Is the use of health services by older adults in New Zealand associated with their housing tenure?

AIM: To explore associations between tenure and the health service use of older New Zealanders. METHODS: Analysis of pooled data for adults aged 55+ from three New Zealand Health Surveys (2013/14, 2014/15, 2015/16) comparing owner-occupiers, private renters and public renters. RESULTS: Public renters, and in some age groups private renters, reported more visits to the GP and a higher proportion reported using a public hospital service in the last year. Renters were less likely than owner-occupiers to have used some privately paid services (visiting a dental health worker or optician). Renters averaged lower co-payments for their last GP visit, but financial barriers to accessing a GP, after-hours medical centre use and not collecting prescriptions were more likely to be reported by renters than owner-occupiers-particularly those that rent publicly. CONCLUSIONS: New Zealanders are simultaneously living longer while having declining opportunities to enter home ownership. Older renters are more likely to live in poorer health and, overall, are more likely to use some (public) health services than owner-occupiers yet are more likely to have unmet health needs. The increasing reliance on renting among older people has implications for population health and wellbeing, health service delivery and transitions to residential care.

The health of older New Zealanders in relation to housing tenure: analysis of pooled data from three consecutive, annual New Zealand Health Surveys.

OBJECTIVE: To explore relationships between the housing tenure of older New Zealanders and their health-related behaviours, and physical and mental health. METHODS: Pooled data were analysed for 15,626 older adults (aged 55+) from three consecutive, annual, nationally representative New Zealand Health Surveys to compare owner-occupiers, private renters and public renters. RESULTS: Most in the sample were owner-occupiers (83.2%), with 12.4% private renters and 4.5% public renters. A higher proportion of renters aged 75+ were female. Maori and Pacific people were more likely to be renters. Renters were more likely to be living alone, on lower annual incomes. Overall measures of physical and mental health showed a health gradient, with public renters in the poorest health and owner-occupiers in the best health. CONCLUSIONS: Rental tenure is associated with poorer health. Implications for public health: Older renters tend to be economically disadvantaged and in poorer health than owner-occupiers. Over time, the proportion of older renters has been increasing. This will have implications for policy and for services in meeting the diverse care and support needs of older people. Higher rates of renting among Maori and Pacific people and older females means that these groups are particularly vulnerable to any negative impact of renting on health.

Enhancement of Glen Moy x Latham raspberry linkage map using GbS to further understand control of developmental processes leading to fruit ripening.

BACKGROUND: The changing climate is altering timing of key fruit ripening processes and increasing the occurrence of fruit defects. To improve our understanding of the genetic control of raspberry fruit development an enhanced genetic linkage map was developed and used to examine ripening phenotypic data. RESULTS: In this study we developed an enhanced genetic linkage map for the raspberry cvs. Glen Moy x Latham reference mapping population using genotyping by sequencing (GbS). Alignment to a newly sequenced draft reference genome of red raspberry, cultivar (cv.) Glen Moy, identified 8019 single nucleotide polymorphisms (SNPs). After stringent filtering to take account of read coverage over all the progeny individuals, association with a single chromosome, heterozygosity and marker regression mapping, 2348 high confidence SNPs were retained and integrated with an existing raspberry genetic map. The linkage map contained many more SNPs segregating in Latham than in Glen Moy. This caused difficulties in quantitative trait loci (QTL) mapping with standard software and a novel analysis based on a hidden Markov model was used to improve the mapping. QTL mapping using the newly generated dense genetic map not only corroborated previously identified genetic locations but also provided additional genetic elements controlling fruit ripening in raspberry. CONCLUSION: The high-density GbS map located the QTL peaks more precisely than in earlier studies, aligned the QTLs with Glen Moy genome scaffolds, narrowed the range of potential candidate genes to these regions that can be utilised in other populations or in gene expression studies to confirm their role and increased the repertoire of markers available to understand the genetic control of fruit ripening traits.

