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Background: The percentage of total body surface area (%TBSA) burned and burn depth provide valuable information on burn injury severity. Objective: This study investigated the concordance between The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes and expert burn clinicians in assessing burn injury severity. Method: We conducted a retrospective population-based review of all patients who sustained a burn injury between July 1, 2009, and June 30, 2019, requiring admission into a specialist burn service across Australia and New Zealand. The %TBSA burned (including the percentage of full thickness burns) recorded by expert burn clinicians within the Burns Registry of Australia and New Zealand (BRANZ) were compared to ICD-10-AM coding. Results: 20,642 cases (71.5%) with ICD-10-AM code data were recorded. Overall, kappa scores (95% confidence interval [CI]) for burn size ranged from 0.64 (95% CI 0.63–0.66) to 0.86 (95% CI 0.78–0.94) indicating substantial to almost perfect agreement across all %TBSA groups. When stratified by depth, the lowest agreement was observed for < 10% TBSA and < 10% full thickness (kappa 0.03; 95% CI 0.02–0.04) and the highest agreement was observed for burns of ≥ 90% TBSA and ≥ 90% full thickness (kappa 0.72; 95% CI 0.58–0.85). Conclusion: Overall, there was substantial agreement between the BRANZ and ICD-10-AM coded data for %TBSA classification. When %TBSA classification was stratified by burn depth, greater agreement was observed for larger and deeper burns compared with smaller and superficial burns. Implications: Greater consistency in the classification of burns is needed. [ABSTRACT FROM AUTHOR]

Background: The Health of the Nation Outcomes Scales for people with Learning Disabilities (HoNOS-LD) is an 18-item measure which provides a structured and standardized approach to rating various clinical and psychosocial outcomes and has been in use nationally since 2002. Aims: To revise and improve the HoNOS-LD's utility in contemporary intellectual disability (ID) services whilst retaining its original objectives and five-point severity ratings. Method: ID clinicians were invited to complete an online survey, rating each item on the existing measure for being fit for purpose, identifying issues and suggesting improvements based on their experience of using the HoNOS-LD in practice. Scales were then assessed and revised sequentially; survey responses were used to inform discussion and revisions to the HoNOS-LD by the Advisory Board. Results: A total of 75 individuals replied. Respondents had used HoNOS-LD for an average of 8.0 years (S.D. 5.28 years) and 88% found the scale to be useful in their practice. On average, respondents used HoNOS-LD ratings to inform care 42.4% of the time (S.D. 33.5%). For each scale there was a significant negative correlation between the percentage of positive/very positive respondent ratings and the number of changes proposed. Common changes included simplifying terms, reducing ambiguity and replacing anachronistic language. Conclusion: The changes outlined in this paper are based on the advisory group's expert consensus. These changes are intended to improve reliability and validity but now need empirical testing as well as review by service users. [ABSTRACT FROM AUTHOR]

Background: The bone–patellar tendon–bone (BTB) autograft is associated with difficulty with kneeling after anterior cruciate ligament (ACL) reconstruction; however, it is unclear whether it results in a more painful or symptomatic knee compared with the hamstring tendon autograft. Purpose: To identify the rate and risk factors for knee pain and difficulty with kneeling after ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Primary ACL reconstruction procedures prospectively recorded in the New Zealand ACL Registry from April 2014 to May 2021 were analyzed. The Knee injury and Osteoarthritis Outcome Score (KOOS) was used to identify patients reporting consequential knee pain (CKP), defined as a KOOS Pain subscore of ≤72 points, and severe kneeling difficulty (SKD), defined as a self-report of "severe" or "extreme" difficulty with kneeling. Absolute values of the KOOS Pain and Symptoms subscales were also compared. Results: A total of 10,999 patients were analyzed. At 2-year follow-up, 9.3% (420/4492) reported CKP, and 12.0% (537/4471) reported SKD. The most important predictor of CKP at 2-year follow-up was having significant pain before surgery (adjusted odds ratio, 4.10; P <.001). The most important predictor of SKD at 2-year follow-up was the use of a BTB autograft rather than a hamstring tendon autograft (21.3% vs 9.4%, respectively; adjusted odds ratio, 3.12; P <.001). There was no difference between the BTB and hamstring tendon grafts in terms of CKP (9.9% vs 9.2%, respectively; P =.494) or in absolute values of the KOOS Pain (mean, 88.7 vs 89.0, respectively; P =.37) and KOOS Symptoms (mean, 82.5 vs 82.1, respectively; P =.49) subscales. Conclusion: At 2-year follow-up after primary ACL reconstruction, 9.3% of patients reported CKP, and 12.0% reported SKD. The BTB autograft was associated with difficulty with kneeling, but it did not result in a more painful or symptomatic knee compared with the hamstring tendon autograft. [ABSTRACT FROM AUTHOR]

Background: Clinical quality registries provide rich and useful data for clinical quality monitoring and research purposes but are susceptible to data quality issues that can impact their usage. Objective : This study assessed the concordance between comorbidities recorded in the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and those in state-based hospital admission datasets. Method: All patients in New South Wales, South Australia, Tasmania, Victoria and Western Australia recorded in ANZDATA as requiring chronic kidney replacement therapy (KRT) between 01/07/2000 and 31/12/2015 were linked with state-based hospital admission datasets. Coronary artery disease, diabetes mellitus, cerebrovascular disease, chronic lung disease and peripheral vascular disease recorded in ANZDATA at each annual census date were compared overall, over time and between different KRT modalities to comorbidities recorded in hospital admission datasets, as defined by the International Classification of Diseases (ICD-10-AM), using both the kappa statistic and logistic regression analysis. Results: 29, 334 patients with 207,369 hospital admissions were identified. Comparison was made at census date for every patient comparison. Overall agreement was "very good" for diabetes mellitus (92%, k = 0.84) and "poor" to "fair" (21–61%, k = 0.02–0.22) for others. Diabetes mellitus recording had the highest accuracy (sensitivity 93% (±SE 0.2) and specificity 93% (±SE 0.2)), and cerebrovascular disease had the lowest (sensitivity 54% (±SE 0.2) and specificity 21% (±SE 0.3)). The false positive rates for cerebrovascular disease, peripheral vascular disease and chronic airway disease ranged between 18 and 33%. The probability of a false positive was lowest for kidney transplant patients for all comorbidities and highest for patients on haemodialysis. Conclusions and Implications: Agreement between the clinical quality registry and hospital admission datasets was variable, with the prevalence of comorbidities being higher in ANZDATA. [ABSTRACT FROM AUTHOR]

