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Background: Younger women (defined as those < 50 years who are likely pre-menopausal at time of diagnosis) with breast cancer often experience persistent treatment-related side effects that adversely affect their physical and psychological wellbeing. The Women's Wellness After Cancer Program (WWACP) was adapted and piloted in Australia to address these outcomes in younger women. The aims of this feasibility study are to determine (1) the potential to translate the Younger WWACP (YWWACP) intervention to a broader population base in Aotearoa/New Zealand and Australia, and (2) the potential for success of a larger, international, phase ΙΙΙ, randomised controlled trial. Methods: This bi-national, randomised, single-blinded controlled trial involves two main study sites in Aotearoa/New Zealand (Kōwhai study) and Australia (EMERALD study). Young women aged 18 to 50 years who completed intensive treatment (surgery, chemotherapy, and/or radiotherapy) for breast cancer in the previous 24 months are eligible. The potential to translate the YWWACP to women in these two populations will be assessed according to several feasibility outcomes. These include examining intervention accessibility, acceptability and uptake; intervention sustainability and adherence; the prevalence components of the intervention in the control group; intervention efficacy; participants' perception of measurement burden; the effectiveness of planned recruitment strategies; and trial methods and procedures. The studies collectively aim to enrol 60 participants in the intervention group and 60 participants in the control group (total = 120 participants). Discussion: Ethical approval has been received from the Southern Health and Disability Ethics Committee (Kōwhai ref: 19/STH/215), and UnitingCare Human Research Ethics Committee (EMERALD ref: 202103). This study will provide important data on the feasibility of the refined YWWACP in the trans-Tasman context. This study will account for and harmonise cross-country differences to ensure the success of a proposed international grant application for a phase ΙΙΙ randomised controlled trial of this program to improve outcomes in younger women living with breast cancer. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): Kōwhai ACTRN12620000260921, registered on 27 February 2020. EMERALD ACTRN12621000447853, registered on 19 April 2021. [ABSTRACT FROM AUTHOR]

Annual population-based estimates of the number of men who have sex with men (MSM) with diagnosed HIV infection (HIV prevalence pool), and the proportion of all MSM this represents (HIV prevalence), have been insufficiently described over the long term. We investigated the dynamic effects of ongoing HIV diagnoses, lower mortality due to treatment and growth in the MSM population over time on these two epidemic indicators using national HIV/AIDS surveillance data in New Zealand, 1985-2009. The diagnosed HIV prevalence pool rose 79% between 1989 and 1999, and 137% between 1999 and 2009. Estimates of diagnosed HIV prevalence as a proportion of MSM were 0.2% of MSM in 1985, and were between 1.5% and 5.0% of MSM by 2009. New Zealand continues to have a relatively low-prevalence HIV epidemic among MSM; however, the number of MSM living with diagnosed infection is growing rapidly 25 years after HIV testing was introduced. [ABSTRACT FROM AUTHOR]

Background Early diagnosis of HIV infection is important for the individual and for disease control. A consensus was recently reached among European countries on definitions of timing of presentation for care: 'Late presentation' refers to entering care with a CD4 count <350 cells/μL or an AIDS-defining event, regardless of the CD4 count. Presentation with 'advanced HIV disease' is a subset having a CD4 count <200 cells/μL and also includes all who have an AIDS-defining event regardless of CD4 count. This study examines timing of presentation in New Zealand from 2005 to 2010. Methods Since 2005, information on the initial CD4 cell count has been requested on all people newly diagnosed with HIV infection through antibody testing in New Zealand. Excluded in this analysis were those previously diagnosed overseas or for an immigration medical. Results A CD4 cell count was provided for 606 (80.3%) of the 755 newly diagnosed adults. Overall, 50.0% were 'late presenters' and 32.0% had 'advanced HIV disease'. Compared with men who have sex with men ( MSM), people heterosexually infected were more likely to present late. 'Late presentation' and presentation with 'advanced HIV disease' were significantly more common among older MSM. Māori and Pacific MSM were more likely to present with 'advanced HIV disease'. Compared with European MSM, the age-adjusted relative risks for Māori and Pacific MSM were 2.1 [95% confidence interval ( CI) 1.4-3.2] and 2.5 (95% CI 1.2-5.0), respectively. Conclusions The high proportion of people presenting late reflects inadequate levels of HIV testing. The lower proportion of late presentations among MSM compared with those heterosexually infected may be explained by a higher proportion of recent locally acquired infections together with different testing patterns. [ABSTRACT FROM AUTHOR]

This unlinked anonymous study aimed at determining the prevalence of HIV among sexual health clinic attenders having blood samples taken for syphilis and/or hepatitis B serology in six major New Zealand cities over a 12-month period in 2005-2006. Overall, seroprevalence was five per 1000 (47/9439). Among men who have sex with men (MSM), the overall prevalence and that of previously undiagnosed HIV were 44.1 and 20.1 per 1000, respectively. In heterosexual men, the overall prevalence was 1.2 per 1000 and in women 1.4 per 1000. HIV remains to be concentrated among homosexual and bisexual men. Comparison with a previous survey in 1996-1997 suggests an increase in the prevalence of undiagnosed HIV among MSM and also an increase in the number of MSM attending sexual health clinics. The low prevalence of HIV among heterosexuals suggests no extensive spread into the groups identified at risk of other sexually transmitted infections. [ABSTRACT FROM AUTHOR]

