title: Persistent problems 1 year after mild traumatic brain injury: a longitudinal population study in New Zealand

authors: Theadom, Alice

subjects: Science & Technology

abstract: 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, postconcussion 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.

text: Persistent problems 1 year after mild traumatic brain injury: a longitudinal population study in New Zealand 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, postconcussion 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.

year: 2016-01-01

title: Palaeolimnological studies on Lake Maratoto, North Island, New Zealand

authors: Green, John D.

abstract: The Middle Waikato (or Hamilton) Basin is a promising area for studies of the postglacial history of Northern New Zealand. The major geomorphological features of the basin were developed in the last 40,000 years, mainly by aggradation of the ancestral Waikato River (Mccraw 1967, Hume et al 1975) and in the process a number of peat bogs and small lakes were formed which now provide suitable locations for palaeoclimatic and palaeoecological investigations. Four pollen diagrams from peats in the area have been published (Harris 1963, McGlone et al 1978) which show similar features to diagrams from elsewhere in the North Island (McGlone and Topping 1979) but there have been no comparable studies of sediments from the lakes.

text: Palaeolimnological studies on Lake Maratoto, North Island, New Zealand The Middle Waikato (or Hamilton) Basin is a promising area for studies of the postglacial history of Northern New Zealand. The major geomorphological features of the basin were developed in the last 40,000 years, mainly by aggradation of the ancestral Waikato River (Mccraw 1967, Hume et al 1975) and in the process a number of peat bogs and small lakes were formed which now provide suitable locations for palaeoclimatic and palaeoecological investigations. Four pollen diagrams from peats in the area have been published (Harris 1963, McGlone et al 1978) which show similar features to diagrams from elsewhere in the North Island (McGlone and Topping 1979) but there have been no comparable studies of sediments from the lakes.

year: 1979

title: Risk assessment for family violence aggressors in Aotearoa New Zealand

authors: Jolliffe Simpson, Apriel D.

subjects: Family violence

abstract: In recent decades Family Violence (FV) researchers have developed risk assessment instruments to enable practitioners to identify the people who are most likely to commit FV in the future, and the families who are most likely to experience ongoing harm. Indeed, risk assessments have become a standard procedure for FV practitioners who are frequently required to make decisions with potential ramifications for families’ safety and wellbeing. Yet, despite considerable developments in risk assessment research and practice, risk assessment instruments have limitations that curb their value to FV practice. In addition, such instruments should be empirically validated, but there is limited evidence for the validity of risk assessment instruments used by agencies that respond to FV in Aotearoa New Zealand. Therefore, in this thesis, we examined the risk assessment procedures that New Zealand Police and the Integrated Safety Response (ISR) used for FV, with the purpose of contributing to the evidence base about risk assessment for FV in New Zealand and identifying strengths, weaknesses, and opportunities for improvement.
This thesis contains three manuscripts either published in or submitted to peer-reviewed academic journals; as well as supplementary chapters that support, extend, and integrate the research findings. In the first manuscript, we examined the predictive validity of risk categories from the Dynamic Risk Assessment for family violence (DYRA) and Static Assessment of Family Violence Recidivism (SAFVR)—the two risk assessment instruments that New Zealand Police use when responding to FV cases—for a sample of 2,115 cases with FV episodes reported to police in Waikato and parts of Canterbury between 1 November – 9 December 2018 (1,817 of which had complete risk categories). We examined the instruments’ ability to predict recurrence (i.e., a further FV-related call for police service) at three intervals (3 days, 12 weeks, and 24 weeks), and found both instruments had a poor ability to discriminate between aggressors who had a recurrence and those who did not, with the SAFVR outperforming the DYRA, and the DYRA performing especially poorly for non-intimate partner cases, and aggressors who were Māori or women. 
In the second manuscript, we explored the risk assessments that Integrated Safety Response (ISR) triage team members conducted for a sub-sample of 842 cases with FV episodes reported to police between 1 – 14 November 2018. We examined the relationship between the factors triage teams recorded during their risk assessments and the risk categories the teams assigned, then tested the association of both the factors and categories with recurrence and physical recurrence within 24 weeks. The predictive validity of ISR triage teams’ risk categories was comparable to the results produced for the DYRA and SAFVR in manuscript one. The ISR risk categories again performed poorly for aggressors who were women, Māori, and for non-intimate partner cases; and overall, fewer than half of the factors triage teams recorded were associated with recurrence or physical recurrence. Then, in an additional chapter, we explored the triage teams’ factors’ utility for case management and found the factors could be used to create three sub-groups of cases with potential implications for their treatment and management. 
Finally, in the third manuscript, we modeled the behavioral patterns of 2,115 aggressors with a FV episode reported to police in Waikato and parts of Canterbury between 1 November – 9 December 2018, by collecting reports for further FV episodes involving those aggressors during the two years after the index episode. We used this information to describe three latent states behind the information reported to police and identified four common pathways through the latent states over time. We concluded this manuscript by discussing changes that could contribute to improvements in how risk for FV aggressors is conceptualized, assessed, and communicated in practice.
In each chapter, we discussed the theoretical and practical implications of the findings, before integrating those findings and implications in a general discussion chapter. Taken together, the results presented herein indicate that the risk assessment instruments used in New Zealand can predict risk for FV recurrence better than chance, but that those assessments should be further developed to improve their value to FV practice and ensure they adequately capture risk for different types of FV cases and groups of people. This thesis advanced our understanding of the limitations of—and opportunities in—risk assessment research and contributed to the evidence base for risk assessment for FV in New Zealand.

