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    Is early life antibiotic-use a risk factor for the development of Type 1 diabetes? : a longitudinal data linkage study : a thesis with publications presented in partial fulfillment to the requirements for the degree of Doctor of Philosophy in Public Health (Epidemiology), Massey University, Wellington, New Zealand
    (Massey University, 2025-09-01) Ram, Sharan
    Introduction: Early-life antibiotic-use may disrupt the gut microbiota, potentially increasing the risk of Type 1 diabetes (T1D). This thesis assessed associations between prenatal and early childhood antibiotic exposure and T1D. Methods: A meta-analysis of 14 studies (2006-2020), encompassing 3,066,063 participants, assessed associations between early-life antibiotic-use and T1D. Subsequently, a longitudinal nation-wide linkage study examined this association in 315,789 New Zealand children born between 2005-2010 and followed until 2021, using Cox proportional hazards regression controlled for potential confounders. Patterns of antibiotic-use during pregnancy and early childhood were also analysed across demographic characteristics. Associations between both pre and post natal antibiotic exposure were assessed, including analyses by antibiotic class and spectrum, and stratification by delivery mode. T1D was identified using insulin dispensing and hospitalisation records. Results: The meta-analysis, showed a pooled risk estimates for prenatal exposure of 1.10 (95% CI: 1.00–1.21); for postnatal antibiotic-use a pooled risk estimate of 1.11 (95%CI 1.04–1.18) was found, with ≥5 courses resulting in a pooled estimate of 1.36 (95%CI 1.15–1.61). Broad-spectrum antibiotics were associated with higher risk (HR: 1.13, 95% CI: 1.03–1.23). In New Zealand, 30% of pregnant women received antibiotics, predominantly penicillin (73.7%). Higher usage was observed among Pacific (38.7%) and Māori (35.7%) women, those most deprived (i.e. those from the lowest socio-economic group) (39.5%). Those who had caesarean deliveries had higher rates of antibiotic use, with incidence rate ratios (IRRs) of 1.27 for elective and 1.09 for emergency procedures. By age five, 96% of children had received antibiotics, with similar subgroup patterns as observed for pregnant women. Prenatal antibiotic-use was associated with an increased T1D risk in a dose-dependent fashion (≥3 courses, HR 1.86; 95%CI:1.44–2.39), with the highest risk for broad-spectrum antibiotics (HR: 1.30; 95%CI: 1.12–1.57). Postnatal antibiotic-use was associated, also in a dose-dependent way, with T1D (≥13 courses, HR 1.93; 95%CI 1.18–3.17; broad-spectrum antibiotics, HR 1.74; 95%CI 1.10-2.78). Stratified analyses by delivery mode resulted in mixed results across different analyses. Conclusion: These findings show high antibiotic-use in New Zealand and among specific ethnic and socio-economic subgroups. It also showed clear associations with the development of childhood T1D, which is consistent with international studies as shown in the meta-analysis, underscoring the need for judicious antibiotic stewardship
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    The associations of childhood adversities and mental disorders with suicidal thoughts and behaviors - Results from the World Mental Health International College Student Initiative
    (Elsevier B V, 2025-08-01) Mortier P; Yang X; Altwaijri YA; Holdcraft JA; Lee S; Sampson NA; Albor Y; Alhadi AN; Alonso J; Al-Saud NK; Andersson C; Atwoli L; Auerbach RP; Muaka CA; Báez-Mansur PM; Ballester L; Bantjes J; Baumeister H; Bendtsen M; Benjet C; Berman AH; Bruffaerts R; Carrasco P; Chan SCN; Cohut I; Covarrubias Díaz Couder MA; Crockett MA; Cuijpers P; David OA; Dong D; Ebert DD; Gaete J; Felez-Nobrega M; García Forero C; Gili M; Gutiérrez-García RA; Haro JM; Hasking P; Hunt X; Husky MM; Jaguga F; Jansen L; Langer ÁI; Liu Y; Mac-Ginty S; Martínez V; Mason A; Mathai M; McLafferty M; Miranda-Mendizabal A; Murray EK; Musyoka CM; O'Neill SM; Papasteri CC; Piqueras JA; Popescu CA; Rapsey C; Robinson K; Rodriguez-Jimenez T; Scarf D; Siu O-L; Stein DJ; Struijs SY; Tomoiaga CT; Valdés-García KP; Vereecke S; Vigo DV; Wang AY; Wong SYS; Kessler RC; World Mental Health International College Student collaborators
