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Demographic profile of the veterinary profession in New Zealand, 1985.

The demographic characteristics of the veterinary profession in New Zealand are examined using information supplied by registered veterinarians to the Veterinary Surgeons Board in their applications for annual practising certificates in 1985. Comparisons are made with the veterinary professions in other similar countries, and with the medical and paramedical professions in New Zealand. In 1985 1308 registered veterinarians were working in New Zealand and 304 were overseas, whereas in 1976 the equivalent figures were 748 and 182. This represents an increase of 73% in the number of registered veterinarians in the last 10 years. Eighteen percent of veterinarians were female. The mean age of veterinarians was 38 years, but females in the profession were on average much younger (32 years) than males (42 years). Clinical practice provides employment for 70% of veterinarians: of these 59% work principally with farm animals and 41% with non-farm animals. The remaining veterinarians are employed by Government (22%), University (5%) and Industry (3%). The current demographic structure of the profession has been markedly influenced by the opening of New Zealand's only veterinary school at Massey University in 1963. Differences from other medical professional populations in New Zealand and overseas principally reflect the marked change in the number and sex ratio of graduates entering the veterinary profession since that time. It will take about another twenty years before the population reaches a stable age and sex structure, assuming that current graduation patterns persist throughout that period. Because the structure of the population is changing, considerable caution is needed in predicting future employment trends from data for a single year.

Journal Article↗

International medical graduates' training needs: perceptions of New Zealand hospital staff.

OBJECTIVE: To determine the opinion of New Zealand doctors and nurses on the possible training needs of international medical graduates (IMGS) in New Zealand hospitals. DESIGN: A postal questionnaire sent to hospital doctors and nurses. METHODS: All doctors working at Wellington, Kenepuru, and Hutt Hospitals in the greater Wellington region, and nurses working in acute medical wards at the same hospitals, were asked to complete a questionnaire based on the Northern Clinical Training Network and Capital Coast District Health Board resident medical officer assessment forms regarding an overseas-trained doctor they had worked with in the last year. RESULTS: The response rate for the doctor's questionnaires was 68/174 (39.1%), with 51 of these from New Zealand doctors rating an international medical graduate. The response rate for the nurses was 58/60 (96.7%). Areas where the median score of the questionnaire was unsatisfactory (less than three out of five on an ordinal scale rating performance) were clinical documentation; communication with patients, families, and other health professionals; knowledge of hospital policies and procedures, and medicolegal matters; and some aspects of patient management. There was no difference in median ratings between doctors and nurses. CONCLUSIONS: More specific training may improve the performance of overseas-trained doctors in the New Zealand health system. A further study of the perceived needs of the overseas-trained doctors themselves may be useful.

Attitude of Health Personnel↗

The rise and fall of smoking in New Zealand.

The prevalence of cigarette smoking in New Zealand has fallen over the past 20 years to 27% in both men and women. Rates remain high in women aged 15-24 years (33%) and in the Maori population (52% of men and women over 15 years). Tobacco consumption has fallen by 46% since 1975 and New Zealand now has the second lowest consumption of all OECD countries. Coincident with the reduction in smoking, there has been a 37% decline in age-standardised coronary heart disease mortality rates in men and 34% in women between 1968 and 1989. Since 1976 the incidence of lung cancer in men has fallen by 25% but increased by 38% in women. The decline was highest in non-Maori men aged 45-54 years (46%). Life expectancy has increased by four years in both men and women since 1970. New Zealand legislation against smoking was introduced in 1903 and culminated in the 1990 Smoke-free Environments Act. This provides for smoke-free environments, prohibition of tobacco advertising, restrictions on tobacco sponsorship, and the establishment of a Health Sponsorship Council.

Adolescent↗

Contraceptive practice in New Zealand.

A survey of contraceptive practice in New Zealand was carried out using a population-based sample of women, aged 25 to 54, selected as control subjects in a national case-control study. The results showed that sterilisation has become the most common means of family limitation. Overall, 45% of women aged 25 to 54 were in a union where one or the other partner had been sterilised. Vasectomy was the most common method of contraceptive sterilisation. The frequency of hysterectomy contributed to the high rates of sterilisation; 12% of women had had a hysterectomy. Over 80% of New Zealand women had used an oral contraceptive at some time, but only 11% were using the pill at the time of the survey. Comparison with earlier studies of contraceptive use in New Zealand show there has been a marked increase in the prevalence of contraceptive sterilisation, and a marked decrease in the use of oral contraceptives.

Acquired Immunodeficiency Syndrome↗

A comparison of two studies reporting the prevalence of the sick building syndrome in New Zealand and England.

