New Zealand's Prospective Outcomes of Injury Study-10 years on (POIS-10): descriptive outcomes to 12 years post-injury.

BACKGROUND: The 'Prospective Outcomes of Injury Study-10 years on' (POIS-10) aims to contribute to improving long-term disability, health and well-being outcomes for injured New Zealanders. This brief report describes recruitment, characteristics and key outcomes to 12 years post-injury. METHODS: Between 2007 and 2009, the study recruited 2856 people, including 566 Maori, from New Zealand's Accident Compensation Corporation's entitlement claims register. People experienced a range of injury types, causes and settings; 25% had been hospitalised for their injury. POIS-10 data were primarily collected via interviewer-administered structured questionnaires. RESULTS: Of the original participants, 2068 (92%) were eligible for follow-up in POIS-10. Of these, 1543 (75%) people participated between March 2020 and July 2021, including 240 Maori. Half of the participants (n=757; 50%) reported ongoing problems attributed to their injury 12 years earlier. Most reported difficulties with items assessing disability (WHO Disability Assessment Schedule II). For health-related quality of life (HRQoL), measured using the EQ-5D-5L, the prevalence of problems was higher 12 years post-injury compared with 12 months post-injury for four of five dimensions. Importantly, the prevalence of problems did not reduce to pre-injury levels for any HRQoL dimension. DISCUSSION: POIS-10 highlights the importance of early post-injury interventions to improve health, disability and well-being outcomes of injured New Zealanders.

Predictors of hospital readmission after trauma: A retrospective cohort study in New Zealand.

INTRODUCTION: Understanding predictors of hospital readmission following major trauma is important as readmissions are costly and some are potentially avoidable. This study describes the incidence of, and sociodemographic, injury-related and treatment-related factors predictive of, hospital readmission related to: a) all-causes, b) the index trauma injury, and c) subsequent injury events in the 30 days and 12 months following discharge for major trauma patients nationally in New Zealand. METHODS: Data from the New Zealand Trauma Registry (NZTR) was linked with Ministry of Health hospital discharge data. Hospital readmissions were examined for all patients entered into the NZTR for an injury event between 1 January and 31 December 2018. Readmissions were examined for the 12-months following the discharge date for participant's index trauma injury. RESULTS: Of 1986 people, 42% had ≥1 readmission in the 12 months following discharge; 15% within 30 days. Seven percent had ≥1 readmission related to the index trauma within 30 days of discharge; readmission was 3.43 (95% CI 1.87, 6.29) times as likely if the index trauma was self-inflicted compared to unintentional, and 1.64 (95% CI 1.15, 2.34) times as likely if the index trauma involved intensive care unit admission. Those admitted to hospital for longer for their index trauma were less likely to be readmitted due to their index trauma injury within 30 days compared to those admitted for 0-1 day. Seventeen percent were readmitted for a subsequent injury event within 12 months, with readmission more likely for older people (>65 years), those with comorbidities, Maori compared with non-Maori and those with higher trauma injury severity. CONCLUSION: A substantial proportion of people are readmitted after discharge for major trauma. Factors identified in this study will be useful to consider when developing interventions to reduce preventable readmissions including those related to the index trauma injury, readmissions from other causes and subsequent injury-related readmissions. Further research specifically examining planned and unplanned readmissions is warranted.

Psychological distress 12 years following injury in New Zealand: findings from the Prospective Outcomes of Injury Study-10 years on (POIS-10).

BACKGROUND: Injuries can have detrimental impacts on mental health, even after physical recovery. In our Prospective Outcomes of Injury Study (POIS), 25% of participants experienced psychological distress (assessed using the Kessler 6) three months after a sentinel injury event (SIE), declining to 16% at 24 months post-SIE. Internationally, studies of hospitalised patients found distress persisted beyond 24 months post-injury and remained higher than the general population. However, most studies only assessed distress at one timepoint, relied on long-term recall, or were limited to small samples or specific injury types. Therefore, we aim to describe the prevalence of psychological distress 12 years post-SIE and to investigate pre-injury, injury-related and early post-injury characteristics associated with long-term distress. METHODS: POIS is a longitudinal cohort study of 2856 New Zealanders injured between 2007 and 2009, who were on the national injury insurer, Accident Compensation Corporation entitlement claims' register. Of these, 2068 POIS participants completed an interview at 24 months and agreed to further contact. They were invited to a follow-up interview 12 years post-SIE which included the Kessler-6 (K6), the psychological distress outcome of interest. Data about a range of pre-injury, injury-related and early (3 months) post-injury characteristics were collected via earlier interviews or administrative data sources (e.g. hospital discharge data). RESULTS: Twelve years post-SIE, 1543 (75%) people were re-interviewed and 1526 completed the K6; n = 177 (12%) reported psychological distress. Multivariable modified Poisson regression models found pre-injury characteristics were associated with an increased risk of clinically relevant distress at 12 years, i.e. having inadequate income, identifying as Maori, Pacific or Asian and having one mental health condition. Early post-injury psychological distress and dissatisfaction with social relationships also increased risk. However, being older was associated with a reduced risk of distress. CONCLUSION: Clinically relevant distress persists long-term post-injury among adults with varying injury severity, types and causes, and at higher prevalence than in the general population. Early identification of injured people at risk of long-term psychological distress provides opportunities for timely interventions to reduce psychological distress.

