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Background Emergency department (ED) clinicians are more frequently providing care, including end-of-life care, to older people. Objectives To estimate the need for ED end-of-life care for people aged ≥65 years, describe characteristics of those dying within 48 hours of ED presentation and compare those dying in ED with those dying elsewhere. Methods We conducted a retrospective cohort study analysing data from 177 hospitals in Australia and New Zealand. Data on older people presenting to ED from January to December 2018, and those who died within 48 hours of ED presentation, were analysed using simple descriptive statistics and univariate logistic regression. Results From participating hospitals in Australia or New Zealand, 10,921 deaths in older people occurred. The 48-hour mortality rate was 6.43 per 1,000 ED presentations (95% confidence interval: 6.31–6.56). Just over a quarter (n = 3,067, 28.1%) died in ED. About one-quarter of the cohort (n = 2,887, 26.4%) was triaged into less urgent triage categories. Factors with an increased risk of dying in ED included age 65–74 years, ambulance arrival, most urgent triage categories, principal diagnosis of circulatory system disorder, and not identifying as an Aboriginal or Torres Strait Islander person. Of the 7,677 older people admitted, half (n = 3,836, 50.0%) had an encounter for palliative care prior to, or during, this presentation. Conclusions Our findings provide insight into the challenges of recognising the dying older patient and differentiating those appropriate for end-of-life care. We support recommendations for national advanced care planning registers and suggest a review of triage systems with an older person-focused lens. [ABSTRACT FROM AUTHOR]

New Zealand (NZ) enforced a rigorous lockdown in response to the outbreak of COVID-19 in 2020. Infection rates remained remarkably low, yet social and personal routines were affected. Factors associated with reporting worsening sleep were explored using an anonymous online survey launched during New Zealand's 2020 lockdown. Participants were 723 adults aged 20-85 years (median: 45 years, 82% women). Bed and wake times occurred significantly later compared to prelockdown estimates and resulted in shorter social jetlag (15 min). During lockdown, 54.5% were identified as "poor sleepers" [i.e. score > 5 on the Pittsburgh Sleep Quality Index (PSQI)]. Overall, 45% rated their sleep quality to worsen compared to pre-lockdown, 22% reported an improvement. Reports of worsening sleep were significantly related to increased sleep latency, reduced sleep efficiency, and heightened PSQI scores compared to those with better sleep or no change. Subjectively worse sleep was significantly associated with less time engaging in physical activity, less exposure to daylight, and social interactions compared to pre-lockdown estimates (p < .05). Logistic regression models identified significant relationships between having more vivid dreams and worsening sleep. Worse sleepers also had increased likelihoods of reporting poorer mood and they also scored higher for anxiety compared to those with no change or improved sleep during lockdown (p < .05). Pandemic-related restrictions contributed to poorer self-reported sleep which was linked to deterioration of mood. Negative affect was comparatively lower than reported elsewhere. These findings provide unique insights to the psychosocial impact of the initial COVID-19 lockdown in New Zealand, where the disease outbreak remained low. [ABSTRACT FROM AUTHOR]

Workplace wellness programmes have increased over the past years, but as yet has not been investigated in food and grocery organizations in New Zealand (NZ). The study aim was to explore the commitment of NZ Food and Grocery Council (FGC) companies in altering the workplace environment for employee health and the efficacy of the current wellness policies. Using a mixed-methods approach, FGC companies (n = 22) completed a workplace environment audit (WEA) survey. Three focus groups were held, consisting of employees (n = 20) from four of the FGC companies that completed the WEA survey. Two sets of data were then compared via methodological triangulation. The mean WEA score was 46% (p = 0.00), indicating an 'average' commitment by the FGC to health-promotion in their own workplaces. Significantly more initiatives related to improving nutrition were offered (p = 0.00) and larger food companies scored higher than smaller companies (p = 0.063). During the focus groups, employees revealed they felt workplace wellness programmes increased productivity, improved their physical health, allowed work–life balance, promoted social interaction and provided health-related education. Barriers to participating in wellness activities were identified as lack of time, working in a blue-collar position and working externally to the main office. The results of this study have large implications for companies and employers in NZ for future planning, implementation and monitoring of health initiatives in the workplace. [ABSTRACT FROM AUTHOR]

