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Item Sia Tō’onga Mo’ui study : New Zealand Pacific lifestyle programme : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Wellington, New Zealand(Massey University, 2024-11-21) Faeamani, GavinObjective and Rationale: Pacific peoples in Aotearoa New Zealand (NZ) have the highest rates of type 2 diabetes (T2DM) compared to other population groups (1). There is a paucity in the design and implementation of culturally tailored approaches in New Zealand focused on targeting major long-term conditions and particularly in reducing the T2DM epidemic among high-risk population groups. This doctoral study investigates a culturally tailored approach focused on reducing the risk of developing T2DM. The objective of this study was to implement a culturally relevant lifestyle change programme by adapting the efficacious Diabetes Prevention Programme (DPP) for use specifically amongst Tongans living in New Zealand. It also seeks to explore and understand the uptake and acceptability of the adapted prevention programme, including identifying the enablers and barriers of the programme in reducing the progression of prediabetes to T2DM in Tongan adults, aged 18-74 years old. Methods: The Sia Tō’onga Mo’ui Diabetes Prevention Programme (STM-DPP) uses a mixed-method approach and includes three phases. Phase 1: uses a citizen’s panel approach, composed of three panel groups made up of community members, (ii) health experts, and (iii) representatives from the first two panels to adapt the Pacific Island Diabetes Prevention Programme (PI-DPP). Phase 2 involves the implementation of the newly adapted, now known as the STM-DPP, by improving diet via weekly Zoom sessions and doing 150 minutes of physical activity every week, aiming to reduce 5% or more of total body weight. Data on clinical markers at baseline and post-programme were collected and analysed to determine the impact of the STM-DPP. Phase 3 included an evaluation of the STM-DPP using focus groups aimed at examining successful processes, benefits, practical applications, behavioural, cultural, and motivational drivers of change. Setting: The study was conducted in Auckland, NZ. Focus group discussions on Zoom were employed due to the restrictions of COVID-19 at the time and associated lockdowns that restricted any face-to-face or in-person meetings. The PI-DPP modules were also being presented weekly on Zoom, with exercise sessions held at the two study site venues. Results: The citizen panels guided the adaptation of the PI-DPP to reflect the Tongan culture and way of life; duration of the programme; consolidate and adapt the contents of the modules; appropriateness of programme delivery and approach; and incentives for participants. The implementation of the STM-DPP included 41 Tongan participants (males = 25, females = 16), of whom 95.2% had BMI≥30.0 and 75.6% had a Prediabetes Risk Test (PRT) score of baseline PRT≥5, indicating a high risk. At the conclusion of the intervention, post-programme data revealed significant changes across all areas for participants in weight, waist-to-height ratio, physical activity capability, and blood pressure. The evaluation of the STM-DPP also reports that the program’s feasibility and acceptability among the Tongan communities were positive, which explained the high uptake of the programme. Conclusions: These results provide evidence-based research affirming that the culturally adapted T2DM prevention programme, STM-DPP, is feasible and acceptable amongst Tongans in NZ. The positive impact of the prevention programme among the Tongan population in Auckland could be made available and adapted to other Pacific populations across NZ.Item Public Health.(2024-12) Röhr S; Gibson R; Alpass FBACKGROUND: High purpose in life - the extent of engagement in activities that are personally valued and give a sense of direction and meaning to life - has been associated with higher cognitive functioning and may protect against dementia. Less is known about gender differences in cognitive functioning regarding purpose in life. Understanding gender-specific links can inform tailored interventions aimed at promoting cognitive health. METHOD: A subsample (n = 875, aged 50-85 years) of the NZHWR study completed face-to-face cognitive assessments and postal surveys in 2012. Cognitive functioning was assessed with Addenbrooke's Cognitive Examination-Revised (ACE-R), adapted for culturally acceptable use in New Zealand. Purpose in life was measured with the Life Engagement Test. Linear regression analysis