AIMS: To determine if New Zealand office personnel experienced a prevalence of sick building syndrome type symptoms similar to levels reported in the international literature. METHODS: A cross-sectional study of 360 office workers in Palmerston North was conducted using a questionnaire based on that used in a previous UK study to estimate the frequency of symptoms of the sick building syndrome. RESULTS: More than 80% of both populations experienced some building-related symptoms, with lethargy, stuffy noses, dry throat and headache regularly affect over 40% of both the Palmerston North and UK samples. New Zealand subjects experienced comparable or slightly higher levels of symptoms, except for itchy eyes, which were significantly more prevalent. A gender and employment bias was found in both studies. CONCLUSIONS: Sick building syndrome was found to be sufficiently prevalent in both surveys to warrant concern. There were sufficient similarities between the two populations to suggest that the conclusions from the UK survey are applicable to the New Zealand context.

Cross-Sectional Studies↗

New Zealand Pacific peoples' drinking style: too much or nothing at all?

AIMS: To describe the alcohol consumption patterns and related harms of some Pacific peoples (Samoan, Cook Islands Maori, Tongan, Niuean, Fijian, and Tokelauan) living in Aotearoa (New Zealand), and to draw comparisons with measures from the general New Zealand population. METHODS: The Pacific Drugs and Alcohol Consumption Survey (PDACS) was carried out with 1103 randomly selected Pacific peoples aged between 13 and 65 years old who were resident in households throughout New Zealand. The survey used computer-assisted telephone interviewing (CATI) and computer assisted cell-phone interviewing (CACI). The interviews were carried out in 2002/03. We descriptively compare findings from the PDACS with those from the 2000 National Alcohol Survey (NAS). RESULTS: Fifty-seven percent of Pacific peoples were drinkers (males 61%, females 51%), compared with 85% of the general New Zealand population (males 88%, females 83%). The average annual consumption of absolute alcohol was 21 litres for Pacific drinkers (males 28 litres, females 14 litres) compared with 11 litres for general New Zealand population drinkers (males 16 litres, females 7 litres). The typical occasional quantity consumed by Pacific drinkers was eight drinks (males: nine drinks, females: five drinks) compared with four drinks for drinkers in the general New Zealand population (males: five drinks, females: around four drinks). Thirty-three percent of Pacific drinkers consumed enough to feel drunk at least weekly (males 41%, females 25%) compared with 9% of drinker in the general New Zealand population (males 13%, females 6%). Eighteen percent of Pacific males and 10% of Pacific females reported being physically assaulted by someone who had been drinking compared with 8% and 5% of national males and females respectively. Twenty-three percent of Pacific males and 16% of Pacific females got drunk when there was an important reason to stay sober, compared with 8% and 5% of general New Zealand males and females respectively. Nineteen percent of Pacific males and 21% of Pacific females reported being involved in a serious argument after they had been drinking compared with 12% and 8% of general New Zealand males and females respectively. CONCLUSIONS: The proportion of Pacific drinkers is less than the proportion of drinkers in the general New Zealand population. However, Pacific drinkers consume larger annual volumes and typical occasion amounts of absolute alcohol than drinkers in the general New Zealand population. Pacific peoples drinking patterns appear to be more harmful with greater proportions of Pacific peoples reporting violence and injury from other peoples' drinking, and greater proportions of Pacific drinkers reporting problems from violence and serious arguments as a result of their own drinking compared with the general New Zealand population and general New Zealand population drinkers.

Adolescent↗

Bias measuring mortality gradients by occupational class in New Zealand.

BACKGROUND: Socioeconomic differences in mortality in New Zealand have traditionally been measured using occupational class from mortality data (based on usual or last occupation) as the numerator, and class from census data (current occupation on census night) as the denominator. Such analyses are prone to numerator-denominator bias. Record linkage of census and mortality data in the New Zealand Census-Mortality Study (NZCMS) allows analyses of 'linked' data that will avoid numerator-denominator bias, but may be prone to other biases. OBJECTIVES: To determine differences in the assignment of occupational class between census and mortality data; to investigate biases in the observed association of class with mortality using linked census-mortality data; and to compare the class-mortality association using unlinked versus linked census-mortality data. METHODS: Census records for males aged 25-64 years on census night 1991 were anonymously and probabilistically linked to 5,844 out of 8,145 eligible deaths occurring in the second and third years following census night. RESULTS: (by objective) Only 47% of linked deaths had an occupation recorded on census data, compared to 84% on mortality data - a census to mortality ratio of 0.56. Relatively fewer deaths were identified as class 4 on census data (census to mortality ratio of 0.45) compared to other classes (ratios 0.55 to 0.64). Linkage bias: A lower likelihood of 25-44 year old deaths (but not 45-64 year olds) from lower socioeconomic classes being successfully linked to a census record meant that analyses using linked census-mortality data underestimated the class-mortality association. Bias due to exclusion of economically inactive: Analyses on linked-census data (using current occupational class) considerably underestimated the estimated association of usual occupational class with mortality. The strength of the association of class with mortality according to linked census-mortality data (and adjusted for the above two biases) and unlinked data were roughly comparable. CONCLUSION: Differences in the recording of occupational class on census and mortality data in New Zealand mean measuring mortality differences by class is thwart with difficulty. If one assumes that biases for any particular method of analysis are similar over time, or one carefully adjusts where possible for bias, using occupational class to monitor trends in socioeconomic mortality gradients may be valid.

