Search

Background and Objectives We investigated the demographic, social and clinical characteristics associated with employment status and income for people with multiple sclerosis ( MS) in New Zealand ( NZ). Methods The NZ National MS Prevalence study included all persons resident in NZ on census day 2006 diagnosed with MS (96.7% coverage). Factors associated with employment and income status among the working age population (25-64 years) were identified by linear regression. Results Over 90% of working age people with MS (n=1727) had a work history, but 54% were not working. Work loss occurred early in the disease course, and at low disability ( P<.001). Advancing age, progressive disease, longer disease duration, higher disability levels, partner loss and lower education were associated with work loss ( P<.001). Working age people with MS had lower income than the NZ population ( P<.0001). Higher qualifications yielded no additional income for MS females and about half the additional income for MS males ( P<.0001). Conclusions MS profoundly reduces employment and income early in the disease course, and at low levels of disability, however, unemployment is not entirely accounted for by clinical, social and demographic factors. These findings suggest social supports should be explored early in the disease course to reduce loss of income and unemployment for people with MS. [ABSTRACT FROM AUTHOR]

Background Chronic lymphocytic leukaemia ( CLL) is associated with an increased incidence and aggressiveness of skin cancers, particularly cutaneous squamous cell carcinoma ( cSCC), but little is known about cSCC incidence in Australasian CLL patients. Aim In this retrospective study, we analysed the incidence of cSCC in patients seen at a tertiary hospital in New Zealand ( NZ). Methods We retrospectively assessed the clinical history and histology data of CLL patients ( n = 371) who presented to the Haematology Department, Christchurch Hospital, NZ during the period 1996-2015. Baseline characteristics, incidence of second cancers, treatment details and overall survival were analysed. Results During follow-up (median = 11.8 years), 221 second cancers were recorded in 88 patients. Of these cancers, 185 were cSCC, removed from 61 patients. In 56% of these patients, >1 cSCC was removed, and the majority of cSCC occurred following the treatment for CLL. The cumulative incidence of a first cSCC was 11% at 5 years, whereas the cumulative incidence of a subsequent cSCC was 88% at 5 years. The incidence of cSCC in male patients was threefold higher than that reported for the general NZ population. Conclusion NZ CLL patients have a high incidence of cSCC relative to the levels observed in the general population, which are themselves among the highest in the world. The careful monitoring of CLL patients is warranted, particularly those who have a progressive disease or have had a first cSCC removed. [ABSTRACT FROM AUTHOR]

Aim This retrospective study compares the overall survival ( OS) of multiple myeloma ( MM) patients following treatment at a New Zealand hospital over a period in which novel therapies were available but restricted, almost exclusively, to thalidomide as a second-line therapy. Methods Clinical, laboratory and OS data were collected on 361 MM patients who were treated at Christchurch Hospital during 2000-2010. Patients were subdivided according to the clinical criteria used to determine front-line treatment decisions. Older patients (age ≥66, n = 180) generally received standard-dose chemotherapy without autologous stem cell transplant ( SCT) and formed one group. Younger patients were further subdivided according to whether they received autologous SCT ( n = 89), allogeneic SCT ( n = 24) or no SCT ( n = 68). Results Older patients had a significantly shorter OS ( P < 0.0001) than younger patients (median OS = 25 vs 78 months) however treated. Analysis of relative survival demonstrated that the increased mortality of older patients was greater than that attributable to normal ageing. Younger patients who received no transplant had a significantly shorter OS ( P < 0.0001) than those who received autologous SCT or allogeneic SCT with 5-year survivals of 38%, 70% and 72% respectively. Use of novel therapies was significantly higher in younger than older patients (60% vs 47%, P = 0.011). Conclusions The front-line treatment groupings of hospital MM patients had significantly different survivals. The OS of SCT ineligible patients remains poor despite the introduction of thalidomide. [ABSTRACT FROM AUTHOR]

Background Identifying eligible individuals for a prevalence survey is difficult in the absence of a disease register or a national population register. Aim To develop a method to identify and invite eligible individuals to participate in a national prevalence survey while maintaining confidentiality and complying with privacy legislation. Methods A unique identifier (based on date of birth, sex and initials) was developed so that database holders could identify eligible individuals, notify us and invite them on our behalf to participate in a national multiple sclerosis prevalence survey while maintaining confidentiality and complying with privacy legislation. Results Several organisations (including central government, health and non-governmental organisations) used the method described to assign unique identifiers to individuals listed on their databases and to forward invitations and consent forms to them. The use of a unique identifier allowed us to recognise and record all the sources of identification for each individual. This prevented double counting or approaching the same individual more than once and facilitated the use of capture-recapture methods to improve the prevalence estimate. Capture-recapture analysis estimated that the method identified over 96% of eligible individuals in this prevalence survey. Conclusions This method was developed and used successfully in a national prevalence survey of multiple sclerosis in New Zealand. The method may be useful for prevalence surveys of other diseases in New Zealand and for prevalence surveys in other countries with similar privacy legislation and lack of disease registers and population registers. [ABSTRACT FROM AUTHOR]