Mapping and expression of genes associated with raspberry fruit ripening and softening.

KEY MESSAGE: QTL mapping identifies a range of underlying and unrelated genes with apparent roles in raspberry fruit ripening and softening that show characteristic developing fruit expression profiles. Fruit softening is an important agronomical trait that involves a complex interaction of plant cell processes. We have used both qualitative and quantitative scoring of fruit firmness, length, mass, and resistance to applied force to identify QTL in a raspberry mapping population. QTLs were located primarily on linkage group (LG) 3 with other significant loci on LG 1 and LG 5 and showed mostly additive effects between the two parents. The expression of key genes that underlie these QTLs with roles in cell-wall solubility, water uptake, polyamine synthesis, transcription, and cell respiration was tested across five stages of fruit development, from immature green to red ripe fruit, using real-time RT-qPCR. Gene expression patterns showed variable expression patterns across fruit development with a highly significant positive and negative correlation between genes, supporting precise regulation of expression of different cell processes throughout raspberry fruit development. Variable timing in expression was also found in some genes at different fruit development stages between soft and firm cultivars. Multiple processes have a role to play in fruit softening and this will require development of multiple marker combinations to genes that characterise raspberry fruit softening.

Collaborating with a social housing provider supports a large cohort study of the health effects of housing conditions.

BACKGROUND: Despite the importance of adequate, un-crowded housing as a prerequisite for good health, few large cohort studies have explored the health effects of housing conditions. The Social Housing Outcomes Worth (SHOW) Study was established to assess the relationship between housing conditions and health, particularly between household crowding and infectious diseases. This paper reports on the methods and feasibility of using a large administrative housing database for epidemiological research and the characteristics of the social housing population. METHODS: This prospective open cohort study was established in 2003 in collaboration with Housing New Zealand Corporation which provides housing for approximately 5% of the population. The Study measures health outcomes using linked anonymised hospitalisation and mortality records provided by the New Zealand Ministry of Health. RESULTS: It was possible to match the majority (96%) of applicant and tenant household members with their National Health Index (NHI) number allowing linkage to anonymised coded data on their hospitalisations and mortality. By December 2011, the study population consisted of 11,196 applicants and 196,612 tenants. Half were less than 21 years of age. About two-thirds identified as Maori or Pacific ethnicity. Household incomes were low. Of tenant households, 44% containing one or more smokers compared with 33% for New Zealand as a whole. Exposure to household crowding, as measured by a deficit of one or more bedrooms, was common for applicants (52%) and tenants (38%) compared with New Zealanders as whole (10%). CONCLUSIONS: This project has shown that an administrative housing database can be used to form a large cohort population and successfully link cohort members to their health records in a way that meets confidentiality and ethical requirements. This study also confirms that social housing tenants are a highly deprived population with relatively low incomes and high levels of exposure to household crowding and environmental tobacco smoke.

CAFÉ: a multicomponent audit and feedback intervention to improve implementation of healthy food policy in primary school canteens: protocol of a randomised controlled trial.

INTRODUCTION: A number of jurisdictions internationally have policies requiring schools to implement healthy canteens. However, many schools have not implemented such policies. One reason for this is that current support interventions cannot feasibly be delivered to large numbers of schools. A promising solution to support population-wide implementation of healthy canteen practices is audit and feedback. The effectiveness of this strategy has, however, not previously been assessed in school canteens. This study aims to assess the effectiveness and cost-effectiveness of an audit and feedback intervention, delivered by telephone and email, in increasing the number of school canteens that have menus complying with a government healthy-canteen policy. METHODS AND ANALYSIS: Seventy-two schools, across the Hunter New England Local Health District in New South Wales Australia, will be randomised to receive the multicomponent audit and feedback implementation intervention or usual support. The intervention will consist of between two and four canteen menu audits over 12 months. Each menu audit will be followed by two modes of feedback: a written feedback report and a verbal feedback/support via telephone. Primary outcomes, assessed by dieticians blind to group status and as recommended by the Fresh Tastes @ School policy, are: (1) the proportion of schools with a canteen menu containing foods or beverages restricted for sale, and; (2) the proportion of schools that have a menu which contains more than 50% of foods classified as healthy canteen items. Secondary outcomes are: the proportion of menu items in each category ('red', 'amber' and 'green'), canteen profitability and cost-effectiveness. ETHICS AND DISSEMINATION: Ethical approval has been obtained by from the Hunter New England Human Research Ethics Committee and the University of Newcastle Human Research Ethics Committee. The findings will be disseminated in usual forums, including peer-reviewed publication and conference presentations. TRIAL REGISTRATION NUMBER: ACTRN12613000543785.

