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Lung cancer screening can significantly reduce mortality from lung cancer. Further evidence about how to optimize lung cancer screening for specific populations, including Aotearoa New Zealand (NZ)’s Indigenous Māori (who experience disproportionately higher rates of lung cancer), is needed to ensure it is equitable. This community-based, pragmatic cluster randomized trial aims to determine whether a lung cancer screening invitation from a patient’s primary care physician, compared to from a centralized screening service, will optimize screening uptake for Māori. Participating primary care practices (clinics) in Auckland, Aotearoa NZ will be randomized to either the primary care-led or centralized service for delivery of the screening invitation. Clinic patients who meet the following criteria will be eligible: Māori; aged 55–74 years; enrolled in participating clinics in the region; ever-smokers; and have at least a 2% risk of developing lung cancer within six years (determined using the PLCO M2012 risk prediction model). Eligible patients who respond positively to the invitation will undertake shared decision-making with a nurse about undergoing a low dose CT scan (LDCT) and an assessment for Chronic Obstructive Pulmonary Disease (COPD). The primary outcomes are: 1) the proportion of eligible population who complete a risk assessment and 2) the proportion of people eligible for a CT scan who complete the CT scan. Secondary outcomes include evaluating the contextual factors needed to inform the screening process, such as including assessment for Chronic Obstructive Pulmonary Disease (COPD). We will also use the RE-AIM framework to evaluate specific implementation factors. This study is a world-first, Indigenous-led lung cancer screening trial for Māori participants. The study will provide policy-relevant information on a key policy parameter, invitation method. In addition, the trial includes a nested analysis of COPD in the screened Indigenous population, and it provides baseline (T0 screen round) data using RE-AIM implementation outcomes.

ObjectiveThere are large inequities in the lung cancer burden for the Indigenous Māori population of New Zealand. We model the potential lifetime health gains, equity impacts and cost-effectiveness of a national low-dose CT (LDCT) screening programme for lung cancer in smokers aged 55–74 years with a 30 pack-year history, and for formers smokers who have quit within the last 15 years.DesignA Markov macrosimulation model estimated: health benefits (health-adjusted life-years (HALYs)), costs and cost-effectiveness of biennial LDCT screening. Input parameters came from literature and NZ-linked health datasets.SettingNew Zealand.ParticipantsPopulation aged 55–74 years in 2011.InterventionsBiennial LDCT screening for lung cancer compared with usual care.Outcome measuresIncremental cost-effectiveness ratios were calculated using the average difference in costs and HALYs between the screened and the unscreened populations. Equity analyses included substituting non-Māori values for Māori values of background morbidity, mortality and stage-specific survival. Changes in inequities in lung cancer survival and ‘health-adjusted life expectancy’ (HALE) were measured.ResultsLDCT screening in NZ is likely to be cost-effective for the total population: NZ$34 400 per HALY gained (95% uncertainty interval NZ$27 500 to NZ$42 900) and for Māori separately (using a threshold of gross domestic product per capita NZ$45 000). Health gains per capita for Māori females were twice that for non-Māori females and 25% greater for Māori males compared with non-Māori males. LDCT screening will narrow absolute inequities in HALE and lung cancer mortality for Māori, but will slightly increase relative inequities in mortality from lung cancer (compared with non-Māori) due to differential stage-specific survival.ConclusionA national biennial LDCT lung cancer screening programme in New Zealand is likely to be cost-effective, will improve total population health and reduce health inequities for Māori. Attention must be paid to addressing ethnic inequities in stage-specific lung cancer survival.

