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Background Side-effect concerns are a major barrier to vaccination against COVID-19 and other diseases. Identifying cost- and time-efficient interventions to improve vaccine experience and reduce vaccine hesitancy—without withholding information about side effects—is critical. Purpose Determine whether a brief symptom as positive signals mindset intervention can improve vaccine experience and reduce vaccine hesitancy after the COVID-19 vaccination. Methods English-speaking adults (18+) were recruited during the 15-min wait period after receiving their second dose of the Pfizer COVID-19 vaccination and were randomly allocated to the symptom as positive signals mindset condition or the treatment as usual control. Participants in the mindset intervention viewed a 3:43-min video explaining how the body responds to vaccinations and how common side effects such as fatigue, sore arm, and fever are signs that the vaccination is helping the body boost immunity. The control group received standard vaccination center information. Results Mindset participants (N = 260) versus controls (N = 268) reported significantly less worry about symptoms at day 3 [ t (506)=2.60, p =.01, d =0.23], fewer symptoms immediately following the vaccine [ t (484)=2.75, p =.006, d =0.24], and increased intentions to vaccinate against viruses like COVID-19 in the future [ t (514)=−2.57, p =.01, d =0.22]. No significant differences for side-effect frequency at day 3, coping, or impact. Conclusions This study supports the use of a brief video aimed at reframing symptoms as positive signals to reduce worry and increase future vaccine intentions. Clinical Trial information Australian New Zealand Clinical Trials Registry: ACTRN12621000722897p. [ABSTRACT FROM AUTHOR]

Background The Dundee classification of cellulitis severity, previously shown to predict disease outcomes, provides an opportunity to improve the management of patients with cellulitis. Methods We developed and implemented a pathway to guide the management of adults with cellulitis based on their Dundee severity class, and measured its effect on patient outcomes. We compared the outcomes in patients admitted to Auckland City Hospital (ACH) between July 2014 and July 2015 (the baseline cohort) with those in patients admitted between June 2017 and June 2018 (the intervention cohort). Results The median length of stay was shorter in the intervention cohort (0.7 days, interquartile range (IQR) 0.1 to 3.0 days) than in the baseline cohort (1.8 days, IQR 0.1 to 4.4 days; P  < .001). The 30-day mortality rate declined from 1.8% (19/1092) in the baseline cohort to 0.7% (10/1362; P  = .02) in the intervention cohort. The 30-day cellulitis readmission rate increased from 6% in the baseline cohort to 11% (P  < .001) in the intervention cohort. Adherence to the ACH cellulitis antibiotic guideline improved from 38% to 48% (P  < .01) and was independently associated with reduced length of stay. Conclusions The implementation of the Auckland cellulitis pathway, readily generalizable to other settings, improved the outcomes in patients with cellulitis, and resulted in an annual saving of approximately 1000 bed days. [ABSTRACT FROM AUTHOR]

Background: Antibiotic prescribing for patients with urinary tract infections (UTIs) is often inconsistent with published guidelines. Pharmacists have a key role in the multidisciplinary team to improve the prescribing of antibiotics. Aim: This study determined the reasons for low guideline adherence and investigated the effects of a pharmacist‐led, non‐confrontational, inexpensive educational intervention on guideline adherence in adult inpatients with UTIs. Methods: The study was performed in three general medical wards in Auckland City Hospital (ACH), New Zealand, during March–September 2015. All patients treated for UTIs were identified by ward pharmacists. A pre‐intervention observation period was followed by an intervention period in which ward pharmacists placed a simple diagnostic and treatment algorithm in the clinical records of all patients being treated for a UTI. Clinical and laboratory data available at the time initial antibiotic therapy was prescribed were used to determine a retrospective diagnosis for each patient. The initial antibiotic therapy was evaluated for adherence to the ACH antibiotic guidelines in relation to both the prescriber's and retrospective diagnosis. Results: Overall, the prescriber's diagnosis was concordant with the retrospective diagnosis in only 48 of 141 episodes (34%). Treatment was adherent to guidelines in 27% pre‐intervention and 33% intervention episodes (p = 0.5). Conclusion: Inaccurate clinical diagnosis in patients with UTIs was a common reason for antibiotic treatment to be non‐adherent to guidelines. The study failed to find an association between the educational intervention and an effect on guideline adherence. Passive interventions are unlikely to be effective and further interventions should consider codesign with users. [ABSTRACT FROM AUTHOR]

