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Introduction. Gender affirming hormone therapy (GAHT) is an important aspect of health care for many transgender and non-binary (TNB) people, but little is known about the long-term outcomes for TNB people in Aotearoa New Zealand (NZ). Pathways to access GAHT are shifting from secondary care towards primary care, so this is an opportune time to commence local research on long-term health and wellbeing outcomes for people initiating GAHT. Aim. This paper aims to report on the key findings from four meetings held to inform the design of a prospective cohort study to follow the journey of people initiating GAHT in primary and secondary care settings in NZ. Methods. We worked with a community advisory group of six TNB young people and sought input from 14 health care providers involved in the care of TNB people initiating GAHT (GPs, secondary care doctors, and mental health providers). Semi-structured interview schedules were used to guide discussions. Template analysis was used to initially code data based on themes identified from the interview schedule and new themes from discussions were added. Results. Participants shared ideas about recruitment and data collection priorities for baseline and follow-up surveys. These included understanding the journey to starting hormone therapy (information-seeking, decision-making), access to services for GAHT initiation, appropriateness of information provision, receipt of the first prescription, goals for and experience of GAHT, and the unique needs of non-binary people. Discussion. Input from a TNB advisory group and health care professionals has informed the development of a survey that will be used to understand the experience of, and outcomes for, people starting GAHT in NZ. Findings from this planned prospective cohort study have the potential to improve access to GAHT for TNB people who wish to pursue this option. [ABSTRACT FROM AUTHOR]

Aim: Develop evidence‐based recommendations for managers to support primary healthcare nurses to thrive at work. Design: A mixed‐methods sequential explanatory design. Methods: National data were collected in 2020 via an e‐survey based on a meta‐analysis of antecedents of thriving from 213 primary healthcare nurses across New Zealand. Structural equation modelling analysis identified the key factors supporting primary healthcare nurses to thrive. This informed a second open‐ended e‐survey in 2022 of 19 nurses from one primary healthcare organization. The thematic analysis provided recommendations for improving management strategies to support thriving primary healthcare nurses. Results: The vitality component of thriving significantly reduced burnout and intention to leave organization and profession. In contrast, the learning component of thriving had a significant positive effect on burnout. The key factors that support thriving at work are empowering leadership and perceived organizational supports (decreases burnout and intention to leave organization and profession through enhanced vitality). Recommendations for improving thriving were made in eight key areas: communication, effective management, professional development, scope of practice, autonomy, effective orientation, reward and work–life balance. Conclusions: Vitality is important in reducing burnout and turnover intentions. While learning was identified as increasing burnout, professional development and training for managers were identified as essential. Hence, the vitality dimension of the thriving at work construct should be studied at the dimension level, but more research is needed into the impact of learning on thriving over time. Primary healthcare nurses have identified that empowering leadership and perceived organizational support are critical factors in supporting them to thrive, and they provide specific recommendations for managers to improve these factors in the clinical setting. No Patient or Public Contribution: This study collected data from Registered Nurses only. What Is Already Known: A plethora of existing research focuses on resilience in nurses rather than thriving at work.Enabling employees to thrive at work contributes to improved well‐being and sustainable organizational performance. What This Paper Adds: Empowering leadership and perceived organizational support are the key factors that support primary healthcare nurses to thrive at work.The vitality dimension of the thriving at work construct should be studied at the dimension level, and further research is needed into the impact of learning on thriving over time.Primary healthcare nurses recommend that managers focus on improving communication, management efficiency, professional development, scope of practice, autonomy, orientation, reward and work–life balance. [ABSTRACT FROM AUTHOR]

