34 research outputs found
The Role of Comorbidities on Outcomes After Traumatic Brain Injury
No full textTraumatic brain injury (TBI) is a leading cause of disability and mortality worldwide resulting in a myriad of difficulties including cognitive impairment, functional disability, postconcussion syndrome (PCS) symptoms and diminished quality of life, that have been known to last many years. The epidemiological transition coinciding with rising trends in both TBIs and chronic health conditions, requires greater attention to be placed on understanding the outcomes of those with TBI who are increasingly also likely to have a health condition or comorbidity. In doing so, it furthers our current limited understanding about the additional mediating and/or moderating role that comorbidities are likely to play on delayed recovery and difficulties experienced after TBI. In the measurement of such outcomes, detailed examination of the psychometric properties of scales using modern methods such as Rasch analysis plays a central role. Psychometric analysis not only ensures that outcome measures uphold validity and reliability for use in the intended populations, but also contributes to precision medicine by increasing measurement accuracy of scales.
The aims of this thesis were twofold. The first objective was to apply Rasch analysis to evaluate the performance of the Cumulative Illness Rating Scale (CIRS), Rivermead Postconcussion Questionnaire (RPQ), as well as the WHO Quality of Life Questionnaire-BREF (WHOQoL-BREF) and its shorter derivatives in TBI and orthopaedic populations. The second objective was to develop and test a conceptual and empirically-derived model that illustrates the structural relationships between the presence of comorbidities and injury characteristics, and their impact on PCS symptoms and quality of life in TBI and orthopaedic samples. These study aims were achieved using an age-sex matched case-control sample consisting of n=109 TBI and n=114 orthopaedic patients recruited from the Midland Trauma Registry in the Waikato district of New Zealand. Participants were assessed via telephone interviews regarding their health history, ongoing symptoms and current quality of life at six months to six years post-injury.
Results from the first study using Rasch analysis demonstrated that the RPQ and WHOQoL-BREF scales are reliable and unidimensional measures of persistent postconcussion symptoms and quality of life, respectively, that can be used for assessment in individuals with either TBI or orthopaedic injuries. Shorter versions such as the EUROHIS-QOL-8 and the development of a new 12-item WHOQoL version were also shown to be reliable measures especially useful in time-restrained settings, or where minimising respondent burden is a priority.
In the second study, multivariate linear regression identified that individuals with TBI or orthopaedic injuries, and with a history of neurological or psychiatric problems were at increased risk of reporting prolonged PCS symptoms and diminished quality of life. Findings from structural equation modelling also revealed that the persistence of post-injury psychological, neurological and musculoskeletal difficulties influenced long-term symptoms and quality of life in both groups. Previous research has misattributed PCS symptoms to the presence of a TBI, whereas a notable finding arising from these findings is that these symptoms are a significant predictor of post-injury quality of life in TBI and orthopaedic patients alike.
This thesis has made practical contributions to psychometric research, adhering to best practice guidelines with the provision of ordinal-to-interval conversion tables for improving clinical assessment. The development of a conceptual model that highlights the impact of comorbidities on injury outcomes serves as an important prognostic tool that can be useful for clinicians to identify high-risk individuals who are likely to have persisting difficulties. Prognostic modelling can therefore enable rehabilitation practitioners to modify treatment and tailor rehabilitation strategies from an early stage according to a patient’s individual needs
The geography of diabetes in Auckland: the influence of the socio-spatial environment on the prevalence of diabetes
No full textFull text is available to authenticated members of The University of Auckland only.Introduction Type 2 diabetes is one of the most common non-communicable diseases in New Zealand. Approximately 176,000 people in New Zealand (5% of adults) have been diagnosed with diabetes, and rates have increased over the last 15 years. Diabetes is known to vary by age group, ethnicity, area-deprivation, District Health Board (DHB) and across geographical regions. However few studies from New Zealand and internationally have investigated the influence the socio-spatial environment has on the prevalence of diabetes. Aims This thesis first investigates the prevalence of type 2 diabetes in Auckland Region, by sociodemographic determinants (age, gender, ethnicity, deprivation), and geographically by Census Area Unit (CAU), Territorial Authority (TA) and District Health Board (DHB). Second, this thesis aims to determine the association between diabetes prevalence and two socio-spatial determinants: access to unhealthy foods and recreational facilities in neighbourhoods. Method Using encrypted National Health Identifiers, data from the Primary Health Organisation (PHO) Enrolment Dataset and the National Minimum Dataset (NMDS) were linked to identify patients diagnosed with type 2 diabetes. For inclusion into the study, participants had to be aged 30 years and above, be enrolled in an Auckland Region PHO between 1 July and 30 September 2011. Additionally, patients had to have complete demographic, residential neighbourhood (census Meshblock), and type 2 diabetes status information. Measurement of the socio-spatial environment focussed on neighbourhood accessibility to unhealthy food outlets and recreational facilities at