Showing papers by "Andrew R. Gray published in 2017"

Ketamine’s dose-related effects on anxiety symptoms in patients with treatment refractory anxiety disorders:

Abstract: The N-methyl-D-aspartate receptor antagonist ketamine has rapid onset activity in treatment-resistant depression, post-traumatic stress disorder and obsessive compulsive disorder. Due to similarities in brain network activity in depression and anxiety disorders, we hypothesized that ketamine might also be active in other refractory anxiety disorders. We evaluated the efficacy and safety of ketamine in 12 patients with refractory generalized anxiety disorder and/or social anxiety disorder who were not currently depressed, using an ascending single dose study design (0.25, 0.5, 1 mg/kg administered subcutaneously) at weekly intervals. Within 1 h of dosing, patients reported reduced anxiety, which persisted for up to seven days. A dose-response profile was noted for anxiolytic effects, dissociative side effects, and changes in blood pressure and heart rate, with minor changes at 0.25 mg/kg, and progressively greater and more durable changes at the higher doses. Ten of 12 patients were treatment responders at 0.5-1 mg/kg. Ketamine was safe and well tolerated in this population. Ketamine may be a potential therapeutic alternative for patients with refractory generalized anxiety disorder/social anxiety disorder. Along with its demonstrated effectiveness in patients with treatment-resistant depression, obsessive compulsive disorder and post-traumatic stress disorder, these data raise the intriguing possibility that ketamine may have broad efficacy in disorders characterized by negative emotional states, and that these disorders may share a common precipitating neurobiology.

Targeting Sleep, Food, and Activity in Infants for Obesity Prevention: An RCT.

Abstract: OBJECTIVE: The few existing early-life obesity prevention initiatives have concentrated on nutrition and physical activity, with little examination of sleep. METHODS: This community-based, randomized controlled trial allocated 802 pregnant women (≥16 years, RESULTS: At 2 years, 686 women remained in the study (86%). No significant intervention effect was observed for BMI at 24 months (P = .086), but there was an overall group effect for the prevalence of obesity (P = .027). Exploratory analyses found a protective effect for obesity among those receiving the “sleep intervention” (sleep and combination compared with FAB and control: odds ratio, 0.54 [95% confidence interval, 0.35–0.82]). No effect was observed for the “FAB intervention” (FAB and combination compared with sleep and control: odds ratio, 1.20 [95% confidence interval, 0.80–1.81]). CONCLUSIONS: A well-developed food and activity intervention did not seem to affect children’s weight status. However, further research on more intensive or longer running sleep interventions is warranted.

Anticipatory guidance to prevent infant sleep problems within a randomised controlled trial: infant, maternal and partner outcomes at 6 months of age.

Abstract: Objective To evaluate the effectiveness of sleep education delivered antenatally and at 3 weeks postpartum to prevent infant sleep problems at 6 months of age Design Sleep intervention within a randomised controlled trial for the Prevention of Overweight in Infancy (POI) study Participants 802 families were randomly allocated to one of four groups: usual care (control), sleep intervention (sleep), food, activity and breastfeeding intervention (FAB), and combined group receiving both interventions (combination) Interventions All groups received standard Well Child care The sleep intervention groups (sleep and combination) received an antenatal group education session (all mothers and most partners) emphasising infant self-settling and safe sleeping, and a home visit at 3 weeks reinforcing the antenatal sleep education FAB and combination groups received four contacts providing education and support on breast feeding, food and activity up to 4 months postpartum Outcome measures Here we report secondary sleep outcomes from the POI study: the prevalence of parent-reported infant sleep problems and night waking, and differences in sleep duration Additional outcomes reported include differences in infant self-settling, safe sleep practices, and maternal and partner reports of their own sleep, fatigue and depression symptoms Results Linear or mixed linear regression models found no significant intervention effects on sleep outcomes, with 191% of mothers and 166% of partners reporting their infant’s sleep a problem at 6 months Actigraphy estimated the number of night wakings to be significantly reduced (8%) and the duration of daytime sleep increased (6 min) in those groups receiving the sleep intervention compared with those who did not However, these small differences were not clinically significant and not observed in 24 hours infant sleep diary data No other differences were observed Conclusion A strategy delivering infant sleep education antenatally and at 3 weeks postpartum was not effective in preventing the development of parent-reported infant sleep problems

Parenting style and family type, but not child temperament, are associated with television viewing time in children at two years of age.

