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Biomedical subjects

E A Mitchell

Publications and source records attributed to E A Mitchell.

At least 73 records · Page 4Linked to original sources
PubMed1998

Side sleeping position and bed sharing in the sudden infant death syndrome.

In the last decade there have been major reductions in the sudden infant death syndrome (SIDS) rate following prevention programmes in Australasia, Europe and North America, mainly due to changing infants from the prone sleeping position onto their sides or backs. This report reviews previous SIDS observational studies with data on side sleeping position and bed sharing. The relative risk for SIDS calculated from previous studies for side vs back sleeping position is 2.02 (95% CI = 1.68, 2.43). This result suggests that further substantial decreases in SIDS could be expected if infants were placed to sleep on their backs. With regard to bed sharing, the summary SIDS relative risk is 2.06 (1.70, 2.50) for infants of smoking mothers and 1.42 (1.12, 1.79) for infants of nonsmoking mothers. Public health policy should be directed against bed sharing by infants whose mothers smoke as they carry an increased risk of SIDS from bed sharing in addition to their already increased risk from maternal smoking. For infants of nonsmoking mothers, who have a low absolute risk of SIDS, the 40-50% increase in risk needs to be balanced against other perceived benefits from bed sharing, such as increased breastfeeding.

Adult↗
PubMed1998

The establishment and duration of breastfeeding. Part 1: Hospital influences.

Most New Zealand mothers initiate breastfeeding in hospital, but many continue for only a relatively short time. Focus group discussions with mothers and health care workers on their perceptions of important factors influencing the duration of breastfeeding indicated many negative initial hospital experiences. Specific concerns included overworked staff; lack of health care workers' skills, particularly in helping infants to latch on; inconsistent advice; noise and embarrassment in four bedded rooms; and the impact of changes in the provision of maternity services and funding.

Breast Feeding↗
PubMed1998

The establishment and duration of breastfeeding. Part 2: Community influences.

Most New Zealand mothers initiate breastfeeding in hospital, but many continue for only a relatively short time. This paper reports on mothers' and health care workers' perceptions of important community factors influencing the duration of breastfeeding. Data collection was by focus group discussions. The results indicate that some mothers have specific plans regarding the duration of breastfeeding but many do not. The importance of practical help, realistic role expectations, community acceptance especially amongst men, adequate maternity leave, and help for those returning to work is emphasised. Conflicting opinions exist about the difficulties of introducing older infants to bottles.

Attitude↗
PubMed1997

Attitudes to the use of dummies in New Zealand; a qualitative study.

AIMS: To explore experiences with, and attitudes to, the use of dummies (pacifiers). METHODS: Seven focus group discussions were held with groups of mothers and of health professionals. RESULTS: Most mothers and health care workers had a generally negative view of dummy use. This related particularly to dislike of toddlers with them and practical issues such as getting lost or dirty. All would allow their use in a very unsettled baby. No mothers had personally experienced problems with breastfeeding due to the use of a dummy, but concern about this possibility was expressed by some health care workers. Recommendations varied about the length of time that dummies need to be avoided. CONCLUSIONS: Mothers in New Zealand use dummies selectively for their infants and were concerned with issues of weaning the baby from the dummy, keeping it clean and not losing it. In analysing the relationships between dummy use and breastfeeding it is important to take into consideration the context of dummy use.

Attitude of Health Personnel↗
PubMed1997

Housing and sudden infant death syndrome. The New Zealand Cot Death Study Group.

AIMS: This paper examined factors relating to the infants' place of domicile to see whether they increased the risk of sudden infant death syndrome (SIDS) beyond social and environmental effects previously published. METHODS: A case control study was undertaken in New Zealand between the years 1987-90. From all sudden infant death syndrome diagnoses over this time, parents of 393 (81%) sudden infant death syndrome infants consented to participate and these derive the cases. Controls were ascertained by randomly sampling 1800 infants from all babies born over 78% of the country. Parents of 1592 (88%) control infants consented to participate in the study. RESULTS: The relative risk of sudden infant death for infants usually residing in houses rented from the government (State houses) was 1.73 (95% CI: 1.13, 2.66) times that of infants with parents owning their house, after adjusting for likely social, economic and environmental confounding factors. However, the type of housing, construction of housing, heating and age of housing was not associated with sudden infant death syndrome. Although house size, measured in terms of bedroom numbers, was similar for sudden infant death syndrome and control infants (chi 2 = 0.40, df = 2, p = 0.82), the number of people normally residing within these houses was different. Sudden infant death syndrome infants' houses were less likely to have two adults and more likely to have more children normally resident. Density calculations (derived by calculating the children and/or adult numbers divided by bedroom numbers) revealed a non significant increase in relative risk, suggesting that housing overcrowding was not associated with sudden infant death syndrome in New Zealand. CONCLUSIONS: Infants domiciled in State houses are more likely to experience sudden infant death syndrome. However, this increased relative risk for sudden infant death syndrome appears to have little to do with the house per se and, perhaps, more to do with socioeconomic characteristics.

Adult↗
PubMed1997

Measuring morbidity from asthma in children.

