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Summary: This survey suggests that patients are prepared to accept higher absolute fracture risk than doctors, before considering pharmacological therapy to be justified. Patients require that drug treatments confer substantial fracture risk reductions in order to consider long-term therapy. Introduction: Absolute fracture risk estimates are now incorporated into osteoporosis treatment guidelines. At present, little is known about how patients regard fracture risk and its management. We set out to describe and compare the views of patients and doctors on the level of fracture risk at which drug treatment is justified. Methods: A cross-sectional survey was conducted on 114 patients referred for bone density measurement and 161 doctors whose practice includes management of osteoporosis. Participants were asked about fracture risk thresholds for pharmacological intervention. Results: The absolute risk of both major osteoporotic fracture and hip fracture at which drug treatment was considered by patients to be justifiable was higher than that reported by doctors [major osteoporotic fracture, median (interquartile range): patients, 50% (25 to 60); doctors, 10% (10 to 20); P < 0.0001; hip fracture: patients, 50% (25 to 60); doctors, 10% (5 to 20); P < 0.0001]. Patients required that a drug provide a median 50% reduction in relative risk of fracture in order to consider taking long-term therapy, irrespective of the treatment mode or dosing schedule. Among doctors, there was an inverse relationship between the number of osteoporosis consultations conducted each month and threshold of risk for recommending drug treatment ( r = −0.22 and r = −0.29 for major osteoporotic fracture and hip fracture, respectively, P < 0.01 for both) Conclusions: Patients are prepared to accept higher absolute fracture risk than doctors, before considering pharmacological therapy to be justified. Patients require that drug treatments confer substantial fracture risk reductions in order to consider long-term therapy. [ABSTRACT FROM AUTHOR]

Objective: To assess the relation between demographic factors and film smoking stereotypes in adolescents and the potential influence of smoker stereotypes on smoking susceptibility. Design: A cross sectional questionnaire survey of school students (n = 3041) aged 12-13 and 16-17 years who were asked to describe the personal characteristics of female and male smokers in films. Selling: 15 primary or intermediate schools and 10 secondary schools in Auckland, New Zealand. Results: Appraisals of smokers in film were strongly influenced by age and sex with younger adolescents and males more likely to see female smokers as sexy, intelligent and healthy whereas older students and females more often appraised female smokers as stressed bored and depressed. Overall, image stereotypes (sexy, stylish) were more likely to be significantly associated with smoking susceptibility than emotional sensitivity stereotypes (stressed, depressed etc). Conclusions: Adolescents differ significantly in their appraisal of smokers in films; however, image based stereotypes, rather than emotional sensitivity stereotypes, are significantly associated with smoking susceptibility. [ABSTRACT FROM AUTHOR]

Background: The extent to which clusters of attempted suicides occur is a significant problem that is complementary to the current available research on the clustering of completed suicide. However, little systematic research on clusters of attempted suicides exists. The present study examines the extent and nature of clustering of suicide attempts.Method: The occurrence of clustering of attempted suicide was examined in nationwide data for all New Zealand hospitals, obtained from the New Zealand Health Statistics Services for the years 1988-1990. The Scan statistic and Knox procedure were employed for testing the significance of clusters in time and time-space, respectively.Results: The analyses indicated that significant time clustering occurred in younger age groups, specifically among 15-19 and 20-24 year olds. The results could not be accounted for by seasonal variations in admissions. Age specificity of time-space clusters emerged, exhibiting a similar pattern to that reported for completed suicides in the US.Conclusions: The results suggest a similar underlying mechanism for the clustering of parasuicide and completed suicides and provide support for the existence of contagion of suicidal behaviour. The implications for prevention are discussed. [ABSTRACT FROM AUTHOR]

