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Introduction: The optimal management of patients taking DOAC medications in the perioperative trauma setting is based on limited evidence. Current guidelines recommend withholding DOAC medications 48-72 hours pre-operatively. The objective of this trial was to determine the utility of measuring DOAC levels prior to surgery, evaluate the safety of a cut-off level of <50 ng/mL and to compare the outcomes with time parameters. Materials and Methods: We performed a cohort study of patients aged 50 years and older admitted with a hip fracture who underwent surgery between January 12 017 and December 31 2019. Primary outcome was time to surgery (TTS) in hours. Secondary outcomes include inpatient transfusion and thromboembolism rates and 30-day mortality. Results: 1579 patients underwent operative management of their hip fracture. The mean TTS in the DOAC group was 33.0 hours. This was significantly longer when compared to patients not on anticoagulation whose mean TTS was 24.4hours (95% CI -13.78: −8.71, P value <.05). It was also significantly higher than patients on warfarin whose mean TTS was 26.4hours (95% CI -12.41: −4.18, P value <.05). There was no significant difference in the transfusion rate and 30-day mortality between the groups (X2 = 2.086, df = 2, P value =.352)]. There was no significant difference in transfusion rates and 30-day mortality between the patients with a DOAC level <50 ng/mL compared with the patients not on any anticoagulation. There was no significant difference in 30-day mortality or transfusion rates between those patients on a DOAC operated within 48 hours compared with those operated after 48 hours (P value =.67). Discussion and Conclusion: DOAC therapy delays surgery for patients with a hip fracture. Using a DOAC level <50 ng/mL is a safe level to proceed with surgery and reduces the TTS compared to following current guidelines. If DOAC levels are not available the data still supports operation at 48 hours. [ABSTRACT FROM AUTHOR]

Background/Objectives: Evidence-based guidelines and care standards recommend offering oral nutrition supplements to all older adults with hip fracture, not just those already malnourished. This study aimed to identify the proportion of inpatients in a sample of hospitals in two countries that were provided with oral nutritional supplementation (ONS) following a hip fracture and to identify factors associated with ONS provision. Methods: An analysis of prospectively collected data from a bi-national Hip Fracture Registry nutrition sprint and registry audit data limited to older adults (≥65 years) undergoing surgical intervention for a fractured hip from 1 to 31 August 2021. Multivariable logistic regression was used to identify factors associated with providing ONS. Results: Patient-level data was available for 385 older adults (median 85 years; 60.5% female) admitted to twenty-nine hospitals. Less than half (n = 47.3%) of the audited inpatients were provided ONS. After adjusting for covariates, ONS was more likely to be provided to older adults who were identified as malnourished on formal testing (OR 11.92; 95%CI 6.57, 21.69). Other factors associated with prescription of ONS included those who did not have a preoperative medical assessment (OR 2.26; 95%CI 1.19, 4.27) or were cognitively impaired (OR 1.83; 95%CI 1.01, 3.32), severely frail, or terminally ill (OR 3.17; 95%CI 1.10, 9.17). Conclusions: ONS was provided in line with evidence-based recommendations for less than half of the older adults with a hip fracture in 29 hospitals in two countries. A structured approach to implementation may be required to reduce complications and improve outcomes for all older adults after a hip fracture, not just those assessed as cognitively impaired, frail, and/or malnourished. [ABSTRACT FROM AUTHOR]

Suicide prevention strategies include attempts to control information young people receive about suicide, but digital communication provides young people with alternative forums to engage with this issue. This article explores the constraints and opportunities for youth to talk about suicide in New Zealand. A thematic analysis of data from focus groups with young people suggests they resist what they see as a taboo on talking about suicide, see adults as unwilling to engage in conversations with them about suicide, and are reluctant to seek help for suicide from mental health professionals. They prefer to talk about suicide with peers, although there are challenges with doing this in person. Access to digital communication may provide young people with alternative forums to communicate about suicide which further undermines their willingness to engage with adults on the subject. This has led to a gap in communication between youth and adults on suicide.

Background: To assess the postintervention arson recidivism and other offending rates of a group of 182 firesetting children and adolescents referred to the New Zealand Fire Awareness and Intervention Program (FAIP) over a follow-up period of 10 years. To investigate predictors of offending behaviour as well as variables associated with previous involvement in firesetting behaviour and offending severity. Method: Data collected at the time of the FAIP intervention was provided by the New Zealand Fire Service and the offence histories of the sample were accessed from the New Zealand Police database (NIA). Data were analyzed using both descriptive and inferential statistics. Results: Although the arson recidivism rate was low (2%), rates of general offending were high, with 59% of the sample having committed an offence during the follow-up period. Fifteen percent of the sample was classified as severe offenders, 40% as moderate and 4% as minor. Of offenders, 12.6% had been imprisoned during the follow-up period. Offending was predicted by experience of abuse and a previous firesetting behaviour at the time of the FAIP intervention. Living with both parents at the time of intervention decreased the probability of an individual engaging in future offending behaviour. The presence of family stress and a diagnosis of Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder (ADD/ADHD) were associated with previous firesetting behaviour. In addition, involvement with family violence (as a perpetrator, complainant or victim) was associated with more severe offending behaviour. Conclusions: In light of existing research, the findings of this study indicate that many firesetters are at risk for future offending and that identification of high-risk individuals is therefore an important consideration for any organization involved with firesetters. To minimize this risk, there is a need for a collaborative, multiagency approach to firesetting behaviour involving comprehensive risk assessment and appropriate referral for at-risk individuals.

