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.

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.

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.

<p>Public health infrastructure (PHI) serves as the core foundation for essential public health and its services. However, the U.S. PHI has been weakened by understaffing, underfunding, limited resources and partnerships, and outdated data and information systems over the past few decades. The recent COVID-19 pandemic exacerbated its vulnerability and weakened nature, resulting in increased health disparities and worse health outcomes in general for the nation. The goal of this study was to identify elements of local PHI that are associated with the completion of 20 key public health activities while adjusting for state differences. Cross-sectional secondary data were acquired and linked from two national surveys of local health departments, the National Profile of Local Health Departments survey and the National Longitudinal Survey of Public Health Systems. In total, 20 multivariable logistic regression models were created to analyze the relationships between variables. State fixed effects were used in multivariable models to control for state differences. It was found that state differences affected the correlations of infrastructure variables. Several staffing elements, abilities to provide certain services, and participation in certain types of actions were strongly correlated with the completion of best practice activities. These findings will add to the discussion of what the minimum necessary elements of PHI may be.</p>

<p><b>Background</b><br></p> <p>More than 90% of individuals aged 65 years or older in the United States (US) are taking at least one prescription medication, and more than 40% are taking five or more prescription medications. The potential for non-adherence and risk of medication therapy problems (MTPs) increases with the use of multiple medications. To enhance patient understanding of appropriate medication use, improve medication adherence, and reduce MTPs, the Centers for Medicare & Medicaid Services (CMS) launched Medication Therapy Management (MTM) services as part of Medicare Prescription Drug (Part D) policy; however, “best practices” for achieving positive MTM outcomes are not well understood.</p><p><br></p> <p> </p> <p><b>Objectives</b></p> <p>This study had two objectives. The first objective was to identify and explain reasons for concordance and discordance between a) consistently high, moderate, and low performing pharmacies and b) pharmacies that improve or worsen in performance overtime. The second objective was to generate hypotheses for strategies that contribute to community pharmacies’ ability to achieve high performance on widely accepted MTM quality measures. </p><p><br></p> <p> </p> <p><b>Methods</b></p> <p>This comparative mixed-methods, case study design incorporated two complementary conceptual models. First, an adaptation of the Positive Deviance (PD) model explains reasons for deviations in MTM quality measure performance among community pharmacies and informs study design. Second, the Chronic Care Model (CCM) guided data collection and analysis. Data consisted of pharmacy/staff demographics and staff interviews. When appropriate, quantitative and qualitative data were analyzed within and across pharmacy MTM performance (i.e., high, moderate, low) or change-in-performance (i.e., consistent, improved, worsened) categories using descriptive statistics and cross-tabulation respectively. MTM performance component measures used to evaluate and rank pharmacy MTM performance mirrored measures under Domain 4 (Drug Safety and Accuracy of Drug Pricing) of the 2017 CMS Medicare Part D Plan’ Star Rating measures. This study was approved by the Institutional Review Board for the Purdue University Human Research Protection Program. </p><p><br></p> <p> </p> <p><b>Results </b></p> <p>Across the sample of eligible pharmacies (N = 56), MTM performance composite scores varied by 21.3%. Of the five component scores, the <i>Comprehensive Medication Review (CMR)</i> component score had the highest percent variation (88.3%). Pharmacy staff at 13 pharmacies of the 18 pharmacies selected as case study sites participated in interviews, yielding a 72.2% case pharmacy participation rate. Of the 13 pharmacies, five were categorized as high performers, four were moderate performers, and four were low performers. Of the 39 pharmacy staff approached across all pharmacies, 25 participated in interviews, yielding a 64.1% participation rate. Interviewees included 11 pharmacists, 11 technicians and three student interns. Eight strategies were hypothesized as positively (7) or negatively (1) contributing to pharmacies’ MTM performance. Hypotheses generated were organized by CCM elements and included: <i>Delivery System Design (DSD)</i> – Having a high degree of technician involvement with MTM activities; Inability to meet cultural, linguistic, and socioeconomic needs of patients (negative); Having sufficient capacity to provide CMRs to patients in person compared to telephone alone; Pharmacy staff placing high priority on addressing MTM activities<i>; Clinical Information Systems (CIS) </i>– Faxing adherence-related MTP recommendations and calling providers on indication-related MTP recommendations; Technicians’ use of CISs to collect/document information for pharmacists; Using maximum number of available CISs to identify eligible MTM patients; <i>Health System Organizations (HSO) </i>– Strong pharmacist-provider relationships and trust. No hypotheses were generated for the remaining three CCM elements.</p><p><br></p> <p> </p> <p><b>Conclusions </b></p> <p></p>A total of eight strategies were hypothesized as contributing to community pharmacies’ ability to achieve high performance on MTM quality measures. Notable strategies were related to three of the six chronic care model elements. Future research should engage stakeholders to assist with prioritizing hypotheses to be statistically tested in a larger representative sample of pharmacies.

This thesis addresses the implications of Australian and South Australian government policies for the provision of online health information. It focuses on subjective meanings about internet use and access by questioning the use of information and communications technology (ICT) for health information. It analyses egalitarian approaches by government entities for universal access and explores how the phenomenon of the internet is claimed to be a potential conduit for social inclusion to reduce health inequalities.

This research examines access to community resources - services, facilities and amenities that are potentially health promoting - in two New Zealand territorial authorities, and the policy and planning frameworks of each regarding community resources. International research evidence indicates that community resource access is potentially beneficial to health and wellbeing, through creating supportive environments for health, and providing venues to facilitate social connections. Review of the urban design and planning literature indicates that community resource access is strongly influenced by the dominant urban design and planning models. Geographic information systems were used to develop a Census meshblock-based indicator of community resource accessibility (the Community Resource Accessibility Index). Quantitative analysis examined associations of resource access with socio-economic and demographic population patterns. Qualitative analysis, using key informant interviews and document analysis, explored policies on community resource access, and the role of health and wellbeing as a policy goal for each territorial authority. Quantitative analysis revealed the socio-economically wealthier city had higher overall levels of community resource access, but within each city, more deprived areas had higher levels of access. The location of community resources within poorer areas reduces the mobility costs of people within these areas to access such resources, and makes more available the general health benefits of community resources. Qualitative analysis indicated community resources are important components of urban strategies. Historic patterns of community resource development, aggregated city wealth and local policies were important determinants of the level of community resource access. In New Zealand, as will be the case internationally to varying degrees, there is considerable scope for territorial authorities to enhance local health and wellbeing, through direct delivery of community resources, and through collaboration with external agencies to develop community resources that are outside the direct responsibilities of territorial authorities. When these findings are considered in the context of the passage of local government legislation in late 2002, there is growing potential for territorial authorities to use a variety of levers to enhance community resource access, and by implication, health and wellbeing. Health promoters have opportunities to engage with local government and contribute to urban development strategies, for the purposes of enhancing population health and reducing health inequalities.

No description available.