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Abstract.Background:Mental illness is an established risk factor for suicide. To develop effective prevention interventions and strategies, the demographic characteristics and stressors (other than, or in addition to, mental illness) that can influence a person's decision to die by suicide need to be identified. Aim:To examine cases of suicide by the presence or absence of a diagnosed mental illness (mental illness status) to identify differences in factors associated with suicide in the groups. Method:Logistic regression analyses were used to investigate mental illness status and exposure to stressors among 2,839 persons who died by suicide in Victoria, Australia (2009–2013), using the Victorian Suicide Register. Results:Females, metropolitan residents, persons treated for physical illness/injury, those exposed to stressors related to isolation, family, work, education, and substance use and those who had made a previous suicide attempt had increased odds of having a diagnosed mental illness. Employed persons had decreased odds of having a diagnosed mental illness. Limitations:The retrospectivity of data collection as well as the validity and reliability of some of the data may be questionable owing to the potential for recall bias. Conclusion:The point of intervention for suicide prevention cannot always be a mental health professional; some people who die by suicide either do not have a mental illness or have not sought help.

Background: Elite junior Australian football players experience high training loads across levels of competition and training. This, in conjunction with impaired wellness, can predispose athletes to injury.Hypothesis: Elite junior Australian football players exposed to high loads with poor wellness are more likely to be at risk of injury than those with improved wellness.Study Design: Longitudinal prospective cohort study.Level of Evidence: Level 3.Methods: Data were collected and analyzed from 280 players across the 2014 season. Internal load was measured via session rating of perceived exertion. Player wellness was reported according to ratings of sleep quality, fatigue, soreness, stress, and mood. Week- and month-based training load measures were calculated, representing a combination of absolute and relative load variables. Principal component analysis factor loadings, based on 17 load and wellness variables, were used to calculate summed variable covariates. Injury was defined as “any injury leading to a missed training session or competitive match.” Associations between covariates and injury risk (yes/no) were determined via logistic generalized estimating equations.Results: A significant interaction term between load and wellness on injury was found [odds ratio (OR) 0.76; 95% CI 0.62-0.92; P< 0.01), indicating that wellness acts as a “dimmer switch” of load on injury. Further, there was evidence of moderated mediation (OR 0.71; 95% CI 0.57-0.87; P< 0.01). When wellness was low, injury risk started to increase substantially at a 1-week load of 3250 au.Conclusions: Subjective measures of training load are associated with injury risk through a nonlinear relationship. This relationship is further influenced by player wellness, which can amplify the risk of injury. There is evidence that higher stress is linked with injury and that soreness and sleep mediate any stress-injury relationship.Clinical Relevance: Coaching efforts to manage training load and player adaptive responses, including wellness, may reduce the risk of injury, with stress, soreness, and sleep particularly relevant at this level.

Existing comorbidity indices such as the Charlson comorbidity index are dated yet still widely used. This study derives and validates up-to-date comorbidity indices for hospital-admitted injury patients, specific to mortality outcomes.

This study aimed to identify stressors over‐represented in the 12 months prior to death among 553 Victorian adults who died by suicide.

Objective: This study aimed to identify stressors over‐represented in the 12 months prior to death among 553 Victorian adults who died by suicide. Methods: Age‐ and sex‐specific suicide rates and relative risks of suicide were calculated using numerator data on suicides occurring in 2013 by people with a given exposure sourced from the Victorian Suicide Register and denominator data on the total Victorian population with that exposure sourced from the 2014 Australian Bureau of Statistics General Social Survey. Results: Mental illness was associated with increased suicide risk among people of all age groups and both sexes. Alcohol and/or other drug problems were associated with increased risk for males and females of all ages, with the exceptions of the oldest males and females, and the youngest females. Trouble with the police was associated with increased risk among all but the oldest males, whereas among females it was associated with elevated risk in those aged 25–44 years and 65+ years. Conclusions and Implications for public health: Males experiencing mental illness and alcohol and other drug problems should be a particular priority for suicide prevention initiatives but people exposed to other stressors such as contact with the police and divorce/relationship separation also warrant attention.

Compared with crashes with motor vehicles, single-bicycle crashes are an under-recognised contributor to cycling injury and the aetiology is poorly understood. Using an in-depth crash investigation technique, this study describes the crash characteristics and patient outcomes of a sample of cyclists admitted to hospital following on-road bicycle crashes. Enrolled cyclists completed a structured interview, and injury details and patient outcomes were extracted from trauma registries. Single-bicycle crashes (n=62) accounted for 48% of on-road crashes and commonly involved experienced cyclists. Common single-bicycle crash types included loss-of-control events, interactions with tram tracks, striking potholes or objects or resulting from mechanical issues with the bicycle. To address single-bicycle crashes, targeted countermeasures are required for each of these specific crash types.

