Zealand Population Research Articles

Respiratory Health Inequities among Children and Young Adults with Cerebral Palsy in Aotearoa New Zealand: A Data Linkage Study.

(1) Background: Respiratory disease is a leading cause of morbidity, mortality, and poor quality of life in children with cerebral palsy (CP). This study describes the prevalence of CP-related respiratory disease and the non-modifiable risk factors for respiratory-related hospital admissions in the Aotearoa New Zealand population. (2) Methods: New Zealand Cerebral Palsy Register (NZCPR) participant data and de-identified data from the National Minimum Dataset and Pharmaceutical Dispensing Collections were linked to identify all respiratory-related hospital admissions and respiratory illness-related antibiotic exposure over 5 years in individuals with CP (0−26 years). (3) Results: Risk factors for respiratory-related hospital admissions included being classified Gross Motor Function Classification System (GMFCS) IV or V compared to GMFCS I [OR = 4.37 (2.90−6.58), p < 0.0001; OR = 11.8 (7.69−18.10), p < 0.0001, respectively,]; having ≥2 antibiotics dispensed per year [OR = 4.42 (3.01−6.48), p < 0.0001]; and being of Māori ethnicity [OR = 1.47 (1.13−1.93), p < 0.0047]. Māori experienced health inequities compared to non-Māori, with greater functional disability, and also experienced greater antibiotic dispensing than the general population. (4) Conclusion: Māori children and young adults have a higher risk of respiratory-related illness. Priority should be given to the screening for potentially modifiable risk factors for all children with CP from diagnosis onwards in a way that ensures Māori health equity.

Mortality after release from incarceration in New Zealand by gender: A national record linkage study

BackgroundPeople who enter and leave places of incarceration experience considerable health inequities and are at increased risk of premature death compared to the general population. Causes of premature death in this population vary markedly between countries and so country-specific information is needed. Additionally, there is a lack of large population-based studies which can disaggregate mortality risk based on person and incarceration factors. This study is the first examination of mortality in the period following release from incarceration in New Zealand. MethodsWe linked deidentified administrative data on incarceration and release between 1 January 1998 and 31 December 2016 with national mortality data for the same period to examine mortality after release in those who had been incarcerated for at least 1 day. Age standardised mortality rates and mortality ratios compared to the general New Zealand population were calculated separately for men and women, for releases from remand compared with prison, and by cause of death and time since release. Results90,195 individuals (13% women, 49% Māori) were followed up for 9.4 years after release from incarceration, with 4,764 deaths over the follow-up period. The overall standardised mortality ratio was 3.3 (95% CI 3.2, 3.4) compared to the general population, and higher for women (3.8) than men (2.7). The most common causes of death were cardiovascular disease, cancer and suicide. Rates of death were similar following release from remand versus prison, however suicide rates were highest following release from remand. Regardless of the type of incarceration, mortality was highest in the first month after release. ConclusionExperience of incarceration in New Zealand is associated with high rates of mortality from both chronic conditions and external causes. There are urgent policy imperatives to recognise and actively address the increased health and mortality risks faced by people released from New Zealand prisons.

SARS-CoV-2 vaccination and myocarditis in a highly vaccinated New Zealand population

Abstract Background A higher incidence of myocarditis has been reported in those who have recently received mRNA SARS – CoV-2 vaccination.1 Canterbury District Health Board (CDHB) serves 578,290 people, including 441,852 adults, with one large tertiary referral hospital offering specialist cardiology services. In 2021 97% of eligible adults received at least one dose and 92% two doses of the BNT162b2 mRNA vaccine (Pfizer-BioNTech). During this time only 21 community cases of COVID-19 infection were reported. We investigated the incidence of myocarditis during the BNT162b2 mRNA vaccine rollout in comparison to the preceding 5 years assuming a stable population size. Methods All adult patients admitted to our hospital who received a diagnostic code of acute myocarditis (ICD10 codes I40, I41 and I51.4) during admission between 2016 and 2021 were included. Demographics and peak troponin concentration (hsTnI) were recorded. Vaccine-associated myocarditis was defined as that leading to admitted within 28 days of BNT162b2 vaccination. Myocarditis-associated mortality was defined as death occurring within 28 days of hospital admission. Incidence of myocarditis before and during COVID-19 vaccination was tested using ANOVA. Results Between 2016 and 2020 there were 178 total hospital admissions (annualised mean 35.6 [SD6.3] range 28–44) with myocarditis. The mean age was 47.8 [SD15.9] years, 38% were women, and median peak hsTnI 641 (IQR 95.25–8526) ng/L. One patient died within 28 days of admission. In 2021 there were 43 myocarditis admissions, mean age 49.7 [SD18] years, 42% women, with a median hsTnI 355 (IQR 106.5–1876.5) ng/L. Nine of these admissions were within 28 days of vaccination. They were 78% female, mean age 52.6 [SD24.8] years, median peak hsTnI 179 (IQR 52–528) ng/L. One patient died during admission. There was no variance in annual incidence of myocarditis during vaccine rollout (p=0.342). Conclusion In a highly vaccinated adult population largely free of COVID-19 infection there were few cases of myocarditis within 28 days of vaccination and no increase in incidence overall compared to the preceding 5 years. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Heart Foundation of New Zealand grant to C Greer