New Zealand children suffer from high rates of skin and soft tissue infection (SSTI). Staphylococcus aureus colonisation is known to increase the risk of nosocomial infection. We aimed to determine whether S. aureus colonisation also increased the risk of community-onset SSTI. This study, performed within the Growing Up in New Zealand cohort, used interview and administrative data, and bacterial culture results from the nose, throat, and skin swabs collected at 4½ years of age. Multivariable log-binomial regression was used to derive adjusted risk ratios. S. aureus was isolated from 2225/5126 (43.4%) children. SSTI affected 1509/5126 (29.4%) children before age five. S. aureus colonisation at any site was associated with SSTI (aRR = 1.09, 95%CI 1.01-1.19), particularly in the year prior to swab collection (aRR = 1.18, 95%CI 1.02-1.37). The strongest association was between skin colonisation and SSTI within the year prior to swab collection (aRR = 1.47, 95%CI 1.14-1.84). Socioeconomic and ethnic variables remained independent determinants of SSTI. S. aureus colonisation was associated with an increased risk of community-onset SSTI. Socioeconomic and ethnic factors and eczema had independent effects on SSTI risk. Interventions which reduce the prevalence of S. aureus colonisation may be expected to reduce the incidence of community-onset SSTI. [ABSTRACT FROM AUTHOR]

Background: Increasing concerns about antibiotic resistance and microbiome disruption have stimulated interest in describing antibiotic consumption in young children. Young children are an age group for whom antibiotics are frequently prescribed.Objectives: To describe community antibiotic dispensing during the first 5 years of life in a large, socioeconomically and ethnically diverse cohort of children, and to determine how antibiotic dispensing varied between population subgroups.Methods: This study was performed within the Growing Up in New Zealand longitudinal cohort study ( www.growingup.co.nz ) with linkage to national administrative antibiotic dispensing data. Descriptive statistics and univariate and multivariable associations were determined.Results: The 5581 cohort children received 53 052 antibiotic courses, of which 54% were amoxicillin. By age 5 years, 97% of children had received one or more antibiotic courses, and each child had received a median of eight antibiotic courses (IQR 4-13). The mean incidence of antibiotic dispensing was 1.9 courses/child/year. Multivariable negative binomial regression showed that Māori and Pacific children received more antibiotic courses than European children, as did children in the most-deprived compared with the least-deprived areas. A distinct seasonal pattern was noted.Conclusions: This study provided a detailed description of antibiotic dispensing within a large and diverse child cohort. Antibiotic exposure was near universal by age 5 years. The predominance of amoxicillin use and the seasonal pattern suggest much antibiotic use may have been for self-limiting respiratory infections. There is a need for safe and effective interventions to improve antibiotic prescribing practices for New Zealand children. [ABSTRACT FROM AUTHOR]

