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Aims: The kaupapa of the Caring for Australians and New Zealanders with Kidney Impairment (CARI) Clinical practice guidelines for management of chronic kidney disease for Māori in Aotearoa New Zealand is to provide whānau-centred and evidence-based recommendations to healthcare systems, healthcare providers and healthcare workers. The guidelines include screening, identification, management and system-level responses to chronic kidney disease (CKD) to deliver best practice care to Māori affected by CKD across community, primary and secondary services., Methods: The guidelines are funded by the Ministry of Health - Manatū Hauora and are written by a panel of Māori and non-Māori clinicians and literacy experts across Aotearoa New Zealand from Kaupapa Māori organisations, general practice and nephrology units using standardised methods. The guidelines methodology included consultation with whānau Māori with lived experience of CKD and primary and secondary care practitioners. Additional guideline development would be required to inform management of CKD for non-Māori in Aotearoa New Zealand., Results: The guidelines provide recommendations about equity, governance and accountability, cultural safety, case management, information systems, social determinants of equity and wellbeing and screening., Conclusions: Recommendations to health services for Māori with CKD are based on giving effect to Te Tiriti o Waitangi and best practice care to prevent CKD, delaying its progression, treating kidney failure through timely transplantation, delivering in community and providing high-quality symptom management., Competing Interests: Nil. Funding from Manatū Hauora Ministry of Health., (© PMA.)

Combining genome assembly with population and functional genomics can provide valuable insights to development and evolution, as well as tools for species management. Here, we present a chromosome-level genome assembly of the common brushtail possum (Trichosurus vulpecula), a model marsupial threatened in parts of their native range in Australia, but also a major introduced pest in New Zealand. Functional genomics reveals post-natal activation of chemosensory and metabolic genes, reflecting unique adaptations to altricial birth and delayed weaning, a hallmark of marsupial development. Nuclear and mitochondrial analyses trace New Zealand possums to distinct Australian subspecies, which have subsequently hybridised. This admixture allowed phasing of parental alleles genome-wide, ultimately revealing at least four genes with imprinted, parent-specific expression not yet detected in other species (MLH1, EPM2AIP1, UBP1 and GPX7). We find that reprogramming of possum germline imprints, and the wider epigenome, is similar to eutherian mammals except onset occurs after birth. Together, this work is useful for genetic-based control and conservation of possums, and contributes to understanding of the evolution of novel mammalian epigenetic traits., (© 2023. Springer Nature Limited.)