Herpes zoster vaccine effectiveness against herpes zoster and postherpetic neuralgia in New Zealand: a retrospective cohort study

Herpes zoster (HZ) and associated complications cause significant burden to older people. A HZ vaccination programme was introduced in Aotearoa New Zealand in April 2018 with a single dose vaccine for those aged 65 years and a four-year catch up for 66-80 year-olds. This study aimed to assess the 'real-world' effectiveness of the zoster vaccine live (ZVL) against HZ and postherpetic neuralgia (PHN). We conducted a nationwide retrospective matched cohort study from 1 April 2018 to 1 April 2021 using a linked de-identified patient level Ministry of Health data platform. A Cox proportional hazards model was used to estimate ZVL vaccine effectiveness (VE) against HZ and PHN adjusting for covariates. Multiple outcomes were assessed in the primary (hospitalised HZ and PHN - primary diagnosis) and secondary (hospitalised HZ and PHN: primary and secondary diagnosis, community HZ) analyses. A sub-group analysis was carried out in, adults ≥ 65 years old, immunocompromised adults, Māori, and Pacific populations. A total of 824,142 (274,272 vaccinated with ZVL matched with 549,870 unvaccinated) New Zealand residents were included in the study. The matched population was 93.4% immunocompetent, 52.2% female, 80.2% European (level 1 ethnic codes), and 64.5% were 65-74 years old (mean age=71.1±5.0). Vaccinated versus unvaccinated incidence of hospitalised HZ was 0.16 vs. 0.31/1,000 person-years and 0.03 vs. 0.08/1000 person-years for PHN. In the primary analysis, the adjusted overall VE against hospitalised HZ and hospitalised PHN was 57.8% (95% CI: 41.1-69.8) and 73.7% (95% CI:14.0-92.0) respectively. In adults ≥ 65 years old, the VE against hospitalised HZ was 54.4% (95% CI: 36.0-67.5) and VE against hospitalised PHN was 75·5% (95% CI: 19.9-92.5). In the secondary analysis, the VE against community HZ was 30.0% (95% CI: 25.6-34.5). The ZVL VE against hospitalised HZ for immunocompromised adults was 51.1% (95% CI: 23.1-69.5), and PHN hospitalisation was 67.6% (95% CI: 9.3-88.4). The VE against HZ hospitalisation for Māori was 45.2% (95% CI: -23.2-75.6) and for Pacific Peoples was 52.2% (95% CI: -40.6 -83·7). ZVL was associated with a reduction in risk of hospitalisation from HZ and PHN in the New Zealand population. Wellington Doctoral Scholarship awarded to JFM.

The Stories That Cripple Us: The Consequences of the Medical Model of Disability in the Legal Sphere

The legal sphere in Aotearoa is becoming more aware of its historically poor representation of gender and racial minorities. However, disabled people continue to be excluded and are often not recognised as an oppressed social group. When stories about disabled people are told in the legal sphere, our existence is diminished to medicalised narratives. These stories pathologise our existence, perpetuating a sense of othering for disabled people. This has a particular impact on disabled students of the law, who are exposed to negative attitudes towards disability through the judiciary and the critical avoidance of disability issues by legal academics. This article demonstrates how the pervasiveness of the medical model in judicial language and legal pedagogy fails to create a space of belonging for disabled people, failing the one in four members of the New Zealand population who are disabled. Overall, it demonstrates a need to undergo a "cripping" of legal education by incorporating socially oriented models of disability into legal study. This will require an adoption of both the traditional social model of disability and Whānau Hauā, an indigenous model of disability. Only by dislodging the medical model of disability will the law become a space of belonging for disabled people.

