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Biomedical subjects

Neil Pearce

Publications and source records attributed to Neil Pearce.

At least 37 records · Page 2Linked to original sources
PubMed2004

Antibiotic sales and the prevalence of symptoms of asthma, rhinitis, and eczema: The International Study of Asthma and Allergies in Childhood (ISAAC).

BACKGROUND: It has been hypothesized that antibiotic use early in life may increase the subsequent risk of asthma. We have conducted an ecologic analysis of the relationship between antibiotics sales and the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema in 99 centres from 28 countries. METHODS: Data for antibiotics sales for 28 countries were obtained from the Institute for Medical Statistics (IMS), Health Global Services, UK and converted to defined daily doses (DDD). Data on the prevalence of symptoms of asthma, rhinitis, and eczema in 13-14 year olds were based on the responses to the written and video questionnaires from the International Study of Asthma and Allergies in Childhood (ISAAC). The analysis was adjusted for gross national product (GNP) as an estimate of the level of affluence. RESULTS: In general, there was a positive association between per capita antibiotics sales and the prevalence of symptoms for asthma, rhinitis, and eczema, but the associations generally became negative once the analyses had been adjusted for GNP. In particular, there were non-significant negative associations between total antibiotics sales and the prevalence of wheeze ever, wheeze in the last 12 months, nose problems with itchy-watery eyes, itchy rash in the last 12 months, and eczema ever. On the other hand there were weak non-significant positive associations for asthma ever, nose problems ever, nose problems in the last 12 months, and itchy rash ever. There was a statistically significant positive association with wheeze at rest as measured by the asthma video questionnaire; however, even this association was weak and would not account for more than a 1% difference in asthma prevalence between countries. CONCLUSIONS: These findings are generally not consistent with the hypothesis that antibiotic use increases the risk of asthma, rhinitis, or eczema. If there is a causal association of antibiotic use with asthma risk, it does not appear to explain the international differences in asthma prevalence.

Adolescent↗
PubMed2004

Regional variations in asthma hospitalisations among Maori and non-Maori.

AIM: To examine regional patterns of asthma hospitalisations in Maori and non-Maori. METHODS: We studied asthma hospitalisations in Maori and non-Maori during 1994-2000. Hospitalisation rates for Maori and non-Maori were calculated for ages 5-34 years in each of the 74 territorial authorities (TAs), of which 15 are urban and 59 predominantly rural. The data were also analysed separately for Maori and non-Maori in the age groups 0-4, 5-14, 15-34 and 35-74 years. RESULTS: For Maori, the highest hospitalisation rates were in Tauranga, Invercargill, Wanganui, South Wairarapa and Gisborne; the lowest rates were in Rodney, Tasman, Franklin, Waitaki and North Shore City. The rate of asthma hospitalisation was higher in Maori than non-Maori in each age-group: 0-4 years relative risk (RR) = 1.43; 5-14 years RR = 1.08; 15-34 years RR = 1.31; 35-74 years RR = 2.97. The differences were higher in rural areas (RR 1.65, 1.17, 1.34 and 3.13 respectively) than in urban areas (RR 1.25, 1.00, 1.22, 2.79 respectively). CONCLUSIONS: These analyses confirm previous evidence that asthma hospitalisation rates are higher in Maori than in non-Maori, despite the fact that asthma prevalence is similar in Maori and non-Maori children. They also indicate that this excess of hospitalisations is higher in rural than in urban areas, although the difference is not large.

Adolescent↗
PubMed2004

Asthma prevalence in European, Maori, and Pacific children in New Zealand: ISAAC study.

The International Study of Asthma and Allergies in Childhood (ISAAC) demonstrated that the highest prevalence of asthma in the world is in English-speaking countries, including New Zealand. In this paper, we compare asthma symptom prevalence in the three major ethnic groups (Maori, Pacific, and European) in the six participating centers in New Zealand. Hospital admission rates for asthma are higher among Maori and Pacific children compared to European children. The working hypothesis was that there were important differences in prevalence of asthma symptoms or diagnosis between ethnic groups which might explain these observed differences in asthma morbidity. In each center in 1992-1993, we sampled approximately 3000 children at each of the age brackets 6-7 years and 13-14 years. There were 37592 participants. Maori children had higher rates of diagnosed asthma and reported asthma symptoms than Pacific children in both age groups (diagnosed asthma in 6-7-year-olds: Maori, 31.7%; Pacific, 21.2%; 95% confidence interval on difference (CID), 7.2, 13.8; P < 0.001; 13-14-year-olds: Maori, 24.7%; Pacific, 19.2%; CID 2.5, 8.5; P < 0.001; recent wheeze in 6-7-year-olds: Maori, 27.6%; Pacific, 22.0%; CID, 2.6, 8.6; P < 0.001; 13-14-year-olds: Maori, 30.8%; Pacific, 21.1%; CID, 4.8, 14.5; P < 0.001;). European children had rates intermediate between those of Maori and Pacific children (6-7-year-olds) or similar to those of Maori children (13-14-year-olds), but had the lowest prevalence of night waking with wheeze in both age groups (e.g., 6-7-year-olds: European, 2.6%; Maori, 5.8%; Pacific, 5.7%; European-Maori CID: -4.2, -2.2, P < 0.001; European-Pacific CID: -4.7, -1.7, P < 0.001; Maori-Pacific CID: -1.7, 1.8, P = 1.0). The pattern of differences closely resembled that in a 1985 Auckland study, despite a 1.5-1.7-fold overall increase in prevalence. In conclusion, there are important differences in asthma prevalence among Maori, Pacific, and European children. These differences are small compared to worldwide variation, but their pattern is stable over time. The higher rate of severe asthma symptoms that Maori and Pacific children report may be one reason for the increased asthma morbidity in these groups. Further studies are needed to determine the reasons for these apparent differences in asthma severity.

