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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Prevalence of driver sleepiness in a random population-based sample of car driving.

STUDY OBJECTIVES: To obtain reliable estimates of the prevalence of driver sleepiness. DESIGN: A two-stage cluster sampling technique was employed to obtain a sample of car drivers representative of time spent driving on public roads in a geographically defined region. Data were collected by interviewer-administered questionnaire, and analysed in accordance with the sampling design. SETTING: The Auckland region of New Zealand, between April 1998 and July 1999. PARTICIPANTS: 588 drivers of cars and other light vehicles recruited at 69 roadside survey sites. MEASUREMENTS AND RESULTS: Of 746 eligible participants, 79% were interviewed, 12% refused, 8% were untraceable, and 1% were unable to give informed consent. From this sample we estimated that 58.7% of driving was undertaken by men. The vast majority of driving (90.8%) was undertaken by drivers with Epworth Sleepiness scores in the normal range (<10), but a significant minority was undertaken by drivers with one or more characteristics likely to impair alertness. 3.1% had < or = 5 hours sleep in the previous 24 hours, and 21.9% had < or = 4 full nights sleep in the previous week. The triad of symptoms associated with sleep apnea (snoring, choking, and breathing pauses while sleeping) was present in 1.6%; and 8.1% worked a pattern of shifts likely to interfere with normal sleep. CONCLUSION: The prevalence of sleepiness amongst a random sample of New Zealand car driving was low, and less than suggested by previous studies.

Invasive pneumococcal disease in a pediatric population, Auckland, New Zealand.

Streptococcus pneumoniae is one of the major invasive pathogens in childhood. The increasing worldwide prevalence of penicillin-resistant strains makes management of invasive infections difficult and underscores the need for effective vaccines. Currently available vaccines are of limited value in the pediatric age group. Trials are taking place to evaluate conjugated pneumococcal vaccines and in view of this it is important to establish local epidemiology of pneumococcal disease. The aims of this population-based study were to review all of the cases of invasive pneumococcal disease occurring during a 9-year period (1984 to 1992) in Auckland, New Zealand. Through the use of laboratory records and hospital discharge codes, 413 isolates from 407 patients were found. Age-specific incidence for all invasive disease was 22.0/100,000 for children less than 15 years old but 56.0/100,000 for children less than 5 years old (chi 2 Yates corrected 18.20; P = 0.001). Two-thirds were less than 2 years old. The rates were higher in Maori and Pacific Island children than in Caucasian children. A total of 70 isolates from 68 patients with meningitis occurred. The majority were less than 5 years old (incidence of meningitis was 10.0/100,000) and 84% were less than 2 years old. The overall mortality from meningitis was 4.3%. Of the 129 isolates serogrouped or serotyped, 14, 6 and 19 accounted for 23%, 16% and 16%, respectively, of cases. Although 98% of serotypes identified would be covered by the currently available 23-valent vaccine, two-thirds of the children affected by these isolates would be unprotected because of poor immunogenicity of polysaccharide vaccines in children less than 2 years old.

The regulation of IgG4. 1. An immunoassay to detect bee venom specific IgG4 subclass levels.

Serum IgG consists of 4 subclasses designated IgG1-4. IgG subclasses have differing structures and different functions. The levels of antigen specific immunoglobulin in each of the subclasses is difficult to quantitate accurately but may be of significant diagnostic and therapeutic value. IgG4 constitutes approximately 4% of total IgG level in the serum. We describe an immunoassay which is highly sensitive and specific for IgG4 directed against bee venom. The assay can be performed in a routine diagnostic laboratory enhancing its value as a clinical tool. It is potentially useful in identifying patients who fail to respond to standard immunotherapy with bee venom. This immunoassay format can also be adapted to other antigens.

Trauma-related hospitalizations among urban adolescents in New Zealand: priorities for prevention.

