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Objectives To determine factors that predict inadequate serum urate (SU) lowering response in a randomized controlled trial of allopurinol dose escalation (DE) in gout. Methods Participants undergoing allopurinol DE were classified as: complete response (CR)—reached target SU at month 9 and 12 of the DE phase or if still dose escalating at month 9 reached target SU by month 12; partial response (PR)—reached target at some stage but not fulfilling criteria for CR; or inadequate response (IR)—did not reach target SU at any time. Results IR was uncommon, occurring in 13/150 (8.7%), compared with 82 (54.7%) CR, and 55 (36.6%) PR. Mean (s. e. m.) SU was higher at the end of the 12-month DE in IR compared with both CR and PR groups; 7.6 (0.31) vs 5.01 (0.06) and 5.97 (0.17) mg/dl respectively (P < 0.001). In univariate analysis, compete responders tended to be older, be receiving less allopurinol, have longer gout duration and were more likely to be New Zealand (NZ) European ethnicity, compared with IR+PR. Using multi-variate logistic regression analysis, only longer duration of gout and NZ European ethnicity remained significant independent predictors of CR. Baseline SU ⩾ 8 mg/dl had a sensitivity of 69.2% and specificity of 85.1% in predicting IR. The odds ratio for an IR if baseline SU was ⩾8 mg/dl was 11.7 (95% CI 3.3, 41.2). Conclusion A minority of people with gout never reach target SU when allopurinol dose is increased in a treat-to-target manner. Approximately one-third of those with SU ⩾ 8mg/dl despite allopurinol ⩾300mg/d have an IR to DE. Trial registration Australian New Zealand Clinical Trails Registry, https://www.anzctr.org.au, ACTRN12611000845932. [ABSTRACT FROM AUTHOR]

Background: The impact of multiple medication exposure on health outcomes among older patients with end-stage kidney disease (ESKD) is unknown.Objective: The objective of this study was to identify the impact of medicine exposure on hospitalisation rates and mortality in a prospective longitudinal observational study of older dialysis patients.Methods: Patient demographics, medication use, hospitalisation, mortality and co-morbidity data were collected through the prospective longitudinal cohort study DOS65 + (Dialysis Outcomes in those aged ≥ 65 years Study) (n = 225). Medication exposure was measured by the total number of individual medications and the number of predetermined ‘medication groups’. Associations between medications prescribed at recruitment and health outcomes as measured by hospitalisation and mortality were assessed by univariate and multivariable regression analyses.Results: Older ESKD patients were exposed to a median of ten (0-20) medications and eight (0-15) medication groups. Multivariate analyses estimate each additional medication increased mortality risk by 8% (relative risk [RR] = 1.08; 95% confidence interval [CI] 1.07-1.09); each medication group increased mortality risk by 11% (RR = 1.11; 95% CI 1.09-1.12). Similar trends were observed for hospitalisation. Certain medication groups were associated with reduced hospitalisation rates, namely angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (RR = 0.62; 95% CI 0.53-0.72) and dihydropyridines (RR = 0.64; 95% CI 0.54-0.76). Warfarin, gastric acid suppressants, diuretics and β-blockers were associated with increased hospitalisation rates. Warfarin was associated with an increased mortality rate (RR = 1.40; 95% CI 1.19-1.65).Conclusions: Multiple medication exposure was prevalent in this older ESKD population, and was associated with an increased risk of mortality and hospitalisation. While this study is not able to determine the cause of these relationships, review of medication use is warranted in this population.Trial Registration: ACTRN12611000024943. [ABSTRACT FROM AUTHOR]

Abstract Objective Little is known about how to best meet the mental health needs of sexual and/or gender (SG) minority young people who are also an ethnic minority (i.e., double minority youth). We aimed to explore the views of mental health providers (hereafter ‘therapists’ for brevity) on the needs of Chinese SG minority youth in a Western nation (New Zealand) and the therapeutic approaches to best address these needs. Method Semi-structured interviews were conducted with eight therapists (including medical practitioners, counsellors, a psychotherapist, and a social worker). All were providers of talking therapies or counselling, experienced in working with Chinese and/or SG minority youth. A general inductive approach to qualitative data analysis was used to identify themes. Results Four categories of mental health needs emerged. These were needs for love and acceptance; migration and Chinese cultural needs; managing cis-heteronormativity and coming-out needs; and intersectional needs of ‘double rejection’. A ‘double-minority-specific’ therapeutic process was identified. This process suggests therapists successfully engage young people through three phases of therapeutic engagement: from exploration of a SG minority orientation; via segmentation of identity and cautious coming out practice; to a sense of accepted and managed, but often discrete identities. Dimensions of therapy to support Chinese SG minority youth prioritized relational, individual-tailored, holistic approaches that attend to potential barriers. Conclusion The results suggest that therapists perceive intersectional challenges for Chinese SG minority youth in a Western context. Tailored therapeutic approaches are advocated to support double minority young people. Highlights • Chinese sexual and/or gender minority (SG) youth face various mental health needs • ‘Double-minority-specific’ therapies from exploration to discrete identity emerged • Therapists should prioritize relational, individually-tailored, holistic approaches [ABSTRACT FROM AUTHOR]

Background: Although generic medicines provide a safe and economical treatment for many illnesses, negative attitudes towards generics are common and branded innovator drugs are often preferred to generic drugs.Objective: The current study examined differences between individuals preferring branded innovator drugs compared with individuals preferring generic drugs or having no preference. We investigated differences in terms of demographics, perceived sensitivity to medicines, symptom burden, and other clinical variables.Methods: A representative general population sample (n = 1000) was recruited using random digit dialling. In a telephone interview, participants were asked about their preferences for and attitudes toward innovator versus generic drugs, perceived sensitivity to medicines, recent symptoms, and other clinical variables, such as the number of general practitioner (GP) visits, and medicine-related information-seeking behaviour.Results: Univariate logistic regression analyses showed that individuals preferring branded innovator medicines reported lower levels of education, more negative attitudes toward generic medicines, higher perceived sensitivity to medicines, a greater symptom burden and more frequent GP visits. There were no between-group differences in whether participants were currently prescribed drugs, or in participants’ medicine-related information-seeking behaviour. Entering all variables into a multivariate logistic regression model confirmed the findings of the univariate models, apart from perceived sensitivity of medicine and symptom burden. The multivariate analysis also confirmed non-European NZ ethnicity and having no current medication prescription to be significantly associated with a preference for branded medicines.Conclusions: Clinicians should be especially aware that the preference for a branded innovator medicine is higher in patients with lower education, higher perceived sensitivity to medicines, higher levels of symptom burden, higher levels of healthcare utilization and not currently taking any prescription medication. [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]

