Socio-demographic profile of medical students in Aotearoa, New Zealand (2016-2020): a nationwide cross-sectional study.

OBJECTIVE: To determine the socio-demographic profile of all students enrolled to study medicine in Aotearoa New Zealand (NZ). DESIGN AND SETTING: Observational, cross-sectional study. Data were sought from the Universities of Auckland and Otago, the two NZ tertiary education institutions providing medical education, for the period 2016-2020 inclusive. These data are a subset of the larger project 'Mirror on Society' examining all regulated health professional enrolled students in NZ. VARIABLES OF INTEREST: gender, citizenship, ethnicity, rural classification, socioeconomic deprivation, school type and school socioeconomic scores. NZ denominator population data (18-29 years) were sourced from the 2018 census. PARTICIPANTS: 2858 students were enrolled to study medicine between 2016 and 2020 inclusive. RESULTS: There were more women (59.1%) enrolled to study medicine than men (40.9%) and the majority (96.5%) were in the 18-29 years age range. Maori students (rate ratio 0.92; 95% CI 0.84 to 1.0) and Pacific students (rate ratio 0.85; 95% CI 0.73 to 0.98) had lower overall rates of enrolment. For all ethnic groups, irrespective of rural or urban origin, enrolment rates had a nearly log-linear negative relationship with increasing socioeconomic deprivation. Enrolments were lower for students from rural areas compared with those from urban areas (rate ratio 0.53; 95% CI 0.46-0.61). Overall NZ's medical students do not reflect the diverse communities they will serve, with under-representation of Maori and Pacific students and students who come from low socioeconomic and rural backgrounds. CONCLUSIONS: To meaningfully address these issues, we suggest the following policy changes: universities commit and act to Indigenise institutional ways of knowing and being; selection policies are reviewed to ensure that communities in greatest need of doctors are prioritised for enrolment into medicine (specifically, the impact of low socioeconomic status should be factored into selection decisions); and the government fund more New Zealanders to study medicine.

National cross-sectional study of the sociodemographic characteristics of Aotearoa New Zealand's regulated health workforce pre-registration students: a mirror on society?

OBJECTIVES: To provide a sociodemographic profile of students enrolled in their first year of a health professional pre-registration programme offered within New Zealand (NZ) tertiary institutions. DESIGN: Observational, cross-sectional study. Data were sought from NZ tertiary education institutions for all eligible students accepted into the first 'professional' year of a health professional programme for the 5-year period 2016-2020 inclusive. VARIABLES OF INTEREST: gender, citizenship, ethnicity, rural classification, socioeconomic deprivation, school type and school socioeconomic scores. Analyses were carried out using the R statistics software. SETTING: Aotearoa NZ. PARTICIPANTS: All students (domestic and international) accepted into the first 'professional' year of a health professional programme leading to registration under the Health Practitioners Competence Assurance Act 2003. RESULTS: NZ's health workforce pre-registration students do not reflect the diverse communities they will serve in several important dimensions. There is a systematic under-representation of students who identify as Maori and Pacific, and students who come from low socioeconomic and rural backgrounds. The enrolment rate for Maori students is about 99 per 100 000 eligible population and for some Pacific ethnic groups is lower still, compared with 152 per 100 000 for NZ European students. The unadjusted rate ratio for enrolment for both Maori students and Pacific students versus 'NZ European and Other' students is approximately 0.7. CONCLUSIONS: We recommend that: (1) there should be a nationally coordinated system for collecting and reporting on the sociodemographic characteristics of the health workforce pre-registration; (2) mechanisms be developed to allow the agencies that fund tertiary education to base their funding decisions directly on the projected health workforce needs of the health system and (3) tertiary education funding decisions be based on Te Tiriti o Waitangi (the foundational constitutional agreement between the Indigenous people, Maori and the British Crown signed in 1840) and have a strong pro-equity focus.

Changing trends in pregnancy registration for New Zealand women.

