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Biomedical subjects

E A Mitchell

Publications and source records attributed to E A Mitchell.

At least 127 records · Page 7Linked to original sources
PubMed1994

Factors adversely associated with breast feeding in New Zealand.

Control data from 1529 infants studied in a multicentre case-control study of sudden infant death in New Zealand were analysed to identify factors that might hinder the establishment and duration of breast feeding. Although 1300 infants (85%) were exclusively breast-fed at discharge from the obstetric hospital, this fell to 940 (61%) by 4 weeks. Logistic regression was used to identify factors that might adversely influence breast feeding 'at discharge', 'at 4 weeks' and the overall 'duration' of breast feeding. When adjusted for confounding factors, not exclusive breast feeding 'at discharge' was significantly associated with: twin pregnancy, being a Pacific Islander, mother not bedsharing, subsequent dummy use, birthweight less than 2500 g, heavy maternal smoking, not attending antenatal classes and mother less than 20 years old at first pregnancy. Mothers smoking more than 20 cigarettes a day were nearly twice as likely to not exclusively breast feed on discharge compared to those who did not smoke. A 'dose response' was apparent with the heaviest smokers having the least likelihood of establishing exclusive breast feeding. Being exclusively breast-fed at discharge but not 'at 4 weeks' was associated with: twin pregnancy, admission to a neonatal intensive care unit, subsequent dummy use and not being married. A shorter overall 'duration' of breast feeding was associated with maternal smoking, subsequent dummy use, mother not bedsharing, twin pregnancy, mother less than 20 years old at first pregnancy, low occupational status and not attending antenatal classes. These effects persisted when social and demographic factors, including birthweight, were taken into account.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Clothing and bedding and its relevance to sudden infant death syndrome: further results from the New Zealand Cot Death Study.

As part of a large nationwide case-control study covering a region with 78% of all births in New Zealand during 1987-90, the clothing and bedding of infants dying of sudden infant death syndrome (SIDS) and that of an appropriate control group were recorded. Cases consisted of 81% (n = 393) of all cases of SIDS in the study area and 88.4% (n = 1592) of 1800 control infants randomly selected from the hospital births and who completed a home interview. Use of a wool 'waterproof' underblanket was associated with a significantly reduced risk of SIDS (adjusted OR 0.44; 95% CI: 0.26-0.73) while sheepskin use was not. Firm tucking was identified as contributing to a reduced risk of SIDS even after adjusting for potentially confounding variables (adjusted OR 0.63, 95% CI: 0.46-0.86). Sixty case infants (15.6% of cases) were found dead with the head covered but there were no equivalent data for controls. Having been found previously completely covered by bedding was equally common in cases and controls (28.8% cases and 30.6% of control infants). Other differences of bedding and clothing between cases and controls were small; mattress characteristics were not studied. The exact methods in which babies are cared for are important and this study suggests that infants are at lower risk of SIDS when firmly tucked in and when sleeping on a 'waterproof' wool underblanket.

Bedding and Linens↗
PubMed1994

Travel and changes in routine do not increase the risk of sudden infant death syndrome.

We investigated the relationship between travel and changes in routine and the sudden infant death syndrome (SIDS) among 485 SIDS cases compared with 1800 randomly selected control infants. There was no increased risk of SIDS with travel. Special events, such as christenings, were not associated with an increased risk of SIDS. However, visits to and by friends or relatives were associated with a significantly reduced risk of SIDS after controlling for potential confounders (odds ratios = 0.70; 95% confidence interval = 0.52, 0.96). These findings may indicate less social support in SIDS cases.

Analysis of Variance↗
PubMed1994

Reduction in mortality from sudden infant death syndrome in New Zealand: 1986-92.

Mortality from sudden infant death syndrome (SIDS, or cot death) in New Zealand has been high by international standards (4/1000 live births). Within New Zealand the rate is higher in Maori than in non-Maori (predominantly European infants) and higher in South Island than in North Island. The National Cot Death Prevention Programme aims to reduce the prevalence of four modifiable risk factors for SIDS, namely infants sleeping prone, maternal smoking, lack of breast feeding, and infants sharing a bed with another person. The aim of this study is to describe the total postneonatal and total SIDS mortality in New Zealand from 1986 to 1992. Official publications from 1986 to 1990 and preliminary death notifications for 1991 and 1992 were examined. Deaths from all causes in the postneonatal age group (28 days to 1 year) and the total number of deaths from SIDS irrespective of age decreased markedly in 1990 and has continued to decrease. This decrease occurred particularly in non-Maori groups, in South Island, and in the winter months. The proportion of infants sleeping in a prone position has decreased from 43% to less than 5%. This suggests that the prone position is causally related to SIDS. The mechanism appears to be related directly or indirectly to environmental temperature.

Age Factors↗
PubMed1994

Risk factors for readmission to hospital for asthma in childhood.