Abstract: Objectives Despite the American Academy of Pediatrics (AAP) recommending that electronic media be avoided in children under two years of age, screen use is common in infants and toddlers. The aims of this study were to determine how parenting style, infant temperament, and family type are associated with television viewing in two-year-old children. Study design Participants were from the Prevention of Overweight in Infancy (POI) randomized controlled trial (n = 802) (Dunedin, New Zealand). Demographic information was collected at baseline (late pregnancy), and television and other screen time assessed by questionnaire at 24 months of age. Parenting style (Parenting Practices Questionnaire), infant temperament (Colorado Childhood Temperament Inventory), and family type (7 categories) were reported by both parents. Results Data were available for 487 participants (61% of the original participants). Median television viewing was relatively low at 21 minutes per day, or 30 minutes in those watching television (82%). Children who watched television played with mobile phones (12% of children) or iPads/tablets (22% of children) more frequently than children who did not (6% of children). In terms of parenting style, children of more authoritarian mothers (β = 17, 95% CI: 6–27 minutes), more authoritarian partners (β = 14, 95% CI: 2–26 minutes), or more permissive mothers (β = 10, 95% CI: 3–17 minutes) watched significantly more television. No significant relationships were observed between child temperament and time watching television after adjustment for confounding variables. Children from “active” families (as rated by partners) watched 29 minutes less television each day (P = 0.002). Conclusions Parenting style and family type were associated with television viewing time in young children, whereas child temperament was not.

A randomized double-blind placebo-controlled trial to investigate the effectiveness and safety of a novel green-lipped mussel extract -BioLex® -for managing pain in moderate to severe osteoarthritis of the hip and knee

Abstract: Extracts from perna canaliculus, the Green Lipped Mussel (GLM) are widely used as a complimentary therapy by patients with osteoarthritis (OA). The current study investigated the potential of a novel GLM formulation as a treatment for OA. A randomized double-blind placebo-controlled trial was undertaken to assess potential impacts on pain and quality of life following 12 weeks of treatment. Eighty patients with moderate to severe OA of the hip or knee were randomized to receive either 600 mg of BioLex®-GLM daily or placebo for 12 weeks. Entry criteria included a minimum 100 mm Visual Analogue Scale pain score (VAS) of 30 mm at baseline. The primary outcome was patient reported pain, measured by the Western Ontario and McMasters OA Index (WOMAC) pain subscale and VAS pain scale. Secondary outcomes included: quality of life (OAQol), total WOMAC score, WOMAC −20 responder criteria, and change in medication use over the study period. Participants were assessed at baseline, 12 weeks (end of therapy) and 15 weeks (3-weeks post-intervention). At week 12, there were no significant differences in VAS or WOMAC pain subscale between active and placebo groups, nor significant improvement in the WOMAC-20 responder criteria or OAQol. Joint stiffness (measured by WOMAC-B stiffness) in the GLM group improved compared with placebo (p = 0.046). There was a significant difference in paracetamol use between the GLM treated group and the placebo group after week 12 (p = 0.001). BioLex® -GLM extract did not confer clinical benefit in moderate to severe OA over the intervention period, however, a significant difference in paracetamol use in the post-intervention period was observed between the BioLex® -GLM group and placebo group. Higher doses and/or longer treatment periods are worthy of future investigation. Australia and New Zealand Clinical Trials Registry: no. ACTRN12611000256976 .

The effectiveness of a primary care nursing-led dietary intervention for prediabetes: a mixed methods pilot study

Abstract: Primary care nurse-led prediabetes interventions are seldom reported. We examined the implementation and feasibility of a 6-month multilevel primary care nurse-led prediabetes lifestyle intervention compared with current practice in patients with prediabetes, with weight and glycated haemoglobin (HbA1c) as outcomes. This study used a convergent mixed methods design involving a 6-month pragmatic non-randomised pilot study with a qualitative process evaluation, and was conducted in two neighbouring provincial cities in New Zealand, with indigenous Māori populations comprising 18.2% and 23.0%, respectively. Participants were non-pregnant adults aged ≤ 70 years with newly diagnosed prediabetes (HbA1c 41-49 mmol/mol), body mass index (BMI) ≥ 25 kg/m2 and not prescribed Metformin. A structured dietary intervention tool delivered by primary care nurses with visits at baseline, 2–3 weeks, 3 months and 6 months was implemented in four intervention practices. Four control practices continued to provide usual care. Primary quantitative outcome measures were weight and HbA1c. Linear and quantile regression models were used to compare each outcome between the two groups at follow-up. Qualitative data included: observations of nurse training sessions and steering group meetings; document review; semi-structured interviews with a purposive sample of key informants (n = 17) and intervention patients (n = 20). Thematic analysis was used. One hundred fifty-seven patients with prediabetes enrolled (85 intervention, 72 control), 47.8% female and 31.2% Māori. Co-morbidities were common, particularly hypertension (49.7%), dyslipidaemia (40.1%) and gout (15.9%). Baseline and 6 month measures were available for 91% control and 79% intervention participants. After adjustment, the intervention group lost a mean 1.3 kg more than the control group (p < 0.001). Mean HbA1c, BMI and waist circumference decreased in the intervention group and increased in the control group, but differences were not statistically significant. Implementation fidelity was high, and it was feasible to implement the intervention in busy general practice settings. The intervention was highly acceptable to both patients and key stakeholders, especially primary care nurses. Study findings confirm the feasibility and acceptability of primary care nurses providing structured dietary advice to patients with prediabetes in busy general practice settings. The small but potentially beneficial mean weight loss among the intervention group supports further investigation. ANZCTR ACTRN12615000806561 . Registered 3 August 2015 (Retrospectively registered).

