Salmon is a good source of long chain (LC) omega 3 fatty acids and selenium; these are well recognised for their health benefits. Recommendations for LC omega 3 fatty acid intakes presume equivalence between fish and fish oil. The aim of this research was to compare the effects of consuming salmon with salmon oil capsules on LC omega 3 fatty acid and selenium status. Forty four healthy subjects were randomly assigned to consume either two servings of 120 g farmed New Zealand King (FNZK) salmon/week or 2, 4 or 6 capsules of salmon oil/day for 8 weeks. Fasting blood samples, anthropometric measures, food consumption habits information and blood pressure (BP) measurements were obtained at the study commencement and ending. Each subject’s intake of LC omega 3 fatty acids and selenium was determined by analysing the fatty acid and selenium content of duplicate portions of cooked salmon and capsules. The amount of salmon consumed was then calculated by subtracting unconsumed amounts of salmon and then calculating the intake of LC omega 3 fatty acids as grams of LC omega 3 fatty acids consumed per day. Percentage of compliance to capsule intake, based on counts of unconsumed capsules, was calculated to determine the amount of LC omega 3 fatty acids consumed per day from capsules. Change in red blood cells (RBC) LC omega 3 fatty acid levels from equivalent amounts of LC omega 3 fatty acids consumed from capsules and salmon were compared using linear regression analysis predictive models fitted to the capsule data. Omega 3 index was calculated. LC omega 3 fatty acid intakes from salmon and 2, 4 and 6 capsules were 0.82, 0.24, 0.47 and 0.68 g/day, respectively. Equal amounts of LC omega 3 fatty acids consumed from salmon and capsules resulted in similar increases in RBC LC omega 3 fatty acids and omega 3 index (RBC eicosapentaenoic acid (EPA): 0.80 [0.58 – 1.02] vs. 1.00 [0.71 – 1.27] %; RBC docosahexaenoic acid (DHA): 0.93 [0.58 – 1.29] vs. 0.99 [0.68 – 1.31] %; omega 3 index: 1.92 [1.46 – 2.38] vs. 2.25 [1.65 – 2.83] %). The capsules did not contain selenium, but the salmon provided 6.84 µg selenium/day. Plasma selenium concentrations increased significantly in the salmon group compared to the capsule

Salmon is a good source of long chain (LC) omega 3 fatty acids and selenium; these are well recognised for their health benefits. Recommendations for LC omega 3 fatty acid intakes presume equivalence between fish and fish oil. The aim of this research was to compare the effects of consuming salmon with salmon oil capsules on LC omega 3 fatty acid and selenium status. Forty four healthy subjects were randomly assigned to consume either two servings of 120 g farmed New Zealand King (FNZK) salmon/week or 2, 4 or 6 capsules of salmon oil/day for 8 weeks. Fasting blood samples, anthropometric measures, food consumption habits information and blood pressure (BP) measurements were obtained at the study commencement and ending. Each subject’s intake of LC omega 3 fatty acids and selenium was determined by analysing the fatty acid and selenium content of duplicate portions of cooked salmon and capsules. The amount of salmon consumed was then calculated by subtracting unconsumed amounts of salmon and then calculating the intake of LC omega 3 fatty acids as grams of LC omega 3 fatty acids consumed per day. Percentage of compliance to capsule intake, based on counts of unconsumed capsules, was calculated to determine the amount of LC omega 3 fatty acids consumed per day from capsules. Change in red blood cells (RBC) LC omega 3 fatty acid levels from equivalent amounts of LC omega 3 fatty acids consumed from capsules and salmon were compared using linear regression analysis predictive models fitted to the capsule data. Omega 3 index was calculated. LC omega 3 fatty acid intakes from salmon and 2, 4 and 6 capsules were 0.82, 0.24, 0.47 and 0.68 g/day, respectively. Equal amounts of LC omega 3 fatty acids consumed from salmon and capsules resulted in similar increases in RBC LC omega 3 fatty acids and omega 3 index (RBC eicosapentaenoic acid (EPA): 0.80 [0.58 – 1.02] vs. 1.00 [0.71 – 1.27] %; RBC docosahexaenoic acid (DHA): 0.93 [0.58 – 1.29] vs. 0.99 [0.68 – 1.31] %; omega 3 index: 1.92 [1.46 – 2.38] vs. 2.25 [1.65 – 2.83] %). The capsules did not contain selenium, but the salmon provided 6.84 µg selenium/day. Plasma selenium concentrations increased significantly in the salmon group compared to the capsule

