Bronchiectasis is associated with delayed diagnosis and adverse outcomes in the New Zealand Common Variable Immunodeficiency Disorders cohort study.

Common variable immunodeficiency disorders (CVID) are multi-system disorders where target organ damage is mediated by infective, autoimmune and inflammatory processes. Bronchiectasis is probably the most common disabling complication of CVID. The risk factors for bronchiectasis in CVID patients are incompletely understood. The New Zealand CVID study (NZCS) is a nationwide longitudinal observational study of adults, which commenced in 2006. In this analysis, the prevalence and risk factors for bronchiectasis were examined in the NZCS. After informed consent, clinical and demographic data were obtained with an interviewer-assisted questionnaire. Linked electronic clinical records and laboratory results were also reviewed. Statistical methods were applied to determine if variables such as early-onset disease, delay in diagnosis and increased numbers of infections were associated with greater risk of bronchiectasis. One hundred and seven adult patients with a diagnosis of CVID are currently enrolled in the NZCS, comprising approximately 70% of patients known to have CVID in New Zealand. Fifty patients (46·7%) had radiologically proven bronchiectasis. This study has shown that patients with compared to those without bronchiectasis have an increased mortality at a younger age. CVID patients with bronchiectasis had a greater number of severe infections consequent to early-onset disease and delayed diagnosis. Indigenous Maori have a high prevalence of CVID and a much greater burden of bronchiectasis compared to New Zealand Europeans. Diagnostic latency has not improved during the study period. Exposure to large numbers of infections because of early-onset disease and delayed diagnosis was associated with an increased risk of bronchiectasis. Earlier diagnosis and treatment of CVID may reduce the risk of bronchiectasis and premature death in some patients.

Development of the hearing protection assessment (HPA-2) questionnaire.

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. AIMS: To describe the development of an easily administered yet robust questionnaire to investigate factors that influence HPD use. METHODS: A 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. RESULTS: Of 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.

Disability studies in Sri Lanka: priorities for action.

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.

Fatalities and hospitalisations due to acute poisoning among New Zealand adults.

BACKGROUND: 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 industrialised countries, demographic trends in incidence, particularly including socio-economic indicators and substances involved, are less well known. AIM: To determine demographic patterns and substances related to acute poisoning fatalities and hospital admissions in New Zealand among people at the age of 25 years or older. METHODS: 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 were analysed. RESULTS: The 1841 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 at the age of 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. CONCLUSIONS: 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.

Learner driver experiences and crash risk as an unsupervised driver.

OBJECTIVE: The purpose of this study was to describe the driving experiences of learner licensed drivers and examine the association between these driving experiences, associated factors, and on-road car crash involvement during the unsupervised restricted license stage. METHODS: Data were drawn from a cohort investigation of newly licensed drivers. Information on demographic characteristics, personality, and risk behaviors was collected at the baseline interview. At the first follow-up interview (restricted license stage) study members were asked details about their experiences as a learner licensed driver: professional driving lessons, supervised driving, unsupervised driving, and driving courses in which they participated. During the second follow-up interview (full license stage), data were collected on crash involvement and driving exposure during the restricted license stage. Regression analysis was used to determine independent relationships between learner license driving experience variables and crash involvement. RESULTS: After adjusting for demographic, personality factors, and driving exposure at the restricted license stage, increased time spent on the learner license was associated with a reduced risk of crash involvement during the unsupervised restricted license stage. CONCLUSION: Results presented in this paper suggest that learner drivers in New Zealand should be encouraged to spend more time on their learner license to enable them to gain skills and experience to help reduce their crash risk when they are allowed to drive unsupervised. IMPACT ON INDUSTRY: Compared with novice drivers who are on their learner license for the least amount of time, those who spend the most amount of time on their learner license have reduced risk of on-road crash involvement as an unsupervised driver. Learner drivers and their supervisors need to be aware of the length of time required for practice in order to reduce the risks of crash involvement when they are able to drive unsupervised (O'Brien et al., 2012). The recently introduced increase in the minimum driver licensing age in NZ, tougher restricted license stage driving test (aimed at encouraging 120 hours of supervised driving), and the Safe Teen driver campaign (NZ Transport Agency, 2012) are all strategies targeted at improving the safety of learner drivers. These strategies need to be evaluated to ensure they are achieving their goals.