Objective: Long-term studies following disasters are rare. It is important to quantify long-term effects of disasters to determine impacts on populations over time. We therefore aim to report the long-term associations between exposure to the Canterbury earthquakes and common mental disorders, taking into account potential confounding factors. Methods: The Christchurch Health and Development Study is a 40-year longitudinal study of a birth cohort of New Zealand children (635 males and 630 females). The Christchurch Health and Development Study includes 884 participants with data on earthquake exposure and mental health outcomes at ages 34 and 40 years. Rates of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) disorders were measured categorically and using an expanded definition that included sub-syndromal symptoms. The current impact of the earthquakes is reported using 12-month prevalence data 7 years after the earthquakes. The cumulative impact of the earthquakes over the 7 years since onset is also reported. Results: There was a linear trend towards increasing rates of disorder with increasing exposure to the earthquakes. After adjusting for covariates, the 12-month prevalence of anxiety disorder symptoms was significantly increased (p = 0.003). The earthquakes were also associated with cumulative increases in symptoms of post-traumatic stress disorder (p < 0.001), anxiety disorder (p = 0.016), nicotine dependence (p = 0.012), and the total number of disorders (p = 0.039). Conclusion: The Canterbury earthquakes were associated with persistent increases in Anxiety Disorder symptoms 7 years after their onset. The earthquakes were also associated with cumulative increases in symptoms of common psychiatric disorders. The magnitude of these effects is small, may no longer be clinically significant and has decreased over time. [ABSTRACT FROM AUTHOR]

Background: Owing to the disappointing regenerative ability of osteochondral tissue, without treatment an osteochondral defect would progress to osteoarthritis. This situation motivates the need for new strategies to enhance the regeneration of osteochondral defects. Purpose: To develop a tissue-engineering scaffold by tethering bone morphogenetic protein 2 (BMP2) and transforming growth factor beta 3 (TGFβ3) in a layer-specific manner on a slotted decellularized osteochondral matrix (SDOM) and to evaluate the efficacy of this scaffold for osteochondral regeneration. Study Design: Controlled laboratory study. Methods: Normal osteochondral tissue from the rabbit patellofemoral groove was sectioned into a slot shape and decellularized for fabricating an SDOM. The collagen-binding domain (CBD) was fused into the N-terminus of BMP2 or TGFβ3 to synthesize 2 recombinant growth factors (GFs) (CBD-BMP2 or CBD-TGFβ3), which were tethered to the bone layer and cartilage layer, respectively, of the SDOM to prepare a tissue-engineering scaffold (namely, CBD-GFs/SDOM). After examining the influence of the CBD-GFs/SDOM on the viability and layer-specific differentiation of bone marrow mesenchymal stem cells in vitro, we determined the regeneration potential of the CBD-GFs/SDOM on osteochondral regeneration in a rabbit model. A total of 72 New Zealand White rabbits with a cylindrical osteochondral defect in the patellofemoral groove were randomly assigned to 3 groups: defect only (control [CTL] group), defect patched with an SDOM (SDOM group), and defect patched with the CBD-GFs/SDOM (CBD-GFs/SDOM group). At 6 or 12 weeks postoperatively, the rabbits were euthanized to harvest the knee joint, which was then evaluated via gross observation, micro–computed tomography, histological staining, and mechanical testing. Results: In vitro, the CBD-GFs/SDOM was noncytotoxic, showed high biomimetics with normal osteochondral tissue, was suitable for cell adhesion and growth, and had good layer-specific ability in inducing stem cell differentiation. Macroscopic images showed that the CBD-GFs/SDOM group had significantly better osteochondral regeneration than the CTL and SDOM groups had. Micro–computed tomography demonstrated that much more bony tissue was formed at the defect sites in the CBD-GFs/SDOM group compared with the defect sites in the CTL or SDOM group. Histological analysis showed that the CBD-GFs/SDOM group had a significant enhancement in osteochondral regeneration at 6 and 12 weeks postoperatively in comparison with the CTL or SDOM group. At 12 weeks postoperatively, the mechanical properties of reparative tissue were significantly better in the CBD-GFs/SDOM group than in the other groups. Conclusion: The CBD-GFs/SDOM is a promising scaffold for osteochondral regeneration. Clinical Relevance: The findings of this study indicated that the CBD-GFs/SDOM is an excellent candidate for reconstructing osteochondral defects, which may be translated for clinical use in the future. [ABSTRACT FROM AUTHOR]