Objective: Professional sport occupies a prominent cultural position in societies across the globe and commercial organisations make use of this to promote their products. The present scoping review explores existing academic literature on the relationship between professional sports clubs and food and drink marketing and considers how this relationship may impact upon the public's health.Design: The scoping review searched six databases. Experts were also consulted. Records written in languages other than English were excluded. We also excluded records relating to mega events (e.g. Olympics, Football World Cup) and alcohol marketing, because of the attention already given to these.Setting: Professional sports clubs.Results: We identified 18 166 titles, reviewed 163 abstracts and read twenty-six full texts. We included six papers in the review. Four were from Australia and New Zealand. The Australasian literature focused largely on the marketing of foods and beverages to children and the potential impact on consumption. Single papers from researchers in Turkey and the USA were identified. The Turkish paper analysed shirt sponsorship in football leagues internationally and showed food and beverage (including alcohol) companies were the most common sponsors. The US paper examined a mixed reaction to a football team named after an energy drink.Conclusions: Commercial relationships between professional sports clubs and Big Food corporations have largely eluded scrutiny in much of the world. The current review highlights the lack of public health research on these relationships. Research exploring the interdependent commercial practices of food and drink companies and professional sports clubs is urgently needed. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Police and ambulance staff are increasingly asked to help people experiencing mental health crises, but they often feel under‐prepared.The single frontline service approach is time‐intensive and risks a coercive pathway to care.The emergency department is the default location for transfers by police or ambulance involving a person involved in a mental health crisis, despite being viewed as suboptimal. What the paper adds to existing knowledge: Police and ambulance staff struggled keeping up with the mental health demand, reporting inadequate mental health training, little enjoyment and negative experiences when trying to access help from other services.Most mental health staff had adequate mental health training and enjoyed their work, but many experienced difficulties getting help from other services.Police and ambulance staff found it hard to work with mental health services. What are the implications for practice: The combination of limited training, poor interagency referral processes, and difficulties accessing support from mental health services means that when police and ambulance services attend mental health crises alone, distress may be heightened and prolonged. Enhanced mental health training for first responders and more streamlined referral processes may improve process and outcomes.Mental health nurses have key skills that could be utilized in assisting police and ambulance staff who attend 911 emergency mental health calls.New models such as co‐response teams, whereby police, mental health clinicians and ambulance staff respond conjointly should be trialled and evaluated. Introduction: First responders are increasingly called to assist people experiencing mental health crises but little research exists canvassing multi‐agency perspectives of such work. Aim/Question: To understand the views of police officers, ambulance and mental health staff attending mental health or suicide‐related crises in Aotearoa New Zealand and to discover how they experience current models of cross‐agency collaboration. Methods: A descriptive cross‐sectional survey involving mixed methods. Quantitative data were analysed using descriptive statistics and free text by content analysis. Results: Participants included 57 police officers, 29 paramedics and 33 mental health professionals. Mental health staff felt adequately trained, but only 36% described good processes for accessing inter‐agency support. Police and ambulance staff felt undertrained and unprepared. Accessing mental health expertise was considered difficult by 89% of police and 62% of ambulance staff. Discussion: Frontline services struggle managing mental health‐related 911 emergencies. Current models are not working well. Miscommunication, dissatisfaction and distrust exist between police, ambulance and mental health services. Conclusion: The single‐agency frontline response may be detrimental to service users in crisis and under‐utilizes the skills of mental health staff. New ways of inter‐agency cooperation are required, such as co‐located police, ambulance and mental health nurses responding in partnership. [ABSTRACT FROM AUTHOR]

This paper explores teenage girls' responses to general advice, and formal prevention messages, designed to reduce sexting-related risk and prevent harm. We conducted workshops with seven groups of girls (28 in total), aged 16–17 years, in a New Zealand city. Each group participated in a series of three workshop sessions. Drawing on a Freirean 'problem-posing' approach, we designed the workshops as spaces in which girls were invited to observe and critically discuss norms related to sharing nudes as well as harm prevention messages. Girls noticed the problematic gender and sexual politics that shape abstinence-based models that target girls (implicitly) to not send nudes, but which leave boys who distribute or otherwise misuse them out of the picture. Participants navigated a careful path between attending to risk and protection on the one hand, and endorsing their right to freedom of expression on the other. We argue for a subtle, but significant, shift away from a focus on sexting safety to a focus on the prevention of image-based sexual coercion, harassment and abuse. This reframing would help to direct prevention efforts to the gendered drivers and dynamics of harm perpetration, and the ways in which they are problematically socially ignored or condoned. [ABSTRACT FROM AUTHOR]

Background: Pacific people living in New Zealand, Australia, United States, and the Pacific region continue to experience a disproportionately high burden of long-term conditions, making culturally contextualised behaviour change interventions a priority. The primary aim of this study was to describe the characteristics of behaviour change interventions designed to improve health and effect health behaviour change among Pacific people.Methods: Electronic searches were carried out on OVID Medline, PsycINFO, PubMed, Embase and SCOPUS databases (initial search January 2019 and updated in January 2020) for studies describing an intervention designed to change health behaviour(s) among Pacific people. Titles and abstracts of 5699 papers were screened; 201 papers were then independently assessed. A review of full text was carried out by three of the authors resulting in 208 being included in the final review. Twenty-seven studies were included, published in six countries between 1996 and 2020.Results: Important characteristics in the interventions included meaningful partnerships with Pacific communities using community-based participatory research and ensuring interventions were culturally anchored and centred on collectivism using family or social support. Most interventions used social cognitive theory, followed by popular behaviour change techniques instruction on how to perform a behaviour and social support (unspecified). Negotiating the spaces between Eurocentric behaviour change constructs and Pacific worldviews was simplified using Pacific facilitators and talanoa. This relational approach provided an essential link between academia and Pacific communities.Conclusions: This systematic search and narrative synthesis provides new and important insights into potential elements and components when designing behaviour change interventions for Pacific people. The paucity of literature available outside of the United States highlights further research is required to reflect Pacific communities living in New Zealand, Australia, and the Pacific region. Future research needs to invest in building research capacity within Pacific communities, centering self-determining research agendas and findings to be led and owned by Pacific communities. [ABSTRACT FROM AUTHOR]

