[Show abstract][Hide abstract] ABSTRACT: Objectives
Using text messaging, underpinned by the Health Belief Model, this study aimed to improve tooth brushing frequencies among unemployed young adults aged 18–24 years.Methods
Set within Work and Income's Linwood Community Link office (one Christchurch branch of the New Zealand Government's employment and beneficiary services), unemployed young adults aged 18–24 years with access to a mobile phone were recruited using either a purpose-built computer kiosk or Work and Income's Facebook site. Participants completed a baseline survey and then received and responded to a series of motivational text messages over 10 weeks. Self-reported tooth brushing frequency was the primary outcome variable. Important socio-demographic (age, gender, ethnicity, employment status) and method-specific (level of attrition, distribution of successful text messages deliveries, active withdrawal) variables were also collected. Longitudinal analyses of these responses employed generalized estimating equation (GEE) models.ResultsFour hundred and three registered for the trial, of whom 171 (42%) were eligible. Self-reported tooth brushing twice or more per day increased from 51% at baseline to 70% at week 3, 74% at week 6, and 73% at week 9 – an increase significant in crude (P < 0.001) and adjusted (P < 0.001) GEE analyses. No important differences were noted between age, gender, or ethnic groups, although attrition was relatively high with only 26% participating by week 9. However, no evidence of differential attrition was observed.Conclusions
Invention through motivational text messaging improved the measured oral health self-care behavior in a hard-to-reach group carrying a disproportionately heavy oral health burden. This intervention warrants further investigation.
Journal of Public Health Dentistry 12/2014; · 1.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Active transport (e.g., walking, cycling) to school (ATS) can contribute to children's physical activity and health. The built environment is acknowledged as an important factor in understanding children's ATS, alongside parental factors and seasonality. Inconsistencies in methodological approaches exist, and a clear understanding of factors related to ATS remains equivocal. The purpose of this study was to gain a better understanding of associates of children's ATS, by considering the effects of daily weather patterns and neighbourhood walk ability and neighbourhood preferences (i.e., for living in a high or low walkable neighbourhood) on this behaviour.
International Journal of Behavioral Nutrition and Physical Activity 06/2014; 11(1):70. · 3.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: Despite many reforms and initiatives, inequities in access to primary health care remain. However, the concept of 'access' and its measurement is complex. This paper aims to provide estimates of general practice visit frequencies for 'attenders' (those who seek consultation) and the proportion of 'non-attenders' (those who never seek consultation) of primary health care services. Methods: A panel study of people enrolled within a large primary health care organisation of affiliated general practices. Standard and zero-inflated regression models were assessed. Results: 980,918 visits were made by 388,424 people, averaging 2.64 visits/person/year. The zero-inflated negative binomial model was superior, and significant age, gender and ethnic differences were observed in attender and non-attender profiles. More Asian (21.0%), Pacific (19.6%) and Māori (17.1%) people were non-attenders than European/Other (9.0%) people. Among attenders, males, Asian and Pacific people, and young to middle-aged adults, generally had relatively lower visit rates. Conclusions: Interpretation of utilisation data must be made with caution because of two distinct characteristics: the differential rates of non-attenders and the highly dispersed distribution of attenders. Implications: Improved understanding of differential non-attender rates and attender visit distributions by demographic factors needs to be considered when addressing improved access to general practice services.
Australian and New Zealand Journal of Public Health 04/2014; 38(2):171-6. · 1.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sick leave due to neck pain (NP-SL) is costly and negatively impacts the productivity of the nursing and midwifery workforce. Identification of modifiable risk indicators is necessary to inform preventive efforts. This study aimed to investigate the role of pain-related psychological features (pain catastrophizing, fear of movement, and pain coping) in NP-SL alongside other potential risk indicators.
A cross-sectional analysis of a large cohort study of Australian and New Zealand nurses and midwives, established between 1st April 2006 to 30th March 2008, was undertaken. Recruitment procedures adopted within each Nursing Council jurisdiction were governed by the individual regulatory authorities and their willingness to engage with the study. Invitations directed potential participants to a purpose-built internet-based survey, where study information was provided and consent requested. Once consent was obtained, a range of standardized tools combined into one comprehensive electronic questionnaire was elicited. Exposure variables assessed included pain characteristics and a broad range of psychological, psychosocial, occupational, general health and demographic factors. Two-way interactions between age and gender and candidate exposures were also assessed. Binary logistic regression was performed using manual backward stepwise elimination of non-significant terms.