Adolescent↗
PubMed2004

Can bacterial endotoxin exposure reverse atopy and atopic disease?

Studies have shown that endotoxin exposure in childhood is associated with a reduced risk of atopy and atopic asthma. It is commonly assumed that these effects only occur in early life. However, recent epidemiologic studies suggest that immune deviation might take place throughout life. Assuming that the immune system is not fixed after the first years of life, we hypothesize that endotoxin exposure might not only inhibit the development of atopic sensitization and disease at any time throughout life but might also reverse this process. This novel extension of the hygiene hypothesis is primarily based on the indirect evidence of several epidemiologic observations showing a reduction in atopy in adults highly exposed to endotoxin that is unlikely to be explained by protective effects alone. In addition, some animal studies demonstrated the potential of endotoxin to downregulate pre-existing airway eosinophilia and hyperreactivity. However, there is currently little direct evidence that endotoxin might reverse atopy and allergic diseases. Observational studies and randomized trials to test this hypothesis could ultimately lead to the development of novel treatments for atopic diseases, such as allergic asthma, hay fever, and eczema.

Bronchial Hyperreactivity↗
PubMed2004

Compression, expansion, or dynamic equilibrium? The evolution of health expectancy in New Zealand.

STUDY OBJECTIVE: To evaluate the New Zealand evidence for three theories of population health change: compression of morbidity, expansion of morbidity, and dynamic equilibrium. DESIGN: Using the Sullivan method, repeated cross sectional survey information on functional limitation prevalence was combined with population mortality data and census information on the utilisation of institutional care to produce health expectancy indices for 1981 and 1996. SETTING: The adult population of New Zealand in 1981 and 1996. PARTICIPANTS: 6891 respondents to the 1981 social indicators survey; 8262 respondents to the 1996 household disability survey. MAIN RESULTS: As a proportion of overall life expectancy at age 15 the expectation of non-institutionalised mobility limitations increased from 3.5% to 6% for men, and from 4.5% to 8% for women; the expectation of agility limitation increased from 3% to 7.5% for men and from 4.5% to 8.5% for women, and the expectation of self care limitations increased from 2.0% to 4.5% for men and from 3.0% to 6.0% for women. These changes were primarily attributable to increases in the expectation of moderate functional limitation. CONCLUSION: The dynamic equilibrium scenario provides the best fit to current New Zealand evidence on changes in population health. Although an aging population is likely to lead to an increase in demand for disability support services, the fiscal impact of this increase may be partially offset by a shift from major to moderate limitations, with a consequential reduction in the average levels of support required.

Adolescent↗
PubMed2004

Infections, medication use, and the prevalence of symptoms of asthma, rhinitis, and eczema in childhood.

BACKGROUND: The "hygiene hypothesis" postulates that infections during infancy may protect against asthma and atopy. There is also some evidence that antibiotic and/or paracetamol use may increase the risk of asthma. METHODS: The study measured the association between infections, and medication use early in life and the risk of asthma at age 6-7 years. It involved 1584 children who had been notified to public health services with serious infections at age 0-4 years, and 2539 children sampled from the general population. For both groups, postal questionnaires were completed by parents. RESULTS: There was little difference in the prevalence of current wheezing between the childhood infections group (prevalence = 23.5%) and the general population group (prevalence = 24.3%). There was also little difference whether the major site of infection was gastrointestinal (prevalence = 24.1%), invasive (prevalence = 24.6%) or respiratory (prevalence = 21.1%). However, in both groups, there were associations with antibiotic (OR = 1.78, 95% CI 1.49 to 2.14) or paracetamol (OR = 1.38, 95% CI 1.04 to 1.83) use in the first year of life or recent paracetamol use (OR = 2.10, 95% CI 1.78 to 2.49) and current wheezing. There was a weak protective effect of childhood infections in children who had not used antibiotics in the first year of life (OR = 0.78, 95% CI 0.55 to 1.10). CONCLUSIONS: These findings are consistent with other evidence that antibiotic use early in life may increase the risk of asthma. They are also consistent with some preliminary evidence associating paracetamol use with an increased risk of asthma. Any protective effect of notifiable childhood infections was weak.