Chronic lymphocytic leukaemia (CLL) is the most common haematological malignancy in Australia and New Zealand (ANZ). Considerable changes to diagnostic and management algorithms have occurred within the last decade. The availability of next‐generation sequencing and measurable residual disease assessment by flow cytometry allow for advanced prognostication and response assessments. Novel therapies, including inhibitors of Bruton's tyrosine kinase (BTKi) and B‐cell lymphoma 2 (BCL2) inhibitors, have transformed the treatment landscape for both treatment‐naïve and relapsed/refractory disease, particularly for patients with high‐risk genetic aberrations. Recommendations regarding appropriate supportive management continue to evolve, and special considerations are required for patients with CLL with respect to the global SARS‐CoV‐2 pandemic. The unique funding and treatment environments in Australasia highlight the need for specific local guidance with respect to the investigation and management of CLL. This consensus practice statement was developed by a broadly representative group of ANZ experts in CLL with endorsement by peak haematology bodies, with a view to providing this standardised guidance. [ABSTRACT FROM AUTHOR]

A significant number of children and adolescents engage in deliberate fire setting, beyond the scope of curiosity and experimentation. Interventions developed to respond to the needs of such fire setters generally involve educational and/or psychosocial approaches. Research evaluating the effectiveness of these interventions is dominated by outcome studies which rely on recidivism rates determined by either official records or parent reports. There has however, been no process evaluation studies published. This study presents a process analysis which aimed to identify the strengths and weaknesses of a Fire Awareness and Intervention Program in New Zealand, from the perspectives of program consumers. Qualitative research methods were employed, with data being derived from in-depth interviews with young people and their parents/caregivers. The analysis indicated that (a) the FAIP was generally regarded as a positive experience, (b) practitioners' qualities of empathy and understanding are important for developing rapport with the young people and their parents, (c) education-based intervention tailored to the young person's age and developmental level is important, (d) educational resources need to be updated and used flexibly to respond appropriately to the age and developmental level of the young person, and (e) inter-agency and intra-agency relationships need to be developed and maintained, with formal arrangements for reciprocal referral systems developed in order to respond to the needs of the clients. The resulting implications for service providers, along with future research are discussed.

Background: The EarlyBird program is a psycho-educational early intervention program for parents of children with autistic spectrum disorder (ASD). It aims to provide parents with skills to increase their child's communication and manage challenging behaviour using behavioural techniques. Method: Two interlinked studies examined access to the EarlyBird program and barriers which may affect uptake. Study 1 investigated who accessed the EarlyBird program, and what factors influenced this choice. Study 2 was a qualitative investigation which focused on barriers to uptake for ethnic minority groups in New Zealand. Results: Findings indicated that approximately 85% of families eligible for the program do not participate. Non-membership of Autism New Zealand (the agency responsible for administering the program), ethnicity, and length of wait time were significant factors in non-participation. Conclusions: A model of factors which may influence uptake of interventions targeting the families of children with a disability is proposed. (Contains 2 tables, 1 figure, and 1 note.)

In recent years the problem of sexually abusive youth has been increasingly recognized as a significant issue in our community. This paper provides a brief overview of the literature that shows sexually abusive youth to be a heterogeneous population. We argue for the development of typologies of adolescent sexual offenders to assist in the guiding of individualized treatment plans to suit adolescents' and families' needs. Further research should focus on development and interventions that are appropriate to adolescent sexual offender types. A description of how treatment issues are being addressed in New Zealand is included and recommendations are made regarding possible future directions for the treatment of sexually abusive youth.

Children with autism display significant learning, social and behavioural difficulties which impact on parents and teachers. Intensive child-focused behavioural interventions have proved to be an effective way of reducing these difficulties. Such programs are expensive to run and are currently not funded in New Zealand. One alternative way to provide early intervention at lower cost is to support parents as change agents or therapists for their child; however, little is known about the efficacy of such parent-focused programs. The NZ Ministry of Education currently resources a parent-focused program called "EarlyBird." This program is delivered to parents in small groups over eight three-hour sessions with homework tasks included. The authors are currently evaluating the effectiveness of this program, measuring outcomes in terms of both parent learning and child behaviour. This paper describes the approach taken in the evaluation of "EarlyBird" and discusses methods and standards which can be used to evaluate parent-focused autism interventions. (Contains 1 figure.)

A growing body of literature argues that achieving radical change in the agri-food system requires a radical renegotiation of our relationship with the environment alongside a change in our thinking and approach to transformational food politics. This paper argues that relational approaches such as a more-than-human ethic of care (MTH EoC) can offer a different and constructive perspective to analyse agri-food system transformation because it emphasises social structures and relationships as the basis of environmental change. A MTH EoC has not yet been applied to regenerative agriculture, yet other literature on regenerative agriculture suggests that care may be present in these spaces and calls for the need for social science analysis of the regenerative movement. This paper uses a MTH EoC lens to reveal a diverse array of ways in which power is and can be deployed for change in the regenerative agriculture movement in Aotearoa, New Zealand. Globally, regenerative agriculture tends to be analysed through positivist, scientific approaches that focus on biophysical markers of ecological improvement. Yet, a relational approach reveals how engagement in regenerative agriculture is creating significant shifts in mindset towards more holistic and relational understandings of biological and social ecosystems. A regenerative mindset framework is suggested as a method of understanding the connection between a regenerative form of thinking, being and doing for farmers. Interviews suggested that this shift in farmers' socio-ecological relations is crucial to the transformational potential of regenerative agriculture. This paper argues that relational analyses such as the MTH EoC approach used to analyse regenerative agriculture in this research, refresh the way we analyse agri-food system change. They also are critical to guiding and supporting on-the-ground socio-ecological shifts that are necessary to see agricultural transformation. [ABSTRACT FROM AUTHOR]

