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ABSTRACT: Little is known of injury outcomes among non-hospitalised injured populations. This study examined the occurrence of poor outcomes 3 months after injury among the 2856 participants in the Prospective Outcomes of Injury Study, most of whom had sustained injuries considered of minor severity (by injury severity scoring) and had not received treatment at a hospital facility. The prevalence of poor outcomes was high across all health, physical functioning and social functioning domains and expectation characteristics examined, including for those participants with the 'least severe' injuries. Approximately half of the cohort reported experiencing moderate to high pain or psychological distress and reduced social participation, and three-quarters did not consider themselves recovered. Our findings demonstrate that, to obtain an accurate understanding of injury burden, injury outcome research should not focus only on those injured persons who are hospitalised.
Injury Prevention 04/2013; · 1.39 Impact Factor
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ABSTRACT: OBJECTIVE: To identify the role of pre-injury socio-demographic and health characteristics, injury and injury-related healthcare characteristics in determining functional outcomes 12 months after injury. STUDY DESIGN: Prospective cohort study involving one year follow-up. SETTING: Persons who were injured and sought treatment from a primary care provider and subsequently required ongoing assistance. PARTICIPANTS: Study participants (aged 18-64 years inclusive) were the 2282 participants in the Prospective Outcomes of Injury Study who completed the 12-month interview. The original cohort of 2856 were injured and registered with New Zealand's national no-fault injury insurance agency. With the exception of injury and hospitalization, information on predictors and outcomes was obtained directly from the participants, primarily by telephone interviews, approximately three and 12 months after their injury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The functional outcomes of interest were the five dimensions of the EQ-5D plus a cognitive dimension. Our multivariate analyses included adjustment for pre-injury EQ-5D status and time between injury and the 12-month interview. RESULTS: Substantial portions of participants continued to have adverse outcomes, especially pain/discomfort, 12 months after their injury. The significance of factors varied by outcome. Factors adversely associated with at least three of the six outcomes were: pre-injury EQ-5D status, being female, aged 45-64 years, inadequate household income, pre-injury disability, two or more prior chronic illnesses, smoking regularly, dislocation or sprains to the spine or upper extremities, and having a relatively severe injury. CONCLUSION: A range of pre-injury socio-demographic and health characteristics are associated with several adverse functional outcomes one year after injury, independent of the nature and severity of injury. The latter, however, also have independent effects on the outcomes.
Archives of physical medicine and rehabilitation 02/2013; · 2.18 Impact Factor
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ABSTRACT: AIMS: Local alcohol policies can be effective in reducing alcohol-related harm. The aim of this study was to examine local government responses to alcohol-related problems and identify factors influencing their development and adoption of alcohol policy. DESIGN, SETTINGS AND PARTICIPANTS: Case studies were used to examine local government responses to alcohol problems in three New Zealand communities: a rural town, a provincial city, and a metropolitan city. Newspaper reports, local government documents and key informant interviews were used to collect data which were analysed using two conceptual frameworks: Kingdon's Streams model and the Stakeholder model of policy development. MEASUREMENTS: Key informant narratives were categorised according to the concepts of the Streams and Stakeholder models. FINDINGS: Kingdon's theoretical concepts associated with increased likelihood of policy change seemed to apply in the rural and metropolitan communities. The political environment in the provincial city, however, was not favourable to the adoption of alcohol restrictions. The Stakeholder model highlighted differences between the communities in terms of power over agenda-setting and conflict between politicians and bureaucrats over policy solutions to alcohol-related harm. These differences were reflected in the ratio of policies considered versus adopted in each location. Decisions on local alcohol policies ultimately lie with local politicians although the policies that can be adopted by local government are restricted by central government legislation. CONCLUSIONS: The adoption of policies and strategies to reduce alcohol-related harm may be better facilitated by an agenda-setting process where no "gate-keepers" determine what gets onto the agenda, and community mobilisation efforts to create competitive local government elections around alcohol issues. Policy adoption would also be facilitated by more enabling central government legislation.