Background: In primary anterior cruciate ligament (ACL) reconstruction, a bone–patellar tendon–bone (BTB) autograft is associated with lower ipsilateral failure rates. BTB autografts are associated with a higher rate of contralateral ACL injuries, which some clinicians view as a marker of success of the BTB autograft. However, there is a lack of evidence on whether BTB autografts improve the rate of return to activity and sport. Purpose: To compare the rate of return to preinjury activity levels in high-activity patients after ACL reconstruction with BTB autograft or hamstring tendon autograft. Study Design: Cohort study; Level of evidence, 3. Methods: In a high-activity cohort of patients recorded between 2014 and 2018 in the New Zealand ACL Registry, prospectively collected data on preinjury and postoperative Marx activity scores were analyzed. The proportion of patients who returned to their preinjury activity levels at 1- and 2-year follow-up was compared between graft types. Results: Overall, 11.3% (208/1844) of patients returned to their preinjury activity levels at 1-year follow-up, and 15.5% (184/1190) returned at 2-year follow-up. At 1-year follow-up, 17.2% of patients with a BTB autograft returned to their preinjury activity levels compared with 9.3% of patients with a hamstring tendon autograft (adjusted odds ratio, 1.59 [95% CI, 1.16-2.17]; P =.004). At 2-year follow-up, 23.3% of patients with a BTB autograft had returned to their preinjury activity levels compared with 13.3% of patients with a hamstring tendon autograft (adjusted odds ratio, 1.63 [95% CI, 1.14-2.34]; P =.008). Male sex and younger age were associated with a higher rate of return to activity at both follow-up time points. Conclusion: The use of BTB autografts increased the odds of returning to preinjury activity levels at early follow-up. A higher rate of return to activity is a possible explanation for the higher rate of contralateral ACL injuries with the use of BTB autografts. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to assess whether obese patients undergoing primary total hip replacement (THR) via a posterior approach had superior revision rates and Oxford Hip Scores (OHS) compared to those via a lateral approach. Patients and methods: This is a retrospective cohort study using prospective data from the New Zealand Joint Registry applying STROBE and RECORD guidelines. Patients undergoing THR since 2010 were stratified by body mass index (BMI) into obese (BMI 30–39 kg/m2), and morbidly obese (BMI ⩾40 kg/m2) groups. All-cause revision rates, and 6-month OHS post-surgery were compared between groups. Multivariate analysis was performed. Results: 12,109 unilateral THRs in obese patients were identified. The mean follow-up was 2.8 years (range 0.01–6.95 years). Univariate analysis in the BMI ⩾ 40 group showed the posterior approach had a significantly lower all-cause revision rate (0.99/100 observed component years (ocys); 95% CI, 0.65–1.44/100 ocys) than the lateral approach (1.71/100 ocys (95% CI, 0.98–2.77/100 ocys), p < 0.05). There was no significant difference in dislocation rates between the surgical approaches. OHS was statistically higher in the posterior approach group in BMI 30–39 patients (p < 0.001) but not clinically significant. Multivariate analysis showed femoral head size significantly influenced all-cause revision rates and mitigated against the increased risk associated with the surgical approach. Conclusion: The choice of surgical approach in obese patients conveys no advantage in overall revision rates in the short-term. Choosing an appropriate size of femoral head may be of greater importance than choice of surgical approach for obese patients in primary THR. [ABSTRACT FROM AUTHOR]

Background: Chronic full-thickness rotator cuff tears (FTRCTs) represent a major clinical concern because they show highly compromised healing capacity. Purpose: To evaluate the efficacy of using a 3-dimensional (3D) bioprinted scaffold with human umbilical cord blood (hUCB)–mesenchymal stem cells (MSCs) for regeneration of chronic FTRCTs in a rabbit model. Study Design: Controlled laboratory study. Methods: A total of 32 rabbits were randomly assigned to 4 treatment groups (n = 8 per group) at 6 weeks after a 5-mm FTRCT was created on the supraspinatus tendon. Group 1 (G1-SAL) was transplanted with normal saline. Group 2 (G2-MSC) was transplanted with hUCB-MSCs (0.2 mL, 1 × 106) into FTRCTs. Group 3 (G3-3D) was transplanted with a 3D bioprinted construct without MSCs, and group 4 (G4-3D+MSC) was transplanted with a 3D bioprinted construct containing hUCB-MSCs (0.2 mL, 1 × 106 cells) into FTRCTs. All 32 rabbits were euthanized at 4 weeks after treatment. Examination of gross morphologic changes and histologic results was performed on all rabbits after sacrifice. Motion analysis was also performed before and after treatment. Results: In G4-3D+MSC, newly regenerated collagen type 1 fibers, walking distance, fast walking time, and mean walking speed were greater than those in G2-MSC based on histochemical and motion analyses. In addition, when compared with G3-3D, G4-3D+MSC showed more prominent regenerated tendon fibers and better parameters of motion analysis. However, there was no significant difference in gross tear size among G2-MSC, G3-3D, and G4-3D+MSC, although these groups showed significant decreases in tear size as compared with the control group (G1-SAL). Conclusion: Findings of this study show that a tissue engineering strategy based on a 3D bioprinted scaffold filled with hUCB-MSCs can improve the microenvironment for regenerative processes of FTRCT without any surgical repair. Clinical Relevance: In the case of rotator cuff tear, the cell loss of the external MSCs can be increased by exposure to synovial fluid. Therefore, a 3D bioprinted scaffold in combination with MSCs without surgical repair may be effective in increasing cell retention in FTRCT. [ABSTRACT FROM AUTHOR]

Background: Microfracture or bone marrow stimulation (BMS) is often the first choice for clinical treatment of cartilage injuries; however, fibrocartilage, not pure hyaline cartilage, has been reported because of the development of fibrosis in the repair tissue. Transforming growth factor β1 (TGF-β1), which can promote fibrosis, can be inhibited by losartan and potentially be used to reduce fibrocartilage. Hypothesis: Blocking TGF-β1 would improve cartilage healing in a rabbit knee BMS model via decreasing the amount of fibrocartilage and increasing hyaline-like cartilage formation. Study Design: Controlled laboratory study. Methods: An osteochondral defect was made in the patellar groove of 48 New Zealand White rabbits. The rabbits were divided into 3 groups: a defect group (defect only), a BMS group (osteochondral defect + BMS), and a BMS + losartan group (osteochondral defect + BMS + losartan). For the rabbits in the BMS + losartan group, losartan was administrated orally from the day after surgery through the day of euthanasia. Rabbits were sacrificed 6 or 12 weeks postoperatively. Macroscopic appearance, microcomputed tomography, histological assessment, and TGF-β1 signaling pathway were evaluated at 6 and 12 weeks postoperatively. Results: The macroscopic assessment of the repair revealed that the BMS + losartan group was superior to the other groups tested. Microcomputed tomography showed superior healing of the bony defect in the BMS + losartan group in comparison with the other groups. Histologically, fibrosis in the repair tissue of the BMS + losartan group was significantly reduced when compared with the other groups. Results obtained with the modified O'Driscoll International Cartilage Repair Society grading system yielded significantly superior scores in the BMS + losartan group as compared with both the defect group and the BMS group (F value: 15.8, P <.001, P =.012, respectively). TGF-β1 signaling and TGF-β-activated kinase 1 of the BMS + losartan group were significantly suppressed in the synovial tissues. Conclusion: By blocking TGF-β1 with losartan, the repair cartilage tissue after BMS was superior to the other groups and consisted primarily of hyaline cartilage. These results should be easily translated to the clinic because losartan is a Food and Drug Administration–approved drug and it can be combined with the BMS technique for optimal repair of chondral defects. Clinical Relevance: Biologically regulated marrow stimulation by blocking TGF-β1 (oral intake of losartan) provides superior repair via decreasing fibrocartilage formation and resulting in hyaline-like cartilage as compared with outcomes from BMS only. [ABSTRACT FROM AUTHOR]

