Investigating the costs of major and minor cycling crashes in Tasmania,Australia

Objective: A pilot study to estimate the societal costs of cycling crashes in Tasmania. Methods: A telephone‐based questionnaire collected information on demographics, cycling habits and details of major and minor crashes. Costs were estimated from medical resource consumption, lost work and leisure time. Results: The survey was completed by 136 cyclists. Participants reported 59 major crashes in five years preceding the interview and 27 minor crashes in 12 months. Mean (standard deviation) costs/major crash were $12,499 ($14,301), including direct medical costs $2,569 ($4,523), direct non‐medical costs $372 ($728), indirect costs of $6,027 ($10,092) and costs of lost leisure time $3,531 ($7,062). Costs/minor crashes were $632 ($795), including direct non‐medical costs of $225 ($601), productivity losses of $117 ($210) and costs of lost leisure time $290 (622). Total annual costs of major cycling crashes in Tasmania were $4,239,097 ($4,850,255). Conclusions: Indirect costs and costs due to lost leisure time are major contributors to the total societal costs. The comprehensive quantification of costs of crashes will inform decision makers formulating policies that improve the safety of cyclists leading to reductions in the economic burden on society.     

Human factors in rural road crashes

Abstract: An in-depth study of 79 vehicle crashes on rural roads in an area of about 100 km radius around Adelaide examined sociodemographic and psychophysiological characteristics of the drivers and riders involved. In many respects this sample of crashes was similar to a much larger number of police-reported crashes in the same area but included: relatively more crashes with severe or fatal injuries; more crashes on divided roads, on sealed roads and on curves; and more crashes involving trucks. Alcohol and lack of seat belt use were shown to be major problems in these rural crashes. The drivers and riders most strongly associated with these particular problems were males, in blue collar occupations and with limited education; they tended to be aged 30 years or more in the case of alcohol abuse, and were likely to be under 30 years in the case of restraint misuse. The attitudes of these drivers and riders, and other characteristics likely to have contributed to their involvement in a crash, are discussed. There is a need to develop specific and effective countermeasures to reduce drink-driving and increase seat belt wearing in rural areas.     

The relationship between distance from inpatient facilities and the rate of psychiatric admissions in Western Australia

Western Australia is the largest and most sparsely populated state in Australia with all its specialised psychiatric inpatient facilities in Perth, the capital city. This study tested a number of hypotheses concerning the effect of distance from Perth, firstly, on total hospitalisation rates for psychiatric illness of the rural population and secondly, on the proportion who were hospitalised in Perth. High rates of alcoholism in males and of neuroses in females, together with local conditions in various rural centres, rather than distance from Perth, were major determining factors affecting both total hospitalisation and the proportion sent to Perth. The major exception was that the proportion of male alcoholics admitted to Perth hospitals decreased the further the patient lived from Perth. These findings were contrary to those reported in the literature. However the distances from Perth were much greater than those usually reported elsewhere. It was concluded that beyond a certain distance from psychiatric facilities, distance per se was not a major factor governing admissions to these facilities.     

Historical trends in road accident types,deaths and casualties in Western Australia

Abstract: Road accident casualties are major consumers of health service resources in Australia, using inpatient care, accident and emergency treatment and other facilities. We analysed hospitalisations resulting from road accidents in Western Australia from 1968 to 1987 to examine trends in accident types, deaths and casualties. Data from the Western Australian Health Department's Hospital Morbidity System were used. Although hospitalisations from road accidents generally decreased, they were still higher than the Australian average in 1985. The rate of decline in hospitalisations was similar to that for fatalities and was not generally related to age or sex. There was some evidence of a more rapid decline in the rate of severe injuries than in minor ones. Further steps need to be taken to reduce the number of casualties from road accidents, as road accidents represent a major public health problem in Western Australia.     

Productivity loss resulting from coronary heart disease in Australia

Background

Coronary heart disease (CHD) is the largest single cause of death in Australia. It places a heavy financial burden on the country’s health system. To date, no study has systematically assessed CHD-related productivity loss in Australia.

Objective

To quantify CHD-related productivity loss in Australia using both the human capital method and the friction method.

Methods

Mathematical models adjusting for economic activity, unemployment and the elasticity of productivity loss of labour reduction were proposed for the quantification. Where Australian data were unavailable, parameters were estimated using data from studies in European countries. Sensitivity analysis was conducted around uncertain parameters.

