Showing papers by "Andrew R. Gray published in 2013"

Disabling musculoskeletal pain in working populations: is it the job, the person or the culture?

Abstract: To compare the prevalence of disabling low back pain (DLBP) and disabling wrist/hand pain (DWHP) among groups of workers carrying out similar physical activities in different cultural environments, and to explore explanations for observed differences, we conducted a cross-sectional survey in 18 countries. Standardised questionnaires were used to ascertain pain that interfered with everyday activities and exposure to possible risk factors in 12,426 participants from 47 occupational groups (mostly nurses and office workers). Associations with risk factors were assessed by Poisson regression. The 1-month prevalence of DLBP in nurses varied from 9.6% to 42.6%, and that of DWHP in office workers from 2.2% to 31.6%. Rates of disabling pain at the 2 anatomical sites covaried (r = 0.76), but DLBP tended to be relatively more common in nurses and DWHP in office workers. Established risk factors such as occupational physical activities, psychosocial aspects of work, and tendency to somatise were confirmed, and associations were found also with adverse health beliefs and group awareness of people outside work with musculoskeletal pain. However, after allowance for these risk factors, an up-to 8-fold difference in prevalence remained. Systems of compensation for work-related illness and financial support for health-related incapacity for work appeared to have little influence on the occurrence of symptoms. Our findings indicate large international variation in the prevalence of disabling forearm and back pain among occupational groups carrying out similar tasks, which is only partially explained by the personal and socioeconomic risk factors that were analysed.

Patterns of multisite pain and associations with risk factors.

Abstract: To explore definitions for multisite pain, and compare associations with risk factors for different patterns of musculoskeletal pain, we analysed cross-sectional data from the Cultural and Psychosocial Influences on Disability (CUPID) study. The study sample comprised 12,410 adults aged 20–59 years from 47 occupational groups in 18 countries. A standardised questionnaire was used to collect information about pain in the past month at each of 10 anatomical sites, and about potential risk factors. Associations with pain outcomes were assessed by Poisson regression, and characterised by prevalence rate ratios (PRRs). Extensive pain, affecting 6–10 anatomical sites, was reported much more frequently than would be expected if the occurrence of pain at each site were independent (674 participants vs 41.9 expected). In comparison with pain involving only 1–3 sites, it showed much stronger associations (relative to no pain) with risk factors such as female sex (PRR 1.6 vs 1.1), older age (PRR 2.6 vs 1.1), somatising tendency (PRR 4.6 vs 1.3), and exposure to multiple physically stressing occupational activities (PRR 5.0 vs 1.4). After adjustment for number of sites with pain, these risk factors showed no additional association with a distribution of pain that was widespread according to the frequently used American College of Rheumatology criteria. Our analysis supports the classification of pain at multiple anatomical sites simply by the number of sites affected, and suggests that extensive pain differs importantly in its associations with risk factors from pain that is limited to only a small number of anatomical sites.

Long-term vitamin D3 supplementation is more effective than vitamin D2 in maintaining serum 25-hydroxyvitamin D status over the winter months.

Abstract: Public health recommendations do not distinguish between vitamin D2 and vitamin D3, yet disagreement exists on whether these two forms should be considered equivalent. The objective of the present study was to evaluate the effect of a daily physiological dose of vitamin D2 or vitamin D3 on 25-hydroxyvitamin D (25(OH)D) status over the winter months in healthy adults living in Dunedin, New Zealand (latitude 46°S). Participants aged 18-50 years were randomly assigned to 25 μg (1000 IU) vitamin D3 (n 32), 25 μg (1000 IU) vitamin D2 (n 31) or placebo (n 32) daily for 25 weeks beginning at the end of summer. A per-protocol approach, which included ≥ 90 % supplement compliance, was used for all analyses. Serum 25-hydroxyvitamin D3 (25(OH)D3), 25-hydroxyvitamin D2 (25(OH)D2) and parathyroid hormone (PTH) were measured at baseline and at 4, 8, 13 and 25 weeks. Geometric mean total serum 25(OH)D concentrations (sum of 25(OH)D2 and 25(OH)D3) at baseline was 80 nmol/l. After 25 weeks, participants randomised to D2 and placebo had a significant reduction in serum 25(OH)D3 concentrations over the winter months compared with vitamin D3-supplemented participants (both P< 0.001). Supplementation with vitamin D2 increased serum 25(OH)D2 but produced a 9 (95 % CI 1, 17) nmol/l greater decline in the 25(OH)D3 metabolite compared with placebo (P< 0.036). Overall, total serum 25(OH)D concentrations were 21 (95 % CI 14, 30) nmol/l lower in participants receiving vitamin D2 compared with those receiving D3 (P< 0.001), among whom total serum 25(OH)D concentrations remained unchanged. No intervention-related changes in PTH were observed. Daily supplementation of vitamin D3 was more effective than D2; however, the functional consequence of the differing metabolic response warrants further investigation.

