Search

Male veterans are vastly over-represented in suicide rates relative to non-veterans. A critical avenue for improving male veterans' mental health outcomes is improving their engagement with mental health services. This study presents a qualitative investigation of mental health practitioners' perspectives on enhancers of engagement in, and drivers of dropout from therapy among male veterans. Participants were 138 mental health practitioners across Australia, the USA, Canada, New Zealand and the UK (44.9% male; age M = 47.5 years, SD = 12 years). Participants responded to qualitative survey items inquiring about their perspectives on what works to engage male veterans in therapy, alongside common drivers of therapy dropout. Under an overarching theme contextualising the therapeutic alliance between veterans and mental health practitioners, interpretive description analyses led to eight distinct subthemes. Results highlight the range of areas in which mental health practitioners can thoughtfully adapt their practice to engage male veterans and align with military masculinities. In addition, findings underscore the range of barriers facing veterans when they seek help, which can precipitate dropout if not overcome by the right balance between practitioner engagement and veteran persistence. [ABSTRACT FROM AUTHOR]

Background: A growing body of transgender health research reports that transgender people often feel pressure to conform to a dominant narrative during gender-affirming readiness assessments. In New Zealand, however, no study to date has specifically examined transgender people’s experiences of readiness assessments for gender-affirming healthcare. Aims: This study aimed to explore the experiences of transgender young adults (aged 16-30) during gender-affirming readiness assessments in New Zealand. We also sought participants’ views on improving transgender healthcare provision. Methods: Thirteen transgender young adults took part in individual interviews or focus groups. Participants were asked to describe how they felt about the questions asked during readiness assessments and how the readiness assessment process could be improved. We used thematic analysis to identify patterns of meaning across the dataset. Results: We identified two themes. Firstly, proving gender explores participants’ views of readiness assessments as designed to establish whether they were “trans enough” or “truly” transgender, and why readiness assessments are conducted in this manner. Secondly, the trans narrative describes the pressure participants felt to adhere to a dominant transgender narrative in order to gain access to the healthcare they needed. Discussion: Our findings call attention to the importance of a trans-affirmative approach and the need to clarify the purpose of gender-affirming healthcare readiness assessments in New Zealand. [ABSTRACT FROM AUTHOR]

Four cases of listeriosis in a hospital (A) in New Zealand were identified in 2012. Pulsed‐field gel electrophoresis (PFGE) used at the time identified four pulsotypes amongst the clinical isolates. Two of the pulsotypes matched to Listeria monocytogenes isolates obtained from ready‐to‐eat (RTE) meat samples from a RTE producer tested during a nationwide microbiological survey the month prior. The outbreak investigation confirmed that the RTE producer had supplied product to the hospital and additional testing confirmed the presence of L.  monocytogenes in RTE meats from the hospital kitchen. Two further listeriosis cases presented in another hospital (B) with one clinical isolate identified as the same pulsotype as identified for one case in hospital A, but the epidemiology information concluded that the clinical cases from hospital B were not linked to the outbreak. Retrospective whole‐genome sequencing confirmed that epidemiologically linked isolates belonging to three different genotypes for clinical cases from hospital A and RTE meats samples from the hospital kitchen differed by 0‐1 core‐genome locus or single nucleotide polymorphisms (SNP). The use of core‐genome multilocus sequence typing and SNP analysis provided a greater degree of discrimination between isolates compared to PFGE. Significance and Impact of the Study: This study describes a listeriosis outbreak associated with a hospital in New Zealand and attributed to contaminated ready‐to‐eat (RTE) meat supplied to the hospital by a single producer. Retrospective whole‐genome sequence analysis of outbreak isolates was found to provide a greater degree of discrimination between isolates compared to pulsed‐field gel electrophoresis and supported the conclusions made at the time of the outbreak. The multiple genotypes identified from clinical cases and the RTE meats obtained during the outbreak highlight the importance of epidemiological concordance alongside genotyping. [ABSTRACT FROM AUTHOR]

The article presents a study which aims to train doctors in collaborative and ethical communication regarding informed consent and assess the impact of training on the behaviour, stress and satisfaction of a physician. It shows that doctors strongly supported the training and did not demonstrate reduced stress and burnout. Results suggest the potential of training to improve a number of aspects of obtaining informed consent.

Epithelial ovarian cancer (EOC) is the most lethal gynaecological malignancy. Despite advances in surgery and chemotherapy, the majority of patients will experience disease recurrence and 5-year survival rates have improved little over the past few decades, highlighting the urgent need for novel therapies. The emergence of ICIs brought much enthusiasm, with curative potential for even the most advanced tumours. Despite this promise, most ovarian cancers exhibit poor responses to anti-PD-1/L1 inhibitors. For many patients with EOC, spontaneous T cell responses against their tumours are absent or weak – approx. 40% of women have no sign of T cells within their tumours, so checkpoint inhibitor drugs are unlikely to work. This relative lack of responses to anti-PD-1/L1 has led us to explore other forms of immunotherapy for EOC, particularly adoptive cell therapy. Using high-dimensional patient profiling we have been rationally developing a T cell product derived from patient peripheral blood to target residual disease following first-line therapies. To identify potential targets for our therapy we used a multiplex digital pathology system to examine the expression of checkpoint receptors and tumour-associated proteins in the tumours of New Zealand patients with High-Grade Serous Ovarian Cancer. We identified three targetable proteins (PRAME, NYESO-1, and Mage-A4) that demonstrate overlapping expression – targeting all three allows 90% coverage of the tumours examined. Analysis of whole tumour slides revealed the presence of tertiary lymphoid structures and tumour-associated fibroblasts linked with fibrosis. In tandem with our investigation of the tumour site, we conducted immunological profiling on peripheral blood to identify variations in the potential starting material derived from ovarian cancer patients. Our analysis revealed alterations in the proportions of T cell subtypes, accompanied by a decrease in PD-1 expression compared to age-matched healthy controls. While these findings shed light on specific immune changes associated with ovarian cancer, our assessment suggests minimal systemic differences that might pose barriers to the manufacturing process. Finally, we have begun using our established priming protocol to grow tumour-specific cells from our patient cohort. Using the information gained from high-dimensional patient profiling, we hope to build a therapy that will rationally target epithelial ovarian cancers and improve progression-free survival [ABSTRACT FROM AUTHOR]

