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Objectives: Community based dementia prevalence studies are expensive and resource intensive. Aotearoa New Zealand (NZ) has never had a community based dementia prevalence study representing all major ethnic groups. In recent years, dementia prevalence estimates have been derived from routinely collected health data but issues of underdiagnosis and undercoding limit their utility. Capture‐recapture techniques can estimate the number of dementia cases missing from health datasets by modelling the ascertained overlaps between linked data sources. Methods: Three routinely collected national health data sets—interRAI, Public hospital discharges, and Pharmaceuticals—were linked and all prevalent cases of dementia in NZ for the year 1 January 2021–31 December 2021 were identified. Capture‐recapture analysis fitted eight loglinear models to the data, with the best fitting model used to estimate the number of prevalent cases missing from all three datasets. Results: We estimated that almost half (47.8%) of dementia cases are not present in any of the three datasets. Dementia prevalence increased from 3.7% to 7.1% (95% CI 6.9%–7.4%) in the NZ 60+ population and from 4.9% to 9.2% (95% CI 8.9%–9.6%) in the NZ 65+ population when missing cases were included. Estimates of missing cases were significantly higher (p < 0.001) in Māori (49.2%), Pacific peoples (50.6%) and Asian (59.6%) compared to Europeans (46.4%). Conclusions: This study provides updated estimates of dementia prevalence in NZ and the proportion of undiagnosed dementia in NZ, highlighting the need for better access to dementia assessment and diagnosis. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Ultrasound picture archiving and communication system (PACS) databases are useful for quality improvement and clinical research but frequently contain free text that is not easily readable. Here, we present a method to extract and clean a semi‐structured echocardiography (cardiac ultrasound) PACS database. Methods: Echocardiography studies between 1 January 2010 and 31 December 2018 were extracted using a data mining tool. Numeric variables were recoded with extreme values excluded. Analysis of free text, including descriptions of the heart valves and right and left ventricular size and function, was performed using a rule‐based system. Different levels of free text variables were initially identified using commonly used phrases and then iteratively developed. Randomly selected sets of 100 studies were compared to the electronic health record to validate the data cleaning process. Results: The data validation step was performed three times in total, with Cohen's kappa ranging between 0.88 and 1.00 for the final set of data validation across all measures. Conclusion: Free text cleaning of semi‐structured PACS databases is possible using freely available open‐source software. The accuracy of this method is high, and the resulting dataset can be linked to administrative data to answer research questions. We present a method that could be used to answer clinical questions or to develop quality improvement initiatives. [ABSTRACT FROM AUTHOR]

Objective: To identify factors associated with death secondary to haemorrhage following major trauma. Methods: A retrospective case–control study was conducted on data from adult major trauma patients attending Christchurch Hospital ED between 1 June 2016 and 1 June 2020. Cases (those who died due to haemorrhage or multiple organ failure [MOF]), were matched to controls (those who survived) in a 1:5 ratio from the Canterbury District Health Board major trauma database. A multivariate analysis was used to identify potential risk factors for death due to haemorrhage. Results: One thousand, five hundred and forty major trauma patients were admitted to Christchurch Hospital or died in ED during the study period. Of them, 140 (9.1%) died from any cause, most attributed to a central nervous system cause of death; 19 (1.2%) died from haemorrhage or MOF. After controlling for age and injury severity, having a lower temperature on arrival in ED was a significant modifiable risk factor for death. Additionally, intubation prior to hospital, increased base deficit, lower initial haemoglobin and lower Glasgow Coma Scale were risk factors associated with death. Conclusions: The present study reaffirms previous literature that lower body temperature on presentation to hospital is a significant potentially modifiable variable in predicting death following major trauma. Further studies should investigate whether all pre‐hospital services have key performance indicators (KPIs) for temperature management, and causes for failure to reach these. Our findings should promote development and tracking of such KPIs where they do not already exist. [ABSTRACT FROM AUTHOR]

Background: Gender disparity in surgery remains an issue worldwide. We analysed the trends in gender distribution in surgical subspecialties across Australia and New Zealand over the last 8 years. Methods: Workforce reports from the Royal Australasian College of Surgeons were reviewed from 2014 to 2021. Data relating to 4802 applicants, 1554 trainees and 6839 active surgeons across nine surgical subspecialties was analysed. Statistical analysis was performed using a difference of proportions hypothesis test. Predictions regarding time to parity were performed using a linear regression model. Results: All nine surgical subspecialties' surgeon numbers saw a steady increase in the representation of women between 2014 and 2021. The most significant rise seen in general surgery from 14% to 21% (P ≤ 0.001). Proportions of women trainees were variable, the only significant rise was seen in orthopaedics from 9% to 19% (P ≤ 0.001). Proportions of women applicants and successful applicants have also been variable. General surgery saw the only consistent increase in women applicants over the last 6 years, from 35% in 2016 to 43% in 2021. Linear regression predictions estimate that paediatric surgery will be the first to reach gender parity in 23 years, and orthopaedics the last, in 186 years. Conclusion: A steady increase in women has been observed across all surgical subspecialities over the last 8 years. However, estimates based on current trends suggest that gender parity may be out of reach for the next eight generations in subspecialties such as cardiothoracic and orthopaedic surgery. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) triples a person's risk of active tuberculosis (TB) and is associated with increased mortality. It is unclear whether diabetes status and/or the associated renal dysfunction is associated with poor TB outcomes in New Zealand, which has high diabetes screening. Aim: To characterise the population of TB‐DM and TB‐alone to assess the effect of diabetes status and renal function on hospitalisation and mortality. Methods: Clinical records from all adult patients diagnosed with TB in Auckland over a 6‐year period (2010–2015) were reviewed. Baseline demographics, clinical presentation and microbiological data were assessed to compare the rates of hospitalisation and mortality between those with TB‐DM and TB‐alone. Statistical significance was defined as P < 0.05. Results: A total of 701 patients was identified with TB; 120 (17%) had an unknown diabetes status and were excluded, and 135 had co‐existing diabetes. The TB‐DM and TB‐alone groups had similar distribution of TB site and proportions of Mycobacterium tuberculosis culture positivity. Univariate analysis showed TB‐DM patients had statistically significantly higher proportions of acute hospitalisation and mortality. Multivariate logistic regression showed only a reduced estimated glomerular filtration rate (eGFR) accounted for the higher rates of hospitalisation, with the odds of hospitalisation increasing by 2% for every unit decrease in eGFR. The odds of mortality increased by 6% for every year increase in age, and the odds of mortality increased by 3% for every unit reduction in eGFR. Conclusions: Diabetes is associated with higher TB hospitalisation and mortality; however, this is likely mediated by increased age and chronic kidney disease. [ABSTRACT FROM AUTHOR]

Background: The New Zealand (NZ) Ministry of Health ethnicity data protocols recommend that people of South Asian (SAsian) ethnicity, other than Indian, are combined with people of Japanese and Korean ethnicity at the most commonly used level of aggregation in health research (level two). This may not work well for perinatal studies, as it has long been observed that women of Indian ethnicity have higher rates of adverse pregnancy outcomes, such as perinatal death. It is possible that women of other SAsian ethnicities share this risk. Aims: This study was performed to identify appropriate groupings of women of SAsian ethnicity for perinatal research. Materials and Methods: National maternity and neonatal data, and singleton birth records between 2008 and 2017 were linked using the Statistics NZ Integrated Data Infrastructure. Socio‐demographic risk profiles and pregnancy outcomes were compared between 15 ethnic groups. Recommendations were made based on statistical analyses and cultural evaluation with members of the SAsian research community. Results: Similarities were observed between women of Indian, Fijian Indian, South African Indian, Sri Lankan, Bangladeshi and Pakistani ethnicities. A lower‐risk profile was seen among Japanese and Korean mothers. Risk profiles of women of combined Indian‐Māori, Indian‐Pacific and Indian‐New Zealand European ethnicity more closely represented their corresponding non‐Indian ethnicities. Conclusions: Based on these findings, we suggest a review of current NZ Ministry of Health ethnicity data protocols. We recommend that researchers understand the risk profiles of participants prior to aggregation of groups in research, to mitigate risks associated with masking differences. [ABSTRACT FROM AUTHOR]

