Showing papers in "The New Zealand Medical Journal in 1997"

Colorectal cancer screening.

Abstract: 1. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017;67(1):7-30. Review/Ot her-Dx N/A To estimate the numbers of new cancer cases and deaths that will occur in the United States in the current year and compile the most recent data on cancer incidence, mortality, and survival. Mortality data were collected by the National Center for Health Statistics. In 2017, 1,688,780 new cancer cases and 600,920 cancer deaths are projected to occur in the United States. For all sites combined, the cancer incidence rate is 20% higher in men than in women, while the cancer death rate is 40% higher. However, sex disparities vary by cancer type. For example, thyroid cancer incidence rates are 3-fold higher in women than in men (21 vs 7 per 100,000 population), despite equivalent death rates (0.5 per 100,000 population), largely reflecting sex differences in the "epidemic of diagnosis." Over the past decade of available data, the overall cancer incidence rate (2004-2013) was stable in women and declined by approximately 2% annually in men, while the cancer death rate (2005-2014) declined by about 1.5% annually in both men and women. From 1991 to 2014, the overall cancer death rate dropped 25%, translating to approximately 2,143,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the cancer death rate was 15% higher in blacks than in whites in 2014, increasing access to care as a result of the Patient Protection and Affordable Care Act may expedite the narrowing racial gap; from 2010 to 2015, the proportion of blacks who were uninsured halved, from 21% to 11%, as it did for Hispanics (31% to 16%). Gains in coverage for traditionally underserved Americans will facilitate the broader application of existing cancer control knowledge across every segment of the population. 4 ACR Appropriateness Criteria®

Diagnostic accuracy of teledermatology: Results of a preliminary study in New Zealand

Abstract: AIM To determine the accuracy of a video conferencing system (telemedicine) in diagnosis of dermatological disorders. METHODS New patients referred to a dermatology clinic were initially examined by telemedicine and then by a standard face to face consultation. The diagnoses made by each type of consultation were compared and accuracy of telemedicine determined. RESULTS One hundred and four patients with 135 dermatological conditions were analysed. Seventy five percent of conditions were correctly diagnosed by telemedicine. In a further 7% a differential diagnosis was made, which included the final diagnosis made face to face. In 12%, the diagnosis was incorrect using the telemedicine system, and in 3% no diagnosis was made. Four per cent of diagnoses were only made when the patient was seen face to face. CONCLUSION This preliminary study suggests that video conferencing equipment can be used with a reasonable degree of accuracy for the diagnosis of dermatological disease.

Prevalence and correlates of cannabis use and dependence in young New Zealanders

Abstract: AIMS: To determine change in patterns of cannabis use in New Zealand in an unselected birth cohort and investigate the relationship between level of cannabis use, violent behaviour and employment history. METHOD: Prospective longitudinal design using members of the Dunedin Multidisciplinary Health and Development Study at ages 15, 18 and 21 years. RESULTS: Rates of cannabis use increased from 15% (n = 144) at age 15 years to more than half of the sample seen at age 21 years (n = 497; 52.4%). DSM-III-R defined cannabis dependence assessed at age 18 and 21 years increased from 6.6% (n = 61) to 9.6% (n = 91). Males were more likely to use and be dependent on cannabis than females. Early use substantially increased the risk for the development of cannabis dependence in young adulthood. Cross-sectional analysis at age 21 found levels of cannabis use and dependence to be higher among the unemployed and those with a history of violent behaviour. CONCLUSIONS: Prevalence rates of cannabis use in young New Zealanders were found to be higher than previously reported. A history of unemployment or of violent behaviour was associated with more frequent cannabis use at age 21. Males were more likely than females to use cannabis frequently and to meet DSM-III-R criteria for dependence at age 21. It is suggested that drug education campaigns should specifically target young males. Language: en

Potent topical steroid in a Chinese herbal cream.

Abstract: Steroids have been discovered previously in oral "herbal" preparations. Using liquid chromatography, we have now confirmed the presence of the potent topical steroid, clobetasol proprionate, in a Chinese herbal cream.

