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.

Under-utilisation of preventive medication in patients with cardiovascular disease is greatest in younger age groups (PREDICT-CVD 15).

INTRODUCTION: Blood pressure-lowering (BPL) and lipid-lowering (LL) medications together reduce estimated absolute five-year cardiovascular disease (CVD) risk by >40%. International studies indicate that the proportion of people with CVD receiving pharmacotherapy increases with advancing age. AIM: To compare BPL and LL medications, by sociodemographic characteristics, for patients with known CVD in primary care settings. METHODS: The study population included patients aged 35-74 with known CVD assessed in primary care from July 2006 to October 2009 using a web-based computerised decision support system (PREDICT) for risk assessment and management. Clinical data linked anonymously to national sociodemographic and pharmaceutical dispensing databases. Differences in dispensing BPL and LL medications in six months before first PREDICT assessment was analysed according to age, sex, ethnicity and deprivation. RESULTS: Of 7622 people with CVD, 1625 <55 years old, 2862 were women and 4609 lived in deprived areas (NZDep quintiles 4/5). The study population included 4249 European, 1556 Maori, 1151 Pacific and 329 Indian peoples. BPL medications were dispensed to 81%, LL medications to 73%, both BPL and LL medications to 67%, and 87% received either class of medication. Compared with people aged 65-75, people aged 35-44 were 30-40% less likely and those aged 45-54 were 10-15% less likely to be dispensed BPL, LL medications or both. There were minimal differences in likelihood of dispensing according to sex, ethnicity or deprivation. DISCUSSION: BPL and LL medications are under-utilised in patients with known CVD in New Zealand. Only two-thirds of patients in this cohort are on both. Younger patients are considerably less likely to be on recommended medications.

A comparative analysis of cardiovascular disease risk profiles of five Pacific ethnic groups assessed in New Zealand primary care practice: PREDICT CVD-13.

BACKGROUND: Data on the cardiovascular disease risk profiles of Pacific peoples in New Zealand is usually aggregated and treated as a single entity. Little is known about the comparability or otherwise of cardiovascular disease (CVD) risk between different Pacific groups. AIM: To compare CVD risk profiles for the main Pacific ethnic groups assessed in New Zealand primary care practice to determine if it is reasonable to aggregate these data, or if significant differences exist. METHODS: A web-based clinical decision support system for CVD risk assessment and management (PREDICT) has been implemented in primary care practices in nine PHOs throughout Auckland and Northland since 2002, covering approximately 65% of the population of these regions. Between 2002 and January 2009, baseline CVD risk assessments were carried out on 11,642 patients aged 35-74 years identifying with one or more Pacific ethnic groups (4933 Samoans, 1724 Tongans, 1366 Cook Island Maori, 880 Niueans, 1341 Fijians and 1398 people identified as Other Pacific or Pacific Not Further Defined). Fijians were subsequently excluded from the analyses because of a probable misclassification error that appears to combine Fijian Indians with ethnic Fijians. Prevalences of smoking, diabetes and prior history of CVD, as well as mean total cholesterol/HDL ratio, systolic and diastolic blood pressures, and Framingham 5-year CVD risk were calculated for each Pacific group. Age-adjusted risk ratios and mean differences stratified by gender were calculated using Samoans as the reference group. RESULTS: Cook Island women were almost 60% more likely to smoke than Samoan women. While Tongan men had the highest proportion of smoking (29%) among Pacific men, Tongan women had the lowest smoking proportion (10%) among Pacific women. Tongan women and Niuean men and women had a higher burden of diabetes than other Pacific ethnic groups, which were 20-30% higher than their Samoan counterparts. Niuean men and women had lower blood pressure levels than all other Pacific groups while Tongan men and women had the highest total cholesterol to HDL ratios. Tongan men and women had higher absolute 5-year CVD risk scores, as estimated by the Framingham equation, than their Samoan counterparts (Age-adjusted mean differences 0.71% [95% CI 0.36% to 1.06%] for Tongan men and 0.52% [95% CI 0.17% to 0.86%] for Tongan women) although these risk differences were only about 10% higher in relative terms. CONCLUSION: The validity of the analyses depend on the assumption that the selection of participants for CVD risk assessment in primary care is similar between Pacific groups. The ethnic-specific CVD risk profiles presented do not represent estimates of population prevalence. Almost all previous Pacific data has been aggregated with Pacific peoples treated as a single entity because of small sample sizes. We have analysed data from the largest study to date measuring CVD risk factors in Pacific peoples living in New Zealand. Our findings suggest that aggregating Pacific population data appears to be reasonable in terms of assessing absolute CVD risk, however there are differences for specific CVD risk factors between Pacific ethnic groups that may be important for targeting community level interventions.