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1.
N Z Med J ; 134(1538): 89-101, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239148

RESUMO

AIM: The primary care response to the coronavirus disease 2019 (COVID-19) pandemic in early 2020 required significant changes to the delivery of healthcare by general practices. This study explores the experiences of New Zealand general practice teams in their use of telehealth during the early stages of the COVID-19 pandemic in New Zealand. METHOD: We qualitatively analysed a subtheme on telehealth of the General Practice Pandemic Experience New Zealand (GPPENZ) study, where general practice team members across the country were invited to participate in five surveys between 8 May 2020 to 27 August 2020. RESULTS: 164 participants enrolled in the study during survey one, with 78 (48%) completing all surveys. Five telehealth themes were identified: benefits, limitations, paying for consults, changes over time and plans for future use. Benefits included rapid triage, convenience and efficiency, and limitations included financial and technical barriers for practices and patients and concerns about clinical risk. Respondents rapidly returned to in-person consultations and wanted clarification of conditions suited to telehealth, better infrastructure and funding. CONCLUSION: To equitably sustain telehealth use, the following are required: adequate funding, training, processes communicated to patients, improved patient access to technology and technological literacy, virtual physical examination methods and integration with existing primary health care services.


Assuntos
COVID-19/prevenção & controle , Medicina Geral , Atenção Primária à Saúde , Telemedicina , Adulto , Idoso , Eficiência , Feminino , Medicina Geral/economia , Pessoal de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Atenção Primária à Saúde/economia , Pesquisa Qualitativa , SARS-CoV-2 , Inquéritos e Questionários , Telemedicina/economia , Triagem , Salas de Espera
2.
N Z Med J ; 134(1538): 102-110, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239149

RESUMO

AIM: To (1) describe the distribution of Ministry of Health (MOH) COVID-19 emergency funding to general practices in March and April 2020 and (2) consider whether further funding to general practices should be allocated differently to support equity for patients. METHODS: Emergency funding allocation criteria and funding amounts by general practice were obtained from the MOH. Practices were stratified according to their proportion of high-needs enrolled patients (Maori, Pacific or living in an area with the highest quintile of socioeconomic deprivation). Funding per practice was calculated for separate and total payments according to practice stratum of high-needs enrolled patients. RESULTS: The median combined March and April funding for general practices with 80% high-needs patients was 28% higher per practice ($36,674 vs $28,686) and 48% higher per patient ($10.50 vs $7.11) compared with the funding received by general practices with fewer than 20% high-needs patients. Although the March allocation did increase funding for high-needs patients, the April allocation did not. CONCLUSIONS: Emergency support funding for general practices was organised by the MOH at short notice and in exceptional circumstances. In the future, the MOH should apply pro-equity resource allocation in all emergencies, as with other circumstances.


Assuntos
COVID-19/economia , Financiamento Governamental/estatística & dados numéricos , Medicina Geral/economia , Equidade em Saúde/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/prevenção & controle , Criança , Pré-Escolar , Emergências , Governo Federal , Financiamento Governamental/economia , Medicina Geral/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Nova Zelândia , Grupo com Ancestrais Oceânicos , Áreas de Pobreza , SARS-CoV-2 , Populações Vulneráveis , Adulto Jovem
3.
N Z Med J ; 134(1538): 111-119, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239150

