1,720,985 research outputs found
Obesity Management in Rural New Zealand General Practice from Healthcare Professional and Client Perspectives
Full text linkObesity is a health issue which currently affects over 34% of New Zealand (NZ) adults. Obesity, if left unchecked, leads to further physical and psychosocial health complications and an overall poor quality of life. People living in rural communities, high deprivation areas, as well as Indigenous Māori and Pacific Island populations in NZ, experience significant obesity health inequities and have a high-risk of developing obesity. General practice clinicians are positioned to be ‘best suited’ to deliver effective obesity healthcare in their practice, however, despite weight management intervention options being available through general practice, the obesity rates have continued to rise in the last 30 years. This suggests that there are potentially barriers to achieving a healthy weight in this context.
The aim of this research thesis is to understand the experiences with, and barriers to, effective obesity management in general practice from clinician and client perspectives to identify areas of improvement in the future.
This research thesis examines obesity healthcare in NZ general practice using a sequential explanatory mixed method research design in three parts. Firstly, a literature review study was conducted as a baseline point to identify the efficacy of any weight management interventions that are available in general practice. Secondly, a quantitative exploratory survey was conducted with Waikato region general practitioners (GP’s). Lastly, interviews with rural clinicians (GPs, nurses, and Indigenous Māori health professionals) and clients (patients engaging with rural general practice) were then conducted to understand the more in-depth perspectives of any barriers experienced with delivering, or engaging with, obesity management in general practice.
The experiences of both clinicians and clients were found to be complex and nuanced, with each participant having a unique experience with obesity management. Concepts such as effective yet inaccessible weight management interventions, interventions not suitable for sociocultural health needs, conflicting nutritional guidelines, lack of rural general practice systemic support, the unique and time consuming nature of obesity ‘treatment’, complications with the role of a clinician in obesity management, stigma or power imbalances in the general practice context, social determinants of health, the obesogenic environment, privatised weight management programmes and the individualised nature of sociocultural norms were found to be significant to effective obesity management.
This research thesis identified that the positioning of general practitioners as ‘best suited’ for delivering effective obesity healthcare in their practice was questionable. Potentially, the clinician role is better suited as a supportive one to an obesity health specialist who can meet the more holistic needs of a client when it comes to weight management. The current health model generates difficulties for clinicians to deliver comprehensive healthcare for such a complex and individualised health issue. Future research should look to develop weight management options that are suitable for rural and indigenous health needs to improve quality of life for clients and reduce health inequities. In addition, wider critical reflection on the current obesity healthcare model and the feasibility of a more specialist service outside general practice is warranted
Evaluating the effectiveness of an education group intervention on the psychological wellbeing of breast cancer patients
Full text linkBreast cancer (BC) is a significant health problem for New Zealand (NZ) women, with approximately 3,300 women diagnosed every year. Psychosocial distress is commonly associated with a BC diagnosis; 20-50% of women with BC will suffer from psychological distress within the first year after diagnosis. Distress is associated with less adherence to treatment; exacerbated preexisting psychological and psychiatric conditions; slower recovery from surgery and other treatment; and poor Quality of Life (QOL) and well-being. To treat distress, the Cancer Society of New Zealand, a local organisation that helps cancer patients, delivers a psychoeducational intervention called the Living Well (LW) programme. This programme deals with emotions, relaxation, perceptions, coping, self-care, and informs patients about their cancer, treatment and what to expect. Very little research has been done in NZ to assess the effectiveness of such programmes. To evaluate the effectiveness of the LW programme for individual BC patients, a repeated measures design was used to investigate the effect of the programme as measured by the Hospital Anxiety and Depression Scale (HADS), a screening tool commonly used to identify anxiety and depression in BC patients.
Stage I-II BC patients referred to the Cancer Society and enrolled in the LW programme were recruited for the study. HADS scores were collected and analysed weekly using a repeated measures design prior to, during and after the intervention (LW programme).
