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Accessible Summary: What is known on the subject?: Seclusion is a harmful and traumatising intervention for people accessing mental health services.People who are subject to seclusion in inpatient mental health services often first experience this within the first 24 h following admission.There is limited research examining how recent contact with services impacts the likelihood of seclusion when people are admitted to inpatient services. What the paper adds to existing knowledge?: Males, Māori and Pasifika experience higher rates of seclusion within the first 24 h following inpatient admission.People perceived by clinicians as overactive, aggressive, disruptive or agitated are seven times more likely to be secluded within the first 24 h.People referred from police or justice services are three times more likely to be secluded within the first 24 h.People who had frequent contact with community mental health services prior to inpatient admission were less likely to be secluded. What are the implications for practice?: The first 24 h of inpatient admission is a critical focus for eliminating the use of seclusion. Initial interactions with people recently admitted should focus on nurturing relationships and reducing distress.Mental health staff should consider the person's cultural needs, referral pathway, recent service contact and baseline ratings on the Health of the Nation Outcomes Scales (HoNOS) when working proactively to prevent the use of seclusion in the first 24 h following admission.Strengthening the focus on nurturing relationships, cultural understanding and non‐coercive de‐escalation approaches requires leadership support and strategic workforce development. Introduction: People who experience seclusion in inpatient mental health services often do so within the first 24 h following admission. There is limited research examining the potential contributing factors, particularly recent contact with services. Aim/Question: To identify factors associated with seclusion within the first 24 h following admission into acute inpatient mental health services. Method: A retrospective analysis was undertaken using routinely collected data from Aotearoa New Zealand mental health services. Results: A higher likelihood of seclusion within the first 24 h following admission was associated with: males, Māori, Pasifika, referrals from police/justice services, inpatient transfers, recent contact with crisis assessment teams and clinician perceptions of aggression, problematic substance use, cognitive problems and hallucinations or delusions. Recent contact with community mental health services was associated with a lower likelihood. Discussion: People's cultural needs, referral pathway, recent service contact and HoNOS scores should be considered when working to prevent the use of seclusion in the first 24 h following admission. Implications for Practice: The first 24 h following inpatient admission is a critical period for preventing the use of seclusion. Nurturing relationships, cultural understanding and use of non‐coercive de‐escalation approaches can support better outcomes for people recently admitted. [ABSTRACT FROM AUTHOR]

Chronic pain is common in older people. However, little is known about how pain is experienced in residents of retirement villages ('villages'), and how pain intensity and associations are experienced in relation to characteristics of residents and village living. We thus aimed to examine pain levels, prevalence and associated factors in village residents. The current paper is a cross‐sectional analysis of baseline data from the 'Older People in Retirement Villages' study in Auckland, New Zealand. Between July 2016 and August 2018, 578 village residents were interviewed face‐to‐face by gerontology nurse specialists, using interRAI Community Health Assessment (CHA) and customised survey. We used a validated pain scale and multivariable logistic regression analyses adjusted for pre‐specified confounders. Residents' median age was 82 years; 420 (73%) were female; 270 (47%) exhibited/reported daily pain, and in 11% this was severe. After controlling for confounders, daily pain was positively associated with self‐reported arthritis (OR = 3.88, 95% CI = 2.57–5.87), poor/fair self‐reported health (OR = 3.19, 95% CI = 1.29–7.93), having no health clinic on‐site (OR = 1.76, 95% CI = 1.10–2.83), and minimal fatigue (diminished energy but completes normal day‐to‐day activities) (OR = 1.77, 95% CI = 1.11–2.81). Similar associations were observed for levels of pain. We conclude that levels of pain and prevalence of daily pain are high in village residents. Self‐reported arthritis, self‐reported poor/fair health, no health clinic on‐site and minimal fatigue are all independently associated with a higher risk of daily pain and with levels of pain. This study suggests potential opportunities for villages to better provide on‐site support to decrease prevalence and severity of pain for their residents, and thus potentially increase wellbeing and quality‐of‐life, though as we cannot prove causality, more research is needed. [ABSTRACT FROM AUTHOR]

This study explores patterns of alcohol drinking within a representative New Zealand sample (2887 participants (1464 female, 1423 male)). Alcohol use and drinking patterns across the population are described. Multivariable logistic regressions document associations between alcohol use and drinking patterns and the likelihood of experiencing different health outcomes. Alcohol use, early drinking initiation, frequent drinking, and heavy episodic drinking (HED) are prevalent in New Zealand and vary in relation to gender, age, and socioeconomic characteristics. Those who reported alcohol-related problems were more likely to report poor mental health (AOR: 2.21; 95% CI: 1.42–3.46) and disability (AOR: 1.79, 95% CI: 1.06–3.00), and less likely to experience positive mental health (AOR: 0.28, 95% CI: 0.18–0.42). Those who reported HED were also less likely to experience good general health (AOR: 0.61, 95% CI: 0.47–0.81) and positive mental health (AOR: 0.67, 95% CI: 0.53–0.84). Younger age cohorts were more likely to engage in early drinking, and those who initiated regular drinking before age 18 were more likely to report HED and alcohol-related problems. Findings indicate that problem drinking and HED are not only associated with poor physical health, but also reduce the likelihood of individuals experiencing positive mental health. This provides information to enable public health practitioners to target alcohol prevention strategies at the entire population of drinkers. [ABSTRACT FROM AUTHOR]