Background: Mobile health (mHealth) apps represent a promising approach for improving health outcomes in patients with chronic illness, but surprisingly few mHealth interventions have investigated the association between user engagement and health outcomes. We aimed to examine the efficacy of a recommended, commercially available gout self-management app for improving self-care behaviors and to assess self-reported user engagement of the app in a sample of adults with gout., Objective: Our objective was to examine differences in self-reported user engagement between a recommended gout app (treatment group) and a dietary app (active control group) over 2 weeks as well as to examine any differences in self-care behaviors and illness perceptions., Methods: Seventy-two adults with gout were recruited from the community and three primary and secondary clinics. Participants were randomized to use either Gout Central (n=36), a self-management app, or the Dietary Approaches to Stop Hypertension Diet Plan (n=36), an app based on a diet developed for hypertension, for 2 weeks. The user version of the Mobile Application Rating Scale (uMARS, scale: 1 to 5) was used after the 2 weeks to assess self-reported user engagement, which included an open-ended question. Participants also completed a self-report questionnaire on self-care behaviors (scale: 1-5 for medication adherence and diet and 0-7 for exercise) and illness perceptions (scale: 0-10) at baseline and after the 2-week trial. Independent samples t tests and analysis of covariance were used to examine differences between groups at baseline and postintervention., Results: Participants rated the gout app as more engaging (mean difference -0.58, 95% CI -0.96 to -0.21) and more informative (mean difference -0.34, 95% CI -0.67 to -0.01) than the dietary app at the 2-week follow-up. The gout app group also reported a higher awareness of the importance of gout (mean difference -0.64, 95% CI -1.27 to -0.003) and higher knowledge/understanding of gout (mean difference -0.70, 95% CI -1.30 to -0.09) than the diet app group at follow-up. There were no significant differences in self-care behaviors between the two groups postintervention. The gout app group also demonstrated stronger negative beliefs regarding the impact of gout (mean difference -2.43, 95% CI -3.68 to -1.18), stronger beliefs regarding the severity of symptoms (mean difference -1.97, 95% CI -3.12 to -0.82), and a stronger emotional response to gout (mean difference -2.38, 95% CI -3.85 to -0.90) at follow-up. Participant feedback highlighted the importance of tracking health-related information, customizing to the target group/individual, providing more interactive features, and simplifying information., Conclusions: Participants found the commercially available gout app more engaging. However, these findings did not translate into differences in self-care behaviors. The gout app group also demonstrated stronger negative illness perceptions at the follow-up. Overall, these findings suggest that the development of gout apps would benefit from a user-centered approach with a focus on daily, long-term self-care behaviors as well as modifying illness beliefs., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617001052325; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373217., (©Anna Serlachius, Kiralee Schache, Anel Kieser, Bruce Arroll, Keith Petrie, Nicola Dalbeth. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 13.08.2019.)

Aim: To compare the relationships of age level, gender, smoking status and ethnicity with Form Two and Form Six students' beliefs about smoking and their familial smoking behaviour., Methods: A stratified sample of 3041 Form Two and Form Six students from schools in the Auckland region was surveyed. Smoking prevalence, frequency, parental smoking and smoking inside the home were assessed using a 60-item questionnaire., Results: Analyses revealed several important differences across and within the Form Two and Form Six data relating to ever smoking, daily smoking and expectations of smoking in the future. Specifically, Form Six students were more likely to be ever smokers, daily smokers and have higher expectations of smoking in the future (p <0.001). Asian students reported a consistently lower propensity to smoke and hold expectations of smoking in the future compared with other ethnic groups. Students from higher-decile-rank schools were more likely to be ever smokers, daily smokers and have positive smoking expectations for the future; (p <0.001, p <0.01, p <0.001). Significant differences in familial smoking acceptability were observed across all measures., Conclusions: The critical age differences were: (1) higher rates of ever smoking; (2) higher rates of daily smoking; and (3) higher levels of smoking expectations in Form Six compared with Form Two. Evidence from this study suggests that by Form Two a proportion of adolescents have already experimented with tobacco and some are daily smokers. Future research should continue to monitor the beliefs and behaviour of young adolescents and older teenagers who are at critical stages for the initiation and establishment of smoking behaviour. In addition, New Zealand's tobacco-control agenda should continue to support adult-focused programmes that reduce the acceptability and visibility of smoking.

Aim: To investigate the effect of aerial Bacillus thuringiensis (Foray 48B) spraying on self-reported symptom complaints, health perceptions, and visits to healthcare providers., Methods: Two hundred and ninety two residents within the Ministry of Agriculture and Forestry (MAF) West Auckland spray zone were recruited by a door-to-door survey of homes within the most intensively sprayed area ten weeks prior to the first aerial spraying. Participants completed a symptom checklist and a questionnaire measuring health perceptions. Three months after the start of spraying, 181 (62%) of the original participants responded to a similar postal questionnaire. Symptom reports, health perceptions and visits to healthcare providers were compared between the baseline and the follow-up questionnaire. Rates of symptom complaints in respondents with previously diagnosed asthma, hay fever, or other allergies were compared to those in respondents without these prior health conditions., Results: Symptom complaints increased significantly following the aerial spraying, in particular: sleep problems, dizziness, difficulty concentrating, irritated throat, itchy nose, diarrhoea, stomach discomfort, and gas discomfort. Analyses showed a significant increase in symptoms in those participants with a previous history of hay fever. While overall self-ratings of health decreased following the spraying, most residents saw their health as unaffected by the spray programme, and there was no significant increase in visits to general practitioners or alternative healthcare providers., Conclusions: Aerial spraying with Foray 48B is associated with some adverse health consequences in terms of significant increases in upper airway, gastrointestinal, and neuropsychiatric symptoms, as well as a reduction in overall perception of health in the exposed population./