Objectives The study aimed to validate Wenger's empirically derived support network typology of responses to the Practitioner Assessment of Network Type (PANT) in an older New Zealander population. The configuration of network types was tested across ethnic groups and in the total sample. Method Data (N = 872, M age = 67 years, SD age = 1.56 years) from the 2006 wave of the New Zealand Health, Work and Retirement study were analyzed using latent profile analysis. In addition, demographic differences among the emerging profiles were tested. Results Competing models were evaluated based on a range of fit criteria, which supported a five-profile solution. The "locally integrated," "community-focused," "local self-contained," "private-restricted," and "friend- and family-dependent" network types were identified as latent profiles underlying the data. There were no differences between Māori and non-Māori in final profile configurations. However, Māori were more likely to report integrated network types. Discussion Findings confirm the validity of Wenger's network types. However, the level to which participants endorse accessibility of family, frequency of interactions, and community engagement can be influenced by sample and contextual characteristics. Future research using the PANT items should empirically verify and derive the social support network types, rather than use a predefined scoring system. [ABSTRACT FROM AUTHOR]

Objective: To evaluate Australian and New Zealand chiropractic students' opinions regarding the identity, role setting, and future of chiropractic practice. Methods: An online, cross-sectional survey was administered to chiropractic students in all chiropractic programs in Australia and New Zealand. The survey explored student viewpoints about the identity, role/scope, setting, and future of chiropractic practice as it relates to chiropractic education and health promotion. Associations between the number of years in the program, highest degree preceding chiropractic education, institution, and opinion summary scores were evaluated by multivariate analysis of variance tests. Results: A total of 347 chiropractic students participated in the study. For identity, most students (51.3%) hold strongly to the traditional chiropractic theory but also agree (94.5%) it is important that chiropractors are educated in evidence-based practice. The main predictor of student viewpoints was a student's chiropractic institution (Pillai's trace = 638, ij/16, 1368] = 16.237, p < .001). Chiropractic institution explained over 50% of the variance around student opinions about role/scope of practice and approximately 25% for identity and future practice. Conclusions: Chiropractic students in Australia and New Zealand seem to hold both traditional and mainstream viewpoints toward chiropractic practice. However, students from different chiropractic institutions have divergent opinions about the identity, role, setting, and future of chiropractic practice, which is most strongly predicted by the institution. Chiropractic education may be a potential determinant of chiropractic professional identity, raising concerns about heterogeneity between chiropractic schools. [ABSTRACT FROM AUTHOR]

The article compares the content and construct/convergent validity of five nutrient profiling models from places such as Canada, Europe, and the Americas, and it mentions evaluations of the nutritional quality and healthfulness of various food items.

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]

Manual therapy (MT) and intermittent pneumatic compression (IPC) are recovery methods used by endurance athletes with little evidence supporting effectiveness. This randomized controlled trial evaluated effectiveness of four daily post-race treatments of a specific MT protocol and IPC compared with supine rest on recovery following an ultramarathon among 56 ultramarathoners. Groups were comparable across all characteristics examined, including post-race plasma creatine kinase concentration. Subject completed timed 400 m runs before the race and on days three, five, seven and 14 post- race, and also provided muscle pain and soreness ratings and fatigue scores immediately before and after treatments, and during the 14 days post- race. Daily subjective measures and 400 m run times were not improved by either treatment, but both treatments reduced (p < .05) muscular fatigue scores acutely after treatment following the race and on post-race day 1, and MT improved (p < .05) muscle pain and soreness acutely following the race. [ABSTRACT FROM AUTHOR]

Background: Classrooms can be noisy and are challenging listening environments for children with auditory processing disorder (APD). This research was undertaken to determine if the Listening Inventory for Education-UK version (LIFE-UK) can differentiate children with listening difficulties and APD from their typically developing peers. Purpose: To investigate reliability and validity of the student and teacher versions LIFE-UK questionnaire for assessing classroom listening difficulties. Research Design: Cross-sectional quantitative study comparing children with listening difficulties with typically developing children. Study Sample: In total, 143 children (7-12 yr) participated; 45 were diagnosed with APD. Fifteen participants with reported listening difficulties who passed the APD test battery were assigned to a ''listening difficulty'' (LiD) group. Eighty three children from nine classrooms formed a Control group. Data Collection and Analysis: Children and teachers completed the LIFE-UK questionnaire student and teacher versions. Factor analysis was undertaken, and item reliability was assessed using Cronbach's alpha. Teacher and student ratings were compared using Spearman correlations. Correlations between LIFE-UK ratings and APD test results were also investigated. Results: Factor analysis revealed three factors accounting for 60% of the variance in the Control group LIFE-UK ratings. After removing six items with low factor loadings, a shortened seven-item version with three factors accounted for 71.8% of the variance for the student questionnaire; Cronbach's alpha indicated good internal reliability for this seven-item version of the student questionnaire. Factors were also derived for the teacher questionnaire. Teacher and student ratings were correlated when participant groups were combined. LIFE-UK ratings correlated weakly with some APD measures, providing some support for the questionnaire validity. Conclusions: The results support the use of either the 13- or 7-item student and the teacher versions of the LIFE-UK to evaluate classroom listening and functional consequences of APD. Factor analysis resulted in groupings of items reflecting differences in listening demands in quiet versus noise for the student questionnaire and attentional versus class participation demands for the teacher questionnaire. Further research is needed to confirm the robustness of these factors in other populations. [ABSTRACT FROM AUTHOR]

Background: The effect of natural disasters internationally is linked to intensity and duration and the impact of these events for tertiary level professional students is not clearly understood. Following a 7.1 magnitude earthquake in New Zealand in 2010 (with aftershocks lasting 27 months) a number of tertiary nursing students experienced significant disruption to their studies. Aim: To compare the psychological health, resilience and the impact on learning for three cohorts of students engaged in tertiary nursing education during this time. Method: A cross-sectional survey design and convenience sampling was used for three cohorts of learners. An online survey was completed (n = 290) and included: Depression Anxiety and Stress Scale; PTSD Checklist; Work and Social Adjustment Scale; Connor-Davidson Resilience Scale. Results: Statistically significant differences were found across the psychometric scales with regard to relationship status. Whilst an increase in self-reported physical and mental health issues prior to and following the earthquakes were noted, mitigating factors were also identified. Conclusions: In order to support psychological health amongst nursing students, tertiary education systems need to plan for sustainable learning. The importance of facilitating future orientation within organisations is necessary to develop resilience amongst staff and students, which, in turn, will enable on-going education during significant disaster events. [ABSTRACT FROM AUTHOR]

