Childhood body mass index and endothelial dysfunction evaluated by peripheral arterial tonometry in early midlife.

BACKGROUND/OBJECTIVES: Endothelial dysfunction predicts mortality but it is unknown whether childhood obesity predicts adult endothelial dysfunction. The aim of this study was to determine whether anthropometric indices of body fat in childhood, adolescence and early midlife are associated with endothelial dysfunction in early midlife. SUBJECTS/METHODS: Participants belonged to a representative birth cohort of 1037 individuals born in Dunedin, New Zealand in 1972 and 1973 and followed to age 38 years, with 95% retention (the Dunedin Multidisciplinary Health and Development Study). We assessed anthropometric indices of obesity at ages 3, 5, 7, 9, 11, 13, 15, 18, 21, 26, 32 and 38 years. We tested associations between endothelial function assessed by peripheral arterial tonometry (PAT) at age 38 and; age 38 cardiovascular risk factors; age 3 body mass index (BMI); and four BMI trajectory groups from childhood to early midlife. RESULTS: Early midlife endothelial dysfunction was associated with BMI, large waist circumference, low high-density lipoprotein cholesterol, low cardiorespiratory fitness and increased high-sensitivity C-reactive protein. After adjustment for sex and childhood socioeconomic status, 3-year-olds with BMI 1 s.d. above the mean had Framingham-reactive hyperemia index (F-RHI) ratios that were 0.10 below those with normal BMI (ß=-0.10, 95% confidence interval (CI) -0.17 to -0.03, P=0.007) at age 38. Cohort members in the 'overweight', 'obese' and 'morbidly obese' trajectories had F-RHI ratios that were 0.08 (ß=-0.08, 95% CI -0.14 to -0.03, P=0.003), 0.13 (ß=-0.13, 95% CI -0.21 to -0.06, P<0.001) and 0.17 (ß=-0.17, 95% CI -0.33 to -0.01, P=0.033), respectively, below age-peers in the 'normal' trajectory. CONCLUSIONS: Childhood BMI and the trajectories of BMI from childhood to early midlife predict endothelial dysfunction evaluated by PAT in early midlife.

How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment.

BACKGROUND: Most information about the lifetime prevalence of mental disorders comes from retrospective surveys, but how much these surveys have undercounted due to recall failure is unknown. We compared results from a prospective study with those from retrospective studies. METHOD: The representative 1972-1973 Dunedin New Zealand birth cohort (n=1037) was followed to age 32 years with 96% retention, and compared to the national New Zealand Mental Health Survey (NZMHS) and two US National Comorbidity Surveys (NCS and NCS-R). Measures were research diagnoses of anxiety, depression, alcohol dependence and cannabis dependence from ages 18 to 32 years. RESULTS: The prevalence of lifetime disorder to age 32 was approximately doubled in prospective as compared to retrospective data for all four disorder types. Moreover, across disorders, prospective measurement yielded a mean past-year-to-lifetime ratio of 38% whereas retrospective measurement yielded higher mean past-year-to-lifetime ratios of 57% (NZMHS, NCS-R) and 65% (NCS). CONCLUSIONS: Prospective longitudinal studies complement retrospective surveys by providing unique information about lifetime prevalence. The experience of at least one episode of DSM-defined disorder during a lifetime may be far more common in the population than previously thought. Research should ask what this means for etiological theory, construct validity of the DSM approach, public perception of stigma, estimates of the burden of disease and public health policy.

The validity of the family history screen for assessing family history of mental disorders.

There is a need to collect psychiatric family history information quickly and economically (e.g., for genome-wide studies and primary care practice). We sought to evaluate the validity of family history reports using a brief screening instrument, the Family History Screen (FHS). We assessed the validity of parents' reports of seven psychiatric disorders in their adult children probands from the Dunedin Study (n = 959, 52% male), using the proband's diagnosis as the criterion outcome. We also investigated whether there were informant characteristics that enhanced accuracy of reporting or were associated with reporting biases. Using reports from multiple informants, we obtained sensitivities ranging from 31.7% (alcohol dependence) to 60.0% (conduct disorder) and specificities ranging from 76.0% (major depressive episode) to 97.1% (suicide attempt). There was little evidence that any informant characteristics enhanced accuracy of reporting. However, three reporting biases were found: the probability of reporting disorder in the proband was greater for informants with versus without a disorder, for female versus male informants, and for younger versus older informants. We conclude that the FHS is as valid as other family history instruments (e.g., the FH-RDC, FISC), and its brief administration time makes it a cost-effective method for collecting family history data. To avoid biasing results, researchers who aim to compare groups in terms of their family history should ensure that the informants reporting on these groups do not differ in terms of age, sex or personal history of disorder.

