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Pacific youth in New Zealand have a disproportionately high risk for gambling and gang involvement compared with New Zealand European youth. Limited evidence indicates that youth gang involvement is associated with problem gambling; no research shows if it is associated with gambling. We conducted exploratory secondary analyses of data from 1063 Pacific youth and their mothers using data from two time points (age nine and 14 years) from a longitudinal cohort study. Gang involvement at age nine years was significantly associated with gambling at age 14 years, with adjusted odds of 2.25 (95% CI [1.16, 4.37]). Of confounders, having a mother with a partner and Cook Islands ethnicity appeared protective against gambling at age 14 years. Despite some study limitations, as youth gambling can lead to subsequent adult problem gambling, our findings highlight the importance of understanding why Pacific youth join gangs, to inform public health policies to reduce the potential for future development of harmful behaviors. [ABSTRACT FROM AUTHOR]

This research examines the impact of digitized and digital indigenous knowledge collections (D‐IKC) on cultural knowledge transmission, social connections, and cultural identity through semi‐structured interviews with 8 users of D‐IKC in New Zealand. The participants acknowledged that D‐IKC brought about many benefits, including the surfacing of otherwise hidden or inaccessible cultural heritage. Concerns around digital access, digital competency, and responsiveness to cultural values need to be thoughtfully addressed nevertheless. Use of D‐IKC had impact not only at an individual level but also at a social‐community level. We highlight several traditional cultural values related to D‐IKC use that are not embodied in existing value‐impact frameworks. This research also found that the intersection and interactions among individual needs, cultural expectations, and norms and affordances around the digital information environments concerned were nuanced and multifaceted. These facets must be incorporated into the stewardship of knowledge collections. We also observed "digital knowledge sharing in the wild"—knowledge transmission that transpired and in some cases led to creation of knowledge resources that materialized outside the bounds of the originating repositories and institutions. Further studies into such self‐organized knowledge transmission/sharing phenomena can lead to valuable insights to inform and shape the curation and design of D‐IKC. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of fever phobia among caregivers of children presenting to New Zealand EDs. Methods: A cross‐sectional survey was administered to caregivers of children <5 years of age presenting to three New Zealand EDs. We defined fever phobia as caregivers having a high level of concern regarding fever or having incorrect beliefs regarding the consequences of fever. Results: A total of 502 caregivers completed the survey. Fever phobia was present in 365 (74.3% [95% confidence interval, CI 70.3–78.0%]) respondents, with 242 (49.3% [95% CI 44.9–53.7%]) caregivers reporting a high level of concern regarding fever, and 288 (61.8% [95% CI 57.3–66.1%]) caregivers reporting at least one incorrect belief regarding the consequences of fever. Majority of caregivers (n = 383, 87.6% [95% CI 84.2–90.4%]) knew the correct dosing interval for paracetamol, compared to less than half of caregivers (n = 179, 42.5% [95% CI 37.9–47.3%]) for ibuprofen. Caregivers reported non‐evidence‐based fever management practices such as sponging, always giving paracetamol and/or ibuprofen for fever, and waking children from sleep to give antipyretics. Over one‐third of caregivers identified ED doctors (n = 195, 40.2% [95% CI 34.7–43.2%]) and ED nurses (n = 173, 35.7% [95% CI 31.5–40.0%]) as sources of information regarding fever management. A higher level of education was associated with fever phobia (odds ratio 1.68 [95% CI 1.04–2.72], P = 0.04). Conclusions: Fever phobia is prevalent among caregivers of children presenting to New Zealand EDs. Opportunistic caregiver education in the ED in conjunction with public health strategies are needed to dispel undue fears and misconceptions about fever. [ABSTRACT FROM AUTHOR]

Objective: A causal relationship between alcohol consumption and injury exists and the prevalence of harmful alcohol intakes in New Zealand adults is high. The present study investigates compliance to blood alcohol (BA) screening policy and the epidemiological profile and hospital‐related outcomes of trauma team activation (TTA) patients with positive BA at a New Zealand level 1 trauma centre. Methods: A retrospective review of Midland Trauma Registry hospitalisation data between January 2012 and December 2019 was conducted. Eligible patients (n = 2168) were ≥15 years who received TTA at Waikato Hospital. BA screening rates, demographic and event information, injury severity and hospital‐related outcomes were examined. Results: The average BA screening rate was 94.0% (95% confidence interval 92.9–95.0%) and 17.9% of screened patients were BA+. BA+ patients were younger than BA− (34.7 and 40.5 years, P < 0.0001). More males than females (20.6 and 12.4%, P < 0.0001), Māori (30.8%) compared to non‐Māori (<16.0%) and unemployed/beneficiaries (33.4%) compared to employed patients (15.5%) were BA+. Road transport crashes accounted for the highest proportion (45.2%) but, in comparison there were higher odds of BA+ from interpersonal violence (odds ratio 4.48, P < 0.0001). No difference between BA+ and BA− was observed in survival rate, injury severity scores, length of intensive care and total hospital stay. Conclusion: Between 2012 and 2019, Waikato Hospital demonstrated high compliance to BA screening policy for TTA patients. Appropriate alcohol awareness initiatives that focus on road safety and interpersonal violence are required to reduce the preventable prevalence and burden of alcohol‐related trauma in the Waikato region. [ABSTRACT FROM AUTHOR]

Low energy availability (LEA) describes the disruption in normal physiological function existent when insufficient energy intake is combined with exercise. To conserve energy a range of endocrine adaptations occur, impairing health and athletic performance. The prevalence of LEA has not been fully established especially among recreational exercisers. Determining recreational exercisers at risk of LEA may help to maximize prevention, early diagnosis and treatment. The design of this study was a cross-sectional online survey. One-hundred and nine female recreational exercisers, with a mean age of 23.8 (SD 6.9) years were recruited via gyms and fitness centers throughout NZ. Participants completed an online questionnaire including questions from the LEAF-Q (Low Energy Availability in Females Questionnaire). A total of 45.0% (CI, 35.4%, 54.8%) of participants were classified as "at risk" of LEA. For every extra hour of exercise per week the odds of being at risk of LEA were 1.13 times greater (CI 1.02, 1.25, p = .016). All participants reporting previous stress fracture injuries (n = 4) were classified as at risk for LEA. Significantly more subjects participating in an individual sport were classified as at risk for LEA (69.6%, CI 24.3%, 54.8%) compared with team sports (34.8%, CI 18.7%, 40.5%) {p = .006). The high prevalence of female recreational exercisers at risk of LEA is of concern, emphasizing the importance of increasing awareness of the issue, and promoting prevention and early detection strategies, so treatment can be implemented before health is severely compromised. [ABSTRACT FROM AUTHOR]

