Добірка наукової літератури з теми "New Zealand. Department of Health. Library"

The New Zealand Health Sector is in a period of extreme pressure and change, not least the libraries within the sector. The aim of this article is to give an overview on the Health Library landscape in New Zealand, and its role in developing a stronghealth workforce; particularly considering upcoming changes to the District Health Board (DHB) structure arising out of the Health and Disability System Review (2020).

Racism is firmly established as a determinant of health and an underlying cause of ethnic health inequities. As an organised system, racism operates at multiple levels (including structurally and interpersonally). Racism and its many manifestations are breaches of international human rights obligations and, in the Aotearoa New Zealand context, te Tiriti o Waitangi. This article considers approaches to anti-racism in health and disability policy in the 30 years following the foundational publication Pūao-te-Ata-Tū (Ministerial Advisory Committee on a Māori Perspective for the Department of Social Welfare, 1988), which was one of the first government publications to name and call out the harmful impacts of institutional racism. The article then examines the ways in which government health and disability sector organisations have talked about and responded to racism at a national level since 1980. The results of this research urge a stronger organisational-level approach to antiracism in the health and disability system for more tangible results, requiring multi-level solutions, and transforming what is considered ‘business as usual’ in health and disability sector institutions.

Objective: To describe the recent work of child psychiatrists in Australia, New Zealand (ANZ) and Papua New Guinea (PNG) adding to mental health capacity building across the life-span, starting with children and adolescents. Method: Concerns about treatment access and clinical training needs, combined with academic leadership and National Department of Health commitment, supported the collaborative involvement of the Royal Australian and New Zealand College of Psychiatry (RANZCP) in workforce development. This has been initially established under the auspices of the Faculty of Child and Adolescent Psychiatry (FCAP). Results: Workforce development in child and adolescent mental health is underway, with sustainability, consolidation and scaling up of initiatives required to meet need. Conclusions: Expanding mental health workforce capacity in partnership with the National Department of Health and the University of Papua New Guinea (UPNG) seems feasible. Ongoing cooperation is required to realize the potential of such collaborative initiatives.

Background. Healthline is one of the 39 free telehealth services that Whakarongorau Aotearoa/New Zealand Telehealth Services provides to New Zealanders. In early 2021, an image upload system for viewing service user-uploaded images was implemented into the Healthline service. Aims. The aim of this research was to understand the utilisation of Healthline’s image upload system by clinicians and service users in New Zealand. Methods. This is a retrospective observational study analysing Healthline image upload data over a two-year period: March 2021 through to December 2022. A total of 40,045 images were analysed, including demographics of the service users who uploaded an image: ethnicity, age group, and area of residence. The outcome or recommendation of the Healthline call was also assessed based on whether an image was included. Results. Images uploaded accounted for 6.0% of total Healthline calls (n=671,564). This research found that more service users were advised to go to an Emergency Department if they did not upload an image compared to service users who used the tool (13.5% vs. 7.7%), whereas a higher proportion of service users were given a lower acuity outcome if they included an image, including visiting an Urgent Care (24.0% vs. 16.9%) and GP (36.7% vs. 24.3%). Conclusion. Service users who did not upload an image had a higher proportion of Emergency Department outcomes than service users who did use the tool. This image upload tool has shown the potential to decrease stress on Emergency Departments around Aotearoa, New Zealand, through increased lower acuity outcomes.

Purpose Over the last decade there has been considerable debate about the merits of targets as a policy instrument. The purpose of this paper is to examine the implementation of two health targets that were cornerstones of New Zealand health policy between 2009 and 2012: immunisation rates for two-year-olds, and time to treatment, discharge or admission in hospital emergency departments. Design/methodology/approach For each policy target, the authors selected four case-study districts and conducted two waves of key-informant interviews (113 in total) with clinical and management staff involved in target implementation. Findings Despite almost identical levels of target achievement, the research reveals quite different mixes of positive and negative implementation consequences. The authors argue that the differences in implementation consequences are due to the characteristics of the performance measure; and the dynamics of the intra-organisational and inter-organisational implementation context. Research limitations/implications The research is based on interviews with clinical and management staff involved in target implementation, and this approach does not address the issue of effort substitution. Practical implications While literature on health targets pays attention to the attributes of target measures, the paper suggests that policymakers considering the use of targets pay more attention to broader implementation contexts, including the possible impact of, and effects on related services, organisations and staff. Originality/value The research focuses specifically on implementation consequences, as distinct from target success and/or changes in clinical and health outcomes. The paper also adopts a comparative approach to the study of target implementation.

