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Animals in captivity can develop physiological characteristics such as obesity that could negatively affect their health. In the captive brushtail possum (Trichosurus vulpecula), it is unknown what effect long-term free-feeding has on body weight. In this study, which took place over 12 months, three possums were fed according to a free-feeding regime. Food intake was measured daily, and the possums were weighed every four days. The possums all gained weight but showed bouts of stable body weights across the year. Stability was evaluated using mathematical models. It was concluded that long-term free-feeding is not recommended for animals-in-waiting for use in operant experiments to mitigate weight gain due to overeating.

This study aimed to explore, describe, and interpret New Zealand probation officers’ insights into supervisees’ non-compliance with community sentences. Seventeen probation officers participated in two focus groups. Probation officers viewed problems with cognitive skills as a key barrier to sentence compliance. They reported that these problems underpinned other factors linked to compliance, such as meeting basic needs and skill acquisition. Probation officers employed a number of social worker oriented evidenced-based strategies, including building high-quality relationships and being flexible, along with modification of sentence requirements to increase supervisee compliance, especially with supervisees who faced considerable obstacles when engaging with a community sentence.

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.

Executive function encompasses multiple processes (e.g. regulating emotions, managing behaviours, problem-solving) essential in daily living. A growing body of neuropsychological research shows a relationship between executive dysfunction and criminal behaviour. However, is executive functioning relevant to sentence management? We examined relationships between self-reported executive functioning and community supervision sentence compliance. Sixty-four individuals serving community-based supervision sentences completed the Behavior Rating Inventory of Executive Function–Adult Version, and their compliance data for six months were collected from probation officer notes. The sample’s mean scores were significantly higher (i.e. poorer executive functioning) than those for the normative sample. Those who complied with sentence conditions had higher mean scores than those who were non-compliant. Subsequent exploratory analyses showed that those with poorer executive functioning received more probation officer support to comply with sentence conditions. Attention to responsivity issues like executive function problems may help avoid entrapping people in the criminal justice system.

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.

This study was an investigation into mind wandering during everyday driving, and its association with crash patterns. We selected a 25 km route on urban roads for analysis of crashes, and an on-road study of mind wandering by a sample of drivers familiar with the route. We analysed reported crashes on the route over a five year period from New Zealand's crash database. For the on-road study a researcher accompanied 25 drivers on the route, asking them what they were thinking about at 15 predetermined road sections. The road sections were selected to include a range of different speed limits and traffic volumes as well as roundabouts, priority intersections and midblocks. Thought samples were categorised as either mind wandering or driving focus, and triggered by the senses, or internally. The frequencies of mind wandering at different road sections on the route were compared to the frequencies of reported crashes along the same route over the preceding five years. Results showed that although all drivers reported mind wandering, it was more likely to be reported at slower, quieter, less complex road sections. Overall, more crashes were reported at priority intersections and midblocks than at roundabouts, but the crash rate (per road section) was higher at roundabouts, where mind wandering was least likely to be reported. These findings suggest that although drivers' minds wander constantly, driving focus is commanded in demanding situations and in response to the actions of other road users. While mind wandering is ubiquitous, drivers are least likely to report mind wandering at locations showing the highest crash rates. More work is needed to test these findings and to provide direction for road safety interventions.

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...

In recent years the number of cars on the road with manufacturer installed in-vehicle information systems (IVIS) has increased dramatically, and with smartphones connecting directly to these systems drivers can access a wide range of applications on the move. Some IVIS features are designed to improve safety (e.g., speed and collision warnings) but access via an IVIS to all apps on a smartphone has the potential to distract drivers and increase crash risk. We undertook this study to find out what IVIS features and apps drivers use and to ask about their effects on driving. An online survey completed by 1017 drivers (50% female, 16- 85 years) revealed the most common activity drivers engaged in was listening to music, followed by listening to directions. Fewer than half of the drivers reported conversing on a hands-free phone and 25% reported texting/sending emails or using social media. Frequency of engagement in secondary tasks decreased with age. Using hand-held mobiles was rated as having the greatest negative impact on driving, with drivers attempting to mitigate the risk by carrying out the activity in slow moving traffic or at traffic lights. Females rated the risk of most of the secondary tasks as greater than males. Almost half of the sample had access to speed warnings systems but only a small proportion had experience of lane departure, dangerous curve or intersection warning systems. Of those with access to driver safety systems, 50-70% never used them despite rating the system as useful and as having safety benefits. As the number of vehicles with manufacturer installed IVIS continues to increase on the road, drivers’ engagement with them while driving is also likely to increase. To address this, there is a need for a multi-agency approach to educate drivers on the safe use of these systems and apps in their vehicles. Incentives for drivers to use the safety-related features may also be worth considering.

