Conference or Workshop ContributionIncludes published papers, abstracts, keynotes, oral presentations and posters.http://hdl.handle.net/10523/6652024-03-18T20:08:31Z2024-03-18T20:08:31ZHospitalisations for epilepsy and status epilepticus – the tip of the iceberg?Tustin, KarenKeenan, NgaireSadleir, LynetteNolan, MelindaMcAnally, HelenaAdams, JudithWicken, AndrewDuncanson, Mavishttp://hdl.handle.net/10523/165802024-03-08T14:18:09Z2024-02-15T00:49:02ZHospitalisations for epilepsy and status epilepticus – the tip of the iceberg?
2023-11-08
Tustin, Karen; Keenan, Ngaire; Sadleir, Lynette; Nolan, Melinda; McAnally, Helena; Adams, Judith; Wicken, Andrew; Duncanson, Mavis
Background: Epilepsy is the most common serious neurological condition in children and adolescents and affects 3–5 in every 1,000. Although most health care for epilepsy is delivered in outpatient settings, data on hospitalisations for epilepsy can provide an epidemiological background to the burden of epilepsy within a population.
Methods: We used data from the National Minimum Dataset (NMDS) to examine rates of hospitalisation for epilepsy and status epilepticus in 0–24-year-olds from 2000 to 2022. We performed a series of time-trend analyses by age group, prioritised ethnicity, and socio-economic deprivation.
Results: Rates of children and young people hospitalised with a diagnosis of epilepsy or status epilepticus have increased overall from 2000 to 2022. Rates of hospitalisation were highest for 0–4-year-olds, for whom there was a particularly large increase in rates after 2020. This trend was not due to an increase in hospitalisation events for individual children; the same patterns were evident for unique individuals. There were disparities for Māori, who were hospitalised at greater rates than were children of other ethnicities, particularly among 15–24-year-olds. Rates of hospitalisation have been consistently highest for children and young people living in the most deprived areas. Recently, however, this deprivation gradient has reduced (although it is still present).
Conclusion: Consistent with other research in Aotearoa, the higher hospitalisation rates for epilepsy and status epilepticus experienced by Māori and those living within high deprivation areas may reflect inadequate access to routine epilepsy care and, hence, suboptimal seizure control. These hospitalisation data will only reflect the tip of the iceberg; this narrow clinical window does not paint the full picture of paediatric epilepsy in Aotearoa. Our findings highlight the importance of a systems-level approach to improve outcomes for all tamariki and taitamariki with epilepsy.
2024-02-15T00:49:02ZSchool attendance among autistic students in Aotearoa | New Zealand: a population study using the integrated data infrastructureBowden, NicholasAnns, FrancescaVu, HienDacombe, JoanneMuir, ColetteRussell, Jinvan de Meer, LarahWilliams, JohnClendon, Sallyhttp://hdl.handle.net/10523/164772024-03-18T14:41:10Z2023-12-17T04:24:41ZSchool attendance among autistic students in Aotearoa | New Zealand: a population study using the integrated data infrastructure
2023-12-07
Bowden, Nicholas; Anns, Francesca; Vu, Hien; Dacombe, Joanne; Muir, Colette; Russell, Jin; van de Meer, Larah; Williams, John; Clendon, Sally
Background: Autistic students face a range of challenges that can make regularly attending school difficult. Extant literature is sparse but indicates autistic students have lower school attendance compared to the general population. However, these studies are often limited by small samples and parent reported data.
Aims: Use whole-of-population data to examine school attendance among autistic students compared to non-autistic students and explore type of non-attendance.
Methods: National retrospective cohort study using population-level data on students aged 5 to 16 years in 2018. Autism identified using diagnostic information contained within multiple health datasets. Regular attendance defined as attending 90% or more of school half days. Association between autism and attendance estimated using complete-case 2-level random intercept modified Poisson regression. Adjusted models controlled for age, sex, ethnicity, deprivation level, rurality and accounted for the correlation structure of the data with students nested within schools.
Results: Among 654,438 enrolled students, 8,427 (1.3%) were autistic. In adjusted analyses, autism was associated with significantly decreased likelihood of regular attendance (incident rate ratio 0.88; 95% confidence interval, 0.86-0.90). The driver for lower attendance among autistic students was justified absence (8.2% of recorded attendance hours for autistic students vs. 5.0% for non-autistic students), in particular medical absence (5.7% vs 4.1%).