Life satisfaction 18 months and 10 years following spinal cord injury: results from a New Zealand prospective cohort study.

PURPOSE: To examine the life satisfaction outcomes after spinal cord injury (SCI) and to identify the factors associated with life satisfaction at 18 months and 10 years post-SCI in New Zealand (NZ). METHODS: Adults (16-64 years) were recruited between 2007 and 2009 from NZ's two spinal units following first admission for SCI. Interviews at 6 months, 18 months, and 10 years post-SCI examined demographic, physical, psychosocial, economic, and environmental characteristics. Multivariable regression models were used to identify predictors of life satisfaction at each timepoint. RESULTS: Overall, 118 people participated at 6 months, 103 at 18 months, and 63 at 10 years post-SCI. Pre-SCI, 90% of participants were satisfied with life, 67% were satisfied at 18 months, and 78% at 10 years. At 18 months post-SCI, participants who reported: never or sometimes using a wheelchair, no problems with self-care, no problems with anxiety or depression, no/lesser disability, or fewer secondary health conditions (SHCs) at 6 months post-SCI were more likely to be satisfied (p < 0.05), compared to those without these characteristics. Participants who experienced considerable disability at 6 months post-SCI were 22% less likely to be satisfied 10 years post-SCI compared to those experiencing no/lesser disability (p = 0.028). CONCLUSIONS: A higher proportion of participants were satisfied at both 18 months and 10 years post-SCI than not satisfied. To improve the likelihood of satisfaction with life, increased focus on reducing disability and providing supports for those using wheelchairs, experiencing anxiety/depression or problems with self-care, and effects of SHCs are promising for future potential interventions.

Health-Related Quality of Life and Disability Among Older New Zealanders With Kidney Failure: A Prospective Study.

Background: Disability is prevalent in individuals with kidney failure and can contribute to significantly reduced quality of life and survival. In older individuals with kidney failure, disability can be caused by a combination of factors, including issues directly related to their kidney disease and/or treatment, including weakness, low energy, and low activity. Few studies have investigated health-related quality of life (HRQoL) as a possible predictor of disability among older individuals experiencing kidney failure. Objective: This study aimed to determine if patient-reported HRQoL, and/or other factors at baseline, predicts disability in people with kidney failure, aged ≥65 years, after 12 months of follow-up. Design: The DOS65+ study was an accelerated longitudinal cohort design comprising of both cross-sectional and longitudinal components. Participants were eligible if they were aged ≥65 years, had chronic kidney disease stage 5G (CKD 5G) (estimated glomerular filtration rate (eGFR) <15 ml/min/1.73 m2), and had: commenced kidney replacement education, or were on an active conservative pathway, or were newly incident dialysis patients commencing dialysis therapy or prevalent on dialysis. Setting: Three New Zealand District Health Board (DHB) nephrology units (Counties Manukau, Hawke's Bay, and Southern DHB) were involved in the study. Participants: Participants were eligible if they were aged ≥65 years, had CKD 5G (eGFR <15 ml/min/1.73 m2), and had: commenced kidney replacement education, or were on an active conservative pathway, or were newly incident dialysis patients commencing dialysis therapy or prevalent on dialysis. Measurements: Disability and HRQoL were measured by EQ-5D-3L, a WHO Disability Assessment Schedule (WHODAS) 2.0. Methods: Baseline and 12-month data from our longitudinal dialysis outcomes in older New Zealanders' study were analyzed to determine if HRQoL at baseline predicted disability outcomes 12 months later. Results: Of the 223 participants at baseline, 157 participants completed a follow-up interview 12 months later. Individuals with "considerable disability" at baseline had a significantly (86%) higher risk of experiencing "considerable disability" at 12 months compared with those with "lesser/no disability" at baseline. Two thirds of those with ≥3 comorbidities were experiencing "considerable disability." In addition, those with problems with EQ-5D-3L self-care, EQ-5D-3L usual activities, and EQ-5D-3L anxiety/depression reported higher rates of disability. Limitations: Selection bias is likely to have been an issue in this study as participants were excluded from the follow-up interview if they had an intercurrent illness requiring hospitalization within 2 weeks of the survey interview or if the treating nephrologist judged that the individual's ability to take part was significantly impaired. Sample size meant there were a limited number of explanatory/confounding variables that could be investigated in the multivariable model. Conclusions: EQ-5D-3L mobility and self-care may be useful in predicting subsequent disability for individuals with CKD 5G. Although individuals with kidney failure often experience disability, previous studies have not clearly identified HRQoL or disability as predictors of later disability for individuals with kidney failure. Therefore, we would recommend the assessment of mobility and self-care, in conjunction with existing disabilities in the clinical review and pre-dialysis education of individuals with kidney failure as they approach the need for kidney replacement therapy.Trial registration: the Australian and New Zealand clinical trials registry: ACTRN12611000024943.