Introduction. Around 5% of the people in Aotearoa New Zealand (NZ) are not enrolled with a general practice. Aim. This study aimed to explore the utilisation of general practice by enrolment status and subsequent use of an emergency department. Methods. We compared a cohort of respondents from New Zealand Health Surveys (2013/14-2018/19) on self-reported general practice utilisation and their substitutes, according to their enrolment status (enrolled and not enrolled). They were then followed up to examine their subsequent use of an emergency department. Time to an emergency department presentation was modelled with proportional hazards regression models with enrolment status as the explanatory variable. Confounding variables used were sex, age group, prioritised ethnicity, the New Zealand Deprivation Index and self-rated health. Results. Those not enrolled were more likely to be young, male, Asian, more socioeconomically deprived and with better health status than those enrolled. Generally, those not enrolled utilised general practice services less. Those not enrolled who had used an emergency department were more likely to have used it as a substitute for general practice (40% vs 26%). Modelling showed that those not enrolled took longer to access an emergency department. Adjusting for confounding variables did not change that interpretation. Discussion. Those not enrolled were younger and healthier and may have a perception that enrolment isn't necessary. As a group, they were more likely to be socioeconomically deprived and to use an emergency department, which is free at a public hospital in NZ, as a substitute for primary care which suggests that cost may influence their choices. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to analyse attitudes, understanding of gambling and gambling related harm among Asians in New Zealand using secondary data from the New Zealand 2006/07 Gaming and Betting Attitudes Survey (GBAS). Design/methodology/approach -- This survey interviewed 1,973 nationwide randomly selected youths and adults ($18 years) using structured questionnaire. Chinese (N = 113) and Indian (N = 122) data were analysed separately to compare between them and with NZ Europeans (N = 792). Descriptive analysis was carried out and was subsequently tested for significant correlations by weighted (p < 0.01) and un-weighted (p < 0.05) variables. Findings -- A higher proportion of Chinese males (66.8 percent) represented in the survey compared to Indian (43.0 percent) and NZ European (48.9 percent) where Chinese consisted of more youthful age structure. Chinese respondents were more likely to be in the lowest income bracket (NZ$10,000) compared to others. Among the ten gambling activities "casino table gambling" and "casino electronic machines" (slot-style machine) were most popular among the Chinese where Indians preferred "gambling/casino evening". A significant proportion of Chinese were unwilling to refer family or friends to gambling help services despite believing that gambling does more harm than good. Pre-committed gambling sum was the most common harm minimising strategy suggested by participants. They believed education and consultation could deter youths from harmful gambling. Research limitations/implications -- This survey highlighted gambling behaviours and thoughts of the ethnic minority population in New Zealand. Study outcomes would be valuable in formulating ethnic specific preventative programme and may have policy implication. Originality/value -- There has been limited research on gambling behaviour of ethnic minorities in New Zealand. This paper fills some of the gaps. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Diabetes mellitus is common in primary care, yet little has been reported of its primary care prevalence or the clinical characteristics of patients with Type 2 diabetes mellitus (T2DM). AIM: To determine the prevalence of diabetes mellitus and clinical characteristics of diabetes patients in primary care in the Waikato region. METHODS: Primary care data were extracted from the electronic records of 15 general practices for patients aged >20 years with current diabetes mellitus at 20 June 2017. Diabetes mellitus was defined as having a glycated haemoglobin (HbA1c) of ≥50 mmol/mol (6.7%) or having being dispensed two or more anti-diabetic medications in the previous 12 months. Additional data collected included patients' ethnicity, age, sex and years since diagnosis. RESULTS: The overall prevalence of diabetes mellitus was 5.7% and was higher for Māori (8.6%), Asian (7.0%) and Pacific peoples (9.1%) than Europeans (5.0%; all P < 0.001). For patients with T2DM for whom current diabetes annual review data were available (n = 2227) the mean body mass index (BMI) was 32.8 ± 0.2 kg/m2, but BMI was higher in Māori, younger patients, females and patients diagnosed <2 years previously (all P < 0.001). Similarly, HbA1c levels were highest in Māori and younger patients (both P < 0.001), with 40% of patients overall having a HbA1c of ≤53 mmol/mol (7.0%). Approximately 70% of all patients had at least one measure of hypertension (systolic ≥130 or diastolic ≥80 mmHg), or dyslipidaemia. More than 85% of patients had completed a recent retinal screen and foot check. DISCUSSION: We found that management of T2DM was suboptimal, with measures for many patients not meeting clinical targets. Support should be provided to improve weight and glycaemic management, particularly for Māori, females and younger patients. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the impact of workplace factors on burnout in New Zealand registered nurses (RNs). Background: Nursing is characterised by chronic workplace stress. Research examining the role of workplace factors (ie practice environment and bullying) in shaping burnout is scarce. Methods: A cross-sectional survey was conducted among 480 New Zealand RNs. Burnout was self-reported using the CBI, while practice environment and negative acts in the workplace were selfreported using PES-NWI, and NAQ-R respectively. The STROBE checklist was used for this paper. Results: For every point increase in PES-NWI, there was a decrease of 6.82, 12.62, and 9.86 points in personal burnout (PB), work-related burnout (WRB), and client-related burnout (CRB) respectively after controlling for demographic and job-related characteristics. For every point increase in NAQ-R, there was an increase of 0.47, 0.50, and 0.20 points in PB, WRB, and CRB respectively after controlling for sample characteristics. These two factors explained for 18.4 percent, 27.6 percent and 12.4 percent of the variation in PB, WRB and CRB respectively. The prevalence of high PB, WRB and CRB was 50.8 percent, 46.5 percent and 16.0 percent respectively. Conclusion: Workplace factors are associated with burnout in RNs. Health-care organisations and nurse leaders have a duty to provide safe and healthy workplaces that cultivate positive outcomes for nurses and patients. Future efforts to reduce workplace stress and burnout in nurses will need to include initiatives that reduce high workloads, provide greater job flexibility and autonomy, increase collaboration and reduce bullying and harassment. [ABSTRACT FROM AUTHOR]

Aim The Late Career Nurse project examined views and characteristics of nurses working in New Zealand who were born before 1960. This paper focuses on the experiences of such nurses who undertake shift work. Background The mean age of registered nurses in New Zealand has been rising steadily, and 40% are now aged 50 years or over. While there is substantial literature on the phenomenon and consequences of the ageing nursing workforce, little is known of the particular experiences of nurses aged over 50 years who work shifts. Method An anonymous online survey was emailed to eligible nurse New Zealand Nurses Organisation members aged over 50 years in February 2012. Quantitative and qualitative analyses of the 3273 responses received were undertaken. Result Over 45% of respondents worked shifts or flexible hours. While shift work suited many, others noted deleterious effects on family and social relationships, physical and mental health (notably sleep patterns and fatigue), and decreasing tolerance for shift work as they age. Poor scheduling practices were particularly detrimental. Conclusion and implications for nursing management Worldwide, workforce ageing means strategies are required to retain older nurses in the workforce. Improved scheduling practices including increasing access to flexible and part time work hours, and development of resources on coping with shift work are recommended. [ABSTRACT FROM AUTHOR]

The increased use of information technology in health care allows researchers to generate data on rates of medication use among population groups, raising questions as to whether these rates are too high or too low. This paper presents findings from a study of records of all prescription medication dispensed in one New Zealand region (Te Tāirawhiti) over a one year period. The study examined patterns of psychotropic medication use amongst older people, by age, gender, ethnicity and socio-economic position. It concludes that the chances of being defined as needing psychotropic medication, that is, of being 'medicalised', are not evenly spread through the elderly population. Gender, age and ethnicity impacted significantly on whether prescriptions were received. Our results suggest the need for a nuanced understanding of the medicalisation of unhappiness and deviant behaviour amongst the elderly which takes into account barriers to treatment for some social groups. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Unmet needs are a key indicator of the success of a health system. Clinicians and funders in Christchurch, Canterbury, New Zealand were concerned that unmet health need was hidden. AIM: The aim of this survey was to estimate the proportion of patients attending general practice who were unable to access clinically indicated referred services. METHODS: The survey used a novel method to estimate unserviced health needs. General practitioners (GPs, n = 54) asked their patients (n = 2135) during a consultation about any health needs requiring a referred service. If both agreed that a service was potentially beneficial and not available, this was documented on an e-referral system for review. The outcomes of actual referrals were also reviewed. RESULTS: The patient group was broadly representative of the Canterbury population, but over-sampled female and middle-aged people and under-sampled Māori. Data adjusted to regional demographics showed that 3.6% of patients had a GP-confirmed unserviced health need. Elective orthopaedic surgery, general surgery and mental health were areas of greatest need. Unserviced health needs were significantly (P = 0.05) associated with greater deprivation, middle-age, and receiving high health-use subsidies. DISCUSSION: To our knowledge, this is the first survey of GP and patient agreement on unserviced referred health needs. Measuring unserviced health needs in this way is directly relevant to service planning because the gaps identified reflect clinically indicated services that patients want and need. The survey method is an improvement on declined referral rates as a measure of need. Key factors in the method were using a patient-initiated GP consultation and an e-referral system to collect data. [ABSTRACT FROM AUTHOR]

Background: Primary care in Aotearoa New Zealand is largely delivered by general practices, heavily subsidised by government. Te Tiriti o Waitangi (1840) guarantees equal health outcomes for Māori and non-Māori, but differences are stark and longstanding. Seven models of primary care have evolved. We hypothesised that patient health outcomes would differ between models of care; and that Māori, Pacific peoples and those living in material deprivation would have poorer outcomes from primary care. Methods: We conducted a cross-sectional study of patient-level data from national datasets and practices, at 30 September 2018, using multilevel mixed effects regression analyses (patients clustered within practices). Primary outcomes, considered to be measures of unmet need for primary care, were polypharmacy (≥ 65 years), HbA1c testing in adults with diabetes, childhood immunisations (6 months), ambulatory sensitive hospitalisations (0–14, 45–64 years) and emergency department attendances. Explanatory variables adjusted for patient and practice characteristics. Equity, by model of care, ethnicity and deprivation, was assumed if they showed no significant association with patient outcomes. Patient characteristics included: age, ethnicity, deprivation, multi-morbidity, first specialist assessments and practice continuity. Practice characteristics included: size, funding and doctor continuity. Clinical input (consultations and time with nurses and doctors) was considered a measure of practice response. Results: The study included 924 general practices with 4,491,964 enrolled patients. Traditional practices enrolled 73% of the population, but, on average, the proportion of Māori, Pacific and people living with material deprivation was low in any one Traditional practice. Patients with high health needs disproportionately enrolled in Māori, Pacific and Trust/NGO practices. There were multiple associations between models of care and patient health outcomes in fully adjusted regressions. No one model of care out-performed others across all outcomes. Patients with higher health need received more clinical input but this was insufficient to achieve equity in all outcomes. Being a Māori or Pacific patient, or living in material deprivation, across models of care, remained associated with poorer outcomes. Conclusions: Model-level associations with poor patient outcomes suggest inequity in measures that might be used to target investment in primary care. [ABSTRACT FROM AUTHOR]

