New Zealand Research Articles

Insights into feeding preterm infants in Aotearoa, New Zealand: a mixed-method study

Optimal nutrition is essential for preterm infants as they face many barriers to achieving exclusive breastfeeding (EBF) and successfully introducing complementary foods (CF)(1). There is limited evidence of early feeding practices of preterm infants in Aotearoa, New Zealand (NZ). We aimed to investigate the facilitators and barriers to EBF and CF introduction in preterm infants in NZ. A nationwide self-completed electronic questionnaire was disseminated via social media to mothers of preterm infants. The survey collected quantitative data on hospital feeding practices, breastfeeding rates, timing of CF introduction, and fussy eating behaviours. Relationships between feeding practices and maternal and infant characteristics, such as ethnicity and level of prematurity, were explored using the Chi-Square statistical test in SPSS. Qualitative information regarding mothers’ experiences with breastfeeding, CF introduction, type of education and support received about the nutrition of preterm infants were collected for thematic analysis using Nvivo. The survey started in April and will close on 20th August 2023. Here we present preliminary findings of a subset of responses collected to date, and full results will be available for the conference. Up to 1st August 2023, 201 mothers had completed the survey. Most mothers self-identified as of New Zealand European (58%) and Māori (13%) background. Most infants (39%) were older than 12 months of chronological age (CA) and born moderate or late preterm (32+0 – 36+6 weeks’ gestation, 70%). Almost 50% of mothers required in-hospital supplementation of mothers’ milk (infant formula, 28% and donor breastmilk, 20%), and 44% of mothers were EBF at the time of hospital discharge. EBF for 5-6 months of CA was reported by 21% of mothers, and 46% provided any breastmilk for more than 6 months of CA. Among mothers who had introduced CF (n = 138), 74% reported introducing CF between 5-8 months of CA, and the infant’s first foods were primarily vegetables (65%) and fruits (60%). Fussy eating behaviour was reported by 47%, and food fussiness was significantly associated with a decreased frequency of vegetable (p<0.001) and fruit (p = 0.004) consumption. Challenges with breastfeeding included the infant’s feeding difficulties, low milk supply, maternal stressors, lack of support and education from health professionals. Challenges to CF introduction included fussiness and maternal fears such as choking and lack of confidence. Support from lactation consultants and previous experience with introducing CF were the most common enablers for breastfeeding and timely CF introduction, respectively. Our findings provide the first insight into the early feeding practices of preterm infants in Aotearoa, New Zealand. This information will support strategies to improve the nutritional management of preterm infants by increasing awareness of common challenges mothers face to achieve the recommended breastfeeding guidelines and CF practices in this vulnerable population.

Baseline lifestyle and biomedical stroke risk factors among New Zealand participants in the PERsonalised Knowledge to reduce the risk of Stroke (PERKS-International) randomised controlled trial –preliminary results

Stroke ranks as the world’s second leading cause of death and third in causing disabilities, a preventable disease affecting people of all demographics. Primary prevention is crucial to mitigate its impact by addressing modifiable risk factors such as poor diet, low physical activity (PA), obesity, smoking, high blood pressure (BP), elevated cholesterol, and blood glucose levels. This study evaluated quality of diet and other stroke modifiable risk factors among New Zealand (NZ) participants recruited at the baseline phase of the PERKS-International trial. PERKS is a Phase III, multicentre, prospective, pragmatic, open-label, single-blinded endpoint, two-arm randomised controlled trial conducted across Australia and NZ(1). Participants aged >35 and ≤75 years with ≥2 modifiable risk factors for stroke were assessed using the Life’s Simple 7 (LS7) score. LS7 includes seven components (BMI, BP, total cholesterol, blood glucose, dietary pattern, smoking, and PA) categorising into ideal,intermediate, and poor level. Height, weight, and BP were measured. Total cholesterol and blood glucose were measured via CardioChek PA Analyser. An online FFQ and Physical Activity Questionnaire were administered. Descriptive analyses and correlation coefficients were used to examine the characteristics of participants at the baseline. In NZ, out of 395 targeted participants, 375 (Female = 230, mean age = 57yrs) from diverse ethnic groups (NZ European = 204, Māori = 35, Pacific = 17) were recruited and assessed. Among LS7 metrics, smoking had the highest proportion of those in the ideal category (88%), followed by blood glucose (62%), total cholesterol (49%), dietary pattern (34%), BP (22%) and BMI (13%). Nearly 64% consumed <5 portions of fruits and vegetables per day. Almost half of the participants consumed beans and pulses less than once a week. About 43% and 31% consumed fibre-rich breakfast cereal and wholemeal bread less than once a week. Almost 10% drank fizzy drinks ≥4 times/week. Nearly 40% consumed sweets such as biscuits, cakes, and chocolate at least twice a week. Over half of the participants consumed red meat and chicken 2-3 times/week. In terms of other risk factors, over half of the participants were obese (BMI≥ 30 kg/m2). Only 12% were current smokers. About 10% drank alcohol 5-7 days/week. Physical activity expenditure (MET minutes/week) showed no significant sex difference. The LS7 factors correlated significantly were BMI and blood glucose (r = 0.157, p<0.01), total cholesterol and smoking (r=-0.129, p<0.01), BP and BMI (with a moderate correlation of r = 0.308, <0.001). The NZ participants in the PERKS-International trial, had poor diets, along with suboptimal lifestyle and biomedical stroke risk factors, reflecting the inclusion criteria for the study. Urgent action is required for the primary stroke prevention at population-level. The results of the trial, expected in 2024, will show the benefit of a mobile phone app on reducing these stroke risk factors.

