Restructuring and hospital care: Sub-national trends, differentials, and their impacts; New Zealand from 1981

An analysis of the "nation's health" is the central concern of this study. Its genesis was a detailed, technical, time-series research on regional and ethnic differentials in health in New Zealand. But as this work progressed it became increasingly evident that the results of this more narrow analysis could make a wider contribution to the development of a knowledge-base on health trends and on the impacts of policy on these. In a sense, the analysis provides a demographic audit of health trends over the last two decades. The focus here is different from that in most other studies on restructuring of the New Zealand health system as their concern was either to review in detail the rewriting of policy per se, and attendant structural and institutional changes (Fougere 2001), or to identify how these changes relate to changes in mortality (Blakely et al. 2008). The research question reported here was, instead, to analyse the most crucial of health outcomes, „how long we live and how often we end up in hospital‟, identified in the earlier quotation, to report patterns and trends in hospital use nationally and sub-nationally over the period under review, and to determine the degrees to which various sub-populations benefited, or did not benefit, from these changes. The analysis focuses on the hospital sector in the system, but it will also show relations between this and other sectors, formal (e.g. primary health) and less formal (notably the healthcare afforded sickness and invalid beneficiaries). Thus two questions are addressed: 1. whether or not the nation‟s population health improved over the period and; 2. whether or not there was a convergence in patterns of health gain across its constituent sub-populations defined geographically and ethnically. This monograph deals with sub-national differences in health in New Zealand over a period of substantial socio-economic restructuring and associated radical changes in health policy, health systems and their related information systems (see also, Text Appendix A). It complements the recently published analysis of national ethnic trends in mortality (Blakely et al. 2004), but differs in several critical respects. That study reviewed health status by emphasising aetiologies and causes of death. In contrast, the present analysis focuses on actuarial dimensions of both mortality and morbidity and on health as measured by functional capacity rather than the disease orientated „burden of disease‟. It goes beyond health status issues to look at the system itself, to assess whether health policy outcomes were generated more through efficiency-gain (economic or service delivery, such as those resulting in a convergence sub-nationally of supply and demand effects), or through health gains, or ideally, by both. To do this, and as a by-product to analyse changes in health status and the system in an era of restructuring, innovative methodologies and composite time-series indices combining the two dimensions of a „nation‟s health‟, needing hospital care and longevity, have had to be custom-designed. To achieve this objective, the ensuing analysis is often technical, and may introduce concepts that are unfamiliar to some readers. In order to look at possible inequalities of outcome, comparisons were made between regions and ethnic groups, as well as age-groups and genders, and as a result, in places the analysis becomes rather complex

Review and update of the Health of the Nation Outcome Scales for Elderly People (HoNOS65+)

Aims and method The Health of the Nation Outcome Scales for Elderly People (HoNOS65+) has been used widely for 20 years, but has not been updated to reflect contemporary clinical practice. The Royal College of Psychiatrists convened an advisory board, with expertise from the UK, Australia and New Zealand, to propose amendments. The aim was to improve rater experience when using the HoNOS65+ glossary by removing ambiguity and inconsistency, rather than a more radical revision. Results Views and experience from the countries involved were used to produce a series of amendments intended to improve intra- and interrater reliability and improve validity. This update will be called HoNOS Older Adults to reflect the changing nature of the population and services provided to meet their needs. These improvements are reported verbatim, together with the original HoNOS65+ to aid comparison. Clinical implications Formal examination of the psychometric properties of the revised measure is needed. However, clinician training will remain crucial

Simulation of Blood Flow and Nanoparticle Transport in a Stenosed Carotid Bifurcation and Pseudo-Arteriole

Numerical simulation of flow through a realistic bifurcated carotid artery geometry with a stenosis has been conducted for comparison to experimental measurements. The behaviour of simplified therapeutic nanoparticles in relatively low concentration was observed using a discrete particle approach. The role of size (diameters from 500 nm to 50 nm) in determining particle residence time and the potential for both desirable and undesirable wall interactions was investigated. It was found that mean particle residence time reduced with decreasing particle diameter, and the percentage of particles experiencing one or more wall interactions increased simultaneously. Further simulations were conducted on a scaled-down version of the geometry which approximated the size and flow conditions of an arteriole with capillary branches, and in this instance the mean residence time increased with decreasing particle diameter, owing largely to the greater influence of Brownian motion. 33% of all 50 nm particles were involved in wall interactions, indicating that smaller particles would have a greater ability to target, for instance, cancerous tumours in such regions

A Large Retinal Capillary Hemangioma in the Anterior Retina Treated with Photodynamic Therapy

www.karger.com/cop This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License (www.karger.com/OA-license), applicable to the online version of the article only. Distribution for non-commercial purposes only

