Ethnic differences in the epidemiology of cutaneous lupus erythematosus in New Zealand.

Background The prevalence and variation by ethnicity of cutaneous lupus in New Zealand is not known. Therefore, a cross-sectional study to determine the prevalence and variation by ethnicity of cutaneous lupus in the ethnically diverse community of South Auckland, New Zealand, was undertaken. Methods Multiple sources were examined to determine the prevalence of acute cutaneous lupus erythematosus, subacute cutaneous erythematosus and discoid lupus erythematosus. Ethnicities examined were European, Maori/Pacific and Indian/Asian. Capture-recapture was used to determine the overall population prevalence of cutaneous lupus. Results A total of 145 cases of cutaneous lupus were identified. There were 22 men and 123 women, with an average age (standard deviation), respectively, of 46.4 (±21.5) and 43.1 (±14.8) years. There were 53 cases of acute cutaneous lupus erythematosus, 19 cases of subacute cutaneous erythematosus and 66 cases of discoid lupus erythematosus. The age and sex adjusted relative risk (95% confidence interval; CI) of Maori/Pacific compared to the European population was 2.47 (95% CI 1.67-3.67) for all types of cutaneous lupus, 1.60 (95% CI 0.84-3.18) for acute cutaneous lupus erythematosus, 0.09 (95% CI 0.01-1.1) for subacute cutaneous erythematosus and 5.96 (95% CI 3.06-11.6) for discoid lupus erythematosus. The overall prevalence of cutaneous lupus was 30.1 (95% CI 25.5-35.4) per 100,000. However, capture-recapture estimated the unadjusted prevalence of cutaneous lupus to be 86.0 (95% CI 78.1-94.7) per 100,000. Conclusion Maori and Pacific people in Auckland, New Zealand, have a greater relative risk of all types of cutaneous lupus compared to the European population and a particularly high risk of discoid lupus erythematosus.

Rheumatic fever in New Zealand: what are the teeth trying to tell us?

Rheumatic fever remains an important disease of childhood in New Zealand, despite increasing access and awareness of the need for preventive antibiotic treatment. Mãori and Pacific children have an incidence rate about 30 times and 70 times higher than European children, from annual notification data (77.7 per 100,000 for Pacific, 30.4 per 100,000 for Mãori, and 1 per 100,000 for European). In the early 20th century, a Canadian dentist, Weston A. Price, noted that 95% of children who presented with acute rheumatic fever also had advanced dental caries. Oral health surveys show that Mãori and Pacific children are disproportionately affected by dental caries compared to European. Excess dietary sugar intake is widely recognised to cause dental decay and also provides energy to some species of bacteria implicated in the pathogenesis of dental decay and rheumatic fever. We suggest that a case-control study be conducted to evaluate the evidence for an association between sugar intake, dental decay and incidence of disease.

The case to ban sugary food and drink from schools: these products are addictive, and kids will learn best without them.

In New Zealand, schools have been a battleground as a setting to address the obesity epidemic, with successive governments enforcing, and then repealing laws to ban junk food from canteen menus. Just what is considered 'junk food' remains controversial, but recently sugar sweetened beverages have become a target of public health groups. The adverse health consequences of their intake have been the principal arguments to reduce their availability. Here, we argue that the advantages of reducing intake of sugar in schools are very likely to lead to educational and other social benefits. Indices of sugar intake have been associated with aggressive behaviour, attention deficit, dysphoria and suicidal thoughts in cross-sectional studies. Longitudinal studies have also linked soft drink intake with impaired cognitive development. We believe that banning sugary drinks from schools will assist teachers and students to better achieve their learning goals, with a side effect of improving their health status.

An 'end-game' for sugar sweetened beverages?

