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Streptococcus pyogenes (group A streptococcus, GAS) causes a wide range of clinical manifestations ranging from mild self-limiting pyoderma to invasive diseases such as sepsis. Also of concern are the post-infectious immune-mediated diseases including rheumatic heart disease. The development of a vaccine against GAS would have a large health impact on populations at risk of these diseases. However, there is a lack of suitable models for the safety evaluation of vaccines with respect to post-infectious complications. We have utilized the Lewis Rat model for cardiac valvulitis to evaluate the safety of the J8-DT vaccine formulation in parallel with a rabbit toxicology study. These studies demonstrated that the vaccine did not induce abnormal pathology. We also show that in mice the vaccine is highly immunogenic but that 3 doses are required to induce protection from a GAS skin challenge even though 2 doses are sufficient to induce a high antibody titer.

Rheumatic fever and rheumatic heart disease (RF/RHD) develop following repeated infection with group A streptococci (GAS). We used the Rat Autoimmune Valvulitis (RAV) model of RF/RHD to demonstrate that repetitive booster immunization with GAS-derived recombinant M protein (rM5) resulted in an enhanced anti-cardiac myosin antibody response that may contribute to the breaking of immune tolerance leading to RF/RHD and increased infiltration of heart valves by mononuclear cells. With each boost, more inflammatory cells were observed infiltrating heart tissue which could lead to severe cardiac damage. We also found evidence that both complement and anti-M protein antibodies in serum from rM5-immunized rats have the potential to contribute to inflammation in heart valves by activating cardiac endothelium. More importantly, we have demonstrated by electrocardiography for the first time in the RAV model that elongation of P-R interval follows repetitive boost with rM5. Our observations provide experimental evidence for cardiac alterations following repeated exposure to GAS M protein with immunological and electrophysiological features resembling that seen in humans following recurrent GAS infection., Competing Interests: Declaration of interest MWC is chief scientific officer at Moleculera Labs, a diagnostic laboratory at the University of Oklahoma Health Sciences Center Research Park, for testing anti-neuronal autoantibodies in neuropsychiatric diseases. The authors alone are responsible for the content and writing of this publication. This study was funded, in part, by grants from the National Heart Foundation (GB06B2497), National Health and Medical Research Council (540419 and 1026753) to NK and CMR and grant HL35280, a Merit Award from the National Heart Lung and Blood Institute to MWC.

Decreasing population sodium intake has been identified as a "best buy" for reducing non-communicable disease. The aim of this study was to explore 10-year changes in the sodium content of New Zealand processed foods. Nutrient data for nine key food groups were collected in supermarkets in 2003 (n = 323) and 2013 (n = 885). Mean (SD) and median (min, max) sodium content were calculated by food group, year and label type (private/branded). Paired t-tests explored changes in sodium content for all products available for sale in both years (matched; n = 182). The mean (SD) sodium content of all foods was 436 (263) mg (100 g)(-1) in 2003 and 433 (304) mg (100 g)(-1) in 2013, with no significant difference in matched products over time (mean (SD) difference, -56 (122) mg (100 g)(-1), 12%; p = 0.22). The largest percentage reductions in sodium (for matched products) were observed for Breakfast Cereals (28%; -123 (125) mg (100 g)(-1)), Canned Spaghetti (15%; -76 (111) mg (100 g)(-1)) and Bread (14%; -68 (69) mg (100 g)(-1)). The reduction in sodium was greater for matched private vs. branded foods (-69 vs. -50 mg (100 g)(-1), both p < 0.001). There has been modest progress with sodium reduction in some New Zealand food categories over the past 10 years. A renewed focus across the whole food supply is needed if New Zealand is to meet its global commitment to reducing population sodium intake.

The article introduces the use of probabilistic risk assessment for modeling the incident response process of online financial services. The main contribution is the creation of incident response trees, using event tree analysis, which provides us with a visual tool and a systematic way to estimate the probability of a successful incident response process against the currently known risk landscape, making it possible to measure the balance between front-end and back-end security measures. The model is presented using an illustrative example, and is then applied to the incident response process of a Swedish bank. Access to relevant data is verified and the applicability and usability of the proposed model is verified using one year of historical data. Potential advantages and possible shortcomings are discussed, referring to both the design phase and the operational phase, and future work is presented., (© 2014 Society for Risk Analysis.)