Improving rates of overweight, obesity and extreme obesity in New Zealand 4-year-old children in 2010-2016.

BACKGROUND: Prevalence of childhood obesity is high in developed countries, and there is a growing concern regarding increasing socio-economic disparities. OBJECTIVES: To assess trends in the prevalence of overweight, obesity and extreme obesity among New Zealand 4-year olds, and whether these differ by socio-economic and ethnic groupings. METHODS: A national screening programme, the B4 School Check, collected height and weight data for 75-92% of New Zealand 4-year-old children (n = 317 298) between July 2010 and June 2016. Children at, or above, the 85th, 95th and 99.7th percentile for age and sex adjusted body mass index (according to World Health Organization standards) were classified as overweight, obese and extremely obese, respectively. Prevalence rates across 6 years (2010/11 to 2015/16) were examined by sex, across quintiles of socio-economic deprivation, and by ethnicity. RESULTS: The prevalence of overweight, obesity and extreme obesity decreased by 2.2 [95% CI, 1.8-2.5], 2.0 [1.8-2.2] and 0.6 [0.4-0.6] percentage points, respectively, between 2010/2011 and 2015/2016. The downward trends in overweight, obesity and extreme obesity in the population persisted after adjustment for sex, ethnicity, deprivation and urban/rural residence. Downward trends were also observed across sex, ethnicity and deprivation groups. CONCLUSIONS: The prevalence of obesity appears to be declining in 4-year-old children in New Zealand across all socio-economic and ethnic groups.

Cost-effectiveness of a worksite hypertension treatment program.

The cost-effectiveness of treating hypertension at the patient's place of work was compared in a randomized controlled trial with care delivered in a community. The average total cost per patient for worksite care in this 12-month study was not significantly different from that for regular care ($242.86 +/- 6.94 vs $211.34 +/- 18.66, mean +/- SEM). The worksite health system cost was significantly more expensive ($197.36 +/- 4.99 vs $129.33 +/- 13.34, p less than 0.001) but the patient cost was significantly less ($45.40 +/- 3.23 vs $82.00 +/- 6.20, p less than 0.01). The mean reduction in diastolic blood pressure (BP) at the year-end assessment was significantly greater in the worksite group (12.1 +/- 0.6 vs 6.5 +/- 0.6 mm Hg, p less than 0.001). The incremental cost-effectiveness ratio of $5.63 per mm Hg for worksite care was less than the base cost-effectiveness ratio of $32.51 per mm Hg for regular care, indicating that the worksite program was substantially more cost-effective. Our findings support health policies that favor allocating resources to work-based hypertension treatment programs for the target group identified in this study.

Clinical effectiveness and cost-effectiveness of monitoring blood pressure of hypertensive employees at work.

In this randomized controlled trial, the value of using occupational health nurses (OHNs) to monitor the care of hypertensive employees at work was compared with regular care (RC) delivered in the community. One year after entry, the blood pressure level, medication history, compliance with treatment, and cost of hypertensive care of the participants were determined by independent evaluators. The reduction in diastolic blood pressure (DBP), the measure of effectiveness, was 10.5 +/- 1.1 mm Hg (mean +/- SEM) in the OHN group and 7.7 +/- 1.1 mm Hg in the RC group, and the proportion under good blood pressure control was 41.8% and 31.0% respectively. These between-group differences were not statistically significant. Although the employees in the OHN group were more medicated and had a lower treatment dropout rate, neither difference was statistically significant. In addition, the proportion of employees who were compliant with prescribed medication was virtually identical in both groups. The cost of the care received by employees in the OHN group of $ 404.14 for the year was substantially higher than that of $ 250.15 in the RC group with the difference principally related to the cost of visiting the OHNs and a significant difference in drug cost (p less than 0.006). The incremental cost-effectiveness (C/E) ratio of $ 53.67 per mm Hg DBP reduction per year for onsite blood pressure monitoring was higher than the base C/E ratio of $ 32.65 per mm Hg for regular care. Our findings indicate that monitoring the blood pressure of hypertensive employees at work is neither clinically effective nor cost-effective.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of patient 'familiarity' with blood pressure assessment on the accuracy of follow-up readings.

