Publications by authors named "Jeroen Douwes"

120 Publications

Enhanced airway sensory nerve reactivity in non-eosinophilic asthma.

BMJ Open Respir Res 2021 Nov;8(1)

Centre for Public Health Research, Massey University, Wellington, New Zealand.

Background: Neural mechanisms may play an important role in non-eosinophilic asthma (NEA). This study compared airway sensory nerve reactivity, using capsaicin challenge, in eosinophilic asthma (EA) and NEA and non-asthmatics.

Methods: Thirty-eight asthmatics and 19 non-asthmatics (aged 14-21 years) underwent combined hypertonic saline challenge/sputum induction, fractional exhaled nitric oxide, atopy and spirometry tests, followed by capsaicin challenge. EA and NEA were defined using a sputum eosinophil cut-point of 2.5%. Airway hyperreactivity was defined as a ≥15% drop in FEV during saline challenge. Sensory nerve reactivity was defined as the lowest capsaicin concentration that evoked 5 (C5) coughs.

Results: Non-eosinophilic asthmatics (n=20) had heightened capsaicin sensitivity (lower C5) compared with non-asthmatics (n=19) (geometric mean C5: 58.3 µM, 95% CI 24.1 to 141.5 vs 193.6 µM, 82.2 to 456.0; p<0.05). NEA tended to also have greater capsaicin sensitivity than EA, with the difference in capsaicin sensitivity between NEA and EA being of similar magnitude (58.3 µM, 24.1 to 141.5 vs 191.0 µM, 70.9 to 514.0) to that observed between NEA and non-asthmatics; however, this did not reach statistical significance (p=0.07). FEV was significantly reduced from baseline following capsaicin inhalation in both asthmatics and non-asthmatics but no differences were found between subgroups. No associations with capsaicin sensitivity and atopy, sputum eosinophils, blood eosinophils, asthma control or treatment were observed.

Conclusion: NEA, but not EA, showed enhanced capsaicin sensitivity compared with non-asthmatics. Sensory nerve reactivity may therefore play an important role in the pathophysiology of NEA.
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http://dx.doi.org/10.1136/bmjresp-2021-000974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8565536PMC
November 2021

Airborne Fumigants and Residual Chemicals in Shipping Containers Arriving in New Zealand.

Ann Work Expo Health 2021 Oct 18. Epub 2021 Oct 18.

Centre for Public Health Research, Massey University, Wellington, New Zealand.

Background: Airborne fumigants and other hazardous chemicals inside unopened shipping containers may pose a risk to workers handling containers.

Methods: Grab air samples from 490 sealed containers arriving in New Zealand were analysed for fumigants and other hazardous chemicals. We also collected grab air samples of 46 containers immediately upon opening and measured the total concentration of volatile organic compounds in real-time during ventilation. Additive Mixture Values (AMV) were calculated using the New Zealand Workplace Exposure standard (WES) and ACGIH Threshold Limit Values (TLV) of the 8-h, time-weighted average (TWA) exposure limit. Regression analyses assessed associations with container characteristics.

Results: Fumigants were detectable in 11.4% of sealed containers, with ethylene oxide detected most frequently (4.7%), followed by methyl bromide (3.5%). Other chemicals, mainly formaldehyde, were detected more frequently (84.7%). Fumigants and other chemicals exceeded the WES/TLV in 6.7%/7.8%, and 7.8%/20.0% of all containers, respectively. Correspondingly, they more frequently exceeded '1' for the AMV-TLV compared to the AMV-WES (25.7% versus 7.8%). In samples taken upon opening of doors, fumigants were detected in both fumigated and non-fumigated containers, but detection frequencies and exceedances of the WES, TLV, and AMVs were generally higher in fumigated containers. Detection frequencies for other chemicals were similar in fumigated and non-fumigated containers, and only formaldehyde exceeded both the WES and TLV in both container groups. Volatile compounds in container air reduced rapidly during ventilation. Some cargo types (tyres; personal hygiene, beauty and medical products; stone and ceramics; metal and glass; and pet food) and countries of origin (China) were associated with elevated airborne chemical and fumigant concentrations.

Conclusion: Airborne chemicals in sealed containers frequently exceed exposure limits, both in fumigated and non-fumigated containers, and may contribute to short-term peak exposures of workers unloading or inspecting containers.
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http://dx.doi.org/10.1093/annweh/wxab090DOI Listing
October 2021

Levels and determinants of urinary phthalate metabolites in New Zealand children and adults.

Int J Hyg Environ Health 2021 09 9;238:113853. Epub 2021 Oct 9.

Research Centre for Hauora and Health, Massey University, Wellington, New Zealand.

Background: This first national biomonitoring survey of urinary phthalate metabolites in the New Zealand population aimed to provide baseline data, identify exposure determinants, and make comparisons with health-based exposure guidance values.

Methods: The survey conducted in 2014-2016 involved the collection of morning-void urine from 298 children (5-18 years) and 302 adults (20-65 years), 33% of Māori ethnicity. A questionnaire collected information on demographic factors and diet. Urine was analysed for creatinine, specific gravity, and 10 phthalate metabolites through liquid chromatography tandem-mass spectrometry (MMP; MEP; MBP iso+n; MBzP; MCHP; MEHP; MEOHP; MEHHP; MCPP; and MiNP). Determinants of exposure were assessed using multivariable linear regression.

Results: Detection frequencies exceeded 95% for metabolites of DEP, DEHP and DBP. The highest GM was observed for the DBP metabolite MBP iso+n (36.1 μg/L adults; 60.5 μg/L children), followed by the sum of three DEHP metabolites (MEHP+MEOHP+MEHHP: 19.0 μg/L adults; 37.0 μg/L children), and the DEP metabolite MEP (19.1 μg/L adults; 12.0 μg/L children). For most phthalate metabolites New Zealand levels were in the mid-range of internationally reported levels, while for DEP they were in the low range. Māori and non-Māori had similar levels. Children had higher GMs than adults for most metabolites, except for MEP. A proportion of children and adults exceeded the biomonitoring equivalents of health-based guidance values for DBP (0-16% and 0-3% respectively), and DEHP (0-0.7% and 0-0.3% respectively). Eating warm meals from plastic containers ≥2 times/week was associated with higher levels of DEHP metabolites, MBP iso+n, and MBzP.

Conclusion: Phthalate exposure is omnipresent in both children and adults in New Zealand. Exceedances of the biomonitoring equivalents for DBP and DEHP indicate that potential health effects from exposure to these phthalates cannot be excluded with sufficient certainty.
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http://dx.doi.org/10.1016/j.ijheh.2021.113853DOI Listing
September 2021

Ischaemic Heart Disease and Occupational Exposures: A Longitudinal Linkage Study in the General and Māori Populations of New Zealand.

Ann Work Expo Health 2021 Oct 9. Epub 2021 Oct 9.

Centre for Public Health Research, Massey University, Wellington, New Zealand.

Objectives: This study assessed associations between occupational exposures and ischaemic heart disease (IHD) for males and females in the general and Māori populations (indigenous people of New Zealand).

Methods: Two surveys of the general adult [New Zealand Workforce Survey (NZWS); 2004-2006; n = 3003] and Māori population (Māori NZWS; 2009-2010; n = 2107), with information on occupational exposures, were linked with administrative health data and followed-up until December 2018. Cox proportional hazards regression (adjusted for age, deprivation, and smoking) was used to assess associations between organizational factors, stress, and dust, chemical and physical exposures, and IHD.