Background: The patellar tendon is often considered the "gold standard" graft for reducing the risk of graft rupture after anterior cruciate ligament (ACL) reconstruction. However, its use may also be associated with an increased risk of injury to the contralateral ACL. Purpose: To clarify the association between graft choice and the risk of revision and contralateral ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Prospective data captured by the New Zealand ACL Registry between April 2014 and December 2018 were reviewed. All primary ACL reconstructions performed using either a hamstring tendon or patellar tendon autograft were included. Cox regression survival analysis adjusting for patient factors was performed to compare the risk of revision and contralateral ACL reconstruction between the hamstring tendon graft and the patellar tendon graft. Results: A total of 7155 primary ACL reconstructions were reviewed, of which 5563 (77.7%) were performed using a hamstring tendon graft and 1592 (22.3%) were performed using a patellar tendon graft. Patients with a hamstring tendon graft had a revision rate of 2.7% compared with 1.3% in patients with a patellar tendon graft (adjusted hazard ratio [HR], 2.51; 95% CI, 1.55-4.06; P <.001). The patellar tendon graft was associated with an increased risk of contralateral ACL reconstruction compared with the hamstring tendon graft (adjusted HR, 1.91; 95% CI, 1.15-3.16; P =.012). The number needed to treat (NNT) with a patellar tendon graft to prevent 1 revision was 73.6. However, the NNT with a hamstring tendon graft to prevent 1 contralateral reconstruction was 116.3. Conclusion: Use of a patellar tendon graft reduced the risk of graft rupture but was associated with an increased risk of injury to the contralateral ACL. Adequate rehabilitation and informed decision making on return to activity and injury prevention measures may be important in preventing subsequent injury to the healthy knee. [ABSTRACT FROM AUTHOR]

This study explored the viability of preventive treatment services for individuals with sexual interest in children, in jurisdictions without mandatory reporting but where risk-related disclosures to authorities are permitted at therapists' discretion. Health professionals (N = 112) were surveyed regarding their comfort, confidence, knowledge of relevant legal provisions, and personal disclosure thresholds, in relation to a hypothetical scenario of a client confiding pedophilic interest to seek help. Findings were mixed regarding implications for prevention service viability. Despite the complexities of the legal and ethical context of the study setting (New Zealand), predictions regarding professionals' uncertainty in relation to their legal and ethical duties, and displaying a bias toward disclosing information to authorities when permitted, were not fully borne out, although pervasive knowledge inaccuracies and associated training needs were revealed. Instead, general tendencies among respondents were toward comfort, confidence, and the inclination toward maintaining client confidentiality. Yet, widespread variance within the sample, and individuals' thresholds appearing rather unpredictable on the basis of demographic or professional variables, highlights likely barriers for potential clients in feeling safe enough to come forward. Given that preventive treatment viability in this context relies on self-referral, it is suggested that a purpose-designed preventive treatment service, with clear accessible confidentiality and reporting policies that are well within the law, could be the best way forward for viable preventive treatment in discretionary reporting contexts. [ABSTRACT FROM AUTHOR]

Rasch analysis was conducted to enhance the precision of the widely used 10-item Perceived Stress Scale using two datasets (n = 450 each) randomly selected from samples of the New Zealand general population (n = 1102), New Zealand university students (n = 479) and US university students (n = 396). The best Rasch model fit (χ 2(27) = 29.92, p =.36), good person separation reliability (.80) and coverage (98%) of the sample by the scale items were achieved when locally dependent items were combined into subtests. These findings support reliability and internal structural validity of the 10-item Perceived Stress Scale. The instrument precision can be further improved using the ordinal-to-linear conversion tables published here. [ABSTRACT FROM AUTHOR]

Background: Little is known about cystic fibrosis patients, who are not considered to be terminally ill, and who die after voluntary cessation of treatment. Aim: This study was undertaken to provide an international snapshot of this issue. Design: An online survey was distributed across three continents. Setting: Distribution to the medical directors of the cystic fibrosis centres affiliated with the US Cystic Fibrosis Foundation, Cystic Fibrosis Australia (inclusion of New Zealand) and to every clinician member of the European Cystic Fibrosis Society. Results: More than 200 cystic fibrosis patients not considered to be terminally ill and, who voluntarily ceased treatment, were reported by the clinicians surveyed. Detailed data were reported in 102 patients (4 children, 25 adolescents and 73 adults). Only one child, six adolescents and one adult were judged by clinicians not to be competent to make the decision to stop treatment. Time-consuming and low immediate-impact therapies, such as respiratory physiotherapy, were most frequently discontinued. Resignation was the main reported reason for discontinuing treatment, followed by reactive depression and lack of familial support. A total of 69% of the patients received palliative care and 72% died in the 6 months following cessation of treatment. Conclusion: Death of cystic fibrosis patients, not considered to be terminally ill, is reported in Europe, the United States and Australia due to voluntary cessation of treatment. [ABSTRACT FROM AUTHOR]

