Do Māori and Pacific Peoples Living with Dementia in New Zealand Receive Equitable Long-Term Care Compared with New Zealand Europeans?

Context: Compared to Europeans, Māori and Pacific peoples living with dementia in the Counties Manukau District Health Board region are three times less likely to use Aged Residential Care (ARC). Objectives: The aim of this study was to investigate whether reduced ARC utilisation by Māori and Pacific peoples living with dementia is equitably compensated by an increase in Home Based Support Service (HBSS). Methods: Routinely collected sociodemographic and clinical data for people diagnosed with dementia at an NZ memory service (2013–2019) were linked with administrative ARC and HBSS invoicing data. Two-part models were used to estimate adjusted costs of HBSS utilisation or ARC placement. Findings: six hundred fifty-seven people of European, Māori and Pacific ethnicity were included in the analysis. Compared to Europeans, both unadjusted and adjusted ARC costs per person-year were significantly lower for both Māori (–NZD$3580, 95$6890, –$140) and Pacific peoples (–NZD$3110, 95%CI: –$5590, –$540) but HBSS cost per person-year was only higher for Pacific peoples (+NZD$640, 95$100, $1180) and not Māori (+NZD$180, 95%CI: –$470,$840). There was no significant difference in the combined HBSS and ARC cost per person-year for Māori (–NZD3460, 95%CI –7200, 280) or Pacific peoples (–NZD2490 95%CI –5090, 110). Conclusions: Lower ARC utilisation amongst Māori and Pacific peoples living with dementia does not translate to an equitable increase in HBSS spend. The difference is likely to be compensated by care provided by unpaid family carers. Addressing the wider determinants of long-term care use in these populations and providing alternative culturally appropriate services must be prioritised to address this inequity in allocation of public sector resources

Stillbirth is associated with perceived alterations in fetal activity - findings from an international case control study

Background Stillbirth after 28 weeks gestation affects between 1.3–8.8 per 1000 births in high-income countries. The majority of stillbirths in this setting occur in women without established risk factors. Identification of risk factors which could be identified and managed in pregnancy is a priority in stillbirth prevention research. This study aimed to evaluate women’s experiences of fetal movements and how these relate to stillbirth. Methods An international internet-based case–control study of women who had a stillbirth ≥28 weeks’ gestation within 30 days prior to completing the survey (n = 153) and women with an ongoing pregnancy or a live born child (n = 480). The online questionnaire was developed with parent stakeholder organizations using a mixture of categorical and open–ended responses and Likert scales. Univariate and multiple logistic regression was used to determine crude (unadjusted) and adjusted odds ratios (aOR) with 95% confidence intervals (CI). Summative content analysis was used to analyse free text responses. Results Women whose pregnancy ended in stillbirth were less likely to check fetal movements (aOR 0.54, 95% CI 0.35–0.83) and were less likely to be told to do so by a health professional (aOR 0.55, 95% CI 0.36–0.86). Pregnancies ending in stillbirth were more frequently associated with significant abnormalities in fetal movements in the preceding two weeks; this included a significant reduction in fetal activity (aOR 14.1, 95% CI 7.27–27.45) or sudden single episode of excessive fetal activity (aOR 4.30, 95% CI 2.25–8.24). Cases described their perception of changes in fetal activity differently to healthy controls e.g. vigorous activity was described as “frantic”, “wild” or “crazy” compared to “powerful” or “strong”. Conclusions Alterations in fetal activity are associated with increased risk of stillbirth. Pregnant women should be educated about awareness of fetal activity and reporting abnormal activity to health professionals

Cost-effectiveness and cost-utility analysis of tiotropium treatment for Bronchiectasis: Evidence from a cross over randomised trial

