How to deal with vaccine hesitancy?

Based on the concerns about vaccine hesitancy and its impact on vaccine uptake rates and the performance of national immunization programmes, the Strategic Advisory Group of Experts (SAGE) on Immunization Working Group on Vaccine Hesitancy [1], carried out a review, and proposed a set of recommendations directed to the public health community, to WHO and its partners, and to the World Health Organization (WHO) member states. The final recommendations issued by SAGE in October 2014 fall into three categories: (1) those focused on the need to increase the understanding of vaccine hesitancy, its determinants and the rapidly changing challenges it entails; (2) those focused on dealing with the structures and organizational capacity to decrease hesitancy and increase acceptance of vaccines at the global, national and local levels; (3) and those focused on the sharing of lessons learnt and effective practices from various countries and settings as well as the development, validation and implementation of new tools to address hesitancy.     

Is particulate air pollution associated with health and health inequalities in New Zealand?

Air pollution can increase mortality risk and may also exacerbate socioeconomic inequalities in health outcomes. This New Zealand study investigated whether exposure to particulate air pollution (PM₁₀) was associated with mortality and health inequalities. Annual mean PM₁₀ estimates for urban Census Area Units (CAUs) were linked to cause-specific mortality data. A dose-response relationship was found between PM₁₀ and respiratory disease mortality, including at concentrations below the existing annual average guideline value of 20 μg m⁻³. Establishing and enforcing a lower guideline value is likely to have population health benefits. However, socioeconomic inequalities in respiratory disease mortality were not significantly elevated with PM₁₀ exposure.     

Is population mixing associated with childhood type 1 diabetes in Canterbury,New Zealand?

There is growing evidence to support a role for infections in the aetiology of childhood type 1 diabetes. However, previous studies suggest that infections can either protect against or initiate type 1 diabetes onset, depending on the timing of exposure. Population mixing has recently been employed as a proxy measure for area-level infectious exposure in childhood diabetes research. Research has found that the incidence of type 1 diabetes tends to be higher in areas with low population mixing, suggesting that children with low infectious exposure in early life have increased susceptibility to the disease. Subsequent exposure to infection could act as the final trigger to type 1 diabetes development.     

Is refined carbohydrate consumption related to allergic diseases?

Exposure to refined carbohydrates has been found to be associated with disorders such as increased blood pressure, retinopathy, adipose tissue inflammation, glucose intolerance, type 2 diabetes mellitus, poor metabolic profile, esophageal adenocarcinoma, and small intestine, prostate, pleural, and pancreatic cancers. Additionally, recent studies have demonstrated that ingestion of refined carbohydrates is related to secretion of cytokines and chemokines. However, to our knowledge, there is still no data on the relationship between refined carbohydrate consumption and allergic disorders ranging from bronchopulmonary to skin diseases. Therefore, the purpose of this review was to evaluate whether consumption of refined carbohydrates plays a role in allergic diseases.     

Is the major increase in notified campylobacteriosis in New Zealand real?

Notifications of campylobacteriosis by New Zealand medical practitioners have increased steadily in the last two decades. To determine if this increase is real, as opposed to a surveillance artefact, we examined both available notification (1980-2003) and hospitalization data (1995-2003). The similarity in the temporal pattern of increasing hospitalizations for campylobacteriosis, with that of notifications, is suggestive that this increase is indeed real. Although some risk factors for this disease have been identified (e.g. uncooked poultry consumption) it is unclear what the likely causes of the increasing rates are. The overall disease burden is also high compared with other developed countries (an annual notification rate of 396 cases per 100000 population in 2003), with highest rates in children aged 1-4 years, males, Europeans, and those living in urban areas. Given the large disease burden, further research and intervention studies should be public health priorities in this country.     

From population structure to genetically-engineered vectors: New ways to control vector-borne diseases?

Epidemiological studies on vectors and the pathogens they can carry (such as Borrelia burgdorferi) are showing some correlations between infection rates and biodiversity highlighting the "dilution" effects on potential vectors. Meanwhile other studies comparing sympatric small rodent species demonstrated that rodent species transmitting more pathogens are parasitized by more ectoparasite species. Studies on population structure and size have also proven a difference on the intensity of the parasitic infection. Furthermore, preliminary results in genetic improvement in mosquitoes (genetic markers, sexing, and genetic sterilization) will also increase performance as it has already been shown in field applications in developing countries. Recent results have greatly improved the fitness of genetically-modified insects compared to wild type populations with new approaches such as the post-integration elimination of transposon sequences, stabilising any insertion in genetically-modified insects. Encouraging results using the Sterile Insect Technique highlighted some metabolism manipulation to avoid the viability of offspring from released parent insect in the wild. Recent studies on vector symbionts would also bring a new angle in vector control capabilities, while complete DNA sequencing of some arthropods could point out ways to block the deadly impact on animal and human populations. These new potential approaches will improve the levels of control or even in some cases would eradicate vector species and consequently the vector-borne diseases they can transmit. In this paper we review some of the population biology theories, biological control methods, and the genetic techniques that have been published in the last years that are recommended to control for vector-borne diseases.     

