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Holistic nursing in New Zealand.

New Zealand nurses are active and dynamic emerging holistic practitioners. Despite an economic recession and dramatic changes in their health care delivery systems, the country's holistic nurses have mobilized to develop and begin a holistic nurses' association. Holistic nurses from both islands have begun independent practices using complementary therapies and modalities. Although New Zealand is distant from North America geographically, there have been increasing numbers of exchange visits and subsequent influence on international holistic nursing practice. New Zealand, being a lush, green, clean, semitropical country in the South Pacific, is a wonderful place for North American nurses to experience cross-cultural nursing while still being in an English-speaking country.

Holistic Health↗

Spatial and temporal patterns of Campylobacter contamination underlying public health risk in the Taieri River, New Zealand.

New Zealand's freshwater ecosystems are subject to microbial contamination from a predominantly agricultural landscape. This study examines the spatial and temporal distribution of the human pathogen Campylobacter in the lower Taieri River, South Island (New Zealand). Enumeration of thermophilic Campylobacter from river samples was performed using a most probable number (MPN) method. Seasonal variation in Campylobacter levels was evident, with higher median levels detected in summer, when human exposure through recreational water use is maximal. Campylobacter levels varied significantly among the 10 sampling sites, increasing below a major tributary entering the river and then showing a downstream decrease. These changes probably resulted from inputs from adjacent farms and instream Campylobacter losses (settling, death). Two main peaks in the flux of Campylobacter were observed, one in winter and one in summer. A decrease in notified cases of campylobacteriosis in the human population was observed when levels of Campylobacter at the main recreational bathing site on the river were low. Continuing land use change and intensification in New Zealand may lead to further increases in microbial contamination of freshwaters, and an associated increase in waterborne enteric diseases such as campylobacteriosis.

Agriculture↗

Continuity through change: the rhetoric and reality of health reform in New Zealand.

New Zealand, like most other developed economies, has struggled to establish the best way of organising and delivering publicly financed health care services. Before the 1990s, hospitals and some related services were planned and provided by regionally based, locally elected health boards. This system was replaced in 1993 with a quasi-market structure in which separate organisations were responsible for the purchasing and provision of services. This in turn was replaced in 2001 by a system of locally elected boards that is remarkably similar to that which existed in the 1980s. The change to and subsequent abandonment of the quasi-market structure implies major changes to the way that health services are organised in New Zealand and suggests policy U-turns in (at least) three key areas: from cooperation to competition (and back); from integration of the roles of purchaser and provider to contractual arrangements (and back); and from local decision-making to centralised decision-making (and back). The aims of this paper are to examine the depth of system change in practice and to consider the extent to which the stated goals of reformers have disguised the degree of continuity between reform eras. We conclude that simplistic distinctions between structural approaches often fail to capture salient influences upon decision-making. New Zealand has not, in fact, been "to market and back" as the rhetoric would have us believe. Key aspects of the health system have endured throughout the reform period and these arguably have more importance for system functioning and performance than the high-level structural changes.

Health Care Reform↗

Advances in health and welfare of farmed deer in New Zealand.

New Zealand has lead the world in pastoral farming of red, wapiti and fallow deer since this was first sanctioned in 1970. Among technological advances in deer production systems have been milestones in our understanding of deer health and welfare in an intensive pastoral farming environment, contributed by the combined efforts of veterinary practitioners, producers and researchers. These advances have impacted enormously on the health and wellbeing of New Zealand's farmed deer population, and contribute significantly to the success of deer production systems and the sustainability of the industry's international markets and reputation. These activities have brought local and international distinction upon the veterinary profession in New Zealand, by demonstrating innovation and initiative in establishing a new discipline of veterinary endeavor. This paper briefly reviews the important milestones in veterinary knowledge of capture-stress management, deer mortalities, the key disease syndromes of tuberculosis, yersiniosis, malignant catarrhal fever (MCF), internal parasites, trace elements and miscellaneous conditions, and selected animal welfare issues.