Addiction 11/2012; · 4.31 Impact Factor
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ABSTRACT: OBJECTIVES: (1) Estimate age, period and cohort effects for motorcyclist traffic casualties 1979-2008 in New Zealand and (2) forecast the incidence of New Zealand motorcycle traffic casualties for the period 2019-2023 assuming future age, cohort and period effects, and compare these with an estimate based on simple linear extrapolation. METHODS: Age-period-cohort (APC) modelling was used to estimate the individual effects of age, period and cohort after adjusting for the other two factors. Forecasting was produced for three period-effect scenarios. RESULTS: After adjusting for cohort and period effects, 15-19-year-olds have substantially elevated risk. The period effect reduced in significance over time until the last period, 2004-2008, where the risk was higher than the preceding period. The 10-year cohorts born 1949-1958, 1954-1963, 1959-1968 and 1964-1973, had elevated risk. The forecasting, based on APC modelling, resulted in the lowest estimates of the future incidence being approximately one-third that of the highest estimate (6641). CONCLUSION: Trends in motorcycle casualties have been influenced by significant independent age, period and cohort effects. These need to be considered in forecasting future casualties. The selection of the period effect has a significant impact on the estimates. Which period-effect scenario readers choose to accept depends on their views about a wide range of factors which might influence motorcycle use and crash risk over time.
Injury Prevention 06/2012; · 1.39 Impact Factor
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ABSTRACT: BACKGROUND: Patient recall or the application of population norms are commonly used methods to estimate (unobservable) health status prior to acute-onset illness or injury; however, both measures are potentially subject to bias. This paper reports tests of the validity of both approaches, and discusses the implications for reporting changes in health-related quality of life following acute-onset illness or injury. METHODS: Recalled pre-injury health status and health status at 5- and 12-months post-injury were collected from participants in a prospective cohort study of people injured in New Zealand. Reported post-injury health status was compared with recalled pre-injury status and New Zealand norms for two groups: those who reported having fully recovered, and those who had not. RESULTS: There was a small but significant difference between pre- and post-injury health state valuations for those who had fully recovered, with recalled pre-injury health status being higher than reported post-injury health. Health status for those who had fully recovered was significantly higher than the population norm. CONCLUSIONS: Retrospective evaluation of health status is more appropriate than the application of population norms to estimate health status prior to acute-onset injury or illness, although there may be a small upward bias in such measurements.
Health and Quality of Life Outcomes 06/2012; 10(1):68. · 2.11 Impact Factor
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ABSTRACT: The continuing decline in response rates to household surveys is a concern for the health and social sciences as it increases the risk of selective non-response biasing the estimates of interest.
We analysed non-response bias in a postal survey measuring drinking behaviour, experience of harm and opinion on local government alcohol policies among residents in six New Zealand communities. The Continuum of Resistance model, which suggests that late respondents to a survey are most similar to non-respondents on the measures of interest, was used to guide our investigation.
Men, younger people, those of Māori descent and those living in more deprived areas were less likely to respond to our survey than women, older people, those not of Māori descent and those living in comparatively affluent areas. Late respondents more closely resembled non-respondents demographically than early respondents. The prevalence of binge drinking and experience of assault was higher, and support for restrictive local government alcohol policies lower, among late respondents. Assuming the drinking behaviour and alcohol-related experiences of non-respondents were the same as those of late respondents, prevalence was under-estimated by 3.4% (relative difference: 13%) and 2.1% (relative difference: 21%) for monthly binge drinking and assault respectively. Policy support was not over-estimated.
The findings add to a growing body of evidence suggesting that surveys under-estimate risk behaviour because of selective non-response and this bias increases as response rates fall. Notably, public opinion may not be subject to such misestimation.
Drug and alcohol dependence 06/2012; 126(1-2):189-94. · 3.60 Impact Factor
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Injury Prevention 01/2012; 18(2):73-4. · 1.39 Impact Factor
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ABSTRACT: Despite a significant improvement since graduated licensing was introduced, traffic related injury remains the leading cause of death and hospitalisation among young New Zealanders. The New Zealand Drivers Study (NZDS) was established with a view to providing information that would lead to an improvement in this situation. The NZDS is a prospective cohort study designed to explore the relationship between a comprehensive range of driving and traffic safety related factors and subsequent traffic crashes and convictions among newly licensed drivers. We describe key process objectives in establishing the cohort, and our success in meeting them and the implications arising thereof.
We compare what occurred with what was proposed in the research protocol.
