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Introduction: Whilst there are many benefits to participating in sports and recreational activities, there is also a risk of injury including sports-related traumatic brain injury ­(SR-TBI). To inform injury prevention initiatives, it is important to explore the burden of SR-TBI at the population level. This review aimed to estimate the incidence of SR-TBI in the general population across injury severities. Methods: Systematic search of electronic databases using keywords from 1965 until June 2019 facilitated by hand searches of reference lists. Original research reporting on the incidence of SR-TBI, capturing people of all ages in a well-defined population area was included. Studies were excluded if they focused on a specific sport(s) or population group. All studies were required to be published in the English language. Quality of studies was determined as poor, moderate or good based on the standards of reporting of neurological disorders criteria. Data on year(s) of data collection, diagnostic criterion, case ascertainment sources, population denominator and incidence per 100,000 and by age, sex, injury severity and sport were extracted by 2 authors independently using a standard data extraction form. Results: Following review of 11 studies meeting the inclusion criteria, the incidence of SR-TBI within hospital-based studies ranged between 3.5 and 31.5 per 100,000. One community-based study using multiple case ascertainment sources identified a higher incidence of 170 per 100,000. SR-TBI accounted for 1.2–30.3% of all TBIs. One study provided incidence data across a 5-year period suggesting an increasing trend in incidence over time. Males were more at risk than females (66.1–75.6%), and adolescents and young adults had the highest incidence of SR-TBI. Conclusion: The primary objective of this review was to provide a summary of descriptive data on SR-TBI epidemiology at the population level. SR-TBI represented up to one-third of all causes of TBI. Trends in incidence by age and sport were challenging to determine due to lack of consistency in reporting as well as the small number of studies overall. Undertaking injury surveillance at all levels of TBI will assist with understanding the nature, mechanism of and surrounding events where injuries occur in sport.

Background: Depression and anxiety are the two most frequently studied emotional outcomes of stroke. However, few previous studies have been carried out at a population level or beyond 6 months post stroke. The aim of this study was to describe depression and anxiety across the first year following incident ischemic stroke (IS), and identify predictive factors in a population-based study. Method: The Hospital Anxiety Depression Scale (HADS) was administered at baseline (within 2 weeks of onset), and again at 1-month, 6-months and 12-months after IS in a sample (N = 365) drawn from a population-based study. Results: Over 75% of those assessed experienced depression or anxiety symptoms below cut-offs for probable disorder across the year post stroke. Moderate to severe symptoms for anxiety were approximately twice as likely (range 4.1%–10.6%) as compared to depression (range 2.5%–5.0%) at each assessment. The greatest improvement in anxiety occurred within the first month post stroke. In contrast, the greatest reduction in depression occurred between 1- to 6-months post stroke. Conclusions: Anxiety symptoms in the moderate to severe range were twice as common as depression, and improved over the first month post stroke, whilst depression symptoms persisted for up to 6 months, indicating a need to target these two issues at different points in the recovery process.

Background: Increasing evidence suggests potential lifetime effects following mild traumatic brain injury (TBI) in childhood. Few studies have examined medium-term outcomes among hospitalized and non-hospitalized samples. Study aims were to describe children's behavioral and emotional adjustment, executive function (EF), quality of life, and participation at 7-years following mild TBI using parents' and teachers' reports.Methods: Nested case control study of 86 children (68% male, mean age at assessment = 11.27 years; range 7–17 years) who sustained a mild TBI 7-years previously, identified from a prospective, population-based study. They were compared to 69 children free from TBI (61% male, mean age at assessment = 11.12 years; range 5–17 years). In addition to parent-reported socio-demographic details, parents (mild TBI n = 86, non-TBI n = 69) completed age-appropriate standardized questionnaires about children's health-related quality of life, behavioral and emotional adjustment, EF, and social participation. Parents own mood was assessed using the Hospital Anxiety and Depression Scale. Teachers (mild TBI n = 53, non-TBI n = 42) completed questionnaires about children's behavioral and emotional adjustment, and EF.Results: Parent reports showed median group-level scores for cases were statistically significantly greater than controls for emotional symptoms, conduct problems, hyperactivity/inattention, total behavioral difficulties, inhibitory control, shifting, planning/organizing, and Global Executive Composite (total) EF difficulties (p-values 0.001–0.029). Parent reports of child quality of life and social participation were similar, as were teacher reports of child behavioral and emotional adjustment, and EF (p > 0.05). When examining clinical cut-offs, compared to controls, cases had a higher risk of parent-reported total EF difficulties (odds ratio = 3.00) and, to a lesser extent, total behavior problems (odds ratio = 2.51).Conclusions: As a group, children with a history of mild TBI may be at elevated risk for clinically significant everyday EF difficulties in the medium-term compared to non-TBI controls, as judged by their parents. Further multi-informant longitudinal research is required, following larger samples. Aspects requiring particular attention include pre-injury characteristics, such as sleep disturbances and comorbidities (e.g., headaches), that may act as potential confounders influencing the association between mild TBI and child behavioral problems.

Background:Emerging data suggest that recovery from mild traumatic brain injury (mTBI) takes longer than previously thought. This paper examines trajectories for cognitive recovery up to 48 months post-mTBI, presenting these visually using a Sankey diagram and growth curve analysis.Methods:This sample (n = 301) represents adults (≥16 years) from a population-based Brain Injury Outcomes in the New Zealand Community study over a 4-year follow-up on the CNS-Vital Signs neuropsychological test. Data were collected within 2 weeks of injury, and then at 1, 6, 12 and 48 months post-injury.Results:Significant improvement in cognitive functioning was seen up to 6 months post-injury. Using growth curve modelling, we found significant improvements in overall neurocognition from baseline to 6 months, on average participants improved one point per month (0.9; 95% CI 0.42–1.39) p < 0.001. No change in neurocognition was found within the time periods 6–12 months or 12–48 months. The Sankey highlighted that at each time point, a small proportion of participants remained unchanged or declined. Proportionally, few show any improvement after the first 6 months.Conclusion:Most individuals remained stable or improved over time to 6 months post-injury. Summary statistics are informative regarding overall trends, but can mask differing trajectories for recovery. The Sankey diagram indicates that not all improve, as well as the potential impact of individuals moving in and out of the study. The Sankey diagram also indicated the level of functioning of those most likely to withdraw, allowing targeting of retention strategies.

