We aimed to describe physical activity and sedentary behaviour of obese children and adolescents in Taranaki, New Zealand, and to determine how these differ in Māori (indigenous) versus ...non-indigenous children. Participants (n = 239; 45% Māori, 45% New Zealand European NZE, 10% other ethnicities) aged 4.8-16.8 years enrolled in a community-based obesity programme from January 2012 to August 2014 who had a body mass index (BMI) ≥ 98
percentile (n = 233) or >91
-98
percentile with weight-related comorbidities (n = 6) were assessed. Baseline activity levels were assessed using the children's physical activity questionnaire (C-PAQ), a fitness test, and ≥3 days of accelerometer wear. Average BMI standard deviation score was 3.09 (SD = 0.60, range 1.52-5.34 SDS). Reported median daily activity was 80 minutes (IQR = 88). Although 44% of the cohort met the national recommended screen time of <2 hours per day, the mean screen time was longer at 165 minutes (SD = 135). Accelerometer data (n = 130) showed low physical activity time (median 34 minutes IQR = 29). Only 18.5% of the total cohort met national recommended physical activity guidelines of 60 minutes per day. There were minimal ethnic differences. In conclusion, obese children/adolescents in this cohort had low levels of physical activity. The vast majority are not meeting national physical activity recommendations.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Pasture-based livestock systems are often associated with losses of reactive forms of nitrogen (N) to the environment. Research has focused on losses to air and water due to the health, economic and ...environmental impacts of reactive N. Di-nitrogen (N2) emissions are still poorly characterized, both in terms of the processes involved and their magnitude, due to financial and methodological constraints. Relatively few studies have focused on quantifying N2 losses in vivo and fewer still have examined the relative contribution of the different N2 emission processes, particularly in grazed pastures. We used a combination of a high (15)N isotopic enrichment of applied N with a high precision of determination of (15)N isotopic enrichment by isotope-ratio mass spectrometry to measure N2 emissions in the field. We report that 55.8 g N m(-2) (95%, CI 38 to 77 g m(-2)) was emitted as N2 by the process of co-denitrification in pastoral soils over 123 days following urine deposition (100 g N m(-2)), compared to only 1.1 g N m(-2) (0.4 to 2.8 g m(-2)) from denitrification. This study provides strong evidence for co-denitrification as a major N2 production pathway, which has significant implications for understanding the N budgets of pastoral ecosystems.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Exploration of dietary pattern associations within a multi-ethnic society context has been limited. We aimed to describe dietary patterns of 5664 pregnant women from the Growing Up in New Zealand ...study, and investigate associations between these patterns and maternal socio-demographic, place of birth, health and lifestyle factors. Participants completed a food frequency questionnaire prior to the birth of their child. Principal components analysis was used to extract dietary patterns and multivariable analyses used to determine associations. Four dietary components were extracted. Higher scores on, 'Junk' and 'Traditional/White bread', were associated with decreasing age, lower educational levels, being of Pacific or Māori ethnicity and smoking. Higher scores on, 'Health conscious' and 'Fusion/Protein', were associated with increasing age, better self-rated health, lower pre-pregnancy body mass index (BMI) and not smoking. Higher scores on 'Junk' and 'Health conscious' were associated with being born in New Zealand (NZ), whereas higher scores on 'Fusion/Protein' was associated with being born outside NZ and being of non-European ethnicity, particularly Asian. High scores on the 'Health conscious' dietary pattern showed the highest odds of adherence to the pregnancy dietary guidelines. In this cohort of pregnant women different dietary patterns were associated with migration, ethnicity, socio-demographic characteristics, health behaviors and adherence to dietary guidelines.
Increasing concerns about antibiotic resistance and microbiome disruption have stimulated interest in describing antibiotic consumption in young children. Young children are an age group for whom ...antibiotics are frequently prescribed.
To describe community antibiotic dispensing during the first 5 years of life in a large, socioeconomically and ethnically diverse cohort of children, and to determine how antibiotic dispensing varied between population subgroups.