Adult↗

Personality testing and profiling for anaesthetic job recruitment: attitudes of anaesthetic specialists/consultants in New Zealand and Scotland.

Specialist/consultant anaesthetists based in New Zealand and Scotland were sent a reply paid postal questionnaire asking about their attitudes to personality testing and personality types in the recruitment process for registrars and specialists. The questionnaire consisted of nine Likert-style questions and 14 visual analogue questions. The overall response rate was 65% (523/808). The responses to all the questions were broadly similar in the two countries. Personality testing was deemed of use in recruiting trainees and specialists, with a slightly greater proportion considering personality traits more important than academic achievement. An overwhelming majority believed the presence of an adverse personality trait would influence an appointment process, but few believed that the personality makeup of anaesthetists influenced the way in which they react to stressful situations. A slight majority considered the interview process a poor predictor of personality. New Zealand anaesthetists rated independence, orderliness, compassion, empathy, reflectiveness and patience higher than did anaesthetists in Scotland. In contrast, anaesthetists in Scotland rated pragmatism, as opposed to perfection, as a more important characteristic than did the New Zealand specialists. Personality assessment, although not effective as the sole tool for candidate selection, may have a role in the process of anaesthetic job recruitment and warrants further investigation.

Anesthesiology↗

Rural hospitals in New Zealand.

AIM: To produce a list of New Zealand rural hospitals, including information on acute bed numbers, population served, average driving time to base hospital, and number and payment of rural hospital doctors. METHODS: Information about rural hospitals was obtained from local doctors and/or administrators, and reflected conditions at June 15, 1998. A 'rural hospital' was defined as a facility with no resident medical specialists, where acutely ill patients are admitted and cared for solely by generalist doctors, either general practitioners or medical officers of special scale. RESULTS: Varying definitions for acute 'facilities' and 'beds' made analysis difficult. There were a total of 36 'rural hospitals' in New Zealand at June 15, 1998 containing 293 acute beds and serving a population of about 340000. Patient care was provided by a total of 131 generalists (general practitioners or medical officers of special scale) equivalent to 40 full-time rural hospital doctors. CONCLUSIONS: Approximately 10% of the New Zealand population are served by rural hospitals. Discrepancies exist between the list of rural hospitals provided in this study and that provided by the Government's recent 'Hospital Services Plan'.

Health Services Research↗

An influenza A(H3) reassortant was epidemic in Australia and New Zealand in 2003.

During 2003, Australia and New Zealand experienced substantial outbreaks of influenza. The strain responsible was an A(H3N2) influenza virus described as A/Fujian/411/2002-like, which had circulated as a minor variant in the previous Northern Hemisphere (NH) winter, mainly in Korea and Japan. Early in the year the isolates were very similar to those that had been previously isolated in the NH, however, a reassortant strain emerged early in the New Zealand winter, followed by the appearance of similar viruses in Australia and other regional areas. While the hemagglutinin HA1 sequence of these viruses demonstrated only minor differences from the A/Fujian/411/2002 reference strain, the neuraminidase gene was clearly different from that of other recently circulating H3 viruses and most closely matched an earlier reference strain A/Chile/6416/2001. Three internal genes (NS, NP, M) in the reassortant viruses were also more closely related to the A/Chile/6416/2001 lineage. This reassortant A(H3) virus predominated in Australia and New Zealand in 2003 was also seen in Brazil and Malaysia during 2003 and was widespread in the United States and Europe during their 2003-04 winter. Interestingly most of the strains of A(H3) that were isolated at the beginning of the 2004 winter in Australia, did not have this earlier A/Chile/6416/2001-like neuraminidase but had a neuraminidase that was similar to that of the reference strain A/Fujian/411/2002. This was suggestive of the re-introduction of influenza A(H3) from other countries, however, there was still low level circulation of the reassortant virus in 2004 with isolates detected in Australia and Singapore.