Aim The study investigated how a speed warning system influence drivers’ speedometer monitoring, and how drivers respond when they receive a speed warning. With a speed warning system, drivers may pay more attention to the exact speed, which would be expected to increase glances to the speedometer. Methods Nineteen participants drove in a driving simulator, either with or without a speed warning system implemented on a smartphone, which alerted them if they exceeded the set speed limit. Their glances to the speedometer and speed warning system’s display were recorded with an eye tracker. Results Drivers sped less with the warning system. The system did not significantly change the speedometer monitoring. Speeding was preceded by fewer speedometer glances, indicating the speeding was linked to participants’ momentary inattention to their speed control. After a warning, the frequency of speedometer glances increased. Interestingly, drivers often started to glance at the speedometer and release the accelerator a couple of seconds before a warning, suggesting that drivers learn to anticipate warnings. The results suggest that drivers do not only react to warnings, but they also actively try to avoid them. Understanding drivers’ speed control with speed warning system may help to create adaptive ISA systems.

The distractive effects of mobile phones are well documented, but the recent development of mobile phone apps that provide speed advisory warnings raises the possibility that this technology may be used to improve driver safety in older vehicles. We examined the effects of an intelligent speed advisory (ISA) app on driving performance in a simulator. One hundred and four participants (mean age = 35.52 years; 52 male) were allocated to complete the drive with the ISA app in one of five modes: active audio visual (n = 22), active visual (n = 22), passive audio visual (n = 21), passive visual (n = 21) or control (n = 18). Another 19 participants (mean age = 27.53 years; 8 male) completed the study wearing eye-tracking glasses. Participants drove a simulated 26.4 km section of rural road which incorporated typical hazards and three speed compliance zones (100 km/h, 80 km/h and 60 km/h speed limits). The app led to good compliance with the posted speed limits, particularly during the 60 km/h road segment, where the control group drove at significantly higher speeds than the groups with the ISA app. No significant differences between the four versions of the ISA app were observed, either for speed compliance or the number of speeding alerts received. Across the entire simulated drive there were relatively few glances at the app with an average glance duration of 190 ms. The ISA app did not lead to any negative effects on driving performance; lane keeping was maintained and it did not impede participants’ ability to overtake vehicles. These findings suggest that when properly configured ISA apps have a demonstrable safety benefit and do not produce adverse distractive effects. The greatest challenge may be encouraging drivers’ to use them appropriately and consistently.

As drivers move through the road transport system they are exposed to a range of different situations and road conditions in a relatively short space of time. Drivers' expectations about what will happen on different types of roads have strong effects on their speed choices, and where they look and what they attend to. As a result it is important to assist drivers to change their expectations when they transition from one road type to another. In this experiment we investigated the effectiveness of different centreline road markings in preparing for a horizontal curve as drivers moved from a motorway to a two-lane rural country road. Fifty individuals were recruited to participate in a video-based simulated driving task to compare three centreline marking types in terms of their effects on speed choice and reactions to a driving hazard (horizontal curve). Although a complex marking previously associated with high risk produced the largest speed reductions during the transition from the motorway, it was the centreline more traditionally associated with rural country roads (dashed white centreline) that was associated with the best hazard reactions post-transition (brake reaction time and speed reduction before a horizontal curve). The findings demonstrated that the look of a road needs to convey a clear and unambiguous message to drivers. The transition to a two-star rural road is best achieved by making the road look like a typical two-star road as soon as possible.

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.

Traumatic Brain Injury (TBI) is a major cause of disability in young people in New Zealand, and has long-term effects on memory and other cognitive functions. This article introduces MyMemory, a mobile augmented memory system that aims to assist TBI survivors in coping with their memory impairments. We here present an exploration of design requirements for mobile memory aids for people with TBI, the MyMemory conceptual design and high-level details of the prototype implementation. We report on the results of our A-B-A-B study with six TBI survivors and three caregivers. The participants with TBI all reported improvements when using MyMemory with regards to their well-being, memory function and autobiographical memory. The caregivers confirmed these observations of TBI participants, however, the results regarding possible reductions of caregiver burden are mixed.

