Zealand Data Research Articles

Pleural infection in a New Zealand centre: high incidence in Pacific people and RAPID score as a prognostic tool.

Whilst there is an increase in incidence of pleural infection worldwide, there is a paucity of New Zealand data. This study looked at the epidemiology of pleural infection in a single New Zealand institution and evaluated the RAPID score as a prognostic tool. A retrospective review was performed on patients with pleural infection over a 3-year period. Pleural infection was defined as having clinical evidence of infection and fulfilling one of the following: (i) positive pleural fluid Gram stain or culture, (ii) frank pus, (iii) pH <7.2 or (iv) radiological evidence of complex effusion. There were 108 patients; 76% were male, and mean age was 54 years. Two thirds of patients came from the most deprived areas. The dominant ethnic group was Pacific people (42%), which was twice as high as the Pacific population in the area (19%), P < 0.0001. After adjusting for deprivation, Pacific people were still over-represented, P = 0.0002. There were 14 deaths (13%), and these were associated with increasing age (P = 0.001) and urea (P = 0.007) but not ethnicity or socioeconomic deprivation. The RAPID score found that those in the high-risk (P = 0.026) and moderate-risk (P = 0.036) groups had significantly higher mortality compared with the low-risk group. The over-representation of Pacific people with pleural infection is not fully explained by socioeconomic deprivation, highlighting other factors at play, such as genetic susceptibility. The RAPID score was of clinical utility in predicting mortality in our population.

Evolution of the Bi-National Colorectal Cancer Audit: history, governance and future directions.

Evolution of the Bi-National Colorectal Cancer Audit: history, governance and future directions.

The Influence of Head Impact Threshold for Reporting Data in Contact and Collision Sports: Systematic Review and Original Data Analysis.

Head impacts and resulting head accelerations cause concussive injuries. There is no standard for reporting head impact data in sports to enable comparison between studies. The aim was to outline methods for reporting head impact acceleration data in sport and the effect of the acceleration thresholds on the number of impacts reported. A systematic review of accelerometer systems utilised to report head impact data in sport was conducted. The effect of using different thresholds on a set of impact data from 38 amateur senior rugby players in New Zealand over a competition season was calculated. Of the 52 studies identified, 42% reported impacts using a >10-g threshold, where g is the acceleration of gravity. Studies reported descriptive statistics as mean ± standard deviation, median, 25th to 75th interquartile range, and 95th percentile. Application of the varied impact thresholds to the New Zealand data set resulted in 20,687 impacts of >10 g, 11,459 (45% less) impacts of >15 g, and 4024 (81% less) impacts of >30 g. Linear and angular raw data were most frequently reported. Metrics combining raw data may be more useful; however, validity of the metrics has not been adequately addressed for sport. Differing data collection methods and descriptive statistics for reporting head impacts in sports limit inter-study comparisons. Consensus on data analysis methods for sports impact assessment is needed, including thresholds. Based on the available data, the 10-g threshold is the most commonly reported impact threshold and should be reported as the median with 25th and 75th interquartile ranges as the data are non-normally distributed. Validation studies are required to determine the best threshold and metrics for impact acceleration data collection in sport. Until in-field validation studies are completed, it is recommended that head impact data should be reported as median and interquartile ranges using the 10-g impact threshold.

Addressing the Absence of Hours Information in Linked Employer-Employee Data

The availability of tax-based payroll data has proved a blessing to labour and business economists wishing to understand workers, their jobs and their employers. Unfortunately, administrative data do not always include key variables of interest. In the case of New Zealand, linked employer-employee data do not include any information on hours worked. We implement a set of complementary methods to patch this gap, deriving an approximate measure of full-time equivalent labour input. In addition, and more specific to the New Zealand data environment, we describe a method for identifying working proprietors using annual tax-filed information, thus providing a more complete picture of total firm labour input.

Algorithms that eliminate the effects of calibration artefact and trial-imposed offsets of Masimo oximeter in BOOST-NZ trial.

