Sue Crengle

Vitamin D During Pregnancy and Infancy and Infant Serum 25-Hydroxyvitamin D Concentration

OBJECTIVE: To determine the vitamin D dose necessary to achieve serum 25-hydroxyvitamin D (25(OH)D) concentration ≥20 ng/mL during infancy. METHODS: A randomized, double-blind, placebo-controlled trial in New Zealand. Pregnant mothers, from 27 weeks’ gestation to birth, and then their infants, from birth to age 6 months, were randomly assigned to 1 of 3 mother/infant groups: placebo/placebo, vitamin D3 1000/400 IU, or vitamin D3 2000/800 IU. Serum 25(OH)D and calcium concentrations were measured at enrollment, 36 weeks’ gestation, in cord blood, and in infants at 2, 4, and 6 months of age. RESULTS: Two-hundred-and-sixty pregnant women were randomized. At enrollment, the proportions with serum 25(OH)D ≥20 ng/mL for placebo, lower-dose, and higher-dose groups were 54%, 64%, and 55%, respectively. The proportion with 25(OH)D ≥20 ng/mL was larger in both intervention groups at 36 weeks’ gestation (50%, 91%, 89%, P < .001). In comparison with placebo, the proportion of infants with 25(OH)D ≥20 ng/mL was larger in both intervention groups to age 4 months: cord blood (22%, 72%, 71%, P < .001), 2 months (50%, 82%, 92%, P < .001), and 4 months (66%, 87%, 87%, P = .004), but only in the higher-dose group at age 6 months (74%, 82%, 89%, P = .07; higher dose versus placebo P = .03, lower dose versus placebo P = .21). CONCLUSIONS: Daily vitamin D supplementation during pregnancy and then infancy with 1000/400 IU or 2000/800 IU increases the proportion of infants with 25(OH)D ≥20 ng/mL, with the higher dose sustaining this increase for longer.

Adolescents' perceptions of a health survey using multimedia computer-assisted self-administered interview

Objective: To ascertain young peoples perceptions of an adolescent health survey when administered by multimedia computer assisted self‐administered Interview (M‐CASI) through analysis of (1) questionnaire item responses and (2) focus group interviews.

Evaluating the short form of the Reynolds Adolescent Depression Scale in New Zealand adolescents.

Objective: The aim of the present study was to examine the reliability and validity of the short form of the Reynolds Adolescent Depression Scale (RADS-SF). Method: A sample of 9567 randomly selected New Zealand secondary school students participated in the Youth2000 Health and Wellbeing Survey that included the full-length version of the RADS. The reliability and validity of the subset of items that make up the RADS-SF and its comparability to the original version were assessed using Cronbachs alpha, kappa statistics, correlations between the two versions of the instrument, confirmatory factor analysis and correlation to other questions in the survey considered likely to be associated with depression. Results: The RADS-SF had Cronbachs alpha of 0.88, was strongly correlated (0.95) to the RADS, had acceptable fit for the data (χ2=2823.27, df=35, comparative fit index=0.96, root mean square error of approximation=0.092, 90% confidence interval=0.089–0.095, standardized root mean square residual=0.042), showed configural invariance across gender, age and ethnic groups, and was strongly correlated with other depression-related questions, such as suicidal ideation (r=0.48). While the overall agreement for classification of depression by the two scores was good (κ=0.75), a higher percentage of students were classified as having depressive symptoms using the recommended RADS-SF cut-off point of 26 compared with the RADS criteria. Conclusions: The RADS-SF was found to have acceptable reliability and validity and to have psychometric properties comparable to the RADS in a large population of New Zealand adolescents.