Background and objectives: The purpose of this study was to investigate, using a questionnaire, the attitudes and possible differences in the use of flexible removable partial dentures (RPDs) among dentists and clinical dental technicians in New Zealand. Methods: A questionnaire consisting 18 questions was modified for an online survey of dentists and clinical dental technicians in New Zealand with a valid email address. Collected data were analyzed by chi-square tests at a - 0.05 level of significance. Results: 334 dentists and 57 clinical dental technicians participated in the study with 215 dentists and 40 clinical technicians stating that they provide flexible RPDs as part of their treatment options. Statistical analysis indicated no significant difference between dentists and clinical dental technicians who offered flexible RPDs in respect to gender, age and dental specialization (P>0.05), but significant differences were found in respect to years in practice and education/training on flexible prostheses (P <0.001). Conclusion: The survey indicated that there was no significant difference between dentists and clinical dental technicians using, selecting and providing flexible RPDs for their patients. Practitioners' age, years in practice and education were associated with the provision of the prostheses; while comfort, aesthetics, cost and metal allergy were the reasons for recommending flexible RPDs. This suggests that although dentists and clinical dental technicians are not formally educated about and/or trained in flexible RPDs, approximately two thirds of respondents offer this treatment option to their patients. Research, particularly clinical research and education are needed to inform clinicians on the use of flexible RPDs. Clinical implications: Both dentists and clinical dental technicians offer flexible RPDs to their patients although there is little research available on these prostheses and most have not been formally educated about the concept. Research is needed to better inform the use of flexible RPDs. [ABSTRACT FROM AUTHOR]

Background Countries with population-based colorectal cancer screening using faecal occult blood test kits performed in the home and posted to the laboratory struggle to achieve higher than 60% uptake. We measured the impact on participation of offering a community laboratory drop-off (CLD) alternative to postal return in New Zealand's Bowel Screening Pilot. Methods From May to September, 2015, a flyer added to the bowel screening test kit offered CLD as an alternative to returning the kit by post. Participation rates for equal-length periods before and after were measured. Interrupted time series and logistic regression models measured CLD-attributable the changes in screening participation. Results Overall, 26% of invitees used the CLD option. The effect of the CLD option on participation varied significantly by age, gender and ethnicity. There was a significant increase in participation among males (+1.75%; P = 0.002); patients under 60 (+1.65%; P = 0.006); Māori and Pacific (+2.88%; P = 0.029); and in the European/other ethnic group (+1.04%; P = 0.045) but not in Asians. Conclusions Both analyses showed that at little or no additional cost, the CLD option produced small but significant increases in participation for non-Asian men and younger invitees. A CLD kit return option may have benefits for other bowel screening programmes. [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]

Narratives are a pervasive form of discourse and a rich source for exploring a range of language and cognitive skills. The limited research base to date suggests that narratives generated using aided communication may be structurally simple, and that features of cohesion and reference may be lacking. This study reports on the analysis of narratives generated in interactions involving aided communication in response to short, silent, video vignettes depicting events with unintended or unexpected consequences. Two measures were applied to the data: the Narrative Scoring Scheme and the Narrative Analysis Profile. A total of 15 participants who used aided communication interacted with three different communication partners (peers, parents, professionals) relaying narratives about three video events. Their narratives were evaluated with reference to narratives of 15 peers with typical development in response to the same short videos and to the narratives that were interpreted by their communication partners. Overall, the narratives generated using aided communication were shorter and less complete than those of the speaking peers, but they incorporated many similar elements. Topic maintenance and inclusion of scene-setting elements were consistent strengths. Communication partners offered rich interpretations of aided narratives. Relative to the aided narratives, these interpreted narratives were typically structurally more complete and cohesive and many incorporated more elaborated semantic content. The data reinforce the robust value of narratives in interaction and their potential for showcasing language and communication achievements in aided communication. [ABSTRACT FROM PUBLISHER]

Children with severe motor impairments are restricted in their manipulation and exploration of objects, but little is known about how such limitations influence cognitive development. This study investigated visual-constructional abilities in 75 children and adolescents, aged 5;0–15;11 (years;months), with severe speech impairments and no intellectual disabilities (aided group) and in 56 children and adolescents with typical development (reference group). Verbal comprehension, non-verbal reasoning, and visual-spatial perception were assessed with standardized tests. The task of the participants was to verbally instruct communication partners to make physical constructions identical to models that the partner could not see. In the aided group, 55.7% of the constructions were identical to the models participants described, compared to 91.3% in the reference group. In the aided group, test results explained 51.4% of the variance in construction errors. The results indicate that the participants’ language skills were decisive for construction success. Visual-perceptual challenges were common among the aided communicators, and their instructions included little information about size and spatial relations. This may reflect less experience with object manipulation and construction than children with typical development, and using aided communication to instruct others to make three-dimensional constructions. The results imply a need for interventions that compensate for the lack of relevant experience. [ABSTRACT FROM PUBLISHER]

Vocabulary learning reflects the language experiences of the child, both in typical and atypical development, although the vocabulary development of children who use aided communication may differ from children who use natural speech. This study compared the performance of children using aided communication with that of peers using natural speech on two measures of vocabulary knowledge: comprehension of graphic symbols and labeling of common objects. There were 92 participants not considered intellectually disabled in the aided group. The reference group consisted of 60 participants without known disorders. The comprehension task consisted of 63 items presented individually in each participant’s graphic system, together with four colored line drawings. Participants were required to indicate which drawing corresponded to the symbol. In the expressive labelling task, 20 common objects presented in drawings had to be named. Both groups indicated the correct drawing for most of the items in the comprehension tasks, with a small advantage for the reference group. The reference group named most objects quickly and accurately, demonstrating that the objects were common and easily named. The aided language group named the majority correctly and in addition used a variety of naming strategies; they required more time than the reference group. The results give insights into lexical processing in aided communication and may have implications for aided language intervention. [ABSTRACT FROM PUBLISHER]