The Dose of Hazelnuts Influences Acceptance and Diet Quality but Not Inflammatory Markers and Body Composition in Overweight and Obese Individuals

Abstract: Regular nut consumption may improve markers of inflammation and endothelial dysfunction. The quantity of nuts required to achieve these health benefits without compromising body weight and acceptance is unknown. This study compared the effects of incorporating hazelnuts at 2 different doses with a diet without nuts on inflammatory markers, cell adhesion molecules, and body composition in 107 overweight and obese individuals. This was a randomized, controlled, parallel 12-wk intervention including 3 treatment arms: no nuts (control group), 30 g/d of hazelnuts, or 60 g/d of hazelnuts. Blood pressure, body composition, plasma high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), lipid, and apolipoprotein (apo) profiles were assessed at baseline and at 6 and 12 wk. "Desire" and "liking" for nuts were assessed during the intervention. Results showed no significant differences in follow-up clinical outcomes between groups after adjusting for baseline values, age, sex, and BMI (all P ≥ 0.10), except for a tendency toward improvement in VCAM-1 concentration in the 60-g/d nut group (P = 0.07). Hazelnut consumption significantly improved diet quality in a dose-response manner. Desire and liking for nuts remained stable in the 30-g/d group, whereas these ratings decreased significantly over time in the 60-g/d group (both P < 0.001). In conclusion, 12 wk of hazelnut consumption appears to have minimal effect on inflammatory markers and cell adhesion molecules in this group of healthy, normocholesterolemic overweight and obese individuals. Nut consumption improves diet quality without adversely affecting body composition. Consuming 30 g/d of nuts regularly is achievable, whereas 60 g/d appears to compromise desire and liking.

Risky Drinking, Risky Sex: A National Study of New Zealand University Students

Abstract: BACKGROUND: Sexual risk taking and heavy alcohol use coexist in many populations of young people. A better understanding of the role of alcohol in sexual behaviors with health risks will inform preventive strategies. This study aimed to estimate the associations of risky sexual behavior with usual drinking pattern, with beliefs that alcohol will positively affect sexual experiences, and with drinking at the time of the sexual event. METHODS: We conducted a cross-sectional web-based survey of randomly selected university students on 8 New Zealand campuses in April 2009. Event-level data (drinking, partner type, and condom use at last sexual intercourse) were collected along with contextual data (usual alcohol consumption [AUDIT-C score], history of binge drinking, alcohol-related sexual enhancement expectancies). Regression models were used to estimate associations and potential mediation. RESULTS: The response rate was 50.6% (n = 2,921). After survey weighting, of those respondents who had ever had sex, 32% reported they had been drinking and 56% reported using a condom at last sex; 10.7% reported that their last sexual intercourse was with a nonregular partner and without a condom ("risky sex") (12.3% of men; 9.8% of women; p = 0.159). For both men and women, alcohol-sex expectancy scores and current drinking (AUDIT-C) scores were independently associated with amount of alcohol at last sex. For both men and women, the association of current drinking or expectancy with risky sex was mediated by alcohol at last sex. CONCLUSIONS: Of the complex factors that contribute to risky sexual behavior and negative sexual health outcomes, heavy drinking appears to be important and is potentially modifiable. Addressing environmental determinants of hazardous drinking is likely to reduce negative sexual health outcomes among university students and other young people. Continuing promotion of condom use is also necessary, and further integration of health promotion activities in alcohol and sexual health is warranted. Language: en

The First New Zealanders: Patterns of Diet and Mobility Revealed through Isotope Analysis