Indigenous health performance measurement systems in Canada, Australia, and New Zealand

The worldwide use of health performance measurement has emerged over the past two decades. Health service managers try to improve effi ciency and outcomes by linking cycles of evaluation to clear and measurable objectives. The World Health Organization (WHO) has defi ned three principal goals for health-care systems as: contributing to good health, responsiveness to the expectations of the population, and fairness of fi nancial contribution. In Canada, Australia, and New Zealand, the extent of Indigenous health disadvantage is well documented. Accordingly, expectations that the development of health performance measurement systems in these nations would give some priority to Indigenous health are reasonable. We discuss here the issues in health performance measurement systems in Indigenous societies within a human rights framework. Our research group examined information systems for Indigenous health in Canada, Australia, and New Zealand, through an extensive, country-specifi c review of both published and unpublished resources, as well as key informant interviews with national, regional, and community health measurement stakeholders. We asked national, regional, and community-level health information specialists and policymakers what health performance measurement systems are used, and how these systems relate to community-based health services and Indigenous peoples’ defi nitions of health. In our thematic analysis, we examined the underlying goals, processes, and contexts of existing Indigenous health measurement systems. We also looked for examples of best practice. Our inquiry identifi ed some advances in the development of Indigenous health performance measurements systems. However, we also identifi ed some important gaps, especially in the development of local and regional information systems and feedback to these systems, as well as in the processes for Indigenous input, including the application of Indigenous-specifi c frame works and indicators. The underlying intent of macro performance measurement systems varies, but includes the fi nancial accountability of programmes and services, political management of programmes, monitoring of the performance of services, and the development of capacity at a programme level. Macro refers to aggregated national or large regional systems. Some key informants felt that despite the often repetitive and lengthy service reporting, feedback processes remained inadequate, especially at community level. For example, our key Canadian informants reported that, in general, data are not compiled and fed back to either the health-care services or to the Indigenous communities from which they came. In New Zealand, key informants indicated that although the national Ministry of Health gathers Māori health data against a long list of indicators, much of those data are not used or fed back to the local level to inform Māori health-care planning and decision-making. Australia now produces a report every 2 years that collates performance data and indicators across a range of Aboriginal and Torres Strait Islander health-care and community service programmes. More importantly, the Australian Federal Health Department, has, since 2001, collaborated with the National Aboriginal Community Controlled Health Organisation on the analysis and publication of performance data from the health-care sector controlled by the Aboriginal community. All three countries have evidence of consultation with Indigenous people in the development of performance measurement systems. In Canada, the Aboriginal Health Reporting Framework process claims to centralise Indigenous consultation. However, the process is clearly driven by federal, provincial, and territorial accountability; is chaired by federal and provincial government representatives; and seeks to identify pan-Indigenous macro-level indicators. In New Zealand, the Ministry of Health held a Viewpoint of community meetings in 2004 to discuss what monitoring framework should be used nationally for Māori health. He Korowai Oranga, the national strategic framework for Māori health, was chosen. This framework can recognise both universal indicators of health such as mortality and disability, and Māori-specifi c indicators such as social determinants, secure cultural identity, and control over one’s destiny. The development of He Korowai Oranga included consultation meetings and written submission as methods of gaining Māori input. In Australia, a collaborative planning strategy has been developed for Aboriginal and Torres Strait Islander health that enables input from Indigenous service stakeholders into all levels and aspects of health system develop ment. Yet, opportunities for input from Indigenous Australian stakeholders outside of health or other community services are few. In all countries, some level of Indigenous involvement in the development of macro health systems has been achieved. Although eff ective consulta tive mechanisms are important, they should not divert attention from the necessity of enabling the development of local measurement systems that are Indigenous-driven. In Canada, several Indigenous groups responded to the gap in local Indigenous health information system Lancet 2006; 367: 2029–31

New Zealand epidemic strain meningococcal B outer membrane vesicle vaccine in children aged 16-24 months

