Domestic/Family Violence Death Reviews (D/FVDRs) have been established in a number of high-income... more Domestic/Family Violence Death Reviews (D/FVDRs) have been established in a number of high-income countries since 1990 as a mechanism to inform prevention-focused interventions to reduce domestic/family violence. D/FVDRs differ in their structure, governance, case identification processes and inclusion criteria, review measures, and outputs. Outside of the United States, the extent of heterogeneity across and within countries has not been explored. This study comprised an international comparison of D/FVDRs and their core elements to inform the establishment of D/FVDRs in other developed countries, and potentially low- and middle-income countries where violence is a leading cause of death. Such a review is also a necessary foundation for any future evaluation D/FVDRs. The review identified 71 jurisdictions where a D/FVDRs had been established in the past two decades, 25 of which met the inclusion criteria. All D/FVDRs examined stated a reduction in deaths as a goal of the review process; however, none reported an actual reduction. The focus of the D/FVDRs examined was on intimate partner homicides; however, more
recently established D/FVDRs include other familial relationships. Almost one third of the D/FVDRs examined reported changes to the domestic/family system that occurred as a result of recommendations made from the review process. While similar in many ways, D/FVDRs differ along a number of important dimensions that make it difficult to identify best practices for jurisdictions
considering the establishment of such an initiative. To share knowledge, existing networks should be expanded nationally and internationally to include jurisdictions that may be considering this initiative.
This study describes the nature and extent of fatal heavy vehicle driver crashes in Victoria betw... more This study describes the nature and extent of fatal heavy vehicle driver crashes in Victoria between 1999 and 2007 and the factors associated with the crash. A descriptive study was conducted comprising the population of heavy vehicle drivers killed in a road transport crash while operating a vehicle of > or =4.5 tonne Gross Vehicle Mass (GVM) for the purposes of work. Information about the nature of crash, environmental, driver, vehicle and occupational factors were collected from the coroner's death investigation file. Of the 91 deaths identified 61 were eligible for review. All 61 cases were male, solo drivers with a mean age of 44.7 years. Most vehicles were articulated in configuration. One-third of crash scenarios involved a single vehicle leaving the roadway on a straight road. One in every six fatally injured drivers was detected with the presence of stimulants or cannabis. Twenty-two drivers were travelling at excessive or inappropriate speeds for the circumstances. ...
To describe the nature and extent of external-cause deaths of residents of nursing homes in Victo... more To describe the nature and extent of external-cause deaths of residents of nursing homes in Victoria, Australia. A retrospective cohort study of all decedents using routinely collected data contained within the National Coronial Information System. Accredited nursing homes in Victoria. Nursing home residents who had died from external causes and whose deaths were reported to the Coroners Court between July 1, 2000, and December 31, 2012. Basic descriptive analysis was conducted to measure frequencies and proportion of exposures within each outcome group, and rates were calculated using population data. One thousand two hundred ninety-six external cause deaths of nursing home residents were identified. Deaths were due to falls (n = 1,155, 89.1%), choking (n = 89, 6.9%), suicide (n = 17, 1.3%), complications of clinical care (n = 8, 0.6%) and resident-on-resident assault (n = 7, 0.5%). Deaths occurred more frequently in women (n = 814, 62.8%), in keeping with the sex distribution in n...
The Coroners Prevention Unit at the Coroners Court of Victoria (CCV) is a multidisciplinary team ... more The Coroners Prevention Unit at the Coroners Court of Victoria (CCV) is a multidisciplinary team that investigates deaths referred by the state's coroners, with a view to identifying prevention opportunities. The death of a woman from acute aortic dissection (AAD) after an emergency department attendance prompted the coroner to request a roundtable meeting with emergency physicians (EPs) from Melbourne. The round table was attended by 17 EPs from Melbourne hospitals, along with representatives from the CCV. The meeting identified important clinical, system and cultural features of AAD presentation and management that might be useful in improving case detection and management, and hence outcomes. A key recommendation was that EPs teach junior staff that AAD is the "subarachnoid haemorrhage of chest pain", to change the way patients with chest pain are assessed, with an emphasis on red flags for AAD being considered at the beginning of any discussion. This innovative col...
