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Biomedical subjects

Ed A Mitchell

Publications and source records attributed to Ed A Mitchell.

14 recordsLinked to original sources
PubMed2005

Teenage use of GP care for moderate to severe asthma in Auckland, New Zealand.

OBJECTIVES: To describe and understand teenagers' frequency of attendance for General Practitioner (GP) care of moderate to severe asthma in the Auckland region. METHODS: Ten Auckland schools identified 510 children aged 13-14 years with breathing problems, who were invited to complete a screening questionnaire. 271 children participated, of whom 114 had moderate to severe asthma. RESULTS: 39% of the 114 had made 0-1 GP visit for asthma, and 17% made 'greater than and equal to' 5 visits. Low attendees (0-1 visit) were disproportionately New Zealand European. High attendees ('greater than and equal to' 5 visits) tended to be Maori and/or Pacific Islanders. Half of the teenagers attended GP asthma care as often as it wanted, independently of ethnicity; 62% tell their parents when they cannot manage their asthma; and 29% must pay for GP care. Expected attendance was increased for Maori and Pacific students versus others by 77% (p=0002), and by asthma of increased severity (p<0.001). Teenager resistance to accessing GP asthma care reduced expected attendance by 24% (p=0.003). CONCLUSIONS: Maori and Pacific peoples have traditionally faced barriers to accessing GP care, but their their more frequent attendance (than New Zealand Europeans) in this case, challenges whether such barriers persist, at least for acute care of moderate to severe asthma.

Adolescent↗
PubMed2005

Pulmonary aspiration of gastric contents and the sudden infant death syndrome.

OBJECTIVE: To determine ante-mortem and post-mortem risk factors for the finding of gastric contents in pulmonary airways (aspiration of gastric contents) at post-mortem examination in the sudden infant death syndrome (SIDS). METHODS: There were 217 post-neonatal deaths in the Auckland region of the New Zealand Cot Death Study. No deaths were certified as due to aspiration of gastric contents. There were 138 SIDS cases. The parents of 110 (80%) of these cases were interviewed. Histological sections from the periphery of the lungs in 99 of the 110 cases were reviewed for evidence of aspiration of gastric contents. A wide range of variables were analysed in SIDS cases with and without aspiration to determine risk factors. RESULTS: Aspiration of gastric contents was identified in 37 (37%) of SIDS cases. Aspiration was of mild-to-moderate degree and in no case was severe and a potential cause of death. Finding infants on their backs at death (P = 0.024) and conducting the post-mortem on the day after the death or subsequently (P = 0.033) were statistically significant variables linked to identification of aspiration. Position placed to sleep, symptoms of gastro-oesophageal reflux and other variables were not related to aspiration. CONCLUSIONS: The only determinants for aspiration of gastric contents identified were agonal or post-mortem events, supporting the contention that aspiration has limited relevance to the mechanism of SIDS.

Asphyxia↗
PubMed2005

Clinical manifestations of a unique X-linked retinal disorder in a large New Zealand family with a novel mutation in CACNA1F, the gene responsible for CSNB2.

PURPOSE: To describe the phenotype in a New Zealand family with an unusual severe X-linked retinal disorder with a novel I745T mutation in CACNA1F, the gene responsible for incomplete congenital stationary night blindness (CSNB2). METHODS: Members of the family tree were invited for clinical, psychophysical and electrodiagnostic evaluation. RESULTS: Male family members had severe non-progressive visual impairment, abnormal colour vision, congenital nystagmus, hyperopia and normal fundi. Some were intellectually disabled. Female family members had congenital nystagmus and decreased visual acuity frequently associated with high myopia. Electroretinograms (ERG) identified reduced rod and cone responses with negative waveform in male and female family members, with atypical features for CSNB2. CONCLUSIONS: Although there were similarities to CSNB2, distinctive features in male family members included severity of phenotype, and association of intellectual disability. Moreover, all female heterozygotes had clinical and ERG abnormalities. CACNA1F encodes the Ca(v)1.4 alpha1 subunit of a voltage-gated calcium channel, which may mediate neurotransmitter release from photoreceptors. Molecular analyses, reported separately, identified a novel I745T CACNA1F mutation that was associated in vitro with major alterations in gating and kinetics of the Ca(v)1.4 channel. It is speculated that the unique phenotype described in this family may reflect similarly altered function of Ca(v)1.4 channel activity in vivo.