Introduction: The outcomes of palliative radiation therapy (RT) for neuroendocrine neoplasms (NEN) are seldom reported. We investigated outcomes following palliative radiotherapy in a cohort of patients with NENs. We hypothesised that well-differentiated NEN will be less likely to have a clinical response than poorly differentiated NEN., Methods: Patients who received at least one course of palliative RT were identified using the New Zealand NETwork! Registry. Patients with Merkel cell carcinoma, pulmonary small cell carcinoma or asymptomatic patients were excluded. Clinical response to RT within 90 days and overall survival were analysed alongside clinical variables (fractionation, RT site, tumour differentiation and tumour primary site)., Results: The cohort comprised 79 patients, with 147 courses of palliative RT delivered. Clinical response was measurable for 100 courses, with clinical response rate of 76%. A course delivered to a well-differentiated NEN was associated with 2.02-fold (95% CI 0.67, 6.12; P = 0.21) increase in odds of a clinical response compared to a poorly differentiated NEN. Median overall survival from the first fraction of RT was 94 days (95% CI 80, 138 days). Overall survival was higher in well-differentiated NEN than in poorly differentiated NEN (HR 0.2, 95% CI 0.10-0.40, P-value < 0.001); 30-day mortality was 7%. There were significantly reduced odds of clinical response for non-bone sites, and for courses >10 fractions compared to a single fraction., Conclusion: Palliative RT is an appropriate option for management of symptoms in patients with both well- and poorly differentiated metastatic NEN., (© 2023 The Authors. Journal of Medical Imaging and Radiation Oncology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Radiologists.)

Clinical trials are a critical element of a modern, high-functioning, learning healthcare system. Clinical trials provide access to novel, as yet unfunded treatments, and deliver cutting-edge healthcare. Evidence from clinical trials ensures appropriateness of healthcare, allows disinvestment from practices that are found not to improve outcomes or be cost-effective, and supports the introduction of new approaches, all of which leads to improvement in health outcomes. In 2020, Manatū Hauora - Ministry of Health and The Health Research Council of New Zealand funded a project to understand the current state of clinical trial activity in Aotearoa New Zealand and to propose the infrastructure required to support equitable clinical trial activity, in order to ensure that trials benefiting from publicly funded infrastructure are responsive to the needs of New Zealanders and ultimately enable equitable delivery of the best healthcare we can achieve to all New Zealanders. This viewpoint reports the process that was undertaken to develop the final proposed infrastructure and the rationale for the approach. The restructuring of the Aotearoa New Zealand health system into Te Whatu Ora - Health New Zealand and Te Aka Whai Ora - Māori Health Authority that will both operate hospital services and commission primary and community healthcare at a national level provides the ideal opportunity to integrate and embed research into Aotearoa New Zealand's healthcare system. Integration of clinical trials and research more broadly into the public healthcare system will require a significant shift in the culture within our healthcare system. Research must be recognised and promoted as a core activity for clinical staff at all levels of the healthcare system, rather than something to be tolerated or even hindered. Strong leadership will be required from the top of Te Whatu Ora - Health New Zealand down to ensure the required cultural shift to recognise the value of clinical trials to all aspects of the healthcare system, and to grow capability and capacity of the health research workforce. The investment required by the Government to implement the proposed clinical trial infrastructure will be substantial, but now is the ideal time for investment in clinical trials infrastructure in Aotearoa New Zealand. We urge the Government to be bold and invest now to ensure the benefits can be reaped for all New Zealanders in years to come., Competing Interests: Lisa K Stamp, Matire Harwood, Stuart Dalziel, Katrina Sharples, and Frank Bloomfield are active clinical triallists. Funding from Health Research Council of New Zealand and the Ministry of Health., (© PMA.)

