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PubMed1992

Four modifiable and other major risk factors for cot death: the New Zealand study.

New Zealand's high mortality rate from sudden infant death syndrome (SIDS) prompted the development of the New Zealand Cot Death Study. A report of the analysis of the data from the first year has been published. This report now gives the major identified risk factors from the full 3 year data set. In this case-control study there were 485 infants who died from SIDS in the post-neonatal age group, and 1800 control infants, who were a representative sample of all hospital births in the study region. Obstetric records were examined and parental interviews were completed in 97.5% and 86.9% of subjects, respectively. As expected many risk factors for SIDS were confirmed including: lower socio-economic status, unmarried mother, young mother, younger school-leaving age of mother, younger age of mother at first pregnancy, late attendance at antenatal clinic, non-attendance at antenatal classes, Maori, greater number of previous pregnancies, the further south the domicile, winter, low birthweight, short gestation, male infant and admission to a special care baby unit. In addition, however, we identified four risk factors that are potentially amenable to modification.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed2000

Shared Governance within the market-oriented health care system of New Zealand.

The New Zealand health reforms, announced in 1991 and implemented over the 3-year period 1992-1994, were market-oriented, following a competitive model that had been applied across New Zealand's public sector. Consideration is given to the effects of the health reforms on nursing and midwifery at Capital Coast Health Limited (CCHL), with the introduction of a market/economic model of health care and its accompanying managerialism. The market model, or the economic era of health care, as some describe it, created an environment where nurses felt powerless. All the directors of nursing and on-going hospital educational programs were disestablished in the public sector; nurses were disheartened, confused and lacked representation at senior management. Integral to, and accompanying, corporatization is managerialism. With corporatization, came managers from the non-health care sector who had no understanding of the complexities of health care. Accompanying managerialism is the notion that any able manager was capable of managing any agency, whether public or private. Naturally, there was an underlying conflict between the caring relationships and their related work in the clinical environment, and the desire for efficiency and economy. It seemed that we were dealing with contrasting themes of 'the market' and 'humanity' This led to further confusion and disempowerment, as the dollar gained prominence, for nursing has always been grounded in the 'humanities'. It was into this environment, after 5 years of the health reforms, that a Nurse Executive was appointed and the concept of Shared Governance was introduced. This article describes why Shared Governance was considered an appropriate model to introduce at CCHL, and identifies some of the tangible benefits being realized 18 months post implementation. Discovering that membership in cross-organizational teams provides a mechanism for networking and creating a broader understanding of the organization has been but one of the major benefits.

Cooperative Behavior↗
PubMed1996

Implementing a community initiative for the prevention of injury on farms in New Zealand.

Among New Zealand occupational injuries, farm-related injuries are second only to forestry in importance. A three-year Farm Safety Study, funded by the Accident Rehabilitation and Compensation Insurance Corporation, researched the epidemiology of farm injury in New Zealand, the safety behaviour and attitudes of people living on farms and the international literature on farm safety strategies. The Farm Safety Study made funds and regional injury information available to a local farm women's network in Southland to initiate work on farm safety through a series of workshops. Evaluation indicated effective coverage of farm types and localities. Outcomes included increased safety awareness, suggestions for a range of individual, community and institutional strategies and proposals for a local fieldworker. Over half the women responding to an evaluation questionnaire reported taking specific action to make their own farm safer. This project indicates that linking integrated, locally based research with action by community groups can be an effective mechanism to advance change.

Accidents, Occupational↗
PubMed1981

The role of dairy products in the New Zealand diet.

New Zealand is both a major producer and large consumer of dairy products. In 1976, for example, daily per capita consumption of liquid milk averaged 471 ml, cheese 13.7 g/d, and butter 38.4 g/d, the last apparently the highest in the world. Recent studies of the dietary habits of New Zealand adults, and of children of early school age in Dunedin (Birkbeck, Guthrie, Herbert, personal communication) have provided information on the role of dairy products as source of nutrients. National consumption figures or family market basket surveys provide no information about individual intakes, since they do not reflect age or sex differences between consumers.

