Purpose Automated insulin delivery (AID) systems are the gold standard for managing type 1 diabetes (T1D), yet access remains inequitable due to funding disparities, workforce limitations, bias, and geographic barriers. The ACCESS-AID study aims to implement a new model of care by using a remote 'Hub' to deliver prioritised training and support to those most in need and to improve workforce capacity by working in partnership with New Zealand's National Public Health service. Methods Eligible participants include all individuals with T1D and eligible people with pancreatogenic/Type 3c diabetes). Enrolment will use a prioritisation score. After informed consent and baseline assessments, participants receive one-day AID training (in-person or remote) by certified, industry provided trainers, followed by 12-weeks of structured support from Hub staff. The primary outcome is implementation effectiveness. Secondary outcomes: clinical and psychosocial impacts, safety, nutrition education effectiveness, and qualitative insights. CGM metrics and HbA1c will be assessed at baseline and 12-weeks, and CGM again at 24-weeks. Hub staff will receive training in AID management, complete self-efficacy assessments, and participate in interviews. Conclusion This model offers a novel, scalable and equity-focused approach to diabetes technology care, which will enhance outcomes for people with diabetes and inform future service delivery for other long-term conditions.

In October 2024, New Zealand's pharmaceutical funding agency (PHARMAC) introduced fully funded access to Tandem t:slim X2 and Ypsomed YpsoPump insulin pumps, alongside Abbott and Dexcom continuous glucose monitoring (CGM). As Medtronic CGM remained unfunded, continued use of Medtronic automated insulin delivery (AID) systems incurred substantial personal cost, prompting prioritized transition to funded alternatives for all pediatric Medtronic users at our center. This retrospective audit evaluated glycemic outcomes 6 months post-transition. Ninety-eight children/adolescents transitioned AID systems; complete 6-month outcome data were available for 79 (mean age 11.6 ± 3.0 years; diabetes duration 4.68 years; pump use duration 2.44 years). Most transitioned to Tandem Control-IQ (n = 66) or YpsoPump with CamAPS FX (n = 11). Mean HbA1c decreased by 0.24% (from 7.14 ± 0.79% to 6.87 ± 0.86%; P = 0.0012), with no episodes of diabetic ketoacidosis or level 3 hypoglycemia. Funding-driven AID transitions can be safely implemented with structured education and follow-up.

Background Typhoid fever incidence estimates are central to policy decisions on vaccine introduction and investments in non-vaccine prevention and control but are often unavailable. We explored whether prevalence metrics from sentinel studies of community-onset bloodstream infections could accurately predict local Salmonella Typhi (S. Typhi) incidence. Methods Using a previous systematic review (January 2018-December 2024), we identified studies reporting both typhoid incidence and prevalence of community-onset bloodstream infections from sentinel sites. From authors, we requested data on blood culture isolates and analysed four metrics: (i) S. Typhi prevalence among probable pathogens, (ii) S. Typhi rank order, (iii) S. Typhi to Escherichia coli ratio, and (iv) S. Typhi to "stably endemic" organisms ratio. Typhoid incidence was categorized as low (<10), medium (10-100) or high (>100) per 100,000 person-years. We used univariate ordinal regression to assess the association between each metric and typhoid incidence level. The model performance was evaluated by the c-statistic, sensitivity, and specificity. Findings Analysis of 29 study sites (20 Africa, 9 Asia) yielded 4,625 probable pathogens. The median (IQR) typhoid incidence was 140 (28-319) per 100,000 person-years. All metrics were associated with increased typhoid incidence level: for each 1% increase in S. Typhi prevalence OR 1.07 (95%CI 1.02-1.15); rank order OR 0.25 (95%CI 0.06-0.64); log S. Typhi to E. coli ratio OR 2.91 (95%CI 1.45-7.42); log S. Typhi to "stably endemic" organisms ratio OR 3.69 (95%CI 1.69-11.3). A parsimonious model using S. Typhi prevalence alone achieved c-statistics of 0.87 (0.58-0.97), 0.76 (0.51-0.91), and 0.88 (0.69-0.96) for low, medium, and high incidence, respectively. Interpretation Sentinel prevalence metrics from bloodstream infections, particularly S. Typhi prevalence among probable pathogens, could be useful for inferring local typhoid fever incidence where direct data are unavailable. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by Gates Foundation (GF) grant INV-030857. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was a secondary analysis of published data and existing de-identified data and was approved by University of Otago Human Ethics Committee HD23/012. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The underlying data are available online at Dataverse: https://doi.org/10.7910/DVN/JTTFYL. This includes the underlying data to replicate all analysis and the supplementary material with detailed methods and results. Local ethical approvals did not include open posting of the isolate-level data. De-anonymised data regarding this study can be requested from the corresponding author. Proposals should be submitted by the study team via the corresponding author by email.

