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INTRODUCTION: Literature suggests that good quality health care access can have a positive impact on the health of people with serious mental illness (SMI), but literature relating to patterns of access by this group is equivocal. AIM: This study was designed to explore health care access patterns in a group of people with SMI and to compare them with a general New Zealand population group, in order for health providers to understand how they might contribute to positive health outcomes for this group. METHODS: The study surveyed 404 mental health consumers aged 18-65 years receiving care from one district health board in Auckland about their patterns of health care access. Results were compared with those from the New Zealand Health Survey of the general population. RESULTS: Findings suggest that the SMI consumer respondents had poorer physical health than the general population respondents, accessed health care services in more complex ways and were more particular about who they accessed for their care than the general population respondents. There was some concern from SMI consumers around discrimination from health care providers. The study also suggested that some proactive management with SMI consumers for conditions such as metabolic syndrome was occurring within the health care community. DISCUSSION: The first point of access for SMI consumers with general health problems is not always the family general practitioner and so other health professionals may sometimes need to consider the mental and physical health of such consumers in a wider context than their own specialism.

Teaching is a powerful way to transmit knowledge, but with this power comes a hazard: When teachers fail to select the best set of evidence for the learner, learners can be misled to draw inaccurate inferences. Evaluating others' failures as teachers, however, is a nontrivial problem; people may fail to be informative for different reasons, and not all failures are equally blameworthy. How do learners evaluate the quality of teachers, and what factors influence such evaluations? Here, we present a Bayesian model of teacher evaluation that considers the utility of a teacher's pedagogical sampling given their prior knowledge. In Experiment 1 (N=1168), we test the model predictions against adults' evaluations of a teacher who demonstrated all or a subset of the functions on a novel device. Consistent with the model predictions, participants' ratings integrated information about the number of functions taught, their values, as well as how much the teacher knew. Using a modified paradigm for children, Experiments 2 (N=48) and 3 (N=40) found that preschool-aged children (2a, 3) and adults (2b) make nuanced judgments of teacher quality that are well predicted by the model. However, after an unsuccessful attempt to replicate the results with preschoolers (Experiment 4, N=24), in Experiment 5 (N=24) we further investigate the development of teacher evaluation in a sample of seven- and eight-year-olds. These older children successfully distinguished teachers based on the amount and value of what was demonstrated, and their ability to evaluate omissions relative to the teacher's knowledge state was related to their tendency to spontaneously reference the teacher's knowledge when explaining their evaluations. In sum, our work illustrates how the human ability to learn from others supports not just learning about the world but also learning about the teachers themselves. By reasoning about others' informativeness, learners can evaluate others' teaching and make better learning decisions., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The Rauemi Atawhai (RA) Program, delivered at Counties Manukau Health by Health Literacy New Zealand (Limited), is a professional development program that aims to develop the capability in health care professionals to recognize and develop health literate, culturally competent health education resources and systems. Local evaluation of this program explored participant learning and barriers to becoming a health literate organization. We found that program participants consolidated their understanding or built a more comprehensive understanding of health literacy. Further, they gained new skills to assist them in developing future consumer resources. However, within the evaluation period, the RA Program had limited influence on the design and refinement of systems for developing, reviewing, disseminating, and evaluating consumer resources for their service, as well as approaches for engaging patients and family in design and review. Significant organizational action is needed to support these changes. Opportunities for leaders and managers to participate in capability building and discussions to create conditions (e.g., resource and authorization) for change in the environments in which staff work are needed. [HLRP: Health Literacy Research and Practice. 2020;4(3):e185-e189.]., (©2020 Hayward, Sinclair, Martin-Babin, et al.)

Objectives: This study aims to describe the impact of a mental health assertive community treatment prison model of care (PMOC) on improving the ability to identify prisoner needs, provide interventions and monitor their efficacy., Methods: We carried out a file review across five prisons of referrals in the year before the implementation of the PMOC in 2010 ( n = 423) compared with referrals in the year after ( n = 477)., Results: Some improvements in the identification of needs and providing interventions were detected. There was increased use of medication management and clinically significant improvement in addressing engagement with families. Monthly multi-disciplinary team face-to-face contact improved., Conclusions: Meeting the needs of mentally ill prisoners is challenged by the complexity of the custodial environment. Improvements made resulted from changing the model of care, rather than adding new resources.

