Shanthi Ameratunga

University of Auckland, Auckland, Auckland, New Zealand

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Publications (228)506.44 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: We aimed to estimate from a societal perspective the 1-year and lifetime direct and indirect costs of traumatic brain injury (TBI) for New Zealand (NZ) in 2010 projected to 2020. Methods: An incidence-based cost of illness model was developed using data from the Brain Injury Outcomes New Zealand in the Community Study. Details of TBI-related resource use during the first 12 months after injury were obtained for 725 cases using resource utilization information from participant surveys and medical records. Total costs are presented in US dollars year 2010 value. Results: In 2010, 11,301 first-ever TBI cases were estimated to have occurred in NZ; total first-year cost of all new TBI cases was estimated to be US $47.9 million with total prevalence costs of US $101.4 million. The average cost per new TBI case during the first 12 months and over a lifetime was US $5,922 (95% confidence interval [CI] $4,777–$7,858), varying from US $4,636 (95% CI $3,756–$5,561) for mild cases to US $36,648 (95% CI $16,348–$65,350) for moderate/severe cases. Because of the unexpectedly large number of mild TBI cases (95% of all TBI cases), the total cost of treating these cases is nearly 3 times that of moderate/severe. The total lifetime cost of all TBI survivors in 2010 was US $146.5 million and is expected to increase to US $177.1 million in 2020. Conclusion: The results suggest that there is an urgent need to develop effective interventions to prevent both mild and moderate/severe TBI.
    Neurology 10/2014; 83(18):1645-1652. · 8.30 Impact Factor
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    ABSTRACT: Objective: To determine the frequency, mechanism(s) and impact of recurrent traumatic brain injury (TBI) over a one year period. Design: Population-based TBI incidence and one-year outcomes study with embedded case control analysis. Participants: All participants (adults and children) who experienced a recurrent TBI (more than one) in the 12 months following an index injury and matched controls who sustained one TBI within the same period, enrolled in a population based TBI incidence and outcomes study. Methods: Details of all recurrent TBIs sustained within 12 months of the initial index injury were recorded. Each recurrent TBI case was matched to a case sustaining one TBI based on: age (±2 years), gender and index TBI severity. Cognitive ability, disability and post-concussion symptoms were assessed one year following the index injury. Results: 9.9% (n=72) of TBI cases experienced at least one recurrent TBI within the year following initial index injury. Males, people aged <35 years and those who had experienced a TBI prior to their index injury were at highest risk of recurrent TBI. Recurrent TBI cases reported significantly increased post-concussion symptoms at one year compared to the matched controls (n=72) sustaining one TBI. There was no difference in overall cognitive ability and disability between the two groups. Conclusion: People experiencing recurrent TBIs are more likely to experience increased frequency and severity of post-concussion symptoms. Greater public awareness of the potential effects of recurrent brain injury is needed.
    Journal of neurotrauma. 10/2014;
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    ABSTRACT: Traumatic injury is a leading contributor to the overall global burden of disease. However, there is a worldwide shortage of population data to inform understanding of non-fatal injury burden. An improved understanding of the pattern of recovery following trauma is needed to better estimate the burden of injury, guide provision of rehabilitation services and care to injured people, and inform guidelines for the monitoring and evaluation of disability outcomes.
    Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention. 08/2014;
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    Sandar Tin Tin, Alistair Woodward, Shanthi Ameratunga
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    ABSTRACT: Bicycle use, despite its proven health and other benefits, is rarely part of everyday travel for many people due to the perceived risk of injury from collision crashes. This article investigated the role of physical vs. attention conspicuity in preventing bicycle crashes involving a motor vehicle in New Zealand.
    European journal of public health. 07/2014;
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    ABSTRACT: This study examines the association between schools and student bullying behaviors and victimization among a nationally representative sample (N = 9,107) of New Zealand high school students. 4 S. Denny et al. In particular, the study sought to explore the role of characteristics of schools and school culture with respect to bystander behavior, while controlling for individual student factors related to victimization and bullying behaviors. Results indicated that a total of 6% of students report being bullied weekly or more often and 5% of students reported bullying other students at least weekly. Results of multilevel analyses suggested that schools characterized by students taking action to stop bullying were associated with less victimization and less reported bullying among students. In contrast, in schools where students reported teachers take action to stop bullying, there was no decline in victimization or bullying. Overall, these findings support whole-school approaches that aid students to take action to stop bullying.