This study assessed the physical activities of Mental Health Nurses (MHN) in New Zealand against the 2018 World Health Organization recommended minimum levels of moderate‐to‐vigorous physical activity. The research design was exploratory and descriptive as there were no previous studies about physical activity levels of MHNs in New Zealand. Quantitative and qualitative data were collected using the International Physical Activity Questionnaire (IPAQ, Long Version) which included options for free‐text responses. Data were analysed using descriptive and inferential statistics. A total of 266 participants returned the survey, a response rate of 4%, and a limitation of the study. More than 50% of MHNs reported <150 min of moderate‐to‐vigorous exercise per week for each of the four physical activity domains. When individual physical activity domains were combined, only 10% spent <150 min on moderate‐to‐vigorous physical activity. Work‐related physical activities were higher for those working in the inpatient area than in community settings. Transport‐related physical activities were higher for those working in community settings. Participants registered from 6 to 20 years had more time sitting than other groups. Nurses aged 55 years and above showed the highest total physical activity levels. Moreover, healthcare organizations and nurse leaders need to promote physical activity and provide wellness intervention for their staff. Nurses who are physically active may be more effective in supporting their patients to increase their physical activity. [ABSTRACT FROM AUTHOR]

Objective: To describe the epidemiology of pediatric type 1 diabetes over 50 years in Canterbury, New Zealand. Further, to explore variation in case presentation according to age, gender, ethnicity, urban/rural character, socio‐economic deprivation and immunogenetic features. Research Design and Methods: Prospective ascertainment of cases commenced in 1982, and incident cases presenting 1970–1982 were ascertained retrospectively from clinical records. Eligibility criteria included diagnosis of type 1 diabetes by a physician and commencement of insulin therapy at diagnosis and age less than 15 years. Data collection included name, hospital number, date of birth, date of diagnosis, and date of initiation of insulin treatment. Full address at diagnosis was assigned an urban–rural classification, and a deprivation score. HLA‐DQ susceptibility alleles and diabetes associated autoantibodies were determined. Results: The incidence of type 1 diabetes increased more than 5‐fold (3.9% per annum) over 50 years for the entire cohort. The mean for 5‐year periods, starting from 1970, increased from 5.3 to 29.0 cases per 100,000 person years. Incidence was greatest in the 10–14 year age group. The cohort is predominantly European (89.4%), but there has been an increase in cases identifying as New Zealand Māori in the last three decades. Weak evidence was found for reduced incidence of type 1 diabetes in rural regions (adjusted IRR = 0.70, 95%CI 0.52 to 0.91, p = 0.011). Conclusions: The incidence of type 1 diabetes in children aged less than 15 years continues to increase with time. Incidence was significantly affected by age, ethnicity, and urban/rural characterization of address at diagnosis. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Preventive medications such as statins are used to reduce cardiovascular risk. There is some evidence to suggest that people of lower socioeconomic position are less likely to be prescribed statins. In New Zealand, Maori have higher rates of cardiovascular disease. AIM: This study aimed to investigate statin utilisation by socioeconomic position and ethnicity in a region of New Zealand. METHODS: This was a cross-sectional study in which data were collected on all prescriptions dispensed from all pharmacies in one city during 2005/6. Linkage with national datasets provided information on patients' age, gender and ethnicity. Socioeconomic position was identified using the New Zealand Index of Socioeconomic Deprivation 2006. RESULTS: Statin use increased with age until around 75 years. Below age 65 years, those in the most deprived socioeconomic areas were most likely to receive statins. In the 55-64 age group, 22.3% of the most deprived population received a statin prescription (compared with 175% of the mid and 18.6% of the least deprived group). At ages up to 75 years, use was higher amongst Maori than non-Maori, particularly in middle age, where Maori have a higher risk of cardiovascular disease. In the 45-54 age group, 11.6% of Maori received a statin prescription, compared with 8.7% of non-Maori. DISCUSSION: Statin use approximately matched the pattern of need, in contrast to other studies which found under-treatment of people of low socioeconomic position. A PHARMAC campaign to increase statin use may have increased use in high-risk groups in New Zealand. [ABSTRACT FROM AUTHOR]

Introduction. Telemedicine, including telephone triage, is increasingly being used in New Zealand general practices. Telephone triage involves diverting requests for same-day healthcare to a phone system where presenting complaints are explored only sufficiently to identify the most appropriate management pathway. Aim. To assess the rates of repeat triage among general practice patients treated virtually via phone and compare these with outcomes for patients who were dealt with in person. Method. 6 weeks of clinical telephone triage data were collected for Gore Medical Centre. Comparisons were made for patients treated virtually or in person, for whether complaints were a respiratory issue or not, and for whether their triage represented incomplete resolution of a previously triaged health complaint. To do this, patient notes for the 7 days prior to the phone triage were reviewed for medical consultations related to the same condition. Results. Over 6 weeks, 455 telephone triages took place at the Gore Medical Centre: 133 triage phone calls resulted in 132 (29%) patients being treated virtually. Over the 6 study weeks, 19 virtually treated triage patients phoned again for further care of the same problem within 7 days (14%) while 23 patients (7%) who had been triaged to in person assessment also sought further care within 7 days. This difference was statistically significant (P < 0.05). There was no statistical difference in re-triage rates between Māori and non-Māori. Young age was a significant predictor for likelihood of re-triage. Discussion. Virtual treatment via telephone triage at Gore Medical Centre resulted in a statistically increased likelihood of re-triage within 7 days compared with in person treatment. This raises questions about the efficacy of virtual treatment via telemedicine compared with in person treatment after triage. [ABSTRACT FROM AUTHOR]

Objectives: Aotearoa New Zealand has demonstrable maternal and perinatal health inequity. We examined the relationships between adverse outcomes in a total population sample of births and a range of social determinant variables representing barriers to equity. Methods: Using the Statistics New Zealand Integrated Data Infrastructure suite of linked administrative data sets, adverse maternal and perinatal outcomes (mortality and severe morbidity) were linked to socio-economic and health variables for 97% of births in New Zealand between 2003 and 2018 (~970,000 births). Variables included housing, economic, health, crime and family circumstances. Logistic regression examined the relationships between adverse outcomes and social determinants, adjusting for demographics (socio-economic deprivation, education, parity, age, rural/urban residence and ethnicity). Results: Māori (adjusted odds ratio=1.21, 95% confidence interval=1.18–1.23) and Asian women (adjusted odds ratio 1.39, 95% confidence interval=1.36–1.43) had poorer maternal or perinatal outcomes compared to New Zealand European/European women. High use of emergency department (adjusted odds ratio=2.68, 95% confidence interval=2.53–2.84), disability (adjusted odds ratio=1.98, 95% confidence interval=1.83–2.14) and lack of engagement with maternity care (adjusted odds ratio=1.89, 95% confidence interval=1.84–1.95) had the strongest relationship with poor outcomes. Conclusion: Maternal health inequity was strongly associated with a range of socio-economic and health determinants. While some of these factors can be targeted for interventions, the study highlights larger structural and systemic issues that affect maternal and perinatal health. [ABSTRACT FROM AUTHOR]