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.

As drivers, we often have the sense that we can recall very little about our everyday trips, particularly on familiar roads when nothing untoward occurs. The failure to recall incidental events from a routine drive is not surprising if these drives are performed at a fairly automatic or preconscious level of engagement. Some researchers have suggested that danger, difficulty, and consequentiality are what make events and actions memorable for drivers. To investigate what drivers remember from a routine trip, we asked participants (n = 75) to drive familiar local roads on a 15 km urban route either on-road in an instrumented car, or in the University of Waikato driving simulator (with and without a passenger). At ten predetermined locations on the drive participants were asked to provide ratings of perceived risk, difficulty and anxiety. At the end of the drive, participants were asked a free recall question about what they remembered from the drive, followed by cued recall questions about six of the locations from the drive prompted by photographs. In general, participants recalled very similar things from the drive, notably what they saw as the poor behaviour of other drivers. The participants’ recall accuracy was rather poor, with memory for whether they had stopped at a particular location having the highest accuracy. Memory of whether there were vehicles ahead and whether they had stopped had a high number of recall false alarms, adding to the suggestion that participants remembered the locations and what usually happens there rather than detailed recollections of a particular occasion. There were no observed relationships between recall accuracy and perceptions of driving risk, difficulty, or anxiety. The results indicated that memories of everyday driving are combinations of examples of bad behaviour of other road users and our recollections of what typically happens at familiar locations.

The aim of this study was to explore how frequently drivers report mind wandering during their daily commute, and to learn more about how conscious and unconscious processes combine during everyday driving. We recorded 587 thought samples across 110 drives by eleven female participants aged between 28 and 48 years who regularly drive between home and work. Using a probe-catch descriptive experience sampling procedure, thought samples were captured and categorised according to whether they were driving-related or not, and according to their trigger (sensory vs internal). We found that drivers on the daily commute reported mind wandering on 63% of reports, and were actively focused on the driving task for between 15% and 20% of samples. For the remaining one fifth of thought samples, drivers were not actively thinking about anything in particular. Over half of drivers’ mind wandering reports were related to things they saw or heard, suggesting that although they are not directly focused on driving all of the time, they frequently and habitually scan the road and roadside environment. When momentary driving task demands do not command attention, drivers’ minds wander towards personal current concerns. Mind wandering is often triggered by what drivers see or hear. These findings suggest that in familiar, undemanding situations, drivers are more likely to be found mind wandering than focusing on driving, however mind wandering is swiftly interrupted when driving task demands command effortful attention. The results have implications for research into mind wandering, implying that a baseline of sustained task focus is not the norm when driving the daily commute. Researchers and policy-makers ought to consider how to design road and traffic systems that align with drivers’ unconscious expectations.

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.

Crashes are over-represented on roads close to home, but it is not clear why. We sought to address this gap by exploring the characteristics of close to home crashes. We used twelve months of crash data that included driver home address, and travel survey data captured over the same period to group crashes based on equivalent amounts of travel at different distances from home, controlling for exposure. We compared crashes on high-speed (rural) and low-speed (urban) roads; crashes caused by different types of error (lapse and violation); and crashes at major intersections (roundabouts and traffic signals), minor intersections (priority intersections and driveways), and midblocks; to find out which road type, error type, and locations were most common in crashes on roads close to home. Findings revealed that crashes over-represented close to home were on low-speed (urban) roads; were more likely to involve lapses of attention than violations; and that crashes related to lapses of attention on low-speed roads were more common at minor intersections and mid-blocks than at major intersections. Although drivers may be most likely to consider busy intersections risky and worthy of effortful focus, these results show that seemingly safe, slow streets and minor intersections account for a surprisingly high proportion of crashes overall, particularly on familiar urban roads close to home. The interplay of drivers’ attentional regulation with momentary driving demands, and risk is complex and worthy of continued investigation.

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.

The focus of the research was to investigate drivers' expectations and mental representations of familiar rural roads. Participants first completed a picture sort task for 34 rural road scenes from the local area and then rated the roads individually in terms of their comfort, driving difficulty, monotony, the speed they would choose, and how safe they would feel while driving. The similarity judgements from the picture sorting task were analysed with multi-dimensional scaling and hierarchical cluster analyses to reveal six non-overlapping road categories with very good agreement across participants. These categories correctly predicted significant differences in the participants' explicit judgements about speed, difficulty, physical comfort, and safety of the individual roads. We believe that these findings can be taken as supporting evidence that these drivers' had formed underlying mental representations or schemata for these familiar roads based on the type of driving required for each.