    Journal of School Violence 04/2014;
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    ABSTRACT: Indicators measuring aspects of performance to assess quality of care are often chosen arbitrarily. The present study aimed to determine what should be considered when selecting healthcare quality indicators, particularly focusing on the application to emergency medicine. Structured searches of electronic databases were supplemented by website searches of quality of care and benchmarking organisations, citation searches and discussions with experts. Candidate attributes of ‘good’ healthcare indicators were extracted independently by two authors. The validity of each attribute was independently assessed by 16 experts in quality of care and emergency medicine. Valid and reliable attributes were included in a critical appraisal tool for healthcare quality indicators, which was piloted by emergency medicine specialists. Twenty-three attributes were identified, and all were rated moderate to extremely important by an expert panel. The reliability was high: alpha = 0.98. Twelve existing tools explicitly stated a median (range) of 14 (8–17) attributes. A critical appraisal tool incorporating all the attributes was developed. This was piloted by four emergency medicine specialists who were asked to appraise and rank a set of six candidate indicators. Although using the tool took more time than implicit gestalt decision making: median (interquartile range) 190 (43–352) min versus 17.5 (3–34) min, their rankings changed after using the tool. To inform the appraisal of quality improvement indicators for emergency medicine, a comprehensive list of indicator attributes was identified, validated, developed into a tool and piloted. Although expert consensus is still required, this tool provides an explicit basis for discussions around indicator selection.
    Emergency medicine Australasia: EMA 04/2014; 26(2). · 0.99 Impact Factor
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    ABSTRACT: The application of disability weights by nature of injury is central to the calculation of disability-adjusted life years (DALYs). Such weights should represent injury diagnosis groups that demonstrate homogeneity in disability outcomes. Existing classifications have not used empirical data in their development to inform groups that are homogeneous for disability outcomes, limiting the capacity to make informed recommendations for best practice in measuring injury burden. The Validating and Improving injury Burden Estimates (Injury-VIBES) Study includes pooled data from over 30 000 injured participants recruited to six cohort studies. The International Classification of Disease 10th Revision (ICD-10) diagnosis codes were mapped to existing injury burden study groupings and prediction models were developed to measure the capacity of the injury groupings and ICD-10 diagnoses to predict disability outcomes at 12 months. Models were adjusted for age, gender and data source and investigated for discrimination using area under the receiver operating characteristic curve (AUC) and calibration using Hosmer-Lemeshow statistics and calibration curves. Discrimination and calibration of models varied depending on the outcome measured. Models using full four-character ICD-10 diagnosis codes, rather than groupings of codes, demonstrated the highest discrimination ranging from an AUC (95% CI) of 0.627 (0.618 to 0.635) for the pain or discomfort item of the EQ-5D to 0.847 (0.841 to 0.853) for the extended Glasgow Outcome Scale independent living outcome. However, gain over other groupings was marginal. Prediction performance was best for measures of function such as independent living, mobility and self-care. The classifications were poorer predictors of anxiety/depression and pain/discomfort. There was no clearly superior classification.
