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Find video protocols related to scientific articles indexed in Pubmed.
Trends in Helicobacter pylori Infection Among M?ori, Pacific, and European Birth Cohorts in New Zealand.
Helicobacter
PUBLISHED: 11-19-2014
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The aim of this paper is to estimate the seroprevalence of Helicobacter pylori infection in the New Zealand population by ethnicity and year of birth.
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Modelling the implications of regular increases in tobacco taxation in the tobacco endgame.
Tob Control
PUBLISHED: 08-21-2014
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We examine the potential role for taxation in the tobacco endgame in New Zealand, where the goal is to become 'smokefree' (less than 5% smoking prevalence) by 2025.
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Does mortality vary between Asian subgroups in New Zealand: an application of hierarchical Bayesian modelling.
PLoS ONE
PUBLISHED: 08-20-2014
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The aim of this paper was to see whether all-cause and cause-specific mortality rates vary between Asian ethnic subgroups, and whether overseas born Asian subgroup mortality rate ratios varied by nativity and duration of residence. We used hierarchical Bayesian methods to allow for sparse data in the analysis of linked census-mortality data for 25-75 year old New Zealanders. We found directly standardised posterior all-cause and cardiovascular mortality rates were highest for the Indian ethnic group, significantly so when compared with those of Chinese ethnicity. In contrast, cancer mortality rates were lowest for ethnic Indians. Asian overseas born subgroups have about 70% of the mortality rate of their New Zealand born Asian counterparts, a result that showed little variation by Asian subgroup or cause of death. Within the overseas born population, all-cause mortality rates for migrants living 0-9 years in New Zealand were about 60% of the mortality rate of those living more than 25 years in New Zealand regardless of ethnicity. The corresponding figure for cardiovascular mortality rates was 50%. However, while Chinese cancer mortality rates increased with duration of residence, Indian and Other Asian cancer mortality rates did not. Future research on the mechanisms of worsening of health with increased time spent in the host country is required to improve the understanding of the process, and would assist the policy-makers and health planners.
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Theoretical impacts of a range of major tobacco retail outlet reduction interventions: modelling results in a country with a smoke-free nation goal.
Tob Control
PUBLISHED: 07-20-2014
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To inform endgame strategies in tobacco control, this study aimed to estimate the impact of interventions that markedly reduced availability of tobacco retail outlets. The setting was New Zealand, a developed nation where the government has a smoke-free nation goal in 2025.
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Thyroid cancer in Pacific women in New Zealand.
N. Z. Med. J.
PUBLISHED: 06-16-2014
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To describe trends in incidence rates of thyroid cancer in New Zealand between 1981-2004 with a particular focus on Pacific women.
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Is expanding HPV vaccination programs to include school-aged boys likely to be value-for-money: a cost-utility analysis in a country with an existing school-girl program.
BMC Infect. Dis.
PUBLISHED: 06-13-2014
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Similar to many developed countries, vaccination against human papillomavirus (HPV) is provided only to girls in New Zealand and coverage is relatively low (47% in school-aged girls for dose 3). Some jurisdictions have already extended HPV vaccination to school-aged boys. Thus, exploration of the cost-utility of adding boys' vaccination is relevant. We modeled the incremental health gain and costs for extending the current girls-only program to boys, intensifying the current girls-only program to achieve 73% coverage, and extension of the intensive program to boys.
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Employment arrangements and mental health in a cohort of working Australians: are transitions from permanent to temporary employment associated with changes in mental health?
Am. J. Epidemiol.
PUBLISHED: 05-28-2014
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We investigated whether being in temporary employment, as compared with permanent employment, was associated with a difference in Short Form 36 mental health and whether transitions from permanent employment to temporary employment were associated with mental health changes. We used fixed-effects regression in a nationally representative Australian sample with 10 waves of data collection (2001-2010). Interactions by age and sex were tested. Two forms of temporary employment were studied: "casual" (no paid leave entitlements or fixed hours) and "fixed-term contract" (a defined employment period plus paid leave). There were no significant mental health differences between temporary employment and permanent employment in standard fixed-effects analyses and no significant interactions by sex or age. For all age groups combined, there were no significant changes in mental health following transitions from stable permanent employment to temporary employment, but there was a significant interaction with age (P = 0.03) for the stable-permanent-to-casual employment transition, because of a small transition-associated improvement in mental health for workers aged 55-64 years (? = 1.61, 95% confidence interval: 0.34, 2.87; 16% of the standard deviation of mental health scores). Our analyses suggest that temporary employment is not harmful to mental health in the Australian context and that it may be beneficial for 55- to 64-year-olds transitioning from stable permanent employment to casual employment.
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Cost-effectiveness analysis of docetaxel versus weekly paclitaxel in adjuvant treatment of regional breast cancer in new zealand.
Pharmacoeconomics
PUBLISHED: 05-27-2014
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There have been recent important changes to adjuvant regimens and costs of taxanes for the treatment of early breast cancer, requiring a re-evaluation of comparative cost effectiveness. In particular, weekly paclitaxel is now commonly used but has not been subjected to cost-effectiveness analysis.
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Do changes in social and economic factors lead to changes in drinking behavior in young adults? Findings from three waves of a population based panel study.
BMC Public Health
PUBLISHED: 05-19-2014
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Social and economic measures in early childhood or adolescence appear to be associated with drinking behavior in young adulthood. Yet, there has been little investigation to what extent drinking behavior of young adults changes within young adulthood when they experience changes in social and economic measures in this significant period of their life.
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Health system costs by sex, age and proximity to death, and implications for estimation of future expenditure.
N. Z. Med. J.
PUBLISHED: 05-13-2014
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Health expenditure increases with age, but some of this increase is due to costs proximal to death. We used linked health datasets (HealthTracker) to determine health expenditure by proximity to death. We then determined the impact on future health expenditure projections of accounting for proximity to death in costs.
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Cost-effectiveness and equity impacts of three HPV vaccination programmes for school-aged girls in New Zealand.
