The risk of developing type 2 diabetes is four fold higher in New Zealand(NZ) Polynesians compared to Caucasians. Hence diabetes is more prevalent in Maori (16.5% of the general population) and Pacific Island people (10.1%) compared to NZ Caucasians (9.3%). It is generally accepted that type 2 diabetes has major genetic determinants and heterozygous mutations in a number of genes have previously been identified in some subsets of type 2 diabetes and certain ethnic groups. The high prevalence of diabetes in NZ Polynesians, when compared with NZ Caucasians, after controlling for age, income and body mass index (BMI), suggest that genes may be important in this population. Therefore, the prevalence of allelic variations in the genes encoding amylin and insulin promoter factor-1 (IPF-1), and exon 2 of the hepatocyte nuclear factor-1α (HNF-1α) gene in NZ Polynesians with type 2 diabetes was determined. These genes are known to produce type 2 diabetes in other populations. The genes investigated were screened for mutations by PCR amplification and direct sequencing of promoter regions, exons and adjacent intronic sequences from genomic DNA. DNA was obtained from 146 NZ Polynesians (131 Maori and 15 Pacific Island) with type 2 diabetes and 387 NZ Polynesian non-diabetic control subjects (258 Maori and 129 Pacific Island). Sequences were compared to previously published sequences in the National Centre for Biotechnology Information database. Allelic variations in IPF-1 and exon 2 of the HNF-1α gene were not associated with type 2 diabetes in NZ Polynesians. However, in the amylin gene, two new and one previously described allele was identified in the Maori population including: two alleles in the promoter region (-132G>A and -215T>G), and a missense mutation in exon 3 (QlOR). The -215T>G allele was observed in 5.4% and l% of type 2 diabetic and non-diabetic Maori respectively, and predisposed the carrier to diabetes with a relative risk of 7.23. The -215T>G allele was inherited with a previously described amylin promoter polymorphism(-230A>C) in 3% of Maori with type 2 diabetes, which suggests linkage equilibrium exists between these two alleles. Both Q10R and -132G>A were observed in 0.76% of type 2 diabetic patients and were absent in non-diabetic subjects. Together these allelic variations may account for approximately 7% of type 2 diabetes in Maori. These results suggest that the amylin gene maybe an important candidate marker gene for type 2 diabetes in Maori.

This social-cultural history explores the changing context, culture, and identity of psychiatric nurses working in New Zealand public mental hospitals between 1939 and 1972. Primary documentary sources and oral history interviews provided the data for analysis. The thesis is divided into two periods: 1939 to 1959 when asylum-type conditions shaped the culture of the institutional workforce, and 1960 to 1972 when mental health reform and nursing professionalisation challenged the isolation and distinct identity of mental hospital nurses. Between 1939 and 1959 the introduction of somatic treatments did not substantially change nursing practice in mental hospitals. Overcrowding, understaffing and poor resources necessitated the continuance of custodial care. The asylum-type institutions were dependent on a male attendant workforce to ensure the safety of disturbed male patients, and the maintenance of hospital farms, gardens, and buildings. Although female nurses provided all the care and domestic work on the female side, the belief that psychiatric nursing was physically demanding, potentially dangerous, and morally questionable, characterised the work as generally unsuitable for women. Introduction of psychiatric nursing registration which was a move toward professionalisation did little to change the dominance of a male, working-class culture. From 1960 to 1972 psychiatric nurses’ identity was contested. New therapeutic roles created the possibility of the nurses becoming health professionals. Their economic security and occupational power, however, was tied to an identity as unionised, male workers. As psychiatric nurses were drawn closer to the female-dominated nursing profession through health service changes and nursing education reform, both men and women acted to protect both their working conditions and their patients’ welfare. To achieve these ends, they employed working-class means of industrial action. By accepting the notion that psychiatric nurses’ identity was socially constructed, this thesis provides an interpretation that goes beyond the assumption that nursing is a woman’s profession. Instead, it presents psychiatric nursing as a changing phenomenon shaped by contested discourses of gender, class and professionalisation. Nursing in public mental hospitals attracted ordinary men and uncommon women whose collective identity was forged from the experience of working in a stigmatised role.