Statistics New Zealand is one of the few national statistical agencies to have applied a stochastic (probabilistic) approach to official demographic projections. This article discusses the experience and benefits of adopting this new approach, including the perspective of a key user of projections, the New Zealand Treasury. Our experience is that the change is less difficult to make than might be expected. Uncertainty in the different projection inputs (components) can be modelled simply or with more complexity, and progressively applied to different projection types. This means that not all the different demographic projections an agency produces need to adopt a stochastic approach simultaneously. At the same time, users of the projections are keen to better understand the relative certainty and uncertainty of projected outcomes, given the important uses of projections. [ABSTRACT FROM AUTHOR]

Aims: Poverty kills children. This study assesses the relationship between poverty and child mortality rates (CMRs) in 71 societies from three world regions to determine whether some countries, relative to their region, neglect their children. Methods: Spearman rank order correlations were calculated to determine any association between the CMR and poverty data, including income inequality and gross national income. A current CMR one standard deviation (SD) above or below the regional average and a percentage change between 1988 and 2010 were used as the measures to assess the progress of nations. Results: There were positive significant correlations between higher CMRs and relative poverty measures in all three regions. In Western countries, the current CMRs in the USA, New Zealand and Canada were 1 SD below the Western mean. The narrowest income inequalities, apart from Japan, were seen in the Scandinavian nations alongside low CMRs. In Asia, the current CMRs in Pakistan, Myanmar and India were the highest in their region and were 1 SD below the regional mean. Alongside South Korea, these nations had the lowest percentage reductions in CMRs. In Sub-Saharan Africa, the current CMRs in Somalia, Burkina Faso, Sierra Leone, Chad, Democratic Republic of Congo and Angola were the highest in their region and were 1 SD below the regional mean. Conclusions: Those concerned with the pursuit of social justice need to alert their societies to the corrosive impact of poverty on child mortality. Progress in reducing CMRs provides an indication of how well nations are meeting the needs of their children. Further country-specific research is required to explain regional differences. [ABSTRACT FROM AUTHOR]

Introduction: Routine measurement of cardiac biomarkers such as troponin T (TnT) is recommended perioperatively, especially in high-risk vascular surgery. Long-term prognosis is worse even in those with nonspecific perioperative myocardial injury. However, a clear understanding of these biomarker profiles and how they should affect patient management is lacking. Methods: We examined the perioperative profile of high-sensitivity TnT (hsTnT) release in 85 patients undergoing elective major vascular surgery. Plasma hsTnT was measured preoperatively, at 6, 12, and 24 hours postoperatively, and then every 24 hours for a maximum of 5 days. Significant elevations in hsTnT with/without clinical indicators of ischemia were used to diagnose myocardial infarction or injury. Results: A high incidence of myocardial injury was evident (46% had elevated hsTnT); only 5% were associated with myocardial infarction, and 41% were due to myocardial injury. Conclusions: This study emphasizes the high incidence of perioperative myocardial injury and stress in vascular surgery as revealed by the use of the robust and very sensitive biomarker of myocardial damage, hsTnT. The high availability and swift development of increasingly sensitive assays allow detection of abnormal elevated hsTnT levels in a higher proportion of the population. Consequent challenges are the reduced specificity to separate acute events as well as to deduce the prognostic value of elevations due to confusing criteria; this is especially the case in a patient group with multiple comorbidities that affect hsTnT levels chronically. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to assess for the presence of multi-drug resistant organisms (MDROs) on tourniquets and quantify the number of bacteria to which patients might be exposed with each blood collection episode. Methods: Tourniquets were randomly sampled in a 246-bed, secondary level, New Zealand hospital, which is currently non-endemic for MDROs. A 6-cm length of each tourniquet sampled was applied to the surface of an agar plate and the colony forming units (CFUs) were enumerated. All colonies were then screened for MDROs using standard methods. CFU counts per linear centimetre were multiplied by a range of patient arm circumference measurements. Comparison was also made between non-disinfected tourniquets left on the wards and phlebotomy service tourniquets after daily decontamination with a proprietary disinfectant. Results: The median exposure risk from non-disinfected tourniquets was 173 CFUs per collect (95% CI, 104–861). None of the general ward tourniquets grew any MDROs but four out of five dedicated, single-patient reusable isolation room tourniquets grew MRSA. Disinfected tourniquets had few if any CFUs and CFU counts were significantly lower than non-disinfected tourniquets (P = 0.0001). Conclusion: The quantitative risk from reusable tourniquets appears low in the setting of MDRO non-endemicity, with the application of standard infection control practices. [ABSTRACT FROM AUTHOR]

Structured abstract: Introduction: This article explores the rate and degree of loneliness in community-dwelling older visually impaired people, and is the first study to investigate the unique contribution that social and emotional loneliness makes to perceived quality of life (PQOL) in this population. Methods: The study constituted a secondary analysis of postal survey data from the second wave (2012) of the nationally representative New Zealand Longitudinal Study of Ageing, a longitudinal study of older New Zealanders. A total of 2,683 participants completed both the visual status screening question and all 11 loneliness items to meet the criteria for inclusion in this study. Results: Those designated as being visually impaired (n = 315) were found to be more likely to experience loneliness (53% vs. 36%) than their sighted peers (n = 2,368). Increased loneliness among those who are visually impaired was found to be associated with decreased economic well-being, mental health, satisfaction with activities of daily living, satisfaction with life, and PQOL. Social loneliness, but not emotional loneliness, was found to make a unique contribution to the prediction of variance in the PQOL of older visually impaired people over and above the impact of other predictors. Discussion: Loneliness is much more prevalent in, and occurs with greater severity among, people who are visually impaired than with those who are not. Social loneliness made a unique contribution to PQOL over and above the contribution of variables that previous research has shown are central to PQOL in this population. Implications for practitioners: Loneliness is not often addressed in vision rehabilitation programs designed for older adults, yet it is apparent from these findings that rates of loneliness may be high in this population. Its effect, even at moderate levels, is detrimental to the PQOL of older people with visual impairments. [ABSTRACT FROM AUTHOR]

