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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]

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]

Introduction. Pacific peoples experience inequity in accessing hearing health care and are disproportionately exposed to the underlying determinants impacting ear and hearing health in Aotearoa New Zealand. Understanding community members’ worldviews, including perspectives, beliefs and values, is essential in developing appropriate and responsive hearing healthcare services to meet the needs of Pacific peoples. Aim. The purpose of this paper is to understand the worldviews, knowledge and beliefs held by Pacific peoples regarding hearing health in Aotearoa New Zealand. Methods. A mixed-methods approach was used. Twelve semistructured face-to-face interviews were conducted with Pacific community members. Twentyfive participants completed an online questionnaire. A simultaneous, integrated mixed-methods approach was used to analyse the qualitative and quantitative data. Results. Five main themes were established, which were: The Meaning of Hearing; Causes of hearing loss; Consequences of hearing loss and Disability; and Improving health care for ear disease and hearing loss. Discussion. Pacific peoples value hearing health to communicate and connect with their families and communities. Participants highlighted the importance of hearing health across the life course. Although the study findings revealed there is potentially less stigma and shame around hearing loss in New Zealand, denial and fatalistic attitudes towards hearing loss may delay some people from seeking healthcare services. Participants expressed key ways in which the health system can be more responsive to the hearing health needs of Pacific peoples in Aotearoa New Zealand. [ABSTRACT FROM AUTHOR]

Introduction. Globally, yoga has gained popularity as a health-promoting and disease-prevention discipline. The common health conditions prompting yoga use include musculoskeletal disorders, mental health conditions, asthma, fibromyalgia, arthritis, diabetes, and cancers. Although the therapeutic benefits of using yoga are well documented, little is known about the characteristics of yoga instructors (YIs) and yoga users (YUs) in New Zealand (NZ). Aim. This paper seeks to profile the characteristics of NZ YIs and YUs and explore reasons for yoga use. Methods. Online surveys for YIs and YUs were conducted to collect the sociodemographic characteristics of 84 YIs and 267 YUs. Descriptive statistics were used to determine trends. Results. The surveys were conducted between September 2020 and February 2021. The YIs were predominantly female (87.1%) with mean ± s.d. years of practice of 9.8 ± 0.8 (95% CI: 8.2, 11.4). YUs were most commonly female (86%), of NZ European descent (63%), aged 45–64 years (56%), not married (52.5%), and with a university or higher education qualification (61.5%). They use yoga to alleviate chronic health conditions like back pain (18%), menopausal symptoms (14.5%), anxiety (13.5%) and depression (11.5%). Discussion. Most YIs in NZ are females facilitating moderatesized yoga classes. YUs in NZ are disproportionately NZ European, female, middle-aged and tertiary educated. They use yoga to help manage long-term conditions, including mental ill-health and musculoskeletal disorders. The study findings could inform health professionals regarding the utilisation of yoga in NZ. Further research is required to gain insights into yoga use. [ABSTRACT FROM AUTHOR]

Introduction. Body image dissatisfaction and its associated challenges have been related to poorer health outcomes among adolescents worldwide, including disordered eating behaviour, depression, and anxiety. However, current prevalence estimates of these issues in Aotearoa New Zealand or, relatedly, the estimates of positive attitudes and behaviours, such as intuitive eating and body appreciation are dated. Aim. The primary aim of this paper was to provide updated estimates for a variety of constructs related to eating behaviours and body image, sourced from a diverse range of early adolescent participants. Methods. For this report, a brief online survey was advertised to adolescents throughout Aotearoa New Zealand (n = 893) via school and community noticeboards. Results. Approximately one-in-three male participants and one-intwo female participants reported body image dissatisfaction. One in four participants reported clinically significant symptoms of depression and anxiety. Discussion. Given such issues, there is clearly still much progress to be made in advancing positive health among early adolescents. Identifying potentially protective constructs such as intuitive eating and body appreciation may offer guidance into the best targets for prevention and early intervention. [ABSTRACT FROM AUTHOR]

