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Throughout the COVID-19 pandemic, pregnant women/people were identified as an at-risk group of severe COVID-19 disease. Consequently, vaccine uptake among this group became a public health priority. However, the relationship between pregnancy and vaccination decision-making is complex, and the heightened uncertainty and anxiety produced through the pandemic further exacerbated this immunization decision. This study explores COVID-19 vaccination decision-making during pregnancy in Aotearoa New Zealand by using an online story completion survey tool. Ninety-five responses were received and analysed using thematic analysis where ambiguity was a core facet within and across stories. Three ambiguities were identified, including who makes the decision (agential), what the risks are (risk) and how immunity to this threat can be best achieved (immunity). We discuss the implications of this ambiguity and how the strong desire to protect the baby persisted across accounts. The recognition of the rather persistent ambiguity in vaccination decision-making helps conceptualize influencing factors taken into account in a more nuanced manner for further research, public health campaigns and health professionals. Future public health campaigns can consider redistributing responsibility for vaccination decision-making in pregnancy, traverse an either/or perspective of 'natural' and 'artificial' immunity-boosting and consider how risk is perceived through anecdotes and viral immediacy. [ABSTRACT FROM AUTHOR]

Summary: Chest pain is the second most common reason for adult emergency department presentations.Most patients have low or intermediate risk chest pain, which historically has led to inpatient admission for further evaluation.Rapid access chest pain clinics represent an innovative outpatient pathway for these low and intermediate risk patients, and have been shown to be safe and reduce hospital costs.Despite variations in rapid access chest pain clinic models, there are limited data to determine the most effective approach. Developing a national framework could be beneficial to provide sites with evidence, possible models, and business cases. Multicentre data analysis could enhance understanding and monitoring of the service. [ABSTRACT FROM AUTHOR]

Objectives. To project the prevalence of people receiving dialysis in Australia for 2021–30 to inform service planning and health policy. Methods. Estimates were based on data from 2011 to 2020 from the Australia & New Zealand Dialysis & Transplant (ANZDATA) Registry and the Australian Bureau of Statistics. We projected dialysis and functioning kidney transplant recipient populations for the years 2021–30. Discrete-time, non-homogenous Markov models were built on probabilities for transition between three mutually exclusive states (Dialysis, Functioning Transplant, Death), for five age groups. Two scenarios were employed – stable transplant rate vs a continued increase – to assess the impact of these scenarios on the projected prevalences. Results. Models projected a 22.5–30.4% growth in the dialysis population from 14 554 in 2020 to 17 829 (‘transplant growth’) – 18 973 (‘transplant stable’) by 2030. An additional 4983–6484 kidney transplant recipients were also projected by 2030. Dialysis incidence per population increased and dialysis prevalence growth exceeded population ageing in 40–59 and 60–69 year age groups. The greatest dialysis prevalence growth was seen among those aged ≥70 years. Conclusion. Modelling of the future prevalence of dialysis use highlights the increasing demand on services expected overall and especially by people aged ≥70 years. Appropriate funding and healthcare planning must meet this demand. [ABSTRACT FROM AUTHOR]

Objectives: To optimise planning of public health services, the impact of high-cost users needs to be considered. However, most of the existing statistical models for costs do not include many clinical and social variables from administrative data that are associated with elevated health care resource use, and are increasingly available. This study aimed to use machine learning approaches and big data to predict high-cost users among people with cardiovascular disease (CVD). Methods: We used nationally representative linked datasets in New Zealand to predict CVD prevalent cases with the most expensive cost belonging to the top quintiles by cost. We compared the performance of four popular machine learning models (L1-regularised logistic regression, classification trees, k-nearest neighbourhood (KNN) and random forest) with the traditional regression models. Results: The machine learning models had far better accuracy in predicting high health-cost users compared with the logistic models. The harmony score F1 (combining sensitivity and positive predictive value) of the machine learning models ranged from 30.6% to 41.2% (compared with 8.6–9.1% for the logistic models). Previous health costs, income, age, chronic health conditions, deprivation, and receiving a social security benefit were among the most important predictors of the CVD high-cost users. Conclusions: This study provides additional evidence that machine learning can be used as a tool together with big data in health economics for identification of new risk factors and prediction of high-cost users with CVD. As such, machine learning may potentially assist with health services planning and preventive measures to improve population health while potentially saving healthcare costs. [ABSTRACT FROM AUTHOR]

