Pacific patients' reasons for attending the emergency department of Counties Manukau for non-urgent conditions.

AIM: To determine Pacific patients' reasons for Emergency Department (ED) use for non-urgent conditions by Pacific people at Counties Manukau Health. METHODS: Patients who self-presented to Counties Manukau ED with a non-urgent condition in June 2019 were surveyed. Responses to open-ended questions were analysed using a general inductive approach, in discussion with key stakeholders. RESULTS: Of 353 participants with ethnicity reported, 139 (39%) were Pacific, 66 (19%) Maori and 148 (42%) were non-Maori non-Pacific, nMnP. A total of 58 (42%) of Pacific participants had been to their general practitioner prior to presenting to the ED; this proportion was similar for Maori (19 [30%]) and nMnP (59 [40%]) (p=0.215). The most common reasons for ED attendance among Pacific (as well as other) participants were 1) advice by a health professional (41%, 95% CI 33-50%), 2) usual care unavailable (28%, 20-36%), 3) symptoms not improving (21%, 14-28%), and 4) symptoms too severe to be managed elsewhere (19%, 12-26%). CONCLUSIONS: Multiple reasons underlie non-urgent use of EDs by Pacific and other ethnic groups. These reasons need to be considered simultaneously in the design, implementation, and evaluation of multi-dimensional initiatives that discourage non-urgent use of EDs to ensure that such initiatives are effective, equitable, and unintended consequences are avoided.

Intracameral phenylephrine and ketorolac during cataract surgery to maintain intraoperative mydriasis and reduce postoperative ocular pain: Integrated results from 2 pivotal phase 3 studies.

PURPOSE: To evaluate the efficacy and safety of phenylephrine 1.0%-ketorolac 0.3% (Omidria) for maintenance of mydriasis during, and reduction of ocular pain after, cataract surgery. SETTING: Twenty centers in the United States and the Netherlands. DESIGN: Prospective randomized clinical trials. METHODS: Patients having cataract surgery or refractive lens exchange were enrolled in 2 clinical trials. Phenylephrine 1.0%-ketorolac 0.3% or placebo was added to irrigation solution and administered intracamerally during the procedure. Integrated analyses of primary and secondary endpoints were conducted. RESULTS: The clinical trials comprised 808 patients (403 treatment and 405 placebo). Phenylephrine 1.0%-ketorolac 0.3% was superior to placebo for the maintenance of mydriasis during, and reduction of ocular pain following, cataract surgery. The mean area under the curve (AUC) change from baseline in pupil diameter was 0.08 mm for treatment compared with -0.50 mm for placebo (P < .0001). The mean AUC of ocular pain visual analog scale scores within 12 hours postoperatively was 4.16 mm for the treatment group and 9.06 mm for the placebo group (P < .001). Results of all secondary efficacy analyses demonstrated a significant treatment effect associated with phenylephrine 1.0%-ketorolac 0.3%. Treatment-emergent adverse events were as expected for a population having cataract surgery; no clinically significant differences in safety measures were observed between treatment groups. CONCLUSION: In this integrated analysis, phenylephrine 1.0%-ketorolac 0.3% administered intracamerally with irrigation solution during cataract surgery was safe and effective for maintaining mydriasis during the procedure and reducing postoperative ocular pain. FINANCIAL DISCLOSURE: Dr. Schaaf is an employee and holds an equity interest in Omeros Corporation. Drs. Hovanesian, Sheppard, Trattler, Gayton, and Ng are consultants to Omeros Corporation. No other author has a financial or proprietary interest in any material or method mentioned.

Pain conditions ranked by healthcare costs for members of a national health plan.

