Massey Research Online - Browsing by Author "Denison H"

Browsing by Author "Denison H"

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Clinical risk factors, bone density and fall history in the prediction of incident fracture among men and women
(2013) Edwards MH; Jameson K; Denison H; Harvey NC; Sayer AA; Dennison EM; Cooper C
The FRAX(tr) algorithm uses clinical risk factors (CRF) and bone mineral density (BMD) to predict fracture risk but does not include falls history in the calculation. Using results from the Hertfordshire Cohort Study, we examined the relative contributions of CRFs, BMD and falls history to fracture prediction. We studied 2299 participants at a baseline clinic that included completion of a health questionnaire and anthropometric data. A mean of 5.5years later (range 2.9-8.8years) subjects completed a postal questionnaire detailing fall and fracture history. In a subset of 368 men and 407 women, bone densitometry was performed using a Hologic QDR 4500 instrument. There was a significantly increased risk of fracture in men and women with a previous fracture. A one standard deviation drop in femoral neck BMD was associated with a hazards ratio (HR) of incident fracture (adjusted for CRFs) of 1.92 (1.04-3.54) and 1.77 (1.16-2.71) in men and women respectively. A history of any fall since the age of 45years resulted in an unadjusted HR of fracture of 7.31 (3.78-14.14) and 8.56 (4.85-15.13) in men and women respectively. In a ROC curve analysis, the predictive capacity progressively increased as BMD and previous falls were added into an initial model using CRFs alone. Falls history is a further independent risk factor for fracture. Falls risk should be taken into consideration when assessing whether or not to commence medication for osteoporosis and should also alert the physician to the opportunity to target falls risk directly.
Geographic Disparities in Stroke Outcomes and Service Access: A Prospective Observational Study
(Wolters Kluwer Health, Inc on behalf of the American Academy of Neurology, 26/07/2022) Thompson SG; Barber PA; Gommans JH; Cadilhac DA; Davis A; Fink JN; Harwood M; Levack W; McNaughton HK; Feigin VL; Abernethy V; Girvan J; Kim J; Denison H; Corbin M; Wilson A; Douwes J; Ranta A
BACKGROUND AND OBJECTIVE: International evidence shows that patients treated at non-urban hospitals experience poorer access to key stroke interventions. Evidence whether this results in poorer outcomes is conflicting and generally based on administrative or voluntary registry data. The aim of this study was to use prospective high-quality comprehensive nationwide patient level data to investigate the association between hospital geography and stroke patient outcomes and access to best practice stroke care in New Zealand. METHODS: This is a prospective, multi-centre, nationally representative observational study involving all 28 New Zealand acute stroke hospitals (18 non-urban), and affiliated rehabilitation and community services. Consecutive adults admitted to the hospital with acute stroke between 1 May and 31 October 2018 were captured. Outcomes included functional outcome (modified Rankin Scale (mRS) shift analysis), functional independence (mRS scores 0-2), quality of life (EQ5D-3L), stroke/vascular events, and death at 3, 6, and 12 months and proportion accessing thrombolysis, thrombectomy, stroke units, key investigations, secondary prevention, and inpatient/community rehabilitation. Results were adjusted for age, sex, ethnicity, stroke severity/type, co-morbidities, baseline function, and differences in baseline characteristics. RESULTS: Overall, 2,379 patients were eligible (mean (standard deviation) age 75 (13.7); 51.2% male; 1,430 urban; 949 non-urban). Patients treated at non-urban hospitals were more likely to score in a higher mRS category (greater disability) at three (aOR=1.28, 1.07-1.53), six (aOR=1.33, 1.07-1.65) and twelve months (aOR=1.31, 1.06-1.62) and were more likely to have died (aOR=1.57, 1.17-2.12) or experienced recurrent stroke and vascular events at 12 months (aOR=1.94, 1.14-3.29 and aOR=1.65, 1.09-2.52). Fewer non-urban patients received recommended stroke interventions including endovascular thrombectomy (aOR=0.25, 95% confidence interval 0.13-0.49), acute stroke unit care (aOR=0.60, 0.49-0.73), antiplatelet prescriptions (aOR=0.72, 0.58-0.88), ≥60 minutes daily physical therapy (aOR=0.55, 0.40-0.77) and community rehabilitation (aOR=0.69, 0.56-0.84). DISCUSSION: Patients managed at non-urban hospitals experience poorer stroke outcomes and reduced access to key stroke interventions across the entire care continuum. Efforts to improve access to high quality stroke care in non-urban hospitals should be a priority.
