Topics covered:

• Improving Hospital Food and Beverage Environments
• Improving Hospital Physical Activity Environments 
• Improving Support for Breastfeeding Employees 
• Improving Support for Tobacco-Free Hospital Environments
• Hospitals Partner with Public Health to Improve Food Environments:
• Addressing Community Health in Schools, Early Care and Education, and the Clinic 
• Community Benefit: Encouraging Healthy Habits Early
• Children’s Hospitals Working Together to Improve their Food Environments 

To read the issues in this series, go to:  http://www.cdc.gov/nccdphp/dnpao/hwi/resources/hospital_p2p.htm

Midwives at Lakes District Hospital are celebrating two major events this week, signifying good news for local mums-to-be and their future families.

Staff at the Lakes Maternity Unit have successfully received approval from the New Zealand Breastfeeding Authority to renew their accreditation as a “Baby Friendly Hospital", under the Baby friendly Hospital Initiative (BFHI). This is a worldwide programme led by the World Health Organization and UNICEF, to strengthen the capacity of national health systems to protect and support breastfeeding.

A “Baby Friendly Hospital” is defined as a healthcare facility where the practitioners who provide care for women and babies adopt practices that aim to protect, promote and support exclusive breastfeeding from birth. At the same time, Baby Friendly facilities ensure that women who choose not to breastfeed are supported in their decision and provided with unbiased information and advice.

The hospital officially celebrated its success at a ceremony held at Lakes District Hospital on Monday 4 May. This event marks a significant achievement by staff says Director of Midwifery for Southern DHB Jenny Humphries, “we have an outstanding team of midwives working at Lakes and this accreditation is a huge achievement by the team and a reflection of their ongoing commitment to ensuring all babies born locally get the best start in life. We received a glowing report about the service we deliver at Lakes, which is great news for the community. Well done team!”

BFHI is a quality tool which establishes standards of care and services are audited on these for accreditation on a three-yearly cycle. Lakes District Hospital first became a BFHI hospital in 2009 and again in 2012. The audit looks at facilities and policies that support breastfeeding and the facility must meet an exclusive breastfeeding rate of at least 75% at discharge.  Lakes District Hospital reached a commendable 92% in 2014.  Hospital staff have a strong commitment to providing culturally appropriate care and involve consumers at all levels, and recent feedback from women found that they enjoyed the ‘royal treatment’,  ‘undivided attention’ and ‘very good treatment’ they received at Lakes.  It was acknowledged that the maternity unit felt ‘warm’ and ‘homely’ with a good use of imagery to portray breastfeeding in a positive manner.

The event on Monday will be quickly followed by celebrations to mark International Midwives Day on Tuesday 5th May. This day provides an opportunity for women and midwives all over the world to unite and focus the world’s attention on the work of midwives. The theme this year is “Midwives: changing the world one family at a time.” Staff at Lakes Hospital will be combining forces with midwives and consumers across the district and celebrating the day in Wanaka. 

The midwives have also started a new sub-committee of the New Zealand College of Midwives to address the specific needs of the women and families in our communities. The midwives of this region now gather every two months to discuss how to best support each other and the women they work with in this stunning but challenging location.

Evidence syntheses, a primary qualitative survey, and discrete choice experiment (DCE) research was undertaken using multidisciplinary, mixed methods. Two mother-and-baby groups in disadvantaged areas collaborated throughout.

The qualitative study included 88 pregnant women/recent mothers/partners, 53 service providers, 24 experts/decision-makers and 63 conference attendees. The surveys included 1144 members of the general public and 497 health professionals. The DCE study included 320 women with a history of smoking.

Twenty-three smoking cessation and 19 breastfeeding studies were included in the review. Vouchers contingent on biochemically proven smoking cessation in pregnancy were effective, with a relative risk of 2.58 (95% confidence interval 1.63 to 4.07) compared with non-contingent incentives for participation (four studies, 344 participants). Effects continued until 3 months post partum. Inconclusive effects were found for breastfeeding incentives compared with no/smaller incentives (13 studies) but provider commitment contracts for breastfeeding show promise. Intervention intensity is a possible confounder.