Adult↗
PubMed1987

Case-control study of occupation and cancer of the prostate in New Zealand.

A New Zealand Cancer Registry based case-control study involved 617 male patients with prostate cancer registered during 1979 and aged 20 years or more at the time of registration. Controls were also males chosen from the Cancer Registry with two controls per case, matched on age and year of registration. There was an elevated risk in the upper social class groupings. The data did not support the findings, from other countries, of elevated risks in agricultural workers (odds ratio = 1.08, 90% confidence limits 0.86-1.36). The only occupational groups showing elevated risks were sales and service workers (odds ratio = 1.29, 90% confidence limits 0.99-1.69) and teachers (odds ratio = 2.44, 90% confidence limits 1.05-5.70). The New Zealand data do not in general suggest that occupational factors--or lifestyle factors associated with occupation--are of major direct importance in the aetiology of prostate cancer.

Humans↗
PubMed2004

Effects of hydrographic barriers on population genetic structure of the sea star Coscinasterias muricata (Echinodermata, Asteroidea) in the New Zealand fiords.

New Zealand's 14 deep-water fiords possess persistent salinity stratification and mean estuarine circulation that may serve to isolate populations of marine organisms that have a dispersal larval phase. In order to investigate this idea, we analysed the population structure of the sea star Coscinasterias muricata using a mitochondrial DNA marker. Genetic differentiation among populations of C. muricata was analysed using 366 base pairs of mtDNA D-loop. We compared populations from the fiords with several others sampled from around New Zealand. At a macro-geographical scale (> 1000 km), restricted gene flow between the North and South Islands was observed. At a meso-geographical scale (10-200 km), significant population structure was found among fiords and between fiords and open coast. The pattern of population genetic structure among the fiords suggests a secondary contact between a northern population and a southern one, separated by a contact or mixing zone. These populations may have diverged by the effects of random genetic drift and population isolation as a consequence of the influence of estuarine circulation on dispersal. In northern Fiordland, genetic structure approximated an isolation by distance model. However, the pattern in genetic differences suggests that distance alone cannot explain the most divergent populations and that fiord hydrography may increase the effect of genetic drift within populations in the fiords. Finally, our study indicates that populations within the fiords underwent recent rapid expansion, followed most probably by genetic drift due to a lack of gene flow among the fiords.

Animals↗
PubMed2006

Principles and processes for effecting change in environmental management in New Zealand.

In New Zealand environmental management is essentially the responsibility of land managers. Management decisions affect both production/productivity and the environment. However, responsibility for ensuring positive environmental outcomes falls on both local (Regional) and Central Government, and both they and international agencies such as the OECD would wish to monitor and report on changes. In terms of policy, strong links have been established via Central and Regional Government to land managers. Consumers in the market place are also, increasingly, requiring responsibility for positive environmental outcomes of those who purchase and process primary products. Strong links for responsibility have been established between our international markets and processing businesses and there is a noticeable strengthening of the links from the processors to the land manager/producer. In New Zealand a range of initiatives has been developed and implemented over recent times, whereby land managers are taking increasing responsibility for accounting for the environmental outcomes of their production activities. The range covers the spectrum from voluntary to compulsory (e.g., in order to meet market requirements) and from those initiated by customers to processor and/or producer initiatives. This paper follows the evolution of the principles that drove the predominant activities of the period and the processes that initiated the changes in environmental management. As the focus of agriculturalists changed from pioneering in a new world, to establishing a production base, to economic reality, and finally to environmental responsibility, the processes of extension adapted to meet the new challenge.

Agriculture↗
PubMed1986

New Zealand contraception and health study: design and preliminary report. New Zealand Contraception and Health Study Group.

