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D'Souza S, Milne BJ, Li C, Anns F, Gardner A, Lumley T, Morton SMB, Murphy IR, Verhagen E, Wright C, Quarrie K. Kumanu Tāngata: the aftermatch study - protocol to examine the health outcomes of high-level male rugby union players using linked administrative data. BMJ Open Sport Exerc Med 2024; 10:e001795. [PMID: 38362564 PMCID: PMC10868174 DOI: 10.1136/bmjsem-2023-001795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
There is increasing interest in the potential long-term outcomes of participation in contact and collision sports, driven by evidence of higher rates of neurodegenerative diseases among former athletes. Recent research has capitalised on large-scale administrative health data to examine health outcomes in contact sport athletes. However, there is limited research on outcomes associated with participation in rugby union, a contact sport with a relatively high incidence of head trauma and musculoskeletal injuries. Additionally, there is scope to investigate a greater range of health outcomes using large, population-based administrative data. The Kumanu Tāngata project is a retrospective cohort study that will use linked information from the New Zealand Rugby Register and health records within a comprehensive deidentified whole-population administrative research database known as the Integrated Data Infrastructure. First-class male rugby union players (N=13 227) will be compared with a general population comparison group (N=2 438 484; weighting will be applied due to demographic differences) on a range of mortality and morbidity outcomes (neurodegenerative diseases, musculoskeletal conditions, chronic physical conditions, mental health outcomes). A range of player-specific variables will also be investigated as risk factors. Analyses will consist primarily of Cox proportional hazards models. Ethics approval for the study has been granted by the Auckland Health Research Ethics Committee (Ref. AH23203). Primary research dissemination will be via peer-reviewed journal articles.
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Affiliation(s)
- Stephanie D'Souza
- COMPASS Research Centre, University of Auckland, Auckland, New Zealand
- School of Social Sciences, University of Auckland, Auckland, New Zealand
| | - Barry J Milne
- COMPASS Research Centre, University of Auckland, Auckland, New Zealand
- School of Social Sciences, University of Auckland, Auckland, New Zealand
| | - Chao Li
- COMPASS Research Centre, University of Auckland, Auckland, New Zealand
| | - Francesca Anns
- COMPASS Research Centre, University of Auckland, Auckland, New Zealand
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Andrew Gardner
- Sydney School of Health Sciences, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Thomas Lumley
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Susan M B Morton
- Research Institute for Innovative Solutions for Well-being and Health (INSIGHT), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Ian R Murphy
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Evert Verhagen
- Department of Public and Occupational Health, EMGO, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Craig Wright
- Social Wellbeing Agency, Wellington, New Zealand
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Hetrick SE, Hobbs M, Fortune S, Marek L, Wiki J, Boden JM, Theodore R, Ruhe T, Kokaua JJ, Thabrew H, Milne B, Bowden N. Proximity of alcohol outlets and presentation to hospital by young people after self-harm: A retrospective geospatial study using the integrated data infrastructure. Aust N Z J Psychiatry 2024; 58:152-161. [PMID: 37888830 PMCID: PMC10838485 DOI: 10.1177/00048674231203909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OBJECTIVES There is a well-established association between alcohol use, misuse, intoxication and self-harm, the latter of which is associated with suicide. This study aimed to better understand the association between proximity to alcohol outlets and the likelihood of young people presenting to hospital following self-harm. METHODS This was a nationwide retrospective geospatial study using data from the New Zealand Integrated Data Infrastructure using population-level data for 10-29-year-olds for the 2018 and 2017 calendar years. Presentations to hospital following self-harm were identified using the national minimum data set. Proximity to alcohol outlets was defined in road network distance (in kilometres) and ascertained using Integrated Data Infrastructure geospatial data. Alternative measures of proximity were employed in sensitivity analyses. Complete-case two-level random intercept logistic regression models were used to estimate the relationship between alcohol outlet proximity and hospital presentation for self-harm. Adjusted models included sex, age, ethnicity, area-level deprivation, urbanicity and distance to nearest medical facility. Analyses were also stratified by urbanicity. RESULTS Of the 1,285,368 individuals (mean [standard deviation] age 20.0 [5.9] years), 7944 (0.6%) were admitted to hospital for self-harm. Overall, the odds of presenting to hospital for self-harm significantly decreased as the distance from the nearest alcohol outlet increased, including in adjusted models (adjusted odds ratio 0.980; 95% confidence interval = [0.969-0.992]); the association was robust to changes in the measure of alcohol proximity. The effect direction was consistent across all categorisations of urbanicity, but only statistically significant in large urban areas and rural areas. CONCLUSIONS The findings of this study show a clear association between young people's access to alcohol outlets and presentation to hospital for self-harm and may provide a mandate for government policies and universal interventions to reduce young people's access to alcohol outlets. Further research regarding causative mechanisms is needed.
