"These pilots are an integral part of Project SWIFT which is all about embracing new technology and tools that let patients better manage their health at home and in the community".

To read the full blogpost, go to:  http://countiesmanukau.health.nz/blog/swift-helping-patients-help-themselves/

To find out more, go to:  http://www.nzno.org.nz/groups/sections/respiratory_nurses/conferences

Massey University researchers in the College of Health have been awarded almost $4 million in the 2015 Health Research Council’s Funding round.

Pro Vice-Chancellor Paul McDonald says the funding will go towards four diverse research projects tackling some of the most pressing health challenges facing New Zealand and the world.

Investigating gut microbiomes in women:
Chair in Nutrition Professor Bernhard Breier has been awarded almost $1.2 million over three years to investigate the gut microbiome – the mass of bacteria residing in the human gut - in women of Pasifika and New Zealand European descent in the fight against obesity. 

Tantalising new evidence suggests that microbial complexity and functionality in the gut may play a crucial role in obesity. Professor Breier and a team from Massey University, and the Universities of Auckland and Otago, will test whether diet, taste perception, sleep and physical activity can modify the gut microbiome and its impact on obesity.

Enabling participation for children with disabilities:
Professor Karen Witten has been awarded almost $800,000 over three years for research into how built environments, amenities and social environments create barriers for children and young people with disabilities. 

In association with non-governmental organisations in the disability sector, Professor Witten will work with children and young people with motor and sensory impairments and their families to understand their experiences in the public realm using a range of methods across diverse Auckland neighbourhoods.

How airway micro-organisms affect children with asthma:
Childhood asthma is a complex condition which could lead to more severe asthma or other conditions in later life. Professor Jeroen Douwes has been awarded nearly $1.2 million over four years to investigate which airway micro-organisms are associated with lung function deficits and non-allergic inflammation in childhood asthma in 240 New Zealand children. It is the fifth consecutive project Professor Douwes has had funded by the Health Research Council.

Improving outcomes for injured New Zealanders:
Last year the Accident Compensation Corporation (ACC) spent $1.8 billion and received 1.8 million injury claims. Of those claims, 28 per cent have been identified as subsequent injury claims. Associate Professor Sarah Derrett has been awarded almost $600,000 over two years for a Subsequent Injury Study to identify if interventions can be developed for people who suffer a re-injury or identify as being “accident prone”.

“These projects are representative of the cutting edge, applied science we are conducting across the College of Health at Massey University,” said Pro Vice-Chancellor Paul McDonald.

“Our top scientists and students are using their talents and novel ideas to solve the 21st century’s biggest health challenges such as obesity, asthma and disability. Winning such a high proportion of the HRC project grants shows our growing strength and ability to look at issues in groundbreaking ways.”

Thirty-three researchers from across New Zealand received a combined total of more than $34.5 million in project funding in the Health Research Council’s 2015 funding round.

Eighteen studies (6 randomised trials, 2 quasi-experimental studies, 8 with historical controls and 3 with retrospective comparators) were included from primary, secondary, community and managed care settings serving a total estimated asthma population of 800,000 people in six countries.

In these studies, targeting professionals (n=2) improved process, but had no clinically significant effect on clinical outcomes. Targeting patients (n=6) improved some process measures, but had an inconsistent impact on clinical outcomes. Targeting the organisation (n=3) improved process measures, but had little/no effect on clinical outcomes.

Interventions that explicitly addressed patient, professional and organisational factors (n=7) showed the most consistent improvement in both process and clinical outcomes. Authors highlighted the importance of health system commitment, skills training for professionals, patient education programmes supported by regular reviews, and on-going evaluation of implementation effectiveness.

The authors conclude that effective interventions combined active engagement of patients, with training and motivation of professionals embedded within an organisation in which self-management is valued. They go on to say that healthcare managers should consider how they can promote a culture of actively supporting self-management as a normal, expected, monitored and remunerated aspect of the provision of care.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1186/s12916-015-0361-0

Pinnock, H., et al. (2015). Implementing supported self-management for asthma: A systematic review and suggested hierarchy of evidence of implementation studies. BMC Medicine, 13:127.

Twenty studies, including 81,746 patients, were analysed in this review, with the authors noting that, overall the studies were of moderate to low methodological quality.

They conclude from their analysis that "chronic disease management programmes for adults with asthma probably improve patients' quality of life, reduce the severity of the asthma, and improve breathing as demonstrated by improved performance in lung function tests after 12 months. It is unclear whether chronic disease management programmes improve the patients' abilities to manage their own asthma or decrease the number of hospitalisations or emergency visits.".

This article is available to read in free full text at: http://dx.doi.org/10.1002/14651858.CD007988.pub2

Peytremann-Bridevaux I, Arditi C, Gex G, Bridevaux PO, Burnand B. (2015). Chronic disease management programmes for adults with asthma. Cochrane Database of Systematic Reviews, 5, CD007988. 

They conclude that "the introduction of national smoke-free legislation in England was associated with "11 000 fewer hospital admissions per year for RTIs in children".

To read the full abstract, and for information on how to access the full text, go to: http://erj.ersjournals.com/content/early/2015/05/28/09031936.00014615.abstract or contact your DHB library, or organisational or local library for assistance.

Been, J.V., et al. (2015). Smoke-free legislation and childhood hospitalisations for respiratory tract infections. European Respiratory Journal, 28 May [Epub before print]

To find out more, go to:  http://www.tsanzsrs2016.com/

In the latest issue (attached below):

In the latest issue (attached below): 

Original Health Navigator NZ material is produced and updated by a team of medical writers and subject experts.

The Health Navigator NZ website is a non-profit community initiative combining the efforts of a wide range of partner and supporter organisations overseen by the Health Navigator Charitable Trust.

People who smoke cannabis as little as once a week are more likely to suffer respiratory symptoms such as morning cough, bringing up phlegm, and wheezing, according to University of Otago research.