Aim: An intervention designed to reduce numbers of hospital-acquired pressure injuries was delivered in Counties Manukau Health hospitals. An audit of a sample of patients was carried out to estimate the cost savings that would have been acquired across the district health board (DHB) due to a reduction in pressure injuries., Method: The pressure injury intervention was delivered from 2011 to 2015. A monthly prospective audit of patients with stages 1, 2, 3 and 4 pressure injuries was carried out. This involved a random sample of five patients per ward in all hospitals in Counties Manukau DHB., Results: It was found that the annual estimated cost of treating pressure injuries in hospital patients was NZ$12,290,484 less in 2015 than in 2011., Conclusion: Implementation of strategies for managing hospital-acquired pressure injuries can lead to potentially large financial savings for hospitals, as well as reducing the burden of managing this difficult condition for patients and staff., Competing Interests: Nil.

Objective: The objective of this study was to evaluate the New Zealand Accident Compensation Corporation's (ACC) 'My Home is My Marae' approach to injury prevention for whānau (families)., Setting: Over an 18 month period from November 2013 to June 2014, 14 'My Home is My Marae' trials were conducted across the South Auckland and Far North regions of New Zealand. ACC engaged with local Māori providers of healthcare, education and social services to deliver the home safety intervention., Participants: Participants of this evaluation were a purposive sample of 14 staff from six provider organisations in South Auckland and the Far North regions of New Zealand., Methods: Kaupapa Māori theory-based evaluation and appreciative inquiry methodologies underpinned the evaluation. Interview participants led discussions about strengths and weaknesses of the approach, and partnerships with ACC and other organisations. The evaluation was also supported by pre-existing information available in project documentation, and quantitative data collected by Māori providers., Results: Five key critical success factors of 'My Home is My Marae' were found from interviews: mana tangata (reputation, respect and credibility); manākitanga (showing care for people); kānohi-ki-te-kānohi (face-to-face approach); capacity building for kaimahi, whānau and providers and 'low or no cost' solutions to hazards in the home. Data collected for the Far North area showed that 76% of the hazards identified could be resolved through 'low or no cost' solutions. Unfortunately, similar data were not available for South Auckland., Conclusions: Injury prevention or health promotion approaches that seek to engage with whānau and/or Māori communities would benefit from applying critical success factors of 'My Home is My Marae'., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

BACKGROUND The Medical Council of New Zealand requires graduating doctors to have community attachments within their first two years of practice by 2020. Counties Manukau Health has developed a programme where house officers (HOs) are attached to a general practice for three months. AIM This study aimed to establish the value of four HO general practice attachments in Counties Manukau and describe how HOs are being used in these practices. METHODS A mixed-methods design was used to evaluate three attachment runs. Two practices provided the number of patients seen by HOs. Fifty-eight patients were surveyed to assess patient perceptions of the HOs. Six HOs, four supervising general practitioners, two PHO senior staff and one practice manager participated in semi-structured interviews. Focus groups were held with nurses, doctors and administrative staff at all four practices. FINDINGS HOs saw 300-600 patients in one practice and 800-1000 in the other during their attachment. Practices developed their own approach to mentoring and teaching HOs. Most patients reported positive perceptions of the HOs. Themes from interviews and focus groups were consistent among participants and included: improved HO confidence, clinical skills and understanding of general practice; extra capacity and improved quality of care and staff satisfaction among practices. CONCLUSION HOs and practices viewed HO attachments in general practice positively. HOs developed clinical skills and understanding of primary health care. Practice teams enjoyed the energy and enthusiasm of the HOs, while providing clinical support to ensure quality patient care.