Vaccine
PUBLISHED: 02-25-2014
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As with many high-income countries, vaccination coverage against human papilloma virus (HPV) infection is not high in New Zealand (NZ) at 47% in school-aged girls for three doses. We estimate the health gains, net-cost and cost-effectiveness of the currently implemented HPV national vaccination programme of vaccination dispersed across schools and primary care, and two alternatives: school-based only (assumed coverage as per Australia: 73%), and mandatory school-based vaccination but with opt-out permitted (coverage 93%). We also generate estimates by social group (sex, ethnic and deprivation group).
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The impact of an unconditional tax credit for families on self-rated health in adults: further evidence from the cohort study of 6900 New Zealanders.
Soc Sci Med
PUBLISHED: 02-18-2014
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It is hypothesized that unconditional (given without obligation) publicly funded financial credits more effectively improve health than conditional financial credits in high-income countries. We previously reported no discernible short-term impact of an employment-conditional tax credit for families on self-rated health (SRH) in adults in New Zealand. This study estimates the effect of an unconditional tax credit for families, called Family Tax Credit (FTC), on SRH in the same study population and setting. A balanced panel of 6900 adults in families was extracted from seven waves (2002-2009) of the Survey of Family, Income and Employment. The exposures, eligibility for and amount of FTC, were derived by applying government eligibility and entitlement criteria. The outcome, SRH, was collected annually. Fixed effects regression analyses eliminated all time-invariant confounding and adjusted for measured time-varying confounders. Becoming eligible for FTC was associated with a small and statistically insignificant change in SRH over the past year [effect estimate: 0.013; 95% confidence interval (CI) -0.011 to 0.037], as was an increase in the estimated amount of FTC by $1000 (effect estimate: -0.001; 95% CI -0.006 to 0.004). The unconditional tax credit for families had no discernible short-term impact on SRH in adults in New Zealand. It did not more effectively improve health status than an employment-conditional tax credit for families.
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Why equal treatment is not always equitable: the impact of existing ethnic health inequalities in cost-effectiveness modeling.
Popul Health Metr
PUBLISHED: 01-01-2014
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A critical first step toward incorporating equity into cost-effectiveness analyses is to appropriately model interventions by population subgroups. In this paper we use a standardized treatment intervention to examine the impact of using ethnic-specific (M?ori and non-M?ori) data in cost-utility analyses for three cancers.
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Fixed effects analysis of repeated measures data.
Int J Epidemiol
PUBLISHED: 12-23-2013
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The analysis of repeated measures or panel data allows control of some of the biases which plague other observational studies, particularly unmeasured confounding. When this bias is suspected, and the research question is: Does a change in an exposure cause a change in the outcome?, a fixed effects approach can reduce the impact of confounding by time-invariant factors, such as the unmeasured characteristics of individuals. Epidemiologists familiar with using mixed models may initially presume that specifying a random effect (intercept) for every individual in the study is an appropriate method. However, this method uses information from both the within-individual/unit exposure-outcome association and the between-individual/unit exposure-outcome association. Variation between individuals may introduce confounding bias into mixed model estimates, if unmeasured time-invariant factors are associated with both the exposure and the outcome. Fixed effects estimators rely only on variation within individuals and hence are not affected by confounding from unmeasured time-invariant factors. The reduction in bias using a fixed effects model may come at the expense of precision, particularly if there is little change in exposures over time. Neither fixed effects nor mixed models control for unmeasured time-varying confounding or reverse causation.
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Cancer care coordinators: what are they and what will they cost?
N. Z. Med. J.
PUBLISHED: 10-24-2013
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Health care resources are scarce, and future funding increases are less likely than in the past; reorientation of health services to more efficient and effective delivery is as timely as ever. In this light, we consider the recent funding decision by the Government to provide $16 million over the next 4 years for cancer coordination nurses. While the intricacies of the role are still being defined, it is likely that cancer care coordinators could benefit patients in terms of access to and timeliness of care, and patient satisfaction. Our research into the role shows that many coordinating activities for cancer patients are already being done, but often in an ad hoc manner by a number of different personnel. Thus, we estimate that the likely true incremental cost of cancer care coordinators is in fact relatively low when considered in opportunity cost terms because the cancer care coordinator will be able to free up time for other staff enabling them to provide care elsewhere in the health system and reduce tasks being unnecessarily repeated. The funding of cancer care coordinators is a great opportunity to improve the timeliness of care and improve the experience of patients through their cancer journey, but the success of these roles depends on the leadership provided, peer support, continual appraisal and the resources available.
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How to substantially increase recruitment in cancer trials in New Zealand.
N. Z. Med. J.
PUBLISHED: 10-24-2013
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Recruitment rates into cancer treatment trials are generally very low, both in New Zealand and internationally. This viewpoint article suggests that recruitment rates could be substantially increased by considering all patients newly diagnosed with cancer to be automatically eligible for randomisation if experimental treatments were available under study protocols for patients with their type of cancer. Patients randomised to be offered the experimental treatment would be approached for consent to receive it, whereas patients randomised not to be offered this treatment would continue to receive standard treatment (thus serving as the control group) and not be approached for consent. Routine adoption of this approach, known as "post-randomisation consent" or "pre-randomisation", would require public consultation and "societal consent". While this proposal is not without significant challenges and potential disadvantages, an informed public discussion on the subject would seem worthwhile given the potential for increasing patient access to new cancer treatments and advancing medical science.
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What will it take to get to under 5% smoking prevalence by 2025? Modelling in a country with a smokefree goal.
Tob Control
PUBLISHED: 09-28-2013
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New Zealand has a goal of becoming a smokefree nation by the year 2025. Smoking prevalence in 2012 was 17%, but is over 40% for M?ori (indigenous New Zealanders). We forecast the prevalence in 2025 under a business-as-usual (BAU) scenario, and determined what the initiation and cessation rates would have to be to achieve a <5% prevalence.