Aims This exploratory study aims to model the impact of sex and age on the percentage of pre-drinking in 27 countries, presenting a single model of pre-drinking behaviour for all countries and then comparing the role of sex and age on pre-drinking behaviour between countries. Methods Using data from the Global Drug Survey, the percentages of pre-drinkers were estimated for 27 countries from 64,485 respondents. Bivariate and multivariate multilevel models were used to investigate and compare the percentage of pre-drinking by sex (male and female) and age (16–35 years) between countries. Results The estimated percentage of pre-drinkers per country ranged from 17.8% (Greece) to 85.6% (Ireland). The influence of sex and age on pre-drinking showed large variation between the 27 countries. With the exception of Canada and Denmark, higher percentages of males engaged in pre-drinking compared to females, at all ages. While we noted a decline in pre-drinking probability among respondents in all countries after 21 years of age, after the age of 30 this probability remained constant in some countries, or even increased in Brazil, Canada, England, Ireland, New Zealand and the United States. Conclusions Pre-drinking is a worldwide phenomenon, but varies substantially by sex and age between countries. These variations suggest that policy-makers would benefit from increased understanding of the particularities of pre-drinking in their own country to efficiently target harmful pre-drinking behaviours. [ABSTRACT FROM AUTHOR]

Objectives To determine factors that predict inadequate serum urate (SU) lowering response in a randomized controlled trial of allopurinol dose escalation (DE) in gout. Methods Participants undergoing allopurinol DE were classified as: complete response (CR)—reached target SU at month 9 and 12 of the DE phase or if still dose escalating at month 9 reached target SU by month 12; partial response (PR)—reached target at some stage but not fulfilling criteria for CR; or inadequate response (IR)—did not reach target SU at any time. Results IR was uncommon, occurring in 13/150 (8.7%), compared with 82 (54.7%) CR, and 55 (36.6%) PR. Mean (s. e. m.) SU was higher at the end of the 12-month DE in IR compared with both CR and PR groups; 7.6 (0.31) vs 5.01 (0.06) and 5.97 (0.17) mg/dl respectively (P < 0.001). In univariate analysis, compete responders tended to be older, be receiving less allopurinol, have longer gout duration and were more likely to be New Zealand (NZ) European ethnicity, compared with IR+PR. Using multi-variate logistic regression analysis, only longer duration of gout and NZ European ethnicity remained significant independent predictors of CR. Baseline SU ⩾ 8 mg/dl had a sensitivity of 69.2% and specificity of 85.1% in predicting IR. The odds ratio for an IR if baseline SU was ⩾8 mg/dl was 11.7 (95% CI 3.3, 41.2). Conclusion A minority of people with gout never reach target SU when allopurinol dose is increased in a treat-to-target manner. Approximately one-third of those with SU ⩾ 8mg/dl despite allopurinol ⩾300mg/d have an IR to DE. Trial registration Australian New Zealand Clinical Trails Registry, https://www.anzctr.org.au, ACTRN12611000845932. [ABSTRACT FROM AUTHOR]

Objectives The study aimed to validate Wenger's empirically derived support network typology of responses to the Practitioner Assessment of Network Type (PANT) in an older New Zealander population. The configuration of network types was tested across ethnic groups and in the total sample. Method Data (N = 872, M age = 67 years, SD age = 1.56 years) from the 2006 wave of the New Zealand Health, Work and Retirement study were analyzed using latent profile analysis. In addition, demographic differences among the emerging profiles were tested. Results Competing models were evaluated based on a range of fit criteria, which supported a five-profile solution. The "locally integrated," "community-focused," "local self-contained," "private-restricted," and "friend- and family-dependent" network types were identified as latent profiles underlying the data. There were no differences between Māori and non-Māori in final profile configurations. However, Māori were more likely to report integrated network types. Discussion Findings confirm the validity of Wenger's network types. However, the level to which participants endorse accessibility of family, frequency of interactions, and community engagement can be influenced by sample and contextual characteristics. Future research using the PANT items should empirically verify and derive the social support network types, rather than use a predefined scoring system. [ABSTRACT FROM AUTHOR]