Results

The annual potential CHD-related productivity loss was estimated to be Australian dollars ($A)1.79 billion in 2004 using the human capital method. The potential loss was considerably higher than the actual loss, estimated to be $A25.02 million using the friction method.

Conclusions

CHD results in significant productivity loss in Australia. A valid economic evaluation of the full scale of the impact of CHD should consider the potential and actual productivity loss as well as the direct healthcare costs incurred by the disease.     

Human factors in the causation of road traffic crashes

Road traffic crashes (RTCs) are responsible for a substantial fraction of morbidity and mortality and are responsible for more years of life lost than most of human diseases. In this review, we have tried to delineate behavioral factors that collectively represent the principal cause of three out of five RTCs and contribute to the causation of most of the remaining. Although sharp distinctions are not always possible, a classification of behavioral factors is both necessary and feasible. Thus, behavioral factors can be distinguished as (i) those that reduce capability on a long-term basis (inexperience, aging, disease and disability, alcoholism, drug abuse), (ii) those that reduce capability on a short-term basis (drowsiness, fatigue, acute alcohol intoxication, short term drug effects, binge eating, acute psychological stress, temporary distraction), (iii) those that promote risk taking behavior with long-term impact (overestimation of capabilities, macho attitude, habitual speeding, habitual disregard of traffic regulations, indecent driving behavior, non-use of seat belt or helmet, inappropriate sitting while driving, accident proneness) and (iv) those that promote risk taking behavior with short-term impact (moderate ethanol intake, psychotropic drugs, motor vehicle crime, suicidal behavior, compulsive acts). The classification aims to assist in the conceptualization of the problem that may also contribute to behavior modification-based efforts.     

Motorcycle helmet use and injury outcome and hospitalization costs from crashes in Washington State.

OBJECTIVES. The incidence, type, severity, and costs of crash-related injuries requiring hospitalization or resulting in death were compared for helmeted and unhelmeted motorcyclists. METHODS. This was a retrospective cohort study of injured motorcyclists in Washington State in 1989. Motorcycle crash data were linked to statewide hospitalization and death data. RESULTS. The 2090 crashes included in this study resulted in 409 hospitalizations (20%) and 59 fatalities (28%). Although unhelmeted motorcyclists were only slightly more likely to be hospitalized overall, they were more severely injured, nearly three times more likely to have been head injured, and nearly four times more likely to have been severely or critically head injured than helmeted riders. Unhelmeted riders were also more likely to be readmitted to a hospital for follow-up treatment and to die from their injuries. The average hospital stay for unhelmeted motorcyclists was longer, and cost more per case; the cost of hospitalization for unhelmeted motorcyclists was 60% more overall ($3.5 vs $2.2 million). CONCLUSIONS. Helmet use is strongly associated with reduced probability and severity of injury, reduced economic impact, and a reduction in motorcyclist deaths.     

Geographic variation in inpatient costs for Acute Myocardial Infarction care: Insights from Italy

Geographic variations in healthcare expenditures have been widely reported within and between countries. Nevertheless, empirical evidence on the role of organizational factors and care systems in explaining these variations is still needed. This paper aims at assessing the regional differences in hospital spending for patients hospitalized for Acute Myocardial Infarction (AMI) in Tuscany and Lombardy regions (Italy), which rank high in terms of care quality and that have been, at least until 2016, characterized by quite different governance systems. Generalized linear models are performed to estimate index, 30-day and one-year hospitalization spending adjusted for baseline covariates. A two-part model is used to estimate 31–365 day expenditure. Adjusted hospital spending for AMI patients were significantly higher in Lombardy compared with Tuscany. In Lombardy, patients experienced higher re-hospitalizations in the 31–365 days and longer length of stays than in Tuscany. On the other hand, no significant regional differences in adjusted mortality rates at both acute and longer phases were found.Comparing two regional healthcare systems which mainly differ in both the reimbursement systems and the level of integration between hospital and community services provides insights into factors potentially contributing to regional variations in spending and, therefore, in areas for efficiency improvement.     

Hospital admissions of Aborigines and non-Aborigines in Western Australia, 1977-1988.