Analysis shows that the participants reacted similarly to the LW programme, as demonstrated by their HADS scores. Across all phases of the study (baseline, intervention and post-intervention) mean depression scores were lower than anxiety scores. During baseline mean anxiety scores were slightly higher, on average, than the intervention and post-intervention phases.
While no consistent systematic effect on well-being from attending the LW programme was found, psychosocial distress in the breast cancer patients recruited for the study was evident. Therefore, there is value and benefit to provide interventions, to aid women by providing information so that they are better informed, can develop improved coping strategies, and develop new avenues for social support
Epidemiological evidence that can help to improve timely diagnosis of colorectal cancer in New Zealand.
Full text linkIncidence rates of colorectal cancer (CRC) in New Zealand (NZ) are among the highest in the world. The long-term survival rates in NZ are poor, which has partially been attributed to late diagnosis. Considering that CRC is a curable disease if diagnosed early, conducting research targeted at the improvement of early diagnosis is therefore important. This thesis provides statistical models for the calculation of CRC incidence rates in the entire NZ population and population strata defined by age, gender, ethnicity and diabetes status, and a model for CRC risk in individual patients referred to the secondary care. The models presented here could assist health professionals in the selection of patients for further investigation to facilitate earlier diagnosis. The empirical part consists of three independent observational studies, briefly described below.
Sub-study 1. The objectives were, first, to describe trends in CRC incidence in the NZ population and, second, to investigate whether there are any strata defined by gender and ethnicity with especially increased incidence rates of CRC. To address these objectives, I analysed data from the New Zealand Cancer Registry (years 1994–2018) using an age- period-cohort (APC) model. The overall CRC incidence rates in NZ decreased between 1994 and 2018 by an average of 1.31% per year. However, the decrease was observed only in patients 50 years and older. In those 30-<50 years old, the incidence rates increased between 1994 and 2018 regardless of gender and ethnicity. The increase was similar for proximal, distal and rectal cancers. The APC analyses revealed very strong cohort effects that could explain nearly the entire trends in CRC incidence, pointing out generations born in the 1970s and 80s being affected by the increased incidence rates, rather than individuals 30-<50 years old. The cohort effects were different in Ma ̄ori and non-Ma ̄ori populations. In non-Ma ̄ori born between approximately 1939 and 1955, incidence rates decreased sharply. By contrast, those Ma ̄ori generations have not benefitted from the sharp decrease in rates. However, CRC incidence increased substantially in both M ̄aori and non-M ̄aori groups born in the 1970s and 80s.
Sub-study 2. The objective was to estimate the IRR for CRC in patients with diabetes compared to those without diabetes, with relation to diabetes duration and use of insulin for diabetes control. Registration in the Virtual Diabetes Register (VDR) in the years 2014–2018 was used as a marker of a diabetes diagnosis. Tables with counts of the entire NZ population stratified by age, gender, and ethnicity were obtained from Statistics NZ. In total, data from 310,710 patients with diabetes, corresponding to 1,277,284 person- years and 2512 incident CRC cases were analysed using a Poisson regression model. Diabetes was associated with an overall increased CRC incidence of 13% compared to non-diabetes [IRR=1.13 (95% CI: 1.08, 1.18)]. The IRR was especially high in the first three months after diabetes diagnosis [IRR=2.55 (95% CI 2.02, 3.21)], likely due to detection bias. The association was equally strong in males and females. However, in the analysis by ethnicity, the incidence of CRC was increased only in non-Ma ̄ori patients and restricted only to those younger than 75 years.
