Tackling Rugby injury: lessons learned from the implementation of a five-year sports injury prevention program.

Rugby Union football is a very popular sport in New Zealand but of all the major sports played in that country, it has the highest reported incidence of injury. In 1995, a national rugby injury prevention program was instigated to address this problem. Known as Tackling Rugby Injury, this multifaceted program was implemented over a five-year period. The program was based on the results of a prospective cohort study of rugby injury, known as the Rugby Injury and Performance Project (RIPP), and was organised around seven themes, five relating to the prevention of injury: coaching, fitness, injury management, tackling, and foul play, and two relating to the implementation and evaluation of the program. The purpose of this paper is to describe the lessons learned from the implementation of Tackling Rugby Injury. Qualitative research methods were used to describe the process of implementation, including informant interviews, participant observation, and the scrutiny of written, visual and archival material. Among the lessons learned were the importance of basing injury prevention strategies on scientific evidence rather than popular belief, the difficulty in implementing complex interventions, the advantages of a formal agreement between partners in the implementation of a program, the central role played by coaches in promoting injury prevention strategies, and the value of describing the process of implementation as well as monitoring injury outcomes and changes in knowledge, attitudes and behaviour. It is hoped that other sports wishing to develop injury prevention programs can learn from this experience.

Direct and indirect cost of general aviation crashes.

BACKGROUND: There have been few well-designed studies which estimate the costs inflicted on society from injuries, fatalities, and property damage caused by aviation crashes. Furthermore, indirect cost estimates from the human capital (HC) approach tend to be substantially smaller than those obtained from the willingness-to-pay (WTP) approach. OBJECTIVES: To estimate the direct and indirect costs of general aviation crashes in New Zealand, and to contrast the HC and WTP approaches used to estimate indirect costs. METHODS: The incidence, morbidity, and mortality from aviation crashes between 1988 and 1997 were estimated from national health and aviation records. Direct costs included medical treatment, damage to aircraft and property, and the cost of crash investigation. For the HC approach, we valued losses to society as the value of lost production from both employed work and household activity. For the WTP approach, we used the Land Transport Safety Authority's estimated values of society's willingness to pay to avoid a fatality or injury. RESULTS: The annual average direct cost of aviation crashes was $9.1 m (range: $8.0 m to $11.4 m). The annual average indirect cost using the HC approach was $13.6 m ($5.6 m to $32.2 m). Using the WTP approach the annual average indirect costs was $49.3 m ($20.6 m to $106.5 m). Indirect costs from premature deaths were the key cost drivers. A sensitivity analysis showed that these values were relatively robust to changes in parameters. CONCLUSION: The annual average cost of general aviation crashes in New Zealand was between $22.6 m and $58.4 m. Indirect costs using the WTP approach were 3.5 times greater than those estimated using the HC approach.

The effectiveness of screening and treating Helicobacter pylori in the management of dyspepsia.

AIMS: (1) To investigate the effects of a Helicobacter pylori screening and treatment strategy on open access endoscopy referral rates in dyspeptic patients aged < 40 years. (2) To determine the effectiveness of an H. pylori screening and treatment strategy, compared with endoscopy, in reducing dyspeptic symptoms, and in the utilization of dyspepsia related health care in general practice. SUBJECTS: Subjects were dyspeptic patients aged < 40 years, who were not taking NSAIDs and were without sinister symptoms. Patients were referred by their general practitioners. METHODS: The proportion of endoscopies carried out in patients aged < 40 years during the 5 years before the introduction of a screening and treatment strategy was compared with the proportion 2 years afterwards, as determined in a retrospective audit. Dyspepsia scores were obtained from unselected endoscopy patients and those who received a 13C-urea breath test (13C-UBT) at their initial visit and 6 months later. The number of visits made by patients with dyspepsia to their GPs, as well as the number of prescriptions given for antisecretory drugs, during the 6 months before attending for investigation were compared, in the same patient groups, with the same variables during the 6 months after the investigation. RESULTS: There was a 37% reduction in open access endoscopies performed in patients aged < 40 years (95% CI, 34-40%) following the introduction of the 13C-UBT service. Six months after attending the 13C-UBT service there was a significant fall in dyspepsia score (15.5 +/- 7.4 to 7.2 +/- 7.0, P < 0.0001), general practice dyspepsia consultations (2.0 +/- 1.3 to 1.0 +/- 1.7, P < 0.0001), H2 receptor antagonist prescription (14.2 +/- 32.6 tablets to 6.7 +/- 25.6 tablets, P = 0.006) but not proton pump inhibitor prescription (6.9 +/- 21.9 tablets to 7.2 +/- 27.6 tablets, P = 0.90). These changes were not significantly different from those found in the open access endoscopy control patients. CONCLUSIONS: An H. pylori screening and treatment strategy reduces the endoscopy workload in young dyspeptic patients. This strategy appears to be as effective as endoscopy in reducing dyspepsia symptoms, dyspepsia consultation rates and the prescribing of anti-secretory drugs.

Evaluating Tackling Rugby Injury: the pilot phase for monitoring injury.

OBJECTIVE: To assess the suitability of two previously unused data sources for monitoring rugby injury throughout New Zealand. METHOD: Interviews were conducted with respondents sampled from players registered with the Rugby Football Unions (RFUs) and players claiming for rugby injuries from the Accident Rehabilitation and Compensation Insurance Corporation (ACC) in Auckland and Dunedin. RESULTS: Of the 500 RFU players sampled, 63% were interviewed and of these 39 (12%) had been injured playing rugby union. Of the 456 ACC claimants sampled, 66% were interviewed and 265 (88%) had been injured playing rugby union. CONCLUSION: Identifying injured players through ACC claims was more efficient, both procedurally and because a smaller sample size was required to detect changes in incidence. IMPLICATIONS: With no routine surveillance of sports injury being undertaken, recording sporting codes in national injury surveillance systems would assist the monitoring of sports injury.

Incidence of death and hospitalization from assault occurring in and around licensed premises: a comparative analysis.

The aim of the research was to: determine the incidence of serious assault in and around licensed premises in New Zealand, and to compare the circumstances of assault with those that occurred in other locations. For the period 1978-87, inclusive, 49 assault fatalities occurred in or around licensed premises representing 9.4% of all homicides and 12.9% where a place was specified. The comparable figures for assaults resulting in hospitalization in 1988 were: 251, 10.2% and 18.4%, respectively. Further analyses suggests that our estimate of the incidence rate is likely to be an underestimate due to changes over time in the large number of assault cases which have no specific place of occurrence identified. In comparison with homes homicides in licensed premises were more likely to involve: males; Maori, unarmed fights and brawls; unknown assailants; alcohol; occur during the evening and toward the end of the week; and result in head injury. For non-fatal events similar differences were found. In comparison with homes non-fatal assaults were more likely to involve: males; young adults, Maori, the unemployed, unarmed fights and brawls, and head injury. There have been a number of significant policy changes in New Zealand since 1988 which may have resulted in a change to the situation reported here.

Need for victimization screening in a black psychiatric population.

Recent reports indicate that violence toward others is a major public health problem in the black community; however, there are very few empirical studies that delineate the severity of the problem. In an effort to add to the meager data on violence in the black community, the authors compiled the results of a victimization screening form obtained from a black outpatient psychiatric population. Recommendations are made that black psychiatric populations be screened for histories of victimization, as victimization is common in this population group and will have a significant impact on treatment.