Health policy versus kava (Piper methysticum): Anxiolytic efficacy may be instrumental in restoring the reputation of a major South Pacific crop.

ETHNOPHARMACOLOGICAL RELEVANCE: Kava (Piper methysticum G. Forst. f.) is by far the most important plant used in the islands of Melanesia, Polynesia and Micronesia for its relaxing effects. Kava drinking is a pillar of South Pacific societies and is also the foundation of their economies. Preparations of kava extract as herbal medicinal drugs were banned in Germany in 2002 and again in 2019, with dramatic consequences for the South Pacific economies. In 2002, the major regulatory argument for the ban of kava was safety issues. In 2019, the assessment report of the European Medicines Agency's Herbal Medicinal Product Committee (HMPC) justified a negative benefit-to-risk ratio by a supposed lack of efficacy of ethanolic extracts for an indication of which kava extract preparations never had an approval. In this HMPC report the efficacy in the approved indications 'nervous anxiety, tension and restlessness' was attributed to the extract branded as 'WS 1490', which was assumed to have been prepared with acetone as an extraction solvent. In addition to this change of indication and the attribution of efficacy to acetone kava extract alone, the German health authorities and the HMPC still refuse to discuss quality issues as a likely factor impacting drug safety. The first case reports of liver toxicity were observed with an acetone extract in a timely relationship with the introduction of 'two-day kava' instead of 'noble kava' as used in ethanolic kava extracts. AIM OF THE STUDY: The correlation between clinical benefits and the type of extract preparation was examined. METHODS: In order to identify the types of kava material and extracts used in clinical trials, the respective publications were compared with regulatory databases and protocols of a German regulatory advisory board. RESULTS AND CONCLUSIONS: The comparison reveals inconsistencies in the regulatory decisions. In all studies with WS 1490, the evidence points to the use of an ethanolic extract. The efficacy of kava extract for the approved indication was clearly demonstrated. The HMPC report and the recent renewed German regulatory ban of kava therefore require major revision, which should include the impact of the use of "two-day kava" on drug safety. Such a revision could contribute to restoring the reputation of "noble kava" on the international markets.

Variation in the use of medicines by ethnicity during 2006/07 in New Zealand: a preliminary analysis.

AIM: To describe variations in dispensing of specific medication groups by ethnicity in New Zealand, adjusting for health need. METHOD: Preliminary linkage of dispensings of prescription medicines in 2006/07 to age/disease burden proxies of health need for Maori, Pacific peoples (Pasifika)--who are mostly of Samoan, Tongan, Niuean, or Cook Islands descent--in New Zealand, and non-Maori/non-Pasifika. These disease burden proxies combine differences in prevalence, age, morbidity, and mortality. Variations were disaggregated by patients being first dispensed medicines ('access') versus subsequent dispensings ('persistence'). RESULTS: Initially, overall age-adjusted incidence of 'scripts' (prescriptions dispensed) to Maori was similar to that of non-Maori. There were differences in therapeutic coverage between Maori and Pasifika, for example greater use of asthma medicines in Maori. However, further adjustments linking with disease burden showed marked variance for a number of diseases. Differences in dispensing included areas of high health need such as heart disease, infections, diabetes, mental health and respiratory disease. Maori had 19-37% lower dispensings overall than non-Maori, with a net difference of nearly 1 million scripts. Maori were both less likely to access medicines, and then after first dispensing had fewer subsequent scripts. Patterns for Pasifika appeared similar, although needs-adjusted analysis is awaited for this population. CONCLUSIONS: Once adjusting for need, there was variable but sizeable differences in medicines dispensed to Maori compared with non-Maori, and likely differences for Pasifika populations. There are however important limitations to this preliminary analysis. Crude and age-standardised metrics may be poor predictors of needs-adjusted gaps in medicines use. In this analysis, solely age-standardised rates tended to underestimate differences once adjusting for burden of disease; future analyses of prescribing patterns should consider better adjusting for disease burden.

Doing what's important: valued activities for older New Zealand Maori and non-Maori.

