Priorities to inform research on marine plastic pollution in Southeast Asia

Southeast Asia is considered to have some of the highest levels of marine plastic pollution in the world. It is therefore vitally important to increase our understanding of the impacts and risks of plastic pollution to marine ecosystems and the essential services they provide to support the development of mitigation measures in the region. An interdisciplinary, international network of experts (Australia, Indonesia, Ireland, Malaysia, the Philippines, Singapore, Thailand, the United Kingdom, and Vietnam) set a research agenda for marine plastic pollution in the region, synthesizing current knowledge and highlighting areas for further research in Southeast Asia. Using an inductive method, 21 research questions emerged under five non-predefined key themes, grouping them according to which: (1) characterise marine plastic pollution in Southeast Asia; (2) explore its movement and fate across the region; (3) describe the biological and chemical modifications marine plastic pollution undergoes; (4) detail its environmental, social, and economic impacts; and, finally, (5) target regional policies and possible solutions. Questions relating to these research priority areas highlight the importance of better understanding the fate of marine plastic pollution, its degradation, and the impacts and risks it can generate across communities and different ecosystem services. Knowledge of these aspects will help support actions which currently suffer from transboundary problems, lack of responsibility, and inaction to tackle the issue from its point source in the region. Being profoundly affected by marine plastic pollution, Southeast Asian countries provide an opportunity to test the effectiveness of innovative and socially inclusive changes in marine plastic governance, as well as both high and low-tech solutions, which can offer insights and actionable models to the rest of the world.

Predicting the dispersal of SARS-CoV-2 RNA from the wastewater treatment plant to the coast

Viral pathogens including SARS-CoV-2 RNA have been detected in wastewater treatment effluent, and untreated sewage overflows, that pose an exposure hazard to humans. We assessed whether SARS-CoV-2 RNA was likely to have been present in detectable quantities in UK rivers and estuaries during the first wave of the Covid-19 pandemic. We simulated realistic viral concentrations parameterised on the Camel and Conwy catchments (UK) and their populations, showing detectable SARS-CoV-2 RNA concentrations for untreated but not for treated loading, but also being contingent on viral decay, hydrology, catchment type/shape, and location. Under mean or low river flow conditions, viral RNA concentrated within the estuaries allowing for viral build-up and caused a lag by up to several weeks between the peak in community infections and the viral peak in the environment. There was an increased hazard posed by SARS-CoV-2 RNA with a T₉₀ decay rate >24 h, as the estuarine build-up effect increased. High discharge events transported the viral RNA downstream and offshore, increasing the exposure risk to coastal bathing waters and shellfisheries – although dilution in this case reduced viral concentrations well below detectable levels. Our results highlight the sensitivity of exposure to viral pathogens downstream of wastewater treatment, across a range of viral loadings and catchment characteristics – with implications to environmental surveillance.

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SARS-CoV-2 RNA from treated sewage unlikely to be detectable in estuaries.

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SARS-CoV-2 RNA from untreated sewage can be detectable in estuaries.

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Peak RNA concentration in estuaries can be delayed from peak community infection.

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RNA concentration is sensitive to viral loading, decay, hydrology, and estuary shape.

Cascade of care of people diagnosed with HIV in New Zealand between 2006 and 2017

OBJECTIVES

We estimated the proportion of people reported with HIV in New Zealand between 2006 and 2017, and alive in 2017-2019, who were on antiretroviral therapy (ART) and had a suppressed viral load (VL), and explored their associated characteristics.

METHODS

Data were anonymously linked to information on ART and VL within the data collection period (January 2017 to August 2019) using the National Health Index (NHI), Ministry of Health and laboratory datasets, as well as information from clinical specialists. Logistic regression was used to test for associations. Sensitivity analyses were undertaken to estimate the range for the key proportions.

RESULTS

Overall, 2355 people were reported with HIV, of whom 116 (5%) had died, 337 (14%) were overseas, and 1701 (72%) were alive in New Zealand; for the remaining 201 (9%) the outcome was unknown. Clinical data were available for 1490 people (87.6%): 1408 (94.5%) were on ART, 11 (< 1%) were not on ART, and for 71 (4.8%) this was unknown. Of those on ART, 1156 (82.1%) had a suppressed VL (< 200 copies/mL), 34 (2.4%) were unsuppressed, and for 218 (15.5%) this was unknown. The estimate of the proportion on ART ranged from 99% to 78%, and those with a suppressed VL ranged from 98% to 78%.