Previous research on cyberbullying has focused almost entirely on examining its prevalence among dominant ethnic populations, leaving it unclear how common cyberbullying is among indigenous peoples. Our study draws on a large sample of Māori adults aged 18–83 years (n = 6,529) who completed the questionnaire-based Māori Identity and Financial Attitudes Study in 2017. We analyzed reports of cyberbullying according to demographic characteristics, namely gender, age, sexual orientation, and multiple ethnic affiliations. On average, 19.3 percent of participants reported ever experiencing cyberbullying, and 4.1 percent reported experiencing cyberbullying within the past month. Young adults (aged 18–25) experienced the most, and incidences progressively declined among older cohorts. Women and those identifying as a minority sexual orientation reported higher rates of cyberbullying than men and heterosexuals. Those identifying as Māori as one of their multiple ethnicities reported higher rates of cyberbullying than those who identified as Māori only. Together, these findings provide a detailed investigation of the prevalence of cyberbullying in a large national indigenous sample. Previous data show that cyberbullying is common among adolescents and adults in New Zealand; however, our data indicate an even higher prevalence among the Māori. Practical and theoretical implications are discussed in light of Māori mental health outcomes. [ABSTRACT FROM AUTHOR]

Bronchiectasis is a chronic respiratory disease that impacts significantly on quality of life for those who have it. There is a paucity of literature exploring the perspectives of children and young people. The aim of this study was to examine the day-to-day life experience of a group of young people with bronchiectasis. A qualitative study using semi-structured interviews explored fifteen young people's perspectives of life with bronchiectasis. Key themes were identified using an inductive iterative approach through constant comparative analysis guided by Thorne's interpretive description. Life with bronchiectasis was conceptualized by participants as "Pretty Normal". This consisted of two co-existing life views which represented how young people balanced the ups and downs of adolescence while learning to accommodate the demands of living with bronchiectasis. Three key thematic elements "sore and tired", 'life interrupted and "looking after self", influenced and challenged these two views of life. Young people with bronchiectasis portray life as being the same as their peers. Despite this, they recognized that the symptoms, interruptions, and self-management responsibilities led them to find ways of coping and integrating their experience into a new and modified view of normal. [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]

Background: Despite an overt commitment to equity, health inequities are evident throughout Aotearoa New Zealand. A general practice electronic alert system was developed to notify clinicians about their patient's risk of harm due to their pre-existing medical conditions or current medication. We aimed to determine whether there were any disparities in clinician action taken on the alert based on patient ethnicity or other demographic factors. Methods: Sixty-six New Zealand general practices from throughout New Zealand participated. Data were available for 1611 alerts detected for 1582 patients between 1 and 2018 and 1 July 2019. The primary outcome was whether action was taken following an alert or not. Logistic regression was used to assess if patients of one ethnicity group were more or less likely to have action taken. Potential confounders considered in the analyses include patient age, gender, ethnicity, socio-economic deprivation, number of long term diagnoses and number of long term medications. Results: No evidence of a difference was found in the odds of having action taken amongst ethnicity groups, however the estimated odds for Māori and Pasifika patients were lower compared to the European group (Māori OR 0.88, 95 %CI 0.63–1.22; Pasifika OR 0.88, 95 %CI 0.52–1.49). Females had significantly lower odds of having action taken compared to males (OR 0.76, 95 %CI 0.59–0.96). Conclusions: This analysis of data arising from a general practice electronic alert system in New Zealand found clinicians typically took action on those alerts. However, clinicians appear to take less action for women and Māori and Pasifika patients. Use of a targeted alert system has the potential to mitigate risk from medication-related harm. Recognising clinician biases may improve the equitability of health care provision. [ABSTRACT FROM AUTHOR]

INTRODUCTION: On-the-spot blood glucose testing is a health service performed in public spaces to raise diabetes awareness and screen for elevated blood glucose levels. AIM: To describe the users of this service and the frequency of detecting elevated blood glucose. METHODS: Data collected at point-of-testing on a standardised form over 20 months in two regions of New Zealand were audited. Descriptive and simple inferential statistics report on population demographics and presence of elevated blood glucose (mmol/L). RESULTS: Data from 2156 individuals were audited. Most (1680, 78%) were female, the mean age was 52 years (standard deviation 18 years) and all major ethnic groups and socioeconomic quintiles were represented. For 53% of responders, this was their first blood glucose test. In total, 153 (7.1%) cases with elevated blood glucose were identified, including 94 who did not report a previous pre-diabetes or diabetes diagnosis. Blood glucose was not correlated with socioeconomic status (r = 0.04; P = 0.07), but weakly correlated with age (r = 0.19; P < 0.001). Blood glucose values did not appear to differ between ethnicities (P = 0.052). Men had a higher mean value than women (P = 0.003). People with elevated blood glucose access their general practitioner more often than people with normal blood glucose, irrespective of a diabetes diagnosis (P = 0.002). DISCUSSION: On-the-spot blood glucose testing is a health service accessed by a wide range of people, although more commonly by women than men. Future interventions targeting men may better engage them in health screening. Alongside awareness raising, on-the-spot community testing identified previously unknown elevated blood glucose levels at a rate of 1-in-22, and may lead to the earlier identification and treatment of prediabetes or diabetes. [ABSTRACT FROM AUTHOR]

Objective: The burden of chronic disease is not evenly shared within our society. In this manuscript, we use comprehensive national-level data to compare morbidity burden between ethnic groups in New Zealand. Methods: We investigated the prevalence of morbidity among all New Zealanders aged 18+ (n = 3,296,837), stratified by ethnic group (Māori, Pacific, Asian, Middle Eastern/Latin American/African, European/Other), using national-level hospitalisation and pharmaceutical data and two measures of morbidity (the M3 and P3 indices). Results and Conclusions: We observed substantial disparities for Māori and Pacific peoples compared to other ethnic groups for the vast majority of commonly-diagnosed morbidities. These disparities appeared strongest for the most-common conditions – meaning that Māori and Pacific peoples disproportionately shoulder an increased burden of these key conditions. We also observed that prevalence of these conditions emerged at earlier ages, meaning that Māori and Pacific peoples also experience a disproportionate impact of individual conditions on the quality and quantity of life. Finally, we observed strong disparities in the prevalence of conditions that may exacerbate the impact of COVID-19, such as chronic pulmonary, liver or renal disease. The substantial inequities we have presented here have been created and perpetuated by the social determinants of health, including institutionalised racism: thus solutions will require addressing these systemic issues as well as addressing inequities in individual-level care. [ABSTRACT FROM AUTHOR]

Background: The testicular cancer incidence in New Zealand is rising. We evaluated if testicular cancer outcomes differed by ethnicity in NZ. Aims: To study if ethnic disparities existed among testicular cancer patients and their outcomes treated at Waikato Regional Cancer Centre. Methods: Retrospective review of testicular cancer cases in the Medical Oncology database, Waikato Hospital, between 2001 and 2013 inclusive. Results: Three hundred and twenty‐five patients were seen, with median follow up of survivors being 101 (range 13–230) months. 95 (29.2%) were Māori, 210 (64.6%) NZ European and 20 (6.1%) of other ethnicity. One hundred and eighty‐two patients were diagnosed with seminoma and 143 with non‐seminoma. Māori represented 27.5% of seminoma and 31.4% of non‐seminoma patients. Median age at diagnosis was 39 years for seminoma and 30 years for non‐seminoma; Māori were significantly younger than non‐ Māori for both seminoma (median age 35 versus 42 years) and non‐seminoma (median age 28 vs 34 years, respectively). While stage distribution of seminoma at diagnosis was similar for Māori and non‐Māori (chi‐squared P = 0.31), significantly more Māori had higher‐stage non‐seminoma than non‐Māori (stage III in 44% and 22%, respectively, chi‐squared P = 0.014). Survival for seminoma (logrank P = 0.19) and non‐seminoma (logrank P = 0.89) patients did not differ significantly by ethnicity. Conclusions: Māori patients were younger at diagnosis of testicular cancer and presented with more advanced non‐seminoma testicular tumours compared with non‐Māori but survival was comparable. [ABSTRACT FROM AUTHOR]