However, the researchers’ study into the long-term respiratory effects of smoking cannabis found that after reducing or quitting cannabis smoking, these symptoms reduced to levels similar to those found in non-users.

In New Zealand, cannabis use is almost as widespread as tobacco with about half of young adults admitting to have used it in the previous year.

Associate Professor Bob Hancox, who led the study, says “Even people who only used cannabis once per week were likely to have a cough, bring up phlegm from the chest, and get wheezy. The good news is that if they stop smoking cannabis, these symptoms usually improve, although there was evidence that cough and wheeze may persist in those who have been long-term heavy users.”

The effect of quitting cannabis use was studied in the Dunedin Multidisciplinary Health and Development Study, which continues to follow the progress of 1037 people born in Dunedin between April 1972 and March 1973. Cannabis and tobacco smoking histories were obtained at ages 18, 21, 26, 32 and 38 years. At each assessment, participants were asked how many times they had used the drug in the previous year.

Many cannabis users already had symptoms of bronchitis (cough, sputum production, and wheeze) by the age of 21 years. These symptoms persisted or got worse at ages 26, 32, and 38 years if people continued to use cannabis weekly or more. The association between cannabis use and bronchitis symptoms remained even after tobacco smoking, asthma, and other factors were taken into account.

Dr Kyle Perrin, medical director at the Asthma Foundation says “Any form of smoking is going to affect your lungs. People who smoke marijuana, even if it is only once a week, need to realise that it will adversely affect their health.”

“The findings indicate that cannabis users are likely to develop bronchitis but that this often gets better on quitting” says Associate Professor Hancox. “However, some people who had been heavy cannabis users had a persistent cough and wheeze even after they cut down or quit. This suggests that long-term heavy cannabis smoking may have lasting effects on the airways.”

The findings appear in the European Respiratory Journal and the study was supported by the Asthma Foundation.

This ASM is the "... largest gathering of respiratory physicians, advanced trainees, respiratory nurses and respiratory and sleep physiologists in this country".

To find out more about this event, go to:  https://outshine.eventsair.com/QuickEventWebsitePortal/tsanz2015/web

The latest edition of the Tobacco Control Update has just been published by the Smokefree Coalition. The issue includes:

Treatment issues discussed will include the new paradigms relating to targeting inflammatory cells better within the airway with treatment and in treating the whole airway and reflecting on how best to use available medications funded by PHARMAC.

Another goal of the day will be understanding the patient journey using case studies of patients referred for specialist respiratory assessment  and then linking back to back to primary care with pulmonary rehab and respiratory nurse input and care plans. 

Audience: This seminar is aimed towards general practitioners and practice nurses, although all health professionals are likely to gain some new insights into the topic. 

To register for this seminar, go to:  http://www.pharmac.health.nz/seminars/copd-and-adult-asthma/

Thirteen studies were added in this update, giving a total of 47 randomised controlled trials, with 2985 participants included in the data analyses. The studies focused on six chronic illnesses (painful conditions, cancer, diabetes, asthma, traumatic brain injury and eczema) and evaluated four types of psychological therapies (cognitive behavioural therapy, family therapy, problem solving therapy, multisystemic therapy). 

The authors conclude from their analysis that "there is little evidence for the efficacy of psychological therapies that include parents on most outcome domains of functioning, for a large number of common chronic illnesses in children. However, psychological therapies are efficacious for some outcomes. CBT [cognitive behavioural therapy] that includes parents is beneficial for reducing children's primary symptoms, and PST [problem solving therapy] that includes parents improved parent adaptive behaviour and parent mental health. There is evidence that the beneficial effects can be maintained at follow-up for diabetes-related symptoms in children, and for the mental health of parents of children with cancer and parents who received PST".

The authors suggest that the small number of studies in this review means that future studies are likely to impact on the findings.

This article is available to read in free full text at:  http://dx.doi.org/10.1002/14651858.CD009660.pub3

Eccleston C, Fisher E, Law E, Bartlett J, Palermo TM. (2015). Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database of Systematic Reviews, 4, Art. No.: CD009660.

They undertook a systematic content assessment of all apps for iOS and Android examining the comprehensiveness of asthma information, consistency with the evidence base for asthma self-management and adherence to best practice principles for trustworthy content, comparing the quality of apps available in 2011 to those released since.

Between 2011 and 2013, numbers of asthma apps more than doubled from 93 to 191, despite withdrawal of 25% of existing apps. Newer apps were no more likely than those available in 2011 to include comprehensive information, such as the use of action plans, or offer guidance consistent with evidence; 13% (n = 19/147) of all apps, and 39% (n = 9/23) of those intended to manage acute asthma, recommended self-care procedures unsupported by evidence.

Despite increases in the numbers of apps targeting specific skills, such as acute asthma management (n = 12 to 23) and inhaler technique (from n = 2 to 12), the proportion consistent with guidelines (17%, n = 4/23) and inhaler instructions (25%, n = 3/12), respectively, was low, and most apps provided only either basic information about asthma (50%, n = 75/147) or simple diary functions (24%, n = 36/147).

The authors conclude that, in addition to persisting questions about clinical quality and safety, dynamic aspects of app turnover and feature evolution affect the suitability of asthma apps for use in routine care. The findings underline the need for coordinated quality assurance processes that can adapt to changing clinical and information governance-related risks, ensure compliance with the evidence base and reflect local variations in clinical practice. It is unclear if substantial clinical benefits can be realized from a landscape dominated by low quality generic information apps and tools that do not adhere to accepted medical practice.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/s12916-015-0303-x

Huckvale, K., et al. (2015). The evolution of mobile apps for asthma: an updated systematic assessment of content and tools. BMC Medicine, 13:58.

In the latest issue (attached below): 

Bishopdale Community Preschool in Christchurch is a not for profit community preschool run by volunteers and governed by parents. Sarah Straver, manager at the school says “We have a high number of children using preventers and emergency inhaler medication – in winter around 30% of the children and in summer it is about 25%. Because of this it is really important for us to consider the wellness of children within the context of our build.” In New Zealand generally 1 in 7 children (about 14%) take asthma medication.

