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Introduction. The volume and quality of online health information requires consumers to be discerning. Aim. This study aimed to explore consumer Internet use for health information, preferred format and what factors helped them to trust the source. Methods. A cross-sectional study was conducted in 2016–2017 with adults attending three cardiology outpatient clinic sites using a short paper-based survey. The survey included questions regarding online health information use and perceived trustworthiness with opportunities for free text responses. Survey data were summarised with key questions adjusted by age group, gender and ethnicity using logistic regression. Results. Of the 708 respondents (51% women, 66% aged 45–74 years, 16% Māori, 12% Pacific), 73% had sought health information online (64% in the previous 12 months), commonly for medication side effects, their health condition and self-help. Most (65%) were successful, although Pacific respondents reported a lower likelihood of search success compared to Europeans. Younger age groups were more concerned about information quality. Fact sheets (80%) were the most popular format and for all ethnic groups, followed by short videos (31%) and discussion groups (23%). Trusting online information required many strategies with 72% wanting health professionals to recommend websites. Discussion. Online health information seeking is a norm for consumers, with simple fact sheets being the preferred format to build knowledge and skills. With the rising tide of misinformation, health portal providers need to offer accurate and easy-to-read fact sheets in their suite of formats and health professionals need to support consumers guiding them to trusted websites. [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]

In New Zealand, people receiving care from specialist mental health and addiction services experience poorer health outcomes compared to the general population. Māori (Indigenous) specialist mental health and addiction service users experience disproportionate inequities. This study aims to: (1) Describe and understand mental health staff perspectives on the quality of care delivered to specialist mental health and addiction service users in their service – including specifically for Māori; and (2) Identify areas staff report as opportunities for quality improvement. In 2020, Southern District Health Board (now Te Whatu Ora – Southern) mental health staff were invited to participate in a cross‐sectional study assessing their perceptions of a range of service aspects. This paper presents quantitative and qualitative analyses about quality of care. Among the 319 staff who completed the questionnaire; 272 provided quality‐of‐care responses. Among these, 78% reported the quality of care delivered to service users as 'good' or 'excellent'; only 60% reported this for Māori service users. Participants identified individual, service and broader system level factors influencing the quality of care delivered to service users, including factors specific for Māori. This study has identified, for what appears to be the first time, empirical and concerning differences in staff ratings of the quality of care delivered to Māori and SMHAS users overall. Findings highlight the need for institutional and managerial prioritization of hauora Māori, and incorporating tikanga Māori and Te Tiriti into practice. [ABSTRACT FROM AUTHOR]

Chronic pain is common in older people. However, little is known about how pain is experienced in residents of retirement villages ('villages'), and how pain intensity and associations are experienced in relation to characteristics of residents and village living. We thus aimed to examine pain levels, prevalence and associated factors in village residents. The current paper is a cross‐sectional analysis of baseline data from the 'Older People in Retirement Villages' study in Auckland, New Zealand. Between July 2016 and August 2018, 578 village residents were interviewed face‐to‐face by gerontology nurse specialists, using interRAI Community Health Assessment (CHA) and customised survey. We used a validated pain scale and multivariable logistic regression analyses adjusted for pre‐specified confounders. Residents' median age was 82 years; 420 (73%) were female; 270 (47%) exhibited/reported daily pain, and in 11% this was severe. After controlling for confounders, daily pain was positively associated with self‐reported arthritis (OR = 3.88, 95% CI = 2.57–5.87), poor/fair self‐reported health (OR = 3.19, 95% CI = 1.29–7.93), having no health clinic on‐site (OR = 1.76, 95% CI = 1.10–2.83), and minimal fatigue (diminished energy but completes normal day‐to‐day activities) (OR = 1.77, 95% CI = 1.11–2.81). Similar associations were observed for levels of pain. We conclude that levels of pain and prevalence of daily pain are high in village residents. Self‐reported arthritis, self‐reported poor/fair health, no health clinic on‐site and minimal fatigue are all independently associated with a higher risk of daily pain and with levels of pain. This study suggests potential opportunities for villages to better provide on‐site support to decrease prevalence and severity of pain for their residents, and thus potentially increase wellbeing and quality‐of‐life, though as we cannot prove causality, more research is needed. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on this subject?: The physical health of people with serious mental illness (SMI) is an issue of growing concern in New Zealand and internationally.Metabolic syndrome is prevalent among people with severe mental illness and increases the likelihood of developing cardiovascular disease and diabetes.No previous international research has investigated rates of metabolic monitoring in specialist mental health services and in primary care. What this paper adds to existing knowledge?: Rates of metabolic monitoring are low in this specialist mental health service and in primary care.Primary care nurses are positive in their views of their role in providing care for people with mental illness, and would value further education in this area. What are the implications for practice?: Services need to consider ways in which nurses can be supported to improve rates of metabolic monitoring.Guidelines may have a role to play in improved monitoring but need service‐level support in order to be effective. Introduction: People with serious mental illness experience significant disparities in their physical health compared with the general population. One indicator of health impairment is metabolic syndrome, which increases the likelihood of developing cardiovascular disease and diabetes. No international studies have reported both primary care and mental health nurses' rates of metabolic monitoring among people with serious mental illness, and no New Zealand studies have investigated rates of metabolic monitoring. Aim: To evaluate metabolic monitoring practices within one of New Zealand's 20 district health board regions. Method: An audit of clinical records in primary care (n = 46) and secondary care (n = 47) settings and a survey of practice nurses were conducted. A survey was sent to 127 practice nurses with a response rate of 19% (n = 24). Data were analysed using descriptive statistics. Results: Rates of metabolic monitoring were low in both services. Survey participants expressed positive views towards physical health monitoring and confidence in relating to mental health consumers. Rates of treatment of metabolic abnormalities were low, and communication between primary and secondary services was limited. Conclusion: Despite existence of guidelines and protocols, metabolic monitoring rates in both primary and secondary health services are low. Incorporating metabolic monitoring systems into service delivery, supported by appropriate tools and resourcing, is essential to achieve better clinical outcomes for people experiencing mental illness. [ABSTRACT FROM AUTHOR]