Background: Free school breakfast programmes (SBPs) exist in a number of high-income countries, but their effects on educational outcomes have rarely been evaluated in randomised controlled trials., Methods: A 1-year stepped-wedge, cluster randomised controlled trial was undertaken in 14 New Zealand schools in low socioeconomic resource areas. Participants were 424 children, mean age 9±2 years, 53% female. The intervention was a free daily SBP. The primary outcome was children's school attendance. Secondary outcomes were academic achievement, self-reported grades, sense of belonging at school, behaviour, short-term hunger, breakfast habits and food security., Results: There was no statistically significant effect of the breakfast programme on children's school attendance. The odds of children achieving an attendance rate <95% was 0.76 (95% CI 0.56 to 1.02) during the intervention phase and 0.93 (95% CI 0.67 to 1.31) during the control phase, giving an OR of 0.81 (95% CI 0.59 to 1.11), p=0.19. There was a significant decrease in children's self-reported short-term hunger during the intervention phase compared with the control phase, demonstrated by an increase of 8.6 units on the Freddy satiety scale (95% CI 3.4 to 13.7, p=0.001). There were no effects of the intervention on any other outcome., Conclusions: A free SBP did not have a significant effect on children's school attendance or academic achievement but had significant positive effects on children's short-term satiety ratings. More frequent programme attendance may be required to influence school attendance and academic achievement., Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR)-ACTRN12609000854235.

This paper reports on a complex environmental approach to addressing 'wicked' health promotion problems devised to inform policy for enhancing food security and physical activity among Māori, Pacific and low-income people in New Zealand. This multi-phase research utilized literature reviews, focus groups, stakeholder workshops and key informant interviews. Participants included members of affected communities, policy-makers and academics. Results suggest that food security and physical activity 'emerge' from complex systems. Key areas for intervention include availability of money within households; the cost of food; improvements in urban design and culturally specific physical activity programmes. Seventeen prioritized intervention areas were explored in-depth and recommendations for action identified. These include healthy food subsidies, increasing the statutory minimum wage rate and enhancing open space and connectivity in communities. This approach has moved away from seeking individual solutions to complex social problems. In doing so, it has enabled the mapping of the relevant systems and the identification of a range of interventions while taking account of the views of affected communities and the concerns of policy-makers. The complex environmental approach used in this research provides a method to identify how to intervene in complex systems that may be relevant to other 'wicked' health promotion problems.

Issue Addressed: Front-of-pack (FOP) labels are identified as a way to encourage healthy food choices and good nutrition, factors critical in promoting health. New Zealand and Australia are currently considering policy on front-of-pack labels. This research aimed to identify the challenges associated with implementing a front-of-pack nutrition labelling policy in New Zealand and with designing research to determine its likely effect., Methods: A strategic sample of key stakeholders with knowledge of food labelling from New Zealand and Australia participated in the research. The 17 participants included five food industry representatives, six policy makers, and six representatives of non-governmental organisations., Results: Several key themes emerged including support for front-of-pack labels from key food industry, policy and NGO stakeholders because of potential for better informed consumers, changes in consumer behaviour and reduction in chronic disease. Barriers to front-of-pack labelling included limited evidence upon which to make decisions, lack of agreement on the label format, and the clash of values between 'profit driven' industry and public health. There is a high level of agreement about the need for real-life research on the effectiveness of FOP labelling., Conclusions: The introduction of consistent, comprehensive front-of-pack nutrition labelling in New Zealand has the potential to assist in the effort to promote healthy eating. This research suggests agreement on front-of-pack labels may not be easy to achieve.

