Reported changes in cycling habits among older adults during the early months of the COVID-19 pandemic, New South Wales, Australia

The im.pact of the 2020 COVID-19 pandemic and the associated public health measures enacted by governments globally bad a significant impact on all aspects of human life including economic activity and mobility. One of the main public health measures designed to reduce the transmission of the SAR-Co V-2 vims have been the implementation ofvarious levels of lockdowns that limited mobility and resulted in almost half of the world's population UD.der som.e form of confinement. Many govemm.ents, including in Australia, UK, and Norway, enacted flexible forms oflockdowns that allowed daily outdoor exercise, while adhering to safe physical distancing, in recognition of the role of physical activity in reducing the mental and physical consequences of confinement. Australia saw first strict lockdown restrictions over March/April 2020 with progressive easing of restrictions during May and Ju.ne 2020. Emerging evidence from these countries has indicated that physical activity, particularly cycling, increased over the lockdown period and the following months as some restrictions were eased. However, many have wamed of a decline in physical activity with serious health consequences among older adults who were at a high.er risk: of m.orbidity and fatality associated with COVID-19 and were m.ore likely tobe confined to their homes for longer periods compared to younger age groups. The aim ofthis stu.dy was to investigate the impact ofCOVID-19 pandemic on cycling activity among older adults aged 50 years and over in New South Wales (NSW), Australia during the early months of the COVID-19 pandemic

Challenges to driver licensing participation for Aboriginal people in Australia: a systematic review of the literature

Introduction: Aboriginal and Torres Strait Islander people are overrepresented in transport-related morbidity and mortality. Low rates of licensure in Aboriginal communities and households have been identified as a contributor to high rates of unlicensed driving. There is increasing recognition that Aboriginal people experience challenges and adversity in attaining a licence. This systematic review aims to identify the barriers to licence participation among Aboriginal people in Australia. Method: A systematic search of electronic databases and purposive sampling of grey literature was conducted, two authors independently assessed publications for eligibility for inclusion. Results: Twelve publications were included in this review, of which there were 11 reporting primary research (qualitative and mixed methods) and a practitioner report. Barriers identified were categorised as individual and family barriers or systemic barriers relating to the justice system, graduated driver licensing (GDL) and service provision. A model is presented that depicts the barriers within a cycle of licensing adversity. Discussion: There is an endemic lack of licensing access for Aboriginal people that relates to financial hardship, unmet cultural needs and an inequitable system. This review recommends targeting change at the systemic level, including a review of proof of identification and fines enforcement policy, diversionary programs and increased provision for people experiencing financial hardship. Conclusion: This review positions licensing within the context of barriers to social inclusion that Aboriginal people frequently encounter. Equitable access to licensing urgently requires policy reform and service provision that is inclusive, responsive to the cultural needs of Aboriginal people and accessible to regional and remote communities

The Motorcycle Safety Research Program at the George Institute

Research on the prevention of road traffic injuries is a primary focus of the Injury Division at the George Institute for International Health. In keeping with a public health approach to injury prevention, our work encompasses research on a range of topics from surveillance, observational and intervention studies through to program evaluation and policy. The Division has a special interest in motorcycle safety as an emerging cause of increased injury in high income countries and a major cause of injuries in low and middle-income countries

Safe system demonstration project in a remote Aboriginal and Torres Strait Islander community

This paper reports on key findings and recommendations of the first known application of a comprehensive Safe System audit in a remote Aboriginal and Torres Strait Islander community; commissioned by the Indigenous Road Safety Working Group with funding from Austroads. The audit was conducted in Bidyadanga WA in collaboration with the Bidyadanga Community Council during June-August 2010, including: review of policy, management and police records; physical observation of roads, speeds and vehicles; and interviews with community members and local stakeholders including regarding road user issues and vehicle access. Bidyadanga was found to have high quality roads and safe speeds within residential areas, with limited need for upgrades and new work; however, several issues were identified on roads to access the nearest town, including a high crash “blackspot” location. Access to safe vehicles was limited. Unlicensed driving, lack of child restraints, drink driving and fatigue were key road user concerns. Needs for across-government improvements in policy and management were identified. Cost effective actions were identified. This project demonstrated that application of the Safe System was feasible in a remote Aboriginal community, while lessons learned can be adapted and applied nationally to improve Aboriginal road safety

Statewide retrospective study of low acuity emergency presentations in New South Wales, Australia: who, what, where and why?