There is limited knowledge about aided language comprehension and use in children who use aided communication and who are considered to have a relatively good comprehension of spoken language. This study’s purpose was to assess their aided language skills. The participants were 96 children and adolescents who used communication aids (aided group) and 73 children and adolescents with natural speech (reference group), aged 5 to 15 years. All of the participants who used aided communication were regarded by their teachers or professionals as having age-appropriate language comprehension. All of the participants completed (a) standardized tests of visual perception, non-verbal reasoning, and comprehension of spoken language, and (b) tasks designed for this study that measured comprehension and production of graphic utterances through communicative problem solving. Using their own communication systems, the participants achieved an average of 72% correct on the graphic symbol comprehension task items, and 63% on the expressive tasks. The participants with natural speech achieved an average of 88% correct on comprehension items, and 93–96% accuracy on production items. The differences between groups were significant on all the tasks and standardized tests. There was considerable variation within the group of participants who used aided communication, and the results reveal a need to develop instruments with norms for aided language competence that can inform the implementation of interventions to support aided language development. [ABSTRACT FROM PUBLISHER]

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]

Objectives: To investigate examiner reliability of scoring intraoral radiographs of bone infill following secondary bone grafting using a categorical scale (modified Kindelan Index) and a 10-cm visual analog scale (VAS). To investigate the level of clinical experience on the reliability of these assessments. Design: Retrospective study involving 10 clinicians of varying clinical experience who were blind to the patient’s identity. Setting: All grafting was carried out within the New Zealand public hospital service. Patients: Fifty-eight grafts (48 UCLP and 5 BCLP) were assessed with 14 duplicated radiographs randomly added to the sample, making a total of 72 radiographs for assessment. Main Outcome Measures: Weighted kappa was used for intra- and interrater examiner reliability for the categorical scale and correlations for the VAS. Results: Relatively poor intrarater examiner agreement for categorical scoring (median 0.46) was found. Clinicians with greater experience generally recording higher intrarater weighted kappa. The intrarater correlations for the continuous scale (median 0.89) suggest better consistency regardless of the level of experience. The interrater relationships were generally low, with an average of weighted kappa of 0.25 while the overall average VAS correlation was 0.49. For the majority of scorers, there was a relationship between the VAS and the Kindelan Index, with lower VAS scores related to worse Kindelan scores. Conclusions: The use of a VAS produced better intra- and interexaminer reliability than the categorical Kindelan Index and was more consistent despite the level of clinical experience. Further evaluation of the validity of the VAS for the assessment of bone infill is warranted. [ABSTRACT FROM AUTHOR]

Background: In the context of the recent surge in community based multilevel interventions for suicide prevention, all of which show promising results, we discuss the implications of the findings of such an intervention designed for and implemented in New Zealand. The multi-level intervention for suicide prevention in New Zealand (MISP-NZ) was a cluster randomised controlled community intervention trial involving eight hospital regions matched into four pairs and randomised to either the intervention or practice as usual (the control). Intervention regions received 25 months of interventions (01 June 2010 to 30 June 2012) including: 1) training in recognition of suicide risk factors; 2) workshops on mental health issues; 3) community based interventions (linking in with community events); and 4) distribution of print material and information on web-based resources.Results: There was no significant difference between the change in rate of suicidal behaviours (ISH or self-inflicted deaths) in the intervention group compared with the control group (rate ratio = 1.07, 95% CI 0.82, 1.38).Conclusions: This study did not provide substantive evidence that the MISP-NZ intervention had an effect on suicidal behaviours raising important questions about the potential effectiveness of the multilevel intervention model for suicide prevention for all countries. Although a range of factors may account for this unanticipated finding, including inadequate study power, differences in design and intervention focus, and country-specific contextual factors, it is possible that the effectiveness of the multilevel intervention model for reducing suicidal behaviours may have been overstated.Trial Registration: This trial was retrospectively registered on 11 April 2013. ACTRN12613000399796 . [ABSTRACT FROM AUTHOR]

Purpose: This study aim was to evaluate whether the Extended International Classification of Functioning, Disability and Health Core Set for Stroke captured the interventions of a community stroke rehabilitation team situated in a large city in New Zealand. It was proposed that the results would identify the contribution of each discipline, and the gaps and differences in service provision to Maori and non-Maori. Applying the Extended International Classification of Functioning, Disability and Health Core Set for Stroke in this way would also inform whether this core set should be adopted in New Zealand. Method: Interventions were retrospectively extracted from 18 medical records and linked to the International Classification of Functioning, Disability and Health and the Extended International Classification of Functioning, Disability and Health Core Set for Stroke. The frequencies of linked interventions and the health discipline providing the intervention were calculated. Results: Analysis revealed that 98.8% of interventions provided by the rehabilitation team could be linked to the Extended International Classification of Functioning, Disability and Health Core Set for Stroke, with more interventions for body function and structure than for activities and participation; no interventions for emotional concerns; and limited interventions for community, social and civic life. Results support previous recommendations for additions to the EICSS. Conclusions: The results support the use of the Extended International Classification of Functioning, Disability and Health Core Set for Stroke in New Zealand and demonstrates its use as a quality assurance tool that can evaluate the scope and practice of a rehabilitation service. [ABSTRACT FROM AUTHOR]

Aims To outline the way the culture of austerity arising from the Global Financial Crisis has been used by Australian and New Zealand governments to maintain and extend healthcare budget cuts, through new public management strategies leading to missed nursing care. Background Ten years on the cost of the Global Financial Crisis continues to be borne by tax payers and those employed by the welfare state, yet analysis shows clearly that it was caused by a failure to adequately regulate markets, particularly the banks and multinational corporations. In health care, one of the impacts is increased workload for nurses leading to missed care. Design/Methods Registered Nurses and midwives ( n = 7,302) completed the MISSCARE surveys between 2012 - 2015, in four Australian states and New Zealand providing quantitative and qualitative responses. The qualitative comments were analysed using a template analysis approach based on key features of New Public Management. Findings Sixty-two qualitative responses identified measures in place directly linked to austerity and new public management strategies that impacted on the quality of patient care and nursing work, as well as contributing to missed care. Conclusion Opportunities for resistance may lie outside public and private health organizations in civil society, in the nurse union movements and other health and nursing professional associations. [ABSTRACT FROM AUTHOR]