RESUMO

AIM: To determine the impact on the Capital & Coast District Health Board (CCDHB) urology service of the implementation of nationwide healthcare restrictions in response to the COVID-19 pandemic. METHODS: This is an observational retrospective study over a 21 working day period during the implementation of National Hospital Response Framework Alert (NHRFA) level 2. We obtained patient data during this period and a corresponding control period prior to the pandemic. The data was focussed on the volume of operating theatre cases, outpatient consultations, procedural clinic appointments and the estimated avoided outpatient travel. RESULTS: Total urology admissions decreased by 27% during the 21-day NHRFA level 2 period. However, acute surgical procedures increased by 30% whereas elective surgical procedures decreased by 32%. Outpatient consultations overall decreased by 32% during NHRFA level 2 despite virtual phone consultations increasing by 274%. Procedural clinic appointments decreased by 85%. The virtual platform also saved each patient an estimated 22.7km of average travel. CONCLUSION: The data demonstrate the effects of restrictions in response to a crisis and set a precedent for future management in such scenarios. The data also show how service efficiency can be optimised while providing an environmentally friendly alternative for routine clinical practice.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , COVID-19/prevenção & controle , Atenção à Saúde/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Urologia/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Humanos , Nova Zelândia , Visita a Consultório Médico/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , SARS-CoV-2 , Telemedicina/estatística & dados numéricos , Viagem/estatística & dados numéricos
4.
N Z Med J ; 134(1538): 120-127, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239151

RESUMO

AIM: In response to the COVID-19 pandemic, the New Zealand government enforced a nationwide 'alert level 4' lockdown from 26 March to 27 April 2020. We assessed the impact of this lockdown on New Zealand's public ophthalmology service. METHOD: An anonymous online survey was sent to all New Zealand-based fellows of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) after lockdown. Respondents provided retrospective assessment of practice patterns and their personal health during the COVID-19 lockdown. This was supported by national-level administrative data, allowing survey findings to be contextualised. RESULTS: Fifty-seven respondents (response rate 49%) working in the public health system participated. A large majority of respondents reduced elective clinic and surgical volumes by at least 75% (82% and 98%, respectively). National-level information confirmed clinic reduced to 38.2% of normal and elective operating volumes to 11.5%, with virtual visits increasing 17.9-fold. Elective clinic and elective operating volumes promptly recovered to usual volumes on the second month post lockdown. Most respondents (58%) followed the RANZCO triaging guideline, and 28% triaged emergencies only. At a personal level, respondents reported a significant physical health benefit (p<0.001) associated with the lockdown experience, but no change in mental health or social wellbeing. CONCLUSIONS: Publicly employed ophthalmologists experienced dramatic reductions to elective clinic and operating volumes during the COVID-19 lockdown. The prompt recovery of service delivery volumes back to pre-lockdown levels supports the value of a COVID-19 elimination strategy in New Zealand. Virtual visits for selected patients allowed ongoing management without risking virus transmission.


Assuntos
COVID-19/prevenção & controle , Atenção à Saúde/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Procedimentos Cirúrgicos Oftalmológicos/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Nova Zelândia , Oftalmologistas/psicologia , Estudos Retrospectivos , SARS-CoV-2 , Inquéritos e Questionários , Telemedicina/estatística & dados numéricos , Triagem/normas
5.
N Z Med J ; 134(1538): 135-138, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239153

RESUMO

Medical students from the University of Otago, Christchurch Department of Medicine were involved in their local COVID-19 response. A group of ten students helped with the assessment of individuals at community-based assessment centres or mobile testing units. They primarily helped assess and test individuals alongside experienced healthcare workers. The students gained valuable clinical and public health experience. Key learning points were the risks of pandemic involvement, identifying local barriers to healthcare and developing an appreciation for an evolving health response. Overall, students felt that preparation for future involvement could benefit further pandemic responses.


Assuntos
COVID-19/diagnóstico , Estudantes de Medicina , Teste para COVID-19 , Humanos , Anamnese , Nasofaringe/virologia , Nova Zelândia , Equipamento de Proteção Individual , SARS-CoV-2
6.
N Z Med J ; 134(1538): 139-143, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239154

RESUMO

173,766 New Zealanders suffer from visual impairment. The associated health-system costs are $523 million in total, or $3,008 per person. Yet eighty percent (80%) of blindness is avoidable if detected on time. Public health services have an increasing workload but are also limited by material and technical resources. Optometry practices continually increase referrals (up to 100% in one year) that cannot be solved on time, reducing the efficiency of the service. Teleophthalmology works by improving the efficiency of screening and monitoring and integrating eye healthcare and by decreasing referrals by up to 40%.


