Search PubMed⌕ Search

Biomedical subjects

J D Langley

Publications and source records attributed to J D Langley.

At least 37 records · Page 2Linked to original sources
PubMed2000

Child injury mortality in New Zealand 1986-95.

OBJECTIVES: Injury has been described as 'the last major plague of the young'. We provide an epidemiological description of injury, as a leading cause of death in New Zealand, and identify options for prevention. METHODS: We identified all deaths due to any cause for the period 1986-95 from the national data and calculated the potential years of life lost for each death. For the same period, we identified all injury deaths for children aged 0-14 years. Causes of injury were examined in four age groups. RESULTS: In the population as a whole, injury was the fourth leading cause of death and the leading cause of potential years of life lost. Injury killed children at the rate of 16.8 per 100,000 person-years. The victims were predominantly male (62%) and 52% were under 5 years of age. In infancy (<1 year of age), suffocation was the leading cause of injury mortality. From 1 to 14 years of age, motor vehicle traffic incidents were the leading cause of mortality. CONCLUSIONS: Motor vehicle traffic incidents, drowning, suffocation and suicide stood out as areas with the greatest potential for reducing child injury mortality. A number of existing prevention strategies show promise (e.g. child restraints), others are inadequately implemented (e.g. swimming pool fencing) or are of unknown efficacy (e.g. government suicide prevention policies). Strategies to reduce infant suffocation and child non-traffic pedestrian deaths remain to be developed and tested.

Adolescent↗
PubMed2000

Dying to go on holiday.

OBJECTIVE: The Christmas period road toll is a highly publicized 'summary' of the number of road deaths that occur each year during New Zealand's summer holiday period. Our aims were to identify significant changes in the Christmas road toll during 1968-98, highlight the ability to detect changes and determine if focusing on the changes in the Christmas road toll provided a useful insight into trends in fatal crashes. METHODS: Regression modelling of the number of fatalities was used to examine trends in the Christmas road toll in New Zealand over time. A power analysis was used to investigate the ability to detect significant reductions in the Christmas road toll. RESULTS: The Christmas road toll has not decreased significantly in the past 30 years and has not improved significantly in contrast to the rest of the year. The number of deaths in any given year can be expected to vary 'naturally' between 10 and 39. The statistical power to detect a hypothetical 19% reduction in the Christmas road toll is minimal. CONCLUSIONS: Stochastic fluctuations in the Christmas road toll make it extremely difficult to identify underlying trends, even if substantial. Little insight can be gained from yearly comparisons of road tolls considered over short periods. More focus should be placed on road tolls that are calculated over longer periods, e.g. the previous six months. IMPLICATIONS: Natural fluctuations arising in small counts will make it difficult to highlight real improvements in road tolls.

Accidents, Traffic↗
PubMed2000

Drowning and alcohol in New Zealand: what do the coroner's files tell us?

OBJECTIVE: To provide a systematic review of the details on alcohol involvement available in the coronial files to determine if there is enough evidence to estimate the role of alcohol in drowning. METHOD: We reviewed the coroner's files of persons 10 years or older who drowned in New Zealand between 1992-1994 inclusive. RESULTS: A total of 320 coroner's files were examined. Blood Alcohol Concentrations (BACs) were taken in 115 cases (36%) and positive for 50% of these. When accounting for the incomplete testing by using all the information on alcohol involvement collected, between 30-40% of the cases were estimated to have a positive BAC and between 17-24% to have a BAC 100 mg/dL or higher. CONCLUSION: The quality and completeness of current coronial information on alcohol involvement in drowning is insufficient to arrive at an accurate estimate of the percentage of drownings where alcohol was a factor. IMPLICATIONS: Coroners should test drowning victims 10 years and older for BAC. These data should be systematically recorded and processed with the goal of determining who should be targeted in drowning and alcohol prevention programs.

Adolescent↗
PubMed2000

Why the government was right to change the 'Our Healthier Nation' accidental injury target.

