RESUMEN
BACKGROUND: The proportion of intense tropical cyclones is expected to increase in a changing climate. However, there is currently no consistent and comprehensive assessment of infectious disease risk following tropical cyclone exposure across countries and over decades. We aimed to explore the tropical cyclone-associated hospitalisation risks and burden for cause-specific infectious diseases on a multi-country scale. METHODS: Hospitalisation records for infectious diseases were collected from six countries and territories (Canada, South Korea, New Zealand, Taiwan, Thailand, and Viet Nam) during various periods between 2000 and 2019. The days with tropical cyclone-associated maximum sustained windspeeds of 34 knots or higher derived from a parametric wind field model were considered as tropical cyclone exposure days. The association of monthly infectious diseases hospitalisations and tropical cyclone exposure days was first examined at location level using a distributed lag non-linear quasi-Poisson regression model, and then pooled using a random-effects meta-analysis. The tropical cyclone-attributable number and fraction of infectious disease hospitalisations were also calculated. FINDINGS: Overall, 2·2 million people who were hospitalised for infectious diseases in 179 locations that had at least one tropical cyclone exposure day in the six countries and territories were included in the analysis. The elevated hospitalisation risks for infectious diseases associated with tropical cyclones tended to dissipate 2 months after the tropical cyclone exposure. Overall, each additional tropical cyclone day was associated with a 9% (cumulative relative risk 1·09 [95% CI 1·05-1·14]) increase in hospitalisations for all-cause infectious diseases, 13% (1·13 [1·05-1·21]) for intestinal infectious diseases, 14% (1·14 [1·05-1·23]) for sepsis, and 22% (1·22 [1·03-1·46]) for dengue during the 2 months after a tropical cyclone. Associations of tropical cyclones with hospitalisations for tuberculosis and malaria were not significant. In total, 0·72% (95% CI 0·40-1·01) of the hospitalisations for all-cause infectious diseases, 0·33% (0·15-0·49) for intestinal infectious diseases, 1·31% (0·57-1·95) for sepsis, and 0·63% (0·10-1·04) for dengue were attributable to tropical cyclone exposures. The attributable burdens were higher among young populations (aged ≤19 years) and male individuals compared with their counterparts, especially for intestinal infectious diseases. The heterogeneous spatiotemporal pattern was further revealed at the country and territory level-tropical cyclone-attributable fractions showed a decreasing trend in South Korea during the study period but an increasing trend in Viet Nam, Taiwan, and New Zealand. INTERPRETATION: Tropical cyclones were associated with persistent elevated hospitalisation risks of infectious diseases (particularly sepsis and intestinal infectious diseases). Targeted interventions should be formulated for different populations, regions, and causes of infectious diseases based on evidence on tropical cyclone epidemiology to respond to the increasing risk and burden. FUNDING: Australian Research Council, Australian National Health, and Medical Research Council.
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Enfermedades Transmisibles , Tormentas Ciclónicas , Hospitalización , Humanos , Hospitalización/estadística & datos numéricos , Enfermedades Transmisibles/epidemiología , Nueva Zelanda/epidemiología , Vietnam/epidemiología , República de Corea/epidemiología , Taiwán/epidemiología , Canadá/epidemiología , Tailandia/epidemiologíaRESUMEN
OBJECTIVE: To identify the prevalence and clinical features of leflunomide-associated peripheral neuropathy in patients with rheumatic disease over a 42-month observational period between January 1, 2016 and June 30, 2019. METHODS: A retrospective observational study was conducted using regional prescription data identifying all patients treated with leflunomide for rheumatic diseases in the Southern District Health Board of New Zealand. Medical records were used to identify patients who developed peripheral neuropathy while receiving treatment with leflunomide. Demographic characteristics, co-therapies, and additional risk factors for peripheral neuropathy were also recorded. RESULTS: A total of 482 patients were identified as receiving leflunomide for the treatment of rheumatic during the study period. In total, 23 patients developed leflunomide-induced peripheral neuropathy within the cohort giving a prevalence of 4.7%. Nerve conduction studies (NCS) performed in 18 (78.2%) of these patients confirmed a distal axonal, sensory, or sensorimotor peripheral neuropathy. The majority of patients (n = 22; 95.6%) either improved, stabilized, or resolved on cessation of the drug, with or without medication washout. Adverse symptoms were reported in association with peripheral neuropathy in 15 of the 23 patients (65.2%): these included pain, poor sleep, compromised skin integrity, poor balance, and a Charcot-like arthropathy. Additional treatment was required to manage symptoms of peripheral neuropathy including nine patients (39%) who received pain relief. CONCLUSIONS: This study supports the previously reported association between leflunomide treatment and the development of a peripheral neuropathy. However, our findings suggest that this is more common than the previous estimates. In patients with psoriatic arthritis and previous tarsitis, there appeared to be an association with a Charcot's-like arthropathy, a complication not previously noted in the literature.