The displayed readings of Masimo pulse oximeters used in the Benefits Of Oxygen Saturation Targeting (BOOST) II and related trials in very preterm babies were influenced by trial-imposed offsets and an artefact in the calibration software. A study was undertaken to implement new algorithms that eliminate the effects of offsets and artefact. In the BOOST-New Zealand trial, oxygen saturations were averaged and stored every 10s up to 36weeks' post-menstrual age. Two-hundred and fifty-seven of 340 babies enrolled in the trial had at least twoweeks of stored data. Oxygen saturation distribution patterns corresponding with a +3% or -3% offset in the 85-95% range were identified together with that due to the calibration artefact. Algorithms involving linear and quadratic interpolations were developed, implemented on each baby of the dataset and validated using the data of a UK preterm baby, as recorded from Masimo oximeters with the original software and a non-offset Siemens oximeter. Saturation distributions obtained were compared for both groups. There were a flat region at saturations 85-87% and a peak at 96% from the lower saturation target oximeters, and at 93-95 and 84% respectively from the higher saturation target oximeters. The algorithms lowered the peaks and redistributed the accumulated frequencies to the flat regions and artefact at 87-90%. The resulting distributions were very close to those obtained from the Siemens oximeter. The artefact and offsets of the Masimo oximeter's software had been addressed to determine the true saturation readings through the use of novel algorithms. The implementation would enable New Zealand data be included in the meta-analysis of BOOST II trials, and be used in neonatal oxygen studies.

Cancer care coordinators in stage III colon cancer: a cost-utility analysis.

BackgroundThere is momentum internationally to improve coordination of complex care pathways. Robust evaluations of such interventions are scarce. This paper evaluates the cost-utility of cancer care coordinators for stage III colon cancer patients, who generally require surgery followed by chemotherapy.MethodsWe compared a hospital-based nurse cancer care coordinator (CCC) with ‘business-as-usual’ (no dedicated coordination service) in stage III colon cancer patients in New Zealand. A discrete event microsimulation model was constructed to estimate quality-adjusted life-years (QALYs) and costs from a health system perspective. We used New Zealand data on colon cancer incidence, survival, and mortality as baseline input parameters for the model. We specified intervention input parameters using available literature and expert estimates. For example, that a CCC would improve the coverage of chemotherapy by 33 % (ranging from 9 to 65 %), reduce the time to surgery by 20 % (3 to 48 %), reduce the time to chemotherapy by 20 % (3 to 48 %), and reduce patient anxiety (reduction in disability weight of 33 %, ranging from 0 to 55 %).ResultsMuch of the direct cost of a nurse CCC was balanced by savings in business-as-usual care coordination. Much of the health gain was through increased coverage of chemotherapy with a CCC (especially older patients), and reduced time to chemotherapy. Compared to ‘business-as-usual’, the cost per QALY of the CCC programme was $NZ 18,900 (≈ $US 15,600; 95 % UI: $NZ 13,400 to 24,600). By age, the CCC intervention was more cost-effective for colon cancer patients < 65 years ($NZ 9,400 per QALY). By ethnicity, the health gains were larger for Māori, but so too were the costs, meaning the cost-effectiveness was roughly comparable between ethnic groups.ConclusionsSuch a nurse-led CCC intervention in New Zealand has acceptable cost-effectiveness for stage III colon cancer, meaning it probably merits funding. Each CCC programme will differ in its likely health gains and costs, making generalisation from this evaluation to other CCC interventions difficult. However, this evaluation suggests that CCC interventions that increase coverage of, and reduce time to, effective treatments may be cost-effective.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0970-5) contains supplementary material, which is available to authorized users.

Alcohol outlet density and violence: A geographically weighted regression approach.

