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1.
Cien Saude Colet ; 26(4): 1419-1428, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33886770

RESUMEN

The present study was an effort to assess the mitigation interventions carried out, so far, by the nations to fight the pandemic COVID-19. The novelty of the study was that it had considered the issue of pandemic mitigation strategy as a decision making problem. The performances of the twenty nations were to be ranked. The problem considered in the study was essentially a Multi-Criteria Decision Analysis (MCDA) problem. The available alternatives were the 20 countries and the 8 traits were the criteria. The Technique of Order Preference Similarity to the Ideal Solution (TOPSIS) was used in the present study. The study used Entropy method for assignment of weights to all the criteria. The performance score obtained in respect of the countries considered in the study and the corresponding ranks indicated the relative performances of the countries in their efforts to mitigate the COVID-19 pandemic. The results show that New Zealand is the best performing country and India is the worst one. Brazil ranked 17th, while the rank of UK was 15. The performance of the USA stood at 18th position.


Asunto(s)
/prevención & control , Pandemias , Brasil/epidemiología , Técnicas de Apoyo para la Decisión , Entropía , Humanos , India/epidemiología , Nueva Zelanda/epidemiología , Pandemias/prevención & control , Reino Unido/epidemiología , Estados Unidos/epidemiología
2.
Artículo en Inglés | MEDLINE | ID: mdl-33800387

RESUMEN

This study aimed to investigate type of loco-regional treatment received, associated treatment factors and mortality outcomes in New Zealand women with early-stage breast cancer who were eligible for breast conserving surgery (BCS). This is a retrospective analysis of prospectively collected data from the Auckland and Waikato Breast Cancer Registers and involves 6972 women who were diagnosed with early-stage primary breast cancer (I-IIIa) between 1 January 2000 and 31 July 2015, were eligible for BCS and had received one of four loco-regional treatments: breast conserving surgery (BCS), BCS followed by radiotherapy (BCS + RT), mastectomy (MTX) or MTX followed by radiotherapy (MTX + RT), as their primary cancer treatment. About 66.1% of women received BCS + RT, 8.4% received BCS only, 21.6% received MTX alone and 3.9% received MTX + RT. Logistic regression analysis was used to identify demographic and clinical factors associated with the receipt of the BCS + RT (standard treatment). Differences in the uptake of BCS + RT were present across patient demographic and clinical factors. BCS + RT was less likely amongst patients who were older (75+ years old), were of Asian ethnicity, resided in impoverished areas or areas within the Auckland region and were treated in a public healthcare facility. Additionally, BCS + RT was less likely among patients diagnosed symptomatically, diagnosed during 2000-2004, had an unknown tumour grade, negative/unknown oestrogen and progesterone receptor status or tumour sizes ≥ 20 mm, ≤50 mm and had nodal involvement. Competing risk regression analysis was undertaken to estimate the breast cancer-specific mortality associated with each of the four loco-regional treatments received. Over a median follow-up of 8.8 years, women who received MTX alone had a higher risk of breast cancer-specific mortality (adjusted hazard ratio: 1.38, 95% confidence interval (CI): 1.05-1.82) compared to women who received BCS + RT. MTX + RT and BCS alone did not have any statistically different risk of mortality when compared to BCS + RT. Further inquiry is needed as to any advantages BCS + RT may have over MTX alternatives.


Asunto(s)
Neoplasias de la Mama , Mastectomía Segmentaria , Anciano , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Terapia Combinada , Femenino , Humanos , Mastectomía , Estadificación de Neoplasias , Nueva Zelanda/epidemiología , Radioterapia Ayuvante , Estudios Retrospectivos
3.
Artículo en Inglés | MEDLINE | ID: mdl-33922464

RESUMEN

Physical activity (PA) is an important part of lifestyle management for adolescents with Type 1 diabetes (T1D). Opportunities for PA were reduced by COVID-19 restrictions. Therefore, the purpose of this cross-sectional study was to compare PA among adolescents with and without T1D during the first New Zealand (NZ) COVID-19 lockdown. PA levels of adolescents aged 11-18 years with T1D (n = 33) and healthy controls (n = 34) were assessed through self-reported and parent proxy-reported questionnaires. Overall, PA levels during lockdown were below recommended levels. PA levels did not differ between T1D and control participants (p = 0.212) nor between genders (p = 0.149). Younger adolescents tended to be more active than older adolescents (p = 0.079). PA level was negatively associated with BMI z-score (r = -0.29, p = 0.026) but was not associated with socioeconomic status (SES) or T1D-related parameters. In the T1D group, higher HbA1c was associated with lower school decile (r = -0.58, p < 0.001) and higher BMI z-score (r = 0.68, p < 0.001). Overall, young people were insufficiently active during lockdown, and some sub-groups were more affected than others by the restrictions. Pandemics are likely to be part of our future, and further studies are needed to understand their impact on the health and wellbeing of adolescents.