Adolescent↗
PubMed2005

Modifiable risk factors for SIDS in Germany: results of GeSID.

BACKGROUND: The incidence of sudden infant death syndrome (SIDS) has been falling in Germany over the last decade. However, little is known about the prevalence and the importance of well-known risk factors in Germany since a local prevention campaign in 1992. DESIGN: A 3-y, population-based, case-control study was conducted in half of Germany, consisting of 333 cases. All sudden and unexpected deaths in infancy, if they fitted the inclusion criteria, were included in the study. Parental interview was carried out soon after the death, and three living control infants, matched for age, gender, region and sleep time, were recruited. RESULTS: The prevalence of placing infants prone to sleep was only 4% in the control group, but this was associated with a markedly increased risk of SIDS (adjusted odds ration, aOR=6.08). Other modifiable risk factors for SIDS were: maternal smoking during pregnancy, breastfeeding for less than 2 wk (aOR=1.71) and co-sleeping (aOR=2.71), while using a pacifier during the last sleep reduced the risk (aOR=0.39). CONCLUSIONS: Previously recognized risk factors for SIDS also occur in Germany. Despite knowledge about the major modifiable risk factors for SIDS, these factors are still present in Germany. To reduce the incidence of SIDS in Germany, a continued effort is needed to inform all parents about preventable risk factors for SIDS.

Adult↗
PubMed2005

Quantification of plagiocephaly and brachycephaly in infants using a digital photographic technique.

OBJECTIVES: The aims of the study were: (1) to develop a technique to quantify plagiocephaly that is safe, accurate, objective, easy to use, well tolerated, and inexpensive; and (2) to compare this method with tracings from a flexicurve ruler. DESIGN: A case-control study of 31 case infants recruited from outpatient plagiocephaly clinics and 29 control infants recruited from other pediatric outpatient clinics. PARTICIPANTS: Infants in the study had been diagnosed with nonsynostotic plagiocephaly or brachycephaly and were between 2 and 12 months old. INTERVENTIONS: Infants' head shapes were measured using (a) digital photographs of a head circumference band and (b) a flexicurve ruler. Flexicurve tracings were scanned, and both the digital photos and the scanned flexicurve tracings were analyzed using a custom-written computer program. MAIN OUTCOME MEASURES: The oblique cranial length ratio was used to quantify cranial asymmetry, and the cephalic index was used to quantify the degree of brachycephaly. RESULTS: The infants tolerated the photo technique better than the flexicurve. Also, mothers preferred the photo technique. There was less within-subject variance for the photos than for the flexicurve measurements. The results suggested that an oblique cranial length ratio of >or= 106% can define plagiocephaly and that a cephalic index of >or= 93% can define brachycephaly. CONCLUSIONS: The photographic technique was better accepted and more repeatable than the flexicurve measuring system. We propose that "normal" head shape is indicated in infants with both an oblique cranial length ratio of less than 106% and a cephalic index of less than 93%.

Case-Control Studies↗
PubMed2004

Causes of late fetal death in New Zealand 1980-1999.