Objectives: HealthPathways, pioneered in Canterbury, New Zealand, in 2008, is a web-based tool designed to promote health care integration and patient management in primary care and to reduce fragmentation in the delivery of health services. This cross-sectional study evaluated the utilisation and perceptions of this tool among health professionals in Australia and New Zealand. Methods: A cross-sectional survey was administered online through Research Electronic Data Capture (REDCap) to general practitioners (GPs), practice nurses and managers, nurse practitioners, specialist and community nurses, hospital clinicians, nurses, managers, and allied health professionals between April and September 2018. The frequency of HealthPathways use in the previous month was modelled as an ordered response using an ordered logistic regression model after adjusting for the possible effects of sex, age, years in clinical practice, location and time spent in practice. Results: Health professionals perceived HealthPathways to be useful in primary care management and referral, as well as in the prereferral treatment of patients. GPs in New Zealand, New South Wales and Victoria were 73%, 47% and 27% more likely to have used HealthPathways ≥10 times in the previous month respectively. Conclusion: The results suggest that HealthPathways is having a positive effect on healthcare systems in New Zealand and Australia. However, differences in uptake suggests the need for focused implementation, integration into eReferral software and expanding the tool to medical students, registrars, allied health professionals and potentially patients to encourage behavioural change. What is known about the topic?: Early evaluations suggest that HealthPathways is a useful tool for health professionals, although uptake and utilisation may be limited. However, there is no comparative evidence regarding uptake and implementation of the tool. What does the paper add?: This study is among the first to provide a comparative narrative of the literature assessing the implementation and uptake of HealthPathways across Australia and New Zealand. It is also among the first to compare the perceptions of allied health professionals in the use of HealthPathways across Australia and New Zealand. What are the implications for practitioners?: The results of this study suggest the need for focused implementation, integration into eReferral software and expanding the tool to medical students, registrars, allied health professionals and potentially patients to encourage behavioural change. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Contemporary mental health policy stipulates consumer participation in all aspects of mental health services including service evaluation and other forms of mental health research.Research is identified as underpinning quality mental health services, and therefore, consumers researchers could enhance the mental health sector by contributing to the quality, credibility and relevance of mental health research. What this paper adds to existing knowledge?: Non‐consumer researchers generally supported the concept of a consumer expert reference group for researchers at the individual and institutional level.A consumer expert reference group should reflect diversity and offer expertise relevant to the topic of research and may represent one way to normalize partnerships with consumer researchers and realize the benefits they can bring to research. What are the implications for practice?: Quality mental health services are underpinned by robust research evidence. It is crucial that consumers are active participants in research activity.The availability of a consumer expert reference group could facilitate collaborations between consumer and non‐consumer researchers and contribute to a stronger consumer focus embedded in mental health research. Introduction: Contemporary mental health policy identifies consumers as active participants in all aspects of mental health services from design to evaluation. Consumer researchers should be actively involved in mental health research and contribute to quality service delivery. Aim: To gain a snapshot of mental health researcher views on strategies for increasing research by or with consumers in mental health through the establishment of an Expert Consumer Researcher Group (ECRG). Methods: Cross‐sectional survey of 41 non‐consumer mental health researchers from Australia or New Zealand. Results: The introduction of an ECRG was considered an effective strategy for linking consumer and non‐consumer researchers and providing specialist advice on research design and methodology. The most suitable location for this group was identified as within consumer advocacy agencies (71%), universities (66%) or research funding bodies (66%). Participants rated their likelihood of seeking advice from the ECRG as high. Discussion: Research participants supported the value of an ECRG. They emphasized the importance of ensuring the group reflected a diversity of views and offered specialized expertise related to the specific topic. The ECRG could benefit both individual researchers and larger research organizations. Implications for practice: An ECRG could facilitate collaborations with consumer researchers and in turn enhance the quality of mental health research. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Diabetes mellitus is common in primary care, yet little has been reported of its primary care prevalence or the clinical characteristics of patients with Type 2 diabetes mellitus (T2DM). AIM: To determine the prevalence of diabetes mellitus and clinical characteristics of diabetes patients in primary care in the Waikato region. METHODS: Primary care data were extracted from the electronic records of 15 general practices for patients aged >20 years with current diabetes mellitus at 20 June 2017. Diabetes mellitus was defined as having a glycated haemoglobin (HbA1c) of ≥50 mmol/mol (6.7%) or having being dispensed two or more anti-diabetic medications in the previous 12 months. Additional data collected included patients' ethnicity, age, sex and years since diagnosis. RESULTS: The overall prevalence of diabetes mellitus was 5.7% and was higher for Māori (8.6%), Asian (7.0%) and Pacific peoples (9.1%) than Europeans (5.0%; all P < 0.001). For patients with T2DM for whom current diabetes annual review data were available (n = 2227) the mean body mass index (BMI) was 32.8 ± 0.2 kg/m2, but BMI was higher in Māori, younger patients, females and patients diagnosed <2 years previously (all P < 0.001). Similarly, HbA1c levels were highest in Māori and younger patients (both P < 0.001), with 40% of patients overall having a HbA1c of ≤53 mmol/mol (7.0%). Approximately 70% of all patients had at least one measure of hypertension (systolic ≥130 or diastolic ≥80 mmHg), or dyslipidaemia. More than 85% of patients had completed a recent retinal screen and foot check. DISCUSSION: We found that management of T2DM was suboptimal, with measures for many patients not meeting clinical targets. Support should be provided to improve weight and glycaemic management, particularly for Māori, females and younger patients. [ABSTRACT FROM AUTHOR]

Background: Players in contact sports frequently experience mild traumatic brain (concussion) injuries (TBI). While there are known disruptions to balance following acute head trauma, it is uncertain if sport-related concussion injuries have a lasting impact on postural control. Aim: To assess postural control in retired rugby players in comparison to retired non-contact sport players, and to evaluate any association with self-reported sport-related concussion history. Methods: Using a cross-sectional design, 75 players in the NZ–RugbyHealth study from three sports groups (44 ± 8 years; 24 elite rugby, 30 community rugby, 21 non-contact sport) took part in this study. The SMART EquiTest® Balance Master was used to assess participant's ability to make effective use of visual, vestibular and proprioceptive information using standardised tests. Postural sway was also quantified using centre of pressure (COP) path length. The relationship among sports group, sport-related concussion history and postural control was evaluated using mixed regression models while controlling for age and body mass index. Results: Limited significant differences in balance metrics were found between the sports groups. A statistically significant (p < 0.001) interaction indicated a relationship between COP path length and sport-related concussion history in the most challenging balance condition, such that path length increased as the number of previous sport-related concussions increased. Conclusion: There was some evidence for a relationship between sport-related concussion recurrence in sports players and postural stability in challenging balance conditions. There was no evidence of impaired balance ability in retired rugby players compared with non-contact sport athletes. [ABSTRACT FROM AUTHOR]

gilmour j.a., huntington a., broadbent r., strong a. & hawkins m. (2012) Nurses' use of online health information in medical wards. Journal of Advanced Nursing 68(6), 1349-1358. Abstract Aim. This paper is a report of a study of nurses' access, use and evaluation of online health information in medical wards. Background. Online health information is commonly used by patients with chronic illness to support their education needs. Nurses have a critical role in assisting patients to access and use this information. Method. This descriptive cross-sectional survey of a random sample of 540 nurses employed in medical wards was carried out in 2009. The response rate was 58·7% (293). The analytical approach included descriptive statistics and non-parametric tests of correlation and differences between groups. A content analysis was performed on the qualitative data. Results. Most respondents (78·6%) were satisfied with work Internet access and 58·2% believed that the use of online information improved care delivery. Nearly half the group was aware of patient misconceptions about their illness due to incorrect interpretations of online information, but only 24·4% checked if patients used online information. There was a significant association between assessing patients use and awareness of patient misconceptions. Conclusion. The findings of this study highlight that while online resources add to education opportunities, the ongoing nursing assessment required to determine online information needs is not always incorporated into nursing practice. Patient misunderstandings of online material were also identified; developing patient competency in evaluating open access health information should now be recognized as an integral aspect of illness management education. [ABSTRACT FROM AUTHOR]

Background: Primary care in Aotearoa New Zealand is largely delivered by general practices, heavily subsidised by government. Te Tiriti o Waitangi (1840) guarantees equal health outcomes for Māori and non-Māori, but differences are stark and longstanding. Seven models of primary care have evolved. We hypothesised that patient health outcomes would differ between models of care; and that Māori, Pacific peoples and those living in material deprivation would have poorer outcomes from primary care. Methods: We conducted a cross-sectional study of patient-level data from national datasets and practices, at 30 September 2018, using multilevel mixed effects regression analyses (patients clustered within practices). Primary outcomes, considered to be measures of unmet need for primary care, were polypharmacy (≥ 65 years), HbA1c testing in adults with diabetes, childhood immunisations (6 months), ambulatory sensitive hospitalisations (0–14, 45–64 years) and emergency department attendances. Explanatory variables adjusted for patient and practice characteristics. Equity, by model of care, ethnicity and deprivation, was assumed if they showed no significant association with patient outcomes. Patient characteristics included: age, ethnicity, deprivation, multi-morbidity, first specialist assessments and practice continuity. Practice characteristics included: size, funding and doctor continuity. Clinical input (consultations and time with nurses and doctors) was considered a measure of practice response. Results: The study included 924 general practices with 4,491,964 enrolled patients. Traditional practices enrolled 73% of the population, but, on average, the proportion of Māori, Pacific and people living with material deprivation was low in any one Traditional practice. Patients with high health needs disproportionately enrolled in Māori, Pacific and Trust/NGO practices. There were multiple associations between models of care and patient health outcomes in fully adjusted regressions. No one model of care out-performed others across all outcomes. Patients with higher health need received more clinical input but this was insufficient to achieve equity in all outcomes. Being a Māori or Pacific patient, or living in material deprivation, across models of care, remained associated with poorer outcomes. Conclusions: Model-level associations with poor patient outcomes suggest inequity in measures that might be used to target investment in primary care. [ABSTRACT FROM AUTHOR]

