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• A substantial proportion of those hospitalised for major trauma are readmitted within 30 days and 12 months. • Key predictive factors were older age, co-morbidities, intensive care unit admission and self-inflicted trauma injury. • Predictors differed for index-related readmissions and readmissions related to subsequent injury events. • Future interventions may need to be targeted differently for preventing subsequent injuries or index trauma injury-related readmissions. Understanding predictors of hospital readmission following major trauma is important as readmissions are costly and some are potentially avoidable. This study describes the incidence of, and sociodemographic, injury-related and treatment-related factors predictive of, hospital readmission related to: a) all-causes, b) the index trauma injury, and c) subsequent injury events in the 30 days and 12 months following discharge for major trauma patients nationally in New Zealand. Data from the New Zealand Trauma Registry (NZTR) was linked with Ministry of Health hospital discharge data. Hospital readmissions were examined for all patients entered into the NZTR for an injury event between 1 January and 31 December 2018. Readmissions were examined for the 12-months following the discharge date for participant's index trauma injury. Of 1986 people, 42% had ≥1 readmission in the 12 months following discharge; 15% within 30 days. Seven percent had ≥1 readmission related to the index trauma within 30 days of discharge; readmission was 3.43 (95% CI 1.87, 6.29) times as likely if the index trauma was self-inflicted compared to unintentional, and 1.64 (95% CI 1.15, 2.34) times as likely if the index trauma involved intensive care unit admission. Those admitted to hospital for longer for their index trauma were less likely to be readmitted due to their index trauma injury within 30 days compared to those admitted for 0–1 day. Seventeen percent were readmitted for a subsequent injury event within 12 months, with readmission more likely for older people (>65 years), those with comorbidities, Māori compared with non-Māori and those with higher trauma injury severity. A substantial proportion of people are readmitted after discharge for major trauma. Factors identified in this study will be useful to consider when developing interventions to reduce preventable readmissions including those related to the index trauma injury, readmissions from other causes and subsequent injury-related readmissions. Further research specifically examining planned and unplanned readmissions is warranted. [ABSTRACT FROM AUTHOR]

Background: Depression during pregnancy is associated with a number of negative impacts on maternal and infant health, therefore good control of depression in pregnant women is crucial. There is a lack of population‐level information about patterns of antidepressant use during pregnancy in New Zealand. Aim: To describe antidepressant dispensing patterns before, during, and after pregnancy in New Zealand, 2005–2014. Materials and Methods: Antidepressant dispensing records from 270 days prior to pregnancy through to 360 days after pregnancy end were linked with 805 990 pregnancies in the New Zealand Pregnancy Cohort. Proportions (and 95% confidence intervals) with at least one dispensing were calculated for the periods before, during, and after pregnancy and compared over time and by maternal characteristics. Results: Dispensing during the first trimester was lower than in the pre‐pregnancy and post‐pregnancy periods, and dropped further in later trimesters. The proportion of pregnancies during which an antidepressant was dispensed rose from 3.1 to 4.9% over the study years. Around 80% of those with a dispensing received a selective serotonin reuptake inhibitor. Dispensing before, during, and after pregnancy varied by ethnicity, age, smoking status, and body mass index. Among women taking an antidepressant before pregnancy, younger women and those of Māori, Pacific, or Asian ethnicity were less likely to continue therapy during pregnancy. Conclusions: This study has established a baseline for antidepressant use around pregnancy in New Zealand, documented increasing use over time, and demonstrated that known ethnic differences in antidepressant use are also evident in the pregnant population. [ABSTRACT FROM AUTHOR]

