Adjusting vehicle secondary safety ratings to account for crash-avoidance technology fitment using real-world crash and injury data.

OBJECTIVES: Publicizing safety ratings of vehicles can motivate manufacturers to prioritize safety and help consumers choose safer vehicles, leading to safer fleets. The benefits of primary safety technologies that prevent crash occurrence are not currently incorporated in current ratings in a way that values their safety benefits consistently. We aimed to propose a method for assigning weights for each safety technology to account for established safety benefits using published effectiveness and prevalence from real-life data. METHODS: To illustrate this method, we present a worked example calculated using crash and injury data from Australia and New Zealand. The method proposed attenuates the weights for given safety technologies where two or more safety technologies fitted to the same vehicle are effective for the same types of crashes. RESULTS: In the worked example using Australasian data, large SUVs were estimated to have the largest safety increment from the fitment of all the technologies considered compared to vehicles without these primary safety technologies, with an almost 17% reduction in crash occurrence. Cars with all the technologies fitted had estimated average crash reduction of between 11% and 12%. CONCLUSIONS: Different market groups have different crash patterns, so the safety attributable to safety technology fitment differs at the market group level. This study presents an approach for providing a summary measure of crash avoidance according to the fitment of safety technologies. If this measure is combined with an estimate of secondary safety (whether derived from existing crash and injury data or from new car crash assessment programs), the combined estimate then represents the important elements of safety provided by the vehicle. The methods presented here form a rational basis for assigning safety ratings to represent the benefits of swiftly developing safety technologies.

Personality, perceptions and behavior: A study of speeding amongst drivers in Victoria, Australia.

INTRODUCTION: Road crashes present a serious public health issue. Many people are seriously or fatally injured every year in avoidable crashes. While these crashes can have multiple contributing factors, including road design and condition, vehicle design and condition, the environment and human error, the performance of illegal driving behavior, including speeding, may also play a role. The current study aimed to examine the mediating influence that four potential deterrents (perceptions towards enforcement, crash risk, social norms and disapproval, and negative personal/emotional affect) have between the Big Five personality traits (conscientiousness; extraversion; agreeableness; neuroticism; openness) and expectations to speed. METHODS: A total of 5,108 drivers in Victoria, Australia completed an online survey in 2019. A mediated regression analysis was used to examine pathways in a conceptual model developed for the study. RESULTS: The results showed that perceptions towards the four potential deterrents examined did mediate the relationship (either completely or partially) between personality and expectations to speed. CONCLUSIONS: The results of this study suggest that if interventions to deter illegal driving behavior are to be successful, one factor that could be taken into account is the personality traits of drivers who may be at greatest risk of the performance of illegal driving behaviors.

Evaluation of the effectiveness of daytime running lights (DRLs).

INTRODUCTION: Many studies have found that daytime running lights (DRLS) are effective in reducing daytime multi-vehicle crashes. From an Australian perspective, while studies exist using data from other jurisdictions, there has been uncertainty about how effective DRLs would be under Australian environmental conditions, which can differ from other parts of the world. In addition, in recent years DRLs have become a standard feature of many new vehicles. The objective of this work was to utilize Australian crash data to estimate the impact of DRLs on casualty crash risk reflecting the Australian crash population and local conditions. It also aimed to broadly examine the real-world crash-based effectiveness of DRLs currently present in the light vehicle fleet. METHOD: The study utilized police reported casualty crash data for crashes that occurred during 2010-2017. The analysis used induced exposure methods, which offers the potential to assess the relationship between crash risk and DRL fitment by intrinsically controlling for confounding factors. RESULTS: It was found that DRL fitment can reduce the overall risk of being involved in a non-nighttime multi-vehicle crash where vehicle visibility may be a factor in crash causation by a statistically significant 8.8%. Estimated crash reductions were higher at dawn or dusk and in higher speed zones. CONCLUSION: Results provide clear evidence that mandating DRLs on all new vehicles would likely lead to reductions in the overall crash risk of the fleet through accelerating fitment through the fleet. PRACTICAL APPLICATION: DRL fitment can reduce the overall risk of being involved in a non-night-time multi-vehicle crash where vehicle visibility may be a factor in crash causation. Governments should consider a DRL mandate on all new vehicle models, including all variants to accelerate the process of fitment through the fleet. This would likely lead to reductions in the overall crash risk of the fleet.

