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A scoping project was funded by the Food and Agriculture Organization in 2017 on the health and safety of aquaculture workers. This project developed a template covering basic types of aquaculture production, health and safety hazards and risks, and related data on injuries and occupational ill health, regulations, social welfare conditions, and labour and industry activity in the sector. Profiles using the template were then produced for key aquaculture regions and nations across the globe where information could be obtained. These revealed both the scale and depth of occupational safety and health (OSH) challenges in terms of data gaps, a lack of or poor risk assessment and management, inadequate monitoring and regulation, and limited information generally about aquaculture OSH. Risks are especially high for offshore/marine aquaculture workers. Good practice as well as barriers to improving aquaculture OSH were noted. The findings from the profiles were brought together in an analysis of current knowledge on injury and work-related ill health, standards and regulation, non-work socioeconomic factors affecting aquaculture OSH, and the role of labour and industry in dealing with aquaculture OSH challenges. Some examples of governmental and labour, industry and non-governmental organisation good practice were identified. Some databases on injury and disease in the sector and research initiatives that solved problems were noted. However, there are many challenges especially in rural and remote areas across Asia but also in the northern hemisphere that need to be addressed. Action now is possible based on the knowledge available, with further research an important but secondary objective.

BackgroundChildhood injury is a leading cause of hospitalisation, yet there has been no comprehensive examination of child injury and survival over time in Australia. To examine the characteristics, temporal trend and survival for children who were hospitalised as a result of injury in Australia.MethodA retrospective examination of linked hospitalisation and mortality data for injured children aged 16 years or less during 1 July 2001 to 30 June 2012. Negative binomial regression examined change in injury hospitalisation trends. Cox proportional hazard regression examined the association of risk factors on 30-day survival.ResultsThere were 6 86 409 injury hospitalisations, with an age-standardised rate of 1489 per 1 00 000 population (95% CI 1485.3 to 1492.4) in Australia. Child injury hospitalisation rates did not change over the 10-year period. For every severely injured child, there are at least 13 children hospitalised with minor or moderate injuries. The total cost of child injury hospitalisations was $A2.1 billion (annually $A212 million). Falls (38.4%) were the most common injury mechanism. Factors associated with a higher risk of 30-day mortality were: child was aged ≤10 years, higher injury severity, head injury, injured in a transport incident or following drowning and submersion or other threats to breathing, during self-harm and usual residence was regional/remote Australia.ConclusionsChildhood injury hospitalisation rates have not reduced in 10 years. Children’s patterns of injury change with age, and priorities for injury prevention alter according to developmental stages. The development of a national multisectorial childhood injury monitoring and prevention strategy in Australia is long overdue.

Children are encouraged to participate in sports to improve general health and well-being and to prevent illnesses related to obesity and a sedentary lifestyle.1 2 Although the benefits of participation in sporting activities are undisputed, injury is a common adverse outcome.3 4 Despite the increasing recognition of the issue worldwide, there is very limited high-quality population-based data quantifying the burden of sports injuries in children and monitor changes over time. Such data are essential for decision-makers to prioritise and develop policy and for stakeholders and researchers to evaluate the impact of sports injury prevention efforts in the real-world setting. This is the first study …

Objectives To estimate the rate of unintentional drowning mortality and hospitalised morbidity using population-based, population-risk and person-time denominator data and to compare the estimates obtained. To then compare exposure-based rates for drowning with road traffic death rates. Method Retrospective analysis of unintentional drowning mortality and hospitalised morbidity of New South Wales (NSW, Australia) residents 16+ years of age during 1 January to 31 December 2005. Information on population-risk and person-time risk was obtained from the 2005 NSW Population Health Survey. Analysis of road traffic death data from NSW and population and person-time risk estimates from the Survey of Vehicle Use, Household Travel Surveys and Roads and Traffic Authority Speed Surveys in 2005. Results Estimated drowning mortality and hospitalised morbidity rates for adults were higher using population-risk and person-time risk exposures compared to a population-based exposure. Population-based estimates of road traffic mortality were four times higher than drowning mortality rates. In contrast, exposure adjusted person-time estimates for drowning were 200 times higher than road traffic fatalities. Conclusions Many injury risks are underestimated when the total age-specific population is used to calculate an injury rate instead of actual population-risk or person-time exposure. This can result in the identification of misleading priorities for injury prevention. Drowning risk is strikingly higher than previously thought based on population-based estimates. This information is important for decision-making and policy development as it provides a basis for comparing the inherent risk in exposure to hazards with potential to cause injury.