Objectives: Knowledge of the patterns of antibiotic consumption within a population provides valuable information on when, where and to whom antibiotics are prescribed. Such knowledge is critical in informing possible public health interventions to reduce inappropriate antibiotic use. The aims of this study were to (i) determine national patterns of antibiotic consumption, including assessment of seasonal variation in prescribing, and (ii) explore potential associations between antibiotic consumption and patient characteristics, such as age, sex and ethnicity.Methods: Data on all subsidized antibiotic dispensing in New Zealand between 1 January 2006 and 31 December 2014 were obtained and stratified according to age, sex and ethnicity. Antibiotic dispensing was expressed as the number of DDDs per 1000 population per day (DID).Results: Total antibiotic consumption in New Zealand increased by 49% from 17.3 DID in 2006 to 25.8 DID in 2014. The increase in antibiotic consumption occurred in all ages and amongst all ethnic groups. The use of extended-spectrum penicillins, which almost doubled in the study period, made a major contribution to the overall increase and was highest in young children and in Pacific peoples. Consumption of quinolones increased early in the study period and then declined from 2011 onwards.Conclusions: Future work should focus on identifying the appropriateness of antibiotic prescribing, particularly for penicillin prescribing in Pacific peoples and children, and on both reducing unwarranted antibiotic use and improving antibiotic selection when therapy is indicated. [ABSTRACT FROM AUTHOR]

Poor adherence to combination antiretroviral therapy (ART) is a major global challenge. In this study we examined the efficacy of a smartphone application incorporating personalized health-related visual imagery that provided real-time information about the level of medication and the patient's level of immunoprotection, in order to improve adherence to ART. We randomized 28 people on ART to either a standard or augmented version of the smartphone application. The augmented version contained components that illustrated participants' current estimated plasma concentrations of antiretroviral drugs and the immune protection provided by ART. Adherence to ART was assessed at baseline and at 3 months using self-reported adherence, pharmacy dispensing records, and HIV viral load. Information was also collected on illness and medication beliefs and use of the application. Participants who received the augmented application showed a significantly higher level of self-reported adherence to ART at 3 months ( p=0.03) and decreased viral load ( p=0.023) as compared to individuals using the standard version. Greater usage of the extra components of the augmented application was associated with greater perceived understanding of HIV infection and increased perceived necessity for ART. Smartphone applications that incorporate personalized health-related visual imagery may have potential to improve adherence to ART. [ABSTRACT FROM AUTHOR]

Background: Adherence to guidelines for community-acquired pneumonia (CAP) has been shown to improve patient outcomes and slow the emergence of antimicrobial resistance. Guidelines for treating CAP vary considerably. Aim: To determine the initial antimicrobial therapy used in hospitalised adults with CAP and to compare it with local and international CAP treatment guidelines. Method: A retrospective cohort study of adults presenting to an Auckland hospital with CAP. Initial choice of antimicrobial therapy was compared to the local hospital guidelines and the British Thoracic Society (BTS), Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) and Swedish Society of Infectious Diseases (SSID) guidelines. Results: Initial treatment in 177 patients presenting with their first episode of CAP included parenteral cephalosporin (61%), amoxycillin+clavulanate (37%), amoxycillin (2.8%) and macrolide (53%). 83/92 (90%) patients with a CURB-65 score of 0-1 were treated with a cephalosporin or amoxycillin+clavulanate. 42/85 (49%) patients with a CURB-65 score ≥ 2 were treated with a macrolide. Adherence with treatment guidelines was 97% (hospital), 53% (IDSA/ATS), 11% (BTS) and 10% (SSID). Conclusion: Initial treatment of adults with CAP adhered closely with local guidelines was discordant with the BTS and SSID guidelines. [ABSTRACT FROM AUTHOR]

Aim: Pertussis disease burden in New Zealand in recent decades has been large compared with other developed countries. However, these comparisons use data from relatively short time periods given the long epidemic cycle of pertussis. To better understand the current disease burden, this study examined pertussis hospitalisation data in New Zealand in both the pre-immunisation and mass immunisation eras. Methods: Hospital discharge data and population data from 1873 to 2004 were used to estimate average pertussis hospital discharge rates per decade. Rates were compared using relative risks and 95% confidence intervals (CI). Results: Average annual pertussis hospitalisation rates per 100 000 were less than two from 1873 to 1919, increased to 12 in the 1940s, decreased to less than four in the 1960s and have increased since then with the rate in the current decade being 5.8. Compared with the 1960s (3.8 per 100 000) the average annual rate has been significantly greater in the 1980s (RR = 1.11, 95% CI 1.03, 1.21), 1990s (RR = 1.33, 95% CI 1.23, 1.44) and 2000s (RR = 1.55, 95% CI 1.42, 1.68). Since 1960 hospitalisation rates have increased for those less than one year old, one to four years old and five years and older. The increases have been most marked for infants (RR 2000s vs. 1960s = 2.87, 95% CI 2.59, 3.18). Conclusion: After an initial decline following mass immunisation, pertussis hospitalisation rates in New Zealand have subsequently increased steadily. To reduce pertussis disease burden improved immunisation coverage and timeliness is required and consideration given to spreading the pertussis vaccine schedule over a wider age range. [ABSTRACT FROM AUTHOR]

