Computational modelling and systems ergonomics: a system dynamics model of drink driving-related trauma prevention.

System dynamics is a computational modelling method that is used to understand the dynamic interactions influencing behaviour in complex systems. In this article we argue that the method provides a useful tool for ergonomists wishing to model the behaviour of complex systems. We present a system dynamics model that simulates the behaviour of a drink driving-related trauma system and explore the potential impact of different road safety policy interventions. The model was simulated over thirty-year periods with different policy interventions. The findings suggest that the greatest reduction in drink driving-related trauma can be achieved by policies that integrate standard road safety interventions (e.g. education and enforcement) with interventions designed to address the societal issue of alcohol misuse and addiction. In closing we discuss the potential use of system dynamics modelling in future ergonomics applications and outline its strengths and weaknesses in relation to existing systems ergonomics methods. Practitioner Summary: The outputs of systems ergonomics methods are typically static and cannot simulate behaviour over time. We propose system dynamics as a useful approach for modelling the behaviour of complex systems. Applied to drink driving-related road trauma, the method was able to dynamically model the potential impacts of different policy interventions.

Land use, transport, and population health: estimating the health benefits of compact cities.

Using a health impact assessment framework, we estimated the population health effects arising from alternative land-use and transport policy initiatives in six cities. Land-use changes were modelled to reflect a compact city in which land-use density and diversity were increased and distances to public transport were reduced to produce low motorised mobility, namely a modal shift from private motor vehicles to walking, cycling, and public transport. The modelled compact city scenario resulted in health gains for all cities (for diabetes, cardiovascular disease, and respiratory disease) with overall health gains of 420-826 disability-adjusted life-years (DALYs) per 100 000 population. However, for moderate to highly motorised cities, such as Melbourne, London, and Boston, the compact city scenario predicted a small increase in road trauma for cyclists and pedestrians (health loss of between 34 and 41 DALYs per 100 000 population). The findings suggest that government policies need to actively pursue land-use elements-particularly a focus towards compact cities-that support a modal shift away from private motor vehicles towards walking, cycling, and low-emission public transport. At the same time, these policies need to ensure the provision of safe walking and cycling infrastructure. The findings highlight the opportunities for policy makers to positively influence the overall health of city populations.

Higher mortality risk among injured individuals in a population-based matched cohort study.

BACKGROUND: Improved understanding of long-term mortality attributable to injury is needed to accurately inform injury burden studies. This study aims to quantify and describe mortality attributable to injury 12 months after an injury-related hospitalisation in Australia. METHOD: A population-based matched cohort study using linked hospital and mortality data from three Australian states during 2008-2010 was conducted. The injured cohort included individuals ≥18 years who had an injury-related hospital admission in 2009. A comparison cohort of non-injured people was obtain by randomly selecting from the electoral roll. This comparison group was matched 1:1 on age, gender and postcode of residence. Pre-index injury health service use and 12-month mortality were examined. Adjusted mortality rate ratios (MRR) and attributable risk were calculated. Cox proportional hazard regression was used to examine the effect of risk factors on survival. RESULTS: Injured individuals were almost 3 times more likely to die within 12 months following an injury (MRR 2.90; 95% CI: 2.76-3.04). Individuals with a traumatic brain injury (MRR 7.58; 95% CI: 5.92-9.70) or injury to internal organs (MRR 7.38; 95% CI: 5.90-9.22) were 7 times more likely to die than the non-injured group. Injury was likely to be a contributory factor in 92% of mortality within 30 days and 66% of mortality at 12 months following the index injury hospital admission. Adjusted mortality rate ratios varied by type of cause-specific death, with MRR highest for injury-related deaths. CONCLUSIONS: There are likely chronic consequences of sustaining a traumatic injury. Longer follow-up post-discharge is needed to consider deaths likely to be attributable to the injury. Better enumeration of long-term injury-related mortality will have the potential to improve estimates of injury burden.

Contextual Determinants of Childhood Injury: A Systematic Review of Studies With Multilevel Analytic Methods.