Background: The incidence of early-onset colorectal cancer (EOCRC), diagnosed before age 50, has been rising in many countries in the past few decades. This study aims to evaluate this trend in Aotearoa New Zealand and assess its impact on Māori., Methods: Crude incidence and age-standardized incidence of colorectal cancer (CRC) was analyzed from all new cases from the Aotearoa New Zealand national cancer registry for the period 2000-2020. Trends were estimated by sex, ethnicity, age group and location of cancer and projections made to 2040., Results: Between 2000 and 2020, there were a total of 56,761 cases of CRC diagnosed in Aotearoa New Zealand, 3,702 of these being EOCRC, with age-standardized incidence decreasing significantly (P = 8.2 × 10 - 80 ) from 61.0 to 47.3 cases per 100,000. EOCRC incidence increased on average by 26% per decade (incidence rate ratio (IRR) 1.26, p = < 0.0001) at all sites (proximal colon, distal colon and rectum), while the incidence in those aged 50-79 years decreased on average by 18% per decade (IRR 0.82, p = < 0.0005), again across all sites. There was no significant average change in CRC incidence in those over 80 years. In Māori, there was no significant change in age-standardized incidence. There was however a significant increase in crude incidence rates (IRR 1.28, p = < 0.0005) driven by significant increases in EOCRC (IRR1.36, p = < 0.0005). By 2040, we predict the incidence of EOCRC will have risen from 8.00 to 14.9 per 100,000 (6.33 to 10.00 per 100,000 in Māori). However, due to the aging population an estimated 43.0% of all CRC cases will be diagnosed in those over 80 years of age (45.9% over 70 years of age in Māori)., Conclusion: The age-standardized incidence of CRC from 2000 to 2020 decreased in Aotearoa New Zealand, but not for Māori. The incidence of EOCRC over the same period continues to rise, and at a faster rate in Māori. However, with the ageing of the population in Aotearoa New Zealand, and for Māori, CRC in the elderly will continue to dominate case numbers., (© 2024. The Author(s).)

Purpose: To describe access to and engagement with cervical and breast screening services for women who are Deaf or live with a physical or sensory disability in Aotearoa New Zealand (NZ)., Method: We carried out an online survey on a convenience sample of 84 women. Tests of association were undertaken between socio-demographics and cervical and breast screening; and between disability type, and health outcomes and barriers to screening respectively. Participants also reported specific barriers to screening., Results: Living without family/partner and unemployment were associated with never having a cervical smear. Non-English preferred language, and urban residence were related to lower levels of breast self-examination; having insufficient income was related to never having a mammogram. Disability type was not related to either smear or mammogram on eligibility, uptake ever, or uptake timeframe. A higher proportion of those with multiple disability types experienced service environment barriers to having a cervical smear. Specific barriers to screening covered accessibility, service environment, and information., Conclusions: This study, unique in Aotearoa, provides insights into disabled women's access to and engagement with screening services and suggests factors that may inhibit or facilitate participation. Women with multiple disabilities may be disadvantaged in the seeking and delivery of screening.Implications for rehabilitationRehabilitation and other practitioners need to be attuned to how women living with multiple disabilities may be disadvantaged in the seeking of, and, more importantly, the delivery of breast or cancer screening.Practitioners need to discuss with disabled women what supports or resources they need to have screening procedures, and to advocate for these supports for their clients.Practitioners need to ensure accessibility that encompasses the whole screening journey from the initial invitation to the obtaining of results.For practitioners to be able to provide equitable service delivery, the government and institutional policies and procedures that are developed must take into consideration the multiple needs of women living with disabilities.

Pacific youth in New Zealand have a disproportionately high risk for gambling and gang involvement compared with New Zealand European youth. Limited evidence indicates that youth gang involvement is associated with problem gambling; no research shows if it is associated with gambling. We conducted exploratory secondary analyses of data from 1063 Pacific youth and their mothers using data from two time points (age nine and 14 years) from a longitudinal cohort study. Gang involvement at age nine years was significantly associated with gambling at age 14 years, with adjusted odds of 2.25 (95% CI [1.16, 4.37]). Of confounders, having a mother with a partner and Cook Islands ethnicity appeared protective against gambling at age 14 years. Despite some study limitations, as youth gambling can lead to subsequent adult problem gambling, our findings highlight the importance of understanding why Pacific youth join gangs, to inform public health policies to reduce the potential for future development of harmful behaviors.

