Does melatonin improve sleep in older people? A randomised crossover trial

Abstract Study objective: to determine whether melatonin will improve quality of sleep in healthy older people with age-related sleep maintenance problems. Design: a double blind randomised placebo controlled crossover trial in healthy older volunteers. Setting: a largely urban population, Auckland, New Zealand. Participants: participants were part of the larger Possible Role of Melatonin in Sleep of Elders study. People 65 years or more of age were recruited through widespread advertising. We screened 414 potential participants by mail using the Pittsburgh Sleep Quality Index, and selected 194 for clinic interview. Exclusions included depression, cognitive impairment, hypnosedative medications, sleep phase abnormalities, medical and/or environmental problems that might impair sleep. Twenty normal and 20 problem sleepers were randomly allocated for this study from a larger sample of 60 normal and 60 problem sleepers. Measurements and results: 24-hour urine 6-sulphatoxymelatonin was measured to estimate melatonin secretion in each participant. Five milligrams of melatonin, or matching placebo were each taken at bedtime for 4 weeks, separated by a 4-week washout period. Sleep quality was measured using sleep diaries, the Leeds Sleep Evaluation Questionnaire, and actigraphy. There was a significant difference between the groups in self-reported sleep quality indicators at entry, but no difference in melatonin secretion. Melatonin did not significantly improve any sleep parameter measured in either group. Conclusion: 5 mg of fast release melatonin taken at bedtime does not improve the quality of sleep in older people with age-related sleep maintenance problems

Utilising measurable uncontrollable factors in parameter design to optimise the response : ba thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Statistics at Massey University

Content removed due to copyright restrictions: Pledger, M. (1996). Observable uncontrollable factors in parameter design. Journal of Quality Technology, 28(2), 153-162This thesis looks at issues in Industrial Experimental Design and Quality Control. The first part is a review of Parameter Design and its evolution into methods of modelling the mean and variance as one system. The second part introduces the concepts of observable and unobservable factors as an extension to the ideas of controllable and uncontrollable factors of Parameter Design. Methods will be devised to show how to choose the best settings of the controllable factors and how to move to those settings once chosen. In the last section estimates for tracking the unobservable uncontrollable factors will be devised. These will be examined to see whether they can be used to improve the monitoring of the system via control charts

Home Advantage in Three National Netball Competitions: Australia (1997-2007), New Zealand (1998-2007) and England (2005/06-2008/09)

Home advantage was evaluated using data from three national netball competitions: The Commonwealth Bank Trophy which ran from 1997 to 2007 in Australia, The National Bank Cup which ran from 1998 to 2007 in New Zealand, and The Co-operative Netball Superleague which ran from 2005/06 to 2008/09 in England. Mixed models were used to analyze the goal advantage in playing at home, and both resampling methods and mixed models were used to analyze the probability of winning at home. In Australia there was a significant overall goal advantage in playing at home of 1.9 goals, 95% CI (1.0, 2.7). This value is small compared to the average score for a home team of 53 goals per game. Only in 1997 and 2006 were significant goal advantages evident, both of value 3.3 goals, 95% CI's (0.5, 6.1) and (0.6, 6.0) respectively. In the Australian competition, across all years, there was a significantly higher probability of winning at home, p = 0.54, 95% CI (0.51, 0.56). For New Zealand and England there was neither a significant home goal advantage nor home win advantage. These are unexpected results as netball is derived from basketball which has been shown to have a large home win advantage.