In New Zealand, as in other industrialised societies, an ageing population has led to an increased need for palliative care services. A cross‐sectional postal survey of bereaved carers was conducted in order to describe both bereaved carer experience of existing services in the last 3 months of life, and to identify factors associated with overall satisfaction with care. A self‐complete questionnaire, using a modified version of the Views of Informal Carers – Evaluation of Services (VOICES) instrument was sent to 4,778 bereaved carers for registered deceased adult (>18yrs) patients in one district health board (DHB) for the period between November 2015 and December 2016. Eight hundred and twenty‐six completed questionnaires were returned (response rate = 21%). The majority of respondents (83.8%) rated their overall satisfaction with care (taking all care during the last 3 months into account), as high. However, satisfaction varied by care setting. Overall satisfaction with care in hospice was significantly higher compared to other settings. Additionally, patients who died in hospice were more likely to be diagnosed with cancer and under 65 years of age. The factors associated with overall satisfaction with care in the last 2 days of life were: caregiver perceptions of treatment with dignity and respect; adequate privacy; sufficient pain relief and decisions in line with the patient's wishes. A more in‐depth exploration is required to understand the quality of, and satisfaction with, care in different settings as well as the factors that contribute to high/low satisfaction with care at the end‐of‐life. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Intentional self-poisoning or self-harm through poisoning, is a common cause of presentations to emergency departments (EDs). National datasets do not allow identification of the substances most commonly used in hospital-treated intentional self-poisoning in New Zealand, nor do they capture sources of these substances. AIM: To investigate the specific substances used in intentional self-poisoning and the sources from which they are obtained. METHODS: In this cross-sectional study, information about the demographics and presentation particulars of intentional self-poisoning patients aged ≥16 years, presenting to three public EDs, as well as the substances they used in the self-poisoning event and the sources of these agents, were collected prospectively. RESULTS: A total of 102 patients were recruited from the potentially eligible 1137 intentional self-poisoning patients presenting to the three EDs during the study period. Seventy per cent used their own prescription medications and 24% used medicines they purchased themselves. Paracetamol and ethanol were most commonly encountered substances. Patients presented a median of 1.9 h after exposure (interquartile range 1.0–3.3 h), 62% self-referred, 60% presented to the ED in the evening or at night and 66% were triaged into Australasian Triage Scale 3 (to be seen within 30 min). Two-thirds were referred to emergency psychiatric services. DISCUSSION: Collecting specific substance information, such as from this study, can assist in planning specific activities to prevent intentional self-poisoning. As most people used their prescribed medicines, the findings can inform and assist doctors in their prescribing practices when they manage patients at risk of self-poisoning. [ABSTRACT FROM AUTHOR]

Background: Research has indicated that clinical staff in long‐term care often lack self‐confidence in palliative care delivery, particularly at the end of life. Goals: (a) To examine the contribution of age, palliative care education, palliative care work‐related experience and psychological empowerment to palliative care delivery confidence and (b) to explore the social reality shaping those factors for long‐term care staff. Design: Explanatory sequential design. Setting: Twenty long‐term care facilities in two district health boards in New Zealand. Participants: Phase 1:139 clinical staff. Phase 2:46 clinical staff who provided care in the last month of a residents' life. Methods: Phase 1: Cross‐sectional survey. Phase 2: Individual semi‐structured interviews. Results: Phase 1: Previous experience (β =.319) and psychological empowerment (β =.311) contribute most to predicting an increase in palliative care delivery confidence. Phase 2: Four factors underlay palliative care delivery confidence, (a) mentorship by hospice nurses or colleagues (b) contextual factors (organisational culture, resources and experience), (c) maturity and (d) formal education. Conclusion: Organisational leadership should use multiple strategies (e.g. power‐sharing, increased opportunities for mentorship) to improve staff palliative care delivery confidence. Implications for Practice: This study adds to the literature in understanding the predictors of palliative care delivery confidence specific to long‐term care staff. The results indicate that educational interventions must be contextually appropriate to achieve sustainable improvements in palliative care confidence and ultimately in resident care at the end of life. [ABSTRACT FROM AUTHOR]

Objectives: The Accident Compensation Corporation is a compulsory, 24-h, no-fault personal injury insurance scheme in New Zealand. The purpose of this large-scale retrospective cohort study was to use Accident Compensation Corporation records to provide information about rugby injury epidemiology in New Zealand, with a focus on describing differences in risk by age and gender. Methods: A total of 635,657 rugby injury claims were made to the Accident Compensation Corporation for players aged 5–40 years over the period 2005–2017. Information about player numbers and estimates of player exposure was obtained from New Zealand Rugby, the administrative organisation for rugby in New Zealand. Results: Over three quarters of claims (76%) were for soft-tissue injuries, with 11% resulting from fractures or dislocations, 6.7% from lacerations, 3.1% from concussions and 2.0% from dental injuries. Body regions injured included shoulder (14%), knee (14%), wrist/hand (13%), neck/spine (13%), head/face (12%), leg (11%) and ankle (10%). The probability of a player making at least one injury claim in a season (expressed as a percentage) was calculated under the assumption that the incidence of claims follows a Poisson distribution. Players aged 5–6 years had a probability of making at least one claim per season of 1.0%, compared to 8.3% for players aged 7–12 years, 35% for age 13–17 years, 53% for age 18–20 years, 57% for age 21–30 years and 47% for age 31–40 years. The overall probability of making at least one claim per season across all age groups was 29%. The relative claim rate for adults (players aged 18 years and over) was 3.92 (90% confidence interval 3.90–3.94) times that of children. Ten percent of players were female, and they sustained 6% of the injuries. Overall, the relative claim rate for female players was 0.57 times that of male players (90% confidence interval 0.56–0.58). The relative claim rate of female to male players tended to increase with age. There were very few female players aged over 30 years; however, those who did play had higher claim rates than male players of the same age group (1.49; 90% confidence interval 1.45–1.53). Conclusions: Injuries resulting from rugby are distributed across the body, and most of the claims are for soft-tissue injuries. Rates of injury increase rapidly through the teenage years until the early 20 s; for male players they then decrease until the mid-30 s. For female players, the injury rate does not decrease as players move into their 30 s. Combining Accident Compensation Corporation injury claim data with national player registration data provides useful information about the risks faced by New Zealand's community rugby players, and the insights derived are used in the development of rugby injury prevention programme content. [ABSTRACT FROM AUTHOR]

