Journal Articles
Permanent URI for this collectionhttps://mro.massey.ac.nz/handle/10179/7915
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Item Antibiotic Use In Utero and Early Life and Risk of Chronic Childhood Conditions in New Zealand: Protocol for a Data Linkage Retrospective Cohort Study(JMIR Publications, 2025-02-28) Ram S; Corbin M; 't Mannetje A; Eng A; Kvalsig A; Baker M; Douwes JBackground: The incidence of many common chronic childhood conditions has increased globally in the past few decades, which has been suggested to be potentially attributed to antibiotic overuse leading to dysbiosis in the gut microbiome. Objective: This linkage study will assess the role of antibiotic use in utero and in early life in the development of type 1 diabetes (T1D), attention-deficit/hyperactive disorder (ADHD), and inflammatory bowel disease. Methods: The study design involves several retrospective cohort studies using linked administrative health and social data from Statistics New Zealand’s Integrated Data Infrastructure. It uses data from all children who were born in New Zealand between October 2005 and December 2010 (N=334,204) and their mothers. Children’s antibiotic use is identified for 4 time periods (at pregnancy, at ≤1 year, at ≤2 years, and at ≤5 years), and the development of T1D, ADHD, and inflammatory bowel disease is measured from the end of the antibiotic use periods until death, emigration, or the end of the follow-up period (2021), whichever came first. Children who emigrated or died before the end of the antibiotic use period are excluded. Cox proportional hazards regression models are used while adjusting for a range of potential confounders. Results: As of September 2024, data linkage has been completed, involving the integration of antibiotic exposure and outcome variables for 315,789 children. Preliminary analyses show that both prenatal and early life antibiotic consumption is associated with T1D. Full analyses for all 3 outcomes will be completed by the end of 2025. Conclusions: This series of linked cohort studies using detailed, complete, and systematically collected antibiotic prescription data will provide critical new knowledge regarding the role of antibiotics in the development of common chronic childhood conditions. Thus, this study has the potential to contribute to the development of primary prevention strategies through, for example, targeted changes in antibiotic use.Item The home literacy environment of school-age autistic children with high support needs.(John Wiley and Sons, 2024-08-01) Westerveld MF; Malone SA; Clendon S; Bowen R; Hayley G; Paynter JBACKGROUND: As a group, autistic children with high support needs (with adaptive functioning in the range of an intellectual disability) are at risk of significant literacy difficulties. We investigated the parent-reported home literacy environment of this group of children. METHOD: Sixty-two parents of autistic children (4.5 to 18.25 years) attending an autism-specific school completed a home literacy survey reporting on their child's: (1) alphabet knowledge, (2) interest in reading, (3) activities/interactions around books, (4) reading ability, and (5) writing ability. RESULTS: We found significant positive correlations between parent-reported child interest in reading and literacy-related interactions and skills, but not with child age. Children using spoken words to communicate obtained significantly greater scores on four home-literacy subscales, but not on reading interest. CONCLUSIONS: A better understanding of the home literacy activities of autistic children with high-support needs is needed to inform educational practices aimed at promoting literacy development in this vulnerable population.Item Using network analysis to identify factors influencing the heath-related quality of life of parents caring for an autistic child(Elsevier Ltd., 2024-09-01) Shepherd D; Buchwald K; Siegert RJ; Vignes MBACKGROUND: Raising an autistic child is associated with increased parenting stress relative to raising typically developing children. Increased parenting stress is associated with lower parent wellbeing, which in turn can negatively impact child wellbeing. AIMS: The current study sought to quantify parenting stress and parent health-related quality of life (HRQOL) in the autism context, and further understand the relationship between them by employing a relatively novel statistical method, Network Analysis. METHODS AND PROCEDURES: This cross-sectional study involved 476 parents of an autistic child. Parents completed an online survey requesting information on parent and child characteristics, parent's perceptions of their autistic child's symptoms and problem behaviours, and assessed their parenting stress and HRQOL. OUTCOMES AND RESULTS: Relative to normative data, parent HRQOL was significantly lower in terms of physical health and mental wellbeing. The structure extracted by the Network Analysis indicated that child age and externalising behaviours were the main contributors to parenting stress, and that externalising behaviours, ASD core behavioural symptoms, and parenting stress predicted HRQOL. CONCLUSIONS AND IMPLICATIONS: Parental responses to child-related factors likely determine parent HRQOL. Findings are discussed in relation to the transactional model, emphasising the importance of both parent and child wellbeing.Item Frequent Use of Baby Food Pouches in Infants and Young Children and Associations with Energy Intake and BMI: An Observational Study.