Electroconvulsive therapy use in Otago, New Zealand: a 10-year retrospective audit of patient-level treatment data.

OBJECTIVES: There are wide global variations in electroconvulsive therapy (ECT) use patterns. This audit reviewed patient-level ECT use patterns over 10 years at a single New Zealand clinic, including factors associated with clinical response and patterns of repeated administration. METHODS: Retrospective audit of all 2003-2012 ECT and clinical file data. RESULTS: A total of 199 patients received ECT, which was used to treat mostly affective disorders in a predominantly female, older population, generally with a single course of treatment. There were different demographics and patterns of ECT use between patients being treated for affective and psychotic disorders. Overall treatment response was high, with over 90% of patients having a full or partial response. Treatment response was not associated with diagnosis, gender, or medication use, but showed a trend in significance for greater response in elderly patients. CONCLUSIONS: ECT use patterns in Otago New Zealand are similar to those reported in Australia, USA, and UK, although yearly use rate in Otago is lower. Because of their different demographic and ECT treatment patterns, future studies should report data for patients with affective and psychotic disorders separately.

Getting kids active by participating in sport and doing it more often: focusing on what matters.

BACKGROUND: Reduced time dedicated to physical education and free play in recent decades emphasizes the need to promote opportunities for sport participation in adolescents in order to increase physical activity levels. The purpose of this study was to examine the association of sociodemographic and biological characteristics, behavioural patterns, and school-related and sport-specific variables with time spent participating in sport. METHODS: A total of 1837 secondary school students (age: 14.6 ± 1.2 years; 50.9 % boys) from 19 of 23 schools in the Otago Region (New Zealand) completed an online sport survey and Youth Physical Activity Questionnaire in 2009. Using multilevel modeling, we examined the association of individual-, school- and sport-related variables on sport participation and the amount of time spent in sports. RESULTS: Higher rates of sport participation were associated with lower neighbourhood deprivation scores (OR (95%CI): 0.75 (0.49-1.14), 0.57 (0.38-0.86), 0.48 (0.28-0.81)), higher quintiles of physical activity (2.89 (2.10-3.96), 2.81 (1.68-4.70), 3.54 (2.24-5.57), 3.97 (1.99-7.95)), highest quintiles of screen time (1.58 (0.94-2.65), 1.99 (1.42-2.80), 2.17 (1.43-3.30), 1.88 (1.37-2.57)) and boys only school status (2.21 (1.57-3.10)). Greater amount of time spent in sports was associated with male gender (0.56 (0.43-0.74), lower neighbourhood deprivation scores (0.72 (0.59-0.93), 0.78 (0.58-1.04), 0.62 (0.39-1.00)), higher quintiles of physical activity (3.18 (2.29-4.41), 4.25 (2.91-6.20), 8.33 (5.58-12.44), 6.58 (4.07-10.64)), highest quintile of screen time (1.83 (1.31-2.56), greater availability of sports outside school (1.68 (1.22-2.32)), better sport management (2.57 (1.63-4.07)) and provision of sport courts at school (0.57 (0.40-0.81)). Conversely, obesity was associated with less time spent participating in sport (0.50 (0.31-0.80)). CONCLUSION: Results support the use of sport participation as an effective strategy to increase physical activity levels and identify target groups and areas for interventions, program design and policy development. Interventions should focus on improving accessibility to sport programs for all adolescents, providing adequate sport grounds at school, and promoting good sport management practices. Programs and policies encouraging sport participation should address in particular the needs of adolescents living in deprived neighborhoods, those attending coeducational and girls-only schools, and those who are obese.

Study design and patient characteristics and outcome in acute mania clinical trials.

OBJECTIVE: The objective of this systematic review was to identify trial design and patient characteristics associated with symptom improvement in acute mania clinical trials. METHODS: Drug trials in acute mania that used the Young Mania Rating Scale (YMRS) score as the primary endpoint were identified using a systematic search strategy. Details of the trial, patient population, and treatment assignment were recorded. Covariates associated with change in YMRS were analyzed using a multiple regression model. RESULTS: A total of 41 studies, comprising 89 treatment arms and 10,471 patients, were selected for this analysis. Three variables were statistically significantly associated with change in YMRS score: treatment assignment, baseline mania score, and study location. Compared with placebo, greater mean (95% confidence interval) reductions in YMRS score were noted for all three active treatment arms [-4.7 (-6.4 to -3.0) for mood stabilizers; -5.9 (-7.6 to -4.2) for antipsychotics; and -8.3 (-10.2 to -6.4) for combined mood stabilizer/antipsychotics; all comparisons p < 0.0001]. Greater changes in YMRS score were associated with higher baseline YMRS scores (p = 0.002) and with studies performed outside of the USA (p= 0.02). Year of study publication was not associated with YMRS score change. Study size, number of study sites, YMRS score required for study entry, inclusion of patients with mixed mania or treatment resistance, and enrollment of inpatients versus outpatients had no significant influence on change in YMRS score. CONCLUSION: These findings may assist in the design of future drug trials for acute mania.

