bluuebunny/crossref_metadata_2025 huggingface dataset:
Are there disparities in care in people with diabetes? A review of care provided in general practice
Authors: Lawrenson Ross , Gibbons Veronique , Joshy Grace , Choi Peter
Published: November 2018

AIM: To estimate the prevalence of diabetes by age, gender and ethnicity; to look at quality of care and to investigate disparities in care. METHOD: A cross-sectional study in three practices in Hamilton. A comprehensive register was generated by identifying patients with diabetes through queries on the practices computer system looking for diagnosis codes for diabetes, prescription of hypoglycaemic agents, participation in the Get Checked programme or laboratory test for HbA1c. We then compared the glycaemic control and uptake of retinal screening in adult patients with Type 2 diabetes. RESULTS: The overall prevalence of diabetes in patients aged 20 years or older was 1221/26 096 (4.7%). Eighty percent had attended for a Get Checked annual review in the last 12 months. After adjusting for age, we found that Maori, males and those diagnosed more than five years ago were at increased risk of having unsatisfactory glycaemic control. Maori or Asian patients and women appeared less likely to have accessed retinal screening in the last two years. DISCUSSION: Computerised records including diagnostic codes and prescriptions in general practices can be used to develop comprehensive diabetes registers. Whilst this study shows that high levels of annual review can be achieved in patients with diabetes, the next challenge is to tackle the disparities in uptake of services such as retinal screening or the achievement of intermediate outcomes such as good glycaemic control. KEYWORDS: Diabetes mellitus; prevalence; health care disparities; ethnic groups; primary health care
Use of the inhaled corticosteroid to bronchodilator ratio in an audit of the treatment of asthma in an academic family medicine residency programme
Authors: Pisarik Paul
Published: November 2018

INTRODUCTION: Asthma affects around 5% of the United States population, with 50% having uncontrolled symptoms. AIM: To improve asthma care by seeing if the inhaled corticosteroid to bronchodilator ratio (RATIO) is associated with asthma control and if non-clinical factors were associated with adherence to asthma guidelines. METHOD: A retrospective study using University of Oklahoma-Tulsa, School of Community Medicine Family Medicine Clinic electronic medical records of a random sample of 49 patients with asthma who were seen at least twice from July 2003 through June 2007 and did not have a diagnosis of chronic obstructive pulmonary disease or exercise-induced asthma. RESULTS: The RATIO for those prescribed corticosteroid inhalers was directly related to the actual step of asthma care (STEP) but inversely related to the number of prednisone courses prescribed per year (R2=.30, p=0.0012). The difference between the actual STEP and ideal STEP (had corticosteroid inhalers been prescribed for all the months in the study) was directly related to the percent of available salbutamol (albuterol) inhalers that non-clinicians refilled and inversely related to the actual STEP (R2=.45, p=1.8 x 10-5). The available corticosteroid inhalers prescribed was directly related to the actual STEP and inversely related to the number of comorbid diagnoses addressed at the last asthma visit (R2=.70, p=5.8 x 10-10). DISCUSSION: Efforts to both limit salbutamol medications, especially by non-clinicians, and simultaneously prescribe appropriate amounts of inhaled corticosteroids, through a dedicated asthma visit, should improve asthma control. A higher RATIO implies better asthma control. KEYWORDS: Asthma; anti-inflammatory agents; albuterol; bronchodilator agents; drug therapy, combination; medical audit
Validation of quality of life and functional measures for older people for telephone administration
Authors: (Suei) Lin Ssu-Yu , Kerse Ngaire , McLean Christine , Moyes Simon
Published: November 2018

INTRODUCTION: Quality of life (QoL) and functional status are important aspects of health especially for older people. Efficient and valid ways of measuring older peoples health is of great importance. AIM: This project aims to establish the reliability of use of (1) a quality of life measure, the WHOQOL-BREF, and (2) a functional measure, the Nottingham Extended Activities of Daily Living scale (NEADL), for use over the telephone. METHODS: With ethical approval, patients over age 75 years (65 years if Maori) have been enrolled in the BRIGHT trial; a randomised controlled trial testing a practice-based screening initiative to prevent disability. Participants with possible disability, defined as being unable to get in and out of the car or take hot drinks from one room to another, completed a telephone interview including the two measures. Seventy participants repeated the two measures during a face-to-face interview within three months. RESULTS: Both WHOQOL-BREF and NEADL scores for the two forms of administration produced high Pearson correlation coefficients. There was good agreement for the WHOQOL-BREF as shown by the Bland-Altman graphs; however there was a tendency of a greater negative difference the greater the average score became (higher level of function) for the NEADL. DISCUSSION: This study shows that telephone interviews can generally provide a valid method to assess the quality of life and function in older people. KEYWORDS: Reliability; Quality of life; WHOQOL-BREF; functional status; NEADL; telephone administration
Charms & Harms: Black cohosh
Authors: Barnes Joanne
Published: November 2018