Māori health providers emerged in Aotearoa/New Zealand in the 1980s as a mechanism to achieve self‐determination for Māori communities. However, the contracts funding Māori health providers limit expressions of self‐determination and fail to reflect Te Tiriti O Waitangi, the founding treaty of Aotearoa/New Zealand. Significant health reforms are proposed in Aotearoa/New Zealand, including the creation of a Māori Health Authority that will commission services from Māori health providers. This paper aims to critique the government contracts provided to Māori health providers in the light of the health reforms. A discourse analysis was undertaken on contracts held by a Māori health provider. The study was informed by a Kaupapa Māori congruent methodology that centralised Māori knowledge. The contractural language utilised a variety of discursive techniques that ultimately limit the power of Māori health providers. These discursive techniques included the redefinition of Māori concepts of self‐determination, the use of rhetoric that was not matched by action, reshaping Māori health priorities to reflect the funders' priorities and the application of a deficit lens to Māori health issues. The discursive techniques present in these contracts is consistent with previous work demonstrating a failure of funders to centralise Māori knowledge and ways of being. Success of the proposed health reforms and the Māori Health Authority should require dismantling of non‐Māori ways of commissioning and contracting, otherwise there is the continued risk of discriminatory contracting practices limiting the expression of self‐determination for Māori health providers. [ABSTRACT FROM AUTHOR]

Objectives: To describe the short term ability of Australian intensive care units (ICUs) to increase capacity in response to heightened demand caused by the COVID‐19 pandemic. Design: Survey of ICU directors or delegated senior clinicians (disseminated 30 August 2021), supplemented by Australian and New Zealand Intensive Care Society (ANZICS) registry data. Setting: All 194 public and private Australian ICUs. Main outcome measures: Numbers of currently available and potentially available ICU beds in case of a surge; available levels of ICU‐relevant equipment and staff. Results: All 194 ICUs responded to the survey. The total number of currently open staffed ICU beds was 2183. This was 195 fewer (8.2%) than in 2020; the decline was greater for rural/regional (18%) and private ICUs (18%). The reported maximal ICU bed capacity (5623) included 813 additional physical ICU bed spaces and 2627 in surge areas outside ICUs. The number of available ventilators (7196) exceeded the maximum number of ICU beds. The reported number of available additional nursing staff would facilitate the immediate opening of 383 additional physical ICU beds (47%), but not the additional bed spaces outside ICUs. Conclusions: The number of currently available staffed ICU beds is lower than in 2020. Equipment shortfalls have been remediated, with sufficient ventilators to equip every ICU bed. ICU capacity can be increased in response to demand, but is constrained by the availability of appropriately trained staff. Fewer than half the potentially additional physical ICU beds could be opened with currently available staff numbers while maintaining pre‐pandemic models of care. [ABSTRACT FROM AUTHOR]

Background: While priority setting is recognized as critical for promoting accountability and transparency in health system planning, its role in supporting rational, equitable and fair pandemic planning and responses is less well understood. This study aims to describe how priority setting was used to support planning in the initial stage of the pandemic response in a subset of countries in the Western Pacific Region (WPR)., Methods: We purposively sampled a subset of countries from WPR and undertook a critical document review of the initial national COVID-19 pandemic response plans. A pre-specified tool guided data extraction and the analysis examined the use of quality parameters of priority setting, and equity considerations., Results: Nine plans were included in this analysis, from the following countries: Papua New Guinea, Tonga, The Philippines, Fiji, China, Australia, New Zealand, Japan, and Taiwan. Most commonly the plans described strong political will to respond swiftly, resource needs, stakeholder engagement, and defined the roles of institutions that guided COVID-19 response decision-making. The initial plans did not reflect strong evidence of public engagement or considerations of equity informing the early responses to the pandemic., Conclusion: This study advances an understanding of how priority setting and equity considerations were integrated to support the development of the initial COVID-19 responses in nine countries in WPR and contributes to the literature on health system planning during emergencies. This baseline assessment reveals evidence of the common priority setting parameters that were deployed in the initial responses, the prioritized resources and equity considerations and reinforces the importance of strengthening health system capacity for priority setting to support future pandemic preparedness., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background/Objectives: To determine the effect of a proactive primary care program on acute hospitalization and aged‐residential care placement for frail older people. Design: Controlled before and after, and controlled after only quasi‐experimental studies, with a comparison group created via propensity score matching. One‐year follow‐up. Setting: Nine general practices in Auckland, New Zealand. Participants: Community‐dwelling people aged 75 and older identified as at increased risk of hospitalization. One thousand and eighty five patients are compared with 3750 comparison patients matched by propensity score based on known risks. Intervention: Primary healthcare based, registered nurse‐led, comprehensive geriatric assessment, goal‐setting, care planning, and regular follow‐up. Patients were also provided self‐management education, health and social care navigation, and transitional care for hospital discharges. Practices received program support, workforce development, and mentoring of primary healthcare nurses by gerontology nurse specialists. Measurements: Outcomes from routinely collected administrative data. Primary: aged‐residential care placement. Secondary outcomes: acute hospitalization, mortality, and other health service utilization. Results: Aged‐residential care placement (odds ratio [OR] 0.66, 95% confidence interval (CI) = 0.48‐0.91) and mortality (OR 0.66, 95% CI = 0.49–0.88) were significantly lower over the first year in Kare patients compared with matched controls. There was no difference in acute hospitalization (+0.06 admissions per year, 95% CI = −0.01–0.13). Support service use (allied health therapists and assessment for social support) was increased, and emergency department use decreased. Conclusion: The Kare participants had lower aged‐residential care placement and mortality in the first year, but no decrease in acute hospitalization. Because the design is nonexperimental caution is required in interpreting these results. See related editorial by Danto‐Nocton et al. and article by Moreno et al. in this issue. [ABSTRACT FROM AUTHOR]