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Understanding price elasticities to inform public health research and intervention studies: key issues.
Am J Public Health
PUBLISHED: 09-12-2013
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Pricing policies such as taxes and subsidies are important tools in preventing and controlling a range of threats to public health. This is particularly so in tobacco and alcohol control efforts and efforts to change dietary patterns and physical activity levels as a means of addressing increases in noncommunicable diseases. To understand the potential impact of pricing policies, it is critical to understand the nature of price elasticities for consumer products. For example, price elasticities are key parameters in models of any food tax or subsidy that aims to quantify health impacts and cost-effectiveness. We detail relevant terms and discuss key issues surrounding price elasticities to inform public health research and intervention studies.
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Do changes in income, deprivation, labour force status and family status influence smoking behaviour over the short run? Panel study of 15 000 adults.
Tob Control
PUBLISHED: 09-03-2013
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Improving social circumstances (eg, an increase in income, finding a job or moving into a good neighbourhood) may reduce tobacco use, but robust evidence on the effects of such improvements is scarce. Accordingly we investigated the link between changing social circumstances and changing tobacco smoking using repeated measures data.
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In-work tax credits for families and their impact on health status in adults.
Cochrane Database Syst Rev
PUBLISHED: 08-08-2013
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By improving two social determinants of health (poverty and unemployment) in low- and middle-income families on or at risk of welfare, in-work tax credit for families (IWTC) interventions could impact health status and outcomes in adults.
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Migration and pacific mortality: estimating migration effects on pacific mortality rates using bayesian models.
Demography
PUBLISHED: 08-02-2013
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Pacific people living in New Zealand have higher mortality rates than New Zealand residents of European/Other ethnicity. The aim of this paper is to see whether Pacific mortality rates vary by natality and duration of residence. We used linked census-mortality information for 25- to 74-year-olds in the 2001 census followed for up to three years. Hierarchical Bayesian modeling provided a means of handling sparse data. Posterior mortality rates were directly age-standardized. We found little evidence of mortality differences between the overseas-born and the New Zealand-born for all-cause, cancer, and cardiovascular disease (CVD) mortality. However, we found evidence for lower all-cause (and possibly cancer and CVD) mortality rates for Pacific migrants resident in New Zealand for less than 25 years relative to those resident for more than 25 years. This result may arise from a combination of processes operating over time, including health selection effects from variations in New Zealands immigration policy, the location of Pacific migrants within the social, political, and cultural environment of the host community, and health impacts of the host culture. We could not determine the relative importance of these processes, but identifying the (modifiable) drivers of the inferred long-term decline in health of the overseas-born Pacific population relative to more-recent Pacific migrants is important to Pacific communities and from a national health and policy perspective.
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Housing affordability and mental health: does the relationship differ for renters and home purchasers?
Soc Sci Med
PUBLISHED: 06-17-2013
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There is increasing evidence of a direct association between unaffordable housing and poor mental health, over and above the effects of general financial hardship. Type of housing tenure may be an important factor in determining how individuals experience and respond to housing affordability problems. This study investigated whether a relationship exists between unaffordable housing and mental health that differs for home purchasers and private renters among low-income households. Data from 2001 to 2010 of the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) survey were analysed using fixed-effects linear regression to examine change in the SF-36 Mental Component Summary (MCS) score of individuals aged 25-64 years, associated with changes in housing affordability, testing for an interaction with housing tenure type. After adjusting for age, survey year and household income, among individuals living in households in the lower 40% of the national income distribution, private renters in unaffordable housing experienced somewhat poorer in mental health than when their housing was affordable (difference in MCS = -1.18 or about 20% of one S.D. of the MCS score; 95% CI: -1.95,-0.41; p = 0.003) while home purchasers experienced no difference on average. The statistical evidence for housing tenure modifying the association between unaffordable housing and mental health was moderate (p = 0.058). When alternatives to 40% were considered as income cut-offs for inclusion in the sample, evidence of a difference between renters and home purchasers was stronger amongst households in the lowest 50% of the income distribution (p = 0.020), and between the 30th and 50th percentile (p = 0.045), with renters consistently experiencing a decline in mental health while mean MCS scores of home purchasers did not change. In this study, private renters appeared to be more vulnerable than home purchasers to mental health effects of unaffordable housing. Such a modified effect suggests that tenure-differentiated policy responses to poor housing affordability may be appropriate.
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Health shocks adversely impact participation in the labour force in a working age population: a longitudinal analysis.
Aust N Z J Public Health
PUBLISHED: 06-05-2013
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It is well understood that health affects labour force participation (LFP). However, much of the published research has been on older (retiring age) populations and using subjective health measures. This paper aims to assess the impact of an objective measure of health shock (cancer registration or hospitalisation) on LFP in a working age population using longitudinal panel study data and fixed effect regression analyses.
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The burden of cancer in New Zealand: a comparison of incidence and DALY metrics and its relevance for ethnic disparities.
Aust N Z J Public Health
PUBLISHED: 06-05-2013
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AIM : Cancer burden measured in disability adjusted life years (DALYs) captures survival and disability impacts of incident cancers. In this paper, we estimate the prospective burden of disease arising from 27 cancer sites diagnosed in 2006, by sex and ethnicity; and determine how its distribution differs from that for incidence rates alone. METHODS : Using a prospective approach, Markov and cancer disease models were used to estimate DALYs with inputs of population counts, incidence and excess mortality rates, disability weights, and background mortality. DALYs were discounted at 3.5% per year. RESULTS : The age standardised M?ori:non-M?ori incidence rate ratios were 1.00 for males and 1.19 for females, whereas for DALYs they were greater at 1.42 for males and 1.68 for females. The total burden of cancer for 2006 incident cases (i.e. not age standardised) was estimated to be approximately 127,000 DALYs. Breast (27%), lung (14%) and colorectal (13%) cancers for females and lung (16%), colorectal (14%), and prostate (16%) cancers for males were the top contributors. By ethnicity, M?ori experienced a substantially higher burden from lung cancer (around 25% for both sexes).