Salmon is a good source of long chain (LC) omega 3 fatty acids and selenium; these are well recognised for their health benefits. Recommendations for LC omega 3 fatty acid intakes presume equivalence between fish and fish oil. The aim of this research was to compare the effects of consuming salmon with salmon oil capsules on LC omega 3 fatty acid and selenium status. Forty four healthy subjects were randomly assigned to consume either two servings of 120 g farmed New Zealand King (FNZK) salmon/week or 2, 4 or 6 capsules of salmon oil/day for 8 weeks. Fasting blood samples, anthropometric measures, food consumption habits information and blood pressure (BP) measurements were obtained at the study commencement and ending. Each subject’s intake of LC omega 3 fatty acids and selenium was determined by analysing the fatty acid and selenium content of duplicate portions of cooked salmon and capsules. The amount of salmon consumed was then calculated by subtracting unconsumed amounts of salmon and then calculating the intake of LC omega 3 fatty acids as grams of LC omega 3 fatty acids consumed per day. Percentage of compliance to capsule intake, based on counts of unconsumed capsules, was calculated to determine the amount of LC omega 3 fatty acids consumed per day from capsules. Change in red blood cells (RBC) LC omega 3 fatty acid levels from equivalent amounts of LC omega 3 fatty acids consumed from capsules and salmon were compared using linear regression analysis predictive models fitted to the capsule data. Omega 3 index was calculated. LC omega 3 fatty acid intakes from salmon and 2, 4 and 6 capsules were 0.82, 0.24, 0.47 and 0.68 g/day, respectively. Equal amounts of LC omega 3 fatty acids consumed from salmon and capsules resulted in similar increases in RBC LC omega 3 fatty acids and omega 3 index (RBC eicosapentaenoic acid (EPA): 0.80 [0.58 – 1.02] vs. 1.00 [0.71 – 1.27] %; RBC docosahexaenoic acid (DHA): 0.93 [0.58 – 1.29] vs. 0.99 [0.68 – 1.31] %; omega 3 index: 1.92 [1.46 – 2.38] vs. 2.25 [1.65 – 2.83] %). The capsules did not contain selenium, but the salmon provided 6.84 µg selenium/day. Plasma selenium concentrations increased significantly in the salmon group compared to the capsule

Whole document restricted until August 2010, see Access Instructions file below for details of how to access the print copy. / Abstract Background Asthma is a common problem in New Zealand, and is associated with significant morbidity and costs to children, their families, and wider society. Previously published New Zealand literature suggested that Māori and Pacific children were less likely than NZ European children to receive asthma medications and elements of asthma education, had poorer knowledge of asthma, and experienced greater morbidity and hospitalisations. However, none of the previous literature had been specifically designed to assess the nature of asthma care in the community, or to specifically answer whether there were ethnic disparities in care. A systematic review of studies published in the international literature that compared asthma management among different ethnic groups drawn from community-based samples was undertaken. The results of this review suggested that minority ethnic group children were less likely to receive elements of asthma medication use, asthma education and self-management (action) plans. Objectives The primary objectives of the study were to: • describe the use of medications, medication delivery systems, asthma education, and self-management plans in primary care for Māori, Pacific, and Other ethnic group children • ascertain whether there were any ethnic disparities in the use of medications, medication delivery systems, asthma education, and self-management plans in primary care after controlling for differences in socio-economic position and other potential confounders. Secondary objectives were to: • describe the asthma-related utilisation of GP, after hours medical care, emergency departments, and hospital admissions among Māori, Pacific, and Other ethnic group children with asthma • ascertain whether differences in medication use, the provision of asthma education, and the provision of self-management plans explained ethnic differences in health service utilisation. Methods A cross-sectional survey was conducted in Auckland, New Zealand. The caregivers of 647 children who were aged 2–14 years, had a diagnosis of asthma or experienced ‘wheeze or whistling in the chest’, and had experienced symptoms in the previous 12 months were identified using random residential address start points and door knocking. Ethnically stratified sampling ratios were used to ensure that approximately equal numbers of children of Māori, Pacific and Other ethnicity were enrolled into the study. A face-to-face interview was conducted with