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Accessible Summary: What is known on the subject?: Seclusion is a harmful and traumatising intervention for people accessing mental health services.People who are subject to seclusion in inpatient mental health services often first experience this within the first 24 h following admission.There is limited research examining how recent contact with services impacts the likelihood of seclusion when people are admitted to inpatient services. What the paper adds to existing knowledge?: Males, Māori and Pasifika experience higher rates of seclusion within the first 24 h following inpatient admission.People perceived by clinicians as overactive, aggressive, disruptive or agitated are seven times more likely to be secluded within the first 24 h.People referred from police or justice services are three times more likely to be secluded within the first 24 h.People who had frequent contact with community mental health services prior to inpatient admission were less likely to be secluded. What are the implications for practice?: The first 24 h of inpatient admission is a critical focus for eliminating the use of seclusion. Initial interactions with people recently admitted should focus on nurturing relationships and reducing distress.Mental health staff should consider the person's cultural needs, referral pathway, recent service contact and baseline ratings on the Health of the Nation Outcomes Scales (HoNOS) when working proactively to prevent the use of seclusion in the first 24 h following admission.Strengthening the focus on nurturing relationships, cultural understanding and non‐coercive de‐escalation approaches requires leadership support and strategic workforce development. Introduction: People who experience seclusion in inpatient mental health services often do so within the first 24 h following admission. There is limited research examining the potential contributing factors, particularly recent contact with services. Aim/Question: To identify factors associated with seclusion within the first 24 h following admission into acute inpatient mental health services. Method: A retrospective analysis was undertaken using routinely collected data from Aotearoa New Zealand mental health services. Results: A higher likelihood of seclusion within the first 24 h following admission was associated with: males, Māori, Pasifika, referrals from police/justice services, inpatient transfers, recent contact with crisis assessment teams and clinician perceptions of aggression, problematic substance use, cognitive problems and hallucinations or delusions. Recent contact with community mental health services was associated with a lower likelihood. Discussion: People's cultural needs, referral pathway, recent service contact and HoNOS scores should be considered when working to prevent the use of seclusion in the first 24 h following admission. Implications for Practice: The first 24 h following inpatient admission is a critical period for preventing the use of seclusion. Nurturing relationships, cultural understanding and use of non‐coercive de‐escalation approaches can support better outcomes for people recently admitted. [ABSTRACT FROM AUTHOR]

Groundwater age or residence time is important for identifying flow and contaminant pathways through groundwater systems. Typically, groundwater age and age distributions are inferred via lumped parameter models based on measured age tracer concentrations. However, due to cost and time constraints, age tracers are usually only sampled at a small percentage of the wells in a catchment. This paper describes and compares two methods to increase the number of groundwater age data points and assist with validating age distributions inferred from lumped parameter models. Two machine learning techniques with different strengths were applied to develop two independent metamodels that each aim to establish relationships between the hydrochemical parameters and the modelled groundwater age distributions in one test catchment. Ensemble medians from the best model realisations per age distribution percentile were used for comparison with the results from traditional lumped parameter models based on age tracers. Results show that both metamodelling techniques predict age distributions from hydrochemistry with good correspondence to traditional lumped parameter model (LPM)-derived age distributions. Therefore, these techniques can be used to assist with the interpretation of lumped parameter models where age tracers have been sampled, and they can also be applied to predict groundwater age distributions for wells in a similar hydrogeological regime that have hydrochemistry data available but no age tracer data. [ABSTRACT FROM AUTHOR]

Objective: To identify baseline factors associated with outcomes from an inpatient multidisciplinary pain management program (PMP) located in a bicultural area of Aotearoa New Zealand. Methods: A prospective cohort study was undertaken involving 164 people with chronic pain who attended the PMP. Demographic, clinical, and psychosocial measures were obtained at baseline, whereas clinical and psychosocial outcome measures were also obtained at program discharge and 3-month follow up (N = 100). Multivariate analyses were used to determine baseline demographic variables that were associated with outcomes at discharge and follow up. Results: Being male and working full-time were associated with poorer outcomes in select measures at discharge. At the 3-month follow up, Māori ethnicity, working full-time, being retired or unemployed, or having chronic widespread pain were associated with poorer outcomes for some measures, whereas those with rheumatoid arthritis had greater self-efficacy. Conclusions: Sex, ethnicity, employment status, and patient condition impact clinical outcomes from the program and in the time from discharge to follow up. Program content and/or delivery should be altered to promote more equitable outcomes for all patients in the long term. What is known about the topic? Multidisciplinary pain management programs (PMPs) are the best treatment for chronic pain, but not everyone benefits from such programs to the same extent. What does this paper add? Ethnicity, employment status, and pain condition are associated with PMP outcomes, but mainly in the long term. What are the implications for practitioners? Program content, delivery, and follow up should be adapted to facilitate equity in long-term outcomes. [ABSTRACT FROM AUTHOR]

Chronic pain is common in older people. However, little is known about how pain is experienced in residents of retirement villages ('villages'), and how pain intensity and associations are experienced in relation to characteristics of residents and village living. We thus aimed to examine pain levels, prevalence and associated factors in village residents. The current paper is a cross‐sectional analysis of baseline data from the 'Older People in Retirement Villages' study in Auckland, New Zealand. Between July 2016 and August 2018, 578 village residents were interviewed face‐to‐face by gerontology nurse specialists, using interRAI Community Health Assessment (CHA) and customised survey. We used a validated pain scale and multivariable logistic regression analyses adjusted for pre‐specified confounders. Residents' median age was 82 years; 420 (73%) were female; 270 (47%) exhibited/reported daily pain, and in 11% this was severe. After controlling for confounders, daily pain was positively associated with self‐reported arthritis (OR = 3.88, 95% CI = 2.57–5.87), poor/fair self‐reported health (OR = 3.19, 95% CI = 1.29–7.93), having no health clinic on‐site (OR = 1.76, 95% CI = 1.10–2.83), and minimal fatigue (diminished energy but completes normal day‐to‐day activities) (OR = 1.77, 95% CI = 1.11–2.81). Similar associations were observed for levels of pain. We conclude that levels of pain and prevalence of daily pain are high in village residents. Self‐reported arthritis, self‐reported poor/fair health, no health clinic on‐site and minimal fatigue are all independently associated with a higher risk of daily pain and with levels of pain. This study suggests potential opportunities for villages to better provide on‐site support to decrease prevalence and severity of pain for their residents, and thus potentially increase wellbeing and quality‐of‐life, though as we cannot prove causality, more research is needed. [ABSTRACT FROM AUTHOR]

Patient portals enable people to access their health information electronically, but concerns about confidentiality and privacy breaches, particularly for young people, may be impeding portal adoption in New Zealand. This paper considers the legal and ethical framework relating to health information privacy and informed consent in New Zealand, and proposes an approach to implementing patient portals for young people. Shared portal access (where both a young person and their parent or guardian have access to the young person's portal) may be appropriate for young children whose parents or guardians are responsible for their health care. However, as children mature and their capacity to make health care decisions increases, general practitioners will need to consider shifting to independent portal access by competent young people. The circumstances of each young person, including their best interests and rights, cultural needs and their views on information disclosure should be taken into account. [ABSTRACT FROM AUTHOR]