Background: Depression during pregnancy is associated with a number of negative impacts on maternal and infant health, therefore good control of depression in pregnant women is crucial. There is a lack of population-level information about patterns of antidepressant use during pregnancy in New Zealand., Aim: To describe antidepressant dispensing patterns before, during, and after pregnancy in New Zealand, 2005-2014., Materials and Methods: Antidepressant dispensing records from 270 days prior to pregnancy through to 360 days after pregnancy end were linked with 805 990 pregnancies in the New Zealand Pregnancy Cohort. Proportions (and 95% confidence intervals) with at least one dispensing were calculated for the periods before, during, and after pregnancy and compared over time and by maternal characteristics., Results: Dispensing during the first trimester was lower than in the pre-pregnancy and post-pregnancy periods, and dropped further in later trimesters. The proportion of pregnancies during which an antidepressant was dispensed rose from 3.1 to 4.9% over the study years. Around 80% of those with a dispensing received a selective serotonin reuptake inhibitor. Dispensing before, during, and after pregnancy varied by ethnicity, age, smoking status, and body mass index. Among women taking an antidepressant before pregnancy, younger women and those of Māori, Pacific, or Asian ethnicity were less likely to continue therapy during pregnancy., Conclusions: This study has established a baseline for antidepressant use around pregnancy in New Zealand, documented increasing use over time, and demonstrated that known ethnic differences in antidepressant use are also evident in the pregnant population., (© 2021 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Aim: To describe the patterns of discontinuation and reinitiation in new users of metformin monotherapy in New Zealand, overall and according to person- and healthcare-related factors., Materials and Methods: We created a cohort (n = 85,066) of all patients in New Zealand with type 2 diabetes mellitus who initiated metformin monotherapy between 1 January 2006 and 30 September 2014 from the national data collections, and followed them until the earlier of their death or 31 December 2015. Discontinuation was defined as a gap in possession of metformin monotherapy of ≥90 days. We explored patterns of discontinuation and reinitiation using competing risks methods., Results: After 1 year of follow-up, 28% of cohort members had discontinued metformin monotherapy at least once; the corresponding figures after 2 and 5 years were 37% and 46%. The proportions who reinitiated metformin monotherapy within 1, 2, and 5 years of their first discontinuation were 23%, 49%, and 73%. Discontinuation after the first reinitiation was common (48% after 1 year). Discontinuation and reinitiation varied by age, ethnicity, and other person- and healthcare-related factors., Discussion: Our findings highlight the dynamic nature of metformin monotherapy use, show that substantial periods of non-use are common, and identify priority populations for interventions to facilitate adherence., Competing Interests: The authors have declared that no competing interests exist.

Objective: To describe prescription medicine dispensing before and during pregnancy in New Zealand, 2005-2015., Methods: Members of the New Zealand Pregnancy Cohort were linked with their dispensing records in a national database of prescription products dispensed from community pharmacies. We identified the proportion of pregnancies during which at least one prescription medicine was dispensed, the number of different medicines used and the most commonly dispensed medicine groups both during pregnancy and in the 270 days before conception. Dispensing during pregnancy was assessed by several maternal characteristics., Results: 874,884 pregnancies were included. Over the study timeframe, the proportion of pregnancies exposed to a non-supplement prescription medicine increased from 38.5% to 67.2%. The mean number of different non-supplement medicines dispensed during pregnancy increased from 2.5 to 3.2. Dispensing during pregnancy was weakly associated with body mass index, smoking status and ethnicity. Pregnancy exposure was highest for Antibacterials (26.0%), Analgesics (16.7%) and Antinausea & Vertigo Agents (11.0%)., Conclusions: From 2005-2015, both the proportion of exposed pregnancies and the number of different medicines dispensed to pregnant women in New Zealand increased., Competing Interests: The authors have declared that no competing interests exist.

Purpose: This study describes dispensing of potentially teratogenic prescription medicines before and during pregnancy in New Zealand over the period 2005-2015., Methods: Records in a national dispensing database were linked with the members of the New Zealand Pregnancy Cohort to determine the proportion of pregnancies with at least one dispensing of a Category D or X medicine, using the Australian pregnancy risk categorisation system. Exposure was examined from 270 days prior to conception through to the end of pregnancy. Pregnancy outcomes of D/X-exposed pregnancies were reviewed., Results: In the study, 874,884 pregnancies were included. Overall, Category D and X medicines were dispensed during 4.3% and 0.058% of pregnancies, respectively. After excluding misoprostol, X exposure decreased to 0.035%. Generally, dispensing declined through the 270-day pre-pregnancy period and continued to decline throughout pregnancy. Dispensing of X medicines increased over the study timeframe, whereas dispensing of D medicines increased from 2005 to 2011 then declined slightly. Smokers were more likely than non-smokers to have been dispensed a D/X medicine, and compared with European women, Māori and Pacific women were less likely to have been dispensed a D/X medicine. Excluding misoprostol, pregnancies exposed to an X medicine were more likely than D/X-unexposed pregnancies to have ended in termination., Conclusion: Dispensing of potentially harmful medicines in pregnancy in New Zealand was low, particularly for Category X medicines. However, exposure did increase over the study timeframe. The inclusion of pregnancies that did not progress past early pregnancy better reflects population-level pregnancy exposure to potentially teratogenic medicines.

Background and Objective: Clinical guidelines recommend the use of beta-blockers and other cardiovascular prevention drugs in patients with acute coronary syndrome (ACS). Studies in several countries have found that beta-blockers are underused in patients with chronic obstructive pulmonary disease (COPD) and co-morbid heart disease, although most have only examined use in subgroups of patients. We undertook a nationwide follow-up study in New Zealand to describe the use of beta-blockers and other cardiovascular prevention drugs in patients with COPD and ACS., Methods: National health and pharmaceutical dispensing data were used to derive the study cohort, identify patients who were admitted to hospital with ACS and/or heart failure before cohort entry and during follow-up, and ascertain drug use., Results: The study cohort included 83 435 patients aged ≥45 years, with 290 400 person-years of follow-up. Among 2637 patients with ≥1 ACS admission during follow-up, only 56.6% received a beta-blocker in the 6 months following the first admission, while 87.7% and 81%, respectively, received aspirin and a statin. Patients with higher COPD severity were less likely to receive a beta-blocker than those with lower severity, as were those with no history of previous ACS and/or heart failure., Conclusion: Use of beta-blockers following an ACS admission was much lower than expected based on the findings of general audits of ACS management in New Zealand. Along with the higher proportions using aspirin and statins, and the differences in beta-blocker dispensing by COPD severity, this suggests a particular reluctance to prescribe beta-blockers to patients with COPD., (© 2019 Asian Pacific Society of Respirology.)