Introduction. Education on health care for patients with diverse sexual orientation, sex characteristics and gender identities is lacking in Aotearoa's medical schools. Aim. This study surveyed fifth-year medical students at the University of Otago Wellington (UOW) about confidence in providing health care to lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA+) patients to identify learning needs. Methods. This anonymous crosssectional survey was designed with input from an advisory group (community members, education, research and subject matter experts). It was administered on paper during class, using Likert scales (level of agreement) and open-ended questions. All fifth-year medical students at the UOW campus were invited to participate in May 2021. Data were analysed in Microsoft Excel (Microsoft Corporation) and free-text comments were analysed using template analysis. Results. In total, 74.7% (71/95) of students completed a survey. Participants lacked knowledge and confidence in their consultation skills with LGBTQIA+ patients and did not feel they had enough teaching in this area. Most (=78.8%) were comfortable with common terms, but half or fewer could explain intersex, gender affirmation and Takatāpui. Free-text comments revealed learning needs relating to consultation skills, ways to approach this topic with sensitivity, and a desire to learn more about the cultural context. Discussion. Medical students view LGBTQIA+ health care as an important topic and want opportunities to improve knowledge and confidence in this area. Students lack confidence in consulting with LGBTQIA+ patients, suggesting that more education focused on practical experience and interactions with real patients would be of benefit. [ABSTRACT FROM AUTHOR]

Background: Non-traumatic lower limb amputation rates are rising worldwide, resulting in increased hospitalisations and use of rehabilitation services. This study aimed to identify key comorbidities associated with prolonged length of stay or decreased functional gain for episodes receiving inpatient rehabilitation following non-traumatic lower limb amputation. Methods: Prospectively collected data submitted to the Australasian Rehabilitation Outcomes Centre were analysed. The cohort comprised episodes for patients (aged ≥18 years) discharged from inpatient rehabilitation between 1 July 2013 and 30 June 2018 following a non-traumatic lower limb amputation. Results: The cohort included 5074 episodes with an average age of 66.3 years and the majority being male (71.7%). Comorbidities affecting the ability to participate in rehabilitation were reported for 65.4% of episodes, most commonly diabetes mellitus (50.3%), cardiac disease (33.5%), and respiratory disease (10.1%). These comorbidities were associated with a prolonged length of stay and reduced functional improvement. Conclusion: This study showed comorbidities contribute to prolonged length of stay and poorer functional outcomes among those undergoing inpatient rehabilitation following non-traumatic lower limb amputation. Future research should focus on strategies to address these comorbidities to help improve patient outcomes and reduce healthcare costs. What is known about the topic? It is known that the presence of comorbidities contributes to lower limb amputation; however, the effect that comorbidities have on inpatient rehabilitation outcomes is not well reported. What does this paper add? This study identified five comorbidities (diabetes mellitus, cardiac disease, respiratory disease, renal failure with dialysis, and mental health problems) associated with prolonged length of stay and decreased functional outcomes following inpatient rehabilitation for non-traumatic lower limb amputation. What are the implications for practitioners? Our findings suggest practitioners should focus on strategies to address these comorbidities to help improve functional outcomes, reduce length of stay, and reduce healthcare costs. [ABSTRACT FROM AUTHOR]

Introduction. Few mandatory community-based attachments for postgraduate year two doctors (PGY2s) in Aotearoa New Zealand are hosted in general practices, due to space, time and remuneration barriers. Aim. This study aimed to explore the costs, barriers and enablers to general practices of hosting PGY2s. Methods. A cost analysis for four general practices beginning to host PGY2s was undertaken, including time spent supervising and supporting PGY2s, revenue impact including subsidies and cost of providing clinical space. Interviews with these practices and seven experienced PGY2 host practices were conducted and analysed thematically. Results. The estimated mean cost of hosting PGY2s excluding room cost was NZ$4907 per 13-week placement (range $890-$9183), increasing to $13 727 per placement (range $5750-$24 715) when room rental was included. Four themes were identified: working within a small business model; a new learning environment for PGY2s; providing positive experiences for the PGY2s; the relationship between practices and district hospitals that employed the PGY2s, including job sizing. Discussion. Tension exists between the small business model of general practice and providing positive experiences for PGY2s in a new learning environment. Guidance and support structures for PGY2 hosting should be developed nationally, and communication and cooperation between practices and employing hospitals needs improvement. Out-of-hours work should be included in community-based attachments so PGY2s' remuneration is consistent. General practice teams are willing to be part of creating a sustainable workforce. However, the time taken to host and costs of providing training in primary care are barriers. There is urgent need to increase funding to general practices for hosting PGY2s. [ABSTRACT FROM AUTHOR]