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Antirreumáticos , Leflunamida , Enfermedades del Sistema Nervioso Periférico , Enfermedades Reumáticas , Humanos , Leflunamida/efectos adversos , Masculino , Femenino , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/epidemiología , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Persona de Mediana Edad , Estudios Retrospectivos , Enfermedades Reumáticas/tratamiento farmacológico , Enfermedades Reumáticas/epidemiología , Prevalencia , Nueva Zelanda/epidemiología , Anciano , Adulto , Antirreumáticos/efectos adversos , Factores de Riesgo , Factores de Tiempo , Conducción Nerviosa/efectos de los fármacosRESUMEN
BACKGROUND: The introduction of complementary foods during the first year of life influences the diversity of the gut microbiome. How this diversity affects immune development and health is unclear. OBJECTIVE: This study evaluates the effect of consuming kumara or kumara with added banana powder (resistant starch) compared to a reference control at 4 months post randomization on the prevalence of respiratory tract infections and the development of the gut microbiome. METHODS: This study is a double-blind, randomized controlled trial of mothers and their 6-month-old infants (up to n=300) who have not yet started solids. Infants are randomized into one of 3 groups: control arm (C), standard kumara intervention (K), and a kumara intervention with added banana powder product (K+) to be consumed daily for 4 months until the infant is approximately 10 months old. Infants are matched for sex using stratified randomization. Data are collected at baseline (prior to commencing solid food) and at 2 and 4 months after commencing solid food (at around 8 and 10 months of age). Data and samples collected at each timepoint include weight and length, intervention adherence (months 2 and 4), illness and medication history, dietary intake (months 2 and 4), sleep (diary and actigraphy), maternal dietary intake, breast milk, feces (baseline and 4 months), and blood samples (baseline and 4 months). RESULTS: The trial was approved by the Health and Disability Ethics Committee of the Ministry of Health, New Zealand (reference 20/NTA/9). Recruitment and data collection did not commence until January 2022 due to the COVID-19 pandemic. Data collection and analyses are expected to conclude in January 2024 and early 2025, respectively. Results are to be published in 2024 and 2025. CONCLUSIONS: The results of this study will help us understand how the introduction of a specific prebiotic complementary food affects the microbiota and relative abundances of the microbial species, the modulation of immune development, and infant health. It will contribute to the expanding body of research that aims to deepen our understanding of the connections between nutrition, gut microbiota, and early-life postnatal health. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12620000026921; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378654. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56772.
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Microbioma Gastrointestinal , Femenino , Humanos , Lactante , Masculino , Método Doble Ciego , Microbioma Gastrointestinal/efectos de los fármacos , Fenómenos Fisiológicos Nutricionales del Lactante/inmunología , Musa , Nueva Zelanda/epidemiología , Infecciones del Sistema Respiratorio/inmunología , Infecciones del Sistema Respiratorio/prevención & control , Infecciones del Sistema Respiratorio/epidemiología , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Comparing COVID-19 response strategies across nations is a key step in preparing for future pandemics. Conventional comparisons, which rank individual non-pharmaceutical intervention (NPI) effects, are limited by: (i) a focus on epidemiological outcomes; (ii) NPIs typically being applied as packages of interventions; and (iii) different political, economic and social conditions among nations. Here, we develop a coupled epidemiological-behavioural-macroeconomic model that can transfer NPI effects from a reference nation to a focal nation. This approach quantifies epidemiological, behavioural and economic outcomes while accounting for both packaged NPIs and differing conditions among nations. As a first proof of concept, we take Germany as our focal nation during Spring 2020, and New Zealand and Switzerland as reference nations with contrasting NPI strategies. Our results suggest that, while New Zealand's more aggressive strategy would have yielded modest epidemiological gains in Germany, it would have resulted in substantially higher economic costs while dramatically reducing social contacts. In contrast, Switzerland's more lenient strategy would have prolonged the first wave in Germany, but would also have increased relative costs. More generally, these findings indicate that our approach can provide novel, multifaceted insights on the efficacy of pandemic response strategies, and therefore merits further exploration and development.