The GUTFIT Cohort: Identifying dietary intake of Chinese New Zealanders with functional constipation

Distinct pathophysiology has been identified with disorders of gut-brain interactions (DGBI), including functional constipation (FC)(1,2), yet the causes remain unclear. Identifying how modifiable factors (i.e., diet) differ depending on gastrointestinal health status is important to understand relationships between dietary intake, pathophysiology, and disease burden of FC. Given that dietary choices are culturally influenced, understanding ethnicity-specific diets of individuals with FC is key to informing appropriate symptom management and prevention strategies. Despite distinct genetic and cultural features of Chinese populations with increasing FC incidence(3), DGBI characteristics are primarily described in Caucasian populations(2). We therefore aimed to identify how dietary intake of Chinese individuals with FC differs to non-Chinese individuals with FC, relative to healthy controls. The Gastrointestinal Understanding of Functional Constipation In an Urban Chinese and Urban non-Chinese New Zealander Cohort (GUTFIT) study was a longitudinal case-control study using systems biology to investigate the multi-factorial aetiology of FC. Here we conducted a cross-sectional dietary intake assessment, comparing Chinese individuals with FC (Ch-FC) against three control groups: a) non-Chinese with FC (NCh-FC) b) Chinese without FC (Ch-CON) and c) non-Chinese without FC (NCh-CON). Recruitment from Auckland, New Zealand (NZ) identified Chinese individuals based on self-identification alongside both parents self-identifying as Chinese, and FC using the ROME IV criteria. Dietary intake was captured using 3-day food diaries recorded on consecutive days, including one weekend day. Nutrient analysis was performed by Foodworks 10 and statistical analysis with SPSS using a generalised linear model (ethnicity and FC status as fixed factors). Of 78 enrolled participants, 66 completed the study and 64 (39.4 ± 9.2 years) completed a 3-day food diary at the baseline assessment. More participants were female (84%) than male (16%). FC and ethnicity status allocated participants into 1 of 4 groups: Ch-FC (n = 11), Ch-CON (n = 18), NCh-FC (n = 16), NCh-CON (n = 19). Within NCh, ethnicities included NZ European (30%), non-Chinese Asian (11%), Other European (11%), and Latin American (2%). Fibre intake did not differ between Ch-FC and NCh-FC (ethnicity × FC status interaction p>0.05) but was independently lower overall for FC than CON individuals (21.8 ± 8.7 versus 27.0 ± 9.7 g, p<0.05) and overall for Ch than NCh (22.1 ± 8.0 versus 27.0 ± 10.4 g, p<0.05). Carbohydrate, protein, and fat intakes were not different across groups (p>0.05 each, respectively). In the context of fibre and macronutrient intake, there is no difference between Ch-FC and NCh-FC. Therefore, fibre and macronutrients are unlikely to contribute to potential pathophysiological differences in FC between ethnic groups. A more detailed assessment of dietary intake concerning micronutrients, types of fibre, or food choices may be indicated to ascertain whether other dietary differences exist.

Inflammatory Bowel Disease exercise and diet (IBDeat) habits study: exploring lifestyle habits and cardiometabolic disease risk factors