The fall in blood pressure that is commonly observed when groups of hypertensive individuals are followed without treatment is usually ascribed to two sources: regression towards the mean and increasing familiarity of the subject with the assessment process. Any effect of the latter process could bias the results of controlled studies in which one group is more frequently assessed than the other, a common situation in community trials. To assess the effect of familiarity, we randomly allocated 116 untreated, mildly hypertensive subjects to three-monthly or yearly assessments. At an independent, blind, year end assessment, both groups showed statistically significant reductions in diastolic blood pressure (P less than 0.001) of 8.4 +/- 1.2 (s.e.m.) and 7.6 +/- 1.6 mmHg respectively, but the difference between the groups was not significant (P = 0.682). We conclude that 'familiarity' does not play an important role in the reduction of blood pressure in long-term follow-up studies of hypertensive subjects.

Post-tubal sterilization problems correlated with ovarian steroidogenesis.

Mid-luteal phase total urinary oestrogen excretion was found to be significantly reduced in women who had previously undergone tubal sterilization at least two years before assay; pregnanediol levels at or below 2.0 mg/24 hrs were significantly more frequent for the study group. These findings indicate that reduced ovarian function is associated with that procedure. The major problems declared as having been experienced subsequent to tubal sterilization were classified into three categories; some women declared problems in more than one category: (1) Abnormal uterine bleeding and/or menorrhagia, (2) Physical problems, (3) Psychological and/or psychiatric problems. Category 1 was associated with a significant fall in total oestrogen excretion, and category 2 with a significant fall in both total oestrogen and pregnanediol excretion. Analysis of category 3 will be published elsewhere. A negative correlation between total oestrogens and cholesterol was observed.

PIP: Mid-luteal phase total urinary estrogen excretion and pregnanediol levels were monitored in 112 self-selected, regularly menstruating women who had been sterilized 2 or more years before, and compared to 55 controls. The controls had neither used contraception or ovulation identification methods within 3 months, nor had they had gynecologic surgery. The mean total estrogen excretion of the study subjects was significantly lower than that of the controls, 29.6 vs 36.0 mcg/24 hours (p0.0001). When the data were presented as histograms, 25% of the study group had estrogen means below the 10 percentile value for controls. The histograms were skewed to the right for both groups. Results for pregnanediol analyzed in the same way did not differ significantly, although 23.4% did have pregnanediol excretion below the 10 percentile level controls. The study subjects were categorized into 3 groups: those with abnormal uterine bleeding, physical problems, and psychological problems. Some other observations included the negative correlation between estrogen and pregnanediol excretion and serum cholesterol levels; as association of low estrogen with abnormal menstrual bleeding; and an association of low estrogen and pregnanediol with physical problems. The authors suggested a theory of localized hypertension and tissue damage to explain poor ovarian function in these sterilized women. Female hormone production has been linked with some of the problems found in these groups, such as weight gain, osteochrondritis,gastritis, irritable bowel syndrome, dysmenorrhagia and breast adenosis.

A longitudinal study of the etiology of separation anxiety.

A longitudinal examination of the relation between separation experiences and the development of separation anxiety at age 3, 11 and 18 years was conducted. Three associative pathways were assessed. Conditioning events were not related to separation anxiety at age 3. Vicarious learning (modelling) in middle childhood (age 9 years) was the conditioning variable most strongly related to separation anxiety at age 11, accounting for 1.8% of the variance in symptoms. Separation experiences (hospitalisations) before the age of 9 were inversely correlated with separation anxiety at age 18. That is, more overnight hospital stays in childhood were related to less separation anxiety in late adolescence. However, none of these conditioning correlates remained significant predictors of separation anxiety in adjusted regression models. In contrast, certain "planned" separations in early-mid childhood were associated with lower levels of separation anxiety at later ages. Generally, the findings were consistent with predictions from the non-associative theory of fear acquisition. That vicarious learning processes appeared to modulate, albeit to a minor degree, the expression of separation anxiety during mid-late childhood suggests that there may be critical periods during which some individuals are susceptible to the interactive effects of both associative and non-associative processes. These findings serve to illustrate the complexity of fear acquisition, the relevance of developmental factors and the likely interplay between associative and non-associative processes in the etiology of fear and anxiety.

Socioeconomic inequalities in oral health in childhood and adulthood in a birth cohort.

