382 results on '"Rolleston, A."'
Search Results
2. The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS): Design and Methodology
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Andrew C. Kerr, Yeun-Hyang Choi, Malcolm E. Legget, Kathryn E. Bradbury, Gerry Devlin, Wil Harrison, A. Mark Richards, Nikki Earle, Clare R Wall, Patrick Gladding, Anna Rolleston, Katrina Poppe, Vicky A. Cameron, Robert N. Doughty, S. Aish, Richard W. Troughton, Ralph A.H. Stewart, and Graeme Porter
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0301 basic medicine ,medicine.medical_specialty ,Acute coronary syndrome ,030204 cardiovascular system & hematology ,acute coronary syndrome ,03 medical and health sciences ,0302 clinical medicine ,study design ,Internal medicine ,Epidemiology ,multi-ethnic ,medicine ,genomics ,Diseases of the circulatory (Cardiovascular) system ,Myocardial infarction ,Risk factor ,Family history ,General Environmental Science ,MENZACS ,business.industry ,Unstable angina ,medicine.disease ,030104 developmental biology ,RC666-701 ,Cohort ,General Earth and Planetary Sciences ,Biomarker (medicine) ,business - Abstract
Background. Each year, approximately 5000 New Zealanders are admitted to hospital with first-time acute coronary syndrome (ACS). The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) is a prospective longitudinal cohort study embedded within the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry in six hospitals. The objective of MENZACS is to examine the relationship between clinical, genomic, and cardiometabolic markers in relation to presentation and outcomes post-ACS. Methods. Patients with first-time ACS are enrolled and study-specific research data is collected alongside the ANZACS-QI registry. The research blood samples are stored for future genetic/biomarker assays. Dietary information is collected with a food frequency questionnaire and information about physical activity, smoking, and stress is also collected via questionnaire. Detailed family history, ancestry, and ethnicity data are recorded on all participants. Results. During the period between 2015 and 2019, there were 2015 patients enrolled. The mean age was 61 years, with 60% of patients aged Conclusion. MENZACS represents a cohort with optimal contemporary management and will be a significant epidemiological bioresource for the study of environmental and genetic factors contributing to ACS in New Zealand’s multi-ethnic environment. The study will utilise clinical, nutritional, lifestyle, genomic, and biomarker analyses to explore factors influencing the progression of coronary disease and develop risk prediction models for health outcomes.
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- 2021
3. Where are the opportunities to address system barriers preventing equitable cardiovascular outcomes for indigenous populations?
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Katharine McBride, Anna Rolleston, McBride, Katharine F, and Rolleston, Anna
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Native Hawaiian or Other Pacific Islander ,cardiovascular disease ,business.industry ,Environmental health ,indigenous health care ,MEDLINE ,Medicine ,Health Services, Indigenous ,Humans ,General Medicine ,business ,Cardiovascular outcomes ,Indigenous - Abstract
Refereed/Peer-reviewed
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- 2021
4. Seeing the unseen: evidence of kaupapa Māori health interventions
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Shemana Cassim, Jacquie Kidd, Ross Lawrenson, Brendan Hokowhitu, Anna Rolleston, and Rawiri Keenan
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Cultural Studies ,History ,medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Psychological intervention ,Aotearoa ,03 medical and health sciences ,0302 clinical medicine ,Chronic disease ,030220 oncology & carcinogenesis ,Anthropology ,Intervention (counseling) ,Medicine ,Narrative ,030212 general & internal medicine ,Ill health ,business ,Psychiatry - Abstract
Māori in Aotearoa have higher incidence, prevalence and mortality from chronic disease. The dominant narrative in Aotearoa about the reasons for Māori ill health neglects to acknowledge the history of colonisation and failures of the health system, alongside the holistic view of health taken by Māori focusing on collective, whānau-based outcomes. In this article, we review health interventions for chronic disease that have a kaupapa Māori philosophical basis. Our findings demonstrate that there is no clear process in health service design, delivery, research and funding that values and understands mātauranga Māori. Western knowledge systems are inadequate for collecting and presenting Māori knowledge. Overall, we highlight that the tension between acknowledging that a “by Māori, for Māori” approach is best, and the difficulty in defining appropriate evidence collection methodology and outcome measures when funders and policy makers continue to require Western-centric interventions is an obstacle to improving Māori health outcomes.
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- 2020
5. Māori, Pacific, Aboriginal and Torres Strait Islander women's cardiovascular health: where are the opportunities to make a real difference?
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Natasha J. Howard, Katharine McBride, Anna Rolleston, Alex Brown, Catherine Paquet, Corina Grey, McBride, Katharine F, Rolleston, Anna, Grey, Corina, Howard, Natasha J, Paquet, Catherine, and Brown, Alex
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Pulmonary and Respiratory Medicine ,Gerontology ,Native Hawaiian or Other Pacific Islander ,Younger age ,Cardiovascular health ,Ethnic group ,Disease ,030204 cardiovascular system & hematology ,Health Services Accessibility ,Indigenous ,03 medical and health sciences ,0302 clinical medicine ,cardiovascular disease ,gender ,Health Services, Indigenous ,Humans ,Medicine ,030212 general & internal medicine ,Cultural Competency ,health equity ,Receipt ,business.industry ,Australia ,Torres strait ,Cardiovascular Diseases ,Women's Health ,Female ,women ,Indigenous peoples ,Cardiology and Cardiovascular Medicine ,business ,Cardiovascular outcomes ,New Zealand - Abstract
Māori and Pacific women in New Zealand and Aboriginal and Torres Strait Islander women in Australia are recognised as nurturers and leaders within their families and communities. However, women’s wellbeing, and that of their communities, are affected by a high burden of cardiovascular disease experienced at a younger age than women from other ethnic groups. There has been little focus on the cardiovascular outcomes and strategies to address heart health inequities among Māori, Pacific, Aboriginal and Torres Strait Islander women. The factors contributing to these inequities are complex and interrelated but include differences in exposure to risk and protective factors, rates of multi-morbidity, and substantial gaps within the health system, which include barriers to culturally responsive, timely and appropriate cardiovascular care. Evidence demonstrates critical treatment gaps across the continuum of risk and disease, including assessment and management of cardiovascular risk in young women and time-critical access to and receipt of acute services. Cardiovascular disease in women impacts not only the individual, but their family and community, and the burden of living with disease limits women’s capacity to fulfil their roles and responsibilities which support and sustain families and communities. Our response must draw on the strengths of Māori, Pacific, Aboriginal and Torres Strait Islander women, acknowledge health and wellbeing holistically, address the health and social needs of individuals, families and communities, and recognise that Indigenous women in New Zealand, Australia and across the Pacific must be involved in the design, development and implementation of solutions affecting their own health. Refereed/Peer-reviewed
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- 2021
6. One size does not fit all – a realist review of screening for asymptomatic atrial fibrillation in Indigenous communities in Australia, Canada, New Zealand and United States
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Stavros Stavrakis, John Skinner, Katrina Poppe, Boe Rambaldini, Anna Rolleston, Maja-Lisa Løchen, Kylie Gwynne, Lis Neubeck, Josephine Gwynn, S Nahdi, and Ben Freedman
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medicine.medical_specialty ,business.industry ,Family medicine ,medicine ,Atrial fibrillation ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Asymptomatic ,Indigenous - Abstract
Background/Introduction Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and it is increasing in prevalence and incidence globally. True prevalence is underestimated because silent/asymptomatic AF is frequent and under-detected, but can cause stroke. Guidelines recommend opportunistic screening for AF in patients aged ≥65 years old. A growing body of evidence from hospital and community-based studies in Australia, New Zealand, Canada and United States indicates this age limit is lower for Indigenous people. Screening for AF meets the World Health Organisation (WHO) criteria for successful routine screening, yet little is known about successful implementation of AF screening in Indigenous communities in developed countries. Purpose The aim of this study is to use a realist approach to identify what works, how, for whom and under what circumstances for AF screening of Indigenous communities in Australia, Canada, New Zealand and United States. Methods In the realist review, eight databases were searched for studies targeted at AF screening in Indigenous communities. Realist analysis was used to identify context-mechanism-outcome configurations across 11 included records (reporting on 5 studies). Snowball referencing and grey literature were used to iteratively incorporate evidence to enhance the refined programme theory that was the product of the realist analysis. Results The realist review included studies using multiple screening strategies such as using tools to increase screening, using different screening environments and training screeners to provide culturally centred care. The realist analysis identified a number of mechanisms that can improve AF screening in Indigenous communities. The contextual factors enabling AF screening programs in Indigenous communities include wider community engagement, opportunistic non-clinical settings, using portable and easy to use devices, increasing knowledge, motivation and confidence in screening amongst Indigenous healthcare workers as well as improving follow-up protocols for abnormal results tailored to screen setting. Barriers to effective AF screening include time-poor working environments, conflicting cultural issues, navigating communication of abnormal results and logistical issues with device use (Figure 1). Conclusion(s) Since the life-course risk for AF in Indigenous population is different, a modified screening strategy needs to be put in place. This realist review provides lessons learned for successful implementation of AF screening programs for Indigenous communities. In order to tackle the gap in cardiovascular burden in Indigenous people, this study calls for action to develop AF screening guidelines for Indigenous populations and provides a guide for policy makers about timely and effective AF screening programs for Indigenous communities. Funding Acknowledgement Type of funding sources: None.
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- 2021
7. 960Dietary intakes of patients with first Acute Coronary Syndrome: the MENZACS study
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Chris Nunn, Suneela Mehta, Graeme Porter, Richard W. Troughton, Erina Korohina, Gerald Devlin, Katrina Poppe, Vicky A. Cameron, Robert N. Doughty, Malcolm E. Legget, Christie Fyfe, Yeun-Hyang Choi, Kathryn E. Bradbury, Anna Rolleston, and Andrew Kerr
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medicine.medical_specialty ,Acute coronary syndrome ,Epidemiology ,business.industry ,Internal medicine ,Lipidomics ,medicine ,Cardiology ,General Medicine ,business ,Missing data ,medicine.disease - Abstract
Background In New Zealand (NZ) approximately 10,000 people experience an acute coronary syndrome (ACS) annually. Little is known about the diets of people who present with first ACS. Methods The Multi-Ethnic NZ study of Acute Coronary Syndromes (MENZACS) is a multi-centre, longitudinal cohort study of patients with first-time ACS. At baseline, patients complete a validated short food frequency questionnaire (FFQ) asking about dietary intakes in the 12 months preceding their event. Participants are followed up for rehospitalisation and mortality. Results Here we present the dietary intakes of the 2,015 participants enrolled into MENZACS. We excluded 90 participants who did not start the FFQ and 42 participants who had extreme energy intakes. For men (n = 1489), the median energy intake was 8637 kJ, and the median percentage of energy from carbohydrate, protein, fat, and saturated fat were 40.3%, 17.9%, 34.7% and 17.8%, respectively. For women (n = 394), the median energy intake was 7499 kJ, and the median percentage of energy from carbohydrate, protein, fat and saturated fat were 40.3%, 18.4%, 35.6%, and 18.0%, respectively. Conclusions Both men and women reported high saturated fat intakes in the year preceding their first ACS. Future work will examine dietary predictors of rehospitalisation and mortality, as well as analyse baseline blood samples for Lipoprotein(a) and lipidomics. Key messages Patients in hospital with first time ACS are able to complete a short food frequency questionnaire, with little missing data.