SUMMARY MESSAGE: Evidence for the efficacy of black cohosh extracts for treatment of menopausal symptoms is inconclusive. Black cohosh extracts have been associated with hepatotoxic reactions including changes in liver function test values, hepatitis, jaundice and hepatic failure. Health professionals should be aware of the possibility of (undisclosed) use of black cohosh, particularly among patients of menopausal age, be vigilant to signs of liver injury in patients using black cohosh, inform users of black cohosh about the possibility of hepatotoxic reactions and signs and symptoms of liver injury. Suspected adverse drug reactions should be reported to CARM. As with all herbal medicines, different black cohosh products vary in their pharmaceutical quality, and the implications of this for efficacy and safety should be considered.
General practitioner perceptions of clinical medication reviews undertaken by community pharmacists
Authors: Bryant Linda , Coster Gregor , McCormick Ross
Published: November 2018

INTRODUCTION: Delivery of current health care services focuses on interdisciplinary teams and greater involvement of health care providers such as nurses and pharmacists. This requires a change in role perception and acceptance, usually with some resistance to changes. There are few studies investigating the perceptions of general practitioners (GPs) towards community pharmacists increasing their participation in roles such as clinical medication reviews. There is an expectation that these roles may be perceived as crossing a clinical boundary between the work of the GP and that of a pharmacist. METHODS: Thirty-eight GPs who participated in the General PractitionerPharmacists Collaboration (GPPC) study in New Zealand were interviewed at the study conclusion. The GPPC study investigated outcomes of a community pharmacist undertaking a clinical medication review in collaboration with a GP, and potential barriers. The GPs were exposed to one of 20 study pharmacists. The semi-structured interviews were recorded and transcribed verbatim then analysed using a general inductive thematic approach. FINDINGS: The GP balanced two themes, patient outcomes and resource utilisation, which determined the over-arching theme, value. This concept was a continuum, depending on the balance. Factors influencing the theme of patient outcomes included the clinical versus theoretical nature of the pharmacist recommendations. Factors influencing resource utilisation for general practice were primarily time and funding. CONCLUSION: GPs attributed different values to community pharmacists undertaking clinical medication reviews, but this value usually balanced the quality and usefulness of the pharmacists recommendations with the efficiency of the system in terms of workload and funding. KEYWORDS: Family physicians; community pharmacy services; drug utilization review; primary healthcare; health plan implementation; qualitative research; interprofessional relations
Charms & Harms: Noni
Authors: Goodyear-Smith Felicity
Published: November 2018

SUMMARY MESSAGE: Evidence for the efficacy of noni for the wide range of medicinal purposes for which it may be used is not available. Health professionals should be aware of the possibility of (undisclosed) use of noni and its use should be avoided, or at least used only with caution, in patients on warfarin. Suspected adverse drug reactions should be reported to CARM. As with all herbal medicines, different noni products vary in their pharmaceutical quality, and the implications of this for efficacy and safety should be considered.
'Going-to-have-cancerness': a study of living with increased risk of BRCA1 and BRCA2 mutations for six South Island women
Authors: Crump Raewyn , Fitzgerald Ruth , Legge Michael
Published: November 2018

INTRODUCTION: Mutations in the BRCA (breast cancer) 1 and 2 genes are thought to lead to 5–10% of breast cancers. AIM: A qualitative study to explore six New Zealand women’s experiences of living with increased risk for a genetic susceptibility to breast cancer. METHODS: Six women were interviewed using semi-structured interviews, to explore their experiences of living at high risk for developing breast cancer due to familial and/or individual genetic susceptibilities. Results were analysed using thematic coding. After a three-year interval, interviewees were contacted again to discuss their experiences (although two were lost to follow-up). FINDINGS: The women held fatalistic views on developing cancer and drew on family experience as much as biomedical research to assess their situation. They became increasingly immersed in biomedical screening and prophylaxis without accompanying improvement to their peace of mind and with unrealistic ideas of it ‘preventing’ cancer. The biomedical management options and advice they reported receiving was factually inconsistent and a discrepancy emerged between women’s expectations of breast cancer health services (including genetic testing) and the delivered support and services. CONCLUSION: This small sample group cannot be used to draw implications on the views of the wider group of higher risk patients, but for these six women, genetic testing, screening and prophylaxis have not provided peace of mind; rather the reverse has occurred. The findings are provocative as they challenge the biomedical idea of patients’ experience of managing their genetic risk information as routinely positive. KEYWORDS: Qualitative research; genes BRCA1; genes BRCA2; breast neoplasm; risk
An audit of two methods of anticoagulation monitoring in a general practice
Authors: Wright Kerr
Published: November 2018