We investigate the relationship between outlet density (of different types) and violence (as measured by police activity) across the North Island of New Zealand, specifically looking at whether the relationships vary spatially. We use New Zealand data at the census area unit (approximately suburb) level, on police-attended violent incidents and outlet density (by type of outlet), controlling for population density and local social deprivation. We employed geographically weighted regression to obtain both global average and locally specific estimates of the relationships between alcohol outlet density and violence. We find that bar and night club density, and licensed club density (e.g. sports clubs) have statistically significant and positive relationships with violence, with an additional bar or night club is associated with nearly 5.3 additional violent events per year, and an additional licensed club associated with 0.8 additional violent events per year. These relationships do not show significant spatial variation. In contrast, the effects of off-licence density and restaurant/café density do exhibit significant spatial variation. However, the non-varying effects of bar and night club density are larger than the locally specific effects of other outlet types. The relationships between outlet density and violence vary significantly across space for off-licences and restaurants/cafés. These results suggest that in order to minimise alcohol-related harms, such as violence, locally specific policy interventions are likely to be necessary. [Cameron MP, Cochrane W, Gordon C, Livingston M. Alcohol outlet density and violence: A geographically weighted regression approach. Drug Alcohol Rev 2016;35:280-288].

On the Use of Upper Stem Diameters to Localize a Segmented Taper Equation to New Trees

Upper stem diameter measurements on trees can be used to localize an existing stem taper equation to individual trees and hence improve the tree-level accuracy of stem taper models. Two approaches of localizing taper equations were evaluated on the Max and Burkhart (1976) taper model: (1) an algebraic constraint (AC) approach where some of the parameters of the taper equation are constrained algebraically so that the taper equation predicts the observed dbh and upper stem diameter(s) and (2) an empirical Bayes random effects prediction (EB) approach where the observed upper stem diameter(s) is/are used to predict the tree-specific taper model parameters for a given tree. Radiata pine (Pinus radiata D. Don) over bark stem sections data from sites across New Zealand and similar data from loblolly pine (Pinus taeda L.) trees from sites across southern United States were used in the analysis. Seventy percent of the trees in each data set were used to fit a random parameter Max and Burkhart (1976) taper equation and the remaining 30% used to validate the model, identify a single upper stem diameter that gave the most accurate localized taper model, and determine the better localizing approach between AC and EB. The AC and EB approaches, with the best localizing upper stem diameter, were tested on additional independent data sets that were not part of the split data sets. Upper stem diameters measured at 60% of total height resulted in the lowest prediction error localized models, with the EB approach generally performing better than the AC approach. Compared to the prediction error from using nonlocalized models, overall model prediction error due to the best localized model was 1 to 3 absolute percentage points smaller with most reductions in prediction error occurring in the portion of the tree bole above 50% of total height.

Measuring accessible journeys: a tool to enable participation

This study set out to demonstrate the feasibility and usefulness of a series of pedestrian counts, including counting the subset of pedestrians who use visibly identifiable mobility aids. The resulting proportion of mobility aid users can then be used as a proxy measure of relative accessibility for each count site. The study acknowledges the diversity of disability, and the count is not intended to capture all people who identify as having disability of any kind. It was estimated from Statistics New Zealand data that approximately 3% of New Zealand's adult population uses a mobility aid for travel at any particular time. This figure includes those identifying as having permanent disability, as well as an estimate to account for those not included in this figure, namely children, people who do not identify as having a disability but nevertheless use a mobility aid, and those with temporary disability requiring use of a mobility aid. The study identified opportunities to use the tool to remove gaps in the delivery of accessible transportation, across all parts of its system from policy and planning, through design, construction and monitoring. Its widespread promotion will support more objective measurement of inclusion, to inform best-practice infrastructure investment for all.

MODELLING A REGIME-SHIFTING BEVERIDGE CURVE

This paper offers new insights into Beveridge curve analysis by modelling the unemployment–vacancy rate relationship within a Markov regime-switching environment in which the probabilities of curve-shifting are determined endogenously by shift factors. Shift factors include structural factors such as labour market participation and net migration, while cyclical variables include GDP growth, the real rate of interest, and labour productivity. This approach enables us to estimate regime-specific parameters and to assess the role played by these factors in influencing the transition probabilities of switching between regimes. Using New Zealand data, we show that increases in the participation rate have shifted the Beveridge curve inward, while increases in net migration have shifted the curve outward.