Prevalence of young-onset dementia: nationwide analysis of routinely collected data

IntroductionYoung-onset dementia prevalence is understudied internationally. Previous studies have been limited by low case numbers, reliance on single sources of routinely collected health data for case identification and inclusion of...

The health, work, and retirement study: representing experiences of later life in Aotearoa New Zealand

ABSTRACT Older adults represent a large and growing section of Aotearoa New Zealand's population. Longitudinal research on experiences of later life enables understanding of both the capabilities with which people are ageing, and their determinants. The Health, Work, and Retirement (HWR) study has to date conducted eight biennial longitudinal postal surveys of health and well-being with older people (n = 11,601 respondents; 49.4% of Māori descent). Survey data are linked at the individual-level to other modes of data collection, including cognitive assessments, life course history interviews, and national health records. This article describes the HWR study and its potential to support our understanding of ageing in Aotearoa New Zealand. We present an illustrative analysis of data collected to date, using indicators of physical health-related functional ability from n = 10,728 adults aged 55–80 to describe mean trajectories of physical ability with age, by birth cohort and gender. As the original participant cohort recruited in 2006 reach ages 71–86 in 2022, future directions for study include expanding the study's core longitudinal measures to include follow-up assessments of cognitive functioning to understand factors predicting cognitive decline, and linkage to national datasets to identify population-level profiles of risk for conditions such as frailty.

Female Sexuality in Aotearoa/New Zealand: Factors and Sexual Response Associated with Masturbation

Objectives Sexual health includes the state of physical, emotional, mental, and social well-being related to sexuality. Masturbation is an important sexual activity with many potential benefits which has gained considerable interest in sexuality research in the past twenty years; however, this research is the first of its kind within the Aotearoa/New Zealand context. In this in-depth investigation, we examined frequencies of, reasons for, and activities during masturbation as well as the relationship between masturbation and other factors. Methods Participants were 698 New Zealand women at least 18 years of age participating in a 42-item anonymous online survey collecting comprehensive information about sexual practices and related factors. Results The results indicated that female masturbation has high prevalence in the New Zealand population. Conclusion The pattern of results enabled us to identify the positive effects of masturbation, masturbation practices commonly used by New Zealand women and the differences between New Zealand women who masturbate frequently and less frequently.

Prevalence of Loneliness and Its Association With General and Health-Related Measures of Subjective Well-Being in a Longitudinal Bicultural Cohort of Older Adults in Advanced Age Living in New Zealand: LiLACS NZ.

ObjectivesThere is evidence that loneliness is detrimental to the subjective well-being of older adults. However, little is known on this topic for the cohort of those in advanced age (80 years or older), which today is the fastest-growing age group in the New Zealand population. We examined the relationships between loneliness and selected subjective well-being outcomes over 5 years.MethodsWe used a regional, bicultural sample of those in advanced age from 2010 to 2015 (Life and Living in Advanced Age: a Cohort Study in New Zealand). The first wave enrolled 937 people (92% of whom were living in the community): 421 Māori (Indigenous New Zealanders aged 80–90 years) and 516 non-Māori aged 85 years. We applied standard regression techniques to baseline data and mixed-effects models to longitudinal data, while adjusting for sociodemographic factors.ResultsFor both Māori and non-Māori, strong negative associations between loneliness and subjective well-being were found at baseline. In longitudinal analyses, we found that loneliness was negatively associated with life satisfaction as well as with mental health-related quality of life.DiscussionOur findings of adverse impacts on subjective well-being corroborate other evidence, highlighting loneliness as a prime candidate for intervention—appropriate to cultural context—to improve well-being for adults in advanced age.

The association of socioeconomic deprivationwith access and survival after hematopoietic stem cell transplantation in New Zealand.

