Sore throat management in New Zealand general practice

Aim: To describe the sore throat management practices by New Zealand general practitioners (GPs) and compare the rate of sore throat presentation over time. Method: Data were collected from the National Primary Medical Care Survey carried out over 2001/2002. Analyses were done on patients who presented to the GP with the symptom of a sore throat as one of their reasons for visit. A systematic review of the New Zealand literature was done for sore throat presentation to GPs since 1966. Results: There were 10,506 records of visits gathered from 246 GPs and 335 patients presented sore throat as a reason for visit. Patients presented sore throat at a rate (SE) of 3.6 (0.26) per 100 encounters and varied by age (p=0.004), but not by socioeconomic deprivation (p=0.415) or by ethnic group (p=0.165). Patients’ perceived urgency of visit had a greater impact in the rate of presentation for the 0–4 year age group than in the at-risk age group of 5–14 years (p=0.001). GPs recorded a ‘Read code’ diagnosis at a rate of 59.2 (3.96) recordings per 100 encounters. Among the 306 recorded diagnoses, 11.4% were explicit recordings of viral diagnoses. 7.6% of GPs ranked themselves as ‘moderately’ and 2.3% as ‘highly’ uncertain of their diagnosis. Throats swabs were taken at a rate of 6.6 (1.68) swabs per 100 encounters. Antibiotic prescribing rate was higher when sore throat was recorded as a reason for visit than not (p<0.001). There were no significant differences in throat swabs taken for sore throat patients prescribed an antibiotic or not (p=0.623). No Pacific person had a throat swab taken. Patients with sore throat who were Maori (73.5 [7.2]) or Pacific people (80.2 [17.3]) were more likely to be prescribed an antibiotic than Europeans (57.4 [4.62]). Since 1966, there were 16 New Zealand studies of patients presenting with respiratory disorders to their GP. Seven of these studies measured GP management of sore throat, and only 3 of these measured the rate of patients’ sore throat symptom presentation. The rate of patients’ sore throat presentation remained similar when compared with the Waikato study of 1991 (2.8%) that had a similar methodology. Conclusion: Sore throat continues to be a common symptom that GPs manage in their work. Ethnic differences may have a part to play in how GPs manage sore throat. More research is needed to discover those factors that would encourage a greater proportion at-risk 5–14 year old children to attend their GP with sore throat

Assessing the Design and Capability of Our Public Health System in a Covid and Post-Covid New Zealand

New Zealand’s public health response to Covid-19, while effective thus far, has raised questions about our country’s public health capability and capacity, our ability to respond to public health challenges, and our ability to protect Mäori communities from bearing the brunt of inequitable outcomes. The aims of this article are to identify and discuss some of the challenges that face New Zealand’s state-mandated public health institutions, and to explore critera for assessing the capability of these institutions. There is no universal standard approach to the design of public health institutions, systems and structures; a variety of different configurations would work in any context and their effectiveness is strongly influenced by national history, and the prevailing policy and political culture. In order to assess the ability of our public health institutions to effectively respond to a diverse array of challenges, we propose a capability framework consisting of ten key elements

Is cost-related non-collection of ? Findings from a large-scale longitudinal study of New Zealand adults

Objective: To investigate whether cost-related noncollection of prescription medication is associated with a decline in health. Settings: New Zealand Survey of Family, Income and Employment (SoFIE)-Health. Participants: Data from 17 363 participants with at least two observations in three waves (2004-2005, 2006-2007, 2008-2009) of a panel study were analysed using fixed effects regression modelling. Primary outcome measures: Self-rated health (SRH), physical health (PCS) and mental health scores (MCS) were the health measures used in this study. Results: After adjusting for time-varying confounders, non-collection of prescription items was associated with a 0.11 (95% CI 0.07 to 0.15) unit worsening in SRH, a 1.00 (95% CI 0.61 to 1.40) unit decline in PCS and a 1.69 (95% CI 1.19 to 2.18) unit decline in MCS. The interaction of the main exposure with gender was significant for SRH and MCS. Non-collection of prescription items was associated with a decline in SRH of 0.18 (95% CI 0.11 to 0.25) units for males and 0.08 (95% CI 0.03 to 0.13) units for females, and a decrease in MCS of 2.55 (95% CI 1.67 to 3.42) and 1.29 (95% CI 0.70 to 1.89) units for males and females, respectively. The interaction of the main exposure with age was significant for SRH. For respondents aged 15-24 and 25-64 years, noncollection of prescription items was associated with a decline in SRH of 0.12 (95% CI 0.03 to 0.21) and 0.12 (95% CI 0.07 to 0.17) units, respectively, but for respondents aged 65 years and over, non-collection of prescription items had no significant effect on SRH. Conclusion: Our results show that those who do not collect prescription medications because of cost have an increased risk of a subsequent decline in health

