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Objective: To estimate mortality attributable to inadequate vegetable and fruit intake in New Zealand in 1997, and the burden of disease that could be avoided in 2011 if modest increases in vegetable and fruit intake were to occur., Methods: Comparative risk assessment methodology was used to estimate both attributable and avoidable mortality due to inadequate vegetable and fruit consumption (< 600 g/day). Vegetables and fruit were defined as all fresh, frozen, canned, dried or juiced vegetables and fruit, except potatoes, nuts, seeds and pulses. Disease outcomes assessed were mortality from ischaemic heart disease, ischaemic stroke, and lung, oesophageal, stomach and colorectal cancers., Results: In 1997, mean vegetable and fruit intake was 420 g/day in males and 404 g/day in females. Inadequate vegetable and fruit intake is estimated to have contributed to 1,559 deaths (6% of all deaths) in that year, including 1,171 from ischaemic heart disease, 179 from ischaemic stroke and 209 from cancer. Modest increases in vegetable and fruit intake (40 g/day above the historic trend) could prevent 334 deaths each year from 2011, mostly from ischaemic heart disease., Conclusions: Inadequate vegetable and fruit intake is an important cause of mortality in New Zealand. Small increases in vegetable and fruit intake could have a major impact on population health within a decade.

Objective: To estimate the prevalence of established risk factors for ischaemic heart disease (IHD) in New Zealand adults and compare the prevalence in adults with and without this disease., Design: Data were obtained from the 2002/03 New Zealand Health Survey. Risk factor prevalence was determined by: self-reported doctor diagnosis of high blood pressure, high cholesterol and diabetes; self-report of smoking and physical inactivity; and measurement of obesity. Presence of IHD was based on self-report of heart disease (doctor diagnosed at age 25 years or over) together with current medical or past surgical treatment for this disease. Multiple logistic regression was used to determine prevalence rate ratios (PRRs) for males and females separately, adjusting for age, ethnicity and deprivation., Results: The overall prevalence of IHD was 8%. Overall risk factor prevalences were in the range of 20-25% for each of high blood pressure, high cholesterol, smoking, obesity and physical inactivity, and approximately 5% for diabetes. Overall, 94-97% of adults with IHD had at least one risk factor (depending on how smoking was defined). The PRRs of IHD were highest for cholesterol (about 4.5), followed by blood pressure (about 2.3), with all other risk factors around 1.5. PAF estimates indicate that 80-85% of IHD was attributable to the presence of at least one risk factor for all age, gender and ethnic groups., Conclusions: Established risk factors account for 80-85% of the non-fatal burden of IHD in New Zealand. Limited research resources would be better used to evaluate which interventions are effective and efficient at reducing exposure of all population groups to known risk factors, rather than on identification of additional risk factors.

Objective: To classify causes of death in New Zealand by risk factor (in addition to condition) as a planning tool for health promotion., Method: Deaths occurring in New Zealand in 1997 were classified by 20 prevalent risk factors using a combination of categorical attribution (rule-based) and counterfactual modelling (population-attributable risk-based) approaches., Results: Approximately 30% of deaths were attributed to the joint effect of dietary factors. Tobacco consumption was responsible for 18% of deaths and insufficient physical activity for almost 10%. Less important behavioural risk factors included alcohol consumption (3%), illicit drug use (0.5%) and unsafe sex (0.5%). Among biological risk factors, higher than optimal total blood cholesterol, systolic blood pressure and body mass index accounted for 17%, 15% and 12% of deaths respectively. Deprivation contributed to 17% of deaths, and adverse in-hospital events to 6%. Among environmental exposures, microbes accounted for 6.5% of deaths, air pollution 3.5% and occupational diseases and injuries 0.5%. Among injury hazards, risk factors related to road traffic were responsible for 2% of deaths, while violence accounted for 2.5% of deaths, mostly through suicide. Cross-classifying deaths by both condition and risk factor, 90% of ischaemic heart disease and 80% of stroke, but only 30% of cancer deaths, could be attributed to specific risk factors., Conclusions: This is the first comprehensive ranking of causes of death at the level of risk factors available for New Zealand and should prove useful as a planning tool, especially for disease prevention and health promotion.