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COVID-19 , SARS-CoV-2 , COVID-19/epidemiología , COVID-19/prevención & control , Humanos , Nueva Zelanda/epidemiología , Suiza/epidemiología , Alemania/epidemiología , Pandemias/prevención & controlRESUMEN
AIMS: This study aimed to evaluate the effectiveness of COVID-19 vaccines in preventing COVID-19 outcomes when the Omicron variant was predominant in Aotearoa New Zealand. METHODS: We conducted a retrospective cohort study using routinely available data (8 December 2020-28 February 2023). We evaluated the vaccine effectiveness (VE) of COVID-19 vaccines using the Cox proportional-hazards model, adjusting for covariates. RESULTS: The VE against COVID-19 hospitalisation (VEH) for the second booster dose compared to no vaccination was found to be 81.8% (95% confidence interval [95% CI]: 73.6-87.5) after 1 month post-vaccination. After 4 months, VEH was 72.2% (95% CI: 58.5-81.4), and after 6 months VEH was 49.0% (95% CI: 7.9-71.8). Similarly, VEH decreased after the first booster dose (1-month VEH=81.6% [95% CI: 75.6-86.1]; 2 months VEH=74.7% [95% CI: 68.2-79.9]; and 6 months VEH=57.4% [95% CI: 45.8-66.6]). VE against COVID-19 death (VED) was 92.9% (95% CI: 82.1-97.2) 2 months after the first booster vaccination, with VED being sustained until months 5 and 6 (VED=87.2%; 95% CI: 67.4-94.9). The VE after the second dose of the vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (VEI) (real-time polymerase chain reaction [RT-PCR]) was sustained at 5 months post-vaccination (40.6%; 95% CI: 25.6-52.5). CONCLUSION: We provide a comprehensive quantification of both VE and VE waning. These findings can guide policymakers to help evaluate the COVID-19 vaccination programme and minimise the effect of future COVID-19 in Aotearoa New Zealand.
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Vacunas contra la COVID-19 , COVID-19 , Hospitalización , SARS-CoV-2 , Humanos , COVID-19/prevención & control , COVID-19/mortalidad , COVID-19/epidemiología , Nueva Zelanda/epidemiología , Estudios Retrospectivos , Vacunas contra la COVID-19/administración & dosificación , Masculino , Hospitalización/estadística & datos numéricos , Femenino , Persona de Mediana Edad , SARS-CoV-2/inmunología , Adulto , Anciano , Eficacia de las Vacunas , Inmunización Secundaria , Adulto Joven , Modelos de Riesgos ProporcionalesRESUMEN
BACKGROUND: There is a lack of literature concerning dermatological conditions affecting patients of Pacific ethnicity. AIM: To investigate dermatological conditions in patients of Pacific ethnicity referred to dermatology from 2016 to 2022. METHODS: Single-centre study of electronic referrals to dermatology from January 2016 to May 2022. RESULTS: Pacific ethnicity was recorded for 1.7% of 30,769 referrals to dermatology, under-representing census data for the local population (5.4%). Dermatological diagnoses were eczema in 36% of patients, benign skin lesions in 11% and skin infection in 8.3%. CONCLUSION: Eczema was the most common reason for referral to dermatology in patients of Pacific ethnicity in the Waikato Region.
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Eccema , Nativos de Hawái y Otras Islas del Pacífico , Derivación y Consulta , Humanos , Nueva Zelanda/epidemiología , Eccema/epidemiología , Derivación y Consulta/estadística & datos numéricos , Femenino , Masculino , Adulto , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , Persona de Mediana Edad , Adolescente , Niño , Adulto Joven , Anciano , Preescolar , Lactante , Dermatología/estadística & datos numéricos , Enfermedades de la Piel/epidemiología , Enfermedades de la Piel/etnologíaRESUMEN
Health promotion programs and strategies have the potential to support people to live healthier lives. Dementia, a collective name for brain disorders that impact thinking and memory, affects over 55 million people worldwide. Currently, there is no cure for dementia, so prevention is critical. Health promotion has the potential to reduce dementia by targeting the twelve potentially modifiable risk factors. A project currently being undertaken by the research team aims to strengthen the quality of clinical care and health services that specifically address dementia risk for Australian Aboriginal and Torres Strait Islander peoples. One of the intended strategies supporting the project's aim is the need for appropriate and safe health promotion programs and resources that support dementia risk reduction. Consequently, the aim of this scoping review is to identify and determine the quality and appropriateness of existing health promotion programs and resources aimed at dementia risk reduction developed or modified for Indigenous populations of Canada, the USA, Aotearoa New Zealand, and Australia that could be incorporated into the broader project. The Joanna Briggs Institute method for scoping reviews will be used to identify programs and resources focussed on dementia risk reduction for Indigenous peoples. Searches will be limited to the English language and literature published since January 2010. Databases to be searched include: CINAHL, Medline, PsychInfo, PubMed, Scopus and Google. Data that answers the research questions will be extracted from the literature and recorded on a data charting form. A combination of quantitative and qualitative methods will be used to analyse the findings of the scoping review. Dissemination of the findings through continuing community engagement, conference presentations and publications will be led by Aboriginal and Torres Strait Islander members of the research team.