Football codes (rugby union, soccer, American football) train and play matches on natural and artificial turfs. A review of injuries on different turfs was needed to inform practitioners and sporting bodies on turf-related injury mechanisms and risk factors. Therefore, the aim of this review was to compare the incidence, nature and mechanisms of injuries sustained on newer generation artificial turfs and natural turfs. Electronic databases were searched using the keywords 'artificial turf', 'natural turf', 'grass' and 'inj*'. Delimitation of 120 articles sourced to those addressing injuries in football codes and those using third and fourth generation artificial turfs or natural turfs resulted in 11 experimental papers. These 11 papers provided 20 cohorts that could be assessed using magnitude-based inferences for injury incidence rate ratio calculations pertaining to differences between surfaces. Analysis showed that 16 of the 20 cohorts showed trivial effects for overall incidence rate ratios between surfaces. There was increased risk of ankle injury playing on artificial turf in eight cohorts, with incidence rate ratios from 0.7 to 5.2. Evidence concerning risk of knee injuries on the two surfaces was inconsistent, with incidence rate ratios from 0.4 to 2.8. Two cohorts showed beneficial inferences over the 90% likelihood value for effects of artificial surface on muscle injuries for soccer players; however, there were also two harmful, four unclear and five trivial inferences across the three football codes. Inferences relating to injury severity were inconsistent, with the exception that artificial turf was very likely to have harmful effects for minor injuries in rugby union training and severe injuries in young female soccer players. No clear differences between surfaces were evident in relation to training versus match injuries. Potential mechanisms for differing injury patterns on artificial turf compared with natural turf include increased peak torque and rotational stiffness properties of shoe-surface interfaces, decreased impact attenuation properties of surfaces, differing foot loading patterns and detrimental physiological responses. Changing between surfaces may be a precursor for injury in soccer. In conclusion, studies have provided strong evidence for comparable rates of injury between new generation artificial turfs and natural turfs. An exception is the likely increased risk of ankle injury on third and fourth generation artificial turfs. Therefore, ankle injury prevention strategies must be a priority for athletes who play on artificial turf regularly. Clarification of effects of artificial surfaces on muscle and knee injuries are required given inconsistencies in incidence rate ratios depending on the football code, athlete, gender or match versus training. [ABSTRACT FROM AUTHOR]

Introduction. Around 5% of the people in Aotearoa New Zealand (NZ) are not enrolled with a general practice. Aim. This study aimed to explore the utilisation of general practice by enrolment status and subsequent use of an emergency department. Methods. We compared a cohort of respondents from New Zealand Health Surveys (2013/14-2018/19) on self-reported general practice utilisation and their substitutes, according to their enrolment status (enrolled and not enrolled). They were then followed up to examine their subsequent use of an emergency department. Time to an emergency department presentation was modelled with proportional hazards regression models with enrolment status as the explanatory variable. Confounding variables used were sex, age group, prioritised ethnicity, the New Zealand Deprivation Index and self-rated health. Results. Those not enrolled were more likely to be young, male, Asian, more socioeconomically deprived and with better health status than those enrolled. Generally, those not enrolled utilised general practice services less. Those not enrolled who had used an emergency department were more likely to have used it as a substitute for general practice (40% vs 26%). Modelling showed that those not enrolled took longer to access an emergency department. Adjusting for confounding variables did not change that interpretation. Discussion. Those not enrolled were younger and healthier and may have a perception that enrolment isn't necessary. As a group, they were more likely to be socioeconomically deprived and to use an emergency department, which is free at a public hospital in NZ, as a substitute for primary care which suggests that cost may influence their choices. [ABSTRACT FROM AUTHOR]

Background: Stroke survivors might perceive their quality of life (QoL) as being affected even years after onset. The purpose of this review was to go through the literature to identify factors related to QoL for persons with stroke in China and Western countries for possible similarities and differences in their respective cultural views. Method: A narrative literature review was conducted on the papers identified by searching PubMed, EBSCO/CINAHL, EMBASE, PsycINFO, China National Knowledge Infrastructure and Wanfang Data that published up to November 2016. Factors predicting QoL after stroke were extracted, and comparisons were made between Chinese and Western studies respecting cultural aspects. Results: A total of 43 articles were included in this review, with 31 conducted in Western countries and 12 in China. Predictors of QoL included Demographic factors: age, gender, marital status, education level, socioeconomic status; Clinically related factors: severity of stroke, physical function, depression/anxiety, cognitive impairment, incontinence and other comorbidities; Environmental factors: residential status, social support, social participation; and Individual factors: coping strategies and self‐perception. Being married and resident at home might be associated with the perception of QoL differently between Chinese and Western survivors. Conclusions: Most predictors of QoL in stroke survivors were the same in China and the Western countries. However, their QoL might be predicted differently regarding to the individualistic and collectivistic cultural differences. [ABSTRACT FROM AUTHOR]

In this paper, we use a finite-state continuous-time Markov chain with one absorbing state to model an individual's lifetime. Under this model, the time of death follows a phase-type distribution, and the transient states of the Markov chain are known as phases. We then attempt to provide an answer to the simple question 'What is the conditional age distribution of the individual, given its current phase'? We show that the answer depends on how we interpret the question, and in particular, on the phase observation scheme under consideration. We then apply our results to the computation of the age pyramid for the endangered Chatham Island black robin Petroica traversi during the monitoring period 2007-2014. [ABSTRACT FROM AUTHOR]

Advance care planning (ACP) has been framed as best practice for quality palliative care, yet a growing body of literature affirms the need for an early iterative ACP process to begin when people are young and healthy. A significant gap appears to exist in the literature regarding the utility of death conversations outside the end-of-life context. Could ‘death conversations’ early in life be an effective tool by which doctor and patient can co-construct a more healthful way of life, and realistic relationship with death? And what variables must be taken into account for these conversations to proceed successfully? This paper provides a narrative exploration of the value of death conversations in the clinical context in New Zealand. Five exemplars are discussed, drawn from a sample of 21 semi-structured interviews with young older adults (54–65 years old) not receiving palliative care or diagnosed with a terminal illness. Together, these narratives indicate that further community consultation is required to determine culturally appropriate ways to initiate productive conversations around aging, death and dying and how to build patient/practitioner/family relationships which allow these conversations to happen safely. There is a need to acknowledge the important factor of culture related to age, generation, sex, faith and ethnicity when engaging in conversations about aging, death and dying. By doing so, health professionals will be best equipped to assist their patients to live well into death. [ABSTRACT FROM PUBLISHER]