Aim: To develop processes for the development of decentralised clinical trial methodology for Aotearoa New Zealand, focussing on equity of access to cancer clinical trials for Māori, Pacific people, vulnerable communities and those in rural settings., Methods: A national steering committee supported by Te Aho o Te Kahu - Cancer Control Agency was formed to: guide the adaptation and implementation of overseas decentralised clinical trial models to suit the needs of Aotearoa New Zealand with an equity focus; provide high-level oversight and expertise for direction and development of policies, procedures and infrastructure compliant with ICH GCP R2; and implement a national strategy., Results: Twelve standard operating procedures were developed, as well as a supervision plan and a glossary. These were made freely available on the New Zealand Association of Clinical Research website., Conclusion: Decentralised clinical trials offer a novel method of trial conduct that is patient- and whānau-centred. The model allows patients to remain in their local area with whānau and support networks, and their local treating team, increasing clinical trial accessibility and quality of care. This methodology has the potential to support improvement in research capabilities nationally and be utilised beyond oncology. It would benefit from significant investment in national clinical trial infrastructure., Competing Interests: Nicola J Lawrence received support from Te Aho o Te Kahu for a project manager for this work and is is co-lead of the New Zealand DCT committee. Marina Dzhelali is a New Zealand Association of Clinical Research board member. Ngapei Ngatai received support from CTNZ for this manuscript. Alvin Tan is director at SalutisCare. Michelle Wilson received support from Te Aho o te Kahu for a project manager for this work and is co-lead of the New Zealand DCT committee., (© PMA.)

Aim: To examine the impact of integrated employment support and mental health treatment (Individual Placement and Support, or "IPS") on Aotearoa New Zealand participants' employment, income, health, education and justice outcomes., Method: De-identified linked data from the Stats NZ Integrated Data Infrastructure and propensity score matching were used to estimate effects., Results: In total, 1,659 IPS participants were matched to 1,503 non-participants. Compared with matched non-participants, matched participants were 1.6 times more likely to be in employment at 12 months. Over 3 years, matched IPS participants had more earnings, more time in employment, greater total income and were more likely to gain qualifications. They also had more face-to-face contacts with mental health teams, mental health-related inpatient stays and mental health service crisis contacts than matched non-participants. Effects for Māori were similar in direction and scale to the overall results., Conclusion: Our results show that people with mental health conditions or problematic substance use who receive employment support made available together with mental health and addiction treatment have more employment, gains in qualifications and more independent income when compared to similar people who do not receive this support. More research is needed to understand differences in engagement with mental health services and effects on participants' health and wellbeing., Competing Interests: Wilson and Gray are employed by agencies that fund IPS. Lockett is employed by a non-government organisation that is associated with organisations that deliver IPS and IPS implementation support. The study was funded by the Ministry of Social Development. FC received funding from MSD to Katoa Ltd to cover time on this project. KM was paid as an analytical consultant under contract to MSD. SB and DP received funding from MSD to University of Otago to cover time on this project. Disclaimer: These results are not official statistics. They have been created for research purposes from the Integrated Data Infrastructure (IDI), which is carefully managed by Stats NZ. For more information about the IDI please visit https://www.stats.govt.nz/integrated-data/. The results are based in part on tax data supplied by Inland Revenue to Stats NZ under the Tax Administration Act 1994 for statistical purposes. Any discussion of data limitations or weaknesses is in the context of using the IDI for statistical purposes and is not related to the data’s ability to support Inland Revenue’s core operational requirements. The views, opinions, findings and recommendations expressed in this report are those of the authors. They do not necessarily reflect the views of the Ministry of Social Development, or people involved in the peer review process. Any errors or omissions are our own., (© PMA.)

