The benefits and harms of rheumatic heart disease screening from the perspective of the screened population.

BACKGROUND: A reduction in the burden of rheumatic heart disease (RHD) may be possible by identifying the condition while the patient is still asymptomatic. Currently, there is much debate about whether it is appropriate to screen for the presence of rheumatic heart disease (RHD) in a symptomless population. The purpose of this study was to identify self-reported benefits and harms from the perspective of screening participants and their families. METHODS: In order to describe participant experiences and changes in behaviour post-screening, we interviewed a sample of parents/caregivers of children who were screened for the presence of RHD between 2007 and 2012 (n=276). A total of n=91 parents/caregivers of children diagnosed with either definite, probable or possible/borderline RHD ('abnormal' cases) were interviewed either by telephone or in-person, along with at least two matched controls (n=185 'normal' controls). RESULTS: We observed evidence of long-standing anxiety and changes in physical activity among those who received an 'abnormal' screening result. The screening event appeared to have minimal impact on those who received a 'normal' result. There was some evidence of improved sore throat advice-seeking following the screening event, particularly among case respondents; however this group showed poorer understanding of the screening test compared to control respondents. CONCLUSIONS: Among other points of discussion, this study brings to light issues regarding a) diminished physical activity habits among those receiving an abnormal result; b) levels of worry (and reassurance) among the screened population, depending on screening outcome; and c) general issues regarding the health literacy of the screened population.

Estimating the risk of acute rheumatic fever in New Zealand by age, ethnicity and deprivation.

In New Zealand, efforts to control acute rheumatic fever (ARF) and its sequelae have focused on school-age children in the poorest socioeconomic areas; however, it is unclear whether this approach is optimal given the strong association with demographic risk factors other than deprivation, especially ethnicity. The aim of this study was to estimate the stratum-specific risk of ARF by key sociodemographic characteristics. We used hospitalization and disease notification data to identify new cases of ARF between 2010 and 2013, and used population count data from the 2013 New Zealand Census as our denominator. Poisson logistic regression methods were used to estimate stratum-specific risk of ARF development. The likelihood of ARF development varied considerably by age, ethnicity and deprivation strata: while risk was greatest in Maori and Pacific children aged 10-14 years residing in the most extreme deprivation, both of these ethnic groups experienced elevated risk across a wide age range and across deprivation levels. Interventions that target populations based on deprivation will include the highest-risk strata, but they will also (a) include groups with very low risk of ARF, such as non-Maori/non-Pacific children; and (b) exclude groups with moderate risk of ARF, such as Maori and Pacific individuals living outside high deprivation areas.

Ethnic patterns of hypospadias in New Zealand do not resemble those observed for cryptorchidism and testicular cancer: evidence of differential aetiology?

It has been proposed that hypospadias, cryptorchidism, poor semen quality and testicular cancer might share common prenatal causes. We have previously demonstrated similar ethnic patterns for the incidence of testicular cancer and cryptorchidism - a known risk factor for testicular cancer. If the underlying exposure(s) that cause hypospadias, cryptorchidism and testicular cancer are shared, then we would expect the incidence relationship between ethnic groups to follow the same pattern across all three conditions. We followed a birth cohort of 318 345 eligible male neonates born in New Zealand between 2000-2010, and linked routinely collected maternity records with inpatient hospitalization and mortality records through to 2011. We searched hospitalization records for diagnoses of hypospadias, and used mortality records for censoring. We used Poisson regression methods to compare the relative risk of hypospadias between ethnic groups, adjusting for perinatal risk factors and total person time. We observed that European/Other children had the highest risk of hypospadias, with Maori, Pacific and Asian boys having around 40% lower risk of disease compared with this group (adjusted relative risk [RR]: Maori 0.62, 95% CI 0.55-0.70; Pacific 0.62, 95% CI 0.53-0.72; Asian 0.57, 95% CI 0.47-0.69). This contrasts substantially with our previous observations for cryptorchidism and testicular cancer, where Maori males have the greatest risk. Our observations suggest that - at least in New Zealand - the exposures that drive the development of hypospadias may differ to those that that drive the development of cryptorchidism and/or testicular cancer.

Cannabis exposure and risk of testicular cancer: a systematic review and meta-analysis.