Patients with inflammatory bowel disease (IBD) have higher risk of developing cardiometabolic diseases due to chronic gut and systemic inflammation which promotes atherogenesis. Adopting healthy lifestyle habits can prevent development of cardiometabolic diseases, but can be challenging for people with IBD. The IBD exercise and diet (IBDeat) habits study describes the lifestyle habits and cardiometabolic disease risk factors of adults with IBD in Aotearoa, New Zealand (NZ).This is a cross-sectional study including adult NZ IBD patients recruited online via Crohn’s and Colitis NZ and Dunedin hospital from 2021 to 2022. An online questionnaire collected demographics, smoking status, comorbidities, medications, disease severity scores, quality of life, physical activity, and dietary intake. The Dunedin cohort had physical measurements taken including anthropometrics, handgrip strength, blood pressure, body composition (bioelectrical impedance), blood nutritional markers, and faecal calprotectin. Data were compared to established reference values and linear regression analysis investigated associations between lifestyle habits and cardiometabolic risk factors. The study received University of Otago ethical approval (reference: H21/135). A total of 213 adults with IBD (54% Crohn’s disease; 46% ulcerative colitis) completed the online questionnaire and a subset of 102 from Dunedin provided physical measurements. Participants characteristics were: median age 37 (IQR 25, 51) years, 71% female, 82% NZ European, 4% smokers, and 1.4% had active IBD. Thirty-five percent of participants had at least one comorbidity and 34% of participants had poor quality of life. Known dietary risk factors associated with cardiometabolic diseases were common: low intakes of vegetables (77%), fruit (51%), fibre (35%) and high intakes of total fat (84%) and saturated fat (98%). Physical activity recommendations were met by 61% of participants and 63% reported barriers to being more active from fatigue (63%) and joint pain (54%). Other cardiometabolic risk factors were common in the Dunedin cohort: high LDL (79%) and total cholesterol (76%), central adiposity (64%), high body fat percentage (44%), high blood pressure (26%), and low handgrip strength (25%). Regression analysis showed that vegetable (per serve) and carbohydrate (per 5% of total daily energy intake (TE)) were associated with 0.22 mmol/L (95%CI 0.43, 0.013) and 0.20 mmol/L (95%CI 0.34, 0.057) lower LDL cholesterol. Discretionary food items were associated with higher LDL cholesterol, 0.11 mmol/L per daily serve (95%CI 0.028, 0.19). A 5% difference in TE intake from carbohydrate was associated with 1.11% (95%CI 2.22%, 0.0038%) lower body fat percentage while protein was associated with 3.1% (95%CI 0.81%, 5.39%) higher body fat percentage. Physical activity had weak associations with cardiometabolic disease risk factors. Adults with IBD have multiple modifiable risk factors for cardiometabolic diseases. Vegetable and carbohydrate intake were associated with lower LDL cholesterol concentration while discretionary food items showed otherwise. Protein intake was associated with higher body fat percentage.

Folic acid and iodine supplement use from preconception through to six weeks postpartum in New Zealand women

Folic acid (FA) and iodine supplements are recommended by the Ministry of Health (MOH) for pregnant and/or lactating women in New Zealand (NZ)(1). Evidence suggests that many NZ women are not just taking FA and iodine in the form of a single-nutrient supplement (SNS) but are taking FA and iodine as part of a multivitamin supplement (MVS) which may or may not contain the recommended doses, and some are using a combination of both(2). No NZ study has examined the daily dose taken from both SNS and MVS for both FA and iodine across all time periods (2, 3). The aim of this study was to investigate what nutritional supplements containing FA and iodine were taken by postpartum NZ women, preconception, during the three trimesters of pregnancy and post-partum, and examine how well the women’s supplement use aligned with the NZ MOH recommendations. This cross-sectional observational study utilised data gathered on FA and iodine supplement use from an anonymous survey between February and August 2022. Descriptive statistics including frequency and percentages were reported. Folic acid and iodine weekly intakes from SNS and MVS were calculated by multiplying the amount of nutrient in each supplement, with the number of times per day taken, and the average number of days taken per week reported. A total of 584 women were included in the analysis. In addition to the SNS for FA (0.8mg and 5mg) and iodine (150 ug), women took 28 different MVS. Fifty-eight percent (preconception; 30% from SNS, 18% from MVS, and 10% from both) and 96% (1st trimester pregnancy; 61% from SNS, 17% from MVS, and 19% from both) of women took FA containing supplements. More than 75% of women reported taking iodine containing supplements during pregnancy (1st and 2nd trimesters: 93%, 3rd trimester: 89%) and postpartum (76%).Approximately 60% took SNS, 18% took only MVS and 14% took both. Based on the MOH recommendations, only 30% (preconception) and 62% (1st trimester) achieved sufficiency of FA supplementation at 0.8mg/day; 35% (preconception) and 69% (1st trimester) achieved sufficiency of FA at 5mg/day; around 50% women achieved sufficiency of iodine supplementation at 150 µg/day during pregnancy while only 37% during postpartum. The balance either took none, an insufficient dose or a dose that exceeded the recommended dose and many took them during non-recommended periods (FA after the 1st trimester; iodine preconception). Most women reported taking FA and/or iodine containing supplements at some point before, during and after their pregnancy. However, it is concerning that a large number of women do not seem to be adhering to the MOH recommendations for FA and iodine supplementation.