ABSTRACT Work factors contributing to injury deaths often transcend conventional boundaries of wo... more ABSTRACT Work factors contributing to injury deaths often transcend conventional boundaries of work activity and location. This article presents a classification system developed to identify and categorise an expanded range of injury deaths connected to work. Development of the classification system was informed from a review of existing definitions, classification systems and research studies on work-related injury. The system was then tested as a pilot on all injury deaths reported to the Victorian State Coroner’s Office in 2001. The classification system comprised four key decisions: case type; intent; work status; and work-relatedness. The application of the system to 1,496 coroner-reported injury deaths in 2001 resulted in the classification of 286 (19.1%) deaths as involving some degree of work-relatedness. This approach has the capacity to more broadly identify and examine the nature and extent of work factors associated with injury deaths in Victoria.
resident-to-resident aggression (RRA) is an understudied form of elder abuse in nursing homes. th... more resident-to-resident aggression (RRA) is an understudied form of elder abuse in nursing homes. the purpose of this systematic review was to examine the published research on the frequency, nature, contributing factors and outcomes of RRA in nursing homes. in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, this review examined all original, peer-reviewed research published in English, French, German, Italian or Spanish between 1st January 1949 and 31st December 2013 describing incidents of RRA in nursing homes. The following information was extracted for analysis: study and population characteristics; main findings (including prevalence, predisposing factors, triggers, nature of incidents, outcomes and interventions). eighteen studies were identified, 12 quantitative and 6 qualitative. The frequency of RRA ranged from 1 to 122 incidents, with insufficient information across the studies to calculate prevalence. RRA commonly occurred between exhibitors with higher levels of cognitive awareness and physical functionality and a history of aggressive behaviours, and female targets who were cognitively impaired with a history of behavioural issues including wandering. RRA most commonly took place in the afternoon in communal settings, was often triggered by communication issues and invasion of space, or was unprovoked. Limited information exists on organisational factors contributing to RRA and the outcomes for targets of aggression. we must continue to grow our knowledge base on the nature and circumstances of RRA to prevent harm to an increasing vulnerable population of nursing home residents and ensure a safe working environment for staff.
The care of older people in residential aged care services could be improved by optimising the us... more The care of older people in residential aged care services could be improved by optimising the use of existing information gathered for medico-legal death investigations. The authors address three myths contributing to underuse of this information: deaths are not preventable; public health gains are too small; and it is someone else's charter or responsibility A significant proportion of deaths are preventable, specifically those occurring prematurely from natural causes or due to injury and trauma. By addressing these preventable deaths, significant public health cost savings and better health outcomes for our growing ageing population can be achieved. Despite substantive monitoring of the provision of aged care, no single entity is explicitly responsible for systematically analysing medico-legal death information. The data and skills for using information from medico-legal death investigations currently exist. Dispelling the myths removes one impediment to investing in this ar...
To investigate whether the Victorian mandatory personal flotation device wearing regulations that... more To investigate whether the Victorian mandatory personal flotation device wearing regulations that came into effect on 1 December 2005 reduced drowning deaths among recreational boaters in Victoria, Australia. A retrospective population-based 'before and after' study using Victorian coronial data on drowning deaths of occupants of recreational vessels operating in Victorian waters. The annual numbers of deaths in the 5 years after the transition year of the regulations (2005) was compared with the annual numbers of deaths in the 6 years prior to the transition year, using the Mann-Whitney U test. There were 59 recreational boating drowning deaths in the 6-year preintervention period (1 December 1998 to 30 November 2004) compared with 16 in the 5-year postintervention period (1 December 2005 to 30 November 2010). The analysis showed a significant decrease in drowning deaths among all recreational boaters (U=30.0, p=0.01) and among these strata: vessel occupants aged 0-29 years (U=28.0, p=0.02) and 30-59 years (U=27.5, p=0.02), vessel occupants engaged in pleasure cruising (U=29.0, p=0.01) and in 'other' boating activities (U=25.0, p=0.04), boaters on small powerboats ≤4.8 m in length (U=29.5; p=0.01), boaters on motorised (U=29.5; p=0.01) and sail-powered vessels (U=26.0; p=0.04), and occupants of vessels operating in inland waterways (U=30.0; p=0.01). These findings provide further support for the adoption of a regulatory approach to personal flotation device wearing to reduce drowning among recreational boaters.
To systematically review published research characterizing the nature and circumstances surroundi... more To systematically review published research characterizing the nature and circumstances surrounding the death of older people in nursing homes specifically using information generated for medicolegal death investigations. Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement using the key words death, nursing homes, and medicolegal death investigation. Cross-sectional data from original, peer-reviewed articles published in English between 2000 and 2013 describing deaths of nursing home residents. Information was extracted for analysis about study and population characteristics, number and type of deaths, study design, findings, and limitations. Thirteen studies were identified. The studies examined external causes of deaths from suicide, choking, restraint or bed-related injuries, falls, and pressure injuries. Deaths were more frequent in women with existing comorbidities. Suicide was predominant in men. Identified risk factors and opportunities to reduce harm were identified at individual, organizational, and structural levels. Overall, the quality of the studies limited the aggregation and comparability of findings. This systematic review informs researchers, clinicians and policy-makers about how to reduce external causes of death in nursing homes.