Introduction. The New Zealand population has one of the highest incidences of skin cancer in the world. Hospital waiting lists for surgical excision of keratinocytic skin cancers (basal cell carcinoma and squamous cell carcinoma) are lengthy, and increasingly, excisions are undertaken in primary care. Teledermatology, in response to general practitioners' electronic referrals (e-referrals), can improve clinical communication between general practitioners and dermatologists. Aim. The aim of this study was to evaluate an excision pathway for keratinocytic cancers diagnosed by teledermatology. Methods. A retrospective observational descriptive review of a 3-month cohort of primary care e-referrals was undertaken. Results. Three hundred and fifty eight suspected keratinocytic cancers (KCs) were diagnosed by teledermatology; histology reports confirmed KC in 201 of 267 excisions (75%). The majority (77.2%) were excised by general practitioners an average of 25 days after the dermatologist's recommendation. The rest were excised by plastic surgeons in private (3.4%) or at a public hospital (19.5%) after an average of 40 or 134 days, respectively. Discussion. E-referral pathways are now widely implemented. However, the ideal workflow for skin cancer management is unknown. We have demonstrated in New Zealand that surgery can be undertaken in primary care within a month of a teledermatology diagnosis and excision recommendation. Conclusion. This study reports prompt excision of KCs by general practitioners after an e-referral and a teledermatology response. [ABSTRACT FROM AUTHOR]

Introduction. Regular diabetic foot checks, at least annually, are important for early identification of risk factors and prevention of ulceration and amputation. To ensure this, most general practices in Aotearoa New Zealand (NZ) offer free annual diabetes reviews (ADRs) which include a comprehensive foot evaluation. However, attendance rates at these ADRs are low. Aim. To explore patients' perspectives on the barriers to attending ADRs and foot checks. Methods. Semi-structured interviews with people with type 2 diabetes who were overdue their ADR (n = 13; 7 women, 6 Māori) from two urban practices were conducted. Interviews were audio recorded and transcribed verbatim and then analysed using an inductive thematic analysis approach. Results. We identified three key themes demonstrating barriers to attendance: healthcareassociated factors (suboptimal clinician-patient relationship, not having a consistent general practitioner (GP)); patient-related factors (co-morbid health conditions, issues surrounding identity, and logistical issues); and systemic factors (COVID-19 pandemic, travel distance to the practice, unawareness of available foot care services). Participants' feedback focused on patient-centred approaches for improvements to service delivery, for example using online educational materials, and utilising culturally appropriate models of health including Te Whare Tapa Whā and Whānau Ora approach. Discussion. We identified several barriers to attendance, some of which are potentially modifiable. Addressing modifiable barriers and incorporating suggestions made by participants may improve access to the ADR and reduce non-attendance. Further participatory action research could explore these insights in ways that facilitate tino rangatiratanga (self-determination) and palpable action. [ABSTRACT FROM AUTHOR]

Introduction. This study presents an innovative model of integrated dermatology service delivery. Kauri HealthCare (KHC) is a general practice serving around 19 000 patients in Palmerston North, New Zealand. A 'mini clinic' is provided by an on-site dermatologist that is available for patients of KHC. Referring practitioners are required to attend with the patient to present their case and seek dermatologist input. This allows for patients to receive a specialist opinion, as well as for the referrer to receive practical and academic teaching, record findings, and arrange any further investigations, follow-up, or management. Aim. To describe the nature of patient presentations and clinical outcomes of a novel dermatologist-general practitioner integrated clinic based in a provincial healthcare practice. Methods. Descriptive analysis of all referrals to the Kauri HealthCare dermatology mini clinic from April 2017 to December 2022. Results. During the study period, 964 diagnoses were recorded across 806 patients booked into the mini clinic. The most common presenting conditions were: (1) eczema; (2) psoriasis; (3) actinic keratoses; (4) naevi; and (5) seborrheic keratosis. Practitioners sought dermatology opinion on the diagnosis and/or management of skin conditions. Further referral to secondary care was not required for 86% of patients. Discussion. Improvements could be made to better serve those of Māori and Pacific ethnicity, or living in high socioeconomic deprivation. Results indicate where teaching could be prioritised for practitioners, postgraduates, and medical students. Overall, this is an innovative clinic model, which seeks to provide equitable care, medical education, and collaboration between primary and secondary services. [ABSTRACT FROM AUTHOR]

