Māori Health Review Issue 3

This prospective cohort study assessed associations between involuntary job loss, mortality and serious illness over 8 years. The cohorts comprised workers from two meat-processing plants in Hawkes Bay, one which closed in 1986 (n = 1,945), and one which remained open until 1994 (n = 1,767). There was 96% complete follow-up for both cohorts. The relative risk of serious self-harm leading to hospitalisation or death was significantly increased for workers who had been made redundant (RR 2.47; 95% CI: 1.04-5.89). For workers made redundant the risk of admission to hospital with a mental health diagnosis was also significantly increased (RR 1.17; 95% CI: 0.68-2.01). None of the other findings were significant. The authors concluded that involuntary job loss increased the risk of mental distress leading to serious self-harm.

Women enrolled in the Nurses’ Health Study provided the data for this prospective, nested, case-control study. A total of 79,439 women, with no history of cardiovascular disease or cancer, were followed-up for 24 years to determine the relationship between aspirin use and mortality risk. The relative risk of all-cause mortality was reduced in women who reported current aspirin use compared to those with no regular aspirin use (RR 0.75; 95% CI 0.71-0.81). Mortality from cardiovascular disease (RR 0.62; 95% CI 0.55-0.71) and cancer (RR 0.88; 95% CI 0.81-0.96) was also reduced. Cardiovascular mortality benefits were achieved with 1-5 years of aspirin use (RR 0.75; 95% CI 0.61-0.92), whereas risk of cancer mortality was not significantly reduced until after 10 years of aspirin use (Plinear trend = 0.005). Only low and moderate aspirin doses were beneficial. Greater benefits were observed in older participants and those with more cardiovascular risk factors.

The authors analysed 14 studies looking at the effects of a single session of exercise (vs a passive condition) on cigarette cravings, withdrawal symptoms and smoking behaviour. Participants refrained from smoking during exercise in all but 1 study. Exercise induced a rapid reduction in cigarette cravings, withdrawal symptoms and negative affect, which was maintained for up to 50 minutes. The mean reduction in ‘strength of desire to smoke’ was 1.1 (SD 0.9) at 10 minutes post-exercise. The reduction in cravings and withdrawal symptoms was observed at different exercise intensities, from as high as 60–85% heart rate reserve (HRR) (lasting 30–40 minutes) to as low as 24% HRR (lasting 15 minutes), and also with isometric exercise (for 5 minutes). The authors noted that distraction was probably not the primary reason for the effects.

The impact of different interventions on smoking cessation in 209 smokers hospitalised with acute cardiovascular disease was assessed in this study. Patients were randomised to treatment with intensive antismoking intervention (comprising a minimum of 12 weeks of behaviour modification counselling plus individualized pharmacotherapy provided at no cost to the participant) or usual care consisting of counselling and printed educational material provided prior to hospital discharge. At 24 months, rates of continuous smoking cessation amongst subjects in the intensive intervention group were 33% versus 9% in the control group (p < 0.001). There were significant reductions in hospitalisations (RRR 44%; p = 0.007) and all-cause mortality in the study group (RRR 77%; p = 0.014) vs controls). The absolute risk reduction in mortality was 9.2% (NNT 11). The authors conclude that hospitalised smokers, especially those with cardiovascular disease, should receive intensive smoking cessation interventions.

The effects of maternal seafood intake during pregnancy on neurodevelopment outcomes in children was examined using 11 ,875 pregnant female participants from the Avon Longitudinal Study of Parents and Children (ALSPAC). Seafood intake was rated as none, some (1–340 g/week), and >340 g/week using a food frequency questionnaire at 32 weeks gestation. (Current US guidelines suggest a limit of 340g/week of seafood in pregnancy.) There was an increased risk of children being in the lowest quartile for verbal intelligence quotient with no seafood consumption (OR 1·48; 95% CI 1·16–1·90) or some seafood consumption (OR 1·09; 95% CI 0·92–1·29). Increased risk of suboptimal outcomes for prosocial behaviour, fine motor, communication, and social development scores was also observed in association with a low maternal seafood intake.

