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Background: Worldwide there is increasing interest in the manipulation of human gut microbiota by the use of probiotic supplements to modify or prevent a range of communicable and non-communicable diseases. Probiotic interventions administered during pregnancy and breastfeeding offer a unique opportunity to influence a range of important maternal and infant outcomes. The aim of the Probiotics in Pregnancy Study (PiP Study) is to assess if supplementation by the probiotic Lactobacillus rhamnosus HN001 administered to women from early pregnancy and while breastfeeding can reduce the rates of infant eczema and atopic sensitisation at 1 year, and maternal gestational diabetes mellitus, bacterial vaginosis and Group B Streptococcal vaginal colonisation before birth, and depression and anxiety postpartum., Methods/design: The PiP Study is a two-centre, randomised, double-blind placebo-controlled trial in Wellington and Auckland, New Zealand. Four hundred pregnant women expecting infants at high risk of allergic disease will be enrolled in the study at 14-16 weeks gestation and randomised to receive either Lactobacillus rhamnosus HN001 (6 × 10(9) colony-forming units per day (cfu/day)) or placebo until delivery and then continuing until 6 months post-partum, if breastfeeding. Primary infant outcomes are the development and severity of eczema and atopic sensitisation in the first year of life. Secondary outcomes are diagnosis of maternal gestational diabetes mellitus, presence of bacterial vaginosis and vaginal carriage of Group B Streptococcus (at 35-37 weeks gestation). Other outcome measures include maternal weight gain, maternal postpartum depression and anxiety, infant birth weight, preterm birth, and rate of caesarean sections. A range of samples including maternal and infant faecal samples, maternal blood samples, cord blood and infant cord tissue samples, breast milk, infant skin swabs and infant buccal swabs will be collected for the investigation of the mechanisms of probiotic action., Discussion: The study will investigate if mother-only supplementation with Lactobacillus rhamnosus HN001 in pregnancy and while breastfeeding can reduce rates of eczema and atopic sensitisation in infants by 1 year, and reduce maternal rates of gestational diabetes mellitus, bacterial vaginosis, vaginal carriage of Group B Streptococcus before birth and maternal depression and anxiety postpartum., Trial Registration: Australian New Zealand Clinical Trials Registration: ACTRN12612000196842. Date Registered: 15/02/12.

Aim: In view of recent studies questioning the usefulness of peritoneal drainage (PD) in premature neonates with pneumoperitoneum, suggesting approximately 75% of those treated with PD needed delayed laparotomy, we reviewed the requirement for laparotomy after initial PD at our institution., Methods: Retrospective cohort of all premature infants with a diagnosis of intestinal perforation (ICD Code P78.0) from 1995 to 2012. Inclusion criteria were pneumoperitoneum on x-ray (isolated perforation or necrotising enterocolitis), birthweight <1800 g and gestational age <33 weeks., Results: Fifty patients met the criteria (38 PD, 12 primary laparotomy). Thirty-two per cent (95% CI 18-49%) received secondary laparotomy after initial PD. There was no significant difference when stratified according to isolated perforation (24%) versus necrotising enterocolitis (56%, P = 0.11). There was no significant difference between PD and primary laparotomy for time to full enteral nutrition, hazard ratio (HR) 0.99 (95% CI 0.48-2.04) or mortality, HR 2.15 (95% CI 0.48-9.63). The HR for mortality was partly confounded by birthweight, birthweight-adjusted HR 1.52 (95% CI 0.32-7.23)., Conclusions: Thirty-two per cent of neonates treated with primary PD received secondary laparotomy, with no significant difference in key outcomes. Primary PD still appears to be of benefit for those without features of necrotising enterocolitis., (© 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).)

Introduction: Self-monitoring of clinical-decision-making is essential for health care professional practice. Using certainty in responses to assessment items could allow self-monitoring of clinical-decision-making by medical students to be tracked over time. This research introduces how aspects of insightfulness, safety and efficiency could be based on certainty in, and correctness of, multiple-choice question (MCQ) responses. We also show how these measures change over time., Methods: With each answer on twice yearly MCQ progress tests, medical students provided their certainty of correctness. An insightful student would be more likely to be correct for those answers given with increasing certainty. A safe student would be expected to have a high probability of being correct for answers given with a high certainty. An efficient student would be expected to have a sufficiently low probability of being correct when they have no certainty. The system was developed using first principles and data from one cohort of students. A dataset from a second cohort was then used as an independent validation sample., Results: The patterns of aspects of self-monitoring were similar for both cohorts. Almost all the students met the criteria for insightfulness on all tests. Most students had an undetermined outcome for the safety aspect. When a definitive result for safety was obtained, absence of safety was most prevalent in the middle of the course, while the presence of safety increased later. Most of the students met the criteria for efficiency, with the highest prevalence mid-course, but efficiency was more likely to be absent later., Discussion: Throughout the course, students showed reassuring levels of insightfulness. The results suggest that students may balance safety with efficiency. This may be explained by students learning the positive implications of decisions before the negative implications, making them initially more efficient, but later being more cautious and safer., (© 2023 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Background: Māori have three times the mortality from lung cancer compared with non-Māori. The Te Manawa Taki region has a population of 900 000, of whom 30% are Māori. We have little understanding of the factors associated with developing and diagnosing lung cancer and ethnic differences in these characteristics., Aims: To explore the differences in the incidence and characteristics of patients with newly diagnosed lung cancer between Māori and non-Māori., Methods: Patients were identified from the regional register. Incidence rates were calculated based on population data from the 2013 and 2018 censuses. The patient and tumour characteristics of Māori and non-Māori were compared. The analysis used Χ 2 tests and logistic models for categorical variables and Student t tests for continuous variables., Results: A total of 4933 patients were included, with 1575 Māori and 3358 non-Māori. The age-standardised incidence of Māori (236 per 100 000) was 3.3 times higher than that of non-Māori. Māori were 1.3 times more likely to have an advanced stage of disease and 1.97 times more likely to have small cell lung cancer. Māori were more likely to have comorbidities, chronic obstructive pulmonary disease, cardiovascular disease and diabetes. They also had higher levels of social deprivation and tended to be younger, female and current smokers., Conclusions: The findings point to the need to address barriers to early diagnosis and the need for system change including the need to introduce a lung cancer screening focussing on Māori. There is also the need for preventive programmes to address comorbidities that impact lung cancer outcomes as well as a continued emphasis on creating a smoke-free New Zealand., (© 2023 Royal Australasian College of Physicians.)