Abstract: Direct evidence of the environmental impact of human colonization and subsequent human adaptational responses to new environments is extremely rare anywhere in the world. New Zealand was the last Polynesian island group to be settled by humans, who arrived around the end of the 13th century AD. Little is known about the nature of human adaptation and mobility during the initial phase of colonization. We report the results of the isotopic analysis (carbon, nitrogen and strontium) of the oldest prehistoric skeletons discovered in New Zealand to assess diet and migration patterns. The isotope data show that the culturally distinctive burials, Group 1, had similar diets and childhood origins, supporting the assertion that this group was distinct from Group 2/3 and may have been part of the initial colonizing population at the site. The Group 2/3 individuals displayed highly variable diets and likely lived in different regions of the country before their burial at Wairau Bar, supporting the archaeological evidence that people were highly mobile in New Zealand since the initial phase of human settlement.

Diet and social status on Taumako, a Polynesian outlier in the Southeastern Solomon Islands.

Abstract: Stable isotopes (δ(13)C, δ(15)N, and δ(34)S) are used to characterize the diet of the adult individuals (n = 99) interred in the Namu burial ground located on the Polynesian outlier of Taumako (∼300-750 BP). Polynesian outliers are islands on the fringe of Remote Oceania that were inhabited by a back migration of populations from Polynesia during prehistory. As a result of admixture with nearby island communities, little is known about the social structure and social diversity of the prehistoric inhabitants of Taumako. The distribution of prestige grave goods within the Namu cemetery has been used as evidence to support the premise that Taumakoan social structure was stratified like Polynesian societies. Here we test the hypothesis that "wealthy" individuals and males will display isotopic ratios indicative of the consumption of "high status" foods in the Pacific islands such as pork, chicken, sea turtle, and pelagic fish. The isotope results suggest the δ(34) S values were diagenetically altered, possibly an effect of volcanism. The carbon and nitrogen stable isotope ratios indicate that the diet of all the individuals included a mixture of C3 terrestrial plant foods (likely starchy staples such as yam, taro, and breadfruit, in addition to nuts) and a variety of marine resources, including reef and pelagic fish. The stable isotope results indicate that wealthy individuals and males were eating more foods from higher trophic levels, interpreted as being high status animal foods. The socially differentiated food consumption patterns are discussed within a Pacific island context.

Providing additional money to food-insecure households and its effect on food expenditure: a randomized controlled trial.

Abstract: Objectives Financial constraint is the underpinning determinant of household food insecurity; however, there has been little research examining the impact that increasing the ‘money available’ to food-insecure households could have on food purchasing. The main objective of the present study was to examine the effect of additional money (in the form of supermarket vouchers) on food expenditure in food-insecure households with children. Design A parallel randomized controlled trial with a 4-week baseline phase followed by a 4-week intervention phase. Households were randomized to either receive vouchers (coupons) for 4 weeks or a control group that did not receive any vouchers. Setting Dunedin, New Zealand. Subjects Low-income households with children ≥ 18 years) reporting food insecurity (n 214). Results The mean monetary value of the vouchers received by households was $NZ 17?00 per week. The voucher group spent ≥ NZ 15.20 (95% CI 1.46, 28.94) more per week on food during the intervention phase compared with the control group (P50.030). There were no differences in expenditure between the voucher and the control group for the food groups ‘fruit and vegetables’ (mean difference: ≥ NZ 0?46; 95% CI 21.97, 2.89; P50.709), ‘meat and poultry’ (mean difference: ≥ NZ 0.29; 95% CI 23.07, 3.64; P50.866) and ‘dairy’ (mean difference: ≥ NZ 0.82; 95% CI 20.75, 2.42; P50.302). Conclusions Providing money via supermarket vouchers to food-insecure resulted in an increase in overall expenditure on food.

Balancing the diet and the budget: Food purchasing practices of food‐insecure families in New Zealand

Abstract: Aim The aims of this study were to examine total food expenditure and the types of food purchased in food-insecure households with children, to compare these by severity of food insecurity (moderate or low food security) and furthermore to estimate food expenditure as a percentage of net household income. Methods The study was conducted in Dunedin, New Zealand (NZ) (from June 2009 to May 2010), and included low-income (≤NZ$45 000/year), food-insecure households with children (n = 165). The main food preparer was interviewed to determine the food security status of the household. Households collected food shopping receipts and recorded all food that was purchased for four weeks. Results Households reported spending NZ$132/week on food. The greatest percentage of food dollars was allocated to the food group meat, fish and poultry (14.5%), followed by fruit and vegetables (13.7%). Households with low food security reported spending less money compared to households with moderate food security on total food and the food groups fruit and vegetables and cereals but not on the food groups meat, fish and poultry or dairy and eggs (excluding milk). Food expenditure was estimated to be more than 30% of net income for households with an annual income of less than NZ$35 000. Conclusions For the core foods fruit, vegetables and cereals, reported food spending was less for households with low food security compared to households with moderate food security. This is likely to contribute to poor health in addition to being an undesirable and stressful condition for a household.