An increasing concern of families caring for children living with disabilities is related to planning for their future care. This qualitative study explores how the country contexts shape the plans for future care provision of Korean parents in New Zealand and Korea. Data were collected using semi-structured interviews with parents (n = 18) and professionals (n = 18). The study revealed that there are differences and similarities regarding the social reality of future care planning among Koreans in different national contexts. Recommendations are made In support of future care planning process taking its place as a conventional phase of care provision for people living with disabilities. [ABSTRACT FROM AUTHOR]

Aim: To determine whether cytisine was at least as effective as varenicline in supporting smoking abstinence for ≥ 6 months in New Zealand indigenous Māori or whānau (extended‐family) of Māori, given the high smoking prevalence in this population. Design Pragmatic, open‐label, randomized, community‐based non‐inferiority trial. Setting: Bay of Plenty, Tokoroa and Lakes District Health Board regions of New Zealand. Participants: Adult daily smokers who identified as Māori or whānau of Māori, were motivated to quit in the next 2 weeks, were aged ≥ 18 years and were eligible for subsidized varenicline. Recruitment used multi‐media advertising. Interventions: A total of 679 people were randomly assigned (1 : 1) to receive a prescription for 12 weeks of cytisine or varenicline, plus low‐intensity cessation behavioural support from the prescribing doctor and community stop‐smoking services or a research assistant. Day 5 of treatment was the designated quit date. Measurements The primary outcome was carbon monoxide‐verified continuous abstinence at 6 months, analysed as intention‐to‐treat (with multiple imputation for missing data). Secondary outcomes measured at 1, 3, 6 and 12 months post‐quit date included: self‐reported continuous abstinence, 7‐day point prevalence abstinence, cigarettes per day, time to (re)lapse, adverse events, treatment adherence/compliance and acceptability, nicotine withdrawal/urge to smoke and health‐care utilization/health‐related quality of life. Findings Verified continuous abstinence rates at 6 months post‐quit date were 12.1% (41 of 337) for cytisine versus 7.9% (27 of 342) for varenicline [risk difference 4.29%, 95% confidence interval (CI) = –0.22 to 8.79; relative risk 1.55; 95% CI = 0.97–2.46]. Sensitivity analyses confirmed that the findings were robust. Self‐reported adverse events over 6 months occurred significantly more frequently in the varenicline group (cytisine: 313 events in 111 participants; varenicline: 509 events in 138 participants, incidence rate ratio 0.56, 95% CI = 0.49–0.65, P < 0.001) compared with the cytisine group. Common adverse events were headache, nausea and difficulty sleeping. Conclusion: A randomized controlled trial found that cytisine was at least as effective as varenicline at supporting smoking abstinence in New Zealand indigenous Māori or whānau (extended‐family) of Māori, with significantly fewer adverse events. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence of new onset type 1 diabetes in children aged 0–14 years from 1977 to 2019 in Auckland, New Zealand. Research design and methods: A cohort study of children with type 1 diabetes aged 0–14 years (n = 1688; 50.4% male) managed by the regional diabetes service between 1977 and 2019. Incidence rates were estimated using census data. Results: The incidence of type 1 diabetes increased by 2.9%/year from 1977 to 2006 (95% confidence interval [CI] 2.13% – 3.48%). Although there was no significant change from 2006 to 2019 (−0.3%/year, 95% CI ‐1.62% – 1.08%), there was a dramatic fall from 1976 to 2018 in the proportion of New Zealand Europeans, from 69.9 to 33.9%. New Zealand Europeans had the highest incidence (23.3/100,000, 95% CI 20.6–26.1) compared to Māori (8.3/100,000, 95% CI 6.3–10.2), Pasifika (8.6/100,000, 95% CI 6.9–10.4) and other (6.4/100,000, 95% CI 4.7–8.0). All groups showed an overall increase in incidence over time, Māori 4.4%/year, Pasifika 3.7%, compared to New Zealand European 2.7%, and other 2.1%. Incidence increased consistently in 5–9 and 10–14 year olds (2.0% and 2.2%/year, respectively). By contrast, whereas 0–4 year olds showed an increase of 4.6%/year from 1977 to 2003 (p < 0.01), there was no change from 2003 to 2019 (p = 0.2). Conclusion: There has been a plateau in the incidence of type 1 diabetes in children 0–4 years of age in the Auckland region since 2003, but not older children. The apparent plateau in the overall incidence of new onset type 1 diabetes in children 0–14 years since 2006 was mediated by substantial changes in the ethnic makeup of the Auckland region. [ABSTRACT FROM AUTHOR]

Background: A significant reduction in perinatal mortality among births ≥1000 g has been observed in New Zealand. Aim: To determine, in a national cohort, if perinatal mortality has reduced in small for gestational age (SGA) and non‐SGA babies. Materials and methods: Retrospective cohort, 2008–2016, of singleton non‐anomalous births and perinatal deaths from 26+0 weeks gestation at birth in New Zealand. Perinatal deaths from the Perinatal and Maternal Mortality Review Committee data set were merged with the Ministry of Health national maternity data set. SGA was defined as less than the 10th customised birthweight centile using New Zealand coefficients. Perinatal mortality was defined as stillbirth from 26 weeks gestation and neonatal death up to the 27th day of life. Results: There was a 30% reduction in perinatal mortality among SGA singleton non‐anomalous babies at 26 weeks or more from 10.38/1000 births in 2008 to 7.28/1000 in 2016 (P = 0.046) but no significant change in mortality among appropriate and large for gestational age babies. Conclusion(s): There has been a significant reduction in perinatal mortality among SGA babies in New Zealand. The mechanism for this reduction is unclear. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to examine ways that older Māori (New Zealand's Indigenous people) enhanced their ability to be peer educators and how this role impacted on their sense of purpose and well-being in later life. Method Kaupapa Māori and community-based participatory research principles guided the peer intervention involving 26 Māori kaumātua (older people 55 years and older) as peer educators (tuakana) for 121 other kaumātua (teina) facing transitions in later life. Each pair held up to 3 conversations; independent coders rated tuakana communication skills. We used mixed methods in a pre- and post-test, clustered staggered design. Participants completed baseline and post-intervention assessments of health and well-being consistent with Māori worldviews. 5 focus groups involving 22 teina and 1 with 5 tuakana were held. Results Tuakana communication skills were rated as high by teina and independent coders. Qualitative analysis supported the importance of Māori communication processes for the role. Further, three measures increased significantly from the baseline to the final period for tuakana accounting for about 15% of the variance in these variables: sense of purpose (p =.07), self-rated health (p =.05), and health-related quality of life (p =.04). The qualitative analysis supported the benefits of the peer educator role for older Māori including enhanced sense of identity, well-being, and social connectedness. Discussion The results demonstrated that kaumātua had strong communication in the peer educator role and that the intervention has positive impacts for them. The study contributes to peer intervention research that may help to improve experiences ofIndigenous and other older people. [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]

