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Access to Mental, Sexual and Reproductive Health Services for Youth

Introduction

Youth in New Zealand traditionally have had poor mental, sexual and reproductive outcomes compared to other developed countries. There are several policies in place to address these issues but, in practice, youth health is still not a priority in many areas. There is a lack of literature on what youth themselves perceive to be the reasons for their poor health outcomes.

Aim

To determine which health services youth are using for mental, sexual and reproductive health, the perceived barriers to use and ideas for improvements.

Methods

We used a mixed methods approach. Convenience sampling was used to recruit 18-25 year olds from public places in the city. Participants completed written questionnaires. Focus groups were recruited from alternative education providers (AEs) and using convenience sampling.

Results

190 youth completed the survey. Youth are most likely to visit a general practitioner (GP) for health care. Young women and those in employment were more likely to access a sexual health service. The barriers identified by both the focus groups and the survey were cost, location, relationship with health care provider and confidentiality.

Discussion

Our findings showed a number of barriers for youth accessing healthcare. Some of these can be addressed with more effective education and awareness of available services and some with further training for health providers.

Authors of Report

Siti Baharom, Fiona Brown, Neelam Dalman, Nicholas Dewar, Azreena Esahak, Gayathri Hemachandra, Amelia Howitt, Hank Lee, Carrie Lobb, Ruth Tay, Joanna White

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An Engaging Approach to Health Prioritization Education

Aim

Economics and ethics are important subject areas that are often difficult to make practical for medical students. This study uses two different methods to engage students in issues around a hypothetical resource allocation scenario involving three different medical interventions..

Method

The study was designed and delivered by trainee interns at the Dunedin School of Medicine. Twenty-six Otago medical students participated in either a 1000minds or jury style presentation and discussion in a two hour evening session. Each group was observed to assess the content and extent to which members joined in the discussion, and exit questionnaires asked how valuable they thought the experience was.

Results

The differing methods appeared to bring out different points, with those in the 1000minds group finding it helped them to think in a structured manner about the important ethical issues around health prioritisation. We observed the members of this group take a more active part in the discussion than in the jury group, who appeared to come to decisions by voting rather than by fully discussing all the issues. The jury group focussed mainly on cost effectiveness when deciding which medical interventions to fund. However, both groups ended up with a similar allocation of their respective hypothetical budgets.

Discussion

The authors and participants found this process a valuable practical application of ‘real world’ health economics and ethics, and suggest that an optimal learning experience may combine aspects of both teaching methods.  

Authors of Report

Monier Al Shwarb, Ahmed Barazanchi, Lizi Edmonds, Samuel McDowell, Rachael Nancekivell, Jessica Roberts, Delia Smith, Omid Yassie

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Dunedin Urgent Doctors Study: Demographic Characteristics of Attendees, Reasons for Attendances and Satisfaction with Service

This study was conducted to establish the profile and experience of people who attend Urgent Doctors in Dunedin. More specifically the aims were to: determine demographic characteristics of people attending Urgent Doctors, find out why people attend Urgent Doctors as opposed to the Emergency Department or their GP and to find out how satisfied they were with the service provided. A questionnaire was developed and a telephone survey conducted of all the patients attending Dunedin Urgent Doctors for a week, 3-9 December 2008. Data collection was done in two parts.  Firstly, demographic and other data including contact information were obtained from the Urgent Doctors database.  Secondly, information was gathered directly from the participants using a telephone interview.  Comparison was also made with the demographic characteristics of Emergency Department attenders from an earlier report.

A total of 300 patients were interviewed, giving a response rate for the survey of 79.4%. The results showed that the largest group using the service are young people, with the likelihood of attendance falling with increasing age. Comparison with Emergency Department attendance showed major differences in the proportion of attenders. This showed the largest differences for 0-15 years (35% of Urgent Doctor attendees and 13% of Emergency Department attendees) and aged 65 and over (7% Urgent Doctors, 25% Emergency Department).  Over 90% of people attending Urgent Doctors were also enrolled with a GP. The major reason for attendance at Urgent Doctors in-hours was convenience. Our survey indicates that people attending Urgent Doctors in-hours may be more willing to pay for convenience, are better informed about the services at Urgent Doctors and might not think their problems are worth attending the Emergency Department for. Overall people surveyed were happy with the waiting time and their consultation but less satisfied with the cost of a consultation. This study showed that Urgent Doctors is providing an important service both in and after hours and that it is appreciated by the people who use it.  Recommendations are made for further research.