Background: Diagnostic screening for pathogenic variants in breast cancer susceptibility genes, including BRCA1, BRCA2, PALB2, PTEN and TP53, may be offered to New Zealanders from suspected high-risk breast (and ovarian) cancer families. However, it is unknown how many high-risk pathogenic variant carriers in New Zealand are not offered genetic screening using existing triage tools and guidelines for breast (and ovarian) cancer patients., Methods: Panel-gene sequencing of the coding and non-coding regions of the BRCA1 and BRCA2 genes, and the coding regions and splice sites of CDH1, PALB2, PTEN and TP53, was undertaken for an unselected cohort of 367 female breast cancer patients. A total of 1685 variants were evaluated using the ENIGMA and the ACMG/AMP variant classification guidelines., Results: Our study identified that 13 (3.5%) breast cancer patients carried a pathogenic or likely pathogenic variant in BRCA1, BRCA2, PALB2, or PTEN. A significantly higher number of pathogenic variant carriers had grade 3 tumours (10/13) when compared to non-carriers; however, no other clinicopathological characteristics were found to be significantly different between (likely) pathogenic variant carriers and non-carriers, nor between variant of unknown significance carriers and non-carriers. Notably, 46% of the identified (likely) pathogenic variant carriers had not been referred for a genetic assessment and consideration of genetic testing., Conclusion: Our study shows a potential under-ascertainment of women carrying a (likely) pathogenic variant in a high-risk breast cancer susceptibility gene. These results suggest that further research into testing pathways for New Zealand breast cancer patients may be required to reduce the impact of hereditary cancer syndromes for these individuals and their families.

Competing Interests: Dr Hamilton reports non-financial support from High Performance Sport NZ during the conduct of the study; Dr Gerrard is the Chair of the Therapeutic Use Exemption Committee (TUEC) Drug-Free Sport New Zealand; Chair, World Anti-Doping Agency (WADA) TUE Expert Group; Chair, TUEC, World Rugby; Vice-Chair, Sports Medicine Committee, International Swimming Federation (FINA); Dr Fulcher reports personal fees from New Zealand Football during the conduct of the study; medical director for New Zealand Football; member of the FIFA Medical Committee; Dr Exeter is a contractor to High Performance Sport NZ; Dr Coleman is a contractor for medical services.

Background: Ulcerative colitis (UC) is a risk factor in developing colorectal cancer (CRC). Surveillance programmes aim to identify premalignant lesions to facilitate improved treatment outcomes. Recent studies have suggested that the risk of CRC in UC has decreased. This study aims to characterize the risk of CRC in UC in a population-based New Zealand cohort., Methods: All patients in the Canterbury Inflammatory Bowel Disease Study, a comprehensive population-based cohort, were reviewed and cases of dysplasia and CRC identified. Demographic data and risk factors were assessed and standardized incidence ratios (SIRs) calculated comparing with the national population., Results: A total of 518 UC cases were analysed (46.3% female). Median follow-up was 17.5 years (interquartile range 12.2-25.1 years). Neoplasia developed in 42 (8.1%) patients, 14 (2.7%) of whom had CRC. The mean age at CRC diagnosis was 63.3 years, and mean duration with UC before CRC 18.4 years (0-36.8 years). The total incidence rate was 1.35/1000 person-year duration (95% confidence interval 0.74-2.27). The age-adjusted SIR was 1.74 (95% confidence interval 1.03-2.93) compared to the New Zealand population. Risk factors for any dysplasia included disease extent and male gender., Conclusion: In this population-based cohort with long-term follow-up, the SIR of CRC in UC patients was significantly lower than the initial epidemiological studies although similar to more recent studies. This increased risk still justifies ongoing screening in the UC population., (© 2020 Royal Australasian College of Surgeons.)

An improved understanding of etiological mechanisms in Parkinson's disease (PD) is urgently needed because the number of affected individuals is projected to increase rapidly as populations age. We present results from a blood-based methylome-wide association study of PD involving meta-analysis of 229 K CpG probes in 1,132 cases and 999 controls from two independent cohorts. We identify two previously unreported epigenome-wide significant associations with PD, including cg06690548 on chromosome 4. We demonstrate that cg06690548 hypermethylation in PD is associated with down-regulation of the SLC7A11 gene and show this is consistent with an environmental exposure, as opposed to medications or genetic factors with effects on DNA methylation or gene expression. These findings are notable because SLC7A11 codes for a cysteine-glutamate anti-porter regulating levels of the antioxidant glutathione, and it is a known target of the environmental neurotoxin β-methylamino-L-alanine (BMAA). Our study identifies the SLC7A11 gene as a plausible biological target in PD.

Aims: To assess the incidence of chlamydial and gonorrhoeal neonatal conjunctivitis (CON and GON), across six district health boards in the greater Midland region of New Zealand., Methods: All positive nucleic acid amplification test (NAAT) eye swabs for Chlamydia trachomatis and NAAT and bacterial eye swabs for Neisseria gonorrhoeae in infants under one year of age were retrieved from three laboratories from 2013-2016. Incidence density rates were calculated using births information from Statistics New Zealand. A subgroup analysis of Waikato and Tairāwhiti cases were further analysed., Results: Calculated rates for the Greater Midland region are CON, 145.9 per 100,000 births/year and GON, 3.79 per 100,000 births/year. For Tairāwhiti and Waikato, the incidence of CON is 2.5 times greater in Māori than non-Māori (95% CI 1.3-5.1, P<0.01). There was no significant difference in mean NZDep13 for Māori vs non-Māori. Mean maternal age at birth was 20., Conclusions: Greater Midland region rates of CON and GON are higher compared to other international reported rates. For Tairāwhiti and Waikato, rates of CON are significantly higher in Māori than non-Māori, although there is no difference in mean NZDep13 scores between Māori and non-Māori. CON appears to be a condition of babies of young mothers with higher deprivation., Competing Interests: Nil.

