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ObjectiveThe Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) was established to investigate the drivers of secondary events after first-time acute coronary syndrome (ACS), including addressing inequitable outcomes by ethnicity. Herein, the first clinical outcomes and prognostic modelling approach are reported.MethodsFirst, in 28 176 New Zealanders with first-time ACS from a national registry, a clinical summary score for predicting 1-year death/cardiovascular readmission was created using Cox regression of 20 clinical variables. This score was then calculated in the 2015 participant MENZACS study to represent clinical risk. In MENZACS, Cox regression was used to assess N-terminal pro-B-type natriuretic peptide (NT-proBNP) as a prognostic marker for death/cardiovascular readmission in four models, adjusting for (1) age and sex; (2) age, sex, ethnicity; (3) clinical summary score; (4) clinical summary score and ethnicity.ResultsOf the 2015 MENZACS participants (mean age 61 years, 79% male, 73% European, 14% Māori, 5% Pacific people), 2003 were alive at discharge. Of the 2003, 416 (20.8%) experienced all-cause death/cardiovascular readmission over a median of 3.5 years. In a simple model, age, male sex, Māori ethnicity and NT-proBNP levels were significant predictors of outcome. After adjustment for the clinical summary score, which includes age and sex, NT-proBNP and ethnicity were no longer statistically significant: log2(NT-proBNP) hazard ratio (HR) 1.03, 95% confidence interval (95% CI) 0.98 to 1.08, p=0.305; Māori ethnicity HR 1.26, 95% CI 0.97 to 1.62, p=0.084.ConclusionsIn 2015 patients with first-time ACS, recurrent events were common (20.8%). Increasing NT-proBNP levels and Māori ethnicity were predictors of death/cardiovascular readmission, but not after adjustment for the 20 clinical risk factors represented by the clinical summary score.Trial registration numberACTRN12615000676516.

Most healthcare providers (HCPs) work from ethical principles based on a Western model of practice that may not adhere to the cultural values intrinsic to Indigenous peoples. Breaking bad news (BBN) is an important topic of ethical concern in health research. While much has been documented on BBN globally, the ethical implications of receiving bad news, from an Indigenous patient perspective in particular, is an area that requires further inquiry. This article discusses the experiences of Māori (Indigenous peoples of New Zealand) lung cancer patients and their families, in order to investigate the ethical implications of receiving bad news. Data collection occurred through 23 semistructured interviews and nine focus groups with Māori lung cancer patients and their families in four districts in the Midland Region of New Zealand: Waikato, Bay of Plenty, Lakes and Tairāwhiti. The findings of this study were categorised into two key themes: communication and context. Avenues for best practice include understanding the centrality of the HCP–patient relationship and family ties in the healthcare journey, and providing patients with the full range of viable treatment options including hope, clear advice and guidance when the situation calls for it. Overall, the findings of this study hold implications for providing culturally safe and humanistic cancer care when BBN to Māori and Indigenous patients.

ObjectivesSerum testosterone (T) levels in men decline with age. Low T levels are associated with sarcopenia and frailty in men aged>80 years. T levels have not previously been directly associated with disability in older men. We explored associations between T levels, frailty and disability in a cohort of octogenarian men.SettingData from all men from Life and Living in Advanced Age Cohort Study in New Zealand, a longitudinal cohort study in community-dwelling older adults.ParticipantsCommunity-dwelling (>80 years) adult men excluding those receiving T treatment or with prostatic carcinoma.Outcomes measuresAssociations between baseline total testosterone (TT) and calculated free testosterone (fT), frailty (Fried scale) and disability (Nottingham Extended Activities of Daily Living scale (NEADL)) (baseline and 24 months) were examined using multivariate regression and Wald’s χ2techniques. Subjects with the lowest quartile of baseline TT and fT values were compared with those in the upper three quartiles.ResultsParticipants: 243 men, mean (SD) age 83.7 (2.0) years. Mean (SD) TT=17.6 (6.8) nmol/L and fT=225.3 (85.4) pmol/L. On multivariate analyses, lower TT levels were associated with frailty: β=0.41, p=0.017, coefficient of determination (R2)=0.10 and disability (NEADL) (β=−1.27, p=0.017, R2=0.11), low haemoglobin (β=−7.38, p=0.0016, R2=0.05), high fasting glucose (β=0.38, p=0.038, R2=0.04) and high C reactive protein (CRP) (β=3.57, p=0.01, R2=0.06). Low fT levels were associated with frailty (β=0.39, p=0.024, R2=0.09) but not baseline NEADL (β=−1.29, p=0.09, R2=0.09). Low fT was associated with low haemoglobin (β=−7.83, p=0.0008, R2=0.05) and high CRP (β=2.86, p=0.04, R2=0.05). Relationships between baseline TT and fT, and 24-month outcomes of disability and frailty were not significant.ConclusionsIn men over 80 years, we confirm an association between T levels and baseline frailty scores. The new finding of association between T levels and disability is potentially relevant to debates on T supplementation in older men, though, as associations were not present at 24 months, further work is needed.