OBJECTIVE: The epidemic of unhealthy weight is now in its third decade. The multitude of initiatives designed to address this issue (globally) have predominantly been ineffective as the prevalence of unhealthy weight has continued to rise. Public health professionals have proposed an 'endgame' for tobacco smoking in New Zealand by 2025, which has received widespread support. Similarly, here, to control the prevalence of unhealthy weight, we consider whether a similar approach to tobacco is justified to restrict the intake of sweetened beverages. APPROACH: This paper reviews the evidence relating sugar sweetened beverages to unhealthy weight and adverse health effects. Current initiatives aimed at reducing sugar sweetened beverage consumption both internationally and in New Zealand are reviewed. FINDINGS: Epidemiological evidence consistently links sugar-sweetened drink intake with unhealthy weight and other risk factors for cardiovascular disease, such as diabetes, gout, and raised blood pressure. Food disappearance data suggests that sugar intake continues to increase in New Zealand, and that a subtle addiction to sugar may underlie this trend. A number of successful initiatives to reduce sugary drink intake are described. IMPLICATION/CONCLUSION: We argue that an 'endgame' to the consumption of sugar-sweetened beverages be supported as a means to address the issue of unhealthy weight at a population level. Finally, a preliminary draft endgame plan is presented for consideration, dialogue and debate.

The story of FiZZ: an advocacy group to end the sale of sugar sweetened beverages in New Zealand.

FIZZ (which stands for fighting sugar in soft-drinks) is a new advocacy group started to reduce population consumption of sugar-sweetened soft drinks in New Zealand. The vision of FIZZ is for New Zealand to be sugary drink free by 2025. This means that sugar sweetened beverages will comprise < or = 5% of the total beverage market, and sugar free drinks will be the norm. In this paper, we outline the story of FIZZ: to reiterate why we believe the group is needed, reflect on what the group has achieved to date, consider what it aims to accomplish, and outline what methods it will seek to achieve these aims. Put simply, we believe that the epidemiological evidence that sugar intake, particularly in liquid form, causes poor physical and mental health is overwhelming. Swapping sugar sweetened drinks for sugar free alternatives, water or milk, is, in our view, an urgently needed and important step which is likely to reduce the epidemic of unhealthy weight (obesity) and its sequelae. The nutrition environment in New Zealand is now out of step with scientific evidence, with virtually unrestricted access to, and sales and marketing of, sugary drinks to both children and adults. FIZZ is seeking the implementation of local and nationwide policy, similar to those implemented for tobacco, to limit advertising, restrict marketing, raise purchase prices and ultimately curb the sales of sugary drinks in New Zealand. FIZZ is also working in communities to raise people's awareness of the harms sugary drinks pose to health. We at FIZZ also acknowledge that the beverage industry may play an important role in accomplishing this vision, and have established that there is common ground upon which FIZZ and industry can engage to reduce the sugary drink intake.

Sugar restriction: the evidence for a drug-free intervention to reduce cardiovascular disease risk.

BACKGROUND/AIM: Uncertainty exists about what dietary component is most likely to cause coronary heart disease. Over the last thirty years, attention has focused on saturated fat and salt as guilty parties. More recently, evidence suggests that excess sugar intake is more likely than either traditional factor to lead to atherosclerotic disease. Some researchers have also speculated that sugar is addictive, in a similar manner to caffeine and established drugs of abuse. METHODS: Here we review the epidemiological, biochemical and psychological evidence that implicates excess sugar intake as an important cause of ill-health. RESULTS: We found relatively consistent evidence of association between markers of sugar intake and risk factors for cardiovascular disease, or the disease itself. This evidence contrasted with rather weaker evidence which linked either saturated fat or salt with cardiovascular disease endpoints. We also found some evidence of a sugar addiction syndrome. CONCLUSION: We suggest that advice to restrict sugar intake should be a routine part of clinical care, particularly when patients are being counselled about cardiovascular risk.

Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial.

