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Biomedical subjects

R Scragg

Publications and source records attributed to R Scragg.

At least 37 records · Page 2Linked to original sources
PubMed1995

A national survey of cigarette smoking in fourth-form school children in New Zealand.

AIMS: To determine the prevalence of cigarette smoking in 14 and 15 year old school children in New Zealand and to examine associated risk factors. METHODS: Nationwide cross-sectional survey of fourth-form school children in New Zealand by means of an anonymous self administered questionnaire in November 1992. RESULTS: Questionnaires from 14,097 fourteen and fifteen year-olds were analysed. 65.6% had tried smoking, and 36.1% regarded themselves as smokers. Females and Maori had significantly higher prevalence rates. Of Maori females 44.6% were current smokers (more than one per month) compared to 24.0% for the whole group, and 33.0% were daily smokers. Pacific Island students, who have similar socioeconomic disadvantage to Maori, have a lower relative risk of smoking (RR) 0.79, (95% confidence interval (CI) 0.68, 0.91), than Europeans. Major independent risk factors were identified and population attributable risk was calculated for parental smoking (22.9%), poor knowledge of adverse health effects (7.3%) and watching televised sports (13.4%). These three modifiable factors accounted for 36.1% of the total smoking prevalence in these children. CONCLUSION: The continued high prevalence of smoking in New Zealand children, especially in Maori and in females, prove current public health measures to be inadequate. Our results suggest that strategies aimed at decreasing parental smoking, improving student knowledge of adverse health effects and preventing tobacco sponsorship of television sports could greatly decrease the smoking prevalence in this age group.

Adolescent↗
PubMed1995

Public health policy on bed sharing and smoking in the sudden infant death syndrome.

AIMS: Further develop New Zealand public health policy on infant bed sharing by quantifying the number of sudden infant death syndrome (SIDS) cases attributable to bed sharing among infants of smoking and nonsmoking mothers. METHODS: A large nation-wide case control study covering a region with 78% of all births in New Zealand during 1987-90. Interviews were completed with parents of 393 (81.0% of total) cases who died from the sudden infant death syndrome in the postneonatal age group, and 1592 (88.4% of total) controls who were a representative sample of all hospital births in the study region. RESULTS: The proportion of control infants who usually bed shared in the last 2 weeks was 65.7% in Maori, 73.7% in Pacific Island people and 35.5% in Europeans (44.5% in all ethnic groups combined, and half of these for less than 2 hours per night). There was an interaction between maternal smoking and infant bed sharing on the risk of sudden infant death separately in Maori, Pacific Island and European infants with the risk being highest in infants exposed to both risk factors. 26% of SIDS deaths were explained by bed sharing among infants of smoking mothers (who comprised 16% of the total infant population) and 3% by bed sharing among infants of non-smoking mothers (28% of total infant population). CONCLUSION: Infant bed sharing is common. The majority of SIDS deaths that are attributed to be sharing occur among infants of smoking mothers. A policy which advises all infants not to bed share is estimated to potentially save an extra 3% of SIDS compared to a policy targeted only on infants of smoking mothers. If public attitudes are favorable to bed sharing, there could be a marginal cost (against its acceptance) by including infants of non-smoking mothers in the recommendation not to bed share. These findings should not be interpreted as indicating that bed sharing where the mother is a nonsmoker is safe or protective against SIDS.

Beds↗
PubMed1995

Foot care among diabetic patients in south Auckland.

AIM: To describe footcare among diabetic patients in south Auckland. METHOD: Direct interview of 331 European, 86 Maori and 123 Pacific Islands patients attending local diabetes services and a stratified subsample of general practitioners. Interviews included closed and open questions of diabetes knowledge, demographic and medical history and were followed by a thorough inspection of the feet. RESULTS: Major lesions (amputation, foot ulcer) and predisposing lesions (callus or fungal infection/maceration) were present in 48.5% of patients. Major lesions were particularly common among Pacific Islands patients (9.4%) vs European (3.9%), Maori (5.5%), (p < 0.05). Fungal infection/maceration was less common among Pacific Islands patients (23.0%) vs 42.3%, 42.2% respectively, (p < 0.001). Fungal infection/maceration was more common and callus formation less common among men when compared with women. Forty percent (n = 214) of patients, including eight with either an ulcer or a blister, had not had their feet examined over the preceding 12 months. Good foot care was present in 52.7% Europeans, 31.0% Maori and 26.8% Pacific Islands patients (p < 0.001). Diabetes knowledge was poorest in those with poor foot care among Europeans and Maori. CONCLUSION: While the provision of footcare advice, adherence to such advice and monitoring of footcare remain uneven, the hospital and community costs of the diabetic foot will continue to be high.

