The Prevention of Overweight in Infancy study (POI.NZ)
Rapid weight gain during the first three years of life predicts child and adult obesity, as well as later cardiovascular and other morbidities. Early infant diet, activity and sleep have been consistently linked to excessive weight gain. Since intervention once children have become overweight is difficult, the Prevention of Overweight in Infancy (POI) study is four-arm randomised controlled trial assessing whether extra education and support around sleep, breastfeeding, diet, and physical activity reduces the number of children showing excessive weight gain over the first two years of life. Also, the study seeks to evaluate if the primary prevention strategies could be delivered separately or together as part of normal health care. This trial is being conducted with 802 families. The POI study intervention commenced in 2009 and the follow-up phase is continuing to 2016.
Other obesity research
Obesity research is carried out and supervised by Dr Helen Paterson. The focus of this research is around the knowledge and practises of New Zealand lead maternity carers and identification of risks factors for excess weight gain in pregnancy.
Key research staff:
Sleep disordered breathing (SDB) research
The main research focus is on developing a better understanding of how the complexities of sleep problems, including sleep disordered breathing (SDB) and obesity-related sleep problems, relate to outcomes of poorer daytime functioning, behavioural adjustment and learning problems in children. A further focus is advancing technology for the measurement of sleep and SDB within paediatric clinical and community settings. The main body of our research has yielded important information enabling us to begin planning for one of our long-term research goals — a randomised controlled trial for the treatment of children with combined SDB and poor academic performance.
Key collaborators are:
- Dr Libby Schaughency, Department of Psychology
- Associate Professor Patrick Dawes, Department of Surgical Sciences
This research, led by Associate Professor David Reith, is on two main themes: pharmacoepidemiology and pharmacokinetics/pharmacodynamics. Both themes are based on extensive collaborations with the School of Pharmacy, the Department of Anaesthesia (University of Otago, Christchurch), and the Department of General Practice (University of Otago, Christchurch). This research frequently involves the joint supervision of graduate and undergraduate students.
This group is primarily engaged in a trial of immunogenicity of a new attenuated rotavirus vaccine specifically developed for neonatal administration. This trial is sponsored by the Murdoch Children’s Research Institute at the Royal Children’s Hospital in Melbourne and supported by the Health Research Council of New Zealand.
The CHIP Study (Children of Incarcerated Parents) and the Father Apart Study
Parental incarceration is a strong risk factor for multiple adverse outcomes for children through the life course, including antisocial behaviour, criminal offending, mental health problems, school failure, drug abuse and unemployment. It is estimated that at any one time 20,000 children in New Zealand have a parent incarcerated. With numbers of prison inmates set to rise from the current 8,790 to 12,500 in 2018, the number of children affected is certain to increase. These figures are of particular concern in the context of New Zealand figures on child and adolescent mental health problems (both externalising and internalising). This currently amounts to a public health issue affecting up to 17,000 children between the ages of 0 to 19 years.
Family discipline and development
The BREEZE study
As an investigator on a large longitudinal randomised control trial (the POI.nz study), Dr Julie Lawrence has built into the first two years of the study a number of measures of early family development and, in particular, the patterns of family discipline that are practised from six to 24 months in a child’s life (it is not an outcome of POI.nz to look at parental discipline). The Breeze study uses this longitudinal data for cohort analyses and goes beyond previous studies, as very few have assessed family discipline further than one-off parental reports. Excellent support is provided to the study by Nicola Liebergreen (Research Assistant).
Disciplinary practices within families can have lifelong effects on children’s well-being and are a particular concern in the context of worsening New Zealand figures on child and adolescent mental health problems. This research will enhance our understanding of parenting practices in early childhood and contribute to more sophisticated explanations of the emergence and maintenance of family discipline. This understanding is necessary for effective evidence-based interventions promoting mental health, as well as to guide government policy. It will be a major resource in understanding parental discipline and parenting behaviours — a critically important issue for the mental health of children and adults.
The Kahungunu Infant Safe Sleep (KISS) Study
The Kahungunu Infant Safe Sleep (KISS) study is funded by the Health Research Council and aims to determine the safety and other benefits, or harm, from providing either a wahakura or bassinet to families. It is mainly based in Māori midwifery services in the Hawke's Bay area. This is a randomised controlled trial of 200 families, and uses infrared cameras in the family home, temperature probes and pulse oximetry to study high risk babies at one month of age, with further follow-up until six months of age. The study has helped develop protocols for high speed data transfer (up to 20 gigabytes per person) using the national KAREN network, as well as developing a collaborative research paradigm with Māori. The study has finished recruiting.
The Incontinence research group comprises Professor Don Wilson, Professor Peter Herbison, Dr Jean Hay Smith, and Gaye Ellis. The research focus is on aspects of pelvic floor dysfunction, urinary and faecal incontinence, and pelvic organ prolapse. Activity relates to primary research (epidemiology and clinical trials) in these subjects and also secondary research with cochrane reviews.
The group is strong with an international profile; three are editors of the Cochrane Urinary and Faecal Incontinence Review Group. Active collaborations exist with the University of Aberdeen and the University of Birmingham which enables the recruitment of sizable cohorts to perform well-powered randomised controlled trials. For instance, the recent POPPY (Physiotherapy for Prolapse) Trial involved 27 centres, including Dunedin, with other sites primarily in the UK.
Other research themes
The department is also involved in a wide range of other significant research projects. These include studies focused on:
- Clinical ethics
- Clinical operative obstetrics (post-operative infection prevention in caesarean delivery and post-partum haemorrhage, and management of the abnormally adherent placenta)
- The evaluation of clinical access priority criteria for assisted reproduction
- The study of nerve injury in women having their first caesarean section
- The clinician's role in the detection of violence and abuse
- Use of the levonorgestrel intrauterine device (Mirena) in adolescents