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- 2021
8. The Diet Quality and Nutrition Inadequacy of Pre-Frail Older Adults in New Zealand
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Martin J. Connolly, Anna Rolleston, Debra L. Waters, Ruth Teh, Leigh Hale, Daniel Barnett, Ngaire Kerse, Richard Edlin, Maisie K. Rowland, Evelingi Leilua, Esther Tay, and Avinesh Pillai
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0301 basic medicine ,Male ,Native Hawaiian or Other Pacific Islander ,Frail Elderly ,macronutrients ,Frail Older Adults ,Nutritional Status ,frailty ,Body weight ,Risk Assessment ,Article ,03 medical and health sciences ,Dietary interventions ,0302 clinical medicine ,Low energy ,Sex Factors ,Risk Factors ,Medicine ,Humans ,TX341-641 ,030212 general & internal medicine ,Geriatric Assessment ,Aged, 80 and over ,030109 nutrition & dietetics ,Nutrition and Dietetics ,business.industry ,Nutrition. Foods and food supply ,Age Factors ,diet quality ,Middle Aged ,Micronutrient ,Diet ,aged ,Cross-Sectional Studies ,Nutrition Assessment ,Diet quality ,micronutrients ,Female ,Independent Living ,business ,Nutritive Value ,Food Science ,Demography ,New Zealand - Abstract
This study aimed to describe the diet quality of pre-frail community-dwelling older adults to extend the evidence of nutrition in frailty prevention. Pre-frailty, the transition state between a robust state and frailty, was ascertained using the FRAIL scale. Socio-demographic, health status, and 24-h dietary recalls were collected from 465 community-dwelling adults aged 75+ (60 years for Māori and Pacific people) across New Zealand. Diet quality was ascertained with the Diet Quality Index-International (DQI-I). Participants (median (IQR) age 80 (77–84), 59% female) had a moderately healthful diet, DQI-I score: 60.3 (54.0–64.7). Women scored slightly higher than men (p = 0.042). DQI-I components identified better dietary variety in men (p = 0.044), and dietary moderation in women (p = 0.002), both sexes performed equally well in dietary adequacy and poorly in dietary balance scores (73% and 47% of maximum scores, respectively). Low energy 20.3 (15.4–25.3) kcal/kg body weight (BW) and protein intakes 0.8 (0.6–1.0) g/kg BW were coupled with a high prevalence of mineral inadequacies: calcium (86%), magnesium (68%), selenium (79%), and zinc (men 82%). In conclusion, the diet quality of pre-frail older adults was moderately high in variety and adequacy but poor in moderation and balance. Our findings support targeted dietary interventions to ameliorate frailty.
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- 2021
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9. An Intervention to Improve Medication Adherence in People With Heart Disease (Text4HeartII): Randomized Controlled Trial
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Paul A. Estabrooks, Jocelyn R. Benatar, Tony Scott, Robyn Whittaker, Leila Pfaeffli Dale, Ralph Maddison, Andrew Kerr, Yannan Jiang, Anna Rolleston, and Ralph A.H. Stewart
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Male ,Acute coronary syndrome ,medicine.medical_specialty ,self-management ,Heart Diseases ,Psychological intervention ,Health Informatics ,Pharmacy ,Context (language use) ,Information technology ,030204 cardiovascular system & hematology ,law.invention ,Medication Adherence ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Quality of life ,law ,cardiovascular disease ,Internal medicine ,Medicine ,text messaging ,risk factors ,Humans ,030212 general & internal medicine ,Original Paper ,business.industry ,Australia ,Odds ratio ,Middle Aged ,medicine.disease ,T58.5-58.64 ,Clinical trial ,Quality of Life ,Public aspects of medicine ,RA1-1270 ,business ,New Zealand - Abstract
Background Mobile health technologies have the potential to improve the reach and delivery of interventions for promoting long-term secondary prevention of coronary heart disease. Objective This study aims to determine the effectiveness of an SMS text messaging intervention (Text4HeartII) for improving adherence to medication and lifestyle changes over and above usual care in people with coronary heart disease at 24 and 52 weeks. Methods A two-arm, parallel, randomized controlled trial was conducted in New Zealand. Participants with a recent acute coronary syndrome were randomized to receive usual cardiac services alone (control, n=153) or a 24-week SMS text message program for supporting self-management plus usual cardiac services (n=153). The primary outcome was adherence to medication at 24 weeks, defined as a medication possession ratio of 80% or more for aspirin, statin, and antihypertensive therapy. Secondary outcomes included medication possession ratio at 52 weeks, self-reported medication adherence, adherence to healthy lifestyle behaviors, and health-related quality of life at 24 and 52 weeks. Results Participants were predominantly male (113/306, 80.3%) and European New Zealanders (210/306, 68.6%), with a mean age of 61 years (SD 11 years). Groups were comparable at baseline. National hospitalization and pharmacy dispensing records were available for all participants; 92% (282/306, 92.1%) of participants completed a 24-week questionnaire and 95.1% (291/306) of participants completed a 52-week questionnaire. Adherence with 3 medication classes were lower in the intervention group than in the control group (87/153, 56.8% vs 105/153, 68.6%, odds ratio 0.60, 95% CI 0.38-0.96; P=.03) and 52 weeks (104/153, 67.9% vs 83/153, 54.2%; odds ratio 0.56, 95% CI 0.35-0.89; P=.01). Self-reported medication adherence scores showed the same trend at 52 weeks (mean difference 0.3; 95% CI 0.01-0.59; P=.04). Moreover, self-reported adherence to health-related behaviors was similar between groups. Conclusions Text4HeartII did not improve dispensed medication or adherence to a favorable lifestyle over and above usual care. This finding contrasts with previous studies and highlights that the benefits of text interventions may depend on the context in which they are used. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12616000422426; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370398. International Registered Report Identifier (IRRID) RR2-10.1186/s13063-018-2468-z
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- 2021
10. Study protocol of a randomised controlled trial to examine the impact of a complex intervention in pre-frail older adults
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Debra L. Waters, Eruera Maxted, Evelingi Leilua, Richard Edlin, Esther Tay, Claire P Heppenstall, Anna Rolleston, Martin J. Connolly, Leigh Hale, Avinesh Pillai, Ngaire Kerse, and Ruth Teh
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Male ,Gerontology ,Aging ,Cost effectiveness ,Cost-Benefit Analysis ,Frail Elderly ,Nutrition Education ,Frailty syndrome ,Psychological intervention ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Randomized controlled trial ,law ,Surveys and Questionnaires ,Intervention (counseling) ,Outcome Assessment, Health Care ,Humans ,Multicenter Studies as Topic ,Medicine ,030212 general & internal medicine ,Exercise ,Aged ,Randomized Controlled Trials as Topic ,Aged, 80 and over ,Frailty ,business.industry ,Australia ,medicine.disease ,Exercise Therapy ,Clinical trial ,Quality of Life ,Accidental Falls ,Female ,Independent Living ,Geriatrics and Gerontology ,business ,030217 neurology & neurosurgery - Abstract
Background Frailty is a multidimensional geriatric syndrome associated with functional loss. The Senior Chef (SC, nutrition) and SAYGO (strength and balance exercise) programmes are well accepted among older adults but the impact of each, or a combination of both, on the frailty syndrome in pre-frail older adults is unknown. Aims To determine the effectiveness and cost-effectiveness of a complex intervention consisting of the SC and/or SAYGO programmes to prevent progression of frailty in pre-frail older adults. Methods A multi-centre randomised controlled assessor-blinded study. The four intervention groups are SC, an 8-week nutrition education and cooking class; SAYGO, a 10-week strength and balance exercise class; SC plus SAYGO, and a social group (Control). Community-dwelling adults aged 75+ (60 + Māori and Pasifika) in New Zealand are recruited through health providers. Participants are not terminally ill or with advanced dementia, and have a score of 1 or 2 on the FRAIL questionnaire. Baseline assessments are completed using standardised questionnaires prior to randomisation. Four follow-up assessments are completed: immediately after intervention, 6, 12 and 24 months post-intervention. The primary outcome is frailty score, secondary outcomes are falls, physical function, quality of life, food intake, physical activity, and sustainability of the strategy. Study outcomes will be analysed using intention-to-treat approach. Cost analyses will be completed to determine if interventions are cost effective relative to the control group. Discussion This trial is designed to be a real world rigorous assessment of whether the two intervention strategies can prevent progression of frailty in older people. If successful, this will generate valuable information about effectiveness of this nutrition and exercise strategy, and provide insights for their implementation. Trial registration Australian and New Zealand Clinical Trials Registry number—ACTRN12614000827639.
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- 2019
11. Diagnostic accuracy of a global cognitive screen for Māori and non‐Māori octogenarians
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Simon A. Moyes, Gary Cheung, Anna Rolleston, Phil C. Wood, Ngaire Kerse, Kristina Zawaly, Stephen Buetow, and Lynette J. Tippett
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0301 basic medicine ,Gerontology ,Ethnic group ,Diagnostic accuracy ,Discriminatory power ,Cognitive aging ,03 medical and health sciences ,Underserved Population ,0302 clinical medicine ,Assessment of cognitive disorders/dementia ,medicine ,Dementia ,Cognitive impairment ,business.industry ,Cognition ,Featured Article ,medicine.disease ,Psychiatry and Mental health ,Sensitivity and specificity ,030104 developmental biology ,Aged 80 and over ,Underserved populations ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Cohort study - Abstract
Introduction We assessed the sensitivity and specificity of the Modified Mini–Mental State Examination (3MS) in predicting dementia and cognitive impairment in Māori (indigenous people of New Zealand) and non-Māori octogenarians. Methods A subsample of participants from Life and Living in Advanced Age: a Cohort Study in New Zealand were recruited to determine the 3MS diagnostic accuracy compared with the reference standard. Results Seventy-three participants (44% Māori) completed the 3MS and reference standard assessments. The 3MS demonstrated strong diagnostic accuracy to detect dementia with areas under the curve of 0.87 for Māori and 0.9 for non-Māori. Our cutoffs displayed ethnic variability and are approximately 5 points greater than those commonly applied. Cognitive impairment yielded low accuracy, and discriminatory power was not established. Discussion Cutoffs that are not age or ethnically appropriate may compromise the accuracy of cognitive screens. Consequently, older age and indigeneity increase the risk of mislabeled cognitive status., Highlights • The cutoffs between Māori and non-Māori octogenarians differed. • Dementia versus no dementia had good discriminant validity. • Applying the typical cutoff would likely lead to misclassification of cognitive function.