Objective The main aim of this study was to explore any association between colorectal cancer (CRC) and rotating shift work in nurses and midwives. The secondary aim of this study was to identify risk factors for CRC in nurses and midwives who are rotating shift workers. Design Cross-sectional study. Setting Electronic survey of participants from Australia, New Zealand and the United Kingdom. Subjects A sample of 8,199 male and female nurses and midwives from Australia, New Zealand and the United Kingdom invited through their registration papers or newsletter advertisement. Main outcome measure Prevalence of CRC in participants who have worked rotating shifts for 1-14 years or ≥15 years compared to participants who have never worked rotating shifts. In addition, risk factors for CRC in the rotating shift work population were analysed in a multivariate logistic regression model in order to obtain odds ratio of CRC. Results No statistically significant difference was found in the prevalence of CRC between those who have never worked rotating shift work, worked 1-14 years and worked 15 or more years. Among rotating shift workers, diabetes was associated with a 123-fold (95% CI 39-392; p<0.001) increased odds of CRC, while Inflammatory Bowel Disease (IBD) was associated with a 190-fold (95%CI 68-526; p<0.001) increased odds of CRC. Screening colonoscopy or sigmoidoscopy for CRC was associated with a 10-fold (95% CI 3-35; p<0.001) increased odds of being diagnosed with CRC. Conclusion No significant association was found between rotating shift work and colorectal cancer in nurses and midwives. In nurses and midwives who are rotating shift workers, diabetes, IBD and CRC screening significantly increased the odds of CRC. [ABSTRACT FROM AUTHOR]

Objectives: To compare periodontitis prevalence estimates obtained using the new classification system with those generated using other case definitions from the literature, examine the strength of the association between tobacco smoking and periodontitis (and that between periodontitis and its impact on oral‐health‐related quality of life; OHRQoL) using those definitions. Methods: We conducted a secondary analysis of data from the 2009 New Zealand Oral Health Survey, a cross‐sectional dental examination survey of a representative sample of people aged 18 or over. We identified cases using 10 different periodontitis case definitions and then compared weighted prevalence estimates across those. The associations between smoking and periodontitis, and between periodontitis and short‐form Oral Health Impact Profile (OHIP‐14) scores, were then compared across the various case definitions. Results: There was considerable variation in periodontitis prevalence estimates (range 3% to 59%). All definitions (but one) showed a higher prevalence of periodontitis in smokers than in non‐smokers. The new classification stage III definition showed the strongest association, with an adjusted prevalence ratio of 1.99 (95%CI: 1.35, 2.91). All case definitions (but one) had a higher mean OHIP‐14 score among people with periodontitis. Conclusions: Periodontitis prevalence estimates are greatly influenced by case definition choice. The new classification system may be more accurate than any other used to date, but questions remain about its utility for periodontal epidemiology. [ABSTRACT FROM AUTHOR]

Introduction. Physical activity (PA) in older people is associated with improved morbidity and mortality outcomes. Increasing numbers of older people are choosing to live in retirement villages, many of which promote themselves as providing opportunities for activity. Aim. To explore the characteristics of PA village residents were undertaking and the associated individual and village factors. Methods. Health, functional and wellbeing information was collected from 577 residents recruited from 34 villages in Auckland, New Zealand, using an International Resident Assessment Instrument and customised survey tools containing items on self-reported PA. Managers from villages completed a survey on village characteristics and facilities. Results. The mean age (s.d.) of village residents was 82 (7) years, and 325 (56%) reporting doing one or more hours of PA in the 3 days prior to assessment. Moderate exercise was performed by 240 (42%) village residents, for a mean (s.d.) of 2.7 (3.4) h per week. The most common activities provided by villages included: bowls/petanque (22, 65%) and exercise classes (22, 65%), and walking was the most common activity undertaken (348, 60%). Factors independently associated with PA included individual factors (gender, fatigue, constipation, self-reported health, number of medications, moving to village for safety and security, utilising village fitness programme, use of the internet, and satisfaction with opportunities to be active) and village-related factors (access to unit, and ownership model). Discussion. PA uptake is determined by many factors at both personal (physical and psychosocial) and environmental levels. Clinicians should focus on individualised PA promotion in those with identified risk factors for low levels of PA. [ABSTRACT FROM AUTHOR]

We examine gendered patterns in the use of violence in response to the partner's violence ("fighting back"). Within each gender, we examined if socio-demographic differences in prevalence were present, and if contextual factors influenced the use of violence against a violent partner. Data from a large, population-based sample of New Zealand adults was used to identify ever-partnered respondents who had experienced physical IPV (n = 407 women, and n = 391 men). Weighted percentages and 95% confidence intervals (95%CIs) were calculated for the use of violence against a violent partner, stratified by gender. Multivariable logistic regression was used to assess the association between each contextual risk factors and the use of violence against a violent partner. For both men and women, at the multivariable level, use of violence against a violent partner was associated with contextual factors related to the abuse. However, for almost all of these variables a higher proportion of women than men experienced the risk factor; for example, a higher proportion of women than men reported having experienced severe IPV (57.6% women; 43.7% men), injuries resulting from IPV (44.5% women, 15.0% men), and fear of a partner (22.7% women, 4.9% men). Women were also more likely to report experiencing other types of IPV (particularly sexual IPV) and were more likely to report that their children were present at the time of violence. These factors contributed to the higher proportion of women who reported fighting back at least once (53.4% of women and 22.3% of men). Health, social, and legal services need to conduct appropriate and thorough assessment of nature and context (current and historical) of the violence that individuals have been exposed to as part of service provision. Assessments need to be carried out with a gender-lens in order to provide comprehensive and appropriate responses. [ABSTRACT FROM AUTHOR]