Background Using a double blind randomized placebo-controlled trial ( Australian New Zealand Clinical Trials Registry: ACTRN12607000518460), we have shown that in a high risk birth cohort, maternal supplementation from 35 weeks gestation until 6 months if breastfeeding and infant supplementation until 2 years with Lactobacillus rhamnosus HN001 ( HN001) (6 × 109 cfu/day) halved the cumulative prevalence of eczema by age 2 years. Bifidobacterium animalis subsp lactis HN019 ( HN019) (9 × 109 cfu/day) had no effect. Objective The aim of this study was to investigate the associations of HN001 and HN019 with allergic disease and atopic sensitization among these children at age 4 years, 2 years after stopping probiotic supplementation. Methods The presence ( UK Working Party's Diagnostic Criteria) and severity SCORing Atopic Dermatitis ( SCORAD) of eczema and atopy (skin prick tests) and parent-reported symptoms of asthma and rhinoconjunctivitis were assessed using standard protocols and questions. Results Four-hundred and seventy-four infants were eligible at birth of whom 425 (90%) participated in this follow-up. The cumulative prevalence of eczema by 4 years (Hazard ratio ( HR) 0.57 (95% CI 0.39-0.83)) and prevalence of rhinoconjunctivitis at 4 years (Relative risk 0.38 (95% CI 0.18-0.83)) were significantly reduced in the children taking HN001; there were also nonsignificant reductions in the cumulative prevalence of SCORAD ≥ 10 ( HR 0.74 (95% CI 0.52-1.05), wheeze ( HR 0.79 (95% CI 0.59-1.07)) and atopic sensitization ( HR = 0.72 (95% CI 0.48-1.06)). HN019 did not affect the prevalence of any outcome. Conclusions and Clinical Relevance This study showed that the protective effect of HN001 against eczema, when given for the first 2 years of life only, extended to at least 4 years of age. This, together with our findings for a protective effect against rhinoconjunctivitis, suggests that this probiotic might be an appropriate preventative intervention for high risk infants. [ABSTRACT FROM AUTHOR]

The Australasian Faculty of Occupational and Environmental Medicine released a position statement which included statements about the chance of ever getting back to work if a person is off work for 20, 45 and 70 days. These statements are being repeated by government and non-government agencies in New Zealand and Australia. They have been presented with the intent to influence public policy. They are presented to general practitioners in the context of certifying people as unfit for work. The statements are based on an incorrect interpretation of the referenced study, are not justified and should be corrected.

Background: The head impulse test (HIT) is a recognised clinical sign of the high frequency vestibulo-ocular reflex (VOR), which can be quantified with video-oculography. This measures the VOR gain as the ratio of angular eye velocity to angular head velocity. Although normative data is available for VOR gain with video-oculography, most normal studies in general include small numbers of subjects and do not include analysis of variation of VOR gain with age. The purpose of our study was to establish normative data across 60 control subjects aged 20 to 80 years to represent a population distribution., Methods: Sixty control subjects without any current or previous form of brain disorder or vertigo participated in this study and form the basis for future comparison to patients with vestibular lesions. The relationship between the horizontal vestibulo-ocular reflex (HVOR) velocity gain and age was analysed using a mixed regression model with a random effect for subjects. Differences in testing technique were assessed to ensure reliability in results., Results: The mean HVOR velocity gain of 60 normal subjects was 0.97 (SD = 0.09) at 80 ms and 0.94 (SD = 0.10) at 60 ms. The 2 SD lower limit of normal HVOR velocity gain was 0.79 at 80 ms and 0.75 at 60 ms. No HVOR velocity gain fell below 0.76 and 0.65 at 80 ms and 60 ms respectively. The HVOR velocity gain declined by 0.012 and 0.017 per decade as age increased at 80 ms and 60 ms respectively. A non-physiologically high horizontal HVOR velocity gain was found to occur in tests where passive HITs were predictable in direction and time and where target distance was below 0.70 m., Conclusions: Normative data with respect to HVOR velocity gain decreases slightly with age, but with careful attention to methodology the 2 SD lower limit of normal is relatively robust across a wide age range and into the eighth decade, without requirement for adjustment with age.