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- 2019
12. End Users Want Alternative Intervention Delivery Models: Usability and Acceptability of the REMOTE-CR Exercise-Based Cardiac Telerehabilitation Program
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Ralph A.H. Stewart, Anna Rolleston, Nicholas Gant, Yannan Jiang, Ian Warren, Ralph Maddison, Robyn Whittaker, Jocelyn Benatar, Andrew Meads, and Jonathan C. Rawstorn
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Adult ,Male ,Telemedicine ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Disease ,Physical Therapy, Sports Therapy and Rehabilitation ,030204 cardiovascular system & hematology ,Coaching ,03 medical and health sciences ,0302 clinical medicine ,Telerehabilitation ,Intervention (counseling) ,Humans ,Medicine ,Single-Blind Method ,030212 general & internal medicine ,Aged ,Monitoring, Physiologic ,Aged, 80 and over ,Cardiac Rehabilitation ,Rehabilitation ,business.industry ,End user ,Usability ,Middle Aged ,Patient Acceptance of Health Care ,Exercise Therapy ,Physical therapy ,Female ,business ,Exercise prescription - Abstract
Objective Evaluate user experiences of an exercise-based cardiac telerehabilitation intervention (REMOTE-CR) that provided near universal access to real-time remote coaching and behavioral support from exercise specialists. Design Secondary analysis (12-week follow-up) of a parallel group, single blind, randomized controlled noninferiority trial (ACTRN12614000843651). Setting Community-based cardiac rehabilitation. Participants Adults (N=162) with coronary heart disease who were eligible for outpatient cardiac rehabilitation. Eighty-two of 162 trial participants were randomized to receive REMOTE-CR; 67 completed usability and acceptability assessment at 12-week follow-up. Intervention REMOTE-CR comprised 12 weeks of individualized exercise prescription, real-time physiological monitoring, coaching, and behavioral support, delivered via a bespoke telerehabilitation platform. Outcomes Ease of use, satisfaction with the technology platform and intervention content, and demand for real-world implementation as an alternative to traditional center-based programs were assessed at 12-week follow-up. Results Components of usability and acceptability were positively evaluated by most participants (44-66 of 67, 66%-99%). Fifty-eight of 67 (87%) would choose REMOTE-CR if it was available as a usual care service, primarily because it provides convenient and flexible access to real-time individualized support from exercise specialists. Technology challenges were rare and had little effect on user experiences or demand for REMOTE-CR. Conclusions REMOTE-CR can extend the reach and impact of existing cardiac rehabilitation services by overcoming traditional participation barriers while preserving expert oversight. Adoption of emerging technologies should be accelerated to support dynamic, engaging, individualized intervention delivery models, but optimizing overall cardiac rehabilitation participation rates will require multiple delivery models that are tailored to satisfy diverse participant preferences.
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- 2018
13. Anaemia and physical and mental health in the very old: An individual participant data meta-analysis of four longitudinal studies of ageing
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Palapar, L., Kerse, N., Rolleston, A., Elzen, W.P.J. den, Gussekloo, J., Blom, J.W., Robinson, L., Martin-Ruiz, C., Duncan, R., Arai, Y., Takayama, M., Teh, R., and TULIP Consortium
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Aging ,Activities of daily living ,Anemia ,Anaemia ,03 medical and health sciences ,0302 clinical medicine ,030502 gerontology ,80 and over ,Humans ,Medicine ,Longitudinal Studies ,030212 general & internal medicine ,Functional ability ,Depression (differential diagnoses) ,Aged ,Aged, 80 and over ,business.industry ,Depression ,Cognition ,General Medicine ,medicine.disease ,Mental health ,Mental Health ,Meta-analysis ,Cohort ,Cognitive function ,Geriatrics and Gerontology ,0305 other medical science ,business ,Demography - Abstract
Objective To determine the physical and mental health of very old people (aged 80+) with anaemia. Methods Individual level meta-analysis from five cohorts of octogenarians (n = 2,392): LiLACS NZ Māori, LiLACS NZ non-Māori, Leiden 85-plus Study, Newcastle 85+ Study, and TOOTH. Mixed models of change in functional ability, cognitive function, depressive symptoms, and self-rated health over time were separately fitted for each cohort. We combined individual cohort estimates of differences according to the presence of anaemia at baseline, adjusting for age at entry, sex, and time elapsed. Combined estimates are presented as differences in standard deviation units (i.e. standardised mean differences–SMDs). Results The combined prevalence of anaemia was 30.2%. Throughout follow-up, participants with anaemia, on average, had: worse functional ability (SMD −0.42 of a standard deviation across cohorts; CI -0.59,-0.25); worse cognitive scores (SMD -0.27; CI -0.39,-0.15); worse depression scores (SMD -0.20; CI -0.31,-0.08); and lower ratings of their own health (SMD -0.36; CI -0.47,-0.25). Differential rates of change observed were: larger declines in functional ability for those with anaemia (SMD −0.12 over five years; CI -0.21,-0.03) and smaller mean difference in depression scores over time between those with and without anaemia (SMD 0.18 over five years; CI 0.05,0.30). Conclusion Anaemia in the very old is a common condition associated with worse functional ability, cognitive function, depressive symptoms, and self-rated health, and a more rapid decline in functional ability over time. The question remains as to whether anaemia itself contributes to worse outcomes or is simply a marker of chronic diseases and nutrient deficiencies.
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- 2021
14. Outcomes of Thyroid Dysfunction in People Aged Eighty Years and Older: An Individual Patient Data Meta-Analysis of Four Prospective Studies (Towards Understanding Longitudinal International Older People Studies Consortium)
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Jacobijn Gussekloo, Anna Rolleston, Robert S. Du Puy, Wendy P. J. den Elzen, Ruth Teh, Simon H. S. Pearce, Nobuyoshi Hirose, Carol Jagger, Simon P. Mooijaart, Rosalinde K. E. Poortvliet, Oliver Menzies, Ngaire Kerse, and Yasumichi Arai
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Pediatrics ,medicine.medical_specialty ,endocrine system ,Time Factors ,Activities of daily living ,endocrine system diseases ,thyroid dysfunction ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Thyroid Function Tests ,Hyperthyroidism ,Risk Assessment ,03 medical and health sciences ,Grip strength ,0302 clinical medicine ,Endocrinology ,Hypothyroidism ,Risk Factors ,medicine ,Humans ,Euthyroid ,Prospective Studies ,Prospective cohort study ,Geriatric Assessment ,IPD-MA ,Subclinical infection ,Aged, 80 and over ,function ,oldest old ,business.industry ,Hazard ratio ,Age Factors ,Prognosis ,mortality ,Functional Status ,Mental Health ,030220 oncology & carcinogenesis ,Meta-analysis ,Asymptomatic Diseases ,Geriatric Depression Scale ,business - Abstract
Background: Subclinical and overt thyroid dysfunction is easily detectable, often modifiable, and, in younger age groups, has been associated with clinically relevant outcomes. Robust associations in very old persons, however, are currently lacking. This study aimed to investigate the associations between (sub-)clinical thyroid dysfunction and disability in daily living, cognitive function, depressive symptoms, physical function, and mortality in people aged 80 years and older. Methods: Four prospective cohorts participating in the Towards Understanding Longitudinal International older People Studies (TULIPS) consortium were included. We performed a two-step individual participant data meta-analysis on source data from community-dwelling participants aged 80 years and older from the Netherlands, New Zealand, United Kingdom, and Japan. Outcome measures included disability in daily living (disability in activities of daily living [ADL] questionnaires), cognitive function (Mini-Mental State Examination [MMSE]), depressive symptoms (Geriatric Depression Scale [GDS]), physical function (grip strength) at baseline and after 5 years of follow-up, and all-cause five-year mortality. Results: Of the total 2116 participants at baseline (mean age 87 years, range 80-109 years), 105 participants (5.0%) were overtly hypothyroid, 136 (6.4%) subclinically hypothyroid, 1811 (85.6%) euthyroid, 60 (2.8%) subclinically hyperthyroid, and 4 (0.2%) overtly hyperthyroid. Participants with thyroid dysfunction at baseline had nonsignificantly different ADL scores compared with euthyroid participants at baseline and had similar MMSE scores, GDS scores, and grip strength. There was no difference in the change of any of these functional measures in participants with thyroid dysfunction during five years of follow-up. Compared with the euthyroid participants, no 5-year survival differences were identified in participants with overt hypothyroidism (hazard ratio [HR] 1.0, 95% confidence interval [CI 0.6-1.6]), subclinical hypothyroidism (HR 0.9 [CI 0.7-1.2]), subclinical hyperthyroidism (HR 1.1 [CI 0.8-1.7]), and overt hyperthyroidism (HR 1.5 [CI 0.4-5.9]). Results did not differ after excluding participants using thyroid-influencing medication. Conclusions: In community-dwelling people aged 80 years and older, (sub-)clinical thyroid dysfunction was not associated with functional outcomes or mortality and may therefore be of limited clinical significance.
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- 2020
15. Hā Ora: secondary care barriers and enablers to early diagnosis of lung cancer for Māori communities
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Jacquie Kidd, Brendan Hokowhitu, Shemana Cassim, Rawiri Keenan, Lynne Chepulis, Denise Aitken, Janice Wong, Karen Middleton, Anna Rolleston, Melissa Firth, and Ross Lawrenson
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Male ,Cancer Research ,Lung Neoplasms ,Native Hawaiian or Other Pacific Islander ,media_common.quotation_subject ,Māori ,Health literacy ,lcsh:RC254-282 ,Health Services Accessibility ,Secondary Care ,Secondary care ,03 medical and health sciences ,Hospital ,0302 clinical medicine ,Nursing ,Agency (sociology) ,Health care ,Diagnosis ,Genetics ,Medicine ,Health Services, Indigenous ,Humans ,030212 general & internal medicine ,Lung cancer ,Early Detection of Cancer ,media_common ,business.industry ,Lung Cancer ,Aotearoa ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Focus group ,Health Literacy ,Oncology ,030220 oncology & carcinogenesis ,Female ,Psychological resilience ,business ,Barriers ,New Zealand ,Research Article - Abstract
Background Lung Cancer is the leading cause of cancer deaths in Aotearoa New Zealand. Māori communities in particular have higher incidence and mortality rates from Lung Cancer. Diagnosis of lung cancer at an early stage can allow for curative treatment. This project aimed to document the barriers to early diagnosis and treatment of lung cancer in secondary care for Māori communities. Methods This project used a kaupapa Māori approach. Nine community hui (focus groups) and nine primary healthcare provider hui were carried out in five rural localities in the Midland region. Community hui included cancer patients, whānau (families), and other community members. Healthcare provider hui comprised staff members at the local primary healthcare centre, including General Practitioners and nurses. Hui data were thematically analysed. Results Barriers and enablers to early diagnosis of lung cancer were categorised into two broad themes: Specialist services and treatment, and whānau journey. The barriers and enablers that participants experienced in specialist services and treatment related to access to care, engagement with specialists, communication with specialist services and cultural values and respect, whereas barriers and enablers relating to the whānau journey focused on agency and the impact on whānau. Conclusions The study highlighted the need to improve communication within and across healthcare services, the importance of understanding the cultural needs of patients and whānau and a health system strategy that meets these needs. Findings also demonstrated the resilience of Māori and the active efforts of whānau as carers to foster health literacy in future generations.
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- 2020
16. Outcomes for working age patients after first-time acute coronary syndrome - ANZACS-QI 35
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Robert N. Doughty, Nikki Earle, Katrina Poppe, Malcolm E. Legget, Gerard Devlin, Andrew Kerr, and Anna Rolleston
- Subjects
Male ,Acute coronary syndrome ,medicine.medical_specialty ,medicine.medical_treatment ,Cardiovascular risk factors ,030204 cardiovascular system & hematology ,Revascularization ,Coronary Angiography ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Registries ,Risk factor ,Working age ,Acute Coronary Syndrome ,Aged ,High rate ,medicine.diagnostic_test ,business.industry ,Clinical events ,medicine.disease ,Quality Improvement ,Angiography ,Female ,Cardiology and Cardiovascular Medicine ,business ,New Zealand - Abstract
Background Acute coronary syndrome (ACS) events and the ongoing burden of disease can have a significant impact on the subsequent life-course of working age people. Methods We report 12-month clinical outcomes for 10,822 patients hospitalized with first-time ACS between 2015-2016 and enrolled in the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry, with a focus on people of working age (defined as Results Nearly half (48%) of first-time ACS occurred in people of working age. Compared to those >65 years, these patients had a high burden of cardiovascular risk factors, and were more likely to be male (75% vs 60%), to be of non-European ethnicity (36% vs 15%), and to be living in areas of high deprivation. Subsequent clinical events were common in the younger patients, with 15% dying or being readmitted for cardiovascular causes within 12 months despite high rates of angiography (96%), revascularization (74%) and evidence-based medical therapy at the time of the index ACS event. Conclusions The high risk factor burden and subsequent high rate of clinical events in working age patients reinforces the need for a longer-term focus on strategies to improve clinical outcomes following first-time ACS.