The metabolic syndrome is common in older adults and may be modified by the diet. The aim of this study was to examine associations between a posteriori dietary patterns and the metabolic syndrome in an older New Zealand population. The REACH study (Researching Eating, Activity, and Cognitive Health) included 366 participants (aged 65–74 years, 36 % male) living independently in Auckland, New Zealand. Dietary data were collected using a 109-item FFQ with demonstrated validity and reproducibility for assessing dietary patterns using principal component analysis. The metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III. Associations between dietary patterns and the metabolic syndrome, adjusted for age, sex, index of multiple deprivation, physical activity, and energy intake were analysed using logistic regression analysis. Three dietary patterns explained 18 % of dietary intake variation – 'Mediterranean style' (salad/leafy cruciferous/other vegetables, avocados/olives, alliums, nuts/seeds, shellfish and white/oily fish, berries), 'prudent' (dried/fresh/frozen legumes, soya-based foods, whole grains and carrots) and 'Western' (processed meat/fish, sauces/condiments, cakes/biscuits/puddings and meat pies/hot chips). No associations were seen between 'Mediterranean style' (OR = 0·75 (95 % CI 0·53, 1·06), P = 0·11) or 'prudent' (OR = 1·17 (95 % CI 0·83, 1·59), P = 0·35) patterns and the metabolic syndrome after co-variate adjustment. The 'Western' pattern was positively associated with the metabolic syndrome (OR = 1·67 (95 % CI 1·08, 2·63), P = 0·02). There was also a small association between an index of multiple deprivation (OR = 1·04 (95 % CI 1·02, 1·06), P < 0·001) and the metabolic syndrome. This cross-sectional study provides further support for a Western dietary pattern being a risk factor for the metabolic syndrome in an older population. [ABSTRACT FROM AUTHOR]

In this article, the author discusses how to make strategic planning a more valuable tool for higher education in today's tough times. Strategic planning is really the answer to five straightforward questions. The first three represent the plan itself, while the last two are what makes the plan vital and dynamic: (1) Why do we exist?; (2) What do we want to create?; (3) How are we going to get there?; (4) How will we know we are successful?; and (5) What do we do now? The author believes that many colleges operate as the nautical equivalents of barges. Institutions of higher education believe in the theory and practice of shared governance. That means everyone they hire to join them on their barge is given an oar. They encourage individual engagement in the hard work of moving the barge from where they are to where they would like to be. And while they have various councils and committees, at the center of what they do is the individual educator. Higher education needs a different type of vessel. It needs a war canoe. Found in various forms in many world cultures, the war canoe is generally a long, single-hulled vessel that is manned by many paddlers. A war canoe uses a slender prow to slice through the water. The pointy end aligns the vessel with its destination as the leader(s) attempts to align the vessel--and all of its occupants--with the chosen destination. Randomness is replaced by coordination as the rowers' efforts are replicated and reinforced. This is the very essence of strategic planning. It is the aligning of the scarce resources in the organization with a clear destination. And as each person begins to understand his or her role in contributing to the success, the random splashing is replaced by a coordinated rhythm. (Contains 1 online resource.)

The global population is aging. Preserving function and independence of our aging population is paramount. A key component to maintaining independence is the preservation of cognitive function. Metabolomics can be used to identify biomarkers of cognition before noticeable deterioration. Our study investigated the plasma metabolome of 332 community-living New Zealanders between 65 and 74 years of age, using gas chromatography-mass spectrometry. Six cognitive domains were assessed. Of the 123 metabolites identified using an in-house mass spectral libraries of standards, nervonic acid had a significant, inverse association with the attention domain (P-value = 1.52E− 4; FDR = 0.019), after adjusting for covariates (apolipoprotein E -ε4 genotype, sex, body fat percentage (standardised by sex), age, education, deprivation index, physical activity, metabolic syndrome, polypharmacy, smoking status, and alcohol intake) and multiple testing. Attention is defined as the ability to concentrate on selected aspects of the environment while ignoring other stimuli. This is the first study to identify nervonic acid as a potential biomarker of attention in older adults. Future research should confirm this association in a longitudinal study. [ABSTRACT FROM AUTHOR]

Purpose: The global population is ageing. Evidence show dietary patterns may be associated with cognitive status in older adults. This cross-sectional study investigated associations between dietary patterns and cognitive function in older adults in New Zealand. Methods: The REACH study (Researching Eating, Activity, and Cognitive Health) included 371 participants (65–74 years, 36% male) living independently in Auckland, New Zealand. Valid and reproducible dietary patterns were derived, using principal component analysis, from dietary data collected by a 109-item validated food frequency questionnaire. Six cognitive domains (global cognition, attention and vigilance, executive function, episodic memory, working memory, and spatial memory) were tested using COMPASS (Computerised Mental Performance Assessment System). Associations between dietary patterns and cognitive scores, adjusted for age, sex, education, physical activity, energy, and Apolipoprotein E-ε4 status were analysed using multiple linear regression analysis. Results: Three dietary patterns explained 18% of dietary intake variation—'Mediterranean style' (comprising: salad vegetables, leafy cruciferous vegetables, other vegetables, avocados and olives, alliums, nuts and seeds, white fish and shellfish, oily fish, and berries); 'Western' (comprising: processed meats, sauces and condiments, cakes, biscuits and puddings, meat pies and chips, and processed fish); and 'Prudent' (comprising: dried legumes, soy-based foods, fresh and frozen legumes, whole grains, and carrots). No associations between any cognitive domain and dietary pattern scores were observed. Global cognitive function was associated with being younger and having a university education. Conclusion: In this cohort of community-dwelling, older adults in New Zealand, current dietary patterns were not associated with cognitive function. [ABSTRACT FROM AUTHOR]

