Showing papers by "Andrew R. Gray published in 2022"

Differential Effects of Cannabis and Tobacco on Lung Function in Mid-Adult Life.

Abstract: RATIONALE Evidence suggests that the effects of smoking cannabis on lung function are different to tobacco. However, long-term follow-up data are scarce, and mostly based on young adults. OBJECTIVE To assess the effects of cannabis and tobacco on lung function in mid-adult life. METHODS Cannabis and tobacco use were reported at ages 18, 21, 26, 32, 38, and 45 years in a population-based cohort study of 1037 participants. Spirometry, plethysmography, and carbon monoxide transfer factor were measured at age 45. Associations between lung function and cannabis use were adjusted for tobacco use. MEASUREMENTS AND MAIN RESULTS Data were available from 881 (88%) of 997 surviving participants. Cumulative cannabis use was associated with lower Forced Expiratory Volume in one second to Forced Vital Capacity ratios, due to a tendency towards higher Forced Vital Capacities. Cannabis use was also associated with higher total lung capacity, functional residual capacity, residual volume, and alveolar volume along with lower mid-expiratory flows, airway conductance, and transfer factor. Quitting regular cannabis use between assessments was not associated with changes in spirometry. CONCLUSIONS Cannabis use is associated with higher lung volumes suggesting hyperinflation. There is evidence of increased large-airways resistance and lower mid-expiratory airflow, but impairment of Forced Expiratory Volume in one second to Forced Vital Capacity ratio is due to higher Vital Capacities. This pattern of effects is different to those of tobacco. We provide the first evidence that lifetime cannabis use may be associated with impairment of gas transfer.

Clinical and Microbiological Evaluation of a Chlorhexidine-Modified Glass Ionomer Cement (GIC-CHX) Restoration Placed Using the Atraumatic Restorative Treatment (ART) Technique

Abstract: The aims of this study were to investigate the clinical effectiveness and patient acceptability of a modified glass ionomer cement placed using the atraumatic restorative treatment (ART) technique to treat root caries, and to carry out microbiological analysis of the restored sites. Two clinically visible root surface carious lesions per participant were restored using ART. One was restored with commercial glass ionomer cement (GIC) (ChemFil® Superior, DENTSPLY, Konstonz, Germany) which acted as the control. The other carious root lesion was restored with the same GIC modified with 5% chlorhexidine digluconate (GIC-CHX; test). Patient acceptability and restoration survival rate were evaluated at baseline and after 6 months. Plaque and saliva samples around the test and control restorations were collected, and microbiological analysis for selected bacterial and fungal viability were completed at baseline, and after 1, 3, and 6 months. In total, 52 restorations were placed using GIC and GIC-CHX in 26 participants; 1 patient was lost to follow-up. After reviewing the restorations during their baseline appointments, participants indicated that they were satisfied with the appearance of the restorations (n = 25, 96%) and did not feel anxious during the procedure (n = 24, 92%). Forty-eight percent (n = 12) of the GIC-CHX restorations were continuous with the existing anatomic form as opposed to six for the GIC restorations (24%), a difference which was statistically significant (p = 0.036). There was no statistically significant reduction in the mean count of the tested microorganisms in plaque samples for either type of restorations after 1, 3, or 6 months. Restoration of carious root surfaces with GIC-CHX resulted in higher survival rates than the control GIC. ART using GIC-CHX may therefore be a viable approach for use in outreach dental services to restore root surface carious lesions where dental services are not readily available, and for older people and special needs groups.

Measuring Changes in Jaw Opening Forces to Assess the Degree of Improvement in Patients with Temporomandibular Disorders

Abstract: Background: Currently, the degree of improvement in patients with TMDs is measured through subjective questionnaires and clinical examination This study aimed to investigate the properties of an objective quantitative measure of jaw-opening forces to assess clinical improvement in temporomandibular disorder (TMD) patients following treatment. Methods: Baseline jaw-opening forces were recorded for TMD-patients (n = 62) and a comparison group of TMD-free participants (n = 56), using a jaw-opening forces measuring device. TMD patients were divided into three subcategories (myofascial pain, disc-displacement, and myofascial pain and disc-displacement combined) and received a combination of treatment for six months; meanwhile, TMD-free participants did not receive treatment. Jaw-opening forces for each participant in both groups were measured at their six-month review appointment. Results: Jaw-opening forces were reliable at baseline (single measure ICC 0.98, 95% CI 0.97–0.98, ICC ≥ 0.94 for all groups and subcategories). Jaw-opening forces increased in the TMD group following treatment at six-months (18.6 N at baseline and 32.4 N at six-months, p < 0.001) and did not change significantly in the TMD-free group (49 N at baseline and 48.3 N at six-months). There was a small improvement in the disc displacement group (27.8% higher forces, p = 0.002). However, the myofascial-pain and myofascial-pain-and-disc-displacement groups showed significant improvement following treatment (93.5% higher forces, p < 0.001; 91.1% higher forces, p < 0.001; respectively). Conclusion: This study demonstrated that the measurement of jaw-opening forces could potentially be used to assess the clinical improvement in TMD patients following diagnosis and treatment.