Globally, there are significant inequalities and disparities in health service delivery to Indigenous populations, including Māori in Aotearoa/New Zealand. This study explored the experiences of adult Māori patients in the emergency department (ED) of a district health facility in New Zealand. Qualitative research exploring the ED experiences of Māori patients is limited. Two semistructured interviews with 4 Māori participants were conducted, audio-recorded, transcribed, and thematically analysed with the help of the Māori health department within the hospital. The participants identified 3 main areas of improvements relating to (a) the ED environment, (b) the interactions with healthcare professionals (HCPs), and (c) the unique factors faced by the kaumātua (Māori elders). The main conclusions were that aspects of the ED environment, including the room layout and lack of privacy, could negatively influence Maori ED experiences. In addition, HCPs not adequately integrating the Māori view of health in their clinical practice also had a negative influence. The kaumātua faced unique challenges, including the language barrier and lack of sufficient information from HCPs during their patient journey. Educating HCPs and making the ED environment more sensitive to Māori could improve their experience.

Nationalism: Past as Prologue began as a single volume being compiled by Ad Akande, a scholar from South Africa, who proposed it to me as co-author about two years ago. The original idea was to examine how the damaging roots of nationalism have been corroding political systems around the world, and creating dangerous obstacles for necessary international cooperation. Since I (Bruce E. Johansen) has written profusely about climate change (global warming, a.k.a. infrared forcing), I suggested a concerted effort in that direction. This is a worldwide existential threat that affects every living thing on Earth. It often compounds upon itself, so delays in reducing emissions of fossil fuels are shortening the amount of time remaining to eliminate the use of fossil fuels to preserve a livable planet. Nationalism often impedes solutions to this problem (among many others), as nations place their singular needs above the common good. Our initial proposal got around, and abstracts on many subjects arrived. Within a few weeks, we had enough good material for a 100,000-word book. The book then fattened to two moderate volumes and then to four two very hefty tomes. We tried several different titles as good submissions swelled. We also discovered that our best contributors were experts in their fields, which ranged the world. We settled on three stand-alone books:” 1/ nationalism and racial justice. Our first volume grew as the growth of Black Lives Matter following the brutal killing of George Floyd ignited protests over police brutality and other issues during 2020, following the police assassination of Floyd in Minneapolis. It is estimated that more people took part in protests of police brutality during the summer of 2020 than any other series of marches in United States history. This includes upheavals during the 1960s over racial issues and against the war in Southeast Asia (notably Vietnam). We choose a volume on racism because it is one of nationalism’s main motive forces. This volume provides a worldwide array of work on nationalism’s growth in various countries, usually by authors residing in them, or in the United States with ethnic ties to the nation being examined, often recent immigrants to the United States from them. Our roster of contributors comprises a small United Nations of insightful, well-written research and commentary from Indonesia, New Zealand, Australia, China, India, South Africa, France, Portugal, Estonia, Hungary, Russia, Poland, Kazakhstan, Georgia, and the United States. Volume 2 (this one) describes and analyzes nationalism, by country, around the world, except for the United States; and 3/material directly related to President Donald Trump, and the United States. The first volume is under consideration at the Texas A & M University Press. The other two are under contract to Nova Science Publishers (which includes social sciences). These three volumes may be used individually or as a set. Environmental material is taken up in appropriate places in each of the three books. * * * * * What became the United States of America has been strongly nationalist since the English of present-day Massachusetts and Jamestown first hit North America’s eastern shores. The country propelled itself across North America with the self-serving ideology of “manifest destiny” for four centuries before Donald Trump came along. Anyone who believes that a Trumpian affection for deportation of “illegals” is a new thing ought to take a look at immigration and deportation statistics in Adam Goodman’s The Deportation Machine: America’s Long History of Deporting Immigrants (Princeton University Press, 2020). Between 1920 and 2018, the United States deported 56.3 million people, compared with 51.7 million who were