AIM: This project explored the usability of the World Health Organisation, International Classification of Functioning, Disability and Health (ICF) for describing older Maori and non-Maori people's self-nominated important activities. METHOD: Within a feasibility-for-cohort study, 112 participants, 33 Maori, aged 75-79 years, and 79 non-Maori, aged 85 years, nominated their three most important activities. Verbatim responses were coded using the ICF classifications and described using non-parametric statistics. RESULTS: Men and women mostly named domestic life, interpersonal relationships and recreation and leisure activities. While Maori frequently named extended family relationship activities as being most important, non-Maori named more recreation and leisure activities. CONCLUSIONS: The ICF is useful for classifying older New Zealanders' important activities, although some activities of older Maori were not specified in the original version used. While important activity patterns were similar for men and women, those related to ancestral connectivity and community collectivity were most important for Maori.

Queer kinship practices in non-western contexts: French Polynesia's gender-variant parents and the law of La République.

French Polynesia is an overseas collectivity of France whose kinship practices accommodate transgender parenting through the involvement of gender-variant (mahu) people in childrearing, including as adoptive parents in customary (faamu) adoption. While the existence and visibility of gender-variant people in French Polynesia is well documented, there is no literature on their involvement in parenting, reflecting a more general dearth of research on LGBT parenting in non-Western contexts. Drawing on the author's fieldwork in French Polynesia, this article fills this gap. The article also discusses the negative implications of France's ambivalence towards LGBT parenting for French Polynesian gender-variant parents and the children they raise.

Tuakana-Teina relationship and leadership in ancient Mangaia and Aotearoa.

The relationship between tuakana and teina (the older and younger sibling or cousin of same sex) is the tumu (foundation, origin, cause) of rank in eastern Polynesia. By examining historical documents from selected island societies, namely, Mangaia and Aotearoa, we can understand the dynamics of this relationship as part of their world-view. Normally tuakana and teina had close, cooperative, mutually respectful and loyal relationships; the teina supporting their elder. Sometimes, however, the moral balance between them was affected either by one of them acting inappropriately towards the other, or by hostile acts from others. To remedy these threats to social cohesion, various strategies were adopted, including peace-making, flight or spatial separation, or fighting. Stories about this relationship continue to serve as the tumu for today's younger generations.

Association of maternal and intrauterine characteristics with age at menarche in a multiethnic population in Hawaii.

This study seeks to further elucidate the mother-daughter hormonal relationship and its effects on daughter's breast cancer risk through the association with early age at menarche. Four hundred and thirty-eight healthy girls, age 9-18 and of White, Asian, and/or Polynesian race/ethnicity, were recruited from an HMO on Oahu, Hawaii. Anthropometric measures were taken at a clinic visit, and family background questionnaires were completed. Cox proportional hazards regression was used to test the association of maternal and intrauterine hormone-related exposures with age at menarche. Weight and gestational age at birth and maternal pregnancy-induced nausea were not associated with age at menarche. Each year older of the mother's age at menarche was associated with a 21% reduced risk of an early age at menarche for the daughter (95% CI: 0.73-0.86). This association between mother's and daughter's menarcheal age was statistically significant for girls of Asian, White, and Mixed, Asian/White race/ethnicity, but not for girls of Mixed, part-Polynesian race/ethnicity (p (interaction) = 0.01). There was a suggestion that maternal history of breast cancer was associated with an increased risk of early age at menarche (HR = 2.18, 95% CI: 0.95-4.98); there was no association with second-degree family history. These findings support the hypothesis that maternal and intrauterine hormone-related exposures are associated with age at menarche.

Polynesia and polygenism: the scientific use of travel literature in the early 19th century.

Christoph Meiners (1747-1810) was one of 18th-century Europe's most important readers of global travel literature, and he has been credited as a founder of the disciplines of ethnology and anthropology. This article examines a part of his final work, "Untersuchungen über die Verschiedenheiten der Menschennaturen" [Inquiries on the differences of human natures], published posthumously in the 1810s. Here Meiners developed an elaborate argument, based on empirical evidence, that the different races of men emerged indigenously at different times and in different places in natural history. Specifically this article shows how a sedentary scholar who never left Europe constructed a narrative of human origins and migrations on the basis of (1) French theory from the 1750s (Charles de Brosses and Simon Pelloutier) and (2) data gathered by explorers as reported in travel literature (J.R. Forster, Pérouse, Cook, Marsden).

Does mortality vary between pacific groups in New Zealand? Estimating Samoan, Cook Island Maori, Tongan, and Niuean mortality rates using hierarchical Bayesian modelling.

