This scoping review explored the relationship between spirituality and identity after trauma. Studies must have explored an aspect of spirituality and identity (e.g., personal, role, group). Trauma was defined by the DSM-5 PTSD Criterion A diagnostic criteria. Four databases were searched (n = 10,641 citations), resulting in 181 relevant publications (57 quantitative studies, 124 qualitative studies) that included 55,783 participants from 30 countries. Quantitative findings predominantly showed positive associations between different aspects of spirituality (e.g., religious beliefs/practices, spiritual wellbeing) and identity post-trauma. Thematic analysis of qualitative findings highlighted that: spirituality had helped people to construct a helpful personal identity; supported role identities; and contributed to coherence; and maintained religious identity post-trauma. However, in some cases, spirituality paradoxically contributed to an unhelpful identity after trauma, or led to the loss of a religious identity.

Background: The leading global cause of death for people aged 5-29 years is road traffic injury, a quarter of which is borne by pedestrians. The epidemiology of major hospitalised pedestrian injury across Australia is not reported. This study aims to address this gap using data from the Australia New Zealand Trauma Registry.Methods: The registry hosts information on patients admitted to 25 major trauma centres across Australia who sustain a major injury (ISS > 12) or die following injury. Patients were included if they were injured due to pedestrian injury from 1st July 2015-30 th June 2019. Analysis included patient and injury characteristics, injury patterns and in-hospital outcomes. Primary endpoints included risk-adjusted mortality and length of stay.Results: There were 2159 injured pedestrians; of these, 327 died. Young adults (20-25 years) were the largest group, especially on weekends. Older adults (70 + years) were the largest cohort in pedestrian deaths. The most common injuries were head (42.2 %). One-third of patients were intubated prior to or on ED arrival (n = 731, 34.3 %).Conclusion: Emergency clinicians should have a high index for severe pedestrian injury. Further reduction in road speed in residential areas could reduce all-age pedestrian injury in Australia.(c) 2023 Published by Elsevier Ltd on behalf of College of Emergency Nursing Australasia.

PURPOSE To examine feasibility and acceptability of providing stepped collaborative care case management targeting posttraumatic stress disorder (PTSD) and pain symptoms after major traumatic injury. MATERIALS AND METHODS Participants were major trauma survivors in Victoria, Australia, at risk of persistent pain or PTSD with high baseline symptoms. Participants were block-randomized, stratified by compensation-status, to the usual care (n = 15) or intervention (n = 17) group (46% of eligible patients). The intervention was adapted from existing stepped collaborative care interventions with input from interdisciplinary experts and people with lived experience in trauma and disability. The proactive case management intervention targeted PTSD and pain management for 6-months using motivational interviewing, cognitive behavioral therapy strategies, and collaborative care. Qualitative interviews explored intervention acceptability. RESULTS Intervention participants received a median of 7 h case manager contact and reported that they valued the supportive and non-judgmental listening, and timely access to effective strategies, resources, and treatments post-injury from the case manager. Participants reported few disadvantages from participation, and positive impacts on symptoms and recovery outcomes consistent with the reduction in PTSD and pain symptoms measured at 1-, 3- and 6-months. CONCLUSIONS Stepped collaborative care was low-cost, feasible, and acceptable to people at risk of PTSD or pain after major trauma.IMPLICATIONS FOR REHABILITATIONAfter hospitalization for injury, people can experience difficulty accessing timely support to manage posttraumatic stress, pain and other concerns.Stepped case management-based interventions that provide individualized support and collaborative care have reduced posttraumatic stress symptom severity for patients admitted to American trauma centers.We showed that this model of care could be adapted to target pain and mental health in the trauma system in Victoria, Australia.The intervention was low cost, acceptable and highly valued by most participants who perceived that it helped them use strategies to better manage post-traumatic symptoms, and to access clinicians and treatments relevant to their needs.

This study investigated relationships between post-traumatic stress symptoms (PTSS) and pain disability. Fifty people with chronic pain (probable PTSD,n = 22) completed measures assessing pain interference, PTSS, fear avoidance, and pain self-efficacy. We hypothesized that people with probable PTSD would have higher fear avoidance and lower pain self-efficacy; and that PTSS would be indirectly associated with pain disability via fear avoidance and self-efficacy. People with probable PTSD had higher fear avoidance, but there were no differences in self-efficacy, pain severity or disability. There was an indirect association between PTSS and pain disability via fear avoidance, but not via self-efficacy.