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The impact of in-work tax credit for families on self-rated health in adults: a cohort study of 6900 New Zealanders.
J Epidemiol Community Health
PUBLISHED: 05-25-2013
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In-work tax credit (IWTC) for families, a welfare-to-work policy intervention, may impact health status by improving income and employment. Most studies estimate that IWTCs in the USA and the UK have no effect on self-rated health (SRH) and several other health outcomes, but these estimates may be biased by confounding. The current study estimates the impact of one such IWTC intervention (called In-Work Tax Credit) on SRH in adults in New Zealand, controlling more fully for confounding.
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Potential advantages and disadvantages of an endgame strategy: a sinking lid on tobacco supply.
Tob Control
PUBLISHED: 04-18-2013
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One possible supply-side strategy for the tobacco endgame is a government-mandated sinking lid on tobacco supply (tradeable but decreasing quotas on sales or imports).
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The mismeasurement of quality by readmission rate: how blunt is too blunt an instrument?: a quantitative bias analysis.
Med Care
PUBLISHED: 04-13-2013
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The rate of readmission is widely used as a measure of hospital quality of care, often with funding implications for outlying facilities.
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The association of active smoking with multiple cancers: national census-cancer registry cohorts with quantitative bias analysis.
Cancer Causes Control
PUBLISHED: 03-27-2013
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(1) Determine the association of multiple cancers with smoking, focusing on cancers with an uncertain association; and (2) illustrate quantitative bias analysis as applied to registry data, to adjust for misclassification of smoking and residual confounding by alcohol and obesity.
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Misclassification of the mediator matters when estimating indirect effects.
J Epidemiol Community Health
PUBLISHED: 03-16-2013
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Confounding of mediator-outcome associations resulting in collider biases causes systematic error when estimating direct and indirect effects. However, until recently little attention has been given to the impact of misclassification bias.
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Foods and dietary patterns that are healthy, low-cost, and environmentally sustainable: a case study of optimization modeling for New Zealand.
PLoS ONE
PUBLISHED: 02-15-2013
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Global health challenges include non-communicable disease burdens, ensuring food security in the context of rising food prices, and environmental constraints around food production, e.g., greenhouse gas [GHG] emissions. We therefore aimed to consider optimized solutions to the mix of food items in daily diets for a developed country population: New Zealand (NZ).
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Ethnic disparities in the quality of hospital care in New Zealand, as measured by 30-day rate of unplanned readmission/death.
Int J Qual Health Care
PUBLISHED: 02-14-2013
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To compare the quality of hospital care for New Zealand (NZ) M?ori and NZ European adult patients, using the rate of unplanned readmission or death within 30 days of discharge as an indicator of quality.
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Inequalities in non-communicable diseases and effective responses.
Lancet
PUBLISHED: 02-12-2013
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In most countries, people who have a low socioeconomic status and those who live in poor or marginalised communities have a higher risk of dying from non-communicable diseases (NCDs) than do more advantaged groups and communities. Smoking rates, blood pressure, and several other NCD risk factors are often higher in groups with low socioeconomic status than in those with high socioeconomic status; the social gradient also depends on the countrys stage of economic development, cultural factors, and social and health policies. Social inequalities in risk factors account for more than half of inequalities in major NCDs, especially for cardiovascular diseases and lung cancer. People in low-income countries and those with low socioeconomic status also have worse access to health care for timely diagnosis and treatment of NCDs than do those in high-income countries or those with higher socioeconomic status. Reduction of NCDs in disadvantaged groups is necessary to achieve substantial decreases in the total NCD burden, making them mutually reinforcing priorities. Effective actions to reduce NCD inequalities include equitable early childhood development programmes and education; removal of barriers to secure employment in disadvantaged groups; comprehensive strategies for tobacco and alcohol control and for dietary salt reduction that target low socioeconomic status groups; universal, financially and physically accessible, high-quality primary care for delivery of preventive interventions and for early detection and treatment of NCDs; and universal insurance and other mechanisms to remove financial barriers to health care.
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Income and individual deprivation as predictors of health over time.
Int J Public Health
PUBLISHED: 02-01-2013
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Poverty, often defined as a lack of resources to achieve a living standard that is deemed acceptable by society, may be assessed using level of income or a measure of individual deprivation. However, the relationship between low income and deprivation is complex--for example, not everyone who has low income is deprived (and vice versa). In addition, longitudinal studies show only a small relationship between short-term changes in income and health but an alternative measure of poverty, such as deprivation, may have a stronger association with health over time. We aim to compare low income and individual deprivation as predictors of self-rated health (SRH), using longitudinal survey data, to test the hypothesis that different measures of poverty may have different associations with health.
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Food prices and consumer demand: differences across income levels and ethnic groups.
PLoS ONE
PUBLISHED: 01-01-2013
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Targeted food pricing policies may improve population diets. To assess their effects on inequalities, it is important to determine responsiveness to price changes across income levels and ethnic groups.
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Comorbidity among patients with colon cancer in New Zealand.
N. Z. Med. J.
PUBLISHED: 09-28-2011
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To identify patient factors that are associated with a higher risk of comorbidity, and to assess the impact of comorbidity on risk of in-hospital death, length of stay and 5-year all-cause survival among a large cohort of patients with colon cancer in New Zealand.
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The relationship between income and health using longitudinal data from New Zealand.
J Epidemiol Community Health
PUBLISHED: 06-28-2011
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Evidence for a cross-sectional relationship between income and health is strong but is probably biased by substantial confounding. Longitudinal data with repeated income and health measures on the same individuals can be analysed to control completely for time-invariant confounding, giving a more accurate estimate of the impact of short-term changes in income on health.
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Social inequalities or inequities in cancer incidence? Repeated census-cancer cohort studies, New Zealand 1981-1986 to 2001-2004.
