A local bicycle helmet 'law' in a Swedish municipality - the effects on helmet use

The municipality of Motala in Sweden introduced a local bicycle helmet 'law' on May 1, 1996. This is not a legally enacted ordinance, but instead a legislated recommendation backed up by information and education. Formally, the law applies to children (aged 6-12 years), although the intention is to increase helmet use by all cyclists. The objective of the present study was to quantitatively evaluate the impact of the Motala helmet law on observed use of helmets by children and adults. Bicycle helmet use was monitored in Motala (n = 2,458/year) and in control towns (n = 17,818/year) both before and after adoption of the helmet law (1995-1998). Chi-square tests showed that helmet wearing 1995-1998 increased in Motala among all bicyclists (from 6.1% to 10.5%) and adults biking on cycle paths (from 1.8% to 7.6%). Helmet use by school children aged 6-12 increased during the first 6 months after introduction of the law (from 65.0% to 75.7%) but then progressively decreased to the pre-law level. Considering children cycling on cycle paths and for recreation in housing areas, there was a tendency towards increased helmet use during the first post-law year, but this was followed by a reduction to a lower level in 1998 than in 1995. Logistic regression analysis taking into account data from the control towns indicated that the helmet law had a positive effect on children cycling to schools during the first 6 months, and a weak delayed but more long-term positive effect on adult cyclists on cycle paths. There were no positive effects on children in housing areas and on cycle paths. The Motala helmet law probably would have had greater and more lasting effects on helmet use by bicyclists, if certain problems had been avoided during the initiation phase. Moreover, although it did have a positive influence on both school children and adults, it is not legally binding, and hence no penalties can be imposed. Presumably, compulsory legislation would have a more substantial impact on helmet wearing than a non-mandatory helmet 'law' such as that introduced in Motala.     

General surgical manpower, Victoria, Australia

To provide information for the planning of general surgical manpower in Victoria for the next 2 decades, an attempt was made to establish a statewide profile of surgical practices and an analysis of surgical activity to determine whether surgeons' and the community's needs were being met. Of 343 practising general surgeons, 280 furnished returns to a questionnaire--a return rate of 81.6%. Responses to the questionnaire reveal that the current surgeon-to-population ratio is optimal, although certain imbalances and concerns exist. Surgeons are fully occupied regardless of age, location of practice or type of practice, and they work long hours. Most surgeons regard themselves as not overworked and most are satisfied, although not all do the type of work they would prefer. Current surgical training programmes, however, appear inadequate for future needs.     

Newborn circumcision in Victoria, Australia: reasons and parental attitudes

Objective: The objective of this study was to study the reasons why some parents continue to seek professional circumcision service for their newborn boys in Victoria, Australia, their attitudes towards newborn circumcision and their personal characteristics. Subjects and methods: One hundred thirty‐six parents (62 fathers and 74 mothers) who presented to the Melbourne Circumcision Centre between July and December 2007 were recruited. They represented the parents of 85 newborn boys. A questionnaire designed by the authors was completed by the parents before circumcision. The responses were tabulated and analysed. Results: The most common reasons for newborn circumcision were hygiene (77.9%), family tradition (57.4%) and medical reasons (36%). The most common perceived benefit was hygiene (95.6%). The most common concern was pain (79.4%). As the number of boys a mother had who were already circumcised increased, the age at circumcision of the newborn boy became earlier (P = 0.024). 41.2% of parents wished for further information to help them better make the decision before or at the time of childbirth in the hospital setting. 76.5% of parents would, 19.1% of parents were unsure and 4.4% would not recommend newborn circumcision by an experienced practitioner to other parents. Conclusion: Some parents continue to circumcise their newborn boys for hygiene, family tradition and medical reasons in Victoria, Australia. Information about the pros and cons of newborn circumcision needs to be made more readily available to empower parents to make free, informed decisions.     