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.

This two-phase study investigated New Zealand primary school teachers’ knowledge and perceptions of childhood mild Traumatic Brain Injury (mTBI), and evaluated the effectiveness of a professional development workshop for enhancing teacher knowledge regarding mTBI. In phase one, 19 teachers from schools in the Waikato and Bay of Plenty engaged in interviews regarding their understanding of mTBI and their experiences of learning and professional development in regards to this topic. In phase two, 38 teachers across three schools participated in and evaluated a workshop that focused on increasing knowledge of possible mTBI effects and intervention strategies. The results of phase one found that teachers had a limited understanding of mTBI, its implications in childhood and how to manage its effects at school. Few had engaged in formal learning opportunities related to childhood TBI. In phase two, the brief professional development workshop resulted in a significant increase in TBI knowledge, with teachers identifying the need for practice adaptation. The findings enrich what is known regarding New Zealand teachers’ knowledge of mTBI and demonstrates the potential usefulness of brief professional development approaches to inform classroom practice and enhance functional outcomes for children who have experienced mTBI.

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.

Objective To assess longer-term social cognition after mild traumatic brain injury (mTBI) and to identify the sociodemographic and acute factors (mood, cognitive functioning, and symptoms) influencing social cognition. Method Data were extracted for 121 adults who experienced a mTBI and completed the Emotion Evaluation and Social Inference Enriched tests of The Awareness of Social Inference Test (TASIT) 4 years postinjury. To identify early indicators of outcome, responses to the Hospital Anxiety and Depression Scale, Rivermead Post-Concussion Symptom Questionnaire, and CNS Vital Signs neurocognitive assessment conducted 1 month postinjury were also extracted. Social cognition scores were compared to age-matched TASIT norms (N = 121). Results The mTBI group was significantly less able to interpret what people say and intend than norms, although the effect sizes were small (d = 0.43). There were 24.8% of people 4 years postmTBI and 9.9% of norms who experienced at least mild impairment in social inference. There were no significant differences between the mTBI group and norms for emotion evaluation. Poorer social inference 4 years after mTBI was significantly associated with lower cognitive flexibility and executive function (F = 2.57, df = 13,26, p = .02). Group differences remained after controlling for cognitive functioning (F = 104.59 df = 1,58, p = .001. Conclusions These novel results suggest that adults postmTBI may experience social inference difficulties 4 years post-TBI that are not completely explained by cognitive difficulties. Further research is needed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Inattention is a road safety problem, but few studies have focused specifically on mind wandering during everyday driving. This paper explores differences in self-reported mind wandering according to driver demographic characteristics (including age and gender), cognitive traits (such as tendency toward cognitive failure or mindful attention), states (such as feeling tired or stressed) and road environment factors (such as route familiarity). Five hundred and two participants (113 male, average age 44.4 years, SD=14.0years) completed a series of questionnaires (Mindful Attention and Awareness Scale (MAAS), Cognitive Failures Questionnaire (CFQ) and Driver Behaviour Questionnaire (DBQ)), as well as study-specific questions about mind wandering during different personal states and across a range of road and traffic situations. All respondents reported mind wandering during driving at least some of the time. Mind wandering was more likely to be reported on familiar roads than on unfamiliar roads and when drivers are tired. Drivers who reported relatively more mind wandering were younger, reported less mindful attention in daily life, more cognitive failures, and more driving violations and lapses. Together, the findings suggest that mind wandering is common in everyday driving, however any link with crash risk remains unclear. Future research using self-report and naturalistic methods could provide more insight into relationships between mind wandering, error and crash risk.

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.

Objective: This research investigated the on-road driving performance of individuals with ADHD across a range of road and traffic conditions to determine whether errors were linked to situational complexity and attentional demands. Method: The everyday driving performance of medicated drivers with ADHD, unmedicated drivers with ADHD, and controls was tested in urban, residential, rural, and highway environments using driver license testing procedures. Results: Unmedicated drivers with ADHD displayed fewer safe driving skills and committed more inattentive and impatient driving errors, particularly in low demand highway and rural driving conditions. Medicated drivers’ performance was not reliably different than controls. Participants in both ADHD groups were more likely than controls to report risky driving and involvement in crashes. Conclusion: The results demonstrate that situations with low attentional demand are particularly risky for unmedicated ADHD drivers and suggest that focus on these situations may be useful in improving driving outcomes for this population.