Introduction. Melanoma is a serious type of skin cancer with a high burden in New Zealand. MelNet Quality Statements (2021) guide the timeliness of investigations and management for melanoma patients, who might experience long delays waiting for treatment. Aim. To assess compliance of melanoma diagnosis and treatment timeliness with the MelNet Quality Statements at Waikato Hospital and in primary care for melanoma and melanoma in situ (MIS). Methods. This is a retrospective clinical audit of patients referred via the Suspected Skin Cancer (SSC) teledermatology pathway between June 2020 and June 2022, and histologically confirmed as having melanoma or MIS. Time intervals between elements of service were analysed. Results. For 43 melanomas and 105 MIS, compliance with MelNet Quality Statements across all melanoma services was poor, except for teledermatology response rates (100% compliance). From referral to first cancer treatment (Statement 2.1.1), compliance was 50% in general practice and 7.7% in Waikato Hospital. From teledermatologist response to biopsy (Statement 2.1.3), compliance was 65.2% in general practice and 7.7% in hospital plastics department. Histopathological reporting delays were also identified. Discussion. Long delays for melanoma care in hospital likely reflect system failures (such as inadequate funding and human resources) and the increasing burden of skin cancer. In contrast, primary care provided quicker diagnostic biopsies and surgical treatments for melanoma. [ABSTRACT FROM AUTHOR]

Introduction. Most New Zealanders experience low back pain (LBP) at least once throughout their lifetime and many seek help from the large range of health providers in primary care. Accident Compensation Corporation (ACC) funds a significant proportion of those claims, but which services are they funding and what are the costs? Method. This was a retrospective audit and descriptive analysis of ACC-funded, non-public hospital healthcare service use by people with LBP in New Zealand (NZ). Outcome measures were the healthcare services accessed by people with ACC-funded LBP,the claims (all occurrences for a service that has generated a payment/ year), single contact (with a service), and costs (NZ$) for services between 2009 and 2020. Results. The number of claims for services were 129 000 for physiotherapy, 105 000 for general practitioner and 59 000 for radiology services. Per single contact, elective surgery and radiology services were the most expensive. During 2009–2020, there were 3.3 million ACC claims for LBP with a total cost of NZ$4 billion. Over this time, there was an increase in claims, costs and single contacts. Costs decreased slightly during 2010 due to changes in healthcare funding and in 2020 due to the COVID-19 pandemic. Discussion. Consumers have considerable choice in where they access health care for ACC-funded LBP services. This study shows the services they use most frequently and the cost to NZ for those services. These data can inform service planning for ACC-funded LBP health care in NZ. [ABSTRACT FROM AUTHOR]

Introduction. Prediabetes is a condition of elevated blood sugar levels which can increase the risk of type 2 diabetes (T2D) if not managed effectively. Prediabetes is likely to affect about 24.6% of New Zealand (NZ) adults, with estimates of 29% of the Pacific population currently living with the condition. A prediabetes diagnosis is an opportunity for intervention from trusted primary care providers. The study aim was to describe primary healthcare clinician's knowledge and practice regarding screening, diagnosing and management of prediabetes in Pacific patients. Methods. An online survey was conducted with current practicing primary healthcare clinicians between February and April 2021. Eligible participants included clinicians employed in a primary healthcare clinic with over 50% of enrolled patients identified as Pacific. Results. Primary healthcare clinicians (n = 30) reported that their prediabetes screening, diagnosis and management were aligned with the NZ Ministry of Health clinical guidelines. The most common factors that prompted screening was a family history of T2D (25/30, 83%), ethnicity (24/30, 80%) weight and BMI (24/30, 80%). The initial management practices involved providing recommendations for dietary changes and physical activity (28/30, 93%) and referring patients to a diabetes prevention lifestyle change programme (16/30, 53%). Discussion. Primary healthcare clinicians are the foremost point of engagement with patients and their fāmili (family) in their health journey. Culturally appropriate tools could be useful to assist healthcare providers to communicate to a higher risk population and most clinicians rely on up to date guidelines for screening and management. [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]