Background: Pedestrians, cyclists and motorcyclists are vulnerable to serious injury due to limited external protective devices. Understanding the level of recovery, and differences between these road user groups, is an important step towards improved understanding of the burden of road trauma, and prioritisation of prevention efforts. This study aimed to characterise and describe patient-reported outcomes of vulnerable road users at 6 and 12 months following orthopaedic trauma. Methods: A registry-based cohort study was conducted using data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) and included pedestrians, cyclists and motorcyclists who were hospitalised for an orthopaedic injury following an on-road collision that occurred between January 2009 and December 2016. Outcomes were measured using the 3-level EuroQol 5 dimensions questionnaire (EQ-5D-3 L), Glasgow Outcome Scale - Extended (GOS-E) and return to work questions. Outcomes were collected at 6 and 12 months post-injury. Multivariable generalized estimating equations (GEE), adjusted for confounders, were used to compare outcomes between the road user groups over time. Results: 6186 orthopaedic trauma patients met the inclusion criteria during the 8-year period. Most patients were motorcyclists (42.8%) followed by cyclists (32.6%) and pedestrians (24.6%). Problems were most prevalent on the usual activities item of the EQ-5D-3 L at 6-months post-injury, and the pain/discomfort item of the EQ-SD3 L at 12 months. The adjusted odds of reporting problems on all EQ-5D-3 L items were lower for cyclists when compared to pedestrians. Moreover, an average cyclist had a greater odds of a good recovery on the GOS-E, (AOR 2.75, 95% CI 2.33, 3.25) and a greater odds of returning to work (AOR = 3.13, 95% CI 2.46, 3.99) compared to an average pedestrian. Conclusion: Pedestrians and motorcyclists involved in on-road collisions experienced poorer patient-reported outcomes at 6 and 12 months post-injury when compared to cyclists. A focus on both primary injury prevention strategies, and investment in ongoing support and treatment to maximise recovery, is necessary to reduce the burden of road trauma for vulnerable road users.

Introduction: Chronic pain is common after traumatic injury and frequently co-occurs with posttraumatic stress disorder (PTSD) and PTSD symptoms (PTSS). Objectives: This study sought to understand the association between probable PTSD, PTSS, and pain. Methods: Four hundred thirty-three participants were recruited from the Victorian Orthopaedic Trauma Outcomes Registry and Victorian State Trauma Registry and completed outcome measures. Participants were predominantly male (n = 324, 74.8%) and aged 17-75 years at the time of their injury (M = 44.83 years, SD = 14.16). Participants completed the Posttraumatic Stress Disorder Checklist, Brief Pain Inventory, Pain Catastrophizing Scale, Pain Self-Efficacy Questionnaire, Tampa Scale of Kinesiophobia, EQ-5D-3L and Roland-Morris Disability Questionnaire 12 months after hospitalization for traumatic injury. Data were linked with injury and hospital admission data from the trauma registries. Results: Those who reported having current problems with pain were 3 times more likely to have probable PTSD than those without pain. Canonical correlation showed that pain outcomes (pain severity, interference, catastrophizing, kinesiophobia, self-efficacy, and disability) were associated with all PTSSs, but especially symptoms of cognition and affect, hyperarousal, and avoidance. Posttraumatic stress disorder symptoms, on the contrary, were predominantly associated with high catastrophizing and low self-efficacy. When controlling for demographics, pain and injury severity, depression, and self-efficacy explained the greatest proportion of the total relationship between PTSS and pain-related disability. Conclusion: Persons with both PTSS and chronic pain after injury may need tailored interventions to overcome fear-related beliefs and to increase their perception that they can engage in everyday activities, despite their pain.

This study investigated parents' attitudes, knowledge and behaviours relating to their role in protecting and teaching their young children road safety skills; and in particular parents' perceptions regarding where they thought their child learnt the most about road safety. A questionnaire exploring attitudes, knowledge and behaviours on general road safety was completed by 272 participants with at least one child aged between 3 and 10 years residing in the Australian state of Victoria. Participants were predominantly female (74%); were either married or in a de facto relationship (92%); and had completed secondary school education (73%). General road safety behaviours and attitudes were fairly positive, with most participants reporting that they restrict their alcohol consumption or do not drink at all while driving (98%), they drive at or below the speed limit (85%) and 'always' wear their seatbelts (98%). However, more than half of the participants reported engaging in distracting behaviours 'sometimes' or 'often' (54%) and only half reported never engaging in aggressive driving (49%). Only 77% believed they were their child's primary learning source for road safety skills (internal locus of control). The remaining 23% believed school, friends or television were the primary source (external locus of control). Parents with an internal locus of control in educating their children about road safety skills were significantly more likely to be educated at a University level or higher and were more likely to reside in metropolitan versus rural/regional areas, compared with parents with an external locus of control. Parents with an internal locus of control typically had greater knowledge about: whether it is legal in Victoria to drive with unrestrained passengers; whether fines were intended for revenue raising; and whether it is OK to drive 10 km/h above the speed limit in some circumstances. This research provides evidence for road safety intervention development, particularly the potential for parents to be the primary trainers in road safety skills. (C) 2017 Elsevier Ltd. All rights reserved.

