Changes in the Sodium Content of New Zealand Processed Foods: 2003–2013

Decreasing population sodium intake has been identified as a “best buy” for reducing non-communicable disease. The aim of this study was to explore 10-year changes in the sodium content of New Zealand processed foods. Nutrient data for nine key food groups were collected in supermarkets in 2003 (n = 323) and 2013 (n = 885). Mean (SD) and median (min, max) sodium content were calculated by food group, year and label type (private/branded). Paired t-tests explored changes in sodium content for all products available for sale in both years (matched; n = 182). The mean (SD) sodium content of all foods was 436 (263) mg (100 g)⁻¹ in 2003 and 433 (304) mg (100 g)⁻¹ in 2013, with no significant difference in matched products over time (mean (SD) difference, −56 (122) mg (100 g)⁻¹, 12%; p = 0.22). The largest percentage reductions in sodium (for matched products) were observed for Breakfast Cereals (28%; −123 (125) mg (100 g)⁻¹), Canned Spaghetti (15%; −76 (111) mg (100 g)⁻¹) and Bread (14%; −68 (69) mg (100 g)⁻¹). The reduction in sodium was greater for matched private vs. branded foods (−69 vs. −50 mg (100 g)⁻¹, both p < 0.001). There has been modest progress with sodium reduction in some New Zealand food categories over the past 10 years. A renewed focus across the whole food supply is needed if New Zealand is to meet its global commitment to reducing population sodium intake.     

Do social and economic reforms change socioeconomic inequalities in child mortality? A case study: New Zealand 1981–1999

BACKGROUND: Socioeconomic inequalities in child mortality are known to exist; however the trends in these inequalities have not been well examined. This study examines the trends in child mortality inequality between 1981 and 1999 against the background of the rapid and dramatic social and economic restructuring in New Zealand during this time period. METHODS: Record linkage studies of census and mortality records of all New Zealand children aged 0-14 years on census night 1981, 1986, 1991, 1996, each followed up for three years for mortality between ages 1-14 years. Socioeconomic position was measured using maternal education, household income, and highest occupational class in the household. Standardised mortality rates, rate ratios, and rates differences as well as regression based measures of inequality were calculated. RESULTS: Mortality in all socioeconomic groups fell between 1981 and 1999. Socioeconomic inequality in child mortality existed by all measures of socioeconomic position, however only trends by income suggested a change over time: the relative index of inequality increased from 1.5 in 1981-84 to 1.8 in 1996-99 (p trend 0.06), but absolute inequality remained stable (slope index of inequality 15/100 000 in 1981-84 and 14/100 000 in 1996-99. CONCLUSIONS: Dramatic changes in income in New Zealand possibly translated into increasing relative inequality in child mortality by income, but not by education or occupational class. The a priori hypothesis that socioeconomic inequalities in child mortality would have increased in New Zealand during a period of rapid structural reform and widening income inequalities was only partly supported.     

Comparing trends in mortality from cardiovascular disease and cancer in the United Kingdom, 1983–2013: joinpoint regression analysis

Background

We aimed to study the time trends underlying a change from cardiovascular disease (CVD) to cancer as the most common cause of age-standardized mortality in the UK between 1983 and 2013.

Methods

A retrospective trend analysis of the World Health Organization mortality database for mortality from all cancers, all CVDs, and their three most common types, by sex and age. Age-standardized mortality rates were adjusted to the 2013 European Standard Population and analyzed using joinpoint regression analysis for annual percent changes.

Results

The difference in mortality rate between total CVD and cancer narrowed over the study period as age-standardized mortality from CVD decreased more steeply than cancer in both sexes. We observed higher overall rates for both diseases in men compared to women, with high mortality rates from ischemic heart disease and lung cancer in men. Joinpoint regression analysis indicated that trends of decreasing rates of CVD have increased over time while decreasing trends in cancer mortality rates have slowed down since the 1990s. The lowest improvements in mortality rates were for cancer in those over 75 years of age and lung cancer in women.

Conclusions

In 2011, the age-standardized mortality rate for cancer exceeded that of CVD in both sexes in the UK. These changing trends in mortality may support evidence for changes in policy and resource allocation in the UK.