This research began a journey towards improved maturity around data quality management in New Zealand health care, where total data quality management is 'business as usual" institutionalised into the daily practices of all those who work in health care. The increasingly information intensive nature of health care demands a proactive and strategic approach to data quality to ensure the right information is available to the right person at the right time in the right format, all in consideration of the rights of the patient to have his/her health data protected and used in an ethical way. The work extends and tests principles to establish good practice and overcome practical barriers. This thesis explores the issues that define and control data quality in the national health data collections and the mechanisms and frameworks that can be developed to achieve and sustain good data quality. The research is interpretive, studying meaning within a social setting. The research provides the structure for learning and potential change through the utilisation of action research. Grounded theory provides the structure for the analysis of qualitative data through inductive coding and constant comparison in the analysis phase of the action research iterative cycle. Participatory observation provided considerable rich data as the researcher was a member of staff within the organisation. Data were also collected at workshops, focus groups, structured meetings and interviews. The development of a Data Quality Evaluation Framework and a national Data quality Improvement Strategy provides clear direction for a holistic and 'whole of health sector' way of viewing data quality, with the ability for organisations to develop and implement local innovations through locally developed strategies and data quality improvement programmes. The researcher utilised the theory of appreciative enquiry (Fry, 2002) to positively encourage change, and to encourage the utilisation of existing organisational knowledge. Simple rules, such as the TDQM process and the data quality dimensions guided the change, leaving room for innovation. The theory of 'complex systems of adjustment' (Champagne, 2002; Stacey, 1993) can be instilled in the organisation to encourage change through the constant interaction of people throughout the organisation.

This research was undertaken approximately 20 months after the introduction of alcohol brand advertising on New Zealand television, which resulted in a fourfold increase in televised alcohol advertising and a 42% increase in overall alcohol advertising. The primary aim of the research was to examine the nature of the relationships between young people's responses to televised alcohol advertising and drinking-related behaviours. The research was based on two surveys, one with l0 to 17 year olds and one with 18 to 29 year olds. The l0 to 17 survey involved 500 randomly selected face-to-face interviews in New Zealand's three largest urban areas. The 18 to 29 survey involved 1012 interviews. Respondents were randomly selected from throughout New Zealand and interviewed using a computer-assisted telephone interviewing (CATI) system. Both surveys asked about responses to specific alcohol advertisements, which were ones these age groups had been more exposed to. One of the two key response measures identified how frequently they recalled having seen the advertisement; this was labelled recalled exposure. Positive response to the advertising was measured by liking of the advertisement. Structural equation modelling (SEM) was used for the analyses, but this was preceded by correlation and regression analyses. On the basis of factor analyses that preceded the structural equation modelling, most of the modelling was based on the responses to the three beer advertisements in each study. 10 to 17 year old survey: The findings from the structural equation modelling were consistent with the hypothesis that positive responses to beer advertising (as measured by liking) were contributing to an increase in expected frequency of future drinking. The data were also consistent with the beer advertising contributing to an increased frequency of current drinking, although the relationship was just under the 0.05 level of significance. There was some limited evidence that recalled exposure may be associated with the drinking status of 10 to 13 year olds but, because of the small number of drinkers in this age group, this result needs to be interpreted with caution. The regression analyses indicated that recalled exposure was a predictor of 10 to 17 year olds' perceptions of how often their age/gender group drank and how accepting their friends were of drinking and occasional drunkenness. Other survey responses were also indicative of an influence of alcohol advertising on young people. Alcohol advertising was an important source of information about drinking, particularly for the 10 to 13 year old males. Almost half of these younger males accepted the portrayals in alcohol advertising as realistic and almost two thirds of them felt that alcohol advertising does encourage teenagers to drink. 