Helmet efficacy in the prevention of bicyclist head injuries: Royal australasian college of surgeons initiatives in the introduction of compulsory safety helmet wearing in Victoria,Australia

The results of a comparative study of the injury profiles of Victorian motorcyclist and bicyclist casualties were used by the Royal Australasian College of Surgeons in initiating a state-wide campaign to promote the wearing of approved safety helmets by Victorian bicyclists and to obtain the necessary legislation whereby such wearing would become compulsory. Bicyclist casualties had sustained more frequent and severe head injuries than motorcyclist casualties although the latter had sustained overall more severe body injuries. Increases in voluntary helmet wearing rates and reductions in costs preceded the introduction in July, 1990 in Victoria of compulsory safety helmet wearing by bicyclists. Sixty-four helmets obtained during a study of more than 1,700 Victorian bicyclists wearing and not wearing helmets were evaluated for performance by impact severity testing and findings related to head injury occurrence. Sixteen helmets sustained more than one impact during the accident. All casualties who sustained a severe head injury (Abbreviated Injury Scale 4) were involved in a collision with a motor vehicle and subjected to more than one impact to the head/helmet and/or the helmet had come off during the accident. Most impacts occurred below the current test lines of Australian and United States standards. Ten percent of impacts were more severe than required in performance standards. Recommendations are made for improvements in the current standard.

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Resumen Los resultados de un estudio comparativo de los perfiles de trauma de motociclistas del estado de Victoria (Australia) y de muertes de accidentes de bicicleta fueron utilizados por el royal Australasian College of Surgeons para iniciar una campaña estatal destinada a promover el uso de cascos de seguridad aprobados por los ciclistas victorianos y a lograr de la legislación necesaria para que su uso fuera obligatorio. Los muertos por accidentes de bicicleta habían sufrido más frecuentes y más severas lesiones craneoencefálicas que los muertos por accidentes de motocicleta, aunque los últimos habían sufrido, en general, más graves lesiones corporales. Se registraron incrementos en la frecuencia del uso voluntario de cascos y reducciones en los costos con anterioridad a la introducción en Victoria, en julio de 1990, de la obligatoriedad del uso de cascos por los ciclistas. Sesenta y cuatro cascos obtenidos en el curso del estudio sobre más de 1700 ciclistas victorianos que usaban y no usaban casco fueron evaluados en cuanto a la eficacia frente al impacto, y los hallazgos se correlacionaron con la incidencia del trauma craneano. Dieciseis cascos sufrieron más de un impacto en el accidente. Todos los muertos que sufrieron trauma craneano severo (AIS 4) estuvieron involucrados en una colisión con un vehículo automotor y sufrieron más de un impacto sobre la cabeza/casco y/o el casco se había soltado durante el accidente. La mayoría de los impactos se produjeron por debajo de los estándares de seguridad establecidos en Australia y en los E.U.A. Diez por ciento de los impactos fueron de mayor severidad que los requeridos en los estándares de referencia. Se hacen recomendaciones para mejorar los estándares actuales.

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Résumé Les résultats d'une étude comparative sur les types d'accidents concernant les motocyclistes et vélocyclistes dans la province de Victoria ont été utilisés par le Royal Australasian College of Surgeons pour faire une campagne nationale en faveur du port de caseque pour tout cycliste et obtenir des instances légales que le port du casque soit obligatoire. Les lésions crâniennes liés à un accident de vélo étaient bien plus fréquentes que celles liées à un accident de moto. Par contre, les accidents de moto provoquaient d'avantage d'accidents corporels sévères. Avant l'introduction en Juillet 1990 de l'obligation du port de casque dans la province de Victoria par les vélocyclistes, il y avait eu une augmentation du port volontaire du casque et par conséquent, une réduction des dépenses dans ce domaine. Parmi une population de plus de 1,700 cyclistes de la province de Victoria, 64 casques ont été choisis au hasard afin d'évaluer leur résistance à un choc et les possibles rapports avec la survenue d'accidents. On a trouvé que 16/64 casques avaient subi plus d'un choc pendant l'accident. Toutes les lésions crâniennes orrespendant à un score AIS de 4 ou plus étaient survenues lors d'un accident entre un cycliste et un véhicule motorisé. De plus, dans cette catégorie, la tête et le casque avaient reçu plus d'un choc et/ou le casque avait été perdu pendant le choc de l'accident. La plupart des chocs étaient inférieurs à la moyenne pour l'Australie et les Etats-Unis. Dix pourcent des chocs, cependant, étaient plus importants. Des recommandations sont proposées pour améliorer les normes des casques.