Background: The emergence of the COVID‐19 and the resulting global pandemic has ushered in far‐reaching changes for countries across the world, not least of which are changes to their education systems. With traditional location‐based exams no longer possible at universities, the uptake of online proctored exams (OPE) has occurred at a pace not seen prior to the pandemic. Students' experiences of online proctored exams during the pandemic are reasonably well‐understood in terms of digital access and ease of use of the technology. However, less is known about students' perceptions of digital confidence and competence to complete an online exam, both of which are important digital equity considerations. Objectives: This study investigates students' digital confidence and competence to undertake online proctored exams to determine whether issues of equity exist for students. Methods: This study reports the results of a survey (N = 761) of one university's students' experiences of end‐of‐semester online proctored exams in New Zealand. Results: Most students were positive about online exams, felt reasonably confident to complete an exam, and had the necessary digital access (i.e., devices, internet) and competence to succeed. However, digital inequalities were found between students' perceptions of digital competence based on ethnicity. While more time learning online equated to increasing self‐reported digital competence for most ethnic groups, this was not the case for Pacific learners. Takeaways: Perceptions of low digital competence can contribute to digital inequalities. Educators can support learners to develop positive perceptions of digital competence by teaching digital literacy skills. Lay Description: What is already known about this topic: Online proctored exams (OPE) have replaced many traditional exams because of the pandemic.Research on the use of online proctored exams during the pandemic suggests some acceptance among students.Apart from access related issues, little is known about digital inequalities associated with online exams. What this paper adds: Most participants were positive about OPE and felt reasonably confident to successfully complete them.Confident students were more likely to report that the exam software was easy to use.Perceptions of digital competence differed based on ethnicity.Marginalized groups were more likely to experience digital inequalities than other groups. Implications for practice and/or policy: Digital inequality is about more than issues of digital access (i.e., devices, internet).Provide differentiated technical support for students who express low digital competence.Teaching online exam digital literacy skills might increase perceptions of digital competence. [ABSTRACT FROM AUTHOR]

This study quantified and compared the collision and non-collision match characteristics across age categories (i.e. U12, U14, U16, U18, Senior) for both amateur and elite playing standards from Tier 1 rugby union nations (i.e. England, South Africa, New Zealand). Two-hundred and one male matches (5911 min ball-in-play) were coded using computerised notational analysis, including 193,708 match characteristics (e.g. 83,688 collisions, 33,052 tackles, 13,299 rucks, 1006 mauls, 2681 scrums, 2923 lineouts, 44,879 passes, 5568 kicks). Generalised linear mixed models with post-hoc comparisons and cluster analysis compared the match characteristics by age category and playing standard. Overall significant differences (p < 0.001) between age category and playing standard were found for the frequency of match characteristics, and tackle and ruck activity. The frequency of characteristics increased with age category and playing standard except for scrums and tries that were the lowest at the senior level. For the tackle, the percentage of successful tackles, frequency of active shoulder, sequential and simultaneous tackles increased with age and playing standard. For ruck activity, the number of attackers and defenders were lower in U18 and senior than younger age categories. Cluster analysis demonstrated clear differences in all and collision match characteristics and activity by age category and playing standard. These findings provide the most comprehensive quantification and comparison of collision and non-collision activity in rugby union demonstrating increased frequency and type of collision activity with increasing age and playing standard. These findings have implications for policy to ensure the safe development of rugby union players throughout the world. The safety of rugby union, especially the tackle, has previously been questioned but limited data are available to understand the collision and non-collision match characteristics between different age categories and playing standards. The frequency of collision and non-collision match characteristics increase with age and playing standard except for the frequency of scrums and tries which are lowest at the Senior Elite level. The activity of the tackle and ruck are also different between age categories and playing standards. Hierarchical cluster analysis demonstrated clear differences in all and collision match characteristics between junior (i.e. U12, U14, U16), and amateur (i.e. U18 and senior) and elite (i.e. U18 and senior) playing levels. Governing bodies and practitioners should be aware of the differences in collision and non-collision match characteristics by age and playing standard, when reviewing future versions of rugby union. [ABSTRACT FROM AUTHOR]

Background: Children's pain in dentistry has undesirable short‐ and long‐term consequences; therefore, less invasive treatments merit consideration. Aim: To investigate procedural pain scores for two treatments for carious primary molars in New Zealand primary care. Design: This study was a split‐mouth randomised control trial, with secondary outcome analysis. Children (4–8 years) with proximal carious lesions on matched primary molars had one tooth treated with the Hall technique (HT) and one treated with a conventional stainless steel crown (CT); treatment type and order of treatment were randomly allocated (allocation concealment). The Wong–Baker self‐report pain scale measured pretreatment dental pain, procedural pain at each treatment and post‐operative pain. Results: Data were analysed for 103 children: 49 children had the HT first and 54 children had the CT first. Procedural pain scores did not differ by treatment type, with 71.8% and 76.7% of children reporting low pain for the HT and the CT, respectively. Fewer children reported low procedural pain for the second treatment than the first (p =.047). Most children reported low procedural pain for both treatments (58.3%), although 41.7% experienced moderate–high procedural pain with at least one treatment. Conclusions: The HT caused pain for as many children as the CT. There is an opportunity for better dental pain management in this setting. [ABSTRACT FROM AUTHOR]

Objective: To compare clinical outcomes between patients for whom their participation in inpatient rehabilitation was and was not impacted by dementia through matching patients reporting dementia (dementia group) with those not reporting dementia (non‐dementia group). Methods: Prospectively collected data held by the Australasian Rehabilitation Outcome Centre (AROC) were analyzed for patients aged 65 years or older receiving inpatient rehabilitation in public hospitals in Australia following a hip fracture and discharged between July 1, 2014, and June 30, 2019. Patients reported as having dementia impacting their rehabilitation program were matched to patients not reporting dementia based on age, admission motor Functional Independence Measure (FIM) score, and accommodation prior to rehabilitation. The matched cohorts were compared in relation to clinical outcomes (motor and cognitive FIM improvement, FIM efficiency, length of stay, and discharge destination) following participation in hospital‐based rehabilitation using univariate analysis. Results: Patients with dementia had significantly lower cognitive FIM scores on commencing rehabilitation (17.6 and 26.9, respectively, P < 0.001) and their median length of stay was 2 days shorter than those without dementia (21 and 23 days, respectively, P < 0.001). Relative change in FIM score and FIM efficiency (per week) were lower in the dementia group [relative FIM score change of dementia vs non‐dementia, respectively, 26.2% vs. 44.0% (P < 0.001) and FIM efficiency, 6.5 vs. 8.9 (P < 0.001)]. Discharge destination between the two groups was statistically different, with 35.7% of patients with dementia being discharged to residential aged care facilities (RACFs) compared to 21.7% of those without dementia (P < 0.001). More patients with dementia had carers in their private residence in the post‐rehabilitation phase, 82.2% vs. 57.6% (P < 0.001). Conclusion: Patients with dementia who sustain a fractured hip benefit from inpatient rehabilitation, although their clinical outcomes are not as good as those without dementia. FIM change and FIM efficiency were lower in the dementia group. Length of stay in the hospital for patients with dementia was shorter due to earlier recognition for the need for placement in either an RACF or at home with carer support. The need for placement in an RACF or carer support in a private residence was significantly greater in the dementia group. [ABSTRACT FROM AUTHOR]

Background: Central venous access device (CVAD) is a common procedure in ICU which, although generally safe, can lead to acute and delayed complications. Training and accreditation process for its insertion vary worldwide. Aims: The objective of this study was to explore variability in existing training and accreditation processes for central venous access device (CVAD) insertion among different intensive care units (ICU), current practices of CVAD insertion among fellows of the College of Intensive Care Medicine (CICM) working in Australia and New Zealand (ANZ) and their recommendations for improvement. Methods: A prospective cross‐sectional web‐based survey was sent through email and CICM e‐newsletter to intensivists and directors of ICU across ANZ. All responses were tabulated, post‐hoc exploratory analysis using multivariable ordinal logistic regression was used and free texts were analysed thematically and summarised. Results: A total of 115 responses was received from various public and private ICU from all states of ANZ; 32% of the participants did not have any accreditation process for CVAD insertion skill in their ICU, whereas 91% of respondents revealed there were no processes to assess deskilling. Most intensivists recommended supervision, simulation, various education tools and ultrasound training to improve training and assessment. Thirty‐five percent of the participants inserted 0–5 CVAD and more than half of the intensivists had inserted <10 CVAD in a 1‐year period. Two‐thirds of the respondents recommended inserting between 6 and 20 CVAD each year to maintain competence. Conclusion: The study identified wide variability in current practice, training methods and accreditation process for CVAD insertion among intensivists and ICU trainees in ANZ. Policy makers should consider revising the current clinical practice and training policies to new policies for accreditation and ongoing assessment for CVAD insertions across ANZ ICU. [ABSTRACT FROM AUTHOR]

