Co-design of youth appropriate services for young people with rheumatic fever/rheumatic heart disease in Counties Manukau District.

AIM: To co-design a rheumatic fever service model which enables young people with acute rheumatic fever/rheumatic heart disease (ARF/RHD) and their families to access the health and wellbeing services they need. METHOD: Co-design, a collaborative and participatory approach, was used to gather experiences and ideas from 21 consumers and 30 health professionals. Thematic analysis was undertaken. RESULTS: Maori and Pacific patients and their whanau/aiga identified the importance of whanau/aiga support and involvement throughout their ARF/RHD journey. They described that the way care was delivered was often frustrating, fragmented and lacked effective communication. Participants expressed the need for information to improve their understanding of ARF/RHD. Health professionals identified the need for better continuity of care and felt that they were currently working siloed from other professionals with little visibility of other roles or opportunity for collaboration. The ideas for improvement were grouped into themes and resulted in development and prototyping of peer support groups, patient and staff education resources, clinical dashboard and pathway development, and an enhanced model of care for delivery to patients receiving penicillin prophylaxis. CONCLUSION: The co-design process enabled consumers and staff of ARF/RHD services to share experiences, identify ideas for improvement, co-design prototypes and test initiatives to better support the needs of those delivering and receiving ARF/RHD services.

Transition from paediatric to adult care in young people with diabetes; A structured programme from a regional diabetes service, Auckland, New Zealand.

AIM: To assess participation with a structured transition programme for adolescents with diabetes. METHODS: Data from a regional cohort aged less than 16 years of age with type 1 (T1) and type 2 diabetes (T2D) in Auckland, New Zealand (2006-2016). Participation was defined as opting into a structured transition programme. RESULTS: Five hundrend and twelve adolescents who were to be transferred to adult care (476 type 1 (T1D) and 36 type 2 (T2D)), overall participation rate of 83%, 86% (408/476) with T1D compared to 47% (17/36) with T2D. Within the cohort of T1D, participation rates for Maori and Pacific were lower (74% and 77%, respectively) than New Zealand Europeans (88%, p = 0.020 and p = 0.039, respectively). Lower socio-economic status was associated with reduced participation (77%) compared to higher socio-economic status (90%, p = 0.002). Of the 476 T1D who participated, 408 (96%) subsequently attended at least one adult service clinic ("capture"). 42% attended an adult clinic within the planned 3 months, 87% at 6 months and retention in adult clinics over 5 years of follow-up was 78%. By contrast, the 68 young people with T1D who did not participate in the structured transition had a capture rate of 78% (p < 0.001) and retention of 63% (p = 0.036). CONCLUSIONS: In adolescents with diabetes, a formal transition from a paediatric service was associated with high rates of adult capture and subsequent retention in adult care over a 5-year follow-up period. Low socio-economic status, Maori or Pacific ethnicity and T2D were associated with reduced participation in the structured transition programme.

Prevalence, severity and impact of chronic pain among a representative cross-sectional study of New Zealand high school students.

AIM: To report the prevalence of self-reported chronic pain and severity among young people in New Zealand and explore the relationships between pain and mental health, substance use, socialisation and school engagement. METHODS: Prevalence of self-reported chronic pain frequency and severity are reported from an anonymous, representative cross-sectional self-administered health and well-being questionnaire by students aged 12-18 years in New Zealand. Multivariable models exploring chronic pain and mental health, substance use, socialisation and school engagement are reported controlling for age, sex, ethnicity, socio-economic status, disability and history of sexual abuse. RESULTS: Overall, 22.8% (95% confidence interval (CI) 21.2-24.5) of young people reported chronic pain for 6 months or more, with 3.2% (95% CI 3.1-4.5) reporting severe pain weekly or more often. Females and rural adolescents were more likely to report chronic and severe pain. Asian youth reported less pain than other ethnic groups. Increased severity of pain was associated more with poorer daily functioning and socialising than with frequency of pain. Severe pain occurring weekly or more often was more common among students who had a disability (2.3% 95% CI 1.8-2.7 vs. 9.8%, 95% CI 7.2-12.5) or a history of sexual abuse (2.4% 95% 1.9-2.9 vs. 8.5%, 95% CI 6.3-10.5). Those reporting chronic pain had higher proportions of self-reported significant depressive symptoms, lower well-being, lower school engagement and lower access to health care, particularly for those reporting higher levels of intensity and frequency of pain. CONCLUSIONS: Chronic pain is common in adolescent populations, and has a significant association with decreased daily functioning, socialising, school engagement and mental well-being. Adolescents with chronic pain report significant unmet health-care needs.

