The utility of a workplace injury instrument in prediction of workplace injury

Workplace injuries are common and destructive to persons, organisations, and society. Various instruments presently exist that are designed to assess the factors underlying workplace injury. The study reports on the construct and predictive validity of a 46-item instrument, the safety perception survey (SPS), currently used to assess safety climate in industrial organisations throughout Australia. Initially, factor analysis was conducted on the data from a sample of 1238 employees from nine organisations, which indicated a one-factor solution, was the best fit. A structural equation model (SEM) linking injury rates to the safety climate measure for 16 sub-groups of six industrial organisations indicated that the measure contributed just 23% of the variance in injury rates. Interestingly, the results indicated that the number of employees was a better and more significant predictor of injury (R² = 0.48). It is proposed that the SPS as is would need to be modified significantly from its current form to produce improvements in validity, as in its current form the survey is no more predictive of injury than organisational size. Future research into safety climate measures should incorporate predictive validity analysis on injury rates, as for many organisations; this is a performance outcome measure.

Laboratory enhanced surveillance for meningococcal disease in Victoria

Objective: To describe the epidemiological and microbiological characteristics and notification patterns of invasive meningococcal disease (IMD) in Victoria between 1990 and 1999.

Methods: Cases of IMD occurring between 1990 and 1995 identified in any of three databases were combined, matching where possible. Statistical modelling provided estimates of cases missing from all datasets. Notification sources for 1999 and 2000 cases were identified. Cases identified from notification and laboratory results provided the data to describe IMD epidemiology between 1990 and 1999.

Results: Between 1990 and 1995, 479 cases of IMD were identified. Three individual datasets each identified between 62 and 82% of cases and 47% of cases were identified in all three datasets. Statistical modelling estimated that between 37 and 83 additional cases were not identified by any dataset. Serogroup B and C strains caused 63 and 33% of culture-positive cases, respectively, with a substantial rise in serogroup C cases in 1999. Epidemiological characteristics remained relatively constant between 1990 and 1998, but an increase in patient age was seen in cases with serogroup C disease in 1999. In addition to three clonal strains seen elsewhere, an additional strain was identified that was unique to Victoria. Since January 1999, only 72% of notifications have come from treating doctors.

Conclusions: Meningococcal disease is of increasing public health significance in Victoria. Laboratory enhanced notification has improved case identification and detailed microbiological information has improved our understanding of the changing epidemiology of this disease. Collaboration with laboratories and other agencies, active investigation of putative cases and microbiological monitoring are important elements in supporting public health decisions about the control of IMD.

Injury profiles of Indigenous and non-Indigenous people in New South Wales

Objectives:
To compare the injury profiles of the Indigenous population in New South Wales with that of the non-Indigenous population.
Design and setting:
Descriptive analysis of NSW Health data obtained from the Health Outcomes Information and Statistical Toolkit (HOIST) database. Hospitalisation data were collected for the period 1 July 1999 to 30 June 2003. Mortality data were collected for the period 1 January 1999 to 31 December 2002.
Main outcome measures:
Hospitalisation and death rates due to injury by age, sex, injury mechanism and Indigenous status. Rate ratios for comparison between Indigenous and non-Indigenous populations.
Results:
Rates of death from injury were higher for all age groups in the Indigenous population, except people older than 65 years. Indigenous people aged 25–44 years were twice as likely to be hospitalised as their non-Indigenous counterparts (rate ratio [RR], 2.09; 95% CI, 2.03–2.14), and five times as likely to be hospitalised for interpersonal violence (RR, 5.19; 95% CI, 4.98–5.40).
Conclusion:
The higher rates of injury-related hospitalisation and death in the Indigenous population in NSW are consistent with data reported for other parts of Australia. Of particular concern is the number of Indigenous deaths and hospitalisations due to interpersonal violence.

Injury prevention during physical activity in the Australian Defence Force

Introduction:
Injuries sustained by Australian Defence Force (ADF) personnel during non-combat military training and sports activity are associated with increasing costs due to work days lost, medical treatment, compensation, and early retirement. In 2001, the ADF commissioned a systematic review of the evidence-base for reducing injuries associated with physical activity, while at the same time improving physical activity participation rates to sustain a trained, fit and deployable workforce.

