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Thornley C.N.,Auckland Regional Public Health Service | Hewitt J.,Institute of Environmental Science and Research Ltd | Perumal L.,Auckland Regional Public Health Service | Van Gessel S.M.,Auckland Regional Public Health Service | And 6 more authors.
Epidemiology and Infection | Year: 2013

Multiple norovirus outbreaks following catered events in Auckland, New Zealand, in September 2010 were linked to the same catering company and investigated. Retrospective cohort studies were undertaken with attendees of two events: 38 (24·1%) of 158 surveyed attendees developed norovirus-compatible illness. Attendees were at increased risk of illness if they had consumed food that had received manual preparation following cooking or that had been prepared within 45 h following end of symptoms in a food handler with prior gastroenteritis. All food handlers were tested for norovirus. A recombinant norovirus GII.e/GII.4 was detected in specimens from event attendees and the convalescent food handler. All catering company staff were tested; no asymptomatic norovirus carriers were detected. This investigation improved the characterization of norovirus risk from post-symptomatic food handlers by narrowing the potential source of transmission to one individual. Food handlers with gastroenteritis should be excluded from the workplace for 45 h following resolution of symptoms. © Cambridge University Press 2013.


PubMed | University of Auckland, Greenlane Clinical Center, Auckland Regional Public Health Service and Auckland University of Technology
Type: | Journal: Journal of paediatrics and child health | Year: 2017

The study assessed whether a healthy food policy implemented in one school, Yendarra Primary, situated in a socio-economically deprived area of South Auckland, had improved student oral health by comparing dental caries levels with students of similar schools in the same region with no such policy.Records of caries of the primary and adult teeth were obtained between 2007 and 2014 for children attending Yendarra, and were compared to those of eight other public schools in the area, with a similar demographic profile. Children were selected between the ages of 8 and 11 years. Linear regression models were used to estimate the strength of association between attending Yendarra school and dental caries.During the study period, 3813 records were obtained of children who attended dental examinations and the schools of interest. In a linear model, mean number of carious primary and adult teeth were 0.37 lower (95% confidence interval: 0.09-0.65) in Yendarra school children, compared to those in other schools, after adjustment for confounders. Pacific students had higher numbers of carious teeth (adjusted coefficient: 0.25; 95% confidence interval: 0.03-0.46) than Mori.This nutrition policy, implemented in a school in the poorest region of South Auckland, which restricted sugary food and drink availability, was associated with a marked positive effect on the oral health of students, compared to students in surrounding schools. We recommend that such policies are a useful means of improving child oral health.


PubMed | University of Otago, New Zealand Ministry of Health and Auckland Regional Public Health Service
Type: | Journal: Journal of paediatrics and child health | Year: 2017

Acute rheumatic fever (ARF) is an important public health problem in low- and middle-income countries and in certain populations in high-income countries. Indigenous Australians, and New Zealand Mori and Pacific people, have incidence rates among the highest in the world. We aimed to investigate ARF cases housing conditions and sore throat treatment to identify opportunities for improving ARF prevention in New Zealand.Recently diagnosed cases and their care givers were interviewed. Information was obtained about the cases demographics, housing circumstances and conditions, and sore throat treatment preceding ARF.We interviewed 55 cases. Most (75%) lived in rental housing and reported multiple measures of deprivation. Common exposures were household crowding (58%), bed-sharing (49%), dampness and mould (76%), cold (82%) and co-habiting with smokers (71%). Experiencing sore throat in the weeks before ARF was recalled by 62%, with 29% seeing a doctor or nurse and 13% of the total sample receiving antibiotics.The environmental conditions reported could contribute to high group A Streptococcus transmission and susceptibility to infection, thus increasing ARF risk. Sore throat treatment has important limitations as an intervention, particularly as 38% of participants did not recall sore throat preceding the diagnosis. The results support the need to improve rental housing. Interventions promoting minimum enforceable standards in social housing and private rental sectors (such as a housing warrant of fitness) could support these changes. A rigorous investigation, such as a case control study, is needed to explore risk factors further.


