Social connectedness and self-perceived health of older adults in New Zealand.

The objective of this research was to explore social connectedness and associations with self-perceived health amongst older adults in New Zealand at a population level. The data for this analysis were derived from the 2016 Health and Lifestyle Survey, a nationally representative survey administered via face-to-face interviews. The findings from this analysis of 1,374 respondents, all of whom were over the age of 55 years, highlight that being female, belonging to older age groups (above 70 years), being employed full-time or part-time, connecting online with known people, considering cultural connections to be important and not feeling isolated from others are significantly and positively associated with positive self-perceived health. The findings underscore the resilience potential of older adults and importance of social connectedness for positive health and well-being. In addition, the findings reveal target areas that would benefit by intervention and support by health professionals and policy makers.

Access to and engagement with cervical and breast screening services for women with disabilities in Aotearoa New Zealand.

PURPOSE: To describe access to and engagement with cervical and breast screening services for women who are Deaf or live with a physical or sensory disability in Aotearoa New Zealand (NZ). METHOD: We carried out an online survey on a convenience sample of 84 women. Tests of association were undertaken between socio-demographics and cervical and breast screening; and between disability type, and health outcomes and barriers to screening respectively. Participants also reported specific barriers to screening. RESULTS: Living without family/partner and unemployment were associated with never having a cervical smear. Non-English preferred language, and urban residence were related to lower levels of breast self-examination; having insufficient income was related to never having a mammogram. Disability type was not related to either smear or mammogram on eligibility, uptake ever, or uptake timeframe. A higher proportion of those with multiple disability types experienced service environment barriers to having a cervical smear. Specific barriers to screening covered accessibility, service environment, and information. CONCLUSIONS: This study, unique in Aotearoa, provides insights into disabled women's access to and engagement with screening services and suggests factors that may inhibit or facilitate participation. Women with multiple disabilities may be disadvantaged in the seeking and delivery of screening.Implications for rehabilitationRehabilitation and other practitioners need to be attuned to how women living with multiple disabilities may be disadvantaged in the seeking of, and, more importantly, the delivery of breast or cancer screening.Practitioners need to discuss with disabled women what supports or resources they need to have screening procedures, and to advocate for these supports for their clients.Practitioners need to ensure accessibility that encompasses the whole screening journey from the initial invitation to the obtaining of results.For practitioners to be able to provide equitable service delivery, the government and institutional policies and procedures that are developed must take into consideration the multiple needs of women living with disabilities.

Sociodemographic and Built Environment Associates of Travel to School by Car among New Zealand Adolescents: Meta-Analysis.

Travelling to school by car diminishes opportunities for physical activity and contributes to traffic congestion and associated noise and air pollution. This meta-analysis examined sociodemographic characteristics and built environment associates of travelling to school by car compared to using active transport among New Zealand (NZ) adolescents. Four NZ studies (2163 adolescents) provided data on participants' mode of travel to school, individual and school sociodemographic characteristics, distance to school and home-neighbourhood built-environment features. A one-step meta-analysis using individual participant data was performed in SAS. A final multivariable model was developed using stepwise logistic regression. Overall, 60.6% of participants travelled to school by car. When compared with active transport, travelling to school by car was positively associated with distance to school. Participants residing in neighbourhoods with high intersection density and attending medium deprivation schools were less likely to travel to school by car compared with their counterparts. Distance to school, school level deprivation and low home neighbourhood intersection density are associated with higher likelihood of car travel to school compared with active transport among NZ adolescents. Comprehensive interventions focusing on both social and built environment factors are needed to reduce car travel to school.

Paramedic-Delivered Fibrinolysis in the Treatment of ST-Elevation Myocardial Infarction: Comparison of a Physician-Authorized versus Autonomous Paramedic Approach.

Background: For those patients who receive fibrinolysis in the treatment of ST-elevation myocardial infarction (STEMI), early treatment, i.e., within 2 hours of symptom onset, confers the greatest clinical benefit. This rationale underpins paramedic-delivered fibrinolysis in the prehospital setting. However, the current New Zealand approach requiring paramedics to first gain physician authorization, has proved inefficient and time consuming, particularly due to technological failings. Therefore, this study aimed to trial a new autonomous paramedic-delivered fibrinolysis model, examining the impact on time-to-treatment, paramedic diagnostic accuracy and patient outcomes. Methods: Utilizing a prospective observational approach, over a 24-month period, paramedics identified patients with a clinical presentation and electrocardiogram features consistent with STEMI, and initiated fibrinolysis. These patients were compared to a historic cohort who received fibrinolysis by paramedics within the same regions but following physician authorization. The main outcome measures were pain-to-needle (PTN) time and accuracy of paramedic diagnosis. A secondary end-point was 30-day and 6-month mortality and hospital length of stay (LOS). Results: A total of 174 patients received fibrinolysis (mean age, 64 years, SD ± 11.2). Median PTN time was 87 minutes (IQR = 58) for the historic cohort (n = 96), versus 65 minutes (IQR = 31) for the experimental cohort (n = 78), (p = 0.007). Autonomous paramedic diagnosis showed a sensitivity of 96% (95% CI 89-99) and specificity of 91% (95% CI 76-98). A significant reduction in both 30-day mortality and hospital LOS was observed among the experimental cohort (p = 0.04 and <0.001, respectively). No significant difference was observed between groups in terms of 6-month mortality. Conclusions: Prehospital fibrinolysis provided autonomously by paramedics without direct physician oversight is safe and feasible. Moreover, this independent approach can significantly improve time-to-treatment, resulting in short term mortality benefit and reduced hospital LOS.