Method:
Literature from on-line library databases, relevant unclassified military reports, and material from previously published sport-specific injury countermeasure reviews were systematically and critically analysed to address the study aims.

Results:
Modification of intensity, frequency and duration of basic military training activities and improved equipment is likely to reduce injury occurrence. Sports injury countermeasures used for the civilian population have merit for the ADF physical activity program. Injury countermeasures should be designed to minimise any possible deterrent effect on the motivation to participate in regular physical activity. Increasing the participation of ADF personnel in physical activity in the presence of evidence-based injury prevention strategies has the potential to increase health, fitness and deployability with minimal impact on injury frequency.

Conclusion:
Recommendations arising from the review include injury intervention trials in basic military training and sports. These and other interventions should be supported by refinement to ADF injury surveillance systems. Research should focus on interventions with the greatest gain for fitness, deployability, and cost effectiveness.

Burden of disease and injury in Aboriginal and non-Aboriginal populations in the Northern Territory

Objective:
To quantify the burden of disease and injury for the Aboriginal and non-Aboriginal populations in the Northern Territory.

Design and setting:
Analysis of Northern Territory data for 1 January 1994 to 30 December 1998 from multiple sources.

Main outcome measures:
Disability-adjusted life-years (DALYs), by age, sex, cause and Aboriginality.

Results:
Cardiovascular disease was the leading contributor (14.9%) to the total burden of disease and injury in the NT, followed by mental disorders (14.5%) and malignant neoplasms (11.2%). There was also a substantial contribution from unintentional injury (10.4%) and intentional injury (4.9%). Overall, the NT Aboriginal population had a rate of burden of disease 2.5 times higher than the non-Aboriginal population; in the 35-54-year age group their DALY rate was 4.1 times higher. The leading causes of disease burden were cardiovascular disease for both Aboriginal men (19.1%) and women (15.7%) and mental disorders for both non-Aboriginal men (16.7%) and women (22.3%).

Conclusions:
A comprehensive assessment of fatal and non-fatal conditions is important in describing differentials in health status of the NT population. Our study provides comparative data to identify health priorities and facilitate a more equitable distribution of health funding.

Risky driving habits and motor vehicle driver injury

Risky driving is an important cause of motor vehicle injury, but there is a lack of good epidemiological data in this field, particularly data comparing risky driving in younger drivers to those of other age groups. We examined the relationship between risky driving habits, prior traffic convictions and motor vehicle injury using cross-sectional data amongst 21,893 individuals in New Zealand, including 8029 who were aged 16–24 years. Those who reported frequently racing a motor vehicle for excitement or driving at 20 km/h or more over the speed limit, and those who had received traffic convictions over the past 12 months, were between two and four times more likely to have been injured while driving over the same time period. Driving unlicensed was a risk factor for older but not younger drivers, and driving at 20 km/h or more above the speed limits was a stronger risk factor for younger (<25 years) than older drivers. These results confirm the need for interventions targeting risky driving and suggest that different strategies may be required for different high-risk groups.

Helmets for preventing injury in motorcycle riders

Background: Motorcycle crash victims form a high proportion of those killed or injured in road traffic accidents. Injuries to the head, following motorcycle crashes, are a common cause of severe morbidity and mortality. It seems intuitive that helmets should protect against head injuries but it has been argued that motorcycle helmet use decreases rider vision and increases neck injuries. This review will collate the 'current available evidence on helmets and their impact on mortality, and head, face and neck injuries following motorcycle crashes.

Objectives: To quantify the effectiveness of wearing a motorcycle helmet in reducing mortality and head and neck injury following motorcycle crashes.

Search strategy: Databases including the Cochrane Injuries Group Specialised Register, Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1,2003), MEDLINE (January 1966 to February 2003), EMBASE (January 1985 to February 2003), CINAHL (January 1982 to February 2003), IRRD (International Road Research Documentation), TRANSDOC, TRIS (Transport Research Information Service), ATRI (Australian Transport Index) (1976 to Feb 2003), Science Citation Index were searched for relevant articles. Web sites of traffic and road accident research bodies including government agencies were also searched. Reference lists from topic reviews, identified studies and bibliographies were examined for relevant articles.