Background Intact proprioception (joint position sense (JPS), kinaesthesia, force sense (FS)) is critical for optimal neuromuscular control of knee functional joint stability. Fatigue is known to impair knee JPS and kinaesthesia, but research regarding the effect of fatigue on knee FS is lacking. Objective To determine the effect of functional fatigue on knee extension FS in uninjured, adult, male football players. It was hypothesized that functional fatigue would result in significant impairment of FS. Design Single-session, pre-/post-intervention repeated measures. Setting University sensorimotor control and biomechanics laboratory. Participants University team players (n=21; age (mean±SD) 21.0±1.2 years; height 178.7±7.2 cm; mass 76.8±11.5 kg; training×2/week; match×1/week) without history of knee intra-articular derangement or surgery. Interventions Functional fatigue was defined/induced using the previously published Functional Agility Short-Term Fatigue Protocol (FAST-FP). The FAST-FP incorporated acceleration-deceleration tasks typical of football training/match play. Main Outcome Measures Dominant leg (preferred kicking leg) knee extension FS was measured in Newtons (N). Players were seated on an isokinetic dynamometer set to isometric mode, the knee flexed 45°. A knee extension target trial-reproduction trial sequence was repeated five times, the difference between trials designated the absolute error (AE), the average AE used for data analyses. Reliability and measurement error for this procedure has been previously established. Force sense measurements were performed before and immediately after the FAST-FP. The FS and FAST-FP procedures were adjacent in the same laboratory space with minimal transition time between tasks. Results Force sense AE significantly increased following fatigue (pre-fatigue=10.9±5.8 N; post-fatigue=23.0±9.2 N; difference=12.1±7.9 N; P=0.00; d=1.59). Conclusions Dominant leg knee extension FS was significantly impaired following functional fatigue. Fatigue-induced impairment of FS could result in sub-optimal neuromuscular control and altered knee functional joint stability that affects knee injury risk.

Background Proprioception (joint position sense (JPS), kinaesthesia, force sense (FS)) is of interest in knee injury prevention. Recent work reports existing knee proprioception tests are inadequate relative to gaining better understanding of knee functional joint stability and injury aetiology. Objective To determine critical psychometric properties of a new knee extension FS test in uninjured, adult, male football players. Hypotheses: 1. the test would demonstrate good reliability; 2. there would be no between-limb significant differences. Design Between-day (D1/D2) repeated measures. Setting University sensorimotor control laboratory. Participants Twelve university team players (age (mean±SD) 21.1±1.5 years; height 177.5±9.3 cm; mass 77.1±15.4 kg) participated. Interventions Players were seated on an isokinetic dynamometer set to isometric mode, the knee flexed 45°. A knee extension target trial-reproduction trial sequence was repeated five times, FS measured in Newtons (N), between-trial differences designated absolute error (AE), average AE used for analyses. Limb order was randomized for D1 and repeated D2. Main Outcome Measures Systematic error (paired t-test; Cohen9s d (d)); relative reliability (ICC 2,k); absolute reliability (standard error of measurement (SEM)); measurement change needed to detect true physiological differences (minimal detectable difference (MDD)); between-limb differences (D2 values; paired t-test). Results There were no significant differences between D1 and D2 values for either limb (P>0.90; d Conclusions There was no systematic error. The FS test demonstrated good reliability. The measurement error and change needed to detect true physiological change were established. There were no between-limb differences. The knee extension FS test offers a new knee proprioception test that can be used in studies of knee functional joint stability and injury aetiology in adult male football players.

Introduction Primary health care nurses (PHCNs) frequently report being interested in sexual health care, believe sexual health care is important, see sexual health care as part of their role and want to further develop their skills in this field. However recent Australian studies demonstrate that opportunities for PHCNs in sexual health care in general practice appears to be underdeveloped and under supported. Methods The Australasian Society for HIV Medicine (ASHM), NSW STI Programs Unit and Australian Primary Health Care Nurse Association (APNA) consulted PHCNs in NSW about their current role, interest in sexual health care and what they believed would assist to further develop their role in this field. Partnerships were formed between NSW primary health care organisations (Medicare Locals), public sexual health services, Family Planning NSW and training providers to also identify how to respond to the identified need. Results Key strategies identified by PHCNs to enhance their role in sexual health care in general practice included the development of competency standards, provision of online training and strong support from GPs. A multi-pronged approach has been undertaken using competency standards and clinical tools to support education and practice, clinical placements in sexual health services to further develop skills and practical resources such as how to bill patients to support this change of practice. Conclusion PHCN are interested in expanding their role in general practice and are in a pivotal position to lead significant changes in general practice for the provision of sexual health care to the community. Key elements to assist this include effective support from GPs, the provision of clinical tools and education and opportunities to connect with sexual health services. Finally primary health care nurses’ own determination and perseverance to take a lead role in sexual health care is critical to the success of this practice change. Disclosure of interest statement The NSW STI Programs Unit is funded by NSW Health. No pharmaceutical grants were received in the development of this project.

Between February and April, 1945, an epidemic of primary atypical pneumonia occurred in British base and training units in the Naples area. During this period approximately 350 cases of primary atypical pneumonia were admitted to a neighbouring British general hospital and 161 to this hospital. Of these 161, 50 unselected consecutive cases were investigated in particular detail. All degrees of severity were represented. There were no deaths. Epidemiologically, it was of interest that the rising incidence of primary atypical pneumonia coincided with the decline of infective hepatitis. Clinical data, serial laboratory investigations, and radiological findings relating to these 50 cases are summarized in this report, which is a preliminary survey of the material collected. In the literature available to us we have been unable to locate any report of the finding of heterophil antibodies in serum from cases of primary atypical pneumonia. For that reason an early report is considered desirable to enable investigators, under research conditions, to repeat the work in subsequent epidemics.