Publications (19)60.32 Total impact
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Article: Incidence of traumatic brain injury in New Zealand: a population-based study.
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ABSTRACT: BACKGROUND: Traumatic brain injury (TBI) is the leading cause of long-term disability in children and young adults worldwide. However, accurate information about its incidence does not exist. We aimed to estimate the burden of TBI in rural and urban populations in New Zealand across all ages and TBI severities. METHODS: We did a population-based incidence study in an urban (Hamilton) and rural (Waikato District) population in New Zealand. We registered all cases of TBI (admitted to hospital or not, fatal or non-fatal) that occurred in the population between March 1, 2010, and Feb 28, 2011, using multiple overlapping sources of information. We calculated incidence per 100 000 person-years with 95% CIs using a Poisson distribution. We calculated rate ratios [RRs] to compare the age-standardised rates between sex, ethnicity, and residency (urban, rural) groups. We used direct standardisation to age-standardise the rates to the world population. RESULTS: The total incidence of TBI per 100 000 person-years was 790 cases (95% CI 749-832); incidence per 100 000 person-years of mild TBI was 749 cases (709-790) and of moderate to severe TBI was 41 cases (31-51). Children (aged 0-14 years) and adolescents and young adults (aged 15-34 years) constituted almost 70% of all TBI cases. TBI affected boys and men more than women and girls (RR 1·77, 95% CI 1·58-1·97). Most TBI cases were due to falls (38% [516 of 1369]), mechanical forces (21% [288 of 1369]), transport accidents (20% [277 of 1369]), and assaults (17% [228 of 1369]). Compared with people of European origin, Maori people had a greater risk of mild TBI (RR 1·23, 95% CI 1·08-1·39). Incidence of moderate to severe TBI in the rural population (73 per 100 000 person-years [95% CI 50-107) was almost 2·5 times greater than in the urban population (31 per 100 000 person-years [23-42]). INTERPRETATION: Our findings suggest that the incidence of TBI, especially mild TBI, in New Zealand is far greater than would be estimated from the findings of previous studies done in other high-income countries. Our age-specific and residency-specific data for TBI incidence overall and by mechanism of injury should be considered when planning prevention and TBI care services. FUNDING: Health Research Council of New Zealand.The Lancet Neurology 11/2012; · 23.46 Impact Factor -
Article: Prevalence and Predictors of 6-Month Fatigue in Patients With Ischemic Stroke: A Population-Based Stroke Incidence Study in Auckland, New Zealand, 2002-2003.
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ABSTRACT: BACKGROUND AND PURPOSE: Although persistent and significant fatigue affects the daily life of stroke survivors, there are no population-based studies examining the prevalence of fatigue in 6-month survivors of ischemic stroke and few studies of predictors of poststroke fatigue. METHODS: This article examined data from the Auckland Regional Community Stroke study conducted in Auckland, New Zealand, in 2002 to 2003. Presence of fatigue was evaluated at 6 months in 613 patients with ischemic stroke using a Short Form 36 Vitality Score (energy and fatigue) of ≤47. Multivariate logistic regression analysis was used to determine predictors of fatigue development 6 months poststroke. RESULTS: The prevalence of fatigue was 30% (28% in men and 33% in women). There was a clear association between increased prevalence of fatigue and advancing age. The only baseline variables independently associated with an increased risk of developing fatigue at 6 months poststroke were prestroke incontinence and being of New Zealand European ethnicity. Being independent and living alone at baseline were associated with significant reduction in the risk of being fatigued at 6 months poststroke. Severe depression at 6 months was significantly and independently associated with being fatigued. CONCLUSIONS: The prevalence of fatigue found in our study is at the lower level of range reported in other studies. The prevalence of fatigue increased with advancing age, as found in most previous studies. Because fatigue can have a negative impact on stroke recovery, particular attention needs to be paid to those who are older, incontinent before stroke, and those who report severe symptoms of depression at 6 months after stroke.Stroke 07/2012; 43(10):2604-2609. · 5.73 Impact Factor -
Article: Coping strategies in female survivors of childhood sexual abuse from two Canadian and two New Zealand cultural groups.