Objective:The impact of traumatic brain injury (TBI) extends beyond the person who was injured. Family caregivers of adults with moderate to severe TBI frequently report increased burden, stress and depression. Few studies have examined the well-being of family members in the mild TBI population despite the latter representing up to 95% of all TBIs.Methods:Five areas of well-being were examined in 99 family members (including parents, partners, siblings, other relatives, adult children, friends or neighbours) of adults (aged ≥16 years) with mild TBI. At 6- and 12-month post-injury, family members completed the Bakas Caregiver Outcomes Scale, Short Form-36 Health Survey, EQ-5D-3L, Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index. Outcomes and change over time and associated factors were examined.Results:At 6 months, group mean scores for health-related quality of life for mental and physical components and overall health status were similar to the New Zealand (NZ) population. Mean scores for sleep, anxiety and depression were below clinically significant thresholds. From 6 to 12 months, there were significant improvements in Bakas Caregiver Outcomes Scale scores by 2.61 (95% confidence interval: 0.72–4.49), health-related quality of life (mental component) and EQ-5D-3L overall health (P= 0.01). Minimally clinically important differences were observed in overall health, anxiety, health-related quality of life and depression at 12 months. Female family members reported significant improvements in physical health over time, and more positive life changes were reported by those caring for males with TBI.Conclusions:The findings suggest diminished burden over time for family members of adults with mild TBI.

Background:Traumatic brain injury (TBI) is common among children. However, their caregivers’ knowledge and understanding of symptoms may influence how the injury is managed.Primary objective:To investigate the knowledge of New Zealand (NZ) parents about TBI and concussion.Method and procedures:Parents (n = 205) of children aged 5–13 years completed a pen-and-paper or online survey containing questions examining their knowledge of TBI terminology, TBI symptoms and knowledge about concussion management.Main outcomes and results:A high proportion (61%) of parents did not think that a concussion was the same as a brain injury. Loss of consciousness (LOC) was the most endorsed symptom of TBI. However, 69% of participants were aware that TBI could occur without LOC. On average, parents correctly identified 19.5 (67.3%) of the 29 symptoms of TBI, but also identified 2.0 (11.9%) of the 17 distractor symptoms as being TBI related. Demographic factors and experience of TBI/concussion were associated with TBI symptom identification accuracy and concussion knowledge.Conclusions:Further education of parents is needed to ensure they recognise the signs and symptoms of concussion/mild TBI so that they can make informed decisions on how best to manage their child’s injury.

Background: Research following mild traumatic brain injury (mTBI) during childhood predominantly examines recovery up to 12 months post-injury. Objectives: To determine children's longer-term (4 years) patterns and predictors of recovery. Methods: Parents of 196 children (aged 1-15 years) completed the Behaviour Assessment System for Children and Pediatric Quality of Life Inventory at baseline, 1, 6, 12, and 48 months post-injury. Children aged ≥8 years at each assessment completed a computerized neurocognitive testing battery. At 1 month, parents completed the Hospital Anxiety and Depression Scale. Multilevel modeling accounted for repeated measures. Results: Children had significantly fewer child behavior problems, better adaptability, and improved quality of life after 12 months. Concurrent improvements in overall neurocognitive function were no longer significant once adjusted for age, gender, and socio-economic status. From 12 to 48 months, quality of life reduced significantly while child behavior and neurocognition plateaued. Child behavior problems and worse quality of life were associated with parental anxiety and lower socio-economic status. Conclusions: Children's recovery in the year following mTBI appears to plateau from 12 to 48 months, with a concomitant reduction in quality of life. Identification and treatment of parent mental health issues may reduce the exacerbation of negative child outcomes following mTBI.

BACKGROUND Previous studies of the Rivermead Post-Concussive Questionnaire(RPQ)'s factor structure were conducted within 1 year post-injury. Post-concussive symptoms may persist, and are common in the general population, so determining if the factor structure in mild-TBI and controls differ is important. This study examined factor structure of the RPQ in adults 4 years post-mild-TBI and in age-/gender-matched controls. METHOD A total of 232 adults 4 years post-mild-TBI and 232 age-/gender-matched controls completed the RPQ. RESULTS Both samples produced a three-factor solution (57.98% and 56.44% of variance in the RPQ). Factor 1 for both samples included all RPQ items and accounted for the majority of variance explained (42.6% and 40.7%). After mild-TBI factor 2 included dizziness, vomiting/nausea, irritability, and double vision; whilst in controls it involved headache, dizziness, vomiting/nausea, and slowed thinking. Factor 3 for mild-TBI included vomiting/nausea, blurred vision, slowed thinking, and poor memory; while for controls it was restricted to visual symptoms (blurred vision, light sensitivity, double vision). CONCLUSION The RPQ factor structure was similar for both groups, although differences were identified in lesser factors. This suggests those with mild-TBI differ minimally from matched controls in the very long term after injury.

Objective: Behavioral and emotional difficulties are reported following pediatric mild traumatic brain injury (TBI). But few studies have used a broad conceptual approach to examine children’s long...

Emotional disorders are considered to contribute to persistent difficulties after mild traumatic brain injury (TBI). Few studies have examined anxiety after mild TBI, and fewer have examined comorbid depression and anxiety and their trajectories over time. This study describes depression and anxiety across 48-months after mild TBI in adults (aged15 years at injury).Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale in a sample of 341 adults with mild TBI within 2 weeks of injury and then at 6-, 12- and 48-months post-injury.Mean anxiety and depression total scores decreased significantly over time. Prevalence of depression ranged from 0% to 7.7%, whilst anxiety was present in 3.7-29.5% of cases. Comorbid anxiety and depression prevalence ranged from 10.2% to 20.7%. At each time of assessment, the greatest proportion of individuals had neither depression nor anxiety (range 28-49%). The findings suggest multiple trajectories over time.The findings indicate that both anxiety and depression need to be screened regularly after mild TBI. Furthermore, it cannot be assumed that someone who initially presents without depression or anxiety will remain free of these as they negotiate life after injury.

This study aimed to examine the role of reinvestment - the propensity to consciously monitor and control actions (movement specific reinvestment) and to consciously monitor and evaluate decision making processes (Decision specific reinvestment) while driving in everyday risky scenarios. The study also aimed to evaluate the association between reinvestment and previously validated driver attitude measures. Fifty one participants completed a series of questionnaires (Driving Self-Efficacy Scale, Driver Attitude Questionnaire, Movement Specific Reinvestment Scale, Decision Specific Reinvestment Scale) after which they completed a test phase in a driving simulator. In the test phase, driving scenarios included roads with different markings (i.e., double yellow, wide centrelines, wire rope barriers, Audio Tactile Profiled markings) and alerting scenarios (i.e., police car present, high crash risk area sign, reduced speed zone). Results revealed that on risky roads (wide centrelines), participants with a high propensity for decision specific reinvestment drove slower than those with a low propensity. Driver experience, attitudes towards speeding and scores on the Decision Reinvestment subscale of the Decision Specific Reinvestment Scale significantly predicted speed choice. More experienced participants with higher scores on the Decision Reinvestment subscale were more likely to drive slower and participants with worse attitudes towards speeding were likely to drive faster. Participants with a low propensity for movement specific reinvestment (specifically, Movement Self-Consciousness) reduced their speed to a greater extent than those with a high propensity when driving in the police car scenario. There was some evidence to suggest that high decision specific and movement specific reinvesters were more likely to be involved in crashes and receive driving infringements. The current study is the first to demonstrate a significant relationship between reinvestment and driving. The implications of these findings for road safety are discussed.