Background Quality smoking data is crucial for assessing smoking-related health risk and eligibility for interventions related to that risk. Smoking information collected in primary care practices (PCPs) is a major data source; however, little is known about the PCP smoking data quality. This project compared PCP smoking data to that collected in the Māori and Pacific Abdominal Aortic Aneurysm (AAA) screening programme. Methods A two stage review was conducted. In Stage 1, data quality was assessed by comparing the PCP smoking data recorded close to AAA screening episodes with the data collected from participants at the AAA screening session. Inter-rater reliability was analysed using Cohen’s kappa scores. In Stage 2, an audit of longitudinal smoking status was conducted, of a subset of participants potentially misclassified in Stage 1. Data were compared in three groups: current smoker (smoke at least monthly), ex-smoker (stopped > 1 month ago) and never smoker (smoked < 100 cigarettes in lifetime). Results Of the 1841 people who underwent AAA screening, 1716 (93%) had PCP smoking information. Stage 1 PCP smoking data showed 82% concordance with the AAA data (adjusted kappa 0.76). Fewer current or ex-smokers were recorded in PCP data. In the Stage 2 analysis of discordant and missing data ( N  = 313), 212 were enrolled in the 29 participating PCPs, and of these 13% were deceased and 41% had changed PCP. Of the 93 participants still enrolled in the participating PCPs, smoking status had been updated for 43%. Data on quantity, duration, or quit date of smoking were largely missing in PCP records. The AAA data of ex-smokers who were classified as never smokers in the Stage 2 PCP data ( N  = 27) showed a median smoking cessation duration of 32 years (range 0–50 years), with 85% ( N  = 23) having quit more than 15 years ago. Conclusions PCP smoking data quality compared with the AAA data is consistent with international findings. PCP data captured fewer current and ex-smokers, suggesting ongoing improvement is important. Intervention programmes based on smoking status should consider complementary mechanisms to ensure eligible individuals are not missed from programme invitation.

Background New Zealand’s Bowel Screening Pilot (BSP) used a mailed invitation to return a faecal immunochemical test. As a pilot it offered opportunities to test interventions for reducing ethnic inequities in colorectal cancer screening prior to nationwide programme introduction. Small media interventions (e.g. educational material and DVDs) have been used at both community and participant level to improve uptake. We tested whether a DVD originally produced to raise community awareness among the Māori population would have a positive impact on participation and reduce the proportion of incorrectly performed tests (spoiled kits) if mailed out with the usual reminder letter. Methods The study was a parallel groups pseudo-randomised controlled trial. Over 12 months, all Māori and Pacific ethnicity non-responders four weeks after being mailed the test kit were allocated on alternate weeks to be sent, or not, the DVD intervention with the usual reminder letter. The objective was to determine changes in participation and spoiled kit rates in each ethnic group, determined three months from the date the reminder letter was sent. Participants and those recording the outcomes (receipt of a spoiled or non-spoiled test kit) were blinded to group assignment. Results 2333 Māori and 2938 Pacific people participated (11 withdrew). Those who were sent the DVD (1029 Māori and 1359 Pacific) were less likely to participate in screening than those who were not (1304 Māori and 1579 Pacific). Screening participation was reduced by 12.3% (95% CI 9.1–15.5%) in Māori (13.6% versus 25.9%) and 8.3% (95% CI 5.8–10.8%) in Pacific (10.1% versus 18.4%). However, spoiled kit rates (first return) were significantly higher among those not sent the DVD (33.1% versus 12.4% in Māori and 42.1% versus 21.9% in Pacific). Conclusion The DVD sent with the reminder letter to BSP non-responders reduced screening participation to an extent that more than offset the lower rate of spoiled kits. Trial registration Australia and New Zealand Clinical Trials Registry ACTRN12612001259831 . Registered 30 November 2013.

Use data envelopment analysis (DEA) to measure the efficiency of New Zealand's District Health Boards (DHBs) at achieving gains in Māori and European life expectancy (LE). Using life tables for 2006 and 2013, a two‐output DEA model established the production possibility frontier for Māori and European LE gain. Confidence limits were generated from a 10,000 replicate Monte Carlo simulation. Results support the use of LE change as an indicator of DHB efficiency. DHB mean income and education were related to initial LE but not to its rate of change. LE gains were unrelated to either the initial level of life expectancy or to the proportion of Māori in the population. DHB efficiency ranged from 79% to 100%. Efficiency was significantly correlated with DHB financial performance. Changes in LE did not depend on the social characteristics of the DHB. The statistically significant association between efficiency and financial performance supports its use as an indicator of managerial effectiveness. Efficient health systems achieve better population health outcomes. DEA can be used to measure the relative efficiency of sub‐national health authorities at achieving health gain and equity outcomes.