18 to 29 year old survey: This study provided support for the hypothesis that more positive responses to televised beer advertisements resulted in larger quantities of alcohol being consumed on typical drinking occasions by 18 to 29 year old New Zealanders. It did not provide support for the hypothesis that drinking larger quantities of alcohol led to more positive responses to beer advertisements. The model showed that positive responses to beer advertisements had both a direct influence on quantity and an indirect influence, via its influence on positive beliefs. This study also provided support for the hypothesis that more positive responses to beer advertising were associated with increased alcohol-related problems. As with the 10 to 17 year olds, recalled exposure was related to perceptions of peer influence and behaviour. It was a significant predictor for female perceptions of peer quantities consumed and male and female perceptions relating to peer approval of drunkenness. The regression analyses also identified that recalled exposure was a predictor of males saying they were drinking more than the year before, however a SEM that specified reciprocal paths between these two variables found neither path to be significant. Discussion and implications This research has identified the importance of examining positive responses to alcohol advertisements. This acknowledges the active recipient of advertising who responds positively to advertising that offers valued outcomes. It also emphasises the importance of considering emotional/affective responses to advertising. However, the study also indicates that the weight of advertising is important, as reflected in the cognitive measure of recalled exposure. This appears to be having most influence on perceptions of what is normative behaviour. The results of the SEMs must be viewed as tentative, given the exploratory nature of the analyses and the limitations of cross-sectional surveys. However, as for all the previous studies, relationships have been identified between measures relating to alcohol advertising and those relating to alcohol consumption. While it is not possible to make definitive statements about directions of influence between these variables, these studies have all provided data that are consistent with the theory-based hypothesis that alcohol advertising does have an influence on alcohol consumption by young people.

Cardiovascular disease is the leading cause of mortality in New Zealand. The most current evidence indicates that the burden of cardiovascular disease is greatest among Maori and Pacific peoples and Pacific peoples have the highest mortality rate for cerebrovascular disease [1]. There is substantial scientific evidence that cardiovascular disease has its origin early in life and that a person's risk of cardiovascular disease is determined by the synergistic effect of all the cardiovascular risk factors over time. The Auckland High School Heart Survey (AHHS) is an epidemiological survey designed to determine the prevalence of risk factors for cardiovascular disease in an adolescent high school population in New Zealand. It takes a 'lifecourse' and primary prevention approach to reducing the incidence of cardiovascular disease. The aims of the study were to determine cardiovascular risk factor levels in, and compare the cardiovascular and diabetes risk factor levels between, Pacific and European students and the main Pacific communities (Samoan, Cook Islands, Tongan, and Niuean). The AHHS was a school-based cross-sectional survey of 2,549 adolescent students, across 10 Auckland High Schools. A cluster sampling technique was used to obtain the target of 1000 Pacific participants, to enable Pacific ethnic-specific analysis. The study specifically aimed to determine ethnic-specific differences in lifestyle, intermediate and outcome variables that have been established as cardiovascular risks. Lifestyle variables included: smoking, alcohol consumption, leisure-time physical activity (LTPA), television exposure and sun exposure. The intermediate variables analysed included: body mass index (BMI), waist to hip ratio (WHR), percentage body fat (PBF) and physical work capacity 170 (PWC170). The outcome variables included: total cholesterol (TC), high density lipoprotein cholesterol (HDLC), ratio of total cholesterol to high density lipoprotein cholesterol (TC:HDLC), low density lipoprotein cholesterol (LDLC), triglycerides (TG), fasting blood glucose (FG), urinary micro albumin (UA), systolic and diastolic blood pressure (SBP & DPB). Demographic variables analysed included: sex, age, ethnic group, school, socio-economic status and growth development and maturation. The AHHS study results showed that demographic variables were strongly associated with both intermediate and outcome variables. The findings showed that there were significant ethnic variations between the four main ethnic groups (Pacific, Maori, Asian and European) in risk factors for cardiovascular disease. Pacific participants had the highest BMI and PBF. Pacific participants had the lowest levels of PWC170. With regard to outcome variables, Pacific adolescents had lower levels of TC, HDLC and LDLC compared to