Elite Junior Australian Football Players With Impaired Wellness Are at Increased Injury Risk at High Loads.

BACKGROUND: Elite junior Australian football players experience high training loads across levels of competition and training. This, in conjunction with impaired wellness, can predispose athletes to injury. HYPOTHESIS: Elite junior Australian football players exposed to high loads with poor wellness are more likely to be at risk of injury than those with improved wellness. STUDY DESIGN: Longitudinal prospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Data were collected and analyzed from 280 players across the 2014 season. Internal load was measured via session rating of perceived exertion. Player wellness was reported according to ratings of sleep quality, fatigue, soreness, stress, and mood. Week- and month-based training load measures were calculated, representing a combination of absolute and relative load variables. Principal component analysis factor loadings, based on 17 load and wellness variables, were used to calculate summed variable covariates. Injury was defined as "any injury leading to a missed training session or competitive match." Associations between covariates and injury risk (yes/no) were determined via logistic generalized estimating equations. RESULTS: A significant interaction term between load and wellness on injury was found [odds ratio (OR) 0.76; 95% CI 0.62-0.92; P < 0.01), indicating that wellness acts as a "dimmer switch" of load on injury. Further, there was evidence of moderated mediation (OR 0.71; 95% CI 0.57-0.87; P < 0.01). When wellness was low, injury risk started to increase substantially at a 1-week load of 3250 au. CONCLUSIONS: Subjective measures of training load are associated with injury risk through a nonlinear relationship. This relationship is further influenced by player wellness, which can amplify the risk of injury. There is evidence that higher stress is linked with injury and that soreness and sleep mediate any stress-injury relationship. CLINICAL RELEVANCE: Coaching efforts to manage training load and player adaptive responses, including wellness, may reduce the risk of injury, with stress, soreness, and sleep particularly relevant at this level.

Quantifying the Foregone Benefits of Intelligent Speed Assist Due to the Limited Availability of Speed Signs across Three Australian States.

By being able to communicate the speed limit to drivers using speed sign recognition cameras, Intelligent Speed Assist (ISA) is expected to bring significant road safety gains through increased speed compliance. In the absence of complete digital speed maps and due to limited cellular connectivity throughout Australia, this study estimated the forgone savings of ISA in the event that speed signs are solely relied upon for optimal advisory ISA function. First, speed-related fatalities and serious injuries (FSI) in the Australian states of Victoria, South Australia, and Queensland (2013-2018) were identified, and published effectiveness estimates of ISA were applied to determine the potential benefits of ISA. Subsequently, taking into account speed sign presence across the three states, the forgone savings of ISA were estimated as FSI that would not be prevented due to absent speed signage. Annually, 27-35% of speed-related FSI in each state are unlikely to be prevented by ISA because speed sign infrastructure is absent, equating to economic losses of between AUD 62 and 153 million. Despite a number of assumptions being made regarding ISA fitment and driver acceptance of the technology, conservative estimates suggest that the benefits of speed signs placed consistently across road classes and remoteness levels would far outweigh the costs expected from the absence of speed signs. The development and utilisation of a methodology for estimating the foregone benefits of ISA due to suboptimal road infrastructure constitutes a novel contribution to research. This work provides a means of identifying where infrastructure investments should be targeted to capitalise on benefits offered by advanced driver assist technologies.

Evaluation of the effectiveness of vehicle roll stability control (RSC) for high center of gravity light passenger vehicles in Australasia.

