Emily Yorkston

Cohort Profile: The Nurses and Midwives e-Cohort Study—A Novel Electronic Longitudinal Study

Nurses and midwives comprise the largest professional group in most national health systems, so shortfalls in numbers can have a substantial impact on health care delivery. A scarcity of human resources in health has been internationally recognized and has led the International Council of Nurses to launch the Global Workforce Project in 2004, and the World Health Organization to announce the Health Workforce Decade 2006–15 in 2006.1,2 Efforts to address workforce needs through coherent workforce planning and policy setting are hampered by the complexity of predicting the supply of and demand for nurses and midwives, and the challenges associated with understanding drivers of workforce retention.3 Available workforce descriptors among regulatory authorities vary considerably; and collections are mostly cross-sectional, frequently incomplete and typically limited to administrative databases. In Australia and New Zealand, workforce issues include the migration of staff between states and countries, and critical personnel shortages in rural and . . . [Full Text of this Article]

Special issues in injury prevention research: developing the science of program implementation.

INTRODUCTION Despite widespread application of the public health approach to injury prevention, there is an acknowledged limitation in the extent to which it facilitates translation of research evidence to injury prevention practice. AIM In this paper we clarify the ecoepidemiological principles that underpin the public health approach to injury control in order to support explicit efforts to address the multilevel component causes and improve the evidence base on which effective program implementation depends. KEYPOINTS: If injury causation is understood in terms of the ecoepidemiological model rather than the proximal risk factor model, then quantification of the context in which the event occurs is evidently as important as quantification of the energy exchange event itself. The ecoepidemiological model of injury causation recognises barriers and facilitators to injury prevention as component causes of population burden of injury and thus delineates these factors as legitimate targets for intervention. Injury prevention programs that are designed to specifically address the factors causally related to the programs implementation, as well as the contextual factors that determine the characteristics of the energy exchange event, are more likely to be implemented and more likely to result in effective uptake of recommended energy exchange countermeasures. CONCLUSION Interventions to reduce the burden of injury in the population should address the individual level factors that increase the risk of injury, but also the upstream factors that influence the extent to which there is widespread adoption by individuals of the recommended countermeasures.

Validity and reliability of responses to a self-report home safety survey designed for use in a community-based child injury prevention programme

Objective: To quantify the validity and reliability of responses to a self-report home safety survey designed for use in a community-based child injury prevention program. Methods: A cross-sectional study of home-based injury risk factors and safety practices was administered to a random sample of households (n = 614) in two rural and remote communities in Queensland, Australia using a Computer Assisted Telephone Interview (CATI) survey. The survey was re-administered during subsequent home interviews with a sub-sample (n = 85) of CATI participants. Results: For all self-reported hazards and safety practices, prevalence estimates obtained from the CATI survey were significantly different from those directly observed at the home interview with proportions of homes exposed to hazards between 10–21% under reported at CATI survey and safety practices over-reported at CATI survey by 17–24%. There was no statistically significant difference however between the estimates of prevalence of hazards and safety practices self-reported at CATI and home interview. Validity of the CATI survey was poor with sensitivity of the CATI question ranging from 0 to 71 and specificity from 32 to 97. While the marginal distribution of prevalences of hazard prevalences and safety practices were similar between CATI and home interviews, the low level of response concordance (κ = −0.24 to 0.41) indicates that reliability of the responses to these questions was low. Conclusion: In view of these limitations in the accuracy of CATI risk factor surveys, their use for priority setting and evaluation in community-based injury prevention programs needs to be considered with caution.

Quantifying the effect of a community-based injury prevention program in Queensland using a generalized estimating equation approach

Objective: To develop a generalized estimating equation (GEE) model of childhood injury rates to quantify the effectiveness of a community-based injury prevention program implemented in 2 communities in Australia, in order to contribute to the discussion of community-based injury prevention program evaluation. Design: An ecological study was conducted comparing injury rates in two intervention communities in rural and remote Queensland, Australia, with those of 16 control regions. A model of childhood injury was built using hospitalization injury rate data from 1 July 1991 to 30 June 2005 and 16 social variables. The model was built using GEE analysis and was used to estimate parameters and to test the effectiveness of the intervention. Results: When social variables were controlled for, the intervention was associated with a decrease of 0.09 injuries/10 000 children aged 0–4 years (95% CI −0.29 to 0.11) in logarithmically transformed injury rates; however, this decrease was not significant (p = 0.36). Conclusions: The evaluation methods proposed in this study provide a way of determining the effectiveness of a community-based injury prevention program while considering the effect of baseline differences and secular changes in social variables.

Making evaluation an integral part of injury programme implementation

Uncertainty about the nature of evaluation can lead to injury prevention programme evaluations being poorly resourced and poorly conducted. The aim of this paper is to demystify programme evaluation and, by stressing its function, offer a perspective on evaluation that may encourage its more widespread integration in the general activity of injury prevention and control. Programme evaluation is best understood simply as the process of getting answers to essential questions about a programme. Methodology used in evaluation needs to be based in empirical science but is otherwise unrestricted except by the chosen question and the practical circumstances relating to the programme and the community in which it is implemented. Discussion about which methodology is appropriate for evaluation research is (unwittingly) a debate about ‘which questions should you be asking?’. If the right people ask the right (and properly formulated) questions and build the means of obtaining the information to answer these questions (using appropriate methodology) into the conduct of the programme then evaluation will no longer be a problem but an essential component of the overall effort to reduce the community burden of injury.

Inflatable rescue boat-related injuries in Queensland surf lifesavers: the epidemiology – biomechanics interface

The objective was to describe the relationship between epidemiological and biomechanical factors in the causal pathway of inflatable rescue boat (IRB)-related injuries in Australian surf lifesavers; to develop epidemiological and biomechanical methodologies and measurement instruments that identify and measure the risk factors, for use in future epidemiological studies. Epidemiological and biomechanical models of injury causation were combined. Host, agent and environmental factors that influenced total available force for transfer to host were specified. Measurement instruments for each of the specified risk factors were developed. Instruments were piloted in a volunteer sample of surf lifesavers. Participant characteristics were recorded using demographic questionnaires; IRB operating techniques were recorded using a custom-made on-board camera (Grand RF-Guard) and images of operating techniques were coded by two independent observers. Ground reaction forces transmitted to the host through the lifesavers feet at the time of wave impact were measured using a custom-built piezoelectric force platform. The demographic questionnaire was found practical; the on-board camera functioned successfully within the target environment. Agreement between independent coders of IRB operating technique images was significant (p < 0.001) with Kappa values ranging from 0.5 to 0.7. Biomechanical instruments performed successfully in the target environment. Peak biomechanical forces were 415.6N (left foot) and 252.9N (right foot). This study defines the relationship between epidemiological and biomechanical factors in modifying the risk of IRB-related injury in a population of surf lifesavers. Preliminary feasibility of combining epidemiological and biomechanical information has been demonstrated. Further testing of the proposed model and measurement instruments is required.