Daniel J. Exeter

Student engagement in very large classes: the teachers’ perspective

The rapid growth in the student population observed in higher education over the past 10–15 years in some countries has coincided with an increased recognition of student engagement and its value in developing knowledge. Active learning approaches have the potential to promote student engagement with lectures, but this becomes more challenging as class sizes increase. This study investigates student engagement from the teachers’ perspective, to identify current practices in teaching, learning and assessment designed to promote student engagement in courses with more than 1000 students enrolled at the University of Auckland, New Zealand. The study is based on semi‐structured interviews with six course coordinators. The results demonstrate that teaching techniques commonly associated with small‐class teaching can be used to engage students in very large classes. The effectiveness of these approaches from the students’ perspectives warrants further investigation.

Rising premature mortality in the UK’s persistently deprived areas: Only a Scottish phenomenon?

In the international literature, many studies find strong relationships between area-based measures of deprivation and mortality. In the U.K., mortality rates have generally fallen in recent decades but the life expectancy gap between the most and least deprived areas has widened, with a number of Scottish studies highlighting increased mortality rates in deprived areas especially in Glasgow. However, these studies relate health outcomes at different time points against period-specific measures of deprivation which may not be comparable over time. Using longitudinal deprivation measures where levels of area deprivation are made comparable over time, a recent study demonstrated how levels of mortality change in relation to changing or persistent levels of (non-) deprivation over time. The results showed that areas which were persistently deprived in Scotland experienced a rise in premature mortality rates by 9.5% between 1981 and 2001. Here, focussing on persistently deprived areas we extended the coverage to the whole of the U.K. to assess whether, between 1991 and 2001, rising premature mortality rates in persistently deprived areas are a Scottish only phenomenon or whether similar patterns are evident elsewhere and for men and women separately. We found that male premature mortality rates rose by over 14% in Scotland over the 10-year period between the early 1990s and 2000s in persistently deprived areas. We found no significant rise in mortality elsewhere in the U.K. and that the rise among men in Scotland was driven by results for Glasgow where mortality rates rose by over 15% during the decade. Our analyses demonstrate the importance of identifying areas experiencing persistent poverty. These results justify even more of a public health focus on Glasgow and further work is needed to understand the demographic factors, such as health selective migration, immobility and population residualisation, which may contribute to these findings.

Does young adult suicide cluster geographically in Scotland

Background: Suicide rose dramatically among young adults in Scotland between 1980–1982 and 1999–2001, especially among those living in deprived areas. Objective: To determine whether there are statistically significant geographical clusters of suicide and undetermined deaths among those aged 15 to 44 years in Scotland, and whether these persist through time. Methods: Deaths from suicide and undetermined causes by young adults in Scotland for three periods—1980 to 1982, 1990 to 1992, and 1999 to 2001—were aggregated into 10 058 small areas for Scotland. Tests for significant (p<0.05) geographical clustering of suicide were carried out for each period separately. Methods of suicide inside the identified clusters were compared with those in the rest of Scotland. Results: A significant geographical cluster of suicide among young adults was identified in east Glasgow in all three time periods (involving 92, 159, and 245 cases). Compared with the rest of Scotland, significantly more deaths in these clusters were caused by poisoning from liquids or solids over the entire period, but this was not the case in the most recent period (1999 to 2001). All three clusters could be explained by the concentration of socioeconomic deprivation in this part of Scotland. Conclusions: One interpretation of this large, persistent, and statistically significant cluster of suicides among young adults in east Glasgow is that suicide is geographically contagious, but the present results suggest that it is explained by the concentration of deprivation in this area. Suicide prevention strategies targeting at-risk populations living in east Glasgow are necessary to reduce the suicide burden in Scotland.

