[Show abstract][Hide abstract] ABSTRACT: We aimed to briefly review literature on the impact of the 1918–19 influenza pandemic on New Zealand’s military forces in the First World War. Collectively, this work identified established risk factors, for example, relating to age, pre-existing chronic conditions, a relatively short time from enlistment to foreign service, and crowded conditions (e.g. in military camps and on a troop ship). But novel risk factors were also identified, e.g. larger chest size and relatively early year of military deployment. The historical experience also has some potential lessons for future pandemic control including: the need to minimise crowding in institutions and other settings; being prepared for future pandemic waves; and planning for ‘protective sequestration’ in some settings.
[Show abstract][Hide abstract] ABSTRACT: Recent experience with pandemic influenza A(H1N1)pdm09 highlighted the importance of global surveillance for severe respiratory disease to support pandemic preparedness and seasonal influenza control. Improved surveillance in the southern hemisphere is needed to provide critical data on influenza epidemiology, disease burden, circulating strains and effectiveness of influenza prevention and control measures. Hospital-based surveillance for severe acute respiratory infection (SARI) cases was established in New Zealand on 30 April 2012. The aims were to measure incidence, prevalence, risk factors, clinical spectrum and outcomes for SARI and associated influenza and other respiratory pathogen cases as well as to understand influenza contribution to patients not meeting SARI case definition.
Western Pacific surveillance and response journal : WPSAR. 04/2014; 5(2):23-30.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is of increasing importance with about one in four people estimated to be diagnosed with COPD during their lifetime. None of the existing medications for COPD has been shown to have much effect on the long-term decline in lung function and there have been few recent pharmacotherapeutic advances. Identifying preventive interventions that can reduce the frequency and severity of exacerbations could have important public health benefits. The Warm Homes for Elder New Zealanders study is a community-based trial, designed to test whether an NZ$500 electricity voucher paid into the electricity account of older people with COPD, with the expressed aim of enabling them to keep their homes warm, results in reduced exacerbations and hospitalisation rates. It will also examine whether these subsidies are cost-beneficial. METHODS: Participants had a clinician diagnosis of COPD and had either been hospitalised or taken steroids or antibiotics for COPD in the previous three years; their median age was 71 years. Participants were recruited from three communities between 2009 to early 2011. Where possible, participants' houses were retrofitted with insulation. After baseline data were received, participants were randomised to either 'early' or 'late' intervention groups. The intervention was a voucher of $500 directly credited to the participants' electricity company account. Early group participants received the voucher the first winter they were enrolled in the study, late participants during the second winter. Objective measures included spirometry and indoor temperatures and subjective measures included questions about participant health and wellbeing, heating, medication and visits to health professionals. Objective health care usage data included hospitalisation and primary care visits. Assessments of electricity use were obtained through electricity companies using unique customer numbers. DISCUSSION: This community trial has successfully enrolled 522 older people with COPD. Baseline data showed that, despite having a chronic respiratory illness, participants are frequently cold in their houses and economise on heating.Trial Registration: The clinical trial registration is NCT01627418.
BMC Public Health 02/2013; 13(1):176. · 2.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Acute rheumatic fever (ARF) and its sequelae, chronic rheumatic heart disease, remain important causes of morbidity and mortality worldwide, but there is little recent information about risk factors. The aim of this study was to examine the association between ARF and household crowding in New Zealand between 1996 and 2005.
This ecologic study used hospitalization data and census data to calculate incidence rates by census area unit (CAU). Rates of ARF were examined in relation to individual factors (age, ethnicity) and area factors based on the CAU of home address (household crowding, New Zealand deprivation index, household income, and proportion of children aged 5-14 years). The multivariate relationship between ARF incidence and CAU-based variables was assessed using a zero-inflated negative binomial model.
This study included 1249 new cases of ARF between 1996 and 2005. At the univariate level, ARF rates were associated with household crowding across all age groups and ethnicities. ARF rates were significantly and positively related to household crowding after controlling for age, ethnicity, household income, and the density of children in the neighborhood. The incidence rate ratio was 1.065 (95% confidence interval, 1.052-1.079) for the total population.
In New Zealand, ARF rates are associated with household crowding at the CAU level. This finding supports action to reduce household crowding to improve health and reduce health inequalities. Our conclusion could be further investigated using a case-control study.
[Show abstract][Hide abstract] ABSTRACT: We examined how New Zealand activities impact on health in Pacific Island Countries and Territories (PICTs) in two domains: the provision of development assistance and the impact of trade. The available evidence suggests that New Zealand's official development assistance (ODA) is capably and strategically administered by its development agency, NZAID. However, New Zealand contributes comparatively little of its economic capacity to ODA; only 0.30% of gross national income, with a relatively small proportion spent in the health sector. Increasing this level of ODA and proportional spending on health is likely to be important for enhancing the long-term impact and credibility of the country's development assistance programme. New Zealand has a liberalised trade policy toward the PICTs which is likely to provide economic benefits. However, the country also exports health-damaging products to PICTs such as high-fat mutton flaps and tobacco. Permitting such exports may undermine non-communicable disease control strategies and are a significant area of policy incoherence given other support provided (e.g. for tobacco control). Overall there remains significant scope for New Zealand to contribute more effectively via aid and trade to health in the South Pacific.
The New Zealand medical journal 02/2009; 122(1291):60-8.
[Show abstract][Hide abstract] ABSTRACT: New Zealand must commit to substantial decreases in its greenhouse gas emissions, to avoid the worst impacts of climate change on human health, both here and internationally. We have the fourth highest per capita greenhouse gas emissions in the developed world. Based on the need to limit warming to 2 degrees C by 2100, our cumulative emissions, and our capability to mitigate, New Zealand should at least halve its greenhouse gas emissions by 2020 (i.e. a target of at least 40% less than 1990 levels). This target has a strong scientific basis, and if anything may be too lenient; reducing the risk of catastrophic climate change may require deeper cuts. Short-term economic costs of mitigation have been widely overstated in public debate. They must also be balanced by the far greater costs caused by inertia and the substantial health and social benefits that can be achieved by a low emissions society. Large emissions reductions are achievable if we mobilise New Zealand society and let technology follow the signal of a responsible target.
The New Zealand medical journal 01/2009; 122(1304):72-95.