INTRODUCTION; Pacific New Zealanders have a high prevalence of smoking, with many first smoking in their pre-adolescent years. AIM: To identify risk factors for tobacco smoking among Pacific pre-adolescent intermediate school children. METHODS: A cross-sectional survey of 2208 Pacific students aged between 10 and 13 years from four South Auckland intermediate schools who were asked about their smoking behaviour between the years 2007 and 2009. RESULTS: The prevalence of Pacific ever-smokers (for 2007) in Year 7 was 15.0% (95% Confidence Interval [Cl] 12.0%-18.3%) and Year 8, 23.0% (95% Cl 19.5%-26.7%). Multivariate modelling showed the risk factors for ever-smoking were Cook Island ethnic group (OR 1.72; 95% Cl 1.26-2.36, ref=Samoan), boys (OR 1.47; 95% Cl 1.14-1.89), age (OR 1.65; 95% Cl 1.36-2.00), exposure to smoking in a car within the previous seven days (OR 2.24; 95% Cl 1.67-3.01), anyone smoking at home within the previous seven days (OR 1.52; 95% Cl 1.12-2.04) and receiving more than $NZ20 per week as pocket money/allowance (OR=1.91,95% Cl 1.23-2.96). DISCUSSION: Parents control and therefore can modify identified risk factors for Pacific children's smoking initiation: exposure to smoking at home or in the car and the amount of weekly pocket money the child receives. Primary health care professionals should advise Pacific parents to make their homes and cars smokefree and to monitor their children's spending. This study also suggests a particular need for specific Cook Island smokefree promotion and cessation resources. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Obesity is disproportionately prevalent among Pacific population groups in New Zealand. Lifestyle behaviours of excessive consumption of high energy, unhealthy foods and inadequate physical activity are risk factors for obesity that can be modified. AIM: To identify and describe the risk factors for and protective factors against obesity among Pacific Is- land (PI) adolescents who attend church and compare them with PI adolescents who do not attend church. METHODS: We investigated the lifestyle behaviours of 2495 PI adolescents at six secondary schools in Auckland, New Zealand (NZ), 77% of whom attend a church or other place of worship. The cross-sectional survey was undertaken in 2005. Structured individual interviews and anthropometric measurements were undertaken. RESULTS: Church attendees had a higher mean body mass index (BMI) compared with non-attendees (BMI 27.4 vs BMI 26.6), adjusted for age, gender and PI ethnicity (p=0.01). The weight status of attendees was associated with less healthy breakfast and lunch sources, lower levels of physical activity, and limited knowledge of the risk factors for obesity (p<0.05) DISCUSSION: Culturally appropriate and ethnic-specific weight management interventions, including monitoring and policy development programmes, are needed urgently to change pro-obesity lifestyle behaviours in PI adolescents and to avoid the burgeoning future obesity-related illnesses that would otherwise result. The church may be an important venue and change agent in the prevention of obesity for this population. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Effective communication is fundamental to successful health care service delivery, and has a positive impact on access, quality of care, health outcomes, and patient satisfaction. Although there are a growing number of New Zealanders who do not speak English proficiently, underutilisation of trained interpreter services appears to be common in primary health care settings. AIMS: To describe the pattern of interpreter service need and utilisation by general practice services, and to identify key barriers and enabling factors to the use of trained interpreters. METHODS: A mixed methods study was employed. Census and Partnership Health Canterbury Te Kei o Te Waka (PHC) databases were combined, and quantitative analysis used to derive interpreter service need and utilisation patterns. Transcripts of focus groups and interviews from general practitioners, practice nurses and practice administration staff within the PHC were analysed, using qualitative methods to identify barriers and enablers to interpreter service use. RESULTS: For the years 2008-2010, approximately 10 742 consultations per year involved a non-English- speaking patient, yet in only approximately 74.8 (0.7%) consultations per year were interpreter services utilised. Analysis of focus groups and interviews identified four global themes that represented barriers for interpreter service utilisation; namely, practicalities, expectations, knowledge of service, and systems. DISCUSSION: The current use of interpreter services in PHC general practice appears to be significantly less than the need. In order to maximise health outcomes and reduce risk, strategies must be initiated to counter the barriers currently inhibiting interpreter service use, including adopting best practice policies. [ABSTRACT FROM AUTHOR]

INTRODUCTION: There is a worldwide trend for diabetes care to be undertaken in primary care. Nurses are expected to take a leading role in diabetes management, but their roles in primary care are unclear in New Zealand, as are the systems of care they work in as well as their training. AIM: To describe and compare demographic details, education and diabetes experience, practice set- ting and facilities available for the three main groups of primary health care nurses working in the largest urban area in New Zealand. METHOD: Of the total number of practice nurses, district nurses and specialist nurses working in Auckland (n=1091), 31% were randomly selected to undertake a self-administered questionnaire and telephone interview in 2006-2008. RESULTS: Overall response was 86% (n=284 self-administered questionnaires, n=287 telephone interviews). Almost half (43%) of primary care nurses were aged over 50 years. A greater proportion of specialist nurses (89%) and practice nurses (84%) had post-registration diabetes education compared with district nurses (65%, p=0.005), from a range of educational settings including workshops, workplaces, conferences and tertiary institutions. More district nurses (35%) and practice nurses (32%) had worked in their current workplace for >10 years compared with specialist nurses (14%, p=0.004). Over 20% of practice nurses and district nurses lacked access to the internet, and the latter group had the least administrative facilities and felt least valued. DISCUSSION: These findings highlight an ageing primary health care nursing workforce, lack of a national primary health care post-registration qualification and a lack of internet access. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Perceived lack of confidential health care is an important barrier for young people accessing health care services in New Zealand (NZ). AIM: To determine the prevalence of forgone health care among a nationally representative sample of NZ secondary school students and to describe the health concerns and specific health issues for which young people had difficulty accessing health care. METHODS: Random sample of 9107 NZ secondary school students participated in a 2007 health survey using internet tablets. Questions about access to health care included whether there had been a time when they had not accessed health care when needed, reasons for difficulty in accessing health care, current health concerns and health risk behaviours. RESULTS: One in six students (17%) had not seen a doctor or nurse when needed in the last 12 months. Female Maori and Pacific students and those living in neighbourhoods with high levels of deprivation were more likely to report forgone health care. Students with chronic health problems, those engaging in health risk behaviours or experiencing symptoms of depression were more likely to report being unable to access health care when needed. Students reporting privacy concerns were more likely to report difficulty accessing health care for sensitive health issues, such as sexual health, emotional problems, pregnancy-related issues, stopping cigarette smoking, or alcohol or drug use. DISCUSSION: NZ secondary school students who forgo health care are at increased risk of physical and mental health problems and in need of accessible and confidential health services. [ABSTRACT FROM AUTHOR]

Study Objectives: To investigate the proportion of children in Aotearoa New Zealand (NZ) who do or do not meet sleep duration and sleep quality guidelines at 24 and 45 months of age and associated sociodemographic factors. Methods: Participants were children (n = 6490) from the Growing Up in New Zealand longitudinal study of child development with sleep data available at 24 and/or 45 months of age (48.2% girls, 51.8% boys; 22.4% Māori [the Indigenous people of NZ], 12.9% Pacific, 13.4% Asian, 45.2% European/Other). Relationships between sociodemographic factors and maternally reported child sleep duration (across 24 hours) and night wakings were investigated cross-sectionally and longitudinally. Estimates of children in NZ meeting sleep guidelines were calculated using a range of analytical techniques including Bayesian linear regression, negative binomial multiple regression, and growth curve models. Results: In NZ, 29.8% and 19.5% of children were estimated to have a high probability of not meeting sleep duration guidelines and 15.4% and 8.3% were estimated to have a high probability of not meeting night waking guidelines at 24 and 45 months respectively, after controlling for multiple sociodemographic variables. Factors associated cross-sectionally with children's sleep included ethnicity, socioeconomic deprivation, material standard of living, rurality, and heavy traffic, and longitudinal sleep trajectories differed by gender, ethnicity, and socioeconomic deprivation. Conclusions: A considerable proportion of young children in NZ have a high probability of not meeting sleep guidelines but this declines across the ages of 24 and 45 months. Sleep health inequities exist as early as 24 months of age in NZ. [ABSTRACT FROM AUTHOR]

Men with prostate cancer experience many side effects and symptoms that may be improved by a physically active lifestyle. It was hypothesized that older men with prostate cancer who were physically active would report significantly higher levels of quality of life (QOL) as assessed by the WHOQOL-BREF and the WHOQOL-OLD. Of the 348 prostate cancer survivors who were invited to participate in the present postal survey, 137 men returned the questionnaires. Those who were physically active had significantly lower prostate specific antigen (PSA) scores and higher social participation than those insufficiently active. These findings offer some support for the benefits of physical activity (PA) within the prostate cancer population in managing the adverse side effects of their treatments on aspects of their QOL. Future research should more closely examine what types of PA best promote improvements in varying aspects of QOL and psychological well-being for prostate cancer survivors. [ABSTRACT FROM AUTHOR]

Low energy availability (LEA) describes the disruption in normal physiological function existent when insufficient energy intake is combined with exercise. To conserve energy a range of endocrine adaptations occur, impairing health and athletic performance. The prevalence of LEA has not been fully established especially among recreational exercisers. Determining recreational exercisers at risk of LEA may help to maximize prevention, early diagnosis and treatment. The design of this study was a cross-sectional online survey. One-hundred and nine female recreational exercisers, with a mean age of 23.8 (SD 6.9) years were recruited via gyms and fitness centers throughout NZ. Participants completed an online questionnaire including questions from the LEAF-Q (Low Energy Availability in Females Questionnaire). A total of 45.0% (CI, 35.4%, 54.8%) of participants were classified as "at risk" of LEA. For every extra hour of exercise per week the odds of being at risk of LEA were 1.13 times greater (CI 1.02, 1.25, p = .016). All participants reporting previous stress fracture injuries (n = 4) were classified as at risk for LEA. Significantly more subjects participating in an individual sport were classified as at risk for LEA (69.6%, CI 24.3%, 54.8%) compared with team sports (34.8%, CI 18.7%, 40.5%) {p = .006). The high prevalence of female recreational exercisers at risk of LEA is of concern, emphasizing the importance of increasing awareness of the issue, and promoting prevention and early detection strategies, so treatment can be implemented before health is severely compromised. [ABSTRACT FROM AUTHOR]