The acceptability of seven promising incentives was mixed. Women (for vouchers) and those with a lower level of education (except for breastfeeding incentives) were more likely to disagree. Those aged ≤ 44 years and ethnic minority groups were more likely to agree. Agreement was greatest for a free breast pump and least for vouchers for breastfeeding. Universal incentives were preferred to those targeting low-income women. Initial daily text/telephone support, a quitting pal, vouchers for > £20.00 per month and values up to £80.00 increase the likelihood of smoking cessation. Doctors disagreed with provider incentives.

A ‘ladder’ logic model emerged through data synthesis and had face validity with service users. It combined an incentive typology and behaviour change taxonomy. 

The authors conclude that incentives provided with other tailored components show promise but reach is a concern. Formal evaluation is recommended and collaborative service-user involvement is important.

This report can be read in free full text at:  http://dx.doi.org/10.3310/hta19300

Morgan H, Hoddinott P, Thomson G, Crossland N, Farrar S, Yi D, et al. (2015). Benefits of incentives for breastfeeding and smoking cessation in pregnancy (BIBS): A mixed-methods study to inform trial design. Health Technol Assessment, 19(30).

Studies reported in this issue (attached below):

In the latest issue (attached below):

Despite these issues, Health at a Glance Asia/Pacific 2014 reveals that life expectancy at birth across 22 Asian countries reached 73.4 years on average in 2012, a gain of about seven years since 1990. In comparison, OECD countries gained 5.3 years during the same period.

But a large regional divide persists: the country with the longest life expectancy is Hong Kong, China with 83.3 years for both men and women. Japan, Australia, Singapore, New Zealand, the Republic of Korea and Macau, China also exceeded 80 years for total life expectancy.

In contrast, eleven countries in the Asia/Pacific region had total life expectancies of less than 70 years, and in Papua New Guinea and Myanmar, a child born in 2012 can expect to live an average of less than or equal to 65 years of life.

The report also reveals the high prevalence of diabetes in Asia/Pacific, which accounted for over 60% of the 5.1 million deaths worldwide caused by the disease in 2013. About 215 million people live with diabetes in the region and half of them are undiagnosed and unaware of developing long-term complications.

To read the full media release from the OECD, go to:  http://www.oecd.org/els/health-systems/asia-pacific-countries-need-to-improve-affordable-access-to-healthcare.htm

The report is available to read in free full text at: http://www.oecd.org/health/health-at-a-glance-asia-pacific-23054964.htm

The Fono, which provides healthcare and community services across four Auckland locations, has launched a new service, Pacific Maternal and Infant Nutrition, to combat the markedly higher prevalence of obesity compared to the total population.

A large proportion of Pacific peoples' health disparity is due to their high chronic disease burden, particularly for cardiovascular disease and type 2 diabetes. Almost 1 in 3 adults in New Zealand were found to be obese in the 2012/13 New Zealand Health Survey (Ministry of Health). 68% of Pacific adults were found to be obese with 27% of Pacific children already faced with obesity.

To read the full media release on Scoop, go to: http://www.scoop.co.nz/stories/GE1411/S00055/the-fono-spreads-healthy-babies-healthy-families-message.htm

Well Child/Tamariki Ora (WCTO) is a series of free health assessments and support services offered to all New Zealand children from birth to five years.

The framework’s three high-level aims focus on family/whānau experience, population health, and best value for the health system’s resources. It also sets quality indicators to monitor health system performance, driving improvement in WCTO services and supporting the programme to give children a strong foundation for ongoing healthy development.

The targets presented in this atlas are Ministry of Health targets for the quality indicators. These targets were set using existing national targets, where available, or by agreeing them with the Ministry of Health’s expert advisory group.

The atlas features easy-to-use maps, graphs and tables that pull together data on the 27 quality indicators. They show how services are performing in different parts of New Zealand, and identify areas where improvements are needed to better support children and their families/whānau.

The quality indicators draw on existing national data collections, such as the Ministry of Health’s PHO Enrolment Collection, the National Immunisation Register, the National Maternity Collection and the B4 School Check information system. They also use data from Plunket and the Ministry of Education.

To access the Atlas, go to:  http://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/atlas-of-healthcare-variation/well-child/

A new online tool produced by the Health Quality & Safety Commission gives New Zealanders a clearer overview of how early childhood health services work for children and their families.

Using data supplied by the Ministry of Health, the Commission has developed a Well Child/Tamariki Ora domain for its Atlas of Healthcare Variation.

The Atlas features easy-to-use maps, graphs and tables highlighting the variation between health care received by people in different geographical areas. It is designed to prompt debate among medical professionals, patients and providers, and to stimulate improvements in our health services.