The barriers and enablers to providing healthy food in New Zealand secondary school canteens

Establishing healthy lifelong eating habits in young people is important for short and long-term health(1). Schools are ideal setting to improve diet. However, research shows that many school food environments are unhealthy(2). In New Zealand (NZ), the canteen is a popular food provision, particularly in secondary schools. This research aimed to explore the barriers and enablers to providing healthy food and beverages in NZ secondary school canteens. In 2022, 6 secondary schools were purposively selected to participate in semi-structured interviews about foods and beverages sold in schools’ canteens and the factors that influenced this. In total, 11 stakeholders representing six schools and one staff member of an external catering company completed interviews. The interviews were transcribed and analysed using a reflexive thematic analysis approach(3). Four themes were developed. Theme 1 Action-oriented school policies that are based on healthy eating principles can facilitate healthier canteens highlighted the use and characteristics of policies. The subtheme highlighted that Mandatory policies are more enforceable. Theme 2 Multiple component opt-in programs or interventions facilitate a healthier school food provision shows that opt-in government interventions (e.g. Ka Ora, Ka Ako, the NZ free school lunch initiative) with funding, monitoring, and incentives can improve food provision. The subtheme Health-enhancing changes inthe school environment has flow-on effect to canteens showed that these changes can affect the entire school food environment. Theme 3 Healthy canteens get lost in the “pecking order” of what’s important highlights that while schools and key stakeholders may believe healthy eating is important, other factors related to well-being and education were more important to prioritise within the school’s limited resources. Theme 4 People’s values, attitudes and beliefs may help and hinder the healthiness of canteens and explores the role champions have in influencing the healthiness of the canteen. Champions were those with a positive, proactive attitude, value healthy eating and are capable. Subtheme 1 Meet student preferences while providing healthy food was a common barrier many champions worked hard to overcome. The final subtheme identified how A collaborative approach within schools and their communities can overcome barriers to healthy canteens. Government mandates and interventions can positively impact the canteen and other food provisions. This research supports a recommendation for schools to create and implement school policies around food encompassing a whole-school approach.

Household food insecurity and associations with energy, nutrient intake, and sociodemographic characteristics in young New Zealand children

Although food insecurity affects a significant proportion of young children in New Zealand (NZ)(1), evidence of its association with dietary intake and sociodemographic characteristics in this population is lacking. This study aims to assess the household food security status of young NZ children and its association with energy and nutrient intake and sociodemographic factors. This study included 289 caregiver and child (1-3 years old) dyads from the same household in either Auckland, Wellington, or Dunedin, NZ. Household food security status was determined using a validated and NZ-specific eight-item questionnaire(2). Usual dietary intake was determined from two 24-hour food recalls, using the multiple source method(3). The prevalence of inadequate nutrient intake was assessed using the Estimated Average Requirement (EAR) cut-point method and full probability approach. Sociodemographic factors (i.e., socioeconomic status, ethnicity, caregiver education, employment status, household size and structure) were collected from questionnaires. Linear regression models were used to estimate associations with statistical significance set at p <0.05. Over 30% of participants had experienced food insecurity in the past 12 months. Of all eight indicator statements, “the variety of foods we are able to eat is limited by a lack of money,” had the highest proportion of participants responding “often” or “sometimes” (35.8%). Moderately food insecure children exhibited higher fat and saturated fat intakes, consuming 3.0 (0.2, 5.8) g/day more fat, and 2.0 (0.6, 3.5) g/day more saturated fat compared to food secure children (p<0.05). Severely food insecure children had lower g/kg/day protein intake compared to food secure children (p<0.05). In comparison to food secure children, moderately and severely food insecure children had lower fibre intake, consuming 1.6 (2.8, 0.3) g/day and 2.6 (4.0, 1.2) g/day less fibre, respectively. Severely food insecure children had the highest prevalence of inadequate calcium (7.0%) and vitamin C (9.3%) intakes, compared with food secure children [prevalence of inadequate intakes: calcium (2.3%) and vitamin C (2.8%)]. Household food insecurity was more common in those of Māori or Pacific ethnicity; living in areas of high deprivation; having a caregiver who was younger, not in paid employment, or had low educational attainment; living with ≥2 other children in the household; and living in a sole-parent household. Food insecure young NZ children consume a diet that exhibits lower nutritional quality in certain measures compared to their food-secure counterparts. Food insecurity was associated with various sociodemographic factors that are closely linked with poverty or low income. As such, there is an urgent need for poverty mitigation initiatives to safeguard vulnerable young children from the adverse consequences of food insecurity.