Aim: To describe adherence to metformin monotherapy in New Zealanders with type 2 diabetes mellitus (T2DM) initiating pharmacological treatment for the first time., Methods: We created a cohort of all New Zealanders with T2DM commencing metformin monotherapy between 1 January 2006 and 30 September 2014 using national data collections and followed them until the end of 2015. We obtained data on person- and health-related characteristics at metformin initiation from these collections and calculated medication possession ratios from pharmacy dispensing data. Regression modelling was used to assess changes in adherence over time., Results: We identified 85,066 people with T2DM who initiated metformin monotherapy. Lower adherence to metformin monotherapy was associated with time since initiating metformin, younger age and being of Māori or Pacific ethnicity. Higher adherence was associated with receiving more non-diabetic medications, a history of CVD and recent cancer registration., Conclusions: Our findings are consistent with international literature and highlight groups of people who experience poor adherence over time. Understanding the drivers of lower adherence in Māori and Pacific peoples is a particular priority given the high prevalence of T2DM in these populations., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Aims: Fewer than 5% of adult cancer patients participate in clinical trials, with multiple patient, clinician and institutional barriers identified. This study aimed to explore patient factors that impact access to cancer trials in New Zealand., Methods: A questionnaire that included demographics and factors that might impact trial participation was circulated via nine district health boards (DHBs) and four cancer foundations to patients with a cancer diagnosis., Results: Between July 2016 and August 2017, 691 patients responded, 62% female and 77% aged >50 years. Most patients (86%) would consider trial participation, which differed by income (p=0.0001) but not by age, tumour type or gender. Patients would consider attending another hospital (44%) or relocating (11%); 10% considered trials a last resort. Advantageous factors to participation included: benefiting others (92%), better treatment (82%), more scans and longer follow-up (47% and 51%). Disincentives included fear of randomisation (78%), treatment toxicities (71%), time and cost of more visits (40%) and unspecified future research (32%)., Conclusion: Identified barriers to trial participation were similar in New Zealand to other developed countries. In this motivated cohort, patients are very interested in trial participation at any stage of their treatment and did not mind extra travel or tests., Competing Interests: Nil.

Purpose: The aim of this study was to use national health databases to assemble a pregnancy cohort for undertaking medicine utilisation and safety studies in New Zealand., Method: Pregnancies conceived between January 2005 and March 2015 were identified in the National Maternity Collection, the National Minimum Dataset, the Mortality Collection, and the Laboratory Claims Collection. Pregnancy start and end dates were calculated and used in conjunction with the National Health Index number to merge the records from the four collections to create the New Zealand Pregnancy Cohort. Records of live born and stillborn infants identified in the National Maternity Collection and the Mortality Collection that were linkable with a cohort member formed the baby cohort., Results: The cohort consists of 941 468 pregnancies to 491 272 women. One-third of the pregnancies, predominantly early pregnancy losses and terminations, were not found in the National Maternity Collection. Records of 632 090 live born or stillborn infants are linked with 623 099 pregnancies., Conclusions: The New Zealand Pregnancy Cohort is a comprehensive collection of virtually all pregnancies which ended in a live or stillbirth and many, though not all, which ended as early pregnancy losses or terminations in New Zealand over the past decade, and better represents the pregnant population than a cohort generated from the National Maternity Collection alone would do. This cohort will be valuable for investigating patterns of medicine use during pregnancy in New Zealand and developing a fuller understanding of potential impacts of foetal exposure in early pregnancy., (© 2018 John Wiley & Sons, Ltd.)

Aim: To evaluate New Zealand media articles on their coverage of key issues regarding health interventions and whether it is consistent with available evidence., Methods: A retrospective analysis was carried out of all articles published in five New Zealand media sources over a 6-week period between 15 October and 26 November 2014. Articles were included if their primary focus was on health interventions involving medications, devices or in-hospital procedures. Articles were assessed for coverage of key issues using previously validated 10-point criteria. A literature review was performed to compare content with scientific evidence., Results: We identified 30 articles for review. Only 4 of 30 articles covered indications, benefits and risks, and of these, two were consistent with available evidence (7%, 95% CI 1%-22%). For articles that discussed at least one of indications, benefits or risks, and there was corresponding evidence available, there was a high level of consistency with the evidence (89%, 95% CI 77%-95%). The overall mean value of coverage from the 10-point criteria was 51% (95% CI 45%-58%). Single questions regarding the potential harm, costs associated with the intervention and the availability of alternative options were particularly poorly covered. They were rated as 'satisfactory' in 13%, 23% and 33% of the 30 articles respectively., Conclusion: New Zealand news articles covering medical treatments and interventions are largely consistent with available evidence but are incomplete. Vital information is being consistently missed, especially around the potential harms and costs of medical interventions., (© 2018 Royal Australasian College of Physicians.)