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/Abstract Objective The present study aims to use a statewide population-based registry to assess the prevalence of low acuity emergency department (ED) presentations, describe the trend in presentation rates and to determine whether they were associated with various presentation characteristics such as the type of hospital as well as clinical and demographic variables. Design and setting This was a retrospective analysis of a population-based registry of ED presentations in New South Wales (NSW). Generalised estimating equations with log links were used to determine factors associated with low acuity presentations to account for repeat presentations and the possibility of clustering of outcomes. Participants Patients were included in this analysis if they presented to an ED between January 2010 and December 2014. The outcomes of interest were low acuity presentation, defined as those who self-presented (were not transported by ambulance), were assigned a triage category of 4 or 5 (semiurgent or non-urgent) and discharged back to usual residence from ED. Results There were 10.7 million ED presentations analysed. Of these, 45% were classified as a low acuity presentation. There was no discernible increase in the rate of low acuity presentations across NSW between 2010 and 2014. The strongest predictors of low acuity ED presentation were age <40 years of age (OR 1.77); injury or musculoskeletal administrative and non-urgent procedures (OR 2.96); ear, nose and throat, eye or oral (OR 5.53); skin or allergy-type presenting problems (OR 2.84). Conclusions Low acuity ED presentations comprise almost half of all ED presentations. Alternative emergency models of care may help meet the needs of these patients

Buckle up safely: a cluster randomised trial to evaluate the effectiveness of a pre-school based program to increase appropriate use of child restraints

BACKGROUND: Road traffic crashes for car occupants are a leading cause of death and serious injury in children from high and middle income countries globally. Correct use of appropriate child restraints can significantly reduce death and serious injury but there is a need for well powered trials to examine effectiveness of programs to increase optimal child restraint practices. The aim of this trial is to examine the effectiveness of a comprehensive intervention to increase the use of appropriate child restraints, and decrease incorrect use of child restraints in pre-school aged children traveling in cars. METHODS AND DESIGN: A cluster randomised controlled trial will be conducted, involving 28 pre-school or childcare centres in low income areas of Sydney, Australia, over one calendar year. The intervention is an educational program involving an in-service for centre staff, distribution of educational materials to parents, a parent workshop demonstrating restraint use, subsidised restraints for parents in need, and vouchers for a free restraint checking service. Blinded assessors will observe restraint use at all centres at the end of the calendar year. Data will be analysed on an intention-to-treat basis; the primary analysis will compare the proportion of each of the two outcome measures (use of appropriate restraints, and incorrect use of restraints) at each centre between intervention and control groups. Detailed process evaluation will be conducted, including examination of implementation and utilisation of various elements of the program by both centres and families. DISCUSSION: This assessor blinded cluster randomised trial is powered to provide credible evidence about the efficacy of an education and distribution program in a pre-school setting to increase appropriate use, and decrease incorrect use of child restraints. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12609000612213

Buckle-Up Safely (Shoalhaven): a process and impact evaluation of a pragmatic multifaceted preschool based pilot program to increase correct use of age appropriate child restraints

Objective: To conduct a process and impact evaluation of a multifaceted education-based pilot program targeting correct use of age-appropriate restraints in a regional setting with a high proportion of Aboriginal and Torres Strait Islander families. Methods: The program was delivered in 2010 in 3 early learning centers where 31 percent of the children were of Aboriginal and Torres Strait Islander descent. Each component of the program was assessed for message consistency and uptake. To measure program effectiveness, participating children were matched 1:1 by age, language spoken at home, and annual household income with 71 children from the control arm of a contemporaneous trial. The outcome measure in the control and program centers (a 4-category ordinal scale of restraint use) was compared using ordinal logistic regression accounting for age of the parent. Results: Process evaluation found that though program components were delivered with a consistency of message, uptake was affected by turnover of all staff at one center and by parents experiencing difficulty in paying for subsidized restraints at each of the centers. Impact evaluation found that children from the centers receiving the program had nearly twice the odds of being in a better restraint category than children matched from the control group (adjusted odds ratio [ORadj] = 2.06, 95% confidence interval [CI], 1.09-3.90). Conclusions: This was a pragmatic study reflecting the real-life issues of implementing a program in preschools where 57 percent of families had a low income and turnover of staff was high. Despite these issues, impact evaluation showed that the integrated educational program showed promise in increasing correct use of age-appropriate restraints. The findings from this pilot study support the use of an integrated educational program that includes access to subsidized restraints to promote best practice child restraint use among communities that include a high proportion of Aboriginal and Torres Strait Islander families in New South Wales. Future trials in similar settings should consider offering more support in centers with high turnover of staff and offering alternative methods of payment when families experience financial difficulties in purchasing the subsidized restraints. If proven in larger trials, this approach could reduce death and injuries in child passengers in this vulnerable group