Immigrants' Location Choices, Geographic Concentration, and Employment in New Zealand

TBC

‘A Common Sense of the Times’? Neo‐liberalism and Changing Public Opinion in New Zealand and the UK

AbstractNeo‐liberalism represents a significant and enduring shift in the politics shaping social policy. Although frequently ascribed a hegemonic, all‐powerful status that focuses our attention on the coherence found in neo‐liberal policies, this article builds on scholarly work highlighting variegation in the neo‐liberal project across different policy areas, national settings and time periods. Specifically, it employs Peck's and Tickell's (2002) view that neo‐liberalism has gone through multiple phases in response to both external and internal crises as an entry point for studying neo‐liberalism's impact on public support for the welfare state. Drawing upon New Zealand and British attitudinal data, the article argues that public reactions to an early period of retrenchment (‘roll‐back’ neo‐liberalism) differ from those reported in the ‘roll‐out’ or embedding phase of neo‐liberalism implemented by Third Way Labour Governments in both countries. Indeed, continuing public support in many policy areas arguably contributed to the internal crisis that provoked an adaptation to the neo‐liberal project. The article further explores public support for the welfare state following the external crisis provoked by the financial meltdown of 2008–09 asking whether New Zealand and British attitudes showed signs of resisting austerity measures or whether they, instead, indicated a third, ‘roll‐over’ period of neo‐liberalism where the public accepted not only a neo‐liberal economic agenda but also the need for further retrenchment of the welfare state. Conclusions about the politics of social policy at the level of public opinion offer both good and bad news for welfare state advocates.

Income redistribution and changes in inequality in New Zealand from 2007 to 2011: Alternative distributions and value judgements

This paper illustrates the effects of using different distributions and summary measures, using New Zealand data for the period 2007–2011. Using an annual accounting period, alternative welfare metrics and units of analysis are investigated. In addition, the sensitivity to assumptions about economies of scale within households is examined, and changes in inequality are decomposed into those arising from population and tax structure changes. When considering the period 2007–2010, all measures agree that inequality fell, although the extent of the reduction varies. For the period 2007–2011 (after the tax reforms of 2010) the answer to the question of whether inequality in New Zealand has risen or fallen depends crucially on the combination of welfare metric, income unit, adult equivalent scale and inequality measure used. In empirical studies, it is therefore important to explore a wide range of alternative approaches, providing information for readers to make their own judgements.

Occupational Attainment and Earnings Among Immigrant Groups: Evidence from New Zealand

This paper concerns the prediction of career success among migrants. We focus specifically on the role of occupation as a mediating variable between the predictor variables education and time since migration, and the dependent variable career success as denoted by occupational status, linked to earnings. Following a review of the literature specifically focused on occupation, we apply Ordered Probit analysis to a sample of over 37,900 employed males surveyed in New Zealand. New Zealand provides an interesting case, as a country where migrants from diverse ethnic groups comprise a significant part of the population. We focus on the occupational attainment of immigrants and the native-born populations and provide evidence on the mediating effect of occupational attainment on earnings. Our analyses show the interplay of factors leading to occupational attainment: for example, education level is of greatest importance, and much of its effect on earnings is through occupational attainment; different immigrant groups have differentiable outcomes, and years of experience in the host country enable gradual occupational advancement. This is the first application of this analysis to New Zealand data. Our results highlight the significant mediating role of occupational attainment in explaining earnings across immigrant and native-born groups.

Educational Mismatches and Earnings in the New Zealand Labor Market

Mismatch of educational skills in the labor market is an emerging topic in the field of labor economics, partly due to its link to labor productivity. This is the first application of this question to New Zealand data. In this paper we examine the incidence of educational mismatch and its earnings effects. Using micro data drawn from the Household Labour Force Survey and the New Zealand Income Supplement (HLFS/NZIS) for the years 2004 to 2007, we find a noteworthy incidence of both over- and under-education. We also find that earnings returns to required years of education exceed the returns with over- and under-education, with a greater earnings penalty associated with under-education. We test hypotheses on three alternative models of educational mismatch. As the New Zealand labor market exhibits assignment-type matching, we argue that the higher than average public expenditure on education serves to improve economic performance. We further examine results stratified by age group and for the native-born and immigrants, and find that our results are robust across these groups.