Acetaminophen↗
PubMed2004

Effect measures in prevalence studies.

There is still considerable confusion and debate about the appropriate methods for analyzing prevalence studies, and a number of recent papers have argued that prevalence ratios are the preferred method and that prevalence odds ratios should not be used. These arguments assert that the prevalence ratio is obviously the better measure and the odds ratio is "unintelligible." They have often been accompanied by demonstrations that when a disease is common the prevalence ratio and the prevalence odds ratio may differ substantially. However, this does not tell us which measure is the more valid to use. In fact, the prevalence odds ratio a) estimates the incidence rate ratio with fewer assumptions than are required for the prevalence ratio; b) can be estimated using the same methods as for the odds ratio in case-control studies, namely, the Mantel-Haenszel method and logistic regression; and c) provides practical, analytical, and theoretical consistency between analyses of a prevalence study and prevalence case-control analyses based on the same study population. For these reasons, the prevalence odds ratio will continue to be one of the standard methods for analyzing prevalence studies and prevalence case-control studies.

Case-Control Studies↗
PubMed2004

Cancer among meat industry workers.

Several studies have found increased risks of cancer among workers in the meat industry, particularly lung and hematologic cancers. Relevant publications were obtained through a computerized literature search with the key words "cancer", "lung cancer", "hematologic neoplasms", "meat products", "abattoirs", and "slaughterhouses", and the evidence available from analyses of routine data, proportionate mortality and incidence studies, and cohort and case-control studies was reviewed. These analyses suggest a significant excess lung cancer risk among meat workers. This risk was associated the most strongly with exposure to animal slaughtering or freshly slaughtered meat or to biological material contained in blood and animal fecal matter, and it was greater than could be attributed to smoking. This finding suggests an etiologic role for biological exposure; however, the specific exposure(s) responsible are unknown, and further research is clearly required. The results of studies of hematologic cancers have been less consistent, but they suggest a small excess risk for leukemia in association with similar exposures.

Case-Control Studies↗
PubMed2004

Cancer in Pacific people in New Zealand: a descriptive study.

Non-Maori Pacific people constitute a significant and rapidly growing population in New Zealand. An accompanying change in lifestyle associated with changing socio-economic environments results in a change in disease patterns including cancer. The paucity of reliable data on cancer necessitates our effort to contribute to the control of cancer by reviewing the available information. Our study indicates a high incidence among non-Maori Pacific people of some cancers of public health importance as well as a disproportionately high mortality rate compared to non-Maori, non-Pacific people in New Zealand. In addition, we challenge previous documentation of a significant and high incidence of cervical cancer among Pacific women compared to non-Pacific people in New Zealand. We also identified the need to remedy the inadequacy in data quality as part of any strategy to prevent and control the rising incidence and mortality attributed to cancer among non-Maori Pacific people. In addition we have commenced regional training on cancer epidemiology and propose further cancer studies in both New Zealand and the Pacific Islands.

Epidemiologic Studies↗
PubMed2004

Health research in the Pacific.

The Pacific Island countries are geographically scattered, with contrasting environmental, social, and political systems, and in varying stages of economic development, but all are going through a rapid epidemiological transition. Processes that took place over thousands of years in Western countries have been very much compacted in time in the Pacific. These processes have produced major changes in environment and lifestyle, which have produced epidemics of non-communicable disease. While it is important to consider non-communicable diseases as a group, it is also important to conduct research into their specific causes. There has been a great deal of research into cardiovascular disease and diabetes in the Pacific, but it is only recently that the importance of cancer as a major source of mortality and morbidity in the Pacific has been recognised, even though it appears to carry a similar burden of morbidity and mortality. It is therefore important that research into the causes and control of cancer in the Pacific is conducted. However, it is also crucially important that this research both learns from the successes and avoids the mistakes of the past. In particular, it is crucial that cancer research in the Pacific is not another opportunity for "research colonialism," but instead provides opportunities for Pacific-training of Pacific health researchers and the conduct of Pacific-led research.

Biomedical Research↗
PubMed2003

Cellular telephone use and time trends for brain, head and neck tumours.

