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    Investigating factors associated with raised blood pressure in New Zealand school children : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand
    (Massey University, 2019) David Roldan, Maria
    Background: Childhood hypertension is associated with an increased risk of target organ damage and adulthood hypertension. Over the last few years, the prevalence of paediatric primary hypertension has been growing. A better understanding of the risk factors associated with high blood pressure could facilitate early detection and intervention. To date, no studies in New Zealand have investigated high blood pressure in the paediatric population. Aim: The aim of this study was to investigate risk factors for raised blood pressure in year five and six primary school children, living in Auckland, New Zealand. Methods: We examined cross-sectional data for school children participating in The Children’s Bone Study. Anthropometric measures included weight, height, BMI, waist circumference and percent body fat. Blood pressure was measured on a single occasion, and the average of three readings was used for analysis. Elevated blood pressure and hypertension were defined according to the American Academy of Pediatrics’ criteria. Demographic information was collected using a questionnaire. Logistic regressions were used to examine the associations between gender, ethnicity and obesity with raised blood pressure (≥90th percentile). Results: The proportion of children (n=669, 10.4 ± 0.62 years) with elevated and hypertensive blood pressure readings were 14.3% and 31.1%, respectively. Age and gender were not significantly associated with raised blood pressure (p=0.485; p=0.109, respectively). South Asian children had significantly greater odds of presenting with raised blood pressure compared to European (OR: 1.65, 95% CI: 1.02—2.65, p<0.05). The adjusted odds of screening with raised blood pressure were significantly greater for children with an obese (OR: 2.88, 95% CI: 1.65—5.01, p<0.001) and overweight (OR: 2.43, 95% CI: 1.54—3.84, p<0.001) BMI than non-overweight children. Percent body fat above the normal range (OR: 2.16, 95% CI:1.51— 3.09, p<0.001) and a waist-to-height ratio ≥0.5 (OR: 2.60, 95% CI: 1.60—4.22, p<0.001) were associated with increased odds of raised blood pressure readings, irrespective of age, gender and ethnicity. Conclusion: Ethnicity, and general and central obesity appear to be key risk factors for raised blood pressure in children. Although blood pressure was only measured on a single occasion, the results suggest that paediatric hypertension may be a potential health concern for New Zealand. Further research is needed to establish a more accurate picture of the situation and allow for New Zealand specific guidelines to be formulated.
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    Biological monitoring of persistent organic pollutants (POPs) in New Zealand : a thesis by publications presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health, Centre for Public Health Research, Massey University, Wellington, New Zealand
    (Massey University, 2018) Coakley, Jonathan Davis
    This thesis reports the results of a national research program investigating persistent organic pollutants (POPs) in New Zealanders. The research investigated human body burdens, and exposure sources, of the following POPs: • Polychlorinated dibenzo-p-dioxins (PCDDs) and furans (PCDFs) • Polychlorinated biphenyls (PCBs) • Organochlorine pesticides (OCPs) such as dichlorodiphenyltrichloroethane (DDT) • Brominated flame retardants (BFRs) such as polybrominated diphenyl ethers (PBDEs) • Perfluoroalkyl substances (PFAS) such as perfluorooctanosulfonic acid (PFOS). Previous research has shown that POPs are toxic, and that they are found in the bodies of all humans and wildlife. This thesis builds on previous research by describing the results of recent studies of New Zealand human body burdens of POPs and comparing these results to previous New Zealand research and international studies. The research includes the second national survey of POPs in the serum of adult New Zealanders, and a related study of the importance of household dust as an exposure source for BFRs in breast-feeding infants. The POPs serum survey methodology was assessed, showing that younger adults, and those of Māori ethnicity, are less likely to participate in human biological monitoring surveys. The research found that the body burdens for the chlorinated POPs were higher for the older age groups. In contrast, the majority of BFRs showed higher serum concentrations in younger age groups. The observed positive association with age for the chlorinated POPs may be attributed primarily to a cohort effect (i.e. more recent cohorts having been exposed to lower levels of chlorinated POPs). The research also provides evidence that within the same cohort, chlorinated POPs body burdens have reduced over time, though some POPs appeared to have reached steady-state concentrations in individuals. In addition, burdens of BFRs and PFASs were found to be higher in men compared to women, possibly due to sex-related differences in human elimination of these POPs. In comparison to international results, New Zealand adults have (a) relatively low body burdens of PCDDs, PCDFs, and PCBs, and (b) similar body burdens of BFRs, PFASs, and OCPs (especially DDT compounds) to the rest of the world. Household dust is an important exposure source of BFRs in human milk. Over the past 15 years, human body burdens (measured in serum and breast milk) of chlorinated POPs have decreased in New Zealand and internationally, illustrating the effectiveness of measures to control POPs (e.g. the Stockholm Convention). The research provides the first reference point for human body burdens of BFRs and PFASs in the New Zealand adult population. In summary, the research outlined in this thesis provides insights into the distribution and dynamics of POPs in humans. The findings from the research, particularly the influence of age on the dynamics of POPs over time, and the exposure of children to POPs at a very early age, provide incentive for further research and public health initiatives. The research provides a resource to inform future biological monitoring programmes, and to aid in the assessment of human health risks from exposure to POPs.
