Rural-urban variation in COVID-19 vaccination uptake in Aotearoa New Zealand: Examining the national roll-out.

This study aimed to understand rural-urban differences in the uptake of COVID-19 vaccinations during the peak period of the national vaccination roll-out in Aotearoa New Zealand (NZ). Using a linked national dataset of health service users aged 12+ years and COVID-19 immunization records, age-standardized rates of vaccination uptake were calculated at fortnightly intervals, between June and December 2021, by rurality, ethnicity, and region. Rate ratios were calculated for each rurality category with the most urban areas (U1) used as the reference. Overall, rural vaccination rates lagged behind urban rates, despite early rapid rural uptake. By December 2021, a rural-urban gradient developed, with age-standardized coverage for R3 areas (most rural) at 77%, R2 81%, R1 83%, U2 85%, and U1 (most urban) 89%. Age-based assessments illustrate the rural-urban vaccination uptake gap was widest for those aged 12-44 years, with older people (65+) having broadly consistent levels of uptake regardless of rurality. Variations from national trends are observable by ethnicity. Early in the roll-out, Indigenous Maori residing in R3 areas had a higher uptake than Maori in U1, and Pacific peoples in R1 had a higher uptake than those in U1. The extent of differences in rural-urban vaccine uptake also varied by region.

Te Paatu o Te Ao Hurihuri - pandemic-related virtual adaptation of an established marae-based workshop for rural doctors: a qualitative study.

Introduction Due to COVID-19 pandemic restrictions in Aotearoa New Zealand, an established remote community marae-based workshop (a component of a postgraduate rural medical programme) was converted into a virtual platform. Aim The aim of this study was to explore student and teacher experiences of this virtual adaptation with focus on cultural aspects. Methods A qualitative exploratory study was undertaken that involved document review and qualitative interviews. Students and teachers were invited to participate. Semi-structured interviews were conducted. Thematic analysis was undertaken using a framework-guided rapid analysis method. The two participant groups' data were analysed concurrently but separately. Results Students found the virtual workshop valuable in furthering their knowledge of Maori culture, cross-cultural communication skills and health inequities in rural clinical practice. Through the innovative efforts of their teachers, they felt some sense of connection with the remote locality and its people. Teachers were able to impart knowledge, connect and keep everyone culturally safe through their commitment and adaptability. However, moving to a virtual platform meant compromise to the cultural experience for students and loss of sharing the learning and experience with their place and their people. Discussion In the event of a further pandemic or other emergency situation, where strong established relationships exist, replacing an in-person remote marae-based workshop with a virtual workshop, while limited, is achievable and has value. When urban tertiary institutions partner with remote Maori communities to deliver virtual teaching, caution is needed in ensuring sustained transparency in priorities and expectations to avoid further exacerbations of power imbalance and resulting loss of value.

The place of rural hospitals in New Zealand's health system: an exploratory qualitative study.

INTRODUCTION: In Aotearoa New Zealand (NZ) there is a knowledge gap regarding the place and contribution of rural hospitals in the health system. New Zealanders residing in rural areas have poorer health outcomes than those living in urban areas, and this is accentuated for Maori, the Indigenous people of the country. There is no current description of rural hospital services, no national policies and little published research regarding their role or value. Around 15% of New Zealanders rely on rural hospitals for health care. The purpose of this exploratory study was to understand national rural hospital leadership perspectives on the place of rural hospitals in the NZ health system. METHODS: A qualitative exploratory study was undertaken. The leadership of each rural hospital and national rural stakeholder organisations were invited to participate in virtual semi-structured interviews. The interviews explored participants' views of the rural hospital context, the strengths and challenges they faced and how good rural hospital care might look. Thematic analysis was undertaken using a framework-guided rapid analysis method. RESULTS: Twenty-seven semi-structured interviews were conducted by videoconference. Two broad themes were identified, as follows. Theme 1, 'Our place and our people', reflected the local, on-the-ground situation. Across a broad variety of rural hospitals, geographical distance from specialist health services and community connectedness were the common key influencers of a rural hospital's response. Local services were provided by small, adaptable teams across broad scopes and blurred primary-secondary care boundaries, with acute and inpatient care a key component. Rural hospitals acted as a conduit between community-based care and city-based secondary or tertiary hospital care. Theme 2, 'Our positioning in the wider health system', related to the external wider environment that rural hospitals worked within. Rural hospitals operating at the margins of the health system faced multiple challenges in trying to align with the urban-centric regulatory systems and processes they were dependent on. They described their position as being 'at the end of the dripline'. In contrast to their local connectedness, in the wider health system participants felt rural hospitals were undervalued and invisible. While the study found strengths and challenges common to all NZ rural hospitals, there were also variations between them. CONCLUSION: This study furthers understanding of the place of rural hospitals in the NZ healthcare system as seen through a national rural hospital lens. Rural hospitals are well placed to provide an integrative role in locality service provision, with many already long established in performing this role. However, context-specific national policy for rural hospitals is urgently needed to ensure their sustainability. Further research should be undertaken to understand the role of NZ rural hospitals in addressing healthcare inequities for those living in rural areas, particularly for Maori.

