Lyndal Bugeja

Reliability of ICD-10 External Cause of Death Codes in the National Coroners Information System

Availability of ICD-10 cause of death codes in the National Coroners Information System (NCIS) strengthens its value as a public health surveillance tool. This study quantified the completeness of external cause ICD-10 codes in the NCIS for Victorian deaths (as assigned by the Australian Bureau of Statistics (ABS) in the yearly Cause of Death data). It also examined the concordance between external cause ICD-10 codes contained in the NCIS and a re-code of the same deaths conducted by an independent coder. Of 7,400 NCIS external cause deaths included in this study, 961 (13.0%) did not contain an ABS assigned ICD-10 code and 225 (3.0%) contained only a natural cause code. Where an ABS assigned external cause ICD-10 code was present (n=6,214), 4,397 (70.8%) matched exactly with the independently assigned ICD-10 code. Coding disparity primarily related to differences in assignment of intent and specificity. However, in a small number of deaths (n=49, 0.8%) there was coding disparity for both intent and external cause category. NCIS users should be aware of the limitations of relying only on ICD-10 codes contained within the NCIS for deaths prior to 2007 and consider using these in combination with the other NCIS data fields and code sets to ensure optimum case identification.

An analysis of stratagems to reduce drowning deaths of young children in private swimming pools and spas in Victoria, Australia

This population-based retrospective case series study examined the frequency and distribution of protective stratagems (legislatively compliant safety barrier, adequate caregiver supervision, water familiarisation and early administration of cardiopulmonary resuscitation [CPR]) amongst drowning deaths of young children (0–4 years) in private swimming pools or spas in Victoria, Australia. In 65.0% (52/80) of deaths, none of the four protective stratagems were known to be present and there was only one case where all four were known to be present. This indicates that if the presence of all four stratagems is increased, this may reduce drowning in this age group and setting. While these results are positive, further examination of the presence and interaction of these stratagems for effectiveness is required. Further research is also warranted to explore the impact of enforcement of pool fencing legislation and potential associations between water familiarisation and drowning risk. In addition, a consensus on the definition of adequate supervision in needed.

Resident-to-resident physical aggression leading to injury in nursing homes: a systematic review

BACKGROUND resident-to-resident aggression (RRA) is an understudied form of elder abuse in nursing homes. OBJECTIVE the purpose of this systematic review was to examine the published research on the frequency, nature, contributing factors and outcomes of RRA in nursing homes. METHODS in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, this review examined all original, peer-reviewed research published in English, French, German, Italian or Spanish between 1st January 1949 and 31st December 2013 describing incidents of RRA in nursing homes. The following information was extracted for analysis: study and population characteristics; main findings (including prevalence, predisposing factors, triggers, nature of incidents, outcomes and interventions). RESULTS eighteen studies were identified, 12 quantitative and 6 qualitative. The frequency of RRA ranged from 1 to 122 incidents, with insufficient information across the studies to calculate prevalence. RRA commonly occurred between exhibitors with higher levels of cognitive awareness and physical functionality and a history of aggressive behaviours, and female targets who were cognitively impaired with a history of behavioural issues including wandering. RRA most commonly took place in the afternoon in communal settings, was often triggered by communication issues and invasion of space, or was unprovoked. Limited information exists on organisational factors contributing to RRA and the outcomes for targets of aggression. CONCLUSIONS we must continue to grow our knowledge base on the nature and circumstances of RRA to prevent harm to an increasing vulnerable population of nursing home residents and ensure a safe working environment for staff.

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.

Nature and Extent of External-Cause Deaths of Nursing Home Residents in Victoria, Australia

To describe the nature and extent of external‐cause deaths of residents of nursing homes in Victoria, Australia.

The socio-environmental determinants of railway suicide: a systematic review

BackgroundRailway suicide has significant adverse impacts for the victims, their family and friends, witnesses to the incident, general public and train network. There is no previous review on the socio-environmental factors and railway suicide. The research question asked in this review was: ‘What socio-environmental risk and protective predictors are significantly associated with railway suicide?’MethodsThe review searched Medline, PsycINFO, Web of Science and Scopus for English-language studies that assessed the associations between socio-environmental (i.e. geographical, physical, economic and social) factors and railway suicide from their inception to June 2013. It was reported based on the PRISMA Statement.ResultsEleven studies met the inclusion criteria. They were categorised into railway environments (availability of railways and trains, accessibility to railways and familiarity with trains), population characteristics and impact of media reporting. Findings from ecological studies using population level railway suicide data suggested weak and inconsistent evidence for the first two categories. The evidence on the impact of media reporting was moderately strong, with irresponsible media reporting being associated with an increased risk of railway suicide.ConclusionsThere is a need for further research activity to strengthen evidence about socio-environmental risk factors for railway suicide. The focus of this research should be on the factors that determine individuals’ decisions of using the railway as a method of suicide, with the consideration of a range of geographical, physical, social, and economic factors.