Background: While research in high‐income countries (HICs) has established high costs associated with alcohol's harm to others (AHTO) in the workplace, scant attention has been paid to AHTO in the workplace in lower‐ or middle‐income countries (LMICs). Aim: To compare estimates and predictors of alcohol's impacts upon coworkers among workers in 12 countries. Methods: Cross‐sectional surveys from 9,693 men and 8,606 women employed in Switzerland, Australia, the United States, Ireland, New Zealand, Chile, Nigeria, Lao PDR, Thailand, Vietnam, India, and Sri Lanka. Five questions were asked about harms in the past year because of coworkers' drinking: Had they (i) covered for another worker; (ii) worked extra hours; (iii) been involved in an accident or close call; or had their (iv) own productivity been reduced; or (v) ability to do their job been affected? Logistic regression and meta‐analyses were estimated with 1 or more harms (vs. none) as the dependent variable, adjusting for age, sex, rurality of location, and the respondent worker's own drinking. Results: Between 1% (New Zealand) and 16% (Thailand) of workers reported that they had been adversely affected by a coworker's drinking in the previous year (with most countries in the 6 to 13% range). Smaller percentages (<1% to 12%) reported being in an accident or close call due to others' drinking. Employed men were more likely to report harm from coworkers' drinking than employed women in all countries apart from the United States, New Zealand, and Vietnam, and own drinking pattern was associated with increased harm in 5 countries. Harms were distributed fairly equally across age and geographic regions. Harm from coworkers' drinking was less prevalent among men in HICs compared with LMICs. Conclusions: Workforce impairment because of drinking extends beyond the drinker in a range of countries and impacts productivity and economic development, particularly affecting men in LMICs. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Pacific women in New Zealand (NZ) have higher rates of antenatal depression than women from other ethnic groups. AIM: To identify factors that are significantly associated with depression symptoms in pregnant Pacific women living in NZ. METHODS: Data were collected from 5657 pregnant women, 727 of whom identified their ethnicity as Pacific Island. Antenatal depression symptoms were measured using the Edinburgh Depression Scale with scores above 12 indicating elevated antenatal depression symptoms (ADS). RESULTS: Pacific women had significantly higher rates of ADS than non-Pacific women, with 23% of pregnant Pacific women experiencing ADS. Factors associated with ADS for Pacific women included age <25 years, moderate to severe nausea during pregnancy, perceived stress, family stress and relationship conflict. Not seeing the importance of maintaining one's Pacific culture and traditions and negative feelings towards NZ culture were also significantly associated with ADS in Pacific women. One in three Pacific women aged <25 years experienced ADS. Pregnant Pacific women without a family general practitioner (GP) before their pregnancy were 4.5-fold more likely to experience ADS than non-Pacific women with a regular GP. DISCUSSION: Further attention is required to providing appropriate primary health care for Pacific women of child-bearing age in NZ. Better screening processes and a greater understanding of effective antenatal support for Pacific women is recommended to respond to the multiple risk factors for antenatal depression among Pacific women. [ABSTRACT FROM AUTHOR]

Abstract: Compared to the general population, people with pre‐existing serious and persistent mental illness (SPMI) have higher rates of physical illness and die at an earlier age, raising questions about their palliative and end‐of‐life care needs when they are diagnosed with an incurable physical illness. In the present study, we explored access to specialist palliative care services within one New Zealand health district. Routinely‐collected, de‐identified patient information on a cohort of people diagnosed with SPMI, and receiving specialist palliative care services from the Capital and Coast District Health Board (CCDHB), was compared to the general population from the same health district. People with SPMI are 3.5 times less likely to receive specialist palliative services compared to the general population from the Capital and Coast District Health Board. The proportion of people identifying as Māori is 1.2 times higher in the SPMI cohort than the general CCDHB population. The SPMI cohort experiences a higher level of deprivation compared to the general population in the CCDHB. The present study confirms that those diagnosed with an SPMI are less likely to use specialist palliative care services at the end of life. Research using a national dataset is needed to determine whether the study findings are applicable to the national population. [ABSTRACT FROM AUTHOR]

Background This study investigates maternal and perinatal outcomes for women with low-risk pregnancies laboring in free-standing birth centers compared with laboring in a hospital maternity unit in a large New Zealand health district. Methods The study used observational data from 47 381 births to women with low-risk pregnancies in South Auckland maternity facilities 2003-2010. Adjusted odds ratios with 95% confidence intervals were calculated for instrumental delivery, cesarean section, blood transfusion, neonatal unit admission, and perinatal mortality. Results Labor in birth centers was associated with significantly lower rates of instrumental delivery, cesarean section and blood transfusion compared with labor in hospital. Neonatal unit admission rates were lower for infants of nulliparous women laboring in birth centers. Intrapartum and neonatal mortality rates for birth centers were low and were not significantly different from the hospital population. Transfers to hospital for labor and postnatal complications occurred in 39% of nulliparous and 9% of multiparous labors. Risk factors identified for transfer were nulliparity, advanced maternal age, and prolonged pregnancy ≥41 weeks' gestation. Conclusions Labor in South Auckland free-standing birth centers was associated with significantly lower maternal intervention and complication rates than labor in the hospital maternity unit and was not associated with increased perinatal morbidity. [ABSTRACT FROM AUTHOR]

Background Menstrual morbidity plays a significant role in adolescent females' lives. There are no studies to date reporting such data from menstrual health education programs in schools. Aims The aim of our study was to report results from an audit of a menstrual health and endometriosis education program in secondary schools and observe age patterns of young women presenting for menstrual morbidity care. Materials and methods Audit data from education in secondary schools and audit data of patients from an Endometriosis and Pelvic Pain Coaching clinic operating in a private endometriosis specialised centre are reported. Results In a region of consistent delivery of the education program, student awareness of endometriosis was 32% in 2015. Overall in 2015, 13% of students experienced distressing menstrual symptoms and 27% of students sometimes or always missed school due to menstrual symptoms. Further, in one region of consistent delivery of the menstrual health education program, data show an increase in younger patients attending for specialised endometriosis care. Conclusions There is strong suggestive evidence that consistent delivery of a menstrual health education program in schools increases adolescent student awareness of endometriosis. In addition, there is suggestive evidence that in a geographical area of consistent delivery of the program, a shift in earlier presentation of young women to a specialised health service is observed. [ABSTRACT FROM AUTHOR]

Purpose: Communication disorders associated with Parkinson’s disease (PD) often lead to restricted participation in life roles, yet there is a limited understanding of influencing factors and few quantitative measurement tools available. This study aimed to identify variables associated with communicative participation in PD and to examine the relationship between the Communicative Participation Item Bank (CPIB) and existing health-related quality-of-life (HRQoL) measures. Method: Self-report data from 378 participants with PD from the US and New Zealand were analysed. Data included responses to the CPIB, PD Questionnaire-8, sub-scales of the Global Health instrument from the Patient Reported Outcomes Measurement Information System (PROMIS) and additional self-report instruments. Result: Greater perceived speech disorder, lower levels of speech usage, fatigue, cognitive and emotional problems and swallowing difficulties were associated with lower levels of communicative participation. Participants’ age significantly influenced findings, interacting with country of residence, sex and speech usage. Scores on the CPIB were moderately correlated with HRQoL measures. Conclusion: Communicative participation in PD is complex and influenced by both demographic and disease-based variables, necessitating a broader view of the communicative experiences of those with PD. Measurement of communicative participation as a separate construct to existing HRQoL measures is recommended. [ABSTRACT FROM PUBLISHER]

Background: The health status of Indigenous populations of Australia and New Zealand (NZ) Māori manifests as life expectancies substantially lower than the total population. Accurate assessment of time trends in mortality and life expectancy allows evaluation of progress in reduction of health inequalities compared to the national or non-Indigenous population. Methods: Age-specific mortality and life expectancy (at birth) (LE) for Indigenous populations (Australia from 1990 and NZ from 1950); and all Australia and non-Māori NZ (from 1890), males (M) and females (F), were obtained from published sources and national statistical agency reports. Period trends were assessed for credible estimates of Indigenous LE, and the LE gap compared to the total population for Australia, and non-Māori for NZ. Period trends in premature adult mortality, as cumulative probability of dying over 15-59 years, were assessed similarly. The relative contribution of differences in age-specific mortality to the LE gap between Indigenous and the all-Australia population, and the non-Māori NZ, was estimated for each country by sex for the most recent period: 2010-2012 for Australia, 2012-2014 for NZ. Results: LE increased for all populations, although LE gaps between Indigenous and all Australia showed little change over time. LE gaps between NZ Māori and non-Māori increased significantly from the early 1980s to the mid-1990s, and since then have fallen again. Recent LE gaps in Australia (M 12.5; F 12.0 years in 2010-2012) were larger than in NZ (M 7.3; F 6.8 years in 2012-2014). Premature adult mortality (15-59 years) improved for all populations, but mortality ratios show little change since 2000, with Indigenous at 3½-4 times that of all Australians, and Māori 2-3 times that of non-Māori. Using decomposition analysis, the age interval contributing most strongly to differences in LE between Indigenous and all Australia was 35-59 years, but between Māori and non-Māori it was 60-74 years. Conclusion: In Australia and NZ, Indigenous LE and adult mortality are improving in absolute terms, but not relative to the entire or non-Indigenous populations, causing gaps in life expectancy to persist. [ABSTRACT FROM AUTHOR]