Assuntos
COVID-19/prevenção & controle , Oftalmologia , Telemedicina , Cegueira/complicações , Disparidades em Assistência à Saúde , Humanos , Nova Zelândia , SARS-CoV-2
7.
Artigo em Inglês | MEDLINE | ID: mdl-34200773

RESUMO

OBJECTIVES: We aimed to examine patterns in smoking and electronic nicotine delivery system (ENDS) use over an extended period of time (up to 20 weeks) in people who smoked and who had never previously made a successful quit attempt using an ENDS. DESIGN AND SETTING: We conducted a longitudinal mixed-methods study in Dunedin, New Zealand, during 2018 and 2019. PARTICIPANTS: Purposively selected participants (N = 45; age (≥18 years), gender, ethnicities, cigarettes/day) who wished to quit smoking. INTERVENTIONS: Participants were provided with a second-generation ENDS device (vape pen or starter "tank" device) at the start of their quit attempt, and asked to complete smartphone-based daily diary surveys assessing smoking and ENDS use. OUTCOME MEASURES: Sunburst plots and a sequence plot were used to describe weekly and daily patterns of smoking and ENDS use (smoking only, ENDS use only, dual use, abstinent). RESULTS: The most frequently reported movements among participants, classified according to their study week behaviour, occurred between dual use and exclusive ENDS use (and vice versa). A smaller group reported moving from dual use to exclusive smoking (and often back to dual use), and a small number reported moving between abstinence and different ENDS and smoked tobacco usage behaviours. Data visualisations focussing on those participants who had provided data during each of weeks 9-12 indicate that only a minority reported sustained dual use; instead, most participants indicated varied smoked tobacco and ENDS use, which included periods of dual use. CONCLUSIONS: The considerable variety observed within and between study participants suggests that high variability is typical rather than exceptional. Transitions from smoking to ENDS use may involve considerable periods of dual use, which is likely to be dynamic and potentially sustained over several months.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Abandono do Hábito de Fumar , Vaping , Adolescente , Humanos , Nova Zelândia/epidemiologia , Fumar , Fumar Tabaco
8.
BMC Fam Pract ; 22(1): 140, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210271

RESUMO

BACKGROUND: Health services internationally have been compelled to change their methods of service delivery in response to the global COVID-19 pandemic, to mitigate the spread of infection amongst health professionals and patients. In Aotearoa/New Zealand, widespread electronic delivery of prescriptions (e-prescribing) was enabled. The aim of the research was to explore patients' experiences of how lockdown, changes to prescribing and the interface between general practices and community pharmacy affected access to prescription medications. METHOD: The research employed a mixed-method approach. This included an online survey (n = 1,010) and in-depth interviews with a subset of survey respondents (n = 38) during the first COVID-19 lockdown (March-May 2020). Respondents were recruited through a snowballing approach, starting with social media and email list contacts of the research team. In keeping with the approach, descriptive statistics of survey data and thematic analysis of qualitative interview and open-ended questions in survey data were combined. RESULTS: For most respondents who received a prescription during lockdown, this was sent directly to the pharmacy. Most people picked up their medication from the pharmacy; home delivery of medication was rare (4%). Survey and interview respondents wanted e-prescribing to continue post-lockdown and described where things worked well and where they encountered delays in the process of acquiring prescription medication. CONCLUSIONS: E-prescribing has the potential to improve access to prescription medication and is convenient for patients. The increase in e-prescribing during lockdown highlighted how the system could be improved, through better feedback about errors, more consistency across practices and pharmacies, more proactive communication with patients, and equitable prescribing costs.


