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In a university student survey on COVID-19 information assessment, 66% participants identified the falsehood of all misinformation statements and 66% provided web page URLs that are adequate in supporting statement accuracy assessment. The most cited web resources were government websites (43%) and media reports (30%). Those who identified misinformation falsehood were more likely to have higher GPA and liberal-leaning political views, and to implement evidence-based COVID prevention measures including mask-wearing and not self-medicating on (hydroxy-)chloroquine.

Summary Mental health issues, such as depression, are rising among young people, who may benefit from online depression-related information. However, the competencies required to search for health information on the Internet and evaluate it before use may be poor among this population. This research aimed to investigate how college students use the Internet for solving problems in realistic case scenarios relevant to depression and to understand whether various literature-indicated literacies and factors may predict effective utilization of relevant online resources. We designed a web-based questionnaire survey including four depression-related case scenarios. A total of 218 undergraduate students who were enrolled in a Northeastern public US university were invited to participate in the survey in 2016, with 192 completed responses being included in this analysis (response rate = 88%; the participants’ median age = 20; 79% female). Approximately half of the participants (47%) answered the depression-related questions in the case scenarios with 90% or higher accuracy. In a multiple linear regression model, prior depression knowledge and eHealth information literacy significantly predicted the effective use of online depression information. However, medical literacy and critical health literacy were not significant predictors. A few additional demographic and experience related factors were positively associated with the effective Internet use (e.g. female, non-Hispanic, psychology or health science major and prior experience with depression). These findings identify a need for college students to develop domain-specific knowledge and literacies in order to facilitate effective use of online information about depression.

Mental health issues such as depression are rising among young people, who may benefit from online depression related information. However, the competencies required to search for and evaluate health information on the Internet were reported as poor among this population. We designed a web-based questionnaire survey including four case scenarios to understand how college students use online depression information, and what competencies or factors may facilitate effective use of the online resources.

Atrial fibrillation (AF) is a major risk factor for ischaemic stroke and cardiovascular events. In New Zealand (NZ), Māori (indigenous New Zealanders) and Pacific people experience higher rates of AF compared with non-Māori/non-Pacific people.To describe a primary care population with AF in NZ. Stroke risk and medication adherence according to ethnicity are also detailed.Electronic medical records for adults (≥20 years, n = 135 840, including 19 918 Māori and 43 634 Pacific people) enrolled at 37 NZ general practices were analysed for AF diagnosis and associated medication prescription information.The overall prevalence of non-valvular AF (NVAF) in this population was 1.3% (1769), and increased with age (4.4% in people ≥55 years). Māori aged ≥55 years were more likely to be diagnosed with NVAF (7.3%) than Pacific (4.0%) and non-Māori/non-Pacific people (4.1%, P0.001). Māori and Pacific NVAF patients were diagnosed with AF 10 years earlier than non-Māori/non-Pacific patients (median age of diagnosis: Māori = 60 years, Pacific = 61 years, non-Māori/non-Pacific = 71 years, P0.001). Overall, 67% of NVAF patients were at high risk for stroke (CHAAF screening and stroke thromboprophylaxis in Māori and Pacific people could start below the age of 65 years in NZ.

To assess the level of agreement in aspirin use measured by self-report and dispensing data.We assessed preventive cardiovascular medication use (prescription-only statins and blood pressure-lowering therapy; and aspirin-also available over-the-counter) at baseline in participants in the New Zealand IMPACT trial for whom these medications were prescribed by their general practitioner. A trial nurse not involved in their ongoing health care obtained participants' self-reported aspirin use data. We obtained dispensing data from the national pharmaceutical dispensing database and assessed agreement between the two measures using kappa coefficients.Of the 513 trial participants, 36% were women, 50% were of Māori ethnicity, and 45% had a history of cardiovascular disease. The level of agreement between self-reported aspirin use and dispensing data was substantial (kappa 0.75, 95% CI 0.69 to 0.82). The level of agreement in aspirin use measured by these two sources of data was similar to that for statin and blood pressure-lowering therapy use, for all participants combined, for subgroups according to ethnicity (Māori and non-Māori) and history of cardiovascular disease.Despite its availability over-the-counter, aspirin use in patients for whom cardiovascular medications are indicated can be assessed accurately from dispensing data.