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ABSTRACT: Individuals from some minority cultures are at greater risk of experiencing childhood sexual abuse (CSA) and are also at heightened risk of negative outcomes from abuse. Coping strategies, which may mediate the relationship between CSA and outcomes, are also impacted by culture. This study examined the use of coping strategies in female survivors of CSA across 4 cultural groupings from 2 countries-86 European Canadians, 40 Native Canadians, 129 European New Zealanders, and 35 Māori New Zealanders-who all completed the Coping Responses Inventory. The 4 groups differed significantly on 7 of the 8 Coping Responses Inventory scales (Logical Analysis, Positive Reappraisal, Problem Solving, Cognitive Avoidance, Acceptance or Resignation, Seeking Alternative Rewards, Emotional Discharge). Whereas New Zealanders differed significantly from Canadians (p<.001), Europeans did not differ significantly from indigenous cultural groups, nor did nationality and culture grouping interact (p>.05). The profile of coping in New Zealand Europeans was relatively flat, with average scores across coping types close to the mean of the t-score distribution. Māori New Zealanders produced a similar profile, with only slight increases on 2 scales of avoidant coping. The findings raise questions about the extent to which generalizations can be made about there being either a "Western/European" culture or a particular "indigenous" culture. This in turn also raises the issue of whether cross-validation and replication of findings are needed if the findings are to be applied outside of the country in which the data were gathered.Journal of Trauma & Dissociation 07/2012; 13(4):435-47. · 1.23 Impact Factor -
Article: Neuropsychological profiles of 5-year ischemic stroke survivors by Oxfordshire stroke classification and hemisphere of lesion.
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ABSTRACT: Although the neuropsychological literature typically examines stroke outcomes by hemisphere of lesion, the medical literature provides classifications more closely linked to circulatory distribution impacted by stroke. This article examined profiles of cognitive function by hemisphere and by Oxfordshire Community Stroke Project stroke classification. This study included a sample of 315 5-year ischemic stroke survivors. Assessment included tests of verbal memory, visual memory, word finding/verbal fluency, abstract visual reasoning, executive functioning, and speed of processing. The sample produced scores within 1 standard deviation of the normative mean on tests of abstract visual reasoning, verbal memory, and visual recall. Impaired performances were observed for executive function and processing speed. Profile analysis revealed no significant differences in overall cognitive performance or in the profile of performance across measures by hemisphere of lesion. However, groups defined by Oxfordshire Community Stroke Project categories produced significantly different cognitive profiles. Post hoc analyses indicate those with posterior stroke performed best overall on all tests except the Stroop Dots trial, whereas those with total anterior stroke produced significantly worse scores on tasks requiring visual abstract reasoning (Block Design, Rey Figure Copy), word finding (Boston Naming Test), and processing speed (Stroop Dots, Trails A). Oxfordshire Community Stroke Project stroke subtypes identified significant differences between groups, suggesting this classification system is of greater use than hemisphere of lesion in predicting poststroke cognitive outcomes.Stroke 01/2012; 43(1):50-5. · 5.73 Impact Factor -
Article: Cognitive and functional outcomes of 5-year subarachnoid haemorrhage survivors: comparison to matched healthy controls.
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ABSTRACT: While neuropsychological deficits have been the focus of research post-subarachnoid haemorrhage (SAH), population-based information on long-term neuropsychological impairment post-SAH are lacking. Neither the profile of long-term neuropsychological deficits nor its relationship to long-term functional outcomes has been established. This was a cross-sectional population-based study of long-term (5 years) neuropsychological and functional outcomes post-SAH. Participants were 27 five-year survivors of SAH previously enrolled in the Auckland Regional Community Stroke study (2002-2003). Twenty-six age-, gender- and ethnicity-matched controls were used to compare mood, functional (i.e. disability; handicap; quality of life, QoL) and neuropsychological outcomes (i.e. verbal memory, visual memory, executive functioning, language, processing speed and visuoperceptual abilities) of SAH survivors. SAH survivors were more depressed and significantly more impaired in the areas of disability, handicap, and QoL than controls. SAH survivors also had significant cognitive deficits across domains when compared to controls. Depressed mood and baseline functioning were related to worse functional outcomes at 5 years post-SAH. Whilst poor cognitive functioning, particularly in the domains of visual memory and language, impacted long-term functional outcomes of SAH survivors. Five-year SAH survivors have many functional and cognitive deficits compared to matched controls. Language and visual memory emerged as independent factors associated with their current functioning.Neuroepidemiology 07/2011; 37(1):31-8. · 2.31 Impact Factor -
Article: Epidemiology of ischaemic stroke and traumatic brain injury.