Aim To examine the relationship of the pain severity scores with demographic variables (age, gender, and ethnicity) and with the frequency of falls, fatigue, and depression in a very large New Zealand sample of people over 65 years assessed using the Home Care International Residential Assessment Instrument. Background Pain is reported to be highly prevalent in older people yet it is poorly correlated with tissue damage. There is convincing evidence that it is related to depression and some evidence of its relationship with fatigue and falls. Design This is a cross-sectional study examining a national cohort assessed on referral for a needs assessment for access to publicly funded service provision or support. Method Participants were 45,418 adults aged over 65 years referred for a mandatory needs assessment between 2012-2014. All variables analysed were drawn from the Home Care International Residential Assessment Instrument. Univariate descriptive statistics were used to characterize the sample in relation to the association of severe pain with age, gender, and ethnicity and with the key variables of interest: falls, fatigue, and depression. Logistic regression models were used to examine the relationship of the presence or not of severe pain with the other key health-related variables: falls, fatigue, and depression, respectively, after controlling for the presence of age, gender, and ethnicity. Odds ratios are reported to quantify the difference in risk with increasing severity of falls, fatigue, and depression. Results The mean age of the cohort was 82.48 years ( SD 7.48) and 48.5% of the sample reported experiencing daily pain. The rates of severe daily pain were 12%-18% with those in the 65-74 years group having the highest reported rate of severe pain (18%) and a gradual decrease in severe pain with age. After co-varying for age, ethnicity, and gender, the presence of severe daily pain was predicted by increasing frequency of falls and fatigue and having current depression. While two-thirds reported their pain control was adequate, a third reported that their pain control was not adequate despite adhering to a therapeutic regime. Conclusion The study highlights how pervasive pain is in this group and its correlation with falls, fatigue, and depression. While the effect sizes were relatively small the results may be clinically significant and it may be clinically important that the presence of pain in older people could indicate the need for further nursing assessment in relation to falls, fatigue, and depression. [ABSTRACT FROM AUTHOR]

Children born small for gestational age (SGA) have an increased risk of cardiovascular disease (CVD) and associated risk factors in later life; however, little is known about their dietary intakes. The objective of this study was to assess dietary intakes in SGA and appropriate for gestational age (AGA) at 3.5, 7, and 11 years. The Auckland Birthweight Collaborative Study is a longitudinal case-control study of children born at term ( n = 871). Children were assessed at 3.5 ( n = 550), 7 ( n = 591), and 11 ( n = 620) years of age. Diet was assessed using a 24-hr record-assisted recall. Reported dietary intakes were analyzed and compared with the Australian and New Zealand Nutrient Reference Values. Compared with AGA, median energy intakes were significantly lower in SGA at 3.5 years (4.2 MJ [IQR, 3.0 to 5.8] vs. 5.4 MJ [IQR, 3.9 to 6.5]; p < .0001) but not at 7 and 11 years. Inadequate dietary intakes of micronutrients were more prevalent among SGA at 3.5 years and 11 years of age. A large proportion of SGA and AGA children consumed more than the recommended amounts of saturated fats, sugars, and sodium. There was no association of dietary intake and socio-demographic factors. This study reveals that dietary intake in 3.5-year-old children born SGA is lower in energy and a variety of micronutrients compared with dietary intake in AGA. These intakes may however be appropriate given their BMI z-scores. High intakes of sodium, saturated fat, and sugars are a concern for all children in this cohort. [ABSTRACT FROM AUTHOR]

We study aftershock sequences of six major earthquakes in New Zealand, including the 2016 M7.8 Kaikaoura and 2016 M7.1 North Island earthquakes. For Kaikaoura earthquake, we assess the expected number of long-delayed large aftershocks of M5+ and M5.5+ in two periods, 0.5 and 3 years after the main shocks, using 75 days of available data. We compare results with obtained for other sequences using same 75-days period. We estimate the errors by considering a set of magnitude thresholds and corresponding periods of data completeness and consistency. To avoid overestimation of the expected rates of large aftershocks, we presume a break of slope of the magnitude-frequency relation in the aftershock sequences, and compare two models, with and without the break of slope. Comparing estimations to the actual number of long-delayed large aftershocks, we observe, in general, a significant underestimation of their expected number. We can suppose that the long-delayed aftershocks may reflect larger-scale processes, including interaction of faults, that complement an isolated relaxation process. In the spirit of this hypothesis, we search for symptoms of the capacity of the aftershock zone to generate large events months after the major earthquake. We adapt an algorithm EAST, studying statistics of early aftershocks, to the case of secondary aftershocks within aftershock sequences of major earthquakes. In retrospective application to the considered cases, the algorithm demonstrates an ability to detect in advance long-delayed aftershocks both in time and space domains. Application of the EAST algorithm to the 2016 M7.8 Kaikoura earthquake zone indicates that the most likely area for a delayed aftershock of M5.5+ or M6+ is at the northern end of the zone in Cook Strait. [ABSTRACT FROM AUTHOR]

Quality objective physical activity data are required to inform physical activity-based health improvement initiatives, however, various challenges undermine acquisition of such data. We examined the efficacy and challenges of a hip-worn accelerometry protocol in women. Specific objectives included determining accelerometer-wear-compliance rates and understanding the barriers and acceptability of wearing accelerometers. Healthy New Zealand women (n = 406) of three ethnicities (Maori (indigenous New Zealander), Pacific, European) aged 16-45 years (30.9 ± 8.7 y) wore hip-mounted Actigraph wGT3X+ accelerometers for 7 consecutive days under a 24-h wear protocol. Post hoc, a sub-sample (n = 45; age: 29.4 ± 9.0 y) was interviewed to investigate comfort/convenience and burdens of accelerometer-wear. Wear-compliance (≥10 h/day, ≥4 day) was 86%. European women returned more valid data (92.7%, p < .04) than Pacific (73.0%) or Maori women (82.1%). Twenty-two participants (5.4%) had completely missing data; 13 due to lost accelerometers. Burden of accelerometer-wear was greatest during sleeping (66.7%) due to discomfort. Embarrassment of accelerometer visibility through clothing and consequent restricted clothing choices caused high burden in social settings (45.2%). Discomfort during sleeping, embarrassment due to perceived appearance in social settings and ethnicity are key factors affecting the efficacy of collecting physical activity data from women using hip-worn accelerometers. Refining accelerometer design to reduce size and subsequently participant burden should improve acceptability and wear-compliance. Increasing overall participant compliance by reducing burden and ensuring appropriate understanding of study aims and relevance should reduce attrition and improve wear-compliance and data quality when collecting accelerometry data from women of different ethnicities. [ABSTRACT FROM AUTHOR]