Knowledge of Osteoporosis and Lifestyle Behaviours Impacting Peak Bone Mass among Young Adults
(LIDSEN Publishing Inc., 2021-01-11) Patel H; Denison H; Zafar S; Teesdale-Spittle P; Dennison E; Marks R
Osteoporosis is a major public health problem through its association with fragility fracture. Low peak bone mass (PBM) is a major contributor to later osteoporosis risk. Despite this, most studies concentrate on older people when the window of opportunity to impact PBM has passed. This study aimed to understand what adolescents and young adults understand about PBM, the risk of osteoporotic fracture and how lifestyle factors impact PBM. Such information may inform educational interventions to reduce future risk of fracture, and provide important public health benefits. New Zealand university students were approached to participate in this study. Nine focus groups of a total of 44 adolescents and young adults, mean age 22.9 (± 4.02) years of different ethnicities (29 female 15 male), were conducted using a semi-structured approach with open-ended questions and prompts. Transcripts were thematically coded using an inductive content analysis approach. Participants reported poor knowledge of PBM and factors impacting risk of osteoporotic fracture. There was a general awareness of the positive and negative impacts of many lifestyle behaviours such as physical activity, diet, tobacco smoking and alcohol consumption on health in general, but not specifically how these impact PBM and good bone health in later life. We conclude that in a cohort of New Zealand University students, current knowledge of osteoporosis and lifestyle factors that impact PBM is limited. Educational interventions in young adults are now warranted to improve PBM and prevent osteoporosis in late adulthood.
Occupational Exposures and Ischaemic Heart Disease: Results from The Entire New Zealand Population
(Swansea University, 7/12/2020) Eng A; Corbin M; Denison H; Barnes L; t'Mannetje A; McLean D; Laird I; Douwes J
Introduction Ischaemic Heart Disease (IHD) is a leading cause of death in Western countries. Common occupational exposures such as loud noise, long working hours, and sedentary work have been associated with increased IHD risks, but inconsistently. Objectives and Approach This study examines associations between incident IHD and exposure to long working hours, sedentary work, and loud noise. Individual-level microdata from Statistics New Zealand Integrated Data Infrastructure (IDI) were extracted for adults (age 20-64 years) with occupation recorded on the 2013 Census. The number of working hours was extracted from the Census, and exposure to sedentary work and loud noise was assessed through job exposure matrices (JEMs). IHD events (from 2013 to end of 2018) were identified using hospitalisations, prescriptions and deaths. Hazard ratios (HRs) were calculated using cox regression adjusted for age, socioeconomic status, and smoking. Results were stratified by sex and ethnicity. Results A total of 20,610 IHD cases were identified from 1,594,680 individuals employed at time of Census. Both short (<35) and long (55+) working hours were associated with an increased IHD risk in crude analyses, but effects disappeared after adjustment for age and socioeconomic status. For females, sedentary work (>90% of the time compared to <50%) was associated with a reduced risk (HR(Non-Māori)=0.86, 95%CI=0.75-0.99; HR(Māori)=0.71, 95%CI=0.44-1.14). For males, exposure to the highest noise category (>90dBA) compared to no exposure (<80dBA) was associated with elevated HRs without reaching statistical significance (HR(Non-Māori)=1.12, 95%CI=0.96-1.29; HR(Māori)=1.25, 95%CI=0.89-1.75). For females exposure to the 80-85dBA category compared to no exposure also showed elevated HRs (HR(Non-Māori)=1.14; 95%CI=1.04-1.26; HR(Māori)=1.16; 95%CI=0.93-1.46), but too few females were employed in jobs with the highest noise exposure. Conclusion These preliminary analyses do not support sedentary work or long working hours as IHD risk factors, but do suggest a modest increase in IHD risk associated with occupational exposure to noise.