Objectives: To assess the utilisation and diagnostic accuracy of biliary point‐of‐care ultrasounds (POCUS) performed and archived in a single New Zealand ED. Methods: A retrospective cohort study of clinically indicated biliary POCUS, archived from 1 October 2019 to 20 May 2020. POCUS interpretation was compared to expert review and radiology imaging when available. The clinician interpretations, diagnostic imaging results and surgical referrals were extracted from electronic medical records. Archived POCUS images were retrospectively reviewed by an expert to determine diagnostic quality, sonographic findings and imaging errors. Results: A total of 133 ultrasounds were included; 118 (90%) archived images were of diagnostic quality. The presence or absence of gallstones was documented in 124 (93%), and other sonographic findings were less consistently documented. There was almost perfect agreement with expert review for gallstones (κ = 0.82, 95% confidence interval 0.72–0.93) and substantial agreement for wall thickening (κ = 0.63, 95% confidence interval 0.42–0.83). For patients discharged following negative POCUS without radiology imaging or surgical review no patients returned and received a diagnosis of cholecystitis over 6 months of follow‐up. Imaging errors included failure to visualise the gallbladder neck, misinterpretation of artefacts and technical errors in measurement of the gallbladder wall. Conclusion: Biliary POCUS was primarily utilised for and was accurate for the detection of gallstones. Further quality assurance and training could be directed at earlier credentialing to address technical errors and improved documentation of POCUS findings. [ABSTRACT FROM AUTHOR]

Background: The incidence of postpartum anaemia (PPA) in New Zealand, and the extent of intravenous iron (IV‐iron) use in its treatment, are unknown. Aims: To report the incidence of PPA in three district health board (DHB) regions and describe current management of moderate to severe PPA, including by ethnicity. Materials and Methods: Retrospective observational study of PPA (haemoglobin (Hb) <100 g/L) in three DHBs from July–December 2019. Cases with moderate to severe PPA (Hb <90 g/L) were reviewed and management compared to local and national guidance. Logistic regression examined demographic associations of PPA. Results: There were 8849 women who gave birth during the study period: 4076 (46%) had postpartum Hb testing and 1544 (38%) had PPA. Of those tested, and after adjusting for deprivation and region, European women had lower adjusted odds ratios compared to Māori for being identified as having PPA (0.46, 95% CI 0.37–0.57, P < 0.01). Of 681 women with Hb <90 g/L, 278 (41%) received IV‐iron only, 66 (10%) red blood cell transfusion (RBC‐T) only and 155 (23%) both. Of those receiving RBC‐T, 40/221 (18%) were actively bleeding. Māori (92/138, 67%) and Pacific (127/188, 68%) women with Hb <90 g/L had the highest incidence of IV‐iron use. No guidelines provided recommendations for haemodynamically stable women without active bleeding. Conclusion: The incidence and management of PPA differs by ethnicity but fewer than half of the women had Hb testing, making precise determination of incidence impossible. The majority of women with Hb <90 g/L received IV‐iron, with or without RBC‐T. [ABSTRACT FROM AUTHOR]

Background: Internationally, placental growth factor (PlGF)‐based tests are used as prognostic markers in suspected preeclampsia. However, Ministry of Health guidelines do not currently endorse PlGF‐based tests in New Zealand (NZ). Aims: To investigate the predictive value of soluble fms‐like tyrosine kinase 1 (sFlt‐1)/PlGF ratio in suspected preeclampsia in a NZ population. Materials and Methods: A prospective cohort study of singleton pregnancies at 20+0–36+6 weeks gestation with suspected preeclampsia as defined by Society of Obstetric Medicine Australia and NZ (SOMANZ) criteria. Primary objective: to evaluate a sFlt‐1/PlGF ratio >38 at ≤35+0 weeks gestation to predict birth ≤14 days. Secondary objectives: to assess a sFlt‐1/PlGF ratio cut‐off of 38 at ≤37+0 weeks gestation, to rule out preeclampsia ≤1 week, rule in preeclampsia ≤4 weeks, and to predict perinatal outcome. Clinicians were blinded to sFlt‐1/PlGF ratio results. Results: Included were 222 participants, 19.4% Māori and 10.4% Pasifika. A sFlt‐1/PlGF >38 predicted birth ≤14 days, positive predictive value (PPV) 51.4% (95% CI, 39.6–63.0) and negative predictive value (NPV) 95.9% (95% CI, 91.4–98.1), median (interquartile range) days to birth 14 (2–27) vs 49 (33–70), P < 0.000. A sFlt‐1/PlGF cut‐off of 38 ruled out preeclampsia ≤1 week (NPV 96.2% (95% CI, 92.3–98.2)) and ruled in preeclampsia ≤4 weeks (PPV 75.0% (95% CI, 65.0–82.9)). A sFlt‐1/PlGF >38 was associated with greater perinatal morbidity. Conclusions: The predictive value of the sFlt‐1/PlGF ratio in NZ is comparable to that reported in international trials. Used in clinical practice the sFlt‐1/PlGF ratio may aid risk stratification in suspected preeclampsia, directing limited resources to those pregnancies at highest risk. [ABSTRACT FROM AUTHOR]

Background: Prototype analyses of well‐being have identified central characteristics and prototypicality for New Zealand teachers, lawyers, adolescents, and work well‐being of nurses. What has not yet been explored is the broad construct of well‐being in intensive care nurses. Aims: To identify intensive care nurses' conceptions of general well‐being and investigate whether their general well‐being is prototypically organized. Design: Prototype analysis. Methods: Three linked studies conceptualize well‐being in this prototype analysis. In study 1, nurses reported features of well‐being. Study 2 investigated the organization of these features. Study 3 sought confirmation of prototypical organization. Results: Sixty‐five New Zealand nurses participated. For study 1 (n = 23), the most frequently reported elements of well‐being included physical health (n = 26), work‐life balance (n = 20), and personal relationships (n = 18). For study 2 (n = 25), the highest rated elements included mental and emotional health, [general] health, work‐life balance, and love. Work‐life balance, physical health, and personal relationships were in the top five most frequently reported and were rated in the top 12 most central. Overall, ratings of centrality and the number of times reported were positively correlated (r = 0.33, P <.005). For study 3 (n = 17), confirmatory analyses did not reach statistical significance (P =.15). Conclusions: Physical health, work‐life balance, and personal relationships are key characteristics of well‐being for intensive care nurses. Mental, emotional, and general health and work‐life balance were considered most important for well‐being. Relevance to clinical practice: Physical health, work‐life balance, and personal relationships are key characteristics of well‐being for intensive care nurses. These characteristics of the broad construct of well‐being are helpful in both defining and identifying conceptual models of well‐being that may be used to inform the development and measurement of well‐being programmes. [ABSTRACT FROM AUTHOR]

Objectives: To assess (i) paediatric fever management practices among New Zealand ED doctors and nurses, including adherence to best practice guidelines; and (ii) the acceptability of a randomised controlled trial (RCT) of antipyretics for relief of discomfort in young children. Methods: A cross‐sectional survey of doctors and nurses across 11 New Zealand EDs. The primary outcome of adherence to paediatric fever management best practice guidelines was assessed with clinical vignettes and defined as single antipyretic use for the relief of fever‐related discomfort. Results: Out of 602 participants (243 doctors, 353 nurses and six unknown; response rate 47.5%), only 64 (10.6%, 95% confidence interval [CI] 8.3–13.4%) demonstrated adherence to best practice guidelines. In a febrile settled child with normal fluid intake, the percentage of participants that would use antipyretics doubled with abnormal vital signs (33.7% vs 72.9%, difference −39.2%, 95% CI –44.4% to −34.0%). Most participants would use antipyretics for reduced fluid intake (n = 494, 82.1%, 95% CI 78.8–85.0%) in a febrile settled child. Over half (n = 339, 57.1%, 95% CI 53.0–61.1%) would advise giving antipyretics to prevent febrile convulsions. Most (n = 467, 80.0%, 95% CI 76.5–83.1%) participants agreed that a RCT of antipyretics in febrile children <2 years of age with relief of discomfort as a primary outcome is needed. Conclusions: Just over 10% of New Zealand ED doctors and nurses demonstrated adherence to paediatric fever management best practice guidelines. A RCT of antipyretics in febrile children <2 years of age specifically addressing relief of discomfort as a primary outcome is strongly supported. [ABSTRACT FROM AUTHOR]

