Bridget Farrant

Shaken baby syndrome in New Zealand, 2000–2002

Aim:  To describe the epidemiology of subdural haemorrhage (SDH) in New Zealand infants.

A survey of sexual and reproductive health in men with cystic fibrosis: new challenges for adolescent and adult services

Background: Improved survival dramatically alters the consequences of adult co-morbidities in men with cystic fibrosis (CF) such as male infertility. Few studies have systematically addressed the impact of sexual and reproductive health issues in these men or considered the implications for healthcare delivery. Method: A descriptive cohort study was undertaken using a sexual and reproductive health survey of men from a large adult CF centre, including men with lung transplantation. Results: The mean (SD) age of the 94 men (response rate 75%) was 30.5 (7.6) years. 94% knew that men with CF had reduced fertility. Men first heard about infertility later than desired (p<0.001) and only 53% heard from their preferred source. Men who were told about infertility when older were more likely to be upset than those told earlier (p<0.01). 53% of men had undergone semen analysis: 68% of men who had not been tested wanted semen analysis. 73% believed semen analysis should occur before 18, but the youngest age of testing was 24 years. In adolescence, one in three men had assumed they did not need to use condoms and one in 10 had confused infertility with impotence. 66% of men wanted more information on reproductive options and 84% wanted children. Seventeen men were parents by natural conception (n = 1), micro-epididymal sperm aspiration (n = 6), donor sperm (n = 9), and through step children (n = 1). Conclusions: Men with CF desire more sexual and reproductive health information. Earlier discussion of sexual and reproductive health is indicated in paediatric settings, and semen analysis should be routinely offered. In adult services greater discussion of reproductive health options is indicated.

The Prevalence of Chronic Health Conditions Impacting on Daily Functioning and the Association With Emotional Well-Being Among a National Sample of High School Students

PURPOSE This study aims to describe the prevalence of self-reported chronic health conditions among high school students in New Zealand, the extent to which the condition impacts on their activities and socialization, and to explore the association between the level of impact of the illness or disability and the emotional well-being of students with chronic health conditions. METHODS A two-stage cluster sample of 9,107 students (Years 9-13) from 96 New Zealand high schools participated in a 2007 health survey using internet tablets. Students were asked about any chronic illness or disabilities lasting more than 6 months, the impact of the illness or disabilities on their daily activities and socialization, and their depressive symptoms (RADS-SF) and emotional well-being (WHO-5). RESULTS Almost one in five students (18%) reported a chronic health condition. Among them, 28% reported an impact of their illness or disability on their activities, and 8% reported an impact on their ability to socialize. High levels of depressive symptoms were found among students with chronic health conditions reporting that their illness or disability impacts their activities (18%) or their ability to socialize (40%), and this was significantly higher than among students without chronic health conditions (10%). CONCLUSIONS Our findings suggest that there is a large group of adolescents with chronic health conditions for whom their illness or disability has an impact on their daily activities and ability to socialize with their peers. These students are more likely to experience emotional distress and require support and opportunities for healthy youth development.

Prevalence of severe obesity among New Zealand adolescents and associations with health risk behaviors and emotional well-being.

OBJECTIVE To describe the prevalence of severe obesity among New Zealand young people attending secondary school and the associations of severe obesity with health risk behaviors and emotional well-being. STUDY DESIGN A random sample of 9107 secondary school students in New Zealand participated in a 2007 health survey. Participants had their height and weight measured and answered an anonymous survey on multiple aspects of their health and well-being. RESULTS Overall, 2.5% of students met the International Obesity Task Force definition of severe obesity. Students with severe obesity had more weight-related concerns, were more likely to have used unhealthy weight control strategies, and were more likely to experience bullying compared with healthy weight students. For example, students with severe obesity were 1.7 times more likely to have been bullied at school (95% CI 1.2-2.7) and 1.9 times more likely to vomit for weight loss (95% CI 1.1-3.3) than were healthy weight students. Indicators of emotional well-being and most health risk behaviors were similar among young people with severe obesity and a healthy weight. CONCLUSIONS Clinicians who work with young people with severe obesity should prioritize discussing issues of bullying and healthy weight control strategies with families and their children.

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.