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- 2020
17. The Association Between Drug Burden Index (DBI) and Health-Related Outcomes: A Longitudinal Study of the 'Oldest Old' (LiLACS NZ)
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Simon A. Moyes, Ngaire Kerse, Cristín Ryan, Oliver Menzies, Anna Rolleston, Carmel Hughes, Ruth Teh, Joanna Broad, and Karen Cardwell
- Subjects
Male ,Longitudinal study ,medicine.medical_specialty ,Activities of daily living ,Population ,Inappropriate Prescribing ,Cholinergic Antagonists ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Activities of Daily Living ,Risk of mortality ,Medicine ,Humans ,Hypnotics and Sedatives ,Pharmacology (medical) ,030212 general & internal medicine ,Longitudinal Studies ,Formulary ,education ,Aged ,Aged, 80 and over ,education.field_of_study ,Evidence-Based Medicine ,business.industry ,Hazard ratio ,Confidence interval ,Hospitalization ,Regression Analysis ,Accidental Falls ,Female ,Geriatrics and Gerontology ,business ,030217 neurology & neurosurgery ,Cohort study - Abstract
Background: The prescribing of medications with anticholinergic and/or sedative properties is considered potentially inappropriate in older people (due to their side-effect profile), and the Drug Burden Index (DBI) is an evidence-based tool which measures exposure to these medications. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ) is an ongoing longitudinal study investigating the determinants of healthy ageing. Using data from LiLACS NZ, this study aimed to determine whether a higher DBI was associated with poorer outcomes (hospitalisation, falls, mortality and cognitive function and functional status) over 36 months follow-up. Methods: LiLACS NZ consists of two cohorts: Māori (the indigenous population of New Zealand) aged ≥ 80 years and non-Māori aged 85 years at the time of enrolment. Data relating to regularly prescribed medications at baseline, 12 months and 24 months were used in this study. Medications with anticholinergic and/or sedative properties (i.e. medications with a DBI > 0) were identified using the Monthly Index of Medical Specialities (MIMS) medication formulary, New Zealand. DBI was calculated for everyone enrolled at each time point. The association between DBI at baseline and outcomes was evaluated throughout a series of 12-month follow-ups using negative binomial (hospitalisations and falls), Cox (mortality) and linear (cognitive function and functional status) regression analyses (significance p < 0.05). Regression models were adjusted for age, gender, general practitioner (GP) visits, socioeconomic deprivation, number of medicines prescribed and one of the following: prior hospitalisation, history of falls, baseline cognitive function [Modified Mini-Mental State Examination (3MS)] or baseline functional status [Nottingham Extended Activities of Daily Living (NEADL)]. Results: Full demographic data were obtained for 671, 510 and 403 individuals at baseline, 12 months and 24 months, respectively. Overall, 31%, 30% and 34% of individuals were prescribed a medication with a DBI > 0 at baseline, 12 months and 24 months, respectively. At baseline and 12 months, non-Māori had a greater mean DBI (0.28 ± 0.5 and 0.27 ± 0.5, respectively) compared to Māori (0.16 ± 0.3 and 0.18 ± 0.5, respectively). At baseline, the most commonly prescribed medicines with a DBI > 0 were zopiclone, doxazosin, amitriptyline and codeine. In Māori, a higher DBI was significantly associated with a greater risk of mortality: at 36 months follow-up, adjusted hazard ratio [95% confidence interval (CI)] 1.89 (1.11–3.20), p = 0.02. In non-Māori, a higher DBI was significantly associated with a greater risk of mortality [at 12 months follow-up, adjusted hazard ratio (95% CIs) 2.26 (1.09–4.70), p = 0.03] and impaired cognitive function [at 24 months follow-up, adjusted mean difference in 3MS score (95% CIs) 0.89 (− 3.89 to − 0.41), p = 0.02). Conclusions: Using data from LiLACS NZ, a higher DBI was significantly associated with a greater risk of mortality (in Māori and non-Māori) and impaired cognitive function (in non-Māori). This highlights the importance of employing strategies to manage the prescribing of medications with a DBI > 0 in older adults.
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- 2020
18. Built environment changes and active transport to school among adolescents:BEATS natural experiment study protocol
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Anna Rolleston, Sandra Mandic, Debbie Hopkins, Gordon Wilson, Antoni Moore, Michael Keall, Kirsten J Coppell, Gavin Kidd, Christina Ergler, Susan Sandretto, Enrique García Bengoechea, John C. Spence, HRB, and Health Research Council of New Zealand
- Subjects
Male ,Geographic information system ,Natural experiment ,Adolescent ,BEATS ,education ,Health Behavior ,Applied psychology ,participatory ,physical activity ,Poison control ,Transportation ,Walking ,Residence Characteristics ,Knowledge translation ,active transport ,Humans ,Medicine ,Body Weights and Measures ,adolescents ,Built Environment ,Exercise ,Built environment ,natural experiment ,Schools ,business.industry ,Dunedin ,Social Support ,Human factors and ergonomics ,Citizen journalism ,General Medicine ,Focus group ,Bicycling ,Interinstitutional Relations ,Socioeconomic Factors ,Research Design ,Geographic Information Systems ,Female ,Public Health ,Safety ,business ,New Zealand - Abstract
IntroductionNatural experiments are considered a priority for examining causal associations between the built environment (BE) and physical activity (PA) because the randomised controlled trial design is rarely feasible. Few natural experiments have examined the effects of walking and cycling infrastructure on PA and active transport in adults, and none have examined the effects of such changes on PA and active transport to school among adolescents. We conducted the Built Environment and Active Transport to School (BEATS) Study in Dunedin city, New Zealand, in 2014–2017. Since 2014, on-road and off-road cycling infrastructure construction has occurred in some Dunedin neighbourhoods, including the neighbourhoods of 6 out of 12 secondary schools. Pedestrian-related infrastructure changes began in 2018. As an extension of the BEATS Study, the BEATS Natural Experiment (BEATS-NE) (2019–2022) will examine the effects of BE changes on adolescents’ active transport to school in Dunedin, New Zealand.Methods and analysisThe BEATS-NE Study will employ contemporary ecological models for active transport that account for individual, social, environmental and policy factors. The published BEATS Study methodology (surveys, accelerometers, mapping, Geographic Information Science analysis and focus groups) and novel methods (environmental scan of school neighbourhoods and participatory mapping) will be used. A core component continues to be the community-based participatory approach with the sustained involvement of key stakeholders to generate locally relevant data, and facilitate knowledge translation into evidence-based policy and planning.Ethics and disseminationThe BEATS-NE Study has been approved by the University of Otago Ethics Committee (reference: 17/188). The results will be disseminated through scientific publications and symposia, and reports and presentations to stakeholders.Trial registration numberACTRN12619001335189.
- Published
- 2020
19. Protein Intake, Distribution and Food Sources in Adults of Advanced Age: Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ)
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Carol Wham, Ngaire Kerse, Simon A. Moyes, Anna Rolleston, and Anishka Ram
- Subjects
business.industry ,Age related ,digestive, oral, and skin physiology ,Medicine ,Distribution (pharmacology) ,business ,Protein intake ,Muscle mass ,Cohort study ,Demography - Abstract
Protein intake and its food sources is important to prevent age related loss of muscle mass andstrength. [...]
- Published
- 2019
20. Quality of prescribing predicts hospitalisation in octogenarians: life and living in advanced age: a cohort study in New Zealand (LiLACS NZ)
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Simon A. Moyes, Martin J. Connolly, Anna Rolleston, Mere Kepa, Tim J Wilkinson, Cristín Ryan, Ngaire Kerse, and Ruth Teh
- Subjects
Male ,Longitudinal study ,medicine.medical_specialty ,Aging ,MEDLINE ,Inappropriate Prescribing ,030204 cardiovascular system & hematology ,lcsh:Geriatrics ,Appropriate prescribing ,Logistic regression ,Drug Prescriptions ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Risk of mortality ,Ethnicity ,Medicine ,Humans ,030212 general & internal medicine ,Longitudinal Studies ,Socioeconomic status ,Potentially Inappropriate Medication List ,Aged ,Aged, 80 and over ,business.industry ,Confounding ,Patient Discharge ,Hospitalization ,lcsh:RC952-954.6 ,Family medicine ,Cohort ,Female ,Geriatrics and Gerontology ,Older people ,business ,Cohort study ,Research Article ,Follow-Up Studies ,Forecasting ,New Zealand - Abstract
Background Prescribing for older people is complex, and many studies have highlighted that appropriate prescribing in this cohort is not always achieved. However, the long-term effect of inappropriate prescribing on outcomes such as hospitalisation and mortality has not been demonstrated. The aim of this study was to determine the level of potentially inappropriate prescribing (PIP) for participants of the Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ) study at baseline and examine the association between PIP and hospitalisation and mortality at 12-months follow-up. Methods PIP was determined using STOPP/START. STOPP identified potentially inappropriate medicines (PIMs) prescribed, START identified potential prescribing omissions (PPOs). STOPP/START were applied to all LiLACS NZ study participants, a longitudinal study of ageing, which includes 421 Māori aged 80–90 years and 516 non-Māori aged 85 years. Participants’ details (e.g. age, sex, living arrangements, socioeconomic status, physical functioning, medical conditions) were gathered by trained interviewers. Some participants completed a core questionnaire only, which did not include medications details. Medical conditions were established from a combination of self-report, review of hospital discharge and general practitioner records. Binary logistic regression, controlled for multiple potential confounders, was conducted to determine if either PIMs or PPOs were associated with hospital admissions and mortality (p Results Full data were obtained for 267 Māori and 404 non-Māori. The mean age for Māori was 82.3(±2.6) years, and 84.6(±0.53) years for non-Māori. 247 potentially inappropriate medicines were identified, affecting 24.3% Māori and 28.0% non-Māori. PIMs were not associated with 12-month mortality or hospitalisation for either cohort (p > 0.05; adjusted models). 590 potential prescribing omissions were identified, affecting 58.1% Māori and 49.0% non-Māori. PPOs were associated with hospitalisation (p = 0.001 for Māori), but were not associated with risk of mortality (p > 0.05) for either cohort within the 12-month follow-up (adjusted models). Conclusion PPOs were more common than PIMs and were associated with an increased risk of hospitalisation for Māori. This study highlights the importance of carefully considering all indicated medicines when deciding what to prescribe. Further follow-up is necessary to determine the long-term effects of PIP on mortality and hospitalisation.