Population cancer awareness is of interest worldwide, as efforts are made to reduce cancer incidence via changes in risk and protective behaviours. To date, few studies have described changes in awareness over time, despite significant investment in raising awareness about various cancer types and risk behaviours. This paper describes the Cancer Awareness in Aotearoa New Zealand (CAANZ) survey, a cross-sectional telephone survey of adult New Zealanders conducted in 2014/2015 (CAANZ15, n = 1064) and its comparison with a similar 2001 study (CAANZ01, n = 438). Both aimed to describe current cancer awareness among a national sample of New Zealand (NZ) adults, with additional aims for CAANZ15 being to explore emerging issues in information provision and supportive care. Follow-up studies are challenged by changes in communication technologies and, in turn, potential issues in sampling. However, given the value of information about changing awareness, pragmatic steps were taken in CAANZ15 to maximise the response rate and comparability of the surveys. A response rate of 64 % was achieved for both samples. When compared to the adult NZ population, the CAANZ15 sample tended to be older, of higher socioeconomic status and under-representative of people with Pacific, Asian or, to a lesser extent, Māori (the indigenous population of NZ) ethnicity. To compensate for possible disproportionate age-by-ethnicity (Māori/non-Māori) groups in the sample, poststratification weighting was adopted. While caution will need to be exercised in drawing conclusions from comparisons made between these two cohorts, the dearth of such studies means that insights gained should be useful for guiding reflection on future cancer control directions and the generation of new hypotheses. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to analyse attitudes, understanding of gambling and gambling related harm among Asians in New Zealand using secondary data from the New Zealand 2006/07 Gaming and Betting Attitudes Survey (GBAS). Design/methodology/approach -- This survey interviewed 1,973 nationwide randomly selected youths and adults ($18 years) using structured questionnaire. Chinese (N = 113) and Indian (N = 122) data were analysed separately to compare between them and with NZ Europeans (N = 792). Descriptive analysis was carried out and was subsequently tested for significant correlations by weighted (p < 0.01) and un-weighted (p < 0.05) variables. Findings -- A higher proportion of Chinese males (66.8 percent) represented in the survey compared to Indian (43.0 percent) and NZ European (48.9 percent) where Chinese consisted of more youthful age structure. Chinese respondents were more likely to be in the lowest income bracket (NZ$10,000) compared to others. Among the ten gambling activities "casino table gambling" and "casino electronic machines" (slot-style machine) were most popular among the Chinese where Indians preferred "gambling/casino evening". A significant proportion of Chinese were unwilling to refer family or friends to gambling help services despite believing that gambling does more harm than good. Pre-committed gambling sum was the most common harm minimising strategy suggested by participants. They believed education and consultation could deter youths from harmful gambling. Research limitations/implications -- This survey highlighted gambling behaviours and thoughts of the ethnic minority population in New Zealand. Study outcomes would be valuable in formulating ethnic specific preventative programme and may have policy implication. Originality/value -- There has been limited research on gambling behaviour of ethnic minorities in New Zealand. This paper fills some of the gaps. [ABSTRACT FROM AUTHOR]

Recent research provides evidence that individuals shift in their perception of variants depending on social characteristics attributed to the speaker. This paper reports on a speech perception experiment designed to test the degree to which the age attributed to a speaker influences the perception of vowels undergoing a chain shift. As a result of the shift, speakers from different generations produce different variants from one another. Results from the experiment indicate that a speaker’s perceived age can influence vowel categorization in the expected direction. However, only older participants are influenced by perceived speaker age. This suggests that social characteristics attributed to a speaker affect speech perception differently depending on the salience of the relationship between the variant and the characteristic. The results also provide evidence of an unexpected interaction between the sex of the participant and the sex of the stimulus. The interaction is interpreted as an effect of the participants’ previous exposure with male and female speakers.The results are analyzed under an exemplar model of speech production and perception where social information is indexed to acoustic information and the weight of the connection varies depending on the perceived salience of sociophonetic trends. [ABSTRACT FROM PUBLISHER]

This paper reviews impacts on the nursing workforce of health policy and reforms of the past two decades and suggests reasons for both current difficulties in retaining nurses in the workforce and measures to achieve short-term improvements. Difficulties in retaining nurses in the New Zealand workforce have contributed to nursing shortages, leading to a dependence on overseas recruitment. In a context of global shortages and having to compete in a global nursing labour market, an alternative to dependence on overseas nurses is self-sufficiency. Discursive paper. Analysis of nursing workforce data highlighted threats to self-sufficiency, including age structure, high rates of emigration of New Zealand nurses with reliance on overseas nurses and an annual output of nurses that is insufficient to replace both expected retiring nurses and emigrating nurses. A review of recent policy and other documents indicates that two decades of health reform and lack of a strategic focus on nursing has contributed to shortages. Recent strategic approaches to the nursing workforce have included workforce stocktakes, integrated health workforce development and nursing workforce projections, with a single authority now responsible for planning, education, training and development for all health professions and sectors. Current health and nursing workforce development strategies offer wide-ranging and ambitious approaches. An alternative approach is advocated: based on workforce data analysis, pressing threats to self-sufficiency and measures available are identified to achieve, in the short term, the maximum impact on retaining nurses. A human resources in health approach is recommended that focuses on employment conditions and professional nursing as well as recruitment and retention strategies. Nursing is identified as 'crucial' to meeting demands for health care. A shortage of nurses threatens delivery of health services and supports the case for self-sufficiency in the nursing workforce. [ABSTRACT FROM AUTHOR]

This article enquires about why some countries have specialised their further education provision more than others, focusing on three types of specialisation: by subject, by geographical area and by age group. The article proposes an analytical framework to understand the drivers for further education provider specialisation, based on four variables: inputs to the further education system, regulatory framework, demand and supporting clusters. It then applies this framework to review the experience of Germany, New Zealand and the Netherlands in recent years. Drawing on this review, the last section of the paper provides some lessons for England and issues for further debate. It is concluded that the model proposed helps to explain the evolution of provider specialisation in the countries covered and that the UK's current specialisation profile suggests that greater efforts should be made to increase geographical specialisation, whereas action in stimulating further specialisation by subject and age group should be subject to caveats. [ABSTRACT FROM AUTHOR]

Intergenerational programmes recognise the relationships between the young and old as mutually important to both age groups and to society in general. While intergenerational programmes are a fairly new venture in New Zealand, the early childhood curriculum -Te Whariki, the woven mat, is a document which is based on the relationships between people and their environment. It is an ecological model where the context of a child's life is a critical factor in determining well-being, a sense of belonging, communication, a desire to explore, and contribution to society. These are the living strands of Te Whariki which are woven together to provide a sense of place from which children can grow strong and confident. These strands also apply to older people as they move through life's changes. This paper will explore the ways in which Te Whariki is an intergenerational curriculum that can be applied to any context and any age. [ABSTRACT FROM PUBLISHER]

This paper examines age-related differences in voice quality between 15 young and 15 old speakers, using electroglottographic (EGG) recordings of three elicitation types: sustained vowels, hVd word lists, and readings of the Rainbow Passage. For each elicitation type, fundamental frequency (F0), contact quotient (Qx), and their standard deviations are analysed. Results found, for all three elicitations, that Qx was significantly lower for older speakers. F0 was higher for the older speakers, but this was only significant for the hVd word lists. Sustained vowels were used to examine the effect of target pitch and loudness on F0 and Qx. Both Qx and F0 were raised with increased target loudness. The hVd word lists were used to examine the phonetic effects of different vowels. Lip rounded vowels had higher Qx than non-lip rounded vowels. Readings of the Rainbow Passage encompassed prosodic and phonetic variations in F0 and Qx, in addition to voice quality. F0 and Qx contours of the hVd word lists and the vowel/ei/taken from the Rainbow Passage were analysed using the discrete cosine transform. The hVd frame produced coarticulation effects on the Qx contour, but no such effects were evident for the vowel /ei/. The study concluded that using multiple elicitation types is beneficial in the study of the effect of age on the voice, and that analysing contour tracks for F0 and Qx will allow further examination of how prosodic and phonetic effects interact with age-related changes in voice quality. [ABSTRACT FROM PUBLISHER]