Objective: The objective was to identify clinically meaningful groups of adolescents based on self-reported mental health and wellbeing data in a population sample of New Zealand secondary school students., Methods: We conducted a cluster analysis of six variables from the Youth19 Rangatahi Smart Survey ( n = 7721, ages 13-18 years, 2019): wellbeing (World Health Organization Well-Being Index), possible anxiety symptoms (Generalized Anxiety Disorder 2-item, adapted), depression symptoms (short form of the Reynolds Adolescent Depression Scale) and past-year self-harm, suicide ideation and suicide attempt. Demographic, contextual and behavioural predictors of cluster membership were determined through multiple discriminant function analysis. We performed cross-validation analyses using holdout samples., Results: We identified five clusters ( n = 7083). The healthy cluster ( n = 2855, 40.31%) reported positive mental health across indicators; the anxious cluster ( n = 1994, 28.15%) reported high possible anxiety symptoms and otherwise generally positive results; the stressed and hurting cluster ( n = 667, 9.42%) reported sub-clinical depression and possible anxiety symptoms and some self-harm; the distressed and ideating cluster ( n = 1116, 15.76%) reported above-cutoff depression and possible anxiety symptoms and high suicide ideation; and the severe cluster ( n = 451; 6.37%) reported the least positive mental health across indicators. Female, rainbow, Māori and Pacific students and those in higher deprivation areas were overrepresented in higher severity clusters. Factors including exposure to sexual harm and discrimination were associated with increasing cluster severity., Conclusion: We identified high prevalence of mental health challenges among adolescents, with distinct clusters of need. Youth mental health is not 'one size fits all'. Future research should explore youth behaviour and preferences in accessing support and consider how to best support the mental health of each cluster., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Background: Mucinous ovarian carcinoma (MOC) is a rare ovarian cancer with limited evidence to support clinical care., Aims: We undertook a clinician survey to better understand current practice in treating MOC in Australia and New Zealand, and to determine any features associated with variation in care. In addition, we aimed to understand future research priorities., Methods: A RedCap survey was distributed to clinician members of the Australia New Zealand Gynaecological Oncology Group (ANZGOG). Questions included respondent demographics, three case studies and future research priorities. Clinicians were asked questions specific to their speciality., Results: Respondents (n = 47) were commonly experienced gynae-oncology specialists, most often surgical (38%) or medical (30%) oncologists. There was good consensus for surgical approaches for stage I disease; however, variation in practice was noted for advanced or recurrent MOC. Variation was also observed for medical oncologists; in early-stage disease there was no clear consensus on whether to offer chemotherapy, or which regimen to recommend. For advanced and recurrent disease a wide range of chemotherapy options was considered, with a trend away from an ovarian-type toward gastrointestinal (GI)-type regimens in advanced MOC. This practice was reflected in future research priorities, with 'Is a GI chemotherapy regimen better than an ovarian regimen?' the most highly ranked option, followed by 'Should stage 1C patients receive chemotherapy?', Conclusions: Although the number of respondents limited the analyses, it was clear that chemotherapy selection was a key point of divergence for medical oncologists. Future research is needed to establish well-evidenced guidelines for clinical care of MOC., (© 2024 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Pundits have speculated that the spread of conspiracies and misinformation (termed "misbeliefs") is leading to a resurgence of right-wing, reactionary movements. However, the current empirical picture regarding the relationship between misbeliefs and collective action is mixed. We help clarify these associations by using two waves of data collected during the COVID-19 Pandemic (in Australia, N = 519, and the United States, N = 510) and democratic elections (in New Zealand N = 603, and the United States N = 609) to examine the effects of misbeliefs on support for reactionary movements (e.g., anti-lockdown protests, Study 1; anti-election protests, Study 2). Results reveal that within-person changes in misbeliefs correlate positively with support for reactionary collective action both directly (Studies 1-2) and indirectly by shaping the legitimacy of the authority (Study 1b). The relationship between misbelief and legitimacy is, however, conditioned by the stance of the authority in question: the association is positive when authorities endorse misbeliefs (Study 1a) and negative when they do not (Study 1b). Thus, the relationship between conspiracy beliefs and action hinges upon the alignment of the content of the conspiracy and the goals of the collective action., (© 2024 The Authors. British Journal of Social Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Objective: To describe the characteristics of the New Zealand child injury prevention workforce and the organisations they represent., Methods: Representatives of organisations on the Safekids Aotearoa database were invited to complete an online survey. The standardised questionnaire asked for information about injury prevention focus and expertise, communication preferences and information access., Results: Of 196 respondents, the majority were female and identified as New Zealand European. For only a small proportion of respondents, child injury prevention is the main focus of their role. The key sources of child injury data and injury prevention information identified was Safekids Aotearoa, followed by the Ministry of Health. Respondents indicated that they would like to receive information on new research, training opportunities and upcoming events, and information from other organisations., Conclusions: Males and people of Pacific and Asian ethnicity are under-represented in the New Zealand child injury prevention workforce in New Zealand. The low engagement of the sector with Māori authorities is of concern, given the inequities in rates of child injury that exist., Implications for Public Health: There is a need to conduct a wider and more regular audit of the child injury prevention sector to determine its composition and identify areas of concern., (© 2022 The Authors.)

Background and Objective: Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious condition occurring in 2%-4% of patients after acute pulmonary embolism. Pulmonary endarterectomy (PEA) is a potential cure for technically operable disease. The epidemiology and long-term outcomes of CTEPH have not been previously described in Australia and New Zealand., Methods: Data were extracted from the Pulmonary Hypertension Society of Australia and New Zealand (PHSANZ) registry for patients diagnosed with CTEPH between January 2004 and March 2020. Baseline characteristics, treatment strategies, outcome data and long-term survival are reported., Results: A total of 386 patients were included with 146 (37.8%) undergoing PEA and 240 (62.2%) in the non-PEA group. PEA patients were younger (55 ± 16 vs. 62 ± 16 years, p < 0.001) with higher baseline 6-min walk distance (6MWD; 405 ± 122 vs. 323 ± 146 m, p = 0.021), whilst both groups had similar baseline pulmonary haemodynamics. Pulmonary hypertension-specific therapy was used in 54% of patients post-PEA and 88% in the non-PEA group. The 1-, 3- and 5-year survival rates were 93%, 87% and 84% for the PEA group compared to 86%, 73% and 62%, respectively, for the non-PEA group (p < 0.001). Multivariate survival analysis showed baseline 6MWD was an independent predictor of survival in both operated and medically managed patients., Conclusion: In this first multicentre report of CTEPH in Australia and New Zealand, long-term survival is comparable to that in other contemporary CTEPH registries. However, PEA was only performed in a minority of CTEPH patients (37.8%) and significantly less than overseas reports. Greater awareness of PEA and improved patient access to experienced CTEPH centres are important priorities., (© 2021 Asian Pacific Society of Respirology.)

Enduring health inequities exist between Māori and non-Māori children within child injury prevention in Aotearoa. These inequities reflect broader patterns of health inequity experienced by Indigenous peoples globally and in Aotearoa. We assert their existence is the result of the ongoing impacts of colonisation and the dominant Pākehā framing by which injury prevention messages and interventions in Aotearoa have largely been developed. We argue the need for a strengths-based approach, grounded in mātauranga Māori (traditional Māori knowledge) and te ao Māori (traditional Māori worldview) perspectives, to form the basis of more effective child injury prevention messaging and interventions. In this viewpoint, we detail foundational elements of mātauranga Māori, tikanga (customs), kawa (practices) and mātāpono (values) that underlie Māori culture and contain protective elements and safety principles that can be readily applied to injury prevention messaging. We present two values-based child-rearing practices: (1) tuakana (older sibling/s) and teina (younger sibling/s) relationships and (2) kotahitanga (collective), which are determined by mātāpono that illustrate the value of a Māori framework. Incorporating a kaupapa Māori (Māori perspective/s) approach to injury prevention is necessary to reduce health inequities between Māori and non-Māori. Moreover, it offers a culturally safe approach that is responsive to Māori and enables tamariki (children) and whānau (families) to flourish., Competing Interests: Nil.