New Zealand's rural hospitals in 2021: findings from an exploratory questionnaire survey.

Introduction There is a gap in our knowledge of the place and contribution of rural hospitals in the New Zealand health system. There is no current description of rural hospital services, no national policies and little published research regarding their value. Aim To explore rural hospital leader perspectives of the role of rural hospitals. Methods An on-line survey of rural hospital leaders conducted to capture perspectives on areas including facility nomenclature; access and equity; funding and the health reforms. Results Fifty-five rural hospital leaders representing 19/24 rural hospitals responded. 'Rural Hospital' was the most common term used to describe facilities with 80% of respondents indicating this as their preferred term. Other descriptive terms varied widely from primary through to secondary care. Respondents indicated that the loss of rural hospital in-patient beds would be unacceptable to communities (median 0, IQR 0, 1). Scores on questions about 'range of services' (median 7, IQR 6, 8), 'accessibility' (median 7, IQR 6, 8) and how rural hospitals were addressing health equity (median 6, IQR 5, 7) were variable. The process for allocating funds to rural hospitals was perceived as lacking transparency (median 3, IQR 2, 5). National strategy and 'local governance and control' were both rated as important (median 9, IQR 7, 10 and median 9, IQR, 8, 10) for a rural hospital's future. Discussion By capturing a collective national rural hospital leadership voice, this study facilitates the understanding of the rural hospital concept. The findings inform subsequent research needed to gain a clearer picture of New Zealand rural hospital provision.

A randomized controlled trial investigating effects of an individualized pedometer driven walking program on chronic low back pain.

BACKGROUND: Walking is an easily prescribed physical activity for people with low back pain (LBP). However, the evidence for its effectiveness to improve pain and disability levels for people with chronic low back pain (CLBP) within a community setting has not been evaluated. This study evaluates the effectiveness of a clinician guided, pedometer-driven, walking intervention for increasing physical activity and improving clinical outcomes compared to education and advice. METHODS: Randomized controlled trial recruiting N = 174 adults with CLBP. Participants were randomly allocated into either a standardized care group (SG) or pedometer based walking group (WG) using minimization allocation with a 2:1 ratio to the WG. Prior to randomization all participants were given a standard package of education and advice regarding self-management and the benefits of staying active. Following randomization the WG undertook a physiotherapist guided pedometer-driven walking program for 12 weeks. This was individually tailored by weekly negotiation of daily step targets. Main outcome was the Oswestry Disability Index (ODI) recorded at baseline, 12 weeks, 6 and 12 months. Other outcomes included, numeric pain rating, International Physical Activity Questionnaire (IPAQ), Fear-Avoidance Beliefs Questionnaire (FABQ), Back Beliefs questionnaire (BBQ), Physical Activity Self-efficacy Scale, and EQ-5D-5L quality of life estimate. RESULTS: N = 138 (79%) participants completed all outcome measures at 12 weeks reducing to N = 96 (55%) at 12 months. Both observed and intention to treat analysis did not show any statistically significant difference in ODI change score between the WG and the SG at all post-intervention time points. There were also no significant between group differences for change scores in all secondary outcome measures. Post hoc sensitivity analyses revealed moderately disabled participants (baseline ODI ≥ 21.0) demonstrated a greater reduction in mean ODI scores at 12 months in the WG compared to SG, while WG participants with a daily baseline step count < 7500 steps demonstrated a greater reduction in mean ODI scores at 12 weeks. CONCLUSIONS: Overall, we found no significant difference in change of levels of (ODI) disability between the SG and WG following the walking intervention. However, ODI responses to a walking program for those with moderate levels of baseline disability and those with low baseline step count offer a potential future focus for continued research into the benefit of walking as a management strategy for chronic LBP. TRIAL REGISTRATION: United States National Institutes of Health Clinical Trails registry (http://ClinicalTrials.gov/) No. NCT02284958 (27/10/2014).