Background: Concerned groups are pressuring government bodies to implement warning labels. However, research informed label development is limited and current labels are generic, despite tobacco research revealing targeted messages are more effective. Expectancy research provides a platform to inform message development, however reliance on researcher-driven survey-dependent expectancies has limited findings. This study aims to extend expectancy theory and inform warning label development by identifying negative expectancies that are participant derived and salient to drinkers from specific segments. Method: A New Zealand sample involving 1168 drinkers (651 men) completed an online survey measuring their demographics, their drinking and self-reported negative alcohol expectancies. Thematic analysis resulted in 13 salient expectancies, and differences between segments were examined. Results: Chi-square analyses revealed: heavy drinkers and young adults were characterised by concerns for self (e.g. liver damage); lighter drinkers and older adults by expectancies that could harm others (e.g. violence); females reported greater concern than males with the majority of expectancies. Conclusion: Results extend alcohol expectancy theory by revealing negative expectancies that are salient to drinkers from specific segments. This study delivers the initial steps for systematically informing alcohol warning label development, by identifying expectancies that are likely to be integrated by drinkers. [ABSTRACT FROM AUTHOR]

Objective:Osteoradionecrosis is a significant complication of head and neck cancer treatment, and its most severe form (grade III) necessitates radical surgery. This study aimed to compare the cost of free-flap reconstructive surgery for grade III osteoradionecrosis and similar non-osteoradionecrosis cases in order to assess the cost burden of osteoradionecrosis treatment.Methods:All patients who underwent free-flap reconstructive surgery for osteoradionecrosis between July 2004 and July 2010 at Auckland City Hospital (19 patients) were identified, and relevant data were collected retrospectively. These patients were matched in terms of age and sex with patients who underwent free-flap reconstructive surgery.Results:The treatment cost was 44 per cent higher in osteoradionecrosis patients when compared to non-osteoradionecrosis patients.Conclusion:The significant financial burden on the health system, and the growing evidence for the effectiveness of pentoxifylline, tocopherol and clodronate, should prompt us to explore this alternative treatment further. [ABSTRACT FROM AUTHOR]

Data from the Patients and Families Psychological Response to the Home Automated External Defibrillator Trial were used to examine the relationship between biopsychosocial variables and patients' coping strategies postmyocardial infarction. This study is the secondary data analysis of longitudinal observational study. A total of 460 patient-spouse pairs were recruited in January 2003 to October 2005. Hierarchical linear regression analysis examined biological/demographic, psychological and social variables regarding patients' coping scores using the Family Crisis Oriented Personal Evaluation Scale. Lower social support and social support satisfaction predicted lower total coping scores. Being younger, male gender and time since the myocardial infarction predicted lower positive coping strategy use. Higher anxiety and lower social support were related to fewer positive coping methods. Lower educational levels were related to increased use of negative coping strategies. Reduced social support predicted lower total coping scores and positive coping strategy use and greater passive coping style use. Social support from a broad network assisted with better coping; those living alone may need additional support. Social support and coping strategies should be taken into consideration for patients who have experienced a cardiac event. [ABSTRACT FROM AUTHOR]

Due to the large number of patients on the waiting list, a relatively low deceased donor rate and a waiting list mortality around 20%, New South Wales (NSW) has been a net importer of donor livers from interstate centres that have declined to use them for various reasons. The Australian National Liver Transplant Unit (ANLTU) at the Royal Prince Alfred hospital (RPA) in Sydney aimed to examine the clinical outcomes of liver transplants using interstate donors where the 'home' state had declined them. From 2004 to 2013, a total of 665 livers were transplanted in our centre, of which 98 donor livers were imported from interstate. After excluding urgent, multi-organ, re-transplants, donation after circulatory death (DCD) and paediatric recipients, there were 55 transplants (interstate group) for comparison with 365 recipients (local group) with the same exclusion criteria. The interstate group had longer cold ischaemic times, compared to the local group (hours, 9.12±0.18 vs 7.22±0.18; P<0.0001). The overall quality of donor graft in the interstate group was significantly worse compared to the local group (DRI, 1.97±0.3 vs 1.57±0.4: P<0.0001). No significant difference in graft survival was recorded between the two groups (months, 93±6.5 vs 96±2.8; NS). Three interstate recipients (5.5%) were re-transplanted compared to 10 (2.7%) in the local group. The ANLTU found that livers that have been declined by other centres can often be transplantable with comparable graft and patient survival. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Although people with serious mental illness (SMI) have a high prevalence of physical illness, health-related quality of life (HQoL) has not been sufficiently explored. AIM: To explore the self-reported HQoL of mental health service users in New Zealand. METHODS: Responses on the Medical Outcomes Study 36 Item Short Form (SF-36) measure of HQoL from 404 adult mental health service users in a metropolitan district health board area in New Zealand were analysed and compared to a representative sample of the general population. RESULTS: Mental health service users scored significantly lower on all eight domains of the SF-36 than the general population, the largest difference being in the role limitation--emotional domain. DISCUSSION: Being female, younger than 25, obese or overweight, or of New Zealand European/Other ethnicity were associated with poorer funct ioning on multiple HQoL domains. Future studies should seek to understand the factors contribut ing to perceptions of HQoL of mental health service users in New Zealand. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether individuals with a history of traumatic brain injury (TBI) experience a greater number of adverse life events (ALE) compared to controls, to identify significant predictors of experiencing ALE and whether the severity of childhood TBI negatively influences adult life outcomes. Design: A total of 167 individuals, injured prior to age 18, 5 or more years post-injury and 18 or more years of age, were recruited in the Canterbury region of New Zealand, with 124 having sustained childhood TBI (62 mild, 62 moderate/severe) and 43 orthopaedic injury controls. Participants were asked about ALE they had experienced and other adult life outcomes. Results: Individuals with a history of TBI experienced more ALE compared to controls. The number of ALE experienced by an individual was associated with more visits to the doctor, lower education level and lower satisfaction with material standard of living. Conclusions: Childhood TBI is associated with an increased number of ALE and adult negative life outcomes. Understanding factors that contribute to negative outcomes following childhood TBI will provide an avenue for rehabilitation and support to reduce any problems in adulthood. [ABSTRACT FROM AUTHOR]

Aim To describe workforce separation rates and its relationship with demographic and work characteristics in the 2005 new graduate cohort's first 5 years as practising RNs in NZ. Background Retaining new graduate RNs is critical to nursing workforce sustainability; one study showed that if an RN is still employed in a hospital setting 5 years after graduation, he/she tends to remain active in the health industry. Design Retrospective analysis using the Nursing Council of New Zealand's registration data set for years 2005-2010. Methods All newly registered NZ graduates practising in NZ in 2005 ( n = 1236) were tracked for 5 years. Results Within 5 years of graduation, 26% of the cohort had separated from the NZ nursing workforce, 18% in the first year. The under-25s ( n = 517), 42% of the cohort, had the highest loss, 32%, in 5 years. Separations were significantly lower for graduates in their 30s vs. their 20s and for those who gained postgraduate tertiary qualifications post-registration (10%) vs. those who did not (29%). Hospitals were the most frequent employment setting over 5 years, the largest increase being community settings. Five-year retention rates in the four largest practice areas were surgical 26%, medical 16%, mental health 60% and continuing care 10%. After 5 years, 24% of those still practising ( n = 920) worked in a different health board region. Conclusions New graduate RN losses were higher than in previous research, with younger RNs at most risk, threatening future sustainability of the nursing workforce and highlighting the need for evidence-based targeted strategies to retain them. [ABSTRACT FROM AUTHOR]