the caregivers of these children. Data was collected about: socio-demographic factors; asthma morbidity; asthma medications and delivery devices; exposure to, and experiences of, asthma education and asthma action plans; and asthma-related health services utilisation. Results In this study, the caregivers of 647 eligible children were invited to participate and 583 completed the interview, giving an overall completion rate of 90.1%. There were no ethnic differences in completion rates. The overall use of inhaled corticosteroid medications had increased since previous New Zealand research was published. Multivariable modelling that adjusted for potential confounders did not identify ethnic differences in the use of inhaled corticosteroids or oral steroids. Some findings about medication delivery mechanisms indicated that care was not consistent with guidelines. About 15% of participants reported they had not received asthma education from a primary care health professional. After adjusting for potential confounders there were no ethnic differences in the likelihood of having received asthma education from a health professional. Among those participants who had received education from a primary care health professional, significantly fewer Māori and Pacific caregivers reported receiving education about asthma triggers, pathophysiology and action plans. Lower proportions of Pacific (77.7%; 95% confidence interval (95%CI) 70.3, 85.1) and Māori (79.8%; 95% CI 73.6, 85.9) caregivers were given information about asthma triggers compared to Other caregivers (89.2%; 95% CI 84.9, 93.6; p=0.01). Fewer Māori (63.6%; 95% CI 55.7, 71.4) and Pacific (68.1%; 95% CI 60.1, 76.1) caregivers reported receiving information about pathophysiology (Other 75.9%; 95% CI 69.5, 82.3; p=0.05). Information about asthma action plans had been given to 22.7% (95% CI 15.5, 29.9) of Pacific and 32.9% (95% CI 25.3, 40.6) of Māori compared to Other participants (36.5%; 95% CI 28.6, 44.3; p=0.04). In addition, fewer Māori (64.2%; 95% CI 56.1, 72.3) and Pacific (68.5%; 95% CI 60.1, 77.0) reported that the information they received was clear and easy to understand (Other 77.9%; 95% CI 71.8, 84.1; p=0.03). About half of those who had received education from a health professional reported receiving further education and, after adjustment for potential confounders, Pacific caregivers were less likely to have been given further education (odds ratio 0.57; 95% confidence interval 0.33, 0.96). A minority of participants (35.3%) had heard about action plans and, after adjustment for potential confounders, Pacific caregivers were less likely to have heard about these plans (odds ratio 0.54; 95% confidence interval 0.33, 0.96). About 10% of the sample was considered to have a current action plan. The mean number of visits to a GP for acute and routine asthma care (excluding after-hours doctors and medical services) in the previous twelve months were significantly higher for Pacific (3.89; CI 3.28, 4.60) and Māori (3.56; CI 3.03, 4.16) children than Other ethnic group children (2.47; CI 2.11, 2.85; p<0.0001). Multivariable modelling of health service utilization outcomes (‘number of GP visits for acute and routine asthma care in the previous twelve months’, ‘high use of hospital emergency departments’, and ‘hospital admissions’) showed that adjustment for potential confounding and asthma management variables reduced, but did not fully explain, ethnic differences in these outcomes. Māori children experienced 22% more GP visits and Pacific children 28% more visits than Other children (p=0.05). Other variables that were significantly associated with a higher number of GP visits were: regular source of care they always used (regression coefficient (RC) 0.24; p<0.01); lower household income (RC 0.31; p=0.004) and having a current action plan (RC 0.38; p=0.006). Increasing age (RC -0.04; p=0.003), a lay source of asthma education (RC -0.41; p=0.001), and higher scores on asthma management scenario (RC -0.03; p=0.05) were all associated with a lower number of GP visits. Pacific (odds ratio (OR) 6.93; 95% CI 2.40, 19.98) and Māori (OR 2.60; 95% CI 0.87, 8.32) children were more likely to have used an emergency department for asthma care in the previous twelve months (p=0.0007). Other variables that had a significant effect on the use of EDs in the multivariable model were: not speaking English in the home (OR 3.72; 95% CI 1.52, 9.09; p=0.004), male sex (OR 2.43; 95% CI 1.15, 5.15; p=0.02), and having a current action plan (OR 7.85; 95% CI 3.49, 17.66; p<0.0001). Increasing age was associated with a reduced likelihood of using