Assuntos
COVID-19 , Atenção à Saúde , Prescrição Eletrônica , Medicina Geral , Acesso aos Serviços de Saúde , Preferência do Paciente/estatística & dados numéricos , Atitude do Pessoal de Saúde , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Serviços Comunitários de Farmácia/normas , Serviços Comunitários de Farmácia/estatística & dados numéricos , Atenção à Saúde/organização & administração , Atenção à Saúde/normas , Prescrição Eletrônica/economia , Prescrição Eletrônica/normas , Prescrição Eletrônica/estatística & dados numéricos , Feminino , Medicina Geral/métodos , Medicina Geral/tendências , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Melhoria de Qualidade , SARS-CoV-2 , Inquéritos e Questionários
9.
BMC Neurol ; 21(1): 262, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34225698

RESUMO

BACKGROUND AND OBJECTIVES: Fatigue and sleep disturbance are debilitating problems following brain injury and there are no established treatments. Building on demonstrated efficacy of blue light delivered via a lightbox in reducing fatigue and daytime sleepiness after TBI, this study evaluated the efficacy of a novel in-home light intervention in alleviating fatigue, sleep disturbance, daytime sleepiness and depressive symptoms, and in improving psychomotor vigilance and participation in daily productive activity, following injury METHODS: The impact of exposure to a dynamic light intervention (Treatment) was compared to usual lighting (Control) in a randomized within-subject, crossover trial. Outcomes were fatigue (primary outcome), daytime sleepiness, sleep disturbance, insomnia symptoms, psychomotor vigilance, mood and activity levels. Participants (N = 24, M ± SDage = 44.3 ± 11.4) had mild-severe TBI or stroke > 3 months previously, and self-reported fatigue (Fatigue Severity Scale ≥ 4). Following 2-week baseline, participants completed each condition for 2 months in counter-balanced order, with 1-month follow-up. Treatment comprised daytime blue-enriched white light (CCT > 5000 K) and blue-depleted light (< 3000 K) 3 h prior to sleep. RESULTS: Random-effects mixed-model analysis showed no significantly greater change in fatigue on the Brief Fatigue Inventory during Treatment, but a medium effect size of improvement (p = .33, d = -0.42). There were significantly greater decreases in sleep disturbance (p = .004), insomnia symptoms (p = .036), reaction time (p = .004) and improvements in productive activity (p = .005) at end of Treatment relative to Control, with large effect sizes (d > 0.80). Changes in other outcomes were non-significant. CONCLUSIONS: This pilot study provides preliminary support for in-home dynamic light therapy to address sleep-related symptoms in acquired brain injury. TRIAL REGISTRATION: This trial was registered with the Australian and New Zealand Clinical Trials Registry on 13 June 2017, www.anzctr.org.au , ACTRN12617000866303.


Assuntos
Lesões Encefálicas/terapia , Fototerapia , Adulto , Austrália , Humanos , Pessoa de Meia-Idade , Nova Zelândia , Projetos Piloto
10.
N Z Med J ; 134(1538): 9-17, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239141

RESUMO

In response to the COVID-19 pandemic, Aotearoa New Zealand adopted a clear 'elimination strategy', which has (up to June 2021) been very successful in both health and economic terms compared to other OECD countries. Nevertheless, the pandemic response has still been a very major shock to the New Zealand health system. This issue of the New Zealand Medical Journal has 14 new pandemic-related articles. Some of this work can help inform vaccination prioritisation decisions and inform preparations of primary and secondary care services and social services for any future raising of levels in the pandemic Alert Level system. Particularly strong themes are around the value (and challenges) of telehealth services, and also the need for responses throughout the health system to ensure health equity and support for the most vulnerable citizens.