Cancer Causes Control
PUBLISHED: 06-16-2011
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We examine incidence trends for 18 adult cancers, by ethnicity and socioeconomic position in New Zealand.
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Mortality among the working age population receiving incapacity benefits in New Zealand, 1981-2004.
Soc Sci Med
PUBLISHED: 06-04-2011
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Like many OECD countries New Zealand has experienced a large increase in the number of working-age people receiving incapacity benefits in the last 3 decades, despite apparent improvements in population health. This paper examines trends in mortality rates of people receiving sickness benefit or invalids benefit (SBIB) between 1981 and 2004 using repeated cohort studies (linking the 1981, 1986, 1991, 1996, and 2001 censuses to mortality data). Mortality rates, standardised for age and ethnicity, were calculated for each census cohort for 25-64 year olds by benefit receipt status. Standardised rate differences and rate ratios and 95% confidence intervals were calculated to measure disparities on both absolute and relative scales. Between 1981 and 2004 overall SBIB receipt increased from 2% to 5% of the working age population. Mortality rates were at least three times higher in the SBIB than the non-SBIB group at all points in time for men and women. Mortality rates declined in all groups, for example in men receiving SBIB, mortality decreased from 2354/100,000 in the 1981-84 cohort to 1371/100,000 in the 2001-04 cohort. Absolute inequalities between SBIB and non-SBIB declined in both men and women (for example in women standardised rate differences decreased from 954/100,000 to 688/100,000) but relative inequalities remained largely stable (for example in men the risk ratio increased from 4.27 to 4.54). Mortality rates declined more in sickness benefit than invalids benefit recipients. The substantial expansion of SBIB receipt in New Zealand has not been accompanied by any reduction in the excess mortality risk experienced by SBIB recipients. These findings are likely to reflect the changing nature of the economy, labour force and disability experience in New Zealand.
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Prioritizing risk factors to identify preventive interventions for economic assessment.
Bull. World Health Organ.
PUBLISHED: 06-01-2011
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To explore a risk factor approach for identifying preventive interventions that require more in-depth economic assessment, including cost-effectiveness analyses.
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The association of food security with psychological distress in New Zealand and any gender differences.
Soc Sci Med
PUBLISHED: 02-25-2011
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Food security (access to safe, nutritious, affordable food) is intrinsically linked to feelings of stress or distress and it is strongly associated with socioeconomic factors. However, the impact of food insecurity on mental health, independent of confounding socioeconomic factors, is not clear. We investigated the association of food insecurity with psychological distress in New Zealand, controlling for socioeconomic factors. Secondarily, we examined the association in males and females. We used data from the Survey of Families, Income and Employment (SoFIE) (N = 18,955). Respondents were classified as food insecure if, in the last 12 months, they: used special food grants/banks, had to buy cheaper food to pay for other things, or went without fresh fruit and vegetables often. Psychological distress was measured using the Kessler-10 scale dichotomised at low (10-15) and moderate to high (16+). Logistic regression analyses were used to investigate the association of food insecurity with psychological distress using a staged modelling approach. Interaction models included an interaction between food security and gender, as well as interactions between gender and all other covariates (significant at p-value < 0.1). Models were repeated, stratified by gender. A strong relationship between food insecurity and psychological distress was found (crude odds ratio OR 3.4). Whilst substantially reduced, the association remained after adjusting for confounding demographic and socioeconomic variables (adjusted OR 1.8). In stratified models, food insecure females had slightly higher odds for psychological distress (fully adjusted OR 2.0) than males (fully adjusted OR 1.5). As such, an independent association of food insecurity with psychological distress was found in both males and females--slightly more so in females. However, we cannot rule out residual confounding as an explanation for the independent association and any apparent gender interaction.
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Health status and epidemiological capacity and prospects: WHO Western Pacific Region.
Int J Epidemiol
PUBLISHED: 02-22-2011
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This article on the state of epidemiology in the WHO Western Pacific Region (WPR) is the first in a series of eight articles commissioned by the International Epidemiological Association (IEA) to identify global opportunities to promote the development of epidemiology.
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When does neighbourhood matter? Multilevel relationships between neighbourhood social fragmentation and mental health.
Soc Sci Med
PUBLISHED: 02-05-2011
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Studies investigating relationships between mental health and residential areas suggest that certain characteristics of neighbourhood environments matter. After developing a conceptual model of neighbourhood social fragmentation and health we examine this relationship (using the New Zealand Index of Neighbourhood Social Fragmentation (NeighFrag)) with self-reported mental health (using SF-36). We used the nationally representative 2002/3 New Zealand Health Survey dataset of urban adults, employing multilevel methods. Results suggest that increasing neighbourhood-level social fragmentation is associated with poorer mental health, when simultaneously accounting for individual-level confounding factors and neighbourhood-level deprivation. The association was modified by sex (stronger association seen for women) and labour force status (unemployed women more sensitive to NeighFrag than those employed or not in labour force). There was limited evidence of any association of fragmentation with non-mental health outcomes, suggesting specificity for mental health. Social fragmentation as a property of neighbourhoods appears to have a specific association with mental health among women, and particularly unemployed women, in our study.
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Do effects of price discounts and nutrition education on food purchases vary by ethnicity, income and education? Results from a randomised, controlled trial.
J Epidemiol Community Health
PUBLISHED: 02-04-2011
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Reducing health inequalities requires interventions that work as well, if not better, among disadvantaged populations. The aim of this study was to determine if the effects of price discounts and tailored nutrition education on supermarket food purchases (percentage energy from saturated fat and healthy foods purchased) vary by ethnicity, household income and education.
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Effects of childhood socioeconomic position on subjective health and health behaviours in adulthood: how much is mediated by adult socioeconomic position?
BMC Public Health
PUBLISHED: 01-06-2011
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Adult socioeconomic position (SEP) is one of the most frequently hypothesised indirect pathways between childhood SEP and adult health. However, few studies that explore the indirect associations between childhood SEP and adult health systematically investigate the mediating role of multiple individual measures of adult SEP for different health outcomes. We examine the potential mediating role of individual measures of adult SEP in the associations of childhood SEP with self-rated health, self-reported mental health, current smoking status and binge drinking in adulthood.