Spinal injuries in New Zealand rugby and rugby league : a twenty year survey

Abstract: AIMS: To establish trends in frequency of serious spinal cord injuries in rugby and rugby league over a 20 year period and to elucidate patterns of injury from retrospective analysis of cases admitted to New Zealand's two spinal injuries units. METHODS: A detailed survey of unit records with follow-up of selected patients; statistical analysis of data. RESULTS: During the 20 years 1976 to 1995, 119 rugby and 22 rugby league players (total 141) were admitted to New Zealand's two spinal injuries units suffering serious spinal injuries and 47 of these became permanently confined to wheelchairs. There was a steady increase in frequency throughout the period studied. Of the injuries 83% occurred in forwards and 17% in backs. In rugby it was the scrum which produced most injuries, and in rugby league it was the tackle. The early season month of April produced most spinal injuries. In the eighteen months since intense compulsory educational programmes on safety were introduced by the New Zealand Rugby Union there have been no serious spinal cord injuries from rugby scrums. CONCLUSION: Contrary to widespread belief, there has not been a decrease in spinal cord injuries in rugby following rule changes in the mid 1980s. The information produced by this retrospective study has been an effective educational platform to make rugby and rugby league safer. Language: en

A randomised intervention study to examine the effect on immunisation coverage of making influenza vaccine available at no cost

Abstract: AIMS This study aims to assess the effects of two interventions on influenza vaccination coverage: a simple organisational strategy, and making the vaccine available free. METHODS Sixteen general practitioners in the Auckland region were randomly selected to participate. Patients over 65 years of these general practitioners were randomly allocated to control, letter of invitation for a flu vaccine, or offer of a free flu vaccine. Administration of a flu vaccine for each person in the study was documented in each general practitioner surgery. Vaccine coverage for each of the three groups was measured. RESULTS Results were available for 15 of the 16 participating general practitioners, a total of 2791 subjects. Immunisation coverage rates for control, letter of invitation and vaccine at no cost, were 17%, 27% and 45% respectively. Statistical analysis, allowing for the cluster method used to obtain subjects, showed risk ratios of 1.55 and 2.65 for the two interventions, with p values of < 0.00001. CONCLUSIONS A potential source of bias in this study is underreporting of administration of vaccine to people in group 1. Notwithstanding this potential bias, both interventions were highly effective at increasing the uptake of influenza vaccine in the elderly population. General practitioners should be recommended to routinely invite patients over 65 years to have a flu vaccine. Given the commitment of the Ministry of Health to the vaccination against influenza of people over 65, this study would suggest that serious consideration should be given to making the vaccine available at no cost to this age group.

Incentives for general practitioners to provide brief interventions for alcohol problems.

Abstract: AIMS: To assess current practices and attitudes of general practitioners towards prevention and intervention with problem drinkers. METHODS: GPs randomly selected in the Central and Southern Health Regions answered a 134 item questionnaire on their involvement with patients with alcohol related problems. RESULTS: In all, 136 general practitioners responded representing 85% of those approached. When asked how often they provided interventions with alcohol problems, 86% reported managing under 13 patients per year, indicating an intervention rate of less than 1% of the mean practice size. In terms of disease prevention, 86% rated 'drinking moderately' as important but this endorsement ranked fifth behind other lifestyle behaviours such as 'not smoking' at 99%. When asked about their perceived role, they indicated higher role legitimacy but lower work satisfaction with alcohol problems. In terms of training, three-quarters stated they had received less than eleven hours of postgraduate alcohol education. They also rated their current effectiveness with alcohol problems as substantially less than potential effectiveness. They indicated the main obstacles to be: government funding policies, lack of adequate training and a need for improved resources and support services. CONCLUSIONS: With research having established the effectiveness of interventions for harmful alcohol consumption, attention has shifted to ways of engaging general practitioners in providing interventions. This study highlighted how changes to government health policy and improved competency and skilled based training could lead to a greater acceptance by general practitioners of the role they could play in reducing alcohol related problems.