The aim of this study was to compare the demand for food under concurrent progressive- and fixed-ratio schedules. Twelve brushtail possums participated in 16 conditions where schedule, progression and food type were varied. An incrementing schedule increased the fixed-ratio requirement within and across sessions and was arranged as either a geometric sequence (base 2), or an arithmetic sequence (step 5). Two foods were tested: a flaked barley and coco-pop(®) mix versus rolled oats. Overall, performance was similar for most possums in the within- and across-session incrementing schedules. An analysis of the estimates of essential value and break point produced the same account of demand for foods under the geometric or arithmetic progressions and within- and across-session procedures for 8 of 12 possums. Six possums showed higher demand for rolled oats compared to flaked barley, and two possums showed higher demand for flaked barley compared to rolled oats. Incrementing ratios within, rather than between sessions using an arithmetic progression was demonstrated to be a time efficient procedure for investigating demand for different food types without affecting conclusions about the relative demand for those foods.

Young drivers show high levels of risky driving and are over-represented in motor vehicle crash statistics world-wide. As well as personality and attitudinal factors, high rates of risk taking during adolescence may be due to poorly developed executive functions, a result of the slow maturation of the pre-frontal cortex of the brain. This study was undertaken to investigate the roles of executive function, personality, attitudes to risk in relation to self-reported driving behaviour. Adolescent (n = 46, age 16-18 years) and adult (n = 32, 25 years and over) male drivers completed a battery of neuropsychological tests to assess general cognitive ability and executive function, and questionnaires to assess driving history, personality, attitudes to physical and psychological risk as well as questionnaires of self-reported driving behaviour (Driver risk taking and Driver Attitude Questionnaire, DAQ). The adolescent drivers showed poorer executive function, higher levels of impulsivity and risk-taking, lower levels of agreeableness and conscientiousness compared to adult drivers. Regression analyses revealed that attitudes to risk, agreeableness and working memory made unique significant contributions in explaining self-reported driving behaviour. Interestingly though, better working memory was associated with higher levels of self-reported risky driving and more accepting attitudes to risky driving. Together the findings suggest that some aspects of executive function, personality, and attitudes to risk may help to explain self-reported driving behaviour. Whether these findings are relevant to female drivers and apply to on-road driving behaviour should be the focus of future studies. Language: en

Approximately one third of car trips involve one or more passengers and yet we know little about how the presence of a passenger helps or hinders safety and efficiency. To date, research in this area has focused on the possible distractive effects of passengers. Although we know that drivers conversing on a mobile phone is distracting and unsafe, epidemiological studies suggest that driving with a passenger has a lower crash risk than driving alone. This paper describes two studies into how drivers and passengers interact during a journey; a survey regarding the most common actions of passengers and how drivers view their helpfulness, and an on-road study of driver and passenger interactions. The results indicated several areas that drivers felt passenger assistance was quite helpful, but in some cases was exhibited very rarely. The on-road study revealed some interesting gender differences in who offers driving support, and who requests it. By understanding how passengers can contribute to safer journeys we can provide that information to drivers at risk, such as those very early or late in their driving careers.

Risk perception plays an important role in driver behaviour, particularly for speed choice. Risk perception studies use a range of techniques from on-road data collection to ratings of still photos, however participants’ ratings differ depending on the study methodology, possibly due to their perception of control. To explore this we conducted a multiple methods study to investigate drivers’ perceptions of risk on rural roads. One group of participants drove (Drivers, n = 13) a 180 km route along rural roads (accompanied by a research assistant) and provided verbal risk ratings at thirteen locations of interest. A second group (Passengers, n = 10) provided ratings at the same points when travelling as a passenger in a vehicle (driven by a research assistant). The third group (Observers, n = 14) were shown videos of the same rural roads (filmed from the drivers’ perspective) and also provided risk ratings at the same locations. A week later participants were invited to the laboratory to review the video footage and comment on factors that contributed to the risk ratings. Overall, the Observers gave the highest risk ratings and Drivers the lowest. The Observers also provided twice the number of comments to justify their risk rating compared to the other two groups. The results suggest that control, and on-road experience play a significant role in how perceptions of driving risk are formed and the degree of risk experienced. These findings also bring into question the accuracy of using video-based tasks to assess drivers’ risk perception (and speed choice), particularly if the findings are used to inform on-road safety interventions.

