Nick Garrett

Campylobacteriosis in New Zealand: results of a case-control study.

STUDY OBJECTIVE: To identify and assess the contributions of major risk factors for campylobacteriosis in New Zealand. DESIGN: Case-control study. Home interviews were conducted over nine months using a standardised questionnaire to assess recent food consumption and other exposures. SETTING: Four centres in New Zealand with high notification rates of campylobacter infections--Auckland, Hamilton, Wellington, and Christchurch. PARTICIPANTS: Case patients were 621 people notified between 1 June 1994 and 28 February 1995 as having campylobacter infection. Control subjects were selected randomly from telephone directories, and were matched 1:1 with case patients in relation to sex, age group, and home telephone prefix. RESULTS: Risk of campylobacteriosis was strongly associated with recent consumption of raw or undercooked chicken (matched odds ratio 4.52, 95% confidence interval 2.88, 7.10). There was also an increased risk with chicken eaten in restaurants (matched odds ratio 3.85; 2.52, 5.88). Recent consumption of baked or roasted chicken seemed to be protective. Campylobacteriosis was also associated with recent overseas travel, rainwater as a source of water at home, consumption of raw dairy products, and contact with puppies and cattle, particularly calves. CONCLUSIONS: Improperly cooked chicken seems to be associated with a large proportion of campylobacteriosis in New Zealand. Thorough cooking of chicken in homes and restaurants could reduce considerably the incidence of this disease.

Household crowding a major risk factor for epidemic meningococcal disease in Auckland children.

Background. New Zealand is in its ninth year of a serogroup B meningococcal disease epidemic with annual rates of up to 16.9 cases per 100 000. The highest incidence is in Maori and Pacific Island children in the Auckland region. We conducted a case-control study to identify potentially modifiable risk factors for this disease. Methods. A case-control study of 202 cases of confirmed and probable meningococcal disease in Auckland children younger than 8 years of age recruited from May, 1997, to March, 1999, was undertaken. Controls (313) were recruited door-to-door by a cluster sampling method based on starting points randomly distributed in the Auckland region. They were frequency matched with the expected distribution of age and ethnicity in the meningococcal disease cases. Results. With the use of a multivariate model and controlling for age, ethnicity, season and socioeconomic factors, risk of disease was strongly associated with overcrowding as measured by the number of adolescent and adult (10 years or older) household members per room [odds ratio (OR), 10.7; 95% confidence interval (CI), 3.9 to 29.5]. This would result in a doubling of risk with the addition of 2 adolescents or adults to a 6-room house. Risk of disease was also associated with analgesic use by the child, which was thought to be a marker of recent illness (OR 2.4, CI 1.5 to 4.0); number of days at substantial social gatherings (10 or more people for > 4 h; OR 1.8, CI 1.2 to 2.6); number of smokers in the household (OR 1.4, CI 1.0 to 1.8); sharing an item of food, drink or a pacifier (OR 1.6, CI 1.0 to 2.7); and preceding symptoms of a respiratory infection (cough, “cold or flu,” runny nose, sneezing) in a household member (OR 1.5, CI 1.0 to 2.5). Conclusion. Some of these identified risk factors for meningococcal disease are modifiable. Measures to reduce overcrowding could have a marked effect on reducing the incidence of this disease in Auckland children.

The occurrence of Campylobacter subtypes in environmental reservoirs and potential transmission routes

Aim:  To identify potential reservoirs and transmission routes of human pathogenic Campylobacter spp.

Interventions for the prevention and management of neck/upper extremity musculoskeletal conditions: a systematic review

Considered from medical, social or economic perspectives, the cost of musculoskeletal injuries experienced in the workplace is substantial, and there is a need to identify the most efficacious interventions for their effective prevention, management and rehabilitation. Previous reviews have highlighted the limited number of studies that focus on upper extremity intervention programmes. The aim of this study was to evaluate the findings of primary, secondary and/or tertiary intervention studies for neck/upper extremity conditions undertaken between 1999 and 2004 and to compare these results with those of previous reviews. Relevant studies were retrieved through the use of a systematic approach to literature searching and evaluated using a standardised tool. Evidence was then classified according to a “pattern of evidence” approach. Studies were categorised into subgroups depending on the type of intervention: mechanical exposure interventions; production systems/organisational culture interventions and modifier interventions. 31 intervention studies met the inclusion criteria. The findings provided evidence to support the use of some mechanical and modifier interventions as approaches for preventing and managing neck/upper extremity musculoskeletal conditions and fibromyalgia. Evidence to support the benefits of production systems/organisational culture interventions was found to be lacking. This review identified no single-dimensional or multi-dimensional strategy for intervention that was considered effective across occupational settings. There is limited information to support the establishment of evidence-based guidelines applicable to a number of industrial sectors.