Background: The relative importance of different strategies to prevent dental caries is not known. Aim: We explored the relationship between oral health behaviours, diet, and the incidence of dental caries. Design: We conducted a study of children participating in the 'Growing Up in New Zealand' cohort. Exposures were oral health behaviours, a food frequency questionnaire, and sociodemographic characteristics that were recorded when the child was nine months and two years old. Outcomes were records of dental caries at ages four to seven years. Results: 4111 children had dental examination records from between the ages of four and seven years. High levels of dental caries were reported in children of Pacific, Asian, and Māori ethnicity. Food frequency questionnaire information was summarised into two principal components. The major axis of variation was in the intake of food and drinks with high concentrations of sugar and refined starch, with this component strongly associated with caries (multivariable incidence rate ratio of caries 0.48; 95% confidence interval: 0.38‐0.61, comparing the extreme quintiles of the first principal component). Conclusions: A diet high in sugar or refined starch was strongly linked to caries. Policies to reduce sugar and refined starch intake should be considered. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to identify behaviours and cues that nurses recognise as indications of unsafe practice, perceived factors that contribute to unsafe practice and actions nurses take in response. Design: Cross‐sectional survey. Methods: National cross‐sectional survey of a random sample of registered nurses (n = 231) in New Zealand, in 2017–2018. The STROBE Checklist was used to report this study. Results: Nurses reported a high rate of episodes of unsafe practices and recognised a range of behaviours and cues that alerted them to the potential for unsafe practice. Several organisational issues were perceived to contribute to unsafe practice occurring. The reporting of episodes of unsafe practice and perceived organisational support was low for nurses compared with managers. Conclusion: Failure to recognise and respond to unsafe practice may indicate a tolerance for substandard practice by individual nurses, or by the organisation. Nurses who recognise unsafe practice must be supported by the organisation. [ABSTRACT FROM AUTHOR]

Background: The New Zealand government implemented restrictive public health interventions to eradicate Covid‐19. Early reports suggest that one downstream ramification is a change in trauma presentations. The aim of this study is to evaluate the effect these public health measures had on major trauma admissions in the Northern Region, New Zealand. Methods: A retrospective comparative cohort study was performed. Two cohorts were identified: 16 March to 8 June 2020 and the same period in 2019. Data was extracted from the New Zealand Major Trauma Registry which prospectively collects data on all major trauma in New Zealand. All patients who presented to a hospital in the Northern Region with major trauma and met the Registry inclusion criteria were included. Results: There were 163 major trauma admissions in 2019 and 123 in 2020, a reduction of 25% (rate ratio 0.75, 95% confidence interval 0.6–0.95; P = 0.018). There was no significant difference in mechanism of injury (P = 0.442), type of injury (P = 0.062) or intent of injury (P = 0.971). There was a significant difference in place of injury (P = 0.004) with 20% of injuries happening at home in 2019 compared with 35% in 2020. Conclusion: This study has shown that public health interventions to prevent the spread of COVID‐19 reduced major trauma admissions in the Northern Region of New Zealand. There was a variation in effect a between institutions within the region and a change in pattern of injury. [ABSTRACT FROM AUTHOR]

Aim: Over the past decade, paradoxes have emerged in the skin cancer prevention and sunburn reduction literature. These include that individuals with higher sun protection knowledge; lower positive attitudes towards tanning; and who are users of sunscreen have higher odds of sunburn. It is also possible that sunburn paradoxes may be associated with those whose sunburn was unintended. New Zealand and Australia have, by far, the highest age standardised incidence rates of melanoma skin cancer in the world, and this study examines the extent to which sunburn and unintended sunburn is associated with the sunburn paradox variables. Method: Sun Exposure Survey data New Zealanders aged 15 + years were gathered by the New Zealand Health Promotion Agency in 2016. Results: Linkages were examined between sunburn, unintended sunburn and the paradox variables: sun protection knowledge, attitudes towards tanning and use of sunscreen. Sunburn was associated with higher respondent sun protection knowledge. No statistically significant associations were found between unintended sunburn and the paradox variables. Conclusion: This research indicates that in a well-designed study of a sample representative of the New Zealand population, the sun protection knowledge sunburn paradox still exists. Despite a high level of sun protection knowledge, many people still become sunburned. Therefore, it is important to examine this paradox further in order to find ways to reduce sunburn frequency among New Zealanders. Potential ways to reduce sunburn are discussed. [ABSTRACT FROM AUTHOR]

Objectives: Stress experienced by mothers during the prenatal period can have negative impacts on offspring development. Elevated BMI in childhood in response to early stress experience is a particularly critical outcome of interest since high BMI in childhood is associated with diabetes, heart disease and stroke in later life. The primary objective of this study was to analyze pathways between prenatal stress and early childhood BMI at 54-months of age and to begin to explore ethnic variations in these pathways. Methods: This study used the Growing Up in New Zealand (GUiNZ) dataset, which is a longitudinal, representative birth cohort study that began with recruiting pregnant women in 2009 and 2010 in Auckland, New Zealand. Path analysis modeling was used to explore risk and protective pathways between prenatal maternal stress and early childhood body mass index (BMI) at 54-months of age and differences by ethnicity (n = 5510). Results: Prenatal stress was positively associated with early childhood BMI at 54-months and maternal nutrition behaviors and length of exclusive breastfeeding mediated this direct relationship (χ2 (1) = 0.83, p = 0.36; AIC = 50,496). Mediation and moderation paths varied by ethnicity. Conclusions for Practice: These findings contribute to the understanding of the intergenerational transmission of stress with respect to early childhood obesity. Reducing early stress exposure and/or addressing mediating and moderating factors linking stress experience with obesity development may prove to be more effective than attempting to alter health behaviors and trajectories in adulthood. [ABSTRACT FROM AUTHOR]

Caloric restriction occurs when athletes attempt to reduce body fat or make weight. There is evidence that protein needs increase when athletes restrict calories or have low body fat. Purpose: The aims of this review were to evaluate the effects of dietary protein on body composition in energy-restricted resistance-trained athletes and to provide protein recommendations for these athletes. Methods: Database searches were performed from earliest record to July 2013 using the terms protein, and intake, or diet, and weight, or train, or restrict, or energy, or strength, and athlete. Studies (N = 6) needed to use adult (≥ 18 yrs), energy-restricted, resistance-trained (> 6 months) humans of lower body fat (males ≤ 23% and females ≤ 35%) performing resistance training. Protein intake, fat free mass (FFM) and body fat had to be reported. Results: Body fat percentage decreased (0.5-6.6%) in all study groups (N = 13) and FFM decreased (0.3-2.7kg) in nine of 13. Six groups gained, did not lose, or lost nonsignificant amounts of FFM. Five out of these six groups were among the highest in body fat, lowest in caloric restriction, or underwent novel resistance training stimuli. However, the one group that was not high in body fat that underwent substantial caloric restriction, without novel training stimuli, consumed the highest protein intake out of all the groups in this review (2.5-2.6g/kg). Conclusions: Protein needs for energy-restricted resistance-trained athletes are likely 2.3-3.1g/kg of FFM scaled upwards with severity of caloric restriction and leanness. [ABSTRACT FROM AUTHOR]

