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Background: Hospitalisation with severe lower respiratory tract infection (LRTI) in early childhood is associated with ongoing respiratory symptoms and possible later development of bronchiectasis. We aimed to reduce this intermediate respiratory morbidity with a community intervention programme at time of discharge.Methods: This randomised, controlled, single-blind trial enrolled children aged <2 years hospitalised for severe LRTI to 'intervention' or 'control'. Intervention was three monthly community clinics treating wet cough with prolonged antibiotics referring non-responders. All other health issues were addressed, and health resilience behaviours were encouraged, with referrals for housing or smoking concerns. Controls followed the usual pathway of parent-initiated healthcare access. After 24 months, all children were assessed by a paediatrician blinded to randomisation for primary outcomes of wet cough, abnormal examination (crackles or clubbing) or chest X-ray Brasfield score ≤22.Findings: 400 children (203 intervention, 197 control) were enrolled in 2011-2012; mean age 6.9 months, 230 boys, 87% Maori/Pasifika ethnicity and 83% from the most deprived quintile. Final assessment of 321/400 (80.3%) showed no differences in presence of wet cough (33.9% intervention, 36.5% controls, relative risk (RR) 0.93, 95% CI 0.69 to 1.25), abnormal examination (21.7% intervention, 23.9% controls, RR 0.92, 95% CI 0.61 to 1.38) or Brasfield score ≤22 (32.4% intervention, 37.9% control, RR 0.85, 95% CI 0.63 to 1.17). Twelve (all intervention) were diagnosed with bronchiectasis within this timeframe.Interpretation: We have identified children at high risk of ongoing respiratory disease following hospital admission with severe LRTI in whom this intervention programme did not change outcomes over 2 years.Trial Registration Number: ACTRN12610001095055. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate the New Zealand Accident Compensation Corporation's (ACC) 'My Home is My Marae' approach to injury prevention for whānau (families). Setting: Over an 18 month period from November 2013 to June 2014, 14 'My Home is My Marae' trials were conducted across the South Auckland and Far North regions of New Zealand. ACC engaged with local Māori providers of healthcare, education and social services to deliver the home safety intervention. Participants: Participants of this evaluation were a purposive sample of 14 staff from six provider organisations in South Auckland and the Far North regions of New Zealand. Methods: Kaupapa Māori theory-based evaluation and appreciative inquiry methodologies underpinned the evaluation. Interview participants led discussions about strengths and weaknesses of the approach, and partnerships with ACC and other organisations. The evaluation was also supported by pre-existing information available in project documentation, and quantitative data collected by Māori providers. Results: Five key critical success factors of 'My Home is My Marae' were found from interviews: mana tangata (reputation, respect and credibility); manākitanga (showing care for people); kānohi-ki-tek ānohi (face-to-face approach); capacity building for kaimahi, whānau and providers and 'low or no cost' solutions to hazards in the home. Data collected for the Far North area showed that 76% of the hazards identified could be resolved through 'low or no cost' solutions. Unfortunately, similar data were not available for South Auckland. Conclusions: Injury prevention or health promotion approaches that seek to engage with whānau and/or Māori communities would benefit from applying critical success factors of 'My Home is My Marae'. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Medical Council of New Zealand requires graduating doctors to have community attachments within their first two years of practice by 2020. Counties Manukau Health has developed a programme where house officers (HOs) are attached to a general practice for three months. AIM: This study aimed to establish the value of four HO general practice attachments in Counties Manukau and describe how HOs are being used in these practices. METHODS: A mixed-methods design was used to evaluate three attachment runs. Two practices provided the number of patients seen by HOs. Fifty-eight patients were surveyed to assess patient perceptions of the HOs. Six HOs, four supervising general practitioners, two PHO senior staff and one practice manager participated in semi-structured interviews. Focus groups were held with nurses, doctors and administrative staff at all four practices. FINDINGS: HOs saw 300-600 patients in one practice and 800-1000 in the other during their attachment. Practices developed their own approach to mentoring and teaching HOs. Most patients reported positive perceptions of the HOs. Themes from interviews and focus groups were consistent among participants and included: improved HO confidence, clinical skills and understanding of general practice; extra capacity and improved quality of care and staff satisfaction among practices. CONCLUSION: HOs and practices viewed HO attachments in general practice positively. HOs developed clinical skills and understanding of primary health care. Practice teams enjoyed the energy and enthusiasm of the HOs, while providing clinical support to ensure quality patient care. [ABSTRACT FROM AUTHOR]