Inferring epidemiological dynamics with Bayesian coalescent inference: the merits of deterministic and stochastic models.

Estimation of epidemiological and population parameters from molecular sequence data has become central to the understanding of infectious disease dynamics. Various models have been proposed to infer details of the dynamics that describe epidemic progression. These include inference approaches derived from Kingman’s coalescent theory. Here, we use recently described coalescent theory for epidemic dynamics to develop stochastic and deterministic coalescent susceptible–infected–removed (SIR) tree priors. We implement these in a Bayesian phylogenetic inference framework to permit joint estimation of SIR epidemic parameters and the sample genealogy. We assess the performance of the two coalescent models and also juxtapose results obtained with a recently published birth–death-sampling model for epidemic inference. Comparisons are made by analyzing sets of genealogies simulated under precisely known epidemiological parameters. Additionally, we analyze influenza A (H1N1) sequence data sampled in the Canterbury region of New Zealand and HIV-1 sequence data obtained from known United Kingdom infection clusters. We show that both coalescent SIR models are effective at estimating epidemiological parameters from data with large fundamental reproductive number and large population size . Furthermore, we find that the stochastic variant generally outperforms its deterministic counterpart in terms of error, bias, and highest posterior density coverage, particularly for smaller and . However, each of these inference models is shown to have undesirable properties in certain circumstances, especially for epidemic outbreaks with close to one or with small effective susceptible populations.

Mandatory notification of impaired doctors.

Mandatory reporting of impaired doctors is compulsory in Australasia. Australian Health Practitioner Regulation Agency guidelines for notification claim high benchmark though the Royal Australasian College of Surgeons and the Royal Australasian College of Physicians suggest they still obstruct doctors seeking help. Western Australia excludes mandatory reporting of practitioner-patients. This study examines reporting, consequences and international experiences with notification. Depressed doctors avoid diagnosis and treatment, fearing consequences, yet are more prone to marital problems, substance dependence and needing psychotherapy. South African research confirms isolation of impaired doctors and delayed seeking help with definable characteristics of those at risk. New Zealand data acknowledge: errors occur; questionable contribution from mandatory reporting; issues concerning competence assessment; favouring reporting to senior colleagues or self-intervention to compliance with mandatory reporting. UK found an anaesthetist guilty of professional misconduct for not reporting and sanctioned doctors regarding Harold Shipman. Australians are reluctant to report, fearing legalistic intrusion into care. Australian research confirmed definable characteristics for doctors with psychiatric illness or alcohol abuse. Exposure to legal medicine evokes personal disenchantment for doctors involved. Medicine poses barriers for impaired doctors. Spanish and UK doctors do not use general practitioners and may have suboptimal care. US and European doctors self-medicate using samples. US drug-dependent doctors also prescribe for spouses. Junior doctors are losing empathy with the profession. UK doctors favour private care, avoiding public scrutiny. NZ and Brazil created specific services for doctors, which appear effective. Mandatory reporting may be counterproductive requiring reappraisal.

Mortality related to after-hours discharge from intensive care in Australia and New Zealand, 2005-2012.

After-hours discharge from the intensive care unit (ICU) is associated with adverse patient outcomes including increased ICU readmissions and mortality. Since Australian and New Zealand data were last published, overall ICU patient mortality has decreased; however it is unknown whether changes in discharge practices have contributed to these improved outcomes. Our aim was to examine trends over time in discharge timing and the contemporary associations with mortality and ICU readmission. Retrospective cohort study using data from the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS APD) for patients admitted to Australian and New Zealand ICUs between January 2005 and December 2012. Data collected included patient characteristics, time of ICU discharge, hospital mortality and ICU readmissions. Between 1 January 2005 and 31 December 2012, there were 710,535 patients available for analysis, of whom 109,384 (15.4 %) were discharged after-hours (1800-0600 hours). There were no changes in timing of ICU discharge over the 8 years of the study. Patients discharged after-hours had a higher hospital mortality (6.4 versus 3.6 %; P < 0.001) and more ICU readmissions (5.1 versus 4.5 %; P < 0.001) than patients discharged in-hours. Although post-ICU mortality for all patients declined during the study period, the risk associated with after-hours discharge remained elevated throughout (odds ratio 1.34, 95 % confidence intervals 1.30-1.38). After-hours discharge remains an important independent predictor of hospital mortality and readmission to ICU. Despite widespread dissemination this evidence has not translated into fewer after-hours discharges or reduction in risk in Australian and New Zealand hospitals.