BACKGROUND AND CONTEXT: Patients with atrial fibrillation (AF) and a five-year stroke risk >15% should be on long-term oral anticoagulant therapy with adjusted dose warfarin unless there is a clear contraindication. ASSESSMENT OF PROBLEM: Ad hoc adjustments of warfarin dose and anticoagulation monitoring by a general practitioner is less efficient than a standardised protocol administered by the practice nurses. This study was a retrospective audit of patient anticoagulation control before and after a change in method of warfarin adjustment. Measures were frequency of testing, time spent in the therapeutic range and mean International Normalised Ratio. RESULTS: Thirty-two patients were studied over a 12-month period. The method change resulted in important improvements in practice efficiency while maintaining the standard of anticoagulation control with no significant increase in frequency of venesection. STRATEGIES FOR IMPROVEMENT: General practices still using ad hoc adjustments of warfarin therapy can adopt a standardised nurse-managed protocol to achieve greater efficiency without adversely affecting patient care. LESSONS: A move from the heavily doctor-intensive ad hoc system to the entirely nurse-led system improved practice efficiency. The doctor was liberated from the process. The nurse no longer had to act as liaison with the doctor. The receptionist did not have to ask patients to ring back once the doctor had seen the results. Patients received their instructions more quickly and their care was not compromised. KEYWORDS: Anticoagulation monitoring; warfarin; family practice
Viewpoint: Primary health care funding for children under six years of age in New Zealand: why is this so hard?
Authors: Fancourt Nicholas , Turner Nikki , Innes Asher M , Dowell Tony
Published: November 2018

The intention of this viewpoint article is to prompt discussion and debate about primary health care funding for children under the age of six. While New Zealand offers a superb natural environment for childhood, our child health outcomes continue to be poor, ranking lowest amongst 29 countries in a recent report by the Organisation for Economic Co-operation and Development. Since 1996, various funding arrangements have been introduced with the goal of achieving free primary health care for children under six years of age and nearly 80% of practices now offer care to this group without charge. Universal no cost or very low cost access for young children, however, remains elusive, particularly for after-hours care, and this is important given that at least one in five children lives in poverty. We are under no illusions about the complexity of primary care funding mechanisms and the challenges of supporting financially-sustainable systems of after-hours care. Good health care early in life, however, is a significant factor in producing a healthier and more productive adult population and improving access to primary care lessens the impact of childhood illness. We suggest that reducing cost barriers to primary care access for young children should remain an important target, and recent examples show that further reductions in cost for primary care visits for young children, including after-hours, is possible. Further funding is needed to make this widespread, in conjunction with innovative arrangements between funding authorities, primary care providers, and emergency departments. We encourage further debate on this topic with a view to resolving the question of whether the goal of free child health care for young children in New Zealand can be realised.
Engaging with complementary and alternative medicine in general practice
Authors: Upsdell Marion , Jaye Chrystal
Published: November 2018

INTRODUCTION: A number of surveys in New Zealand have documented the growing interest and experience that GPs have in their encounters with complementary and alternative medicine. This study has focussed on reasons why some GPs choose to engage with CAM, how these reflect their aims of health care, the difficulties they encounter and how these are negotiated within the consultation. METHOD: A sample of 12 mainstream GPs from the greater Auckland area agreed to a semi-structured interview, and the transcripts were analysed using grounded theory technique. FINDINGS: All general practitioners interviewed in this study were confronted to a greater or lesser extent with their patients interest in CAM. Not all chose to engage with the subject. Those who did engage cited a number of reasons for doing so which included a desire to remain patient-centred, to place their patients choices within the context of a good diagnosis, to provide what evidence-based information they could and to minimise potential harms from its use. CONCLUSION: This study adds weight to findings in previous studies that many general practitioners encounter CAM in their consultations and explores reasons why they choose to engage with it. The findings suggest that increased dialogue with non-mainstream health practitioners and access to knowledge sources giving a basic understanding of CAM practices and philosophies that both CAM and mainstream practitioner communities regard as reliable would be of benefit to these GPs. KEYWORDS: Complementary and alternative medicine; family practice; patient-centered medicine
The health promotion shift into Primary Health Organisations: Implications for the health promotion workforce
Authors: Lovell Sarah , Neuwelt Pat
Published: November 2018

INTRODUCTION: Reconciling the primary care sectors traditional concern for individual health outcomes with a population health approach is integral to the implementation of New Zealands Primary Health Care Strategy, and a key challenge for health promotion in New Zealand. The purpose of this study was to examine the views of health promoters, their funders and managers toward the implementation of the Primary Health Care Strategys health promotion agenda. METHODS: Focus groups and interviews were carried out with 64 health promoters and 21 health sector managers and planners and funders over the 12 months beginning March 2008. Interview and focus group transcripts were analysed thematically. FINDINGS: Primary Health Organisations (PHOs) have been perceived as both an opportunity and a threat to health promotion. The opportunity was seen to lie in the development of health promotion responsive to the needs of communities. Yet the numerous PHOs that emerged spread funding and capacity for health promotion thin, particularly amongst smaller PHOs. CONCLUSION: The failure of the Ministry of Health to engage the health promotion workforce in the development and implementation of the Primary Health Care Strategy has led to a clear sense of vulnerability among health promoters. Ideological divisions between primary care and public health have been exacerbated by the restructuring of health promotion funding and delivery. Within non-governmental organisations and public health units concern continues to surround the legitimacy of health promotion approaches undertaken within the primary health care sector. KEYWORDS: Health promotion; primary health care; health policy; Primary Health Organisations; New Zealand; restructuring
New Zealand health disparities  pharmacists knowledge gaps and training needs
Authors: Aspden Trudi , Butler Cassandra , Moore Barbara , Sheridan Janie
Published: November 2018