Results: Dust [hazard ratio (HR) 1.6, 95%CI 1.1-2.4], smoke or fumes (HR 1.5, 1.0-2.3), and oils and solvents (HR 1.5, 1.0-2.3) were associated with IHD in NZWS males. A high frequency of awkward or tiring hand positions was associated with IHD in both males and females of the NZWS (HRs 1.8, 1.1-2.8 and 2.4, 1.1-5.0, respectively). Repetitive tasks and working at very high speed were associated with IHD among NZWS females (HRs 3.4, 1.1-10.4 and 2.6, 1.2-5.5, respectively). Māori NZWS females working with vibrating tools and those exposed to a high frequency of loud noise were more likely to experience IHD (HRs 2.3, 1.1-4.8 and 2.1, 1.0-4.4, respectively). Exposure to multiple dust and chemical factors was associated with IHD in the NZWS males, as was exposure to multiple physical factors in males and females of the NZWS.

Conclusions: Exposures associated with an elevated IHD risk included dust, smoke or fumes, oils and solvents, awkward grip or hand movements, carrying out repetitive tasks, working at very high speed, loud noise, and working with tools that vibrate. Results were not consistently observed for males and females and between the general and Māori populations.
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http://dx.doi.org/10.1093/annweh/wxab087DOI Listing
October 2021

Acceptability of human papillomavirus (HPV) self-sampling among never- and under-screened Indigenous and other minority women: a randomised three-arm community trial in Aotearoa New Zealand.

Lancet Reg Health West Pac 2021 Nov 7;16:100265. Epub 2021 Sep 7.

Research Centre for Hauora and Health, Massey University, PO Box 756, Wellington 6140, New Zealand.

Background: Internationally, self-sampling for human papillomavirus (HPV) has been shown to increase participation in cervical-cancer screening. In Aotearoa New Zealand, there are long-standing ethnic inequalities in cervical-cancer screening, incidence, and mortality, particularly for indigenous Māori women, as well as Pacific and Asian women.

Methods: We invited never- and markedly under-screened (≥5 years overdue) 30-69-year-old Māori, Pacific, and Asian women to participate in an open-label, three-arm, community-based, randomised controlled trial, with a nested sub-study. We aimed to assess whether two specific invitation methods for self-sampling improved screening participation over usual care among the least medically served populations Women were individually randomised 3:3:1 to: clinic-based self-sampling (CLINIC - invited to take a self-sample at their usual general practice); home-based self-sampling (HOME - mailed a kit and invited to take a self-sample at home); and usual care (USUAL - invited to attend a clinic for collection of a standard cytology sample). Neither participants nor research staff could be blinded to the intervention. In a subset of general practices, women who did not participate within three months of invitation were opportunistically invited to take a self-sample, either next time they attended a clinic or by mail.

Findings: We randomised 3,553 women: 1,574 to CLINIC, 1,467 to HOME, and 512 to USUAL. Participation was highest in HOME (14.6% among Māori, 8.8% among Pacific, and 18.5% among Asian) with CLINIC (7.0%, 5.3% and 6.9%, respectively) and USUAL (2.0%, 1.7% and 4.5%, respectively) being lower. In fully adjusted models, participation was statistically significantly more likely in HOME than USUAL: Māori OR=9.7, (95%CI 3.0-31.5); Pacific OR=6.0 (1.8-19.5); and Asian OR=5.1 (2.4-10.9). There were no adverse outcomes reported. After three months, 2,780 non-responding women were invited to participate in a non-randomised, opportunistic, follow-on substudy. After 6 months,192 (6.9%) additional women had taken a self-sample.

Interpretation: Using recruitment methods that mimic usual practice, we provide critical evidence that self-sampling increases screening among the groups of women (never and under-screened) who experience the most barriers in Aotearoa New Zealand, although the absolute level of participation through this population approach was modest. Follow-up for most women was routine but a small proportion required intensive support.

Trial Registration: ANZCTR Identifier: ACTRN12618000367246 (date registered 12/3/2018) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371741&isReview=true; UTN: U1111-1189-0531.

Funding: Health Research Council of New Zealand (HRC 16/405).

Protocol: http://publichealth.massey.ac.nz/assets/Uploads/Study-protocol-V2.1Self-sampling-for-HPV-screening-a-community-trial.pdf.
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http://dx.doi.org/10.1016/j.lanwpc.2021.100265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8427317PMC
November 2021

Cancer incidence in agricultural workers: Findings from an international consortium of agricultural cohort studies (AGRICOH).

Environ Int 2021 12 27;157:106825. Epub 2021 Aug 27.

Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.

Background: Agricultural work can expose workers to potentially hazardous agents including known and suspected carcinogens. This study aimed to evaluate cancer incidence in male and female agricultural workers in an international consortium, AGRICOH, relative to their respective general populations.

Methods: The analysis included eight cohorts that were linked to their respective cancer registries: France (AGRICAN: n = 128,101), the US (AHS: n = 51,165, MESA: n = 2,177), Norway (CNAP: n = 43,834), Australia (2 cohorts combined, Australian Pesticide Exposed Workers: n = 12,215 and Victorian Grain Farmers: n = 919), Republic of Korea (KMCC: n = 8,432), and Denmark (SUS: n = 1,899). For various cancer sites and all cancers combined, standardized incidence ratios (SIR) and 95% confidence intervals (CIs) were calculated for each cohort using national or regional rates as reference rates and were combined by random-effects meta-analysis.

Results: During nearly 2,800,000 person-years, a total of 23,188 cancers were observed. Elevated risks were observed for melanoma of the skin (number of cohorts = 3, meta-SIR = 1.18, CI: 1.01-1.38) and multiple myeloma (n = 4, meta-SIR = 1.27, CI: 1.04-1.54) in women and prostate cancer (n = 6, meta-SIR = 1.06, CI: 1.01-1.12), compared to the general population. In contrast, a deficit was observed for the incidence of several cancers, including cancers of the bladder, breast (female), colorectum, esophagus, larynx, lung, and pancreas and all cancers combined (n = 7, meta-SIR for all cancers combined = 0.83, 95% CI: 0.77-0.90). The direction of risk was largely consistent across cohorts although we observed large between-cohort variations in SIR for cancers of the liver and lung in men and women, and stomach, colorectum, and skin in men.

Conclusion: The results suggest that agricultural workers have a lower risk of various cancers and an elevated risk of prostate cancer, multiple myeloma (female), and melanoma of skin (female) compared to the general population. Those differences and the between-cohort variations may be due to underlying differences in risk factors and warrant further investigation of agricultural exposures.
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http://dx.doi.org/10.1016/j.envint.2021.106825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8484858PMC
December 2021

Objectively Measured Physical Activity Is Associated With Body Composition and Metabolic Profiles of Pacific and New Zealand European Women With Different Metabolic Disease Risks.

Front Physiol 2021 26;12:684782. Epub 2021 May 26.

School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand.