OBJECTIVE: Rollover crashes, which occur when the vehicle's side or roof makes impact with the ground, present particularly serious injury risk. Higher rollover risk has been found for high riding vehicles - those with a relatively high center of gravity compared to the width of the wheel track. Electronic Stability Control (ESC), which automatically applies brakes to individual wheels and reduces engine power to help drivers regain control when traction is lost, has been shown to be effective in preventing a proportion of rollovers. A newer safety technology, Roll Stability Control (RSC), uses similar technology aimed specifically to reduce rollover risk. This study sought to estimate rollover crash rates associated with the fitment of RSC compared to non-fitment for high center of gravity (CG) light passenger vehicles using an induced exposure analysis. METHODS: Police-recorded Australasian crash data were studied for the years 2008-2017. A quasi-induced exposure analysis was restricted to vehicles already equipped with ESC as vehicles fitted with RSC always have ESC fitted. Rollover risk associated with RSC fitment was assessed, controlling for year of crash, speed limit at crash location, year of vehicle manufacture, vehicle market group, driver age, driver gender and jurisdiction identifier. RESULTS: The analysis found a statistically significant rollover risk ratio of 0.76 (95% CI 0.62-0.93), representing a 24% reduction in rollover risk, associated with RSC fitment for vehicles manufactured between 2008 and 2017. Analysis by particular market groups found significant risk ratio reductions for commercial utilities and large SUVs, but not for the other high CG market groups individually. CONCLUSIONS: These results suggest that RSC is a highly effective safety feature for high CG vehicles. Fleet data from Australia and New Zealand showed declining rates of RSC fitment over recent years for SUVs, meaning the potential road safety benefits of the technology are not being fully realized.

Australian Injury Comorbidity Indices (AICIs) to predict burden and readmission among hospital-admitted injury patients.

BACKGROUND: Existing comorbidity measures predict mortality among general patient populations. Due to the lack of outcome specific and patient-group specific measures, the existing indices are also applied to non-mortality outcomes in injury epidemiology. This study derived indices to capture the association between comorbidity, and burden and readmission outcomes for injury populations. METHODS: Injury-related hospital admissions data from July 2012 to June 2014 (161,334 patients) for the state of Victoria, Australia were analyzed. Various multivariable regression models were run and results used to derive both binary and weighted indices that quantify the association between comorbidities and length of stay (LOS), hospital costs and readmissions. The new and existing indices were validated internally among patient subgroups, and externally using data from the states of New South Wales and Western Australia. RESULTS: Twenty-four comorbidities were significantly associated with overnight stay, twenty-seven with LOS, twenty-eight with costs, ten with all-cause and eleven with non-planned 30-day readmissions. The number of and types of comorbidities, and their relative impact were different to the associations established with the existing Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Measure (ECM). The new indices performed equally well to the long-listed ECM and in certain instances outperformed the CCI. CONCLUSIONS: The more parsimonious, up to date, outcome and patient-specific indices presented in this study are better suited for use in present injury epidemiology. Their use can be trialed by hospital administrations in resource allocation models and patient classification models in clinical settings.

Retrospective evaluation of vehicle whiplash-reducing head restraint systems to prevent whiplash injury in Victoria, Australia.

Head restraint systems specifically engineered to reduce the impact of whiplash injury in the event of a rear-end collision were introduced in the late 1990s with the aim of reducing whiplash injury risk that went 'beyond simple geometric improvements' to head restraints. Whilst studies have shown that whiplash-reducing head restraint systems are highly effective in reducing whiplash injury, these were based on a limited range of systems including Toyota's Whiplash Injury Lessening (WIL) seating system, Volvo's Whiplash Injury Prevention System (WHIPS) and the Saab Active Head Restraint (SAHR) and have generally focussed on Swedish crash and insurance data. However, there has been no broad real-world crash-based evaluation of the effectiveness of whiplash-reducing head restraint systems currently present in the vehicle fleet that validates the results of these studies in other populations. The objective of this study was to undertake a retrospective evaluation of vehicle whiplash-reducing head restraint systems to prevent whiplash injury using real-world crash data linked to insurance claims data in Victoria, Australia. It was found that whiplash-reducing head restraint systems are associated with a statistically significant reduction in the odds of driver and front seat passenger whiplash injury in a vehicle struck in a rear-end collision of 11.6 % (95 % CI 0.20 %, 21.6 %). The results indicate that whiplash-reducing head restraint systems are an effective technology for reducing the risk of whiplash injury to drivers and front seat passengers in a vehicle struck in a rear-end collision. Considering that around a quarter of all casualty crashes involving passenger and light commercial vehicles are rear-end, the fitment of whiplash-reducing head restraint systems to all vehicles as a standard safety feature would likely see a significant reduction in the incidence of whiplash injury.