How Does Driving Anxiety Relate to the Health and Quality of Life of Older Drivers?

OBJECTIVES: 11% of drivers aged 65+ report moderate to extreme driving anxiety, with associated reduction in driving. Knowledge about the relationships of driving anxiety with health and quality of life for older people is minimal. The present study examined these relationships. METHOD: 1170 community dwelling drivers aged 65+ in New Zealand completed a population survey. RESULTS: After adjusting for socio-demographic variables, higher driving anxiety was associated with lower quality of life and lower odds of 'very good' self-reported health, but no difference in odds of multi-comorbidity. DISCUSSION: Further research is needed to examine the influence of driving anxiety on health and quality of life outcomes with a broader range of older people who experience more challenges to their health and wellbeing, especially to mental health.

Predictors of EQ-5D-3L outcomes amongst injured Maori: 1-year post-injury findings from a New Zealand cohort study.

PURPOSE: Maori, the Indigenous population of New Zealand (NZ), are at higher risk of problems with health-related quality of life (HRQoL) 12 months following injury. This paper examines pre-injury sociodemographic and health characteristics and injury-related factors, including healthcare access, and their association with HRQoL outcomes 12 months after injury. METHODS: The Prospective Outcomes of Injury Study recruited 2856 injured New Zealanders aged 18-64 years from the entitlement claims register of the country's no-fault injury insurance agency. One-fifth (n = 566) of the cohort were Maori. Information on predictors and outcomes, with the exception of injury and hospitalisation, was obtained directly from participants at approximately 3 and 12 months post-injury. The outcomes of interest were responses to the five dimensions of the EQ-5D-3L and a dichotomous measure obtained by summing scored responses to each question. Modified Poisson regression was used to identify predictors of each outcome at 12 months post-injury. RESULTS: Predictors differed by outcome. Being female, experiencing EQ-5D-3L problems pre-injury, having ≥ 2 chronic conditions pre-injury, perceiving one's injury to be a threat of long-term disability, and having trouble accessing health services for injury were common predictors of EQ-5D-3L problems at 12 months post-injury for Maori. CONCLUSION: Opportunities exist to improve HRQoL outcomes by identifying individuals in the early stages of injury recovery who may benefit from further treatment and support.

Missing cases of injury death: use of quantitative methods and case reviews to inform future improvements in case definition.

BACKGROUND: Knowledge of fatal injuries is required to inform prevention activities. Where hospital patients with an injury principal diagnosis (PDx) died and were certified to a medical underlying cause of death (UCoD), there is the potential to underestimate injury mortality. We sought to characterise injury/non-injury (NI) mismatches between PDx and UCoD by identifying which subgroups had small/large mismatches, and to understand why mismatches had occurred using informative examples. METHOD: Hospital records (n=10 234) with a PDx of injury were linked to the mortality collection using a unique personal identifier. Percentages UCoD coded to a NI were tabulated, for three follow-up periods and by selected variables. Additionally, we reviewed a sample of 70 records for which there was a mismatch. RESULTS: %NIs were 39%, 66% and 77% for time from injury to death of <1 week, <90 days and <1 year, respectively. Variations in %NI were found for all variables. Illustrative examples of 70 medical UCoD deaths showed that for 12 cases the injury event was unequivocally judged to have resulted in premature death. A further 16 were judged as injury deaths using balance of probability arguments. CONCLUSION: There is variation in rates of mismatch between PDx of injury and UCoD of NI. While legitimate reasons exist for mismatches in certain groups, a material number of injury deaths are not captured using UCoD alone; a new operational definition of injury death is needed. Early solutions are proposed. Further work is needed to investigate operational definitions with acceptable false positive and negative detection rates.

