Lesley Day

Purpose: The purpose of this paper is to examine the level of physical preparation for bushfire among Victorian residents in established high risk bushfire locations, and to assess whether these levels of preparation changed over time. Design/methodology/approach: Data were analysed from a telephone survey among Victorian residents (n=614-629) living in high risk bushfire locations over a three-year period (2012-2014). The survey measured residents’ bushfire awareness, knowledge, planning, preparation and engagement with bushfire services. This paper focusses on the extent to which respondents undertook physical preparatory bushfire activities over the three-year period using: first, principal components analysis to generate a single preparation variable by identifying a smaller number of uncorrelated variables (or principal components) from a larger set of data, second, analysis of variance to assess differences in preparation scores between years, and third, Tukey’s honest significant difference test to confirm where the differences occurred between groups. Findings: Results indicated only moderate levels of physical preparation for bushfires amongst respondents. The activities that respondents rated the lowest were: “having protective covers for windows” and “having firefighting equipment to protect the house”. A significant difference in total preparation scores over time was observed, F(2, 1,715)=6.159, p<0.005, with lower scores in 2012 compared with 2013 and 2014 scores. Social implications: This study found some marginal improvements in levels of physical bushfire preparation from 2012 to 2014. However, the results indicate only moderate levels of preparation overall, despite respondents living in established high risk locations. Originality/value: This study provides evidence for the current levels of preparedness in high risk bushfire communities, and emphasises the need for future initiatives to focus on specific bushfire preparation activities but also to consider the broader range of interventions that are likely to contribute to desired safety outcomes.

Falls among older people are of growing concern globally. Implementing cost-effective strategies for their prevention is of utmost importance given the ageing population and associated potential for increased costs of fall-related injury over the next decades. The purpose of this study was to undertake a cost-utility analysis and secondary cost-effectiveness analysis from a healthcare system perspective, of a group-based exercise program compared to routine care for falls prevention in an older community-dwelling population. A decision analysis using a decision tree model was based on the results of a previously published randomised controlled trial with a community-dwelling population aged over 70. Measures of falls, fall-related injuries and resource use were directly obtained from trial data and supplemented by literature-based utility measures. A sub-group analysis was performed of women only. Cost estimates are reported in 2010 British Pound Sterling (GBP). The ICER of GBP£51,483 per QALY for the base case analysis was well above the accepted cost-effectiveness threshold of GBP£20,000 to £30,000 per QALY, but in a sensitivity analysis with minimised program implementation the incremental cost reached GBP£25,678 per QALY. The ICER value at 95% confidence in the base case analysis was GBP£99,664 per QALY and GBP£50,549 per QALY in the lower cost analysis. Males had a 44% lower injury rate if they fell, compared to females resulting in a more favourable ICER for the women only analysis. For women only the ICER was GBP£22,986 per QALY in the base case and was below the cost-effectiveness threshold for all other variations of program implementation. The ICER value at 95% confidence was GBP£48,212 in the women only base case analysis and GBP£23,645 in the lower cost analysis. The base case incremental cost per fall averted was GBP£652 (GBP£616 for women only). A threshold analysis indicates that this exercise program cannot realistically break even. The results suggest that this exercise program is cost-effective for women only. There is no evidence to support its cost-effectiveness in a group of mixed gender unless the costs of program implementation are minimal. Conservative assumptions may have underestimated the true cost-effectiveness of the program.

Rationale, aims and objectives: The extent to which best practice for falls prevention is being routinely delivered by health care providers for community‐dwelling older adults is unclear. We investigated falls prevention practice among Hospital Admission Risk Programs (HARP) that provide and coordinate specialized health care for people at high risk of hospitalization.Method: Cross‐sectional survey of all HARP services in Victoria, excluding one paediatric programme (n = 34). The questionnaire focused upon medication review and exercise prescription, as these are the evidence‐based falls interventions with a good fit with HARP services.Results: Completed questionnaires were received from 24 programmes (70.6%) that service 15 250 older clients (60+ years). All except one programme screened for medicine use; however, a lower proportion (65% of those that screen) target falls risk medications. Among the 17 programmes responding to the exercise prescription question, all routinely include strengthening exercises, and almost all (n = 15) include flexibility, endurance training and movement of the centre of gravity. A lesser proportion (71%) includes reducing the need for upper limb support. The majority of services (88%) undertake falls risk assessments, and all of these either make referral appointments for clients or refer to other services that make referral appointments for clients. Follow‐up of appointments and the resulting recommendations was high.Conclusion: Screening for falls risk medications could be improved and staff training in exercise prescription for balance challenge in this high‐risk group may be needed. Although evidence‐based falls prevention practice within Victorian HARP services appears strong, the effect on falls risk may not be as high as that achieved in randomized trials.

Motorcycle sales, registration and use are increasing in many countries. The epidemiological literature on risk factors for motorcycle injury is becoming outdated, due to changes in rider demography, licensing regulations, traffic mix and density, road environments, and motorcycle designs and technologies. Further, the potential contribution of road infrastructure and travel speed has not yet been examined.

Studies comparing internally linked (person–identifying) and unlinked (episodes of care) hospital discharge data (HDD) on hip fractures have mainly focused on incidence overestimation by unlinked HDD, but little is known about the impact of overestimation on patient profiles such as comorbidity estimates. In view of the continuing use of unlinked HDD in hip fracture research and the desire to apply research results to hip fracture prevention, we concurrently assessed the accuracy of both incidence and comorbidity estimates derived from unlinked HDD compared to those estimated from internally linked HDD.