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Ingamells S, Bell R, Nip J, Innes C, Te Whaiti S, Tino A, McBain L, McMenamin J, Hudson B, Gibson M, Lawton B, Sykes P. Perceived barriers to self-collected HPV testing for cervical cancer screening, and knowledge of HPV: a survey of primary healthcare smear-takers across Aotearoa New Zealand. N Z Med J 2024; 137:57-76. [PMID: 38386856 DOI: 10.26635/6965.6308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
AIMS Cervical cancer remains a burden within Aotearoa New Zealand, with 2022 screening rates sitting 12.7% below target. The National Cervical Screening Programme has changed to primary human papillomavirus (HPV) testing for all screen-eligible people, with the aim for home self-testing. Little is known about the readiness of primary care for the change to self-testing and its associated challenges. A pilot HPV cervical cancer screening programme is being conducted in 17 practice centres. The aim of this study is to explore smear-taker knowledge at these centres about the use of primary HPV testing for cervical cancer screening. METHODS This is an ethically approved questionnaire study, with data from a structured web-based questionnaire sent to all smear-takers at the pilot centres. RESULTS We achieved a total completion rate of 57.8%. The average score for "Knowledge of HPV" was 56.5% (range=20-100%). The challenges to patient home HPV self-testing were felt to be overall "not at all" to "mildly challenging". Up to 73.3% of participants identified ongoing needs for further education. CONCLUSIONS The findings indicate knowledge deficits regarding HPV testing for cervical cancer screening and a desire for the provision of further education. Overall, respondents felt that no major barriers to implementing HPV self-testing would occur.
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Affiliation(s)
- Sarah Ingamells
- Senior obstetrics and gynaecology registrar, Department of Obstetrics and Gynaecology, University of Otago Christchurch, Christchurch, New Zealand
| | - Rebecca Bell
- Senior research assistant, University of Otago Christchurch, Christchurch, New Zealand
| | - Janine Nip
- Research fellow, University of Otago Christchurch, Christchurch, New Zealand
| | - Carrie Innes
- Research fellow, University of Otago Christchurch, Christchurch, New Zealand
| | - Sarah Te Whaiti
- Senior obstetrics and gynaecology registrar, Department of Obstetrics and Gynaecology, University of Otago Christchurch, Christchurch, New Zealand
| | - Alex Tino
- PhD student, University of Otago Christchurch, Christchurch, New Zealand
| | - Lynn McBain
- Associate Professor, Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
| | - John McMenamin
- Clinical Health Director, Health and Research Collaborative, Whanganui, New Zealand
| | - Ben Hudson
- Senior Lecturer, Department of Primary Care and Clinical Simulation, University of Otago Christchurch, Christchurch, New Zealand
| | - Melanie Gibson
- Senior research fellow, Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Bev Lawton
- Professor, Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Peter Sykes
- Associate Professor, Department of Obstetrics and Gynaecology, University of Otago Christchurch, Christchurch, New Zealand
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Gibson-Helm M, Slater T, MacDonald EJ, Stevenson K, Adcock A, Geller S, Parag V, Lambert C, Bennett M, Hibma M, Sykes P, Saville M, Hawkes D, Stanton JA, Clueard MA, Jelley G, Lawton B. Te Ara Waiora-Implementing human papillomavirus (HPV) primary testing to prevent cervical cancer in Aotearoa New Zealand: A protocol for a non-inferiority trial. PLoS One 2023; 18:e0280643. [PMID: 36952546 PMCID: PMC10035917 DOI: 10.1371/journal.pone.0280643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Cervical cancer is caused by high-risk types of human papillomavirus (HPV). Testing for high-risk HPV is a more sensitive screening method than cervical cytology for detecting cervical changes that may lead to cancer. Consistent with recent evidence of efficacy and acceptability, Aotearoa New Zealand plans to introduce HPV testing as the primary approach to screening, replacing cervical cytology, from mid-2023. Any equitable cervical screening programme must be effective across a diverse population, including women that the current programme fails to reach, particularly Māori and those in rural areas. Currently, we do not know the best model for implementing an equitable HPV self-testing screening programme. METHODS This implementation trial aims to assess whether a universal offer of HPV self-testing (offered to all people eligible for cervical screening) achieves non-inferior screening coverage (equal) to a universal offer of cervical cytology alone (the present programme). The study population is all people aged from 24.5 to 70 years due for cervical screening in a 12-month period (including those whose screening is overdue or who have never had screening). A range of quantitative and qualitative secondary outcomes will be explored, including barriers and facilitators across screening and diagnostic pathways. This study takes place in Te Tai Tokerau/Northland which covers a diverse range of urban and rural areas and has a large Indigenous Māori population. A total of fourteen practices will be involved. Seven practices will offer HPV self-testing universally to approximately 2800 women and will be compared to seven practices providing routine clinical care (offer of cervical cytology) to an approximately equal number of women. DISCUSSION This trial will answer important questions about how to implement an equitable, high-quality, effective national programme offering HPV self-testing as the primary screening method for cervical cancer prevention. TRIAL REGISTRATION Prospectively registered with the Australian New Zealand Clinical Trials Registry 07/12/2021: ACTRN12621001675819.