Several countries of the British Commonwealth, including Australia and the United Kingdom, vest i... more Several countries of the British Commonwealth, including Australia and the United Kingdom, vest in coroners the power to issue recommendations for protecting public health and safety. Little is known about whether and how organisations that receive recommendations act on them. Concerns that recommendations are frequently ignored prompted the government of Victoria, Australia, to introduce a requirement in 2008 compelling organisations that receive recommendations to provide a written statement of action. We conducted a prospective study of organisations that received recommendations from Victorian coroners over a 33-month period. Using an online survey, we asked representatives of "recipient organisations" what action (if any) their organisations took, and what factors influenced their decision. We also probed views of the quality of the recommendations and the mandatory response regime in general. Responses were analysed at the recommendation- and recipient organisation-level by calculating counts and proportions and using chi-square analyses to test for sub-group differences. Ninety of 153 recipient organisations surveyed responded (59% response rate); they received 164 recommendations (mean = 1.9; range, 1-7) from 74 cases. A total of 37% (60/164) of the recommendations were accepted and implemented, 27% (45/164) were rejected, and for 36% (59/164) the recommended action was "supplanted" (i.e., action had already been taken). In nearly half of rejected recommendations (18/45), recipient organisations indicated implementation was not logistically viable. In half of supplanted recommendations, an internal investigation had prompted the action. Three quarters (67/90) of recipient organisations believed the introduction of a mandatory response regime was a good idea, but fewer regarded the recommendations they received as appropriate (52/90) or likely to be effective in preventing death and injury (45/90). Only a third of coroners' recommendations were implemented by the organisations to which they were directed. In drawing policy lessons, it is important to separate recommendations that were rejected from those in which action had already been taken. Rejected recommendations raise questions about the quality of the recommendations, the reasonableness of the organisation's response, or both. Supplanted recommendations focus attention on the adequacy of consultation between coroners and affected organisations and the length of time it takes for recommendations to be issued.
To better understand the non-reporting of reportable deaths by determining the frequency and natu... more To better understand the non-reporting of reportable deaths by determining the frequency and nature of reportable deaths referred to the Coroners Court of Victoria (CCOV) by the Registry of Births, Deaths and Marriages (BDM). Review of referrals from BDM to the CCOV between 2003 and 2011 where an external cause of death was recorded on the death certificate, with detailed review for the period 1 July 2010 to 30 June 2011. Frequency and nature of deaths referred, accuracy of cause of death recorded on death certificate, and degree of change made to cause of death after investigation. Over 9 years, there were 4283 referrals (annual mean, 476). Of 656 deaths referred between 1 July 2010 and 30 June 2011, 320 (48.8%) were found to be reportable. Most causes of death related to injuries; less common were choking, deaths after medical procedures, poisoning and transport-related deaths. Most of the deceased were women (55.9%), were aged ≥ 80 years (80.0%), and died in hospital (68.4%). In 309 cases (96.6%), the coroner changed the cause of death after investigation, with a major change in 146 (45.6%), minor change in 160 (50.0%), and deletion of comorbidities in three (0.9%). Twenty-one cases (6.6%) were investigated further, with one proceeding to an inquest. Deaths referred by BDM represent a proportion of the unquantified pool of non-reported deaths. Non-reporting of potentially reportable deaths and inaccurate completion of death certificates have significant implications for the health system and community. Further education of medical practitioners about reportable deaths and death certificates is required. Doctors should report any death about which they have doubt.
Despite widespread application of the public health approach to injury prevention, there is an ac... more Despite widespread application of the public health approach to injury prevention, there is an acknowledged limitation in the extent to which it facilitates translation of research evidence to injury prevention practice. In this paper we clarify the ecoepidemiological principles that underpin the public health approach to injury control in order to support explicit efforts to address the multilevel component causes and improve the evidence base on which effective program implementation depends. KEYPOINTS: If injury causation is understood in terms of the ecoepidemiological model rather than the proximal risk factor model, then quantification of the context in which the event occurs is evidently as important as quantification of the energy exchange event itself. The ecoepidemiological model of injury causation recognises barriers and facilitators to injury prevention as component causes of population burden of injury and thus delineates these factors as legitimate targets for intervention. Injury prevention programs that are designed to specifically address the factors causally related to the program's implementation, as well as the contextual factors that determine the characteristics of the energy exchange event, are more likely to be implemented and more likely to result in effective uptake of recommended energy exchange countermeasures. Interventions to reduce the burden of injury in the population should address the individual level factors that increase the risk of injury, but also the upstream factors that influence the extent to which there is widespread adoption by individuals of the recommended countermeasures.