New Zealand's Sexual Violence Courts Pilot was established in late 2016, intended in part, to reduce the stress experienced by complainants. Young witnesses who testified in the specialist courts and their caregivers were interviewed about their experiences of court involvement. Interview transcripts were analysed using thematic analysis and the following themes were identified: The period between reporting an alleged offence and the trial is far too long and stressful; moving forward with life is difficult until the trial has concluded; cross-examination is distressing; feeling comfortable and supported when at court is important; safety and distance from the defendant when at court is important; separation of young witnesses from their caregivers at court is difficult; information is lacking throughout the process; and parenting young witnesses through the court process is challenging. Young witnesses typically experienced court involvement as very stressful and distressing, and further innovation within the courts is therefore needed. [ABSTRACT FROM AUTHOR]

Background: Early (1957-1997) remediation strategies, predominantly Pinus radiata D.Don afforestation and indigenous shrubland reversion, proved effective in treating gully erosion in the East Coast region, North Island, New Zealand. However, the expansion of untreated gullies and initiation of new ones necessitated additional investment in land-use change (1997-- 2017) to reduce their on- and off-site impacts. Methods: Gullies were digitised from aerial photography flown in ~1957 (before reforestation) and again in 1997. The region was re-flown in 2017, providing an opportunity to assess remediation successes and failures. For hill country areas, gully location and size were recorded by vegetation type, for major catchments, for two contrasting geological terrains, and for land designated in Gisborne District Council's Combined Regional and District Plan as Land Overlay 3A (LO3A). Results: Between 1997 and 2017, 601 treated gullies fully re-stabilised and 315 new gullies formed. There remain 1864 gullies, comprising 5347 ha. This represents a 13% reduction in numbers and a 31% decrease in area during this 20-year period. Over the longer 60-year period, and across all land uses, 2942 treated gullies successfully stabilised. However, with the initiation of 1446 new gullies there are currently 5347 ha of gully requiring further treatment, with the largest of the affected area equally distributed across pastoral and reforested hill country and primarily located within the Tertiary terrain, Waiapu catchment, and areas designated as LO3A. Conclusions: Although attempts at gully remediation since the early 1960s have resulted in a 45% reduction in gully number, the current area of hill country affected by gullying is only 5% less than 60 years ago. During this period, gully initiation and development have outstripped mandated erosion control targets set by the East Coast Forestry Project (ECFP), for land designated as LO3A, and for the 'Restoration of the Waiapu Catchment' by 2020-22. Addressing ongoing on- and off-site impacts of gully erosion will require further significant long-term investment in the prioritisation and completion of these unfulfilled targets. For gullies identified in the National Environmental Standard for Plantation Forestry (NES-PF) as high erosion risk (orange zone) or where the erosion risk is very high (red zone), we recommend: (i) a revision of remediation strategies for the larger and more actively eroding of gullies destined for future afforestation, and (ii) for gullies within exotic production forests, the replanting of species (exotic or indigenous) better suited to providing long-term stabilisation, post-harvest. [ABSTRACT FROM AUTHOR]

Background: Provision of quality care can help to reduce adverse health outcomes following hip fracture. While surgical management by either a consultant or junior surgeon has shown inconclusive differences in patient outcomes, consultant presence is often recommended, yet little is known about the factors that influence whether a consultant surgeon is present during hip fracture surgery. The aim of this study is to examine patient, surgical and hospital factors associated with having a consultant surgeon present during hip fracture surgery. Methods: An examination of hip fracture surgeries of adults aged ≥ 50 years admitted to hospitals in Australia and New Zealand between 1 January 2015 and 31 December 2018 using data from the Australia and New Zealand Hip Fracture Registry was conducted. Multivariable logistic regression was used to examine factors associated with the presence of a consultant surgeon during hip fracture surgery. Results: There were 29 530 hip fracture surgeries 58.1% had a consultant surgeon present (range 8.5–100% by hospital). Patients were more likely to have a consultant surgeon present during surgery if they had private health insurance, were operated on after hours, required total hip replacements or were operated on in hospitals that conducted ≤150 surgeries per year. Conclusion: There is variation in the presence of consultant surgeons within Australia and New Zealand during hip fracture surgery, potentially associated with the complexity of surgery and hospital factors. However, further research is needed to determine the optimum level of supervision required based on patient factors and surgical complexity. [ABSTRACT FROM AUTHOR]

Aim: To describe the multi‐disciplinary child protection teams which administer the National Child Protection Alert System in District Health Boards in New Zealand and the understanding and perceptions of that system held by team members. Methods: This is a mixed‐method observational study. In December 2016 and January 2017, all child protection alert system multi‐disciplinary team members were invited to participate in an online survey. Quantitative data were expressed with simple descriptive statistics. Qualitative findings were analysed using thematic analysis. Results: Ninety‐one (56.9%) of 160 team members nationwide completed the survey. All 20 District Health Boards and multiple disciplines were represented. Most respondents agreed that they received good information to make decisions (74/90, 82.2%), that it was usually easy to reach consensus (82/91, 90.1%), that the system helped to keep children safe (72/91, 79.1%) and that it did not stigmatise families (49/91, 53.9%). Qualitative analysis identified considerable variation in understanding of the system and a need for more training to support more consistent implementation of the system. Conclusions: Overall, health professionals responsible for the child protection alert system regard it positively but express a need for more training for team members and front‐line staff to maximise the system's potential and minimise any risk of stigmatisation. [ABSTRACT FROM AUTHOR]