Socioeconomic distribution of smoking in a population of 10,529 New Zealanders.

Abstract: AIMS This study aimed to investigate the associations of several smoking variables with socioeconomic status. METHODS Cross-sectional analyses of data about smoking behaviour and socioeconomic status (education, occupation and neighbourhood income) were performed using baseline data from the Fletcher Challenge-University of Auckland Heart and Health Study (10,529 participants). RESULTS After adjustment for age and sex, lower educational level was associated with: (1) higher frequency of ever having smoked (65% of participants who had attended secondary school for fewer than two years, versus 43% of participants who had attended university; 2p < 0.0001); (2) lower likelihood of having quit (46% versus 71%; 2p < 0.0001); (3) higher likelihood of being a current smoker (35% versus 12%; 2p < 0.0001); (4) higher tobacco consumption per smoker (13 manufactured cigarettes/day versus 8 manufactured cigarettes/day; 2p < 0.0001); and (5) higher tobacco consumption per participant (1980 cigarette-equivalents/year versus 450 cigarette-equivalents/year; 2p < 0.0001). Similar, but shallower, associations of these smoking variables were observed with occupation and neighbourhood income (with the exception that tobacco consumption per smoker was not associated with neighbourhood income). The socioeconomic gradients of tobacco consumption per study participant with all three socioeconomic indicators were particularly steep among younger participants, men and Maori. CONCLUSIONS Participants of low socioeconomic status consumed a disproportionately large amount of tobacco. Policies that prevent smoking initiation and promote smoking cessation in low socioeconomic groups are therefore needed. These should include targeting of mass media messages to low socioeconomic groups, public subsidisation of nicotine replacement therapy and higher taxes on tobacco.

Social class and male cancer mortality in New Zealand 1984-7.

Abstract: Social class differences in cancer mortality among New Zealand men aged 15-64 years are examined for the period 1984-7.... The strongest social class mortality gradients were found for cancers of the larynx liver buccal cavity/pharynx oesophagus lung and for soft tissue sarcoma. On the other hand rectal cancer malignant melanoma colon cancer brain/nervous system cancers and multiple myeloma showed higher death rates for the more advantaged socioeconomic groups. (EXCERPT)

Vaccine adverse events reported in New Zealand 1990-5.

Abstract: Aim. New Zealand monitors vaccine safety through vaccinator reports of adverse events following immunisation. The rate of reporting for the commonly used vaccines during 1990-5 are presented. During this time new vaccines were added to the immunisation schedule, enabling comparison of reporting rates.

Home birth in New Zealand 1973-93: incidence and mortality.

Abstract: Aims To determine for the period 1973-93, national and regional (1991 and 1992 only) incidence of home birth in New Zealand, with home birth defined as home being the intended place of birth at the onset of labour, to calculate perinatal and maternal mortality rates for home birth, and to categorise the cause of perinatal death. Methods Data sheets for 9776 planned home births were analysed. These had been collected by the Home Birth Associations of New Zealand/Aotearoa. National perinatal data and data from National Women's Hospital, Auckland were used for comparison. Trend analysis was performed by Poisson regression allowing for overdispersion. Results Planned home birth made up 2% of the total births in 1993, up from 0.04% in 1973. The home birth perinatal mortality rate for this period was 2.97 per 1000 total births, with no change over time. This was not significantly different from the rate for a selected low risk group at National Women's Hospital. Lethal anomalies caused 31% of the perinatal deaths. There was one maternal death (maternal mortality rate: 1.02 per 10,000 total births). There were significant differences in the rate of home birth in separate area health board regions for 1991 and 1992. Conclusion Home birth was a safe and increasingly popular: though minor, option for New Zealand women from 1973-93.

Rapid assay of plasma brain natriuretic peptide in the assessment of acute dyspnoea.