Socioeconomic deprivation (SED) is a risk factor for reduced survival of hematopoietic stem cell transplant (HSCT) recipients. This study aimed to evaluate access and long-term survival of HSCT recipients. This was a hospital HSCT Registry-based retrospective cohort study. Patients who underwent HSCT from January 2010 to June 2020 were identified. HSCT recipients younger than 16 years of age, patients who reported their residential address as a post office box or the Department of Corrections, and those who left the country after HSCT were excluded from the study. HSCT recipients with the 2018 New Zealand deprivation index (NZDep2018) deciles 8, 9, and 10 were assigned to the higher SED group and those with NZDep2018 deciles from 1 to 7 were allocated to the lower SED group. The total number of New Zealanders in the higher and lower SED strata was obtained from the 2018 Census. Eight hundred fifty-one HSCT recipients met the eligibility criteria. HSCT recipients from the higher and lower SED strata of the New Zealand population had similar access to HSCT (odds ratio=.9; 95% confidence interval (CI): .77-1.04; p=.155). Mortality in the higher and lower SED groups of HSCT recipients was 9.6/100 person-years (95% CI: 7.7-12/100 person-years) and 8.1/100 person-years (95% CI: 6.9-9.4/100 person-years), respectively. The mortality ratio was 1.2 (95% CI: .9-1.6), p=.098. Both groups had similar survival. New Zealand residents from the higher and lower SED strata have similar access to HSCT. SED is not associated with reduced survival in adult HSCT recipients.

The predictive value of the sFlt-1/PlGF ratio in suspected preeclampsia in a New Zealand population: A prospective cohort study.

Internationally, placental growth factor (PlGF)-based tests are used as prognostic markers in suspected preeclampsia. However, Ministry of Health guidelines do not currently endorse PlGF-based tests in New Zealand (NZ). To investigate the predictive value of soluble fms-like tyrosine kinase 1 (sFlt-1)/PlGF ratio in suspected preeclampsia in a NZ population. A prospective cohort study of singleton pregnancies at 20+0 -36+6 weeks gestation with suspected preeclampsia as defined by Society of Obstetric Medicine Australia and NZ (SOMANZ) criteria. to evaluate a sFlt-1/PlGF ratio >38 at ≤35+0 weeks gestation to predict birth ≤14 days. to assess a sFlt-1/PlGF ratio cut-off of 38 at ≤37+0 weeks gestation, to rule out preeclampsia ≤1week, rule in preeclampsia ≤4 weeks, and to predict perinatal outcome. Clinicians were blinded to sFlt-1/PlGF ratio results. Included were 222 participants, 19.4% Māori and 10.4% Pasifika. A sFlt-1/PlGF >38 predicted birth ≤14 days, positive predictive value (PPV) 51.4% (95% CI, 39.6-63.0) and negative predictive value (NPV) 95.9% (95% CI, 91.4-98.1), median (interquartile range) days to birth 14 (2-27) vs 49 (33-70), P< 0.000. A sFlt-1/PlGF cut-off of 38 ruled out preeclampsia ≤1week (NPV 96.2% (95% CI, 92.3-98.2)) and ruled in preeclampsia ≤4 weeks (PPV 75.0% (95% CI, 65.0-82.9)). A sFlt-1/PlGF >38 was associated with greater perinatal morbidity. The predictive value of the sFlt-1/PlGF ratio in NZ is comparable to that reported in international trials. Used in clinical practice the sFlt-1/PlGF ratio may aid risk stratification in suspected preeclampsia, directing limited resources to those pregnancies at highest risk.

Association between mRNA COVID-19 vaccination and myocarditis

In early December 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan City, China, causing the first cases of coronavirus disease (COVID-19). It rapidly spread globally, and by 11 March 2020, a pandemic was declared by the World Health Organisation (WHO). The unprecedented global disruption to the spheres of society, the economy, and personal health placed increasing pressure on the development of safe and efficacious vaccines against COVID-19. Of those developed, the Pfizer (BioNTech/ Comirnaty BNT162b2) and Moderna (mRNA-1273) vaccines both utilise messenger RNA (mRNA) technology to provide immunisation against COVID-19. Clinical trials have demonstrated high efficacy of these mRNA vaccines in providing protection against COVID-19.1 However, reports from the Centres for Disease Control and Prevention (CDC) have described an association between the mRNA COVID-19 vaccines and the development of myocarditis. International literature has identified myocarditis developing in young males following mRNA COVID-19 vaccination. Preliminary results reported by the Centre for Adverse Reactions Monitoring (CARM) suggest that this adverse effect has also occurred in the New Zealand (NZ) population. The true incidence of post-vaccination myocarditis remains uncertain, as recorded cases rely on passive reporting systems; hence, there may be under-reporting of cases. Therefore, continued evaluation of case reports, retrospective studies, and ultimately an active reporting system, will be required to determine the rate of myocarditis following COVID-19 mRNA vaccination. In the interim, it has been determined that the benefits of the COVID-19 vaccination in reducing the risk of developing COVID-19 outweigh the potential adverse effects of the vaccine.