Aim: To describe the use of contraindicated and use-with-caution medicines among new users of simvastatin., Methods: We used information from Ministry of Health national datasets to establish a cohort of all patients aged >18 years who initiated simvastatin use between January 2006 and December 2013 (n=349,371). We estimated the cumulative incidences of the first dispensing of contraindicated and use-with-caution medicines during simvastatin use, and explored factors associated with co-prescription, using Kaplan-Meir and Cox regression methods, respectively., Results: Eleven percent and 16% of patients were dispensed a contraindicated and use-with-caution medicine, respectively, during the first two years of simvastatin use; by seven years, the figures were 17% and 26%. Thirty-six percent of patients were co-prescribed a contraindicated medicine on >1 occasion; the corresponding proportion for use-with-caution medicines was 84%. For a substantial proportion of those co-prescribed a use-with-caution medicine, the concomitant daily dose of simvastatin exceeded the maximum dose recommended at the time of prescribing. In the majority of cases, the prescriber of simvastatin and the contraindicated or use-with-caution medicine were the same. Co-prescribing of contraindicated medicines varied by sex, age, ethnicity and comorbidity., Conclusions: The prescription of contraindicated and use-with-caution drugs to patients taking simvastatin is not uncommon in New Zealand., Competing Interests: Nil.

Introduction: Intensity-modulated radiotherapy (IMRT) has become the standard of care for squamous cell cancer of the head and neck (HNSCC). This report presents early outcomes of IMRT with concomitant chemotherapy in a community setting in New Zealand., Methods: Forty-eight patients with stage III and IV advanced HNSCC received definitive treatment with IMRT. A dose of 66 Gy in 30 fractions was delivered over 6 weeks with 3-weekly concurrent cisplatin after a single induction cycle of cisplatin and 5-fluorouracil. Acute toxicity, locoregional control (LRC), disease-free survival and overall survival (OS) outcomes were analysed., Results: Follow-up ranged from 2 to 82 months (median 34 months). Acute grade 2 toxicity was observed in 27 patients and grade 3 toxicity in 19 patients. No patients experienced grade 4 toxicity and there were no treatment-related deaths. Locoregional failures occurred in six patients and distant metastatic disease occurred in five patients. Actuarial estimates of 3-year LRC, disease-free survival and OS were 87.3%, 74.4% and 73.7% respectively., Conclusion: Definitive treatment of stage III and IV cancer of the head and neck with IMRT and concurrent chemotherapy was achievable in the community setting. Acute toxicities were manageable and 3-year outcomes were comparable to other published series.

Background: Gallstone disease is a worldwide problem causing morbidity, mortality and a drain on health-care resources. This prospective study aimed to investigate the spectrum of gallstone types in New Zealand and relate these to known risk factors., Methods: Gallstone samples were collected from 107 patients undergoing surgery for gallstone disease at Auckland City Hospital between June 2009 and June 2010. Detailed chemical analyses were performed using Fourier Transform Raman spectroscopy. The relationship between gallstone type and age, gender, ethnicity, obesity and positive family history were analysed., Results: Median age was 51 years (range 19-88), 75 (70%) were female, one third were obese (body mass index ≥ 30) and 41% had a positive family history. Major ethnic groups were European (51%), Asian (23%) and Māori/Pacific (18%). Gallstone types included pure or mixed cholesterol stones (74%), black pigment stones (20%) and brown pigment stones (5%). Asians had a higher proportion of black pigment stones and NZ Europeans had more cholesterol and mixed cholesterol stones (odds ratio 3.6 (95% CI 1.1 to 11.5)). The frequency of cholesterol/mixed cholesterol stones was not significantly different between NZ Europeans and Māori/Pacific groups (P = 0.7). Black pigment stones were more common in older patients (mean 68.0 years compared with 47.6 for cholesterol/mixed cholesterol stones) (P = 0.0001). There was no significant relationship between stone type and family history (P = 0.16) or gender (P = 0.17)., Conclusion: This novel prospective study highlights risk factors and ethnic differences in gallstone composition in New Zealand. These may be important when considering gallstone prevention strategies., (© 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.)

Context: The associations between timing of first live birth and previous sexual behavior and pregnancies are not well understood., Methods: Members of a 1972-1973 New Zealand birth cohort were surveyed at ages 21, 26 and 32 about their sexual and reproductive histories; 506 men and 479 women participated in at least one assessment. Relative risks and 95% confidence intervals were calculated using Poisson regression to examine associations between the likelihood of first live birth at specific ages (prior to age 21, at age 21-25, at age 26-31) and selected characteristics., Results: Birth prior to age 21 was more likely for men and women who initiated intercourse before age 15 (relative risks, 3.1 and 2.0, respectively), and less likely for those who initiated at age 18 or later (0.3 and 0.1, respectively), than for those aged 15-17 at first coitus. Prior miscarriage was associated (although sometimes marginally) with an elevated likelihood of first birth across genders and ages (1.7-1.8). Prior abortion was associated with an elevated likelihood of first birth at age 21-25 for women (1.6) and a reduced likelihood at age 26-31 for men (0.5). Having multiple sexual partners at age 21-25 was negatively associated with the likelihood of a first birth at age 26-31 for men. Marriage and cohabitation were positively associated with birth timing., Conclusions: Early sexual initiation and relationship instability may promote parenthood at younger ages, whereas greater relationship stability may do so at older ages., (Copyright © 2012 by the Guttmacher Institute.)