Aims: Food insecurity is a lack of assured access to sufficient nutritious food. We aimed to investigate the demographic and socio-economic determinants of food insecurity in New Zealand and whether these determinants vary between males and females., Methods: We used data from the longitudinal Survey of Families, Income and Employment (SoFIE) (n=18,950). Respondents were classified as food insecure if, in the past 12 months, they had to use special food grants or food banks, been forced to buy cheaper food to pay for other things, or had to go without fresh fruit and vegetables often. Logistic regression analyses were used to investigate the association of demographic and socio-economic factors on food insecurity. Models were repeated stratifying by males and females., Results: More than 15% of the SoFIE population in NZ were food insecure in 2004/05. The prevalence of food insecurity was much greater in females (19%) than males (12%). The adjusted odds of food insecurity was significantly higher in females compared to males (OR 1.6, 95% CI 1.5-1.8). In univariate analyses, food insecurity was associated with sole parenthood, unmarried status, younger age groups, Māori and Pacific ethnicity, worse self-rated health status, renting, being unemployed and lower socioeconomic status. Income was the strongest predictor of food insecurity in multivariate modelling (OR 4.9, 95%CI 4.0-5.9 for lowest household income quintile versus highest). The associations of demographic and socioeconomic factors with food insecurity were similar in males and females., Conclusions: Food insecurity is a timely and relevant issue, as it affects a significant number of New Zealanders. Targeted policy interventions aimed at increasing money available in households are needed., (© 2010 The Authors. ANZJPH © 2010 Public Health Association of Australia.)

Background: Approximately 55,000 children in New Zealand do not eat breakfast on any given day. Regular breakfast skipping has been associated with poor diets, higher body mass index, and adverse effects on children's behaviour and academic performance. Research suggests that regular breakfast consumption can improve academic performance, nutrition and behaviour. This paper describes the protocol for a stepped wedge cluster randomised trial of a free school breakfast programme. The aim of the trial is to determine the effects of the breakfast intervention on school attendance, achievement, psychosocial function, dietary habits and food security., Methods/design: Sixteen primary schools in the North Island of New Zealand will be randomised in a sequential stepped wedge design to a free before-school breakfast programme consisting of non-sugar coated breakfast cereal, milk products, and/or toast and spreads. Four hundred children aged 5-13 years (approximately 25 per school) will be recruited. Data collection will be undertaken once each school term over the 2010 school year (February to December). The primary trial outcome is school attendance, defined as the proportion of students achieving an attendance rate of 95% or higher. Secondary outcomes are academic achievement (literacy, numeracy, self-reported grades), sense of belonging at school, psychosocial function, dietary habits, and food security. A concurrent process evaluation seeks information on parents', schools' and providers' perspectives of the breakfast programme., Discussion: This randomised controlled trial will provide robust evidence of the effects of a school breakfast programme on students' attendance, achievement and nutrition. Furthermore the study provides an excellent example of the feasibility and value of the stepped wedge trial design in evaluating pragmatic public health intervention programmes., Trial Registration Number: Australian New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12609000854235.

Objective: To determine how various population groups in New Zealand interpret the nutrition content claims '97% fat free' and 'no added sugar' on food labels., Methods: A survey of adult supermarket shoppers was conducted at 25 Auckland supermarkets over a six-week period in 2007. Supermarkets were located in areas where greater than 10% of the resident population were known to be Māori, Pacific or Asian, based on 2001 Census meshblock data. Four questions in the survey assessed understanding and interpretation of the nutrition content claims '97% fat free' and 'no added sugar'., Results: There were 1,525 people who completed the survey, with approximately equal representation from Māori, Pacific, Asian and New Zealand European and Other ethnicities. Nearly three-quarters (72%) of participants correctly estimated the fat content of a 100 g product that was '97% fat free', and understood that a product with 'no added sugars' could contain natural sugar. However, up to three-quarters of Māori, Pacific, and Asian shoppers assumed that if a food carried a '97% fat free' or 'no added sugar' claim it was therefore a healthy food. Similarly, low-income shoppers were significantly more likely than medium- or high-income shoppers to assume that the presence of a claim meant a food was definitely healthy., Conclusion: Percentage fat free and no added sugar nutrition content claims on food are frequently misinterpreted by shoppers as meaning the food is healthy overall and appear to be particularly misleading for Māori, Pacific, Asian and low-income groups., Implications: Nutrition content claims have potential for harm if the food they are placed on is not healthy overall. Such claims should therefore only be permitted to be placed on healthy foods., (© 2010 The Authors. Journal Compilation © 2010 Public Health Association of Australia.)