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PubMed2000

Asthma in New Zealand: myths and realities.

Asthma is a major health problem in New Zealand, generating large costs to the health services and industry. However, there are several myths concerning asthma in New Zealand. These are that it is more common and more severe in New Zealand than in the rest of the world, that it is more common in rural areas and that asthma mortality in New Zealand is the highest in the world. Using recently published data, it is now possible to show that none of these "facts" is true. In fact, asthma in New Zealand appears to have a prevalence and severity similar to those of the other major English-speaking countries and in this respect can be thought of as being first equal in the world. The relevance of correcting these myths is that they could influence future research. Previous research into the causes of asthma has sometimes focused on factors unique to New Zealand in an attempt to explain the increasing prevalence of asthma around the world. It may be more productive to direct future research towards identifying factors that the major English-speaking countries have in common.

Adolescent↗
PubMed2003

[A study of susceptibility genes mapping for aberrant B1 cell proliferation in New Zealand mice].

OBJECTIVE: To map the susceptibility genes for aberrant B1 cell proliferation in New Zealand mice. METHODS: New Zealand Black (NZB) x New Zealand White (NZW) F1 x NZW backcross mice model was set up and polymorphic microsatellite markers and quantitative trait locus (QTL) analysis was used. RESULTS: Susceptibility genes of aberrant B1 cell proliferation was linked to the microsatellite markers on chromosome 1, 4, 19 in NZB and on chromosome 17 in NZW such as D1Mit115, D4Mit58, D19Mit73 and D17Mit61 nearby which there existed Fcgr2b, c-jun, Fas and tumor necrosis factor (TNF)alpha, H-2 genes according to the QTL analysis. CONCLUSION: B1 cell proliferation in New Zealand mice was controlled by multiple genes and the candidate susceptibility genes were Fcgr2b, c-jun, Fas derived from NZB strain and TNF alpha, H-2 genes derived from NZW strain.

Animals↗
PubMed1986

Asthma mortality: comparison between New Zealand and England.

Causes for the high mortality from asthma in New Zealand were investigated by comparing deaths from asthma in caucasian subjects aged 15-64 in New Zealand with those from asthma in the same age group in two regions in England. There were no significant differences in the accuracy of death certification. The verified asthma mortality in New Zealand (4.2/100,000) was over twice that in England. Many characteristics of patients and management, including poor compliance with treatment and deficiencies in long term and emergency care, were qualitatively similar in the two countries. New Zealand had an apparently higher rate of non-preventable deaths from asthma, suggesting a greater severity of asthma in New Zealand. In both countries, however, most deaths were associated with poor assessment, underestimation of severity and inappropriate treatment (over-reliance on bronchodilators and underuse of systemic corticosteroids), and delays in obtaining help. A greater frequency of some of these deficiencies in management remains a possible additional explanation for part of the excess mortality in New Zealand.

Adolescent↗
PubMed1992

Incidence of cancer among Pacific Island people in New Zealand.

AIM: to describe the epidemiology of new cancer registrations among Pacific Island people in New Zealand with a view to identifying important cancers for preventive activities. METHODS: new cancer cases registered with the New Zealand Cancer Registry of the Health Statistical Services for the decade 1979-88 were analysed. Cancer cases among Pacific Island people were compared with cancer cases among Maori and the remainder of the New Zealand population (other). RESULTS: while the number of cases reported among Pacific Island people was relatively small (1884), age standardised rates for cancer of all sites were much higher than age standardised rates for Maori and other populations. The age standardised rate (per 100,000 person years) for cancer of all sites among males in all age groups was 400 for Pacific Island, 308.8 for Maori and 295.3 for others. The age standardised rate for cancer of all sites among women in all age groups was 373.3 for Pacific Island women, 324.2 for Maori and 313.4 for other women. Liver cancer was more common among Pacific Island men than could be explained by temporary migration from the Pacific Islands for treatment. The age standardised rate for liver cancer was 28.2 for Pacific Island men, 11.4 for Maori and 1.9 for other men. Cancer of the cervix was the leading site among Pacific Island women as in Maori women, compared with breast cancer among women in the rest of the population. The age standardised rate for cervical cancer was 61.8 for Pacific Island, 69.0 for Maori and 59.3 for other women. CONCLUSION: in the decade 1979-88 there was an excess number of new registrations for some cancers described among Pacific Island people compared with Maori and other ethnic groups. Temporary migration from the Pacific Islands for treatment may explain some of the excess cases.