IntroductionOne-third of patients with refractory epilepsy may be candidates for resective surgery, which can lead to positive clinical outcomes if efficiently managed. In Australia, there is currently between a 6-month and 2-year delay for patients who are candidates for respective epilepsy surgery from the point of referral for surgical assessment to the eventual surgical intervention. This is a major challenge for implementation of effective treatment for individuals who could potentially benefit from surgery. This study examines implications of delays following the point of eligibility for surgery, in the assessment and treatment of patients, and the factors causing treatment delays.Methods and analysisMixed methods design: Observations of qualitative consultations, patient and healthcare professional interviews, and health-related quality of life assessments for a group of 10 patients and six healthcare professionals (group 1); quantitative retrospective medical records’ reviews examining longitudinal outcomes for 50 patients assessed for, or undergoing, resective surgery between 2014 and 2016 (group 2); retrospective epidemiological study of all individuals hospitalised with a diagnosis of epilepsy in New South Wales (NSW) in the last 5 years (2012–2016; approximately 11 000 hospitalisations per year, total 55 000), examining health services’ use and treatment for individuals with epilepsy, including refractory surgery outcomes (group 3).Ethics and disseminationEthical approval has been granted by the North Sydney Local Health District Human Research Ethics Committee (HREC/17/HAWKE/22) and the NSW Population & Health Services Research Ethics Committee (HREC/16/CIPHS/1). Results will be disseminated through publications, reports and conference presentations to patients and families, health professionals and researchers.

Background Injury, predominantly fall-related injury, is the most common reason for hospitalisation for people with dementia. Trends in fall-related injury hospitalisations for older people generally have changed over the past decade. It is unknown what impact dementia has on these trends. Methods Fall-related injury hospitalisations during 1 January 2003 to 31 December 2012 for people aged 65 and older admitted to a hospital in New South Wales, Australia were identified. Hospitalisation records were probabilistically linked to provide comprehensive person-based records. Rates were age-standardised to the 2001 Australian Standard population. Trends over time were analysed using negative binomial regression analysis Results There were 52,502 hospitalisations for people with dementia and 203,330 for people without dementia. People with dementia were more likely to be admitted for a hip fracture (ARR 1.76; 95% CI: 1.73–1.79, p Conclusions Fall-related fracture rates, notably hip fractures, have decreased over the past ten years in people with dementia, whilst there has not been a corresponding decrease in people without dementia. Rates for non-fracture injuries including TBI have increased in both people with and without dementia. The reasons for these differences are not clear.

Background Recovery following hip fracture can be aided by access to, and participation in, rehabilitation-related activities. However, access to rehabilitation can differ for individuals with and without dementia. This study compares the characteristics and health outcomes of individuals with and without dementia following a hip fracture; and their access to and outcomes following hospital-based rehabilitation. Methods An examination of hip fractures involving individuals aged 65 years and older with and without dementia using linked hospital separation, rehabilitation and mortality records during 1 January 2009 to 31 December 2013 in New South Wales, Australia. Comorbidities were identified using a 1-year lookback period and a modified Charlson Comorbidity Index. Logistic regression was used to examine the association of a hospital-based rehabilitation and individual characteristics. Results There were 8,785 individuals with and 23,520 individuals without dementia who sustained a hip fracture. Individuals with dementia had a higher age-adjusted 30-day mortality rate compared to individuals without dementia (11.7% vs 5.7%), a lower proportion of age-adjusted 28-day re-admission (17.3% vs 24.4%), and a longer age-adjusted mean length of stay (22.2 vs 21.9 days). Compared to individuals without dementia, individuals with dementia had 4.3 times (95% CI: 3.90–4.78) lower odds of receiving hospital-based rehabilitation. However, when they did receive rehabilitation they achieved significant motor functional gain at discharge compared to admission assessed using the Functional Independence Measure (p Conclusions Within a population-based cohort, older individuals with dementia can benefit from access to, and participation in, rehabilitation activities following a hip fracture. This will ensure that they have the best chance of returning to their pre-fracture physical function and mobility.

