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To define and demonstrate effective cataract surgical coverage (eCSC), a candidate UHC indicator that combines a coverage measure (cataract surgical coverage, CSC) with quality (post-operative visual outcome). All Rapid Assessment of Avoidable Blindness (RAAB) surveys with datasets on the online RAAB Repository on April 1 2016 were downloaded. The most recent study from each country was included. By country, cataract surgical outcome (CSOGood, 6/18 or better; CSOPoor, worse than 6/60), CSC (operated cataract as a proportion of operable plus operated cataract) and eCSC (operated cataract and a good outcome as a proportion of operable plus operated cataract) were calculated. The association between CSC and CSO was assessed by linear regression. Gender inequality in CSC and eCSC was calculated. Datasets from 20 countries were included (2005-2013; 67,337 participants; 5,474 cataract surgeries). Median CSC was 53.7% (inter-quartile range[IQR] 46.1-66.6%), CSOGood was 58.9% (IQR 53.7-67.6%) and CSOPoor was 17.7% (IQR 11.3-21.1%). Coverage and quality of cataract surgery were moderately associated-every 1% CSC increase was associated with a 0.46% CSOGood increase and 0.28% CSOPoor decrease. Median eCSC was 36.7% (IQR 30.2-50.6%), approximately one-third lower than the median CSC. Women tended to fare worse than men, and gender inequality was slightly higher for eCSC (4.6% IQR 0.5-7.1%) than for CSC (median 2.3% IQR -1.5-11.6%). eCSC allows monitoring of quality in conjunction with coverage of cataract surgery. In the surveys analysed, on average 36.7% of people who could benefit from cataract surgery had undergone surgery and obtained a good visual outcome.

To assess diabetes eye service use in New Zealand among people aged ≥15 years by estimating service attendance, biennial screening rate, and disparities in the use of screening and treatment services. We obtained Ministry of Health data from the National Non-Admitted Patient Collection on diabetes eye service events between 1 July 2006 and 31 December 2019 and sociodemographic and mortality data from the Virtual Diabetes Register and linked these using a unique patient identifier (encrypted National Health Index). We 1) summarized attendance at retinal screening and ophthalmology services, 2) calculated biennial and triennial screening rate, 3) summarized treatment with laser and anti-VEGF and used log-binomial regression to examine associations of all of these with age group, ethnicity, and area-level deprivation. In total, 245,844 people aged ≥15 years had at least one diabetes eye service appointment attended or scheduled; half of these (n = 125,821, 51.2%) attended only retinal screening, one-sixth attended only ophthalmology (n = 35,883, 14.6%) and one-third attended both (n = 78,300, 31.8%). The biennial retinal screening rate was 62.1%, with large regional variation (73.9% in Southern District to 29.2% in West Coast). Compared with NZ Europeans, Māori were approximately twice as likely to never receive diabetes eye care or to access ophthalmology when referred from retinal screening, 9% relatively less likely to receive biennial screening and received the fewest anti-VEGF injections when treatment was commenced. Disparities in service access were also present for Pacific Peoples compared to NZ Europeans, younger and older age groups compared to those aged 50-59 years and those living in areas with higher deprivation. Access to diabetes eye care is suboptimal, with substantial disparity between age groups, ethnicity groups, area level deprivation quintile and across districts. Efforts to improve access to and quality of diabetes eye care services must include strengthening data collection and monitoring.

Background Fear or anxiety could result in adverse consequences on the course of labour. To date, family members are still not permitted in the delivery rooms in the majority of hospitals in China, and continuous support from hospital professional staff is also limited. This study aimed to evaluate the benefits of continuous support by family members and hospital professional staff during labour in China. Methods In this Cross-Sectional study, 362 primiparous pregnancies who self-requested to receive continuous or one to one support with vaginal delivery and 362 primiparous pregnant women with routine hospital maternal care were included from a university teaching hospital. Data on the length of labour, postpartum haemorrhage (PPH), use of pain relief, use of oxytocin, fetal distress, emergency caesarean section and apgar score at 1 and 5 min were retrospectively collected from hospital medical data-base and compared between the two groups. Results Multiple linear regressions adjusting for maternal age, BMI and birth weight, revealed the estimated length of labour for women with routine hospital maternal care was 2.03 times (95%CI 1.86 to 2.21) the duration of women with supportive care (median time, 3.05 h vs 1.5 h). In addition, Fisher’s exact test showed the emergency caesarean section rate was significantly lower in women with supportive care compared to women with routine hospital maternal care (3.3% vs 24%). Conclusion Our results suggest that continuous support from family members together with hospital professional staff should be considered as part of intrapartum care in hospitals in China.