Workplace injuries in Fiji: a population-based study (TRIP 7).

BACKGROUND: Workplace injury rates in low and middle-income countries are known to be high. Contemporary data on this topic from Pacific Island countries and territories are scant. AIMS: To describe the epidemiology of fatal and hospitalized workplace injuries in Fiji using a population-based trauma registry. METHODS: An analysis of data from a prospective population-based surveillance registry investigated the characteristics associated with workplace injuries resulting in death or hospital admission among people aged 15 years and older in Viti Levu, the largest island in the Republic of Fiji, from October 2005 to September 2006. Incidence rates were calculated using denominator data from the 2004-05 Fiji Employment Survey. RESULTS: One hundred and eighty-nine individuals met the study eligibility criteria (including nine deaths). This corresponded to annual injury-related hospitalization and death rates of 73.4 and 3.7 per 100 000 workers, respectively. Males accounted for 95% of injuries, and hospitalization rates were highest among those aged 15-29 years (33 per 100 000 workers). Fijian and Indian workers had similar rates of admission to hospital (38.3 and 31.8 per 100 000 workers, respectively). Fractures (40%) and 'cuts/bites/open wounds' (32%) were the commonest types of injury while 'being hit by a person or object' (34%), falls (27%) and 'cutting or piercing' injuries (27%) were the commonest mechanisms. Overall, 7% of injuries were deemed intentional. CONCLUSIONS: Acknowledging the likely underestimation of the overall burden of workplace injuries, these findings support the need to identify context-specific risk factors and effective approaches to preventing workplace injuries in Fiji.

Development and piloting of the Fiji Injury Surveillance in Hospitals System (TRIP Project-1).

INTRODUCTION: Whilst more than 90% of injury related deaths are estimated to occur in low-and-middle-income countries (LMICs), the epidemiology of fatal and hospitalised injuries in Pacific Island Countries has received scant attention. This study describes the development and piloting of a population-based trauma registry in Fiji to address this gap in knowledge. METHODS: The Fiji Injury Surveillance in Hospitals (FISH) system was an active surveillance system designed to identify injuries resulting in death or a hospital admission in Viti Levu, Fiji. During the pilot conducted over five months in 2005, Accident and Emergency registers, admission folders and morgue registers from 8 of Viti Levu's 12 hospitals, and an additional 3 hospitals in other parts of the country were reviewed by hospital staff and medical students to identify cases and extract a minimum data set that included demographic factors; the mechanism, nature and context of injury; substance use; and discharge outcomes. The system was audited to identify and redress difficulties with data quality in a manner that also supported local capacity development and training in injury surveillance and data management. RESULTS: This pilot study demonstrated the potential to collect high quality data on injuries that can pose a significant threat to life in Fiji using a mechanism that also increased the capability of health professionals to recognise the significance of injury as a public health issue. CONCLUSION: The injury surveillance system piloted provides the opportunity to inform national injury control strategies in Fiji and increase the capacity for injury prevention and more focused research addressing risk factors in the local context.

Sleep, blood pressure and obesity in 22,389 New Zealanders.

AIM: To determine the relationship of sleep disorders with blood pressure and obesity in a large, relatively healthy, community-based cohort. METHODS: A cross-sectional study was undertaken using data from 22,389 volunteer blood donors in New Zealand aged 16-84 years. Height, weight, neck circumference and blood pressure were measured directly, and data on sleep and other factors were ascertained using a validated self-administered questionnaire. RESULTS: Even in a relatively young, non-clinical cohort, lack of sleep (34%), snoring (33%), high blood pressure (20%) and obesity (19%) are common. After adjusting for relevant confounders, participants at high risk of sleep apnoea had double the odds of having high blood pressure but only in participants over 40 years. Very low and high quantities of sleep are also associated with high blood pressure. Even after controlling for neck circumference, self-reported sleep apnoea, sleep dissatisfaction and low amounts of sleep are associated with a higher body mass index. CONCLUSIONS: Obesity and hypertension have significant associations with a variety of sleep disorders, even in those less than 40 years of age and after adjusting for a wide range of potential confounders.