Background:Childhood mild traumatic brain injury (mTBI) has been associated with negative adult outcomes. Effective interventions require identification of the injury event. There is currently little information regarding the accuracy of adult recall of childhood mTBI. Method:Prospectively collected information from a large birth cohort was used to examine adult recall accuracy at age 25 for 161 childhood mTBI events occurring before age 10. Results:At age 25 cohort members recalled 11 outpatient injuries and 16 inpatient injuries. Recall accuracy increased with age. Logistic regression analysis distinguished between respondents who reported and did not report a childhood mTBI event correctly classifying 84.5% of cases. Age at injury, injury severity and loss of consciousness (LoC) made a unique statistically significant contribution to the model. Conclusions:Most childhood mTBI events are not recalled in adulthood. Age at injury, injury severity and LoC significantly increase likelihood of recall and should be used in measures that evaluate whether injury has occurred.Implications for rehabilitationTraumatic brain injury occurs frequently and often results in ongoing deficits in attention, concentration, executive function and later mental health problems.Identification of a history of traumatic brain injury is essential to ensure that appropriate rehabilitative input is provided.Rehabilitation professionals need to be aware that mental health problems may be secondary to a prior traumatic brain injury.It is important for rehabilitation professionals elicit an accurate history of traumatic brain injury to ensure that their treatment plans are tailored to the needs of this group. [ABSTRACT FROM PUBLISHER]

Previous reviews have indicated that immigration from South Asian to Western countries leads to unhealthy changes in diet; however, these reviews have been limited by the methods used in some included studies. This critical narrative review summarizes findings from original research articles that performed appropriate statistical analyses on diet data obtained using culturally appropriate diet assessment measures. All studies quantitatively compared the diets of South Asian immigrants with those of residents of Western or South Asian countries or with those of South Asian immigrants who had varying periods of time since immigration. Most studies examined total energy and nutrient intake among adults. Total energy intake tended to decrease with increasing duration of residence and immigrant generation, and immigrants consumed less protein and monounsaturated fat compared with Westerners. However, findings for intakes of carbohydrate, total fat, saturated fat, polyunsaturated fat, and micronutrients were mixed. Studies that examine food group intake and include South Asians living in South Asia as a comparison population are needed. [ABSTRACT FROM AUTHOR]

This study compared the effects of six warm-up modalities on peak power output (PPO) during the high-pull exercise. Nine resistance-trained males completed six trials using different warm-ups: highpull specific (HPS), cycle, whole body vibration (WBV), cycle+HPS, WBV+HPS and a control. Intramuscular temperature (Tm) was increased by 2°C using WBV or cycling. PPO, Tm and electromyography (EMG) were recorded during each trial. Two high-pulls were performed prior to and 3 min after participants completed the warm-up. The greatest increase in PPO occurred with HPS (232.8 ± 89.7 W, P < 0.001); however, this was not different to combined warm-ups (cycle+HPS 158.6 ± 121.1 W; WBV +HPS 177.3 ± 93.3 W, P = 1.00). These modalities increased PPO to a greater extent than those that did not involve HPS (all P < 0.05). HPS took the shortest time to complete, compared to the other conditions (P < 0.05). EMG did not differ from pre to post warm-up or between modalities in any of the muscles investigated. No change in Tm occurred in warm-ups that did not include cycling or WBV. These results suggest that a movement-specific warm-up improves performance more than temperature- related warm-ups. Therefore, mechanisms other than increased muscle temperature and activation may be important for improving short-term PPO. [ABSTRACT FROM AUTHOR]

Background: In-store availability of healthy and unhealthy foods may influence consumer purchases. Methods used to measure food availability, however, vary widely. A simple, valid, and reliable indicator to collect comparable data on in-store food availability is needed. Methods: Cumulative linear shelf length of and variety within 22 healthy and 28 unhealthy food groups, determined based on a comparison of three nutrient profiling systems, were measured in 15 New Zealand supermarkets. Inter-rater reliability was tested in one supermarket by a second researcher. The construct validity of five simple indicators of relative availability of healthy versus unhealthy foods was assessed against this 'gold standard'. Results: Cumulative linear shelf length was a more sensitive and feasible measure of food availability than variety. Four out of five shelf length ratio indicators were significantly associated with the gold standard (p = 0.70-0.75). Based on a non-significant difference from the 'gold standard' (d = 0.053 ± 0.040) and feasibility, the ratio of cumulative linear shelf length of fresh and frozen fruits and vegetables versus soft and energy drinks, crisps and snacks, sweet biscuits and confectionery performed best for use in New Zealand supermarkets. Conclusions: Four out of the five shelf length ratio indicators of the relative availability of healthy versus unhealthy foods in-store tested could be used for future research and monitoring, but additional validation studies in other settings and countries are recommended. Consistent use of those shelf length ratio indicators could enhance comparability of supermarket food availability between studies, and help inform policies to create healthy consumer food retail environments. [ABSTRACT FROM AUTHOR]

Objective Pain is a common feature of ED presentations and the timely provision of adequate analgesia is important for patient care. However, there is currently no New Zealand data with respect to this indicator of care quality. The present study aimed to provide a baseline for the quality of care with respect to the provision of timely and adequate analgesia in New Zealand EDs. Methods The present study is a secondary analysis of data initially collected for the Shorter Stays in Emergency Department Study, using a retrospective chart review of 1685 randomly selected ED presentations (2006-2012) from 26 New Zealand public hospital EDs. Results Of the 1685 charts randomly selected, 1547 (91%) were reviewed from 21 EDs. There were 866 ED presentations with painful conditions, of whom 132 (15%) did not have pain recorded, 205 (24%) did not receive pain relief and 19 (2%) did not have time of analgesia documented leaving 510 (59%) for the analysis of time to analgesia. Four hundred and fifty-seven (53%) did not have pain well documented sufficiently to assess adequacy, leaving 277 (32%) for the analysis of adequacy of analgesia. The median (interquartile range) time to analgesia was 62 (30-134) min and the provision of adequate analgesia was 141/277 (51%, 95% CI: 45-57%); however, there was some variation between hospitals for both outcomes. Conclusion Although these outcomes are on a par with other countries, this baseline audit has shown both poor documentation and variation in the provision of timely and adequate pain relief in New Zealand EDs, with room for improvement with respect to this quality indicator. [ABSTRACT FROM AUTHOR]

