Stuart Newstead

Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia--an evaluation.

On July 1, 1990, a law requiring wearing of an approved safety helmet by all bicyclists (unless exempted) came into effect in Victoria, Australia. Some of the more important steps that paved the way for this important initiative (believed to be the first statewide legislation of its type in the world) are described, and the initiatives effects are analysed. There was an immediate increase in average helmet-wearing rates from 31% in March 1990 to 75% in March 1991, although teenagers continued to show lower rates than younger children and adults. The number of insurance claims from bicyclists killed or admitted to hospital after sustaining a head injury decreased by 48% and 70% in the first and second years after the law, respectively. Analysis of the injury data also showed a 23% and 28% reduction in the number of bicyclists killed or admitted to hospital who did not sustain head injuries in the first and second post-law years, respectively. For Melbourne, where regular annual surveys of helmet wearing have been conducted, it was possible to fit a logistic regression model that related the reduction in head injuries to increased helmet wearing. Surveys in Melbourne also indicated a 36% reduction in bicycle use by children during the first year of the law and an estimated increase in adult use of 44%.

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.

Riding through red lights: The rate, characteristics and risk factors of non-compliant urban commuter cyclists

This study determined the rate and associated factors of red light infringement among urban commuter cyclists. A cross-sectional observational study was conducted using a covert video camera to record cyclists at 10 sites across metropolitan Melbourne, Australia from October 2008 to April 2009. In total, 4225 cyclists faced a red light and 6.9% were non-compliant. The main predictive factor for infringement was direction of travel, cyclists turning left (traffic travels on the left-side in Australia) had 28.3 times the relative odds of infringement compared to cyclists who continued straight through the intersection. Presence of other road users had a deterrent effect with the odds of infringement lower when a vehicle travelling in the same direction was present (OR=0.39, 95% CI 0.28-0.53) or when other cyclists were present (OR=0.26, 95% CI 0.19-0.36). Findings suggest that some cyclists do not perceive turning left against a red signal to be unsafe and the opportunity to ride through the red light during low cross traffic times influences the likelihood of infringement.

Firearm related deaths: the impact of regulatory reform

Objectives: To examine trends in rates of firearm related deaths in Victoria, Australia, over 22 years in the context of legislative reform and describe and investigate impact measures to explain trends. Design: Mortality data were extracted from vital statistics for 1979–2000. Data on firearm related deaths that were unintentional deaths, assaults, suicides, and of undetermined intent were analyzed. Rates were calculated with population data derived from estimates by the Australian Bureau of Statistics. A quasi-experimental design that used a Poisson regression model was adopted to compare relative rates of firearm related deaths for Victoria and the rest of Australia over three critical periods of legislative reform. The Wilcoxon signed ranks test was used to assess changes in the types of firearm related deaths before and after 1998. Results: In Victoria, two periods of legislative reform related to firearms followed mass shooting events in 1988 and 1996. A national firearm amnesty and buyback scheme followed the latter. Victorian and Australian rates of firearm related deaths before reforms (1979–86) were steady. After initial Victorian reforms, a significant downward trend was seen for numbers of all firearm related deaths between 1988 and 1995 (17.3% in Victoria compared with the rest of Australia, p<0.0001). A further significant decline between 1997 and 2000 followed the later reforms. After the later all state legislation, similar strong declines occurred in the rest of Australia from 1997 (14.0% reduction compared with Victoria, p = 0.0372). Victorian reductions were observed in frequencies of firearm related suicides, assaults, and unintentional deaths before and after the 1988 reforms, but statistical significance was reached only for suicide. Conclusion: Dramatic reductions in overall firearm related deaths and particularly suicides by firearms were achieved in the context of the implementation of strong regulatory reform.

The crash reduction effectiveness of a network-wide traffic police deployment system

Random Road Watch (RRW) is a traffic policing program in operation in Queensland, Australia. It differs from conventional traffic policing in that an explicit resource management technique is used which randomly schedules low levels of police enforcement in a manner intended to provide long-term, widespread coverage of a road network and hence maximise road safety benefits. Implementation of the program studied in Queensland covered 55% of total crashes within the state. This study aimed to measure the crash effects of the RRW program in Queensland. A quasi-experimental study design was used for the evaluation incorporating Poisson regression statistical analysis techniques. Analysis of the effects of the Queensland RRW program on crash frequency has shown the program to be effective overall. Estimated program effects were largest on fatal crashes, with an estimated reduction of 31%. Estimated aggregate program crash effects reduced with crash severity and increased with time after program introduction. Crash reductions in the third year after program introduction translated into savings, at state level, of some 12% of the states crashes of all severities and some 15% of the states fatal road crashes. Overall, the program produced a significant 11% reduction in total crashes in areas outside of metropolitan Brisbane. The opportunity-cost benefit/cost ratio for the program was estimated to be 55:1.