Abstract: AIM: Recognition of heart failure may be difficult in patients presenting with acute dyspnoea, particularly in the presence of chronic airways obstruction or obesity. In a previous study of patients with acute dyspnoea, we showed that the measurement of plasma brain natriuretic peptide (BNP)-a hormone secreted in increased amounts by the failing heart-accurately distinguishes heart failure from primary lung disorder. The aim of the present study was to develop a rapid assay for BNP and evaluate its diagnostic use in patients acutely hospitalised for increasing dyspnoea of any cause. METHODS: A rapid assay for plasma BNP, providing results within 24 h of blood collection, was developed without loss of precision. The results of the rapid and previously established BNP assays were highly correlated (r = 0.9). To determine the diagnostic value of the rapid assay, measurements were undertaken on the day of admission in 123 breathless patients (mean age 68.3, range 23 to 90 years) and related to conventional diagnostic assessments and final outcome. RESULTS: In patients diagnosed and treated urgently for clinical heart failure, plasma BNP was significantly higher (115 (SE 13) pmol/L, n = 39) than in those without clinical heart failure (33 (5) pmol/L, n = 84, p < 0.001). Using a cut-off of 50 pmol/L for the presence of heart failure, there was discordance between BNP level and clinical diagnosis in 21 of 123 cases. Reassessment after independent analysis of discordant cases increased the difference in BNP level in the presence (123 (13) pmol/L, n = 43) or absence (24 (1.5) pmol/L, n = 80) of heart failure. Using two way analysis of variance, no further improvement in discrimination was found when chest radiographs were used together with the BNP data. CONCLUSION: Rapid BNP assays are practicable and provide accurate information on cardiac status-superior to chest radiographs in many cases-early in the course of the patient's presentation with acute dyspnoea.

Geographical variation in the prevalence of asthma symptoms in New Zealand.

Abstract: Aims To examine geographical variations in the prevalence of asthma symptoms in a random population sample of New Zealand adults aged 20-44 years. Methods A one page asthma symptom questionnaire was sent to 31470 people aged 20-44 years. The questionnaire asked about respiratory symptoms, asthma attacks and asthma treatment. Those who had not responded after two reminder postcards were followed with a telephone call where possible. Results A response rate of 82% (25664) was achieved. The 12 month period prevalence of asthma (defined as woken by shortness of breath, or an attack of asthma in the past year, or current asthma medication) was 15.2% overall, but was higher in females (17.0%) than in males (13.2%); the prevalence was 22.1% in Maori, 20.6% in Pacific Islanders and 14.3% in non Polynesians. In North Island electorates, the highest age and ethinicity standardised prevalences were found in some of the electorates in the Auckland and Wellington urban regions although prevalence was also high in some rural electorates including Raglan (18.0%), Horowhenua (18.4%) and Wairarapa (18.4%); the lowest prevalences were found in other rural electorates including King Country (5.5%), Matamata (10.1%) and Rotorua (10.3%). In South Island electorates, the highest prevalences were found in some electorates in the Christchurch and Dunedin urban areas, and the lowest prevalences were again found in rural electorates including Clutha (11.3%), Rangiora (9.5%) and Wallace (9.4%). Conclusions This study confirms the previously reported high frequency of asthma symptoms in New Zealand adults, with higher symptom prevalence in Maori and in women. It shows significant urban/rural differences, as well as marked differences in prevalence between various rural areas. The reasons for these patterns are unclear and require further study.

The cost of campylobacteriosis in New Zealand in 1995.

Abstract: AIM To estimate the financial impact of campylobacter infection in Canterbury and New Zealand in 1995. METHODS The records of Canterbury Health Laboratories and hospital notes were searched to locate all inpatients admitted with campylobacteriosis in Christchurch in 1995 and to determine the costs involved. Further estimates of costs of outpatient care and costs due to lost productivity were made using local notification data. The computer database was searched for all cases of Guillain-Barre syndrome and reactive arthritis in 1995, and an estimate made of the cost attributable to campylobacter. RESULTS There were 65 admissions for campylobacteriosis at a cost of $92,262. Notified cases in general practice were estimated to cost $61,911 and loss of work an additional $338,499. Of the eight admissions with Guillain-Barre syndrome in 1995, the estimated cost of cases due to campylobacter infection was $89,522. Inpatient costs of reactive arthritis were negligible. Overall costs in Canterbury in 1995 amounted to $582,194, with a corresponding national figure of $4.48 million. The true cost of campylobacter infection may be up to ten times higher. CONCLUSIONS The current high incidence of campylobacter infection has considerable financial impact on the community. Further public health and research initiatives to decrease incidence and associated costs are encouraged.