Background: Chronic tinnitus (phantom perception of sound) significantly disrupts quality of life in 15-20% of those who experience it. Understanding how certain personality traits impact tinnitus perception and distress can be beneficial for the development of interventions to improve the lives of tinnitus sufferers. Purpose: Four key self-reported personality traits (social closeness, stress reaction, alienation, and self-control) were identified from previous research as being associated with tinnitus. These were compared between tinnitus and age-, gender-, and hearing level-matched nontinnitus controls to see whether underlying profile differences exist, and if personality traits levels correlate with various tinnitus characteristics assessed in typical clinical questionnaires. Research Design: A Web-based personality survey was administered comprising of self-control, stress reaction, alienation, and social closeness subscale questions of the Multidimensional Personality Questionnaire, the Hearing Handicap Inventory-Screening Version, TFI, and the Tinnitus Case History Questionnaire. Study Sample: A total of 154 participants with tinnitus (81 males, 73 females, mean age = 62.6 yr) and 61 control (32 males, 29 females, mean age = 59.62 yr) participants were recruited via e-mail invitations to a tinnitus research clinic database, poster, and social media Web site advertising. Data Collection and Analysis: Statistical analysis was conducted using parametric statistics and IBM SPSS® Version 22 software. Results: Tinnitus sufferers displayed higher levels of stress reaction, lower social closeness, lower self-control, and higher alienation than the control group (p < 0.05). Alienation was related to tinnitus pitch and self-reported hyperacusis measured using the Tinnitus Case History Questionnaire (p < 0.05). Stress reaction correlated with self-reported hyperacusis, whether tinnitus sufferers had sought other treatments, and whether loud sounds make the tinnitus worse (p < 0.05). Conclusions: The four personality traits examined in this study exhibited a consistent association with tinnitus perception and distress, and differentiated tinnitus sufferers from nontinnitus control. Some of the traits also correlated significantly with certain characteristics measured in tinnitus history questionnaires. Personality traits are described in relation to "maladaptive" residuals under the Adaptation Level Theory model of tinnitus. The results of the study suggest that certain personality traits correlate with the clinical presentation of tinnitus. [ABSTRACT FROM AUTHOR]

Background:There is growing international support for a public health approach to palliative care; however, the status of the movement in the New Zealand context is unknown. Aim:To explore the understandings, uptake, and nature of a public health approach to palliative care by hospices in New Zealand. Methods:A mixed method study, using a convergent parallel design, was conducted. In phase one, quantitative data were collected using an online survey of hospice leaders, and in phase two, qualitative data were generated from semi-structured telephone interviews with a sub-sample of phase one participants. Data from the survey were analysed using appropriate statistical techniques. Transcripts of the telephone interviews were analysed using thematic analysis. The findings from each phase were then triangulated to check for congruency. Sample:Fifteen leaders (12 chief executive officers and three senior managers) at New Zealand hospices participated in the online survey, representing a response rate of 54%. Ten of these participants took part in a semi-structured telephone interview. Results:Analysis of the quantitative results confirmed that a public health approach to palliative care was a current priority at 60% of New Zealand hospices. However, both phases of the study demonstrated that community engagement, one of the chief out-workings of a public health approach to palliative care, was incompletely understood and practised. Furthermore, the qualitative results showed that, while this approach is supported, there are significant barriers to implementation, including paternalism, resource constraints, adequate evaluation, and incomplete understanding of key concepts, such as social networking and community engagement. Conclusion:This study is the first to explore the extent to which a public health approach to palliative care is supported by hospices in New Zealand. The unique new findings show that there is need for the model to be recognized in policy. Related to practice, if the model is to be implemented to maximum benefit, further conceptual clarity of the key tenets is needed. In addition, addressing the barriers to implementation identified by this study will need to be prioritized by hospice leadership. [ABSTRACT FROM AUTHOR]

Background: Antioxidant and anti-inflammatory properties of honey have been largely recognized by various studies. Almost all of the potential benefits are associated with polyphenol content. Honey varieties from the arid region are reported to be rich in polyphenols, but data related to its bioactivity in vitro is greatly lacking. This study aimed at establishing the antioxidant and anti-inflammatory properties of arid region honey. Four honey varieties from arid region (H1, H2, H3, and H4) and two popular non-arid region honey (H5 and H6) were tested in vitro in this study. Methods: The erythrocyte membrane protection effect of honey varieties were measured by hemolysis assay after exposing erythrocytes to a peroxide generator. The subsequent production of MDA (malondialdehyde) content in erythrocytes was measured. Immunomodulatory effect of the honey varieties was tested in prostate cancer cells PC- 3 and PBMC (peripheral blood mononuclear cells) by measuring the IL-6 (interleukin 6) and NO (nitric oxide) levels in cell culture supernatant after incubation with the honey varieties. PC-3 cell viability was assessed after incubation with honey varieties for 24 h. Results: Arid region honey exhibited superior erythrocyte membrane protection effect with H4 measuring 1.3 ± 0. 042mMTE/g and H2 measuring 1.122 ± 0.018mMTE/g. MDA levels were significantly reduced by honey samples, especially H4 (20.819 ± 0.63 nmol/mg protein). We observed a significant decrease in cell population in PC-3 after 24 h in culture on treatment with honey. A moderate increase in NO levels was observed in both cultures after 24 h at the same time levels of IL-6 were remarkably reduced by honey varieties. Conclusion: The results demonstrate the antioxidant effect of arid region honey due to its erythrocyte membrane protection effect and subsequent lowering of oxidative damage as evident from lower levels of lipid peroxidation byproduct MDA. Arid region honey varieties were as good as non-arid region types at decreasing cell viability of prostate cancer cells. The moderate increase in NO levels in PC-3 and PBMCs were not significant enough to elicit any pro-inflammatory response. However, IL-6 secretion was remarkably reduced by all honey varieties in a comparable level indicating the potential anti-inflammatory property of arid region honey. [ABSTRACT FROM AUTHOR]

Objective Prognostication is important in clinical decision-making, especially for older people. The aim was to present estimates of life expectancy for older people in New Zealand. Methods Statistics New Zealand age-sex-specific death rates were used to derive quartiles of expected years of life remaining in people aged over 65 years. Results Given current patterns and trends in New Zealand death rates, 50% of women reaching age 80 years in 2016 can expect to live at least another 10.5 years, 25% will live over 14.7 years, and 25% will die within 6.2 years. Comparable results for men reaching age 80 years in 2016 are 8.5 years, 12.7 years and 4.6 years, respectively. Of those reaching age 90 years in 2016, median expected years of life left is 4.2 years for women and 3.4 years for men. Conclusion Demographic norms are useful as a guide when specific predictive tools are unavailable. [ABSTRACT FROM AUTHOR]