    Injury Prevention 03/2014; · 1.76 Impact Factor
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    R Reddy, D Welch, S Ameratunga, P Thorne
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    ABSTRACT: Background Noise-induced hearing loss (NIHL) remains an important occupational health issue as the second most commonly self-reported occupational injury or illness. The incorrect and inconsistent use of hearing protection devices (HPDs) compromises their effectiveness in preventing NIHL.AimsTo describe the development of an easily administered yet robust questionnaire to investigate factors that influence HPD use.MethodsA hearing protection assessment (HPA-2) questionnaire was developed using items based on themes identified in our previous research. These fell into two classes: supports and barriers to wearing HPD, which formed two scales within the questionnaire. The questionnaire, which also included demographic items, was administered to workers from 34 manufacturing companies. The internal consistency of the scales was tested, and factor analysis was conducted to investigate the underlying structure of the scales.ResultsOf the 1053 questionnaires distributed, 555 completed questionnaires were received giving a response rate of 53%. The Cronbach's alpha for the barriers scale (α = 0.740) and supports scale (α = 0.771) indicated strong internal reliability of the questionnaire. The supports and barriers were further described as five key factors (risk justification, HPD constraints, hazard recognition, behaviour motivation and safety culture) that influence hearing protection behaviour. Workers who reported always using HPDs had more supports across these factors, while those who did not always wear HPDs reported more barriers.Conclusions The HPA-2 questionnaire may be useful in both research and interventions to understand and motivate hearing protection behaviour by identifying and targeting supports and barriers to HPD use at different levels of the ecological model.
    Occupational Medicine 02/2014; · 1.45 Impact Factor
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    ABSTRACT: Aim: To examine whether use of a standardized cardiovascular disease (CVD) risk assessment recommended by national guidelines is associated with appropriate initiation and maintenance of medication in a large primary care cohort.Methods and design: A total of 90,631 people aged 30-80 years were followed for up to 3 years after a formal CVD risk assessment was undertaken between January 2006 and October 2009, during routine primary care visits in New Zealand. Patients either had prior CVD or had their CVD risk estimated using a modified Framingham prediction equation for fatal or non-fatal CVD events. The individual risk profiles were anonymously linked to national dispensing data for blood-pressure-lowering and lipid-lowering medications in the 6-month period before and in consecutive 6-month blocks after the baseline CVD risk assessment.Results: At baseline, a combination of blood-pressure-lowering and lipid-lowering therapy was already being used by about two-thirds of patients with prior CVD, one-quarter with a 5-year CVD risk greater than 10% (approximately 20% 10-year risk), and one-tenth with CVD risk below this level. Among these previously treated patients, dispensing rates for blood-pressure-lowering, lipid-lowering, or both medications together declined by only 4-16% up to 3 years after baseline assessment, irrespective of risk category. Among patients untreated at baseline, combination therapy was initiated within 6 months for 21% with prior CVD, 16% with 5-year CVD risk greater than 15% (approximately 30% 10-year risk and the national drug-treatment threshold), 10% with 5-year CVD risk between 10 and 14% (approximately 20-29% 10-year risk), and 3% in the lowest risk category. Across the study population, patients with prior CVD had the highest dispensing rates for each category of medication, and incrementally higher dispensing rates were noted as CVD risk group increased.Conclusions: In this primary care cohort, most patients already using CVD medications at the time of the baseline CVD risk assessment maintained treatment over a maximum of 3 years follow up, irrespective of their estimated baseline risk. Among patients untreated at baseline, subsequent dispensing rates were strongly related to estimated CVD risk group. Around 15-20% of untreated patients meeting national drug-treatment criteria commenced combination pharmacotherapy within 6 months of CVD risk assessment.
    European journal of preventive cardiology. 02/2014; 21(2):192-202.