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Affiliation(s)
- Melanie Gibson-Helm
- Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa (NCWHRA), Victoria University of Wellington, Wellington, New Zealand
| | - Tania Slater
- Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa (NCWHRA), Victoria University of Wellington, Wellington, New Zealand
| | - Evelyn J MacDonald
- Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa (NCWHRA), Victoria University of Wellington, Wellington, New Zealand
| | - Kendall Stevenson
- Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa (NCWHRA), Victoria University of Wellington, Wellington, New Zealand
| | - Anna Adcock
- Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa (NCWHRA), Victoria University of Wellington, Wellington, New Zealand
| | - Stacie Geller
- National Center of Excellence in Women's Health, University of Illinois, Chicago, IL, United States of America
| | - Varsha Parag
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Charles Lambert
- Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa (NCWHRA), Victoria University of Wellington, Wellington, New Zealand
| | - Matthew Bennett
- Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa (NCWHRA), Victoria University of Wellington, Wellington, New Zealand
| | - Merilyn Hibma
- Department of Pathology, University of Otago, Dunedin, New Zealand
| | - Peter Sykes
- Christchurch Hospital and University of Otago, Canterbury, New Zealand
| | - Marion Saville
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Australia
| | - David Hawkes
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Australia
| | - Jo-Ann Stanton
- Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa (NCWHRA), Victoria University of Wellington, Wellington, New Zealand
| | | | - Grahame Jelley
- Mahitahi Hauora Primary Health Entity, Northland, New Zealand
| | - Bev Lawton
- Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa (NCWHRA), Victoria University of Wellington, Wellington, New Zealand
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MacDonald EJ, Geller S, Sibanda N, Stevenson K, Denmead L, Adcock A, Cram F, Hibma M, Sykes P, Lawton B. Reaching under-screened/never-screened indigenous peoples with human papilloma virus self-testing: A community-based cluster randomised controlled trial. Aust N Z J Obstet Gynaecol 2020; 61:135-141. [PMID: 33350455 DOI: 10.1111/ajo.13285] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/10/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Indigenous women in the high-income countries of Canada, Australia, New Zealand and USA, have a higher incidence and mortality from cervical cancer than non-Indigenous women. Increasing cervical screening coverage could ultimately decrease cervical cancer disparities. AIMS To increase cervical screening for under-screened/never-screened Māori women. MATERIALS AND METHODS This study was a cluster randomised controlled trial. Inclusion criteria were women aged 25-69, last screened ≥4 years ago, in Northland, New Zealand. The intervention arm was the offer of a human papilloma virus (HPV) self-test and the control arm was the usual offer of standard care - a cervical smear. The primary outcome was rate of cervical screening in the intervention group compared to control in Māori, the Indigenous peoples of New Zealand. Six primary care clinics were randomly allocated to intervention or control. RESULTS Of 500 eligible Māori women in the intervention arm, 295 (59.0%) were screened. Of 431 eligible Māori women in the control arm, 94 (21.8%) were screened. Adjusting for age, time since last screen, deprivation index, Māori women in the intervention arm were 2.8 times more likely to be screened than women in the control arm (95% CI: 2.4-3.1, P-value <0.0001). CONCLUSIONS Offer of HPV self-testing could potentially halve the number of under-screened/never-screened Māori women and decrease cervical morbidity and mortality. These results may be generalisable to benefit Indigenous peoples facing similar barriers in other high-income countries.