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Affiliation(s)
- Sarah E Hetrick
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
- Suicide Prevention Office, Auckland, New Zealand
- A Better Start: E Tipu e Rea National Science Challenge, Auckland, New Zealand
| | - Matthew Hobbs
- Te Taiwhenua o te Hauora-GeoHealth Laboratory, University of Canterbury, Christchurch, Canterbury, New Zealand
- Te Kaupeka Oranga, Faculty of Health, University of Canterbury, Christchurch, Canterbury, New Zealand
- The Cluster for Community and Urban Resilience (CURe), University of Canterbury, Christchurch, Canterbury, New Zealand
| | - Sarah Fortune
- Department of Social and Community Health, School of Population Health, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Lukas Marek
- Te Taiwhenua o te Hauora-GeoHealth Laboratory, University of Canterbury, Christchurch, Canterbury, New Zealand
- Te Kaupeka Oranga, Faculty of Health, University of Canterbury, Christchurch, Canterbury, New Zealand
| | - Jesse Wiki
- Epidemioloigy and Biostatistics, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Joseph M Boden
- Christchurch Health and Development Study, University of Otago, Christchurch, Canterbury, New Zealand
| | - Reremoana Theodore
- National Centre for Lifecourse Research, University of Otago, Dunedin, New Zealand
| | - Troy Ruhe
- Va'a O Tautai - Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Jesse J Kokaua
- National Centre for Lifecourse Research, University of Otago, Dunedin, New Zealand
- Va'a O Tautai - Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Hiran Thabrew
- Te Ara Hāro, Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Barry Milne
- A Better Start: E Tipu e Rea National Science Challenge, Auckland, New Zealand
- School of Social Sciences and Centre of Methods and Policy Application in the Social Sciences (COMPASS), The University of Auckland, Auckland, New Zealand
| | - Nicholas Bowden
- A Better Start: E Tipu e Rea National Science Challenge, Auckland, New Zealand
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
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Anns F, D’Souza S, MacCormick C, Mirfin-Veitch B, Clasby B, Hughes N, Forster W, Tuisaula E, Bowden N. Risk of Criminal Justice System Interactions in Young Adults with Attention-Deficit/Hyperactivity Disorder: Findings From a National Birth Cohort. J Atten Disord 2023; 27:1332-1342. [PMID: 37254493 PMCID: PMC10498656 DOI: 10.1177/10870547231177469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To examine criminal justice system (CJS) interactions and pathways through the justice system for young adults with ADHD compared to young adults without ADHD. METHOD Nationwide 3-year birth cohort study using linked health and CJS data. Cox proportional hazards models were employed to examine associations between ADHD and police proceedings, court charges, court convictions, and incarcerations. RESULTS Young adults with ADHD were significantly more likely to interact with the CJS including police proceedings (hazard ratio [HR], 2.1 95% CI [2.0, 2.2]) court charges (HR, 2.2 95% CI [2.1, 2.3]), court convictions (HR, 2.3 95% CI [2.2, 2.4]), and incarceration (HR, 4.8 95% CI [4.3, 5.4]). CONCLUSIONS Young adults with ADHD are overrepresented at all stages of the CJS. Results highlight the importance of early identification and responsivity to ADHD within the CJS and suggest that the NZ justice system may require changes to both areas to ensure that young individuals with ADHD receive equitable access to, and treatment within, the CJS.