An updated Cochrane Review showed that maternal supplementation with omega-3 fatty acids reduced preterm birth, offering a potential strategy for prevention. We hypothesised that pregnant women with obesity, at higher risk of preterm birth, would have low omega-3 fatty acid levels and may benefit from supplementation. Our study measured the omega-3 fatty acid levels of 142 participants from the Healthy Mums and Babies study, Counties Manukau, Auckland, New Zealand. Counties Manukau is a multi-ethnic community with high rates of socio-economic deprivation, obesity, and preterm birth. Red blood cell omega-3 fatty acid levels were measured from samples collected between 120 and 176 weeks' gestation. Contrary to our hypothesis, participants in our study had similar or higher levels of omega-3 fatty acids to those reported in pregnant populations in Australia, Norway, China, and Germany. Our findings emphasise the importance of testing omega-3 fatty acid status before supplementing groups at risk of preterm birth. [ABSTRACT FROM AUTHOR]

Examines women's studies in New Zealand as provided by teaching institutions, women's groups, and government bodies and as represented in resources and publications. Reports on a survey of women's studies teachers focusing on program content, methodology, ideology, and aims. Provides case studies of three women's studies programs. (LL)

Caregiver support is vital in improving outcomes for child sexual abuse victims; however, the disclosure can significantly affect caregivers, thus impacting their ability to meet their children’s needs. To maximize the support from caregivers, their own needs following disclosure need to be met. This study investigated the impact of child sexual abuse disclosure and associated needs as identified by caregivers. Sixty needs assessment forms were collected from families who accessed a parenting support pilot program run in New Zealand. These forms were completed by nonoffending caregivers during an assessment session with their counselor and consisted of both open-ended and Likert scale questions focusing on both the needs of the child and the family. Caregivers identified a range of impacts of the disclosure on their children, themselves, and other families members and the related support that may be needed. In particular, caregivers identified that they needed support with child behavior management and with their own coping. The findings suggest that interventions with caregivers following disclosure of child sexual abuse may be a valuable adjunct to therapy provided directly to the child. [ABSTRACT FROM PUBLISHER]

This article examined commonalities in adolescents' priorities for engagement with psychological support in the context of contemporary youth culture in New Zealand. These were explored across a range of different services including a face-to-face hospital-based mental health service, a face-to-face school-based counseling service, a telephone counseling service and a new form of counseling using mobile phone text. Interviews were conducted with 63 young people aged 13-18 who had used at least one of these services. A thematic analysis identified that there were common priorities for participants across the different services including their need to keep control; not to have their parents involved; to have a relationship with a counselor which was more like a friendship than a professional relationship; to talk freely and be listened to; and to have the service be accessible and flexible enough to fit around their lives. Text and telephone counseling were seen to be particularly appropriate for meeting some of these needs. Professionals working with young people should consider offering a suite of options for psychological support, allowing young people to balance their different needs and priorities and thus facilitate their engagement. [ABSTRACT FROM AUTHOR]

Background: Anticipatory guidance around the management of sleep and crying problems in early infancy has been shown to improve both infant behaviour and parent symptoms of postnatal depression. Digital technology offers platforms for making such programs widely available in a cost-efficient manner. However, it remains unclear who accesses online parenting advice and in particular, whether the parents who would most benefit are represented amongst users. It is also unknown whether the uptake of online programs can be improved by health professional recommendations, or whether parents require additional prompts and reminders to use the program. In this study we aim to: (1) determine whether weekly email prompts increase engagement with and use of a brief online program about infant sleeping and crying, (2) determine whether encouragement from a maternal and child health nurse promotes greater engagement with and use of the program, (3) examine who uses a brief online program about infant sleeping and crying; and, (4) examine the psychosocial characteristics of participants.Methods/design: This study is a randomised, parallel group, superiority trial, with all participating primary carers of infants aged 2 to 12 weeks, receiving access to the online program. Two modes of recruitment will be compared: recruitment via an online notice published on a non-commercial, highly credible and evidence-based website for parents and carers and via the parent's Maternal and Child Health nurse. After baseline assessment, parents will be randomised to one of two support conditions: online program alone or online program plus weekly email prompts. Follow up data will be collected at 4 months of infant age.Discussion: Results from this trial will indicate whether involvement from a health professional, and/or ongoing email contact is necessary to engage parents in a brief online intervention, and promote parental use of strategies suggested within the program. Results of this trial will inform the development of recruitment and engagement strategies for other online interventions.Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12613001098729. Registered 01 October 2013. [ABSTRACT FROM AUTHOR]

Background and Objective Modeling of periodontal bone regeneration in a large animal enables better examination of the spatial and temporal regulation of osteogenesis and the remodeling of the healing defect. RANK, RANKL and osteoprotegerin ( OPG) are known to be important regulators of bone healing. The aim of this study was to create periodontal defects surgically in a large animal model and to examine bone regeneration and the expression of RANK, RANKL and OPG proteins in the defect site during bone regeneration. Material and Methods Periodontal defects were made in the furcation of the second mandibular premolar of sheep. Wound healing was examined 6 h, and 1, 4 and 6 wk after surgery and in control tissue. The teeth and defect region were decalcified and paraffin embedded. Immunohistochemistry for RANK, RANKL and OPG was conducted. Osteoclasts were identified using TRAP staining. Results The defects were examined at different time points after surgery and by 6 wk the defect region had fully regenerated with new bone, albeit less dense than that in the unwounded controls. RANK-positive osteoclasts were present at the edge of the wound from week 1 and were found within the defect at week 6, corresponding to osteoclast activation and bone remodeling. RANKL staining increased from week 1 compared with unwounded tissue, and peaked at 4 and 6 wk, as the osteoblast numbers increased. At the same time, OPG immunostaining was high in controls and at week 6, suggesting that it may act to block RANKL and control the bone remodeling within the defect. Conclusion Distinctive temporal and spatial expression patterns for RANK, RANKL and OPG proteins were observed during healing of surgically created periodontal wounds in a sheep model. The research identifies possible therapeutic approaches to periodontal bone repair via modulation of these members of the tumor necrosis factor family. [ABSTRACT FROM AUTHOR]