Adolescent↗
PubMed1995

Serum 25-hydroxyvitamin D3 levels decreased in impaired glucose tolerance and diabetes mellitus.

A cross-sectional survey was carried out in a New Zealand Polynesian and Caucasian workforce of 5677 staff aged 40-64 years to determine whether serum concentrations of 25-hydroxyvitamin D3 are altered in people with newly diagnosed diabetes mellitus and impaired glucose tolerance (IGT). Serum 25-hydroxyvitamin D3 concentration was significantly lower in newly detected cases with diabetes and IGT (n = 238) compared with controls individually matched by sex, age (+/- 2 years), ethnicity, and date of interview (mean (S.D.): 69 (31) vs. 76 (34) nmol/l; P = 0.0016). Among controls, serum concentrations were significantly lower in Maori (mean (S.E.) = 65 (5) nmol/l; P = 0.0013) and Pacific Islanders (59 (4) nmol/l; P = 0.0001) compared with Europeans (82 (3) nmol/l), after adjusting for age, sex, and time of year. We conclude that diabetes and IGT are associated with low serum concentrations of 25-hydroxyvitamin D3 and that low concentrations of this hormone in New Zealand Polynesians may partly explain their increased prevalence of diabetes/IGT compared with Europeans.

Adult↗
PubMed1995

Serum 25-hydroxycholecalciferol concentration in newly detected hypertension.

Although blood concentrations of the active metabolite 1,25-dihydroxyvitamin D are raised in hypertension, concentrations of 25-hydroxyvitamin D, the main vitamin D metabolite, do not appear to have been reported in newly detected hypertension. Serum levels of 25-hydroxycholecalciferol were measured in 186 newly detected hypertensive patients (blood pressure > 160/95 mm Hg and never on antihypertensive medication) and normotensive controls individually matched by sex, age (+/- 2 years), ethnicity, and date of interview. Serum 25-hydroxycholecalciferol levels were similar in cases (mean (SD) = 64 (21) nmol/L) and controls (67 (28) nmol/L, P = .20). We conclude that serum 25-hydroxycholecalciferol, a marker of body vitamin D, is normal in hypertension.

Age Factors↗
PubMed1995

Differences in intake of specific food plants by Polynesians may explain their lower incidence of colorectal cancer compared with Europeans in New Zealand.

Epidemiological studies have implicated obesity; high intakes of alcohol, fat, and energy; and low intakes of food plants as risk factors for colorectal cancer. In New Zealand, Polynesians (including Maoris and people from several Pacific Islands) are more likely to be overweight and have higher intakes of fat and energy than Europeans, and they are likely to have similar total intakes of food plants. Yet, in New Zealand, Polynesians have a significantly lower incidence of colorectal cancer than the Europeans. It is possible that the difference in incidence of colorectal cancer is due to differences in consumption of specific food plants by Polynesians and Europeans in New Zealand. Here we have compared the consumption of specific food plants by 429 Maoris, 643 Pacific Islanders, and 4,451 Europeans in paid employment in New Zealand. Of the 51 food plants eaten by New Zealanders, 6 were eaten significantly more frequently and 17 significantly less frequently by the two Polynesian groups than by Europeans. The quantity of any protective chemical components (or other as yet unknown protective factors) in food plants is likely to be related to their botanical classification. Differences in the intake of specific food plants may at least partly explain differences in the incidence of colorectal cancer between Polynesians and Europeans.

Anticarcinogenic Agents↗
PubMed1995

Life-style factors associated with winter serum 25-hydroxyvitamin D levels in elderly adults.

A cross-sectional survey of community-dwelling elderly volunteers (104 women, 87 men, mean age 70 years) was carried out in winter to determine whether cardiovascular and other potentially modifiable lifestyle factors were associated with serum levels of 25-hydroxyvitamin D during this period. Mean winter levels of serum 25-hydroxyvitamin D were higher in men than in women (14.2 vs. 12.2 ng/ml, p = 0.021), higher in those who used margarine daily compared with less often (14.4 vs. 11.9 ng/ml, p = 0.005), and higher in those who holidayed overseas in the last 6 months at a lower latitude than in Great Britain or Germany (14.9 vs. 12.4 ng/ml, p = 0.044), after controlling for other confounders. Serum 25-hydroxyvitamin D levels were not related to the number of hours spent outdoors during the previous month (r = 0.04, p > 0.05). When participants were classified by tertile of low-density lipoprotein (LDL) cholesterol, mean serum 25-hydroxyvitamin D was raised in the highest (14.3 ng/ml, p = 0.011) and middle (13.3 ng/ml, p = 0.15) tertiles compared with the lowest tertile (11.9 ng/ml), after controlling for other confounders. All other cardiovascular risk factors, including total- and HDL-cholesterol, blood pressure, BMI, smoking and leisure physical activity, were unrelated to serum vitamin D. These results suggest that body vitamin D levels in elderly people during winter are related to diet and overseas holidays within the last 6 months, but not to UK winter sun exposure, nor to the major cardiovascular risk factors apart from LDL cholesterol.