Reducing ethnic and geographic inequities to optimise New Zealand stroke care (REGIONS Care): Protocol for a nationwide observational study
(JMIR Publications, 12/01/2021) Ranta A; Thompson S; Harwood MLN; Cadilhac DA-M; Barber PA; Davis AJ; Gommans JH; Fink JN; McNaughton HK; Denison H; Corbin M; Feigin V; Abernethy V; Levack W; Douwes J; Girvan J; Wilson A; Derrick, T
Background: Stroke systems of care differ between larger urban and smaller rural settings and it is unclear to what extent this may impact on patient outcomes. Ethnicity influences stroke risk factors and care delivery as well as patient outcomes in nonstroke settings. Little is known about the impact of ethnicity on poststroke care, especially in Māori and Pacific populations. Objective: Our goal is to describe the protocol for the Reducing Ethnic and Geographic Inequities to Optimise New Zealand Stroke Care (REGIONS Care) study. Methods: This large, nationwide observational study assesses the impact of rurality and ethnicity on best practice stroke care access and outcomes involving all 28 New Zealand hospitals caring for stroke patients, by capturing every stroke patient admitted to hospital during the 2017-2018 study period. In addition, it explores current access barriers through consumer focus groups and consumer, carer, clinician, manager, and policy-maker surveys. It also assesses the economic impact of care provided at different types of hospitals and to patients of different ethnicities and explores the cost-efficacy of individual interventions and care bundles. Finally, it compares manual data collection to routine health administrative data and explores the feasibility of developing outcome models using only administrative data and the cost-efficacy of using additional manually collected registry data. Regarding sample size estimates, in Part 1, Study A, 2400 participants are needed to identify a 10% difference between up to four geographic subgroups at 90% power with an α value of .05 and 10% to 20% loss to follow-up. In Part 1, Study B, a sample of 7645 participants was expected to include an estimated 850 Māori and 419 Pacific patients and to provide over 90% and over 80% power, respectively. Regarding Part 2, 50% of the patient or carer surveys, 40 provider surveys, and 10 focus groups were needed to achieve saturation of themes. The main outcome is the modified Rankin Scale (mRS) score at 3 months. Secondary outcomes include mRS scores; EQ-5D-3L (5-dimension, 3-level EuroQol questionnaire) scores; stroke recurrence; vascular events; death; readmission at 3, 6, and 12 months; cost of care; and themes around access barriers. Results: The study is underway, with national and institutional ethics approvals in place. A total of 2379 patients have been recruited for Part 1, Study A; 6837 patients have been recruited for Part 1, Study B; 10 focus groups have been conducted and 70 surveys have been completed in Part 2. Data collection has essentially been completed, including follow-up assessment; however, primary and secondary analyses, data linkage, data validation, and health economics analysis are still underway. Conclusions: The methods of this study may provide the basis for future epidemiological studies that will guide care improvements in other countries and populations. International Registered Report Identifier (IRRID): DERR1-10.2196/25374
The impact of ethnicity on stroke care access and patient outcomes: a New Zealand nationwide observational study
(Elsevier Ltd, 2022-03) Thompson SG; Barber PA; Gommans JH; Cadilhac DA; Davis A; Fink JN; Harwood M; Levack W; McNaughton H; Feigin VL; Abernethy V; Girvan J; Denison H; Corbin M; Wilson A; Douwes J; Ranta A
BACKGROUND: Ethnic inequities in stroke care access have been reported internationally but the impact on outcomes remains unclear. In New Zealand, data on ethnic stroke inequities and resultant effects on outcomes are generally limited and conflicting. METHODS: In a prospective, nationwide, multi-centre observational study, we recruited consecutive adult patients with confirmed stroke from 28 hospitals between 1 May and 31 October 2018. Patient outcomes: favourable functional outcomes (modified Rankin Scale 0-2); quality of life (EQ-5D-3L); stroke/vascular events; and death at three, six and 12 months. Process measures: access to reperfusion therapies, stroke-units, investigations, secondary prevention, rehabilitation. Multivariate regression