New Zealand is located in the converging zone between the Australian and Pacific Plates. The Pacific Plate is descending beneath the Australian Plate in the north of New Zealand, while the Australian Plate is descending beneath the Pacific Plate in the south. The contrastive tectonics is connected by the Alpine Fault, the transform fault with NE‐SW strike along most of the length of New Zealand. Recently, previous studies showed that a cluster analysis of dense Global Navigation Satellite System (GNSS) velocity field objectively yields major velocity discontinuities, which may reflect an important tectonic boundary. We applied two different types of clustering algorithms: hierarchical agglomerative clustering (HAC) and Euler pole clustering (EPC), to the dense GNSS horizontal velocity data in New Zealand. Both methods agree that the primary kinematic boundary lies from the northern Wairarapa region to the southwestern end of the Alpine Fault. The HAC introduces a cluster boundary along the North Island Dextral Fault Belt whereas EPC emphasizes the importance of the Taupo Volcanic Zone (TVZ). Since EPC fits the data reasonably well, it indicates the TVZ is an important boundary. This result displays the limitation of the flat earth assumption. The Chatham Islands is identified as an independent cluster by the HAC, but not by the EPC. Further cluster splits illustrate that the relative motion between the two plates is accommodated by distributed deformation in the Marlborough Fault Zone in the South Island whereas the North Island is characterized by local block rotations. Plain Language Summary: Relative motion between the Australian and Pacific Plates has been causing crustal deformation in New Zealand. Identifying the spatial distribution of crustal deformation is essential for assessing seismic hazards. Observation using Global Navigation Satellite System (GNSS) provides velocities of ground motion associated with the interaction of two plates. Owing to accumulated spatially dense velocity data, we can apply a cluster analysis to this dense velocity data. Observed GNSS velocities are grouped into several clusters. By mapping the velocities of each cluster, we can identify their boundaries and relative motions, where the crustal deformation is localized. In the North Island, we identified a boundary along the Taupo Volcanic Zone, where extensional motion is prevailing, not along the North Island Dextral Fault Belt, one of the major geological structures in the North Island. In the northern part of the South Island, crustal deformation is distributed in the Marlborough Fault Zone. The cluster boundaries converge into the Alpine Fault as it goes westward. The obtained cluster boundaries are not consistent with the surface traces of active faults, which illustrates the spatially continuous distribution of crustal deformation in New Zealand. Key Points: Primary kinematic boundaries from clustering results reflect plate interaction in the Hikurang trough and Alpine FaultCrustal deformation in the North Island is characterized by clockwise block rotationDistributed crustal deformation is predominant in the South Island [ABSTRACT FROM AUTHOR]

Objective: This study aimed to retrospectively examine the contribution of nurses to population health outcomes with reference to nurse visits and blood pressure measurement in primary health settings. Design: A retrospective study was conducted using New Zealand Health Survey (NZHS) from 2012 to 2017. Sample: Adult population who are 18 years old and over living in New Zealand. Measurements: Age, gender, and ethnicity, the service utilization of primary health care nurse visit and blood pressure measurement were extracted from the NZHS (2012–2017) to compare with the service utilization of primary health care nurses by different demographic groups. Results: Females who have treated hypertension shows higher utilization of nurse visit than males. From 2015 to 2017, the participants in this cohort have visited a primary health care nurse at least more than once within a year. With blood pressure control, the overall pooled results show the impact of visiting primary health nurses on systolic and diastolic blood pressure control. Conclusion: Our study at a national scale, demonstrated the impact of nurse's contribution to population health outcomes among people living with hypertension in New Zealand. Nurses are key to improving population health outcomes and to achieve universal health coverage. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the prevalence of halitosis in young adults. Methods: Young adults (n = 372; mean age = 21.0 ± 2.6 years old, range = 18–30 years) in Dunedin, New Zealand, were recruited into the cross sectional study after providing informed consent. The prevalence of halitosis was determined using both objective measurements (parts per billion [ppb] volatile sulphur compounds [VSCs] in the exhaled air) and subjective measurements (self‐reported halitosis questionnaire, tongue coating index, and organoleptic assessment). Results: Volatile sulphur compounds measurements indicated that the prevalence of halitosis (values ≥140 ppb) was 31.2%; 25.6% of participants self‐reported halitosis. The organoleptic assessment revealed that 14.3% of the participants had a score of ≥2. A positive correlation was found between the VSC measurements and organoleptic assessment (p < 0.05). No significant relationship was found between self‐reported halitosis and either organoleptic assessment or VSC measurements. Self‐reported dry mouth, smoking, oral hygiene index, DMFT index, and tongue coating score were significantly associated with the organoleptic assessment (p < 0.05). The self‐reported dry mouth, mouth breathing and tongue coating score were significantly associated with the VSC scores (p < 0.05). Conclusion: Halitosis, as represented by VSC, was found in 31.2% of the participants. VSC scores and organoleptic assessment were positively correlated. There was no significant relationship between self‐reported halitosis and either organoleptic assessment or VSC measurements. [ABSTRACT FROM AUTHOR]

Summary: Objective: Rapid weight gain (RWG) in infancy is strongly associated with subsequent obesity risk, but little is known about the factors driving RWG. This study explored the child and maternal factors associated with infant RWG. Methods: Data from seven Australian and New Zealand cohorts were used (n = 4542). Infant RWG was defined as a change in weight z‐score ≥0.67 from birth to age 1 year. Univariable and multivariable logistic regression assessed the association between child and maternal factors and infant RWG in each cohort. Meta‐analysis was conducted to obtain pooled effect sizes. Results: Multivariable analyses revealed boys were more likely to experience RWG (OR 1.42 95% CI 1.22, 1.66) than girls. Higher birth weight in kg (OR 0.09, 95% CI 0.04, 0.20) and gestational age in weeks (OR 0.69, 95% CI 0.48, 0.98) were associated with lower RWG risk. Children who were breastfed for ≥6 months showed lower RWG risk (OR 0.45, 95% CI 0.38, 0.53). Children of native‐born versus overseas‐born women appeared to have higher RWG risk (OR 1.37, 95% CI 0.99, 1.90). Maternal smoking during pregnancy increased RWG risk (OR 1.60, 95% CI 1.28, 2.01), whereas children who started solids ≥6 months (OR 0.77, 95% CI 0.63, 0.93) and children with siblings (OR 0.68, 95% CI 0.57, 0.81) showed lower RWG risk in univariable analysis, but these associations were attenuated in multivariable analysis. No association was found for maternal age, education, marital status and pre‐pregnancy BMI. Conclusion: Maternal country of birth, smoking status, child sex, birth weight, gestational age, infant feeding and parity were potential determinants of infant RWG. [ABSTRACT FROM AUTHOR]

Introduction: It is well established that rural workforce outcomes are more likely among medical graduates who spend time training in non‐urban areas; however, fewer studies have assessed whether graduates are more likely to return to the specific area where they undertook rural training. Objective: This study aimed to determine whether graduates who had undertaken a regional–rural immersion program in Northland, NZ, were more likely to have returned to work in Northland as of mid‐2021, relative to peers who did not participate. Design: This prospective cohort study used longitudinal tracking survey responses, medical school administrative data and workforce outcome information. A multinomial model, accounting for other covariates, was built to determine the association between graduates practising in Northland (population ⟨ 100 000), which encompasses both rural (population ⟨ 25 000) and regional (25 000 ⟩ population ⟨ 100 000) areas, and having participated in a Northland‐based immersion program during medical school. The study population was University of Auckland domestic medical students graduating between 2009 and 2018, inclusive. Immersion program participants who responded to longitudinal career tracking surveys were included in the study sample. Findings The final sample size was 1320 students (80% of population of interest). Graduates who undertook the Northland immersion program (n = 169) were more likely than non‐participants (n = 1151) to be working in Northland as of 2020–2021 (relative risk: 3.2). Discussion and Conclusion: Regional–rural immersion programs might preferentially build workforces in that specific region; however, further research is required to understand whether these findings are generalizable, and the main reasons for this effect. [ABSTRACT FROM AUTHOR]

Background and purpose: Social engagement is an important active aging strategy to promote older adults' mental health. The purposes of this study were to compare social engagement in older populations around the world and explore associations with mental health outcomes. Materials and methods: An international cross‐sectional survey was conducted from 2017 to 2019. Data were retrieved from The International Social Survey Programme for a secondary data analysis across 30 countries. This study applied the Taxonomy of Social Activities and its six levels as operational definitions for a consistent concept of social engagement for international comparisons. Results: In total, 9403 older adults with a mean age of 72.85 ± 6.40 years responded. The highest levels of older adults' social engagement were found in Switzerland, Thailand, and New Zealand. Older adults of a higher age, with a lower educational level, who were permanently sick or disabled, who had no partner, who were widowed or whose civil partner had died, who lived alone, and who had lower self‐placement in society had significantly lower social engagement than did their counterparts. In the regression model, older adults' social engagement positively predicted general health, self‐accomplishment, and life satisfaction, but negatively predicted loneliness and depression. Conclusions: In aging societies worldwide, encouraging older adults' social engagement would be beneficial to promote mental health. Implications for nursing practice and health policies: Community professional nurses can develop strategies of social engagement based on the needs and sociodemographic factors of older adults to improve their mental health. Developing efficient strategies and local policies by learning from successful experiences in other countries is important to promote social engagement in aging societies. [ABSTRACT FROM AUTHOR]