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Affiliation(s)
- Evelyn Jane MacDonald
- Centre for Women's Health Research, Te Tātai Hauora O Hine, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Stacie Geller
- Center for Research on Women and Gender, National Center of Excellence in Women's Health, Department of Obstetrics and Gynecology, College of Medicine, University of Illinois, Chicago, USA
| | - Nokuthaba Sibanda
- Centre for Women's Health Research, Te Tātai Hauora O Hine, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Kendall Stevenson
- Centre for Women's Health Research, Te Tātai Hauora O Hine, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Lorna Denmead
- Centre for Women's Health Research, Te Tātai Hauora O Hine, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Anna Adcock
- Centre for Women's Health Research, Te Tātai Hauora O Hine, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | | | - Merilyn Hibma
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Peter Sykes
- Department of Obstetrics and Gynaecology, University of Otago, Christchurch, New Zealand
| | - Bev Lawton
- Centre for Women's Health Research, Te Tātai Hauora O Hine, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
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MacDonald EJ, Lepine S, Pledger M, Geller SE, Lawton B, Stone P. Pre‐eclampsia causing severe maternal morbidity – A national retrospective review of preventability and opportunities for improved care. Aust N Z J Obstet Gynaecol 2019; 59:825-830. [DOI: 10.1111/ajo.12971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/19/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Evelyn Jane MacDonald
- Women's Health Research CentreFaculty of HealthVictoria University of Wellington Wellington New Zealand
| | - Sam Lepine
- Wellington Regional Hospital Wellington New Zealand
| | - Megan Pledger
- Health Services Research CentreFaculty of HealthVictoria University of Wellington Wellington New Zealand
| | - Stacie E. Geller
- Centre for Research on Women and GenderUniversity of Illinois Chicago Illinois USA
| | - Bev Lawton
- Women's Health Research CentreFaculty of HealthVictoria University of Wellington Wellington New Zealand
| | - Peter Stone
- Department of Obstetrics and GynaecologyUniversity of Auckland Auckland New Zealand
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MacFarlane M, Thompson JMD, Zuccollo J, McDonald G, Elder D, Stewart AW, Lawton B, Percival T, Baker N, Schlaud M, Fleming P, Taylor B, Mitchell EA. Smoking in pregnancy is a key factor for sudden infant death among Māori. Acta Paediatr 2018; 107:1924-1931. [PMID: 29869345 DOI: 10.1111/apa.14431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/23/2018] [Accepted: 05/31/2018] [Indexed: 11/27/2022]
Abstract
AIM To examine the sudden unexpected death in infancy (SUDI) disparity between Māori and non-Māori in New Zealand. METHODS A nationwide prospective case-control study ran from March 2012 to February 2015. Exposure to established SUDI risk factors was analysed to investigate the disparity experienced by Māori. Infant ethnicity was based on mother's ethnicity. Māori ethnicity was prioritised. Non-Māori includes Pacific, Asian, NZ European and Other. RESULTS There were 137 cases and 649 controls. The Māori SUDI rate was 1.41/1000 live births compared to 0.53/1000 for non-Māori. Parents/caregivers of 132 cases (96%) and 258 controls (40%) were interviewed. Smoking in pregnancy was associated with an equally increased SUDI risk for Māori (adjusted OR = 8.11, 95% CI = 2.64, 24.93) and non-Māori (aOR = 5.09, 95% CI = 1.79, 14.47), as was bed-sharing (aOR = 3.66, 95% CI = 1.49, 9.00 vs aOR = 11.20, 95% CI = 3.46, 36.29). Bed-sharing prevalence was similar; however, more Māori controls smoked during pregnancy (46.7%) than non-Māori (22.8%). The main contributor relating to increased SUDI risk for Māori/non-Māori infants is the combination of smoking in pregnancy and bed sharing. CONCLUSION The association between known SUDI risk factors, including bed sharing and/or smoking in pregnancy and SUDI risk, is the same regardless of ethnicity. Māori infants are exposed more frequently to both behaviours because of the higher Māori smoking rate.