     

Correlation between parental perception and actual childhood patterns of bicycle helmet use and riding practices: implications for designing injury prevention strategies

BACKGROUND/PURPOSE: Bicycle injuries account for 10% of all pediatric traumatic deaths. Bicycle helmets have proven to decrease morbidity and mortality, yet trauma data show low helmet use among injured children. However, owning a bicycle helmet does not universally result in a child wearing a helmet. Furthermore, we hypothesize that parental perception of their children's use of the bicycle helmet may not reflect accurately true utilization by their child. To investigate this hypothesis the authors examined both parents' and their children's reports of bicycle ownership, supervision, riding patterns, and helmet use. METHODS: A random sample of grade 5 and 6 students (ages 8 to 12) and their parents were surveyed about bicycle ownership, riding patterns, supervision, and helmet use. The children and their guardians responded independently to the questionnaire. Statistical analysis was performed using the chi(2) test when indicated. RESULTS: Eighty-eight of 102 children (86%) responded. This represented 56% girls and 44% boys aged 8 to 12 years. Sixty-nine of 90 (77%) of the parents returned the survey. Ninety-six percent of the children owned a bicycle. A total of 87.5% of children owned a bicycle helmet. Eighty percent of the time children ride their bicycles on the road or sidewalk, with less then 20% on marked trails or parks. Parents reported that their children wear a helmet 90% of the time. In contrast, children report no helmet use in up to 61% of riding instances (P <.05). Parents themselves do not wear a helmet in greater then 60% when riding, which is correlated by their children. Seventy-one percent of the children report that they ride unsupervised the majority of the time. CONCLUSIONS: Bicycle and bicycle helmet ownership is high among this study group. There is a significant possibility that children will ride unsupervised, in at-risk situations, without wearing a helmet. Parental perceptions about bicycle helmet use by their children may not accurately reflect true utilization. In this study group parents appear as poor role models for their children. Injury prevention strategies need to focus on children and adults to improve effectiveness.     

Neurosurgery in Victoria, Australia: training and practice compared with the United Kingdom

In the UK there are currently great changes taking place in both higher surgical training and consultant practice. Australia inherited the British system, many aspects of which it retains, but has moved to a US type training programme. Recent experience of British and Australian neurosurgical practice allows useful comparisons to be made with possible benefit to both. Neurosurgery in Australia is a more consultant based service than that in the UK, with 73 consultants for a population of 18 million. Consultants work primarily from their private rooms and consultant numbers in the public sector are misleading as few of them approach full time. Neurosurgical training is organized on a national basis with a finite training programme. This consists of a rotation of different jobs supplemented by consultant led lectures and tutorials. Training is regularly monitored, with a final exit examination. The disadvantages are the relative lack of operating whilst training, many neurosurgeons becoming accredited with the personal operating experience expected of a British registrar; and the working hours; most trainees work 1 in 1, which precludes any sort of normal family life. In summary, the relative strengths of the British and Australian systems are largely complementary, there being ample scope for each to learn from the other.     

Advancing age and trauma: Triage destination compliance and mortality in Victoria,Australia

Objective

To describe the association between increasing age, pre-hospital triage destination compliance, and patient outcomes for adult trauma patients.

Methods

A retrospective data review was conducted of adult trauma patients attended by Ambulance Victoria (AV) between 2007 and 2011. AV pre-hospital data was matched to Victorian State Trauma Registry (VSTR) hospital data. Inclusion criteria were adult patients sustaining a traumatic mechanism of injury. Patients sustaining secondary traumatic injuries from non-traumatic causes were excluded. The primary outcomes were destination compliance and in-hospital mortality. These outcomes were evaluated using multivariable logistic regression.

Results

There were 326,035 adult trauma patients from 2007 to 2011, and 18.7% met the AV pre-hospital trauma triage criteria. The VSTR classified 7461 patients as confirmed major trauma (40.9% > 55 years). Whilst the trauma triage criteria have high sensitivity (95.8%) and a low under-triage rate (4.2%), the adjusted odds of destination compliance for older trauma patients were between 23.7% and 41.4% lower compared to younger patients. The odds of death increased 8% for each year above age 55 years (OR: 1.08; 95% CI: 1.07, 1.09).

Conclusions

Despite effective pre-hospital trauma triage criteria, older trauma patients are less likely to be transported to a major trauma service and have poorer outcomes than younger adult trauma patients. It is likely that the benefit of access to definitive trauma care may vary across age groups according to trauma cause, patient history, comorbidities and expected patient outcome. Further research is required to explore how the Victorian trauma system can be optimised to meet the needs of a rapidly ageing population.     

A decreasing trend in fall-related hip fracture incidence in Victoria, Australia

Summary

In Victoria, Australia, the age-standardised incidence of fall-related hip fracture hospitalisations decreased significantly by 25% over the period 1998/1999–2008/2009. Significant decreases in fall-related hip fractures were observed in males and females, across all 5-year age groups, in Australian-born and overseas-born Victorians, in all socio-economic quintiles and in community-dwelling older people.