text: Risk assessment for family violence aggressors in Aotearoa New Zealand In recent decades Family Violence (FV) researchers have developed risk assessment instruments to enable practitioners to identify the people who are most likely to commit FV in the future, and the families who are most likely to experience ongoing harm. Indeed, risk assessments have become a standard procedure for FV practitioners who are frequently required to make decisions with potential ramifications for families’ safety and wellbeing. Yet, despite considerable developments in risk assessment research and practice, risk assessment instruments have limitations that curb their value to FV practice. In addition, such instruments should be empirically validated, but there is limited evidence for the validity of risk assessment instruments used by agencies that respond to FV in Aotearoa New Zealand. Therefore, in this thesis, we examined the risk assessment procedures that New Zealand Police and the Integrated Safety Response (ISR) used for FV, with the purpose of contributing to the evidence base about risk assessment for FV in New Zealand and identifying strengths, weaknesses, and opportunities for improvement.
This thesis contains three manuscripts either published in or submitted to peer-reviewed academic journals; as well as supplementary chapters that support, extend, and integrate the research findings. In the first manuscript, we examined the predictive validity of risk categories from the Dynamic Risk Assessment for family violence (DYRA) and Static Assessment of Family Violence Recidivism (SAFVR)—the two risk assessment instruments that New Zealand Police use when responding to FV cases—for a sample of 2,115 cases with FV episodes reported to police in Waikato and parts of Canterbury between 1 November – 9 December 2018 (1,817 of which had complete risk categories). We examined the instruments’ ability to predict recurrence (i.e., a further FV-related call for police service) at three intervals (3 days, 12 weeks, and 24 weeks), and found both instruments had a poor ability to discriminate between aggressors who had a recurrence and those who did not, with the SAFVR outperforming the DYRA, and the DYRA performing especially poorly for non-intimate partner cases, and aggressors who were Māori or women. 
In the second manuscript, we explored the risk assessments that Integrated Safety Response (ISR) triage team members conducted for a sub-sample of 842 cases with FV episodes reported to police between 1 – 14 November 2018. We examined the relationship between the factors triage teams recorded during their risk assessments and the risk categories the teams assigned, then tested the association of both the factors and categories with recurrence and physical recurrence within 24 weeks. The predictive validity of ISR triage teams’ risk categories was comparable to the results produced for the DYRA and SAFVR in manuscript one. The ISR risk categories again performed poorly for aggressors who were women, Māori, and for non-intimate partner cases; and overall, fewer than half of the factors triage teams recorded were associated with recurrence or physical recurrence. Then, in an additional chapter, we explored the triage teams’ factors’ utility for case management and found the factors could be used to create three sub-groups of cases with potential implications for their treatment and management. 
Finally, in the third manuscript, we modeled the behavioral patterns of 2,115 aggressors with a FV episode reported to police in Waikato and parts of Canterbury between 1 November – 9 December 2018, by collecting reports for further FV episodes involving those aggressors during the two years after the index episode. We used this information to describe three latent states behind the information reported to police and identified four common pathways through the latent states over time. We concluded this manuscript by discussing changes that could contribute to improvements in how risk for FV aggressors is conceptualized, assessed, and communicated in practice.
In each chapter, we discussed the theoretical and practical implications of the findings, before integrating those findings and implications in a general discussion chapter. Taken together, the results presented herein indicate that the risk assessment instruments used in New Zealand can predict risk for FV recurrence better than chance, but that those assessments should be further developed to improve their value to FV practice and ensure they adequately capture risk for different types of FV cases and groups of people. This thesis advanced our understanding of the limitations of—and opportunities in—risk assessment research and contributed to the evidence base for risk assessment for FV in New Zealand.

year: 2023