OBJECTIVES: To measure the short-term effects of an electronic nicotine delivery device ("e cigarette", ENDD) on desire to smoke, withdrawal symptoms, acceptability, pharmacokinetic properties and adverse effects. DESIGN: Single blind randomised repeated measures cross-over trial of the Ruyan V8 ENDD. SETTING: University research centre in Auckland, New Zealand. PARTICIPANTS: 40 adult dependent smokers of 10 or more cigarettes per day. INTERVENTIONS: Participants were randomised to use ENDDs containing 16 mg nicotine or 0 mg capsules, Nicorette nicotine inhalator or their usual cigarette on each of four study days 3 days apart, with overnight smoking abstinence before use of each product. MAIN OUTCOME MEASURES: The primary outcome was change in desire to smoke, measured as "area under the curve" on an 11-point visual analogue scale before and at intervals over 1 h of use. Secondary outcomes included withdrawal symptoms, acceptability and adverse events. In nine participants, serum nicotine levels were also measured. RESULTS: Over 60 min, participants using 16 mg ENDD recorded 0.82 units less desire to smoke than the placebo ENDD (p=0.006). No difference in desire to smoke was found between 16 mg ENDD and inhalator. ENDDs were more pleasant to use than inhalator (p=0.016) and produced less irritation of mouth and throat (p<0.001). On average, the ENDD increased serum nicotine to a peak of 1.3 mg/ml in 19.6 min, the inhalator to 2.1 ng/ml in 32 min and cigarettes to 13.4 ng/ml in 14.3 min. CONCLUSIONS: The 16 mg Ruyan V8 ENDD alleviated desire to smoke after overnight abstinence, was well tolerated and had a pharmacokinetic profile more like the Nicorette inhalator than a tobacco cigarette. Evaluation of the ENDD for longer-term safety, potential for long-term use and efficacy as a cessation aid is needed. Trial registration No.12607000587404, Australia and New Zealand Clinical Trials Register.

Conspicuity and bicycle crashes: preliminary findings of the Taupo Bicycle Study.

OBJECTIVE: To describe the methods, characteristics of participants, and report on the preliminary findings of a longitudinal study of cyclists. DESIGN: Web-based survey to establish a cohort of cyclists. SETTING: Participants in the largest mass-participation bicycle event in New Zealand, the Wattyl Lake Taupo Cycle Challenge. PARTICIPANTS: 2469 riders who had enrolled online in the 2006 Wattyl Lake Taupo Cycle Challenge. MAIN OUTCOME MEASURES: Self-reported crashes in preceding 12 months. RESULTS: Of 5653 eligible riders, 2469 (44%) completed the study questionnaire. Mean age was 44 years, 73% were male, and the average number of kilometers cycled per week in the preceding 12 months was 130. The annual incidence of crashes leading to injury that disrupted usual daily activities for at least 24 h was 0.5 per cyclist/year. About one-third of these crashes resulted in presentation to a health professional. The mean number of days absent from work attributable to bicycle crashes was 0.39 per cyclist/year. After adjustment for potential confounders and exposure (kilometers cycled per year), the rate of days off work from bicycle crash injury was substantially lower among riders who reported always wearing fluorescent colors (multivariate incidence rate ratio 0.23, 95% CI 0.09 to 0.59). CONCLUSIONS: Low cyclist conspicuity may increase the risk of crash-related injury and subsequent time off work. Increased use of high-visibility clothing is a simple intervention that may have a large impact on the safety of cycling.

The role of surgery in the management of obesity.

This article reviews the role of surgery in the management of obesity. Surgery is discussed in the context of the different approaches to conservative treatment. Although there are no randomised trials, the available data suggest that open surgery is the most effective treatment for severe obesity when offered to carefully selected patients who are managed by a multidisciplinary team, committed to long-term follow-up. Results from ongoing, randomised controlled trials are awaited. Laparoscopic adjustable gastric banding is a promising technique which offers the benefits of less invasive surgery, appears to be as effective as open surgery but its diffusion should follow more rigorous evaluation.

Hip fracture in elderly men: prognostic factors and outcomes.