This study was performed within the Growing Up in New Zealand longitudinal cohort study ( www.growingup.co.nz ) with linkage to national administrative antibiotic dispensing data. Descriptive statistics and univariate and multivariable associations were determined.
The 5581 cohort children received 53 052 antibiotic courses, of which 54% were amoxicillin. By age 5 years, 97% of children had received one or more antibiotic courses, and each child had received a median of eight antibiotic courses (IQR 4-13). The mean incidence of antibiotic dispensing was 1.9 courses/child/year. Multivariable negative binomial regression showed that Māori and Pacific children received more antibiotic courses than European children, as did children in the most-deprived compared with the least-deprived areas. A distinct seasonal pattern was noted.
This study provided a detailed description of antibiotic dispensing within a large and diverse child cohort. Antibiotic exposure was near universal by age 5 years. The predominance of amoxicillin use and the seasonal pattern suggest much antibiotic use may have been for self-limiting respiratory infections. There is a need for safe and effective interventions to improve antibiotic prescribing practices for New Zealand children.
In a recent issue of the BMC Public Health journal, Littlewood et al. described the results of a systematic review of interventions to prevent or treat childhood obesity in Māori or Pacific Island ...peoples. They found that studies to date have had limited impact on improving health outcomes for Māori and Pacific Island peoples, and suggest this may be due to a lack of co-design principles in the conception of the various studies. Ensuring that interventions are appropriate for groups most affected by obesity is critical; however, some inaccuracies should be noted in the explanation of these findings. There is a risk with systematic reviews that the context of intervention trials is lost without acknowledging the associated body of literature for programmes that refer to the ongoing commitment to communities and groups most affected by obesity.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Aim
To determine whether vitamin D supplementation reduces primary care visits for acute respiratory infection (ARI).
Methods
A randomised, double‐blind, placebo‐controlled trial was conducted in New ...Zealand and powered to determine the vitamin D dose needed to achieve normal vitamin D status during infancy. Healthy pregnant women, from 27 weeks’ gestation to birth, and their infants, from birth to age 6 months, were assigned to placebo or one of the two dosages of daily oral vitamin D3. Woman/infant pairs were randomised to placebo/placebo, 1000 IU/400 IU or 2000 IU/800 IU. For this ad hoc analysis, the primary care records of enrolled children were audited to age 18 months.
Results
Two hundred and sixty pregnant women were randomised to placebo (n = 87), lower‐dose (n = 87) or higher‐dose (n = 86) vitamin D3. In comparison with the placebo group (99%), the proportion of children making any ARI visits was smaller in the higher‐dose (87%, p = 0.004), but not the lower‐dose vitamin D3 group (95%, p = 0.17). The median number of ARI visits/child was less in the higher‐dose vitamin D3 group from age 6–18 months (placebo 4, lower dose 3, higher dose 2.5; p = 0.048 for higher‐dose vitamin D3 vs. placebo).
Conclusion
Vitamin D3 supplementation during pregnancy and infancy reduces primary care visits for ARI during early childhood.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Women's health during their reproductive years and whilst pregnant has implications for their children's health, both in utero and during childhood. Associations of women's pre-pregnancy dietary ...patterns (DP) with maternal socio-demographic characteristics and nutrient intake were investigated in ProcriAr cohort study in São Paulo/Brazil, 2012.
The DPs of 454 women were investigated by principal component factor analysis, using dietary information from a validated 110-item food frequency questionnaire. Multiple linear regression models identified independent associations between DPs and maternal socio-demographic characteristics and Spearman's correlation determined associations between DPs and nutrients intake.