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    Bridget Kool, Emily Smith, Kimiora Raerino, Shanthi Ameratunga
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    ABSTRACT: Brief interventions (BIs) have been shown to be effective in modifying hazardous drinking behaviours in a range of settings. However, they are underutilised in hospitals due to resource constraints. We explored the perspectives of admitted trauma patients about the appeal, acceptability and content of a Brief Intervention (BI) delivered via text messages. Thirty mobile phone users (>=16 years old) admitted to Auckland City Hospital as a result of injury were recruited (December 2010 - January 2011). Participants were interviewed face-to-face during their hospital stay using a semi-structured interview guide that explored topics including perceptions of the proposed intervention to reduce hazardous drinking and related harm, and perceived acceptability of an m-health program. Where issues relating to content of messages were raised by participants these were also captured. In addition, a brief survey captured information on demographic information, mobile phone usage and type of phone, along with the frequency of alcohol use. 22 of the 30 participants were male, and almost half were aged 20 to 39 years. The majority of participants identified as New Zealand Europeans, six as Maori (New Zealand's indigenous population) and of the remainder two each identified as Pacific and of Asian ethnicity. Most (28/30) participants used a mobile phone daily. 18 participants were deemed to be drinking in a non-hazardous manner, seven were hazardous drinkers, and three were non-drinkers. Most participants (21/30) indicated that text messages could be effective in reducing hazardous drinking and related harms, with more than half (17/30) signalling they would sign-up. Factors identified that would increase receptiveness included: awareness that the intervention was evidence-based; participants readiness-to-change; informative messages that include the consequences of drinking and practical advice; non-judgemental messages; and ease-of-use. Areas of potential concern included: confidentiality and frequency of messages. The cultural relevance of the messages for Maori was highlighted as important. This study indicates that trauma patients recognize potential benefits of mobile-health interventions designed to reduce hazardous drinking. The feedback provided will inform the development of an intervention to be evaluated in a randomised controlled trial.
    BMC Research Notes 01/2014; 7(1):4.
  • Nicki Jackson, Simon Denny, Shanthi Ameratunga
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    ABSTRACT: There is growing interest in the role of the neighborhood environment on adolescent alcohol use. Multi-level designs are ideally suited to this investigation due to their ability to examine area-level effects over and above the effects due to neighborhood composition. To date, most research in this area has focused on the physical availability of alcohol in the neighborhood. We reviewed the multi-level evidence on neighborhood-level risk and protective factors which influence adolescent alcohol use, excluding studies which assessed the impact of neighborhood-level alcohol availability and advertising. Systematic searches in Medline, EMBASE, CINAHL Plus, PsycINFO, Sociological Abstracts and SCOPUS identified 23 studies, examining 11 different neighborhood-level exposures. The majority of studies found no associations with residential mobility, neighborhood disorder or crime, employment or job availability, neighborhood attitudes to drinking, social capital and collective efficacy. For studies examining neighborhood-level socio-economic disadvantage mixed results were found. High levels of both adult and adolescent alcohol use in the community appeared to be associated with alcohol use whilst protective effects were found for enforcement of liquor laws. Methodological limitations within studies were evident. The dearth of high-quality, multi-level studies indicate that further research is required to inform the development of multi-faceted place-based policy and preventative interventions to reduce adolescent alcohol use. Future studies should consider the neighborhood context from the outset of study design and identify the individual-level control variables to adequately isolate neighborhood effects. Inclusion of moderation and mediation analyses would greatly contribute towards the understanding of causal pathways of neighborhood effects.
    Social Science & Medicine (1967) 01/2014;
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    ABSTRACT: This study investigated whether hospitalised fall-related injuries among young and middle-aged adults were associated with short term effects of alcohol intake, marijuana use and sleep deprivation. A case-crossover design was used to study 690 adults (aged 20 to 64 years) admitted to public hospitals within 48 hours of a fall-related injury, occurring at home, in three regions of New Zealand during August 2008 to December 2009. A matched-pair interval method of analysis was used to compare alcohol intake, marijuana use and sleep deprivation before the event with similar information in two control periods: 24 hours-before and 1 week-before the time of injury. After adjustment for other paired exposures, the estimated risk of injury was substantially higher after consuming alcohol within the preceding 6 hours, with a dose response gradient. After adjusting for confounding variables, the data did not support a significantly elevated risk of fall-related injury associated with sleep deprivation (<6 hours sleep in the preceding 24 hours), or marijuana use in the preceding 3 hours. The findings support the expansion of efforts to reduce the harmful effects of alcohol intake in the home environment.
    The New Zealand medical journal. 01/2014; 127(1406):32-8.
