Trends in cardiovascular management of people with diabetes by primary healthcare nurses in Auckland, New Zealand.

AIMS: The study aim was to re-examine current work practices and evaluate time trends in the cardiovascular management of people with diabetes consulted by primary healthcare nurses in New Zealand. METHODS: Primary healthcare nurses in the Auckland region were surveyed in 2006-2008 and 2016, with about one-third of practice, home care and specialist nurses randomly selected to participate. Nurses completed a self-administered questionnaire about demographic and workplace details, and a telephone interview about clinical care provided for people with diabetes during nursing consultations. Information was collected on a representative sample of people with diabetes consulted on one randomly selected work-day in the previous week. RESULTS: Of all people with diabetes consulted by nurses, practice nurses consulted significantly more in 2016 (83%) compared with 60% in 2006-2008, whereas specialist nurse consultations decreased from 23% to 8% (P = 0.01). In 2016, in people with diabetes, BMI was higher, and total cholesterol lower, yet the proportions of those receiving lifestyle advice (dietary and activity) remained unchanged from 2006-2008 levels. Smoking prevalence in people with diabetes was unchanged between the two surveys, although more people were asked if they wished to stop in 2016 compared with 2006-2008 (98% vs. 73%). In 2016, hours of nurses' diabetes education were associated with increased routine assessments of risk factors in people with diabetes and checking laboratory results. CONCLUSIONS: Practice nurses are undertaking an increasing proportion of diabetes consultations. Although BMI in people with diabetes is increasing, the proportion of nurses offering lifestyle advice remains unchanged. Increasing diabetes education could strengthen the management of people with diabetes by community nurses.

Overview of results from the Vitamin D Assessment (ViDA) study.

BACKGROUND: The Vitamin D Assessment (ViDA) study is a randomised, double-blind, placebo-controlled trial to evaluate the efficacy of monthly vitamin D supplementation in reducing the incidence of a range of acute and chronic diseases and intermediate outcomes. METHODS: The study was carried out in Auckland, New Zealand, among 5110 adults, aged 50-84 years, who were followed for a median 3.3 years. The intervention was vitamin D3 (2.5 mg or 100,000 IU) or placebo softgel oral capsules, mailed monthly to participants' homes, with two capsules sent in the first mail-out post-randomisation (i.e. 200,000 IU bolus, or placebo), followed 1 month later (and thereafter monthly) with 100,000 IU vitamin D3 or placebo capsules. Outcomes were monitored through routinely collected health data and self-completed questionnaires. RESULTS: The results showed no beneficial effect of vitamin D supplementation on incidence of cardiovascular disease, falls, non-vertebral fractures and all cancer. However, beneficial effects from vitamin D supplementation were seen: for persistence with taking statins in participants on long-term statin therapy; and also in bone mineral density and arterial function in participants with low 25-hydroxyvitamin D levels, and in lung function among ever smokers (especially if vitamin D deficient). The latter findings are consistent with several previous studies, CONCLUSION: Monthly high-dose vitamin D supplementation does not prevent a range of diseases, but may be beneficial for some intermediate outcomes in people who are vitamin D deficient. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry identifier: ACTRN12611000402943.

Design effects associated with dietary nutrient intakes from a clustered design of 1 to 14-year-old children.

OBJECTIVE: To calculate intra-cluster and intra-household design effects and intra-class correlation coefficients for dietary nutrients obtained from a 24 h record-assisted recall. DESIGN: Children were recruited using clustered probability sampling. Randomly selected starting-point addresses were obtained with probability proportional to mesh block size. SETTING: Children aged 1-14 years in New Zealand. SUBJECTS: There were 125 children in 50 clusters, giving an average of 2.498 children per cluster. In 15 homes, there were two children for the calculation of intra-household statistics. RESULTS: Intra-cluster design effects ranged from 1.0 for cholesterol, beta-carotene, vitamin A, vitamin D, vitamin E, selenium, fructose and both carbohydrate and protein expressed as their contribution to total energy intakes to 1.552 for saturated fat, with a median design effect of 1.148. Their corresponding intra-cluster correlations ranged from 0 to 0.37, respectively. Intra-household design effects ranged from 1.0 for height to 1.839 for vitamin B(6), corresponding to intra-household correlations of 0 and 0.839. The median intra-household design effect was 1.550. Using a sampling design of two to three households per cluster for estimating dietary nutrient intakes would need, on average, a 15% increase in sample size compared with simple random sampling with a maximum increase of 55% to cover all nutrients. CONCLUSIONS: These data enable sample sizes for dietary nutrients to be estimated for both cluster and non-cluster sampling for children aged 1-14 years. The larger design effects found within households suggest that little extra information may be obtained by sampling more than one child per household.