Background and context: General practice teams frequently request orthopaedic and musculoskeletal physiotherapy. In the Canterbury District Health Board (DHB) region, before November 2018, the criteria for DHB-funded physiotherapy were unclear. Wait times were many months. Care was provided on hospital sites. Limited data were available about the service. Assessment of problem: A clinical project group including private and DHB hospital physiotherapists and general practitioners was established. Patients requiring orthopaedic and musculoskeletal physiotherapy who had certain criteria were seen by physiotherapists in contracted private clinics in the community instead of by physiotherapists in hospital departments. Patients received up to NZ$300 (excluding GST) of care. A claiming process was established that required the physiotherapy clinics to provide data on patient outcomes. Results: In the first 12 months of the programme, 1229 requests were accepted. Patients waited an average of 11.1 days for their first appointment. There was an average Patient Specific Functional Scale increase of 3.7 after treatment. Strategies for improvement: A change environment was critical for this community-based, geographically distributed model to succeed. It was supported by key clinicians and funders with sufficient authority to make changes as required. It required ongoing clinical oversight and operational support. Lessons: DHB orthopaedic and musculoskeletal physiotherapy can be moved from hospital sites to a community-based, distributed service in a timely, effective and equitable fashion. There was a prompt time to treatment. Data collection was improved by tracking 'before' and 'after' measures. [ABSTRACT FROM AUTHOR]

Aotearoa-New Zealand is expecting the number of older adults to double in the next 20 years. Despite publicly funded health and welfare support for older citizens, the aging experience differs across ethnic groups. This creates opportunities and challenges for health and social services to deliver culturally safe and equitable care for all older New Zealanders. Longitudinal and large data sets are pivotal for characterizing the aging experience from birth to advanced age. The New Zealand research funding system responded to predicted demographic changes by increasing funding in order to inform and address key health and well-being issues for older people. In addition, government strategies and policies increasingly focus on social aspects of aging and health inequities and require researchers and organizations to be better connected to end-users. New Zealand needs to continue to fund research that identifies unique and courageous service delivery solutions that result in positive social, financial, psychological, and physical aging for older New Zealanders. [ABSTRACT FROM AUTHOR]

Aim: The goal of this paper is to provide a protocol for conducting a fifth population-based Auckland Regional Community Stroke study (ARCOS V) in New Zealand. Methods and Discussion : In this study, for the first time globally, (1) stroke and TIA burden will be determined using the currently used clinical and tissue-based definition of stroke, in addition to the WHO clinical classifications of stroke used in all previous ARCOS studies, as well as more advanced criteria recently suggested for an "ideal" population-based stroke incidence and outcomes study; and (2) age, sex, and ethnic-specific trends in stroke incidence and outcomes will be determined over the last four decades, including changes in the incidence of acute cerebrovascular events over the last decade. Furthermore, information at four time points over a 40-year period will allow the assessment of effects of recent changes such as implementation of the FAST campaign, ambulance pre-notification, and endovascular treatment. This will enable more accurate projections for health service planning and delivery. Conclusion: The methods of this study will provide a foundation for future similar population-based studies in other countries and populations. [ABSTRACT FROM AUTHOR]

Background: In New Zealand, health equity is a pressing concern and reaching disadvantaged populations has become the goal to close the inequity gap. Building and strengthening health systems is one way to secure better outcomes. However, the discourse to date has predominately focussed on inequities in health outcomes for Māori. This study has interest in the African ethnic minority community in New Zealand. It undertakes a narrative review of the New Zealand health system which aims to identify literature around the attainment of health equity of African minority by: (i) providing a critical overview of the healthcare delivery system using World Health Organization's six inter-related building blocks of health system strengthening; (ii) developing a summary and discussions of the research results and; (iii) identifying priorities and recommendations for future research. Method: A narrative review of 27 articles published between January 2010 and June 2019 were selected from CINAHL, PubMed, Scopus, Google Scholar. Grey literature also informed the review. Articles excluded studies: (i) non-related to New Zealand; (ii) with no focus on equity on ethnic minority in the delivering of healthcare; (iii) had no full text available. Findings: Literature on Africans health outcomes were scarce regarding the six building blocks. However, findings show inequities in accessibility of health services, a non-ethnic inclusive health workforce, a leadership and governance which lack political will on migrant health and resultantly an under-performing health information system which influences resource allocation. Recommendation and conclusion: An improvement and well-functioning health information system is pivotal to capture the unmet needs of the African population. There is a need for research and political will to invest in African minority health and diverse workforce that understands the background of the African population; and action to address structural and institutional racism and white privilege to address root causes of inadequate access and care processes for ethnic minorities. [ABSTRACT FROM AUTHOR]