Authors of Report

Cara Thomson, Debra Wilson, Rachel Dyer, Liisa Stone, Mike Tolmay, Liz Williams, Susan Francis, Simon Richards, Peter Kerstens

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Futures Beyond Care-Giving: Evaluating the Issues Facing Former Carers

‘Futures Beyond Care-giving: Evaluating the Issues Facing Former Carers’ was a research project run by a group of ten final year medical students, which aimed at investigating the experiences of former carers and its effects on their life. The study also examined the adaptation process from being a carer to a former carer; hence evaluating the perceived or required supports and information, and the barriers to accessing it. Sixty one former carers, who reside in Dunedin City area, were invited to participate. Twenty three positive responders were interviewed in-person using a standardised questionnaire. The data were collated in Microsoft Excel spreadsheets, quantitative data were analysed using Statview and qualitative data were analysed using a thematic analysis model. Main results were as follows; mean age of the participants was 73.1±12.1, over 2/3 were female and most were NZ Europeans.  Almost 2/3 of the subjects were caring for their spouses with a mean duration of care-giving of 11.9 years and a mean of 5.7 years post care-giving. Important care-giving experiences included significant stress, high physical and emotional demands, and a negative impact on social life, guilt and resentment. Nevertheless, there were positive experiences, such as gladness, stronger emotional bonding with the care recipients and pride. As former-carers, notable experiences included: relief, loneliness, necessity to keep busy with hobbies, holidays, new caring roles, increased self value and self-esteem, and an increase in social contact. Family, friends and general practitioners were thought to be useful sources of support.

Authors of Report

Mohamad Rukasri Abdul Rahim, Tarun Ahuja, James Crighton, Stephen Currin, Pamela Downer, Nam Eun Kim, Martin Wei Teck Lee, Nicola O’Brien, Rebecca Tordoff, Hsiang-Ning Tsao

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ODHB Clinical Staff Attitudes to Infectious Illness

Background

Norovirus is the major cause of non-bacterial gastroenteritis in the world. It is spread easily via multiple routes with a minute viral load needed to cause infection.

Sickness presenteeism (SP) may have been a significant factor in the Dunedin Public Hospital Norovirus outbreak in August 2008. 383 staff and 143 patients were infected on different wards throughout the hospital. It is suspected that staff may have contributed to the spread of Norovirus by either coming to work unwell; being asymptomatic but infectious; or by staff becoming infected by patients, other staff or in the community.

The aim of this study was to assess ODHB clinical staff’s attitudes to acute personal illness.

Methods

A self-reported, retrospective questionnaire was developed and a sample of 400 clinical staff employed by the ODHB who met the inclusion criteria was randomly selected to receive a confidential survey. The data received from the questionnaire was collected and analysed using SPSS. Ethical approval was obtained from the Lower South Regional Ethics Committee and from the ODHB.

Results

Results showed that doctors are more likely to exhibit SP than other clinical staff.  There were two main reasons given for not taking sick leave: clinical staff do not believe they are unwell enough to justify taking sick leave or they do not want to increase the workload of others.

When considering attitudes towards household illness, the results showed that clinical staff without dependents are significantly more likely to not take sick leave for household illness.

The majority of study participants would not contact anyone for advice about whether to take leave and around two-thirds of those who did not take leave for acute illness would have advised a colleague to take leave for the same illness.

Conclusion

This study may help guide further improvements to infection control within the ODHB. But a larger study with more focussed questions may provide additional information to determine the reasons for presenteeism within clinical hospital staff.