Mild traumatic brain injury (mTBI) in children is most commonly associated with parent-reported child behaviour problems. The extent to which parent and child ratings align is unknown.To examine differences in child behaviour and patterns of recovery over the first 12 months following mTBI based on parent and child self-report.Ninety-nine children (8-15 years) with mTBI and one of their parents completed the Behavioural Assessment Scale for Children - version 2 to assess child hyperactivity, anxiety and depression at baseline, 1, 6 and 12 months post-injury. Differences between ratings from parents and children were evaluated using Bland-Altman limits of agreement analyses. Child recovery over time was examined using mixed models repeated measures analyses.Parent and child ratings for child hyperactivity, anxiety and depression differed significantly at baseline and these differences remained constant at each follow-up. Parents tended to report more child hyperactivity, anxiety and depression. Over time, parents and children reported fewer child hyperactivity and anxiety problems.Parents and children have poor agreement in ratings of child behaviour yet there is general agreement in patterns of recovery in the year following mTBI. Findings show the importance of considering both parent and self-report of child behaviour.

Mild traumatic brain injury (mTBI) is common injury during childhood and adolescence but the long-term outcomes are poorly understood. This study examined post-concussive symptoms and behavioural outcomes in children and adolescents up to 24 months post-mTBI.Parents of children aged 8-15 years with mTBI completed the BASC-2 and Rivermead Post-Concussion Symptoms Questionnaire at baseline, 1-, 6-, 12- and 24 months post-injury. An age-matched traumatic brain injury-free cohort was recruited and assessed at 12- and 24 months.PCSs decreased significantly over the first 12 months post-injury. At 12- and 24 months post-injury, the mTBI group reported more PCSs and behavioural symptoms compared to controls. Parents of children with mTBI were more likely to report ≥4 problematic PCS symptoms (28% at both time points) compared to controls (7.7% and 1.7% at 12 and 24 months, respectively). The mTBI group was 4.63 times more likely to have four or more ongoing PCS symptoms at 12 months post-injury compared to controls. Headache was the most common acute post-injury symptom (55%), while the most commonly reported persistent symptoms were irritability, frustration, forgetfulness and fatigue.PCSs are common 2 years post-mTBI in childhood or adolescence. Given this, additional intervention and support is needed for families post-injury.

The notion that most crashes happen close to home has been repeated so often it has come to be an accepted truth. Despite this, to our knowledge there have not been any studies to date which have adequately accounted for rates of exposure in drawing conclusions concerning relative crash risk and distance from home. We addressed this gap by using data representative of all travel (from the New Zealand Household Travel Survey) and crashes in New Zealand, by New Zealand drivers, from 1 July 2013 to 30 June 2014. Trip origins, destinations and driver home address were used to convert 31,102 trips into travel exposure on roads at increasing distance from home. Travel data were compared with crash distance from home for 6,295 injury crashes involving 9,315 drivers. Analysis showed that on average, drivers were indeed more likely to crash close to home. Roads within 11 km (6.8 miles) of home accounted for half of all travel and 62% of all crashes. The ‘close to home’ effect held for male and female drivers. Novice (learner) drivers were the only demographic subgroup to not exhibit the close to home effect. Compared with crashes further away, crashes close to home were more likely to involve alcohol and diverted attention, and less likely to involve driver fatigue. These findings provide a mandate for continued investigation into the science of typical, everyday driving. We contend that behavioural effects associated with driving on familiar roads may be a factor in injury crash risk for experienced drivers.

This study explored the patterns of drug driving in New Zealand by investigating 1) drivers' perceptions about impairment caused by legal and illegal drugs 2) countermeasures employed by drivers when under the influence of drugs (e.g., decisions not to drive) 3) drivers' attitudes about police enforcement of drug driving and 4) the factors that predict the likelihood of engaging in drug driving. Participants (n=434) were licensed drivers who completed an online questionnaire. Results of the questionnaire indicated that drivers rated hallucinogens and opiates as being the illegal drugs producing the highest level of driving impairment and cannabis the lowest. For legal drugs, sedatives were rated as having the highest driving impairment and anti-nausea and anti-depressants the lowest. Respondents' drug use history had an effect on their ratings of impairment for anti-anxiety drugs, anti-depressants, kava, sedatives, cannabis and hallucinogens such that drug users reported higher impairment ratings than Non-user. Making a decision not to drive after taking drugs was reported by users of alcohol (73.6%), cannabis (57.0%), strong painkillers (42.5%), and anti-depressants (10.0%). Respondents who reported drink driving were 3.26 times more likely to report drug driving than those reporting no drink driving. Respondents also showed greater acceptance towards driving under the influence of legal drugs (43.5%) compared to illegal drugs (10.3%). Those who did not have favourable attitudes about drug driving were less likely to report having driven under the influence of drugs. Drivers in this sample were less aware of the potential negative effects of legal drugs on driving compared to illegal drugs. More than half the respondents from this study acknowledged drug driving as a road safety issue which needs more resources dedicated to it.

Objective: To identify the systems available to sub-classify mild traumatic brain injury (TBI) and to determine their utility in predicting 1-year outcome.Methods: A systematic review to identify mild-TBI sub-classification systems was conducted until March 2016. The identified systems were applied to a cohort ofN= 290 adults who had experienced a mild-TBI, and who had been assessed for post-concussion symptoms 1-year post injury. ANOVAs and regression models were used to determine whether each sub-classification system could distinguish between outcomes and to explore their contribution to explaining variance in post-concussion symptoms 1-year post injury.Results: Nineteen sub-classification systems for mild-TBI met the inclusion criteria for this review. The Saal (1991) classification system significantly differentiated the experience of post-concussion symptoms in our cohort 1-year post injury (F= 2.39,p= 0.05). However, the findings did not remain significant following correction for multiple comparisons and inclusion of socio-demographic and contextual factors in the regression model.Conclusions: Current sub-classification systems fail to explain much of the variance in post-concussion symptoms 1 year following mild-TBI. Further research is needed to identify the factors (including socio-demographic and contextual factors) to determine, who may be at risk of developing persistent post-concussion symptoms.