To read the full story on the HQSC website, go to:  http://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/news-and-events/news/1378/

Morning presentations were followed by discussion groups focusing on improving the capacity and effectiveness of the public health workforce in working with Asian families. The Agencies for Nutrition Action (ANA) has made the following presentations available at: http://ana.org.nz/event/2013-asian-forum/

• Plunket: Improving support to Asian Families. Early findings from a recent literature review and research into services for Asian families. Agnes Wong, Project Leader and Jess Beauchamp, Clinical Advisor, Plunket.
• Diabetes and breastfeeding. Eleanor Gates, Baby Friendly Hospitals Initiative Coordinator/Lactation Consultant, Waitemata DHB.
• Developmental Origins of Health & Disease: from evidence to workforce training, Gravida. New scientific research forming part of a new workforce education curriculum. Assoc Professor Mark Vickers, Principal Investigator Gravida.
• National Workforce Development Service. Jackie Gunn, Lead Curriculum Developer, Gravida.
• Counties Manakau Improving Nutrition Project. Pam Henry, Portfolio Manager Child Health and Maternity, CMDHB.
• Waitemata & Auckland Collective Project. Grant Berghan, Project  Manager, Waitemata DHB Maternal & Infant Nutrition & Physical Activity Collective.

Whanganui child health workers have launched a multi-pronged, collaborative effort to implore parents of babies and infants to breastfeed, not to smoke, to lay their babies on their backs and to not sleep with their babies.
 
Concerned by Whanganui’s alarming child death rates, the Whanganui District Health Board (WDHB), Plunket, the Whanganui Regional Health Network (WRNH) and the Teen Parents Reference Group are applying for funds to purchase Pepi pods (safe, portable baby beds) to distribute to parents of new babies considered at risk of sudden unexpected death in infancy (SUDI).
 
Health services throughout the region are committed to encouraging women not to smoke during pregnancy, to educate themselves and their wider whanau/families about safe sleeping practices for babies, and to improve breast feeding rates in Whanganui.
 
Wanganui Hospital’s head of paediatrics David Montgomery says he’s sure parents and the wider community will welcome this news after reading in Tuesday’s Chronicle that Whanganui has the highest rate of infant deaths in the country.
 
As chair of Whanganui’s Child and Youth Mortality Review Committee, Dr Montgomery says it’s very upsetting to know the deaths of many babies are preventable
 
The national Child and Youth Mortality Review Committee’s latest survey results released last week said the WDHB had reported 18 deaths of children between 28 days and a year old in the four years to 2012. This gave the region a mortality rate of 4.03 for every 1000 live births. Northland was second highest with a rate of 3.25 per 1000 births.
 
“Tragically, high numbers of Maori babies across the country are dying due to SUDI,” Dr Montgomery says. “Health workers in Whanganui are determined we will bring about change in our region.
 
“Our collaborative efforts include working closely with Whakawhetu (the National SUDI prevention for Maori) who have been here training our workforce to help them relay the SUDI messages in a manner that’s culturally appropriate for Maori.
 
“Our midwives and Well Child providers (Tamariki Ora and Plunket) are working hard to educate all parents of new babies about how to reduce the SUDI risks. Parents need to understand that if their baby falls in the SUDI risk category with low birth weight, exposure to smoke, and sleeping in positions which compromise their airways, their baby is vulnerable.
 
“It’s all about doing everything possible to enhance a baby’s ability to breathe well. Occasionally babies do die for reasons we don’t understand but to see them dying unnecessarily is heart breaking. We have to find ways to ensure parents and the whole whanau/family understand how important it is to follow the safe sleeping messages.”
 
Dr Montgomery says he believes the education effort being made in Whanganui will make a difference “but it’s going to take the whole community to protect Whanganui’s babies”.

In the latest issue (attached below): 

Included in the report are two health sector case studies: Waikato DHB's delivery of immunisation and public health messages and the Ministry of Health's Breastfeeding NZ Facebook page.

The report is available to download and read in free full text at: http://www.oag.govt.nz/2013/social-media

Office of the Auditor-General (2013). Learning from public entities' use of social media. Wellington: Office of the Auditor-General.

The first annual report for Waikato District Health Board (DHB) as part of a focus on maternity quality and safety confirms that a number of changes have taken place in recent months in response to an action plan introduced in September last year.

