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.

Genomic insights into the peopling of the Southwest Pacific.

The appearance of people associated with the Lapita culture in the South Pacific around 3,000 years ago marked the beginning of the last major human dispersal to unpopulated lands. However, the relationship of these pioneers to the long-established Papuan people of the New Guinea region is unclear. Here we present genome-wide ancient DNA data from three individuals from Vanuatu (about 3,100-2,700 years before present) and one from Tonga (about 2,700-2,300 years before present), and analyse them with data from 778 present-day East Asians and Oceanians. Today, indigenous people of the South Pacific harbour a mixture of ancestry from Papuans and a population of East Asian origin that no longer exists in unmixed form, but is a match to the ancient individuals. Most analyses have interpreted the minimum of twenty-five per cent Papuan ancestry in the region today as evidence that the first humans to reach Remote Oceania, including Polynesia, were derived from population mixtures near New Guinea, before their further expansion into Remote Oceania. However, our finding that the ancient individuals had little to no Papuan ancestry implies that later human population movements spread Papuan ancestry through the South Pacific after the first peopling of the islands.

Water and nutrient intake in pregnant New Zealand women: association with wheeze in their infants at 18 months.

The association between water and nutrient intake in pregnant women, and wheeze in their 18 month old infants, was investigated in a prospective study. Volunteers (n=369) recruited from northern New Zealand were visited in months 4 and 7 of pregnancy. At each visit anthropometric measurements were taken, diet assessed by 24-hour recall and 3-day food records and questionnaires determining personal details administered. Eighteen months after birth, infants were measured, and questions on infant feeding and wheeze asked. Overall, mothers reported 32% of their infants had wheezed in the last 12 months. After adjusting for significant covariates and energy intake, higher maternal intakes of dietary water (p=0.009) and manganese (p=0.024) were associated with decreased wheeze, and glucose (p=0.003) with increased wheeze. Prevalence of infant wheeze decreased 18.5% from the lower to the upper quartile of water intake, and 17.4% from the lower to the upper quartile of manganese intake. Wheeze was more common in Polynesian than European infants (41.8% vs 28.9%). Polynesian mothers consumed significantly less dietary water (median 451 g less) and manganese (median 1374 µg less) than European mothers per day. Glucose was only significant because of strong association with infant wheeze at extremely high maternal intakes of >40 g/day in ~10% of the subjects. There was no association between maternal dietary supplement intake and wheeze. Mothers estimated at high risk of infant wheeze consumed less tap water, whole grains, tea, fruit; and more fruit juice, soft drink, processed meat and fish products, and refined grain products. This is the first study to report an intergenerational association between maternal water, and glucose intake with infant wheeze.

A novel ryanodine receptor mutation and genotype-phenotype correlation in a large malignant hyperthermia New Zealand Maori pedigree.

Malignant hyperthermia (MH) is a pharmacogenetic disorder that predisposes to a sometimes fatal hypermetabolic reaction to halogenated anaesthetics. MH is considered to originate from abnormal regulation of skeletal muscle Ca(2+) release. Current diagnosis of MH susceptibility (MHS) relies on in vitro contracture testing (IVCT) of skeletal muscle. The ryanodine receptor (RYR1) encoding the major Ca(2+) release channel in the skeletal muscle sarcoplasmic reticulum has been shown to be mutated in a number of MH pedigrees. The large Maori pedigree reported here is the largest MHS pedigree investigated to date and comprises five probands who experienced clinical episodes of MH and 130 members diagnosed by the IVCT. Sequencing of the 15 117 bp RYR1 cDNA in a MHS individual from this pedigree identified a novel C14477T transition that results in a Thr4826 to Ile substitution in the C-terminal region/transmembrane loop of the skeletal muscle ryanodine receptor. This is the first mutation in the RyR1 C-terminal region associated solely with MHS. Although linkage analysis showed strong linkage (max LOD, 11.103 at theta = 0.133) between the mutation and MHS in the pedigree using the standardized European IVCT phenotyping protocol, 22 MHS recombinants were observed. The relationship between the IVCT response and genotype was explored and showed that as IVCT diagnostic cut-off points were made increasingly stringent, the number of MHS discordants decreased with complete concordance between the presence or absence of the C14477T mutation and MHS and MH normal phenotypes, respectively, using a cut-off of 1.2 g tension at 2.0 mM caffeine and 1.8 g tension at 2.0% halothane. Many MHS pedigrees investigated have been excluded from linkage to the RYR1 gene on the basis of a small number of recombinants; however, the linkage analysis reported here suggests that other recombinant families excluded from linkage to the RYR1 gene may actually demonstrate linkage as the number of members tested within the pedigrees increases. The high number of discordants observed using the standardized diagnostic cut-off points is likely to reflect the presence of a second MHS susceptibility locus in the pedigree.