Traffic offending and deterrence: An examination of recidivism amongst drivers in Victoria, Australia born prior to 1975.

To deter the performance of illegal driving behaviours, traffic infringement notices may be issued. Whilst there is a substantial body of research that has examined rates of reoffending following a traffic infringement, there have been few studies examining the length of time to next traffic offence. Where this research has been conducted, the findings do not provide current understandings, given the substantial changes in traffic sanctioning over time. The aim of this study was to address this gap, by examining risk factors for recidivism following a driver receiving a traffic infringement notice, as well as the time to next traffic offence. Licensing and infringements data held in the Driver Licensing System (DLS), maintained by the road authority in Victoria, Australia were used. All drivers included in the study were born prior to 1975, and received their first Victorian drivers licence between 1994 and 2016. Data from 203,620 drivers were used. Cox proportional hazards modelling was undertaken to examine factors associated with recidivism within 12 months of receiving a traffic infringement. 131,691 (64.7%) drivers had received at least one traffic infringement in Victoria, Australia since receiving their Victorian driver's licence. Factors found to be associated with longer time to further traffic offending in the year that followed the first infringement included being female; receiving a first Victorian driver's licence when aged 45+ years; and being licenced 10+ years. Traffic infringements deter some groups of Victorian drivers, but not others. If drivers are to be deterred from further illegal driving behaviour, it is important other countermeasures are developed and trialled.

The Australian Injury Comorbidity Indices (AICIs) to predict in-hospital complications: A population-based data linkage study.

BACKGROUND: Hospital-admitted patients are at risk of experiencing certain adverse outcomes during their hospital-stay. Patients may need to be admitted to the intensive care unit or be placed on the ventilator while there is also a possibility for complications to develop. Pre-existing comorbidity could increase the risk of these outcomes. The Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Measure (ECM), originally derived for mortality outcomes among general medical populations, are widely used for assessing these in-hospital complications even among specific injury populations. This study derived indices to specifically capture the effect of comorbidity on intensive care unit and ventilator use as well as hospital-acquired complications for injury patients. METHODS: Retrospective data on injury hospital-admissions from July 2012 to June 2014 (161,334 patients) for the state of Victoria, Australia was analysed. Results from multivariable regression analysis were used to derive the Australian Injury Comorbidity Indices (AICIs) for intensive care unit and ventilator hours and hospital-acquired complications. The AICIs, CCI and ECM were validated on data from Victoria and two other Australian states. RESULTS: Five comorbidities were significantly associated with intensive care unit hours, two with ventilator hours and fifteen with hospital-acquired complications for hospitalised injury patients. Not all diseases listed in the CCI or ECM were found to be associated with these outcomes. The AICIs performed equally well in terms of predictive ability to the long-listed ECM and in most instances outperformed the CCI. CONCLUSIONS: Associations between outcomes and comorbidities vary based on the type of outcome measure. The new comorbidity indices developed in this study provide a relevant, parsimonious and up-to-date method to capture the effect of comorbidity on in-hospital complications among admitted injury patients and is better suited for use in that context compared to the CCI and ECM.

The Australian Injury Comorbidity Index to Predict Mortality.