Purpose: Purpose in life and capabilities are two significant individual elements that enhance quality of life among older people. Capabilities refers to the extent to which older people are free to make choices that are important to them. At present, it is not known how purpose in life interacts with capabilities to influence quality of life for those living with a disability. This study examined the extent to which purpose in life and capabilities interacts with health status to affect quality of life, particularly for older people with a disability. Methods: Self-report data from participants in a longitudinal cohort study of older New Zealanders were analyzed. Responses from 452 older people with a disability were compared with 3299 age- and gender-matched older people without a disability on indicators related to health and aging. The associations were tested using hierarchical regression. Mediational impact of purpose in life and capabilities were tested via path analysis. Results: Mental health, physical health, purpose in life, and capabilities accounted for a significant amount of variance in quality of life for older people with a disability. Purpose in life and capabilities were significant unique mediators for older people with a disability. Conclusions: Purpose in life may help older people with a disability to deal with early onset stressors or changes in mental and physical health to maintain overall quality of life. The role of capabilities suggests that the social environment and access to resources and choices are important in ensuring that older people aging with or into a disability achieve quality of life in a socially just environment. Purpose in life and capability are unique mediators of the relationship between health status and quality of life. Purpose in life may act as an effective buffering mechanism to deal with disability in later life while capability can empower older people with a disability to achieve quality of life in a just environment. The notion of successful aging with disability should be re-defined as using psychological, social support, and healthcare resources to live a life consistent with personal values in the context of disability Rather than emphasizing structural factors and physical functioning in activity participation, older people with disability should be supported to decide and pursue their own preferences. Rehabilitation professionals can work flexibly with older people with disability to maximize their resilience, dignity, autonomy and choice, and positive connection to others. [ABSTRACT FROM AUTHOR]

Background: Netball is estimated to be played by more than 20 million people worldwide, but there is evidence of high injury incidence. A thorough understanding of the types and rates of netball injuries is essential for effective injury management and prevention strategies to be developed and implemented. This systematic review summarises the published findings with respect to injury types, participant characteristics and any identified risk factors for netball injuries. Methods: A librarian-assisted computer search of seven scientific databases was conducted for studies reporting on netball injuries. Inclusion criteria were studies published in English, in peer-reviewed journals, which reported data on injuries and variables (e.g. age and competition level) that have been proposed as possibly associated with netball injury risk. Results: Forty-six studies (43.5% prospective, 37% hospital/insurance records, 19.5% retrospective) from 45 articles were included after screening. The majority of studies (74%) were conducted in Australia or New Zealand. There was little consistency in the definition of 'injury'. Elite or sub-elite level players were included in 69% of studies where the level of competition was reported. The duration of injury surveillance was generally related to the format of competition from which data were collected. Self-report questionnaires were used in 48% of studies and only 26% of studies used qualified health professionals to collect data courtside. Injuries to the ankle and knee were the most common (in 19 studies) although the incidence varied considerably across the studies (ankle 13–84% and knee 8–50% of injuries). Prevention of ankle and knee injuries should be a priority. Children sustained more upper limb injuries (e.g. fractures) compared with adults who sustained more lower limb injuries (e.g. ankle and knee sprains/strains). A large number of potential risk factors for injury in netball have been investigated in small numbers of studies. The main circumstances of injury are landings, collisions and falls. Conclusion: Further studies should be directed towards recreational netball, reporting on injury incidence in players by age and utilising high-quality, standardised methods and criteria. Specific injury diagnosis and a better understanding of the circumstances and mechanisms of injury would provide more meaningful data for developing prevention strategies. [ABSTRACT FROM AUTHOR]

Single nucleotide polymorphisms and pre‐ and peri‐conception folic acid (FA) supplementation and dietary data were used to identify one‐carbon metabolic factors associated with pregnancy outcomes in 3196 nulliparous women. In 325 participants, we also measured circulating folate, vitamin B12 and homocysteine. Pregnancy outcomes included preeclampsia (PE), gestational hypertension (GHT), small for gestational age (SGA), spontaneous preterm birth (sPTB) and gestational diabetes mellitus (GDM). Study findings show that maternal genotype MTHFR A1298C(CC) was associated with increased risk for PE, whereas TCN2 C766G(GG) had a reduced risk for sPTB. Paternal MTHFR A1298C(CC) and MTHFD1 G1958A(AA) genotypes were associated with reduced risk for sPTB, whereas MTHFR C677T(CT) genotype had an increased risk for GHT. FA supplementation was associated with higher serum folate and vitamin B12 concentrations, reduced uterine artery resistance index and increased birth weight. Women who supplemented with <800 μg daily FA at 15‐week gestation had a higher incidence of PE (10.3%) compared with women who did not supplement (6.1%) or who supplemented with ≥800 μg (5.4%) (P <.0001). Higher serum folate levels were found in women who later developed GDM compared with women with uncomplicated pregnancies (Mean ± SD: 37.6 ± 8 nmol L−1 vs. 31.9 ± 11.2, P =.007). Fast food consumption was associated with increased risk for developing GDM, whereas low consumption of green leafy vegetables and fruit were independent risk factors for SGA and GDM and sPTB and SGA, respectively. In conclusion, maternal and paternal genotypes, together with maternal circulating folate and homocysteine concentrations, and pre‐ and early‐pregnancy dietary factors, are independent risk factors for pregnancy complications. [ABSTRACT FROM AUTHOR]

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The study aimed to investigate the association between caregiver experiences of racial discrimination and physical and emotional health outcomes for their children and to explore potential pathway variables in this relation. We analysed data from two instances of the New Zealand Health Survey that provide nationally representative data for children and adults, with high response rates for each of the major ethnic groupings (Indigenous Māori, Pacific, Asian, and European/Other). Questionnaires from the primary caregiver and their child (5 to 14 years) were linked to create n = 2,958 child-primary caregiver dyads in the 2006/07 Survey and n = 2,632 dyads in the 2011/12 Survey. Children whose caregivers reported any experience of racial discrimination had poorer mental health, self-esteem, and behaviour scores on the CHQ PF-28 scale, even after adjustment for caregiver sociodemographic variables. Multivariable models identified a worsening in child emotional health as the number of reported racism experiences increased. Caregiver experiences of racism were not associated with medicated asthma in their children. Multivariable models suggest that caregiver psychological distress may be a pathway linking vicarious racism to poorer child emotional health. [ABSTRACT FROM AUTHOR]