Ballet dancing is a multifaceted activity requiring muscular power, strength, endurance, flexibility, and agility; necessitating demanding training schedules. Furthermore dancers may be under aesthetic pressure to maintain a lean physique, and adolescent dancers require extra nutrients for growth and development. This cross-sectional study investigated the nutritional status of 47 female adolescent ballet dancers (13-18 years) living in Auckland, New Zealand. Participants who danced at least 1 hr per day 5 days per week completed a 4-day estimated food record, anthropometric measurements (Dual-energy X-ray Absorptiometry) and hematological analysis (iron and vitamin D). Mean BMI was 19.7 ± 2.4kg/m² and percentage body fat, 23.5 ± 4.1%. The majority (89.4%) of dancers had a healthy weight (5th-85th percentile) using BMI-for-age growth charts. Food records showed a mean energy intake of 8097.3 ± 2155.6kJ/day (48.9% carbohydrate, 16.9% protein, 33.8% fat, 14.0% saturated fat). Mean carbohydrate and protein intakes were 4.8 ±1.4 and 1.6 ± 0.5g/kg/day respectively. Over half (54.8%) of dancers consumed less than 5g carbohydrate/kg/day, and 10 (23.8%) less than 1.2 g protein/kg/day. Over 60% consumed less than the estimated average requirement for calcium, folate, magnesium and selenium. Thirteen (28.3%) dancers had suboptimal iron status (serum ferritin (SF) <20µg/L). Of these, four had iron deficiency (SF < 12µg/L, hemoglobin (Hb) ≥120g/L) and one iron deficiency anemia (SF < 12µg/L, Hb < 120g/L). Mean serum 25-hydroxy vitamin D was 75.1 ± 18.6nmol/L, 41 (91.1%) had concentrations above 50nmol/L. Female adolescent ballet dancers are at risk for iron deficiency, and possibly inadequate nutrient intakes. [ABSTRACT FROM AUTHOR]

Background: Studies in southern New Zealand indicate that up to a quarter of women experienced infertility, likely due to delay in childbearing. However, these findings may not be generalisable to the whole population. Aims: To assess the lifetime prevalence of infertility and evidence for disparities for New Zealand men and women in a nationally representative sample. Materials and Methods: In 2014/15 a general health survey with a module on sexual and reproductive health was conducted among New Zealand residents aged 16–74 years; 3792 men and 5222 women provided information on infertility. Result(s): There were 8.2% (95% CI 7.1–9.4%) of men and 12.5% (11.3–13.8%) of women who had experienced infertility; among fertility‐tested women this was 15.4% (14.0–16.9%). Prevalence peaked in the 35–44 year age group (14.3% for men, 19.1% for women and 20.8% for fertility‐tested women). Estimates for European, Māori and Asian ethnicities were similar. Pacific men and women had higher relative risks: 2.37 (95% CI 1.51–3.71) and 1.76 (1.27–2.44), respectively, compared with Europeans. Medical help was sought by 69.3% (95% CI 62.4–75.5%) of infertile men and 68.2% (63.1–72.9%) of women; this was significantly lower for Māori and Pacific. Conclusions: Infertility levels for those of European ethnicity were similar to studies in southern New Zealand, and in other high‐income countries. However, infertility levels were just as high for Māori, and higher for Pacific people, despite experiencing fertility at younger ages. Focusing on reducing causes of infertility other than delayed childbearing would likely contribute to addressing this health disparity. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to identify behaviours and cues that nurses recognise as indications of unsafe practice, perceived factors that contribute to unsafe practice and actions nurses take in response. Design: Cross‐sectional survey. Methods: National cross‐sectional survey of a random sample of registered nurses (n = 231) in New Zealand, in 2017–2018. The STROBE Checklist was used to report this study. Results: Nurses reported a high rate of episodes of unsafe practices and recognised a range of behaviours and cues that alerted them to the potential for unsafe practice. Several organisational issues were perceived to contribute to unsafe practice occurring. The reporting of episodes of unsafe practice and perceived organisational support was low for nurses compared with managers. Conclusion: Failure to recognise and respond to unsafe practice may indicate a tolerance for substandard practice by individual nurses, or by the organisation. Nurses who recognise unsafe practice must be supported by the organisation. [ABSTRACT FROM AUTHOR]

A range of barriers that impede collaborations between consumer researchers and other researchers have been identified, despite clear acknowledgement of the benefits of this approach in the literature. Recent research has questioned whether the costs of collaborative research outweigh the benefits. The overarching aim of the current study is to better understand non-consumer researchers' attitudes to, and issues concerning, engagement with consumer researchers. Non-consumer researchers from mental health disciplines were invited to participate in the cross-sectional Consumers as Researchers in Mental Health survey, and to respond to open-ended questions about their experiences of collaborative research with consumer researchers. The findings demonstrate a range of benefits associated with collaborations with consumer researchers – including increased relevance and credibility of research, and greater translation of research findings into changes in health policy, service, research and education. Collaborations were found to be varied and not limited by research design, decision-making styles, or research topic. Understanding these benefits within the context of identified barriers can make an important contribution to the proliferation of mental health consumer researcher roles. [ABSTRACT FROM AUTHOR]

Consumer collaboration in mental health research has demonstrated significant benefits and reflects both contemporary research practice and policy goals for the expected genuine involvement of consumers in all aspects of mental health service delivery. Notable barriers have been identified as impeding consumer researcher positions that must be better understood and ultimately addressed. The aim of this research was to better understand these barriers from the perspectives of non‐consumer researchers who have worked collegially with consumer researchers. We developed a self‐report survey, Consumers as Researchers in Mental Health (CaRiMH) and administered it to non‐consumer mental health researchers in Australia and New Zealand. Findings suggest a lack of organizational structures to support both consumer research and capacity building of consumer researchers. Most consumer researchers were employed casually with no set hours. Although consumer researchers were typically remunerated, inadequate funding and inflexibility of employment were highlighted as major barriers. There was variation in opinion about token involvement of consumer researchers and some uncertainty about whether these roles, where they existed, were actively resisted. Despite the acknowledged barriers, participants were positive about collaborations with consumer researchers. Overall, findings suggest consumer research is unlikely to proliferate without greater attention to organizational structures. A systematic and strategic approach to advancing mental health consumer research is required, including extra‐organizational policy factors. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the association between caregiver experiences of racial discrimination and physical and emotional health outcomes for their children and to explore potential pathway variables in this relation. We analysed data from two instances of the New Zealand Health Survey that provide nationally representative data for children and adults, with high response rates for each of the major ethnic groupings (Indigenous Māori, Pacific, Asian, and European/Other). Questionnaires from the primary caregiver and their child (5 to 14 years) were linked to create n = 2,958 child-primary caregiver dyads in the 2006/07 Survey and n = 2,632 dyads in the 2011/12 Survey. Children whose caregivers reported any experience of racial discrimination had poorer mental health, self-esteem, and behaviour scores on the CHQ PF-28 scale, even after adjustment for caregiver sociodemographic variables. Multivariable models identified a worsening in child emotional health as the number of reported racism experiences increased. Caregiver experiences of racism were not associated with medicated asthma in their children. Multivariable models suggest that caregiver psychological distress may be a pathway linking vicarious racism to poorer child emotional health. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Intentional self-poisoning or self-harm through poisoning, is a common cause of presentations to emergency departments (EDs). National datasets do not allow identification of the substances most commonly used in hospital-treated intentional self-poisoning in New Zealand, nor do they capture sources of these substances. AIM: To investigate the specific substances used in intentional self-poisoning and the sources from which they are obtained. METHODS: In this cross-sectional study, information about the demographics and presentation particulars of intentional self-poisoning patients aged ≥16 years, presenting to three public EDs, as well as the substances they used in the self-poisoning event and the sources of these agents, were collected prospectively. RESULTS: A total of 102 patients were recruited from the potentially eligible 1137 intentional self-poisoning patients presenting to the three EDs during the study period. Seventy per cent used their own prescription medications and 24% used medicines they purchased themselves. Paracetamol and ethanol were most commonly encountered substances. Patients presented a median of 1.9 h after exposure (interquartile range 1.0–3.3 h), 62% self-referred, 60% presented to the ED in the evening or at night and 66% were triaged into Australasian Triage Scale 3 (to be seen within 30 min). Two-thirds were referred to emergency psychiatric services. DISCUSSION: Collecting specific substance information, such as from this study, can assist in planning specific activities to prevent intentional self-poisoning. As most people used their prescribed medicines, the findings can inform and assist doctors in their prescribing practices when they manage patients at risk of self-poisoning. [ABSTRACT FROM AUTHOR]