(MDPI (Basel, Switzerland), 2024-09-19) McLean NH; Bruckner BR; Heath A-LM; Haszard JJ; Daniels L; Conlon CA; von Hurst PR; Beck KL; Te Morenga LA; Firestone R; McArthur J; Paul R; Cox AM; Jones EA; Katiforis I; Brown KJ; Casale M; Jupiterwala RM; Rowan MM; Wei A; Fangupo LJ; Healey M; Pulu V; Neha T; Taylor RW; Fernandez M-LOBJECTIVE: Most wet commercial infant foods are now sold in squeezable 'pouches'. While multiple expert groups have expressed concern about their use, it is not known how commonly they are consumed and whether they impact energy intake or body mass index (BMI). The objectives were to describe pouch use, and determine associations with energy intake and BMI, in infants and young children. METHODS: In this observational cross-sectional study of 933 young New Zealand children (6.0 months-3.9 years), pouch use was assessed by a questionnaire ('frequent' use was consuming food from a baby food pouch ≥5 times/week in the past month), usual energy intake using two 24-h recalls, and BMI z-score calculated using World Health Organization standards. RESULTS: The sample broadly represented the wider population (27.1% high socioeconomic deprivation, 22.5% Māori). Frequent pouch use declined with age (infants 27%, toddlers 16%, preschoolers 8%). Few children were both frequent pouch users and regularly used the nozzle (infants 5%, toddlers 13%, preschoolers 8%). Preschoolers who were frequent pouch users consumed significantly less energy than non-users (-580 kJ [-1094, -67]), but infants (115 [-35, 265]) and toddlers (-206 [-789, 378]) did not appear to have a different energy intake than non-users. There were no statistically significant differences in the BMI z-score by pouch use. CONCLUSIONS: These results do not support the strong concerns expressed about their use, particularly given the lack of evidence for higher energy intake or BMI.Item Severe weather events and cryptosporidiosis in Aotearoa New Zealand: A case series of space-time clusters.(Cambridge University Press, 2024-04-15) Grout L; Hales S; Baker MG; French N; Wilson NOccurrence of cryptosporidiosis has been associated with weather conditions in many settings internationally. We explored statistical clusters of human cryptosporidiosis and their relationship with severe weather events in New Zealand (NZ). Notified cases of cryptosporidiosis from 1997 to 2015 were obtained from the national surveillance system. Retrospective space-time permutation was used to identify statistical clusters. Cluster data were compared to severe weather events in a national database. SaTScan analysis detected 38 statistically significant cryptosporidiosis clusters. Around a third (34.2%, 13/38) of these clusters showed temporal and spatial alignment with severe weather events. Of these, nearly half (46.2%, 6/13) occurred in the spring. Only five (38%, 5/13) of these clusters corresponded to a previously reported cryptosporidiosis outbreak. This study provides additional evidence that severe weather events may contribute to the development of some cryptosporidiosis clusters. Further research on this association is needed as rainfall intensity is projected to rise in NZ due to climate change. The findings also provide further arguments for upgrading the quality of drinking water sources to minimize contamination with pathogens from runoff from livestock agriculture.Item Telehealth-delivered naturalistic developmental behavioural intervention with and without caregiver acceptance and commitment therapy for autistic children and their caregivers: protocol for a multi-arm parallel group randomised clinical trial.