    Objective: To investigate the associations of demographic variables, childhood adversities (CAs), and mental disorders (MDx) with onset, transition, and persistence of suicidal thoughts and behaviors (STB) among first-year university students. Method: Poisson regression models within a discrete-time survival framework were constructed using web-based self-report survey data from 72,288 incoming university students across 18 countries (response rate=20.9%; median age=19 years, 57.9% female, 1.4% transgender, 21.0% non-heterosexual). These models examined the associations of four demographic variables, five CAs, and eight MDx with STB outcomes. Results: Lifetime prevalence of suicidal ideation, plans, and attempts was 47.0%, 26.0%, and 9.6%, respectively; 12-month estimates were 30.6%, 14.0%, and 2.3%. In unadjusted analyses, associations were strongest between lifetime onset of suicidal ideation and CAs (RR range 4.4–7.0), particularly parental psychopathology (relative risk [RR]=7.0 [95% CI 6.5–7.7]), followed by MDx (RR range 1.3–3.0). Of the demographic subgroups, transgender students had highest risk of STB (lifetime ideation onset RR=2.4 [2.3–2.6]; ideation-to-attempt transition RR=1.5 [1.3–1.8]). In fully adjusted models, strongest predictors of lifetime ideation onset were emotional abuse (RR=2.1 [1.9–2.2]), major depressive disorder (RR=2.0 [1.9–2.1]), and bipolar disorder (RR=1.8 [1.6–2.0]). Ideation-to-attempt transition remained most strongly associated with panic disorder (RR=1.5 [1.3–1.7]), bipolar disorder (RR=1.4 [1.2–1.7]), and sexual abuse (RR=1.4 [1.2–1.7]). Most predictors were significantly but weakly associated with persistence of ideation and plan, while only physical abuse remained associated with repeated suicide attempts (RR=1.3 [1.0–1.8]). Conclusion: CAs and MDx are strong predictors of both onset of and transition within the STB spectrum, underscoring the importance of implementing early-life prevention interventions.
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    A temporal network analysis of risk factors for suicide : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Manawatū, New Zealand
    (Massey University, 2024-03-19) Holman, Mikayla
    Suicide is a major public health concern in New Zealand, with the number of lives lost due to suicide increasing almost every year. The factors influencing a person’s decision to take their own life are numerous and often complex. Some of these factors are dynamic, fluctuating over short periods of time and ultimately altering a person’s risk for suicide. Network analysis is a novel statistical technique that can be used to explore complex causal associations in systems of variables, such as risk factors for suicide. The present study used temporal network analysis to explore the associations between dynamic risk factors for suicide over time. Data collection involved ecological momentary assessment, where a general community sample of 39 adult participants completed a brief survey five times per day for ten days, resulting in 1420 completed surveys. Each survey assessed participants’ momentary experience of suicidal ideation, depressed mood, hopelessness, social support, self-esteem, thwarted belongingness, perceived burdensomeness, anhedonia, worthlessness, alcohol intoxication, and fatigue. All variables fluctuated from measurement to measurement at least some of the time, highlighting the dynamic nature of suicide risk. Temporal, contemporaneous, and between-persons networks of the 11 measured variables were estimated using temporal network analysis. In the temporal network, hopelessness was the only variable that predicted an increase in suicidal ideation at the subsequent measurement. Multiple nodes were estimated to be positively associated with suicidal ideation in the contemporaneous network, including depressed mood, thwarted belongingness, perceived burdensomeness, and worthlessness, while self-esteem was negatively associated with suicidal ideation in this network. In the between-persons network, hopelessness was the only variable with a significant association with suicidal ideation. The results of this study highlight the importance of continuously assessing changes in suicide risk factors given their dynamic nature. Hopelessness may be an especially important risk factor to assess given its temporal association with increased suicidal ideation. Regarding future research opportunities, experimental N=1 network studies about the effectiveness of personalised interventions based on node centrality are an important next step in determining whether individualised networks have a place in personalised treatment for suicidality.