Background: In recent decades, financial investment has been made in health-related programs and services to overcome inequities and improve Indigenous people's wellbeing in Australia and New Zealand. Despite policies aiming to 'close the gap', limited evaluation evidence has informed evidence-based policy and practice. Indigenous leaders have called for evaluation stakeholders to align their practices with Indigenous approaches. Methods: This study aimed to strengthen culturally safe evaluation practice in Indigenous settings by engaging evaluation stakeholders, in both countries, in a participatory concept mapping study. Concept maps for each country were generated from multi-dimensional scaling and hierarchical cluster analysis. Results: The 12-cluster Australia map identifies four cluster regions: An Evaluation Approach that Honours Community; Respect and Reciprocity; Core Heart of the Evaluation; and Cultural Integrity of the Evaluation. The 11-cluster New Zealand map identifies four cluster regions: Authentic Evaluation Practice; Building Māori Evaluation Expertise; Integrity in Māori Evaluation; and Putting Community First. Both maps highlight the importance of cultural integrity in evaluation. Differences include the distinctiveness of the 'Respecting Language Protocols' concept in the Australia map in contrast to language being embedded within the cluster of 'Knowing Yourself as an Evaluator in a Māori Evaluation Context' in the New Zealand map. Participant ratings highlight the importance of all clusters with some relatively more difficult to achieve, in practice. Notably, the 'Funding Responsive to Community Needs and Priorities' and 'Translating Evaluation Findings to Benefit Community' clusters were rated the least achievable, in Australia. The 'Conduct of the Evaluation' and the 'Prioritising Māori Interests' clusters were rated as least achievable in New Zealand. In both countries, clusters of strategies related to commissioning were deemed least achievable. Conclusions: The results suggest that the commissioning of evaluation is crucial as it sets the stage for whether evaluations: reflect Indigenous interests, are planned in ways that align with Indigenous ways of working and are translated to benefit Indigenous communities Identified strategies align with health promotion principles and relational accountability values of Indigenous approaches to research. These findings may be relevant to the commissioning and conduct of Indigenous health program evaluations in developed nations. [ABSTRACT FROM AUTHOR]

The article focuses on investment on US health care system. Topics include decrease in life expectancy rate, rise in mortality due to diseases and rise of suicide rates, requirement of "Health in All Policies" approach in National policymaking, and New Zealand's Wellbeing Budget and features population health improvement.

Objective: To explore associations between frailty (Clinical Frailty Scale score of 5 or more) in very old patients in intensive care units (ICUs) and their clinical outcomes (mortality, discharge destination).Design, Setting and Participants: Retrospective population cohort analysis of Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database data for all patients aged 80 years or more admitted to participating ICUs between 1 January 2017 and 31 December 2018.Main Outcome Measures: Primary outcome: in-hospital mortality; secondary outcomes: length of stay (hospital, ICU), re-admission to ICU during the same hospital admission, discharge destination (including new chronic care or nursing home admission).Results: Frailty status data were available for 15 613 of 45 773 patients aged 80 years or more admitted to 178 ICUs (34%); 6203 of these patients (39.7%) were deemed frail. A smaller proportion of frail than non-frail patients were men (47% v 57%), the mean illness severity scores of frail patients were slightly higher than those of non-frail patients, and they were more frequently admitted from the emergency department (28% v 21%) or with sepsis (12% v 7%) or respiratory complications (16% v 12%). In-hospital mortality was higher for frail patients (17.6% v 8.2%; adjusted odds ratio [OR], 1.87 [95% CI, 1.65-2.11]). Median lengths of ICU and hospital stay were slightly longer for frail patients, and they were more frequently discharged to new nursing home or chronic care (4.9% v 2.8%; adjusted OR, 1.61 [95% CI, 1.34-1.95]).Conclusions: Many very old critically ill patients in Australia and New Zealand are frail, and frailty is associated with considerably poorer health outcomes. Routine screening of older ICU patients for frailty could improve outcome prediction and inform intensive care and community health care planning. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including the effect of the proposed Māori Health Authority on the New Zealand health system, anthropometric changes to people before and after the arrival of the Europeans in the country, and longitudinal general practice research in a Tongan medical centre.