Aims: To estimate the burden and inequity of unintentional childhood injury for children in Aotearoa., Methods: We used administrative data from the Accident Compensation Corporation (ACC) and the Ministry of Health to estimate the direct, indirect and intangible costs of unintentional injuries in children aged under 15 and the inequity of the impact of childhood injury on discretionary household income. We used an incidence approach and attributed all costs arising from injuries to the year in which those injuries were sustained., Results: 257,000 children experienced unintentional injury in 2014, resulting in direct and indirect costs of almost $400 million. The burden of lost health and premature death was the equivalent of almost 200 full lives at perfect health. Pacific children had the highest incidence rates. Māori had the lowest rates of ACC claims but the highest rate of emergency department attendance. Children living with the highest levels of socioeconomic deprivation had the highest rate of hospital admission following injury. The proportional loss in discretionary income arising from an injury was higher for Māori and Pacific compared to non-Māori, non-Pacific households., Conclusion: The burden of unintentional childhood injury is greater than previously reported and has a substantial and iniquitous societal impact. There should be a focus on addressing inequities in incidence and access to care in order to reduce inequities in health and financial impact., Competing Interests: Nil.

Background: We describe the investigation of a Campylobacter outbreak linked to contamination of an untreated, groundwater derived drinking water supply., Methods: We analysed epidemiological data collected from clinician-confirmed diarrheal cases and estimated the total burden of Havelock North cases using an age-adjusted cross-sectional telephone survey. Campylobacter isolates from case fecal specimens, groundwater samples, and sheep fecal specimens from paddocks adjacent to the drinking water source were whole genome sequenced., Findings: We estimate between 6260 and 8320 cases of illness including up to 2230 who lived outside the reticulation area, were linked to the contaminated water supply. Of these, 953 cases were physician reported, 42 were hospitalized, three developed Guillain-Barré syndrome, and Campylobacter infection contributed to at least four deaths. Of the 12 genotypes observed in cases, four were also observed in water, three were also observed in sheep and one was also observed in both water and sheep., Interpretation: The contamination of the untreated reticulated water supply occurred following a very heavy rainfall event which caused drainage of sheep feces into a shallow aquifer. The existence of a routine clinical surveillance system for campylobacteriosis facilitated identification of the outbreak, recovery of clinical isolates, and early testing of the water for pathogens. Genotyping of the Campylobacter jejuni helped define the source of the outbreak and confirm outbreak periods and cases. Expected increases in heavy rainfall events and intensification of agriculture mean that additional safeguards are needed to protect populations from such drinking water outbreaks., Funding: NZ Ministry of Health, Health Research Council, ESR SSIF, Royal Society., (Copyright © 2020. Published by Elsevier Ltd.)

Biological control (biocontrol) as a component of pest management strategies reduces reliance on synthetic chemicals, and seemingly offers a natural approach that minimizes environmental impact. However, introducing a new organism to new environments as a classical biocontrol agent can have broad and unanticipated biodiversity effects and conservation consequences. Nematodes are currently used in a variety of commercial biocontrol applications, including the use of Phasmarhabditis hermaphrodita as an agent targeting pest slug and snail species. This species was originally discovered in Germany, and is generally thought to have European origins. P. hermaphrodita is sold under the trade name Nemaslug®, and is available only in European markets. However, this nematode species was discovered in New Zealand and the western United States, though its specific origins remained unclear. In this study, we analyzed 45 nematode strains representing eight different Phasmarhabditis species, collected from nine countries around the world. A segment of nematode mitochondrial DNA (mtDNA) was sequenced and subjected to phylogenetic analyses. Our mtDNA phylogenies were overall consistent with previous analyses based on nuclear ribosomal RNA (rRNA) loci. The recently discovered P. hermaphrodita strains in New Zealand and the United States had mtDNA haplotypes nearly identical to that of Nemaslug®, and these were placed together in an intraspecific monophyletic clade with high support in maximum likelihood and Bayesian analyses. We also examined bacteria that co-cultured with the nematode strains isolated in Oregon, USA, by analyzing 16S rRNA sequences. Eight different bacterial genera were found to associate with these nematodes, though Moraxella osloensis, the bacteria species used in the Nemaslug® formulation, was not detected. This study provided evidence that nematodes deriving from the Nemaslug® biocontrol product have invaded countries where its use is prohibited by regulatory agencies and not commercially available., Competing Interests: The authors have declared that no competing interests exist

The tuatara (Sphenodon punctatus)-the only living member of the reptilian order Rhynchocephalia (Sphenodontia), once widespread across Gondwana 1,2 -is an iconic species that is endemic to New Zealand 2,3 . A key link to the now-extinct stem reptiles (from which dinosaurs, modern reptiles, birds and mammals evolved), the tuatara provides key insights into the ancestral amniotes 2,4 . Here we analyse the genome of the tuatara, which-at approximately 5 Gb-is among the largest of the vertebrate genomes yet assembled. Our analyses of this genome, along with comparisons with other vertebrate genomes, reinforce the uniqueness of the tuatara. Phylogenetic analyses indicate that the tuatara lineage diverged from that of snakes and lizards around 250 million years ago. This lineage also shows moderate rates of molecular evolution, with instances of punctuated evolution. Our genome sequence analysis identifies expansions of proteins, non-protein-coding RNA families and repeat elements, the latter of which show an amalgam of reptilian and mammalian features. The sequencing of the tuatara genome provides a valuable resource for deep comparative analyses of tetrapods, as well as for tuatara biology and conservation. Our study also provides important insights into both the technical challenges and the cultural obligations that are associated with genome sequencing.