To describe the presence of alcohol, cannabis and amphetamines in work-related injury deaths in V... more To describe the presence of alcohol, cannabis and amphetamines in work-related injury deaths in Victoria, 2001-6, an observational study of work-related deaths reported to the State Coroner's Office, Victoria, Australia was conducted. Case and postmortem forensic toxicology data were obtained from the National Coroner's Information System for work-related injury deaths with positive toxicology screens. Over 6 years there were 43 worker deaths in a total of 355 unintentional work-related injury deaths. The coroner mentioned the presence of alcohol/drugs in 22 of the 43 worker deaths with positive toxicology screens. Toxicology screens were positive for alcohol and/or drugs in 79 work-related deaths overall. Overall, alcohol was present in 26 (7%) work-related deaths and cannabis or amphetamines in 20 (6%). Incidents were mainly transport related. Alcohol and/or drugs were present in a significant portion of work-related deaths. Research is needed to determine the relative contribution of alcohol and drugs compared with other contributing factors to work-related deaths.
ObjectivesExploring the characteristics of recommendations generated from medicolegal death inves... more ObjectivesExploring the characteristics of recommendations generated from medicolegal death investigations is an important step towards improving their contribution to injury prevention. This study aimed to: (1) quantify coroners' recommendations; and (2) examine the nature of these recommendations according to public health principles of injury causation and prevention.MethodsDeaths where coroners' recommendations were and were not made in the State of Victoria, Australia during the period 1 July 2000 to 30 June 2005 were compared by sex, age group and underlying cause of death. The nature of recommendations made was examined retrospectively using a derived model based on principles of injury causation and prevention, comprising seven elements: (1) priority population; (2) risk/contributing factors; (3) countermeasure; (4) level of intervention; (5) strategy for implementation; (6) organisation; (7) time frame for implementation.ResultsCoroners' recommendations were relatively rare, made in only ∼6% of external-cause deaths. When coroners did make recommendations, they were statistically significantly more likely for persons aged 0-14 years and deaths resulting from transport crashes, complications of medical and surgical care, drowning and inanimate mechanical forces. Of the coroners' recommendations, ∼70% included at least four of the model's seven elements. The elements 'countermeasure' and 'level of intervention' were most commonly specified by coroners (∼95%) in their recommendations.ConclusionsThis study shows that highly evolved medicolegal death investigation systems may not draw systematically from the scientific research evidence base to inform the formulation of coroners' public health and safety recommendations. To maximise its contribution to fatal injury prevention, the medicolegal death investigation may benefit from incorporation of a public health perspective.
Forensic toxicological data provides valuable insight into the potential contribution of alcohol ... more Forensic toxicological data provides valuable insight into the potential contribution of alcohol and drugs to external-cause deaths. There is a paucity of material that guides injury researchers on the principles that need to be considered when examining the presence and contribution of alcohol and drugs to these deaths. This paper aims to describe and discuss strengths and limitations of postmortem forensic toxicology sample selection, variations in analytical capabilities and data interpretation for injury prevention research. Issues to be considered by injury researchers include: the circumstances surrounding death (including the medical and drug use history of the deceased person); time and relevant historical factors; postmortem changes (including redistribution and instability); laboratory practices; specimens used; drug concentration; and attribution of contribution to death. This paper describes the range of considerations for testing and interpreting postmortem forensic toxicology, particularly when determining impairment or toxicity as possible causal factors in injury deaths. By describing these considerations, this paper has application to decisions about study design and case inclusion in injury prevention research, and to the interpretation of research findings.
