The New Zealand medical journal
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To estimate the effectiveness of colorectal cancer screening with faecal occult blood testing (FOBT), flexible sigmoidoscopy (FS), and combinations of FOBT and FS in preventing colorectal cancer (CRC) deaths. ⋯ There is high-quality evidence showing that guaiac-based FOBT screening reduces mortality from CRC. No such evidence exists for screening with FS either alone, or in combination with FOBT, but this should be re-evaluated once data become available from four large ongoing trials.
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Smokers need new products and policies to escape smoking's risks. And the next generation needs policies that will better protect them from becoming smokers. Low-nitrosamine tobacco snuff (hereafter termed 'snuff') is 20 times less dangerous than cigarette smoking. ⋯ Tax each class of tobacco products proportionate to the respective risks of each. (Tax cigarettes at 20 times the snuff rate, instead of at the same rate.) Legislate, to expand the Smoke-free Environments Act's aims to include ending the sale of cigarettes and ending smoking deaths--i.e: Allow oral snuff to compete with cigarettes for market share (and for the smoker's nicotine receptors). Reduce addiction to smoking, by decreasing the nicotine content of cigarettes by 5% every 6 months. (Below 20% of current levels, most smokers will quit or switch to snuff.), Allot cigarette supply quotas to manufacturers and importers, decreasing by 5% every 6 months, on the grounds that cigarette smoke is irremediably toxic. The summed effects of these changes could end cigarette sales within 10 years, and prevent 90% of cigarette deaths within 22 years thereafter.
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Comparative Study
Punitive parenting practices of contemporary young parents.
To describe the punitive parenting practices of a cohort of young (<25 years) New Zealand parents and to examine the life course risk factors that placed these parents at increased risk of severe child physical punishment/abuse. ⋯ The use of physical punishment and more severe forms of physical assault/abuse are relatively common amongst contemporary young parents. Implications of study findings for social policy aimed at reducing levels of family violence in New Zealand are considered.
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Comparative Study
The influence of hospital environment on postoperative length of stay following major colorectal surgery.
Elective colorectal resection is associated with a postoperative stay (LOS) of 7-10 days. Counties Manukau District Health Board (DHB) has two sites for elective colorectal surgery: Manukau Surgery Centre (MSC)-a stand-alone elective surgical site; and Middlemore Hospital (MMH)-a general hospital. MSC opened in 2001 and it was noted that patients recovered more quickly there than patients operated on at MMH. It was thus our aim to identify if LOS following major elective colorectal surgery is influenced by hospital environment. ⋯ Because MSC and MMH are both part of the same DHB, share the same surgeons, and service an identical population, it can be concluded that environmental differences are likely to be influential in the recovery process. However, further research is required to elucidate the significance of individual factors.
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To quantify the proportion of emergency department (ED) discharges that could have been managed in primary care, and to determine the consistency with which healthcare professionals assess cases as 'primary care appropriate'. ⋯ Our study has shown retrospectively that a significant number of ED presentations may have been managed in primary care. However this was determined with knowledge of investigation results and final diagnosis, by clinicians who had poor agreement about individual cases. In reality, triage nurses in ED have only the presenting complaint. This study shows how variable clinicians can be in determining primary care appropriateness even with full clinical details.