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2.
Pediatr Infect Dis J ; 39(11): 995-1001, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32502125

RESUMO

BACKGROUND: Acute rheumatic fever (ARF) predominantly affects indigenous Maori schoolchildren in Bay of Plenty region, and more so male Maori students, especially when socioeconomically deprived. We evaluated the effectiveness of strategies for reducing ARF with group A streptococcal pharyngitis treatment in 2011-18. METHODS: We retrospectively assessed outcomes of 3 open cohorts of Maori schoolchildren receiving different interventions: Eastern Bay rural Cohort 1, mean deprivation decile 9.80, received school-based sore-throat programs with nurse and general practice (GP) support; Eastern Whakatane township/surrounds Cohort 2, mean deprivation 7.25, GP management; Western Bay Cohort 3, mean deprivation 5.98, received predominantly GP care, but 3 highest-risk schools received school-based programs. Cases were identified from ICD10 ARF-coded hospital discharges, notifications to Ministry of Health, and a secondary-prevention penicillin database. Primary outcomes were first-presentation ARF cohorts' incidence preintervention (2000-10) and postintervention (2011-18) with cases over annual school rolls' Maori students-year denominators. RESULTS: Overall, ARF in Maori schoolchildren declined in the cohorts with school-based programs. Cohort 1 saw a postintervention (2011-18) decline of 60%, 148 to 59/100,000/year, rate ratio (RR) = 0.40(CI 0.22-0.73) P = 0.002. Males' incidence declined 190 to 78 × 100,000/year RR = 0.41(CI 0.19-0.85) P = 0.013 and females too, narrowing gender disparities. Cohort 3 ARF incidence decreased 48%, 50 to 26/100,000/year RR = 0.52(CI 0.27-0.99) P = 0.044. In contrast, ARF doubled in Cohort 2 students with GP-only care without school-based programs increasing 30 to 69/100,000/year RR = 2.28(CI 0.99-5.27) P = 0.047, especially for males 39/100,000/year to 107/100,000/year RR = 2.71(CI 1.00-7.33) P = 0.0405. CONCLUSIONS: School-based programs with indigenous Maori health workers' sore-throat swabbing and GP/Nurse support reduced first-presentation ARF incidence in Maori students in highest-risk settings.


Assuntos
Faringite/microbiologia , Faringite/terapia , Febre Reumática/microbiologia , Febre Reumática/prevenção & controle , Serviços de Saúde Escolar , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Masculino , Havaiano Nativo ou Outro Ilhéu do Pacífico , Nova Zelândia/epidemiologia , Faringite/epidemiologia , Estudos Retrospectivos , Febre Reumática/epidemiologia , Fatores Sexuais , Streptococcus pyogenes
3.
J Prim Health Care ; 8(2): 94-8, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27477550

RESUMO

The international '#1WordforFamilyMedicine' initiative explores the identity of General Practitioners (GPs) and Family Physicians (FPs) by allowing the international Family Medicine community to collaborate on advocating for the discipline via social media. The New Zealand version attracted 83 responses on social media. Thematic analysis was performed on the responses and a 'word cloud' image was created based on an image identifying the country around the world - that of the silver fern. The '#1WorldforFamilyMedicine' project was promoted by WONCA (World Organisation of Family Doctors) globally to help celebrate World Family Doctor Day on 19 May 2015. To date, over 80 images have been created in 60 different countries on six continents. The images represent GPs' love for their profession and the community they serve. We hope that this initiative will help inspire current and future Family Medicine and Primary Care providers.


Assuntos
Medicina de Família e Comunidade/organização & administração , Liderança , Atenção Primária à Saúde/organização & administração , Mídias Sociais , Atitude do Pessoal de Saúde , Humanos , Nova Zelândia , Assistência Centrada no Paciente/organização & administração , Papel do Médico
4.
J Rural Health ; 32(1): 56-62, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26174590