(BMJ Publishing Group Limited, 2023-05-30) McLay L; Emerson LM; Waddington H; van Deurs J; Hunter J; Blampied N; Hapuku A; Macfarlane S; Bowden N; van Noorden L; Rispoli MINTRODUCTION: Timely access to early support that optimises autistic children's development and their caregiver's mental health is critical. Naturalistic developmental behavioural interventions (NDBIs) and acceptance and commitment therapy (ACT) are evidence-based supports that can enhance child learning and behaviour, and adult well-being, respectively. The traditional face-to-face delivery of these approaches is resource intensive. Further, little is known about the benefit of parallel child-focused and caregiver-focused supports. The aims of this trial are to evaluate the effectiveness and social validity of telehealth-delivered, caregiver-implemented, child-focused NDBI and caregiver-focused ACT when delivered alone and in parallel, on autistic children's social communication and caregiver well-being. METHODS AND ANALYSIS: The study will use a randomised, single-blind clinical trial with three parallel arms: NDBI; ACT and ACT+NDBI. We will recruit a minimum of 78, 2-5-year-old autistic children and their families throughout Aotearoa New Zealand. Support will be delivered over 13 weeks using a combination of culturally enhanced web-based modules and online group coaching. Primary outcome variables include children's social communication/engagement with their caregiver as well as caregiver stress and will be evaluated using a repeated measures multivariate analysis of variance. Outcome variables are assessed at baseline (before randomisation), immediately postparticipation and at 3-month follow-up. ETHICS AND DISSEMINATION: The trial is approved by the Health and Disability Ethics Committee (2022 FULL 12058). The findings of this trial will be disseminated through peer-reviewed journals and national and international conference proceedings regardless of the magnitude/direction of effect. Additionally, data will be shared with stakeholder groups, service providers and health professionals. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12622001134718).Item Hauora Māori - Māori health: a right to equal outcomes in primary care.(BioMed Central Ltd, 2024-02-27) Sheridan N; Jansen RM; Harwood M; Love T; Kenealy T; Primary Care Models Study GroupBackground For more than a century, Māori have experienced poorer health than non-Māori. In 2019 an independent Tribunal found the Government had breached Te Tiriti o Waitangi by “failing to design and administer the current primary health care system to actively address persistent Māori health inequities”. Many Māori (44%) have unmet needs for primary care. Seven models of primary care were identified by the funders and the research team, including Māori-owned practices. We hypothesised patient health outcomes for Māori would differ between models of care. Methods Cross-sectional primary care data were analysed at 30 September 2018. National datasets were linked to general practices at patient level, to measure associations between practice characteristics and patient health outcomes. Primary outcomes: polypharmacy (≥ 55 years), HbA1c testing, child immunisations, ambulatory sensitive hospitalisations (0–14, 45–64 years) and emergency department attendances. Regressions include only Māori patients, across all models of care. Results A total of 660,752 Māori patients were enrolled in 924 practices with 124,854 in 65 Māori-owned practices. Māori practices had: no significant association with HbA1c testing, ambulatory sensitive hospitalisations or ED attendances, and a significant association with lower polypharmacy (3.7% points) and lower childhood immunisations (13.4% points). Māori practices had higher rates of cervical smear and cardiovascular risk assessment, lower rates of HbA1c tests, and more nurse (46%) and doctor (8%) time (FTE) with patients. The average Māori practice had 52% Māori patients compared to 12% across all practices. Māori practices enrolled a higher percentage of children and young people, five times more patients in high deprivation areas, and patients with more multimorbidity. More Māori patients lived rurally (21.5% vs 15%), with a greater distance to the nearest ED. Māori patients were more likely to be dispensed antibiotics or tramadol. Conclusions Māori practices are an expression of autonomy in the face of enduring health system failure. Apart from lower immunisation rates, health outcomes were not different from other models of care, despite patients having higher health risk profiles. Across all models, primary care need was unmet for many Māori, despite increased clinical input. Funding must support under-resourced Māori practices and ensure accountability for the health outcomes of Māori patients in all models of general practice.Item Developmental and epileptic encephalopathy: Personal utility of a genetic diagnosis for families(Wiley Periodicals LLC on behalf of International League Against Epilepsy, 2021-03) Jeffrey JS; Leathem J; King C; Mefford HC; Ross K; Sadleir LGObjectives Identifying genetic pathogenic variants improves clinical outcomes for children with developmental and epileptic encephalopathy (DEE) by directing therapy and enabling accurate reproductive and prognostic information for families. We aimed to explore the additional personal utility of receiving a genetic