BACKGROUND:Typhoid fever incidence estimates are central to policy decisions on vaccine introduction and investments in non-vaccine prevention and control but are often unavailable. We explored whether prevalence metrics from sentinel studies of community-onset bloodstream infections could accurately predict local Salmonella enterica serovar Typhi (Salmonella Typhi) incidence. METHODS:Using a previous systematic review (January 2018-December 2024), we identified studies reporting both typhoid incidence and prevalence of community-onset bloodstream infections from sentinel sites. From authors, we requested data on blood culture isolates and analysed four metrics: (i) Salmonella Typhi prevalence among probable pathogens, (ii) Salmonella Typhi rank order, (iii) Salmonella Typhi to Escherichia coli ratio, and (iv) Salmonella Typhi to 'stably endemic' organisms ratio. Typhoid incidence was categorized as low (<10), medium (10-100) or high (>100) per 100,000 person-years. We used univariate ordinal regression to assess the association between each metric and typhoid incidence level. The model performance was evaluated by the c-statistic, sensitivity, and specificity. RESULTS:Analysis of 29 study sites (20 Africa, 9 Asia) yielded 4625 probable pathogens. The median (IQR) typhoid incidence was 140 (28-319) per 100,000 person-years. All metrics were associated with increased typhoid incidence level: for each 1% increase in Salmonella Typhi prevalence OR 1.07 (95%CI 1.02-1.15); for each unit increase in rank order OR 0.25 (95%CI 0.06-0.64); for each unit increase in the log Salmonella Typhi to E. coli ratio OR 2.88 (95%CI 1.48-7.39) for each unit increase in the log Salmonella Typhi to 'stably endemic' organisms ratio OR 3.74 (95%CI 1.80-10.7). A parsimonious model using Salmonella Typhi prevalence alone achieved c-statistics of 0.87 (0.58-0.97), 0.76 (0.51-0.91), and 0.88 (0.69-0.96) for low, medium, and high incidence, respectively. CONCLUSION:Sentinel prevalence metrics from bloodstream infections, particularly Salmonella Typhi prevalence among probable pathogens, could be useful for inferring local typhoid fever incidence where direct data are unavailable.

This study evaluated sociodemographic characteristics of students enrolled in dentistry, oral health and dental technology in Aotearoa New Zealand (NZ) between 2016 and 2020. Sociodemographic data were obtained from central student record systems and NZ population data from the 2018 Census. Age, gender and citizenship status were analysed for the whole cohort, whilst other categories were analysed for NZ citizens and permanent residents only. Descriptive statistics were presented as raw counts or rates per 100,000 of the population. Most NZ students were educated in the public system. For dentistry and dental technology, a third of the cohort were international students, contrasting with only 4% of oral health students. Most NZ-educated students attended schools serving socioeconomically privileged communities. For all programmes, most students came from urban areas and there were more female than male students enrolled. Māori and Pacific students represented 9.3% and 5.4% of enrolments, despite representing 20% and 9% of the NZ population. Māori and Pacific peoples and those from rural and low socioeconomic areas were underrepresented, despite efforts to address such inequities. Admission policies in NZ universities need to ensure that Māori and Pacific peoples and those from rural and low socioeconomic areas are considered from a social justice and equity positioning.