BACKGROUND Pacific mortality rates are traditionally presented for all Pacific people combined, yet there is likely heterogeneity between separate Pacific ethnic groups. We aimed to determine mortality rates for Samoan, Cook Island Maori, Tongan, and Niuean ethnic groups (living in New Zealand). METHODS We used New Zealand Census-Mortality Study (NZCMS) data for 2001-04, for 380,000 person years of follow-up of 0-74 year olds in the 2001-04 cohort for which there was complete data on sex, age, ethnicity (total counts), natality, and household income. Given sparse data, we used hierarchical Bayesian (HB) regression modelling, with: a prior covariate structure specified for sex, age, natality (New Zealand/Overseas born), and household income; and smoothing of rates using shrinkage. The posterior mortality rate estimates were then directly standardised.RESULTS Standardising for sex, age, income, and natality, all-cause mortality rate ratios compared to Samoan were: 1.21 (95% credibility interval 1.05 to 1.42) for Cook Island Maori; 0.93 (0.77 to 1.10) for Tongan; and 1.07 (0.88 to 1.29) for Niuean. Cardiovascular disease (CVD) mortality rate ratios showed greater heterogeneity: 1.66 (1.26 to 2.13) for Cook Island Maori; 1.11 (0.72 to 1.58) for Niuean; and 0.86 (0.58 to 1.20) for Tongan. Results were little different standardising for just sex and age. We conducted a range of sensitivity analyses about a plausible range of (differential) return migration by Pacific people when terminally ill, and a plausible range of census undercounting of Pacific people. Our findings, in particular the elevated CVD mortality among Cook Island Maori, appeared robust. CONCLUSIONS To our knowledge, this project is the first time in New Zealand that clear (and marked in the case of CVD) differences in mortality have been demonstrated between different Pacific ethnic groups. Future health research and policy should, wherever possible and practicable, evaluate and incorporate heterogeneity of health status among Pacific people.

Low prevalence of retinopathy, but high prevalence of nephropathy among Maori with newly diagnosed diabetes-Te Wai o Rona: Diabetes Prevention Strategy.

AIMS/HYPOTHESIS: To describe the prevalence of retinopathy and microalbuminuria at diagnosis of diabetes in a predominantly Maori study population. METHODS: Biomedical assessment including photographic retinal examination was undertaken among 157 (68.9% of eligible) members of Maori families (3.3% non-Maori) diagnosed with diabetes during a community screening programme (n=5240) as part of a diabetes prevention strategy. RESULTS: Mean HbA1c of those with newly diagnosed diabetes was 7.8+/-1.5% with 34.4% having an HbA1c >/=8.0%. Retinopathy was present in 3 (1.7%) subjects, cataracts in 3.2%, microalbuminuria in 29.6% and albuminuria in 7.7%. After adjusting for covariates, only smoking was a risk factor for microalbuminuria/proteinuria (current and former smokers: increased 3.81(1.32-11.0) and 3.67(1.30-10.4) fold, respectively). CONCLUSIONS: The prevalence of retinopathy at diagnosis was lower than in previous studies, yet that of microalbuminuria/proteinuria remained high. The retinopathy data suggest that case detection for diabetes in the community may be improving, but that other strategies among those at risk of diabetes, including those promoting smoking cessation, will be needed to reduce the risk of renal disease among Maori with diabetes.

Maori and non-Maori differences in caesarean section rates: a national review.

AIM: To investigate the relationship between caesarean section (CS), deprivation, and ethnicity; and to examine Maori/non-Maori differences in CS after controlling for possible confounding factors. METHOD: Total, acute, and elective CS rates (as proportions of women giving birth in New Zealand hospitals) during 1997-2001 were examined by ethnicity and area deprivation. Logistic regression was used to adjust for age, deprivation, some clinical factors, and District Health Board (DHB). RESULTS: Total, acute, and elective CS rates were significantly higher among non-Maori compared to Maori women (total CS, 21% vs 13%, ratio 1.59, p<0.0001). CS rates decreased with increasing levels of deprivation. After controlling for deprivation and age, differences between Maori (M) and non-Maori (nM) remained (total CS odds ratio nM:M 1.43, 95% confidence interval 1.39-1.48; elective OR 1.44 (1.36-1.52); acute OR 1.38 (1.33-1.43)). Differences also remained after controlling for other factors including a limited number of clinical factors. CONCLUSION: Results suggest that non-clinical factors may be contributing to ethnic differences in CS in New Zealand. While deprivation contributes to this difference it does not fully explain it. Further research is needed to investigate whether ethnic differences in CS impact on birth outcomes, and which factors, other than those clinically indicated, contribute to ethnic differences in caesarean section in New Zealand.