Septic arthritis is a rarely reported manifestation of disease due to Streptococcus pneumoniae. We have reviewed our recent experience of this diseaese in 14 adult patients. Common features in patients with S. pneumoniae septic arthritis included advanced age (median=63 y), pre-existing joint disease (6/14), large joint disease (14/14), polyarthritis (6/14), and associated meningitis, pneumonia or both (6/14). Two patients with septic arthritis and meningitis, and another with Down's syndrome and sleep apnoea, died during treatment. In the remaining 11 patients, treatment for at least 19 d, predominantly with intravenous benzyl penicillin, plus joint lavage, resulted in cure. [ABSTRACT FROM AUTHOR]

Antibiotic resistance, principally a consequence of the human use of antibiotics dispensed in the community, is a relentlessly growing threat to human health in Aotearoa New Zealand. Reducing the prescription of antibiotics for conditions in which they confer no benefit is the most effective method of slowing the spread of antibiotic resistance. In Aotearoa New Zealand, as in many other nations, antibiotic "treatment" of acute respiratory tract infections is the most important component of unnecessary antibiotic use. Because of the ethnic inequities in the incidence and consequences of infectious diseases in Aotearoa New Zealand, Māori and Pacific patients should receive antibiotic treatment more frequently than patients of other ethnicities. However, Māori and Pacific people who present to their doctor with conditions that do not require antibiotic treatment deserve the same excellent treatment as anyone else and should not be prescribed an antibiotic when it will provide no benefit. Setting annual goals for reductions in community antibiotic dispensing has been an effective method to encourage sustained improvements in antibiotic prescribing in other nations, and may help to quickly reduce inappropriate antibiotic prescribing in Aotearoa New Zealand., Competing Interests: None, (© PMA.)

Background: Mobile health platforms like smartphone apps that provide clinical guidelines are ubiquitous, yet their long-term impact on guideline adherence remains unclear. In 2016, an antibiotic guidelines app, called SCRIPT, was introduced in Auckland City Hospital, New Zealand, to provide local antibiotic guidelines to clinicians on their smartphones., Objective: We aimed to assess whether the provision of antibiotic guidelines in a smartphone app resulted in sustained changes in antibiotic guideline adherence by prescribers., Methods: We analyzed antibiotic guideline adherence rates during the first 24 hours of hospital admission in adults diagnosed with community-acquired pneumonia using an interrupted time-series study with 3 distinct periods post app implementation (ie, 3, 12, and 24 months)., Results: Adherence increased from 23% (46/200) at baseline to 31% (73/237) at 3 months and 34% (69/200) at 12 months, reducing to 31% (62/200) at 24 months post app implementation (P=.07 vs baseline). However, increased adherence was sustained in patients with pulmonary consolidation on x-ray (9/63, 14% at baseline; 23/77, 30% after 3 months; 32/92, 35% after 12 month; and 32/102, 31% after 24 months; P=.04 vs baseline)., Conclusions: An antibiotic guidelines app increased overall adherence, but this was not sustained. In patients with pulmonary consolidation, the increased adherence was sustained., (©Chang Ho Yoon, Imogen Nolan, Gayl Humphrey, Eamon J Duffy, Mark G Thomas, Stephen R Ritchie. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 02.05.2023.)