Objectives: To describe trends in HIV diagnoses among men who have sex with men (MSM) in New Zealand 1996-2008, and to identify characteristics associated with HIV diagnoses in the resurgent phase., Methods: Data collected through routine surveillance of HIV infection, where the mode of transmission included homosexual contact, were analysed over the period 1996-2008., Results: Annual HIV diagnoses were low during 1996-2000, rose sharply between 2001 and 2005, and remained at an elevated plateau between 2006 and 2008. Over a quarter were attributed to HIV infection acquired overseas (28.6%). Trends in diagnoses of locally acquired HIV infection closely mirrored the trend of three diagnosis phases. Increases in locally acquired HIV occurred among virtually all characteristics of MSM. However, compared with MSM diagnosed in the low phase 1996-2000, individuals diagnosed in the resurgent phase 2001-05 were more likely to be aged 30-39, to have tested HIV-negative within the previous 2 years, to live in the Northern region encompassing Auckland, and to be of non-European ethnicity. The per capita HIV diagnosis rate among MSM was lowest in 1997, at 22.0 per million males aged 15-64, and highest in 2005 at 66.7 per million., Conclusion: The increase in HIV diagnoses among MSM in New Zealand was primarily due to an increase in locally acquired HIV infection, which disproportionately affected some groups of MSM. Factors driving this change in local epidemic conditions need to be identified. The rate of new HIV diagnoses among MSM remains low by international standards.

Background: Gout is a common and challenging problem in South Auckland, New Zealand. Allopurinol is widely used but urate reduction remains unsatisfactory. Allopurinol dosing guidelines and a therapeutic range for plasma oxypurinol levels have been published., Aims: We aimed to determine the appropriateness of allopurinol dosing according to current guidelines and to assess the relationship between plasma creatinine, oxypurinol and urate. In addition, we assessed the clinical usefulness of the oxypurinol level., Methods: Thirty-one patients, on a stable dose of allopurinol for at least three weeks, had plasma creatinine, urate and oxypurinol measured as part of routine clinical assessment. Relationships between the various methods were examined using regression analysis. Fisher's exact test was used to test associations with categorical variables., Results: Fifty-five per cent of patients were on higher than recommended doses of allopurinol. There was a statistically significant relationship between calculated creatinine clearance and plasma oxypurinol level. Only 50% of patients with a plasma oxypurinol within the therapeutic range (30-100 micromol/L) had a plasma urate < 0.42 mmol/L and this did not increase significantly in the patients with an oxypurinol level > 100 micromol/L., Conclusions: There is poor adherence to the current recommended dosing guidelines for allopurinol. Creatinine clearance rather than plasma creatinine needs to be used to predict the dose of allopurinol. The current role of the oxypurinol level is to identify non-compliers with allopurinol therapy. We need further research to clarify whether increasing the dose of allopurinol outside the recommended dose range to reach an oxypurinol level of close to 100 micromol/L may be of benefit in those who have not had sufficient urate reduction.

Aim: To improve understanding of the HIV epidemic in New Zealand through use of an enhanced voluntary reporting system for new diagnoses of HIV., Methods: Routine reporting of new HIV diagnoses by the two laboratories that perform confirmatory HIV antibody testing, to the Department of Health and later to the AIDS Epidemiology Group, has been in place since 1985. From January 1996, this was supplemented by a questionnaire about demographic characteristics and circumstances of HIV exposure sent to clinicians requesting the HIV test., Results: From January 1996 to December 1998, 260 new diagnoses of HIV were reported (205 males, 55 females) and extra information was obtained from clinicians for 253 (97.3%) people. HIV diagnosis rate was highest for 'other' ethnicity and similar for European, Maori and Pacific Island ethnic groups. Sexual intercourse between men was the commonest mode of infection (43.5%), followed by heterosexual intercourse (40.0%) and injecting drug use (2.7%). Places of infection were New Zealand (38.5%), Australia (7.7%), 'other' overseas (45.4%) and unknown (8.5%). Heterosexual infections were acquired through contact with a person in or from a high prevalence area (mainly in Africa or Asia) for 86.7% of males and 68.2% of females. Second generation heterosexual transmission was rare., Conclusions: Introduction of an enhanced surveillance system has been successful. Results confirm continuing spread of HIV in New Zealand amongst men who have sex with men, and suggest low levels of heterosexual and injecting drug use transmission in New Zealand. Of major importance in the occurrence of heterosexual infection is the role of imported HIV.