Asunto(s)
Diabetes Mellitus Tipo 1 , Adolescente , Niño , Control de Enfermedades Transmisibles , Estudios Transversales , Diabetes Mellitus Tipo 1/epidemiología , Ejercicio Físico , Femenino , Humanos , Masculino , Nueva Zelanda/epidemiología , Pandemias
5.
N Z Med J ; 134(1530): 12-20, 2021 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-33651773

RESUMEN

AIM: Burnout has a damaging effect on both the wellbeing of medical professionals and patients alike. Empathy is an important part of the therapeutic relationship and could be damaged by burnout. We aimed to describe the prevalence of burnout, assess levels of empathy and explore the relationship between burnout and empathy among senior medical officers (SMOs). We hypothesised that there would be a negative correlation between empathy and burnout. METHOD: This was a cross-sectional observational study involving SMOs from a variety of specialities. The focus is on SMOs with relatively prolonged contact times with patients. Email invitations were sent out requesting participation in an electronic survey on the QuestionPro platform. The survey comprised 42 questions enquiring about demographics, empathy (Jefferson Scale of Physician Empathy) and burnout (Copenhagen Burnout Inventory). Correlational analyses were performed. RESULTS: Three hundred and fourteen invitations were sent out and 178 responses were received (56.7% response rate). Forty-five percent of SMOs surveyed were experiencing high levels of personal burnout. There was a statistically significant negative correlation between empathy and patient-related burnout (p=0.018). CONCLUSIONS: The results show high levels of personal burnout among SMOs and suggest that empathy reduces as patient-related burnout increases. The nature of this relationship is a complex one, and other contributing variables should be considered.


Asunto(s)
Agotamiento Profesional/epidemiología , Empatía , Relaciones Médico-Paciente , Médicos/estadística & datos numéricos , Adulto , Agotamiento Profesional/psicología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Médicos/psicología , Encuestas y Cuestionarios
6.
N Z Med J ; 134(1530): 21-29, 2021 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-33651774

RESUMEN

AIM: E-scooters were introduced to New Zealand in 2018 as a means of city transport. Since their introduction, their use has resulted in high injury rates. No studies have directly compared e-scooters to other forms of transport. METHOD: The Auckland City Hospital trauma registry was retrospectively searched for patients admitted with an e-scooter injury. A comparison group of patients admitted with an injury secondary to cycling during the same period was collected. RESULTS: 178 patients were identified: 69 with e-scooter injuries and 109 with injuries sustained while cycling. The hospitalisation rate for e-scooter injuries was 326 hospitalisations per million hours. There was a significant difference found in blood ethanol levels (18.6 vs 6.4% positive, p-value=0.01), mechanism of injury (isolated falls: 87 vs 60.6%), time of injury (55.1 vs 40.4% between 5pm-8am) and protective gear use (worn in 10.1 vs 78.9%). No differences were found in injury severity, ICU admissions, length of stay or mortality. CONCLUSION: This study demonstrates a concerningly high e-scooter-related hospitalisation rate and suggests e-scooters are currently not as safe as cycling. Strategies to improve e-scooter safety are needed and could include zero tolerance for alcohol, mandatory protective gear, restricted operating times and changes in road laws.


Asunto(s)
Vehículos a Motor Todoterreno/estadística & datos numéricos , Juego e Implementos de Juego/lesiones , Heridas y Traumatismos/epidemiología , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Femenino , Dispositivos de Protección de la Cabeza/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Hospitales Urbanos , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Sistema de Registros , Estudios Retrospectivos , Heridas y Traumatismos/etiología , Adulto Joven
7.
N Z Med J ; 134(1530): 69-75, 2021 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-33651779

RESUMEN

Injury remains one of the leading causes of years of life lost worldwide. In 2015, the New Zealand Major Trauma Registry was developed to provide a comprehen-sive data registry within New Zealand for looking at the outcomes and determinants of major trauma. It has published yearly major trauma reports since its founding.