CONCLUSIONS

Among people with HIV in New Zealand who are under care, a high proportion were on ART and had suppressed VL. Increasing collection of NHIs and better linkage with laboratory information will reduce the number with unknown information and provide more complete VL results in the future.

Abstract P5-17-05: Sorafenib plus Ixabepilone as First-Line Treatment for Patients with HER2-Negative Metastatic Breast Cancer: Preliminary Results of the Phase II Trial of the Sarah Cannon Research Institute

Background: Sorafenib (S) is an oral multi-kinase inhibitor with effects on tumor proliferation and angiogenesis, targeting VEGFR1 and VEGFR2. It has modest activity as a single agent in breast cancer. In combination with capecitabine, S demonstrated a significant improvement of 2.3 months in progression free survival (PFS) in patients (pts) with metastatic breast cancer (MBC) and added benefit when combined with paclitaxel. Ixabepilone (Ixa) is a semi-synthetic analog of epothilone B with excellent single agent activity in MBC. The phase I portion of this trial identified the MTD of the Ixa and S combination. We now report the initial results of the phase II trial with this novel combination.

Methods: Eligibility criteria included: HER2-negative MBC previously untreated with chemotherapy; measurable disease; ECOG PS 0–2; normal LVEF; and adequate bone marrow and organ function. Prior hormonal therapy for MBC was permitted. Pts received Ixa 32mg/m2 IV on day 1 of each 21-day cycle and S 400mg PO BID. Following a minimum of 4 cycles of the combination, responding pts could discontinue Ixa and remain on study treatment with S monotherapy. Granulocyte-stimulating growth factors were permitted after cycle one. Tumor assessments were performed every 9 weeks. Pts continued study treatment until disease progression or unacceptable toxicity. The primary endpoint of this trial was PFS; the addition of S to Ixa was hypothesized to improve PFS from 4.2 month to 6.2 months in this patient population. The total enrollment goal is 85 pts, and the trial is currently open to accrual.

Results: Between 5/2010 and 4/2012, 76 pts have been enrolled, and 57 pts (56 females, 1 male) are included in this analysis. Baseline characteristics included: median age 58; 61% were ER and/or PR positive; 39% were triple-negative; 39% received neoadjuvant therapy. Anthracycline exposure was noted in 34 pts and prior taxane exposure in 39 pts. 29 pts received prior hormonal therapy, 7 of these for MBC. Sites of metastatic disease included lymph nodes 42%, lung 35%, liver 30%, bone 30%, and 23% other. 19 pts (33%) had 3 or more sites of metastatic disease. Median treatment duration was 3 cycles (9 weeks), range 1–11+ cycles with 9 pts discontinuing Ixa after a median of 6 cycles and continuing on S monotherapy. 12 pts (21%) had objective responses (1 CR, 11 PR); 3 of the 22 (14%) triple-negative patients had responses (1 CR, 2 PR). An additional 24 patients (42%) had stable disease at first reevaluation. Neutropenia was the most common grade 3/4 toxicity (26%) with growth factor use reported in 35%. Grade 3/4 non-hematologic toxicity occurring in &gt; 5% of patients consisted of: rash (12%), fatigue (11%), hypersensitivity reaction (7%, Ixa= 3 pts and S= 1 pt), and neuropathy (7%). Discontinuation due to adverse events occurred in 11%.

Conclusion: The combination of Ixa and full dose S was well tolerated with no new observed toxicities. Adverse events were manageable and consisted primarily of G3/4 neutropenia and rash. Study is ongoing and updated results will be presented.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-17-05.

Finding low-energy conformations of lattice protein models by quantum annealing

Lattice protein folding models are a cornerstone of computational biophysics. Although these models are a coarse grained representation, they provide useful insight into the energy landscape of natural proteins. Finding low-energy threedimensional structures is an intractable problem even in the simplest model, the Hydrophobic-Polar (HP) model. Description of protein-like properties are more accurately described by generalized models, such as the one proposed by Miyazawa and Jernigan (MJ), which explicitly take into account the unique interactions among all 20 amino acids. There is theoretical and experimental evidence of the advantage of solving classical optimization problems using quantum annealing over its classical analogue (simulated annealing). In this report, we present a benchmark implementation of quantum annealing for lattice protein folding problems (six different experiments up to 81 superconducting quantum bits). This first implementation of a biophysical problem paves the way towards studying optimization problems in biophysics and statistical mechanics using quantum devices.