Background: Lone parents and their children experience higher than average levels of adverse health and social outcomes, much of which are explained by high rates of poverty. Many high income countries have attempted to address high poverty rates by introducing employment requirements for lone parents in receipt of welfare benefits. However, there is evidence that employment may not reduce poverty or improve the health of lone parents and their children.Methods: We conducted a systematic review of qualitative studies reporting lone parents' accounts of participation in welfare to work (WtW), to identify explanations and possible mechanisms for the impacts of WtW on health and wellbeing. Twenty one bibliographic databases were searched. Two reviewers independently screened references and assessed study quality. Studies from any high income country that met the criteria of focussing on lone parents, mandatory WtW interventions, and health or wellbeing were included. Thematic synthesis was used to investigate analytic themes between studies.Results: Screening of the 4703 identified papers and quality assessment resulted in the inclusion of 16 qualitative studies of WtW in five high income countries, USA, Canada, UK, Australia, and New Zealand, covering a variety of welfare regimes. Our synthesis found that WtW requirements often conflicted with child care responsibilities. Available employment was often poorly paid and precarious. Adverse health impacts, such as increased stress, fatigue, and depression were commonly reported, though employment and appropriate training was linked to increased self-worth for some. WtW appeared to influence health through the pathways of conflict and control, analytical themes which emerged during synthesis. WtW reduced control over the nature of employment and care of children. Access to social support allowed some lone parents to manage the conflict associated with employment, and to increase control over their circumstances, with potentially beneficial health impacts.Conclusion: WtW can result in increased conflict and reduced control, which may lead to negative impacts on mental health. Availability of social support may mediate the negative health impacts of WtW. [ABSTRACT FROM AUTHOR]

In contemporary times, evidence-based medicine is used as the basis for clinical decision-making. For a great number of diseases, surveillance guidelines, which are informed by evidence-based medicine, have been drawn up with much input from specialists in their relevant fields. However, these guidelines are implemented in general practice where different rationalities are brought to bear on clinical decision-making. This qualitative study interviewed both specialists and General Practitioners in New Zealand about their use of surveillance guidelines for colorectal cancer. Tension between both groups of medical professionals was apparent with regard to referral practices, with specialists advocating a rational approach to risk. However, the socio-cultural context within which General Practitioners' clinical decision-making takes place demands a more reflexive process. This paper argues the need to explore power within medical practice as the devolution of power to one group, specialists, who are constructed as the knowledge 'elite', sidelines other groups, in this case General Practitioners, who have to deal with the more qualitative aspects of health service delivery. [ABSTRACT FROM AUTHOR]

Worldwide, populations are ageing and consequently so are the consumer profiles for most organisations. Understanding how best to ensure satisfaction in interactions with older customers, patients, members of organisations, and so on is therefore increasingly important. This paper examines two research questions: (a) How satisfied or dissatisfied are older people with their customer service experience, and what are the factors associated with dissatisfaction? and (b) What prompts older people to want to change service providers? The research questions are addressed using a mixed-methods approach – quantitative analysis of observation logs, supported by illustrative quotes from focus groups. We find that on the whole older people are generally satisfied with their interactions with organisations, although a substantial minority of interactions lead to dissatisfaction or lower-than-expected satisfaction. Dissatisfaction with interactions is mostly associated with impersonal communications, including interactions that are not conducted face to face, and those that are one-off interactions rather than repeated interactions. Media and communications firms prompted the greatest levels of dissatisfaction among older consumers. Dissatisfied older consumers from our sample are more than 12 times more likely to report an intention to switch providers than satisfied consumers. This highlights the potential costs to organisations of poor customer interactions with older people. [ABSTRACT FROM PUBLISHER]

Unhealthy food environments are known to be major drivers of diet-related non-communicable diseases globally, and there is an imperative for major food companies to be publicly accountable for their actions to improve the healthiness of food environments. This paper examines the prevalence of publicly available policies and commitments of major packaged food and soft drink manufacturers, and fast-food restaurants in Australia, New Zealand and Fiji with respect to reducing food marketing to children and product (re)formulation. In each country, the most prominent companies in each sector were selected. Company policies, commitments and relevant industry initiatives were gleaned from company and industry association websites. In Australia and New Zealand, there are a higher proportion of companies with publicly available marketing and formulation policies than in Fiji. However, even in Australia, a large proportion of the most prominent food companies do not have publicly available policies. Where they exist, policies on food marketing to children generally focus on those aged less than 12, do not apply to all types of media, marketing channels and techniques, and do not provide transparency with respect to the products to which the policies apply. Product formulation policies, where they exist, focus mostly on salt reduction and changes to the make-up of overall product portfolios, and do not generally address saturated fat, added sugar and energy reduction. In the absence of strong policies and corresponding actions by the private sector, it is likely that government action (e.g. through co-regulation or legislation) will be needed to drive improved company performance. [ABSTRACT FROM AUTHOR]

The design of urban environments often influences neighborhood physical activity and is crucial to supporting the health and mobility of aging urban populations. However, changes to urban infrastructure take time to implement and are rarely evaluated over long periods. In this study, we examined the long-term outcomes of rapid urban change and rebuilding following a sequence of devastating earthquakes in Christchurch, New Zealand. The study drew on a novel mixed-methods approach, including on-site environmental audits, desktop spatial analyses, and subjective auditor observations, to track support for active aging over a decade of post-disaster rebuilding in 10 aging neighborhoods. [ABSTRACT FROM AUTHOR]