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ABSTRACT: Acquired brain injury, including both Ischaemic stroke (IS) and Traumatic Brain injury (TBI), is one of the most common causes of disability and death in adults. Yet there are vast differences in our knowledge of their epidemiology. While the incidence, case-fatality and risk factors for stroke are well established, work needs to continue particularly in low-income countries, where these data remain sparse; and in relation to specific stroke subtypes such as IS. Similar data regarding the epidemiology of TBI are generally lacking. The majority of TBI incidence studies have focussed on hospital-based samples and there are no established criteria from which to design high quality epidemiological studies. The need to establish such criteria separate from those already available for stroke is suggested given the differing demographic profile of TBI as well as differences in seeking of medical attention for TBI. The immense burden of stroke can be reduced by prevention of modifiable risk factors particularly in developing countries where both changing lifestyle and lack of healthcare resources are contributing to rising stroke incidence and mortality. Similarly, studies to date indicate that TBI incidence can be reduced by addressing modifiable risk factors such as alcohol abuse, risk-taking behaviour and socioeconomic disparities.Best practice & research. Clinical anaesthesiology. 12/2010; 24(4):485-94. -
Article: Natural history of attention deficits and their influence on functional recovery from acute stages to 6 months after stroke.
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ABSTRACT: Attention deficits are common after stroke, yet their natural course is undefined. This paper examines the course of recovery of attention up to 6 months after stroke. Also examined was the relationship of attention deficits to hemisphere of lesion and to wider outcomes (e.g. quality of life) 6 months after stroke. After stroke, 43 individuals completed attention tests (Trails A/B, Paced Auditory Serial Addition Test, Bells Test, Integrated Auditory Visual Continuous Performance Test) at baseline (within 4 weeks after stroke), 6 weeks and 6 months after stroke. At baseline, 25-60% of attention test scores showed impairment. The sample was significantly disabled (Modified Rankin Scale, MRS), had poor quality of life (36-item short-form questionnaire of the Medical Outcomes Study, SF-36) and significant cognitive difficulties (Cognitive Failures Questionnaire). Visual alternating attention, auditory/visual sustained and alternating attention improved significantly across each time frame. Hemisphere of lesion was not significantly related to baseline attention or to degree of improvement (p > 0.05). However, it was noted that while left-hemisphere stroke was associated with improved Trails A performance at each assessment, right-hemisphere lesions improved from baseline to 6 weeks but declined from 6 weeks to 6 months. Improved physical outcomes (e.g. MRS) at 6 months were predicted from less severe stroke, while an improved SF-36 mental component score was best predicted from age. Cognitive ability was predicted from Trails A attention. While left-hemisphere stroke was associated with improved Trails A performance at each assessment, right-hemisphere lesions improved from baseline to 6 weeks but declined from 6 weeks to 6 months. The findings suggest that attention deficits, particularly with more complex forms of attention, are common acutely after stroke and that while they improve over time, they have a significant impact on wider aspects of functioning.Neuroepidemiology 09/2010; 35(4):255-62. · 2.31 Impact Factor -
Article: Long-term neuropsychological and functional outcomes in stroke survivors: current evidence and perspectives for new research.
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ABSTRACT: To appraise the literature on long-term neuropsychological and functional outcomes in stroke survivors and identify the gaps, challenges and future research in this area. Stroke care resources are scarce, and the number of stroke survivors is likely to increase with the ageing of the population. Thus, evaluating the cost, frequency and prognostic factors of long-terms stroke functional and neuropsychological outcomes is of paramount importance for evidence-based clinical decision making, including the rationale, planning, provision and allocation of health services, and the development of effective interventions. Summary of review Stroke has an enormous physical, emotional and economic impact on the patients, families and society. However, accurate data on frequency, relationship and predictors of various long-term functional (body functioning, activity and participation) outcomes and costs of stroke are scarce, and no accurate and comprehensive data exist on long-term neuropsychological outcomes and their relationships with other functional outcomes poststroke. There is a lack of accurate data on the frequency, relationship and predictors of various long-term functional outcomes and costs of stroke. There is a pressing need for good-quality population-based studies for evaluating the frequency and prognostic factors of long-term functional and neuropsychological outcomes of stroke in various populations.International Journal of Stroke 03/2008; 3(1):33-40. · 2.38 Impact Factor -
Article: Applied brain injury research in New Zealand: can we do better?