The aim of this study was to describe temporal patterns in the frequency, nature and circumstances of injuries occurring among a cohort of 356 rugby players during a club rugby season in New Zealand. It was found that the rate of injury in games decreased significantly over time in both males and females. The reduction in injury rate over the season was more pronounced in some grades, but no differences were found when examined by gender. playing position, age, ethnicity or by health and fitness types. Trends in injury rate were consistent over the rugby season and did not appear to be the result of a bias involving under-reporting of end-of-season injuries. The types and severity of injury remained relatively constant, but the proportion of injuries occurring in back play fell significantly over the season and injuries were more likely to occur in the trunk body region as the season progressed. This study supported the hypothesis that higher rates of injury occur at the start of the rugby season and decrease over the course of the season. This reduction is consistent over time and across player types, and is not attributable either to decreasing injury severity or to increasing player fitness.

Study Objective: To assess spatial clustering of childhood leukaemias and lymphomas in New Zealand, using a national dataset from a country with no nuclear installations., Design: New Zealand Map Grid coordinates, derived from the birth addresses of cases and controls were used in clustering analyses that applied Cuzick and Edwards' method., Setting: The whole of New Zealand., Participants: The cases were ascertained from the New Zealand Cancer Registry. They were diagnosed with leukaemia or lymphoma at ages 0-14 years during the period 1976 to 1987. For Hodgkin's disease, the age range was extended to include those aged from 0-24 years. The cancer registrations were linked with national birth records, to obtain the birth addresses of the cases. The controls were selected at random from birth records, with matching to cases (1:1) on age and sex. The analyses included 600 cases and 600 controls., Main Results: There was no statistically significant spatial clustering for any tumour group overall, including acute lymphoblastic leukaemia, acute nonlymphoblastic leukaemia, other leukaemias, non-Hodgkin's lymphomas, Hodgkin's disease, and all these combined. Significant clustering was found in a sub-analysis for one of three age specific subgroups of acute lymphoblastic leukaemia (ages 10-14 years, p = 0.003)., Conclusion: The subgroup finding may have been real or a chance association, as several comparisons were made. This study found little evidence for spatial clustering of leukaemias or lymphomas in a population with no nuclear installations.

Aim: To measure the occurrence of sexually transmitted diseases (STDs) and of HIV testing in a population of STD clinic attenders and the associations of these with age, gender, ethnicity, intravenous drug use, sexual practices and other STDs., Methods: The study population comprised 8478 new attenders who had blood taken at STD clinics in Auckland and Christchurch between August 1991 and August 1992. Demographic and behavioural information was recorded, along with STD diagnoses and whether or not an HIV test was carried out. These data were analysed by univariate and multivariate methods to determine patterns of disease and voluntary HIV testing., Results: The proportions of the study group with each of the six major STD diagnoses were syphilis 0.8%, gonorrhoea 3.1%, chlamydial infection 11.7%, nonspecific urethritis/cervicitis 12.0%, genital warts 17.4% and genital herpes 6.1%. Gonorrhoea and chlamydial infection were significantly correlated. Both Maori and Pacific Islands ethnicity were significantly associated with the occurrence of bacterial STDs and inversely associated with viral STDs. Twenty-two percent of subjects had voluntary HIV testing at this single visit. Maori were tested at 60% of the European rate and Pacific Islands people at 25-30%., Conclusions: The profiles of different STDs vary in terms of the sociodemographic and behavioural characteristics of those most often affected. There are major differences in patterns of disease and service use between ethnic groups that require further investigation.

Objective: To describe the AIDS epidemic in New Zealand, and to discuss the reasons for an apparent decline in incidence., Methods: The AIDS Epidemiology Group collects information on persons diagnosed with AIDS through a compulsory notification system. Data were presented on people diagnosed to the end of 1994, and reported by the end of September 1995., Results: The cumulative incidence of AIDS in New Zealand was similar to that in some other Western countries, such as the United Kingdom, Germany and Sweden, before 1989, but has been declining since 1989. The epidemic is concentrated among men who have sex with men (89%). The median survival after diagnosis with AIDS is 13 months., Conclusions: The observed decline is not likely to be due to reporting delays or changes in reporting or diagnostic practices. The major factor was probably a rapid decline in HIV incidence among homosexual men a decade ago, and the effective prevention of epidemics in other subgroups. The epidemic in New Zealand started later than in other countries, enabling an earlier response, and there is evidence of behaviour change in high risk groups. Preventive efforts and monitoring must be maintained in order to ensure there is no reversal of this decline.

Aims: To measure the prevalence of juvenile spring eruption of the ears in Dunedin primary school aged children. To characterise the population of children affected by juvenile spring eruption in New Zealand., Methods: Children attending three primary schools were examined for evidence of clinical and preclinical juvenile spring eruption on a single occasion in the late spring. Ear protuberance, hair cover and other factors related to sun exposure were assessed., Results: The overall prevalence of clinical juvenile spring eruption was 6.7% (95% confidence interval = 4.7% to 7.5%). The prevalence in males was 12% (95% CI = 7.3% to 17%). Lack of hair cover and protuberant ears (75th percentile or greater) were strongly associated with clinical juvenile spring eruption. There was no evidence of an association between clinical juvenile spring eruption and skin tone, hair colour, time spent outdoors, sunscreen use, and hat use., Conclusion: Juvenile spring eruption is a relatively common dermatological condition among primary school aged children in Dunedin, especially boys.