Introduction. The New Zealand Medicinal Cannabis Scheme (NZMCS) was established in April 2020 with the aim of expanding access to quality controlled medicinal cannabis products and developing a domestic medicinal cannabis industry. Yet, two years later, many patients report challenges in utilising the NZMCS, including physicians' reluctance to provide prescriptions for products. Aim. To explore the barriers and facilitators to prescribing medicinal cannabis in New Zealand. Methods. We conducted semi-structured interviews with 31 New Zealand physicians (general practitioners, specialists, and cannabis clinicians) who had discussed medicinal cannabis with patients in the last 6 months. Results. Physicians reported the principal barrier to prescribing medicinal cannabis was the limited clinical evidence to support cannabis therapy. Further barriers included: a perceived lack of knowledge of medicinal cannabis; concerns over professional reputation; social stigma; and the price of products. Conversely, the factors that facilitated cannabis prescribing included patients' and physicians' knowledge of medicinal cannabis; some physicians' desire to avoid patients having to engage with private cannabis clinics; and the timing of prescription requests (ie considering medicinal cannabis after other treatments had been exhausted). Discussion. Further clinical research of medicinal cannabis medications, education and training, and information would support physicians to deliver more informed advice to patients and enhance professional confidence with cannabis therapies. [ABSTRACT FROM AUTHOR]

Background: Long-term residential care (LTC) supports the most vulnerable and is increasingly relevant with demographic ageing. This study aims to describe entry to LTC and identify predictive factors for older Māori (indigenous people of New Zealand) and non-Māori.Methods: LiLACS-NZ cohort project recruited Māori and non-Māori octogenarians resident in a defined geographical area in 2010. This study used multivariable log-binomial regressions to assess factors associated with subsequent entry to LTC including: self-identified ethnicity, demographic characteristics, self-rated health, depressive symptoms and activities of daily living [ADL] as recorded at baseline. LTC entry was identified from: place of residence at LiLACS-NZ interviews, LTC subsidy, needs assessment conducted in LTC, hospital discharge to LTC, and place of death.Results: Of 937 surveyed at baseline (421 Māori, 516 non-Māori), 77 already in LTC were excluded, leaving 860 participants (mean age 82.6 +/- 2.71 years Māori, 84.6 +/- 0.52 years non-Māori). Over a mean follow-up of 4.9 years, 278 (41% of non-Māori, 22% of Māori) entered LTC; of the 582 who did not, 323 (55%) were still living and may yet enter LTC. In a model including both Māori and non-Māori, independent risks factors for LTC entry were: living alone (RR = 1.52, 95%CI:1.15-2.02), self-rated health poor/fair compared to very good/excellent (RR = 1.40, 95%CI:1.12-1.77), depressive symptoms (RR = 1.28, 95%CI:1.05-1.56) and more dependent ADLs (RR = 1.09, 95%CI:1.05-1.13). For non-Māori compared to Māori the RR was 1.77 (95%CI:1.39-2.23). In a Māori-only model, predictive factors were older age and living alone. For non-Māori, factors were dependence in more ADLs and poor/fair self-rated health.Conclusions: Non-Māori participants (predominantly European) entered LTC at almost twice the rate of Māori. Factors differed between Māori and non-Māori. Potentially, the needs, preferences, expectations and/or values may differ correspondingly. Research with different cultural/ethnic groups is required to determine how these differences should inform service development. [ABSTRACT FROM AUTHOR]

Background: Interstitial Lung Disease (ILD) is a group of respiratory conditions affecting the lung interstitium often associated with progressive respiratory failure. There is increasing recognition of the need for improved epidemiological data to help determine best practice and improve standardisation of care. The Australasian ILD Registry (AILDR) is a bi-national registry of patients with all ILD subtypes designed to establish a clinically meaningful database reflecting real world practice in Australasia with an objective to improve diagnostic and treatment pathways through research and collaboration.Methods: AILDR is a prospective observational registry recruiting patients attending ILD clinics at centres around Australia and New Zealand. Core and non-core data are stored on a secure server. The pilot phase was launched in 2016 consisting of four sites in Australia. Currently in its second phase a further 16 sites have been recruited, including three in New Zealand.Results: A total of 1061 participants were consented during the pilot phase. Baseline data demonstrated a mean age 68.3 ± 12.5 (SD) years, mean FVC (%predicted) 79.1 ± 20.4 (SD), mean DLCO (%predicted) 58.5 ± 17.9 (SD) and nadir exertional SpO2 (%) 91 ± 6.9 (SD). Idiopathic pulmonary fibrosis (31%) and connective-tissue disease related ILD (21.7%) were the two most common subtypes. Baseline demographics and physiology were not significantly different across the four centres.Conclusion: AILDR is an important clinical and research tool providing a platform for epidemiological data that will prove essential in promoting understanding of a rare cohort of lung disease and provide foundations for our aspiration to standardise investigation and treatment pathways of ILD across Australasia. [ABSTRACT FROM AUTHOR]

Literacy success lays the foundation for children's later educational, health, and well-being outcomes. Thus, early identification of literacy need is vital. Using data from New Zealand's national preschool health screening program for fiscal years 2010/2011-2014/2015, demographic and health variables from 255,090 children aged 4 years were related to whether they received a literacy intervention in early primary school. Overall, 20,652 (8.1%) children received an intervention. Time-to-event analysis revealed that all considered variables were significantly related to literacy intervention (all p < .01), but the full model lacked reasonable predictive power for population screening purposes (Harrell's c-statistic = .624; 95% CI [.618, .629]). Including more direct literacy measures in the national screening program is likely needed for improvement. [ABSTRACT FROM AUTHOR]