Europeans. However, Pacific participants had higher levels of TC:HDLC, FG, TG and DPB. To a lesser degree, lifestyle variables were also associated with other variables. However, the weaker association was likely due to measurement error. The findings of the AHHS study show that ethnic differences present in the adult population are already established among adolescents [2]. Some significant differences were also found between the Pacific ethnic groups (Samoan, Cook Islands, Tongan and Niuean). Among Pacific participants, Cook Islands participants also had the highest level of adjusted mean PWC170. With regard to outcome variables (lipids, fasting glucose and blood pressure), Tongan participants had lower TC, LDLC and TC:HDLC compared to Samoans. However, Tongan participants had significantly higher levels of TG compared to Samoans. For Pacific participants, Cook Islands participants significantly differed from Samoan in smoking, alcohol consumption and PWC170. Cook Islands participants were more likely to have tried smoking for the first time and at an earlier age. They were also more likely to smoke daily and to smoke higher amounts than the other Pacific ethnic groups. Cook Islands participants were more likely to have tried alcohol and at an earlier age. They were also more likely to be drinking alcohol weekly or more often when compared to Samoans. The AHHS study is one of the first pieces of epidemiological research undertaken in New Zealand that provides evidence that there are significant differences between Pacific ethnic groups for this age group. The AHHS study was also able to identify the determinant that explains ethnic differences in outcome variables. BMI was the most significant variable in determining the ethnic differences in outcome variables (lipids, blood pressure and fasting glucose). The AHHS study results showed that Pacific participants had the highest BMI levels of all the ethnic groups, followed by Maori. Television watching was the one lifestyle risk factor that was positively associated with BMI. The most effective variable in terms of decreasing mean difference in BMI was PWC170. PWC170 was significantly lower in Pacific, Asian, and Maori participants compared with European participants. Pacific participants had the lowest levels of PWC170 compared to all other ethnic groups. The AHHS findings support early interventions and programmes targeted to adolescents to reduce the incidence of cardiovascular disease. The findings which show that there are significant differences between Pacific ethnic groups for this age group, may warrant some specific public health initiatives being targeted directly to Pacific ethnic-specific groups. In addition, interventions and programmes that target reducing BMI and improving physical fitness should have an impact on a number of important cardiovascular risk factor outcome variables in adolescents, including: blood pressure, lipids and fasting glucose.

Background: There is a high rate of mental disorders among general practice attendees that is associated with substantial morbidity, disability and global burden. As a consequence GPs play a pivotal role in ensuring that patients with mental disorders are recognised and optimally treated. While there is little doubt of the role GPs play in managing mental illness in general practice the literature suggests a proportion of patients will go unrecognised or else be inadequately diagnosed and in some instances inadequately treated by their GP. The known problems of under diagnosis of mental disorders has been seen until recently to be a problem of GP knowledge and skill, which has led to the close scrutiny of GP performance in this field. In response to this close scrutiny has been the development of a wide range of physician education programs aimed to improving the clinical performance of GPs. However, more recently it has been acknowledged that reasons for low recognition and inadequate treatment of mental disorders in general practice is not only the GPs lack of skill and knowledge, but instead involves a complex interplay of GP, patient and systemic factors unique to GPs, their patients and the general practice setting. Therefore there is a growing interest in research to not only explore ways to improve the clinical performance of GPs, but to also gain a better understanding of the range of issues that GPs are confronted with when managing mental disorders in general practice. Aim: There were two aims of this research: 1) examine GP attitudes, reported confidence and behaviour pertaining to the detection, diagnosis and management of mental illness in general practice (Study One); and 2) describe the epidemiology of depression in general practice and investigate symptom attribution styles as it relates to depression (Study Two). Methodology: In Study One 800 randomly selected rural and urban GPs in the North Island were invited to complete the Attitudes, Reported Confidence and Behaviour Questionnaire Revised (ARCBQ-R). The ARCBQ-R had been previously piloted and reliability and validity issues addressed and published elsewhere. In Study Two, 15 general practices were randomly selected from a database