Meshblock level. Locality information of unhealthy food outlets and recreational facilities were obtained from the Zenbu directory of businesses in New Zealand. Accessibility was based on travel distance (metres) from population weighted centroids of Meshblocks to destinations with 1,000m for food outlets and 1,500 for recreational facilities. Levels of accessibility were indexed into quintiles from quintile 1 (low access) to quintile 5 (high access). Poisson regression analyses were conducted to investigate a patient’s likelihood of having diabetes, controlling for demographic and socio-spatial determinants and results were presented as Incidence Rate Ratios (IRRs) and 95% confidence intervals (CI). Findings This thesis used a study population of 746,568 participants, from which 63,761 patients were identified as having type 2 diabetes (9% prevalence for the Auckland region). After controlling for socio-demographic and socio-spatial factors, females in the study population were 13% less likely to have diabetes (IRR 0.87; 95% CI 0.86-0.88) than males. The likelihood of diabetes increased with age, peaking among those aged 75-79 years. Compared with the people aged 55-64 years, participants aged 30-34 years were 82% less likely (IRR 0.18; 95% CI 0.17-0.19), to have diabetes while participants aged 75-79 years were 61% more likely to have diabetes (IRR 1.61; 95% CI 1.56-1.65). Indian (IRR 3.48; 95% CI 3.39-3.58), Pacific Island (IRR 3.31; 95% CI 3.23-3.39) and Māori (IRR 2.37; 95% CI 2.29-2.45) participants were significantly more likely than the New Zealand/Other ethnic group to have diabetes. There were increasing IRRs across the New Zealand Index of Deprivation (NZDep 2006) quintiles, with the most deprived areas (quintile 5) having nearly twice the likelihood of diabetes (IRR 1.92; 95% CI 1.86-1.99) than residents living in least deprived areas. Across DHBs, residents of Counties Manukau DHB portrayed a 10% higher likelihood for diabetes (IRR 1.09; 95%CI 1.06-1.12) than residents of Auckland DHB, whereas no statistically significant differences were observed for Waitemata DHB. A similar burden of diabetes was evident at the TA level. Controlling for socio-demographic and socio-spatial factors, neighbourhoods with high accessibility to unhealthy foods were associated with 30% lower likelihood for diabetes (IRR 0.70; 95%CI 0.64- 0.77), however there was no statistically significant association between accessibility to recreational facilities and diabetes prevalence. Conclusion This thesis found increased risk for diabetes among participants aged 65 years and older, Maori, Pacific and Indian groups and for people living in the most deprived neighbourhoods of Auckland. Additionally, the thesis observed differences in diabetes rates, across geographical regions at the level of MB, CAU, TA ad DHB. This was the first study in New Zealand to investigate the association between the socio-spatial environment and diabetes. Surprisingly, there was a negative association between diabetes and increased neighbourhood accessibility to unhealthy food outlets. The need for a routinely updated is overdue in New Zealand and this thesis calls for urgent need to develop a routine diabetes register in New Zealand. Other key recommendations proposed in this thesis include improving geographic identifiers in health datasets and improving resources for physical activity opportunities in areas of high need
Is the Rivermead Post-Concussion Symptoms Questionnaire a reliable and valid measure to assess long-term symptoms in traumatic brain injury and orthopedic injury patients? A novel investigation using Rasch analysis
No full textPersistent post-concussion syndrome (PCS) symptoms are known to last years after traumatic brain injury (TBI), and similar symptoms are increasingly being documented among those who have not experienced a TBI. There remains however, a dearth of empirical evidence on the structural composition of symptoms beyond the postacute symptom phase after TBI, and little is known about the potential use of PCS symptom scales to measure PCS-like symptoms in non-TBI individuals. Our objective was therefore to examine the psychometric performance and dimensionality of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) as a measure of long-term PCS symptoms among a TBI and non-TBI sample. A case-control sample of 223 patients with injury, consisting of age- and sex-matched TBI participants (n = 109) and orthopedic participants (n = 114) were recruited from a regional trauma registry in New Zealand (NZ), and assessed at mean 2.5 years post-injury. Results from the Rasch analysis showed that the RPQ achieved fit to the Rasch model, demonstrating very good reliability (Person Separation Index [PSI] = 0.87), thereby indicating that the measure can be used reliably for individual and group assessment of symptoms among both TBI and orthopedic patients. In this study we demonstrated evidence of a unidimensional construct of PCS symptoms in both groups, which helps alleviate previous uncertainty about factor structure, and permits the calculation of a total RPQ score. Conversion of ordinal to interval total scores presented within are recommended for clinicians and researchers, to improve instrument precision, and to facilitate the interpretation of change scores and use of parametric methods in data analysis
Female Sexuality in Aotearoa/New Zealand: Factors and Sexual Response Associated with Masturbation
No full textObjectives: Sexual health includes the state of physical, emotional, mental, and social well-being related to sexuality. Masturbation is an important sexual activity with many potential benefits which has gained considerable interest in sexuality research in the past twenty years; however, this research is the first of its kind within the Aotearoa/New Zealand context. In this in-depth investigation, we examined frequencies of, reasons for, and activities during masturbation as well as the relationship between masturbation and other factors.
