The journey from traffic offender to severe road trauma victim: Destiny or preventive opportunity?

Background Road trauma is a leading cause of death and injury in young people. Traffic offences are common, but their importance as a risk indicator for subsequent road trauma is unknown. This cohort study assessed whether severe road trauma could be predicted by a history of prior traffic offences. Methodology and Principal Findings Clinical data of all adult road trauma patients admitted to the Western Australia (WA) State Trauma Centre between 1998 and 2013 were linked to traffic offences records at the WA Department of Transport. The primary outcomes were alcohol exposure prior to road trauma, severe trauma (defined by Injury Severity Score > 15), and intensive care admission (ICU) or death, analyzed by logistic regression. Traffic offences directly leading to the road trauma admissions were excluded. Of the 10,330 patients included (median age 34 years-old, 78% male), 1955 (18.9%) had alcohol-exposure before road trauma, 2415 (23.4%) had severe trauma, 1360 (13.2%) required ICU admission, and 267 (2.6%) died. Prior traffic offences were recorded in 6269 (60.7%) patients. The number of prior traffic offences was significantly associated with alcohol-related road trauma (odds ratio [OR] per offence 1.03, 95% confidence interval [CI] 1.02-1.05), severe trauma (OR 1.13, 95% CI 1.14-1.15), and ICU admission or death (OR 1.10, 95% CI 1.08-1.11). Drink-drinking, seat-belt, and use of handheld electronic device offences were specific offences strongly associated with road trauma leading to ICU admission or death-all in a 'dose-related' fashion. For those who recovered from road trauma after an ICU admission, there was a significant reduction in subsequent traffic offences (mean difference 1.8, 95% CI 1.5 to 2.0) and demerit points (mean difference 7.0, 95% CI 6.5 to 7.6) compared to before the trauma event. Significance Previous traffic offences were a significant risk factor for alcohol-related road trauma and severe road trauma leading to ICU admission or death

Healthcare system priorities for successful integration of genomics: An Australian focus

This paper examines key considerations for the successful integration of genomic technologies into healthcare systems. All healthcare systems strive to introduce new technologies that are effective and affordable, but genomics offers particular challenges, given the rapid evolution of the technology. In this context we frame internationally relevant discussion points relating to effective and sustainable implementation of genomic testing within the strategic priority areas of the recently endorsed Australian National Health Genomics Policy Framework. The priority areas are services, data, workforce, finances, and person-centred care. In addition, we outline recommendations from a government perspective through the lens of the Australian health system, and argue that resources should be allocated not to just genomic testing alone, but across the five strategic priority areas for full effectiveness

Editorial: Precision Public Health

Traditional public health practice has had a central reliance on data, and the core discipline of epidemiology, in order to inform health policy and priority setting, drive health improvement across whole populations, and target disadvantaged populations. Core public health activities include risk factor and disease surveillance, screening, development of interventions, assurance, and evaluation. Since the 1970s, New Public Health has also emphasized community engagement, health promotion, partnerships, and advocacy. In the last 20 years, and particularly with the sequencing of the human genome and advances in other “-omics,” informatics and a range of technologies, new possibilities have opened up for a much more finely delineated view of the “time-person-place” triad that underpins epidemiology, and the balancing of genetic, biological, environmental, and social determinants of disease. This may lead, we argue in this article, to new preventive and treatment options and the next paradigm shift in public health, namely toward “Precision Public Health” or PPH. However, we also caution against a blind optimism about what technology can achieve on its own, and argue for a solid grounding of PPH on the old verities of public health, namely whole population health improvement and equity

Genomic testing for human health and disease across the life cycle: Applications and ethical, legal, and social challenges

The expanding use of genomic technologies encompasses all phases of life, from the embryo to the elderly, and even the posthumous phase. In this paper, we present the spectrum of genomic healthcare applications, and describe their scope and challenges at different stages of the life cycle. The integration of genomic technology into healthcare presents unique ethical issues that challenge traditional aspects of healthcare delivery. These challenges include the different definitions of utility as applied to genomic information; the particular characteristics of genetic data that influence how it might be protected, used and shared; and the difficulties applying existing models of informed consent, and how new consent models might be needed