AIMS:The first 26 weeks of the 2GO-CGM trial assessed the efficacy and safety of real-time continuous glucose monitoring (rtCGM) use within a supported specialist model of care in a cohort of community-based adults with insulin-requiring type 2 diabetes in New Zealand. METHODS:A 26-week randomised one-way crossover 'waitlist-controlled' trial comparing rtCGM (Dexcom G6) with self-monitoring of blood glucose (SMBG). All participants completed 2 weeks of SMBG before being randomised to 12 weeks (phase 1) use of SMBG followed by 12 weeks (phase 2) use of rtCGM (Group A) or 24 weeks of rtCGM (Group B). A time-adjusted within-subject analysis was conducted to estimate the overall treatment effect of rtCGM versus SMBG. RESULTS:Sixty-seven participants were randomised to Group A or B, and all were included in the analysis (53% indigenous Māori, 57% female, median age 53 [range 16-69] years). Baseline-adjusted mean time in range (3.9-10.0 mmol/L) was 15% (95% CI 10-20; p = <0.001) higher with rtCGM use versus SMBG use. There was no evidence of a difference in Hba1c between rtCGM and SMBG use (-3.4 mmol/mol [0.31%], 95% CI -9.4 to 2.7 mmol/mol [-0.86 to 0.24%], p = 0.27). One participant withdrew in phase 2 due to unmanageable skin reactions to the CGM device. There were no severe hypoglycaemia or ketoacidosis events in either group during the study. CONCLUSIONS:Use of rtCGM demonstrates safe and sustained glycaemic improvement in rtCGM use with insulin-requiring type 2 diabetes during the first 26 weeks of the 2GO-CGM study.

AIM:To analyse trends in community systemic antibiotic dispensing to children and young people (0-14 years) in New Zealand between 2010 and 2019. METHODS:Dispensing data were retrieved from the National Pharmaceuticals Collection and population data from the Te Whatu Ora Populations Web Tool. Dispensing rates were described using the number of defined daily doses/1000 inhabitants per day (DID) and courses dispensed/1000 inhabitants/year. RESULTS:Total antibiotic dispensing declined over the study period, both in terms of courses dispensed (annual percentage change [APC] -3.4% per year) and DIDs (APC -0.67% per year). Amoxicillin/clavulanic acid showed the greatest decline in dispensing (APC -9.5% per year), while cefalexin had the most significant increase (APC +53.7% per year). The highest dispensing rates were observed among children aged 0-4 years, Pacific patients and those in the lowest socioeconomic quintile. Counties Manukau had the highest regional dispensing rates. Antibiotic stewardship, as per the WHO AWaRe guidelines, improved: Access antibiotics increased from 83% to 91%, while Watch antibiotics decreased from 17% to 9% of total dispensing. CONCLUSIONS:These findings suggest an overall improvement in prescribing practices, likely due to the adoption of antimicrobial stewardship programmes. Further study is under way to understand the reasons for and any risks associated with, high community rates of cefalexin dispensing.

This study evaluated a next-generation automated insulin delivery (AID) algorithm for Omnipod in type 1 and type 2 diabetes across multiple phases: 14-day run-in with usual therapy, 48-h AID use in a hotel setting (type 1 only), and up to 6 weeks of outpatient AID use. Participants did, or did not, deliver manual boluses at alternating periods. Twelve adults with type 1 diabetes completed the hotel phase; 9 of those 12 plus 8 adults with type 2 diabetes completed the subsequent outpatient phase. Outpatient % continuous glucose monitor readings >250 mg/dL decreased from 33.5% at baseline to 9.4% with, and 14.3% without, manual boluses in type 1 diabetes and from 20.8% to 7.7% with, and 10.5% without, manual boluses in type 2 diabetes. Time below 70 mg/dL remained <4% during all phases. No adverse events occurred. In conclusion, a next-generation AID algorithm demonstrated feasibility in people with diabetes.

