Adam Roth

Concurrent outbreaks of dengue, chikungunya and Zika virus infections - an unprecedented epidemic wave of mosquito-borne viruses in the Pacific 2012-2014.

Since January 2012, the Pacific Region has experienced 28 new documented outbreaks and circulation of dengue, chikungunya and Zika virus. These mosquito-borne disease epidemics seem to become more frequent and diverse, and it is likely that this is only the early stages of a wave that will continue for several years. Improved surveillance and response measures are needed to mitigate the already heavy burden on island health systems and limit further spread to other parts of the world.

Noncommunicable diseases and risk factors in adult populations of several Pacific Islands: results from the WHO STEPwise approach to surveillance

Objective: To provide an overview of the prevalence of noncommunicable diseases (NCDs) and their risk factors in several Pacific island countries and territories (PICTs), in accordance with global NCD targets.

Prevalence of sexually transmitted infections in female clinic attendees in Honiara, Solomon Islands

Objectives This study sought to determine the prevalence of common bacterial sexually transmitted infections, including Chlamydia trachomatis and Neisseria gonorrhoeae, in women attending clinics in the Solomon Islands. Methods We conducted a sexual health survey among women attending three nurse-led community outpatient clinics in August 2014, to establish the prevalence of bacterial sexually transmitted infections in female clinic attenders in Honiara, Solomon Islands. Vaginal swab samples were tested for infection with C. trachomatis and N. gonorrhoeae using a commercial strand displacement amplification assay. Serum samples were tested for syphilis. Results We enrolled 296 women, aged 16–49, attending three clinics. Knowledge of safe sexual practices was high but reported condom usage was low. The prevalence of infection with C. trachomatis was 20%. The prevalence of infection with N. gonorrhoeae and syphilis were 5.1% and 4.1%, respectively. Conclusions Bacterial sexually transmitted infections are a major health problem in the Solomon Islands. Interventions are urgently needed.

Prevalence and sociodemographic risk factors of chlamydia, gonorrhoea and syphilis: a national multicentre STI survey in New Caledonia, 2012.

Objectives To estimate prevalence and identify sociodemographic risk factors for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and Treponema pallidum infections in New Caledonia. Method A national cross-sectional survey was undertaken using a three-stage random sampling of general practice surgeries and public dispensaries. Participants were included through opportunistic screening and using a systematic step for selection. The study sample was weighted to the general population aged 18–49 years. Prevalence and risk factors were calculated by logistic regression. Results CT was the most common sexually transmitted infection, with a prevalence of 9% (95% CI 6.6% to %11.4), followed by NG 3.5% (95% CI 1.9% to 5.1%), previous or latent syphilis 3% (95% CI 1.7% to 4.3%), NG and CT co-infection 2.1% (95% CI 0.8% to 3.3%) and active syphilis 0.4% (95% CI 0.0% to 0.9%). Being from a young age group (18–25 years), being single, having a low level of education and province of residence were all associated with higher prevalence of all three STIs. Being of Melanesian origin was associated with higher prevalence of both CT and NG. There was a significant interaction between ethnic group and province of residence for prevalence of CT. Female gender was associated with higher prevalence of CT. Conclusions The prevalence of CT was similar to estimates from other healthcare-based surveys from the Pacific, but higher for NG and lower for active syphilis infection. All sexually transmitted infections estimates were much higher than those found in population-based surveys from Europe and the USA. The sociodemographic risk factors identified in this study will help guide targeted prevention and control strategies in New Caledonia.

Alcohol use in the Pacific region: results from the STEPwise approach to surveillance, Global School-Based Student Health Survey and Youth Risk Behavior Surveillance System

Abstract Introduction and Aims Alcohol use is a leading risk factor for disease and injury in Pacific Island countries and territories (PICT). This paper examines drinking patterns across 20 PICTs. Design and Methods We synthesised published data from the STEPwise approach to surveillance or similar surveys for adults 25–64 years, and from the Global School‐Based Student Health surveys and Youth Risk Behavior Surveillance System (YRBSS) for youth. We examined current and heavy drinking, and for adults also frequency of consumption. Using YRBSS, we studied trends in youth alcohol use in US‐affiliated PICTs between 2001 and 2013. Results Alcohol consumption in adults and youth varied considerably across PICTs. In eight PICT populations, over 60% of male adults were current drinkers. Male adults consumed alcohol more frequently and engaged in heavy drinking more than female adults. Similar gender differences occurred in current and heavy drinking among youth. Across 10 PICTs, current drinking prevalence in males 13–15 years ranged from 10% to over 40%. Declines in alcohol use among grade 9–12 students were observed in YRBSS, although the magnitude differed by island and sex. Discussion and Conclusions Alcohol consumption varies widely between PICTs. There are marked gender differences in use and abstention. There is scope in PICTs for implementation of best practice strategies to reduce alcohol‐related harm. These need to be gender responsive and cognisant of concerning patterns of youth drinking. Strengthening surveillance of alcohol use and its consequences is vital to inform and monitor the impact of national and regional policies. [Kessaram T, McKenzie J, Girin N, Roth A, Vivili P, Williams G, Hoy D. Alcohol use in the Pacific region: Results from the STEPwise approach to surveillance, Global School‐Based Student Health Survey and Youth Risk Behavior Surveillance System. Drug Alcohol Rev 2016;35:412–423]

Adapting to the health impacts of climate change in a sustainable manner.