Information and consent for newborn screening: practices and attitudes of service providers

OBJECTIVES

To gather information about the practices and attitudes of providers of maternity care with respect to informed consent for newborn screening (NBS).

METHODS

A questionnaire concerning information provision and parental consent for NBS was sent to all 1036 registered lead maternity carers (LMC) in New Zealand.

RESULTS

93% of LMC in New Zealand report giving parents information concerning NBS, most frequently after delivery (73%) and in the third trimester (60%). The majority (85%) of LMC currently obtain some form of consent (verbal or written) for NBS from parents and consider this to be the ideal approach (94%). Despite this a significant minority of LMC (23%) reported considering that NBS should be mandatory. Of those in our survey who believed that NBS should be mandatory, paradoxically most (89%) still believed that some form of parental consent should be obtained; of those who believed testing should not be mandatory, only a small proportion (10%) would accept parental refusal without question.

CONCLUSIONS

When the results of this survey are considered in conjunction with existing evidence there appears to be a consensus that good quality information in the prenatal period should be an integral part of any NBS programme. The issue of consent is more complex and there is less agreement on the preferred degree of parental involvement in decisions to allow babies to undergo NBS. A policy that both strongly recommends NBS but also allows parental choice appears to be most consistent with the views of LMC in this survey.

Federated repositories of X-ray diffraction images

There is a pressing need for the archiving and curation of raw X-ray diffraction data. This information is critical for validation, methods development and improvement of archived structures. However, the relatively large size of these data sets has presented challenges for storage in a single worldwide repository such as the Protein Data Bank archive. This problem can be avoided by using a federated approach, where each institution utilizes its institutional repository for storage, with a discovery service overlaid. Institutional repositories are relatively stable and adequately funded, ensuring persistence. Here, a simple repository solution is described, utilizing Fedora open-source database software and data-annotation and deposition tools that can be deployed at any site cheaply and easily. Data sets and associated metadata from federated repositories are given a unique and persistent handle, providing a simple mechanism for search and retrieval via web interfaces. In addition to ensuring that valuable data is not lost, the provision of raw data has several uses for the crystallographic community. Most importantly, structure determination can only be truly repeated or verified when the raw data are available. Moreover, the availability of raw data is extremely useful for the development of improved methods of image analysis and data processing.

Risk of herpes simplex virus type 2 acquisition increases over early adulthood: evidence from a cohort study

DESIGN/ SETTING: A cohort study of 1037 people born in Dunedin, New Zealand, in 1972 or 1973.

PARTICIPANTS

At assessment at age 32 years, 884 participants (432 women and 452 men; 87.1% of the surviving cohort) provided both sera and information on sexual behaviour.

MAIN OUTCOME MEASURES

The proportion of participants with antibodies to HSV-2 infection at ages 26 and 32 years was measured, and the incidence rates from first coitus to age 26 years and from age 26 to 32 years calculated, adjusting for the number of sexual partners and same-sex contact in these age periods.

RESULTS

At age 32 years, 14.6% of men and 22.5% of women had antibodies to HSV-2. The incidence rates for men and women from first coitus to age 26 years were, respectively, 6.5 and 14.3 per 1000 person-years. The incidence rates for men and women from age 26-32 years, respectively, were 14.3 and 15.8 per 1000 person-years. When adjusted for sexual behaviour, the incidence rate ratio, comparing the older with the younger age periods, was 2.9 (95% confidence interval (CI) 1.7 to 4.9) for men and 2.0 (1.2 to 3.4) for women. The adjusted incidence rate ratio when comparing women to men from first coitus to age 26 years was 2.5 (1.6 to 4.0), and from age 26-32 years was 1.3 (0.78 to 2.2). A test for interaction indicated that men and women had different patterns of incidence over time (p = 0.039).

