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1.
BMC Health Serv Res ; 22(1): 50, 2022 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-35012524

RESUMEN

PURPOSE: Quality improvement is an international priority, and health organisations invest heavily in this endeavour. Little, however, is known of the role and perspectives of Quality Improvement Managers who are responsible for quality improvement implementation. We explored the quality improvement managers' accounts of what competencies and qualities they require to achieve day-to-day and long-term quality improvement objectives. DESIGN: Qualitative exploratory design using an interpretivist approach with semi-structured interviews analysed thematically. SETTING AND PARTICIPANTS: Interviews were conducted with 56 quality improvement managers from 15 (out of 20) New Zealand District Health Boards. Participants were divided into two groups: traditional and clinical quality improvement managers. The former group consisted of those with formal quality improvement education-typically operations managers or process engineers. The latter group was represented by clinical staff-physicians and nurses-who received on-the-job training. RESULTS: Three themes were identified: quality improvement expertise, leadership competencies and interpersonal competencies. Effective quality improvement managers require quality improvement experience and expertise in healthcare environments. They require leadership competencies including sense-giving, taking a long-term view and systems thinking. They also require interpersonal competencies including approachability, trustworthiness and supportiveness. Traditional and clinical quality improvement managers attributed different value to these characteristics with traditional quality improvement managers emphasising leadership competencies and interpersonal skills more than clinical quality improvement managers. CONCLUSIONS: We differentiate between traditional and clinical quality improvement managers, and suggest how both groups can be better prepared to be effective in their roles. Both groups require a comprehensive socialisation and training process designed to meet specific learning needs.


Asunto(s)
Liderazgo , Mejoramiento de la Calidad , Atención a la Salud , Humanos , Nueva Zelanda , Investigación Cualitativa
2.
Virology ; 565: 38-51, 2022 01 02.
Artículo en Inglés | MEDLINE | ID: mdl-34715607

RESUMEN

The South Island robin (Petroica australis) is a small passerine bird endemic to New Zealand (Aotearoa). Although its population has declined recently and it is considered 'at risk,' little research has been done to identify viruses in this species. This study aimed to survey the diversity of single-stranded DNA viruses associated with South Island robins in a small, isolated population on Nukuwaiata Island. In total, 108 DNA viruses were identified from pooled fecal samples collected from 38 individual robins sampled. These viruses belong to the Circoviridae (n = 10), Genomoviridae (n = 12), and Microviridae (n = 73) families. A number of genomes that belong to the phylum Cressdnaviricota but are otherwise unclassified (n = 13) were also identified. These results greatly expand the known viral diversity associated with South Island robins, and we identify a novel group of viruses most closely related genomoviruses.


Asunto(s)
Virus ADN/clasificación , Heces/virología , Pájaros Cantores/virología , Animales , Virus ADN/genética , Virus ADN/aislamiento & purificación , ADN de Cadena Simple , ADN Viral , Genoma Viral , Secuenciación de Nucleótidos de Alto Rendimiento , Microbiota , Nueva Zelanda , Filogenia , Análisis de Secuencia de ADN
3.
J Environ Manage ; 301: 113812, 2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-34601350

RESUMEN

Removing vegetation cover from hill-slope land increases risk for soil erosion and delivery of sediment to waterways. In New Zealand's productive landscapes, clear-fell harvesting of forestry blocks and winter forage grazing by agricultural livestock are two significant causes of vegetation removal. Bare ground exposed by these activities varies annually and seasonally in location and spatial extent. Modelling soil erosion therefore requires temporally and spatially explicit mapping of this bare ground. We have developed an automated mapping method using time-series satellite imagery, thereby enabling wide-area coverage and ease of updating. The temporal analysis identifies land use along with the period of vegetation removal. It produces results per land parcel (in vector format) for use in a Geographic Information System. We present a description of our method, national maps and statistics of bare ground extent in New Zealand's hill-country forestry and winter forage grazing land in 2018, and an assessment of accuracy. The attributes of the mapped land parcels are designed for input into a soil erosion estimation model such as the New Zealand Universal Soil Loss Equation.