To read the full media from the Asthma Foundation, go to: http://www.scoop.co.nz/stories/GE1502/S00031/childrens-health-a-major-factor-in-pre-school-build.htm

Several families in Taumarunui are receiving help from community organisations and the Waikato District Health Board (DHB) to try and reduce environment-induced asthma in children.

Patients’ access to quality health care in rural parts of Waikato DHB has long been a concern for the DHB, but the roll out of a new ‘model of care’ which is linking community and hospital services in Taumarunui looks to be the new benchmark.

Click to enlarge

Integral to the implementation of theTaumarunui Integrated Health Care Model is the development of a number of referral pathways for local services.

Currently paediatric asthma patients that present at Taumarunui’s Emergency Department are offered the opportunity for referral onto this pathway.

Project coordinator Penny Neal said the approach is about working collaboratively with local organisations to try and improve the overall health of the community.

“It is the start of transformation; we have gone from a culture of working in silos to now working collaboratively,” she said.

The asthma referral pathway identifies children that present at the hospital or GP with asthma and refers them on for assessment and treatment.

They are then asked if they would like to enrol with the Whanau Ora programme delivered by Taumarunui Community Kokiri Trust which involves a Whanau Ora assessment and holistic approach to improving social, physical and spiritual wellbeing. For the asthma pathway this includes being referred to a public health nurse for a home visiting programme

“It is important that we engage with families/whanau on an aspirational level not just physical health one – it is the only way we will help change that environment,” said Neal.

Currently the asthma programme is working with a number of families/whanau.

This year a number of other pathways using the same integrated model of care will be rolled out including pathways for the frail elderly, vulnerable children, and a generic referral pathway that facilitates smooth referral for patients who may need several organisations help.

The objective of this systematic review and meta-analysis was to determine which models of self-management support are associated with significant reductions in health services utilisation (including hospital use) without compromising outcomes, among patients with long-term conditions.

The authors included patients with long-term conditions in all health-care settings and self-management support interventions with varying levels of additional professional support and input from multidisciplinary teams. They found 184 studies that met the inclusion criteria and provided data for analysis.

The most common categories of long-term conditions included in the studies were cardiovascular (29%), respiratory (24%) and mental health (16%). Of the interventions, 5% were categorised as ‘pure self-management’ (without additional professional support), 20% as ‘supported self-management’ (< 2 hours’ support), 47% as ‘intensive self-management’ (> 2 hours’ support) and 28% as ‘case management’ (> 2 hours’ support including input from a multidisciplinary team). We analysed data across categories of long-term conditions and also analysed comparing self-management support (pure, supported, intense) with case management.

Only a minority of self-management support studies reported reductions in health-care utilisation in association with decrements in health. Self-management support was associated with small but significant improvements in QoL. Evidence for significant reductions in utilisation following self-management support interventions were strongest for interventions in respiratory and cardiovascular disorders. Caution should be exercised in the interpretation of the results, as the authors found evidence that studies at higher risk of bias were more likely to report benefits on some outcomes. Data on hospital use outcomes were also consistent with the possibility of small-study bias.

The authors conclude that very few self-management support interventions achieve reductions in utilisation while compromising patient outcomes. Evidence for significant reductions in utilisation were strongest for respiratory disorders and cardiac disorders. Research priorities relate to better reporting of the content of self-management support, exploration of the impact of multimorbidity and assessment of factors influencing the wider implementation of self-management support.

This report is available to read in free full text at:  http://www.journalslibrary.nihr.ac.uk/hsdr/volume-2/issue-54#hometab0

Panagioti M, Richardson G, Murray E, Rogers A, Kennedy A, Newman S, et al. (2014). Reducing Care Utilisation through Self-management Interventions (RECURSIVE): A systematic review and meta-analysis. Health Services and Delivery Research, 2(54).

A new smart asthma inhaler with an audio-visual function has dramatically improved child and adolescent use of preventative asthma medication.

The users also experienced significant improvements to their symptoms, well-being and quality of life and needed their reliever medication less frequently.

The University of Auckland study, funded by Cure Kids and the Health Research Council, showed a significant improvement in night time awakening, coughing and wheezing.

Clinical pharmacist, Amy Chan, a doctoral student with the University of Auckland, is the lead author on the paper.  

“We know one of the key reasons for children not taking their medication is parent and patient forgetfulness.  The Smartinhaler reminder system is now clinically proven to be a real solution to the problem,” she says.

“What we’ve been able to establish for the first time with this study is that the ringtone Smartinhaler significantly improves adherence to preventative medication, which results in improved quality of life for children with asthma. It’s hugely exciting,” says Ms Chan.

Children in the study were also given a Smartinhaler tracker for their rescue or ‘blue’ inhaler to measure the amount of rescue medication they used. The device was able to objectively count date and time of rescue medication use. This provided a good indication of asthma being out of control.

When symptoms worsened participants used their rescue reliever inhaler (blue inhaler), which is also known as a rescue medication because it provides immediate relief.  Recent studies have shown that overuse of the blue inhaler is a predictor of worsening asthma and general morbidity.

The study found that use of the rescue medication was significantly reduced in the group using the Nexus6 Smartinhaler reminder device.

Cure Kids Chair of Child Health Research and Ms Chan's supervisor on the study, Professor Ed Mitchell, says he is “absolutely staggered by the size of the effect. To see the improvement in the lives of these children is astounding.”

The participants also reported taking part in more sports and family activities. Parents reported feeling less frightened by their child’s asthma.

New Zealand has the second highest rates of asthma in the world and one in four Kiwi children experiences asthma symptoms. Despite this, regular adherence to asthma medication is poor.

New Zealand digital health company Nexus6 Ltd created the new Smartinhaler device called the SmartTrack, which was used in the study. The device has 14 different ringtones, which are cycled so users don’t get reminder fatigue. The SmartTrack reminder is only triggered when a dose is missed.