Aged↗
PubMed1995

Health status and occupation: use of a health status index to measure the health of occupations.

A total of 4466 employed persons completed the short Auckland University Health Status Index (AUHSI) questionnaire and a health score was assigned to each individual on the basis of their responses. This health score was found to have statistically significant associations with a number of health-related measures, including socio-economic status (P < 0.001), and with occupational group: administrative, clerical/sales/service, skilled trades and unskilled labour (P < 0.001). Within the occupational groups, 3361 employees could be assigned to 42 specific occupations having 19 or more members each. After controlling for age and gender, significant differences in mean health score for specific occupation were found in the clerical/sales/service (P < 0.05), skilled trades (P = 0.002) and unskilled manual (P < 0.05) groups. It is postulated that these differences may be due to the nature of the specific occupation. Some possible reasons are listed. It is concluded that a global measure of health status such as this may be useful in the planning and evaluation of occupational health services.

Female↗
PubMed1995

A quantification of alcohol-related mortality in New Zealand.

BACKGROUND: There are no published New Zealand (NZ) studies on alcohol drinking and total mortality, despite its importance to alcohol health policy. AIMS: To estimate the proportion of NZ deaths caused or prevented by alcohol drinking. METHODS: The proportion of current alcohol drinkers from recent NZ surveys, and pooled relative risks from a review of the international literature on alcohol and mortality, were used to calculate disease-specific population attributable risks. The number of deaths caused (or prevented) by alcohol were calculated for 1987 New Zealand deaths. Person-years of life lost (or saved) were calculated using recent NZ life tables. RESULTS: The association between alcohol and total mortality was related to age. Alcohol was estimated to have caused 3.0% of all deaths among 0-14 year olds and 20.1% of deaths among 15-34 year olds, mostly from road injuries. In contrast, alcohol was estimated to have prevented 0.5% of all deaths among 35-64 year olds and 3.4% of deaths among > or = 65 year olds due to its protective effect against coronary heart disease. For all age groups, alcohol was estimated to have prevented 1.5% of deaths. However, the number of person-years of life lost among ages less than 35 years was greater than those saved in the older age groups, so that alcohol was estimated to have caused the loss of 9525 person-years of life for all ages combined. CONCLUSIONS: The adverse effects of alcohol on total mortality are confined to age groups less than 35 years. Public health policy to minimise deaths from alcohol should be concentrated on this group.

Accidents, Traffic↗
PubMed1995

Serum 25-hydroxyvitamin D3 is related to physical activity and ethnicity but not obesity in a multicultural workforce.

BACKGROUND: Recent research suggests that body vitamin D levels are decreased in coronary heart disease and diabetes, but it is unclear which cardiovascular risk factors are related to vitamin D status. AIMS: To examine the relation between vitamin D status and major cardiovascular risk factors. METHODS: Serum 25-hydroxyvitamin D3, a marker of recent sun exposure and vitamin D status, was measured in 390 New Zealand residents (95 Pacific Islanders, 74 Maori and 221 others mostly of European descent), who were part of a larger cross-sectional survey of a workforce (n = 5677) aged 40-64 years. RESULTS: Serum 25-hydroxyvitamin D3 levels were significantly lower in Pacific Islanders (mean (SE) = 56 (3) nmol/L; p = 0.0001) and Maoris (68 (3) nmol/L; p = 0.036) compared with Europeans (75 (2) nmol/L) after adjusting for age, sex and time of year. Also adjusting for ethnic group, 25-hydroxyvitamin D3 was higher in people doing vigorous (aerobic) leisure physical activities (71 (2) nmol/L; p = 0.0066) and moderate (non-aerobic) activities (68 (3) nmol/L; p = 0.12) compared with those who were inactive (63 (2) nmol/L). However, 25-hydroxyvitamin D3 was unrelated to body mass index, serum lipids, blood pressure or cigarette smoking. CONCLUSIONS: People with increased skin pigmentation, such as Polynesians, and people who are inactive, have decreased body levels of vitamin D; this might partly explain their increased risk of cardiovascular disease.