The burden of cardiovascular disease (CVD) among New Zealand (NZ) indigenous people (Māori) is well recognized. A major challenge to CVD risk management is to improve adherence to long-term medications.To elicit patients' and providers' perspectives on how to support Māori with high CVD risk and low medication adherence to achieve better adherence.Analysis of electronic health records (EHR) of four NZ general practices identified medication adherence status of Māori patients with high CVD risk (≥15%, 5-year). A random sample of these patients participated in focus group discussions on barriers to long-term medication adherence. Their primary care providers also participated in separate focus groups on the same topic.A range of factors are identified influencing adherence behaviour, including patient's medication knowledge, patient-doctor communication effectiveness and cost.Analysis of barriers to medication adherence in primary care suggests opportunities for health information technology to improve adherence, including patient education, decision support, clinician training and self-service facilities.

Diabetes is a common disease affecting 9% of the adult population worldwide. People with impaired glucose tolerance ('prediabetes') are at high risk of progressing to type 2 diabetes.To understand prediabetes incidence rate, we analysed the electronic medical records (EMR) from 14 New Zealand general practices regarding patients aged ≥20 years and enrolled with the practices between 2009 and 2012. Prediabetes incidence rate was calculated by the number of patients with an initial HbA1c of 41-49 mmol/mol in 2011 among those who had not been diagnosed or treated for diabetes.28,192 adults were included in the analysis, 11% of this cohort had diabetes before 2011. 1,276 new cases of prediabetes were identified in 2011, giving a 5.0% incidence rate. The relative risk (RR) for prediabetes was increased for the Māori and Pacific groups versus non-Māori/non-Pacific people, with RR of 1.97 in the younger age groups (lt;50 years) and RR of 1.42 in the 50+ group. The RR for having uncontrolled HbA1c (highest HbA1c in 2011 ≥65 mmol/mol) among the whole adult population was also increased for the Māori and Pacific groups versus non-Māori/non-Pacific people (RR=3.35 among thoselt;50 years, RR=4.35 in the 50+ group).EMR analysis identified an alarming incidence rate of prediabetes, especially among Māori and Pacific groups, highlighting the need to better prevent and manage the condition.

Skin and subcutaneous tissue infections (SSTI) are common conditions that cause avoidable hospitalisation in New Zealand. As part of a program to improve the management of SSTI in primary care, electronic medical records (EMR) of four Auckland general practices were analysed to identify SSTI occurrences in the last three years.An ontology for SSTI risks, manifestation and treatment was created based on literature and guidelines. An SSTI identification algorithm was developed examining EMR data for skin swab tests, diagnoses (READ codes) and textual clinical notes.High occurrence and recurrence rates in those aged 20 or younger were found. Due to low usage of READ coding and laboratory tests, 65% of SSTI occurrences were identified by notes. However, 91% of all identified SSTI occurrences were appropriately treated with oral/topical antibiotics according to prescription records in the EMR. The F1 score of the analysis algorithm is 0.76 using manual review as gold standard.The SSTI identification algorithm shows a reasonable accuracy suggesting the feasibility of automatic detecting SSTI occurrences using clinical data that are routinely collected in healthcare delivery.

Health literacy has been described as the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Improving health literacy may serve to promote concordance with therapy, engage patients in their own health care, and improve health outcomes. Patient portal technology aims at enabling patients and families to have easy access to key information in their own medical records and to communicate with their health care providers electronically. However, there is a gap in our understanding of how portals will improve patient outcome. The authors believe patient portal technology presents an opportunity to improve patient concordance with prescribed therapy, if adequate support is provided to equip patients (and family/carers) with the knowledge needed to utilise the health information available via the portals. Research is needed to understand what a health consumer will use patient portals for and how to support a user to realise the technology's potential.