Objectives: In March 2018, New Zealand (NZ) introduced standardised tobacco packaging that also featured new pictorial warnings, with implementation completed by early June 2018. We evaluated how the new packaging affected tobacco pack displays in outdoor areas of hospitality venues., Design: Before-and-after descriptive field observation study., Setting: Central city area of the capital city of NZ (Wellington)., Participants: Observations of people smoking and tobacco packs were made at 56 hospitality venues with outdoor tables (2422 separate venue observations), after the introduction of standardised tobacco packaging. Comparisons were made with a prior study in the same setting, from a time when tobacco packaging still featured brand imagery., Results: A total of 8191 patrons, 1113 active smokers and 889 packs and pouches (522 of known orientation) were observed over 2422 venue observations. There were 0.80 visible packs per active smoker in 2018, compared with 1.26 in 2014 (risk ratio (RR)=0.64, 95% CI 0.60 to 0.67, p<0.0001). The new packs in 2018 were also less likely to be displayed face-up, compared with packs in 2014, which had brand imagery on the front face (RR=0.77, 95% CI 0.72 to 0.83, p<0.0001). Pack and pouch display (RR=3.09 in 2014 and 3.10 in 2018) and active smoking (RR=3.16 in 2014 compared with 3.32 in 2018) were higher at venues without children present, compared with venues with children present (this finding was consistent over time)., Conclusions: The reduction in the number of visible packs per active smoker, along with the reduction in face-up positioning of packs, suggests that smokers found the new standardised packs less attractive. Countries introducing standardised packaging should consider evaluating social display of tobacco packaging., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: A proxy is someone other than a patient who reports a patient's outcomes as if they are the patient. Due to known discordance with patient reports, proxies are often not recommended in clinical trials; however, proxies may be needed in certain research contexts. We aimed to identify and describe trials registered on the Australian New Zealand Clinical Trials Registry (ANZCTR) with proxy-reported endpoints., Methods: ANZCTR was systematically searched from inception (2005) to 31 March 2017 for trials with proxy-reported endpoints. Primary and secondary endpoints for each trial retrieved by the search were individually coded (proxy-reported: yes/no), and trials with confirmed proxy-reported endpoints were included in the analysis., Results: Of 13,666 registered trials, 469 (3.4%) included a proxy-reported endpoint (867 individual proxy-reported endpoints in total: 62% family member proxy, 22% health professional). Proxy endpoint inclusion did not significantly increase over time (r = 0.18, p = 0.59). Mental health (11.5%), stroke (10.3%) and neurological (8.3%) trials had the highest proportion of trials using proxies. Of the 469 trials, 123 (26.2%) studies involved paediatric patients., Discussion: Proxy-reported endpoints are included in a small but notable number of studies, which may indicate other types of outcomes are used for patients unable to self-report, or that these patients are under-researched.

Aims: This study investigated New Zealand nurses' views on legalising assisted dying across a range of clinical conditions, nurses' willingness to engage in legal assisted dying, potential deterrents and enablers to such engagement, and nurses' perceptions of the proper role of their professional bodies in relation to legalising assisted dying., Background: A Bill for legalising assisted dying is currently before the New Zealand parliament. Of the 16 jurisdictions where assisted dying has been specifically legislated, only the Canadian federal statute provides nurses with explicit legal protection for their performance of assisted dying-related tasks. An absence of policy development and planning for safe nursing practice prior to legalisation of assisted dying results in a gap in professional support and guidance., Design: Exploratory cross-sectional survey., Respondents: A self-selected sample of 475 New Zealand nurses responded to an anonymous online survey disseminated through the newsletters and websites of relevant medical and nursing professional bodies. A sub-sample of nurses who expressed support for or ambivalence about legalisation (n = 356): rated their level of support for legalising assisted dying in New Zealand across a range of medical conditions, and their willingness to participate in a range of assisted dying tasks; identified barriers and facilitators to potential participation; and assessed the responsibility of the professional bodies to provide practice supports., Method: Mixed-method approach using descriptive analysis of quantitative data; qualitative data were analysed thematically., Results: Nurses supported legalisation at a rate (67%) significantly greater than that of doctors (37%) and for a diverse range of medical conditions. Most supporting nurses were willing to engage in the full range of relevant assisted dying roles. They identified several practical and ethical supports as essential to safe engagement, in particular practice guidelines, specific training, legal protections, clinical supervision and mentoring, and independent review of assisted dying service provision. They saw the facilitation of these supports as primarily the responsibility of their professional bodies., Implications for Policy: Nursing bodies should proactively facilitate workforce awareness and development of assisted dying policy and practice supports in anticipation of legalisation. This can be done through information campaigns and by adapting assisted dying policy, practice materials and systems already developed internationally. Nursing bodies need to engage in formulating legislation to ensure inclusion of explicit protections for participating nurses and to delegate relevant responsibilities to regulatory bodies., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

In New Zealand, there is a high prevalence of childhood poverty and food insecurity, which can impact a family's ability to provide high quality, nutrient dense foods for their children. In an attempt to increase the quality of the food consumed by children attending a decile two (low socio-economic) kindergarten and to address food insecurity issues, an educational health and wellness initiative, in conjunction with a free lunch programme, was introduced. The impact of the lunches and the effectiveness of the programme were evaluated. Baseline and end-intervention 24-h modified dietary recall questionnaire data and a vegetable- and fruit-specific food frequency questionnaire (FFQ) were collected. A follow-up FFQ was administered six months after the end of the intervention. The nutrient composition of the foods recorded in the 24-h recall questionnaires were analysed using FoodWorks8™. Whilst no significant differences were observed with the intakes of individual nutrients, there was a significant decrease in the consumption of ultra-processed snack foods ( p = 0.015). The results of the follow-up FFQ, including the comments collected from the parents, suggested that the intervention had a longer-term positive impact on not only the children involved in the study but also on their whānau (wider family members)., Competing Interests: The authors declare no conflict of interest.