INTRODUCTION: Reducing health disparities is a priority for the New Zealand (NZ) Government and the health care sector and, although not mandatory until 2012, Competence Standard 1 for NZ pharmacists has been revised to reflect this. AIM: The main aim was to understand the information needs of pharmacists in the context of reducing health inequalities in NZ through undertaking a baseline study of pharmacists knowledge of health status disparities, identifying relevant resources most commonly read by pharmacists, soliciting ideas on how the profession can contribute to reducing health disparities and gauging pharmacists willingness to undergo further training. METHOD: An anonymous, semi-structured questionnaire was posted out to 500 randomly selected practising pharmacists registered in NZ. RESULTS: A 27% response rate was achieved. In general, responding pharmacists had good health disparity knowledge about asthma and the prevalence of cardiovascular disease, but were less knowledgeable about differences in life expectancies and some mortality rates. Responding pharmacists made a variety of achievable suggestions where pharmacists can contribute to decreasing health disparities. Eighty percent of respondents indicated they were interested in learning more about cultural competence and health disparities in their community. DISCUSSION: Our results indicate a need for pharmacists to up-skill in the area of health disparities and cultural competence and for more effective promotion of the resources available to pharmacists to improve their knowledge in this area. The pharmacists in this study appear willing to undertake such study; however, due to the low response rate generalisations to all pharmacists practising in New Zealand cannot be made. KEYWORDS: Pharmacists; New Zealand; health disparities; cultural competency
The educational value of peer groups from a general practitioner perspective
Authors: Lillis Steven
Published: November 2018

INTRODUCTION: Peer review groups are compulsory for New Zealand (NZ) general practitioners (GPs) but little is known about how they function. This study aimed to understand the educational value of peer group meetings to general practitioners and explore methods of increasing value. METHODS: A qualitative study was undertaken comprising a single meeting involving 22 NZ GPs with an interest in education and subsequent thematic analysis on the raw data. FINDINGS: Respondents indicated a strong belief in the educational value of peer groups. Pastoral care was also perceived as a valuable outcome of peer groups that was somewhat separate from the educational value. It would appear that the majority of peer groups work on the basis of internally driven contemporaneous learning needs based on difficult work experiences. There was limited concern over the wide interpretation of what constitutes acceptable topics for discussion as well as the informal nature of training and structuring the meetings. DISCUSSION: The interactive nature of peer group learning with subject matter of real life problems would suggest peer groups have the potential to make significant change in the performance of doctors. A broad and differing range of experience in the group is more likely to generate an educationally valuable environment. It would appear that there may be a limited role for assisting peer groups with methods of structuring content and increasing effectiveness. KEYWORDS: Education, medical, continuing; peer group; peer review, research
Assessing the effectiveness of cold chain management for childhood vaccines
Authors: Turner Nikki , Laws Athene , Roberts Loretta
Published: November 2018

INTRODUCTION: Effective immunisation programmes require a stable cold chain to maintain potency of vaccines from national stores through to delivery sites. AIM: To assess the effectiveness of the New Zealand cold chain and examine the possible impacts of policy changes over the same time period on cold chain effectiveness. METHODS: Heat- and freeze-sensitive monitors were attached to 5% of randomly selected childhood vaccines from 2002 to 2008. Six-monthly reports on data collected from monitor cards were collated and analysed to look for changes over time in freeze and heat exposure failures for vaccines. RESULTS: From December 2002 to June 2008 a total of 21 431 monitor cards were included in vaccines distributed from the national store; 9474 (44.2%) of all cards were returned and 8249 (38.5% of total) were correctly completed. Over this period the percentage of valid returns recorded as heat exposed decreased from 38% to 7% (Χ2 371, p2 134.228, p2 163.83, p<0.0001), giving estimated annual savings of nearly NZ$4 million. DISCUSSION: Significant improvements can be made in cold chain management with resulting savings in vaccine wastage. This study demonstrates that such improvements have been made in New Zealand in recent years. This is likely to be due to a combination of improving equipment, systems, education and training, increased provider attention and quality standards. KEYWORDS: Vaccination; cold chain; refrigeration; primary health care
Nurses' perceptions of nurse-led healthy lifestyle clinics
Authors: Marshall Bob , Floyd Sue , Forrest Rachel
Published: November 2018