Aim Surgical reconstructions of orbital fractures due to trauma are increasing worldwide. This study identifies characteristics of patients facing such procedures, possible causes for increasing trends, and factors associated with the duration from trauma to surgical procedures. Methods Trauma-related orbital reconstruction procedures in New Zealand over a 15-year period were identified from Ministry of Health hospital discharge data. Age-standardised rates for each year and age-specific rates for each gender were calculated using age, sex and year-specific population data from New Zealand population censuses. The contribution of these procedures to total trauma-related maxillofacial procedures was assessed. Descriptive statistics were used to identify demographic, trauma-related, and procedure-related characteristics associated with higher frequency and increasing trends. Characteristics independently associated with time delay from trauma to surgery were identified by multivariable Cox regression modelling. Results Orbital procedures are most common among males and the young to middle aged, and trends in frequency and rates of procedures are sharply increasing outnumbering other types of trauma-related maxillofacial procedures, with interpersonal violence being a major contributor to this increase. Younger age and higher number of injuries are associated with less time delay from injury to procedure while Asian ethnicity, motor vehicle accidents, non-maxillofacial primary diagnoses, and higher number of medical comorbidities are associated with longer delay. Conclusion The first three findings are consistent with international literature, and could be considered by policy makers when deriving preventive measures. The findings related to time delay are new and could contribute information towards forming clinical guidelines if similar patterns were identified elsewhere. [ABSTRACT FROM AUTHOR]

Contact with child protection systems are a key site of the expression of social inequalities, yet research into the size and nature of this relationship remains sparse in the Aotearoa New Zealand system context. This article reports on a study of the relationships between child protection system contact and small area-level deprivation. Using a national linked dataset including all children with system contact in 2013–14, (n = 13,851 children) it found there is a marked relationship between deprivation and system contact, and significant differences between regions for all three outcomes of interest. Compared to children living in the least deprived quintile of small areas, children in the most deprived quintile had, on average, 13 times the rate of substantiation, 18 times the rate of a family group conference, and 6 times their chance of placement in foster care. There was limited evidence for the 'inverse intervention law' that proposes that children in similarly deprived small areas have higher rates of child protection system contact if they live in less deprived regions (larger areas). The pattern of placements showed the strongest support for this law, with children in similarly deprived small areas having, on average, almost twice the rate of placement if they lived in less deprived regions compared to more deprived regions. These findings have implications for policy, as they suggest a need to apply an inequalities perspective to child protection similarly to health inequities. Specifically, action is needed to address the causes of deprivation, provide services that respond to families living in poverty, address biases, and undertake further research to examine the interactions between demand and supply of services between similar deprivation levels. • Contact with child protection systems may reflect social inequalities similar to health inequities. • This article reports on a study of relationships between child protection system contact and deprivation. • There was a strong relationship between deprivation and all types of system contact, showing evidence of a marked social gradient in contact patterns. • There was limited evidence for the 'inverse intervention law', showing a small increase in the chances of care for equally deprived children in different regions. • Implications are that more policy attention is required to address the causes of social inequalities in system contact. [ABSTRACT FROM AUTHOR]

Background Effective use of routinely collected hospital discharge data (HDD) to estimate injury incidence requires a separate identification of new injuries from readmissions for a previous injury. The aim was to determine the accuracy of a computerised algorithm to identify injury readmissions in HDD. Methods A random sample of 2000 events ('key events') were selected from the 2006 injury subset of New Zealand's HDD. Discharge histories from 1989 to 2007 were extracted for individuals and manually reviewed by at least two people to determine the 'gold standard' readmission status of each key event. The algorithm relies on four variables: unique national person identifier, dates of injury, admission and discharge. Reviewers were provided with these variables as well as additional discharge information (eg, discharge type and external cause code narrative) recorded in the HDD. Results of the manual review were compared to those obtained from the algorithm. Results The algorithm assigned 1811 (90.6%) as incident admissions compared to 1800 (90.0%) classified by the gold standard. Agreement was 97.9%, and accuracy measures (sensitivity, specificity, negative predictive value and positive predictive value) ranged from 87% to 99%. No statistically significant differences between readmission assignation by the algorithm and the gold standard were observed by age, nature of injury, external cause of injury or body region. Conclusions Any country with electronic HDD could readily identify readmissions and, thus, accurately estimate injury incidence from HDD, providing that a unique person identifier and the date of injury were included in addition to the obligatory dates of admission and discharge. [ABSTRACT FROM AUTHOR]