OBJECTIVES: To determine whether adult oral health is predicted by (a) childhood socioeconomic advantage or disadvantage (controlling for childhood oral health), or (b) oral health in childhood (controlling for childhood socioeconomic advantage or disadvantage), and whether oral health in adulthood is affected by changes in socioeconomic status (SES). METHODS: Participants in a longstanding cohort study underwent systematic dental examination for dental caries and tooth loss at ages 5 and 26 years. The examination at age 26 years included the collection of data on periodontal attachment loss and plaque level. Childhood SES was determined using parental occupation, and adult SES was determined from each study member's occupation at age 26 years. Regression models were used to test the study hypotheses. RESULTS: Complete data were available for 789 individuals (47.4% female). After controlling for childhood oral health, those who were of low SES at age 5 years had substantially greater mean DFS and DS scores by age 26 years, were more likely to have lost a tooth in adulthood because of caries, and had greater prevalence and extent of periodontitis. A largely similar pattern was observed (after controlling for childhood SES) among those with greater caries experience at age 5 years. For almost all oral health indicators examined, a clear gradient was observed of greater disease at age 26 years across socioeconomic trajectory groups, in the following order of ascending disease severity and prevalence: 'high-high', 'low-high' (upwardly mobile), 'high-low' (downwardly mobile) and 'low-low'. CONCLUSION: Adult oral health is predicted by not only childhood socioeconomic advantage or disadvantage, but also by oral health in childhood. Changes in socioeconomic advantage or disadvantage are associated with differing levels of oral health in adulthood. The life-course approach appears to be a useful paradigm for understanding oral health disparities.

Couples' experiences with in vitro fertilization.

In vitro fertilization (IVF) is one of the newest techniques for treatment of infertility. While the medical aspects of IVF have been extensively reported, little research has explored this procedure from the couple's point of view. In this descriptive study, 28 couples who had experienced at least one IVF procedure were interviewed. The results indicate that while IVF offers hope for infertile couples, the procedure, if unsuccessful, can be emotionally traumatic. In addition, the results suggest that comprehensive anticipatory information and emotional support are the primary needs of couples undergoing IVF.

Users of unconventional practitioners: a profile of 26 year old New Zealanders.

AIMS: To profile 26 year old New Zealand users of unconventional practitioners. METHODS: 977 members of the Dunedin Multidisciplinary Health and Development Study participating in the age-26 assessment (1998-1999) answered questions about twelve-month service use, education, income, recent medical history, current health status and avoidance of medical situations. RESULTS: 10% had used an unconventional practitioner in the previous twelve months. The majority (88%) had also used a conventional practitioner. Those using both types of practitioner were heavy users of health services (twelve visits/year). Compared to those who used conventional practitioners exclusively, they had significantly higher incomes and were more likely to report a serious injury, a current disability, a history of back problems, role limitations due to physical health problems, and more bodily pain (all p < 0.01). CONCLUSIONS: 26 year old New Zealand users of unconventional practitioners have a similar profile to their counterparts in other developed countries. It appears that their health needs are not fully met by conventional services, emphasising the need for more research into the aetiology and treatment of ailments (e.g. back pain) for which unconventional practitioners are commonly sought. The Medical Council of New Zealand guidelines on unconventional medicine are discussed in light of these findings.

Brain drain or OE? Characteristics of young New Zealanders who leave.

AIMS: To characterise the emigration patterns of young New Zealanders. METHODS: The 980 members of the Dunedin Multidisciplinary Health and Development Study participating in the "age-26" (1998-1999) assessment provided information about emigration behaviour, qualifications, aspects of physical and mental health and personality. RESULTS: 26% of the sample had moved overseas to live between the ages of 18 and 26, with the United Kingdom and Australia being the most common destinations. Compared to non-emigrants, emigrants had higher IQ scores, were better qualified, leaner and fitter, and had happier and less stress-prone personalities. Based on their planned return date, 63% of emigrants were considered to be on their OE overseas experience (OE, return in <5 years), 18% were defined as brain-drain emigrants (return in >5 years or never) and 18% were uncertain about their return. Brain-drain emigrants were more likely than OE emigrants to leave for better work opportunities, and they were also more likely to go to Australia. However, there were no differences in terms of qualifications, intelligence and personality between OE and brain-drain emigrants. CONCLUSIONS: Most young New Zealanders in this cohort who left for overseas were embarking on their OE. Brain-drain emigrants make up a sizeable minority of emigrants, but appear to possess no more skills than those who plan or choose to return.

Persistence and perceived consequences of cannabis use and dependence among young adults: implications for policy.

AIMS: To document patterns of cannabis use and dependence from late-adolescence through to the mid-twenties; to describe perceived consequences of cannabis use among young people; and to consider policy implications of these findings. METHODS: This was a longitudinal study of the Dunedin Multidisciplinary Health and Development Study birth cohort with repeated measures of cannabis use at ages 18, 21 and 26 years. RESULTS: Twelve month prevalence rates of cannabis use (just over 50%) and dependence (just under 10%) remained stable between age 21 and 26 years, contrary to an expected decline. Cannabis dependence, as distinct from occasional use, was associated with high rates of harder drug use, selling of drugs and drug conviction. Cumulatively, almost 3/4 of our cohort had tried cannabis by age 26. Young people thought the risk of getting caught using cannabis was trivial, and that using cannabis had few negative social consequences. CONCLUSIONS: The persistent high rates of cannabis use and dependence among young New Zealand adults raises important issues for policy makers. Current laws are not particularly effective in deterring use. Whereas occasional use does not appear to present a serious problem, cannabis dependence among users is a serious public health issue that warrants immediate action.