Background: Fear of contracting coronavirus disease 2019 may be the latest addition to the barriers to clinic attendance. This study aimed to examine the impact of coronavirus disease 2019 and other variables on non-attendance rate at an out-patient clinic. Methods: Clinic attendance at the Department of Otolaryngology and Head and Neck Surgery, Waikato Hospital, New Zealand, was assessed. For each appointment, the impact of coronavirus disease 2019 and other variables on non-attendance rate were analysed. Results: In total, 1963 appointments were scheduled, with 194 non-attendances (9.9 per cent). Patients who had their appointments confirmed beforehand were 10.0 times more likely to attend their appointment. Sex, socioeconomic status, ethnicity and age were found to impact non-attendance rate. Conclusion: In New Zealand, coronavirus disease 2019 does not appear to be a barrier to out-patient clinic appointment attendance. The patient's age, sex, ethnicity, socioeconomic status and prior appointment confirmation were found to influence clinic attendance. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Diabetes mellitus is common in primary care, yet little has been reported of its primary care prevalence or the clinical characteristics of patients with Type 2 diabetes mellitus (T2DM). AIM: To determine the prevalence of diabetes mellitus and clinical characteristics of diabetes patients in primary care in the Waikato region. METHODS: Primary care data were extracted from the electronic records of 15 general practices for patients aged >20 years with current diabetes mellitus at 20 June 2017. Diabetes mellitus was defined as having a glycated haemoglobin (HbA1c) of ≥50 mmol/mol (6.7%) or having being dispensed two or more anti-diabetic medications in the previous 12 months. Additional data collected included patients' ethnicity, age, sex and years since diagnosis. RESULTS: The overall prevalence of diabetes mellitus was 5.7% and was higher for Māori (8.6%), Asian (7.0%) and Pacific peoples (9.1%) than Europeans (5.0%; all P < 0.001). For patients with T2DM for whom current diabetes annual review data were available (n = 2227) the mean body mass index (BMI) was 32.8 ± 0.2 kg/m2, but BMI was higher in Māori, younger patients, females and patients diagnosed <2 years previously (all P < 0.001). Similarly, HbA1c levels were highest in Māori and younger patients (both P < 0.001), with 40% of patients overall having a HbA1c of ≤53 mmol/mol (7.0%). Approximately 70% of all patients had at least one measure of hypertension (systolic ≥130 or diastolic ≥80 mmHg), or dyslipidaemia. More than 85% of patients had completed a recent retinal screen and foot check. DISCUSSION: We found that management of T2DM was suboptimal, with measures for many patients not meeting clinical targets. Support should be provided to improve weight and glycaemic management, particularly for Māori, females and younger patients. [ABSTRACT FROM AUTHOR]

Census-based deprivation indices have been widely used in Aotearoa/New Zealand, Canada and UK to measure area-based socio-economic inequalities. This paper examines the indicators used in census-based area deprivation indices using a political ecology approach. We question whether the current indicators of deprivation derived from census data are meaningful for the all age groups and minority groups in the population, with a particular focus on deprivation indicators used in New Zealand, Canada and the United Kingdom. We comparatively reviewed methodological papers and reports that describe the indicators of deprivation in Aotearoa/New Zealand, Canada and the UK from 1975 to 2014. We consider the relationship between the notion of standards of living and measurements of deprivation and explore how hegemonic cultural constructs are implicit in measures of deprivation that privilege a Eurocentric, ageist and gender normative construction of statistics. We argue for more political ecological analyses to studying the relationship between social inequalities, geographies, health inequities and political economy to transform structures of oppression and inequality. This requires turning the analytical gaze on the wealthy and privileged instead of defaulting into deficit models to account for inequality. Studies of deprivation and inequality would benefit from understanding the processes and operations of power in the (re)production of socio-economic and health inequities to inform holistic strategies for social justice. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the impact of workplace factors on burnout in New Zealand registered nurses (RNs). Background: Nursing is characterised by chronic workplace stress. Research examining the role of workplace factors (ie practice environment and bullying) in shaping burnout is scarce. Methods: A cross-sectional survey was conducted among 480 New Zealand RNs. Burnout was self-reported using the CBI, while practice environment and negative acts in the workplace were selfreported using PES-NWI, and NAQ-R respectively. The STROBE checklist was used for this paper. Results: For every point increase in PES-NWI, there was a decrease of 6.82, 12.62, and 9.86 points in personal burnout (PB), work-related burnout (WRB), and client-related burnout (CRB) respectively after controlling for demographic and job-related characteristics. For every point increase in NAQ-R, there was an increase of 0.47, 0.50, and 0.20 points in PB, WRB, and CRB respectively after controlling for sample characteristics. These two factors explained for 18.4 percent, 27.6 percent and 12.4 percent of the variation in PB, WRB and CRB respectively. The prevalence of high PB, WRB and CRB was 50.8 percent, 46.5 percent and 16.0 percent respectively. Conclusion: Workplace factors are associated with burnout in RNs. Health-care organisations and nurse leaders have a duty to provide safe and healthy workplaces that cultivate positive outcomes for nurses and patients. Future efforts to reduce workplace stress and burnout in nurses will need to include initiatives that reduce high workloads, provide greater job flexibility and autonomy, increase collaboration and reduce bullying and harassment. [ABSTRACT FROM AUTHOR]

Aim The Late Career Nurse project examined views and characteristics of nurses working in New Zealand who were born before 1960. This paper focuses on the experiences of such nurses who undertake shift work. Background The mean age of registered nurses in New Zealand has been rising steadily, and 40% are now aged 50 years or over. While there is substantial literature on the phenomenon and consequences of the ageing nursing workforce, little is known of the particular experiences of nurses aged over 50 years who work shifts. Method An anonymous online survey was emailed to eligible nurse New Zealand Nurses Organisation members aged over 50 years in February 2012. Quantitative and qualitative analyses of the 3273 responses received were undertaken. Result Over 45% of respondents worked shifts or flexible hours. While shift work suited many, others noted deleterious effects on family and social relationships, physical and mental health (notably sleep patterns and fatigue), and decreasing tolerance for shift work as they age. Poor scheduling practices were particularly detrimental. Conclusion and implications for nursing management Worldwide, workforce ageing means strategies are required to retain older nurses in the workforce. Improved scheduling practices including increasing access to flexible and part time work hours, and development of resources on coping with shift work are recommended. [ABSTRACT FROM AUTHOR]

The increased use of information technology in health care allows researchers to generate data on rates of medication use among population groups, raising questions as to whether these rates are too high or too low. This paper presents findings from a study of records of all prescription medication dispensed in one New Zealand region (Te Tāirawhiti) over a one year period. The study examined patterns of psychotropic medication use amongst older people, by age, gender, ethnicity and socio-economic position. It concludes that the chances of being defined as needing psychotropic medication, that is, of being 'medicalised', are not evenly spread through the elderly population. Gender, age and ethnicity impacted significantly on whether prescriptions were received. Our results suggest the need for a nuanced understanding of the medicalisation of unhappiness and deviant behaviour amongst the elderly which takes into account barriers to treatment for some social groups. [ABSTRACT FROM AUTHOR]

Many western countries have experienced increased rates of youth suicide over recent years. This has been an issue of particular concern in New Zealand, since it had the highest rate of youth suicide among OECD countries in the mid-1990s. However, while attention is drawn to the now declining youth suicide rate by politicians and policy-makers, what is obscured is a cohort effect. In this paper we will argue that a cohort effect is clearly visible; suicide rates among 15-24 year olds came to the fore in the mid-1980s, peaking 10 years later, and were displaced by that among 25-35 year olds by the late-1990s. Further, this century has been characterised by the rise of suicide rates among 35-44 year olds. This effect correlates with a dramatic downturn in the New Zealand economy in a five-year period bracketing 1970. We argue for an increased focus on social and economic factors underlying suicide. [ABSTRACT FROM AUTHOR]