The cohort included 4,903 currently working nurses or midwives aged 18-65 years. Of these, 2,481 (50.6%) reported neck pain in the preceding 12 months. Our sample comprised of 1,854 working nurses and midwives with neck pain in the preceding year who supplied sick leave data. Of these, 343 (18.5%) reported taking sick leave in the preceding year due to their neck pain. The final most parsimonious multivariable model demonstrated neck pain severity (adjusted odds ratio, [aOR] = 1.59), passive pain coping (aOR = 1.08) and fear of movement (aOR = 1.06) increased the likelihood of NP-SL in the previous year. Interactions between demographic and general health factors exhibited both protective and risk relationships with NP-SL, and there was no association between pain catastrophizing and NP-SL.
Findings demonstrate that sick leave due to neck pain was associated with pain severity, fear of movement and passive pain coping. In addition, there were complex interactions found between demographic and general health factors. These features represent potentially modifiable targets for preventive programs.
[Show abstract][Hide abstract] ABSTRACT: In 2006 there were 432,700 people in Australia who had acquired brain injury (ABI) with some limitation of activities; 90% of these were traumatic brain injuries (TBIs) and nearly a third sustained injury below age 15 years. One to four years post injury, 20% to 46% of children with traumatic brain injury (TBI) have clinically significant disorders of attention. There is controversy as to whether central nervous system (CNS) stimulants can be an effective method of treating these.Objectives were to determine the efficacy of CNS stimulants for children with TBI, and to calculate the sample size for a larger trial using the Conners' Long Forms Parent Rating Scales Score as the primary endpoint.
Pilot series of aggregated prospective randomised, double-blind, n-of-1 trials of stimulant versus placebo within individual patients. Setting: tertiary children's public hospital. Participants: ten children aged 6 to 16 years more than 12 months post TBIwith attention, concentration and behavioral difficulties on stimulants. Interventions: Three cycles of methylphenidate or dexamphetamine orally at doses titrated by physician compared to placebo. Main Outcome Measures: Conners 3 Parent (Conners 3-P) and Teacher (Conners 3-T) Rating Scales (Global Index), Behaviour Rating Inventory of Executive Function (BRIEF) and Eyberg Child Behaviour Inventory (ECBI).
Five of ten patients completed the study. Data from 18 completed cycles from seven patients were analysed. The posterior mean difference between stimulant and placebo scores for the Conners 3-PS (Global Index) was 2.3 (SD 6.2; 95% credible region -1.0 to 6.1; posterior probability that this mean difference was greater than zero was 0.92), and for the Conners 3-T (Global Index) the posterior mean difference was 5.9 (SD 4.5; 95% credible region -3.1 to 14.9; posterior probability 0.93). Posterior mean differences suggest improvement in behaviour and executive function and a decrease in number and intensity of child behaviour problems when taking stimulants compared to placebo. Taken together these data are suggestive of a small benefit at group level.
In this pilot study, there was sufficient evidence that stimulants may be useful in management of behavioral and cognitive sequelae following TBI, to warrant a larger trial.Trial registration: The trial was registered with the Australian and New Zealand Clinical Trials Registry: registration number ACTRN12609000873224.
[Show abstract][Hide abstract] ABSTRACT: Background: Breaks in sedentary behavior are associated with reduced body size in general populations. This study is the first to consider the relationship between objectively assessed sedentary breaks and body size in Pacific children and their mothers. Methods: Pacific children aged 6 years (n = 393) and their mothers (n = 386) residing in New Zealand were invited to participate in 2006. Sedentary time was assessed via accelerometry. Average frequency, duration, and intensity of breaks in sedentary time per hour were calculated. Waist circumference was assessed and demographic factors collected via questionnaire. Relationships between waist circumference and potential associated factors for participants were assessed using linear regression analyses. Results: Accelerometer data were obtained from 126 children (52 boys) and 108 mothers. Mean (standard deviation) waist circumference values for mothers and children were 114 cm (20.1 cm) and 59.4 cm (7.8 cm), respectively. For mothers, time spent sedentary and being an ex/nonsmoker were positively related to waist circumference. For children, watching television every day and having a mother with a high waist circumference was associated with a greater waist circumference. Conclusion: Strategies that focus on reducing sedentary time in Pacific mothers and on encouraging television free days in young Pacific children are recommended.
Journal of Physical Activity and Health 11/2013; 10(8):1166-74. · 1.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: It is estimated that 39,000 Australians die from malignant disease yearly. Of these, 60% to 88% of advanced cancer patients suffer xerostomia, the subjective feeling of mouth dryness. Xerostomia has significant physical, social and psychological consequences which compromise function and quality of life. Pilocarpine is one treatment for xerostomia. Most studies have shown some variation in individual response to pilocarpine, in terms of dose used, and timing and extent of response.We will determine a population estimate of the efficacy of pilocarpine drops (6 mg) three times daily compared to placebo in relieving dry mouth in palliative care (PC) patients. A secondary aim is to assess individual patients' response to pilocarpine and provide reports detailing individual response to patients and their treating clinician.