Nutrient trade in Oceania

Human nutrition is a key component of the definitions of both sustainable food systems and sustainable healthy diets, and features prominently in the Sustainable Development Goals. However, progress towards complete nutrition and food security for the entire global population is poor, and the burden of malnutrition and food insecurity is felt in countries of all income levels, including in Oceania. While countries like Australia and New Zealand (NZ) are widely perceived as sources of high-quality food exported overseas due to great surpluses above national requirement, this hides domestic issues. The international nutrition community recognises and are demanding that our food systems must be sustainable, which is not yet the case anywhere in Oceania. Food insecurity at the household level is not uncommon, nor are nutrient deficiencies. It is often presumed that, should the inequitable distribution of food be balanced, these challenges would disappear. However, food supply and trade data show that even at the national and regional levels, insufficient food and nutrient supplies to meet population requirements are the established norm. For example, it has been demonstrated that domestic vegetable production falls short of NZ dietary recommendations, with imports making a negligible difference other than via energy dense crops(1). Likewise, after consideration of trade, NZ has undersupplies of calcium, potassium, vitamins C and E, and dietary fibre compared to population requirements(2). A wealth of data exists quantifying food production, trade, and availability and various scales. Increasingly, researchers are matching these to human requirements, whether at the food or nutrient level, to identify gaps(3). Insights generated from these data-driven approaches are being directed at trade policy, enabling decisions that can realise aspirational goals to reduce food insecurity through international trade. Making this data accessible to all via interactive user interfaces promotes wider engagement, understanding, and dissemination of findings. It also allows stakeholders in various countries to identify their own vulnerabilities, both as a result of current undersupplies, and due to high reliance on trading partners for food and nutrition security. Trade data can also be connected to environmental measures to identify scenarios where trade can be leveraged to the benefit of both nutrition and broader sustainability goals(4). High level, data driven approaches are not a substitute for individual-based studies on nutrition, but are a useful complement to them. With regionally or nationally deficient food and nutrient supplies, complete nutrition for individuals cannot be attained. A holistic, system-wide understanding is necessary for any policy decisions to advance nutrition.

A conceptual cost estimation model for the pre-design stage of road projects using multiple regression analysis

Purpose The current estimation practice in construction projects greatly needs upgrading, as there has been no improvement in the cost overrun issue over the past 70 years. The purpose of this research was to develop a new multiple regression analysis (MRA)-based model to forecast the final cost of road projects at the pre-design stage using data from 43 projects in New Zealand (NZ). Design/methodology/approach The research used the case study of 43 completed road projects in NZ. Document analysis was conducted to collect data, and statistical tests were used for model development and analysis. Findings Eight models were developed, and all models achieved the required F statistics and met the regression assumptions. The models’ mean absolute percentage error (MAPE) was between 21.25% and 22.77%. The model with the lowest MAPE comprised the road length and width, number of bridges, pavement area, cut and fill area, preliminary cost and cost indices change. Research limitations/implications The model is based on road projects in NZ. However, it was designed to be able to adapt to other contexts. The findings suggest that the model can be used to improve traditional conceptual estimating methods. Past project data is often stored by the project team but rarely used for analysing and forecasting purposes. This research emphasises that past data can be effectively used to predict the project cost at the pre-design stage with limited information. Originality/value No research was conducted to adopt cost modelling techniques into the conceptual estimation practice in the NZ construction industry.

Strongyloidiasis in Auckland: A ten-year retrospective study of diagnosis, treatment and outcomes of a predominantly Polynesian and Fijian migrant cohort.

Strongyloides stercoralis is not endemic in Aotearoa New Zealand (AoNZ). However, approximately one third of Auckland residents are born in endemic countries. This study aimed to describe the epidemiology and management of strongyloidiasis in Auckland, with a focus on migrants from Pacific Island Countries and Territories. This study retrospectively reviewed clinical, laboratory and pharmacy records data for all people diagnosed with strongyloidiasis in the Auckland region between July 2012 and June 2022. People with negative Strongyloides serology were included to estimate seropositivity rate by country of birth. Over ten years, 691 people were diagnosed with strongyloidiasis. Most diagnoses were made by serology alone (441, 64%). The median age was 63 years (range 15-92), 500 (72%) were male, and the majority were born in Polynesia (350, 51%), Fiji (130, 19%) or were of Pasifika ethnicity (7%). Twelve participants (1.7%) had severe strongyloidiasis at diagnosis. The total proportion treated with ivermectin was only 70% (484/691), with no differences between immunocompromised and immunocompetent participants, nor by ethnicity. The outcome of treatment (based on a combination of serology and/or eosinophilia and/or stool microscopy) could only be determined in 50% of the treated cohort. One participant failed treatment with ivermectin, experiencing recurrent strongyloidiasis, and another participant died in association with severe strongyloidiasis. The rate of 'positive' Strongyloides serology was highest among participants born in Samoa (48%), Fiji (39%), and Southeast Asian countries (34%). Strongyloidiasis was common and under-treated in Auckland during the study period. Clinicians should have a low threshold for considering strongyloidiasis in migrants from endemic countries, including Polynesia and Fiji.