BACKGROUND: In recent years there has been an emerging interest in sudden unexplained intrauterine death. AIMS: To determine the major causes of late fetal death (LFD) in New Zealand during 1980-1999 and to document the proportion of deaths considered unexplained. In addition, to quantify the number of LFD undergoing post-mortem during this period. METHODS: Using the Office for National Statistics (UK) hierarchical classification system, all information available on death certificates was used to assign a single cause to LFD for the period 1980-1999. Trends were analysed using logistic regression and risk factor profiles established for each cause of death. Post-mortem rates and the characteristics of those failing to undergo post-mortem were analysed for the period 1989-1999. RESULTS: LFD rates declined from 60.1 per 10 000 in 1980-1981 to 30.5 in 1998-1999. The declines were not uniform across all causes, with intrapartum deaths declining 73%, congenital anomalies 70% and antepartum asphyxia 50%. In contrast, unspecified deaths increased 1%, and with the decline in other causes of death, also increased proportionally, from 10.8% of LFD in 1980-81 to 28.1% in 1998-1999. Post-mortem rates fell by 31% during 1989-1999, with Maori and Pacific babies and those in more deprived New Zealand Deprivation Index areas being significantly less likely to undergo post-mortem. CONCLUSIONS: While total LFD rates declined significantly during 1980-1999, rates of unspecified LFD remained static. Low post-mortem rates, however, suggest that many of these deaths may be uninvestigated rather than truly unexplained. Nevertheless, the persistence of a category of death which, to date, has failed to improve with advances in obstetric technology suggests that further measures are necessary if New Zealand's LFD rates are to continue to decline.

Adult↗
PubMed2004

Ethnicity and birth outcome: New Zealand trends 1980-2001. Part 1. Introduction, methods, results and overview.

BACKGROUND: New Zealand Government policy during the past decade has placed a high priority on closing socioeconomic and ethnic gaps in health outcome. AIM: To analyse New Zealand's trends in preterm and small for gestational age (SGA) births and late fetal deaths during 1980-2001 and to undertake ethnic specific analyses, resulting in risk factor profiles, for each ethnic group. METHODS: De-identified birth registration data from 1 189 120 singleton live births and 5775 stillbirths were analysed for the period 1980-2001. Outcomes of interest included preterm birth, SGA and late fetal death while explanatory variables included maternal ethnicity, age and New Zealand Deprivation Index decile. Trend analysis was undertaken for 1980-1994 while multivariate logistic regression was used to explore risk factors for 1996-2001. RESULTS: During 1980-1994, preterm birth rates were highest amongst Maori women. Preterm rates increased by 30% for European/other women, in contrast to non-significant declines of 7% for Maori women and 4% for Pacific women during this period. During the same period, rates of SGA were highest amongst Maori women. Rates of SGA declined by 30% for Pacific women, 25% for Maori women and 19% for European/other women during this period. Rates of late fetal death were highest amongst Pacific women during 1980-1994, but declined by 49% during this period, the rate of decline being similar for all ethnic groups. CONCLUSIONS: The marked differences in both trend data and risk factor profiles for women in New Zealand's largest ethnic groups would suggest that unless ethnicity is specifically taken into account in future policy and planning initiatives, the disparities seen in this analysis might well persist into future generations.

Birth Rate↗
PubMed2004

Ethnicity and birth outcome: New Zealand trends 1980-2001: Part 2. Pregnancy outcomes for Maori women.

BACKGROUND: While traditionally Maori perinatal mortality has been similar to that of other ethnic groups, rates of preterm birth, small for gestational age (SGA) and teenage pregnancy have remained high. AIMS: To review current trends in preterm birth, SGA and teenage pregnancy for Maori during 1980-2001 and to highlight the major factors that have influenced Maori reproductive outcomes during this period. METHODS: De-identified birth registration data from 1 189 120 singleton live births and 5775 stillbirths were analysed for 1980-2001. Outcomes of interest included preterm birth, SGA and late fetal death while explanatory variables included maternal ethnicity, age and NZ Deprivation Index decile. Trend analysis was undertaken for 1980-1994 and multivariate logistic regression was used to explore risk factors for 1996-2001. RESULTS: During 1980-1994, Maori women had the highest preterm birth rates of any ethnic group in New Zealand, but in relative terms, inequalities declined as a consequence of a non-significant 7% fall in rates being offset by a statistically significant 30% increase for the European/other ethnic group. Rates of SGA were also higher amongst Maori women but declined by 25% during the 1980-1994 period. In addition, Maori women experienced significant socioeconomic gradients in SGA, with risk for Maori women in the most deprived NZDep areas being double that of Maori living affluent areas. Paradoxically, while Maori women had high rates of teenage pregnancy, this did not confer additional risk for preterm birth or SGA during the 1996-2001 period. CONCLUSIONS: While high rates of teenage pregnancy amongst Maori women appear not to confer additional risk for preterm birth or SGA, the social consequences of early childbearing may well be significant. The persistence of elevated rates of preterm birth and large socioeconomic gradients in SGA amongst Maori suggest that broader social and policy interventions are necessary if Maori are to achieve optimal birth outcomes in the coming decades.