Competing Interests: Dr Murdoch reports he is a member of the panel for the Office of the Prime Minister’s Chief Science Advisor’s project on Antimicrobial Resistance and Infectious Diseases. Mr McRae reports he is a member of the New Zealand Antimicrobial Stewardship/Infection Pharmacist Expert Group, and a member of the Infection Prevention Advisory Group for ACC. Ms Mccall reports she is a member of the Canterbury District Health Board Hospital Antimicrobial Stewardship Committee. Dr Maze reports he is a member of the Canterbury District Health Board Hospital Antimicrobial Stewardship Committee. Ms Lim reports that she is a member of the New Zealand Antimicrobial Stewardship/Infection Pharmacist Expert Group and Southern District Health Board Antimicrobial Stewardship Committee. Miss Li reports that she is a member of the New Zealand Antimicrobial Stewardship/Infection Pharmacist Expert Group and a member of the Capital and Coast District Health Board Antimicrobial Stewardship Committee. Dr Kelly reports he is Chair of the National Infection Prevention and Control Expert Group, Ministry of Health. Mr Issa reports he is a member of the New Zealand Antimicrobial Stewardship/Infection Pharmacist Expert Group; a member of the Waikato District Health Board, Antimicrobial Steering Group; coordinator on the New Zealand Hospital Pharmacists’ Association – Infectious Disease/Antimicrobial Stewardship Special Interest Network; a member of the New Zealand Hospital Pharmacists’ Association; and a member of Pharmaceutical Society of New Zealand. Dr Howard reports involvement in writing antimicrobial guidelines at Waikato District Health Board. Mrs Hardie reports she is a member of the New Zealand Antimicrobial Stewardship/Infection Pharmacist Expert Group and member of the Waitematā District Health Board Antimicrobial Stewardship Committee. Dr Gardiner reports that she is co-lead for the New Zealand Antimicrobial Stewardship/Infection Pharmacist Expert Group; a member of the panel for the Office of the Prime Minister’s Chief Science Advisor’s project on Antimicrobial Resistance and Infectious Diseases; a member of the Steering Group for the ACC scoping report on developing national antimicrobial guidance for NZ; and Secretary of the Canterbury Antimicrobial Stewardship Strategic Group and Secretary of the CDHB Hospital Antimicrobial Stewardship Committee. Mr Duffy reports that he is co-lead for the New Zealand Antimicrobial Stewardship/Infection Pharmacist Expert Group; a member of the Ministry of Health AMR Co-ordination (HARC) Group; a member of the Steering Group for the ACC scoping report on developing national antimicrobial guidance for NZ; a member of the PTAC Anti-infective sub-committee (PHARMAC); and a member of Auckland DHB Antimicrobial Stewardship Committee. Ms du Plessis reports that she is Lead for the Counties-Manukau Hospital Antimicrobial Stewardship Program and Chair for the Counties-Manukau Hospital Antimicrobial Stewardship Committee. Dr Chambers reports being Deputy Chair of Canterbury District Health Board Hospital Antimicrobial Stewardship Committee; a member of the reference group for the Prime Minister’s Chief Science Advisor’s project on Antimicrobial Resistance and Infectious Diseases; and a member of PTAC Anti-infective sub-committee (PHARMAC). Dr Campbell reports that she is the Pharmaceutical Society of NZ representative on the NZ Antimicrobial Stewardship/Infection Pharmacist Expert Group; a member of the Ministry of Health Antimicrobial Resistance Coordination Group representing the Pharmaceutical Society of New Zealand; and a member of the Reference Group for the Office of the Prime Minister’s Chief Science Advisor’s project on Antimicrobial Resistance and Infectious Diseases. Dr Bupha-Intr reports that she is a member of the Capital and Coast DHB Antimicrobial Stewardship Committee. Dr Briggs reports that he is a member of the PTAC Anti-Infective Subcommittee (PHARMAC). Dr Birch reports being on the Canterbury District Health Board Hospital Antimicrobial Stewardship Committee. Dr Betty reports having provided advice to the panel for the Office of the Prime Minister’s Chief Science Advisor’s project on Antimicrobial Resistance and Infectious Diseases, and being Medical Director of the Royal NZ College of General Practice. Dr Batlle-Perales reports being a member of the Antimicrobial Steering Group at Waikato Hospital. Brendan Arnold is the clinical lead for Antimicrobial Stewardship at Southern District Health Board.