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    Apparent prevalence and risk factors for bovine tuberculosis in the state of Paraná, Brazil: an assessment after 18 years since the beginning of the Brazilian program
    (Springer Nature BV, 2022-12) Rodrigues DL; Amorim EA; Ferreira F; Amaku M; Baquero OS; de Hildebrand E Grisi Filho JH; Dias RA; Heinemann MB; Telles EO; Gonçalves VSP; Compton C; Ferreira Neto JS
    Bovine tuberculosis (bTB) impacts considerably animal production and one health worldwide. To describe the prevalence, risk factors, and spatial pattern of the disease in the state of Paraná, Brazil, a cross-sectional study was conducted from September 2018 to February 2019. The area was divided into seven regions. Within each region, farms were randomly selected, and a predetermined number of cows was selected and tested by a comparative cervical tuberculin test. 17,210 animals were tested across 1757 farms. Herd prevalence of bTB-infected herds in Paraná was 2.5% [1.87-3.00%]. It has varied from 0.8 to 3.98% among seven regions, with clustering being detected in the west, central, and northeast areas. Animal prevalence was 0.35% [0.21-0.59%] and has varied from 0.08 to 0.6% among the pre-set regions. No major shifts in the prevalence of bTB were detected since 2007. Large-sized herds, dairy production, and feeding with whey were detected to be correlated with the presence of bTB. Exclusively among dairy herds, veterinary assistance from cooperatives, possession of self-owned equipment to cool milk, and feeding with whey were correlated with the disease. Considering these results, it is recommended that the state of Paraná seek to implement a surveillance system for the detection of bTB-infected herds transforming them into free ones, if possible, incorporating elements of risk-based surveillance. Health education is also recommended to inform farmers about the risks of introducing animals without testing and of feeding raw whey to calves.
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    Does parity matter in women’s risk of dementia? A COSMIC collaboration cohort study
    (BMC, 2020-08-05) Bae JB; Lipnicki DM; Han JW; Sachdev PS; Kim TH; Kwak KP; Kim BJ; Kim SG; Kim JL; Moon SW; Park JH; Ryu S-H; Youn JC; Lee DY; Lee DW; Lee SB; Lee JJ; Jhoo JH; Llibre-Rodriguez JJ; Llibre-Guerra JJ; Valhuerdi-Cepero AJ; Ritchie K; Ancelin M-L; Carriere I; Skoog I; Najar J; Sterner TR; Scarmeas N; Yannakoulia M; Dardiotis E; Meguro K; Kasai M; Nakamura K; Riedel-Heller S; Roehr S; Pabst A; van Boxtel M; Köhler S; Ding D; Zhao Q; Liang X; Scazufca M; Lobo A; De-la-Cámara C; Lobo E; Kim KW; for Cohort Studies of Memory in an International Consortium (COSMIC)
    Background Dementia shows sex difference in its epidemiology. Childbirth, a distinctive experience of women, is associated with the risk for various diseases. However, its association with the risk of dementia in women has rarely been studied. Methods We harmonized and pooled baseline data from 11 population-based cohorts from 11 countries over 3 continents, including 14,792 women aged 60 years or older. We investigated the association between parity and the risk of dementia using logistic regression models that adjusted for age, educational level, hypertension, diabetes mellitus, and cohort, with additional analyses by region and dementia subtype. Results Across all cohorts, grand multiparous (5 or more childbirths) women had a 47% greater risk of dementia than primiparous (1 childbirth) women (odds ratio [OR] = 1.47, 95% confidence interval [CI] = 1.10–1.94), while nulliparous (no childbirth) women and women with 2 to 4 childbirths showed a comparable dementia risk to primiparous women. However, there were differences associated with region and dementia subtype. Compared to women with 1 to 4 childbirths, grand multiparous women showed a higher risk of dementia in Europe (OR = 2.99, 95% CI = 1.38–6.47) and Latin America (OR = 1.49, 95% CI = 1.04–2.12), while nulliparous women showed a higher dementia risk in Asia (OR = 2.15, 95% CI = 1.33–3.47). Grand multiparity was associated with 6.9-fold higher risk of vascular dementia in Europe (OR = 6.86, 95% CI = 1.81–26.08), whereas nulliparity was associated with a higher risk of Alzheimer disease (OR = 1.91, 95% CI 1.07–3.39) and non-Alzheimer non-vascular dementia (OR = 3.47, 95% CI = 1.44–8.35) in Asia. Conclusion Parity is associated with women’s risk of dementia, though this is not uniform across regions and dementia subtypes.