     

Climate trends in indices for temperature and precipitation across New York State, 1948–2008

New York State (NYS) is a geographically diverse area susceptible to climate change, but trends in climate extreme indicators have not been extensively studied. Our objectives are to describe temporal and spatial trends in various extreme indicators and their sensitivity to climate change and to demonstrate geographic differences in indicator trends in NYS. We analyzed data from the US Historical Climatology Network for NYS from 1948 to 2008. We assessed trends in 15 temperature and 11 precipitation indicators using linear regression with bootstrapping in SAS and RClimDex software. The indicators showing the most substantial change per decade were frost days (?0.97 days per decade) and diurnal temperature (?0.11°C). For precipitation indicators, the number of heavy precipitation days (+0.99 days), consecutive wet days (+ 0.42 days), the total wet day precipitation (+30.19 mm), and the simple daily intensity index (+0.18 mm/day) showed the most change per decade. The most representative indicators that showed significant trends for more than half of the stations were number of cool nights, diurnal temperature, and number of frost days and increase in total wet day precipitation and simple daily intensity index for precipitation. The most sensitive regions for changes in extreme indicators were the eastern and Great Lakes regions of NYS. In light of these consistent temporal trends of warming and increasing precipitation in NYS with large geographic variation, the indicators that have been identified should be further evaluated and assessed for their health impact. Geographical differences in climate trends may be of use in informing policy and resource allocation for climate change adaptation.     

Austerity and old-age mortality in England: a longitudinal cross-local area analysis, 2007–2013

Objective

There has been significant concern that austerity measures have negatively impacted health in the UK. We examined whether budgetary reductions in Pension Credit and social care have been associated with recent rises in mortality rates among pensioners aged 85 years and over.

Design

Cross-local authority longitudinal study.

Setting

Three hundred and twenty-four lower tier local authorities in England.

Main outcome measure

Annual percentage changes in mortality rates among pensioners aged 85 years or over.

Results

Between 2007 and 2013, each 1% decline in Pension Credit spending (support for low income pensioners) per beneficiary was associated with an increase in 0.68% in old-age mortality (95% CI: 0.41 to 0.95). Each reduction in the number of beneficiaries per 1000 pensioners was associated with an increase in 0.20% (95% CI: 0.15 to 0.24). Each 1% decline in social care spending was associated with a significant rise in old-age mortality (0.08%, 95% CI: 0.0006–0.12) but not after adjusting for Pension Credit spending. Similar patterns were seen in both men and women. Weaker associations observed for those aged 75 to 84 years, and none among those 65 to 74 years. Categories of service expenditure not expected to affect old-age mortality, such as transportation, showed no association.

Conclusions

Rising mortality rates among pensioners aged 85 years and over were linked to reductions in spending on income support for poor pensioners and social care. Findings suggest austerity measures in England have affected vulnerable old-age adults.     

Human Physique and Sexual Attractiveness in Men and Women: A New Zealand–U.S. Comparative Study

Men and women living in New Zealand and California completed five studies regarding human physique and sexual attractiveness. In Studies 1–3, women rated images of male stimuli and, in Studies 4–5, men rated female stimuli. In Study 1, women in both countries rated mesomorphic (muscular) and average male somatotypes as most attractive, followed by ectomorphic (slim) and endomorphic (heavily built) figures. In Study 2, amount and distribution of masculine trunk hair (chest and abdominal) was altered progressively in a series of front-posed male figures. In both countries, the image lacking any trunk hair was rated as the most attractive, with a steady decline in attractiveness as hirsutism became more pronounced. Study 3 assessed attractiveness of front-posed male figures that varied only in the length of the non-erect penis. Five lengths were presented: The smallest penile size was rated as less attractive than three intermediate sizes. The largest penile size was not the most attractive, but received higher scores than the unaltered and smallest penile size. In Study 4, men rated the attractiveness of back-posed female images varying in waist-to-hip ratio (WHR) (from 0.5 to 1.0). The 0.7 WHR figure was rated more attractive in New Zealand and the 0.6 WHR in California. Study 5 measured the attractiveness of female skin color; men expressed preferences for lighter skinned female figures in New Zealand and California. Results indicate very similar preferences for sexually dimorphic physical traits among men and women of European extraction, living in two culturally and geographically different environments.     

