Pacific Islands Families Study: Household Food Security during Pregnancy and Secondary School Educational Achievement.

Nutritional environment in early life is a key factor for brain development and function. It is important to understand the relationship between nutrition in early life and academic achievement in adolescence. The birth cohort of the Pacific Islands Families (PIF) study was born in the year 2000. When their child was six weeks old, mothers were asked questions concerning food security over the past year. Two binary measures of food security were derived as previously used in PIF and also by the Ministry of Health (MOH). In 2020, records of academic achievement from the National Certificate of Educational Achievement (NCEA) for 649 (317 female, 332 male) cohort members showed progressive achievement at levels 1, 2, and 3 of NCEA and allowed University Entrance (UE) to be assessed. The prevalence of food insecurity was not different for sex but high at 29% and 42% using the PIF and MOH definitions of food insecurity, respectively. More females (27%) than males (18%) achieved UE as their highest qualification, and more males (40%) than females (31%) achieved NCEA levels 1 or 2 as their highest qualification. UE was achieved by 25% of those born into food-secure households and 17% from food-insecure households. Logistic regression demonstrated that the odds of achieving UE were 1.8-fold (95% CI 1.2, 2.6, p = 0.003) higher in females than males and, independently, 1.6-fold (95% CI 1.1, 2.5 p = 0.026) higher if the household was food secure. This work emphasises the importance of maternal and early-life food security for subsequent academic achievement and the well-being of future generations.

Preterm birth among Pacific Islanders in the United States and the US-affiliated Pacific Islands: A systematic review and meta-analysis.

OBJECTIVE: To better understand the epidemiology of preterm birth among Pacific Islanders in the United States and the US-Affiliated Pacific Islands. METHODS: Systematic searches of MEDLINE, Embase, CINAHL, PsycINFO, two nonindexed regional journals, and gray literature were conducted and finalized in September 2021. Observational studies published since January 2010 that documented preterm birth outcomes among Pacific Islanders in the United States and the US-Affiliated Pacific Islands were eligible for inclusion. Outcomes of interest included preterm birth prevalence, risk compared with white women, and risk factors for preterm birth among Pacific Islanders. RESULTS: Fourteen of the 3183 screened articles were included in meta-analyses. Random-effects models were used for pooled estimates with 95% confidence intervals. The pooled prevalence of preterm birth among Pacific Islanders was 11.2%, 95% CI: 9.3%-13.6%. Marshallese women had the highest pooled prevalence (20.7%, 95% CI 18.6%-23.0%) among Pacific Islander subgroups. Compared with white women, Pacific Islander women had higher odds of experiencing preterm birth (OR = 1.40, 95% CI: 1.28-1.53). Four risk factors for preterm birth could be explored with the data available: hypertension, diabetes, smoking, and pre-pregnancy body mass index; hypertension and diabetes significantly increased the odds of preterm birth. CONCLUSIONS: Existing literature suggests that United States Pacific Islanders were more likely to experience preterm birth than white women, although the pooled prevalence varied by Pacific Islander subgroup. Data support the need for disaggregation of Pacific Islanders in future research and argue for examination of subgroup-specific outcomes to address perinatal health disparities.

Epidemiology of tuberculosis in the Pacific island countries and areas, 2000-2020.

Objective: Tuberculosis (TB) is one of the most important infectious diseases with an estimated 9.9 million people falling ill globally in 2020. We describe the epidemiology of TB in the Pacific island countries and areas (PICs) to inform potential priority actions to implement the Western Pacific Regional Framework to End TB 2021-2030. Methods: A descriptive analysis was conducted using annual TB surveillance data submitted by national TB programmes to the World Health Organization (WHO) and TB burden estimates (incidence rates and number of deaths) generated by WHO for the PICs, for the period 2000-2020. We also analysed TB case numbers, multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB), recent risk factor indicators and treatment outcomes. Results: The estimated TB incidence rate in the PICs increased between 2000 and 2020 from 62 to 69 per 100 000 population, with an 8% reduction observed since 2015. TB cases increased by 29% during 2000-2020, with 1746 cases in 2020 and a high proportion in children (19%). Bacteriological diagnosis was used for 58% of total TB cases, although some countries reported clinical diagnoses in over 60% of cases. From 2015 to 2019, 52 MDR/RR-TB cases were reported and there were 94 TB/HIV coinfected cases in 2015-2020. Treatment success was 74% in 2019 due to 18% of cases being unevaluated. In 2020, the estimated proportion of TB cases attributable to smoking, malnutrition, alcohol abuse and diabetes was 17%, 16%, 11% and 9%, respectively. Discussion: There was an increasing trend in TB cases, estimated incidence and deaths between 2000 and 2020. Laboratory services were scaled up in some PICs and case-finding activities greatly contributed to the detection of cases. To end the incidence of TB, continued efforts on case finding, contact investigation and scaling up TB preventive treatment should be prioritized. At the same time, collaboration with other sectors for risk factor management and decentralized management need to be considered.