Although the adverse health consequences of zinc deficiency are becoming increasingly well known internationally, few studies have investigated zinc status in Australia and New Zealand. The aim of this review was to identify which population groups, if any, in Australia and New Zealand are likely to be at risk of zinc deficiency. A literature review was conducted to identify papers on zinc status in Australasia using electronic databases (MEDLINE, BIOSIS Previews, CINAHL, EMBASE, Web of Knowledge, ProQuest and Cochrane Library). Government databases and reference lists from peer-reviewed journal articles were also accessed. Thirty-one Australasian studies that measured dietary zinc intake and/or serum zinc were identified. Many were based on a small number of self-selected subjects, and did not use the recommended procedures for evaluating the prevalence of inadequate zinc intakes and low serum zinc concentrations. Existing data suggest that at-risk groups in Australasia are toddlers, adolescents (especially those of Pacific and Aboriginal ethnicities), institutionalised elderly and possibly people with diabetes. Data on the zinc status of selected population groups in Australasia are limited. Randomised controlled zinc supplementation trials that include the recommended indicators and other clinical outcomes are needed to confirm the existence of zinc-related health outcomes among the at-risk groups identified. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Unmet needs are a key indicator of the success of a health system. Clinicians and funders in Christchurch, Canterbury, New Zealand were concerned that unmet health need was hidden. AIM: The aim of this survey was to estimate the proportion of patients attending general practice who were unable to access clinically indicated referred services. METHODS: The survey used a novel method to estimate unserviced health needs. General practitioners (GPs, n = 54) asked their patients (n = 2135) during a consultation about any health needs requiring a referred service. If both agreed that a service was potentially beneficial and not available, this was documented on an e-referral system for review. The outcomes of actual referrals were also reviewed. RESULTS: The patient group was broadly representative of the Canterbury population, but over-sampled female and middle-aged people and under-sampled Māori. Data adjusted to regional demographics showed that 3.6% of patients had a GP-confirmed unserviced health need. Elective orthopaedic surgery, general surgery and mental health were areas of greatest need. Unserviced health needs were significantly (P = 0.05) associated with greater deprivation, middle-age, and receiving high health-use subsidies. DISCUSSION: To our knowledge, this is the first survey of GP and patient agreement on unserviced referred health needs. Measuring unserviced health needs in this way is directly relevant to service planning because the gaps identified reflect clinically indicated services that patients want and need. The survey method is an improvement on declined referral rates as a measure of need. Key factors in the method were using a patient-initiated GP consultation and an e-referral system to collect data. [ABSTRACT FROM AUTHOR]

Background: Primary care in Aotearoa New Zealand is largely delivered by general practices, heavily subsidised by government. Te Tiriti o Waitangi (1840) guarantees equal health outcomes for Māori and non-Māori, but differences are stark and longstanding. Seven models of primary care have evolved. We hypothesised that patient health outcomes would differ between models of care; and that Māori, Pacific peoples and those living in material deprivation would have poorer outcomes from primary care. Methods: We conducted a cross-sectional study of patient-level data from national datasets and practices, at 30 September 2018, using multilevel mixed effects regression analyses (patients clustered within practices). Primary outcomes, considered to be measures of unmet need for primary care, were polypharmacy (≥ 65 years), HbA1c testing in adults with diabetes, childhood immunisations (6 months), ambulatory sensitive hospitalisations (0–14, 45–64 years) and emergency department attendances. Explanatory variables adjusted for patient and practice characteristics. Equity, by model of care, ethnicity and deprivation, was assumed if they showed no significant association with patient outcomes. Patient characteristics included: age, ethnicity, deprivation, multi-morbidity, first specialist assessments and practice continuity. Practice characteristics included: size, funding and doctor continuity. Clinical input (consultations and time with nurses and doctors) was considered a measure of practice response. Results: The study included 924 general practices with 4,491,964 enrolled patients. Traditional practices enrolled 73% of the population, but, on average, the proportion of Māori, Pacific and people living with material deprivation was low in any one Traditional practice. Patients with high health needs disproportionately enrolled in Māori, Pacific and Trust/NGO practices. There were multiple associations between models of care and patient health outcomes in fully adjusted regressions. No one model of care out-performed others across all outcomes. Patients with higher health need received more clinical input but this was insufficient to achieve equity in all outcomes. Being a Māori or Pacific patient, or living in material deprivation, across models of care, remained associated with poorer outcomes. Conclusions: Model-level associations with poor patient outcomes suggest inequity in measures that might be used to target investment in primary care. [ABSTRACT FROM AUTHOR]

This study assessed the physical activities of Mental Health Nurses (MHN) in New Zealand against the 2018 World Health Organization recommended minimum levels of moderate‐to‐vigorous physical activity. The research design was exploratory and descriptive as there were no previous studies about physical activity levels of MHNs in New Zealand. Quantitative and qualitative data were collected using the International Physical Activity Questionnaire (IPAQ, Long Version) which included options for free‐text responses. Data were analysed using descriptive and inferential statistics. A total of 266 participants returned the survey, a response rate of 4%, and a limitation of the study. More than 50% of MHNs reported <150 min of moderate‐to‐vigorous exercise per week for each of the four physical activity domains. When individual physical activity domains were combined, only 10% spent <150 min on moderate‐to‐vigorous physical activity. Work‐related physical activities were higher for those working in the inpatient area than in community settings. Transport‐related physical activities were higher for those working in community settings. Participants registered from 6 to 20 years had more time sitting than other groups. Nurses aged 55 years and above showed the highest total physical activity levels. Moreover, healthcare organizations and nurse leaders need to promote physical activity and provide wellness intervention for their staff. Nurses who are physically active may be more effective in supporting their patients to increase their physical activity. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The rate of sexually transmitted infections (STIs) amongst midlife and older heterosexual women in New Zealand is rising. Popular culture celebrates a heightened sexuality for this population group. However, depictions of sexually savvy 'cougars' are at odds with reality for many women. International literature highlights that these women are often ill-equipped to negotiate safer sex and condom use, instead focusing on pleasing men and attributing their silence to spontaneity. The study aimed to explore barriers to safer heterosexual sex as perceived by midlife and older New Zealand women who are re-partnering or in casual relationships. METHODS: This qualitative study utilised Interpretive Phenomenology Analysis, supported by the theory of gender and power, to examine the gender-normative assumptions and behaviours in women's accounts of unprotected sex. Eight single women aged 40-69 participated in individual, in-depth interviews. This exploration included eliciting women's accounts of potential information resources, such as clinical consultations. FINDINGS: Analysis indicated that these women held misconceptions about STI transmission but had not sought educational material, nor discussed their sexual health with health professionals. Results highlighted women's ambivalence about prioritising safer sex, preferring to comply with partners' wishes, particularly when under the influence of alcohol. Women described valuing their own pleasure and their distaste for condom use, but data emphasised that women predominantly aligned their choices with men's preferences. CONCLUSION: This study highlights that the women were both ill-informed and vulnerable with regards to sexual health. General practitioners are well placed to provide education and sexual health advice. [ABSTRACT FROM AUTHOR]