Healthcare resource utilization (HCRU) and associated costs specific to pain are a growing concern, as increasing dollar amounts are spent on pain-related conditions. Understanding which pain conditions drive the highest utilization and cost burden to the healthcare system would enable providers and payers to better target conditions to manage pain adequately and efficiently. The current study focused on 36 noncancer chronic and 14 noncancer acute pain conditions and measured the HCRU and costs per member over 365 days. These conditions were ranked by per-member costs and total adjusted healthcare costs to determine the most expensive conditions to a national health plan. The top 5 conditions for the commercial line of business were back pain, osteoarthritis (OA), childbirth, injuries, and non-hip, non-spine fractures (adjusted annual total costs for the commercial members were $119 million, $98 million, $69 million, $61 million, and $48 million, respectively). The top 5 conditions for Medicare members were OA, back pain, hip fractures, injuries, and non-hip, non-spine fractures (adjusted annual costs for the Medicare members were $327 million, $218 million, $117 million, $82 million, and $67 million, respectively). The conditions ranked highest for both per-member and total healthcare costs were hip fractures, childbirth, and non-hip, non-spine fractures. Among these, hip fractures in the Medicare member population had the highest mean cost per member (adjusted per-member cost was $21,058). Further examination specific to how pain is managed in these high-cost conditions will enable providers and payers to develop strategies to improve patient outcomes through appropriate pain management.

Prevalence of diagnosed opioid abuse and its economic burden in the veterans health administration.

OBJECTIVE: Evaluate prevalence and risk-adjusted healthcare costs of diagnosed opioid abuse in the national Veterans Health Administration (VHA). Costs were compared between patients with and without diagnosed opioid abuse. DESIGN: Medical and pharmacy claims analysis of VHA data (10/01/2006 to 09/30/2010) were retrospectively analyzed. Prevalence was calculated as the percent of patients with diagnosed opioid abuse for the entire VHA membership and those with noncancer pain diagnoses, compared between patients prescribed opioids prior to abuse diagnosis and those not prescribed opioids through the VHA system. Healthcare utilization and costs were estimated using matching techniques and generalized linear models to control for clinical and demographic differences between patients with and without diagnosed opioid abuse. Separate comparisons were made (with diagnosed abuse vs. without) for each cohort: patients with/without opioid prescriptions. RESULTS: Five-year diagnosed opioid abuse was 1.11%. Among patients prescribed opioids, 5-year abuse prevalence was 3.04%. Pain patients prescribed opioids had the highest abuse rate at 3.26%. Adjusted annual healthcare costs for diagnosed opioid abuse patients were higher than for those without diagnosed abuse, (prescribed opioids overall healthcare costs: $28,882, with diagnosed abuse vs. $13,605 for those without; not prescribed opioids: $25,197 vs. $6350, P-value< 0.0001; opioid-specific healthcare costs for patients prescribed opioids: $8956 vs. $218; patients not prescribed opioids: $8733 vs. $20). CONCLUSIONS: Diagnosed opioid abuse prevalence is almost 7-fold higher in the veteran's administration population than in commercial health plans and translates to a significant economic burden. Appropriate interventions should be considered to prevent and reduce opioid abuse.

Differences in healthcare utilization and associated costs between patients prescribed vs. nonprescribed opioids during an inpatient or emergency department visit.