OBJECTIVE: To examine prognostic factors and outcomes after hip fracture in men aged 60 years and older. DESIGN AND SETTING: Cohort study of all men presenting to St George Hospital (a 650-bed tertiary care centre) with hip fractures in 1995, recruited retrospectively from medical records and evaluated prospectively at six and 12 months after fracture. PATIENTS: 51 men aged 60 years or more (and, for comparison, 51 age-matched women) who presented with hip fracture not caused by high impact injuries or local bone disease. MAIN OUTCOME MEASURES: Prognostic factors (such as pre-existing illness and osteoporotic risk factors) and outcome data (such as fracture-related complications, mortality, and level of function as measured by the Barthel index of activities of daily living at six and 12 months postfracture). RESULTS: Median age of the 51 men was 80 years (interquartile range, 74-86 years); four were aged under 70 years. Outcome assessment was possible for 41 men (80%). Similar proportions of men and women came from institutions (32% v. 28%), and similar additional proportions required institutionalisation after discharge (18% v. 14%). Fracture-related complications affected similar proportions of men and women (30% v. 32%), and mean length of hospital stay was similar. Fourteen per cent of men died in hospital compared with only 6% of women (P = 0.06). Men had more risk factors for osteoporosis (P < 0.01). Physical functioning (measured by the Barthel index) deteriorated significantly in men from 14.9 at baseline to 13.4 at six months (P < 0.05) and 12.4 at 12 months (P < 0.05) after fracture. CONCLUSION: Compared with women, elderly men presenting with hip fracture have higher mortality and have more risk factors for osteoporosis. Like women with hip fracture, men are usually fragile, with pre-existing medical illness and fracture-related complications contributing to their overall poor outcomes.

Effect of clinical pharmacy input on physician prescribing habits in the nursing home care unit.

The goal of this study was to evaluate any changes in medication use in our 60-bed nursing home care unit as a result of eliminating clinical pharmacy services during a 2-week period. Information was obtained on patient medications and number of doses dispensed. All patients were found to have a 6% increase in average number of scheduled medications, a 3% increase in average total medications, and an increase in scheduled doses dispensed by 10% during the absence of clinical pharmacy services. These numbers declined by 16, 18, and 9%, respectively, 2 weeks after the return of clinical pharmacy services. When evaluating only those 37 patients present the entire 4 week period, average scheduled medications rose 5% and total medications rose 4% during the absence of clinical pharmacy services and declined 13 and 17%, respectively, upon return of services. Eleven patients showed an increase in total number of medications during the absence of clinical pharmacy services whereas 21 patients showed a decline in medications after the return of clinical pharmacy services (P less than 0.001). The authors conclude that clinical pharmacy services must be provided on a continuous basis to maintain good physician prescribing habits in the nursing home care unit.

Using public health nursing data for program advocacy.

Developing and maintaining public health nursing programs in an era of funding cutbacks is a challenge faced by all public health nursing administrators today. The authors describe the development, testing, and implementation of a public health nursing data collection method, which proved to be invaluable in describing and justifying public health nursing services to policy makers, legislative representatives, and community residents.

The influence of enteral feedings on sustained-release theophylline absorption.

In a randomized, crossover study the influence of enteral feedings (Ensure) on the absorption of theophylline from a sustained-release preparation (Theo-24) was evaluated. Six healthy, male subjects, age 22 to 37 years, participated. In phase 1 the subjects received a single oral dose of Theo-24 6 mg/kg with 100 ml of water at 8:00 A.M. In phase 2, they received 100 ml boluses of Ensure hourly, beginning 3 hours prior to the oral dose and continuing for a total of 1000 ml. In phase 3, subjects received a single 30-minute intravenous infusion of an equivalent dose of aminophylline. After each dose, serial blood samples were collected for 72 hours. No statistically significant differences in area under the curve (AUC infinity 0) (126.0 vs 127.3 micrograms hr/ml), maximum concentration (3.80 vs 4.08 micrograms/ml), or time to peak plasma level (13 vs 11 hrs) were found between phases 1 and 2. Mean AUC infinity 0 for the intravenous phase (161.4 micrograms hr/ml) was significantly higher than the AUC for either oral study (p less than 0.05). The mean bioavailability was 81% for phase 1 and 80% for phase 2. Percent absorbed versus time plots revealed no difference in rate of absorption between treatments. We conclude that short-term administration of the enteral feeding. Ensure does not influence the absorption of theophylline when administered as the sustained-release product Theo-24.