Improving the quality of care for adolescents and young adults on an adult medical ward.

BACKGROUND: Adolescents and young adults have health needs that are distinctly different from children and adults. A lack of education and training is reported by clinicians to be one of the main barriers to providing comprehensive developmentally appropriate care to young people, including the provision of confidential healthcare and taking a holistic approach. AIM: This study documents the current provision of care to young people on an adult inpatient medical ward at a large tertiary teaching hospital in Auckland. METHODS: Forty-three staff and 40 patients aged 16-24 years on an adult medical ward completed surveys, which were based on the Northern Regional Alliance, Northern Regional Youth Health Network Standards for Quality Care for Adolescents and Young Adults in Secondary or Tertiary Care. RESULTS: Few (12%) staff had completed any specific training in looking after adolescent and young adult patients. Confidentiality was not routinely discussed with young people by 50% of clinicians, and only 23% of staff reported that they see a young person alone as part of their consultation or admission. Less than half of young people reported receiving a comprehensive psychosocial assessment that included sexual health, mental health and suicide, and safety. CONCLUSIONS: Key components of comprehensive developmentally appropriate healthcare were not regularly carried out by staff on an adult medical ward. These findings suggest that further education and training, and service improvements are needed in tertiary adult hospital settings.

The wellbeing and health needs of a cohort of transgender young people accessing specialist medical gender-affirming healthcare in Auckland.

INTRODUCTION: Increasing numbers of young people are seeking gender-affirming healthcare in Aotearoa New Zealand, and although international studies report health and wellbeing benefits of early medical intervention, we have no published reports on the impact of health services in this country. METHODS: Transgender young people accessing a specialist service providing medical gender-affirming healthcare were invited to take part in a survey about their health and wellbeing. RESULTS: High or very high psychological distress levels were reported by 74% of respondents, with 39% being unable to access mental health support when needed. DISCUSSION: Although the proportion of transgender young people with high or very high levels of psychological distress was five times greater (74%) than for the general population of young people (14.5%) in Aotearoa New Zealand, it was not as large as the proportion found for transgender young people in a community study (86%) in which an unmet need for hormones was reported by 29%. This highlights the need for clear referral pathways to access specialist gender-affirming healthcare services in order to reduce disparities in mental health outcomes.

Transitioning from paediatric to adult services with cystic fibrosis or bronchiectasis: What is the impact on engagement and health outcomes?

AIM: To determine whether the transfer of young people with cystic fibrosis (CF) or bronchiectasis from paediatric to adult services is associated with changes in service engagement and/or health outcomes. METHODS: Young people aged ≥15 years of age with CF or bronchiectasis who transferred from the Auckland-based paediatric service (Starship Children's Hospital) to one of three Auckland-based District Health Boards between 2005 and 2012 were identified and included if they had 3 years care both pre-transfer and post-transfer care. Transfer preparation, service engagement (clinics scheduled, clinics attended) and health outcomes (lung function, hospitalisations) were collected per annum. RESULTS: Fifty-seven young people transferred in this period with 46 meeting inclusion criteria (CF n = 20, bronchiectasis n = 26). The CF group had better transfer documentation, were transferred at an older age (11 months older P < 0.0001 95%CI: 6.7 months, 14.7 months), were 20 times more likely to attend clinics (P < 0.0001, 95%CI: 7.8, 66.1) and had 3-4 more clinics scheduled pre-transfer (P < 0.0001, 95%CI: 3.4, 4.9) and post-transfer (P < 0.0001, 95%CI: 2.4, 3.8) despite having less severe respiratory disease as measured by FEV1 for each year (P < 0.01, 95%CI: 0.34, 1.22). CONCLUSION: The transfer of young people with CF to adult services did not affect health engagement or outcomes, in contrast to those with bronchiectasis. Use of a formalised transfer process, more clinic appointments offered and greater resources for CF may be responsible for this difference. Comprehensive transition with purposeful, planned movement and developmentally appropriate care is a key goal.