Arterial waveform parameters in a large, population-based sample of adults: relationships with ethnicity and lifestyle factors.

This corrects the article DOI: 10.1038/jhh.2016.78.

Arterial waveform parameters in a large, population-based sample of adults: relationships with ethnicity and lifestyle factors.

Little is known about how aortic waveform parameters vary with ethnicity and lifestyle factors. We investigated these issues in a large, population-based sample. We carried out a cross-sectional analysis of 4798 men and women, aged 50-84 years from Auckland, New Zealand. Participants were 3961 European, 321 Pacific, 266 Maori and 250 South Asian people. We assessed modifiable lifestyle factors via questionnaires, and measured body mass index (BMI) and brachial blood pressure (BP). Suprasystolic oscillometry was used to derive aortic pressure, from which several haemodynamic parameters were calculated. Heavy alcohol consumption and BMI were positively related to most waveform parameters. Current smokers had higher levels of aortic augmentation index than non-smokers (difference=3.7%, P<0.0001). Aortic waveform parameters, controlling for demographics, antihypertensives, diabetes and cardiovascular disease (CVD), were higher in non-Europeans than in Europeans. Further adjustment for brachial BP or lifestyle factors (particularly BMI) reduced many differences but several remained. Despite even further adjustment for mean arterial pressure, pulse rate, height and total:high-density lipoprotein cholesterol, compared with Europeans, South Asians had higher levels of all measured aortic waveform parameters (for example, for backward pressure amplitude: ß=1.5 mm Hg; P<0.0001), whereas Pacific people had 9% higher loge (excess pressure integral) (P<0.0001). In conclusion, aortic waveform parameters varied with ethnicity in line with the greater prevalence of CVD among non-white populations. Generally, this was true even after accounting for brachial BP, suggesting that waveform parameters may have increased usefulness in capturing ethnic variations in cardiovascular risk. Heavy alcohol consumption, smoking and especially BMI may partially contribute to elevated levels of these parameters.

Short-term repeatability of a food frequency questionnaire in New Zealand children aged 1-14 y.

OBJECTIVE: To evaluate the repeatability of a children's food frequency questionnaire (FFQ) by gender, ethnicity, and age group. DESIGN: A 117-item FFQ asking about food intake patterns over the past 4 weeks was developed using food records from 428 children (204 boys and 224 girls) and the reproducibility on average 13 days apart was tested in 130 children (78 boys and 52 girls). Children were recruited using clustered probability sampling (n=103), and a convenience sample of 25 Maori children. SETTING: Children aged 1-14 y from Auckland, Feilding and Shannon, New Zealand. SUBJECTS: There were 71 Maori, 20 Pacific, and 39 Other children. RESULTS: Spearman correlations between the two FFQs ranged from 0.50 for bread to 0.82 for fruit, with a median of 0.76 for spreads and nonmilk drinks, and Cronbach's coefficient alpha's ranged from 0.59 for bread to 0.92 for nonmilk drinks, with a median of 0.85 for mixed meat dishes. There were no significant differences between the two administrations, apart from reporting higher intakes of vegetables and snacks & sweets in the first FFQ. Correlation coefficients tended to be slightly higher in boys than in girls, and in Other ethnic groups compared to Maori and Pacific children. Correlations were slightly higher for the 1-4 y age group, intermediate in the 10-14 y age group, and lowest in the 5-9 y-old age group. CONCLUSIONS: Overall, the FFQ described here shows similar or better repeatability in New Zealand children of all major ethnic groups compared to other child or adolescent FFQs.