Authors of Report

Lisa Bracewell, Duncan Campbell, Palmira Faure, Emily Giblin, Tessa Morris, Liyana Satterthwaite, Cameron Simmers, Caroline Ulrich

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Pacific People in Dunedin: Perception and Health

Objective

To describe the health perception and parameters in the Pacific Community in Dunedin, and to determine the relationship between health parameters and health perception in the Dunedin Pacific Community.

Methods

During the 2-day Pacific Sports Tournament, a questionnaire survey constructed from SF-12 and questions about weight, smoking, alcohol, and exercise, was distributed amongst the study participants via consecutive sampling. Their corresponding basic health parameters such as  blood pressure, blood sugar level, and body mass index were also recorded, in terms of. These data were analysed and correlated.

Results

Mean PCS score was 45.8 and mean MCS score was 49.6. Mean values for blood pressure, blood sugar level, and body mass index were 133/83mmHg, 6.3mmol/L, and 33.0, respectively. Weight perception in Pacific Island people correlated with their BMI score (p<0.001).

Conclusion

In general Pacific Island people at the Sports Tournament had a poorer health perception according to the SF-12, and had suboptimal health parameters. These two variables generally did not correlate, but weight perception and BMI were significantly congruent.

Authors of Report

Lewis Ball, Justine Gibson, Angela Kang, Jasmine Mackay, Sze Chen Ooi, Prerna Sehgal, Arihia Waaka, David Willis, Oscar Yang

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Subjective Experiences of Inpatient Care by Older Patients with Mental Illness

Introduction

Mental health care provision is an important aspect of any comprehensive health care service. These mental health services encompass a wide range of people from many areas of society, and advocacy and increased funding have lead to vast improvements in the range of services over time. Despite this mental health concerns among the older population remain largely overlooked and under treated. As with all mental health concerns there are patients for whom it is considered necessary to treat as inpatients to achieve appropriate improvement in their condition. Although previous studies have addressed the adequacy of inpatient mental health services in general, there is a distinct lack of research on the effectiveness of these services for the ageing population. In particular there is very little research on the perception of these services from the patient point of view.

The Mental Health Service for Older Patients (MHSOP) inpatient service at Dunedin Public Hospital is provided by ward 6c; a dedicated service for older people with mental health concerns. Our study sought to assess patient satisfaction of this service and assess the subjective experiences of these patients.

Method

This study was undertaken over a 6 week period as part of the Trainee Intern (6th year medical student) course at Otago University. The study was conducted by formal structured interview of patients admitted to the MHSOP ward over the previous 6 months. Potential study participants were initially identified from the Otago District Health Board database server. A total of 127 patients were identified. Patients under the age of 55, deceased or with ICD-10 codes of delirium or dementia were removed. This left a shortlist of 74 possible participants. These patients and their general practitioners were sent letters outlining the study and aims. Patients were then contacted by phone and if they desired were enrolled in the study. A further 16 patients were identified as unsuitable due to co-morbidities leaving a total of 58 patients eligible for the study. A total of only 18 patients agreed to participate in the study.

The Interview was conducted by the use of a structured interview schedule which addressed aspects of the admission and discharge processes, the stay on the ward, staff and patient safety as well as assessing satisfaction and perceived efficacy of treatment. Likert scales were used to assess the overall satisfaction with each section.

Results

The ages of the participants ranged from 65 to 84 years of age, with a mean age of 73. The majority of patients were female, making up 71% of participants. Of the 18 patients interviewed: 8 had a diagnosis of depression alone, 2 had anxiety alone, 4 had both depression and anxiety, 2 patients had depression and another psychiatric co-morbidity other than anxiety, and 1 had a diagnosis of paranoid schizophrenia and 1 interview was excluded from the results due to cognitive impairment.

The mean satisfaction ratings for each of the components were as follows. For ‘Admission’ 8.8, ‘Stay in ward’ 8.6, ‘Discharge’ 8.8, ‘Staff’ 9.1, ‘Safety’ 8.9, ‘Perceived improvement due to admission’ 8.0, and ‘Overall satisfaction’ with stay 8.9.  The medians were 9, 8, 9, 10, 9, 8 and 9 respectively.