assessed associations of gender, purpose in life and their interaction with cognitive functioning, controlling for socioeconomic factors (age, age², education, ethnicity [Māori, Indigenous people of New Zealand, and Non-Māori, mostly of European descent], marital status, employment, individual-level economic hardship, area-based socioeconomic deprivation), lifestyle and health factors (smoking, alcohol consumption, physical activity, SF-12 physical and mental health, social engagement, social loneliness). RESULT: The analytical sample (n = 643) was M = 65.3 (SD = 7.4) years old; 53.3% women, 21.2% Māori. The ACE-R score was M = 92.9 (SD = 5.3). N = 55 (8.5%) scored ≥1.5SD below the mean, indicating cognitive impairment. Women had higher cognitive functioning (M = 93.7, SD = 4.6 vs. M = 92.0, SD = 5.8; Z = -3.88, p<.001) and purpose in life (M = 26.2, SD = 3.8 vs. M = 25.8, SD = 3.4; Z = -2.19, p = .029) than men. In the adjusted regression analysis (R² = 27.6%), higher purpose in life (B = 0.29, 95%CI = 0.12;0.46; p = .001) and female gender (B = 9.97, 95%CI = 4.71;15.24, p<.001) were associated with higher cognitive functioning. The association of purpose in life with cognitive functioning was less pronounced for women than men (B = -0.31, 95%CI = -0.51;-0.11; p = .003) (Fig. 1). Significant covariates included age², education, deprivation, and social loneliness. CONCLUSION: In this sample of older New Zealanders, a gender difference in cognitive functioning varied by level of purpose in life. Women had higher cognitive functioning than men, particularly at lower purpose in life, with the difference decreasing as purpose in life increases. Interventions to enhance purpose in life might particularly benefit men. Notably, cognitive functioning may also impact purpose in life, emphasising the need for longitudinal studies.Item Area-based socioeconomic deprivation is associated with cognitive decline in midlife to early late-life New Zealanders without cognitive impairment(Wiley Periodicals LLC on behalf of Alzheimer's Association, 2025-01-09) Röhr S; Gibson R; Alpass FBackground Research identified individual-level socioeconomic factors as key determinants of cognitive health. This study investigated the effect of area-based socioeconomic deprivation on cognitive outcomes in midlife to early late-life New Zealanders without cognitive impairment. Understanding geographical dimensions of socioeconomic determinants of cognitive health is important from an equity perspective. Method Data stemmed from a subsample of the New Zealand Health, Work and Retirement Study, a cohort study on ageing. In 2010, 1,001 participants aged 49-84 years completed face-to-face interviews and were reassessed two years later. Cognitive functioning was measured using Addenbrooke’s Cognitive Examination–Revised, adapted for culturally acceptable use in New Zealand. Area-based socioeconomic deprivation was assessed using the New Zealand Deprivation Index (NZDep2006). Linear mixed-effects models analysed the association between area-based socioeconomic deprivation and cognitive outcomes, controlling for individual-level socioeconomic (age, age², gender, education, ethnicity [Māori, Indigenous people of New Zealand, and Non-Māori, mostly of European descent], marital status, employment, net personal income), lifestyle and health variables (Lifestyle for Brain Health/LIBRA index, social loneliness). Result The analysis included 783 participants (54.7% female, mean age 62.7 years, 25.0% Māori). Individuals with cognitive impairment at baseline (n = 69) and older than 75 years were excluded (n = 79). Further attrition was due to missing data. At baseline, 39.7% resided in low deprivation areas, 39.0% in moderate, and 21.3% in high deprivation areas. The unadjusted model indicated a significant association between higher area-based socioeconomic deprivation and lower cognitive functioning (B = -0.16, 95%CI: -0.22,-0.10; p < .001) and cognitive decline (B = -0.12, 95%CI: -0.21;-0.03; p = .015). The adjusted model yielded similar results for cognitive functioning (B = -0.08, 95%CI: -0.15;-0.01; p = .050) and cognitive decline (B = -0.12, 95%CI: -0.20;-0.04, p = .013) (Fig. 1). Influential covariates included gender, education, and lifestyle (LIBRA). Conclusion This study demonstrated a relationship between higher area-based socioeconomic deprivation and lower cognitive functioning, along with cognitive decline, in cognitively unimpaired New Zealanders aged 48 to 75 years. These findings emphasize the importance of considering neighbourhood characteristics