of Auckland General Practices, of which 35 consecutive general care attendees were recruited from each of the 15 general practices. Consenting patients completed a self report questionnaire on mood and health and a computerised version of the Composite International Diagnostic Interview (CIDI) questionnaire (depression module only). Results: Study One: Four hundred and sixteen (52%) GPs completed the ARCBQ-R. GPs are confronted with a wide range of mental disorders in their day-to-day practice, with a predominance of depression and anxiety. GPs were most confident in detecting, diagnosing and treating depression and were most confident in prescribing antidepressants, particularly SSRIs for depression and anxiety. GP confidence in detection, diagnosis and treatment of mental illness was influenced by a number of GP factors such as: interest in mental health, previous mental health training, gender and exposure to mental disorders in their practice. Systemic and patients factors were also reported to influence the way in which GPs recognise and manage mental disorders in their practice. Only a small proportion of GPs reported to use solely DSM-IV or ICD-10 classifications when making a diagnosis, and the majority relied on informal ways to diagnose mental disorders in their patients, which raises questions about the appropriateness of formal diagnostic classifications in general practice. Training needs for this group of GPs involved both treatment and diagnostic issues pertaining to more complex disorders. GPs believed that shared care of mental disorders is the most effective way to provide optimal care for patients. However a number of issues pertaining to availability and assessibility of secondary mental health services along with structural issues such as cost, time and extended consultations in general practice must be addressed before this model of care can work to its full potential. Study Two: A total of 475 general practice attendees agreed to take part in this study. Approximately 20% of general practice attendees met DSM-IV criteria for major depression in the last 12 months and 12% for major depression with a recency of '1 month to less than 2 weeks'. Just under 5% of the sample met DSM-IV criteria for dysthymia, of which 80% had comorbid major depression. A greater proportion of participants who were divorced or separated, unemployed or looking for work, younger in age, of Maori ethnicity and had a history of mental illness met criteria for DSM-IV major depression. Compared to non-depressed participants, depressed participants in this study reported significantly more missed work or social activity in the last year due to emotional problems. With the aid of two screening questions for depression, GPs in this study accurately identified 75% of depressed general practice attendees. The most common attribution style amongst general practice attendees was a normalising attribution style. Patient attribution styles was not found to influence the level of depression detection by GPs, instead past and current illness profiles influenced GP detection rates of depression. Conclusion: The current research findings report figures and trends consistent with overseas studies, not only demonstrating the high prevalence of mental illness, particularly that of depression present in general practice attendees, but the many issues that shape mental health care in general practice. Inline with Klinkman's 'Competing Demands Model' GPs perform three important functions: 1) to identify mental disorders in the community; 2) directly provide mental health care to patients; and 3) a referral agent to secondary mental health services. Like Klinkman's model, results derived from the two studies suggest GPs attitudes towards mental health will shape the level of involvement across these three functions. Results derived from 'Study One' and 'Study Two' extends on Klinkman's model to incorporate 'shared care' as a potential model for managing more severe complex disorders. However, before such a model of 'shared care' can be implemented it is essential that accessibility and communication channels between primary and secondary sectors are improved, and structural funding arrangements including the appropriate remuneration for GPs time is addressed. In reality not all GPs will be interested in managing mental illness in their practice and therefore will not have the motivation to acquire and maintain a level of knowledge sufficient to work with patients with mental illness, whether it be in the capacity of 'shared care' or solely the responsibility of the GP. However, it is not unreasonable to expect GPs to have the necessary skills and ability to at least detect and diagnose mental illness in their patient population, and if necessary refer patients on to secondary mental health services. Prerequisite training in mental health, training in diagnostic classifications along with considerations around their appropriateness in general practice, a sound knowledge of patient risk factors for mental illnesses and established networks with secondary mental health services is necessary before GPs can successfully fulfill these roles.