Domestic/Family Violence Death Reviews (D/FVDRs) have been established in a number of high-income... more Domestic/Family Violence Death Reviews (D/FVDRs) have been established in a number of high-income countries since 1990 as a mechanism to inform prevention-focused interventions to reduce domestic/family violence. D/FVDRs differ in their structure, governance, case identification processes and inclusion criteria, review measures, and outputs. Outside of the United States, the extent of heterogeneity across and within countries has not been explored. This study comprised an international comparison of D/FVDRs and their core elements to inform the establishment of D/FVDRs in other developed countries, and potentially low- and middle-income countries where violence is a leading cause of death. Such a review is also a necessary foundation for any future evaluation D/FVDRs. The review identified 71 jurisdictions where a D/FVDRs had been established in the past two decades, 25 of which met the inclusion criteria. All D/FVDRs examined stated a reduction in deaths as a goal of the review process; however, none reported an actual reduction. The focus of the D/FVDRs examined was on intimate partner homicides; however, more
recently established D/FVDRs include other familial relationships. Almost one third of the D/FVDRs examined reported changes to the domestic/family system that occurred as a result of recommendations made from the review process. While similar in many ways, D/FVDRs differ along a number of important dimensions that make it difficult to identify best practices for jurisdictions
considering the establishment of such an initiative. To share knowledge, existing networks should be expanded nationally and internationally to include jurisdictions that may be considering this initiative.
This study describes the nature and extent of fatal heavy vehicle driver crashes in Victoria betw... more This study describes the nature and extent of fatal heavy vehicle driver crashes in Victoria between 1999 and 2007 and the factors associated with the crash. A descriptive study was conducted comprising the population of heavy vehicle drivers killed in a road transport crash while operating a vehicle of > or =4.5 tonne Gross Vehicle Mass (GVM) for the purposes of work. Information about the nature of crash, environmental, driver, vehicle and occupational factors were collected from the coroner's death investigation file. Of the 91 deaths identified 61 were eligible for review. All 61 cases were male, solo drivers with a mean age of 44.7 years. Most vehicles were articulated in configuration. One-third of crash scenarios involved a single vehicle leaving the roadway on a straight road. One in every six fatally injured drivers was detected with the presence of stimulants or cannabis. Twenty-two drivers were travelling at excessive or inappropriate speeds for the circumstances. ...
To describe the nature and extent of external-cause deaths of residents of nursing homes in Victo... more To describe the nature and extent of external-cause deaths of residents of nursing homes in Victoria, Australia. A retrospective cohort study of all decedents using routinely collected data contained within the National Coronial Information System. Accredited nursing homes in Victoria. Nursing home residents who had died from external causes and whose deaths were reported to the Coroners Court between July 1, 2000, and December 31, 2012. Basic descriptive analysis was conducted to measure frequencies and proportion of exposures within each outcome group, and rates were calculated using population data. One thousand two hundred ninety-six external cause deaths of nursing home residents were identified. Deaths were due to falls (n = 1,155, 89.1%), choking (n = 89, 6.9%), suicide (n = 17, 1.3%), complications of clinical care (n = 8, 0.6%) and resident-on-resident assault (n = 7, 0.5%). Deaths occurred more frequently in women (n = 814, 62.8%), in keeping with the sex distribution in n...
The Coroners Prevention Unit at the Coroners Court of Victoria (CCV) is a multidisciplinary team ... more The Coroners Prevention Unit at the Coroners Court of Victoria (CCV) is a multidisciplinary team that investigates deaths referred by the state's coroners, with a view to identifying prevention opportunities. The death of a woman from acute aortic dissection (AAD) after an emergency department attendance prompted the coroner to request a roundtable meeting with emergency physicians (EPs) from Melbourne. The round table was attended by 17 EPs from Melbourne hospitals, along with representatives from the CCV. The meeting identified important clinical, system and cultural features of AAD presentation and management that might be useful in improving case detection and management, and hence outcomes. A key recommendation was that EPs teach junior staff that AAD is the "subarachnoid haemorrhage of chest pain", to change the way patients with chest pain are assessed, with an emphasis on red flags for AAD being considered at the beginning of any discussion. This innovative col...
ABSTRACT Work factors contributing to injury deaths often transcend conventional boundaries of wo... more ABSTRACT Work factors contributing to injury deaths often transcend conventional boundaries of work activity and location. This article presents a classification system developed to identify and categorise an expanded range of injury deaths connected to work. Development of the classification system was informed from a review of existing definitions, classification systems and research studies on work-related injury. The system was then tested as a pilot on all injury deaths reported to the Victorian State Coroner’s Office in 2001. The classification system comprised four key decisions: case type; intent; work status; and work-relatedness. The application of the system to 1,496 coroner-reported injury deaths in 2001 resulted in the classification of 286 (19.1%) deaths as involving some degree of work-relatedness. This approach has the capacity to more broadly identify and examine the nature and extent of work factors associated with injury deaths in Victoria.