Background: New Zealand has experienced an epidemic of Neisseria meningitidis dominated by strain B:4:P1.7b,4 since 1991. Children younger than 5 years are at highest risk. Previous serogroup B outer membrane vesicle (OMV) strain specific vaccines have shown variable efficacy in this age group. Objective: To evaluate the immunogenicity, reactogenicity and safety in 16–24-month-old children of an OMV vaccine developed against the New Zealand epidemic strain. Methods: Children (332) aged 16–24 months were randomized to receive the New Zealand candidate vaccine made using strain NZ98/254 (B:4:P1.7b,4) or the Norwegian parent vaccine made using strain 44/76 (B:15:P1.7,16). Vaccines (25 μg/dose) were administered at 0, 6 and 12 weeks in this observer-blind trial. Immune response was measured by serum bactericidal assay and enzyme-linked immunosorbent assay. Sero-response was defined as a 4-fold or greater rise in serum bactericidal antibody titer compared with baseline, with titers <1:4 required to increase to ≥1:8 to be considered a sero-response. Local and systemic reactions were monitored for 7 days after vaccination. Results: Sero-response against NZ98/254 was achieved after 3 doses in 75% (95% CI: 69–80%) receiving the New Zealand candidate vaccine by both intention to treat (ITT) and per protocol (PP) analyses. In Norwegian parent vaccinees this was seen in 3% (0–12%) (ITT) and 4% (0–13%) (PP). Vaccines were well tolerated with no vaccine-related serious adverse events. Conclusion: The New Zealand candidate vaccine administered to these 16–24-month-old children in 3 doses was safe and elicited a promising immune response against the candidate vaccine strain NZ98/254 (N. meningitidis B:4:P1.7b,4) contributing to vaccine licensure for this age group.

Effectiveness of fixed dose combination medication ('polypills') compared with usual care in patients with cardiovascular disease or at high risk : A prospective, individual patient data meta-analysis of 3140 patients in six countries

AIMS To conduct a prospective, individual participant data (IPD) meta-analysis of randomised controlled trials comparing a polypill-based approach with usual care in high risk individuals. METHODS AND RESULTS Three trials comparing polypill-based care with usual care in individuals with CVD or high calculated cardiovascular risk contributed IPD. Primary outcomes were self-reported adherence to combination therapy (anti-platelet, statin and ≥ two blood pressure (BP) lowering agents), and difference in mean systolic BP (SBP) and LDL-cholesterol at 12 months. Analyses used random effects models. Among 3140 patients from Australia, England, India, Ireland, New Zealand and The Netherlands (75% male, mean age 62 years), median follow-up was 15 months. At baseline, 84%, 87% and 61% respectively were taking a statin, anti-platelet agent and at least two BP lowering agents. At 12 months, compared to usual care, participants in the polypill arm had higher adherence to combination therapy (80% vs. 50%, RR 1.58; 95% CI, 1.32 to 1.90; p < 0.001), lower SBP (-2.5 mmHg; 95% CI, -4.5 to -0.4; p = 0.02) and lower LDL-cholesterol (-0.1 mmol/L; 95% CI, -0.2 to 0.0; p = 0.04). Baseline treatment levels were a major effect modifier for adherence and SBP (p-homog < 0.0001 and 0.02 respectively) with greatest improvements seen among those under-treated at baseline. CONCLUSIONS Polypill therapy significantly improved adherence, SBP and LDL-cholesterol in high risk patients compared with usual care, especially among those who were under-treated at baseline.

Do Schools Influence Student Risk-taking Behaviors and Emotional Health Symptoms?

PURPOSE Many schools engage in health promotion, health interventions, and services aimed at improving the health and well-being outcomes for students. The purpose of this study was to examine the effects of schools on student health risk-taking behaviors and depressive symptoms. METHOD A nationally representative sample (n = 9,056) of students from 96 secondary schools completed a health and well-being survey using Internet Tablets that included questions on school climate, health risk-taking behaviors, and mental health. Teachers (n = 2,901) and school administrators (n = 91) completed questionnaires on aspects of the school climate which included teacher well-being and burnout, the staff work environment, health and welfare services for students, and school organizational support for student health and well-being. Multilevel models were used to estimate school effects on the health risk-taking behaviors and depression symptoms among students. RESULTS Schools where students reported a more positive school climate had fewer students with alcohol use problems, and fewer students engaging in violence and risky motor vehicle behaviors. Schools where teachers reported better health and welfare services for students had fewer students engaging in unsafe sexual health behaviors. Schools where teachers reported higher levels of well-being had fewer students reporting significant levels of depressive symptoms. CONCLUSIONS More positive school climates and better school health and welfare services are associated with fewer health risk-taking behaviors among students. However, the overall school effects were modest, especially for cigarette use and suicidal behaviors.