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

Abstract: 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. Language: en

Nosocomial infection in Auckland Healthcare hospitals.

Abstract: AIM To determine the prevalence of nosocomial infection in Auckland Healthcare hospitals. BACKGROUND Nosocomial infections cause patient morbidity and prolong hospital stay. Reporting surveillance results to staff has been shown to reduce nosocomial infection rates. METHOD Point prevalence study for all patients in Auckland, Green Lane and National Women's hospitals. Standard definitions for nosocomial infections were used. RESULTS One hundred and ten (12%) of 932 patients had 129 nosocomial infections: 27 (20%) surgical site infections; 25 (19%) lower respiratory tract infections; 23 (18%) skin/ soft tissue infections; 19 (15%) urinary tract infections; 14 (11%) bloodstream infections; and 21 (17%) other infections. Predominant organisms were: Staphylococcus aureus (29%), Escherichia coli (21%), other gram negative bacilli (14%), Pseudomonas aeruginosa (6%), streptococci (6%) and Candida albicans (6%). The prevalence of nosocomial infection was lower in National Women's Hospital (5%) than either Green Lane or Auckland hospitals (15% and 14% respectively), p 50 yr (14%), p 7 days, p < 0.01. Risk factors for nosocomial infection were present in many patients: 339 (36%) had intravenous catheters in place; 268 (29%) patients had undergone surgery during their current admission; 122 (13%) had urinary catheters in place; and 122 (13%) had other invasive devices in situ. CONCLUSION Our results are comparable with hospitals of similar size overseas. This study provides a base line for future studies which will enable the monitoring of trends over time and the impact of focused infection control initiatives.

Maori/non-Maori patterns of contact, expressed morbidity and resource use in general practice : data from the Waikato medical care survey 1991-2

Abstract: Aims To compare patterns of contact, expressed morbidity and resource use in primary care for a representative sample of patients of Maori and non-Maori background. Methods The data are drawn from a survey of general practice in the Waikato region representing a one per cent sample of all week day encounters. The data were recorded by participating general practitioners in four collection weeks spaced over the period of a year. In total, 12,833 patient encounter forms were completed. Results Annual rates of general practitioner contact for Maori are slightly lower than those for patients of non-Maori background. The case-mix pattern of general practitioner contact is very similar between the two groups. There is a limited correspondence between ethnic patterns of general practitioner usage and health need (as measured by mortality levels and rates of public hospital discharge). Conclusions The near equivalence in ethnic rates of general practitioner contact revealed in this study contrasts strikingly both with the level of hospitalisation for Maori, which is nearly double that of non-Maori, and with the difference in mortality rates (30% higher for Maori). Attention devoted to improving access to general practitioner services among Maori may be necessary if important areas of ill health and hospital resource use are to be addressed effectively.

The Diabetes Care Support Service for general practitioners in Auckland.

Abstract: Aims Diabetic complications can often be prevented by timely detection and intervention. Optimising diabetes care requires effective monitoring of risk factors at both practice and district level. We describe a novel method which combines district monitoring of diabetes with enhanced diabetes care by individual general practitioners. Methods All general practitioners in south and west Auckland (n = 291) were invited to join the Diabetes Care Support Service (DCSS). This involved the identification of all diabetic patients within the practice and the completion of an audit from with key measures of diabetes and its care. Results Audit was completed for 217 (75%) of general practitioners and 4611 diabetic patients: 39% of general practitioners completed their own audit. The proportion of completed patient assessments ranged between 35% (foot pulses) and 89% (blood pressure). The process was found to be helpful by 88% of general practitioners (who commented). Conclusion The DCSS is a seamless, service-orientated approach to the delivery of diabetes care by primary and secondary services and is likely to improve care district-wide and identify the need for further interventions. Subsequent audit passes will allow the demonstration and monitoring of any changes that occur, as well as the demonstration of its feasibility and acceptability on an ongoing basis.