The spectrum captured: a methodological approach to studying incidence and outcomes of traumatic brain injury on a population level.

OBJECTIVE: Drawing on the experience of conducting the Brain Injury Incidence and Outcomes New Zealand in the Community study, this article aims to identify the issues arising from the implementation of proposed guidelines for population-based studies of incidence and outcomes in traumatic brain injury (TBI). STUDY DESIGN AND SETTING: All new cases of TBI (all ages and severities) were ascertained over a 1-year period, using overlapping prospective and retrospective sources of case ascertainment in New Zealand. All eligible TBI cases were invited to participate in a comprehensive assessment at baseline and at 1-month follow-up. RESULTS: Our experience to date has revealed the feasibility of case ascertainment methods. Consultation with community health services and professionals resulted in feasible referral pathways to support the identification of TBI cases. 'Hot pursuit' methods of recruitment were essential to ensure complete case ascertainment for this population with few additional cases of TBI identified through cross-checks. CONCLUSION: This review of proposed guidelines in relation to practical study methodology provides a framework for future comparable population-based epidemiological studies of TBI incidence and outcomes in developed countries.

Self-reported oral health, dental self-care and dental service use among New Zealand secondary school students: findings from the Youth 07 study.

AIM: The primary aim was to describe New Zealand secondary school students' use of dental services and determine the nature and extent of any inequities by deprivation status and ethnicity. A secondary aim was to to describe their toothbrushing practices and self-reported dental pain experience, past restorative treatment and tooth loss. METHOD: Secondary analysis of data from the cross-sectional Youth 07: National Survey of the Health and Wellbeing of New Zealand Secondary School Students. A representative sample of 9,098 secondary school students aged 13-17 years from 96 secondary schools across New Zealand took part, with a response rate of 73%. Self-report information about oral health care behaviour, past dental experiences and dental visiting pattern was collected. Data analysis took the complex survey design into account, and multivariate analysis was undertaken to examine the associations of dental service-use. RESULTS: A dental visit in the previous 12 months was reported by 72% of participants. The odds of having done so were higher among females, those who brushed at least twice daily, and those who had been kept awake at night by dental pain. Lower odds were seen among students identifying with Maori, Pacific or Asian people (and those in the 'Other' ethnic category) than among European students, and among those residing in medium- or high-deprivation areas than those in lo-deprivation areas. One in seven participants reported having lost a tooth due to oral disease. Having had a tooth filled was reported by almost three-quarters of the sample, and having been kept awake by dental pain at night was reported by just over one in five. Almost two-thirds reported brushing their teeth twice or more in the previous 24 hours, and a small minority had not brushed at all. CONCLUSION: Ethnic and socio-economic inequities in the use of dental services are apparent among New Zealand adolescents.

Chronic neck pain following car crashes: a population-based study from Auckland, New Zealand.

BACKGROUND: In a setting with a 'no fault' universal government-funded accident compensation system, we undertook a study to (i) estimate the prevalence and predictors of chronic neck pain in car occupants surviving serious injury-producing crashes and (ii) compare the longer-term health-related quality of life of crash survivors with and without neck discomfort. METHODS: A prospective cohort study recruited hospitalized survivors aged ≥16 years and non-hospitalized drivers of cars involved in serious crashes in Auckland over a 10-month period. Participants completed a structured questionnaire at recruitment and 5 and 18 months later. RESULTS: Of the 268 participants, 50 (18.7%) reported neck pain or stiffness at 5 and 18 months following the crash. Of these, 70% noted the discomfort led to limitations in work and recreation. Depressive and post-traumatic stress symptoms at 5 months were associated with an increased risk of moderate to severe neck discomfort at 18 months. Participants with and without neck discomfort had significantly reduced health-related quality of life based on Short Form-36 scores. CONCLUSION: Significant neck discomfort limiting usual function is relatively common up to 18 months following crashes. The reductions in health status among crash survivors with and without neck pain reveal the complexities in attributing longer-term adverse outcomes to a particular condition in the absence of an appropriate comparison group. The findings indicate the need to manage judiciously comorbid conditions while prioritizing efforts to support crash survivors' return to their usual social roles and activities.