Assuntos
COVID-19/prevenção & controle , COVID-19/economia , COVID-19/psicologia , Humanos , Nova Zelândia , SARS-CoV-2
11.
N Z Med J ; 134(1538): 18-27, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239142

RESUMO

AIMS: To identify the extent of the provision of handwashing amenities in public toilets at the time of the COVID-19 pandemic, and also to make comparisons with a related pre-pandemic survey. METHODS: We collected data from 400 toilet facilities that were open to the public: all those in three contiguous city council territories (228) and a further convenience sample of 172 around other parts of New Zealand. Comparisons were made with the data on the same facilities included in a 2012/2013 survey. RESULTS: Of the toilets in this survey, 2.5% had no water for handwashing and 14.8% had no soap. There was COVID-19-related health messaging signage in 19.5% of toilets, with posters of the COVID-19 QR code used for contact tracing in 12.3%, and generic handwashing signage in 1.8%. The handwashing water had 'no-touch' activation at 28.0% of toilets, and 18.5% of toilets had no-touch bowl flushing. Toilet bowl lids were not present at 32.8%, and 2.3% of toilets had damage that would impair their functionality (eg, broken toilet seats). This new survey found significantly increased provision of soap (risk ratio = 1.47; 95%CI: 1.25 to 1.72), but no increased provision of water, at the 128 sites that had also been examined in the previous survey. CONCLUSIONS: Although handwashing is probably a much less critical COVID-19 control intervention than reducing aerosol transmission, it should still be strongly supported. Yet this survey found multiple deficiencies with handwashing amenities at public toilets and only modest improvements since a previous survey.


Assuntos
COVID-19/prevenção & controle , Desinfecção das Mãos/instrumentação , Logradouros Públicos , Toaletes , Educação em Saúde , Humanos , Nova Zelândia , Pôsteres como Assunto , SARS-CoV-2 , Sabões , Toaletes/normas , Água
12.
N Z Med J ; 134(1538): 28-43, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239143

RESUMO

AIMS: We aim to quantify differences in clinical outcomes from COVID-19 infection in Aotearoa New Zealand by ethnicity and with a focus on risk of hospitalisation. METHODS: We used data on age, ethnicity, deprivation index, pre-existing health conditions and clinical outcomes on 1,829 COVID-19 cases reported in New Zealand. We used a logistic regression model to calculate odds ratios for the risk of hospitalisation by ethnicity. We also considered length of hospital stay and risk of fatality. RESULTS: After controlling for age and pre-existing conditions, we found that Maori have 2.50 times greater odds of hospitalisation (95% CI 1.39-4.51) than non-Maori non-Pacific people. Pacific people have three times greater odds (95% CI 1.75-5.33). CONCLUSIONS: Structural inequities and systemic racism in the healthcare system mean that Maori and Pacific communities face a much greater health burden from COVID-19. Older people and those with pre-existing health conditions are also at greater risk. This should inform future policy decisions including prioritising groups for vaccination.


Assuntos
COVID-19/etnologia , Hospitalização/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , COVID-19/mortalidade , COVID-19/terapia , Criança , Pré-Escolar , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Medição de Risco , Fatores de Risco , SARS-CoV-2 , Adulto Jovem
13.
N Z Med J ; 134(1538): 44-51, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239144

RESUMO

AIMS: Stress plays a key role in Parkinson's disease (PD) by acting on the dopaminergic system and worsening patients' motor function. The impact of New Zealand's strict lockdown measures to contain COVID-19 on perceived stress and PD motor symptoms remains unknown. Here we examined the relationship between perceived levels of stress, changes in physical activity levels and PD motor symptoms during lockdown. METHODS: During lockdown, 134 participants with PD and 49 controls completed a survey assessing perceived stress, self-reported changes in PD motor symptoms and physical activity duration and intensity prior to and during lockdown. RESULTS: Perceived stress was higher in PD than controls, and in those reporting a worsening of tremor, balance/gait, dyskinesia and bradykinesia compared to those indicating no change during the COVID-19 lockdown. These effects were not modulated by physical activity. CONCLUSIONS: Reducing stressors may be an important adjunct treatment strategy to improve motor function in PD.