There are now extra midwifery staff in delivery suite and in the Women’s Assessment unit, beefed up midwifery leadership, an additional obstetrician and gynaecologist on staff and more equipment to ensure clinical efficiency and timely patient care.

Senior medical officers also now present after hours to support the operational environment and more lead maternity care and consumer engagement with the maternity quality and safety programme.

Waikato DHB clinical midwife director Corli Roodt, who also chairs the Midland Maternity Action Group, said the significant investment in patient safety meant Waikato DHB was well on the way to establishing itself as a centre of excellence in New Zealand.

“Maternity quality and safety is not just about what happens in the hospital, it’s about working together across the whole community to improve women’s health and the health outcomes of newborns,” said Mrs Roodt.   

A Waikato Pepi pods project driven by Waikato DHB’s Te Puna Oranga (Maori Health) across the Midland region has made great strides towards reducing the incidence of Sudden Unexplained Infant Deaths and to get messages out about the importance of smoke free homes and breastfeeding.

As part of the local maternity quality and safety programme, Waikato DHB established a group made of local midwives, primary care providers, consumers, primary birthing facility staff and hospital staff to oversee quality activities.

The annual report, presented to the Waikato DHB board last week and to the Ministry of Health last month, gives an over view of maternity services in the Waikato, describes the birthing population and issues related to maternity and birth outcomes.

“Waikato has one of the highest numbers of women birthing outside of a main hospital in community facilities,” said Mrs Roodt.

“Encouraging the option of primary birthing is important to the DHB and it is worth reflecting that the good outcome Waikato demonstrates against the national clinical indicators for normal births and low caesarean section rates are a result of low risk women being able to birth in environments suited to their needs within their own communities.”

Waikato DHB has six primary birthing units and funds five privately owned and operated birthing units.

In 2010-2011, 32 per cent of all Waikato births occurred in primary birthing facilities.

“This is because Waikato has more primary birthing facilities available to women across the district than any other DHB in the country.”

For women with higher needs and complications the Waikato community has access to a tertiary hospital centre at Waikato Hospital that can care for complicated cases in need of medical interventions.

The annual report shows that the Waikato health community continues to promote breastfeeding for both maternal and infant health benefits and has increased its breast-feeding rates significantly at discharge from hospital with work on going to continue support for the mother returning home.

The report also describes future quality activities due for undertaking in 2013/14.

“Our birthing population data tells us that we have a high proportion of births to young Māori women and higher smoking rates than other DHB areas which can lead to poorer health outcomes for mothers and newborns.

“We have large numbers of women living in higher deprivation areas which impacts on health inequalities and health outcomes. This information has led us to focus on premature births data, health needs of women, smoking during pregnancy and early registration with a midwife in our plan for this year,” said Mrs Roodt.

We do have many challenges ahead, but we are confident that with the commitment of the passionate members of Women’s Health and our partners in the community, we will not only deliver against the maternity quality and safety requirements planned, but we will establish Waikato as a centre of excellence in New Zealand, she said.

Read the full report at http://www.waikatodhb.health.nz/women

• Long-term, exclusive breastfeeding and adiposity in children
• Nocturnal glucose control with an artificial pancreas
• Dual-hormone artificial pancreas in type 1 diabetes
• Evaluation of a personalised artificial pancreas
• Behavioural weight loss in serious mental illness
• Hypoglycaemia and harms in an online social network
• Diagnosed and undiagnosed diabetes, and prediabetes, in NZ
• Menopausal age, reproductive lifespan and type 2 diabetes risk
• Occurrence and recurrence of diabetes in pregnancy
• Natural fibre complex reduces bodyweight

To subscribe to the research review, go to: http://researchreview.co.nz

The key question for the review was "What are the key components of health visitor interventions and relationships between the current health visiting service, its processes and outcomes for children and families?"

The review is available to read in full text at: http://www.kcl.ac.uk/nursing/research/nnru/publications/Reports/Why-Health-Visiting-NNRU-report-12-02-2013.pdf

Cowley, S., et al. (2013). Why health visiting? A review of the literature about key health visitor interventions, processes and outcomes for children and families. London: National Nursing Unit, King's College, London.

The survey was completed by 125 participants, and 19 (15.2%) stated their main place of employment had a pain management policy during immunisations (20  were not sure). Distraction strategies were frequently used for all age groups, while breastfeeding for infants younger than 6 months was used occasionally (44.6%), often (9.1%) or never (45.5%) and even less frequently for infants aged 6–12 months. Sucrose or other sweet solutions were almost never used for infants prior to, or during, immunisation. Lollies were frequently given to children after immunisations. 