Background: The high prevalence of serious mental illness (SMI) in prisons remains a challenge for mental health services. Many prisoners with SMI do not receive care. Screening tools have been developed but better detection has not translated to higher rates of treatment. In New Zealand a Prison Model of Care (PMOC) was developed by forensic mental health and correctional services to address this challenge. The PMOC broadened triggers for referrals to mental health teams. Referrals were triaged by mental health nurses leading to multidisciplinary team assessment within specified timeframes. This pathway for screening, referral and assessment was introduced within existing resources., Method: The PMOC was implemented across four prisons. An AB research design was used to explore the extent to which mentally ill prisoners were referred to and accepted by prison in-reach mental health teams and to determine the proportion of prison population receiving specialist mental health care., Results: The number of prisoners in the study in the year before the PMOC (n =  9,349) was similar to the year after (n = 19,421). 24.6 % of prisoners were screened as per the PMOC in the post period. Referrals increased from 491 to 734 in the post period (Z = -7.23, p < 0.0001). A greater number of triage assessments occurred after the introduction of the PMOC (pre = 458; post = 613, Z = 4.74, p < 0.0001) leading to a significant increase in the numbers accepted onto in-reach caseloads (pre = 338; post = 426, Z = 3.16, p < 0.01). Numbers of triage assessments completed within specified time frames showed no statistically significant difference before or after implementation. The proportion of prison population on in-reach caseloads increased from 5.6 % in the pre period to 7.0 % in the year post implementation while diagnostic patterns did not change, indicating more prisoners with SMI were identified and engaged in treatment., Conclusions: The PMOC led to increased prisoner numbers across screening, referral, treatment and engagement. Gains were achieved without extra resources by consistent processes and improved clarity of professional roles and tasks. The PMOC described a more effective pathway to specialist care for people with SMI entering prison.

Background: It is well recognised that prisoners with serious mental illness (SMI) are at high risk of poor outcomes on return to the community. Early engagement with mental health services and other community agencies could provide the substrate for reducing risk., Aim: To evaluate the impact of implementing an assertive community treatment informed prison in-reach model of care (PMOC) on post-release engagement with community mental health services and on reoffending rates., Methods: One hundred and eighty prisoners with SMI released from four prisons in the year before implementation of the PMOC were compared with 170 such prisoners released the year after its implementation., Results: The assertive prison model of care was associated with more pre-release contacts with community mental health services and contacts with some social care agencies in some prisons. There were significantly more post-release community mental health service engagements after implementation of this model (Z = -2.388, p = 0.02). There was a trend towards reduction in reoffending rates after release from some of the prisons (Z =1.82, p = 0.07)., Conclusions and Implications for Practice: Assertive community treatment applied to prisoners with mental health problems was superior to 'treatment as usual', but more work is needed to ensure that agencies will engage prisoners in pre-release care. The fact that the model showed some benefits in the absence of any increase in resources suggests that it may be the model per se that is effective., (Copyright © 2014 John Wiley & Sons, Ltd.)

How can the large, systematic differences that exist between individuals' color preferences be explained? The ecological valence theory (Palmer & Schloss, Proceedings of the National Academy of Sciences 107:8877-8882, 2010) posits that an individual's preference for each particular color is determined largely by his or her preferences for all correspondingly colored objects. Therefore, individuals should differ in their color preferences to the extent that they have different preferences for the same color-associated objects or that they experience different objects. Supporting this prediction, we found that individuals' color preferences were predicted better by their own preferences for correspondingly colored objects than by other peoples' preferences for the same objects. Moreover, the fit between color preferences and affect toward the colored objects was reliably improved when people's own idiosyncratic color-object associations were included in addition to a standard set of color-object associations. These and related results provide evidence that individual differences in color preferences are reliably influenced by people's personal experiences with colored objects in their environment.

Aims: Communication failures in healthcare are frequent and linked to adverse events and treatment errors. Simulation-based team training has been proposed to address this. We aimed to explore the feasibility of a simulation-based course for all members of the operating room (OR) team, and to evaluate its effectiveness., Methods: Members of experienced OR teams were invited to participate in three simulated clinical events using an integrated surgical and anesthesia model. We collected information on costs, Behavioural Marker of Risk Index (BMRI) (a measure of team information sharing) and participants' educational gains., Results: We successfully recruited 20 full OR teams. Set up costs were NZ$50,000. Running costs per course were NZ$4,000, excluding staff. Most participants rated the course highly. BMRI improved significantly (P = 0.04) and thematic analysis identified educational gains for participants., Conclusion: We demonstrated feasibility of multidisciplinary simulation-based training for surgeons, anesthetists, nurses and anaesthetic technicians. The course showed evidence of participant learning and we obtained useful information on cost. There is considerable potential to extend this type of team-based simulation to improve the performance of OR teams and increase safety for surgical patients.