Background: While there is a global focus on severe maternal morbidity (SMM), less is known about the impact of SMM on fetal and neonatal outcomes. Aims: To examine fetal/neonatal outcomes associated with SMM. Materials and Methods: A national New Zealand (NZ) retrospective cohort study describing fetal/neonatal outcomes of all women with SMM admitted to a NZ Intensive Care Unit (ICU) or High Dependency Unit (HDU) in 2014. Adverse fetal/neonatal outcomes were defined as one or more of the following: fetal or early neonatal death, hypoxic ischaemic encephalopathy, Apgar score less than seven at five minutes, admission to Neonatal Intensive Care Unit or Special Care Baby Unit. Results: There were 400 women with SMM admitted to NZ ICU/HDU units in 2014, and 395 (98.8%) had complete birth/pregnancy outcome information. Of these, 49.4% (195/395) were associated with an adverse fetal/neonatal outcome. Indigenous Māori women had a 30% higher rate of adverse fetal/neonatal outcome compared to NZ European women (63.7% and 48.9% respectively; relative risk = 1.30, 95% CI 1.04–1.64). Pre‐eclampsia was associated with an adverse fetal/neonatal outcome in 67% (81/120). Perinatal‐related mortality rate was 53.1 per 1000 total births compared to NZ perinatal mortality of 11.2 per 1000 total births for 2014. Conclusion: SMM events are associated with high rates of adverse fetal/neonatal outcomes with a higher burden of adverse events for Māori. Further research is needed to explore opportunities in maternal and neonatal care pathways to improve fetal/neonatal outcomes and address inequities. [ABSTRACT FROM AUTHOR]

Introduction: New Zealand's Alcohol Licencing Trusts (ALTs) are community-owned entities that sell alcohol in their districts and return profits back to the local community. Aim: To investigate support for applying the ALT model to regulate legal cannabis. Method: An online survey asked people living in two ALT districts to rate their support for applying the ALT model to legal cannabis; 2,379 people completed the survey. Logistic regression models were fitted to identify predictors of support for applying the ALT model to cannabis. Results: Thirty-nine per cent supported the ALT model for legal cannabis. Reasons for support included: the trust's donations to the community (53%), potential to restrict cannabis sales (43%), controlling the cannabis industry (43%), and better than the current prohibition (42%). Support for the existing ALT (OR = 8.86), recent history of cannabis use (OR = 1.42), younger age (OR = 1.02) and not being in employment (OR = 1.46) predicted support for the model for cannabis. Cannabis users were more likely to support the trust model on pragmatic grounds ('better than prohibition') while non-users valued the model's capacity to responsibly regulate sales and the cannabis industry. Discussion: The ALT model can offer a middle-ground approach that attracts support from cannabis users and non-users, albeit on different grounds. [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]

INTRODUCTION: Mass masking is emerging as a key non-pharmaceutical intervention for reducing community spread of COVID-19. However, although hand washing, social distancing and bubble living have been widely adopted by the 'team of 5 million', mass masking has not been socialised to the general population. AIM: To identify factors associated with face masking in New Zealand during COVID-19 Alert Level 4 lockdown to inform strategies to socialise and support mass masking. METHODS: A quantitative online survey conducted in New Zealand during April 2020 invited residents aged ≥18 years to complete a questionnaire. Questions about face masking were included in the survey. The sample was drawn from a commissioned research panel survey, with boosted sampling for Māori and Pacific participants. Responses were weighted to reflect the New Zealand population for all analyses. RESULTS: A total of 1015 individuals participated. Self-reported beliefs were strongly related to behaviours, with respondents viewing face masking measures as 'somewhat' or 'very' effective in preventing them from contracting COVID-19 more likely to report having worn a face mask than respondents who viewed them as 'not at all' effective. The strongest barriers to face mask use included beliefs that there was a mask shortage and that the needs of others were greater than their own. DISCUSSION: Highlighting the efficacy of and dispelling myths about the relative efficacy of mask types and socialising people to the purpose of mass masking will contribute to community protective actions of mask wearing in the New Zealand response to COVID-19. [ABSTRACT FROM AUTHOR]

Background: Management of children with minor blunt head trauma often includes a period of observation to determine the need for cranial computed tomography (CT). Our objective was to estimate the effect of planned observation on CT use for each Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) risk group among children with minor head trauma. Methods: This was a secondary analysis of a prospective observational study at 10 emergency departments (EDs) in Australia and New Zealand, including 18,471 children < 18 years old, presenting within 24 hours of blunt head trauma, with Glasgow Coma Scale scores of 14 to 15. The planned observation cohort was defined by those with planned observation and no immediate plan for cranial CT. The comparison cohort included the rest of the patients who were either not observed or for whom a decision to obtain a cranial CT was made immediately after ED assessment. The outcome clinically important TBI (ciTBI) was defined as death due to head trauma, neurosurgery, intubation for > 24 hours for head trauma, or hospitalization for ≥ 2 nights in association with a positive cranial CT scan. We estimated the odds of cranial CT use with planned observation, adjusting for patient characteristics, PECARN TBI risk group, history of seizure, time from injury, and hospital clustering, using a generalized linear model with mixed effects. Results: The cranial CT rate in the total cohort was 8.6%, and 0.8% had ciTBI. The planned observation group had 4,945 (27%) children compared to 13,526 (73%) in the no planned observation group. Cranial CT use was significantly lower with planned observation (adjusted odds ratio [OR] = 0.2, 95% confidence interval [CI] = 0.1 to 0.1), with no difference in missed ciTBI rates. There was no difference in the odds of cranial CT use with planned observation for the group at very low risk for ciTBI (adjusted OR = 0.9, 95% CI = 0.5 to 1.4). Planned observation was associated with significantly lower cranial CT use in patients at intermediate risk (adjusted OR = 0.2, 95% CI = 0.2 to 0.3) and high risk (adjusted OR = 0.1, 95% CI = 0.0 to 0.1) for ciTBI. Conclusions: Even in a setting with low overall cranial CT rates in children with minor head trauma, planned observation was associated with decreased cranial CT use. This strategy can be safely implemented on selected patients in the PECARN intermediate‐ and higher‐risk groups for ciTBI. [ABSTRACT FROM AUTHOR]