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    Sandar Tin Tin, Alistair Woodward, Shanthi Ameratunga
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    ABSTRACT: It is known that experience of a previous crash is related to incidence of future crashes in a cohort of New Zealand cyclists. This paper investigated if the strength of such association differed by crash involvement propensity and by the need for medical care in the previous crash. The Taupo Bicycle Study involved 2590 adult cyclists recruited in 2006 and followed over a median period of 4.6 years through linkage to four national databases. The crash involvement propensity was estimated using propensity scores based on the participants' demographic, cycling and residential characteristics. Cox regression modelling for repeated events was performed with multivariate and propensity score adjustments. Analyses were then stratified by quintiles of the propensity score. A total of 801 (31.0%) participants reported having experienced at least one bicycle crash in the twelve months prior to the baseline survey. They had a higher risk of experiencing crash events during follow-up (hazard ratio (HR): 1.43; 95% CI: 1.28, 1.60) but in the stratified analysis, this association was significant only in the highest two quintiles of the propensity score where the likelihood of having experienced a crash was more than 33%. The association was stronger for previous crashes that had received medical care (HR 1.63; 95% CI: 1.41, 1.88) compared to those that had not (HR 1.30; 95% CI: 1.14, 1.49). Previous crash experience increased the risk of future crash involvement in high-risk cyclists and the association was stronger for previous crashes attended medically. What distinguishes the high risk group warrants closer investigation, and the findings indicate also that health service providers could play an important role in prevention of bicycle crash injuries.
    PLoS ONE 01/2014; 9(1):e87633. · 3.53 Impact Factor
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    Advances in Mental Health 01/2014;
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    ABSTRACT: To determine associations between the number of injuries sustained and three measures of disability 12-months post-injury for hospitalised patients. Data from 27,840 adult (18+ years) participants, hospitalised for injury, were extracted for analysis from the Validating and Improving injury Burden Estimates (Injury-VIBES) Study. Modified Poisson and linear regression analyses were used to estimate relative risks and mean differences, respectively, for a range of outcomes (Glasgow Outcome Scale-Extended, GOS-E; EQ-5D and 12-item Short Form health survey physical and mental component summary scores, PCS-12 and MCS-12) according to the number of injuries sustained, adjusted for age, sex and contributing study. More than half (54%) of patients had an injury to more than one ICD-10 body region and 62% had sustained more than one Global Burden of Disease injury type. The adjusted relative risk of a poor functional recovery (GOS-E<7) and of reporting problems on each of the items of the EQ-5D increased by 5-10% for each additional injury type, or body region, injured. Adjusted mean PCS-12 and MCS-12 scores worsened with each additional injury type, or body region, injured by 1.3-1.5 points and 0.5 points, respectively. Consistent and strong relationships exist between the number of injury types and body regions injured and 12-month functional and health status outcomes. Existing composite measures of anatomical injury severity such as the NISS or ISS, which use up to three diagnoses only, may be insufficient for characterising or accounting for multiple injuries in disability studies. Future studies should consider the impact of multiple injuries to avoid under-estimation of injury burden.
    PLoS ONE 01/2014; 9(12):e113467. · 3.53 Impact Factor
  • Roshini Peiris-John, Bridget Kool, Shanthi Ameratunga
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    ABSTRACT: Acute poisoning accounts for a significant proportion of the total burden of disease worldwide. While the rate of poisoning fatalities in New Zealand is comparable to other industrialized countries, demographic trends in incidence particularly including socioeconomic indicators and substances involved are less well known. To determine demographic patterns and substances related to acute poisoning fatalities and hospital admissions in New Zealand among people aged 25 years or older. Records with a poisoning external cause of injury code were identified using the national mortality (1999-2008) and hospital discharge (2000-2009) databases and population-based incidence and trends analysed. The 1,841 fatalities and 29,881 primary hospital admissions over the 10 year period accounted for mean annual rates of 7.1 and 115.4/100,000 respectively. The majority of deaths from acute poisoning were among males with the converse for hospitalisations for self-poisoning. While hospitalisation for intentional poisoning decreased with advancing age, admissions for unintentional poisoning increased, especially in Pacific people aged 65 years or older. Overall, fatality and hospitalisation rates increased with increasing deprivation. Two-thirds of deaths and hospitalisations were due to intentional self-poisoning. Carbon monoxide was involved in most fatal intentional self-poisoning events while pharmaceuticals were the main agent involved in fatal unintentional poisonings and poisoning admissions, irrespective of intent. The majority of hospitalisations and deaths due to poisoning in New Zealand adults are intentional self-harm episodes. A comprehensive approach to monitoring poisoning, the underlying risks and the implementation of interventions is required to minimise risks.