Summary: This article introduces a special issue of the Australian and New Zealand Journal of Statistics, dedicated as a Festschrift for Geoff McLachlan on the occasion of his 75th birthday. [ABSTRACT FROM AUTHOR]

Objective: With longer life expectancies, cardiovascular diseases are increasingly common among older adults, which also leads to functional changes that severely impact their quality of life. This study aimed to identify the predictors of health‐related quality of life (HRQOL) among older New Zealanders with cardiovascular health problems. Methods: A cross‐sectional data analysis of the 2015/16 New Zealand Health Survey was performed. In total, 2203 older New Zealanders with cardiovascular health problems were identified and included in the final analyses. The association between demographics, physical activity, health measurements, and HRQOL was examined using a multiple linear regression model. Results: Significant differences in HRQOL were identified between the demographics and cardiovascular risk factors. Predictors of higher HRQOL among older New Zealanders with cardiovascular conditions were increased physical activity (β = 0.218), age (β = −0.067), employed (β = 0.137), lower waist circumference (β = −0.261), male (β = 0.127), and being without a history of diabetes (β = −0.071). Conclusions: Physical activity is the strongest predictor of HRQOL in older adults with cardiovascular problems. Older female New Zealanders with cardiovascular health problems have lower perceptions of their health status. These predictors should be considered while designing and developing intervention and health education that aims to improve the HRQOL of older adults. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of New Zealand's (NZ) first wave of COVID‐19, which included a nationwide lockdown, on the health and psychosocial well‐being of Māori, Pacific Peoples and NZ Europeans in aged residential care (ARC). Methods: interRAI assessments of Māori, Pacific Peoples and NZ Europeans (aged 60 years and older) completed between 21/3/2020 and 8/6/2020 were compared with assessments of the same ethnicities during the same period in the previous year (21/3/2019 to 8/6/2019). Physical, cognitive, psychosocial and service utilisation indicators were included in the bivariate analyses. Results: A total of 538 Māori, 276 Pacific Peoples and 11,322 NZ Europeans had an interRAI assessment during the first wave of COVID‐19, while there were 549 Māori, 248 Pacific Peoples and 12,367 NZ Europeans in the comparative period. Fewer Māori reported feeling lonely (7.8% vs. 4.5%, p = 0.021), but more NZ Europeans reported severe depressive symptoms (6.9% vs. 6.3%, p = 0.028) during COVID‐19. Lower rates of hospitalisation were observed in Māori (7.4% vs. 10.9%, p = 0.046) and NZ Europeans (8.1% vs. 9.4%, p < 0.001) during COVID‐19. Conclusions: We found a lower rate of loneliness in Māori but a higher rate of depression in NZ European ARC populations during the first wave of COVID‐19. Further research, including qualitative studies with ARC staff, residents and families, and different ethnic communities, is needed to explain these ethnic group differences. Longer‐term effects from the COVID‐19 pandemic on ARC populations should also be investigated. [ABSTRACT FROM AUTHOR]

Objective: To identify factors associated with caregiver distress among home care clients in New Zealand. Methods: The cohort consisted of 105,978 community‐dwelling people aged 65 years or older requiring home care services in New Zealand who had at least one informal caregiver. Bivariate and multivariable logistic regression analyses were used to identify factors associated with caregiver distress. Results: Variables associated with risk of caregiver distress included Depression Rating Scale score, aggressive behaviour symptoms, primary informal caregiver relationship to patient, Cognitive Performance Scale score, Changes in Health, End‐stage disease, and Signs and Symptoms Scale score, informal care time, secondary informal caregiver relationship to care recipient, activities of daily living hierarchy scale score and any hospitalisation. Conclusions: The study has identified important characteristics that are associated with caregiver stress. These results suggest that caregiver distress can be relieved by promoting protective factors and aiming to reduce risk factors among home care clients in New Zealand. [ABSTRACT FROM AUTHOR]

Background: Objective assessment of grit and its association with burnout in obstetrics and gynaecology (O&G) training is underexplored. Aim: This study utilises the Short Grit Scale and the Oldenburg Burnout Inventory to investigate the association of grit with burnout, thriving and career progression among O&G trainees and Fellows in Australia/New Zealand. Materials and Methods: A cross‐sectional survey of the RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) members was conducted. Participants were categorised by seniority level (core trainees, advanced trainees and Fellows). Mean grit and burnout scores were compared with one‐way analyses of variance. Correlation between grit and burnout was estimated using Pearson's correlation coefficient. Logistic regression models were used to determine factors associated with high vs low burnout. Grit was categorised as low/medium/high for regression models. Results: A total of 751 (26%) participants completed the survey. Fellows reported higher mean grit than core (P = 0.02) and advanced trainees (P = 0.03), and lower mean burnout than core trainees (P < 0.001). Moderate negative correlation was demonstrated between grit and burnout scores (r = −0.34). In the multivariable model, only seniority (adjusted adds ratio (OR): 0.40 for Fellows vs core trainees, P = 0.008) and grit levels (adjusted OR:4.52 for low versus high, P < 0.001; 2.32 for low vs medium, P = 0.001) were significantly associated with burnout. Conclusion: This study demonstrates the protective role of grit in combating burnout among RANZCOG trainees and Fellows. While further well‐designed studies are warranted, findings from our study are expected to help the College in developing targeted interventions and subsequently minimise burnout‐related adverse outcomes in high‐risk groups. [ABSTRACT FROM AUTHOR]

Purpose: To examine potential indicators of health need for primary care in spatial equity research, and evidence of the Inverse Care Law in the Waikato region of New Zealand. Methods: A cross‐sectional analysis of 7 health need indicators (ambulatory sensitive hospitalizations; cancer rate; mortality rate; New Zealand index of multiple deprivation‐health domain; age; New Zealand index of deprivation; smoking rate) that were identified through a systematic review was carried out. Values of indicators were mapped and analyzed using geographic information systems (GIS). Spearman's correlations were calculated between indicators, and clusters of high need were identified through spatial autocorrelation. The impact of incorporating indicator‐based weightings into an accessibility model was tested using analysis of variance and Spearman's correlations. General practice service spatial equity was assessed by comparing clusters of high access versus need, and quantified through the Gini coefficient. Findings: Ambulatory sensitive hospitalization (ASH) rates were significantly correlated with all indicators. Health needs were significantly clustered, but incorporating indicator weightings into the spatial accessibility analysis did not impact accessibility scores. A misalignment of access and need, and a Gini coefficient of 0.281 suggest that services are not equitably distributed. Conclusion: ASH rates seem a robust indicator of health need. However, data access issues may restrict their use. Area‐level socioeconomic deprivation measures incorporate some social determinants of health, and they have potential for wider use. High need clusters vary spatially according to the indicator used. GIS techniques can identify "hot‐spots" of need, but these can be masked in accessibility models. [ABSTRACT FROM AUTHOR]

Background: Long‐acting reversible contraceptives (LARCs) include both progestogen‐containing implants and intrauterine devices releasing either a progestogen or copper, providing highly effective contraception. Increasing uptake of LARCs is advocated by governments and professional organisations as an important strategy to reduce unintended pregnancy; such uptake requires, among other measures, adequate training of doctors in the areas of obstetrics and gynaecology and women's health. Aims: To assess The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) trainees' (Fellowship, Diploma or Certificate of Women's Health) experience and training in insertion and removal of LARCs. Materials and methods: An invitation email to participate in an anonymous survey approved by the Continuing Professional Development Committee of RANZCOG was sent to all current RANZCOG trainees in the three categories. The responses were categorised and analysed. Results: Of 1686 invited trainees, 294 (17.4%) responded: 250 in Australia and 44 in New Zealand; 127 were undertaking Fellowship training (8.3% of those invited) and 166 (100% of those invited) were undertaking training for the Diploma (either DRANZCOG and DRANZCOG Advanced) or the Certificate of Women's Health. Significant numbers of all categories of trainees had no or limited experience of insertion or removal of LARCs of all types and/or lacked self‐confidence in LARC provision. Conclusion: RANZCOG needs to address this training deficiency to continue as the leader in Australia in the provision of women's reproductive healthcare. [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]

Summary: This article introduces a special issue of the Australian and New Zealand Journal of Statistics, being a Festschrift for Adrian Baddeley on the occasion of his 65th birthday. [ABSTRACT FROM AUTHOR]