The New Zealand contraception and health study is investigating the potential health risks associated with oral contraceptives, intrauterine contraceptive devices and injectable medroxy-progesterone acetate. This prospective observational study, begun as a pilot study in 1980, will record for at least six years the health of approximately 7500 women divided into three groups of equal size according to contraceptive method at entry. A major objective is to compare the incidence of dysplasia, carcinoma in situ and invasive carcinoma of the cervix in each group. This paper describes the design of the study and reports its progress.

Adult↗
PubMed2005

Occupational bladder cancer in New Zealand: a 1-year review of cases notified to the New Zealand Cancer Registry.

AIM: To identify which cases of adult bladder cancer notified to the New Zealand Cancer Registry in 2001 had a probable occupational cause. METHODS: Occupational Safety and Health (OSH), in conjunction with the Massey University Centre for Public Health Research, interviewed and obtained an occupational history for 210 (162 men, 48 women) cases. RESULTS: Of the 162 male cases (response rate 65%), 45 (28%) were considered to be 'probable' occupational cancers. Of the 48 female cases (response rate 76%), three cases (6%) were considered to be 'probable' occupational cancers. The largest occupational group for men was truck drivers, which made up 51% of probable cases. Other common groups were engineering and metal workers (18%), crop farmers/orchardists (7%), textile and leather workers (7%), painters/furniture finishers (7%), and plastics manufacturing workers (4%). The three female cases considered to be of occupational origin included two textile workers and one telephonist. CONCLUSIONS: The percentage of cases considered to be of occupational origin is similar to that reported in Europe and the United States, indicating that occupational cancer is a major occupational health problem in New Zealand as it is in other parts of the world.

Female↗
PubMed1996

New Zealand guidelines for the management of dyslipidaemia: implications for treatment in an urban New Zealand population.

AIMS: The paper uses coronary heart disease risk factor prevalence data from a defined urban population to assess the potential impact of implementing the New Zealand National Heart Foundation "Guidelines for detection and management of dyslipidaemia" on the treatment of dyslipidaemia in New Zealand. METHODS: Coronary heart disease risk factor data was collected on an age stratified random sample of Auckland residents aged 35-74 years. The 10 year absolute risk of coronary heart disease was calculated for each participant aged between 35-64 years and management options determined from the National Heart Foundation guidelines. The Framingham equation used in these guidelines was used to extrapolate the 10 year risk of a coronary event in the 65-74 year age group. The proportions of participants potentially requiring treatment with lipid modifying medication were identified and extrapolated to the New Zealand European population. A sensitivity analysis was undertaken to assess the impact of 5% and 10% reductions in total cholesterol following dietary intervention on numbers meeting the drug treatment criteria. RESULTS: The proportion of participants potentially requiring lipid modifying treatment based on the guidelines was considerably higher than estimates of current treatment rates in each age group. The number meeting the treatment criteria increased dramatically with age. By the age of 65-74 years one in five participants met the drug treatment criteria. A 5% and 10% reduction in total cholesterol following dietary intervention reduced the proportion of participants potentially requiring drugs by almost one quarter and one half respectively. CONCLUSION: The approach taken by the New Zealand National Heart Foundation guidelines appropriately gives highest priority to patients at highest risk of a coronary event. If this high risk approach is extrapolated to older age groups, it will lead to more drug treatment among the elderly. Further evidence from randomised controlled trials on benefits of using cholesterol modifying medication in older age groups is required. Future guidelines need to address specifically criteria for use of lipid modifying medications in older age groups. Reductions in the numbers meeting drug treatment criteria following 5% and 10% reductions in total cholesterol reinforces the importance of dietary management.

Adult↗
PubMed1996

The computer research network of the Royal New Zealand College of General Practitioners: an approach to general practice research in New Zealand.