Assuntos
COVID-19/prevenção & controle , Doença de Parkinson/psicologia , Estresse Psicológico/complicações , Estudos de Casos e Controles , Progressão da Doença , Exercício Físico , Marcha , Humanos , Hipocinesia/etiologia , Nova Zelândia , Doença de Parkinson/complicações , Equilíbrio Postural , SARS-CoV-2 , Inquéritos e Questionários , Tremor/etiologia
14.
N Z Med J ; 134(1538): 52-67, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239145

RESUMO

AIM: This research explores the experience of low-income New Zealanders during the COVID-19 pandemic lockdown and their advice to the Government about addressing future pandemics. New Zealand had a rapid and effective lockdown that meant the virtual elimination of community transmission. METHOD: Twenty-seven semi-structured interviews were undertaken with low-income people in June-July 2020 immediately after lockdown was lifted. RESULTS: Life during lockdown was challenging for study participants. They were fearful of the virus and experienced mental distress and isolation. Most participants felt safe at home and reported coping financially while still experiencing financial stress. Participants were resourceful and resilient. They coped with lockdown by using technology, self-help techniques and support from others. New Zealand's welfare state ensured participants had access to health services and welfare payments, but there were challenges. Welfare payments did not fully meet participants' needs, and support from charitable organisations was critical. Participants were overwhelmingly positive about the Government's response and advised the Government to take the same approach in the future. This is a particularly reassuring finding from some of the most vulnerable New Zealanders. CONCLUSIONS: An early and hard lockdown, the welfare state, compassion and clearly communicated leadership were keys to a successful lockdown for the low-income people in this study. Research of the experience of low-income people during pandemics is critical to ensuring inequities in pandemic impact are mitigated.


Assuntos
COVID-19/prevenção & controle , COVID-19/psicologia , Pandemias/prevenção & controle , Pobreza , Assistência Pública , Adaptação Psicológica , Adulto , COVID-19/economia , Feminino , Abastecimento de Alimentos , Política de Saúde , Acesso aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Angústia Psicológica , Pesquisa Qualitativa , SARS-CoV-2 , Segurança , Apoio Social , Seguridade Social , Tecnologia
15.
N Z Med J ; 134(1538): 68-76, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239146

RESUMO

AIM: Quick COVID-19 Surveys are an international collaboration designed to rapidly analyse and disseminate a primary care perspective on the pandemic and associated health response. In this paper we present results from surveys relating to opening the New Zealand border. METHOD: Three surveys were distributed to primary care practices between May and December 2020. A range of primary care member organisations distributed the survey augmented by snowballing. Quantitative data were analysed using descriptive statistics and qualitative data through an inductive process and grouped into themes. RESULTS: Respondents became increasingly supportive of opening a trans-Tasman border but not internationally. Two broad themes were evident: (1) making sure that the border is not an Achilles heel and (2) effective strategies to reduce local transmission. These themes highlight primary care's concerns around management of the border and the management of local spread respectively. CONCLUSION: The results highlight concerns around border control from a primary care perspective. The border control issues raised by primary care have proven to be prophetic at times and reflect the role that primary care has as observers of society. The survey mechanism provides a template for rapidly eliciting a primary care voice for future health issues.


Assuntos
Atitude do Pessoal de Saúde , COVID-19/prevenção & controle , Política de Saúde , Atenção Primária à Saúde , COVID-19/transmissão , Humanos , Nova Zelândia , SARS-CoV-2 , Inquéritos e Questionários , Viagem
16.
BMC Health Serv Res ; 21(1): 701, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34271945