This study examined agreement between ratings of health and emotional distress by women and their midwives.Physical complaints and medical complications during pregnancy can significantly impact a woman's experience of pregnancy. Previous studies have found that women and their healthcare providers may have differing perceptions of their condition and how they are coping with the challenges of pregnancy.This study used questionnaires completed by women and their midwives to assess perceptions of health and emotional distress in two contexts. Sixty-eight of the women were on an antenatal unit, hospitalised for complications of their pregnancy; 33 women were a comparison group in community maternity care.Many women in the hospital experienced high levels of emotional distress and worry about their pregnancy; 45% scored in the clinical range on state anxiety, and 28% screened positive for depression. However, midwives rating emotional distress did not pick up on this consistently, and women and hospital midwives often viewed their health status differently. In the community, women's ratings of their health were more consistent with the ratings of their midwives, and midwives were attuned to acute anxiety, but had more difficulty picking up on cues to depression.It is challenging, particularly in the unfamiliar and stressful environment of the antenatal unit, for midwives to assess emotional distress and needs for health information. Deliberate screening for antenatal distress might provide the opening for midwives to empower women to identify their options, strengths, and strategies for self-care and emotional resilience.

The prevalence and adverse consequences of alcohol-impairment in drivers of motor vehicles is well documented. By comparison, driving under the influence of legal and illegal psychotropic drugs is poorly characterised in most countries. This study was conducted to investigate the prevalence of drugged driving in New Zealand, and to obtain a profile of the types of drugs most commonly taken prior to driving. A stratified sample (n=2000) of drivers (representative of the age distribution of licensed drivers) from across NZ completed a telephone survey (41% male, mean age 47.26 years). Additional participants completed the survey online (n=434; 28% male, mean age 34.54 years) Participants were asked to report their use of 17 different types of prescription and non-prescription psychoactive drugs in the previous 12 months and to indicate if they had taken them less than 3 h prior to driving. The legal drugs most commonly taken prior to driving (other than alcohol, consumed by 13% of the sample) were strong painkillers (11%), antidepressants (7%) anti-nausea medication (4%) and anti-anxiety medication (3%). Other than cannabis, taken by 4% of the sample, the prevalence of illegal drug use less than 3 h before driving was generally low (

Sensory impairment is a common aftereffect of mild traumatic brain injury (TBI); however, their influence upon treatment outcomes and quality of life has yet to be investigated. This study sought to determine the effects of noise and light sensitivity upon the quality of life of individuals diagnosed with a TBI. A cross-sectional adult sample obtained from a longitudinal study (n = 293) provided measures of light and noise sensitivity and quality of life 12 months post injury. Sensitivities were taken from the Rivermead Post-concussion Symptoms Questionnaire, while quality of life was estimated using the Short-Form 36 health survey (SF-36). Approximately 42% of participants reported ongoing difficulties with noise and light sensitivity. Additionally, those reporting sensory difficulties also reported lower SF-36 domain and composite scores compared to those reporting no such symptoms. After controlling for known co-factors, hierarchical multiple regression analyses indicated that the combination of light and noise sensitivity explained between 8 and 35% of the variance in SF-36 scores. Light and noise sensitivity appear to degrade the quality of life of those with a mild TBI. Our findings challenge contemporary rehabilitation practices that tend to sideline sensory complaints and instead focus on the remediation of acute TBI symptoms.

The idea that drivers' perceptions of risk affect their decisions and choices, particularly as regards their speed, is at the heart of many years of our education, engineering, and enforcement strategies to improve road safety. Our previous research has shown that horizontal curvature, road width, vertical curvature and separation from on-coming traffic are principal determinants to perceptions of risk on rural roads. The present study examined the relationship between drivers' perceptions of risk and the speeds they choose to drive. Participants drove high definition videos of familiar rural roads in a driving simulator and a smaller group of participants drove the same roads in a university fleet vehicle similar to the one used in the simulator. The results showed that double yellow and wide centreline markings were associated with lower speed choices and higher perceptions of risk, an effect magnified under high traffic conditions. Similarly, in both the simulator and on the roads, driving on narrow roads was associated with significantly lower speeds and increased risk ratings, while wider roads showed a small but significant increase in speeds as compared to standard width control roads. Finally, a range of other road and traffic conditions such as one-lane bridges, level crossings, police cars, and crash area warning signs were also found to be associated with lower speed choices and higher risk perceptions.

We examined the factor structure of the Rivermead Post-Concussion Symptom Questionnaire (RPQ), the most commonly used measure of post-concussive symptoms, over the first year post-injury.Factor analysis (orthogonal rotation) was used to examine the RPQ items that form coherent subsets/factors within 2-weeks, and 1, 6, and 12-months post-mTBI in 527 adults (age16 years).At baseline, three factors accounted for 63.95% of the variance; factor 1 reflected cognitive and physiological disturbances; factor 2 included items reflecting mood, sleep, and nausea/vomiting; and factor 3 included visual/auditory disturbances, dizziness, and headaches. At 1 month, three factors were again extracted (63.26% variance). Factor 1 reflected cognitive and mood symptoms, factor 2 reflected mood with headache, nausea, and dizziness; and factor 3 reflected visual disturbances. Two factors were obtained at 6 and 12 months (63.7% and 63.38% of variance): factor 1 included mood/cognitive items, restlessness, sleep disturbance, and noise sensitivity; whereas, factor 2 included physiological symptoms.The factor structure of the RPQ changes over time; however, it was relatively stable from 6 to 12-months post-injury. Subject to further evaluation, assessments conducted from 6 months could consider using these two factors as subscales. Changing the factor structure of RPQ before 6 months suggests that timing of assessment should be considered in applying these factors.

Background Mild traumatic brain injury (mTBI) is a common problem in general practice settings, yet previous research does not take into account those who do not attend hospital after injury. This is important as there is evidence that effects may be far from mild. Aim To determine whether people sustain any persistent effects 1 year after mTBI, and to identify the predictors of health outcomes. Design and setting A community-based, longitudinal population study of an mTBI incidence cohort ( n = 341) from a mixed urban and rural region (Hamilton and Waikato Districts) of the North Island of New Zealand (NZ). Method Adults (>16 years) completed assessments of cognitive functioning, global functioning, post-concussion symptoms, mood, and quality of life over the year after injury. Results Nearly half of participants (47.9%) reported experiencing four or more post-concussion symptoms 1 year post-injury. Additionally, 10.9% of participants revealed very low cognitive functioning. Levels of anxiety, depression, or reduced quality of life were comparable with the general population. Having at least one comorbidity, history of brain injury, living alone, non-white ethnic group, alcohol and medication use, and being female were significant predictors of poorer outcomes at 12 months. Conclusion Although some people make a spontaneous recovery after mTBI, nearly half continue to experience persistent symptoms linked to their injury. Monitoring of recovery from mTBI may be needed and interventions provided for those experiencing persistent difficulties. Demographic factors and medical history should be taken into account in treatment planning.