Low vitamin D status is common among elderly Dunedin women

Abstract: AIMS: To review vitamin D status and the relationship of serum 25-hydroxyvitamin D levels to hip bone mineral density in a group of healthy elderly women living independently in their own homes in Dunedin. METHODS: Thirty-eight elderly subjects (> 70 years of age) were studied. Serum levels of 25-hydroxyvitamin D (25(OH)D) were measured by radioimmunoassay in summer and winter. Femoral neck bone mineral density was measured by dual x-ray energy absorptiometry. RESULTS: Hip density was correlated with serum 25(OH)D levels at study entry. In summer, 10 of 38 patients (26.3%) had serum 25(OH)D levels below the reference range for healthy adults (40-185 nmol/L). Six patients subsequently withdrew from the study. In winter, 22 of the remaining 32 women (68.8%) had serum 25(OH)D values below the reference range. Subjects with low 25(OH)D values were given halibut oil tablets (400 IU vitamin D3 per day) to improve their serum 25(OH)D levels. CONCLUSIONS: Vitamin D deficiency is common among elderly women with a high risk of fracture who live in southern New Zealand. This is most marked in the winter months. Vitamin D replacement is cheap and effective and should be considered in patients over 70 years of age who have a high risk of fracture and who live in temperate climates. Language: en

Characteristics of patients admitted to hospital with chronic obstructive pulmonary disease.

Abstract: AIMS To examine the characteristics of patients admitted to Auckland Hospital with chronic obstructive pulmonary disease (COPD) and to assess their management prior to hospitalisation. METHODS Prospective survey of 99 patients admitted with COPD over an 8 week period. Of these, 80 patients were interviewed about their social circumstances, physical functioning, smoking habits and medical treatment. They also had their inhaler technique checked and FEV1 measured. RESULTS Subjects had a mean age of 70.6 years with a mean FEV1 of 29% of predicted. 45% lived alone and a third still smoked. The mean value for their usual physical functioning was 15.4 (possible 10-30) on the SF-36 health status questionnaire. 84% of all subjects used a beta-agonist, 50% an anticholinergic bronchodilator, 69% inhaled steroids, 18% oral steroids, and 19% theophylline. 40% used nebulised medication and only 6% had domiciliary oxygen. 40% reported having an influenza vaccination in the preceding year and 27% had participated in some form of pulmonary rehabilitation. The mean length of stay was 7.5 days. CONCLUSIONS Patients hospitalized for COPD report marked impairment in physical functioning, despite which many live alone. They frequently use inhaled and oral steroids, and nebulised medication, but only a minority had received an influenza vaccination or attended pulmonary rehabilitation.

The effect of frequent vacuum cleaning on the house dust mite allergen, Der p 1 in carpets: a pilot study.

Abstract: AIM To determine the effect of frequent vacuum cleaning of carpets on Der p 1, the major group one allergen of the house dust mite Dermatophagoides pteronyssinus. METHODS Nine rooms and three hallways in the resident medical officers quarters at Wellington Hospital were regularly vacuum cleaned (daily, except weekends) over a five week period. Dust samples were collected before and at weekly intervals for Der p 1 measurement by a double monoclonal antibody ELISA technique. RESULTS Der p 1 concentrations progressively declined from an initial geometric mean level (95% CI) of 4.47 micrograms/g fine dust (0.11-21.73) to 1.83 micrograms/g (0.29-9.57) after five weeks, a mean reduction of 48.0% (31.7-65.5). Similarly when expressed per unit area Der p 1 levels declined from 6.35 micrograms/m2 (1.15-35.16) to 1.66 micrograms/m2 (0.33-9.04), a mean reduction of 68.5% (58.6-78.3). CONCLUSIONS Frequent vacuum cleaning over a short time significantly reduces house dust mite allergen levels in carpets. Larger long term trials are warranted to determine if greater reductions are possible that would be beneficial to house dust mite sensitive individuals.