To assess associations between physical activity (PA), body composition, and biomarkers of metabolic health in Pacific and New Zealand European (NZE) women who are known to have different metabolic disease risks. Pacific ( = 142) or NZE ( = 162) women aged 18-45 years with a self-reported body mass index (BMI) of either 18.5-25.0 kg⋅m or ≥30.0 kg⋅m were recruited and subsequently stratified as either low (<35%) or high (≥35%) BF%, with approximately half of each group in either category. Seven-day accelerometery was used to assess PA levels. Fasting blood was analysed for biomarkers of metabolic health, and whole body dual-energy X-ray absorptiometry (DXA) was used to estimate body composition. Mean moderate-to-vigorous physical activity (MVPA; min⋅day) levels differed between BF% ( < 0.05) and ethnic ( < 0.05) groups: Pacific high- 19.1 (SD 15.2) and low-BF% 26.3 (SD 15.6) and NZE high- 30.5 (SD 19.1) and low-BF% 39.1 (SD 18.4). On average Pacific women in the low-BF% group engaged in significantly less total PA when compared to NZE women in the low-BF% group (133 cpm); no ethnic difference in mean total PA (cpm) between high-BF% groups were observed: Pacific high- 607 (SD 185) and low-BF% 598 (SD 168) and NZE high- 674 (SD 210) and low-BF% 731 (SD 179). Multiple linear regression analysis controlling for age and deprivation showed a significant inverse association between increasing total PA and fasting plasma insulin among Pacific women; every 100 cpm increase in total PA was associated with a 6% lower fasting plasma insulin; no significant association was observed in NZE women. For both Pacific and NZE women, there was an 8% reduction in fasting plasma insulin for every 10-min increase in MVPA ( ≤ 0.05). Increases in total PA and MVPA are associated with lower fasting plasma insulin, thus indicating a reduction in metabolic disease risk. Importantly, compared to NZE, the impact of increased total PA on fasting insulin may be greater in Pacific women. Considering Pacific women are a high metabolic disease risk population, these pre-clinical responses to PA may be important in this population; indicating promotion of PA in Pacific women should remain a priority.
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http://dx.doi.org/10.3389/fphys.2021.684782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188826PMC
May 2021

Total blood mercury and its determinants in New Zealand children and adults.

J Expo Sci Environ Epidemiol 2021 03 18;31(2):289-298. Epub 2021 Feb 18.

Centre for Public Health Research, Massey University, Wellington, New Zealand.

Background: Mercury is a widespread persistent environmental pollutant associated with adverse health effects.

Objective: This first national biomonitoring survey of blood total mercury (tHg) conducted in New Zealand aimed to provide baseline data and identify exposure determinants.

Methods: Blood was collected from 191 children (age 5-18 years) and 304 adults (20-65) in 2014-2016 and analysed for tHg using inductively coupled plasma mass spectrometry. Linear regression was used to assess associations with demographic and lifestyle factors.

Results: Blood mercury was detected in 93% of children and 99% of adults, with geometric means (GMs) of 0.86 and 1.65 µg/L, respectively. The 60-65-year olds had the highest GM (2.34 µg/L). Regression indicated that tHg was 40% higher in boys compared to girls. Eating fish ≥ 3 times/week (compared to ≤once/week) was associated with 2.7 and 1.7 times higher tHg in children and adults, respectively. Shellfish consumption was also associated with higher tHg. High daily tap water consumption (≥2 L for children, ≥3 L for adults) was associated with lower tHg. In adults, smoking and milk consumption were associated with higher tHg.

Significance: Fish and shellfish consumption is a strong determinant of New Zealanders blood tHg levels, with water and milk consumption possibly acting as modulating factors.
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http://dx.doi.org/10.1038/s41370-021-00296-7DOI Listing
March 2021

An empirical test of the biodiversity hypothesis: Exposure to plant diversity is associated with a reduced risk of childhood acute lymphoblastic leukemia.

Sci Total Environ 2021 May 10;768:144627. Epub 2021 Jan 10.

Center for Public Health Research, Massey University-Wellington Campus, PO Box 756, Wellington 6140, New Zealand. Electronic address:

The biodiversity hypothesis posits that declining biodiversity may be responsible, at least in part, for the global increase in immune diseases. However, few studies have been able to demonstrate a link between exposure to biodiversity and specific health outcomes. We test whether exposure to plant diversity protects against childhood acute lymphoblastic leukemia (ALL) by promoting immune maturation. Our sample consisted of all children born in New Zealand from 1998 to 2013 (n = 899,126; 264 ALL cases), which we followed from birth to age five. We calculated plant-diversity metrics using the Global Biodiversity Information Facility, which contains over two million geocoded plant records in New Zealand. Consistent with previous research, children who had always lived in an urban area, or who had an older mother, were at greater risk for ALL, whereas children with older siblings were at lower risk. In addition, we found that plant-diversity metrics based on the maximum number of plant genera a child was exposed to during the first two years of life were protective of ALL. Specifically, exposure to the highest tertile of plant diversity was associated with a reduction in ALL risk of 35% (95% CI: 11%-53%). Exposure to plant diversity, and associated microbial communities, may be a viable public-health intervention to reduce the risk of ALL and possibly other immune diseases.
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http://dx.doi.org/10.1016/j.scitotenv.2020.144627DOI Listing
May 2021

Reducing Ethnic and Geographic Inequities to Optimise New Zealand Stroke Care (REGIONS Care): Protocol for a Nationwide Observational Study.

JMIR Res Protoc 2021 Jan 12;10(1):e25374. Epub 2021 Jan 12.

Nelson-Malborough District Health Board, Neslon-Malborough, New Zealand.

Background: Stroke systems of care differ between larger urban and smaller rural settings and it is unclear to what extent this may impact on patient outcomes. Ethnicity influences stroke risk factors and care delivery as well as patient outcomes in nonstroke settings. Little is known about the impact of ethnicity on poststroke care, especially in Māori and Pacific populations.

Objective: Our goal is to describe the protocol for the Reducing Ethnic and Geographic Inequities to Optimise New Zealand Stroke Care (REGIONS Care) study.

Methods: This large, nationwide observational study assesses the impact of rurality and ethnicity on best practice stroke care access and outcomes involving all 28 New Zealand hospitals caring for stroke patients, by capturing every stroke patient admitted to hospital during the 2017-2018 study period. In addition, it explores current access barriers through consumer focus groups and consumer, carer, clinician, manager, and policy-maker surveys. It also assesses the economic impact of care provided at different types of hospitals and to patients of different ethnicities and explores the cost-efficacy of individual interventions and care bundles. Finally, it compares manual data collection to routine health administrative data and explores the feasibility of developing outcome models using only administrative data and the cost-efficacy of using additional manually collected registry data. Regarding sample size estimates, in Part 1, Study A, 2400 participants are needed to identify a 10% difference between up to four geographic subgroups at 90% power with an α value of .05 and 10% to 20% loss to follow-up. In Part 1, Study B, a sample of 7645 participants was expected to include an estimated 850 Māori and 419 Pacific patients and to provide over 90% and over 80% power, respectively. Regarding Part 2, 50% of the patient or carer surveys, 40 provider surveys, and 10 focus groups were needed to achieve saturation of themes. The main outcome is the modified Rankin Scale (mRS) score at 3 months. Secondary outcomes include mRS scores; EQ-5D-3L (5-dimension, 3-level EuroQol questionnaire) scores; stroke recurrence; vascular events; death; readmission at 3, 6, and 12 months; cost of care; and themes around access barriers.

Results: The study is underway, with national and institutional ethics approvals in place. A total of 2379 patients have been recruited for Part 1, Study A; 6837 patients have been recruited for Part 1, Study B; 10 focus groups have been conducted and 70 surveys have been completed in Part 2. Data collection has essentially been completed, including follow-up assessment; however, primary and secondary analyses, data linkage, data validation, and health economics analysis are still underway.

Conclusions: The methods of this study may provide the basis for future epidemiological studies that will guide care improvements in other countries and populations.

International Registered Report Identifier (irrid): DERR1-10.2196/25374.
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http://dx.doi.org/10.2196/25374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838000PMC
January 2021

Association between home insulation and hospital admission rates: retrospective cohort study using linked data from a national intervention programme.