- Published
- 2019
21. High nutrition risk related to dietary intake is associated with an increased risk of hospitalisation and mortality for older Māori: LiLACS NZ
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Ngaire Kerse, Anna Rolleston, Ruth Teh, Carol Wham, Sylvia M. North, and Simon A. Moyes
- Subjects
0301 basic medicine ,Male ,medicine.medical_specialty ,Aging ,Activities of daily living ,Native Hawaiian or Other Pacific Islander ,Nutritional Status ,Māori ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,Activities of Daily Living ,Medicine ,Humans ,030212 general & internal medicine ,Mortality ,Socioeconomic status ,Aged ,Aged, 80 and over ,octogenarian ,030109 nutrition & dietetics ,business.industry ,Public health ,Dietary intake ,lcsh:Public aspects of medicine ,Hazard ratio ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Middle Aged ,Risk evaluation ,Nutrition risk ,Hospitalization ,Increased risk ,Population Surveillance ,nutrition risk ,Female ,LiLACS NZ ,business ,Energy Intake ,New Zealand - Abstract
Objectives: To investigate the association between domains of nutrition risk with hospitalisations and mortality for New Zealand Māori and non‐Māori in advanced age. Methods: Within LiLACS NZ, 256 Māori and 399 non‐Māori octogenarians were assessed for nutrition risk using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II) questionnaire according to three domains of risk. Sociodemographic and health characteristics were established. Five years from inception, survival analyses examined associations between nutrition risk from the three domains of SCREEN II with all‐cause hospital admissions and mortality. Results: For Māori but not non‐Māori, lower nutrition risk in the Dietary Intake domain was associated with reduced hospitalisations and mortality (Hazard Ratios [HR] [95%CI] 0.97 [0.95–0.99], p=0.009 and 0.91 [0.86–0.98], p=0.005, respectively). The ‘Factors Affecting Intake’ domain was associated with mortality (HR, [95%CI] 0.94 [0.89–1.00], p=0.048), adjusted for age, gender, socioeconomic deprivation, education, previous hospital admissions, comorbidities and activities of daily living. Conclusion: Improved dietary adequacy may reduce poor outcomes for older Māori. Implications for public health: Nutrition risk among older Māori is identifiable and treatable. Effort is needed to engage relevant community and whānau (family) support to ensure older Māori have food security and cultural food practices are met.
- Published
- 2018
22. Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial
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Marj Moodie, Yannan Jiang, Anna Rolleston, Robyn Whittaker, Jonathan C. Rawstorn, Ralph A.H. Stewart, Nicholas Gant, Lan Gao, Jocelyne Benatar, Andrew Meads, Ian Warren, and Ralph Maddison
- Subjects
Male ,medicine.medical_specialty ,Waist ,Cost-Benefit Analysis ,medicine.medical_treatment ,Coronary Disease ,030204 cardiovascular system & hematology ,Rehabilitation Centers ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Telerehabilitation ,medicine ,Humans ,030212 general & internal medicine ,Internet ,Rehabilitation ,business.industry ,VO2 max ,Heart ,Middle Aged ,medicine.disease ,Telemedicine ,Cardiac Risk Factors and Prevention ,Exercise Therapy ,3. Good health ,cardiac rehabilitation ,ehealth/telemedicine/mobile health ,Treatment Outcome ,Cardiovascular Diseases ,Quality of Life ,Physical therapy ,Non inferiority trial ,Female ,Cardiology and Cardiovascular Medicine ,Exercise prescription ,business ,coronary artery disease ,New Zealand - Abstract
ObjectiveCompare the effects and costs of remotely monitored exercise-based cardiac telerehabilitation (REMOTE-CR) with centre-based programmes (CBexCR) in adults with coronary heart disease (CHD).MethodsParticipants were randomised to receive 12 weeks of telerehabilitation or centre-based rehabilitation. REMOTE-CR provided individualised exercise prescription, real-time exercise monitoring/coaching and theory-based behavioural strategies via a bespoke telerehabilitation platform; CBexCR provided individualised exercise prescription and coaching via established rehabilitation clinics. Outcomes assessed at baseline, 12 and/or 24 weeks included maximal oxygen uptake (V̇O2max, primary) modifiable cardiovascular risk factors, exercise adherence, motivation, health-related quality of life and programme delivery, hospital service utilisation and medication costs. The primary hypothesis was a non-inferior between-group difference in V̇O2max at 12 weeks (inferiority margin=−1.25 mL/kg/min); inferiority margins were not set for secondary outcomes.Results162 participants (mean 61±12.7 years, 86% men) were randomised. V̇O2 max was comparable in both groups at 12 weeks and REMOTE-CR was non-inferior to CBexCR (REMOTE-CR-CBexCR adjusted mean difference (AMD)=0.51 (95% CI −0.97 to 1.98) mL/kg/min, p=0.48). REMOTE-CR participants were less sedentary at 24 weeks (AMD=−61.5 (95% CI −117.8 to −5.3) min/day, p=0.03), while CBexCR participants had smaller waist (AMD=1.71 (95% CI 0.09 to 3.34) cm, p=0.04) and hip circumferences (AMD=1.16 (95% CI 0.06 to 2.27) cm, p=0.04) at 12 weeks. No other between-group differences were detected. Per capita programme delivery (NZD1130/GBP573 vs NZD3466/GBP1758) and medication costs (NZD331/GBP168 vs NZD605/GBP307, p=0.02) were lower for REMOTE-CR. Hospital service utilisation costs were not statistically significantly different (NZD3459/GBP1754 vs NZD5464/GBP2771, p=0.20).ConclusionREMOTE-CR is an effective, cost-efficient alternative delivery model that could—as a complement to existing services—improve overall utilisation rates by increasing reach and satisfying unique participant preferences.
- Published
- 2018
23. Burden of atrial fibrillation in Māori and Pacific people in New Zealand: a cohort study
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Anna Rolleston, Robert N. Doughty, Ruth Teh, Chris Paltridge, Matire Harwood, Natalie Walker, Ben Freedman, Richard Hulme, Jim Warren, Yulong Gu, and John Kennelly
- Subjects
Pediatrics ,medicine.medical_specialty ,education.field_of_study ,business.industry ,Medical record ,Population ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,Medication prescription ,03 medical and health sciences ,0302 clinical medicine ,Internal Medicine ,medicine ,030212 general & internal medicine ,Young adult ,Risk factor ,education ,business ,Stroke ,Cohort study - Abstract
BACKGROUND Atrial fibrillation (AF) is a major risk factor for ischaemic stroke and cardiovascular events. In New Zealand (NZ), Māori (indigenous New Zealanders) and Pacific people experience higher rates of AF compared with non-Māori/non-Pacific people. AIM To describe a primary care population with AF in NZ. Stroke risk and medication adherence according to ethnicity are also detailed. METHODS Electronic medical records for adults (≥20 years, n = 135 840, including 19 918 Māori and 43 634 Pacific people) enrolled at 37 NZ general practices were analysed for AF diagnosis and associated medication prescription information. RESULTS The overall prevalence of non-valvular AF (NVAF) in this population was 1.3% (1769), and increased with age (4.4% in people ≥55 years). Māori aged ≥55 years were more likely to be diagnosed with NVAF (7.3%) than Pacific (4.0%) and non-Māori/non-Pacific people (4.1%, P < 0.001). Māori and Pacific NVAF patients were diagnosed with AF 10 years earlier than non-Māori/non-Pacific patients (median age of diagnosis: Māori = 60 years, Pacific = 61 years, non-Māori/non-Pacific = 71 years, P < 0.001). Overall, 67% of NVAF patients were at high risk for stroke (CHA2 DS2 -VASc ≥ 2) at the time of AF diagnosis. Almost half (48%) of Māori and Pacific NVAF patients aged
- Published
- 2018
24. Text4Heart II – improving medication adherence in people with heart disease: a study protocol for a randomized controlled trial
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Hannah Bartley, Yannan Jiang, Jocelyne Benatar, Paul A. Estabrooks, Ralph Maddison, Ralph A.H. Stewart, Tony Scott, Andrew Kerr, Anna Rolleston, Jonathan C. Rawstorn, Leila Pfaeffli Dale, Rachel K. Sullivan, Robert N. Doughty, and Robyn Whittaker
- Subjects
medicine.medical_specialty ,Time Factors ,Heart Diseases ,Cost-Benefit Analysis ,Reminder Systems ,medicine.medical_treatment ,Health Behavior ,Medicine (miscellaneous) ,030204 cardiovascular system & hematology ,Childhood obesity ,Medication Adherence ,law.invention ,Study Protocol ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Self-management ,Humans ,Multicenter Studies as Topic ,Pharmacology (medical) ,030212 general & internal medicine ,mHealth ,Randomized Controlled Trials as Topic ,lcsh:R5-920 ,Cardiac Rehabilitation ,Rehabilitation ,business.industry ,Behavior change ,Cardiovascular Agents ,Health Care Costs ,medicine.disease ,Cardiovascular disease ,Self Care ,Clinical trial ,Treatment Outcome ,Health promotion ,Text messaging ,Risk factors ,Physical therapy ,business ,lcsh:Medicine (General) ,Risk Reduction Behavior ,New Zealand - Abstract
Background: Cardiac rehabilitation (CR) is an essential component of contemporary management for patients with coronary heart disease, including following an acute coronary syndrome (ACS). CR typically involves education and support to assist people following an ACS to make lifestyle changes and prevent subsequent events. Despite its benefits, uptake and participation in tradition CR programs is low. The use of mobile technologies (mHealth) offers the potential to improve reach, access, and delivery of CR support. We aim to determine the effectiveness and cost-effectiveness of a text-messaging intervention (Text4Heart II) to improve adherence to medication and lifestyle change in addition to usual care in people following an ACS. A second aim is to use the RE-AIM framework to inform the potential implementation of Text4Heart II within health services in New Zealand. Methods: Text4Heart II is a two-arm, parallel, superiority randomized controlled trial conducted in two large metropolitan hospitals in Auckland, New Zealand. Three hundred and thirty participants will be randomized to either a 24-week theory- and evidence-based personalized text message program to support self-management in addition to usual CR, or usual CR alone (control). Outcomes are assessed at 6 and 12 months. The primary outcome is the proportion of participants adhering to medication at 6 months as measured by dispensed records. Secondary outcomes include medication adherence at 12 months, the proportion of participants adhering to self-reported healthy behaviors (physical activity, fruit and vegetable consumption, moderating alcohol intake and smoking status) measured using a composite health behavior score, self-reported medication adherence, cardiovascular risk factors (lipids, blood pressure), readmissions and related hospital events at 6 and 12 months. A cost-effectiveness analysis will also be conducted. Using the RE-AIM framework, we will determine uptake and sustainability of the intervention. Discussion: The Text4Heart II trial will determine the effectiveness of a text-messaging intervention to improve adherence to medication and lifestyle behaviors at both 6 and 12 months. Using the RE-AIM framework this trial will provide much needed data and insight into the potential implementation of Text4Heart II. This trial addresses many limitations/criticisms of previous mHealth trials; it builds on our Text4Heart pilot trial, it is adequately powered, has sufficient duration to elicit behavior change, and the follow-up assessments (6 and 12 months) are long enough to determine the sustained effect of the intervention. Trial registration Australian New Zealand Clinical Trials Registry, ID: ACTRN12616000422426 . Registered retrospectively on 1 April 2016.