BACKGROUND: Readmissions account for part of the increase in hospital admissions for asthma in childhood seen in many countries. METHODS: This observational study recorded demographic features and the severity, treatment and management of asthma in 1034 individual children admitted to hospital over a one year period, followed for a maximum of 33 months. RESULTS: Readmissions were common, with 33% readmitted by six months and 51% by two years. After controlling for a wide range of variables, factors that significantly increased readmission were: female sex (relative risk (RR) 1.23; 95% confidence interval (CI) 1.03 to 1.46), young age (age < 5 years RR 1.71; 95% CI 1.41 to 2.08), number of previous admissions (one previous admission RR 1.32; two, RR 1.68; three, RR 2.00; four or more, RR 2.80), and inpatient intravenous treatment (RR 1.29; 95% CI 1.08 to 1.55). Inpatient treatment with theophylline was used frequently (98.4%), but was associated with decreased readmissions (RR 0.51, 95% CI 0.28 to 0.92). Factors which did not predict readmission included ethnicity, respiratory and pulse rate, medical team, prescribed prophylactic treatment, type of follow up, or the use of action plans. CONCLUSIONS: Risk factors for readmission relate to the characteristics of the individual (age and sex), severity of the condition (intravenous treatment), and number of previous admissions which may reflect severity or behaviour of the illness. Medical treatment and management did not influence readmissions. Strategies to reduce the high readmission rate for asthma in childhood need to be developed.

Age Distribution↗
PubMed1994

Postnatal depression in a community cohort.

A community cohort of 206 European and Maori women completed a questionnaire screening for postnatal depression at 4 weeks postpartum. The prevalence of major depressive disorder amongst the women was 7.8% with a further 13.6% of women experiencing more minor depressive symptoms. Postnatal depression was more likely to occur in women who were single, were less than 20 years old at the birth of their first child, were unhappy with their relationship with their partner, had a history of previous psychiatric hospitalisation, and were Maori. Women who were depressed were more likely to show a lack of enjoyment of and less positive attitude towards their infant. The study highlights the value of screening for postnatal depression with a simple questionnaire, as few depressed women would have been otherwise recognised.

Adolescent↗
PubMed1993

Bed sharing, smoking, and alcohol in the sudden infant death syndrome. New Zealand Cot Death Study Group.

OBJECTIVES: To investigate why sharing the bed with an infant is a not consistent risk factor for the sudden infant death syndrome in ethnic subgroups in New Zealand and to see if the risk of sudden infant death associated with this practice is related to other factors, particularly maternal smoking and alcohol consumption. DESIGN: Nationwide case-control study. SETTING: Region of New Zealand with 78% of all births during 1987-90. SUBJECTS: Home interviews were completed with parents of 393 (81.0% of total) infants 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: Maternal smoking interacted with infant bed sharing on the risk of sudden infant death. Compared with infants not exposed to either risk factor, the relative risk for infants of mothers who smoked was 3.94 (95% confidence interval 2.47 to 6.27) for bed sharing in the last two weeks and 4.55 (2.63 to 7.88) for bed sharing in the last sleep, after other confounders were controlled for. The results for infants of non-smoking mothers were inconsistent with the relative risk being significantly increased for usual bed sharing in the last two weeks (1.73; 1.11 to 2.70) but not for bed sharing in the last sleep (0.98; 0.44 to 2.18). Neither maternal alcohol consumption nor the thermal resistance of the infant's clothing and bedding interacted with bed sharing to increase the risk of sudden infant death, and alcohol was not a risk factor by itself. CONCLUSION: Infant bed sharing is associated with a significantly raised risk of the sudden infant death syndrome, particularly among infants of mothers who smoke. The interaction between maternal smoking and bed sharing suggests that a mechanism involving passive smoking, rather than the previously proposed mechanisms of overlaying and hyperthermia, increases the risk of sudden infant death from bed sharing.

Adult↗
PubMed1993

Evaluation of the cot death prevention programme in South Auckland.

AIMS: The National Cot Death Prevention Programme aims to reduce the prevalence of four modifiable risk factors for cot death, namely infant sleeping prone, maternal smoking, lack of breast feeding and infant sharing a bed with another person. This study evaluated the knowledge of 200 mothers of infants in South Auckland and estimated the prevalence of these infant care practices, which were compared with that found in the New Zealand Cot Death Study. METHODS: 200 mothers were interviewed. RESULTS: The prevalence of these modifiable risk factors in this study and that found in 1987/89 in Auckland were: prone sleep position: 2.5% compared with 36.8%, p < 0.001; infant sharing a bed with another person: 23.5% and 45.2%, p < 0.001; maternal smoking: 24.0% and 26.1%, p = ns; lack of breast feeding at 4 weeks of age: 11.0% and 13.6%, p = ns. The following percentage of mothers knew that there were risk factors for cot death: prone sleep position 95.5%, maternal smoking 89.4%, lack of breast feeding 63.1% and infant sharing a bed with another person 68.0%. CONCLUSIONS: This study shows that infant care practices are changing and highlights the need for continuing efforts, especially relating to maternal smoking and the practice of infants sharing a bed with another person.

Beds↗
PubMed1993

Ethnic differences in mortality from sudden infant death syndrome in New Zealand.