Objective: To describe the epidemiology of pediatric type 1 diabetes over 50 years in Canterbury, New Zealand. Further, to explore variation in case presentation according to age, gender, ethnicity, urban/rural character, socio‐economic deprivation and immunogenetic features. Research Design and Methods: Prospective ascertainment of cases commenced in 1982, and incident cases presenting 1970–1982 were ascertained retrospectively from clinical records. Eligibility criteria included diagnosis of type 1 diabetes by a physician and commencement of insulin therapy at diagnosis and age less than 15 years. Data collection included name, hospital number, date of birth, date of diagnosis, and date of initiation of insulin treatment. Full address at diagnosis was assigned an urban–rural classification, and a deprivation score. HLA‐DQ susceptibility alleles and diabetes associated autoantibodies were determined. Results: The incidence of type 1 diabetes increased more than 5‐fold (3.9% per annum) over 50 years for the entire cohort. The mean for 5‐year periods, starting from 1970, increased from 5.3 to 29.0 cases per 100,000 person years. Incidence was greatest in the 10–14 year age group. The cohort is predominantly European (89.4%), but there has been an increase in cases identifying as New Zealand Māori in the last three decades. Weak evidence was found for reduced incidence of type 1 diabetes in rural regions (adjusted IRR = 0.70, 95%CI 0.52 to 0.91, p = 0.011). Conclusions: The incidence of type 1 diabetes in children aged less than 15 years continues to increase with time. Incidence was significantly affected by age, ethnicity, and urban/rural characterization of address at diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to collect and compare practising characteristics for dental hygienists (DHs) in New Zealand (NZ) and Sweden. Methods: Dental hygienists from NZ and Sweden were invited to participate in an anonymous online survey focussing on their working practices. An email, with a link to the online survey and a participant information sheet, was sent to DHs registered with their professional association in their respective country. Frequency analyses and cross‐tabulations were conducted using chi‐square and Fisher's exact tests to investigate possible statistical associations to allow for comparisons between the countries. Results: DH is a female‐dominated workforce with equal distribution of gender in both countries. The majority of DHs in NZ worked in private practice while Swedish DHs mostly worked in the public sector. NZ participants were younger and with a more recent qualification than their Swedish counterparts. The highest degree of education was a PhD for DHs working in Sweden, compared with a master's degree for NZ participants. The majority of participants from both countries treated patients 65 years of age or older, with the most common medical conditions being cardiovascular disease and diabetes mellitus. The most common dental condition observed/treated was periodontal disease. Over 60% agreed to have an understanding of information technology (IT). The most used technical equipment was digital radiology, followed by other diagnostic tools. Conclusion: Findings confirm previous international data on demographical uptake for the DH workforce in NZ and Sweden. A coherence was seen in patient characteristics, DHs' attitudes towards information technology and use of technical equipment. [ABSTRACT FROM AUTHOR]

Introduction. Telemedicine, including telephone triage, is increasingly being used in New Zealand general practices. Telephone triage involves diverting requests for same-day healthcare to a phone system where presenting complaints are explored only sufficiently to identify the most appropriate management pathway. Aim. To assess the rates of repeat triage among general practice patients treated virtually via phone and compare these with outcomes for patients who were dealt with in person. Method. 6 weeks of clinical telephone triage data were collected for Gore Medical Centre. Comparisons were made for patients treated virtually or in person, for whether complaints were a respiratory issue or not, and for whether their triage represented incomplete resolution of a previously triaged health complaint. To do this, patient notes for the 7 days prior to the phone triage were reviewed for medical consultations related to the same condition. Results. Over 6 weeks, 455 telephone triages took place at the Gore Medical Centre: 133 triage phone calls resulted in 132 (29%) patients being treated virtually. Over the 6 study weeks, 19 virtually treated triage patients phoned again for further care of the same problem within 7 days (14%) while 23 patients (7%) who had been triaged to in person assessment also sought further care within 7 days. This difference was statistically significant (P < 0.05). There was no statistical difference in re-triage rates between Māori and non-Māori. Young age was a significant predictor for likelihood of re-triage. Discussion. Virtual treatment via telephone triage at Gore Medical Centre resulted in a statistically increased likelihood of re-triage within 7 days compared with in person treatment. This raises questions about the efficacy of virtual treatment via telemedicine compared with in person treatment after triage. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Most exercise studies for older adults have been university- or hospital-based. Little is known about the benefits and factors influencing long-term participation in community-based exercise programmes, especially in New Zealand. AIM: To quantify the objective benefits, participant perceptions and retention rates of a New Zealand community-based exercise programme for adults (60 years or older). METHODS: Study 1 involved assessing the benefits of 12 weeks' training on a convenience sample of 62 older adults commencing the never2old Active Ageing programme. Study 2 assessed the perceptions of 150 current participants on a variety of programme components that could act as barriers or facilitators to continued engagement. Study 3 assessed the retention rates of 264 participants in the programme over a two-year period. RESULTS: Significant improvements in many physical functional scores were observed in Study 1 (5-30 percentile points; p<0.05). Questionnaire responses from participants in Study 2 indicated many perceived benefits (positive responses from 67-95% on various questions) and that core components of the programme were rated very highly (64-99% on various components). Retention rates were high, with Study 3 finding 57% of participants still engaging in the programme at the end of the two-year period. DISCUSSION: A community-based exercise programme for older adults can improve many objective and subjective measures of physical fitness and functional performance and have good retention rates. General practitioners and other allied health professionals in New Zealand should consider promoting programmes, such as the never2old Active Ageing programme, to their older patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Herpes zoster and its sequelae can have a serious impact on quality of life, particularly in the elderly. The duration and severity of herpes zoster symptoms can be reduced with antiviral treatment. Early treatment is most effective. AIM: To identify how soon after onset of herpes zoster symptoms adults presented to a suburban Dunedin general practice and to describe which patients received antiviral treatment. METHODS: Adult herpes zoster cases were identified from a large suburban general practice from 2004 to 2009. Duration of symptoms at presentation and antiviral prescription were identified from medical records and described by patient characteristics. RESULTS: We identified 278 incident cases. Approximately one-third presented within three days of symptoms, one-third after three days, and in one-third of cases the duration of symptoms was not documented. A higher percentage of patients with ophthalmic herpes zoster presented within three days (45%), while a lower percentage of men (24%) and patients from the lowest socioeconomic quintile (25%) presented within three days. Most incident cases received antiviral treatment. A higher percentage of patients with ophthalmic herpes zoster and patients who presented within three days of symptoms received antiviral treatment. Some patients who presented after seven days of symptoms also received treatment. Antiviral prescribing did not increase with patient age. DISCUSSION: Despite many adults with acute herpes zoster presenting after three days of symptoms, most received antiviral treatment. It is not known why many presented late. It is not known whether late treatment is effective. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Preventive medications such as statins are used to reduce cardiovascular risk. There is some evidence to suggest that people of lower socioeconomic position are less likely to be prescribed statins. In New Zealand, Maori have higher rates of cardiovascular disease. AIM: This study aimed to investigate statin utilisation by socioeconomic position and ethnicity in a region of New Zealand. METHODS: This was a cross-sectional study in which data were collected on all prescriptions dispensed from all pharmacies in one city during 2005/6. Linkage with national datasets provided information on patients' age, gender and ethnicity. Socioeconomic position was identified using the New Zealand Index of Socioeconomic Deprivation 2006. RESULTS: Statin use increased with age until around 75 years. Below age 65 years, those in the most deprived socioeconomic areas were most likely to receive statins. In the 55-64 age group, 22.3% of the most deprived population received a statin prescription (compared with 175% of the mid and 18.6% of the least deprived group). At ages up to 75 years, use was higher amongst Maori than non-Maori, particularly in middle age, where Maori have a higher risk of cardiovascular disease. In the 45-54 age group, 11.6% of Maori received a statin prescription, compared with 8.7% of non-Maori. DISCUSSION: Statin use approximately matched the pattern of need, in contrast to other studies which found under-treatment of people of low socioeconomic position. A PHARMAC campaign to increase statin use may have increased use in high-risk groups in New Zealand. [ABSTRACT FROM AUTHOR]