We were very pleased to have interest in our paper in this journal1 on the unrecognised importance of drowning as a cause of premature death and suffering. Mr Morgan raises some specific questions about the methodology we chose in our paper.2 The objective of our paper was to demonstrate that calculating the rate of drowning using the total population as a denominator underestimates the risk of drowning, as it assumes equal exposure to water for the whole population. Five estimates of incidence rates of drowning morbidity and mortality were provided in the paper, four of which were adjusted for different levels of self-reported risk. One rate was estimated using the total population as the denominator; three used various levels of reported exposure for the denominator (ie, population risk) and one used a person-time risk measure for reported hours spent swimming. Mr Morgan's questions only related to the drowning death rate calculations for the person-time risk measure related to swimming, and these are …

Background Land transport crashes are responsible for a large proportion of injury-related morbidity and subsequent disability. The accurate identification of land transport morbidity is essential to inform and evaluate countermeasures and policy. Aims/Objectives/Purpose To develop and compare ICD-based non-fatal injury severity measures, in order to accurately define injury severity resulting from land transport crashes. Methods All land transport hospital admissions and fatalities from 2001 to 2007 in New South Wales, Australia, were examined. Previously published limitations of the ICD-based International Classification Injury Severity Score (ICISS) were addressed by: including multiple admissions and deaths that occurred outside hospital using data linkage; including comorbidity and age; and accounting for multiple injuries, using multiplicative or worst injury methods. The performance of the different approaches in predicting mortality was assessed with multivariate logistic regression, by comparing the discrimination, calibration and goodness-of-fit. Results/Outcomes There were 109 843 land transport hospital admissions during the study period, of which 3471 were fatalities. The inclusion of age and comorbidity improved the prediction of mortality for all ICISS methods. The inclusion of multiple admissions and deaths outside hospital substantially improved the performance of ICISS. ICISS determined from the worst injury had improved discrimination and goodness-of-fit compared with the multiplicative method, for individuals with multiple injuries. The superior ICISS approach demonstrated excellent predictive power (concordance of 0.950). Significance/Contribution to the Field ICISS is a robust predictor of mortality for land transport trauma. Superior performance was achieved with the worst injury method, and including age, comorbidity, multiple admissions and deaths outside hospital. This is an abstract of a presentation at Safety 2012, the 11th World Conference on Injury Prevention and Safety Promotion, 1-4 October 2012, Michael Fowler Center, Wellington, New Zealand. Full text does not seem to be available for this abstract.

Background Falls are one of the leading causes of injury in older people. Rehabilitation services can assist individuals to improve mobility and function after sustaining a fall-related injury. However, the true impact of fall-related injuries resulting in hospitalisation are often underestimated because of failure to consider sub-acute and non-acute care provided following an acute care episode. Aim To examine fall-related sub-acute and non-acute care and to establish and project the burden of fall-related rehabilitation in acute care to 2020. Method Retrospective review of sub-acute and non-acute records linked to hospital admission and/or emergency department presentations during 2001–2002 to 2008–2009 in New South Wales (NSW), Australia. Analysis of temporal trends and projections to 2020 of rehabilitation-related (ICD-10-AM: Z47, Z48, Z50, Z75.1) acute hospital admissions. Results There were 4317 individuals with a fall-related injury who were admitted to hospital and later admitted for sub-acute and non-acute care; 84% of these were aged 65+ years; 70.4% were female; 27.2% had femur fractures. Total mean FIM scores significantly increased from 78.4 to 94.6 (p Significance This is the first study to provide a snap-shot of the epidemiological profile of individuals using sub-acute and non-acute care in NSW using linked data. This information can be used to inform resource implications for fall-related sub-acute and non-acute care and acute rehabilitation services.