The role of alcohol in unintentional falls among young and middle-aged adults: a systematic review of epidemiological studies.

OBJECTIVE: To appraise the published epidemiological evidence quantifying the risk of falls associated with acute and usual alcohol consumption among young and middle-aged adults. DESIGN: Systematic review. DATA SOURCES: searches of electronic databases (eg, Medline, EMBASE, CINAHL, PsycINFO, Scopus), websites of relevant organisations, major injury journals, reference lists of relevant articles, and contact with experts in the field. INCLUSION CRITERIA: epidemiological studies with an English language abstract investigating alcohol use as a risk factor (exposure) for unintentional falls or related injuries among individuals aged 25-60 years. Studies were critically appraised using the GATE LITE tool. Meta-analysis was not attempted because of the heterogeneity of the eligible studies. RESULTS: Four case-control, three cohort and one case-crossover study fulfilled the inclusion criteria. The studies showed an increased risk of unintentional falls among young and middle-aged adults with increasing exposure to alcohol use. However, the magnitude of this risk varied considerably across studies with most estimates being relatively imprecise. Modest evidence of a dose-response relationship with acute alcohol use was observed. The association between usual alcohol use and fall risk was inconclusive, and evidence of a gender difference was inconsistent. CONCLUSIONS: Alcohol use appears to be an important risk factor for falls among young and middle-aged adults. Controlled studies with sufficient power that adjust effect estimates for potential confounders (eg, fatigue, recreational drug use) are required to determine the population-based burden of fall-related injuries attributable to alcohol. This can help inform and prioritize falls prevention strategies for this age group.

Prospective outcomes of injury study.

BACKGROUND: In New Zealand (NZ), 20% of adults report a disability, of which one-third is caused by injury. No prospective epidemiological studies of predictors of disability following all-cause injury among New Zealanders have been undertaken. Internationally, studies have focused on a limited range of predictors or specific injuries. Although these studies provide useful insights, applicability to NZ is limited given the importance of NZ's unique macro-social factors, such as NZ's no-fault accident compensation and rehabilitation scheme, the Accident Compensation Corporation (ACC). OBJECTIVES: (1) To quantitatively determine the injury, rehabilitation, personal, social and economic factors leading to disability outcomes following injury in NZ. (2) To qualitatively explore experiences and perceptions of injury-related outcomes in face-to-face interviews with 15 Maori and 15 other New Zealanders, 6 and 12 months after injury. SETTING: Four geographical regions within NZ. DESIGN: Prospective cohort study with telephone interviews 1, 4 and 12 months after injury. PARTICIPANTS: 2500 people (including 460 Maori), aged 18-64 years, randomly selected from ACC's entitlement claims register (people likely to be off work for at least 1 week or equivalent). DATA: Telephone interviews, electronic hospital and ACC injury data. Exposures include demographic, social, economic, work-related, health status, participation and/or environmental factors. OUTCOME MEASURES: Primary: disability (including WHODAS II) and health-related quality of life (including EQ-5D). Secondary: participation (paid and unpaid activities), life satisfaction and costs. ANALYSIS: Separate regression models will be developed for each of the outcomes. Repeated measures outcomes will be modelled using general estimating equation models and generalised linear mixed models.

New Zealand Drivers Study: a follow-up study of newly licensed drivers.

BACKGROUND: Despite significant improvement since graduated licensing was introduced, traffic-related injury remains the leading cause of death and hospitalisation among young New Zealanders. Most research to date has used routinely collected crash data but has been limited in that these databases do not, and realistically cannot, include the level of detail required to ensure that learner driver policy and programmes are based on sound scientific evidence applicable to young drivers in the current New Zealand context. OBJECTIVES: To examine the driving-related experiences of newly licensed drivers to identify factors associated with increased or decreased risk of negative traffic outcomes. DESIGN: Multistage prospective cohort study. SETTING: New Zealand. PARTICIPANTS: Newly licensed drivers. EXPOSURES: background demographic details, pre-licence driving, previous crashes, driving intentions, motivations for driving and licensing, sensation seeking, aggression, impulsivity, quality and quantity of driving experience, driving supervision, driving behaviour, alcohol and other drug use, compliance with New Zealand's graduated driver licensing scheme, driver training/education, cell phone use, and sleep. OUTCOMES: crash, conviction, infringements, risky driving. EXPOSURES: participants and their parents. Outcomes: participants and official records. BIAS: On the basis of a pilot study, participation and attrition bias are likely to be minimal. A comparison of baseline data for those followed and those not followed will be undertaken. Information bias will be minimised by standardised questionnaires. Information on potential confounders is to be collected and controlled for in analyses. STUDY SIZE: 5000 (including 1500 Maori). STATISTICAL METHODS: Survival analysis, logistic or Poisson regression, generalised estimating equations.