BACKGROUND: The definition of injury that underpins the contemporary approach to injury prevention is an etiological definition relating to bodily damage arising from transfer of energy to tissues of the body beyond the limits compatible with physiological function. Causal factors proximal to the energy transfer are nested within a more complex set of contextual determinants. For effective injury control, understanding of these determinants is critical. OBJECTIVES: The primary aims of this study were to describe the area-level determinants that have been included in multilevel analyses of childhood injury and to quantify the relationships between these area-level exposures and injury outcomes. SEARCH METHODS: We conducted a systematic review of peer-reviewed, English-language literature published in scientific journals between January 1997 and July 2014, reporting studies that employed multilevel analyses to quantify the eco-epidemiological causation of physical unintentional injuries to children aged 16 years and younger. We conducted and reported the review in accordance with the PRISMA guidelines. SELECTION CRITERIA: We included etiological studies of causal risk factors for unintentional traumatic injuries to children aged 0 to 16 years. Methodological inclusion criteria were as follows: Epidemiological studies quantifying the relationship between risk factors (at various levels) and injury occurrence in the individual; Studies that recognized individual exposure and at least 1 higher level of exposure with units at lower levels or microunits (e.g., individuals) nested within units at higher levels or macrounits (e.g., areas or neighborhoods); Injury outcomes (dependent variable) examined at the individual level; and Central analytic techniques belonging to the following categories: multilevel models, hierarchical models, random effects models, random coefficient models, covariance components models, variance components models, and mixed models. We combined criteria from the checklist described by the Cochrane Effective Practice and Organization of Care Review Group with factors in the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement, and we used several quality assessment items from other injury-related systematic reviews to create a quality assessment checklist for this review. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and selected analysis features for the included studies by using preformatted tables. They extracted information as reported in the articles. We determined statistical significance of estimates and effects by using the conventional threshold, P < .05. Any differences in the information extracted were resolved by discussion between authors and by specifically rereading and rechecking the facts as reported in the relevant articles. We tabulated results from the final multilevel model(s) in each of the included articles with key aspects summarized in text. Interpretations of the results and identification of key issues raised by the collated material are reported in the Discussion section of this article. MAIN RESULTS: We identified 11,967 articles from the electronic search with only 14 being included in the review after a detailed screening and selection process. Nine of the 14 studies identified significant fixed effects at both the area and individual levels. The area-level variables most consistently associated with child injury rates related to poverty, education, employment, and access to services. There was some evidence that injury rates were lower in areas scoring well on area-level summary measures of neighborhood safety. There was marked variation in the methods used and in the mapping of measured variables onto the conceptual model of ecological causation. AUTHOR CONCLUSIONS: These results help establish the scope for the public policy approach to injury prevention. More consistent reporting of multilevel study results would aid future interpretation and translation of such findings.

The Relationship Between Maternal Education and Child Health Outcomes in Urban Australian Children in the First 12 Months of Life.

OBJECTIVES: To describe the relationship between maternal education and child health outcomes at 12 months of age in a cohort of children in urban Australia, and to determine whether this relationship could be explained by the intermediate factors of maternal health behaviour and the social environmental context. METHODS: Data were derived from The Environments for Health Living Griffith Birth Cohort Study. Women attending their third trimester antenatal appointment at one of three public hospitals were recruited between 2006 and 2010 and invited to complete a 48-item, baseline self-administered questionnaire. Twelve months following the birth of their baby, a follow-up questionnaire consisting of 63 items was distributed. RESULTS: Women for whom complete follow-up data were not available were different from women who did complete follow-up data. The children of women with follow-up data-whom at the time of their pregnancy had not completed school or whose highest level of education was secondary school or a trade-had respectively a 59 and 57 % increased chance of having had a respiratory/infectious disease or injury in the first year of life (according to parent proxy-reports), compared to children of women with a tertiary education. When maternal behavioural and social environmental factors during pregnancy were included in the model (n=1914), the effect of secondary education was still evident but with a reduced odds ratio of 1.35 (95 % CI 1.07-1.72) and 1.19 (95 % CI 0.87-1.64), respectively. The effect of not having completed school was no longer significant. CONCLUSIONS: Results indicate that the relationship between maternal education and child outcomes may be mediated by maternal social environmental and behavioural factors. Results are likely an underestimation of the effect size, given the under representation in our cohort of participants with maternal characteristics associated with elevated risk of infant morbidity.

Right care, right time, right place: improving outcomes for people with spinal cord injury through early access to intervention and improved access to specialised care: study protocol.

