Comparison of data sets for surveillance of work-related injury in Victoria, Australia.

OBJECTIVE: To investigate differences and similarities between three sources of work-related injury information: workers compensation claims, emergency department (ED) presentation data and hospital admissions data. METHODS: This population-based, retrospective descriptive analysis of non-fatal, work-related injuries of workforce participants in Victoria, Australia, has compared data from workers compensation claims and ED presentation and hospital admission data sets for the period 2004-2011. Work-related injury case frequency and rate were compared across study years according to gender, age, geographical location and injury type. Injury rates were expressed as cases per million hours worked. RESULTS: Rates of hospital admissions for treatment of work-related injury increased over the study period, compared with decreasing rates of injury in compensation claims and ED data. The highest rate of injuries to younger workers was captured in ED data. There was greater capture of musculoskeletal injuries by workers' compensation data, and of open wound and burn injury by the ED data. Broad similarities were noted for temporal trends according to gender, for the distribution of cases across older age groups and for rates of fracture injuries. CONCLUSIONS: These study findings inform use of workers' compensation, ED presentation and hospital admission data sets as sources of information for surveillance of work-related injuries in countries where these types of data are routinely collected. Choice of data source for investigation of work-related injury should take into consideration the population and injury types of interest.

The association between jockey experience and race-day falls in flat racing in Australia.

OBJECTIVES: Apprentice thoroughbred racing jockeys have a higher fall rate than their more experienced counterparts. The authors describe rates of occurrence and investigate risk factors for falls among less-experienced thoroughbred flat racing jockeys in Australia who commenced their race riding career between August 2002 and July 2009. METHODS: Data on race-day falls were extracted from stewards' reports. Denominator data were provided by Racing Information Services Australia on races conducted in Australia. HRs were estimated using time-to-event (survival analysis) methods. RESULTS: Factors found to be associated with falls by less-experienced jockeys (as indicated by number of career rides or career stage) were older jockey age at commencement of career (p=0.001), fewer previous rides this meeting (p<0.001), fewer previous starts by the horse (p<0.001), younger horse age (p<0.001), lower race grade (p<0.001), lower prize money (p<0.001), shorter race distance (p<0.001) and drier track rating (p<0.001). Apprentice experience was inversely and strongly associated with increased rates of falls (p<0.001). Three indicators of less accomplished horses (lower race grade, fewer previous starts by the horse and less prize money at stake) and two race conditions (drier tracks and shorter race distance) were found to be associated with a progressively higher hazard of falls for less-experienced jockeys. CONCLUSIONS: This study identified factors that preferentially contribute to falls by inexperienced jockeys. The authors suggest that consideration be given to restricting apprentice jockeys with little race-riding experience from riding horses that have not yet won a race (maiden) or that have had few previous race starts.

Development of the Falls Risk for Older People in the Community (FROP-Com) screening tool.

BACKGROUND: the aim of this study was to develop a brief screening tool for use in the emergency department (ED), to identify people who require further assessment and management. METHODS: this prospective study included 344 community-dwelling older people presenting to an ED after a fall. After direct discharge participants had a home-based assessment performed that included the Falls Risk for Older People in the Community (FROP-Com), a comprehensive, yet simple, multifactorial falls risk assessment tool. They were then monitored for falls for 12 months. The items from the FROP-Com assessment tool predictive of falls in a multifactorial logistic regression were used to develop the FROP-Com screen. RESULTS: the items significantly predictive of falls and combined to form the FROP-Com screen were: falls in the previous 12 months, observation of the person's balance and the need for assistance to perform domestic activities of daily living. At the cut-off with the highest Youden index sensitivity was 67.1% (95% CI 59.9-74.3) and specificity was 66.7% (95% CI 59.8-73.6). CONCLUSION: the FROP-Com screen has a relatively good capacity to predict falls. It can be used in time-limited situations to classify those at high risk of falls who require more detailed assessment and management.

The reliability and predictive accuracy of the falls risk for older people in the community assessment (FROP-Com) tool.