Introduction. In New Zealand, nurses visiting families postnatally use the Patient Health Questionnaire-3 (PHQ-3) to screen and detect postnatal depression. Exploring nurses' perception of the tool when using it with women across cultures is central to ensuring the PHQ-3 tool supports equitable screening and detection of postnatal depression, yet little is known about nurses' confidence with, and use of, the tool with people of differing cultures. Aim. The aim of this study was to understand nurses' confidence in using the PHQ-3 to screen for postnatal depression, particularly its use cross-culturally. Methods. Quantitative online survey research was carried out in 2019. Fifty-two percent of eligible registered nurses participated (n = 187), completing Likert scale responses and open questions about the use of the screening tool with specific groups, and barriers and facilitators to screening. Results. Ninety-five percent of participants were confident in their use of the PQH-3, 70% of nurses agreed the PHQ-3 supports the identification of postnatal depression, and most respondents (54.5%) disagreed that the PHQ-3 was a good screening tool cross-culturally. Discussion. Nurses were confident in their use of the PHQ-3, and it was relatively highly regarded in its ability to detect postnatal depression. However, less confidence in its use across cultures implies the PHQ-3 does not translate to evidence-based, cross-cultural care. To serve culturally diverse populations, consultation is needed on both languages used and cultural practices so that tools are appropriate, otherwise they cannot be validated for use cross-culturally. [ABSTRACT FROM AUTHOR]

Introduction. There is a high prevalence of malnutrition among older adults entering residential aged care (RAC). Aim. To determine whether 60 mL of a compact oral nutrition supplement (ONS; daily total: 576 kcal, 35 g protein) consumed four times daily with medication rounds improves malnutrition status, body weight, and body composition measures among older adults in RAC. Methods. Residents (n = 20; mean age: 86.7 ± 6.8 years; 50% female) screened for malnutrition (20% malnourished, 80% at risk of malnutrition) using the Mini Nutritional Assessment-short form were recruited during April–June 2021. Participants received 60 mL of an ONS four times daily using the Medication Pass Nutrition Supplement Programme (Med Pass). The ONS intake and participant compliance were recorded. Body mass index, fat, and muscle mass (bioelectrical impedance), malnutrition risk, depressive symptoms, and quality of life were assessed at baseline and following the 18-week intervention. Results. Median overall compliance was 98.6%. An ONS intake did not significantly increase mean ± s.d. any body composition measures or improve health and wellbeing outcomes; however, it resulted in increased body weight and body mass index (BMI; 13/20 (65%) participants), body fat mass and percentage (10/16 (63%) participants) and muscle mass (9/16 (56%) participants). Malnutrition risk scores improved in 65% (13/20) of participants, resulting in 10% being assessed as malnourished, 65% at risk of malnutrition, and 25% with normal nutrition status. Discussion. Delivery of a compact oral nutrition supplement with the medication round was accepted by residents. Its efficacy in improving malnutrition risk and body composition among residents warrants further investigation. [ABSTRACT FROM AUTHOR]

Introduction. The ‘Raising Healthy Kids (RHK) health target’ recommended that children identified as having obesity [body mass index (BMI) ≥98th centile] through growth screening at the B4 School Check (B4SC) be offered referral for subsequent assessment and intervention. Aim. To determine the impact of the ‘RHK health target’ on referral rates for obesity in Aotearoa New Zealand (NZ). Methods. A retrospective audit was undertaken of 4-year-olds identified to have obesity in the B4SC programme in Taranaki and nationally in 2015–19. Key outcomes were: ‘RHK health target’ rate [proportion of children with obesity for whom District Health Boards (DHBs) applied the appropriate referral process]; Acknowledged referral rate (proportion of children with a referral for obesity whose referral was acknowledged by DHBs); and Declined referral rate (proportion of children offered a referral for obesity who declined their referral). Results. Data were audited on 266 448 children, including 7464 in Taranaki. ‘RHK health target’ rates increased markedly between 2015–16 and 2016–17 following the health target implementation (NZ: 34–87%; P < 0.0001, Taranaki: 21–68%; P < 0.0001). Acknowledged referral rates also increased post-target nationally (56–90%; P < 0.0001), and remained high in Taranaki over the 4-year period (ranging from 89 to 99%). However, there were notably high Declined referral rates across NZ (26–31%) and in Taranaki (although variable: 38–69%). Discussions. The ‘RHK health target’s’ focus on referral rather than intervention uptake limited the policy’s impact on improving preschool obesity. Future policy should focus on ensuring access to multidisciplinary intervention programmes across NZ to support healthy lifestyle change. [ABSTRACT FROM AUTHOR]