INTRODUCTION: Nineteen Nurse-Led Healthy Lifestyle Clinics (NLHLCs) were implemented and targeted Maori, Pacific and people living in high deprivation areas. The general focus of the clinics was on lifestyle issues and much of the nursing was educative and preventative care. The aim of this project was to assess nurses’ experiences and opinions of their participation in the clinics. METHODS: Nurses participating in the clinics were asked to complete a monthly narrative report over five reporting periods, and these were collated and evaluated for emergent themes. Sixteen nurses were subsequently interviewed and the transcripts analysed to identify major themes and sub-themes. FINDINGS: In total, 167 narrative reports were collected from 53 of the 115 participating nurses. Almost all the nurses either strongly agreed or agreed that they enjoyed working in an NLHLC. This enjoyment was the result of: increased time for in-depth consultations, being able to provide enhanced holistic patient care, developing knowledge, gaining experience, receiving positive patient feedback and the satisfaction of seeing patient improvements. Nurses reported that the opportunity and responsibility of providing holistic nursing care, and the skills and knowledge gained from participating in the project, were extremely valuable. CONCLUSION: NLHLCs provide benefits for both patient and nurse. For the nurse, job satisfaction is increased through positive patient feedback, opportunities for professional development and a greater feeling of empowerment. KEYWORDS: Nurse-led clinic; self perception; lifestyle risk reduction; nursing evaluation research
What contributes to delays? The primary care determinants of immunisation timeliness in New Zealand
Authors: Petousis-Harris Helen , Grant Cameron , Goodyear-Smith Felicity , Turner Nikki , York Deon , Jones Rhys , Stewart Joanna
Published: November 2018

INTRODUCTION: Delay in receipt of the first vaccine dose in the primary series is one of the strongest and most consistent predictors of subsequent incomplete immunisation. AIM: To describe the on-time immunisation delivery of New Zealand infant scheduled vaccines by primary care practices and identify characteristics of practices, health professionals and patients associated with delays in receipt of infant immunisations. METHODS: Timeliness of immunisation delivery and factors associated with timely immunisation were examined in 124 randomly selected primary care practices in two large regions of New Zealand. RESULTS: A multiple regression model of demographic, practice, nurse, doctor and caregiver association explained 68% of the variance in immunisation timeliness between practices. Timeliness was higher in practices without staff shortages (ß-coefficient -0.0770, p= 0.01), where nurses believed parental apathy (ß-coefficient 0.0819, p=0.008) or physicians believed parental access (ß-coefficient 0.109, p=0.002) was a barrier, and lower in practices with Maori governance (ß-coefficient -0.0868, p=0.05), higher social deprivation (ß-coefficient -0.0643,<0.001) and where caregivers received immunisation-discouraging information (ß-coefficient -0.0643, p=0.04). DISCUSSION: Interventions supporting practice teams and providers in primary care settings could produce significant improvements in immunisation timeliness. KEYWORDS: Immunization; vaccination; immunization programs; primary health care; family practice
New Zealand Diabetes Cohort Study cardiovascular risk score for people with Type 2 diabetes: validation in the PREDICT cohort
Authors: Robinson Tom , Raina Elley C , Wells Sue , Robinson Elizabeth , Kenealy Tim , Pylypchuk Romana , Bramley Dale , Arroll Bruce , Crengle Sue , Riddell Tania , Ameratunga Shanthi , Metcalf Patricia , Drury Paul
Published: November 2018

INTRODUCTION: New Zealand (NZ) guidelines recommend treating people for cardiovascular disease (CVD) risk on the basis of five-year absolute risk using a NZ adaptation of the Framingham risk equation. A diabetes-specific Diabetes Cohort Study (DCS) CVD predictive risk model has been developed and validated using NZ Get Checked data. AIM: To revalidate the DCS model with an independent cohort of people routinely assessed using PREDICT, a web-based CVD risk assessment and management programme. METHODS: People with Type 2 diabetes without pre-existing CVD were identified amongst people who had a PREDICT risk assessment between 2002 and 2005. From this group we identified those with sufficient data to allow estimation of CVD risk with the DCS models. We compared the DCS models with the NZ Framingham risk equation in terms of discrimination, calibration, and reclassification implications. RESULTS: Of 3044 people in our study cohort, 1829 people had complete data and therefore had CVD risks calculated. Of this group, 12.8% (235) had a cardiovascular event during the five-year follow-up. The DCS models had better discrimination than the currently used equation, with C-statistics being 0.68 for the two DCS models and 0.65 for the NZ Framingham model. DISCUSSION: The DCS models were superior to the NZ Framingham equation at discriminating people with diabetes who will have a cardiovascular event. The adoption of a DCS model would lead to a small increase in the number of people with diabetes who are treated with medication, but potentially more CVD events would be avoided. KEYWORDS: Cardiovascular disease; diabetes; prevention; risk assessment; reliability and validity
Addressing patient alcohol use: a view from general practice
Authors: Mules Thomas , Taylor Jennifer , Price Rachel , Walker Logan , Singh Baneet , Newsam Patrick , Palaniyappan Thenmoli , Snook Toby , Ruselan Mahfuzah , Ryan John , Santhirasegaran Jaishree , Shearman Phoebe , Watson Petronella , Zino Richard , Signal Louise , Fouge Geoff
Published: November 2018