BACKGROUND: Traumatic spinal cord injury is a devastating condition impacting adversely on the health and wellbeing, functioning and independence, social participation and quality of life of the injured person. In Australia, there are approximately 15 new cases per million population per year; economic burden estimates suggest 2 billion dollars annually. For optimal patient outcomes expert consensus recommends expeditious transfer ("<24 hours of injury") to a specialist Spinal Cord Injury Unit, where there is an interdisciplinary team equipped to provide comprehensive care for the many and complex issues associated with traumatic spinal cord injury. No study of this patient population has been undertaken, that assessed the extent to which care received reflected clinical guidelines, or examined the patient journey and outcomes in relation to this. The aims of this study are to describe the nature and timing of events occurring before commencement of specialist care, and to quantify the association between these events and patient outcomes. METHODS AND DESIGN: The proposed observational study will recruit a prospective cohort over two years, identified at participating sites across two Australian states; Victoria and New South Wales. Included participants will be aged 16 years and older and diagnosed with a traumatic spinal cord injury. Detailed data will be collected from the point of injury through acute care and subacute rehabilitation, discharge from hospital and community reintegration. Items will include date, time, location and external cause of injury; ambulance response, assessments and management; all episodes of hospital care including assessments, vital signs, diagnoses and treatment, inter-hospital transfers, surgical interventions and their timing, lengths of stay and complications. Telephone follow-up of survivors will be conducted at 6, 12 and 24 months. DISCUSSION: There is limited population level data on the effect of delayed commencement of specialist care (>24 hours) in a Spinal Cord Injury Unit. Examining current health service and clinical intervention pathways in this Australian population-based sample, in relation to their outcomes, will provide an understanding of factors associated with patient flow, resource utilisation and cost, and patient and family quality of life. Barriers to streamlined effective early-care pathways and facilitators of optimal treatment for these patients will be identified.

Population based case-control study of serious non-fatal motorcycle crashes.

BACKGROUND: Motorcycle sales, registration and use are increasing in many countries. The epidemiological literature on risk factors for motorcycle injury is becoming outdated, due to changes in rider demography, licensing regulations, traffic mix and density, road environments, and motorcycle designs and technologies. Further, the potential contribution of road infrastructure and travel speed has not yet been examined. METHODS/DESIGN: A population based case-control study together with a nested case-crossover study is planned. Cases will be motorcycle riders who are injured but not killed in a motorcycle crash on a public road within 150 km radius of Melbourne, Australia, and admitted to one of the study hospitals. Controls will be motorcycle riders who ride through the crash site on the same type of day (weekday or weekend) within an hour of the crash time. Data on rider, bike, and trip characteristics will be collected from the participants by questionnaire. Data on crash site characteristics will be collected in a structured site inspection, and travel speed for the cases will be estimated from these data. Travel speed for the controls will be measured prior to recruitment with a radar traffic detection device as they ride through the crash site. Control sites for the case-crossover study will be selected 1 km upstream from the crash site and matched on either intersection status or road curvature (either straight or cornered). If the initial site selected does not match the case site on these characteristics, then the closest matching site on the case route will be selected. Conditional multivariate logistic regression models will be used to compare risk between the matched case and control riders and to examine associations between road infrastructure and road environment characteristics and crash occurrence. Interactions between type of site and speed will be tested to determine if site type is an effect modifier of the relationship between speed and crash risk. The relationship between rider factors and travel speed generally will be assessed by multivariate regression methods. DISCUSSION: In the context of the changing motorcycling environment, this study will provide evidence on contemporary risk factors for serious non-fatal motorcycle crashes.

Socio-economic determinants of suicide: an ecological analysis of 35 countries.

PURPOSE: A long tradition of research has shown a relationship between suicide rates and socio-economic factors. However, most investigations have neglected to account for country-specific influences. The purpose of this study was to clarify the association between socio-economic variables and gender-specific suicide rates in 35 countries, using analytic techniques able to control for effects embedded within different country contexts. METHOD: Data relating to male and female age-standardised suicide rates (obtained from the WHO Statistical Information System) were analysed using fixed-effect regression. The possible associations between suicide rates and social variables were tested using data for 35 countries over the period 1980-2006. RESULTS: Findings indicated that higher male and female suicide rates were associated with increased female labour force participation, unemployment, and the proportion of persons over 65 years. Reductions in male and female suicide rates were associated with increased health spending per capita. The study also revealed that higher fertility was associated with a reduction in male suicide. Female labour force participation had a stronger effect on male suicide rates. CONCLUSIONS: The results of this study suggest that variables related to the labour market and the economy were better explanatory factors of suicide rates than population-level indicators of interpersonal relationships. Although results were generally similar for males and females, males appeared to be more sensitive to changes in the social environment than women.