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Affiliation(s)
- M MacFarlane
- Department of Paediatrics: Child and Youth Health; University of Auckland; Auckland New Zealand
| | - J M D Thompson
- Department of Paediatrics: Child and Youth Health; University of Auckland; Auckland New Zealand
| | - J Zuccollo
- University of Otago; Wellington New Zealand
| | - G McDonald
- University of Otago; Dunedin New Zealand
| | - D Elder
- University of Otago; Wellington New Zealand
| | - A W Stewart
- University of Auckland; Auckland New Zealand
| | - B Lawton
- Centre for Women's Health Research; Victoria University of Wellington; Wellington New Zealand
| | - T Percival
- University of Auckland; Auckland New Zealand
| | - N Baker
- Nelson Hospital; Nelson New Zealand
| | - M Schlaud
- Robert Koch University; Berlin Germany
| | | | - B Taylor
- University of Otago; Dunedin New Zealand
| | - E A Mitchell
- Department of Paediatrics: Child and Youth Health; University of Auckland; Auckland New Zealand
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Filoche S, Cram F, Lawton B, Beard A, Stone P. Implementing non-invasive prenatal testing into publicly funded antenatal screening services for Down syndrome and other conditions in Aotearoa New Zealand. BMC Pregnancy Childbirth 2017; 17:344. [PMID: 28978305 PMCID: PMC5628435 DOI: 10.1186/s12884-017-1535-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 09/25/2017] [Indexed: 11/28/2022] Open
Abstract
Background Non-invasive prenatal testing (NIPT) is a relatively new screen for congenital conditions – specifically, common fetal aneuploidies including Down Syndrome. The test is based on isolating freely circulating fragments of fetal-placental DNA that is present in the mother’s blood. NIPT has a superior clinical performance compared to current screening, and has been available privately in Aotearoa New Zealand for the last 4 years. Main issue The proposed implementation of NIPT as a publicly funded service may widen the inequity in access to optional antenatal screening that already exists in this country. Conclusion This paper discusses precautions that can be taken at the health system, organisation, and personnel levels to ensure that access to NIPT is equitable, that services are culturally responsive, and women’s informed choice is promoted and protected. The adoption of NIPT into publicly funded services is an example of how genetic screening is becoming mainstreamed into health services; as such our approach may also have relevance around the introduction of other genetic and genomic screening initiatives.
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Affiliation(s)
- Sara Filoche
- Women's Health Research Centre, Department of Obstetrics and Gynaecology, University of Otago, Wellington, New Zealand.
| | | | - Bev Lawton
- Women's Health Research Centre, Department of Obstetrics and Gynaecology, University of Otago, Wellington, New Zealand
| | - Angela Beard
- Christchurch Obstetric Associates, Christchurch, New Zealand
| | - Peter Stone
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
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Mitchell EA, Thompson JM, Zuccollo J, MacFarlane M, Taylor B, Elder D, Stewart AW, Percival T, Baker N, McDonald GK, Lawton B, Schlaud M, Fleming P. The combination of bed sharing and maternal smoking leads to a greatly increased risk of sudden unexpected death in infancy: the New Zealand SUDI Nationwide Case Control Study. N Z Med J 2017; 130:52-64. [PMID: 28571049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Despite a major reduction in overall infant mortality, sudden unexpected death in infancy (SUDI) continues to be of concern in New Zealand, as the rate is high by international standards, and is even higher in indigenous Māori. AIM To identify modifiable risk factors for SUDI. METHODS A three-year (1 March 2012-28 February 2015) nationwide case-control study was conducted in New Zealand. RESULTS There were 137 SUDI cases, giving a SUDI mortality rate of 0.76/1,000 live births. The rate for Māori was 1.41/1,000, Pacific 1.01/1,000 and non-Māori non-Pacific (predominantly European) 0.50/1,000. The parent(s) of 97% of the SUDI cases were interviewed. Six hundred and forty-nine controls were selected and 258 (40%) were interviewed. The two major risk factors for SUDI were: maternal smoking in pregnancy (adjusted OR=6.01, 95% CI=2.97, 12.15) and bed sharing (aOR=4.96, 95% CI=2.55, 9.64). There was a significant interaction (p=0.002) between bed sharing and antenatal maternal smoking. Infants exposed to both risk factors had a markedly increased risk of SUDI (aOR=32.8, 95% CI=11.2, 95.8) compared with infants not exposed to either risk factor. Infants not sharing the parental bedroom were also at increased risk of SUDI (aOR=2.77, 95% CI=1.45, 5.30). Just 21 cases over the three-year study were not exposed to smoking in pregnancy, bed sharing or front or side sleeping position. CONCLUSIONS This study has shown that many of the risk factors that were identified in the original New Zealand Cot Death Study (1987-1989) are still relevant today. The combination of maternal smoking in pregnancy and bed sharing is extremely hazardous for infants. Furthermore, our findings indicate that the SUDI prevention messages are still applicable today and should be reinforced. SUDI mortality could be reduced to just seven p.a. in New Zealand (approximately one in 10,000 live births).