Objective to investigate predictors of anxiety for women experiencing hospitalisation during pregnancy and a comparison group of pregnant women (with or without medical complications) in the community. Design correlational, cross-sectional observational questionnaire study. Setting regional antenatal inpatient unit and community-based settings in New Zealand in 2009 and 2010. Participants 118 pregnant women in hospital and 114 pregnant women in community. Measurements and findings women in hospital and community groups completed a battery of questionnaires on pregnancy and health history, life events, anxiety, optimism, coping, and relationship factors. Midwives caring for the women provided ratings of health status and psychological distress. Both groups of women had scores on state anxiety significantly above local norms; women in the hospital were significantly higher than those in the community on state anxiety and worry about their pregnancy. The groups did not differ on factors such as life events, optimism, and coping self-efficacy. Ratings of health and distress made by women and their midwives showed poor agreement. Predictors of acute anxiety differed across the groups: for hospitalised women, anxiety was predicted by their rating of their health and their dispositional optimism; for women in the community, anxiety was predicted by stressful life events, dispositional optimism, and coping self-efficacy. Key conclusions many women hospitalised during pregnancy are extremely anxious, and those most vulnerable are those who are less optimistic and see their health as poor. Health care professionals may not be aware of how anxious women are, and women and their hospital caregivers had poor agreement on ratings of the woman׳s health status. Implications for research and practice women hospitalised during pregnancy are at risk for high levels of anxiety. Midwives are well placed to help women by recognising their distress, supporting informed optimism, and guiding women toward realistic coping strategies and using existing social support networks. Research is needed on strategies for implementation and effectiveness of brief interventions to support women to manage anxiety and stress during pregnancy both in hospital and in the community.

Individual differences with regard to speed preference may be a source of speed heterogeneity and conflicts in traffic, such as tailgating and dangerous overtaking. The main aim of the current study was to explore drivers’ speed preferences when driving for different reasons (saving money on fuel, driving safely, driving for fun or driving as usual) and the relationship of these preferences to observed speeds and self-reported speed. 193 drivers were interviewed at five different locations, and were asked about their speeds on roads they had just travelled. Drivers’ speeds on these roads were also sampled with a speed gun. The results showed large differences between speeds chosen for different driving purposes; the lowest speeds were chosen when the goal was economy and the highest when driving for fun. In addition, there were individual differences in speed preferences such that some drivers indicated that their usual speed was above what they believed was a safe speed while others indicated that they usually drove even slower than what they thought was safe. These differences may account for much of the speed heterogeneity observed in on-road behaviour. The results also showed that drivers’ speed choices are highly influenced by their usual speeds, even more so than their beliefs regarding what constitutes a safe speed, which may help explain non-compliance with speed limits. No relationship was found between speed choice and risk perception.

Objective: The study aimed to estimate the incidence, prevalence and disability-adjusted life years (DALY) for traumatic brain injury (TBI) in New Zealand (NZ) in 2010. Methods: A multi-state life table model was constructed using inputs from the Brain Injury Outcomes New Zealand in the Community study for the first-ever incidence of TBI in a lifetime and its severity distribution, from the NZ Ministry of Health's Mortality Collection for the data on TBI mortality and from Statistics of NZ for the population data. The modeled estimate of prevalence was combined with the disability weights for TBI (by stage and severity level) from the Global Burden of Disease 2010 study to obtain estimates of health loss (DALYs) for TBI. Results: Approximately, 11,300 first-ever incident TBIs occurred in NZ during 2010, with 527,000 New Zealanders estimated to have ever experienced a TBI (prevalent cases). The estimated 20,300 DALYs attributable to TBI accounted for 27% of total injury-related health loss and 2.4% of DALYs from all causes. Of the total DALYs attributable to TBI, 71% resulted from fatal injuries. However, non-fatal outcomes accounted for a substantial share of the burden (29%) with mild TBI making the greater contribution of non-fatal outcomes (56%). Conclusions: The burden of TBI in NZ is substantial, and mild TBI contributes to a major part of non-fatal outcomes.

The potential for using road markings to indicate speed limits was investigated in a driving simulator over the course of two sessions. Two types of experimental road markings, an “Attentional” set designed to provide visually distinct cues to indicate speed limits of 60, 80 and 100 km/h, and a “Perceptual” set designed to also affect drivers’ perception of speed, were compared to a standard undifferentiated set of markings. Participants (n = 20 per group) were assigned to one of four experimental groups (Attentional-Explicit, Attentional-Implicit, Perceptual-Explicit, Perceptual-Implicit) or a Control group (n = 22; standard road markings). The Explicit groups were instructed about the meaning of the road markings while those in the Implicit and Control groups did not receive any explanation. Participants drove five 10 km simulated roads containing three speed zones (60, 80 and 100 km/h) during the first session. The participants returned to the laboratory approximately 3 days later to drive five more trials including roads they had not seen before, a trial that included a secondary task, and a trial where speed signs were removed and only markings were present. The findings indicated that both types of road markings improved drivers’ compliance with speed limits compared to the control group, but that explicit instruction as to the meaning of the markings was needed to realise their full benefit. Although previous research has indicated the benefit of road markings used as warnings to indicate speed reductions in advance of horizontal or vertical curves, the findings of the present experiment also suggest that systematically associating road markings with specific speed limits may be a useful way to improve speed limit compliance and increase speed homogeneity.

OBJECTIVE: To explore what helps and hinders recovery and adaptation after disabling traumatic brain injury (TBI) and make recommendations for improving service responsiveness. DESIGN: A longitudinal qualitative descriptive study across all TBI severities. SETTING: Community. PARTICIPANTS: Forty people with TBI, and 22 significant others, 6 to 9 months following a TBI. MAIN MEASURES: Semistructured interviews, analyzed using qualitative description, focused on (a) key areas of importance or concern and (b) strategies or actions that people found helpful or that hindered recovery. RESULTS: Traumatic brain injury produced a complex set of challenges in keeping up with life, and understanding what having a TBI means for, and to, me. This period encompassed a tangled fit and misfit in life as brain injury did not occur in isolation. People had to actively change some aspects of life and yet allow other changes to happen. Valued supports from others included being looked out for and having someone to help drive the process. CONCLUSION: Improved services delivery and better outcomes may result if we respond to the person within his or her context; listen, believe, and acknowledge the person's story through our actions; and avoid assumptions about aspects of life that mean most to people and who/what may help best. Language: en

