Roderick John McClure

AGE AND GENDER DIFFERENCES IN RISK-TAKING BEHAVIOUR AS AN EXPLANATION FOR HIGH INCIDENCE OF MOTOR VEHICLE CRASHES AS A DRIVER IN YOUNG MALES

Risk-taking behaviour has been identified as a possible explanation for the high incidence of motor vehicle crashes involving young male drivers. This study examines the extent to which differences in risk-taking behaviour explain the differential crash rates by age and gender. A random sample of 689 adults aged 17-88 were selected from motor vehicle license holders within randomly selected geographical areas across Queensland. Participants completed a questionnaire covering their attitudes towards driving behaviour and general risk-taking behaviour, selected demographic characteristics and self-reported history of road crashes as a driver. Univariate analysis showed that males scored higher means than females in driver aggression and thrill seeking and in their general risk acceptance. Multivariate logistic regression analysis indicated that males were twice as likely (OR 2.46, CI 1.59-3.83) to have reported at least one crash as a driver compared to females and nearly three times as likely (OR 2.88, CI 1.84-4.49) to have reported two or more crashes. Drivers aged 17-29 were also twice as likely (OR 2.31, CI 1.10-4.19) to have reported at least one crash when compared to those aged over 50 years. When risk-taking behaviours were introduced into the logistic model the odds of males (OR 1.70, CI 1.29-3.30) or 17-29 year olds (OR 1.30, CI 0.93-3.91) being involved in at least one crash substantially reduced. An increased risk of a crash as a driver can, in part, be explained by the age and gender differential in risk-taking behaviour. The challenge for public health professionals is to determine suitable strategies to modify risk-taking behaviour in young or male drivers.

INJURY AND RISK-TAKING BEHAVIOR - A SYSTEMATIC REVIEW

There is a substantial body of work in the scientific literature discussing the role of risk-taking behavior in the causation of injury. Despite the quantity of diverse writings on the subject most is in the form of theoretical commentaries. This review was conducted to critically assess the empirical evidence supporting the association between injury and risk-taking behavior. The review found six case-control studies and one retrospective cohort study, which met all the inclusion criteria. Meta-analysis was not possible due to the diversity of the independent and outcome variables in each of the studies reviewed. Overall the review found that risk-taking behavior, however it is measured, is associated with an increased chance of sustaining an injury except in the case of high skilled, risk-taking sports where the effect may be in the other direction. Drawing specific conclusions from the research presented in this review is difficult without an agreed conceptual framework for examining risk-taking behavior and injury. Considerable work needs to be done to provide a convincing evidence base on which to build public health interventions around risk behavior. However, sufficient evidence exists to suggest that effort in this area may be beneficial for the health of the community.

Combining non-parametric models with logistic regression: an application to motor vehicle injury data

To date, computer-intensive non-parametric modelling procedures such as classification and regression trees (CART) and multivariate adaptive regression splines (MARS) have rarely been used in the analysis of epidemiological studies. Most published studies focus on techniques such as logistic regression to summarise their results simply in the form of odds ratios. However flexible, non-parametric techniques such as CART and MARS can provide more informative and attractive models whose individual components can be displayed graphically. An application of these sophisticated techniques in the analysis of an epidemiological case-control study of injuries resulting from motor vehicle accidents has been encouraging. They have not only identified potential areas of risk largely governed by age and number of years driving experience but can also identify outlier groups and can be used as a precursor to a more detailed logistic regression analysis.

Healthy ageing: how is it defined and measured?

A review of existing studies which defined and measured healthy ageing as an outcome was undertaken to clarify the term for the purposes of informing policy development and further research into positive health outcomes in older age. Studies which measured the prevalence of healthy (or successful) ageing in population‐based settings were identified from a search of health and gerontology databases. Eighteen studies met the selection criteria. The arbitrary nature of the definition, populations sampled, domains selected and measures within the domains resulted in considerable variation between the studies in the proportion of the study population classified as ‘healthy ageing’, which ranged from 3% to 80%.

