Antenatal immunisation intentions of expectant parents: Relationship to immunisation timeliness during infancy.

BACKGROUND: Most women decide about infant immunisation during pregnancy. However, we have limited knowledge of the immunisation intentions of their partners. We aimed to describe what pregnant women and their partners intended for their future child's immunisations, and to identify associations between parental intentions and the subsequent timeliness of infant immunisation. METHODS: We recruited a cohort of pregnant New Zealand (NZ) women expecting to deliver between April 2009 and March 2010. The cohort included 11% of births in NZ during the recruitment period and was generalisable to the national birth cohort. We completed antenatal interviews independently with mothers and partners. We determined immunisation receipt from the National Immunisation Register and defined timely immunisation as receiving all vaccines (scheduled at 6-weeks, 3- and 5-months) within 30 days of their due date. We described independent associations of immunisation intentions with timeliness using adjusted odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Of 6172 women, 5014 (81%) intended full immunisation, 245 (4%) partial immunisation, 140 (2%) no immunisation and 773 (13%) were undecided. Of 4152 partners, 2942 (71%) intended full immunisation, 208 (5%) partial immunisation, 83 (2%) no immunisation and 921 (22%) were undecided. Agreement between mothers and partners was moderate (Kappa=0.42). Timely immunisation occurred in 70% of infants. Independent of their partner's intentions, infants of pregnant women who decided upon full immunisation were more likely to be immunised on time (OR=7.65, 95% CI: 4.87-12.18). Independent of the future mother's intentions, infants of partners who had decided upon full immunisations were more likely to be immunised on time (OR=3.33, 95% CI: 2.29-4.84). CONCLUSIONS: During pregnancy, most future parents intend to fully immunise their child; however, more partners than mothers remain undecided about immunisation. Both future mothers' and future fathers' intentions are independently associated with the timeliness of their infant's immunisations.

Depression symptoms during pregnancy: Evidence from Growing Up in New Zealand.

BACKGROUND: Depression during pregnancy has significant implications for pregnancy outcomes and maternal and child health. There is a need to identify which family, physical and mental health factors are associated with depression during pregnancy. METHODS: An ethnically and socioeconomically diverse sample of 5664 pregnant women living in New Zealand completed a face-to-face interview during the third trimester. Antenatal depression (AD) symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Maternal demographic, physical and mental health, and family and relationship characteristics were measured. The association between symptoms of AD and maternal characteristics was determined using multiple logistic regression. RESULTS: 11.9% of the participating women had EPDS scores (13+) that indicated probable AD. When considering sociodemographic predictors of AD symptoms, we found that women from non-European ethnicities, specifically Pacific Islander, Asian and other, were more likely to suffer from AD symptoms. Greater perceived stress during pregnancy and a diagnosis of anxiety both before and during pregnancy were also associated with greater odds of having AD according to the EPDS. LIMITATIONS: The women were in their third trimester of pregnancy at the interview. Therefore, we cannot discount the possibility of recall bias for questions relating to pre-pregnancy status or early-pregnancy behaviours. CONCLUSIONS: AD is prevalent amongst New Zealand women. Ethnicity, perceived stress and anxiety are particularly associated with a greater likelihood of depression during pregnancy. Further attention to supporting maternal mental health status in the antenatal period is required.

"On solid ground": family and school connectedness promotes adolescents' future orientation.

The present study investigated the role of connectedness to the family and school contexts on future orientation of New Zealand adolescents. Participants were 1774 young people (51.9% female) aged between 9 and 16 years at time 1 of the study, who reported their connectedness to family and school and their perceptions of future orientation at three times of measurement one year apart. Structural equation modelling was used to test the combined role of family and school connectedness on future orientation over time. Findings supported a multiple mediation model in that adolescents' connectedness to family and school predicted more positive perceptions of future orientation both directly and indirectly via the effect of the context variables on each other.

Infection frequency of hepatitis C virus and IL28B haplotypes in Papua New Guinea, Fiji, and Kiribati.

