Showing papers by "Andrew R. Gray published in 2015"

Adherence, tolerance and effectiveness of two different pelvic support belts as a treatment for pregnancy-related symphyseal pain - a pilot randomized trial

Abstract: Pregnancy-related pubic symphysis pain is relatively common and can significantly interfere with daily activities. Physiotherapist-prescribed pelvic support belts are a treatment option, but little evidence exists to support their use. This pilot compared two pelvic belts to determine effectiveness (symptomatic relief), tolerance (comfort) and adherence (frequency, duration of use). Unblinded, 2-arm, single-center, randomized (1:1) parallel-group trial. Twenty pregnant women recruited from the community (Dunedin, New Zealand), with physiotherapist-diagnosed symphyseal pain, were randomly allocated to wear either a flexible or rigid belt for three weeks. One author, not involved in data collection, randomized the allocation to trial group. The unblinded primary outcome was the Patient Specific Functional Scale (PSFS). Secondary outcomes were pain intensity during the preceding 24 hours and preceding week (visual analogue scale [VAS]), and disability (Modified Oswestry Disability Questionnaire [MODQ]). Duration of use (hours) was recorded daily by text messaging. Participants were assessed at baseline, by weekly phone interviews and at intervention completion (three weeks). To assess comfort, women wore the alternate belt in the fourth week. Twenty pregnant women (mean ± SD age, 29.4 ± 6.5 years; mean gestation at baseline, 30.8 ± 5.2 weeks) were randomized to treatment groups (flexible = 10, rigid =10) and all were included in analysis. When adjusted for baseline, PSFS scores were not significantly different between groups at follow up (mean difference −0.1; 95% CI: −2.5 to 2.3; p =0.94). Pain in the preceding 24 hours reached statistical significance in favor of the flexible belt (VAS, p = 0.049). Combining both groups’ data, function and pain were significantly improved at three weeks (mean difference −2.3; 95% CI: 1.2 to 3.5; p< 0.001). Belts were worn for an average of 4.9 ± 2.9 hours per day; women preferred the flexible belt. No adverse events were reported. These preliminary results suggest the flexible pelvic support belt may be more effective in reducing pain and is potentially better tolerated than a rigid belt. Based on these data, a larger trial is both feasible and clinically useful. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614000898651 , 25th August, 2014.

Effects of quitting cannabis on respiratory symptoms

Abstract: Smoking cannabis is associated with symptoms of bronchitis. Little is known about the persistence of symptoms after stopping cannabis use. We assessed associations between changes in cannabis use and respiratory symptoms in a population-based cohort of 1037 young adults. Participants were asked about cannabis and tobacco use at ages 18, 21, 26, 32 and 38 years. Symptoms of morning cough, sputum production, wheeze, dyspnoea on exertion and asthma diagnoses were ascertained at the same ages. Frequent cannabis use was defined as ≥52 occasions over the previous year. Associations between frequent cannabis use and respiratory symptoms were analysed using generalised estimating equations with adjustments for tobacco smoking, asthma, sex and age. Frequent cannabis use was associated with morning cough (OR 1.97, p<0.001), sputum production (OR 2.31, p<0.001) and wheeze (OR 1.55, p<0.001). Reducing or quitting cannabis use was associated with reductions in the prevalence of cough, sputum and wheeze to levels similar to nonusers. Frequent cannabis use is associated with symptoms of bronchitis in young adults. Reducing cannabis use often leads to a resolution of these symptoms. Smoking cannabis causes symptoms of bronchitis but these symptoms improve after quitting or cutting down cannabis use

Secular changes in intakes of foods among New Zealand adults from 1997 to 2008/09.

