40 cm). Relative to passing events that occurred on roads without a marked bicycle lane and without parked cars, passing events on roads with a bike lane with no parked cars had a reduced mean passing distance of 27 cm (Q1: 25 cm, Q3: 29 cm), and passing events on roads with a bike lane and parked cars had a mean lower passing distance of 40 cm (Q1: 37 cm, Q3: 43 cm). CONCLUSIONS: One in every 17 passing events was a close (<100 cm) passing event. We identified that on-road bicycle lanes and parked cars reduced passing distance. These data can be used to inform the selection and design of cycling-related infrastructure and road use with the aim of improving safety for cyclists.