Edible gardens in early childhood education settings in Aotearoa, New Zealand.

Abstract: Issue addressed This paper aims to explore the presence and role of edible gardens in Aotearoa/New Zealand Early Childhood Education Services (ECES). Methods Participant ECES providers were identified from the Ministry of Education database of Early Childhood Education Services (March 2009). These include Education and Care and Casual Education and Care, Kindergarten, Home-based Education and Care services, Playcentres, Te Kōhanga Reo. A structured, self-administered questionnaire was sent to the Principal or Head Teacher of the service Results Of the 211 ECES that responded (55% response rate), 71% had edible gardens, incorporating vegetables, berry fruit, tree fruit, edible flowers and nut trees. Garden activities were linked with teaching across all strands of the New Zealand early childhood curriculum. In addition, 34% provided guidance on using garden produce and 30% linked the garden with messages on fruit and vegetable consumption. Most gardens were established recently (past 2 years) and relied on financial and non-financial support from parents, teachers and community organisations. Barriers included a lack of funding, space, time and staff support. Conclusions/Implications Study findings suggest that gardens are already being used as a versatile teaching tool in many ECES settings. Most gardens are new, with a need to support the sustainability and workforce development among teachers and parents in order to be able to maintain these resources for future generations. So what? Given the inherent links between gardening and healthy food and exercise, there seem to be extensive opportunities for health promotion aligned with the edible garden movement.

Vitamin D insufficiency and deficiency: New Zealand general practitioners' perceptions of risk factors and clinical management.

Abstract: Aims To report perceptions regarding vitamin D sources; risk factors, prevention and management of vitamin D deficiency and insufficiency; supplement prescribing practices; patients' enquiries. Methods A NSW survey instrument was adapted and pre-tested for NZ conditions. Royal NZ College of General Practitioners online weekly newsletter recipients were provided an electronic survey link. The Medical Council emailed an invitation and online survey link to non-respondents. Hard copy questionnaires were posted to remaining non-respondents. Results 1089 GPs responded (32% participation). Several sources of information on vitamin D were identified. Sun exposure was considered the main vitamin D source in summer (85%), but in winter (47%) supplements (13%) and food sources were more commonly mentioned. Daily sunlight exposure at low UV times (79%) was identified as the main factor preventing deficiency, followed by high-dose supplements and fortified foods (54% each), winter sun-protection relaxation (48%), daily low-dose supplements (47%), daily sunlight exposure at peak UV times (35%) and relaxation of sun protection, year-round. Patient characteristics prompting alertness to vitamin D status included being housebound or institutionalised (96%), wearing concealing clothing (88%), past history of bone fractures (87%), age over 65 years (84%), poor nutrition (71%) and current bone disease (69%). Insufficiency and deficiency were managed primarily through high-dose supplementation and advice to receive more sunlight. Almost half (47%) had received patient requests for vitamin D testing, and 40% requests for prescribed vitamin D. Conclusions Study results should help inform possible educational and other interventions to optimise vitamin D and sun-exposure advice.

Correction: The First New Zealanders: Patterns of Diet and Mobility Revealed through Isotope Analysis

Abstract: In the Author Contributions statement, the last author (HRB) was incorrectly omitted from the list of those authors who wrote the paper. The Author Contributions statement should read: "Conceived and designed the experiments: RLK HRB BS. Performed the experiments: RLK CS MR BS. Analyzed the data: RLK AG. Contributed reagents/materials/analysis tools: CS MR JS RF RKW. Wrote the paper: RLK RKW CJ EB NT SEH HRB."