Risk factors for asthma symptoms in Kawerau children.

AIMS: To study risk factors for asthma prevalence in Kawerau children aged 8-13 years. METHODS: Questionnaires on asthma symptoms and risk factors were completed in 1992 by parents of 708 Kawerau schoolchildren aged 8-13 years, a response rate of 82.0%; for a subgroup of children, stored serum samples from a 1984 survey were also analysed. RESULTS: The overall prevalence of current wheeze (21.3%) was similar to that observed in other New Zealand surveys. The prevalence of current wheeze was elevated in males (odds ratio (OR) = 1.7, 95% CI 1.2-2.5), in those who had been passively exposed to cigarette smoke from the primary caregiver (OR = 1.4, 95% CI 1.0-2.1), in those who had had pets in the home at age 0-5 years (OR = 1.9, 95% CI 1.2-2.9) and in those with one or more birth parents with asthma (OR = 2.1, 95% CI 1.4-3.1); current wheeze was less common in those with older children living in the same household (for 2 or more older children in the same household, OR = 0.5, 95% CI 0.2-1.0). In a small nested case-control study it was found that current wheeze was more common in those with high levels of IgE (OR = 6.4, 95% CI 1.3-36.4) or low levels of selenium (OR = 3.1, 95% CI 0.9-11.8) in stored serum collected 8 years previously. There was no difference in the proportions with current wheeze, or with diagnosed asthma between Maori and European children, but Maori children were more likely to have current frequent nocturnal wheeze (OR = 2.2, 95% CI 1.0-5.1), current severe wheeze (OR = 1.8, 95% CI 0.8-3.7) or to have been admitted to hospital with asthma (OR = 2.4, 95% CI 1.2-4.8). Passive exposure to tobacco smoke was more common among Maori children, but this only partially accounted for the greater asthma severity in Maori children, and the lower prescribing of prophylactic medications in this group may also have contributed. CONCLUSIONS: Multiple factors were associated with asthma symptoms in children in this age-group, including a family history of asthma, male gender, environmental tobacco smoke, environmental allergen exposure, atopy, and low selenium status. Further studies are required to assess the relative contributions of these factors to the prevalence of asthma in New Zealand.

Culture, theory, and the practice of occupational therapy in New Zealand/Aotearoa.

In the context of contemporary New Zealand, this paper discusses the need for occupational therapy to substantiate its claims of being a holistic profession with particular reference to the Maori, the indigenous people of New Zealand (referred to by the Maori as Aotearoa). In this era of accountability and consumer choice, occupational therapists need to more effectively meet the cultural needs of their clients through an understanding of both the material and nonmaterial aspects of their cultures. However, for New Zealand occupational therapists, cultural sensitivity is not enough to contribute to changing the diminished life chances of the Maori. It is proposed in this paper that the Model of Human Occupation (Kielhofner, 1985; Kielhofner & Burke, 1980), when combined with the work of radical community educators such as Freire (1972), could provide the sociopolitical dimension to New Zealand practice. The Model of Human Occupation is examined in light of current occupational therapy practice in New Zealand. It is argued that this model, when accompanied by a broader understanding of the sociopolitical processes informing monoculturalism, could be seen as a suitable framework for understanding cultural differences in New Zealand and could assist in the move toward providing culturally appropriate occupational therapy for indigenous peoples such as the Maori.