Treatment outcomes of adult acute lymphoblastic leukaemia in Auckland, New Zealand.

AIM: Acute lymphoblastic leukaemia/lymphoma (ALL) is a rare disease that requires an intensive chemotherapy regimen for successful treatment. This is a single-centre retrospective audit to assess the treatment outcomes in the largest ALL centre in New Zealand. METHOD: Data such as survival and adverse events of patients with de novo ALL referred to Auckland City Hospital for treatment were included in this audit. Sub-group analyses were also performed. RESULTS: Sixty-five patients aged from 18 upwards with ALL were included in this audit. The median survival of all patients was 37.6 months. Adolescent and young adults (AYA) treated on the COG (paediatric) protocols had a mean survival of 48.3 months (median not reached), while adults treated with the UKALL14 protocol had a median survival of 37.6 months. In the UKALL14 sub-group, Maori/Pacific Islanders had an inferior EFS that was statistically significant. CONCLUSION: Overall AYA outcomes are comparable to international standards. Our adult outcomes may be poorer than the original UKALL14 trial, with Maori/Pacific Island patients having shorter survival.

Underserved Pacific Islanders With Locally Advanced Cervical Cancer Receive Higher Rates of Standard-of-Care Radiation Treatment Through the Pacific Island Health Care Project and Military Health System Compared to the Average U.S. Population.

INTRODUCTION: Brachytherapy, with external beam radiation, increases survival in the treatment of locally advanced cervical cancer (LACC). In 2016, Robin et al. reported only 44% of patients received standard-of-care (SOC) brachytherapy in the USA. The Pacific Island Health Care Project has provided humanitarian medical care to women from the U.S. Associated Pacific Islands (USAPI) for three decades at Tripler Army Medical Center (TAMC), a military health care system (MHS) facility. We evaluated whether this underserved and understudied patient population received SOC treatment for LACC at TAMC. MATERIALS AND METHODS: The TAMC tumor registry was searched for all cervical cancer cases from 1997 to 2019. Subjects were excluded if they did not have stage IB2-IVA disease and were not from USAPI. The primary outcome was the overall utilization of brachytherapy, and statistical analysis was performed using the chi-square test. RESULTS: We identified 214 women with cervical cancer treated at TAMC, of which 67 met the study criteria. Ninety-two percent had squamous cell carcinoma on histology. Of the patients identified, 48 (71.6%, P < .001) were treated with brachytherapy. Fifteen (22.4%) patients received external radiation alone, and four (6.0%) received chemoradiation without brachytherapy. A post-hoc power analysis was conducted with a power of 91.3%. CONCLUSIONS: Women with cervical cancer from USAPI in the PIHCP program treated at TAMC received significantly higher rates of SOC radiation treatment than the U.S. population on average. This highlights the ability of PIHCP, through the MHS, to deliver SOC treatment for cervical cancer to an otherwise underserved patient population.

Oral Cancer Disparities in the Outer US-affiliated Pacific Islands.