The subjective categories that drivers use to distinguish between different road types have been shown to influence the speeds they choose to drive but as yet we do not understand the road features that drivers use to make their discriminations. To better understand how drivers describe and categorise the roads they drive, 55 participants were recruited to drive a video of familiar urban roads in a driving simulator at the speed they would drive these roads in their own cars (using the accelerator and brake pedal in the driving simulator to adjust their speed). The participants were then asked to sort photos of the roads they had just driven into piles so that their driving would be the same on all roads in one pile but different to the other piles. Finally, they answered a series of questions about each road to indicate what speed they would drive, the safe speed for the road, their speed limit belief as well as providing ratings of comfort, difficulty and familiarity. Overall, drivers' categorisation of roads was informed by a number of factors including speed limit belief, road features and markings (including medians), road width, and presence of houses, driveways and footpaths. The participants' categories were congruent with what they thought the speed limits were, but not necessarily the actual speed limits. Mismatches between actual speed limits and speed limit beliefs appeared to result from category-level expectations about speed limits that took precedence over recent experience in the simulator. Roads that historically had a 50km/h speed limit but had been reduced to 40km/h were still regarded as 50km/h roads by the participants, underscoring the point that simply posting a sign with a lower speed limit is not enough to overcome drivers' expectations and habits associated with the visual appearance of a road. The findings provided insights into how drivers view and categorise roads, and identify specific areas that could be used to improve speed limit credibility.

It has long been presumed that drivers’ perceptions of risk play an important role in guiding on-road behaviour. The answer to how accurately drivers perceive the momentary risk of a driving situation, however, is unknown. This research compared drivers’ perceptions of the momentary risk for a range of roads to the objective risk associated with those roads. Videos of rural roads, filmed from the drivers’ perspective, were presented to 69 participants seated in a driving simulator while they indicated the momentary levels of risk they were experiencing by moving a risk meter mounted on the steering wheel. Estimates of the objective levels of risk for the roads were calculated using road protection scores from the KiwiRAP database (part of the International Road Assessment Programme). Subsequently, the participants also provided risk estimates for still photos taken from the videos. Another group of 10 participants viewed the videos and photos while their eye movements and fixations were recorded. In a third experiment, 14 participants drove a subset of the roads in a car while providing risk ratings at selected points of interest. Results showed a high degree of consistency across the different methods. Certain road situations were rated as being riskier than the objective risk, and perhaps more importantly, the risk of other situations was significantly under-rated. Horizontal curves and narrow lanes were associated with over-rated risk estimates, while intersections and roadside hazards such as narrow road shoulders, power poles and ditches were significantly under-rated. Analysis of eye movements indicated that drivers did not fixate these features and that the spread of fixations, pupil size and eye blinks were significantly correlated with the risk ratings. An analysis of the road design elements at 77 locations in the video revealed five road characteristics that predicted nearly 80% of the variance in drivers’ risk perceptions; horizontal curvature, lane and shoulder width, gradient, and the presence of median barriers.

Rationale Recurrent stroke is prevalent in both developed and developing countries, contributing significantly to disability and death. Recurrent stroke rates can be reduced by adequate risk factor management. However, adherence to prescribed medications and lifestyle changes recommended by physicians at discharge after stroke is poor, leading to a large number of preventable recurrent strokes. Using behavior change methods such as Motivational Interviewing early after stroke occurrence has the potential to prevent recurrent stroke. Aims and/or hypothesis The overall aim of the study is to determine the effectiveness of motivational interviewing in improving adherence to medication and lifestyle changes recommended by treating physicians at and after hospital discharge in stroke patients 12 months poststroke to reduce risk factors for recurrent stroke. Design Recruitment of 430 first-ever stroke participants will occur in the Auckland and Waikato regions. Randomization will be to intervention or usual care groups. Participants randomized to intervention will receive four motivational interviews and five follow-up assessments over 12 months. Nonintervention participants will be assessed at the same time points. Study outcomes Primary outcome measures are changes in systolic blood pressure and low-density lipoprotein levels 12 months poststroke. Secondary outcomes include self-reported adherence and barriers to prescribed medications, new cardiovascular events (including stroke), changes in quality of life, and mood. Discussion The results of the motivational interviewing in stroke trial will add to our understanding of whether motivational interviewing may be potentially beneficial in the management of stroke and other diseases where similar lifestyle factors or medication adherence are relevant.

BackgroundStroke is a leading cause of death and disability worldwide. Stroke burden is immense as it leads to premature deaths, leaves survivors with ongoing disabilities, and has a major financial impact on the individual, their families, and the community. Reliable, high-quality evidence is needed on stroke risk factors, incidence, and outcomes to provide information on how best to reduce this burden. Population-based studies are regarded as the ‘gold-standard’ of measuring disease burden but are not common due to the logistical and financial challenges they present. The Auckland Regional Community Stroke Studies are among a few in the world that have been carried out at a population level and at regular intervals.AimThe aim of the fourth Auckland Regional Community Stroke Studies IV is to examine the current measures of stroke incidence, prevalence, and outcomes as well the trends over four decades. This article describes the methodology of the Auckland Regional Community Stroke Studies IV with stroke and transient ischemic attacks cases registered over a 12-month period from March 1, 2011 to February 29, 2012.ConclusionsThe methodology described may be used as a guide in order to design similar population-based stroke incidence and outcome studies in other countries and populations, thus facilitating the collection of most consistent and accurate stroke epidemiological data.

This paper describes our research into the processes that govern driver attention and behavior in familiar, well-practiced situations. The experiment examined the effects of extended practice on inattention blindness and detection of changes to the driving environment in a high-fidelity driving simulator. Participants were paid to drive a simulated road regularly over 3 months of testing. A range of measures, including detection task performance and driving performance, were collected over the course of 20 sessions. Performance from a yoked Control Group who experienced the same road scenarios in a single session was also measured. The data showed changes in what drivers reported noticing indicative of inattention blindness, and declining ratings of mental demand suggesting that many participants were “driving without awareness”. Extended practice also resulted in increased sensitivity for detecting changes to road features associated with vehicle guidance and improved performance on an embedded vehicle detection task (detection of a specific vehicle type). The data provide new light on a “tandem model” of driver behavior that includes both explicit and implicit processes involved in driving performance. The findings also suggest reasons drivers are most likely to crash at locations very near their homes.