Aggregated n-of-1 trials (3 cycle, double blind, placebo-controlled crossover trials using standardized measures of effect). Individual trials will identify which patients respond to the medication. To produce a population estimate of a treatment effect, the results of all cycles will be aggregated.
Managing dry mouth with treatment supported by the best possible evidence will improve functional status of patients, and improve quality of life for patients and carers. Using n-of-1 trials will accelerate the rate of accumulation of high-grade evidence to support clinical therapies used in PC.Trial registration: Australia and New Zealand Clinical Trial Registry Number: 12610000840088.
BMC Palliative Care 10/2013; 12(1):39. · 1.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Paper-based Aboriginal and Torres Strait Islander health checks have promoted a preventive approach to primary care and provided data to support research at the Inala Indigenous Health Service, south-west Brisbane, Australia. Concerns about the limitations of paper-based health checks prompted us to change to a computerised system to realise potential benefits for clinical services and research capability. We describe the rationale, implementation and anticipated benefits of computerised Aboriginal and Torres Strait Islander health checks in one primary health care setting.
In May 2010, the Inala Indigenous Health Service commenced a project to computerise Aboriginal and Torres Strait Islander child, adult, diabetic, and antenatal health checks. The computerised health checks were launched in September 2010 and then evaluated for staff satisfaction, research consent rate and uptake. Ethical approval for health check data to be used for research purposes was granted in December 2010.
Three months after the September 2010 launch date, all but two health checks (378 out of 380, 99.5%) had been completed using the computerised system. Staff gave the system a median mark of 8 out of 10 (range 5-9), where 10 represented the highest level of overall satisfaction. By September 2011, 1099 child and adult health checks, 138 annual diabetic checks and 52 of the newly introduced antenatal checks had been completed. These numbers of computerised health checks are greater than for the previous year (2010) of paper-based health checks with a risk difference of 0.07 (95% confidence interval 0.05, 0.10). Additionally, two research projects based on computerised health check data were underway.
The Inala Indigenous Health Service has demonstrated that moving from paper-based Aboriginal and Torres Strait Islander health checks to a system using computerised health checks is feasible and can facilitate research. We expect computerised health checks will improve clinical care and continue to enable research projects using validated data, reflecting the local Aboriginal and Torres Strait Islander community's priorities.
BMC Medical Informatics and Decision Making 09/2013; 13(1):108. · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the frequency and types of stressful events experienced by urban Aboriginal and Torres Strait Islander children, and to explore the relationship between these experiences and the children's physical health and parental concerns about their behaviour and learning ability.
Cross-sectional study of Aboriginal and Torres Strait Islander children aged ≤ 14 2013s presenting to an urban Indigenous primary health care service in Brisbane for annual child health checks between March 2007 and March 2010.
Parental or carer report of stressful events ever occurring in the family that may have affected the child.
Of 344 participating children, 175 (51%) had experienced at least one stressful event. Reported events included the death of a family member or close friend (40; 23%), parental divorce or separation (28; 16%), witness to violence or abuse (20; 11%), or incarceration of a family member (7; 4%). These children were more likely to have parents or carers concerned about their behaviour (P < 0.001) and to have a history of ear (P < 0.001) or skin (P = 0.003) infections.
Children who had experienced stressful events had poorer physical health and more parental concern about behavioural 1s than those who had not. Parental disclosure in the primary health care setting of stressful events that have affected the child necessitates appropriate medical, psychological or social interventions to ameliorate both the immediate and potential lifelong negative impact. However, treating the impact of stressful events is insufficient without dealing with the broader political and societal 1s that result in a clustering of stressful events in the Aboriginal and Torres Strait Islander population.