Perspectives on walking from people with multiple sclerosis and reactions to video self-observation.

Purpose: People with multiple sclerosis (MS) rank walking among the most challenging aspects of their condition. A greater understanding of people's perspectives concerning their walking may help to prioritize walking outcomes and strategies for optimizing walking. The purpose was to explore perceptions of walking in people with MS and to describe their reactions after observing themselves walk on video.Materials and methods: An interpretive thematic analysis study using face-to-face, semi-structured interviews was conducted with 14 people who self-identified a change in their walking due to MS. Participants were video-recorded walking and watched their video during the interview.Results: Four themes were identified: "awareness," "acceptance," "constant change," and "increased effort." People with MS develop awareness of how their walking performance looks and awareness of constantly-changing internal factors and external factors which impact their walking. Awareness of change in fatigue, temperature, terrain, and the use of aids in particular are perceived relevant to walking and to impact the effort required to walk. People with MS also describe differences in their acceptance of how others view their walking and the changes related to walking. An analogy with a marionette performing describes how people perceive walking as no longer automatic; instead walking requires the person to consciously pull the strings to walk. An increase in both the physical and cognitive effort is required to walk and an awareness and acceptance of a variety of changes in oneself and the lived world may help or hinder walking. People with MS are willing to watch themselves walk on video and are not surprised by what they observe.Conclusions: People with MS develop a learned self-awareness with variable levels of acceptance about their walking function and what it looks like. The perceptions on walking from persons with MS suggest that focusing on reducing the effort to walk and minimizing the constantly-changing variables may help to optimize walking.Implications for rehabilitationPeople with multiple sclerosis are challenged by the increased effort and constant change required to walk in their day-to-day lives.A focus on minimizing both the effort to walk and the changing variables (i.e., fluctuating symptoms and environmental factors) is warranted.People with multiple sclerosis develop a learned awareness of how they walk and how their walking looks.Acceptance of loss of walking function is variable.Video self-observation is a feasible tool which warrants further exploration for enhancing acceptance of walking function and accommodating strategies.

Gait quality and velocity influences activity tracker accuracy in individuals post-stroke.

Objective: Fitbit Zip™ (FBZ) is a low-cost user-friendly device that could help motivate individuals post-stroke to increase their physical activity. However, inaccuracy in step counts from altered gait variables could cause dissatisfaction and reduce compliance. The aim of this study was to determine the influence of gait variables on the concurrent validity of the FBZ. Method: In a cross-sectional study, 19 community-dwelling stroke survivors (mean 66 (SD 8) years)  wore a FBZ at the non-paretic hip, and were videoed completing a six minute walk test (6MWT). Steps recorded by the FBZ were compared against the criterion standard of manually counted steps from video-recordings. Spatio-temporal gait parameters were calculated, and gait quality was assessed using the Wisconsin Gait Analysis (WGA) tool. Concurrent validity of FBZ was determined using Kendall's Tau correlation coefficient. Linear regression analysis determined the association between gait parameters, quality, and FBZ accuracy. Results: A very strong correlation was observed between the FBZ steps and manual counting (τ = 0.80, p < .001). Step difference demonstrated significant negative association with gait velocity (R2 = 0.35, B = -59.94, p = .007), and positive association with WGA score (R2 = 0.69, B = 4.59, p < .001), indicating poor FBZ accuracy in participants with lower speed (≤0.8m/s) and poor gait quality (WGA score>16). Conclusions: FBZ is an accurate measure of step activity in independent ambulators with stroke walking at speeds > 0.8m/s, but accuracy can be compromised with lower speed and poor gait quality. Clinicians should consider gait velocity and quality before advising FBZ as a motivational tool to increase physical activity in individuals post-stroke.