CONCLUSION

In the general population, the risk of acquiring HSV-2 infection seems to increase with age at least to the early 30s, and differences in risk of acquisition for women compared with men become less with age. Health promotion and treatment to control HSV-2 infection should be aimed at all ages, not just at the young.

Ixabepilone given weekly in patients with advanced malignancies: Final efficacy and safety results of a phase I trial

2040

Background: Ixabepilone is a potent tubulin-targeting agent. The first epothilone analog, ixabepilone, has been developed to optimize the characteristics of the naturally occurring epothilone B. Methods: This open-label, single-arm Phase I dose escalation study was designed to establish the maximum tolerated dose (MTD), dose-limiting toxicity (DLT), safety and a recommended dose of ixabepilone when administered as a weekly infusion to patients (pts) with solid tumors who had failed standard therapy. Eligible pts were aged ≥18 years and had histologically/cytologically confirmed solid tumor disease and an ECOG status of 0–2. Ixabepilone was administered weekly as a 30-minute infusion on a 21-day schedule. Due to neurotoxicity, infusion time was increased to 1 hour with a 1-week break allowed. Dosing ranged from 1–30 mg/m2. Tumor evaluations were performed every 6 or 8 weeks (21-day or 28-day schedule, respectively). Toxicity was evaluated continuously. Results: 34 pts were treated on the 21-day schedule (median age 55, range 30–73) and 52 on the 28-day schedule (median age 55, range 33–79). 88% of pts had received prior chemotherapy. Grade 3 fatigue was the DLT in 2 of the 4 pts treated with 30 mg/m2 ixabepilone. No DLTs were seen at doses ≤25 mg/m2 on the 21-day schedule, or at doses of 15, 20 or 25 mg/m2 on the 28-day schedule. The MTD was 25 mg/m2 for the 21-day schedule. Of 12 pts who received this dose and schedule, 7 (58%) experienced Grade 1/2 neuropathy, 1 (8%) developed Grade 3 sensory neuropathy and 3 (25%) experienced Grade 3 fatigue. Of 52 pts who received 20 mg/m2 on the 28-day schedule, 2 (13%) had Grade 3 neutropenia, 1 (7%) had Grade 3/4 sensory neuropathy and 4 (27%) had Grade 3 fatigue. Five pts (two pts [21-day schedule], three pts [28-day schedule]) with breast, colon, ovary, head and neck tumors achieved objective partial responses. Conclusions: The recommended doses of ixabepilone from this study are 25 mg/m2 (30-minute weekly infusion, 21-day schedule) and 20 mg/m2 (1-hour weekly infusion, 28-day schedule). Ixabepilone demonstrated efficacy and an acceptable safety profile in pts with a broad range of tumor types, several of whom had failed a taxane.

[Table: see text]

Predicting early fatherhood and whether young fathers live with their children: prospective findings and policy reconsiderations

This prospective study of a birth cohort addressed three questions. Which individual and family-of-origin characteristics predict the age at which young men make the transition to fatherhood? Do these same characteristics predict how long young men live with their child? Are individual differences in the amount of time fathers spend living with their child associated with the father's psychosocial characteristics in young adulthood? In this unique study, it was found that by age 26, 19% of the 499 study men had become fathers. Individual and family-of-origin characteristics were assessed from birth until age 15 and contemporaneous characteristics were assessed at age 26. Young men who experienced a stressful rearing environment and a history of conduct problems were more likely to become fathers at an early age and to spend less time living with their child. Of those who experienced none of the risk factors, fewer than 10% had become fathers by age 26 compared to more than 60% of those who experienced five risk factors. Fathers who lived apart from their child reported the most social and psychological difficulties in young adulthood. These findings point to individual and family-of-origin characteristics that might be targeted in order to delay fatherhood and increase levels of paternal involvement. However, given their troubled life histories and poor social-psychological adjustment in young adulthood, some absent fathers might have difficulties providing positive parenting and partnering unless policy initiatives to promote intact families also support young fathers.