We congratulate the current UK Government on their inclusion of accidental injury as one of the national targets in the White Paper: Saving Lives-Our Healthier Nation (OHN). We had concerns about the particular target that was proposed in the Green Paper: 'ellipsisto reduce the rate of accidents-here being defined as those which involve a hospital visit or consultation with a family doctor-by at least a fifthellipsis'. The limitations of this target were: firstly, it would focus attention on minor injury and so not reflect the main burden of injury; and secondly, that ascertainment of cases would be influenced by social factors as well as provision of service and access factors. The new target stated in Saving Lives also has its limitations since it will be influenced by service factors. This target is to reduce by 10% the rate of serious injury, defined as injury resulting in four or more days in hospital. We have proposed the use of an alternative indicator of unintentional injury occurrence, based on serious long bone fracture admitted to the hospital. This alternative indicator is based on the occurrence of serious rather than minor injury. It is likely that a high proportion of cases of these injuries can be identified from existing data sources. Ascertainment of cases is likely to be independent of social, service or access factors. Finally, these injuries are associated with significant long term outcomes including disablement, reduced functional capacity and reduced quality of life. It does have the limitation that it does not measure all serious injury. Such a measure is much more difficult to achieve. Further improvements to our proposed indicator could be made in a number of ways, through investigating an extended definition of the indicator to include a range of other serious injuries, improving the quality of existing data, making other data sources available, including outpatient data, and making serious injury a notifiable disease.

Accident Prevention↗
PubMed1999

Road traffic practices among a cohort of young adults in New Zealand.

AIM: To describe the road safety practices of young adults in New Zealand. METHOD: Face to face structured interviews, seeking information on a range of road safety practices, were conducted with 948 members of the Dunedin Multidisciplinary Health and Development Study cohort when they were 21 years old. RESULTS: In the 30 days before the interview, 49% of the males and 32% of the females reported driving within two hours of drinking alcohol; 19% males and 8% females reported driving after drinking too much to perhaps be able to drive safely: and 25% males and 9% females reported driving after using marijuana. Also, 25% males and 6% females reported that they "often" drove fast just for the thrill of it, and 38% males and 11% females reported "often" driving faster than 120 kph on the open road. Seatbelt use as a driver was reported as "always" or "nearly always" by 87% of the males and 95% of the females, but as a rear seat passenger it was 34% for males and 47% for females. CONCLUSIONS: Unsafe road traffic practices, especially among males, were unacceptably high. Continued efforts are required to find new ways of addressing these issues.

Accidents, Traffic↗
PubMed1999

An evaluation of the general effect of the New Zealand graduated driver licensing system on motorcycle traffic crash hospitalisations.

In 1987, New Zealand introduced a comprehensive Graduated Driver Licensing System (GDLS) which was designed to allow new drivers to gain driving experience while being excluded from high risk situations. This study sought to evaluate the impact of the GDLS on motorcycle traffic crashes that resulted in serious injury. Injury crash data were obtained from the New Zealand Health Information Services national public hospital inpatient data files for the years 1978-1994, inclusive. Cases were disaggregated into three age groups, 15-19 years, 20-24 years, and 25 years or older, for which injury trends were obtained. In order to determine whether trends in motorcycle traffic crashes simply followed national trends in other injury events, two non-traffic comparison groups for the main target group (15-19 years) were included. Using time series analyses, the introduction of the GDLS was found to be closely followed by a significant reduction (22%) in motorcycle traffic crash hospitalizations for the 15-19 year age group. An examination of vehicle registration and driver licensure data suggests that the reduction in injury crashes may, largely, be attributable to an overall reduction in exposure to motorcycle riding.

Accidents, Traffic↗
PubMed1999

Water trauma and swimming experiences up to age 9 and fear of water at age 18: a longitudinal study.