Self-regulation of older drivers was explored according to their cognitive status in this pilot study by examining situations commonly avoided by older drivers. In addition, the role of driver insight on self-regulation was examined via passenger reports. Telephone interviews were conducted comprising 49 drivers aged 65 years and above and 40 passengers who acted as informants. Self-regulation was found to be common, with the majority of drivers (71.4%) reporting sometimes or always avoiding one of seven driving situations. However, drivers with cognitive impairment reported self-regulating more often than drivers without cognitive impairment. The largest discrepancy between passenger and driver reports of self-regulation behaviours was found for the drivers with cognitive impairment. These results possibly reflect a decreased awareness of self-regulatory driving behaviours in this subgroup of older drivers and may suggest that other external factors are contributing to self-regulation in older drivers with cognitive impairment. A discussion of these factors is provided with the aim of maintaining mobility and enhancing quality of life in this growing segment of the driver population. (C) 2016 Elsevier Ltd. All rights reserved.

Despite high levels of community education and sustained enforcement, alcohol-related crashes and drink-driving offences continue to pose a threat to road safety. Alcohol interlock programs are one element of enforcement. High-range, repeat or other serious drink-driving offenders can be required to fit alcohol interlocks to their vehicles. The interlock is an electronic breath-testing device that prevents the car from starting if alcohol is detected. This report examines the evidence base and develops options to extend the coverage of alcohol interlock programs to: a wider segment of drink-driving offenders; other high-risk groups; corporate fleets; and if appropriate, the broader driving population on a voluntary basis. The report assesses where additional road safety benefit could be gained over and above existing strategies to mitigate the frequency and consequences of drink-driving. This report presents an overview of current Australasian drink-driving legislation and alcohol interlock program requirements. It identifies gaps in current alcohol interlock programs in Australasia and overseas, identifies opportunities to expand alcohol interlock programs and assesses whether evidence shows a need to expand their coverage given rates of alcohol-related crashes and blood alcohol concentration (BAC) offences. The report examines published evaluations of alcohol interlock programs so as to understand their effectiveness and to assist in making recommendations as to how current programs could be modified, expanded, or tailored to specific driver/rider groups. A review of current and future alcohol interlock technology builds an understanding of system specification, cost and device calibration issues that impact driver and community acceptance. This review, as well as an examination into community attitudes to the expansion of alcohol interlock devices, helps to identify options to expand current alcohol interlock programs.

This thesis investigated driving behaviour of senior drivers with cognitive impairment in order to gain an understanding of how cognition impacts on driver behaviour and fitness to drive.

BACKGROUND:Cognitive decline contributes significantly to the safety risk of older drivers. Some drivers may be able to compensate for the increased crash risk by avoiding complex driving situations or restricting their driving.OBJECTIVE AND METHOD:A comprehensive English-language systematic review was conducted to determine the level of evidence for older adult drivers with cognitive impairment engaging in self-regulation.RESULTS:Twelve studies were included in the review. The majority of studies investigated driver avoidance, followed by driver restriction. Few studies ascertained the reasons for changing driving behaviour.CONCLUSIONS:The evidence supports the view that drivers with cognitive impairment do restrict their driving and avoid complex driving situations. However, it remains to be determined whether the drivers who engage in self-regulation have insight into their own driving abilities or whether external factors result in self-regulation of driving behaviour.

PURPOSE:To examine the frequency, distribution and determinants of a change in recovery expectations following non-life threatening acute orthopaedic trauma to Victorian workers. It is proposed that interventions to modify recovery expectations may reduce the burden associated with injury. However, it is not known whether recovery expectations change over time or the factors that are associated with change.METHODS:A prospective inception cohort study was carried out in which participants were recruited following presentation to hospital for treatment of their injury and followed for 6 months post-injury. Baseline data was obtained by survey and medical record review. Binary logistic regression was used to examine factors associated with a change in recovery expectations between week 2 and week 12 post-injury.RESULTS:The cohort comprised injured workers (n = 145) who had sustained nonlife threatening acute orthopaedic trauma. Factors associated with an improvement in recovery expectations or recovery timeframe included more years of education and higher social functioning. Participants whose injury involved a perception of responsibility by a third party were 7.18 (95 % CI 1.86-27.68) times more likely to change their recovery expectations to more negative expectations and less likely to change to an earlier recovery timeframe. Participants with more severe injuries were more likely to change their recovery timeframe to a longer timeframe.CONCLUSION:Change in recovery expectations provide some information on injured workers who may benefit from targeted interventions to improve or maintain recovery expectations. The post-injury time-point at which recovery expectations are measured is important if recovery expectations are to inform long-term outcomes.