OBJECTIVE/HYPOTHESIS: Oral cancers in the US-affiliated Pacific Islands are poorly described despite disproportionately higher incidences in certain jurisdictions. This study attempts to better characterize the incidence, staging, and management of oral cancers in this region. STUDY DESIGN: Retrospective Epidemiological Study. METHODS: A retrospective review was conducted across the US-affiliated Pacific Islands between 2007 and 2019. Patient data were obtained for individuals with primary head and neck cancers from the Pacific Regional Central Cancer Registry database. All cohorts were age-adjusted to the 2000 US Standard Population. Further analysis was performed on oral cavity cancers due to their clear predominance within the sample. RESULTS: A total of 585 patients with primary head and neck cancers were included. The average age was 54.5 ± 12.9 years, and most patients were male (76.8%). Oral cancer subsite analysis revealed the proportional incidence of buccal mucosa was higher in 5 of 9 jurisdictions when compared with the United States (p < 0.001). Tongue and lip cancers were not found to have significantly higher incidence proportions. Patients in the Pacific Islander group were less likely to be detected at earlier stages for cancers of the cheek and other mouth (p < 0.001), tongue (p < 0.001), and lips (p < 0.001) compared with the United States. CONCLUSIONS: Many Pacific Island populations are burdened with higher incidences of oral cancer with later staging. Further investigation is recommended to evaluate oral cancer-related outcomes and mortality in this region. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:1899-1905, 2023.

The long-term outcome of New Zealand Maori and Pacific Island children diagnosed with childhood onset lupus nephritis.

OBJECTIVE: To determine the long-term outcome of Maori and Pacific Island children diagnosed with childhood onset lupus nephritis. METHOD: A chart review was conducted of children diagnosed with biopsy proven lupus nephritis seen by the Starship Hospital and Kidz First paediatric rheumatology and/or Starship renal services between January 1992 and January 2018. Baseline and follow-up kidney histology, adherence and response to therapy including partial or full renal remission, refractory disease, end-stage kidney disease (ESKD) and mortality were determined. RESULTS: In a New Zealand cohort of 42 with childhood onset lupus nephritis, Maori and Pacific Island children were significantly more likely to develop class 4 lupus nephritis (RR (95% CI), 11.3 (3.84-49.9), p < 0.0001), demonstrate medication nonadherence (RR (95% CI) 12.4 (3.48-85.7), p < 0.0001) and experience end stage kidney disease (RR (95% CI) 15.7 (2.97-389.3), p = 0.0003) and mortality (RR (95% CI) 11.1 (1.91-280.1), p = 0.005) compared to non-Maori and Pacific Island children. In addition, Maori children with childhood onset lupus nephritis developed chronic histological changes significantly more rapidly than Pacific or Asian children (p = 0.038). CONCLUSION: Lupus nephritis is more common among Maori and Pacific Island children in New Zealand associated with a significant incidence of end stage kidney disease and mortality, with some Maori children developing rapid histologic disease progression.

Assessing the progress on the implementation of policy and legislation actions to address the Non-Communicable Diseases crisis in the Pacific.

AIM: To assess the progress on the implementation of Non-Communicable Diseases (NCD) related policies and legislations in the Pacific Island Countries and Territories (PICTs). MATERIALS AND METHODS: The Pacific Monitoring Alliance for NCD Action (MANA) Dashboard was used to assess the progress on the implementation. The MANA Dashboard includes 31 indicators across four different domains such as leadership and governance; preventative policies and legislations; health system response programs; and monitoring This progress assessment was conducted between 2019 and 2020 for all 21 PICTs. The data were analyzed and compared with the baseline status (2018) report and presented across four different domains of the MANA dashboard. RESULTS: This progress assessment found that PICTs overall have made advancements in a number of areas, particularly the establishment of a national multi-sectoral NCD taskforce; implementation of referenced approaches to restrict trans-fat in the food supply in national documents; and fiscal measures to affect access and availability to less healthy foods and drinks. However, the strengths of actions varied across PICTs, and most are categorised as low strengths. Measures which had the most limited progress in implementation include policy and legislation that restrict alcohol advertising; tobacco industry interference; marketing of foods and non-alcoholic beverages to children; and marketing for breast milk substitutes. CONCLUSIONS: This progress assessment further highlights that while PICTs continue to make progress, NCD policy and legislation gaps still exist, both in terms of weaknesses of existing measures and areas that have had little attention to-date. These require urgent actions to scale up NCD related policies and legislation at regional and national level.