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Demencia , Promoción de la Salud , Humanos , Demencia/prevención & control , Demencia/epidemiología , Demencia/etnología , Australia/epidemiología , Canadá/epidemiología , Estados Unidos/epidemiología , Promoción de la Salud/métodos , Nueva Zelanda/epidemiología , Conducta de Reducción del Riesgo , Nativos de Hawái y Otras Islas del PacíficoRESUMEN
OBJECTIVES: Community based dementia prevalence studies are expensive and resource intensive. Aotearoa New Zealand (NZ) has never had a community based dementia prevalence study representing all major ethnic groups. In recent years, dementia prevalence estimates have been derived from routinely collected health data but issues of underdiagnosis and undercoding limit their utility. Capture-recapture techniques can estimate the number of dementia cases missing from health datasets by modelling the ascertained overlaps between linked data sources. METHODS: Three routinely collected national health data sets-interRAI, Public hospital discharges, and Pharmaceuticals-were linked and all prevalent cases of dementia in NZ for the year 1 January 2021-31 December 2021 were identified. Capture-recapture analysis fitted eight loglinear models to the data, with the best fitting model used to estimate the number of prevalent cases missing from all three datasets. RESULTS: We estimated that almost half (47.8%) of dementia cases are not present in any of the three datasets. Dementia prevalence increased from 3.7% to 7.1% (95% CI 6.9%-7.4%) in the NZ 60+ population and from 4.9% to 9.2% (95% CI 8.9%-9.6%) in the NZ 65+ population when missing cases were included. Estimates of missing cases were significantly higher (p < 0.001) in Maori (49.2%), Pacific peoples (50.6%) and Asian (59.6%) compared to Europeans (46.4%). CONCLUSIONS: This study provides updated estimates of dementia prevalence in NZ and the proportion of undiagnosed dementia in NZ, highlighting the need for better access to dementia assessment and diagnosis.
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Demencia , Humanos , Demencia/epidemiología , Nueva Zelanda/epidemiología , Anciano , Masculino , Prevalencia , Femenino , Anciano de 80 o más Años , Persona de Mediana EdadRESUMEN
OBJECTIVE: To compare life expectancy levels and within-country geographic variation in life expectancy across six high-income Anglophone countries between 1990 and 2018. DESIGN: Demographic analysis using aggregated mortality data. SETTING: Six high-income Anglophone countries (USA, UK, Canada, Australia, Ireland and New Zealand), by sex, including an analysis of subnational geographic inequality in mortality within each country. POPULATION: Data come from the Human Mortality Database, the WHO Mortality Database and the vital statistics agencies of six high-income Anglophone countries. MAIN OUTCOME MEASURES: Life expectancy at birth and age 65; age and cause of death contributions to life expectancy differences between countries; index of dissimilarity for within-country geographic variation in mortality. RESULTS: Among six high-income Anglophone countries, Australia is the clear best performer in life expectancy at birth, leading its peer countries by 1.26-3.95 years for women and by 0.97-4.88 years for men in 2018. While Australians experience lower mortality across the age range, most of their life expectancy advantage accrues between ages 45 and 84. Australia performs particularly well in terms of mortality from external causes (including drug- and alcohol-related deaths), screenable/treatable cancers, cardiovascular disease and influenza/pneumonia and other respiratory diseases compared with other countries. Considering life expectancy differences across geographic regions within each country, Australia tends to experience the lowest levels of inequality, while Ireland, New Zealand and the USA tend to experience the highest levels. CONCLUSIONS: Australia has achieved the highest life expectancy among Anglophone countries and tends to rank well in international comparisons of life expectancy overall. It serves as a potential model for lower-performing countries to follow to reduce premature mortality and inequalities in life expectancy.
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Causas de Muerte , Países Desarrollados , Esperanza de Vida , Humanos , Esperanza de Vida/tendencias , Masculino , Femenino , Anciano , Australia/epidemiología , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Países Desarrollados/estadística & datos numéricos , Anciano de 80 o más Años , Mortalidad/tendencias , Irlanda/epidemiología , Canadá/epidemiología , Reino Unido/epidemiología , Estados Unidos/epidemiología , Disparidades en el Estado de Salud , AdultoRESUMEN
BACKGROUND: Isolation of cases and quarantining of non-immune contacts are the mainstay of measles outbreak management in elimination settings. Serology testing of exposed contacts may not be feasible in large outbreaks; therefore, vaccination history is used as a proxy for determining immunity to measles and thus prevention of onward virus transmission. This study sought to investigate the risk of measles virus transmission from individuals with a history of one or two doses of measles-containing vaccine (MCV). METHODS: Retrospective analysis of data from measles cases reported to Auckland Regional Public Health Service during the 2019 Auckland region measles outbreak. Vaccination history was verified using patient records and the New Zealand National Immunisation Register. Onward transmission was determined through case interviews and assessment of exposed contacts. RESULTS: 1451 measles cases were assessed as eligible for vaccination at the time of measles outbreak. Of these, 1015 (70.0%) were unvaccinated, 220 (15.2%) had unknown vaccination status, 139 (9.6%) had received only one dose of MCV and 77 (5.3%) had received two doses of the vaccine. Compared to unvaccinated cases, the odds of onward transmission were lower among those with one dose only (OR 0.41, 95% CI: 0.20-0.75) or two doses of MCV (OR 0.44, 95% CI: 0.17-0.95). Median time since vaccination was longer among those with onward transmission compared to those without onward transmission for one and two doses of the vaccine, suggesting a potential effect of waning immunity among this cohort. CONCLUSION: These findings support the hypothesis that measles cases with a history of prior vaccination are less likely to transmit the virus to others compared to unvaccinated cases. Such information can be used to support decisions around quarantine requirements for vaccinated contacts in future measles outbreaks.