Background and Objective The role of two recently identified and closely related T-helper cell subsets - regulatory T-cells [Tregs; forkhead box P3-positive ( FOXP3+)] and Th17 cells [interleukin-17-positive ( IL-17+)] - in periodontal disease is yet to be determined. Tregs are essential in maintaining peripheral tolerance and regulating the immune response. Th17 cells play a critical role in several autoimmune diseases, inflammation and host defence. The aim of this study was to determine the presence of FOXP3+ Tregs and IL-17+ cells, and their possible spatial interaction, in diseased periodontal tissues. Material and Methods Twenty-nine archival tissues with nonspecific gingival inflammation were grouped based on the intensity (minimally or intensely inflamed) and nature (T-cell predominant or B- and plasma-cell predominant) of the inflammatory infiltrate. Using double-labelling immunohistochemistry, the concomitant presence of FOXP3+ and IL-17+ cells was determined and their spatial relationship was established. In addition, the proportions of FOXP3+ and IL-17+ cells were compared between the groups. Results Of the 29 gingival specimens investigated, 17 were intensely inflamed (≥ 1000 inflammatory cells per 0.12 mm2) and 12 were minimally inflamed (≤ 600 cells per 0.12 mm2). Based on the percentage of CD19+ B-cells and plasma cells collectively and CD3+ T-cells, gingival tissues were also grouped into B- and plasma-cell-predominant gingival tissues ( n = 21; 50.7% total B- and plasma cells vs. 19.1% T cells; p < 0.001) and T-cell-predominant gingival tissues ( n = 8; 61.0% T-cells vs. 15.2% B- and plasma cells; p = 0.007). More FOXP3+ cells than IL-17+ cells were observed in all archival gingival tissues examined. A trend towards an increased number of FOXP3+ cells was observed for intensely inflamed gingival tissues (6.7%) and for B- and plasma-cell-predominant tissues (6.4%) compared with minimally inflamed gingival tissues (4.6%) and T-cell-predominant gingival tissues (4.5%). However, no statistically significant difference in the mean percentage of FOXP3+ cells between the groups was observed. Interestingly, FOXP3+ cells were significantly correlated with the B- and plasma-cell/T-cell ratio in B- and plasma-cell-predominant tissues ( r = 0.713, p < 0.001). Overall, there were very few IL-17+ cells (< 1%). All IL-17+ cells identified in this study had an ovoid/plasmacytoid morphology and were larger in size compared with adjacent inflammatory cells. IL-17+ and FOXP3+ cells were not adjacent to each other in any of the areas examined, suggesting that FOXP3+ Tregs do not directly interact with IL-17+ cells in diseased gingival tissues. IL-17+/ FOXP3+ cells were not detected in the tissues examined. Conclusion These results show that FOXP3+ cells are more prominent than IL-17+ cells in periodontal disease processes, which may suggest a predominant role for FOXP3+cells in periodontal disease. Further studies are required to characterize these cells more precisely and to understand, in more detail, their roles in the pathophysiology of periodontal disease. [ABSTRACT FROM AUTHOR]

The Evidence Act 2006 came into law in New Zealand in 2007. Among the many reforms was an amendment to the law pertaining to expert opinion evidence. In keeping with other jurisdictions, New Zealand adopted the “substantial helpfulness” test in relation to the admissibility of expert evidence. Since 2008, the courts have regularly admitted what has been termed “counterintuitive” expert psychological evidence in child sexual abuse trials, and appellate courts have upheld the use of this evidence. Such evidence has the purpose of educating juries, with particular reference to commonly held misconceptions about child sexual abuse. We discuss what is meant by the term counterintuitive evidence, why such evidence has been deemed helpful and the types of counterintuitive evidence currently given by psychologist expert witnesses in the New Zealand courts. [ABSTRACT FROM PUBLISHER]

Background and Objective There is a paucity of data in relation to the possible emergence of triclosan ( TCS)-resistant bacteria following long-term exposure to TCS toothpaste. Therefore, this study investigated whether long-term continuous exposure to TCS in toothpaste selects for TCS-resistant bacteria within the oral biofilm. Material and Methods Dental plaque samples were collected from 40 individuals during year 5 of a randomised controlled trial. Participants had been randomly assigned to use TCS (3000 μg/ mL TCS) ( n = 18) or placebo toothpaste ( n = 22). Diluted plaque samples were plated on to Wilkins-Chalgren agar plates containing 5% (v/v) laked sheep red blood cells and TCS (concentrations ranging from 25 to 150 μg/ mL) and incubated at 37°C under microaerophilic and anaerobic conditions for 2-10 d. Selected bacterial isolates were identified by partial 16S rDNA sequencing and TCS minimum inhibitory concentration (MIC) determined for each isolate. Results At 3000 μg/ mL TCS no growth was observed under microaerophilic or anaerobic conditions in either group. The MICs of TCS for all isolates ranged from 125 to 1000 μg/ mL in both groups. Species common to both groups had similar MICs. Veillonella parvula and Campylobacter gracilis were the most frequent isolates from both groups, with similar MICs in both groups. Conclusion The use of TCS-containing toothpaste did not appear to lead to an increase in MIC of TCS of oral bacterial isolates. [ABSTRACT FROM AUTHOR]