Adolescent↗
PubMed2005

Pharmacy-based needle exchange in New Zealand: a review of services.

BACKGROUND: New Zealand has been offering needle exchange services since 1987. Over 170 community pharmacies are involved in the provision of this service. However, no recent detailed review of New Zealand's pharmacy-based needle exchange has been published. This study aimed to explore service provision, identify problems faced by pharmacists, and look for improvements to services. METHODS: The study used a cross-sectional survey of all needle exchange pharmacies. Postal questionnaires were used with postal and telephone follow-up. RESULTS: A response rate of 88% was obtained overall. Pharmacists had been providing the service for a mean of 6 years. Pharmacies had given out an average of 130 injecting units, in a mean of 62 transactions to a mean of 17 clients in the 4 weeks prior to completing the questionnaire. The majority had not incurred problems such as violence or intoxicated clients in the last 12 months, although almost one third had experienced shoplifting which they associated with service provision. Training and improving return rates were identified as potential areas for further development. CONCLUSION: New Zealand needle exchange pharmacies are providing services to a number of clients. The majority of service providers had been involved for a number of years, indicating the problems incurred had not caused them to withdraw their services--findings which echo those from the UK. Further training and support, including an exploration of improving return rates may be needed in the future.

Journal Article↗
PubMed1997

Vaccine adverse events reported in New Zealand 1990-5.

AIM: New Zealand monitors vaccine safety through vaccinator reports of adverse events following immunisation. The rate of reporting for the commonly used vaccines during 1990-5 are presented. During this time new vaccines were added to the immunisation schedule, enabling comparison of reporting rates. METHOD: The number of events were obtained from the CARM database and a rate calculated based on estimated vaccine use. RESULTS: Injection site reaction with adult tetanus-diphtheria vaccine was most commonly reported (68/100,000); a rate five times higher than with tetanus vaccine. There were also more reported reactions from diphtheria-tetanus-pertussis-Haemophilus influenzae type b (DTPH) than DTP vaccine, with 'abnormal crying' the commonest reaction reported after 29/100,000 doses of DTPH and 3/100,000 doses of DTP. The next commonest reaction for DTPH was injection site reaction (25/100,000) which compares to 17/100,000 doses of DTP. For the other inactivated vaccines, more reports were made for fever following Hib (16/100,000), than for hepatitis B (2/100,000) or influenza (1/100,000). The most common reports following measles-mumps-rubella (MMR) vaccine were rash (17/100,000), fever (12/100,000), and injection site inflammation (5/100,000). There were very few reports following polio vaccine, with rash, fever and headache all reported at less than 1/100,000 doses. CONCLUSION: Although only a proportion of events are reported, the picture presented here confirms the overall safety of vaccines and the value of the adverse event monitoring system. Monitoring vaccine adverse events is an essential part of the immunisation programme.

Adult↗
PubMed2004

Epigenetic events and protection from colon cancer in New Zealand.

The incidence of colon cancer is high in many developed nations, especially New Zealand. Molecular understanding of the nature of colon cancer shows a disease whose well-characterized morphological progression is paralleled at the cellular level by increased numbers of gene or chromosome mutations, loss of heterozygosity, changed methylation patterns, and genomic instability. In the present study, we consider whether an imbalance of factors that affect DNA methylation patterns might explain at least part of the high colon cancer incidence in New Zealand. Folate is the major micronutrient whose intake impacts methylation, particularly through interaction with choline and methionine. Folate is generally somewhat deficient in the New Zealand diet, with the voluntary addition of folate to white flour not producing desired levels. Selenium affects methylation status in several ways and is recognized as being low in New Zealand soils and, therefore, diet. Zinc is also low in the diets of some New Zealand population groups, which can lead to hypomethylation. Several of the components of fruits and vegetables affect methylation patterns, and the average New Zealand intake, at two to three servings per day, is considerably below recommended amounts. Low dietary fiber, high tobacco use, and increasing rates of obesity are also likely New Zealand risk factors that may impact on methylation status. Dietary supplementation is not as common in New Zealand as in countries such as the United States, but may provide a way to raise the levels of nutrients and phytochemicals affecting methylation status, thereby enhancing colon cancer protection.