Objective: The aim was to investigate the prevalence of self-reported sleep complaints in New Zealand adults and determine the independent association of sleep complaints with adverse health outcomes. Design: We used 2002/03 New Zealand Health Survey data (n = 12,500 adults, ≥15 years). The prevalence of self-reported sleep complaints was estimated by ethnicity. The relationship between sleep complaints and mental health, physical health and health risk behaviors were investigated using multivariable logistic regression models. Results: The prevalence of each sleep complaint measure was highest for the indigenous Māori population (23.6% reported ‘any’ sleep complaint; 10.3% reported multiple sleep complaints). Reporting ‘any’ sleep complaint was associated with higher odds of poorer mental health, diagnosed high blood pressure, diagnosed diabetes, diagnosed heart disease, poor/fair self-rated health, obesity, current smoking, and hazardous drinking. Conclusion: The higher prevalence of sleep complaints among Māori and the consistent association with poor health suggests a potential role for suboptimal sleep in ethnic health inequities. [ABSTRACT FROM AUTHOR]

Background: The effect of natural disasters internationally is linked to intensity and duration and the impact of these events for tertiary level professional students is not clearly understood. Following a 7.1 magnitude earthquake in New Zealand in 2010 (with aftershocks lasting 27 months) a number of tertiary nursing students experienced significant disruption to their studies. Aim: To compare the psychological health, resilience and the impact on learning for three cohorts of students engaged in tertiary nursing education during this time. Method: A cross-sectional survey design and convenience sampling was used for three cohorts of learners. An online survey was completed (n = 290) and included: Depression Anxiety and Stress Scale; PTSD Checklist; Work and Social Adjustment Scale; Connor-Davidson Resilience Scale. Results: Statistically significant differences were found across the psychometric scales with regard to relationship status. Whilst an increase in self-reported physical and mental health issues prior to and following the earthquakes were noted, mitigating factors were also identified. Conclusions: In order to support psychological health amongst nursing students, tertiary education systems need to plan for sustainable learning. The importance of facilitating future orientation within organisations is necessary to develop resilience amongst staff and students, which, in turn, will enable on-going education during significant disaster events. [ABSTRACT FROM AUTHOR]

Aim: This study investigated differences in cognitive function between former rugby and non-contact-sport players, and assessed the association between concussion history and cognitive function. Methods: Overall, 366 former players (mean ± standard deviation [SD] age 43.3 ± 8.2 years) were recruited from October 2012 to April 2014. Engagement in sport, general health, sports injuries and concussion history, and demographic information were obtained from an online self-report questionnaire. Cognitive functioning was assessed using the online CNS Vital Signs neuropsychological test battery. Cohen's d effect size statistics were calculated for comparisons across player groups, concussion groups (one or more self-reported concussions versus no concussions) and between those groups with CNS Vital Signs age-matched norms (US norms). Individual differences within groups were represented as SDs. Results: The elite-rugby group ( n = 103) performed worse on tests of complex attention, processing speed, executive functioning, and cognitive flexibility than the non-contact-sport group ( n = 65), and worse than the community-rugby group ( n = 193) on complex attention. The community-rugby group performed worse than the non-contact group on executive functioning and cognitive flexibility. Compared with US norms, all three former player groups performed worse on verbal memory and reaction time; rugby groups performed worse on processing speed, cognitive flexibility and executive functioning; and the community-rugby group performed worse on composite memory. The community-rugby group and non-contact-sport group performed slightly better than US norms on complex attention, as did the elite-rugby group for motor speed. All three player groups had greater individual differences than US norms on composite memory, verbal memory and reaction time. The elite-rugby group had greater individual differences on processing speed and complex attention, and the community-rugby group had greater individual differences on psychomotor speed and motor speed. The average number of concussions recalled per player was greater for elite rugby and community rugby than non-contact sport. Former players who recalled one or more concussions (elite rugby, 85 %; community rugby, 77 %; non-contact sport, 23 %) had worse scores on cognitive flexibility, executive functioning, and complex attention than players who did not recall experiencing a concussion. Conclusions: Past participation in rugby or a history of concussion were associated with small to moderate neurocognitive deficits (as indicated by worse CNS Vital Signs scores) in athletes post retirement from competitive sport. [ABSTRACT FROM AUTHOR]

Little population-based work has been published about the mental health of adolescents with both sexual/gender (SG) and ethnic minority (i.e. double minority) status. This study aimed to provide an overview on their mental health. Analysis of data from a total of 17,607 high school students from New Zealand's 2007 and 2012 cross-sectional nationally representative Adolescent Health Surveys, including a total of 1306 (7.4%) SG minority participants, of whom 581 (3.3%) were also an ethnic minority. SG minority status, minority ethnicity, and female sex were associated with higher mental distress and poorer well-being. Generally speaking, double minority students reported poorer mental health than SG majority students of the same ethnicity, but reported better mental health than SG minority New Zealand European students. Explanations and future directions for research were suggested to further explore how double minority students negotiate mental health in the context of their communities/cultures in New Zealand. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate dietetic practice in the management of gestational diabetes in New Zealand, compare this with evidence ‐ based guidelines and determine the need for New Zealand ‐ specific evidence ‐ based nutrition practice guidelines for gestational diabetes. Methods: A 64 ‐ item cross ‐ sectional online survey of New Zealand ‐ registered dietitians providing care to women with gestational diabetes was undertaken. Participants were recruited through Dietitians New Zealand, District Health Boards and private practices across New Zealand. The survey examined dietetic service provision, management recommendations, guideline use, service evaluation, compliance with national and international guidelines and the perceived need for New Zealand ‐ specific evidence ‐ based guidelines for the nutritional management of gestational diabetes. Results: Thirty ‐ three (62%) eligible dietitians participated in the survey. There was significant variation in dietetic services and management recommendations. Nine (28%) dietitians felt the service within which they worked did not offer adequate dietetic services for women with gestational diabetes. Compliance with national and international evidence ‐ based guidelines ranged from 28 to 100% depending on the recommendation. Twenty ‐ five (76%) respondents felt there was a need for New Zealand ‐ specific evidence ‐ based nutrition practice guidelines for gestational diabetes. Conclusions: These results highlight differences in dietetic services and practice in New Zealand and variations in compliance with local and international evidence ‐ based guidelines. The development of New Zealand ‐ specific evidence ‐ based nutrition practice guidelines for gestational diabetes is supported. [ABSTRACT FROM AUTHOR]