Identifying priority policy issues and health system research questions associated with recovery outcomes for burns survivors in India: a qualitative inquiry

Objectives This study aimed to identify priority policy issues and health system research questions associated with recovery outcomes for burns survivors in India. Design Qualitative inquiry; data were collected through semistructured in-depth interviews and focus group discussions. Setting Nine sites in urban and rural settings across India, through primary, secondary and tertiary health facilities. Participants Healthcare providers, key informants, burns survivors and/or their carers. Results Participants acknowledged the challenges of burns care and recovery, and identified the need for prolonged rehabilitation. Challenges identified included poor communication between healthcare providers and survivors, limited rehabilitation services, difficulties with transportation to health facility and high cost associated with burns care. Burns survivors and healthcare providers identified the stigma attached with burns as the biggest challenge within the healthcare system, as well as in the community. Systems barriers (eg, limited infrastructure and human resources), lack of economic and social support, and poor understanding of recovery and rehabilitation were identified as major barriers to recovery. Conclusions Though further research is needed for addressing gaps in data, strengthening of health systems can enable providers to address issues such as developing/providing, protocols, capacity building, effective coordination between key organisations and referral networks

He\u27s the number one thing in my world : Application of the precede-proceed model to explore child car seat use in a regional community in new South Wales

We explored the factors influencing the use of age-appropriate car seats in a community with a high proportion of Aboriginal families in regional New South Wales. We conducted a survey and three focus groups with parents of children aged 3-5 years enrolled at three early learning centres on the Australian south-east coast. Survey data were triangulated with qualitative data from focus groups and analysed using the PRECEDE-PROCEED conceptual framework. Of the 133 eligible families, 97 (73%) parents completed the survey including 31% of parents who reported their children were Aboriginal. Use of age-appropriate car seats was reported by 80 (83%) of the participants, and awareness of the child car seat legislation was high (91/97, 94%). Children aged 2-3 years were less likely reported to be restrained in an age-appropriate car seat than were older children aged 4-5 years (60% versus 95%: χ 2 = 19.14, p \u3c 0.001). Focus group participants highlighted how important their child\u27s safety was to them, spoke of the influence grandparents had on their use of child car seats and voiced mixed views on the value of authorised child car seat fitters. Future programs should include access to affordable car seats and target community members as well as parents with clear, consistent messages highlighting the safety benefits of using age-appropriate car seats

Addressing the barriers to driver licensing for Aboriginal people in New South Wales and South Australia

Objective: Low rates of driver licensing have been linked to increased risk of transport-related injury, and reduced access to health services, employment and educational opportunities in the Aboriginal population. This paper reports on how barriers to obtaining a driver licence are being addressed in four Aboriginal communities in New South Wales and South Australia. Methods: Qualitative data were collected over a four-month period in 2013. Interviews with Aboriginal and non-Aboriginal stakeholders (n=31) and 11 focus groups with Aboriginal participants (n=46) were analysed thematically using a framework approach. Results: Factors facilitating licensing included: family support, professional lessons, alternative testing and programs that assist with literacy, fines management, financial assistance and access to a supervising driver. Stakeholders recommended raising awareness of existing services and funding community-based service provision to promote access to licensing. Discussion: Facilitating licence participation requires systemic change and long-term investment to ensure interagency collaboration, service use and sustainability of relevant programs, including job search agencies. Implications for public health: The disadvantage faced by Aboriginal people in driver licensing is a fundamental barrier to participation and a social determinant of health. Understanding the factors that promote licensing is crucial to improving access for under-serviced populations; recommendations provide pragmatic solutions to address licensing disadvantage