Translation and Impact of Funded Australian Cardiovascular Research: A Review With Perspective.

This aim of this paper is to set the scene for the need for impact assessment and return on investment in funded cardiovascular research in Australia, starting with the historical perspective on waste in health and medical research. Recently there has been a substantial move from discussion and policy about the need for research translation, into practice and application via the evolution of funding streams like the Australian Medical Research Future Fund (MRFF). Health and medical research funders play a critical role in both setting the expectations for research translation and impact and helping researchers to meet these expectations. As a leading cause of death, cardiovascular disease is a national health priority, recognised as such with a AUD$220 million MRFF allocation to the Cardiovascular Health Mission. Focussing on cardiovascular research, we address some of the barriers researchers face in prospectively planning for research translation and impact assessment, and call for an ecosystem that supports a return on investment for all stakeholders, especially the community and patient end-users.

Vision screening in preschoolers: the New South Wales Statewide Eyesight Preschooler Screening program.

OBJECTIVE: To evaluate screening and diagnostic outcomes of the New South Wales Statewide Eyesight Preschooler Screening (StEPS) program, a state-funded, universal vision screening program for 4-year-old children. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional evaluation of the StEPS program, in which eligible 4-year-old children were offered a vision screen in local health districts in NSW, between 1 July 2010 and 30 June 2011. MAIN OUTCOME MEASURES: Number and proportion of eligible children who were offered screening; accepted screening; were screened and scored a pass or were referred (routinely or urgently) for further vision assessment; and were referred for further assessment and required intervention. RESULTS: Of 91 324 eligible 4-year-olds in NSW, 80 328 (88.0%) were offered screening, and 65 834 (72.1% of the eligible population) were screened. Of the children who were screened, 3867 (5.9%) scored less than 6/9-2 but better than 6/18 in one or both eyes and were referred to their general practitioner or eye health professional for further vision assessment. A further 1425 children (2.2%) scored 6/18 or less in one or both eyes and were referred for high-priority assessment. In the two local health districts with the most complete follow-up data, 704 of 779 children (90.4%) with routine referrals and 278 of 285 (97.5%) with high-priority referrals required treatment or review at a later date. CONCLUSIONS: The StEPS program has achieved a high screening participation rate in NSW. Many children have been diagnosed and received treatment for previously undetected serious vision disorders that may otherwise have been diagnosed too late for effective intervention.

Marijuana use and car crash injury.

AIMS: To investigate the relationship between marijuana use prior to driving, habitual marijuana use and car crash injury. DESIGN AND SETTING: Population based case-control study in Auckland, New Zealand. PARTICIPANTS: Case vehicles were all cars involved in crashes in which at least one occupant was hospitalized or killed anywhere in the Auckland region, and control vehicles were a random sample of cars driving on Auckland roads. The drivers of 571 case and 588 control vehicles completed a structured interview. MEASUREMENTS: Self reported marijuana use in the 3 hours prior to the crash/survey and habitual marijuana use over the previous 12 months were recorded, along with a range of other variables potentially related to crash risk. The main outcome measure was hospitalization or death of a vehicle occupant due to car crash injury. FINDINGS: Acute marijuana use was significantly associated with car crash injury, after controlling for the confounders age, gender, ethnicity, education level, passenger carriage, driving exposure and time of day (OR 3.9, 95% CI 1.2-12.9). However, after adjustment for these confounders plus other risky driving at the time of the crash (blood alcohol concentration, seat-belt use, travelling speed and sleepiness score), the effect of acute marijuana intake was no longer significant (OR 0.8, 95% CI 0.2-3.3). There was a strong significant association between habitual use and car crash injury after adjustment for all the above confounders plus acute use prior to driving (OR 9.5, 95% CI 2.8-32.3). CONCLUSIONS: This population-based case-control study indicates that habitual use of marijuana is strongly associated with car crash injury. The nature of the relationship between marijuana use and risk-taking is unclear and needs further research. The prevalence of marijuana use in this driving population was low, and acute use was associated with habitual marijuana use, suggesting that intervention strategies may be more effective if they are targeted towards high use groups.

Risky driving habits and motor vehicle driver injury.

Risky driving is an important cause of motor vehicle injury, but there is a lack of good epidemiological data in this field, particularly data comparing risky driving in younger drivers to those of other age groups. We examined the relationship between risky driving habits, prior traffic convictions and motor vehicle injury using cross-sectional data amongst 21,893 individuals in New Zealand, including 8029 who were aged 16-24 years. Those who reported frequently racing a motor vehicle for excitement or driving at 20 km/h or more over the speed limit, and those who had received traffic convictions over the past 12 months, were between two and four times more likely to have been injured while driving over the same time period. Driving unlicensed was a risk factor for older but not younger drivers, and driving at 20 km/h or more above the speed limits was a stronger risk factor for younger (<25 years) than older drivers. These results confirm the need for interventions targeting risky driving and suggest that different strategies may be required for different high-risk groups.

Seatbelt non-use and car crash injury: an interview study.