The effect of a preanaesthetic information booklet on patient understanding and satisfaction

Abstract: AIM To determine if a brief user friendly anaesthetic booklet compliments the anaesthetic service currently provided, in terms of greater patient understanding and satisfaction. METHOD Two questionnaires were completed by participants in each group, one questionnaire preoperatively and the other postoperatively. The booklet group received the anaesthetic booklet in the mail with their booking card while the control group only received their booking card. RESULTS Of the 209 eligible, 140 patients consented to and completed the preoperative questionnaire, of whom 53 were in the anaesthetic booklet group and 87 were in the control group. The postoperative questionnaire was completed by 38 and 65 respectively. The anaesthetic booklet group had better understanding of what a premed will do (p < 0.05) and how long after an anaesthetic to wait before driving (p < 0.025). The percentage of correct answers for the more general anaesthetic questions was high and very similar in both groups. There was no significant difference in the satisfaction scores between groups. Satisfaction scores for both groups rose significantly in the postoperative questionnaire when compared with the preoperative questionnaire (p < 0.001). CONCLUSION The value of the anaesthetic booklet is in providing detailed anaesthetic information to the patient. This will aid the preanaesthetic consultation with the anaesthetist and provide a focus for further discussion about the intended anaesthetic. Patient satisfaction with the anaesthetic service was high in both groups pre- and postoperatively and was not altered by the anaesthetic booklet.

Life and death on the waiting list for coronary bypass surgery.

Abstract: Aim To assess the baseline characteristics of patients referred for isolated coronary bypass surgery (CABG), waiting times for coronary bypass surgery and clinical events while waiting for coronary bypass surgery. To compare the New Zealand priority scoring system with a previously validated Ontario urgency score. Methods Outcomes in a consecutive case series of 88 patients referred from Christchurch Hospital for coronary bypass surgery between July 1 and December 31 1993 were compared with a previous Christchurch case series and a contemporary Canadian case series. Patients were stratified according to both Ontario and New Zealand priority scores. Results Of 88 patients, one patient died prior to surgery, 79 had undergone coronary bypass surgery (with three deaths), and eight were still waiting as at December 31 1995. Twenty five percent of patients had left main disease, another 60% had multivessel disease that included the proximal left anterior descending coronary artery and 64% had angina at rest or on minimal exertion. The median waiting time was 92 days (inter-quartile range 20-234), 8 (6-12) days in the 23 patients who underwent surgery as in-hospital cases, and 181 (83-295) in those who waited at home. Patients with left main disease waited a median of 41 (11-205) days. While waiting at home one patient died, one patient suffered a myocardial infarction, and 17 patients were readmitted with unstable angina. Readmissions were not predicted by New Zealand or Ontario priority scores, nor by clinical variables. Conclusions Thresholds for referral are very similar, but waiting times for coronary bypass surgery are far longer in New Zealand than Canada. The long waiting times are a considerable cost to both patients and government. Priority scores facilitate comparison between countries but they may not predict readmission to hospital while on a long waiting list.

Risk factors for adolescent pregnancy: how important is child sexual abuse? Otago Women's Health Study.