The authors conclude that strategies, such as sweet solutions, breastfeeding or topical anaesthetics, where feasible, should be facilitated.

To view the full abstract and for information on how to access the full text, go to:
http://onlinelibrary.wiley.com/doi/10.1111/jpc.12161/abstract or contact your DHB library, or organisational or local library for assistance.

Harrison, D., Elia, S., Royle, J. & Manias, E. (2013), Pain management strategies used during early childhood immunisation in Victoria. Journal of Paediatrics and Child Health, 49(4), 313-318.

Drawing on a wide range of data sources, it gives readers a better understanding of the factors that affect the health of populations and the performance of health systems in these countries and economies.

Indicators covered in the report include:

Chapter 1. Health status; Life expectancy at birth; Infant mortality; Under-5 mortality; Mortality from all causes; Mortality from cardiovascular disease; Mortality from cancer; Mortality from injuries; Maternal mortality; HIV/AIDS; Tuberculosis; Malaria; Diabetes.

Chapter 2. Determinants of health; Reproductive health; Low birthweight; Breastfeeding; Nutrition; Underweight and overweight; Water and sanitation; Tobacco; Alcohol.

Chapter 3. Health care resources and utilisation; Doctors and nurses; Consultations with doctors; Hospital beds and average length of stay; Hospital discharges; Pregnancy and birth;

Chapter 4. Health expenditure and financing; Health expenditure per capita; Health expenditure in relation to GDP; Financing of health care; Pharmaceutical expenditure.

Chapter 5. Quality of care; Health care quality: Policy context and measurement; In-hospital mortality following acute myocardial infarction and stroke; Mortality from breast, cervical and colorectal cancer; Childhood immunisation programmes; Measuring mental health care quality; Quality of care initiatives in the Asia/Pacific region.

The report is available to read in full text at: http://www.oecd.org/health/healthataglance/asia

OECD (2012). Health at a glance: Asia/Pacific 2012. OECD.

Drawing on a wide range of data sources, it gives readers a better understanding of the factors that affect the health of populations and the performance of health systems in these countries and economies. 

Each of the indicators is presented in a user-friendly format, consisting of charts illustrating variations across countries and over time, a brief descriptive analysis highlighting the major findings conveyed by the data, and a methodological box on the definition of the indicator and any limitations in data comparability.

The report includes data on: mortality from cancer and cardiovascular disease; breastfeeding; nutrition; tobacco; consultations with doctors; hospital beds and average length of stay; hospital discharges; health expenditure; in-hospital mortality; immunisation; and mental health care quality.

The report is available in full text at: http://www.oecd.org/health/healthpoliciesanddata/healthataglanceasiapacific2012.htm

Go to: http://www.eiseverywhere.com/ehome/pha2012/-conference-presentations/

The report Now we are born, released recently, details the findings from interviews and data collected from 6790 children born in the northern North Island in 2009 and 2010. 

The data in the report was drawn from interview surveys of mothers before they gave birth and followup interviews covering the first 9 months of their child’s life, allowing researchers to compare parental antenatal intentions for their children’s postnatal environments with the reality for families.

Even though the information gleaned from the study covers just the very start of a New Zealander’s life, interesting findings are coming to light. Some of the many noteworthy statistics are listed in this news item.

To read the full news item at the Science Media Centre, go to: http://www.sciencemediacentre.co.nz/2012/03/23/study-describes-life-for-new-new-zealanders/

The award recognises outstanding achievement in Māori public health, and this year set out to recognise a person, group or organisation, iwi/hapu, or marae who has shown leadership in supporting the hauora of the people of Canterbury following the 2010-2011 earthquakes".

To read the full story, go to: http://www.scoop.co.nz/stories/GE1109/S00003/christchurch-trust-wins-major-maori-public-health-award.htm

The emphasis is on celebrating the successes of the Counties Manukau community, providers and partner organisations in response to the burden posed by diabetes, cardiovascular diseases, cancers and chronic respiratory diseases on the community of Counties Manukau.

The document is available at: http://www.cmdhb.org.nz/About_CMDHB/Planning/Health-Status/CreatingBetterFuture/CBF-ourstories.pdf