Low vitamin D status is associated with increased risk of pneumonia, greater disease severity and poorer outcome. However, no trials have examined the effect of adjunctive vitamin D therapy on outcomes in adults with community-acquired pneumonia (CAP). We conducted a randomised, double-blind, placebo-controlled trial examining the effects of adjunctive vitamin D in adults hospitalised with CAP. Participants were randomised to either a single oral dose of 200,000 IU vitamin D 3 or placebo. The primary outcome was the complete resolution of chest radiograph infiltrate at 6 weeks post-study treatment. Secondary outcomes included length of hospital stay, intensive care admission and return to normal activity. Only participants who completed the study or died within the 6 week period were included in the analysis (n = 60 vitamin D, n = 57 placebo). Adjunctive vitamin D did not have any effect on the primary outcome (OR 0.78, 95% CI 0.31 to 1.86, p = 0.548). However, there was evidence it increased the complete resolution of pneumonia in participants with baseline vitamin D levels <25 nmol/L (OR 17.0, 95% CI 1.40-549.45, P = 0.043), but this did not reach statistical significance using exact methods (OR 13.0, 95%CI 0.7-960.4, P = 0.083). There were no significant effects for any secondary outcome.

Background and Objectives: The home food environment is known to influence children's diet and selected health outcomes. However, similar research in adults is scarce. The home is arguably the most important food environment for New Zealand adults as the majority of food consumed is stored and prepared in the home. Therefore we investigated relationships between home food availability and nutrient intake in 50 year olds from Canterbury, New Zealand., Methods and Study Design: A cross-sectional study where participants completed a home food inventory and a four-day estimated food diary. Regression analysis was used to investigate relationships between home availability of 'Fruit and Vegetables' and 'Obesogenic Foods' and intake of selected nutrients, adjusting for Body Mass Index and demographic factors. Men and women (n=216) aged 50 were randomly selected from Canterbury District Health Board area electoral rolls., Results: Women with a high 'Obesogenic Foods' score were significantly more likely to have a high intake of saturated fat (OR 5.8, CI: 1.67, 19.6) and high sugar intake (OR 3.1, CI: 1.23, 7.58). Men with a high 'Obesogenic Foods' score were less likely to have high folate (OR 0.14, CI: 0.05, 0.40) and fibre intake (OR 0.21, CI: 0.07, 0.60). Men and women with a higher 'Fruit and Vegetables' score were more likely to have high vitamin C intake (OR 5.6 and 4.5 respectively)., Conclusions: Home Food Inventory scores are associated with selected nutrient intakes, particularly in women, suggesting that they are useful for identifying those groups with less favourable nutrient intakes. Future research should investigate whether these scores can predict health outcomes.

Objectives: The purpose of this study is to observe the education and vocational achievements and social participation of cochlear implant recipients as they graduate from a paediatric cochlear implant programme and identify any significant associations that might exist., Method: This study identified 56 patients from the Southern Cochlear Implant Programme (SCIP) who received cochlear implants before the age of 19 (paediatric) and are now over the age of 19 (adult). A questionnaire investigated their education, employment, and identity with the hearing and deaf communities. Also included were the satisfaction with life scale and Hearing Participation Scale (HPS). Subjects ranged in age from 19 to 32., Results: Twenty-six patients responded to the questionnaire, including one non-user. Twenty identified strongly or very strongly with the hearing community. There was weak evidence of a linear association between strong identity with the hearing community and a higher HPS score. No other statistically significant associations were detected. Interestingly, 12 out of 26 participants found employment through family., Conclusion: Positive outcome trends in education and employment were seen in this study although no statistical significance was achieved. There is a strong bias for those who use their cochlear implants regularly, and there are no data available for those who do not use their cochlear implants for comparison as only one non-user completed the survey, despite efforts to include this group. This study shows that there is perceived benefit in implantation for patients who use it regularly but further research is needed with a more diverse group of cochlear implant recipients.

