The impact of the COVID-19 pandemic on cancer diagnosis and service access in New Zealand-a country pursuing COVID-19 elimination.

BACKGROUND: The COVID-19 pandemic has disrupted cancer services globally. New Zealand has pursued an elimination strategy to COVID-19, reducing (but not eliminating) this disruption. Early in the pandemic, our national Cancer Control Agency (Te Aho o Te Kahu) began monitoring and reporting on service access to inform national and regional decision-making. In this manuscript we use high-quality, national-level data to describe changes in cancer registrations, diagnosis and treatment over the course of New Zealand's response to COVID-19. METHODS: Data were sourced (2018-2020) from national collections, including cancer registrations, inpatient hospitalisations and outpatient events. Cancer registrations, diagnostic testing (gastrointestinal endoscopy), surgery (colorectal, lung and prostate surgeries), medical oncology access (first specialist appointments [FSAs] and intravenous chemotherapy attendances) and radiation oncology access (FSAs and megavoltage attendances) were extracted. Descriptive analyses of count data were performed, stratified by ethnicity (Indigenous Maori, Pacific Island, non-Maori/non-Pacific). FINDINGS: Compared to 2018-2019, there was a 40% decline in cancer registrations during New Zealand's national shutdown in March-April 2020, increasing back to pre-shutdown levels over subsequent months. While there was a sharp decline in endoscopies, pre-shutdown volumes were achieved again by August. The impact on cancer surgery and medical oncology has been minimal, but there has been an 8% year-to-date decrease in radiation therapy attendances. With the exception of lung cancer, there is no evidence that existing inequities in service access between ethnic groups have been exacerbated by COVID-19. INTERPRETATION: The impact of COVID-19 on cancer care in New Zealand has been largely mitigated. The New Zealand experience may provide other agencies or organisations with a sense of the impact of the COVID-19 pandemic on cancer services within a country that has actively pursued elimination of COVID-19. FUNDING: Data were provided by New Zealand's Ministry of Health, and analyses completed by Te Aho o Te Kahu staff.

The culpability of drivers killed in New Zealand road crashes and their use of alcohol and other drugs.

Over a period of five years, blood samples were taken from 1046 drivers killed as a result of a motor vehicle crash on New Zealand roads. These were analysed for the presence of alcohol and a range of both illicit drugs and psychoactive medicinal drugs. Driver culpability was determined for all crashes. The control group of drug- and alcohol-free drivers comprised 52.2% of the study population. Drivers positive for psychoactive drugs were more likely to be culpable (odds ratio (OR) 3.5, confidence interval (CI) 95% 2.4-5.2) than the control group. Driver culpability exhibited the expected positive association with alcohol use (OR 13.7, 95% CI 4.3-44) and with combined alcohol and cannabis use (OR 6.9, 95% CI 3.0-16). There was only a weak positive association between cannabis use (with no other drug) and culpability (OR 1.3, CI 95% 0.8-2.3). Furthermore, the OR for drivers with blood tetrahydrocannabinol (THC) concentrations greater than 5 ng/mL was lower (OR 1.0, CI 95% 0.4-2.4) than drivers with blood THC concentrations less than 2 ng/mL (OR 3.1, CI 95% 0.9-10). This is inconsistent with results reported by other studies where a significant increase in crash risk was found with blood THC levels greater than 5 ng/mL. In this study, there were very few drivers who had used a single drug, other than cannabis or alcohol. Therefore, from this study, it is not possible to comment on any relationship between opioid, stimulant or sedative drug use and an increased risk of being killed in a crash for the drivers using these drugs. The results from a multivariate analysis indicate that driver gender, age group and licence status, (P=0.022, P=0.016, P=0.026, respectively), the type of vehicle being driven (P=0.013), the number of vehicles in the crash (P<0.001), the blood alcohol concentration of the driver (P<0.001) and the use of any drug other than alcohol and cannabis (P=0.044), are all independently associated with culpability.

The detection of spatially localised outbreaks in campylobacteriosis notification data.

This paper applies a Bayesian hierarchical model designed to identify potential outbreaks of campylobacteriosis from a background of sporadic cases. We assume that such outbreaks are characterized by spatially-localised periods of increased incidence. As well as calculating an outbreak probability for each potential disease cluster, the model simultaneously estimates the underlying spatial and temporal distribution of sporadic cases. The model is applied to notification data from a region of New Zealand for the period 2001-2007 and correctly identifies known outbreaks, whilst highlighting an appropriate number of potential outbreaks for further investigation. Using simulated data, we show that if additional epidemiological information is included in the construction of the model then it can outperform an established method.

Microbial groundwater quality and its health implications for a border-strip irrigated dairy farm catchment, South Island, New Zealand.

Intensification of dairying on irrigated pastures has led to concern over the microbial quality of shallow groundwater used for drinking purposes. The effects of intensive dairying and border-strip irrigation on the leaching of E. coli and Campylobacter to shallow groundwater were assessed over a three-year period in the Waikakahi catchment, Canterbury, New Zealand. Well selection excluded other sources of contamination so that the effect of dairying with border-strip irrigation could be assessed. Groundwater samples (135) were collected, mostly during the irrigation season, with E. coli being detected in 75% of samples. Campylobacter was identified in 16 samples (12%). A risk assessment of drinking water with these levels of Campylobacter was undertaken. A probability distribution was fitted to the observed Campylobacter data and the @RISK modeling software was used, assuming a dose response relationship for Campylobacter and consumption of 1 L/day of water. The probability of infection on any given day in the study area was estimated at 0.50% to 0.76%, giving an estimated probability of infection during the irrigation season of 60% to 75%. An epidemiological assessment of the Canterbury region comparing areas encompassing dairy within major irrigation schemes (approximately 55% border-strip irrigation) to two control groups was undertaken. Control group 1 (CG1) encompasses areas of dairying without major irrigation schemes, and a second larger control group (CG2) comprises the rest of the Canterbury region. Comparisons of the subject group to control groups indicated that there was a statistically significant increase in age-standardised rates of campylobacteriosis (CG1 Relative Risk (RR)=1.51 (95% CI = 1.31-1.75); CG2 RR = 1.51 (1.33-1.72)); cryptosporidiosis (CG1 RR = 2.08 (1.55-2.79); CG2 RR = 5.33 (4.12-6.90)); and salmonellosis (CG2 RR = 2.05 (1.55-2.71)).