Predicting early fatherhood and whether young fathers live with their children: prospective findings and policy reconsiderations

This prospective study of a birth cohort addressed three questions. Which individual and family-of-origin characteristics predict the age at which young men make the transition to fatherhood? Do these same characteristics predict how long young men live with their child? Are individual differences in the amount of time fathers spend living with their child associated with the father's psychosocial characteristics in young adulthood? In this unique study, it was found that by age 26, 19% of the 499 study men had become fathers. Individual and family-of-origin characteristics were assessed from birth until age 15 and contemporaneous characteristics were assessed at age 26. Young men who experienced a stressful rearing environment and a history of conduct problems were more likely to become fathers at an early age and to spend less time living with their child. Of those who experienced none of the risk factors, fewer than 10% had become fathers by age 26 compared to more than 60% of those who experienced five risk factors. Fathers who lived apart from their child reported the most social and psychological difficulties in young adulthood. These findings point to individual and family-of-origin characteristics that might be targeted in order to delay fatherhood and increase levels of paternal involvement. However, given their troubled life histories and poor social-psychological adjustment in young adulthood, some absent fathers might have difficulties providing positive parenting and partnering unless policy initiatives to promote intact families also support young fathers.

Unwanted pregnancy and contraceptive knowledge: identifying vulnerable groups from a randomized controlled trial of educational interventions

OBJECTIVES

The aim of this study was to identify predictors of contraceptive pill knowledge and their relationship to educational interventions.

METHODS

A total of 636 women attending for a follow-up appointment for repeat prescription of the combined oral contraceptive pill with a GP or practice nurse were randomized to receive leaflets (simple summary leaflet or FPA leaflet), advice or neither. Sociodemographic details and contraceptive knowledge were determined using a validated contraceptive knowledge questionnaire sent after 3 months by post. The main outcomes were sociodemographic, contraceptive, attitudinal and educational predictors of knowledge.

RESULTS

A total of 522 (82%) had complete questionnaires. After controlling for educational intervention and other confounding variables, independent predictors of knowledge were further education (adjusted odds ratio 2.98, 95% confidence interval 1.78-4.99); number of years on the pill (0-5, 6-10, >10 years) 1.0, 0.56 (0.33-0.95) and 0.34 (0.19-0.59), respectively; past emergency contraception (1.87, 1.18-2.97); and importance attached to not falling pregnant (1.83, 1.02-3.29). These predictors are less powerful than the impact of most educational interventions (range of odds ratios for interventions: 1.85-6.81), and there was no evidence of a separate effect of educational intervention in any subgroup, except that leaflets have a larger effect in women who have needed emergency contraception in the past (no past use or simple summary and FPA leaflets, 1.74 and 0.90, respectively; with past use, 3.47 and 3.83; interaction term chi-square 6.92, P = 0.03).

CONCLUSION

Educational interventions are as important as sociodemographic features in determining knowledge. With limited time for full educational interventions in practice, priorities for intervention should be women who have used emergency contraception in the past-who will benefit most-and those on the pill for >5 years or with no further education who are at highest risk due to poor knowledge.

Performance comparison of suspended bed and batch contactor chromatography

In some applications, the purification and recovery of biomolecules is performed via a cascade of batch adsorption and desorption stages using agitated contactors and related filtration devices. Suspended bed chromatography is a recent process-scale innovation that is applicable to these separations. This hybrid technique exploits the benefits of combining batch adsorption in an agitated contactor with elution in an enclosed column system. To some extent, the process is similar to batch contactor chromatography but can be fully contained and significantly quicker. The process has two steps; first the fluid containing the sample is mixed with the adsorbent in a stirred tank. Second, the slurry suspension is transferred directly into a specialized column, such as an IsoPak column. The media with the adsorbed product is formed as a packed bed, whilst the suspension liquid is passed out of the column. The product is then eluted from the packed bed utilizing standard column-chromatography techniques. The performance of the suspended bed and the agitated contactor operations are demonstrated both by full-scale experimental results and process simulations. The purification of ovalbumin from a hen-egg white feedstock by anion-exchange chromatography was used as a case study in order to prove the concept. With the availability of both pump-packed systems and shear-resistant media, suspended bed chromatography is a better alternative for a range of applications than the traditional batch separations using agitated contactors.

Enhanced surveillance of HIV infections in New Zealand, 1996-1998

AIM

To improve understanding of the HIV epidemic in New Zealand through use of an enhanced voluntary reporting system for new diagnoses of HIV.

