A cohort study comparing cardiovascular risk factors in rural Maori, urban Maori and non-Maori communities in New Zealand.

OBJECTIVES: To understand health disparities in cardiovascular disease (CVD) in the indigenous Maori of New Zealand, diagnosed and undiagnosed CVD risk factors were compared in rural Maori in an area remote from health services with urban Maori and non-Maori in a city well served with health services. DESIGN: Prospective cohort study. SETTING: Hauora Manawa is a cohort study of diagnosed and previously undiagnosed CVD, diabetes and risk factors, based on random selection from electoral rolls of the rural Wairoa District and Christchurch City, New Zealand. PARTICIPANTS: Screening clinics were attended by 252 rural Maori, 243 urban Maori and 256 urban non-Maori, aged 20-64 years. MAIN OUTCOME MEASURES: The study documented personal and family medical history, blood pressure, anthropometrics, fasting lipids, insulin, glucose, HbA1c and urate to identify risk factors in common and those that differ among the three communities. RESULTS: Mean age (SD) was 45.7 (11.5) versus 42.6 (11.2) versus 43.6 (11.5) years in rural Maori, urban Maori and non-Maori, respectively. Age-adjusted rates of diagnosed cardiac disease were not significantly different across the cohorts (7.5% vs 5.8% vs 2.8%, p=0.073). However, rural Maori had significantly higher levels of type-2 diabetes (10.7% vs 3.7% vs 2.4%, p<0.001), diagnosed hypertension (25.0% vs 14.9% vs 10.7%, p<0.001), treated dyslipidaemia (15.7% vs 7.1% vs 2.8%, p<0.001), current smoking (42.8% vs 30.5% vs 15.2%, p<0.001) and age-adjusted body mass index (30.7 (7.3) vs 29.1 (6.4) vs 26.1 (4.5) kg/m(2), p<0.001). Similarly high rates of previously undocumented elevated blood pressure (22.2% vs 23.5% vs 17.6%, p=0.235) and high cholesterol (42.1% vs 54.3% vs 42.2%, p=0.008) were observed across all cohorts. CONCLUSIONS: Supporting integrated rural healthcare to provide screening and management of CVD risk factors would reduce health disparities in this indigenous population.

Improving the recognition of depression in adolescence: can we teach the teachers?

This study evaluated the effectiveness of a schools-based psychoeducational intervention designed to help teachers recognize the symptoms of clinical depression in their adolescent pupils. Around 151 teachers in eight high schools in Scotland, UK were randomly assigned to experimental and control groups and all received training on depression. The ability of the experimental teachers to report which pupils were depressed was compared with the control group whose reporting task occurred before they had received training. The teachers were reporting on 2262 pupils who had been independently screened for clinical depression using a two-stage screening procedure with the Mood and Feelings Questionnaire (MFQ) and semi-structured clinical interview (K-SADS). Systematic evaluation showed that training teachers with this package did not improve their ability to recognize their depressed pupils. Recognizing depressive illness in adolescence is one of the main public health challenges for adolescent mental health services and this study adds to the growing literature on the difficulties in achieving this.

Epidemiology of pain in New Zealand.

Information on the prevalence of pain in the general population has relevance for the allocation of health services and for understanding of chronic pain. In 1986 a sample of 1498 adults were interviewed using the Diagnostic Interview Schedule. Questions on pain were taken from the somatisation section of the interview schedule. These responses were used to determine the lifetime prevalence of pain in the urban population of New Zealand. The majority of subjects reported more than one life disrupting experience of pain. Pain was most common in the joints, back, head and abdomen. Women reported more pain than men. In general the prevalence of pain increased with age, however this was not true for headaches and abdominal pain. Most subjects related their pain symptoms to a physical cause.