Background: The Dundee classification is a simple severity assessment tool that could optimize treatment decisions and clinical outcomes in adult patients with cellulitis; however, it has not been validated in a large cohort., Objectives: To determine whether the Dundee classification reliably identified those patients with cellulitis who had a higher mortality, a longer length of hospital stay or an increased risk of readmission., Methods: We performed a retrospective study of all adults with a primary discharge diagnosis of cellulitis admitted to Auckland City Hospital from August 2013 to June 2015. We classified patients by severity using the Dundee scoring system., Results: The 30 day all-cause mortality in adult patients with a discharge diagnosis of cellulitis was 2% (29/1462) overall, and was 1% (10/806), 2% (6/271), 3% (10/353) and 9% (3/32) in Classes 1, 2, 3 and 4 of the Dundee classification, respectively (P = 0.01). Mortality was strongly associated with age >65 years (OR 9.37, 95% CI 3.00-41.23) and with heart failure (OR 6.16, 95% CI 2.73-14.23). There were significant associations between the Dundee classification and the incidence of bacteraemia, the length of hospital stay and the rate of readmission to hospital., Conclusions: The Dundee classification is a simple, reliable tool that can be easily applied in clinical settings to predict risk of mortality in order to determine which patients can be managed in the community with oral or intravenous therapy, and which require inpatient care.

Aim: Infectious disease (ID) hospitalisation rates are increasing in New Zealand (NZ), especially in pre-school children, and Māori and Pacific people. We aimed to identify risk factors for ID hospitalisation in infancy within a birth cohort of NZ children, and to identify differences in risk factors between ethnic groups., Methods: We investigated an established cohort of 6846 NZ children, born in 2009-2010, with linkage to a national data set of hospitalisations. We used multivariable logistic regression to obtain odds ratios (OR) for factors associated with ID hospitalisation in the first year of life, firstly for all children, and then separately for Māori or Pacific children., Results: In the whole cohort, factors associated with ID hospitalisation were Māori (OR: 1.49, 95% CI: 1.17-1.89) or Pacific (2.51; 2.00-3.15) versus European maternal ethnicity, male gender (1.32; 1.13-1.55), low birthweight (1.94, 1.39-2.66), exclusive breastfeeding for <4 months (1.22, 1.04-1.43), maternal experience of health-care racism (1.60, 1.19-2.12), household deprivation (most vs. least deprived quintile of households (1.50, 1.12-2.02)), day-care attendance (1.43, 1.12-1.81) and maternal smoking (1.55, 1.26-1.91). Factors associated with ID hospitalisation for Māori infants were high household deprivation (2.16, 1.06-5.02) and maternal smoking (1.48, 1.02-2.14); and for Pacific infants were delayed immunisation (1.72, 1.23-2.38), maternal experience of health-care racism (2.20, 1.29-3.70) and maternal smoking (1.59, 1.10-2.29)., Conclusions: Māori and Pacific children in NZ experience a high burden of ID hospitalisation. Some risk factors, for example maternal smoking, are shared, while others are ethnic-specific. Interventions aimed at preventing ID hospitalisations should address both shared and ethnic-specific factors., (© 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

AMR has been cited as the most significant health issue of the 21st century with potentially serious consequences for the health of global populations, including New Zealand, and its health system. Proactive approaches to combating AMR through better understanding of the causes will inform measures required to reduce potential threats. The Royal Australasian College of Physicians (RACP) identifies three pathogens where increased resistance is of concern and recommends collaborative responses to prevent emerging threats to New Zealand populations. An international best practice AMR programme would include antimicrobial stewardship (AMS) building on evidence, policy, organisational support, multidisciplinary teams and patient experience. The planned Ministry of Health-led collaborative approach to developing a national strategy and programme will provide sector direction. Implementation will require extensive engagement with the health sector and communities to develop joint solutions that prevent further increases in AMR.