Asunto(s)
Agricultura Forestal , Erosión del Suelo , Agricultura , Conservación de los Recursos Naturales , Monitoreo del Ambiente , Sistemas de Información Geográfica , Nueva Zelanda , Suelo
4.
J Med Virol ; 94(2): 454-460, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-31017663

RESUMEN

Acute respiratory infections (ARIs) are a major cause of morbidity among children. Respiratory viruses are commonly detected in both symptomatic and asymptomatic periods. The rates of infection and community epidemiology of respiratory viruses in healthy children needs further definition to assist interpretation of molecular diagnostic assays in this population. Children otherwise healthy aged 1 to 8 years were prospectively enrolled in the study during two consecutive winters, when ARIs peak in New Zealand. Parents completed a daily symptom diary for 8 weeks, during which time they collected a nasal swab from the child for each clinical ARI episode. A further nasal swab was collected by research staff during a clinic visit at the conclusion of the study. All samples were tested for 15 respiratory viruses commonly causing ARI using molecular multiplex polymerase chain reaction assays. There were 575 ARIs identified from 301 children completing the study, at a rate of 1.04 per child-month. Swabs collected during an ARI were positive for a respiratory virus in 76.8% (307 of 400), compared with 37.3% (79 of 212) of swabs collected during asymptomatic periods. The most common viruses detected were human rhinovirus, coronavirus, parainfluenza viruses, influenzavirus, respiratory syncytial virus, and human metapneumovirus. All of these were significantly more likely to be detected during ARIs than asymptomatic periods. Parent-administered surveillance is a useful mechanism for understanding infectious disease in healthy children in the community. Interpretation of molecular diagnostic assays for viruses must be informed by understanding of local rates of asymptomatic infection by such viruses.


Asunto(s)
Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/virología , Virus/aislamiento & purificación , Enfermedad Aguda , Infecciones Asintomáticas/epidemiología , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Lactante , Masculino , Técnicas de Diagnóstico Molecular , Reacción en Cadena de la Polimerasa Multiplex , Nueva Zelanda/epidemiología , Nariz/virología , Vigilancia de la Población , Prevalencia , Infecciones del Sistema Respiratorio/diagnóstico , Estaciones del Año , Virus/clasificación , Virus/genética
5.
N Z Vet J ; 70(1): 49-54, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34499591

RESUMEN

AIMS: To determine the level and timing of lamb loss that occurs during the first year of life on a typical hill country sheep and beef farm in the central North Island of New Zealand and to determine how much of this loss can be prevented through vaccination against the five main clostridial diseases using a commercially available multivalent clostridial vaccine. METHODS: The study was conducted on a single commercial hill country sheep and beef farm in the central North Island of New Zealand, with a history of never vaccinating their stock against clostridial disease. Lambs were blocked on sex and randomly selected at docking into treatment (n = 1,705 lambs) and control (n = 1,709 lambs) groups. Treated lambs were vaccinated at docking and 4 weeks later with 1 mL of multivalent clostridial vaccine. Control lambs were not vaccinated. Different coloured ear tags were used to identify the lambs in the treatment and control groups. All lambs were counted at docking (October 2019) and at six other management event times between docking and when the replacement hoggets were set stocked for lambing (August 2020). The number of lambs sold between each management event, from each group was also counted. The difference in the number of lambs from one management event to another, minus the lambs sold between these events was regarded as the lamb losses for that period. RESULTS: The total percentage of lamb losses from docking to pre-lamb was 4.8% (81/1,705) and 6.2% (106/1,709) in the vaccinated and unvaccinated lambs respectively OR = 0.75 (95% CI = 0.56-1.02; p = 0.06). Most lamb loss occurred in the period after docking, followed by the period between weaning and the first post-weaning drench. Less lamb loss occurred in the vaccinated lambs (27/1,705; 1.6%) after docking than in the unvaccinated lambs (66/1,709; 3.9%). This was mainly due to lower female lamb losses in the vaccinated (5/868; 0.6%) compared to the unvaccinated (38/868; 4.4%) group (p < 0.001). CONCLUSIONS: Vaccination of lambs at docking and 4 weeks later, with a multivalent 5-in-1 clostridial vaccine was associated with a 23.6% (25/106) reduction in total lamb loss from docking to pre-lambing. In female lambs, vaccination was associated with an 87% (33/38) reduction in lamb loss after docking and a 37% (22/59) reduction over the total trial period.