Occurrence of microplastics within a freshwater aquaculture system in the Pacific Islands, Viti Levu, Fiji.

Microplastics (MPs) have become frequent topics of research within Pacific Islands (PIs) in recent years; however, within PI freshwater aquaculture systems, MPs have not yet been quantified. As such this study is aimed at quantifying and characterizing the MP load from across a freshwater aquaculture system within Fiji. Water, sediment, and fish samples were collected from various stages between water source and drainage channels of an aquaculture facility in Navua, Fiji. MPs were extracted using established protocols and analyzed for abundance, form type, size, and polymer composition. Results show no significant difference in MP abundance between sampling sites for, water (average: 3.2 ± 1.14 MP/L), sediment (average: 2.3 ± 0.7 MP/100 g DW), and fish (average: 2.7 ± 1.4 MP/fish). Fibers were the most frequent form type in all three elements (average: 2.9 ± 0.2 MP/L in water, 2.1 ± 0.75 MP/100 g DW, 2.8 ± 0.14 MP/fish); however, the difference across sites was significant within water samples only. In water and sediments, smaller MPs (< 1.4 mm) were the most frequent comprising > 35% in all three elements; however, the difference was not significant between sites. Polymer analysis found that polypropylene, polyurethane, and nylon were the most abundant polymers, which coupled with observed form type and size characteristics suggest a common sources of MPs across sites.

Factors Associated with Low Screening Participation and Late Presentation of Cancer amongst Women in the Pacific Island Countries and Territories: A Systematic Review.

BACKGROUND AND OBJECTIVE: In most Pacific Island Countries and Territories (PICTs), cancer patients commonly present at very late stages and by the time the disease is diagnosed, it is often too late for treatment. This review examines the evidence on factors associated with low cancer screening participation and late presentation of cancer among women of the PICTs. MATERIALS AND METHODS: Medline, PubMed, ProQuest and The Cumulative Index to Nursing and Allied Health Literature were searched to identify relevant studies for this review. Terms of medical subject headings was performed in combination with other key words such as "screening", "delay", "determinants", "awareness". RESULTS: Eleven studies met the inclusion criteria of this review. Six factors were identified from these studies: resources and facilities, trust in the health care system, culture and tradition, modesty, awareness and socioeconomic status. CONCLUSION: Due to several barriers and factors, women in the PICTs are hindered from accessing cancer screening practices and often present late with cancer symptoms leading to advanced stage diagnosis. The findings of this study provide a foundation for future studies that could focus more in-depth to explain how these factors contribute to the presentation of cancer in late stages.

How is surgery included in the Strategic Health Plans of the Pacific, Papua New Guinea and Timor-Leste?

BACKGROUND: Papua New Guinea, Pacific Island nations, and Timor-Leste represent a range of island nations with populations ranging from a few thousand to 8 million. They perform on average about 25% of the Lancet Commission of Global Surgery's target 5000 per 100 000 population and their health workforce have significant deficits of trained surgeons and anaesthetists. This study was conducted to determine how the current national health plans of these nations have included surgery and anaesthesia. METHODS: The most recent (as of December 2018) published national health plans of 10 Pacific Island nations (Cook Islands, Fiji, Nauru, Federated States of Micronesia, Kiribati, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu), Papua New Guinea and Timor-Leste were reviewed for content and process, searching for key words and identifying themes related to surgery and anaesthesia. RESULTS: There were 12 national health plans with a combined total of 478 pages. There was limited surgical and/or anaesthesia input within the planning process. Injuries, blindness, cancer and non-communicable diseases were included themes, but the potential role of surgical care in addressing these conditions was not well documented. The need for better information and registries was noted by several nations but possible surgical care delivery or outcome metrics were not included. CONCLUSION: There is limited mention of surgical and anaesthesia care planning within current health plans in the Pacific, PNG and TL. There is a need for greater surgical and anaesthesia engagement in future plans with performance measured against World Health Organization core surgical indicators.

Molecular signatures of long-distance oceanic dispersal and the colonization of Pacific islands in Lycium carolinianum.

