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PubMed1990

Why are hospital admission and mortality rates for childhood asthma higher in New Zealand than in the United Kingdom?

New Zealand has higher mortality and hospital admission rates for asthma than England and Wales. To determine the reasons for this the available data on asthma mortality and hospital admissions from the Auckland region of New Zealand were compared with data from the South West Thames Region of England for 1979-86 and data from previous surveys on prevalence of wheeze (Auckland 1985, Croydon 1978). In addition, a survey of general practitioners was carried out to determine their approach to the management of asthma, patient simulations being used. Asthma mortality in children of European descent aged 5-14 years was 2.5 times higher in Auckland than in South West Thames. The reported lifetime, 12 month, and one month prevalences of wheeze were also higher in Auckland (by 18.5%, 32.1%, and 87.5%). Unexpectedly, the hospital admission rate for asthma in children of European descent aged 5-14 years was 5% less in Auckland than in South West Thames. Comparative studies of hospital case notes and of the replies from general practitioners showed that in Auckland the duration of illness before admission was greater and that general practitioners were less likely to admit patients with acute asthma. The overall standard of general practitioner care in Auckland was, if anything, higher than in South West Thames but in both areas there was considerable variation. On balance it was concluded that the higher mortality rate in New Zealand is explained by higher levels of morbidity rather than relative deficiencies in care. Nevertheless, the implications of the lesser use of hospital care for acute asthma observed in Auckland need further consideration.

Acute Disease↗

PubMed1994

HLA class I gene, antigen and haplotype frequencies in New Zealand Maori and Europeans.

AIM: To determine class I HLA gene, antigen and haplotype frequencies for New Zealand Maori and Europeans. METHODS: Statistical analysis was performed using accumulated data from Maori (n = 576) and European (n = 1747) parentage studies. RESULTS: HLA class I gene, antigen and haplotype frequencies are as tabulated. Significant statistical differences were shown to exist between New Zealand Maori, New Zealand Europeans and Europeans. Gene frequencies of HLA A1, 3, 9, 11, 19 and HLA B7, 8, 12, 16, 22, and 40 differed significantly between New Zealand Maori and New Zealand European data. Gene frequencies of HLA A1 and B12 differed significantly between New Zealand European and European data. CONCLUSIONS: This HLA frequency data can be used for calculating more reliable indices of paternity or for determining the potential availability of matched organs for transplantation, as well as for anthropological studies. The data may also be useful in forensic investigations.

Europe↗

PubMed1998

Parents and other relatives accused of sexual abuse on the basis of recovered memories: a New Zealand family survey.

AIM: To survey New Zealand families where an alleged perpetrator and/or other family member denies an accusation involving the childhood molestation of one family member by another, based on a memory recovered in adulthood. As the validity of such memories is crucial, our aim was to develop a profile of such families and to compare it with New Zealand epidemiological data. METHOD: Information was collected by questionnaire regarding family demographics, characteristics of the accuser, family life, events surrounding and leading up to the accusations, consequences of the accusations and details of the accuser's current life situation. The 73 subjects included fathers, mothers, siblings and other relatives of the accusing adults. RESULTS: Most accusers were highly educated white women, frequently first born or older children from relatively large families, statistically different proportions from those expected. Many accusations involved events of low base-rate probability including satanic ritual abuse. Proportions differed from those of another New Zealand prevalence survey of 1019 18-year-olds in almost every way. CONCLUSION: The data suggest that it is unlikely that many, if not most, of the memories of child sexual abuse recovered in adulthood are a true reflection of history. Memories recovered during therapy should be treated with respect as part of the patient's narrative truth, but not assumed to be factually accurate without corroborative evidence.

Adult↗

PubMed2000

Corporate governance of public health services: lessons from New Zealand for the state sector.

New Zealand public hospitals and related services were grouped into 23 Crown Health Enterprises and registered as companies in 1993. Integral to this change was the introduction of corporate governance. New directors, largely from the business sector, were appointed to govern these organisations as efficient and effective businesses. This article presents the results of a survey of directors of New Zealand publicly-owned health provider organisations. Although directors thought they performed well in business systems development, they acknowledged their shortcomings in meeting government expectations in respect to financial performance and social responsibility. Changes in public health sector provider performance indicators have resulted in a mixed report card for the sector six years after corporate governance was instituted.

Delivery of Health Care↗

PubMed1997

Beyond ideology: the emerging roles of New Zealand's crown health enterprises.