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.

Effectiveness of Mandatory License Testing for Older Drivers in Reducing Crash Risk Among Urban Older Australian Drivers

Most licensing jurisdictions in Australia maintain mandatory assessment programs targeting older drivers, whereby a driver reaching a specified age is required to prove his or her fitness to drive through medical assessment and/or on-road testing. Previous studies both in Australia and elsewhere have consistently failed to demonstrate that age-based mandatory assessment results in reduced crash involvement for older drivers. However studies that have based their results upon either per-population or per-driver crash rates fail to take into account possible differences in driving activity. Because some older people maintain their driving licenses but rarely if ever drive, the proportion of inactive license-holders might be higher in jurisdictions without mandatory assessment relative to jurisdictions with periodic license assessment, where inactive drivers may more readily either surrender or lose their licenses. The failure to control for possible differences in driving activity across jurisdictions may be disguising possible safety benefits associated with mandatory assessment. The current study compared the crash rates of drivers in Melbourne, Australia, where there is no mandatory assessment and Sydney, Australia, where there is regular mandatory assessment from 80 years of age onward. The crash rate comparisons were based on four exposure measures: per population, per licensed driver, per distance driven, and per time spent driving. Poisson regression analysis incorporating an offset to control for inter-jurisdictional road safety differences indicated that there was no difference in crash risk for older drivers based on population. However drivers aged 80 years and older in the Sydney region had statistically higher rates of casualty crash involvement than their Melbourne counterparts on a per license issued basis (RR: 1.15, 1.02–1.29, p = 0.02) and time spent driving basis (RR: 1.19, 1.06–1.34, p = 0.03). A similar trend was apparent based on distance travelled but was of borderline statistical significance (RR: 1.11, 0.99–1.25, p = 0.07). Collectively, it can be inferred from these findings that mandatory license re-testing schemes of the type evaluated have no demonstrable road safety benefits overall. Further research to resolve this on-going policy debate is discussed and recommended.

DETERMINANTS OF RETURN TO WORK FOLLOWING NON-LIFE-THREATENING ACUTE ORTHOPAEDIC TRAUMA: A PROSPECTIVE COHORT STUDY

OBJECTIVE To determine factors associated with return to work following acute non-life-threatening orthopaedic trauma. DESIGN Prospective cohort study. PARTICIPANTS One hundred and sixty-eight participants were recruited and followed for 6 months. The study achieved 89% participant follow-up. METHODS Baseline data were obtained by survey and medical record review. Participants were further surveyed at 2 weeks, 3 and 6 months post-injury. Logistic regression was used to examine the association between potential predictors and first return to work by these 3 time-points. RESULTS Sixty-eight percent of participants returned to work within 6 months. Those who sustained isolated upper extremity injuries were more likely to return to work early. Significant positive determinants of return to work included a strong belief in recovery, the presence of an isolated injury, education to university level and self-employment. Determinants associated with non-return to work included the receipt of compensation, older age, pain attitudes and blue-collar work. The primary reason given for return to work was financial security. CONCLUSION Demographic, injury, occupation and psychosocial factors were significant predictors of return to work. The relative importance of factors at different time-points suggests that return to work is a multifactorial process that involves the complex interaction of many factors in a time-dependent manner.

A systematic review of early prognostic factors for persistent 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.

Analysis of factors that increase motorcycle rider risk compared to car driver risk

As in other parts of the Western world, there is concern in New Zealand about increasing popularity of motorcycles because of potential increases in road trauma. This study sought to identify important factors associated with increased risk for motorcyclists to inform potential policy approaches to reduce motorcyclist injury, such as changes to motorcyclist licensing, training and education. Using data extracted from a register of all New Zealand licensed motor vehicles that were matched to crash data, statistical models were fitted to examine patterns of motorcycle risk in comparison with small cars. These showed generally elevated risks for motorcyclists compared to cars, but particularly elevated risks for motorcycle owners aged in their 20s or who lived in more urbanised settings. In crashes, motorcyclists have little protection from injury, putting the motorcyclist at high risk of injury. When comparing new motorcycles with new cars, the odds of fatal or serious injury to a motorcycle rider involved in an injury crash were almost eight times the odds for a car driver.