An evaluation of the effects of an innovative school-based cycling education program on safety and participation.

Cycling education programs for children could play a role in promoting both cycling participation and cycling safety, and they exist in many countries - often in school settings. Evaluations have generally shown improvements in skills and knowledge, but effects on less-researched outcomes such as safety-related behaviour, crashes or injuries, cycling participation, and cycling confidence, are unclear. The present research evaluated Safe Cycle, an innovative Australian school-based program that addresses hazard awareness and overconfidence in addition to more typical content (e.g. handling skills), in terms of a comprehensive range of outcomes. Students from Years 4 to 8 (n = 108) completed online surveys in class before, immediately after, and approximately 14 weeks after, the 8-week program was delivered. Significant increases in knowledge and confidence were observed, while results also suggested increases in cycling participation. The program appeared to address illusory invulnerability effectively, but there was no evidence that the program improved safety-relevant cycling behaviours or experience of crashes. The benefits of Safe Cycle might be enhanced by including elements to increase motivation to perform safety-relevant behaviours and durability of program effects.

On the use of naturalistic methods to examine safety-relevant behaviours amongst children and evaluate a cycling education program.

School-based cycling education programs aim to improve cycling safety and participation amongst children. Available research suggests that typical programs, which focus on bicycle manoeuvring skills, have limited effects on behaviour observed on a track or planned route. The current study uses theoretically more valid, naturalistic cycling data, to evaluate Safe Cycle, a program that incorporates hazard and self-awareness training. Soon after Safe Cycle was delivered at treatment schools, research bicycles instrumented with a rearward- and a forward-facing camera were loaned to six children from treatment schools and six children from (waitlist) control schools. In each group half the children were in Year 6, and half were in Year 7/8. Each child was instructed to ride the research bicycle instead of their own bicycle for the 1-2 weeks that they had a research bicycle. Video data were reduced using a purpose-designed coding scheme that identified whether participants performed specific safety-relevant behaviours in appropriate circumstances. While the participants controlled their bicycles well, gave way appropriately to traffic at intersections, and stopped at red lights, participants frequently removed one or both hands from the handlebars, and seldom signalled turns, conducted over-shoulder-checks when changing lanes, or looked in multiple directions at intersections (except when crossing a road). While aspects of design and small sample sizes limited evaluation findings, this research demonstrated the feasibility and potential of naturalistic data to support cycling education program evaluation. Further, the study substantially extended available naturalistic study of children's cycling behaviour to highlight behaviours which might be targeted by cycling safety initiatives.

Fall-related hospitalization in people with Parkinson's disease.

BACKGROUND AND PURPOSE: Falls are common in people with Parkinson's disease (PD) but few data exist on fall-related hospitalizations in this group. This population-based study compared fall-related hospital admissions, injury rates and consequences in people with and without PD, and determined whether PD was an independent predictor of fall-related hospital length of stay. METHODS: This was a retrospective study using probabilistic linkage of hospital data in people aged ≥65 years hospitalized for a fall between 1 July 2005 and 31 December 2013 in New South Wales, Australia. Rates of hospital admissions and injuries per person admitted over the study period were compared between people with and without PD using Poisson or negative binomial regression. Multilevel linear modelling was used to analyse length of stay by clustering individuals and adjusting for possible confounders. RESULTS: There were 342 265 fall-related hospital admissions in people aged ≥65 years during the study period, of which 8487 (2.5%) were for people with PD. Sixty-seven per cent of fall-related PD admissions were associated with injury and 35% were associated with fracture. People with PD had higher rate ratios for fall admissions (1.63, 95% confidence interval 1.59-1.67) and injury (1.47, 95% confidence interval 1.43-1.51) and longer median length of stay [9 (interquartile range 1-27) vs. 6 (interquartile range 1-20) days in people without PD; P < 0.001]. PD remained associated with increased length of stay after controlling for comorbidity, age, sex and injury (P < 0.001). CONCLUSIONS: This study provides important benchmark data for hospitalizations for falls and fall injuries for older people with PD, which may be used to monitor the effect of fall prevention programmes.

Predictors of older drivers' involvement in rapid deceleration events.