Asunto(s)
Grupo de Ascendencia Oceánica/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Heridas y Traumatismos/etnología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Hospitales , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Sistema de Registros , Estudios Retrospectivos , Heridas y Traumatismos/mortalidad , Adulto Joven
8.
PLoS One ; 16(3): e0248075, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33662028

RESUMEN

The world is facing the coronavirus pandemic (COVID-19), which began in China. By August 18, 2020, the United States, Brazil, and India were the most affected countries. Health infrastructure and socioeconomic vulnerabilities may be affecting the response capacities of these countries. We compared official indicators to identify which vulnerabilities better determined the exposure risk to COVID-19 in both the most and least affected countries. To achieve this purpose, we collected indicators from the Infectious Disease Vulnerability Index (IDVI), the World Health Organization (WHO), the World Bank, and the Brazilian Geography and Statistics Institute (IBGE). All indicators were normalized to facilitate comparisons. Speed, incidence, and population were used to identify the groups of countries with the highest and lowest risks of infection. Countries' response capacities were determined based on socioeconomic, political, and health infrastructure conditions. Vulnerabilities were identified based on the indicator sensitivity. The highest-risk group included the U.S., Brazil, and India, whereas the lowest-risk group (with the largest population by continent) consisted of China, New Zealand, and Germany. The high-sensitivity cluster had 18 indicators (50% extra IDVI), such as merchandise trade, immunization, public services, maternal mortality, life expectancy at birth, hospital beds, GINI index, adolescent fertility, governance, political stability, transparency/corruption, industry, and water supply. The greatest vulnerability of the highest-risk group was related first to economic factors (merchandise trade), followed by public health (immunization), highlighting global dependence on Chinese trade, such as protective materials, equipment, and diagnostic tests. However, domestic political factors had more indicators, beginning with high sensitivity and followed by healthcare and economic conditions, which signified a lesser capacity to guide, coordinate, and supply the population with protective measures, such as social distancing.


Asunto(s)
/epidemiología , Brasil/epidemiología , China/epidemiología , Prestación de Atención de Salud , Alemania/epidemiología , Humanos , India/epidemiología , Nueva Zelanda/epidemiología , Pandemias , Sistemas Políticos , Medición de Riesgo , Factores Socioeconómicos , Estados Unidos/epidemiología , Organización Mundial de la Salud
9.
ANZ J Surg ; 91(4): 633-638, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33656252

RESUMEN

BACKGROUND: The New Zealand government implemented restrictive public health interventions to eradicate Covid-19. Early reports suggest that one downstream ramification is a change in trauma presentations. The aim of this study is to evaluate the effect these public health measures had on major trauma admissions in the Northern Region, New Zealand. METHODS: A retrospective comparative cohort study was performed. Two cohorts were identified: 16 March to 8 June 2020 and the same period in 2019. Data was extracted from the New Zealand Major Trauma Registry which prospectively collects data on all major trauma in New Zealand. All patients who presented to a hospital in the Northern Region with major trauma and met the Registry inclusion criteria were included. RESULTS: There were 163 major trauma admissions in 2019 and 123 in 2020, a reduction of 25% (rate ratio 0.75, 95% confidence interval 0.6-0.95; P = 0.018). There was no significant difference in mechanism of injury (P = 0.442), type of injury (P = 0.062) or intent of injury (P = 0.971). There was a significant difference in place of injury (P = 0.004) with 20% of injuries happening at home in 2019 compared with 35% in 2020. CONCLUSION: This study has shown that public health interventions to prevent the spread of COVID-19 reduced major trauma admissions in the Northern Region of New Zealand. There was a variation in effect a between institutions within the region and a change in pattern of injury.


