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A Discourse on Diarrhoea:  Campylobacter in Otago/Southland

Objectives:

  • To complete a descriptive study of campylobacter data from the Otago (1990 - Aug 1998) and Southland areas (1994 – Aug 1998) and analyse the data for location (TLA), notification date (month, year and season), sex, subject age and occupation.  A comparative data analysis can be made between the Southland and Otago areas.
  • To complete an extensive literature review of descriptive and case-control studies from within New Zealand and internationally.  This review will include current ESR and CDC literature on campylobacter.
  • To obtain information about the environmental presence of campylobacter in Otago and Southland, and nationally.  The information will be gathered by personal communications with leading researchers in the field of communicable diseases, microbiology and veterinary science.
  • To visit a local poultry processing plant to obtain information about handling/management of chickens, in particular what steps are taken or have been taken to determine the presence of campylobacter and prevent its spread etc.
  • To review and modify the current questionnaire sent to all people notified as having campylobacter.  This questionnaire was constructed by the Public Health Service (Health Care Otago).

Authors of Report

Winsome Aroha, Arif Burhan, Gregory Harkness, Adrian Hindes, John Irvine, Nick Norman, Shen Tat Ooi

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Barriers to Achieving Healthy Nutrition in Student Flats

Abstract

Nutrition is a key factor in the continued health and well-being of New Zealanders.  The scientific rationale for promoting healthful dietary practices to reduce the risk of chronic diseases has become increasingly compelling.  The aim of the present study was to identify the socio-demographic, personal, psychosocial and behavioural causes of inadequate consumption of food among university students who are flatting.  The findings have practical implications regarding the identification of subgroups to be targeted for intervention and factors to be addressed in such programs.  A cross-sectional design was used by contacting 710 individuals randomly selected from the 1998 Otago University Student Telephone Directory for participation in a phone survey.  The response rate was 83.6%.

The Ministry of Health has established guidelines for five basic food groups: fruit, vegetable, bread and cereal, milk and milk products and meat and meat substitutes.  Thus these guidelines should cater to all different types of healthy dietary regime.  The survey asked questions in four basic areas.  Demographic data and knowledge of the Ministry of Health dietary guidelines were ascertained, along with intake of the above food groups and barriers to further intake.

The results of this study showed that the main barrier for fruit and meat intake is ‘expense’ while for vegetables it was ‘could not be bothered’ and ‘taste’.  Most respondents were happy with their intake of bread and cereal and their reported barriers would ‘could not be bothered’, ‘taste’, and being fattening’.  For dairy products all barriers were reported.

Knowledge of the Ministry of Health guidelines for healthy eating was not shown to increase the likelihood of reaching these guidelines.  In fact, for five out of six analyses, lack of knowledge of the guidelines increases the likelihood of meeting them.

Three target areas have been identified in this study to improve student nutrition:

  1. Increase intake of breads and cereals among women.
  2. Increase intake of fruits and vegetables, particularly among men.
  3. Increase intake of meat and meat substitutes in women.

Authors of Report

Katie Tuck, Rachel Potae, Soheila Safari, Noraliza Ariffin, Ben Margetts, Rob Orec, Richard Pendleton

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Gender Differences in Health Care Utilisation and Health Education

Abstract

Aim

To develop hypotheses about gender differences in health care utilization and levels of health knowledge.

Method

A telephone survey was carried out.  The questionnaire was designed to elicit information on the subjects’ use of health care services, their threshold for seeking medical attention and general knowledge of health issues.  Results were compared between males and females.

Subjects

A random sample of 230 males and 230 females aged between 26-45 years and living in Dunedin area were chose from the electoral roll.  Of these, 140 males and 145 females participated in the survey.

Results

Women were more likely to have seen their GP in the last year (60% less than six times vs 80% for males, p=0.021).  Males were less likely to attend for psychological problems and less likely to feel their doctor could help with mood disturbances (p=0.036 and 0.004 respectively).  Overall knowledge of meningitis symptoms was low with women more likely than men to report stiff neck, rash and confusion as features of meningitis.