New Zealand has unenviably high rates of bacterial resistance to topical antimicrobials. In this Viewpoint, we review the history and usage of topical antimicrobials in New Zealand, and suggest some strategies to mitigate further increases in antimicrobial resistance to topical agents.

Our aim was to assess national prescribing trends and determine longitudinal resistance patterns for topical antimicrobials in New Zealand. We observed a dramatic increase in fusidic acid (FA) resistance, and clonal expansion of FA-resistant Staphylococcus aureus. This increase was concurrent with a significant national increase in topical FA dispensing., (© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Steadily rising rates of antimicrobial resistance, in a range of common bacterial pathogens, are a major threat to human health in New Zealand in the near future. The single largest contributor to this threat is the high level of antimicrobial consumption in New Zealand. Antimicrobial consumption in New Zealand needs to be reduced if we are to slow the spread of antimicrobial-resistant bacteria. Reporting the per capita antimicrobial consumption within each District Health Board (DHB), in relation to targets for reductions from present levels of consumption, could provide an impetus for DHBs to address this threat to the health of their populations.

Background: New Zealand has a higher incidence of Staphylococcus aureus disease than other developed countries, with significant sociodemographic variation in incidence rates. In contrast to North America, the majority of disease is due to methicillin-susceptible S. aureus (MSSA), although relatively little is known about the comparative demographics of MSSA and methicillin-resistant S. aureus (MRSA) infections in New Zealand., Methods: Our objectives were to describe the trends, incidence and patient demographics of all S. aureus infections in patients presenting to our institution between 2001 and 2011, and compare the epidemiology of MSSA and MRSA infections. We identified all patients with S. aureus infections over the study period. A unique S. aureus infection was defined as the first positive S. aureus culture taken from the same patient within a thirty-day period. Standard definitions were used to classify episodes into community- or healthcare-associated S. aureus infection., Results: There were 16,249 S. aureus infections over the study period. The incidence increased significantly over the study period from 360 to 412 per 100,000 population (P < 0.001), largely driven by an increase in community-associated non-invasive MSSA infections. When compared with MSSA infections, patients with non-multiresistant MRSA infections were more likely to be older, have hospital-onset infections and be Māori or Pacific Peoples., Conclusions: Our work provides valuable baseline data on the epidemiology and trends of S. aureus infections in New Zealand. The significant increase in community-associated S. aureus infections is of public health importance. Future studies should investigate the reasons underlying this concerning trend.

We analyzed all cases of community-onset Staphylococcus aureus skin and soft tissue infection in children presenting to our hospital between 2007 and 2010. A total of 1860 children were included. There was significant sociodemographic disparity, with the incidence disproportionately higher in Maori and Pacific Island children residing in deprived areas.