Rapid deceleration occurs when substantial force slows the speed of a vehicle. Rapid deceleration events (RDEs) have been proposed as a surrogate safety measure. As there is concern about crash involvement of older drivers and the effect of age-related declining visual and cognitive function on driving performance, we examined the relationship between RDEs and older driver's vision, cognitive function and driving confidence, using naturalistic driving measures. Participants aged 75 to 94 years had their vehicle instrumented for 12 months. To minimise the chance of identifying false positives, accelerometer data was processed to identify RDEs with a substantial deceleration of >750 milli-g (7.35m/s2). We examined the incidence of RDEs amongst older drivers, and how this behaviour is affected by differences in age; sex; visual function, cognitive function; driving confidence; and declines over the 12 months. Almost two-thirds (64%) of participants were involved in at least one RDE, and 22% of these participants experienced a meaningful decline in contrast sensitivity during the 12 months. We conducted regression modelling to examine associations between RDEs and predictive measures adjusted for (i) duration of monitoring and (ii) distance driven. We found the rate of RDEs per distance increased with age; although, this did not remain in the multivariate model. In the multivariate model, we found older drivers who experienced a decline in contrast sensitivity over the 12 months and those with lower baseline driving confidence were at increased risk of involvement in RDEs adjusted for distance driven. In other studies, contrast sensitivity has been associated with increased crash involvement for older drivers. These findings lend support for the use of RDEs as a surrogate safety measure, and demonstrate an association between a surrogate safety measure and a decline in contrast sensitivity of older drivers.

Variations in car crash-related hospitalization costs amongst young adults in New South Wales, Australia.

BACKGROUND: This study aims to examine factors associated with variation in crash-related hospitalization costs for young adults in New South Wales (NSW), Australia with a particular focus on types of vehicle occupant, rurality of residence and socioeconomic status (SES). METHODS: Data on patients aged 17-25 years, admitted to public hospitals due to a crash during July 2000-June 2007 were extracted from the NSW Health Admission Collection database. The hospitalization cost of each admission was calculated based on published charges for specific Australian Refined-Diagnosis Related Groups (AR-DRG). Multivariable analyses using generalized estimating equations were used to estimate costs by vehicle occupant type (driver, passenger and other occupants), rurality of residence (urban, regional and rural areas) and SES (low, moderate and high SES areas). RESULTS: During 2000-2007, there were 11,892 crash-related hospitalizations involving young adults, aged 17-25 years, in NSW. These cost the health sector about A$87.6 million or on average, A$7363 per hospitalization (mean length of stay (LOS) 5.3 days). Compared to drivers, passengers had significantly longer LOS (<0.01) as well as higher hospitalization costs (p = 0.04). Regional and rural young adults had significantly longer LOS and higher hospitalization costs compared to urban young adults (p<0.05). Compared with young adults from high SES areas, young adults from moderate SES areas had significantly higher costs (p = 0.02), whilst the higher costs for young adults of low SES areas was borderline significant (p = 0.06), although differences in LOS by SES were not significant. CONCLUSION: Annually, young adults' crashes in NSW were estimated to cost the health sector at least A$14.6 million between 2001 and 2007. The higher hospitalization costs and LOS for young adults living in regional and rural vs. urban areas, and those living in moderate and low SES vs. high SES areas partly reflects the severity of these crashes and challenges for treatment. Based on these findings, a strong economic argument can be made for targeting prevention strategies to young people living in rural and low SES areas. The area variations in costs also suggest some scope for policy makers to consider potentially more efficient ways of targeting both treatment and preventative programmes.

Fatal crash trends for Australian young drivers 1997-2007: geographic and socioeconomic differentials.