We successfully established a cohort of 3992 newly licensed car drivers with substantial heterogenity in sociodemographic, behavioural, and driving experiences. We have 825 Maori that will allow us to undertake a separate Maori analyses. Response rates to interviews at the restricted and full licence stages have been very high at 87% and 93%, respectively. We have been successful via linkage in following them through the stages of licensure and via linkage obtaining national data on the outcomes of interest.
The NZDS is well placed to make a significant contribution to our knowledge of young driver road safety behaviour. This process has already commenced.
The New Zealand medical journal 01/2012; 125(1357):98-112.
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ABSTRACT: To reduce the burden on injury survivors and their supporters, factors associated with poor outcomes need to be identified so that timely post-injury interventions can be implemented. To date, few studies have investigated outcomes for both those who were hospitalised and those who were not.
To describe the prevalence and to identify pre-injury and injury-related predictors of disability among hospitalised and non-hospitalised people, three months after injury.
Participants in the Prospective Outcomes of Injury Study were aged 18-64 years and on an injury entitlement claims register with New Zealand's no-fault injury compensation insurer, following referral by healthcare professionals. A wide range of pre-injury demographic, health and injury-related characteristics were collected at interview. Participants were categorised as 'hospitalised' if they were placed on New Zealand's National Minimum Data Set within seven days of the injury event. Injury severity scores (NISS) and 12 injury categories were derived from ICD-10 codes. WHODAS assessed disability. Multivariable analyses examined relationships between explanatory variables and disability.
Of 2856 participants, 2752 (96%) had WHODAS scores available for multivariable analysis; 673 were hospitalised; 2079 were not. Disability was highly prevalent among hospitalised (53.6%) and non-hospitalised (39.4%) participants, three-months after injury. In both groups, pre-injury disability, obesity and higher injury severity were associated with increased odds of post-injury disability. A range of other factors were associated with disability in only one group: e.g. female, ≥2 chronic conditions and leg fracture among hospitalised; aged 35-54 years, trouble accessing healthcare, spine or lower extremity sprains/dislocations and assault among non-hospitalised.
Disability was highly prevalent among both groups yet, with a few exceptions, factors associated with disability were not common to both groups. Where possible, including a range of injured people in studies, hospitalised and not, will increase understanding of the burden of disability in the sub-acute phase.
PLoS ONE 01/2012; 7(9):e44909. · 4.09 Impact Factor
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ABSTRACT: In a graduated driver license environment, (1) compare nonprogressors with progressors in terms of prelearner license sociodemographic and behavioral factors, (2) determine whether nonprogressors were more likely to have had a traffic offense than progressors, and (3) determine why nonprogressors chose not to progress.
Our study population was that of the New Zealand Drivers Study (NZDS), a prospective cohort study of newly licensed drivers designed to explore the relationship between a comprehensive range of driving and traffic safety related factors and subsequent traffic crashes and convictions among newly licensed drivers. Nonprogressors, those who had not progressed from a learner to a restricted license 2 years after being eligible to do so, were compared with progressors in terms of their sociodemographic, behavioral characteristics, and traffic offense outcomes.
Nonprogressors represented 38 percent of the cohort and had different sociodemographic and behavioral profiles than progressors. A delay in progression was associated with reduced risk of being a traffic offender. The primary reasons reported for nonprogression were too lazy or busy or limited access to the means to drive.
Before restricting how long a novice driver can hold a learner license, as has been suggested by the Ministry of Transport, consideration should be given to the potential increased risk of offending once unsupervised driving is permitted.
Traffic injury prevention 01/2012; 13(1):7-13.
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ABSTRACT: To describe the distribution of, and trends in, the characteristics of serious non-fatal assault injury for the period 2000-2009.
Serious non-fatal hospitalised assault injury for the 2000-2009 period were identified and described by: sociodemographic characteristics, location of incidents, methods used to inflict injury, alcohol involvement, and nature of injury. Trends in assault by age, gender, and method were examined.
Males, 15-24 year olds, Maori, Pacific Islanders, and those from deprived neighbourhoods had markedly elevated assault rates. Assault by bodily force and head injuries predominated with the former being the major category of assault that increased the most over time
There is a disturbing level of serious assault in New Zealand and the situation is getting worse. We need to review current efforts to prevent these incidents.
The New Zealand medical journal 01/2012; 125(1363):65-76.
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ABSTRACT: Injury outcome studies have tended to collect limited pre-injury characteristics, focus on a narrow range of injury types, predictors and outcomes, and be restricted to high threat to life injuries. We sought to identify the role of pre-injury socio-demographic and health characteristics, injury and injury-related healthcare in determining short-term functional outcomes for a wide range of injuries.