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Brotes de Enfermedades , Vacuna Antisarampión , Virus del Sarampión , Sarampión , Vacunación , Humanos , Sarampión/epidemiología , Sarampión/prevención & control , Sarampión/transmisión , Nueva Zelanda/epidemiología , Brotes de Enfermedades/prevención & control , Masculino , Femenino , Vacuna Antisarampión/administración & dosificación , Vacuna Antisarampión/inmunología , Estudios Retrospectivos , Niño , Adolescente , Preescolar , Virus del Sarampión/inmunología , Adulto , Vacunación/estadística & datos numéricos , Adulto Joven , Lactante , Persona de Mediana EdadRESUMEN
Spatial life course epidemiological approaches offer promise for prospectively examining the impacts of air pollution exposure on longer-term health outcomes, but existing research is limited. An essential aspect, often overlooked is the comprehensiveness of exposure data across the lifecourse. The primary objective was to meticulously reconstruct historical estimates of air pollution exposure to include prenatal exposure as well as annual exposure from birth to 10 years (1977-1987) for each cohort member. We linked these data from a birth cohort of 1,265 individuals, born in Aotearoa/New Zealand in mid-1977 and studied to age 40, to historical air pollution data to create estimates of exposure from birth to 10 years (1977-1987). Improvements in air quality over time were found. However, outcomes varied by demographic and socioeconomic factors. Future research should examine how inequitable air pollution exposure is related to health outcomes over the life course.
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Contaminación del Aire , Exposición a Riesgos Ambientales , Nueva Zelanda/epidemiología , Humanos , Contaminación del Aire/efectos adversos , Contaminación del Aire/análisis , Femenino , Masculino , Exposición a Riesgos Ambientales/efectos adversos , Adulto , Embarazo , Cohorte de Nacimiento , Preescolar , Lactante , Recién Nacido , Estudios de Factibilidad , Niño , Efectos Tardíos de la Exposición Prenatal/epidemiología , Estudios de Cohortes , Contaminantes Atmosféricos/análisis , Contaminantes Atmosféricos/efectos adversos , Adulto Joven , AdolescenteRESUMEN
OBJECTIVE: Previous research has identified that gout impacts various domains of daily life. However, there have been no qualitative studies focusing on employment. This study aimed to understand the impact of gout on employment. METHODS: Semistructured interviews were conducted in Spain and Aotearoa/New Zealand, in people with gout (according to the 2015 American College of Rheumatology/European Alliance of Associations for Rheumatology criteria) who had experienced a gout flare during their employment. The interviews were guided by questions exploring the impact on employment, job changes, disclosure and co-workers' reactions. Data were analysed thematically. RESULTS: Eighteen participants were interviewed (89% male, mean age 52.9 years). Six themes were identified. The characteristics of the disease (pain intensity, tophi and joints affected) and the job itself (including physical job requirement and workplace flexibility) determined the experience of working with gout. The experiences were divided into physical (from total incapacity to working despite pain), emotional (feeling responsible, embarrassment, guilt and depression) and social (including disclosure responses and financial impact). Gout management strategies including rapid gout flare management and urate-lowering therapy reduced the number of flares and the intensity of pain, and allowed work attendance and participation. CONCLUSION: Both gout and work characteristics influence the employment experience for people with gout. Effective management of gout led to improved work experiences in all its domains.
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Empleo , Gota , Investigación Cualitativa , Humanos , Gota/psicología , Gota/epidemiología , Masculino , Persona de Mediana Edad , Femenino , Adulto , Nueva Zelanda/epidemiología , España/epidemiología , Anciano , Calidad de Vida , Entrevistas como Asunto , Lugar de Trabajo/psicologíaRESUMEN
AIMS: Post mastectomy pain syndrome (PMPS) can have significant negative effects on patients' quality of life after mastectomy. The estimated prevalence of PMPS varies widely and there is little data from a New Zealand population. This limits clinicians' ability to meaningfully describe and discuss pain-related complications of mastectomy peri-operatively. METHOD: We designed a single-centre, retrospective study to describe acute post-operative analgesic requirements after mastectomy, to describe the prevalence of PMPS at least 1 year after surgery, and to identify associated risk factors for this complication. RESULTS: One hundred and thirty mastectomy patients met inclusion criteria and 59 were willing and able to participate in 12-month follow-up. Acute post-operative pain was generally well managed with modest doses of oral analgesics. Sixty-six percent (n=39) of women reported some form of persistent pain symptoms post-mastectomy; this was associated with younger age, axillary surgery and chemotherapy. Only 5% of patients (n=3) met consensus criteria for PMPS, which limited identification of risk factors for this more severe complication. CONCLUSION: Despite PMPS occurring infrequently, post-operative pain of a less severe nature after mastectomy occurs commonly. Clinicians should remain vigilant to possible risk factors for this post-operative complication and counsel patients appropriately.