Feasibility of a Family Meal Intervention to Address Nutrition, Emotional Wellbeing, and Food Insecurity of Families With Adolescents.

OBJECTIVE: To assess the feasibility of a family meal intervention to address indicators of parent and adolescent nutrition and well-being and household food security. METHODS: Nine adolescents and a parent/caregiver were recruited from a youth health clinic. Families were provided with meal plans, recipes, and ingredients for 5 meals weekly for 4 weeks. Participants completed baseline and follow-up surveys and open-ended interviews. RESULTS: Overall, fidelity to the intervention was high among families; the frequency of family meals increased by approximately 2 meals/wk. Both parent/caregivers and adolescents reported improvements to nutrition (4 of 9 increased vegetable consumption for both) and most reported improvements to mental well-being. Household food insecurity also reduced during the intervention (means of 8.2 and 0.2 at baseline and follow-up, respectively). CONCLUSIONS AND IMPLICATIONS: Providing families with meal plans, recipes, and ingredients is an acceptable way to increase weekly frequency of family meals. Future research may consider the family meal as a way to engage with families about broader concerns.

The Prevalence of Postgraduate Education in Youth Health Among High School Clinicians and Associated Student Health Outcomes.

PURPOSE: Despite numerous calls to improve training in adolescent health, there is little known about the prevalence or effectiveness of specialized training in adolescent health. METHODS: A two-stage random sampling cluster design was used to collect nationally representative data from 8,500 students from 91 high schools. Student data were linked to data from a survey of school health clinicians from participating schools on their level of training in youth health. Multilevel models accounting for demographic characteristics of students were used to estimate the association between nurses and physicians training in youth health and health outcomes among students. RESULTS: Almost all nurses and physicians reported some training in youth health, either having attended lectures or study days in youth health (n = 60, 80%) or completed postgraduate papers in youth health (n = 13, 17.3%). Students in schools where the nurses and physicians had received postgraduate training in youth health were less likely than students from schools with clinicians having attended lectures or study days in youth health to report emotional and behavior difficulties (11.8 vs. 12.7, p = .002) and binge drinking (19.6% vs. 24.9%, p = .03). There were no significant associations between depressive symptoms, suicide risk, cigarette, marijuana, contraception use, or motor vehicle risk behaviors among students and level of training among clinicians in their schools' health service. CONCLUSIONS: Postgraduate training in youth health among nurses and physicians in school health services is associated with fewer students reporting mental health difficulties and binge alcohol use. These findings support specialized training in youth health for clinicians working predominantly with young people.

Adolescent and young adult medicine in Australia and New Zealand: towards specialist accreditation.

In Australia and New Zealand, a critical mass of academic and clinical leadership in Adolescent Medicine has helped advance models of clinical services, drive investments in teaching and training, and strengthen research capacity over the past 30 years. There is growing recognition of the importance of influencing the training of adult physicians as well as paediatricians. The Royal Australasian College of Physicians (RACP) is responsible for overseeing all aspects of specialist physician training across the two countries. Following advocacy from adolescent physicians, the RACP is advancing a three-tier strategy to build greater specialist capacity and sustain leadership in adolescent and young adult medicine (AYAM). The first tier of the strategy supports universal training in adolescent and young adult health and medicine for all basic trainees in paediatric and adult medicine through an online training resource. The second and third tiers support advanced training in AYAM for specialist practice, based on an advanced training curriculum that has been approved by the RACP. The second tier is dual training; advanced trainees can undertake 2 years training in AYAM and 2 years training in another area of specialist practice. The third tier consists of 3 years of advanced training in AYAM. The RACP is currently seeking formal recognition from the Australian Government to have AYAM accredited, a process that will be subsequently undertaken in New Zealand. The RACP is expectant that the accreditation of specialist AYAM physicians will promote sustained academic and clinical leadership in AYAM to the benefit of future generations of young Australasians.

The prevalence of chronic health conditions impacting on daily functioning and the association with emotional well-being among a national sample of high school students.