The climate is changing and this poses significant threats to human health. Climate change is one of the greatest challenges facing Pacific Island countries and territories due to their unique geophysical features, and their social, economic and cultural characteristics. The Pacific region also faces challenges with widely dispersed populations, limited resources and fragmented health systems. Over the past few years, there has been a substantial increase in international aid for health activities aimed at adapting to the threats of climate change. This funding needs to be used strategically to ensure an effective approach to reducing the health risk from climate change. Respecting the principles of development effectiveness will result in more effective and sustainable adaptation, in particular, 1) processes should be owned and driven by local communities, 2) investments should be aligned with existing national priorities and policies, and 3) existing systems must not be ignored, but rather expanded upon and reinforced.

An epidemiological study to assess the true incidence and prevalence of rheumatic heart disease and acute rheumatic fever in New Caledonian school children

To provide in New Caledonian school children (i) the prevalence of rheumatic heart disease (RHD) detected by annual screening program using new World Heart Federation diagnostic criteria; (ii) the point prevalence of acute rheumatic fever (ARF); and (iii) to investigate socio‐demographic risk factors associated with RHD.

Overweight and obesity in New Caledonian adults: results from measured and adjusted self-reported anthropometric data.

AIMS To estimate the overweight (OW) and obesity (Ob) prevalence and associated socio-demographic risk factors in New Caledonian adults aged 18-67years. METHODS From a randomly selected cross-sectional population survey, self-reported (n=2513) and measured (n=736) height and weight data were collected. Separate linear regression analyses for measured weight and height were performed, using cases with both self-reported weight and height and socio-demographic variables. The final weight and height assigned to each case was either measured or predicted from the regression (n=2075). OW prevalence was defined as: Body Mass Index (BMI) ≥25 and <30kg/m-2; and Ob: BMI ≥30kg/m-2. Samples were weighted to the general adult population. Prevalence and Odds ratios (ORs) were calculated by gender, and adjusted for socio-demographic variables, to assess differentials in OW, Ob and OW-Ob, using multinomial and logistic regressions. RESULTS Male (M) OW was 35% (95% CI: 31-38), Ob 29% (95% CI: 26-32) and OW-Ob 64% (95% CI: 60-67); female (F) OW was 26% (95% CI: 23-28), Ob 34% (95% CI: 31-37) and OW-Ob 60% (95% CI: 57-63). Compared to Melanesians (OR=1.0) for male/female: Polynesians had the highest prevalence of OW (1.7/1.5), Ob (4.7/3.5), and OW-Ob (3.0/2.5); New Caledonian-born Europeans had greater OW, Ob and OW-Ob (0.3/0.4) than immigrant Europeans (0.2/0.2). CONCLUSIONS Findings contribute to obesity comparisons with other Pacific Islands, and they establish trends in New Caledonia for targeting policies and strategies of prevention.

Who will lead the physicians unwilling to lead? Institutional logics and double-bind situations in health care leadership

Purpose – Health care organizations are increasingly demanded to balance the institutional logic of “medical professionalism” and “business-like health care,” that is, to both recognize physicians’ professional expertise while locating it in a wider social, economic, and political organizational setting. The purpose of this paper is to examine the implications from this shift in terms of leadership work in health care organizations. Design/methodology/approach – Case study methodology including interviews with 15 residents in Swedish health care organizations. Findings – A study of the willingness of residents to take on leadership positions show that leadership roles are treated as what is potentially hindering the acquisition of the know-how, skills, and expertise demanded to excel in the clinical work. Consequently, taking on leadership positions in the future was relatively unattractive for the residents. In order to overcome such perceived conflict between professional skill development and leadershi...

Investigating an outbreak of acute fever in Chuuk, Federated States of Micronesia.

OBJECTIVE In September 2012, there was an unexpected increase of acute febrile illness (AFI) in Chuuk State of the Federated States of Micronesia. At the same time, dengue outbreaks were occurring in two of the Federated States of Micronesias other three states. The cause of AFI was suspected to be dengue; however, by the end of October, only one of 39 samples was positive for dengue. The objective of the investigation was to establish the cause of the outbreak. METHODS A line list was created and data analysed by time, place, person and clinical features. Reported symptoms were compared with the published symptoms of several diagnoses and laboratory testing undertaken. RESULTS Of the 168 suspected cases, 62% were less than 20 years of age and 60% were male. The clinical features of the cases were not typical for dengue but suggestive of respiratory illness. Nasopharyngeal swabs were subsequently collected and found to be positive for influenza. Public health measures were undertaken and the AFI returned to expected levels. DISCUSSION Clinical diagnosis of acute febrile illness (AFI) can often be difficult and misleading. This can mean that opportunities for preventive measures early on in an outbreak are missed. In any outbreak, descriptive epidemiological analyses are valuable in helping to ascertain the cause of the outbreak.