Purpose: To measure the iodine status and iodine intake of New Zealand adults 18-64 years of age following mandatory fortification of bread with iodine. Methods: A cross-sectional survey of NZ adults living in Dunedin and Wellington during February-November 2012. Three hundred and one men and women aged 18-64 years randomly selected from the New Zealand Electoral Roll completed a 24-h urine collection, a demographic and iodine-specific food frequency questionnaire (FFQ), and had height and weight measured. Urine collections were analysed for iodine and reported as median urinary iodine concentration (UIC) µg/L and median urinary iodine excretion (UIE) µg/day. The FFQ was used to estimate iodine intake with and without discretionary iodised salt use. Results: The median UIC for all adults was 73 µg/L, indicative of mild iodine deficiency. The mean urinary volume was 2.0 L. As an estimate of iodine intake, the median UIE was 127 µg/day. Estimated iodine intake, using the FFQ which included discretionary iodised salt use, was 132 µg/day. Iodine intakes were associated with UIC ( P = 0.040) and UIE ( P = 0.003), but not with bread iodine intake and iodised salt use. Conclusion: Using the WHO/UNICEF/ICCIDD target for iodine sufficiency (a UIC of >100 µg/L) based on school-aged children with a mean urinary volume of 1.0 L, the iodine status of NZ adults does not reach adequate levels (73 µg/L). A more realistic parameter in a population with a higher urinary volume excretion (2.0 L) is the UIE. A median UIE of 127 µg/day suggests that the iodine status of NZ adults is now likely to be adequate. [ABSTRACT FROM AUTHOR]

A limited number of studies have examined associations between nut consumption and nutrient intakes or diet quality. None has investigated these associations in the Southern Hemisphere. The purpose of this study was to examine associations between nut consumption and nutrient intakes among adult New Zealanders. Data from the 24-h recalls of 4721 participants from the cross-sectional 2008/09 New Zealand Adult Nutrition Survey (2008/09 NZANS) were used to determine whole nut intake and total nut intake from all sources as well as nutrient intakes. Regression models, both unadjusted and adjusted for potential confounders, were used to estimate differences in nutrient intakes between those consuming and those not consuming nuts. From adjusted models, compared with non-whole nut consumers, whole nut consumers had higher intakes of energy and percentage of energy from total fat, MUFA and PUFA, whereas percentage of energy from SFA and carbohydrate was lower (all P≤0·025). After the additional adjustment for energy intake, whole nut consumers had higher intakes of dietary fibre, vitamin E, folate, Cu, Mg, K, P and Zn (all P≤0·044), whereas cholesterol and vitamin B12 intakes were significantly lower (both P≤0·013). Total nut consumption was associated with similar nutrient profiles as observed in whole nut consumers, albeit less pronounced. Nut consumption was associated with better nutrient profiles, especially a lower intake of SFA and higher intakes of unsaturated fats and a number of vitamins and minerals that could collectively reduce the risk for chronic disease, in particular for CVD. [ABSTRACT FROM AUTHOR]

Background: Despite poor cancer survival statistics, Māori do not readily access hospice services. This study aims to explore how hospice services respond to Māori by investigating the different influences and interactions between three perspectives of hospice care. Method: The authors conducted a Māori-centred, cross-sectional qualitative study by undertaking semi-structured interviews with hospice patients and whānau (families) (n=8), hospice representatives (n=4), and representatives from three Māori health provider organisations (n=5). Conclusions: The study found that negative perceptions of hospice are being changed by hospices' relationships with other organisations and positive stories from whānau. Involvement from whānau, continuity of care and after-hours care with a greater Māori workforce and a further emphasis on culturally safe care are critical for this work to gain momentum. Findings can be of use to further develop quality of care indicators that reflect the perspectives of patients and whānau, and those who provide their care. [ABSTRACT FROM AUTHOR]

Most HIV behavioural surveillance programmes for gay, bisexual and other men who have sex with men (MSM) sample from location-based (offline) or web-based (online) populations, but few combine these two streams. MSM sampled online have been found to differ demographically and behaviourally from those sampled offline, meaning trends identified in one system may not hold for the other. The aim was to examine trends among MSM responding to supplementary repeat online behavioural surveillance surveys who had not participated in offline surveillance earlier that year in the same city, to see whether trends were parallel, converged or diverged. We recruited a total of 1613 MSM from an Internet dating site in Auckland, New Zealand in 2006, 2008 and 2011 using identical questionnaires and eligibility criteria to offline surveillance. Condom use was stable over time, HIV testing rates rose, the proportion reporting over 20 recent male partners declined, and anal intercourse rates increased, consistent with trends in offline surveillance conducted concomitantly and reported elsewhere. Variant trends included greater stability in condom use with casual partners among online-recruited MSM, and a rise in regular fuckbuddy partnering not identified among offline-recruited MSM. Among MSM recruited online, the frequency of checking Internet dating profiles increased between 2008 and 2011. In conclusion, supplementary web-based behavioural surveillance among MSM generally corroborates trends identified in offline surveillance. There are however some divergent trends, that would have been overlooked if only one form of surveillance had been conducted. As MSM populations increasingly shift their socialising patterns online and diversify, multiple forms of HIV behavioural monitoring may be required. [ABSTRACT FROM AUTHOR]

Introduction Palliative care delivery has become integral to the role of healthcare staff in residential aged care (RAC) internationally. Challenges within this work environment (e.g. workload, staffing levels, resources) may impact on healthcare staffs' willingness to undertake formal palliative care education. The study described herein explored factors (socioenvironmental and psychological) that influence staff willingness to engage in palliative care education. Methods The predictors of palliative care education uptake for healthcare staff (n = 431) from 52 New Zealand RAC facilities in one large urban District Health Board were assessed. Logistic regression was used to explore willingness to engage in education. Results Higher scores for burnout predicted a decreased likelihood of engaging in palliative care education (odds ratio (OR) 0.41, P = 0.01). The identified predictor of willingness to engage in education was previous palliative care experience (OR 1.59, P = 0.027). Discussion These results can inform the design and delivery of future palliative care education programmes within RAC. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The increasing prevalence of diabetes has led to expanded roles for primary health care nurses in diabetes management. AIM: To describe and compare anthropometric and glycaemic characteristics of patients with diabetes and their management by practice nurses, district nurses and specialist nurses. METHODS: Primary health care nurses in Auckland randomly sampled in a cross-sectional survey, completed a postal self-administered questionnaire (n=284) and telephone interview (n=287) between 2006 and 2008. Biographical and diabetes management details were collected for 265 (86%) of the total 308 patients with diabetes seen by participants on a randomly selected day. RESULTS: Nurses were able to access key clinical information for only a proportion of their patients: weight for 68%; BMI for 16%; HbA1c for 76% and serum glucose levels for 34% (for either measure 82%); although most (96%) records were available about whether patients self-monitored blood glucose levels. Most nursing management activities focused on giving advice on dietary intake (70%) and physical activity (66%), weighing patients (58%), and testing or discussing blood glucose levels (42% and 43%, respectively). These proportions varied by nurse group (p<0.05), generally being highest for specialist nurses and lowest for district nurses. DISCUSSION: Most practice and specialist nurses could access patients' weight and HbA1c levels and focused their clinical management on health education to decrease these if indicated. Communication and organisational systems and contracts that allow district nurses to work across both primary and secondary health services are necessary to improve community-based nursing services for patients with diabetes. [ABSTRACT FROM AUTHOR]

Aim The aim of the present study was to describe the health and dietary treatment of people with coeliac disease in New Zealand. Methods The New Zealand Coeliac Health Survey was a self-administered cross-sectional survey adapted, with permission, from the Canadian Celiac Health Survey. All members of Coeliac New Zealand Incorporated (n = 2720) were surveyed, primarily online (n = 2383). Surveys were posted to those without an email address (n = 337). Results The overall response rate was 46.5% (n = 1264). This analysis included biopsy-positive respondents aged 16 years and over (n = 936). Mean age at diagnosis was 43.5 ( SD: 15.5) years. The median time between reported onset of symptoms and diagnosis of coeliac disease was 5 years ( IQR 1-16). Most (88.4%) described their diet as being strictly gluten free, yet many had incomplete recovery from symptoms. Of 81.6% reported being referred to a dietitian, 19.9% considered the information they received to be fair or poor. Following a gluten-free diet was very difficult for 6.2%, and moderately difficult for 29.8%. Common problems included finding good quality gluten-free foods and identifying whether foods were gluten free or not from the label. More than one-third (36.3%) avoided travelling because of coeliac disease at least some of the time, and one-quarter (25.6%) never or rarely ate at restaurants. Conclusions Although coeliac disease is a common condition in New Zealand, ongoing symptoms among patients suggest that dietary management is inadequate. Knowledge of a gluten-free diet and its implementation among dietitians, and the preparation of commercial and restaurant gluten-free foods could be improved. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the use of the Gold Standards Framework Prognostic Indicator Guidance (GSF-PIG) as a screening tool in an acute hospital setting. Prospective cross-sectional study of 501 adult inpatients in a tertiary teaching hospital in New Zealand who were screened using the GSF-PIG was conducted. The use of the GSF-PIG as a screening tool in an acute setting could be the first step towards the implementation of a more systematic way of addressing patient need.