Discussion/Conclusion: The findings of this study raise a number of concerns around inclusionary practices and unmet need for autistic students. To improve attendance of autistic students, comprehensive and targeted supports are required to help the student, whānau, and school.
2023-12-17T04:24:41ZUsing population-level data for Takiwātanga | autism research in Aotearoa | New ZealandBowden, NicholasVu, HienAnns, FrancescaDacombe, JoanneWilliams, JohnTupou, JessicaTheodore, ReremoanaSporle, AndrewDiamond, ToriRuhe, TroyKokaua, JesseGibb, ShereeMcLay, LaurieSchluter, Philliphttp://hdl.handle.net/10523/164762024-03-18T14:40:59Z2023-12-17T04:20:27ZUsing population-level data for Takiwātanga | autism research in Aotearoa | New Zealand
2023-12-06
Bowden, Nicholas; Vu, Hien; Anns, Francesca; Dacombe, Joanne; Williams, John; Tupou, Jessica; Theodore, Reremoana; Sporle, Andrew; Diamond, Tori; Ruhe, Troy; Kokaua, Jesse; Gibb, Sheree; McLay, Laurie; Schluter, Phillip
Aotearoa | New Zealand has a world-leading research database called the Integrated Data Infrastructure (IDI). The IDI contains a range of population-level data linked at the individual level including health, education, social service, tax, census, and criminal justice system information. These data present a unique opportunity for Takiwātanga | autism research. In this presentation, Nick will provide an overview of the IDI and discuss how it is being used for autism research in Aotearoa. He will present some examples of existing research, and the discuss the development of several new streams of research including how the IDI can be used to evaluate the impact of education-based funding supports on health and educational outcomes for autistic students, Māori-centred autism research, and Pacific-centred autism research.
2023-12-17T04:20:27ZThe Role of the Litigant in Person in Civil CourtsToy-Cronin, Bridgettehttp://hdl.handle.net/10523/164752024-02-26T14:52:17Z2023-12-15T02:34:58ZThe Role of the Litigant in Person in Civil Courts
2022-07
Toy-Cronin, Bridgette
LiPs are increasingly prominent players in the social world of the court. There is a growing literature addressing many questions relating to LiPs and this article contributes to that literature, exploring the creation and maintenance of the social role of the LiP. I argue that the high-status actors and those in the inner circle of the social world of the court—the judiciary, lawyers, and court staff—engage in boundary work, defining the role of the LiP. In carrying out this work they shape two roles for the LiP: the vulnerable and the vexatious. Simultaneously they maintain the fiction that the ideal LiP is one who performs the lawyer’s role. This role is neither possible nor desired by the high-status actors; LiPs must remain differentiated. If court reform to address the challenges presented by LiPs is to succeed, it must account for these role dynamics.
2023-12-15T02:34:58ZPaediatricians in Aotearoa contribute to rare disease surveillanceDuncanson, MavisWheeler, BenjaminMcIntyre, PeterBates, Rachelhttp://hdl.handle.net/10523/164742024-03-08T14:18:47Z2023-12-15T02:08:11ZPaediatricians in Aotearoa contribute to rare disease surveillance
2023
Duncanson, Mavis; Wheeler, Benjamin; McIntyre, Peter; Bates, Rachel
Background: Monthly surveys provide an opportunity for paediatricians in Aotearoa to contribute to international and national surveillance of rare childhood conditions. This is linked to active surveillance of acute flaccid paralysis (AFP) undertaken for Manatū Hauora and reported to the Western Pacific Region (WPR) Office of the World Health Organization (WHO).
Methods:
• Review and analysis of the NZPSU database to describe the contribution of paediatricians to this project in 2022/23, identify conditions under surveillance and review recent research findings
• Audit of AFP surveillance against hospital discharge diagnoses and World Health Organization standards
Results: Each month from July 2022 to June 2023 around 200 paediatricians responded to an online survey reporting children in their care with acute flaccid paralysis or other rare childhood diseases.The overall response rate was 74%.
In 2022 responding paediatricians reported 20 cases of acute flaccid paralysis, 4 infants with HIV positive birthing parent, 22 infants with birthing parent with positive syphilis serology, 8 adverse drug reactions in childhood, 46 children aged under 15 years who presented with self-harm and were seen by a paediatrician, and 22 cases of severe acute hepatitis. From March 2022 there were reports of 52 children with COVID-19 who required ICU level care or who had a multi-inflammatory condition. There were no reports of congenital rubella. Principal investigators for each condition obtained further clinical information and used this to inform policy and practice. Achievements include third trimester testing for syphilis and ongoing research to address self-harm in the paediatric population.