granted legal immigration status during the same dates. Nearly nine of ten deportees were Mexican (Nolan, 2020, 83). This kind of nationalism, has become an assassin of democracy as well as an impediment to solving global problems. Paul Krugman wrote in the New York Times (2019:A-25): that “In their 2018 book, How Democracies Die, the political scientists Steven Levitsky and Daniel Ziblatt documented how this process has played out in many countries, from Vladimir Putin’s Russia, to Recep Erdogan’s Turkey, to Viktor Orban’s Hungary. Add to these India’s Narendra Modi, China’s Xi Jinping, and the United States’ Donald Trump, among others. Bit by bit, the guardrails of democracy have been torn down, as institutions meant to serve the public became tools of ruling parties and self-serving ideologies, weaponized to punish and intimidate opposition parties’ opponents. On paper, these countries are still democracies; in practice, they have become one-party regimes….And it’s happening here [the United States] as we speak. If you are not worried about the future of American democracy, you aren’t paying attention” (Krugmam, 2019, A-25). We are reminded continuously that the late Carl Sagan, one of our most insightful scientific public intellectuals, had an interesting theory about highly developed civilizations. Given the number of stars and planets that must exist in the vast reaches of the universe, he said, there must be other highly developed and organized forms of life. Distance may keep us from making physical contact, but Sagan said that another reason we may never be on speaking terms with another intelligent race is (judging from our own example) could be their penchant for destroying themselves in relatively short order after reaching technological complexity. This book’s chapters, introduction, and conclusion examine the worldwide rise of partisan nationalism and the damage it has wrought on the worldwide pursuit of solutions for issues requiring worldwide scope, such scientific co-operation public health and others, mixing analysis of both. We use both historical description and analysis. This analysis concludes with a description of why we must avoid the isolating nature of nationalism that isolates people and encourages separation if we are to deal with issues of world-wide concern, and to maintain a sustainable, survivable Earth, placing the dominant political movement of our time against the Earth’s existential crises. Our contributors, all experts in their fields, each have assumed responsibility for a country, or two if they are related. This work entwines themes of worldwide concern with the political growth of nationalism because leaders with such a worldview are disinclined to co-operate internationally at a time when nations must find ways to solve common problems, such as the climate crisis. Inability to cooperate at this stage may doom everyone, eventually, to an overheated, stormy future plagued by droughts and deluges portending shortages of food and other essential commodities, meanwhile destroying large coastal urban areas because of rising sea levels. Future historians may look back at our time and wonder why as well as how our world succumbed to isolating nationalism at a time when time was so short for cooperative intervention which is crucial for survival of a sustainable earth. Pride in language and culture is salubrious to individuals’ sense of history and identity. Excess nationalism that prevents international co-operation on harmful worldwide maladies is quite another. As Pope Francis has pointed out: For all of our connectivity due to expansion of social media, ability to communicate can breed contempt as well as mutual trust. “For all our hyper-connectivity,” said Francis, “We witnessed a fragmentation that made it more difficult to resolve problems that affect us all” (Horowitz, 2020, A-12). The pope’s encyclical, titled “Brothers All,” also said: “The forces of myopic, extremist, resentful, and aggressive nationalism are on the rise.” The pope’s document also advocates support for migrants, as well as resistance to nationalist and tribal populism. Francis broadened his critique to the role of market capitalism, as well as nationalism has failed the peoples of the world when they need co-operation and solidarity in the face of the world-wide corona virus pandemic. Humankind needs to unite into “a new sense of the human family [Fratelli Tutti, “Brothers All”], that rejects war at all costs” (Pope, 2020, 6-A). Our journey takes us first to Russia, with the able eye and honed expertise of Richard D. Anderson, Jr. who teaches as UCLA and publishes on the subject of his chapter: “Putin, Russian identity, and Russia’s conduct at home and abroad.” Readers should find Dr. Anderson’s analysis fascinating because Vladimir Putin, the singular leader of Russian foreign and domestic policy these days (and perhaps for the rest of his life, given how malleable Russia’s Constitution has become) may be a short man physically, but has high ambitions. One of these involves restoring the old