Sub-study 3. The objective was to develop a predictive model for CRC risk in individual patients referred to secondary care. To develop such a model, I extracted information from free text included in e-referrals from GPs’ to the Gastroenterology and General Surgery departments in the Waikato Hospital from 2015-2018, including: symptoms; test results; and family history of CRC. The reference test was a full colonoscopy with visualisation of the cecum. Data from 3015 patients, 20-<90 years old were analysed using a logistic regression model. The final model included the following predictors associated with increased CRC risk: anaemia, rectal bleeding, palpable mass in abdomen or rectum, weight loss, age and gender, and a decreased CRC risk: family history of CRC, abdominal pain, and inflammatory bowel disease. The model discriminates patients with low CRC risk well. According to the final cross-validated model, around 20% of patients from our cohort had performed colonoscopy despite a very low CRC risk (less than 1.5%).
In conclusion, the APC analysis revealed an alarming pattern. According to the fitted APC model, the combination of increasing age and cohort effect in generations born in the 1970s and 80s will bring a wave of CRC diagnoses in the near future when the young generations with high CRC incidence rates will replace the old generations with low CRC incidence. The results from this study could therefore help policy-makers to plan the needs for gastroenterology services.
Secondly, CRC incidence rates in diabetes have been found to be slightly increased com- pared to non-diabetes but only in non-Ma ̄ori individuals younger than 75 years.
Third, the results suggest that males underutilise health services. As shown in sub- study 3, males underwent fewer colonoscopies than females, despite having a higher risk of CRC. The higher detection bias in males than in females (sub-study 2) could also suggest underuse of health services by males, but the difference was not statistically significant.
Finally, based on the fitted models for CRC incidence in sub-studies 1 and 2, population- wide CRC screening for Ma ̄ori and patients with diabetes, based on the incidence, instead of age alone, would be proposed to start at age 57.5 years if the screening in the general population starts at age 60 years
An Investigation of the Health Benefits of Honey as a Replacement For Sugar In the Diet
No full textSugar (primarily sucrose) has been a part of the daily diet for literally hundreds of years, but research is now suggesting that sugar intake can be detrimental to our health. In particular, excessive consumption of simple sugars with high glycemic index (GI) values have been shown to cause overeating and weight gain. As well, elevated postprandial hyperglycemia can result after consuming sugars and this has been linked to disease formation and progression, the development of advanced glycation endproducts, inflammation and increased mortality rates. Honey has been recognised as having a number of beneficial health properties, including slower uptake into the bloodstream, a pharmacological action of reducing blood glucose levels and a high level of bioavailable antioxidants, all of which may mean that honey could be less harmful to health than sucrose in the diet. This study was therefore designed to investigate the health benefits of honey in the diet as a replacement for sucrose, using small animal studies. As well, because of the interest in using honey as a replacement for sucrose in sweetened dairy foods, a small number of in vitro investigations were carried out to determine whether honey could retain its bioactive properties when combined with milk/dairy products.
Using the in vitro studies, it was shown that the combination of milk with honey had no effect on either the antibacterial or antioxidant capabilities of honey. During the animal feeding studies a number of significant findings were observed. In the earlier work it was shown that honey had a significant effect on protein metabolism when fed for 14 days at a level of 600 g/kg diet (comprising 480 g sugars and 120 g water) compared with animals fed an equivalent amount of sucrose. In this study, honey-fed rats exhibited significantly lower weight gains (p less than 0.001), food intake (p less than 0.05) and nitrogen intakes (p less than 0.05) and significantly higher faecal nitrogen outputs (p less than 0.05) compared with sucrose-fed rats. Animals fed a diet consisting of 480 g/kg of mixed sugars as in honey generally exhibited protein metabolism parameters that were comparable to those of the sucrose-fed rats, suggesting that the effects of honey on protein metabolism were not due solely to its distinctive sugar composition.
Furthermore, in another study that specifically investigated the effects of honey on weight regulation, honey (100 g/kg diet) resulted in significantly reduced weight gain after 6 weeks (p less than 0.01) compared with animals fed the same amount of sugars as sucrose, although food intake was not reduced in this study. Percentage weight gains were shown to be comparable between honey-fed rats and those fed a sugar-free diet, suggesting that differences in glycemic control may be partly responsible for the results seen. Fasting lipid profiles and blood glucose levels were also measured in this study, but no significant differences were observed between diet groups.