Abstract: OBJECTIVE To examine changes in the food choices of New Zealand (NZ) adults, between the 1997 National Nutrition Survey (NNS97) and the 2008/09 NZ Adult Nutrition Survey (2008/09 NZANS). DESIGN The 2008/09 NZANS and the NNS97 were cross-sectional surveys of NZ adults (aged 15 years and over). Dietary intake data were collected using a computer-based 24 h diet recall. Logistic regression models were used to examine changes over time in the percentage reporting each food group, with survey year, sex and age group (19-30 years, 31-50 years, 51-70 years, ≥71 years) as the variables. SETTING NZ households. SUBJECTS Adults aged 19 years and over (NNS97, n 4339; 2008/09 NZANS, n 3995). RESULTS In the 2008/09 NZANS compared with NNS97, males and females were less likely to report consuming bread, potatoes, beef, vegetables, breakfast cereal, milk, cheese, butter, pies, biscuits, cakes and puddings, and sugar/confectionery (all P<0.001). In contrast, there was an increase in the percentage reporting rice and rice dishes (P<0.001), and among females a reported increase in snacks and snack bars (e.g., crisps, extruded snacks, muesli bars; P=0.007) and pasta and pasta dishes (P=0.017). Although food choices were associated with sex and age group, there were few differential changes between the surveys by sex or age group. CONCLUSIONS For all age groups there was a shift in the percentage who reported consuming the traditional NZ foods, namely bread, beef, potatoes and vegetables, towards more rice and rice dishes. Declines in the consumption of butter, pies, biscuits, cakes and puddings are congruent with current dietary guidelines.

Association of Nut Consumption with Cardiometabolic Risk Factors in the 2008/2009 New Zealand Adult Nutrition Survey

Abstract: Nut consumption has been associated with improvements in risk factors for chronic disease in populations within North America, Europe and Iran. This relationship has not been investigated in New Zealand (NZ). The associations between nut consumption and cardiometabolic risk factors among New Zealanders were examined. Data from the 24-h diet recalls of 4721 participants from the NZ Adult Nutrition Survey 2008/2009 (2008/2009 NZANS) were used to determine whole and total nut intake. Anthropometric data and blood pressure were collected, as well as blood samples analysed for total cholesterol (total-C) and HDL cholesterol (HDL-C), glycated haemoglobin (HbA1c), C-reactive protein (CRP) and folate. Participants were classified according to their five-year cardiovascular disease (CVD) risk. Both whole and total nut consumers had significantly lower weight, body mass index (BMI), waist circumference and central adiposity than non-nut consumers (all p ≤ 0.044). Whole blood, serum and red blood cell folate concentrations were significantly higher among whole nut consumers compared to non-whole nut consumers (all p ≤ 0.014), with only serum folate higher in total nut consumers compared to non-total nut consumers (p = 0.023). There were no significant differences for blood pressure, total-C, HDL-C and HbA1c; however, significant negative associations between total nut consumption and CVD risk category (p < 0.001) and CRP (p = 0.045) were apparent. Nut consumption was associated with more favourable body composition and a number of risk factors, which could collectively reduce chronic disease.

Effects of regular consumption of different forms of almonds and hazelnuts on acceptance and blood lipids

Abstract: Purpose Regular nut consumption is inversely associated with cardiovascular disease risk. No study has compared the effects of regular consumption of different types and forms of nuts on acceptance, which is a crucial determinant of long-term compliance to consume nuts regularly.

Screening for hazardous alcohol use among university students using individual questions from the Alcohol Use Disorders Identification Test-Consumption.

Abstract: INTRODUCTION AND AIMS: Abbreviated versions of the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) instrument have not been investigated among students. We compared a modified second item (AUDIT-2*) (typical quantity per occasion as the number of drinks, rather than categorical responses) and the third item (AUDIT-3) (heavy episodic drinking frequency) with AUDIT-C scores and described their associations with sociodemographic variables. DESIGN AND METHODS: We analysed cross-sectional data from the 2011 baseline of the Graduate Longitudinal Study New Zealand, including respondents aged up to 25 years (n = 5082, response rate 65%). Hazardous drinking was defined as an AUDIT-C score of seven or greater for men and five or greater for women. We calculated the area under receiver operating characteristic curves, sensitivities, specificities, and positive and negative predictive values for the AUDIT-2* and AUDIT-3. Odds ratios and 95% confidence intervals were calculated to describe the associations between drinking patterns and sociodemographic factors. RESULTS: Based on the sex-specific AUDIT-C cut-points, 36% of participants reported drinking at hazardous levels. For the AUDIT-2*, the best combination of sensitivity and specificity was obtained for a cut-point of five standard drinks. The best cut-point for the AUDIT-3 was for monthly heavy episodic drinking. Positive and negative predictive values were above 0.80 for both cut-points. Consumption was associated with age, degree level, domestic/international status, accommodation type, relationship status and employment. DISCUSSION AND CONCLUSIONS: The AUDIT-2* and the AUDIT-3 appear to be promising standalone screening items for detecting hazardous drinking in this population of heavy-drinking students. [Blank M-L, Connor J, Gray A, Tustin K. Screening for hazardous alcohol use among university students using individual questions from the Alcohol Use Disorders Identification Test-Consumption. Drug Alcohol Rev 2015]. Language: en