PubMed | University of Auckland, Greenlane Clinical Center and Auckland Regional Public Health Service
Type: | Journal: Journal of epidemiology and community health | Year: 2016

To determine whether dental caries, as an indicator of cumulative exposure to sugar, is associated with the incidence of acute rheumatic fever and chronic rheumatic heart disease, in Mori and Pacific children aged 5 and 6years at their first dental visit.A cohort study was undertaken which linked school dental service records of caries with national hospital discharge and mortality records. Cox models were used to investigate the strength of the association between dental caries and rheumatic fever incidence.A total of 20333 children who were free of rheumatic heart disease at enrolment were available for analysis. During a mean follow-up time of 5years, 96 children developed acute rheumatic fever or chronic rheumatic heart disease. After adjustment for potential confounders, children with five or more primary teeth affected by caries were 57% (95% CI: 20% to 106%) more likely to develop disease during follow-up, compared to children whose primary teeth were caries free. The population attributable to the risk for caries in this cohort was 22%.Dental caries is positively associated with the incidence of acute rheumatic fever and chronic rheumatic heart disease in Mori and Pacific children. Sugar intake, an important risk factor for dental caries, is also likely to influence the aetiology of rheumatic fever.


Thornley C.N.,Auckland Regional Public Health Service | Emslie N.A.,Air New Zealand Medical Unit | Sprott T.W.,Air New Zealand Medical Unit | Greening G.E.,Institute of Environmental Science and Research | Rapana J.P.,Auckland Regional Public Health Service
Clinical Infectious Diseases | Year: 2011

(See the Editorial Commentary by Lopman, on pages 521-22.)Background. Previously reported outbreaks of norovirus gastroenteritis associated with aircraft have been limited to transmission during a single flight sector. During October 2009, an outbreak of diarrhea and vomiting occurred among different groups of flight attendants who had worked on separate flight sectors on the same airplane. We investigated the cause of the outbreak and whether the illnesses were attributable to work on the airplane.Methods.Information was obtained from flight attendants on demographic characteristics, symptoms, and possible transmission risk factors. Case patients were defined as flight attendants with diarrhea or vomiting <51 hours after the end of their first flight sector on the airplane during 13-18 October 2009. Stool samples were tested for norovirus RNA.Results.A passenger had vomited on the Boeing 777-200 airplane on the 13 October flight sector. Sixty-three (82%) of 77 flight attendants who worked on the airplane during 13-18 October provided information, and 27 (43%) met the case definition. The attack rate among flight attendants decreased significantly over successive flight sectors from 13 October onward (P <. 001). Working as a supervisor was independently associated with development of illness (adjusted odds ratio, 5.8; 95% confidence interval, 1.3-25.6). Norovirus genotype GI.6 was detected in stool samples from 2 case patients who worked on different flight sectors.Conclusions.Sustained transmission of norovirus is likely to have occurred because of exposures on this airplane during successive flight sectors. Airlines should make provision for adequate disinfection of airplanes with use of products effective against norovirus and other common infectious agents after vomiting has occurred. © 2011 The Author.


Thornley S.,University of Auckland | Jackson G.,Counties Manukau District Health Board | McRobbie H.,Queen Mary, University of London | Sinclair S.,Counties Manukau District Health Board | Smith J.,Auckland Regional Public Health Service
New Zealand Medical Journal | Year: 2010

Aims: Nicotine replacement therapy (NRT) is a life-saving, cost-effective smoking cessation treatment that doubles the chances of long-term abstinence regardless of the amount of additional support provided. We investigate the proportion of working age people (age 15-64 years) in Counties Manukau District Health Board (CMDHB) who obtained at least one packet of subsidised NRT during 2007, and whether this varied by demographic characteristics. Method: We linked health data in residents of CMDHB aged 15 to 64, using a cross sectional method, to estimate the odds of Maori and Pacific ethnic groups with high smoking prevalence accessing subsidised NRT during 2007 using logistic regression. Demographic variables such as age, gender, other ethnic groups, and socioeconomic deprivation (NZdep) were also included. Results: Subsidised NRT was infrequently (proportion of 'ever users' 0.5%/year, or about 2.1% of smokers) claimed for in CMDHB in 2007. When adjusted for demographic variables, Pacific peoples were 60% less likely to claim NRT than European (odds ratio 0.34; 95%CI 0.29-0.41), despite a higher prevalence of smoking in the former group. An over four-fold increased use of NRT was observed in those aged 55 to 64 years compared to 15 to 25 year olds. Conclusion: Dispensing of NRT is low overall in CMDHB. Lowest rates of treatment were observed in younger age groups, men and Pacific and Maori people. Programmes to increase uptake of such treatment in these groups are urgently needed. ©NZMA.