There has been a recent upsurge in human cases of leptospirosis in New Zealand, with wildlife a suspected emerging source, but up-to-date knowledge on this topic is lacking. We conducted a cross-sectional study in two farm environments to estimate Leptospira seroprevalence in wildlife and sympatric livestock, PCR/culture prevalence in wildlife, and compare seroprevalence and prevalence between species, sex, and age groups. Traps targeting house mice (Mus musculus), black rats (Rattus rattus), hedgehogs (Erinaceus europaeus) and brushtail possums (Trichosurus vulpecula) were set for 10 trap-nights in March-April 2017 on a dairy (A) and a beef and sheep (B) farm. Trapped wild animals and an age-stratified random sample of domestic animals, namely cattle, sheep and working dogs were blood sampled. Sera were tested by microagglutination test for five serogroups and titres compared using a Proportional Similarity Index (PSI). Wildlife kidneys were sampled for culture and qPCR targeting the lipL32 gene. True prevalence in mice was assessed using occupancy modelling by collating different laboratory results. Infection profiles varied by species, age group and farm. At the MAT cut-point of ≥ 48, up to 78% of wildlife species, and 16-99% of domestic animals were seropositive. Five of nine hedgehogs, 23/105 mice and 1/14 black rats reacted to L. borgpetersenii sv Ballum. The sera of 4/18 possums and 4/9 hedgehogs reacted to L. borgpetersenii sv Hardjobovis whilst 1/18 possums and 1/9 hedgehogs reacted to Tarassovi. In ruminants, seroprevalence for Hardjobovis and Pomona ranged 0-90% and 0-71% depending on the species and age group. Titres against Ballum, Tarassovi and Copenhageni were also observed in 4-20%, 0-25% and 0-21% of domestic species, respectively. The PSI indicated rodents and livestock had the most dissimilar serological responses. Three of nine hedgehogs, 31/105 mice and 2/14 rats were carrying leptospires (PCR and/or culture positive). True prevalence estimated by occupancy modelling in mice was 38% [95% Credible Interval 26, 51%] on Farm A and 22% [11, 40%] on Farm B. In the same environment, exposure to serovars found in wildlife species was commonly detected in livestock. Transmission pathways between and within species should be assessed to help in the development of efficient mitigation strategies against Leptospira., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Moinet et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Early peritoneal dialysis catheter (PDC)-related complications are frequent and make an important contribution to long-term PD survival. We aimed to analyse the incidence and specific causes of early PDC-related complications., Methods: This study was conducted from January 2001 to December 2012, utilising the New Zealand PD Registry (NZPDR) data. The objectives of this study were to analyse the incidence and causes of PDC-related complications within 4 weeks and 3 months of insertion. A logistic regression analysis was conducted to analyse any demographic or clinical risk factors of early PDC-related complications., Results: Of the 2573 PDC insertions during this period, majority 88% were surgically inserted. The number of complication within 4 weeks ranged from minimum of 20% to a maximum of 34% annually, with infections and flow dysfunctions leading the causes. There has been a minor drop in the infection rates from 19 to 16% (p = 0.21), and flow dysfunction from 12 to 9% (p = 0.16), from 2001 to 2012. A reduced odds of early complication was noted in elderly individuals above 60 years age, with odds ratio of (OR) of 0.73 (95% CI 0.53-0.99), while as higher odds of early complications were recorded in female gender, OR 1.41 (95% CI 1.06-1.88). Of the 10% of patients who failed to initiate PD within 90 days, flow dysfunction contributed to 32%, followed by infectious and surgical causes in 16% and 15%, respectively. The median time from insertion of PDC to initiation of PD was 17 days (interquartile range of 14-24 days) CONCLUSIONS: Improvements in PDC insertion techniques and reduction in infection rates may result in improvements in long-term PD technique survival., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V. part of Springer Nature.)

Aims: This study describes 47 presentations of suspected leptospirosis in general practice in New Zealand. Our primary aim was to assess the laboratory diagnosis of leptospirosis in these patients, by comparing polymerase chain reaction (PCR) tests, microscopic agglutination test (MAT) and culture results., Methods: Patients suspected of leptospirosis were recruited from general practices in the Waikato (n=17) and Wairoa (n=30) between August 2011 and June 2015. Blood and urine samples were tested for leptospirosis at two diagnostic laboratories and one research laboratory using PCR tests, MAT and culture., Results: Forty-seven patients were recruited for this study: 37 during the acute phase of the illness (within 10 days of symptom onset) and 10 after the acute phase. Eleven of the acute phase patients (11/37, 30%) and two of the later phase patients (2/10, 20%) returned positive leptospirosis test results. The 11 acute phase leptospirosis positive patients had the following positive diagnostic tests: PCR and paired MAT (+/- blood culture) (n=3), PCR only (+/- blood culture) (n=4), paired MAT only (n=3) and blood culture only (n=1). Urine PCR (performed only on Wairoa patients) was the only positive test for two of these patients., Conclusion: About a quarter of farm workers and meat workers presenting to general practice with flu-like symptoms will have leptospirosis, but they will not be diagnosed unless appropriately tested, and then they may only test positive for some of the tests available. To increase the likelihood of making a diagnosis, clinicians should order multiple laboratory tests, including blood and urine PCR and a paired MAT., Competing Interests: Nil.