In Australia, approximately 30 percent of road deaths are associated with drivers having an illegal blood alcohol concentration (BAC), with evidence that over the past decade this proportion has increased. It is important to identify and understand the characteristics of drivers most at risk for driving with high BAC levels, and consequently are at increased risk of crash involvement. The aims of the following analysis were to examine the characteristics of single vehicle fatality crashes in Australia from 2000-2006. Of particular interest was the presence and level of alcohol among drivers. Specifically, we aimed to determine the differences in demographic and crash characteristics of drivers (i.e., age, gender, combined drug use) based on BAC level. The Australian Fatal Road Crash Database (FRCD) comprised 3557 single-vehicle crashes which resulted in the death of 2256 drivers and 1234 passengers in the period 2000 to 2006 inclusive. Approximately 54 percent of single vehicle driver fatalities where the BAC was known recorded a BAC greater than 0.0 g/100ml, with 34 percent of fatally injured drivers exceeding a BAC of 0.15 g/100 ml. The findings highlight clear patterns and characteristics of alcohol-related crashes, and give important insights into the demographic profile of intoxicated drivers. Of note was the use of illicit drugs such as cannabis, but also prescription drugs, such as anti-depressants. This research has important implications for how we tackle the drink-driving problem in Australia, particularly in relation to high-BAC drivers.

In many parts of the world, licensing guidelines state that drivers with medical conditions such as epilepsy are restricted or prohibited from driving. These guidelines are sometimes subjective and not strongly evidence-based, rendering the task of assessing fitness to drive a complex one. Determining fitness to drive is not only essential for maintaining the safety of individual drivers but has implications for the community at large. It is therefore important to review the current state of knowledge regarding epilepsy and driving in order to aid health professionals required to assess fitness to drive and to guide future research directions. This review outlines the functional impairments related to epilepsy and driving, treatment and management issues, motor vehicle crash risk for drivers with epilepsy, estimates of predicted seizure occurrence and concludes with a discussion of the international licensing guidelines and relevant legal issues. More comprehensive research, including investigation into the effects of antiepileptic medication on driving, could aid in the development of policies and guidelines for assessing fitness to drive.

Crashes involving pedestrians are severe in nature due to pedestrians' vulnerability, lack of protection and limited biomechanical tolerance to violent forces if hit by a vehicle. Children are thought to constitute a high-risk sub-group. This paper provides an analysis of serious casualty child pedestrians in Victoria and highlights some important features of these collisions. The findings show that young children (especially males) are at significant risk of serious injury, that the majority of collisions occur on urban roads with speed limits of 5060km/h, and that (for older children) crossing the road at midblock sections without the aid of pedestrian crossings and (for younger children) emerging from parked vehicles are predominantly problematic. The implications of these findings are discussed, particularly with regard to developing targeted initiatives within the Safe System framework that may achieve significant reductions in child pedestrian injury crashes.

While there is a large body of research indicating that individuals with moderate to severe dementia are unfit to drive, relatively little is known about the driving performance of older drivers with mild cognitive impairment (MCI). The aim of the current study was to examine the driving performance of older drivers with MCI on approach to intersections, and to investigate how their healthy counterparts perform on the same driving tasks using a portable driving simulator. Fourteen drivers with MCI and 14 age-matched healthy older drivers (aged 65–87 years) completed a 10-min simulator drive in an urban environment. The simulator drive consisted of stop-sign controlled and signal-controlled intersections. Drivers were required to stop at the stop-sign controlled intersections and to decide whether or not to proceed through a critical light change at the signal-controlled intersections. The specific performance measures included; approach speed, number of brake applications on approach to the intersection (either excessive or minimal), failure to comply with stop signs, and slower braking response times on approach to a critical light change. MCI patients in our sample performed more poorly than controls across a number of variables. However, because the trends failed to reach statistical significance it will be important to replicate the study using a larger sample to qualify whether the results can be generalised to the broader population.