A small number of retrospective studies on the etiology of specific fears have obtained findings consistent with a biological (non-associative) explanation of fear acquisition. Unfortunately, reliance on imperfect memory to recall conditioning events which occurred many years earlier limits the conclusions that can be drawn from such data. The present investigation attempts to overcome this methodological shortcoming by examining the relationship between water trauma (i.e. conditioning) and water skills (e.g. swimming) before the age of 9 and the presence of water fear and phobia at age 18 in a longitudinal birth cohort. We found no evidence of a relationship between water confidence and water trauma up to the age of 9 and fear of water at age 18. Similar findings were obtained for water phobia at age 18 with the exception that study members who were less able to immerse themselves in water with confidence at age 9 were more likely to report water phobia at age 18. Associative and non-associative explanations of these findings were discussed.

Adolescent↗
PubMed1999

Achieving compliance with pool fencing legislation in New Zealand: a survey of regulatory authorities.

OBJECTIVES: To identify the status of compliance and enforcement of New Zealand's Fencing of Swimming Pools Act (FOSP Act), 10 years after its introduction, and to identify methods for improving both compliance with the act and the process of enforcement. METHODS: A postal questionnaire was sent to all 74 authorities in New Zealand in which they were asked questions about their enforcement of the FOSP Act. Semistructured telephone interviews were conducted with 12 authorities to supplement the data obtained in the postal survey. RESULTS: Based on responses to the survey, it was estimated that there are over 59,000 domestic swimming pools in New Zealand, giving rates of 46 pools/1000 dwellings and 16 pools/1000 persons. The authorities reported that 44% of pools complied with the act, and a further 4% had been granted exemptions. Nineteen per cent of pools were reported to not comply with the act, and the compliance status of a further 33% was not known, or not stated by the authority. Only 9% of authorities had procedures for locating and inspecting pools, while 28% had a programme of reinspection to ensure that pools continued to comply. Pool owner resistance was considered to be the main difficulty with enforcing the act, and nearly half of the authorities believed publicity or education was needed to overcome these barriers. Fifty two per cent of authorities had publicized the act during the 12 months preceding the survey. CONCLUSIONS: Due to ambiguities within the legislation, and differing levels of commitment by authorities to locate pools and monitor compliance, compliance with the FOSP Act is not consistent nationally. If the act were less ambiguous, there would be greater consistency and more enforcement.

Accident Prevention↗
PubMed1999

Validity of self reported crashes and injuries in a longitudinal study of young adults.

OBJECTIVES: The aim of this study was to determine the validity of self report as a source of information on crashes and injuries. SETTING: This study was part of the Dunedin Multidisciplinary Health and Development Study (DMHDS), which is a longitudinal study of the health, development, and behaviour of a cohort of young New Zealanders. METHOD: At the age 21 assessment DMHDS study members were asked to report serious injury and motor vehicle traffic crashes experienced over the previous three years. The self reported injuries were compared with the New Zealand Health Information Service (NZHIS) public hospital discharge file to determine the completeness of the self reported data. The traffic crashes were compared with the police traffic crash reports to determine the accuracy of self reported crash details. RESULTS: Twenty five (86%) of the 29 unintentional injuries, six (67%) of the nine assaults, and one (14%) of the six self inflicted injuries on the NZHIS file were self reported. The level of agreement between the self reported crash details and those recorded on the traffic crash report was high. CONCLUSIONS: The results show that self reports can be a useful and valid source of injury and crash data.

Accidents, Traffic↗
PubMed1999

Coding the circumstances of injury: ICD-10 a step forward or backwards?