Journal Article↗

Impact of health reorganization on nurses in New Zealand.

New Zealand, like many other Western countries, has undergone widesweeping restructuring in its public sector over the past few years. Embracing a market economy, successive governments--both liberal and conservative--have encouraged competition and deregulation. Below, how the New Zealand nurses reorganized to meet this new challenge.

Economic Competition↗

Estimating the dollar value of the illicit market for cannabis in New Zealand.

New data collected on the procurement and purchase of cannabis in the 2001 New Zealand National Drug Survey are used to estimate the dollar value of the illicit market for cannabis as well conduct other economic analyses of the illicit purchase of cannabis in New Zealand. Eighty-four per cent of last-year cannabis users received at least some of their cannabis 'free', 38% 'bought' at least some of their cannabis, while only 8% grew any of their supply. By proportion of the total dollar value of the cannabis market, sales of 'tinnies' (1.5 g) had the biggest share of the market (30%), followed closely by 50 NZ dollars bags (4 g) (29%) and ounces (28 g) (26%). The average price paid per gram of cannabis fell steadily from 20.50 NZ dollars per gram for a joint to 5.63 per gram for a pound (NZ dollars). The distribution of spending on cannabis was positively skewed (average 1313 NZ dollars, median 400 NZ dollars, mode 100, range 5 - 55,200, interquartile range 100 - 1200) (NZ dollars). The bottom 50% of cannabis buyers spent a median amount on cannabis of 100 NZ dollars a year while the top 5% spent a median amount of 7425 a year (NZ dollars). The dollar value of the illicit cannabis market was estimated to be 190 million (131 - 249 million) (NZ dollars). Three limitations are acknowledged with the market estimate calculated: (i) the truncated age range of the survey data (13 - 45 years); (ii) the likely underestimation of heavy cannabis use in household drug surveys; (iii) a degree of 'double-counting' when the same cannabis is bought and sold a number of times.

Adolescent↗

Soil quality at a national scale in New Zealand.

New Zealand is a signatory to international conventions on environmental performance, and soil quality information is needed for reporting both at a national and regional level. Soil quality was measured at 222 sites in five regions of New Zealand (12 soil orders and 9 land-use categories). Topsoil (0-100 mm) properties measured were total carbon and nitrogen, potentially mineralizable N, pH, Olsen P, cation exchange capacity, bulk density, total porosity, macroporosity, and total available and readily available water. Our objectives were to gauge the representativeness of the sample, determine the contribution from land use or soil order to variability, rationalize the data set, and identify concerns for long-term sustainable land use. Soil and land use combinations were both under- or overrepresented in the data set compared with national distribution. Soil order and land-use categories explained 55 to 76% of the variance in soil properties. Total C contents of pastures were comparable with indigenous forest soils, but pastures were less acidic and with higher N and P contents. Plantation forests had characteristics similar to indigenous forests on comparable soils. Cropland soils comprised <1% of the national land cover and generally had high inorganic fertility and low organic matter, with evidence of compaction. Seven characteristics (total C, total N, mineralizable N, pH, Olsen P, bulk density, and macroporosity) explained 87% of the total variability. The findings are being used by monitoring agencies to raise awareness about soil quality in the wider community, set land management guidelines, and develop policies.

Agriculture↗

The epidemic of asbestos-related diseases in New Zealand.

New Zealand is a small country with a big asbestos disease problem. The lack of action on warnings in the 1960s and 1970s has led to epidemics of mesothelioma and asbestosis, which can be clearly documented via the death and cancer registers. In addition, an uncertain number of lung cancers due to asbestos exposure has occurred. The epidemic started in the 1980s, and will eventually have cost the lives of at least 2000 to 3000 workers. Prevention against ongoing exposures from asbestos installed in buildings is essential, and another key issue for New Zealand is to ensure that fair workers' compensation is provided to all victims of asbestos diseases.

Asbestosis↗

The burden of infectious disease in New Zealand.