analyses assessed associations between ethnicity and outcomes and process measures. FINDINGS: The cohort comprised 2,379 patients (median age 78 (IQR 66-85); 51·2% male; 76·7% European, 11·5% Māori, 4·8% Pacific peoples, 4·8% Asian). Non-Europeans were younger, had more risk factors, had reduced access to acute stroke units (aOR=0·78, 95%CI, 0·60-0·97), and were less likely to receive a swallow screen within 24 hours of arrival (aOR=0·72, 0·53-0·99) or MRI imaging (OR=0·66, 0·52-0·85). Māori were less frequently prescribed anticoagulants (OR=0·68, 0·47-0·98). Pacific peoples received greater risk factor counselling. Fewer non-Europeans had a favourable mRS score at three (aOR=0·67, 0·47-0·96), six (aOR=0·63, 0·40-0·98) and 12 months (aOR=0·56, 0·36-0·88), and more Māori had died by 12 months (aOR=1·76, 1·07-2·89). INTERPRETATION: Non-Europeans, especially Māori, had poorer access to key stroke interventions and experience poorer outcomes. Further optimisation of stroke care targeting high-priority populations are needed to achieve equity. FUNDING: New Zealand Health Research Council (HRC17/037).
The importance of fall history in fracture risk assessment
(2013) Edwards MH; Jameson KA; Denison H; Harvey NC; Sayer AA; Dennison EM; Cooper C
Understanding the Barriers and Enablers to Sporting Activity in Relation to Bone Health: A Qualitative Narrative Study among Adolescents and Young Adults in New Zealand
(Longdom Publishing, 2020-07-29) Patel H; Denison H; Teesdale-Spittle P; Dennison E
Background: Sports participation may be considered a method of reducing the risk of fragility fracture in later life by maximizing Peak Bone Mass (PBM) in the growing years. However, sports participation typically declines during late adolescence and adulthood. This qualitative study aims to identify barriers and facilitators to engaging with regular weight bearing sporting activity in adolescents and young adults in New Zealand. Methods: 44 adolescents and young adults aged 17 to 33 participated in nine focus groups. The study was conducted using a semi-structured approach with open-ended questions and prompts. Transcripts were thematically coded using an inductive content analysis approach. Results: The three main barriers to sports participation that emerged were a) structural (disorientation in a new living environment, facilities, access to healthcare), b) social (financial and time constraints) and c) personal (social pressures and lack of an understanding of why sporting activity matters for bone health) while enablers of sports participation included a) supportive environments, b) access to health checks including support to avoid injury and c) education to better understand benefits of recreational sporting activity. Conclusions: Current awareness of osteoporosis and lifestyle factors that impact PBM is limited. Educational interventions are now warranted and urgently required.
What are the barriers to adoption of a lifestyle associated with optimal peak bone mass acquisition? A qualitative study of young adults in New Zealand
(MDPI (Basel, Switzerland), 2022-02-08) Zafar S; Denison H; Patel H; Dennison E; Longo UG
Objective: This study aimed to investigate the barriers to adopting lifestyle factors other than physical activity important for optimal peak bone mass (PBM) acquisition—namely, dietary factors, avoidance of cigarette smoking, and keeping alcohol consumption within recommended limits. Materials and Methods: University students and staff aged 18–35 years were recruited. Six semi-structured, in-depth focus group interviews were conducted with a total of 28 participants. The interviews were digitally recorded and transcribed. A thematic approach for data analysis using a constant comparative method was performed using NVivo software. Results: Three major themes emerged: socio-cultural barriers (peer pressure and cultural norms); personal barriers (time, cost, and diet preferences); and other barriers (medical illness and lack of symptoms associated with low bone mass density). Conclusions: We identified several barriers to adoption of lifestyle behaviours that might be beneficial to PBM acquisition. These data might facilitate the development of public health interventions designed to help young adults embrace osteoprotective lifestyles, and hence reduce the burden of osteoporotic fracture in later life.

Browsing by Author "Denison H"

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