PURPOSE: To: (a) determine the magnitude, characteristics, and in-patient costs of injury among hospitalized urban adolescents in New Zealand (NZ); (b) identify regional priorities for injury prevention and investigative research; and (c) compare the study findings with published data from other industrialized countries. METHODS: The 1989-1993 files of the NZ Hospital Discharge Database were accessed to identify and analyze trauma-related admissions of adolescents residing in NZ's largest metropolitan region. RESULTS: The estimated 9569 hospitalizations for injury accounted for one-fourth of all adolescent admissions in the region, a mean annual hospitalization rate of 1292/100,000 population and a minimum annual cost of NZ $5.8 million for in-patient care. Males and indigenous Maori youth had comparatively higher rates of hospitalizations for most major causes of injury. Falls, pedal cyclist injury, cuts, and piercing injuries were leading causes of hospitalization for trauma in early adolescence. Admission rates for motorcylist and other motor vehicle occupant trauma and self-inflicted injury increased substantially among older adolescents. Sport and recreational activities comprised at least one-sixth of injury admissions. CONCLUSIONS: The overall rates of injury resulting in hospitalization among Auckland adolescents were comparable to those reported from Australia and France, but higher than those from the United States, Canada, and Israel. By identifying priority issues and high-risk groups, this study provides a foundation for regional injury control initiatives. It also demonstrates the utility and limitations of E-coded hospital discharge registries in defining the burden of serious nonfatal trauma.

Adolescents' perceptions of a health survey using multimedia computer-assisted self-administered interview.

OBJECTIVE: To ascertain young people's perceptions of an adolescent health survey when administered by multimedia computer assisted self-administered Interview (M-CASI) through analysis of (1) questionnaire item responses and (2) focus group interviews. SETTING: Auckland, New Zealand, 1999. STUDY TYPE: Pilot testing of a 488-item branching questionnaire delivered using a youth-oriented and user-friendly M-CASI interface in a variety of settings using both desktop and laptop computers. Post pilot focus groups of participants identifying their perceptions and experiences of the survey. SAMPLE: 110 school students aged 12 to 18 years. RESULTS: The mean number of questions answered by participants was 316 with the median time to completion being 48 minutes. On average 65% of the total number of questions were seen and of these 1.5% were deliberately not answered. A high level of acceptability and enjoyment of M-CASI was found in the analysis of focus group responses and agreed with the item responses relating to M-CASI within the questionnaire itself. Participants identified privacy and confidentiality as being particularly important for the honesty of their responses. The passive matrix screens of the computers were popular as they could only be viewed from in front. CONCLUSIONS: M-CASI is an acceptable instrument for the administration of a youth health survey. Laptop computers with passive matrix screens are able to enhance perceptions of privacy and confidentiality, which may improve honesty of responses. IMPLICATIONS: M-CASI is now feasible and offers advantages in health surveying.

A prospective cohort study of blood donors: methodological issues in the investigation of injuries and chronic diseases.

Blood donors have made important contributions to research, most notably in cross-sectional seroprevalence studies. The proposed New Zealand Blood Donors Health Study is a prospective cohort study of 30,000 New Zealand donors designed to investigate the determinants of common injuries, cardiovascular disease and cancer. While robust from an analytic perspective, the execution of prospective cohort studies in many settings is impeded by methodological, economic and organisational barriers. We examined the operational considerations of implementing a large-scale cohort study at a transfusion centre and evaluated measures taken to optimise data collection procedures. A pilot study of 1,000 participants revealed donor motivation to participate in this research was high (91% response rate). Comprehensive exposure data on lifestyle, behavioural and psychosocial factors were obtained from 95% of participants. Substantial heterogeneity in levels of potential risk factors was noted among respondents. Detailed dietary habit information and a study blood sample were obtained from 67% and 100% of participants, respectively. Study recruitment and baseline data collection was feasible during routine donor visits with minimal interruption to donor centre staff and procedures. We conclude the study design and characteristics of the regional donor program enhance the efficiency and significance of the proposed research.