Prevalence and predictors of post-traumatic stress symptoms in 2200 hospitalised and non-hospitalised injured New Zealanders.

OBJECTIVE: Post-traumatic stress disorder following injuries unrelated to mass casualty events has received little research attention in New Zealand. Internationally, most studies investigating predictors of post-injury post-traumatic stress disorder focus on hospitalised patients although most survivors are not hospitalised. We compared the prevalence and predictors of symptoms suggestive of post-traumatic stress disorder 12 months following injury among hospitalised and non-hospitalised entitlement claimants in New Zealand's Accident Compensation Corporation. This government-funded universal no-fault insurance scheme replaced tort-based compensation for injuries in 1974 since when civil litigation (which can bias post-traumatic stress disorder estimates) has been rare. METHODS: A total of 2220 Accident Compensation Corporation claimants aged 18-64 years recruited to the Prospective Outcomes of Injury Study were interviewed at 12 months post-injury to identify symptoms suggestive of post-traumatic stress disorder using the Impact of Events Scale. Multivariable models examined the extent to which baseline sociodemographic, injury, health status and service interaction factors predicted the risk of post-traumatic stress disorder symptoms among hospitalised and non-hospitalised groups. RESULTS: Symptoms suggestive of post-traumatic stress disorder were reported by 17% of hospitalised and 12% of non-hospitalised participants. Perceived threat to life at the time of the injury doubled this risk among hospitalised (adjusted relative risk: 2.0; 95% confidence interval: 1.2-3.2) and non-hospitalised (relative risk: 1.8; 95% confidence interval: 1.2-2.8) participants. Among hospitalised participants, other predictors included female gender, Pacific and 'other' minority ethnic groups, pre-injury depressive symptoms, financial insecurity and perceived inadequacies in healthcare interactions, specifically information and time to discuss problems. Among non-hospitalised survivors, predictors included smoking, hazardous drinking, assault and poor expectations of recovery. CONCLUSION: One in six hospitalised and one in eight non-hospitalised people reported post-traumatic stress disorder symptoms 12 months following injury. Perceived threat to life was a strong predictor of this risk in both groups. Identifying early predictors of post-traumatic stress disorder, regardless of whether the injury required hospitalisation, could help target tailored interventions that can reduce longer-term psychosocial morbidity.

Students' use of caffeine, alcohol, dietary supplements, and illegal substances for improving academic performance in a New Zealand university.

This study aimed to describe patterns of use and attitudes towards a broad variety of substances for improving academic performance at a New Zealand university. 685 students (from 1800 invited) completed an online questionnaire (38% response rate). They were asked about their lifetime and current substance use for improving academic performance, as well as their reasons for use, attitudes and perceptions of: caffeine, alcohol, dietary supplements, prescription stimulants, other prescription substances, and illicit substances. 80% (95% CI: 76.3, 82.5) reported ever using any substance to help improve academic performance, mainly to stay awake and improve concentration. Caffeine (70%, 95% CI: 66.3, 73.3) and dietary supplements (32%, 95% CI: 28.3, 35.5) were most commonly used. 4% (95% CI: 2.7, 5.9) reported use of prescription stimulants, mostly methylphenidate, and another 4% (95% CI: 2.7, 5.9) reported using illicit substances for improving academic performance. Users of prescription stimulants were more likely than non-users to believe that they were safe, morally acceptable, and that they should be available legally for enhancing academic performance. We close with discussions on broadening the focus of substances for improving academic performance in public health debates. Further qualitative research from small countries is also needed to move towards a place-based approach for clarifying ethical implications, inform policy in universities, and understand how injustices are created through the use of and ability to purchase different substances.

Predictors of Health Deterioration Among Older New Zealanders Undergoing Dialysis: A Three-Year Accelerated Longitudinal Cohort Study.