New Zealand travellers to high-risk destinations for arbovirus infection make little effort to avoid mosquito bites

ABSTRACT There has been no local transmission of arbovirus disease recorded in New Zealand to date. However, in the past two decades, there have been increasing numbers of overseas-acquired cases of arbovirus infections in New Zealand, mainly dengue, Zika, chikungunya and Ross River viruses. The repeated introduction of these viruses to the immunologically naïve New Zealand population through viraemic travellers represents a potential risk for local transmission by resident or new mosquito vectors. This study assessed the extent to which these imported arbovirus disease cases used the bite-avoidance measures recommended by the New Zealand Ministry of Health between 2001–2017. The majority of notified cases reported making little effort to avoid mosquito bites even during high-risk periods and outbreaks. This suggests that the infection of New Zealand travellers might be due to underestimation or unawareness of the risk of travel-related mosquito-borne diseases. New Zealand travellers to endemic or epidemic areas, mainly in the Asia-Pacific region, should be informed about ongoing risks according to season and epidemic activity at the destination and updated on the latest disease situation and new trends. This would reduce the likelihood of pathogen introduction and, therefore, local transmission of arbovirus infection in New Zealand.

Building on Aotearoa New Zealand’s Integrated Data Infrastructure

Stats NZ established the Integrated Data Infrastructure (IDI) to enable longitudinal research into the causes and correlates of social outcomes for New Zealanders. The IDI was established in 2011, building off earlier experiences linking employer and employee data (which itself subsequently formed the basis of another linked database known as the Longitudinal Business Database [LBD]). Data in the IDI form an ‘ever-resident’ Aotearoa New Zealand population of around nine million people. Access to the IDI is available for bona fide researchers so long as they meet established criteria to show that they will keep the data safe and work with it in a culturally appropriate way. This article gives a brief history to the development of the IDI (and the LBD) and shares some lessons learned along the way for the benefit of others starting down this integrated data journey.

The Cost-effectiveness of a Mass Media Campaign to Promote Smartphone Apps for Weight Loss: Updated Modeling Study.

BackgroundEvidence suggests that smartphone apps can be effective in the self-management of weight. Given the low cost, broad reach, and apparent effectiveness of weight loss apps, governments may seek to encourage their uptake as a tool to reduce excess weight in the population. Mass media campaigns are 1 mechanism for promoting app use. However, the cost and potential cost-effectiveness are important considerations.ObjectiveThe aim of our study was to use modeling to assess the health impacts, health system costs, cost-effectiveness, and health equity of a mass media campaign to promote high-quality smartphone apps for weight loss in New Zealand.MethodsWe used an established proportional multistate life table model that simulates the 2011 New Zealand adult population over the lifetime, subgrouped by age, sex, and ethnicity (Māori [Indigenous] or non-Māori). The risk factor was BMI. The model compared business as usual to a one-off mass media campaign intervention, which included the pooled effect size from a recent meta-analysis of smartphone weight loss apps. The resulting impact on BMI and BMI-related diseases was captured through changes in health gain (quality-adjusted life years) and in health system costs. The difference in total health system costs was the net sum of intervention costs and downstream cost offsets because of altered disease rates. An annual discount rate of 3% was applied to health gains and health system costs. Multiple scenarios and sensitivity analyses were conducted, including an equity adjustment.ResultsAcross the remaining lifetime of the modeled 2011 New Zealand population, the mass media campaign to promote weight loss app use had an estimated overall health gain of 181 (95% uncertainty interval 113-270) quality-adjusted life years and health care costs of –NZ $606,000 (–US $408,000; 95% uncertainty interval –NZ $2,540,000 [–US $1,709,000] to NZ $907,000 [US $610,000]). The mean health care costs were negative, representing overall savings to the health system. Across the outcomes examined in this study, the modeled mass media campaign to promote weight loss apps among the general population would be expected to provide higher per capita health gain for Māori and hence reduce health inequities arising from high BMI, assuming that the intervention would be as effective for Māori as it is for non-Māori.ConclusionsA modeled mass media campaign to encourage the adoption of smartphone apps to promote weight loss among the New Zealand adult population is expected to yield an overall gain in health and to be cost-saving to the health system. Although other interventions in the nutrition and physical activity space are even more beneficial to health and produce larger cost savings (eg, fiscal policies and food reformulation), governments may choose to include strategies to promote health app use as complementary measures.