The New Zealand medical journal 02/2008; 121(1268):U2893. -
Article: Memory deficit after traumatic brain injury: how big is the problem in New Zealand and what management strategies are available?
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ABSTRACT: Traumatic brain injury (TBI) impacts a significant portion of individuals, and can have lasting consequences. One of the most common and persistent difficulties experienced post-TBI is deficits in memory, which impact up to 80% of TBI survivors. Early memory rehabilitation research concentrated on the direct retraining approach. In recent years, the focus of rehabilitative efforts has shifted to teaching compensatory strategies and optimizing residual abilities, with the most recent efforts focussing on group-format rehabilitation and integration of technologies (e.g. cellular phones) as a means of compensation. This review examines the evidence for these various approaches to memory rehabilitation, concluding that there remains a need for full scale randomised clinical trials to determine their efficacy in improving independence.The New Zealand medical journal 02/2008; 121(1268):U2903. -
Article: Post stroke fatigue--where is the evidence to guide practice?
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ABSTRACT: A significant proportion of stroke survivors suffer from persistent and significant fatigue which is linked to reduced independence and case fatality. Despite its high prevalence and detrimental effects, studies of post-stroke fatigue (PSF) interventions are scarce. Only one randomised controlled trial of post-stroke fatigue treatment (i.e. fluoxetine) was identified, and though improving post-stroke emotional incontinence and depression in patients with fatigue this did not improve PSF itself. Despite there being no literature on its efficacy, patient and family education/counselling has been identified as an important rehabilitation intervention for the management of stroke-related fatigue, which has been found effective in other patient groups (i.e. cancer, multiple sclerosis, and those with traumatic brain injury). Factors contributing to the lack of evidence for PSF management are identified and it is concluded that there is a need to better differentiate those most likely to suffer PSF, to validate existing assessments of fatigue, and to evaluate the efficacy of fatigue management and treatment strategies in stroke survivors.The New Zealand medical journal 02/2007; 120(1264):U2780. -
Article: Into the unknown: the experiences of individuals living with multiple sclerosis.
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ABSTRACT: This article examines the narratives of 16 individuals diagnosed with multiple sclerosis (MS). Before diagnosis, the participants had experienced disparate and transient symptoms. Diagnosis itself involved numerous tests and health practitioners, varied responses to the diagnosis, an inability to assimilate information about the disease, and a view of MS as being the lesser of two evils. Immediately after diagnosis, participants revealed concerns about the unpredictable progression of the disease. Patient narratives reflected both negative and positive aspects of living with a chronic illness, such as shifting roles, discrimination, reevaluation of priorities, reinvestment in the family, and positive lifestyle changes. All aspects of the narratives revealed fear and anxiety in relation to the unknown.Journal of Neuroscience Nursing 01/2007; 38(6):435-41, 446. · 0.81 Impact Factor -
Article: The impact of neuropsychological deficits on functional stroke outcomes.
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ABSTRACT: This review examines the available literature on neuropsychological outcomes of stroke and the literature on the ability of specific areas of neuropsychological deficit to predict functional stroke outcome. The literature reviewed indicates that post-stroke deficits in executive function, memory, language, and speed of processing are common, with those identified as having progressive 'post-stroke dementia' presenting with a similar, though more impaired profile, with increased impairments particularly noted in the area of memory. It is clear that some aspects of neuropsychological functioning (e.g., presence of neglect, aphasia, anosognosia; and verbal memory and attention deficits) show promise as a means of predicting post-stroke functional outcomes. Examining the available literature, it becomes evident that there is a need for long-term, large scale (i.e., population based) follow-up studies, evaluating likely long-term neuropsychological outcomes of stroke and their prognostic utility.Neuropsychology Review 07/2006; 16(2):53-64. · 6.62 Impact Factor -
Article: Replication of dissociation-psychosis link in New Zealand students and inmates.