Rungan S.,Starship Childrens Hospital | Reeve A.M.,Auckland Regional Public Health Service | Reed P.W.,Starship Childrens Hospital | Voss L.,Starship Childrens Hospital
Pediatric Infectious Disease Journal | Year: 2013

Background: New Zealand accepts 750 refugees annually who enter via the Mangere Refugee Resettlement Centre. Aims: To evaluate the health needs of refugee children less than 5 years of age. Methods: Retrospective audit on the outcomes of health screening and referrals in children less than 5 years of age at the Mangere Refugee Resettlement Centre between 2007 and 2011. Results: Of the 343 children, the most common infectious diseases were latent tuberculosis (15%) and parasitic infections (15%). In those older than 1 year old who had rubella and measles serology information, immunity was found in 50% and 59%, respectively. Hepatitis B immunity was found in 68%. Complete vaccination certificates were available for 66% on arrival to New Zealand. Vaccinations were administered to 73% while at the Mangere Refugee Resettlement Centre. Iron deficiency and vitamin D deficiency were the main noninfectious diseases found and were present in 33% and 12%, respectively. The total requiring referral for further medical assessment or support was 58% with 19% requiring referral to more than one service. Conclusions: Screening identified health needs in otherwise asymptomatic newly arriving refugee children. A proportion of children required access to multiple specialized medical services and may benefit from a comprehensive pediatric service. © 2013 Lippincott Williams &Wilkins.


Priest P.,University of Otago | Sadler L.,National Womens Health | Sykes P.,University of Otago | Marshall R.,University of Auckland | And 2 more authors.
Cancer Causes and Control | Year: 2010

Objective The aim of this study is to assess whether ethnic inequalities in cervical cancer mortality are due to differences in survival independent of stage and age at diagnosis, and to assess the contribution of screening to stage at diagnosis. Methods Demographic data and cervical screening history were collected for 402 women with histologically proven primary invasive cervical cancer, diagnosed in New Zealand between 1 January 2000 and 30 September 2002. Date of death was available for women who died up to 30 September 2004. Results A Cox proportional hazard model showed that, after adjusting for age, the Maori mortality rate was 1.80 times (95% CI 1.07-3.04) that of non-Mãori. This reduced to 1.25 (95% CI 0.74-2.11) when stage at diagnosis was also adjusted for. Among determinants of late stage at diagnosis, older age and being Maori significantly increased the risk, while screening was protective. Conclusions These results indicate that later stage at diagnosis is the main determinant of Maori women's higher mortality from cervical cancer. Improving cervical screening among Maori women would reduce stage at diagnosis and therefore ethnic inequalities in mortality.


PubMed | Auckland Regional Public Health Service, Community and Public Health and Rehabilitation and Population Health
Type: Journal Article | Journal: The New Zealand medical journal | Year: 2015

This special article defines the public health principles and core public health functions that are combined to produce the public health services essential for a highly-functioning New Zealand health system. The five core functions are: health assessment and surveillance; public health capacity development; health promotion; health protection; and preventive interventions. The core functions are interconnected and are rarely delivered individually. Public health services are not static, but evolve in response to changing needs, priorities, evidence and organisational structures. The core functions describe the different ways public health contributes to health outcomes in New Zealand and provide a framework for ensuring services are comprehensive and robust.


Wilson D.,University of Auckland | Koziol-Mclain J.,University of Auckland | Garrett N.,University of Auckland | Sharma P.,Auckland Regional Public Health Service
International Journal for Quality in Health Care | Year: 2010

Objective: Refine instrument for auditing hospital-based child abuse and neglect violence intervention programmes prior to field-testing. Design: A modified Delphi study to identify and rate items and domains indicative of an effective and quality child abuse and neglect intervention programme. Experts participated in four Delphi rounds: two surveys, a one-day workshop and the opportunity to comment on the penultimate instrument. Setting: New Zealand. Participants: Twenty-four experts in the field of care and protection of children. Main Outcome Measures. Items with panel agreement ≥85% and mean importance rating ≥4.0 (scale from 1 (not important) to 5 (very important)). Results: There was high-level consensus on items across Rounds 1 and 2 (89% and 85%, respectively). In Round 3 an additional domain (safety and security) was agreed upon and cultural issues, alert systems for children at risk, and collaboration among primary care, community, non-government and government agencies were discussed. The final instrument included nine domains ('policies and procedures', 'safety and security', 'collaboration', 'cultural environment', 'training of providers', 'intervention services', 'documentation' 'evaluation' and 'physical environment') and 64 items. Conclusions: The refined instrument represents the hallmarks of an ideal child abuse and neglect programme given current knowledge and experience. The instrument enables rigorous evaluations of hospital-based child abuse and neglect intervention programmes for quality improvement and benchmarking with other programmes. © The Author 2010. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

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