Epidemiological differences between localized and nonlocalized low back pain

Abstract: Study Design. A cross-sectional survey with a longitudinal follow-up. Objectives. The aim of this study was to test the hypothesis that pain, which is localized to the low back, differs epidemiologically from that which occurs simultaneously or close in time to pain at other anatomical sites Summary of Background Data. Low back pain (LBP) often occurs in combination with other regional pain, with which it shares similar psychological and psychosocial risk factors. However, few previous epidemiological studies of LBP have distinguished pain that is confined to the low back from that which occurs as part of a wider distribution of pain. Methods. We analyzed data from CUPID, a cohort study that used baseline and follow-up questionnaires to collect information about musculoskeletal pain, associated disability, and potential risk factors, in 47 occupational groups (office workers, nurses, and others) from 18 countries. Results. Among 12,197 subjects at baseline, 609 (4.9%) reported localized LBP in the past month, and 3820 (31.3%) nonlocalized LBP. Nonlocalized LBP was more frequently associated with sciatica in the past month (48.1% vs. 30.0% of cases), occurred on more days in the past month and past year, was more often disabling for everyday activities (64.1% vs. 47.3% of cases), and had more frequently led to medical consultation and sickness absence from work. It was also more often persistent when participants were followed up after a mean of 14 months (65.6% vs. 54.1% of cases). In adjusted Poisson regression analyses, nonlocalized LBP was differentially associated with risk factors, particularly female sex, older age, and somatizing tendency. There were also marked differences in the relative prevalence of localized and nonlocalized LBP by occupational group. Conclusion. Future epidemiological studies should distinguish where possible between pain that is limited to the low back and LBP that occurs in association with pain at other anatomical locations. Level of Evidence: 2

Implications of Wear at the Titanium-Zirconia Implant-Abutment Interface on the Health of Peri-implant Tissues.

Abstract: Purpose: To investigate the presence of metallic particles in the peri-implant mucosa around titanium dental implants after 5 years of loading using single-implant crowns with respect to clinical signs of peri-implant inflammation. Materials and Methods: Sixteen participants from an ongoing, prospective, single-arm clinical trial who had received titanium dental implants restored with single maxillary crowns veneered to zirconia abutments were available for the study. Exfoliative cytology samples were obtained from the periimplant tissues and contralateral tooth sites using microbrushes and were evaluated by means of light microscopy (LM), scanning electron microscopy, and energy-dispersive spectroscopy (EDS). Trace elemental analysis was also carried out on the microbrushes using inductively coupled plasma mass spectrometry. Peri-implant and periodontal parameters (plaque, bleeding, attachment level, radiographic bone levels) were recorded. Results: Titanium particles were found in both the single-implant crown and contralateral natural tooth sites. LM and EDS analyses showed significantly higher numbers of Ti particles at the implant-abutment interfaces (mean = 14.168; SD = 2.36) and in the internal aspects of peri-implant mucosa in contact with the prostheses (mean = 4.438; SD = 2.22) when compared with other test and control areas. Mean probing depths were ≤ 3 mm, and no differences were found in plaque or bleeding on probing between implant and tooth sites. Median bone levels were within the normal range for both implant (mesial: 0.5 mm; distal: 0.8 mm) and tooth (mesial: 1.5 mm; distal: 1.8 mm) sites. Conclusion: Loading of single-implant zirconia crowns can cause the release of Ti particles because of functional wear at the implant-abutment level. The presence of these metal particles in the peri-implant area did not appear to affect peri-implant health in this patient group.

Do dry roasting, lightly salting nuts affect their cardioprotective properties and acceptability?