This study aimed to evaluate risk factors associated with shedding of pathogenic Leptospira species in urine at animal and herd levels. In total, 200 dairy farms were randomly selected from the DairyNZ database. Urine samples were taken from 20 lactating, clinically normal cows in each herd between January and April 2016 and tested by real-time polymerase chain reaction (PCR) using gyrB as the target gene. Overall, 26.5% of 200 farms had at least one PCR positive cow and 2.4% of 4000 cows were shedding Leptospira in the urine. Using a questionnaire, information about risk factors at cow and farm level was collected via face-to-face interviews with farm owners and managers. Animals on all but one farm had been vaccinated against Hardjo and Pomona and cows on 54 of 200 (27%) farms had also been vaccinated against Copenhageni in at least one age group (calves, heifers and cows). Associations found to be statistically significant in univariate analysis (at P < 0.2) were assessed by multivariable logistic regression. Factors associated with shedding included cattle age (Odds ratio (OR) 0.82, 95% CI 0.71-0.95), keeping sheep (OR 5.57, 95% confidence interval (CI) 1.46-21.25) or dogs (OR 1.45, 95% CI 1.07-1.97) and managing milking cows in a single as opposed to multiple groups (OR 0.45, 95% CI 0.20-0.99). We conclude that younger cattle were more likely to be shedding Leptospira than older cattle and that the presence of sheep and dogs was associated with an increased risk of shedding in cows. Larger herds were at higher risk of having Leptospira shedders. However, none of the environmental risk factors that were assessed (e.g. access to standing water, drinking-water source), or wildlife abundance on-farm, or pasture were associated with shedding, possibly due to low statistical power, given the low overall shedding rate.

Leptospira infection in dairy cattle and leptospirosis in dairy farm workers were common in New Zealand prior to the introduction of dairy cattle vaccination in the 1980s. Despite widespread vaccination within the dairy industry, the long-term effectiveness of vaccination and current Leptospira exposure status remained unknown. A cross-sectional study was conducted from January-April 2016 to investigate the prevalence of pathogenic Leptospira spp. DNA in urine at cow and herd level, and its relationship to five Leptospira serovars known to be endemic. Two hundred dairy farms were randomly selected from the national database. Twenty paired blood and urine samples were collected on each farm from adult cows (n = 4000). Sera were tested using the Microscopic Agglutination Test against serovars Hardjobovis (termed Hardjo), Pomona, Copenhageni, Ballum and Tarassovi with titres ≥48 being considered positive. Urine was tested using quantitative real-time PCR (qPCR) that amplifies the gryB gene. All but one herd had been vaccinated with a bivalent Hardjo/Pomona or trivalent vaccine incorporating Copenhageni. In total, 2.4% of cows were urine qPCR positive and 27% of farms had at least one urine qPCR positive cow. Overall 63% of cows were seropositive to one or more serovars: 44% for Hardjo, 28% for Pomona, 15% for Copenhageni (in vaccinated herds), and for unvaccinated cows: 1% for Copenhageni, and 3% for Ballum and 17% for Tarassovi. Of the 94 qPCR urine-positive cows, 51 were seropositive to Tarassovi, 3 to Ballum, 3 to Copenhageni, 24 to Hardjo, and 17 to Pomona, the latter two presumably reflecting vaccination titres. A strong association was found between shedding and serology for Tarassovi. While there was no evidence that current vaccination programmes were ineffective in protecting against their target serovars, serovar Tarassovi has apparently emerged in NZ dairy cattle. As Tarassovi is currently not included in vaccines and is prevalent in notified leptospirosis cases in dairy workers, we concluded that this serovar poses a public health risk., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Aim: To characterize mutations in penA , mtrR , ponA , and porB IB , considered target genes for antimicrobial resistance, in Neisseria gonorrhoeae isolates with elevated minimum inhibitory concentrations (MICs) of ceftriaxone cultured from patients in New Zealand. Results: Out of 28 isolates supplied by the Institute of Environmental Science and Research Limited (ESR), Porirua, New Zealand, 14 were found to show reduced susceptibility to ceftriaxone (MIC of 0.06 mg/L) according to criteria used by the ESR and the Australian Gonococcal Surveillance Programme (AGSP) when tested in our laboratory. Rates of resistance to ciprofloxacin, azithromycin, penicillin, and tetracycline were 100% (28/28), 7% (2/28), 36% (10/28), and 25% (7/28), respectively. Ten different penA (Penicillin binding protein 2 [PBP2]) sequences were observed. The most common mosaic penA M-1 resembled mosaic penA XXXIV, which has been associated with ceftriaxone treatment failures in other countries. Four semimosaic PBP2 sequences were observed and may be novel PBP sequences, while four out of five nonmosaic PBP2 sequences were similar to PBP2 sequences reported in Australia. Twenty-one isolates harbored mutations in all 4 genes ( penA , mtrR , porB IB , and ponA ), and 13 of these exhibited reduced susceptibility to ceftriaxone. Conclusion: Mutations in penA , mtrR , porB IB , and ponA observed in this study may have contributed to reduced susceptibility to ceftriaxone among New Zealand gonococcal isolates. Over half (16/22) of mosaic penA sequences from the gonococcal isolates resembled penA XXXIV.