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Affiliation(s)
- Edwin A Mitchell
- Professorial Research Fellow, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland
| | - John Md Thompson
- Epidemiologist/Statistician, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland
| | - Jane Zuccollo
- Perinatal Pathologist, Department of Obstetrics and Gynaecology, University of Otago, Wellington
| | | | - Barry Taylor
- Dean, Department of the Dean, Dunedin School of Medicine, University of Otago, Dunedin
| | - Dawn Elder
- Professor and HOD, Department of Paediatrics and Child Health, University of Otago, Wellington
| | - Alistair W Stewart
- Biostatistician, Section of Epidemiology & Biostatistics, School of Population Health, University of Auckland, Auckland
| | - Teuila Percival
- Senior Lecturer, Pacific Health Section, School of Population Health, University of Auckland, Auckland
| | | | - Gabrielle K McDonald
- Senior Lecturer, Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin
| | - Bev Lawton
- Senior Research Fellow, Department of Obstetrics and Gynaecology: Women's Health Research Centre, University of Otago, Wellington
| | - Martin Schlaud
- Professor of Epidemiology, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Peter Fleming
- Professor of Infant Health and Developmental Physiology, School of Social and Community Medicine, University of Bristol, Bristol, England
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Abstract
To explore access to secondary mental health services for New Zealand women during pregnancy and for up to 1 year post-delivery. A retrospective cohort analysis of public hospital maternity data linked to mental health collections. 27 in 1000 pregnancies were associated with access to secondary mental health services (736/27,153). Independent of ethnicity, young age (<20 years) was associated with access (RR1.84; 95 %CI 1.42-2.38; P < .0001). Smoking (1.48; 1.24-1.78; P < .0001), alcohol (1.3; 0.97-1.71; P < .0001) and substance use (3.57; 2.61-4.88; P < .0001) during pregnancy were independent risk factors associated with access. Antenatal period provides an opportunity for navigating to services to ensure timely access to secondary mental health services.
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Affiliation(s)
- Sara K Filoche
- Women's Health Research Centre, Department of Primary Health Care and General Practice, University of Otago, Wellington, 6242, Wellington, New Zealand.
| | - Bev Lawton
- Women's Health Research Centre, Department of Primary Health Care and General Practice, University of Otago, Wellington, 6242, Wellington, New Zealand
| | - James Stanley
- Biostatistical Group, Dean's Department, University of Otago, 6242, Wellington, New Zealand
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Filoche S, Garrett S, Stanley J, Rose S, Robson B, Elley CR, Lawton B. Wāhine hauora: linking local hospital and national health information datasets to explore maternal risk factors and obstetric outcomes of New Zealand Māori and non-Māori women in relation to infant respiratory admissions and timely immunisations. BMC Pregnancy Childbirth 2013; 13:145. [PMID: 23837612 PMCID: PMC3716936 DOI: 10.1186/1471-2393-13-145] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/03/2013] [Indexed: 11/16/2022] Open
Abstract
Background Significant health inequities exist around maternal and infant health for Māori, the indigenous people of New Zealand. The infants of Māori are more likely to die in their first year of life and also have higher rates of hospital admission for respiratory illnesses, with the greatest burden of morbidity being due to bronchiolitis in those under one year of age. Timely immunisations can prevent some respiratory related hospitalisations, although for Māori, the proportion of infants with age appropriate immunisations are lower than for non-Māori. This paper describes the protocol for a retrospective cohort study that linked local hospital and national health information datasets to explore maternal risk factors and obstetric outcomes in relation to respiratory admissions and timely immunisations for infants of Māori and non-Māori women. Methods/Design The study population included pregnant women who gave birth in hospital in one region of New Zealand between 1995 and 2009. Routinely collected local hospital data were linked via a unique identifier (National Health Index number) to national health information databases to assess rates of post-natal admissions and access to health services for Māori and non-Māori mothers and infants. The two primary outcomes for the study are: 1. The rates of respiratory hospitalisations of infants (≤ 1 yr of age) calculated for infants of both Māori and non-Māori women (for mothers under 20 years of age, and overall) accounting for relationship to parity, maternal age, socioeconomic deprivation index, maternal smoking status. 2. The proportion of infants with age appropriate immunisations at six and 12 months, calculated for both infants born to Māori women and infants born to non-Māori women, accounting for relationship to parity, maternal age, socioeconomic deprivation index, smoking status, and other risk factors. Discussion Analysis of a wide range of routinely collected health information in which maternal and infant data are linked will allow us to directly explore the relationship between key maternal factors and infant health, and provide a greater understanding of the causes of health inequalities that exist between the infants of Māori and non-Māori mothers.
