G. Peter Herbison

Long-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study

BACKGROUND Breastfeeding is widely advocated to reduce risk of atopy and asthma, but the evidence for such an effect is conflicting. We aimed to assess long-term outcomes of asthma and atopy related to breastfeeding in a New Zealand birth cohort. METHODS Our cohort consisted of 1037 of 1139 children born in Dunedin, New Zealand, between April, 1972, and March, 1973, and residing in Otago province at age 3 years. Children were assessed every 2-5 years from ages 9 to 26 years with respiratory questionnaires, pulmonary function, bronchial challenge, and allergy skin tests. History of breastfeeding had been independently recorded in early childhood. FINDINGS 504 (49%) of 1037 eligible children were breastfed (4 weeks or longer) and 533 (51%) were not. More children who were breastfed were atopic at all ages from 13 to 21 years to cats (p=0.0001), house dust mites (p=0.0010), and grass pollen (p<0.0001) than those who were not. More children who were breastfed reported current asthma at each assessment between age 9 (p=0.0008) and 26 years (p=0.0008) than those who were not. Breastfeeding effects were not affected by parental history of hayfever or asthma. Multifactor analysis controlling for socioeconomic status, parental smoking, birth order, and use of sheepskin bedding in infancy, showed odds ratios of 1.94 (95% CI 1.42-2.65, p<0.0001) for any allergen positive at age 13 years, 2.40 (1.36-4.26, p=0.0003) for current asthma at 9 years, and 1.83 (1.35-2.47, p<0.0001) for current asthma at 9-26 years by repeated-measures analysis. INTERPRETATION Breastfeeding does not protect children against atopy and asthma and may even increase the risk.

Impact of sexual and physical abuse on women's mental health

The level of psychiatric symptomatology was assessed with the General Health Questionnaire and the Present State Examination in a random community sample of women. Subsequently it was ascertained which of the women had been the victims of sexual or physical abuse, in either childhood or adult life. Women with a history of being abused were significantly more likely to have raised scores on both measures of psychopathology and to be identified as psychiatric cases. 20% of women who had been exposed to sexual abuse as a child were identified as having psychiatric disorders, predominantly depressive in type, compared with 6.3% of the non-abused population. Similar increases in psychopathology were found in women who had been physically or sexually assaulted in adult life. These findings indicate that the deleterious effects of abuse can continue to contribute to psychiatric morbidity for many years.

Persistent urinary incontinence and delivery mode history: a six-year longitudinal study.

Objective  To investigate the prevalence of persistent and long term postpartum urinary incontinence and associations with mode of first and subsequent delivery.

Randomised controlled trial of conservative management of postnatal urinary and faecal incontinence: six year follow up

Abstract Objective To determine the long term effects of a conservative nurse-led intervention for postnatal urinary incontinence. Design Randomised controlled trial. Setting Community based intervention in three centres in the United Kingdom and New Zealand. Participants 747 women with urinary incontinence at three months after childbirth, of whom 516 were followed up again at 6 years (69%). Intervention Active conservative treatment (pelvic floor muscle training and bladder training) at five, seven, and nine months after delivery or standard care. Main outcome measures Urinary and faecal incontinence, performance of pelvic floor muscle training. Results Of 2632 women with urinary incontinence, 747 participated in the original trial. The significant improvements relative to controls in urinary (60% v 69%) and faecal (4% v 11%) incontinence at one year were not found at six year follow up (76% v 79% (95% confidence interval for difference in means −10.2% to 4.1%) for urinary incontinence, 12% v 13% (−6.4% to 5.1%) for faecal incontinence) irrespective of subsequent obstetric events. In the short term the intervention had motivated more women to perform pelvic floor muscle training (83% v 55%) but this fell to 50% in both groups in the long term. Both urinary and faecal incontinence increased in prevalence in both groups during the study period. Conclusions The moderate short term benefits of a brief nurse-led conservative treatment of postnatal urinary incontinence may not persist, even among women with no further deliveries. About three quarters of women with urinary incontinence three months after childbirth still have this six years later.

Relations of bronchial responsiveness to allergy skin test reactivity, lung function, respiratory symptoms, and diagnoses in thirteen-year-old New Zealand children

BACKGROUND Many factors have been found to relate univariately to bronchial responsiveness (BR), but their independent relationships are often unclear because many are interrelated. OBJECTIVE The purpose of this study was to present a multivariate analysis of the closeness of the association of various factors that are related univariately to BR, including allergy skin tests. METHODS The results of methacholine challenge were transformed into a continuous variable (BRindex), which has a nearly Gaussian distribution. With stepwise multiple regression, the closeness of the association of the independent variables with BRindex was evaluated. RESULTS Of the 11 skin tests applied, four showed independent relationships to BRindex (mite, cat, dog, and Aspergillus species). The sizes of these skin test reactions were correlated with BRindex, and their sum appeared to maximize the overall correlation of allergy skin tests with BRindex (r = 0.516). The lowness of the ratio of forced expiratory volume in 1 second to vital capacity and of percent predicted forced expiratory volume in 1 second added significantly to the skin tests in correlating with BRindex, (multiple r = 0.621). Adding diagnoses and symptoms increased the multiple r to 0.685. CONCLUSIONS The size of the reactions to the four skin tests noted above showed much closer correlations with BR than total serum IgE had shown at age 11, and the relationship was present in asthmatic and nonasthmatic subjects.