Asunto(s)
Enfermedades de los Bovinos , Carne Roja , Enfermedades de las Ovejas , Animales , Bovinos , Enfermedades de los Bovinos/prevención & control , Femenino , Nueva Zelanda/epidemiología , Ovinos , Enfermedades de las Ovejas/prevención & control , Vacunación/veterinaria , Destete
6.
Sci Total Environ ; 803: 149947, 2022 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-34487905

RESUMEN

The popular concept of wellbeing has added multiple dimensions to the current socio-economic measures of vulnerability from natural hazards. Due to the wellbeing concept's relevance in various policy agendas, there is a need for a stronger integration of what is predominantly a socio-economic concept into the natural hazards space. Graphical methods have been used as transdisciplinary engagement tools to translate verbal descriptions of socio-ecological systems into simulation models able to test hypotheses. The purpose of this article is to identify the graphical methods that have been used in the literature to graphically represent, structure and model different segments of the hazard risk chain. A thorough review of the literature on natural hazards was performed using a set of keywords and filters that resulted in a total of 94 articles, which were then categorised based on the graphical methods used, broad families, properties, hazard types, and segments along the risk chain considered. A case study on volcanic hazards in Mount Taranaki, New Zealand showcased ways forward by conceptually combining methods to link hazards to impacts on wellbeing. Out of the review it was identified that the most widely used methodologies in the natural hazards space are probabilistic graphs (e.g. Bayesian networks) representing the random nature of hazards while mapping methods based on System Dynamic principles (SD) (e.g. causal loop diagrams) are used to characterise the dynamically emergent behaviours of socio-economic agents. While studies linking hazards to wellbeing using graphs are scarce, there is a nascent literature on the characterisation of wellbeing's multi-dimensionality using networks and SD diagrams. Hence, the possibilities to use common methods, or combinations of these, are numerous potentially enabling the creation of graph-based, distilled simulation models that can be used by experts from different backgrounds to quantitatively model the wellbeing impacts exerted by natural hazards.


Asunto(s)
Ecosistema , Políticas , Teorema de Bayes , Humanos , Nueva Zelanda
7.
Sci Total Environ ; 804: 150047, 2022 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-34508931

RESUMEN

Decreasing soil cadmium (Cd) is one method of removing Cd from the food chain. Phosphorus (P) fertilisers are a major source of Cd inputs into soil. Stopping P fertiliser should theoretically decrease Cd inputs and soil Cd accumulation, but there are few field data to show if this occurs. We examined three long-term grazed pasture trials in New Zealand (Ballantrae, Winchmore and Whatawhata) where P fertiliser had been applied (from 10 to 100 kg P ha-1 yr-1) for up to six years and then stopped for 10 to 26 years. Stopping P fertiliser applications reduced soil Cd concentrations at Winchmore and Whatawhata where P had been applied at ≥34 kg P ha-1 yr-1. No reductions occurred below this rate nor at Ballantrae where only 10 years post P-application data were available. Decreases were ascribed to moderate rainfall (1630 mm at Whatawhata and 740 mm rainfall plus 770 mm irrigation at Winchmore) that enhanced Cd leaching and may have been aided at Winchmore by a decrease in soil pH over time (0.4 units). However, because stopping P fertiliser inputs may quickly impair pasture production, additional strategies may be required to decrease soil Cd quickly.


Asunto(s)
Fertilizantes , Contaminantes del Suelo , Cadmio/análisis , Fertilizantes/análisis , Nueva Zelanda , Fosfatos , Suelo , Contaminantes del Suelo/análisis
8.
J Sci Med Sport ; 25(1): 25-30, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34602333