Trial planning requires making efficient yet practical design choices. In a cluster randomized crossover trial, clusters of subjects cross back and forth between implementing the control and intervention conditions over the course of the trial, with each crossover marking the start of a new period. If it is possible to set up such a trial with more crossovers, a pertinent question is whether there are efficiency gains from clusters crossing over more frequently, and if these gains are substantial enough to justify the added complexity and cost of implementing more crossovers. We seek to determine the optimal number of crossovers for a fixed trial duration, and then identify other highly efficient designs by allowing the total number of clusters to vary and imposing thresholds on maximum cost and minimum statistical power. Our results pertain to trials with continuous recruitment and a continuous primary outcome, with the treatment effect estimated using a linear mixed model. To account for the similarity between subjects' outcomes within a cluster, we assume a correlation structure in which the correlation decays gradually in a continuous manner as the time between subjects' measurements increases. The optimal design is characterized by crossovers between the control and intervention conditions with each successive subject. However, this design is neither practical nor cost-efficient to implement, nor is it necessary: the gains in efficiency increase sharply in moving from a two-period to a four-period trial design, but approach an asymptote for the scenarios considered as the number of crossovers continues to increase. [ABSTRACT FROM AUTHOR]

Background: Physician migration has been gaining attention worldwide. In Germany, physician migration became a topic of interest in the context of the discussion about a shortage of physicians, for which one contributing factor may be physicians leaving the country. However, there is a lack of literature on "push" factors causing German physicians to leave. The present study seeks to provide current data in an effort to promote the identification of "push" factors motivating German physicians to emigrate.Methods: In a cross-sectional survey, all physicians ≤40 years of age registered with the State Chamber of Physicians of Saxony, Germany (n = 5956) were sent a paper-pencil questionnaire examining socio-demographics, job satisfaction, the wish to emigrate, and the likelihood of moving abroad in the near future. Variables associated with the wish to emigrate were assessed with multivariate logistic regression models.Results: Approximately 30% of participants wished to emigrate. The favourite destination countries were Switzerland, Scandinavian countries, and Australia or New Zealand. Of participants wishing to emigrate, approximately 52% thought it likely to emigrate for a limited, and 15% for an unlimited period of time. Participants with the wish to emigrate were significantly less satisfied with their job situation as compared to physicians without the wish to emigrate, the one exception being their "relationship with patients". The three aspects with the highest difference in satisfaction were the overall work situation, followed by work load, and time for family, friends, and leisure activities. Being a woman, being in a relationship, and having children were associated with a lower chance for wishing to emigrate. Higher satisfaction with the factors "work load", "patient care", and "structural aspects" was also associated with a lower chance for wishing to emigrate.Conclusions: Emigration seems to be a viable option for at least a subset of physicians. Preventive measures should address modifiable determinants associated with an increased chance for wishing to emigrate, such as job satisfaction. Especially satisfaction with the factor "work load" seems to play a crucial role as a "push" factor for physician emigration. [ABSTRACT FROM AUTHOR]

Background: Nurse-led models of comprehensive geriatric assessment and care coordination can improve health management as well as reduce hospitalisations for high risk community dwelling older people. This study investigated the effect on healthcare utilisation of systematic case finding to identify high risk older people in the community with a subsequent comprehensive assessment and care coordination intervention by a Gerontology Nurse Specialist based in primary care.Methods: This was a controlled before-after study design located within primary healthcare practices in Auckland, New Zealand. An intervention model was initiated within two primary healthcare practices and involved a screening tool to identify high risk older people with succeeding gerontology nurse specialist assessment and care coordination. The comparison group included older people who received usual care at three comparable primary healthcare practices. The primary outcome measure was acute hospital admissions. Secondary outcomes included hospital re-admissions, length of stay, emergency department presentations, residential care admissions, and community contacts.Results: A total of 579 older people were posted the screening tool in the intervention group, with 517 completed screens (89% response rate) formulating the intervention group. A total of 101 older people were identified as high risk from these screens (20%). The comparison group comprised 883 older people. Comparing the intervention and comparison group, no statistical differences were found for hospital admissions, emergency department presentations, hospital re-admissions, length of stay, or residential care admission. Community physiotherapy showed a statistically significant increase for the intervention compared to the comparison group (p = 0.03). Non-significant findings revealed decreased risk of entering residential care and fewer frequent hospital re-admissions for the intervention group when compared with the comparison group.Conclusions: This specialist nurse-led intervention involving comprehensive assessment and care coordination care did not appear superior to usual care, however, there is benefit to exploring a more robust randomised controlled trial design.Trial Registration: Retrospectively registered on 18/09/2017 with the Australian New Zealand Clinical Trials Registry (ANZCTR). Registration number ACTRN12617001332314. [ABSTRACT FROM AUTHOR]