Presents the first theoretical and methodological shift in the measurement of area deprivation in NZ since the 1990s and describes the development of the New Zealand Index of Multiple Deprivation (IMD). Describes briefly the development of Data Zones, an intermediary geographical scale, before outlining the development of the New Zealand Index of Multiple Deprivation (IMD), which uses routine data sets and methods comparable to current international deprivation indices. Identifies 28 indicators of deprivation from national health, social development, taxation, education, police databases, geospatial data providers and the 2013 Census, all of which represented seven domains of deprivation : employment; income; crime; housing; health; education; and geographical access Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

Background Rheumatoid arthritis (RA) treat-to-target (T2T) regimens often use the disease activity score (28 joints) incorporating C-reactive protein (DAS28 CRP ) as an outcome measure. We compared changes in the DAS28 CRP with changes in magnetic resonance imaging (MRI) inflammation on treatment escalation. Methods Eighty seropositive RA patients with active disease were enrolled. Group A ( N  = 57) escalated to another conventional disease-modifying therapy (cDMARD) combination, and Group B ( N  = 23) to anti-TNF therapy/cDMARDs. Contrast-enhanced 3T-MRI wrist scans were obtained before and 4 months after regimen change. Scan pairs were scored for inflammation (MRI(i)) and damage. Disease activity was assessed using the DAS28 CRP . Results Eighty patients were enrolled and 66 MRI scan pairs were available for analysis. Intra-reader reliability was high: intraclass correlation coefficient (average) 0.89 (0.56–0.97). ΔDAS28 CRP did not differ between groups: Group A, −0.94 (−3.30, 1.61); Group B, −1.53 (−3.59, 0.56) ( p  = 0.45). ΔMRI(i) also did not differ: Group A, 0 (−25, 10); Group B, −1 (−15, 28) ( p  = 0.12). Combining groups, ΔMRI(i) correlated weakly with ΔDAS28 CRP (Spearman’s 0.36, p  = 0.003). Using multiple linear regression analysis adjusting for confounders, ΔDAS28 CRP was associated with ΔMRI(i) ( p  = 0.056). Of the individual MRI measures, only Δtenosynovitis correlated with ΔDAS28 CRP (Spearman’s 0.33, p  = 0.007). ΔMRI(i) was negatively associated with the MRI erosion score at entry ( p  = 0.0052). Conclusions We report the first study investigating the link between changes in clinical and imaging inflammation in a real-world RA cohort escalating to conventional and biologic DMARDs. The association was significant but relatively weak, suggesting that MRI targets cannot yet be advocated as outcomes for T2T escalation. Trial registration ANZCTR 12614000895684 . Registered 22 August 2014.

Our study aims to estimate the prevalence of symptoms of depression and daily life hassles in elite athletes. A cross-sectional prospective epidemiological study design. An online anonymous survey was administered during a 2-month period from May to July 2015. Athletes 18 years of age (or older) who were members of the High Performance Sport New Zealand programme were invited to participate. Of 370 potential participants, 187 completed responses were received (51%). Symptoms of depression were measured by the Centre for Epidemiological Studies Depression Scale—Revised (CESD-R). Life stress was measured by the Daily Hassles Questionnaire. Overall 21% (n=39) of participants reported symptoms consistent with depression. Only 2 of the 39 athletes were currently taking an anti-depressant medication. Those contemplating retirement, partaking in individual sport, and who were less than 25 years old had significantly increased odds of experiencing depression. Reported life stressors were higher in females, in those who play an individual sport and those in a centralised programme. There was a significant correlation between higher levels of life stress and experiencing depressive symptoms. This study highlights that depressive symptoms are prevalent in elite athletes with multiple potential risk factors identified including high life stress. These variables warrant further exploration to enable the early identification of athletes with depressive symptoms, screening and support for elite athletes.

Objective Mobile Health approaches show promise as a delivery mode for alcohol screening and brief intervention. The ‘YourCall’ trial evaluated the effect of a low-intensity mobile phone text message brief intervention compared with usual care on hazardous drinking and alcohol-related harms among injured adults. This paper extends our previously published primary outcome analysis which revealed a significant reduction in hazardous drinking associated with the intervention at 3 months, with the effect maintained across 12 months follow-up. The objective of the current study was to evaluate the effect of the intervention on alcohol-related harms and troubles and help-seeking behaviours (secondary outcomes) at 12-months follow-up. Results A parallel two-group, single-blind, randomised controlled trial was conducted in 598 injured inpatients aged 16–69 years identified as having medium-risk hazardous drinking. Logistic regression models applied to 12-month follow-up data showed no significant differences between intervention and control groups in self-reported alcohol-related harms and troubles and help-seeking behaviours. Although this text message intervention led to a significant reduction in hazardous alcohol consumption (previously published primary outcome), changes in self-reported alcohol-related harms and troubles and help seeking behaviours at 12-months follow up (secondary outcomes) were small and non-significant. Trial registration ACTRN12612001220853. Retrospectively registered 19 November 2012.