Exploring parent views of community matrons.

The children's national service framework advocates children's services being designed and delivered around the needs of the child. This article details parental perception of and satisfaction with a paediatric community matron service that aims to reduce emergency admission of children aged 0-16 with respiratory disease. Parents valued the individualised holistic relationship formed between the community matron, child and family. One in four said their child's hospital attendance was reduced.

Aging and Health Literacy.

A recent study comparing older adults' health literacy skills with their satisfaction with health care providers' communication efforts did not find a correlation between the two measures. However, the results were interesting, including the fact that almost 40 percent of participants experienced moderate to severe difficulties in understanding everyday health information as presented in a food label (Newest Vital Sign assessment). This has implications for senior patient engagement in health care, particularly at a time when so many health transactions such as scheduling and records requests, not to mention general health information, are moving to online only format. Librarians should be aware of the issues surrounding health literacy in older adults and work with providers to address those deficits in health care navigation in this population.

Environmental and seasonal influences on red raspberry flavour volatiles and identification of quantitative trait loci (QTL) and candidate genes.

Raspberry volatiles are important for perceptions of sensory quality, mould resistance and some have nutraceutical activities. Twelve raspberry character volatiles were quantified, 11 of them in fruit from two seasons, from plants from the Glen Moy × Latham mapping population growing in both open field and under cover (polytunnels). Effects of season and environment were examined for their impact on the content of α-ionone, α-ionol, ß-ionone, ß-damascenone, linalool, geraniol, benzyl alcohol, (Z)-3-hexenol, acetoin, acetic and hexanoic acids, whilst raspberry ketone was measured in one season. A significant variation was observed in fruit volatiles in all progeny between seasons and method of cultivation. Quantitative trait loci were determined and mapped to six of the seven linkage groups, as were candidate genes in the volatiles pathways.

Rationale for regular reporting on health disparities and inequalities - United States.

Most U.S. residents want a society in which all persons live long, healthy lives; however, that vision is yet to be realized fully. As two of its primary goals, CDC aims to reduce preventable morbidity and mortality and to eliminate disparities in health between segments of the U.S. population. The first of its kind, this 2011 CDC Health Disparities and Inequalities Report (2011 CHDIR) represents a milestone in CDC's long history of working to eliminate disparities. Health disparities are differences in health outcomes and their determinants between segments of the population, as defined by social, demographic, environmental, and geographic attributes. Health inequalities, which is sometimes used interchangeably with the term health disparities, is more often used in the scientific and economic literature to refer to summary measures of population health associated with individual- or group-specific attributes (e.g., income, education, or race/ethnicity). Health inequities are a subset of health inequalities that are modifiable, associated with social disadvantage, and considered ethically unfair. Health disparities, inequalities, and inequities are important indicators of community health and provide information for decision making and intervention implementation to reduce preventable morbidity and mortality. Except in the next section of this report that describes selected health inequalities, this report uses the term health disparities as it is defined in U.S. federal laws and commonly used in the U.S. public health literature to refer to gaps in health between segments of the population.

HealthyME HealthyU(©2010UCPGB): a collaborative project to enhance access to health information and services for individuals with disabilities.

