A Successful Midwifery Model for a High Deprivation Community in New Zealand: A Mixed Methods Study

In August 2011, the Ministry of Health (MOH) commissioned a report to provide information, evidence, and analysis regarding an integrated lead maternity care model for a midwifery practice situated in Counties Manukau, New Zealand, a high deprivation area. The final report was entitled “A Successful Lead Maternity Care Midwifery Practice in Counties Manukau” (Priday & McAra-Couper, 2011). The project was both qualitative (qualitative descriptive) and quantitative (descriptive statistics) in its review and audit of the Midwifery Practice. The midwives from this practice have been providing continuity of midwifery care for 17 years, and the MOH was interested in how this group of midwives (“the Midwifery Practice”) was working and the implications of this style of practice. The report demonstrated that the Midwifery Practice provides continuity of care for predominantly Pacific and Maori (indigenous) women and young women, including adolescents. The socioeconomic indicators of these women place them in the high deprivation index group. Given these three factors—ethnicity, age, and deprivation decile—high perinatal mortality and other adverse outcomes could be expected. However, statistics demonstrate low perinatal mortality and morbidity, with most women booking for care before 20 weeks’ gestation and recording optimal birth outcomes. The Midwifery Practice is integrated into the community facilitating a connected and accessible service for women and families. These findings are significant in light of the repeated call from the Perinatal and Maternal Mortality Review Committee (PMMRC, 2013), urging stakeholders who provide health and social services to identify the reasons why women are failing to engage with care and to identify interventions to address barriers. This article summarizes the findings from the report.

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Making Social Services Work for Everyone: a summary of the recent Productivity Commission inquiry

Policy Quarterly ◽

10.26686/pq.v12i2.4703 ◽

2016 ◽

Vol 12 (2) ◽

Author(s):

Dave Heatley

Keyword(s):

New Zealand ◽

Social Policy ◽

Social Services ◽

Institutional Design ◽

Well Being ◽

Programme Evaluation ◽

Final Report ◽

Productivity Commission ◽

The Subject

Social services are those dedicated to enhancing people’s economic and social well-being by helping them lead more stable, healthy, self-sufficient and fulfilling lives. New Zealand’s social services – specifically, those provided, funded or otherwise supported by government – were the subject of a recent New Zealand Productivity Commission inquiry (Box 1). The commission’s final report is wide-ranging, covering subjects from service commissioning to purchasing and contracting, programme evaluation, institutional design and system stewardship. The report’s recommendations on many of these topics reflect standard social policy principles and may hold few surprises for readers of Policy Quarterly.

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Rural midwifery practice in Aotearoa/New Zealand: Strengths, vulnerabilities, opportunities and challenges

New Zealand College of Midwives ◽

10.12784/nzcomjnl56.2020.3.17-25 ◽

2020 ◽

Vol 56 ◽

pp. 17-25

Author(s):

Rea Daellenbach ◽

Lorna Davies ◽

Mary Kensington ◽

Susan Crowther ◽

Andrea Gilkison ◽

...

Keyword(s):

New Zealand ◽

Rural Communities ◽

Social Services ◽

Health Professionals ◽

Rural Women ◽

Rural Areas ◽

Service Providers ◽

Rural Practice ◽

Midwifery Practice ◽

Adverse Weather

Background: The sustainability of rural maternity services is threatened by underfunding, insufficient resourcing and challenges with recruitment and retention of midwives. Aims: The broader aim of this study was to gain knowledge to inform the optimisation of equitable and sustainable maternity care for rural communities within New Zealand and Scotland, through eliciting the views of rural midwives about their working conditions and practice. This article focuses on the New Zealand midwives’ responses. Method: Invitations to participate in an online questionnaire were sent out to midwives working in rural areas. Subsequently, themes from the survey results were followed up for more in-depth discussion in confidential, online group forums. 145 New Zealand midwives responded to the survey and 12 took part in the forums. Findings: The New Zealand rural midwives who participated in this study outlined that they are attracted to, and sustained in, rural practice by their sense of connectedness to the countryside and rural communities, and that they need to be uniquely skilled for rural practice. Rural midwives, and the women they provide care to, frequently experience long travel times and distances which are economically costly. Adverse weather conditions, occasional lack of cell phone coverage and variable access to emergency transport are other factors that need to be taken into account in rural midwifery practice. Additionally, many participants noted challenges at the rural/urban interface in relation to referral or transfer of care of a woman and/or a baby. Strategies identified that support rural midwives in New Zealand include: locum and mentoring services, networking with other health professionals, support from social services and community service providers, developing supportive relationships with other rural midwives and providing rural placements for student midwives. Conclusion: Midwives face economic, topographic, meteorological and workforce challenges in providing a service for rural women. However, midwives draw strength through their respect of the women, and the support of their midwifery colleagues and other health professionals in their community.