AIMS: To develop new measures of asthma morbidity which would be applicable to children with asthma of all grades of severity. METHODS: This study used a cross sectional sample of asthmatic children. Traditional asthma morbidity measures (admission to hospital, use of Emergency Room, general practitioner, after hours deputising service and ambulance) were compared with new measures (school attendance, teacher assessment, parental perception of morbidity and parents emotional response to child's asthma). RESULTS: Data was obtained for 381 children with asthma. Children with poor school attendance were found in the severe group as judged by a composite score using traditional measures (r = 0.30, p < 0.0001). A new composite morbidity score based on two questions about parental perception of severity (how often has asthma prevented participation in activities and rating of severity of asthma in general over the last year) and two questions about parent emotional response to the child's asthma (how often has your child's asthma (a) made you feel frightened and (b) stopped family activities) was developed. This new measure of asthma morbidity was correlated with the composite score using traditional morbidity measures (r = 0.43, p < 0.0001) and with school attendance (r = 0.28, p < 0.0001). CONCLUSION: These new morbidity measures are quick and easy to use, and provide an opportunity to measure asthma severity at the moderate to mild end of the severity spectrum. We recommend their use for both clinical assessment and research.

Absenteeism↗
PubMed1997

The changing epidemiology of SIDS following the national risk reduction campaigns.

Prone sleeping position is causally associated with SIDS. The change in the proportion of infants sleeping prone has resulted in a dramatic reduction in SIDS and total postneonatal mortality. The effect of prone sleeping position is modified by season, latitude, illness, thermal insulation and sheepskins. This suggests that the mechanism by which prone sleeping position causes SIDS is in some way related to temperature.

Case-Control Studies↗
PubMed1997

The effect of season-of-response to ISAAC questions about asthma, rhinitis and eczema in children.

BACKGROUND: To examine whether responses to questions about the lifetime prevalence and 12-month period prevalence of symptoms of asthma and allergies are affected by the season in which the questions are asked. METHODS: The international Study of Asthma and Allergies in Childhood (ISAAC) Phase One was undertaken in six New Zealand centres; in three centres the effect of season was studied. Over three school terms at least 3000 children were studied in each of two age groups per centre (6-7 years; 13-14 years), one-third in each term respectively. The ISAAC standardized written questionnaires were used to identify asthma, rhinitis and eczema symptoms. The written questionnaire in the younger age group was completed by the parent/guardian. The older age group self-completed the written questionnaire and also a video questionnaire about asthma symptoms. RESULTS: The total number of respondents was 21,437, approximately half in each age group. The season of responding had no effect on the level of response to eczema questions. For the written asthma questionnaire no season-of-response effect was present for 6-7 year olds; for 13-14 year olds there was a trend to a higher rate of positive responses by those responding in winter, but in only one question did this reach statistical significance. With the video questionnaire there was a similar trend for a higher rate of positive responses when questions were asked in winter, but this did not reach statistical significance. For rhinitis symptoms there was a statistically significant season-of-response effect in both age groups with two questions; the fewest positive responses by the winter responders. CONCLUSIONS: There was no significant effect of season-of-response to questions on eczema symptoms, and most questions on asthma symptoms. There was a season-of-response effect on responses to questions on rhinitis symptoms suggesting a recall bias relating to recency of symptoms.

Adolescent↗
PubMed1997

Gender and the sudden infant death syndrome. New Zealand Cot Death Study Group.

A nationwide case-control study compared the prevalence and magnitude of risk factors for sudden infant death syndrome (SIDS) in male and female infants. The risk factors of SIDS and their magnitude for males and females are very similar. After adjustment for potential confounders male infants had a 1.42-fold (95% CI = 1.04, 1.94) increased risk of SIDS compared with females. Risk factors identified in most epidemiological studies are not the reason for the increased SIDS mortality seen in male infants.

Birth Weight↗
PubMed1997

Influences on breastfeeding in southeast England.

Factors associated with not exclusively breastfeeding at discharge from the obstetric hospital and with duration of breastfeeding were examined in 700 randomly sampled infants. Obstetric records were examined in 97.7% of the subjects and 73.0% of subject families were interviewed. There were 444 (66.5%) infants exclusively breastfed at discharge from the obstetric hospital. Factors associated with not exclusively breastfeeding at discharge from the obstetric hospital after adjusting for potential confounders were: mother leaving school aged less than 18 years, mother not attending antenatal classes and the use of a dummy in the 2 weeks before the interview. Bed sharing practice in the 2 weeks before the interview was associated with exclusively breastfeeding at discharge from the obstetric hospital. Factors associated with a shorter duration of breastfeeding were: mother leaving school before 18 years of age, smoking 20 or more cigarettes per day and use of a dummy. Dummy use may causally reduce breastfeeding or might be a marker for breastfeeding difficulties. There was a dose-response relationship with smoking, with heavier smokers breastfeeding for the shortest time periods. Bed sharing was associated with a longer duration of breastfeeding. This may not necessarily be a causal relationship because breastfeeding may promote bed sharing. The effect of dummy use and bed sharing on breastfeeding warrants further study.

Adult↗
PubMed1997

SIDS, illness, and acute medical care. New Zealand Cot Death Study Group.