In response to the limited information about health information and training needs among persons with disabilities, a collaborative group of Alabama researchers, educators, and clinicians was formed to implement a statewide needs assessment with support provided by the Alabama Council for Developmental Disabilities and the National Network of Libraries of Medicine. Educational and assessment activities were guided by the Systems Model of Clinical Preventive Care and Health Information National Trends Survey (HINTS) methodology. Four constructs from the 2007 HINTS Annotated Version were identified as relevant to the concepts of local interest. Results of printed and online surveys administered to 251 family and other caregivers, 87 individuals with disabilities, 110 clinical service providers, and 570 health professions students revealed outstanding health communication needs to improve access to reliable consumer information and clinical services. HealthyME HealthyU(©2010UCPGB) developed new educational materials that address issues identified from the needs assessment, specifically (a) accessibility of health care facilities; (b) patient-provider communication; (c) personal health management by consumers and families/caregivers; and (d) sources of trustworthy electronic health information. Six brief digital video training modules were developed for consumers, families, and professionals featuring as speakers health care providers, health professions students, and individuals with cognitive disabilities. Following field testing, video modules were revised and then widely distributed to consumers, family caregivers, and service providers. Preliminary evaluation indicates content is relevant and comprehensible to individuals with disabilities.

Culture at the centre of community based aged care in a remote Australian Indigenous setting: a case study of the development of Yuendumu Old People's Programme.

INTRODUCTION: Yuendumu is a Warlpiri Aboriginal community 300 km north west of Alice Springs in Central Australia. Since emerging from the welfare period in the early 1970s, a range of services have evolved with the aim of developing a comprehensive community based aged care service. In 2000 Mampu Maninja-kurlangu Jarlu Patu-ku Aboriginal Corporation (Yuendumu Old Peoples Programme; YOPP) commenced operation to manage the developing services. This case study aims to describe, from the analytic standpoint of community control and cultural comfort, the main features of the 'Family Model of Care', which underpins the operations of the service and YOPP management processes. METHODS: Data were mostly generated from participant observation by the authors in the development and management of YOPP between 1993 and 2009. A literature review of Indigenous history and public health in Central Australia was also undertaken, which was supplemented by a review of Programme documentation, including evaluations, needs assessments and annual reports. RESULTS: The design and operations of YOPP are embodied in a documented 'Family Model of Care' which provides important lessons for the provision of aged care in a cross-cultural context. According to the concepts 'community control' and 'cultural comfort' outlined in this article, mainstream services can function in a complementary and supportive manner with professional services being accountable and responsive to a local management system that is governed by the structures and norms of community tradition. CONCLUSIONS: The notions of 'cultural comfort' and 'community control' as operating principles have enabled YOPP to continue under the management of local people, sustain core cultural strengths and values, and meet the needs for increased quality of care for the aged in Yuendumu. This model of care emphasizes and recognizes paradigms of mutual competence between traditional and mainstream human service culture, and offers important lessons for improvement to the quality of aged care in remote Indigenous communities in Australia and elsewhere.

Responding to Health Information and Training Needs of Individuals with Disabilities.

The role of a medical librarian includes guiding consumers to search for information related to specific health needs and interpret information for personal use. Little is known about barriers to accessing health information and clinical services for those with cognitive and physical disabilities. The purpose of this paper is to describe a statewide needs assessment of the health information and services needs of individuals with disabilities and their caregivers.Data from the needs assessment conducted by the Health Services Training Project of more than 1,000 respondents indicate unmet needs for outreach to increase effective use of library and information resources. Fewer consumers and their caregivers utilized the Internet to search for health information as compared to clinical service providers and students in health professions. A majority of consumers reported difficulty obtaining and understanding online health information. Service providers and students shared concerns about information quality. Consumers and caregivers expressed highest levels of trust in information provided by service providers, nonprofit health agencies, reference books, and libraries.

Effects of universal newborn hearing screening on an early intervention program for children with hearing loss, birth to 3 yr of age.