AIM:To compare demographics, therapeutics and outcomes in children and adolescents with diabetes in Aotearoa, New Zealand from the KiwiDiab network. METHODS:All cases of type 1 diabetes (T1D) and type 2 diabetes (T2D) from the 13 regional centres that provide care were collated for the 2023 calendar year. RESULTS:There were 1849 children and adolescents with diabetes: 1642 (88.8%) had T1D, mean age at diagnosis 9 years (interquartile range [IQR]: 6-12), mean age in clinic 12 years (IQR: 9-14); 47% were female and 69% identified as NZ European, 16% Māori and 8.3% Pacific. Overall, 23% of children and adolescents with T1D achieved an HbA1c level < 53 mmol/mol (7.0%). The mean (±standard deviation) HbA1c for any insulin pump use was 59 ± 11 mmol/mol (7.5% ± 1.0%) compared to 72 ± 19 (8.7% ± 1.8%) for those on multi-daily injections (MDI) and 96 ± 25 (11.0% ± 2.3%) on twice-daily (BD) insulin (p < 0.001). For the 23% of those using automated insulin delivery, mean HbA1c was similar across ethnic groups. However, HbA1c was higher for those on MDI or BD of Pacific or Māori versus European or Asian ethnicity (p < 0.001). There were 151/1849 (8.2%) children and adolescents with T2D: mean age at diagnosis 13 years (IQR: 12-14), age in clinic 14 years (IQR: 12-15); 61% were female, 38% Māori and 42% Pacific. CONCLUSIONS:This inaugural national benchmarking report demonstrates the differences in diabetes technology usage and HbA1c levels for children and adolescents in Aotearoa, New Zealand. This highlights the need for ongoing benchmarking activities on a regular basis.

AIM:We aimed to investigate community systemic antibiotic dispensing in New Zealand across 2010-2019. METHODS:This longitudinal study utilised dispensing data from the National Pharmaceutical Collection and population data from the Health New Zealand - Te Whatu Ora populations web tool. Dispensing rates were measured as the number of defined daily doses/1,000 inhabitants per day (DIDs) and courses dispensed/1,000 inhabitants/year. Dispensing data were stratified by antibiotic group, AWaRe (Access, Watch, Reserve) categories, district health board (DHB) region and patient characteristics. RESULTS:Between January 1 2010 and December 31 2019, community systemic antibiotic dispensing in New Zealand declined, with courses dispensed dropping from 930 to 782 (average annual change [AAC] -1.9%) and DID from 20.9 to 19.6 (AAC -0.75%). Watch antibiotics decreased by 8% in courses dispensed/1,000 inhabitants/year, with quinolones showing the largest proportional reduction (-37 courses dispensed/1,000 inhabitants/year; AAC -13.4%). Conversely, first-generation cephalosporins increased significantly (+45 courses dispensed/1,000 inhabitants/year; AAC +56%), primarily due to cefalexin. Ethnic differences persisted, with Pacific people consistently exhibiting the highest dispensing rates. Most DHB regions experienced an overall decline in dispensing during this period. CONCLUSIONS:The study identified encouraging trends in antibiotic dispensing, reflecting New Zealand's antimicrobial stewardship initiatives, but also highlighted the rise in cefalexin and ongoing variations that require further investigation.

BACKGROUND:Pacific region-specific data on the clinical course of COVID-19 are limited. We aimed to describe clinical features and outcomes from Aotearoa New Zealand patients, focusing on Māori and Pacific peoples. METHODS:We conducted a retrospective cohort study among adults (≥16 years) hospitalised due to COVID-19 at 11 hospitals from January to May 2022. We included all Māori and Pacific patients and every second non-Māori, non-Pacific (NMNP) patient using data from chart review and national datasets. RESULTS:Of 2319 patients, 582 (25%) were Māori, 914 (39%) Pacific peoples and 862 NMNP (median age 52, 57 and 63 years respectively). Vaccination coverage (≥2 doses) was 73.4% (n = 437) for Māori, 76.7% (n = 701) for Pacific peoples (n = 701) and 84.8% (n = 731) for NMNP. Among 832 (35.9%) with complications, Māori had a greater risk than NMNP of acute kidney injury (risk ratio (RR) 1.87, P < 0.001), cardiac arrhythmia (RR = 1.60, P = 0.023), shock (RR = 2.64, P = 0.005), myocardial infarction (RR 2.21, P = 0.042), cardiac arrest (RR 2.68, P = 0.046) and acute respiratory distress syndrome (RR = 2.81, P = 0.008). Pacific patients experienced a greater risk than NMNP of acute kidney injury (RR = 2.18, P < 0.001) and pneumonia (RR = 1.32, P = 0.047) and a lower risk of thromboembolism (RR = 0.35, P = 0.004) and myocarditis/pericarditis (RR = 0.23, P = 0.003). During admission, 23 (3.3%) Māori, 36 (3.9%) Pacific and 28 (3.2%) NMNP patients died, with no difference in age-standardised mortality. CONCLUSIONS:The clinical course of patients hospitalised by COVID-19 varied between ethnic groups, likely reflecting differential access to social determinants of health. Healthcare services that respond to this variability are needed to achieve the highest attainable health for all.