New Zealand mortality records for the years 1980 to 1993 were analysed to estimate the aggregate burden of infectious disease using a recoding of ICD-9 codes to identify deaths with infectious aetiology. The recoding scheme was modified from one developed by US CDC, which used expert panels to assign ICD codes to categories dependent on the proportion of the code attributable to infection. ICD-9 Chapter One ('Infectious and parasitic diseases') accounted for only 0.7% of total deaths. Following recoding, this proportion increased tenfold, with 6.9% of deaths attributable to infectious disease. This proportion was stable or declined only slowly between 1980 and 1993. While rates varied by age, gender and ethnicity, the results indicate that infectious disease still accounts for a substantial proportion of the burden of disease in New Zealand.

Adolescent↗

Continuing Mycobacterium bovis transmission from animals to humans in New Zealand.

New Zealand has a large reservoir of Mycobacterium bovis infection in wild and farmed animals. This study aimed to assess the extent of human infection with this organism and the potential contribution of these animal sources. Combined epidemiological and laboratory investigation of human tuberculosis cases over the period 1995-2002 showed that M. bovis accounted for 2.7% (54/1997) of laboratory-confirmed human tuberculosis cases, a rate of 0.2/100,000 population. M. bovis isolates from humans (23) were typed using restriction endonuclease analysis (REA) and compared with isolates from wild and domestic animals (2600). Fourteen (61%) of the human isolates had REA patterns that were identical to patterns for isolates from cattle, deer, possums, ferrets, pigs, and occasionally cats. These results suggest a low level of ongoing M. bovis transmission from animal reservoirs to humans in New Zealand.

Adult↗

Alpha-2-HS-glycoprotein polymorphism in New Zealand Europeans and New Zealand Maori.

The polymorphism of alpha-2-HS-glycoprotein (AHSG, alpha 2HS) was analysed in a sample of New Zealanders consisting of 194 New Zealand Europeans and 236 New Zealand Maori. Thin layer polyacrylamide gel isoelectric focusing followed by immunofixation revealed four different AHSG phenotypes in New Zealand Europeans and three different AHSG phenotypes in New Zealand Maori. The AHSG*2 frequency of 0.695 for the New Zealand Maori population was found to be one of the highest reported for any population. AHSG*2 appears to be a useful genetic marker for Maori in anthropological studies.

Alleles↗

Application of subjective methods to the determination of the likelihood and consequences of the entry of foot-and-mouth disease into New Zealand.

New Zealand has a history of continuous freedom from foot-and-mouth disease and relies on a two-tier system of surveillance to maintain this status. The first involves border control procedures and stringent importation standards, and the second is an exotic disease and pest response programme. As part of an economic evaluation comparing the exotic disease and pest response programme against a hypothetical lower grade ;measured response programme subjective judgements of the risks involved were required. Twenty-eight selected animal health professionals, predominantly veterinarians, were posted a questionnaire that used three techniques (single point estimates, three point estimates and elicitation methods) to determine the risk components in a foot-and-mouth disease outbreak. The two key variables were the probability of an outbreak in New Zealand, and the number of secondary properties to which the disease spread during the epidemic. A Delphi conference of ten selected participants then focused mainly on the two key variables, with a second round postal extension to this group for the first variable. The individual data sets were then analysed and combined using a stochastic simulation technique. The final mean probability of an outbreak was about once in 50 years (0.0199). The mean numbers of farms to which disease would spread during an epidemic under the existing exotic disease and pest response programme, a measured response programme which allowed vaccination and a measured response programme which excluded vaccination were estimated to be 61, 478 and 2230 respectively. The policy implications arising from the quantification of these two key variables are that more expenditure on preparedness is justifiable and current resource planning is barely adequate.

Journal Article↗

Ultraviolet-A light prolongs survival and improves immune function in (New Zealand black x New Zealand white)F1 hybrid mice.