STUDY OBJECTIVE: Existing comorbidity indices such as the Charlson comorbidity index are dated yet still widely used. This study derives and validates up-to-date comorbidity indices for hospital-admitted injury patients, specific to mortality outcomes. METHODS: Injury-related hospital admissions data for 2 cohorts of patients in the Australian state of Victoria were linked to mortality data: July 2012 to June 2014 (161,334 patients) and July 2006 to June 2015 (614,762 patients). Logistic regression models were fitted, and results were used to derive binary and weighted comorbidity indices to predict mortality outcomes. The indices were validated with data from New South Wales (Australia). RESULTS: There were 11 comorbidity groups identified as associated with inhospital death (cohort 1), 13 with 30-day mortality, and 19 with 1-year mortality (cohort 2). The newly derived weights for comorbidities were very different from the Charlson comorbidity index weights for some conditions. The area under the curve statistics for inhospital death, 30-day mortality, and 1-year mortality were similar for the newly derived binary comorbidity indices (0.920, 0.923, and 0.910, respectively), the Charlson comorbidity index (0.915, 0.919, and 0.906, respectively), and the Elixhauser comorbidity measure (0.924, 0.923, and 0.908, respectively). The false-negative rates for the new binary indices (15.8%, 15.8%, and 16.3%, respectively) were statistically equal to those of the Charlson comorbidity index (17.4%, 16.3%, and 16.5%, respectively) and the Elixhauser comorbidity measure (15.2%, 14.8%, and 16.3%, respectively). CONCLUSION: The newly derived Australian Injury Comorbidity Indices, which are a binary representation of individual conditions associated with the outcome of interest, are useful in quantifying the effect of comorbidity among injury patients. They include a shorter list of conditions than existing indices such as the Charlson comorbidity index and Elixhauser comorbidity measure, are up to date, and consider the individual association of each condition over a summed score such as the Charlson comorbidity index. Indices that quantify the effect of comorbidities should consider the population, disease prevalence, and outcome of interest and require periodic updating.

Identifying Typologies of Persons Who Died by Suicide: Characterizing Suicide in Victoria, Australia.

The objective of the study was to determine whether people who died by suicide form groups based on demographic, psychosocial, mental and physical health factors and exposure to stressors. A retrospective case series review of 2,839 individuals who died by suicide in Victoria, Australia over the period 2009-2013 was conducted. A two-stage cluster analysis was performed. Diagnosis of mental illness was present in 52% of cases and initial cluster analysis determined two groups with the main predictor of group membership being the presence of diagnosed mental illness. Further analysis identified four subgroups within the mental illness group and two within the non-mental illness group. The study demonstrates that suicide does not always occur in the context of mental illness; people who die by suicide cannot be considered a homogenous group.

Absolute and Relative Load and Injury in Elite Junior Australian Football Players Over 1 Season.

PURPOSE: To investigate the association between training and match loads and injury in elite junior Australian football players over 1 competitive season. METHODS: Elite junior Australian football players (n = 290, age 17.7 [0.3] y, range 16-18 y) were recruited from the under-18 state league competition in Victoria to report load and injury information. One-week load (session rating of perceived exertion multiplied by duration) and all time-loss injuries were reported using an online sport-injury surveillance system. Absolute load measures (weekly sums) enabled the calculation of relative measures such as the acute:chronic workload ratio. Load measures were modeled against injury outcome (yes/no) using a generalized estimating equation approach, with a 1-wk lag for injury. RESULTS: Low (<300 arbitrary units [au]) and high (>4650 au) 1-wk loads were associated with significantly higher risk of injury. Furthermore, low (<100 au) and high (>850 au) session loads were associated with a higher risk of injury. High strain values (>13,000) were associated with up to a 5-fold increase in the odds of injury. There was a relatively flat-line association between the acute:chronic workload ratio and injury. CONCLUSIONS: This study is the first investigation of elite junior athletes demonstrating linear and nonlinear relationships between absolute and relative load measures and injury. Coaches should focus player loads on, or at least close to, the point at which injury risk starts to increase again (2214 au for 1-wk load and 458 au for session load) and use evidence-based strategies across the week and month to help reduce the risk of injury.

Pathways to Suicide Among People With a Diagnosed Mental Illness in Victoria, Australia.

Background: People who have mental illness are at increased risk of suicide. Therefore, identifying "typical" trajectories to suicide in this population has the potential to improve the effectiveness of suicide prevention strategies. Aim: The aim of this study was to explore the pathways to suicide among a sample of Victorians with a diagnosed mental illness. Method: Victorian Suicide Register (VSR) data were used to generate life charts and identify typical life trajectories to suicide among 50 Victorians. Results: Two distinct pathways to suicide were identified: (1) where diagnosis of mental illness appeared to follow life events/stressors; and (2) where diagnosis appeared to precede exposure to life events/stressors. Some events acted as distal factors related to suicide, other events were more common as proximal factors, and still others appeared to act as both distal and proximal factors. Limitations: The data source might be biased because of the potential for incomplete information, or alternatively, the importance of some factors in a person's life may have been overstated. Conclusion: Strategies to reduce suicide need to consider the chronology of exposure to stressors in people's lives and clearly need to be different depending on whether proximal or distal risk factors are the target of a given strategy or intervention.