Lactation Consultant Support from Late Pregnancy with an Educational Intervention at 4 Months of Age Delays the Introduction of Complementary Foods in a Randomized Controlled Trial

Abstract: Background Although the WHO recommends that complementary feeding in infants should begin at 6 mo of age, it often begins before this in developed countries. Objective Our objective was to determine whether lactation consultant (LC) support, with educational resources given at 4-mo postpartum, can delay the introduction of complementary foods until around 6 mo of age. Methods A total of 802 mother-infant pairs were recruited from the single maternity hospital serving Dunedin, New Zealand (59% response rate) and randomly assigned to the following: 1) usual care (control group); 2) infant sleep education intervention (Sleep); 3) food, activity, and breastfeeding intervention (FAB); or 4) combination (both) intervention (Combo). Certified LCs delivered 3 intervention sessions (late pregnancy and 1-wk and 4-mo postpartum). The 4-mo contact used educational resources focused on developmental readiness for complementary foods. Age when complementary foods were introduced was obtained from repeated interviews (monthly from 3- to 27-wk postpartum). Results A total of 49.5% and 87.2% of infants received complementary foods before 5 and 6 mo of age, respectively. There was evidence of group differences in the number of infants introduced to complementary foods before 5 mo (P = 0.006), with those receiving support and resources (FAB and Combo groups combined; 55.6%) more likely to wait until at least 5 mo compared with controls (control and Sleep groups combined; 43.3%) (OR: 1.52; 95% CI: 1.08, 2.16). However, there was no evidence they were more likely to wait until 6 mo of age (P = 0.52). Higher maternal age, higher parity, and a less positive attitude toward breastfeeding were positively associated, and drinking alcohol during pregnancy was negatively associated, with later age of introduction of complementary foods. Conclusions Providing an LC and educational resources at 4-mo postpartum to predominantly well-educated, mainly European, women can delay the introduction of complementary foods until 5 mo of age, but not until the WHO recommendation of 6 mo. This trial was registered at clinicaltrials.gov as NCT00892983.

Obesity and the extent of liver damage among adult New Zealanders: findings from a national survey.

Abstract: Summary Objective Non-alcoholic fatty liver disease (NAFLD), defined as excessive fat accumulation in hepatocytes when no other pathologic causes are present, is an increasingly common obesity-related disorder. We sought to describe the prevalence of elevated liver enzymes, a marker of liver damage, among New Zealand adults, and high-risk subgroups including those with an elevated body mass index and those with pre-diabetes or diabetes, to gain a better understanding of the burden of liver disease. Methods A total of 4,721 New Zealanders aged 15+ years participated in a nationally representative nutrition survey. Liver enzymes, alanine transaminase (ALT) and gamma glutamyl transpeptidase (GGT) were measured in serum. Results were available for 3,035 participants, of whom 10.8% were Māori and 4.5% Pacific. Results Overall, the prevalence of elevated ALT and elevated GGT was 13.1% (95% confidence interval [CI]: 11.2 – 15.0) and 13.7% (95% CI: 12.0 – 15.4), respectively. Odds ratios for an elevated ALT or GGT markedly increased with increasing body mass index. Men with obesity had the highest elevated ALT prevalence (28.5%; 95% CI: 21.7–35.4), and women with diabetes had the highest elevated GGT prevalence (36.5%; 95% CI: 26.0–47.0). Adding alcohol consumption categories to each of the adjusted models did not meaningfully change any results, although for women, heavy alcohol consumption was associated with an elevated GGT (overall p = 0.03). Conclusions Obesity-related liver disease is likely to increasingly burden the New Zealand health sector and contribute to health disparities unless effective obesity treatment and prevention measures are given high priority. © 2015 The Authors. Obesity Science & Practice published by John Wiley & Sons Ltd, World Obesity and The Obesity Society.