Driving on the unfamiliar side of the road contributes to tourist road accidents and may deter self-driving tourists from travelling to certain countries. Experienced drivers usually drive on &ldquo, autopilot&rdquo, but under unfamiliar circumstances, drivers might generate instructions to avoid certain behaviour. Previous research has revealed that avoidant instructions can sometimes cause behaviour in the unintended direction (i.e., &ldquo, ironic&rdquo, behaviour). This study examined the effect of avoidant instructions (i.e., do not drift towards the centreline) while driving on the unfamiliar side of the road under high cognitive load. Participants (8 males, 9 females) drove on simulated roads under neutral and avoidant instructions, with or without a secondary task, in control and roadworks scenarios. Avoidant instructions did not lead to ironic behaviour (doing what one has been instructed not to do) but were associated with overcompensatory behaviour&mdash, driving further from the centreline compared to neutral instructions. Overcompensatory effects were not present when driving with a secondary task or in a roadworks scenario. The findings suggest that avoidant instructions do not lead to dangerous ironic behaviours. Further work needs to be undertaken on driving instructions given to tourists in other contexts like physiological fatigue.

Purpose: Hypomimia, or facial masking, is a decrease in voluntary control and spontaneous movement of the muscles of the face, which may occur in Parkinson's disease. Little is known about the psychosocial consequences or management of this symptom. The aim of this study was to provide an initial overview of patient & spousal experiences of living with an acquired nonverbal expressive impairment in Parkinson's disease. Method: This qualitative study involved a community sample of individuals with Parkinson's who experienced facial masking, and their close romantic partners. Nine people who had Parkinson's and nine of their spouses or partners participated in separate (individual) semi-structured interviews. Results: A descriptive thematic approach was used to analyze the interview data. Key themes relevant to rehabilitation included the misidentification of masking as negative affect, poor symptom recognition, and unmet health resource needs. Conclusions: The results indicate masking can have an adverse impact on close relationships and psychological well-being. This study presents an initial basis for clinicians working with Parkinson's populations to recognize of the needs of people who experience masking and better support such individuals and their families to live satisfying social and emotional lives. Implications for Rehabilitation People who have Parkinson's and their families are often unaware facial masking is a symptom of Parkinson's disease. Masking may be confused with negative affect and become a barrier to satisfying close relationships. Masking related health resources and support are perceived to be of poor availability and quality. This qualitative study suggests masking be considered as an etiology of interpersonal and psychological difficulties in Parkinson's disease, and encourages better recognition of this unique population's health education needs.

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.

Traumatic Brain Injury (TBI) has long-term effects on memory and cognitive functions. This paper discusses the challenges encountered and lessons learned from developing augmented memory aids for people with TBI. In particular, the paper discusses methodologies used to elicit potentially sensitive and personal data.

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.

The relationship between moderate/severe traumatic brain injury (TBI) and cognitive deficits is well known. The nature, duration and predictors of cognitive difficulties post-mild TBI remain unclear. This study examined cognitive, mood and post-concussion outcomes of mild TBI over 1-year post-injury.Adults (15 years) with mild TBI (n = 260) completed neuropsychological (CNS-Vital Signs, Behavioural Dyscontrol Scale), mood (Hospital Anxiety Depression Scale) and behavioural assessments (Cognitive Failures Questionnaire, Rivermead Post-Concussion Questionnaire) at baseline, 1-, 6- and 12-months post-injury.Over the 12-months post-injury self-reported cognition (p = 0.027), post-concussion symptoms (p 0.001), depression (p 0.001), anxiety (p 0.001) and dyscontrol (p = 0.025) improved significantly. Assessments of memory, processing speed, executive function, psychomotor speed/reaction time, complex attention and flexibility also improved significantly. At baseline20% of individuals produced very low scores on executive ability, complex attention and cognitive flexibility. At 1- and 6-month follow-ups20% of participants were very low for complex attention, with 16.3% remaining so at 12-months. Executive abilities and speed were related to post-concussion symptoms, mood and self-reported cognition at 12-months.Whilst significant improvements were noted across measures over time, a significant proportion of individuals still perform poorly on neuropsychological measures 12-months after mild TBI; and these were linked to post-concussion symptoms, mood and self-reported cognitive outcomes. This implies a longer trajectory for recovery than has previously been suggested, which has implications for provision of assessment and rehabilitation services for more extended periods.

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.