The authors assessed the prevalence of insulin resistance, impaired fasting glycaemia, impaired glucose tolerance, and diabetes mellitus in 589 randomly selected individuals aged > 25 years from the Ngati Porou Hauora Register. A questionnaire and anthropometric measures were used to determine the effectiveness of different ways of identifying individuals with insulin resistance. Rates of diabetes (10.6%) and insulin resistance (37.0%) were high in this population. Diabetes was most prevalent in those aged 60-69 (34.1%), whereas rates of insulin resistance were highest amongst participants aged 30-39 (44.3%). Factors more common in insulin-resistant individuals were gout and family history of diabetes. These individuals also had greater waist circumferences, higher blood pressure, and lower levels of HDL cholesterol. The authors note that given the links between insulin resistance, cardiovascular risk and development of type 2 diabetes, the high rates of insulin resistance in younger members of this population are of particular concern.

The authors conducted a systematic review and meta-analysis in order to assess the effectiveness of pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance. The analysis included 21 randomised, controlled trials, reporting data for 8,084 patients. For lifestyle interventions compared to standard advice, the hazard ratio (HR) was 0.51 (95% CI 0.44-0.60), NNTB 6.4 (95% CI 5.0- 8.4). For oral diabetes drugs vs control HR 0.70 (95% CI 0.62-0.79), NNTB 10.8 (95% CI 8.1-15.0). For orlistat vs control HR 0.44 (95% CI 0.28-0.69), NNTB 5.4 (95% CI 4.1-7.6). For the herbal remedy jiangtang bushen vs standard diabetes advice HR 0.32 (95% CI 0.03-3.07), NNTB 4.0 (95% CI NNTH 16.9 to NNTB 24.8). In conclusion the authors note that both lifestyle and pharmacological interventions reduce the rate of progression to type 2 diabetes to a similar degree.

The authors discuss disparities in health for Mäori in relation to measures of socioeconomic deprivation. They identify 3 specific areas of importance with regard to disparities. The first is a ‘distribution gap’. This relates to the skewed geographic distribution of Mäori toward more deprived areas: 56% live in areas ranked in the 3 lowest deciles. There is also an ‘outcome gap’, which relates to differences in outcome which are still observed once deprivation is controlled for. The third area is a ‘gradient gap’. This is described as the relationship between ethnicity and increasing deprivation. It appears that increasing deprivation compounds risk for Mäori but not for Pakeha. The authors suggest that the design and provision of healthcare services should be informed by both a disparities focus, and a development focus.

Te Ohu Rata o Aotearoa (Mäori Medical Practitioners) Hui aTau and Scientific Meeting 2007, 5th and 6th May, Tangata Marae Matamata This is the eleventh annual meeting for Te ORA. The theme the conference is ‘Tohungia te pae tawhiti – Determining the future’ with a focus on achieving equity in health outcomes for Mäori and setting a timeline for that goal. For more information, contact Lorraine Byers at 0800 4 TEORA (0800 4 83672) or teora@teora.Ma.ori.nz Launch for ‘Hauora IV – Mäori Health Standards 1991 to 2004’ Known for providing high quality Mäori health statistics, the latest in the Hauora series – Haoura IV – will be launched on 28 June 2007 at the Wellington School of Medicine. Hauora IV not only provides the latest in Mäori health data. Expert commentaries are also presented in chapters that cover many of the major health issues faced by Mäori including diabetes, cancer, cardiovascular disease and mental health. Four Hauora workshops will be provided in order to acquaint people with the data. These will be held in Hawkes Bay, Auckland, Christchurch and Wellington in late 2007/early 2008. For more information contact Dr Fiona Cram on email fionac@katoa.net.nz

The authors discuss the use of human rights discourse as a framework for arguing that the Australian Government has an international obligation to improve Indigenous health. Two potential directions for this discourse are examined. These focus on the human right to health, and the interactions between health and human rights. The authors find that there is a limited opportunity to improve the health of Indigenous Australians through international law in relation to both legal and moral imperatives. In their conclusions they note that barriers to using this framework to improve Indigenous health include some which are perpetuated by the Australian Government. However, despite the governments hostility toward including human rights considerations into its public policy decision making, human rights discourse “does provide a sustainable intellectual framework in which to consider the social and structural determinants of health and maintain these issues on the political agenda.”