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Introduction: The global burden of diabetes mellitus (diabetes) is significant and of increasing concern with more pregnant women being diagnosed with gestational diabetes mellitus (GDM). The Cook Islands face mounting pressures to address diabetes alongside competing population health needs and priorities. Cook Islands residents frequently travel to New Zealand to access health services. Inadequate information systems also make it difficult for countries to prioritise preventative measures for investment. In the absence of good data to inform effective diabetes preventative and treatment measures, people with diabetes are likely to progress to complications which will burden society and health systems in the Cook Islands and New Zealand.Aim: To determine the prevalence of diabetes and prediabetes, and incidence of GDM, in the Cook Islands.Methods: We analysed two Te Marae Ora Cook Islands Ministry of Health datasets, the Non‐Communicable Diseases (NCD) register examining demographic data for the period 1967 to December 2018 and same for the GDM register from January 2009 to December 2018.Results: Of the 1270 diabetes cases, 53% were female and half were aged 45–64 years. There were 54 pre-diabetes cases and 146 GDM. Of the 20 GDM cases who developed type 2 diabetes, 80% were diagnosed before the age of 40 years. Data quality was poor.Discussion: The Cook Islands diabetes registers provide important data to inform priorities for diabetes-related preventative and treatment measures. A data analyst has been employed to ensure quality, regularly audited data and information systems.

Here is your chance to get right off the tourism grid in the Polynesian Isles, with a full-colour planning section; guide to travel with children; chapters full of tips for families; inspirational image gallery, and more.

Excess bodyweight is a major public health concern. However, few worldwide comparative analyses of long-term trends of body-mass index (BMI) have been done, and none have used recent national health examination surveys. We estimated worldwide trends in population mean BMI. We estimated trends and their uncertainties of mean BMI for adults 20 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (960 country-years and 9·1 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean BMI by age, country, and year, accounting for whether a study was nationally representative. Between 1980 and 2008, mean BMI worldwide increased by 0·4 kg/m 2 per decade (95% uncertainty interval 0·2–0·6, posterior probability of being a true increase >0·999) for men and 0·5 kg/m 2 per decade (0·3–0·7, posterior probability >0·999) for women. National BMI change for women ranged from non-significant decreases in 19 countries to increases of more than 2·0 kg/m 2 per decade (posterior probabilities >0·99) in nine countries in Oceania. Male BMI increased in all but eight countries, by more than 2 kg/m 2 per decade in Nauru and Cook Islands (posterior probabilities >0·999). Male and female BMIs in 2008 were highest in some Oceania countries, reaching 33·9 kg/m 2 (32·8–35·0) for men and 35·0 kg/m 2 (33·6–36·3) for women in Nauru. Female BMI was lowest in Bangladesh (20·5 kg/m 2, 19·8–21·3) and male BMI in Democratic Republic of the Congo 19·9 kg/m 2 (18·2–21·5), with BMI less than 21·5 kg/m 2 for both sexes in a few countries in sub-Saharan Africa, and east, south, and southeast Asia. The USA had the highest BMI of high-income countries. In 2008, an estimated 1·46 billion adults (1·41–1·51 billion) worldwide had BMI of 25 kg/m 2 or greater, of these 205 million men (193–217 million) and 297 million women (280–315 million) were obese. Globally, mean BMI has increased since 1980. The trends since 1980, and mean population BMI in 2008, varied substantially between nations. Interventions and policies that can curb or reverse the increase, and mitigate the health effects of high BMI by targeting its metabolic mediators, are needed in most countries. Bill & Melinda Gates Foundation and WHO.

Global change and human expansion have resulted in many species extinctions worldwide, but the geographic variation and determinants of extinction risk in particular guilds still remain little explored. Here, we quantified insular extinctions of frugivorous vertebrates (including birds, mammals and reptiles) across 74 tropical and subtropical oceanic islands within 20 archipelagos worldwide and investigated extinction in relation to island characteristics (island area, isolation, elevation and climate) and species’ functional traits (body mass, diet and ability to fly). Out of the 74 islands, 33 islands (45%) have records of frugivore extinctions, with one third (mean: 34%, range: 2–100%) of the pre-extinction frugivore community being lost. Geographic areas with more than 50% loss of pre-extinction species richness include islands in the Pacific (within Hawaii, Cook Islands and Tonga Islands) and the Indian Ocean (Mascarenes, Seychelles). The proportion of species richness lost from original pre-extinction communities is highest on small and isolated islands, increases with island elevation, but is unrelated to temperature or precipitation. Large and flightless species had higher extinction probability than small or volant species. Across islands with extinction events, a pronounced downsizing of the frugivore community is observed, with a strong extinction-driven reduction of mean body mass (mean: 37%, range: –18–100%) and maximum body mass (mean: 51%, range: 0–100%). The results document a substantial trophic downgrading of frugivore communities on oceanic islands worldwide, with a non-random pattern in relation to geography, island characteristics and species’ functional traits. This implies severe consequences for ecosystem processes that depend on mutualistic plant–animal interactions, including ecosystem dynamics that result from the dispersal of large-seeded plants by large-bodied frugivores. We suggest that targeted conservation and rewilding efforts on islands are needed to halt the defaunation of large and non-volant seed dispersers and to restore frugivore communities and key ecological interactions.