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    WHO long form scoring, reliability, validity and norms for New Zealand : a thesis presented in fulfilment of the requirements for the degree of Master of Public Health at Massey University, Wellington Campus, New Zealand
    (Massey University, 2006) Blakey, Karen Sarah
    Background Self-reported health measures provide information about a wider range of health outcomes than objective measures of health status, such as mortality and hospitalisation rates. National health surveys play a role in monitoring population health. The New Zealand Health Monitor (NZHM) is the organised, co-ordinated and integrated survey programme of the Ministry of Health in New Zealand. The New Zealand Health Survey (NZHS) is one of the chief surveys of the NZHM. One of the categories of information collected in the NZHM is health outcomes, and within this there is the subcategory of health status. The International Classification of Functioning and Disability (ICF) provides the framework to describe the critical elements of non-fatal health outcomes captured by health status instruments. NZHM is to collect data on most if not all of these 21 ICF dimensions. The WHO Long Form was developed as the health module in the WHO Multi-country Survey Study. The WHO Long Form is made up of 20 health domains, some overlapping with the eight SF-36 domains. The WHO Long Form did not have a set scoring system for scales, unlike the SF-36 instrument. The SF-36 has been previously tested and validated in New Zealand in the 1996/97 NZHS. Methods The 2002/03 NZHS used a complex sample design. A total of 12,929 people responded to the survey, with 12,529 respondents being included in the CURF dataset available for research. The health status section of the 2002/03 NZHS measures health-related quality of life (HRQL) covered 16 health and health-related domains. The questions were derived from the SF-36 and the WHO Long Form questionnaire on health status. The health domains covered in the 2002/03 NZHS were general health, vision, hearing, digestion, breathing, pain, sleep, energy and vitality, understanding, communication, physical functioning, self-care. The health-related domains covered in the 2002/03 NZHS were mental health, role-physical and role-emotional (usual activities), and social functioning. There were five key aims specific to the current thesis. First, to group the WHO Long Form items in the 2002/03 NZHS into scales for each health domain and develop standard scoring protocols for each scale. Second, to test the reliability of the scales using standard psychometric tests for the total NZ population and for major population subgroups. Third, to test the validity of the scales using the standard psychometric tests for the total NZ population and for major population subgroups. Fourth, to construct norms for the WHO Long Form scales for the NZ population. And finally, to provide recommendations for the health status component of future NZ health surveys. Results In summary, this thesis developed a method for producing scale scores for domains of health not previously measured in New Zealand Health Surveys, providing greater coverage of domains from the ICF. There were virtually no missing data for all items and subgroups within the questions used to develop the scales. The scaling approach was consistent with that for the SF-36, allowing the new scales to be presented alongside the SF-36 scales. All scales for the total population and major population subgroups met the required criterion for satisfactory psychometric properties, with the exception of digestion and bodily excretions scale. For the digestion and bodily excretions scale, the Cronbach's alpha was lower than that required for between group comparisons. The composite physical functioning and social functioning scales performed no better than the existing SF-36 scales and were highly correlated with these scales. Conclusion Notwithstanding the limitations of this study, key findings of interest are that the new WHO Long Form questions can be used to form scales that cover physical functioning, social functioning, vision, hearing, digestion and bodily excretions, breathing, self-care, understanding, communication and sleep. The majority of the questions and scales work for the NZ population and subgroups. All but one of the scales, digestion and bodily excretions, have satisfactory psychometric properties for the total population and major subpopulation groups of interest. The respondent burden is an important consideration for the NZHS, thus it cannot be argued that enough is gained from adding questions to the physical functioning and Social Functioning domains, thus it would be recommended that the SF-36 scales are used to measure there two domains of health. The new WHO Long Form scales can now be presented alongside the SF-36 scales and used in future analyses looking at interrelationships between factors such as health risk and health status.