Abstract: Previous studies have reported improvements in cardiovascular disease (CVD) risk factors with the consumption of raw nuts. However, around one-third of nuts consumed are roasted and salted. Thus, it is important to determine whether roasting and salting nuts affect the health benefits observed with raw nuts. This study aimed to compare the effects of consuming two different forms of hazelnuts on cardiovascular risk factors and acceptance. Using a randomised crossover design, 72 participants were asked to consume 30 g/day of either raw or dry roasted, lightly salted hazelnuts for 28 days each. CVD risk factors were measured at the beginning and end of each treatment period. “Desire to consume” and “overall liking” for both forms of hazelnuts were assessed daily using a 150-mm visual analogue scale. Body composition, blood pressure, plasma total and low-density lipoprotein-cholesterol, apolipoprotein A1 and B100, glucose and α-tocopherol concentrations did not differ between forms of hazelnuts (all P ≥ 0.054). High-density lipoprotein (HDL)-cholesterol (P = 0.037) and triacylglycerol (P < 0.001) concentrations were significantly lower following the consumption of dry roasted, lightly salted hazelnuts when compared to the raw hazelnuts. Compared with baseline, consuming both forms of hazelnuts significantly improved HDL-cholesterol and apolipoprotein A1 concentrations, total-C/HDL-C ratio, and systolic blood pressure without significantly changing body composition. Acceptance ratings did not differ between forms of hazelnuts and remained high throughout the study. Dry roasting and lightly salting nuts do not appear to negate the cardioprotective effects observed with raw nut consumption, and both forms of nuts are resistant to monotony. Public health messages could be extended to include dry roasted and lightly salted nuts as part of a heart healthy diet.

Energy compensation and nutrient displacement following regular consumption of hazelnuts and other energy-dense snack foods in non-obese individuals

Abstract: Regular nut consumption reduces cardiovascular disease risk, partly from improvements to dietary quality. Examining how individuals make dietary changes when consuming nuts may reveal key behavioural eating patterns beneficial for the development of dietary interventions. We examined the effects of nuts in comparison with other energy-dense snacks on energy compensation, nutrient displacement, and food group patterns. This was a 12-week randomised, controlled, parallel study with four arms: ~1100 kJ/day for each of hazelnuts (42 g), chocolate (50 g), potato crisps (50 g), or no added snack food. Diet records, body composition, and physical activity were measured at baseline and week 12, in 102 non-obese participants. Significant improvements in diet quality were observed in the hazelnut group, particularly when consumed as snacks. Intakes of monounsaturated fat (MUFA) and vitamin E were significantly higher (all P < 0.05), whereas saturated fat and carbohydrate were significantly lower (both P ≤ 0.022) in the hazelnut group compared to the other groups. Partial energy compensation did not differ significantly between groups, but nutrient displacement values for MUFA and fibre differed significantly. Within the hazelnut group, there was nearly complete displacement for fibre, partial displacement for energy, protein, total fat, MUFA, PUFA, potassium, folate, and vitamin E, and overcompensation for carbohydrate and sugar. Our results demonstrate that energy compensation occurs for all three intervention snacks in this non-obese population. Regular nut consumption significantly improves nutrient profiles compared to other snacks with changes occurring at the snack level.

Barriers to and facilitators and perceptions of nut consumption among the general population in New Zealand.

Abstract: Objective Despite considerable evidence supporting the health benefits of regular nut consumption, nut intakes remain lower than recommended among many populations. Understanding how the general population perceives nuts could inform strategies to promote regular nut consumption and increase intakes among the general public. Design Cross-sectional study. Participants were invited to complete a questionnaire which included information on nut consumption and knowledge and perceptions of nuts. Setting The study was set in New Zealand (NZ). Subjects Participants (n 1600), aged 18 years or over, were randomly selected from the NZ electoral roll. Results A total of 710 participants completed the questionnaire (response rate 44 %). More than half of the respondents believed that nuts are healthy, filling, high in protein and high in fat. The most common reason cited by consumers for eating nuts was taste (86 % for nuts, 85 % for nut butters), while dental issues was the most frequent reason for avoidance. About 40 % of respondents were not aware of the effects of nut consumption on lowering blood cholesterol and CVD risk. Conclusions Despite overall basic knowledge of the nutritional value of nuts, a substantial proportion of the general population was unaware of the cardioprotective effects of nuts. The present study identified common motivations for eating and avoiding nuts, as well as perceptions of nuts which could affect intake. These should guide the content and direction of public health messages to increase regular nut consumption. The public’s knowledge gaps should also be addressed.

Associations between Nut Consumption and Health Vary between Omnivores, Vegetarians, and Vegans.