Adult↗
PubMed1995

Sudden infant death syndrome in New Zealand: are risk scores useful? New Zealand National Cot Death Study Group.

STUDY OBJECTIVE: To evaluate the Christchurch, Invercargill, Dunedin (CID) and Oxford record linkage study (ORLS) risk scores in five regions of New Zealand and examine the effect of risk factors for sudden infant death syndrome (SIDS), such as prone sleeping position, maternal smoking, breast feeding, measures of illness, the use of antenatal classes, community health care, and medical services on a high and low risk group delineated by the CID score. DESIGN: This was a case-control study of infants dying of SIDS. SETTING: Both the cases and controls were born in one of five health districts in New Zealand and their parents were interviewed between 1 November 1987 and 31 October 1990. PARTICIPANTS: The cases were 485 infants who died of SIDS. The controls were a random sample drawn from the same five regions in which the cases were born, chosen so that their age on the day on which they were interviewed was similar to the age at death of the cases. Risk scores were calculated for 387 case and 1579 controls. MEASUREMENTS AND MAIN RESULTS: Using the recommended cut off points the sensitivity and specificity of the CID and ORLS were found to be similar to those described for other samples. The differences among the regions were significant. There was, however, no evidence that the association between SIDS and the risk factors considered was different in the high and low risk groups delineated by the CID score. The relative attributable risk for smoking was 32.3% in the high risk group. The excess risk that could be attributed to a different prevalence of any of the other risk factors in the high risk group was small when compared with the low risk group. CONCLUSIONS: Health care resources should be spent on promoting and evaluating good child care practices for all, rather than identifying and promoting special interventions for those in the high risk category.

Breast Feeding↗
PubMed1995

Effect of winter oral vitamin D3 supplementation on cardiovascular risk factors in elderly adults.

OBJECTIVE: A possible role for vitamin D deficiency in contributing to the winter increase in cardiovascular disease mortality was investigated by testing the effect of vitamin D supplementation on blood pressure and other cardiovascular risk factors during winter. DESIGN: Randomised double-blind trial of vitamin D supplementation in winter. SUBJECTS: Men and women, mean age 70 years (range 63-76) recruited from general practitioner age-sex registers in Cambridge (UK). INTERVENTION: 95 people received a single oral dose of 2.5 mg cholecalciferol and 94 received the placebo at baseline interviews during December 1991. Follow-up assessment was 5 weeks later during January 1992. RESULTS: Comparing follow-up with baseline assessment, serum 25-hydroxyvitamin D increased in the treated group and decreased slightly in the placebo group [mean (s.d.) change: 7.2 (+/- 3.8) vs -1.4 (+/- 1.1) ng/ml, P = 0.0001]; while parathyroid hormone decreased in the treated, and increased in the placebo, group [-0.27 (+/- 0.78) vs 0.13 (+/- 0.75) pmol/l, P = 0.0004]. However, the mean change in blood pressure was similar in both groups: systolic -5 (+/- 13) vs -5 (+/- 16) mmHg, P = 0.81; diastolic -1 (+/- 9) vs -1 (+/- 9), P = 0.92; as was the mean change in serum cholesterol [-0.07 (+/- 0.52) vs -0.05 (+/- 0.60) mmol/l, P = 0.81]. In contrast, the mean change in radial pulse was significantly decreased in the treated group compared with placebo [-2 (+/- 9) vs 1 (+/- 7) beats per min, P = 0.030]. CONCLUSIONS: The failure of vitamin D supplementation to change blood pressure or serum cholesterol suggests that the winter increase in these factors is not caused by decreased vitamin D levels.

Aged↗
PubMed1994

Observations on ethnic differences in SIDS mortality in New Zealand.

INTRODUCTION: Within New Zealand the SIDS mortality rate is higher in Maori than in non-Maori, predominantly European. AIMS: This paper addresses two questions (1) How should ethnicity be defined, by biological or cultural criteria? (2) Why is the SIDS rate higher in Maori, because of different risk factors or because of a higher prevalence of common risk factors? METHODS: A nationwide case-control study. RESULTS: The majority of mothers with some Maori blood (as reported on the infants birth registration form) report they are Maori (as recorded in the obstetric records or interview). Risk factors for SIDS are similar in the various ethnic groups in New Zealand. CONCLUSIONS: Using a biological definition underestimates the number of Maori infants compared to the cultural definition. Differences in SIDS mortality appear to be explained by differences in prevalence of known risk factors, the most important of which, prone sleeping position, maternal smoking, lack of breast feeding and bed sharing, are culturally determined rather than biologically.