Aim: We report a quantification and visualisation of the association between the time to notify public health service (PHS) and the duration and size of institutional gastroenteritis outbreaks, and explore the seasonality and trend of the outbreaks., Method: Descriptive analysis was performed on institutional gastroenteritis outbreak data from a North Island PHS (1 January 2009-31 December 2014). Time-series analysis was used to explore the seasonality and trend of outbreaks. Multivariate analyses were performed to quantify the association between the time to notify PHS and the duration and size of outbreaks., Results: One hundred and seventy-five gastroenteritis outbreaks (from 58 facilities) were included in descriptive analyses. A significant increasing trend (p=0.01) without seasonal pattern was confirmed by time-series analysis. Shorter notification time was associated with shorter duration and smaller size of outbreaks, eg, duration of outbreaks when time to notify was ≥7 days, was 3.4 days (p=0.001, 95% CI=3.1-3.7) longer than baseline time to notify (0-1 day)., Conclusion: Prompt notification to the PHS appears to be a factor associated with reduced outbreak duration and size., Competing Interests: Nil.

Background: Additive Bayesian Network (ABN) is a graphical model which extends Generalized Linear Modelling (GLM) to multiple dependent variables. The present study compares results from GLM with those from ABN analysis used to identify factors associated with Leptospira interrogans sv Pomona (Pomona) infection by exploring the advantages and disadvantages of these two methodologies, to corroborate inferences informing health and safety measures at abattoirs in New Zealand (NZ)., Methodology and Findings: In a cohort study in four sheep slaughtering abattoirs in NZ, sera were collected twice a year from 384 meat workers and tested by Microscopic Agglutination with a 91% sensitivity and 94% specificity for Pomona. The study primarily addressed the effect of work position, personal protective equipment (PPE) and non-work related exposures such as hunting on a new infection with Pomona. Significantly associated with Pomona were "Work position" and two "Abattoirs" (GLM), and "Work position" (ABN). The odds of Pomona infection (OR, [95% CI]) was highest at stunning and hide removal (ABN 41.0, [6.9-1044.2]; GLM 57.0, [6.9-473.3]), followed by removal of intestines, bladder, and kidneys (ABN 30.7, [4.9-788.4]; GLM 33.8, [4.2-271.1]). Wearing a facemask, glasses or gloves (PPE) did not result as a protective factor in GLM or ABN., Conclusions/significance: The odds of Pomona infection was highest at stunning and hide removal. PPE did not show any indication of being protective in GLM or ABN. In ABN all relationships between variables are modelled; hence it has an advantage over GLM due to its capacity to capture the natural complexity of data more effectively., (Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.)

The aims of this study were to determine the annual incidence of infection with Leptospira interrogans serovar Pomona and/or Leptospira borgpetersenii serovar Hardjo and its association with influenza-like illness (ILI) in meat workers in New Zealand. Sera were collected twice, 50-61 weeks apart, from 592 workers at eight abattoirs slaughtering sheep (n = 4), cattle (n = 2) and deer (n = 2), and tested by the microscopic agglutination test for Hardjo and Pomona. Forty-nine (8·3%) participants either seroconverted or had at least a twofold increased serological titre against either serovar. The worker infection risk was higher in sheep abattoirs (11·9%) than in abattoirs processing deer (0%) or cattle (1·2%) (P < 0·01). The annualized risk of mild (ILI) or severe clinical disease attributable to the two Leptospira serovars was 2·7%. This study has demonstrated that meat workers are at substantial risk of infection and clinical disease, suggesting further investigation of infection sources and preventive measures are warranted.

