Consensus statement: New Zealand guidelines for the detection and management of nephropathy in diabetes. New Zealand Society for the Study of Diabetes.
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New Zealand Obese (NZO) mice exhibit a polygenic syndrome of hyperphagia, obesity, hyperinsulinemia, and hyperglycemia similar to that observed in young diabetes mutant mice on the C57BLKS/J background (C57BLKS/J-Lepr(db)/Lepr(db)). Here we show that in NZO this syndrome is accompanied by a marked elevation of the leptin protein in adipose tissue and serum. The promoter region and the complementary DNA of the ob gene of NZO mice, including its 5'-untranslated region, are identical with the wild-type sequence (C57BL, BALB/c), except that the transcription start is located 5 bp upstream of the reported site. In contrast to C57BLKS/J+/+ and C57BL/6J-Lep(ob)/Lep(ob) mice, NZO mice failed to respond to recombinant leptin (7.2 microg/g) with a reduction of food intake. Leptin receptor messenger RNA as detected by PCR appears as abundant in hypothalamic tissue of NZO mice as in tissue from lean mice. Ten nucleotide polymorphisms are found in the complementary DNA of the leptin receptor, resulting in two conservative substitutions (V541I and V651I) in the extracellular part of the receptor and one nonconservative substitution (T1044I) in the intracellular domain between the presumed Jak and STAT binding boxes. However, these mutations are also present in the related lean New Zealand Black strain (body fat at 9 weeks: New Zealand Black, 6.2 +/- 1.3%; NZO, 17.0 +/- 1.7%). Thus, the polymorphic leptin receptor seems to play only a minor, if any, role in the obesity and hyperleptinemia of the NZO mouse. It is suggested that the main defect in NZO is located distal from the leptin receptor or at the level of leptin transport into the central nervous system.
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Most New Zealand soils contain relatively low concentrations of the anionic trace elements F, I and Se. Some areas of Australia also have a history of I deficiency. In view of current interest in establishing nutrient reference intakes for Se and I in New Zealand and Australia, it is timely to review current understanding of the intakes and status of these two elements. In spite of a recent increase in Se status, the status of New Zealanders remains low compared with populations of many other countries and may still be considered marginal, although the clinical consequences of the marginal Se status are unclear. There are no recent reports of blood Se levels in Australia, but earlier reports indicate that they were generally greater than those of New Zealanders. Similarly, the consequences of decreasing I status in Australia and New Zealand are unclear. Mild I deficiency in New Zealand has resulted in enlarged thyroid glands indicating an increased risk of goitre. Currently there is little evidence, however, of any associated clinical disease. Public health recommendations to reduce salt intake, together with the reduction in I content of dairy products, are likely to result in further decreases in the I status of New Zealand and Australian residents. Some action is needed to prevent this decline and it may be necessary to consider other means of fortification than iodized salt. The consequences of possible interactions between Se and I in human nutrition are also unclear and no practical recommendations can be made.
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AIMS: (1) To describe New Zealand's primary care system (2) to compare New Zealand to other Anglo-American members of the OECD with respect to the adequacy of primary care, and (3) to assess the cost-efficiency and effectiveness of New Zealand's system by comparing health spending and health indicators relevant to primary care. METHOD: A cross-national comparison of primary care, health spending and health indicators in New Zealand, Australia, Canada, the United Kingdom and the United States of America. Main outcome measures were health spending measured in purchasing power parties. Health indicators: mean life expectancy in years, years of potential life lost and infant mortality rates. RESULTS: New Zealand's primary care system ranked below the UK, above the USA and similar to Canada and Australia. Favourable characteristics of New Zealand's primary care system were the use of generalists as the predominant type of practitioner and the low proportion of active physicians who were specialists. Compared to the other countries, New Zealand scored poorly for financial that are necessary for the practise of good primary care. New Zealand and the UK had the lowest spending per capita on health care. New Zealand and the USA scored lowest for all three of the health care indicators. CONCLUSIONS: The quality of primary care in New Zealand is limited by barriers to access to care and the intermediate level of practise characteristics essential to primary care. Compared to other AngloAmerican OECD nations, New Zealand has relatively low levels of national health expenditure. In order to improve the quality of primary care, future reform should aim to facilitate access to care, increase the gatekeeping role of primary care physicians, and promote the practise characteristics essential to primary care.
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Surgery in New Zealand is performed by more than 500 surgeons who serve a population of 3.8 million people. Most of the surgeons are trained in New Zealand under the auspices of the Royal Australasian College of Surgeons. Surgical services are consistent with the highest standards of Western countries.
Trauma in New Zealand is modest in extent in relation to many other areas of the world. Trauma care is delivered in the context of an ad hoc trauma system which nevertheless seems to function reasonably well. Current funding strictures in the short term seem likely to prevent formal adoption of a trauma system which would have the prospect of providing information determining the real quality of trauma care in New Zealand.
Previous New Zealand case-control studies have found increased risk for leukaemia, non-Hodgkin's lymphoma (NHL) and multiple myeloma in farmers. We report here a further series of New Zealand Cancer Registry based case-control studies of farming and site-specific cancer risks. These involved 19,904 males aged 20 years or more who were registered with cancer between 1980 and 1984. For each cancer site, the registrations for other sites formed the control group. Farmers had elevated risks for malignant melanoma (Odds Ratio [OR] = 1.25, 95% confidence interval [Cl] 1.05-1.50), and for cancer of the lip (OR = 2.43, 95% Cl 1.81-3.27), rectum (OR = 1.19, 95% Cl 1.03-1.38), bone (OR = 1.95, 95% Cl 1.00-3.80), prostate (OR = 1.26, 95% Cl 1.13-1.41) and brain (OR = 1.34, 95% Cl 1.04-1.74). Decreased risks were observed for cancer of the larynx (OR = 0.66, 95% Cl 0.45-0.96), lung (OR = 0.70, 95% Cl 0.63-0.77) and testis (OR = 0.58, 95% Cl 0.39-0.88). Livestock farmers had a relatively high risk for brain cancer, while the risk for cancer of the lip was highest among dairy farmers. Farmers also had increased risks for cancer of the lymphatic and haematopoietic system (International Classification of Disease 9th edn (ICD) 200-208) (OR = 1.24, 95% Cl 1.08-1.42), leukaemia (OR = 1.24, 95% Cl 0.99-1.55) and non-Hodgkin's lymphoma (NHL) (OR = 1.24, 95% Cl 0.99-1.56), as described previously.
The New Zealand School Dental Service provides dental care for children 2 1/2-13 yr of age, without using routine diagnostic radiographs. This study investigated the pattern of dental X-ray exposure in groups of New Zealand children. One group consisted of 100 children who had all treatment before the age of 13 years with the School Dental Service. The other group consisted of 82 children who were treated in the University of Otago School of Dentistry paedodontic programme. Children in both groups turned 13 years of age between 1977 and 1982. From age 13 years these children were cared for by contracting dentists. Radiographic histories were recorded from School of Dentistry charts, and from the area Principal Dental Officer. Cumulative radiation doses were calculated. Surfaces restored at age 13 were noted from Department of Health records. Results show that by age 13 children enrolled in the School of Dentistry paedodontic programme received a mean cumulative skin dose of 23.03 mSv. Thyroid dose was 0.242 mSv. Children treated in the School Dental Service received a mean cumulative skin dose of 1.01 mSv and a thyroid dose of 0.006 mSv. Cumulative radiation dose for both groups was low. There was no significant difference in the mean number of restorations placed at age 13 years despite an extremely low level of diagnostic radiography in the School Dental Service group.
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