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Neoplasias de la Mama , Mastectomía , Dolor Postoperatorio , Centros de Atención Terciaria , Humanos , Femenino , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/epidemiología , Dolor Postoperatorio/etiología , Mastectomía/efectos adversos , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , Anciano , Neoplasias de la Mama/cirugía , Factores de Riesgo , Analgésicos/uso terapéutico , Nueva Zelanda/epidemiología , Dolor Agudo/etiología , Dolor Agudo/tratamiento farmacológico , Dolor Agudo/epidemiología , Prevalencia , Dolor Crónico/epidemiología , Dolor Crónico/etiología , Dolor Crónico/tratamiento farmacológico , Dimensión del DolorRESUMEN
AIM: In New Zealand, colorectal cancer (CRC) is the second highest cause of cancer death. We sought to characterise a unique population, the individuals who attempt to engage one or multiple times with screening yet fail to ever obtain successful screening. METHODS: This is a cross-sectional descriptive analysis on data from the New Zealand National Bowel Screening Programme 2012 to 2022. RESULTS: Over 7,000 individuals (1.26% of all participants) have attempted but failed to be successfully screened in the national bowel screening programme. Males compared with females (OR 1.11, 95% CI 1.06-1.17), Asian (OR 1.65, 95% CI 1.55-1.77), Maori (OR 2.07, 95% CI 1.92-2.24) or Pacific peoples (OR 2.30, 95% CI 2.09-2.52) compared with Europeans had greater odds to attempt but fail to be screened. Maori New Zealand Index of Deprivation (NZDep) quintile five (most deprived) had 4.12 (95% CI 3.64-4.67, plt;0.0001) the odds to attempt but fail to be screened compared with European deprivation quintile one participants (least deprived). CONCLUSIONS: There are important variations in the failure to successfully receive CRC screening by gender, age, ethnicity, deprivation level and screening year. We suggest drop-off location checking services for all participants are required.
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Neoplasias Colorrectales , Detección Precoz del Cáncer , Nativos de Hawái y Otras Islas del Pacífico , Humanos , Nueva Zelanda/epidemiología , Masculino , Femenino , Estudios Transversales , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/etnología , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , Persona de Mediana Edad , Detección Precoz del Cáncer/estadística & datos numéricos , Anciano , Pueblo Asiatico/estadística & datos numéricos , Población Blanca/estadística & datos numéricos , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/estadística & datos numéricos , Pueblo MaoríRESUMEN
INTRODUCTION: Intentional physical self-injury (IPSI) is a pressing health challenge and there is little awareness of injury patterns, management and outcomes. This study examines IPSI's epidemiological and clinical aspects in one major Auckland hospital, highlighting demography, injury patterns and implications for clinical practice and prevention. METHODS: Using Auckland City Hospital Trauma Registry data, a retrospective, descriptive study was conducted covering adult patients admitted from January 2015 to December 2019. It assessed demographic characteristics, injury patterns and outcomes, using Mann-Whitney U tests, Fisher's exact tests and Chi-squared tests. RESULTS: Among 137 IPSI admissions, 92 (67%) required surgery, and 24% experienced post-operative complications. Major trauma was identified in 39 (28.5%) admissions. Discharge destinations varied, with only 64 (47%) patients returning home unassisted. Injury severity did not significantly vary across sex, age or injury event location. Major injuries often resulted from falls (19 of 39) and minor injuries from lacerations/stabs (73 of 98). CONCLUSIONS: IPSI represents a significant challenge to Auckland health services, with a notable burden of care. The study highlights the need for targeted interventions to reduce the incidence of IPSI and improve outcomes. It underscores the importance of multidisciplinary approaches to care, integrating surgical, mental health and rehabilitative services.
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Conducta Autodestructiva , Humanos , Nueva Zelanda/epidemiología , Masculino , Femenino , Conducta Autodestructiva/epidemiología , Adulto , Estudios Retrospectivos , Estudios Transversales , Persona de Mediana Edad , Anciano , Adulto Joven , Adolescente , Complicaciones Posoperatorias/epidemiología , Sistema de Registros , Heridas y Lesiones/epidemiología , Puntaje de Gravedad del Traumatismo , Accidentes por Caídas/estadística & datos numéricosRESUMEN
INTRODUCTION: To assesses the alcohol-related burden of child maltreatment among Maori in Aotearoa New Zealand. We compared the risk of child maltreatment among Maori (0-17 years) exposed to parents with alcohol-related hospitalisation or mental health/addiction service use. We also conducted a sensitivity analysis to estimate the number of cases of maltreatment that could be attributed to alcohol among Maori. METHODS: A cohort study of 16,617 Maori aged 0-17 and their parents from 2000 to 2017 was conducted using the Statistics New Zealand Integrated Data Infrastructure. A Bayesian piecewise exponential model estimated the risk of time to first child maltreatment event. This analysis used data from child protection, hospital, mortality and police records, and specifically focused on the risk associated with exposure to parents with an alcohol-attributable hospitalisation or mental health/addiction service use event. Potential confounders for both parents and Maori (0-17 years) were included. We calculated a population-attributable fraction to estimate the proportion of maltreatment cases that could be attributed to alcohol in 2017. RESULTS: Results showed a 65% increased risk for young Maori exposed to parents with heavy alcohol use. We estimated 17% of substantiated child maltreatment among Maori could be attributed to parental hazardous alcohol consumption. DISCUSSION AND CONCLUSIONS: Severe or hazardous alcohol consumption among parents is a risk factor for child maltreatment among Maori. Maori alcohol consumption and harm are symptomatic of wider inequities related, among other things, to the ongoing effects of colonisation, as well as gaps in the regulation of alcohol sales.