Modelling SARS-CoV-2 disease progression in Australia and New Zealand: an account of an agent-based approach to support public health decision-making.

OBJECTIVE: In 2020, we developed a public health decision-support model for mitigating the spread of SARS-CoV-2 infections in Australia and New Zealand. Having demonstrated its capacity to describe disease progression patterns during both countries' first waves of infections, we describe its utilisation in Victoria in underpinning the State Government's then 'RoadMap to Reopening'. METHODS: Key aspects of population demographics, disease, spatial and behavioural dynamics, as well as the mechanism, timing, and effect of non-pharmaceutical public health policies responses on the transmission of SARS-CoV-2 in both countries were represented in an agent-based model. We considered scenarios related to the imposition and removal of non-pharmaceutical interventions on the estimated progression of SARS-CoV-2 infections. RESULTS: Wave 1 results suggested elimination of community transmission of SARS-CoV-2 was possible in both countries given sustained public adherence to social restrictions beyond 60 days' duration. However, under scenarios of decaying adherence to restrictions, a second wave of infections (Wave 2) was predicted in Australia. In Victoria's second wave, we estimated in early September 2020 that a rolling 14-day average of <5 new cases per day was achievable on or around 26 October. Victoria recorded a 14-day rolling average of 4.6 cases per day on 25 October. CONCLUSIONS: Elimination of SARS-CoV-2 transmission represented in faithfully constructed agent-based models can be replicated in the real world. IMPLICATIONS FOR PUBLIC HEALTH: Agent-based public health policy models can be helpful to support decision-making in novel and complex unfolding public health crises.

Childhood obesity: how do Australian general practitioners feel about managing this growing health problem?

General practitioners (GPs) are ideally placed to identify and treat childhood obesity, but its prevalence continues to rise and evidence for effective GP interventions is lacking. Further analysis of the barriers to effective identification and management of childhood obesity is warranted. This survey aimed to explore how Queensland GPs feel about managing the growing problem of childhood obesity. A cross-sectional survey was sent to a random sample of 573 Queensland GPs about perceptions of diagnosis and management of childhood obesity. A total of 30% of GPs responded (n=170). The main perceived obstacles to identification of childhood obesity were uncertainty about definition criteria and how to calculate body mass index, and lack of access to body mass index percentile charts. The main perceived obstacles in managing childhood obesity were lack of financial incentive, time constraints, lack of health system support and parental resistance. Only 22% of respondents indicated awareness of the National Health and Medical Research Council guidelines for management of obese children and 92% had never used any formal clinical guidelines in assessment or management of childhood obesity. Addressing these barriers to identification of childhood obesity by GPs may facilitate more effective management. Strategies include greater emphasis on this issue in general practice training, financial incentives for diagnosis and management, incorporating clinical management guidelines into medical software, and increasing allied and community health support.

Federal and state cooperation necessary but not sufficient for effective regional mental health systems: insights from systems modelling and simulation.

For more than a decade, suicide rates in Australia have shown no improvement despite significant investment in reforms to support regionally driven initiatives. Further recommended reforms by the Productivity Commission call for Federal and State and Territory Government funding for mental health to be pooled and new Regional Commissioning Authorities established to take responsibility for efficient and effective allocation of 'taxpayer money.' This study explores the sufficiency of this recommendation in preventing ongoing policy resistance. A system dynamics model of pathways between psychological distress, the mental health care system, suicidal behaviour and their drivers was developed, tested, and validated for a large, geographically diverse region of New South Wales; the Hunter New England and Central Coast Primary Health Network (PHN). Multi-objective optimisation was used to explore potential discordance in the best-performing programs and initiatives (simulated from 2021 to 2031) across mental health outcomes between the two state-governed Local Health Districts (LHDs) and the federally governed PHN. Impacts on suicide deaths, mental health-related emergency department presentations, and service disengagement were explored. A combination of family psychoeducation, post-attempt aftercare, and safety planning, and social connectedness programs minimises the number of suicides across the PHN and in the Hunter New England LHD (13.5% reduction; 95% interval, 12.3-14.9%), and performs well in the Central Coast LHD (14.8% reduction, 13.5-16.3%), suggesting that aligned strategic decision making between the PHN and LHDs would deliver substantial impacts on suicide. Results also highlighted a marked trade-off between minimising suicide deaths versus minimising service disengagement. This is explained in part by the additional demand placed on services of intensive suicide prevention programs leading to increases in service disengagement as wait times for specialist community based mental health services and dissatisfaction with quality of care increases. Competing priorities between the PHN and LHDs (each seeking to optimise the different outcomes they are responsible for) can undermine the optimal impact of investments for suicide prevention. Systems modelling provides essential regional decision analysis infrastructure to facilitate coordinated federal and state investments for optimal impacts.