AIM: The objective of this study was to determine whether incidence rates of head and neck malignancies in New Zealand have varied since the introduction of cellular telephones in 1987. In particular, we sought to compare trends in tumour rates in anatomical sites that receive high, medium and low levels of cellular telephone radiation (based on dosimetry data). METHODS: We investigated whether trends in tumour incidence rates in New Zealand have varied since the introduction of cellular telephones in 1987. The exposure measure used was the proportion of cellular telephone subscribers within the national population, calculated using the number of subscribers over the study period. RESULTS: The graphs for high, medium and low exposure sites did not display any significant changes in trend patterns for either gender over the years 1986 to 1998. CONCLUSIONS: Incidence rates for malignancies arising in the head and neck, including those sites that hypothetically receive the highest levels of radio frequency radiation during cellular telephone use, have not changed materially since the introduction of cellular telephones to New Zealand. However, ecological studies of this nature are limited in many ways and a stronger study design is clearly needed to establish more exactly any elevation in risk.

Adult↗
PubMed2003

What proportion of rhinitis symptoms is attributable to atopy?

The aim of this study was to assess what proportion of patients with rhinitis symptoms (unrelated to infection) in population-based studies is attributable to atopy. We assessed the relevance of atopy in rhinitis in different countries and populations and between different age groups by performing a Medline search from 1980 onward on population-based studies. In the 22 identified population-based studies found, the overall proportion of rhinitis cases that were atopic was 61%, the proportion of noncases that were atopic was 20%, and the proportion of rhinitis cases that were attributable to atopy was 53%. There is variation between studies but little evidence of systematic geographic variation. For future research on the prevalence and possible increase of atopic rhinitis, it seems to be of major importance to differentiate between atopic and other forms of rhinitis.

Adolescent↗
PubMed2003

Respiratory symptoms and occupational exposures in New Zealand plywood mill workers.

OBJECTIVES: To study work exposure and respiratory symptoms in New Zealand plywood mill workers. METHODS: Personal inhalable dust (n = 57), bacterial endotoxin (n = 20), abietic acid (n = 20), terpene (n = 20) and formaldehyde (n = 22) measurements were taken and a respiratory health questionnaire was administered to 112 plywood mill workers. RESULTS: Twenty-six percent of the dust exposures exceeded 1 mg/m(3), however, none of the samples exceeded the legal limit of 5 mg/m(3) [geometric mean (GM) = 0.7 mg/m(3), geometric standard deviation (GSD) = 1.9]. Workers in the composer area (where broken sheets are joined together) were significantly (P < 0.01) more highly exposed. Endotoxin levels were low to moderate (GM = 23.0 EU/m(3), GSD = 2.8). Abietic acid levels ranged from 0.3 to 2.4 micro g/m(3) (GM = 0.7 micro g/m(3), GSD = 1.8) and were significantly (P < 0.05) higher for workers in the composer area of the process. Geometric mean levels of alpha-pinene, beta-pinene and Delta(3)-carene were 1.0 (GSD = 2.7), 1.5 (GSD = 2.8) and 0.1 (GSD = 1.4), respectively, and alpha-pinene and beta-pinene levels were significantly (P < 0.001) higher for workers in the 'green end' of the process, up to and including the veneer dryers. Formaldehyde levels ranged from 0.01 to 0.74 mg/m(3) [GM = 0.08 mg/m(3) (= 0.06 p.p.m.), GSD = 3.0]. Asthma symptoms were more common in plywood mill workers (20.5%, n = 112) than in the general population [12.8%, n = 415, adjusted OR (95% CI) = 1.5 (0.9-2.8)]. Asthma symptoms were associated with duration of employment and were reported to lessen or disappear during holidays. No clear association with any of the measured exposures was found, with the exception of formaldehyde, where workers with high exposure reported more asthma symptoms (36.4%) than low exposed workers [7.9%, adjusted OR (95% CI) = 4.3 (0.7-27.7)]. CONCLUSIONS: Plywood mill workers are exposed to inhalable dust, bacterial endotoxin, abietic acid, terpenes and formaldehyde, and they appear to have an increased risk of developing work-related respiratory symptoms. These symptoms may be due to formaldehyde exposure, although a potential causal role for other exposures cannot be excluded.

Abietanes↗
PubMed2003

Is social capital the key to inequalities in health?

There has been vigorous debate between the "social capital" and "neomaterialist" interpretations of the epidemiological evidence regarding socioeconomic determinants of health. We argue that levels of income inequality, social capital, and health in a community may all be consequences of more macrolevel social and economic processes that influence health across the life course. We discuss the many reasons for the prominence of social capital theory, and the potential drawbacks to making social capital a major focus of social policy. Intervening in communities to increase their levels of social capital may be ineffective, create resentment, and overload community resources, and to take such an approach may be to "blame the victim" at the community level while ignoring the health effects of macrolevel social and economic policies.

Community Health Planning↗