BMJ 2020 12 29;371:m4571. Epub 2020 Dec 29.

Centre for Public Health Research, Massey University Wellington, New Zealand.

Objectives: To investigate whether retrofitting insulation into homes can reduce cold associated hospital admission rates among residents and to identify whether the effect varies between different groups within the population and by type of insulation.

Design: A quasi-experimental retrospective cohort study using linked datasets to evaluate a national intervention programme.

Participants: 994 317 residents of 204 405 houses who received an insulation subsidy through the Energy Efficiency and Conservation Authority Warm-up New Zealand: Heat Smart retrofit programme between July 2009 and June 2014.

Main Outcome Measure: A difference-in-difference approach was used to compare the change in hospital admissions of the study population post-insulation with the change in hospital admissions of the control population that did not receive the intervention over the same two timeframes. Relative rate ratios were used to compare the two groups.

Results: 234 873 hospital admissions occurred during the study period. Hospital admission rates after the intervention increased in the intervention and control groups for all population categories and conditions with the exception of acute hospital admissions among Pacific Peoples (rate ratio 0.94, 95% confidence interval 0.90 to 0.98), asthma (0.92, 0.86 to 0.99), cardiovascular disease (0.90, 0.88 to 0.93), and ischaemic heart disease for adults older than 65 years (0.79, 0.74 to 0.84). Post-intervention increases were, however, significantly lower (11%) in the intervention group compared with the control group (relative rate ratio 0.89, 95% confidence interval 0.88 to 0.90), representing 9.26 (95% confidence interval 9.05 to 9.47) fewer hospital admissions per 1000 in the intervention population. Effects were more pronounced for respiratory disease (0.85, 0.81 to 0.90), asthma in all age groups (0.80, 0.70 to 0.90), and ischaemic heart disease in those older than 65 years (0.75, 0.66 to 0.83).

Conclusion: This study showed that a national home insulation intervention was associated with reduced hospital admissions, supporting previous research, which found an improvement in self-reported health.
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http://dx.doi.org/10.1136/bmj.m4571DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7770561PMC
December 2020

House characteristics and condition as determinants of visible mold and musty odor: Results from three New Zealand House Condition Surveys in 2005, 2010, and 2015.

Indoor Air 2020 Dec 17. Epub 2020 Dec 17.

Centre for Public Health Research, Massey University, Wellington Campus, Wellington, New Zealand.

This study assessed associations between house characteristics and mold and musty odor, using data from three consecutive (2005, 2010, and 2015) New Zealand House Condition Surveys, involving a total of 1616 timber-framed houses. Mold, musty odor, and house characteristics were assessed by independent building inspectors. We used multivariate logistic regression analyses mutually adjusted for other house characteristics for each survey separately. Positive and independent associations were found with tenure, ventilation, insulation, and envelope condition for both mold in living and bedrooms and musty odor. In particular, we found significant dose-response associations with envelope condition, ventilation, and insulation. Odds of mold increased 2.4-15.9 times (across surveys) in houses with the worst building envelope condition (BEC; p < 0.05-0.001 for trend); optimal ventilation reduced the risk of mold by 60% and the risk of musty odor by 70%-90% (p < 0.01 for trend). Other factors associated with mold and musty odor included: tenure, with an approximate doubling of odds of mold across surveys; and insulation with consistent dose-response patterns in all outcomes and surveys tested (p < 0.05 for trend in two surveys with mold and one survey for odor). In conclusion, this study showed the importance of BEC, ventilation, and insulation to avoiding harmful damp-related exposures.
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http://dx.doi.org/10.1111/ina.12774DOI Listing
December 2020

New Zealand hospital stroke service provision.

N Z Med J 2020 12 4;133(1526):18-30. Epub 2020 Dec 4.

Associate Professor of Neurology and Head of Department, Department of Medicine, University of Otago, Wellington; Consultant Neurologist, Department of Neurology, Capital and Coast District Health Board, Wellington.

Aim: To describe stroke services currently offered in New Zealand hospitals and compare service provision in urban and non-urban settings.

Method: An online questionnaire was sent to stroke lead clinicians at all New Zealand District Health Boards (DHBs). Questions covered number and location of stroke inpatients, stroke service configuration, use of guidelines/protocols, staffing mix, access to staff education, and culture appropriate care.

Results: There were responses from all 20 DHBs. Differences between urban and non-urban hospitals included: access to acute stroke units (55.6% non-urban vs 100% urban; p=0.013), stroke clinical nurse specialists (50% vs 90%; p=0.034), stroke clot retrieval (38.9% vs 80%; p=0.037) and Pacific support services (55.6% vs 100%; p=0.030). There were also differences in carer training (66.7% non-urban vs 100% urban; p=0.039) and goal-specific rehabilitation plans in the community (61.1% vs 100%; p=0.023). Access to TIA services, stroke rehabilitation units, early supported discharge, psychologists, continuing staff education, and culturally responsive stroke care were suboptimal irrespective of hospital location.

Conclusion: Hospital location is associated with differences in stroke services provision across New Zealand and ongoing work is required to optimise consistent access to best practice care. These results, in conjunction with an ongoing (REGIONS Care) study, will be used to determine whether this affects patient outcomes.
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December 2020

Carriage of Extended-Spectrum-Beta-Lactamase- and AmpC Beta-Lactamase-Producing Escherichia coli Strains from Humans and Pets in the Same Households.

Appl Environ Microbiol 2020 11 24;86(24). Epub 2020 Nov 24.

EpiLab, School of Veterinary Science, Massey University, Palmerston North, New Zealand

Extended-spectrum-beta-lactamase (ESBL)- or AmpC beta-lactamase (ACBL)-producing bacteria are the most common cause of community-acquired multidrug-resistant urinary tract infections (UTIs) in New Zealand. The carriage of antimicrobial-resistant bacteria has been found in both people and pets from the same household; thus, the home environment may be a place where antimicrobial-resistant bacteria are shared between humans and pets. In this study, we sought to determine whether members (pets and people) of the households of human index cases with a UTI caused by an ESBL- or ACBL-producing strain also carried an ESBL- or ACBL-producing strain and, if so, whether it was a clonal match to the index case clinical strain. Index cases with a community-acquired UTI were recruited based on antimicrobial susceptibility testing of urine isolates. Fecal samples were collected from 18 non-index case people and 36 pets across 27 households. Eleven of the 27 households screened had non-index case household members (8/18 people and 5/36 animals) positive for ESBL- and/or ACBL-producing strains. Whole-genome sequence analysis of 125 isolates (including the clinical urine isolates) from these 11 households showed that within seven households, the same strain of ESBL-/ACBL-producing was cultured from both the index case and another person (5/11 households) or pet dog (2/11 households). These results suggest that transmission within the household may contribute to the community spread of ESBL- or ACBL-producing that produce extended-spectrum beta-lactamases (ESBLs) and AmpC beta-lactamases (ACBLs) are important pathogens and can cause community-acquired illnesses, such as urinary tract infections (UTIs). Fecal carriage of these resistant bacteria by companion animals may pose a risk for transmission to humans. Our work evaluated the sharing of ESBL- and ACBL-producing isolates between humans and companion animals. We found that in some households, dogs carried the same strain of ESBL-producing as the household member with a UTI. This suggests that transmission events between humans and animals (or vice versa) are likely occurring within the home environment and, therefore, the community as a whole. This is significant from a health perspective, when considering measures to minimize community transmission, and highlights that in order to manage community spread, we need to consider interventions at the household level.
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http://dx.doi.org/10.1128/AEM.01613-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7688229PMC
November 2020

Associations of Occupational Exposures to Electric Shocks and Extremely Low-Frequency Magnetic Fields With Motor Neurone Disease.