The current study aimed to quantify the real-world, everyday travel behaviours of child vehicle occupants and associations with child restraint systems (CRS)/booster seat (BS) head positions that are suboptimal in terms of crash injury risk.

Older drivers are frequently viewed as overly represented in crashes, particularly when crash involvement per distance travelled is considered. This perception has led to a call for tighter licensing conditions for older drivers, a policy which inevitably results in mobility restrictions for at least some drivers. However there is a growing body of research evidence which shows that as a group, older drivers represent no greater road risk than drivers from other age groups once different levels of driving activity are taken into account. This paper has examined aspects of older drivers' fitness to drive based on survey data and off-road and on-road driving performance from a sample of 905 New Zealand older drivers. The results show that policies which target all older drivers and lead to licensing and mobility restrictions cannot be justified from a safety basis.

AbstractTwo measures of aggressivity of Australian passenger vehicles have been developed. The first measures the aggressivity to occupants of other cars. This type of aggressivity rating is based on two-car crashes between passenger vehicles and measures the injury risk each make/model in the collisions poses to the drivers of the other vehicles. The second measures aggressivity to unprotected road users. These aggressivity ratings reflect the threat of severe injury to pedestrians, bicyclists and motorcyclists by die make/model of vehicle colliding with them. This analysis was based on nearly 102,000 drivers involved in tow-away crashes with the makes/models which were the focus of the study and on nearly 22,000 injured pedestrians, bicyclists, and motorcyclists. The results suggest that crasbworthiness and aggressivity are two different aspects of a vehicle's safety performance, with good performance on one dimension not necessarily being associated with good performance on the other.

Current knowledge about human immunodeficiency virus (HIV) disease is used to assess past and future trends in Australian HIV/AIDS (acquired immune deficiency syndrome) incidence, focusing on the precision with which such assessments can be made. The statistical method of back‐projection is applied to reconstruct the past pattern of HIV incidence from surveillance data on AIDS incidence to June 1992. The results indicate that HIV incidence rose rapidly in the early 1980s to peak in 1983–1984, followed by a sharp decline. This finding is insensitive to plausible variations from the assumptions made, and is consistent with both success in preventive strategies and high levels of infection in a subgroup having a high probability of exposure. Cumulative HIV incidence to the end of 1987 is estimated with a 90 per cent confidence interval from 9 350 to 10 350. Estimation of the cumulative HIV incidence to June 1992 is less precise, with a 90 per cent confidence interval of 12 900 to 17 800. After adjustment for underreporting the incidence could be as high as 22 000, but only if recent infection rates, which cannot be quantified accurately, were very high. Based on data to June 1992, the estimated trend in AIDS incidence indicates 680 new cases in 1993, rising gradually to 695 in 1995. The estimated rate of increase in AIDS incidence over the recent past and near future is significantly less than that observed earlier in the epidemic. This is a consequence of both the earlier peak in HIV incidence and the effect of therapy.

Persistent or chronic pain is prevalent in many developed countries, with estimates ranging from 10% to higher than 50%, and is a major economic burden to individuals and societies. However, the variation in pain outcomes after acute orthopedic trauma and treatment confronts treating physicians with uncertainty in providing prognostic advice regarding long-term recovery. Although several previous reviews have addressed the determinants of chronic pain outcomes secondary to acute trauma, they have primarily focused on specific injury samples and, furthermore, lack consistency with respect to the important prognostic factors, which limits the generalizability of findings. This review, however, aimed specifically to identify the early prognostic factors associated with variation in persistent pain outcomes following acute orthopedic trauma presenting with a spectrum of pathologies.BACKGROUND: Acute orthopedic trauma contributes substantially to the global burden of disease.OBJECTIVES: The present systematic review aimed to summarize the current knowledge concerning prognostic factors for the presence of persistent pain, pain severity and pain-related disability following acute orthopedic trauma involving a spectrum of pathologies to working-age adults.METHODS: The Ovid MEDLINE and EMBASE databases were searched for level II prognostic studies published between January 1996 and October 2010. Studies that were longitudinal and reported results with multivariate analyses appropriate for prognostic studies were included. Studies that addressed two specific injury types that have been the subject of previous reviews, namely, injuries to the spinal column and amputations, were excluded.RESULTS: The searches yielded 992 studies; 10 studies met the inclusion criteria and were rated for methodological quality. Seventeen factors were considered in more than one cohort. There was strong evidence supporting the association of female sex, older age, high pain intensity, preinjury anxiety or depression, and fewer years of education with persistent pain outcomes. There was moderate evidence supporting the association between postinjury depression or anxiety with persistent pain, and that injury severity was not a risk factor for ongoing pain.CONCLUSION: Many individuals experience persistent pain following acute trauma. Due to the lack of studies, the use of different constructs to measure the same factor and the methodological limitations associated with many of the studies, the present review was only able to reliably identify a limited set of factors that predicted persistent pain. Recommendations for the conduct of future methodologically rigorous studies of persistent pain are provided.