diagnosis for families. Methods Semi-structured interviews were conducted with fifteen families of children with a DEE who had received a genetic diagnosis. The interviews stimulated discussion focusing on the impact of receiving a genetic diagnosis for the family. Interview transcripts were analyzed using the six-step systematic process of interpretative phenomenological analysis (IPA). Results Three key themes were identified: “Importance of the label,” “Relief to end the diagnostic journey,” and “Factors that influence personal utility.” Families reported that receiving a genetic label improved their knowledge about the likely trajectory of the DEE, increased their hope for the future, and helped them communicate with others. The relief of finally having an answer for the cause of their child's DEE alleviated parental guilt and self-blame as well as helped families to process their grief and move forward. Delay in receipt of a genetic diagnosis diluted its psychological impact. Significance To date, the factors associated with the personal utility of a genetic diagnosis for DEEs have been under appreciated. This study demonstrates that identifying a genetic diagnosis for a child's DEE can be a psychological turning point for families. A genetic result has the potential to set these families on an adaptive path toward better quality of life through increased understanding, social connection, and support. Early access to genetic testing is important as it not only increases clinical utility, but also increases personal utility with early mitigation of family stress, trauma, and negative experiences.Item A first nation-wide assessment of soil-transmitted helminthiasis in Fijian primary schools, and factors associated with the infection, using a lymphatic filariasis transmission assessment survey as surveillance platform(Public Library of Science (PLoS), 2020-09) Kim SH; Stothard JR; Rinamalo M; Rainima-Qaniuci M; Talemaitoga N; Kama M; Rafai E; Jang S; Kim JY; Oh YM; Kim E-M; Hong S-T; Lowry JH; Verweij JJ; Kelly-Hope LA; Choi M-HBackground Soil-transmitted helminthiasis (STH) is endemic in Fiji but its prevalence is not known and likely to have changed after a decade of mass drug administration (MDA) for lymphatic filariasis (LF). By linking with LF transmission assessment surveys (LF-TAS), we undertook the first nation-wide assessment of STH in Fijian primary schools, as well as an analysis of factors associated with STH infections. Methodology/Principal findings A cross-sectional assessment for STH was conducted in all four Divisions of Fiji from 2014 to 2015. In the Western, Central, and Northern Divisions, schools were sub-sampled after LF-TAS, while, in the Eastern Division, schools were selected via simple random sampling. For the diagnosis of STH, stool samples were examined by coproscopy with a single Kato-Katz thick smear (KK) and the formol-ether-acetate concentration technique, except for the samples from the Eastern Division where only KK was used. Mean prevalence of any STH among class 1–2 students at the national level was 10.5% (95% CI: 6.9–15.5). Across the three Divisions via LF-TAS, the prevalence levels for ascariasis were 8.7% (95% CI: 4.3–16.6), hookworm 3.9% (95% CI: 2.3–6.6) and trichuriasis 0%. In the Eastern Division, ascariasis prevalence was 13.3% (95% CI: 6.4–25.6), and hookworm 0.7% (95% CI: 0.2–2.5), with one case of trichuriasis. Among class 3–8 students, ascariasis prevalence was lower. Lower risk of any STH was associated with wearing shoes (adjusted OR 0.54, 95% CI: 0.32–0.90) and having piped water from the Fiji Water Authority at home (adjusted OR 0.48, 95% CI: 0.25–0.92). Conclusions After a decade of community-based LF-MDA, STH in school-age children in Fiji is now close to 10%, but localities of endemicity remain. Preventive chemotherapy should be maintained in areas with elevated STH prevalence alongside targeted delivery of integrated WASH interventions. LF-TAS has provided an opportunity to develop future public health surveillance platforms. Author summary Soil-transmitted helminth infections (STH) are common in school-age children in the developing world and can cause morbidity to affected human beings depending on the intensity and duration of infection. In Fiji, where there has been a long history of implementing a program for eliminating lymphatic filariasis (LF) due to inadequate sanitation conditions, there is a need to assess the current epidemiological profile of STH since the LF mass drug administration (MDA) as a community-based intervention may soon stop. By linking with ongoing LF-transmission assessment surveys (LF-TAS), we undertook the first nation-wide assessment of STH in Fijian primary schools. Mean prevalence of STH across three Divisions of Fiji in class 1–2 students chosen for LF-TAS was 12.1% (ascariasis 8.7%, hookworm 