The International Classification of Diseases (ICD) E codes are the most widely used coding frame for categorising the circumstances of injury and poisoning. In 1992 major revisions to the E codes were released. The aim of this paper was to consider whether the changes made are a step forward or backwards in terms of facilitating injury prevention. The approach taken was to reflect on some former injury prevention research needs and the challenges they presented using data coded according to ICD-9, and then to consider how, if at all, ICD-10 has addressed these difficulties. As with ICD-9, there are essentially two axes associated with each cause: intent and mechanism of injury, and these are captured by one code. This approach can have the unintended effect of hiding the significance of some mechanisms of injury. While there have been significant improvements in some areas, such as falls, in others, such as injuries due to firearms, ICD-10 has taken a step backward. In addition the failure to produce mutually exclusive codes presents problems for determining the incidence of downing events. A welcome addition are "optional" activity codes which enable the identification of work related and sport related injury for the first time. Nevertheless, the limited range of codes and absence of coding guides limits their utility. The revised place of occurrence codes do not represent a significant improvement on ICD-9 in that they are limited to 10, they are not mutually exclusive, and they do not adequately cover a range of specific places of occurrence. In summary, relative to its predecessor, ICD-10 represents a significant improvement in many areas. Unfortunately, it still falls far short of the mark for many injury prevention needs.

Accidental Falls↗
PubMed1998

Trends in motorcyclist and occupant fatalities and serious injuries due to traffic crashes.

AIM: To describe trends in motorcycle traffic crashes and compare these trends in other crashes and vehicle registrations. METHOD: National fatality and public hospital inpatient data were used to select cases. Relative changes in both deaths and hospitalisations, and vehicle registrations were examined in each year during the period 1980-98. RESULTS: The results show that deaths and serious injuries to motorcyclists have declined substantially over the period 1980-1995. The trend in serious injuries to motorcyclists closely followed the trend in motorcycle registrations. The association was less evident for motorcyclist fatalities and for occupants there was no clear association with trends in registrations for either outcome. CONCLUSIONS: The reduction in motorcycle injuries has contributed substantially to our improved road safety record. We need to protect these gains but in order to do this we need a clear understanding of how they were achieved. Such an understanding is currently lacking.

Accidents, Traffic↗
PubMed1998

Evidence for a non-associative model of the acquisition of a fear of heights.

Theories that fear results from previous traumatic experience (i.e. conditioning theories) have enjoyed widespread support for over half a century. Recent research, however, has cast doubt on the validity of these models in some specific phobias. Two studies on the etiology of height phobia have obtained findings consistent with a non-associative, evolutionary explanation of fear acquisition (Menzies and Clarke, 1993a, Behaviour Research and Therapy, 31, 355-365; Menzies and Clarke, 1995a, Behaviour Research and Therapy, 33, 795-805). Unfortunately, the retrospective nature of these studies limits the conclusions that can be drawn from these data. Like all retrospective research, these studies depend on adult subjects imperfect ability to recall conditioning events that may have occurred many years earlier. The present investigation overcomes these methodological shortcomings by examining the relationship between putative conditioning events before the age of 9 yr and the presence of height fear at ages 11 and 18 yr in a large birth cohort studied longitudinally. To our knowledge this is the first study that has prospectively examined the relationship between relevant traumatic events early in life and the onset of height fear in late adolescence. No positive relationship was found between a history of falls resulting in injury (i.e. fracture, dislocation, intracranial injury or laceration) before the age of 9 and fear of heights at age 11 or 18. Interestingly, falls resulting in injury between the ages of 5 and 9 occurred more frequently in those without a fear of heights at 18 (P < 0.01)--a finding in the opposite direction to that predicted by conditioning theory but consistent with non-associative theories of fear acquisition. In general, the results provide strong support for non-associative models of fear and are difficult to reconcile with conditioning theories.

Accidental Falls↗
PubMed1998

Adult thermal injuries in New Zealand resulting in death and hospitalization.