Am J Epidemiol 2021 02;190(3):393-402

In a New Zealand population-based case-control study we assessed associations with occupational exposure to electric shocks, extremely low-frequency magnetic fields (ELF-MF) and motor neurone disease using job-exposure matrices to assess exposure. Participants were recruited between 2013 and 2016. Associations with ever/never, duration, and cumulative exposure were assessed using logistic regression adjusted for age, sex, ethnicity, socioeconomic status, education, smoking, alcohol consumption, sports, head or spine injury, and solvents, and was mutually adjusted for the other exposure. All analyses were repeated stratified by sex. An elevated risk was observed for having ever worked in a job with potential for electric shocks (odds ratio (OR) = 1.35, 95% confidence interval (CI): 0.98, 1.86), with the strongest association for the highest level of exposure (OR = 2.01, 95% CI: 1.31, 3.09). Analysis by duration suggested a nonlinear association: Risk was increased for both short duration (<3 years; OR = 4.69, 95% CI: 2.25, 9.77) and long duration (>24 years; OR = 1.88; 95% CI: 1.05, 3.36) in a job with high level of electric shock exposure, with less pronounced associations for intermediate durations. No association with ELF-MF was found. Our findings provide support for an association between occupational exposure to electric shocks and motor neurone disease but did not show associations with exposure to work-related ELF-MF.
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http://dx.doi.org/10.1093/aje/kwaa214DOI Listing
February 2021

Pacific meets west in addressing palliative care for Pacific populations in Aotearoa/New Zealand: a qualitative study.

BMC Palliat Care 2020 Jul 8;19(1):100. Epub 2020 Jul 8.

Centre for Public Health Research, Massey University, Wellington Campus, PO Box 756, Wellington, 6140, New Zealand.

Background: While many Aotearoa/New Zealanders are receiving excellent palliative care the Pacific populations have limited access to available hospice and palliative care services. Little research has been conducted to identify barriers unique to Pacific populations accessing these services. The purpose of this study was to explore key stakeholders' perspectives on the determinants of low access among Pacific populations to these services.

Methods: Forty-five semi-structured interviews were conducted face-to-face with hospice patients and their families, hospice/health providers and key informants from the Auckland and Wellington region of Aotearoa/New Zealand. The interviews were recorded and transcribed verbatim and a thematic analysis was carried out by identifying, coding and categorising patterns in the data. Identified themes were then discussed further to determine the relevance of the data grouped by theme.

Results: Five interrelated themes affecting access emerged: perception of hospice (often negative) through lack of accurate information, but changing; families' role to look after their own and sick elderly; hospice experiences; continuity of care in the community and the need for information and communication.

Conclusion: Hospice and associated palliative care services are under-utilised and commonly misunderstood among Pacific populations in Aotearoa/New Zealand. There is active support following appropriate information received, hence the need for community education and culturally appropriate hospice and palliative services. Inadequate inter-professional communication contributes to polypharmacy and inefficiency in continuity of care across all levels. The Pacific individual is one component of a collective that is critical in major decisions in end-of-life and life changing situations. The findings may guide policies and further research to improve Hospice and Palliative services in Aotearoa/New Zealand.
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http://dx.doi.org/10.1186/s12904-020-00604-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7346658PMC
July 2020

Exposures to Fumigants and Residual Chemicals in Workers Handling Cargo from Shipping Containers and Export Logs in New Zealand.

Ann Work Expo Health 2020 10;64(8):826-837

Centre for Public Health Research, Massey University, Wellington, New Zealand.

Objectives: Previous studies have reported high concentrations of airborne fumigants and other chemicals inside unopened shipping containers, but it is unclear whether this is reflective of worker exposures.

Methods: We collected personal 8-h air samples using a whole-air sampling method. Samples were analysed for 1,2-dibromoethane, chloropicrin, ethylene oxide, hydrogen cyanide, hydrogen phosphide, methyl bromide, 1,2-dichloroethane, C2-alkylbenzenes, acetaldehyde, ammonia, benzene, formaldehyde, methanol, styrene, and toluene. Additive Mixture Values (AMVs) were calculated using the New Zealand Workplace Exposure standard (WES) and American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Values (TLVs) of the 8-h, time-weighted average exposure limit. Linear regression was conducted to assess associations with work characteristics.

Results: We included 133 workers handling shipping containers, 15 retail workers unpacking container goods, 40 workers loading fumigated and non-fumigated export logs, and 5 fumigators. A total of 193 personal 8-h air measurements were collected. Exposures were generally low, with >50% below the limit of detection for most chemicals, and none exceeding the NZ WES, although formaldehyde exceeded the TLV in 26.2% of all measurements. The AMV-TLV threshold of 1 was exceeded in 29.0% of the measurements. Levels and detection frequencies of most chemicals varied little between occupational groups, although exposure to methyl bromide was highest in the fumigators (median 43 ppb) without exceeding the TLV of 1000 ppb. Duration spent inside the container was associated with significantly higher levels of ethylene oxide, C2-alkylbenzenes, and acetaldehyde, but levels were well below the TLV/WES. Exposure levels did not differ between workers handling fumigated and non-fumigated containers.

Conclusions: Personal exposures of workers handling container cargo in New Zealand were mainly below current exposure standards, with formaldehyde the main contributor to overall exposure. However, as it is not clear whether working conditions of participants included in this study were representative of this industry as a whole, and not all relevant exposures were measured, we cannot exclude the possibility that high exposures may occur in some workers.
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http://dx.doi.org/10.1093/annweh/wxaa052DOI Listing
October 2020

The Prevalence of Cardiovascular Risk Factors in Different Occupational Groups in New Zealand.

Ann Work Expo Health 2020 07;64(6):645-658

Centre for Public Health Research, Massey University, Wellington, New Zealand.

Objectives: Although cardiovascular disease (CVD) risk has been shown to differ between occupations, few studies have specifically evaluated the distribution of known CVD risk factors across occupational groups. This study assessed CVD risk factors in a range of occupational groups in New Zealand, stratified by sex and ethnicity.

Methods: Two probability-based sample surveys of the general New Zealand adult population (2004-2006; n = 3003) and of the indigenous people of New Zealand (Māori; 2009-2010; n = 2107), for which occupational histories and lifestyle factors were collected, were linked with routinely collected health data. Smoking, body mass index, deprivation, diabetes, high blood pressure, and high cholesterol were dichotomized and compared between occupational groups using age-adjusted logistic regression.

Results: The prevalence of all known CVD risk factors was greater in the Māori survey than the general population survey, and in males compared with females. In general for men and women in both surveys 'Plant and machine operators and assemblers' and 'Elementary workers' were more likely to experience traditional CVD risk factors, while 'Professionals' were less likely to experience these risk factors. 'Clerks' were more likely to have high blood pressure and male 'Agricultural and fishery workers' in the general survey were less likely to have high cholesterol, but this was not observed in the Māori survey. Male Māori 'Trades workers' were less likely to have high cholesterol and were less obese, while for the general population survey, this was not observed.

Conclusions: This study showed differences in the distribution of known CVD risk factors across occupational groups, as well as between ethnic groups and males and females.
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http://dx.doi.org/10.1093/annweh/wxaa040DOI Listing
July 2020

Gender differences in respiratory health outcomes among farming cohorts around the globe: findings from the AGRICOH consortium.