BACKGROUND: Little has been published on changes in young driver fatality rates over time. This paper examines differences in Australian young driver fatality rates over the last decade, examining important risk factors including place of residence and socioeconomic status (SES). METHODS: Young driver (17-25years) police-recorded passenger vehicle crashes were extracted from New South Wales State records from 1997-2007. Rurality of residence and SES were classified into three levels based on drivers' residential postcode: urban, regional, or rural; and high, moderate, or low SES areas. Geographic and SES disparities in trends of fatality rates were examined by the generalized linear model. Chi-square trend test was used to examine the distributions of posted speed limits, drinking driving, fatigue, seatbelt use, vehicle age, night-time driving, and the time from crash to death across rurality and socioeconomic status. RESULTS: Young driver fatality rate significantly decreased 5% per year (p<0.05); however, stratified analyses (by rurality and by SES) showed that only the reduction among urban drivers was significant (average 5% decrease per year, p<0.01). The higher relative risk of fatality for rural versus urban drivers, and for drivers of low versus high SES remained unchanged over the last decade. High posted speed limits, fatigue, drink driving and seatbelt non-use were significantly associated with rural fatalities, whereas high posted speed limit, fatigue, and driving an older vehicle were significantly related to low SES fatality. CONCLUSION: The constant geographic and SES disparities in young driver fatality rates highlight safety inequities for those living in rural areas and those of low SES. Better targeted interventions are needed, including attention to behavioral risk factors and vehicle age.

Road crash trends for young drivers in New South Wales, Australia, from 1997 to 2007.

OBJECTIVES: The objective of this article was to explore overall crash and injury trends over the past decade for young drivers residing in New South Wales (NSW), Australia, including gender and age disparities. METHODS: Passenger vehicle crashes for drivers aged 17-25 occurring during 1997-2007 were extracted from the state crash database to calculate crash rates (per licensed driver). Generalized linear models were used to examine crash trends over time by severity of driver injury, adjusting for age, gender, rurality of residence, and socioeconomic status. Yearly adjusted relative risks of crash by gender and by age group were also examined over the study period. RESULTS: Young driver noninjury and fatality rates significantly decreased by an average of 4 percent (95% CI: 4-5) and 5 percent (95% CI: 0-9) respectively each year from 1997 to 2007. Young driver injury rates significantly increased by about 12 percent (95% CI: 9-14) to the year 2001 and then significantly decreased. The relative risk of crash (regardless of driver injury) for males compared to females significantly decreased over time. Compared to drivers aged 21-25, drivers aged 17 and particularly 18- to 20-year-olds had significantly and consistently higher crash risks across the study period. CONCLUSIONS: Overall, there has been a significant decline in young driver crashes in NSW over the last decade. Regardless of injury severity, males' risk of crash has reduced more than female young drivers, but drivers aged 17 continue to be at higher risk. These findings provide feedback on potential road safety successes and areas needing specific interventions for future improvements.

Socioeconomic status and risk of car crash injury, independent of place of residence and driving exposure: results from the DRIVE Study.

BACKGROUND: Previous studies that found increased crash risks for young drivers of low socioeconomic status (SES) have failed to adjust for factors such as driving exposure and rural residence. This aim of this study is to examine the independent effect of SES on crash risk, adjusting for such factors, and to examine the relationship between injury severity following a crash and SES. METHODS: Information on risk factors for crash collected from 20,822 newly licenced drivers aged 17-24 years in New South Wales, Australia, as part of the DRIVE Study was prospectively linked to hospitalisation data. SES was classified as high, moderate or low based on the Australia 2001 Socio-Economic Index for Areas. Poisson regression was used to model risk of crash-related hospitalisation by SES, adjusting for confounders. Two measures of injury severity--urgency of treatment and length of hospital stay--were examined by SES. RESULTS: Results of multivariable analysis showed that drivers from low SES areas had increased relative risk (RR 1.8, 95% CI 1.1 to 3.1) of crash-related hospitalisation compared to drivers from high SES areas. This increased risk remained when adjusting for confounders including driving exposure and rurality (RR 1.9, 95% CI 1.1 to 3.2). No significant association was found between injury severity and SES. CONCLUSION: The higher risk of crash-related hospitalisation for young drivers from low SES areas is independent of driving exposure and rural-urban differences. This finding may help improve and better target interventions for youth of low SES.

Risk and type of crash among young drivers by rurality of residence: findings from the DRIVE Study.