    Internal Medicine Journal 12/2013; · 1.82 Impact Factor
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    ABSTRACT: Uni-dimensional measures of alcohol consumption may be unable to fully capture the complexity of adolescent drinking and experience of alcohol-related harms. Latent class analysis provides an empirical method to understand different adolescent drinking patterns. Latent class analysis was used to create typologies of drinking among the 5018 current drinkers in the national Youth '07 survey. Determinants of drinking patterns were identified using multinomial logistic regression. Four latent classes were identified, demonstrating an overall increase in risk of alcohol-related outcomes from increasing consumption. One class strongly deviated from this pattern, having moderate consumption patterns but disproportionately high levels of alcohol-related problems. Multinomial logistic regression found that the strongest predictors of belonging to high-risk drinking typologies were having a positive attitude to regular alcohol use, buying own alcohol, peers using alcohol, and obtaining alcohol from friends and/or other adults. Other significant predictors included being male, having a strong connection to friends, having parents with a low level of knowledge of their daily activities and poor connection to school. Class membership also varied by ethnicity. The latent class approach demonstrated variability in alcohol-related harms across groups of students with different drinking patterns. Longitudinal studies are necessary to determine the causes of this variability in order to inform the development of targeted policy and preventative interventions. Legislative controls, such as increasing the legal purchase age and reducing the commercial availability of alcohol, will continue to be important strategies for reducing harm in young people.
    Drug and alcohol dependence 12/2013; · 3.60 Impact Factor
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    Sandar Tin Tin, Alistair Woodward, Shanthi Ameratunga
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    ABSTRACT: Loss to follow-up, if related to exposures, confounders and outcomes of interest, may bias association estimates. We estimated the magnitude and direction of such bias in a prospective cohort study of crash injury among cyclists. The Taupo Bicycle Study involved 2590 adult cyclists recruited from New Zealand's largest cycling event in 2006 and followed over a median period of 4.6 years through linkage to four administrative databases. We resurveyed the participants in 2009 and excluded three participants who died prior to the resurvey. We compared baseline characteristics and crash outcomes of the baseline (2006) and follow-up (those who responded in 2009) cohorts by ratios of relative frequencies and estimated potential bias from loss to follow-up on seven exposure-outcome associations of interest by ratios of HRs. Of the 2587 cyclists in the baseline cohort, 1526 (60%) responded to the follow-up survey. The responders were older, more educated and more socioeconomically advantaged. They were more experienced cyclists who often rode in a bunch, off-road or in the dark, but were less likely to engage in other risky cycling behaviours. Additionally, they experienced bicycle crashes more frequently during follow-up. The selection bias ranged between -10% and +9% for selected associations. Loss to follow-up was differential by demographic, cycling and behavioural risk characteristics as well as crash outcomes, but did not substantially bias association estimates of primary research interest.
    Injury Prevention 12/2013; · 1.76 Impact Factor
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    ABSTRACT: Abstract Purpose: To review the published literature relating to disability in Sri Lanka, identify research gaps and inform priorities for action. Methods: A narrative literature review was undertaken and relevant articles extracted using electronic databases such as Medline and PubMed. The available literature was examined in relation to the nine key recommendations of the World Report on Disability. Results: Over the past 30 years, published disability research in Sri Lanka has primarily focussed on mental health, visual impairment and healthcare delivery. Significant gaps were apparent in evidence relating to the status and services for people with intellectual disability, policies and their impact, provider attitudes, barriers to education and employment, health workforce training and access to healthcare. Conclusions: While published studies provide insights on several dimensions of disability, there are important research gaps pointing to unmet needs that require attention to support the health and wellbeing of people living with disability in Sri Lanka. To address these gaps, it is imperative that a critical mass of multi-disciplinary researchers including people living with disabilities collaborate on a strategic program of research using effective participatory approaches that engage all sectors and communities relevant to uphold the rights of people living with disability. Implications for Rehabilitation All nine key recommendations in the World Report on Disability are highly pertinent to the needs and status of people living with disabilities in Sri Lanka. Significant gaps in research on disability-related health issues exist and warrant more focussed attention by researchers, funders and policy makers. It is imperative that national stakeholders including the Ministries of Health and Social Welfare, organisations representing people living with disability and related advocacy groups, work collaboratively to identify and implement a research strategy that would better inform disability policies and programmes that have access and equity as core principles. Implementation of a national disability survey by the Department of Census and Statistics, will help prioritize disability research in the country.