Axillary traction: An effective method of resolving shoulder dystocia.

BACKGROUND: At Counties Manukau Health in Auckland, New Zealand, axillary traction is being used when an internal manoeuvre is required for resolution of shoulder dystocia. AIMS: This study presents the outcomes for mother and baby from use of axillary traction and other internal manoeuvres. MATERIALS AND METHODS: Retrospective review of the clinical records of mother and baby for all labours complicated by shoulder dystocia was carried out for an eight-year period. Maternal and neonatal information were compared for the three cohorts of the first internal manoeuvre documented: axillary traction, posterior arm delivery and rotational manoeuvres. RESULTS: There were 226 women who required the use of internal manoeuvres with no significant differences in age, body mass index, parity, ethnicity, diabetes incidence, induction and augmentation of labour rates, length of the first stage and birth weight between the cohorts. Axillary traction was the first internal manoeuvre used for 119 (52.7%) with a success rate of 95.8%. Posterior arm delivery was used first for 49 (21.7%) women with a success rate of 85.7%. Rotational manoeuvres were used first for 58 (25.7%) women with a statistically inferior success rate of 48.3%. There was no significant difference in the maternal and neonatal complication rates between the cohorts. CONCLUSION: Axillary traction has been utilised as the first internal manoeuvre for a large number of women with a higher success rate than other internal manoeuvres without any increase in maternal or neonatal morbidity. It is recommended that this be the first internal manoeuvre attempted when shoulder dystocia occurs.

Paramedic-initiated helivac to tertiary hospital for primary percutaneous coronary intervention: a strategy for improving treatment delivery times.

BACKGROUND: In regions of New Zealand without coronary catheterisation laboratory (CCL) facilities, patients presenting with ST-elevation myocardial infarction (STEMI) are often subjected to prolonged delays before receiving primary percutaneous coronary intervention (PPCI) if it is the chosen reperfusion strategy. Therefore, we aimed to trial a new process of paramedic-initiated helivac of STEMI patients from the field directly to the CCL. METHODS: Utilising a prospective observational approach, over a 48-month period, paramedics identified patients with a clinical presentation and electrocardiogram features consistent with STEMI and transported them directly to the regional air ambulance base for helivac to the CCL (flight time 30-35 minutes). These patients were compared to two historic STEMI cohorts either transported by paramedics to the region's local hospital or self-presenting, prior to helivac. The primary outcome measures were: first medical contact-to-balloon (FMCTB) time and accuracy of paramedic diagnosis. Secondary outcome measures were mortality at 30 days and six months, and hospital length of stay (LOS). RESULTS: A total of 92 patients underwent helivac for PPCI (mean age of 64 years, SD ±10.3). Median FMCTB time was 155 minutes (IQR 27) for the historic cohorts (n=57), versus 102 minutes (IQR 16) for the experimental cohort (n=35, P<0.001). Paramedic diagnosis showed a sensitivity of 97% (95% CI: 85 to 99) and a specificity of 100% (95% CI: 84 to 100) with no inappropriate CCL activations. No significant difference was observed between groups in terms of 30 day and 6-month mortality. Hospital LOS was significantly shorter among the experimental cohort (P=0.01). CONCLUSIONS: Paramedic-initiated helivac of STEMI patients from the field directly to the CCL for PPCI is safe and feasible and can significantly improve time-to-treatment to within benchmark timeframes, resulting in reduced hospital LOS.

Neighbourhoods for Active Kids: study protocol for a cross-sectional examination of neighbourhood features and children's physical activity, active travel, independent mobility and body size.