Background Countries with population-based colorectal cancer screening using faecal occult blood test kits performed in the home and posted to the laboratory struggle to achieve higher than 60% uptake. We measured the impact on participation of offering a community laboratory drop-off (CLD) alternative to postal return in New Zealand's Bowel Screening Pilot. Methods From May to September, 2015, a flyer added to the bowel screening test kit offered CLD as an alternative to returning the kit by post. Participation rates for equal-length periods before and after were measured. Interrupted time series and logistic regression models measured CLD-attributable the changes in screening participation. Results Overall, 26% of invitees used the CLD option. The effect of the CLD option on participation varied significantly by age, gender and ethnicity. There was a significant increase in participation among males (+1.75%; P = 0.002); patients under 60 (+1.65%; P = 0.006); Māori and Pacific (+2.88%; P = 0.029); and in the European/other ethnic group (+1.04%; P = 0.045) but not in Asians. Conclusions Both analyses showed that at little or no additional cost, the CLD option produced small but significant increases in participation for non-Asian men and younger invitees. A CLD kit return option may have benefits for other bowel screening programmes. [ABSTRACT FROM AUTHOR]

Previous reviews have indicated that immigration from South Asian to Western countries leads to unhealthy changes in diet; however, these reviews have been limited by the methods used in some included studies. This critical narrative review summarizes findings from original research articles that performed appropriate statistical analyses on diet data obtained using culturally appropriate diet assessment measures. All studies quantitatively compared the diets of South Asian immigrants with those of residents of Western or South Asian countries or with those of South Asian immigrants who had varying periods of time since immigration. Most studies examined total energy and nutrient intake among adults. Total energy intake tended to decrease with increasing duration of residence and immigrant generation, and immigrants consumed less protein and monounsaturated fat compared with Westerners. However, findings for intakes of carbohydrate, total fat, saturated fat, polyunsaturated fat, and micronutrients were mixed. Studies that examine food group intake and include South Asians living in South Asia as a comparison population are needed. [ABSTRACT FROM AUTHOR]

As a primary intervention, raising the topics of faith and religion with individuals traumatised by terrorism and/or natural disasters can be daunting for social workers, because victims often enter the helping relationship with feelings of helplessness, loss of personal control and of doubt about their relationships, environment, and their cultural and belief systems. Just as clients benefit from knowledge and awareness in the aftermath of a traumatic event, insights gleaned from traumatic experiences and from research can be useful for social workers grappling with the challenges associated with designing and deploying appropriate helping strategies with victims of disaster and terrorism. This article draws on extant literature and survey research, to explore how social workers might ethically assess clients' spiritual perspectives and incorporate helping activities that support clients' recovery, in the context of a spiritually sensitive helping relationship with victims of disaster and terrorism. [ABSTRACT FROM AUTHOR]

Background: Part of the visits to emergency departments (EDs) is related to complaints that may well be treated in primary care.Objectives: (i) To investigate how the likelihood of attending an ED is related to accessibility and continuity of primary care. (ii) To investigate the reasons for patients to visit EDs in different countries.Methods: Data were collected within the EU Seventh Framework project Quality and Costs in Primary Care (QUALICOPC) in 31 European countries, Australia, New Zealand and Canada. The data were collected between 2011 and 2013 and contain survey data from 60991 patients and 7005 GPs, within 7005 general practices.Outcome Measure: whether the patient visited the ED in the previous year (yes/no). Multilevel logistic regression analyses were carried out to analyse the data.Results: Some 29.4% had visited the ED in the past year. Between countries, the percentages varied between 18% and 40%. ED visits show a significant and negative relation with better accessibility of primary care. Patients with a regular doctor who knows them personally were less likely to attend EDs. Only one-third of all patients who visited an ED indicated that the main reason for this was that their complaint could not be treated by a GP.Conclusions: Good accessibility and continuity of primary care may well reduce ED use. In some countries, it may be worthwhile to invest in more continuous relationships between patients and GPs or to eliminate factors that hamper people to use primary care (e.g. for costs or travelling). [ABSTRACT FROM AUTHOR]