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Air pollution and mortality in New Zealand: cohort study.
J Epidemiol Community Health
PUBLISHED: 10-21-2010
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Few cohort studies of the health effects of urban air pollution have been published. There is evidence, most consistently in studies with individual measurement of social factors, that more deprived populations are particularly sensitive to air pollution effects.
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Seasonal patterns of mortality in relation to social factors.
J Epidemiol Community Health
PUBLISHED: 10-19-2010
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New Zealand is a temperate country with substantial excess winter mortality. We investigated whether this excess winter mortality varies with social factors.
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Ending appreciable tobacco use in a nation: using a sinking lid on supply.
Tob Control
PUBLISHED: 09-30-2010
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We discuss some of the practical and ethical questions that may arise for a jurisdiction where a sinking lid endgame strategy for tobacco supply is implemented. Such a strategy would involve regular required reductions in the amount of tobacco released to the market for sale, sufficient to achieve the desired level of commercial sales by a target date. Tobacco manufacturers would periodically bid to the government for a residual quota. Prices would increase as supply reduced. The price level would be influenced by demand, which in turn would reflect the impact of other interventions to reduce demand and the changing normality of smoking. Higher priced tobacco could result in increased smuggling, theft, illegal sales and short-to-medium-term aggravation of some social inequalities. We suggest that the strategy be introduced in conjunction with a range of complementary interventions that would help reduce demand, and thus help ensure that the possible adverse effects are minimised. These complementary interventions include: providing comprehensive best practice smoking cessation support, better information to smokers and the public, strengthened regulation of tobacco retailing and supply, further controlling the pack and product design, measures to restrict supplies that bypass the increases in product price, strengthened enforcement and combating industry attacks. General prerequisites for a sinking lid strategy include public support for the goal of a tobacco-free society, and strong political leadership. The likely context for initial success in jurisdictions includes geographical isolation and/or strong border controls, absence of significant tobacco production and/or manufacturing and low government corruption.
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Ethnic counts on mortality and census data 2001-06: New Zealand census-mortality study update.
N. Z. Med. J.
PUBLISHED: 08-20-2010
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To provide an update for the assessment of discrepancies in ethnicity counts in the 2001 census and mortality data for the 2004-2006 period.
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If nobody smoked tobacco in New Zealand from 2020 onwards, what effect would this have on ethnic inequalities in life expectancy?
N. Z. Med. J.
PUBLISHED: 08-20-2010
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Smoking contributes to the 7 to 8 year gap between Maori and non-Maori life expectancy (2006 Census). To inform current discussions by policy-makers on tobacco control, we estimate life-expectancy in 2040 for Maori and non-Maori, never-smokers and current-smokers. If nobody smoked tobacco from 2020 onwards, then life expectancy in 2040 will be approximated by projected never-smoker life expectancy.
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Trends in survival and life expectancy by ethnicity, income and smoking in New Zealand: 1980s to 2000s.
N. Z. Med. J.
PUBLISHED: 08-20-2010
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Survival and life expectancy are commonly used metrics to describe population health. There are two objectives to this paper: (1) to provide an explanation of methods and data used to develop New Zealand life-tables by ethnic, income and smoking groups; and (2) to compare cumulative survival and life expectancy trends in these subpopulations.
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What is behind smoker support for new smokefree areas? National survey data.
BMC Public Health
PUBLISHED: 08-18-2010
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Some countries have started to extend indoor smokefree laws to cover cars and various outdoor settings. However, policy-modifiable factors around smoker support for these new laws are not well described.
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Do New Zealands immigrants have a mortality advantage? Evidence from the New Zealand Census-Mortality Study.
Ethn Health
PUBLISHED: 07-31-2010
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To examine all-cause mortality differentials among New Zealands (NZ) immigrant population. Unlike other studies that use the total non-migrant population as the reference group, we use NZ-born populations of the same ethnic group for comparison purposes. Our study intends to answer two questions: first, do immigrants have a mortality advantage relative to their NZ-born counterparts of the same ethnicity? Second, does an immigrant mortality advantage, if one exists, decline as duration of residence increases?
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Ethnicity and management of colon cancer in New Zealand: do indigenous patients get a worse deal?
Cancer
PUBLISHED: 06-22-2010
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Racial and ethnic inequalities in colon cancer treatment have been reported in the United States but not elsewhere. The authors of this report compared cancer treatment in a nationally representative cohort of Maori (indigenous) and non-Maori New Zealanders with colon cancer.
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Change in income and change in self-rated health: Systematic review of studies using repeated measures to control for confounding bias.
Soc Sci Med
PUBLISHED: 05-24-2010
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It is generally assumed that income is strongly and positively associated with health. However, much of the evidence supporting this assumption comes from cross-sectional data or analyses that have not fully accounted for biases from confounding and health selection (the reverse pathway from health to income). This paper reports results of a systematic review of panel and longitudinal studies investigating whether changes in income led to changes in self-rated health (SRH) in adults. A variety of electronic databases were searched, up until January 2010, and thirteen studies were included, using data from five different panel or longitudinal studies. The majority of studies found a small, positive and statistically significant association of income with SRH, which was much reduced after controlling for unmeasured confounders and/or health selection. Residual bias, particularly from measurement error, probably reduced this association to the null. Most studies investigated short-term associations between income and SRH or the effect of temporary (usually one year) income changes or shocks, so did not rule out possibly stronger associations between health and longer-term average income or income lagged over longer time periods. Nevertheless, the true causal short-term relationship between income and health, estimated by longitudinal studies of income change and SRH that control for confounding, may be much smaller than that suggested by previous, mostly cross-sectional, research.
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Ethnic and socioeconomic trends in breast cancer incidence in New Zealand.