Abstract: Regular nut consumption is associated with reduced risk factors for chronic disease; however, most population-based studies lack consideration of effect modification by dietary pattern. The UK Women’s Cohort Study (UKWCS) provides an ideal opportunity to examine relationships between nut consumption and chronic disease risk factors in a large sample with diverse dietary patterns. Nut and nutrient intake from 34,831 women was estimated using a food frequency questionnaire among self-identified omnivores, vegetarians and vegans. In this cross-sectional analysis, higher nut consumption was associated with lower body weight (difference between highest and lowest consumption categories from adjusted model: 6.1 kg; 95% CI: 4.7, 7.6) body mass index (BMI, 2.4 units difference; 95% CI: 1.9, 2.9), and waist circumference (2.6 cm difference; 95% CI: 1.4, 3.8) (all p for linear trend < 0.001). Higher nut consumption was also associated with reduced prevalence of high cholesterol and high blood pressure; having a history of heart attack, diabetes and gallstones; and markers of diet quality (all adjusted p for linear trend ≤ 0.011). Higher nut consumption appeared overall to be associated with greater benefits amongst omnivores compared to vegetarians and vegans. Findings support existing literature around beneficial effects of nut consumption and suggest that benefits may be larger among omnivores. Nut promotion strategies may have the highest population impact by specifically targeting this group.

Effect of ketamine dose on self-rated dissociation in patients with treatment refractory anxiety disorders.

Abstract: Patients receiving ketamine for refractory depression and anxiety report dissociative symptoms in the first 60 min post-dose. The most commonly used instrument to assess this is the Clinician-Administered Dissociative States Scale (CADSS), developed based on the assessment of patients with dissociative symptoms. Its psychometric properties for ketamine-induced dissociation have not been reported. We evaluated these from a study using 0.25-1 mg/kg ketamine and midazolam (as an active control) in 18 patients with treatment-resistant anxiety. Dissociation ratings were increased by ketamine in a dose-dependent manner. In contrast, midazolam showed no effect on ratings of dissociation. For individual CADSS items, the magnitude of change and the ketamine dose at which changes were observed were not homogenous. The Cronbach alpha for the total scale was high (0.937), with acceptable item-rest correlations for almost all individual items. Purposefully removing items to maximise alpha did not lead to meaningful improvements. Acceptable internal consistency was still observed after removing items which lacked evidence of responsiveness at lower doses. The high Cronbach alpha values identified in this study suggests that the CADSS is an internally consistent instrument for evaluating ketamine-induced dissociation in clinical trials in anxiety, although it does not capture symptoms such as thought disorder.

Perceptions and Knowledge of Nuts amongst Health Professionals in New Zealand

Abstract: Despite their nutritional value, population‐level nut consumption remains low. Studies suggest that individuals would eat more nuts on their doctor’s advice, making health professionals potentially important for promoting nut consumption. This cross‐sectional study aimed to examine the perceptions and knowledge of nuts and the predictors of nut promotion among health professionals in New Zealand. Dietitians, general practitioners (GPs), and practice nurses were identified from the Electoral Roll and invited to complete a questionnaire (n = 318, 292, and 149 respondents respectively). Over one‐fifth of GPs and practice nurses believed that eating nuts could increase blood cholesterol concentrations and cause weight gain. The most common perceptions overall were that nuts are healthy; high in protein, fat, and calories; and are satiating. Nut consumption was recommended for reasons relating to these perceptions and because of nuts’ selenium content. Conversely, reasons for suggesting the consumption of fewer nuts included that they were high in calories and fat, would cause weight gain, and concerns regarding allergies and cost. All groups of health professionals were more likely to promote nut consumption if they perceived nuts to reduce the risk of diabetes (all p ≤ 0.034). Education could improve health professionals’ knowledge regarding the effects of nut consumption on blood cholesterol and body weight, alongside other health benefits, which should improve the advice given to patients and may thereby increase nut consumption.

Place, health, and community attachment: Is community capacity associated with self-rated health at the individual level?

Abstract: Community-level interventions dominate contemporary public health responses to health inequalities as a lack of political will has discouraged action at a structural level. Health promoters commonly leverage community capacity to achieve programme goals, yet the health implications of low community capacity are unknown. In this study, we analyse perceptions of community capacity at the individual-level to explore how place-based understandings of identity and connectedness are associated with self-rated health. We examine associations between individual community capacity, self-rated health and income using a cross-sectional survey that was disseminated to 303 residents of four small (populations 1500-2000) New Zealand towns. Evidence indicating a relationship between individual community capacity and self-reported health was unconvincing once the effects of income were incorporated. That is, people who rated their community's capacity higher did not have better self-rated health. Much stronger evidence supported the relationship between income and both higher individual community capacity and higher self-rated health. We conclude that individual community capacity may mediate the positive association between income and health, however, overall we find no evidence suggesting that intervening to enhance individual community capacity is likely to improve health outcomes.