Introduction

The study aim was to investigate trends in the incidence of fall-related and hip fracture hospitalisations among Victorians aged 65 years and older overall and by age, gender, country of birth, socio-economic status (SES) and location of the event (home, residential care institution, etc.) over the 11-year period 1998/1999 to 2008/2009.

Methods

Annual counts and age-standardised rates for fall-related hospitalisations among people aged 65 years and older were estimated using Victorian hospital admissions data. The statistical significance of changes in trends over time were analysed using a log-linear regression model of the rate data assuming a Poisson distribution of cases.

Results

Although the age-standardised incidence of fall-related hospitalisations increased significantly by 13% (95% confidence interval [CI], 9% to 18%) in Victoria, the age-standardised incidence of fall-related hip fracture hospitalisations decreased from 600/100,000 in 1998/1999 to 467/100,000 in 2008/2009 — an estimated overall reduction of 25% (95% CI, ?29% to ?22%). By contrast, the age-standardised incidence of fall-related hospitalisations for fractures at other body sites either increased significantly or showed no significant change. Significant decreases in fall-related hip fractures were observed in both males and females, across all 5-year age groups, in both Australian-born and overseas-born Victorians, in all socio-economic quintiles and in community-dwelling older people but not in people living in residential care facilities.

Conclusion

Despite the downward trend in the age-standardised incidence of fall-related hip fractures in Victoria, the burden of fall-related and hip fracture hospitalisations on health care systems and the community is set to escalate due to the ageing of the Victorian population.     

The evolution of an integrated State Trauma System in Victoria, Australia

The incidence of major trauma and associated fatalities in the State of Victoria, Australia, have declined over 20 years following the successful implementation of strategies to modify environmental and behavioural factors that contribute to motor vehicle injuries. However, several system deficiencies in the management of major trauma patients had remained unresolved. To investigate these shortfalls the State Government of Victoria established a task force in 1997 to review trauma and emergency services. The task force adopted the principle of "the right patient to the right hospital in the shortest time" and in 2000 began to deploy an integrated State Trauma System. Implementation of such a system required the designation of specific hospitals of various levels to care for trauma patients; the concentration of trauma expertise at these centres; integration and coordination between the service providers; development of agreed triage and transfer protocols and improved education, training and research programs. A statewide major trauma database was established to enable system monitoring and facilitate further enhancements. The Victorian experience with the development of an integrated trauma system should aid in the development of similar systems nationally and internationally and is described in this paper.     

Crash severity, injury patterns, and helmet use in adolescent motorcycle riders

BACKGROUND: This study examined crash severity and injury patterns between helmeted and unhelmeted adolescent motorcycle riders. METHODS: Among an initial population of 4,721 junior college students, 1,284 students were involved in 1,889 motorcycle crashes during a 20-month follow-up period. Crash severity was measured by both the type of collision object and the repair cost of motorcycle damage. RESULTS: The incidence rates of crash, injury, hospitalization, and deaths per 1,000 person-years in the cohort were 358, 104, 14, and 1.3, respectively. Compared with helmeted riders, unhelmeted riders had more noncollisions and fewer collisions with a moving car but there was no significant difference in repair cost of motorcycle damage between these groups. More injuries to the external skin, face, and head and more severe injuries occurred in unhelmeted than in helmeted riders. Among crashes resulting in hospitalization/death, more injuries to the face and head occurred in unhelmeted riders than in helmeted riders. CONCLUSION: Crashes involving unhelmeted riders were not more severe but more frequently involved face and head injuries than crashes involving helmeted riders.     

A local bicycle helmet 'law' in a Swedish municipality--the structure and process of initiation and implementation

On May 1, 1996, the Municipality of Motala in Sweden introduced a local bicycle helmet 'law.' It is, however, not an official law in a legal sense, but a municipally endorsed recommendation supported by promotional activities. This 'law' applies to children (ages 6-12), although the objective is to increase helmet use among cyclists of all ages. The study is a qualitative evaluation of the structure and process during initiation and implementation of the Motala bicycle helmet law. The aim was to describe the activities that were carried out, which actors took part and the opinions of the most closely involved actors. The results are based on analysis of written material and on interviews with eight of the actors. The mass media focused much attention on the bicycle helmet law, especially during the first six months after its introduction. The name helmet law was presumably of significance in this context. It is essential that relevant target groups provide sufficient support and that committed individuals initiate and promote the work, which, however, must not become dependent on a single individual. All issues concerning bicycle helmets should be coordinated with the law. Also, continuous engagement of the municipal government and a strategy for the control and follow-up of the law are needed. Local bicycle helmet laws of this type have a potential to produce a long-lasting effect on helmet use, provided some of the problems encountered can be avoided and some of the promotional activities are intensified.     