OBJECTIVES: To examine the factors which might explain the higher mortality from sudden infant death syndrome in Maori infants (7.4/1000 live births in 1986 compared with 3.6 in non-Maori children). DESIGN: A large nationwide case control study. SETTING: New Zealand. 485 infants who died of sudden infant death syndrome were compared with 1800 control infants. There were 229 Maori and 240 non-Maori cases of sudden infant death syndrome (16 cases unassigned) and 353 Maori and 1410 non-Maori controls (37 unassigned). RESULTS: Maori infants had 3.81 times the risk (95% confidence interval 3.06 to 4.76) of sudden infant death syndrome compared with non-Maori infants. The risk factors for sudden infant death syndrome within groups were remarkably similar. When Maori and non-Maori controls were compared the prevalence of many of the known risk factors was higher in Maori infants. In particular, mothers were socioeconomically disadvantaged, younger, and more likely to smoke and their infants were of lower birth weight and more likely to share a bed with another person. Multivariate analysis controlling for potential confounders found that simply being Maori increased the risk of sudden infant death syndrome by only 1.37 (95% CI = 0.95 to 2.01), not statistically significantly different from 1. Population attributable risk was calculated for prone sleeping position, maternal smoking, not breast feeding, and infants sharing a bed with another person. In total these four risk factors accounted for 89% of deaths from sudden infant death syndrome in Maori infants and 79% in non-Maori infants. CONCLUSION: The high rate of sudden infant death syndrome among Maori infants is based largely on the high prevalence in the Maori population of the major risk factors. Other risk factors, not related to ethnicity, probably explain remaining differences between Maori and non-Maori children.

Birth Weight↗
PubMed1993

Breastfeeding and the risk of sudden infant death syndrome.

The New Zealand Cot Death Study, a multicentre case-control study, was set up to identify risk factors associated with sudden infant death syndrome (SIDS). In the 3 years of the study there were 485 infant deaths classified as SIDS in the study areas and 1800 infants who were randomly selected as controls. Data were collected by parent interviews and from obstetric notes. A full set of data for this analysis was available from 356 cases and 1529 control infants. The relationship between length of any breastfeeding and SIDS was examined: 92% of the controls were initially breastfed compared to 86% of the cases. As time went by, cases stopped breastfeeding sooner than controls: by 13 weeks, 67% controls were breastfed versus 49% cases. A reduced risk for SIDS in breastfed infants persisted during the first 6 months after controlling for confounding demographic, maternal and infant factors. Infants exclusively breastfed 'at discharge from the obstetric hospital' (odds ratio [OR] = 0.52, 95% confidence interval (CI): 0.35-0.71) and during the last 2 days (OR = 0.65, 95% CI: 0.46-0.91) had a significantly lower risk of SIDS than infants not breastfed after controlling for potential confounders. We have shown a substantial association of breastfeeding with a lowered risk for SIDS. This supports the need for more positive promotion and active community support to further enhance the level and length of exclusive breastfeeding.

Breast Feeding↗
PubMed1993

Dummies and the sudden infant death syndrome.

The association between dummy use and sudden infant death syndrome (SIDS) was investigated in 485 deaths due to SIDS in the postneonatal age group and compared with 1800 control infants. Parental interviews were completed in 87% of subjects. The prevalence of dummy use in New Zealand is low and varies within New Zealand. Dummy use in the two week period before death was less in cases of SIDS than in the last two weeks for controls (odds ratio (OR) 0.76, 95% confidence interval (CI) 0.57 to 1.02). Use of a dummy in the last sleep for cases of SIDS or in the nominated sleep for controls was significantly less in cases than controls (OR 0.44, 95% CI 0.26 to 0.73). The OR changed very little after controlling for a wide range of potential confounders. It is concluded that dummy use may protect against SIDS, but this observation needs to be repeated before dummies can be recommended for this purpose. If dummy sucking is protective then it is one of several factors that may explain the higher mortality from SIDS in New Zealand than in other countries, and may also explain in part the regional variation within New Zealand.

Case-Control Studies↗
PubMed1993

Smoking and the sudden infant death syndrome.

OBJECTIVE: Maternal smoking has been shown to be a risk factor for sudden infant death syndrome (SIDS). The effect of smoking by the father and other household members has not previously been examined. METHODS: A large nationwide case-control study. Four hundred eighty-five SIDS deaths in the postneonatal age group were compared with 1800 control infants. RESULTS: Infants of mothers who smoked during pregnancy had a 4.09 (95% confidence interval [CI] = 3.28, 5.11) greater risk of death than infants of mothers who did not smoke. Infants of mothers who smoked postnatally also had an increased risk of SIDS compared with infants of nonsmokers and, furthermore, the risk increased with increasing levels of maternal smoking. Smoking by the father and other household members increased the risk (odds ratio [OR] = 2.41, 95% CI = 1.92, 3.02 and OR = 1.54, 95% CI = 1.20, 1.99, respectively). Smoking by the father increased the risk of SIDS if the mother smoked, but had no effect if she did not smoke. In analyses controlled for a wide range of potential confounders, smoking by the mother and father was still significantly associated with an increased risk of SIDS. CONCLUSION: Passive tobacco smoking is causally related to SIDS.

Case-Control Studies↗