Antigens, Viral↗

The prevention of early-onset neonatal group B streptococcus infection: technical report from the New Zealand GBS Consensus Working Party.

AIMS: Early-onset neonatal group B streptococcus (GBS) is the leading infectious cause of disease in newborn babies. Since intrapartum antibiotics interrupt vertical GBS transmission, this is now a largely preventable public health problem. An important first step is to develop (then implement) nationally, agreed prevention policies. METHODS: Representatives from the New Zealand College of Midwives, the Paediatric Society of New Zealand, the New Zealand Committee of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Royal New Zealand College of General Practitioners, and the Homebirth Association met to review evidence that will assist in the formulation of GBS prevention policies that are most suitable for New Zealand. RESULTS: The Technical Working Group noted that (i) no strategy will prevent all cases of early-onset GBS infection, (ii) intrapartum antibiotics are associated with rare, but serious, adverse effects, (iii) concerns remain over developing antibiotic resistance, (iv) an economic analysis is required to help inform policy, (iv) reliable bedside diagnostic tests for GBS in early labour are not yet available and (iv) the most important determinant of effectiveness will be compliance with a single national prevention policy. CONCLUSIONS: As an interim measure a GBS risk-based prevention strategy is recommended. This exposes the least numbers of women and their babies to antibiotics, while virtually preventing all deaths from GBS sepsis. Continuing education of health professionals and pregnant women, auditing protocol compliance, tracking adverse events amongst pregnant women, and national surveillance of neonatal sepsis and mortality rates and antibiotic resistance are necessary for the strategy's success.

Antibiotic Prophylaxis↗

Running on the spot: lessons from a decade of health reform in New Zealand.

Over the past 10 years the New Zealand public health system has been the subject of major reforms. This paper describes these reforms and asks what real changes resulted from the decade of restructuring, and what general lessons might be learned from these experiences? The discussion contributes to the ongoing economic debate concerning the role of markets in the health sector. It also highlights some of the more practical issues and problems that are relevant for health policy makers. The New Zealand reforms have been costly, and yet any benefits appear to have been considerably less than expected, especially in terms of efficiency gains. Explanations for this include the possibility that the magnitude of potential efficiency gains had been overestimated, and that any incentives for improving efficiency were weakened by the particular institutional arrangements that were established. Some of the more interesting developments that have occurred in the service delivery area have emerged largely from unplanned responses to the reforms rather than by design. New Zealand's experiences illustrate that, unless due cognizance is taken of the norms and values of those working within a system, structural change is unlikely to bring about the expected responses, nor achieve the desired outcomes. Given the high cost of reform, incremental change, which aims to tackle specific issues, may be a more cost-effective means of securing the desired results.

Health Care Reform↗

Users of unconventional practitioners: a profile of 26 year old New Zealanders.

AIMS: To profile 26 year old New Zealand users of unconventional practitioners. METHODS: 977 members of the Dunedin Multidisciplinary Health and Development Study participating in the age-26 assessment (1998-1999) answered questions about twelve-month service use, education, income, recent medical history, current health status and avoidance of medical situations. RESULTS: 10% had used an unconventional practitioner in the previous twelve months. The majority (88%) had also used a conventional practitioner. Those using both types of practitioner were heavy users of health services (twelve visits/year). Compared to those who used conventional practitioners exclusively, they had significantly higher incomes and were more likely to report a serious injury, a current disability, a history of back problems, role limitations due to physical health problems, and more bodily pain (all p < 0.01). CONCLUSIONS: 26 year old New Zealand users of unconventional practitioners have a similar profile to their counterparts in other developed countries. It appears that their health needs are not fully met by conventional services, emphasising the need for more research into the aetiology and treatment of ailments (e.g. back pain) for which unconventional practitioners are commonly sought. The Medical Council of New Zealand guidelines on unconventional medicine are discussed in light of these findings.

Adult↗

The New Zealand health reforms of the 1990s in context.

The New Zealand health sector reforms of the 1990s have to be seen in the context of the long term development of the New Zealand health system. The evolutionary change between 1938 and 1990 was abruptly replaced by the revolutionary policy of commercialization from 1991 to 1993. This proved unsatisfactory, with the promised benefits such as significant productivity increases not occurring. In some ways the system functioned even more imperfectly, although this was in part due to the funding cutbacks which took place at the same time. The policy shifts from the mid 1990s have largely taken the New Zealand health system back to where it would have been, had the evolution up to 1990 continued. There remains unfinished business, the largest of which is that the tensions between the managers and the health professionals have not been resolved. The New Zealand experience provides strong evidence that comprehensive commercialization--business practices within, market relations between institutions--will not make a significant contribution to the design of effective health systems.