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Maltrato a los Niños , Pueblo Maorí , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Consumo de Bebidas Alcohólicas/etnología , Consumo de Bebidas Alcohólicas/epidemiología , Alcoholismo/etnología , Alcoholismo/epidemiología , Teorema de Bayes , Maltrato a los Niños/etnología , Maltrato a los Niños/estadística & datos numéricos , Estudios de Cohortes , Nueva Zelanda/epidemiología , Padres , Factores de RiesgoRESUMEN
BACKGROUND: No routinely recommended cardiovascular disease (CVD) risk prediction equations have adjusted for CVD preventive medications initiated during follow-up (treatment drop-in) in their derivation cohorts. This will lead to underestimation of risk when equations are applied in clinical practice if treatment drop-in is common. We aimed to quantify the treatment drop-in in a large contemporary national cohort to determine whether equations are likely to require adjustment. METHODS: Eight de-identified individual-level national health administrative datasets in Aotearoa New Zealand were linked to establish a cohort of almost all New Zealanders without CVD and aged 30-74 years in 2006. Individuals dispensing blood-pressure-lowering and/or lipid-lowering medications between 1 July 2006 and 31 December 2006 (baseline dispensing), and in each 6-month period during 12 years' follow-up to 31 December 2018 (follow-up dispensing), were identified. Person-years of treatment drop-in were determined. RESULTS: A total of 1 399 348 (80%) out of the 1 746 695 individuals in the cohort were not dispensed CVD medications at baseline. Blood-pressure-lowering and/or lipid-lowering treatment drop-in accounted for 14% of follow-up time in the group untreated at baseline and increased significantly with increasing predicted baseline 5-year CVD risk (12%, 31%, 34% and 37% in <5%, 5-9%, 10-14% and ≥15% risk groups, respectively) and with increasing age (8% in 30-44 year-olds to 30% in 60-74 year-olds). CONCLUSIONS: CVD preventive treatment drop-in accounted for approximately one-third of follow-up time among participants typically eligible for preventive treatment (≥5% 5-year predicted risk). Equations derived from cohorts with long-term follow-up that do not adjust for treatment drop-in effect will underestimate CVD risk in higher risk individuals and lead to undertreatment. Future CVD risk prediction studies need to address this potential flaw.
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Enfermedades Cardiovasculares , Factores de Riesgo de Enfermedad Cardiaca , Hipolipemiantes , Humanos , Persona de Mediana Edad , Masculino , Femenino , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Anciano , Medición de Riesgo/métodos , Adulto , Nueva Zelanda/epidemiología , Hipolipemiantes/uso terapéutico , Antihipertensivos/uso terapéuticoRESUMEN
BACKGROUND: Maori have historically seen a lower rate of inflammatory bowel disease (IBD) compared to New Zealand's non-Maori population. Recent reports have shown an increasing rate of IBD among Maori patients. AIM: We performed a study to identify the phenotypes of IBD in the Maori population. METHODS: Patients with IBD of Maori ethnicity were retrospectively identified from four large regions of New Zealand. Electronic records were reviewed to collect details of patients' demographics, phenotypes and clinical features. RESULTS: We identified 165 Maori patients with IBD, of whom 74 (45.4%) had Crohn disease (CD), 86 (53.5%) had ulcerative colitis (UC) and 5 (3.0%) had IBD-unclassified (IBD-U). There were more female (61.8%) patients compared to male (38.2%). This was attributed to the higher ratio of female patients with CD over male (73.9% vs 26.1%), whereas sex was evenly distributed in UC (female 52.2%, male 48.8%). Ileocolonic CD was most frequently seen (36.2%), and the majority had non-stricturing disease (62.3%) with the absence of perianal involvement (78.2%). Bimodal age peaks were observed, with a first peak at 25-29 years and a second peak at 45-49 years. There was a five-fold increase in the incidence of IBD in Maori over 20 years. CONCLUSIONS: We present the largest study describing IBD in Maori. IBD phenotypes in Maori were similar to previous regional IBD reports, but there was a significantly higher proportion of female patients with CD in Maori and an earlier second age peak at 45-49 years. Increasing incidence of IBD in Maori has again been demonstrated.