The Medical journal of Australia 07/2013; 199(1):42-5. · 2.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction: The primary aim of this study was to assess the interobserver and intraobserver reproducibility of the first-trimester frontomaxillary facial angle (FMFA) measurement using both 2D and 3D ultrasound. Assessment of the relationship between crown-to-rump length (CRL) and FMFA measurement was also reviewed. Materials and Methods: Two experienced operators imaged the same 30 patients over a 1-month period collecting both 2D static images and 3D volumes during nuchal translucency assessment at 11-14 weeks' gestation. The operators were blinded to each other's images and results. Results: The mean 2D FMFA measurement was 88.0° and 88.4° for observer 1 and 2, respectively; while the mean 3D FMFA measurement was 87.8° and 88.0°, respectively. Intraclass correlation suggests good intraobserver and interobserver agreement with no statistically significant difference between operators in either 2D (p = 0.14) or 3D (p = 0.11) measurements. The FMFA was unchanged with increasing CRL. Discussion: Both 2D and 3D FMFA measurements have been demonstrated to be equivalent and reliable. Strict image acquisition criteria must be followed for accurate and reproducible FMFA measurements. There was no change demonstrated in FMFA measurement with increasing CRL.
Fetal Diagnosis and Therapy 06/2013; · 1.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: It is estimated that 22,800 children were living with an Acquired Brain Injury (ABI) (0.6% of children aged under 15 years) in Australia during 2003. Many children after a traumatic brain injury will experience difficulties with attention and concentration; a condition termed secondary Attention Deficit-Hyperactivity Disorder. There is conflicting evidence on whether treatment with stimulant therapy with medications such as methylphenidate or dexamphetamine will improve the attention and behavior of children with this condition.Methods/design: Single patient trials (n-of-1s or SPTs) evaluate the effect of titrated doses of psychostimulants methylphenidate or dexamphetamine compared to placebo on attention and behavior, in children with TBI and secondary ADHD. The aggregation of multiple SPTs will produce a population estimate of the benefit. Forty-two children will be registered into the trial through rehabilitation services at three large children's hospitals in Australia. Patients will complete up to 3 cycles of treatment. Each cycle is 2 weeks long comprising seven days each of treatment and placebo, with the first two days of each cycle considered a washout period and the data not analysed. The order of treatment and placebo is randomly allocated for each cycle. The Conners' Parent Rating Scales long forms will be employed to measure change in attention-deficit/hyperactivity and related problems of the child, and the primary outcome measure is the Conners' Global Index Parent Version. Secondary outcomes include the teacher and child (if aged > 12 years) Conners' Rating Scales, the Behaviour Rating Inventory of Executive Function among other measures. This study will provide high-level evidence using a novel methodological approach to inform clinicians about the most appropriate treatment for individual children. Through aggregation of individual trials, a population estimate of treatment effect will be provided to guide clinical practice in the treatment of children with secondary ADHD after a traumatic brain injury. DISCUSSION: This study employs an innovative methodological approach on the effectiveness of CNS stimulants for secondary ADHD from a brain injury. The findings will both guide clinicians on treatment recommendations, and inform the concept and acceptance of SPTs in paediatric research.Trial registration: Australian New Zealand Clinical Trials Registry. ACTRN12609000873224(https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12609000873224).
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: It is estimated that 29% of deaths in Australia are caused by malignant disease each year and can be expected to increase with population ageing. In advanced cancer, the prevalence of fatigue is high at 70--90%, and can be related to the disease and/or the treatment. The negative impact of fatigue on function (physical, mental, social and spiritual) and quality of life is substantial for many palliative patients as well as their families/carers.Method/design: This paper describes the design of single patient trials (n-of-1 s or SPTs) of a psychostimulant, methylphenidate hydrochloride (MPH) (5 mg bd), compared to placebo as a treatment for fatigue, with a population estimate of the benefit by the aggregation of multiple SPTs. Forty patients who have advanced cancer will be enrolled through specialist palliative care services in Australia. Patients will complete up to 3 cycles of treatment. Each cycle is 6 days long and has 3 days treatment and 3 days placebo. The order of treatment and placebo is randomly allocated for each cycle. The primary outcome is a reduction in fatigue severity as measured by the Functional Assessment of Cancer Therapy-fatigue subscale (FACIT-F). Secondary outcomes include adverse events, quality of life, additional fatigue assessments, depression and Australian Karnovsky Performance Scale. DISCUSSION: This study will provide high-level evidence using a novel methodological approach about the effectiveness of psychostimulants for cancer-related fatigue. If effective, the findings will guide clinical practice in reducing this prevalent condition to improve function and quality of life.Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12609000794202 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12609000794202.
BMC Palliative Care 04/2013; 12(1):17. · 1.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Workplace bullying is repeated systematic, interpersonal abusive behaviours that negatively affect the targeted individual and the organisation in which they work. It is generally the result of actual or perceived power imbalances between perpetrator and victim, and includes behaviours that intimidate, offend, degrade or humiliate a worker. It is illegal, and bullied employees can take legal action against their employers for a breach of implied duty of trust and confidence. Despite this, workplace bullying occurs in many Australian workplaces, including Australian general practices.