This study examined the correlates of right-wing authoritarianism (RWA) in older adults. Participants were given tasks measuring emotion recognition, executive functions and fluid IQ and questionnaires measuring RWA, perceived threat and social dominance orientation. Study 1 established higher age-related RWA across the age span in more than 2,600 New Zealanders. Studies 2 to 4 found that threat, education, social dominance and age all predicted unique variance in older adults' RWA, but the most consistent predictor was emotion recognition, predicting unique variance in older adults' RWA independent of all other variables. We argue that older adults' worse emotion recognition is associated with a more general change in social judgment. Expression of extreme attitudes (right- or left-wing) has the potential to antagonize others, but worse emotion recognition means that subtle signals will not be perceived, making the expression of extreme attitudes more likely. Our findings are consistent with other studies showing that worsening emotion recognition underlies age-related declines in verbosity, understanding of social gaffes, and ability to detect lies. Such results indicate that emotion recognition is a core social insight linked to many aspects of social cognition., ((c) 2016 APA, all rights reserved).)

Child welfare data collected for administrative purposes are often used as a source of information for understanding the population impact of child abuse and neglect (CA/N). This study used administrative data linked at the individual level for a cohort of Aotearoa New Zealand (NZ) children to follow and extend a model developed by Drake et al. In this investigation, we aimed to build an understanding of the high representation of indigenous NZ children in administratively sourced measures of CA/N. Variation in rate ratios (RRs) within infant mortality and birth outcomes considered as possible proxies for actual CA/N RRs leaves open a range of interpretations. Our findings indicate that a more nuanced interpretation of the overrepresentation of indigenous children in administratively recorded maltreatment statistics is required. Rather than considering risk and bias as competing explanations, we suggest an acknowledgment of the impact of colonization and the existence of systemic bias generating increased risk as key drivers. As linked administrative data are increasingly used for research and evaluation, and considered for use in supporting decision making, there is a need for a deeper understanding of the drivers of administratively recorded CA/N in order to effectively address the needs of indigenous populations., (© The Author(s) 2015.)

Background: There are limited clinical data on enteric fever in the Pacific and New Zealand (NZ) compared with the Indian subcontinent (ISC) and South-East Asia (SEA). Our objective was to describe enteric fever in Auckland - a large Pacific city, focusing on disease acquired in these regions., Methods: We reviewed enteric fever cases hospitalised in Auckland from January 2005 to December 2010., Results: Microbiologically confirmed EF was identified in 162 patients. Travel regions: Pacific, 40 cases (25%) (Samoa, 38; Fiji, two), ISC, 72 (44%), SEA, seven (4%), other, three (2%), no travel, 40 (25%). Enteric fever rates for Auckland resident travellers were: India 50.3/100 000; Samoa 19.7/100 000.All Pacific cases were Salmonella Typhi. Of local isolates (without travel history), 38 were S. Typhi (36 fully susceptible, one multi-drug resistant (MDR) + nalidixic acid resistant (NAR), one unknown) and two S. Paratyphi (both NAR). Of non-Pacific travel, 56/82 (69%) isolates were S. Typhi, the remainder S. Paratyphi (15 isolates were fully susceptible, only 1% were MDR). Significant associations of serotype and antibiotic resistance with different travel regions and similarity of phage types (local and Pacific) were observed. Headache, vomiting and acute kidney injuries were more frequent with Pacific travel, while abdominal distension and cholecystitis with local disease. Shorter duration of treatment in the Pacific group was seen despite length of stay in hospital not being reduced. Local cases were associated with longer hospital admissions., Conclusions: One half of cases in Auckland are acquired either from Pacific or locally. Similarities mean that disease acquired locally is likely of Pacific origin., (© 2014 Royal Australasian College of Physicians.)

A widespread salmonellosis outbreak linked to consumption of hummus made from contaminated tahini imported from Turkey occurred in New Zealand in November 2012. This article summarizes the outbreak detection, investigation, and control. The New Zealand Enteric Reference Laboratory alerted public health units regarding a cluster of 11 persons with Salmonella Montevideo infection identified from different regions of the North Island of New Zealand. A multiagency outbreak investigation commenced to determine the source of illness and prevent further transmission. Salmonellosis is a notifiable disease in New Zealand. Outbreak cases were identified through routine salmonellosis notifications, and interviewed using a standardized questionnaire to identify common exposures. Clinical and food isolates were initially characterized by serotyping and then further typed by pulsed-field gel electrophoresis (PFGE). PFGE profiles were sent to PulseNet and international alerts were posted. The scope of the investigation widened to include persons with either Salmonella Maastricht and Salmonella Mbandaka infection following detection of these serotypes in tahini epidemiologically linked to laboratory-confirmed cases. All three of the tahini-associated serotypes were detected in people who had consumed tahini, and these were found to have PFGE profiles indistinguishable from the tahini isolates. Twenty-seven salmonellosis cases infected with at least one of the three tahini-associated Salmonella serotypes were detected between September 1 and December 31, 2012; of these, 16 (59%) cases (12 with Salmonella Montevideo, 3 with Salmonella Mbandaka, and 1 with Salmonella Maastricht infection) had PFGE patterns indistinguishable from the outbreak profile. The investigation led to a trade withdrawal and consumer recall for tahini sesame paste from the consignment and products containing this tahini. The outbreak ceased following the recall. The importer of the implicated tahini was reminded of his duties as a food importer, including ensuring appropriate product testing. Changes to New Zealand legislation strengthened food safety responsibilities of food importers.

The dominant model that informs clinical training for preventing violence and managing aggression posits arousal as mediated downwards from higher cortical structures. This view results in an often-misplaced reliance on verbal and cognitive techniques for de-escalation. The emergence of sensory modulation, via the Six Core Strategies, is an alternative or complementary approach that is associated with reduced rates of seclusion and restraint. Sensory-based interventions are thought to promote adaptive regulation of arousal and emotion, but this connection has had limited theoretical and empirical development. This paper presents results of a pilot trial of sensory-based interventions in four inpatient mental health units in New Zealand. Narrative analysis of interview and focus group data suggest that modifications to the environment and the use of soothing stimuli moderate or optimize arousal and promote an ability to adaptively regulate emotion. Findings are discussed in light of recent advances in the neurophysiology of emotional regulation and the General Aggression Model that posits arousal and maladaptive emotional regulation as precursors to aggression., (© 2013 The Authors; International Journal of Mental Health Nursing © 2013 Australian College of Mental Health Nurses Inc.)