J Agromedicine 2021 04 17;26(2):97-108. Epub 2020 Mar 17.

Monash Centre for Occupational and Environmental Health (MonCOEH), Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.

: Respiratory hazards of farming have been identified for centuries, with little focus on gender differences. We used data from the AGRICOH consortium, a collective of prospective cohorts of agricultural workers, to assess respiratory disease prevalence among adults in 18 cohorts representing over 200,000 farmers, farm workers, and their spouses from six continents.: Cohorts collected data between 1992 and 2016 and ranged in size from 200 to >128,000 individuals; 44% of participants were female. Farming practices varied from subsistence farming to large-scale industrial agriculture. All cohorts provided respiratory outcome information for their cohort based on their study definitions. The majority of outcomes were based on self-report using standard respiratory questionnaires; the greatest variability in assessment methods was associated with chronic obstructive pulmonary disease (COPD).: For all three respiratory symptoms (cough, phlegm, and wheeze), the median prevalence in men was higher than in women, with the greatest difference for phlegm (17% vs. 10%). For asthma, women had a higher prevalence (7.8% vs 6.5%), with the difference associated with allergic asthma. The relative proportion of allergic asthma varied among cohorts. In two of eight cohorts for women and two of seven cohorts for men, allergic asthma was more common than non-allergic asthma.: These findings indicate that respiratory outcomes are common among farmers around the world despite differences in agricultural production. As women in the general population are at higher risk of asthma, exploring gender differences in occupational studies is critical for a deeper understanding of respiratory disease among agricultural workers.
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http://dx.doi.org/10.1080/1059924X.2020.1713274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7494561PMC
April 2021

Respiratory health in professional cleaners: Symptoms, lung function, and risk factors.

Clin Exp Allergy 2020 05 31;50(5):567-576. Epub 2020 Mar 31.

Centre for Public Health Research, Massey University, Wellington, New Zealand.

Background: Cleaning is associated with an increased risk of asthma symptoms, but few studies have measured functional characteristics of airway disease in cleaners.

Aims: To assess and characterize respiratory symptoms and lung function in professional cleaners, and determine potential risk factors for adverse respiratory outcomes.

Methods: Symptoms, pre-/post-bronchodilator lung function, atopy, and cleaning exposures were assessed in 425 cleaners and 281 reference workers in Wellington, New Zealand between 2008 and 2010.

Results: Cleaners had an increased risk of current asthma (past 12 months), defined as: woken by shortness of breath, asthma attack, or asthma medication (OR = 1.83, 95% CI = 1.18-2.85). Despite this, they had similar rates of current wheezing (OR = 0.93, 95% CI = 0.65-1.32) and were less likely to have a doctor diagnosis of asthma ever (OR = 0.62, 95% CI = 0.42-0.92). Cleaners overall had lower lung function (FEV , FVC; P < .05). Asthma in cleaners was associated with less atopy (OR = 0.35, 95% CI = 0.13-0.90), fewer wheezing attacks (OR = 0.40, 95% CI = 0.17-0.97; >3 vs ≤3 times/year), and reduced bronchodilator response (6% vs 9% mean FEV -%-predicted change, P < .05) compared to asthma in reference workers. Cleaning of cafes/restaurants/kitchens and using upholstery sprays or liquid multi-use cleaner was associated with symptoms, whilst several exposures were also associated with lung function deficits (P < .05).

Conclusions And Clinical Relevance: Cleaners are at risk of some asthma-associated symptoms and reduced lung function. However, as it was not strongly associated with wheeze and atopy, and airway obstruction was less reversible, asthma in some cleaners may represent a distinct phenotype.
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http://dx.doi.org/10.1111/cea.13597DOI Listing
May 2020

Where are we at with lead? Current levels, time trend, and determinants of blood lead in New Zealand children and adults.

Int J Hyg Environ Health 2020 04 30;225:113468. Epub 2020 Jan 30.

Centre for Public Health Research, Massey University. PO Box 756, Wellington, 6140, New Zealand.

Aims: A national biomonitoring survey was conducted in 2014-2016, to determine current blood lead levels (BLL) in New Zealand children and adults and identify determinants of BLL.

Methods: Blood samples were provided by 191 children (age 5-18) and 304 adults (age 20-65) and analysed for BLL using inductively coupled mass spectroscopy. Linear regression on log-transformed BLL was used to assess associations between BLL and demographic and lifestyle factors collected via questionnaire.

Results: The geometric mean (GM) BLL was 0.86 μg/dl (95%CI 0.80-0.92) for children and 1.31 μg/dl (1.23-1.39) for adults, representing a 90% reduction in BLL over the past 36 years. For children, shellfish consumption was associated with 20% higher BLL. Adult BLLs were positively associated with age, beer consumption, spirits consumption, having roof water as the home's water supply, and having worked in glass manufacturing. Determinants of reduced BLL were tofu and canned food consumption. For women, menopause was associated with 34% higher BLL.

Conclusions: Although significant reductions in New Zealanders' BLL have been achieved in the past decades, this study identified several additional opportunities to reduce further background exposure to lead. In particular, consideration needs to be given to reducing lead levels in New Zealand roof water supplies.
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http://dx.doi.org/10.1016/j.ijheh.2020.113468DOI Listing
April 2020

Exposure Determinants of Wood Dust, Microbial Components, Resin Acids and Terpenes in the Saw- and Planer Mill Industry.

Ann Work Expo Health 2020 03;64(3):282-296

Centre for Public Health Research, Massey University, Wellington Campus, Wellington, New Zealand.

Objectives: Sawmill workers have an increased risk of adverse respiratory outcomes, but knowledge about exposure-response relationships is incomplete. The objective of this study was to assess exposure determinants of dust, microbial components, resin acids, and terpenes in sawmills processing pine and spruce, to guide the development of department and task-based exposure prediction models.

Methods: 2474 full-shift repeated personal airborne measurements of dust, resin acids, fungal spores and fragments, endotoxins, mono-, and sesquiterpenes were conducted in 10 departments of 11 saw- and planer mills in Norway in 2013-2016. Department and task-based exposure determinants were identified and geometric mean ratios (GMRs) estimated using mixed model regression. The effects of season and wood type were also studied.

Results: The exposure ratio of individual components was similar in many of the departments. Nonetheless, the highest microbial and monoterpene exposure (expressed per hour) were estimated in the green part of the sawmills: endotoxins [GMR (95% confidence interval) 1.2 (1.0-1.3)], fungal spores [1.1 (1.0-1.2)], and monoterpenes [1.3 (1.1-1.4)]. The highest resin acid GMR was estimated in the dry part of the sawmills [1.4 (1.2-1.5)]. Season and wood type had a large effect on the estimated exposure. In particular, summer and spruce were strong determinants of increased exposure to endotoxin (GMRs [4.6 (3.5-6.2)] and [2.0 (1.4-3.0)], respectively) and fungal spores (GMRs [2.2 (1.7-2.8)] and [1.5 (1.0-2.1)], respectively). Pine was a strong determinant for increased exposure to both resin acid and monoterpenes. Work as a boilerman was associated with moderate to relatively high exposure to all components [1.0-1.4 (0.8-2.0)], although the estimates were based on 13-15 samples only. Cleaning in the saw, planer, and sorting of dry timber departments was associated with high exposure estimates for several components, whereas work with transportation and stock/finished goods were associated with low exposure estimates for all components. The department-based models explained 21-61% of the total exposure variances, 0-90% of the between worker (BW) variance, and 1-36% of the within worker (WW) variances. The task-based models explained 22-62% of the total variance, 0-91% of the BW variance, and 0-33% of the WW variance.