Selection criteria: We considered for inclusion studies that investigated a population of motorcycle riders who had crashed, examining helmet use as an intervention and with outcomes that included one or more of the following: death, head, neck or facial injury. Studies included any that compared an intervention and control group and, therefore, included any randomised controlled trials, non-randomised controlled trials, cohort, case-control and cross-sectional studies. Ecological and case series studies were excluded.

Data collection and analysis: Two reviewers independently screened reference lists for eligible articles. Two reviewers independently assessed articles for inclusion criteria. Data were abstracted by two independent reviewers using a standard abstraction form.

Main results: Fifty-three observational studies were identified of varying quality. Despite methodological differences there was a remarkable consistency in results, particularly for mortality and head injury outcomes. Motorcycle helmets appear to reduce the risk of mortality although, due to heterogeneity in study design, an overall estimate of effect was not calculated. There was some evidence that the effect of helmets on mortality is modified by speed. Motorcycle helmets were found to reduce the risk of head injury and from five well-conducted studies the risk reduction is estimated to be 72% (OR 0.28, 95%CI 0.23,0.35). Insufficient evidence was found to estimate the effect of motorcycle helmets compared with no helmet on facial or neck injuries. However, studies of poorer quality suggest that helmets have no effect on the risk of neck injuries and are protective for facial injury. There was insufficient evidence to demonstrate whether differences in helmet type confer more or less advantage in injury reduction.

Conclusions: Motorcycle helmets reduce the risk of mortality and head injury in motorcycle riders who crash, although the former effect may be modified by other crash factors such as speed. Further well-conducted research is required to determine the effects of helmets and different helmet types on mortalIty, head, neck and facial injuries. However, the findings suggest that global efforts to reduce road traffic injuries may be facilitated by increasing helmet use by motorcyclists.

Older people playing ball : what is the risk of falling and injury?

Increasing physical activity amongst seniors is important for public health, yet guidance is needed to minimise injury risks. To describe the incidence of falls/injuries in a walking team ball game (Lifeball) designed for seniors, a prospective cohort study was undertaken amongst community dwelling Lifeball participants in Australia. Players completed a telephone survey soon after commencing Lifeball (2004) and 12 months later (2005). Attendance and incident records were audited for the period. Subjects joined a Lifeball group with opportunity to play at least once per week. Baseline was completed by 284 players aged between 40 and 96 years (mean 67 years), with most (83.8%, 238/284) female. Of 263 followed up, the average attendances was 25, with 19.3% attending on fewer than 4 occasions and 14.3% attending 52 or more times. Most (93.9%) reported no injuries requiring medical attention. However, 16 (6.1%) had injuries requiring medical attention and their 27 injuries represent an injury rate of 3.3 per 1000 hours of participation. Twenty participants (7.6%) had a Lifeball fall equating to a fall rate of 2.8 per 1000 hours of participation. Falls in Lifeball were not associated with measured predictors (age, gender, falls history, perceived falls risk or hours played). Incident records showed a trip/stumble involving rushing, walking backwards, or overextending (all against rules) as common falling causes. Lifeball is not ‘risk free’ however due to a lack of comparative data it is difficult to compare injury rate to relevant activities. Prevention of injury should concentrate on enforcing safety rules.

Reconstructing the incidence of human immunodeficiency virus (HIV) in Hong Kong by using data from HIV positive tests and diagnoses of acquired immune deficiency syndrome