INTRODUCTION: Maori are overrepresented in cardiovascular disease (CVD) mortality and morbidity statistics in New Zealand (NZ). AIM: To examine cardiovascular risk (CVR) assessment and management for Maori, utilising Caring Does Matter (CDM) initiative data. METHODS: Using 16 general practices? electronic medical records ? which include ethnicity data ? the rate of CVR screening, CVD medication treatment and adherence levels, and physiological measures for Maori patients at high CVR (=15% five-year risk of a cardiovascular event) were compared to findings for Pacific and non-Maori/non-Pacific patients. RESULTS: Records for 72 351 adults (10 358 Maori; 14%) showed that Maori patients have a poorer CVR assessment rate (46% at guideline-indicated age) than Pacific and non-Maori/non-Pacific groups; when assessed, a greater proportion of Maori patients (38%) were at high CVR. The proportion of high-CVR Maori patients being treated with oral antidiabetic medication (42%) was lower than for Pacific patients but higher than for non-Maori/non-Pacific patients. Lower rates of antihypertensive adherence were found for high-CVR Maori patients than for non-Maori/non-Pacific patients (although higher than for Pacific patients). The high-CVR Maori patients who adhered to CVD medications had lower blood pressure, total-to-HDL cholesterol ratio and HbA1c than non-adherers. DISCUSSION: The association between higher medication adherence and better control of risk factors suggests that adherence should be further promoted by clinicians. More active CVR assessment, treatment and support of medication adherence in Maori attending general practices is justified, given their high mortality rate from CVD in comparison to the overall NZ population. KEYWORDS: Antihypertensives; blood pressure; cardiovascular diseases; haemoglobin A, glycosylated; medication adherence

Referrals are traditionally defined as sending a patient to another program or practitioner for services or advice. The increasing adoption of electronic referral systems (eReferrals) requires a more complex model and shared understanding of what a referral is. eReferrals are designed to support writing referrals and automating referrals processing, and sometimes triaging. The reported benefits of eReferrals include secured delivery of referrals, improved efficiency, access to care, quality of care and continuity of care, better quality of documentation and communication, as well as reduced cost. Improvement in the time to prioritise referrals, more reliable and transparent referral handling, and better-supported hospital-community communications have been observed in regional eReferral trials in New Zealand. In the authors' opinion, teleconsultation and virtual shared care relationships have the potential to transform healthcare delivery, and they can be facilitated by eReferral technology. But the opportunities introduced by information technologies for eReferrals present several complex and contentious issues. This paper explores the potential roles and models for eReferral and its challenge to what constitutes a medical consultation. Future research is needed to understand how to facilitate and fund virtual clinics, and to support mentorships among healthcare professionals as well as for health consumers.

The Caring Does Matter (CDM) programme aimed to improve cardiovascular disease risk (CVR) management in Pacific people, targeting medication adherence problems. This paper presents cluster analysis of CDM data to model medication adherence and cardiovascular risk factors in high-CVR patients.Changes in cardiovascular medication adherence status and in physiological measures of high-CVR Pacific patients, as well as their baseline physiological measures, demographics and other risk factors are included in the analysis. Differences in resulting clusters are described to provide insight into the population.1786 Pacific patients were identified with high CVR (≥ 10%, 5 year event risk) at baseline and were still enrolled with the thirteen participating general practices at CDM end. Two of three models attempted produced significant clusters: a two-cluster model indicating patients who failed to improve adherence during the programme had higher prevalence of diabetes; and a three-cluster model where one cluster was characterised by higher but improving blood pressure, and another characterised by higher but improving HbA1c.Cluster analysis reveals statistically distinct patient groups, including differences in characteristics of patients less responsive to the programme intervention. This provides a basis for further efforts to understand the population and better tailor interventions.

The literature describes three categories of health records: the Official Medical Records held by healthcare providers, Personal Health Records owned by patients, and--a possible in between case--the Shared Care Record. New complications and challenges arise with electronic storage of this latter class of record; for instance, an electronic shared care record may have multiple authors, which presents challenges regarding the roles and responsibilities for record-keeping. This article discusses the definitions and implementations of official medical records, personal health records and shared care records. We also consider the case of a New Zealand pilot of developing and implementing a shared care record in the National Shared Care Planning Programme. The nature and purpose of an official medical record remains the same whether in paper or electronic form. We maintain that a shared care record is an official medical record; it is not a personal health record that is owned and controlled by patients, although it is able to be viewed and interacted with by patients. A shared care record needs to meet the same criteria for medico-legal and ethical duties in the delivery of shared care as pertain to any official medical record.