resident-to-resident aggression (RRA) is an understudied form of elder abuse in nursing homes. th... more resident-to-resident aggression (RRA) is an understudied form of elder abuse in nursing homes. the purpose of this systematic review was to examine the published research on the frequency, nature, contributing factors and outcomes of RRA in nursing homes. in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, this review examined all original, peer-reviewed research published in English, French, German, Italian or Spanish between 1st January 1949 and 31st December 2013 describing incidents of RRA in nursing homes. The following information was extracted for analysis: study and population characteristics; main findings (including prevalence, predisposing factors, triggers, nature of incidents, outcomes and interventions). eighteen studies were identified, 12 quantitative and 6 qualitative. The frequency of RRA ranged from 1 to 122 incidents, with insufficient information across the studies to calculate prevalence. RRA commonly occurred between exhibitors with higher levels of cognitive awareness and physical functionality and a history of aggressive behaviours, and female targets who were cognitively impaired with a history of behavioural issues including wandering. RRA most commonly took place in the afternoon in communal settings, was often triggered by communication issues and invasion of space, or was unprovoked. Limited information exists on organisational factors contributing to RRA and the outcomes for targets of aggression. we must continue to grow our knowledge base on the nature and circumstances of RRA to prevent harm to an increasing vulnerable population of nursing home residents and ensure a safe working environment for staff.
The care of older people in residential aged care services could be improved by optimising the us... more The care of older people in residential aged care services could be improved by optimising the use of existing information gathered for medico-legal death investigations. The authors address three myths contributing to underuse of this information: deaths are not preventable; public health gains are too small; and it is someone else's charter or responsibility A significant proportion of deaths are preventable, specifically those occurring prematurely from natural causes or due to injury and trauma. By addressing these preventable deaths, significant public health cost savings and better health outcomes for our growing ageing population can be achieved. Despite substantive monitoring of the provision of aged care, no single entity is explicitly responsible for systematically analysing medico-legal death information. The data and skills for using information from medico-legal death investigations currently exist. Dispelling the myths removes one impediment to investing in this ar...
To investigate whether the Victorian mandatory personal flotation device wearing regulations that... more To investigate whether the Victorian mandatory personal flotation device wearing regulations that came into effect on 1 December 2005 reduced drowning deaths among recreational boaters in Victoria, Australia. A retrospective population-based 'before and after' study using Victorian coronial data on drowning deaths of occupants of recreational vessels operating in Victorian waters. The annual numbers of deaths in the 5 years after the transition year of the regulations (2005) was compared with the annual numbers of deaths in the 6 years prior to the transition year, using the Mann-Whitney U test. There were 59 recreational boating drowning deaths in the 6-year preintervention period (1 December 1998 to 30 November 2004) compared with 16 in the 5-year postintervention period (1 December 2005 to 30 November 2010). The analysis showed a significant decrease in drowning deaths among all recreational boaters (U=30.0, p=0.01) and among these strata: vessel occupants aged 0-29 years (U=28.0, p=0.02) and 30-59 years (U=27.5, p=0.02), vessel occupants engaged in pleasure cruising (U=29.0, p=0.01) and in 'other' boating activities (U=25.0, p=0.04), boaters on small powerboats ≤4.8 m in length (U=29.5; p=0.01), boaters on motorised (U=29.5; p=0.01) and sail-powered vessels (U=26.0; p=0.04), and occupants of vessels operating in inland waterways (U=30.0; p=0.01). These findings provide further support for the adoption of a regulatory approach to personal flotation device wearing to reduce drowning among recreational boaters.
To systematically review published research characterizing the nature and circumstances surroundi... more To systematically review published research characterizing the nature and circumstances surrounding the death of older people in nursing homes specifically using information generated for medicolegal death investigations. Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement using the key words death, nursing homes, and medicolegal death investigation. Cross-sectional data from original, peer-reviewed articles published in English between 2000 and 2013 describing deaths of nursing home residents. Information was extracted for analysis about study and population characteristics, number and type of deaths, study design, findings, and limitations. Thirteen studies were identified. The studies examined external causes of deaths from suicide, choking, restraint or bed-related injuries, falls, and pressure injuries. Deaths were more frequent in women with existing comorbidities. Suicide was predominant in men. Identified risk factors and opportunities to reduce harm were identified at individual, organizational, and structural levels. Overall, the quality of the studies limited the aggregation and comparability of findings. This systematic review informs researchers, clinicians and policy-makers about how to reduce external causes of death in nursing homes.