INTRODUCTION: General practitioners (GPs) have the potential to promote alcohol harm minimisation via discussion of alcohol use with patients, but knowledge of GPs current practice and attitudes on this matter is limited. Our aim was to assess GPs current practice and attitudes towards discussing alcohol use with their patients. METHODS: This qualitative study involved semi-structured, face-to-face interviews with 19 GPs by a group of medical students in primary care practices in Wellington, New Zealand. FINDINGS: Despite agreement amongst GPs about the importance of their role in alcohol harm minimisation, alcohol was not often raised in patient consultations. GPs usual practice included referral to drug and alcohol services and advice. GPs were also aware of national drinking guidelines and alcohol screening tools, but in practice these were rarely utilised. Key barriers to discussing alcohol use included its societal taboo nature, time constraints, and perceptions of patient dishonesty. CONCLUSION: In this study there is a fundamental mismatch between the health communitys expectations of GPs to discuss alcohol with patients and the reality. Potential solutions to the most commonly identified barriers include screening outside the GP consultation, incorporating screening tools into existing software used by GPs, exploring with GPs the social stigma associated with alcohol misuse, and framing alcohol misuse as a health issue. As it is unclear if these approaches will change GP practice, there remains scope for the development and pilot testing of potential solutions identified in this research, together with an assessment of their efficacy in reducing hazardous alcohol consumption. KEYWORDS: Primary health care; general practice; alcohol drinking; alcohol-related disorders, attitude of health personnel
Potion or Poison? Colloidal silver
Authors: Woods David
Published: November 2018

SUMMARY MESSAGE: Colloidal silver is widely marketed for a variety of health benefits. A range of potentially useful in vitro effects have been shown, but no scientific evidence of actual patient benefit. Adverse effects are possible and are more likely with products with high silver content or long-term use.
Living large: the experiences of large-bodied women when accessing general practice services
Authors: Russell Nicola , Carryer Jenny
Published: November 2018

INTRODUCTION: Numerous studies report high levels of stigma and discrimination experienced by obese/overweight women within the health care system and society at large. Despite general practice being the most utilised point of access for health care services, there is very little international or national exploration of the experiences of large-bodied women (LBW) accessing these services. The aim of this study was to explore LBWs experiences of accessing general practice services in New Zealand. METHODS: This is a qualitative, descriptive, feminist study. Local advertising for participants resulted in eight self-identified, large-bodied women being interviewed. A post-structural feminist lens was applied to the data during thematic analysis. FINDINGS: The women in this study provided examples of verbal insults, inappropriate humour, negative body language, unmet health care needs and breaches of dignity from health care providers in general practice. Seven themes were identified: early experiences of body perception, confronting social stereotypes, contending with feminine beauty ideals, perceptions of health, pursuing health, respecting the whole person, and feeling safe to access care. CONCLUSION: Pressure for body size vigilance has, in effect, excluded the women in this study from the very locations of health that they are encouraged to attend  including socialising and exercising in public, screening opportunities that require bodily exposure, and accessing first point of care health services. KEYWORDS: General practice; obesity; primary health care; social stigma; women
Effective general practice: audit and feedback for the primary series of immunisations
Authors: Reynolds Gary , Timo Mareta , Dev Anjileena , Poole Tracey , Turner Nikki
Published: November 2018

INTRODUCTION: General practice immunisation audits do not always match the national rates recorded on the New Zealand (NZ) National Immunisation Register (NIR). AIM: To complete audits at one general practice for infants requiring the primary series of immunisations (6-week, 3-month and 5-month vaccines) over a 12-month period and compare findings with the NIR audit. METHODS: A manual and electronic practice management system (PMS) audit were compared with identical NIR audit parameters for completion of the 5-month vaccination from 1 February 2011 to 1 February 2012. All three results were then combined with further sub-audits of the total practice newborn population to produce a multifaceted audit, identifying further eligible patients. The NIR database query tool was used to corroborate data on partially immunised and unimmunised patients identified. RESULTS: All three initial audits produced different results for vaccinated and eligible patients: NIR 31/36; PMS audit 39/43; manual audit 41/48. The multifaceted audit identified 48 eligible infants. All 48 (100%) started their primary series  95.8% (46 of 48) fully immunised; 4.2% (2 of 48) partially immunised, missing only one injection. None were unimmunised, contrary to initial audits. Lower levels of timeliness of delivery were confirmed for this practice, with 52.1% (25 of 48) immunised on time. DISCUSSION: Results show 9.7% higher levels of immunisation than reported by NIR statistics for this practice (95.8% vs 86.1%), above current NZ government and World Health Organization targets. The multifaceted audit produced the best estimate of eligible patients and identified deficiencies in vaccine delivery. KEYWORDS: Children; general practice; immunisation schedule; medical audit; New Zealand
Potion or Poison? Vitamin C
Authors: Martini Nataly
Published: November 2018