The aim of this study was to map the association between Chronic Pain (CP) and Obsessive–Compulsive Disorder (OCD) in the present literature. A scoping review was conducted with a comprehensive search of literature in peer-reviewed journals. Search parameters included articles written in English, published at any time, and including terms associated with both CP and OCD. Databases searched for purposes of this study included Psychinfo, Medline, Embase, Emcare, CINAHL, Scopus, Web of Science, Cochrane, and Google Scholar. The review included 87 records, comprising 49 primary research and 38 secondary research records. Extracted information from these were grouped into four broad classifications. The Prevalence and Severity classification included information from 39 records which comprised: (1) primary research detailing current OCD prevalence rates in CP conditions (differentiated between general population and Pain/Medical/Hospital clinics); (2) primary research detailing lifetime OCD prevalence rates in CP conditions; (3) primary research detailing CP prevalence rates in OCD; (4) primary research detailing relationships between OCD and CP through psychometric measures; and (5) secondary research relating to prevalence rates. The Neurobiology classification included information from 28 records (primary and secondary research) detailing convergent and divergent neurobiological/neurophysiological aspects as reported for both OCD and CP. The Psychological Models/Factors classification included information from 7 records (primary and secondary research) detailing pain-related anxiety, neuropsychological measures, catastrophic thinking, preservative thinking, early maladaptive schemas, schema modes, childhood trauma experiences, and conditional associative learning, as reported for OCD and CP. The Intervention classification included information from 32 records which comprised: (1) primary research on neurosurgical, medication, and psychotherapeutic interventions; (2) secondary research on Deep Brain Stimulation; (3) secondary research on Medication; (4) secondary research on lesion, cingulotomy, and other surgical procedures; and (5) secondary research on other interventional procedures. While there has been considerable and growing research in the fields of both OCD and CP over the years, focused research into their potential association has been limited and potentially overlooked. The results of this review, however, suggest a complex relationship between CP and OCD. Prevalence rates between the two conditions vary widely across different populations, although the underlying reason for this remains unclear at this stage. There are commonalities in terms of alterations in pain processing, the dysregulation of certain brain regions, and the abnormalities in neurotransmitter systems in both conditions. In their treatment, use can be made of overlapping pathophysiological processes, the convergent and divergent psychological aspects, and the range of interventional approaches that share targets to promote efficacy. However, the complex presentations of both OCD and CP make it a challenging relationship to accurately clarify. Further directed and robust, high-quality studies will be needed to expand our understanding of this area.

BACKGROUND:Legionnaires' disease (LD) is typically treated with macrolides, including the azalide azithromycin, or quinolones. In 2013, guidelines for empirical treatment of community-acquired pneumonia at Christchurch Hospital, New Zealand were changed to prioritize oral azithromycin over IV clarithromycin. OBJECTIVES:To determine whether the change in antimicrobial guidelines led to altered outcomes for patients subsequently confirmed to have LD. METHODS:Patients with confirmed LD between 2010 and 2020 were identified from clinical and laboratory data. Hospital records were used to identify mortality, ICU admission, length of hospital stay, time to clinical stability, and time to first anti-Legionella treatment. Mean differences, risk ratios (RRs) and an interrupted time series with propensity adjustment were used to compare patient outcomes before and after the guideline change. RESULTS:There were 323 patients included: 128 before and 195 after the change. Patient outcomes generally improved after the change including: mortality within 30 days (RR 0.4, 95% CI 0.2-0.8); ICU admission (RR 0.6, 95% CI 0.5-0.9); length of stay (difference -2.3 days, 95% CI -4.3 to -0.4); and time to clinical stability (difference -2.4 days, 95% CI -4.3 to -0.5). The interrupted time series analysis suggested improvements in patient outcomes may have occurred regardless of the guideline change. CONCLUSIONS:Outcomes for patients with LD were not worsened by the change in antimicrobial guidelines and may have improved. Overall rates of mortality were low. This result was reassuring given the harm that may result from unnecessary use of IV compared with oral antimicrobial agents.