METHODS

Routine reporting of new HIV diagnoses by the two laboratories that perform confirmatory HIV antibody testing, to the Department of Health and later to the AIDS Epidemiology Group, has been in place since 1985. From January 1996, this was supplemented by a questionnaire about demographic characteristics and circumstances of HIV exposure sent to clinicians requesting the HIV test.

RESULTS

From January 1996 to December 1998, 260 new diagnoses of HIV were reported (205 males, 55 females) and extra information was obtained from clinicians for 253 (97.3%) people. HIV diagnosis rate was highest for 'other' ethnicity and similar for European, Maori and Pacific Island ethnic groups. Sexual intercourse between men was the commonest mode of infection (43.5%), followed by heterosexual intercourse (40.0%) and injecting drug use (2.7%). Places of infection were New Zealand (38.5%), Australia (7.7%), 'other' overseas (45.4%) and unknown (8.5%). Heterosexual infections were acquired through contact with a person in or from a high prevalence area (mainly in Africa or Asia) for 86.7% of males and 68.2% of females. Second generation heterosexual transmission was rare.

CONCLUSIONS

Introduction of an enhanced surveillance system has been successful. Results confirm continuing spread of HIV in New Zealand amongst men who have sex with men, and suggest low levels of heterosexual and injecting drug use transmission in New Zealand. Of major importance in the occurrence of heterosexual infection is the role of imported HIV.

Suspended bed chromatography, a new approach in downstream processing

A new technique in downstream processing, suspended bed chromatography has been developed. This hybrid technique exploiting the benefits of batch adsorption and the process advantages of an enclosed column system can be carried out using established contactors and adsorbents. A 44 cm I.D. IsoPak column and the anion-exchange cellulose Express-Ion Exchanger Q were used in the purification of ovalbumin from hen-egg white. After suspension of 16.25 kg Express-Ion Q in 500 l of feedstock containing 5 g protein/l, adsorption was effected by recirculation of the suspension using the IsoPak slurry preparation station. Protein-loaded adsorbent was collected in the IsoPak column unit, where it was washed and protein desorbed using gradient elution at a flow-rate of 300 cm/h. The entire process was complete in under 3 h. With the introduction of pump-packed column systems and the availability of mechanically strong adsorbents suitable for column separations, suspended bed chromatography offers a new approach to downstream processing and provides a less challenging alternative to batch separations.

The determinants of sexual intercourse before age 16

PURPOSE

To identify risk and protective factors for initiation of sexual intercourse before age 16 years at the level of the individual, family, and school.

METHODS

A longitudinal study based on a cohort of 1020 people born in Dunedin, New Zealand in 1972/73 and followed up to age 21 years. Demographic characteristics of the sample were similar to the New Zealand population of that age, except that a smaller proportion (3%) were Maori or Pacific Island Polynesian. Information on individual, family and school factors was collected by interview with parents at ages 3, 5, 7 and 9 years and then by postal questionnaire two-yearly up to 15 years. Subjects were assessed two-yearly from age 3 years and interviewed about their behaviours and ambitions at ages 11, 13, and 15 years. Questions about age at first intercourse were asked by computer at age 21 years. Multivariate logistic regression was used to model associations with age of first intercourse less than 16 years.

RESULTS

Data on age at first intercourse were available for 926/1020 (91%) of surviving members of the cohort assembled at age 3 years. Overall 27.5% of males and 31.7% of females reported sexual intercourse before age 16 years. In multivariate analyses the independent predictors for early sexual initiation for males were: not having outside home interests at age 13 years, no religious activity at age 11 years, not being attached to school at age 15 years, a low reading score, and a diagnosis of conduct disorder in early adolescence. For females, independent predictors were: socioeconomic status in the middle range, mother having her first child before age 20 years, IQ in the middle range, not being attached to school, being in trouble at school, planning to leave school early, cigarette smoking and higher self-esteem score.

CONCLUSIONS

Individual and school factors appear to be more important than family composition or socioeconomic status in the decision to have sexual intercourse before age 16 years. The lowering of age at first intercourse may be partly a cohort effect related to high rates of teenage childbearing in the mothers' generation, and to changes in social acceptability of early sexual behaviour.

Psychiatric disorders and risky sexual behaviour in young adulthood: cross sectional study in birth cohort

OBJECTIVE

To determine if risky sexual intercourse, sexually transmitted diseases, and sexual intercourse at an early age are associated with psychiatric disorder.