Adolescent↗
PubMed2004

Ethnicity and birth outcome: New Zealand trends 1980-2001: Part 3. Pregnancy outcomes for Pacific women.

BACKGROUND: Pacific women in New Zealand reside in areas of higher socioeconomic deprivation compared to women from other ethnic groups. Pacific women and their health are further disadvantaged because of genetic predisposition and sociocultural factors that cause ill-health. The correlations between pregnancy outcomes, risk factors and other health indices in Pacific women need evaluation. AIMS: To examine trends in preterm birth, small for gestational age (SGA) and late fetal death for Pacific women during 1980-2001 and to explore risk factors which make this group vulnerable to adverse birth outcome. METHODS: De-identified birth registration data from 1 189 120 singleton live births and 5775 stillbirths were analysed for 1980-2001. Outcomes of interest included preterm birth, SGA and late fetal death while explanatory variables included maternal ethnicity, age and NZ Deprivation Index decile. Trend analysis was undertaken for 1980-1994 and multivariate logistic regression was used to explore risk factors for 1996-2001. RESULTS: Pacific women had the lowest rates of preterm birth and SGA when compared to Maori and European women. In addition, preterm birth rates underwent a non-significant 4% decline and SGA rates a 30% decline during 1980-1994. Although there has been a 49% decline in late fetal deaths during 1980-1994, the rate remained higher for Pacific women than for Maori and European/other women. CONCLUSIONS: Despite residing in areas of high socioeconomic deprivation, which is associated with poor pregnancy outcomes for Maori and European/other women, Pacific women had better pregnancy outcomes, with lower preterm and SGA rates. The significant decline in rates of late fetal death during the past two decades is a cause for celebration; however, the rate remains higher for Pacific women than for other ethnic groups. Biological, cultural and social factors might explain the better pregnancy outcomes for Pacific women and these factors should be considered when developing future prevention programmes.

Adolescent↗
PubMed2004

Ethnicity and birth outcome: New Zealand trends 1980-2001: Part 4. Pregnancy outcomes for European/other women.

BACKGROUND: In the early 1980s European/other women made up 80% of New Zealand's population and experienced rates of preterm birth that were lower than for other ethnic groups. Rates of small for gestational age (SGA) and late fetal death were intermediate between those of Maori and Pacific women. AIMS: To examine trends in preterm birth, SGA and late fetal death for European/other women during 1980-2001 and to explore risk factors which make this group vulnerable to adverse birth outcome. METHODS: De-identified birth registration data from 1 189 120 singleton live births and 5775 stillbirths were analysed for 1980-2001. Outcomes of interest included preterm birth, SGA and late fetal death while explanatory variables included maternal ethnicity, age and NZ Deprivation Index decile. Trend analysis was undertaken for 1980-1994 and multivariate logistic regression was used to explore risk factors for 1996-2001. RESULTS: During 1980-1994, rates of preterm birth rose by 30% for European/other women, in contrast to a non-significant decline of 7% for Maori women and 4% for Pacific women. Rates of SGA declined 19% for European/other women, compared to 25% for Maori and 30% for Pacific women. Preterm birth and SGA were positively associated with teenage pregnancy and increasing NZDep deprivation. During 1980-1994, rates of late fetal death declined by 49%, with declines being similar for all ethnic groups. CONCLUSIONS: The progressive rise in preterm birth during the past two decades is a cause of concern for European/other women, particularly as it appears confined to this ethnic group. While rates of SGA have declined, albeit at a slower rate than for other ethnic groups, the elevated risk amongst teenagers and those living in the more deprived NZDep areas suggests that greater gains are achievable if interventions are targeted towards these particular groups.

Adolescent↗
PubMed2004

Plagiocephaly and brachycephaly in the first two years of life: a prospective cohort study.