PURPOSE:This study examined telehealth delivery of complex wheelchair assessment in Aotearoa New Zealand, specifically: what works, for whom, and in which contexts, with exploration of culturally specific factors for indigenous Māori. MATERIALS AND METHODS:A mixed methods realist evaluation was conducted with remote specialist assessors (physiotherapists and occupational therapists), on-site assistants, and wheelchair users. Interviews/focus groups, mobility goal achievement, satisfaction, and fidelity of tele-delivered assessment of wheelchair and seating (tAWS) contributed to Context-Mechanism-Outcome configurations (CMOc). RESULTS:Four remote specialist assessors delivered tAWS, but it was declined by on-site assistants in 78% of cases in which specialist assessors perceived it could work. When tAWS was delivered to wheelchair users (N = 5), the majority of goals were achieved, with high service satisfaction. CMOc's highlight the influence of system design in the uptake of telehealth by health professionals. CONCLUSIONS:While therapists can navigate complexity for successful tAWS, therapist and system barriers limit its uptake, particularly confidence in conducting assessment and use of technology among the non-adopters. Telehealth specific training in culturally-responsive rehabilitation is recommended. This evaluation contributes to telehealth program theory and the mechanisms to be addressed for telehealth to meet its potential to enhance equity in health outcomes.

Objectives To examine associations between subjective and objective cognitive problems, and factors potentially modifying these relationships, after mild traumatic brain injury (mTBI). Methods Treatment-seeking adults (n = 95) were assessed 6 weeks (Time 1) and then 6 months later (Time 2) after mTBI. Validated questionnaires assessed cognitive, emotional and somatic mTBI symptoms, distress, catastrophising, and beliefs about symptoms and recovery. Cognitive performance was measured using the National Institutes of Health Toolbox Cognition Battery. Using correlations and linear regression, we explored associations between psychological factors, objectively measured cognitive performance and self-reported cognitive symptoms. Results There were only modest correlations between subjective cognitive symptoms and objective cognitive performance at assessment timepoints. In contrast, there were medium to large correlations between subjective cognitive symptoms, post-concussion symptom burden and psychological factors. Post-concussion symptom burden and beliefs about symptoms and recovery at Time 1 predicted persisting self-reported cognitive symptoms at Time 2. Conclusions High post-concussion symptom burden and non-recovery expectations may increase risk for persistent subjectively experienced cognitive symptoms. Our findings may guide targeted treatment efforts focusing on factors with potential to influence cognitive symptom reporting after mTBI. Summary In this study, we investigated factors that might influence cognitive recovery after concussion. We found having many post-concussion symptoms and fears of nonrecovery may increase risk for persisting cognitive symptoms. Our findings may guide targeted treatment efforts focusing on factors with potential to influence cognitive symptom reporting after concussion.

OBJECTIVE:Determine the feasibility of high-risk human papillomavirus (HPV)-based cervical screening that included the option of a vaginal swab HPV test (vaginal self-test). DESIGN:Implementation trial. SETTING:17 primary care practices. POPULATION OR SAMPLE:People due for a cervical screening test. METHODS:Participants could choose a clinician-taken cervical test or a vaginal self-test (undertaken in clinic or at home), unless a cervical co-test (HPV and cytology) was clinically indicated. MAIN OUTCOME MEASURES:Proportion of participants who had (a) a vaginal self-test, (b) an HPV-detected result and (c) HPV detected on a vaginal self-test and returned for further investigation. RESULTS:3121 people were enrolled. Participation rates were high for people of all recorded ethnicities. A vaginal self-test was undertaken by 95% (2954/3121, 95% confidence interval [CI] [93.8, 95.4]) of people. HPV was detected in 12.9% (404/3121, 95% CI [11.8, 14.2]) of people. 95% (384/404, 95% CI [92.5, 97.0]) of people with HPV detected had follow-up cytology or colposcopy. 2.6% (82/3121, 95% CI [2.1, 3.2]) had HPV 16/18 detected, all of whom attended colposcopy. Cytology triage was completed for 92% (276/301, 95% CI [88.0, 94.3]) of people with non-16/18 HPV types (HPV other) detected on a vaginal self-test. This varied by ethnicity and screening history. CONCLUSION:This study confirms the feasibility of cervical screening with the universal option of a vaginal self-test and demonstrated a clear preference for the vaginal self-test. Challenges remain in relation to equitable provision of cytology triage. Ongoing programme monitoring is imperative. TRIAL REGISTRATION:Australia and New Zealand Clinical Trial Register. ANZCTR Reference number: ACTRN12622000699763 (https://anzctr.org.au/).