Background: Chronic kidney disease is common in Pasifika people with type 2 diabetes. Lowering blood pressure (BP) and reducing proteinuria may slow the rate of progression of renal disease., Method: We conducted a 2-year study in patients with type 2 diabetes with estimated glomerular filtration rate (eGFR) greater than or equal to 40 ml/mmin/1.73 m² and urinary albumin-creatinine ratio (ACR) greater than or equal to 40 mg/mmol to evaluate a community-based programme aimed at optimising BP. Primary outcomes included BP reduction, remission of albuminuria and change in eGFR., Results: Thirty-nine of 47 patients completed greater than or equal to 17 months of intervention. The mean age was 53 plus or minus 8 years; 77% were male. An increase in antihypertensive therapy intensity was accompanied by a median (IQR) reduction in BP of 13[-1.5-22.5)/ 12(1-19) mmHg p<0.05] and urinary ACR (51(20-97) vs. 126(65-194) mg/mmol, p<0.05). Twelve (28%) of 43 patients achieving remission of albuminuria had a faster eGFR loss in the first year compared to the non-remitting group [13.6(4.0-16.6) vs. 3.5(-0.97-7.5) ml/min/1.73 m²/year, (p=0.02), but the rate of loss slowed in the second year. Two patients reached ESRF., Concluison: This community-based programme was effective in lowering BP and urinary ACR. In patients who achieved remission of albuminuria, a slower eGFR decline was observed after 12 months.

Aims: To determine the seroprevalence and quantify putative risk factors for exposure to leptospirosis both within and outside the veterinary curriculum among undergraduate veterinary students at Massey University, New Zealand., Methods: A cross-sectional study was conducted from September 2010 to November 2011. In total, 302 students were blood sampled, with serum tested by microscopic agglutination test (MAT) for antibodies to Leptospira borgpetersenii serovars Hardjobovis, Leptospira interrogans Pomona and Leptospira borgpetersenii Ballum. Information on demographic characteristics, potential exposure within and outside the veterinary curriculum in the previous 18 months, and previous leptospirosis-like clinical history were recorded using an online questionnaire., Results: All students were MAT negative for each serovar, using a cut-point of ≥1:48. Potential exposure to animal urine within and outside the veterinary curriculum was reported by 259/302 (85.8%) and 150/302 (49.7%) of the students, respectively. The median number of potential exposures to animal urine by each student within the veterinary curriculum in the previous 18 months was 63 (min 1, max 155). The other potential exposures among respondents included home slaughter (63/302; 20.9%), hunting (43/302; 14.2%) and outdoor activities involving exposure to fresh water (241/302; 79.8%)., Conclusions: This study demonstrated that these veterinary students were at low risk of contracting leptospirosis, despite frequent exposure to potential sources of infection. The findings in this study contribute to a broader understanding of the occupational risk of leptospirosis. Data describe the level of animal exposure in veterinary students, which can support other zoonotic disease studies in this group.

Aim: To investigate the seroprevalence of Leptospira spp. serovars Hardjo-bovis and Pomona on deer and mixed deer, sheep and/or beef cattle farms in the lower North Island of New Zealand and to examine associations between putative risk factors for seropositive deer herds., Methods: Serological screening was conducted on 19 commercial deer farms, 16 with sheep and/or beef cattle, between August and October each year between 2006 and 2008. No leptospiral vaccination had been conducted on the farms. On each farm every year, serum samples were collected from a random sample of 20 or more rising 2-year-old replacement animals from each species. The microscopic agglutination test (MAT) was used to detect leptospiral antibodies against Leptospira borgpetersenii serovar Hardjo-bovis and Leptospira interrogans serovar Pomona. For both serovars, a titre of ≥1:48 was considered positive and a herd was considered seropositive if >3 of 20 serum samples were positive. Information on potential herd-level risk factors for deer herds being seropositive was obtained from a questionnaire completed by the farm owner or manager., Results: The mean percentage of deer, cattle and sheep herds seropositive for Hardjo-bovis alone over 3 years was 42%, 53% and 54%, respectively, and for serovar Pomona was 7%, 5% and 0%, respectively. Antibodies to both serovars were found in 23%, 16% and 10% of deer, cattle and sheep herds, respectively. At the individual animal level, 228/1,107 (21%) deer, 308/767 (40%) cattle and 369/1,244 (30%) sheep were seropositive for Hardjo-bovis, 102 (9%) deer, 51 (7%) cattle and 23 (2%) sheep were seropositive for Pomona, and 49 (4%) deer, 28 (4%) cattle and 18 (1%) sheep were seropositive for both serovars. Deer herds were more likely to be seropositive for Hardjo-bovis in 2006 than 2008 (p=0.008), when seropositive in the preceding year (p=0.016) and on hilly compared with flat topography (p<0.001). Deer herds were more likely to be seropositive for Pomona when seropositive in the preceding year (p=0.016), when co-grazing with sheep flocks that were seropositive for Pomona (p<0.001), and when herds had a closed- compared with open-herd replacement policy (p<0.001)., Conclusions: Exposure to Leptospira spp. was widely distributed in deer, sheep and beef cattle in the lower North Island of New Zealand. Co-grazing of deer with sheep that were seropositive was a potential risk factor for deer herds to be seropositive.

