Work status and disability trajectories over 12 months after injury among workers in New Zealand
Return to work (RTW) is often used as a measure of outcome and scheme performance by injury compensation insurers (e.g. ACC and work-based injury insurance schemes overseas). While RTW is an undeniably important outcome for workers and insurers alike, findings from the Prospective Outcomes of Injury Study (POIS) suggest that RTW is an insufficient measure of outcome when considered in isolation from disability. For example POIS analyses of RTW over 1 year for 1975 injured ACC claimants (who had been in paid employment at the time of their injury) found that of those who were not working at both 3 and 12-months post-injury, only 20% reported no (considerable) disability at either time point. In contrast, of those who were in paid work by 3-months post-injury 68% reported no (considerable) disability at either 3 or 12 months post-injury. There poor concordance between RTW and disability outcomes. RTW is one performance measure of outcome following injury, but it does not adequately reflect outcomes of importance to individuals, their families and wider society such as disability.
Using triggers in primary care patient records to flag increased adverse event risk and measure patient safety at clinic level
This paper looked at how much harm occurs in general practice and developed a tool, called a ‘Trigger Tool’, which could assist primary care in measuring harm. According to the findings harm occurs in about 7% of consultations, although it possibly could be higher, and is predominately due to side effects of medication. The tool that was developed identifies warnings events (triggers) that general practice teams can investigate to see if harm has occurred. The tool is very good at picking up the majority of harm that occurs in general practice and not as good at excluding events in which harm did not occur.
Outcomes in HrHPV-positive women with low grade cervical smears and normal or low grade initial colposcopy results
Genital human papillomavirus (HPV) infection is the most commonly diagnosed sexually transmitted infection in New Zealand. HPV infection is a prerequisite for the development of cervical cancer. For a woman with cervical smear abnormality and a high-risk type HPV (HrHPV) test, management must balance the need to identify and treat abnormalities likely to progress to cancer and avoid unnecessary treatment related to transient HPV infection. Women 30 years and older who are HrHPV-positive and have either normal or low grade abnormalities at colposcopic biopsy may be followed up with a 12-month cervical smear rather than a repeat colposcopy. Women with a normal smear and HrHPV-positive test should undergo a repeat co-test in 12 months, and if the co-test is positive should be referred for colposcopy.
Sex workers’ utilisation of health services in a decriminalised environment
Sex work was decriminalised in New Zealand in 2003. Prior to this, most sex workers reported having regular sexual health check-ups and most attended their general practitioner for this, followed by a local Sexual Health Clinic and then New Zealand Prostitutes’ Collective’s (NZPC) weekly sexual health clinic. There has been little change since decriminalisation. Most sex workers do not disclose their occupation to health workers because of perceptions of the stigma attached to their occupation. This has implications for the thoroughness of the check-up. It would seem that encouraging attendance at the NZPC clinic would be beneficial as then disclosure would not be an issue. However, these clinics are not available outside of Christchurch, Wellington and Auckland and are only run on a once a week basis in Christchurch and Auckland and twice a week in Wellington
Pacific Islands Families Study: depressive symptoms in 9-year-old Pacific children living in New Zealand
This study investigated associations between individual, maternal, cultural and sociodemographic variables with symptoms of child depression in 9-year-old Pacific children living in New Zealand. At approximately 9 years of age, child self-reports (n=858) of depressive symptoms were gathered. We found that being a victim or perpetrator of bullying, previous internalising behaviour problems and low maternal education were significantly associated with high child depression scores. Low depression scores were associated with children’s positive perception of self, physical abilities, parental and peer relationships, high verbal intelligence, and high performance at school. These findings indicate that building up child self-esteem and supportive relationships around the child are likely to reduce the risk of depression and these strengths may mitigate against bullying involvement
Changes in the provision of transient ischaemic attack services in New Zealand 2008 to 2013
Stroke is a major cause of death and disability in New Zealand. A transient ischaemic attack or TIA occurs when there are temporary symptoms of a stroke that improve on their own but may be a sign that a stroke is going to occur in the next few days. People with a TIA need prompt assessment and treatment in order to prevent a stroke occurring. We conducted a survey of TIA services in 2008 and found there were unacceptable delays in the assessment and management of patients with TIA in New Zealand hospitals. We repeated the survey in 2013 and found that in many areas there has been significant improvement over the last 5 years. However, there are still areas where improvement is needed and district health boards (DHBs) need to consider adequately resources TIA services as a high priority in order to reduce the rates of death and disability from stroke in New Zealand.