Navigating WeChat in COVID Times as a Chinese Care Home Resident

Context: In New Zealand, COVID-19-related lockdowns led to the implementation of visiting restrictions in care homes. This placed residents at risk of isolation. The Chinese community is a fast-growing ethnic group and faces additional difficulties, including language and cultural barriers. Information and communication technologies (ICTs) may enhance communication and maintain social connectedness between families and care homes during lockdowns. Objective(s): To explore the role of technology in the experiences of Chinese care home residents living in New Zealand during three lockdown periods from 2020 to mid-2021. Method(s): We performed semi-structured interviews with predominantly Chinese individuals (n = 18) across two Chinese-run care homes in Auckland, New Zealand. Participants included residents (n = 6), family members (n = 6) and facility staff (n = 6). Interviews were conducted and transcribed in either English or Mandarin Chinese, then coded and analysed to synthesise themes. Findings: We identified five themes: (i) an online care home community via WeChat, (ii) benefits of technology, (iii) barriers to technology use, (iv) the infodemic: technology as information overload and (v) the use of technology post-lockdowns. Limitations: Sample sizes for each sub-group were limited. The generalisability of findings is limited to those with no dementia or mild dementia. Residents with more severe dementia were excluded from the study but might also have benefitted from the intervention. Implications: The main finding of this study is that WeChat is an effective means of maintaining social connections in the Chinese care home community, particularly when usage is facilitated by staff. We recommend care homes consider using social media platforms to connect residents with the outside world. Sufficient resources, training and staff are needed to advocate for care home residents to be part of a digital community in a way that is culturally relevant

Predictive factors of nonfatal self-harm among community-dwelling older adults assessed for support services

Background: Older adults receiving support services are a population at risk for self-harm due to physical illness and functional impairment, which are known risk factors. This study aims to investigate the relative importance of predictive factors of nonfatal self-harm among older adults assessed for support services in New Zealand. Methods: interRAI-Home Care (HC) national data of older adults (aged ≥ 60) were linked to mortality and hospital discharge data between January 1, 2012 and December 31, 2016. We calculated the crude incidence of self-harm per 100,000 person-years, and gender and age-adjusted standardized incidence ratios (SIRs). The Fine and Gray competing risk regression model was fitted to estimate the hazard ratio (HR; 95% CIs) of self-harm associated with various demographic, psychosocial, clinical factors, and summary scales. Results: A total of 93,501 older adults were included. At the end of the follow-up period, 251 (0.27%) people had at least one episode of nonfatal self-harm and 36,333 (38.86%) people died. The overall incidence of nonfatal self-harm was 160.39 (95% CI, 141.36–181.06) per 100,000 person-years and SIR was 5.12 (95% CI, 4.51–5.78), with the highest incidence in the first year of follow-up. Depression diagnosis (HR, 3.02, 2.26–4.03), at-risk alcohol use (2.38, 1.30–4.35), and bipolar disorder (2.18, 1.25–3.80) were the most significant risk factors. Protective effects were found with cancer (0.57, 0.36–0.89) and severe level of functional impairment measured by Activities of Daily Living (ADL) Hierarchy Scale (0.56, 0.35–0.89). Conclusion: Psychiatric factors are the most significant predictors for nonfatal self-harm among older adults receiving support services. Our results can be used to inform healthcare professionals for timely identification of people at high risk of self-harm and the development of more efficient and targeted prevention strategies, with specific attention to individuals with depression or depressive symptoms, particularly in the first year of follow-up

Comparison of laser speckle contrast imaging and laser-Doppler fluxmetry in boys and men

Objective: We compare microvascular reactivity assessed by laser-Doppler fluxmetry (LDF) and laser speckle contrast imaging (LSCI) of boys and men during rest, post-occlusive reactive hyperaemia (PORH), and cycling exercise. Methods: 19 boys (9±1 y) and 18 men (22±2 y) participated. LDF and LSCI measures were taken of the forearm during rest, PORH, and exercise. Results: For all 3 assessments, the LSCI presented with higher flux values than the LDF for both boys and men (p<0.001). Bland-Altman analyses indicated that there was a positive linear bias between LSCI and LDF measurements in both boys and men. Regression analyses showed that the responses for the two methods were variable, depending on the particular assessment. For instance, at rest in boys there was no relationship between LDF and LSCI (r2=0.002), whilst in men there was a strong relationship (r2=0.86). Conclusions: LSCI presented with higher values than LDF during rest, PORH, and exercise; the disparity between the two measures was larger as blood flow increased. The assessments were generally consistent, both methods appear to provide usable data for the assessment of microvascular reactivity in both boys and men. There are biases to each method and the data are not interchangeable between LDF and LSCI.Collaborative Health Research Projec