Aims: To describe inconsistencies in reporting past-year drinking status and heavy drinking occasions (HDOs) on single questions from two different instruments, and to identify associated characteristics and impacts. Methods: We compared computer-presented Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) with categorical response options, and mental health interview (MHI) with open-ended consumption questions, completed on the same day. Participants were 464 men and 459 women aged 38 (91.7% of surviving birth cohort members). Differences in dichotomous single-item measures of abstention and HDO frequency, associations of inconsistent reporting with sex, socioeconomic status (SES) and survey order, and impacts of instrument choice on associations of alcohol with sex and SES were examined. Results: The AUDIT-C drinking frequency question estimated higher past-year abstention prevalence (AUDIT = 7.6%, MHI = 5.4%), with one-third of AUDIT-C abstainers being MHI drinkers. Only AUDIT-C produced significant sex differences in abstainer prevalence. Inconsistencies in HDO classifications were bidirectional, but with fewer HDOs reported on the MHI than AUDIT-C question. Lower SES was associated with inconsistency in abstention and weekly+ HDOs. Abstention and higher HDO frequency were associated with lower SES overall, but sex-specific associations differed by instrument. Conclusions: In this context, data collection method affected findings, with inconsistencies in abstention reports having most impact. Future studies should: (a) confirm self-reported abstention; (b) consider piloting data collection methods in target populations; (c) expect impacts of sex and SES on measurements and analyses. [ABSTRACT FROM AUTHOR]

Heterogeneity in the expression of schizotypy may arise from underlying dimensional processes or a taxonic population structure. In a 2-phase study, we tested the taxonicity of self-reported schizotypy within a general psychiatric sample (n = 109) and examined taxon validity by testing its association with clinical schizotaxia in follow-up subsamples. Taxometric analyses indicated a taxonic structure (schizotypy prevalence = 38.8%) provided the best description of the underlying population distribution. After a year, schizotypal (n = 14) and nonschizotypal (n = 14) subsamples returned for diagnosis of clinical schizotaxia by assessment of executive functioning, attention, memory, and negative symptoms. Seven patients met diagnostic criteria, all members of the schizotypy class. Schizotypy was associated with impaired attention and memory, more negative symptoms, poorer global functioning, and more extensive psychiatric histories. We reconcile inconsistencies in the literature by discussing threats to the validity of this and similar research on Meehl's taxonomic model of schizotypy, including conceptual limitations of the lexical hypothesis and conventions of factor analysis. Scrutiny of Meehl's model should involve disambiguation and better measurement of the schizotaxia-schizotypy phenotype. [ABSTRACT FROM AUTHOR]

Objectives. The aims of this study were to establish whether, in patients with gout, MPO is released from neutrophils and urate is oxidized to allantoin and if these effects are attenuated by allopurinol.Methods. MPO, urate, allantoin and oxypurinol were measured in plasma from 54 patients with gout and 27 healthy controls. Twenty-three patients had acute gout, 13 of whom were receiving allopurinol, and 31 had intercritical gout, 20 of whom were receiving allopurinol. Ten additional gout patients had samples collected before and after 4 weeks of allopurinol.Results. Plasma MPO and its specific activity were higher (P < 0.05) in patients with acute gout not receiving allopurinol compared with controls. MPO protein in patients’ plasma was related to urate concentration (r = 0.5, P < 0.001). Plasma allantoin was higher (P < 0.001) in all patient groups compared with controls. In controls and patients not receiving allopurinol, allantoin was associated with plasma urate (r = 0.62, P < 0.001) and MPO activity (r = 0.45, P < 0.002). When 10 patients were treated with allopurinol, it lowered their plasma urate and allantoin (P = 0.002). In all patients receiving allopurinol, plasma allantoin was related to oxypurinol (r = 0.65, P < 0.0001). Oxypurinol was a substrate for purified MPO that enhanced the oxidation of urate.Conclusion. Increased concentrations of urate in gout lead to the release of MPO from neutrophils and the oxidation of urate. Products of MPO and reactive metabolites of urate may contribute to the pathology of gout and hyperuricaemia. At low concentrations, oxypurinol should reduce inflammation, but high concentrations may contribute to oxidative stress. [ABSTRACT FROM PUBLISHER]