Study participants (aged 18-64 years inclusive) were those in the Prospective Outcomes of Injury Study, a cohort of 2856 persons who were injured and registered with New Zealand's national no-fault injury insurance agency. All information used in this paper was obtained directly from the participants, primarily by telephone interviews, approximately three months after their injury. The functional outcomes of interest were the five dimensions of the EQ-5D plus a cognitive dimension. We initially examined bivariate relationships between our independent measures and the dependent measures. Our multivariate analyses included adjustment for pre-injury EQ-5D status and time between injury and when information was obtained from participants.
Substantial portions of participants continued to have adverse outcomes approximately three months after their injury. Key pervasive factors predicting adverse outcomes were: being female, prior chronic illness, injuries to multiple body regions, being hospitalized for injury, self-perceived threat to life, and difficulty accessing health services.
Future injury outcome studies should include participants whose injuries are considered 'minor', as judged by acute health service utilization, and also consider a wider range of potential predictors of adverse outcomes.
Health and Quality of Life Outcomes 08/2011; 9:68. · 2.11 Impact Factor
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ABSTRACT: In many countries, including New Zealand, alcohol availability and promotion have increased markedly in the last three decades as a result of liberalised central and/or state government alcohol policies. Accordingly, communities are increasingly relying on local government to manage alcohol-related problems. New Zealand's Local Government Act (2002) states the purpose of local government as facilitating public decision-making and promoting community well-being. We sought to describe public sentiment towards alcohol and local government alcohol policies.
A cross-sectional survey was conducted in 2007 with a sample of 2337 residents aged 18 years and over in a diverse set of New Zealand communities. Data were collected via a self-administered pen-and-paper questionnaire.
There were responses from 1372 individuals (response: 59%). Problem drinking amongst youth (<25 years of age) was considered the leading problem by the majority of respondents in six of seven areas. Alcohol was considered to play a major role in incidents of violence, vandalism, dangerous driving and traffic crashes. Fifty-eight percent of respondents agreed that "it is up to local government to make sure alcohol does not become a problem in the community". There was strong support for local governments to restrict the hours of operation of on-licenced premises, to use liquor bans to control drinking in public places, and for local governments and police to be stricter in their enforcement of drinking laws.
There is strong support for local government alcohol policies that restrict the availability and promotion of alcohol. The study findings are important in light of the stated purpose of local government in New Zealand and the recently completed "once in a generation" review of alcohol laws and policies.
The International journal on drug policy 07/2011; 23(1):45-53. · 2.54 Impact Factor
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Sarah Derrett,
Gabrielle Davie,
Shanthi Ameratunga,
Emma Wyeth,
Sarah Colhoun,
Suzanne Wilson,
Ari Samaranayaka,
Rebbecca Lilley,
Brendan Hokowhitu,
Paul Hansen, John Langley
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ABSTRACT: The Prospective Outcomes of Injury Study aims to identify predictors of disability following injury. Participants were selected from the entitlement claims register of New Zealand's no-fault compensation insurer, the Accident Compensation Corporation, and followed up by interview for 2 years. This report describes changes to intended Prospective Outcomes of Injury Study methods and key characteristics of the cohort, with an emphasis on general health and disability before injury and soon afterwards. There were 2856 injured participants in the first interview, which occurred 3.2 months (median) after injury. The recruitment period was extended to enable inclusion of sufficient Māori participants. At the first interview, most participants were experiencing worse health status and increased disability compared to before injury, despite less than one-third reporting admission to hospital because of their injury. Analysis of outcome predictors related to post-injury function, disability and return-to-work soon after injury and 1 year later is now under way.
Injury Prevention 07/2011; 17(6):415-8. · 1.39 Impact Factor
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Injury Prevention 06/2011; 17(4):219-21. · 1.39 Impact Factor
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Epidemiology (Cambridge, Mass.) 05/2011; 22(3):443-4. · 5.51 Impact Factor
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ABSTRACT: To investigate whether valid indicators of injury-related impairment could be developed based on data from a New Zealand national no-fault accident insurance scheme.
The feasibility of (1) developing impairment related indicators using insurance data directly, and (2) deriving diagnosis specific probability of impairment measures based on hospital discharge data were investigated.