RESUMO

BACKGROUND: Health systems must reorient towards preventative and co-ordinated care to reduce hospital demand and achieve positive and fiscally responsible outcomes for older persons with complex needs. Integrated care models can improve outcomes by aligning primary practice with the specialist health and social services required to manage complex needs. This paper describes the impact of a community-facing program that integrates care at the primary-secondary interface on the rate of Emergency Department (ED) presentation and hospital admissions among older people with complex needs. METHODS: The Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) study is a multicentre randomised controlled trial with a stepped wedge cluster design. General practitioners (GPs; n = 14) in primary practice within the Cairns region are considered 'clusters' each comprising a mixed number of participants. 80 community-dwelling persons over 70 years of age if non-Indigenous and over 50 years of age if Indigenous were included at baseline with no new participants added during the study. Clusters were randomly assigned to one of three steps that represent the time at which they would commence the OPEN ARCH intervention, and the subsequent intervention duration (3, 6, or 9 months). Each participant was its own control. GPs and participants were not blinded. The primary outcomes were ED presentations and hospital admissions. Data were collected from Queensland Health Casemix data and analysed with multilevel mixed-effects Poisson regression modelling to estimate the effectiveness of the OPEN ARCH intervention. Data were analysed at the cluster and participant levels. RESULTS: Five clusters were randomised to steps 1 and 2, and 4 clusters randomised to step 3. All clusters (n = 14) completed the trial accounting for 80 participants. An effect size of 9% in service use (95% CI) was expected. The OPEN ARCH intervention was found to not make a statistically significant difference to ED presentations or admissions. However, a stabilising of ED presentations and a trend toward lower hospitalisation rates over time was observed. CONCLUSIONS: While this study detected no statistically significant change in ED presentations or hospital admissions, a plateauing of ED presentation and admission rates is a clinically significant finding for older persons with complex needs. Multi-sectoral integrated programs of care require an adequate preparation period and sufficient duration of intervention for effectiveness to be measured. TRIAL REGISTRATION: The OPEN ARCH study received ethical approval from the Far North Queensland Human Research Ethics Committee, HREC/17/QCH/104-1174 and is registered on the Australian and New Zealand Trials Registry, ACTRN12617000198325p .


Assuntos
Serviço Hospitalar de Emergência , Hospitalização , Idoso , Idoso de 80 Anos ou mais , Austrália , Hospitais , Humanos , Nova Zelândia , Queensland/epidemiologia
17.
BMJ Open ; 11(7): e048107, 2021 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-34281926

RESUMO

OBJECTIVES: To compare psychological outcomes, experiences and sources of stress over the COVID-19 lockdown in New Zealand in essential workers (healthcare and 'other' essential workers) with that of workers in nonessential work roles. DESIGN: Online cross-sectional survey. SETTING: Conducted in New Zealand over level 4 lockdown in April/May 2020. PARTICIPANTS: Findings from employed participants (2495) are included in this report; 381 healthcare workers, 649 'other' essential workers and 1465 nonessential workers. PRIMARY AND SECONDARY OUTCOME MEASURES: Measures included psychological distress (Kessler Psychological Distress Scale (K10)), anxiety (Generalised Anxiety Disorder (GAD-7)), well-being (WHO-5), alcohol use, subjective experiences and sources of stress. Differences between work categories were quantified as risk ratios or χ2 tests. RESULTS: After controlling for confounders that differed between groups of essential and nonessential workers, those in healthcare and those in 'other' essential work were at 71% (95% CI 1.29 to 2.27) and 59% (95% CI 1.25 to 2.02) greater risk respectively, of moderate levels of anxiety (GAD-7 ≥10), than those in nonessential work. Those in healthcare were at 19% (95% CI 1.02 to 1.39) greater risk of poor well-being (WHO-5 <13). There was no evidence of differences across work roles in risk for psychological distress (K10 ≥12) or increased alcohol use. Healthcare and 'other' essential workers reported increased workload (p<0.001) and less uncertainty about finances and employment than those in nonessential work (p<0.001). Healthcare and nonessential workers reported decreased social contact. No difference by work category in health concerns was reported; 15% had concerns about participants' own health and 33% about other people's health. CONCLUSIONS: During the pandemic lockdown, essential workers (those in healthcare and those providing 'other' essential work) were at increased risk of anxiety compared with those in nonessential work, with those in healthcare also being at increased risk of poor well-being. This highlights the need to recognise the challenges this vital workforce face in pandemics.