Does ST resolution achieved via different reperfusion strategies (fibrinolysis vs percutaneous coronary intervention) have different prognostic meaning in ST-elevation myocardial infarction? A systematic review.

OBJECTIVE: We perform a systematic review to discern if ST resolution achieved via percutaneous coronary intervention (PCI) has a different meaning to that achieved via fibrinolysis. BACKGROUND: Resolution of ST-segment elevation in acute myocardial infarction has been widely used as a surrogate for treatment success. A recent randomized study suggested that after primary PCI, the prognostic significance of ST resolution may have been overemphasized. METHODS: Using the MEDLINE, COCHRANE, EMBASE, and PUBMED databases to search for the relevant papers, we analyze the data with a new ST-resolution score. ST-resolution groups of <30%, 30% to < 70%, and ≥ 70% are given scores of 1, 2, and 3 respectively, whereas ST-resolution groups reported as < 50% are scored as 1.5, and ≥ 50% scored as 2.5. RESULTS: We identify 18 fibrinolysis cohorts (32,341 patients) and 5 PCI cohorts (1,913 patients). The mean ST-resolution score weighted for the number of patients in each cohort is 1.87 ± 0.15 for PCI and 1.66 ± 0.20 for fibrinolysis (P < .001). The raw combined 30-day mortality is 4.9% with fibrinolysis and 4.3% with PCI (P = .452 by Poisson regression). There is a linear relationship with lower 30-day mortality associated with higher ST-resolution score. The regression line for the PCI cohorts almost overlaps with that from the fibrinolysis cohorts. On multivariate regression, only ST-resolution score is significant in predicting 30-day mortality. When tested, the interaction term (treatment group × ST resolution score) is never a significant predictor (P > .25 in all models). CONCLUSION: ST resolution after different reperfusion therapies has similar prognostic meaning.

Health research policy: a case study of policy change in Aboriginal and Torres Strait Islander health research.

BACKGROUND: There is considerable potential for health research to contribute to improved health services, programs, and outcomes; the policies of health research funding agencies are critical to achieving health gains from research. The need for research to better address health disparities in Indigenous people has been widely recognised. This paper: (i) describes the policy changes made by the National Health and Medical Research Council (NHMRC) from 1997 to 2002 to improve funding of Aboriginal health research (ii) examines catalysts for the policy changes (iii) describes the extent to which policy changes were followed by new models of research and (iv) outlines issues for Indigenous health policy in the future. METHODS: This study had two parts: (i) semi-structured interviews were conducted over a four -month period with seven individuals who played a leading role in the policy changes at NHMRC during the period 1997-2002, to describe policy changes and to examine the catalysts for the changes; (ii) a case study was undertaken to evaluate projects by recipients of NHMRC People Support awards and NHMRC Capacity Building Grants in Population Health Research to examine the types of research being undertaken five years after the policy changes were implemented. The proposals of these researchers were assessed in terms of whether they reported intending to: evaluate interventions; engage Indigenous community members and organisations; and build research capacity among Indigenous people. RESULTS: Seven policy changes over a period of five years were identified, including those to: establish an ethical approach to working with Indigenous people; increase the influence of Indigenous people within NHMRC; encourage priority research directed at improving Indigenous health; and recognise Aboriginal and Torres Strait Islander health research as a priority area including a commitment to an expenditure target of 5% of annual funds. Seven catalysts for this change were identified. These included: a perceived lack of effective response to the health needs of Indigenous people; a changed perception of the role of NHMRC in encouraging research to maximise health gains; and leadership within the organisation.The case study analysis demonstrated that 45% of all People Support recipients intend to engage Indigenous community members and organisations in consultation, 26% included an evaluation of an intervention and two (6.5%) were granted to an individual from an Indigenous background. Six of seven Population Health Capacity Building Grants that were awarded to study Indigenous health between 2004 and 2006 included an intervention component; these grants supported 34 researchers from Indigenous backgrounds. CONCLUSION: NHMRC made significant policy changes from 1997 to 2002 to better support Indigenous health as a result of external pressure and internal commitment.The policy changes have made some progress in supporting better research models particularly in improving engagement with Indigenous communities. However, there remains a need for further reform to optimise research outcomes for Indigenous people from research.