To assess gender differences in cardiovascular disease risk (CVR) assessment and management for Pacific people in New Zealand.New Zealand guidelines indicate CVR assessment from age 35 years for Pacific men and from age 45 years for Pacific women. Using general practice electronic medical records from 16 practices in New Zealand, the rate of CVR screening, treatment patterns and physiological measures for high-CVR (≥15% five-year) patients were assessed for Pacific patients ≥20 years of age by gender.Records for 10 863 Pacific patients showed a higher proportion of indicated women screened for CVR (65 vs 56%), but a lower proportion of assessed women with high CVR (28% for Pacific women vs 40% for Pacific men). Many of these high-CVR patients had physiological measures well above desirable levels based on their most recent readings. In the high-CVR group, women had similar CVR levels to men, but higher systolic blood pressure and HbA1c level, and a higher proportion of women were treated with antihypertensive and oral antidiabetic medication. There were substantial levels of poor medication adherence, particularly for cholesterol-lowering medication. Women and men were equally likely to adhere to treatment. Those adhering to relevant medications had lower blood pressure, total-to-HDL cholesterol ratio and HbA1c than non-adherers.Pacific men were less likely than Pacific women to have their CVR assessed when indicated, more likely once assessed to have high CVR and equally likely to adhere to treatment. Medication adherence was associated with better control of risk factors and should be further promoted in this population.

An exploratory study was conducted to understand patient propensity to use a Personal Health Record (PHR) linked to their primary care clinicians' Electronic Health Record (EHR). Individuals with long-term conditions rely on information exchange for effective self-care. PHRs could be helpful. The research questions were: How do we know if certain people will use PHRs for self-care?Semi-structured interviews and observation were conducted with ten patients regarding their use of a PHR available to them.Reasons for using PHR functions fell into two patterns: interaction and review. Patients used their PHR if they could interact with their GP, e.g. order a repeat prescription, and if they could review information, e.g. laboratory results, medicines list. Perceived usefulness (PU) of the PHR was strong, especially if linked to a self-care action. Interestingly, behavioural intent to use was not adversely affected by difficulties in using some aspects of the tool, if the PU of a function was strong.Patient experience with a PHR linked to their EHR kept by their GP shows positive perceptions regarding the PHR usefulness. Future research could develop guidelines for clinicians to help select patients for PHR use in self-care.

This paper reports on a small study in which we investigated factors influencing the adoption of Personal Health Records (PHRs), with specific reference to those linked to Electronic Health Records. Long term conditions are a growing concern in healthcare delivery, especially as the need for services outstrips resources. PHRs could be useful in supporting self-care of people with long term conditions, e.g. diabetes.We used a Grounded Theory approach to gather initial data to inform future research. This meant that we were guided and informed by data collected.[1] The aim was to find a baseline for PHR research using the Technology Acceptance Model [2], after which emerging topics will be pursued with constant comparison to this first study and subsequent studies. We interviewed ten patients from a Wellington primary care practice who had been using a PHR linked to their doctor's Practice Management System, and observed them using and navigating the software at home.Three groups of factors appeared to influence the participants' use of the PHR. (1) Their perception that convenience, time saving (for them, their GP's practice personnel and their GP), efficiency and effectiveness of care is a result of using the PHR. (2) Computer and health literacy contribute to being able to effectively use the PHR. PHR usage impacts positively on the relationship with their doctor and vice versa, and improves their ability to navigate the health system. (3) It is not clear how PHR-related services are paid for, who pays and under what circumstances.These findings are in keeping with those of Santana et al[3] who indicate that patients are interested in viewing and using laboratory results, medicines and diagnosis lists, and ordering repeat prescriptions and corresponding with their clinicians. Literacy does matter, especially in terms of PHRs providing a transparent 'source of truth' and memory aid about medications, laboratory results and diagnoses. The combination of computer and health literacy requires further research. The cost of incorporating PHRs into healthcare services needs to be articulated so that it makes sense in the current capitation funding model. LIMITATIONS of this research include the small sample size, bias based on small context and self-selection into the interview cohort.three groups of influencing factors have been elicited from the interviews and observations to indicate potential acceptance and adoption of PHRs in self-care of long term conditions. The next step is to examine the social situatedness of long term conditions and how PHRs support self-care.