This article explores the issue of workplace bullying with particular reference to bullying within general practice and provides a framework for managing these situations.
All general practices need organisation-wide anti-bullying policies that are endorsed by senior management, clearly define workplace bullying, and provide a safe procedure for reporting bullying behaviours. General practitioners should investigate whether workplace issues are a potential contributor to patients who present with depression and/or anxiety and assess the mental health of patients who do disclose that they are victims of workplace bullying, Importantly, the GP should reassure their patient that bullying is unacceptable and illegal, and that everyone has the right to a safe workplace free from violence, harassment and bullying. The time has come for all workplaces to acknowledge that workplace bullying is unacceptable and intolerable.
Australian family physician 04/2013; 42(4):186-8. · 0.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Harmful alcohol consumption amongst Pacific people (those of Polynesian descent) is recognized as a public health priority in New Zealand, yet little epidemiological information exists on this pattern of drinking. Using a large birth cohort study, which includes the mother, father and child triad, this study aims to determine the prevalence and change in any harmful drinking levels prenatally, antenatally and in the postpartum period for mothers and fathers, and to measure the concordance of both partners' reports of that drinking in an ethnically representative sample of Pacific families within New Zealand. Participants were selected from births where at least one parent was identified as being of Pacific ethnicity and a New Zealand permanent resident (1376 mothers and 825 fathers at baseline); many of whom are young to middle aged adults. These participants have been prospectively followed-up multiple times since. The Alcohol Use Disorders Identification Test consumption questions (AUDIT-C) were used over successive measurement waves to define any and harmful drinking levels. Recommended screening thresholds were employed. Longitudinal analyses on complete cases and imputed data, accounting for differential attrition, were undertaken and reported. Clear temporal patterns of alcohol consumption emerged for both mothers and fathers, together with significant and important ethnic differences. Moreover, there was considerable movement in alcohol consumption categories between consecutive measurement waves for both mothers and fathers. Among couples, there was significant asymmetry in drinking patterns and poor statistical agreement. However, 9.1% (14.1% in imputed analyses) of Pacific children aged 2 years had both parents indicated for harmful drinking. The significant important heterogeneity and ethnic differences suggest that both ethnic-specific and pan-Pacific interventions and prevention strategies are likely needed for successful interventions. More emphasis should be placed on targeting and addressing parents' alcohol misuse, particularly in the antenatal or postnatal period.
[Show abstract][Hide abstract] ABSTRACT: Accurate measurement of physical activity is fundamentally important in epidemiological research of physical activity behavior. A widely used telephone-based physical activity questionnaire was compared with other methods of administration and objective measures (pedometers and accelerometers) among 80 adults (43 women). The telephone questionnaire was comparable to both the self-administered form and international telephone-administered equivalent. Although moderate correlation coefficients with objective measures supported the use of the questionnaire, wide prediction intervals generated using Bland Altman methods highlighted large discrepancies between the measures, particularly in the moderate intensity category. These findings illustrate the limitations of correlation coefficients in validation studies and the inaccuracy of self-report questionnaires in measuring physical activity.
Research Quarterly for Exercise and Sport. 01/2013; 78(3):189-196.
[Show abstract][Hide abstract] ABSTRACT: Effective communication is fundamental to successful health care service delivery, and has a positive impact on access, quality of care, health outcomes, and patient satisfaction. Although there are a growing number of New Zealanders who do not speak English proficiently, underutilisation of trained interpreter services appears to be common in primary health care settings.
To describe the pattern of interpreter service need and utilisation by general practice services, and to identify key barriers and enabling factors to the use of trained interpreters.
A mixed methods study was employed. Census and Partnership Health Canterbury Te Kei o Te Waka (PHC) databases were combined, and quantitative analysis used to derive interpreter service need and utilisation patterns. Transcripts of focus groups and interviews from general practitioners, practice nurses and practice administration staff within the PHC were analysed, using qualitative methods to identify barriers and enablers to interpreter service use.
For the years 2008-2010, approximately 10 742 consultations per year involved a non-Englishspeaking patient, yet in only approximately 74.8 (0.7%) consultations per year were interpreter services utilised. Analysis of focus groups and interviews identified four global themes that represented barriers for interpreter service utilisation; namely, practicalities, expectations, knowledge of service, and systems.
The current use of interpreter services in PHC general practice appears to be significantly less than the need. In order to maximise health outcomes and reduce risk, strategies must be initiated to counter the barriers currently inhibiting interpreter service use, including adopting best practice policies.
Journal of primary health care 01/2013; 5(2):129-37.