RESUMEN

OBJECTIVE: To quantify and describe boxing-related deaths in Australia. DESIGN: Retrospective analysis of news media reports of all boxing-related fatalities in Australia during 1832 to 2020. METHODS: Australia and New Zealand Newsstream, Factiva, Informit, Google News, Fairfax Media Archive, and Trove were searched from inception to December 31, 2020. News media articles reporting all-cause boxing-related mortality were included for analysis. RESULTS: There were 163 boxing-related fatalities in Australia during 1832 to 2020, including 122 (74.8%) professional and 40 (24.5%) amateur athletes. The most common causes of death were traumatic brain injury (n = 121; 74.2%) and cardiac arrest (n = 11; 6.7%). Boxing-related deaths occurred most frequently during the decades from 1910 to 1930. The fatality rate remained relatively steady from the 1870s through the 1930s, and then declined precipitously until the 1980s. Since legislation to regulate boxing started being introduced in the mid-1970s, there were a total of eleven deaths, of which all but one were caused by traumatic brain injury. CONCLUSIONS: Participation in boxing is associated with risk of death, in particular death caused by traumatic brain injury. The boxing-related fatality rate declined precipitously prior to government legislation to regulate boxing started being introduced, with no discernible further reduction in fatalities since. Given that a main purpose of government regulation of boxing is to protect the health and safety of athletes, the findings herein suggest that current regulations are either inadequate or not effectively implemented.


Asunto(s)
Boxeo , Australia/epidemiología , Humanos , Medios de Comunicación de Masas , Nueva Zelanda/epidemiología , Estudios Retrospectivos
9.
Health Soc Care Community ; 30(1): 133-141, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-33894085

RESUMEN

A generalist-specialist model of palliative care is well established as a framework for the provision of community care in resource-rich countries. However, evidence is lacking regarding how the model is experienced by family carers and the extent to which access to both generalist and specialist palliative care is equitable. A cross-sectional postal survey was undertaken to explore bereaved family's experiences of generalist palliative care and its intersection with hospice services in the last 3 months of life. A modified version of the Views of Informal Carers-Evaluation of Services survey was sent to 4,778 bereaved family. Data were collected between February 2017 and October 2018. Chi-square was utilised to identify factors that impacted on experiences of generalist palliative care; analysis of free text data comprising 45,823 words was undertaken using a directed content analysis approach. Eight hundred and twenty-six questionnaires were returned (response rate = 21%). Seventy per cent of people (n = 579) spent some time at home in the last 3 months prior to death. People who received support from hospice were more likely to receive support from multiple other services. Those who received no community services were less likely to feel supported by their general practitioner, less likely to spend the last 2 days of life or die at home. Feeling supported had a strong association with services working well together, being involved in decision-making and being aware of the poor prognosis. The provision of palliative care is complicated by a lack of integration with specialist palliative care and may be the basis of continuing inequities in the provision of community care at the end of life. The assumption at a policy level that "generalists" are willing and able to play a key role in palliative care provision needs to be further challenged.


Asunto(s)
Cuidados Paliativos al Final de la Vida , Cuidado Terminal , Cuidadores , Estudios Transversales , Humanos , Nueva Zelanda , Cuidados Paliativos
10.
Health Soc Care Community ; 30(1): e105-e112, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-33970523

RESUMEN

Primary health is at the forefront of efforts to address health inequities. Effective primary health care keeps people well and improves longevity and quality of life. The persistence of health inequities, particularly between Indigenous peoples and non-Indigenous peoples globally, suggests that there is a need to strengthen policy and practise. Unique to Aotearoa (New Zealand) is te Tiriti o Waitangi, a treaty negotiated in 1840 between the British Crown and hapu (Maori [Indigenous] subtribes). This treaty is foundational to public policy in Aotearoa and requires the Crown (New Zealand government) to uphold a set of responsibilities around protecting and promoting Maori health. This paper examines to what extent Primary Health Organisations are upholding te Tiriti o Waitangi. The study utilises data from a nationwide telephone survey of public health providers conducted in 2019-2020 recruited from a list on the Ministry of Health website. This paper focuses on data about te Tiriti application from 21 Primary Health Organisations from a sample size of thirty. Critical te Tiriti analysis, an emerging methodology, was used to assess to what extent the participating primary health organisations were te Tiriti compliant. The critical te Tiriti analysis found poor to fair compliance with most elements of te Tiriti but good engagement with equity. Suggestions for strengthening practise included examining relationships with Maori, utilising a planned approach, structural mechanisms, normalising Maori world views and consistency in application. The onus needs to be on non-Maori to contribute to the cultural change and power-sharing required to uphold te Tiriti. Critical te Tiriti analysis is a useful methodology to review te Tiriti compliance and could be used in other contexts to review alignment with Indigenous rights and aspirations.