Health Care Reform↗

Trends in the use of inhaled corticosteroids for childhood asthma in New Zealand.

OBJECTIVE: To compare the dispensed volumes and prescribed doses for inhaled corticosteroids (ICS) for children in New Zealand. DESIGN: Longitudinal analysis of prescribing trends using the Royal New Zealand College of General Practitioners Research Unit database and the Pharm Warehouse database of the New Zealand Health Information System. SETTING: New Zealand from 1993 to 2001. SUBJECTS: Children aged 0-5 years and 6-17 years. MAIN OUTCOME MEASURES: The ratio of potency-adjusted mean daily dose of fluticasone propionate (FP) to beclomethasone (BDP) and dispensed volumes of FP, BDP and budesonide. RESULTS: The ratio of potency-adjusted mean daily dose of FP to BDP prescribed to children aged 0-17 years ranged from 1.22 to 1.91. With the introduction of FP, the total amount of ICS dispensed to children aged 0-5 years in New Zealand nearly doubled, when adjusted for potency. CONCLUSIONS: The introduction of FP into New Zealand corresponds with an increase in the total amount of ICS dispensed and an increase in the adjusted daily dose prescribed.

Administration, Inhalation↗

Ultraviolet radiation--induced chromosomal abnormalities in fetal fibroblasts from New Zealand black mice.

Fibroblasts from New Zealand Black mouse fetuses manifest increased frequency of chromosomal breaks and interchanges after exposure to ultraviolet radiation when compared with cells from BABL/c fetuses. This chromosomal instability is similar to what has been reported in cells from patients with xeroderma pigmentosum and may be related to the chromosomally abnormal clones and malignancy previously reported in adult New Zealand Black mice.

Animals↗

Comparison of work related fatal injuries in the United States, Australia, and New Zealand: method and overall findings.

OBJECTIVES: To compare the extent, distribution, and nature of fatal occupational injury in New Zealand, Australia, and the United States. SETTING: Workplaces in New Zealand, Australia, and the United States. METHODS: Data collections based on vital records were used to compare overall rates and distribution of fatal injuries covering the period 1989-92 in Australia and the United States, and 1985-94 in New Zealand. Household labour force data (Australia and the United States) and census data (New Zealand) provided denominator data for calculation of rates. Case definition, case inclusion criteria, and classification of occupation and industry were harmonised across the three datasets. RESULTS: New Zealand had the highest average annual rate (4.9/100,000), Australia an intermediate rate (3.8/100,000), and the United States the lowest rate (3.2/ 100,000) of fatal occupational injury. Much of the difference between countries was accounted for by differences in industry distribution. In each country, male workers, older workers, and those working in agriculture, forestry and fishing, in mining and in construction, were consistently at higher risk. Intentional fatal injury was more common in the United States, being rare in both Australia and New Zealand. This difference is likely to be reflected in the more common incidence of work related fatal injuries for sales workers in the United States compared with Australia and New Zealand. CONCLUSIONS: The present results contrasted with those obtained by a recent study that used published omnibus statistics, both in terms of absolute rates and relative ranking of the three countries. Such differences underscore the importance of using like datasets for international comparisons. The consistency of high risk areas across comparable data from comparable nations provides clear targets for further attention. At this stage, however, it is unclear whether the same specific occupations and/or hazards are contributing to the aggregated industry and occupation group rates reported here.

Accidents, Occupational↗

A Comparison of Risk and Protective Factors for Colorectal Cancer in the Diet of New Zealand Maori and non-Maori.

By international standards New Zealand (population 3.8 x 10(6)) has a high rate of colorectal cancer, with approximately 2000 new cases occurring and approximately 1000 deaths each year. But within the New Zealand population, a lower incidence of colorectal cancer is reported for Maori than for non-Maori New Zealanders (22.2 and 43.7 per 100,000 respectively). Information from the New Zealand National Nutrition Survey 1997 shows that in comparison to non-Maori, Maori eat more in total, eat more red meat, drink more alcohol, consume more saturated fat, have a higher prevalence of obesity and have a lower proportion of individuals consuming a given level of fruit and vegetables per day. All these factors would be expected to increase colorectal cancer risk. Puha (sow thistle; Sonchus sp.) and watercress (Nasturtium officinale, N.aquaticum) are foods with plausible cancer protective properties which are components of the Maori, but not the non-Maori diet.

Journal Article↗