INTRODUCTION: Early pregnancy registration is recommended and provides an opportunity for screening, risk assessment and health promotion. AIM: To determine the gestation at pregnancy registration for a cohort of pregnant New Zealand women who received maternity care from a midwife Lead Maternity Carer (LMC) and to determine if women are registering earlier in pregnancy. METHODS: The gestation of pregnancy at registration was reviewed for the 81,821 women who registered with a midwife LMC between 2008 and 2010 and had data recorded in the New Zealand College of Midwives Clinical Outcomes Research Database (COMCORD). RESULTS: Over the three-year period, there was a trend towards earlier registration with 22.0% of women registering before 10 weeks' gestation in 2008 increasing to 29.9% in 2010. Women of New Zealand European ethnicity were more likely to register before 10 weeks' gestation compared to women who identified as Maori or Pacific ethnicity. Women under 20 or over 40 years of age were more likely to register in the second or third trimester than other age groups. DISCUSSION: Groups that were slower to register with a midwife LMC were women under 20 years or over 40 years of age and women of Maori or Pacific ethnicity. These groups have higher perinatal mortality rates, higher rates of smoking and lower uptake of antenatal Down syndrome screening. Further research is required to explore the barriers to earlier registration for these groups.

Outcomes of physiological and active third stage labour care amongst women in New Zealand.

BACKGROUND: during the third stage of labour there are two approaches for care provision - active management or physiological (expectant) care. The aim of this research was to describe, analyse and compare the midwifery care pathway and outcomes provided to a selected cohort of New Zealand women during the third stage of labour between the years 2004 and 2008. These women received continuity of care from a midwife Lead Maternity Carer and gave birth in a variety of birth settings (home, primary, secondary and tertiary maternity units). METHODS: retrospective aggregated clinical information was extracted from the New Zealand College of Midwives research database. Factors such as type of third stage labour care provided; estimated blood loss; rate of treatment (separate to prophylaxis) with a uterotonic; and placental condition were compared amongst women who had a spontaneous onset of labour and no further assistance during the labour and birth. The results were adjusted for age, ethnicity, parity, place of birth, length of labour and weight of the baby. FINDINGS: the rates of physiological third stage care (expectant) and active management within the cohort were similar (48.1% vs. 51.9%). Women who had active management had a higher risk of a blood loss of more than 500mL, the risk was 2.761 when a woman was actively managed (95% CI: 2.441-3.122) when compared to physiological management. Women giving birth at home and in a primary unit were more likely to have physiological management. A longer labour and higher parity increased the odds of having active management. Manual removal of the placenta was more likely with active management (0.7% active management - 0.2% physiological p<0.0001). For women who were given a uterotonic drug as a treatment rather than prophylaxis a postpartum haemorrhage of more than 500mL was twice as likely in the actively managed group compared to the physiological managed group (6.9% vs. 3.7%, RR 0.54, CI: 0.5, 0.6). CONCLUSIONS: the use of physiological care during the third stage of labour should be considered and supported for women who are healthy and have had a spontaneous labour and birth regardless of birth place setting. Further research should determine whether the use of a uterotonic as a treatment in the first instance may be more effective than as a treatment following initial exposure prophylactically.

Incarceration and the tasks of grief: a narrative review.

AIM: This study is a report of a narrative review to explore the challenges facing prisoners and the corrections system in the presence of the death of a significant person to the prisoner. BACKGROUND: Death of a loved one is an important challenge, amplified for incarcerated men. There are unique aspects of incarceration that prevent prisoners from having access to usual ritual expressions and support structures. DATA SOURCES: A search of the CINAHL, ProQuest Medical, PubMed, EBSCO and COCHRANE databases was conducted for papers published from 1998-2007. The search terms were bereavement and prison nursing. A hand search of material specific to grief and incarceration was also undertaken. REVIEW METHODS: A narrative technique involving reading, writing, thinking, interpreting, arguing and justifying was used to synthesize the material and create a convincing and cohesive story. RESULTS: Limited research is available specifically addressing the grief experience of incarcerated individuals or the impact of unresolved grief on recidivism. However, a number of potential challenges to the grieving process in the prison system are identified in the literature, such as the prison culture of toughness and limited options for funeral attendance. CONCLUSION: Whilst the literature is scant, it is clear that issues of masculinity and culture have a strong impact on the ability of incarcerated men to resolve grief issues. More research is required to understand the impact of this on issues, such as recidivism. In the meantime, prison nurses have an important role to play in supporting prisoners who have lost a loved one during their incarceration.