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Objectives: Rates of acute rheumatic fever, a sequelae of group A Streptococcal (GAS) infection, remain unacceptably high in Indigenous Māori and Pacific children in New Zealand. This prospective study aimed to describe GAS antibody titres in healthy children (5-14 years) by ethnicity, and to determine how paired titres vary with GAS culture positive and negative pharyngitis, and GAS skin infections.Methods: Analysis included 887 children (32% Māori, 36% Pacific, 33% European/Other) from Auckland, New Zealand. Cases comprise 772 children who had a sore throat or skin infection, which resulted in a swab taken for culture. Healthy controls were asymptomatic (N = 154) and matched by age, ethnicity and region. All participants had a serum sample, with a second sample collected from cases only. Sera were analysed for anti-streptolysin O (ASO) and anti-DNase-B (ADB) antibodies.Results: Healthy Māori and Pacific children had higher GAS antibody titres than healthy European/Other children. Children with GAS-positive sore throat had the highest mean ASO titres and children with GAS-positive skin infection had the highest mean ADB titres. When a two-fold increase or an upper limit of normal cut-off (ASO 450 IU/ml, ADB 400 U/ml) was applied to titres from children with GAS-positive sore throat, 62.1% were classified as having serologically confirmed GAS pharyngitis and 37.9% had GAS detected without serological response.Conclusions: Elevated ASO titres were associated with GAS pharyngitis and elevated ADB titres were associated with GAS skin infections in New Zealand children. Higher ASO/ADB titres in healthy Māori and Pacific children could indicate a greater prior exposure to GAS infections. [ABSTRACT FROM AUTHOR]

Bariatric surgery is the most effective intervention for alleviating obesity and its complications. Indigenous people worldwide experience higher rates of obesity and obesity disease burden. However, few studies exploring bariatric surgery among Indigenous peoples are published. In this study we aimed to explore the motivation of Māori women in coming forward for bariatric surgery. Māori women who had bariatric surgery prior to December 31, 2014, were invited to participate in semi-structured interpersonal interviews. Kaupapa Māori research, an Indigenous Māori research methodology, informed this study. Interviews were recorded, transcribed and subject to inductive thematic analysis. Twenty-nine Māori women participated in semi-structured interpersonal interviews. The majority of women reported that the presence of obesity-related disease alongside the desire for a better quality of life served as the greatest sources of motivation for having bariatric surgery. Whānau (family) were key for participants achieving the preoperative milestones needed to be accepted for bariatric surgery. Interpersonal experiences of fat-shaming and yo-yo dieting also impacted their choice to have surgery. This study is one of the first to describe the motivations of Indigenous Māori women to have bariatric surgery. Our study conveys the importance of health, a desire to have a better quality of life and whānau in motivating Māori women to come forward for bariatric surgery. [ABSTRACT FROM AUTHOR]

Abstract Introduction Indigenous peoples suffer high rates of obesity and obesity-related disease worldwide. Currently, bariatric surgery is the most effective intervention for severe obesity and obesity-related disease. The role bariatric surgery plays in alleviating the obesity burden amongst Indigenous peoples is unknown. We aimed to collate studies investigating bariatric surgery in Indigenous peoples and to provide a simple framework to use in future research surrounding this important issue. Materials and methods We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that investigated outcomes for Indigenous peoples at any point along the bariatric surgery journey were included. Results Six articles were included in this review. Three studies investigated access to bariatric surgery and the remaining three studies investigated short to long-term outcomes following bariatric surgery. A narrative review was performed given study heterogeneity and quality of included studies. Indigenous peoples had lower access to bariatric surgery and in one study had greater weight loss in comparison to non-Indigenous peoples. Conclusion Despite a paucity of studies, it appears that there is emerging interest in investigating bariatric surgery among Indigenous peoples. We encourage those who seek to investigate this important issue at any point along the bariatric surgery journey, to do so using an equity-based approach. [ABSTRACT FROM AUTHOR]

Background Atrial fibrillation (AF) is associated with increased risk of cardiovascular disease (CVD) complications including stroke. We investigated the assessment and management of cardiovascular risk among patients with AF aged 35–74 years, by ethnic group, in a large cohort of people receiving a CVD risk assessment in primary care (PREDICT). Methods PREDICT was linked to national dispensing, hospitalisation and mortality records. AF was present if recorded in PREDICT or during a prior hospitalisation; medications were those dispensed ≤ 6 months before or after a PREDICT assessment; the CHA 2 DS 2 -VASc score and a New Zealand (NZ) adjusted Framingham CVD risk were calculated. Data were linked to outcomes of stroke or major adverse cardiovascular event (MACE). Results 12,739 (2.8%) of 447,020 people aged 35–74 years had AF. Māori, the indigenous population of NZ, had the highest proportion of AF, which by age group, was similar to that among Europeans 10 years older. 77% were at high stroke risk, of whom 42% received anticoagulation; 54% were at high CVD risk, of whom 67% received both lipid- and blood pressure-lowering medication. Per category of predicted risk, stroke risk was overestimated and risk of MACE was underestimated. Conclusions The burden of AF and risk factors differed by ethnic group thus recommendations to screen for AF above a universal age threshold may introduce inequity in the detection and management of associated risk. The high burden of comorbidities at younger ages among many ethnic groups contributes to the poor performance of available risk assessment tools, further compounding potential inequity. [ABSTRACT FROM AUTHOR]

Abstract: Background: Cardiovascular disease (CVD) is the leading cause of death, and principal reason for the large difference in life expectancy between indigenous Māori and the non-indigenous population in New Zealand. CVD guidelines recommend that people who are at high risk or who have had previous CVD should be offered aspirin, blood pressure lowering and lipid lowering therapies. However, prescribing and adherence rates are low and CVD events remain high. Aim: To assess whether a medication strategy using a fixed dose combination pill (‘polypill’) could improve prescribing and adherence to recommended medications, lower blood pressure and improve lipids compared with current care over 12months. Methods: IMProving Adherence using Combination Therapy (IMPACT) is an open-label randomised controlled trial comparing a once-daily polypill containing four preventive medications with usual care. Six hundred participants who have had previous CVD events or are at high risk of CVD will be enrolled, including 300 Māori. Participants are identified, enrolled and prescribed either the polypill or current medications at their usual primary health care practice, with medications (including the polypill) dispensed through local community pharmacies. The polypill contains 75mg aspirin, 40mg simvastatin, 10mg lisinopril and either 12.5mg hydrochlorothiazide or 50mg atenolol. Primary outcomes are adherence to guidelines-recommended medications and changes in systolic blood pressure and low density lipoprotein at 12months. Secondary outcomes include other lipids, medication dispensing, barriers to adherence, CVD and other serious adverse events, quality of life and prescriber acceptability. The trial is registered with the Australian New Zealand Clinical Trial Registry (ACTRN12606000067572). [Copyright &y& Elsevier]