Participants' mean age was 26.1 years (standard deviation = 6.3), 10.3% had more than 8 years of formal education, 30% were migrants from outside of the Southeast of Brazil, 48% were employed, 13% were smokers, and 51% were overweight/obese. Four DPs were derived: 'Lentils, whole grains and soups,' 'Snacks, sandwiches, sweets and soft drinks,' 'Seasoned vegetables and lean meats,' and 'Sweetened juices, bread and butter, rice and beans'. The 'Lentils, whole grains and soups' score was positively related to maternal age, being non-smoker and born in the South, North or Midwest of Brazil. The 'Snacks, sandwiches, sweets and soft drinks' score was positively related to higher maternal education, and negatively related to age, lack of formal work and being born in the Northeast region. The 'Seasoned vegetables and lean meats' score was positively related to higher maternal education. The 'Sweetened juices, bread and butter, rice and beans' score was positively related to unemployment and to no family history of hypertension, and negatively related to maternal overweight and obesity. Dietary intake of fruits and vegetables, foods that require preparation, nutrients from one-carbon metabolism, protein, iron, calcium and vitamin D were correlated with the 'Seasoned vegetables and lean meats'. Dietary intake of sugar-sweetened and alcoholic beverages, industrialized and takeaway foods, and foods rich in sugar, energy, fat, and synthetic folate were correlated with the 'Snacks, sandwiches, sweets and soft drinks'.
Findings from this study add perspectives to be considered in the implementation of health interventions, which could improve women's nutritional status and provide an adequate environment for the developing fetus.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Using data from a nationally generalisable birth cohort, we aimed to: (i) describe the cohort’s adherence to national evidence-based dietary guidelines using an Infant Feeding Index (IFI) and (ii) ...assess the IFI’s convergent construct validity, by exploring associations with antenatal maternal socio-demographic and health behaviours and with child overweight/obesity and central adiposity at age 54 months. Data were from the Growing Up in New Zealand cohort (n 6343). The IFI scores ranged from zero to twelve points, with twelve representing full adherence to the guidelines. Overweight/obesity was defined by BMI-for-age (based on the WHO Growth Standards). Central adiposity was defined as waist-to-height ratio > 90th percentile. Associations were tested using multiple linear regression and Poisson regression with robust variance (risk ratios, 95 % CI). Mean IFI score was 8·2 (sd 2·1). Maternal characteristics explained 29·1 % of variation in the IFI score. Maternal age, education and smoking had the strongest independent relationships with IFI scores. Compared with children in the highest IFI tertile, girls in the lowest and middle tertiles were more likely to be overweight/obese (1·46, 1·03, 2·06 and 1·56, 1·09, 2·23, respectively) and boys in the lowest tertile were more likely to have central adiposity (1·53, 1·02, 2·30) at age 54 months. Most infants fell short of meeting national Infant Feeding Guidelines. The associations between IFI score and maternal characteristics, and children’s overweight/obesity/central adiposity, were in the expected directions and confirm the IFI’s convergent construct validity.
This commentary examines the ethical significance of recently published research demonstrating the extent to which healthcare workers experienced stress and increased challenges in the workplace due ...to inadequate access to personal protective equipment (PPE) during the first COVID-19 surge in Aotearoa New Zealand. The inadequate state of New Zealand's PPE stockpile and distribution system at the beginning of the pandemic was a critical signal, a "canary in the coalmine", of broader challenges facing the New Zealand healthcare system, particularly for healthcare worker safety and wellbeing. As New Zealand reforms its health system with the aim of improving access to and equity of care, an opportunity exists to apply critical lessons learnt from the COVID-19 pandemic about the need to prioritise the wellbeing of the healthcare workers we are dependent upon to deliver that care. Failure to apply this new knowledge will see the system similarly unprepared for future public health emergencies, which are likely to be imminent, and potentially with healthcare workers less willing to accept the burdens placed on them. The Nurture Framework, which has emerged from the voices of healthcare workers within this research, should be adopted as part of health reforms and ongoing emergency preparedness planning. Trust, transparency, respect and safety, the four values of the Framework, are fundamental for all workers who contribute their skills, knowledge and time to our healthcare organisations.
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