Objectives: To investigate diet and nutrition-related factors associated with bone loss in a group of postmenopausal (PM) women. Nutritional intake, inflammatory markers and body composition (weight, body mass index, fat/lean mass) were analysed for associations with bone mineral density (BMD). Design: A cross sectional study examining correlations between BMD (Duel-energy X ray absorptiometry; (DXA) and dietary intake (3-day diaries), body composition and plasma bone and inflammatory markers: C-terminal telopeptide of type I collagen (CTX) and procollagen type I N propeptide (P1NP), C- reactive protein (CRP), interleukin 6 and 10 (IL-6, IL-10), tumour necrosis factor (TNF) and osteoprotegerin (OPG). Setting: Community dwelling women from the Auckland, Hawke's Bay and Manawatu regions in New Zealand. Participants: 142 healthy, PM women aged 50-70 years. Results: OPG (per kilogram fat mass) was increased in women with osteoporosis (p<0.001) compared to groups classified with normal BMD and osteopenia. Protein, vitamin B12, zinc, potassium and dairy intake were all positively correlated with higher BMD while dairy and potassium intakes also inversely correlated with CTX. Body composition (weight, BMI and fat/lean mass) had strong positive associations with BMD. Multiple regression analysis showed body weight, potassium and dairy intake were predictors of increased BMD in PM women and explained 39% (r=0.39, p< 0.003) of variance. Conclusion: BMD was negatively correlated with OPG and positively with weight, dairy and potassium intake. This study highlights the importance of maintaining adequate body weight and emphasising dairy and potassium predominantly sourced from fruit/vegetables to reduce bone loss at midlife. [ABSTRACT FROM AUTHOR]

Background: Sick leave due to neck pain (NP-SL) is costly and negatively impacts the productivity of the nursing and midwifery workforce. Identification of modifiable risk indicators is necessary to inform preventive efforts. This study aimed to investigate the role of pain-related psychological features (pain catastrophizing, fear of movement, and pain coping) in NP-SL alongside other potential risk indicators. Methods: A cross-sectional analysis of a large cohort study of Australian and New Zealand nurses and midwives, established between 1st April 2006 to 30th March 2008, was undertaken. Recruitment procedures adopted within each Nursing Council jurisdiction were governed by the individual regulatory authorities and their willingness to engage with the study. Invitations directed potential participants to a purpose-built internet-based survey, where study information was provided and consent requested. Once consent was obtained, a range of standardized tools combined into one comprehensive electronic questionnaire was elicited. Exposure variables assessed included pain characteristics and a broad range of psychological, psychosocial, occupational, general health and demographic factors. Two-way interactions between age and gender and candidate exposures were also assessed. Binary logistic regression was performed using manual backward stepwise elimination of non-significant terms. Results: The cohort included 4,903 currently working nurses or midwives aged 18-65 years. Of these, 2,481 (50.6%) reported neck pain in the preceding 12 months. Our sample comprised of 1,854 working nurses and midwives with neck pain in the preceding year who supplied sick leave data. Of these, 343 (18.5%) reported taking sick leave in the preceding year due to their neck pain. The final most parsimonious multivariable model demonstrated neck pain severity (adjusted odds ratio, [aOR] = 1.59), passive pain coping (aOR = 1.08) and fear of movement (aOR = 1.06) increased the likelihood of NP-SL in the previous year. Interactions between demographic and general health factors exhibited both protective and risk relationships with NP-SL, and there was no association between pain catastrophizing and NP-SL. Conclusions: Findings demonstrate that sick leave due to neck pain was associated with pain severity, fear of movement and passive pain coping. In addition, there were complex interactions found between demographic and general health factors. These features represent potentially modifiable targets for preventive programs. [ABSTRACT FROM AUTHOR]

This cross-sectional study investigated the spoken expository discourse skills of children and adolescents elicited in generation and retelling conditions. There were three groups of participants: young school-age children (M = 7.0 years; n = 64); intermediate-school-age children (M = 11.3 years; n = 18) and high-school-age students (M = 17.6 years; n = 18). Participants were asked to generate expository discourse using the favourite game or sport (FGS) task and to retell an expository passage about the game of curling. All samples were transcribed and analysed on measures of verbal productivity (number of utterances), syntactic complexity (mean length of utterance in T-units [MLU] and clausal density) and verbal fluency (percent maze words). Results indicated that although all age groups produced longer samples in the generation condition, MLU was significantly longer in the retelling condition. The results suggest that the expository retelling task may be a clinically useful addition to a language assessment battery for children and adolescents. [ABSTRACT FROM AUTHOR]

Women of child bearing age that regularly drink alcohol are at risk for drinking in early pregnancy. Evidence indicates a majority of women stop alcohol consumption on pregnancy recognition. However, there is a dearth of studies reporting on patterns and correlates of drinking in early pregnancy prior to stopping on pregnancy recognition, which the current study aims to address. In 2005, a New Zealand nationwide cross-sectional survey was conducted on a random sample of 1,256 women aged 16-40 years. Data were collected via an interviewer-administered questionnaire using a web-assisted telephone interviewing system. Of the 1,256 women who participated, 127 (10 %) were currently pregnant and 425 women (34 %) were previously pregnant. Half of currently pregnant women and 37 % of previously pregnant women reported that they ceased drinking on recognising pregnancy. Women categorised as 'risky drinkers' and those aged 16-24 years had higher odds to drink and binge drink in early pregnancy, compared with non-risky drinkers and women of other age categories respectively. A majority of women stop alcohol consumption on pregnancy recognition but prior to this, drink at levels posing a risk for the developing foetus. Women most at risk for drinking and binge drinking in early pregnancy were younger in age and exhibited risky drinking behaviour prior to pregnancy. A targeted intervention to reduce the risk for an alcohol exposed pregnancy is warranted for sexually active younger women in New Zealand and elsewhere. [ABSTRACT FROM AUTHOR]

Background New Zealand has an urgent need to train and retain obstetrics and gynaecology academics, and postgraduate training pathways are being considered. Aims To gauge registrar interest in an academic training position and an academic career; analyse the importance of various encouraging factors; and investigate how demographics, experience and encouragers may be associated with academic interest. Methods All obstetric and gynaecology registrars working in New Zealand were invited by their clinical directors to participate in an online survey in March-June 2011. Statistical analysis, using Fisher's Exact and chi-squared tests, was used to investigate how demographic, experience and encourager variables were associated with academic interest. Results Of the 58 participants, 46 were women, 32 were New Zealand medical graduates and 43 were on the training program. Over half (54%) indicated they would consider a 1-year rotating research/teaching position and 45% an academic career. The most important encouraging factors for academic work were interest, opportunity to balance clinical and academic roles, job flexibility (lifestyle and family) and a supportive academic environment. Women were nearly nine times more likely to consider academic training ( OR 8.75, P = 0.007), and trainees were one-third as likely to consider it compared to non-trainees ( OR 0.31, P = 0.073). Conclusions New Zealand has the unique ability to approach retention and training issues in a flexible and innovative manner which utilises international links. Clinical academic training positions should be set-up with quality supervision and support similar pay scales and the opportunity for simultaneous part-time clinical practice. [ABSTRACT FROM AUTHOR]