Traditional workforce planning methodologies and interprofessional education (IPE) approaches will not address the significant challenges facing health care systems seeking to integrate services, eliminate waste and meet rising demand within fixed or shrinking budgets. This article describes how New Zealand's workforce planning approach could be used as a model by other countries to move toward needs-based, interprofessional workforce planning. Such an approach requires a paradigm shift to reframe health workforce planning away from a focus on shortages toward assessing how to more effectively deploy and retrain the existing workforce; away from silo-based workforce projection models toward methodologies that recognize professions' overlapping scopes of practice; and away from a focus on traditional health professions toward including both health and social care workers. We propose that IPE must develop new models of learning that are delivered in the context of practice. This will require a shift from today's predominant focus on preparing students in the pipeline to be collaboration-ready to designing clinical practice environments that support continuous learning that benefits not just learners, but patients, populations, and providers as well. We highlight the need for improved data and methods to evaluate IPE and call for better collaboration between health workforce planners and IPE stakeholders. [ABSTRACT FROM AUTHOR]

Objective: This paper describes a workshop process conducted to guide funding priorities for the Ageing Well National Science Challenge in New Zealand (NZ). Methods: Based on the Checklist for Health Research Priority Setting, stakeholders networking workshops were conducted in five main cities in NZ (n = 133 attendees). Each workshop involved an introductory presentation; small group work exploring the a priori areas of: mind health, social well‐being, health services and age‐friendly environments; capturing key ideas on flip charts; feedback; and discussion of documented content. Results: Suggested strategies to address these issues incorporated reduction in segregated "villages," delivery of integrated care and provision of age‐friendly transport. Proposed examples of monitoring impact included increased tertiary participation by older people and presence of more housing options. Conclusion: Actively engaging older adults and community stakeholders in setting research priorities provided a unique opportunity to understand the key areas older adults think important for future research. [ABSTRACT FROM AUTHOR]

Abstract Background Dietitians in countries across the world have been implementing the Nutrition Care Process (NCP) and Terminology (NCPT) during the past decade. The implementation process has been evaluated in specific countries and in smaller international studies; however, no large international study comparing implementation between countries has been completed. Objective The aim of this study was to describe and compare the level of NCP/NCPT implementation across 10 countries. Methods A previously tested web-based survey was completed in 2017 by 6,719 dietitians across 10 countries. Participants were recruited through e-mail lists, e-newsletters, and social media groups for dietitians. Nondietitians were excluded through screening questions and targeted dissemination channels. Main outcome measures and statistical analysis The main outcome of interest was the level of implementation of each of the four NCP steps. Differences in implementation between the NCP (process) and NCPT (terminology) were also measured. Differences between groups were assessed using Kruskal-Wallis test and Mann-Whitney U test. Multiple linear regression was used to assess relationships between the main outcomes and respondent demographic information. Results Australia, New Zealand, and the United States had higher implementation rates compared with other countries surveyed. Awareness of the NCP was high in most countries (>90%) but lower in Greece (50%). All countries had a higher implementation level of the NCP (process) compared with the NCPT (terminology). Dietitians working with inpatients reported the highest implementation levels while those working in public health reported the lowest. Conclusions Dietitians in countries with more experience in NCP/NCPT implementation and a clear implementation strategy had higher levels of implementation. To achieve a successful NCP/NCPT implementation among dietitians, there is a need to promote the value of a standardized dietetic language together with the more easily implemented process. There is also a need to promote NCP/NCPT for all areas of practice, and develop strategic plans for implementation of the NCP and NCPT. [ABSTRACT FROM AUTHOR]

Background and objectives: To update information on the treatment of children under general anaesthetic (GA) in New Zealand in order to provide evidence for health service planning and dental care provision for children, and to determine whether District Health Boards (DHBs) have followed guidelines that were published in 2008. Methods: A questionnaire was sent to all Clinical Directors of DHBs in New Zealand. This was complemented by structured interviews with a number of those Clinical Directors. Results: The numbers of children receiving dental care under GA have risen substantially, from 4,646 in 2004/2005 to 7,755 in 2014 (a 65% increase). Hospital dental departments are reporting difficulties meeting demand. The 2008 guidelines have been widely used by hospital dental units in providing such care. Resources (both in the community oral health services and the hospital dental services) have had to increase; first to attempt to prevent, and second to treat those who develop decay. This has been at some considerable cost to the health system. However, many DHBs are still struggling to meet the increasing demand. All Clinical Directors believed that reducing demand for dental care under GA should be an explicit goal of the Government and DHBs. Conclusions: Hospital dental units have adopted many of the 2008 guidelines, but variations persist in access to such treatment, with DHBs under more pressure than ever to cope with the growing demand for child dental care under GA. [ABSTRACT FROM AUTHOR]