BACKGROUND: Patient involvement in dialysis decision-making is crucial, yet little is known about patient-reported outcomes over time on dialysis. OBJECTIVE: To examine health-related outcomes over 24 and 36 months in an older cohort of dialysis patients. DESIGN: The "Dialysis outcomes in those aged ≥65 years study" is a prospective longitudinal cohort study of New Zealanders with kidney failure. SETTING: Three New Zealand nephrology units. PATIENTS: Kidney failure (dialysis and predialysis) patients aged 65 or above. We have previously described outcomes after 12 months of dialysis therapy relative to baseline. MEASUREMENTS: Patient-reported social and health factors using the SF-36, EQ-5D, and Kidney Symptom Score questionnaires. METHODS: This article describes and compares characteristics of 120 older kidney failure patients according to whether they report "Same/better" or "Worse" health 24 and 36 months later, and identifies predictors of "worse health." Modified Poisson regression modeling estimated relative risks (RR) of worse health. RESULTS: Of 120 patients at 12 months, 47.5% had worse health or had died by 24 months. Of those surviving at 24 months (n = 80), 40% had "Worse health" or had died at 36 months. Variables independently associated with reduced risk of "Worse health" (24 months) were as follows: Maori ethnicity (RR = 0.44; 95% CI = 0.26-0.75), Pacific ethnicity (RR = 0.39; 95% CI = 0.33-0.46); greater social satisfaction (RR = 0.57; 95% CI = 0.46-0.7). Variables associated with an increased risk of "Worse health" were as follows: problems with usual activities (RR = 1.32; 95% CI = 1.04-1.37); pain or discomfort (RR = 1.48; 95% CI = 1.34, 1.63). At 36 months, lack of sense of community (RR = 1.41; 95% CI = 1.18-1.69), 2 or more comorbidities (RR = 1.21; 95% CI = 1.13-1.29), and problems with poor health (RR = 1.47; 95% CI = 1.41-1.54) were associated with "Worse health." LIMITATIONS: Participant numbers restricted the number of variables able to be included in the multivariable model, and hence there may have been insufficient power to detect certain associations. CONCLUSIONS: In this study, the majority of older dialyzing patients report "Same/better health" at 24 and 36 months. Maori and Pacific people report better outcomes on dialysis. Social and/or clinical interventions aimed at improving social satisfaction, sense of community, and help with usual activities may impact favorably on the experiences for older dialysis patients. TRIAL REGISTRATION: Australian and New Zealand clinical trials registry: ACTRN12611000024943.

CONTEXTE: La participation des patients à la prise de décisions est essentielle en contexte de traitements de dialyse. On en sait toutefois peu sur les résultats observés par les patients en cours de traitement. OBJECTIF: Examiner les résultats liés à la santé sur une période de 24 et de 36 mois dans une cohorte de patients âgés suivant des traitements de dialyse. TYPE D'ÉTUDE: Cette étude intitulée Dialysis outcomes in those aged ≥65 years est une étude de cohorte prospective et longitudinale menée auprès de Néo-Zélandais atteints d'insuffisance rénale. CADRE: Trois unités de néphrologie en Nouvelle-Zélande. SUJETS: Des patients âgés de plus de 65 ans atteints d'insuffisance rénale (dialyse et prédialyse). Nous avions antérieurement décrit les résultats observés après 12 mois de dialyse par rapport au début de l'étude. MESURES: Les facteurs sociaux et l'état de santé déclarés par les patients par l'entremise des questionnaires SF-36, EQ-5D et Kidney Symptom Score. MÉTHODOLOGIE: Dans cet article, nous décrivons et comparons les caractéristiques de 120 patients âgés atteints d'insuffisance rénale selon qu'ils avaient déclaré un état de santé « inchangé/meilleur ¼ ou « empiré ¼ après 24 et 36 mois. Nous discutons également des facteurs prédictifs d'un état de santé jugé « empiré ¼. Un modèle de régression de Poisson corrigé a servi à estimer le risque relatif (RR) de progresser vers un état de santé « empiré ¼. RÉSULTATS: Des 120 patients évalués après 12 mois, 47,5 % avaient déclaré un état de santé « empiré ¼ ou étaient décédés après 24 mois. Parmi les survivants à 24 mois d'étude (n = 80), 40 % avaient déclaré un état de santé « empiré ¼ ou étaient décédés après 36 mois. Les variables associées de façon indépendante à un risque réduit de voir l'état de santé empiré (24 mois) étaient : le fait d'être Maori (RR = 0,44; IC 95% = 0.26-0.75) ou issu d'une population du Pacifique (RR = 0.39; IC 95% = 0.33-0.46) et une satisfaction sociale plus élevée (RR = 0.57; IC 95% = 0.46-0.7) constituent les variables qui ont été associées de façon indépendante à un risque réduit de voir un état de santé empiré après 24 mois. Parmi les variables associées à un risque accru d'aggravation de l'état de santé, on compte des difficultés à pratiquer les activités quotidiennes (RR = 1.32; IC 95% = 1.04-1.37) et la douleur ou l'inconfort (RR = 1.48; IC 95% = 1.34-1.63). Après 36 mois de traitement, l'absence d'un sentiment de communauté (RR = 1,41; IC 95% = 1.18-1.69), le fait de présenter au moins deux maladies concomitantes (RR = 1.21; IC 95% = 1.13-1.29) et des problèmes liés à une mauvaise santé (RR = 1.47; IC 95% = 1.41-1.54) ont été associés à un état de santé jugé « empiré ¼. LIMITES: Le faible nombre de participants a restreint le nombre de variables pouvant être incluses dans le modèle multivarié, il est donc possible que la puissance de détection de certaines associations soit insuffisante. CONCLUSION: Dans cette étude, la majorité des patients âgés sous dialyse ont déclaré avoir un état de santé « inchangé/meilleur ¼ après 24 et 36 mois de traitement. Les patients Maoris et ceux qui sont originaires du Pacifique ont déclaré de meilleurs résultats de dialyse. Les interventions sociales ou cliniques visant à améliorer la satisfaction sociale, le sentiment d'appartenance à la communauté et l'aide aux activités quotidiennes pourraient avoir un effet bénéfique sur le vécu des patients âgés suivant des traitements de dialyse.