The results were published this month in The Lancet Respiratory Medical Journal.  To the researchers’ knowledge, this is the largest study in the world to investigate the effects of an inhaler device with audio-visual reminder function on asthma adherence and outcomes in children and adolescents.

It is also the first to show significant benefits in asthma outcomes and quality of life. The results are expected to gain international interest.

The controlled trial recruited 220 children between the ages of six and 15 who presented to emergency departments with asthma symptoms.

The study was randomised with half of the participants receiving a SmartTrack device for use with their preventative or ‘orange’ inhaler that had the audiovisual elements turned on, and the other half receiving the same device with the audiovisual elements turned off.

Participants were followed up every two months for six months and general asthma control was checked.

Key findings from the study were:

• Medication adherence rate for the patient group given the audiovisual enabled SmartTrack inhaler were 84 percent compared to 30 percent for the control group. This equals a 180% increase in medication adherence.
• The use of emergency medication or the ‘blue’ inhaler was significantly reduced. The median percentage days on which a reliever was used in the intervention group was 9.5 percent compared to 17.4 percent in the control group. This equals a 45percentreduction in rescue medication use.
• Symptoms, well-being and quality of life for the children was significantly improved.

Software developers, medical specialists, healthcare professionals and people with long term health issues such as diabetes, asthma and heart problems, will be gathering in Auckland for a weekend to create novel health technology solutions next month.

The inaugural ‘Health Hackathon: Solving self-care’ takes place over a weekend in mid-February and is attracting interest from around New Zealand and overseas.

A hackathon is a collaborative competition – a free event that brings together people with a range of relevant talents, to discuss, brainstorm, and create technical solutions in response to a problem.

The Health Hackathon from 13^th to 15^th February is hosted by Health Informatics NZ and the University of Auckland at the Tamaki Innovation Campus in Glen Innes.

It’s led by Dr Karen Day who is conducting research as part of the hackathon event, into ‘stimulating innovative health care solutions’. She is also the director for the postgraduate programme in health informatics and teaches associated courses.

“This health hackathon is an opportunity for people with a range of expertise to get together to work on technical solutions for people with health problems,” says Karen Day.  “They volunteer their time, talents and energy to collaborate on developing technology solutions – in this case to solve the problem of self-care for long-term health issues.”

“There are 90 places and registrations are coming in quickly,” she says. “The spirit of the hackathon is about openness to collaborate creativity, similar to the spirit that is well known about open source software.”

“Hackathons are a collaborative phenomenon around the world and attract a lot of interest globally,” says Karen.  “We have had people from Australia, America and the United Kingdom enquire about the event.”

“For many, the attraction is the creative buzz and unique experience of taking part in developing a solution with all the content, expertise and support available there to push on and create an outcome,” says Karen.  “They say it’s an incredible experience, being together and working on a solution to a problem in an intensely creative and supportive atmosphere. "

"Teams are often so energised by it, they will work through the night during the hackathon if you don’t stop them."

“People attending the hackathon with a long-term health issue can identify a team that they want to work with, or present an idea they want to work on,” she says.  “At the start of the hackathon, people pitch their ideas, and teams are formed with a balance of roles, (such as health professionals, software developers, and healthcare consumers) to work on a specific problem.”  

Karen expects they will have teams of four to eight people, each working on a particular long-term health self-care issue.  The solution might be a software device app, new website, SMS product or other service.

“Each person brings their particular knowledge and skills to help people and working together, push themselves with problem solving to create a solution,” says Karen. “A lot of those taking part are very experienced and highly qualified people.”

The health hackathon also attracts experienced and skilled mentors who can move from group to group, asking relevant questions and challenging each team’s thinking, and ideally, entrepreneurs and angel investors with start-up capital who can see potential in a group’s solution and might be able to help them take it to the market.

At the end of the weekend, each team presents its idea to a panel of four judges who decide on the best idea from the health hackathon, depending on its clinical accuracy and appropriateness, consumer usefulness, software excellence, and commercial potential. 

These presentations are filmed and put on the Health Informatics NZ website for the People’s Vote that allows the public to pick an idea.  The winner of the prestigious People’s Vote is the solution with the most votes by 14^th March.

The research aspect of the Health Hackathon is to understand how the teams progress their self-care solutions and how these solutions can be helpful.

 For more information on this Health Hackathon at Tamaki Innovation Campus, University of Auckland, February 13 to 15 go to the website, 'Health Hackathon: Solving Self-care' , Karen’s blog on the hackathon at Day by Day and Twitter hastag #hacknz2015

The purpose of the Atlas is to stimulate questions and debate about why there is variation. The debate may then lead to improvements in our health care services.

The Atlas displays information in easy-to-use maps, graphs and tables and is organised into ‘domains’, which cover specific clinical areas: asthma, demography, diabetes, cardiovascular disease, maternity, mental health, opoids, polypharmacy in older people, surgical procedures, trauma, Well Child/Tamariki Ora.

The Atlas is available at: http://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/atlas-of-healthcare-variation/

For more information on the Atlas, go to: http://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/news-and-events/news/494/

The internationally acclaimed housing and health research team at the University of Otago, Wellington, has won the 2014 Prime Minister’s Science Prize, valued at $500,000.

The 28-member He Kainga Oranga/Housing and Health Research Programme’s research over more than 15 years has involved thousands of New Zealanders and informed policy developments for successive New Zealand governments.

The Programme is led by Professor Philippa Howden-Chapman from the University of Otago, Wellington, who is the first woman research leader and first social scientist to receive the prestigious award.

Professor Howden-Chapman’s five co-directors are Professors Michael Baker and Julian Crane from the University of Otago, Professors Chris Cunningham and Robyn Phipps from Massey University and Dr Malcolm Cunningham formerly from BRANZ. The team is made up of researchers in the areas of social science, epidemiology, biostatistics, engineering, physics, architecture, building science, and economics.

University of Otago Vice-Chancellor Professor Harlene Hayne warmly congratulated the team on winning the Prime Minister’s Science Prize, noting that Otago researchers have now taken the prize twice since it was inaugurated in 2009.