EDs (OR 0.90; 95% CI 0.81, 1.00; p=0.05). Hospitalisations were more likely in the Pacific (OR 8.94; 95% CI 2.25, 35.62) and Māori (OR 5.40; 95% CI 1.28, 23.06) ethnic groups (p=0.007). Four other variables had a significant effect on hospital admissions in the multivariable model. Participants who had a low income (OR 3.70; 95% CI 1.49, 9.18; p=0.005), and those who had a current action plan (OR 8.39; 95% CI 3.85, 18.30; p<0.0001) were more likely to have been admitted to hospital in the previous 12 months. Increasing age (OR 0.88; 95% CI 0.80, 0.98; p=0.02) and parental history of asthma (OR 0.39; 95% CI 0.18, 0.85; p=0.02) were associated with reduced likelihood of admission. Conclusions The study is a robust example of cross-sectional design and has high internal validity. The study population is representative of the population of children with asthma in the community. The three ethnic groups are also considered to be representative of those ethnic groups in the community. The study, therefore, has good representativeness and the findings of the study can be generalised to the wider population of children with asthma in the Auckland region. The results suggested that some aspects of pharmacological management were more consistent with guideline recommendations than in the past. However, given the higher burden of disease experienced by Māori and Pacific children, the lack of observed ethnic differences in the use of preventative medications may reflect under treatment relative to need. There are important ethnic differences in the provision of asthma education and action plans. Future approaches to improving care should focus on interventions to assist health professionals to implement guideline recommendations and to monitor ethnic disparities in their practice. Asthma education that is comprehensive, structured and delivered in ways that are effective for the people concerned is needed.

Whole document restricted until August 2010, see Access Instructions file below for details of how to access the print copy. / Abstract Background Asthma is a common problem in New Zealand, and is associated with significant morbidity and costs to children, their families, and wider society. Previously published New Zealand literature suggested that Māori and Pacific children were less likely than NZ European children to receive asthma medications and elements of asthma education, had poorer knowledge of asthma, and experienced greater morbidity and hospitalisations. However, none of the previous literature had been specifically designed to assess the nature of asthma care in the community, or to specifically answer whether there were ethnic disparities in care. A systematic review of studies published in the international literature that compared asthma management among different ethnic groups drawn from community-based samples was undertaken. The results of this review suggested that minority ethnic group children were less likely to receive elements of asthma medication use, asthma education and self-management (action) plans. Objectives The primary objectives of the study were to: • describe the use of medications, medication delivery systems, asthma education, and self-management plans in primary care for Māori, Pacific, and Other ethnic group children • ascertain whether there were any ethnic disparities in the use of medications, medication delivery systems, asthma education, and self-management plans in primary care after controlling for differences in socio-economic position and other potential confounders. Secondary objectives were to: • describe the asthma-related utilisation of GP, after hours medical care, emergency departments, and hospital admissions among Māori, Pacific, and Other ethnic group children with asthma • ascertain whether differences in medication use, the provision of asthma education, and the provision of self-management plans explained ethnic differences in health service utilisation. Methods A cross-sectional survey was conducted in Auckland, New Zealand. The caregivers of 647 children who were aged 2–14 years, had a diagnosis of asthma or experienced ‘wheeze or whistling in the chest’, and had experienced symptoms in the previous 12 months were identified using random residential address start points and door knocking. Ethnically stratified sampling ratios were used to ensure that approximately equal numbers of children of Māori, Pacific and Other ethnicity were enrolled into the study. A face-to-face interview was conducted with the caregivers of these children. Data was collected about: socio-demographic factors; asthma morbidity; asthma medications