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    A study on individual health beliefs and practices in relation to propensity for selfcare : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing Studies at Massey University
    (Massey University, 1981) Nevatt, Elizabeth Alice
    In this thesis the concepts of Selfcare and of health, which is the goal of selfcare, are explored in relation to the selfcare nursing model. It is a basic premise of the selfcare model that the client be involved to the fullest possible extent in regaining or developing selfcare skills. The proposition offered in this thesis is that individuals differ with respect to their readiness for such involvement and effort in their own health work, and hence in ability to benefit from the application of the model. The study aimed at developing a means of identifying and predicting these differences. It was hypothesized that the individual's perceptions and beliefs about health (Health Concept), his attributions about the location of blame for illness (Blame for illness), and the extent to which he perceives himself as having control over the contingencies of his behaviour (Locus of Control) would all systematically influence his readiness to engage in selfcare (Propensity for Selfcare). A Health Questionnaire designed to obtain data on individual health related beliefs and practices was constructed. This was mailed to a randomly drawn sample of non-academic staff from one university. A combination of univariate and multivariate analyses of the 86 completed questionnaires showed the major variables as described above to be significantly interrelated. The pattern of relationships which emerged between responses to other items in the questionnaire cast further light on the complex determinants of health behaviour. Of particular interest was the suggestion that the manner of perceiving health is a crucial factor. Use of the principal axes method of factor analysis allowed a shortened version of the original questionnaire to be produced. The profile yielded by scores on this instrument not only describes the client in terms of the four major health related variables identified in the study but can also be used to predict readiness to benefit from a selfcare nursing approach.
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    A pilot nutrition survey of the adult Niuean population in Niue : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutritional Science at Massey University
    (Massey University, 2003) Tasmania, Gaylene Mitikulena
    A pilot nutrition survey was conducted on 50 randomly selected adult Niueans aged between 18 and 60 years, living in Niue. The survey consisted of three visits per person, each encompassing a 24-hour dietary recall, body measurements and questionnaires. The body measurements included weight, height, waist and hip circumference, elbow breadth and body-fat using Bioelectrical Impedance Analysis. Other measurements taken were of blood pressure and blood glucose. By comparison, the Niuean population have a higher percentage energy contribution from fat and protein but a lower contribution from total carbohydrates than the NZ population. These differences in energy contributions may attribute to some extent to the prevalence of overweight and obesity in the Niuean population. Some nutrient intakes were inadequate and are of some concern particularly calcium, iron, and vitamin A. Forty-four percent and forty percent of the subjects had calcium and iron intakes below two-thirds of the RDI respectively. Alcohol consumption was much more common among the men than the women. Based on the reported volumes consumed 83% of the men who drank alcohol, drank to intoxicating levels well above the legal limit, during a drinking session. The average weight of the Niuean men was 92 kg; some 13 kg heavier than the average in 1987 and 23 kg heavier than the average in 1953. Likewise with the women whose average weight was 87 kg; 10 kg heavier than the average in 1987 and 25 kg heavier than the average in 1953. The prevalence of obesity and overweight in the Niuean population studied is very high, in both the men and the women. The prevalence of obesity was observed to be 1 in 2 men, an increase of at least five times the rate it was 22 years ago. Prevalence of obesity among the women over the same period has also increased to be 2 in 3 women.