BACKGROUND: the Falls Risk for Older People in the Community assessment (FROP-Com) tool was designed for use in targeted multi-factorial falls prevention programmes. It fills the gap between the short screening tools and the longer assessment tools, e.g. the physiological profile assessment (PPA). The aim of this study was to determine the reliability and predictive accuracy of the FROP-Com. METHODS: the intra-rater and inter-rater reliability studies were performed with 20 participants each. The prospective study was performed with 344 community-dwelling older people presenting to an emergency department after a fall and being discharged directly home. Following a home-based assessment, including the FROP-Com, Timed Up and Go (TUG) and functional Reach (FR), participants were monitored for falls for 12 months. RESULTS: the intra-class correlation coefficient (ICC) for intra-rater reliability and inter-rater reliability for the FROP-Com was 0.93 (95% CI 0.84-0.97) and 0.81 (95% CI 0.59-0.92) respectively. The AUC for the FROP-Com was 0.68 (95% CI 0.63-0.74). At the cut-off 18/19, sensitivity was 71.3% (95% CI 64.4-78.3) and specificity was 56.1% (95% CI 48.9-63.4). The AUC for the TUG was 0.63 (95% CI 0.57-0.69) and for the FR was 0.60 (95% CI 0.54-0.66). CONCLUSION: the FROP-Com demonstrated good reliability and a moderate capacity to predict falls.

Effectiveness of interventions in preventing injuries in agriculture--a systematic review and meta-analysis.

OBJECTIVES: This study reviewed the effectiveness of interventions in preventing occupational injuries among workers in agriculture. METHODS: Randomized controlled trials, controlled before-after studies, and interrupted time-series studies assessing interventions aimed at preventing injuries among workers in agriculture were considered. MEDLINE and five other databases were searched up to June 2006. Two authors independently assessed the eligibility of studies and the methodological quality of the ones included. Randomized controlled trials were combined in a meta-analysis. Interrupted time-series studies were reanalyzed to assess the immediate and progressive effect on injuries. RESULTS: Five randomized controlled trials and three interrupted time-series studies met the inclusion criteria. Six studies evaluated educational interventions and financial incentives, and two studies evaluated the effect of legislation. Three randomized controlled trials on educational interventions with 4670 adult participants did not indicate any injury-reducing effect, with a rate ratio of 1.02 (95% confidence interval 0.87-1.20), nor did two randomized controlled trials among children (6895 participants). Financial incentives decreased the injury level immediately after the intervention in one interrupted time-series study. Banning endosulfan pesticide in Sri Lanka led to a significant decrease in the trend of poisonings over time. Legislation requiring rollover protective structures on all tractors in Sweden did not produce a reduction in injuries, but the same requirement for new tractors was associated with a decrease in fatal injuries. CONCLUSIONS: The reviewed studies provided no evidence that educational interventions are effective in decreasing injury rates among agricultural workers. Financial incentives may be a better means of reducing injury rates. Banning highly toxic pesticides may be effective. Legislation on safety devices on tractors yielded contradictory results.

A randomized controlled trial of a multifactorial falls prevention intervention for older fallers presenting to emergency departments.

OBJECTIVES: To investigate the effect of a referral-based targeted multifactorial falls prevention intervention on the occurrence of recurrent falls and injuries in older people presenting to an emergency department (ED) after a fall and discharged directly home from the ED. DESIGN: Randomized controlled trial. Assessors of outcomes were unaware of group allocation. SETTING: Seven EDs in metropolitan Melbourne, Australia. PARTICIPANTS: Inclusion criteria were community dwelling, aged 60 and older, presenting to an ED after a fall, and discharged directly home. Exclusion criteria were unable to follow simple instructions or walk independently. INTERVENTION: Targeted referrals to existing community services and health promotion recommendations, based on the falls risk factors found in a baseline assessment. MEASUREMENTS: Primary outcome measures were falls and resultant injuries occurring over the 12-month follow-up period. Falls and injury data were collected using falls calendars supported by medical record reviews. RESULTS: Three hundred sixty-one participants were randomized to the standard care group and 351 to the intervention group. No significant difference was found between the two groups over the 12-month follow-up period in number of fallers (relative risk (RR)=1.11, 95% confidence interval (CI)=0.95-1.31] or number of participants sustaining an injury from a fall (RR=1.06, 95% CI=0.86-1.29). CONCLUSION: This study does not support the use of a referral-based targeted multifactorial intervention program to reduce subsequent falls or fall injuries in older people who present to an ED after a fall.

The incidence of race-day jockey falls in Australia, 2002-2006.