“This prestigious prize recognises transformational science that has had a significant impact on New Zealand or internationally. Philippa Howden-Chapman and her team have most certainly achieved this impact by demonstrating the major health, social and economic benefits that accrue from improving the condition of people’s homes.”

The team has worked nationwide to address long-standing quality deficiencies in housing, particularly as they affect vulnerable groups such as children, older people, and those with chronic health conditions including asthma.

Through large-scale community trials, involving around 10,000 New Zealanders, the team has tested, quantified and demonstrated the effectiveness of initiatives such as retrofitting insulation to modern standards, installing effective and non-polluting heating, and remediating injury hazards in homes.

One example is the team’s collaborative work in evaluating the Warm-Up New Zealand: Heat Smart Programme, which was based on the robust evidence from two of its earlier randomised community studies. This research showed that insulation and/or heating retrofits led to significant reductions in hospitalisations, the amount of medication required, energy consumption, and premature mortality of people aged 65 and over. A conservative estimate of the programme’s net benefit has been shown to be around $950 million.

Another example is the team’s work over a decade, monitoring reductions in hospitalisation rates when low-income families move from being private sector tenants to renting a state house.

Professor Howden-Chapman says she was motivated to establish the team by concern about growing inequality in New Zealand and the desire to do something practical to improve the health and wellbeing of New Zealanders.

“There’s been a long-standing assumption that all New Zealanders would own their own house but a lot of people now live in rental housing. I wanted to provide evidence to support the premise that everyone should have the right to warm, dry, safe housing regardless of whether they own or rent.”

In 2009, Professor Howden-Chapman was invited to chair the World Health Organization’s (WHO) Housing and Health Guidelines Development Group. She also works closely with the International Energy Agency (IEA) on the co-benefits of improving energy efficiency in housing.

Dr Carlos Dora, Coordinator of the WHO’s Department of Public Health and Environment says Professor Howden-Chapman and her team are global leaders in the area of effective healthy housing intervention and a source of evidence and inspiration for healthy built environments.

“We cherish their work and look forward to New Zealand’s continuing cutting edge scientific insights that allow us to build a healthier and more equitable future,” he says.

Nina Campbell, leader of the IEA’s multiple benefits study, says the team’s work has positioned New Zealand as a front runner in policy innovation. “Philippa’s work stood out as one of the most analytically robust and politically compelling pieces among the huge range of studies we reviewed. These findings have attracted keen interest from policy makers in IEA countries.”

Professor Howden-Chapman attributes the team’s success to the robust design of its research and a commitment to working in partnership with communities.

“I feel very proud of what our team’s been able to do. We’ve gone on a long journey together—many of the team have been involved from the beginning and that’s because they find it very rewarding to be doing research that directly improves people’s lives.

“Our team feels very honoured to have won the Prime Minister’s Science Prize. It’s a fulsome acknowledgement of the work we’ve done over a decade and a half and recognition to all those people who’ve been involved in citizen science, helping us collect data winter after winter, to understand and deal with a really serious problem for New Zealand.”

The team will use $400,000 of the prize money to carry out a community trial on the impact of improving housing on new born infants.

The 2014 Prime Minister’s Science Prizes were presented to winners on Tuesday 2 December at the Museum of New Zealand, Te Papa Tongarewa in Wellington.

The work of Otago’s Dr Karl Iremonger, which includes discovering a new brain cell structure and communication system, was also recognised through being awarded the MacDiarmid Emerging Scientist Prize at the same ceremony.

Watch Professor Howden-Chapman discussing the team’s work on YouTube.

Dr Jean Simpson, the Director of the University of Otago based NZ Child & Youth Epidemiology Service, which prepared the Technical Report for the Child Poverty Monitor, says while the reduction from 27% to 24% of children in households in income poverty is in the right direction, New Zealand still has one in four of its children aged 0—17 years living in income poverty.

"There is plenty of research that shows that living in poverty can be bad for children’s health. We know that poor health can affect a child’s ability educationally and socially, and there are also long term health consequences that will have implications for the Health budget." Dr Simpson says it is also good to see figures such as infant mortality continuing to fall, but that only gives part of the picture.

To read the full media release from the University of Otago, go to:  http://www.scoop.co.nz/stories/GE1412/S00012/health-issues-highlighted-in-child-poverty-monitor.htm

The latest edition of the Tobacco Control Update has just been published by the Smokefree Coalition.

Chronic Obstructive Pulmonary Disease (COPD) causes breathlessness, coughing and wheezing. It kills millions of people worldwide.

The Community Respiratory Service is a team of health professionals at the Canterbury Clinical Network working towards better, sooner, more convenient management for people with respiratory problems.

To read the full media release from the Canterbury Clinical Network, go to: http://www.scoop.co.nz/stories/GE1411/S00054/christchurch-takes-part-in-world-copd-day-november-19-2014.htm

A new global campaign to combat asthma is being led from Auckland.

Professor Innes Asher, head of Paediatrics at the University of Auckland is the Chair of the Global Asthma Network.

This week, Professor Asher and her colleagues around the world, will launch the Global Asthma Report 2014, a cutting edge overview of issues about asthma globally.

“Political commitment and action are required to make the burden of asthma a thing of the past,” says Professor Asher. “The Global Asthma Report 2014 makes many recommendations to the World Health Organisation (WHO), governments, health authorities and health professionals, which, if followed, will massively reduce the serious burden of asthma globally.”

Asthma is a huge problem in the world, causing wheezing and difficulty breathing. It is a common chronic disease and cause of disability affecting 334 million people of all ages in all parts of the world.

“Millions of people suffer from asthma because they do not get access to the medicines that lessen their breathing difficulties,” she says. “Economies suffer because asthma keeps people away from work, or if they are at work, asthma stops them working effectively.”

The economic burden of asthma in Europe was estimated at 19 billion Euros for 2011 alone.