Implementation of the Diabetes Community Exercise and Education Programme (DCEP) for the management of type 2 diabetes: qualitative process evaluation

Abstract: Objectives To examine context-specific delivery factors, facilitators and barriers to implementation of the Diabetes Community Exercise and Education Programme (DCEP) for adults with type 2 diabetes (T2D) using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Design A qualitative evaluation embedded within the DCEP pragmatic randomised controlled trial. Data collected via focus groups and interviews and analysed thematically. Setting Community-based in two cities (Dunedin and Invercargill) in the lower south island of New Zealand. Participants Seventeen adults diagnosed with T2D attending DCEP and 14 healthcare professionals involved in DCEP delivery. Intervention DCEP is a twice weekly session of exercise and education over 12 weeks, followed by a twice weekly ongoing exercise class. Results While our reach target was met (sample size, ethnic representation), the randomisation process potentially deterred Māori and Pasifika from participating. The reach of DCEP may be extended through the use of several strategies: promotion of self-referral, primary healthcare organisation ownership and community champions. DCEP was considered effective based on perceived benefit. The social and welcoming environment created relationships and connections. People felt comfortable attending DCEP and empowered to learn. Key to implementation and adoption was the building of trusting relationships with local health providers and communities. This takes time and care and cannot be rushed. Training of staff and optimising communication needed further attention. To maintain DCEP, delivery close to where people live and a generic approach catering for people with multiple chronic conditions may be required. Conclusions For success, lifestyle programmes such as DCEP, need time and diligence to build and maintain networks and trust. Beyond frontline delivery staff and target populations, relationships should extend to local healthcare organisations and communities. Access and ongoing attendance are enabled by healthcare professionals practicing in a nuanced person-centred manner; this, plus high staff turnover, necessitates ongoing training. Trial registration number ACTRN12617001624370.

Consuming Almonds or Biscuits for 1-Year: Effects on Body Weight, Satiety, and Diet Quality

Abstract: Abstract Objectives Given almonds are rich in unsaturated fat, vitamins, minerals, and phytonutrients, they may provide health benefits over other common snack foods. Many studies report health benefits with regular almond consumption, with no evidence for adverse effects on body weight. However, most interventions have been relatively short and longer studies are needed to support recommendations. Our 12-month trial compared the effects of consuming almonds versus biscuits on body weight and composition, satiety, and diet quality. Methods We randomly assigned 136 community-living adults (74% female, mean age 36 years, BMI < 30 kg/m2) who reported that they regularly snacked on discretionary foods to receive almonds or biscuits daily for one year. These isocaloric snacks provided either 10% of participants’ total energy requirements or 1030 kJ (equivalent to 42.5 g almonds), whichever provided greater energy. Body composition, assessed by dual-energy x-ray absorptiometry, and anthropometry were measured at baseline and 12 months. Diet quality was measured by 3-day weighed diet records at baseline, 3, 6, and 12 months, along with subjective appetite ratings before and after consuming their study snack using visual analogue scales. Results In intention to treat analyses, there was no evidence that body weight changed differently from baseline to 12 months (geometric means 67.1 kg and 69.5 kg in the almond group and 66.3 kg and 66.3 kg in the biscuit group, p = 0.275). There was also no evidence of differences for changes in waist circumference, lean body mass, % body fat, or visceral fat between the groups (all p ≥ 0.180). Subjective appetite ratings did not differ between groups (all p ≥ 0.112). Absolute intakes of protein, fibre, vitamin E, calcium, copper, magnesium, phosphorous, zinc, and the % energy from total fat, monounsaturated fat, polyunsaturated fat significantly increased in the almond compared to the biscuit group (all p ≤ 0.033). Conversely, the percentage of energy from carbohydrate (p = 0.004) and sugar (p = 0.014) significantly decreased for the almond compared to the biscuit group. Conclusions Providing almonds as snacks amongst regular consumers of discretionary snack foods for 12 months did not adversely affect body weight and composition, but improved diet quality compared to providing biscuits. Funding Sources Almond Board of California.