Antidepressant dispensing trends in New Zealand between 2004 and 2007

Objective: The aim of the present study was to explore antidepressant dispensing trends in New Zealand over a 3 year period (2004-2007) with a focus on trends by age, gender, ethnicity, District Health Board and type of antidepressant. Method: Prevalence of antidepressant agents dispensed in the years ending June 2004-2005, 2005-2006 and 2006-2007 was calculated separately for the population aged 15-24, 24-44, 45-64 and 65-100 years, (>=65) by gender. The f rst occurrence of antidepressant dispensing for each individual in each year was extracted to calculate age-specific antidepressant dispensing rates standardized to the 2006 Census population for the New Zealand European/Other (NZEO) ethnic group. Results: The 12 month prevalence of antidepressant dispensing among the total population aged 15-100 years increased from 7.36%% in 2004-2005 to 8.21%% in 2005-2006 and to 9.39%% in 2006-2007 Selective serotonin re-uptake inhibitor (SSRI) and tricyclic antidepres-sants (TCA) accounted for >90%% of all antidepressants dispensed each year. SSRIs were more frequently prescribed to young adults (15-24 years) than TCAs, although this relation changed with increasing age. In women aged >=65, TCAs were more commonly dispensed than SSRIs, while among men in the same age group, dispensing patterns were similar for both agents. Age-specific dispensing rates were higher among female than male subjects, and the NZEO combined populations were dispensed signif cantly more antidepressant agents than Māori or Pacific peoples. Considerable regional variations in antidepressant dispensing were found by ethnicity and gender. Conclusion: There are considerable variations in antidepressant dispensing in NZ, and the rate of dispensing has increased over the 3 years of the present study. Further work is required to investigate the different rates of antidepressant dispensing found between ethnic groups. Depression is strongly associated with suicide and the trend of increased dispensing of antidepressants found in the present study should continue to have a positive effect on suicide rates in NZ.

Standardised criteria improve accuracy of ECG interpretation in competitive athletes: a randomised controlled trial

Background Screening to prevent sudden cardiac death remains a contentious topic in sport and exercise medicine. The aim of this study was to assess whether the use of a standardised criteria tool improves the accuracy of ECG interpretation by physicians screening athletes. Methods Design: Randomised control trial. Study population: General practitioners with an interest in sports medicine, sports physicians, sports medicine registrars and cardiologists from Australia and New Zealand were eligible to participate. Outcome measures: Accuracy, sensitivity, specificity and false-positive rates of screening ECG interpretation of athletes. Intervention: A two-page standardised ECG criteria tool was provided to intervention participants. Control participants undertook ‘usual’ interpretation. Results 62 physicians, with a mean duration of practice of 16 years, were randomised to intervention and control. 10 baseline and 30 postrandomisation athlete ECGs were interpreted by the participants. Intervention participants were more likely to be correct: OR 1.72 (95% CI 1.31 to 2.27, p<0.001). Correct ECG interpretation was higher in the intervention group, 88.4% (95% CI 85.7% to 91.2%), than in the control group, 82.2% (95% CI 78.8% to 85.5%; p=0.005). Sensitivity was 95% in the intervention group and 92% in the control group (p=0.4), with specificity of 86% and 78%, respectively (p=0.006). There were 36% fewer false positives in the intervention group (p=0.006). Conclusions ECG interpretation in athletes can be improved by using a standardised ECG criteria tool. Use of the tool results in lower false-positive rates; this may have implications for screening recommendations. Trial Registration number: ACTRN12612000641897.

“Whose data is it anyway?” The implications of putting small area-level health and social data online

Data from electronic patient management systems, routine national health databases, and social administrative systems have increased significantly over the past decade. These data are increasingly used to create maps and analyses communicating the geography of health and illness. The results of these analyses can be easily disseminated on the web often without due consideration for the identification, access, ethics, or governance, of these potentially sensitive data. Lack of consideration is currently proving a deterrent to many organisations that might otherwise provide data to central repositories for invaluable social science and medical research. We believe that exploitation of such data is needed to further our understanding of the determinants of health and inequalities. Therefore, we propose a geographical privacy-access continuum framework, which could guide data custodians in the efficient dissemination of data while retaining the confidentiality of the patients/individuals concerned. We conclude that a balance of restriction and access is needed allowing linkage of multiple datasets without disclosure, enabling researchers to gather the necessary evidence supporting policy changes or complex environmental and behavioural health interventions.