Objectives: Aotearoa New Zealand has demonstrable maternal and perinatal health inequity. We examined the relationships between adverse outcomes in a total population sample of births and a range of social determinant variables representing barriers to equity. Methods: Using the Statistics New Zealand Integrated Data Infrastructure suite of linked administrative data sets, adverse maternal and perinatal outcomes (mortality and severe morbidity) were linked to socio-economic and health variables for 97% of births in New Zealand between 2003 and 2018 (~970,000 births). Variables included housing, economic, health, crime and family circumstances. Logistic regression examined the relationships between adverse outcomes and social determinants, adjusting for demographics (socio-economic deprivation, education, parity, age, rural/urban residence and ethnicity). Results: Māori (adjusted odds ratio=1.21, 95% confidence interval=1.18–1.23) and Asian women (adjusted odds ratio 1.39, 95% confidence interval=1.36–1.43) had poorer maternal or perinatal outcomes compared to New Zealand European/European women. High use of emergency department (adjusted odds ratio=2.68, 95% confidence interval=2.53–2.84), disability (adjusted odds ratio=1.98, 95% confidence interval=1.83–2.14) and lack of engagement with maternity care (adjusted odds ratio=1.89, 95% confidence interval=1.84–1.95) had the strongest relationship with poor outcomes. Conclusion: Maternal health inequity was strongly associated with a range of socio-economic and health determinants. While some of these factors can be targeted for interventions, the study highlights larger structural and systemic issues that affect maternal and perinatal health. [ABSTRACT FROM AUTHOR]

Previous research on cyberbullying has focused almost entirely on examining its prevalence among dominant ethnic populations, leaving it unclear how common cyberbullying is among indigenous peoples. Our study draws on a large sample of Māori adults aged 18–83 years (n = 6,529) who completed the questionnaire-based Māori Identity and Financial Attitudes Study in 2017. We analyzed reports of cyberbullying according to demographic characteristics, namely gender, age, sexual orientation, and multiple ethnic affiliations. On average, 19.3 percent of participants reported ever experiencing cyberbullying, and 4.1 percent reported experiencing cyberbullying within the past month. Young adults (aged 18–25) experienced the most, and incidences progressively declined among older cohorts. Women and those identifying as a minority sexual orientation reported higher rates of cyberbullying than men and heterosexuals. Those identifying as Māori as one of their multiple ethnicities reported higher rates of cyberbullying than those who identified as Māori only. Together, these findings provide a detailed investigation of the prevalence of cyberbullying in a large national indigenous sample. Previous data show that cyberbullying is common among adolescents and adults in New Zealand; however, our data indicate an even higher prevalence among the Māori. Practical and theoretical implications are discussed in light of Māori mental health outcomes. [ABSTRACT FROM AUTHOR]

Bronchiectasis is a chronic respiratory disease that impacts significantly on quality of life for those who have it. There is a paucity of literature exploring the perspectives of children and young people. The aim of this study was to examine the day-to-day life experience of a group of young people with bronchiectasis. A qualitative study using semi-structured interviews explored fifteen young people's perspectives of life with bronchiectasis. Key themes were identified using an inductive iterative approach through constant comparative analysis guided by Thorne's interpretive description. Life with bronchiectasis was conceptualized by participants as "Pretty Normal". This consisted of two co-existing life views which represented how young people balanced the ups and downs of adolescence while learning to accommodate the demands of living with bronchiectasis. Three key thematic elements "sore and tired", 'life interrupted and "looking after self", influenced and challenged these two views of life. Young people with bronchiectasis portray life as being the same as their peers. Despite this, they recognized that the symptoms, interruptions, and self-management responsibilities led them to find ways of coping and integrating their experience into a new and modified view of normal. [ABSTRACT FROM AUTHOR]

Should there be a female age limit on public funding for assisted reproductive technology (ART)? The question bears significant economic and sociopolitical implications and has been contentious in many countries. We conceptualise the question as one of justice in resource allocation, using three much-debated substantive principles of justice—the capacity to benefit, personal responsibility, and need—to structure and then explore a complex of arguments. Capacity-to-benefit arguments are not decisive: There are no clear cost-effectiveness grounds to restrict funding to those older women who still bear some capacity to benefit from ART. Personal responsibility arguments are challenged by structural determinants of delayed motherhood. Nor are need arguments decisive: They can speak either for or against a female age limit, depending on the conception of need used. We demonstrate how these principles can differ not only in content but also in the relative importance they are accorded by governments. Wide variation in ART public funding policy might be better understood in this light. We conclude with some inter-country comparison. New Zealand and Swedish policies are uncommonly transparent and thus demonstrate particularly well how the arguments we explore have been put into practice. [ABSTRACT FROM AUTHOR]

Successful behavior change according to the transtheoretical model involves progressing through a series of stages of change. This paper examines the proportion of men in each stage of change for fruit and vegetable intake, compares stage classification with intentions and behavior, and the impact of contextual factors on stage membership. Men randomly selected from the New Zealand electoral roll completed a postal questionnaire (n = 518; 45% response rate). One-third (32%) of respondents were not intending to eat five or more servings of fruit and vegetables a day (precontemplation stage), 10% were contemplating change (contemplation stage), 7% preparing to change (preparation stage), and 51% were already doing so in the combined action/maintenance stage. Intentions increased on average across stages, and fruit and vegetable intake was at least two servings higher in action/maintenance. Dietary guideline knowledge, older age, higher income, education and food security increased the likelihood of being in action/maintenance. Simple health promotion messages should be directed toward men, promoting conventional and affordable produce, and dietary guidelines. Community and policy approaches that increase food skills and knowledge, fruit and vegetable access and affordability would support behavior change. [ABSTRACT FROM AUTHOR]

Skilled migration flows into New Zealand are important to the Department of Labour's goal of building New Zealand's workforce and attracting (and retaining) talent to contribute to the nation's economic transformation. Globally, female migrants constitute nearly half of all migrants in developed and developing countries. This global presence of women in migration is also reflected in the increase of women using what have previously been male-dominated migration streams. This research paper focuses on the migration of Asian women into New Zealand for two reasons. Firstly, Asian migrants are a significant and increasing source of skilled labour, which New Zealand is in competition for; and secondly, the 2006 Census shows that in key working-age groups there are significantly more Asian women than men living in New Zealand. The Department of Labour's databases were analysed to calculate trends and gender ratios in migrants entering New Zealand through the Skilled/Business stream and Temporary categories from 1997/98 to 2005/06 as principal applicants. Our results show that although men dominate the overall Skilled/Business stream and Temporary categories, there is large diversity by nationality and women from some Asian countries are critical players in the migration process. Census data, which represent the net result of inflows and outflows, suggest that there have been more Asian women than men migrating to New Zealand. Department of Labour immigration data do not fully support this overall gendered migration from Asia, but consideration of gender, age, country of origin and migration stream uncovers much complexity within these overall flows. [ABSTRACT FROM AUTHOR]