3.9%, and trichuriasis 0%). In the remaining Division, the Eastern, ascariasis prevalence was 13.3%, and hookworm 0.7%. Wearing shoes and use of piped water reduced the prevalence of STH. It is concluded that STH in school-age children in Fiji is at low levels, but hot spot localities of elevated STH endemicity remain. Therefore, preventive chemotherapy should be maintained in these localities alongside targeted delivery of appropriate integrated water, sanitation and hygiene interventions.Item A Mixed-Methods Study of Factors Influencing Access to and Use of Micronutrient Powders in Rwanda(Johns Hopkins Center for Communication Programs, 2021-06-30) Dusingizimana T; Weber JL; Ramilan T; Iversen PO; Brough LThe World Health Organization recommends point-of-use fortification with multiple micronutrients powder (MNP) for foods consumed by children aged 6-23 months in populations where anemia prevalence among children under 2 years or under 5 years of age is 20% or higher. In Rwanda, anemia affects 37% of children under 5 years. The MNP program was implemented to address anemia, but research on factors affecting the implementation of the MNP program is limited. We conducted a mixed-methods study to examine the factors influencing access to and use of MNP among mothers (N=379) in Rutsiro district, northwest Rwanda. Inductive content analysis was used for qualitative data. Logistic regression analysis was used to determine factors associated with the use of MNP. Qualitative results indicated that the unavailability of MNP supplies and distribution issues were major barriers to accessing MNP. Factors influencing the use of MNP included mothers' perceptions of side effects and health benefits of MNP, as well as inappropriate complementary feeding practices. Mothers of older children (aged 12-23 months) were more likely to use MNP than those of younger children (aged 6-11 months) (adjusted odds ratio [aOR]=3.63, P<.001). Mothers whose children participated in the supplementary food program were nearly 3 times more likely to use MNP than those whose children had never participated in the program (aOR=2.84, P=.001). Increasing household hunger score was significantly associated with lower odds of using MNP (aOR=0.80, P=.038). Mechanisms to monitor MNP supply and program implementation need to be strengthened to ensure mothers have access to the product. MNP program implementers should address gaps in complementary feeding practices and ensure mothers have access to adequate complementary foods. L'Organisation Mondiale de la Santé recommande l'enrichissement de l'alimentation à domicile (enrichissement sur le point d'utilisation) à l'aide des poudres de micronutriments multiples (PMN) pour les aliments consommés par les enfants âgés de 6 à 23 mois dans les populations où la prévalence de l'anémie chez les enfants de moins de 2 ans ou 5 ans est de 20% ou plus. Au Rwanda, l'anémie touche 37% des enfants de moins de 5 ans et le programme de PMN a été mis en œuvre pour lutter contre l'anémie. Cependant, la recherche sur les facteurs qui affectent la mise en œuvre du programme de PMN est limitée. Nous avons mené une étude par méthodes mixtes pour examiner les facteurs qui influencent l'accès des mères (n=379) à la PMN et son utilisation dans le district de Rutsiro, au nord-ouest du Rwanda. L'analyse du contenu inductif a été utilisée pour les données qualitatives. Pour déterminer les facteurs associés à l'utilisation des PMN, une régression logistique a été utilisée. Les résultats qualitatifs ont indiqué que l'indisponibilité des approvisionnements en PMN et les problèmes de distribution constituaient des obstacles majeurs à l'accès à la PMN. Les facteurs qui influencent l'utilisation des PMN comprenaient les perceptions, chez les mères, des effets secondaires et des avantages des PMN pour la santé, ainsi que des pratiques d'alimentation complémentaire inappropriées. Les mères d'enfants plus âgés (12 à 23 mois) étaient plus susceptibles d'utiliser la PMN que celles d'enfants plus jeunes (6 à 11 mois) (odds ratio ajusté [ORA]=3,63, P<0,001). Les mères des enfants qui avaient participé au programme d'alimentation complémentaire étaient près de 3 fois plus susceptibles d'utiliser la PMN que celles des enfants qui n'avaient jamais participé au programme (ORA=2,84, P=0,001). L'augmentation du score de faim dans les ménages était significativement associée à des chances plus faibles d'utiliser la PMN (ORA=0,80, P=0,038). Les mécanismes de suivi de l'approvisionnement en PMN et de la mise en œuvre du programme doivent être renforcés pour s'assurer que les mères ont accès au produit. Les responsables de la mise en œuvre du programme de PMN devraient combler les lacunes au niveau des pratiques d'alimentation complémentaire et veiller à ce que les mères aient accès à des aliments complémentaires adéquats.