Adverse drug events are a major cause of acute medical admission

Adverse drug events (ADE) contribute significantly to hospital admissions. Prospective New Zealand data are scant, and the ability of clinical coding to identify ADE associated admissions is uncertain. Outcomes after cessation of causative medications are unknown. To assess the frequency, nature and causality of ADE associated with acute admissions to General Medicine at Christchurch Hospital. Prospective observational study of patients admitted to our medical team over 20 weeks. Of 336 admissions, 96 (28.6%) were ADE related. Sixty-five (19.3%) were caused by an ADE, and 31 (9.2%) were contributed to by an ADE. The mean age of non-ADE patients was 64.3 years (range 16-91), which was similar to the mean age of ADE patients (65.9 years; 21-92). However, if intentional overdoses and recreational drug use were excluded, ADE patients were significantly older at 72.4 years (21-92) (P = 0.0007). ADE patients took more regular medications on admission (mean 6.6, range 0-22) than non-ADE patients (mean 5.0, 0-18), (P = 0.003). The average length of stay was similar. The commonest medications implicated were vasodilators, psychotropics and diuretics. The most common adverse effects were postural hypotension and/or vasovagal syncope (29% of ADE), intentional overdoses and recreational drug use (15%) and acute renal failure and/or clinical dehydration (10%). Seventy-six patients had culprit medications stopped or reduced, and this potentially contributed to six readmissions. Coding identified 61% of ADE associated admissions. ADE are a common cause of hospital admission. The most frequent problems are postural hypotension and vasovagal syncope, intentional drug misuse and dehydration.

Is expanding HPV vaccination programs to include school-aged boys likely to be value-for-money: a cost-utility analysis in a country with an existing school-girl program.

BackgroundSimilar to many developed countries, vaccination against human papillomavirus (HPV) is provided only to girls in New Zealand and coverage is relatively low (47% in school-aged girls for dose 3). Some jurisdictions have already extended HPV vaccination to school-aged boys. Thus, exploration of the cost-utility of adding boys’ vaccination is relevant. We modeled the incremental health gain and costs for extending the current girls-only program to boys, intensifying the current girls-only program to achieve 73% coverage, and extension of the intensive program to boys.MethodsA Markov macro-simulation model, which accounted for herd immunity, was developed for an annual cohort of 12-year-olds in 2011 and included the future health states of: cervical cancer, pre-cancer (CIN I to III), genital warts, and three other HPV-related cancers. In each state, health sector costs, including additional health costs from extra life, and quality-adjusted life-years (QALYs) were accumulated. The model included New Zealand data on cancer incidence and survival, and other cause mortality (all by sex, age, ethnicity and deprivation).ResultsAt an assumed local willingness-to-pay threshold of US$29,600, vaccination of 12-year-old boys to achieve the current coverage for girls would not be cost-effective, at US$61,400/QALY gained (95% UI $29,700 to $112,000; OECD purchasing power parities) compared to the current girls-only program, with an assumed vaccine cost of US$59 (NZ$113). This was dominated though by the intensified girls-only program; US$17,400/QALY gained (95% UI: dominant to $46,100). Adding boys to this intensified program was also not cost-effective; US$128,000/QALY gained, 95% UI: $61,900 to $247,000).Vaccination of boys was not found to be cost-effective, even for additional scenarios with very low vaccine or program administration costs – only when combined vaccine and administration costs were NZ$125 or lower per dose was vaccination of boys cost-effective.ConclusionsThese results suggest that adding boys to the girls-only HPV vaccination program in New Zealand is highly unlikely to be cost-effective. In order for vaccination of males to become cost-effective in New Zealand, vaccine would need to be supplied at very low prices and administration costs would need to be minimised.