Background: In the context of the recent surge in community based multilevel interventions for suicide prevention, all of which show promising results, we discuss the implications of the findings of such an intervention designed for and implemented in New Zealand. The multi-level intervention for suicide prevention in New Zealand (MISP-NZ) was a cluster randomised controlled community intervention trial involving eight hospital regions matched into four pairs and randomised to either the intervention or practice as usual (the control). Intervention regions received 25 months of interventions (01 June 2010 to 30 June 2012) including: 1) training in recognition of suicide risk factors; 2) workshops on mental health issues; 3) community based interventions (linking in with community events); and 4) distribution of print material and information on web-based resources.Results: There was no significant difference between the change in rate of suicidal behaviours (ISH or self-inflicted deaths) in the intervention group compared with the control group (rate ratio = 1.07, 95% CI 0.82, 1.38).Conclusions: This study did not provide substantive evidence that the MISP-NZ intervention had an effect on suicidal behaviours raising important questions about the potential effectiveness of the multilevel intervention model for suicide prevention for all countries. Although a range of factors may account for this unanticipated finding, including inadequate study power, differences in design and intervention focus, and country-specific contextual factors, it is possible that the effectiveness of the multilevel intervention model for reducing suicidal behaviours may have been overstated.Trial Registration: This trial was retrospectively registered on 11 April 2013. ACTRN12613000399796 . [ABSTRACT FROM AUTHOR]

Variable decisions are a persistent problem in child welfare decision-making. This article reports on the findings of a study of variability drivers in Aotearoa New Zealand. Using a mixed methods ecological approach, it compares ‘risk-averse’ and ‘risk friendly’ practitioners (n = 67 child welfare social workers). The study found the risk-averse group contained more non-governmental child welfare workers, but there were no other demographic differences. Risk-averse respondents were more certain of their conclusions even when little information was provided, and rated the children’s safety lower. The risk-averse group estimated more harm to children over time, if there was no intervention. Both groups described risk and safety factors similarly, but despite this shared knowledge base, risk and safety level perceptions still differed. When explaining problem causes the risk-averse group focused on the past trauma histories of parents, whereas the risk-friendly group focused more on issues in the present. This pattern suggests practitioners conceptualise the meaning and weighting of risk factors differently, with some having a ‘developmental lifespan- futurist’ orientation as opposed to a ‘welfare/needs-presentist’ orientation. Implications for practice are discussed. [ABSTRACT FROM PUBLISHER]

Purpose: Communication disorders associated with Parkinson’s disease (PD) often lead to restricted participation in life roles, yet there is a limited understanding of influencing factors and few quantitative measurement tools available. This study aimed to identify variables associated with communicative participation in PD and to examine the relationship between the Communicative Participation Item Bank (CPIB) and existing health-related quality-of-life (HRQoL) measures. Method: Self-report data from 378 participants with PD from the US and New Zealand were analysed. Data included responses to the CPIB, PD Questionnaire-8, sub-scales of the Global Health instrument from the Patient Reported Outcomes Measurement Information System (PROMIS) and additional self-report instruments. Result: Greater perceived speech disorder, lower levels of speech usage, fatigue, cognitive and emotional problems and swallowing difficulties were associated with lower levels of communicative participation. Participants’ age significantly influenced findings, interacting with country of residence, sex and speech usage. Scores on the CPIB were moderately correlated with HRQoL measures. Conclusion: Communicative participation in PD is complex and influenced by both demographic and disease-based variables, necessitating a broader view of the communicative experiences of those with PD. Measurement of communicative participation as a separate construct to existing HRQoL measures is recommended. [ABSTRACT FROM PUBLISHER]

Objective: Patients with atherosclerotic cardiovascular disease (CVD) vary significantly in their risk of future CVD events; yet few clinical scores are available to aid assessment of risk. We sought to develop a score for use in primary care that estimates short-term CVD risk in these patients.Methods: Adults aged <80 years with prior CVD were identified from a New Zealand primary care cohort study (PREDICT), and linked to national mortality, hospitalisation and dispensing databases. A Cox model with an outcome of myocardial infarction, stroke or CVD death within 2 years was developed. External validation was performed in a cohort from the UK.Results: 24 927 patients, 63% men, 63% European, median age 65 years (IQR 58-72 years), experienced 1480 CVD events within 2 years after a CVD risk assessment. A risk score including ethnicity, comorbidities, body mass index, creatine creatinine and treatment, in addition to established risk factors used in primary prevention, predicted a median 2-year CVD risk of 5.0% (IQR 3.5%-8.3%). A plot of actual against predicted event rates showed very good calibration throughout the risk range. The score performed well in the UK cohort but overestimated risk for those at highest risk, who were predominantly patients defined as having heart failure.Conclusions: The PREDICT-CVD secondary prevention score uses routine measurements from clinical practice that enable it to be implemented in a primary care setting. The score will facilitate risk communication between primary care practitioners and patients with prior CVD, particularly as a resource to show the benefit of risk factor modification. [ABSTRACT FROM AUTHOR]