Objective:To examine the effect of an early exercise and education programme on psychosocial health of transient ischaemic attack (TIA) and mild, non-disabling stroke patients.Design:Randomized, parallel-group, clinical trial.Setting:Hospital and academic institution.Participants:A total of 55 newly diagnosed transient ischaemic attack/mild stroke patients (Mean[SD]; 69[11]y).Intervention:Participants were randomized to either an eight-week, twice weekly, 90-minute exercise and education programme (experimental group) or to a usual care control group.Main measures:Psychosocial measures (SF-36, Hospital Anxiety and Depression Scale, Profile of Mood States, International Physical Activity Questionnaire, Stroke Awareness Questionnaire) were assessed at baseline and eight-week and 12-month follow-up.Results:The experimental group demonstrated improvements in the Physical Component Score (Mean[SD]; 44.1[11.7] to 47.4[11.3]%), Vitality (46.5[12.4] to 54.2[14.2]%), Physical Functioning (45.6[10.7] to 51.9[14.7]%), Role Physical (38.7[10.8] to 43.1[13.6]%) and Global Health (49.1[10.3] to 54.4[13.6]%) from the SF-36, at the eight-week follow-up assessment (P < 0.05). There were no further changes in these measures between the eight-week and 12-month follow-up assessment (P > 0.05). The experimental group demonstrated a greater awareness of the signs and symptoms associated with stroke (P < 0.05). There were no differences in the Mental Component Score (SF-36), the Hospital Anxiety and Depression Scale or the International Physical Activity Questionnaire between treatment groups (P > 0.05).Conclusion:Early engagement in an exercise and education programme may improve physical health perceptions in transient ischaemic attack/mild stroke patients. However, secondary prevention exercise and education programmes warrant further research with regards to their effects on perceptions of mental health in this population group. [ABSTRACT FROM AUTHOR]

Objective: Personality has been associated with a variety of outcomes in adulthood. Most of the literature related to mental state disorder and personality is cross sectional. Methods: Data from more than 900 participants of the Christchurch Health and Development Study (CHDS) were examined. Extroversion and neuroticism were measured at 14 years old and social outcomes at age 30. The presence of mental state disorder between 18-30 years old was identified. Multiple potential confounders in childhood were included in the analysis. Results: Neuroticism at fourteen was significantly correlated with multiple environmental exposures whereas extroversion had relatively few associations. Regression analysis found that neuroticism at 14 predicted depression, anxiety, suicidality and overall mental health problems at 30 as well as poor self-esteem but not relationship quality or wellbeing. Extroversion at 14 predicted alcohol and drug dependence and overall mental health problems, but also predicted improved social wellbeing, self-esteem and relationship quality at 30. Conclusions: In this analysis extroversion interacts with significantly fewer environmental factors than neuroticism in predicting adult outcomes. Neuroticism at 14 years predicts poorer mental health outcomes in adulthood. Extroversion in childhood may be a protective factor in the development of mental disorder other than alcohol use disorders. Extroverted adolescents have more positive social outcomes at 30 years. [ABSTRACT FROM AUTHOR]

Background: Direct impacts with the head (linear acceleration or pressure) and inertial loading of the head (rotational acceleration or strain) have been postulated as the 2 major mechanisms of head-related injuries such as concussion. Although data are accumulating for soccer and American football, there are no published data for nonhelmeted collision sports such as rugby union. Purpose: To quantify head impacts via instrumented mouthguard acceleration analyses for rugby union players over a season of matches. Study Design: Descriptive epidemiology study. Methods: Data on impact magnitude and frequency were collected with molded instrumented mouthguards worn by 38 premier amateur senior rugby players participating in the 2013 domestic season of matches. Results: A total of 20,687 impacts >10g (range, 10.0-164.9g) were recorded over the duration of the study. The mean ± SD number of impacts per player over the duration of the season of matches was 564 ± 618, resulting in a mean ± SD of 95 ± 133 impacts to the head per player, per match over the duration of the season of matches. The impact magnitudes for linear accelerations were skewed to the lower values (Sp = 3.7 ± 0.02; P<.001), with a mean linear acceleration of 22.2 ± 16.2g. Rotational accelerations were also skewed to the lower values (Sp = 2.0 ± 0.02; P < .001), with a mean rotational acceleration of 3902.9 ± 3948.8 rad/s2. Conclusion: The acceleration magnitudes and number of head impacts in amateur rugby union players over a season of matches, measured via instrumented mouthguard accelerations, were higher than for most sports previously reported. Mean linear acceleration measured over a season of matches was similar to the mean linear accelerations previously reported for youth, high school, and collegiate American football players but lower than that for female youth soccer players. Mean rotational acceleration measured over a season of matches was similar to mean rotational accelerations for youth, high school, and collegiate American football players but less than those for female youth soccer players, concussed American collegiate players, collegiate American football players, and professional American football players. [ABSTRACT FROM AUTHOR]

This study investigated ‘healthy’ participants’ perceptions of types 1 and 2 diabetes using mixed methods. A total of 38 participants were asked about their perceptions of both types of diabetes using video-based vignettes of four cases. Participants answered standardised questionnaires while thinking aloud and could expand during semi-structured interview sections. Four themes were identified: knowledge of diabetes, power to influence diabetes, limitations of responsibility or blame for diabetes and feelings about individuals with diabetes. Perceived controllability of causes and perceptions of illness management informs understanding of stigma and risk and emphasises the importance of comparing perceptions of both types of diabetes. [ABSTRACT FROM PUBLISHER]

The article discusses a study that aims to assess patients' perspectives of community treatment orders (CTOs), assessing for correlates with clinical and demographic variables. Details on the methods of the study and its results are offered. It highlights that more than half of patients under a CTO consider it negatively. The group is identified by patients who work, experience coercion and are unsatisfied with care.