The distance and internal composition of the neutron star in EXO 0748-676 with XMM-Newton

Recently, the neutron star X-ray binary EXO 0748-676 underwent a transition to quiescence. We analyzed an XMM-Newton observation of this source in quiescence, where we fitted the spectrum with two different neutron-star atmosphere models. From the fits we constrained the allowed parameter space in the mass-radius diagram for this source for an assumed range of distances to the system. Comparing the results with different neutron-star equations of state, we constrained the distance to EXO 0748-676. We found that the EOS model 'SQM1' is rejected by the atmosphere model fits for the known distance, and the 'AP3' and 'MS1' is fully consistent with the known distance.Comment: 6 pages, 7 figures, 2 tables, submitted to MNRAS on June 20, 101

Junior doctor psychiatry placements in hospital and community settings : a phenomenological study

OBJECTIVES: The proportion of junior doctors required to complete psychiatry placements in the UK has increased, due in part to vacant training posts and psychiatry career workforce shortages, as can be seen across the world. The aim of this study was to understand the lived experience of a Foundation Year 1 junior doctor psychiatry placement and to understand how job components influence attitudes. DESIGN: The study was conducted using a cross-sectional qualitative phenomenological approach. SETTING: Hospital and community psychiatry department settings in the North East of England, UK. PARTICIPANTS: In total, 14 Foundation Year 1 junior doctors were interviewed including seven men and seven women aged between 23 and 34 years. The majority had completed their medical degree in the UK and were White British. RESULTS: The lived experience of a junior doctor psychiatry placement was understood by three core themes: exposure to patient recovery, connectedness with others in the healthcare team and subjective interpretations of psychiatry. The experiences were moderated by instances of role definition, reaction to the specialty and the organisational fit of the junior doctor capacity in the specialty. CONCLUSIONS: The study reinforces and adds to the literature by identifying connectedness as being important for both job satisfaction and morale, which is currently damaged within the junior doctor population. The study provides in-depth insights into the lived experience of psychiatry placements and can be taken forward by educationalists to ensure the placements are meaningful experiences for junior doctors by developing role definition, belonging, structure and psychiatric care responsibility

Sexual Signal Evolution Outpaces Ecological Divergence during Electric Fish Species Radiation

Natural selection arising from resource competition and environmental heterogeneity can drive adaptive radiation. Ecological opportunity facilitates this process, resulting in rapid divergence of ecological traits in many celebrated radiations. In other cases, sexual selection is thought to fuel divergence in mating signals ahead of ecological divergence. Comparing divergence rates between naturally and sexually selected traits can offer insights into processes underlying species radiations, but to date such comparisons have been largely qualitative. Here, we quantitatively compare divergence rates for four traits in African mormyrid fishes, which use an electrical communication system with few extrinsic constraints on divergence. We demonstrate rapid signal evolution in the Paramormyrops species flock compared to divergence in morphology, size, and trophic ecology. This disparity in the tempo of trait evolution suggests that sexual selection is an important early driver of species radiation in these mormyrids. We also found slight divergence in ecological traits among closely related species, consistent with a supporting role for natural selection in Paramormyrops diversification. Our results highlight the potential for sexual selection to drive explosive signal divergence when innovations in communication open new opportunities in signal space, suggesting that opportunity can catalyze species radiations through sexual selection, as well as natural selection

The potential impact of the next influenza pandemic on a national primary care medical workforce