Eating frequency in relation to BMI in very young children: a longitudinal analysis.

Abstract: Objective Eating less frequently is associated with increased obesity risk in older children but data are potentially confounded by reverse causation, where bigger children eat less often in an effort to control their weight. Longitudinal data, particularly in younger children, are scarce. We aimed to determine whether eating frequency (meals and snacks) at 2 years of age is associated with past, current or subsequent BMI. Design Cohort analysis of a randomised controlled trial. Eating frequency at 2 years of age was estimated using 48 h diaries that recorded when each child ate meals and snacks (parent-defined) in five-minute blocks. Body length/height and weight were measured at 1, 2 and 3·5 years of age. Linear regression assessed associations between the number of eating occasions and BMI Z-score, before and after adjustment for potential confounding variables. Setting Prevention of Overweight in Infancy (POI) study, Dunedin, New Zealand. Subjects Children (n 371) aged 1-3·5 years. Results On average, children ate 5·5 (sd 1·2) times/d at 2 years of age, with most children (88-89 %) eating 4-7 times/d. Eating frequency at 2 years was not associated with current (difference in BMI Z-score per additional eating occasion; 95 % CI: -0·02; -0·10, 0·05) or subsequent change (0·02; -0·03, 0·06) in BMI. Similarly, BMI at age 1 year did not predict eating frequency at 2 years of age (difference in eating frequency per additional BMI Z-score unit; 95 % CI: -0·03; -0·19, 0·13). Conclusions Number of eating occasions per day was not associated with BMI in young children in the present study.

Unintended Sunburn: A Potential Target for Sun Protection Messages.

Abstract: New Zealand (NZ) has the highest melanoma incidence rate in the world. Primary prevention efforts focus on reducing sunburn incidence and increasing sun protective practices in the population. However, sunburn from excessive ultraviolet radiation (UVR) remains common. To reduce sunburn incidence, it is important to examine those individuals who experience unintended sunburn. This study aims to use data from the NZ Triennial Sun Protection Survey to describe respondents who were not intending to tan but were sunburnt after outdoor UVR exposure. Information on sociodemographics, concurrent weather conditions, sun protection attitudes and knowledge, and outdoor behaviour was also collected. The results showed 13.5% of respondents’ experienced unintended sunburn during the survey weekend but had not attempted to obtain a tan that summer. Respondents who reported unintended sunburn were more likely than others to have been near water and in unshaded areas, used sunscreen, had higher SunSmart knowledge scores, had lower positive attitudes towards tanning, and were outdoors for a longer duration with less body coverage. As sunburn was unintended these respondents’ outdoor sun protective behaviours may be amenable to change. Future public health initiatives should focus on increasing sun protection (clothing and shade) and reducing potential barriers to sun protection.

Audit of the association between length of time spent on diagnostic work-up and tumour stage in patients with symptomatic colon cancer.

Abstract: Background Colorectal cancer is one of the most incident cancers in New Zealand. Due to resource limitations, some patients experienced protracted wait times before reaching a definitive diagnosis. We analysed the relationship between time to diagnosis and clinical stage and reviewed the length of time for components of the diagnostic work-up to identify priority areas for service improvement. We benchmarked our timeliness against introduced standards. Methods This retrospective study included all patients with colonic (not rectal) cancer between October 2007 and September 2009. Patients were stratified into an early and advanced group. Types of delay were calculated from the onset of symptoms to the administration of treatment. The compliance with target waiting times was assessed. Results Fifty-eight patients were included in the early group and 83 patients in the advanced group. There were no significant differences in demographics or symptoms. The work-up was longer than international benchmarks, but with wide variations. There was no statistical difference between lengths of work-up in the groups. The advanced group had increased utilization of private and emergency investigations. Forty-four per cent met the diagnostic colonoscopy target waiting time of 42 days with a trend in favour of the advanced group and 21% received treatment within 62 days (non-significant). Conclusion Current systems are not sophisticated enough to predict the stage of colon cancer. Here, long waiting times were not associated with cancer stage in symptomatic patients. Resources need to be directed to diagnostic colonic imaging.

Resolution of infertility and number of children: 1386 couples followed for a median of 13 years.