Asunto(s)
Hospitalización/estadística & datos numéricos , Salud Pública , Heridas y Traumatismos/epidemiología , Estudios de Cohortes , Humanos , Puntaje de Gravedad del Traumatismo , Nueva Zelanda/epidemiología , Estudios Retrospectivos , Centros Traumatológicos/estadística & datos numéricos
10.
ANZ J Surg ; 91(4): 495-506, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33656269

RESUMEN

BACKGROUND: Long-term effects after COVID-19 may affect surgical safety. This study aimed to evaluate the literature and produce evidence-based guidance regarding the period of delay necessary for adequate recovery of patients following COVID-19 infection before undergoing surgery. METHODS: A rapid review was combined with advice from a working group of 10 clinical experts across Australia and New Zealand. MEDLINE, medRxiv and grey literature were searched to 4 October 2020. The level of evidence was stratified according to the National Health and Medical Research Council evidence hierarchy. RESULTS: A total of 1020 records were identified, from which 20 studies (12 peer-reviewed) were included. None were randomized trials. The studies comprised one case-control study (level III-2 evidence), one prospective cohort study (level III-2) and 18 case-series studies (level IV). Follow-up periods containing observable clinical characteristics ranged from 3 to 16 weeks. New or excessive fatigue and breathlessness were the most frequently reported symptoms. SARS-CoV-2 may impact the immune system for multiple months after laboratory confirmation of infection. For patients with past COVID-19 undergoing elective curative surgery for cancer, risks of pulmonary complications and mortality may be lowest at 4 weeks or later after a positive swab. CONCLUSION: After laboratory confirmation of SARS-CoV-2 infection, minor surgery should be delayed for at least 4 weeks and major surgery for 8-12 weeks, if patient outcome is not compromised. Comprehensive preoperative and ongoing assessment must be carried out to ensure optimal clinical decision-making.


Asunto(s)
Procedimientos Quirúrgicos Operativos , Adolescente , Adulto , Australia/epidemiología , Femenino , Humanos , Masculino , Nueva Zelanda/epidemiología
11.
PLoS One ; 16(3): e0248176, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33667280

RESUMEN

Testing and case identification are key strategies in controlling the COVID-19 pandemic. Contact tracing and isolation are only possible if cases have been identified. The effectiveness of testing should be assessed, but a single comprehensive metric is not available to assess testing effectiveness, and no timely estimates of case detection rate are available globally, making inter-country comparisons difficult. The purpose of this paper was to propose a single, comprehensive metric, called the COVID-19 Testing Index (CovTI) scaled from 0 to 100, derived from epidemiological indicators of testing, and to identify factors associated with this outcome. The index was based on case-fatality rate, test positivity rate, active cases, and an estimate of the detection rate. It used parsimonious modeling to estimate the true total number of COVID-19 cases based on deaths, testing, health system capacity, and government transparency. Publicly reported data from 165 countries and territories that had reported at least 100 confirmed cases by June 3, 2020 were included in the index. Estimates of detection rates aligned satisfactorily with previous estimates in literature (R2 = 0.44). As of June 3, 2020, the states with the highest CovTI included Hong Kong (93.7), Australia (93.5), Iceland (91.8), Cambodia (91.3), New Zealand (90.6), Vietnam (90.2), and Taiwan (89.9). Bivariate analyses showed the mean CovTI in countries with open public testing policies (66.9, 95% CI 61.0-72.8) was significantly higher than in countries with no testing policy (29.7, 95% CI 17.6-41.9) (p<0.0001). A multiple linear regression model assessed the association of independent grouping variables with CovTI. Open public testing and extensive contact tracing were shown to significantly increase CovTI, after adjusting for extrinsic factors, including geographic isolation and centralized forms of government. The correlation of testing and contact tracing policies with improved outcomes demonstrates the validity of this model to assess testing effectiveness and also suggests these policies were effective at improving health outcomes. This tool can be combined with other databases to identify other factors or may be useful as a standalone tool to help inform policymakers.


Asunto(s)
/diagnóstico , /epidemiología , Australia/epidemiología , Cambodia/epidemiología , Trazado de Contacto , Política de Salud , Hong Kong/epidemiología , Humanos , Islandia/epidemiología , Modelos Lineales , Nueva Zelanda/epidemiología , Taiwán/epidemiología , Vietnam/epidemiología
12.
PLoS One ; 16(3): e0238800, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33760817