Aim: The aim of this study is to determine the relative cost-effectiveness of administering tiotropium compared to a placebo in adult patients with non-cystic fibrosis (CF) bronchiectasis with airflow obstruction, from a funder perspective. Methods: Clinical efficacy data was obtained from a randomised placebo-controlled crossover study of tiotropium treatment in adult patients with stable, non-CF bronchiectasis in combination with aggregated hospital costs and cost of health services (NZ, 2016) obtained via self-reported health utilisation data. A decision tree/Markov model consisting of patient transition and outcomes was developed. A cost-effectiveness and cost-utility analysis was performed to produce incremental cost-effectiveness ratios (ICERs) and reported in costs per exacerbation avoided and costs per quality-adjusted life-years (QALYs) gained. Sensitivity and scenario analyses were also conducted to test the robustness of outcomes illustrated by using cost-effectiveness acceptability curves against a willingness-to-pay threshold (WTP) and identifying the conditions in which tiotropium could be cost- effective for bronchiectasis patients. The WTP threshold was based on the Gross Domestic Product (GDP) per capita as recommended by the World Health Organization (WHO). Results: There were no significant differences between costs and outcomes for treatment and control arms. The mean (Standard error) number of exacerbations was 1.2 (0.12) for tiotropium and 1.23 (0.11) for the placebo; the mean QALYs was 0.88 and 0.87 respectively. First year costs per patient were NZD 641 (95% CI $583,$702) for tiotropium (TI) and NZD 503 (95% CI $430,$585) for placebo (PL) treatment in the year 2016. Patients treated with tiotropium gained 0.62 (95% CI 0.58, 0.65) quality adjusted life years compared to 0.59 (95% CI 0.56, 0.62) QALYs for the placebo. In incremental terms, TI gained additional QALYs of 0.03 units and 0.01 of exacerbation events at an incremental cost of NZD 137 resulting in the cost per exacerbation avoided of NZD 12,896 (95% CI $5,850,$15,300) and the cost per QALY gained of NZD 4,655 (95% CI $3,900,$7,650). The reported incremental cost effectiveness ratios are well-below the willingness-to-pay threshold for New Zealand (~ NZD 40,000). Conclusion: The results from this study show that tiotropium may be cost-effective compared to a placebo, particularly in terms of improving QALYs, but less likely in respect of reducing exacerbations. Sensitivity analysis suggests that favourable outcomes may be linked to patients with moderate to severe bronchiectasis. Further studies are required before a more definitive answer can be reached

Household Smoking Status and Heavy Metal Concentrations in Toenails of Children

There is limited evidence on the distribution of heavy metals and its association with secondhand smoking (SHS) within Pacific Island children living in New Zealand. Certain heavy metals such as cadmium (Cd), lead (Pb), and aluminum (Al) bioaccumulates in the body and can deteriorate health in both children and adults. Others, such as chromium (Cr) and nickel (Ni) in trace amounts are necessary but become toxic at high levels. Exposure routes of these elements include food, water, and air. The purpose of this study was to identify the distribution of toxic metal concentrations and its possible correlation with SHS within the Pacific Island children. A sub-sample of children within Pacific Island families longitudinal study, at the nine-year phase, who were living in the New Zealand city of Auckland were invited to participate, (n = 278). Toenails were used as a biomarker to determine Cr, Pb, Cd, Cu, Ni, and Al concentration using inductively coupled plasma mass spectrometry. Reliable and validated questionnaires were used for demographics, lifestyle, and health outcome variables. Significant differences between household smoking status and ethnicity, as well as parents’ marital status, were observed (p < 0.05). There was no statistical difference in heavy metal concentrations in smoking versus non-smoking households. However, Cr, Pb, Cd, Cu, and Ni concentrations were all higher than the required optimal health value in both groups. A high concentration of heavy metals was observed in these children that exceeded the value required for optimal health, although no significant difference in heavy metals with regards to secondhand smoking was observed. SHS was associated with children’s ethnicity and parental marital status, but not with household income levels or maternal education

Additional file 1: Table S1. of Stillbirth is associated with perceived alterations in fetal activity – findings from an international case control study

Maternal report of practices of monitoring fetal movements and their perception of fetal movements during the last 2 weeks of pregnancy comparing controls with known birth weight and the total population (ZIP 19 kb

Prospective community programme versus parent-driven care to prevent respiratory morbidity in children following hospitalisation with severe bronchiolitis or pneumonia

BACKGROUND: Hospitalisation with severe lower respiratory tract infection (LRTI) in early childhood is associated with ongoing respiratory symptoms and possible later development of bronchiectasis. We aimed to reduce this intermediate respiratory morbidity with a community intervention programme at time of discharge. METHODS: This randomised, controlled, single-blind trial enrolled children aged &lt;2 years hospitalised for severe LRTI to ‘intervention’ or ‘control’. Intervention was three monthly community clinics treating wet cough with prolonged antibiotics referring non-responders. All other health issues were addressed, and health resilience behaviours were encouraged, with referrals for housing or smoking concerns. Controls followed the usual pathway of parent-initiated healthcare access. After 24 months, all children were assessed by a paediatrician blinded to randomisation for primary outcomes of wet cough, abnormal examination (crackles or clubbing) or chest X-ray Brasfield score ≤22. FINDINGS: 400 children (203 intervention, 197 control) were enrolled in 2011–2012; mean age 6.9 months, 230 boys, 87% Maori/Pasifika ethnicity and 83% from the most deprived quintile. Final assessment of 321/400 (80.3%) showed no differences in presence of wet cough (33.9% intervention, 36.5% controls, relative risk (RR) 0.93, 95% CI 0.69 to 1.25), abnormal examination (21.7% intervention, 23.9% controls, RR 0.92, 95% CI 0.61 to 1.38) or Brasfield score ≤22 (32.4% intervention, 37.9% control, RR 0.85, 95% CI 0.63 to 1.17). Twelve (all intervention) were diagnosed with bronchiectasis within this timeframe. INTERPRETATION: We have identified children at high risk of ongoing respiratory disease following hospital admission with severe LRTI in whom this intervention programme did not change outcomes over 2 years