- Published
- 2018
25. Patterns of multi-morbidity and prediction of hospitalisation and all-cause mortality in advanced age
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Avinesh Pillai, Joanna Broad, Martin J. Connolly, Anna Rolleston, Ngaire Kerse, Oliver Menzies, Tim J Wilkinson, Robert N. Doughty, Cristín Ryan, Ruth Teh, and Thomas Lumley
- Subjects
Male ,Aging ,Multivariate statistics ,Native Hawaiian or Other Pacific Islander ,Time Factors ,MEDLINE ,Inappropriate Prescribing ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Cause of Death ,Health care ,Multi morbidity ,Humans ,Medicine ,030212 general & internal medicine ,Geriatric Assessment ,Potentially Inappropriate Medication List ,Aged, 80 and over ,Polypharmacy ,business.industry ,Age Factors ,Multimorbidity ,General Medicine ,Prognosis ,medicine.disease ,Comorbidity ,Hospitalization ,Female ,Geriatrics and Gerontology ,Risk assessment ,business ,New Zealand ,Demography ,Cohort study - Abstract
Background multi-morbidity is associated with poor outcomes and increased healthcare utilisation. We aim to identify multi-morbidity patterns and associations with potentially inappropriate prescribing (PIP), subsequent hospitalisation and mortality in octogenarians. Methods life and Living in Advanced Age; a Cohort Study in New Zealand (LiLACS NZ) examined health outcomes of 421 Māori (indigenous to New Zealand), aged 80-90 and 516 non-Māori, aged 85 years in 2010. Presence of 14 chronic conditions was ascertained from self-report, general practice and hospitalisation records and physical assessments. Agglomerative hierarchical cluster analysis identified clusters of participants with co-existing conditions. Multivariate regression models examined the associations between clusters and PIP, 48-month hospitalisations and mortality. Results six clusters were identified for Māori and non-Māori, respectively. The associations between clusters and outcomes differed between Māori and non-Māori. In Māori, those in the complex multi-morbidity cluster had the highest prevalence of inappropriately prescribed medications and in cluster 'diabetes' (20% of sample) had higher risk of hospitalisation and mortality at 48-month follow-up. In non-Māori, those in the 'depression-arthritis' (17% of the sample) cluster had both highest prevalence of inappropriate medications and risk of hospitalisation and mortality. Conclusions in octogenarians, hospitalisation and mortality are better predicted by profiles of clusters of conditions rather than the presence or absence of a specific condition. Further research is required to determine if the cluster approach can be used to target patients to optimise resource allocation and improve outcomes.
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- 2017
26. Descriptive Epidemiology of Physical Activity Levels and Patterns in New Zealanders in Advanced Age
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Mere Kepa, Anna Rolleston, Ralph Maddison, Ruth Teh, Ngaire Kerse, Joanna Broad, Tim Olds, Carol Wham, Santosh Jatrana, Casey Jordan Mace, Mace, Casey, Kerse, Ngaire, Maddison, Ralph, Olds, Timothy, Jatrana, Santosh, Wham, Carol, Kepa, Mere, Rolleston, Anna, Teh, Ruth, and Broad, Joanna
- Subjects
Male ,Gerontology ,Cross-sectional study ,Population ,Physical activity ,physical activity ,Physical Therapy, Sports Therapy and Rehabilitation ,Motor Activity ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Quality of life ,Accelerometry ,Humans ,Medicine ,Longitudinal Studies ,030212 general & internal medicine ,education ,Aged, 80 and over ,education.field_of_study ,business.industry ,aging ,Rehabilitation ,Descriptive epidemiology ,Physical activity level ,Cross-Sectional Studies ,Female ,Geriatric Depression Scale ,Geriatrics and Gerontology ,business ,030217 neurology & neurosurgery ,New Zealand ,advanced age ,Cohort study - Abstract
Background:Little is known about the physical activity levels and behaviors of advanced age New Zealanders.Methods:A cross-sectional analysis of data from Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ), Te Puāwaitanga O Nga Tapuwae Kia ora Tonu, measures of physical activity (PASE) (n = 664, aged 80–90 [n = 254, Māori, aged 82.5(2), n = 410 non-Māori, aged 85(.5)]) was conducted to determine physical activity level (PAL). A substudy (n = 45) was conducted to attain detailed information about PAL and behaviors via the Multimedia Activity Recall for Children and Adults (MARCA) and accelerometry. The main study was analyzed by sex for Māori and non-Māori.Results:Men consistently had higher levels of physical activity than women for all physical activity measures. Sex was significant for different domains of activity.
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- 2016
27. The effect of a 12-week exercise and lifestyle management programme on cardiac risk reduction: A pilot using a kaupapa Māori philosophy
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Katrina Poppe, Anna Rolleston, and Robert N. Doughty
- Subjects
Gerontology ,medicine.medical_specialty ,Waist ,business.industry ,Disease ,Indigenous ,Lifestyle management ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Blood pressure ,030502 gerontology ,Physical therapy ,medicine ,Christian ministry ,030212 general & internal medicine ,0305 other medical science ,Cardiac risk ,business - Abstract
Introduction: Cardiovascular disease remains the leading cause of premature death and disability for all New Zealanders. Māori, the Indigenous people of New Zealand, are disproportionately affected. The New Zealand Māori Health Strategy recognises that “health and wellbeing are influenced and affected by the ‘collective’ … and the importance of working with people in their social contexts, not just with their physical symptoms” (Ministry of Health, 2002, p. 1). In a Māori worldview, a holistic approach to health is innate. Objectives: This project piloted a kaupapa Māori approach within an existing 12-week clinical exercise and lifestyle management programme. The aims of the study were to determine the effectiveness of a kaupapa Māori 12-week exercise and lifestyle management programme on parameters of cardiac risk and quality of life. Methods: 12 Māori participants attended, 3 times per week over a 12-week period, for monitored, supervised, and individualised exercise. Participants performed a progressive aerobic-only programme for 6 weeks and then a combined aerobic and resistance training programme from weeks 7 through 12. Education sessions were chosen by participants. Results: There was a statistically significant improvement in waist circumference (–3.7 cm; p = .05), hip circumference (–4.6 cm; p = .03), systolic blood pressure (–22 mm Hg; p = .01), and HDL cholesterol (0.22 mmol/L; p = .01). In addition, physical (p = .05) and overall (p = .03) quality of life improved. Conclusion: A kaupapa Māori approach within a structured lifestyle management programme modifies cardiac risk parameters in Māori.
- Published
- 2017
28. A017 Cardiac Biomarkers to Guide Risk in Secondary Prevention Post-Acute Coronary Syndromes
- Author
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Sue Wells, R. Stewart, A.M. Richards, M. Stubbs, Malcolm E. Legget, T. Evans, Robert N. Doughty, S. Aish, M. Heath, Katrina Poppe, and Anna Rolleston
- Subjects
Pulmonary and Respiratory Medicine ,Secondary prevention ,medicine.medical_specialty ,Cardiac biomarkers ,business.industry ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine - Published
- 2020
29. A028 The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS): Baseline Characteristics of Patients With First-time ACS
- Author
-
Katrina Poppe, Richard W. Troughton, N. Earle, Gerry Devlin, Anna Rolleston, Andrew C. Kerr, C. Choi, P. Gladding, Vicky A. Cameron, Malcolm E. Legget, Chris Nunn, G. Porter, Robert N. Doughty, and S. Aish
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Baseline characteristics ,Internal medicine ,Ethnic group ,medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
30. Does potentially inappropriate prescribing predict an increased risk of admission to hospital and mortality? A longitudinal study of the ‘oldest old’
- Author
-
Karen Cardwell, Ngaire Kerse, Cristín Ryan, Ruth Teh, Simon A. Moyes, Oliver Menzies, Anna Rolleston, Carmel Hughes, and Joanna Broad
- Subjects
Male ,Longitudinal study ,Population ,Inappropriate Prescribing ,030204 cardiovascular system & hematology ,lcsh:Geriatrics ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Patient Admission ,SDG 3 - Good Health and Well-being ,Risk of mortality ,Medicine ,Humans ,030212 general & internal medicine ,Longitudinal Studies ,Mortality ,education ,Potentially Inappropriate Medication List ,STOPP/START criteria ,Aged, 80 and over ,education.field_of_study ,business.industry ,Potentially inappropriate prescribing ,Hazard ratio ,Odds ratio ,Health outcomes ,Health equity ,Hospitalization ,lcsh:RC952-954.6 ,Adults aged ≥80 years ,Cohort ,Female ,Geriatrics and Gerontology ,business ,Cohort study ,Demography ,Research Article ,Follow-Up Studies ,Forecasting ,New Zealand - Abstract
Background Potentially inappropriate prescribing (PIP) is associated with negative health outcomes, including hospitalisation and mortality. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ) is a longitudinal study of Māori (the indigenous population of New Zealand) and non-Māori octogenarians. Health disparities between indigenous and non-indigenous populations are prevalent internationally and engagement of indigenous populations in health research is necessary to understand and address these disparities. Using LiLACS NZ data, this study reports the association of PIP with hospitalisations and mortality prospectively over 36-months follow-up. Methods PIP, from pharmacist applied criteria, was reported as potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs). The association between PIP and hospitalisations (all-cause, cardiovascular disease-specific and ambulatory-sensitive) and mortality was determined throughout a series of 12-month follow-ups using binary logistic (hospitalisations) and Cox (mortality) regression analysis, reported as odds ratios (ORs) and hazard ratios (HRs), respectively, and the corresponding confidence intervals (CIs). Results Full demographic data were obtained for 267 Māori and 404 non-Māori at baseline, 178 Māori and 332 non-Māori at 12-months, and 122 Māori and 281 non-Māori at 24-months. The prevalence of any PIP (i.e. ≥1 PIM and/or PPO) was 66, 75 and 72% for Māori at baseline, 12-months and 24-months, respectively. In non-Māori, the prevalence of any PIP was 62, 71 and 73% at baseline, 12-months and 24-months, respectively. At each time-point, there were more PPOs than PIMs; at baseline Māori were exposed to a significantly greater proportion of PPOs compared to non-Māori (p = 0.02). In Māori: PPOs were associated with a 1.5-fold increase in hospitalisations and mortality. In non-Māori, PIMs were associated with a double risk of mortality. Conclusions PIP was associated with an increased risk of hospitalisation and mortality in this cohort. Omissions appear more important for Māori in predicting hospitalisations, and PIMs were more important in non-Māori in predicting mortality. These results suggest understanding prescribing outcomes across and between population groups is needed and emphasises prescribing quality assessment is useful.
- Published
- 2019
31. Walking an Indigenous Pathway: Bridging the Gap in Cardiovascular Health
- Author
-
Anna Rolleston and Alex Brown
- Subjects
Pulmonary and Respiratory Medicine ,Gerontology ,Bridging (networking) ,Native Hawaiian or Other Pacific Islander ,business.industry ,Cardiovascular health ,Indigenous health ,Australia ,Congresses as Topic ,Health equity ,Indigenous ,Cardiovascular Diseases ,Medicine ,Health Services, Indigenous ,Humans ,Cardiology and Cardiovascular Medicine ,business ,New Zealand - Published
- 2019
32. Penis Captivus
- Author
-
J.D. Rolleston
- Subjects
Penis captivus ,Levator ani ,medicine.anatomical_structure ,business.industry ,Vagina ,Psychogenic disease ,Medicine ,Anatomy ,business ,medicine.disease ,Penis - Abstract
DEFINITION. In the present paper the term “penis captivus” is applied to incarceration of the organ in the vagina due to psychogenic spasmodic contraction of the levator ani, and not to the condition resulting from insertion of the penis into rings and similar inanimate objects.