OBJECTIVES: Compare healthcare resource utilization (HCRU) and costs between patients prescribed opioids (RxOP) and those who were not (NoRxOP) during an emergency department (ED) or inpatient visit. METHODS: Retrospective cohort analysis was performed (January 2006 to September 2010). Continuously eligible RxOP patients in ED/inpatient settings (January 2007 to September 2009) were included if age was ≥ 12 years by initial prescription date (or random date between first ED/inpatient admission and September 30, 2009 [NoRxOP patients]). Healthcare resource utilization and costs for 12 months after initial prescription were compared. Univariate descriptive analyses were performed for baseline and outcome variables and compared using appropriate tests. Risk adjustment compared HCRU between RxOP and NoRxOP cohorts for the postindex period. RESULTS: Of 27,599 eligible patients, RxOP patients (n = 18,819) were younger, less likely to be male, more likely to reside in southern United States and to have Preferred Provider Organization health plans, and had lower comorbidity index scores, compared with NoRxOP patients (n = 8,780). RxOP patients were less likely to have nonpain-related comorbidities and more frequently diagnosed with pain-related comorbidities. Unmatched and propensity-matched RxOP patients experienced higher HCRU and costs in all subcategories (total, inpatient, outpatient ED, physician, pharmacy, other outpatient settings). Opioid abuse frequency was low in patients with common diagnoses/procedures within 3 months before initial prescription (0.48%). Average time to abuse was < 1 year (201 days). CONCLUSION: Most patients were prescribed opioids initially during ED/inpatient visits and incurred higher HCRU than those not prescribed opioids. Among those with diagnosed opioid abuse after initiating opioids, time to diagnosis was rapid (range: 14 to 260 days) for patients with common diseases and procedures.

Cost drivers of prescription opioid abuse in commercial and Medicare populations.

OBJECTIVE: Growth in the number of patients with pain conditions, and the subsequent rise in prescription opioid use for treatment, has been accompanied by an increase in diagnosed opioid abuse. Understanding what drives the incremental healthcare costs of members diagnosed with prescription opioid abuse may assist in developing better screening techniques for abuse. DESIGN: This retrospective analysis examined costs, resource use, and comorbidities 365 days pre- and postdiagnosis in prescription opioid users diagnosed with abuse (cases) vs. their matched nondiagnosed controls. Inclusion criteria for cases were diagnosis of opioid abuse (ICD-9-CM: 304.0x, 304.7x, 305.5x, 965.0x). Multivariate analysis used generalized linear modeling with log-transformed cost as dependent variable, controlling for comorbidities. RESULTS: Final sample sizes were 8,390 cases and 16,780 matched controls. Postindex abuse-related costs were $2,099 for commercial members, $539 for Medicare members aged < 65, and $170 for Medicare members aged ≥ 65. A higher percentage of cases had pain conditions (82.0% vs. 57.4% commercial, 95.9% vs. 87.5% Medicare members aged < 65, 92.9% vs. 82.4% Medicare members aged ≥ 65, P < 0.0001), and a higher numbers of cases had multiple opioid prescribers (3.7 vs. 1.4 commercial, 3.3 vs. 2.2 Medicare < 65, 2.2 vs. 1.6 Medicare ≥ 65, P < 0.0001) than controls preindex. Cases had higher rates of substance abuse and psychiatric diagnoses pre- and postindex (P < 0.0001, all comparisons). Adjusted costs were 28% higher for cases than for controls (P < 0.0001). CONCLUSION: Costs of members diagnosed with prescription opioid abuse are driven by higher pain and psychiatric comorbidities relative to nonabuse controls.

The prevalence of diagnosed opioid abuse in commercial and Medicare managed care populations.

PURPOSE: To measure the prevalence of diagnosed opioid abuse and prescription opioid use in a multistate managed care organization. METHODS: This retrospective claims data analysis reviewed the prevalence of diagnosed opioid abuse and the parallel prevalence of prescription opioid use in half-year intervals for commercial and Medicare members enrolled with Humana Inc., from January 1, 2008 to June 30, 2010. Diagnosis of opioid abuse was defined by ≥ 1 medical claim with any of the following ICD-9-CM codes: 304.0 ×, 304.7 ×, 305.5 ×, 965.0 ×, excluding 965.01, and opioid use was defined by ≥ 1 filled prescription for an opioid. The prevalence of opioid abuse was defined by the number of members with an opioid abuse diagnosis, divided by the number of members enrolled in each 6-month interval. RESULTS: The 6-month prevalence of diagnosed opioid abuse increased from 0.84 to 1.15 among commercial and from 3.17 to 6.35 among Medicare members, per 1,000. In contrast, there was no marked increase in prescription opioid use during the same time period (118.0 to 114.8 for commercial members, 240.6 to 256.9 for Medicare members, per 1,000). The prevalence of diagnosed opioid abuse was highest among members younger than 65 years for both genders in commercial (18- to 34-year-olds) and Medicare (35- to 54-year-olds) populations. CONCLUSIONS: Despite a stable rate of prescription opioid use among the observed population, the prevalence of diagnosed opioid abuse is increasing, particularly in the Medicare population.