Prospective Outcomes of Injury Study 10 Years on (POIS-10): An Observational Cohort Study.

Injury is a leading cause of disability and is costly. This prospective cohort study extension aims to improve disability, health, and wellbeing outcomes for injured New Zealanders, including for Maori. We will identify predictors and modifiable risk factors of long-term outcomes (positive and negative), and develop an Injury Early Care Tool (INJECT) to inform the implementation of effective interventions to improve outcomes. In the Prospective Outcomes of Injury Study (POIS), 2856 people participated following an injury (occurring between 2007 and 2009) registered with New Zealand's no-fault accident compensation scheme (ACC). POIS-10 will invite 2121 people (including 358 Maori) who completed a 24-month POIS interview and agreed to follow-up, anticipating 75% participation (n = 1591). Interviews will collect sociodemographic characteristics, life events, comorbidities, and new injuries since participants' 24-month interview, as well as key disability, health, and wellbeing outcomes 12 years post-injury. Injury-related data will be collected from ACC and hospitalisation records 12 years post-injury. Regression models for the main outcomes will examine the direct effects of predictor variables after adjustment for a wide range of confounders. POIS-10 is enhanced by our partnership with ACC, and expert advisors and will benefit injured people, including Maori, through increased understanding of mechanisms and interventions to improve long-term post-injury outcomes.

Secondary health conditions and disability among people with spinal cord injury: A prospective cohort study.

Objective: To examine how secondary health conditions (SHCs) that develop early after a spinal cord injury (SCI) are related to disability over time.Design: Prospective cohort study.Setting: Two spinal units in New Zealand (Burwood Spinal Unit and Auckland Spinal Rehabilitation Unit).Participants: Between 2007 and 2009, 91 people participated in three telephone interviews approximately 6, 18, and 30 months after the occurrence of a SCI.Outcome measures: SHCs were measured using 14 items derived from the Secondary Complications Survey. Disability was measured using the 12-item World Health Organization Disability Assessment Schedule 2.0. Linear regression analyses were performed to investigate associations between SHCs at 6 months and disability at each assessment point.Results: The most prevalent SHCs were leg spasms, constipation, back pain, pain below the level of SCI, and shoulder pain. Constipation, urinary tract infection, and headaches at 6 months post-SCI were associated with significantly higher levels of disability at each subsequent follow-up, independent of age, sex and SCI impairment. Back pain, and pain below the SCI, at 6 months were associated with significantly greater disability at 18 months, and difficulty coughing at 6 months was associated with significantly greater disability at 30 months.Conclusion: The experience of specific SHCs in the first 6 months after an SCI is related to greater long-term disability. In order to reduce the disability burden of people with SCI, efforts should be directed toward early prevention of these SHCs.

Older Drivers and Their Future Mobility: Views and Involvement of Their Adult Children.

In car-dependent societies like New Zealand, getting the right balance between mobility and safety could improve outcomes for older people but will require changes to policy and practice. Driving cessation is a major life transition with many impacts, and adult children are frequently involved in both the transition to non-driving and maintaining mobility afterward. This cross-sectional study (N = 675) sought perspectives of family members of drivers aged 65 or older enrolled in a longitudinal study. Most (94%) were adult children, two thirds were women, and 19% were moderately to extremely anxious about their parent's driving. Loss of independence, driving's role in identity, and reluctance to rely on family were recognized as important barriers to driving cessation. Most (80%) felt that families, as well as older drivers, would be adversely affected by driving cessation. Families identified accessible local information and services, alternative transport, and community-based programs for drivers and families as assistance most needed.

Predictors of subsequent injury at work: findings from a prospective cohort of injured workers in New Zealand.