Causes of variation between loads estimated using alternative calculation methods and their repeatability were investigated using 20 years of daily flow and monthly concentration samples for 77 rivers in New Zealand. Loads of dissolved and total nitrogen and phosphorus were calculated using the Ratio, L5, and L7 methods. Estimates of loads and their precision associated with short-term records of 5, 10, and 15 years were simulated by subsampling. The representativeness of the short-term loads was quantified as the standard deviation of the 20 realizations. The L7 method generally produced more realistic loads with the highest precision and representativeness. Differences between load estimates were shown to be associated with poor agreement between the data and the underlying model. The best method was shown to depend on the match between the model and functional and distributional characteristics of the data, rather than on the contaminant. Short-term load estimates poorly represented the long-term load estimate, and deviations frequently exceeded estimated imprecision. The results highlight there is no single preferred load calculation method, the inadvisability of 'unsupervised' load estimation and the importance of inspecting concentration-flow, unit load-flow plots and regression residuals. Regulatory authorities should be aware that the precision of loads estimated from monthly data are likely to be 'optimistic' with respect to the actual repeatability of load estimates. [ABSTRACT FROM AUTHOR]

Objective To identify factors influencing whether Australian medical graduates prefer to, or actually, work rurally. Design Secondary analysis of longitudinal data from Medical Schools Outcomes Database ( MSOD) using univariate and multivariate logistic regression. Setting Twenty Australian medical schools. Participants Australian or New Zealand citizens and Australian permanent residents who completed MSOD questionnaires between 2006 and 2013. Main outcome measures Preferred and actual work locations 1 ( PGY1) and 3 ( PGY3) years postgraduation. Results Of 20 784 participants, 4028 completed a PGY1 or PGY3 questionnaire. Self-reported preference for rural practice location at medical school commencement was the most consistent independent predictor of whether a graduate would have a rural location preference at PGY1 (odds ratio ( OR) 6.07, 95% confidence interval ( CI) 4.91-7.51) and PGY3 ( OR 7.95, 95% CI 4.93-12.84), and work rurally during PGY1 ( OR 1.38, 95% CI 1.01-1.88) and PGY3 ( OR 1.86, 95% CI 1.30-2.64). The effect of preferred practice location at medical school commencement is independent of, and enhances the effect of, rural background. Graduates of graduate-entry programs or with dependent children were less likely to have worked rurally during PGY1 and PGY3 respectively. Conclusion The most consistent factor associated with rural preferences and work location was students' preferred location of practice at medical school commencement; this association is independent of, and enhances the effect of, rural background. Better understanding of what determines rural preference at medical school commencement and its influence on rural workplace outcomes beyond PGY3 is required to inform Australian medical school selection policies and rural health curricula. [ABSTRACT FROM AUTHOR]

Background: Little is known about cystic fibrosis patients, who are not considered to be terminally ill, and who die after voluntary cessation of treatment. Aim: This study was undertaken to provide an international snapshot of this issue. Design: An online survey was distributed across three continents. Setting: Distribution to the medical directors of the cystic fibrosis centres affiliated with the US Cystic Fibrosis Foundation, Cystic Fibrosis Australia (inclusion of New Zealand) and to every clinician member of the European Cystic Fibrosis Society. Results: More than 200 cystic fibrosis patients not considered to be terminally ill and, who voluntarily ceased treatment, were reported by the clinicians surveyed. Detailed data were reported in 102 patients (4 children, 25 adolescents and 73 adults). Only one child, six adolescents and one adult were judged by clinicians not to be competent to make the decision to stop treatment. Time-consuming and low immediate-impact therapies, such as respiratory physiotherapy, were most frequently discontinued. Resignation was the main reported reason for discontinuing treatment, followed by reactive depression and lack of familial support. A total of 69% of the patients received palliative care and 72% died in the 6 months following cessation of treatment. Conclusion: Death of cystic fibrosis patients, not considered to be terminally ill, is reported in Europe, the United States and Australia due to voluntary cessation of treatment. [ABSTRACT FROM AUTHOR]

After English, the two languages most spoken by children in Aotearoa/New Zealand are Mäori, the indigenous language of the country, and Samoan, the language of one of New Zealand's first migrant groups. The ongoing vitality of both these Polynesian languages relies on them being transmitted to new generations of children. This study uses specially commissioned datasets from the 2013 Census to explore the rates of intergenerational transmission of these two languages, and sheds light on how the different circumstances relating to Mäori and Samoan affect their rates of intergenerational transmission. The statistics presented also generate a number of potential questions for future investigation. [ABSTRACT FROM AUTHOR]

Introduction To evaluate the effectiveness of the levonorgestrel intrauterine system ( LNG- IUS) in obese women with heavy menstrual bleeding in Counties Manukau Auckland area, New Zealand. Methods Prospective observational study in a tertiary teaching hospital. Twenty women with heavy menstrual bleeding ( HMB) who agreed to treatment with the LNG- IUS and had a body mass index ( BMI) of >30 kg/m2 were recruited between May and December 2014. The women completed two validated tools (Menstrual Impact Questionnaire and the Pictorial Bleeding Assessment Chart) at recruitment, 6 and 12 months follow-up. Demographic, medical and laboratory variables were obtained from the relevant CMH databases. Data on side effects and satisfaction were obtained from the women at 12 months. Results The median age (range) and BMI of the 20 women were 40.5 years (27-52 years) and 40.6 kg/m2 (30-68), respectively. Three LNG- IUS were removed due to infection and pain and these women were subsequently booked for a hysterectomy. The reduction in menstrual loss was estimated at 19.7% per month (95% CI (12.5%, 26.2%); P < 0.001), which translates to 73.2% per period of 6 months (95% CI (55.3%, 83.9%)) and 92.8% per period of 12 months (95% CI (80.0%, 97.4%)). The six items in the quality of life measure improved significantly in 14 women but only 12 women were satisfied with the treatment. Conclusion The LNG- IUS was an effective treatment for 67% of obese women with heavy menstrual bleeding over a 12-month period, as assessed by the reduction in menstrual bleeding and the improvement in the quality of life measures. [ABSTRACT FROM AUTHOR]