Population-based estimates of injuries in Sri Lanka.

BACKGROUND: Injuries are the leading cause of public hospital admission in Sri Lanka. Data on injury epidemiology to plan prevention programmes to reduce injury burden are not readily available. OBJECTIVES: To assess the incidence of various types of injuries in the Galle district, Sri Lanka. METHODS: 9568 individuals of all ages were selected from 2000 households in a population-based cross-sectional survey using a stratified cluster sampling technique. Data on non-fatal injuries in the last 30 days irrespective of severity, fatal injuries and those that resulted in disability in the last 12 months were documented. Proxy data were used for half of the injury cases. RESULTS: 195 (2%) individuals reported non-fatal injuries during the last 30 days, giving an age-sex-urban-rural adjusted annual incidence of 24.6 per 100 population. The leading causes of non-fatal injuries were falls (adjusted annual incidence 6.7 per 100 population, 95% CI 6.0 to 7.3) and mechanical injuries (6.3; 95% CI 5.7 to 6.8), followed by road traffic injuries (4.9; 95% CI 4.4 to 5.5). 114 (58.5%) individuals needed outpatient care and 50 (25.6%) needed inpatient care for their injuries. The annual injury mortality rate and disability rate were 177 (95% CI 72 to 283) and 290 (95% CI 250 to 330) per 100,000 population, respectively. CONCLUSIONS: Nearly one in four people reported non-fatal injury; the majority sought medical attention in this population. It is important to utilise injury epidemiology to develop and implement interventions to reduce the burden of injuries in the population and on the hospitals in Sri Lanka.

Taking a risk perception approach to improving beach swimming safety.

BACKGROUND: Beach swimming is generally associated with a healthy lifestyle, yet the risk of drowning is universally significant. PURPOSE: The purpose of the study was to investigate the factors associated with safe swimming behavior using protection motivation theory as a guiding theoretical framework. METHOD: This cross-sectional study surveyed a sample of beachgoers (N = 3371) aged > or =16 years who completed an anonymous, self-report questionnaire to assess the associations between perceptions of the risk of drowning and safe swimming behavior. RESULTS: Compared with males, females perceived greater severity, vulnerability, response efficacy, and concern regarding their risk of drowning. Males, Maori, and 16 to 29 year olds reported higher self-efficacy scores compared to females, other ethnic groups, and older participants, respectively. After controlling for confounding variables, people perceiving a greater threat (severity) of experiencing difficulty while swimming as well as those reporting higher response efficacy (beliefs about the effectiveness of drowning prevention measures) were more likely to report safe swimming behavior. CONCLUSION: The effectiveness of water safety education programs could be strengthened by enhancing risk appraisal and coping skills and counter-acting the tendency of males and younger adults to overestimate their swimming ability and underestimate their risk with regard to drowning.

Conspicuity and bicycle crashes: preliminary findings of the Taupo Bicycle Study.