Audit against hospital discharge data identified a further 5 cases with AFP. The AFP rate of 2.6 cases per 100,000 0–14-year olds was considerably higher than the expected rate of 1 case per 100,000. Two timely stool samples were provided for only 44% of AFP cases in 2022.
Conclusion: Paediatricians are key players in routine active surveillance that contributes to understanding of poliomyelitis in the WPR and enhances understanding of rare childhood diseases in Aotearoa.
2023-12-15T02:08:11ZUpdate from Te Ratonga Mātai Tahumaero Taitamariki o Aotearoa (NZCYES)Duncanson, Mavishttp://hdl.handle.net/10523/164732024-02-15T15:53:00Z2023-12-15T02:04:48ZUpdate from Te Ratonga Mātai Tahumaero Taitamariki o Aotearoa (NZCYES)
2023
Duncanson, Mavis
2023-12-15T02:04:48ZSnapshots of child and youth population healthDuncanson, Mavishttp://hdl.handle.net/10523/164712024-02-26T14:52:57Z2023-12-15T01:27:02ZSnapshots of child and youth population health
2023
Duncanson, Mavis
This keynote address will present series of snapshots that reflect some of the work undertaken by the three child population health research groups within the Department of Women's and Children's Health at the Dunedin School of Medicine within the University of Otago. The New Zealand Paediatric Surveillance Unit has an important role in certifying polio-free status on behalf of Manatū Hauora, and providing a platform to investigate other rare childhood conditions. The New Zealand Child and Youth Epidemiology Service was established in partnership with The Paediatric Society of New Zealand Te Kāhui Mātai Arotamariki o Aotearoa and former district health boards, with support of the Ministry of Health and now Te Whatu Ora. The Mortality Review Data Group has a statutory data role to drive improved quality and safety in child health through the Health Quality and Safety Commission, reporting on child and youth mortality and on perinatal and maternal mortality in Aotearoa.
2023-12-15T01:27:02ZThe role of lactogenic hormones in suppression of fever responses during late pregnancy.Stewart, A.M.Grattan, D.R.Georgescu, T.http://hdl.handle.net/10523/164522024-01-24T00:58:30Z2023-12-10T22:33:48ZThe role of lactogenic hormones in suppression of fever responses during late pregnancy.
2023-11-08
Stewart, A.M.; Grattan, D.R.; Georgescu, T.
Milne, Trudy; Anwar, Mudassir; Burga, Laura; Harcombe, Helen; Garelja, Michael; Middleton, Adam; Ribeiro, Daniel; Fleming, Nicholas; Ogbuehi, Kelechi; Bahn, Andrew
Fever during pregnancy increases the risk of complications for both the foetus and mother. However, during late pregnancy in mice, fever induced by the bacterial mimetic lipopolysaccharide (LPS) is suppressed while other sickness symptoms like reduced food intake remain. This likely plays a role in safeguarding the foetus from elevated temperatures around parturition. What mediates this mechanism is unknown. Prolactin and placental lactogen are high during late pregnancy, and there is expression of the prolactin receptor (Prlr) in glutamatergic (Vglut2) neuronal populations involved in fever. It is hypothesised that lactogenic hormone action on glutamatergic neuronal populations in the brain mediates suppression of fever responses during late pregnancy.
To investigate this hypothesis, the Prlr was specifically knocked out from glutamatergic neurons (Prlrlox/lox/Vglut2Cre). Pregnant mice were injected with saline on day 17 and LPS on day 18 of pregnancy with body temperature recorded using radiotelemetry. Inconsistent with the hypothesis, deletion of Prlr from glutamatergic neurons did not prevent the suppression of the fever response in late pregnancy, as there was no difference in the LPS response from controls (Prlrlox/lox) (measured by area under the curve) (one-way ANOVA, P = 0.7537, n = 6-7).
Despite the absence of a fever response, sickness symptoms, such as reduced food intake, were observed in both Prlrlox/lox/Vglut2Cre (4.18 ± 0.31 g to 2.42 ± 0.27 g (presented as mean ± SEM) (one-way ANOVA, P = 0.0023, n = 6)), and Prlrlox/lox mice (3.64 ± 0.17 g to 2.28 ± 0.21 g, one-way ANOVA, P = 0.0019, n = 8).
These data show that lactogenic hormone action on Vglut2 neurons does not mediate late pregnancy fever suppression in mice. This study begins to shed light on the mechanism by which fever responses are suppressed.
2023-12-10T22:33:48Z