Background: In 2017, the American College of Cardiology and American Heart Association (ACC/AHA) lowered blood pressure (BP) thresholds to define hypertension in adults outside pregnancy. If used in pregnancy, these lower thresholds may identify women at increased risk of adverse outcomes, which would be particularly useful to risk-stratify nulliparous women. In this secondary analysis of the SCOPE cohort, we asked whether, among standard-risk nulliparous women, the ACC/AHA BP categories could identify women at increased risk for adverse outcomes. Methods and findings: Included were pregnancies in the international SCOPE cohort with birth at ≥20 weeks' gestation, 2004 to 2008. Women were mostly of white ethnicity, in their 20s, and of normal-to-overweight body mass index (BMI). Excluded were pregnancies ending in fetal loss at <20 weeks' gestation, and those terminated at any point in pregnancy. Women were categorized by highest BP during pregnancy, using ACC/AHA criteria: normal (BP <120/80 mmHg), "Elevated BP" (BP 120 to 129 mmHg/<80 mmHg), "Stage-1 hypertension" (systolic BP [sBP] 130 to 139 mmHg or diastolic BP [dBP] 80 to 89 mmHg), and "Stage-2 hypertension" that was non-severe (sBP 140 to 159 mmHg or dBP 90 to 109 mmHg) or severe (sBP ≥160 mmHg or dBP ≥110 mmHg). Primary outcomes were preterm birth (PTB), low birthweight, postpartum hemorrhage, and neonatal care admission. Adjusted relative risks (aRRs) and diagnostic test properties were calculated for each outcome, according to: each BP category (versus "normal"), and using the lower limit of each BP category as a cut-off. RRs were adjusted for maternal age, BMI, smoking, ethnicity, and alcohol use. Of 5,628 women in SCOPE, 5,597 were included in this analysis. When compared with normotension, severe "Stage 2 hypertension" was associated with PTB (24.0% versus 5.3%; aRR 4.88, 95% confidence interval, CI [3.46 to 6.88]), birthweight <10th centile (24.4% versus 8.8%; aRR 2.70 [2.00 to 3.65]), and neonatal unit admission (32.9% versus 8.9%; aRR 3.40 [2.59 to 4.46]). When compared with normotension, non-severe "Stage 2 hypertension" was associated with birthweight <10th centile (16.1% versus 8.8%; aRR 1.82 [1.45 to 2.29]) and neonatal unit admission (15.4% versus 8.9%; aRR 1.65 [1.31 to 2.07]), but no association with adverse outcomes was seen with BP categories below "Stage 2 hypertension." When each BP category was assessed as a threshold for diagnosis of abnormal BP (compared with BP values below), only severe "Stage 2 hypertension" had a useful (good) likelihood ratio (LR) of 5.09 (95% CI [3.84 to 6.75]) for PTB. No BP threshold could rule-out adverse outcomes (i.e., had a negative LR <0.2). Limitations of our analysis include lack of ethnic diversity and use of values from clinical notes for BP within 2 weeks before birth. This study was limited by: its retrospective nature, not all women having BP recorded at all visits, and the lack of detail about some outcomes. Conclusions: In this study, we observed that 2017 ACC/AHA BP categories demonstrated a similar pattern of association and diagnostic test properties in nulliparous women, as seen in the general obstetric population. BP thresholds below the currently used "Stage 2 hypertension" were not associated with PTB, low birthweight, postpartum hemorrhage, or neonatal unit admission. This study does not support implementation of lower BP values as abnormal in nulliparous pregnant women. Laura Slade, Maya Blackman and colleagues assess the associations between differing blood pressure thresholds and adverse pregnancy outcomes in a cohort of standard-risk nulliparous women. Author summary: Why was this study done?: In 2017, the American College of Cardiology (ACC) and American Heart Association (AHA) revised what they considered to be normal blood pressure (BP) outside pregnancy. No pregnancy guidelines have revised their definition of hypertension, which is a systolic blood pressure ≥140 mmHg or a diastolic blood pressure ≥90 mmHg, which ACC/AHA criteria outside pregnancy classify as "Stage 2 hypertension." We performed a secondary analysis of the SCOPE pregnancy cohort, asking whether among standard-risk nulliparous women, the ACC/AHA BP categories before "Stage 2 hypertension" could identify women at risk for adverse pregnancy outcomes. What did the researchers do and find?: For the available outcomes of preterm birth (PTB), birthweight <10th percentile, postpartum hemorrhage, and neonatal unit admission, only "Stage 2 hypertension" was associated with an increased risk of adverse outcomes. The association with the adverse outcomes evaluated was particularly true for severe "Stage 2 hypertension," defined as a systolic blood pressure ≥160 mmHg or a diastolic blood pressure ≥90 mmHg. What do these findings mean?: The findings of this study do not support implementation of lower BP values as abnormal in nulliparous pregnant women. Our findings are limited by a lack of ethnic diversity in our study population and use of clinical BP measurements for values within 2 weeks before birth. [ABSTRACT FROM AUTHOR]

Background: We aimed at investigating the efficacies of probiotics in alleviating the core and associated symptoms of autism spectrum disorder (ASD). Methods: Randomized placebo-controlled trials were identified from major electronic databases from inception to Nov 2023. The outcomes of interests including improvements in the total and associated symptoms of ASD were quantitatively expressed as effect size (ES) based on standardized mean difference (SMD) with 95% confidence interval (CI). Results: Ten studies with 522 participants (mean age = 8.11) were included in this meta-analysis. The primary results revealed significant improvement in total symptoms in the probiotics group compared with the controls (SMD = − 0.19, p = 0.03, ten studies, n = 522) but not the core symptoms (i.e., repetitive restricted behaviors, As affiliations 3 and 5 are same, we have deleted the duplicate affiliations and renumbered accordingly. Please check and confirm.problems with social behaviors/communication). Subgroup analyses demonstrated improvement in total symptoms in probiotics users relative to their controls only in studies using multiple-strain probiotics (SMD = − 0.26, p = 0.03, five studies, n = 288) but not studies using single-strain regimens. Secondary results showed improvement in adaptation (SMD = 0.37, p = 0.03, three studies, n = 139) and an improvement trend in anxiety symptoms in the probiotics group compared with controls (SMD = − 0.29, 95% CI − 0.60 to 0.02, p = 0.07, three studies, n = 163) but failed to demonstrate greater improvement in the former regarding symptoms of irritability/aggression, hyperactivity/impulsivity, inattention, and parental stress. Conclusions: Our study supported probiotics use against the overall behavioral symptoms of ASD, mainly in individuals receiving multiple-strain probiotics as supplements. However, our results showed that probiotics use was only associated with improvement in adaptation and perhaps anxiety, but not core symptoms, highlighting the impact of adaptation on quality of life rather than just the core symptoms. Nevertheless, the limited number of included trials warrants further large-scale clinical investigations. [ABSTRACT FROM AUTHOR]

This article describes the origins and development of Te Mauri (the life essence), a unique Māori (Indigenous people of New Zealand) public health and well-being programme aimed at addressing critical gaps in knowledge about supportive cancer care for whānau (families) living with cancer in Aotearoa (New Zealand). Te Mauri is a kaupapa Māori (Māori philosophy) public health initiative having a whānau ora (family well-being) approach, so is based not on the individual, or patient, but within whānau and the core role of communities in relation to the provision of cancer care, the promotion of recovery from cancer, and the maintenance of well-being for current and future generations. Te Mauri makes an important contribution to expanding mātauranga Māori (Māori knowledge) and the range of Indigenous models of care so that cancer service provision is improved for the benefit of all those who are on a cancer journey. [ABSTRACT FROM AUTHOR]