How should we construct psychiatric family history scores? A comparison of alternative approaches from the Dunedin Family Health History Study.

BACKGROUND: There is increased interest in assessing the family history of psychiatric disorders for both genetic research and public health screening. It is unclear how best to combine family history reports into an overall score. We compare the predictive validity of different family history scores. METHOD: Probands from the Dunedin Study (n=981, 51% male) had their family history assessed for nine different conditions. We computed four family history scores for each disorder: (1) a simple dichotomous categorization of whether or not probands had any disordered first-degree relatives; (2) the observed number of disordered first-degree relatives; (3) the proportion of first-degree relatives who are disordered; and (4) Reed's score, which expressed the observed number of disordered first-degree relatives in terms of the number expected given the age and sex of each relative. We compared the strength of association between each family history score and probands' disorder outcome. RESULTS: Each score produced significant family history associations for all disorders. The scores that took account of the number of disordered relatives within families (i.e. the observed, proportion, and Reed's scores) produced significantly stronger associations than the dichotomous score for conduct disorder, alcohol dependence and smoking. Taking account of family size (i.e. using the proportion or Reed's score) produced stronger family history associations depending on the prevalence of the disorder among family members. CONCLUSIONS: Dichotomous family history scores can be improved upon by considering the number of disordered relatives in a family and the population prevalence of the disorder.

Labetalol: potent antihypertensive agent that blocks both alpha- and beta-adrenergic receptors.

Labetalol was administered as the sole antihypertensive agent to 20 ambulatory patients with mild to moderate hypertension. The mean systolic and diastolic blood pressures (+/- standard error of the mean) with the patients sitting fell significantly (P < 0.001), from 145.5 +/- 3.2 and 103.7 +/- 1.6 mm Hg respectively at the start of labetalol therapy (after a period free of antihypertensive medication) to 125.7 +/- 2.0 and 87.2 +/- 1.1 mm Hg by the end of the trial. The diastolic blood pressure was well controlled (90 mm Hg or less) with labetalol therapy in 90% of the patients. The medication was well tolerated, and no orthostatic fall in the diastolic blood pressure was observed. Pharmacologically labetalol most closely resembles a combination of a nonselective beta-adrenergic blocker like propranolol and a postsynaptic alpha-adrenergic blocker like prazosin.

Cometabolic degradation of 4-chlorophenol by Alcaligenes eutrophus.

Alcaligenes eutrophus was grown in batch cultures using either phenol as a sole substrate or mixtures of phenol and 4-chlorophenol. Phenol was found to be the sole source for carbon and energy while 4-chlorophenol was utilized only as a cometabolite. Maximum growth rates on phenol reached only 0.26 h-1, significantly below the growth rates reported earlier with Pseudomonas putida. The cometabolite was found to decrease biomass yield and increase lag time before logarithmic growth occurred. Both phenol and 4-chlorophenol were found to inhibit the growth rate linearly with maximum concentrations of 1080 ppm and 69 ppm respectively, beyond which no growth occurred. The best-fit parameters are incorporated into a simple, dynamic (i.e. time-varying) model capable of predicting all the batch growth conditions presented here. It is shown that P. putida is capable of faster bioremediation when phenol is the sole carbon source or for mixed substrates with low concentrations of the cometabolite, but for high concentrations of 4-chlorophenol, A. eutrophus becomes superior because of the long lag times that occur in the Pseudomonas species.

A model to show human uterine receptivity and embryo viability following ovarian stimulation for in vitro fertilization.

A comparison of the implantation rates following in vitro fertilization (IVF) and embryo transfer (ET) for four major groups indicates differences in the implantation rates as well as in the incidence of multiple implantation. By assuming that the probability of implantation is the product of two variables, uterine receptivity (U) and embryo viability (E), estimates for U and E are derived for each of the four IVF groups using maximum likelihood methods. The UE model is tested using chi-squared goodness-of-fit methods for predicted implantation rates versus observed. The possibility that differences in U values between groups are due to different ovarian stimulation protocols is discussed, as is the value of the UE model in highlighting differences between IVF groups and its importance in predicting multiple pregnancy rates.