Introduction: Motorcyclists in New Zealand suffer a disproportionate number of road traffic crashes. In 1995, 2% of all registered vehicles in NZ were motorcycles, but 9% of reported injuries and 13% of all fatalities were in motorcycle riders. Generally there is a lack of good evidence about many postulated risk factors, with previous studies reporting inconsistent findings. Aim: To identify the role of age, gender, experience, training and alcohol consumption as risk factors for moderate to fatal injury resulting from a motorcycle crash. These factors were chosen because they are the subject of current policy debate in New Zealand. Methods: A population-based case-control study was conducted in the Auckland region over a three year period from Feb 1993. The study base was defined as motorcycles being ridden on non-residential public roads of the Auckland region over a three year period between the 15th of February 1993 and the 14th of February 1996 between 6am and midnight. A case was defined as a motorcycle crash occurring within the study base in which either or both the motorcycle driver or pillion passenger met the injury criteria: were admitted to a public hospital within Auckland; were treated in the Public Hospital Emergency Department in the region with an Injury Severity Score of 5 or greater; or died as a result of a motorcycle crash. The aim was to identify all cases using comprehensive case finding procedures included surveillance of emergency departments, the Coroner's office and injury crashes reported to the Police. Controls, or the sample of the study base, were identified from roadside surveys which were conducted at random times from 150 random sites chosen from non-residential roads. Each road was sampled in proportion to its total length. This produced a random sample of motorcycle riding from the study base. If possible, the motorcyclist was stopped at the survey site. If this was not possible, they were identified by following up their registration plate number. Interviewer-administered questionnaires were used, either face-to-face or by telephone, to obtain exposure data. Objective alcohol data were also obtained from blood and breathalyser tests. Results: Information was obtained on 477 cases and 1518 controls, with interviews completed for 94.5% of case drivers and 81.2% of control drivers. Motorcyclists aged 25 years and over had the lowest risk of moderate to fatal injury from a motorcycle crash when compared to drivers aged from 15 to 19 years (adjusted RR=0.45, 95%Cl=0.33-0.62); the risk for 20 to 24 year olds was intermediate (adjusted RR=0.72, 95%Cl=0.52-1.00). There was insufficient evidence from this study to assess whether there was a changing pattern of risk for motorcycle riders aged over 50 years. The population attributable risk for 15 to 16 year olds in this study was only 0.72%. There was no evidence of an association between gender and risk, indicating that most motorcycle injuries occur in males because most motorcycle riding is done by males. Motorcyclists with more than five years of regular on-road motorcycle riding experience were associated with some increased risk compared to those with less than two years (adjusted RR=1.57, 95%Cl=0.96-2.58), particularly among the 20 to 24 year age group. Motorcyclists who had ridden their motorcycle 10,000 kilometres or more had a lower risk compared to those who had ridden less than 1000 kilometres (adjusted RR=0.52, 95%Cl=0.35-0.79). There was no clear effect observed for other measures of experience including off-road motorcycle riding, other motor vehicle driving and familiarity with the road. There was some evidence that motorcyclists who had attended motorcycle training were at lower risk (adjusted RR=0.74, 95%Cl=0.49-1.14), but the precision of this estimate was poor. There was less clear evidence of an association with recent non-motorcycle training and risk. Motorcyclists who reported having consumed alcohol within 12 hours were at higher risk (adjusted RR=1.53, 95%Cl=1.05-2.23) with a population attributable risk of 11%. Discussion: The methods used in this study to identify and sample the study base by obtaining a random sample of motorcycle riding are likely to have provided a valid estimate of the risks associated with the exposures measured. However some limitations of the study design include the general reliance on self-reported measures of exposures, the lack of data collected on other motor vehicles on the road and the poor quality of data available on alcohol and other environmental factors. This study has identified the following groups of motorcyclists to be at increased risk of moderate to fatal injury: riders aged less than 20 years, riders with more than five years of riding, riders who have not undertaken a motorcycle training course, riders who have ridden less than 1000 kilometres on their current motorcycle and those who have recently consumed any alcohol. Given these results, combined with the information obtained from the systematic literature review, the provisions of the Graduated Drivers Licensing System should be reviewed. This should include consideration of basing restrictions for riding primarily on the age rather than the experience of the motorcyclist and the completion of specific motorcycle training courses only, rather than a training course for any motor vehicle. Further research should consider some of the shortcomings of this study that have been outlined above and also consider methods of increasing the proportion of female riders and older riders in research. The limited evidence of benefit from motorcycle training courses, while encouraging, indicates that further investigation of their benefit in controlled trials is required.