Systematic literature review and meta-analysis of the efficacy and safety of prescription opioids, including abuse-deterrent formulations, in non-cancer pain management.

OBJECTIVE: This study was conducted to compare safety and efficacy outcomes between opioids formulated with technologies designed to deter or resist tampering (i.e., abuse-deterrent formulations [ADFs]) and non-ADFs for commonly prescribed opioids for treatment of non-cancer pain in adults. METHODS: PubMed and Cochrane Library databases were searched for opioid publications between September 1, 2001 and August 31, 2011, and pivotal clinical trials from all years; abstracts from key pain conferences (2010-2011) were also reviewed. One hundred and ninety-one publications were initially identified, 68 of which met eligibility criteria and were systematically reviewed; a subset of 16 involved a placebo group (13 non-ADFs vs placebo, 3 ADFs vs placebo) and reported both efficacy and safety outcomes, and were included for a meta-analysis. Summary estimates of standardized difference in mean change of pain intensity (DMCPI), standardized difference in sum of pain intensity difference (DSPID), and odds ratios (ORs) of each adverse event (AE) were computed through random-effects estimates for ADFs (and non-ADFs) vs placebo. Indirect treatment comparisons were conducted to compare ADFs and non-ADFs. RESULTS: Summary estimates for standardized DMCPI and for standardized DSPID indicated that ADFs and non-ADFs showed significantly greater efficacy than placebo in reducing pain intensity. Indirect analyses assessing the efficacy outcomes between ADFs and non-ADFs indicated that they were not significantly different (standardized DMCPI [0.39 {95% confidence interval (CI) 0.00-0.76}]; standardized DSPID [-0.22 {95% CI -0.74 to 0.30}]). ADFs and non-ADFs both were associated with higher odds of AEs than placebo. Odds ratios from indirect analyses comparing AEs for ADFs vs non-ADFs were not significant (nausea, 0.87 [0.24-3.12]; vomiting, 1.54 [0.40-5.97]; dizziness/vertigo, 0.61 [0.21-1.76]; headache, 1.42 [0.57-3.53]; somnolence/drowsiness, 0.47 [0.09-2.58]; constipation, 0.64 [0.28-1.49]; pruritus 0.41 [0.05-3.51]). CONCLUSION: ADFs and non-ADFs had comparable efficacy and safety profiles, while both were more efficacious than placebo in reducing pain intensity.

Inefficiencies in osteoarthritis and chronic low back pain management.

OBJECTIVE: To identify inefficiencies in drug and medical service utilization related to pain management in patients with osteoarthritis and chronic low back pain. STUDY DESIGN: This retrospective cohort study applied revised measures of pain management inefficiencies to Humana Medicare members with osteoarthritis and/or chronic low back pain. METHODS: Subjects had either 2 or more claims for osteoarthritis on different days or 2 or more claims for low back pain 90 or more days apart, from January 1, 2008, to June 30, 2010, with the first occurrence assigned the index date. Inefficiencies were identified for 365 days postindex.Pain-related healthcare costs postindex were compared between members with and without inefficiencies. A generalized linear model calculated adjusted costs per member controlling for age, sex, and comorbidities. RESULTS: Most members diagnosed with osteoarthritis, chronic low back pain, or both (N = 68,453) had at least 1 inefficiency measure (n = 37,863) during the postindex period. High per member costs were for repeated surgical procedures ($26,451) and inpatient admissions ($19,372) compared with members without inefficiencies ($781; P < .0001). High total costs (prevalence times per member cost) were for repeated diagnostic testing and excessive office visits. Members with an inefficiency had adjusted pain-related costs 5.42 times higher than those of members without an inefficiency (P <.0001). CONCLUSIONS: Pain management inefficiencies are common and costly among Humana Medicare members with osteoarthritis and/or chronic low back pain. Further work by providers and payers is needed to determine benefits of member identification and early intervention for these inefficiencies.