RESUMEN

New Zealand had 1499 cases of COVID-19 before eliminating transmission of the virus. Extensive contract tracing during the outbreak has resulted in a dataset of epidemiologically linked cases. This data contains useful information about the transmission dynamics of the virus, its dependence on factors such as age, and its response to different control measures. We use Monte-Carlo network construction techniques to provide an estimate of the number of secondary cases for every individual infected during the outbreak. We then apply standard statistical techniques to quantify differences between groups of individuals. Children under 10 years old are significantly under-represented in the case data. Children infected fewer people on average and had a lower probability of transmitting the disease in comparison to adults and the elderly. Imported cases infected fewer people on average and also had a lower probability of transmitting than domestically acquired cases. Superspreading is a significant contributor to the epidemic dynamics, with 20% of cases among adults responsible for 65-85% of transmission. Subclinical cases infected fewer individuals than clinical cases. After controlling for outliers serial intervals were approximated with a normal distribution (µ = 4.4 days, σ = 4.7 days). Border controls and strong social distancing measures, particularly when targeted at superspreading, play a significant role in reducing the spread of COVID-19.


Asunto(s)
/epidemiología , Brotes de Enfermedades/prevención & control , /prevención & control , Trazado de Contacto/métodos , Trazado de Contacto/estadística & datos numéricos , Epidemias/prevención & control , Humanos , Método de Montecarlo , Nueva Zelanda/epidemiología , /patogenicidad
13.
N Z Med J ; 134(1531): 50-58, 2021 03 26.
Artículo en Inglés | MEDLINE | ID: mdl-33767476

RESUMEN

AIM: To assess the effects of the community lockdown phases on trauma-related admissions to Midland region hospitals over the period 15 February to 10 July 2020, and to compare volume variation with the same period in the previous three years. METHODS: A retrospective, descriptive study of prospectively collected data from the Midland Trauma Registry in New Zealand. RESULTS: There was a 36.7% (p<.00001) reduction in injury admissions during Alert Level 4 ('Lockdown') compared with the same period in 2017, 2018 and 2019. This was in the context of volume increases during the pre-lockdown period (17.8%, p<.00001) and a 'rebound' as restrictions eased. There was an increase in injuries occurring at home (28.3%, p<.00001) and on footpaths (37.9%, p=0.00076), while there was a decline in events on roads (33.0%, p=0.017), at schools (75.0%, p<.00001) and in sports areas (79.7%, p<.00001). Falls remained the dominant mechanism of injury in 2020, contributing 39.9% of all hospitalisations. CONCLUSIONS: The reduction in hospital admissions during alert levels 4 and 3 was short lived, with a rebound evident when restrictions eased. Hospital resources have been strained because this rebound coincided with a planned 'catch up' on healthcare that was delayed during the higher community restriction levels.


Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Control de Enfermedades Transmisibles/métodos , Hospitalización/estadística & datos numéricos , Cuarentena/estadística & datos numéricos , Heridas y Traumatismos , Adulto , /prevención & control , Niño , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Nueva Zelanda/epidemiología , Estudios Retrospectivos , Índices de Gravedad del Trauma , Heridas y Traumatismos/epidemiología , Heridas y Traumatismos/etiología , Heridas y Traumatismos/terapia
14.
N Z Med J ; 134(1531): 67-76, 2021 03 26.
Artículo en Inglés | MEDLINE | ID: mdl-33767478

RESUMEN

AIMS: To assess how well the NZ COVID Tracer QR (Quick Response) code poster is displayed by Dunedin businesses and other venues in which groups of people gather indoors, and to calculate the proportions of visitors to those venues who scan the QR code poster. METHODS: We randomly selected 10 cafes, 10 restaurants, 10 bars, five churches, and five supermarkets and visited them at their busiest times. We evaluated the display of QR code posters using a six-item assessment tool that was based on guidance provided to businesses and services by the Ministry of Health, and we counted the number of people who entered each venue during a one-hour period and the number who scanned the QR code poster. RESULTS: All six criteria for displaying QR code posters were met at half of the hospitality venues, four of five churches, and all supermarkets. Scanning proportions were low at all venues (median 10.2%), and at 12 (30%) no visitors scanned; eight of these venues were bars. CONCLUSION: This audit provides a snapshot of the display and scanning of QR code posters in a city with no managed isolation and quarantine facilities and where no COVID-19 cases have been detected for 10 months.