Background: Adverse pregnancy outcomes are more common in women with hyperglycaemia. Many women have suboptimal uptake of HbA1c testing postdelivery. Aims: To compare pregnancy outcomes among multi‐ethnic women with different degrees of hyperglycaemia during pregnancy, and their association with postnatal HbA1c uptake after the introduction of email reminders. Materials and Methods: A retrospective and prospective single‐centre study was conducted in South Auckland in 2639 women with early gestational diabetes mellitus (GDM) (diagnosed < 20 weeks), late GDM (diagnosed ≥ 20 weeks), overt diabetes in pregnancy, or known type 2 diabetes (T2DM) during pregnancy. Automated email reminders were sent to general practitioners to increase postnatal HbA1c screening. Results: HbA1c during pregnancy increased across the late GDM (n = 1425), early GDM (n = 148), overt diabetes (n = 573) and T2DM (n = 493) groups (P < 0.001). Stillbirth was least common in the late GDM group (0, 0.7, 0.5, and 1.9%, respectively, P < 0.001), as were caesarean delivery (32.7, 45.1, 39.4, and 53.5%, respectively, P < 0.001), large for gestational age (LGA) (14.7, 18.2, 22.3, and 30.5%, respectively, P < 0.001), small for gestational age (8.8, 16.7, 11.0, and 11.1%, respectively, P = 0.02), and preeclampsia/eclampsia (7.7, 9.2, 13.0, and 14.8%, respectively, P < 0.001). LGA and preeclampsia/eclampsia were more common among Pacific and Māori women than European women (LGA, 30.1, 22.7, 10.3%, respectively, P < 0.001; preeclampsia/eclampsia, 13.5, 14.0, and 8.1%, respectively, P < 0.001). Postpartum HbA1c screening increased among women with GDM/overt diabetes after the introduction of the reminder emails (39.6% vs 34.0%, P = 0.03). Conclusions: Women with late GDM are least likely to experience adverse outcomes. Email reminders to improve postpartum HbA1c screening warrant further investigation. [ABSTRACT FROM AUTHOR]

We test the hypothesis that ocean seafloor pressures impart stresses that alter the initiation or termination of transient slow slip events (SSEs) on shallow submarine and near‐coastal faults, using simulated seafloor pressures and a new catalog of SSEs in the Hikurangi subduction zone. We show that seafloor pressures may be represented by an average time history over the ~100‐km dimensions of the study area. We account for SSE uncertainties and the multiplicity of processes that affect SSEs statistically by estimating the probabilities of rejecting the null hypothesis that SSE initiation or termination pressures are those to be expected by chance sampling of known (modeled) seafloor pressures, with low probabilities indicating some causal connection. No impact of ocean pressure changes on SSE initiation is detectable, but a correlation with their terminations is suggested. SSE slip that weakens the fault and makes it more sensitive to small stress changes may explain results. Plain Language Summary: The ocean waters may impart stresses that change how shallow submarine and near‐coastal faults start or stop slipping, particularly when they slip slowly over days to months (in episodes called slow slip events or SSEs). We can now assess this possibility using new simulated seafloor pressures and a catalog of SSEs in the Hikurangi subduction zone, encompassing the onshore and offshore region of northeastern New Zealand. We only ask how probable this causal connection is because SSEs are difficult to measure precisely and many physical processes may change their behaviors. Our statistical analyses do not reveal any impact of ocean pressure changes on how or when SSEs start, but do indicate they may affect when SSEs end. One explanation of this result is that the slow slippage actually causes the fault to become weaker, making it more sensitive to the small stress changes imparted by the ocean. Key Points: Ocean water column changes may affect how and when Hikurangi shallow slow slip events end, but have no detectable impact on their startsTransient slow slip events may weaken faults, making them more sensitive to small stress changes (

Objectives: A recent North American study reported seasonal differences in cognitive functioning in older adults. We assessed seasonality of cognitive functioning in a large data set of older adults in New Zealand. Methods: The International Residential Assessment Instrument‐Home Care (interRAI‐HC) data set was analysed using a non‐parametric method for testing seasonal distribution of cognitive and depression scale scores. Results: Participants were 73 285 New Zealanders 65 years and older who completed their first interRAI‐HC assessment (mean age, 81.4 years; 57% female). We analysed this sample cross‐tabulating season (summer, autumn, winter and spring) and the Cognitive Performance Scale (CPS) score (Kruskal‐Wallis test, P = 0.45). Month‐by‐month CPS scores also demonstrated no variation (Spearman's test, P = 0.96). There was no association between season of assessment and the Depression Rating Scale score, ruling out variability in affect impacting on cognitive performance (Kruskal‐Wallis test, P = 0.99). Conclusion: Our findings, limited to the Southern Hemisphere, demonstrate a lack of seasonality in cognitive performance and impairment in older adults. [ABSTRACT FROM AUTHOR]

Aim: In New Zealand, there are few adequate food frequency questionnaires for assessing dietary intake. This study aimed to develop and assess the relative validity of a multi‐nutrient, culturally appropriate, semi‐quantitative food frequency questionnaire for use in young adult New Zealand women (the New Zealand Women's Food Frequency Questionnaire (NZWFFQ)). Methods: Women (n = 110) aged 16–45 years of Māori, Pacific or European ethnicity completed a NZWFFQ assessing dietary intake over the previous month, and a 4‐day weighed food record. Relative validity was evaluated by comparing nutrient intakes from the NZWFFQ with the food record using Spearman's rank correlation coefficients, cross‐classification, the weighted kappa statistic and Bland–Altman analysis. Results: Nutrient intake was higher from the NZWFFQ compared with the food record for all nutrients (range: 1%–64% difference) except alcohol (−16% difference). Energy‐adjusted correlations ranged from 0.23 to 0.67 (average 0.48). Correct classification into same and adjacent quartiles was over 70% for all nutrients except folate and vitamin D. Gross misclassification into opposite quartiles ranged from 1% (monounsaturated fat, magnesium, calcium) to 10% (iron). The weighted kappa showed poor agreement for vitamin D and folate, fair agreement for most nutrients, and moderate agreement for fibre, vitamin E, magnesium, calcium and phosphorus. Conclusions: The NZWFFQ overestimated intake of nearly all nutrients. While not suitable for assessing absolute intake, the NZWFFQ is suitable for ranking individuals based on nutrient intake demonstrating reasonable relative validity for this purpose. [ABSTRACT FROM AUTHOR]

Background: Tracheostomy management is considered an area of advanced practice for speech–language therapists (SLTs) internationally. Infrequent exposure and limited access to specialist SLTs are barriers to competency development. Aims: To evaluate the benefits of postgraduate tracheostomy education programme for SLTs working with children and adults. Methods & Procedures: A total of 35 SLTs participated in the programme, which included a 1‐day tracheostomy simulation‐based workshop. Before the workshop, SLTs took an online knowledge quiz and then completed a theory package. The workshop consisted of part‐task skill learning and simulated scenarios. Scenarios were video recorded for delayed independent appraisal of participant performance. Manual skills were judged as (1) completed successfully, (2) completed inadequately/needed assistance or (3) lost opportunity. Core non‐medical skills required when managing a crisis situation and overall performance were scored using an adapted Ottawa Global Rating Scale (GRS). Feedback from participants was collected and self‐perceived confidence rated prior, immediately post and 4 months post‐workshop. Outcomes & Results: SLTs successfully performed 94% of manual tasks. Most SLTs (29 of 35) scored > 5 of 7 on all elements of the adapted Ottawa GRS. Workshop feedback was positive with significant increases in confidence ratings post‐workshop and maintained at 4 months. Conclusions & Implications: Postgraduate tracheostomy education, using a flipped‐classroom approach and low‐ and high‐fidelity simulation, is an effective way to increase knowledge, confidence and manual skill performance in SLTs across patient populations. Simulation is a well‐received method of learning. [ABSTRACT FROM AUTHOR]

A lucky chance encounter for statistical science in NZ. [ABSTRACT FROM AUTHOR]