Objectives: To gain a clearer conceptual understanding of medical students' disease and its impact on students, by separating the process of thinking that one may have a particular illness under study from the emotional distress that may accompany these thoughts., Method: In a questionnaire survey, the responses of 92 first-year and 85 third-year medical students were compared with those of 82 law students, with regard to medical students' disease perception, medical students' disease distress, hypochondriacal beliefs, concerns about health, the value placed on health, and recent visits to doctors in the past 12 months., Setting: The University of Auckland, New Zealand., Results: Both groups of medical students scored higher on medical students' disease perception than law students. First-year students scored higher on medical students' disease distress and hypochondriacal concerns than both law and third-year medical students. While medical students place a higher value on health, there were no differences with regard to health visits in the past year., Conclusions: The results support the separation of medical students' disease into perceptual and emotional components. This conceptualization of medical students' disease as a normal process rather than a form of hypochondriasis may be used to brief medical students when they enter medical school, in order to reduce the distress associated with the condition. Medical students' disease can also be used as a personally relevant example in teaching about how patients make sense of symptoms.

This study investigated the positive effects or changes that patients identified in their lives following a myocardial infarction (MI) or breast cancer. One hundred and forty-three patients were assessed in hospital following a first-time MI and 52 breast cancer patients were assessed on referral for radiotherapy. Approximately 3 months later both groups were asked if any positive changes had taken place in their lives following their illness. Patients' written responses to a single open-ended question were read independently by three judges who identified seven major positive themes. Approximately 60% of each patient group reported positive changes from their illness and the reporting of such changes was unrelated to illness severity. The most common theme reported by MI patients was healthy lifestyle change (68%), whereas, for breast cancer patients, it was improved close relationships with others (33%). These results are discussed in terms of the way patients make sense of and adapt to chronic illness.

The selection of entrants for medical school, as now widely agreed, should include measurements of non-academic as well as academic attributes. The authors have developed a process to assess the personal attributes of applicants. This included a structured panel interview carried out twice on each applicant by independent interviewers and a group exercise in which several applicants were observed whilst discussing a problem. Training for interviewers took the form of a half-day interactive workshop. One hundred and forty-one school-leaving applicants completed the new assessment. No relationship was found between academic achievement as reflected by marks in a national examination and scores in the panel interview, the group exercise, or the school principal's report. However, significant intercorrelations were found between the panel interview, group exercise and school report. The results of this experience have encouraged the Auckland School to continue to explore methods to measure these attributes in a carefully controlled study.

Aim: To report the sources of stress and satisfaction in the specialist workforce of three crown health enterprises (CHEs)., Method: Ninety eight specialists in Northland Health, Waitemata Health and Southern Health completed a questionnaire rating 39 factors for causing stress and satisfaction in their daily work., Results: The commonest sources of stress for specialists were keeping up to date, carrying a heavy clinical workload and time pressure generally. There were significant differences between specialty groups as well as regional differences. Specialists in two CHEs found dealing with management a major stressor. This finding is a major difference from previous overseas studies., Conclusions: Doing the job properly, having a job that seems worthwhile, having control of one's professional life and a job that is interesting provide the greatest sources of work satisfaction for medical specialists.

This study examined women's attitudes and motivations towards cervical screening. The sample consisted of 680 women attending three general practices in two New Zealand towns. Subjects completed a questionnaire relating to their knowledge of the cervical smear test and their current cervical smear status. The questionnaire also assessed what influenced their decision to have an up to date smear test or what reasons subjects gave for not having a current test. Women's preference for the smear taker was also investigated. Most women in the sample (92%) indicated they knew what a cervical screening test was. Current smears were proportionately less common in the at risk groups. The most frequently reported motivation for women to have a current smear was that their doctor had recommended it (30.6%), followed by the response that it was an established part of their personal health routine (20.2%). Most women who didn't have current smear tests gave the reason that they had not got around to having a test (39.4%), with the next reported reason being that the test was embarrassing (17.8%) and their doctor didn't suggest it (14.7%). The majority of women in the sample (59.7%) preferred their own doctor to do the test. The findings of this study highlight the importance of the women's general practitioner in influencing women in high risk groups to have smear tests. They also suggest significant improvements in increasing the number of women screened could be made using existing services.

Rates of attempted suicide have increased in most Western countries over the past 20 years. This level of deliberate self-harm is made more significant by the fact that a large proportion of attempted suicides will reattempt in the six months following their attempt and as a group they have a high risk of eventually killing themselves. While much of the research on prediction of suicidal behaviour has concentrated on demographic factors, little is known about the psychological variables that precede the suicidal act. This study examined 67 New Zealand suicide attempters on a range of psychological variables including self-esteem, hopelessness, depression, cognitive rigidity and social skills. Subjects were followed up after six months to determine their level of suicidal behaviour and ideation. Results suggest hopelessness and self-esteem are important indicators of future suicidal behaviour, with differential effects over short- and long-term periods. The implications for psychological assessment and suicidal risk assignment are discussed.