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    Association of mental demands in the workplace with cognitive function in older adults at increased risk for dementia
    (BioMed Central Ltd, 2021-12-10) Zülke AE; Luppa M; Röhr S; Weißenborn M; Bauer A; Samos F-AZ; Kühne F; Zöllinger I; Döhring J; Brettschneider C; Oey A; Czock D; Frese T; Gensichen J; Haefeli WE; Hoffmann W; Kaduszkiewicz H; König H-H; Thyrian JR; Wiese B; Riedel-Heller SG
    Objectives Growing evidence suggests a protective effect of high mental demands at work on cognitive function in later life. However, evidence on corresponding associations in older adults at increased risk for dementia is currently lacking. This study investigates the association between mental demands at work and cognitive functioning in the population of the AgeWell.de-trial. Methods Cross-sectional investigation of the association between global cognitive functioning (Montreal Cognitive Assessment) and mental demands at work in older individuals at increased risk for dementia (Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE)score ≥ 9; n = 941, age: 60–77 years). Occupational information was matched to Occupational Information Network (O*NET)-descriptors. Associations between cognitive function and O*NET-indices executive, verbal and novelty were investigated using generalized linear models. Results Higher values of index verbal (b = .69, p = .002) were associated with better cognitive function when adjusting for covariates. No association was observed for indices executive (b = .37, p = .062) and novelty (b = .45, p = .119). Higher education, younger age, and employment were linked to better cognitive function, while preexisting medical conditions did not change the associations. Higher levels of depressive symptomatology were associated with worse cognitive function. Conclusions Higher levels of verbal demands at work were associated with better cognitive function for older adults with increased dementia risk. This suggests an advantage for older persons in jobs with high mental demands even after retirement and despite prevalent risk factors. Longitudinal studies are warranted to confirm these results and evaluate the potential of workplaces to prevent cognitive decline through increased mental demands.
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    Baseline audiological profiling of South African females with cervical cancer: an important attribute for assessing cisplatin-associated ototoxicity
    (BioMed Central Ltd, 2021) Paken J; Govender CD; Pillay M; Ayele BT; Sewram V
    Background Cisplatin is a popular antineoplastic agent used to treat cervical cancer in women from low and middle-income countries. Cisplatin treatment is associated with ototoxicity, often resulting in hearing loss. In light of this, it is crucial to conduct baseline audiological assessments prior to treatment initiation in order to evaluate the extent of cisplatin-associated-ototoxicity. Additionally, the identification of inherent risk factors and hearing patterns in specific patient cohorts is needed, especially in South Africa, a middle-income country characterized by the quadruple burden of disease (Human Immunodeficiency Virus (HIV), Tuberculosis (TB), Diabetes and Hypertension). Methods This study aimed to describe a profile of risk factors and hearing in a cohort of females with cervical cancer before cisplatin treatment commenced. A descriptive study design that included 82 cervical cancer patients, who underwent audiological evaluation prescribed for ototoxicity monitoring was conducted. Results All participants (n = 82) presented with risk factors (diabetes, hypertension, HIV, and antiretroviral therapy) for cisplatin ototoxicity and/or pre-existing sensorineural hearing loss. High-frequency tinnitus was the most common otological symptom experienced by 25 (31%) participants. Fifty-nine (72%) participants presented with normal hearing, twenty-two (27%) with a sensorineural hearing loss, and 36% were diagnosed with mild hearing loss. Abnormal Distortion Product Otoacoustic Emissions (DPOAE) findings were obtained bilaterally in two participants (2.4%), in the right ear only of another two (2.4%) participants and the left ear of three participants (3.7%). Most participants (94%) had excellent word recognition scores, demonstrating an excellent ability to recognize words within normal conversational levels under optimal listening conditions. Age was significantly associated with hearing loss at all thresholds. Among the co-morbidities, an HIV positive status significantly triggered hearing loss, especially at higher frequencies. Conclusion This study demonstrated that South African females with cervical cancer present with various co-morbidities, which may predispose them to develop cisplatin-associated -ototoxic hearing loss. Identification of these co-morbidities and hearing loss is essential for the accurate monitoring of cisplatin toxicities. Appropriate management of these patients is pivotal to reduce the adverse effects that hearing impairment can have on an individual’s quality of life and to facilitate informed decision-making regarding the commencement of cisplatin chemotherapy.