BACKGROUND: The aetiology of testicular cancer remains elusive. In this manuscript, we review the evidence regarding the association between cannabis use and testicular cancer development. METHODS: In this systematic review and meta-analysis, we reviewed literature published between 1(st) January 1980 and 13(th) May 2015 and found three case-control studies that investigated the association between cannabis use and development of testicular germ cell tumours (TGCTs). RESULTS/CONCLUSIONS: Using meta-analysis techniques, we observed that a) current, b) chronic, and c) frequent cannabis use is associated with the development of TGCT, when compared to never-use of the drug. The strongest association was found for non-seminoma development--for example, those using cannabis on at least a weekly basis had two and a half times greater odds of developing a non-seminoma TGCT compared those who never used cannabis (OR: 2.59, 95% CI 1.60-4.19). We found inconclusive evidence regarding the relationship between cannabis use and the development of seminoma tumours. It must be noted that these observations were derived from three studies all conducted in the United States; and the majority of data collection occurred during the 1990's.

Consideration of comorbidity in treatment decision making in multidisciplinary cancer team meetings: a systematic review.

BACKGROUND: Comorbidity is very common among patients with cancer. Multidisciplinary team meetings (MDTs) are increasingly the context within which cancer treatment decisions are made internationally. Little is known about how comorbidity is considered, or impacts decisions, in MDTs. METHODS: A systematic literature review was conducted to evaluate previous evidence on consideration, and impact, of comorbidity in cancer MDT treatment decision making. Twenty-one original studies were included. RESULTS: Lack of information on comorbidity in MDTs impedes the ability of MDT members to make treatment recommendations, and for those recommendations to be implemented among patients with comorbidity. Where treatment is different from that recommended due to comorbidity, it is more conservative, despite evidence that such treatment may be tolerated and effective. MDT members are likely to be unaware of the extent to which issues such as comorbidity are ignored. CONCLUSIONS: MDTs should systematically consider treatment of patients with comorbidity. Further research is needed to assist clinicians to undertake MDT decision making that appropriately addresses comorbidity. If this were to occur, it would likely contribute to improved outcomes for cancer patients with comorbidities.

The health of lone mothers in New Zealand.

AIMS: To compare the sociodemographic characteristics and the mental and physical health status of lone and couple mothers, and to explore possible contributing factors to any differential health status identified. METHODS: Data from the 1996/97 New Zealand Health Survey were analysed. Lone and couple mothers were compared according to sociodemographic factors, health risk behaviours and three medical conditions. Their self-reported health was measured and compared using the SF-36 questionnaire. Multivariate analyses were performed to explore the possible contributing factors to any health disadvantage identified. RESULTS: Lone mothers (n=721) were more likely to be Maori, to have lower family incomes, lower educational qualifications and to live in more deprived areas. There were no significant differences between lone and couple mothers in their prevalence of probable asthma and diagnosed diabetes mellitus, or in their self-reported physical health status after adjustment for socioeconomic variables. However, lone mothers had higher rates of ever having been on medication for hypertension (OR=2.3; 1.2-4.1), and significantly worse self-reported mental health which persisted after adjustment for differences in socioeconomic and other factors. CONCLUSIONS: These findings suggest that lone mothers are a vulnerable group and special consideration should be given to them if inequalities in health are to be addressed.

A challenge to the cross-cultural validity of the SF-36 health survey: factor structure in Maori, Pacific and New Zealand European ethnic groups.

This paper reports on a principal component factor analysis of the SF-36 health status questionnaire in the three major ethnic groups in New Zealand (New Zealand Europeans, Maori and Pacific). The SF-36 is hypothesised to have a two-dimensional structure with distinct (weakly correlated) mental and physical health components, and support for this structural model has generally been found cross-nationally. However, in Maori and Pacific models of health mental and physical dimensions are not generally seen as separable, or independently functioning. This raises the possibility that the questionnaire's hypothesised structural model would not be supported among Maori and Pacific ethnic groups. This study evaluated that possibility. The results of the analysis showed a similar factor structure among New Zealand Europeans, and younger Maori (<45 years) to that reported by Ware et al. for Western European countries. Among Pacific people and older Maori (45 years and over), however, the factor structure did not clearly differentiate physical and mental health components. Implications are discussed both specific to the SF-36 (and in particular the use of principal component summary scores), and more generally for the cross-cultural validity of self-reported health status measures.

A moment in time: selected results from the 1996-1997 New Zealand health survey.

This article presents key results from the 1996-1997 New Zealand Health Survey, the second of two nationally representative surveys on the health status and health service utilization of New Zealanders. This survey involved a face-to-face interview with 7,862 adults and 1,019 children carried out during the period of a year. The survey had an adult response rate of 73.8%. Using the results of this survey, this article highlights some of the major public health issues facing New Zealanders. These issues include smoking, physical inactivity, alcohol use, asthma, and diabetes. The results presented here show that significant disparities exist between particular demographic and socioeconomic groups in New Zealand in relation to both health risk factors and specific chronic diseases. The policy implications of the results are discussed in relation to existing public health strategies and future initiatives.