Population based study of hospitalised fall related injuries in older people

Objective: This study aimed to identify the distribution of fall related injury in older people hospitalised for acute treatment of injury, in order to direct priorities for prevention. Setting: A follow up study was conducted in the Brisbane Metropolitan Region of Australia during 1998. Methods: Medical records of patients aged 65 years and over hospitalised with a fall related injury were reviewed. Demographic and injury data were analysed and injury rates calculated using census data as the denominator for the population at risk. Results: From age 65, hospitalised fall related injury rates increased exponentially for both males and females, with age adjusted incidence rates twice as high in women than men. Fractures accounted for 89% of admissions, with over half being to the hip. Males were significantly more likely than females to have fractured their skull, face, or ribs (p<0.01). While females were significantly more likely than males to have fractured their upper or lower limbs (p<0.01), the difference between proportions of males and females fracturing their hip was not significant. Males were more likely than females (p<0.01) to have fall related head injuries (13% of admissions). Compared with hip fractures, head injuries contributed significantly to the burden of injury in terms of severity, need for intensive care, and excess mortality. Conclusions: The frequency and impact of hip fractures warrants continued emphasis in falls program interventions for both males and females to prevent this injury. However, interventions that go beyond measures to slow and protect against bone loss are also needed to prevent fall related head injuries.

A systematic review of early prognostic factors for return to work following acute orthopaedic trauma

INTRODUCTION Acute orthopaedic trauma is a major contributor to the global burden of disease. This study aims to synthesise and summarise current knowledge concerning prognostic factors for return to work and duration of work disability following acute orthopaedic trauma. METHODS A systematic review of prognostic studies was performed. The Medline, Embase, PsychINFO, CINAHL and AMED electronic databases were searched for studies between 1985 and May 2009. Included studies were longitudinal, reported results with multivariate statistical analyses appropriate to prognostic studies, comprised persons employed at the time of the injury, included prognostic factors measured proximal to the injury and focused on upper and lower extremity injuries. RESULTS Searches yielded 980 studies of which 15 met the inclusion criteria and were rated for methodological quality. Analysis focused on the 14 factors considered in more than one study. There was limited evidence for the role of any factor as a predictor of return to work. There is strong evidence for level of education and blue collar work and moderate evidence for self-efficacy, injury severity and compensation as prognostic factors for the duration of work disability. Significant methodological issues were encountered in the course of the review that limited interpretation of the evidence and the conclusions that could be drawn from the findings. CONCLUSION People who have sustained acute orthopaedic trauma regardless of severity experience difficulties in returning to work. Due to the lack of factors considered in more than one cohort, the results of this review are inconclusive. The review highlights the need for more prospective studies that are methodologically rigorous, have larger sample sizes and considers a comprehensive range of factors.

Land use, transport, and population health: estimating the health benefits of compact cities

Using a health impact assessment framework, we estimated the population health effects arising from alternative land-use and transport policy initiatives in six cities. Land-use changes were modelled to reflect a compact city in which land-use density and diversity were increased and distances to public transport were reduced to produce low motorised mobility, namely a modal shift from private motor vehicles to walking, cycling, and public transport. The modelled compact city scenario resulted in health gains for all cities (for diabetes, cardiovascular disease, and respiratory disease) with overall health gains of 420-826 disability-adjusted life-years (DALYs) per 100 000 population. However, for moderate to highly motorised cities, such as Melbourne, London, and Boston, the compact city scenario predicted a small increase in road trauma for cyclists and pedestrians (health loss of between 34 and 41 DALYs per 100 000 population). The findings suggest that government policies need to actively pursue land-use elements-particularly a focus towards compact cities-that support a modal shift away from private motor vehicles towards walking, cycling, and low-emission public transport. At the same time, these policies need to ensure the provision of safe walking and cycling infrastructure. The findings highlight the opportunities for policy makers to positively influence the overall health of city populations.