PREMISE: Long-distance dispersal has been important in explaining the present distributions of many plant species. Despite being infrequent, such dispersal events have considerable evolutionary consequences, because bottlenecks during colonization can result in reduced genetic diversity. We examined the phylogeographic history of Lycium carolinianum, a widespread taxon that ranges from southeastern North America to several Pacific islands, with intraspecific diversity in sexual and mating systems. METHODS: We used Bayesian, likelihood, and coalescent approaches with nuclear and plastid sequence data and genome-wide single nucleotide polymorphisms to reconstruct the dispersal history of this species. We also compared patterns of genetic variation in mainland and island populations using single nucleotide polymorphisms and allelic diversity at the S-RNase mating system gene. RESULTS: Lycium carolinianum is monophyletic and dispersed once from the North American mainland, colonizing the Pacific islands ca. 40,100 years ago. This dispersal was accompanied by a loss of genetic diversity in SNPs and the S-RNase locus due to a colonization bottleneck and the loss of self-incompatibility. Additionally, we documented at least two independent transitions to gynodioecy: once following the colonization of the Hawaiian Islands and loss of self-incompatibility, and a second time associated with polyploidy in the Yucatán region of Mexico. CONCLUSIONS: Long-distance dispersal via fleshy, bird dispersed fruits best explains the unusually widespread distribution of L. carolinianum. The collapse of diversity at the S-RNase locus in island populations suggests that self-fertilization may have facilitated the subsequent colonization of Pacific islands following a single dispersal from mainland North America.

A prediction model for childhood obesity in New Zealand.

Several early childhood obesity prediction models have been developed, but none for New Zealand's diverse population. We aimed to develop and validate a model for predicting obesity in 4-5-year-old New Zealand children, using parental and infant data from the Growing Up in New Zealand (GUiNZ) cohort. Obesity was defined as body mass index (BMI) for age and sex ≥ 95th percentile. Data on GUiNZ children were used for derivation (n = 1731) and internal validation (n = 713). External validation was performed using data from the Prevention of Overweight in Infancy Study (POI, n = 383) and Pacific Islands Families Study (PIF, n = 135) cohorts. The final model included: birth weight, maternal smoking during pregnancy, maternal pre-pregnancy BMI, paternal BMI, and infant weight gain. Discrimination accuracy was adequate [AUROC = 0.74 (0.71-0.77)], remained so when validated internally [AUROC = 0.73 (0.68-0.78)] and externally on PIF [AUROC = 0.74 [0.66-0.82)] and POI [AUROC = 0.80 (0.71-0.90)]. Positive predictive values were variable but low across the risk threshold range (GUiNZ derivation 19-54%; GUiNZ validation 19-48%; and POI 8-24%), although more consistent in the PIF cohort (52-61%), all indicating high rates of false positives. Although this early childhood obesity prediction model could inform early obesity prevention, high rates of false positives might create unwarranted anxiety for families.

Assessing the links between human rights and global tobacco control through statements made on global fora.

BACKGROUND: Increasingly, international health bodies frame public health measures, including tobacco control, in the context of human rights (HR). It is unclear how prevalent is the connection between human rights and tobacco control within global health governance. This paper describes the inclusion of HR in tobacco control governance, and the inclusion of tobacco control in HR treaty oversight. We depict the current reach of HR's normative influence in framing the tobacco epidemic in global, regional, and country-specific contexts. METHODS: We reviewed documents (agenda, reports) from 2010 to 2019 from the World Health Assembly (WHA); the WHO Western Pacific Regional Committee Meetings (RCM); the WHO Framework Convention on Tobacco Control (WHO FCTC) Conferences of the Parties (COP); and documents provided by Pacific Island Countries party to, or by committees overseeing, HR treaties. We purposively selected the Western Pacific Region, and Pacific Island Countries specifically, to represent countries of varying populations, capacities, and governance. RESULTS: Tobacco control and HR are infrequently mentioned together in the WHAs, and primarily in only one COP. Tobacco control is mentioned in 47 HR treaty committee documents for Pacific Island Countries, mostly under the Convention of the Rights of the Child recognizing or calling for ratification of the WHO FCTC. HR and tobacco control are connected in WHO Western Pacific RCM, particularly through their two most-recent action plans adopted by respective RCMs. DISCUSSION: Tobacco control as a HR concern is gaining traction within HR treaty bodies, at least with respect to children's health in the Western Pacific Region. CONCLUSION: Globally, HR is just emerging as an influence in global health governance for tobacco discussions. Within the Western Pacific Region however tobacco control is seen by some authorities as a HR issue. Similarly, to HR experts, tobacco control is becoming important to how Pacific Island Countries fulfill their treaty obligations, suggesting tobacco control advocates might explore these mechanisms to further influence the development of strong tobacco control measures to implement the WHO FCTC.