Pacific Island countries and territories (PICTs) face unique challenges in delivering health care and sustaining digital health systems. These challenges include geographically dispersed populations and service delivery points, workforce shortages, and poor infrastructure. National electronic health records (EHRs) can strengthen health systems by facilitating continuity of care but are only available in 47% of countries worldwide. The status of national EHRs in PICTs has not been previously described in the published literature. This study aimed to map national EHR coverage in 14 PICTs of the World Health Organization (WHO) Western Pacific Region classified as Small Island Developing States (SIDS). This included the presence or absence of a national EHR; identification of EHR software used; coverage nationally and across primary, secondary, and tertiary facilities; presence or absence of supporting digital health or health information system strategies and policies; comparison of national EHR coverage in PICTs with national EHR coverage globally; and exploration of a relationship between EHR coverage and country income in PICTs. Given the absence of peer-reviewed literature on EHRs in PICTs, an environmental scan methodology was selected to review gray literature sources. We conducted a 3-stage environmental scan to systematically search publicly available websites across government, bilateral, multilateral, and philanthropic organizations for documents describing the status of national EHR implementations in the aforementioned 14 PICTs. Of the 14 PICTs assessed, 12 countries (86%) have an EHR implemented at some level of the public health system, and 8 (57%) have a single national system implemented at more than one facility. Although this is higher than national EHR coverage rates globally (57/122, 47%), average coverage across the 12 PICTs using EHRs was only 39% (median 16%). We also identified a positive relationship between EHR coverage and country income status and generally medium to high EHR coverage across tertiary hospitals (19/41, 46%) and secondary care facilities (29/77, 38%) but low implementation at primary care facilities (61/4158, 1.5%). EHR coverage across all facilities in the 14 countries assessed was 2.5% (108/4267). EHR software used includes Tamanu (Nauru, Palau, Samoa, Kiribati, Fiji [Aspen Medical public-private partnership hospitals]), Medtech (Cook Islands, Niue), Vesalius (Tonga), PATIS Plus (Fiji), and custom systems. Our findings demonstrate, for the first time, that EHRs are being implemented in PICTs, including at scale in some settings. Despite high apparent coverage in some PICTs, the success of implementation and health worker usage remains unclear. Gray literature indicates that some EHRs currently available are failing or incapable of scaling nationally. To support sustainability of national EHRs in PICTs, governments should prioritize the implementation of fit-for-purpose, open-source, and scalable EHRs, and future studies should assess the success of EHR adoption and impact in the region.

Aim: To quantify the influence of past archipelago configuration on present‐day insular biodiversity patterns, and to compare the role of long‐lasting archipelago configurations over the Pleistocene to configurations of short duration such as at the Last Glacial Maximum (LGM) and the present-day. Location: 53 volcanic oceanic islands from 12 archipelagos worldwide—Azores, Canary Islands, Cook Islands, Galápagos, Gulf of Guinea, Hawaii, Madeira, Mascarenes, Pitcairn, Revillagigedo, Samoan Islands and Tristan da Cunha. Time period: The last 800 kyr, representing the nine most recent glacial–interglacial cycles. Major taxa studied: Land snails and angiosperms. Methods: Species richness data for land snails and angiosperms were compiled from existing literature and species checklists. We reconstructed archipelago configurations at the following sea levels: the present‐day high interglacial sea level, the intermediate sea levels that are representative of the Pleistocene and the low sea levels of the LGM. We fitted two alternative linear mixed models for each archipelago configuration using the number of single‐island endemic, multiple‐island endemic and (nonendemic) native species as a response. Model performance was assessed based on the goodness‐of‐fit of the full model, the variance explained by archipelago configuration and model parsimony. Results: Single‐island endemic richness in both taxonomic groups was best explained by intermediate palaeo‐configuration (positively by area change, and negatively by palaeo‐connectedness), whereas non‐endemic native species richness was poorly explained by palaeo‐configuration. Single‐island endemic richness was better explained by intermediate archipelago configurations than by the archipelago configurations of the LGM or present‐day