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Affiliation(s)
| | - Stephanie D’Souza
- University of Auckland, New Zealand
- A Better Start National Science Challenge, New Zealand
| | | | | | - Betony Clasby
- Donald Beasley Institute, Dunedin, Otago, New Zealand
- University of Sheffield, UK
- University of Otago, Dunedin, New Zealand
| | | | | | - Eden Tuisaula
- Donald Beasley Institute, Dunedin, Otago, New Zealand
| | - Nicholas Bowden
- A Better Start National Science Challenge, New Zealand
- University of Otago, Dunedin, New Zealand
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Mujoo H, Bowden N, Thabrew H, Kokaua J, Audas R, Taylor B. Identifying neurodevelopmental disabilities from nationalised preschool health check. Aust N Z J Psychiatry 2023; 57:1140-1149. [PMID: 36748102 PMCID: PMC10363952 DOI: 10.1177/00048674231151606] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Models of psychometric screening to identify individuals with neurodevelopmental disabilities (NDDs) have had limited success. In Aotearoa/New Zealand, routine developmental surveillance of preschool children is undertaken using the Before School Check (B4SC), which includes psychometric and physical health screening instruments. This study aimed to determine whether combining multiple screening measures could improve the prediction of NDDs. METHODS Linked administrative health data were used to identify NDDs, including attention deficit hyperactivity disorder, autism spectrum disorder and intellectual disability, within a multi-year national cohort of children who undertook the B4SC. Cox proportional hazards models, with different combinations of potential predictors, were used to predict onset of a NDD. Harrell's c-statistic for composite models were compared with a model representing recommended cutoff psychometric scores for referral in New Zealand. RESULTS Data were examined for 287,754 children, and NDDs were identified in 10,953 (3.8%). The best-performing composite model combining the Strengths and Difficulties Questionnaire, the Parental Evaluation of Developmental Status, vision screening and biological sex had 'excellent' predictive power (C-statistic: 0.83) compared with existing referral pathways which had 'poor' predictive power (C-statistic: 0.68). In addition, the composite model was able to improve the sensitivity of NDD diagnosis detection by 13% without any reduction in specificity. CONCLUSIONS Combination of B4SC screening measures using composite modelling could lead to significantly improved identification of preschool children with NDDs when compared with surveillance that rely on individual psychometric test results alone. This may optimise access to academic, personal and family support for children with NDDs.
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Affiliation(s)
- Himang Mujoo
- A Better Start National Science Challenge, Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Nicholas Bowden
- A Better Start National Science Challenge, Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Hiran Thabrew
- A Better Start National Science Challenge, Liggins Institute, University of Auckland, Auckland, New Zealand
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Jesse Kokaua
- A Better Start National Science Challenge, Liggins Institute, University of Auckland, Auckland, New Zealand
- Va’a O Tautai – Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Richard Audas
- Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John’s, NL, Canada
| | - Barry Taylor
- A Better Start National Science Challenge, Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
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Gorman E, Bowden N, Kokaua J, McNeill B, Schluter PJ. A national multiple baseline cohort study of mental health conditions in early adolescence and subsequent educational outcomes in New Zealand. Sci Rep 2023; 13:11025. [PMID: 37419984 PMCID: PMC10329034 DOI: 10.1038/s41598-023-38131-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 07/03/2023] [Indexed: 07/09/2023] Open
Abstract
Young people experiencing mental health conditions are vulnerable to poorer educational outcomes for many reasons, including: social exclusion, stigma, and limited in-school support. Using a near-complete New Zealand population administrative database, this prospective cohort study aimed to quantify differences in educational attainment (at ages 15-16 years) and school suspensions (over ages 13-16 years), between those with and without a prior mental health condition. The data included five student cohorts, each starting secondary school from 2013 to 2017 respectively (N = 272,901). Both internalising and externalising mental health conditions were examined. Overall, 6.8% had a mental health condition. Using adjusted modified Poisson regression analyses, those with prior mental health conditions exhibited lower rates of attainment (IRR 0.87, 95% CI 0.86-0.88) and higher rates of school suspensions (IRR 1.63, 95% CI 1.57-1.70) by age 15-16 years. Associations were stronger among those exhibiting behavioural conditions, compared to emotional conditions, in line with previous literature. These findings highlight the importance of support for young people experiencing mental health conditions at this crucial juncture in their educational pathway. While mental health conditions increase the likelihood of poorer educational outcomes, deleterious outcomes were not a necessary sequalae. In this study, most participants with mental health conditions had successful educational outcomes.