PURPOSE: This study aims to describe the prevalence of self-reported chronic health conditions among high school students in New Zealand, the extent to which the condition impacts on their activities and socialization, and to explore the association between the level of impact of the illness or disability and the emotional well-being of students with chronic health conditions. METHODS: A two-stage cluster sample of 9,107 students (Years 9-13) from 96 New Zealand high schools participated in a 2007 health survey using internet tablets. Students were asked about any chronic illness or disabilities lasting more than 6 months, the impact of the illness or disabilities on their daily activities and socialization, and their depressive symptoms (RADS-SF) and emotional well-being (WHO-5). RESULTS: Almost one in five students (18%) reported a chronic health condition. Among them, 28% reported an impact of their illness or disability on their activities, and 8% reported an impact on their ability to socialize. High levels of depressive symptoms were found among students with chronic health conditions reporting that their illness or disability impacts their activities (18%) or their ability to socialize (40%), and this was significantly higher than among students without chronic health conditions (10%). CONCLUSIONS: Our findings suggest that there is a large group of adolescents with chronic health conditions for whom their illness or disability has an impact on their daily activities and ability to socialize with their peers. These students are more likely to experience emotional distress and require support and opportunities for healthy youth development.

Clustering of adolescent health concerns: a latent class analysis of school students in New Zealand.

AIMS: The aims of this study are to identify clinically meaningful groups of adolescents based on their engagement in high levels of risk behaviours or severe emotional health concerns and to describe the demographic characteristics of these groups in two populations of school students in New Zealand. METHODS: A nationally representative sample of secondary school students was surveyed in 2007; alternative education (AE) students in Auckland and Northland were surveyed in 2009. A total of 9107 secondary school students and 335 AE students completed a youth health questionnaire using Internet tablets. Latent class analysis (LCA) was used to identify groups of students on the basis of distinct profiles of their risk behaviours and mental health concerns. RESULTS: The majority (80%) of students in secondary schools are 'healthy' and report few health concerns, 16% are considered 'risky' or 'distressed', and 4% report 'multiple' risk behaviour profiles or emotional health concerns. In AE, only 21% of students were considered 'healthy' with most featuring in the 'risky' or 'multiple' groups. Females were more likely to be 'distressed', whereas males were more likely to feature in the 'risky' or 'multiple' groups. CONCLUSIONS: Clinically-concerning health risk behaviours and emotional health concerns 'cluster' in up to 20% of students in secondary schools and up to 79% of students in AE. Gender, ethnic and socio-economic disparities are also observed. This highlights the importance of comprehensive psychosocial assessment and appropriate service provision, particularly for at-risk groups.

Forgone health care among secondary school students in New Zealand.

INTRODUCTION: Perceived lack of confidential health care is an important barrier for young people accessing health care services in New Zealand (NZ). AIM: To determine the prevalence of forgone health care among a nationally representative sample of NZ secondary school students and to describe the health concerns and specific health issues for which young people had difficulty accessing health care. METHODS: Random sample of 9107 NZ secondary school students participated in a 2007 health survey using internet tablets. Questions about access to health care included whether there had been a time when they had not accessed health care when needed, reasons for difficulty in accessing health care, current health concerns and health risk behaviours. RESULTS: One in six students (17%) had not seen a doctor or nurse when needed in the last 12 months. Female Maori and Pacific students and those living in neighbourhoods with high levels of deprivation were more likely to report forgone health care. Students with chronic health problems, those engaging in health risk behaviours or experiencing symptoms of depression were more likely to report being unable to access health care when needed. Students reporting privacy concerns were more likely to report difficulty accessing health care for sensitive health issues, such as sexual health, emotional problems, pregnancy-related issues, stopping cigarette smoking, or alcohol or drug use. DISCUSSION: NZ secondary school students who forgo health care are at increased risk of physical and mental health problems and in need of accessible and confidential health services.

Prevalence of severe obesity among New Zealand adolescents and associations with health risk behaviors and emotional well-being.