SUMMARY MESSAGE: For most people, a healthy diet will provide an adequate dose of vitamin C. Use of vitamin C may reduce the duration of symptoms but not the incidence of the common cold. High doses (>2 g/day) can have adverse effects and may interact with warfarin and aluminium. Vitamin C should be used cautiously with oestrogens, cancer chemotherapy, HIV medications, statins and fluphenazine.
Factors contributing to high immunisation coverage among New Zealand Asians
Authors: Pal Moneeta , Goodyear-Smith Felicity , Exeter Daniel
Published: November 2018

INTRODUCTION: While New Zealand (NZ) immunisation coverage has improved steadily over the years, there is inequity between ethnic groups, with rates lower in Maori and Pacific people and highest in Asian people. This qualitative study aimed to identify attitudes and behaviours of NZ Asian parents of children under the age of five years that might contribute to their seeking immunisation for their children. METHODS: In-depth, semi-structured interviews were conducted to explore attitudes, values, experiences, knowledge, behaviour and perceived barriers regarding childhood immunisation. Transcripts were analysed using a general inductive approach. FINDINGS: Key themes identified were a general positive attitude towards immunisation, being well-informed and aware of the value of immunisation, accepting governmental encouragement to use immunisation services, and perceiving minimal barriers to immunisation services access. CONCLUSION: The findings of this study suggest that high immunisation coverage rates among NZ Asians may be primarily due to parental attitudes, rather than the quality and accessibility of immunisation services in NZ. KEYWORDS: Asian continental ancestry group; child; culture; ethnic groups; immunisation; qualitative research
The patient perspective on a first raised PSA test
Authors: Brown Charis , Hodgson Fraser , Obertova Zuzana , Holmes Michael , Lawrenson Ross
Published: November 2018

INTRODUCTION: Approximately 350 000 prostate-specific antigen (PSA) tests are undertaken in New Zealand on a quarter of a million men each year. A number of studies have looked at PSA testing done by general practitioners (GPs) and subsequent outcomes. Few have looked at the patient perspective after a raised PSA result. AIM: To explore patient experiences up to and following a raised PSA test. METHODS: Thirty-one general practices within the Midland region were recruited. Community laboratory databases were used to identify all men with a first raised PSA test during 2010. Questionnaires were sent to these men. RESULTS: One hundred and ninety-four (63%) eligible responses were received from 307 eligible men delivered questionnaires. For 54% of men this was their first PSA test. Most men (66%) identified that their PSA test was initiated by their GP. Forty-three percent of men identified having symptoms at the time of their first raised PSA test. A digital rectal examination (DRE) was performed on 73% of men at the time of the test. Fifty-eight percent of men were referred to see a specialist. Maori men were less likely to be referred after a raised PSA. Of all men referred, 61% received a biopsy. DISCUSSION: PSA testing is predominantly initiated by GPs. We found the care pathway is variable for men after an elevated PSA result. Standardisation of the pathway prior to and post diagnosis would assist patients in knowing what to expect and would aid in GP management of men being investigated for prostate cancer. KEYWORDS: Patient care; prostate-specific antigen; screening, opportunistic
More than ideology: perceived unfairness differentiates supporters of a new anti-austerity party from supporters of traditional left-wing parties / Más que ideología: la injusticia percibida diferencia a los simpatizantes de un nuevo partido antiausteridad de los simpatizantes de los partidos tradicionales de izquierda
Authors: Vázquez Alexandra , Lois David
Published: November 2018

After the outbreak of the economic crisis in 2008, anti-austerity parties in South Europe have gained prominence and dramatically transformed the political landscape. In Spain, the emergence of PODEMOS, a left-wing, anti-austerity party, has jeopardized the traditional two-party system. However, little is known about the psychological reasons that prompted more than one million Spaniards to vote for a newly created party in its first elections. To fill this gap the present study examines why people intend to vote for PODEMOS as opposed to traditional left-wing parties. We found that in addition to conventional predictors of voting behaviour (ideological orientation and party identification), perceived unfairness — a key variable within the collective action theory — critically influenced the preference for PODEMOS as opposed to traditional left-wing parties. A qualitative analysis of the reasons that participants reported in an open question yielded similar results. These findings suggest that supporting an anti-austerity party might be considered a collective action aimed at promoting social change.
Job search self-efficacy as a mediator between emotional intelligence and the active job search process / Autoeficacia de búsqueda como mediadora de la inteligencia emocional y la búsqueda activa de empleo
Authors: Nieto-Flores María-Pilar , Berrios M. Pilar , Extremera Natalio
Published: November 2018