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Affiliation(s)
- Emma Gorman
- School of Organisations, Economy and Society, University of Westminster, 35 Marylebone Rd, Marylebone, London, NW1 5LS, UK.
| | - Nicholas Bowden
- Department of Women's and Children's Health, University of Otago, 201 Great King St, Dunedin, 9016, New Zealand
- A Better Start National Science Challenge, Auckland, New Zealand
| | - Jesse Kokaua
- Department of Women's and Children's Health, University of Otago, 201 Great King St, Dunedin, 9016, New Zealand
- A Better Start National Science Challenge, Auckland, New Zealand
- Va'a O Tautai-Centre for Pacific Health, Division of Health Sciences, University of Otago, 78 Frederick St, Dunedin, 9017, New Zealand
| | - Brigid McNeill
- Te Kāhui Pā Harakeke, Child Well‑being Research Institute, Te Whare Wānanga o Waitaha, University of Canterbury, Christchurch, 8041, New Zealand
- Te Kura Whakangungu Kaiako, The School of Teacher Education, Te Whare Wānanga o Waitaha, University of Canterbury, Christchurch, 8041, New Zealand
| | - Philip J Schluter
- Te Kāhui Pā Harakeke, Child Well‑being Research Institute, Te Whare Wānanga o Waitaha, University of Canterbury, Christchurch, 8041, New Zealand
- Te Kaupeka Oranga, Faculty of Health, Te Whare Wānanga o Waitaha, University of Canterbury, Christchurch, 8041, New Zealand
- Primary Care Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, Australia
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M H, N B, L M, J W, J K, R T, T R, J B, H T, S H, B M. The environment a young person grows up in is associated with their mental health: A nationwide geospatial study using the integrated data infrastructure, New Zealand. Soc Sci Med 2023; 326:115893. [PMID: 37119566 DOI: 10.1016/j.socscimed.2023.115893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/19/2023] [Accepted: 04/06/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Mental health conditions often arise during adolescence, are multifaceted in aetiology, and may be related to the type of environment in which young people reside. This study used nationwide population-level data to investigate whether the environment a young person grows up in is associated with their mental health. METHOD Data were extracted from the Integrated Data Infrastructure (IDI), a large nationwide research repository, for 917,211 young people (aged 10-24 years) including sociodemographic and mental health data (i.e. emotional, behavioural, substance problems, and self-harm). Environmental data were sourced from the nationwide area-based Healthy Location Index (HLI), which has comprehensive data on the location of several health-constraining (i.e. fast-food outlets) and health-promoting features (i.e. physical activity facilities). Environments were classified as: i) health-promoting, ii) health-constraining, or iii) neither. Associations between the HLI and mental health were investigated using multi-level mixed effects logistic regression modelling. RESULTS Overall, there was evidence of an association between the environment a young person resided in and their mental health. Young people residing in health-constraining environments had higher odds of any mental health condition (Adjusted Odds Ratio (AOR) = 1.020 [1.001, 1.040]) and any emotional condition (AOR = 1.037 [1.012, 1.062]). Young people residing in health-promoting environments had lower odds of substance problems (AOR = 0.950 [0.905, 0.997]). There were no significant effects of the environment on behavioural conditions. CONCLUSION Our study utilises a large national sample of almost one million young people to confirm the importance of environmental determinants for mental health. It is possible that leverage points for improving the mental health of young people, and reducing the burden to the health system of mental health, can be sought in upstream environmental based interventions.