Body mass index and percent body fat in a New Zealand multi-ethnic adolescent population.

Abstract Objective. Previous studies show that body mass index (BMI) does not fully explain differences in percent body fat (%BF) between ethnic groups and few studies have investigated this in adolescents. We sought to compare %BF for a given BMI between adolescents from four ethnic groups and to explain ethnic differences in this relationship. Methods. Weight, height and waist circumference were measured in 202 boys and 197 girls (age range 12-19 years; 129 Pacific Island, 91 European, 90 Maori and 89 Asian Indian). Fat mass, appendicular skeletal muscle mass (ASMM), leg length, bone mineral content (BMC), and fat distribution measures were derived from dual-energy X-ray absorptiometry. Results. For the same BMI and age, compared with European boys, %BF in Maori, Pacific Island and Asian Indian boys was 2.8% lower (P=0.017), 5.2% lower (P<0.0001), and 3.5% higher (P=0.0025), respectively. Compared with European girls, %BF, adjusted for BMI, for Maori, Pacific Island and Asian Indian girls was 1.9% lower (P=0.024), 4.1% lower (P<0.0001) and 3.6% higher (P<0.0001), respectively. Adjustment for ASMM, BMC and fat distribution variables, in particular, significantly reduced the differences between ethnic groups. In boys, readily measured variables, conicity index and waist circumference/height, had notable effects on ethnic differences in %BF. Conclusions. Our results show that BMI is not an equivalent measure of %BF between adolescent Europeans, Maori, Pacific Islanders and Asian Indians. Differences in muscularity, bone mass, relative leg length, fat distribution and body shape contribute to this disparity.

Dietary intakes of Pacific, Maori, Asian and European adolescents: the Auckland High School Heart Survey.

OBJECTIVE: To compare dietary intakes of European, Maori, Pacific Island and Asian adolescents living in Auckland. METHODS: A self-administered food frequency questionnaire was used to assess daily nutrient intakes of 2,549 14- to 21-year-old high-school students in Auckland (1,422 male and 1,127 female) in a cross-sectional survey carried out between 1997 and 1998. RESULTS: Compared with Europeans, Maori and Pacific Islanders consumed more energy per day. Carbohydrate, protein and fat intakes were higher in Maori and Pacific Islanders than in Europeans. Cholesterol intakes were lowest in Europeans and alcohol intakes were highest in Europeans and Maori. When nutrient intakes were expressed as their percentage contribution to total energy, many ethnic differences in nutrient intakes between Europeans and Maori or Pacific Islanders were eliminated. After adjustment for energy intake and age, Europeans ate the fewest eggs, and Pacific Islanders and Asians ate more servings of chicken and fish, and fewer servings of milk and cereal than Europeans. Compared to Europeans, Pacific Islanders consumed larger portion sizes for nearly every food item. CONCLUSION: There were marked differences in nutrient intakes between Pacific, Maori, Asian and European adolescents. Ethnic differences in food selections, frequency of food servings and portion sizes contribute to the differences in nutrient intakes between these ethnic groups. These differences generally matched those of other studies in children and adults from these ethnic groups. IMPLICATIONS: Interventions that reduce frequency of food consumption and serving sizes and promote less-fatty food choices in Maori and Pacific adolescents are needed.

Relationships of skin depths and temperatures when varying pulse repetition frequencies from 2.0-microm laser light incident on pig skin.