The Port Hills wildfire experience demonstrates the severity of wildfire risk on the periphery of urban areas in some parts of New Zealand, and highlights the need to build resilience to this peril. The current paper focuses on the role of land-use planning in reducing wildfire risk and building resilience at the wildland-urban interface -- hereafter termed wildfire planning. It identifies and recommends strategies for institutionalising wildfire planning in New Zealand. Very little scholarly attention has been focused on this topic to date and little effort has been made to institutionalise wildfire planning in New Zealand. Extensive experience in wildfire planning in Australia, called bushfire planning, can inform future wildfire planning efforts in New Zealand, given local natural hazards planning provisions and experience. We reviewed publications, plans and policy provisions related to the post-2009 Black Saturday Victorian bushfire experience, alongside insights drawn from key informant interviews. Based on these insights, we have identified barriers and enablers for institutionalising bushfire planning and distilled particular lessons. The current article follows these findings with key topics for building a wildfire planning research and practice agenda in New Zealand, concerning measures to: (1) reduce wildfire risk; (2) mobilise and integrate domains of professional practice relevant to wildfire planning; (3) develop community-based wildfire planning capability; and (4) meet the needs of current and future generations by institutionalising wildfire resilient development pathways at New Zealand's wildland-urban interface. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) risk prediction equations are primarily used in clinical settings to inform individual risk management decisions. We sought to develop and validate alternative equations derived solely from linked routinely collected national health data that could be applied countrywide to inform population health planning.Methods: Individual-level linkage of eight administrative health datasets identified all New Zealand residents aged 30-74 years in contact with publicly funded health services during 2006 with no previous hospitalizations for CVD or heart failure, and with complete data on eight pre-specified predictors. The linked health datasets encompassed demographic characteristics, hospitalizations, outpatient visits, primary care enrolment, primary care reimbursement, community laboratory requests, community pharmaceutical dispensing and mortality. Sex-specific Cox models were developed to estimate the risk of CVD death or hospitalization within 5 years and included sex, age, ethnicity, level of deprivation, diabetes, previous hospitalization for atrial fibrillation and baseline preventive pharmacotherapy (blood-pressure-lowering, lipid-lowering and antiplatelet/anticoagulant medications) as predictors. Calibration and discrimination were assessed in the whole cohort, in 15-year age bands, in different ethnic groups, in quintiles of deprivation, according to baseline dispensing of pharmacotherapy, and in regional sub-populations.Results: First CVD events occurred in 62 031 of the 1 746 695 people during 8 526 024 person-years of follow-up (mean = 4.8 years). Median 5-year CVD risk was 1.1% in women and 2.6% in men. In both sexes, the risk equations were well calibrated throughout the risk range and had good risk discrimination in the national, regional and ethnic populations, within 15-year age bands, in deprivation quintiles and according to baseline medication dispensing.Conclusions: Robust policy-focused CVD risk equations can be developed solely from administrative health data to inform population health planning, and will complement CVD primary prevention at the individual level using clinical risk tools. Similar policy-focused equations could be replicated in countries and regions with linked administrative health datasets. [ABSTRACT FROM AUTHOR]

Aim: In New Zealand, there is a paucity of information on children with chronic conditions and disabilities (CCD). One reason is that many are managed in hospital outpatients where diagnostic coding of health-care events does not occur. This study explores the feasibility of coding paediatric outpatient data to provide health planners with information on children with CCD.Methods: Thirty-seven clinicians from six District Health Boards (DHBs) trialled coding over 12 weeks. In five DHBs, the International Classification of Diseases and Related Health Problems, 10th Edition, Australian Modification (ICD-10-AM) and Systematised Nomenclature of Medicine Clinical Terms (SNOMED-CT) were trialled for 6 weeks each. In one DHB, ICD-10-AM was trialled for 12 weeks. A random sample (30%) of ICD-10-AM coded events were also coded by clinical coders. A mix of paper and electronic methods were used.Results: In total 2,604 outpatient events were coded in ICD-10-AM and 693 in SNOMED-CT. Dual coding occurred for 770 (29.6%) ICD-10-AM events. Overall, 34% of ICD-10-AM and 40% of SNOMED-CT events were for developmental and behavioural disorders. Chronic medical conditions were also common. Clinicians were concerned about the workload impacts, particularly for paper-based methods. Coder's were concerned about clinician's adherence to coding guidelines and the poor quality of documentation in some notes.Conclusion: Coded outpatient data could provide planners with a rich source of information on children with CCD. However, coding is also resource intensive. Thus its costs need to be weighed against the costs of managing a much larger health budget using very limited information. [ABSTRACT FROM AUTHOR]

Background: Canada's universal health care system does not include universal coverage of prescription drugs. We sought to estimate the effects of adding universal public coverage of an essential medicines list to existing public drug plans in Canada.Methods: We used administrative and market research data to estimate the 2015 shares of the volume and cost of prescriptions filled in the community setting that were for 117 drugs on a model list of essential medicines for Canada. We compared prices of these essential medicines in Canada with prices in the United States, Sweden and New Zealand. We estimated the cost of adding universal public drug coverage of these essential medicines based on anticipated effects on medication use and pricing.Results: The 117 essential medicines on the model list accounted for 44% of all prescriptions and 30% of total prescription drug expenditures in 2015. Average prices of generic essential medicines were 47% lower in the US, 60% lower in Sweden and 84% lower in New Zealand; brand-name drugs were priced 43% lower in the US. Estimated savings from universal public coverage of these essential medicines was $4.27 billion per year (range $2.72 billion to $5.83 billion; 28% reduction) for patients and private drug plan sponsors, at an incremental government cost of $1.23 billion per year (range $373 million to $1.98 billion; 11% reduction).Interpretation: Our analysis showed that adding universal public coverage of essential medicines to the existing public drug plans in Canada could address most of Canadians' pharmaceutical needs and save billions of dollars annually. Doing so may be a pragmatic step forward while more comprehensive pharmacare reforms are planned. [ABSTRACT FROM AUTHOR]