The effect of MHC polymorphism on individual fitness variation in the wild remains equivocal; however, much evidence suggests that heterozygote advantage is a major determinant. To understand the contribution of MHC polymorphism to individual disease resistance or susceptibility in natural populations, we investigated two MHC class II B loci, DQB and DRB, in the New Zealand sea lion (NZSL, Phocarctos hookeri). The NZSL is a threatened species which is unusually susceptible to death by bacterial infection at an early age; it has suffered three bacterial induced epizootics resulting in high mortality levels of young pups since 1997. The MHC DQB and DRB haplotypes of dead NZSL pups with known cause of death (bacteria, enteritis or trauma) were sequenced and reconstructed, compared to pups that survived beyond 2 months of age, and distinct MHC DRB allele frequency and genotype differences were identified. Two findings were striking: (i) one DRB allele was present only in dead pups, and (ii) one heterozygous DRB genotype, common in live pups, was absent from dead pups. These results are consistent with some functional relationship with these variants and suggest heterozygote advantage is operating at DRB. We found no association between heterozygosity and fitness at 17 microsatellite loci, indicating that general heterozygosity is not responsible for the effect on fitness detected here. This result may be a consequence of recurrent selection by multiple pathogen assault over recent years and highlights the importance of heterozygote advantage at MHC as a potential mechanism for fitness differences in wild populations., (© 2015 John Wiley & Sons Ltd.)

Though there is much agreement on the importance of the social determinants of health, debate continues on suitable empirically-based models to underpin efforts to tackle health and health care disparities. We demonstrate an approach that uses a dynamic micro-simulation model of the early life course, based on longitudinal data from a New Zealand cohort of children born in 1977, and counterfactual reasoning applied to a range of outcomes. The focus is on health service use with a comparison to outcomes in non-health domains, namely educational attainment and antisocial behaviour. We show an application of the model to test scenarios based on modifying key determinants and assessing the impact on putative outcomes. We found that appreciable improvement was only effected by modifying multiple determinants; structural determinants were relatively more important than intermediary ones as potential policy levers; there was a social gradient of effect; and interventions bestowed the greatest benefit to the most disadvantaged groups with a corresponding reduction in disparities between the worst-off and the best-off. Our findings provide evidence on how public policy initiatives might be more effective acting broadly across sectors and across social groups, and thus make a real difference to the most disadvantaged., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Aims: To examine the relationship between fructose and lactose consumption and irritable bowel syndrome (IBS) symptoms in 50-year-old adults residing in Canterbury, New Zealand., Methods: The Canterbury Health Ageing and Life Course (CHALICE) study is a study of 50-year-old Cantabrians. A 4-day estimated food and beverage diary (FBD) was completed by 227 participants, 75.7% of those recruited. The Birmingham IBS symptom questionnaire was administered and individual participant scores were calculated for constipation, diarrhoea, pain score, and total symptom score. Associations between symptoms and the intake of fructose and lactose were examined using binary logistic regression., Results: Greater mean daily intakes of fructose (P=0.05) and lactose (P=0.04) were associated with a lower prevalence of IBS pain symptoms after adjusting for demographics and social economic status. However there was no evidence of an association with constipation, diarrhoea or total IBS score., Conclusions: Although our data show inverse relationships between fructose and lactose intakes and IBS pain symptoms, the use of cross-sectional data do not allow us to determine causality in these relationships. However it is possible that participants may have reduced their intake of fructose and lactose in response to IBS related pain. Follow up of this cohort would allow us to determine if this is the case. Future research could also investigate whether people with IBS could benefit from guidance from a dietitian around consumption of high lactose or fructose-containing foods.

Aim: Cardiovascular disease is a leading cause of death in New Zealand, but risk factors may be decreased by consuming a heart healthy diet. This pilot study investigated whether participants met the guidelines for a heart healthy diet and whether a novel heart healthy dietary pattern could be identified using principal components analysis (PCA). The second aim of this project was to assess if higher education, standard of living and nutrition literacy are associated with a heart healthy dietary pattern., Method: This exploratory study was undertaken using data from the first participants enrolled in the Canterbury Health Ageing and Lifecourse study: an observational study of 50 year olds in the Canterbury District Health Board region. Eighty-two people were selected from the General and Maori electoral role and interviewed prior to the 22 February 2011 Christchurch Earthquake. PCA was conducted to identify dietary patterns, based on intake of specific nutrients as indicated by the New Zealand and international heart healthy dietary guidelines., Results: 62 participants completed questionnaires and an estimated food record. No participants met all five of the heart healthy dietary guidelines. One dietary pattern was produced by PCA: a "higher CVD risk" pattern. Regression analysis indicated that higher standard of living, education and nutrition literacy were inversely associated with a "higher CVD risk" pattern., Conclusion: Higher standard of living, education and nutrition literacy were associated with a healthier dietary eating pattern. However, as no participants met all the dietary recommendations more education and support is needed to help people meet these.