Abstract: Study question How common were children among infertile couples? Summary answer A total of 61.7% of infertile couples presenting for care subsequently had live born children 13.1 years after first being clinically assessed, with a mean of 1.7 children among those who had at least one. What is known already While the prognoses for infertile couples undertaking specific treatments have been well described, less is known about those not undergoing these treatments or the total number of children. This information is necessary for decision-making in many individual cases; not knowing this has been cited by patients and clinicians as impeding implementation of care. Study design, size, duration The sole provider of specialist fertility care for the two southern-most regions in New Zealand enroled 1386 infertile couples from 1998 to 2005 in a longitudinal study with follow-up on all births until the end of 2014. Couples were followed in care for a median of 1.1 years and median follow-up for births was 13.1 years. Participants/materials, setting, methods Clinic-collected data were linked to national maternity data to extend follow-up past the end of clinical contact. The primary outcome was the total number of live born children. Hurdle regression was used to investigate factors associated with resolving infertility and the total number of children. Main results and the role of chance Infertility was resolved with a live birth by 61.7% (95% CI 59.1-64.2%) of couples; just over half of all first births were treatment-dependent. Among couples who resolved their infertility, 55.6% (52.2-58.9%) had at least one additional child and the mean number of children was 1.7. While female age strongly influenced outcomes, one-third of women aged 40-41 years had a child, not significantly less than those in their late 30s. The lowest levels of resolution occurred in women aged ≥42 years, couples who were infertile for >4 years and women with a BMI ≥ 35 kg/m2. Moderate obesity did not affect outcomes. Limitations, reasons for caution The main limitation of this study was insufficient data to investigate male factor infertility outcomes. It is also possible that treatment-dependent resolution could be higher in more recent cohorts with the increased use of ART. Wider implications of the findings Outcomes in these couples are comparable to those seen in other studies in high-income countries despite the relatively low contribution of ART. The prognosis for most infertile couples is positive and suggests many will not require treatment. Further research is needed to inform best practice for women in their early forties or with moderate obesity, and to develop prediction models that are more relevant for the initial management of infertility. Study funding/competing interest(s) This study was co-funded by a University of Otago PhD Scholarship and the Department of Women's and Children's Health, University of Otago. There were no competing interests to declare.

Prediction Equations Overestimate the Energy Requirements More for Obesity-Susceptible Individuals.

Abstract: Predictive equations to estimate resting metabolic rate (RMR) are often used in dietary counseling and by online apps to set energy intake goals for weight loss. It is critical to know whether such equations are appropriate for those susceptible to obesity. We measured RMR by indirect calorimetry after an overnight fast in 26 obesity susceptible (OSI) and 30 obesity resistant (ORI) individuals, identified using a simple 6-item screening tool. Predicted RMR was calculated using the FAO/WHO/UNU (Food and Agricultural Organisation/World Health Organisation/United Nations University), Oxford and Miflin-St Jeor equations. Absolute measured RMR did not differ significantly between OSI versus ORI (6339 vs. 5893 kJ·d-1, p = 0.313). All three prediction equations over-estimated RMR for both OSI and ORI when measured RMR was ≤5000 kJ·d-1. For measured RMR ≤7000 kJ·d-1 there was statistically significant evidence that the equations overestimate RMR to a greater extent for those classified as obesity susceptible with biases ranging between around 10% to nearly 30% depending on the equation. The use of prediction equations may overestimate RMR and energy requirements particularly in those who self-identify as being susceptible to obesity, which has implications for effective weight management.

Psychosocial effects in parents and children 12 years after newborn genetic screening for type 1 diabetes.

Abstract: Little is known about the psychosocial consequences of testing newborns for genetic susceptibility to multifactorial diseases. This study reports quantitative psychosocial evaluations of parents and children 12 years after screening for type 1 diabetes (T1D). Two parent-child cohorts participated: children at increased genetic risk of T1D and children at low genetic risk. T1D risk status was determined at birth as part of a prospective study investigating potential environmental triggers of autoimmunity. Parent measures included ratings of children’s emotional, behavioural and social functioning (Child Behaviour Checklist) and parenting style (Alabama Parenting Questionnaire). Child self-concept was assessed using the self-description questionnaire (SDQ1). Statistical analyses were conducted to test for differences between the groups. Twelve years after testing there was no evidence that knowledge of a child’s increased genetic risk of T1D adversely affected parental ratings of their child’s emotional, behavioural or social functioning, or impacted upon parenting style. There was no adverse effect upon the child’s assessment of their self-concept. This study provides important preliminary data concerning longer-term psychosocial effects of incorporating tests for genetic risk of complex disorders into NBS panels. While it is reassuring that no significant adverse effects have been detected, more data will be required to adequately inform policy.