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Affiliation(s)
- Hobbs M
- Faculty of Health, University of Canterbury, Christchurch, Canterbury, New Zealand; GeoHealth Laboratory, Geospatial Research Institute, University of Canterbury, Christchurch, Canterbury, New Zealand.
| | - Bowden N
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Marek L
- GeoHealth Laboratory, Geospatial Research Institute, University of Canterbury, Christchurch, Canterbury, New Zealand
| | - Wiki J
- GeoHealth Laboratory, Geospatial Research Institute, University of Canterbury, Christchurch, Canterbury, New Zealand
| | - Kokaua J
- Va'a O Tautai - Centre for Pacific Health, Health Sciences, University of Otago, Dunedin, New Zealand
| | - Theodore R
- National Centre for Lifecourse Research, University of Otago, Dunedin, New Zealand
| | - Ruhe T
- Va'a O Tautai - Centre for Pacific Health, Health Sciences, University of Otago, Dunedin, New Zealand
| | - Boden J
- Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago Christchurch, New Zealand
| | - Thabrew H
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Hetrick S
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Milne B
- Centre of Methods and Policy Application in the Social Sciences, University of Auckland, Auckland, New Zealand
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Maessen SE, Taylor BJ, Gillon G, Moewaka Barnes H, Firestone R, Taylor RW, Milne B, Hetrick S, Cargo T, McNeil B, Cutfield W. A better start national science challenge: supporting the future wellbeing of our tamariki E tipu, e rea, mō ngā rā o tō ao: grow tender shoot for the days destined for you. J R Soc N Z 2023. [DOI: 10.1080/03036758.2023.2173257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Sarah E. Maessen
- A Better Start National Science Challenge, Auckland, New Zealand
- Liggins Institute, Auckland, New Zealand
| | - Barry J. Taylor
- A Better Start National Science Challenge, Auckland, New Zealand
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Gail Gillon
- A Better Start National Science Challenge, Auckland, New Zealand
- Child Well-being Research Institute, University of Canterbury, Christchurch, New Zealand
| | - Helen Moewaka Barnes
- A Better Start National Science Challenge, Auckland, New Zealand
- Whariki Research Group, SHORE and Whariki Research Centre, School of Public Health, Massey University, Auckland, New Zealand
| | - Ridvan Firestone
- A Better Start National Science Challenge, Auckland, New Zealand
- Research Centre for Hauora & Health, College of Health, Massey University, Wellington, New Zealand
| | - Rachael W. Taylor
- A Better Start National Science Challenge, Auckland, New Zealand
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Barry Milne
- A Better Start National Science Challenge, Auckland, New Zealand
- Centre of Methods and Policy Application in Social Sciences, University of Auckland, Auckland, New Zealand
| | - Sarah Hetrick
- A Better Start National Science Challenge, Auckland, New Zealand
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Tania Cargo
- A Better Start National Science Challenge, Auckland, New Zealand
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Bridgid McNeil
- A Better Start National Science Challenge, Auckland, New Zealand
- Child Well-being Research Institute, University of Canterbury, Christchurch, New Zealand
- School of Teacher Education, University of Canterbury, Christchurch, New Zealand
| | - Wayne Cutfield
- A Better Start National Science Challenge, Auckland, New Zealand
- Liggins Institute, Auckland, New Zealand
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Milne BJ, D'Souza S, Andersen SH, Richmond-Rakerd LS. Use of Population-Level Administrative Data in Developmental Science. ANNUAL REVIEW OF DEVELOPMENTAL PSYCHOLOGY 2022; 4:447-468. [PMID: 37284522 PMCID: PMC10241456 DOI: 10.1146/annurev-devpsych-120920-023709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Population-level administrative data-data on individuals' interactions with administrative systems (e.g., health, criminal justice, and education)-have substantially advanced our understanding of life-course development. In this review, we focus on five areas where research using these data has made significant contributions to developmental science: (a) understanding small or difficult-to-study populations, (b) evaluating intergenerational and family influences, (c) enabling estimation of causal effects through natural experiments and regional comparisons, (d) identifying individuals at risk for negative developmental outcomes, and (e) assessing neighborhood and environmental influences. Further advances will be made by linking prospective surveys to administrative data to expand the range of developmental questions that can be tested; supporting efforts to establish new linked administrative data resources, including in developing countries; and conducting cross-national comparisons to test findings' generalizability. New administrative data initiatives should involve consultation with population subgroups including vulnerable groups, efforts to obtain social license, and strong ethical oversight and governance arrangements.