Asunto(s)
Calidad de Vida , Humanos , Nueva Zelanda , Salud Pública
11.
New Phytol ; 233(1): 546-554, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34610149

RESUMEN

Some plant traits may be legacies of coevolution with extinct megafauna. One example is the convergent evolution of 'divaricate' cage architectures in many New Zealand lineages, interpreted as a response to recently extinct flightless avian browsers whose ancestors arrived during the Paleogene period. Although experiments have confirmed that divaricate habit deters extant browsers, its abundance on frosty, droughty sites appears consistent with an earlier interpretation as a response to cold, dry Plio-Pleistocene climates. We used 45 protein-coding sequences from plastid genomes to reconstruct the evolutionary history of the divaricate habit in extant New Zealand lineages. Our dated phylogeny of 215 species included 91% of New Zealand eudicot divaricate species. We show that 86% of extant divaricate plants diverged from non-divaricate sisters within the last 5 Ma, implicating Plio-Pleistocene climates in the proliferation of cage architectures in New Zealand. Our results, combined with other recent findings, are consistent with the synthetic hypothesis that the browser-deterrent effect of cage architectures was strongly selected only when Plio-Pleistocene climatic constraints prevented woody plants from growing quickly out of reach of browsers. This is consistent with the abundance of cage architectures in other regions where plant growth is restricted by aridity or short frost-free periods.


Asunto(s)
Aves , Plantas , Animales , Nueva Zelanda , Filogenia
12.
Asia Pac J Ophthalmol (Phila) ; 10(6): 579-589, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34905518

RESUMEN

PURPOSE: To evaluate the prevalence and risk factors for the development of any and referable diabetic eye disease in a multi-ethnic New Zealand population with diabetes mellitus attending a regional retinal screening service. METHODS: Retrospective observational cohort study of people living with diabetes who attended the Auckland Regional Diabetic Retinal Screening Programme 2006-2018 inclusive (n = 41,786). RESULTS: Any retinopathy/maculopathy was present at first screening for 48.2% [95% confidence interval (CI): 45.8%-50.6%] / 37.8% (95% CI: 35.5%- 40.1%) of people with Type 1 and 25% (95% CI: 24.6%-25.4%) / 21.9% (95% CI: 21.5%-22.3%) with Type 2 diabetes. Referable retinopathy at baseline screening was 4.4% (95% CI: 3.6%-5.3%) and 1.6% (95% CI: 1.5%-1.7%) among people with Type 1 and Type 2 diabetes mellitus, respectively. After 4 years, cumulative incidence for referable retinopathy /referable maculopathy was 12/36 per 1000 people with Type 1 and 2.4/16 per 1000 people with Type 2 diabetes. Independent hazards for disease progression varied for the diabetes cohort types but baseline grade, duration of diabetes, and HbA1c were common to all. CONCLUSIONS: Referable diabetic eye disease at the first screening and after 4 years of follow-up is uncommon. Lengthening of the screening intervals for people with no or mild diabetic eye disease at first screening assessment could be considered.


Asunto(s)
Diabetes Mellitus Tipo 2 , Retinopatía Diabética , Oftalmopatías , Estudios de Cohortes , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Retinopatía Diabética/epidemiología , Progresión de la Enfermedad , Humanos , Tamizaje Masivo , Nueva Zelanda/epidemiología , Estudios Retrospectivos , Factores de Riesgo
13.
J Law Med ; 28(4): 1114-1126, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34907690

RESUMEN

The Human Rights Review Tribunal of New Zealand recently determined that it has the power to award damages for loss of dignity in cases where the person whose rights have been breached does not have the mental capacity to understand that this is the case, or the impact of that breach on their dignity. In defining the meaning of dignity, determining how to assess its loss (by way of an objective rather than subjective test) and categorising the nature of damages for loss of dignity as vindicatory rather than compensatory, the Tribunal broke new ground. However, after analysing the Tribunal's decision, and considering relevant case law, this article concludes that the Tribunal's decision was flawed, and that the legislation only allows for the award of compensatory damages. Legislative change would be required to expand the scope of remedies available to include vindicatory damages.