OBJECTIVE: To describe the prevalence of severe obesity among New Zealand young people attending secondary school and the associations of severe obesity with health risk behaviors and emotional well-being. STUDY DESIGN: A random sample of 9107 secondary school students in New Zealand participated in a 2007 health survey. Participants had their height and weight measured and answered an anonymous survey on multiple aspects of their health and well-being. RESULTS: Overall, 2.5% of students met the International Obesity Task Force definition of severe obesity. Students with severe obesity had more weight-related concerns, were more likely to have used unhealthy weight control strategies, and were more likely to experience bullying compared with healthy weight students. For example, students with severe obesity were 1.7 times more likely to have been bullied at school (95% CI 1.2-2.7) and 1.9 times more likely to vomit for weight loss (95% CI 1.1-3.3) than were healthy weight students. Indicators of emotional well-being and most health risk behaviors were similar among young people with severe obesity and a healthy weight. CONCLUSIONS: Clinicians who work with young people with severe obesity should prioritize discussing issues of bullying and healthy weight control strategies with families and their children.

Association between availability and quality of health services in schools and reproductive health outcomes among students: a multilevel observational study.

OBJECTIVES: We determined the association between availability and quality of school health services and reproductive health outcomes among sexually active students. METHODS: We used a 2-stage random sampling cluster design to collect nationally representative data from 9107 students from 96 New Zealand high schools. Students self-reported whether they were sexually active, how often they used condoms or contraception, and their involvement in pregnancy. School administrators completed questionnaires on their school-based health services, including doctor and nursing hours per week, team-based services, and health screening. We conducted analyses using multilevel models controlling for individual variables, with schools treated as random effects. RESULTS: There was an inverse association between hours of nursing and doctor time and pregnancy involvement among sexually active students, with fewer pregnancies among students in schools with more than 10 hours of nursing and doctor time per 100 students. There was no association between doctor visits, team-based services, health screening, and reproductive health outcomes. CONCLUSIONS: School health services are associated with fewer pregnancies among students, but only when the availability of doctor and nursing time exceeds 10 hours per 100 students per week.

Access to private and confidential health care among secondary school students in New Zealand.

PURPOSE: Private and confidential health care is an important indicator of the quality of health care for adolescents. The objective of this study was to determine the prevalence of health care utilization and private and confidential health care among a nationally representative population of high school students. METHODS: A two-stage cluster sample of 9,107 students (grades 8-12, response rate 73%) from 96 New Zealand high schools (response rate 84%) participated in a 2007 health survey using Internet tablets. Questions included when and where they had accessed health care, if their health care provider had explained that their health care was confidential, and if they had been seen in private by their health care provider. RESULTS: Although 83% of students had accessed health care in the previous 12 months, only 27% of students reported receiving private and confidential health care. Students who had accessed health care from a school-based health center (adjusted relative risk [95% confidence interval] 1.54 [1.42-1.66]) or family planning/sexual health clinics (adjusted relative risk = 2.1 [1.9-2.26]) were more likely to report receiving private and confidential health care compared with students who had not accessed health care from these settings. CONCLUSIONS: While most young people access health care from their family doctor or general practitioner's clinic, rates of private and confidential health care were low suggesting that opportunities to adequately explore and respond to important yet sensitive topics are compromised in primary care settings.

Shaken baby syndrome in New Zealand, 2000-2002.

AIM: To describe the epidemiology of subdural haemorrhage (SDH) in New Zealand infants. METHODS: Prospective enrollment of all cases of infantile SDH from 2000 to 2002. Retrospective analysis of national discharge and death data for the same period. RESULTS: Seventy-seven cases of infantile SDH were identified prospectively, and a further 49 cases retrospectively. Of these 126 cases, 92 resulted from non-birth-related trauma. Forty-eight of these were attributed to abuse and 28 to accidental injury. Sixteen cases were undetermined. The 'minimum' annual incidence of inflicted infantile SDH in New Zealand is 14.7 per 100,000 (95% confidence interval(CI) 10.8-19.4), and the 'maximum' 19.6 per 100,000 (95% CI 15.1-25.0). Among Maori, the 'minimum' is 32.5 per 100,000 (95% CI 21.4-47.3), and the 'maximum' 38.5 per 100,000 (95% CI 26.3-54.4). CONCLUSIONS: The epidemiology of infantile subdural haemorrhage in New Zealand is similar to that described elsewhere. Non-accidental head injury is a significant child health issue in New Zealand, and the incidence is particularly high among Maori.