Aims: To undertake a pilot study to measure the sero-prevalence to Leptospira serovars Hardjo and Pomona in an occupationally exposed group. To evaluate worker age, sex and previous clinical episodes of leptospirosis as risk factors for sero-positivity., Methods: A cross-sectional sero-prevalence study was conducted in February and March 2008 at a predominantly sheep slaughterhouse in Hawke's Bay, New Zealand. A single blood sample was collected from 242 meatworkers, comprising 145 men and 97 women. Sera were tested by the Microscopic Agglutination Test (MAT) with a titre cut point of 1:24, using serovars Pomona and Hardjo as antigens. Age, sex, and details of previous clinical episodes of leptospirosis were recorded., Results: Overall sero-prevalence was 9.5%. Ten (4.1%) workers were positive to serovar Hardjo (titres 1:24-1:192), 13 (5.4%) were positive to serovar Pomona (titres 1:24-1:768), and one worker was positive for both serovars. Sero-prevalence was 13.1% and 4.1% in men and women, respectively. The median age for sero-positive workers was 54 years while that for sero-negative workers was 48 years. Twenty-three workers (9.5%) reported a leptospirosis disease episode 1-35 years previously, and 14 of those were sero-positive in the current study., Conclusion: The sero-prevalence observed suggests significant exposure to leptospirosis from sheep in meatworkers in the slaughterhouse studied. This sero-prevalence was similar to that reported in a survey in 1982. Further study is needed to determine the link between sero-prevalence and incidence, whether the prevalence of leptospirosis is similar in other slaughterhouses, and to develop a better understanding of risk factors important for the reduction of exposure of this occupationally acquired disease.

In many countries relatively high notification rates of campylobacteriosis are observed in children under 5 years of age. Few studies have considered the role that environmental exposure plays in the epidemiology of these cases. Wild birds inhabit parks and playgrounds and are recognized carriers of Campylobacter, and young children are at greater risk of ingesting infective material due to their frequent hand-mouth contact. We investigated wild-bird fecal contamination in playgrounds in parks in a New Zealand city. A total of 192 samples of fresh and dried fecal material were cultured to determine the presence of Campylobacter spp. Campylobacter jejuni isolates were also characterized by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST), and the profiles obtained were compared with those of human isolates. C. jejuni was isolated from 12.5% of the samples. MLST identified members of clonal complexes ST-45, ST-682, and ST-177; all of these complexes have been recovered from wild birds in Europe. PFGE of ST-45 isolates resulted in profiles indistinguishable from those of isolated obtained from human cases in New Zealand. Members of the ST-177 and ST-682 complexes have been found in starlings (Sturnus vulgaris) in the United Kingdom, and these birds were common in playgrounds investigated in New Zealand in this study. We suggest that feces from wild birds in playgrounds could contribute to the occurrence of campylobacteriosis in preschool children. Further, the C. jejuni isolates obtained in this study belonged to clonal complexes associated with wild-bird populations in the northern hemisphere and could have been introduced into New Zealand in imported wild garden birds in the 19th century.