Characterising the decay of organic metal complexes in speleothem-forming cave waters

Organic metal complexes (OMCs) transport trace metals (e.g., Co, Ni, Cu) from surface soils, via the unsaturated zone, to sites of cave carbonate (speleothem) formation. OMCs clearly imprint on speleothem trace element chemistry, but the role of kinetic factors in the signal transfer process has yet to be elucidated. We investigated whether OMCs may viably link metal concentrations in stalagmites and local hydrology (i.e., drip rate), via their time-sensitive dissociation (or ‘decay’) in the speleothem water thin-film. We performed competitive ligand exchange experiments using water and soil samples from eight geographically diverse Aotearoa New Zealand caves, providing a first comparative characterisation of speleothem-specific OMC kinetics. Critically, this approach corroborated that NOM ligands limit transition metal availability at the dripwater-speleothem interface, exhibiting stabilities on the order Cu ≈ Co > Ni, whereas organic complexation of the alkaline earth metals Mg and Sr was virtually absent. Systematic variations of OMC stability with natural organic matter characteristics were not observed amongst water samples, whilst enhanced complexation was clearly evident in the comparably organic-rich soil extracts. Our results imply that the supply of transition metals to speleothems is inversely related to drip rate, increasing with drip interval via the decay of OMCs. This process appears most sensitive on time-scales relevant to typical speleothem-forming settings (<0 to ca. 40 drips min−1, corresponding to ca. <5.6 mL min−1), and therefore provides a general, mechanistic link to a quantitative proxy of palaeoclimatic cave drip rates.

Immune system modulation & virus transmission during parasitism identified by multi-species transcriptomics of a declining insect biocontrol system

BackgroundThe Argentine stem weevil (ASW, Listronotus bonariensis) is a significant pasture pest in Aotearoa New Zealand, primarily controlled by the parasitoid biocontrol agent Microctonus hyperodae. Despite providing effective control of ASW soon after release, M. hyperodae parasitism rates have since declined significantly, with ASW hypothesised to have evolved resistance to its biocontrol agent. While the parasitism arsenal of M. hyperodae has previously been investigated, revealing many venom components and an exogenous novel DNA virus Microctonus hyperodae filamentous virus (MhFV), the effects of said arsenal on gene expression in ASW during parasitism have not been examined. In this study, we performed a multi-species transcriptomic analysis to investigate the biology of ASW parasitism by M. hyperodae, as well as the decline in efficacy of this biocontrol system.ResultsThe transcriptomic response of ASW to parasitism by M. hyperodae involves modulation of the weevil’s innate immune system, flight muscle components, and lipid and glucose metabolism. The multispecies approach also revealed continued expression of venom components in parasitised ASW, as well as the transmission of MhFV to weevils during parasitism and some interrupted parasitism attempts. Transcriptomics did not detect a clear indication of parasitoid avoidance or other mechanisms to explain biocontrol decline.ConclusionsThis study has expanded our understanding of interactions between M. hyperodae and ASW in a biocontrol system of critical importance to Aotearoa-New Zealand’s agricultural economy. Transmission of MhFV to ASW during successful and interrupted parasitism attempts may link to a premature mortality phenomenon in ASW, hypothesised to be a result of a toxin-antitoxin system. Further research into MhFV and its potential role in ASW premature mortality is required to explore whether manipulation of this viral infection has the potential to increase biocontrol efficacy in future.

Sizing Up General Practice Environments for Big-Bodied Patients: An Environmental Assessment of Three Facilities in Aotearoa New Zealand.

This research describes the physical environments of and equipment in Aotearoa New Zealand (NZ) general practices in relation to available standards for big-bodied people (BBP) seeking healthcare. The prevalence of BBP both in NZ and globally has increased over the last 30 years and is expected to increase further. As the first and most utilized point of contact for patients in NZ and many countries, it is essential that general practices provide suitable environments to cater for and meet the needs of big-bodied patients seeking healthcare. An exploratory study utilizing an environmental investigation was undertaken in three diverse general practices. Data collection consisted of direct observation and physical measurements of practice layout and equipment. Findings were compared to the existing guidelines or standards for the healthcare of BBP. The analysis identified most environmental facets and equipment in all three general practices did not meet published guidelines for the care of BBP. In the global context of increasing and sustained prevalence of BBP, this exploratory study highlights it is crucial that general practices and similar community-based facilities review their physical environments and equipment and consider modifications to improve accessibility, inclusivity, and comfort for BBP.