- Published
- 2019
33. Outcomes Among Patients With First-Time Acute Coronary Syndromes in New Zealand: The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS)
- Author
-
Yeun-Hyang Choi, N. Earle, Richard W. Troughton, P. Gladding, Anna Rolleston, Katrina Poppe, Gerry Devlin, Vicky A. Cameron, V. Pera, Robert N. Doughty, C. Wall, S. Aish, Mark Richards, Malcolm E. Legget, R. Stewart, Alan R. Kerr, G. Porter, and Wil Harrison
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Internal medicine ,Ethnic group ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
34. Correction: Alcohol consumption of UK members of parliament: cross-sectional survey
- Author
-
Michael Keall, Kirsten Coppell, John C Spence, Sandra Mandic, Debbie Hopkins, Enrique García Bengoechea, Antoni Moore, Susan Sandretto, Christina Ergler, Anna Rolleston, Gavin Kidd, and Gordon Wilson
- Subjects
Parliament ,business.industry ,Cross-sectional study ,media_common.quotation_subject ,Environmental health ,Medicine ,General Medicine ,business ,Alcohol consumption ,media_common - Published
- 2020
35. A014 Governance of Research to Achieve Equity in Cardiovascular Health Outcomes: MENZACS
- Author
-
R. Stewart, Vicky A. Cameron, H. Wihongi, Robert N. Doughty, Corina Grey, Anna Rolleston, Malcolm E. Legget, and K. Henare
- Subjects
Pulmonary and Respiratory Medicine ,Public economics ,business.industry ,Cardiovascular health ,Corporate governance ,Equity (finance) ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
36. Triggering Transformations
- Author
-
Cynthia Penalva, Shelley K. Green, Michael Rolleston, Monica Schroeder, and Valerie Bruce Judd
- Subjects
Psychotherapist ,Mindfulness ,Addiction ,media_common.quotation_subject ,medicine.disease ,Mental health ,Substance abuse ,Eating disorders ,Sexual abuse ,medicine ,Domestic violence ,Psychology ,Clinical social work ,media_common - Abstract
This chapter describes a relational, solution-focused approach to Equine-assisted psychotherapy (EAP) that incorporates attention to mindfulness, allowing clients struggling with substance abuse to work on their individual goals alongside other group participants. In the treatment of substance abuse, mindfulness practices may help clients avoid relapse by increasing their awareness of negative patterns of thoughts and emotions that could increase the likelihood of relapse triggers. Clinically, the combination of the equine-assisted experiential model and a solution-focused emphasis offers opportunities for heightened awareness and transformation. EAP approaches have been applied to many different clinical concerns, including substance abuse, eating disorders, domestic violence, trauma, post-traumatic stress disorder, and physical or sexual abuse. The horses assist the therapists in shining light on the clients' abilities and strengths in relation to their problem. Clinical approaches that address the addiction without considering the clients' strengths, resources, and resilience miss critical opportunities to engage clients in a collaborative process that can anchor their decision to remain sober.
- Published
- 2018
37. P3636Outcomes in working age first-acute coronary syndrome patients: the ANZACS-QI New Zealand national cohort
- Author
-
N. Earle, Anna Rolleston, Katrina Poppe, M L Legget, Andrew Kerr, and Robert N. Doughty
- Subjects
Pediatrics ,medicine.medical_specialty ,Acute coronary syndrome ,business.industry ,Medicine ,Working age ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,National cohort - Published
- 2018
38. Physical Activity, Function, and Mortality in Advanced Age: A Longitudinal Follow-Up (LiLACS NZ)
- Author
-
Santosh Jatrana, Anna Rolleston, Ngaire Kerse, Simon A. Moyes, and Casey Mace Firebaugh
- Subjects
Male ,Aging ,Activities of daily living ,Physical activity ,Physical Therapy, Sports Therapy and Rehabilitation ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,030212 general & internal medicine ,Mortality ,Exercise ,Survival analysis ,Aged, 80 and over ,business.industry ,Rehabilitation ,Hazard ratio ,Physical Functional Performance ,Quartile ,Cohort ,Functional status ,Female ,Geriatrics and Gerontology ,business ,Gerontology ,Lower mortality ,030217 neurology & neurosurgery ,Demography ,New Zealand - Abstract
The relationship between physical activity, function, and mortality is not established in advanced age. Physical activity, function, and mortality were followed in a cohort of Māori and non-Māori adults living in advanced age for a period of 6 years. Generalized linear regression models were used to analyze the association between physical activity and Nottingham Extended Activities of Daily Living scale, whereas Kaplan–Meier survival analysis and Cox proportional hazard models were used to assess the association between the physical activity and mortality. The hazard ratio for mortality for those in the least active physical activity quartile was 4.1 for Māori and 1.8 for non-Māori compared with the most active physical activity quartile. There was an inverse relationship between physical activity and mortality, with lower hazard ratios for mortality at all levels of physical activity. Higher levels of physical activity were associated with lower mortality and higher functional status in advanced-aged adults.
- Published
- 2018
39. Community-Based Maintenance Cardiac Rehabilitation
- Author
-
Garrick Hately, Sandra Mandic, Anna Rolleston, and Stacey Reading
- Subjects
Community based ,Social sensitivity ,Rehabilitation ,Best practice ,medicine.medical_treatment ,Disease ,030204 cardiovascular system & hematology ,Successful programs ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,medicine ,Outpatient clinic ,030212 general & internal medicine ,Psychology ,Lifestyle behavior - Abstract
Community-based cardiac rehabilitation programs play an important role in restoring and maintaining functional capacity and psychological well-being in patients with cardiovascular disease. The overarching goal of community-based programs is to promote and support long-term adherence to exercise and healthy lifestyle behavior. These programs exist in a continuum of forms ranging from those that offer services similar to hospital-based outpatient clinics, to clubs operated and managed by patients themselves. Most programs not only are centered on providing exercise training but also may provide health-related education, nutritional guidance, and behavioral counseling. The most successful programs are grounded in scientific best practice while maintaining cultural and social sensitivity to the individuals and communities they serve. This chapter discusses outcomes of participation in community-based cardiac rehabilitation, adherence to such programs and special considerations including cultural aspects and program implementation in rural communities. We provide examples of several cardiac rehabilitation programs and recommendations for setting up such programs.
- Published
- 2018
40. Atrial Fibrillation Among Indigenous Populations Globally
- Author
-
Boe Rambaldini, Ben Freedman, Stavros Stavrakis, Katrina Poppe, Anna Rolleston, Sturla Bjørn Einarsson, Kylie Gwynne, and Maja-Lisa Løchen
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Internal medicine ,Cardiology ,Medicine ,Atrial fibrillation ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Indigenous - Published
- 2019
41. Cohort Profile: Te Puawaitanga o Nga Tapuwae Kia Ora Tonu, Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ)
- Author
-
Ashley J. Adamson, Merryn Gott, Carol Wham, Ruth Teh, Ngaire Kerse, Karen Hayman, Thomas Lumley, Santosh Jatrana, Joanna Broad, Mere Kepa, Simon A Moyes, and Anna Rolleston
- Subjects
Aged, 80 and over ,Male ,Gerontology ,Aging ,Native Hawaiian or Other Pacific Islander ,Epidemiology ,business.industry ,General Practice ,Longevity ,Comorbidity ,General Medicine ,White People ,Diet ,Cohort Studies ,Hospitalization ,Social Class ,Patient Satisfaction ,Cohort ,Humans ,Medicine ,Female ,business ,New Zealand ,Cohort study - Published
- 2015
42. Micronutrient intake in advanced age: Te Puāwaitanga o Ngā Tapuwae Kia ora Tonu, Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ)
- Author
-
Anna Rolleston, Marama Muru-Lanning, Carol Wham, Ashley J. Adamson, Simon A. Moyes, Karen Hayman, Ngaire Kerse, and Ruth Teh
- Subjects
Gerontology ,Vitamin ,0301 basic medicine ,Male ,Aging ,Native Hawaiian or Other Pacific Islander ,medicine.medical_treatment ,Medicine (miscellaneous) ,Nutritional Status ,Nutrient density ,Cohort Studies ,chemistry.chemical_compound ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Vitamin B12 ,030212 general & internal medicine ,Aged, 80 and over ,030109 nutrition & dietetics ,Nutrition and Dietetics ,Vitamin C ,business.industry ,Vitamin E ,medicine.disease ,Micronutrient ,Nutrition Surveys ,Malnutrition ,chemistry ,Dietary Reference Intake ,Female ,business ,Demography ,New Zealand - Abstract
A high prevalence of undernutrition has previously been reported in indigenous Māori (49 %) and non-Māori (38 %) octogenarians and may be associated with risk of micronutrient deficiencies. We examined vitamin and mineral intakes and the contributing food sources among 216 Māori and 362 non-Māori participating in Life and Living to Advanced age a Cohort Study in New Zealand, using a repeat 24-h multiple-pass recall. More than half of the Māori and non-Māori participants had intakes below the estimated average requirement from food alone for Ca, Mg and Se. Vitamin B6(Māori women only), folate (women only), vitamin E (Māori women; all men) and Zn (men only) were low in these ethnic and sex subgroups. Women had intakes of higher nutrient density in folate, vitamin C, Ca, Mg, K, vitamin A (non-Māori) andβ-carotene (Māori) compared with men (Pβ-carotene, folate, vitamin C, Ca and Mg were no longer significantly different, but vitamins B2, B12, E and D, Fe, Na, Se and Zn became significantly different for Māori between men and women. When controlling for age and physical function, vitamins A and C and Ca were no longer significantly different, but vitamin B2, Fe, Na and Zn became significantly different for non-Māori between men and women. For those who took nutritional supplements, Māori were less likely to be deficient in food alone intake of vitamin A, folate and Mg, whereas non-Maori were less likely to be deficient in intakes of Mg, K and Zn, but more likely to be deficient in vitamin B12intake. A lack of harmonisation in nutrient recommendations hinders the interpretation of nutrient adequacy; nonetheless, Ca, Mg and Se are key micronutrients of concern. Milk and cheese were important contributions to Ca intake, whereas bread was a key source of Mg and Se. Examination of dietary intake related to biochemical status and health outcomes will establish the utility of these observations.
- Published
- 2016
43. Clinical Characteristics and Burden of Risk Factors Among Patients With Early Onset Acute Coronary Syndromes: The ANZACS-QI New Zealand National Cohort (ANZACS-QI 17)
- Author
-
Robert N. Doughty, Anna Rolleston, Malcolm E. Legget, Katrina Poppe, Andrew Kerr, and Nikki Earle
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,Acute coronary syndrome ,Pediatrics ,medicine.medical_specialty ,Time Factors ,030204 cardiovascular system & hematology ,Coronary Angiography ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Risk Factors ,Diabetes mellitus ,medicine ,Humans ,030212 general & internal medicine ,Registries ,Young adult ,Risk factor ,Acute Coronary Syndrome ,Age of Onset ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Incidence (epidemiology) ,Incidence ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Prognosis ,Quality Improvement ,Population Surveillance ,Cohort ,Age of onset ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,New Zealand - Abstract
Background Cardiovascular (CV) risk factor profiles of people experiencing acute coronary syndromes (ACS) vary with age, and in New Zealand (NZ), Māori and people of Pacific Island descent typically present with ACS at a younger age. We aimed to explore age- and ethnicity-related differences in CV risk factors in a large NZ cohort with first-time ACS. Methods The All NZ Acute Coronary Syndrome Quality Improvement program (ANZACS-QI) registry collects comprehensive data for patients admitted with ACS at NZ hospitals. This analysis includes patients with no prior atherosclerotic CV disease enrolled from 1 July, 2012 to 30 June, 2015. Results 14,190 patients had confirmed ACS, 8493 (60%) patients with no prior CVD comprised the study cohort. The mean age was 64 years, 25% were aged 2 ), and higher total cholesterol:HDL ratios (≥4.0, 70% vs 50%), all p 2 (67%) and higher median HbA1c than older patients with diabetes (69mmol/mol vs 55mmol/mol). Māori and people of Pacific Island descent were overrepresented in the younger age group; these patients had a very high risk factor burden. Conclusions A quarter of NZ patients admitted to hospital with a first-time CV disease event are aged 2 , and 16% have diabetes.