The human immunodeficiency virus–acquired immune deficiency syndrome (HIV–AIDS) epidemic in Hong Kong has been under surveillance in the form of voluntary reporting since 1984. However, there has been little discussion or research on the reconstruction of the HIV incidence curve. This paper is the first to use a modified back-projection method to estimate the incidence of HIV in Hong Kong on the basis of the number of positive HIV tests only. The model proposed has several advantages over the original back-projection method based on AIDS data only. First, not all HIV-infected individuals will develop AIDS by the time of analysis, but some of them may undertake an HIV test; therefore, the HIV data set contains more information than the AIDS data set. Second, the HIV diagnosis curve usually has a smoother pattern than the AIDS diagnosis curve, as it is not affected by redefinition of AIDS. Third, the time to positive HIV diagnosis is unlikely to be affected by treatment effects, as it is unlikely that an individual receives medication before the diagnosis of HIV. Fourth, the induction period from HIV infection to the first HIV positive test is usually shorter than the incubation period which is from HIV infection to diagnosis of AIDS. With a shorter induction period, more information becomes available for estimating the HIV incidence curve. Finally, this method requires the number of positive HIV diagnoses only, which is readily available from HIV–AIDS surveillance systems in many countries. It is estimated that, in Hong Kong, the cumulative number of HIV infections during the period 1979–2000 is about 2600, whereas an estimate based only on AIDS data seems to give an underestimate.

Barriers experienced by Asians in accessing injury-related services and compensations

Introduction: The Accident Compensation Corporation (ACC) administers New Zealand’s (NZ) accident compensation scheme. Asians in NZ are apparently under-serviced by ACC and may be experiencing barriers to accessing services. This study identifies barriers that Asians in NZ face in accessing ACC’s injury-related services and compensations.

Methods: By utilising a qualitative research design, 113 Chinese, Korean, Indian, and South East Asian participants residing in Auckland, NZ were recruited through maximum variation and purposive snowball sampling. Data were gathered during 2006 through 22 individual in-depth interviews and 14 focus group discussions based on semi-structured interview schedules. Interviewees included Asian general practitioners, traditional health providers, users and non-users of injury-related services, case managers and Asian community leaders. Data were analysed using a general inductive approach.

Findings: Results show that personal/cultural characteristics such as age, gender, English language competence, injury-related language competence, differing Asian worldviews, and consequent help-seeking behaviours act as barriers to accessing services and entitlements. This is exacerbated by logistical and environmental factors such as cost, transport, time, inadequate interpretation and translation services, as well as institutional barriers such as lack of information about services, culturally inappropriate services, discriminatory attitudes and employment risks.

Conclusion: It is evident that Asians living in NZ are experiencing several cultural, environmental and institutional barriers to accessing ACC services. There is clearly a need for more culturally relevant information and injury-related services if Asian immigrants’ use of such services and entitlements is to be increased.

Ozbot and haptics : remote surveillance to physical presence

This paper reports on robotic and haptic technologies and capabilities developed for the law enforcement and defence community within Australia by the Centre for Intelligent Systems Research (CISR). The OzBot series of small and medium surveillance robots have been designed in Australia and evaluated by law enforcement and defence personnel to determine suitability and ruggedness in a variety of environments. Using custom developed digital electronics and featuring expandable data busses including RS485, I2C, RS232, video and Ethernet, the robots can be directly connected to many off the shelf payloads such as gas sensors, x-ray sources and camera systems including thermal and night vision. Differentiating the OzBot platform from its peers is its ability to be integrated directly with haptic technology or the 'haptic bubble' developed by CISR. Haptic interfaces allow an operator to physically 'feel' remote environments through position-force control and experience realistic force feedback. By adding the capability to remotely grasp an object, feel its weight, texture and other physical properties in real-time from the remote ground control unit, an operator's situational awareness is greatly improved through Haptic augmentation in an environment where remote-system feedback is often limited.

Identification of a by-product of nitric oxide synthase activity in human acute brain injury with in vivo proton magnetic resonance spectroscopy

BACKGROUND AND PURPOSE: Laboratory studies have been used to identify nitric oxide as a notable mediator in neuronal death after acute brain injury. To our knowledge, this has not previously been confirmed with in vivo study in humans. Our purpose was to seek in vivo evidence for the induction of nitric oxide synthase (NOS) in human acute brain injury by using proton MR spectroscopy.

METHODS: In vitro proton MR spectra were obtained in neural extracts from 30 human cadavers, and in vivo spectra were obtained in 20 patients with acute brain injury and in a similar number of control subjects.