Russian (and Soviet) empire, which would involve re-subjugating a number of nations that broke off as the old order dissolved about 30 years ago. President (shall we say czar?) Putin also has international ambitions, notably by destabilizing the United States, where election meddling has become a specialty. The sight of Putin and U.S. president Donald Trump, two very rich men (Putin $70-$200 billion; Trump $2.5 billion), nuzzling in friendship would probably set Thomas Jefferson and Vladimir Lenin spinning in their graves. The road of history can take some unanticipated twists and turns. Consider Poland, from which we have an expert native analysis in chapter 2, Bartosz Hlebowicz, who is a Polish anthropologist and journalist. His piece is titled “Lawless and Unjust: How to Quickly Make Your Own Country a Puppet State Run by a Group of Hoodlums – the Hopeless Case of Poland (2015–2020).” When I visited Poland to teach and lecture twice between 2006 and 2008, most people seemed to be walking on air induced by freedom to conduct their own affairs to an unusual degree for a state usually squeezed between nationalists in Germany and Russia. What did the Poles then do in a couple of decades? Read Hlebowicz’ chapter and decide. It certainly isn’t soft-bellied liberalism. In Chapter 3, with Bruce E. Johansen, we visit China’s western provinces, the lands of Tibet as well as the Uighurs and other Muslims in the Xinjiang region, who would most assuredly resent being characterized as being possessed by the Chinese of the Han to the east. As a student of Native American history, I had never before thought of the Tibetans and Uighurs as Native peoples struggling against the Independence-minded peoples of a land that is called an adjunct of China on most of our maps. The random act of sitting next to a young woman on an Air India flight out of Hyderabad, bound for New Delhi taught me that the Tibetans had something to share with the Lakota, the Iroquois, and hundreds of other Native American states and nations in North America. Active resistance to Chinese rule lasted into the mid-nineteenth century, and continues today in a subversive manner, even in song, as I learned in 2018 when I acted as a foreign adjudicator on a Ph.D. dissertation by a Tibetan student at the University of Madras (in what is now in a city called Chennai), in southwestern India on resistance in song during Tibet’s recent history. Tibet is one of very few places on Earth where a young dissident can get shot to death for singing a song that troubles China’s Quest for Lebensraum. The situation in Xinjiang region, where close to a million Muslims have been interned in “reeducation” camps surrounded with brick walls and barbed wire. They sing, too. Come with us and hear the music. Back to Europe now, in Chapter 4, to Portugal and Spain, we find a break in the general pattern of nationalism. Portugal has been more progressive governmentally than most. Spain varies from a liberal majority to military coups, a pattern which has been exported to Latin America. A situation such as this can make use of the term “populism” problematic, because general usage in our time usually ties the word into a right-wing connotative straightjacket. “Populism” can be used to describe progressive (left-wing) insurgencies as well. José Pinto, who is native to Portugal and also researches and writes in Spanish as well as English, in “Populism in Portugal and Spain: a Real Neighbourhood?” provides insight into these historical paradoxes. Hungary shares some historical inclinations with Poland (above). Both emerged from Soviet dominance in an air of developing freedom and multicultural diversity after the Berlin Wall fell and the Soviet Union collapsed. Then, gradually at first, right wing-forces began to tighten up, stripping structures supporting popular freedom, from the courts, mass media, and other institutions. In Chapter 5, Bernard Tamas, in “From Youth Movement to Right-Liberal Wing Authoritarianism: The Rise of Fidesz and the Decline of Hungarian Democracy” puts the renewed growth of political and social repression into a context of worldwide nationalism. Tamas, an associate professor of political science at Valdosta State University, has been a postdoctoral fellow at Harvard University and a Fulbright scholar at the Central European University in Budapest, Hungary. His books include From Dissident to Party Politics: The Struggle for Democracy in Post-Communist Hungary (2007). Bear in mind that not everyone shares Orbán’s vision of what will make this nation great, again. On graffiti-covered walls in Budapest, Runes (traditional Hungarian script) has been found that read “Orbán is a motherfucker” (Mikanowski, 2019, 58). Also in Europe, in Chapter 6, Professor Ronan Le Coadic, of the University of Rennes, Rennes, France, in “Is There a Revival of French Nationalism?” Stating this title in the form of a question is quite appropriate because France’s nationalistic shift has built and ebbed several times during the last few decades. For a time after 2000, it came