Human perception of 2.0-microm infrared laser irradiation has become significant in such disparate fields as law enforcement, neuroscience, and pain research. Several recent studies have found damage thresholds for single-pulse and continuous wave irradiations at this wavelength. However, the only publication using multiple-pulse irradiations was investigating the cornea rather than skin. Literature has claimed that the 2.0-microm light characteristic thermal diffusion time was as long as 300-ms. Irradiating the skin with 2.0-microm lasers to produce sensation should follow published recommendations to use pulses on the order of 10 to 100 ms, which approach the theoretical thermal diffusion time. Therefore, investigation of the heating of skin for a variety of laser pulse combinations was undertaken. Temperatures of ex vivo pig skin were measured at the surface and at three depths from pulse sequences of six different duty factors. Differences were found in temperature rise per unit exposure that did not follow a linear relation to duty factor. The differences can be explained by significant heat conduction during the pulses. Therefore, the common heat modeling assumption of thermal confinement during a pulse may need to be experimentally verified if the pulse approaches the theoretical thermal confinement time.

Helicobacter pylori infection and iron deficiency in teenage females in New Zealand.

BACKGROUND: Iron deficiency is an important problem in New Zealand children and young adults. Iron deficiency and Helicobacter pylori (H. pylori) infection are each more common in Maori and Pacific Island ethnic groups. AIMS: This study seeks to determine if H. pylori infection is associated with iron deficiency. METHODS: 792 female students from 7 Auckland high schools (median age 16 years) had H. pylori serology and tests for iron deficiency assessed by a combination of serum ferritin, iron saturation and mean cell volume. RESULTS: The prevalence of positive H. pylori serology was highest for Pacific Island students (49.0%; CI 38.0-60.0), intermediate for Maori (26.7%; CI 16.9-36.4) and Asian (24.7%; CI 12.6-36.7) and lowest for European (13.7%; 6.0-21.4) p<0.0001. Students with positive H. pylori serology had lower mean levels of iron saturation (p=0.013), but not of ferritin (p=0.068), haemoglobin (p=0.08) or mean cell volume (p=0.16), compared to those with negative serology. Positive H. pylori serology was associated with increased risk of iron deficiency (RR 1.20; CI 1.08-1.34), but not anaemia (RR 1.01; CI 0.87-1.18), after adjusting for age, ethnicity and school SES decile. CONCLUSIONS: This study indicates that H. pylori infection is associated with iron deficiency in adolescent females. There are significant differences in H. pylori serology amongst different ethnic groups in New Zealand.

Cultured human keratinocytes for optical transmission measurement.

The challenges of measuring optical properties of human tissues include the thickness of the sample, homogenization, or crystallization from freezing of the tissue. This investigation demonstrates a method to avoid these problems by growing optically thin samples of human keratinocytes as a substitute for ex vivo epidermis samples. Several methods of growth were investigated. Resulting samples were measured on a spectrophotometer for transmission between 300 nm and 2600 nm. The efficacy of the cell growth was confirmed with histological examination of several cultured keratinocyte samples. Limitations were the requirement to measure samples immediately after removal from the incubation environment, and the absence of the irregular structures of normal skin such as hair and glands.

Prediction of fatness by standing 8-electrode bioimpedance: a multiethnic adolescent population.