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ABSTRACT: To assess the relationship between dissociative and psychotic experiences, New Zealand university students (N = 119) and prison inmates (N = 42) were administered the Dissociative Experiences Scale (DES) and Symptom Checklist-90-Revised (SCL-90-R). Strong correlations were found between DES scores and the psychoticism and paranoid ideation subscales of the SCL-90-R (students: r = .520, .517, respectively; inmates: r = .637, .649, respectively). While other correlations were also significant (but smaller), these results are consistent with previous studies that have used a range of measures of psychosis or schizotypy with a variety of clinical and nonclinical populations. Such consistent findings in the face of methodological diversity offer strong support for the validity of a link between the concepts of dissociation and psychosis. While this relationship has previously been interpreted indirectly, as dissociative experiences predisposing to psychotic symptoms, we suggest a direct route: that dissociative experiences of various forms may underlie some (or even all) psychotic symptoms.Journal of Nervous & Mental Disease 12/2005; 193(11):722-7. · 1.68 Impact Factor -
Article: Models of response to childhood sexual abuse: their implications for treatment.
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ABSTRACT: Childhood sexual abuse (CSA) has been linked to adult mental health problems and indicators of severity of psychiatric illness. There exist large, unexplained individual differences in the presentation of mental health problems following CSA. Complex statistical methodologies allow researchers to examine models of response to CSA and its impact on mental health. Two early models are presented and critiqued. Two more recent models are then presented. It is concluded that whereas no single variable can, on its own, account for individual variation in symptom development, empirically tested models point toward a complex interaction between abuse-related factors, interactions with others (e.g., responses to disclosure, attachment), and individual factors (e.g., attributions, emotion-focused coping) as mediators and moderators of outcome. The implications of increased understanding of the complex interaction of these factors in understanding clinical presentations and in the formulation of treatment plans are explored.Trauma Violence & Abuse 05/2003; 4(2):95-111. · 3.27 Impact Factor -
Article: The impact of American content on California Verbal Learning Test performance: a New Zealand illustration.
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ABSTRACT: The assessment of verbal memory is a core component of neuropsychological assessment, and is often assessed through the use of list-learning tasks. As with other neuropsychological tests, list-learning tasks may be impacted by cultural relevance of test content. This study examined the extent to which the American content of the California Verbal Learning Test (CVLT) impacts upon the verbal memory performance of New Zealanders. Participants included 90 healthy New Zealand adults who ranged in age from 17 to 81 years. Each participant completed the CVLT and a new version of this test that was modified to reflect New Zealand content (NZ-VLT). Performance on the two measures was not significantly impacted by gender, cultural identity (European/Pakeha; Maori or Pacific Islander), or version of the test administered first. Poorer performances on all scores for both measures were significantly related to increased age, with larger correlation coefficients produced for the New Zealand version of the task. Within-subject comparisons revealed that participants performed significantly better on the New Zealand version of the task for short-delay free recall, long-delay free recall, and recognition trials. Implications of these findings are presented to aid clinicians in future applications of the CVLT in New Zealand.The Clinical Neuropsychologist 09/2002; 16(3):290-9. · 2.12 Impact Factor -
Article: Evaluating and overcoming barriers to taking abuse histories
Professional Psychology Research and Practice 01/2001; 32(4):407. · 1.34 Impact Factor -
Article: Assessing suicidality in adults: Integrating childhood trauma as a major risk factor
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ABSTRACT: Can knowing whether an adult client was abused as a child assist psychologists when assessing suicidality? Reviewing the files of 200 outpatients revealed, in keeping with previous studies, that child abuse was related not only to previous psychiatric admissions and younger age at first treatment and first admission, but also to past and present suicidality. Current suicidality was predicted better by child sexual abuse (experienced on average 20 years previously) than by a current diagnosis of depression. Evidence that abuse histories are not routinely taken, and recommendations for why, and how, taking abuse histories should be integrated into suicide assessment and treatment, are presented.Professional Psychology Research and Practice 01/2001; 32(4):367. · 1.34 Impact Factor -
Article: Poststroke dementia: Prevalence, incidence and risk factors
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ABSTRACT: The following review provides a brief synopsis of the existing literature on poststroke dementia. This includes a summary regarding poststroke dementia prevalence, incidence, and commonly identified risk factors. Factors contributing to differing reports, such as differences in methodology and diagnostic criteria, are noted, and their impact on our knowledge base is outlined. It is concluded that a standardized criteria for studying incidence and prevalence of poststroke dementia is required.
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2002–2012
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University of Auckland
- • Department of Psychology
- • School of Population Health
Auckland, Auckland, New Zealand
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