An assessment of the potential impact of the Omicron variant of SARS-CoV-2 in Aotearoa New Zealand.

New Zealand delayed the introduction of the Omicron variant of SARS-CoV-2 into the community by the continued use of strict border controls through to January 2022. This allowed time for vaccination rates to increase and the roll out of third doses of the vaccine (boosters) to begin. It also meant more data on the characteristics of Omicron became available prior to the first cases of community transmission. Here we present a mathematical model of an Omicron epidemic, incorporating the effects of the booster roll out and waning of vaccine-induced immunity, and based on estimates of vaccine effectiveness and disease severity from international data. The model considers differing levels of immunity against infection, severe illness and death, and ignores waning of infection-induced immunity. This model was used to provide an assessment of the potential impact of an Omicron wave in the New Zealand population, which helped inform government preparedness and response. At the time the modelling was carried out, the date of introduction of Omicron into the New Zealand community was unknown. We therefore simulated outbreaks with different start dates, as well as investigating different levels of booster uptake. We found that an outbreak starting on 1 February or 1 March led to a lower health burden than an outbreak starting on 1 January because of increased booster coverage, particularly in older age groups. We also found that outbreaks starting later in the year led to worse health outcomes than an outbreak starting on 1 March. This is because waning immunity in older groups started to outweigh the increased protection from higher booster coverage in younger groups. For an outbreak starting on 1 February and with high booster uptake, the number of occupied hospital beds in the model peaked between 800 and 3,300 depending on assumed transmission rates. We conclude that combining an accelerated booster programme with public health measures to flatten the curve are key to avoid overwhelming the healthcare system.

Predicting vaginal birth after caesarean section: Validation of the Grobman model in a New Zealand population.

The decision regarding mode of birth following a primary caesarean section is important. Women may choose an elective repeat caesarean section or a trial of labour in an attempt to achieve a vaginal birth after caesarean (VBAC). The highest morbidity and mortality is associated with those who have an emergency caesarean section following a trial of labour. Therefore, the ability to accurately predict successful VBAC is important in antenatal counselling. To test the validity of the Grobman prediction nomogram in a New Zealand (NZ) population. A retrospective cohort study was performed of women carrying a singleton, cephalic pregnancy at term and who had one previous lower segment caesarean section in Northland, NZ. The probabilities of successful VBAC were calculated using the variables in the Grobman model and compared with observed VBAC rates using a calibration curve. The predictive ability of the model was assessed using area under the receiver operating characteristic curve (AUC). Of the 421 eligible women, 354 elected to undergo a trial of labour, of whom 69.5% had a successful VBAC. The AUC for the Grobman model was 0.72 (95% CI 0.67-0.78) with predicted and actual outcomes being similar when predicted success was over 50%. The predictive ability of the model appeared more accurate for Māori and Pacifika women compared to the NZ European population. The Grobman model predicts successful VBAC reasonably well in a NZ population and can be used as an antenatal counselling aid.

Metabolic disease in the Pacific: Lessons for indigenous populations.

Twenty-five percent of the New Zealand population is either Māori or Pacific and are thus indigenous to the region. The New Zealand National Metabolic Service has considerable experience in diagnosing and managing metabolic diseases in this population. The frequencies and phenotypes of inborn errors of metabolism in indigenous people differ from that in Western European populations. Metabolic services need to be aware of these local variations and adapt their screening and treatment protocols accordingly. Likewise, the services themselves need to adopt culturally appropriate practices. This includes an understanding of the language, ideally employment of indigenous people and targeting of the service to meet the needs of the people. Knowledge of the metabolic diseases common within particular ethnic groups is important for the rapid delivery of appropriate management. Newborn screening protocols need to reflect the local populations. With the advent of expanded newborn screening relatively benign forms of fatty acid oxidation disorders have been commonly encountered. This high prevalence may reflect a selective evolutionary advantage as similar conditions have been found in other ethnic groups with traditionally high fat and low carbohydrate diets. HLA haplotypes of indigenous populations are less represented in international stem cell transplant databanks thereby making the option of human stem cell transplant more challenging. The recent discovery that short-chain enoyl-CoA hydratase deficiency is particularly common in New Zealand with nearly a dozen cases identified this year suggests there is still a lot to learn regarding Māori and Pacific and indeed an indigenous metabolic disease.