New Zealand has experienced radical public sector restructuring over the last decade, including the corporatization and subsequent privatization of state trading units and the reform of social services, including health. In 1991 a new government proposed and then implemented more radical health reforms, which included the corporatization of state-owned provider units (23 crown health enterprises) and the creation of an internal market with purchasers (four regional health authorities) separated from providers. Interviews with chief executives of crown health enterprises suggest that provider units are seeking a wider role than envisaged, with an interest in the health needs of their populations and undertaking some purchasing on their behalf. The purchasers see a narrower role for crown health enterprises. Both purchasers and providers report that competition between providers is not particularly helpful (and with only limited opportunities for this to occur), with collaboration being seen as more useful. Providers are critical of purchasers ability to adopt a strategic approach. Unlike other aspects of New Zealand's restructuring, there appears to be a retreat from some of the more radical facets of the reforms, reflecting both the resistance of the health sector and a newly uncertain political climate.

Economic Competition↗

PubMed2004

Compression, expansion, or dynamic equilibrium? The evolution of health expectancy in New Zealand.

STUDY OBJECTIVE: To evaluate the New Zealand evidence for three theories of population health change: compression of morbidity, expansion of morbidity, and dynamic equilibrium. DESIGN: Using the Sullivan method, repeated cross sectional survey information on functional limitation prevalence was combined with population mortality data and census information on the utilisation of institutional care to produce health expectancy indices for 1981 and 1996. SETTING: The adult population of New Zealand in 1981 and 1996. PARTICIPANTS: 6891 respondents to the 1981 social indicators survey; 8262 respondents to the 1996 household disability survey. MAIN RESULTS: As a proportion of overall life expectancy at age 15 the expectation of non-institutionalised mobility limitations increased from 3.5% to 6% for men, and from 4.5% to 8% for women; the expectation of agility limitation increased from 3% to 7.5% for men and from 4.5% to 8.5% for women, and the expectation of self care limitations increased from 2.0% to 4.5% for men and from 3.0% to 6.0% for women. These changes were primarily attributable to increases in the expectation of moderate functional limitation. CONCLUSION: The dynamic equilibrium scenario provides the best fit to current New Zealand evidence on changes in population health. Although an aging population is likely to lead to an increase in demand for disability support services, the fiscal impact of this increase may be partially offset by a shift from major to moderate limitations, with a consequential reduction in the average levels of support required.

Adolescent↗

PubMed1978

Cervical cancer and cytology screening in New Zealand.

Cytology screening, used in New Zealand since 1955 at an intensity comparable to that in Canada generally, has not favourably affected incidence and mortality rates for cervical cancer; these have actually risen significantly in 20 to 34-year-old New Zealand women. Canadian claims that mortality falls are related to intensity of cytological screening are not justifiable, so that the significance of the 'pre-cancers' revealed by cytology and the value of population screening would seem to be doubtful.

Adult↗

PubMed2004

Categorical ethnicity and mental health literacy in New Zealand.

OBJECTIVE: Public social policies in New Zealand assume that there are fundamental differences between Maori views of health phenomena and non-Maori perceptions. The biomedical model and a Maori model known as Te Whare Tapa Wha are commonly employed to characterise these differences. Using the categorical ethnicity demarcation 'Maori/non-Maori' we investigate this claim with respect to mental health literacy about depression. DESIGN: Participants were randomly selected from the General and Maori Electoral Rolls and recruited by post (N=205). A vignette methodology was employed and involved the development of a fictional character as a target stimulus who exhibited the minimum DSM-IV-R criteria for a major depressive disorder. Participants responded to items regarding problem recognition, well-being, causal attributions, treatment preferences, and likely prognosis. RESULTS: The majority of Maori and non-Maori participants correctly identified the problem the vignette character was experiencing and nominated congruent attributions for the causes of the problem. In relation to treatment strategies and likely prognosis, independent of self-assigned ethnicity, participants rated professional treatments above alternative options. Overall the categorical ethnicity distinction 'Maori and non-Maori' produced no systematic variation with regards to individual evaluative responses about a major depressive disorder. CONCLUSIONS: Contrary to the embedded assumption within New Zealand's public health strategies that there are essential differences between the way Maori and non-Maori view health problems, and that the categorical ethnicity demarcation reliably reflects these differences, we found no evidence for the veracity of this claim using a major depressive disorder as a target for judgements. Alternative explanations are canvassed as to why this assumption about fundamental differences based on categorical ethnicity has gained ascendancy and prominence within the sphere of New Zealand health.

Adult↗

PubMed1997

Regional variation in the incidence of hip fracture in New Zealand.

