Epidemiology of acute rheumatic fever in New Zealand 1996-2005

Aim: Acute rheumatic fever (ARF) and its sequela chronic rheumatic heart disease remain significant causes of morbidity and mortality in New Zealand, particularly among Māori and Pacific peoples. Despite its importance, ARF epidemiology has not been reviewed recently. The aims of this study were to assess trends in ARF incidence rates between 1996 and 2005 and the extent to which ARF is concentrated in certain populations based on age, sex, ethnicity and geographical location.

Methods: This descriptive epidemiological study examined ARF incidence rates using hospitalisation data (1996–2005) and population data from the 1996 and 2001 censuses. Rates were compared by using rate ratios and 95% confidence intervals.

Results: New Zealand's annual ARF rate was 3.4 per 100 000. ARF was concentrated in certain populations: 5- to 14-year-olds, Māori and Pacific peoples and upper North Island areas. From 1996 to 2005, the New Zealand European and Others ARF rate decreased significantly while Māori and Pacific peoples’ rates increased. Compared with New Zealand European and Others, rate ratios were 10.0 for Māori and 20.7 for Pacific peoples. Of all cases, 59.5% were Māori or Pacific children aged 5–14 years, yet this group comprised only 4.7% of the New Zealand population.

Conclusion: ARF rates in New Zealand have failed to decrease since the 1980s and remain some of the highest reported in a developed country. There are large, and now widening, ethnic disparities in ARF incidence. ARF is so concentrated by age group, ethnicity and geographical area that highly targeted interventions could be considered, based on these characteristics.

Behavioural effects of tourism on oceanic common dolphins, Delphinus sp., in New Zealand: the effects of Markov analysis variations and current tour operator compliance with regulations

Common dolphins, Delphinus sp., are one of the marine mammal species tourism operations in New Zealand focus on. While effects of cetacean-watching activities have previously been examined in coastal regions in New Zealand, this study is the first to investigate effects of commercial tourism and recreational vessels on common dolphins in an open oceanic habitat. Observations from both an independent research vessel and aboard commercial tour vessels operating off the central and east coast Bay of Plenty, North Island, New Zealand were used to assess dolphin behaviour and record the level of compliance by permitted commercial tour operators and private recreational vessels with New Zealand regulations. Dolphin behaviour was assessed using two different approaches to Markov chain analysis in order to examine variation of responses of dolphins to vessels. Results showed that, regardless of the variance in Markov methods, dolphin foraging behaviour was significantly altered by boat interactions. Dolphins spent less time foraging during interactions and took significantly longer to return to foraging once disrupted by vessel presence. This research raises concerns about the potential disruption to feeding, a biologically critical behaviour. This may be particularly important in an open oceanic habitat, where prey resources are typically widely dispersed and unpredictable in abundance. Furthermore, because tourism in this region focuses on common dolphins transiting between adjacent coastal locations, the potential for cumulative effects could exacerbate the local effects demonstrated in this study. While the overall level of compliance by commercial operators was relatively high, non-compliance to the regulations was observed with time restriction, number or speed of vessels interacting with dolphins not being respected. Additionally, prohibited swimming with calves did occur. The effects shown in this study should be carefully considered within conservation management plans, in order to reduce the risk of detrimental effects on common dolphins within the region.

Effects of a free school breakfast programme on school attendance, achievement, psychosocial function, and nutrition: a stepped wedge cluster randomised trial

BACKGROUND: Approximately 55,000 children in New Zealand do not eat breakfast on any given day. Regular breakfast skipping has been associated with poor diets, higher body mass index, and adverse effects on children's behaviour and academic performance. Research suggests that regular breakfast consumption can improve academic performance, nutrition and behaviour. This paper describes the protocol for a stepped wedge cluster randomised trial of a free school breakfast programme. The aim of the trial is to determine the effects of the breakfast intervention on school attendance, achievement, psychosocial function, dietary habits and food security.

METHODS/DESIGN: Sixteen primary schools in the North Island of New Zealand will be randomised in a sequential stepped wedge design to a free before-school breakfast programme consisting of non-sugar coated breakfast cereal, milk products, and/or toast and spreads. Four hundred children aged 5-13 years (approximately 25 per school) will be recruited. Data collection will be undertaken once each school term over the 2010 school year (February to December). The primary trial outcome is school attendance, defined as the proportion of students achieving an attendance rate of 95% or higher. Secondary outcomes are academic achievement (literacy, numeracy, self-reported grades), sense of belonging at school, psychosocial function, dietary habits, and food security. A concurrent process evaluation seeks information on parents', schools' and providers' perspectives of the breakfast programme.

DISCUSSION: This randomised controlled trial will provide robust evidence of the effects of a school breakfast programme on students' attendance, achievement and nutrition. Furthermore the study provides an excellent example of the feasibility and value of the stepped wedge trial design in evaluating pragmatic public health intervention programmes.

