Issue 228 - 18 March 2021

Welcome to the fortnightly Health Improvement and Innovation Digest. The Digest has links to key evidence of interest, with access to new content arranged by topic.

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Article Access

For articles that aren't open access, contact your DHB library, or organisational or local library for assistance in accessing the full text. If your organisation has a subscription, you may be able to use the icon under full text links in PubMed to access the full article.

Health Equity (New Zealand)

Māori lives matter
In this presentation from the Health Quality & Safety Commission's Ō tātou hiranga advance care planning hui, Hector Matthews shines the spotlight on Māori inequity and the systemic biases that perpetuate inequities. He challenges us to confront some uncomfortable truths about inequity and explore ways we can truly place people’s cultural framework at the centre of their care and wellbeing.

Ensuring the right to food for indigenous children: a case study of stakeholder perspectives on policy options to ensure the rights of tamariki Māori to healthy food
The United Nations Convention on the Rights of the Child confirms a child’s right to adequate food, and to the highest attainable standard of health. For indigenous children, these rights are also recognised in the UN Declaration on the Rights of Indigenous Peoples. However, Indigenous children endure higher rates of obesity and related health conditions than non-indigenous children, including in Aotearoa New Zealand (NZ). For indigenous tamariki (Māori children) in NZ, high levels of obesity are interconnected with high rates of food insecurity. Therefore there is a need for action. This study, published in the International Journal for Equity in Health, aimed to investigate policy options that would safeguard the rights of indigenous children to healthy food.

Health Equity (International)

Green Space and Health Equity: A Systematic Review on the Potential of Green Space to Reduce Health Disparities
Disadvantaged groups worldwide, such as low-income and racially/ethnically minoritized people, experience worse health outcomes than more privileged groups, including wealthier and white people. Such health disparities are a major public health issue in several countries around the world. This systematic review, published in the International Journal of Environmental Research and Public Health, examines whether green space shows stronger associations with physical health for disadvantaged groups than for privileged groups.

Quality Improvement (International)

Patient and lay carer education for preventing pressure ulceration in at‐risk populations
Pressure ulcers (PUs) are injuries to the skin and underlying tissues that occur most commonly over bony prominences, such as the hips and heels as a result of pressure and shear forces. PUs cause pain, discomfort, longer hospital stays, and decreased quality of life. They are also very costly to treat and consume substantial parts of healthcare budgets. PUs are largely preventable, and education targeted at patients and their carers is considered important. The objective of this Cochrane Review was to assess the effects of patient and/or lay carer education on preventing pressure ulceration in at‐risk people, in any care setting.

Learning health systems using data to drive healthcare improvement and impact: a systematic review
The transition to electronic health records offers the potential for big data to drive the next frontier in healthcare improvement. Yet there are multiple barriers to harnessing the power of data. The Learning Health System (LHS) has emerged as a model to overcome these barriers, yet there remains limited evidence of impact on delivery or outcomes of healthcare. The objective of this systematic review, published in BMC Health Services Research, was to gather evidence on the effects of LHS data hubs or aligned models that use data to deliver healthcare improvement and impact.

Cancer Services (New Zealand)

Associated Factors and Survival Outcomes for Breast Conserving Surgery versus Mastectomy among New Zealand Women with Early-Stage Breast Cancer
This study, published in the International Journal of Environmental Research and Public Health, aimed to investigate type of loco-regional treatment received, associated treatment factors and mortality outcomes in New Zealand women with early-stage breast cancer who were eligible for breast conserving surgery (BCS).

Cardiovascular Disease and Diabetes (New Zealand)

Pre-diabetes prevalence and associated factors in New Zealand school children: a cross-sectional study
The incidence of pre-diabetes and type 2 diabetes mellitus (T2DM) is increasing in children. Early identification of pre-diabetes is an important first step in preventing the progression to T2DM. The aim of this study, published in the New Zealand Medical Journal, was to investigate the association of selected factors with pre-diabetes in children.

Cardiovascular Disease and Diabetes (International)

Digital Technology Interventions for Risk Factor Modification in Patients With Cardiovascular Disease: Systematic Review and Meta-analysis
Approximately 50% of cardiovascular disease (CVD) cases are attributable to lifestyle risk factors. Despite widespread education, personal knowledge, and efficacy, many individuals fail to adequately modify these risk factors, even after a cardiovascular event. Digital technology interventions have been suggested as a viable equivalent and potential alternative to conventional cardiac rehabilitation care centers. However, little is known about the clinical effectiveness of these technologies in bringing about behavioral changes in patients with CVD at an individual level. The aim of this study, published in JMIR Mhealth Uhealth, was to identify and measure the effectiveness of digital technology (eg, mobile phones, the internet, software applications, wearables, etc) interventions in randomized controlled trials (RCTs) and determine which behavior change constructs are effective at achieving risk factor modification in patients with CVD.