Exposure of hospitality workers to environmental tobacco smoke

Objective: To determine quantitatively the extent of exposure of hospitality workers to environmental tobacco smoke (ETS) exposure during the course of a work shift, and to relate these results to the customer smoking policy of the workplace. Subjects: Three categories of non-smoking workers were recruited: (1) staff from hospitality premises (bars and restaurants) that permitted smoking by customers; (2) staff from smokefree hospitality premises; and (3) government employees in smokefree workplaces. All participants met with a member of the study team before they began work, and again at the end of their shift or work day. At each meeting, participants answered questions from a standardised questionnaire and supplied a saliva sample. Main outcome measures: Saliva samples were analysed for cotinine. The difference between the first and second saliva sample cotinine concentrations indicated the degree of exposure to ETS over the course of the work shift. Results: Hospitality workers in premises allowing smoking by customers had significantly greater increases in cotinine than workers in smokefree premises. Workers in hospitality premises with no restrictions on customer smoking were more highly exposed to ETS than workers in premises permitting smoking only in designated areas. Conclusions: Overall, there was a clear association between within-shift cotinine concentration change and smoking policy. Workers in premises permitting customer smoking reported a higher prevalence of respiratory and irritation symptoms than workers in smokefree workplaces. Concentrations of salivary cotinine found in exposed workers in this study have been associated with substantial involuntary risks for cancer and heart disease.

Effect of telephone counseling on physical activity for low-active older people in primary care: a randomized, controlled trial.

OBJECTIVES: To assess the long‐term effectiveness of a telephone counseling intervention on physical activity and health‐related quality of life in low‐active older adults recruited through their primary care physician.

Investigation of Health Effects of Hydrogen Sulfide from a Geothermal Source

Abstract Little is known about health effects from chronic exposure to hydrogen sulfide (H2S). The city of Rotorua, New Zealand, is exposed to H2S by virtue of its location over a geothermal field. In this study, the authors classified areas within Rotorua as high-, medium, or low-H2S exposure areas. Using 1993-1996 morbidity data, standardized incidence ratios were calculated for neurological, respiratory, and cardiovascular effects. Poisson regression analysis was used to confirm results. Results showed exposure-response trends, particularly for nervous system diseases, but also for respiratory and cardiovascular diseases. Data on confounders were limited to age, ethnicity, and gender. The H2S exposure assessment had limitations. Assumptions were that recent exposure represented long-term exposure and that an individuals entire exposure was received at home. The results of this study strengthen the suggestion that there are chronic health effects from H2S exposure. Further investigation is warranted.

Does clinic-measured gait speed differ from gait speed measured in the community in people with stroke?

Objective: To compare the extent to which gait speed measured in the clinic setting differs from that measured in the community. Design: Participants completed the 10-m walk test at a self-selected speed in a clinic setting. Following this they completed a 300-m community-based walking circuit that covered a variety of environmental conditions. Gait velocity was sampled at different points in the circuit. The same circuit and sampling points were used for all participants. Clinic gait velocity was compared to gait velocity measured on five occasions during the community-based circuit. Setting: Physiotherapy clinic and local shopping mall. Participants: Twenty-eight chronic stroke patients who regularly accessed the community divided into two groups based on their gait velocity in the clinic. Main outcome measures: Walking velocity. Results: Spearman rank correlation coefficient indicated that there was a strong correlation between the total time taken to walk the 300-m course and the clinic-based gait velocity (r=-0.88, P<0.0001). A linear mixed model with repeated measures analysis revealed significant interaction between community measures for group A versus group B (F4,26=4.49, P=0.0068) and significant differences across community conditions (F4,26=7.12, P=0.0005). Conclusion: The clinic-based 10-m walk test is able to predict walking velocity in a community setting in chronic stroke patients who score 0.8 m/s or faster. However, for those who score less than 0.8 m/s in the clinic test, gait velocity in the community may be overestimated.

Persistence of oral polio vaccine virus after its removal from the immunisation schedule in New Zealand

On Feb 1, 2002, inactivated poliomyelitis vaccines replaced live-attenuated oral poliovirus vaccine (OPV) in New Zealands immunisation schedule, allowing systematic monitoring of OPV virus circulation. Findings of paediatric-inpatient surveillance indicate that 7% of children excreted polioviruses before this switch, but none did so 1 month afterwards. Acute flaccid paralysis surveillance detected no poliovirus during and after the switch, whereas enterovirus surveillance detected poliovirus only once during the switch. Environmental surveillance identified polioviruses in sewage samples until May, 2002, after which they were detected infrequently. Intratypic differentiation and sequencing showed that all polioviruses were Sabin-like. Multiple surveillance methods hence showed that OPV strains did not persist for extended periods after a vaccine switch in a developed country with a temperate climate. Sequence homology with Sabin vaccine parent strains indicated that polioviruses detected more than 4 months after the switch were of recent origin, consistent with importation from OPV-using countries.

Statistical comparison of Campylobacter jejuni subtypes from human cases and environmental sources.

Aim:  To analyse Campylobacter jejuni typing data to define statistically which potential reservoirs and transmission sources contain isolates that are most similar to one another and to isolates from human infections.