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Risk of perinatal mortality in the first year of midwifery practice in New Zealand: analysis of a retrospective national cohort

BMJ Open ◽

10.1136/bmjopen-2017-019026 ◽

2018 ◽

Vol 8 (4) ◽

pp. e019026 ◽

Cited By ~ 1

Author(s):

Lynn C Sadler ◽

Judith McAra-Couper ◽

Deborah Pittam ◽

Michelle R Wise ◽

John M D Thompson

Keyword(s):

New Zealand ◽

Perinatal Mortality ◽

First Year ◽

Midwifery Practice ◽

National Cohort

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Prevalence and predictors of adverse outcomes in neonatal seizures

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-200499 ◽

2021 ◽

pp. 1-7

Author(s):

K. Famra ◽

P. Barta ◽

A. Aggarwal ◽

B.D. Banerjee

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Birth Asphyxia ◽

Adverse Outcomes ◽

Neonatal Seizures ◽

Clinical Practices ◽

Inborn Errors ◽

Mortality And Morbidity ◽

Low Birth Weight Babies

OBJECTIVES: Neonatal seizures are significant cause of neonatal mortality and morbidity. Current study was planned to study prevalence of adverse outcomes in neonatal seizures and identify its predictors. METHODS: This observational descriptive study was carried out on 220 neonates with seizures. Neonates who succumbed to illness/ death before investigations, or whose maternal records were incomplete were excluded. Blood sugar, serum calcium, serum electrolytes, and USG skull were done in all patients. CT scan, MRI and inborn errors of metabolism profile were done as and when indicated. Adverse outcomes were defined as death, phenobarbitone non responders, or abnormal examination at discharge. Antenatal, perinatal and neonatal predictors of adverse outcomes in neonatal seizures were evaluated. RESULTS: Out of 220 neonates with seizures 76(34.5%) had adverse outcomes. Very low birth weight babies (≤1500 gm) [OR 1.27(CI 0.57–2.84)], microcephaly [OR 5.93 (CI 0.55–64.41)], Apgar score≤3 at 5 minutes [OR 11.28(CI 14.18–30.45)], seizure onset within 24 hours [OR 5.99(CI 12.43–14.78)], meningitis [OR 2.63(CI 0.08–6.39)], septicemia [OR1.22(CI 0.45–3.31)] and abnormal cranial USG [OR 7.95(CI 12.61–24.22)] were significant predictors of adverse outcomes in neonates with seizures. CONCLUSION: Prematurity, very low birth weight, birth asphyxia, meningitis, septicemia and abnormal USG could predict adverse outcomes in neonatal seizures. Improved antenatal and neonatal clinical practices may help reduce adverse outcomes in these patients.

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The Road to Better Management in Resistant Hypertension–Diagnostic and Therapeutic Insights

Pharmaceutics ◽

10.3390/pharmaceutics13050714 ◽

2021 ◽

Vol 13 (5) ◽

pp. 714

Author(s):

Elisabeta Bădilă ◽

Cristina Japie ◽

Emma Weiss ◽

Ana-Maria Balahura ◽

Daniela Bartoș ◽

...

Keyword(s):

Blood Pressure ◽

Resistant Hypertension ◽

Renin Angiotensin System ◽

Drug Regimen ◽

Secondary Hypertension ◽

Adverse Outcomes ◽

Uncontrolled Hypertension ◽

White Coat Hypertension ◽

Mineralocorticoid Receptor Antagonist ◽

Mortality And Morbidity

Resistant hypertension (R-HTN) implies a higher mortality and morbidity compared to non-R-HTN due to increased cardiovascular risk and associated adverse outcomes—greater risk of developing chronic kidney disease, heart failure, stroke and myocardial infarction. R-HTN is considered when failing to lower blood pressure below 140/90 mmHg despite adequate lifestyle measures and optimal treatment with at least three medications, including a diuretic, and usually a blocker of the renin-angiotensin system and a calcium channel blocker, at maximally tolerated doses. Hereby, we discuss the diagnostic and therapeutic approach to a better management of R-HTN. Excluding pseudoresistance, secondary hypertension, white-coat hypertension and medication non-adherence is an important step when diagnosing R-HTN. Most recently different phenotypes associated to R-HTN have been described, specifically refractory and controlled R-HTN and masked uncontrolled hypertension. Optimizing the three-drug regimen, including the diuretic treatment, adding a mineralocorticoid receptor antagonist as the fourth drug, a β-blocker as the fifth drug and an α1-blocker or a peripheral vasodilator as a final option when failing to achieve target blood pressure values are current recommendations regarding the correct management of R-HTN.