Background: Bell's palsy or acute idiopathic lower motor neurone facial paralysis is characterized by sudden onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. While there is high level evidence in adults demonstrating an improvement in the rate of complete recovery of facial nerve function when treated with steroids compared with placebo, similar high level studies on the use of steroids in Bell's palsy in children are not available. The aim of this study is to assess the utility of steroids in Bell's palsy in children in a randomised placebo-controlled trial.Methods/design: We are conducting a randomised, triple-blinded, placebo controlled trial of the use of prednisolone to improve recovery from Bell's palsy at 1 month. Study sites are 10 hospitals within the Australian and New Zealand PREDICT (Paediatric Research in Emergency Departments International Collaborative) research network. 540 participants will be enrolled. To be eligible patients need to be aged 6 months to < 18 years and present within 72 hours of onset of clinician diagnosed Bell's palsy to one of the participating hospital emergency departments. Patients will be excluded in case of current use of or contraindications to steroids or if there is an alternative diagnosis. Participants will receive either prednisolone 1 mg/kg/day to a maximum of 50 mg/day or taste matched placebo for 10 days. The primary outcome is complete recovery by House-Brackmann scale at 1 month. Secondary outcomes include assessment of recovery using the Sunnybrook scale, the emotional and functional wellbeing of the participants using the Pediatric Quality of Life Inventory and Child Health Utility 9D Scale, pain using Faces Pain Scale Revised or visual analogue scales, synkinesis using a synkinesis assessment questionnaire and health utilisation costs at 1, 3 and 6 months. Participants will be tracked to 12 months if not recovered earlier. Data analysis will be by intention to treat with primary outcome presented as differences in proportions and an odds ratio adjusted for site and age.Discussion: This large multicenter randomised trial will allow the definitive assessment of the efficacy of prednisolone compared with placebo in the treatment of Bell's palsy in children.Trial Registration: The study is registered with the Australian New Zealand Clinical Trials Registry ACTRN12615000563561 (1 June 2015). [ABSTRACT FROM AUTHOR]

Background: Behavioural brief interventions (BI) can support people to reduce harmful drinking but multiple barriers impede the delivery and equitable access to these. To address this challenge, we developed YourCall™, a novel short message service (SMS) text message intervention incorporating BI principles. This protocol describes a trial evaluating the effectiveness of YourCall™ (compared to usual care) in reducing hazardous drinking and alcohol related harm among injured adults who received in-patient care.Methods/design: Participants recruited to this single-blind randomised controlled trial comprised patients aged 16-69 years in three trauma-admitting hospitals in Auckland, New Zealand. Those who screened positive for moderately hazardous drinking were randomly assigned by computer to usual care (control group) or the intervention. The latter comprised 16 informational and motivational text messages delivered using an automated system over the four weeks following discharge. The primary outcome is the difference in mean AUDIT-C score between the intervention and control groups at 3 months, with the maintenance of the effect examined at 6 and 12 months follow-up. Secondary outcomes comprised the health and social impacts of heavy drinking ascertained through a web-survey at 12 months, and further injuries identified through probabilistic linkage to national databases on accident insurance, hospital discharges, and mortality. Research staff evaluating outcomes were blinded to allocation. Intention-to-treat analyses will include assessment of interactions based on ethnicity (Māori compared with non-Māori).Discussion: If found to be effective, this mobile health strategy has the potential to overcome current barriers to implementing equitably accessible interventions that can reduce harmful drinking.Trial Registration: Universal Trial Number (UTN) U1111-1134-0028. ACTRN12612001220853 . Submitted 8 November 2012 (date of enrolment of first participant); Version 1 registration confirmed 19 November 2012. Retrospectively registered. [ABSTRACT FROM AUTHOR]

Very old people (referred to as those aged 85 years and over) are the fastest growing age segment of many Western societies owing to the steady rise of life expectancy and decrease in later life mortality. In the UK, there are now more than 1·5 million very old people (2·5 % of total population) and the number is projected to rise to 3·3 million or 5 % over the next 20 years. Reduced mobility and independence, financial constraints, higher rates of hospitalisation, chronic diseases and disabilities, changes in body composition, taste perception, digestion and absorption of food all potentially influence either nutrient intake or needs at this stage of life. The nutritional needs of the very old have been identified as a research priority by the British Nutrition Foundation's Task Force report, Healthy Ageing: The Role of Nutrition and Lifestyle. However, very little is known about the dietary habits and nutritional status of the very old. The Newcastle 85+ study, a cohort of more than 1000 85-year olds from the North East of England and the Life and Living in Advanced Age study (New Zealand), a bicultural cohort study of advanced ageing of more than 900 participants from the Bay of Plenty and Rotorua regions of New Zealand are two unique cohort studies of ageing, which aim to assess the spectrum of health in the very old as well as examine the associations of health trajectories and outcomes with biological, clinical and social factors as each cohort ages. The nutrition domain included in both studies will help to fill the evidence gap by identifying eating patterns, and measures of nutritional status associated with better, or worse, health and wellbeing. This review will explore some of this ongoing work. [ABSTRACT FROM PUBLISHER]