and broader socioeconomic factors in strategies aimed at mitigating cognitive health disparities and reducing the impact of dementia in disadvantaged communities.Item New Campylobacter Lineages in New Zealand Freshwater: Pathogenesis and Public Health Implications(John Wiley and Sons, 2024-12) Cookson AL; Burgess S; Midwinter AC; Marshall JC; Moinet M; Rogers L; Fayaz A; Biggs PJ; Brightwell GThis study investigated the diversity of thermophilic Campylobacter species isolated from three New Zealand freshwater catchments affected by pastoral and urban activities. Utilising matrix-assisted laser desorption ionisation-time of flight and whole genome sequence analysis, the study identified Campylobacter jejuni (n = 46, 46.0%), C. coli (n = 39, 39%), C. lari (n = 4, 4.0%), and two novel Campylobacter species lineages (n = 11, 11%). Core genome sequence analysis provided evidence of prolonged persistence or continuous faecal shedding of closely related strains. The C. jejuni isolates displayed distinct sequence types (STs) associated with human, ruminant, and environmental sources, whereas the C. coli STs included waterborne ST3302 and ST7774. Recombination events affecting loci implicated in human pathogenesis and environmental persistence were observed, particularly in the cdtABC operon (encoding the cytolethal distending toxin) of non-human C. jejuni STs. A low diversity of antimicrobial resistance genes (aadE-Cc in C. coli), with genotype/phenotype concordance for tetracycline resistance (tetO) in three ST177 isolates, was noted. The data suggest the existence of two types of naturalised waterborne Campylobacter: environmentally persistent strains originating from waterbirds and new environmental species not linked to human campylobacteriosis. Identifying and understanding naturalised Campylobacter species is crucial for accurate waterborne public health risk assessments and the effective allocation of resources for water quality management.Item Development of a cross-sectoral antimicrobial resistance capability assessment framework.(BMJ Publishing Group, 2024-02-05) Ferdinand AS; McEwan C; Lin C; Betham K; Kandan K; Tamolsaian G; Pugeva B; McKenzie J; Browning G; Gilkerson J; Coppo M; James R; Peel T; Levy S; Townell N; Jenney A; Stewardson A; Cameron D; Macintyre A; Buising K; Howden BP; Biswas SAntimicrobial resistance (AMR) is an urgent and growing global health concern, and a clear understanding of existing capacities to address AMR, particularly in low-income and middle-income countries (LMICs), is needed to inform national priorities, investment targets and development activities. Across LMICs, there are limited data regarding existing mechanisms to address AMR, including national AMR policies, current infection prevention and antimicrobial prescribing practices, antimicrobial use in animals, and microbiological testing capacity for AMR. Despite the development of numerous individual tools designed to inform policy formulation and implementation or surveillance interventions to address AMR, there is an unmet need for easy-to-use instruments that together provide a detailed overview of AMR policy, practice and capacity. This paper describes the development of a framework comprising five assessment tools which provide a detailed assessment of country capacity to address AMR within both the human and animal health sectors. The framework is flexible to meet the needs of implementers, as tools can be used separately to assess the capacity of individual institutions or as a whole to align priority-setting and capacity-building with AMR National Action Plans (NAPs) or national policies. Development of the tools was conducted by a multidisciplinary team across three phases: (1) review of existing tools; (2) adaptation of existing tools; and (3) piloting, refinement and finalisation. The framework may be best used by projects which aim to build capacity and foster cross-sectoral collaborations towards the surveillance of AMR, and by LMICs wishing to conduct their own assessments to better understand capacity and capabilities to inform future investments or the implementation of NAPs for AMR.Item Population structure and pathogen interaction of Escherichia coli in freshwater: Implications of land-use for water quality and public health in Aotearoa New Zealand.