A cluster of salmonellosis cases caused by Salmonella Typhimurium phage type 42 (STM42) emerged in New Zealand in October 2008. STM42 isolates from a wheat-based poultry feed raw material (broll; i.e., product containing wheat flour and particles of grain) had been identified in the 2 months prior to this cluster. Initial investigations indicated that eating uncooked baking mixture was associated with illness. A case-control study was conducted to test the hypothesis that there was an association between STM42 cases and consumption of raw flour or other baking ingredients. Salmonella isolates from human and non-human sources were compared using pulsed-field gel electrophoresis (PFGE) and multiple-locus variable number tandem repeat analysis (MLVA). Environmental investigations included testing flour and other baking ingredients from case homes, unopened bags of flour purchased from retail stores, and inspection of an implicated flour mill. A case-control study of 39 cases and 66 controls found cases had 4.5 times the odds of consuming uncooked baking mixture as controls (95% confidence interval [CI] 1.6-12.5, p-value 0.001). Examination of individual baking ingredients found that, after adjusting for eggs, flour had an odds ratio (OR) of 5.7 (95% CI 1.1-29.1, p-value 0.035). After adjusting for flour, eggs had an OR of 0.8 (95% CI 0.2-3.4, p-value 0.762). PFGE patterns were identical for all STM42 isolates tested; however, MLVA distinguished isolates that were epidemiologically linked to the cluster. STM42 was recovered from flour taken from four cases' homes, two unopened packs purchased from retail stores and packs from three batches of retrieved (recalled) product. This outbreak was associated with the consumption of uncooked baking mixture containing flour contaminated with STM42. The implicated flour mill initiated a voluntary withdrawal from sale of all batches of flour thought to be contaminated. Media releases informed the public about implicated flour brands and the risks of consuming uncooked baking mixture.

Context: The novel influenza A(H1N1) pandemic affected Australia and New Zealand during the 2009 southern hemisphere winter. It caused an epidemic of critical illness and some patients developed severe acute respiratory distress syndrome (ARDS) and were treated with extracorporeal membrane oxygenation (ECMO)., Objectives: To describe the characteristics of all patients with 2009 influenza A(H1N1)-associated ARDS treated with ECMO and to report incidence, resource utilization, and patient outcomes., Design, Setting, and Patients: An observational study of all patients (n = 68) with 2009 influenza A(H1N1)-associated ARDS treated with ECMO in 15 intensive care units (ICUs) in Australia and New Zealand between June 1 and August 31, 2009., Main Outcome Measures: Incidence, clinical features, degree of pulmonary dysfunction, technical characteristics, duration of ECMO, complications, and survival., Results: Sixty-eight patients with severe influenza-associated ARDS were treated with ECMO, of whom 61 had either confirmed 2009 influenza A(H1N1) (n = 53) or influenza A not subtyped (n = 8), representing an incidence rate of 2.6 ECMO cases per million population. An additional 133 patients with influenza A received mechanical ventilation but no ECMO in the same ICUs. The 68 patients who received ECMO had a median (interquartile range [IQR]) age of 34.4 (26.6-43.1) years and 34 patients (50%) were men. Before ECMO, patients had severe respiratory failure despite advanced mechanical ventilatory support with a median (IQR) Pao(2)/fraction of inspired oxygen (Fio(2)) ratio of 56 (48-63), positive end-expiratory pressure of 18 (15-20) cm H(2)O, and an acute lung injury score of 3.8 (3.5-4.0). The median (IQR) duration of ECMO support was 10 (7-15) days. At the time of reporting, 48 of the 68 patients (71%; 95% confidence interval [CI], 60%-82%) had survived to ICU discharge, of whom 32 had survived to hospital discharge and 16 remained as hospital inpatients. Fourteen patients (21%; 95% CI, 11%-30%) had died and 6 remained in the ICU, 2 of whom were still receiving ECMO., Conclusions: During June to August 2009 in Australia and New Zealand, the ICUs at regional referral centers provided mechanical ventilation for many patients with 2009 influenza A(H1N1)-associated respiratory failure, one-third of whom received ECMO. These ECMO-treated patients were often young adults with severe hypoxemia and had a 21% mortality rate at the end of the study period.

Results from recently published clinical trials provide additional information to be considered in the choice of therapies in the management of acute coronary syndromes. This addendum summarises the important findings and their implications for recommended practice.

Aim: To improve detection and quality of assessment of child and partner abuse within a health service., Methods: A formal organisational change approach was used to implement the New Zealand Family Violence Intervention Guidelines in a mid-sized regional health service. The approach includes obtaining senior management support, community collaboration, developing resources to support practice, research, evaluation and training. Formal pre-post evaluations were conducted of the training. Barriers and enablers of practice change were assessed through 85 interviews with 60 staff. More than 6000 clinical records were audited to assess rates of questioning for partner abuse. Identifications of partner abuse and referrals made were counted through the Family Violence Accessory File. Referrals to the Department of Child, Youth and Family Services (CYFS) were recorded routinely by the CYFS. Audits assessed quality of assessment of child and partner abuse, when identified., Results: More than 700 staff were trained in dual assessment for child and partner abuse. Evaluations demonstrate improved confidence following training, though staff still need support. Barriers and enablers to asking about partner abuse were identified. Referrals from the health service to the CYFS increased from 10 per quarter to 70 per quarter. Identification of partner abuse increased from 30 to 80 per 6-month period. Routine questioning rates for partner abuse vary between services., Conclusion: Achieving and sustaining improved rates of identification and quality of assessment of child and partner abuse is possible with a formal organisational change approach.