Action indicators for injury prevention.

There is considerable confusion about the nature of indicators, their use in the injury field and surprisingly little discussion about these important tools. To date discussions of injury indicators have focused on the content and presentation of health outcome measures and on the dearth of data on exposure measures. Whereas these are valuable measures and assessing the optimal use of available routinely collected data in forming indicators is important, they do not provide sufficient information to support comprehensive prevention efforts, nor do they harness the full potential of indicators as tools to support prevention efforts. This paper provides an overview of the characteristics and uses of indicators for the field of injury prevention in order to make the case for action indicators and provide a framework for their appropriate use.

Risk factors and obstetric complications of large for gestational age births with adjustments for community effects: results from a new cohort study.

BACKGROUND: High birth weight has serious adverse impacts on chronic health conditions and development in children. This study identifies the social determinants and obstetric complications of high birth weight adjusted for gestational age and baby gender. METHODS: Pregnant women were recruited from three maternity hospitals in South-East Queensland in Australia during antenatal clinic visits. A questionnaire was completed by each participant to elicit information on eco-epidemiological exposures. Perinatal information was extracted from hospital birth records. A hierarchical mixture regression model was used in the analysis to account for the heterogeneity of birth weights and identify risk factors and obstetric complications of births that were large for gestational age. A generalized linear mixed model was used to adjust for (random) "community" effects. RESULTS: Pre-pregnancy obesity (adjusted OR = 2.73, 95% CI = 1.49-5.01), previous pregnancy (adjusted OR = 2.03, 95% CI = 1.08-3.81), and married mothers (adjusted OR = 1.85, 95% CI = 1.00-3.42) were significantly associated with large for gestational age babies. Subsequent complications included the increased need for delivery by caesarean sections or instrumental procedures (adjusted OR = 1.98, 95% CI = 1.10-3.55), resuscitation (adjusted OR = 2.52, 95% CI = 1.33-4.79), and transfer to intensive/special care nursery (adjusted OR = 3.76, 95% CI = 1.89-7.49). Communities associated with a higher proportion of large for gestational age births were identified. CONCLUSIONS: Pre pregnancy obesity is the principal modifiable risk factor for large for gestational age births. Large for gestational age is an important risk factor for the subsequent obstetric complications. The findings improve the evidence-base on which to base preventive interventions to reduce the impact of high birth weight on maternal and child health.

The population approach to falls injury prevention in older people: findings of a two community trial.

BACKGROUND: There is a sound rationale for the population-based approach to falls injury prevention but there is currently insufficient evidence to advise governments and communities on how they can use population-based strategies to achieve desired reductions in the burden of falls-related injury. The aim of the study was to quantify the effectiveness of a streamlined (and thus potentially sustainable and cost-effective), population-based, multi-factorial falls injury prevention program for people over 60 years of age. METHODS: Population-based falls-prevention interventions were conducted at two geographically-defined and separate Australian sites: Wide Bay, Queensland, and Northern Rivers, NSW. Changes in the prevalence of key risk factors and changes in rates of injury outcomes within each community were compared before and after program implementation and changes in rates of injury outcomes in each community were also compared with the rates in their respective States. RESULTS: The interventions in neither community substantially decreased the rate of falls-related injury among people aged 60 years or older, although there was some evidence of reductions in occurrence of multiple falls reported by women. In addition, there was some indication of improvements in fall-related risk factors, but the magnitudes were generally modest. CONCLUSIONS: The evidence suggests that low intensity population-based falls prevention programs may not be as effective as those that are intensively implemented.