BACKGROUND: Universal Newborn Hearing Screening (UNHS) was introduced in Kansas in 1999. Prior to UNHS a small percentage of newborns were screened for and identified with hearing loss. PURPOSE: The purpose of this study was to determine the effects of UNHS on a local early intervention (EI) program for young children with hearing loss. RESEARCH DESIGN: This was a retrospective study based on the chart review of children enrolled in the EI program during target years before and after the establishment of UNHS. STUDY SAMPLE: Charts for 145 children were reviewed. DATA COLLECTION AND ANALYSIS: The chart review targeted the following aspects of the EI program: caseload size, percentage of caseload identified by UNHS, age of diagnosis, age of enrollment in EI, degree of hearing loss, etiology of hearing loss, late onset of hearing loss, age of hearing aid fit, percentage of children fit with hearing aids by 6 mo, percentage of children with profound hearing loss with cochlear implants, and percentage of children with additional disabilities. RESULTS: Changes in the EI program that occurred after UNHS were increases in caseload size, percentage of caseload identified by UNHS, percentage of children fit with hearing aids by 6 mo of age, and percentage of children with profound hearing loss with cochlear implants. There were decreases in age of diagnosis, age of enrollment in EI, and age of hearing aid fit. Before UNHS, the majority of children had severe and profound hearing loss; after UNHS there were more children with mild and moderate hearing loss. The percentage of known etiology and late-onset hearing loss was approximately the same before and after UNHS, as was the percentage of children with additional disabilities. CONCLUSION: UNHS had a positive impact on caseload size, age of diagnosis, age of enrollment in EI, and age of hearing aid fit. The percentage of the caseload identified in the newborn period was about 25% before UNHS and over 80% after its implementation. After UNHS, the EI caseload included as many children with mild and moderate hearing loss as with severe and profound loss. By the last reporting year in the study (academic year 2005-2006) all children with profound hearing losses had cochlear implants.

Mapping QTLs for developmental traits in raspberry from bud break to ripe fruit.

Protected cropping systems have been adopted by the UK industry to improve fruit quality and extend the current season. Further manipulation of season, alongside consideration of climate change scenarios, requires an understanding of the processes controlling fruit ripening. Ripening stages were scored from May to July across different years and environments from a raspberry mapping population. Here the interest was in identifying QTLs for the overall ripening process as well as for the time to reach each stage, and principal coordinate analysis was used to summarise the ripening process. Linear interpolation was also used to estimate the time (in days) taken for each plot to reach each of the stages assessed. QTLs were identified across four chromosomes for ripening and the time to reach each stage. A MADS-box gene, Gene H and several raspberry ESTs were associated with the QTLs and markers associated with plant height have also been identified, paving the way for marker assisted selection in Rubus idaeus.

Environmental and seasonal influences on red raspberry anthocyanin antioxidant contents and identification of quantitative traits loci (QTL).

Consumption of raspberries promotes human health through intake of pharmaceutically active antioxidants, including cyanidin and pelargonidin anthocyanins; products of flavonoid metabolism and also pigments conferring colour to fruit. Raspberry anthocyanin contents could be enhanced for nutritional health and quality benefits utilising DNA polymorphisms in modern marker assisted breeding. The objective was to elucidate factors determining anthocyanin production in these fruits. HPLC quantified eight anthocyanin cyanidin and pelargonidin glycosides: -3-sophoroside, -3-glucoside, -3-rutinoside and -3-glucosylrutinoside across two seasons and two environments in progeny from a cross between two Rubus subspecies, Rubus idaeus (cv. Glen Moy)xRubus strigosus (cv. Latham). Significant seasonal variation was detected across pigments less for different growing environments within seasons. Eight antioxidants mapped to the same chromosome region on linkage group (LG) 1, across both years and from fruits grown in field and under protected cultivation. Seven antioxidants also mapped to a region on LG 4 across years and for both growing sites. A chalcone synthase (PKS 1) gene sequence mapped to LG 7 but did not underlie the anthocyanin quantitative traits loci (QTL) identified. Other candidate genes including basic-helix-loop-helix (bHLH), NAM/CUC2-like protein and bZIP transcription factor underlying the mapped anthocyanins were identified.