Conclusions: Exposure determinants in sawmills including department, task, season, and wood type differed for individual components, and explained a relatively large proportion of the total variances. Application of department/task-based exposure prediction models for specific exposures will therefore likely improve the assessment of exposure-response associations.
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http://dx.doi.org/10.1093/annweh/wxz096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064270PMC
March 2020

Comparison of two invitation-based methods for human papillomavirus (HPV) self-sampling with usual care among un- and under-screened Māori, Pacific and Asian women: study protocol for a randomised controlled community trial to examine the effect of self-sampling on participation in cervical-cancer screening.

BMC Cancer 2019 12 9;19(1):1198. Epub 2019 Dec 9.

Centre for Public Health Research, Massey University, Wellington, New Zealand.

Background: Māori, Pacific and Asian women in New Zealand have lower cervical-cancer screening rates than European women, and there are persistent inequities in cervical cancer outcomes for Māori and Pacific women. Innovative ways to address access barriers are required. New Zealand is transitioning to screening with human papillomavirus (HPV) DNA testing, which could allow women themselves, rather than a clinician, to take the sample. Internationally, self-sampling has been found to increase screening participation rates. The aim of this open-label community-based randomised controlled trial is to investigate whether self-sampling increases screening participation among un- and under-screened Māori, Pacific and Asian women in New Zealand.

Methods/design: We aim to invite at least 3550 un- or under-screened (≥5 years overdue) Māori, Pacific and Asian women (1050, 1250, 1250 respectively), aged 30-69 years, for screening. The three study arms are: usual care in which women are invited to attend a clinic for a standard clinician-collected cytology test; clinic-based self-sampling in which women are invited to take a self-sample at their usual general practice; and mail-out self-sampling in which women are mailed a kit and invited to take a self-sample at home. Women will be randomised 3:3:1 to the clinic and mail-out self-sampling groups, and usual care. There is also a nested sub-study in which non-responding women in all allocation groups, when they subsequently present to the clinic for other reasons, are offered clinic or home-kit self-sampling. The primary outcome will be the proportion of women who participate (by taking a self-sample or cytology test).

Discussion: This trial is the first to evaluate the effectiveness of mailed self-sampling in New Zealand and will be one of the first internationally to evaluate the effectiveness of opportunistic in-clinic invitations for self-sampling. The trial will provide robust evidence on the impact on participation proportions from different invitation approaches for HPV self-sampling in New Zealand un- and under-screened Māori, Pacific and Asian women.

Trial Registration: ANZCTR Identifier: ACTRN12618000367246 (date registered 12/3/2018) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371741&isReview=true; UTN: U1111-1189-0531.
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http://dx.doi.org/10.1186/s12885-019-6401-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6902319PMC
December 2019

Measuring stroke and transient ischemic attack burden in New Zealand: Protocol for the fifth Auckland Regional Community Stroke Study (ARCOS V).

Int J Stroke 2020 07 24;15(5):573-583. Epub 2019 Oct 24.

Centre for Public Health Research, Massey University, Wellington, New Zealand.

The goal of this paper is to provide a protocol for conducting a fifth population-based Auckland Regional Community Stroke study (ARCOS V) in New Zealand. : In this study, for the first time globally, (1) stroke and TIA burden will be determined using the currently used clinical and tissue-based definition of stroke, in addition to the WHO clinical classifications of stroke used in all previous ARCOS studies, as well as more advanced criteria recently suggested for an "ideal" population-based stroke incidence and outcomes study; and (2) age, sex, and ethnic-specific trends in stroke incidence and outcomes will be determined over the last four decades, including changes in the incidence of acute cerebrovascular events over the last decade. Furthermore, information at four time points over a 40-year period will allow the assessment of effects of recent changes such as implementation of the FAST campaign, ambulance pre-notification, and endovascular treatment. This will enable more accurate projections for health service planning and delivery. The methods of this study will provide a foundation for future similar population-based studies in other countries and populations.
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http://dx.doi.org/10.1177/1747493019884528DOI Listing
July 2020

Relationship between exposure to the natural environment and recovery from hip or knee arthroplasty: a New Zealand retrospective cohort study.

BMJ Open 2019 09 20;9(9):e029522. Epub 2019 Sep 20.

Centre for Public Health Research, Massey University, Wellington, New Zealand.

Objectives: Determine whether patients who live in greener and more walkable neighbourhoods live longer, and take fewer opioids, following hip or knee arthroplasty.

Design: Retrospective cohort study.

Setting: Residential environment following surgery at one of 54 New Zealand hospitals.

Participants: All people who received a total hip or knee arthroplasty at a publicly-funded hospital in New Zealand in 2006 and 2007 (7449 hip arthroplasties and 6558 knee arthroplasties).

Primary And Secondary Outcome Measure: Time to all-cause mortality and number of postsurgical opioid prescriptions.

Results: Patients who lived in greener neighbourhoods, as measured by the Normalised Difference Vegetation Index, lived longer following hip or knee arthroplasty (standardised OR: 0.95, 95% CI 0.92 to 0.99). However, when we estimated separate hip-arthroplasty-only and knee-arthroplasty-only models, greenness was only significantly associated with greater longevity following hip arthroplasty. Similarly, patients who lived in greener neighbourhoods took fewer opioids in the 12 months following hip or knee arthroplasty (standardised OR: 0.97, 95% CI 0.95 to 0.99), but in separate hip-arthroplasty-only and knee-arthroplasty-only models, greenness was only significantly associated with lower opioid use following hip arthroplasty. Walkability was not significantly associated with postsurgical opioid use or postsurgical longevity. All ORs were adjusted for sex, ethnicity, age, presurgical chronic health conditions, presurgical opioid use, social deprivation and length of hospital stay.

Conclusions: Consistent with the literature on enhanced-recovery programme, people who lived in greener neighbourhoods took fewer opioids, and lived longer, following hip arthroplasty. Improving access to the natural environment may therefore be an effective component of postsurgical recovery programme.
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http://dx.doi.org/10.1136/bmjopen-2019-029522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756456PMC
September 2019

Predictors Linking Obesity and the Gut Microbiome (the PROMISE Study): Protocol and Recruitment Strategy for a Cross-Sectional Study on Pathways That Affect the Gut Microbiome and Its Impact on Obesity.

JMIR Res Protoc 2019 Aug 26;8(8):e14529. Epub 2019 Aug 26.

School of Exercise, Sport and Nutrition, College of Health, Massey University, Auckland, New Zealand.

Background: The prevalence of obesity has increased substantially over recent decades and is associated with considerable health inequalities. Although the causes of obesity are complex, key drivers include overconsumption of highly palatable, energy-dense, and nutrient-poor foods, which have a profound impact on the composition and function of the gut microbiome. Alterations to the microbiome may play a critical role in obesity by affecting energy extraction from food and subsequent energy metabolism and fat storage.

Objective: We report the study protocol and recruitment strategy of the PRedictors linking Obesity and the gut MIcrobiomE (PROMISE) study, which characterizes the gut microbiome in 2 populations with different metabolic disease risk (Pacific and European women) and different body fat profiles (normal and obese). It investigates (1) the role of gut microbiome composition and functionality in obesity and (2) the interactions between dietary intake; eating behavior; sweet, fat, and bitter taste perception; and sleep and physical activity; and their impact on the gut microbiome, metabolic and endocrine regulation, and body fat profiles.