Outcomes from international field trials with Male Aedes Sound Traps: Frequency-dependent effectiveness in capturing target species in relation to bycatch abundance.

Aedes aegypti and Aedes albopictus vector dengue, chikungunya and Zika viruses. With both species expanding their global distributions at alarming rates, developing effective surveillance equipment is a continuing priority for public health researchers. Sound traps have been shown, in limited testing, to be highly species-specific when emitting a frequency corresponding to a female mosquito wingbeat. Determining male mosquito capture rates in sound traps based on lure frequencies in endemic settings is the next step for informed deployment of these surveillance tools. We field-evaluated Male Aedes Sound Traps (MASTs) set to either 450 Hz, 500 Hz, 550 Hz or 600 Hz for sampling Aedes aegypti and/or Aedes albopictus and compared catch rates to BG-Sentinel traps within Pacific (Madang, Papua New Guinea) and Latin American (Molas, Mexico and Orange Walk Town, Belize) locations. MASTs set to 450-550 Hz consistently caught male Ae. aegypti at rates comparable to BG-Sentinel traps in all locations. A peak in male Ae. albopictus captures in MASTs set at 550 Hz was observed, with the lowest mean abundance recorded in MASTs set to 450 Hz. While significantly higher abundances of male Culex were sampled in MASTs emitting lower relative frequencies in Molas, overall male Culex were captured in significantly lower abundances in the MASTs, relative to BG-Sentinel traps within all locations. Finally, significant differences in rates at which male Aedes and Culex were positively detected in trap-types per weekly collections were broadly consistent with trends in abundance data per trap-type. MASTs at 550 Hz effectively captured both male Ae. aegypti and Ae. albopictus while greatly reducing bycatch, especially male Culex, in locations where dengue transmission has occurred. This high species-specificity of the MAST not only reduces staff-time required to sort samples, but can also be exploited to develop an accurate smart-trap system-both outcomes potentially reducing public health program expenses.

Multiethnic genome-wide association study of differentiated thyroid cancer in the EPITHYR consortium.

Incidence of differentiated thyroid carcinoma (DTC) varies considerably between ethnic groups, with particularly high incidence rates in Pacific Islanders. DTC is one of the cancers with the highest familial risk suggesting a major role of genetic risk factors, but only few susceptibility loci were identified so far. In order to assess the contribution of known DTC susceptibility loci and to identify new ones, we conducted a multiethnic genome-wide association study (GWAS) in individuals of European ancestry and of Oceanian ancestry from Pacific Islands. Our study included 1554 cases/1973 controls of European ancestry and 301 cases/348 controls of Oceanian ancestry from seven population-based case-control studies participating to the EPITHYR consortium. All participants were genotyped using the OncoArray-500K Beadchip (Illumina). We confirmed the association with the known DTC susceptibility loci at 2q35, 8p12, 9q22.33 and 14q13.3 in the European ancestry population and suggested two novel signals at 1p31.3 and 16q23.2, which were associated with thyroid-stimulating hormone levels in previous GWAS. We additionally replicated an association with 5p15.33 reported previously in Chinese and European populations. Except at 1p31.3, all associations were in the same direction in the population of Oceanian ancestry. We also observed that the frequencies of risk alleles at 2q35, 5p15.33 and 16q23.2 were significantly higher in Oceanians than in Europeans. However, additional GWAS and epidemiological studies in Oceanian populations are needed to fully understand the highest incidence observed in these populations.