Aims and objectives To identify preoperative risk factors that potentially affect postoperative length of stay of patients undergoing total hip replacement. Background With limited health resources and an ageing population, alongside an increasing prevalence of osteoarthritis and the growing need for total hip replacement, reducing length of stay is a mainstay of effective and cost-efficient orthopaedic practice. Design A retrospective observational study. Methods Data from a convenience sample of 243 patients having undergone an elective unilateral total hip replacement between January 2008-December 2009 were collected. Demographic data were studied and allied against the main preoperative risk factors - with length of stay being the main outcome measure. Results Pearson's correlation demonstrated a moderate positive correlation between age and a longer postoperative stay. The number of comorbidities did not have an impact on length of stay. Demographic findings included almost half the cohort lived with hypertension, and 66% of the available cases ( n = 196) were deemed overweight. Conclusions Collecting accurate and comprehensive assessment information relating to preoperative risk factors for total hip replacement, significantly impacts on postoperative outcomes specifically related to length of stay. Relevance to clinical practice In complex healthcare systems, where there is a need for quality client outcomes tempered against limited resources, this study highlights the benefits of accurate preassessment of orthopaedic clients undergoing major surgical intervention against the desirable outcomes of reduced lengths of admission. [ABSTRACT FROM AUTHOR]

Objective. To explore the practices of members of the Australian and New Zealand Society of Palliative Medicine (ANZSPM) in assessing and treating depression in palliative care patients. Methods. Semistructured questionnaires were forwarded to ANZSPM members in consecutive mail-outs to survey diagnostic and treatment practices for depression. Results. The response rate was 62.3%. The median prevalence of depression, as perceived by respondents, in the present respondent patient populations was 20% (range 0%-90%); 57.1% of respondents always assessed for depression, whereas 42.9% assessed for depression sometimes. The majority (98.9%) of respondents relied on clinical interviews to assess depression; non-somatic symptoms of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria were more useful than somatic symptoms. The depression screening tools most frequently used were one- and two-item questions. Pharmacological and non-pharmacological methods were used to treat depression, with selective serotonin reuptake inhibitors the most frequently prescribed medications. Psycho-educational and supportive counselling were the most frequently used non-pharmacological interventions. Nominated measures to augment depression management included improving access to psychiatry, psychology and other allied health services, the development of a screening tool specific to palliative care patients and associated guidelines for depression management. Conclusions. This is the first Australasian study to explore the practice of medical practitioners regarding depression in palliative patients. Incorporation of screening tool questions into palliative care assessment interviews may warrant future research. [ABSTRACT FROM AUTHOR]

This cross-sectional study investigated the spoken expository discourse skills of children and adolescents elicited in generation and retelling conditions. There were three groups of participants: young school-age children (M = 7.0 years; n = 64); intermediate-school-age children (M = 11.3 years; n = 18) and high-school-age students (M = 17.6 years; n = 18). Participants were asked to generate expository discourse using the favourite game or sport (FGS) task and to retell an expository passage about the game of curling. All samples were transcribed and analysed on measures of verbal productivity (number of utterances), syntactic complexity (mean length of utterance in T-units [MLU] and clausal density) and verbal fluency (percent maze words). Results indicated that although all age groups produced longer samples in the generation condition, MLU was significantly longer in the retelling condition. The results suggest that the expository retelling task may be a clinically useful addition to a language assessment battery for children and adolescents. [ABSTRACT FROM AUTHOR]

Aim and objective. To investigate health differences between nurses who report meeting the daily physical activity recommendations in or away from the workplace. Background. Adhering to the national physical activity recommendations has known health benefits. Whilst often considered a workplace active profession, data are emerging of poor health amongst nurses. However, health differences between workplace or leisure-time physically active nurses are understudied. Design. The investigation is an observation study of Australian and New Zealand nurses. Data were generated from the longitudinal, population-based, observational e-Cohort nursing survey. Methods. Data were informed and groups defined by the self-reported minutes per day of moderate physical activity collected from a large international survey of practicing nurses ( n = 2264). Groups were: Group (G) 1 - high workplace (≥30 minutes/day)/high leisure (≥30 minutes/day), G2 - high workplace/low leisure (<30 minutes/day), G3 - low workplace/low leisure (<30 minutes/day) and G4 - low workplace/high leisure. Results. G2 had a high BMI and were younger than G4. G4 were significantly more active away from work and more likely to report cycling to work than G2. In contrast, G2 were most likely to have taken sick days because of their health (χ2 = 19·101), have difficulty sleeping most of the time and have a medical history of diagnosed anxiety and depression. Conclusions. This study shows that improved well-being can be achieved in nursing cohort through leisure-time physical activity. Relevance to clinical practice. This research shows that nurse should consider leisure-time physical activity necessary to maintain and prolong health and that workplace activity is not a sufficient stimulus. This has important implications for workforce planners and administrators. [ABSTRACT FROM AUTHOR]

Background Primary postpartum hemorrhage is a leading cause of maternal mortality and morbidity internationally. Research comparing physiological (expectant) and active management of the third stage of labor favors active management, although studies to date have focused on childbirth within hospital settings, and the skill levels of birth attendants in facilitating physiological third stage of labor have been questioned. The aim of this study was to investigate the effect of place of birth on the risk of postpartum hemorrhage and the effect of mode of management of the third stage of labor on severe postpartum hemorrhage. Methods Data for 16,210 low-risk women giving birth in 2006 and 2007 were extracted from the New Zealand College of Midwives research database. Modes of third stage management and volume of blood lost were compared with results adjusted for age, parity, ethnicity, smoking, length of labor, mode of birth, episiotomy, perineal trauma, and newborn birthweight greater than 4,000 g. Results In total, 1.32 percent of this low-risk cohort experienced an estimated blood loss greater than 1,000 mL. Place of birth was not found to be associated with risk of blood loss greater than 1,000 mL. More women experienced blood loss greater than 1,000 mL in the active management of labor group for all planned birth places. In this low-risk cohort, those women receiving active management of third stage of labor had a twofold risk (RR: 2.12, 95% CI: 1.39-3.22) of losing more than 1,000 mL blood compared with those expelling their placenta physiologically. Conclusions Planned place of birth does not influence the risk of blood loss greater than 1,000 mL. In this low-risk group active management of labor was associated with a twofold increase in blood loss greater than 1,000 mL compared with physiological management. ( BIRTH 39:2 June 2012) [ABSTRACT FROM AUTHOR]

Objective: Our aim was to investigate whether secondary school students with mental health problems sought help from general practitioners and to investigate whether mental illness type, socio-demographic variables, family, school and community factors were associated with seeking help.Method: A randomly selected sample of 9699 secondary school students from across New Zealand participated in the Youth2000 Health and Wellbeing Survey. Data analysis included uni-variate and regression analyses.Results: Having symptoms of anxiety (p<0.0001), depression (p<0.0001), and suicidal thoughts (p<0.0001) were associated with help seeking. However, 82%of students who had significant mental health problems had not sought help from a general practitioner. Rates of help seeking increased with age for girls and decreased with age for boys. Seeking help for mental health problems was also associated with living in a single parent family (p<0.0001), living in an over-crowded house (p=0.0006), and being well known by a teacher (p=0.0004).Conclusions: The majority of New Zealand secondary school students with mental health problems do not obtain the help they need from general practitioners. Given the prevalence of mental health problems, it is important to find ways of identifying adolescents with difficulties and encouraging them to seek help. [ABSTRACT FROM PUBLISHER]