Financial restraints and poverty lead to poor diets and poor health outcomes. Limited research shows that socioeconomic status is related to home availability of certain foods. However, studies in this area have used different socio-economic indicators, which may not equally influence eating-related behaviors. Using multiple indicators of socio-economic status may provide a more accurate picture of these relationships. The aim of this study was to investigate whether several socio-economic indicators are independently associated with home availability of selected foods known to influence chronic disease risk in 50 year olds from Canterbury, New Zealand, participating in the CHALICE study. Participants were selected randomly from health research extracts from Canterbury. Data from 216 participants (110 females, 106 males) were included. The presence (but not quantity) of foods/beverages in the home was measured by a validated home food inventory. Linear regression analyses were performed for the following home food inventory scores: fruit, vegetables, lower fat dairy, obesogenic foods and sweetened beverages with household income, standard of living and education using multivariate models. Higher household income and standard of living were individually associated with a 2% to 3% higher fruit and vegetables (3 to 5 types/forms) and total food scores (6 to 9 types/forms) (p<0.03). Higher education level was associated with a 2.5% increase in fruit and vegetables score (4 types/forms) and an 8% decrease in sweetened beverages score (0.4 beverages) (p<0.02). These results suggest that using only one measure of socio-economic status cannot accurately capture the effects of social inequalities in food availability. Those experiencing the most social disadvantage had a lesser availability of fruit and vegetables which may be detrimental to good health.

Background: New Zealand (NZ) has a high prevalence of multiple sclerosis (MS). Worldwide, the prevalence of MS appears to be increasing., Objectives: To review all published prevalence studies undertaken in NZ to determine whether the prevalence of MS in NZ is increasing., Methods: PubMed, Medline, Scopus, Web of Knowledge, EMBASE, AMED and CINAHL were searched to identify studies reporting the prevalence of MS in NZ. Prevalence rates from the National MS Prevalence study in 2006 were compared with earlier prevalence rates for the same regions using Poisson regression., Results: Prevalence rates reported in the earlier regional studies ranged from 23.6 to 68.5/100,000 population; in the same regions in 2006, the range was 47.6-134.2/100,000 population. Prevalence rates were significantly increased in all regions studied except for the Bay of Plenty. The increase in prevalence was seen in both sexes. The sex ratio remained constant over time., Conclusions: In studies spanning almost 40 years (1968-2006), the prevalence of MS within the same regions of NZ has significantly increased whereas the sex ratio and latitudinal gradient have remained stable., (© 2014 S. Karger AG, Basel.)

Background: Surveying volunteer members of a multiple sclerosis registry is a very cost-effective way of assessing the impact of the disease on life outcomes. However, whether the data from such a study can be generalised to the whole population of persons living with MS in a country or region is unclear., Methods: Here we compare the demographic and disease characteristics of participants in one such study, the Australian Multiple Sclerosis Longitudinal Study (AMSLS), with two well-characterised MS prevalence studies with near-complete ascertainment of MS in their study regions., Results: Although some differences were found, these largely represented the effects of geography (sex ratios) and local factors (national immunomodulatory therapy prescribing requirements), and the cohorts were otherwise comparable. Overall, despite comprising only 12-16% of MS cases in Australia, the AMSLS is highly representative of the MS population., Conclusions: Therefore with some minor caveats, the AMSLS data can be generalised to the whole Australasian MS population. Volunteer disease registries such as this can be highly representative and provide an excellent convenience sample when studying rare conditions such as MS.

Aims: New Zealand's ageing population threatens the financial sustainability of our current model of health service delivery. The Canterbury Health, Ageing and Life Course (CHALICE) study aims to develop a comprehensive and flexible database of important determinants of health to inform new models. This paper describes the design, methodology, and first 300 participants of CHALICE., Methods: Commencing August 2010, CHALICE is a multidisciplinary prospective random cohort study and biobank of 1,000 Canterbury adults aged 49-51 years at inception, stratified by self-identified Maori (n=200) and non-Maori (n=800) ethnicity. Assessment covers sociodemographic, physical, cognition, mental health, clinical history, family and social, cardiovascular, and lifestyle domains. Detailed follow-up assessment occurs every 5 years, with a brief postal follow-up assessment undertaken annually., Results: For the first 300 participants (44 Maori, 256 non-Maori), the participation rate is 63.7%. Overall, 53.3% of participants are female, 75.3% are living in married or de facto relationships, and 19.0% have university degrees. These sociodemographic profiles are comparable with the 2006 Census, Canterbury region, 50-54 years age group percentages (50.7%, 77.2%, and 14.3%, respectively)., Conclusions: CHALICE has been designed to provide quality data that will inform policy development and programme implementation across a broad spectrum of health indicators.

Background: Treatment acceptance by patients is influenced by the way treatment effects are presented. Presentation of benefits using relative risk increases treatment acceptance compared to the use of absolute risk. It is not known whether this effect is modified by prior presentation of a patient's individualised risk estimate or how presentation of treatment harms by relative or absolute risk affects acceptance., Aim: To compare acceptance of a hypothetical treatment to prevent hip fracture after presentation of the treatment's benefit in relative or absolute terms in the context of a personal fracture risk estimate, and to reassess acceptance following subsequent presentation of harm in relative or absolute terms., Design and Setting: Randomised controlled trial of patients recruited from 10 GPs' lists in Christchurch, New Zealand., Method: Women aged ≥ 50 years were invited to participate. Participants were given a personal 10-year hip fracture risk estimate and randomised to receive information on a hypothetical treatment's benefit and harm in relative or absolute terms., Results: Of the 1140 women invited to participate 393 (34%) took part. Treatment acceptance was greater following presentation of benefit using absolute terms than relative terms after adjustment forage, education, previous osteoporosis diagnosis, and self-reported risk (OR 1.73, 95% confidence interval [CI] = 1.10 to 2.73, P = 0.018). Presentation of the treatment's harmful effect in relative terms led to a greater proportion of participants declining treatment than did presentation in absolute terms (OR 4.89, 95% CI = 2.3 to 11.0, P<0.001)., Conclusion: Presentation of treatment benefit and harm using absolute risk estimates led to greater treatment acceptance than presentation of the same information in relative terms.