Prebiotic and probiotic usage has exploded, with most formulations promoting gastrointestinal and immunological benefits. Prebiotics modulate the gut microbiota, as a result, short‐chain fatty acids are released into the bloodstream. Prebiotics have immunomodulatory properties that reduce inflammation while enhancing immune responses and boosting gut health. The potential of probiotics has shown steady expansion in the digestive system, metabolic balance, and vaginal health. Probiotics offer therapeutic and preventative strategies for a range of human diseases. The in vitro studies suggested the delivery matrix might influence their effects through physicochemical interactions with molecular and cellular structures as well as modifications in cellular expression. Dietary fibers and polyphenols both contribute significantly to human health protection and can ferment in the gut microbiota to create butyrate. This comprehensive review aims to highlight the probiotics and prebiotics, and provide evidence to support their use in preventive and therapeutic medicine. It is anticipated that it will help the clinical and preclinical research to look into the effects of inclusion and processing on their activity in different food delivery formulations. There are potential opportunities needed to enhance immunological and digestive health by comprehending and using the interaction between the gut microbiota and the immune system in our diet. [ABSTRACT FROM AUTHOR]

Background: Childhood is a time when health behaviours are established and the foundations for health literacy are cemented. In Aotearoa New Zealand nurses are responsible for communicating health messages to children at key stages in children's lives. Objectives/Aims: This review explores the ways in which nurses communicate health messages to children and adolescents in Aotearoa New Zealand. It evaluates whether current approaches to health communication are in-line with a child's rights-based approach. Design: An integrative review using a systematic literature search strategy. Data sources: In July 2022, 9 databases were searched including: Medline (Ovid), Embase (Ovid), Scopus (Elsevier), Cochrane Library, EBSCO (host), Web of Science Core Collection, CINHIAL plus, psychINFO and PsychEXTRA. Methods: Following title and abstract screening 41 articles went through to full-text screening. These were uploaded into NVivo v.12 for analysis. Results were analysed using content analysis with a deductive coding framework informed by the UN Convention on the Rights of the Child. A total of 20 articles met all inclusion criteria and were assessed of high quality using the Mixed Methods Appraisal Tool. Results: Nurses communicate health messages using a variety of strategies, some of which align with the rights of the child. No evidence was found of nurses communicating health messages through play or creative activities or by adopting principles and practice of continuity of care, including health communication beyond the paediatric context. Conclusion: Opportunities exist for improvements to the rights of children and adolescents within nursing practice. Further research about the rights of children in healthcare services including not only identifying the barriers but research that includes interventions and proposes solutions is necessary. [ABSTRACT FROM AUTHOR]

In the United States, autism spectrum disorder (ASD) affects 1 in 33 children and is characterized by atypical social interactions, communication difficulties, and intense, restricted interests. Microbial dysbiosis in the gastrointestinal (GI) tract is frequently observed in individuals with ASD, potentially contributing to behavioral manifestations and correlating with worsening severity. Moreover, dysbiosis may contribute to the increased prevalence of GI comorbidities in the ASD population and exacerbate immune dysregulation, further worsening dysbiosis. Over the past 25 years, research on the impact of microbial manipulation on ASD outcomes has gained substantial interest. Various approaches to microbial manipulation have been preclinically and clinically tested, including antibiotic treatment, dietary modifications, prebiotics, probiotics, and fecal microbiota transplantation. Each method has shown varying degrees of success in reducing the severity of ASD behaviors and/or GI symptoms and varying long-term efficacy. In this review, we discuss these microbiome manipulation methods and their outcomes. We also discuss potential microbiome manipulation early in life, as this is a critical period for neurodevelopment. [ABSTRACT FROM AUTHOR]

Objective: Chronic tension-type headache (CTTH) is a chronic syndrome characterized by frequent headache occurring more than 15 days per month. The intensity and duration of headache pain can be very distressing and disabling on an individuals' well-being. The purpose of this study was to examine the applicability of sauna bathing as a new method of treatment for reducing pain in patients with CTTH., Methods: Thirty-seven people who fulfilled the International Headache Society criteria for CTTH were randomly assigned into two groups. The control group (n=20) received advice and education while the intervention group (n=17) received the same advice and attended a sauna regularly for 8 weeks. Reductions in subjective pain were determined using the numerical pain rating scale (NPRS). Disturbance in sleep, depression as assessed by Beckman Disability Index (BDI), and Headache Disability Index (HDI) were measured., Results: Mean change in headache intensity significantly differed between the sauna and control group by 1.27 (95% confidence interval, 0.48-2.07; F=10.17; df=1, 117; p=0.002). There was no statistically significant change in duration of headache or improvement in sleep, depression, or HDI between the sauna and control groups., Conclusion: Regular sauna bathing is a simple, self-directed treatment that is effective for reducing headache pain intensity in CTTH.

Purpose: Acute radiation cystitis, inflammation of the bladder, is a common side effect in men receiving external beam radiation for prostate cancer. Although several treatments provide symptomatic relief, there is no effective treatment to prevent or treat radiation cystitis. Cranberry products have been associated with urinary tract health. This study aimed to determine the effect of highly standardized cranberry capsules (containing 72 mg proanthocyanidins [PACS]) compared with that of placebo capsules on the incidence and severity of radiation cystitis., Methods: Forty-one men with prostate cancer participated in a double blinded randomized placebo controlled study. Men took one capsule a day at breakfast during treatment and for 2 weeks after treatment completion. Severity of urinary symptoms and the bother these caused were measured using the individual items of the urinary domain of the Modified Expanded Prostate Index Composite (EPIC)., Results: The incidence of cystitis was lower in men taking cranberry capsules (65%) compared with those that took placebo capsules (90%) (p = 0.058); severe cystitis was seen in 30% of men in the cranberry arm and 45% in the placebo arm (p = 0.30). Overall, the incidence of pain/burning was significantly lower in the cranberry cohort (p = 0.045). Men on the low hydration regimen who took cranberry had less pain/burning (p = 0.038), stronger urine steam (p = 0.030) and used significantly fewer pads/liners (p = 0.042), which was significantly different from those on the high hydration regimen (p = 0.028)., Conclusion: Men receiving radiation therapy for prostate cancer may benefit from using cranberry capsules, particularly those on low hydration regimens or with baseline urinary symptoms.