Academic interest in geographic mobility of indigenous peoples has increased in recent years with a corresponding growth in the literature relating to Māori mobility more specifically. With this greater acknowledgement of Māori issues has also come an awareness of the need for iwi-specific research because of the diversity within and between Māori and iwi. The present research contributes to a larger project exploring Tūhoe regional mobility. In this paper, we analyse published data and unpublished census data from 2001 that relate specifically to Tūhoe regional mobility and the relationship between mobility and language. Region of residence in 1996 and 2001 were analysed in relation to age, sex, and broad language groups. Overall, this analysis found important and diverse relationships between age, sex, language, and region of residence in New Zealand among Māori who identify as Tūhoe. For example, patterns of mobility for different age groups and sex had some similarities with other research, such as a higher proportion of "stayers" in older age groups, but differences were also found, such as higher proportions of "movers" among females in some age groups. Interestingly, we found that language between "movers" and "stayers" differed depending on the region of residence. A greater proportion of "movers" were able to converse in Māori in Auckland and the Waikato, but a slightly greater proportion of "stayers" could converse in Māori in the Hawke's Bay and Bay of Plenty. These results suggest that geographic mobility among Māori, and Tūhoe more specifically, are complex and should not be overly-simplified in more aggregate analyses. [ABSTRACT FROM AUTHOR]

Background: Studies in southern New Zealand indicate that up to a quarter of women experienced infertility, likely due to delay in childbearing. However, these findings may not be generalisable to the whole population. Aims: To assess the lifetime prevalence of infertility and evidence for disparities for New Zealand men and women in a nationally representative sample. Materials and Methods: In 2014/15 a general health survey with a module on sexual and reproductive health was conducted among New Zealand residents aged 16–74 years; 3792 men and 5222 women provided information on infertility. Result(s): There were 8.2% (95% CI 7.1–9.4%) of men and 12.5% (11.3–13.8%) of women who had experienced infertility; among fertility‐tested women this was 15.4% (14.0–16.9%). Prevalence peaked in the 35–44 year age group (14.3% for men, 19.1% for women and 20.8% for fertility‐tested women). Estimates for European, Māori and Asian ethnicities were similar. Pacific men and women had higher relative risks: 2.37 (95% CI 1.51–3.71) and 1.76 (1.27–2.44), respectively, compared with Europeans. Medical help was sought by 69.3% (95% CI 62.4–75.5%) of infertile men and 68.2% (63.1–72.9%) of women; this was significantly lower for Māori and Pacific. Conclusions: Infertility levels for those of European ethnicity were similar to studies in southern New Zealand, and in other high‐income countries. However, infertility levels were just as high for Māori, and higher for Pacific people, despite experiencing fertility at younger ages. Focusing on reducing causes of infertility other than delayed childbearing would likely contribute to addressing this health disparity. [ABSTRACT FROM AUTHOR]

Phytophthora agathidicida is associated with a root rot that threatens the long-term survival of the iconic New Zealand kauri. Although it is widely assumed that this pathogen arrived in New Zealand post-1945, this hypothesis has yet to be formally tested. Here we describe evolutionary analyses aimed at evaluating this and two alternative hypotheses. As a basis for our analyses, we assembled complete mitochondrial genome sequences from 16 accessions representing the geographic range of P. agathidicida as well as those of five other members of Phytophthora clade 5. All 21 mitogenome sequences were very similar, differing little in size with all sharing the same gene content and arrangement. We first examined the temporal origins of genetic diversity using a pair of calibration schemes. Both resulted in similar age estimates; specifically, a mean age of 303.0–304.4 years and 95% HPDs of 206.9–414.6 years for the most recent common ancestor of the included isolates. We then used phylogenetic tree building and network analyses to investigate the geographic distribution of the genetic diversity. Four geographically distinct genetic groups were recognised within P. agathidicida. Taken together the inferred age and geographic distribution of the sampled mitogenome diversity suggests that this pathogen diversified following arrival in New Zealand several hundred to several thousand years ago. This conclusion is consistent with the emergence of kauri dieback disease being a consequence of recent changes in the relationship between the pathogen, host, and environment rather than a post-1945 introduction of the causal pathogen into New Zealand. [ABSTRACT FROM AUTHOR]

Background: Despite an overt commitment to equity, health inequities are evident throughout Aotearoa New Zealand. A general practice electronic alert system was developed to notify clinicians about their patient's risk of harm due to their pre-existing medical conditions or current medication. We aimed to determine whether there were any disparities in clinician action taken on the alert based on patient ethnicity or other demographic factors. Methods: Sixty-six New Zealand general practices from throughout New Zealand participated. Data were available for 1611 alerts detected for 1582 patients between 1 and 2018 and 1 July 2019. The primary outcome was whether action was taken following an alert or not. Logistic regression was used to assess if patients of one ethnicity group were more or less likely to have action taken. Potential confounders considered in the analyses include patient age, gender, ethnicity, socio-economic deprivation, number of long term diagnoses and number of long term medications. Results: No evidence of a difference was found in the odds of having action taken amongst ethnicity groups, however the estimated odds for Māori and Pasifika patients were lower compared to the European group (Māori OR 0.88, 95 %CI 0.63–1.22; Pasifika OR 0.88, 95 %CI 0.52–1.49). Females had significantly lower odds of having action taken compared to males (OR 0.76, 95 %CI 0.59–0.96). Conclusions: This analysis of data arising from a general practice electronic alert system in New Zealand found clinicians typically took action on those alerts. However, clinicians appear to take less action for women and Māori and Pasifika patients. Use of a targeted alert system has the potential to mitigate risk from medication-related harm. Recognising clinician biases may improve the equitability of health care provision. [ABSTRACT FROM AUTHOR]

INTRODUCTION: On-the-spot blood glucose testing is a health service performed in public spaces to raise diabetes awareness and screen for elevated blood glucose levels. AIM: To describe the users of this service and the frequency of detecting elevated blood glucose. METHODS: Data collected at point-of-testing on a standardised form over 20 months in two regions of New Zealand were audited. Descriptive and simple inferential statistics report on population demographics and presence of elevated blood glucose (mmol/L). RESULTS: Data from 2156 individuals were audited. Most (1680, 78%) were female, the mean age was 52 years (standard deviation 18 years) and all major ethnic groups and socioeconomic quintiles were represented. For 53% of responders, this was their first blood glucose test. In total, 153 (7.1%) cases with elevated blood glucose were identified, including 94 who did not report a previous pre-diabetes or diabetes diagnosis. Blood glucose was not correlated with socioeconomic status (r = 0.04; P = 0.07), but weakly correlated with age (r = 0.19; P < 0.001). Blood glucose values did not appear to differ between ethnicities (P = 0.052). Men had a higher mean value than women (P = 0.003). People with elevated blood glucose access their general practitioner more often than people with normal blood glucose, irrespective of a diabetes diagnosis (P = 0.002). DISCUSSION: On-the-spot blood glucose testing is a health service accessed by a wide range of people, although more commonly by women than men. Future interventions targeting men may better engage them in health screening. Alongside awareness raising, on-the-spot community testing identified previously unknown elevated blood glucose levels at a rate of 1-in-22, and may lead to the earlier identification and treatment of prediabetes or diabetes. [ABSTRACT FROM AUTHOR]