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    Pesticide exposure in New Zealand school-aged children: Urinary concentrations of biomarkers and assessment of determinants
    (Elsevier Ltd, 2022-05) Li Y; Wang X; Feary McKenzie J; 't Mannetje A; Cheng S; He C; Leathem J; Pearce N; Sunyer J; Eskenazi B; Yeh R; Aylward LL; Donovan G; Mueller JF; Douwes J
    This study aimed to assess pesticide exposure and its determinants in children aged 5-14 years. Urine samples (n = 953) were collected from 501 participating children living in urban areas (participant n = 300), rural areas but not on a farm (n = 76), and living on a farm (n = 125). The majority provided two samples, one in the high and one in the low spraying season. Information on diet, lifestyle, and demographic factors was collected by questionnaire. Urine was analysed for 20 pesticide biomarkers by GC-MS/MS and LC-MS/MS. Nine analytes were detected in > 80% of samples, including six organophosphate insecticide metabolites (DMP, DMTP, DEP, DETP, TCPy, PNP), two pyrethroid insecticide metabolites (3-PBA, trans-DCCA), and one herbicide (2,4-D). The highest concentration was measured for TCPy (median 13 μg/g creatinine), a metabolite of chlorpyrifos and triclopyr, followed by DMP (11 μg/g) and DMTP (3.7 μg/g). Urine metabolite levels were generally similar or low compared to those reported for other countries, while relatively high for TCPy and pyrethroid metabolites. Living on a farm was associated with higher TCPy levels during the high spray season. Living in rural areas, dog ownership and in-home pest control were associated with higher levels of pyrethroid metabolites. Urinary concentrations of several pesticide metabolites were higher during the low spraying season, possibly due to consumption of imported fruits and vegetables. Organic fruit consumption was not associated with lower urine concentrations, but consumption of organic food other than fruit or vegetables was associated with lower concentrations of TCPy in the high spray season. In conclusion, compared to other countries such as the U.S., New Zealand children had relatively high exposures to chlorpyrifos/triclopyr and pyrethroids. Factors associated with exposure included age, season, area of residence, diet, in-home pest control, and pets.