The subjective experiences of these patients were generally rated very high. Most of the comments from patients showed that they were very satisfied with the time they spent on the ward. This was true for a diverse range of aspects of the ward.

Conclusion

It was very pleasing to find such high overall ratings of the services provided by the ward. However we consider it unusual that none of the patients who were interviewed had had negative experiences. Past research has found that around 20% of the population of older people with mental health concerns admitted to specialist wards consider the experience negative overall. Our study found that there were no ratings below a 7/10 for all components of the interview except in overall improvement of the patient’s condition. Only 1 patient reported no overall improvement in their condition; while still reporting that the ward services were highly satisfactory.

We highly recommend that future studies be designed as prospective studies to minimise recall bias which can be a significant issue in this population. Further research is greatly needed in this area so that these services can continue to be improved. This will become increasingly important as health systems evolve to cope with the increasing size and demand of the ageing population.

Authors of Report

James Wilkins, Elizabeth De Lautour, Salma Quatre, Elizabeth Pollock, Lewis Lam, Sunee Kim, Gayathra De Silva, Toby Hutchinson, Tze Ying Chan

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Use of Alcohol-Based Hand Sanitiser Provided in University Common Areas: Can it Protect Against Influenza and Infectious Gastroenteritis Among Students?

Abstract

Alcohol-based hand sanitisers are used widely for hand hygiene in the community, though the evidence of their effectiveness as a public health intervention in adults is limited.1  As part of its H1N1 pandemic response, the University of Otago distributed a large number of alcohol-based hand sanitiser (ABHS) units throughout the common areas of the campus. 

This case-control study aimed to assess the impact of this intervention on symptoms of influenza and infectious gastroenteritis amongst students. We hypothesised that use of ABHS would be protective against acquisition of infectious illness, as shown by existing literature.1 A self-administered questionnaire was offered to students attending the University of Otago Student Health service during a study period of twelve days asking them to report current symptoms of influenza-like illness (ILI) and infectious gastroenteritis (IG).  They were also asked about their use of ABHS in the preceding week and any factors they felt would encourage or inhibit their use of ABHS.  Based on self-reported infectious symptoms, students were classified as cases or controls and analysed for their ABHS use. 

A total of 549 surveys were collected with 60 meeting criteria for a case and 489 controls.  There was a lower rate of use of ABHS amongst cases compared with controls (OR 0.764, 95% CI 0.436 – 1.338), though not to a statistically significant degree (p-value 0.346).   However amongst students who usually washed their hands between zero to four times a day, there was a statistically significant protective effect observed with the use of ABHS (OR 0.35, p-value <0.05), whilst no effect was observed amongst students who washed their hands greater than four times a day.  This effect was most marked amongst male student (OR 0.167, p-value 0.06).  When the data was stratified by gender and ILI or IG, there were significantly lower rates of ABHS use amongst males with infectious gastroenteritis (p-value 0.01) and there were trends towards lower rates in the other groups.  Overall 53% of students had never used ABHS in the preceding week, and only 13% used ABHS more than half of the times they visited common areas. The most common reasons for not using were “I forget” (29%) or “I dislike the smell” (25%).  Encouragingly a large number of students said they are reminded to use ABHS when they see it (35%), and that it is convenient to use (45%).

Conculsion

We conclude that, although overall use of ABHS in common areas did not appear to significantly decrease the acquisition of infectious illness among University of Otago students, there is evidence of a significant protective effect of ABHS in common areas for students who wash their hands zero to four times a day.  This effect was most marked among male students.  The overall low use of ABHS mean that future improvements can to be made in the frequency of use of ABHS, and that by targeting certain university subpopulations it may be possible to increase the efficacy of this public health intervention.

Authors of Report

Lisa Barneto, Alison Chang, Brent Cumming, Mohammed Felemban, Jammy Lee, Jennifer Lee, Shannon McCarthy, Elvina Yung

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