The ability to drive is important to patients and driving restriction often leads to restriction of employment and social opportunities. In March 2012, Austroads released revised Assessing Fitness to Drive Guidelines (AFTDG) with significant changes for drivers with seizures and epilepsy. Our study aimed to assess the impact of the 2012 AFTDG on a Seizure Clinic cohort compared to the previous 2003 AFTDG and an individual's current driving status. We also aimed to quantify the difference in AFTDG interpretation between expert and non-expert doctors. We performed a retrospective observational audit of case notes for all patients managed in a public hospital outpatient Seizure Clinic between 1 March 2010 and 1 March 2012. A total of 142 patients were included in the analysis. Comparison between the 2003 and 2012 AFTDG resulted in reduced eligibility to drive a private vehicle by 2.1% (52.5% versus 50.4%) and commercial vehicle by 2.2% (4.5% versus 2.3%). The proportion of those currently driving against guideline recommendations increased (private 8.8% versus 19%; commercial 50% versus 100%) and the non-expert assessor was more likely to agree with the experts with the 2012 AFTDG. In summary, the 2012 AFTDG has had a measurable impact on driving eligibility in individuals with seizure although it is easier to interpret for non-expert doctors. Greater awareness of the 2012 AFTDG is required to reduce the proportion of patients driving against current recommendations., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Aim: To collect data on tobacco brand visibility on packaging on outdoor tables at bars/cafes in a downtown area, prior to a proposed plain packaging law., Method: The study was conducted in the Central Business District of Wellington City in March 2014. Observational data were systematically collected on tobacco packaging visibility and smoking by patrons at 55 bars/cafes with outdoor tables., Results: A total of 19,189 patrons, 1707 tobacco packs and 1357 active smokers were observed. One tobacco pack was visible per 11.0 patrons and the active smoking prevalence was 7.1% (95%CI: 4.9-9.2%), similar to Australian results (8.3%). Eighty percent of packs were positioned face-up (showing the brand), 8% face-down (showing the large pictorial warning), and 12% in other positions. Pack visibility per patron was significantly greater in areas without child patrons (RR=3.1, p<0.0001). Both smoking and pack visibility tended to increase from noon into the evenings on weekends. Inter-observer reliability for key measures in this study was high (Bland-Altman plots)., Conclusion: Tobacco branding on packaging was frequently visible because of the way smokers position their packs. These results highlight the residual problem posed by this form of marketing. The results also provide baseline data for the future evaluation of plain packaging if a proposed law is implemented in New Zealand. Other results warrant further research, particularly the reasons for lower pack visibility and smoking when children were present.

Indices of thyroid function were measured in 97 preterm infants at birth and at 5, 10, and 15 days of age. Triiodothyronine uptake, free thyroxine index, thyroxine, free thyroxine, triiodothyronine, reverse triiodothyronine, and thyroxine binding globulin values at birth correlated with gestational age, whereas thyroid stimulating hormone values did not. Treatment with steroids prenatally had no apparent effect on thyroid function at birth or postnatally. Infants developing respiratory distress syndrome had normal values for all indices at birth. These infants had significantly lower thyroxine, free thyroxine index, free thyroxine, and triiodothyronine values at 5 days of age, while thyroid stimulating hormone values remained normal. This alteration in thyroid function was interpreted as being secondary to respiratory distress syndrome. Gestational maturity and respiratory distress syndrome, if present, must be taken into account when evaluating thyroxine variables in preterm infants, whereas measurement of thyroid stimulating hormone as the screen for congenital hypothyroidism circumvents these considerations. [ABSTRACT FROM AUTHOR]

To determine the incidence of bronchial gland duct ectasia in fatal asthma and its association with interstitial emphysema, the histological features of 72 patients in whom death was considered to be due to asthma, and 72 matched control subjects in whom sudden death was not attributed to asthma, were reviewed. In all cases and controls, sections of two or more blocks of lung tissue stained with haematoxylin and eosin were obtained at necropsy. Bronchial gland duct ectasia was diagnosed if there was more than one abnormally dilated epithelial lined protrusion from a bronchus, extending through the smooth muscle layer. A histological diagnosis of asthma was made if four of the five following criteria were present: mucus plugging, basement membrane thickening, epithelial shedding, submucosal eosinophil leucocyte infiltration and smooth muscle hypertrophy. A histological diagnosis of asthma was made in 53 of 72 clinical cases of fatal asthma and in five of 72 control subjects. Interstitial emphysema was present in 10 clinical cases of fatal asthma, all of whom had bronchial gland duct ectasia and a histological diagnosis of asthma. Interstitial emphysema was not observed in control subjects. It is concluded that bronchial gland duct ectasia is a common histological feature of severe asthma, and that interstitial emphysema may be consequent on rupture of these dilated gland ducts. [ABSTRACT FROM PUBLISHER]