Aborigines were admitted to hospital in Western Australia 2.8 times as frequently as other persons in 1977-1988. Their highest relative admission rates were in the 0-5 years age group, mostly for respiratory and gastrointestinal infections. Relative admission rates (all ages) for some categories were: infectious and parasitic, 4 to 10-fold; respiratory, 5-fold; nervous system, 4-fold; injury and poisoning, 3 to 5-fold; mental disorders, double the non-Aboriginal rate. Admissions for respiratory illnesses were consistently much higher in Aborigines of all ages. There were some significant declines in relative hospital admission rates for Aborigines over the study period.     

The high costs of aggression: public expenditures resulting from conduct disorder

OBJECTIVES: We explored the economic implications of conduct disorder (CD) among adolescents in 4 poor communities in the United States. We examined a range of expenditures related to this disorder across multiple public sectors, including mental health, general health, school, and juvenile justice. METHODS: We used self- and parental-report data to estimate expenditures during a 7-year period in late adolescence of a sample of youths. We contrasted expenditures for youths with CD and youths with oppositional defiant disorder, elevated symptoms (no CD diagnosis), and all others. Diagnosis was determined with a structured assessment. RESULTS: Additional public costs per child related to CD exceeded $70000 over a 7-year period. CONCLUSIONS: Public expenditures on youths with CD are substantially larger than for youths with closely related conditions, reflecting the importance of prevention and early treatment for the disorder.     

Hospital infection control in Australia

Australia is a large country divided into six states and two territories, each of which has infection control programmes. This paper looks at the organization of infection control in Australia, as well as describing the national bodies involved and recent state initiatives in infection control.     

Talipes equinovarus in Western Australia

In Western Australia (WA), talipes equinovarus is a notifiable birth defect and, since 1980, has been ascertained by the population-based Birth Defects Registry (BDR). Talipes equinovarus deformities were classified as two distinct and distinguishable types, viz. isolated talipes equinovarus (no other birth defects present) and associated talipes equinovarus (other birth defects present). The birth prevalence of associated talipes in WA between 1980 and 1994 was 0.90 per 1000 births, and of isolated talipes was 1.25 per 1000 births. The rate of the isolated deformity was higher in Aboriginal infants (3.49 per 1000 births) than in Caucasian infants (1.11 per 1000 births) and non-Aboriginal non-Caucasian infants (0.73 per 1000 births). The sex differential in the rate of the isolated deformity was greatest among Aboriginal infants, with the rate in males being almost four times that in females. The birth prevalence of both types of the deformity remained stable over the 15-year study period. The rate of caesarean and breech deliveries and the proportion of bilaterally affected feet was greater among infants with associated talipes equinovarus deformity. An accurate and complete identification of cases of isolated talipes equinovarus in the 1980-94 WA birth cohort provides a basis for furthering the understanding of the epidemiology and hence the aetiology of the deformity.     

A review of questionnaires exploring driver's exposure and risk factors in road crashes

Given the diversity of questionnaires currently being used in the study of the analytic epidemiology of traffic injuries, we made a review of studies on this question published between 1989 and 2011 in order to identify their advantages and disadvantages. We were able to observe that most of the questionnaires were focused on the human factor regarding the risk of road crashes, but very few of them included intensity of exposure and its association with other risk factors in road crashes. Many questionnaires have a high number of items and complex rating scales. Furthermore, in Spain there are few validated questionnaires which contain complete information about exposure and road crashes. In Spain we should work on the design and validation of questionnaires containing questions aimed at obtaining complete and easy information about the epidemiology of traffic injuries. In this way we would be able to increase our awareness of traffic injuries and how to prevent them.     

Hospital admissions for lower respiratory tract illness before the age of two years in Western Australia

Summary. .In this study, hospital admissions for lower respiratory tract illness before two years of age have been documented for all children born in Western Australia in 1986. Admissions data were linked to birth and death records for individual children. Of the total cohort, 5% of non-Abqriginal and 17% of Aboriginal children were hospitalised only once for lower respiratory tract illness; 1% of non-Aboriginal and 11% of Aboriginal children had repeated admissions. Perinatal conditions comprised the greatest proportion of the admissions for non-Aboriginal children, and pneumonia for Aboriginal children. Non-Aboriginal children had decreasing admission rates from the neonatal period onwards, whereas those for Aboriginal children increased. For all children, those of low or high birthweight, male sex and those with young or unmarried mothers or residing in country regions were more likely to be admitted. This research has highlighted potential risk factors for serious respiratory illness in early childhood and has shown the feasibility of using linked data for the total population to formulate and test hypotheses relating to respiratory morbidity.