Objective: To assess the mean package size and manufacturer-recommended serving size of sweet beverages available in four high-income countries: Australia, Canada, the Netherlands and New Zealand.Design: Cross-sectional surveys.Setting: The two largest supermarket chains of each country in 2012/2013.Subjects: Individual pack size (IPS) drinks (n 891) and bulk pack size (BPS) drinks (n 1904).Results: For all IPS drinks, the mean package size was larger than the mean serving size (mean (sd)=412 (157) ml and 359 (159) ml, respectively). The mean (sd) package size of IPS drinks was significantly different for all countries (range: Australia=370 (149) ml to New Zealand=484 (191) ml; P<0·01). The mean (sd) package size of Dutch BPS drinks (1313 (323) ml) was significantly smaller compared with the other countries (New Zealand=1481 (595) ml, Australia=1542 (595) ml, Canada=1550 (434) ml; P<0·01). The mean (sd) serving size of BPS drinks was significantly different across all countries (range: Netherlands=216 (30) ml to Canada=248 (31) ml; P<0·00). New Zealand had the largest package and serving sizes of the countries assessed. In all countries, a large number of different serving sizes were used to provide information on the amount appropriate to consume in one sitting.Conclusions: At this point there is substantial inconsistency in package sizes and manufacturer-recommended serving sizes of sweet beverages within and between four high-income countries, especially for IPS drinks. As consumers do factor serving size into their judgements of healthiness of a product, serving size regulations, preferably set by governments and global health organisations, would provide consistency and assist individuals in making healthier food choices. [ABSTRACT FROM AUTHOR]

Purpose: Despite strong investment in raising literacy achievement for all children, significant inequalities in literacy outcomes continue to exist among some of the world's most advanced economies. This study investigated the influence of a short, intensive period of phonological awareness (PA) instruction implemented by classroom teachers on raising the literacy achievement of children with and without spoken language impairment (SLI). Method: A quasi-experimental design was employed to measure the PA, reading, and spelling development of one hundred twenty-nine 5-year-olds. Thirty-four children received 10 weeks of PA instruction from their teachers. Ninety-five children continued with their usual reading program, which included phonics instruction but did not target PA. Results: Children who received PA instruction demonstrated superior literacy outcomes compared to children who followed the usual literacy curriculum. Children with SLI showed significant improvements in PA, reading, and spelling but had a different pattern of response to instruction compared to children with typical language. Importantly, the number of children experiencing word decoding difficulties at the end of the program was 26% among children who followed the usual literacy curriculum compared to 6% among children who received the PA instruction. Implications: A short, intensive period of classroom PA instruction can raise the literacy profiles of children with and without spoken language difficulties. [ABSTRACT FROM AUTHOR]

Background: Parents play an important role in the lives of adolescents and efforts aimed at strengthening parenting skills and increasing knowledge on adolescent development hold much promise to prevent and mitigate adolescent mental health problems. Innovative interventions that make use of technology-based platforms might be an effective and efficient way to deliver such support to parents. This protocol presents the design of a randomised controlled trial to investigate the effectiveness of a SMS-based mobile intervention (MyTeen) for parents of adolescents on promoting parental competence and mental health literacy.Methods: A parallel two-arm randomised controlled trial will be conducted in New Zealand, aiming to recruit 214 parents or primary caregivers of adolescents aged 10-15 years via community outreach and social media. Eligible participants will be allocated 1:1 into the control or the intervention group, stratified by ethnicity. The intervention group will receive a tailored programme of text messages aimed at improving their parental competence and mental health literacy, over 4 weeks. The control group (care-as-usual) will receive no intervention from the research team, but can access alternative services if they wish, and will be offered the intervention programme upon completion of a 3-month post-randomisation follow-up assessment. Data will be obtained at baseline, post intervention (1-month), and 3-month follow up. The primary outcome is parental competence assessed by the Parental Sense of Competence Scale at 1-month follow up. Secondary outcomes include: mental health literacy; knowledge of help-seeking; parental distress; parent-adolescent communication; and programme satisfaction.Discussion: To our knowledge this is the first randomised controlled trial on the effectiveness of delivering a parenting support intervention for parents of adolescents solely via a SMS-based mobile intervention. If effective, it could have great potential to reach and support parents of adolescents.Trial Registration: Australian New Zealand Clinical Trial Registry ( ACTRN12618000117213 ) Registered on 29/01/2018. [ABSTRACT FROM AUTHOR]

Background: Information communication technology (ICT) is a critical enabler of integrated models of community-based primary health care; however, little is known about how existing technologies have been used to support new models of integrated care. To address this gap, we draw on data from an international study of integrated models, exploring how ICT is used to support activities of integrated care and the organizational and environmental barriers and enablers to its adoption.Methods: We take an embedded comparative multiple-case study approach using data from a study of implementation of nine models of integrated community-based primary health care, the Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH) study. Six cases from Canada, three each in Ontario and Quebec, and three in New Zealand, were studied. As part of the case studies, interviews were conducted with managers and front-line health care providers from February 2015 to March 2017. A qualitative descriptive approach was used to code data from 137 interviews and generate word tables to guide analysis.Results: Despite different models and contexts, we found strikingly similar accounts of the types of activities supported through ICT systems in each of the cases. ICT systems were used most frequently to support activities like care coordination by inter-professional teams through information sharing. However, providers were limited in their ability to efficiently share patient data due to data access issues across organizational and professional boundaries and due to system functionality limitations, such as a lack of interoperability.Conclusions: Even in innovative models of care, managers and providers in our cases mainly use technology to enable traditional ways of working. Technology limitations prevent more innovative uses of technology that could support disruption necessary to improve care delivery. We argue the barriers to more innovative use of technology are linked to three factors: (1) information access barriers, (2) limited functionality of available technology, and (3) organizational and provider inertia. [ABSTRACT FROM AUTHOR]