Effect of comorbidity on injury outcomes: a review of existing indices.

PURPOSE: Accounting for comorbidity in predicting outcomes for patients is vital in clinical care, epidemiological research, and health service planning. The aim of this study was to review published literature to compare the performance of existing comorbidity indices and their use in injury populations. METHODS: A thematic literature search for comorbidity indices and/or injury outcomes was conducted. Methods, results, and recommendations from selected articles were abstracted, documented, and compared; comparisons of results were made in terms of the indices' ability to predict outcomes, using the C-statistic, R2, and odds ratios. RESULTS: Fifty-two articles relating to the derivation and/or validation of comorbidity measures were found. The most commonly used measures were the Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Measure (ECM). The ECM was found to outperform the CCI in terms of predictive ability, although the CCI was more widely used. Derivation of study-specific weights to the CCI added more predictive power to the index. CONCLUSIONS: Existing literature that compared the predictive abilities of the ECM and CCI favors the ECM. This literature review did not identify a measure specifically designed for general injury populations. Development of an injury-specific comorbidity measure will be timely and assist future research in injury epidemiology.

Complications, burden and in-hospital death among hospital treated injury patients in Victoria, Australia: a data linkage study.

BACKGROUND: A wide range of outcome measures can be calculated for hospital-treated injury patients. These include mortality, use of critical care services, complications, length of stay, treatment costs, readmission and nursing care after discharge. Each address different aspects and phases of injury recovery and can yield vastly different results. This study aims to: (1) measure and report this range of outcomes in hospital-treated injury patients in a defined population; and (2) describe the associations between injury characteristics, socio-demographics and comorbidities and the various outcomes. METHODS: A retrospective analysis was conducted of injury-related hospital admissions from July 2012 to June 2014 (152,835 patients) in Victoria, Australia. The admission records were linked within the dataset, enabling follow-up, to assess the outcomes of in-hospital death, burden, complications and 30-day readmissions. Associations between factors and outcomes were determined using univariate regression analysis. RESULTS: The proportion of patients who died in hospital was 0.9%, while 26.8% needed post-discharge care. On average patients had 2.4 complications (confidence interval (CI) 2.4-2.5) related to their initial injury, the mean cost of treating a patient was Australian dollars 7013 (CI 6929-7096) and the median length of stay was one day (inter quartile range 1-3). Intensive-care-unit-stay was recorded in 3% of the patients. All-cause 30-day readmissions occurred in 12.3%, non-planned 30-day readmissions in 7.9%, while potentially avoidable 30-day readmissions were observed in 3.2% of the patients. Increasing age was associated with all outcomes. The need for care post-discharge from hospital was highest among children and the oldest age group (85 years and over). Injury severity was associated with all adverse outcomes. Increasing number of comorbidities increased the likelihood of all outcomes. Overall, outcomes are shown to differ by age, gender, comorbidities, body region injured, injury type and injury severity, and to a lesser extent by socio-economic areas. CONCLUSIONS: Outcomes and risk factors differ depending on the outcome measured, and the method used for measuring the outcome. Similar outcomes measured in different ways produces varying results. Data linkage has provided a valuable platform for a comprehensive overview of outcomes, which can help design and target secondary and tertiary preventive measures.

Relative risk of suicide following exposure to recent stressors, Victoria, Australia.