Strategic significance of the island state of Sri Lanka

The study is focused on an analysis of the major diplomatic documents from the mid eighteenth century to the present as regards Sri Lanka, or Ceylon as it was known till 1972. The objectives of the study are to identify the issues underlying these diplomatic documents. These include the political and strategic factors and other subsidiary issues like trade and commerce relevant at the time these treaties, agreements, and proposed treaties were formulated. It is also a geopolitical study as it relates to Sri Lanka's geographical position in the Indian Ocean, and her possession of the Trincomalee Harbour on its east coast, which is one of the great natural harbours of the world. Over the centuries this harbour has had significant strategic value for naval deployments. The case study of the eighteenth and nineteenth centuries studies the diplomatic documents against the political and strategic background for the French Revolution and actions of Napoleon, and the Anglo/French rivalry, spreading from Europe to North America and Asia. In the twentieth century the environment for studying the place of Sri Lanka in the Indian Ocean was created by the Russian Revolution, the failure to keep the peace of Versailles after World War I, the conflict and horrors of World War II which led to the disintegration of European colonial empires in Asia and Africa, and the tensions generated by the Cold War. A study of the documents would reveal that in international relations what matters is the ability of a party to promote its interests, and this depends on its power. This realist approach contrasts to the idealist approach where policies are based on moral and ethical principles. For the realist the states should follow to protect their interests and to survive. To achieve this is to strive for a ‘balance of power’. To do so is to form a favourable alliance system. As the documents examined cover a period from the mid-eighteenth century to the later part of the twentieth century, they reflect the changing technologies that have had an influence on naval and military matters. For example, this period witnessed great changes in technology of energy utilized to propel warships, from wind, to steam, to fuel and finally to nuclear power. These changes had an influence in determining strategic policies involving weapon systems and communications within a global and regional setting. The period covered was the beginning of the process described a ‘globalisation’. Its idea is not unique to this century; there were many attempts, in various times of history, to integrate societies within a global context. Viewed in this light, the Anglo-French rivalry of the eighteenth and nineteenth centuries was the indication of a global naval strategy, in which Sri Lanka was a major factor in the Indian Ocean region. This process was associated with the phenomena called the ‘expansion of Europe’. It covered all the oceans of the world and in the nineteenth and twentieth centuries led to the founding of the largest maritime empire the world has ever seen: The British Empire. After World War I, the British naval strength (the basis of the British Empire) and her consequent position as a great power, was challenged by other powers like the United States of America and Japan. After World War II, the US Navy was supreme: and there was a close alliance between Britain and the USA. The strength of the US/British alliance was based on the navy and its bases, which were spread throughout the globe; to project power, and act as deterrence and balancing force. Sri Lanka, due to her strategic position, was a part of this evolving process, and was tied to a global strategy (with its regional connotations) from the eighteenth century to the present.

Population development and historical occurrence of king penguins at the Falkland Island

After an extended period of sporadic sightings of small numbers of king penguins at the Falkland Islands, they established themselves on Volunteer Point, situated at the north-east of the islands, by the late 1970s. By 1980, a small breeding population was present which yielded some 40 fledglings during that same year. Since 1991, the population has been monitored annually and the resulting fledgling counts analysed to assess population trends. The population demonstrated a significant increase over the past three decades, at about 10% per annum, with time explaining 75% of the variation in count data. The current population is estimated to be 720 breeding pairs. Despite several authors having alluded to the existence of a large colony of king penguins at the Falklands prior to human exploitation, we found no evidence in support of this. We furthermore found no evidence in the literature in support of exploitation for king penguin oil during the 19th century. Unlike at other breeding sites, increasing numbers of king penguins at the Falklands is consequently unlikely to be a recovery response following exploitation, but rather an indication of either increased immigration or of improved feeding conditions.

Inter- and intra-beach thermal variation for Green Turtle nests on Ascension Island, South Atlantic

Nest temperatures for green turtles (Chelonia mydas) nesting on Ascension Island, South Atlantic (7°57'S 14°22'W), were examined. Temperature probes were placed into nests on two beaches, Long Beach (26 nests) and North East Bay (8 nests). Within these beaches there was relatively little thermal variation (SD of nest temperature was 0.32°C for Long Beach and 0.30°C for North East Bay). To examine inter-beach thermal variation temperature probes were buried at 55 cm on 12 beaches. Inter-beach thermal variation was large and was related to the beach albedo with the darkest beach (albedo, 016) being 4.2°C warmer than the lightest coloured beach (albedo, 0.73).

Prevalence and risk factors for stunting and severe stunting among under-fives in North Maluku province of Indonesia

BACKGROUND: Adequate nutrition is needed to ensure optimum growth and development of infants and young children. Understanding of the risk factors for stunting and severe stunting among children aged less than five years in North Maluku province is important to guide Indonesian government public health planners to develop nutrition programs and interventions in a post conflict area. The purpose of the current study was to assess the prevalence of and the risk factors associated with stunting and severe stunting among children aged less than five years in North Maluku province of Indonesia. METHODS: The health and nutritional status of children aged less than five years was assessed in North Maluku province of Indonesia in 2004 using a cross-sectional multi-stage survey conducted on 750 households from each of the four island groups in North Maluku province. A total of 2168 children aged 0-59 months were used in the analysis. RESULTS: Prevalence of stunting and severe stunting were 29% (95%CI: 26.0-32.2) and 14.1% (95%CI: 11.7-17.0) for children aged 0-23 months and 38.4% (95%CI: 35.9-41.0) and 18.4% (95%CI: 16.1-20.9) for children aged 0-59 months, respectively. After controlling for potential confounders, multivariate analysis revealed that the risk factors for stunted children were child's age in months, male sex and number of family meals per day (