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    Body-composition assessment using air displacement plethysmography in healthy term infants : an observational study : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand
    (Massey University, 2016) Ichhpuniani, Bani
    Background: Infant body weight and composition at birth have been recognised to be important indicators of fetal growth, maternal and offspring health, and later health outcomes. While it is well documented that average birth weight varies significantly between New Zealand-born infants of different ethnicities, there is limited evidence on body composition in new-born infants. Ethnic differences in body composition have been reported in New Zealand adults and children and it is currently unknown whether these differences are evident shortly after birth. The aim of this study was to examine the differences in fat mass (FM) and fat free mass (FFM) using Air Displacement Plethysmography (ADP) between NZ European (reference group), Māori, Pacific, Asian and South Asian healthy term infants. Method: Healthy term infants (37 to 42 weeks’ gestation) were recruited from Auckland City Hospital (ACH). Birth parameters were recorded and weight, length, and head circumference and waist circumference were measured using standardised techniques. Air Displacement Plethysmography (ADP) was used to measure fat mass (FM) and fat free mass (FFM) of the infants. Ethnicity of all infants and their mothers was classified using standard ethnicity data protocols. Dummy variable multiple linear regression analysis and t-tests were used to compare FM and FFM of Māori, Pacific, Asian, and South Asian infants with New Zealand European (NZE) infants. Results: Body composition was assessed in 214 healthy term infants at a mean age of 1.7±0.85 days, while adjusting for gender and postnatal age. South Asian infants had significantly lower FFM (2691.7±389.7g vs 2938.6±364.0g, P= 0.006) and weight than NZE infants (3045.5±535.2g vs 3352.3±575.8g, P= 0.014). They also had the smallest head (34.2±1.7cm vs 35.4±1.7cm, P= 0.002) and waist circumference (31.5±3.0cm vs 33.2±2.1cm, P= 0.003). Waist circumference of Asian infants was also significantly smaller than NZ European infants (32.3±2.1cm vs 33.2±2.1cm, P= 0.044). When categorised by gender, males had significantly greater FFM, weight, length and head circumference (P< 0.05). No gender or ethnic difference was noted in FM (g) or %FM. Conclusion: This is the first study in New Zealand to report body composition in healthy term infants using ADP. While no differences in FM were seen between NZE and each of the other ethnicities, the differences noted in FFM and weight between NZE and South Asian infants were comparable to other studies. Longitudinal assessment of changes in FM and FFM is needed to establish the significance of ethnic differences.
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    Paradoxes in women's health protection practices : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing Studies at Massey University
    (Massey University, 1987) Page, Aroha Evelyn
    The study explored the basis of the relatively low uptake of cervical screening and practice of breast self-examination among New Zealand women. Consistent with an interpretative approach to social phenomena it was anticipated that part of the explanation would lie in the meanings which women attach to health in general and to these specific healthprotecti'() IJ practices. Theoretical sampling was effected by semi-structured interviews with 45 women. Transcripts of these interviews provided the substantive data which were then analysed by the process of constant comparative analysis and other grounded theory strategies for analysis. The concept of a health-protectix-..o paradox centred around the core-variable 'vigilanceharmonizing' which was generated to reconcile the seeming inconsistencies within, and between, individual women and their health protection practices. This conceptualization was developed from the substantive data in order to provide a model designed to increase the effectiveness of nursing interventions for this area. The model, by illuminating processes from the client's perspective then can indicate those processes most suitable for incorporation in effective health education measures designed to promote the uptake of cervical screening and breast self-examination by women. As an adjunct to the study, a breast cancer case history is presented which shows the theory-in-use. The use of this case-history lies in the fact that it shares the substantive area of inquiry which serves to accentuate the viability, relevance and applicability of the grounded theory.
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    An exploration of nurses' experiences of delivering the before school check : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosphy in Nursing at Massey University, Albany, New Zealand
    (Massey University, 2013) Williams, Sarah Jill
    The New Zealand Well Child/Tamariki Ora (WCTO) programme is a community based well child health service; the programme is supported through the WCTO Framework and an associated National Schedule. The schedule outlines a total of 12 core contacts that every child and their family are entitled to receive from birth to five years. The first four of these are provided by the child’s lead maternity caregiver, with the remainder contracted out to Well Child Providers. The Before School Check (B4SC) is the eighth and final core contact under the WCTO schedule and is performed between 4 and 5 years of age. The B4SC was initiated in September 2008 and utilises not only a developmental screening questionnaire but also a health assessment, behavioural screen, hearing and vision assessment and oral health screen. This check is not necessarily always delivered by the child’s well child provider but can also be done through their family doctor or practice nurse. The purpose of this study was to explore nurse’s experiences of implementing and delivering the B4SC. Since its implementation in 2008 the B4SC has been delivered in a variety of ways by a range of nurses across the country. This study focused on the experiences of nurses working in Auckland and the participants included practice nurses, plunket nurses and public health nurses. Using semi-structured interviewing the participants in this study were given the opportunity to share their experiences and to discuss any issues raised. Based on their experiences participants were also asked if they had any recommendations for the further development of the B4SC. Thematic analysis using a general inductive approach was used to analyse the data and a number of themes emerged. Although the participants were very positive about the potential benefits of the check they expressed a range of challenges in the delivery of it. Five key themes were identified entitled: Construct constraints, Time, Translation & Culture, Child Interaction and Training & Support. Recommendations are made based on the study findings and suggestions for further research are presented.
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    Progression to diabetes : 5 year follow-up of the Northland Diabetes Screening and Cardiovascular risk assessment pilot : a thesis presented to fulfil requirements for the degree of Master of Public Health at Massey University, Wellington, New Zealand
    (Massey University, 2014) White, Bronwyn Kaye
    Aim: The primary aim was to determine the effect the Northland Diabetes Screening and Cardiovascular risk assessment pilot had on the progression from a normal glucose test (NGT) at baseline to diabetes. Method: Patients from a single practice (Maori = 1509, Non-Maori = 619) who were invited onto the pilot with NGT at baseline were retrospectively followed up for 7 years. Results for Pilot (PG) (Maori = 336, Non-Maori 255) and Non-Pilot (NPG) groups (Maori = 537, Non-Maori = 204) were compared on progression to diabetes, impaired glucose tolerance (IGT), all-cause mortality. Results for Maori: There were 10 incidence cases of diabetes, 20 IGT and 18 deaths from any-cause during a median duration of follow-up of 6.4 years in the PG compared with 22 incidence cases of diabetes, 23 IGT and 30 deaths from any-cause in the NPG followed for a median duration of 4.3 years. Participation in the pilot was associated with a statistically significant protective effect on progression to diabetes (Age-adjusted rate ratio 0.44(95% CI 0.2156, 0.912) and all-cause mortality (Age-adjusted rate ratio 0.49 (95% CI 0.2771, 0.8626). Results for Non-Maori: There were 12 incidence cases of diabetes, 13 IGT diagnoses and 19 deaths from any-cause during a median duration of follow-up of 6.2 years in the PG compared with 9/204 diabetes incidence cases, 11 IGT and 13 deaths from any-cause in the NPG followed for a median duration of 4.7 years. There was no statistically significant association with participation in the pilot on progression to diabetes, IGT or all-cause mortality. Conclusion: The protective effect for Maori patients in the pilot on progression to diabetes was either because they had inherently lower risk than the non-pilot group or potentially because their baseline results were interpreted in the context of their CVD risk. The effectiveness of CVDRA programmes on reducing incidence diabetes should be formally assessed. Research focusing on risk reduction for Maori aged 35-49 years is recommended.