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Enfermedades Inflamatorias del Intestino , Nativos de Hawái y Otras Islas del Pacífico , Fenotipo , Humanos , Masculino , Nueva Zelanda/epidemiología , Femenino , Adulto , Persona de Mediana Edad , Estudios Retrospectivos , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , Nativos de Hawái y Otras Islas del Pacífico/etnología , Adulto Joven , Enfermedades Inflamatorias del Intestino/etnología , Enfermedades Inflamatorias del Intestino/epidemiología , Adolescente , Anciano , Enfermedad de Crohn/etnología , Colitis Ulcerosa/etnología , Niño , Pueblo MaoríRESUMEN
OBJECTIVE: To evaluate associations of wildfire fine particulate matter ≤2.5 mm in diameter (PM2.5) with diabetes across multiple countries and territories. RESEARCH DESIGN AND METHODS: We collected data on 3,612,135 diabetes hospitalizations from 1,008 locations in Australia, Brazil, Canada, Chile, New Zealand, Thailand, and Taiwan during 2000-2019. Daily wildfire-specific PM2.5 levels were estimated through chemical transport models and machine-learning calibration. Quasi-Poisson regression with distributed lag nonlinear models and random-effects meta-analysis were applied to estimate associations between wildfire-specific PM2.5 and diabetes hospitalization. Subgroup analyses were by age, sex, location income level, and country or territory. Diabetes hospitalizations attributable to wildfire-specific PM2.5 and nonwildfire PM2.5 were compared. RESULTS: Each 10 µg/m3 increase in wildfire-specific PM2.5 levels over the current day and previous 3 days was associated with relative risks (95% CI) of 1.017 (1.011-1.022), 1.023 (1.011-1.035), 1.023 (1.015-1.032), 0.962 (0.823-1.032), 1.033 (1.001-1.066), and 1.013 (1.004-1.022) for all-cause, type 1, type 2, malnutrition-related, other specified, and unspecified diabetes hospitalization, respectively. Stronger associations were observed for all-cause, type 1, and type 2 diabetes in Thailand, Australia, and Brazil; unspecified diabetes in New Zealand; and type 2 diabetes in high-income locations. An estimate of 0.67% (0.16-1.18%) and 1.02% (0.20-1.81%) for all-cause and type 2 diabetes hospitalizations were attributable to wildfire-specific PM2.5. Compared with nonwildfire PM2.5, wildfire-specific PM2.5 posed greater risks of all-cause, type 1, and type 2 diabetes and were responsible for 38.7% of PM2.5-related diabetes hospitalizations. CONCLUSIONS: We show the relatively underappreciated links between diabetes and wildfire air pollution, which can lead to a nonnegligible proportion of PM2.5-related diabetes hospitalizations. Precision prevention and mitigation should be developed for those in advantaged communities and in Thailand, Australia, and Brazil.
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Diabetes Mellitus , Hospitalización , Material Particulado , Incendios Forestales , Humanos , Hospitalización/estadística & datos numéricos , Material Particulado/análisis , Material Particulado/efectos adversos , Masculino , Australia/epidemiología , Persona de Mediana Edad , Femenino , Diabetes Mellitus/epidemiología , Anciano , Tailandia/epidemiología , Nueva Zelanda/epidemiología , Brasil/epidemiología , Canadá/epidemiología , Taiwán/epidemiología , Adulto , Exposición a Riesgos Ambientales/efectos adversos , Exposición a Riesgos Ambientales/estadística & datos numéricosRESUMEN
BACKGROUND: Early life environments can have long-lasting impacts on future health and wellbeing. Maternal health during pregnancy, including experiencing stress or mood disorders, has been associated with psychopathology in later life. Anxiety disorders are one of the most prevalent mental health conditions, affecting approximately 7 % of children and adolescents globally, with a lifetime prevalence of 15-20 %. Identifying prenatal risk factors can support future and current public health interventions and maternity care. METHODS: Data were obtained from the Growing Up in New Zealand longitudinal study of child development. Prenatally, mothers provided sociodemographic information as well as data on their mental health, potential teratogens, and lifestyle factors such as supplement intake and exercise levels. At 8-years old, 4922 children self-completed the PROMIS-SF anxiety measure. Bivariate analyses and backward stepwise regression were used to determine the best multivariable model. RESULTS: Significant prenatal predictors of anxiety symptoms at 8-years old included elevated maternal depression symptoms, body mass index in the overweight/obese range, exercise patterns, and paracetamol, anti-inflammatory and alcohol intake. LIMITATIONS: Sample attrition from baseline to 8-year may have affected statistical power. To further untangle the effect of timing and duration of the exposures reported in this study, larger sample sizes would be required. CONCLUSIONS: Prenatal mental health and wellbeing was significantly associated with child anxiety symptoms at 8-years of age. This study highlights the importance of supporting expectant mothers' health and wellbeing during pregnancy to ensure children have the best opportunity to have good mental health.