RESUMO

PURPOSE: To examine prostate-specific antigen (PSA) screening patterns and outcomes in rural and urban men in New Zealand. METHODS: Men aged 40+ years were identified from 18 rural and 13 urban general practices across the Midland Cancer Network region. Computerized practice records were cross-referenced with community laboratory data to ascertain the number and level of PSA tests undertaken in 2010 and 3 years prior. For men with an elevated PSA result in 2010, practice records were searched for information on specialist visits, and they were cross-referenced with histology reports regarding biopsy and prostate cancer diagnosis. FINDINGS: The study population included 34,960 men aged 40+ years, of whom 48% were enrolled in rural practices. Men in rural practices were 43% less likely to be screened with a PSA test in 2010, but they were 53% more likely to have an elevated PSA result. The prostate cancer detection rate from all screened men was 6 per 1,000 for rural men compared with 3 per 1,000 for urban men. Rural men were more likely diagnosed with Gleason score 9 tumors and metastatic disease. CONCLUSION: Significant differences were found in PSA screening patterns between rural and urban general practices. Due to lower screening rates, rural men were more likely to be diagnosed with prostate cancer when screened and also seemed to be diagnosed with more advanced disease compared with urban men. Despite ongoing discussions about the benefits and harms of PSA screening, PSA testing as such seems to be under-utilized in New Zealand rural practices.


Assuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Neoplasias da Próstata/epidemiologia
5.
J Prim Health Care ; 5(3): 243-8, 2013 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-23998175

RESUMO

INTRODUCTION: Undertaking training in rural areas is a recognised way of helping recruit staff to work in rural communities. Postgraduate year two medical doctors in New Zealand have been able to undertake a three-month placement in rural practice as part of their pre-vocational training experience since November 2010. AIM: To describe the experience of a rural general practice team providing training to a postgraduate year two medical trainee, and to describe the teaching experience and range of conditions seen by the trainee. METHODS: A pre- and post-placement interview with staff, and analysis of a logbook of cases and teaching undertaken in the practice. RESULTS: The practice team's experience of having the trainee was positive, and the trainee was exposed to a wide range of conditions over 418 clinical encounters. The trainee received 22.5 hours of formal training over the three-month placement. DISCUSSION: Rural general practice can provide a wide range of clinical experience to a postgraduate year two medical trainee. Rural practices in New Zealand should be encouraged to offer teaching placements at this training level. Exposure to rural practice at every level of training is important to encourage doctors to consider rural practice as a career.


Assuntos
Medicina Geral/organização & administração , Internato e Residência/organização & administração , Seleção de Pessoal/métodos , Serviços de Saúde Rural/organização & administração , Estudantes de Medicina , Atitude do Pessoal de Saúde , Escolha da Profissão , Competência Clínica , Humanos , Avaliação de Programas e Projetos de Saúde , Recursos Humanos
6.
Rural Remote Health ; 8(4): 1024, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18999904

RESUMO

INTRODUCTION: As the rural general practice workforce in New Zealand changes, after hours services are under pressure to change. This is an international problem. This article reports on an initiative in a rural New Zealand community to meet the need for after hours care. First contact for patients is with a community nursing team operating from the local health centre, complemented by on-call advice from GPs and GP clinics twice daily at weekends. OBJECTIVE: To report on the demand for after hours services generated by a geographically defined community in New Zealand. DESIGN: A prospective cross-sectional survey of after hours utilization over a one month period using questionnaires was completed by the full range of healthcare professionals providing care. SETTING: A single geographically defined rural community of 9200 people in the North Island of New Zealand. PARTICIPANTS: Rural GPs, community nurses and the ambulance service. RESULTS: Only 90/204 patient contacts were seen by the GPs with the remainder being managed by the nurses or ambulance staff. Nurses referred more patients to the base hospital but overall 87% of contacts handled by the doctors and nurses were managed locally. Estimated out of hours contact rate was 320/1000 persons/year (including telephone consultations). For direct face-to-face contact the rate was 245/1000 per year: for Maori the rate was 425/1000 per year while for non-Maori the rate was 151/1000 per year. Ambulance services provided an urgent call service at the rate of 29/1000 persons per year. CONCLUSION: A collaborative service providing after hours care to a rural community is described and utilization rates assessed. The model of first on-call nurse with GP back up provides a sustainable service and reduces the burden on rural doctors without reducing patient access.


Assuntos
Plantão Médico/organização & administração , Relações Comunidade-Instituição , Medicina de Família e Comunidade/organização & administração , Serviços de Saúde Rural/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Padrões de Prática Médica/organização & administração , Estudos Prospectivos
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