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Smartphone-Based Prediction Model for Postoperative Cardiac Surgery Outcomes Using Preoperative Gait and Posture Measures

Sensors ◽

10.3390/s21051704 ◽

2021 ◽

Vol 21 (5) ◽

pp. 1704

Author(s):

Rahul Soangra ◽

Thurmon Lockhart

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Cardiac Surgery ◽

Regression Model ◽

Mobile Phone ◽

Gait Speed ◽

Adverse Outcomes ◽

Postoperative Outcomes ◽

Mortality And Morbidity ◽

Prediction Of Mortality

Gait speed assessment increases the predictive value of mortality and morbidity following older adults’ cardiac surgery. The purpose of this study was to improve clinical assessment and prediction of mortality and morbidity among older patients undergoing cardiac surgery through the identification of the relationships between preoperative gait and postural stability characteristics utilizing a noninvasive-wearable mobile phone device and postoperative cardiac surgical outcomes. This research was a prospective study of ambulatory patients aged over 70 years undergoing non-emergent cardiac surgery. Sixteen older adults with cardiovascular disease (Age 76.1 ± 3.6 years) scheduled for cardiac surgery within the next 24 h were recruited for this study. As per the Society of Thoracic Surgeons (STS) recommendation guidelines, eight of the cardiovascular disease (CVD) patients were classified as frail (prone to adverse outcomes with gait speed ≤ 0.833 m/s) and the remaining eight patients as non-frail (gait speed > 0.833 m/s). Treating physicians and patients were blinded to gait and posture assessment results not to influence the decision to proceed with surgery or postoperative management. Follow-ups regarding patient outcomes were continued until patients were discharged or transferred from the hospital, at which time data regarding outcomes were extracted from the records. In the preoperative setting, patients performed the 5-m walk and stand still for 30 s in the clinic while wearing a mobile phone with a customized app “Lockhart Monitor” available at iOS App Store. Systematic evaluations of different gait and posture measures identified a subset of smartphone measures most sensitive to differences in two groups (frail versus non-frail) with adverse postoperative outcomes (morbidity/mortality). A regression model based on these smartphone measures tested positive on five CVD patients. Thus, clinical settings can readily utilize mobile technology, and the proposed regression model can predict adverse postoperative outcomes such as morbidity or mortality events.

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The Epidemiology of Noise Sensitivity in New Zealand

Neuroepidemiology ◽

10.1159/000511353 ◽

2020 ◽

Vol 54 (6) ◽

pp. 482-489

Author(s):

Daniel Shepherd ◽

Marja Heinonen-Guzejev ◽

Kauko Heikkilä ◽

David Welch ◽

Kim N. Dirks ◽

...

Keyword(s):

New Zealand ◽

Social Determinants ◽

Social Deprivation ◽

Personal Characteristics ◽

Social Position ◽

Noise Sensitivity ◽

Noise Annoyance ◽

High Deprivation ◽

Cultural Determinants ◽

And Task

Background: Sensitivity to noise, or nuisance sounds that interrupt relaxation and task-related activities, has been shown to vary significantly across individuals. The current study sought to uncover predictors of noise sensitivity, focussing on possible social and cultural determinants, including social position, education, ethnicity, gender, and the presence of an illness. Method: Data were collected from 746 New Zealand adults residing in 6 areas differentiated by social position. Participants responded to questions probing personal characteristics, noise sensitivity, illness, neighbourhood problems, and noise annoyance. It was hypothesized that those in high-deprivation areas and/or experiencing illness report higher levels of noise sensitivity. Results: Approximately 50 and 10% of the participants reported being moderately or very noise sensitive, respectively. Significant predictors of noise sensitivity included age, length of residence, level of social deprivation, and self-reported illness. Conclusion: There is evidence of social determinants of noise sensitivity, including social position and residential factors.

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