Oral contraceptives and fatal pulmonary embolism.

In a national case-control study of fatal pulmonary embolism in New Zealand women of childbearing age, we estimated that current users of combined oral contraceptives had a relative risk of 9.6 (95% CI 3.1-29.1). From national distribution data, the absolute risk of death from pulmonary embolism in current users was estimated to be 10.5 per million woman-years.

Noise exposure and hearing loss in agriculture: a survey of farmers and farm workers in the Southland region of New Zealand.

Farmers are known to be exposed to intermittent intense noise from a variety of sources, but long-term exposure and the resulting risk of hearing loss have not been well characterized. We studied a cross-sectional random sample of farms on which agricultural workers completed an audiometric test and questionnaire, and performed noise dosimetry on a subsample. Sixty-five percent of farms and a total of 586 workers participated. Noise on the subsample of 60 farms lay in a range between 84.8 to 86.8 dB(A) and hearing losses were consistent with this level of exposure. Age, driving tractors without cabs, and working with metal were important risk factors. Reported compliance with hearing protection was higher than that actually observed. The majority of farmers have a moderate risk of hearing loss, but a significant minority is at high risk. Elimination and isolation of noise sources are the control methods of choice, and if residual hearing protection is required, compliance must be improved.

Return to Continence After Radical Retropubic Prostatectomy: A Randomized Trial of Verbal and Written Instructions Versus Therapist-Directed Pelvic Floor Muscle Therapy

OBJECTIVES To test the effectiveness of weekly postoperative pelvic floor muscle training (PFMT) versus supportive telephone contact by a urology nurse for men at 4 weeks after radical prostatectomy. METHODS This was a randomized controlled trial in three Canadian centers. At 4 weeks after surgery, standardized verbal and written instruction about PFMT was provided to all subjects. Randomization occurred after initial instruction. Continence was defined as 8 g or less of urine loss on a 24-hour pad test. Primary outcome was grams of urine loss on pad test; secondary outcomes were International Prostate Symptom Score (IPSS), Incontinence Impact Questionnaire (IIQ-7) score, cost, and perception of urine loss as a problem. Data were obtained at baseline (preoperatively) and at weeks 4, 8, 12, 16, and 28 and 1 year after surgery. RESULTS A total of 216 men were enrolled; 11 were dry or withdrew at 4 weeks. Ninety-nine were randomized to the control group and 106 to the treatment group. There were no group differences at baseline for prostate-specific antigen level (mean [standard deviation] 8.4 [10.4] ng/mL; 7.6 [4.6] ng/mL), Gleason score (6.3 [0.86]), IPSS, IIQ-7 score, pad test, or voiding diary. At 8 weeks 23% of the control group and 20% of the treatment group were continent; at 12 weeks, 28% and 32%; 16 weeks, 40% and 44%; 28 weeks, 50% and 47%; and at 52 weeks, 64% and 60%, respectively. There were no significant differences between groups at any time point for the outcome variables. CONCLUSIONS Verbal instruction and written information with telephone support seemed to be as effective as intensive PFMT. Less-intense therapy may be more cost-effective.

Postoperative anemia and quality of life after primary hip arthroplasty in patients over 65 years old.

BACKGROUND: It is uncertain whether anemia in elderly patients after primary hip arthroplasty has an effect on their quality of life. METHODS: We conducted a prospective observational study over 3 mo to investigate the association between discharge hemoglobin levels and subjective experience of quality of life at 2 mo postoperatively in patients aged over 65 yr who were scheduled for primary hip arthroplasty. Quality of life was measured preoperatively and at 2 mo postoperatively using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Functional Assessment of Cancer Therapy Anemia (FACT-Anemia) subscale. Pearson correlation coefficients between change in SF-36 and FACT-Anemia subscale scores (from preoperatively to 2 mo postoperatively) and hemoglobin on Day 8 were calculated. RESULTS: Eighty-seven patients were included in the study. Data were available at 2 mo postoperatively from 79 of these patients. The correlation between Day 8 postoperative hemoglobin and change in SF-36 was 0.49 (P < 0.0005) and change in FACT-Anemia subscale score was 0.46 (P =< 0.0005). The correlation was not significantly changed after adjusting for advancing age, presence of significant cardiovascular disease, or whether the patient was transfused. CONCLUSIONS: We found a positive correlation between hemoglobin levels on discharge and change in quality of life scores from preoperatively to 2 mo postoperatively in patients over 65 yr old after primary hip arthroplasty.

Validity of the GHQ-28 in New Zealand Women

The GHQ-28 was validated against the short PSE in a New Zealand community study of female psychiatric morbidity. The GHQ-28 total scores were significantly correlated with the PSE scores. Higher coefficients were obtained using the scoring method of Good child and Duncan-Jones than with the standard scoring method. In this data set, the 3/4 cutoff had the best sensitivity and specificity. The correlations of the GHQ-28 subscales with ICD diagnostic classes and ad hoc PSE sub-scores were also statistically significant. Because the distribution of the GHQ-28 scores is positively skewed, non-parametric statistics may be preferable to the traditional Pearsons correlation coefficient. Overall, the results from this study confirm the GHQ-28 to be a valid and practical screen for presence or absence of psychiatric disorder in New Zealand women.