Discussion

The low response rate and the selection bias involved in the survey are important consideration when analyzing the information gained from this study.  However even with these problems it is possible to gain some appreciation of certain trends in the comparison of health care utilization between genders.  Two of the most striking differences found were that females had their blood pressures checked more often and that they knew more about meningitis symptomatology.  The reasons for these differences are discussed.  An issue for concern raised in this study is that the overall knowledge of meningitis was quite low, hinting that the general public needed more awareness.  Females were also more likely to see their GP for psychiatric problems as compared to males.  This also raises important issues that need attention given the high rates of suicide among males.  Finally there was no significant difference between the genders in regard to the threshold and attendances at their general practitioner’s in this study.

Authors of Report

Tony Falkiner, Ann Horner, Heather Lane, Geoff McCracken, Maree Owen, Kah Mun

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Gut Feelings: An Assignment of Priority Criteria in the Gastroenterology Endoscopy Unit and Patient Perceptions of Waiting Times

Abstract

Up to 1% of the general population currently require a gastroscopic investigate each year.  Although this number has increased substantially over the past decade, the number of abnormalities shown by this investigation has risen only slightly.  In fact, up to 30% of all gastroscopies will be normal.  In these days of budgetary restraint and tight resource allocation, it is important to have a standardized set of criteria in place to determine who warrants investigation, and how long they ought to wait for that investigation.

Since 1996, the gastroenterology department at Dunedin Public Hospital has used a criteria priority system for gastroscopy, colonoscopy, or ERCP, where each referral letter was graded according to the set down criteria, and the grade determined how long the patient had to wait for the procedure.  One of the aims of this study was to assess the inter- and intra-rater reliability of the four grading gastroenterologists in the department as they used this criteria system.  The other aim of this study was to assess patient perceptions of being told they must wait for an investigation.

153 referral letters were graded by the four gastroenterologists, and a group of trainee interns (as a collective); and then after a period of 2-3 weeks, regarded by the gastroenterologists.  Comparisons were made between the grades, with respect to where to send the patient (outpatients, procedure, or other), and what grade to give the patient when a procedure was indicated.

Agreement between two graders on where to send the patient, ranged from k=0.76 (substantial agreement), to k=0.22, (fair agreement).  Closeness between two graders on what grade to assign a patient ranged from ICC=0.62 (substantial agreement) to ICC=0.10 (slight agreement).  Intra-rater reliability was as high as k=0.9 (almost perfect agreement) for where to send the patient, and ICC=0.89 (almost perfect agreement) for what grade to allocate.  The difficulties inherent in a grading system such as this are discussed.

The patient survey had responders (53%) who were mostly female (p=0.04) and over 60 years old (p=0.01).  Women were more dissatisfied (p=0.01) and worried (p=0.02) about the waiting time than men, and this was not because they had to wait longer that men (p=0.63), or that they rated their symptoms as being more severe.  Those who rated their symptoms as being more severe tended to have to wait less time for a procedure.  All patients rated the information pamphlet they received as being very helpful.

Authors of Report

Mohna Sharma, Azlina Ali Abdul Hassan, Homizarina Othman, Elaine Tan, Simon Ling, Chong Meng Yeo, Paul Manley, Andrew Warnock

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HIV and Mothers-to-be!  Screening Practices, Knowledge and Attitudes of Paternity Carers in the Otago Region

Perinatal transmission of HIV is an issue of increasing importance in New Zealand and worldwide.  Over 100 New Zealand women are currently HIV positive and seven babies are known to have been infected perinatally in this country so far.  Early AZT treatment can reduce the risk of perinatal transmission by approximately 70% and antenatal HIV screening has been demonstrated to be practical and effective in several countries.  Despite the existence of nationwide guidelines for screening and testing, the subject of HIV is infrequently broached in antenatal practice in this country.

An anonymous survey was set to 166 Otago GPs, midwives, and obstetricians, aiming to access knowledge, attitudes and practices pertaining to HIV in the antenatal setting (response rate 61%).

Knowledge of HIV demographics in New Zealand was generally good, but most recipients were unaware of the national screening guidelines and less than a third were aware of the existence of effective treatment to reduce the risk of perinatal transmission.  Most respondents were prepared to consider antenatal HIV screening as a relevant issue, but in practice 73% broached the subject of HIV seldom or never in the antenatal setting, and only 4% had ordered HIV testing for more than 5% of their antenatal patients.