OBJECTIVE: This study aimed to identify stressors over-represented in the 12 months prior to death among 553 Victorian adults who died by suicide. METHODS: Age- and sex-specific suicide rates and relative risks of suicide were calculated using numerator data on suicides occurring in 2013 by people with a given exposure sourced from the Victorian Suicide Register and denominator data on the total Victorian population with that exposure sourced from the 2014 Australian Bureau of Statistics General Social Survey. RESULTS: Mental illness was associated with increased suicide risk among people of all age groups and both sexes. Alcohol and/or other drug problems were associated with increased risk for males and females of all ages, with the exceptions of the oldest males and females, and the youngest females. Trouble with the police was associated with increased risk among all but the oldest males, whereas among females it was associated with elevated risk in those aged 25-44 years and 65+ years. Conclusions and Implications for public health: Males experiencing mental illness and alcohol and other drug problems should be a particular priority for suicide prevention initiatives but people exposed to other stressors such as contact with the police and divorce/relationship separation also warrant attention.

Crash characteristics of on-road single-bicycle crashes: an under-recognised problem.

Compared with crashes with motor vehicles, single-bicycle crashes are an under-recognised contributor to cycling injury and the aetiology is poorly understood. Using an in-depth crash investigation technique, this study describes the crash characteristics and patient outcomes of a sample of cyclists admitted to hospital following on-road bicycle crashes. Enrolled cyclists completed a structured interview, and injury details and patient outcomes were extracted from trauma registries. Single-bicycle crashes (n=62) accounted for 48% of on-road crashes and commonly involved experienced cyclists. Common single-bicycle crash types included loss-of-control events, interactions with tram tracks, striking potholes or objects or resulting from mechanical issues with the bicycle. To address single-bicycle crashes, targeted countermeasures are required for each of these specific crash types.

Differences in Characteristics and Exposure to Stressors Between Persons With and Without Diagnosed Mental Illness Who Died by Suicide in Victoria, Australia.

Background: Mental illness is an established risk factor for suicide. To develop effective prevention interventions and strategies, the demographic characteristics and stressors (other than, or in addition to, mental illness) that can influence a person's decision to die by suicide need to be identified. Aim: To examine cases of suicide by the presence or absence of a diagnosed mental illness (mental illness status) to identify differences in factors associated with suicide in the groups. Method: Logistic regression analyses were used to investigate mental illness status and exposure to stressors among 2,839 persons who died by suicide in Victoria, Australia (2009-2013), using the Victorian Suicide Register. Results: Females, metropolitan residents, persons treated for physical illness/injury, those exposed to stressors related to isolation, family, work, education, and substance use and those who had made a previous suicide attempt had increased odds of having a diagnosed mental illness. Employed persons had decreased odds of having a diagnosed mental illness. Limitations: The retrospectivity of data collection as well as the validity and reliability of some of the data may be questionable owing to the potential for recall bias. Conclusion: The point of intervention for suicide prevention cannot always be a mental health professional; some people who die by suicide either do not have a mental illness or have not sought help.

A Prospective Cohort Study of Load and Wellness (Sleep, Fatigue, Soreness, Stress, and Mood) in Elite Junior Australian Football Players.

PURPOSE: To investigate associations between load (training and competition) and wellness in elite junior Australian Football players across 1 competitive season. METHODS: A prospective cohort study was conducted during the 2014 playing season in 562 players from 9 teams. Players recorded their training and match intensities according to the session-rating-of-perceived-exertion (sRPE) method. Based on sRPE player loads, a number of load variables were quantified, including cumulative load and the change in load across different periods of time (including the acute-to-chronic load ratio). Wellness was quantified using a wellness index including sleep, fatigue, soreness, stress, and mood on a Likert scale from 1 to 5. RESULTS: Players spent an average of 85 (21) min in each match and 65 (31) min per training session. Average match loads were 637 (232) arbitrary units, and average training loads were 352 (233) arbitrary units. Over the 24 wk of the 2014 season, overall wellness had a significant linear negative association with 1-wk load (B = -0.152; 95% confidence interval, -0.261 to -0.043; P = .006) and an inverse U-curve relationship with session load (B = -0.078; 95% confidence interval, 0.143 to 0.014; P = .018). Mood, stress, and soreness were all found to have associations with load. CONCLUSIONS: This study demonstrates that load (within a session and across the week) is important in managing the wellness of elite junior Australian Football players. Quantifying loads and wellness at this level will help optimize player management and has the potential to reduce the risk of adverse events such as injury.