Although ultraviolet (UV) light is generally harmful to patients with systemic lupus erythematosus, most clinical and immunologic studies of UV exposure have evaluated the effects of UV-B (280-320 nm). The long-wavelength UV-A band (320-400 nm), however, is less toxic than UV-B and has different immunologic actions. Therefore, we studied the effect of UV-A irradiation on survival and immunologic function in the (New Zealand black x New Zealand white)F1 hybrid mouse model of systemic lupus erythematosus. Twenty-one (New Zealand black x New Zealand white)F1 mice were treated with 3.5 joules/cm2/day of UV-A light for 5 days each week, beginning at age 10 weeks. A control group consisted of 20 untreated animals. All UV-A-irradiated mice survived to 32 weeks, compared with 12 of 20 mice in the nonirradiated group (P = 0.0013). Splenomegaly was significantly decreased in the irradiated mice (P less than 0.03). Mice that received UV-A treatment combined with depilation had significantly improved lymphocyte responses to phytohemagglutinin and lipopolysaccharide and significantly decreased levels of anti-DNA antibodies compared with mice that received neither treatment. Reductions in spleen size and anti-DNA antibody titer were significantly correlated with improved parameters of lymphocyte function. These results suggest that a relatively small dose of UV-A exerts significant therapeutic action in murine lupus, perhaps through an effect on immunologic regulation.

Animals↗

Detection of native and denatured DNA antibody forming cells by the enzyme-linked immunospot assay. A clinical study of (New Zealand black x New Zealand white)F1 mice.

A new method for measuring DNA antibody forming cells (DNA-AFC) using the enzyme-linked immunospot (ELISPOT) assay is described. This method uses enzyme-linked immunosorbent assay (ELISA) techniques applied to cells cultured on DNA-coated plates, which allows visual quantitation of spots representing imprints of specific antibodies from DNA-AFC. Specificity for DNA was confirmed by inhibition studies and lack of reactivity by anti-lysozyme hybridomas. Isotypes of IgG and IgM can be measured using the appropriate antisera in the assay. A study of 16 female (New Zealand black x New Zealand white)F1 ([NZB x NZW]F1) female mice showed significant correlation between age, rising blood urea nitrogen levels, and increasing proteinuria and increasing numbers of DNA-AFC. In contrast, the correlation between circulating antibodies to DNA (ELISA method) and clinical parameters of nephritis was not significant. Both the native DNA ELISPOT and the native DNA ELISA had similar significant linear correlations with age. This is the first report of use of the ELISPOT assay for measurement of DNA-AFC. The DNA-AFC measured by this method were specific and correlated with the presence of clinical nephritis in (NZB x NZW)F1 mice. This method should allow further study on the regulation of DNA-AFC in vitro and in vivo, and will be useful in the investigation of DNA-AFC and cellular mechanisms of autoimmunity.

Animals↗

Travelling seeds? Examples from New Zealand.

New Zealand is an archipelago isolated in time and space. Flowering plants have evolved in the almost-complete absence of terrestrial mammals, some of the most prolific seed-dispersers from the rest of the world, and fascinating mechanisms for spreading seeds have developed.

Animals↗

Towards general practice-led integrated healthcare in New Zealand.

New Zealand's recent painful experience of health system reforms has shown that professional incentives are more powerful than market incentives, and that medical leadership, with accountability for both cost and quality, may be the key to success.

Cost-Benefit Analysis↗

Developing areas in cancer in New Zealand.

New Zealand has a cancer profile similar to those of Western developed countries, with a high rate of melanoma, similar to Australia. Statistics separating the Maori from the non-Maori population, although open to difficulties in interpretation, show higher rates in Maori of liver, stomach, lung and cervix uterine cancer and lower rates of colorectal cancer and of melanoma. Screening and prevention programmes are limited by resource constraints; there is population screening for cervical cancer and breast cancer screening is being developed. Screening for hepatitis B and liver cancer is proposed, despite conflicting scientific opinions, while screening for colorectal cancer is not planned, despite randomized trial evidence of benefit. There is no clear national cancer control programme at present. Investigation of stomach cancer in Maori families had identified a new gene.

Breast Neoplasms↗