Access to Private and Confidential Health Care Among Secondary School Students in New Zealand

PURPOSE Private and confidential health care is an important indicator of the quality of health care for adolescents. The objective of this study was to determine the prevalence of health care utilization and private and confidential health care among a nationally representative population of high school students. METHODS A two-stage cluster sample of 9,107 students (grades 8-12, response rate 73%) from 96 New Zealand high schools (response rate 84%) participated in a 2007 health survey using Internet tablets. Questions included when and where they had accessed health care, if their health care provider had explained that their health care was confidential, and if they had been seen in private by their health care provider. RESULTS Although 83% of students had accessed health care in the previous 12 months, only 27% of students reported receiving private and confidential health care. Students who had accessed health care from a school-based health center (adjusted relative risk [95% confidence interval] 1.54 [1.42-1.66]) or family planning/sexual health clinics (adjusted relative risk = 2.1 [1.9-2.26]) were more likely to report receiving private and confidential health care compared with students who had not accessed health care from these settings. CONCLUSIONS While most young people access health care from their family doctor or general practitioners clinic, rates of private and confidential health care were low suggesting that opportunities to adequately explore and respond to important yet sensitive topics are compromised in primary care settings.

Adolescent and young adult medicine in Australia and New Zealand: towards specialist accreditation.

Abstract In Australia and New Zealand, a critical mass of academic and clinical leadership in Adolescent Medicine has helped advance models of clinical services, drive investments in teaching and training, and strengthen research capacity over the past 30 years. There is growing recognition of the importance of influencing the training of adult physicians as well as paediatricians. The Royal Australasian College of Physicians (RACP) is responsible for overseeing all aspects of specialist physician training across the two countries. Following advocacy from adolescent physicians, the RACP is advancing a three-tier strategy to build greater specialist capacity and sustain leadership in adolescent and young adult medicine (AYAM). The first tier of the strategy supports universal training in adolescent and young adult health and medicine for all basic trainees in paediatric and adult medicine through an online training resource. The second and third tiers support advanced training in AYAM for specialist practice, based on an advanced training curriculum that has been approved by the RACP. The second tier is dual training; advanced trainees can undertake 2 years training in AYAM and 2 years training in another area of specialist practice. The third tier consists of 3 years of advanced training in AYAM. The RACP is currently seeking formal recognition from the Australian Government to have AYAM accredited, a process that will be subsequently undertaken in New Zealand. The RACP is expectant that the accreditation of specialist AYAM physicians will promote sustained academic and clinical leadership in AYAM to the benefit of future generations of young Australasians.

Sexual and reproductive health in men with cystic fibrosis: Consistent preferences, inconsistent practices

BACKGROUND Sexual and reproductive health (SRH) is increasingly relevant for men with CF. However, the extent of similarities or differences in SRH clinical practices across different centres or states is unknown as single clinic studies are not informative about variations in male preferences or clinical practices. We wished to determine the variability of male SRH knowledge and preferences, and clinical practices across different CF clinics. METHODS Men attending 5 adult CF clinics in Australasia completed a survey of SRH knowledge, attitudes and behaviours. RESULTS 264 (64%) men participated, with a median age of 30 years (17-56). 65% knew of near universal infertility due to a transport problem. 43% heard about infertility from their preferred source, but significantly later than desired. Less than half had undergone semen analysis (SA), which, while varying by site, was consistently later than preferred. 57 men were fathers, of whom 29 had utilised ART. CONCLUSION Mens preferences around SRH were more consistent than clinical practices. Clinical practice guidelines and training for health professionals would help reduce the gap between mens SRH preferences and clinical practice.

Clustering of adolescent health concerns: a latent class analysis of school students in New Zealand.

The aims of this study are to identify clinically meaningful groups of adolescents based on their engagement in high levels of risk behaviours or severe emotional health concerns and to describe the demographic characteristics of these groups in two populations of school students in New Zealand.

Sexuality in Young People with Neurogenic Bladder Dysfunction

Families and health professionals have important roles in creating expectations that young people with neurogenic bladder are sexual beings, just like other young people. Most young people with neurogenic bladder dysfunction hope they will have intimate sexual relationships and family life in the future, with many being more sexually experienced in adolescence than their parents realise. While some will have normal sexual function, others will have various difficulties with erection and ejaculation, orgasm, and reproduction. As a group, the evidence suggests that these young people have very poor knowledge of the specific difficulties they may experience in relationship to sexual and reproductive health, and that they and their families want more information. This group of young people have unacceptably high rates of unplanned pregnancy and sexual abuse, and it is unknown what routine sexual health screening they receive. Addressing sexual and reproductive health issues in a sensitive and age-appropriate manner is an important component of health in this group of young people.