Sexual attraction, depression, self-harm, suicidality and help-seeking behaviour in New Zealand secondary school students

Objective: To describe the sexual attractions of New Zealand secondary school students and investigate the associations between sexual attraction and self-reported depression, self-harm, suicidality and help-seeking behaviour. Method: Multiple logistic regression was used to examine the associations between sexual attraction and depressive symptoms, suicidality, self-harming and help-seeking behaviours in a nationally representative secondary school health and well-being survey, undertaken in 2007. Results: Of the students surveyed, 92% were attracted to the opposite sex, 1% to the same sex, 3% to both sexes, 2% were not sure and 2% were attracted to neither sex. Students who were attracted to the same or to both sexes consistently had higher prevalence estimates of depression (p = < 0.0001), suicidality (p = < 0.0001) and self-harming (p = < 0.0001). Odds ratios were highest for students who reported they were attracted to both sexes for depressive symptoms (OR 3.7, 95%CI 2.8–4.7), self-harm (OR 5.8, 95%CI 4.4–7.6) and attempted suicide (OR 7.0, 95%CI 5.2–9.4). Students not exclusively attracted to the opposite sex were more likely to report having seen a health professional for an emotional worry and were more likely to have difficulty accessing help for emotional concerns. Conclusions: The study findings highlight significant mental health disparities faced by students attracted to the same or both sexes, with those attracted to both sexes appearing particularly vulnerable. There is a vital need to ensure primary care and mental health services have the capacity and capability to screen and provide appropriate responsive care for youth who are attracted to the same or both sexes.

Juxtaposing Beliefs and Reality: Prevalence Rates of Intimate Partner Violence and Attitudes to Violence and Gender Roles Reported by New Zealand Women

This study documents the prevalence of intimate partner violence (IPV) for four ethnic groups and explores ethnic-specific differences and similarities in women’s attitudes. Data are from a cross-sectional survey of 2,674 ever-partnered women aged 18 to 64 years. High rates of IPV among all ethnic groups reinforce the need to retain and expand current prevention and intervention efforts. Violence was not regarded as normative for any ethnic group. All women, but Pacific and Asian women in particular, would benefit from interventions that reinforce women’s acceptance of seeking and utilizing outside intervention in cases of partner maltreatment.

Stability and change in the mental health of New Zealand secondary school students 2007–2012: Results from the national adolescent health surveys

Objective: To describe the self-reported mental health of New Zealand secondary school students in 2012 and to investigate changes between 2007 and 2012. Methods: Nationally representative health and wellbeing surveys of students were completed in 2007 (n=9107) and 2012 (n=8500). Logistic regressions were used to examine the associations between mental health and changes over time. Prevalence data and adjusted odds ratios are presented. Results: In 2012, approximately three-quarters (76.2%, 95% CI 74.8–77.5) of students reported good overall wellbeing. By contrast (also in 2012), some students reported self-harming (24.0%, 95% CI 22.7–25.4), depressive symptoms (12.8%, 95% CI 11.6–13.9), 2 weeks of low mood (31%, 95% CI 29.7–32.5), suicidal ideation (15.7%, 95% 14.5–17.0), and suicide attempts (4.5%, 95% CI 3.8–5.2). Between 2007 and 2012, there appeared to be slight increases in the proportions of students reporting an episode of low mood (OR 1.14, 95% CI 1.06–1.23, p=0.0009), depressive symptoms (OR 1.16, 95% CI 1.03–1.30, p=0.011), and using the Strengths and Difficulties Questionnaire - emotional symptoms (OR 1.38, 95% CI 1.23–1.54, p<0.0001), hyperactivity (OR 1.16, 95% CI 1.05–1.29, p=0.0051), and peer problems (OR 1.27, 95% CI 1.09–1.49, p=0.0022). The proportion of students aged 16 years or older reporting self-harm increased slightly between surveys, but there was little change for students aged 15 years or less (OR 1.29, 95% CI 1.15–1.44 and OR 1.10, 95% 0.98–1.23, respectively, p=0.0078). There were no changes in reported suicidal ideation and suicide attempts between 2007 and 2012. However, there has been an improvement in self-reported conduct problems since 2007 (OR 0.78, 95% CI 0.70–0.87, p<0.0001). Conclusions: The findings suggest a slight decline in aspects of self-reported mental health amongst New Zealand secondary school students between 2007 and 2012. There is a need for ongoing monitoring and for evidence-based, accessible interventions that prevent mental ill health and promote psychological wellbeing.