Several countries of the British Commonwealth, including Australia and the United Kingdom, vest i... more Several countries of the British Commonwealth, including Australia and the United Kingdom, vest in coroners the power to issue recommendations for protecting public health and safety. Little is known about whether and how organisations that receive recommendations act on them. Concerns that recommendations are frequently ignored prompted the government of Victoria, Australia, to introduce a requirement in 2008 compelling organisations that receive recommendations to provide a written statement of action. We conducted a prospective study of organisations that received recommendations from Victorian coroners over a 33-month period. Using an online survey, we asked representatives of "recipient organisations" what action (if any) their organisations took, and what factors influenced their decision. We also probed views of the quality of the recommendations and the mandatory response regime in general. Responses were analysed at the recommendation- and recipient organisation-level by calculating counts and proportions and using chi-square analyses to test for sub-group differences. Ninety of 153 recipient organisations surveyed responded (59% response rate); they received 164 recommendations (mean = 1.9; range, 1-7) from 74 cases. A total of 37% (60/164) of the recommendations were accepted and implemented, 27% (45/164) were rejected, and for 36% (59/164) the recommended action was "supplanted" (i.e., action had already been taken). In nearly half of rejected recommendations (18/45), recipient organisations indicated implementation was not logistically viable. In half of supplanted recommendations, an internal investigation had prompted the action. Three quarters (67/90) of recipient organisations believed the introduction of a mandatory response regime was a good idea, but fewer regarded the recommendations they received as appropriate (52/90) or likely to be effective in preventing death and injury (45/90). Only a third of coroners' recommendations were implemented by the organisations to which they were directed. In drawing policy lessons, it is important to separate recommendations that were rejected from those in which action had already been taken. Rejected recommendations raise questions about the quality of the recommendations, the reasonableness of the organisation's response, or both. Supplanted recommendations focus attention on the adequacy of consultation between coroners and affected organisations and the length of time it takes for recommendations to be issued.
To better understand the non-reporting of reportable deaths by determining the frequency and natu... more To better understand the non-reporting of reportable deaths by determining the frequency and nature of reportable deaths referred to the Coroners Court of Victoria (CCOV) by the Registry of Births, Deaths and Marriages (BDM). Review of referrals from BDM to the CCOV between 2003 and 2011 where an external cause of death was recorded on the death certificate, with detailed review for the period 1 July 2010 to 30 June 2011. Frequency and nature of deaths referred, accuracy of cause of death recorded on death certificate, and degree of change made to cause of death after investigation. Over 9 years, there were 4283 referrals (annual mean, 476). Of 656 deaths referred between 1 July 2010 and 30 June 2011, 320 (48.8%) were found to be reportable. Most causes of death related to injuries; less common were choking, deaths after medical procedures, poisoning and transport-related deaths. Most of the deceased were women (55.9%), were aged ≥ 80 years (80.0%), and died in hospital (68.4%). In 309 cases (96.6%), the coroner changed the cause of death after investigation, with a major change in 146 (45.6%), minor change in 160 (50.0%), and deletion of comorbidities in three (0.9%). Twenty-one cases (6.6%) were investigated further, with one proceeding to an inquest. Deaths referred by BDM represent a proportion of the unquantified pool of non-reported deaths. Non-reporting of potentially reportable deaths and inaccurate completion of death certificates have significant implications for the health system and community. Further education of medical practitioners about reportable deaths and death certificates is required. Doctors should report any death about which they have doubt.
Despite widespread application of the public health approach to injury prevention, there is an ac... more Despite widespread application of the public health approach to injury prevention, there is an acknowledged limitation in the extent to which it facilitates translation of research evidence to injury prevention practice. In this paper we clarify the ecoepidemiological principles that underpin the public health approach to injury control in order to support explicit efforts to address the multilevel component causes and improve the evidence base on which effective program implementation depends. KEYPOINTS: If injury causation is understood in terms of the ecoepidemiological model rather than the proximal risk factor model, then quantification of the context in which the event occurs is evidently as important as quantification of the energy exchange event itself. The ecoepidemiological model of injury causation recognises barriers and facilitators to injury prevention as component causes of population burden of injury and thus delineates these factors as legitimate targets for intervention. Injury prevention programs that are designed to specifically address the factors causally related to the program's implementation, as well as the contextual factors that determine the characteristics of the energy exchange event, are more likely to be implemented and more likely to result in effective uptake of recommended energy exchange countermeasures. Interventions to reduce the burden of injury in the population should address the individual level factors that increase the risk of injury, but also the upstream factors that influence the extent to which there is widespread adoption by individuals of the recommended countermeasures.