Aims: To assess current attitudes and practice toward antenatal human immunodeficiency virus (HIV) risk assessment, HIV testing and barriers towards implementation of these among midwives, general practitioners (GPs) and obstetricians in the upper South Island, Methods: A survey was conducted among maternity care providers by anonymous self-administered questionnaire. Most questions were dichotomous, forced choice or Likert scale format but there were four open- ended questions asking for a written response., Results: The response rate was 57% overall. The main finding was that 275 (66%) of respondents assessed risk of HIV in less than 10% of patients, and 328 (midwives 93, 85%; GP's 226,77%; obstetricians 9,64%) respondents had performed less than three HIV tests in the past twelve months. Most respondents strongly agreed that detection of HIV during pregnancy is beneficial to mother 318 (83%) and to baby 367 (96%) and to mother prior to pregnancy 353 (92%). 202 (52%) supported and 44 (11%) were opposed to an antenatal screening programme in New Zealand. Most knew how to assess risk for HIV saw themselves as having an important role in antenatal HIV testing, and were comfortable performing risk assessment. Multiple reasons for current practices were offered, including perceived reluctance by women to be tested, lack of time, skills, knowledge and support services, and low rates of HIV in the community., Conclusions: The current policy of routine HIV risk assessment is not working among respondents. A systematic reassessment and implementation of a workable strategy needs to be undertaken in New Zealand.

Aims: To elicit acceptability of HIV screening during pregnancy in women of reproductive age in Christchurch., Methods: In-depth face-to-face interviews were conducted with women of reproductive age recruited from seven different service sites in Christchurch., Results: Women wanted to know about treatment that significantly reduces the risk of mother-to-child transmission. They wanted to know about other antenatal screening and were prepared to provide general consent, rather than specific consent for HIV testing. All study participants favoured routine offer of HIV testing during pregnancy for all women and most would agree to be tested, if the test was offered and recommended., Conclusions: The results of this study indicate the need to develop and test a user-friendly approach for offering routine HIV testing during standard antenatal care in New Zealand.

Aim: To improve understanding of the HIV epidemic in New Zealand through use of an enhanced voluntary reporting system for new diagnoses of HIV., Methods: Routine reporting of new HIV diagnoses by the two laboratories that perform confirmatory HIV antibody testing, to the Department of Health and later to the AIDS Epidemiology Group, has been in place since 1985. From January 1996, this was supplemented by a questionnaire about demographic characteristics and circumstances of HIV exposure sent to clinicians requesting the HIV test., Results: From January 1996 to December 1998, 260 new diagnoses of HIV were reported (205 males, 55 females) and extra information was obtained from clinicians for 253 (97.3%) people. HIV diagnosis rate was highest for 'other' ethnicity and similar for European, Maori and Pacific Island ethnic groups. Sexual intercourse between men was the commonest mode of infection (43.5%), followed by heterosexual intercourse (40.0%) and injecting drug use (2.7%). Places of infection were New Zealand (38.5%), Australia (7.7%), 'other' overseas (45.4%) and unknown (8.5%). Heterosexual infections were acquired through contact with a person in or from a high prevalence area (mainly in Africa or Asia) for 86.7% of males and 68.2% of females. Second generation heterosexual transmission was rare., Conclusions: Introduction of an enhanced surveillance system has been successful. Results confirm continuing spread of HIV in New Zealand amongst men who have sex with men, and suggest low levels of heterosexual and injecting drug use transmission in New Zealand. Of major importance in the occurrence of heterosexual infection is the role of imported HIV.

Background: Accurate clerical coding of discharge diagnoses is important partly because results may be used to derive a recommended costing for hospital length of stays (LOS). Some authors think that discharge coding undertaken by clinicians will result in less diagnostic misclassification than clerical coding. This presupposes a high degree of between-observer diagnostic agreement between clinicians., Aims: To compare discharge coding undertaken by two general physicians, for patients receiving a clerical discharge code of cerebrovascular disease. The recommended LOS was then calculated from each observer's discharge codes using the Physicians Diagnosis Related Group Working Guidebook., Results: Eighty-two cases were coded as stroke by the clerical coder. Both medical coders agreed with this diagnosis in 68 (83%) of these cases. The corresponding figure for cases coded by the clerical coder as transient cerebral ischaemia was 47% (32/68) agreement between all three observers. Correcting for chance agreement between medical observers using the kappa statistic, a value of 0.64 was obtained for the combined stroke and transient cerebral ischaemia discharges, suggesting moderate diagnostic agreement. Using the clerical coder's results, the mean recommended LOS for all cases of cerebrovascular disease over the study period was calculated at 6.68 days. The corresponding values for the two medical coders were 6.68 days and 6.75 days., Conclusions: Diagnostic agreement between clinicians was moderate. Consideration of alternative diagnostic possibilities and the difficulty in determining the duration of neurological deficit were the main reasons for diagnostic disagreement. The mean recommended LOS was similar, however, when comparing results from all three observers.

The case of a six year old European male with congenital central hypoventilation is reported to illustrate that survival and positive developmental outcome is possible in a remote town in the Northland. Initial and ongoing problems include persistent ventilatory requirement, medical, developmental and psychosocial issues. Positive parental attitude, meticulous care to activities of daily living, medical and psychosocial surveillance and continuing support contribute to the success in management. Various treatment options are also discussed. Primary failure of respiratory regulation, also known as congenital central hypoventilation or Ondine's curse, has been infrequently reported in children. Survival and positive developmental outcome is possible but requires intensive support and positive parental attitude, as well as parental education and ongoing medical and psychosocial surveillance. We report this case to illustrate that this could be achieved even in a remote country town.

During an outbreak of food poisoning at a church camp, 16 of the 25 people attending were affected. Despite a thorough search for a bacterial pathogen none was identified. An examination of the Escherichia coli serotypes present suggest that E. coli O159. H9 may have been the organism causing the outbreak.

Information on alcohol use was collected during a survey of dietary intake and energy expenditure of fifteen year olds. Drinking habits of children from solo parent families were little different from those in two parent families. Thirty-two percent of the girls and 26% of the boys said they never drank. Mothers of non-drinkers were twice as likely to be full-time homemakers than mothers of drinkers. Blood alcohol levels were calculated from reported alcohol consumption. While most subjects drank sensibly, a group did not. Most weekends 7% of all girls and 22% of all boys drank sufficient liquor to give them blood alcohol levels over the legal limit. Boys in this group had a mean energy intake and expenditure 30% higher than the rest.