close to assuming the role of a substantial minority, only to ebb after that. In 2017, the candidate of the National Front reached the second round of the French presidential election. This was the second time this nationalist party reached the second round of the presidential election in the history of the Fifth Republic. In 2002, however, Jean-Marie Le Pen had only obtained 17.79% of the votes, while fifteen years later his daughter, Marine Le Pen, almost doubled her father's record, reaching 33.90% of the votes cast. Moreover, in the 2019 European elections, re-named Rassemblement National obtained the largest number of votes of all French political formations and can therefore boast of being "the leading party in France.” The brutality of oppressive nationalism may be expressed in personal relationships, such as child abuse. While Indonesia and Aotearoa [the Maoris’ name for New Zealand] hold very different ranks in the United Nations Human Development Programme assessments, where Indonesia is classified as a medium development country and Aotearoa New Zealand as a very high development country. In Chapter 7, “Domestic Violence Against Women in Indonesia and Aotearoa New Zealand: Making Sense of Differences and Similarities” co-authors, in Chapter 8, Mandy Morgan and Dr. Elli N. Hayati, from New Zealand and Indonesia respectively, found that despite their socio-economic differences, one in three women in each country experience physical or sexual intimate partner violence over their lifetime. In this chapter ther authors aim to deepen understandings of domestic violence through discussion of the socio-economic and demographic characteristics of theit countries to address domestic violence alongside studies of women’s attitudes to gender norms and experiences of intimate partner violence. One of the most surprising and upsetting scholarly journeys that a North American student may take involves Adolf Hitler’s comments on oppression of American Indians and Blacks as he imagined the construction of the Nazi state, a genesis of nationalism that is all but unknown in the United States of America, traced in this volume (Chapter 8) by co-editor Johansen. Beginning in Mein Kampf, during the 1920s, Hitler explicitly used the westward expansion of the United States across North America as a model and justification for Nazi conquest and anticipated colonization by Germans of what the Nazis called the “wild East” – the Slavic nations of Poland, the Baltic states, Ukraine, and Russia, most of which were under control of the Soviet Union. The Volga River (in Russia) was styled by Hitler as the Germans’ Mississippi, and covered wagons were readied for the German “manifest destiny” of imprisoning, eradicating, and replacing peoples the Nazis deemed inferior, all with direct references to events in North America during the previous century. At the same time, with no sense of contradiction, the Nazis partook of a long-standing German romanticism of Native Americans. One of Goebbels’ less propitious schemes was to confer honorary Aryan status on Native American tribes, in the hope that they would rise up against their oppressors. U.S. racial attitudes were “evidence [to the Nazis] that America was evolving in the right direction, despite its specious rhetoric about equality.” Ming Xie, originally from Beijing, in the People’s Republic of China, in Chapter 9, “News Coverage and Public Perceptions of the Social Credit System in China,” writes that The State Council of China in 2014 announced “that a nationwide social credit system would be established” in China. “Under this system, individuals, private companies, social organizations, and governmental agencies are assigned a score which will be calculated based on their trustworthiness and daily actions such as transaction history, professional conduct, obedience to law, corruption, tax evasion, and academic plagiarism.” The “nationalism” in this case is that of the state over the individual. China has 1.4 billion people; this system takes their measure for the purpose of state control. Once fully operational, control will be more subtle. People who are subject to it, through modern technology (most often smart phones) will prompt many people to self-censor. Orwell, modernized, might write: “Your smart phone is watching you.” Ming Xie holds two Ph.Ds, one in Public Administration from University of Nebraska at Omaha and another in Cultural Anthropology from the Chinese Academy of Social Sciences, Beijing, where she also worked for more than 10 years at a national think tank in the same institution. While there she summarized news from non-Chinese sources for senior members of the Chinese Communist Party. Ming is presently an assistant professor at the Department of Political Science and Criminal Justice, West Texas A&M University. In Chapter 10, analyzing native peoples and nationhood, Barbara Alice Mann, Professor of Honours at the University of Toledo, in “Divide, et Impera: The Self-Genocide Game” details ways in which European-American invaders deprive the conquered