Alcohol Drinking↗
PubMed1976

The need to train anaesthetists in New Zealand.

A survey of New Zealand public hospitals undertaken at the end of 1974 shows that the country is training half the number of anaesthetists to maintain the public hospital-based anaesthetic services. There is a need to develop and expand training programmes for anaesthetists. New graduates can be assured that there are career prospects in the specialty.

Anesthesiology↗
PubMed2001

Drowning-related deaths in New Zealand, 1980-94.

OBJECTIVE: To describe the epidemiology of drowning in New Zealand for the period 1980-94. METHODS: Drowning-related incidents were identified by linking New Zealand Health Information Service and Water Safety New Zealand databases. RESULTS: 2,606 drowning-related incidents were identified. In three-quarters of the incidents, drowning was listed as the immediate cause of death. The majority of drownings were unintentional (85%), involved males (76%), and 0-4 and 15-24 year age groups had the highest rates. Boating was the leading cause of unintentional drowning (28%) followed by swimming and other water sports (19%), motor vehicle drownings (13%) and falls or slips (12%). CONCLUSIONS AND IMPLICATIONS: Although there has been a significant decline in drownings, New Zealand compares poorly internationally. In particular, our unintentional drowning rate is twice that of Australia. For New Zealand to continue to make substantial progress in addressing its overall drowning rate, we need to continue and strengthen our efforts in priority areas, in particular those due to motor vehicle crashes and boating and among pre-schoolers, adolescents and young adults. Motor vehicle traffic crashes warrant closer attention than has been the case to date.

Accidents↗
PubMed2005

General practice and the New Zealand health reforms--lessons for Australia?

New Zealand's health sector has undergone three significant restructures within 10 years. The most recent has involved a Primary Health Care Strategy, launched in 2001. Primary Health Organisations (PHOs), administered by 21 District Health Boards, are the local structures for implementing the Primary Health Care Strategy. Ninety-three percent of the New Zealand population is now enrolled within 79 PHOs, which pose a challenge to the well-established Independent Practitioner Associations (IPAs). Although there was initial widespread support for the philosophy underlying the Primary Health Care Strategy, there are concerns amongst general practitioners (GPs) and their professional organisations relating to its implementation. These centre around 6 main issues: 1. Loss of autonomy, 2. Inadequate management funding and support, 3. Inconsistency and variations in contracting processes, 4. Lack of publicity and advice around enrollment issues, 5. Workforce and workload issues, 6. Financial risks. On the other hand, many GPs are feeling positive regarding the opportunities for PHOs, particularly for being involved in the provision of a wider range of community health services. Australia has much to learn from New Zealand's latest health sector and primary health care reforms. The key lessons concern: The need for a national primary health care strategy, active engagement of general practitioners and their professional organisations, recognition of implementation costs, the need for infrastructural support, including information technology and quality systems, robust management and governance arrangements, issues related to critical mass and population/distance trade offs in service delivery models.

Journal Article↗
PubMed2001

Molecular epidemiology of 'Norwalk-like viruses' associated with gastroenteritis outbreaks in New Zealand.