We previously reported a study of deaths and cancer incidence in Royal New Zealand (RNZ) Navy personnel who participated in atmospheric nuclear weapons tests conducted by the United Kingdom in the Pacific in 1957-58. The study involved 528 men known to have participated in the tests, and a control group of 1,504 men who were in the RNZ Navy during the same period but were not involved in the tests. The original follow-up was carried out for the period 1957-87 with an observed increase in risk of leukemia and other hematologic cancers, but little or no increase of non-hematologic cancers or non-cancer deaths in test participants. Follow-up now has been extended for the period 1988-92. For the total follow-up period, there were 97 deaths in test participants and 256 deaths in controls, a relative risk (RR) of 1.1 (90 percent confidence interval [CI] = 0.9-1.3). The RR of death from causes other than cancer was 1.0 (CI = 0.8-1.3), whereas the RR of cancer death was 1.2 (CI = 0.8-1.7) and that of cancer incidence was 1.0 (CI = 0.8-1.4). For cancers other than hematologic malignancies, the RR was 1.0 (CI = 0.7-1.5) for mortality, and 1.0 (CI = 0.7-1.3) for incidence. However, there were eight deaths from hematologic cancers in test participants (RR = 3.8, CI = 1.4-10.8), including four leukemias (RR = 5.6, CI = 1.0-41.7). The RR for incidence of hematologic cancers was 1.9 (CI = 0.8-4.3), and that for leukemia was 5.6 (CI = 1.0-41.6). We concluded that the evidence is still consistent with the hypothesis that some leukemias and other hematologic cancers may have resulted from participation in the nuclear weapons test program, but the further follow-up strengthens the evidence that there is no increased risk for non-hematologic cancers or for causes of death other than cancer in the test participants. [ABSTRACT FROM AUTHOR]

We present the first case of simultaneous muscle-specific kinase antibody positive myaesthenia gravis and relapsing-remitting multiple sclerosis to be reported in the English literature along with the inherent diagnostic and treatment challenges. There may be an association between myaesthenia and central nervous system demyelination. We identified 72 previously published cases of myaesthenia with central nervous system demyelination. Of 19 cases of myaesthenia with relapsing-remitting multiple sclerosis, nine (47%) were acetylcholine receptor antibody negative, but there were no previously published cases with muscle-specific kinase antibody. Further research is required to clarify this association and optimal treatment in such cases., (© 2013.)

For Aotearoa New Zealand Māori, sleep and wairua (spirit) are closely intertwined. During sleep the wairua awakens and journeys across multiple dimensions of time and space to attain the tools and knowledge the individual needs to navigate waking life. While this function of sleep is understood within Mātauranga Māori (bodies of knowledge regarding everything within the universe) (Hikuroa 2017), it has yet to be explored within psychological sleep research. This qualitative study contributes to addressing this gap by exploring nine Māori participants' personal experiences of wairua during sleep. A whakapapa thematic analysis identified two interconnected layers. The first layer contributed to a spiritual explanatory framework for sleep, developed to encompass participants' beliefs regarding wairua, which were utilised to interpret their sleep experiences. The second layer describes these interpretations, comprised of three central themes: (1) Tohu/Guidance; (2) Ako/Space and time for learning; and (3) Tau/Attaining a state of stability, peace, and purpose. These findings suggest that the spiritual experience of sleep supported participants in navigating their waking lives safely, purposefully, and meaningfully, contributing to Indigenous and Māori scholarship regarding the spiritual and cultural purpose of sleep, and with important implications for clinical, social, and academic approaches to understanding and supporting sleep. [ABSTRACT FROM AUTHOR]

Aim: To determine whether health promotion activities in March-August 2009 increased sore throat swabbing rates among Flaxmere (Hawke's Bay, New Zealand) children aged 5-14 years, and in particular among Māori and Pacific children., Method: Monthly totals of Hawke's Bay bacterial throat swabs for the period March-October 2008 and March-October 2009 were obtained. Using Poisson regression, the 2008 and 2009 test rates for Flaxmere children residing in the target area during the intervention were compared with non-Flaxmere children. Flaxmere test rates were determined for Māori or Pacific children and non-Māori non-Pacific children separately., Results: Flaxmere children had a higher pre-intervention bacterial throat swab rate, compared to non-Flaxmere children (6.0% vs 3.2%; p<0.001). The throat swab rate increased significantly for Flaxmere children during the intervention period, compared to both the previous year (1.6; 1.3-2.0) and compared to the increase observed among non-Flaxmere children (1.4; 1.1-1.8). Subanalysis among Flaxmere children found a significant increase in the throat swab rate of Māori and Pacific children (1.8; 1.4-2.4)., Conclusions: A demonstrable increase in throat swabbing rates among high-risk Flaxmere children was observed following a combination of health promotion interventions. The increase in throat swabbing rates observed among Māori and Pacific children suggest that the intervention was effective for children with the highest risk., (©NZMA)

Aim: To understand declining response rates in New Zealand sleep health surveys by examining contextual changes and specific aspects of the questionnaires and research design that may have contributed., Method: From 1999-2008, four population surveys were undertaken, seeking to recruit equal numbers of Māori and non-Māori, consistent with the Kaupapa Māori principle of equal explanatory power; using the electoral roll as a sampling frame and including extensive follow-up., Results: In successive surveys, there were fewer respondents in all age groups. Response rates from Māori were lower in all surveys and the percentage decline was greater than for non-Māori. Between 1999 and 2008, the response rates from the initial mail-out decreased by 50% and the proportion of the sample that were uncontactable increased by 50%. Identified societal trends included decreased currency of electoral roll address information, declining use of listed landline telephone numbers, and possibly declining willingness to participate from increasing respondent burden. Contributing study design features may have included changes in Māori leadership, increasing complexity of questions and saliency of the research topic to potential participants., Conclusions: The declining response rate in sleep population surveys is likely to be due to a number of factors. The pros and cons of using the electoral roll as a sampling frame in mail surveys should be carefully considered.