BACKGROUND: Most previous literature on urban/rural differences in road crashes has a primary focus on severe injuries or deaths, which may be largely explained by variations of medical resources. Little has been reported on police-reported crashes by geographical location, or crash type and severity, especially among young drivers. METHODS: DRIVE is a prospective cohort study of 20,822 drivers aged 17-24 in NSW, Australia. Information on risk factors was collected via online questionnaire and subsequently linked to police-reported crashes. Poisson regression was used to analyse risk of various crash types by three levels of rurality of residence: urban, regional (country towns and surrounds) and rural. RESULTS: Compared to urban drivers, risk of crash decreased with increasing rurality (regional adjusted RR: 0.7, 95% CI 0.6-0.9; rural adjusted RR: 0.5, 95% CI 0.3-0.7). Among those who crashed, risk of injurious crash did not differ by geographic location; however, regional and rural drivers had significantly higher risk of a single versus multiple vehicle crash (regional adjusted RR 1.8, 95% CI 1.3-2.5; rural adjusted RR: 2.0, 95% CI 1.1-3.6), which was explained by speeding involvement and road alignment at the time or site of crash. CONCLUSIONS: Although young urban drivers have a higher crash risk overall, rural and regional residents have increased risk of a single vehicle crash. Interventions to reduce single vehicle crashes should aim to address key issues affecting such crashes, including speeding and specific aspects of road geometry.

Do inadequacies in ICD-10-AM activity coded data lead to underestimates of the population frequency of sports/leisure injuries?

AIMS: To assess the use of the International Classification of Diseases Australian Modification (ICD-10-AM) activity sub-codes for identifying sports/leisure injury hospitalizations and the impact of missing codes on population incidence estimates. METHODS: Injury-related hospital separations in New South Wales, Australia, for the period 2003-04 were examined with sports/leisure cases identified by the ICD-10-AM activity codes. RESULTS: Over 30% of all injury hospitalizations had either a missing or unspecified activity code. Among cases with valid activity codes, 13.9% of all injury hospitalizations were associated with sports/leisure. When adjusted for underreporting associated with undefined or missing activity codes, sports/leisure injuries accounted for up to 20% of injury hospitalizations. CONCLUSION: Defining sports/leisure injury cases on the basis of activity codes is likely to lead to an underestimate of their contribution to the overall injury burden. Improvements need to be made to the completeness of activity coding of hospitalization data.

Helmets for preventing injury in motorcycle riders.

BACKGROUND: Motorcycle crash victims form a high proportion of those killed or injured in road traffic crashes. Injuries to the head, following motorcycle crashes, are a common cause of severe morbidity and mortality. It seems intuitive that helmets should protect against head injuries but it has been argued that motorcycle helmet use decreases rider vision and increases neck injuries. This review will collate the current available evidence on helmets and their impact on mortality, and head, face and neck injuries following motorcycle crashes. OBJECTIVES: To assess the effects of wearing a motorcycle helmet in reducing mortality and head and neck injury following motorcycle crashes. SEARCH STRATEGY: We searched the Cochrane Injuries Group Specialised Register, Cochrane Central Register of Controlled Trials (The Cochrane Library issue 2, 2007), MEDLINE (up to April 2007), EMBASE (up to April week 16, 2007), CINAHL (January 1982 to February 2003), TRANSPORT (up to issue 12, 2006) (TRANSPORT combines the following databases: Transportation Research Information Services (TRIS) International Transport Research Documentation (ITRD) formerly International Road Research Documentation (IRRD), ATRI (Australian Transport Index) (1976 to Feb 2003), Science Citation Index were searched for relevant articles. Websites of traffic and road safety research bodies including government agencies were also searched. Reference lists from topic reviews, identified studies and bibliographies were examined for relevant articles. SELECTION CRITERIA: We considered studies that investigated a population of motorcycle riders who had crashed, examining helmet use as an intervention and with outcomes that included one or more of the following: death, head, neck or facial injury. We included any studies that compared an intervention and control group. Therefore the following study designs were included: randomised controlled trials, non-randomised controlled trials, cohort, case-control and cross-sectional studies. Ecological and case series studies were excluded. DATA COLLECTION AND ANALYSIS: Two authors independently screened reference lists for eligible articles. Two authors independently assessed articles for inclusion criteria. Data were abstracted by two independent authors using a standard abstraction form. MAIN RESULTS: Sixty-one observational studies were selected of varying quality. Despite methodological differences there was a remarkable consistency in results, particularly for death and head injury outcomes. Motorcycle helmets were found to reduce the risk of death and head injury in motorcyclists who crashed. From four higher quality studies helmets were estimated to reduce the risk of death by 42% (OR 0.58, 95% CI 0.50 to 0.68) and from six higher quality studies helmets were estimated to reduce the risk of head injury by 69% (OR 0.31, 95% CI 0.25 to 0.38). Insufficient evidence was found to estimate the effect of motorcycle helmets compared with no helmet on facial or neck injuries. However, studies of poorer quality suggest that helmets have no effect on the risk of neck injuries and are protective for facial injury. There was insufficient evidence to demonstrate whether differences in helmet type confer more or less advantage in injury reduction. AUTHORS' CONCLUSIONS: Motorcycle helmets reduce the risk of death and head injury in motorcycle riders who crash. Further well-conducted research is required to determine the effects of helmets and different helmet types on mortality, head, neck and facial injuries. However, the findings suggest that global efforts to reduce road traffic injuries may be facilitated by increasing helmet use by motorcyclists.

