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.

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.

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.

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.

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.

Elite Junior Australian Football Players Experience Significantly Different Loads Across Levels of Competition and Training Modes.

Lathlean, TJH, Gastin, PB, Newstead, S, and Finch, CF. Elite junior Australian football players experience significantly different loads across levels of competition and training modes. J Strength Cond Res 32(7): 2031-2038, 2018-Well-developed physical qualities such as high jumping ability, running endurance, acceleration, and speed can help aspiring junior elite Australian football (AF) players transition to the Australian Football League competition. To do so, players need to experience sufficient load to enhance their physical resilience without increasing their risk of negative outcomes in terms of impaired wellness or injury. The aim of this study was to investigate the differences in load for different levels of competition and training modes across one competitive season. Elite junior AF players (n = 562, aged 17.7 ± 0.3, range: 16-18 years) were recruited from 9 teams across the under-18 state league competition in Victoria. All players recorded their training and match intensities according to the session rating of perceived exertion method. Training sessions were categorized according to skills, strength, conditioning, and other activities, whereas matches were identified according to level of competition. The loads in U18 state league matches (656.7 ± 210.9 au) were significantly higher (p = 0.027) than those in school matches (643.3 ± 260.9 au) and those in U18 representative matches (617.2 ± 175.4). Players, who undertook more than one match per week, experienced significantly less load in subsequent matches (p < 0.001). Furthermore, U18 state league training sessions carried the most load when compared with other training modes. This article highlights that different combinations of training and match involvement affect overall player load, which may predispose players to negative outcomes such as impaired wellness or increased injury risk.

Did compulsory wear regulations increase personal flotation device (PFD) use by boaters in small power recreational vessels? A before-after observational study conducted in Victoria, Australia.

OBJECTIVE: To estimate the effect of the 2005 Victorian mandatory personal flotation device (PFD) wearing regulations on PFD use by occupants of small (hull length ≤4.8 m) power recreational vessels. DESIGN: Before-after observational study investigating the probability of PFD use among occupants of small vessels before and after the regulations were introduced compared with the probability of use by their counterparts on large power vessels (hull length >4.8-12 m) who were not required to wear PFDs before or after the regulations were introduced in the low-risk conditions in which observations occurred. METHODS: Statewide observation surveys of boaters were conducted in peak boating periods between January and March 2005 (prelegislation) and 2007 (postlegislation). Data collection included size of vessel, age and sex of boaters, life jacket use, boat type, activity of boaters, type of waterway and weather and water conditions. Logistic regression modelling tested whether there were statistically significant differences in the change in the relative odds of occupants wearing PFDs from the preintervention to the postintervention period in small compared with large power recreational vessels. RESULTS: The probability of PFD use increased from 22% to 63% on small power vessels compared with 12% to 13% on large vessels. Regression analysis showed a high statistically significant increase in the odds of PFD use on small vessels relative to large vessels (OR 6.2, 95% CI 4.2 to 9.3, p<0.001). No statistically significant effect on use on large vessels was associated with the regulation (OR 1.27, 95% CI 0.94 to 1.70, p=0.15). Relative to large vessels, on small vessels the odds of PFD use increased significantly in both sexes, all age groups, all vessel types and activity groupings except for towed water sports where the increase was only marginally statistically significant. CONCLUSIONS: The legislative intervention was successful in increasing PFD wearing in small vessels. However, visible enforcement and tougher penalties are needed to optimise compliance.

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.

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.

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.

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.

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.

A systematic review of early prognostic factors for persisting pain following acute orthopedic trauma.

BACKGROUND: Acute orthopedic trauma contributes substantially to the global burden of disease. OBJECTIVES: The present systematic review aimed to summarize the current knowledge concerning prognostic factors for the presence of persistent pain, pain severity and pain-related disability following acute orthopedic trauma involving a spectrum of pathologies to working-age adults. METHODS: The Ovid MEDLINE and EMBASE databases were searched for level II prognostic studies published between January 1996 and October 2010. Studies that were longitudinal and reported results with multivariate analyses appropriate for prognostic studies were included. Studies that addressed two specific injury types that have been the subject of previous reviews, namely, injuries to the spinal column and amputations, were excluded. RESULTS: The searches yielded 992 studies; 10 studies met the inclusion criteria and were rated for methodological quality. Seventeen factors were considered in more than one cohort. There was strong evidence supporting the association of female sex, older age, high pain intensity, preinjury anxiety or depression, and fewer years of education with persistent pain outcomes. There was moderate evidence supporting the association between postinjury depression or anxiety with persistent pain, and that injury severity was not a risk factor for ongoing pain. CONCLUSION: Many individuals experience persistent pain following acute trauma. Due to the lack of studies, the use of different constructs to measure the same factor and the methodological limitations associated with many of the studies, the present review was only able to reliably identify a limited set of factors that predicted persistent pain. Recommendations for the conduct of future methodologically rigorous studies of persistent pain are provided.