A retrospective analysis of 301 patients was undertaken between 1993 and 2003 to evaluate the relationship of ethnicity with incidence, treatment and survival in patients undergoing surgery for high grade glioma (HGG) in New Zealand. There was no difference in age standardised incidence of HGG in Māori compared to non-Māori patients; 4.2/100,000 person years (95% confidence interval [CI] 2.6-6.9) versus 4.1 (95% CI 3.6-4.6). Māori were more likely to have complete tumour resection (odds ratio 3.59 (95% CI 1.01-12.76)) but waited 1.32 (95% CI 0.98-1.79) times longer for radiotherapy. Median survival was 29 weeks with poorer survival in Māori compared to non-Māori (hazard ratio 1.55 [95% CI 0.95-2.55]). We concluded that the incidence of HGG in Māori is similar to non-Maori. However, Māori with HGG have higher rates of complete resection but wait longer for radiotherapy and may have poorer overall survival than non-Māori., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Background: Racial and ethnic inequalities in colon cancer treatment have been reported in the United States but not elsewhere. The authors of this report compared cancer treatment in a nationally representative cohort of Maori (indigenous) and non-Maori New Zealanders with colon cancer., Methods: On the basis of cancer registry data, 301 Maori patients and 329 randomly selected non-Maori patients were identified who were diagnosed with colon cancer between 1996 and 2003. Medical notes were reviewed, and surgical and oncology treatments were compared by indigenous status., Results: Maori and non-Maori patients had similar rates of surgical resection, although Maori patients were less likely to undergo extensive lymph node clearance and were more likely to die during the postoperative period. Maori patients were significantly less likely to receive chemotherapy for stage III disease (relative risk [RR], 0.69; 95% confidence interval [CI], 0.53-0.91) and were more likely to experience a delay of at least 8 weeks before starting chemotherapy (RR, 1.98; 95%CI, 1.23-3.16). Treatment disparities were not explained by differences in tumor characteristics or patient comorbidity., Conclusions: Maori New Zealanders with colon cancer were less likely to receive adjuvant chemotherapy and experienced a lower quality of care compared with non-Maori patients. The authors concluded that attention to health system factors is needed to ensure equal access and quality of cancer treatment for indigenous and ethnic minority populations.

Objective: Māori women in New Zealand have higher incidence of and mortality from cervical cancer than non-Māori women, however limited research has examined differences in treatment and survival between these groups. This study aims to determine if ethnic disparities in treatment and survival exist among a cohort of Māori and non-Māori women with cervical cancer., Methods: A retrospective cohort study of 1911 women (344 Māori and 1567 non-Māori) identified from the New Zealand Cancer Register with cervical cancer (adenocarcinoma, adenosquamous or squamous cell carcinoma) between 1 January 1996 and 31 December 2006., Results: Māori women with cervical cancer had a higher receipt of total hysterectomies, and similar receipt of radical hysterectomies and brachytherapy as primary treatment, compared to non-Māori women (age and stage adjusted). Over the cohort period, Māori women had poorer cancer specific survival than non-Māori women (mortality hazard ratio (HR) 2.07, 95% confidence interval (CI): 1.63-2.62). From 1996 to 2005, the survival for Māori improved significantly relative to non-Māori., Conclusion: Māori continue to have higher incidence and mortality than non-Māori from cervical cancer although disparities are improving. Survival disparities are also improving. Treatment (as measured) by ethnicity is similar., Implications: Primary prevention and early detection remain key interventions for addressing Māori needs and reducing inequalities in cervical cancer in New Zealand., (© 2010 The Authors. Journal Compilation © 2010 Public Health Association of Australia.)

Aims: This study aims to assess the quality of routinely collected comorbidity data in New Zealand which are increasingly used in health service planning and research., Methods: Detailed medical notes-based comorbidity data from a cohort study of New Zealanders diagnosed with colon cancer in 1996-2003, were compared with routine hospital discharge data collected from the same patients using 1-year and 8-year lookback periods. We compared agreement between data sources for individual conditions, Charlson comorbidity index scores and total comorbidity counts using McNemar's p-test and the kappa statistic. We also assessed the association of comorbidity with all-cause survival using Cox proportional hazard models using data ascertained from the two sources., Results: Among these 569 patients, we found generally higher comorbidity was measured from notes than administrative data, with better comparability with an 8-year lookback period. Regardless of source of data, all measures of comorbidity significantly improved the ability of multivariable models to explain all-cause survival, but using both data sources combined resulted in better risk adjustment than either source separately., Conclusion: While differences in medical notes and administrative comorbidity data exist, the latter provides a reasonably useful source of accessible information on comorbidity for risk adjustment particularly in multivariable models.

Aims: To estimate the prevalence of Raynaud's phenomenon (RP) in the New Zealand adult population., Methods: 350 adults 18 years and over, random selected from the electoral roll, were sent a postal survey based on the UK Scleroderma Study Group questionnaire. Participants were classified as having RP if they had biphasic colour changes., Results: There was a 67% response rate. The prevalence of RP was estimated to be 18.8% (95% Confidence Interval (CI) 13.0%-27.1%) in females and 4.9% (95%CI 1.9%-13.0%) in males. The prevalence decreased with age. There was a higher prevalence in the warmer north of the country. People of Maori descent and in more manual occupations had more serve symptoms. Among those reporting symptoms 11% (95%CI 7%-17%) had consulted a doctor., Conclusion: New Zealand has high rates of RP. Few people with RP consult medical practitioners about their symptoms.

Purpose: To assess agreement between the iCare rebound tonometer and Goldmann tonometry and to assess the influence of central corneal thickness and the value of scleral rebound tonometer readings., Methods: Prospective single-centre cross-sectional study comparing iCare rebound tonometer (RT) intraocular pressure (IOP) readings taken from corneal and scleral locations to Goldmann applanation tonometer (GAT) readings in 100 subjects attending ophthalmology clinics., Results: There was a significant difference between RT and GAT, with RT tending to overestimate IOP. The mean difference between RT and GAT measurements was 3.36 mmHg. The mean difference between the log of RT and the log of GAT measurements was 0.2356, a ratio of 1.27 (P < 0.0001). A formula derived from a linear regression analysis suggested that a 10% increase in CCT increased the RT IOP reading by 9.9%. Scleral RT readings showed no relationship to GAT readings., Conclusions: The rebound tonometer cannot replace the Goldmann tonometer in the office setting given the wide limits of agreement between the two devices. Corneal rebound tonometer readings are influenced by CCT whereas scleral rebound tonometer readings are of no value.