This paper provides an overview of thermal injury resulting in death or hospitalization in New Zealand adults, defined as age 15 years and over. For the 10-year period 1978-1987, there were 493 adult thermal injury deaths resulting in an overall rate of 2.1 per 100000 person-years (95%CI: 1.9-2.3). For the year 1988, there were 644 hospitalizations resulting in a rate of 25.1 per 100000 (95%CI: 23.2-27.1). The highest rates of death and hospitalization were observed in the elderly (65 years of age and over). Young males (15-29 years) also had a very high rate of hospitalization. Residential fire was the most common type of burn event resulting in death (44%), and smoking materials were the most common source of ignition in fatal residential fires (37%). Hot liquids were the most common source of thermal energy for the hospitalized injuries (34%). Typical scenarios involved burns from hot water expelled from automobile radiators, from hot water use in the workplace, from hot beverages, and from household hot tap-water. The epidemiology of the adult thermal injuries in New Zealand is similar to that reported in other developed countries. Opportunities and strategies for the prevention of these injuries are discussed.

Accidents, Home↗
PubMed1998

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.

Adolescent↗
PubMed1998

Drowning surveillance: how well do E codes identify submersion fatalities.

OBJECTIVES: The aim was to determine in New Zealand: (1) to what degree the International Classification of Diseases Supplementary Classification (ICD) external cause (E) codes for drowning identify all deaths involving drowning; (2) how the other drowning deaths are distributed across E codes; and (3) whether the proportion of drownings not identified by traditional ICD E codes has changed over time. METHODS: Mortality files for the period 1977-92, which were coded in the range E800-E999 (external causes of injury and poisoning), were searched electronically using the keyword "drown". RESULTS: 2718 cases that involved drowning were identified. This represents a 17.7% increase in the number of cases one would identify using ICD drowning E codes alone. The majority (65%) of the 408 drownings not coded as such were coded as motor vehicle traffic crashes. The number of drownings that were not identified by ICD E codes remained relatively constant over time, although the number of deaths E coded as drowning declined significantly in recent years. CONCLUSION: Standard ICD E codes for drowning do not identify all drowning related deaths, which may make comparisons of injury rates between countries difficult, especially for injuries such as drownings and burns that can be both nature of injury and external cause codes. Multiple cause coding and the inclusion of free text narratives are an important tool to improve the value of a country's vital statistics for injury prevention, and facilitate comparisons with other countries.

Cause of Death↗
PubMed1998

Determining first admissions in a hospital discharge file via record linkage.

The aim of this study was to identify first admissions in a public hospital discharge file with the greatest possible accuracy. Computerised data linkage was used to link injury events. This involved the use of "internal" data linkage (unduplication) which, in data linkage terms, is equivalent to matching two identical files. Admission status indicators obtained from deterministic and probabilistic linkages were compared with those obtained from a manual review. Small absolute reductions in error were obtained using a probabilistic linkage over a deterministic linkage. However, these reflected large relative reductions in error. A validity check confirmed initial results and discounted against possible bias due to the subjective nature of the probabilistic linking procedure.

Humans↗
PubMed1997

Trends in cycle injury in New Zealand under voluntary helmet use.

Twelve months before the wearing of a cycle helmet was to become mandatory in New Zealand, a substantial proportion of cyclists on public roads had 'voluntarily' adopted wearing a helmet. Helmet wearing rates had increased up to 84, 62 and 39% for primary school children, secondary school children, and adults respectively by the end of the period of interest. The purpose of this study was to examine the serious injury trends for three age groups of cyclists: primary school age (5-12 years), secondary school age (13-18 years), and adults (over 18 years) admitted to selected public hospitals between 1980 and 1992; twelve months before the introduction of helmet legislation. Serious injury was defined as 'admitted to hospital' then disaggregated by type of crash and length of stay. Statistical models were constructed that included the proportion of people admitted to hospital with a head injury, then analysed using Poisson regression. Results revealed that the increased helmet wearing percentages has had little association with serious head injuries to cyclists as a percentage of all serious injuries to cyclists for all three groups, with no apparent difference between bicycle only and all cycle crashes. Discussion of the results includes possible explanations for the absence of a decline in the percentage of serious head injury among cyclists as cycle helmet wearing has increased.

Adolescent↗