“Avoidable asthma deaths are still occurring due to inappropriate management of asthma, including over-reliance on reliever medication rather than preventer medication,” says Professor Asher. “Asthma is a particularly serious burden in low- and middle-income countries least able to afford the costs.”

Good long-term management can reduce the burden of asthma, she says.  This includes using relatively simple measures within a systematic national or local strategy which can improve early detection of asthma and provide effective preventive treatment.

“Quality-assured essential asthma medicines are not available to many people with asthma, yet guaranteed access to these medicines is vital to improving asthma outcomes,” says Professor Asher.

Asthma which is well controlled imposes far less of an economic and personal burden than non-controlled asthma.

“While our knowledge has increased, the remaining gaps in the data about asthma are significant. New surveys are needed to update asthma trends, assess the burden of asthma, access to effective management and understand the causes,” she says.  “The Global Asthma Network is working towards closing the data gaps.”

• Latest asthma research
• Maps and data on the global prevalence
• Economic burden of asthma
• Success stories
• Key recommendations

To read the report in full text, go to: http://www.globalasthmareport.org/

The journal is open access and relevant to anyone with an interest in the primary care management of respiratory and respiratory-related allergic diseases.

It is the official journal of the Primary Care Respiratory Society UK and the International Primary Care Respiratory Group).

The full archive of Primary Care Respiratory Journal is still available at www.thepcrj.org 

Topics covered include:

• surveillance
• epidemiology
• prevention by vaccines
• prevention and treatment by antivirals
• clinical studies
• public health & pandemic preparedness
• basic scientific research
• transmission between animals and humans

Influenza and Other Respiratory Viruses is the official journal of the International Society of Influenza and Other Respiratory Virus Diseases - an independent scientific professional society - dedicated to promoting the prevention, detection, treatment, and control of influenza and other respiratory virus diseases.

The Space to Breathe Programme was developed to promote appropriate use of asthma medicines and provide self-management education in order to improve health outcomes for children with asthma.  

For health professionals, tools and resources have been developed to help support and educate caregivers of children with asthma.  For caregivers, there are a range of resources to help understand and better manage asthma.  All resources  and tools can be found on the Space to Breathe website.

PHARMAC decisions to fund four new medicines will improve treatment options for over 10,000 people with a wide range of respiratory conditions.

From 1 November 2014 funding will be available for two medicines, glycopyrronium and indacaterol for chronic obstructive pulmonary disease (COPD), omalizumab for severe allergic asthma, and an inhalation form of the antibiotic tobramycin for cystic fibrosis.

Director of Operations Sarah Fitt says there are currently limited medicine options for these conditions.  Having further choice is likely to be welcomed by patients and clinicians, and lead to better outcomes.

“For example, patients with the more severe forms of allergic asthma are often admitted to hospital for treatment. Omalizumab is a new generation treatment for this form of asthma. It’s an injection that’s shown to be particularly effective in allergic asthma, and would likely help patients with the most severe forms better control their symptoms and avoid regular hospital treatment. About 180 patients over five years are likely to use omalizumab.”

At present only one medicine – tiotropium – is funded specifically for COPD.

“Having two further funded treatments specifically registered for the treatment of COPD symptoms provides greater choice and the ability to tailor treatment to the patient,” says Sarah Fitt.

PHARMAC estimates about 10,000 patients could benefit from these new COPD medicines over five years.

The inhalation form of tobramycin contains no preservatives and is specifically formulated for inhalation, which makes it more suitable for patients, she says.

The medicines have been funded as part of a major multi-product agreement with pharmaceutical company Novartis.

The latest edition of the Tobacco Control Update has just been published by the Smokefree Coalition.

Nearly 12,000 New Zealanders are set to benefit from major agreements that have been approved by PHARMAC.

Agreements with two companies, Novartis and Biogen Idec, have been approved which will see 10 new medicines funded, and either reduced prices or widened access to eight others.

Director of Operations Sarah Fitt says the agreement with Novartis involves the highest number of new medicines funded from one agreement in PHARMAC’s 21-year history. Nine new medicines, including new treatments for dementia, the respiratory condition chronic obstructive pulmonary disease (COPD), asthma, multiple sclerosis, chronic myeloid leukaemia and a type of brain tumour, are included in the Novartis agreement.

“This is a major step forward in medicines availability,” says Sarah Fitt. “It’s a great example of PHARMAC and suppliers finding creative and innovative ways to make new medicines available to patients, and negotiating to make other medicines more cost effective.”

“While pricing and contract details will remain confidential, these new agreements are worth millions of dollars of new spending. They will lead to better health outcomes for a wide range of people – from the very young to the very old.”

The genesis of the agreement was PHARMAC’s internal planning which identified opportunities to fund several medicines on PHARMAC’s prioritisation list, and release savings on some already funded medicines. PHARMAC put a proposal to Novartis, which the company was able to consider.

“At the same time we were looking to provide better access to new medicines for multiple sclerosis, and we were able to talk with Biogen about its multiple sclerosis product natalizumab. It’s great to be able to list these two multiple sclerosis medicines from two different companies at the same time, while also making them available to people earlier in disease.”

While contract details are confidential, Sarah Fitt says the new multiple sclerosis medicines will account for most of the projected new spending from the deals. In terms of patient numbers, the biggest products are glycopyrronium and indacaterol, which both treat COPD. PHARMAC estimates about 10,000 people will benefit from these treatments over five years.

More than 1000 people are also estimated to use the newly-funded Alzheimer’s disease treatment rivastigmine, which is a patch that sticks to the skin.

The changes, including listing of the new medicines, take effect from 1 November 2014.

Medicines funded in the decision
New medicines
Multiple Sclerosis: Natalizumab and fingolimod - two new-generation medicines for a particular and most common type of multiple sclerosis, called relapsing-remitting multiple sclerosis. These will be funded from first diagnosis and with fewer relapses required – a major change to the availability of funded treatments for multiple sclerosis. Based on the evidence to date, these drugs appear to be more effective than current treatments for multiple sclerosis. Existing treatments will still be funded and also available earlier, but only for people in whom the new treatments are clinically inappropriate.