and delivery devices; exposure to, and experiences of, asthma education and asthma action plans; and asthma-related health services utilisation. Results In this study, the caregivers of 647 eligible children were invited to participate and 583 completed the interview, giving an overall completion rate of 90.1%. There were no ethnic differences in completion rates. The overall use of inhaled corticosteroid medications had increased since previous New Zealand research was published. Multivariable modelling that adjusted for potential confounders did not identify ethnic differences in the use of inhaled corticosteroids or oral steroids. Some findings about medication delivery mechanisms indicated that care was not consistent with guidelines. About 15% of participants reported they had not received asthma education from a primary care health professional. After adjusting for potential confounders there were no ethnic differences in the likelihood of having received asthma education from a health professional. Among those participants who had received education from a primary care health professional, significantly fewer Māori and Pacific caregivers reported receiving education about asthma triggers, pathophysiology and action plans. Lower proportions of Pacific (77.7%; 95% confidence interval (95%CI) 70.3, 85.1) and Māori (79.8%; 95% CI 73.6, 85.9) caregivers were given information about asthma triggers compared to Other caregivers (89.2%; 95% CI 84.9, 93.6; p=0.01). Fewer Māori (63.6%; 95% CI 55.7, 71.4) and Pacific (68.1%; 95% CI 60.1, 76.1) caregivers reported receiving information about pathophysiology (Other 75.9%; 95% CI 69.5, 82.3; p=0.05). Information about asthma action plans had been given to 22.7% (95% CI 15.5, 29.9) of Pacific and 32.9% (95% CI 25.3, 40.6) of Māori compared to Other participants (36.5%; 95% CI 28.6, 44.3; p=0.04). In addition, fewer Māori (64.2%; 95% CI 56.1, 72.3) and Pacific (68.5%; 95% CI 60.1, 77.0) reported that the information they received was clear and easy to understand (Other 77.9%; 95% CI 71.8, 84.1; p=0.03). About half of those who had received education from a health professional reported receiving further education and, after adjustment for potential confounders, Pacific caregivers were less likely to have been given further education (odds ratio 0.57; 95% confidence interval 0.33, 0.96). A minority of participants (35.3%) had heard about action plans and, after adjustment for potential confounders, Pacific caregivers were less likely to have heard about these plans (odds ratio 0.54; 95% confidence interval 0.33, 0.96). About 10% of the sample was considered to have a current action plan. The mean number of visits to a GP for acute and routine asthma care (excluding after-hours doctors and medical services) in the previous twelve months were significantly higher for Pacific (3.89; CI 3.28, 4.60) and Māori (3.56; CI 3.03, 4.16) children than Other ethnic group children (2.47; CI 2.11, 2.85; p<0.0001). Multivariable modelling of health service utilization outcomes (‘number of GP visits for acute and routine asthma care in the previous twelve months’, ‘high use of hospital emergency departments’, and ‘hospital admissions’) showed that adjustment for potential confounding and asthma management variables reduced, but did not fully explain, ethnic differences in these outcomes. Māori children experienced 22% more GP visits and Pacific children 28% more visits than Other children (p=0.05). Other variables that were significantly associated with a higher number of GP visits were: regular source of care they always used (regression coefficient (RC) 0.24; p<0.01); lower household income (RC 0.31; p=0.004) and having a current action plan (RC 0.38; p=0.006). Increasing age (RC -0.04; p=0.003), a lay source of asthma education (RC -0.41; p=0.001), and higher scores on asthma management scenario (RC -0.03; p=0.05) were all associated with a lower number of GP visits. Pacific (odds ratio (OR) 6.93; 95% CI 2.40, 19.98) and Māori (OR 2.60; 95% CI 0.87, 8.32) children were more likely to have used an emergency department for asthma care in the previous twelve months (p=0.0007). Other variables that had a significant effect on the use of EDs in the multivariable model were: not speaking English in the home (OR 3.72; 95% CI 1.52, 9.09; p=0.004), male sex (OR 2.43; 95% CI 1.15, 5.15; p=0.02), and having a current action plan (OR 7.85; 95% CI 3.49, 17.66; p<0.0001). Increasing age was associated with a reduced likelihood of using EDs (OR 0.90; 95% CI 0.81, 1.00; p=0.05). Hospitalisations were more likely in the Pacific (OR 8.94; 95% CI 2.25, 35.62) and