Estimating the incidence of hospitalized injurious falls: impact of varying case definitions.

AIM: To assess the validity of widely used approaches to estimate the incidence of hospitalized falls. METHODS: Internal probabilistic data linkage of the 2000-01 New South Wales Inpatient Statistics Collection was used to identify first admissions for injurious falls. RESULTS: Using data linkage techniques, a total of 20,883 (93.9%, 95% CI 93.5 to 94.2) cases were identified as first admission for injurious falls corresponding to an incidence rate of 1161.4 per 100,000. The exclusion of non-acute admissions approach provided the best estimate of incidence (1185.4 per 100,000 people). When comparing the performance of different approaches to identifying first admissions to that of the data linkage "gold standard", the method based on the transfer variable performed best in terms of sensitivity and specificity. CONCLUSIONS: All the examined approaches have relatively low specificity raising questions about their use. The introduction of a unique patient identifier and the date of injury in hospital discharge datasets would facilitate the identification of incident cases of fall related hospitalizations.

Reporting of the incidence of hospitalised injuries: numerator issues.

OBJECTIVES: To examine and discuss the implications on the incidence of hospitalised injuries of selecting cases from principal diagnosis field only compared with considering all diagnosis fields, the inclusion compared with the exclusion of medical injuries, and the impact of identifying multiple admissions. METHODS: Analysis of data from the 1999-2000 New South Wales Inpatient Statistics Collection, Australia, including an internal linkage of the same dataset. RESULTS: Approximately 27.5% of records with a non-injury primary diagnosis include a nature of injury diagnosis in a subsequent diagnostic field. This figure increased to more than half (53%) of discharges for medical injuries. The internal linkage showed that 6.5% of discharges were repeat admissions for the same International Classification of Diseases, 10th revision (ICD-10) injury code and that 13.8% were repeat admissions for any ICD-10 injury code. The proportions of repeat admissions varied according to the type and the mechanism of injury. CONCLUSIONS: Selecting hospitalised injury cases from the principal diagnosis alone would underestimate medical injury cases as well as other injuries occurring in hospital. Repeat admissions should always be considered particularly in the case of thermal injuries, self harm, and medical injuries. Due to the limitations of data linkage, alternative methods need to be developed to identify repeat admissions. Other areas in which further research would be beneficial to a more uniform reporting of injury hospitalisations include better identification of injuries occurring in hospital, a review of ICD-10 injury codes, and the development an ICD-10 based severity measure which can be readily used with hospital discharge data.

Trends in the incidence of ectopic pregnancy in New South Wales between 1990-1998.

During the last three decades, ectopic pregnancy rates have increased considerably in different parts of the world including Australia. Recent reports, however, suggest that the incidence is decreasing or at least stabilising. An analysis of the New South Wales Inpatient Statistics Data collected during the period between 1990 and 1998 has shown a decline in the rate of ectopic pregnancy after 1993. Overall the rate decreased from 17.4 per 1,000 births in 1990-1991 to 16.2 per 1,000 births in 1997-1998. The decline was greater for women aged 35-44 years than for younger women. The findings are consistent with recent studies in other countries, which indicate slowing or the end of the previous upward trend in the incidence of ectopic pregnancy