Computers are now in widespread use by general practitioners (GPs) in many countries. In New Zealand this development has advanced general practice research by enabling collaboration among a small population of doctors practising in geographically diverse locations. This paper reviews the establishment of the Computer Research Network of the Royal New Zealand College of General Practitioners (RNZCGP) and its development between 1990 and 1995. The Network consists of 181 general practices (approximately 450 GPs) from throughout urban and rural New Zealand. All participants use computers in their practices to record consultation notes and to generate prescriptions, investigations and referral forms. Computer programs developed in the RNZCGP Research Unit are run on commercial software in doctors' surgeries to provide anonymous, individual data. In addition to the routine analysis of utilization for feedback to participants, 13 research projects have been completed. These include investigations of access to general practice care, use of health services by individuals and families, surveillance of immunization uptake, epidemiology of common conditions, and the use of pharmaceuticals in general practice. The RNZCGP Computer Research Network is an example of a computerized general practice research network that has been productive without receiving significant financial resources or having a formal management structure.

Confidentiality↗
PubMed2006

Health status of New Zealand European, Maori, and Pacific patients with diabetes at 242 New Zealand general practices.

OBJECTIVE: To compare the care and health status of different ethnic groups attending general practices with diabetes. METHOD: We analysed information about 13,281 patients with any type of diabetes, collected by 242 general practices in the first visit of the Southlink Independent Practitioner Association's Get Checked program. These patients constituted about 60% of patients with diabetes in the South Island of New Zealand. RESULTS: 13,196 (99.4%) patients had Type 1 or Type 2 diabetes. Of these, 11,911 (90.3%) were Europeans, and 759 (5.8%) were Maori or Pacific Islanders (mostly of Samoan, Tongan, Niuean, or Cook Islands origin). There was no difference between ethnic groups in total cholesterol, proportions on oral therapy or statins, or having a foot check. Maori and Pacific Islanders had poorer glycaemic control (HbA1c > 8.0 for 41.5% of Maori or Pacific Islanders versus 23.8% of New Zealand Europeans; 95% confidence interval for the difference [CI]: 14.0, 21.1), and were less likely to have retinopathy screening (71.9% versus 77.9%; CI: -9.2, -2.6). In patients with Type 2 diabetes (and compared with Europeans) Maori and Pacific Islanders were younger, had higher mean body mass indices (males 33.9 versus 29.5; CI: 3.9, 5.0 and females - 34.6 versus 30.7; CI: 3.2, 4.6) and diastolic blood pressures 82.4 mmHg versus 78.7 mmHg (CI: 2.9, 4.5), and were more likely to smoke (27.5% versus 10.9%; CI: 13.3, 19.9). Overall, Maori and Pacific Islanders were more likely to be at high risk for microvascular complications (9.0% versus 4.4%; CI: 2.5, 6.6). CONCLUSIONS: In this study, Maori and Pacific Island patients had a demographic profile suggesting greater health vulnerability (especially for those with Type 2 diabetes) yet similar routine diabetes care (especially for those with Type 1 diabetes). Ethnic inequalities were noted in seven of nine health status measures. IMPLICATIONS: The Get Checked program aims to increase the health of all patients with diabetes but whether it accentuates or diminishes ethnic disparities is not yet known.

Adolescent↗
PubMed2006

Perceptions of migrant doctors joining the New Zealand medical workforce.

New Zealand, like many first World countries, has become increasingly dependent on overseas-trained doctors (OTDs). This qualitative study identifies and explores issues of concern to OTDs when first integrating into the New Zealand medical system through the New Zealand Registration Examination (NZREX) pathway. The data were collected using semistructured interviews and focus groups involving 10 OTDs who were working in a New Zealand hospital. The study identified four key issues: work issues which included difficulty finding employment and difficulty integrating into their work role; a bridging programme which improved the ability of OTDs to gain knowledge and experience of the New Zealand medical working environment; financial difficulties which were a major impediment to attaining registration and a career pathway in New Zealand; and bureaucratic barriers (including examinations and information availability), which were seen as necessary but unsympathetic processes in gaining registration. Sociocultural educational theory provides a useful framework for understanding the difficulties faced by OTDs integrating into a New Zealand medical workforce.

Acculturation↗