INTRODUCTION: New Zealand children's physical activity, including independent mobility and active travel, has declined markedly over recent decades. The Neighbourhoods for Active Kids (NfAK) study examines how neighbourhood built environments are associated with the independent mobility, active travel, physical activity and neighbourhood experiences of children aged 9-12 years in primary and intermediate schools across Auckland, New Zealand's largest city. METHODS AND ANALYSIS: Child-specific indices of walkability, destination accessibility and traffic exposure will be constructed to measure the built environment in 8 neighbourhoods in Auckland. Interactive online-mapping software will be used to measure children's independent mobility and transport mode to destinations and to derive measures of neighbourhood use and perceptions. Physical activity will be measured using 7-day accelerometry. Height, weight and waist circumference will be objectively measured. Parent telephone interviews will collect sociodemographic information and parent neighbourhood perceptions. Interviews with school representative will capture supports and barriers for healthy activity and nutrition behaviours at the school level. Multilevel modelling approaches will be used to understand how differing built environment variables are associated with activity, neighbourhood experiences and health outcomes. DISCUSSION: We anticipate that children who reside in neighbourhoods considered highly walkable will be more physically active, accumulate more independent mobility and active travel, and be more likely to have a healthy body size. This research is timely as cities throughout New Zealand develop and implement plans to improve the liveability of intensifying urban neighbourhoods. Results will be disseminated to participants, local government agencies and through conventional academic avenues.

Cognitive neuropsychological functioning in New Zealand Maori diagnosed with schizophrenia.

OBJECTIVE: Previous research suggests that New Zealand Maori may have an elevated rate of schizophrenia. However, there is limited evidence on important clinical features of the illness in this population. This study examined cognitive neuropsychological functioning in 54 adult Maori diagnosed with schizophrenia and 56 Maori controls. This study also examined associations between cognition, medication and symptoms of psychosis in the schizophrenia group. METHOD: The groups were matched on socio-demographic variables, handedness and premorbid cognitive ability. Participants were assessed on neuropsychological tests of attention, executive ability, motor, premorbid ability, verbal/non-verbal memory and verbal fluency (English/Maori versions). The Positive and Negative Syndrome Scale was used to assess psychotic symptoms. Information on cultural identity, duration of illness, duration of untreated psychosis, medication and substance abuse was collected. RESULTS: The performance of the schizophrenia group was significantly lower than the control group on all the neuropsychological tests, except the test of attention. The effect sizes were moderate to large: 0.78 for motor function; 1.3 for executive ability, verbal fluency and visual memory; 1.6 for verbal learning and 1.8 for verbal memory. These differences remained after adjustment for multiple comparisons and covariates. A higher dose of antipsychotic medication and a higher anticholinergic load were associated with greater verbal memory impairment (r = -0.38 and r = -0.38, respectively). A longer duration of illness was associated with greater impairment of verbal memory (rho = -0.48), verbal learning (rho = -0.41) and visual memory (rho = -0.44). CONCLUSION: The findings for the schizophrenia group show a profile of generalised cognitive impairment with greater impairment of verbal memory. The cognitive impairment in this group was independent of psychotic symptoms, but was associated with a higher antipsychotic dose, higher anticholinergic load and longer duration of illness. These findings have implications for clinical prescribing practices and rehabilitation for New Zealand Maori diagnosed with schizophrenia.

Cost-effectiveness of pedometer-based versus time-based Green Prescriptions: the Healthy Steps Study.

This paper reports on the cost-effectiveness of pedometer-based versus time-based Green Prescriptions in improving physical activity and health-related quality of life (EQ-5D) in a randomised controlled trial of 330 low-active, community-based adults aged 65 years and over. Costs, measured in $NZ (NZ$1=A$0.83, December 2008), comprised public and private health care costs plus exercise-related personal expenditure. Based on intention-to-treat data at 12-month follow up, the pedometer group showed a greater increase in weekly leisure walking (50.6 versus 28.1min for the time-based group, adjusted means, P=0.03). There were no significant between-group differences in costs. The incremental cost-effectiveness ratios, for the pedometer-based versus time-based Green Prescription, per 30min of weekly leisure walking and per quality-adjusted life year were, (i) when including only community care costs, $115 and $3105, (ii) when including only exercise and community care costs, $130 and $3500, and (iii) for all costs, -$185 and -$4999, respectively. The cost-effectiveness acceptability curves showed that the pedometer-based compared with the time-based Green Prescription was statistically cost-effective, for the above cost categories, at the following quality-adjusted life year thresholds: (i) $30000; (ii) $30500; and (iii) $16500. The additional program cost of converting one sedentary adult to an active state over a 12-month period was $667. The outcomes suggest the pedometer-based Green Prescription may be cost-effective in increasing physical activity and health-related quality of life over 12 months in previously low-active older adults.

Healthy Steps trial: pedometer-based advice and physical activity for low-active older adults.