E-prescribing and access to prescription medicines during lockdown: experience of patients in Aotearoa/New Zealand

Background: Health services internationally have been compelled to change their methods of service delivery in response to the global COVID-19 pandemic, to mitigate the spread of infection amongst health professionals and patients. In Aotearoa/New Zealand, widespread electronic delivery of prescriptions (e-prescribing) was enabled. The aim of the research was to explore patients’ experiences of how lockdown, changes to prescribing and the interface between general practices and community pharmacy affected access to prescription medications. Method: The research employed a mixed-method approach. This included an online survey (n = 1,010) and in-depth interviews with a subset of survey respondents (n = 38) during the first COVID-19 lockdown (March–May 2020). Respondents were recruited through a snowballing approach, starting with social media and email list contacts of the research team. In keeping with the approach, descriptive statistics of survey data and thematic analysis of qualitative interview and open-ended questions in survey data were combined. Results: For most respondents who received a prescription during lockdown, this was sent directly to the pharmacy. Most people picked up their medication from the pharmacy; home delivery of medication was rare (4%). Survey and interview respondents wanted e-prescribing to continue post-lockdown and described where things worked well and where they encountered delays in the process of acquiring prescription medication. Conclusions: E-prescribing has the potential to improve access to prescription medication and is convenient for patients. The increase in e-prescribing during lockdown highlighted how the system could be improved, through better feedback about errors, more consistency across practices and pharmacies, more proactive communication with patients, and equitable prescribing costs

COVID-19 Pandemic Lockdown and Wellbeing: Experiences from Aotearoa New Zealand in 2020

In 2020, in the first COVID-19 pandemic lockdown, Aotearoa New Zealand consistently maintained stringent public health measures including stay-at-home lockdowns and distancing responses. Considering the widespread disruption to social functioning caused by the pandemic, this paper aimed to explore environmental and social factors that influenced the wellbeing of individuals during the first lockdown in Aotearoa New Zealand. Our mixed-methods study involved a survey (n = 1010) and semi-structured interviews of a subset of surveyed individuals undertaken at the tail end of the first 2020 lockdown. Survey participants were recruited through social media-driven snowball sampling, less than 50% were aged under 45 years and 85% identified as female. Of those interviewed, 63% identified as female. Qualitative interview findings and open-ended survey results were analysed thematically. Participants described a variety of factors influencing wellbeing, largely related to the community and household; physical, behavioural, and lifestyle factors; access to health services; and social and economic foundations. While much of the focus of COVID-19 recovery was on reversing the economic and physical toll of the pandemic, our findings emphasise the need to empower individuals, families, and communities to mitigate the pandemic’s negative implications on wellbeing

Telehealth consultations in general practice during a pandemic lockdown: survey and interviews on patient experiences and preferences

© 2020, The Author(s). Background: During the first COVID-19 pandemic ‘lockdown’ in Aotearoa/New Zealand (March–May 2020, in which strict ‘stay at home’ measures were introduced), general practices were advised to use telephone and video consultations (telehealth) wherever possible instead of the usual in-person visits. This was a sudden change for most practices and patients. This research aimed to explore how patients accessed general practice during lockdown and evaluate their experiences with telehealth, to inform how telehealth could be most effectively used in the future. Methods: Using a mixed-method approach, we undertook an online survey and in-depth interviews with adults (> 18 years) who had contact with practices during lockdown, recruited through social media and email lists. We present descriptive statistics from the survey data (n = 1010) and qualitative analysis of interview data (n = 38) and open-ended survey questions, using a framework of access to health care, from the patient’s perspective. Results: In general, patients reported high satisfaction with telehealth in general practice during lockdown. Telehealth was convenient and allowed patients to safely access health care without having to weigh-up the fear of COVID-19 infection against the need to be seen. Telehealth worked best for routine and familiar health issues and when rapport was established between patients and clinicians. This was easier with a pre-existing clinical relationship, but not impossible without one. Telehealth was less suitable when a physical examination was needed, when the diagnosis was unknown or for patients who had a strong preference to be seen in-person. Conclusions: Even in this disruptive lockdown period, that prompted an unexpected and rapid implementation of telehealth services in general practices, most patients had positive experiences with telehealth. In the future, patients want the choice of consultation type to match their needs, circumstances, and preferences. Technological issues and funding barriers may need to be addressed, and clear communication for both patients and clinicians is needed about key aspects of telehealth (e.g. cost, appropriateness, privacy). Maintaining telehealth as an option post-lockdown has the potential to increase timely and safe access to primary health care for many patients