It has been estimated that there are more than 60 million Hepatitis C virus (HCV) carriers in the World Health Organisation's Western Pacific region (WHO-WPR), where liver cancer is among the top three causes of cancer death. WHO and the US Centres for Disease Control and Prevention report the prevalence of HCV in the South Pacific islands (countries within the WHO-WPR) to be high (5-10% and >2% respectively). However, since HCV is not tested for in many of these countries, there is sparse data available to support this assertion. We screened ∼2000 apparently healthy individuals from Papua New Guinea, Fiji and Kiribati and found a sero-prevalence of 2.0%, 0.1% and 0%, respectively. All sero-positive samples tested negative for HCV RNA. Curious as to why all the sero-positive individuals were negative for HCV-RNA, we also screened them for the HCV protective IL28B SNP markers rs12979860 and rs8099917. All antibody-positive participants bar one had HCV protective haplotypes. Our results suggest that HCV is present in these Pacific island countries, albeit at a prevalence lower than previous estimates. As none of our participants had undergone antiviral treatment, and therefore must have cleared infection naturally, we hypothesise that genotypes 1 and/or 4 are circulating in South Pacific Island people and that these peoples are genetically predisposed to be more likely to spontaneous resolve HCV infection than to become chronic carriers.

Family routines and rituals in the context of chronic conditions: a review.

This paper is a systematic review of 39 empirical studies on family routines and rituals in the context of a chronic condition of a family member. The search strategy encompassed a wide spectrum of chronic conditions affecting family members from childhood/adolescence to adulthood. Twenty quantitative, 13 qualitative, 3 mixed-methods, and 3 intervention studies published between 1995 and 2012 were reviewed. A conceptual framework of routines and rituals as key elements of family health was adopted, resulting in three main findings. First, a chronic condition in a family member impacted the frequency and nature of family's routines and rituals. Second, these whole-family interactions held important functions for individuals and families, constituting strategic resources in the condition's management and opportunities for emotional support exchanges, and providing the family with a sense of normalcy amid the challenges posed by chronic conditions. Third, family routines and rituals were linked to positive health and adaptation outcomes for both patients and family members. Implications for future research include the need for the distinction between routines and rituals against a conceptual background, use of validated assessment methods, and empirical examination of predictors of changes in routines and rituals throughout the course of the condition and of the mechanisms linking these family events to positive outcomes. Conclusions support the inclusion of routines and rituals in a family-centered care approach to the understanding and treatment of chronic conditions.

Children born small for gestational age are not at special risk for preschool emotion and behaviour problems.

Despite the wealth of literature examining long term outcomes of preterm low birthweight children, few studies have directly assessed the developmental impact of being born full term but small for gestational age (SGA). We aim to determine whether (i) being SGA increases preschool behavioural problems and (ii) other risk factors operate differently in SGA and appropriate for gestational age (AGA) controls. 550 New Zealand European mothers and their 3.5 year old children participated in this study. All children were born at full term (>37 weeks' gestation) and approximately half were SGA (≤sex specific 10th percentile for gestation) the remainder were AGA controls. Extensive data were collected at the child's birth, 1 year and 3.5 years. Behavioural problems were measured when children were 3.5 years, using the Strengths and Difficulties Questionnaire (SDQ). Multiple regression analyses were used to examine the associations between risk factors and behavioural problems; statistical weighting was used for analyses of the total study group. There was no significant difference in behavioural problems between SGA and AGA groups. In the total sample the significant predictors of behavioural problems included: mothers' school leaving age; smoking during pregnancy; maternal alcohol use during pregnancy; and absence of the father. Predictors of behavioural problems were found to be the same for SGA and AGA groups. These results do not support the view that SGA is a risk for behavioural preschool difficulties or that SGA children are sensitised to risks known to be associated with such difficulties in the preschool years.

Genomic analysis of hepatitis B virus reveals antigen state and genotype as sources of evolutionary rate variation.

Hepatitis B virus (HBV) genomes are small, semi-double-stranded DNA circular genomes that contain alternating overlapping reading frames and replicate through an RNA intermediary phase. This complex biology has presented a challenge to estimating an evolutionary rate for HBV, leading to difficulties resolving the evolutionary and epidemiological history of the virus. Here, we re-examine rates of HBV evolution using a novel data set of 112 within-host, transmission history (pedigree) and among-host genomes isolated over 20 years from the indigenous peoples of the South Pacific, combined with 313 previously published HBV genomes. We employ Bayesian phylogenetic approaches to examine several potential causes and consequences of evolutionary rate variation in HBV. Our results reveal rate variation both between genotypes and across the genome, as well as strikingly slower rates when genomes are sampled in the Hepatitis B e antigen positive state, compared to the e antigen negative state. This Hepatitis B e antigen rate variation was found to be largely attributable to changes during the course of infection in the preCore and Core genes and their regulatory elements.

Family rituals in New Zealand families: links to family cohesion and adolescents' well-being.