Aim: To test for association of SLC11A1 with inflammatory bowel disease (IBD) and Mycobacterium avium subspecies paratuberculosis (MAP) status in a Caucasian cohort., Methods: five hundred and seven Crohn's disease (CD) patients, 474 ulcerative colitis (UC) patients, and 569 healthy controls were genotyped for SLC11A1 1730G>A and SLC11A1 469+14G>C using pre-designed TaqMan SNP assays. χ(2) tests were applied to test for association of single nucleotide polymorphisms (SNPs) with disease, and the presence of MAP DNA., Results: SLC11A1 1730G>A and SLC11A 1469+14G>C were not associated with CD, UC, or IBD. The SLC11A1 1730A minor allele was over-represented in patients who did not require immunomodulator therapy (P = 0.002, OR: 0.29, 95% CI: 0.13-0.66). The frequency of the SLC11A1 469+14C allele was higher in the subset of study participants who tested positive for MAP DNA (P = 0.02, OR: 1.56, 95% CI: 1.06-2.29). No association of SLC11A1 1730G>A with MAP was observed., Conclusion: Although SLC11A1 was not associated with IBD, association with MAP suggests that SLC11A1 is important in determining susceptibility to bacteria implicated in the etiology of CD.

Objectives: Human beta-defensin 2 (hBD-2 or DEFB4) is a highly inducible, antimicrobial peptide, which may have an important role in the innate immune response at epithelial surfaces. Genomic copy number of DEFB4 is polymorphic, with most individuals possessing 3-5 copies. Increased DEFB4 copy number is a susceptibility factor for psoriasis, whereas a single study in a Crohn's disease (CD) cohort reported that decreased DEFB4 copy number is associated with colonic inflammation. Here, we analyze association of DEFB4 copy number with CD in a New Zealand case-control cohort of European origin., Methods: DEFB4 gene copy number was determined using TaqMan quantitative PCR in 466 CD patients and 329 controls. DNA samples, independently genotyped for DEFB4 copy number by alternative methods, were used to validate the assay., Results: Increased DEFB4 genomic copy number was seen in CD patients compared with controls. Individuals with >4 copies had a significantly higher risk of developing CD than those with <4 copies (odds ratio 1.54; 95% confidence interval 1.13-2.09, P=5e-05). DEFB4 genomic copy number did not differ by disease location within the CD cohort (P=0.948), nor did analysis of CD patients who had undergone surgery detect association of decreased DEFB4 genomic copy number (<4) in colonic CD compared with ileal CD (P=0.120)., Conclusions: Our results indicate that elevated DEFB4 copy number is a risk factor for CD (irrespective of intestinal location), and challenge previous data supporting positive association of lower DEFB4 genomic copy number with colonic CD.

Objectives: To describe the recruitment strategy and association between facility and staff characteristics and success of resident recruitment for the Promoting Independence in Residential Care (PIRC) trial., Design: Cross-sectional study of staff and facility characteristics and recruitment rates within facilities with calculation of cluster effects of multiple measures., Setting and Participants: Staff of low-level dependency residential care facilities and residents able to engage in a physical activity program in 2 cities in New Zealand., Measures: A global impression of staff willingness to facilitate research was gauged by research nurses, facility characteristics were measured by staff interview. Relevant outcomes were measured by resident interview and included the following: (1) Function: Late Life FDI scale, timed-up-and-go, FICSIT balance scale and the Elderly Mobility Scale; (2) Quality of Life: EuroQol quality of life scale, Life Satisfaction Index; and (3) falls were assessed by audit of the medical record. Correlation between recruitment rates, facility characteristics and global impression of staff willingness to participate were investigated. Design effects were calculated on outcomes., Results: Forty-one (85%) facilities and 682 (83%) residents participated, median age was 85 years (range 65-101), and 74% were women. Participants had complex health problems. Recruitment rates were associated (but did not increase linearly) with the perceived willingness of staff, and were not associated with facility size. Design effects from the cluster recruitment differed according to outcome., Conclusions: The recruitment strategy was successful in recruiting a large sample of people with complex comorbidities and high levels of functional disability despite perceptions of staff reluctance. Staff willingness was related to recruitment success.