of their sense of nationhood as part of a subjugation system that amounts to genocide, rubbing out their languages and cultures -- and ultimately forcing the native peoples to assimilate on their own, for survival in a culture that is foreign to them. Mann is one of Native American Studies’ most acute critics of conquests’ contradictions, and an author who retrieves Native history with a powerful sense of voice and purpose, having authored roughly a dozen books and numerous book chapters, among many other works, who has traveled around the world lecturing and publishing on many subjects. Nalanda Roy and S. Mae Pedron in Chapter 11, “Understanding the Face of Humanity: The Rohingya Genocide.” describe one of the largest forced migrations in the history of the human race, the removal of 700,000 to 800,000 Muslims from Buddhist Myanmar to Bangladesh, which itself is already one of the most crowded and impoverished nations on Earth. With about 150 million people packed into an area the size of Nebraska and Iowa (population less than a tenth that of Bangladesh, a country that is losing land steadily to rising sea levels and erosion of the Ganges river delta. The Rohingyas’ refugee camp has been squeezed onto a gigantic, eroding, muddy slope that contains nearly no vegetation. However, Bangladesh is majority Muslim, so while the Rohingya may starve, they won’t be shot to death by marauding armies. Both authors of this exquisite (and excruciating) account teach at Georgia Southern University in Savannah, Georgia, Roy as an associate professor of International Studies and Asian politics, and Pedron as a graduate student; Roy originally hails from very eastern India, close to both Myanmar and Bangladesh, so he has special insight into the context of one of the most brutal genocides of our time, or any other. This is our case describing the problems that nationalism has and will pose for the sustainability of the Earth as our little blue-and-green orb becomes more crowded over time. The old ways, in which national arguments often end in devastating wars, are obsolete, given that the Earth and all the people, plants, and other animals that it sustains are faced with the existential threat of a climate crisis that within two centuries, more or less, will flood large parts of coastal cities, and endanger many species of plants and animals. To survive, we must listen to the Earth, and observe her travails, because they are increasingly our own.

Abstract EThis chapter discusses interpersonal psychotherapy (IPT) in New Zealand. New Zealand has both private and publicly funded health services, with the majority of healthcare accessed through the public sector. The Health and Disability Commission NZ (HDCNZ) reported that 1 in 5 New Zealanders experience mental health issues, increasing to almost 1 in 3 for Maori, with the most prevalent disorders being mood disorders, anxiety, mental distress, eating disorders, addictions, post-traumatic stress disorder (PTSD), and schizophrenia. This means there is an ever-increasing need to provide effective and efficient mental health services, including evidenced-based talking therapies. IPT research and training initially developed at the Department of Psychological Medicine, University of Otago, Christchurch, in the South Island of New Zealand under the leadership of Professor Peter Joyce in the mid-1990s after Professor Chris Fairburn ran a training workshop. Since then, there have been a number of successful studies that have used IPT and adaptations of IPT and interpersonal social rhythm therapy (IPSRT) to inform clinical practice. The chapter then considers a cultural adaptation of IPT for Māori, the indigenous culture of New Zealand.

The role of the occupational physician, and relationships with employers and insurers. New Zealand’s Accident Compensation Commission and its role as a state insurer. The need for system change in order not only to prevent health and disability but to improve people’s health. Case example showing the role of the health and safety manager and the effect of the sick note on return to work. The views of the chair of Council of the Royal College of General Practitioners (RCGP) on the relationship between GP and patient. The conflict of interest between GPs and occupational physicians. Author’s research to elucidate the problem, working with the Trades Union Congress and the Department for Work and Pensions, resulting in a consensus statement and editorial in The BMJ. Author’s work on the Policy and Advocacy Committee of the Australasian Faculty of Occupational and Environmental Medicine of the Royal Australasian College of Physicians. Launch of position statement, ‘Realising the Health Benefits of Work’, in 2010. Work with Helen Kelly, President of the New Zealand Council of Trade Unions, and the concept of ‘good work’. Dame Carol Black and the Black Review, Working for a Healthier Tomorrow. The constraint of short appointment times for GPs in the UK: RCGP’s aim to increase appointment times from the current 10 minutes to 15 minutes by 2030.