This research examined the longitudinal links between perceptions of family rituals, family cohesion, and adolescents' well-being in 713 adolescent-parent/caregiver dyads in New Zealand. Parents (86% mothers) assessed family ritual meaning and family cohesion, and adolescents (10 to 16 years old at Time 1) reported on family cohesion and well-being at two times of measurement with a 1-year interval. Structural equation modeling (SEM) was used to assess stability coefficients, cross-lagged effects, and to test a multistep mediation model. Results showed longitudinal bidirectional effects between perceptions of family ritual meaning and family cohesion (for parents), and between perceptions of family cohesion from parents/caregivers and adolescents. In addition, family ritual meaning was found to be linked to adolescents' well-being indirectly via parents' and adolescents' family cohesion. Results support and expand previous research on the direct and indirect effects of family rituals in family and individual positive outcomes.

Relationships between family connectedness and body satisfaction: a longitudinal study of adolescent girls and boys.

The present study examined the longitudinal links between perceptions of family connectedness and body satisfaction in 1,774 (52% female) adolescents. Participants (10-15 years of age at Time 1) completed self-report measures at three measurement occasions separated by 1 year each. Mean group difference results showed that both body satisfaction levels and perceived levels of family connectedness decreased over 2 years for the whole sample. As expected, girls were generally less satisfied with their bodies than boys, particularly in the older cohort. Structural equation modelling was used to assess stability coefficients and cross-lagged effects, and longitudinal bidirectional effects between perceptions of family connectedness and body satisfaction were found for girls, but not for boys. This result suggests that adolescent girls' body satisfaction is both affected by and a predictor of perceived family connectedness.

Invasive pneumococcal disease in Fiji: clinical syndromes, epidemiology, and the potential impact of pneumococcal conjugate vaccine.

Invasive pneumococcal disease (IPD) epidemiology and the potential impact of the pneumococcal conjugate vaccine in Fiji are documented. The annual incidence was 26.5 and 10.9 in those aged <5 and > or =55 years per 100,000, respectively. The case fatality rate was 9.4% and 67% in <5 and >65 year olds, respectively. One pneumococcal death and case would be prevented in <5 years olds for every 1930 and 128 infants vaccinated with 7vPCV, respectively.

The development and evaluation of a PDA-based method for public health surveillance data collection in developing countries.

BACKGROUND AND PURPOSE: EpiData and Epi Info are often used together by public health agencies around the world, particularly in developing countries, to meet their needs of low-cost public health data management; however, the current open source data management technology lacks a mobile component to meet the needs of mobile public health data collectors. The goal of this project is to explore the opportunity of filling this gap through developing and trial of a personal digital assistant (PDA) based data collection/entry system. It evaluated whether such a system could increase efficiency and reduce data transcription errors for public surveillance data collection in developing countries represented by Fiji. METHODS: A generic PDA-based data collection software eSTEPS was developed. The software and the data collected using it directly interfaces with EpiData. A field trial was conducted to test the viability of public health surveillance data collection using eSTEPS. The design was a randomised, controlled trial with cross-over design. 120 participants recruited from the Fiji School of Medicine were randomly assigned to be interviewed by one of six interviewers in one of the two ways: (1) paper-based survey followed by PDA survey and (2) PDA survey followed by paper-based survey. Data quality was measured by error rates (logical range errors/inconsistencies, skip errors, missing values, date or time field errors and incorrect data type). Work flow and cost were evaluated in three stages of the survey process: (1) preparation of data collection instrument, (2) data collection and (3) data entry, validation and cleaning. User acceptance was also evaluated in the two groups of participants: (1) data collectors and (2) survey participants. RESULTS: None of the errors presented in 20.8% of the paper questionnaires was found in the data set collected using PDA. Sixty-two percent of the participants perceived that the PDA-based questionnaire took less time to complete. Data entry, validation and cleaning for the PDA-based data collection from 120 participants took a total of 1.5h, a 93.26% reduction of time from 20.5h required using paper and pen. The cost is also significantly reduced with PDA-based protocol. Both data collectors and participants prefer to use PDA instead of paper for data collection. The trial results prove that eSTEPS is a feasible solution for public health surveillance data collection in the field. Several deficiencies of the software were also identified and would be addressed in the next version. CONCLUSION: eSTEPS offers the potential to meet the need for an effective mobile public health data collection tool for use in the field. The eSTEPS field trial proves that PDA was more efficient than paper for public health survey data collection. It also significantly reduced errors in data entry. The later benefit was derived from the software providing its users with the flexibility of building their own constraints to control the data type, range and logic of data entry.

Esophagopharyngeal reflux.

