Māori Health Review Issue 49

These University of Otago researchers analysed data from three waves of a panel study providing information on mental health, psychological distress, labour force status, household income, area and individual deprivation, in this investigation into changes in multiple socioeconomic measures and mental health/illness over time within individuals. The data were analysed by fixed-effects regression modelling to control for time-invariant unobserved confounders. Moving into inactive labour force status was associated with a 1.34 unit decline in SF-36 mental health score and a 0.50 unit increase in psychological distress score. Increased individual deprivation resulted in a 1.47 unit decline in mental health score and a 0.57 unit increase in psychological distress. Increasing and decreasing levels of individual deprivation were associated with significant changes in both outcomes.

This paper reports data from a nationwide audit of androgen deprivation therapy (ADT) and chemotherapy treatment for prostate cancer undertaken in New Zealand men within the first year after prostate cancer diagnosis. The study population included 15,947 men diagnosed with prostate cancer between 2006 and 2011; 4978 (31%) were prescribed ADT or chemotherapeutic agents. ADT was dispensed for 72% of men with metastatic disease, while only 24 men (0.2%) received chemotherapeutic agents. Age-adjusted analyses revealed that compared with younger men, older men (>70 years) with advanced (regional or metastatic) disease were more likely to receive anti-androgens only and to be treated with orchidectomy. Māori and Pacific men (compared with non-Māori/ non-Pacific men) were more likely to receive pharmacological ADT; Māori men were also more likely to be treated with orchidectomy

This paper examines demographic and geographic factors associated with non- attendance for first specialist assessment (FSA) in publicly-funded New Zealand rheumatology services and it suggests changes in service provision that might improve attendance rates. The study researchers collected administrative data for 1953 new referrals over a 2-year period from a single public rheumatology unit. Non-attendance was found to be associated with ethnicity, age and waiting times. Māori and Pacific Peoples were each almost twice as likely to miss a FSA (p=0.02; OR 1.87; 95% CI 1.11 to 3.15 and OR 1.89; 95% CI 1.11 to 3.22) as New Zealand Europeans. Patients aged 20–29 years were least likely to attend appointments (p≤0.001; OR 2.81; 95% CI 1.59 to 4.98). Non-attendance was independently associated with longer waiting times to FSA; the uneven provision of services and being domiciled further from the main rheumatology clinic were strong predictors of longer waiting times (p≤0.001).

This US-based study investigated individual and joint associations of the home environment and the neighbourhood-built environment with adolescent dietary patterns and body mass index (BMI) z-score. Data were analysed from 2682 racially/ethnically and socioeconomically diverse adolescents (53.2% girls; mean age 14.4 years) attending Minnesota middle and high schools who participated in the EAT (Eating and Activity in Teens) 2010 study. Study participants completed height and weight measurements and surveys. In multiple regression analyses, supportive family environments (i.e., higher family functioning, frequent family meals, and parent modelling of healthful eating) were associated with higher adolescent fruit and vegetable intake, lower fast food consumption, and lower BMI z-score. Fewer associations were observed between the built environment and adolescent outcomes. Evidence indicated that the relationship between a supportive family environment and adolescent fruit and vegetable intake and BMI was enhanced when the neighbourhood was supportive of healthful behaviour.

Outcomes are reported in this paper from a survey involving patients with rheumatic fever treated with four weekly intramuscular (IM) benzathine penicillin injections in the Counties Manukau District Health Board (CMDHB) region. The survey evaluated the effectiveness of 0.25 mL of lignocaine 2% and a vibrating device with cold pack (Buzzy) for pain management of their injections. Patients were also questioned about their fear. The lignocaine was mixed in with the benzathine penicillin prior to administration. Pain scores were assessed during, at 2 min and 1 hour after administration and the following day. Pain at injection delivery and fear scores were higher for participants aged ≤13 years. Overall pain scores were significantly reduced with lignocaine and Buzzy over all four time points and there was a corresponding significant reduction in fear of the injections. Lignocaine and Buzzy resulted in a greater reduction in pain than lignocaine alone, only when the injection was being administered to those ≤13 years. Results of a file audit undertaken five months later showed that 66% of all rheumatic fever patients of CMDHB were choosing to use lignocaine and 43% were choosing to use Buzzy. In total, 71% of all rheumatic fever patients were choosing one or both of these analgesic interventions.

This study investigated the effectiveness of a school-based health program for Indigenous Australian students in Brisbane, between April and October 2013. The Deadly Choices? health education program was delivered weekly at 6 education facilities to participants from years 7 to 12 over 7 weeks. One school that received the Deadly Choices program the following term acted as the control group. All participants were surveyed immediately prior to and after the intervention to assess its impact upon knowledge, attitudes, self-efficacy and behaviours in relation to chronic disease and associated risk factors. Participants within the intervention group reported mostly significant improvements over time for questions relating to knowledge, attitudes and self-efficacy regarding leadership, chronic disease and risk factors. They also reported significant changes in regard to breakfast frequency (p=0.002), physical activity frequency (p≤0.001), fruit (p=0.004) and vegetable (p≤0.001) intake. Overall, there were few significant differences between the control and intervention groups regarding health attitudes and behaviours; considerably more improvements were observed relating to self-efficacy and knowledge of chronic disease and associated risk factors between groups. The program also facilitated 30 Aboriginal and Torres Strait Islander health checks for participants.

This paper describes the gap between the health and well-being status of Indigenous people living in remote areas of northern Australia and non-Indigenous Australians. This disparity is predicted to increase over time, due to direct and indirect impacts resulting from expected large increases in hot spells in desert regions and more extremes in rainfall in other areas of the north. The paper argues that it is time to explicitly draw on Indigenous definitions of health, which directly address the need to connect individual and community health to the health of their country, in order to develop effective climate adaptation and health strategies. The authors explain how current health policies overlook this ‘missing’ dimension of Indigenous connection to country, and why that is likely to be detrimental to the health and well-being of people living in remote communities in a climatechanged future.

This assessment of Māori experiences of aphasia therapy sought to determine what makes a service culturally safe as well as “accessible to and culturally appropriate for” Māori with aphasia and their whānau. In-depth semistructured interviews were undertaken with 11 Māori with aphasia and 23 of their nominated whānau members. They reported a wide variety of experiences of aphasia therapy, embedded within 6 themes: We’re happy to do the work, but we can’t do it alone; Relationship; Our worldview; The speech language therapy setting; Aphasia resources; and Is this as good as it gets? While some Māori with aphasia reportedly received an accessible and culturally appropriate service, others did not. The paper highlights the importance of a strong therapeutic relationship for Māori with aphasia. It advises that therapy will be successful when there is collaboration between the clinician and whānau, with therapy resources that affirm the identity of the person with aphasia.