SF-36 health survey reliability, validity and norms for New Zealand.

OBJECTIVE: To assess the acceptability, reliability and validity of the SF-36 health survey in the New Zealand population and provide key population norms. METHOD: The SF-36 questionnaire was part of the 1996/97 New Zealand health survey, a cross-sectional, nationally representative survey of 7,862 adults (15 years and over). RESULTS: Overall, in the New Zealand population the questionnaire performed as well as or better than in other national surveys, but there was variability in data completeness across subgroups, and responses were skewed towards the healthy end of the scales. Males scored higher than females on almost all scales; increasing age was associated with decreasing scores (with the exception of the mental health scale); and New Zealand Europeans tended to report better health than the other ethnic groups. CONCLUSIONS: Satisfactory psychometric performance was demonstrated for the SF-36 in the New Zealand population, but researchers need to find ways of increasing data completeness in population groups shown here to have lower completion rates. The questionnaire may be better at discriminating patient rather than population subgroups. The SF-36 normative data confirm in kind, if not in degree, population subgroup disparities in health status observed using objective measures. IMPLICATIONS: Overall, the SF-36 questionnaire appears to be a valid and reliable measure of health-related quality of life for the New Zealand population. However, this paper highlights issues for researchers using the SF-36, such as the skewed nature of responses obstained in a population sample.

Does the frame affect the picture? A study into how attitudes to screening for cancer are affected by the way benefits are expressed.

OBJECTIVE: To find out how presenting information about the benefits of screening for cancer in different ways affects an individual's decision to accept or reject screening. METHODS: A telephone survey of the Wellington region, New Zealand was carried out. RESULTS: A response rate of 75.6% was obtained. Respondents were most likely to accept screening when the benefits of screening were presented as a relative risk reduction. They were most likely to reject screening when the benefits were presented as numbers needed to screen to save on life. CONCLUSIONS: An individual's decision about screening for cancer is affected by the way the benefits are framed. Health professionals must choose between framing the benefits of screening in the most positive light, to enhance participation rates, and presenting information in such a way as to reduce framing effects--for example, by expressing the benefits in a variety of forms. Clearly there may be a tension between these approaches; the former is arguably manipulation, and the latter may enhance informed choice, but may also reduce participation rates in screening programmes.

Is confidence in immunisation declining?

There is no regular immunisation coverage information in New Zealand that is reliable. Immunisation benefit data do provide an indication of trends. The benefit data show a decline in coverage in 1997, after several years of improving coverage. The reasons for the decline are not known, but media reports which dented public and professional confidence in immunisation may have played a role.

Acute gastroenteritis diagnostic practices of New Zealand general practitioners.

AIMS: A sample of New Zealand general practitioners was surveyed to determine the laboratory referral practices of general practitioners for patients with acute gastroenteritis, with particular reference to viral gastroenteritis. METHODS: A mail questionnaire was sent to 209 general practitioners throughout New Zealand. RESULTS: The most important criteria for laboratory referral of a diarrhoeal specimen were prolonged duration of illness, presence of blood in the stool, a recent history of overseas travel, tramping or camping, shellfish consumption, or if the patient worked in the food, child care, or health care industries. Most general practitioners reported that they would refer diarrhoeal specimens from less than 25% of their patients with acute gastroenteritis. Requests for testing for viruses other than rotavirus were rare. CONCLUSION: The viral agents causing acute gastroenteritis were less likely to receive laboratory confirmation than other causes of gastroenteritis. On the basis of current laboratory investigation practices of general practitioners, foodborne viral gastroenteritis outbreaks are unlikely to be identified as such in New Zealand.

[Auditory evoked potentials by electric stimulation of the cochlea]. / Potentiels évoqués auditifs par stimulation électrique de la cochlée.

The recording of auditory brain stem potentials evoked by electrical stimulation of the cochlea is a part of our assessment protocol before pediatric cochlear implantation. It constitutes an objective and reproducible method to estimate the stimulability of the auditory system for candidates to cochlear implant. Ten children, aged from 3 to 12 years, with deep deafness of the 2nd and 3rd group with no response to ABR, undergone electric stimulation of the cochlea. All patients were anesthetized and paralyzed. Electric pulses are delivered by a cochlear stimulator, through a transtympanic needle electrode, placed in the promontory. We record responses on a Medelec "Saphire" computer. One of the main problem we try to solve is the stimulus artefact which occurs during the first ms. The other one is to be sure that the recorded responses are corresponding to the neural activity of the auditory nerve and the brainstem auditory pathway.