OBJECTIVES: To describe rates of occurrence of falls, injuries and fatalities to horse-racing jockeys in Australia. DESIGN AND SETTING: Retrospective analysis of data on race-day falls from stewards' reports provided by the Principal Racing Authority of each state and territory of Australia, August 2002 - July 2006. MAIN OUTCOME MEASURES: Fall, injury and fatality incidence rates; comparison with overseas rates. RESULTS: There were 3360 jockey falls from 748 367 rides. Falls occurred at a rate of 0.42 per 100 rides in flat races and 5.26 per 100 rides in jumps races. In flat racing, 54.6% (1694/3101) of falls occurred before the start of the race and 11.1% (344/3101) of falls occurred post-race. The 34.3% (1063/3101) of falls that occurred during flat races resulted in 61.7% (516/836) of the injuries sustained. In jumps racing, most falls occurred at a jump and 9.7% (25/259) of jockeys who fell were transported to hospital and/or declared unfit to ride. There were five fatalities resulting from falls during the study period, all in flat racing. Fall and injury rates were comparable with those found in the United Kingdom, Ireland, France and Japan. CONCLUSIONS: Being a jockey carries a substantial risk of injury and death. Although rates of injury in Australia are not exceptional by international standards, there can be improvement to safety standards in the Australian racing industry.

Trends in exposure of veterinarians to physical and chemical hazards and use of protection practices.

OBJECTIVES: To determine whether exposure to physical and chemical occupational hazards and use of protective practices has changed in recent veterinary graduates, and to describe trends in exposure to occupational hazards and use of protective practices over time. METHODS: This paper reports on a retrospective cohort study of veterinarians who graduated from any of the four Australian veterinary schools between 1960 and 2000 and were currently in clinical practice. A self-completed postal questionnaire was used to collect personal details, professional history since graduation, and details of occupational hazards and protective practices used. The prevalence of occupational hazards and use of protective practices was examined by decade of graduation adjusting for gender, type of practice and number of hours worked. RESULTS: After adjusting for other factors, recent graduates tended to take more X-rays than early graduates-graduates since 1990 were 2.59 times more likely to take more than seven X-rays a week compared with graduates before 1970. Recent graduates were also more likely to personally restrain animals during X-rays but were more likely to use X-ray protection. Of those who undertook surgery, recent graduates were more likely to use anaesthetic waste gas scavengers. Over time, veterinary jobs have become more likely to involve longer hours of surgery, but shorter periods of driving. The use of scavengers for waste anaesthetic gas has increased markedly over time from 3.8% of jobs commencing in the 1960s to over 70% for jobs commencing since 1997. CONCLUSIONS: This survey is, to our knowledge, the first to examine trends in the occupational health and safety practices of veterinarians. We have shown that occupational health issues are still important in veterinary practice, with most veterinarians exposed to a number of physical and chemical hazards and many using inadequate protection.

Effectiveness of falls clinics: an evaluation of outcomes and client adherence to recommended interventions.

OBJECTIVES: To evaluate outcomes associated with falls clinic programs. DESIGN: Longitudinal. SETTING: Thirteen outpatient falls clinics in Victoria, Australia. PARTICIPANTS: Four hundred fifty-four people referred for clinic assessment (mean age+/-standard deviation 77.9+/-8.8; 73% female). INTERVENTION: After assessment, multifactorial interventions were organized to address identified risk factors. MEASUREMENTS: A Minimum Data Set was developed and used across all clinics to derive common data on falls, falls injuries, and secondary measures associated with falls risk, including balance, falls efficacy, gait, leg strength, function, and activity. All measures were repeated 6 months later. RESULTS: Clients had a high risk of falls, with 78% having had falls in the preceding 6 months (63% multiple fallers, 10% experiencing fractures from the falls). An average of 7.6+/-2.8 falls risk factors were identified per client. The clinic team organized an average of 5.7+/-2.3 new or additional interventions per client. Sixty-one percent of eligible clients returned for the 6-month assessment. At this time, there was more than a 50% reduction in falls, multiple falls, and fall injuries (P < or = .004) and small but significant improvements evident on secondary measures of balance, leg strength, gait speed, and confidence outcomes (P < .006). Average adherence to recommendations was 74.3%. Factors associated with higher adherence included being male, younger than 65, living with others, and having a caregiver (P < .05). CONCLUSION: This large multicenter study identified high falls risk of older people referred to falls clinics, the multifactorial nature of their presenting problems and provides preliminary evidence of positive outcomes after falls clinic management.