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.

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.

First return to work following injury: does it reflect a composite or a homogeneous outcome?

OBJECTIVE: To test whether return to work as a binary (yes/no) outcome that includes all persons who returned to work regardless of mode of return reflects a composite or a homogeneous outcome in a cohort of workers who have sustained acute orthopaedic trauma resulting in hospitalisation. METHODS: Prospective cohort study. One hundred and sixty-eight participants were recruited and followed for 6 months. The study achieved 89% follow-up. Baseline data were obtained at study recruitment and participants were further surveyed by phone at three timepoints during the study. Polytomous logistic regression was used to simultaneously examine the association between potential predictors and different modes of first return to work (RTW). A test of the equality of the ORs associated with the independent predictor variables was also undertaken. RESULTS: Of the 152 participants with full follow-up, 46 (30%) returned first to full duties, 58 (38%) returned first to modified work and 48 (32%) did not return to work during the study period. Significant determinants of the two modes of return to work were different. A test of the equality of ORs indicated that the relative ORs for the difference in the slope coefficients for five of the 10 independent factors in the two polytomous logistic regression sub-models corresponding to each mode of return to work were statistically significant. This raises the likelihood that first RTW reflects a composite rather than a homogeneous outcome. CONCLUSION: The study provides evidence that RTW may reflect a composite outcome when it includes different modes of first RTW. The identified predictive factors appear to exert different mechanisms of action depending on the mode of RTW. The findings suggest that the different modes of RTW may need to be considered independently. The results of the study have potentially important implications for research and insurance practice.

Screening for pre-clinical disability in different residential settings.

BACKGROUND: Preventing disability and offering effective interventions to older people during early decline in function is most likely to be effective if those most at risk of progressive disablement are able to be identified. Similarly the ability to easily identify a group with similar functional profile from disparate sectors of the community is of significant benefit to researchers. This study aimed to (1) describe the use of a pre-clinical disability screening tool to select a functionally comparable group of older men and women with early functional limitation from different settings, and (2) explore factors associated with function and disability. METHODS: Self-reported function and disability measured with the Late-Life Function and Disability Instrument along with a range of physical performance measurements were compared across residential settings and gender in a sample of 471 trial participants identified as pre-clinically disabled after being screened with the Fried pre-clinical disability tool. Factors that might lie on the pathway to progressive disablement were identified using multiple linear regression analysis. RESULTS: We found that a sample population, screened for pre-clinical disability, had a functional status and disability profile reflecting early functional limitation, regardless of residential setting or gender. Statistical models identified a range of factors associated with function and disability which explained a greater degree of the variation in function, than disability. CONCLUSIONS: We selected a group of people with a comparable function and disability profile, consistent with the pre-clinical stage of disability, from a sample of older Australian men and women from different residential settings using the Fried pre-clinical disability screening tool. The results suggest that the screening tool can be used with greater confidence for research, clinical and population health purposes. Further research is required to examine the validity of the tool. These findings offer insight into the type of impairment factors characterising early functional loss that could be addressed through disability prevention initiatives. TRIAL REGISTRATION: ACTRN01206000431527.

Bio-psychosocial determinants of time lost from work following non life threatening acute orthopaedic trauma.

BACKGROUND: To determine factors predicting the duration of time away from work following acute orthopaedic non life threatening trauma METHODS: Prospective cohort study conducted at four hospitals in Victoria, Australia. The cohort comprised 168 patients aged 18-64 years who were working prior to the injury and sustained a range of acute unintentional orthopaedic injuries resulting in hospitalization. Baseline data was obtained by survey and medical record review. Multivariate Cox proportional hazards regression analysis was used to examine the association between potential predictors and the duration of time away from work during the six month study. The study achieved 89% follow-up. RESULTS: Of the 168 participants recruited to the study, 68% returned to work during the six month study. Multivariate Cox proportional hazards regression analysis identified that blue collar work, negative pain attitudes with respect to work, high initial pain intensity, injury severity, older age, initial need for surgery, the presence of co-morbid health conditions at study entry and an orthopaedic injury to more than one region were associated with extended duration away from work following the injury. Participants in receipt of compensation who reported high social functioning at two weeks were 2.58 times more likely to have returned to work than similar participants reporting low social functioning. When only those who had returned to work were considered, the participant reported reason for return to work " to fill the day" was a significant predictor of earlier RTW [RR 2.41 (95% C.I 1.35-4.30)] whereas "financial security" and "because they felt able to" did not achieve significance. CONCLUSIONS: Many injury-related and psycho social factors affect the duration of time away from work following orthopaedic injury. Some of these are potentially modifiable and may be amenable to intervention. Further consideration of the reasons provided by participants for returning to work may provide important opportunities for social marketing approaches designed to alleviate the financial and social burden associated with work disability.

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.

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.