Methods: Healthy Pacific and New Zealand (NZ) European women aged between 18 and 45 years from the Auckland region were recruited for this cross-sectional study. Participants were recruited such that half in each group had either a normal weight (body mass index [BMI] 18.5-24.9 kg/m) or were obese (BMI ≥30.0 kg/m). In addition to anthropometric measurements and assessment of the body fat content using dual-energy x-ray absorptiometry, participants completed sweet, fat, and bitter taste perception tests; food records; and sleep diaries; and they wore accelerometers to assess physical activity and sleep. Fasting blood samples were analyzed for metabolic and endocrine biomarkers and DNA extracted from fecal samples was analyzed by shotgun sequencing. Participants completed questionnaires on dietary intake, eating behavior, sleep, and physical activity. Data were analyzed using descriptive and multivariate regression methods to assess the associations between dietary intake, taste perception, sleep, physical activity, gut microbiome complexity and functionality, and host metabolic and body fat profiles.

Results: Of the initial 351 women enrolled, 142 Pacific women and 162 NZ European women completed the study protocol. A partnership with a Pacific primary health and social services provider facilitated the recruitment of Pacific women, involving direct contact methods and networking within the Pacific communities. NZ European women were primarily recruited through Web-based methods and special interest Facebook pages.

Conclusions: This cross-sectional study will provide a wealth of data enabling the identification of distinct roles for diet, taste perception, sleep, and physical activity in women with different body fat profiles in modifying the gut microbiome and its impact on obesity and metabolic health. It will advance our understanding of the etiology of obesity and guide future intervention studies involving specific dietary approaches and microbiota-based therapies.

Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000432213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370874.

International Registered Report Identifier (irrid): RR1-10.2196/14529.
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http://dx.doi.org/10.2196/14529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732966PMC
August 2019

Acceptability of human papillomavirus self-sampling for cervical-cancer screening in under-screened Māori and Pasifika women: a pilot study.

N Z Med J 2019 06 21;132(1497):21-31. Epub 2019 Jun 21.

Professor and Director, Centre for Public Health Research, Massey University, Wellington.

Aim: To assess whether self-sampling for cervical-cancer screening is acceptable to New Zealand women.

Methods: Māori, Pacific and Asian un- or under-screened women aged 30-69 years were asked to: 1) examine three self-sampling devices; 2) complete a questionnaire on demographics and experiences with the devices; and 3) take a self-sample. Samples were tested 'off-label' using the cobas® 4800 human papillomavirus (HPV) test (Roche Diagnostics NZ).

Results: Thirty-one Pacific, 12 Māori, nine Asian and four women of other ethnicities participated (mean age, 39.5 years). Before trying any devices, 78% indicated a preference to self-sample, compared to 22% who preferred a physician-collected sample (PCS). After trying a device (HerSwab™, 91%; Delphi Screener™, 14%; cobas Swab, 13%; 12.5% used >1 device), fewer women (66%) preferred to self-sample next time, fewer (16%) preferred a PCS, while 18% expressed no preference. One of 32 samples with valid results (35 were tested) was positive for HPV 'other' oncogenic types.

Conclusions: This was the first New Zealand study to invite women, including Māori women, to take a self-sample for cervical-cancer screening. The pilot study suggests that un- and under-screened women generally find self-sampling acceptable and all sample types are suitable for use with the cobas HPV test.
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June 2019

Association between exposure to the natural environment, rurality, and attention-deficit hyperactivity disorder in children in New Zealand: a linkage study.

Lancet Planet Health 2019 05;3(5):e226-e234

Centre for Public Health Research, Massey University, Wellington, New Zealand.

Background: Several small experimental studies and cross-sectional observational studies have shown that exposure to the natural environment might protect against attention-deficit hyperactivity disorder (ADHD) or moderate the symptoms of ADHD in children. We aimed to assess whether exposure to the natural environment protects against ADHD and whether this hypothesised protective effect varies across a child's life course.

Methods: We did a longitudinal study with data collected from all children born in New Zealand in 1998, excluding those without an address history, those who were not singleton births, and those who died or emigrated before 18 years of age. We used Statistics New Zealand's Integrated Data Infrastructure to identify children with ADHD and to define covariates. ADHD was defined according to hospital diagnosis or pharmacy records (two or more prescriptions for ADHD drugs). Exposure to green space for each year of a child's life (from gestation to 18 years of age) was estimated at the meshblock level (the smallest geographical unit for which the New Zealand Census reports data) using normalised difference vegetation index (NDVI), and land-use data from Landcare Research New Zealand. We used logit models to assess the associations between ADHD prevalence and minimum, maximum, and mean lifetime NDVI, as well as rural living, controlling for sex, ethnicity, mother's educational level, mother's smoking status, mother's age at parturition, birth order, antibiotic use, and low birthweight.

Findings: Of the 57 450 children born in New Zealand in 1998, 49 923 were eligible and had available data, and were included in the analysis. Children who had always lived in a rural area after 2 years of age were less likely to develop ADHD (odds ratio [OR] 0·670 [95% CI 0·461-0·974), as were those with increased minimum NDVI exposure after age 2 years (standardised OR for exposure vs first quartile: second quartile 0·841 [0·707-0·999]; third quartile 0·809 [0·680-0·963]; fourth quartile 0·664 [0·548-0·805]). In early life (prenatal to age 2 years), neither rural living nor NDVI were protective against ADHD. Neither mean nor maximum greenness was significantly protective against ADHD.

Interpretation: Rurality and increased minimum greenness were strongly and independently associated with a reduced risk of ADHD. Increasing a child's minimum lifetime greenness exposure, as opposed to maximum or mean exposure, might provide the greatest increment of protection against the disorder.

Funding: None.
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http://dx.doi.org/10.1016/S2542-5196(19)30070-1DOI Listing
May 2019

Review of Methodologies for Assessing Sustainable Diets and Potential for Development of Harmonised Indicators.

Int J Environ Res Public Health 2019 04 2;16(7). Epub 2019 Apr 2.

School of Health Sciences, College of Health Science, Massey University, Palmerston North 4442, New Zealand.

The underlying values and priorities that drive policy responses depend largely on the constructs that researchers and decision makers select to measure and the metrics used. Despite much recent attention being given to sustainable diets and food systems and to the importance of clearly measuring sustainability to meet targets, to achieve goals, and to appraise dietary and environmental policies, it is not commonly agreed how the different indicators of sustainable diets are assessed. The evidence base for assessment of these indicators are frequently weak, fragmented, and arbitrary. The aim of this paper was to compare a range of published methods and indicators for assessing sustainable diets and food systems in order to harmonise them. Keyword and reference searches were performed in PubMed, Scopus, CAB Abstracts, and Web of Knowledge. Fifty-two studies (21 proposed methods and 31 used methods) that combined environment, nutrition and health, and socioeconomic aspects of sustainable diets were reviewed. The majority (over 90%) of the studies focused on high-income countries. Twenty-eight studies assessed the environmental effects of different dietary practices, eight of the studies examined the nutrition and health indicators used for assessing sustainable food systems, and seven studies assessed the social and economic costs of diets. A classification of the elements was developed, and common elements are proposed for standardizing. These elements were categorized into nutrition and health indicators, environment indicators, and socioeconomic indicators. Standardized or harmonized indicators can be used for consistency and applicability purposes and to support, implement, and monitor relevant policies.
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http://dx.doi.org/10.3390/ijerph16071184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6479933PMC
April 2019
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