Get 'Er Done: Experiences of Canadian Farmers Living with Chronic Low Back Disorders.

Purpose: This study explored the experiences of adult farmers living with chronic low back disorders (LBDs) in Saskatchewan. Method: A qualitative phenomenological approach with inductive thematic analysis was used to analyze semi-structured interviews that had been audio recorded and transcribed verbatim. Interview items focused on the perceived cause of LBDs, their impact on social and work life, coping strategies, and health care access and use. Results: A total of 12 face-to-face interviews were conducted with 11 men and 1 woman aged 40-84 years. Two overarching themes emerged: seasonality and isolation. Related sub-themes included pushing through, doing less, barriers to health care, and self-management. Conclusions: Farmers are faced with seasonal demands and geographical constraints, which lead them to push through the pain or do less when experiencing an episode of low back pain. In addition, farmers identified many barriers to accessing health care services that caused them to develop self-management techniques to cope or to go without care. This study provides the groundwork for future research addressing the unique occupational demands of farmers. Knowledge of farmers' experiences with chronic LBDs and their challenges regarding health care access can help inform health care providers and decision makers and contribute to tailored services and management approaches for similar rural and remote regions in other parts of the world.

Objectif : explorer les expériences des agriculteurs adultes de la Saskatchewan qui souffrent de douleurs lombaires chroniques. Méthodologie : les chercheurs ont utilisé une approche phénoménologique qualitative associée à une analyse thématique inductive pour dépouiller des entrevues semi-structurées enregistrées puis transcrites textuellement. Les volets de l'entrevue portaient sur les causes perçues des douleurs lombaires, les effets de ces douleurs sur la vie sociale et professionnelle, les stratégies d'adaptation, l'accès aux soins de santé et l'utilisation de ces soins. Résultats : au total, les chercheurs ont effectué 12 entrevues individuelles auprès de 11 hommes et une femme de 40 à 84 ans. Deux thèmes globaux ont émergé : le caractère saisonnier et l'isolement. Les sous-thèmes connexes incluaient le fait de persévérer, le fait d'en faire moins, les obstacles aux soins et l'autogestion des soins. Conclusion : les agriculteurs doivent se soumettre à des exigences saisonnières et des contraintes géographiques, ce qui les incite soit à persévérer soit à en faire moins lorsqu'ils souffrent de douleurs lombaires. Ils ont également énuméré de nombreux obstacles aux services de santé, qui les portent à adopter des techniques d'autogestion pour endurer ou poursuivre sans se faire soigner. L'étude jette les bases de futures recherches sur les exigences professionnelles caractéristiques des agriculteurs. Ce regard sur les expériences des agriculteurs à l'égard des douleurs lombaires chroniques et de leurs difficultés à obtenir des soins peut éclairer les dispensateurs de soins et les décideurs et contribuer à la création de services adaptés et d'approches de prise en charge dans des régions rurales et éloignées semblables d'autres parties du monde.

Measurement properties of instruments assessing permanent functional impairment of the spine: a systematic review protocol.

