A configural model of expert judgement as a preliminary epidemiological study of injury problems: an application to drowning

Robust epidemiological studies identifying determinants of negative health outcomes require significant research effort. Expert judgement is proposed as an efficient alternative or preliminary research design for risk factor identification associated with unintentional injury. This proposition was tested in a multi-factorial balanced experimental design using specialist judges (N = 18), lifeguards and surfers, to assess the risk contribution to drowning for swimming ability, surf bathing experience, and wave height. All factors provided unique contributions to drowning risk (p < .001). An interaction (p = .02) indicated that occasional surf bathers face a proportionally increased risk of drowning at increased wave heights relative to experienced surf bathers. Although findings were limited by strict criteria, and no gold standard comparison data were available, the study provides new evidence on causal risk factors for a drowning scenario. Countermeasures based on these factors are proposed. Further application of the method may assist in developing new interventions to reduce unintentional injury

Surf Bather Drowning Risk and Exposure-Related Factors Identified by an Expert Panel

In the absence of an established literature, identifying and quantifying surf bather drowning risk factors requires a clearly defined problem-focused research strategy. To initiate this strategy, nominal group technique (NGT) was used to identify and rank risk and water exposure-related factors based on consensus of an expert panel. The results identified, in order, level of experience (encompassing swimming ability in surf conditions), lack of local knowledge (encompassing awareness of surf hazards, including rip currents), and surf conditions (encompassing prevailing wave height and rip currents) as the three most influential surf bather drowning risk factors. Factors most influential on exposure to water were identified and ranked as prevailing weather, geographic location (encompassing bather accessibility to the beach), and infrastructure (encompassing the presence of artificial beach amenities). This study provides direction for future analytic epidemiological research and complementary studies on drowning at surf beaches and other locations

Drowning risk analysis comparing surf bather subgroups

The study assessed the utility of risk analysis for advancing knowledge on drowning risk factors. The setting was unintentional drowning of surf bathers in Australia. Bathers reported earlier exposure to selected risk factors (swimming ability, wave height associated with rip currents and surf bathing experience) and were observed for water exposure (in minutes). These data were then assembled in mathematical models. The analysis forecast relative drowning risk pertaining to risk markers representing selected surf bather subgroups (gender, age and water activity). Contextualized through previous study findings, comparison of results with a gold standard obtained from mortality data generated new surf bather drowning hypotheses suitable for future testing by rigorous analytical epidemiologic designs. The hypotheses were: (1) The male to female comparative surf bather drowning rate is explained primarily by differences in crude water exposure; (2) the association of cardio-vascular medical conditions with surf bather drowning is stronger for older surf bathers compared to younger surf bathers; and (3) other risk contributors to surf bather drowning are: Poorly calibrated perception of bathing ability (overconfidence) and use of alcohol. Nonetheless, drowning rates appear generally consistent with time exposure to water. The study findings may also support drowning prevention strategies targeting risk marker subgroups

Development and trial of a water exposure measure of estimated drowning risk for surf bathers

To better address drowning issues, risk assessment at the group and sample levels would be enhanced by precise measures of exposure to water. The aim of the study was to develop and pilot test a method of measuring exposure to water based on estimating immersions for surf bathers. Validated direct observation counts provided peak-bathing period point estimates and a daily bather immersion profile for an identified sampling frame comprising 20 beaches over 39 summer days. An estimated 10,089 water immersions occurred at the peak-bathing period in the sampling frame. Swimmers comprised 86.0% and surfers with equipment 14.0% of the observed bathing sample, respectively. For swimmers only on patrolled beaches, 77.1% bathed in the lifesaver supervised (flag) zones. The study has implications for the provision of organized bather supervision and provides a foundation for generation of hypotheses on the nature of drowning risk for selected surf bather groups

Bio-psychosocial determinants of time lost from work following non life threatening acute orthopaedic trauma