The current health reforms in Aotearoa New Zealand are being described as "transformational". Political leaders and Crown officials maintain the reforms embed a commitment to Te Tiriti o Waitangi, address racism and promote health equity. These claims are familiar and have been used to socialise previous health sector reforms. This paper interrogates claims of engagement with Te Tiriti by undertaking a desktop critical Tiriti analysis (CTA) of Te Pae Tata: the Interim New Zealand Health Plan. CTA follows five stages from orientation, close reading, determination, strengthening practice, to the Māori final word. The determination was done individually and a consensus was negotiated from the indicators; silent, poor, fair, good, or excellent. Te Pae Tata proactively engaged with Te Tiriti across the entirety of the plan. The authors assessed Te Tiriti elements of the preamble, kāwanatanga and tino rangatiratanga as "fair", ōritetanga as "good" and wairuatanga as "poor". Engaging more substantively with Te Tiriti requires the Crown to recognise that Māori never ceded sovereignty and treaty principles are not equivalent to the authoritative Māori text. Recommendations of the Waitangi Tribunal WAI 2575 and Haumaru reports need to be explicitly addressed to allow monitoring of progress., Competing Interests: Nil, (© PMA.)

Historically, public health shared common concerns with town planning, as both sought to create healthy living environments. This article explores how the relationship between the two areas developed and changed in New Zealand and how this experience reflects New Zealand's colonial status and history and its bicultural character. It explores Māori experience of both areas in the period from 1840 to 1990 including how Māori concerns and interests were addressed and influenced public health and planning. The experience of Māori in these areas is also considered in terms of some of the experiences of First Nation people in Australia and Canada. It concludes that the shared history of planning and public health was not sustained beyond the 1940s. [ABSTRACT FROM AUTHOR]

There remain many treatment uncertainties in cystic fibrosis (CF). With limited resources, research should focus on questions which are most important to the CF community. We conducted a James Lind Alliance Priority Setting Partnership in CF. Research questions were elicited and then prioritised in successive surveys. A workshop agreed the final top 10. Online methods avoided cross infection and widened participation. The elicitation survey had 482 respondents (1080 questions) and prioritisation survey 677 respondents. Participants were drawn equally from the patient and clinical communities globally. We have achieved a consensus on 10 research priorities which will be attractive to funders. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Early pregnancy registration is recommended and provides an opportunity for screening, risk assessment and health promotion. AIM: To determine the gestation at pregnancy registration for a cohort of pregnant New Zealand women who received maternity care from a midwife Lead Maternity Carer (LMC) and to determine if women are registering earlier in pregnancy. METHODS: The gestation of pregnancy at registration was reviewed for the 81 821 women who registered with a midwife LMC between 2008 and 2010 and had data recorded in the New Zealand College of Midwives Clinical Outcomes Research Database (COMCORD). RESULTS: Over the three-year period, there was a trend towards earlier registration with 22.0% of women registering before 10 weeks' gestation in 2008 increasing to 29.9% in 2010. Women of New Zealand European ethnicity were more likely to register before 10 weeks' gestation compared to women who identified as Maori or Pacific ethnicity. Women under 20 or over 40 years of age were more likely to register in the second or third trimester than other age groups. DISCUSSION: Croups that were slower to register with a midwife LMC were women under 20 years or over 40 years of age and women of Maori or Pacific ethnicity. These groups have higher perinatal mortality rates, higher rates of smoking and lower uptake of antenatal Down syndrome screening. Further research is required to explore the barriers to earlier registration for these groups. [ABSTRACT FROM AUTHOR]

The purpose of this article is to clarify the current New Zealand driving licensing requirements for older adults and to provide practical recommendations for those health professionals who make decisions regarding driving ability in older adults. Health professionals involved in the assessment of older drivers were asked to clarify areas where more efficient use could be made of assessment resources. A review of driving literature was performed to find specific factors associated with increased risk of negative driving outcomes in older adults. Particular attention was paid to the suitability of different types of on-road assessment for certain patient groups, the effect of specific diseases and medications on driving safety, and the effect of cognitive impairment. A list of seven recommendations were compiled which include a focus on appropriate on-road driving assessment referral, driver refresher courses, cognitive screening for those presenting for licence renewal and sensitive broaching of the topic of driving cessation. [ABSTRACT FROM AUTHOR]