Trauma care systems: a comparison of trauma care in Victoria, Australia, and Hong Kong, China

BACKGROUND: Despite the high incidence of major trauma, few studies have directly compared the performance of trauma systems. This study compared the trauma system performance in Victoria, Australia, (VIC) and Hong Kong, China (HK). METHODS: Prospectively collected data over 5 years from January 2001 from the 2 trauma systems were compared using univariate analysis. Variables were then entered into a multivariate logistic regression to assess differences in outcome between the systems and adjusted for effects of clinically important factors. RESULTS: Five thousand five thirty-six cases from VIC and 580 cases from HK were taken for analysis. The HK group was older, but mechanisms of injury were similar in both systems. Thoracic and abdominal trauma was more common in VIC, compared with more head injuries in HK. More patients were admitted to intensive care in VIC and patients stayed in intensive care 1 day longer on average, despite more comorbidity in HK patients. Overall mortality was 20.2% for HK and 11.9% for VIC (X(2)(1) = 32.223, P < 0.001). CONCLUSION: The performance of the HK trauma system was comparable to international standards, but there was a significant difference in the probability of survival of major trauma between the 2 systems. Possible modifiable factors may include criteria for activation of trauma calls and improved ICU utilization.     

Incidence of non-traumatic spinal cord injury in Victoria, Australia: a population-based study and literature review

STUDY DESIGN: Data extraction from a state-wide, population-based, health-administration database of hospital admissions. OBJECTIVE: To determine the incidence of non-traumatic spinal cord injury (NTSCI).Setting:Victoria, Australia. METHODS: All patients admitted to hospital with a new onset of NTSCI, or who developed NTSCI after hospitalization, between 1 July 2000 and 30 June 2006, were identified using a population-based database. Age and gender of NTSCI patients were recorded. RESULTS: The number of adults aged 15 years and older with NTSCI in each of the 12-month periods was 82, 111, 96, 108, 133 and 101. The average age-adjusted incidence rate of NTSCI in adults was 26.3 cases per million per year. There was no statistically significant increase in the age-adjusted incidence of NTSCI over the study period (Spearman's rho=0.35, P=0.5). The incidence of NTSCI was significantly greater than the reported incidence for traumatic spinal cord injury (chi2 (1)=19.5, P<0.0000). There was a very strong correlation between age and the incidence of NTSCI, for both men (Spearman's rho=1, P<0.0000) and women (Spearman's rho=0.98, P=0.0000). Men had a statistically significantly (chi2 (1)=13.1, P=0.000) higher incidence of NTSCI (30.5 million adults per year) compared to women (22.9 million adults per year). The average incidence of NTSCI in children <15 years was 0.7 cases per million per year. CONCLUSION: NTSCI is strongly correlated with age and is more common than traumatic spinal cord injury. The method used in this study to calculate the incidence of NTSCI can be used to monitor the anticipated increase in the incidence of NTSCI in the years ahead, and can be used to in comparative studies.     

Road traffic fatalities in Victoria, Australia and changes to the trauma care system

BACKGROUND: The aim was to identify organizational and clinical errors in the management of road traffic fatalities and to use this information to improve Victoria's trauma care system. METHODS: A multidisciplinary committee evaluated the complete ambulance, hospital and autopsy records of 559 consecutive road traffic fatalities, who were alive on arrival of ambulance services, in five substantial time periods between 1992 and 1998. Patients who survived more than 30 days were excluded. Errors or inadequacies in each phase of management, including those contributing to death, were identified and an assessment was made of the potential preventability of death. RESULTS: Findings between 1992 and 1998 were similar. In 1998, 1672 problems were identified in 110 deaths with 1024 (61 per cent) contributing to death. Eight hundred and forty-two (50 per cent) of the total problems occurred in the emergency department. There were frequent problems in initial patient reception and medical consultation, resuscitation, investigation and assessment (especially of the abdomen and head), and in transfer to the operating theatre or to a higher-level hospital. Victoria's combined preventable and potentially preventable death rate has been unchanged between 1992 and 1998 (34-38 per cent). CONCLUSION: The problems identified led to a Ministerial Taskforce on Trauma and Emergency Services in Victoria as a consequence of which a new trauma system is now being implemented.