Objective: The aim of this study was to examine whether participation in a 4-week massage intervention is associated with reduced distress and enhanced antibody responses after hepatitis B vaccine in students embarking on academic examinations., Methods: Seventy medical student volunteers (36 women, 34 men) were randomly assigned to intervention or control groups. Baseline assessments were made of distress, health behaviors, and prevaccination antibodies to hepatitis B surface antigen. Intervention participants received weekly 45-minute massages before an examination period. At the end of the intervention and 1 week before commencing the examination period, all participants received an intramuscular hepatitis B vaccination and repeated the assessments completed at baseline. Serum antibody responses to hepatitis B surface antigen were measured at 2 and 6 weeks postvaccination., Results: Examinations were associated with increased distress in both the massage and the control groups: perceived stress (F(1,67) = 10.64, p = .002), anxiety (F(1,67) = 15.72, p < .001) and negative affect (F(1,66) = 5.80, p = .019); these increases did not differ between the massage and the control groups. Furthermore, massage was associated with lower levels of antibody to hepatitis B surface antigen after vaccination at both time points (F(1,63) = 6.29, p = .015)., Conclusions: These findings indicate that a brief massage intervention did not attenuate emotional distress during an examination period but did result in lowered antibody responses to vaccination. Further research is required to establish whether these effects were attributable to the nature of intervention (i.e., duration and type of massage) and/or its limited relevance to a healthy population confronting a relatively acute stressor such as examinations.

Background: Studies have reported higher rates of diseases caused by Staphylococcus aureus (S. aureus) amongst Maori and Pacific people, compared with people of other ethnicities., Aim: We aimed to estimate the prevalence of nasal carriage and to explore demographic differences between S. aureus carriers and non-carriers in Auckland, New Zealand., Materials and Methods: Nasal swab specimens were obtained from healthy population volunteers, who did not have recent healthcare contact. Each participant completed a short questionnaire., Results: 78/424 (18%; 95%CI, 15-22) S. aureus carriers were identified. Female participants were less likely to be S. aureus carriers than males; but there were no differences in the ages or ethnic groups between S. aureus carriers and non-carriers. Socioeconomic deprivation, recent non-hospital healthcare contact and past history of S. aureus infection were not associated with S. aureus carriage., Conclusion: Ethnic variation in the prevalence of S. aureus nasal carriage does not contribute to an increased risk of disease caused by S. aureus.

Aim: To estimate the burden of skin and soft tissue infection caused by Staphylococcus aureus (S. aureus), and to determine the effects of ethnicity and age on the rate of skin and soft tissue due to MRSA in the Auckland community., Materials and Methods: We reviewed the culture and susceptibility results of all wound swabs processed by Auckland's only community microbiology laboratory in 2007. Demographic data for a random sample of 1000 people who had a wound swab collected and for all people from whom a methicillin-resistant S. aureus (MRSA) strain was isolated were obtained and compared to demographic data for the total population of Auckland., Results: S. aureus was isolated from 23853/47047 (51%) wound swab cultures performed in 2007; the estimated annual incidence of S. aureus isolation from a wound swab was 1847/100,000 people; and the estimated annual incidence of MRSA isolation from a wound swab was 145/100,000 people. Maori and Pacific people had higher rates of non-multiresistant MRSA infection compared with New Zealand European and Asian people; elderly New Zealand European people had much higher rates of multiresistant MRSA infections compared with people from other ethnic groups., Conclusion: S. aureus is a very common cause of disease in the community and the incidence of infection with MRSA subtypes varies with ethnicity.

Aim: This paper characterises the health and wellbeing of HIV-positive people in New Zealand., Methods: The HIV Futures New Zealand Survey is a self-complete anonymous questionnaire distributed in a variety of ways. Data were collected on health, clinical, and social variables., Results: There were 226 responses, estimated to be approximately 25% of the HIV positive population. Respondents were aged between 18 and 68, and 56% were homosexual men. Most (68%) reported a viral load on most recent test of below 500 copies/mL and 59% had a CD4 lymphocyte count on most recent test of over 250 cells/mcL. However, 28% reported a major health condition in addition to HIV and 21% had a mental health condition. Most respondents (64%) were currently using antiretroviral therapy. Many (84%) knew other people with HIV and had contact with an HIV/AIDS organisation (77%). Forty-two percent of respondents had stopped working because of HIV, and 47% reported their main source of income as a Government benefit., Conclusions: This research has demonstrated that, while the HIV-positive population of New Zealand generally has improved health as a result of antiretroviral therapy, there are still significant social and economic barriers to their quality of life.