Dr Lara Harvey


Hospitalised hot tap water scald patients following the introduction of regulations in NSW, Australia: who have we missed?

Harvey LA, Poulos RG, Finch CF, Olivier J, Harvey JG

Scalds from hot tap water are serious injuries that are potentially preventable by restricting the temperature of hot tap water delivery. In July 1999, regulations were introduced in NSW to require that all new hot water installations deliver water at temperatures not exceeding 50 degrees C to sanitary fixtures. This study investigates trends in hot tap water scald injury hospitalisations following the introduction of these regulations. Hot tap water scald cases for 1999-2007 were identified from hospitalisation data for all public and private hospitals in NSW. To investigate hot tap water scald hospitalisations over time, negative binomial regression analysis was performed. There were 845 hospitalisations for hot tap water scalds in NSW over the period of the study. Hospital admission rates for hot tap water scalds decreased by an estimated 6% (3.2-8.5, 95%CI) per year since the introduction of regulations. While those most at risk were infants, toddlers and the elderly, almost a third of hospitalisations were for adults (25-64 years). The majority of hot tap water scalds were sustained at home and a further 4% occurred in a residential institute or school. The majority of scalds were severe, and a quarter required admission for longer than a week. The introduction of regulations in NSW appears to have had a positive impact on the rates of hospitalisations for hot tap water scalds; however, scalds continue to cause significant morbidity and mortality. This highlights the need for a review of the scope and implementation of the existing regulations and ongoing education of the general public to the dangers of hot tap water.

Safe hot tap water: knowledge, attitude and practice of plumbers, students and regulatory authorities following the introduction of plumbing regulations in NSW, Australia.

Harvey LA, Poulos RG, Finch CF, Harvey JG

Regulations to restrict the temperature of domestic hot tap water were introduced in NSW in 1999. This study investigates the impact of the regulations on the knowledge, attitude and practice of workforce professionals responsible for their uptake and enforcement. Telephone surveys were conducted with a random sample of 110 plumbers and 30 regulating authorities. Surveys were recorded, transcribed and coded. Written questionnaires were completed by 151 plumbing students. The regulations are well known and supported by the majority of plumbers, students and regulators; however 75% of plumbers reported customer dissatisfaction with them. Only a minority of plumbers (11%), students (7%) and regulators (27%) correctly appreciated the impact of a decrease in water temperature in reducing burns. This study identifies the need to improve plumbers and students' understanding of the safety issues underlying the regulations in order to promote more effective advocacy for homes not currently covered by the regulations, and to provide more public education to increase acceptance of them. As only houses built or substantially renovated after June 1999 are likely to have been impacted by the current regulations, there is a need to increase the scope of the regulations to include not only new installations, but also the replacement of existing heated water units if the goal of universal protection is to be achieved.

A population-based survey of knowledge of first aid for burns in New South Wales.

Harvey LA, Barr ML, Poulos RG, Finch CF, Sherker S, Harvey JG

To determine the current level of knowledge of first aid for a burn injury and sources of this knowledge among the general population of New South Wales. A minority of people living in NSW know the optimal time for cooling a burn injury and other appropriate first aid steps for burns. This study demonstrates a gap in the public's knowledge, especially among non-English speaking people and older people, and highlights the need for a clear, consistent first aid message.

The impact of recent changes in smoke alarm legislation on residential fire injuries and smoke alarm ownership in New South Wales, Australia.

Harvey LA, Poulos RG, Sherker S

In 2006, New South Wales (NSW) state legislation changed from requiring smoke alarms in new houses only to all houses. We evaluated the impact of this legislative change on residential fire injury and smoke alarm ownership characteristics. Residential fire injuries for 2002 to 2010 were identified from hospitalization data for all hospitals in NSW. Data relating to smoke alarm ownership and demographic factors were obtained from the NSW Population Health Survey. Negative binomial regression analysis was used to analyze trends over time. Prior to the introduction of universal legislation, hospitalization rates were increasing slightly; however, following the introduction of legislation, hospitalization rates decreased by an estimated 36.2% (95% confidence interval [CI], 16.7-55.8) annually. Smoke alarm ownership increased from 73.3% (95% CI, 72.5-74.2) prelegislation to 93.6% (95% CI, 93.1-94.2) 18 months postlegislation. Thirty percent of households reported testing their alarms regularly. Speaking a language other than English (relative risks [RRs], 1.82; 95% CI, 1.44-2.99), allowing smoking in the home (RR, 1.73; 95% CI, 1.31-2.27), and being part of the most disadvantaged socioeconomic group (RR, 1.47; 95% CI, 1.14-1.91) remain major risk factors for nonownership. Broadening the scope of state legislation has had a positive impact on residential fire-related hospitalizations and smoke alarm ownership. However, it is of concern that the legislation has been the least effective in increasing smoke alarm ownership among non-English-speaking households, in households where smoking is allowed, in low socioeconomic households, and that a high proportion of householders do not test their smoke alarms regularly. Targeted campaigns are needed to reach these high-risk groups and to ensure that smoke alarms are functional.