Asunto(s)
Trazado de Contacto , Presentación de Datos , Instalaciones Privadas y Públicas no Médicas , Carteles como Asunto , Adulto , /prevención & control , Trazado de Contacto/métodos , Trazado de Contacto/estadística & datos numéricos , Presentación de Datos/normas , Presentación de Datos/estadística & datos numéricos , Femenino , Humanos , Masculino , Auditoría Administrativa , Mercadotecnía/normas , Nueva Zelanda/epidemiología , Instalaciones Privadas y Públicas no Médicas/organización & administración , Instalaciones Privadas y Públicas no Médicas/normas , Instalaciones Privadas y Públicas no Médicas/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Salud Pública/métodos
15.
N Z Med J ; 134(1531): 83-85, 2021 03 26.
Artículo en Inglés | MEDLINE | ID: mdl-33767480

RESUMEN

We report the earliest known cluster of SARS-CoV-2 infection so far reported, which occurred in New Zealand in late February 2020. The cluster includes one confirmed and five probable cases. The cluster was identified while investigating a weak positive nasopharyngeal swab (NPS) polymerase chain reaction (PCR) test that was returned by a male in his 60s in September 2020. The PCR result, combined with a clear clinical and epidemiological history of a COVID-19 like illness in late February 2020, prompted serological testing. SARS-CoV-2 IgG antibodies were detected and supported historical infection. Serology was also reactive for five close contacts who had also experienced a COVID-19 like illness in February 2020. Combined case histories and investigations suggest that this local cluster was import related, with the index case identified as a family member visiting from Italy in February. Case investigation also suggests this cluster was active in New Zealand prior to any previously documented local cases, indicating that SARS-CoV-2 was present and local transmission was occurring earlier than initially suspected. A weak positive PCR result, six months after acute infection, supports international evidence that SARS-CoV-2 genetic material can be detected for several months after initial COVID-19 infection, and that this is not necessarily indicative of infectivity.


Asunto(s)
/métodos , Trazado de Contacto/métodos , Anticuerpos Antivirales/aislamiento & purificación , /epidemiología , /transmisión , Femenino , Humanos , Italia , Masculino , Anamnesis/métodos , Persona de Mediana Edad , Nueva Zelanda/epidemiología , /aislamiento & purificación , Evaluación de Síntomas , Enfermedad Relacionada con los Viajes
16.
N Z Med J ; 134(1531): 11-22, 2021 03 12.
Artículo en Inglés | MEDLINE | ID: mdl-33767484

RESUMEN

AIMS: To investigate regional variation in myeloma incidence in New Zealand in order to inform aetiological investigations. METHODS: All new registrations of myeloma (1991-2016) were extracted from the New Zealand Cancer Registry. Ethnic classifications used prioritised ethnicity. For geographical groupings, 74 Territorial Local Authority (TLA) categories for 2006 and population densities were used. Negative binomial regression was used to estimate incidence rate ratios, 95% confidence intervals and p-values. RESULTS: Between 1 January 1991 and 31 December 2016, 7,083 myelomas were registered. The Clutha TLA had a significantly lower incidence than the New Zealand average. Compared to Clutha, many regions had a significantly higher incidence, but there was no clear spatial pattern. The highest incidence rate was for Maori men in the North Island. Women had significantly lower incidence than men of the same ethnic group and in the same area. CONCLUSIONS: As both extremes of myeloma incidence occurred in rural areas, and as all TLAs (except one, Horowhenua) in the two lowest risk categories were rural, it seems unlikely that farming confers an increased risk. Results suggest that some other factor is driving the differences in myeloma incidence by ethnic group. We have provided a baseline of the geographical burden of myeloma in New Zealand.


Asunto(s)
Mieloma Múltiple/epidemiología , Distribución por Edad , Anciano , Anciano de 80 o más Años , Grupos Étnicos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Población , Sistema de Registros , Distribución por Sexo
17.
N Z Med J ; 134(1531): 76-90, 2021 03 12.
Artículo en Inglés | MEDLINE | ID: mdl-33767489