BMC Cancer
PUBLISHED: 05-15-2010
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Breast cancer incidence varies between social groups, but differences have not been thoroughly examined in New Zealand. The objectives of this study are to determine whether trends in breast cancer incidence varied by ethnicity and socioeconomic position between 1981 and 2004 in New Zealand, and to assess possible risk factor explanations.
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Ethnic and socioeconomic trends in testicular cancer incidence in New Zealand.
Int. J. Cancer
PUBLISHED: 05-06-2010
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Ethnic differences in testicular cancer incidence within countries are often sizeable, with white populations consistently having the highest ethnic-specific rates. Many studies have found that high socioeconomic status is a risk factor for testicular cancer. The objectives of this article are to test whether trends in testicular cancer incidence have varied by ethnicity and socioeconomic position in New Zealand between 1981 and 2004. Five cohorts of the entire New Zealand population for 1981-1986, 1986-1991, 1991-1996, 1996-2001 and 2001-2004 were created, and probabilistically linked to cancer registry records, allowing direct determination of ethnic and household income trends in testicular cancer incidence. There were more than 2,000 cases of testicular cancer over the study period. We found increasing rates of testicular cancer for all ethnic and income groups since 1990s. Maori had higher rates, and Pacific and Asian lower rates than European/other men with rate ratios pooled over time of 1.51 (95% CI 1.31-1.74), 0.40 (95% CI 0.26-0.61) and 0.54 (95% CI 0.31-0.94), respectively. Overall, men with low incomes had higher risk of testicular cancer than those with high incomes (pooled rate ratio for lowest to highest income groups = 1.23; 95% CI 1.05-1.44). There was no strong evidence that disparities in testicular cancer incidence have varied by ethnicity or household income over time. Given the lack of understanding of the etiology of testicular cancer, the unusual patterns identified in the New Zealand context may provide some etiological clues for future novel research.
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How well does routine hospitalisation data capture information on comorbidity in New Zealand?
N. Z. Med. J.
PUBLISHED: 04-03-2010
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This study aims to assess the quality of routinely collected comorbidity data in New Zealand which are increasingly used in health service planning and research.
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Educational inequalities in mortality over four decades in Norway: prospective study of middle aged men and women followed for cause specific mortality, 1960-2000.
BMJ
PUBLISHED: 02-25-2010
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To determine the extent to which educational inequalities in relation to mortality widened in Norway during 1960-2000 and which causes of death were the main drivers of this disparity.
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Measuring cancer survival in populations: relative survival vs cancer-specific survival.
Int J Epidemiol
PUBLISHED: 02-08-2010
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Two main methods of quantifying cancer patient survival are generally used: cancer-specific survival and relative survival. Both techniques are used to estimate survival in a single population, or to estimate differences in survival between populations. Arguments have been made that the relative survival approach is the only valid choice for population-based cancer survival studies because cancer-specific survival estimates may be invalid if there is misclassification of the cause of death. However, there has been little discussion, or evidence, as to how strong such biases may be, or of the potential biases that may result using relative survival techniques, particularly bias arising from the requirement for an external comparison group.
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Survival disparities in Indigenous and non-Indigenous New Zealanders with colon cancer: the role of patient comorbidity, treatment and health service factors.
J Epidemiol Community Health
PUBLISHED: 01-09-2010
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Ethnic disparities in cancer survival have been documented in many populations and cancer types. The causes of these inequalities are not well understood but may include disease and patient characteristics, treatment differences and health service factors. Survival was compared in a cohort of Maori (Indigenous) and non-Maori New Zealanders with colon cancer, and the contribution of demographics, disease characteristics, patient comorbidity, treatment and healthcare factors to survival disparities was assessed.
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Effects of price discounts and tailored nutrition education on supermarket purchases: a randomized controlled trial.
Am. J. Clin. Nutr.
PUBLISHED: 12-30-2009
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Traditional methods to improve population diets have largely relied on individual responsibility, but there is growing interest in structural interventions such as pricing policies.
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Support by New Zealand smokers for new types of smokefree areas: national survey data.
N. Z. Med. J.
PUBLISHED: 10-24-2009
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To describe smoker support for new smokefree laws covering cars and outdoor settings, in a national sample of New Zealand (NZ) smokers.
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Do ethnic and socio-economic inequalities in mortality vary by region in New Zealand? An application of hierarchical Bayesian modelling.
Soc Sci Med
PUBLISHED: 08-25-2009
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We hypothesised that ethnic and socio-economic inequality in mortality might vary by region in New Zealand. Linked 2001-2004 census-mortality data were stratified by region (District Health Boards or DHBs), sex, age and ethnic groups, and income quintiles. To accommodate data sparseness, and to achieve accurate estimates of DHB-specific mortality rates and rate ratios by ethnicity and income, we used hierarchical Bayesian methods. To aid presentation of results, we used posterior mortality rates from the models to calculate directly standardised rates and rate ratios, with credible intervals. M?ori-European/Other mortality rate ratios were often similar across DHBs, but Waitemata and Canterbury DHBs (both predominantly urban areas with low M?ori population) had significantly lower rate ratios. In contrast, Bay of Plenty and Waikato DHBs (heterogeneous by both ethnicity and socio-economic position) had significantly higher rate ratios. There was little variation in mortality inequalities by income across DHBs. Examining the underlying rates for ethnic and income groups separately, there were significant variations across DHBs, but these were often correlated such that the ethnic or income rate ratio was similar across DHBs. The application of hierarchical Bayesian allowed more definitive conclusions than routine empirical methods when comparing small populations such as social groups across regions. The range of hierarchical Bayesian estimates of M?ori mortality and M?ori:European rate ratios across regions was considerably narrower than empirical standardisation estimates.
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Does mortality vary between pacific groups in New Zealand? Estimating Samoan, Cook Island Maori, Tongan, and Niuean mortality rates using hierarchical Bayesian modelling.