Māori (OR 5.40; 95% CI 1.28, 23.06) ethnic groups (p=0.007). Four other variables had a significant effect on hospital admissions in the multivariable model. Participants who had a low income (OR 3.70; 95% CI 1.49, 9.18; p=0.005), and those who had a current action plan (OR 8.39; 95% CI 3.85, 18.30; p<0.0001) were more likely to have been admitted to hospital in the previous 12 months. Increasing age (OR 0.88; 95% CI 0.80, 0.98; p=0.02) and parental history of asthma (OR 0.39; 95% CI 0.18, 0.85; p=0.02) were associated with reduced likelihood of admission. Conclusions The study is a robust example of cross-sectional design and has high internal validity. The study population is representative of the population of children with asthma in the community. The three ethnic groups are also considered to be representative of those ethnic groups in the community. The study, therefore, has good representativeness and the findings of the study can be generalised to the wider population of children with asthma in the Auckland region. The results suggested that some aspects of pharmacological management were more consistent with guideline recommendations than in the past. However, given the higher burden of disease experienced by Māori and Pacific children, the lack of observed ethnic differences in the use of preventative medications may reflect under treatment relative to need. There are important ethnic differences in the provision of asthma education and action plans. Future approaches to improving care should focus on interventions to assist health professionals to implement guideline recommendations and to monitor ethnic disparities in their practice. Asthma education that is comprehensive, structured and delivered in ways that are effective for the people concerned is needed.

Whole document restricted, see Access Instructions file below for details of how to access the print copy. / This exploratory study investigates Traumatic Brain Injury (TBI) rehabilitation processes and outcomes among culturally diverse outpatients in community-based rehabilitation who have sustained a Mild to Moderate TBI. The major aims of this study are twofold: firstly, to determine whether community-based rehabilitation outcomes following TBI differ across Mäori, Pacific and Pakeha cultures; and secondly, to determine and identify any service delivery needs for Mäori and Pacific people in TBI rehabilitation that may be distinct from Pakeha. A fixed comparative non-experimental design was utilised where participants were selected using direct control based on their self-identified ethnic group resulting in sub-samples of 11 Mäori, l1 Pacific and 11 Pakeha (n=33). A "Close Other" from their care-giving support network was selected by the participant to take part in the study (n=20). Each participant completed the Neurobehavioural Cognitive Status Examination (Cognistat), the Brain Injury Community Rehabilitation Outcome Scales (BICRO Scales), the Client Satisfaction Questionnaire (CSQ-31), the Beck Depression Inventory, 2nd Edition (BDI-II), the Impact of Events Scale Revised (IES-R) and a semi-structured qualitative interview, while a "Close Other" completed a BICRO "Carer" questionnaire. Results indicate that all participants were at a homogenous level of overall cognitive functioning but Pacific peoples scored significantly lower than both Mäori and Pakeha on two Language subtests and significantly lower than Pakeha on the Memory subtest. Statistical analysis suggests that both Years of Formal Education and English as a Second Language are important factors contributing to these differences. Individual handicap increased following TBI and decreased following rehabilitation, with no significant difference across cultures and suggesting efficacy of rehabilitation. Of the total sample, 42% scored in the clinically depressed range (half of whom were Pakeha) and 24% of the sample showed mild signs of post-traumatic stress (of whom almost 90% were Mäori or Pacific). Although 97% of participants were generally satisfied with their overall rehabilitation service, Mäori and Pacific people were significantly less satisfied with their Physical Surroundings and the Quantity of Services they received. In conclusion, there appears to be universalities in TBI experience and global rehabilitation outcomes that transcends individual cultures. However, there are micro-level cultural variations that have valuable implications when planning culturally appropriate rehabilitation services for the future. For Mäori and Pacific People, acculturation levels will determine the extent to which these implications apply.