Asunto(s)
Derechos Humanos , Respeto , Emociones , Humanos , Nueva Zelanda
14.
BMC Gastroenterol ; 21(1): 471, 2021 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-34911443

RESUMEN

BACKGROUND: New Zealand has high rates of colorectal cancer (CRC) but poor outcomes. Most patients with CRC are diagnosed following referral from general practice, where a general practitioner (GP) assesses symptoms according to national guidelines. All referred patients are then re-prioritised by the hospital system. The first objective of this study was to identify what proportion of patients referred by general practice to surgical/gastroenterology at Waikato District Health Board (DHB) had a colonoscopy. The second objective was to determine what proportion of these referrals have an underlying CRC and the factors associated with the likelihood of this diagnosis. METHODS: This study is a retrospective analysis of e-referral data for patients aged 30-70+ who were referred from 75 general practices to general surgery, gastroenterology or direct to colonoscopy at Waikato DHB, 01 January 2015-31 December 2017. Primary and secondary outcome measures included the proportion and characteristics of patients who were having colonoscopy, and of those, who were diagnosed with CRC. Data were analysed using chi square and logistic regression. RESULTS: 6718/20648 (32.5%) patients had a colonoscopy and 372 (5.5%) of these were diagnosed with CRC. The probability of having CRC following a colonoscopy increased with age (p value < 0.001). Females (p value < 0.001), non-Maori (p value < 0.001), and patients with a high suspicion of cancer (HSCan) label originating from their GP were more likely to have a colonoscopy, while the odds ratio of Maori having a colonoscopy was 0.66 (95% CI 0.60-0.73). The odds ratio of a CRC diagnosis following colonoscopy was 1.67 (95% CI 1.35-2.07) for men compared to women, and 2.34 (95% CI 1.70-3.22) for those with a GP HSCan label. Of the 585 patients referred with a GP HSCan, 423 (72.3%) were reprioritised by the hospital and 55 patients had their diagnosis unnecessarily delayed. CONCLUSIONS: If a GP refers a patient with an HSCan, and the patient receives a colonoscopy, then the likelihood of having CRC is almost 15.0%. This would suggest that these patients should be routinely prioritised without further triage by the hospital. Further research is needed to understand why Maori are less likely to receive a colonoscopy following referral from general practice.


Asunto(s)
Neoplasias Colorrectales , Medicina General , Colonoscopía , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Detección Precoz del Cáncer , Femenino , Humanos , Masculino , Nueva Zelanda/epidemiología , Derivación y Consulta , Estudios Retrospectivos
15.
Anaesth Intensive Care ; 49(6): 422-429, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34894746

RESUMEN

This cross-sectional overview of the second 4000 incidents reported to webAIRS has findings that are very similar to the previous overview of the first 4000 incidents. The distribution of patient age, body mass index and American Society of Anesthesiologists physical status was similar, as was anaesthetist gender, grade, location and time of day of incidents. About 35% of incidents occurred during non-elective procedures (vs. 33% in the first 4000 incidents). The proportion of incidents in the various main categories was also similar, with respiratory/airway being most common, followed by cardiovascular, medication-related and medical device or equipment-related incidents. Together these categories made up about 78% of all incidents in both overviews. The immediate outcome was comparable with reports of harm in about a quarter of incidents and a similar rate of deaths (4.7% vs. 4.2%). However, the proportion of patients who had received total intravenous anaesthesia was higher (17.6% vs. 7.7%) and the proportion of patients who received combined intravenous and inhalational anaesthesia was lower (52.3% vs. 58.4%), as was the proportion receiving local anaesthesia alone (1.6% vs. 6.7%). There was a small increase in the number of incidents resulting in unplanned admission to a high dependency or intensive care unit (18.1% vs. 13.5%). It is not clear whether these differences represent trends or random observations. About 48% of incidents were considered preventable by the reporters (vs. 52% in the first 4000). These findings support continued emphasis on human and system factors to promote and improve patient safety in anaesthesia care.