Comparison of Munsell(®) color chart assessments with primary schoolchildren's self-reported skin color

Abstract: The Cancer Society of New Zealand Inc., the National Institute of Water and Atmospheric Research, the National Research Foundation of South Africa and the University of Otago.

Food for thought: edible gardens in New Zealand primary and secondary schools.

Abstract: Issue addressed School gardens are a potentially important health promotion tool, allowing the growth and consumption of fruit and vegetables to be embedded within the students’ educational experience. This study aimed to investigate the implementation of edible gardens in New Zealand (NZ) primary and secondary schools. Methods A questionnaire mailed to principals from a randomly selected sample of 764 NZ schools included questions on whether or not the school had a garden and, if so, what produce was grown; how long the garden had been in place; how harvested crops were distributed; and curriculum integration. Results Among 491 responding schools (64.3% response rate), 52.9% currently had an edible garden – with most gardens started in the previous two years. Vegetables, herbs and tree fruit were commonly grown. Gardens were integrated into curriculum subjects, cooking lessons, recipes and messages promoting increased fruit and vegetable consumption. Conclusions Edible gardens were common within NZ schools, though often relatively new, and were used for teaching in a variety of curriculum areas. So what? Given the current popularity of school gardens, there are opportunities to deliver health promotion messages regarding consumption of fruit and vegetables, and for these to be reinforced by real life experience growing and preparing healthy food.

Retinal detachments in southern New Zealand: do poorer patients have poorer outcomes?

Abstract: AIMS To investigate associations between socioeconomic status, retinal detachment type and post-operative visual outcomes in southern New Zealand. METHODS A retrospective review of all cases of rhegmatogenous retinal detachments in Dunedin Hospital over two years was performed. Patient demographics and macula involvement at presentation were the primary outcome measures. The New Zealand Deprivation Index was used to group patients into low (30% least deprived), medium (middle 40%) and high (30% most deprived). Patients were excluded if they were not from New Zealand, or had traumatic detachments. RESULTS During the study period, 95 retinal detachments in 94 patients were managed in Dunedin Hospital. Only 15% of retinal detachments occurred in the most deprived. More deprived patients had longer delays before assessment in hospital (mean of 29.8 days versus 10.1 days for the least deprived and 12.8 days for the medium category, overall p=0.025). There was no evidence of an association between deprivation and macula-off status (overall p=0.650) or visual acuity at one or three months (p=0.063 and p=0.328 respectively). Nor was there an association between referral pathway and macula-off status (p=0.242). CONCLUSIONS Retinal detachment in southern New Zealand may be less common amongst those with the most deprived socioeconomic status who also experience longer delays till first treatment; but there was no association between socioeconomic status and patients being macula-off at presentation, or having poorer visual outcomes. More targeted patient education towards our most deprived citizens may reduce delays in treatment, and result in better visual outcomes.

Oral Fatty Acid Sensitivity among Obesity Resistant and Obesity Susceptible Individuals

Abstract: Context: While rates of global obesity are high, a substantial proportion of the population remain lean despite living in an obesogenic environment. One potential difference between obesity resistant individuals (ORIs) and obesity susceptible individuals (OSIs) is oral fatty acid sensitivity. Objective: We compared oral fatty acid sensitivity and fat ranking ability between ORIs and OSIs. Design and participants: Oral sensitivity to oleic acid (1.4 mM) was determined using triplicate triangle tests amongst 50 ORIs and 36 OSIs. Participants tasted three milk samples, consisting of one sample with oleic acid and two control samples without oleic acid. Hypersensitive individuals were defined as those who chose the oleic acid sample three out of three tests. Participants also ranked the fat content of custard samples containing 0%, 2%, 6% and 10% fat. Statistics: Logistic regression models including sex, age, and percentage body fat estimated adjusted odds ratios (OR) for oral fatty acid sensitivity between ORI and OSI. Negative binomial regression adjusting for age, BMI, and height compared fat ranking scores between ORIs and OSIs. Results: The odds of being hypersensitive to fatty acids amongst ORIs was 3.60 times that for OSIs (P=0.034). There was no evidence for an association between resistance to obesity and the ability to rank the fat levels in a food (P=0.600). Conclusion: Hypersensitivity to oral fatty acids among ORIs may influence their dietary fat intake, and thus their body weight regulation. Future larger studies are needed to confirm this.