Objective. Gout is strongly associated with obesity. The aim of this study was to determine if obesity altered the inflammatory phenotype of non-adipose tissue-resident macrophages in response to the gout-causing agent monosodium urate (MSU) crystals.Methods. C57BL/6J mice were fed a high-fat diet for 12 weeks. Resident peritoneal macrophages were stimulated ex vivo with MSU crystals (200 µg/ml for 18 h) and the supernatants were collected. Mice were challenged with MSU crystals in vivo (3 mg, intraperitonal) and the peritoneal lavage fluid was collected (8 and 16 h). Cytokine and chemokine levels were analysed by multiplex bead array and peritoneal cell populations were analysed by flow cytometry.Results. Peritoneal macrophages from obese mice produced elevated background levels of IL-6, monocyte chemoattractant protein 1 (MCP-1) and keratinocyte-derived cytokine (KC) that decreased following MSU crystal stimulation ex vivo. MSU-induced IL-1β production was higher for macrophages from obese mice compared with controls. High background levels of IL-6, MCP-1, KC and GM-CSF, but not IL-1β, were measured in the peritoneal fluid of unchallenged obese mice. MSU crystal challenge in vivo raised IL-1β levels equally in both control and obese mice, whereas elevated background levels of IL-6, MCP-1, KC and GM-CSF levels dropped in obese mice. There was a consistent trend towards lower numbers of naive peritoneal resident macrophages and MSU-recruited monocytes and neutrophils in obese mice.Conclusion. Obesity induces a background pro-inflammatory environment orchestrated by non-adipose tissue-resident macrophages. However, this may not automatically translate into exacerbation of MSU crystal-induced inflammation in gout. [ABSTRACT FROM PUBLISHER]

Objectives. Bone erosion has been linked with tophus deposition in gout but the roles of osteitis (MRI bone oedema) and synovitis remain uncertain. Our aims in this prospective 3 T MRI study were to investigate the frequency of these features in gout and determine their relation to one another.Methods. 3 T MRI scans of the wrist were obtained in 40 gout patients. Scans were scored independently by two radiologists for bone oedema, erosions, tophi and synovitis. Dual-energy CT (DECT) scans were scored for tophi in a subgroup of 10 patients.Results. Interreader reliability was high for erosions and tophi [intraclass correlation coefficients (ICCs) 0.77 (95% CI 0.71, 0.87) and 0.71 (95% CI 0.52, 0.83)] and moderate for bone oedema [ICC = 0.60 (95% CI 0.36, 0.77)]. Compared with DECT, MRI had a specificity of 0.98 (95% CI 0.93, 0.99) and sensitivity of 0.63 (95% CI 0.48, 0.76) for tophi. Erosions were detected in 63% of patients and were strongly associated with tophi [odds ratio (OR) = 13.0 (95% CI 1.5, 113)]. In contrast, no association was found between erosions and bone oedema. Using concordant data, bone oedema was scored at 6/548 (1%) sites in 5/40 patients (12.5%) and was very mild (median carpal score = 1, maximum = 45). In logistic regression analysis across all joints nested within individuals, tophus, but not synovitis, was independently associated with erosion [OR = 156.5 (21.2, >999.9), P < 0.0001].Conclusion. Erosions were strongly associated with tophi but not bone oedema or synovitis. MRI bone oedema was relatively uncommon and low grade. These findings highlight the unique nature of the osteopathology of gout. [ABSTRACT FROM PUBLISHER]