The source data were lump sum payment data for permanent impairment arising from an injury event between 1 April 2002 and 31 October 2006, and hospital discharge data for injury events between 1 April 2002 and 31 December 2005.
A threat of impairment measure was developed that was based on a list of International Classification of Diseases codes (version 10) which, if assessed would attract a lump sum payment for permanent impairment, and would almost always be expected to be admitted to hospital.
A group of approximately 80 diagnoses satisfying the above criteria were identified. The trend in age standardised injury rates for the threat of impairment indicator is consistent with the trend for the New Zealand threat to life indicator.
This work has provided a method for the development of hospital discharge-based serious threat of impairment injury indicators. This is an important first step in developing a comprehensive package of (threat of) disability indicators.
Injury Prevention 08/2010; 16(4):240-6. · 1.39 Impact Factor
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ABSTRACT: Before an intended Prospective Outcomes of Injury Study (POIS), a pilot was undertaken to determine whether: 1) injured entitlement claimants would participate in an injury study when first approached by their insurer, the Accident Compensation Corporation (ACC); 2) people with different types of injury would participate; 3) injured people would answer detailed questions about their injury, alcohol use, disability, health and financial status; and 4) participants would be satisfied with the process of recruitment and interviewing.
ACC randomly selected eligible entitlement claimants who were: aged 18 to 65 years, New Zealand residents at the time of injury, from one of four regions, and registered for an acute injury in November 2006. ACC sent a covering letter introducing the study and advised people of the opportunity to 'opt out', together with a Participant Information Sheet. Contact details those not opting out were provided to the researchers who then arranged a telephone interview. After interview, participants were sent a thank you letter and $10 voucher. Interviews included a range of measures selected to reflect the World Health Organization model of functioning, disability and health including the short-form WHODAS II, the EQ-5D and questions about their health, satisfaction with ACC and health services, financial status, paid and unpaid activities and demographics.
66% (111/168) of contactable people participated. Compared to non-participants, participants were more likely to be older and female. Participants reported a range of anatomical regions injured and injury types, including multiple trauma following vehicle crashes, burns, blood poisoning, sprains and strains. Missing responses were highest for total income. However, few responses were missing to questions about difficulty living on household income, likelihood of financial hardship, standard of living and other personal questions. Interviews took an average of 57 minutes. Two-thirds of participants expressed a positive impression of the interview and questions. Four percent reported feeling negative about the initial contact coming from ACC.
An injury outcome study collecting a range of pre-injury and post-injury data, able to identify predictors of disability, was both feasible and acceptable to the intended study population. Methods that required refinement were identified for the main POIS study which is currently underway.
The New Zealand medical journal 06/2010; 123(1316):66-74.
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ABSTRACT: Although opportunities exist for positive experiences in research, Maori in New Zealand, like other indigenous people colonised by Europeans in the nineteenth century, have also been subject to research and associated policies that have had long-lasting negative consequences. Researchers have subsequently been challenged by Maori to conduct research that is acceptable, accountable and relevant. Much of this debate has taken place within the framework of the Treaty of Waitangi, a treaty of cession signed between Maori and British Crown representatives in 1840. Nowadays, health and health research statutes exist that require researchers to respond to the 'principles' of the Treaty. Few practical examples of how health researchers have undertaken this have been published.
We examine how, in developing a national study of injury outcomes, we responded to the Treaty. Our study, the Prospective Outcomes of Injury Study, aims to quantitatively identify predictors of disability following injury and to qualitatively explore experiences and perceptions of injury outcomes.
Responses to the Treaty included: consultation with Maori groups, translation of the questionnaire into te reo Maori, appointment of interviewers fluent in te reo Maori, sufficient numbers of Maori participants to allow Maori-specific analyses and the inclusion of a Maori-specific qualitative component. While this article is located within the New Zealand context, we believe it will resonate with, and be of relevance to, health researchers in other former settler societies. We do not contend this project represents an 'ideal' model for undertaking population-based research. Instead, we hope that by describing our efforts at responding to the Treaty, we can prompt wider debate of the complex realities of the research environment, one which is scientifically, ethically and culturally located.
Ethnicity and Health 06/2010; 15(3):303-16. · 1.64 Impact Factor
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Ethnicity and Health 06/2010; 15(3):303-316. · 1.64 Impact Factor