Outbreaks of gastroenteritis are a major public health problem in New Zealand. The introduction of molecular detection methods has now shown that the 'Norwalk-like viruses' (NLVs) are the major cause of food and waterborne nonbacterial gastroenteritis. Reverse transcription and polymerase chain reaction (RT-PCR) were used to determine the presence of NLVs in faecal specimens from 83 nonbacterial gastroenteritis outbreaks occurring in New Zealand between August 1995 and July 1999. Further characterisation of the NLVs for epidemiological purposes was carried out by dot blot DNA hybridisation and DNA sequencing of representative outbreak strains. The majority of NLV strains occurring in New Zealand since August 1995 are similar to those occurring overseas. The predominant New Zealand strain is genetically similar to the Bristol/Lordsdale virus group. Several New Zealand outbreaks were attributed to Auckland virus, a Mexico-like NLV strain identified as the most likely cause of gastroenteritis after consumption of contaminated oysters in 1994. A new strain, designated Napier virus, has been identified in six outbreaks since 1996. A number of strains closely resembling internationally recognised strains, including Southampton virus, Saratoga virus; Desert Shield virus and Melksham virus have been associated with gastroenteritis outbreaks across New Zealand. Application of these typing methods has provided information on disease transmission for epidemiological investigations of public health significance.

Amino Acid Sequence↗
PubMed2006

Trends in absolute socioeconomic inequalities in mortality in Sweden and New Zealand. A 20-year gender perspective.

BACKGROUND: Both trends in socioeconomic inequalities in mortality, and cross-country comparisons, may give more information about the causes of health inequalities. We analysed trends in socioeconomic differentials by mortality from early 1980s to late 1990s, comparing Sweden with New Zealand. METHODS: The New Zealand Census Mortality Study (NZCMS) consisting of over 2 million individuals and the Swedish Survey of Living Conditions (ULF) comprising over 100, 000 individuals were used for analyses. Education and household income were used as measures of socioeconomic position (SEP). The slope index of inequality (SII) was calculated to estimate absolute inequalities in mortality. Analyses were based on 3-5 year follow-up and limited to individuals aged 25-77 years. Age standardised mortality rates were calculated using the European population standard. RESULTS: Absolute inequalities in mortality on average over the 1980s and 1990s for both men and women by education were similar in Sweden and New Zealand, but by income were greater in Sweden. Comparing trends in absolute inequalities over the 1980s and 1990s, men's absolute inequalities by education decreased by 66% in Sweden and by 17% in New Zealand (p for trend <0.01 in both countries). Women's absolute inequalities by education decreased by 19% in Sweden (p = 0.03) and by 8% in New Zealand (p = 0.53). Men's absolute inequalities by income decreased by 51% in Sweden (p for trend = 0.06), but increased by 16% in New Zealand (p = 0.13). Women's absolute inequalities by income increased in both countries: 12% in Sweden (p = 0.03) and 21% in New Zealand (p = 0.04). CONCLUSION: Trends in socioeconomic inequalities in mortality were clearly most favourable for men in Sweden. Trends also seemed to be more favourable for men than women in New Zealand. Assuming the trends in male inequalities in Sweden were not a statistical chance finding, it is not clear what the substantive reason(s) was for the pronounced decrease. Further gender comparisons are required.

Adult↗
PubMed2006

The role of the Therapeutic Goods Administration and the Medicine and Medical Devices Safety Authority in evaluating complementary and alternative medicines in Australia and New Zealand.

Currently, the regulation of complementary and alternative medicines and related health claims in Australia and New Zealand is managed in a number of ways. Complementary medicines, including herbal, minerals, nutritional/dietary supplements, aromatherapy oils and homeopathic medicines are regulated under therapeutic goods/products legislation. The Therapeutic Goods Administration (TGA), a division of the Commonwealth Department of Health and Ageing is responsible for administering the provisions of the legislation in Australia. The New Zealand Medicines and Medical Devices Safety Authority (Medsafe) administers the provision of legislation in New Zealand. In December 2003 the Australian and New Zealand governments signed a Treaty to establish a single, bi-national agency to regulate therapeutic products, including medical devices prescription, over-the-counter and complementary medicines. A single agency will replace the Australian TGA and the New Zealand Medsafe. The role of the new agency will be to safeguard public health through regulation of the quality, safety and efficacy or performance of therapeutic products in both Australia and New Zealand. The major activities of the new joint Australia New Zealand therapeutic products agency are in product licensing, specifying labelling standards and setting the advertising scheme, together with determining the risk classes of medicines and creating an expanded list of ingredients permitted in Class I medicines. A new, expanded definition of complementary medicines is proposed and this definition is currently under consultation. Related Australian and New Zealand legislation is being developed to implement the joint scheme. Once this legislation is passed, the Treaty will come into force and the new joint regulatory scheme will begin. The agency is expected to commence operation no later than 1 July 2006 and will result in a single agency to regulate complementary and alternative medicines.

