The impact of the Thai motorcycle transition on road traffic injury: Thai cohort study results

OBJECTIVES The aim of this study was to investigate the impact of motorcycle to car transitioning and urbanisation on traffic injury rates in Thailand. DESIGN Analysis of two consecutive surveys of a large national cohort study. SETTING Thailand. PARTICIPANTS The data derived from 57,154 Thai Cohort Study (TCS) participants who provided relevant data on both the 2005 and 2009 surveys. PRIMARY AND SECONDARY OUTCOME MEASURES Motorcycle and car traffic crash injury self-reported in 2009, with twelve months' recall. RESULTS In 2009, 5608(10%) participants reported a traffic crash injury. Most crashes involved a motorcycle (74%). Car access increased and motorcycle use decreased between 2005 and 2009. Among those who used a motorcycle at both time points, traffic injury incidence was 2.8 times greater compared to those who did not use a motorcycle at either time point. Multivariable logistic regression models were used to test longitudinal and cross sectional factors associated with traffic crash injury: in the adjusted model, cars were negatively and motorcycles positively associated with injury. Living in an urban area was not injury protective in the adjusted model of traffic crash injury. CONCLUSIONS Ongoing urbanisation in Thailand can be expected to lead to further reductions in road traffic injuries based on transition from motorcycles to cars in urban areas. Cities, however, do not provide an intrinsically safer traffic environment. To accommodate a safe transition to car use in Thailand, traffic infrastructural changes anticipating the growing car density in urban areas is warranted.The Thai Cohort Study is funded by the International Collaborative Research Grants Scheme with joint grants from the Wellcome Trust UK (GR071587MA) and the Australian National Health and Medical Research Council (NHMRC) (268055) and as a global health grant from the NHMRC (585426)

Predictors of injury mortality: findings from a large national cohort in Thailand

OBJECTIVE To present predictors of injury mortality by types of injury and by pre-existing attributes or other individual exposures identified at baseline. DESIGN 5-year prospective longitudinal study. SETTING Contemporary Thailand (2005-2010), a country undergoing epidemiological transition. PARTICIPANTS Data derived from a research cohort of 87 037 distance-learning students enrolled at Sukhothai Thammathirat Open University residing nationwide. MEASURES Cohort members completed a comprehensive baseline mail-out questionnaire in 2005 reporting geodemographic, behavioural, health and injury data. These responses were matched with national death records using the Thai Citizen ID number. Age-sex adjusted multinomial logistic regression was used to calculate ORs linking exposure variables collected at baseline to injury deaths over the next 5 years. RESULTS Statistically significant predictors of injury mortality were being male (adjustedOR 3.87, 95% CI 2.39 to 6.26), residing in the southern areas (AOR 1.71, 95% CI 1.05 to 2.79), being a current smoker (1.56, 95% CI 1.03 to 2.37), history of drunk driving (AOR 1.49, 95% CI 1.01 to 2.20) and ever having been diagnosed for depression (AOR 1.91, 95% CI 1.00 to 3.69). Other covariates such as being young, having low social support and reporting road injury in the past year at baseline had moderately predictive AORs ranging from 1.4 to 1.6 but were not statistically significant. CONCLUSIONS We complemented national death registration with longitudinal data on individual, social and health attributes. This information is invaluable in yielding insight into certain risk traits such as being a young male, history of drunk driving and history of depression. Such information could be used to inform injury prevention policies and strategies.This study was supported by the International Collaborative Research Grants Scheme with joint grants from the Wellcome Trust UK (GR071587MA) and the Australian National Health and Medical Research Council (268055), and as a global health grant from the NHMRC (585426)

Determinants of workplace injury among Thai Cohort Study participants

OBJECTIVES: To explore individual determinants of workplace injury among Thai workers. DESIGN: Cross-sectional analysis of a large national cohort. SETTING: Thailand. PARTICIPANTS: Thai Cohort Study participants who responded to the 2009 follow-up survey were included if they reported doing paid work or being self-employed (n=51 751). OUTCOME MEASURES: Self-reported injury incidence over the past 12 months was calculated. Multivariate logistic regression models were used to test associations between individual determinants and self-reported workplace injury. RESULTS: Workplace injuries were reported by 1317 study participants (2.5%); the incidence was 34 (95% CI 32 to 36)/1000 worker-years for men, and 18 (17–20) for women. Among men working ≥41 h and earning <10 000 Baht, the injury rate was four times higher compared with men working <11 h and earning ≥20 001 Baht; differences in injury rates were less pronounced in women. Multivariate modelling showed that working ≥49 h/week (23%) and working for ≤10 000 Bath/month (37%) were associated with workplace injury. The increase in injury risk with increased working hours did not exceed the risk expected from increased exposure. CONCLUSIONS: Reductions in occupational injury rates could be achieved by limiting working hours to 48/week. Particularly for Thai low wage earners and those with longer workdays, there is a need for effective injury preventive programmes.NHMRC (National Health and Medical Research Council of Australia

The Child Behaviour Assessment Instrument: development and validation of a measure to screen for externalising child behavioural problems in community setting