The lack of knowledge of screening guidelines and availability of effective treatment highlighted in this study may explain the low levels of antenatal HIV screening in the current practice.  Screening performed at current levels of likely to be ineffective, as overseas research has demonstrated that health care professionals are unable to identify at-risk women without discussion of risk factors and frequent serological testing.  Further education of antenatal carers may help break down some of the current barriers to effective antenatal screening in New Zealand.

Authors of Report

Rachel Clarke, Luisa Fonua, Geogry Peter Kini, Kaye Logan, Chris Millar, Katherine Muir, Hamish Simmers, Helen Weston

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How Healthy are Otago's Schools? A Descriptive Study of the Knowledge and Utilization of the Healthy School's - Kura Waiora (1995) document in the Otago Region

This project was designed to evaluate the implementation of the Healthy Schools – Kura Waiora 1995 Ministry of Health document.  The intention of this document was to encourage “a comprehensive approach to school health, focusing on the way health is viewed in all areas of school life’.  176 Otago primary and secondary schools were sent questionnaires to access the utilization and barriers to implementation of this document.  Of the 88 respondents, the results showed that health education was considered to be a high priority in schools, but the Healthy Schools document was infrequently utilized in designing health education programmes.  The main barriers to implementation were lack of time, funding and resources.  It was felt that insufficient follow up was given to the schools once they received the document.  In conclusion, the document has only minimally altered the teaching and promotion of health in the Otago schools replying to the study.

Authors of Report

Joelon Hays, John Geddes, Anne Tait, Alan Machinney, Cheryl Yeung, David Palmer, Vance Mannis

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Peripheral Intravenous Cannulation: Ported vs Non-Ported Cannula Use in Dunedin Public Hospital

Peripheral intravenous cannulation, for the administration of fluids, medications, blood, or nutrition, is one of the most common invasive procedures performed in hospital.  Up to 70% of patients develop symptoms of thrombophlebitis, secondary to cannula placement, requiring removal and resisting of the cannula.  Dunedin Hospital routinely uses two types of cannula, a non-ported, and a ported model.  Anecdotal reports have indicated an increased complication rate associated with the side-ported models.  This study was designed to assess the usage patterns of the different models within the hospital, to identify the incidence of adverse outcomes, and quantify any difference in incidence between ported and non-ported cannulas.  Medical and surgical patients were followed over a two week period, to give 167 cannula placements for analysis.  An overall complication rate of 52% was seen, with 71% of these due to varying degrees of thrombophlebitis.  No difference in complication rates was found between ported and non-ported cannulas.  Recommendations for protocol development and continuing research were made.

Authors of Report

J Lee, Z Ahmad, E Lim, A McConnell, Z Muhammed, G Mudu, G Richards

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The Dual Role of OSH: Concern Amongst Otago Employers

Aim

To evaluate the attitude of employers to the dual delivery of advisory and enforcement roles by the Occupational Safety and Health service (OSH) of the Department of Labour.

Method

A postal questionnaire was sent to a random sample of 227 employers from the Otago OSH database.  The sample was stratified according to the number of employees.  Questionnaires were scored by blinded markers.  Key associations were postulated before the data was perused, and the Mantel-Haenszel test for linear association used to test these associations.  Confidence intervals were calculated for unpaired data.

Results

A response rate of 61% was achieved.  Overall, employers were not highly concerned about conflict between the advisory and enforcement roles of OSH.  Perception of a high degree of role conflict was significantly associated with lower OSH consultation rates, lower opinions about the worth of OSH advice, and perceptions of OSH enforcement practices as “unfair”.  Employers having direct experience of OSH enforcement actions were significantly less likely to perceive OSH as unfair.

Conclusion

Whilst Otago employers are not highly concerned about role conflict, some employers have a negative view of OSH.  This not based on direct experience with the service.  Changes to the structure of OSH would be unlikely to alter these second-0hand perceptions.  We recommend that OSH structure remain as it is for the future.

Authors of Report

Christina Baker, Adam Durrant, Adrian Feint, Iain Gilmore, Kate Hill, Christopher Lind, Peter McQuillan, Debra Taylor

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