ObjectivesTo determine professional footballers’ level of understanding of the purpose of the precompetition medical assessment (PCMA) and to evaluate their knowledge of potential outcomes following a PCMA, including disqualification.MethodsProfessional footballers from the Australasian A-League and Westfield W-League were asked to complete a 25-question survey. The relationship between dichotomised outcomes and explanatory variables was analysed with multivariate logistic regression; p<0.05 was considered statistically significant.ResultsA total of 212 players participated (response rate=48.8%). Most respondents selected ‘To detect medical conditions that may affect performance’ and ‘To detect current injuries’ (n=137, 64.6%; n=130, 61.3%) as the purpose of a PCMA. Approximately one-third (n=74, 38.1%) were neutral or believed that a normal PCMA prevented cardiac arrest. Receiving more PCMAs (p<0.0003) and receiving an explanation during their PCMA (p=0.0175) led to greater awareness of the assessment’s limitations. Most participants did not know the definitions of syncope (n=181, 93.3%) or Marfan syndrome (n=183, 94.3%). Fifty players (28.1%) did not know that disqualification was a possible outcome of a PCMA, and younger players were less aware of this possible outcome (p=0.0216).ConclusionProfessional footballers appear to have a limited understanding of the purpose of a PCMA, emphasising the musculoskeletal system and performance. They also appear unfamiliar with the components of the PCMA and medical terms. Finally, many are unaware that disqualification can result from an abnormal PCMA. Player health knowledge must be improved; the informed consent process appears an ideal time to provide this education.

To identify contemporary studies investigating multifaceted and inter‐linked contributory frameworks for unintentional injuries among children in New Zealand. A literature review was performed in seven databases. Studies published in English up to February 2020 reporting risk factors for child injury in New Zealand were included. Eligible study designs included: cohort, case‐control and case‐crossover studies. The quality of studies was assessed using the GATE frame tool. The PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) reporting guidelines were followed. Thirteen studies fulfilled the inclusion criteria, dating from 1977 to 2008. The factors associated with child injury (0 to 14 years) included socioeconomic disadvantage, number of children, younger maternal age and sole parents. Vehicle speed and traffic volume were associated with an increased risk of driveway‐related pedestrian injury. The review findings have reinforced the need for cross‐agency action to address the social determinants of child injury. Contemporary longitudinal studies are needed to assist in understanding how the interactions between children, family and their wider societal context affect their risk of experiencing injury over time.

Screening and brief intervention for hazardous alcohol use in trauma care settings is known to reduce alcohol intake and injury recidivism, but is often not implemented due to resource constraints. Brief interventions delivered by mobile phone could overcome this challenge. This study aimed to evaluate the effect of a mobile phone text message intervention (YourCall TM ) on hazardous drinkers admitted for an injury. The parallel two-group, single-blind, randomised controlled trial enrolled 598 injured patients aged 16–69 years identified as medium-risk drinkers at recruitment. The intervention group ( n  = 299) received 16 text messages incorporating brief intervention principles in the 4 weeks following discharge from hospital. Controls ( n  = 299) received usual care and one text message acknowledging participation in the trial. The primary outcome was the difference in hazardous alcohol use (assessed using AUDIT-C) between study groups at 3 months, with the maintenance of effect examined at 6 and 12 months’ follow-up. Data were analysed using a mixed-effects model for repeated measures. Both groups had similar baseline features. Compared to controls, hazardous drinking was significantly lower in the intervention group at 3 months and maintained over the 12-month follow-up period (least squares mean difference in AUDIT-C scores: −0.322; 95% CI: −0.636, −0.008; p  = 0.04). The intervention effect was similar among Māori (New Zealand’s indigenous population) and non-Māori (interaction p  = 0.59), and among younger (16–29 years) and older (30–69 years) patients ( p  = 0.77). The effectiveness of this intervention reflects the potential of low cost, scalable mobile health technologies to overcome common barriers in implementing alcohol harm reduction strategies following injury. Mobile health text message intervention to reduce hazardous drinking Mobile phone text messages reduce dangerous patterns of alcohol consumption and could help prevent alcohol-related injuries. A trial carried out in New Zealand led by Sarah Sharpe at the University of Auckland examined the effect of sending 16 automated text messages over a four-week period to 299 adults discharged from hospital following an injury and identified as moderate risk hazardous drinkers. The messages, which encouraged patients to reduce their alcohol consumption and offered information on how to do so in an easy-to-understand and non-judgemental manner, reduced hazardous drinking throughout the 12-month follow-up period compared with a control group that received usual care. These findings suggest that text message interventions are an effective, low cost and easily scalable solution to curb harmful alcohol consumption.