Reliability of home-based physiological sleep measurements in snoring and non-snoring 3-year olds

Abstract: To study snoring and non-snoring 3-year olds in their own homes and to establish reference values and night-to-night variability of physiological measurements taken during sleep. One hundred and sixty-six children, aged 3.2–4.0 years, identified as at high (n = 83, M/F = 1.5:1) or low (n = 83, M/F = 1.4:1) risk for persistent snoring, as rated by a parent, wore a sleep screening system (Grey Flash) for up to five consecutive nights, to measure snoring, oxygen saturation, heart rate, movement, sleep efficiency, and sleep timing. The snoring group snored 25% of their total sleep time, while the non-snoring group snored just 7.6%. Reliability estimates were calculated, using intraclass correlations to establish the reliability of single recordings and the Spearman–Brown prophecy formula to estimate reliability over multiple recordings. Snoring (percent), turn index (number of turns per hour), and mean heart rate were adequately assessed in both groups with one recording night (all intraclass correlation coefficients (ICCs) ≥0.70). Furthermore, mean SpO2 was measured with sufficient reliability with two recordings in non-snorers (ICC = 0.71), while five recording nights were necessary to reach reliability in snorers (ICC = 0.71). SpO2 nadir did not reach adequate reliability in either group even after seven recording nights. Our results showed that snoring can be measured reliably at home with just one recording night, whereas most other physiological sleep measures require two or more recordings.

A nationwide survey of weight control practices among middle-aged New Zealand women.

Abstract: Aim To examine the prevalence of weight control practices in a nationwide representative sample of 40-50 year old New Zealand women Methods In May 2009, a cross-sectional mail survey was conducted among 2500 women randomly selected from nationwide electoral rolls who were each mailed a self-administered questionnaire about their weight control practices, demographics and anthropometry Results After excluding ineligible recipients, a 66% participation rate was achieved (n=1601) Thirty-nine percent of the sample (n=630) reported trying to control their weight, and among those who were not, 69% (n=674) were attempting to prevent weight gain The weight control practices most commonly used were cutting down on meal/snack size (42%) and cutting down on fats/sugars (45%) Smoking, exercising in a driven or compulsive way, and fasting were used at least once a week as weight control strategies by 14%, 22% and 5% of women, respectively Other potentially health-damaging practices (ie laxatives, diuretics, diet pills, vomiting) were employed by 1-4% of women Conclusions Most women reported weight control practices that were consistent with public health messages, however the use of smoking and exercising in a driven or compulsive way are of particular concern

A controlled comparison of teaching methods in first-year university physics

Abstract: This study presents a rigorous comparison between two teaching methods currently used in the first year of university-level physics programmes. Two groups of year 12 and 13 school students, aged between 16 and 18 years old, were given a short lecture course on elementary Newtonian Mechanics, one group attending more traditional passive-student lectures and the other attending an interactive active-student programme. The two groups were constructed to be as similar as possible in terms of relevant factors and were pre-tested with the Force Concept Inventory (FCI) and post-tested with the FCI and the Mechanics Baseline Test (MBT). Several measures of learning based on pre-test/post-test score change were employed to assess the relative effectiveness of the two lecture styles. The principal result of this study was the early onset of greater learning gains among students in the active-student programme compared to students in the passive-student programme. The particular choice of learning gain metr...

Summer weekend sun exposure and sunburn among a New Zealand urban population, 1994-2006.

Abstract: AIM To describe summer weekend sun exposure and sunburn experience, 1994-2006, among urban New Zealanders (15-69 years) by sex, age group, skin type and outdoor activity type. METHOD A series of five telephone surveys undertaken in the summers of 1994, 1997, 1999-2000, 2002-3 and 2005-6 provided a sample of 6,195 respondents with usable data from five major cities (Auckland, Hamilton, Wellington, Christchurch and Dunedin). Respondents were administered a Computer Assisted Telephone Interview (CATI) questionnaire which sought sociodemographic information, sun exposure, and sunburn experience during the most recent weekend. RESULTS Overall, 69% of the sample had spent at least 15 minutes outdoors between 11am and 4pm. Weekend sunburn was reported by 21%, and was more common among males, young adults and those with highly sun-sensitive skin than females, older adults and those with less sensitive skin. The head/face/neck was the body area most frequently and severely sunburned. Sunburn was associated with greater time spent outdoors and occurred most frequently during water-based (29%) and passive recreational activities (25%) and paid work (23%). CONCLUSIONS Sun protection strategies could usefully be targeted not only towards at-risk population groups, but also towards those activities and contexts most strongly associated with potentially harmful sun exposure.