During long-term (12 months) feeding weight gain was again significantly reduced in rats fed honey (p less than 0.05) and a sugar-free diet (p less than 0.01) compared with those fed sucrose, the weights of honey-fed rats and those fed the sugar-free diet being comparable at the end of the study. In addition, blood glucose levels were significantly lower (p less than 0.001), and HDL-cholesterol levels significantly higher (p less than 0.05) in animals fed honey compared with those fed sucrose after 52 weeks, but no differences in these parameters were observed between rats fed sucrose and a sugar-free diet. No other significant differences in lipid profiles were observed. Immunity measures were improved after feeding honey or sucrose for 52 weeks, animals in both of these diet groups having significantly higher levels of neutrophil phagocytosis compared with those fed the sugar-free diet (both p less than 0.0001). In addition, the percentage of leukocytes that were lymphocytes was significantly higher in honey-fed rats at the end of the study. Furthermore, levels of oxidative damage in aortic collagen were significantly reduced in rats fed honey or the sugar-free diet (both p less than 0.05) compared with those fed sucrose after 52 weeks.
Full body DEXA scans were also undertaken in this 12-month study to assess body fat levels and bone mineral composition and density, although they revealed few statistically significant differences. Percentage body fat levels were shown to be nearly 10% lower in honey-fed rats compared with sucrose-fed animals at the end of the study (p less than 0.05), but no other significant differences between diet groups were observed. With one exception, no differences in bone mineral composition or bone mineral density were observed between the three diet groups after 52 weeks. This data agreed with the results generated from two earlier studies that showed that feeding honey short-term (for 6-8 weeks) to rats that were either calcium-deficient or fed a low calcium diet had no effect on bone calcium levels, bone mineral content, bone mineral density or bone breaking parameters.
Lastly, long-term feeding of honey to rats had a number of statistically significant effects on anxiety and cognitive performance when assessed using animal maze tasks. Anxiety-like behaviour was significantly reduced in honey-fed rats overall compared with those fed sucrose (p = 0.056) or a sugar free diet (p less than 0.05). Spatial memory was also better in honey fed-rats throughout the 12 month study, these animals not displaying the same degree of age-related spatial memory loss seen in the other two diet groups. No significant differences in recognition memory or learning capability were observed between diet groups after 52 weeks.
In conclusion, both short-term and long-term feeding of honey result in a number of health benefits compared with eating similar amounts of sucrose. These include less weight gain, improved immunity, reduced levels of oxidative damage and improved cognitive performance.. These effects of honey are likely to occur through a number of different processes, although the presence of high concentrations of antioxidants and other minor components in honey are likely to be important contributors. Honey may therefore help to improve human heath if it is used as an alternative to sucrose in foods and beverages, although feeding studies in humans are required to assess its efficacy. In addition, more animal studies are needed to assess which features of honey (e.g. fructose content, antioxidant content and bioactivities) are required to achieve optimal effects, and to determine what impact heating and food processing may have on the beneficial health effects of honey
New Zealand breakfast cereals: are there sufficient low-sugar, low-sodium options?