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Affiliation(s)
- Barry J Milne
- School of Social Sciences and Centre of Methods and Policy Application in the Social Sciences (COMPASS), University of Auckland, Auckland, New Zealand
| | - Stephanie D'Souza
- School of Social Sciences and Centre of Methods and Policy Application in the Social Sciences (COMPASS), University of Auckland, Auckland, New Zealand
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9
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Mitchell EA, Zhang D, Thompson JMD, Liu C, Leversha A, Milne BJ. Maternal mental health and substance use disorders in sudden unexpected death in infancy using routinely collected health data in New Zealand, 2000-2016. Arch Dis Child 2022; 107:917-921. [PMID: 35676082 DOI: 10.1136/archdischild-2021-323006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 05/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Mortality from sudden unexpected death in infancy (SUDI) has declined dramatically since the 'Back to Sleep' campaign. Deaths now are more prevalent in those with socioeconomic disadvantage. The investigation of SUDI frequently identifies parents that have mental health or drug, alcohol and addiction problems. AIMS To estimate the prevalence of maternal mental health and substance use disorders and assess the magnitude of their risk for SUDI. METHODS We conducted a population-based cohort study using data from the Integrated Data Infrastructure (IDI), a large research database containing linked data from a range of government agencies. The study population was all live births and their mothers in New Zealand from 2000 to 2016. The exposures of interest were maternal mental health problems and maternal substance use disorders in the year prior to the birth. The outcome was deaths from SUDI. RESULTS The total population was 1086 504 live births and of these 1078 811 (99.3%) were able to be linked to other data sets within the IDI. The prevalence of maternal mental health problems in the total population was 5.2% and substance use disorder was 0.7%. There were 42 deaths from SUDI (0.75/1000) that were exposed to maternal mental illness and 864 deaths (0.84/1000) that were not exposed (adjusted relative risk (aRR)=1.23, 95% CI 0.90 to 1.68). There were 21 deaths from SUDI (2.67/1000) that were exposed to maternal substance use disorders and 885 (0.83/1000) that were not exposed (aRR=1.82, 95% CI 1.17 to 2.83). CONCLUSIONS Maternal substance use disorders, but not maternal mental health problems, in the year prior to the child's birth was associated with an increased risk of SUDI. However, the numbers that are affected are small and the effect size moderate. This group of women should receive additional SUDI prevention services and Safe Sleep advice.
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Affiliation(s)
- Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Doney Zhang
- Centre of Methods and Policy Application in the Social Sciences, Faculty of Arts, The University of Auckland, Auckland, New Zealand
| | - John M D Thompson
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Chris Liu
- Centre of Methods and Policy Application in the Social Sciences, Faculty of Arts, The University of Auckland, Auckland, New Zealand
| | - Alison Leversha
- Community Paediatrics, Auckland District Health Board, Auckland, New Zealand
| | - Barry J Milne
- Centre of Methods and Policy Application in the Social Sciences, Faculty of Arts, The University of Auckland, Auckland, New Zealand
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10
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Thabrew H, Aljawahiri N, Kumar H, Bowden N, Milne B, Prictor M, Jordan V, Breedvelt J, Shepherd T, Hetrick S. 'As Long as It's Used for Beneficial Things': An Investigation of non-Māori, Māori and Young People's Perceptions Regarding the Research use of the Aotearoa New Zealand Integrated Data Infrastructure (IDI). J Empir Res Hum Res Ethics 2022; 17:471-482. [PMID: 35849389 DOI: 10.1177/15562646221111294] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Aotearoa New Zealand Integrated Data Infrastructure (IDI) is a national database containing a wide range of data about people and households. There is limited information about public views regarding its use for research.A qualitative study was undertaken to examine the views of forty individuals attending a large hospital in Auckland, including those of Māori ethnicity and young people. Semi-structured interview data were analysed using Braun and Clarke's method of thematic analysis.Seven key themes emerged: 1) Limited knowledge about medical data held in national databases; 2) Conditional support for the use of the IDI, including for research; 3) Concerns regarding the misuse of IDI data; 4) The importance of privacy; 5) Different views regarding consent for use of data for research; 6) Desire for access to personal data and the results of research; and 7) Concerns regarding third party and commercial use. Young people and those of Māori ethnicity were more wary of data misuse than others.Although there is reasonable support for the secondary use of public administrative data in the IDI for research, there is more work to be done to ensure ethical and culturally appropriate use of this data via improved consent privacy management processes and researcher training.