Aims: To examine cardiovascular preventive and renal protective treatment for different ethnic groups with diabetes in primary care., Methods: The study population included patients with type 2 diabetes attending an annual review in New Zealand primary care during 2004. Primary care data were linked to hospital admission data to identify previous cardiovascular disease (CVD). For those without previous CVD, 5-year cardiovascular risk was calculated. Proportions on, and predictors of appropriate treatment according to guidelines were investigated., Results: Data were available on 29,179 patients. Maori and Pacific participants had high rates of obesity, poor glycaemic control and albuminuria. Two thirds of all participants with previous CVD (68% of Maori and 70% of Pacific) and 44% with high CVD risk received appropriate CVD treatment; 73% of Maori, 62% of Pacific and 65% of European patients with albuminuria received ACE-inhibitors. Those with high CVD risk were more likely, and those that were young were less likely, to receive anti-hypertensive and lipid-lowering treatment after controlling for other factors., Conclusion: Maori and Pacific people were receiving similar high rates of appropriate CVD and renal preventive drug therapy to Europeans, but their prevalence of smoking, obesity, raised HbA1c and albuminuria were substantially higher. Non-drug components of preventive care also need to be addressed to reduce major ethnic disparities in diabetes-related morbidity and mortality in New Zealand.

Background: Introducing cardiopulmonary resuscitation (CPR) training in the high-school curriculum has been widely recommended as a long-term strategy to educate the wider community. Although CPR has been included in the New Zealand school curriculum, it is listed as an optional subject only., Aim: To assess the attitude towards and knowledge of CPR in 16-17-year-old high-school students in New Zealand., Methods: Questionnaires were administered to 494 students aged 16-17 years across six high schools in Wellington, New Zealand. Both knowledge and attitude were evaluated in the questionnaire., Results: Students showed poor theoretical knowledge, with a mean (SD) score of 5.61 (2.61) out of a maximum score of 18. Although there was no difference between male and female students, those who had received previous first-aid training (70%) showed greater knowledge (6.04 (2.56)) than their untrained counterparts (4.91 (2.24); p = 0.001). Those students with a positive attitude towards CPR and first-aid training (63%) acquired a higher knowledge score (6.12 (2.4)) than those with a negative attitude (17%; 4.65 (2.5); p = 0.001). Students with negative associations were also less likely to want to learn more about CPR and first aid (11%) when compared with those with positive associations (92%), and indicated less willingness to perform CPR on a stranger (negative v positive, 47% v 70%)., Conclusions: These findings suggest that although most high-school students are willing and motivated to learn CPR, a smaller percentage of students had a negative attitude towards CPR that would act as a barrier to future learning or performance of resuscitation. Introducing CPR training to high schools is still recommended; however, this study shows the need to associate this training with positive references in an attempt to assist those for whom negative attitude may present as a barrier to learning and retaining CPR knowledge.

Aims: To describe the characteristics and workload of New Zealand general medical practitioners (GPs)., Methods: Data were collected from a stratified random sample of GPs as part of the The National Primary Medical Care Survey carried out in 2001., Results: Data were submitted by 244 practitioners; a 62% response rate. Women made up 63% of the GP workforce aged under 40 years, but only 19% of those aged over 50 years. New Zealand graduates made up 69% of GPs; graduates from other areas occupied particular niches in the GP workforce. Each week, GPs worked (on average) 4 days and saw 102 patients. Eighty percent undertook after-hours work, and the average on-call roster was 1-in-8. At least 8% of visits to GPs occurred after-hours. Parameters of workload were lower for women and for those working in community-owned clinics, and higher for those working outside cities., Conclusions: An increasing proportion of GPs are women, and more GPs are working part time. In addition, if the changes in primary healthcare add to GPs' responsibilities, then more doctors will be needed. At present, GPs' workload is high in rural areas, which suggests inadequate recruitment; the distribution of GPs is a more important workforce issue than absolute numbers.

Aims: This study examined basic aspects of knowledge and attitudes towards resuscitation in a New Zealand urban community., Methods: Using a telephone survey, we questioned 400 subjects aged (over 17 years of age), on their prior training, knowledge, and attitudes towards resuscitation., Results: Seventy-four percent of subjects had previously been taught cardiopulmonary resuscitation (CPR). Of these, 12% had been taught during the previous year, and 63% over 5 years previously. Older subjects were less likely to have learnt CPR than younger subjects. Seventy-three percent of those surveyed desired to know more about resuscitation (than they currently did) and 70% thought that resuscitation should be a compulsory component of the New Zealand Driver's Licence test. Sixty-three percent said they would be willing to perform mouth-to-mouth ventilation on a stranger. CPR knowledge was poor, however, with only 4% knowing an acceptable rate at which to perform chest compressions, and only 9% knowing the correct compression-to-ventilations ratio for adult CPR. Overall knowledge was highest for those taught in the previous year, and for those persons aged between 26 and 45 years., Conclusions: Although attitudes of the community toward CPR are positive, theoretical knowledge relating to basic CPR is poor. This suggests that present community CPR educational strategies have limited efficacy.