The Aotearoa New Zealand (NZ) Cervical Screening Programme (NCSP) commenced in 1990. The NCSP has failed to equally reach its eligible population, consequently, cervical cancer rates by ethnicity are inequitable. In 2008, the Aotearoa NZ human papillomavirus (HPV) vaccination programme was introduced. The aim of this study was to determine the impact of HPV vaccination on the occurrence of high-grade cervical abnormalities and cancer in the cohort of people who were eligible for vaccination and underwent cervical screening. Data on the NCSP register were matched to the national vaccination register and the incidence of detected cervical abnormalities by vaccination status, ethnicity, birth cohort, and year of vaccination was determined. HPV vaccination was associated with a marked reduction in cervical cancer (hazard ratio [HR] 0.32) and adenocarcinoma in situ (HR 0.26). Vaccinated people were also less likely to experience a high-grade squamous cervical cytology (HR 0.75) or histology (HR 0.71). We observed equitable access to vaccination and protection against HSIL among Māori, Pacific, and European people. This data is important evidence of the real-world effectiveness of HPV vaccination in Aotearoa NZ. Vaccination improves outcomes equitably for Māori, Pacific peoples, and NZ Europeans. Increased vaccination rates are required for cervical cancer elimination.

Chronic low-grade inflammation is a characteristic of people with metabolic syndrome and is thought to contribute to the condition progressing to the more severe type 2 diabetes and cardiovascular disease (CVD). The aim was to carry out a double-blind randomised placebo-controlled trial in people with metabolic syndrome to determine if supplementation with a micronutrient formula containing 1000 mg/d vitamin C could attenuate inflammation in people with metabolic syndrome. We recruited 72 adults aged a median of 52 years with metabolic syndrome, defined as obesity (based on waist circumference or BMI), and at least two of hyperglycaemia, raised triglycerides, lowered HDL cholesterol, hypertension, or taking medications for these conditions. A further inclusion criteria comprised C-reactive protein (CRP) concentrations ≥ 3 mg/L, i.e., high risk of CVD. The participants were randomised to daily micronutrient formula (n = 37) or matched placebo control (n = 35) for 12 weeks. The primary outcome was change in CRP concentrations and secondary outcomes included changes in vitamin C concentrations, pro-inflammatory cytokines (IL-6, TNFα), oxidative stress marker (F2isoprostanes), glycaemic indices (glucose, insulin, HbA1c), lipid markers (triglycerides, LDL and HDL cholesterol), anthropometric parameters (weight, BMI), insulin resistance and insulin sensitivity, and metabolic severity score. The participants had a low median (Q1, Q3) vitamin C status of 29 (15, 41) µmol/L and a high proportion of hypovitaminosis C (38%) and outright deficiency (19%). Following 12 weeks of micronutrient supplementation, at least 70% of the participants reached adequate vitamin C status (≥50 µmol/L), however, there was no change in CRP concentrations relative to the placebo group (Δ−0.3 [95%CI −2.7, 2.1] mg/L, p = 0.8). Similar trends were observed for IL-6, TNFα and F2isoprostanes (p > 0.05). Instead, there were small improvements in BMI, fasting glucose and HbA1c concentrations, insulin sensitivity and metabolic severity score in the micronutrient group relative to placebo (p < 0.05). Overall, 12-week micronutrient supplementation was unable to mitigate systemic inflammation in people with metabolic syndrome but may improve several metabolic health indices.