OBJECTIVES: Although referrals for nonsynostotic plagiocephaly (NSP) have increased in recent years, the prevalence, natural history, and determinants of the condition have been unclear. The objective of this study was to assess the prevalence and natural history of NSP in normal infants in the first 2 years of life and to identify factors that may contribute to the development of NSP. METHODS: Two hundred infants were recruited at birth. At 6 weeks, 4 months, 8 months, 12 months, and 2 years, the head circumference shape was digitally photographed, and head shape was quantified using custom-written software. At each age, infants were classified as cases when the cephalic index was > or =93% and/or the oblique cranial length ratio was > or =106%. Neck rotation and a range of infant, infant care, socioeconomic, and obstetric factors were assessed. RESULTS: Ninety-six percent of infants were followed to 12 months, and 90.5% were followed to 2 years. Prevalence of plagiocephaly and/or brachycephaly at 6 weeks and 4, 8, 12, and 24 months was 16.0%, 19.7%, 9.2%, 6.8%, and 3.3% respectively. The mean cephalic index by 2 years was 81.6% (range: 72.0%-102.6%); the mean oblique cranial length ratio was 102.6% (range: 100.1%-109.4%). Significant univariate risk factors of NSP at 6 weeks include limited passive neck rotation at birth, preferential head orientation, supine sleep position, and head position not varied when put to sleep. At 4 months, risk factors were male gender, firstborn, limited passive neck rotation at birth, limited active head rotation at 4 months, supine sleeping at birth and 6 weeks, lower activity level, and trying unsuccessfully to vary the head position when putting the infant down to sleep. CONCLUSIONS: There is a wide range of head shapes in infants, and prevalence of NSP increases to 4 months but diminishes as infants grow older. The majority of cases will have resolved by 2 years of age. Limited head rotation, lower activity levels, and supine sleep position seem to be important determinants.

Beds↗
PubMed2003

Determinants of nonsynostotic plagiocephaly: a case-control study.

OBJECTIVE: There has been a large increase in reported cases of nonsynostotic plagiocephaly in infants since the adoption of supine sleeping recommendations to prevent sudden infant death syndrome. The objective of this study was to identify and quantify the determinants of nonsynostotic plagiocephaly in infants. METHODS: One hundred infants who received a diagnosis of having nonsynostotic plagiocephaly were recruited as case patients and compared with 94 control subjects who were selected from a citywide database of infants. The infants all were aged between 2 and 12 months. Information concerning sociodemographic variables, obstetric factors, infant factors, and infant care practices was obtained by parental interview. RESULTS: Case patients were significantly more likely to be male (adjusted odds ratio [aOR]: 2.51; 95% confidence interval [CI]: 1.23-5.16), to be a firstborn (aOR: 2.94; 95% CI: 1.46-5.96), and to have been premature (aOR: 3.26; 95% CI: 1.02-10.47). In the first 6 weeks, they were more likely to have been sleeping in the supine position (aOR: 7.02; 95% CI: 2.98-16.53), not to have had the head position varied when put down to sleep (aOR: 7.11; 95% CI: 2.75-18.37), and to have had <5 minutes a day of tummy time (OR: 2.26; 95% CI: 1.03-5.00). Mothers of case patients were more likely to perceive their infants as less active (aOR: 3.23; 95% CI: 1.38-7.56), to have a developmental delay (aOR: 3.32; 95% CI: 1.01-10.85), and to have had a definite preferred head orientation at 6 weeks (aOR: 37.46; 95% CI: 8.44-166.32). Case mothers were more likely to have no or low educational qualifications (aOR: 5.61; 95% CI: 2.02-15.56), although they were more likely to have attended antenatal classes (aOR: 6.61; 95% CI: 1.59-27.47). CONCLUSIONS: Early identification of a preferred head orientation, which may indicate the presence of neck muscle dysfunction, may help prevent the development or further development of nonsynostotic plagiocephaly in infants. Plagiocephaly might also be prevented by varying the head position when putting the very young infant down to sleep and by giving supervised tummy time when awake.

Case-Control Studies↗