Chronic obstructive pulmonary disorder: Glycopyrronium and indacaterol - two new medicines for the respiratory condition chronic obstructive pulmonary disorder (COPD). At the moment there are limited medication options for patients with COPD – this will give greater choice for doctors and, with better outcomes, could lead to fewer people needing hospital treatment.

Alzheimer’s: Rivastigmine patches - a new funded treatment option for Alzheimer’s disease. This is the second funded treatment for Alzheimer’s disease, giving more choice for clinicians and patients where the existing funded treatment is not tolerated.
Brain tumour: Everolimus - a newly funded drug to treat a type of brain tumour (subependymal giant cell astrocytoma) that mainly affects children. At the moment the only treatment option is surgery. This would be a less invasive treatment option.

Severe allergic asthma: Omalizumab - a newly funded medicine for severe allergic asthma. There’s a small group of people whose allergic asthma is so severe the currently available medicines aren’t effective and patientscan require admission to hospital. Omalizumab could help reduce the number of asthma flare-ups these patients have, which may help avoid hospital admission and help patientse manage their asthma at home.

Cystic fibrosis: Tobramycin - A new formulation of this antibiotic, specifically developed for inhalation and used to treat the respiratory condition cystic fibrosis.

Chronic myeloid leukaemia: Nilotinib - a newly funded treatment option for chronic myeloid leukaemia. A third treatment option, adding to the range of CML drugs that has turned this form of leukaemia into a manageable chronic condition for most patients.

Iron overload: Deferasirox – a newly funded treatment for people who have too much iron in their bloodstream secondary to disorders like thalassaemia. The currently funded treatments aren’t suitable for everyone, so having further options is a benefit.

Details on the medicines in the agreements are outlined on the PHARMAC website.

The journal is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

Infants whose mothers take vitamin D supplements during pregnancy and infancy are less likely to get respiratory infections, according to research from the University of Auckland.

Researchers conducted a trial of vitamin D supplementation during pregnancy and infancy with pregnant women attending a maternity care clinic in South Auckland.

The study showed that, in comparison to a placebo group, vitamin D supplementation during pregnancy and infancy resulted in a smaller proportion of infants making primary care visits for respiratory infections.

The findings were recently published on line in the journal, Acta Paediatrica.

The main aim of this clinical trial, (funded by the Health Research Council of New Zealand, the University of Auckland and Cure Kids), was to determine the vitamin D dose during pregnancy and infancy necessary to prevent vitamin D insufficiency during infancy.

The research team led by paediatric specialist, Associate Professor Cameron Grant from the University of Auckland and Starship Children’s Hospital, completed this latest study as a secondary analysis.

Consent from participating mothers was gained for review of the primary care records of the enrolled children.  The reason for each primary care visit up to age 18 months was also determined in the study.

“This careful and thorough review of the primary care records enabled us to determine that daily vitamin D supplementation given to the mothers during the latter half of pregnancy, and then their infants to age 6 months, resulted in a smaller proportion of infants making any primary care visits for respiratory infections up to age 18 months,” says Dr Grant.  “Interestingly the effect appeared to persist after the vitamin D supplementation was discontinued.”

“By starting vitamin D during pregnancy and giving it as a daily dose, rather than a larger dose less frequently, we were able to safely and effectively improve the vitamin D status of the infants from birth,” he says.

Dr Grant says the research team are now concentrating on determining how vitamin D supplementation may have caused this beneficial effect. 

“That the effect of vitamin D persisted after the supplementation was discontinued suggests that vitamin D may have caused some adaptation of the children’s immune system that resulted in them either being less susceptible to infection with a respiratory virus or less prone to becoming unwell once infected,” he says. 

“Respiratory infections are a leading cause of primary care visits and hospital admissions both in New Zealand and internationally during early childhood, so these findings are of high public health relevance.”

“The findings highlight the importance of conducting such trials in populations that have the greatest potential to benefit, namely those in whom vitamin D insufficiency is more common and for whom respiratory infections in early childhood are a particular issue,” he says.

Trial results published today show the vaccine works in mice, preventing inflammation of the lungs and airways.

The vaccine is a novel way of dealing with allergies which, if successful in humans, could be expanded to other allergies and diseases.

The research, published in Nature Chemical Biology, was a collaboration between the Malaghan Institute and Victoria University's Ferrier Research Institute".

To read the full story in the Dominion Post, go to: http://www.stuff.co.nz/dominion-post/10582301/City-scientists-patent-asthma-breakthrough

An article on the vaccine discovery is also available on the Health Research Council website: http://www.hrc.govt.nz/news-and-publications/news-media#malaghan-in-asthma-vaccine-discovery

The latest edition of the Tobacco Control Update has just been published by the Smokefree Coalition.

The issue includes:

The journal is dedicated to publishing high quality, peer-reviewed, medical research in all disciplines and therapeutic areas of respiratory and critical care medicine.

The journal focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.

The latest edition of the Tobacco Control Update has just been published by the Smokefree Coalition. The issue includes:

The authors included 101 full-text articles in the analysis. The most frequent study design was pre-post, followed by prospective, population based case series or consecutive case series, and randomized trials. Paper-based reminders were the most frequent with fully computerized, then computer generated, and other modalities. No study reported a decrease in health care practitioner performance or declining patient outcomes. The most common primary outcome measure was compliance with provided or prescribing guidelines, key clinical indicators such as patient outcomes or quality of life, and length of stay.

The authors conclude that the number of publications on asthma protocol reminder systems is increasing. The number of computerized and computer-generated studies is also increasing. Asthma guidelines generally improved patient care and practitioner performance regardless of the implementation method.

This is an open access article and is available to download and read in full text at: http://dx.doi.org/10.1186/1472-6947-14-82

Dexheimer, J.W., et al. (2014). A systematic review of the implementation and impact of asthma protocols. BMC Medical Informatics and Decision Making, 14:82.

