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.

Endovascular aortic repair: can we predict who will not get long-term benefit?

AIM

The aim of this study is to review our endovascular aortic repair (EVAR) experience in Dunedin Public Hospital as well as assessing the applicability of Mount Sinai score and the American Society of Anesthesiologists physical status classification (ASA) in finding which patients will be most likely to benefit from EVAR.

METHODS

A retrospective study of 54 patients who had EVAR from 2000 to December 2009 in Dunedin Public Hospital was conducted. Univariate, bivariate and multivariate regressions analyses were used in assessing the data with the occurrence of postoperative complications and mortality as the primary outcome variable.

RESULTS

The overall mortality at 30 days was 1.8%. The Mount Sinai score and smoking status were both found to be significant predictors of mortality.

DISCUSSION

The Mount Sinai score was a good predictor for mortality as it factors in the patient's comorbidities. This study indicates that smoking status was an important factor and it should be added to long-term risk predicting models.

Effect of micronutrient sprinkles on reducing anemia: a cluster-randomized effectiveness trial

OBJECTIVE

To evaluate the effectiveness of Sprinkles alongside infant and young child feeding (IYCF) education compared with IYCF education alone on anemia, deficiencies in iron, vitamin A, and zinc, and growth in Cambodian infants.

DESIGN

Cluster-randomized effectiveness study.

SETTING

Cambodian rural health district.

PARTICIPANTS

Among 3112 infants aged 6 months, a random subsample (n = 1350) was surveyed at baseline and 6-month intervals to age 24 months.

INTERVENTION

Daily micronutrient Sprinkles alongside IYCF education vs IYCF education alone for 6 months from ages 6 to 11 months.

MAIN OUTCOME MEASURES

Prevalence of anemia; iron, vitamin A, and zinc deficiencies; and growth via biomarkers and anthropometry.

RESULTS

Anemia prevalence (hemoglobin level <11.0 g/dL [to convert to grams per liter, multiply by 10.0]) was reduced in the intervention arm compared with the control arm by 20.6% at 12 months (95% CI, 9.4-30.2; P = .001), and the prevalence of moderate anemia (hemoglobin level <10.0 g/dL) was reduced by 27.1% (95% CI, 21.0-31.8; P < .001). At 12 and 18 months, iron deficiency prevalence was reduced by 23.5% (95% CI, 15.6-29.1; P < .001) and 11.6% (95% CI, 2.6-17.9; P = .02), respectively. The mean serum zinc concentration was increased at 12 months (2.88 μg/dL [to convert to micromoles per liter, multiply by 0.153]; 95% CI, 0.26-5.42; P = .03). There was no statistically significant difference in the prevalence of zinc and vitamin A deficiencies or in growth at any time.

CONCLUSIONS

Sprinkles reduced anemia and iron deficiency and increased the mean serum zinc concentration in Cambodian infants. Anemia and zinc effects did not persist beyond the intervention period. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12608000069358.

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.

Predicted versus absolute values in the application of exhaled nitric oxide measurements

BACKGROUND

Constitutional factors such as age, sex and height, and acquired factors such as atopy and smoking, influence exhaled nitric oxide (F(E)NO) levels. The utility of predicted values based on reference equations which account for these factors has not been evaluated.

AIM

To compare the performance characteristics of absolute versus % predicted values for F(E)NO as predictors of diagnosed asthma and steroid response.

METHODS

We compared the sensitivities, specificities and likelihood ratios using F(E)NO (% predicted) with absolute values for F(E)NO (ppb) in 52 steroid-naive subjects with non-specific respiratory symptoms. The reference equations of Olin et al. (Chest, 2007) and Dressel et al. (Resp. Med., 2008) were used to derive predicted values. Receiver operating curve analyses were performed and the areas under the curve (AUC) were calculated for two outcomes: diagnosed asthma (yes/no), and steroid response after fluticasone for 4 weeks (defined as ≥ 12% increase in FEV(1); increase in mean morning PEF ≥ 15%; reduction in symptoms ≥ 1 point; increase in PC(20)AMP of ≥ 2 doubling doses).

RESULTS

The AUCs for diagnosed asthma were: F(E)NO (absolute) 0.770; F(E)NO (% pred.): 0.758 (Olin) and 0.775 (Dressel) (NS). The AUCs for F(E)NO (abs.) and F(E)NO (% pred.) with respect to the four indices of steroid response were likewise not significantly different.

CONCLUSION

Correcting F(E)NO for combinations of age, sex, height, smoking and atopy using reference equations did not enhance the performance characteristics of F(E)NO as a predictor of either the diagnosis of asthma or steroid responsiveness in patients with chronic airways-related symptoms.

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.

A decade of NHMRC People Support expenditure in review: is support for Indigenous health research increasing?

OBJECTIVE

To investigate National Health and Medical Research Council (NHMRC) support over the decade to 2006 for researchers studying Indigenous health and researchers who self-identified as Indigenous.

DESIGN AND SETTING

Review of data on all recipients of People Support awards and Capacity Building Grants in Population Health Research who were researching Indigenous health or who self-identified as Indigenous between 1996 and 2006.

MAIN OUTCOME MEASURES

Annual People Support and Capacity Building grants and expenditure, by broad research area, state or territory, administering institution, and Indigenous status (as self-identified by award recipients in their applications).

RESULTS

Between 1996 and 2006, 134 People Support awards were made to researchers studying Indigenous health; of these, 27 (20%) were to researchers who self-identified as Aboriginal or Torres Strait Islander. In 2006, about 2.9% of the annual expenditure on all People Support funding was for Indigenous health research, representing a doubling in the proportion of funds since 2001. There was no increase in the number of self-identified Indigenous researchers funded under People Support, but Capacity Building Grants increased the number of people from Indigenous backgrounds supported by the NHMRC, with funds allocated to 36 Indigenous researchers from 2002 to 2006, compared with 14 funded by People Support during the same period.

CONCLUSIONS

Funding to support Indigenous health research through the People Support scheme has increased since the NHMRC adopted policy changes in 2002, but it has not reached the targeted expenditure of at least 5% of agency allocations. The Capacity Building Grants have been a more effective vehicle for funding researchers from Indigenous backgrounds.

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.