Background Road trauma identified using hospital admission records and/or police-reported crashes are susceptible to changes in policy and resourcing. Divergence between the incidence of police and hospital reported road trauma trends needs to be explored, as this may have an impact on the development and evaluation of road safety policy. Aim To compare the temporal trends in police, hospital, and linked police-hospital records for non-fatal road trauma for road users by injury severity. Method Temporal trends for road users were examined in: (i) hospital admission, (ii) police-reported crashes, and (iii) linked police-hospital records during 2001–2009 in New South Wales, Australia by injury severity. Injury severity was identified using the International Classification of Diseases Injury Severity Scores (ICISS). Results Hospital records showed significantly increasing injury trends for motorcyclists and pedal cyclists (6.3% and 5.5%) and significantly decreasing trends for motor vehicle occupants and pedestrians (1.7% and 2.2%) per year. These trends were similar for linked hospital-police data, except for pedal cyclists. In police-reported crashes, there were significant decreases for pedal cycle, motor vehicle and pedestrian casualty rates (1.5%, 3.8% and 5.2%), and a significant increase for motorcyclists (1.8%) each year. Serious injury (ICISS greater than 0.965) showed less fluctuation in injury trends over time than more minor injuries. Significance Differences in the annual percent change over time between hospital and police-reported crashes are evident which may influence policymaking. Motorcycle trauma were increasing 3.5-fold using hospital admissions compared to police-reported crashes, while pedal cyclists showed divergent trends between data collections.

Background Despite considerable advances in falls prevention research and practice, the rate of falls-related hospitalisations continues to increase. Yet, there is some evidence that hip fracture rates, a major cause of fall-related morbidity, are declining. An examination of trends in types of injuries that contribute to the overall fall injury rate is required to understand these conflicting trends. Aim To examine the trends in fall-related hospital admissions by injury type in New South Wales (NSW), Australia. Method A retrospective review of fall-related injury hospitalisations in NSW among individuals aged 65+ years, by injury type, was conducted from 1 July 1998 to 30 June 2009. Incident cases were identified using the referral source field and direct age standardised admission rates were calculated. Negative binomial regression was used to examine the statistical significance of changes in the trend over time of hospitalised fall-related injuries by injury type. Results The overall fall-related hospitalisation rate increased by 1.7% each year (p Conclusion It appears that, while falls prevention efforts in NSW are not yet affecting hospitalised falls injury rates, efforts in relation to bone health may be having an effect in preventing fractures. It is likely that the increase in severe head injuries is due to improvements in diagnosis.

Introduction Burden of disease estimates have been used to inform prioritisation of research needs. In Australia, National Health Priority Areas (NHPAs), of which injury prevention is one, have been identified as priorities for prevention and research. The National Health and Medical Research Council (NHMRC) is the principal source of medical research funding in Australia. This research aims to examine NHMRC funding for each NHPA to quantify the relationship between grants awarded and burden of disease measures. Method A retrospective analysis of NHMRC funding from 2000 to 2008 to assess the strength of correlation between level of funding and the contribution of each NHPA to burden of disease measures (YLD, YLL, DALY) and health system expenditure was conducted. Also examined were observed versus expected research grants by grant type relative to the proportional contribution of each NHPA to DALYs. Results There were 6099 new and continuing grants awarded, ranging from a total of $A94.6 to $A423.3 million during 2000–2008. Both YLL and DALYs were strongly correlated with NHMRC funding. Injury received a lesser number of scholarships, overseas training fellowships, career awards, research project and programme grants than what would be expected based on its proportional contribution to total NHPA DALYs. Conclusion Injury research and investigator training appears to be underfunded by the NHMRC in Australia based on burden of disease measures. Investigator training dollars should be allocated to ensure an optimum workforce distribution that is capable of undertaking research in areas deemed to be of national importance.