The objective of this study was to validate an 8-electrode bioimpedance analysis (BIA(8)) device (BC-418; Tanita, Tokyo, Japan) for use in populations of European, Maori, Pacific Island, and Asian adolescents. Healthy adolescents (215 M, 216 F; 129 Pacific Island, 120 Asian, 91 Maori, and 91 European; age range 12-19 years) were recruited by purposive sampling of high schools in Auckland, New Zealand. Weight, height, sitting height, leg length, waist circumference, and whole-body impedance were measured. Fat mass (FM) and fat-free mass (FFM) derived from the BIA(8) manufacturer's equations were compared with measurements by dual-energy X-ray absorptiometry (DXA). DXA-measured FFM was used as the reference to develop prediction equations based on impedance. A double cross-validation technique was applied. BIA(8) underestimated FM by 2.06 kg (P < 0.0001) and percent body fat (%BF) by 2.84% (P < 0.0001), on average. However, BIA(8) tended to overestimate FM and %BF in lean and underestimate FM and %BF in fat individuals. Sex-specific equations developed showed acceptable accuracy on cross-validation. In the total sample, the best prediction equations were, for boys: FFM (kg) = 0.607 height (cm)(2)/impedance ( ohm) + 1.542 age (y) + 0.220 height (cm) + 0.096 weight (kg) + 1.836 ethnicity (0 = European or Asian, 1 = Maori or Pacific) - 47.547, R(2) = 0.93, standard error of estimate (SEE) = 3.09 kg; and, for girls: FFM (kg) = 0.531 height (cm)(2)/impedance ( ohm) + 0.182 height (cm) + 0.096 weight (kg) + 1.562 ethnicity (0 = non-Pacific, 1 = Pacific) - 15.782, R(2) = 0.91, SEE = 2.19 kg. In conclusion, equations for fatness estimation using BIA(8) developed for our sample perform better than reliance on the manufacturer's estimates. The relationship between BIA and body composition in adolescents is ethnicity dependent.

Associations between after-school physical activity, television use, and parental strategies in a sample of New Zealand adolescents.

BACKGROUND: Youth display suboptimal levels of[1] physical activity and sedentary behaviors. Few studies have examined the existence of the "displacement hypothesis" or the effect of parental strategies on activity behaviors during the after-school period. METHODS: A total of 3471 students (12-18 years old) completed a self-report survey that assessed after-school physical activity and television (TV) use and perceived parental strategies (ie, encouragement to be active, TV-viewing rules). Participants were grouped into 4 activity groups: high TV/low active, high TV/active, low TV/low active, or low TV/active. Descriptive statistics and nominal logistic-regression analyses were conducted. RESULTS: Compared with students who watched less than 1 h of TV, participants who watched >or=4 h of TV were half as likely to be active after school (>or=4 h; adjusted odds ratio 0.51, 95% CI .40-.65). Compared with the low TV/active group, the other activity groups were at least 1.28 times more likely to have parents that provided only 1 parental strategy (encouragement for activity or TV rules) and up to 4.7 times more likely to have parents that provided neither strategy. DISCUSSION: Sedentary behaviors are associated with displacement of active pursuits. Parental strategies exert a strong influence on after-school behaviors of high school students.

Twelve-month prevalence, severity, and treatment contact of mental disorders in New Zealand born and migrant Pacific participants in Te Rau Hinengaro: The New Zealand Mental Health Survey.

OBJECTIVE: To investigate differences in 12-month prevalences of mental disorders and 12-month treatment contact among New Zealand born and migrants in separate ethnic groups in Te Rau Hinengaro: The New Zealand Mental Health Survey (NZMHS). DATA: The NZMHS is a nationally representative face-to-face household survey, carried out in 2003-2004 with a response rate of 73.3%. It surveyed 12,992 New Zealand adults aged 16 and over Pacific people were over sampled This paper focuses on the 2374 Pacific participants but includes for comparison 8160 non-Maori-non-Pacific participants (Others). METHOD: Multiple logistic regression models were used to produce estimates weighted to account for diferent probabilities of selection and taking account of the complex survey design. RESULTS: The prevalence of mental disorder was lowest among those who migrated as adults compared with those who migrated as young children (child migrants) or New Zealand-born (NZ born) migrant descendants in both Pacific and other ethnic groups. While Pacific people have higher rates of disorder than Others, many of the observed differences between Pacific and Others were explained by population differences in age and sex. Service use in the last 12 months by people with a disorder was low among Pacific peoples overall, but spec fically among older migrants. Older Pacific migrants with a disorder had particularly low use of specialist mental health services. CONCLUSION: An interesting picture has emerged regarding need for and use of mental health services. The burden of mental disorder is highest while service use was lower among Pacflc peoples generally Those born in or who migrated as children to New Zealand had higher levels of disorder but were also more likely to use services than older migrants.