This article analyses the relationship between different modes of accountability in New Zealand's publicly funded health sector since 2001. It adopts a 'multiple modes of governance' framework, drawing on the findings of an evaluation of health system restructuring conducted between 2001 and 2005. In broad terms, governance of the health system has moved from a combination of hierarchy and market to a mixture of hierarchy and collaboration. This article assesses the degrees to which hierarchical and collaborative accountability regimes have clashed with or complemented each other. We also identify areas in which none of these modes of accountability operate. [ABSTRACT FROM AUTHOR]

A wide array of health policies and initiatives have emerged in New Zealand recently in an attempt to resurrect a presumed 'lost', adventure-loving, physically capable and non-obese Kiwi kid. Chief among these is Mission-On—a 67 million dollar package of 10 initiatives designed to explicitly target the eating and exercise dispositions of young people. I suggest that Mission-On, together with the raft of other avowedly health-promoting resources being directed at young people, provides an exemplary case of body pedagogies at play both via its far-ranging formally enunciated objectives and due to its annexing of these to popular cultures, familial obligations and educational missives. The aim of this paper, therefore, is to examine how pedagogies, like those regularly deployed under the Mission-On rubric, are made sense of by young children. The key habits and dispositions children believe are needed to achieve a healthy 'self' are highlighted, together with some of the ways in which young people come to assess the veracity of health knowledge. Analysis of interviews with New Zealand primary school students suggests that children engage with, enact and disrupt health imperatives in multiple ways, often linked to their differing social and spatial locations in home, school and community contexts. While their testimony points to small fissures in the Mission-On armoury, it is suggested that in a climate so thoroughly saturated with messages around healthy eating and exercise, it remains challenging for children to imagine themselves as the adventurous, confident, fun-loving 'kiwi kids' government desires to 'bring back'. [ABSTRACT FROM AUTHOR]

Background: The experience of menstruation and reproductive health by adolescent girls has been poorly studied in New Zealand. Aims: To develop and pilot a Web-based survey of 16-year-olds’ experience of menstruation and reproductive health with the eventual objective of conducting a larger population-based survey. A secondary aim was to report on the experience of menstrual and reproductive health in a group of 16-year-old girls in an urban setting. Methods: A Web-based survey was developed and tested in 2006 with assistance of a multidisciplinary advisory group. The final version of the questionnaire had 146 questions in 11 sections and the topics were menstrual history, general health including use of medications, access to medical care or health information, sexual health, family history and personal information including smoking, height, weight, ethnicity, paid employment of parents, drug and alcohol use and exercise patterns. Results: Seventy-five 16-year-old students completed the survey. Twenty-five per cent considered that their periods were quite a bit or a lot of trouble and 10% avoided certain activities during their menstrual periods, nearly 50% of girls always experienced some pain with every period, and 30% had seen a health professional about their period pains. Thirty-three stated that menstruation was moderately to severely painful and that daily activity was affected. Fifty per cent of girls were sexually active and of these 80% described it as painful. Conclusions: The Web-based survey was a successful approach to collecting information and could be used in a larger study. [ABSTRACT FROM AUTHOR]

This article proposes a strategic framework or road map for sustainable m-health. The drivers and critical success factors of this framework are identified from the literature and a survey of the views of senior strategists in the New Zealand health sector. The success factors are associated with key tasks in the framework that identify suitable applications, channel development activity, and confirm activity by continued support of innovation whilst moving successful applications into the mainstream. The two most important outcomes from the research are that m-health has a crucial, even inevitable, role to play in future healthcare, and the development and exploitation of m-health demands a top-down strategy or framework to match and encourage bottom-up innovation by healthcare practioners. Without such a strategy to guide (but not direct) innovation, many otherwise valuable advances will not be sustainable and resources will be wasted on questionable applications that will slow development and reduce credibility. [ABSTRACT FROM AUTHOR]

The article explores solutions to the shortage of physicians in Australia and New Zealand. Aside from a shortage of physicians, Australia and New Zealand face ethnic, regional and discipline-related shortfalls in health and related services. Among the effective variables in health workplace planning are sociocultural and economic changes, and pharmaceutical and other medical related industry developments and marketing. One solution to doctor shortages is to identify and employ disruptive innovations.

The article focuses on the study emphasizing on the health needs of elderly Indians who migrated to New Zealand. It points that there are gaps in the knowledge about the health status of Indian communities and plans for developing health policies and practices that are appropriate for them should be given attention. It also points that these Indian migrants are similar to Asian communities. Moreover, is enumerates on the different causes why health conditions of Asian people are ignored.

This paper provides an overview of the regulation of quality assurance for genetic testing in Australia and New Zealand and outlines the steps currently being taken to critically appraise and improve the regulatory framework in each country. It aims to contextualize this framework within the broader context of quality and patient safety concerns; and to draw together the concerns and recommendations of the various organizations that have been working to improve quality assurance in this area. [ABSTRACT FROM AUTHOR]