To describe the presence of alcohol, cannabis and amphetamines in work-related injury deaths in V... more To describe the presence of alcohol, cannabis and amphetamines in work-related injury deaths in Victoria, 2001-6, an observational study of work-related deaths reported to the State Coroner's Office, Victoria, Australia was conducted. Case and postmortem forensic toxicology data were obtained from the National Coroner's Information System for work-related injury deaths with positive toxicology screens. Over 6 years there were 43 worker deaths in a total of 355 unintentional work-related injury deaths. The coroner mentioned the presence of alcohol/drugs in 22 of the 43 worker deaths with positive toxicology screens. Toxicology screens were positive for alcohol and/or drugs in 79 work-related deaths overall. Overall, alcohol was present in 26 (7%) work-related deaths and cannabis or amphetamines in 20 (6%). Incidents were mainly transport related. Alcohol and/or drugs were present in a significant portion of work-related deaths. Research is needed to determine the relative contribution of alcohol and drugs compared with other contributing factors to work-related deaths.
ObjectivesExploring the characteristics of recommendations generated from medicolegal death inves... more ObjectivesExploring the characteristics of recommendations generated from medicolegal death investigations is an important step towards improving their contribution to injury prevention. This study aimed to: (1) quantify coroners' recommendations; and (2) examine the nature of these recommendations according to public health principles of injury causation and prevention.MethodsDeaths where coroners' recommendations were and were not made in the State of Victoria, Australia during the period 1 July 2000 to 30 June 2005 were compared by sex, age group and underlying cause of death. The nature of recommendations made was examined retrospectively using a derived model based on principles of injury causation and prevention, comprising seven elements: (1) priority population; (2) risk/contributing factors; (3) countermeasure; (4) level of intervention; (5) strategy for implementation; (6) organisation; (7) time frame for implementation.ResultsCoroners' recommendations were relatively rare, made in only ∼6% of external-cause deaths. When coroners did make recommendations, they were statistically significantly more likely for persons aged 0-14 years and deaths resulting from transport crashes, complications of medical and surgical care, drowning and inanimate mechanical forces. Of the coroners' recommendations, ∼70% included at least four of the model's seven elements. The elements 'countermeasure' and 'level of intervention' were most commonly specified by coroners (∼95%) in their recommendations.ConclusionsThis study shows that highly evolved medicolegal death investigation systems may not draw systematically from the scientific research evidence base to inform the formulation of coroners' public health and safety recommendations. To maximise its contribution to fatal injury prevention, the medicolegal death investigation may benefit from incorporation of a public health perspective.
Forensic toxicological data provides valuable insight into the potential contribution of alcohol ... more Forensic toxicological data provides valuable insight into the potential contribution of alcohol and drugs to external-cause deaths. There is a paucity of material that guides injury researchers on the principles that need to be considered when examining the presence and contribution of alcohol and drugs to these deaths. This paper aims to describe and discuss strengths and limitations of postmortem forensic toxicology sample selection, variations in analytical capabilities and data interpretation for injury prevention research. Issues to be considered by injury researchers include: the circumstances surrounding death (including the medical and drug use history of the deceased person); time and relevant historical factors; postmortem changes (including redistribution and instability); laboratory practices; specimens used; drug concentration; and attribution of contribution to death. This paper describes the range of considerations for testing and interpreting postmortem forensic toxicology, particularly when determining impairment or toxicity as possible causal factors in injury deaths. By describing these considerations, this paper has application to decisions about study design and case inclusion in injury prevention research, and to the interpretation of research findings.
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Papers by Lyndal Bugeja
recently established D/FVDRs include other familial relationships. Almost one third of the D/FVDRs examined reported changes to the domestic/family system that occurred as a result of recommendations made from the review process. While similar in many ways, D/FVDRs differ along a number of important dimensions that make it difficult to identify best practices for jurisdictions
considering the establishment of such an initiative. To share knowledge, existing networks should be expanded nationally and internationally to include jurisdictions that may be considering this initiative.
recently established D/FVDRs include other familial relationships. Almost one third of the D/FVDRs examined reported changes to the domestic/family system that occurred as a result of recommendations made from the review process. While similar in many ways, D/FVDRs differ along a number of important dimensions that make it difficult to identify best practices for jurisdictions
considering the establishment of such an initiative. To share knowledge, existing networks should be expanded nationally and internationally to include jurisdictions that may be considering this initiative.