One component of the Back to Sleep campaign to reduce the risk of sudden infant death syndrome (SIDS) is the recommendation that parents seek medical attention if their infant is unwell. The aim of this study was to investigate of SIDS could in part be explained by sick infants not getting appropriate medical care. Data on symptoms of illness and on acute medical contacts made for infants dying from SIDS (n = 390) within two weeks of their death were compared with those from a randomly selected group of control infants (n = 1592). SIDS cases had more severe illness than controls (odds ratio (OR) = 3.43; 95% confidence interval (CI) = 1.69 to 5.38), and were more likely to have seen a general practitioner (OR = 1.37; 95% CI = 1.09 to 1.73) or attended hospital (OR = 3.43, 95% CI = 1.09 to 1.73). Only 1.3% of all SIDS cases had symptoms suggesting severe illness and had not seen a general practitioner. A lack of medical contacts in the two weeks before death does not contribute to the risk of SIDS.

Acute Disease↗
PubMed1997

Why is sudden infant death syndrome more common at weekends? The New Zealand National Cot Death Study Group.

OBJECTIVES: To determine whether the prevalence of known risk factors and the magnitude of their association with sudden infant death syndrome (SIDS) differed between weekends and weekdays. METHOD: A large nationwide case-control study, comparing interview data for 393 cases with 1591 controls. RESULTS: Sudden infant death syndrome occurred more often at weekends, more deaths occurring on Sunday than on any other day of the week. Significant interaction effects were found between weekends and sharing a room with an adult and the parents going to a party. After adjustment for confounders, room sharing was less protective at the weekends (odds ratio (OR) = 0.66, 95% confidence interval (CI) 0.43 to 1.03) than it was on weekdays (OR = 0.41, 95% CI 0.30 to 0.57) using not room sharing and weekdays as the reference group. Although the likelihood of SIDS after a party was higher at weekends (OR = 2.47, 95% CI 1.11 to 5.47) than on weekdays (OR = 0.55, 95% CI 0.21 to 1.37), few cases were reported. Being Maori (OR = 3.35, 95% CI 1.75 to 6.43) or the child of an unmarried mother (OR = 3.91, 95% CI 2.20 to 6.92) were risk factors for SIDS occurring on Sundays. CONCLUSIONS: The increase in SIDS at weekends may be explained in part by the lesser protective effect of sharing a bedroom with an adult at that time. It may also be related to social activities that occur at weekends.

Case-Control Studies↗
PubMed1997

Risk factors for sudden infant death syndrome following the prevention campaign in New Zealand: a prospective study.

OBJECTIVES: To identify the risk factors for sudden infant death syndrome (SIDS) following a national campaign to prevent SIDS. METHODS: For 2 years (October 1, 1991 through September 30, 1993) data were collected by community child health nurses on all infants born in New Zealand at initial contact and at 2 months. RESULTS: There were 232 SIDS cases in the postneonatal age group (2.0/1000 live births) and these were compared with 1200 randomly selected control subjects. Information was available for 127 cases (54.7%) and 922 (76.8%) of controls. The previously identified modifiable risk factors were examined. The prevalence of prone sleeping position of the infant was very low (0.7% at initial contact and 3. 0% at 2 months), but was still associated with an increased risk of SIDS. In addition, the side sleeping position was also found to have an increased risk of SIDS compared with the supine sleeping position (at 2 months: adjusted odds ratio (OR) = 6.57; 95% confidence interval (CI) = 1.71, 25.23). Maternal smoking was found to be the major risk factor for SIDS. Bed sharing was also associated with an increased risk of SIDS. There was an interaction between maternal smoking and bed sharing on the risk of SIDS. Compared with infants not exposed to either bed sharing or maternal smoking, the adjusted OR for infants of mothers who smoked was 5.01 (95% CI = 2.01, 12.46) for bed sharing at the initial contact and 5.02 (95% CI = 1.05, 24. 05) for bed sharing at 2 months. In this study breastfeeding was not associated with a statistically significant reduction in the risk of SIDS. The other risk factors for SIDS identified were: unmarried mother, leaving school at a younger age, young mother, greater number of previous pregnancies, late attendance for antenatal care, smoking in pregnancy, male infant, Maori ethnicity, low birth weight, and shorter gestation. CONCLUSIONS: After adjustment for potential confounders, prone and side sleeping positions, maternal smoking, and the joint exposure to bed sharing and maternal smoking were associated with statistically significant increased risk of SIDS. A change from the side to the supine sleeping position could result in a substantial reduction in SIDS. Maternal smoking is common in New Zealand and with the reduction in the prevalence of prone sleeping position is now the major risk factor in this country. However, smoking behavior has been difficult to change. Bed sharing is also a major factor but appears only to be a risk to infants of mothers who smoke. Addressing bed sharing among mothers who smoke could reduce SIDS by at least one third. Breastfeeding did not appear to offer a statistically significant reduction in SIDS risk after adjustment of potential confounders, but as breastfeeding rates are comparatively good in New Zealand, this result should be interpreted with caution as the power of this study to detect a benefit is small.

Beds↗