Background: Infectious diseases (ID) physicians perform a pivotal role in directing the response to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Aim: To assess the impact of SARS‐CoV‐2 on workload and the perceptions of ID physicians regarding the national response in Australia and New Zealand in the pre‐pandemic. Methods: A survey of ID physicians in Australia and New Zealand was undertaken from 3 to 10 March 2020. Respondents were asked to estimate time spent on SARS‐CoV‐2‐related activities in February and report their agreement with statements on a 5‐point Likert scale ranging from 'strongly agree' to 'strongly disagree'. We also asked about the intended use of investigational agents. Results: There were 214 respondents (36% of 600 eligible participants). The median workload due to SARS‐CoV‐2‐related activities was 34% of one full‐time equivalent (interquartile range 18–68%). Less than a quarter (50, 23%) of respondents had experience managing cases, while 33% (70) had experience preparing during similar pandemics. Nevertheless, 88% (188/213) believed they were well informed when giving testing and management advice, and 45% (95/212) believed their national response was well coordinated. Additionally, 41% (88/214) were worried about becoming infected through occupational exposure. Over half (116, 54%) the respondents intended to use lopinavir/ritonavir in confirmed cases of COVID‐19 with severe disease. Conclusions: ID physicians spent a large proportion of time on SARS‐CoV‐2‐related activities. Increased staffing is required to avoid burnout. Importantly, ID physicians feel well informed when giving advice. A national body should be established to co‐ordinate response. Treatment efficacy trials are needed to clarify the utility of unproven treatments. [ABSTRACT FROM AUTHOR]

Reducing children's exposure to unhealthy food advertising is an accepted strategy to end childhood obesity. This study aimed to (i) measure children's space-time exposures to unhealthy food advertising in public outdoor spaces, using GPS and wearable cameras; and (ii) test effectiveness of banning options. We compiled data (collected July 2014—June 2015) on 138 12-year-old children in Wellington, New Zealand, using wearable cameras and GPS devices worn over 4 days. In 2017–18, we linked 59 150 images taken in public outdoor spaces to GPS data. Of these, 1631 contained unhealthy food advertising exposures, defined as ≥50% of an advertisement observed in each image. We examined spatial patterns using kernel density mapping and graphed space-time trends. We interpolated a kriged exposure rate across Wellington to estimate exposure reductions for potential bans. Children were exposed to 7.4 (95% CI 7.0–7.8) unhealthy food advertisements/hour spent in outdoor public spaces. Exposures occurred in shopping centres, residential areas and sports facilities, commonly involving fast food, sugary drinks and ice cream. Peak exposure times were weekend afternoons/evenings and weekdays before/after school. In Wellington, we estimated that banning such advertising within 400 m of playgrounds would yield a 33% reduction in exposure, followed by in residential areas (27%), within 400 m of schools (25%), and 50% for a ban combining all above. This work documents the extent of children's exposure to unhealthy food advertising and the potential impact of bans. Given the ubiquity of advertising in public spaces, this New Zealand research offers innovative methods and findings likely relevant in other jurisdictions. [ABSTRACT FROM AUTHOR]

Objective: Cardiovascular disease is the leading cause of death in breast cancer survivors. While evidence shows circuit resistance training (CRT) is effective for improving muscle and cardiorespiratory fitness, whether CRT is an efficacious therapy for decreasing cardiovascular risk in cancer survivors is unclear. Methods: Fifty‐one breast cancer survivors were recruited to either 12 weeks CRT (n = 26), or a non‐exercising wait‐list control (n = 25). Two supervised 60 min CRT sessions per week were undertaken, comprising resistance and functional exercises, and aerobic exercise stations. Primary outcome measure was the gold‐standard assessment of arterial stiffness, aortic pulse wave velocity (PWV). Secondary outcomes included: cardiorespiratory fitness (CRF), upper and lower body strength, arterial wave reflections, central blood pressure and rate pressure product. Results: Compared to the control group, the CRT group had a statistically significant medium effect decrease in PWV 0.9 m/s (95% CI: 0.1, 1.7). There were large effect improvements in VO2max (4.3 ml kg−1 min−1, 95% CI: 5.8, 2.8), upper and lower body strength (3.7 kg, 95% CI: 1.9, 5.6 and 10.4 kg, 1.6, 19.1) respectively. Conclusion: Findings support the existing literature demonstrating that 12 weeks CRT improves muscle and cardiorespiratory fitness and is also an effective strategy for decreasing a proven cardiovascular risk factor in breast cancer survivors. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Intercalated degrees are one of the most focused undergraduate research training activities offered to medical students worldwide. The effect of intercalating on actual career choices has not been previously investigated. AIM: To examine the effect of obtaining an intercalated research degree on choosing general practice as a career. METHODS: This was a retrospective, matched cohort study of intercalating students at the University of Otago, New Zealand (1995–2008). Medical students who completed the intercalated Bachelor of Medical Sciences with Honours, BMedSc(Hons), degree were retrospectively identified. Gender- and graduation year-matched controls were identified from a publicly available graduate database in a 1:1 ratio. MEDLINE® and Google Scholar-indexed publications resulting from BMedSc(Hons) projects were determined using standardised search criteria. Speciality choice was obtained from online lists of registered doctors. RESULTS: Over the 14-year period, 99 (3.9%) students completed an intercalated degree with a publication rate of 36.4%. Of these, 42 (42.4%) were female and over two-thirds (68.7%) of projects were laboratory-based. The median follow-up period after graduation was 14 years (range 7.7–21.7 years). The congruence between students' BMedSc(Hons) research subject area and clinical speciality was 9.1%. Sixteen (16.2%) intercalating students chose general practice as a career, whereas 83 (83.8%) chose 19 different hospital-based specialties. Compared to controls, students who completed an intercalated degree were significantly less likely to pursue a career in general practice (odds ratio 0.37; 95% confidence interval = 0.18 – 0.77; P = 0.007). DISCUSSION: The present study findings suggest that completing an intercalated degree is associated with lower odds of pursuing a career in general practice. Future research should explore reasons for this observation to help develop strategies to promote primary care and general practice careers among medical graduates, including those interested in research careers. [ABSTRACT FROM AUTHOR]

Background To achieve the World Health Organization hepatitis C virus (HCV) elimination targets, it is essential to increase access to direct-acting antivirals (DAAs), especially among people who inject drugs (PWID). We aimed to determine the effectiveness of providing DAAs in primary care, compared with hospital-based specialist care. Methods We randomized PWID with HCV attending primary care sites in Australia or New Zealand to receive DAAs at their primary care site or local hospital (standard of care [SOC]). The primary outcome was to determine whether people treated in primary care had a noninferior rate of sustained virologic response at Week 12 (SVR12), compared to historical controls (consistent with DAA trials at the time of the study design); secondary outcomes included comparisons of treatment initiation, SVR12 rates, and the care cascade by study arm. Results We recruited 140 participants and randomized 136: 70 to the primary care arm and 66 to the SOC arm. The SVR12 rate (100%, 95% confidence interval [CI] 87.7–100) of people treated in primary care was noninferior when compared to historical controls (85% assumed). An intention-to-treat analysis revealed that the proportion of participants commencing treatment in the primary care arm (75%, 43/57) was significantly higher than in the SOC arm (34%, 18/53; P <.001; relative risk [RR] 2.48, 95% CI 1.54–3.95), and the proportion of participants with SVR12 was significantly higher in the primary care arm, compared to in the SOC arm (49% [28/57] and 30% [16/53], respectively; P =.043; RR 1.63, 95% CI 1.0–2.65). Conclusions Providing HCV treatment in primary care increases treatment uptake and cure rates. Approaches that increase treatment uptake among PWID will accelerate elimination strategies. Clinical Trials Registration NCT02555475. [ABSTRACT FROM AUTHOR]