The article presents research which discussed the impact of earthquake sequence in New Zealand on the adverse mental health conditions of people in the area. Topics covered include information on an earthquake that hit Christchurch, New Zealand in September 2010 as well as participation of 295 people in the study. Also mentioned are the damages caused by the disaster.

The article presents research which examined the occurrence of childhood trauma in children with bipolar disorder. Topics covered include the impact of stress on the treatment course for the children and the rate of childhood trauma in patients with the condition. Also mentioned is the use of the Childhood Trauma Questionnaire in the study.

The article presents research which examined the use of electroconvulsive therapy in Otago, New Zealand. Topics covered include the global variations in the adoption of the treatment approach, and the participation of 199 patients with affective disorders in the study. Also mentioned is the prevalence of the method in other countries including the U.S. and Australia.

This study tested the effects of social network engagement and social support on the health of older people moving into retirement, using a model which includes social context variables. A prospective survey of a New Zealand population sample aged 54-70 at baseline (N = 2,282) was used to assess the effects on mental and physical health across time. A structural equation model assessed pathways from the social context variables through network engagement to social support and then to mental and physical health 2 years later. The proposed model of effects on mental health was supported when gender, economic living standards, and ethnicity were included along with the direct effects of these variables on social support. These findings confirm the importance of taking social context variables into account when considering social support networks. Social engagement appears to be an important aspect of social network functioning which could be investigated further. [ABSTRACT FROM AUTHOR]

The article discusses a study to identify the time course of the retrieval of words from semantic memory. The study contains a test administered to 65 inpatients with major depression and 50 healthy controls. The result showed a shortcoming in the retrieval of words from long-term memory in depressed patients. It is concluded that a generalized impairment in memory retrieval could be a characteristic of major depression.

Background: Because socioeconomic and cultural factors contribute to where one dies, it is important to document place of death determinants in diverse societies.Aim: The purpose of this study was to describe where persons in an Aotearoa New Zealand hospice die, and to identify factors that are associated with place of death.Design: A retrospective chart review was conducted.Setting/Participants: Data were extracted from the charts of all patients receiving services from one hospice (i.e. secondary care) for whom death occurred during 2006–2008; 1268 cases for whom place of death was recorded comprise this sample.Results: For close to half (47%), death occurred in the hospice inpatient unit, whereas 29% died at home, 8% died in an acute hospital setting, and 17% died in an aged/residential care facility. Bivariate analyses showed that persons who die in an aged/residential care facility are more likely to be aged 65 or older, unmarried, have a non-cancer diagnosis, and are likely poorer. Asians, those aged less than 65, those with cancer, and those admitted initially to hospice for respite care tended to die in the hospice inpatient unit. Multinominal logistic regression indicated that dying at home was only predicted by being from a Pacific Island.Conclusions: Age, economics, diagnosis, ethnicity, marital status, and whether one enters a hospice service for (at least in part) respite were all associated to a certain extent with where one dies. These findings contribute to the growing evidence linking various factors, especially ethnic groups, with place of death. [ABSTRACT FROM PUBLISHER]

Objective: Few community interventions following stroke enhance activity, participation or quality of life. We tested two novel community interventions designed to promote self-directed rehabilitation following stroke.Design: This was a randomized, controlled parallel group 2×2 trial.Setting: Community.Participants: Maori and Pacific New Zealanders, >15 years old, randomized within three months of a new stroke.Interventions: A DVD of four inspirational stories by Maori and Pacific people with stroke and a ‘Take Charge Session’ – a single structured risk factor and activities of daily living assessment, designed to facilitate self-directed rehabilitation.Main measures: Primary outcomes were Health-related Quality of Life (Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the Short Form 36 (SF-36)) 12 months from randomization. Secondary outcomes were Barthel Index, Frenchay Activities Index, Carer Strain Index and modified Rankin score.Results: One hundred and seventy-two people were randomized with 139 (80.8%) followed up at 12 months post randomization. The effect of the Take Charge Session on SF-36 PCS at 12 months was 6.0 (95% confidence interval (CI) 2.0 to 10.0) and of the DVD was 0.9 (95% CI −3.1 to 4.9). Participants allocated to the Take Charge Session were less likely to have a modified Rankin score of >2 (odds ratio (OR) 0.42, 95% CI 0.2 to 0.89) and their carers had lower (better) Carer Strain Index scores (−1.5, 95% CI −2.8 to −0.1).Conclusion: A simple, low-cost intervention in the community phase of stroke recovery aiming to promote self-directed rehabilitation improved outcomes. [ABSTRACT FROM PUBLISHER]

The decrease in physical activity time in and out of school increases the need for active commuting. School travel plan programs have been used internationally to increase active commuting in elementary school children. However, little research has been conducted in the reliability and validity of travel survey instruments. The purpose of this study was to evaluate the test–retest reliability and validity of the Hands-Up survey to assess active commuting to school from a random sample of children within the Auckland region, New Zealand. Test–retest reliability and criterion validity of travel modes were determined in 118 elementary school children in the Auckland region. The survey tool consisted of one question on commuting to school. Test–retest reliability and validity were evaluated using kappa coefficients. The level of agreement between the children’s responses (κ = .96, 95% confidence interval = 0.92-1.00) and between children’s and parents’ (κ = .91, 95% confidence interval = 0.85-0.98) were almost perfect. The Hands-Up survey is a valid and reliable tool to determine travel mode to school among elementary school children. [ABSTRACT FROM PUBLISHER]