From 1 October 2014 UK schools will be allowed to keep a salbutamol inhaler for use in emergencies when a child with asthma cannot access their own inhaler.

A guidance document, publushed by the Department of Health will give schools that choose to keep an emergency inhaler the basis to create a policy or protocol for using it.

To read the guidance document, go to: https://www.gov.uk/government/publications/emergency-asthma-inhalers-for-use-in-schools

Asthma New Zealand works towards helping people with asthma, and their families, by providing the information they need to understand, manage and live with asthma. While there is no real cure for asthma, it can be kept under control. Asthma New Zealand has teamed up with John McRae, CEO of events, promotions and development company VADR, to develop an innovative way for those with asthma to manage their symptoms.

Together they’ve developed the Breathe Easy asthma management app, the first iPhone App that allows users to monitor asthma symptoms and easily report back to their GP. Breathe Easy is the first mobile health app available in NZ, and monitors peak flow levels, creates action plans to share with their GP, offers reminders to take medication and provides links to important information and support from Asthma New Zealand. It is essentially a digitalised system that improves on, and will eventually replace, current paper-based asthma management plans, which help those with asthma to prevent or reduce the severity of their symptoms.

To read th full media release from Asthma New Zealand on the Scoop website, go to:  http://www.scoop.co.nz/stories/GE1409/S00004/app-allows-those-with-asthma-to-breathe-easy.htm

To read the document, go to: http://asthmafoundation.org.nz/wp-content/uploads/2012/04/2014-Asthma-Information.pdf

In the latest issue (attached below):

Data published in the Health Quality & Safety Commission’s asthma domain on the Atlas of Healthcare Variation shows about 5000 children a year went to hospital with asthma or wheeze, with a three-fold difference between DHBs.

To read the full news article on the HQSC website, go to:  http://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/news-and-events/news/1653/

In the latest issue (attached below): 

The 201113 New Zealand Health Survey, funded by the Ministry of Health, has found residents in the Waitemata district to have among the lowest rates of smoking, obesity, heart disease, stroke, diagnosed diabetes, and medicated asthma rates in the country.

Overall, more than 92% of people living within the Waitemata District Health Board area reported excellent, very good or good selfrated health, up from 88.8% in the 200607 survey.

To read the full media release from the Waitemata DHB, go to: http://www.scoop.co.nz/stories/GE1403/S00079/waitemata-residents-among-the-healthiest-in-new-zealand.htm

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/j.jaip.2013.06.015 or contact your DHB library, or organisational or local library for assistance.

Chan, A.H.Y., et al. (2013). Adherence monitoring and e-health: How clinicians and researchers can use technology to promote inhaler adherence for asthma. The Journal of Allergy and Clinical Immunology: In Practice, 1(5), 446-454.

Studies in this issue (attached below):

Genetic risk assessments could be used to predict which children with asthma are likely to grow out of the condition, and which will continue having symptoms as they grow older, new research emerging from the University of Otago’s world-renowned Dunedin Multidisciplinary Study suggests.

A team of Otago and Duke University researchers set out to test how genetic discoveries about asthma predisposition relate to the developmental and biological characteristics of the condition. Their findings are newly published Online First in the UK journal The Lancet Respiratory Medicine.

After analysing data from the long-running Dunedin Multidisciplinary Health and Development Study of around 1,000 children born in 1972-73, the team discovered that those with childhood asthma and higher genetic risk scores for being predisposed to it were more than one-third (36%) more likely to develop asthma that persists throughout their lives than those found to have a lower genetic risk.

Approximately half of all children with asthma will grow out of it by the time they reach adolescence or adulthood. Currently, there are no tests that can predict which children will never grow out of asthma and which will recover as they get older.

Recent genome-wide association studies (GWAS) have identified several genetic variants (single nucleotide polymorphisms, or SNPs) which carry a small increased risk of asthma. The current study was designed to investigate whether these known genetic risks are related to the onset, persistence, and severity of asthma, and with disruptions to daily life (e.g. absence from school and work, and hospital admissions).

The researchers constructed a genetic risk score based on 15 GWAS-identified variants and then tested associations between the scores and physical manifestations* of asthma in 880 Study members.

They established that boys and girls with higher risk scores had a greater likelihood of developing asthma over the 38 years of follow-up than those with a lower genetic risk, and developed asthma earlier in life.

Participants with asthma and a higher genetic risk were also more likely to develop atopic (allergic) asthma and impaired lung function (airway hyper-responsiveness and incompletely reversible airflow obstruction), and to miss school or work and to be hospitalised because of asthma, than those with a lower genetic risk.

Importantly, the predictive value of the genetic risk score was independent of, and provided additional information to, family history.

“Although our study revealed that genetic risks can help to predict which childhood-onset asthma cases remit and which become life-course-persistent, genetic risk prediction for asthma is still in its infancy,” explains lead author Daniel Belsky from Duke University Medical Center in the USA. “As additional risk genes are discovered, the value of genetic assessments is likely to improve. But our predictions are not sufficiently sensitive or specific to support their immediate use in routine clinical practice.”

*These manifestations included atopy, which is associated with a persistent and severe asthma; airway hyper-responsiveness, which provides indirect confirmation of active airway inflammation; and incompletely reversible airflow obstruction, which identifies harmful changes to the airways resulting from chronic asthma.

Belsky, D. W., Sears, M. R., Hancox, R. J., Harrington, H. L., Houts, R., Moffitt, T. E., Sugden, K., Williams, B. S., Poulton, R., and Caspi, A. (2013). Polygenic risk and asthma's development and course in the first 4-decades of life. Lancet Respiratory Medicine, 1(6), 453-461.

Now available to read in free full text at:  http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(13)70101-2/fulltext

This article is available to read in full text at:  http://www.jmir.org/2014/2/e51/

Morrison, D., et al. (2014). Digital asthma self-management interventions: A systematic review. Journal of Medical Internet Research, 16(2).