Objective. Little is known on epidemiology of chronic pain in New Zealand. Its management has been based on data and models in North American/ European studies. This project evaluated demographic and psychosocial correlates of pain severity, duration, and disability ( PSDD) in chronic pain patients for assessment at a New Zealand tertiary care Pain Medicine Center. Design and Setting. This study was a retrospective, cross-sectional analysis on existing clinical assessment data (audit) collected over an 18-month period. Methods. Pre-admission data were collected on a consecutive series of 874 patients presenting for assessment. Assessment Tools. This included demographic (gender, educational attainment, ethnicity) and psychosocial data. Pain severity was measured by numerical rating scale and present pain intensity using Mc Gill Pain Questionnaire. Duration was measured in months. Disability was measured by using Pain Disability Index and depression using the Center for Epidemiological Studies Depression Scale. Distress was measured using the Kessler Psychological Distress Scale and self-efficacy using the Pain Self- Efficacy Questionnaire. Catastrophizing was measured by Coping Strategies Questionnaire and pain acceptance by the Pain Solutions Questionnaire. Results. No difference was found in mean values of all PSDD between genders and between ethnicities. Years of education did not form an important correlate of PSDD. Catastrophizers experienced more pain and were more disabled. Patients with severe pain experienced greater distress. Depressed patients were more disabled. Patients presenting with a high degree of self-efficacy were likely to have lower pain levels and to be less disabled. Level of acceptance of pain was positively associated with reported duration of pain and negatively associated with total disability. Conclusion. Through this study, more is now known about effects of chronic pain on New Zealanders. The use of validated psychometric testing enables proper assessment and informs clinical management for chronic pain patients. [ABSTRACT FROM AUTHOR]

Objective. To investigate the effect of hyperuricaemia on serum chemokine (C-C motif) ligand 2 (CCL2) levels and blood monocytes in people with gout. Methods. Whole blood was collected from subjects with a history of acute or chronic gout but not currently experiencing an attack of gout, subjects with asymptomatic hyperuricaemia and healthy individuals with normouricaemia. Serum concentrations of CCL2 were measured by bead array and levels of CD14+/CD11b+ blood monocytes determined by flow cytometry.Results. Subjects with gout and asymptomatic hyperuricaemia had higher serum levels of CCL2 and showed an increase in the percentage of circulating CD14+ monocytes compared with subjects with normouricaemia. Conclusion. Hyperuricaemia causes elevated serum CCL2 levels and increased monocyte recruitment that may be driven by soluble uric acid-induced CCL2 production. Hyperuricaemia may initiate subclinical priming of circulating blood monocytes for adhesion and trafficking during a gout attack. [ABSTRACT FROM AUTHOR]

Micronutrient status during pregnancy influences maternal and fetal health, birth outcomes, and the risk of chronic disease in offspring. Research reporting dietary intake during pregnancy in nationally representative population samples, however, is limited. This review summarizes the micronutrient intakes of pregnant women from developed countries and compares them with relevant national recommendations. A systematic search without date limits was conducted. All studies reporting the micronutrient intakes of pregnant women were considered, irrespective of design. Two authors independently identified studies for inclusion and assessed methodological quality. Nutritional adequacy was summarized, with confounding factors considered. Meta-analysis data are reported for developed countries collectively, by geographical region, and by dietary methodology. Pregnant women in developed countries are at risk of suboptimal micronutrient intakes. Folate, iron, and vitamin D intakes were consistently below nutrient recommendations in each geographical region, and calcium intakes in Japan were below the Japanese recommendations and the average intake levels in other developed countries. Research examining the implications of potential nutrient insufficiency on maternal and offspring health outcomes is needed along with improvements in the quality of dietary intake reporting. [ABSTRACT FROM AUTHOR]