Is the food environment surrounding schools associated with the diet quality of adolescents in Otago,New Zealand?

Using a sample of adolescents from schools in Otago, New Zealand, associations between food outlets around schools and dietary quality were investigated. Food outlet environment data were derived using GIS data. Multivariate regression analysis results showed that outlet density, in an 800 m buffer around schools, of cafes and restaurants, supermarkets and takeaways was associated with higher Diet Quality Index scores in boys, and distance to nearest outlet for convenience stores, cafes and restaurants and supermarkets with lower scores for girls. Effect sizes were small, suggesting that the food environment around schools plays a minor role in adolescent diet quality.     

How much does health care contribute to health inequality in New Zealand?

OBJECTIVE: To quantify the contribution of health care to ethnic and socio-economic inequalities in health in New Zealand in 2000-02, using the concept of 'amenable' mortality (deaths at ages 0-74 years from causes responsive to health care). DATA SOURCES AND METHODS: Mortality data for 2000-02 were provided by the New Zealand Health Information Service and 2001 Census population data were provided by Statistics New Zealand. The classification of ICD-10 codes as amenable or non-amenable used in the Australian and New Zealand Atlas of Avoidable Mortality (2006) was adopted. Ethnicity was categorised as Maori, Pacific or European/Other. Socio-economic position was measured using a Census-based small area deprivation index, the NZDep2001. Mortality rates were standardised for age by the direct method for the ethnic group comparisons, and for both age and ethnicity for the deprivation group comparisons. The contribution of health care to health inequality was then quantified as the ratio of the difference in standardised amenable mortality rates to the difference in standardised total mortality rates (in the age group 0-74 years) between relevant groups. RESULTS: Amenable causes of death were estimated to account for 27%, 34%, 33% and 44% of the total mortality disparity (0-74 years) for Maori males, Maori females, Pacific males and Pacific females respectively, relative to their European/ Other counterparts (adjusting for age). The corresponding proportions for the 'deprived' population relative to the 'non-deprived' population were 26% (males) and 30% (females), adjusting for age and ethnicity. CONCLUSIONS: Amenable causes of death made a substantial contribution to differences in mortality in the 0-74 year age range between ethnic and socio-economic groups in New Zealand in 2000-02, ranging from 26-44% depending on the group.     

Is obesity-induced ECM remodeling a prelude to the development of various diseases?

Due to the increasing incidence rate of obesity worldwide and the associated complications such as type 2 diabetes and cardiovascular diseases, research on the adipose tissue physiology and the role of the extracellular matrix (ECM) has gained tremendous attention. The ECM, one of the most crucial components in body tissues, undergoes remodeling and regeneration of its constituents to guarantee normal tissue function. There is a crosstalk between fat tissue and various body organs, including but not limited to the liver, heart, kidney, skeletal muscle, and so forth. These organs respond to fat tissue signals through changes in ECM, function, and their secretory products. Obesity can cause ECM remodeling, inflammation, fibrosis, insulin resistance, and disrupted metabolism in different organs. However, the mechanisms underlying the reciprocal communication between various organs during obesity are still not fully elucidated. Gaining a profound knowledge of ECM alterations during the progression of obesity will pave the way toward developing potential strategies to either circumvent pathological conditions or open an avenue to treat complications associated with obesity.     

Is change in global self-rated health associated with change in affiliation with a primary care provider? Findings from a longitudinal study from New Zealand

AimsTo investigate the association of self-rated health and affiliation with a primary care provider (PCP) in New Zealand.MethodsWe used data from a New Zealand panel study of 22,000 adults. The main exposure was self-rated health, and the main outcome measure was affiliation with a PCP. Fixed effects conditional logistic models were used to control for observed time-varying and unobserved time-invariant confounding.ResultsIn any given wave, the odds of being affiliated with a PCP were higher for those in good and fair/poor health relative to those in excellent health. While affiliation for Europeans increased as reported health declined, the odds of being affiliated were lower for Māori respondents reporting very good or good health relative to those in excellent health. No significant differences in the association by age or gender were observed.ConclusionsOur data support the hypothesis that those in poorer health are more likely to be affiliated with a PCP. Variations in affiliation for Māori could arise for several reasons, including differences in care-seeking behaviour and perceived need of care. It may also mean that the message about the benefits of primary health care is not getting through equally to all population groups.     

How to deal with stress in organizations?--a health perspective on theory and practice

This review is focused on organizational aspects of stress reduction. Theoretical models are presented. The association with a few health outcomes (cardiovascular disease, musculoskeletal disorders, and functional gastrointestinal illness) is examined. A few examples of evaluations of health consequences of improved work organization are introduced. Realistic expectations are discussed against the background of etiologic fractions. Concepts like psychological demands, decision latitude, social support, and effort-reward balance or imbalance are discussed and related to practical reorganizational efforts.