OBJECTIVES: People who have experienced a work-related injury can experience further work injuries over time. This study examines predictors of subsequent work-related injuries over 24 months among a cohort of injured workers. METHODS: Participants were those recruited to the earlier Prospective Outcomes of Injury Study (POIS) who had a work-related injury (the 'sentinel' injury). Data from POIS participant interviews were combined with administrative data from the Accident Compensation Corporation (New Zealand's no-fault universal injury insurer) and hospital discharge data. Modified Poisson regression modelling was used to examine whether presentinel injury sociodemographic and health, sentinel injury or presentinel injury work-related factors predicted subsequent work-related injuries. RESULTS: Over a third of participants (37%) had at least one subsequent work-related injury in 24 months. Factors associated with an increased risk of work-related subsequent injury included being in a job involving carrying or moving heavy loads more than half the time compared with those in jobs that never involved such tasks (RR 1.42, 95% CI 1.01 to 2.01), having an inadequate household income compared with those with an adequate household income (RR 1.33, 95% CI 1.02 1.74) and being aged 50-64 years compared with those aged 30-49 years (RR 1.25, 95% 1.00 to 1.57). CONCLUSION: Subsequent work-related injuries occur frequently, and presenting with a work-related injury indicates a potentially important intervention point for subsequent injury prevention. While the strength of associations were not strong, factors identified in this study that showed an increased risk of subsequent work-related injuries may provide a useful focus for injury prevention or rehabilitation attention.

Risk and protective factors for post-traumatic stress among New Zealand military personnel: A cross sectional study.

BACKGROUND: Post-traumatic stress (PTS) is prevalent among military personnel. Knowledge of the risk and protective factors associated with PTS in this population may assist with identifying personnel who would benefit from increased or targeted support. AIMS: To examine factors associated with PTS among New Zealand military personnel. METHODS: For this cross-sectional study, currently serving and retired military personnel were invited to complete a questionnaire. The questionnaire included a measure of PTS (the Military Post-traumatic Stress Disorder Checklist; PCL-M), where scores ≥30 indicate the experience of significant PTS symptoms and scores ≥45 indicate a presumptive clinical diagnosis of post-traumatic stress. Potential risk and protective factors associated with PTS were examined using logistic regression modelling. RESULTS: 1817 military personnel completed the questionnaire. PCL-M scores were ≥30 for 549 (30%) participants and ≥45 for 179 (10%) participants. Factors associated with higher PCL-M scores were trauma exposure, older age, male sex, and Maori ethnicity. Factors associated with lower PCL-M scores were greater length of service, psychological flexibility, and better quality sleep. CONCLUSIONS: PTS was found to be prevalent among New Zealand military personnel. The experience of trauma was strongly associated with PTS. However, factors such as psychological flexibility (the ability to adapt to changes in circumstances) and good sleep were protective, suggesting that these factors could be key targets for interventions designed to reduce PTS among military personnel in New Zealand.

Use of mixed methods to investigate case definitions to improve the identification of serious injury cases from hospital episode data.

INTRODUCTION: It has been commonplace internationally, when using hospital data, to use the principal diagnosis to identify injury cases and the first external cause of injury code (E-code) to identify the main cause. Our purpose was to investigate alternative operational definitions of serious non-fatal injury to identify cases of interest for injury surveillance, both overall and for four common causes of injury. METHODS: Serious non-fatal injury cases were identified from New Zealand (NZ) hospital discharge data using an alternative definition: that is, case selection using principal and additional diagnoses. Separately, identification of cause used all E-codes on the discharge record. Numbers of cases identified were contrasted with those captured using the usual definition. Views of NZ government stakeholders were sought regarding the acceptability of the additional cases found using these alternative definitions. Views of international experts were also canvassed. RESULTS: When using all diagnoses there was a 7% increase in 'all injury' cases identified, a 17% increase in self-harm cases and 8% increase in falls cases. Use of all E-codes resulted in a 4% increase in self-harm cases, 2% increase in assault cases and 1% increase in both falls and motor vehicle traffic crash cases. DISCUSSION: A case definition based solely on principal diagnosis fails to count a material number of serious non-fatal injury cases that are of interest to the injury prevention community. There is a need, therefore, to use an alternative case definition that includes additional diagnoses. Use of multiple E-codes to classify cause of injury should be considered.

Migrants and disability following injury: findings from a prospective study in New Zealand.