OBJECTIVE: Laryngopharyngeal reflux (LPR) is the disorder caused by the regurgitation of gastric contents into the laryngopharynx. Many persons diagnosed with LPR who fail medical therapy regurgitate contents from the proximal esophagus into the laryngopharynx (esophagopharyngeal reflux or EPR) on cinefluoroscopy. STUDY DESIGN: Retrospective review. SUBJECTS AND METHODS: The charts of consecutive adult patients with findings of EPR on cinefluoroscopy were reviewed. RESULTS: Twenty patients met the diagnostic criteria for EPR (mean age, 50 years of age; 60% female). Most common symptoms were cough (40%), dysphagia (35%), dysphonia (25%), and chronic throat clearing (25%). Eighty-five percent had a prior diagnosis of acid reflux disease (LPR or GER) and were unsuccessfully treated with proton pump inhibitors and/or anti-reflux surgery; 15% had fluoroscopic oropharyngeal abnormalities; all patients had fluoroscopic esophageal abnormalities. CONCLUSION: EPR is characterized by regurgitation of proximal esophageal contents into the laryngopharynx. The symptoms are similar to LPR. EPR appears to be caused by a disorder of volume clearance and esophageal dysmotility not acid and peptic injury.

Validity and reliability of the Eating Assessment Tool (EAT-10).

OBJECTIVES: The Eating Assessment Tool is a self-administered, symptom-specific outcome instrument for dysphagia. The purpose of this study was to assess the validity and reliability of the 10-item Eating Assessment Tool (EAT-10). METHODS: The investigation consisted of 4 phases: 1) line-item generation, 2) line-item reduction and reliability, 3) normative data generation, and 4) validity analysis. All data were collected prospectively. Internal consistency was assessed with the Cronbach alpha. Test-retest reliability was evaluated with the Pearson product moment correlation coefficient. Normative data were obtained by administering the instrument to a community cohort of healthy volunteers. Validity was assessed by administering the instrument before and after dysphagia treatment and by evaluating survey differences between normal persons and those with known diagnoses. RESULTS: A total of 629 surveys were administered to 482 patients. The internal consistency (Cronbach alpha) of the final instrument was 0.960. The test-retest intra-item correlation coefficients ranged from 0.72 to 0.91. The mean (+/- SD) EAT-10 score of the normal cohort was 0.40 +/- 1.01. The mean EAT-10 score was 23.58 +/- 13.18 for patients with esophageal dysphagia, 23.10 +/- 12.22 for those with oropharyngeal dysphagia, 9.19 +/- 12.60 for those with voice disorders, 22.42 +/- 14.06 for those with head and neck cancer, and 11.71 +/- 9.61 for those with reflux. The patients with oropharyngeal and esophageal dysphagia and a history of head and neck cancer had a significantly higher EAT-10 score than did those with reflux or voice disorders (p <0.001). The mean EAT-10 score of the patients with dysphagia improved from 19.87 +/- 10.5 to 5.2 +/- 7.4 after treatment (p <0.001). CONCLUSIONS: The EAT-10 has displayed excellent internal consistency, test-retest reproducibility, and criterion-based validity. The normative data suggest that an EAT-10 score of 3 or higher is abnormal. The instrument may be utilized to document the initial dysphagia severity and monitor the treatment response in persons with a wide array of swallowing disorders.

Determinants of developmental delay in infants aged 12 months.

The aim of this study was to determine which demographic, maternal, obstetric and postnatal variables were associated with achievement of developmental milestones at the age of 12 months in term infants. Mothers and babies were enrolled in the Auckland Birthweight Collaborative Study shortly after birth. All infants were full term (gestation >or= 37 weeks). Approximately half of the sample were small for gestational age (SGA = birthweight 10th percentile). A maternal interview was conducted soon after birth. Phase 2 of the study occurred 12 months later when mothers were sent a postal questionnaire requesting information about the child's health and development during the first year of life using the Denver Prescreening Developmental Questionnaire. Seven hundred and forty-four (85.4%) European mothers returned the postal questionnaire. SGA children were not at increased risk of developmental delay at 12 months of age. In a sample representative of New Zealand European children, after adjustment for the effects of potential confounders, maternal smoking during pregnancy (OR = 2.1 [95% CI 1.1, 4.0]), maternal smoking during the first year of life (OR = 1.9 [95% CI 1.0, 3.8]) and low levels of satisfaction with parenting (OR = 2.4 [95% CI 1.1, 5.2]) were associated with significantly increased risk of developmental delay. In the subgroup of SGA children, maternal smoking during pregnancy (OR = 2.9 [95% CI 1.4, 6.2]), high levels of stress associated with parenting (OR = 2.2 [95% CI 1.2, 4.0]), and low levels of satisfaction with parenting (OR = 4.3 [95% CI 1.3, 13.5]) were significantly associated with developmental delay after adjustment for the effects of potential confounders. In conclusion, maternal and postnatal factors were better predictors of developmental delay than demographic variables.