Introduction. Patients with obstructive sleep apnoea (OSA) commonly present in primary care. Increasing physical activity reduces symptoms and severity of OSA. Low motivation is a barrier to physical activity in adults with OSA. Aim. To investigate the feasibility and acceptability of an exercise and personalised text messaging programme to enhance motivation and support physical activity behaviour change in adults with OSA. Methods. Participants were recruited from the local Sleep Clinic. Exclusion criteria were unstable angina, and/or poorly controlled hypertension. The intervention comprised three groups, who received either individual exercise prescription, personalised text messages or both over a 24-week period. Participants were allocated to one of the three groups. The primary outcome was feasibility of study design including participant recruitment and retention. Secondary outcomes were a change in 6-min walk distance and exercise self-efficacy over time. Results. Thirty participants were recruited, 17 male and 13 female, with a mean age of 54.6 years. The study design appears feasible and the outcome measures used were acceptable to participants. Recruitment and retention rates were lower than anticipated. A trend towards increased functional exercise capacity was identified in all three groups, along with a corresponding increase in exercise selfefficacy over time. Discussion. Exercise and personalised text messaging both appear to offer an acceptable and feasible means to increase physical activity in adults with OSA. A larger scale trial may provide justification for physiotherapist input to support patients with OSA to address physical inactivity. [ABSTRACT FROM AUTHOR]

Introduction. Type 2 diabetes mellitus (T2DM) is a highly prevalent and potentially preventable condition associated with significant health, social, and economic costs. The detection and management of pre-diabetes is an important opportunity to prevent or delay the onset of T2DM and associated morbidities; however, its importance is controversial as the health risks associated with pre-diabetes are poorly understood. Aim. To understand the cardio-metabolic health profile of a sample of adults with pre-diabetes in Aotearoa New Zealand. Methods. Secondary analyses of baseline data from all 153 adults recruited to an intervention trial for adults with pre-diabetes were carried out. A profile of cardio-metabolic risk was measured by describing the proportion with metabolic syndrome (MetS) calculated using Adult Treatment Panel III criteria, which includes blood pressure, lipids, and obesity in addition to glycaemic measures. The severity of MetS was calculated as MetS Z-scores. Subgroup analyses for sex, ethnicity and glycated haemoglobin (HbA1c) were performed. Results. Overall, 74% of this study population had MetS, and the proportion varied according to ethnicity and HbA1c level. The severity of MetS was highly variable, with MetS-Z-scores ranging from -1.0 to 2.8. Although mean MetS Z-scores differed according to ethnicity and HbA1c level, all subgroups included individuals with widely differing severity of MetS, suggesting likely quite different risks for progression to diabetes or cardiovascular disease across the range of pre-diabetes defined by HbA1c. Discussion. Single biochemical markers of glycaemia are insufficient to ascertain overall cardio-metabolic risk when prioritising clinical efforts for those with pre-diabetes, particularly in primary care, where the potential for preventing or delaying the onset of type 2 diabetes mellitus (T2DM) is significant. Findings indicate the importance of attending to all cardiometabolic risk factors when caring for people with pre-diabetes. The development of tools using multiple relevant variables and predicting a comprehensive range of outcomes would improve timely risk stratification and treatment effect monitoring of pre-diabetes populations. [ABSTRACT FROM AUTHOR]

Introduction. Recently immigrated Pakistani women need knowledge about their new country's healthcare system to better access appropriate care. Aim. This study explores the knowledge of Pakistani immigrant women about New Zealand's healthcare system. Methods. An online questionnaire was developed and administered using Qualtrics© software. Closed and open-ended questions were asked about knowledge and challenges when entering a new healthcare system. The target population was Pakistani women aged =18 years, living in New Zealand for <5 years. Participants were recruited from different cities, primarily through snowball sampling using various social media. The survey was conducted in English, and responses were analysed using Microsoft Excel. Results. Two hundred respondents (covering 881 family members) answered most questions. The average age of the participants was 26-34 years, and most were housewives. Recently immigrated Pakistani women considered it difficult to access information about medical centres, GP registration, subsidised medicines, maternity services, emergency/after-hours services, and mental health for children and adults. Most participants stated that they obtained information about the healthcare system from friends and searched Google. Discussion. Recently immigrated Pakistani women face challenges finding information about New Zealand's healthcare system, which may impact access to health care for themselves and their families. Information is particularly needed before or soon after arrival in New Zealand. [ABSTRACT FROM AUTHOR]