Objective: To determine the feasibility, the cluster design effect and the variance and minimal clinical importance difference in the primary outcome in a pilot study of a structured approach to goal-setting.Design: A cluster randomized controlled trial.Setting: Inpatient rehabilitation facilities.Subjects: People who were admitted to inpatient rehabilitation following stroke who had sufficient cognition to engage in structured goal-setting and complete the primary outcome measure.Interventions: Structured goal elicitation using the Canadian Occupational Performance Measure.Main measures: Quality of life at 12 weeks using the Schedule for Individualised Quality of Life (SEIQOL-DW), Functional Independence Measure, Short Form 36 and Patient Perception of Rehabilitation (measuring satisfaction with rehabilitation). Assessors were blinded to the intervention.Results: Four rehabilitation services and 41 patients were randomized. We found high values of the intraclass correlation for the outcome measures (ranging from 0.03 to 0.40) and high variance of the SEIQOL-DW (SD 19.6) in relation to the minimally importance difference of 2.1, leading to impractically large sample size requirements for a cluster randomized design.Conclusions: A cluster randomized design is not a practical means of avoiding contamination effects in studies of inpatient rehabilitation goal-setting. Other techniques for coping with contamination effects are necessary. [ABSTRACT FROM AUTHOR]

The purpose of this study was to preliminarily examine family involvement with the primary caregivers of a specific population of New Zealand primary school students through a pilot validation of a New Zealand version of the Family Involvement Questionnaire, Elementary Version (FIQ-E; Manz, Fantuzzo, & Power, 2004). Participants were 285 primary caregivers of children attending primary school in Dunedin, New Zealand. Confirmatory and exploratory factor analyses were conducted to determine the factor structure of the New Zealand version of the FIQ-E. Exploratory factor analysis revealed a factor structure similar to the original FIQ-E; however, fewer and different items loaded onto the common factors. Implications for these findings, including differences in the factor structure and intercultural family involvement research, are explored. [ABSTRACT FROM AUTHOR]

Objectives: Health funders face the challenge of determining the appropriate level of surgeon fees in fee-forservice schemes. A resource-based relative value scale (RBRVS) attempts to identify the fees that would exist in a competitive market. Private insurance providers in New Zealand do not use a RBRVS but rather rely on a market. We explore the extent to which private surgeon fees in New Zealand are consistent with fees that would be generated by a RBRVS. Methods: Data on 155,290 surgical procedures from 2004-06 were provided by New Zealand's largest private health insurer. 314 procedure codes were matched to the Australian Ministry of Health and Ageing's RBRVS. A random effects model determined predicted surgeon reimbursements based on the RBRVS, the location and the year. Procedure volume and specialty were explored as potential sources of deviations. Results: The RBRVS, location and year explain 79% of the variation in surgeon fees. After accounting for the RBRVS, location and year, no statistical differences were found between five out of the seven specialties, but higher volume procedures were associated with lower fees. There was some evidence that the model explained less variation in lower volume procedures. Conclusions: Surgical fees were generally consistent with those predicted by the RBRVS. However, the fees for high volume procedures were relatively lower than predicted while the fees for low volume procedures appeared more variable. The findings are consistent with the hypothesis that market forces lowered prices for procedures with higher volumes. This has implications for how health funders might determine private surgical fees, especially in mixed public-private systems. [ABSTRACT FROM AUTHOR]

Recent research provides evidence that individuals shift in their perception of variants depending on social characteristics attributed to the speaker. This paper reports on a speech perception experiment designed to test the degree to which the age attributed to a speaker influences the perception of vowels undergoing a chain shift. As a result of the shift, speakers from different generations produce different variants from one another. Results from the experiment indicate that a speaker’s perceived age can influence vowel categorization in the expected direction. However, only older participants are influenced by perceived speaker age. This suggests that social characteristics attributed to a speaker affect speech perception differently depending on the salience of the relationship between the variant and the characteristic. The results also provide evidence of an unexpected interaction between the sex of the participant and the sex of the stimulus. The interaction is interpreted as an effect of the participants’ previous exposure with male and female speakers.The results are analyzed under an exemplar model of speech production and perception where social information is indexed to acoustic information and the weight of the connection varies depending on the perceived salience of sociophonetic trends. [ABSTRACT FROM PUBLISHER]

It is well established that speakers accommodate in speech production. Recent work has shown a similar effect in perception—speech perception is affected by a listener’s beliefs about the speaker. In this paper, we explore the consequences of such perceptual accommodation for experiments in speech perception and lexical access. Our interest is whether perceptual accommodation to one speaker—the experimenter who meets participants, for example— might have carry-over effects on participants’ behavior in subsequent tasks that do not directly involve the experimenter’s voice. We explore this possibility by exposing groups of participants to different varieties of English before they participate in experiments involving speech perception and/or lexical access. Our results reveal that the nature of this prior exposure considerably influences participants’ behavior in the tasks.This suggests that the phonetic detail of encountered speech is stored in the lexicon, together with information about the speaker’s regional origin. Subparts of phonetically detailed lexical distributions can then be effectively ‘primed’ by exposure to speakers or lexical items associated with particular dialects. We argue for an exemplar model of lexical representation with both word-level and phoneme-level representations. The consequences of cross-dialectal priming vary, depending on whether tasks involve primarily word-level or phoneme-level access. [ABSTRACT FROM PUBLISHER]

Objectives: Tinnitus is associated with hearing loss in adulthood, often resulting from noise or age, but it is not known whether children's hearing and/or middle ear health predispose them to tinnitus in adulthood. Methods: The participants were members of the Dunedin Multidisciplinary Health and Development Study, born in Dunedin, New Zealand, between April 1972 and March 1973. The base sample consisted of 1,037 children. Otitis media was assessed at 5,7, and 9 years of age; audiometry and tympanometry findings were recorded at 11 years of age, and a detailed description of the tympanic membrane was made at 15 years of age. At 32 years of age, 970 of the 1,015 living study members (96%) answered questions about tinnitus. Results: Children who had otitis media and a raised audiometric threshold went on to experience more tinnitus in adulthood than did those without middle ear disease or those who had otitis media without a raised threshold. In those who had recovered from otitis media, audiometric threshold elevation at lower and higher frequencies was associated with experiencing tinnitus in adulthood. Neither childhood otitis media alone nor elevated thresholds alone predicted adult tinnitus. Conclusions: Childhood otitis media with an associated hearing loss in the low and high frequencies was associated with a greater probability of experiencing tinnitus in adulthood. [ABSTRACT FROM AUTHOR]