Background: The current work examined experiences of Health-Related Quality of Life (HRQOL) among older adults with a diagnosis of Diabetes Mellitus (DM) over time compared to those without a diagnoses DM. Methods: The sample was drawn from six biennial waves of the New Zealand Health, Work and Retirement survey, a prospective population-based cohort study of older adults 55–70 years at baseline. Data on sociodemographic factors, health behaviours, chronic disease diagnoses and physical and mental HRQOL (SF-12v2) were obtained using six biennial surveys administered 2006–2016. Generalised Estimating Equation models, adjusted for time-constant and -varying factors, were employed to compare HRQOL and its determinants over time for older adults with and without a diagnosis of DM. Results: DM was negatively associated with physical HRQOL [β (95% CI) − 7.43 (− 8.41, − 6.44)] with older adults affected by DM reporting scores 7.4 points lower than those without DM. Similarly, the mean Mental HRQOL score was lower among those affected by DM [β = − 4.97 (− 5.93, − 4.01)] however, scores increased over time for both groups (p < 0.001). Greater age, more chronic conditions, sight and sleep problems, obesity, lower annual income, and fewer years of education were predictors of poorer HRQOL among older adults. Conclusions: Older adults affected by diabetes experienced poorer physical and mental HRQOL compared to those not affected when controlling for a range of sociodemographic and health related indices. A management aim must be to minimise the gap between two groups, particularly as people age. [ABSTRACT FROM AUTHOR]

Introduction: Evaluating how therapeutic horse riding improves health for children experiencing disability is made complex by a lack of clarity around mechanisms of treatment effect. This research develops an explanatory theory outlining how health outcomes may be optimised, by exploring what works for which riders, under what conditions and how. Method: Within a realist research framework, we undertook three phases of study using a mix of qualitative and quantitative data collection and analysis approaches. Findings were then integrated into an overall evaluative account. Results: Riders with a range of impairments (n = 32; aged 5 to 17 years), caregivers (n = 29) and therapeutic horse riding providers (n = 16) participated. Three key mechanisms of intervention effect are proposed: (1) therapeutic horse riding facilitates development of a rider's self-concept through opportunities for accessible, meaningful participation; (2) the context in which therapeutic horse riding is provided promotes a focus on riders' capacities and strengths and (3) therapeutic horse riding provides opportunities for a broad range of learning experiences. Conclusion: Therapeutic horse riding provides opportunities for meaningful occupational participation for children experiencing disability. Ensuring that the physical and ideological context in which therapeutic horse riding is provided focuses on a rider's capacities and strengths will enhance self-concept development and participation outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The present study investigated the impact of introducing C‐MAC videolaryngoscopy as the standard method of visualising glottic structures on first‐pass intubation success of emergency medicine (EM) registrars in a large tertiary academic hospital in New Zealand. Methods: In this retrospective cohort study, all patients receiving attempted orotracheal intubation in Auckland City Hospital ED 1 year prior to and 1 year after the introduction of C‐MAC videolaryngoscopy were compared. The primary outcome was first‐pass intubation success rates by EM registrars. Secondary outcomes were first‐pass success rates by all intubators, and incidence of any complication of intubation. Results: There were 163 intubations by EM registrars from June 2015 to August 2017. There was a clinically important and statistically significant improvement in first‐pass success from 59.2% (95% confidence interval [CI] 44.1–68.8%) to 85.1% (95% CI 76.0–91.2%, P < 0.001) after the introduction of C‐MAC. In multivariate analysis, the independent predictors of success were: Airway Not Predicted Difficult, odds ratio (OR) 2.49 (95% CI 1.06–5.85, P = 0.037); and use of videolaryngoscope, OR 4.49 (95% CI 1.85–10.91, P = 0.001). Overall, complications of intubation improved significantly after introduction of C‐MAC (28.9%, 95% CI 19.9–40.0% prior to C‐MAC introduction; 16.1%, 95% CI 9.7–25.3% after; P = 0.048). Conclusion: This is the first published study specifically addressing EM registrar intubation success rates in New Zealand, adding to the existing body of data suggesting that videolaryngoscopy may improve success rates for novice intubators. [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]

Objective: The study investigated: (1) the effect of combining web-based patient education (WBPE) with action and coping plans on patients' adherence to physiotherapy and their subsequent functional outcomes; and (2) the participants' satisfaction with the WBPE program. Methods: One hundred and eight participants enrolled in this 8-week two group randomized controlled trial. They were allocated to either the WBPE planning group or the attention-control group. The WBPE group made action and coping plans and were familiarized with their web-based program. The attention control group was given access to a web-based neutral information program about shoulder injuries and physiotherapy rehabilitation. Throughout the 8-week study physiotherapists measured the participants' clinic-based adherence and participants recorded their home-based adherence using a self-report diary. Functional outcomes for all participants were measured at the beginning and end of the study. Participants provided feedback about their respective websites. Results: The intervention group had a significantly higher clinic based adherence than the control group (p < 0.04). Both groups had a significant improvement in shoulder function but there was no significant difference between them. Participants in the intervention group were highly satisfied with the WBPE program. The preferred delivery of physiotherapy by 87% of the intervention group was a combination of face-to-face appointments and WBPE. Control participants indicated that they would have appreciated information about shoulder exercises and the shoulder complex in their program. Discussion: The WBPE program was an effective adjunct to physiotherapy in terms of patient satisfaction and clinic-based treatment adherence. [ABSTRACT FROM AUTHOR]

Background: Providing effective shade in playgrounds may reduce children's risk of sunburn, skin cancer, and heat stress, and increase play times. We aimed to determine the sufficiency of playground shade in New Zealand, a country with high skin cancer rates but limited research on regional shade practices. Methods: A random sample of one playground per 10,000 population was selected from each territorial local authority (TLA), for a total of 559 playgrounds. Google Earth satellite and Street View images were used to estimate the amount of shade (trees or built structures) covering playground activity areas at solar noon on the summer solstice. Results: Most playgrounds (60%) had no shade over play equipment, seats, and tables. Playgrounds from more deprived areas were 43% less likely to have at least one source of shade (odds ratio = 0.57; 95% CI: 0.35–0.94). Shade sufficiency varied considerably between council regions, with the best shading practice observed in Waikato, Whangarei, and Wairarapa. Conclusions: The findings support policy efforts to increase shade nationwide. Establishing minimum standards for playground shade and showcasing successful efforts to date may help encourage TLAs with less shade to improve. Moreover, the display of sun safety signage may help promote sun protection behaviour among playground visitors. [ABSTRACT FROM AUTHOR]