Introduction. Prediabetes is the asymptomatic precursor to type two diabetes mellitus, a significant and growing public health problem in New Zealand (NZ). Little is known about how general practitioners (GPs) and nurses view prediabetes care, and similarly little is known about how people with prediabetes view their condition and care. Aim. This study aimed to investigate the views of NZ GPs and nurses, and people with prediabetes about prediabetes and its management. Methods. This was a mixed qualitative methods study that is part of a randomised control trial of a prediabetes intervention. Results. Three key themes emerged from the health professional data (GPs and nurses) and another three themes emerged from people with prediabetes data. GPs and nurses were uncertain about the progression of prediabetes; they felt prediabetes was not a priority and they were unsure about what to advise. People with prediabetes were uncertain about the diagnosis and information given to them; they were unsure about what to do about prediabetes and they found lifestyle change hard. Discussion. GPs, nurses and people with prediabetes, expressed much uncertainty, but also some certainty about prediabetes. All were certain that prediabetes is common and increasing and that sustained lifestyle change was very difficult. But uncertainty prevailed about whether, in reality, prediabetes could be stopped, who would be most likely to benefit from lifestyle interventions and how best to achieve these. Older Māori and Pacific women were keen to promote lifestyle change and this appeared best done through Māori and Pacific peoples' organisations by means of co-designed interventions. [ABSTRACT FROM AUTHOR]

Introduction. Basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and actinic keratosis (AK) are usually located on sun-exposed areas of the body. Aims. Our main aims were to identify the common body site locations of BCC, SCC and AK in patients attending the Waikato District Health Board teledermoscopy clinic, also known as the Waikato Virtual Lesion Clinic, as well as to analyse whether the distribution of location changes with age and sex. Methods. This is a retrospective study where the body site location of 3272 keratinocytic lesions was determined and analysed in 1864 patients attending the Waikato District Health Board teledermoscopy clinics between 2010 and 2021. Results. All three types of lesion were most commonly located in the head and neck region (40.9% of BCCs, 38% of SCCs, 83.2% of AKs), followed by 26.8% on the trunk for BCC, 32.3% on the lower extremities for SCC, and 11.6% on the upper extremities for AK. Discussion. Our findings of body site locations for keratinocytic lesions were consistent with other studies. Patients were commonly diagnosed with multiple keratinocytic lesions. [ABSTRACT FROM AUTHOR]

Objective. Effective clinical governance can improve delivery of health outcomes. This exploratory study compared perceptions of clinical governance development held by registered health professionals employed by two different but interrelated health organisations in the broader New Zealand (NZ) health system. Most staff in public sector healthcare service delivery organisations (i.e. District Health Boards (DHBs)) are registered health professionals, whereas these clinical staff represent a small minority (5%) in social insurance organisations (i.e. the Accident Compensation Corporation (ACC)). Given these different contexts, comparison of results from three surveys of clinical governance perceptions identified key learnings for the development of clinical governance. Methods. The Clinical Governance Development Index (CGDI) was administered to registered health professional staff in NZ DHBs and ACC, at different time points. The data were explored, compared and reported. Results. Responses to survey items completed by NZ DHB staff and registered health professionals employed by ACC were compared. For each administration, there was a similar profile of positive responses across the seven CGDI items. The 2020 ACC survey results for one item were clearly different. This item asked about perceptions of full and active involvement in organisational processes and decision making (i.e. clinical engagement). Conclusions. Perceptions of registered health professionals working in the NZ public sector delivering health services were compared with those held by staff employed by a NZ social insurer predominantly commissioning and influencing care. The results indicated similar levels of clinical governance development. Clinical governance development in the ACC context can benefit from clear communication, building strong supporting structures and greater management-clinical provider partnerships. Clinical governance development drives health outcomes and regular measurement of developmental progress can provide momentum. There is room across the NZ health system to raise awareness and leverage clinical governance to deliver improved health outcomes. [ABSTRACT FROM AUTHOR]