Assessing Maori/non-Maori differences in cardiovascular disease risk and risk management in routine primary care practice using web-based clinical decision support: (PREDICT CVD-2).

AIM: To describe the cardiovascular disease risk factor status and risk management of Maori compared with non-Maori patients opportunistically assessed in routine practice using PREDICT-CVD, an electronic clinical decision support programme. METHODS: In August 2002, a primary healthcare organisation, ProCare, implemented PREDICT-CVD as an opportunistic cardiovascular risk assessment and management programme. Between 2002 and February 2006, over 20,000 cardiovascular risk assessments were undertaken on Maori and non-Maori patients. Odds ratios and mean differences in cardiovascular risk factors and risk management for Maori compared to non-Maori (European and other, Pacific, Indian, and other Asian) patients were calculated. RESULTS: Baseline risk assessments were completed for 1450 (7%) Maori patients and 19, 164 (93%) non-Maori patients. On average, Maori were risk assessed 3 years younger than non-Maori. Maori patients were three times more likely to be smokers, had higher blood pressure and TC/HDL levels, and twice the prevalence of diabetes and history of cardiovascular disease as non-Maori. Among patients with a personal history of cardiovascular disease, Maori were more likely than non-Maori to receive anticoagulants, blood pressure-lowering and lipid-lowering medications. However, of those patients with a history of ischaemic heart disease, Maori were only half as likely as non-Maori to have had a revascularisation procedure. CONCLUSION: An electronic decision support programme can be used to systematically generate cardiovascular disease risk burden and risk management data for Maori and non-Maori populations in routine clinical practice in real-time. Moreover, the PREDICT-CVD programme has established one of the largest cohorts of Maori and non-Maori ever assembled in New Zealand. Initial findings suggest that Maori are more likely than non-Maori to receive drug-based cardiovascular risk management if they have a personal history of cardiovascular disease. In contrast, among the subgroup of patients with a history of ischaemic heart disease, Maori appear to receive significantly fewer revascularisations than non-Maori.

Experiences of Maori families accessing health care for their unwell children: a pilot study.

The aim of this study was to explore with a small number of Maori families their experiences of accessing health care when their children were unwell with a respiratory condition. Although there is a wide variety of literature exploring Maori and their ability to access health care, there is a very limited amount that describes the experience of individual Maori families in accessing health care for their children. A qualitative research methodology was used in the study. Participating families were among those experiencing an admission to a children's ward between July and December 2003. Four families were interviewed. They discussed in depth their experience of accessing health care for their unwell children. Data were analysed using thematic analysis, and three common themes were evident: family resources, choice of health service provider and parents' feelings of vulnerability. The findings highlight that while socio-economic status plays a large part in determining the ease with which families can access the needed health care, there are other barriers within the health system which also pose difficulties for Maori.

The femoral head: sex assessment of prehistoric New Zealand Polynesian skeletal remains.

Prehistoric Polynesian skeletal remains are frequently being recovered in New Zealand due to the increasing pace of urbanisation. Since such material must often be reinterred quickly, it is important that the sex of individuals be determined from the remains in a relatively short time. For this purpose, discriminant function analysis was utilised for sex determination of prehistoric adult New Zealand Polynesian femora (47 male and 44 female). Three measurements of the femoral head were taken and subjected to Statistical Package for the Social Sciences (SPSS) discriminant function analysis. For the discriminant functions derived, accuracy of sex determination ranged from 80.9% to 82.4%. Reduction in error over random assignment by sex ranged from 62% to 65%.

The articular surfaces of the hindfoot: sex assessment of prehistoric New Zealand Polynesian skeletal remains.

Prehistoric Polynesian skeletal remains are frequently being recovered in New Zealand due to the increasing pace of urbanisation. Since such material must often be reinterred quickly, it is important that the sex of individuals be determined from the remains in a relatively short time. For this purpose, discriminant function analysis was utilised for sex determination of prehistoric adult New Zealand Polynesian tali (24 male and 27 females) and calcanei (26 males and 22 females). Two measurements of the trochlear articular surface of the talus and two measurements of the posterior talar articular surface of the calcaneus were taken and subjected to Statistical Package for the Social Sciences (SPSS) discriminant function analysis. For the single discriminant function derived, accuracy in sex determination was 92.3% and reduction in error over random assignment by sex was 85%.