Comparison of injury severity scores derived from ICD-10-AM codes with trauma registry derived scores: A study from New Zealand

IntroductionVarious attempts at automation have been made to reduce the administrative burden of manually assigning Abbreviated Injury Severity (AIS) codes to derive Injury Severity Scores (ISS) in trauma registry data. The accuracy of the resulting measures remains unclear, especially in the New Zealand (NZ) context. The aim of this study was to compare ISS derived from hospital discharge International Classification of Diseases Australian Modification (ICD-10-AM) codes with ISS recorded in the NZ Trauma Registry (NZTR). MethodsIndividuals admitted to hospital and enrolled in the NZTR between 1 December 2016 and 30 November 2018 were included. ISS were calculated using a modified ICD to AIS mapping tool. The agreement between both methods for raw scores was assessed by the Intraclass Correlation Coefficient (ICC), and for categorical scores the Kappa and weighted Kappa index were used. Analysis was conducted by gender, age, ethnicity, and mechanism of injury. Results3,156 patients fulfilled the inclusion criteria. The ICC for agreement between the methods was poor (0.40, 95 % CI: 0.37–0.43). The Kappa index indicated slight agreement between both methods when using a cut-off value of 12 (0.06; 95 % CI: 0.01–0.12) and 15 (0.13 6; 95 % CI: 0.09–0.17). ConclusionAlthough the overall agreement between NZTR-ISS and ICD-ISS was slight, ICD-derived scores may be useful to describe injury patterns and for body region-specific estimations when manually coded ISS are not available.

Persistent Opioid Use After Hospital Admission From Surgery in New Zealand: A Population-Based Study.

Persistent opioid use (POU) is common after surgery and is associated with an increased risk of mortality and morbidity. There have been no population-based studies exploring POU in opioid-naïve surgical patients in New Zealand (NZ). This study aimed to determine the incidence and risk factors for POU in opioid-naïve patients undergoing surgery in all NZ hospitals. We included all opioid-naïve patients who underwent surgery without a concomitant trauma diagnosis and received opioids after discharge from any NZ hospital between January 2007 and December 2019. Patients were considered opioid naïve if no opioids had been dispensed to them or if they did not have a prior diagnosis of an opioid-use disorder up to 365 days preceding the index date. The primary outcome was the incidence of POU, defined a priori as opioid use after discharge between 91 and 365 days. We used a multivariable logistic regression to identify risk factors for POU. We identified 1789,407 patients undergoing surgery with no concomitant diagnosis of trauma; 377,144 (21.1%) were dispensed opioids and 260,726 patients were eligible and included in the analysis. Of those included in the final sample, 23,656 (9.1%; 95% confidence interval [CI], 9.0%-9.2%) developed POU. Risk factors related to how opioids were prescribed included: changing to different opioid(s) after discharge (adjusted odds ratio [aOR], 3.21; 95% CI, 3.04-3.38), receiving multiple opioids on discharge (aOR, 1.37; 95% CI, 1.29-1.45), and higher total oral morphine equivalents (>400 mg) (aOR, 1.23; 95% CI, 1.23-1.45). Conversely, patients who were coprescribed nonopioid analgesics on discharge had lower odds of POU (aOR, 0.91; 95% CI, 0.87-0.95). Only small differences were observed between different ethnicities. Other risk factors associated with increased risk of POU included undergoing neurosurgery (aOR, 2.02; 95% CI, 1.83-2.24), higher comorbidity burden (aOR, 1.90; 95% CI, 1.75-2.07), preoperative nonopioid analgesic use (aOR, 1.65; 95% CI, 1.60-1.71), smoking (aOR, 1.44; 95% CI, 1.35-1.54), and preoperative hypnotics use (aOR, 1.35; 95% CI, 1.28-1.42). Approximately 1 in 11 opioid-naïve patients who were dispensed opioids on surgical discharge, developed POU. Potentially modifiable risk factors for POU, related to how opioids were prescribed included changing opioids after discharge, receiving multiple opioids, and higher total dose of opioids given on discharge. Clinicians should discuss the possibility of developing POU with patients before and after surgery and consider potentially modifiable risk factors for POU when prescribing analgesia on discharge after surgery.