OBJECTIVE: To describe the methods, characteristics of participants, and report on the preliminary findings of a longitudinal study of cyclists. DESIGN: Web-based survey to establish a cohort of cyclists. SETTING: Participants in the largest mass-participation bicycle event in New Zealand, the Wattyl Lake Taupo Cycle Challenge. PARTICIPANTS: 2469 riders who had enrolled online in the 2006 Wattyl Lake Taupo Cycle Challenge. MAIN OUTCOME MEASURES: Self-reported crashes in preceding 12 months. RESULTS: Of 5653 eligible riders, 2469 (44%) completed the study questionnaire. Mean age was 44 years, 73% were male, and the average number of kilometers cycled per week in the preceding 12 months was 130. The annual incidence of crashes leading to injury that disrupted usual daily activities for at least 24 h was 0.5 per cyclist/year. About one-third of these crashes resulted in presentation to a health professional. The mean number of days absent from work attributable to bicycle crashes was 0.39 per cyclist/year. After adjustment for potential confounders and exposure (kilometers cycled per year), the rate of days off work from bicycle crash injury was substantially lower among riders who reported always wearing fluorescent colors (multivariate incidence rate ratio 0.23, 95% CI 0.09 to 0.59). CONCLUSIONS: Low cyclist conspicuity may increase the risk of crash-related injury and subsequent time off work. Increased use of high-visibility clothing is a simple intervention that may have a large impact on the safety of cycling.

A systematic review of epidemiological studies investigating risk factors for work-related road traffic crashes and injuries.

OBJECTIVE: To critically appraise the published evidence for risk factors for injuries and deaths relating to work-related road traffic crashes. DESIGN: Systematic review. DATA SOURCES: Electronic databases searched included Medline, EMBASE, PsycINFO, Transport database, and the Australian Transport and Road Index (ATRI) database. Additional searches included websites of relevant organizations, reference lists of included studies, and issues of major injury journals published within the past 5 years. INCLUSION CRITERIA: Studies were included if they investigated work-related traffic crashes or related injuries or deaths as the outcome, measured any potential risk factor for work-related road traffic crash as an exposure, included a relevant comparison group, and were written in English. METHODS: Included studies were critically appraised using the GATE-lite critical appraisal form (www.epiq.co.nz). Meta-analysis was not attempted because of the heterogeneity of the included studies. FINDINGS: Of 25 studies identified, three of four robust (case-control and case-crossover) studies found an increased injury risk (i) among workers after extended shifts, (ii) for tractor-trailers with brake and steering defects, and (iii) for "double configuration" trucks. The fourth study showed that alcohol and drug use were not risk factors in an industry with a random testing policy. The best cross-sectional studies showed associations between injury and sleepiness, time spent driving, occupational stress, non-insulin-dependent uncomplicated diabetes, and use of narcotics and antihistamines. CONCLUSIONS: Modifiable behavioral and vehicle-related risk factors are likely to contribute to work-related traffic injury. Fatigue and sleepiness-the most commonly researched topics-were consistently associated with increased risk.

Shift work and work injury in the New Zealand Blood Donors' Health Study.

OBJECTIVE: To investigate associations between work patterns and the occurrence of work injury. METHODS: A cross sectional analysis of the New Zealand Blood Donors Health Study conducted among the 15 687 (70%) participants who reported being in paid employment. After measurement of height and weight, a self-administered questionnaire collected information concerning occupation and work pattern, lifestyle behaviour, sleep, and the occurrence of an injury at work requiring treatment from a doctor during the past 12 months. RESULTS: Among paid employees providing information on work pattern, 3119 (21.2%) reported doing shift work (rotating with nights, rotating without nights, or permanent nights) and 1282 (8.7%) sustained a work injury. In unadjusted analysis, work injury was most strongly associated with employment in heavy manual occupations (3.6, 2.8 to 4.6) (relative risk, 95% CI), being male (1.9, 1.7 to 2.2), being obese (1.7, 1.5 to 2.0), working rotating shifts with nights (2.1, 1.7 to 2.5), and working more than three nights a week (1.9, 1.6 to 2.3). Snoring, apnoea or choking during sleep, sleep complaints, and excessive daytime sleepiness were also significantly associated with work injury. When mutually adjusting for all significant risk factors, rotating shift work, with or without nights, remained significantly associated with work injury (1.9, 1.5 to 2.4) and (1.8, 1.2 to 2.6), respectively. Working permanent night shifts was no longer significantly associated with work injury in the adjusted model. CONCLUSION: Work injury is highly associated with rotating shift work, even when accounting for increased exposure to high risk occupations, lifestyle factors, and excessive daytime sleepiness.