The utility of medico-legal databases for public health research: a systematic review of peer-reviewed publications using the National Coronial Information System.

BackgroundMedico-legal death investigations are a recognised data source for public health endeavours and its accessibility has increased following the development of electronic data systems. Despite time and cost savings, the strengths and limitations of this method and impact on research findings remain untested. This study examines this issue using the National Coronial Information System (NCIS).MethodsPubMed, ProQuest and Informit were searched to identify publications where the NCIS was used as a data source for research published during the period 2000–2014. A descriptive analysis was performed to describe the frequency and characteristics of the publications identified. A content analysis was performed to identify the nature and impact of strengths and limitations of the NCIS as reported by researchers.ResultsOf the 106 publications included, 30 reported strengths and limitations, 37 reported limitations only, seven reported strengths only and 32 reported neither. The impact of the reported strengths of the NCIS was described in 14 publications, whilst 46 publications discussed the impacts of limitations. The NCIS was reported to be a reliable source of quality, detailed information with comprehensive coverage of deaths of interest, making it a powerful injury surveillance tool. Despite these strengths, researchers reported that open cases and missing information created the potential for selection and reporting biases and may preclude the identification and control of confounders.ConclusionsTo ensure research results are valid and inform health policy, it is essential to consider and seek to overcome the limitations of data sources that may have an impact on results.

Effectiveness of the 2005 compulsory personal flotation device (PFD) wearing regulations in reducing drowning deaths among recreational boaters in Victoria, Australia

Objective To investigate whether the Victorian mandatory personal flotation device wearing regulations that came into effect on 1 December 2005 reduced drowning deaths among recreational boaters in Victoria, Australia. Design A retrospective population-based ‘before and after’ study using Victorian coronial data on drowning deaths of occupants of recreational vessels operating in Victorian waters. Methods The annual numbers of deaths in the 5 years after the transition year of the regulations (2005) was compared with the annual numbers of deaths in the 6 years prior to the transition year, using the Mann-Whitney U test. Results There were 59 recreational boating drowning deaths in the 6-year preintervention period (1 December 1998 to 30 November 2004) compared with 16 in the 5-year postintervention period (1 December 2005 to 30 November 2010). The analysis showed a significant decrease in drowning deaths among all recreational boaters (U=30.0, p=0.01) and among these strata: vessel occupants aged 0–29 years (U=28.0, p=0.02) and 30–59 years (U=27.5, p=0.02), vessel occupants engaged in pleasure cruising (U=29.0, p=0.01) and in ‘other’ boating activities (U=25.0, p=0.04), boaters on small powerboats ≤4.8 m in length (U=29.5; p=0.01), boaters on motorised (U=29.5; p=0.01) and sail-powered vessels (U=26.0; p=0.04), and occupants of vessels operating in inland waterways (U=30.0; p=0.01). Conclusions These findings provide further support for the adoption of a regulatory approach to personal flotation device wearing to reduce drowning among recreational boaters.

The public policy approach to injury prevention

Despite widespread application of the public health approach to injury prevention, its facilitation of the translation of injury research to practice is limited. This paper describes a public policy approach to injury prevention, derived from Kingdons streams approach,1 which may circumvent the research-to-practice block, specifically for use by practitioners. The central premise of the proposed public policy approach is that policy action is a consequence of windows of opportunity created by the convergence of three streams: (1) problem recognition; (2) development of injury prevention policy; and (3) political will. The role of the injury prevention practitioner is to encourage a convergence of these elements, and thus maximise the opportunity provided to galvanise policy action. Effective injury prevention relies on creating windows of opportunity and focusing resources on achieving prolonged engagement from all aspects of society. It is not intended that the public policy approach replace the existing public health model, which remains a critical paradigm within which researchers from all disciplines can develop the evidence base for practice. Rather, the role of the public policy approach to injury prevention is to facilitate the implementation of effective countermeasures. The gap between available research evidence and effective implementation of this research by practitioners (the research-to-practice block) is an important issue that remains to be adequately addressed within the field of injury prevention.2–4 The issue is complicated by the fact that many people would consider themselves both researchers and practitioners, and there are many who do injury prevention but may not explicitly identify themselves as injury prevention practitioners.5 In this paper we use the term ‘practitioner’ to refer to any person or body with a role in injury prevention. The purpose of the paper is to explain the …

Premature deaths of nursing home residents: an epidemiological analysis

Objectives: To conduct a descriptive epidemiological analysis of external cause deaths (premature, usually injury‐related, and potentially preventable) of nursing home residents in Australia.