<p>Abstract</p> <p>Background</p> <p>In Sri Lanka, behavioural problems have grown to epidemic proportions accounting second highest category of mental health problems among children. Early identification of behavioural problems in children is an important pre-requisite of the implementation of interventions to prevent long term psychiatric outcomes. The objectives of the study were to develop and validate a screening instrument for use in the community setting to identify behavioural problems in children aged 4-6 years.</p> <p>Methods</p> <p>An initial 54 item questionnaire was developed following an extensive review of the literature. A three round Delphi process involving a panel of experts from six relevant fields was then undertaken to refine the nature and number of items and created the 15 item community screening instrument, Child Behaviour Assessment Instrument (CBAI). Validation study was conducted in the Medical Officer of Health area Kaduwela, Sri Lanka and a community sample of 332 children aged 4-6 years were recruited by two stage randomization process. The behaviour status of the participants was assessed by an interviewer using the CBAI and a clinical psychologist following clinical assessment concurrently. Criterion validity was appraised by assessing the sensitivity, specificity and predictive values at the optimum screen cut off value. Construct validity of the instrument was quantified by testing whether the data of validation study fits to a hypothetical model. Face and content validity of the CBAI were qualitatively assessed by a panel of experts. The reliability of the instrument was assessed by internal consistency analysis and test-retest methods in a 15% subset of the community sample.</p> <p>Results</p> <p>Using the Receiver Operating Characteristic analysis the CBAI score of >16 was identified as the cut off point that optimally differentiated children having behavioural problems, with a sensitivity of 0.88 (95% CI = 0.80-0.96) and specificity of 0.81 (95% CI = 0.75-0.87). The Cronbach's alpha exceeded Nunnaly's criterion of 0.7 for items related to inattention, aggression and impaired social interaction.</p> <p>Conclusions</p> <p>Preliminary data obtained from the study indicate that the Child Behaviour Assessment Instrument is a valid and reliable screening instrument for early identification of young children at risk of behavioural problems in the community setting.</p

The impact of the thai motorcycle transition on road traffic injury: Thai cohort study results

Objective

A framework for considering the utility of models when facing tough decisions in public health: a guideline for policy-makers

The COVID-19 pandemic has brought the combined disciplines of public health, infectious disease and policy modelling squarely into the spotlight. Never before have decisions regarding public health measures and their impacts been such a topic of international deliberation, from the level of individuals and communities through to global leaders. Nor have models-developed at rapid pace and often in the absence of complete information-ever been so central to the decision-making process. However, after nearly 3 years of experience with modelling, policy-makers need to be more confident about which models will be most helpful to support them when taking public health decisions, and modellers need to better understand the factors that will lead to successful model adoption and utilization. We present a three-stage framework for achieving these ends

Modelling SARS-CoV-2 disease progression in Australia and New Zealand: an account of an agent-based approach to support public health decision-making

Objective: In 2020, we developed a public health decision-support model for mitigating the spread of SARS-CoV-2 infections in Australia and New Zealand. Having demonstrated its capacity to describe disease progression patterns during both countries' first waves of infections, we describe its utilisation in Victoria in underpinning the State Government's then 'RoadMap to Reopening'. Methods: Key aspects of population demographics, disease, spatial and behavioural dynamics, as well as the mechanism, timing, and effect of non-pharmaceutical public health policies responses on the transmission of SARS-CoV-2 in both countries were represented in an agent-based model. We considered scenarios related to the imposition and removal of nonpharmaceutical interventions on the estimated progression of SARS-CoV-2 infections. Results: Wave 1 results suggested elimination of community transmission of SARS-CoV-2 was possible in both countries given sustained public adherence to social restrictions beyond 60 days' duration. However, under scenarios of decaying adherence to restrictions, a second wave of infections (Wave 2) was predicted in Australia. In Victoria's second wave, we estimated in early September 2020 that a rolling 14-day average of Conclusions: Elimination of SARS-CoV-2 transmission represented in faithfully constructed agent-based models can be replicated in the real world

Bio-psychosocial determinants of time lost from work following non life threatening acute orthopaedic trauma

<p>Abstract</p> <p>Background</p> <p>To determine factors predicting the duration of time away from work following acute orthopaedic non life threatening trauma</p> <p>Methods</p> <p>Prospective cohort study conducted at four hospitals in Victoria, Australia. The cohort comprised 168 patients aged 18-64 years who were working prior to the injury and sustained a range of acute unintentional orthopaedic injuries resulting in hospitalization. Baseline data was obtained by survey and medical record review. Multivariate Cox proportional hazards regression analysis was used to examine the association between potential predictors and the duration of time away from work during the six month study. The study achieved 89% follow-up.</p> <p>Results</p> <p>Of the 168 participants recruited to the study, 68% returned to work during the six month study. Multivariate Cox proportional hazards regression analysis identified that blue collar work, negative pain attitudes with respect to work, high initial pain intensity, injury severity, older age, initial need for surgery, the presence of co-morbid health conditions at study entry and an orthopaedic injury to more than one region were associated with extended duration away from work following the injury. Participants in receipt of compensation who reported high social functioning at two weeks were 2.58 times more likely to have returned to work than similar participants reporting low social functioning. When only those who had returned to work were considered, the participant reported reason for return to work " to fill the day" was a significant predictor of earlier RTW [RR 2.41 (95% C.I 1.35-4.30)] whereas "financial security" and "because they felt able to" did not achieve significance.</p> <p>Conclusions</p> <p>Many injury-related and psycho social factors affect the duration of time away from work following orthopaedic injury. Some of these are potentially modifiable and may be amenable to intervention. Further consideration of the reasons provided by participants for returning to work may provide important opportunities for social marketing approaches designed to alleviate the financial and social burden associated with work disability.</p

Short sleep and obesity in a large national cohort of Thai adults

Objective: To investigate the relationship between short sleep and obesity among Thai adults