- Published
- 2016
44. The effect of a cycling stage race on whole-body protein turnover
- Author
-
Ien J. Hellemans, Benjamin F. Miller, Nancy J. Rehrer, Elaine Rush, Anna Rolleston, and Cheryl Murphy
- Subjects
medicine.medical_specialty ,Meal ,business.industry ,Protein metabolism ,Protein turnover ,Energy balance ,Physical Therapy, Sports Therapy and Rehabilitation ,General Medicine ,Profile of mood states ,chemistry.chemical_compound ,Animal science ,Endocrinology ,chemistry ,Endurance training ,Internal medicine ,medicine ,Orthopedics and Sports Medicine ,Cycling ,Whole body ,business ,human activities - Abstract
Marked energy expenditure, independent of energy balance, could change whole-body protein turnover. The aims of the present study were to determine the effect of participation in a 6-day, 10-stage cycling stage tour on whole-body protein turnover in elite male cyclists, and to determine whether energy and protein turnover are related to fatigue and over-reaching. 13C-leucine was used to determine 18-h whole-body protein turnover in cyclists both before and immediately after a cycling stage race. The 18-h period included two feeding periods to simulate a normal evening meal and a normal breakfast meal, and two fasted periods including overnight. Blood was drawn for the determination of plasma cortisol and serum ferritin on days 2, 4, and 6 and a Profile of Mood States questionnaire was administered on alternate days during the tour event for determination of markers of over-reaching. Mean leucine rate of appearance was unchanged from pre- to post-tour during both fed and fasted conditions and mean...
- Published
- 2010
45. Energy intake and expenditure during a 6-day cycling stage race
- Author
-
Benjamin F. Miller, Ien J. Hellemans, Anna Rolleston, Nancy J. Rehrer, and Elaine Rush
- Subjects
medicine.medical_specialty ,business.industry ,Respiratory gas exchange ,Energy balance ,Physical Therapy, Sports Therapy and Rehabilitation ,Fat mass ,Endocrinology ,Animal science ,Energy expenditure ,Internal medicine ,Basal metabolic rate ,Lean body mass ,Medicine ,Orthopedics and Sports Medicine ,business ,Cycling ,Body mass index - Abstract
Energy intake (EI) and energy expenditure (EE) are relatively easy to measure accurately over short periods in a laboratory setting, but less so during a multi-day competition. Our goal was to measure EI and EE as accurately as possible during a 6-day, 10-stage cycling race. We prepared all meals and supplements, assessed EI (weighed diet-records) and macrontrient intake, total EE (doubly labelled water), resting metabolic rate (respiratory gas exchange), exercise EE (power meters), and body mass. Body composition was measured several days before and after racing (dual x-ray absorptiometry). Body mass remained stable over the course of the race. The mean EI (27.3+/-3.8 MJ/day) nearly matched EE (27.4+/-2.0 MJ/day). The majority (62%) of EE was exercise EE. Macronutrient intake was within or exceeded the recommendations. Lean body mass increased and fat mass decreased in most of our participants. Our study indicates that EI can match high EE with adequate macronutrient intake during multi-day cycle racing and may be facilitated by appropriate foods being available at appropriate times. This optimization of nutritional provision supports positive changes in body composition.
- Published
- 2010
46. Outcomes in Working Age First-Acute Coronary Syndrome Patients: The ANZACS-QI New Zealand National Cohort
- Author
-
Nikki Earle, Katrina Poppe, Robert N. Doughty, Malcolm E. Legget, Anna Rolleston, and Andrew Kerr
- Subjects
Pulmonary and Respiratory Medicine ,Acute coronary syndrome ,Pediatrics ,medicine.medical_specialty ,business.industry ,medicine ,Working age ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,National cohort - Published
- 2018
47. Testosterone in advance age: a New Zealand longitudinal cohort study: Life and Living in Advanced Age (Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu)
- Author
-
Santosh Jatrana, Ruth Teh, Simon A. Moyes, Anna Rolleston, Yih Harng Chong, Tim J Wilkinson, Oliver Menzies, Joanna Broad, Martin J. Connolly, and Ngaire Kerse
- Subjects
Male ,Gerontology ,Sarcopenia ,medicine.medical_specialty ,Multivariate analysis ,Activities of daily living ,Frail Elderly ,Geriatric Medicine ,030209 endocrinology & metabolism ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Activities of Daily Living ,medicine ,Humans ,Longitudinal Studies ,030212 general & internal medicine ,Testosterone ,Aged, 80 and over ,Frailty ,biology ,business.industry ,Research ,C-reactive protein ,General Medicine ,medicine.disease ,aged ,disability ,Quartile ,Multivariate Analysis ,testosterone ,Cohort ,biology.protein ,Independent Living ,business ,New Zealand ,Cohort study - Abstract
ObjectivesSerum testosterone (T) levels in men decline with age. Low T levels are associated with sarcopenia and frailty in men aged>80 years. T levels have not previously been directly associated with disability in older men. We explored associations between T levels, frailty and disability in a cohort of octogenarian men.SettingData from all men from Life and Living in Advanced Age Cohort Study in New Zealand, a longitudinal cohort study in community-dwelling older adults.ParticipantsCommunity-dwelling (>80 years) adult men excluding those receiving T treatment or with prostatic carcinoma.Outcomes measuresAssociations between baseline total testosterone (TT) and calculated free testosterone (fT), frailty (Fried scale) and disability (Nottingham Extended Activities of Daily Living scale (NEADL)) (baseline and 24 months) were examined using multivariate regression and Wald’s χ2techniques. Subjects with the lowest quartile of baseline TT and fT values were compared with those in the upper three quartiles.ResultsParticipants: 243 men, mean (SD) age 83.7 (2.0) years. Mean (SD) TT=17.6 (6.8) nmol/L and fT=225.3 (85.4) pmol/L. On multivariate analyses, lower TT levels were associated with frailty: β=0.41, p=0.017, coefficient of determination (R2)=0.10 and disability (NEADL) (β=−1.27, p=0.017, R2=0.11), low haemoglobin (β=−7.38, p=0.0016, R2=0.05), high fasting glucose (β=0.38, p=0.038, R2=0.04) and high C reactive protein (CRP) (β=3.57, p=0.01, R2=0.06). Low fT levels were associated with frailty (β=0.39, p=0.024, R2=0.09) but not baseline NEADL (β=−1.29, p=0.09, R2=0.09). Low fT was associated with low haemoglobin (β=−7.83, p=0.0008, R2=0.05) and high CRP (β=2.86, p=0.04, R2=0.05). Relationships between baseline TT and fT, and 24-month outcomes of disability and frailty were not significant.ConclusionsIn men over 80 years, we confirm an association between T levels and baseline frailty scores. The new finding of association between T levels and disability is potentially relevant to debates on T supplementation in older men, though, as associations were not present at 24 months, further work is needed.
- Published
- 2017
48. Risk Factor Burden in Young First-acute Coronary Syndrome Patients: The ANZACS-QI New Zealand National Cohort
- Author
-
Katrina Poppe, Anna Rolleston, Robert N. Doughty, Andrew Kerr, Nikki Earle, and Malcolm E. Legget
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Acute coronary syndrome ,business.industry ,Emergency medicine ,medicine ,Retrospective cohort study ,Medical emergency ,Risk factor ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,National cohort - Published
- 2016
49. THE EFFECT OF FUNCTIONAL FATIGUE ON KNEE FORCE SENSE IN UNINJURED ADULT MALE FOOTBALL PLAYERS
- Author
-
Mark Rolleston and Nicholas C. Clark
- Subjects
medicine.medical_specialty ,Football players ,Adult male ,Proprioception ,business.industry ,Biomechanics ,Joint stability ,Repeated measures design ,Physical Therapy, Sports Therapy and Rehabilitation ,General Medicine ,Football ,Isometric exercise ,Physical medicine and rehabilitation ,Physical therapy ,Medicine ,Orthopedics and Sports Medicine ,business - Abstract
Background Intact proprioception (joint position sense (JPS), kinaesthesia, force sense (FS)) is critical for optimal neuromuscular control of knee functional joint stability. Fatigue is known to impair knee JPS and kinaesthesia, but research regarding the effect of fatigue on knee FS is lacking. Objective To determine the effect of functional fatigue on knee extension FS in uninjured, adult, male football players. It was hypothesized that functional fatigue would result in significant impairment of FS. Design Single-session, pre-/post-intervention repeated measures. Setting University sensorimotor control and biomechanics laboratory. Participants University team players (n=21; age (mean±SD) 21.0±1.2 years; height 178.7±7.2 cm; mass 76.8±11.5 kg; training×2/week; match×1/week) without history of knee intra-articular derangement or surgery. Interventions Functional fatigue was defined/induced using the previously published Functional Agility Short-Term Fatigue Protocol (FAST-FP). The FAST-FP incorporated acceleration-deceleration tasks typical of football training/match play. Main Outcome Measures Dominant leg (preferred kicking leg) knee extension FS was measured in Newtons (N). Players were seated on an isokinetic dynamometer set to isometric mode, the knee flexed 45°. A knee extension target trial-reproduction trial sequence was repeated five times, the difference between trials designated the absolute error (AE), the average AE used for data analyses. Reliability and measurement error for this procedure has been previously established. Force sense measurements were performed before and immediately after the FAST-FP. The FS and FAST-FP procedures were adjacent in the same laboratory space with minimal transition time between tasks. Results Force sense AE significantly increased following fatigue (pre-fatigue=10.9±5.8 N; post-fatigue=23.0±9.2 N; difference=12.1±7.9 N; P=0.00; d=1.59). Conclusions Dominant leg knee extension FS was significantly impaired following functional fatigue. Fatigue-induced impairment of FS could result in sub-optimal neuromuscular control and altered knee functional joint stability that affects knee injury risk.
- Published
- 2017
50. RELIABILITY, PRECISION OF MEASUREMENT AND MINIMAL DETECTABLE DIFFERENCE OF RIGHT AND LEFT KNEE EXTENSION FORCE SENSE MEASUREMENT IN UNINJURED ADULT MALE FOOTBALL PLAYERS
- Author
-
Nicholas C. Clark and Mark Rolleston
- Subjects
medicine.medical_specialty ,Proprioception ,business.industry ,Work (physics) ,Joint stability ,Repeated measures design ,Physical Therapy, Sports Therapy and Rehabilitation ,General Medicine ,Isometric exercise ,Test (assessment) ,Standard error ,Physical therapy ,Medicine ,Orthopedics and Sports Medicine ,business ,human activities ,Reliability (statistics) - Abstract
Background Proprioception (joint position sense (JPS), kinaesthesia, force sense (FS)) is of interest in knee injury prevention. Recent work reports existing knee proprioception tests are inadequate relative to gaining better understanding of knee functional joint stability and injury aetiology. Objective To determine critical psychometric properties of a new knee extension FS test in uninjured, adult, male football players. Hypotheses: 1. the test would demonstrate good reliability; 2. there would be no between-limb significant differences. Design Between-day (D1/D2) repeated measures. Setting University sensorimotor control laboratory. Participants Twelve university team players (age (mean±SD) 21.1±1.5 years; height 177.5±9.3 cm; mass 77.1±15.4 kg) participated. Interventions Players were seated on an isokinetic dynamometer set to isometric mode, the knee flexed 45°. A knee extension target trial-reproduction trial sequence was repeated five times, FS measured in Newtons (N), between-trial differences designated absolute error (AE), average AE used for analyses. Limb order was randomized for D1 and repeated D2. Main Outcome Measures Systematic error (paired t-test; Cohen9s d (d)); relative reliability (ICC 2,k); absolute reliability (standard error of measurement (SEM)); measurement change needed to detect true physiological differences (minimal detectable difference (MDD)); between-limb differences (D2 values; paired t-test). Results There were no significant differences between D1 and D2 values for either limb (P>0.90; d Conclusions There was no systematic error. The FS test demonstrated good reliability. The measurement error and change needed to detect true physiological change were established. There were no between-limb differences. The knee extension FS test offers a new knee proprioception test that can be used in studies of knee functional joint stability and injury aetiology in adult male football players.
- Published
- 2017
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