Background: Outcome measurement in child and adolescent mental health services in New Zealand became mandatory in 2005 and little is known about how this is perceived by service users. Aims: This study aimed to ascertain what service users think about routine outcome measurement in child and adolescent mental health services. Method: Nine semi-structured focus groups of child and adolescent service users (n=34) and family members (n=21) were held in different sites in New Zealand to determine their views on outcome measures. Results: Consumers supported outcome assessment with some provisos that have important implications for clinical services: the method of collecting information is critical to acceptance; assessment should be done in the context of an established relationship with the clinician; care is needed over the timing and context of assessment, access to information and feedback of results; and measures should be brief and holistic and their limitations recognised. Conclusion: Service users support outcome measures but their implementation requires care and consultation. [ABSTRACT FROM AUTHOR]

Aims To compare a monotherapy of Er: YAG laser debridement (ERL), wavelength 2940 nm, with mechanical scaling and root planing ( SRP) for the treatment of chronic periodontitis using clinical and patient-centred outcomes. Methods Twenty-eight participants had two randomly assigned quadrants treated with ERL and two with SRP. Full-mouth plaque index, probing depth, bleeding on probing, clinical attachment level and gingival recession were recorded at baseline and 6- and 12-weeks post therapy. A questionnaire was used to assess pain, discomfort and satisfaction during and after treatment. Results Twenty-two participants completed treatment and had 6- and 12-week clinical re-evaluations. SRP provided greater mean pocket depth reduction at 6- and 12-weeks ( p = 0.01 and p = 0.003 respectively), and a greater reduction in pockets ≥ 4 mm at 6 weeks only ( p = 0.03) compared with ERL. SRP also resulted in a significant reduction in bleeding on probing ( BOP) sites at 12 weeks compared with ERL and a statistically significant greater reduction in mean clinical attachment level ( CAL) at 6- ( p = 0.02) and 12-weeks ( p = 0.03). Patients expressed greater satisfaction with SRP on the day of treatment but were equally satisfied subsequently. Conclusion SRP resulted in a statistically significant greater short-term improvement in clinical parameters and patient satisfaction compared with ERL. [ABSTRACT FROM AUTHOR]

Background: the right for patients of all diagnoses to be in receipt of palliative care from an early point in the diagnosis of a life-limiting condition is now enshrined in policy in a number of countries and increased emphasis is placed upon the role of generalist palliative care. However, little is known as to how this policy is enacted on the ground.Aim: to explore understandings of, and perceived roles in relation to, palliative care provision amongst generalist and specialist health care providers in England and New Zealand.Design: qualitative data were collected via individual interviews and focus groups.Setting/participants: participants comprised generalist and specialist palliative care providers working in a variety of settings in England (n = 58) and New Zealand (n = 80).Results: the following issues with significant implications for this new phase of development for palliative care were identified: (1) difficulties with terminology and perceived roles/responsibilities; (2) problems of integrating palliative care into a generalist workload; (3) challenges in generalist/specialist partnership working; and (4) the potential negative consequences of specialization.Conclusions: these data indicate that, within England and New Zealand, the policy rhetoric of universal palliative care provision is not being straightforwardly translated into service delivery and individual clinical practice. Further research is required to explore and evaluate different models of organization and service provision that empower ‘generalists’ to provide palliative care, without resulting in deskilling. Finally, definitional clarity at an academic/policy level is also needed. [ABSTRACT FROM PUBLISHER]

doi: 10.1111/j.1741-2358.2010.00402.x Experiences and perceptions of oral health and oral health care among a sample of older New Zealanders Background: Most research on older people's oral health has been quantitative. A need for more in-depth understanding of the oral health of that age group has pointed to a need for more qualitative investigations. Objective: To explore experiences and perceptions of oral health and oral health care among an ethnically-mixed sample of older New Zealanders. Methods: In-depth interviews were conducted with 24 older people in two communities in New Zealand's South Island. Thematic analysis of transcribed data was undertaken. Results: Three main themes that emerged were: (1) the processes of negotiating a tension between cost and convenience of access; (2) the experiential constraining of oral health maintenance; and (3) trusting in dental professionals. These serve to organise processes such as normalising, justifying and social comparisons that create an equilibrium or tolerance and acceptance of what might otherwise be considered to be relatively poor oral health. Conclusions: We identified a number of shared experiences which affect older people's ability to maintain their oral health in the face of material and social barriers to oral health care. Because expectations were generally lower, there was greater concordance between experience and expectation, and people tended to be fairly satisfied with their oral health and the care they had received. [ABSTRACT FROM AUTHOR]

In April 2010 the New Zealand Family Court introduced the National Early Intervention Process (NEIP) to diversify its previous unitary dispute resolution pathway into two tracks (standard and urgent). A 'triage' model is now in use to assess and assign cases appropriately. This article outlines the key milestones in the Family Court's 30-year history which have led to this new initiative to reduce delays and help avoid the escalation of family conflicts over the care of children into bitter and intractable disputes. NEIP represents the most overarching reform of the Family Court since the Court's inception in 1981. [ABSTRACT FROM AUTHOR]