Introduction: Although people with serious mental illness (SMI) have a high prevalence of physical illness, health-related quality of life (HQoL) has not been sufficiently explored., Aim: To explore the self-reported HQoL of mental health service users in New Zealand., Methods: Responses on the Medical Outcomes Study 36 Item Short Form (SF-36) measure of HQoL from 404 adult mental health service users in a metropolitan district health board area in New Zealand were analysed and compared to a representative sample of the general population., Results: Mental health service users scored significantly lower on all eight domains of the SF-36 than the general population, the largest difference being in the role limitation-emotional domain., Discussion: Being female, younger than 25, obese or overweight, or of New Zealand European/Other ethnicity were associated with poorer functioning on multiple HQoL domains. Future studies should seek to understand the factors contributing to perceptions of HQoL of mental health service users in New Zealand.

Objective: To describe patterns of mental health service contact before and after contact with a regional forensic mental health service (FMHS) to assist regional mental health service planning., Method: All new referrals to Auckland Regional FMHS in 2006 were audited for contact with mental health services in the three years before and three years after their contact in 2006., Results: A total of 925 identified individuals were referred to the Auckland Regional FMHS in 2006, predominantly through the court (81%) or prison (17%). In the preceding three years, 30.2% of these service users had no mental health service contact, 41.4% had general adult mental health service (GAMHS) contact alone, 22.6% had both FMHS and GAMHS contact, and 5.8% had FMHS contact alone. In the three years after 2006, 13.4% had no further contact with either FMHS or GAMHS, 20.3% had GAMHS contact alone, 51.2% of the sample had contact with both FMHS and GAMHS, and 15% had only FMHS contact., Conclusions: The service utilization patterns of this population support the establishment of strong links between GAMHS and FMHS in courts and prisons. Further research is needed to determine the specific models most likely to improve clinical outcomes.

Shyness (or social anxiety) and social phobia can be viewed as two distinct conditions, and this study investigates whether they are related to use of the Internet generally, and for communication purposes. 362 participants from two schools, a college and a university in the Teesside area in England were asked to complete Mattick and Clarke's (1998) Social Phobia (SPS) and Social Interaction Anxiety (SIAS) scales and also answer a questionnaire which asked them about their use of the Internet generally and for communication purposes. The findings from these suggested that social anxiety and social phobia are not highly associated with use of the Internet either in general, or for communication purposes, although minor associations with certain aspects of Internet use are discussed.

Recently, a number of commentators have suggested that growth in use of the Internet may be slowing, and its impact may have been exaggerated. However, a disproportionate number of the nonusers tend to be those over the age of 50, and the young are most likely to go online eventually. Therefore, the most appropriate people to survey with regard to Internet use are adolescents and young adults who are likely to be the Internet users or nonusers of the future. This survey was conducted to find out more about the activities and opinions of secondary-school aged children who do, and do not, use the Internet. Mobile phone use was also examined in this survey as this has also shown a meteoric rise in adults and more particularly in young people. Generally, the survey revealed that children aged between 11 and 16 years old are quite comfortable with the Internet, use it a moderate amount and for a variety of purposes. However, boys were more likely to use the Internet than girls and sometimes for slightly different purposes. Reasons for not using the Internet generally revolved around a lack of access to equipment. Furthermore, a higher percentage of adolescents have mobile phones than adults and girls are more likely to own a mobile phone than boys. Mobile phones were also used for a variety of purposes, most notably making and receiving calls and text-messaging. The most common reasons for children not owning a mobile phone was because they had no need for one. Finally, a significant positive relationship between the use of emails and text messaging suggests that the mobile phone may supplement some of the previous functions of the Internet.