Objective: To determine whether the prevalence of HIV infection among injecting drug users in New Zealand has remained low since the introduction of a needle and syringe exchange scheme in May 1988., Design: Anonymous survey of intravenous drug users attending outlets of the exchange scheme, based on questionnaires and saliva testing., Setting: Twelve pharmacies and community outreach organisation in six cities., Subjects: Altogether 620 people provided saliva specimens and completed questionnaires. These represented 73% of those who visited exchange scheme outlets during a three month period in 1992., Main Outcome Measure: Saliva was tested for antibodies to HIV-1 and HIV-2 using an IgG-capture enzyme linked immunosorbent assay (GACELISA)., Results: Of 591 specimens eligible for inclusion, only three (0.5%) were repeatedly reactive in the GACELISA test, while two of these were also positive in a Western blot test., Conclusions: Although surveys show that sharing of needles and syringes was common in New Zealand until recently, the prevalence of HIV infection in intravenous drug users has remained low. This can probably be attributed to the success of educational campaigns and legislative action to allow a needle and syringe exchange scheme to be set up.

Aim: To determine the prevalence of HIV infection among patients attending the four sexually transmitted disease (STD) clinics in two metropolitan areas of New Zealand., Methods: The population studied comprised everyone who attended between August 1991 and August 1992 because of concern about a possible new episode of an STD and who had a blood specimen taken for hepatitis B (or syphilis) serology. The study involved unlinked anonymous testing of left-over blood specimens, following ethical guidelines that have been proposed internationally., Results: Among 8478 specimens tested, 23 (2.7 per 1000) were found to be HIV positive. The seroprevalence rates per 1000 among women, heterosexual men, and homosexual or bisexual men were 1.1, 1.3, and 44, respectively. All but five of the infected people were either known to be HIV positive or had an identifiable test during their clinic attendance., Conclusions: The seroprevalence rates are similar to those reported from STD clinics in England, and suggest that heterosexual transmission of HIV infection has not yet been extensive in New Zealand.

Aims: To assess the survival of Auckland residents diagnosed with AIDS between 1983 and 1989., Methods: Retrospective case review, Results: Sixty nine Auckland residents were diagnosed with AIDS between 1983 and the end of 1989, and were cared for by the infectious disease unit, Auckland Hospital. The overall median survival was 289 days with 48% and 20% surviving at one and two years respectively. Survival was longer among those who were infected through homosexual contact, were younger, and not known to the infectious disease unit prior to the diagnosis of AIDS. Although survival was longer for those diagnosed in 1988 compared to earlier years, it was shorter again for those diagnosed in 1989. Pneumocystis carinii pneumonia, the AIDS defining condition in 63.8% of people, was found less frequently in 1989, and overall was associated with a longer survival than most of the other AIDS-defining diagnoses. A quarter of the people were not known to be infected with HIV prior to the AIDS-defining condition., Conclusion: In New Zealand, as in other countries, changes in treatment strategies of people with HIV infection may impinge on the survival of people with AIDS.

Melanocytic nevi of diameter greater than or equal to 2 mm were counted on most of the skin surface of 349 adolescents aged 14-15 years of European race or ethnicity in Dunedin, New Zealand. Total counts are described by means of a form of Poisson-error log-linear modeling suitable for data showing unexplained variation (NE Breslow, Appl Statist 1984;33:38-44). There were marked interpersonal variation in the number of nevi; only some was attributable to observed factors. The mean and median counts were 23.8 and 18 nevi, respectively. The estimated ratio of the number of nevi for females compared with males was 0.7 (95% confidence interval (CI) 0.6-0.8). Greater amounts of sunbathing were associated with greater numbers of nevi. Hair and eye color, socioeconomic status, and sunburn history did not show statistically significant effects. Time since menarche and shaving status also showed no effects. Lack of suntan was associated with lower counts. Freckling was positively correlated with higher counts; the severe freckling group had an estimated ratio of 1.9 (95% CI 1.3-2.8) compared with those with no or very few freckles. The results are consistent with the hypothesis that ultraviolet radiation exposure from recreational sun exposure positively influences the total burden of nevi in normal subjects. Comparison with other epidemiologic studies suggests that the typical ultraviolet radiation dose-nevus yield curve might be steeper in males than females. Unexplained variation of nevus count may reflect heterogeneity of constitutional factors not yet measured in epidemiologic studies.

Nonmelanoma skin cancer mortality rates for recent decades show a biphasic pattern: from 1950-65 rates decreased; from 1966-86 rates increased. Age standardised mortality rates for 35-74 year old males increased from 1.6 (95% CI, 1.3-1.9) deaths per 100,000 person years in 1966-72 to 2.3 (95% CI, 2.0-2.5) deaths per 100,000 person years in 1980-86. Rates in women were lower but showed a similar percentage increase (46%), between these periods, to that observed for men (44%). The increased mortality from 1966 was presumably a result of increased ultraviolet exposure.

Psychiatric symptomatology was assessed in a group of mothers of preschool children. One fifth described the number of symptoms suggestive of a psychiatric diagnosis. The findings are discussed with reference to previous work.

Psychiatric symptomatology was assessed in a group of mothers of preschool children. One-fifth described the number of symptoms suggestive of a psychiatric diagnosis. The findings are discussed.