PURPOSE: We compared the effectiveness of 2 physical activity prescriptions delivered in primary care--the standard time-based Green Prescription and a pedometer step-based Green Prescription--on physical activity, body mass index (BMI), blood pressure, and quality of life in low-active older adults. METHODS: We undertook a randomized controlled trial involving 330 low-active older adults (aged =65 years) recruited through their primary care physicians' patient databases. Participants were randomized to either the pedometer step-based Green Prescription group (n = 165) or the standard Green Prescription group (n = 165). Both groups had a visit with the primary care practitioner and 3 telephone counseling sessions over 12 weeks aimed at increasing physical activity. Outcomes were the changes in physical activity (assessed with the Auckland Heart Study Physical Activity Questionnaire), blood pressure, BMI, quality of life (assessed with the 36-Item Short Form Health Survey), physical function status (assessed with the Short Physical Performance Battery), and falls over a 12-month period. RESULTS: Of the patients invited to participate, 57% responded. At 12 months, leisure walking increased by 49.6 min/wk for the pedometer Green Prescription compared with 28.1 min/wk for the standard Green Prescription (P=.03). For both groups, there were significant increases across all physical activity domains at 3 months (end of intervention) that were largely maintained after 12 months of follow-up. BMI did not change in either group. Significant improvements in blood pressure were observed for both groups without any differences between them. CONCLUSIONS: Pedometer use resulted in a greater increase in leisure walking without any impact on overall activity level. All participants increased physical activity, and on average, their blood pressure decreased over 12 months, although the clinical relevance is unknown.

Validation of dynamic contrast-enhanced ultrasound in rodent kidneys as an absolute quantitative method for measuring blood perfusion.

Contrast-enhanced ultrasound (CEUS) has demonstrated utility in the monitoring of blood flow in tissues, organs and tumors. However, current CEUS methods typically provide only relative image-derived measurements, rather than quantitative values of blood flow in milliliters/minute per gram of tissue. In this study, CEUS derived parameters of blood flow are compared with absolute measurements of blood flow in rodent kidneys. Additionally, the effects of contrast agent infusion rate and transducer orientation on image-derived perfusion measurements are assessed. Both wash-in curve and time-to-refill algorithms are examined. Data illustrate that for all conditions, image-derived flow measurements were well-correlated with transit-time flow probe measurements (R > 0.9). However, we report differences in the sensitivity to flow across different transducer orientations as well as the contrast analysis algorithm utilized. Results also indicate that there exists a range of contrast agent flow rates for which image-derived estimates are consistent.

The healthy steps study: a randomized controlled trial of a pedometer-based green prescription for older adults. Trial protocol.

BACKGROUND: Graded health benefits of physical activity have been demonstrated for the reduction of coronary heart disease, some cancers, and type-2 diabetes, and for injury reduction and improvements in mental health. Older adults are particularly at risk of physical inactivity, and would greatly benefit from successful targeted physical activity interventions. METHODS/DESIGN: The Healthy Steps study is a 12-month randomized controlled trial comparing the efficacy of a pedometer-based Green Prescription with the conventional time-based Green Prescription in increasing and maintaining physical activity levels in low-active adults over 65 years of age. The Green Prescription interventions involve a primary care physical activity prescription with 3 follow-up telephone counselling sessions delivered by trained physical activity counsellors over 3 months. Those in the pedometer group received a pedometer and counselling based around increasing steps that can be monitored on the pedometer, while those in the standard Green Prescription group received counselling using time-based goals. Baseline, 3 month (end of intervention), and 12 month measures were assessed in face-to-face home visits with outcomes measures being physical activity (Auckland Heart Study Physical Activity Questionnaire), quality of life (SF-36 and EQ-5D), depressive symptoms (Geriatric Depression Scale), blood pressure, weight status, functional status (gait speed, chair stands, and tandem balance test) and falls and adverse events (self-report). Utilisation of health services was assessed for the economic evaluation carried out alongside this trial. As well, a process evaluation of the interventions and an examination of barriers and motives for physical activity in the sample were conducted. The perceptions of primary care physicians in relation to delivering physical activity counselling were also assessed. DISCUSSION: The findings from the Healthy Steps trial are due in late 2009. If successful in improving physical activity in older adults, the pedometer-based Green Prescription could assist in reducing utilisation of health services and improve cardiovascular health and reduction of risk for a range of non-communicable lifestyles diseases. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN012606000023550.

First incursion of Salmonella enterica serotype typhimurium DT160 into New Zealand.

An outbreak of human Salmonella enterica serotype Typhimurium DT160 infection in New Zealand was investigated from May to August 2001. Handling of dead wild birds, contact with persons with diarrheal illness, and consumption of fast food were associated with infection. Contaminated roof-collected rainwater was also detected.