INTRODUCTION: Permanent functional impairment (PFI) of the spine is a rating system used by compensation authorities, such as workers compensation boards, to establish an appropriate level of financial compensation for persistent loss of function. Determination of PFI of the spine is commonly based on the assessment of spinal movement combined with other measures of physical and functional impairments; however, the reliability and validity of the measurement instruments used for these evaluations have yet to be established. The aim of this study is to systematically review and synthesise the literature concerning measurement properties of the various and different instruments used for assessing PFI of the spine. METHODS: Three conceptual groups of terms (1) PFI, (2) spinal disorder and (3) measurement properties will be combined to search Medline, EMBASE, CINAHL, Web of Science, Scopus, PEDro, OTSeeker and Health and Safety Science Abstracts. We will examine peer-reviewed, full-text articles over the full available date range. Two reviewers will independently screen citations (title, abstract and full text) and perform data extraction. Included studies will be appraised as to their methodological quality using the COnsensus-based Standards for the selection of health Measurement INstruments criteria. Findings will be summarised and presented descriptively, with meta-analysis pursued as appropriate. ETHICS AND DISSEMINATION: This review will summarise the current level of evidence of measurement properties of instruments used for assessing PFI of the spine. Findings of this review may be applicable to clinicians, policy-makers, workers' compensation boards, other insurers and health and safety organisations. The findings will likely provide a foundation and direction for future research priorities for assessing spinal PFI. PROSPERO REGISTRATION NUMBER: CRD42017060390.

Trends of ATV use and associated injury on Saskatchewan farms.

PURPOSE: All-terrain vehicles (ATV's) are a hazardous source of injury in many contexts and geographical regions, but to date have not been investigated in Saskatchewan. METHODS: Baseline surveys from the Saskatchewan Farm Injury Project were examined at two time points in terms of: (1) rates and correlated characteristics of reported ATV use; and (2) qualitative content analysis of injury events involving ATVs. The sample of eligible farmers was 2,972 in 2007 and 1,702 in 2013. FINDINGS: Self-reported ATV use increased on Saskatchewan farms over the five-year period, both in terms of the number of individuals using ATV's on the farm and the days per year of operation. ATV use is significantly more common on farms with livestock, among male farmers, and among younger farmers. Farmers with low back pain were also more likely to report ATV use. Qualitative content analysis of farmers' reported "most serious injury" on the farm revealed themes related to: (1) tasks undertaken with ATV's at the time of the incident (e.g., stock work and personal transport); (2) contributing factors (vehicle, environmental and driver); and (3) safety reflections. CONCLUSION: The apparent trends of increasing ATV use on Saskatchewan farms and serious nature of the injury incidents reported indicate that this is an issue worthy of further investigation.

"There are risks to be taken and some just push it too far": how farmers perceive quad-bike incident risk.

OBJECTIVE: To qualitatively explore how farmers perceive personal risk of an occupational quad-bike incident and develop a model of the factors that modify this perception. METHODS: Grounded theory methods were used to inform data collection and analysis. Semi-structured interviews were undertaken with eight New Zealand livestock farmers. Interviews were inductively analysed to derive categories that helped explain the processes involved in quad-bike incident risk perception. RESULTS: Farmers perceived personal risk of experiencing a quad-bike incident could be modelled on a sliding scale from low to high. Four core categories encapsulated risk perception: the impact of previous quad-bike incidents; personal attributes; getting the job done; and being familiar with the performance of the quad bike, the terrain and task(s) being undertaken. An exploratory model was developed to elucidate the temporal gap between farmers' reflections on their perceived risk and reported real-time risk management. CONCLUSIONS: These findings have implications for planning quad-bike safety interventions, which may benefit from incorporating both 'reflective' contemplation of risks and skills for coping with things suddenly going wrong 'in the moment'.

Walking away from back pain: one step at a time - a community-based randomised controlled trial.

BACKGROUND: Low back pain is highly prevalent and a significant public health burden in Western society. Feasibility studies suggest personalised pedometer-driven walking is an acceptable and effective motivating tool in the management of chronic low back pain (CLBP ≥ 12 weeks). The proposed study will investigate pedometer-driven walking as a low cost, easily accessible, and sustainable means of physical activity to improve disability and clinical outcomes for people with CLBP in Saskatchewan, Canada. METHODS/DESIGN: A fully-powered single-blinded randomised controlled trial will compare back care advice and education with back care advice and education followed by a 12-week pedometer-driven walking programme in adults with CLBP. Adults with self-reported CLBP will be recruited from the community and screened for elibility. Two-hundred participants will be randomly allocated to one of two intervention groups. All participants will receive a single back care advice and education session with a physiotherapist. Participants in the walking group will also receive a physiotherapist-facilitated pedometer based walking programme. The physiotherapist will facilitate the participant to monitor and progress the walking programme, by phone, on a weekly basis over 10 weeks following two face-to-face sessions. Outcome measures of self-reported disability, physical activity, participants' low back pain beliefs/perceptions, quality of life and direct/indirect cost estimates will be gathered at baseline, three months, six months, and 12 months by a different physiotherapist blinded to group allocation. Following intervention, focus groups will be used to explore participants' thoughts and experiences of pedometer-driven walking as a management tool for CLBP. DISCUSSION: This paper describes the design of a community-based RCT to determine the effectiveness of a pedometer-driven walking programme in the management of CLBP. TRIAL REGISTRATION: United States National Institutes of Health Clinical Trails registry (http://ClinicalTrials.gov/) No. NCT02284958 . Registered on 27(th) October 2014).