Working with volunteers is a challenging occupation, especially in an environment of increasingly precarious casualisation. Although this trend is evident in other types of work, workers’ engagement with the purpose and mission of volunteerism can particularly emphasise blurred boundaries between the work and non-work spheres, potentially confusing employee identities. Emerging from an ongoing ethnographic study, this account draws on Sally’s precarious experiences as a leader of volunteers in the conservation sector. She reflects on the joys and challenges of leading volunteers in a messy environment of paradoxically interacting overwork and underwork, while highlighting issues of precarity and balance within and beyond her role as employee.

PurposeThis paper proposes a dialogical approach for analyzing and presenting Interpretative Phenomenological Analysis (IPA) data in organizational research.Design/methodology/approachThe paper explores the story behind a story, showing how qualitative research can be fictionalized and reflexively framed in contemporary organizational settings, illustrated by IPA research conducted by the authors, into selection interviewing in Australia. Drawing from researchers' narrative notes that reflexively interpret interview data in narrative form, the data were re-interpreted in fictionalized dialogical form, enabling findings to be analyzed and presented more interactively.FindingsThe application of new interpretative techniques, like fictionalized dialogue, contributes to a richer interpretation of phenomena in qualitative organizational and management research, not limited to IPA studies.Originality/valueFictionalized dialogue brings to the surface an additional level of analysis that contributes to thematic analysis in a novel manner, also serving as a communicative tool.

Purpose: The burden of abdominal aortic aneurysms (AAA) has changed in the last 20 years but is still considered to be a major cause of cardiovascular mortality. The introduction of endovascular aortic repair (EVAR) and improved peri-operative care has resulted in a steady improvement in both outcomes and long-term survival. The objective of this study was to identify the burden of AAA disease by analysing AAA-related hospitalisations and deaths. Methodology: All AAA-related hospitalisations in NZ from January 2001 to December 2021 were identified from the National Minimum Dataset, and mortality data were obtained from the NZ Mortality Collection dataset from January 2001 to December 2018. Data was analysed for patient characteristics including deprivation index, repair methods and 30-day outcomes. Results: From 2001 to 2021, 14,436 patients with an intact AAA were identified with a mean age of 75.1 years (SD 9.7 years), and 4100 (28%) were females. From 2001 to 2018, there were 5000 ruptured AAA with a mean age of 77.8 (SD 9.4), and 1676 (33%) were females. The rate of hospitalisations related to AAA has decreased from 43.7 per 100,000 in 2001 to 15.4 per 100,000 in 2018. There was a higher proportion of rupture AAA in patients living in more deprived areas. The use of EVAR for intact AAA repair has increased from 18.1% in 2001 to 64.3% in 2021. The proportion of octogenarians undergoing intact AAA repair has increased from 16.2% in 2001 to 28.4% in 2021. The 30-day mortality for intact AAA repair has declined from 5.8% in 2001 to 1.7% in 2021; however, it has remained unchanged for ruptured AAA repair at 31.6% across the same period. Conclusions: This study highlights that the incidence of AAA has declined in the last two decades. The mortality has improved for patients who had a planned repair. Understanding the contemporary burden of AAA is paramount to improve access to health, reduce variation in outcomes and promote surgical quality improvement.

This article explores public house (pub) employees' relationship to alcohol, its service and consumption using data drawn from an ethnographic study of workers in a chain of pubs. These workers experience a particularly complex relationship between their work and their leisure; they belong to a culture in which drinking in public is the norm for consumers and, as employees, they are responsible for enforcing drinking rules within their workplace – which is also where much of their own leisure takes place. The concept of partial consumer is used to analyse the fluidity of the work–leisure and service–consumption divides in this context. The drinking norms that develop within the pub enable these workers to construct contextually variable behavioural norms around drinking behaviour, allowing them to behave differently behind and in front of the bar, the symbolic barrier between work and leisure.

Calculates the 30-day case fatality rate (CFR) of ischaemic stroke in New Zealand from routinely collected data for two 5-year periods (2000-2004 and 2010-2014) in Māori, Pacific, Asian and European people. Tests ethnic inequalities between Europeans and people of other ethnicities in each time period. 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.