Objectives To explore the experience of fatigue and sleep difficulties over the first 2 years after traumatic brain injury (TBI). Design Longitudinal qualitative descriptive analysis of interviews completed as part of a larger longitudinal study of recovery following TBI. Data relating to the experience of fatigue and/or sleep were extracted and coded by two independent researchers. Setting Community-based study in the Hamilton and Auckland regions of New Zealand. Participants 30 adult participants who had experienced mild, moderate or severe brain injury within the past 6 months (>16 years of age). 15 participants also nominated significant others to take part. Interviews were completed at 6, 12 and 24 months postinjury. Results Participants described feeling unprepared for the intensity, impact and persistent nature of fatigue and sleep difficulties after injury. They struggled to learn how to manage their difficulties by themselves and to adapt strategies in response to changing circumstances over time. Four themes were identified: (1) Making sense of fatigue and sleep after TBI; (2) accepting the need for rest; (3) learning how to rest and; (4) need for rest impacts on ability to engage in life. Conclusions Targeted support to understand, accept and manage the sleep and fatigue difficulties experienced may be crucial to improve recovery and facilitate engagement in everyday life. Advice needs to be timely and revised for relevance over the course of recovery.

Background and Purpose— Although the neuropsychological literature typically examines stroke outcomes by hemisphere of lesion, the medical literature provides classifications more closely linked to circulatory distribution impacted by stroke. This article examined profiles of cognitive function by hemisphere and by Oxfordshire Community Stroke Project stroke classification. Methods— This study included a sample of 315 5-year ischemic stroke survivors. Assessment included tests of verbal memory, visual memory, word finding/verbal fluency, abstract visual reasoning, executive functioning, and speed of processing. Results— The sample produced scores within 1 standard deviation of the normative mean on tests of abstract visual reasoning, verbal memory, and visual recall. Impaired performances were observed for executive function and processing speed. Profile analysis revealed no significant differences in overall cognitive performance or in the profile of performance across measures by hemisphere of lesion. However, groups defined by Oxfordshire Community Stroke Project categories produced significantly different cognitive profiles. Post hoc analyses indicate those with posterior stroke performed best overall on all tests except the Stroop Dots trial, whereas those with total anterior stroke produced significantly worse scores on tasks requiring visual abstract reasoning (Block Design, Rey Figure Copy), word finding (Boston Naming Test), and processing speed (Stroop Dots, Trails A). Conclusions— Oxfordshire Community Stroke Project stroke subtypes identified significant differences between groups, suggesting this classification system is of greater use than hemisphere of lesion in predicting poststroke cognitive outcomes.

This research examined the development of proceduralised "driving without awareness" in a driving simulator by paying participants to drive a simulated road regularly over 12 weeks of testing. This longitudinal research paradigm is a significant departure from previous studies which have examined drivers in a conscious attentional mode using short experimental sessions or cross-sectional designs comparing expert and novice performance. During each session, participants took two "trips" on the simulated road; sometimes travelling on a "to and from" journey on one half of the road, sometimes traversing the entire road in one direction. A range of measures, including driving performance, vehicle detection, perceptual speed regulation, and hazard reactions were collected. The results showed the development of driving patterns and changes in object detection performance indicative of proceduralised driving. Speed and lane position variability quickly decreased with practice, as did participants' subjective experiences of driving difficulty. Performance on an embedded detection task appeared to become a proceduralised part of the driving task, becoming highly efficient in later stages of the experiment. The changes in attentional focus and driving performance over time provide new light on previous research findings and allow us to critically re-examine several established models of driver behaviour.

Background and Purpose— Stroke recurrence rates are high (20%–25%) and have not declined over past 3 decades. This study tested effectiveness of motivational interviewing (MI) for reducing stroke recurrence, measured by improving adherence to recommended medication and lifestyle changes compared with usual care. Methods— Single-blind, prospective phase III randomized controlled trial of 386 people with stroke assigned to either MI treatment (4 sessions at 28 days, 3, 6, and 9 months post stroke) or usual care; with outcomes assessed at 28 days, 3, 6, 9, and 12 months post stroke. Primary outcomes were change in systolic blood pressure and low-density lipoprotein cholesterol levels as indicators of adherence at 12 months. Secondary outcomes included self-reported adherence, new stroke, or coronary heart disease events (both fatal and nonfatal); quality of life (Short Form-36); and mood (Hospital Anxiety and Depression Scale). Results— MI did not significantly change measures of blood pressure (mean difference in change, −0.2.35 [95% confidence interval, −6.16 to 1.47]) or cholesterol (mean difference in change, −0.0.12 [95% confidence interval, −0.30 to 0.06]). However, it had positive effects on self-reported medication adherence at 6 months (1.979; 95% confidence interval, 0.98–3.98; P =0.0557) and 9 months (4.295; 95% confidence interval, 1.56–11.84; P =0.0049) post stroke. Improvement across other measures was also observed, but the differences between MI and usual care groups were not statistically significant. Conclusions— MI improved self-reported medication adherence. All other effects were nonsignificant, though in the direction of a treatment effect. Further study is required to determine whether MI leads to improvement in other important areas of functioning (eg, caregiver burden). Clinical Trial Registration— URL: http://www.anzctr.org.au . Unique identifier: ACTRN-12610000715077.

Objective SmartQuit® is a smartphone application (app) for smoking cessation based on Acceptance and Commitment Therapy, a behavioural therapy that encourages individuals to accept internal experiences, such as cravings to smoke, without acting on those experiences or urges. We used a single-subject (A-B-A) design with 10 participants to examine whether SmartQuit® use would reduce cigarette intake in a New Zealand sample. Methods 10 smokers tallied their own cravings experienced and cigarettes smoked then sent those tallies to the first author every day until we observed stable patterns (Phase A1). We then gave the participants individual access to the SmartQuit® app (Phase B). When they advised that they had ceased using the app, they again recorded daily cravings and cigarettes smoked for a minimum of three days (Phase A2). We also collected follow-up smoking and craving data at 1, 2 and up to 13 months after completion of Phase A2. Results Using SmartQuit® reduced our participants’ daily cigarette intake significantly in the short-term and three individuals remained smoke-free up to 13 months later. Cravings to smoke did not differ significantly across Phases A1, B and A2, but graphical analysis showed a trend for decreasing cravings. Conclusion Our results suggest that SmartQuit® provides another readily accessible intervention to help people stop smoking and is suited for use with a New Zealand population.