The widely used tectonic discrimination diagram, \"Th/Yb-Nb/Yb,\" has long served as a global standard. However, it is limited in scope, as it primarily distinguishes igneous rock samples within well-established tectonic settings, such as nonsubduction environments (e.g. midoceanic ridge and oceanic island basalts) and subduction-related volcanic arcs (e.g. continental and island arcs). This study presents a novel approach to geochemical modeling for Th-Nb-Yb systematics, aimed at enhancing our understanding of various magmatic and tectonic settings. We developed a new geochemical discrimination diagram based on Nb/Yb versus Th/Nb ratios, which successfully identifies and differentiates a wider range of tectonic environments than previous models. Our findings demonstrate that this diagram can distinguish between intracontinental rifting, mixed oceanic-continental rifts producing low-alkaline-enriched tholeiitic magmatism, within-plate continental extensional settings (early lithospheric rifts), and alkaline arcs. Additionally, the model identifies magmatic interactions associated with active continental margin that occur due to oceanic slab break-off. Furthermore, our research refines the use of Th/Yb, Nb/Yb, and La/Yb ratios for improved and more accurate magmatic alkalinity discrimination, enabling clearer differentiation among tholeiitic, calc-alkaline, enriched tholeiitic, and alkaline rock types. These advancements provide a more comprehensive framework for interpreting magmatic processes and their tectonic implications, offering valuable insights to the fields of geochemistry and tectonics.

Motivation Past sea level fluctuations have shaped island area and archipelago configuration. The availability of global high‐resolution data on bathymetry and past sea levels allows reconstruction of island palaeo‐geography. Studies on the role of palaeo‐area often consider only the Last Glacial Maximum, which neglects the dynamics of island fusion and fission resulting from cyclic sea level fluctuations throughout the Quaternary. Currently, no global database is available to test the role of changing island geographies driven by Quaternary sea level change on evolutionary, ecological and archaeological patterns. However, data on island palaeo‐environments is crucial for understanding insular biodiversity distributions and human settlement patterns. Here, we present the Palaeo‐Islands and Archipelago Configuration (PIAC) database, containing sea level‐driven palaeo‐geography changes over the late Quaternary of 178 islands in 27 archipelagos, and discuss its relevance, limitations and uncertainties. The R functions developed to create the PIAC database are provided to allow calculations for other islands, time steps, sea‐level curves and higher spatio‐temporal resolutions. Main types of variables contained Polygon shapefiles with archipelago configuration and tables with palaeo‐area per island. Spatial location and grain The database has a global representation, with 27 archipelagos being covered: Aldabra, Azores, Balearic Islands, California Channel Islands, Canary Islands, Cape Verde, Comoros, Cook Islands, Crozet Islands, Dutch Caribbean, Galápagos, Gulf of Guinea, Hawaii, Inner Seychelles, Juan Fernández, Kuril Islands, Madeira, Marianas, Marquesas, Mascarenes, Phoenix Islands, Pitcairn Islands, Prince Edward Islands, Revillagigedo, Samoan Islands, Society Islands and Tristan da Cunha. All data are at 1 km2 spatial resolution. Time period and grain The focus of this paper is on the last 35 kyr; data for the last 140 kyr are also provided. The grain is 1 kyr temporal resolution. Level of measurement Data are per island, grouped per archipelago. Software format The data were produced in the R programming language.

This research examines outcomes from introducing cultural values into Cook Islands secondary schools during two cycles of action research comprising planning, implementing, observing and reflecting. The cultural values upon which the physical education lessons were based were: tāueue (participation), angaanga kapiti (cooperation), akatano (discipline), angaanga taokotai (community involvement), te reo Maori Kuki Airani (Cook Islands Maori language), and auora (physical and spiritual wellbeing). The cultural values were believed to be an essential element of teaching physical education but one challenge was how to assist teachers to implement the cultural values into classroom teaching as most participant teachers were not Cook Islanders. Findings from this action research project suggest that while participant teachers and community cultural experts may agree to incorporate cultural values in teaching Cook Islands secondary school students, teachers nonetheless find difficulties in implementing this objective.