Aims: The aim of this study was to evaluate the economic cost of community-acquired pneumonia (CAP) in New Zealand adults. Although this is an important illness, there is little published information on the national costs of treatment. Without such information, new treatment options cannot be evaluated in economic terms., Methods: Costs were estimated from a societal perspective for the adult population (aged 15 years and over) using New Zealand age-specific hospital admission rates (average of 2000-2002), population data (2003), and unit costs (2003) in combination with international data on the proportion of pneumonia cases hospitalised. Univariate and multivariate sensitivity analyses were used to determine the major cost drivers and evaluate uncertainty in the estimates., Results: It was estimated that in 2003 there were 26,826 episodes of pneumonia in adults; a rate of 859 per 100,000 people. The annual cost was estimated to be 63 million dollars, (direct medical costs of 29 million dollars; direct non-medical costs of 1 million dollars; lost productivity of 33 million dollars)., Conclusions: The major generators of costs for community-acquired pneumonia are the number of hospitalisations (particularly for the group aged 65 years and over) and loss of productivity. Intensified prevention and effective community treatment programmes focussing on the 65 years and older age groups should be investigated (as they have the greatest potential to reduce healthcare costs).

Objective: To determine the extent to which clinic-based sexually transmitted infection (STI) surveillance underrepresents the number of laboratory-confirmed cases of Chlamydia trachomatis and Neisseria gonorrhoeae in the Waikato and Bay of Plenty regions of New Zealand; and to estimate incidence rates for these two infections., Methods: Data on C. trachomatis and N. gonorrhoeae were collected from diagnostic laboratories in the study regions for the year 2000, and compared with routine clinic-based STI surveillance data., Results: Most laboratory-confirmed C. trachomatis (65.5%) and N. gonorrhoeae (55.7%) infections were diagnosed by healthcare providers outside the clinic-based STI surveillance system. The estimated incidence rate for C. trachomatis was 501 per 100,000, and 50 per 100,000 for N. gonorrhoeae., Conclusions and Implications: Laboratory surveillance of C. trachomatis and N. gonorrhoeae provides a more complete picture of disease burden. Given the high infection rates reported, developing a national strategy for the management of STIs should be a public health priority in New Zealand.

Aims: To describe the surveillance and epidemiology of sexually transmitted infections (STIs) in New Zealand., Methods: Sexual health clinics submitted STI data to the Institute of Environmental Science and Research (ESR). Infection rates were calculated by dividing the number of diagnoses by the number of total clinic visits. Because the denominator used to calculate infection rates changed in 1998, STI rates in 1998 cannot be directly compared with previous years and case numbers were used to identify recent trends., Results: In 1998, genital warts was the most commonly diagnosed STI (4.7%), followed by chlamydia (3.0%) and genital herpes (1.0%). Approximately two-thirds of gonorrhoea, chlamydia and genital warts diagnoses were in people aged less than 25 years. Chlamydia rates were 7.3% in Maori, 7.1% in Pacific Island people, and 2.1% in European. Gonorrhoea rates were 1.6% in Maori, 1.9% in Pacific Island people and 0.2% in European. The number of chlamydia and gonorrhoea cases increased between 1995 and 1998., Conclusions: The reporting of data by age, sex and ethnicity has allowed a more useful evaluation of the incidence of STIs. The majority of STIs were diagnosed among young New Zealanders, and disproportionately high chlamydia and gonorrhoea infection rates were found among Maori and Pacific Island people.

Overexpression of the RHAMM gene by transfection into fibroblasts is transforming and causes spontaneous metastases in the lung. H-ras-transformed fibrosarcomas transfected with a dominant suppressor mutant of RHAMM exhibit a so-called revertant phenotype and are completely nontumorigenic and nonmetastatic. Conversely, fibroblasts stably expressing low levels of RHAMM as a result of antisense transfection are resistant to ras transformation. Collectively, these results indicate that RHAMM acts downstream of ras. The loss of functional RHAMM ablates signaling within focal adhesions, in particular changes in focal adhesion kinase phosphorylation, and as a result these focal adhesions are unable to turn over in response to hyaluronan. These results provide evidence of the oncogenic potential of a novel extracellular matrix receptor and establish a functional link between transformation by ras and signaling within focal adhesions that are required for transformation by this oncogene.