Between September 2010 and May 2011 we evaluated three implementations of electronic referral (eReferral) systems at Hutt Valley, Northland and Canterbury District Health Boards in New Zealand.Qualitative and quantitative data were gathered through project documentation, database records and stakeholder interviews. This paper reports on the user perspectives based on interviews with 78 clinical, management and operational stakeholders in the three regions. Themes that emerge across the regions are compared and synthesised. Interviews focused on pre-planned domains including quality of referral, ease of use and patient safety, but agendas were adapted progressively to elaborate and triangulate on themes emerging from earlier interviews and to clarify indications from analysis of database records.The eReferral users, including general practitioners, specialists and administrative staff, report benefits in the areas of: (1) availability and transparency of referral-related data; (2) work transformation; (3) improved data quality and (4) the convenience of auto-population from the practice management system into the referral forms. eReferral provides enhanced visibility of referral data and status within the limits of the implementation (which only goes to the hospital door in some cases). Users in all projects indicated the desire to further exploit IT to enhance two-way communication between community and hospital. Reduced administrative handling is a clear work transformation benefit with mixed feedback regarding clinical workload impact. Innovations such as GP eReferral triaging teams illustrate the further potential for workflow transformation. Consistent structure in eReferrals, as well as simple legibility, enhances data quality. Efficiency and completeness is provided by auto-population of forms from system data, but opens issues around data accuracy. All three projects highlight the importance of user involvement in design, implementation and refinement. In keeping with this, Canterbury utilises a systematic pathway definition process that brings together GPs and specialist to debate and agree on the local management of a condition. User feedback exposes many opportunities for improving usability.The findings are based on individual experiences accounted by participating stakeholders; the risk of bias is mitigated, however, by triangulation across three distinct implementations of eReferrals. Quantitative follow-up on key outstanding issues, notably impact of structured eReferral forms on GP time to write a referral, is warranted.Key eReferral users include clinicians on both ends of the referral process as well as the administrative staff. User experience in three eReferral projects has shown that they particularly appreciate improvement of referral visibility, as well as information quality; promising workflow transformations have been achieved in some places. Auto-population of forms leads to opportunities, and issues, that are prompting further attention to data quality. While the importance of user feedback should be obvious, it is not universal to seek it or to provide resources to effectively follow up with improvements driven by such feedback. To maximise benefits, innovative health IT projects must take an iterative approach guided by ongoing user experience.

Based on the biomechanical response of human knee joint to a front impact in occupants accidents, a finite element (FE) model of human knee joint was developed by using computer simulation technique for impacting. The model consists of human anatomical structure, including femoral condyle, tibia condyle, fibular small head, patellar, cartilage, meniscus and primary ligament. By comparing the results of the FE model with experiments of the knee joint in axial load conditions, the validation of the model was verified. Furthermore, this study provides data for the mechanical of human knee joint injury, and is helpful for the design and optimization of the vehicle protective devices.

Purpose: This study aimed to characterize the challenges in using genetic information in health care and to identify opportunities for improvement. Methods: Taking a grounded theory approach, semistructured interviews were conducted with 48 participants to collect multiple stakeholder perspectives on genetic services in New Zealand. Results: Three themes emerged from the data: (1) four service delivery models were identified in operation, including both those expected models involving genetic counselors and variations that do not route through the formal genetic service program; (2) multiple barriers to sharing and using genetic information were perceived, including technological, organizational, institutional, legal, ethical, and social issues; and (3) impediments to wider use of genetic testing technology, including variable understanding of genetic test utilities among clinicians and the limited capacity of clinical genetic services. Targeting these problems, information technologies and knowledge management tools have the potential to support key tasks in genetic services delivery, improve knowledge processes, and enhance knowledge networks. Conclusion: Because of the effect of issues in genetic information and knowledge management, the potential of human genetic variation knowledge to enhance health care delivery has been put on a “leash.”

Organizational knowledge management (KM) research studies the nature of knowledge, the scope of KM, the factors and mechanisms that affect KM outcomes, as well as theoretical KM frameworks. This paper discusses the implications of past studies for the KM efforts in the human genetic variation (HGV) research domain and presents a HGV-KM research model. This model identifies the context of HGV KM studies, the predispositions and factors that may impact KM outcomes, and important KM processes. It also represents the relationships among these issues. Applying the model, further studies will point the way for improved capture and dissemination of HGV knowledge from routine HGV research activities to contribute to the global genetics knowledge base.