Traumatic brain injury in older adults: characteristics, causes and consequences.

Harvey LA, Close JC

The rapid increase in hospitalised TBI is being predominantly driven by falls in the oldest old and the greatest increase predominantly in intracranial haemorrhages, highlighting the need for future research to quantify the risk versus benefit of anticoagulant therapies.

Making burns count: the impact of varying case selection criteria on the identification of ICD-10 coded hospitalised burns.

Harvey LA, Poulos RG, Finch CF

The development, implementation and evaluation of health policy and prevention measures rely on good quality, consistent data. Current methods for identifying burn cases in hospitalisation data provide wide differences in estimation of number and nature of cases. It is important for clinicians to understand the implications of coding on the epidemiology and measurement of the burden of burn.

Associations between obesity and overweight and fall risk, health status and quality of life in older people.

Mitchell RJ, Lord SR, Harvey LA, Close JC

To determine whether overweight and obese individuals have higher reported fall and fall injury risk than individuals of healthy weight, and to examine the influence of BMI on health, quality of life and lifestyle characteristics of fallers. Older obese individuals have an increased risk of falls and obese fallers have a higher prevalence of pain and inactivity than fallers of a healthy weight.

Determinants of uptake of home modifications and exercise to prevent falls in community-dwelling older people.

Harvey LA, Mitchell RJ, Lord SR, Close JC

To examine the age-specific population prevalence and predictors of uptake of home modifications and exercise to prevent falls in the NSW older population. More than one-quarter of the older population of NSW report having made modifications to their home and one-third increased exercise to prevent falls. There was a clear gradient of increased uptake of home modifications with increasing age, with the reverse trend for increased exercise.

Obesity and falls in older people: mediating effects of disease, sedentary behavior, mood, pain and medication use.

Mitchell RJ, Lord SR, Harvey LA, Close JC

Obesity has been associated with an increased risk of falls among older people. However, it is not certain whether factors commonly associated with falls and/or obesity mediate this risk. This research examines whether specific diseases, sedentary behavior, mood, pain, and medication use mediate the association between obesity and falls. A representative sample of community-living individuals aged 65+ years in New South Wales (NSW), Australia were surveyed regarding their experience of falls, height, weight, lifestyle and general health within a 12 month period. Intervening variable effects were examined using Freedman and Schatzkin's difference in coefficients tests and regression analyses were used to estimate relative risks. Obesity was associated with a 25% higher risk (95%confidence interval (CI) 1.11-1.41; p<0.0003) of having fallen in the previous 12 months compared to non-obese individuals. The strongest mediators of the association between obesity and falls were sleeping tablets (t=-5.452; p<0.0001), sitting for more than 8h per day on weekdays (t=5.178; p<0.0001), heart disease/angina (t=3.526; p<0.0001), anti-depressant use (t=3.102; p=0.002), moderate/extreme anxiety or depression (t=3.038; p=0.002), and diabetes (t=3.032; p=0.002). Sedentary behavior, chronic health conditions and medication use were identified as mediators for the association between obesity and falls in community living older people. Interventions aimed at weight reduction and increased activity may have benefits not only for fall prevention, but also for the mediating health, mood and lifestyle factors identified here.

Clothing-related burns in New South Wales, Australia: impact of legislation on a continuing problem.

Harvey LA, Connolley S, Harvey JG

To combat the risk of nightwear burns a mandatory standard regulating the design, flammability and labelling requirements of children's nightwear was introduced in Australia in 1987. This population-based study examined the trends, characteristics and causes of clothing-related burns to inform a review of the current standard, and to facilitate the development of targeted prevention strategies. Clothing-related burns for 1998-2013 were identified from hospitalisation data for all hospitals in NSW and detailed information regarding circumstance of injury from a burn data registry. To investigate percentage annual change (PAC) in trends negative binomial regression analysis was performed. There were 541 hospitalisations for clothing-related burns, 18% were nightwear-related and 82% were for other clothing. All clothing burns decreased by an estimated 4% per year (95% CI -6.2 to -2.1). Nightwear-related burns decreased by a significantly higher rate (PAC -7.4%; 95% CI -12.5 to -2.1) than other clothing (PAC -2.5%; 95%CI -4.7 to -0.1). Exposure to open heat source (campfire/bonfire) was the most common cause, followed by cooking. Of factors known to be associated with clothing burns, accelerant use was reported in 27% of cases, cigarettes 17%, loose skirt or dress 8%, and angle grinders in 6% of cases. Hospitalisations for clothing burns are relatively uncommon in NSW and rates, particularly of nightwear burns, have decreased over the last 15 years. Strategies for continued reduction of these injuries include increasing the scope of the current clothing standard or developing new standards to include all children's clothing and adult nightwear, and increasing community awareness of the risk associated with open heat sources, accelerant use and loose clothing.