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    Adolescent anaemia status and non-haem iron source food use at the Beddawi refugee camp in North Lebanon : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nutritional Sciences at Massey University, Manawatū, New Zealand
    (Massey University, 2022) Soukieh, Jasmine
    Palestinian refugees at long-term Lebanese camps are at increased anaemia risk. Adolescent Palestinians at these camps, with their disproportionately high poverty burdens, are at particular risk, though little-to-no data are available to describe this. Anaemia in Lebanon has been attributed, largely, to inadequate intake of bioavailable iron. This may occur when a population is reliant on non-haem iron food sources to meet nutrient needs, as is often the case in long-term camp settings. No studies are currently available that describe adolescent Palestinian diets at Lebanese camps. There is also a dearth of studies exploring food preparation practices that may be harnessed to optimise iron bioavailability from consumed foods at these camps. This study used an embedded mixed-methods design to evaluate anaemia prevalence, iron source food consumption, and micronutrient dietary diversity (DDS-M) for a group of adolescent Palestinians (n = 66) at the Beddawi refugee camp in North Lebanon. The study also explored household plant-food use and preparation, with particular reference to dark leafy greens, and plant-food valuation with household food preparers (FPs). Anaemia prevalence for adolescents was 29%. Median DDS-M was 4 [IQR = 1.63, range = 2-6]. Grain-based foods were consumed by the largest proportion of adolescents (100%), followed by milk source foods (84.8%) and fruits (59.1%). Jute mallow, chicory, parsley and spinach were the dark leafy greens used by the largest proportions of households (> 80%). Household use of a subset of dark leafy greens was positively associated with adolescent DDS-M (rho = 0.31, S = 14303, p-value = 0.03). All FPs reported plant food valuation; however, FPs in households with non-anaemic adolescents related plant food valuation responses with more detailed nutrient and health rationales than FPs in households with anaemic adolescents. Lemon juice, capsicum and chilli were among foods commonly reported to be co-consumed with plant meals described by FPs. Soaking pulses ahead of use was also reported. Anaemia is a moderate public health concern for this group of adolescents, and the micronutrient content of their diets is insufficiently diverse. Increased consumption of accessible dark leafy greens and co-consumption of reported vitamin C-rich foods with non-haem iron meals, in combination with extending pulse-soaking practices to additional grains may contribute to optimising dietary and biochemical iron status for these adolescents.
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    Non-suicidal self-injury and suicide risk among young adults : an examination of the role of perceived burdensomeness : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2019) Edwards, Louise
    Background: Non-suicidal self-injury (NSSI) is defined as direct, self-inflicted damage of body tissue in the absence of the intent to die, and outside of that which is socially sanctioned (Nock, 2009). The Interpersonal-Psychological Theory of Suicide (IPTS; Joiner, 2005; Van Orden et al., 2010) posits that serious suicide attempts occur when an individual experiences both thwarted belongingness and perceived burdensomeness (leading to the desire to die) and the capability to act upon that desire (acquired capability). Current Study: The current research suggests the possibility that in addition to the role played in suicidal behaviours, perceived burdensomeness (PB) also plays a role in NSSI and conceivably in the transition between NSSI and a suicide attempts. The aims of the current study were to gain further insight into the role of PB and its relationship with NSSI and to explore themes, narratives and meaning making of PB amongst those who have engaged in NSSI. The study hypothesised that higher levels of PB will be present amongst individuals who have engaged in NSSI compared with those who have not. Methods: A mixed methods approach was utilised, consisting of an anonymous online survey completed by 159 young New Zealanders (18 – 24 years of age). Results: A total of 36.9% of participants endorsed perceiving some degree of burdensomeness towards significant others in their lives, while over half of participants (51.6%) endorsed having engaged in NSSI. Question responses were combined to produce an overall PB score to be used for comparison between groups. An interpretative phenomenological analysis (IPA) was conducted consisting of six in-depth semi-structured interviews with individuals who had engaged in NSSI and made at least one suicide attempt. Study findings include the following, in a sample of individuals who engaged in self- injurious behaviours, scores on a measure of PB increased as self-injurious behaviour moved from NSSI to suicidal behaviour. Findings: Findings suggested that emotional regulation or reducing internal distress was a major driver for engaging in NSSI. Regression analysis suggested that scores on a screening measure for Major Depressive Disorder, scores on a screening measure for Borderline Personality Disorder, frequency of NSSI and number of NSSI methods used were independently predictive of PB score, accounting for 39.8% of the variation in PB scores. However Major Depression scores were most significantly predictive, accounting for 34.2% of the variation in PB scores. A model of the interaction of PB, guilt and shame has been proposed from the IPA findings. Major conclusions were that higher levels of PB are present in individuals who have engaged in NSSI compared to those who have not engaged in any self-injurious behaviours; that there is evidence to suggest that a continuum of PB may exist moving from NSSI behaviours to suicidal behaviours and finally that PB is an important construct both clinically and for research into NSSI and suicide prevention. Study limitations are discussed and suggestions for future research made.