AIM: To determine the regional incidence of hip fracture among individuals aged 60 years or older in New Zealand. METHODS: New Zealand Health Information Service inpatient morbidity data for the years 1988-92 were examined by area health board region to identify all hip fractures (ICD N820) among individuals aged 60 years or older. RESULTS: Substantial regional variation exists in the incidence of hip fractures among older people in New Zealand. Among both men and women, similar regional variations were observed with the age-standardised rates being consistently highest in the West Coast (790 per 100,000 for women and 360 per 100,000 in men) and lowest in Northland (540 per 100,000 in women and 185 per 100,000 in men). CONCLUSION: These findings have implications for resource allocation, both in terms of targeting prevention initiatives and in providing acute and long term management of hip fracture patients. In addition, they raise questions as to why such variations in hip fracture incidence exist in New Zealand.

Aged↗

PubMed2001

Liability of health professionals for a breach of the abortion law of New Zealand.

The abortion law of New Zealand appears to have been interpreted very liberally over recent years by sectors of the medical profession. Indeed the interpretation of the law appears to have been so liberal that it raises questions as to the lawfulness of many of the abortions carried out in New Zealand. The current practice and application of the abortion law is such that it may expose some medical consultants certifying and performing abortions to criminal proceedings and civil claims.

Abortion, Illegal↗

PubMed2000

EMS in New Zealand.

The EMS system in New Zealand is much like the system in America. Our training programs and reference books have been developed largely from American institutions and programs. Much of our equipment is made by American manufacturers. The main difference between the two systems lies in the range of terrain that exists in New Zealand. This requires ambulance officers to be proficient in treating a wide range of cases, from a saltwater drowning victim to a ski accident injury in the mountains just 50 km away.

Ambulances↗

PubMed1998

NZDep91: A New Zealand index of deprivation.

In New Zealand, existing area-based indices of deprivation were inadequate because of lack of theoretical underpinning and use of comparatively large areas resulting in masking of variation within them. There is growing demand for small area based indices of deprivation for the purposes of resource allocation, research, and community advocacy. This paper describes a new Census-based index of deprivation based on the smallest possible geographical areas using existing Census boundaries. The index uses deprivation variables selected according to established theory, and derived from the 1991 New Zealand Census. Ten age and gender standardised variables were combined using principal components analysis. Each variable is a standardised proportion of people in a small area with a lack of a defined material or social resource. Age/gender standardisation is important to avoid confounding and to improve the performance of indices in resource allocation formulae. The index correlates highly with mortality, hospital discharges, lung cancer registrations and childhood immunisation status.

Adolescent↗

PubMed1999

Increasing patient numbers: the implications for New Zealand emergency departments.

Within the New Zealand (NZ) health care system, a number of changes have affected the way health care is accessed and delivered. Emergency Departments (EDs) are noticing increased attendance of patients with minor or non-urgent conditions. This increase in patient volume, together with on-going fiscal constraints and restructuring, has placed an added strain on the functioning of EDs. New Zealand nurses need to question the role currently given to EDs and identify the issues surrounding the increased use of these departments for primary health care. Is this move feasible in the NZ environment, and what are the implications for emergency nurses?

Emergency Nursing↗

PubMed1987

Progress towards achieving health for all New Zealanders by the year 2000.

New Zealand has been faced in recent years with a serious failure to maintain its relative position, in comparison to other OECD countries, in its social, economic and health status indicators. Although health costs so far have been successfully controlled, through a largely capitation funded service, its health organisational problems are typical of developed countries including major problems of equity and efficiency. Despite these problems some important recent initiatives give optimism for future health improvement. These include the spread of the service concept through service development groups and moves towards decentralisation through area health boards. Population-based funding of hospital and area health boards, supplemented with service planning guidelines, has proved to be an important lever for change. Maori health initiatives are beginning to show the way to improving the status of this disadvantaged section of society and perhaps for other New Zealanders as well. Important issues yet to be faced include establishing an effective central organisation for the health services, education and training for leadership and a more central place for the still largely fragmented and isolated primary health care services.

Delivery of Health Care↗

PubMed1999

Development of the New Zealand Joint Register.

In 1997, to mark 30 years of joint arthroplasty in New Zealand, the New Zealand Orthopaedic Association agreed to establish a national hip and knee register, to be based in the Department of Orthopaedic Surgery at Christchurch Hospital. This paper details the steps in the development of the Register, the problems encountered and their solutions, and the trial process involved before the national implementation of the data collection process in 42 hospitals throughout New Zealand in April of 1999. The whole process took seventeen months and the special features are the enthusiastic and voluntary involvement of nursing staff and the inclusion of patient generated outcomes data. However, it will be at least five years before there is sufficient data for any meaningful analysis.