(John Wiley & Sons, Inc., 2024-08-02) Cookson AL; Devane M; Marshall JC; Moinet M; Gardner A; Collis RM; Rogers L; Biggs PJ; Pita AB; Cornelius AJ; Haysom I; Hayman DTS; Gilpin BJ; Leonard MFreshwater samples (n = 199) were obtained from 41 sites with contrasting land-uses (avian, low impact, dairy, urban, sheep and beef, and mixed sheep, beef and dairy) and the E. coli phylotype of 3980 isolates (20 per water sample enrichment) was determined. Eight phylotypes were identified with B1 (48.04%), B2 (14.87%) and A (14.79%) the most abundant. Escherichia marmotae (n = 22), and Escherichia ruysiae (n = 1), were rare (0.68%) suggesting that these environmental strains are unlikely to confound water quality assessments. Phylotypes A and B1 were overrepresented in dairy and urban sites (p < 0.0001), whilst B2 were overrepresented in low impact sites (p < 0.0001). Pathogens ((Salmonella, Campylobacter, Cryptosporidium or Giardia) and the presence of diarrhoeagenic E. coli-associated genes (stx and eae) were detected in 89.9% (179/199) samples, including 80.5% (33/41) of samples with putative non-recent faecal inputs. Quantitative PCR to detect microbial source tracking targets from human, ruminant and avian contamination were concordant with land-use type and E. coli phylotype abundance. This study demonstrated that a potential recreational health risk remains where pathogens occurred in water samples with low E. coli concentration, potential non-recent faecal sources, low impact sites and where human, ruminant and avian faecal sources were absent.Item Present and future distribution of bat hosts of sarbecoviruses: implications for conservation and public health(The Royal Society, 2022-05-25) Muylaert RL; Kingston T; Luo J; Vancine MH; Galli N; Carlson CJ; John RS; Rulli MC; Hayman DTSGlobal changes in response to human encroachment into natural habitats and carbon emissions are driving the biodiversity extinction crisis and increasing disease emergence risk. Host distributions are one critical component to identify areas at risk of viral spillover, and bats act as reservoirs of diverse viruses. We developed a reproducible ecological niche modelling pipeline for bat hosts of SARS-like viruses (subgenus Sarbecovirus), given that several closely related viruses have been discovered and sarbecovirus-host interactions have gained attention since SARS-CoV-2 emergence. We assessed sampling biases and modelled current distributions of bats based on climate and landscape relationships and project future scenarios for host hotspots. The most important predictors of species distributions were temperature seasonality and cave availability. We identified concentrated host hotspots in Myanmar and projected range contractions for most species by 2100. Our projections indicate hotspots will shift east in Southeast Asia in locations greater than 2°C hotter in a fossil-fuelled development future. Hotspot shifts have implications for conservation and public health, as loss of population connectivity can lead to local extinctions, and remaining hotspots may concentrate near human populations.Item Community health and human-animal contacts on the edges of Bwindi Impenetrable National Park, Uganda(PLOS, 2021-11-24) Muylaert RL; Davidson B; Ngabirano A; Kalema-Zikusoka G; MacGregor H; Lloyd-Smith JO; Fayaz A; Knox MA; Hayman DTS; Fèvre ECross-species transmission of pathogens is intimately linked to human and environmental health. With limited healthcare and challenging living conditions, people living in poverty may be particularly susceptible to endemic and emerging diseases. Similarly, wildlife is impacted by human influences, including pathogen sharing, especially for species in close contact with people and domesticated animals. Here we investigate human and animal contacts and human health in a community living around the Bwindi Impenetrable National Park (BINP), Uganda. We used contact and health survey data to identify opportunities for cross-species pathogen transmission, focusing mostly on people and the endangered mountain gorilla. We conducted a survey with background questions and self-reported diaries to investigate 100 participants' health, such as symptoms and behaviours, and contact patterns, including direct contacts and sightings over a week. Contacts were revealed through networks, including humans, domestic, peri-domestic, and wild animal groups for 1) contacts seen in the week of background questionnaire completion, and 2) contacts seen during the diary week. Participants frequently felt unwell during the study, reporting from one to 10 disease symptoms at different intensity levels, with severe symptoms comprising 6.4% of the diary records and tiredness and headaches the most common symptoms. After human-human contacts, direct contact with livestock and peri-domestic