Nutrition in pregnancy in the Wellington region.

The diets of 115 pregnant women in the Wellington region were assessed for nutrient intake using 24 h dietary recall. Assessment was performed in both the second and third trimester. Women came from three ethnic groups, European (61), Maori (29) and Pacific Islanders (25). Comparisons of nutrient intake were made between these groups. The overall energy intake was similar between the groups (range 4.8-19.7 MJ/d) but Maori (p less than 0.05) and Pacific Islanders (p less than 0.02) had a significant decrease in energy intake from second to third trimester. Pacific Islanders consumed significantly more starch (121 g/d, p less than 0.05) whereas Maori women consumed significantly more sucrose (86 g/d, p = 0.0002). The mean intake in Pacific Islanders contained significantly less calcium (882 mg/d, p = 0.0002) and zinc (9.0 mg/d, p = 0.014). Forty-four percent Europeans, 28% Maori and 51% Pacific Islanders had an estimated iron intake below the minimum safe intake for pregnancy. However dietary iron intake did not relate to the presence of anaemia nor whether iron supplements were given.

Maoris take up the fight against ill health.

The beginnings of grass-roots primary care are taking shape in New Zealand's Maori community. By referring to a scheme initiated in the Waikato area, the authors explain the difficulties encountered by this ethnic minority in striving towards self-help in matters of health.

PIP: This paper discusses the establishment of a Maori health center in Waikato, New Zealand. The center was staffed by 3 health care female workers, and registered nurses, and emphasized disease prevention, nutrition, and family planning services. In addition, an antenatal component having midwives and obstetric nurses was later added to the center. This center was set up at a time of political and social revitalization in the "Nga Ringa Aroba" tribe. Among the responsibilities of the health center was to reach out to the community and provide preventive and educational services. Clearly, the efforts of these health workers influenced peoples' awareness of health related disorders and good health habits. Also this program proved that health improvement through personal commitment was feasible. However, this establishment faced strong resistance from the existing government agencies; the staff from Maori health center were denied diagnostic tools and their responsibilities were reduced to referral services only. Consequently, the Maori community has received mixed messages from the government bodies in New Zealand as to what is expected of them. With regards to the community as a whole, there is mounting evidence of dissatisfaction with the health services and in turn people are increasingly relying on potentially dangerous alternatives, such as traditional healers.

Dental caries prevalence in early Polynesians from the Hawaiian Islands.

We examined the skeletal remains of 1338 early Hawaiians (preserved in the Bishop Museum, Honolulu) to determine total caries and root surface caries prevalence. Specimens from seven islands were represented in the collection. Estimation of age at death was made by a combination of dental developmental staging for younger individuals and occlusal attrition and/or alveolar bone loss in adults. Museum records were also consulted for age estimation of adults which was primarily based on osteological criteria. The material was divided into six age groups. Predentate infants and edentulous adults were not included. A total of 19,425 teeth was examined. Caries lesions were observed in 462 individuals (34.5%) and 1895 teeth (9.8%). Coronal caries lesions in children and adolescents tended to be small and not particularly destructive of tooth structure. Root surface lesions in young adults were also small but increased progressively in size in the older groups, resulting in pulp exposure and coronal amputation. Although coronal caries was apparently not a significant dental health problem in children and young adults (compared with contemporary Hawaiians), root surface caries was an increasingly important source of tooth morbidity and tooth mortality in the older population groups. This age-related caries pattern was similar for all of the islands.

Influence of alpha thalassaemia on haematological parameters in Polynesian patients.

DNA mapping of the alpha globin gene cluster in cord blood from Polynesians has shown an increased frequency of alpha thalassaemia and triplicated alpha genes. Reduced levels of haemoglobin, mean corpuscular haemoglobin or mean corpuscular volume in these neonates may indicate alpha thalassaemia. Recognition of this will avoid unnecessary haematological investigations and iron supplementation.