[Show abstract][Hide abstract] ABSTRACT: Background:
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.
All inpatients with suspected respiratory infections who were admitted overnight to the study hospitals were screened daily. If a patient met the World Health Organization's SARI case definition, a respiratory specimen was tested for influenza and other respiratory pathogens. A case report form captured demographics, history of presenting illness, co-morbidities, disease course and outcome and risk factors. These data were supplemented from electronic clinical records and other linked data sources.
Hospital-based SARI surveillance has been implemented and is fully functioning in New Zealand. Active, prospective, continuous, hospital-based SARI surveillance is useful in supporting pandemic preparedness for emerging influenza A(H7N9) virus infections and seasonal influenza prevention and control.
[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 a 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.
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.
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.
The clinical trial registration is http://NCT01627418
Full-text · Article · Feb 2013 · BMC Public Health
[Show abstract][Hide abstract] ABSTRACT: Introduction There is evidence that indigenous peoples suffered disproportionately in the 2009 influenza pandemic, and we aimed to examine any such patterns for Māori and Pacific peoples in New Zealand (NZ).
Methods We analysed data from a national Mortality Review Committee and conducted analyses for datasets covering the 1918 and 1957 influenza pandemic periods.
Results In the 2009 pandemic the Māori mortality rate (2/100 000) was higher than the European New Zealander rate (1.7 and 2.6 times, depending on the method of age-standardisation and with only the latter result being statistically significant). Pacific peoples in NZ had a higher mortality rate (5/100 000) which was significantly higher than that for European New Zealanders (4.6–4.8 times). These mortality differentials for the 2009 pandemic were consistent with those seen for hospital and intensive care admissions. By comparison, the Māori mortality rate in the 1918 pandemic (4230/100 000 population) was 7.3 times the European settler rate. For NZ military personnel we estimated the mortality rate for Māori was 2.3 times the European rate. In the 1957 pandemic the Māori mortality rate (40/100 000) was 6.2 times the European rate.
Conclusion Mortality rates in the 2009 influenza pandemic for Māori and Pacific peoples were elevated compared to other New Zealanders. This pattern is consistent with previous pandemics, albeit with evidence for some decline in relative ethnic health inequalities over the past century. Nevertheless, the persistence of such inequalities in 2009 highlights the need for improved public health responses.
[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.
No preview · Article · Apr 2011 · The Pediatric Infectious Disease Journal
[Show abstract][Hide abstract] ABSTRACT: _ Defining homelessness has long been a topic of debate, but inter-national agreement is elusive, and most of the various definitions of homeless-ness in use across the world are not conceptually grounded. The two aims of this paper are: to provide an analysis and critique of the validity of the European Typology of Homelessness and Housing Exclusion (ETHOS), which is arguably the most prominent definition and classification of homelessness with an articulated theoretical foundation in current use; and to propose a modified approach to conceptualising homelessness that the authors have developed. We begin by describing a set of considerations and criteria that can be used for assessing any system of measurement. Two parts of the ETHOS concep-tualisation are then examined: the conceptual model, and the typology of subgroups that make up the homeless and housing excluded populations. Each part is found to have conceptual weaknesses that compromise its validity. A modified definition and classification of homelessness, which we think overcomes these weaknesses, is proposed.
[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.
Full-text · Article · Oct 2009 · The New Zealand medical journal
[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.
No preview · Article · Feb 2009 · The New Zealand medical journal