Objective: To understand the challenges managing medication use and knowledge of people living with multimorbidity. Methods: A cross‐sectional survey of 234 adults with multimorbidity, identified using retrospective hospital discharge data. Participants were recruited from two primary health organisations in New Zealand. Results: Three quarters of participants (75%) were prescribed four or more medications, and one in four (27%) were prescribed eight or more medications. Participants reported knowing what their medications were for (88%, 95% CI 81.4–93.8) and when to take them (99%, 95% CI 97.5–99.9). However, over a fifth (22%, 95% CI 13.7–30.4) reported some problems managing multiple medications, and 40% (95% CI 30.2–50.2) reported a problem with side effects. Conclusion: The results highlight the need to consider how prescribing can be adapted for people with multimorbidity and move beyond the application of multiple disease‐specific guidelines. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to quantify the proportion of patients undergoing rapid sequence intubation using ketamine in Australian and New Zealand EDs between 2010 and 2015. Methods: The Australian and New Zealand Emergency Department Airway Registry is a multicentre airway registry prospectively capturing data from 43 sites. Data on demographics and physiology, the attending staff and indication for intubation were recorded. The primary outcome was the annual percentage of patients intubated with ketamine. A logistic regression analysis was conducted to evaluate the factors associated with ketamine use. Results: A total of 4658 patients met inclusion criteria. The annual incidence of ketamine use increased from 5% to 28% over the study period (P < 0.0001). In the logistic regression analysis, the presence of an emergency physician as a team leader was the strongest predictor of ketamine use (odds ratio [OR] 1.83, 95% confidence interval [CI] 1.44–2.34). The OR for an increase in one point on the Glasgow Coma Scale was 1.10 (95% CI 1.07–1.12), whereas an increase of 1 mmHg of systolic blood pressure had an OR of 0.98 (95% CI 0.98–0.99). Intubation occurring in a major referral hospital had an OR of 0.68 (95% CI 0.56–0.82), while trauma conferred an OR of 1.38 (95% CI 1.25–1.53). Conclusions: Ketamine use increased between 2010 and 2015. Lower systolic blood pressure, the presence of an emergency medicine team leader, trauma and a higher Glasgow Coma Scale were associated with increased odds of ketamine use. Intubation occurring in a major referral centre was associated with lower odds of ketamine use. [ABSTRACT FROM AUTHOR]

Background It is unclear if haemodiafiltration improves patient survival compared with standard haemodialysis. Observational studies have tended to show benefit with haemodiafiltration, while meta-analyses have not provided definitive proof of superiority. Methods Using data from the Australia and New Zealand Dialysis and Transplant Registry, this binational inception cohort study compared all adult patients who commenced haemodialysis in Australia and New Zealand between 2000 and 2014. The primary outcome was all-cause mortality. Cardiovascular mortality was the secondary outcome. Outcomes were measured from the first haemodialysis treatment and were examined using multivariable Cox regression analyses. Patients were censored at permanent discontinuation of haemodialysis or at 31 December 2014. Analyses were stratified by country. Results The study included 26 961 patients (4110 haemodiafiltration, 22 851 standard haemodialysis; 22 774 Australia, 4187 New Zealand) with a median follow-up of 5.31 (interquartile range 2.87–8.36) years. Median age was 62 years, 61% were male, 71% were Caucasian. Compared with standard haemodialysis, haemodiafiltration was associated with a significantly lower risk of all-cause mortality [adjusted hazard ratio (HR) for Australia 0.79, 95% confidence interval (95% CI) 0.72–0.87; adjusted HR for New Zealand 0.88, 95% CI 0.78–1.00]. In Australian patients, there was also an association between haemodiafiltration and reduced cardiovascular mortality (adjusted HR 0.78, 95% CI 0.64–0.95). Conclusion Haemodiafiltration was associated with superior survival across patient subgroups of age, sex and comorbidity. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the prevalence of hearing loss and ear problems in Pacific children, and investigate current and past demographic, health and social factors potentially associated with hearing and ear problems. Design: A cross-sectional observational study design nested within a birth cohort was employed. Study sample: Nine-hundred-twenty Pacific children aged 11 years were audiologically assessed. Using average hearing thresholds at 500, 1k and 2k Hz, 162 (18%) right and 197 (21%) left ears had ≥20 dB hearing loss. Hearing loss was mild (20-39 dB) in most cases; 2% of ears had moderate to moderate-severe (40-69 dB) hearing loss. However, only 101 (11%) children had normal peripheral hearing defined by passing hearing threshold, tympanogram and distortion product otoacoustic emission assessments. Those with confirmed middle ear disease at age 2 years had significantly increased odds of a non-Type A tympanogram (adjusted odds ratio: 2.00; 95% confidence interval: 1.56, 2.50) when re-assessed at age 11 years. Conclusions: Hearing loss, abnormal tympanograms, and auditory processing difficulties were present in many Pacific children. Interventions are also urgently needed to mitigate the effect of the longstanding ear disease likely to be present for many Pacific children. [ABSTRACT FROM AUTHOR]

Healthcare support workers face challenging situations in their day‐to‐day work but may have minimal training on how to deal with such incidents. Although staff training is often recommended as an essential part of any comprehensive approach for preventing and managing workplace violence, there is paucity of evidence on the content and effectiveness of such training. This study aimed to evaluate the effect of an intervention (communication skills training) to reduce the experience of aggression for healthcare support workers. A two arm, cluster randomised, single‐blinded, controlled trial among healthcare support workers in nongovernmental organisations (NGOs) and District Health Boards (DHBs) in New Zealand was conducted. The trial was conducted across 14 NGOs and DHB in Otago, Southland, and Auckland regions of New Zealand. One hundred and twenty‐seven participants were randomised to one of two groups. Both the intervention (communication skills) and control condition (mindfulness) were group‐based, fully scripted, and structured training interventions that consisted of four once weekly workshops that were facilitated by one of two nonclinical facilitators. Measurements of perceived aggression, psychological well‐being, and distress and communication competence were taken pre‐, post‐, 3 months' post‐, and 6 months' postintervention. There was a significant drop in the rate of aggression over time with a mean score and standard deviation of 10.37 (9.169) at baseline dropping to 6.07 (6.923) for the Perception of Patient Aggression Scale‐New Zealand across both intervention and control. Equivalent results were noted with increased psychological well‐being and communication competence and decreased distress with both interventions. This was sustained at 6 months' follow‐up. However, the between groups effect did not demonstrate a statistically significant difference between the intervention and control groups. Both mindfulness and communication skills training can reduce the experience of aggression reported by healthcare support workers. [ABSTRACT FROM AUTHOR]