Australia↗
PubMed1976

Increased survival times of New Zealand hybrid mice immunosuppressed by graft-versus-host reactions.

New Zealand mice develop autoimmune disease usually accompanied by glomerulonephritis. A graft-versus-host reaction was induced in New Zealand Black X New Zealand White F1 hybrid mice by administration of New Zealand White spleen cells. The mice so treated had diminished antibody responses to both an exogenous antigen (sheep red blood cells) and an endogenous antigen (native DNA). They had much less glomerulonephritis and increased survival times compared to unmanipulated controls, apparently due to immunosuppression. Similar hybrid mice treated with high doses of cyclophosphamide (70mg/kg/week) were more immunosuppressed than mice with graft-versus-host reactions and had even greater survival times.

Animals↗
PubMed1994

Specialist training and examinations in anaesthesia and intensive care in Australia and New Zealand.

The Australian and New Zealand College of Anaesthetists approves specialist training positions and requires specified periods of training in anaesthesia and intensive care. A common Primary examination in basic sciences is used by both specialties. The Final examinations are different in content although structurally similar with both written and oral sections. The College Assessor reviews training prior to granting approval to present for the Final examination. The syllabus for the Final examination is based on two College documents entitled Objectives of Training, one for anaesthesia and one for intensive care. Other requirements and anticipated future changes to the present training, examination and recertification systems include examination review, in-training assessment, a formal project, a new pain management qualification and a maintenance of standards (recertification) programme.

Anesthesia↗
PubMed1996

No-fault liability--twenty years experience in New Zealand.

In 1974 the New Zealand Government enacted the Accident Compensation Act to make provision for the rehabilitation and compensation of persons who suffer personal injury by accident. It abolished actions for damages arising directly or indirectly out of personal injury by accident and death resulting therefrom. In 1992 this Act was replaced by the Accident Rehabilitation and Compensation Insurance Act. This paper examines the problems which arose from the implementation of the first Act and the reasons for the latest Act.

Accidents, Occupational↗
PubMed2001

Aboriginal mortality in Canada, the United States and New Zealand.

Indigenous populations in New World nations share the common experience of culture contact with outsiders and a prolonged history of prejudice and discrimination. This historical reality continues to have profound effects on their well-being, as demonstrated by their relative disadvantages in socioeconomic status on the one hand, and in their delayed demographic and epidemiological transitions on the other. In this study one aspect of aboriginals' epidemiological situation is examined: their mortality experience between the early 1980s and early 1990s. The groups studied are the Canadian Indians, the American Indians and the New Zealand Maori (data for Australian Aboriginals could not be obtained). Cause-specific death rates of these three minority groups are compared with those of their respective non-indigenous populations using multivariate log-linear competing risks models. The empirical results are consistent with the proposition that the contemporary mortality conditions of these three minorities reflect, in varying degrees, problems associated with poverty, marginalization and social disorganization. Of the three minority groups, the Canadian Indians appear to suffer more from these types of conditions, and the Maori the least.

Adolescent↗
PubMed1995

Ethics in a bicultural context -- a report from New Zealand.

The distinctiveness of Bioethics in New Zealand stems in part from a renewal of emphasis on Maori rights, based on the Treaty of Waitangi, the foundation document of the New Zealand state. Increasingly, committees dealing with health research ethics and with the ethics of assisted reproductive technology have to incorporate Maori values and perspectives.

Advisory Committees↗