Unrealistic optimism, fatalism, and risk-taking in New Zealand farmers' descriptions of quad-bike incidents: a directed qualitative content analysis.

Quad-bike incidents are a major cause of occupational injury and fatality on farms warranting health and safety attention. As part of a larger study, we carried out a face-to-face survey with 216 farmers in New Zealand. We quantitatively identified farmers' propensity for risk-taking, unrealistic optimism, and fatalism as risk factors in quad-bike loss-of-control events (LCEs). The purpose of the analysis presented in this article was to use these same farmers' recollections of LCEs to explore the a priori constructs in more detail using qualitative methods. Participants reporting one or more LCEs described their first LCE and any experienced in the previous 12 months. Participants provided open-text responses about what occurred at each LCE, their reflections, and general thoughts on LCE risk factors. Directed qualitative content analysis (QCA) was used to "unpack" risk-taking, unrealistic optimism, and fatalism whilst also delineating any additional concepts that farmers associate with LCEs. Risk-taking elements were more evident than unrealistic optimism or fatalism and more suggestive of farmers finding themselves in risky situations rather than engaging in risk-seeking behavior per se. Additional inductively derived categories of fatigue/stress, multitasking, inexperience, and quad-bike faults highlight the complex nature of LCEs and the importance of risk assessment covering these concepts as well as risky situations.

Is workplace satisfaction associated with self-reported quad bike loss of control events among farm workers in New Zealand?

This study investigated whether rural workers who have higher workplace satisfaction are less likely to report quad bike loss of control events (LCEs). Two independent samples of farmers completed a survey regarding LCEs and workplace satisfaction. In the first sample (n = 130) analysis revealed no relationship (p = 0.74) between workplace satisfaction and LCEs but lower rates of LCEs were reported by employees (IRR 0.52, 95%CI 0.31-0.86) compared to self-employed participants. In the second sample (n = 112), workplace satisfaction was weakly related to LCEs (IRR 1.04, 95%CI 1.00, to 1.09) with participants who found their job more psychologically demanding more likely to have had an LCE (IRR 1.14, 95%CI 1.05-1.23). Exploring the role of psychological demands on safety behaviour with respect to quad bike use, may help to address this important safety issue.

Repeated Administration of Cocaine Alters Dopamine Uptake and Release in the Striatum Nucleus Accumbensa.

Male Sprague-Dawley rats were administered 25 mg/kg, intraperitoneally (i.p.) cocaine-HCl twice daily for 14 consecutive days (total of 50 mg/kg), while control animals received an equivalent volume of 0.9% saline. After three days of withdrawal, the animals were sacrificed for dissection of striatal (STR) and nucleus accumbens (NA) brain regions. The treated group demonstrated a dose-dependent reduction for in vitro cocaine inhibition of [3H]dopamine (DA) uptake in the NA tissue verses controls. There were no significant differences amongst the treated and control groups for in vitro cocaine inhibition of [3H]DA in the STR. In vitro d-amphetamine (1, 5 and 10 µM)-stimulated DA release from STR tissue was not significantly different between the treated and the control groups. However, there was a significant decline in basal STR DA release and a significant enhancement of d-amphetamine (1 and 5 µM)-stimulated DA release in the NA for the treatment group versus controls. The results from the present study indicates sensitization to cocaine is primarily related to DA uptake and release in the NA.