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Objectives Smoking during pregnancy is harmful for the woman and the unborn child, and the harms raise risks for the child going forward. Indigenous women often have higher rates of smoking prevalence than non-indigenous. Exercise has been proposed as a strategy to help pregnant smokers to quit. Māori (New Zealand Indigenous) women have high rates of physical activity suggesting that an exercise programme to aid quitting could be an attractive initiative. This study explored attitudes towards an exercise programme to aid smoking cessation for Māori pregnant women. Methods Focus groups with Māori pregnant women, and key stakeholder interviews were conducted. Results Overall, participants were supportive of the idea of a physical activity programme for pregnant Māori smokers to aid smoking cessation. The principal, over-arching finding, consistent across all participants, was the critical need for a Kaupapa Māori approach (designed and run by Māori, for Māori people) for successful programme delivery, whereby Māori cultural values are respected and infused throughout all aspects of the programme. A number of practical and environmental barriers to attendance were raised including: cost, the timing of the programme, accessibility, transport, and childcare considerations. Conclusions A feasibility study is needed to design an intervention following the suggestions presented in this paper with effort given to minimising the negative impact of barriers to attendance. [ABSTRACT FROM AUTHOR]

Football codes (rugby union, soccer, American football) train and play matches on natural and artificial turfs. A review of injuries on different turfs was needed to inform practitioners and sporting bodies on turf-related injury mechanisms and risk factors. Therefore, the aim of this review was to compare the incidence, nature and mechanisms of injuries sustained on newer generation artificial turfs and natural turfs. Electronic databases were searched using the keywords 'artificial turf', 'natural turf', 'grass' and 'inj*'. Delimitation of 120 articles sourced to those addressing injuries in football codes and those using third and fourth generation artificial turfs or natural turfs resulted in 11 experimental papers. These 11 papers provided 20 cohorts that could be assessed using magnitude-based inferences for injury incidence rate ratio calculations pertaining to differences between surfaces. Analysis showed that 16 of the 20 cohorts showed trivial effects for overall incidence rate ratios between surfaces. There was increased risk of ankle injury playing on artificial turf in eight cohorts, with incidence rate ratios from 0.7 to 5.2. Evidence concerning risk of knee injuries on the two surfaces was inconsistent, with incidence rate ratios from 0.4 to 2.8. Two cohorts showed beneficial inferences over the 90% likelihood value for effects of artificial surface on muscle injuries for soccer players; however, there were also two harmful, four unclear and five trivial inferences across the three football codes. Inferences relating to injury severity were inconsistent, with the exception that artificial turf was very likely to have harmful effects for minor injuries in rugby union training and severe injuries in young female soccer players. No clear differences between surfaces were evident in relation to training versus match injuries. Potential mechanisms for differing injury patterns on artificial turf compared with natural turf include increased peak torque and rotational stiffness properties of shoe-surface interfaces, decreased impact attenuation properties of surfaces, differing foot loading patterns and detrimental physiological responses. Changing between surfaces may be a precursor for injury in soccer. In conclusion, studies have provided strong evidence for comparable rates of injury between new generation artificial turfs and natural turfs. An exception is the likely increased risk of ankle injury on third and fourth generation artificial turfs. Therefore, ankle injury prevention strategies must be a priority for athletes who play on artificial turf regularly. Clarification of effects of artificial surfaces on muscle and knee injuries are required given inconsistencies in incidence rate ratios depending on the football code, athlete, gender or match versus training. [ABSTRACT FROM AUTHOR]

We surveyed New Zealand residential facilities/assisted-living programs for adults with intellectual disabilities (ID) to document the need for, and provision of, augmentative and alternative communication (AAC). Organizations ( n = 100) registered to provide residential care/assisted-living to adults with ID across New Zealand were invited to complete a paper or online survey. Fifty seven organizations representing 127 separate facilities/assisted living programs responded. The facilities/programs accommodated 2,356 adults and employed 3,062 staff. Nearly one-third (28.8 %) of the adults were identified as candidates for AAC intervention. However, most staff had limited or no AAC experience and perceived considerable need for training in this area. We conclude there is substantial need for AAC intervention among adults with ID in New Zealand residential facilities/assisted-living programs. To facilitate this, support staff may need training to ensure effective interaction with AAC users and competence in providing effective AAC intervention. [ABSTRACT FROM AUTHOR]

Acromioclavicular joint (ACJ) separation injuries are common injuries among sporting populations. ACJ separations are graded according to severity from grade I being a mild sprain to grade VI, which is severe dislocation with displacement. There is consensus in the literature that grade I-III ACJ separations are managed conservatively and grades IV-VI are managed surgically. Despite conservative care being recommended for lesser grades of injury, there is very little evidence in the literature as to what constitutes conservative care. Therefore, the purpose of this paper was, first, to review the relevant anatomy and kinematics of the ACJ and, second, to review the literature relating to current evidence of conservative management of ACJ injury. Using this data, a best practice guideline for conservative rehabilitation in grade I-III ACJ separations was developed. For the conservative management, a literature search was undertaken using the following databases in the Auckland University of Technology's electronic library resources; MEDLINE, CINAHL, SPORTDiscus~" and the Cochrane Library. The following keywords or phrases were used: 'acromioclavicular joint separa- tions', 'injury', 'dislocations', 'rehabilitation', 'conservative care', 'physio- therapy' and 'exercise'. A total of 24 articles was identified. There were no randomized con- trolled trials (RCTs) that investigated conservative treatment for grade I-III ACJ sprains. Therefore, a narrative review was formulated covering the anatomy and biomechanics of the ACJ, injury mechanisms and relevant literature reviewed covering rehabilitation principles. Conservative manage- ment of grade I-III ACJ separations is still the main recommendation following this review. A best practice guideline for managing grade I-III ACJ separations is presented to help guide clinicians until well constructed RCTs are carried out to improve the conservative management of ACJ injuries. [ABSTRACT FROM AUTHOR]

This paper summarizes survey and interview results from a cross-sectional study of New Zealand health care chaplaincy personnel concerning their involvement in multiple bioethical issues encountered by patients, families and clinical staff within the health care context. Some implications of this study concerning health care chaplaincy, ecclesiastical institutions, health care institutions and government responsibilities are discussed and recommendations presented. [ABSTRACT FROM AUTHOR]

Two major statistical issues confronting comparative analyses of hospital outcomes are adequacy of case-mix adjustment and proper accounting for random variation. Hierarchical modeling has been proposed to improve precision and reduce the impact of random variation but becomes difficult to implement when there are numerous case-mix factors to control. In this paper we formulate the problem of hospital performance comparisons within the framework of potential outcomes and illustrate an approach to hospital comparisons which combines multiple category propensity score methods for the control of case-mix variations with hierarchical Bayesian modeling of case-mix adjusted summaries. The approach is similar to that proposed by Huang et al. (Health Serv Res 40:253-278, ) but extends their approach by using a Bayesian model to accommodate hospital level attributes and to facilitate joint modeling of performance for multiple outcomes. The analytical approach is illustrated by a comparison of 30 day post admission mortality risks for patients treated for acute myocardial infarction, pneumonia or stroke in 34 New Zealand public hospitals. In a small simulation study, reported in electronic supplementary material, hierarchical models outperformed non-hierarchical models, achieving both better credible interval coverage and shorter average interval lengths for measures of between hospital variation based on contrasts between the 90th and 10th percentiles of the mortality risk distribution. Simulation performance of hierarchical and non-hierarchical models in detecting unusual performance was similar. [ABSTRACT FROM AUTHOR]