Effects of patient decision aids in patients with type 2 diabetes mellitus: A systematic review and meta‐analysis
This study, published in the International Journal of Nursing Practice, aimed to systematically evaluate the effectiveness of patient decision aids on knowledge, decisional conflict and decisional self‐efficacy outcomes in patients with diabetes.

Primary Mental Health (International)

Second‐generation antidepressants for treatment of seasonal affective disorder
Seasonal affective disorder (SAD) is a seasonal pattern of recurrent depressive episodes that is often treated with second‐generation antidepressants (SGAs), light therapy, or psychotherapy. The objective of this Cochrane Review was to assess the efficacy and safety of second‐generation antidepressants (SGAs) for the treatment of seasonal affective disorder (SAD) in adults in comparison with placebo, light therapy, other SGAs, or psychotherapy.

Interventions for self‐harm in children and adolescents
Self‐harm (SH) is a growing problem in most countries, often repeated, and associated with suicide. Evidence assessing the effectiveness of interventions in the treatment of SH in children and adolescents is lacking, especially when compared with the evidence for psychosocial interventions in adults. The objective of this Cochrane Review was to assess the effects of psychosocial interventions or pharmacological agents or natural products for SH compared to comparison types of care (e.g. treatment‐as‐usual, routine psychiatric care, enhanced usual care, active comparator, placebo, alternative pharmacological treatment, or a combination of these) for children and adolescents (up to 18 years of age) who engage in SH.

Suitability of Text-Based Communications for the Delivery of Psychological Therapeutic Services to Rural and Remote Communities: Scoping Review
People living in rural and remote areas have poorer access to mental health services than those living in cities. They are also less likely to seek help because of self-stigma and entrenched stoic beliefs about help seeking as a sign of weakness. E-mental health services can span great distances to reach those in need and offer a degree of privacy and anonymity exceeding that of traditional face-to-face counseling and open up possibilities for identifying at-risk individuals for targeted intervention. This scoping review, published in JMIR Mental Health, maps the research that has explored text-based e-mental health counseling services and studies that have used language use patterns to predict mental health status. In doing so, one of the aims was to determine whether text-based counseling services have the potential to circumvent the barriers faced by clients in rural and remote communities using technology and whether text-based communications, in particular, can be used to identify individuals at risk of psychological distress or self-harm.

Smoking Cessation (International)

Smoking cessation for improving mental health
There is a common perception that smoking generally helps people to manage stress, and may be a form of 'self‐medication' in people with mental health conditions. However, there are biologically plausible reasons why smoking may worsen mental health through neuroadaptations arising from chronic smoking, leading to frequent nicotine withdrawal symptoms (e.g. anxiety, depression, irritability), in which case smoking cessation may help to improve rather than worsen mental health. The objective of this Cochrane Review was to examine the association between tobacco smoking cessation and change in mental health.

Weight Management (International)

A Review of Registered Randomized Controlled Trials for the Prevention of Obesity in Infancy
Childhood overweight and obesity is a worldwide public health issue. The objective of this article, published in the International Journal of Environmental Research and Public Health, was to describe planned, ongoing and completed randomized controlled trials (RCTs) designed for the prevention of obesity in early childhood.

Key Ministry of Health Publications

Health and Independence Report 2019
The 2019 Health and Independence report presents the latest data on measures of health, including life expectancy, causes of health loss, and determinants of health.

Pacific Provider Development Fund Commissioning Framework consultation
The Ministry of Health is seeking your views on the process, and its associated documents, developed for the Pacific Provider Development Funds (PPDF) from 2021/22.  The closing date for submissions is 11.45 pm, Friday 9 April 2021.

The Cost and Value of Employment in the Health and Disability Sector
This paper provides evidence on the economic and social returns of investing in the health and disability workforce to provide a basis for health and financial decision makers to work together around shared goals and public finance objectives.

District Health Board Initiative

Hāwera Hospital leads search for eMedicine system for Te Manawa Taki region
Hāwera Hospital may be small but it is taking giant steps in the search for an electronic medicines prescribing and administration (eMedicine) system for Te Manawa Taki (TMT, formerly Midland) region district health boards. Over the next six months Taranaki’s rural hospital will be piloting OPENeP, a secure eMedicine system currently used in the UK and parts of Europe, which provides a clear overview of patients’ medication records in a single, shared location.

The information available on or through this newsletter does not represent Ministry of Health policy. It is intended to provide general information to the health sector and the public, and is not intended to address specific circumstances of any particular individual or entity.