Aims: There is limited information on the effects of smoking behaviour on mortality in patients with end-stage renal failure (ESRF). This study aimed to assess the interaction of smoking on death rate in patients with renal failure on dialysis., Methods: All patients (n=1293) commencing peritoneal dialysis between 1985 and 1995 for renal failure in New Zealand were prospectively followed 6 monthly until 1997 and data entered on the National database. Mortality rates were calculated from the national database and rates in patients with diabetes compared with those without diabetes and in those who did or did not smoke., Results: Follow-up data was available on all patients for a range of 20-40 months. 35% of the patients were clinically classified as having diabetic nephropathy as the cause of renal failure (11% type 1, 24% type 2). Seventeen percent of the total cohort were current smokers, 45% former smokers and 38% lifetime non smokers at dialysis commencement. These rates were similar between patients with diabetes (18% current, 51% former, 32% non-smoker) and those without diabetes (17% current, 42% former, 41% non-smoker). At survey end in 1997, 43% of the patients without diabetes had died compared with 59% of patients with type 1 diabetes (p<0.05) and 62% of patients with type 2 diabetes (p<0.05). The age-adjusted mortality of patients with a history of current or former smoking was higher than non-smokers. Those patients with diabetes and a history of smoking had even higher mortality., Conclusions: Patients with a current or former history of smoking on peritoneal dialysis are at greatly increased risk of death. A strategy of aggressive smoking cessation efforts should be adopted for these patients at the earliest opportunity.

Background: Factors that predict peritoneal transport status in peritoneal dialysis (PD) patients are poorly understood. The aim of the present study is to determine these factors in Australian and New Zealand incident PD patients., Methods: The study included all patients on the Australian and New Zealand Dialysis and Transplant Registry who started PD therapy between April 1, 1991, and March 31, 2002, and underwent a peritoneal equilibration test (PET) within the first 6 months. Predictors of peritoneal transport category and dialysate-plasma creatinine ratio at 4 hours (D-P Cr 4h) were assessed by multivariate ordinal logistic regression and multiple linear regression, respectively., Results: A total of 3,188 patients were studied. Mean D-P Cr 4h was 0.69 +/- 0.13. High transport status was associated with older age (adjusted odds ratio [OR], 1.08 for each 10 years; 95% confidence interval [CI], 1.03 to 1.13), Maori and Pacific Islander racial origin (OR, 1.48; 95% CI, 1.13 to 1.94), and normal body mass index (BMI; < 18.5 kg/m2: OR, 0.90; 95% CI, 0.65 to 1.24; BMI of 18.5 to 25 kg/m2: OR, 1 [reference]; BMI of 25 to 30 kg/m2: OR, 0.81; 95% CI, 0.70 to 0.95; BMI > 30 kg/m2: OR, 0.71; 95% CI, 0.58 to 0.86), but was not independently predicted by sex, diabetes, other comorbid diseases, smoking, previous hemodialysis therapy or transplantation, or residual renal function. Similar results were found when peritoneal permeability was modeled as a continuous variable (D-P Cr 4h)., Conclusion: In Australian and New Zealand PD patients, higher peritoneal transport status is independently associated with racial origin, older age, and lower BMI. The diversity of peritoneal transport characteristics in different ethnic populations suggests that additional validation of PET measurements in various racial groups and study of their relationship to patient outcomes are warranted.

Background: The psychological processes involved in the delay between noticing breast symptoms and seeking medical care are not well understood., Methods: We evaluated 85 women referred to a specialist breast clinic prior to their clinic appointment. We assessed the relationship between delay and the type of breast symptom, immediate emotional response to the symptom, perceived risk of breast cancer, fear of breast cancer treatment, and disclosure of the breast symptom to others., Results: Delay was unrelated to demographic factors but was related to the type of breast symptom; women who had a breast lump waited a significantly shorter time period before visiting the doctor than those without a breast lump. Initial symptom distress on the discovery of the breast symptom was also significantly related to delay. Knowledge of a friend or family member with breast cancer, perceived risk of breast cancer and fear of breast cancer treatment, and disclosure of the symptom to a partner or other person were all unrelated to delay., Conclusions: The results show the importance of the type of symptom and initial emotional distress in delay and highlight the importance of widening public perceptions of breast symptoms other than breast lumps in order to reduce delay times.

Recipients of live related and first cadaveric renal allografts were retrospectively reviewed before and after institution of a standardized regimen incorporating greater immunosuppression, (by the addition of antilymphocyte preparations). The two review groups were comparable with 11 live related and 27 first cadaver grafts in each. Despite a small advantage in terms of graft survival and diminished rejection, this was at the expense of septic morbidity. The implications of this are discussed.