Summary Background Traumatic brain injury (TBI) is the leading cause of long-term disability in children and young adults worldwide. However, accurate information about its incidence does not exist. We aimed to estimate the burden of TBI in rural and urban populations in New Zealand across all ages and TBI severities. Methods We did a population-based incidence study in an urban (Hamilton) and rural (Waikato District) population in New Zealand. We registered all cases of TBI (admitted to hospital or not, fatal or non-fatal) that occurred in the population between March 1, 2010, and Feb 28, 2011, using multiple overlapping sources of information. We calculated incidence per 100 000 person-years with 95% CIs using a Poisson distribution. We calculated rate ratios [RRs] to compare the age-standardised rates between sex, ethnicity, and residency (urban, rural) groups. We used direct standardisation to age-standardise the rates to the world population. Results The total incidence of TBI per 100 000 person-years was 790 cases (95% CI 749–832); incidence per 100 000 person-years of mild TBI was 749 cases (709–790) and of moderate to severe TBI was 41 cases (31–51). Children (aged 0–14 years) and adolescents and young adults (aged 15–34 years) constituted almost 70% of all TBI cases. TBI affected boys and men more than women and girls (RR 1·77, 95% CI 1·58–1·97). Most TBI cases were due to falls (38% [516 of 1369]), mechanical forces (21% [288 of 1369]), transport accidents (20% [277 of 1369]), and assaults (17% [228 of 1369]). Compared with people of European origin, Maori people had a greater risk of mild TBI (RR 1·23, 95% CI 1·08–1·39). Incidence of moderate to severe TBI in the rural population (73 per 100 000 person-years [95% CI 50–107) was almost 2·5 times greater than in the urban population (31 per 100 000 person-years [23–42]). Interpretation Our findings suggest that the incidence of TBI, especially mild TBI, in New Zealand is far greater than would be estimated from the findings of previous studies done in other high-income countries. Our age-specific and residency-specific data for TBI incidence overall and by mechanism of injury should be considered when planning prevention and TBI care services. Funding Health Research Council of New Zealand.

The aim of the current study was to compare the effects of training in higher-order driving skills (e.g., perceptual, motivational, insight) and vehicle handling skill training in relation to on-road driving performance, hazard perception, attitudes to risky driving and driver confidence levels in young, inexperienced drivers. Thirty-six young drivers (23 males and 13 females, average age 16.3 years), mostly on a restricted NZ driver licence, participated in a Driver Training Research camp. Participants were randomly allocated to one of three equally sized groups according to the type of driving skill training (5 days) they received: higher-order, vehicle handling or control (no training). Professional driver assessors conducted a comprehensive driving assessment before (Baseline) and after the training (Post Training). At both time points, participants also carried out a computerised hazard perception task, and completed self-report questionnaires to assess attitudes to risky driving and driver confidence. In terms of on road driving, the participants who received higher-order driving skill training showed a statistically significant improvement in relation to visual search and the composite driving measure. This was accompanied by an improvement in hazard perception, safer attitudes to close following and to dangerous overtaking and a decrease in driving related confidence. The participants who received vehicle handling skill training showed significant improvements in relation to their on-road direction control, speed choice and the composite driving score. However, this group showed no improvement in hazard perception, attitudes to risky driving or driver confidence. The findings will be discussed in the context of driver training as a viable crash prevention intervention in regard to young, inexperienced drivers.

Acquired brain injury, including both Ischaemic stroke (IS) and Traumatic Brain injury (TBI), is one of the most common causes of disability and death in adults. Yet there are vast differences in our knowledge of their epidemiology. While the incidence, case-fatality and risk factors for stroke are well established, work needs to continue particularly in low-income countries, where these data remain sparse; and in relation to specific stroke subtypes such as IS. Similar data regarding the epidemiology of TBI are generally lacking. The majority of TBI incidence studies have focussed on hospital-based samples and there are no established criteria from which to design high quality epidemiological studies. The need to establish such criteria separate from those already available for stroke is suggested given the differing demographic profile of TBI as well as differences in seeking of medical attention for TBI. The immense burden of stroke can be reduced by prevention of modifiable risk factors particularly in developing countries where both changing lifestyle and lack of healthcare resources are contributing to rising stroke incidence and mortality. Similarly, studies to date indicate that TBI incidence can be reduced by addressing modifiable risk factors such as alcohol abuse, risk-taking behaviour and socioeconomic disparities.

To evaluate the effectiveness of an Acceptance Commitment Therapy based self-help book for people with chronic pain.This was a randomized 2 group study design. Over a 6-week period, 6 participants read the self-help book and completed exercises from it with weekly telephone support whereas 8 others formed a wait-list control group. Subsequently, 5 of the wait-list participants completed the intervention. Participants completed preintervention and postintervention questionnaires for acceptance, values illness, quality of life, satisfaction with life, depression, anxiety, and pain. Initial outcome data were collected for 8 control participants and 6 intervention participants. Including the wait-list controls, a total of 11 participants completed preintervention and postintervention measures. Whilst completing the self-help intervention, each week participants' rated the content of the book according to reading level and usefulness, and their comprehension of the content was also assessed.Compared with controls, participants who completed the book showed improved quality of life and decreased anxiety. When data from all the treatment participants were pooled, those who completed the intervention showed statistically significant improvements (with large effect sizes) for acceptance, quality of life, satisfaction with life, and values illness. Medium effect sizes were found for improvements in pain ratings.These findings support the hypothesis that using the self-help book, with minimal therapist contact adds value to the lives of people who experience chronic pain.

This study used a video-based hazard perception dual task to compare the hazard perception skills of young drivers with middle aged, more experienced drivers and to determine if these skills can be improved with video-based road commentary training. The primary task required the participants to detect and verbally identify immediate hazard on video-based traffic scenarios while concurrently performing a secondary tracking task, simulating the steering of real driving. The results showed that the young drivers perceived fewer immediate hazards (mean = 75.2%, n = 24, 19 females) than the more experienced drivers (mean = 87.5%, n = 8, all females), and had longer hazard perception times, but performed better in the secondary tracking task. After the road commentary training, the mean percentage of hazards detected and identified by the young drivers improved to the level of the experienced drivers and was significantly higher than that of an age and driving experience matched control group. The results will be discussed in the context of psychological theories of hazard perception and in relation to road commentary as an evidence-based training intervention that seems to improve many aspects of unsafe driving behaviour in young drivers.

Lavender is a popular treatment for stress and mild anxiety in Europe and the USA. The present study investigated the effects of (Lavandula angustifolia Mill. (Lamiaceae)) lavender odour inhalation over 2 weeks or 24 h periods, on gerbil behaviour in the elevated plus maze in mature male and female gerbils, and compared results with the effects of diazepam (1 mg/kg) i.p. after 30 min and 2-week administration. Traditional measures of open entries showed an increasing trend over the 2 weeks exposure, whereas ethological measures indicative of anxiety; stretch-attend frequency and percentage protected head-dips, were significantly lower. Exploratory behaviour, total head-dip frequency, increased after 24 h lavender and 2 weeks exposure. These results are comparable with diazepam administration. There were sex differences in protected head-dip an ethological indicator of anxiety: females showed a significant decrease in protected head-dips compared to both males and to female controls. In conclusion exposure to lavender odour may have an anxiolytic profile in gerbils similar to that of the anxiolytic diazepam. In addition, prolonged, 2-week lavender odour exposure increased exploratory behaviour in females indicating a further decrease in anxiety in this sex.