Review of injuries over a one year period among 87,134 adults studying at an open university in Thailand.

Countries need epidemiological information about population injury statistics to devise preventive strategies. To generate such information we estimated the one-year incidence and distribution of injury in a group of 87,134 adult Sukhothai Thammathirat Open University distance-learning students residing throughout Thailand. Those who participated joined the study by filling out a baseline questionnaire in 2005 which included a one-year recall of injuries serious enough to interfere with daily activities and/or require medical treatment. The more serious injuries were categorised by location, mechanism and intentionality. We collected sociodemographic information about the participants. Nearly 22% of participants reported at least one injury during the previous 12 months. Males, those with lower income and the less educated, had higher injury rates. Home injuries were more common among females. Sports, road and workplace injuries were more common among males. Transport injuries decreased with age and falls increased with age. Most injuries were unintentional. Injury rates among Thai adults are high. We identified at risk groups by injury mechanism and setting. Before interventions can be devised more research is needed regarding exposure and vulnerability in at risk socio-demographic groups.

Bad behaviour or societal failure? Perceptions of the factors contributing to drivers' engagement in the fatal five driving behaviours.

The so-called 'fatal five' behaviours (drink and drug driving, distraction and inattention, speeding, fatigue, and failure to wear a seat belt) are known to be the major behavioural contributory factors to road trauma. However, little is known about the factors that lead to drivers engaging in each behaviour. This article presents the findings from a study which collected and analysed data on the factors that lead to drivers engaging in each behaviour. The study involved a survey of drivers' perceptions of the causes of each behaviour and a subject matter expert workshop to gain the views of road safety experts. The results were mapped onto a systems ergonomics model of the road transport system in Queensland, Australia, to show where in the system the factors reside. In addition to well-known factors relating to drivers' knowledge, experience and personality, additional factors at the higher levels of the road transport system related to road safety policy, transport system design, road rules and regulations, and societal issues were identified. It is concluded that the fatal five behaviours have a web of interacting contributory factors underpinning them and are systems problems rather than driver-centric problems. The implications for road safety interventions are discussed.

Patterns of health care use of injured adults: A population-based matched cohort study.

BACKGROUND: Healthcare use by traumatically injured individuals prior to and subsequent to their injury are not often explored for different types of injuries. This study aims to describe health care use 12 months preceding and 12 months following a traumatic injury by injury type and injury severity. METHOD: Hospital and mortality data from three Australian states were linked in a population-based matched cohort study. Individuals ≥18 years who had an injury-related hospital admission in 2009 were identified as the injured cohort. A comparison cohort of non-injured people, matched 1:1 on age, gender and postcode of residence, was randomly selected from the electoral roll. Twelve-month pre- and post-index injury health service use was examined. Rates, adjusted rate ratios and attributable risk proportions were calculated by injury type and severity. RESULTS: The injury cohort experienced higher 12-month pre- and post-injury hospital admissions than the non-injured group. By 6 to 7 months post-injury, the injury cohort had largely returned to their pre-injury health service use levels, except for injuries involving dislocations, sprains and strains and injury to nerves and spinal cord. Hip fracture (17.69 per 100 person-months) and poisoning (16.09 per 100 person-months) had the highest rates of post-injury hospitalisation in the injured cohort. The adjusted rate ratios (ARR) for post-injury hospitalisation were highest for poisoning (ARR: 3.77; 95% CI: 3.38-4.21) and injury to nerves and spinal cord (ARR: 2.73; 95% CI: 2.27-3.28). Poisoning also had the highest ARR for post-injury LOS (ARR: 5.31; 95% CI: 4.51-6.27). CONCLUSIONS: After sustaining a traumatic injury, many individuals are readmitted to hospital and require ongoing care up to 12 months post-injury. That injured individuals post-injury largely return to their pre-index injury hospital use by 6 to 7 months could imply a return to pre-injury function and/or that other measures of health service use should be explored. Trauma services should consider long-term follow-up and support services for seriously injured patients post-hospital discharge.

Mental health: a cause or consequence of injury? A population-based matched cohort study.