SUMMARY The accuracy with which geophysical observations are made is inherently determined by the geometry of the observation network, and typically depends on a highly non-linear relationship between data and earth parameters. Statistical experimental design provides a means of optimizing the network geometry to provide maximum information about parameters of interest. Here, we re-derive the nonlinear experimental design D N optimization method, without the need for the usual assumption of a multivariate normal model of data uncertainties. We demonstrate the criterion's utility by applying it to the problem of seismic network expansion in the active Kawerau geothermal field, Taupo Volcanic Zone, New Zealand. The design calculations maximize the ratio of the hypocentre data generalized variance (attributable to resolvable spatial separation of earthquakes) to the measurement error generalized variance (attributable to observational uncertainties), and incorporate realistic 3-D velocity and attenuation models, surface noise sources, and both P- and S-wave data. In geologically complex areas, statistical experimental design provides a means of objectively deploying finite observational resources to target areas of particular interest while taking into account environmental and logistical factors. [ABSTRACT FROM AUTHOR]

Before the 2005 launch of the New Zealand SunSmart Schools Accreditation Programme (SSAP), 242 randomly sampled primary schools completed a mail survey about sun protection policies, practices, curriculum and environment. A 2009 follow-up included 189 (78%) and their mean Total Accreditation Score (TAS = total SSAP requirements met, range 0–12), increased by 0.8 (95% CI 0.5–1.2, P < 0.001) from 7.8 (95% CI 7.4–8.1) to 8.6 (95% CI 8.3–8.9) with evidence changes differed between regions (P = 0.024). The 2009 mean TAS varied by region (range 7.9–9.4, unadjusted P = 0.004, adjusted P = 0.013) with no clear pattern, but likely resource allocation association. TAS of schools acknowledging input from Health Promoting Schools demonstrated a tendency towards being statistically significantly higher by 0.5 (95% CI −0.1 to 1.1, P = 0.082), but statistically significantly higher by 1.1 (95% CI 0.5–1.7, P < 0.001) for schools acknowledging Cancer Society input. Lowest attainment was for the clothing (43%), shade (52%) and curriculum (55%) criteria. Key perceived barriers were cost, particularly of shade and limited support by parents and others. Schools which had not applied for accreditation identified lack of programme awareness and ‘other priorities’ as barriers; further information, better resourcing and training assistance as key needs. Observed positive change justifies increased support to consolidate gains and achieve sustainable universality. [ABSTRACT FROM PUBLISHER]

Objective. To determine the effects of furosemide on serum urate (SU), plasma oxypurinol and urinary urate.Methods. Twenty-three cases with gout receiving furosemide and allopurinol were recruited. Twenty-three controls with gout receiving allopurinol but no diuretics were matched on age, gender, estimated glomerular filtration rate and allopurinol dose. SU, plasma oxypurinol and urinary urate were assessed on a single occasion. The effects of a single dose of furosemide 40 mg were examined in a separate group of 10 patients receiving allopurinol but not diuretic.Results. Cases had significantly higher SU and plasma oxypurinol compared with controls despite receiving similar doses of allopurinol. There was no difference in urinary urate excretion. There was a significant increase in area under the curve (AUC)0–24 for oxypurinol after administration of furosemide 40 mg.Conclusion. The interaction between allopurinol and furosemide results in increased SU and plasma oxypurinol. The exact mechanisms remain unclear but complex interactions that result in attenuation of the hypouricaemic effects of oxypurinol are likely.Trial registration: Australian New Zealand Clinical Trials Registry, www.anzctr.org.au, 12609000529246. [ABSTRACT FROM PUBLISHER]