This study analyses the role of job search self-efficacy as a possible mediating variable in the relationship between emotional intelligence (EI) and the active job search process in a sample of 196 unemployed people in Andalusia, 107 men and 89 women aged 18 to 59 ( M = 30.90; SD = 8.07). They were all provided an EI scale, a job search self-efficacy measure and an active job search measure, and provided their social and demographic information. As expected, EI was positively associated with higher levels of job search self-efficacy, as well as higher levels of job search intensity. In addition, mediation analyses indicated that EI had a significant indirect effect (through self-efficacy) on the active job search process. The results are discussed for application in future career guidance programmes.
Dramatherapy and Gender: Shattering Norms and Unearthing Possibilities
Authors: Wilkinson Georgina Beth
Published: November 2018

This critique was initially written as part of my MA Dramatherapy Independent Scholarship at the University of Derby, standing alongside a 30-minute solo performance. Together, they created an overall body of work; an autoethnographic research project into a topic based upon personal experience. Originally titled “Dramatherapy and the Glass Slipper: Utilising the Story of Cinderella to Challenge What It Means to Be a Woman”, this theoretical and embodied investigation navigated my experience of gender within western society through the medium of dramatherapy, with Cinderella as its metaphor. One year on, I am proud to be returning to this investigation as part of the Dramatherapy journal LBGTQ+ special edition, enabling me to reflect upon my continuing journey with, and experience of, gender, society and dramatherapy. Utilising both my original research and recent reflections, this article will present how dramatherapy enabled me to explore, question and challenge the social construct of gender. Ultimately, igniting a personal transformation to a more authentic self, as well as unearthing a professional endeavour to create a therapeutic experience that can acknowledge the spectrum of individual experiences; one based on humanness.
Microstructure and corrosion behaviour of additively manufactured Ti–6Al–4V with various post-heat treatments
Authors: Xu Yangzi , Lu Yuan , Liang Jianyu , Sisson Richard D.
Published: November 2018

This paper presents the results of an experimental investigation into the effects of solution treatment, age and stress relief on the corrosion behaviour of direct metal laser sintered Ti–6Al–4V. The evidence of microstructural change and phase evolution, as affected by heat-treatment temperature, was characterised through scanning electron microscopy and X-ray diffraction. The corrosion behaviour was evaluated electrochemically in Ringer's solution, at 37°C. It was determined that the non-equilibrium α’ phase, with a small amount of β nuclei, formed in the as-printed sample. Enhancement in the resistance of the passive oxide layer on the alloy was observed after solution treatment and age, as well as after high-temperature stress relief. The structure of the passive layer of the surface showed a heat-treatment temperature dependency.
Arc joining of aluminium alloy to stainless steel with the aid of milling
Authors: Xu Huibin , Gao Pengyu , Cong Wei , Li Moyang , Cai Yuhua
Published: November 2018

The aluminium alloy and stainless steel were successfully joined by arc brazing with the aid of milling without using flux at a low heat input. With the increase of the radial cutting depth, more and more strip steel chips appeared in the welded seam, the shear strength of welded seam increased gradually. When the radial cutting depth was 0.10 mm, a very thin and wavy θ-FeAl3 IMCs layer can be obtained at the joint interface. At this time, there was the maximum value of shear strength of the joint interface (111 MPa). The fracture of joint interface goes through by a fluctuating path.
Impact of Early Telephone Contact on 3-Month Follow-Up Rates following Residential Drug and Alcohol Treatment: A Randomized Controlled Trial
Authors: Deane Frank P. , Blackman Russell , Kelly Peter J.
Published: November 2018

Background: Routine outcome monitoring (ROM) is an important component of service provision and qualitity assurance procedures. However, a major logistical and financial challenge for organizations is successfully following up participants once they have left residential alcohol and other drug treatment. The aim of the current study was to assess the impact and effectiveness of an “early” follow-up contact and brief interview on subsequent 3-month ROM follow-up success. Methods: Participants were 800 clients attending specialist residential alcohol and other drug treatment provided by The Salvation Army. As part of routine outcome assessment procedures, all people attending these programs are asked to complete a 3-month follow-up assessment. Participants were randomly allocated either to the early contact condition (i.e., “early” 2-week follow-up contact prior to the 3-month follow-up assessment) or to the control condition (i.e., no “early” 2-week follow-up prior to the 3-month follow-up assessment). The primary outcomes were the proportion of participants who were followed up and surveyed at 3 months. Results: There were significantly higher follow-up rates at 3 months post discharge for participants in the early contact group (55.6%) compared with the control condition (46.1%). Although there were higher rates of 3-month follow-up for participants in the early contact group, rates of successful survey completion were not significantly different between the 2 groups. Conclusions: Including an early 2-week telephone call prior to the 3-month assessment increased the number of participants we were able to follow up at 3 months post discharge but did not improve the rate of survey participation at 3 months. The additional costs associated with this activity and the modest increase in follow-up rates need to be considered prior to organizations investing in these follow-up enhancement activities.