The Pacific OPIC Project (Obesity Prevention in Communities) -- objectives and designs.

BACKGROUND: Evidence on how to reduce the increasing prevalence of youth obesity is urgently needed in many countries. The Pacific OPIC Project (Obesity Prevention In Communities) is a series of linked studies in four countries (Fiji, Tonga, New Zealand, Australia) which is designed to address this important problem. OBJECTIVES: The studies aim to: 1) determine the overall impact of comprehensive, community-based intervention programs on overweight/obesity prevalence in youth; 2) assess the feasibility of the specific intervention components and their impacts on eating and physical activity patterns; 3) understand the socio-cultural factors that promote obesity and how they can be influenced; 4) identify the effects of food-related policies in Fiji and Tonga and how they might be changed; 5) estimate the overall burden of childhood obesity (including loss of quality of life); 6) estimate the costs (and cost-effectiveness) of the intervention programs, and; 7) increase the capacity for obesity prevention research and action in Pacific populations. DESIGN: The community studies use quasi-experimental designs with impact and outcome assessments being measured in over 14,000 youth across the intervention and control communities in the four sites. The multi-strategy, multi-setting interventions will run for 3 years before final follow up data are collected in 2008. The interventions are being informed by socio-cultural studies that will determine the family and societal influences on food intake, physical activity and body size perception. PROGRESS AND CONCLUSIONS: Baseline studies have been completed and interventions are underway. Despite the many challenges in implementing and evaluating community-based interventions, especially in the Pacific, the OPIC Project will provide rich evidence about what works and what does not work for obesity prevention in youth from European and Pacific backgrounds.

Dietary patterns of New Zealand European preschool children.

AIMS: To record and describe the dietary patterns of a large group of New Zealand (NZ) European preschool children and to compare these with NZ Ministry of Health (MOH) food and nutrition guidelines. METHODS: Mothers were interviewed when children enrolled in the Auckland Birthweight Collaborative (ABC) study were seen at 3.5 years of age. Approximately half of the children in the study were born small for gestational age (SGA =10th percentile) and the remaining were born appropriate for gestational age (AGA >10th percentile). Food frequency information was collected on 549 New Zealand European children. The analysis utilised weighting to allow for the disproportionate sampling of children born SGA. RESULTS: Compared with nutritional guidelines, 27% and 54% of preschool children did not eat the recommended two or more servings of fruit per day or two or more servings of vegetables per day, respectively; 93% of children did not eat breads and cereals the recommended four or more times a day. CONCLUSION: A notable proportion of children were not eating fruit and vegetables at levels recommended by the MOH. Preschool children's food frequency patterns were, however, similar to patterns reported for school-aged children in the National Children's Nutrition Survey.

Laboratory-based Salmonella surveillance in Fiji, 2004-2005.

Although foodborne diseases are an important public health problem worldwide, the burden of foodborne illness is not well described in most Pacific Island Countries and Territories. Laboratory-based surveillance programs can detect trends and outbreaks, estimate burden of illness, and allow subtyping of enteric pathogens (e.g. Salmonella serotyping), which is critical for linking illness to food vehicles and animal reservoirs. To enhance public health capacity in Fiji for foodborne disease surveillance, we developed the Salmonella Surveillance Project (SSP), a collaboration to pilot laboratory-based surveillance for Salmonella. A network of national and international partners was formed including epidemiologists, microbiologists, and environmental health personnel. Ministry of Health personnel were trained in foodborne disease surveillance and outbreak investigation. Three clinical microbiology laboratories from different parts of the country functioned as sentinel sites, reporting all laboratory-confirmed Salmonella infections using a standardized case report form. Non-Typhi Salmonella isolates were collected for serotyping. In 2004-2005, 86 non-Typhi Salmonella and 275 S. Typhi laboratory-confirmed infections were reported. Salmonella enterica serotype I 3,10: r:- and Salmonella enterica serotype Weltevreden were the most commonly isolated non-Typhi serotypes. In Fiji, the SSP utilized international partnerships to facilitate training, and to enhance laboratory capacity and surveillance for salmonellosis. Incorporating laboratory-based foodborne disease reporting into national disease surveillance will enable public health officials to describe the burden of foodborne illness, identify outbreaks, conduct analytic epidemiology studies, and improve food safety.