The ICD-10 Charlson Comorbidity Index predicted mortality but not resource utilization following hip fracture.

Toson B, Harvey LA, Close JC

To evaluate the performance of the Charlson Comorbidity Index (CCI) in the prediction of mortality, 30-day readmission, and length of stay (LOS) in a hip fracture population using algorithms designed for use in International Classification of Diseases, 10th Revision (ICD-10)–coded administrative data sets. The CCI is a valid tool for predicting mortality but not resource utilization after hip fracture. We recommend the use of the Quan algorithm rather than Sundararajan algorithm and to model individual conditions rather than categorized weighted scores.

Dementia and intentional and unintentional poisoning in older people: a 10 year review of hospitalization records in New South Wales, Australia.

Mitchell RJ, Harvey LA, Brodaty H, Draper B, Close JC

Clinicians need to be aware of the risks of poisoning for individuals with dementia and care is required in appropriate prescription, safe administration, and potential for self-harm with commonly used medications, such as anticholinesterase medications, antihypertensive drugs, and laxatives.

The association of physical illness and self-harm resulting in hospitalisation among older people in a population-based study.

Mitchell R, Draper B, Harvey L, Brodaty H, Close J

With population ageing, self-harm injuries among older people are increasing. Further examination of the association of physical illness and self-harm among older people is warranted. This research aims to identify the association of physical illness with hospitalisations following self-harm compared to non-self-harm injury among older people. Older people who are experiencing chronic health conditions, particularly tinnitus, malignancies, diabetes and chronic pain may be at risk of self-harm. Targeted screening may assist in identifying older people at risk of self-harm.

Dementia: A risk factor for burns in the elderly.

Harvey L, Mitchell R, Brodaty H, Draper B, Close J

Burns in people with dementia are significant injuries, which have not decreased over the past ten years despite prevention efforts to reduce burns in older people. Targeted prevention education in the home and residential aged care facilities is warranted.

Hip fracture and the influence of dementia on health outcomes and access to hospital-based rehabilitation for older individuals.

Mitchell R, Harvey L, Brodaty H, Draper B, Close J

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. Implications for Rehabilitation Older individuals with dementia can benefit from rehabilitation activities following a hip fracture. Early mobilisation of individuals post-hip fracture surgery, where possible, is advised. Further work is needed on how best to work with individuals with dementia after a hip fracture in residential aged care to maximise any potential functional gains.

The impact of geographical location on trends in hospitalisation rates and outcomes for fall-related injuries in older people.

Sukumar DW, Harvey LA, Mitchell RJ, Close JC

This population-based study investigates the influence of geographical location on hospital admissions, utilisation and outcomes for fall-related injury in older adults, adjusting for age, sex and comorbidities. Over the study period, rural residents of NSW had lower rates of fall-related injury hospitalisation and a lower annual increase in hospitalisation rates compared to urban residents. When hospitalised, rural residents had a shorter length-of-stay, but higher rates of readmission and mortality. These differences existed following standardisation.

New ICD-10 version of the Multipurpose Australian Comorbidity Scoring System outperformed Charlson and Elixhauser comorbidities in an older population.

Toson B, Harvey LA, Close JC

To translate, validate, and compare performance of an International Classification of Diseases, 10th revision (ICD-10) version of the Multipurpose Australian Comorbidity Scoring System (MACSS) against commonly used comorbidity measures in the prediction of short- and long-term mortality, 28-day all-cause readmission, and length of stay (LOS). This work presents a rigorous translation of the ICD-9 MACSS for use with ICD-10 coded data. The updated ICD-10 MACSS outperformed both Charlson and Elixhauser measures in an older population and is recommended for use with large administrative data sets in predicting mortality outcomes.

Differing trends in fall-related fracture and non-fracture injuries in older people with and without dementia.

Harvey L, Mitchell R, Brodaty H, Draper B, Close J

To explore the impact of dementia on the trends in fall-related fracture and non-fracture injuries for older people. Rates of fall-related fracture and non-fracture hospitalisations for people with dementia remain higher than for those without dementia. However, fall-related fracture hospitalisation rates have decreased for people with dementia, while there has not been a corresponding decrease in people without dementia.