BACKGROUND: While a number of studies report high prevalence of mental health problems among injured people, the temporal relationship between injury and mental health service use has not been established. This study aimed to quantify this relationship using 10 years of follow-up on a population-based cohort of hospitalised injured adults. METHODS: The Manitoba Injury Outcome Study is a retrospective population-based matched cohort study that utilised linked administrative data from Manitoba, Canada, to identify an inception cohort (1988-1991) of hospitalised injured cases (ICD-9-CM 800-995) aged 18-64 years (n = 21,032), which was matched to a non-injured population-based comparison group (n = 21,032). Pre-injury comorbidity and post-injury mental health data were obtained from hospital and physician claims records. Negative Binomial regression was used to estimate adjusted rate ratios (RRs) to measure associations between injury and mental health service use. RESULTS: Statistically significant differences in the rates of mental health service use were observed between the injured and non-injured, for the pre-injury year and every year of the follow-up period. The injured cohort had 6.56 times the rate of post-injury mental health hospitalisations (95% CI 5.87, 7.34) and 2.65 times the rate of post-injury mental health physician claims (95% CI 2.53, 2.77). Adjusting for comorbidities and pre-existing mental health service use reduced the hospitalisations RR to 3.24 (95% CI 2.92, 3.60) and the physician claims RR to 1.53 (95% CI 1.47, 1.59). CONCLUSION: These findings indicate the presence of pre-existing mental health conditions is a potential confounder when investigating injury as a risk factor for subsequent mental health problems. Collaboration with mental health professionals is important for injury prevention and care, with ongoing mental health support being a clearly indicated service need by injured people and their families. Public health policy relating to injury prevention and control needs to consider mental health strategies at the primary, secondary and tertiary level.

Acute alcohol consumption and mechanism of injury.

OBJECTIVE: The purpose of this study was to determine whether injury mechanism among injured patients is differentially distributed as a function of acute alcohol consumption (quantity, type, and drinking setting). METHOD: A cross-sectional study was conducted between October 2000 and October 2001 in the Gold Coast Hospital Emergency Department, Queensland, Australia. Data were collected quarterly over a 12-month period. Every injured patient who presented to the emergency department during the study period for treatment of an injury sustained less than 24 hours prior to presentation was approached for interview. The final sample comprised 593 injured patients (males=377). Three measures of alcohol consumption in the 6 hours prior to injury were obtained from self-report: quantity, beverage type, and drinking setting. The main outcome measure was mechanism of injury, which was categorized into six groups: road traffic crash (RTC), being hit by or against something, fall, cut/piercing, overdose/poisoning, and miscellaneous. Injury intent was also measured (intentional vs. unintentional). RESULTS: After controlling for relevant confounding variables, neither quantity nor type of alcohol was significantly associated with injury mechanism. However, drinking setting (i.e., licensed premise) was significantly associated with increased odds of sustaining an intentional versus unintentional injury (odds ratio [OR] = 2.79, 95% confidence interval [CI] = 1.4-5.6); injury through being hit by/against something versus other injury types (OR = 2.59, 95% CI = 1.4-4.9); and reduced odds of sustaining an injury through RTC versus non-RTC (OR = 0.02, 95% CI = 0.004-0.9), compared with not drinking alcohol prior to injury. CONCLUSIONS: No previous analytical studies have examined the relationship between injury mechanism and acute alcohol consumption (quantity, type, and setting) across all types of injury and all injury severities while controlling for potentially important confounders (demographic and situational confounders, risk-taking behavior, substance use, and usual drinking patterns). These data suggest that among injured patients, mechanism of injury is not differentially distributed as a function of quantity or type of acute alcohol consumption but may be differentially distributed as a function of drinking setting (i.e., RTC, intentional injury, being hit). Therefore, prevention strategies that focus primarily on the quantity and type of alcohol consumed should be directed generically across injury mechanisms and not limited to particular cause of injury campaigns.

The development of national injury prevention policy in the Australian health sector: and the unmet challenges of participation and implementation.

For the last 20 years injury prevention policy in Australia has been hampered by poor consultation practices, limited stakeholder involvement, inadequate allocation of resources, poor implementation, and an absence of performance measures. This paper describes the development of injury prevention policy in Australia from its beginnings in 1981 to the current day and considers what measures should be undertaken to create an effective platform for the reduction of the burden of injury in Australia. The National Injury Prevention and Safety Promotion Plan 2004-2014, released in 2005, needs to be supported by a whole of government commitment to the reduction of injury. The Council of Australian Governments would be an ideal forum to monitor progress, supported by a cross-government Ministerial Council.