How much atopy is attributable to common childhood environmental exposures? A population-based birth cohort study followed to adulthood.

Abstract: Background The rising prevalence of atopic diseases implies a strong influence of environmental determinants. Epidemiological studies have identified several early life exposures that appear to influence the risk of developing atopic sensitization, but the combined influence of these exposures is unknown. We sought to estimate the proportion of atopy that could be attributed to common childhood exposures associated with atopic sensitization in adolescence and young adulthood. Methods Atopic sensitization was measured by skin-prick tests for common aeroallergens in a population-based New Zealand birth cohort at ages 13 and 32 years. The independent effects of previously identified risk and protective factors for atopic sensitization were assessed using multiple logistic regression. Population attributable fractions were calculated for atopic sensitization in childhood and adulthood. Results Tobacco smoke exposure, dog and cat ownership, nail-biting and thumb-sucking, attending pre-school day care, and household crowding were associated with a lower risk of atopic sensitization whereas breastfeeding was associated with a higher risk. Population attributable fractions for combined effects of these environmental factors suggest that they may account for 58% of atopic sensitization at age 13 and 49% at age 32 years. Conclusions A substantial proportion of atopic sensitization appears to be attributable to common childhood environmental and lifestyle factors, and the influence of these exposures persists into adulthood. The absolute risks attributable to these exposures will be different in other cohorts and we cannot assume that these associations are necessarily causal. Nevertheless, the findings suggest that identifiable childhood environmental factors contribute substantially to atopic sensitization.

Current nut recommendation practices differ between health professionals in New Zealand

Abstract: Objective Despite evidence linking regular nut consumption with reduced chronic disease risk, population-level intakes remain low. Research suggests nut-promoting advice from doctors facilitates regular nut consumption. However, there is no information on current nut recommendation practices of health professionals. The aim of the present study was to examine the advice provided by health professionals regarding nut consumption. Design In this cross-sectional study, participants were invited to complete a survey including questions about their nut recommendation practices. Setting New Zealand (NZ). Subjects The NZ Electoral Roll was used to identify dietitians, general practitioners and practice nurses. Results In total 318 dietitians, 292 general practitioners and 149 practice nurses responded. Dietitians were more likely (82·7 %) to recommend patients increase consumption of nuts than general practitioners (55·5 %) and practice nurses (63·1 %; both P<0·001). The most popular nuts recommended were almonds, Brazil nuts and walnuts, with most health professionals recommending raw nuts. The most common recommendation for frequency of consumption by dietitians and practice nurses was to eat nuts every day, while general practitioners most frequently recommended 2–4 times weekly, although not statistically significantly different between professions. Dietitians recommended a significantly greater amount of nuts (median 30 g/d) than both general practitioners and practice nurses (20 g/d; both P<0·001). Conclusions Dietitians were most likely to recommend consumption of nuts in accordance with current guidelines, but there are opportunities to improve the adoption of nut consumption recommendations for all professions. This may be a viable strategy for increasing population-level nut intakes to reduce chronic disease.

Eyesight: a study of the staff of a dental school.

Abstract: The aim was to investigate the vision of all 90 dentally qualified staff at a dental school Ethical approval was obtained and a questionnaire-based survey conducted Data were screened and analysed using Stata 131 The χ2 and Fisher’s Exact tests were used to test for significance with an alpha level of 005 The participation rate was 956% Most of the teachers (92%) considered their eyesight was satisfactory to practice dentistry Of the 97% who had been tested at some stage, 15% had their eye examination due to sight deterioration with 22% needing correction Almost two-thirds were myopic and a third were hyperopic Forty-nine per cent wore spectacles only, with about a quarter of this group alternating between spectacles and contact lenses Of those with corrected vision, 80% followed their optometrist’s recall advice Four participants reported that they were colour blind While 4% had had laser-eye surgery, a further 27% were interested in this Magnification was used by 72% with no significant differences between genders, age of staff member, place of qualification or registration status Most of the staff (81%) thought that screening of dental student’s eyesight should be mandatory, and regular eye examinations as a condition of dental practice was supported by 67% The number of teachers reporting recent vision tests was encouraging; nevertheless, a worrying 8% surveyed were unsure if their eyesight was satisfactory for work The commonest vision problem was myopia, with almost half of the teachers wearing spectacles It is clear that visual standards for dentistry would be helpful Magnification use was high, with many non-users indicating their intention to buy loupes Within the limits of this study the teachers were conscientious regarding their eye care, irrespective of their training and age There was strong support for the mandatory testing of vision for all dentists and especially dental students