Critical Review of Brown and Thomas "The First New Zealanders? An Alternative Interpretation of the Stable Isotope Data from Wairau Bar".

Abstract: This formal comment has been written in response to Brown and Thomas’s article in the current issue of PLoS ONE entitled “The first New Zealanders? An alternative interpretation of the stable isotope data from Wairau Bar”. In their article, Brown and Thomas attempt to reanalyse and re-interpret the stable isotope (δ13C and δ15N) and radiogenic isotope (87Sr/86Sr) data originally presented in Kinaston et al. [1] “The first New Zealanders: patterns of diet and mobility revealed through isotope analysis.” PLoS ONE 8(5): e64580. Brown and Thomas (p. 2) were prompted to undertake their ‘critical review’ of our study as a result of a disagreement with the groupings of burials, and state “ultimately, these divisions introduce bias, which leads to conclusions that we feel are not supported by the available data.” The criticisms of Brown and Thomas are not valid. There are three major flaws in the analyses and interpretations, and their findings do not add anything meaningful to the interpretations we already presented. The first flaw is a misunderstanding by Brown and Thomas about the differences between the two approaches and the logic of the argument we set out. The second relates to their treatment of stable isotope data, especially their new dietary interpretations. The third pertains to the way they have used the biologically available 87Sr/86Sr baseline (from dog enamel) to interpret the human 87Sr/86Sr ratios and their use of a ranked ordering of the human 87Sr/86Sr ratios. We present our detailed responses in relation to each of these flaws as follows, in addition to comments regarding more minor inconsistencies in their analysis and interpretations. Brown and Thomas argue that we were wrong in the way they grouped burials at Wairau Bar and thus in the way they constructed analytical units. They attempt to demonstrate this by taking the isotope data from Kinaston et al. and running it through a number of cluster analyses while “treating the isotope data independently from cultural or biological factors” (Brown and Thomas). Brown and Thomas are not able to replicate the existence of Group 1 by clustering the stable isotope values and 87Sr/86Sr ratios and this, they believe, undermines our findings. This criticism misses the fundamental point of Kinaston et al. Group 1 (Burials 1–7) is an independently defined group based on a range of archaeological and biological factors. The grouping was first introduced as a concept by Duff (page 61 in [2]) who suggested that “…burials 1–7, appear to have been the exclusive resting place of men of superior rank”. The burials 1–7 grouping was further validated by Anderson (Table 9.1 in [3])who grouped all the burials according to the presence or absence of moa eggs, moa bone elements, artefact types, and material used for artefact manufacture. Brown and Thomas dismiss the differences in grave good type and number as simply being a result of taphonomic bias, providing a convenient means to disregard the evidence that is actually available; specifically that “there is a ratio of approximately 5:1 in favor of Group 1 in terms of mean numbers of grave goods” (page 2 in [1]). There are also stratigraphic grounds justifying this treatment of burial groups which were first noted by Owen Wilkes (summarized in [3]). Most recently, Buckley et al. [4] re-evaluated the health indicators of the entire Wairau Bar burial population and discussed the data in reference to these groupings. They found that oral health, which reflects aspects of diet, further reinforces the identification of burials 1–7 as a group. Thus we. do not need to demonstrate the existence of Group 1; it is already well attested in the literature [3,4]. The logic of our approach is as follows: There is a group of burials (1–7) at Wairau Bar, which for reasons that include spatial, stratigraphic, material culture and other factors (some of which were outlined in the text and others cited below), have proven to stand out from the others in interesting ways. Can we add knowledge about the diet and origins of this group through the application of new analytical methods? Explaining Exploratory versus Confirmatory Analyses To take a data-driven exploratory approach such as cluster analysis, as Brown and Thomas have done, would not have been appropriate in our study because this would address a very different question. They are effectively looking for ‘patterns’ within the data based on isotope values, while we were examining how isotope values were distributed across the population given the already accepted groupings. Data-driven exploratory approaches can be very useful for generating new hypotheses, such as “are there groups”, but are much less useful for examining whether or not the new, in this case the isotope, data are consistent with an existing model. Cluster analysis in its conventional (non-Bayesian) form fails to make direct use of this existing knowledge in the modelling process. In summary, the approach Brown and Thomas used would have been entirely appropriate if we were interested in the question “are there possibly different groups amongst the burials?” but are not at all appropriate for addressing our question about whether Group 1 was distinct from the rest of the sample in terms of diet and origins. Furthermore, it is important to note that when hierarchical cluster analysis is performed in an agglomerative fashion, there are implications from the choice of linkage method, and different linkage methods can produce very different clusters. With single linkage, there is the well-known problem of observations combining in chains, which can produce ultimately meaningless clusters. Other approaches, including Ward’s linkage as used in Brown and Thomas’s article, are often not stable in the presence of a small number of changes to the data set and, as Blashfield and Aldenderfer (page 450 in [5]) noted,“stability is an important property of any classification in that stable groups are more likely to represent ‘natural’ groups in the data than those which disappear when cases are reordered or a few cases are omitted”. Such problems are especially common in small data sets, as is the case here. We note that Brown and Thomas do not present sensitivity analyses to explore the robustness of their findings. The hypothesis-driven confirmatory approach that we used is more appropriate for our study because it applies existing knowledge about the burials and how they had been grouped, and then develops hypotheses about those groups in terms of the isotope data. We tested these hypotheses using statistical tests of means, including t-tests and regression models; tests of variances, in particular Levene’s test; and correlations. This approach allowed us to ask the question of interest to us, specifically: Are there differences between the burials in Group 1 and the remainder of the burials (Group 2/3) that cannot be readily attributed to chance? It is not surprising that the two approaches result in different interpretations of the data as the goals are clearly different. By way of example, suppose we were to perform both a test for difference in means and an exploratory cluster analysis on heights from a sample of individuals suspected to be from two distinct populations which are known to have different mean heights but whose height distributions overlap. It would not be at all surprising if, despite finding that the mean heights for the two groups differed statistically significantly as expected, we also found individuals from the two different populations ended up included in the same clusters. In fact, it would be remarkable if the resulting clusters exactly reflected the underlying populations, especially with a mixture of men and women in the sample. If there was any overlap between the isotope values for the underlying groups, similar issues could readily arise in a cluster analysis of that data also.