Randomized, multicenter, controlled trial comparing the efficacy and safety of darbepoetin alpha administered every 3 weeks with or without intravenous iron in patients with chemotherapy-induced anemia.

PURPOSE: The concomitant use of intravenous (IV) iron as a supplement to erythropoiesis-stimulating agents in patients with chemotherapy-induced anemia is controversial. This study was designed to evaluate the efficacy and safety of darbepoetin alpha given with IV iron versus with local standard practice (oral iron or no iron). PATIENTS AND METHODS: In this multicenter, randomized, open-label, phase III study, 396 patients with nonmyeloid malignancies and hemoglobin (Hb) less than 11 g/dL received darbepoetin alpha 500 microg with (n = 200) or without (n = 196) IV iron once every 3 weeks (Q3W) for 16 weeks. RESULTS: The hematopoietic response rate (proportion of patients achieving Hb >or= 12 g/dL or Hb increase of >or= 2 g/dL from baseline) was significantly higher in the IV iron group: 86% versus 73% in the standard practice group (difference of 13% [95% CI, 3% to 23%]; P = .011). Fewer RBC transfusions (week 5 to the end of the treatment period) occurred in the IV iron group: 9% versus 20% in the standard practice group (difference of -11% [95% CI, -18% to -3%]; P = .005). Both treatments were well tolerated with no notable differences in adverse events. Serious adverse events related to iron occurred in 3% of patients in the IV iron group and were mostly gastrointestinal in nature. CONCLUSION: Addition of IV iron to darbepoetin alpha Q3W in patients with chemotherapy-induced anemia was well tolerated, resulting in an improved hematopoietic response rate and lower incidence of transfusions compared with darbepoetin alpha alone.

Effect of insulating existing houses on health inequality: cluster randomised study in the community.

OBJECTIVE: To determine whether insulating existing houses increases indoor temperatures and improves occupants' health and wellbeing. DESIGN: Community based, cluster, single blinded randomised study. SETTING: Seven low income communities in New Zealand. PARTICIPANTS: 1350 households containing 4407 participants. INTERVENTION: Installation of a standard retrofit insulation package. MAIN OUTCOME MEASURES: Indoor temperature and relative humidity, energy consumption, self reported health, wheezing, days off school and work, visits to general practitioners, and admissions to hospital. RESULTS: Insulation was associated with a small increase in bedroom temperatures during the winter (0.5 degrees C) and decreased relative humidity (-2.3%), despite energy consumption in insulated houses being 81% of that in uninsulated houses. Bedroom temperatures were below 10 degrees C for 1.7 fewer hours each day in insulated homes than in uninsulated ones. These changes were associated with reduced odds in the insulated homes of fair or poor self rated health (adjusted odds ratio 0.50, 95% confidence interval 0.38 to 0.68), self reports of wheezing in the past three months (0.57, 0.47 to 0.70), self reports of children taking a day off school (0.49, 0.31 to 0.80), and self reports of adults taking a day off work (0.62, 0.46 to 0.83). Visits to general practitioners were less often reported by occupants of insulated homes (0.73, 0.62 to 0.87). Hospital admissions for respiratory conditions were also reduced (0.53, 0.22 to 1.29), but this reduction was not statistically significant (P=0.16). CONCLUSION: Insulating existing houses led to a significantly warmer, drier indoor environment and resulted in improved self rated health, self reported wheezing, days off school and work, and visits to general practitioners as well as a trend for fewer hospital admissions for respiratory conditions.

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While NHS Direct downsizes its operations--with subsequent loss of nursing jobs--its Scottish counterpart, NHS 24, is moving in the opposite direction. But it has not all been plain sailing.