N. Z. Med. J.
PUBLISHED: 05-26-2009
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BACKGROUND Pacific mortality rates are traditionally presented for all Pacific people combined, yet there is likely heterogeneity between separate Pacific ethnic groups. We aimed to determine mortality rates for Samoan, Cook Island M?ori, Tongan, and Niuean ethnic groups (living in New Zealand). METHODS We used New Zealand Census-Mortality Study (NZCMS) data for 2001-04, for 380,000 person years of follow-up of 0-74 year olds in the 2001-04 cohort for which there was complete data on sex, age, ethnicity (total counts), natality, and household income. Given sparse data, we used hierarchical Bayesian (HB) regression modelling, with: a prior covariate structure specified for sex, age, natality (New Zealand/Overseas born), and household income; and smoothing of rates using shrinkage. The posterior mortality rate estimates were then directly standardised.RESULTS Standardising for sex, age, income, and natality, all-cause mortality rate ratios compared to Samoan were: 1.21 (95% credibility interval 1.05 to 1.42) for Cook Island M?ori; 0.93 (0.77 to 1.10) for Tongan; and 1.07 (0.88 to 1.29) for Niuean. Cardiovascular disease (CVD) mortality rate ratios showed greater heterogeneity: 1.66 (1.26 to 2.13) for Cook Island M?ori; 1.11 (0.72 to 1.58) for Niuean; and 0.86 (0.58 to 1.20) for Tongan. Results were little different standardising for just sex and age. We conducted a range of sensitivity analyses about a plausible range of (differential) return migration by Pacific people when terminally ill, and a plausible range of census undercounting of Pacific people. Our findings, in particular the elevated CVD mortality among Cook Island M?ori, appeared robust. CONCLUSIONS To our knowledge, this project is the first time in New Zealand that clear (and marked in the case of CVD) differences in mortality have been demonstrated between different Pacific ethnic groups. Future health research and policy should, wherever possible and practicable, evaluate and incorporate heterogeneity of health status among Pacific people.
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(Mis)classification of ethnicity on the New Zealand Cancer Registry: 1981-2004.
N. Z. Med. J.
PUBLISHED: 05-26-2009
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M?ori and Pacific peoples are undercounted in cancer incidence statistics relative to census statistics. We use linked census and Cancer Registry data sets to determine the extent of misclassification between 1981 and 2004.
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The effect of comorbidity on the use of adjuvant chemotherapy and survival from colon cancer: a retrospective cohort study.
BMC Cancer
PUBLISHED: 04-20-2009
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Comorbidity has a well documented detrimental effect on cancer survival. However it is difficult to disentangle the direct effects of comorbidity on survival from indirect effects via the influence of comorbidity on treatment choice. This study aimed to assess the impact of comorbidity on colon cancer patient survival, the effect of comorbidity on treatment choices for these patients, and the impact of this on survival among those with comorbidity.
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Changing trends in indigenous inequalities in mortality: lessons from New Zealand.
Int J Epidemiol
PUBLISHED: 03-30-2009
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We describe trends from 1951 to 2006 in inequalities in mortality between the indigenous (M?ori) and non-indigenous (non-M?ori, mainly European-descended) populations of New Zealand. We relate these trends to the historical context in which they occurred, including major structural adjustment of the economy from the mid 1980s to the mid 1990s, followed by a retreat from neoliberal social and economic policies from the late 1990s onwards. This was accompanied by economic recovery and the introduction of health reforms, including a reorientation of the health system towards primary health care.
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A national study of the association between neighbourhood access to fast-food outlets and the diet and weight of local residents.
Health Place
PUBLISHED: 02-20-2009
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Differential locational access to fast-food retailing between neighbourhoods of varying socioeconomic status has been suggested as a contextual explanation for the social distribution of diet-related mortality and morbidity. This New Zealand study examines whether neighbourhood access to fast-food outlets is associated with individual diet-related health outcomes. Travel distances to the closest fast-food outlet (multinational and locally operated) were calculated for all neighbourhoods and appended to a national health survey. Residents in neighbourhoods with the furthest access to a multinational fast-food outlet were more likely to eat the recommended intake of vegetables but also be overweight. There was no association with fruit consumption. Access to locally operated fast-food outlets was not associated with the consumption of the recommended fruit and vegetables or being overweight. Better neighbourhood access to fast-food retailing is unlikely to be a key contextual driver for inequalities in diet-related health outcomes in New Zealand.
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Socioeconomic inequalities in cancer survival in New Zealand: the role of extent of disease at diagnosis.
Cancer Epidemiol. Biomarkers Prev.
PUBLISHED: 02-17-2009
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We examined socioeconomic inequalities in cancer survival in New Zealand among 132,006 people ages 15 to 99 years who had a cancer registered (1994-2003) and were followed up to 2004. Relative survival rates (RSR) were calculated using deprivation-specific life tables. A census-based measure of socioeconomic position (New Zealand deprivation based on the 1996 census) based on residence at the time of cancer registration was used. All RSRs were age-standardized, and further standardization was used to investigate the effect of extent of disease at diagnosis on survival. Weighted linear regression was used to estimate the deprivation gap (slope index of inequality) between the most and least deprived cases. Socioeconomic inequalities in cancer survival were evident for all of the major cancer sites, with the deprivation gap being particularly high for prostate (-0.15), kidney and uterus (both -0.14), bladder (-0.12), colorectum (-0.10), and brain (+0.10). Accounting for extent of disease explained some of the inequalities in survival from breast and colorectal cancer and melanoma and all of the deprivation gaps in survival of cervical cancer; however, it did not affect RSRs for cancers of the kidney, uterus, and brain. No substantial differences between the total compared with the non-M?ori population were found, indicating that the findings were not due to confounding by ethnicity. In summary, socioeconomic disparities in survival were consistent for nearly all cancer sites, persisted in ethnic-specific analyses, and were only partially explained by differential extent of disease at diagnosis. Further investigation of reasons for persisting inequalities is required.
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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.