Dental education is a unique form of health professional education. This is because the clinical training component largely occurs within the dental school and involves students carrying out irreversible patient interventions early in their education. Perhaps not surprisingly, previous research indicates that dental education (and particularly the clinical component) is stressful for many students. In their responses to an annual clinical learning environment survey, final-year Bachelor of Dental Surgery (BDS) students at the University of Otago have suggested that teaching staff play a key role in mitigating or compounding stressors associated with students' clinical work. In 2007-2009 questionnaire responses, students identified the kinds of staff feedback which they found constructive or unhelpful while working in patient clinic settings, described their responses to feedback received, and identified ways in which students' clinical learning experiences might be improved. This paper outlines 2007-2009 University of Otago Faculty of Dentistry clinical learning environment survey findings, and relates these to the literature on effective teaching and clinical teaching. It then describes programmatic changes and research initiatives developed in response to student feedback. [ABSTRACT FROM AUTHOR]

The aim of this process evaluation was to identify consumer perspectives of strengths and weaknesses of programme delivery at three New Zealand community treatment programmes for sexually abusive youth. Qualitative methods were employed, with data being obtained from in-depth interviews with 24 sexually abusive youth and 23 caregivers across three sites. Results indicated that clients value good pre-entry information to reduce barriers to participation; engagement in treatment is facilitated by the quality of the client-therapist relationship, family involvement, culturally appropriate communication and creative and physical activities; and post-treatment support is important. Findings highlight the importance of engaging adolescents and their families actively during the intake period, the treatment phase and post-treatment transition. They also support the use of flexible and integrated approaches to treatment that attend to the cultural context for ethnic minorities. This suggests that programmes should aim to provide wraparound services that promote engagement during the referral phase and offer transitional programmes and aftercare follow-up. Recognition should also be given to issues of cultural difference by ensuring that cultural services for ethnic minorities are integrated into all levels of programme delivery. [ABSTRACT FROM AUTHOR]

Young adults (N = 25) who grew up in stepfamilies in New Zealand took part in narrative interviews on relationships development with their stepfathers. Initially interview data were analyzed using thematic analysis that indicated the importance of perceptions of the stepfather’s personal qualities; warmth and support; discipline issues; and perceptions of his impact on the family. In addition, a narrative analysis examined five types of stories, which ranged from Continuous Positive Regard to Continuous Struggle. Positive stepfather—stepchild relationships were characterized by stepfather warmth and support, and stepchild acceptance. Boundary-related discipline issues underlay many stepfather—stepchild difficulties. Implications for stepfather roles, stepfamily parental alliance, and relationships with stepchildren are discussed. [ABSTRACT FROM PUBLISHER]

Treating young people at high risk for suicide has been identified as a priority area for development in mental health services. This study aimed to establish the prevalence of suicide ideation and suicidal behaviour in a child and adolescent mental health service and examine if children and adolescents with deliberate self-harm (DSH) were different from those who had not engaged in DSH in terms of individual and family risk factors. A file audit was conducted of 100 clients in a South Auckland service. Just under half of the clients (48%, N = 48) had engaged in DSH at the time of initial assessment, a further 16% (N = 16) had expressed suicide ideation without DSH. Children and adolescents who had engaged in DSH and/or had suicide ideation were older, had more maternal substance abuse, more family history of offending, were more likely to have been sexually abused, used more substances themselves, and were more likely to have previous episodes of DSH. [ABSTRACT FROM AUTHOR]

Precocity is particularly important for the economic production of intensively planted apple trees. Unfortunately some cultivars show a propensity for barewood on young trees, which limits early production on 2 year-old spur sites. The new cultivar, 'Scifresh' (Jazz™) has shown serious problems of barewood under New Zealand conditions on M.9 and M.26 rootstocks. Barewood has been associated with excessive flowering on feathers and 1 year-old wood. Weak flower clusters develop towards the base of the shoots which do not set fruit and drop off, leaving blind buds. Although there are larger, more well-developed flower clusters on the distal parts of the 1 year-old shoots, cropping these can result in spur extinction. Therefore, in both cases, there is a lack of spur development for the following season resulting in barewood. Experimental treatments have focused on: 1) the effect of timing (January-May) and concentration (400 and 133 mg l-1 gibberellic acid GA3) sprays in the nursery to reduce flowering on 1 year-old wood; and 2) the effect of concentration and timing of localised cytokinin applications in the Spring to re-invigorate blind buds. Two applications of 400 mg l-1 GA3 in late January and late February in the first year in the nursery were effective in eliminating flowering on "knip boom" trees in the following Spring after cutting back. Two applications of 400 mg l-1 GA3, in early and late January, to "knip boom" trees in their second year in the nursery reduced flowering by over 40% when the trees were planted in the orchard. Twelve months later these trees showed an increased density of spur flowers on the original feathers. Aqueous solutions of the cytokinins benzyladenine and thidiazuron, at 500 mg or 2500 mg respectively, were applied by brush, prior to, during and post-budbreak, to sections of barewood on 2 year-old or 3 year-old wood on main branches of 'Scifresh'/M.9 trees. Thidiazuron (at 2500 mg l-1) was far more effective than benzyladenine at inducing growth of dormant buds, even resulting in multiple bud-breaks at individual sites. [ABSTRACT FROM AUTHOR]

A review of the dating violence literature reveals a limited number of studies with high school students and few studies that investigate the contextual issues of violence, such as meaning, motivation, and consequences. The present study sought to investigate the extent of dating violence victimization in a New Zealand sample of senior high school students (aged 16 to 18 years) and the perceived reasons for the violence, emotional effects, disclosure of the violence, and relationship consequences. A questionnaire that contained both open-ended and forced-choice items pertaining to experiences of violence and its consequences was developed using material gathered from focus group discussions with high school students. Findings showed gender similarity in the extent of violence and a number of significant gender differences in the aftermath of violence, particularly in the area of sexual coercion. These findings are discussed in the context of future research and prevention of dating violence. [ABSTRACT FROM AUTHOR]