Assuntos
COVID-19 , Saúde Mental , Ansiedade/epidemiologia , Controle de Doenças Transmissíveis , Estudos Transversais , Atenção à Saúde , Depressão , Pessoal de Saúde , Humanos , Nova Zelândia/epidemiologia , SARS-CoV-2
18.
Nat Commun ; 12(1): 4313, 2021 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-34262041

RESUMO

How a history of influenza virus infections contributes to protection is not fully understood, but such protection might explain the contrasting age distributions of cases of the two lineages of influenza B, B/Victoria and B/Yamagata. Fitting a statistical model to those distributions using surveillance data from New Zealand, we found they could be explained by historical changes in lineage frequencies combined with cross-protection between strains of the same lineage. We found additional protection against B/Yamagata in people for whom it was their first influenza B infection, similar to the immune imprinting observed in influenza A. While the data were not informative about B/Victoria imprinting, B/Yamagata imprinting could explain the fewer B/Yamagata than B/Victoria cases in cohorts born in the 1990s and the bimodal age distribution of B/Yamagata cases. Longitudinal studies can test if these forms of protection inferred from historical data extend to more recent strains and other populations.


Assuntos
Vírus da Influenza B/imunologia , Influenza Humana/epidemiologia , Influenza Humana/imunologia , Distribuição por Idade , Proteção Cruzada , Humanos , Memória Imunológica , Vírus da Influenza B/classificação , Influenza Humana/virologia , Modelos Estatísticos , Nova Zelândia/epidemiologia , Probabilidade
19.
N Z Med J ; 134(1537): 128-134, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239152

RESUMO

Structural discrimination worsens physical health inequities and significantly reduces life expectancy for people with mental health and addiction issues. Aotearoa has recently made some notable changes in health policy by formally recognising the physical health needs of people with mental health and addiction issues. The COVID-19 vaccination sequencing framework provides an important opportunity to protect and promote the health of people with addiction and mental health issues. An expert advisory group, convened as part of the Aotearoa Equally Well collaborative, considered findings of a literature review on the vulnerability of people with mental health and addiction issues of contracting and dying from COVID-19. Evidence indicates an association between mental health and addiction issues and infection risk and worse outcomes. The group concluded mental health and addiction issues should be recognised as underlying health conditions that increase COVID-19 vulnerability, and that people with these issues should be prioritised for vaccination. For too long the health system has failed to address the life expectancy gap of people with addiction and mental health issues. Now is an opportunity to change the korero. People with mental health and addiction issues experience significant physical health inequities. Addressing these inequities must be integral in modern health policy-including our COVID-19 pandemic response.


Assuntos
COVID-19 , Disparidades em Assistência à Saúde , Transtornos Mentais/terapia , Discriminação Social , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Política de Saúde , Acesso aos Serviços de Saúde , Humanos , Saúde Mental , Nova Zelândia , Pandemias , SARS-CoV-2 , Estigma Social
20.
N Z Med J ; 134(1537): 144-147, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239155

RESUMO

Serology is now a well-established diagnostic tool for the diagnosis of COVID-19 infections in New Zealand. Using local and international experience, we provide an overview of serological response to infection and vaccination as well as the use and interpretation of antibody tests in our setting. We also discuss the potential future role of post-vaccination serology testing as a correlate of immunity. We conclude that, given the pitfalls of testing, clinical microbiologist advice is necessary for interpretation of high-consequence cases.


Assuntos
Teste Sorológico para COVID-19 , COVID-19/diagnóstico , Humanos , Nova Zelândia , SARS-CoV-2
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