Cerebral palsy is one of the chronic conditions which have become a serious health burden worldwide. Consequently, this health burden involves healthcare as a whole, regardless of whether the focus is on the macro or micro system. Glaserian grounded theory was employed to explore and explain the experiences of families who have a child with cerebral palsy, particularly in the Thai cultural context. Unstructured interviews and participant observations were used along the process of data collection from 15 families who have a child with cerebral palsy. Data encompassed a variety of qualitative data sources: interviews, observational field notes, personal documents, pictures, drawings, and information from a literature review. The process of data analysis was guided by Glaserian grounded theory throughout the processes of constant comparative analysis to generate a substantive theory. The substantive theory comprised three core categories: Enduring despair, culture of obligation and responsibility and living with, which were integrated into the basic social psychological process of never-ending caring. The metaphor of a waterwheel was used to depict the basic process. The substantive theory of never-ending caring for a child with cerebral palsy provided an explicit understanding of the experiences of these families in day-to-day living with, and care of, a child with cerebral palsy. It is hoped that this understanding will be a constituent of health care - particularly of people with chronic conditions, whereby the practice of healthcare professionals will improve, thus enhancing the efforts of their work to achieve the ultimate goal of improving the quality of life of children with cerebral palsy and their families.

Events around conception such as maternal undernutrition and twinning may have effects on offspring physiology and disease risk in adulthood. Periconceptional undernutrition alters offspring physiology and adult pathology without affecting birth size, while twinning affects birth size and physiology but with inconsistent effects on adult pathology. We investigated the effects of these two periconceptional events and their interaction on maternal cardiovascular adaptation to pregnancy and fetal growth, physiology and endocrinology in late gestation in sheep. Pre and/or postconception undernutrition resulted in increased uterine blood flow in late gestation, but no change in maternal blood volume. Preconception undernutrition alone resulted in a relatively large placenta with a small, slow-growing fetus in late gestation. In contrast, postconception undernutrition alone resulted in a fetus with rapid late-gestation growth that was maintained through a maternal fast. Fetuses of ewes undernourished throughout both periods were similar in growth rate and size to controls. Maternal fasting also demonstrated that plasma levels of C-type natriuretic peptide are acutely and independently regulated by nutrient supply in mother and fetus. Fetuses of ewes undernourished both pre- and postconception had increased glucose disposal following a glucose challenge. Hypothalamic-pituitary-adrenal axis tests in these fetuses showed decreased pituitary adrenocorticotropin hormone response to direct stimulation but increased adrenal response to decreased cortisol negative feedback. Twin fetuses grew more slowly in late gestation than singletons. Twins also had a smaller insulin response to arginine and a greater insulin response to glucose, but periconceptional undernutrition abolished this difference. Twins had suppressed baseline hypothalamic-pituitary-adrenal axis function and decreased adrenal sensitivity compared to singletons, but increased fetal pituitary adrenocorticotropin hormone response to direct stimulation and decreased cortisol negative feedback. These studies suggest that firstly, fetal size is a poor reflection of fetal growth trajectory, physiology and endocrinology. Secondly, pre- and postconception undernutrition affect late-gestation fetal growth in different ways, while undernutrition in both periods alters fetal endocrine status in late gestation. Thirdly, the biology of twin fetal development is fundamentally different from that of singletons, which may explain the inconsistency of the relationship between birth weight and adult disease risk in twins. / Auckland Medical Research Foundation, Health Research Council of New Zealand