DESIGN

Cross sectional study of a birth cohort at age 21 years with assessments presented by computer (for sexual behaviour) and by trained interviewers (for psychiatric disorder).

SETTING

New Zealand in 1993-4.

PARTICIPANTS

992 study members (487 women) from the Dunedin multidisciplinary health and development study. Complete data were available on both measures for 930 study members.

MAIN OUTCOME MEASURES

Psychiatric disorders (anxiety, depression, eating disorder, substance dependence, antisocial disorder, mania, schizophrenia spectrum) and measures of sexual behaviour.

RESULTS

Young people diagnosed with substance dependence, schizophrenia spectrum, and antisocial disorders were more likely to engage in risky sexual intercourse, contract sexually transmitted diseases, and have sexual intercourse at an early age (before 16 years). Unexpectedly, so were young people with depressive disorders. Young people with mania were more likely to report risky sexual intercourse and have sexually transmitted diseases. The likelihood of risky behaviour was increased by psychiatric comorbidity.

CONCLUSIONS

There is a clear association between risky sexual behaviour and common psychiatric disorders. Although the temporal relation is uncertain, the results indicate the need to coordinate sexual medicine with mental health services in the treatment of young people.

Sexual abstinence at age 21 in New Zealand: the importance of religion

Most research on adolescent sexual behaviour has focused on early initiation and consequent risks. We have instead examined the circumstances of young people who have not had sexual intercourse before age 21, in order to throw light on the ways in which young people might resist societal pressures for early sexual intercourse. The sample was a cohort born in Dunedin, New Zealand in 1972/73, formed at age 3, and followed with regular assessments of personal, family and educational functioning to age 21. At age 18 and 21 information on sexual behaviour was collected, using a computer presented questionnaire. The response rate at age 21 was 935/1020 (91.7%) of the survivors of the original cohort. Overall 11.3% of the men and 8.1% of the women reported never having sexual intercourse. Sex with a man was reported by 20 men (4.5%), of whom only two reported having sex only with men. Being first born and being persistently involved in religious activities, measured at both 11 years and 21 years, were significant predictors of abstinence for both sexes. Examination of perceptions of an ideal lifestyle, sexual behaviour and religious involvement showed that religion was an important factor in decisions to delay sexual intercourse past age 20, especially for men. It would be helpful to examine further the features of moral decision making which are characteristic of religious experiences.

Pregnancies among New Zealand teenagers: trends, current status and international comparisons

AIMS

To examine trends in birth and total pregnancy rates among teenage women in New Zealand, ethnic differences and international comparisons.

METHODS

Routinely collected data on births and abortions by age in New Zealand have been used to derive teenage birth rates and estimated total teenage pregnancy rates.

RESULTS

The teenage birth rate rose from the end of the Second World War until 1972, then dropped until 1986, since when it has risen slightly. An increase in the proportion of teenage pregnancies aborted since 1986 has prevented a more marked increase in the birth rate. In 1997, the teenage birth rate for Maori was nearly five times, and the Pacific rate over three times, that of European/Pakeha teenagers. Although the abortion rate was slightly higher among Maori than European/Pakeha teenagers, Maori who became pregnant were much less likely to have an abortion. Of the developed OECD countries, only the USA has a higher teenage birth rate than New Zealand. However, the teenage birth rate among European/Pakeha in New Zealand, while higher than in many Western European countries, is similar to the total rate in Australia, and less than that in the UK and Canada.

CONCLUSIONS

This analysis shows that using routinely collected data, it is possible to monitor national teenage pregnancy rates. Improvements in monitoring could be made by collecting ethnicity data on abortions and births in a consistent manner, together with the area of residence of women having abortions. The findings indicate the importance of understanding the impact on Maori women who become pregnant as teenagers and on their children.

Tension between policy and practice

This is the first in a series of articles in which the political influences on the health service are examined. Niall Dickson, currently Social Affairs Editor with the BBC, gave this paper at Congress 1999--which had the overall theme of Rewind, Pause, Fastforward. Niall Dickson is a former editor of Nursing Times (1983-1988) and he has a continuing interest in matters affecting health and social policy.