Arthroplasty, Replacement, Hip↗

PubMed2000

Epstein Barr virus genome in nasopharyngeal carcinomas from New Zealand.

BACKGROUND: The population in New Zealand is a heterogeneous mix of Caucasians (80%), Maori (9%), and Polynesians (10%). It is believed that the Polynesians are of Chinese descent and may harbor the same high incidence of nasopharyngeal carcinoma (NPC). In addition, it is not known whether the Epstein-Barr virus (EBV) is as closely associated with the development of NPC in Polynesians as it is in those of Chinese origin. METHODS: This study reexamines the associative correlation between EBV and NPC with two methods of genetic detection, polymerase chain reaction (PCR) and in-situ hybridization (ISH). In addition, geographic heterogeneity was analyzed to determine whether there are differences in the prevalence of EBV in NPCs among the ethnic mixed populations found in New Zealand. Nasopharyngeal biopsy specimens from 20 patients with NPC and 36 controls were obtained from Auckland. RESULTS: With PCR, EBNA-1, a genomic sequence of EBV in NPC samples was able to be detected with 76.5% sensitivity and 96.7% specificity. By use of ISH, EBV was detected in NPC tissue with 82.4% sensitivity and 100% specificity. CONCLUSION: There seems to be no geoanthropologic differences in terms of the association of EBV with NPC.

Asian People↗

PubMed2003

Prioritizing patients for elective surgery: a prospective study of clinical priority assessment criteria in New Zealand.

OBJECTIVES: Many hospitals in New Zealand have been using clinical priority assessment criteria (CPAC) to select and prioritize patients for access to publicly funded elective surgery. CPAC usually consist of clinical, patient-experienced, and social measures. The objective of this study was to determine how robust patient rankings were and the extent to which the patients selected were those who benefited the most from surgery. METHODS: Patients prioritized for cataract (n = 101), prostate (n = 103), and hip or knee joint replacement (n = 137) surgery according to CPAC were assessed using the EQ-5D, SF-12, and condition-related patient-experienced health status measures before and after treatment. Correlations between the rankings of patients on the CPACs and the alternative instruments were explored. RESULTS: For each surgery group, the CPAC ranking of patients was not strongly correlated with rankings obtained using their before-treatment EQ-5D (valued) profiles or the SF-12, although there was some correlation with rankings according to the condition-related measures. Improvements in the health status of patients who were operated on, as measured by the change in their EQ-5D values, were poorly correlated with equivalent changes on the SF-12 and condition-related measures. Patients' baseline health status according to the CPAC, the EQ-5D, and the SF-12 patient-experienced measures was only slightly related to the magnitude of benefit following surgery. The strongest predictors of improvement in health status were the baseline condition-related measures. CONCLUSIONS: The current method of prioritizing patients in New Zealand requires reconsideration, although a gold standard method for prioritization is not immediately apparent from these results.

Arthroplasty, Replacement↗

PubMed1993

Long-term supplementation with selenate and selenomethionine: selenium and glutathione peroxidase (EC 1.11.1.9) in blood components of New Zealand women.

Thirty-three New Zealand women aged 18-23 years received daily for 32 weeks, 200 micrograms Se as Se-enriched yeast (selenomethionine), or brewer's yeast mixed with selenate, or no added Se (placebo) in a double-blind trial. Se supplementation raised (P = 0.001) platelet glutathione peroxidase (EC 1.11.1.9; GSHPx) activity, and also Se and GSHPx in whole blood, erythrocytes and plasma. Selenomethionine was more effective in raising blood Se concentrations than selenate, but both were equally effective in raising GSHPx activities in whole blood, erythrocytes and plasma, indicating a similar bioavailability for the two forms. These observations and those of gel filtration studies of erythrocytes and plasma proteins reported elsewhere (Butler et al. 1991) are consistent with the incorporation of Se from selenomethionine into a general tissue protein pool while selenate is directly available for GSHPx synthesis, and explain the poorer correlation between Se and GSHPx in individuals with higher Se status. However, selenate raised platelet GSHPx activities to a greater extent than did selenomethionine suggesting some other effect of selenate on platelets which needs further investigation. A response of GSHPx activity in these New Zealand subjects indicates that their dietary Se intake is insufficient to meet recommended intakes based on the criterion of saturation of GSHPx activity, and could reflect a marginal Se status. The level of blood Se necessary for saturation of GSHPx of about 100 ng Se/ml whole blood confirms observations in earlier studies.

Adolescent↗