Background: The number of vaginal breech and twin deliveries may be insufficient for adequate training. Objective: To determine whether advanced trainees and new Fellows in obstetrics are gaining adequate experience and confidence in vaginal breech and twin deliveries. Methods: An online survey was emailed to registered Royal Australia and New Zealand College of Obstetrics and Gynaecology (RANZCOG) advanced trainees and new Fellows (Years 1–5). This survey asked about their experience, confidence and whether they intend to perform vaginal breech and twin deliveries as specialists. Results: The survey was sent to 703 advanced trainees (162) and Fellows (541) and answered by 217 (31.7%). Experience and confidence in vaginal breech and twin deliveries increased with the number of procedures performed (P < 0.001) in both groups and were significantly higher among Fellows. Despite the level of experience, 100% of respondents felt confident in managing vaginal twin deliveries with or without supervision, whereas 14.9% of respondents did not feel confident in managing vaginal breech deliveries. Intention to offer these procedures in their practice depended on confidence levels, and there was a significant difference between twins and breech. Overall, 87.3% of respondents intended to offer vaginal twin deliveries in their practice, while only 32.7% intended to offer vaginal breech deliveries. Conclusion: Confidence in complex vaginal deliveries increases with increasing number of procedures performed and a significant proportion of trainees and Fellows consider they do not have sufficient experience. The association between confidence and intention to offer these procedures is stronger in twins than in breech deliveries. [ABSTRACT FROM AUTHOR]

Background: Germline BRCA1/2 mutations account for approximately 15% of invasive ovarian carcinomas. Referral of all women with non‐mucinous epithelial tubo‐ovarian and peritoneal cancer, especially high‐grade serous carcinoma (HGSC) to genetic services for genetic counselling and subsequent BRCA testing, has become standard of care in many countries. Publicly funded BRCA testing was restricted to women ≤70 years old with HGSC in New Zealand for most of our study period. Referral rates of women with HGSC for BRCA mutation testing in New Zealand have not previously been reported. Aims: To determine the proportion of eligible patients with tubo‐ovarian or peritoneal HGSC referred to Auckland Gynaecologic Oncology Centre who were referred for genetic counselling. To determine the number of patients who underwent BRCA1/2 genetic testing and the rate of germline BRCA mutations. Methods: Eligible cases were identified from Auckland Gynaecologic Oncology multidisciplinary meetings database from 1 January 2012 to 31 December 2014. Genetic referrals sent were checked against the genetic services database to ensure that referrals were received. Genetic counselling clinic attendance, uptake and results of genetic testing were also collected. Results: One hundred and four eligible patients were identified with 58 patients referred. Referral rates increased from 37.5% in 2012 to 64.3% in 2014. Of the 58 patients referred, 53 attended genetic counselling, and 49 underwent BRCA mutation testing, of whom 10 (20.4%) tested positive for a germline BRCA mutation. Conclusion: Overall, 55.8% of eligible patients were referred for genetic testing; however, referral rates increased with time. This BRCA mutation‐positive rate is comparable with current international data. [ABSTRACT FROM AUTHOR]

Background: DriveSafe measures awareness of the driving environment. It is one subtest of DriveSafe DriveAware, a cognitive fitness‐to‐drive screening instrument. We converted DriveSafe to a touchscreen format for ease of administration; this necessitated the development of an automatic data collection and scoring system to reflect the decision that would otherwise have been made by an expert rater. We applied a structured process to determine what constituted 'correct' scores. We then examined the resulting scoring parameters to determine if these discriminated at‐risk drivers from a comparison sample. Methods: Thirty at‐risk older drivers and 30 younger drivers took touchscreen DriveSafe. Following presentation of images containing between one and four objects/hazards for 4 seconds, participants indicated their recall of object/hazard characteristics (type, location and direction of movement) by touching the screen. We analysed responses via descriptive statistics to compare spread, accuracy and consistency; and via a Fisher's exact test to determine whether the set scoring parameters could discriminate between at‐risk and comparison drivers. Results: Fisher's exact test results indicated 24 of 28 location zones and 18 of 28 direction ranges discriminated at‐risk drivers from the comparison group (P < 0.05). Frequency of missed or incorrectly identified hazards was much higher for the at‐risk group for all variables. At‐risk drivers missed or misidentified significantly (P < 0.00) more object types (34%), directions (47%), and locations (36%) than the comparison group (≤4% for each variable). At‐risk drivers entered 31 additional responses for objects/hazards not displayed; the comparison group entered no additional responses. Conclusion: The automatic variable data collection and scoring system reflected decisions that would have been made by an expert rater. This systematic process provided automated scoring decisions that enabled us to discriminate at‐risk drivers from a comparison group. Psychometric evaluation of data gathered with touchscreen DriveSafe is required prior to use in clinical practice. [ABSTRACT FROM AUTHOR]

Aim: Total gastrectomy and Ivor Lewis oesophagectomy procedures are the mainstay of upper gastrointestinal cancer management. Maintenance of adequate nutritional intake is essential for positive patient outcomes. Although numerous nutritional support options exist, clear evidence‐based guidelines on the optimal means and duration of nutritional support are lacking. The aim of this study is to establish preliminary data on the current perioperative nutritional practices of upper gastrointestinal surgeons performing these procedures across Australia and New Zealand. It is hoped this will help provide the platform for future research towards establishing evidence‐based guidelines in upper gastrointestinal surgery. Methods: A questionnaire exploring the nutritional practices and considerations of surgeons was developed and emailed to the members of the Australia & New Zealand Gastric & Oesophageal Surgery Association. Results: A total of 27.4% of Australia & New Zealand Gastric & Oesophageal Surgery Association members completed the questionnaire. Surgeons reported inserting a jejunostomy feeding tube intraoperatively in Ivor Lewis oesophagectomy procedures 80–100% of the time, compared to only 20–39% of the time in total gastrectomy procedures. For both procedures, surgeons often refer their patients to a dietitian preoperatively, and always postoperatively. Preoperative immune‐enhancing nutrition is rarely administered. Patient age and BMI are deemed to be of low importance when determining the means of nutritional support. Conclusions: This study has demonstrated the current nutritional practices employed in Australia and New Zealand for patients undergoing major upper gastrointestinal surgery. Questions remain regarding the noted differences between procedures as well as the optimal means and duration of perioperative nutritional support. [ABSTRACT FROM AUTHOR]

Aim: Fruit and vegetables are strongly promoted because of the nutrients they provide; many processed products contain added sugar and sodium. The present study aims to quantify the sugar and sodium content of pre‐packaged fruit and vegetable‐based products that are available in New Zealand supermarkets. Methods: Nutrition Information Panel data were collected from non‐frozen, processed fruit and vegetable products in New Zealand supermarkets (including soups, sauces, jams and spreads, pickles, chutneys and dips, and canned/bottled fruit and vegetables) where fruit and/or vegetables were the majority ingredient(s). Results: With the exception of canned/bottled vegetables, more than 60% of products contained added sugar. Per serve, the median sugar content was highest in canned/bottled fruit (17.8 g). More than 75% of soups, vegetable‐based sauces, pickles/chutneys and canned/bottled vegetables contained added sodium, with soups (722 mg) recording the highest median values per serve. Conclusions: Consumers need to be aware that although they are encouraged to eat a diet high in fruit and vegetables, there may be large quantities of added sugar and sodium in manufactured fruit and vegetable products that can have significant negative impacts on their health. Government health promotion campaigns encouraging the consumption of fruit and vegetables should be careful to target fresh, frozen and home‐prepared foods, and work on educating the public about the lower nutritional quality associated with most processed fruit and vegetable products. [ABSTRACT FROM AUTHOR]

How computers in schools impact on children's learning has been studied through research that explores student achievement at one point in time or by comparing different classroom contexts with differing results. The introduction of an optional netbook purchasing scheme for children in a low socio‐economic community provided an opportunity to compare the academic improvement for those who joined the scheme with those who did not with both groups learning within the same context with the same teachers. Using nationally calibrated assessment tools that test reading, writing, and mathematical skill progression, the student achievement data from six schools across a 2‐year period were analysed using chi‐square testing, regression analysis, propensity score matching, and cumulative logit modelling. The results identified few significant differences between the students in most aspects of achievement and no significant difference in academic improvement between the two groups. Lay Description: What is currently known about the subject matter: Whole class use of netbooks can improve achievement in reading, writing and mathematics.Children in low socio‐economic contexts have limited access to the Internet or netbooks for learning. What this paper adds to this: The use of netbooks alone has an insignificant effect on achievement in standardized assessments.Academic progress of children in the same context is similar whether using netbooks or not. Implication of study findings for practitioners: Introduction of netbook schemes should enable all students to have dedicated access. [ABSTRACT FROM AUTHOR]