<p>Abstract</p> <p>Background</p> <p>To determine factors predicting the duration of time away from work following acute orthopaedic non life threatening trauma</p> <p>Methods</p> <p>Prospective cohort study conducted at four hospitals in Victoria, Australia. The cohort comprised 168 patients aged 18-64 years who were working prior to the injury and sustained a range of acute unintentional orthopaedic injuries resulting in hospitalization. Baseline data was obtained by survey and medical record review. Multivariate Cox proportional hazards regression analysis was used to examine the association between potential predictors and the duration of time away from work during the six month study. The study achieved 89% follow-up.</p> <p>Results</p> <p>Of the 168 participants recruited to the study, 68% returned to work during the six month study. Multivariate Cox proportional hazards regression analysis identified that blue collar work, negative pain attitudes with respect to work, high initial pain intensity, injury severity, older age, initial need for surgery, the presence of co-morbid health conditions at study entry and an orthopaedic injury to more than one region were associated with extended duration away from work following the injury. Participants in receipt of compensation who reported high social functioning at two weeks were 2.58 times more likely to have returned to work than similar participants reporting low social functioning. When only those who had returned to work were considered, the participant reported reason for return to work " to fill the day" was a significant predictor of earlier RTW [RR 2.41 (95% C.I 1.35-4.30)] whereas "financial security" and "because they felt able to" did not achieve significance.</p> <p>Conclusions</p> <p>Many injury-related and psycho social factors affect the duration of time away from work following orthopaedic injury. Some of these are potentially modifiable and may be amenable to intervention. Further consideration of the reasons provided by participants for returning to work may provide important opportunities for social marketing approaches designed to alleviate the financial and social burden associated with work disability.</p

Road traffic injury—a global public health scourge: a review for World Health Day 2004 (April 7)

Abstract Objective: Globally in 2000, 1.2 million deaths resulted from road traffic injury (RTI) and about 10 times this number were injured. Because of the size of the problem, its expected growth and its preventability World Health Day 2004 (April 7) was devoted to RTI. This review highlights attention to RTI by the ANZJPH and investigates relevance to the developing world, where 90% of all RTI deaths now occur. Method: All articles published by the ANZJPH over the five‐year period 1999–2004, which met the World Health Organization definition of RTI, were reviewed. Results: The eight studies selected and reviewed focused particularly on young drivers, alcohol use and Indigenous Australians, using a range of research and evaluation methods. Risk factors identified including widespread risky driving behaviour by young males and alcohol involvement. Intervention successes included legislative change regarding utility passengers, current vehicle inspection certificate and effects associated with the lead‐up to New Zealand's 1992 Transport Act. Conclusions: The dramatic and continued reduction in Australia's road toll following peak rates in the 1960s has relied on scientific research, such as that reviewed here, for its effective evidence base. This review indicates that RTI is established on the public health agenda in Australia—a key aim of WHO's five‐year strategy, for emulation by developing regions and nations. Implications: High‐income countries such as Australia and New Zealand have the knowledge, expertise and also the responsibility to assist regional low‐and middle‐income countries to counter the growing scourge of RTI that accompanies rapid motorisation

Drowning deaths between 1861 and 2000 in victoria, australia

OBJECTIVE: To identify the long-term patterns of drowning mortality in the state of Victoria, Australia, and to describe the historical context in which the decrease occurred. METHODS: We obtained data on drowning deaths and population statistics from the Australian Bureau of Statistics and its predecessors for the period 1861 to 2000. From these data, we calculated drowning death rates per 100 000 population per year, by gender and age. We reviewed primary and secondary historical resources, such as government and newspaper archives, books and the Internet, to identify changes or events in the state that may have affected drowning mortality. FINDINGS: From 1861 to 2000, at least 18 070 people drowned in Victoria. Male drowning rates were higher than those for females in all years and for all ages. Both sexes experienced the highest drowning rate in 1863 (79.5 male deaths per 100 000 population and 18.8 female death per 100 000 population). The lowest drowning rate was documented in 2000 (1.4 male deaths per 100 000 population and 0.3 female deaths per 100 000 population). The reduction patterns of drowning mortality occurred within a historical context of factors that directly affected drowning mortality, such as the improvement in people’s water safety skills, or those that incidentally affected drowning mortality, like infrastructure development. CONCLUSION: We identified patterns of reduction in drowning mortality, both in males and females and across age groups. These patterns could be linked to events and factors that happened in Victoria during this period. These findings may have relevance to current developing communities