animals were the most common. The contact networks were moderately connected and revealed a preference in contacts within the same taxon and within their taxa groups. Sightings of wildlife were much more common than touching. However, despite contact with wildlife being the rarest of all contact types, one direct contact with a gorilla with a timeline including concerning participant health symptoms was reported. When considering all interaction types, gorillas mostly exhibited intra-species contact, but were found to interact with five other species, including people and domestic animals. Our findings reveal a local human population with recurrent symptoms of illness in a location with intense exposure to factors that can increase pathogen transmission, such as direct contact with domestic and wild animals and proximity among animal species. Despite significant biases and study limitations, the information generated here can guide future studies, such as models for disease spread and One Health interventions.Item Assessing the Dynamic Outcomes of Containment Strategies against COVID-19 under Different Public Health Governance Structures: A Comparison between Pakistan and Bangladesh(MDPI (Basel, Switzerland), 2022-08) Zhang W; Huggins T; Zheng W; Liu S; Du Z; Zhu H; Raza A; Tareq AHCOVID-19 scenarios were run using an epidemiological mathematical model (system dynamics model) and counterfactual analysis to simulate the impacts of different control and containment measures on cumulative infections and deaths in Bangladesh and Pakistan. The simulations were based on national-level data concerning vaccination level, hospital capacity, and other factors, from the World Health Organization, the World Bank, and the Our World in Data web portal. These data were added to cumulative infections and death data from government agencies covering the period from 18 March 2020 to 28 February 2022. Baseline curves for Pakistan and Bangladesh were obtained using piecewise fitting with a consideration of different events against the reported data and allowing for less than 5% random errors in cumulative infections and deaths. The results indicate that Bangladesh could have achieved more reductions in each key outcome measure by shifting its initial lockdown at least five days backward, while Pakistan would have needed to extend its lockdown to achieve comparable improvements. Bangladesh’s second lockdown appears to have been better timed than Pakistan’s. There were potential benefits from starting the third lockdown two weeks earlier for Bangladesh and from combining this with the fourth lockdown or canceling the fourth lockdown altogether. Adding a two-week lockdown at the beginning of the upward slope of the second wave could have led to a more than 40 percent reduction in cumulative infections and a 35 percent reduction in cumulative deaths for both countries. However, Bangladesh’s reductions were more sensitive to the duration of the lockdown. Pakistan’s response was more constrained by medical resources, while Bangladesh’s outcomes were more sensitive to both vaccination timing and capacities. More benefits were lost when combining multiple scenarios for Bangladesh compared to the same combinations in Pakistan. Clearly, cumulative infections and deaths could have been highly impacted by adjusting the control and containment measures in both national settings. However, COVID-19 outcomes were more sensitive to adjustment interventions for the Bangladesh context. Disaggregated analyses, using a wider range of factors, may reveal several sub-national dynamics. Nonetheless, the current research demonstrates the relevance of lockdown timing adjustments and discrete adjustments to several other control and containment measures.Item The WHO Foundation should not accept donations from the alcohol industry(BMJ Publishing Group Ltd, 2022-05-16) Leung JYY; Casswell SSummary box The WHO Foundation, established to fundraise for WHO, does not explicitly preclude funding from the alcohol industry, exposing WHO to potential influence by the industry’s conflicting interests. The WHO Foundation’s Gift Acceptance Policy also lacks transparency, preventing public scrutiny of donations. To protect the independence and integrity of WHO, the WHO Foundation should not accept any donations from the alcohol industry. WHO needs further resources to implement stronger safeguards against alcohol industry interference, as shown in its development of an action plan (2022–2030) to effectively implement the global strategy to reduce the harmful use of alcohol.