Background: Comorbidity has a well documented detrimental effect on cancer survival. However it is difficult to disentangle the direct effects of comorbidity on survival from indirect effects via the influence of comorbidity on treatment choice. This study aimed to assess the impact of comorbidity on colon cancer patient survival, the effect of comorbidity on treatment choices for these patients, and the impact of this on survival among those with comorbidity., Methods: This retrospective cohort study reviewed 589 New Zealanders diagnosed with colon cancer in 1996-2003, followed until the end of 2005. Clinical and outcome data were obtained from clinical records and the national mortality database. Cox proportional hazards and logistic regression models were used to assess the impact of comorbidity on cancer specific and all-cause survival, the effect of comorbidity on chemotherapy recommendations for stage III patients, and the impact of this on survival among those with comorbidity., Results: After adjusting for age, sex, ethnicity, area deprivation, smoking, stage, grade and site of disease, higher Charlson comorbidity score was associated with poorer all-cause survival (HR = 2.63 95%CI:1.82-3.81 for Charlson score > or = 3 compared with 0). Comorbidity count and several individual conditions were significantly related to poorer all-cause survival. A similar, but less marked effect was seen for cancer specific survival. Among patients with stage III colon cancer, those with a Charlson score > or = 3 compared with 0 were less likely to be offered chemotherapy (19% compared with 84%) despite such therapy being associated with around a 60% reduction in excess mortality for both all-cause and cancer specific survival in these patients., Conclusion: Comorbidity impacts on colon cancer survival thorough both physiological burden of disease and its impact on treatment choices. Some patients with comorbidity may forego chemotherapy unnecessarily, increasing avoidable cancer mortality.

Background: The role of probiotics in prevention of allergic disease is still not clearly established, although early reports suggested Lactobacillus GG halved the risk of eczema at 2 years., Objective: To determine whether probiotic supplementation in early life could prevent development of eczema and atopy at 2 years., Methods: Double-blind, randomized placebo-controlled trial of infants at risk of allergic disease. Pregnant women were randomized to take Lactobacillus rhamnosus HN001 (L rhamnosus), Bifidobacterium animalis subsp lactis strain HN019 or placebo daily from 35 weeks gestation until 6 months if breast-feeding, and their infants were randomized to receive the same treatment from birth to 2 years (n = 474). The infant's cumulative prevalence of eczema and point prevalence of atopy, using skin prick tests to common allergens, was assessed at 2 years., Results: Infants receiving L rhamnosus had a significantly (P = .01) reduced risk of eczema (hazard ratio [HR], 0.51; 95% CI, 0.30-0.85) compared with placebo, but this was not the case for B animalis subsp lactis (HR, 0.90; 95% CI, 0.58-1.41). There was no significant effect of L rhamnosus (HR, 0.74; 95% CI, 0.46-1.18) or B animalis subsp lactis (HR, 0.82; 95% CI, 0.52-1.28) on atopy. L rhamnosus (71.5%) was more likely than B animalis subsp lactis (22.6%) to be present in the feces at 3 months, although detection rates were similar by 24 months., Conclusion: We found that supplementation with L rhamnosus, but not B animalis subsp lactis, substantially reduced the cumulative prevalence of eczema, but not atopy, by 2 years. Understanding how Lactobacilli act to prevent eczema requires further investigation.

Aim: To investigate whether a relationship exists between preoperative intra-articular steroid injections and postoperative wound healing in total knee arthroplasty (TKA). Similar research studies on total hip arthroplasty (THA) have found higher rates of post surgical problems in hips that have been injected with steroids., Methods: Thirty-eight patients with TKA postoperative wound infection, and 352 TKA patients without postoperative wound infection were compared against corticosteroid injected and non-injected patients. Variables measured were diabetes, cigarette smoking, knee scores, number of injections, injection administrator, and preoperative injection intervals., Results: No significant difference emerged in rates of infection or between smoking rates and diabetes. Number of injections, preoperative injection interval and injection administrator did not significantly influence outcome. A significant difference exists between each group's knee scores., Conclusions: Injecting knees with corticosteroids prior to TKA did not increase the incidence of postoperative wound infection.

Fractionated external beam radiotherapy is an important component of standard treatment for high grade glioma. Due to resource constraints, patients may experience delays in receiving treatment. The purpose of this study was to evaluate the effect of radiotherapy waiting time on survival in patients with high grade glioma. A retrospective analysis was performed of 172 patients with a histological diagnosis of WHO Grade 3 or 4 Astrocytoma who had undergone surgery at Wellington Hospital between 1993 and 2003, and who subsequently underwent radiotherapy. Time to radiotherapy after surgery varied from 7 days to over 16 weeks. Multiple Cox regression analysis showed that age, performance status, tumour grade, extent of surgical resection, radiotherapy dose, and time to radiotherapy from day of surgery were all independently related to survival. Every additional week of delay until the start of radiotherapy increases the risk of death (hazard ratio) by 8.9% (95%CI 2.0%-16.1%). A 6 week delay in starting radiotherapy (from 2 weeks post-op to 8 weeks) reduces median survival by 11 weeks for a typical patient. Delay in radiotherapy results in a clinically significant reduction in survival. These findings have implications for resource allocation and for the design of clinical trials.

The study of inequities in health is a critical component of monitoring government obligations to uphold the rights of Indigenous Peoples. In Aotearoa/New Zealand the indigenous Māori population has a substantially younger age structure than the non-indigenous population making it necessary to account for age differences when comparing population health outcomes. An age-standardised rate is a summary measure of a rate that a population would have if it had a standard age structure. Changing age standards have stimulated interest in the potential impact of population standards on disparities data and consequently on health policy. This paper compares the age structure of the Māori and non-Māori populations with two standard populations commonly used in New Zealand: Segi's world and WHO world populations. The performance of these standards in Māori and non-Māori mortality data was then measured against the use of the Māori population as a standard. It was found that the choice of population standard affects the magnitude of mortality rates, rate ratios and rate differences, the relative ranking of causes of death, and the relative width of confidence intervals. This in turn will affect the monitoring of trends in health outcomes and health policy decision-making. It is concluded that the choice of age standard has political implications and the development and utilisation of an international indigenous population standard should be considered.