Objectives. To validate the Dudley Inflammatory Bowel Disease Questionnaire (DISQ) for determining the presence and severity of bowel symptoms in axial SpA.Methods. Seventy-seven SpA patients were assessed for disease activity using the BASDAI. All participants, including 32 healthy controls and 29 patients with Crohn's Disease (CD), completed the DISQ and an assessment of stool form and frequency. Validation of the DISQ was undertaken in accordance with OMERACT criteria.Results. Validity of the DISQ for measuring bowel symptoms in SpA was confirmed (Cronbach's α 0.79). Mean DISQ scores (s.d.) were: controls 2.6 (2.6), SpA 8.7 (6.1) and CD 17.1 (10.2). Differences were significant between controls and SpA, and SpA and CD, and correlated with disease activity (ρ 0.27, P = 0.02). In SpA, DISQ scores of those taking NSAIDs (n = 59) did not differ from those not taking NSAIDs (n = 18) (P = 0.31). Stool form and frequency differed significantly between SpA patients and healthy controls (P < 0.001). Using the DISQ the prevalence of clinically relevant bowel symptoms in SpA is 31%, and 7.8% experience bowel symptoms equivalent to active CD.Conclusion. The DISQ is a valid measure of bowel symptoms in SpA. Bowel symptoms are prevalent in SpA and correlate with disease activity. Symptoms do not relate to treatment with NSAIDs. We conclude that bowel symptoms should be included as a domain in the clinical assessment of patients with SpA and that the DISQ has potential as an outcome measure in clinical trials. [ABSTRACT FROM PUBLISHER]

The difference, if any, between men's and women's voting patterns is of particular interest to historians of gender and politics. For elections that were held before the introduction of opinion surveying in the 1940s, little data are available with which to estimate such differences. We apply six methods for ecological inference to estimate men's and women's voting rates in New Zealand (NZ), 1893–1919. NZ is an interesting case-study, since it was the first self-governing country where women could vote. Furthermore, NZ officials recorded the voting rates of men and women at elections, making it possible to compare estimates produced by methods for ecological inference with known true values, thus testing the efficacy of different methods for ecological inference for this data set. We find that the most popular methods for ecological inference, namely Goodman's ecological regression and King's parametric method, give poor estimates, as does the much debated neighbourhood method. However, King's non-parametric method, Chambers and Steel's semiparametric method and the Steel, Beh and Chambers homogeneous approach all gave good estimates that were close to the known values, with the homogeneous approach performing best overall. The success of these methods in this example suggests that ecological inference may be a viable option when investigating gender and voting. Moreover, researchers using ecological inference in other fields may do well to consider a range of statistical methods. This work is a significant NZ contribution to historical politics and the first quantitative contribution, in the area of NZ gender and politics. [ABSTRACT FROM AUTHOR]

O'Driscoll, R. L., Gauthier, S., and Devine, J. A. 2009. Acoustic estimates of mesopelagic fish: as clear as day and night? – ICES Journal of Marine Science, 66: 1310–1317.The pelagic ecosystem on the Chatham Rise east of New Zealand has been monitored annually using acoustic surveys since 2001. Most of the acoustic backscatter comes from diurnally migrating mesopelagic fish, which are the major prey of hoki (Macruronus novaezelandiae) and other valuable commercial species. Mesopelagic schools and layers typically occur at 100–400 m depth during the day and migrate above 200 m depth at night. Previous acoustic estimates of the biomass of mesopelagic fish on the Chatham Rise were based only on night-time estimates from the upper 200 m and may significantly underestimate actual biomass. Paired day–night comparisons found that an estimated 20% of the total daytime backscatter migrates to depths of 0–14 m at night, where it is too shallow to be detected by hull-mounted acoustic instruments. In contrast, there is a positive bias associated with acoustic estimates of mesopelagic organisms during the day because they can occur close to the bottom mixed with demersal fish. Two alternative approaches for estimating biomass of diurnally migrating mesopelagic species are suggested. The first applies a correction based on the estimated proportion of backscatter migrating into the surface deadzone to night-time estimates of backscatter in the upper 200 m. The second uses night-time estimates of demersal backscatter, which remains deeper than 200 m at night, to correct daytime estimates of total backscatter. Both methods gave similar estimates of abundance and demonstrated that there was no statistically significant trend in mesopelagic fish biomass on the Chatham Rise over the past seven years. [ABSTRACT FROM PUBLISHER]

A letter to the editor is presented in response to the article "Digital tomosynthesis for bone erosion scoring in gout: comparison with plain radiography and computed tomography" on the June 27, 2014 issue.