How much does health care contribute to health gain and to health inequality? Trends in amenable mortality in New Zealand 1981–2004

Objective : To estimate the contribution of health care to health gain, and to ethnic and socio-economic health inequalities, in New Zealand over the past quarter century.
Method : Amenable and all-cause mortality rates by ethnicity and equivalised household income tertile from 1981–84 to 2001–04 were estimated from linked census-mortality datasets (the New Zealand Census-Mortality Study). Amenable mortality (deaths under age 75 from conditions responsive to health care) was defined using a classification recently developed for use in Australia and New Zealand. The contribution of health care to the observed improvement in population health status was estimated by the ratio of the difference in amenable to the difference in all-cause mortality over the observation period.
Results : Trends in amenable causes of death were estimated to account for approximately one-third of the fall in mortality over the past quarter century, for the population as a whole and for all income and ethnic groups except Pacific peoples, for whom there was no reduction in amenable mortality. In 2001–04, amenable causes accounted for approximately one quarter of the mortality gap between all ethnic groups compared to the European/Other reference.
Discussion : Our finding provides one indicator of the social impact of health care over this period. More importantly, that Pacific peoples seem to have benefited less than other ethnic groups calls for urgent explanation. Also, our finding that amenable causes account for about one quarter of current mortality disparities, clearly indicates that improvement in access to and quality of health care for disadvantaged groups could substantively reduce health inequalities.     

Maternal Tdap vaccination: Coverage and acute safety outcomes in the vaccine safety datalink, 2007–2013

IntroductionSince October 2012, the combined tetanus toxoid, reduced diphtheria toxoid, acellular pertussis vaccine (Tdap) has been recommended in the United States during every pregnancy.MethodsIn this observational study from the Vaccine Safety Datalink, we describe receipt of Tdap during pregnancy among insured women with live births across seven health systems. Using a retrospective matched cohort, we evaluated risks for selected medically attended adverse events in pregnant women, occurring within 42 days of vaccination. Using a generalized estimating equation, we calculated adjusted incident rate ratios (AIRR).ResultsOur vaccine coverage cohort included 438,487 live births between January 1, 2007 and November 15, 2013. Across the coverage cohort, 14% received Tdap during pregnancy. By 2013, Tdap was administered during pregnancy in 41.7% of live births, primarily in the 3rd trimester. Our vaccine safety cohort included 53,885 vaccinated and 109,253 matched unvaccinated pregnant women. There was no increased risk for a composite outcome of medically attended acute adverse events within 3 days of vaccination. Similarly, across the safety cohort, over a 42 day window, incident neurologic events, thrombotic events, and new onset proteinuria did not differ by maternal receipt of Tdap. Among women receiving Tdap at 20 weeks gestation or later, as compared to their matched controls, there was no increased risk for gestational diabetes or cardiac events while venous thromboembolic events and thrombocytopenia were diagnosed within 42 days of vaccination at slightly decreased rates.ConclusionTdap coverage during pregnancy increased from 2007 through 2013, but was still below 50%. No acute maternal safety signals were detected in this large cohort.     

Influence of birth origin and risk factor profile on hepatitis B mortality: Philadelphia,PA 2003–2013

Purpose

Chronic hepatitis B virus (HBV) affects specific subpopulations in the United States, including individuals born in HBV-endemic countries and persons engaging in high-risk behaviors.

Geographic Divergence of Bovine and Human Shiga Toxin–Producing Escherichia coli O157:H7 Genotypes,New Zealand

Shiga toxin-producing Escherichia coli (STEC) O157:H7 is a zoonoticpathogen of public health concern worldwide. To compare the local and large-scalegeographic distributions of genotypes of STEC O157:H7 isolates obtained from variousbovine and human sources during 2008–2011, we used pulsed-field gelelectrophoresis and Shiga toxin–encoding bacteriophage insertion (SBI) typing.Using multivariate methods, we compared isolates from the North and South Islands ofNew Zealand with isolates from Australia and the United States. The STEC O157:H7population structure differed substantially between the 2 islands and showed evidenceof finer scale spatial structuring, which is consistent with highly localizedtransmission rather than disseminated foodborne outbreaks. The distribution of SBItypes differed markedly among isolates from New Zealand, Australia, and the UnitedStates. Our findings also provide evidence for the historic introduction into NewZealand of a subset of globally circulating STEC O157:H7 strains that have continuedto evolve and be transmitted locally between cattle and humans.     