Development of a 15-Item Scale to Measure Parental Perceptions of Their Neighborhood

Abstract: Socioecological theory suggests that there are a range of influences that affect the physical activity levels of children, including parents' perceptions of the neighborhood. A questionnaire instrument to quantify parental neighborhood perceptions was developed for the Location of Children's Activity in Their Environment study as a potential predictor of children's physical activity. A literature review revealed a lack of appropriate instruments, many containing highly localized items. Following initial instrument development including pretesting, where items showed face and content validity, a two-phase pilot study was undertaken. Pilot testing investigated test-retest reliability (overall intraclass correlation coefficient = .75) and internal consistency (α = .62 and α = .73 for the two phases, respectively), finding that the instrument was acceptable overall although some changes in wording were made to specific items with low reliability and/or internal consistency. Using data from the first year of the Location of Children's Activity in Their Environment study, the instrument showed acceptable internal consistency (overall α = .73) and predictive validity (associated with time living in residence and walking to school) to be used in future studies. The scale was not found to be associated with child physical activity, which may be due to activity displacement. Proposed subscales for the neighborhood infrastructure and social aspects were marginal for internal consistency and a safety subscale was not acceptable in this regard. Given the impact of parental perceptions of the neighborhood, and its potential modifiable nature, a measure of it should be included in studies looking at the intensity and location of children's physical activity.