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Affiliation(s)
- Hiran Thabrew
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.,Consult Liaison Team, 36716Starship Hospital, Auckland, New Zealand
| | - Noor Aljawahiri
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Harshali Kumar
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Nicholas Bowden
- 161293Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,A Better Start National Science Challenge, Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Barry Milne
- A Better Start National Science Challenge, Liggins Institute, The University of Auckland, Auckland, New Zealand.,589107Centre of Methods and Policy Application in Social Sciences, University of Auckland, Auckland, New Zealand
| | - Megan Prictor
- Health, Law and Emerging Technologies programme, 90147Melbourne Law School, The University of Melbourne, Carlton, Australia
| | - Vanessa Jordan
- Department of Obstetrics and Gynaecology, 62710Faculty of Medical and Health Sciences, Auckland, New Zealand
| | | | - Toni Shepherd
- Consult Liaison Team, 36716Starship Hospital, Auckland, New Zealand
| | - Sarah Hetrick
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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11
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Fortune S, Hetrick S, Sharma V, McDonald G, Scott KM, Mulder RT, Hobbs L. Multisite sentinel surveillance of self-harm in New Zealand: protocol for an observational study. BMJ Open 2022; 12:e054604. [PMID: 35613789 PMCID: PMC9134176 DOI: 10.1136/bmjopen-2021-054604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION New Zealand (NZ) has a persistently high rate of suicide, particularly among young people. Hospital presentation for self-harm (SH) is one of the strongest predictors of death by suicide. Improving the monitoring of SH and suicide is a key recommendation for suicide prevention by WHO. This study will establish the first ever sentinel surveillance for SH at several large hospitals and a monthly survey of all practicing paediatricians in NZ. The study will provide robust information about the epidemiology of SH, factors associated with SH and the types of interventions required for those presenting to hospital with SH. METHOD AND ANALYSIS This observational study will establish SH surveillance in the emergency departments of three public hospitals for the first time in NZ, where study population will include individuals of all ages who present with SH or suicidal ideation. The study methodology is in line with the WHO Best Practice guidelines and international collaborators in Australia and Europe. Electronic triage records will be reviewed manually by the research team to identify potential cases that meet inclusion criteria. For all eligible cases, variables of interest will be extracted from routine clinical records by the research team and recorded on a secure web-based survey application. Additionally, SH surveillance data for the national paediatric population (<15 years) will be obtained via the New Zealand Paediatric Surveillance Unit (NZPSU); paediatricians will report on included cases using the same variables using a secure survey application. A deidentified dataset will be produced for aggregated statistical analysis. ETHICS AND DISSEMINATION The University of Otago Health Ethics Committee granted ethical approval for this study in addition to local ethics approval at participating hospital sites. The study findings will be disseminated to relevant stakeholders in NZ, in addition to international audiences through publications in peer-reviewed scientific journals and conference presentations.