Case-Control Studies↗
PubMed1994

Prevalence of known diabetes in a multiethnic community.

AIMS: To describe the prevalence of known diabetes in an area of New Zealand with a large Pacific Islands and Maori population. METHOD: A cross sectional door to door census with identification of those with known diabetes was conducted between April and October 1992. The data was validated by comparison with available local general practice diabetes registers and data from a repeat visit to a randomly selected 5% of houses. RESULTS: Interviews were completed at 92.7% of the 5081 households, containing 22,651 residents (1417 European, 5606 Maori, 14,802 Pacific Islands). The Pacific Islands population was 40% larger than that predicted from the 1991 census. The age adjusted prevalence of known diabetes in adults (aged > or = 20 years) was 2.8% (95% CI 1.9-3.9) in Europeans, 6.9% (95% CI 6.0-7.9) in Maori and 4.6% (95% CI 4.1-5.1) in Pacific Islands people. The greatest differences in prevalence were found in those aged 40-59 years. Interviews at 185/280 houses revisited showed that 13% of households had moved completely in the 2-8 months between visits. Comparison between participating general practice registers and the door to door survey database showed that 11.2% (26/232) of diabetic individuals were missed by the door to door survey, and 23.7% (55/232) were not on the register of the named general practitioner. CONCLUSIONS: The prevalence of known diabetes in the community is much higher than that in the workforce. Differences between Maori and Pacific Islands people may be due to more undiagnosed diabetes or a lower risk of diabetes in the latter.

Adolescent↗
PubMed1994

Ethnic differences in diabetes knowledge and education: the South Auckland Diabetes Survey.

AIM: To compare the knowledge of diabetes, and diabetes education provision/preferences among European, Maori and Pacific Islands diabetic patients in south Auckland. METHOD: The 331 European, 86 Maori and 123 Pacific Islands patients who were interviewed attended local diabetes services and a stratified subsample of general practitioners. Interviews included closed and open questions of diabetes knowledge, age, sex, diabetes treatment, employment status, weekly household income, school/further education received and the actual and preferred format of diabetes education. RESULTS: Pacific Islands patients knew least, and Europeans most, about diabetes from both open and closed diabetes knowledge questions. The majority of Pacific Islands patients could not name the nature, symptoms or complications of diabetes. This was unaffected by duration of diabetes, place of birth or time in New Zealand, although insulin treated Pacific Islands patients knew more than noninsulin treated patients (closed score 71 SD (4)% vs 61 SD (2)% p < 0.05). Pacific Islands patients were least likely to have received diabetes education (European 69%, Maori 70%, Pacific Islands 49%, p < 0.001). Knowledge scores were higher in those who had received education at diagnosis. Europeans were least likely to want further education (Europeans 52%, Maori 69%, Pacific Islands 63%, p < 0.01). The preferred sources for ongoing education were the lay educator/diabetes nurse specialist service (Europeans 28%, Maori 37%, Pacific Islands 76%), and the hospital based clinic among Europeans (27%) and Maori (36%). No Pacific Islands patients preferred a hospital based ongoing education service, while few diabetic patients of any ethnic group preferred to receive education via their general practitioner. In all ethnic groups, patients wanting more education knew more than those who did not. CONCLUSION: The local delivery of diabetes education is uneven. Among Pacific Islands people, it is grossly inadequate. In order for all patients to receive such education, the diabetes services need to be better coordinated and integrated with primary health care.

Aged↗
PubMed1994

Single-dose cholecalciferol suppresses the winter increase in parathyroid hormone concentrations in healthy older men and women: a randomized trial.

A randomized double-blind controlled trial of a single oral dose of 2.5 mg (100,000 IU) cholecalciferol (vitamin D3) was conducted in the winter in 189 healthy free-living men and women aged 63-76 y. The mean baseline serum concentration for 25-hydroxyvitamin D was 34.5 nmol/L and for parathyroid hormone 3.18 pmol/L. After 5 wk, mean serum 25-hydroxyvitamin D concentrations were 60% higher in the treated than in the placebo group (P < 0.001). There was a 12% difference in parathyroid hormone concentrations in the treated compared with the placebo group (P < 0.001). No differences in serum calcium were seen. Findings suggest that 25-hydroxyvitamin D has a physiological role in the regulation of parathyroid secretion independent of serum calcium in healthy elderly people. Parathyroid concentrations rise and 25-hydroxyvitamin D concentrations decline with age. These results may have implications for the prevention of osteoporotic fractures that occur with increased frequency in winter and in elderly people.

Aged↗