Participation in paid and unpaid work one year after injury and the impact of subsequent injuries for Māori: Results from a longitudinal cohort study in New Zealand

IntroductionIndigenous populations experience greater injury burdens than non-indigenous groups. This paper investigated, for injured Māori (New Zealand's indigenous population): 1) participation in paid and unpaid work 12 months after injury, 2) whether subsequent injuries are predictive of reduced participation, and 3) if particular characteristics of subsequent injuries predict reduced participation. MethodsThe Subsequent Injury Study utilised data from the earlier Prospective Outcomes of Injury Study, a study of 2856 injured New Zealanders (including 566 Māori; 20%) who had an Accident Compensation Corporation (ACC; New Zealand's no-fault injury insurer) entitlement claim (sentinel injury). Data about subsequent injuries reported to ACC and hospital discharge data for injuries resulting in hospitalisation were also utilised. Multivariable models were used to examine if certain aspects of subsequent injury predicted either of two outcomes – reduced participation in paid, and unpaid work 12 months after a sentinel injury. ResultsEligible participants were identified from the 405 Māori participants interviewed at 12 months. Thirty-two percent sustained at least one ACC subsequent injury, and 16% reported reduced participation in unpaid work. Of the eligible participants working for pay at the time of their sentinel injury, 35% reported reduced participation in paid work. Although the relationship between sustaining a subsequent injury (or not) and reduced participation in paid work was unclear (aRR 1.4, 95%CI 0.9,2.3), particular subsequent injury characteristics were identified as being independently predictive: subsequent injury resulting from an assault (aRR 2.4, 95%CI 1.2,4.9), a subsequent injury involving an entitlement claim (aRR 2.0, 95%CI 1.1,3.4), sustaining more than one subsequent injury (aRR 2.0, 95%CI 1.1,3.6), and only non-work-related subsequent injuries (aRR 1.6, 95%CI 1.0,2.7). ConclusionsReduced participation in paid work is prevalent for Māori after an ACC entitlement claim injury. Particular characteristics of subsequent injuries after such an event impacts on participation in paid work 12 months after the sentinel injury, but the picture is less clear for unpaid work. Understanding the changes in paid and unpaid work, and the predictive characteristics of subsequent injuries for injured Māori, is important for future injury prevention strategies and supporting return to work rehabilitation programmes, specifically for Māori.

Automated pneumothorax triaging in chest X-rays in the New Zealand population using deep-learning algorithms.

The primary aim was to develop convolutional neural network (CNN)-based artificial intelligence (AI) models for pneumothorax classification and segmentation for automated chest X-ray (CXR) triaging. A secondary aim was to perform interpretability analysis on the best-performing candidate model to determine whether the model's predictions were susceptible to bias or confounding. A CANDID-PTX dataset, that included 19,237 anonymized and manually labelled CXRs, was used for training and testing candidate models for pneumothorax classification and segmentation. Evaluation metrics for classification performance included Area under the receiver operating characteristic curve (AUC-ROC), sensitivity and specificity, whilst segmentation performance was measured using mean Dice and true-positive (TP)-Dice coefficients. Interpretability analysis was performed using Grad-CAM heatmaps. Finally, the best-performing model was implemented for a triage simulation. The best-performing model demonstrated a sensitivity of 0.93, specificity of 0.95 and AUC-ROC of 0.94 in identifying the presence of pneumothorax. A TP-Dice coefficient of 0.69 is given for segmentation performance. In triage simulation, mean reporting delay for pneumothorax-containing CXRs is reduced from 9.8 ± 2 days to 1.0 ± 0.5 days (P-value < 0.001 at 5% significance level), with sensitivity 0.95 and specificity of 0.95 given for the classification performance. Finally, interpretability analysis demonstrated models employed logic understandable to radiologists, with negligible bias or confounding in predictions. AI models can automate pneumothorax detection with clinically acceptable accuracy, and potentially reduce reporting delays for urgent findings when implemented as triaging tools.