RESUMEN

AIMS: The incidence of pre-diabetes and type 2 diabetes mellitus (T2DM) is increasing in children. Early identification of pre-diabetes is an important first step in preventing the progression to T2DM. The aim was to investigate the association of selected factors with pre-diabetes in children. METHODS: This data were from a subset of the 685 children recruited for the Children's Bone Study, a cross-sectional study of children aged 8-11 years in Auckland, New Zealand. Glycated haemoglobin (HbA1c) was measured from a finger-prick blood test. Children were classified as normoglycaemic (HbA1c≤39mmol/mol) and pre-diabetic (HbA1c>39mmol/mol). Anthropometry included weight, height, waist circumference (WC) and percentage body fat (%BF) measured using bioelectrical impedance analysis. Information about age, gender, ethnicity and physical activity was collected by questionnaires. RESULTS: HbA1c was measured in 451 children (10.4±0.6years, 45% male). Pre-diabetes was present in 71 (16%) children and was greatest in South Asian (n=13, 30%), Pacific Island (n=29, 27%) and Maori (n=10, 18%) children, compared with European children (n=10, 6.0%) (P< 0.001). South Asian and Pacific Island ethnicity, high WC, high %BF and low physical activity were associated with pre-diabetes. CONCLUSIONS: Factors associated with pre-diabetes in children were ethnicity, anthropometric measures and physical-activity levels. The prevalence of pre-diabetes in children of South Asian and Pacific Island ethnicities suggests the need for appropriate and timely identification and intervention to halt the progression to T2DM.


Asunto(s)
Hemoglobina A Glucada/análisis , Estado Prediabético/epidemiología , Constitución Corporal , Niño , Grupos de Población Continentales , Estudios Transversales , Grupos Étnicos , Ejercicio Físico , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Nueva Zelanda/epidemiología , Prevalencia
19.
Diving Hyperb Med ; 51(1): 25-33, 2021 Mar 31.
Artículo en Inglés | MEDLINE | ID: mdl-33761538

RESUMEN

INTRODUCTION: New Zealand's (NZ) long coastline offers a diverse underwater environment with abundant opportunities for harvesting seafood and for recreation. Fatalities from snorkelling/breath-hold diving have been reported from the 1960s through to 2006. Those from 2007 to 2016 are reported here. METHODS: The National Coronial Information System, the Australasian Diving Safety Foundation diving fatality database, and the Water Safety NZ "Drownbase" were searched and additional coronial data provided by the NZ Ministry of Justice. An anonymised database was created and analysed for multiple factors. A chain of events analysis was performed for each case. RESULTS: There were 38 snorkelling or breath-hold-related deaths in NZ, 33 men and five women. Twenty-nine were breath-hold divers involved in gathering seafood, and six 'surface snorkellers', predominantly sightseeing. Two-thirds were diving alone and/or were not being observed by anyone out of the water. Twenty-eight victims were classified as overweight or obese and 19/38 were Maori. Pre-existing health factors that may have or definitely contributed to the fatality were present in 30 cases. The most common of these were cardiac (18/38). Two divers had insulin-dependent diabetes mellitus, one each epilepsy and asthma whilst cannabis and/or alcohol were possible factors in seven deaths. Five (possibly six) deaths resulted from apnoeic hypoxia. CONCLUSIONS: Overall, death from snorkelling/breath-hold diving was an uncommon event (38 in 10 years). Poor judgement was a common feature. Middle-aged Maori men with pre-existing disease feature strongly. This suggests an on-going need for appropriate water safety education within and beyond the Maori community.


Asunto(s)
Buceo , Ahogamiento , Contencion de la Respiración , Causas de Muerte , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología
20.
BMJ Health Care Inform ; 28(1)2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33753326

RESUMEN

INTRODUCTION: Telehealth became the most practical option for general practice consultations in Aotearoa New Zealand (NZ) as a result of the national lockdowns in response to the COVID-19 pandemic. What is the consumer experience of access to telehealth and how do consumers and providers perceive this mode of care delivery going forward? METHODS AND ANALYSIS: A national survey of general practice consumers and providers who used telehealth services since the national lockdowns in 2020 will be distributed. It is based on the Unified Theory of Acceptance and Use of Technology framework of technology acceptance and the access to care framework. The data will be statistically analysed to create a foundation for in-depth research on the use of telehealth services in NZ general practice services, with a specific focus on consumer experiences and health outcomes. ETHICS AND DISSEMINATION: Ethics approval was granted by the Auckland Health Research Ethics Committee on 13/11/2020, reference AH2539. The survey will be disseminated online.


Asunto(s)
/epidemiología , Medicina General/organización & administración , Telemedicina/organización & administración , Actitud hacia los Computadores , Humanos , Nueva Zelanda/epidemiología , Pandemias , Estudios Prospectivos , Proyectos de Investigación , Encuestas y Cuestionarios , Teléfono , Comunicación por Videocoferencia
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