Coronary heart disease is the leading cause of death and a major cause of morbidity in New Zealand. Although the mortality rates are now declining, they remain high by international standards and there is considerable scope for the prevention of coronary heart disease. There is a paucity of New Zealand data on the aetiology of this disease. The Auckland Heart Study is a case-control study of coronary heart disease which was designed to determine whether a range of variables including; smoking, passive smoking, hypertension, exercise, alcohol, serum lipids, and dietary and psychosocial factors, are related to coronary heart disease in New Zealand. Other factors examined included respiratory infection, sex hormones and serum vitamins. The study also documented the prevalence of the major risk factors in the Auckland adult population so as to examine trends in risk factors since the 1982 Auckland Risk Factor Study. The study was conducted between 1 March 1986 and 3 May 1988. There were two case groups: non fatal myocardial infarction cases and coronary death cases; and two control groups: myocardial infarction controls and coronary death controls. Participants were aged 25-64 years.

This thesis traces the public health debate about venereal disease in New Zealand from 1920, when the first venereal disease clinics were established, to 1980 before the first AIDS/HIV cases emerged. Studies of venereal disease in New Zealand have concentrated on issues of morality and on the political and social debates; this thesis focuses on treatment procedures and Health Department campaigns. The thesis explores the role of doctors in relation to venereal disease. While advancements in drug therapy benefited patients, medical authority was undermined by demanding and defaulting patients, inadequate medical education, and a low status of the profession. The medical profession developed epidemiological studies and defined 'at risk' groups in post-war decades. Despite claims to be 'scientific', the assessments were informed by stereotypes which had changed little over time. The thesis evaluates the scope of preventative health campaigns. Defined as a public health issue by the 1920s, venereal disease was seen as an individual responsibility by the 1960s. During this time the use of legislation declined, and education and contact tracing increased. The control of infection was limited owing to financial and administrative problems, defaulters and opposition from doctors. Those deemed most at risk were not reached by government educational campaigns, leaving much to the work of welfare groups and individual doctors. The health campaigns targeted groups like Maori and servicemen. The historiography has tended to overlook Maori, and, when military campaigns are discussed, to focus on females. This thesis attempts to redress the balance. Maori had, at least until the 1950s, different treatment experiences from non-Maori patients, although this did not necessarily imply discrimination. The military did attempt to control servicemen, though each Service had different experiences. This thesis stresses the complexity of the gender issue. There was a change from blaming females for infection in the early twentieth century to increasingly pointing to male responsibility. Despite these changes, even with the concept of individual risk pattern by the 1960s, and the understanding that men could be asymptomatic carriers, women were persistently seen as the 'reservoir'. A gender bias persisted. / Note: Thesis now published. (2007) Kampf, Antje. Mapping Out the Venereal Wilderness: Public Health and STD in New Zealand, 1920-1980. Berlin: Lit-Verlag. http://www.lit-verlag.de/isbn/3-8258-9765-9. Whole Document not available at the request of the author.

The Reaccreditation Programme of the Royal New Zealand College of General Practitioners (RNZCGP) became compulsory for all members in 1994. Ongoing reaccreditation of medical specialists is a new, but rapidly growing trend on which little research has been done. The aim of this thesis is to investigate the effects of reaccreditation on general practice in New Zealand in the first three years of the programme. The history and current status of reaccreditation programmes throughout the world is summarised. The requirements of the RNZCGP Reaccreditation Programme are described and contrasted with the requirements of other programmes. A basic assumption of the Reaccreditation Programme that general practitioners can accurately identify their own areas of deficiency, is tested and found to be incorrect. A very low correlation between general practitioners' self assessments of knowledge on a given topic, and their results on a written objective test was found. The attitudes of general practitioners to the Reaccreditation programme, both shortly before it began and three years post-implementation are tested using a validated semantic differential questionnaire. Initial acceptance was reasonably high, but this decreased with time. Qualitative and quantitative studies of the ways in which general practitioners have altered their educational activities because of the programme showed improvements in the quality of the activities selected, but little increase in overall time spent. Analysis of the effects of the compulsory audit aspect of the Reaccreditation Programme showed that this activity has resulted in significant improvements to patient care. The effects of the programme on general practice are analysed in the light of current change theories and finally recommendations are made regarding the possible future development of the RNZCGP Reaccreditation Programme.