Background: For parents who experience stillbirth, knowing the cause of their baby's death is important. A post mortem examination is the gold standard investigation, but little is known about what may influence parents' decisions to accept or decline. Aim: We aimed to identify factors influencing maternal decision‐making about post mortem examination after late stillbirth. Methods: In the New Zealand Multicentre Stillbirth Study, 169 women with singleton pregnancies, no known abnormality at recruitment, and late stillbirth (≥28weeks gestation), from seven health regions were interviewed within six weeks of birth. The purpose of this paper was to explore factors related to post mortem examination decision‐making and the reasons for declining. We asked women if they would make the same decision again. Results: Maternal decision to decline a post mortem (70/169, 41.4%) was more common among women of Māori (adjusted odds ratio (aOR) 4.99 95% confidence interval (CI) 1.70–14.64) and Pacific (aOR 3.94 95% CI 1.47–10.54) ethnicity compared to European, and parity two or more (aOR 2.95 95% CI 1.14–7.62) compared to primiparous. The main reason for declining was that women 'did not want baby to be cut'. Ten percent (7/70) who declined said they would not make this decision again. No woman who consented regretted her decision. Conclusion: Ethnic differences observed in women's post mortem decision‐making should be further explored in future studies. Providing information of the effect of post mortem on the baby's body and the possible emotional benefits of a post mortem may assist women faced with this decision in the future. [ABSTRACT FROM AUTHOR]

More than 10% of adults are prescribed antidepressants annually in some countries. Recent increases in prescribing can be explained more by repeat prescriptions than new patients. This raises the question of whether antidepressants are addictive. A total of 1829 New Zealanders who had been prescribed antidepressants completed an online survey; 44% had been taking antidepressants for more than 3 years and were still taking them. Withdrawal effects when stopping medication were reported by 55%, and addiction by 27%. Paroxetine had particularly high rates of withdrawal symptoms. Only 1% of participants recalled being told about withdrawal effects when prescribed the drugs. Such high rates of withdrawal symptoms suggest that all concerned, including mental health nurses, need to help people considering antidepressants to understand that it can be difficult to withdraw from them. It will also be beneficial to closely monitor people already taking antidepressants and who are at risk of long-term usage. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety, quality and impact of point‐of‐care ultrasound on patient management when performed by rural generalist doctors. Design: Cross‐sectional descriptive study. Setting: Six rural small hospitals serving a range of communities in rural New Zealand. Participants: All generalist doctors practising ultrasound in the study hospitals. Main outcome measures: Technical quality, accuracy, impact on diagnostic certainty, patient disposition and overall patient care. Result: Participants correctly interpreted 90% of images and a similar percentage of point‐of‐care ultrasound findings when compared with the results of formal imaging or the final diagnosis. In total, 87% of scans contributed to the diagnostic process, changing the diagnostic probability. There was a 4% overall reduction in the number of patients needing hospital admission or transfer to an urban base hospital. The overall impact on patient care was positive for 71% of point‐of‐care ultrasound scans. Three percent of scans had the potential for patient harm. Conclusion: Rural generalists' practise a broad scope of point‐of‐care ultrasound that, when used as a part of the full clinical assessment, has a positive impact on patient care, improving diagnostic certainty and reducing the need for hospital admission and inter‐hospital transfer. There are challenges in learning and maintaining the skills needed to practise a high standard of point‐of‐care ultrasound in this context. Further consideration needs to be given to the development safe scopes of practice, training, credentialing and quality assurance. [ABSTRACT FROM AUTHOR]

Background: Recent New Zealand guidelines recommend annual glycated haemoglobin (HbA1c) measurements from three months postpartum, replacing the glucose tolerance test (GTT) at six weeks, to screen for persistent hyperglycaemia following gestational diabetes. Data suggest that this screening approach may miss cases of type 2 diabetes, but are they detected at subsequent screening and will screening rates improve? Aims: Our aim was to evaluate the effectiveness of HbA1c monitoring in improving screening rates following gestational diabetes and in detecting postpartum hyperglycaemia. Materials and Methods: During 2015 in Christchurch, all women with gestational diabetes were offered HbA1c and GTT measurements at three months postpartum and subsequent annual HbA1c measurements were recommended. Data from electronic hospital records were collected for a minimum 18 months postpartum. Results: Of the cohort of 333 women, 218 (65%) completed both HbA1c and GTT at three months postpartum, 74 (22%) HbA1c only, 16 (5%) GTT only, 25 (8%) no screening; 184 (55%) had subsequent HbA1c tests. Diabetes was detected by GTT in five (2%) women and by HbA1c in only one out of five (20%); the disagreement between tests resolved in three out of four (75%) women with subsequent testing. Prediabetes was detected by GTT in 30 (14%) women; however, HbA1c only detected five out of 30 (17%) and subsequent HbA1c testing identified a further two out of 30 with prediabetes. Conclusions: HbA1c measurement at three months postpartum had a good uptake. However, most cases of diabetes were identified by subsequent HbA1c testing, the uptake of which was suboptimal. The importance of annual HbA1c monitoring following gestational diabetes needs greater emphasis. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: While dietary sources of calcium are important for bone health, the intake of milk and milk products decreases as children get older. A free milk in schools program may mitigate this decrease in milk consumption. We evaluated the Fonterra Milk for schools program (a free milk initiative) by determining changes in children's milk consumption and anthropometric measures over a 2‐year period. METHODS: The evaluation was conducted in children aged 7‐9 years in a representative sample of primary schools participating in the free milk program, in Auckland, New Zealand. The primary outcome was the proportion of children meeting the New Zealand guidelines for dairy and milk product consumption over 7 days (≥2 servings per day). Changes in anthropometric measures were also assessed as secondary outcomes. RESULTS: Nine schools (N = 511 children) participated in the evaluation. The proportion of children meeting the New Zealand guidelines for milk and milk product consumption over 7 days increased significantly from baseline to 2 years' follow‐up (72% vs 94%; p < .001). Body mass index z scores did not change significantly between baseline and 2 years' follow‐up. CONCLUSIONS: The Fonterra Milk for Schools initiative appears to be an effective way of increasing milk/milk product consumption behaviors in school‐aged children. [ABSTRACT FROM AUTHOR]

Background: A variety of advanced practice nursing roles and titles have proliferated in response to the changing demands of a population characterized by increasing age and chronic illness. Whilst similarly identified as advanced practice roles, they do not share a common practice profile, educational requirements or legislative direction. The lack of clarity limits comparative research that can inform policy and health service planning. Aims: To identify advanced practice roles within nursing titles employed in New Zealand and practice differences between advanced practice and other roles. Method: Replicating recent Australian research, 3255 registered nurses/nurse practitioners in New Zealand completed the amended Advanced Practice Delineation survey tool. The mean domain scores of the predominant advanced practice position were compared with those of other positions. Differences between groups were explored using one‐way ANOVA and post hoc between group comparisons. Results: Four nursing position bands were identified: nurse practitioner, clinical nurse specialist, domain‐specific and registered nurse. Significant differences between the bands were found on many domain scores. The nurse practitioner and clinical nurse specialist bands had the most similar practice profiles, nurse practitioners being more involved in direct care and professional leadership. Conclusions: Similar to the position of clinical nurse consultant in Australia, those practicing as clinical nurse specialists were deemed to reflect the threshold for advanced practice nursing. The results identified different practice patterns for the identified bands and distinguish the advanced practice nursing roles. Implications for nursing policy: By replicating the Australian study of Gardener et al. (2016), this NZ paper extends the international data available to support more evidence‐based nursing workforce planning and policy development. [ABSTRACT FROM AUTHOR]

Aim: To establish the prevalence of nutrition risk and associated risk factors among adults of advanced age newly admitted to hospital. Methods: A cross‐sectional study was undertaken in adults aged over 85 years admitted to one of two hospital wards in Auckland within the previous 5 days. An interviewer‐administered questionnaire was used to establish participant's socio‐demographic and health characteristics. Markers of body composition and muscle strength were collected. Nutrition risk was assessed using the Mini Nutritional Assessment‐Short Form (MNA‐SF), dysphagia risk using the 10‐Item Eating Assessment Tool (EAT‐10) and level of cognition using the Montreal Cognitive Assessment. Results: A total of 88 participants with a mean age of 90.0 ± 3.7 years completed the assessments. A third (28.4%) of the participants were categorised by the MNA‐SF as malnourished and 43.2% were classified at risk of malnutrition. A third (29.5%) were at risk of dysphagia as assessed by EAT‐10. Malnourished participants were more likely to be at risk of dysphagia (P = 0.015). The MNA‐SF score was positively correlated with body mass index (r = 0.484, P < 0.001) and grip strength (r = 0.250, P = 0.026) and negatively correlated with risk of dysphagia (r = −0.383, P < 0.001). Conclusions: Among newly hospitalised adults of advanced age, over two thirds were malnourished or at risk of malnutrition, and a third were at risk of dysphagia. Nutrition risk was positively correlated with low BMI and grip strength and negatively correlated with dysphagia risk. Findings highlight the importance of screening for dysphagia risk, especially in those identified to be malnourished or at nutrition risk. [ABSTRACT FROM AUTHOR]