Measuring and reporting environmental impacts of dairy farming

Purpose This study aims to explore farmers’ perceptions of environmental impacts of dairying and their practices towards implementing environmental management accounting (EMA) techniques. Design/methodology/approach Semi-structured interviews were held with five dairy farmers in the South Island of New Zealand (NZ). Findings Dairy farmers perceive environmental sustainability in dairying as being able to feed people while protecting the environment so that future generations can also enjoy the natural world. Recognising the need to alter their practices to reduce environmental damage they have produced, dairy farmers use some EMA techniques, but the primary motivation is compliance with government regulations. Other motivations for using EMA techniques are high economic returns, maintaining their reputation and self-satisfaction. Barriers to implementing EMA techniques are primarily due to lack of clarity and feasibility of regulations, coercion and inadequate communication by regulators and high compliance costs. Originality/value The findings contribute to the current EMA literature by providing a better understanding of EMA practices of dairy farmers in NZ, barriers to implementing EMA and how those barriers could be reduced. It may also help NZ central and local government in developing environmental strategies and policies. Furthermore, this research is expected to help people in the dairy industry to find ways to educate farmers about how the measures that are required can help them to reduce both the environmental impacts and the costs of dairying, thus contributing to sustainable development globally.

Motivators and barriers to plant-based product consumption across Aotearoa New Zealand flexitarians

Limited knowledge exists concerning Aotearoa New Zealand (A-NZ) flexitarians and their respective motivators and barriers towards consumption of novel plant-based products (PBPs) heralded as aids for dietary meat reduction. This study aimed to determine if A-NZ flexitarians, who have tried novel PBPs, can be segmented based on different motivators and barriers to meat reduction and PBP consumption, if the consumer profile of the different segments varies according to identified gender, generation group, neophobia and meat and PBP consumption frequency. It also aimed to identify sensory characteristics novel PBPs need to possess to be attractive to A-NZ flexitarians and if these vary across segments. PBP-consuming flexitarians (n = 584), stratified according to age (Millennial/Gen X), identified gender and meat consumption frequency, completed an online survey regarding a) their level of agreement regarding statements related to factors driving PBP consumption and flexitarianism in general, and b) their satisfaction with the sensory experience of consuming current PBPs. ‘Tastes good’ was the top-rated factor for selecting PBPs for all consumers, but most were dissatisfied with the sensory characteristics of current PBPs. K-means cluster analysis identified three flexitarian segments based on similarities and differences in key motivations and barriers to consume PBPs. Attitudes and behaviours related to nutrition/health, and social status attained from eating both PBPs and meat products, accounted for most variation across the respondents. Overall, higher food neophobia was associated with higher PBP consumption, suggesting that neophobia itself is not necessarily a barrier to PBP consumption in A-NZ flexitarians. Improving the sensory profiles of PBPs whilst delivering nutritional requirements presented as key considerations for future product development and research. This research highlights the importance of understanding the distinct values, attitudes and behaviours of different flexitarian groups as opposed to generalised research aimed at flexitarians per se.

Student-centred curriculum integration in primary schools: nurturing democratic citizenship in Aotearoa New Zealand

AbstractThis article investigates how James A. Beane’s model of student-centred curriculum integration (CI) enhances students’ learning experiences in the classroom by meeting diverse learning needs and fostering democratic citizenship. It discusses the theory of Beane’s model of CI with respect to John Dewey’s underpinning philosophy of democratic education and explores the practice of Beane’s model via the narratives of two of the authors who implemented the model in primary schools in Aotearoa/ New Zealand (NZ). The findings show that implementing student-centred CI in contexts that are meaningful and relevant to students has the capacity to enhance the value and impact of students’ learning experiences. In the process, the democratic design of Beane’s model allows issues of social justice, inclusion and multiculturalism to be tackled by giving students agency and enabling them to ‘make a difference’ within their communities.

Examining the impact of COVID-19 on Māori:non-Māori health inequities in Aotearoa, New Zealand: an observational study protocol

IntroductionThe COVID-19 pandemic has had both direct and indirect impacts on the health of populations worldwide. While racial/ethnic health inequities in COVID-19 infection are now well known (and ongoing), knowledge...

Living with dementia in Aotearoa New Zealand: Samoan families’ perspectives

There is very little research about dementia in Aotearoa (New Zealand) New Zealand (NZ) Pacific communities, but information available suggests that Pacific people are presenting with dementia at a younger age and with more severe cognitive symptoms than do non-Pacific. The Samoan ethnic group is NZ’s largest Pacific population. This study explores experiences and understanding of dementia from family sessions with 25 people from 10 Samoan families living with dementia. Thematic analysis of the interviews showed there was no Samoan concept for dementia as a disease of the brain that required special medical attention; instead, Samoan elders spoke of memory loss as part of ageing, signifying the end to one’s purpose in life. A formal medical diagnosis saw family members honouring their obligations to care for their loved one at home, often at great cost. Culturally appropriate services, incorporating Samoan concepts of care and ageing, were rarely available.