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Affiliation(s)
- Sarah Fortune
- Department of Social and Community Health, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
- The Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Sarah Hetrick
- Department of Psychological Medicine, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Vartika Sharma
- Department of Psychological Medicine, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Gabrielle McDonald
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Kate M Scott
- The Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Roger T Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Linda Hobbs
- The Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
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12
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McLay LK, Schluter PJ, Eggleston MJF, Woodford EC, Bowden N. Melatonin dispensing among New Zealand children aged 0-18 years with autism: a nationwide cross-sectional study. Sleep Med 2021; 80:184-192. [PMID: 33601231 DOI: 10.1016/j.sleep.2021.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE/BACKGROUND Sleep problems in children on the autism spectrum are prevalent and persistent. Such problems are the result of a combination of biopsychosocial factors, including abnormal melatonin secretion. Exogenous melatonin is an empirically supported and popular treatment for sleep problems. However, we know little about rates of melatonin dispensing and associated variables. This study investigated rates of melatonin dispensing and the sociodemographic and child characteristics associated with its use in New Zealand. METHODS This nationwide cross-sectional study used linked administrative health data obtained via the Integrated Data Infrastructure (IDI). Data were obtained for 11,202, 0-18 year old children on the autism spectrum. Descriptive data, and adjusted and unadjusted risk ratios, were calculated for sociodemographic and child characteristics. RESULTS Melatonin is accessed by almost one quarter of children on the autism spectrum in New Zealand, with higher observed rates among females and those aged between 5 and 11 years, of European ethnicity, and presenting with co-occurring mental health conditions. CONCLUSIONS Findings are largely consistent with research investigating both sleep disturbances and psychotropic drug use among children on the autism spectrum. High rates of melatonin use, age- and sex-related differences in its use, and the complexity associated with the presence of co-occurring conditions necessitates development of practice guidelines for melatonin dispensing. Further investigation into the duration of melatonin use and the interaction between child characteristics, co-occurring conditions, sociodemographic variables and melatonin dispensing is warranted.
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Affiliation(s)
- L K McLay
- School of Health Sciences, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, New Zealand.
| | - P J Schluter
- School of Health Sciences, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, New Zealand; School of Clinical Medicine, Primary Care Clinical Unit, The University of Queensland, Brisbane, Australia.
| | - M J F Eggleston
- Mental Health Division, Canterbury District Health Board, New Zealand.
| | - E C Woodford
- School of Health Sciences, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, New Zealand
| | - N Bowden
- A Better Start National Science Challenge, New Zealand; Department of Women's and Children's Health, University of Otago, New Zealand.
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13
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Bowden N, Thabrew H, Kokaua J, Audas R, Milne B, Smiler K, Stace H, Taylor B, Gibb S. Autism spectrum disorder/Takiwātanga: An Integrated Data Infrastructure-based approach to autism spectrum disorder research in New Zealand. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:2213-2227. [PMID: 32677449 PMCID: PMC7542998 DOI: 10.1177/1362361320939329] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
New Zealand has few estimates of the prevalence of autism spectrum disorder and no national registry. The use of administrative data sources is expanding and could be useful in autism spectrum disorder research. However, the extent to which autism spectrum disorder can be captured in these data sources is unknown. In this study, we utilised three linked administrative health data sources from the Integrated Data Infrastructure to identify cases of autism spectrum disorder among New Zealand children and young people. We then investigated the extent to which a range of mental health, neurodevelopmental and related problems co-occur with autism spectrum disorder. In total, 9555 unique individuals aged 0–24 with autism spectrum disorder were identified. The identification rate for 8-year-olds was 1 in 102. Co-occurring mental health or related problems were noted in 68% of the autism spectrum disorder group. The most common co-occurring conditions were intellectual disability, disruptive behaviours and emotional problems. Although data from the Integrated Data Infrastructure may currently undercount cases of autism spectrum disorder, they could be useful for monitoring service and treatment-related trends, types of co-occurring conditions and for examining social outcomes. With further refinement, the Integrated Data Infrastructure could prove valuable for informing the national incidence and prevalence of autism spectrum disorder and the long-term effectiveness of clinical guidelines and interventions for this group.
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Affiliation(s)
- Nicholas Bowden
- A Better Start National Science Challenge, New Zealand.,University of Otago, New Zealand
| | - Hiran Thabrew
- A Better Start National Science Challenge, New Zealand.,The University of Auckland, New Zealand
| | - Jesse Kokaua
- A Better Start National Science Challenge, New Zealand.,University of Otago, New Zealand
| | - Richard Audas
- A Better Start National Science Challenge, New Zealand.,University of Otago, New Zealand
| | - Barry Milne
- A Better Start National Science Challenge, New Zealand.,The University of Auckland, New Zealand
| | | | | | - Barry Taylor
- A Better Start National Science Challenge, New Zealand.,University of Otago, New Zealand
| | - Sheree Gibb
- A Better Start National Science Challenge, New Zealand.,University of Otago, Wellington, New Zealand
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