Asunto(s)
Anestesia por Inhalación , Gestión de Riesgos , Estudios Transversales , Humanos , Internet , Nueva Zelanda/epidemiología
16.
Diving Hyperb Med ; 51(4): 345-354, 2021 Dec 20.
Artículo en Inglés | MEDLINE | ID: mdl-34897599

RESUMEN

INTRODUCTION: New Zealand (NZ) diving-related fatalities have been reported since the 1960s. The aim is to identify contributing risk factors, including medical, and to inform appropriate preventative strategies. METHODS: NZ scuba diving fatalities from 2007 to 2016 were searched from multiple sources - the National Coronial Information System (NCIS); the NZ Chief Coroner's office; Water Safety NZ Drownbase™ and the NZ Police National Dive Squad records. For inclusion, a victim must have been wearing a scuba set (which may include a rebreather). A key word search of the NCIS was made and the results matched to the other databases. An Excel® database was created and a chain of events analysis (CEA) conducted. RESULTS: Forty-eight scuba diving fatalities were identified, 40 men and eight women, average age 47 years (range 17-68), 20 of Maori ethnicity. Thirty-five were classified as overweight (14) or obese (21). Pre-existing medical risk factors were identified, either pre dive or at autopsy, in 37 divers, the commonest being ischaemic heart disease (IHD, 20), left ventricular hypertrophy (LVH, 18) and hypertension (seven). IHD, LVH and obesity were variously associated with each other. The likely commonest disabling conditions, identified in 32 cases, were asphyxia (15), cardiac (nine) and pulmonary barotrauma/cerebral arterial gas embolism (five). Multiple environmental and diving practice breaches and poor planning were identified in the CEA, similar to those seen in other studies. Thirty-eight divers had not released their weight belt. Information on resuscitation was limited. CONCLUSIONS: Obesity and cardiovascular disease were common and Maori appear to be over-represented, both as previously reported.


Asunto(s)
Buceo , Adolescente , Adulto , Anciano , Autopsia , Causas de Muerte , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Factores de Riesgo , Adulto Joven
17.
Stud Health Technol Inform ; 284: 311-315, 2021 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-34920532

RESUMEN

BACKGROUND: Weight estimation is critical in paediatric resuscitation, as stopping to weigh a child could influence their survival. Weight estimation methods used in New Zealand (NZ) are not accurate for the population, increasing the complexity of prescribing medication and selecting equipment. AIM: Develop regression equations (RE) to predict the weight of NZ children based on height, sex, age and ethnicity to be deployed in a mobile application (Weight Estimation Without Waiting). METHODS: The RE was derived from retrospective regression modelling of a large existing dataset. Data were presented using descriptive statistics and calculation of means, limits of agreement and the proportion of weight estimates within a percentage of actual weight. CONCLUSION: The RE developed in this study outperformed existing age-based weight estimation methods while providing a method to ensure that weight estimation techniques evolve with NZ children.


Asunto(s)
Familia , Niño , Humanos , Nueva Zelanda , Estudios Retrospectivos
18.
PLoS One ; 16(12): e0261163, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34928994

RESUMEN

New Zealand's rate of suicide persistently exceeds the global average. The burden of suicide in New Zealand is disproportionately borne by youth, males and Maori (NZ indigenous people). While the demographic characteristics of suicide decedents are established, there is a need to identify potential points of contact with health services where preventative action could take place. This paper aims to determine if suicide deaths in New Zealand were likely to be preceded by contact with health services, and the type and time frame in which these contacts took place. This study utilised a whole-of-population-cohort of all individuals age 15 years and over, who were alive on March 5th 2013, followed up to December 2015. Associations between the odds of suicide, demographic factors, area-based deprivation, and the timing of last contact with primary, secondary, and tertiary services were analysed using univariate and multivariate logistic regression. Contact with a health service in the 6 Months prior to death was associated with the highest odds of suicide. Over half of the suicide decedent population (59.4%) had contacted primary health services during this period. Large proportions of the suicide decedent population contacted secondary and tertiary services in the 6 Months prior to death, 46.5% and 30.4% respectively. Contact with primary, secondary and tertiary services in the prior 6 Months, were associated with an increased odds of suicide of 2.51 times [95% CI 2.19-2.88], 4.45 times [95% CI 3.69-4.66] and 6.57 times [95% CI 5.84-7.38], respectively, compared to those who had no health services contact.