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Affiliation(s)
- Sara Filoche
- Women's Health Research Centre, Dept of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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Heath B, Cui Y, Worton S, Lawton B, Ward G, Ballini E, Doe C, Ellis C, Patel B, McMahon N. Translation of flecainide- and mexiletine-induced cardiac sodium channel inhibition and ventricular conduction slowing from nonclinical models to clinical. J Pharmacol Toxicol Methods 2011; 63:258-68. [DOI: 10.1016/j.vascn.2010.12.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 12/20/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
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Abstract
The paper presents a low-temperature plastic-model technique for the simulation of thermal strains in diesel-engine pistons. Various difficulties in obtaining accurate thermal-strain measurements from resistance strain gauges attached to plastics are discussed. These difficulties include: the formation of a hot spot under the gauge, caused either by the low-conductivity gauge or by the electrical power dissipated by the grid; the apparent strain characteristics of gauges mounted on plastics; reinforcement of the model by the gauge; irreversible expansion of the plastic causing zero drift. An application of the technique is given, and the service failure of a 19-in diameter piston crown is explained.
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Affiliation(s)
- B Lawton
- Mirrlees-National Research Division, Hazel Grove, Stockport
- Department of Mechanical Engineering, University of Salford
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Lawton B, Laird MPB. Prediction of skin burn injury. Part 1: numerical modelling; part 2: parametric and sensitivity analysis. Proc Inst Mech Eng H 2003; 216:425-6; discussion 426-7. [PMID: 12502007 DOI: 10.1243/095441102321032229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- B Lawton
- Department of Aerospace, Power and Sensors, Royal Military College of Science, Cranfield University, Shrivenham, Swondon SN6 8LA, UK
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13
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Lawton B, Reid P, Cormack D, Dowell T, Stone P. Māori women and menopause. Pac Health Dialog 2001; 8:163-5. [PMID: 12017818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Māori are the indigenous people of New Zealand who in total make up 14.5% of the population. Although this group has a significantly lower life expectancy than non-Māori, coupled with increased rates of mortality and morbidity, very little is known about the menopausal health needs of older Māori women. As the first step in addressing the health needs of this group, older Māori women's definitions, attitudes, symptoms, expectations and health needs at menopause need to be identified and described. The study Ngā Ruahine or "Māori in Menopause" is the foundation study of the Aotearoa Women's Health Initiative (AWHI). AWHI is a women's health programme being developed by the Wellington School of Medicine, which involves a suite of studies. The objective is to describe the journey of older Māori women through menopause and beyond and to compare and contrast the experience of Māori women from both traditional and contemporary upbringings, with reference to the Pākehā (European) population. It is hoped that this work could lead to further studies such as, for example, a longitudinal observational study looking at older New Zealand women. The potential significance of this approach is discussed.
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Affiliation(s)
- B Lawton
- Department of General Practice, Wellington School of Medicine, PO Box 7343, Wellington South, New Zealand.
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Lawton B. Misleading claims for dietary isoflavones. Climacteric 2000; 3:71. [PMID: 11910614 DOI: 10.3109/13697130009167605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lawton B. EAPs in the 1990s: challenges and opportunities. Health Values 1989; 13:43-5. [PMID: 10318176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Lawton B. The EAP and workplace psychiatric injury. Occup Med 1988; 3:695-706. [PMID: 3067399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The author provides brief historical and current overviews of EAP development, describes such programs' tasks and goals, and discusses how a professionally staffed EAP can address psychiatric injury in the workplace. Based on his experience in a major financial corporation, he describes strategies and interventions used by the EAP he oversees.
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Affiliation(s)
- B Lawton
- Wells Fargo Bank, N.A., San Francisco, California
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Lawton B. Health & planning delivery. Part I: interview with Dr Ben Lawton by Jon Soffer. Wis Med J 1978; 77:13-6. [PMID: 695687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Lawton B, Sherman FS. Pediatric management problems: urinary tract infection. Pediatr Nurs 1977; 3:32-3. [PMID: 586545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Dunn BH, Williams WT, Lawton B. Patient management problems: failure to thrive. Pediatr Nurs 1976; 2:47. [PMID: 1049035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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