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Research into births and healthy homes to improve outcomes for NZers - HRC

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Fuseworks Media

Newly funded study aims to improve outcomes for more than one in 10 NZ births 

New Zealand researchers are about to undertake the largest-ever trial of corticosteroids in women having planned caesareans, to assess the treatment’s benefit and potential harm in newborns.

Associate Professor Katie Groom from The University of Auckland’s Liggins Institute has just been awarded $1.43 million by the Health Research Council of New Zealand (HRC) to lead a nationwide placebo-controlled, randomised trial into the effects of maternal corticosteroid use prior to planned caesarean at between 35 to 39 weeks of pregnancy.

She says the trial will address a serious evidence gap and will reliably inform future practice across New Zealand and globally.

In New Zealand, birth by planned caesarean section continues to rise and now accounts for more than one in 10 births (7,500 babies a year). To counter the increased risk of breathing problems that can occur with planned caesareans, mums are often given corticosteroids at near to full-term stages of pregnancy; however, there is surprisingly limited evidence about the benefits or harm of this fairly common practice.

While corticosteroids administered in earlier stages of pregnancy have well-established benefits for babies born prematurely, little is known about their use at near or full-term, says Associate Professor Groom.

"There is low-quality evidence on respiratory benefits, minimal evidence on long-term effects, and no evidence of their effect on blood-sugar levels.

"The steroids might help babies with breathing, but they might also disrupt glucose control, which could be detrimental in the long-term, so our trial will look at the balance of benefit versus potential harm."

She says high-quality evidence is required to allow women with planned caesareans to make informed decisions about their treatments.

The C-STEROID Trial will take place in at least 14 hospitals across New Zealand and include 2548 babies and their mothers.

"This will be a national effort to answer an important question. Findings aim to be definitive and will inform clinical practice in New Zealand and across the world," she says.

Another benefit of the trial will be the opportunity to follow-up a cohort of the children when they reach the age of six or seven and can be assessed for long-term impacts, such as childhood executive function, body size, and respiratory, cardiovascular and metabolic wellbeing.

The HRC’s chief executive, Professor Sunny Collings, says clinical trials like this are imperative to ensuring patient care is informed by strong, reliable evidence - not just the ‘best available’ evidence which is often low quality.

"Interventions in pregnancy and infancy can have long-lasting effects. This trial will find out what happens in the short-term, but maintaining contact with the cohort to allow assessment of the longer-term effects will be a major contribution in its own right," she says.

Associate Professor Groom’s study is one of 47 new studies awarded a total of $71.58 million in the Health Research Council’s latest funding results released today.

Of that total, $19.88 million was awarded to four research ‘programmes’ that will take up to five years to complete; $47.73 million was awarded to 39 research projects, including $4.87 million for four Rangahau Hauora Māori projects; and another $3.97 million was awarded to four Pacific research projects.

Healthy homes for all Kiwis at heart of major new research programme

The team whose highly influential research provided the evidence base for such major changes to New Zealand’s housing policy as the EECA Warmer Homes insulation scheme and new national Healthy Housing Standards for rental properties have received a $5 million Health Research Council (HRC) Programme grant to work on interventions that will help all New Zealanders live in warm, dry, mould-free and safe homes.

From the University of Otago, Wellington, Associate Professor Nevil Pierse and Distinguished Professor Philippa Howden-Chapman will work with other members of the He Kāinga Oranga/Housing and Health Research Programme team - a multidisciplinary group including researchers from the universities of Otago, Victoria and Massey, BRANZ and Motu Economic and Public Policy Research - to test a suite of new interventions designed to increase equitable health outcomes and enhance New Zealanders’ wellbeing. They will also evaluate and scale up existing housing interventions that are proven to be effective.

Programme co-leader Associate Professor Pierse says that despite the significant progress made in recent years to improve the quality of New Zealand’s homes through subsidised insulation schemes and energy-efficient heating, up to 900,000 New Zealand homes remain unhealthy, with low-income renters most at risk.

"New Zealand’s poor housing quality, particularly private rental housing, has created a large health burden, with 28,000 children and 54,000 adults hospitalised each year for potentially avoidable hospitalisations linked to old, cold, damp and mouldy houses. Most of these affected children come from low-income households, with Māori and Pasifika children three and four times over-represented," says Associate Professor Pierse.

As part of the five-year Programme, the He Kāinga Oranga research team will work closely with the Ministry of Business, Innovation and Employment to measure the impact that new mandatory Healthy Homes Standards for rental properties (due to be in place from July 2021), are having on housing quality, including indoor temperatures, air quality, physical and mental health, and mortality. The standards cover improvements to heating, insulation and ventilation, and addressing issues with moisture ingress and drainage.

He Kāinga Oranga took a leading role in developing the World Health Organization (WHO) International Guidelines on Housing and Health, and they will also analyse why some of the interventions included in these guidelines were left out of New Zealand’s Healthy Homes Standards, such as interventions for eradicating mould, reducing injuries in the home, and mitigating increased temperatures due to climate change.

"Although we’ve seen positive changes to policy at the Tenancy Tribunal, local council and national level and in global guidelines, they’ve all picked up different parts of the evidence base. Some parts, particularly the evidence for preventing injuries in homes, haven’t had the emphasis that they deserve. Together with our government, community and Māori partners throughout New Zealand, we will work to drive the translation and implementation of that research forward," says Associate Professor Pierse.

HRC chief executive Professor Sunny Collings says the Health Research Council will now have funded He Kāinga Oranga’s housing and health research for 25 years, enabling the team to consistently build on the evidence base for healthy housing interventions and translate this into policy across a range of government departments.

"Through their research, He Kāinga Oranga has completely changed the conversation around housing and health. People now understand that the condition of their house can significantly impact on their health. The EECA schemes that have run alongside this research have insulated 300,000 New Zealand homes to date, which amounts to a cost savings of about $4 billion to the health sector and prevented some 80,000 hospitalisations," says Professor Collings.

"There’s been a huge shift in the knowledge, evidence and policy base as a result of this research. It’s been recognised by the International Council of Science and the WHO, and it’s changed housing policy not only in New Zealand, but in Australia, Scotland, the UK and Canada."

Professor Collings says this new Programme will build on the great work done previously to deliver tangible health benefits and broader social, cultural and wellbeing benefits at a wider population level.

The Health Research Council’s Programme grants are awarded for research that will contribute to significantly improving health outcomes for New Zealanders.

Associate Professor Nevil Pierse and Distinguished Professor Philippa Howden-Chapman’s grant is one of four Programme grants announced today for a combined total of $19.88 million. The HRC has also announced funding for 39 Projects ($47.73 million) and 4 Pacific Projects ($3.97 million).

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