Cohort Profile: The PREDICT Cardiovascular Disease Cohort in New Zealand Primary Care (PREDICT-CVD 19)

Cohort Profile: The PREDICT Cardiovascular Disease Cohort in New Zealand Primary Care (PREDICT-CVD 19) Sue Wells,* Tania Riddell, Andrew Kerr, Romana Pylypchuk, Carol Chelimo, Roger Marshall, Daniel J. Exeter, Suneela Mehta, Jeff Harrison, Cam Kyle, Corina Grey, Patricia Metcalf, Jim Warren, Tim Kenealy, Paul L. Drury, Matire Harwood, Dale Bramley, Geeta Gala and Rod Jackson School of Population Health, University of Auckland, Auckland, New Zealand, Middlemore Hospital, Cardiology Department, Auckland, New Zealand, School of Pharmacy, University of Auckland, Auckland, New Zealand, Endocrinology Services, Auckland District Health Board, Auckland, New Zealand, Computer Sciences, University of Auckland, School of Medicine, University of Auckland, Auckland, New Zealand, Waitemata District Health Board, Auckland, New Zealand and Northern Regional Alliance, Auckland, New Zealand

Obesogenic Retail Food Environments Around New Zealand Schools: A National Study.

INTRODUCTION This is the first nationwide spatial analysis of retail food environments around more and less socioeconomically deprived schools in New Zealand. METHODS Addresses from all food outlets were retrieved from 66 City and District Councils in 2014. All fast food, takeaway, and convenience outlets (FFTCs) were geocoded and (spatially) validated in 2015. Density and proximity of FFTCs around/from all schools were stratified by urban/rural area and quintile of school socioeconomic deprivation. RESULTS About 68.5% urban and 14.0% rural schools had a convenience store within 800 m; 62.0% urban and 9.5% rural schools had a fast food or takeaway outlet within 800 m. Median road distance to the closest convenience store from urban schools was significantly higher for the least (617 m) versus the most deprived (521 m) schools (p<0.001); the opposite was found for rural schools. Median FFTC density was 2.4 (0.8-4.8) per km(2) and maximum density was 85 per km(2) within 800 m of urban schools. Median density of convenience stores around the least deprived urban schools was significantly lower than around the most deprived schools (p<0.01). CONCLUSIONS Access to unhealthy foods through FFTCs within walking distance from urban schools is substantial in New Zealand, and greater for the most versus the least deprived schools. Health promoters should work with retailers to explore feasible actions to reduce childrens exposure to unhealthy foods before and after school, and provisions to allow Councils to restrict new FFTCs in school neighborhoods could be included in the Local Government Act.

Ethnic, socioeconomic and geographical inequalities in road traffic injury rates in the Auckland region

Objective: To describe ethnic, socioeconomic and geographical differences in road traffic injury (RTI) within Auckland, New Zealands largest city.

One in four major ischaemic heart disease events are fatal and 60% are pre-hospital deaths: a national data-linkage study (ANZACS-QI 8)

Aims The aim of this study is to determine proportions of major ischaemic heart disease (IHD) events that are fatal and where they occur, in an era of rapidly falling IHD mortality. Methods and results Individual person linkage of national data sets identified all IHD hospitalizations and deaths in New Zealand from December 2008 to November 2010. Outcome measures were proportions of people: (i) hospitalized with IHD and alive at 28 days; (ii) hospitalized with IHD and died within 28 days; (iii) hospitalized for a non-IHD cause and died from IHD within 28 days; and (iv) not hospitalized and died from IHD. Three event definitions were used [broad-balanced: IHD deaths and IHD hospitalizations, unbalanced: IHD deaths and myocardial infarction (MI) hospitalizations, and narrow-balanced: MI deaths and MI hospitalizations]. About 37 867 IHD hospitalizations and 9409 IHD deaths were identified using the broad IHD definition. Approximately one-quarter of IHD events were fatal: 4% were deaths within 28 days of an IHD hospitalization, 6% were IHD deaths within 28 days of a non-IHD hospitalization, and 14% were non-hospitalized IHD deaths. Using different event definitions, overall case fatality varied from 24–25% (broad and narrow balanced) to 37–39% (unbalanced), whereas the proportion of all deaths that were non-hospitalized was approximately 60%. Forty per cent of deaths were first-ever events that manifested as non-hospitalized IHD deaths. Conclusion About one-quarter of IHD are fatal, although the proportion is dependent on disease definitions and age. About 60% of all IHD deaths occur out of hospital, and of these 60% are in people not previously hospitalized for IHD.