BACKGROUND: Another influenza pandemic is all but inevitable. We estimated its potential impact on the primary care medical workforce in New Zealand, so that planning could mitigate the disruption from the pandemic and similar challenges. METHODS: The model in the "FluAid" software (Centers for Disease Control and Prevention, CDC, Atlanta) was applied to the New Zealand primary care medical workforce (i.e., general practitioners). RESULTS: At its peak (week 4) the pandemic would lead to 1.2% to 2.7% loss of medical work time, using conservative baseline assumptions. Most workdays (88%) would be lost due to illness, followed by hospitalisation (8%), and then premature death (4%). Inputs for a "more severe" scenario included greater health effects and time spent caring for sick relatives. For this scenario, 9% of medical workdays would be lost in the peak week, and 3% over a more compressed six-week period of the first pandemic wave. As with the base case, most (64%) of lost workdays would be due to illness, followed by caring for others (31%), hospitalisation (4%), and then premature death (1%). CONCLUSION: Preparedness planning for future influenza pandemics must consider the impact on this medical workforce and incorporate strategies to minimise this impact, including infection control measures, well-designed protocols, and improved health sector surge capacity

Maintaining a sense of direction during long-range communication on DNA

Many biological processes rely on the interaction of proteins with multiple DNA sites separated by thousands of base pairs. These long-range communication events can be driven by both the thermal motions of proteins and DNA, and directional protein motions that are rectified by ATP hydrolysis. The present review describes conflicting experiments that have sought to explain how the ATP-dependent Type III restriction–modification enzymes can cut DNA with two sites in an inverted repeat, but not DNA with two sites in direct repeat. We suggest that an ATPase activity may not automatically indicate a DNA translocase, but can alternatively indicate a molecular switch that triggers communication by thermally driven DNA sliding. The generality of this mechanism to other ATP-dependent communication processes such as mismatch repair is also discussed

In vitro anti-plasmodial activity of Dicoma anomala subsp. gerrardii (Asteraceae): identification of its main active constituent, structure-activity relationship studies and gene expression profiling

<p>Abstract</p> <p>Background</p> <p>Anti-malarial drug resistance threatens to undermine efforts to eliminate this deadly disease. The resulting omnipresent requirement for drugs with novel modes of action prompted a national consortium initiative to discover new anti-plasmodial agents from South African medicinal plants. One of the plants selected for investigation was <it>Dicoma anomala </it>subsp. <it>gerrardii</it>, based on its ethnomedicinal profile.</p> <p>Methods</p> <p>Standard phytochemical analysis techniques, including solvent-solvent extraction, thin-layer- and column chromatography, were used to isolate the main active constituent of <it>Dicoma anomala </it>subsp. <it>gerrardii</it>. The crystallized pure compound was identified using nuclear magnetic resonance spectroscopy, mass spectrometry and X-ray crystallography. The compound was tested <it>in vitro </it>on <it>Plasmodium falciparum </it>cultures using the parasite lactate dehydrogenase (pLDH) assay and was found to have anti-malarial activity. To determine the functional groups responsible for the activity, a small collection of synthetic analogues was generated - the aim being to vary features proposed as likely to be related to the anti-malarial activity and to quantify the effect of the modifications <it>in vitro </it>using the pLDH assay. The effects of the pure compound on the <it>P. falciparum </it>transcriptome were subsequently investigated by treating ring-stage parasites (alongside untreated controls), followed by oligonucleotide microarray- and data analysis.</p> <p>Results</p> <p>The main active constituent was identified as dehydrobrachylaenolide, a eudesmanolide-type sesquiterpene lactone. The compound demonstrated an <it>in vitro </it>IC₅₀of 1.865 μM against a chloroquine-sensitive strain (D10) of <it>P. falciparum</it>. Synthetic analogues of the compound confirmed an absolute requirement that the α-methylene lactone be present in the eudesmanolide before significant anti-malarial activity was observed. This feature is absent in the artemisinins and suggests a different mode of action. Microarray data analysis identified 572 unique genes that were differentially expressed as a result of the treatment and gene ontology analysis identified various biological processes and molecular functions that were significantly affected. Comparison of the dehydrobrachylaenolide treatment transcriptional dataset with a published artesunate (also a sesquiterpene lactone) dataset revealed little overlap. These results strengthen the notion that the isolated compound and the artemisinins have differentiated modes of action.</p> <p>Conclusions</p> <p>The novel mode of action of dehydrobrachylaenolide, detected during these studies, will play an ongoing role in advancing anti-plasmodial drug discovery efforts.</p