Full text linkWe wish to respond to a letter by Gina Levy of Kellogg (Australia) Pty Ltd – Research and Technology, Australia entitled ‘The New Zealand breakfast cereal category is dynamic and responsive to consumer preferences’, published in Public Health Nutrition⁽¹⁾ in response to our published article ‘The nutritional quality of New Zealand breakfast cereals: an update’⁽²⁾. We thank the author for her interest in our publication and will respond to several of her comment
The long-term effects of feeding honey compared with sucrose and a sugar-free diet on weight gain, lipid profiles, and DEXA measurements in rats
No full textTo determine whether honey and sucrose would have differential effects on weight gain during long-term feeding, 45 2-mo-old Sprague Dawley rats were fed a powdered diet that was either sugar-free or contained 7.9% sucrose or 10% honey ad libitum for 52 wk (honey is 21% water). Weight gain was assessed every 1 to 2 wk and food intake was measured every 2 mo. At the completion of the study blood samples were removed for measurement of blood sugar (HbA1c) and a fasting lipid profile. DEXA analyses were then performed to determine body composition and bone mineral densities. Overall weight gain and body fat levels were significantly higher in sucrose-fed rats and similar for those fed honey or a sugar-free diet. HbA1c levels were significantly reduced, and HDL-cholesterol significantly increased, in honey-fed compared with rats fed sucrose or a sugar free diet, but no other differences in lipid profiles were found. No differences in bone mineral density were observed between honey- and sucrose-fed rats, although it was significantly increased in honey-fed rats compared with those fed the sugar-free diet
The effects of honey compared with sucrose and a sugar-free diet on neutrophil phagocytosis and lymphocyte numbers after long-term feeding in rats
No full textTo determine whether honey and sucrose would have differential effects on levels of neutrophil phagocytosis after long-term feeding 36 2-month old Sprague Dawley rats were fed a powdered diet that was either sugar-free or contained 7.9% sucrose or 10% honey (honey is 21% water) ad libitum for 52 weeks. The percent of neutrophils exhibiting phagocytosis, and the percentage of leukocytes that were lymphocytes were then measured by flow cytometry after 52 weeks. Results: Neutrophil phagocytosis was similar between sucrose- and honey-fed rats, and lower in rats fed the sugar-free diet (79.2%, 74.7% and 51.7 %, respectively). The percentage of leukocytes that were lymphocytes differed significantly between all three treatments, the levels being highest in honey-fed rats (53% vs 40.1% and 29.5% for sucrose- and sugar-free fed rats). In conclusion: Honey may have a beneficial effect on immune activity, possibly attenuating the decline seen in older age
Metaheuristic optimization of insulin infusion protocols using historical data with validation using a patient simulator
Full text linkMetaheuristic search algorithms are used to develop new protocols for optimal intravenous insulin infusion rate recommendations in scenarios involving hospital in-patients with Type 1 Diabetes. Two metaheuristic search algorithms are used, namely, Particle Swarm Optimization and Covariance Matrix Adaption Evolution Strategy. The Glucose Regulation for Intensive Care Patients (GRIP) serves as the starting point of the optimization process. We base our experiments on a methodology in the literature to evaluate the favorability of insulin protocols, with a dataset of blood glucose level/insulin infusion rate time series records from 16 patients obtained from the Waikato District Health Board. New and significantly better insulin infusion strategies than GRIP are discovered from the data through metaheuristic search. The newly discovered strategies are further validated and show good performance against various competitive benchmarks using a virtual patient simulator
[Letter to the Editor] Sugar-sweetened beverages: still cause for concern in New Zealand and Australia
Full text linkWe would like to respond to the letter submitted to Public Health Nutrition by Ms Rich of the Food and Grocery Council of New Zealand(1) in response to our article ‘The nutritional content of supermarket beverages: a cross sectional analysis of New Zealand, Australia, Canada and the UK’ (2)
Added sugar in packaged/processed fruit and vegetable products
Full text linkBoth Type 2 Diabetes Mellitus (T2DM) and prediabetes are prevalent in New Zealand affecting approximately 7% and 26% of adults, respectively. ¹ Dietary recommendations for both groups include consuming less sugar in an attempt to improve glycemic control. Fruits and vegetables are generally considered to be a healthy option, although a recent survey of New Zealand supermarket foods suggest that processed foods dominate the marketplace and that the majority of these foods contain added sugars. ² Further, processed fruit and vegetable-based products have been shown to be ‘less healthy’ than those that are minimally processed, ² though the levels of added sugars in these products has not been quantified. Thus, our study aimed to evaluate the sugar content of commonly consumed, processed/packaged fruit and vegetable products available in New Zealand supermarkets
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