OBJECTIVES: To compare the prevalence of disability between migrants and non-migrants at three and 24 months post-injury, and to identify key predictors of post-injury disability among migrants. METHODS: Disability among 2,850 injured participants, including 677 migrants to New Zealand, was measured prospectively using the World Health Organization Disability Assessment Schedule. RESULTS: Migrants experienced higher risk of disability than non-migrants at three months post-injury (aRR=1.14, 95%CI 1.03-1.26). Both groups had similar disability prevalence, but higher than pre-injury, at 24 months. For migrants, strong predictors of disability at three months post-injury were: higher injury severity, pre-injury obesity, and perceiving the injury as a threat of disability. Having multiple chronic conditions was a predictor of disability at both time points. CONCLUSIONS: Disability was persistent for migrants and non-migrants to 24 months post-injury. The disability risk at three months was higher for migrants. Certain predictors associated with disability were identified. Implications for public health: Despite having accessed healthcare services for their injury, migrants (compared with non-migrants) had higher risks of disability at least in the first three months post-injury. Interventions should be focused during this critical period on identified key predictors to promote faster recovery and reduce disability.

Subsequent injuries experienced by Maori: results from a 24-month prospective study in New Zealand.

AIM: Maori, the indigenous population of New Zealand, experience a disproportionate burden of injury compared to non-Maori. Injury burden can be exacerbated by subsequent injuries (injuries that occur after, but not necessarily because of, an earlier or 'sentinel' injury). Despite obligations under New Zealand's Treaty of Waitangi, it appears no published studies have investigated subsequent injuries among Maori. This study aims to describe subsequent injuries experienced by Maori and reported to New Zealand's no-fault injury Accident Compensation Corporation (ACC), and determine: the number and timing of subsequent injury (SI) claims reported to ACC in 24 months following a sentinel injury; the proportions experiencing ≥1 SI; and the nature of SIs. METHODS: The Subsequent Injury Study analysed interview, ACC and hospital discharge data. SIs were classified as injury events involving an ACC claim within 24 months of a sentinel injury. RESULTS: Of 566 participants, 349 (62%) experienced ≥1 SI in the 24 months post-sentinel injury. Those with moderate/high alcohol use, or cognitive difficulties, before the sentinel injury were more likely to experience SIs. Fewer SIs occurred between 0-3 months after a sentinel injury compared to later periods. Spine dislocations/sprains/strains were the most common SI type. CONCLUSIONS: Despite their descriptive nature, our findings point to both the complexity of SI and the need for a greater research, ACC and health service focus on SI if the burden of injury for Maori is to be truly addressed. That 62% of Maori who had already experienced a profound sentinel injury went on to experience ≥1 SIs reported to ACC within a 24-month period suggests that the burden is considerable, and that preventive opportunities are being missed. Additional analyses are now underway to investigate factors predicting SI, while accounting for potential confounders, in order to assist in the development of SI prevention initiatives for Maori at multiple points in the complex post-injury pathway.

Recruitment and participant baseline characteristics in the dialysis outcomes in those aged 65 years or older study.

BACKGROUND: Despite an increasing number of older people commencing dialysis the impact of dialysis on their quality of life and survival, remains unclear. The Dialysis Outcomes in those aged over 65 years or older study is an accelerated prospective cohort longitudinal design study, designed to obtain sufficient health related quality of life data, linked to clinical data, to inform clinicians' and patients' decision-making with respect to end stage kidney disease (ESKD), outcomes, and options for management in New Zealand (NZ). METHODS: The study has an accelerated prospective cohort longitudinal design, comprised of cross-sectional and longitudinal components. We report the baseline data on the 225 participants enrolled in the study. Dialysis duration was grouped in tertiles from less than one year (incident patients), 1-3 years and greater than 3 years. Health related quality of life data was obtained from self-reported questionnaires including KDQoL-36, EQ-5D-3 L, FACIT, WHODAS II, and the Personal Well-being Score. RESULTS: The median age of the cohort was 71 years and two thirds were male. Three quarters of the participants were on dialysis at the baseline, with 42% of those on home dialysis (haemodialysis or peritoneal dialysis). Maori and Pacific people were over represented (20% Maori and 24% Pacific) in the sample, when compared to the general NZ population of the same age group (where 5% are Maori and 2% are Pacific). At baseline, there were no differences observed in sociodemographic, quality of life or health characteristics between the dialysis groups either by modality or duration of dialysis. CONCLUSIONS: We report the baseline characteristics of participants enrolled prospectively into a longitudinal cohort observational study examining health related quality of life factors with clinical characteristics on dialysis outcomes in a group of New Zealanders aged 65 years or older who are either on dialysis or have been educated about dialysis (BMC Nephrol 14:175, 2013). Subsequent publications are planned, analysing the prospective longitudinal data to identify key factors that determine both outcome and quality of life for individuals of this age group. TRIAL REGISTRATION: ACTRN12611000024943 .