Events around conception such as maternal undernutrition and twinning may have effects on offspring physiology and disease risk in adulthood. Periconceptional undernutrition alters offspring physiology and adult pathology without affecting birth size, while twinning affects birth size and physiology but with inconsistent effects on adult pathology. We investigated the effects of these two periconceptional events and their interaction on maternal cardiovascular adaptation to pregnancy and fetal growth, physiology and endocrinology in late gestation in sheep. Pre and/or postconception undernutrition resulted in increased uterine blood flow in late gestation, but no change in maternal blood volume. Preconception undernutrition alone resulted in a relatively large placenta with a small, slow-growing fetus in late gestation. In contrast, postconception undernutrition alone resulted in a fetus with rapid late-gestation growth that was maintained through a maternal fast. Fetuses of ewes undernourished throughout both periods were similar in growth rate and size to controls. Maternal fasting also demonstrated that plasma levels of C-type natriuretic peptide are acutely and independently regulated by nutrient supply in mother and fetus. Fetuses of ewes undernourished both pre- and postconception had increased glucose disposal following a glucose challenge. Hypothalamic-pituitary-adrenal axis tests in these fetuses showed decreased pituitary adrenocorticotropin hormone response to direct stimulation but increased adrenal response to decreased cortisol negative feedback. Twin fetuses grew more slowly in late gestation than singletons. Twins also had a smaller insulin response to arginine and a greater insulin response to glucose, but periconceptional undernutrition abolished this difference. Twins had suppressed baseline hypothalamic-pituitary-adrenal axis function and decreased adrenal sensitivity compared to singletons, but increased fetal pituitary adrenocorticotropin hormone response to direct stimulation and decreased cortisol negative feedback. These studies suggest that firstly, fetal size is a poor reflection of fetal growth trajectory, physiology and endocrinology. Secondly, pre- and postconception undernutrition affect late-gestation fetal growth in different ways, while undernutrition in both periods alters fetal endocrine status in late gestation. Thirdly, the biology of twin fetal development is fundamentally different from that of singletons, which may explain the inconsistency of the relationship between birth weight and adult disease risk in twins. / Auckland Medical Research Foundation, Health Research Council of New Zealand

Events around conception such as maternal undernutrition and twinning may have effects on offspring physiology and disease risk in adulthood. Periconceptional undernutrition alters offspring physiology and adult pathology without affecting birth size, while twinning affects birth size and physiology but with inconsistent effects on adult pathology. We investigated the effects of these two periconceptional events and their interaction on maternal cardiovascular adaptation to pregnancy and fetal growth, physiology and endocrinology in late gestation in sheep. Pre and/or postconception undernutrition resulted in increased uterine blood flow in late gestation, but no change in maternal blood volume. Preconception undernutrition alone resulted in a relatively large placenta with a small, slow-growing fetus in late gestation. In contrast, postconception undernutrition alone resulted in a fetus with rapid late-gestation growth that was maintained through a maternal fast. Fetuses of ewes undernourished throughout both periods were similar in growth rate and size to controls. Maternal fasting also demonstrated that plasma levels of C-type natriuretic peptide are acutely and independently regulated by nutrient supply in mother and fetus. Fetuses of ewes undernourished both pre- and postconception had increased glucose disposal following a glucose challenge. Hypothalamic-pituitary-adrenal axis tests in these fetuses showed decreased pituitary adrenocorticotropin hormone response to direct stimulation but increased adrenal response to decreased cortisol negative feedback. Twin fetuses grew more slowly in late gestation than singletons. Twins also had a smaller insulin response to arginine and a greater insulin response to glucose, but periconceptional undernutrition abolished this difference. Twins had suppressed baseline hypothalamic-pituitary-adrenal axis function and decreased adrenal sensitivity compared to singletons, but increased fetal pituitary adrenocorticotropin hormone response to direct stimulation and decreased cortisol negative feedback. These studies suggest that firstly, fetal size is a poor reflection of fetal growth trajectory, physiology and endocrinology. Secondly, pre- and postconception undernutrition affect late-gestation fetal growth in different ways, while undernutrition in both periods alters fetal endocrine status in late gestation. Thirdly, the biology of twin fetal development is fundamentally different from that of singletons, which may explain the inconsistency of the relationship between birth weight and adult disease risk in twins. / Auckland Medical Research Foundation, Health Research Council of New Zealand