Changes in sodium levels of processed foods among the International Food and Beverage Association member companies in Australia: 2013–2017

Excess dietary sodium is a modifiable cause of high blood pressure. The World Health Organization has targeted a 30 % reduction in mean population sodium consumption by 2025. In 2008, members of the International Food and Beverage Alliance (IFBA) made commitments to lower sodium content in their products. The aim of this study was to determine recent changes in sodium levels between 2013 and 2017 in foods and beverages produced by companies that are IFBA members (n = 10) and non-IFBA members (n = 6) that were included in the 2018 Global Access to Nutrition Index operating in Australia. Independent Samples t-tests and Mann Whitney U tests were used to test the differences in sodium levels. There was no clear difference in sodium content between 2013 and 2017 detectable for the IFBA members (mean difference 17 mg/100 g, 95 % confidence interval (CI), –82 to +48; p = 0.612; median difference 27 mg/100 g, p = 0.582). For the non-IFBA companies there was a decrease in median sodium content (−30 mg/100 g; P = 0.002) but not mean sodium content (−52 mg/100 g, 95 % CI −106 to +3; p = 0.064). Sodium reduction in IFBA companies appear to have had slow progress in Australia. Stronger implementation and monitoring programs are needed to drive industry action.     

Change in Obesity Prevalence among New York City Adults: the NYC Health and Nutrition Examination Survey, 2004 and 2013–2014

The objective of this study was to measure change in obesity prevalence among New York City (NYC) adults from 2004 to 2013–2014 and assess variation across sociodemographic subgroups. We used objectively measured height and weight data from the NYC Health and Nutrition Examination Survey to calculate relative percent change in obesity (≥?30 kg/m²) between 2004 (n =?1987) and 2013–2014 (n =?1489) among all NYC adults and sociodemographic subgroups. We also examined changes in self-reported proxies for energy imbalance. Estimates were age-standardized and statistical significance was evaluated using two-tailed T tests and multivariable regression (p <?0.05). Between 2004 and 2013–2014, obesity increased from 27.5 to 32.4% (p =?0.01). Prevalence remained stable and high among women (31.2 to 32.8%, p =?0.53), but increased among men (23.4 to 32.0%, p =?0.002), especially among non-Latino White men and men age ≥?65 years. Black adults had the highest prevalence in 2013–2014 (37.1%) and Asian adults experienced the largest increase (20.1 to 29.2%, p =?0.06), especially Asian women. Foreign-born participants and participants lacking health insurance also had large increases in obesity. We observed increases in eating out and screen time over time and no improvements in physical activity. Our findings show increases in obesity in NYC in the past decade, with important sociodemographic differences.     

Enablers and barriers to secondary prophylaxis for rheumatic fever among Māori aged 14–21 in New Zealand: a framework method study

Background

Acute rheumatic fever (ARF) rates have declined to near zero in nearly all developed countries. However, in New Zealand rates have not declined since the 1980s. Further, ARF diagnoses in New Zealand are inequitably distributed--occurring almost exclusively in Māori (the indigenous population) and Pacific children--with very low rates in the majority New Zealand European population. With ARF diagnosis, secondary prophylaxis is key to prevent recurrence. The purpose of this study was to identify the perceived enablers and barriers to secondary recurrence prophylaxis following ARF for Māori patients aged 14–21.

Methods

This study took a systems approach, was informed by patient voice and used a framework method to explore potential barriers and enablers to ongoing adherence with monthly antibiotic injections for secondary prophylaxis. Qualitative interviews were conducted with 19 Māori ARF patients receiving recurrence prophylaxis in the Waikato District Health Board region. Participants included those fully adherent to treatment, those with intermittent adherence or those who had been “lost to follow-up.”

Results

Barriers and enablers were presented around three factors: system (including access/resources), relational and individual. Access and resources included district nurses coming to patients as an enabler and lack of income and time off work as barriers. Relational characteristics included support from family and friends as enablers and district nurse communication as predominantly a positive although not enabling factor. Individual characteristics included understanding, personal responsibility and fear/pain of injections.

Conclusion

This detailed exploration of barriers and enablers for ongoing secondary prophylaxis provides important new information for the prevention of recurrent ARF. Among other considerations, a national register, innovative engagement with youth and their families and a comprehensive pain management programme are likely to improve adherence to ongoing secondary prophylaxis and reduce the burden of RHD for New Zealand individuals, families and health system.

     

Nature's good for you: Sir Truby King,Seacliff Asylum,and the greening of health care in New Zealand, 1889–1922

Sir Frederic Truby King's work at Seacliff Asylum in New Zealand, between 1889 and 1922, illustrates a prominent role of agriculture in relationship to human health and the environment. King utilized farming practices, a rural setting, occupational therapy, dietary changes and moves towards self-sufficiency as examples of asylum management practices, but these also ensured patient health and well-being. In this article, we analyze King's practices at Seacliff as a genealogical precursor to today's green care and care farming movements.