Abstract: This study analyzed cross-sectional data gathered via postal surveys and interviews in 1989 from the Otago Womens Health Child Sexual Abuse study to assess the relative roles of childhood sexual abuse and other adverse developmental factors on the incidence of adolescent pregnancy (before age 19). Interviews were conducted with 252 victims of childhood sexual abuse and 225 controls. The sexual abuse rate under age 16 was 32% with the most severe incidences experienced by 19.7% of the women. Corresponding figures under age 12 were 20.3% and 13.2%. Adolescent pregnancy occurred in 55 of the 477 interviewed women and the incidence was higher in women who reported childhood sexual abuse with a clear increase in pregnancy among those who reported the most severe forms of abuse. Of the 21 women who reported sexual assault at ages 16-18 38.1% experienced adolescent pregnancy versus only 10.3% of those who did not experience such assault. Adolescent pregnancy was also associated with the following family and psychosocial variables: living in a nonnuclear family or in a family characterized by frequent fighting being physically punished after age 12 and not having a confidante as a child. The child sexual abuse variable was confounded by these other characteristics and was only independently predictive of adolescent pregnancy when it took the form of intercourse. It is concluded therefore that adolescent pregnancy is not a random occurrence in this population but is related to the presence of psychosocial problems in families. Measures to reduce adolescent pregnancy should focus on improving the functioning of families as well as on providing good sex education.

Primary care and health reform in New Zealand.

Abstract: Aims (1) To describe New Zealand's primary care system (2) to compare New Zealand to other Anglo-American members of the OECD with respect to the adequacy of primary care, and (3) to assess the cost-efficiency and effectiveness of New Zealand's system by comparing health spending and health indicators relevant to primary care. Method A cross-national comparison of primary care, health spending and health indicators in New Zealand, Australia, Canada, the United Kingdom and the United States of America. Main outcome measures were health spending measured in purchasing power parties. Health indicators: mean life expectancy in years, years of potential life lost and infant mortality rates. Results New Zealand's primary care system ranked below the UK, above the USA and similar to Canada and Australia. Favourable characteristics of New Zealand's primary care system were the use of generalists as the predominant type of practitioner and the low proportion of active physicians who were specialists. Compared to the other countries, New Zealand scored poorly for financial that are necessary for the practise of good primary care. New Zealand and the UK had the lowest spending per capita on health care. New Zealand and the USA scored lowest for all three of the health care indicators. Conclusions The quality of primary care in New Zealand is limited by barriers to access to care and the intermediate level of practise characteristics essential to primary care. Compared to other AngloAmerican OECD nations, New Zealand has relatively low levels of national health expenditure. In order to improve the quality of primary care, future reform should aim to facilitate access to care, increase the gatekeeping role of primary care physicians, and promote the practise characteristics essential to primary care.

Body size of New Zealand Pacific Islands children and teenagers

Abstract: AIM To describe the mean height, weight and body mass index of Pacific Islands children aged 5-18 years residing in New Zealand and compare them with international reference charts commonly used in New Zealand. METHODS Data from three data sets were used, which included 816 children from most Pacific countries with measurements being obtained in Auckland and Wellington. Mean values and 95% confidence intervals were compared to National Center for Health Statistics (USA) standards for height and weight. RESULTS The mean height of males and females was on about the 95th percentile from age 5 to about age 10-11. During the teenage years it moved to the 50th percentile. Mean weight remained close to the 95th percentile until the mid teens and then it fell below the 95th percentile later in the teenage years. CONCLUSION Mean body height and weight of Pacific Islands children were very high compared with international standards especially between 5-12 years and new Polynesian standards need to be developed.

Patterns of general practitioner usage among Pacific people: Indicative results from the Waikato Medical Care Survey 1991-2

Abstract: AIMS: To report patterns of medical contact in a representative sample of Pacific people attending the general practitioner. METHODS: The data were drawn from a survey of general practice in the Waikato region representing a one per cent sample of all weekday encounters. In total, 12,833 patient encounter forms were completed. Just over one per cent of all encounters were recorded for patients of Pacific Islands background. RESULTS: Rates of medical contact for Pacific patients were lower-3.4 visits per year versus 4.5 for the whole sample-fewer follow up visits were requested (71% versus 76.2%), presentation was delayed (4.9 days from onset versus 3.7 for the sample) and there was an apparently lower level of rapport achieved. CONCLUSION: Overall levels of medical contact and return visits among Pacific patients appear to be lower and presentation delayed in this Waikato sample.