Introduction: According to estimates from the Brazilian Department of Health, in 2021 we will see more than 65,000 cases of breast cancer in Brazil. The predominance of advanced cases in the Brazilian Unified Health System (SUS) stems from the long time for diagnosis and treatment of patients and, consequently, leads to a higher mortality rate. There is a lack of data on the age of our patients to establish an adequate coping strategy for the disease and thus reduce mortality in our country. The Department of Health recommends mammography from the age of 50. The Brazilian Society of Mastology (SBM), on the other hand, recommends exams starting at 40. Before that, only for groups at risk. In 2018, there were 2,1 million new cases, equivalent to 11.6% of all estimated cancers. This value corresponds to an estimated risk of 55.2/100 thousand. The highest expected incidence rates were in Australia and New Zealand, in Northern European countries and in Western Europe. Regardless of the country’s socioeconomic situation, the incidence of this cancer ranks among the top positions for female malignancies. On the other hand, there has been a decline in the trend of incidence rates in some developed countries, partly linked to the decrease in hormone replacement therapy in postmenopausal women. Objectives: This paper aims to describe treatment of breast cancer according the age group of 11,323 women by SUS at Pérola Byington Hospital from January 2011 to December 2019. Methods: A hospital-based observational crosssectional study was carried out, in which the eligible population consisted of 11,323 patients with breast cancer treated by SUS at Pérola Byington Hospital whose data was registered in the data collection system of that hospital. Women under the age of 20 years up to over 80 years were selected. Results: A predominance of the diagnosis was observed in women aged 50 to 59 years (27.91%), followed by patients aged 40 to 49 years (23.90%) and by patients aged 60 to 69 years (22.26%). Women under the age of 20 were diagnosed in 0.06% of cases and over 80 years of age in 4.75%. Conclusions: The diagnosis of breast cancer in women under 40 years of age is rare, representing around 10% of all registered cases. But, when it occurs in this age group, the disease tends to be more aggressive, raising a question of from what age the screening test should be performed.

This research presents a virtual reality simulator for total hip replacement surgery. The simulator supports a library of 3D hip stem models for different sizes and manufacturers. The 3D hip stems can be adjusted in size and shape by parametric software and sent for 3D printing. Biocompatible materials such as titanium enable the 3D printed stems to be directly implanted on patients. Currently surgical simulation for orthopaedic procedures is not as advanced as other surgical disciplines. As a result there are only limited training simulators available for orthopaedic surgery such as total hip replacement, hip resurfacing or knee replacement. This is demanding since 66,000 hip replacements are performed annually in the UK. One area which is neglected in VR orthopaedic simulation is the digital library generation of implants. Currently orthopaedic surgeons have limited choice in terms of an exact identification of implant specific to patient requirements. We conducted a literature review of orthopaedic training simulators which found no simulators catering for this [9]. Orthopaedic surgeons generally have a positive opinion for the use of virtual reality (VR) training systems. A survey amongst all orthopaedic surgeons in New Zealand found that 77% of qualified surgeons believe simulation is effective for practicing and learning surgical procedures [1]. A separate review from the American Academy of Orthopaedic Surgeons (AAOS) showed that over 80% agreed that surgical skills simulations should become a required part of orthopaedic training, based on views from 185 program directors and 4549 residents. There was a strong agreement that simulation technology should be a required component of orthopaedic resident training [2]. The hip replacement procedure has been considered as the most successful and influential orthopaedic surgery of the twentieth century. Currently over 66,000 total hip replacements (THR) are performed each year in England and Wales by the National Health Service (NHS) and around 75,000 hip fractures are treated each year in the UK. Knee arthroscopy has increased 49% from 1996–2006 and now over 1 million are performed each year [3]. Each year there are an increasing number of orthopaedic procedures due to the aging population. Currently 247,000 hip fractures occur yearly in the United States, with the majority occurring in the population over 45 years old [4]. The incidence of hip fracture is also on the rise, partly due to the aging population, with over half a million hip fractures annually expected by 2040. The cost of these fractures is also expected to rise from $7 billion per year [4], to nearly $16 billion per year by 2040 [5]. Each hip fracture is estimated at costing between $39,555 and $40,600 in the first year after surgery [6]. Hip fractures have the highest cost of any orthopaedic procedure after surgery, and also incur $11,241 each year following surgery in extra health costs. Due to increased life expectancy, worldwide by 2050, it is projected that 6.26 million hip fractures will occur annually [7]. A paradigm shift is underway toward use of surgical training simulations [8]. The conventional master-apprentice learning model for surgical training of ‘see one, do one, teach one’ has recently been seen as inefficient. Due to orthopaedics being heavily dependent on technical skill, orthopaedic VR simulation holds potential to have great impact for improving surgical skill. The transition to VR simulation is relatively new compared to cadaver training which has been the gold standard for several centuries.