The public health impact of minor injury

The mortality and hospital morbidity data usually used to quantify the burden of injury are generally considered to represent only the tip of the iceberg. This article documents the population-based morbidity arising from non-hospitalised injuries and demonstrates the public health importance of this group of injuries. A prospective cohort study was conducted in an Australian population using a sample of injured adults to identify the health outcomes arising from the range of injuries. The total health loss caused by injury experienced by these subjects over the period of injury recovery was calculated and then weighted to provide population estimates. This study has shown that minor injuries are responsible for the greater part of the injury-related health burden in the adult community. Injuries that can be coded as 1 on the Abbreviated Injury Scale account for 80% of the morbidity arising over the first six months after injury and about 75% of the estimated lifetime morbidity. The lifetime estimates of morbidity resulting from injuries not considered serious enough to admit to hospital were of an order of magnitude higher than those that resulted in either death or hospitalisation. Sprains contributed as much to the total morbidity as all other injuries types combined and limb injuries contributed more to the total morbidity than injuries to the more central structures. The results of this study provide a strong argument for the recognition of the public health importance of minor injury. Strategies for the prevention and management of minor injury must be included in national programmes for injury control.

Bio-Psychosocial Determinants of Persistent Pain 6 Months After Non-Life-Threatening Acute Orthopaedic Trauma

UNLABELLED The study quantifies the association between a range of bio-psychosocial factors and the presence of persistent pain, pain severity and pain interfering with normal work activities in a cohort of 168 patients with a range of non-life-threatening orthopaedic injuries. Participants were recruited following presentation to 1 of 4 Victoria hospitals for treatment for their injury and followed until 6 months postinjury. Multivariate analysis was employed to determine factors associated with pain outcomes, 6 months postinjury. The prevalence of pain was common; 54% of participants reported the presence of persistent pain at 6 months, with the majority (87%) reporting that pain interfered to an extent with their normal work activities. High initial pain, external attributions of responsibility for the injury, and psychological distress were found to be significant independent predictors of the presence of all 3 outcomes. In addition, poor recovery expectations was found to be a significant predictor of pain-related work disability and being injured at work a significant predictor of pain severity. Many of these factors are potentially modifiable and should alert the clinician about the need for interventions in order to prevent the development of pain chronicity. PERSPECTIVE This study has quantified determinants of pain, 6 months after non-life-threatening acute orthopaedic trauma. Psychosocial factors strongly predicted persistent pain, pain-related work disability, and pain severity. These findings may assist clinicians to determine the need for, and likely effectiveness of, individual pain-management approaches in this population.

Ten-year outcomes following traumatic brain injury: A population-based cohort

Primary objective: To quantify the 10 year health service use (HSU) and mortality outcomes for people with a traumatic brain injury (TBI). Research design: A population-based matched cohort study using linked administrative data from Manitoba, Canada (Manitoba Injury Outcome Study). Methods and procedures: An inception cohort (1988–1991) of hospitalized cases with TBI aged 18–64 years (n= 1290) was identified and matched to a non-injured comparison group (n= 1290). Survival analysis, Negative binomial and Poisson regression were used to quantify associations between injury and HSU/mortality outcomes for 10 years following the TBI event. Main outcome and results: The majority of deaths (47.2%) occurred in the first 60 days following injury. Excluding the first 60 days, the adjusted 10 year mortality remained elevated (mortality rate ratio = 1.48, 95% CI = 1.02–2.15). After adjusting for demographic characteristics and pre-existing health status, the TBI cohort had more post-injury hospitalizations (rate ratio (RR) = 1.54, 95% CI = 1.39–1.71), greater cumulative lengths of stay (RR = 5.14, 95% CI = 3.29–8.02) and a greater post-injury physician claims rate (RR = 1.44, 95% CI = 1.35–1.53) than the non-injured cohort. Conclusions: People who sustain a TBI and survive the initial acute phase of care experience substantially increased long-term morbidity compared to the general population, regardless of the level of injury severity.