    Disability and Rehabilitation 12/2013; · 1.54 Impact Factor
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    Sandar Tin Tin, Alistair Woodward, Shanthi Ameratunga
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    ABSTRACT: Regular cycling plays an important role in increasing physical activity levels but raises safety concerns for many people. While cyclists bear a higher risk of injury than most other types of road users, the risk differs geographically. Auckland, New Zealand's largest urban region, has a higher injury risk than the rest of the country. This paper identified underlying factors at individual, neighbourhood and environmental levels and assessed their relative contribution to this risk differential. The Taupo Bicycle Study involved 2590 adult cyclists recruited in 2006 and followed over a median period of 4.6 years through linkage to four national databases. The Auckland participants were compared with others in terms of baseline characteristics, crash outcomes and perceptions about environmental determinants of cycling. Cox regression modelling for repeated events was performed with multivariate adjustments. Of the 2554 participants whose addresses could be mapped, 919 (36%) resided in Auckland. The Auckland participants were less likely to be Maori but more likely to be socioeconomically advantaged and reside in an urban area. They were less likely to cycle for commuting and off-road but more likely to cycle in the dark and in a bunch, use a road bike and use lights in the dark. They had a higher risk of on-road crashes (hazard ratio: 1.47; 95% CI: 1.22, 1.76), of which 53% (95% CI: 20%, 72%) was explained by baseline differences, particularly related to cycling off-road, in the dark and in a bunch and residing in urban areas. They were more concerned about traffic volume, speed and drivers' behaviour. The excess crash risk in Auckland was explained by cycling patterns, urban residence and factors associated with the region's car-dominated transport environment.
    Environmental Health 12/2013; 12(1):106. · 2.71 Impact Factor

Publication Stats

2k Citations
506.44 Total Impact Points


  • 1994–2014
    • University of Auckland
      • • School of Population Health
      • • Section of Epidemiology and Biostatistics
      • • Faculty of Medical and Health Sciences
      • • Department of Surgery
      • • Injury Prevention Information Centre
      • • Department of Medicine
      Auckland, Auckland, New Zealand
  • 2013
    • Monash University (Australia)
      • Department of Epidemiology and Preventive Medicine
      Melbourne, Victoria, Australia
  • 2005–2013
    • Royal Prince Alfred Hospital
      Camperdown, New South Wales, Australia
    • Royal Alexandra Hospital
      Edmonton, Alberta, Canada
  • 2012
    • University of Otago
      • Injury Prevention Research Unit
      Dunedin, Otago, New Zealand
    • Canadian Society for Epidemiology and Biostatistics 
  • 2011–2012
    • Fiji National University
      • • Research Unit
      • • College of Medicine, Nursing and Health Sciences
      Suva City, Central, Fiji
    • University of Bologna
      • Department of Experimental, Diagnostic and Specialty Medicine DIMES
      Bologna, Emilia-Romagna, Italy
  • 2008–2012
    • Auckland University of Technology
      • Faculty of Health and Environmental Sciences
      Окленд, Auckland, New Zealand
    • Victoria University of Wellington
      • School of Psychology
      Wellington, Wellington, New Zealand
    • Auckland City Hospital
      • Department of Virology and Immunology
      Auckland, Auckland, New Zealand
  • 2003–2006
    • University of Sydney
      Sydney, New South Wales, Australia
    • The Royal Children's Hospital
      Melbourne, Victoria, Australia