Asunto(s)
Servicios de Salud Mental/estadística & datos numéricos , Aceptación de la Atención de Salud , Suicidio/estadística & datos numéricos , Suicidio/tendencias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Factores de Tiempo , Adulto Joven
19.
Nutrients ; 13(12)2021 Nov 25.
Artículo en Inglés | MEDLINE | ID: mdl-34959788

RESUMEN

Caffeine-related health incidents in New Zealand have escalated over the last two decades. In order to reduce the risk of substance-related harm, it is important to understand the consumers' motivations for its use. This is especially true for tertiary students who are presumed to be at a higher risk due to seeking out caffeine's well-known cognitive benefits as well as the targeted marketing of such products to young adults. This study examined the habits and motivations for caffeine consumption in tertiary students in New Zealand. A previously validated caffeine consumption-habits (CaffCo) questionnaire was administered online to 317 tertiary students (n = 169 females), aged ≥16 years. Of the 99.1% of participants who regularly consumed caffeine, coffee (76.3%) tea (71.6%) and chocolate (81.7%) consumption were the most prevalent. Motivations for caffeinated-product consumption differed according to caffeine source. Tea was consumed for the warmth and taste, coffee was consumed to stay awake and for warmth, and chocolate, for the taste and as a treat. Marketing was not identified by participants as influencing their consumption of caffeinated products. Knowledge of motivations for caffeine consumption may assist in identifying strategies to reduce caffeine intake in those New Zealand tertiary students who regularly consume amounts of caffeine that exceed safe level.


Asunto(s)
Cafeína/análisis , Dieta/psicología , Conducta Alimentaria/psicología , Motivación , Estudiantes/psicología , Adolescente , Chocolate/análisis , Café , Femenino , Humanos , Masculino , Nueva Zelanda , , Adulto Joven
20.
BMC Pregnancy Childbirth ; 21(1): 827, 2021 Dec 13.
Artículo en Inglés | MEDLINE | ID: mdl-34903186

RESUMEN

BACKGROUND: Perinatal (antenatal and postpartum) depression impacts approximately 12% of mothers. Perinatal depression can impact everyday functioning for mothers, and the relationship with, and development of, their children. The purpose of this study was to investigate depression trajectories from the antenatal period through 54-months postpartum and associations with child body mass index at 54-months postpartum. METHODS: This study applied latent growth modeling to the Growing Up in New Zealand study, which is a longitudinal pregnancy cohort study that provides nationally representative-level data, to investigate associations between depression at three time points (antenatal, 9-months postpartum, 54-months postpartum) and child body mass index at 54-months (n=4897). RESULTS: The average slope of depression for this sample is low and decreases over time. When child BMI was added to the model as an outcome variable, both antenatal depression (B=.25, p<.01), and the rate of change of depression across the perinatal and postpartum periods (B=.09, p<.01) were associated with child BMI at 54-months postpartum. After controlling for sociodemographic characteristics, antenatal depression, but not the slope of depression, remained significantly associated with child BMI (B=.05, p<.05). When controlling for maternal pre-pregnancy BMI the effect of antenatal depression on child BMI at 54-months was entirely attenuated (χ2 (9) = 39.60, p < .05, SRMR = 0.01, CFI = .99, RMSEA = 0.03, BIC=53213). CONCLUSIONS: Our findings align with the Developmental Origins of Health and Disease theory and imply that both the physical and mental health of mothers during pregnancy may be important indicators of child growth and development outcomes. Early intervention directed towards women who have even mild depression scores during pregnancy may promote healthy child development outcomes. Additionally, given the heterogeneity of depressive symptoms over time seen in this study, multiple assessment periods across the postpartum period may be valuable to adequately address and support maternal mental health.


Asunto(s)
Índice de Masa Corporal , Desarrollo Infantil , Depresión Posparto/epidemiología , Depresión/epidemiología , Madres/psicología , Preescolar , Estudios de Cohortes , Depresión/clasificación , Depresión Posparto/clasificación , Femenino , Humanos , Lactante , Análisis de Clases Latentes , Estudios Longitudinales , Nueva Zelanda/epidemiología , Cuestionario de Salud del Paciente , Embarazo , Escalas de Valoración Psiquiátrica
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