RESULTS: We identified a unique peak at 3.15 ppm by using in vivo proton MR spectroscopy in eight of 20 patients with acute brain injury but not in 20 healthy volunteers (P < .002). On the basis of in vitro data, we have tentatively assigned this peak to citrulline, a NOS by-product.

CONCLUSION: To our knowledge, our findings suggest, for the first time, that excitotoxicity may occur in human acute brain injury. Confirmation with the acquisition of spectra in very early acute cerebral injury would provide a rationale for the use of neuroprotective agents in these conditions, as well as a new noninvasive method for quantification.

Neuromuscular adaptations to training, injury and passive interventions: implications for running economy

Performance in endurance sports such as running, cycling and triathlon has long been investigated from a physiological perspective. A strong relationship between running economy and distance running performance is well established in the literature. From this established base, improvements in running economy have traditionally been achieved through endurance training. More recently, research has demonstrated short-term resistance and plyometric training has resulted in enhanced running economy. This improvement in running economy has been hypothesized to be a result of enhanced neuromuscular characteristics such as improved muscle power development and more efficient use of stored elastic energy during running. Changes in indirect measures of neuromuscular control (i.e. stance phase contact times, maximal forward jumps) have been used to support this hypothesis. These results suggest that neuromuscular adaptations in response to training (i.e. neuromuscular learning effects) are an important contributor to enhancements in running economy. However, there is no direct evidence to suggest that these adaptations translate into more efficient muscle recruitment patterns during running. Optimization of training and run performance may be facilitated through direct investigation of muscle recruitment patterns before and after training interventions.

There is emerging evidence that demonstrates neuromuscular adaptations during running and cycling vary with training status. Highly trained runners and cyclists display more refined patterns of muscle recruitment than their novice counterparts. In contrast, interference with motor learning and neuromuscular adaptation may occur as a result of ongoing multidiscipline training (e.g. triathlon). In the sport of triathlon, impairments in running economy are frequently observed after cycling. This impairment is related mainly to physiological stress, but an alteration in lower limb muscle coordination during running after cycling has also been observed. Muscle activity during running after cycling has yet to be fully investigated, and to date, the effect of alterations in muscle coordination on running economy is largely unknown. Stretching, which is another mode of training, may induce acute neuromuscular effects but does not appear to alter running economy.

There are also factors other than training structure that may influence running economy and neuromuscular adaptations. For example, passive interventions such as shoes and in-shoe orthoses, as well as the presence of musculoskeletal injury, may be considered important modulators of neuromuscular control and run performance. Alterations in muscle activity and running economy have been reported with different shoes and in-shoe orthoses; however, these changes appear to be subject-specific and nonsystematic. Musculoskeletal injury has been associated with modifications in lower limb neuromuscular control, which may persist well after an athlete has returned to activity. The influence of changes in neuromuscular control as a result of injury on running economy has yet to be examined thoroughly, and should be considered in future experimental design and training analysis.

ID scanning, the media and the politics of urban surveillance in an Australian regional city

Computerised ID scanning technologies have permeated many urban night-time economies in Australia, the United States, Canada and the United Kingdom. This paper documents how one media organisation’s overt and tacit approval of ID scanners helped to normalise this form of surveillance as a precondition of entry into most licensed venues in the Australian city of Geelong. After outlining how processes of governance “from above” and “from below” interweave to generate distinct political and media demands for strategies to prevent localised crime problems, a chronological reconstruction of media reports over a three-and-a half year period demonstrates how ID scanning became the centrepiece of a holistic reform strategy to combat alcohol-related violence in this nightclub precinct. Several discursive techniques helped to normalise this “technological fix”, while suppressing critical discussion of viable concerns over information privacy, data security and system networking. These
included pairing reports of an initial “signal crime” with examples of “virtual victimhood” to stress the urgency of a radical surveillance-based response, which was supported by anecdotal statements from key “primary definers” highlighting the success of this initiative in targeting a wider population of antisocial “others”. The implications of these reporting practices are discussed in light of the media’s central role in reforming the Geelong night-time economy and broader trends in using novel surveillance technologies to combat urban crime problems at the expense of alternative measures that protect individual liberty.