OBJECTIVES: To examine the relationship between seatbelt non-use at the time of a crash, habitual non-use of seatbelts, and car crash injury; and to calculate the population attributable risk for car crash injury due to seatbelt non-use. METHODS: A population-based case control, interview study in Auckland, New Zealand, with 571 injured or killed drivers as cases and 588 population-based controls randomly selected from the driving population. RESULTS: Unbelted drivers had 10 times the risk of involvement in an injury crash compared to belted drivers after adjustment for multiple confounders. Habitual non-users were likely to be unbelted when involved in a crash. The population attributable risk for seatbelt non-use was 13%. CONCLUSIONS: Non-use of seatbelts is very strongly associated with increased injury crash involvement. Even where seatbelt use rates are higher than 90%, there remains a small group of habitual non-users who are at high risk; these drivers may benefit from targeted interventions.

Unlicensed drivers and car crash injury.

OBJECTIVE: Previous studies have indicated that unlicensed drivers are more likely to engage in risky driving behaviors, and are more likely than licensed drivers to be at fault and more seriously injured when involved in a crash. However, the prevalence of unlicensed drivers in the general driving population has not been measured, and the risk of an unlicensed driver being involved in an injury crash has not been quantified. We examined the association between unlicensed driving and car crash injury using data from a population-based case control study. METHODS: The study population was the drivers of all cars on public roads in the Auckland region. Cases were 571 vehicles involved in a crash resulting in any occupant being hospitalised or killed, from the study base, during the recruitment period. Controls were 588 vehicles selected from the driving population using a random cluster sampling method. The drivers of all vehicles completed a structured interview covering multiple potentially crash-related factors. RESULTS: Driving unlicensed was reported by 12% of case and 1% of control drivers. Unlicensed drivers were at significantly higher risk of car crash injury than those holding a valid licence (odds ratio 11.1, 95% confidence interval 4.2 to 29.7) after adjustment for age and sex. After further adjustment for education level, ethnicity, driving exposure, time of day, sleepiness score, year of vehicle manufacture, passenger carriage, seatbelt use, blood alcohol concentration, and travelling speed at time of crash, the increased risk was still present but no longer significant (OR 3.9, 95% CI 0.7-22.4). CONCLUSIONS: Unlicensed drivers are a high risk group for car crash injury after taking other crash-related risk factors into account. Strategies to reduce unlicensed driving may therefore facilitate reductions in road crashes, although further work is needed in this area.

Does periodic vehicle inspection reduce car crash injury? Evidence from the Auckland Car Crash Injury Study.

OBJECTIVES: This paper examines the association between periodic motor vehicle inspection and frequent tire pressure checks, and the risk of car crash injury. METHODS: Data were analysed from the Auckland Car Crash Injury Study, a population-based case-control study in Auckland, NZ, where vehicles are required to undergo six-monthly safety inspections. Cases were all cars involved in crashes in which at least one occupant was hospitalised or killed, which represented 571 drivers. Controls were randomly selected cars on Auckland roads (588 drivers). Participants completed a structured interview. RESULTS: Vehicles that did not have a current certificate of inspection had significantly greater odds of being involved in a crash where someone was injured or killed compared with cars that had a current certificate, after adjustment for age, sex, marijuana use, ethnicity and licence type (OR 3.08, 95% CI 1.87-5.05). Vehicles that had not had their tire pressure checked within the past three months also had significantly greater odds of being involved in a crash compared with those that had a tire pressure check, after adjustment for age, sex, ethnicity, seatbelt use, licence type, self-reported speed and hours per week of driving exposure (OR 1.89, 95% CI 1.16-3.08). CONCLUSIONS: This study provides new evidence, using rigorous epidemiological methods and controlling for multiple confounding variables, of an association between periodic vehicle inspections and three-monthly tire pressure checks and reduced risk of car crash injury. DISCUSSION: This research suggests that vehicle inspection programs should be continued where they already exist and contributes evidence in support of introducing such programs to other areas.

Car insurance and the risk of car crash injury.

Despite speculation about the role of vehicle insurance in road traffic accidents, there is little research estimating the direction or extent of the risk relationship. Data from the Auckland Car Crash Injury Study (1998-1999) were used to examine the association between driving an uninsured motor vehicle and car crash injury. Cases were all cars involved in crashes in which at least one occupant was hospitalized or killed anywhere in the Auckland region. Controls were 588 drivers of randomly selected cars on Auckland roads. Participants completed a structured interview. Uninsured drivers had significantly greater odds of car crash injury compared to insured drivers after adjustment for age, sex, level of education, and driving exposure (odds ratio 4.77, 95% confidence interval 2.94-7.75). The causal mechanism for insurance and car crash injury is not easily determined. Although we examined the effects of multiple potential confounders in our analysis including socioeconomic status and risk-taking behaviours, both of which have been previously observed to be associated with both insurance status and car crash injury, residual confounding may partly explain this association. The estimated proportion of drivers who are uninsured is between 5 and 15% in developed countries, representing a significant public health problem worthy of further investigation.