'From Kava to Lager'--alcohol consumption and drinking patterns for older adults of Pacific ethnic groups, and Europeans in the Diabetes Heart and Health Study (DHAHS) 2002-2003, Auckland New Zealand.

AIM: This paper describes and compares alcohol consumption and drinking patterns for Pacific ethnic groups (Samoan, Tongan, Niue, Cook Islands) and European New Zealanders by gender participating in the 2002-03 Diabetes Heart and Health Study (DHAHS). METHODS: The DHAHS was a cross-sectional population based study of people age 35-74 years carried out in Auckland between 2002-03. A total of 1011 Pacific people comprising of 484 Samoan, 252 Tongan, 109 Niuean, 116 Cook Islanders and 47 'Other Pacific' (mainly Fijian) and 1745 European participants took part in the survey Participants answered a self-administered questionnaire to assess whether they consumed alcohol, their drinking patterns and consumption levels and reasons for stopping drinking. RESULTS: Approximately half (51.3%) of all Pacific people did not currently drink compared to 6.2% of the European population. Of 'non-drinkers'--never Drinking'was significantly more common in Pacific (40%) compared to Europeans (13%) p < 0.0001. Ex-drinkers comprised 6.3% of the 'ever-drank' population for European compared to 27.6% for Pacific. The majority of Pacific men and women drinkers (>60%) consumed alcohol 'weekly' or 'less than weekly'. In contrast the majority of European men and women drinkers (>60%) consumed alcohol '2-3 days per week' or 'daily'. European men were significantly more likely to drink wine and spirits, and European women were significantly more likely to drink wine than their Pacific counterparts. Pacific drinkers consumed an average of 6.9 drinks on a typical occasion and 82 mls of pure alcohol per week, compared to 3.6 drinks and 126 mls per week for Europeans. CONCLUSION: Middle-aged and older Pacific adults are less likely to consume alcohol than Europeans however those who drink consume more on a typical occasion but drink less regularly resulting in lower weekly consumption of pure alcohol. Drinking patterns in these Pacific adults tend to show substantial diversity by age (older are less likely to drink), sex (women less likely to drink), and financial deprivation (middle groups consume more than least and most financially deprived). For Europeans a more homogenous drinking style prevailed by age, sex, and deprivation. Pacific drinkers were also approximately five times more likely to stop drinking compared to Europeans, citing family and social reasons as their main motivation for stopping drinking.

Feasibility, design and conduct of a pragmatic randomized controlled trial to reduce overweight and obesity in children: The electronic games to aid motivation to exercise (eGAME) study.

BACKGROUND: Childhood obesity has reached epidemic proportions in developed countries. Sedentary screen-based activities such as video gaming are thought to displace active behaviors and are independently associated with obesity. Active video games, where players physically interact with images onscreen, may have utility as a novel intervention to increase physical activity and improve body composition in children. The aim of the Electronic Games to Aid Motivation to Exercise (eGAME) study is to determine the effects of an active video game intervention over 6 months on: body mass index (BMI), percent body fat, waist circumference, cardio-respiratory fitness, and physical activity levels in overweight children. METHODS/DESIGN: Three hundred and thirty participants aged 10-14 years will be randomized to receive either an active video game upgrade package or to a control group (no intervention). DISCUSSION: An overview of the eGAME study is presented, providing an example of a large, pragmatic randomized controlled trial in a community setting. Reflection is offered on key issues encountered during the course of the study. In particular, investigation into the feasibility of the proposed intervention, as well as robust testing of proposed study procedures is a critical step prior to implementation of a large-scale trial.