Methods: Participants were 698 New Zealand women at least 18 years of age participating in a 42-item anonymous online survey collecting comprehensive information about sexual practices and related factors.
Results: The results indicated that female masturbation has high prevalence in the New Zealand population.
Conclusion: The pattern of results enabled us to identify the positive effects of masturbation, masturbation practices commonly used by New Zealand women and the differences between New Zealand women who masturbate frequently and less frequently
Female Sexuality in Aotearoa/New Zealand: Factors and Sexual Response Associated with Masturbation
No full textSexual health includes the state of physical, emotional, mental, and social well-being related to sexuality. Masturbation is an important sexual activity with many potential benefits which has gained considerable interest in sexuality research in the past twenty years; however, this research is the first of its kind within the Aotearoa/New Zealand context. In this in-depth investigation, we examined frequencies of, reasons for, and activities during masturbation as well as the relationship between masturbation and other factors
A Systematic Review of the Worldwide Prevalence of Survivors of Poliomyelitis Reported in 31 Studies
No full textBackground Accurate prevalence figures estimating the number of survivors of poliomyelitis (disease causing acute flaccid paralysis) following poliovirus infection are not available. We aim to undertake a systematic review of all literature concerning the prevalence of survivors of poliomyelitis.
Methods Electronic databases were searched from 1900 up to May 2016 for peer-reviewed studies using a population-based approach witha defined denominator and some form of diagnostic or clinical verification of polio. Exclusion criteria were any prevalence data that were unable to be extracted or calculated and studies reporting on incidence only. The quality of each included study was assessed using an existing tool modified for use in prevalence studies. Average crude prevalence rates were used to calculate worldwide estimates.
Results Thirty-one studies met criteria with 90% of studies conducted in low-income to lower middle-income countries. Significant variability in the prevalence of survivors of poliomyelitis was revealed, in low- income to lower middle-income (15 per 100 000 in Nigeria to 1733 in India) and upper-middle to high-income countries (24 (Japan) to 380 per 100 000 (Brazil). The total combined prevalence of survivors of poliomyelitis for those studies at low to moderate risk of bias ranged from 165 (high-income countries) to 425 (low-income to lower middle-income countries) per 100 000 person-years. Historical lameness surveys of children predominated, with wide variation in case definition and assessment criteria, and limited relevance to current prevalence given the lack of incidence of poliovirus infection in the ensuing years.
Conclusions These results highlight the need for future epidemiological studies of poliomyelitis to examine nationally representative samples, including all ages and greater focus on high-income countries. Such efforts will improve capacity to provide reliable and more robust worldwide prevalence estimates
Determining the feasibility and preliminary efficacy of a stroke instructional and educational DVD in a multinational context: a randomized controlled pilot study
No full textTo assess the feasibility of conducting a randomized controlled trial of an instructional and educational stroke DVD and determine the feasibility and preliminary efficacy of this intervention in a multinational context.Non-funded, pilot randomized controlled trial of intervention versus usual care.International, multicentre, community-based.Community-living adults up to three years post stroke with moderate to severe disability and their nominated informal caregivers.Intervention patients viewed and practised rehabilitation techniques demonstrated in the DVD over six weeks.Trial feasibility by number of active recruitment sites, recruitment efficiency, randomization and follow-up. Intervention feasibility by patient and caregiver impressions. Preliminary efficacy by the quality of life - 5-level EuroQol-5D (EQ-5D) health status measure, General Health Questionnaire and Centre for Epidemiological Studies-Depression at two months.In total, 14 recruitment sites were established across eight countries. Recruitment was achieved at nine (64%) sites. Over 16 months, 66 participants were recruited (mean (SD) age = 63.5 (12.47) years) and randomized to intervention ( n = 34) and control ( n = 32) groups. In total, 54 (82%) completed a follow-up assessment. Patient and/or caregiver comments about the benefits and barriers to accessing the intervention were mixed. There were no significant between-group differences in outcomes at two months ( P > 0.05).Conducting a multinational trial of a stroke DVD requires full funding. The intervention was acceptable to some patients and their caregivers, yet a generalized education approach did not fully meet their needs and/or expectations. A more individualized method may be required to meet peoples' changing needs during stroke recovery
Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017
No full textBACKGROUND: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates.
METHODS: Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate.
RESULTS: For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced.
CONCLUSIONS: The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum
Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016
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