Cannabis and methamphetamine in New Zealand: a Kaupapa Māori literature review
Future research on cannabis and methamphetamine use in New Zealand must make an explicit commitment to be of benefit to Māori, and implement Kaupapa Māori-consistent research approaches. This was the finding of a Kaupapa Māori review which analysed 30 literature sources, the majority of which were journal articles. Research mainly utilised quantitative survey data collection methods, focused on large population groups and investigated individual characteristics of cannabis and/or methamphetamine users. A general population approach was taken in most articles, with Māori only briefly mentioned, or differences in drug use assessed between Māori and others. The value of focusing on drug use, rather than drug users, was highlighted in more recent research either led by Māori or undertaken with a critical lens.
An excellent, and timely, review of the literature on this topic. I think a Kaupapa Māori approach to relevant legislation, to ensure adequate consultation and due consideration to its impacts, is also critical here (e.g. legalising cannabis and now the re-introduction of pseudoephedrine).
Reference: N Z Med J. 2023;136(1584):73-83.
Reflections on the Prospective Outcomes of Injury Study (POIS; 2006-2023): how population-based research can address Māori outcomes and governance
The Prospective Outcomes of Injury Study (POIS) has influenced Accident Compensation Corporation (ACC) research strategy and outcomes focus, according to researchers from the Ngāi Tahu Māori Health Research Unit at Otago University, Dunedin. The study has provided disability, health, and wellbeing outcomes knowledge that was previously unavailable, especially for Māori, they noted. POIS recruited 2856 injured New Zealanders with an ACC entitlement claim between 2007 and 2009, of whom 20% were Māori. Detailed information was shared by participants (at 3, 12 and 24 months, and 12 years post-injury) regarding injury, socio-demographics, health, health services access, employment and wellbeing. In-depth interviews were also undertaken, and administrative data about injury-related hospitalisations, the sentinel injury and subsequent injuries were collected.
This reads as a reflection on undertaking Kaupapa Māori health research – the wider impacts on leadership and policy development, improvements to data collection, storage and analysis, but also how there is so much to do with tight timelines, budgets, and reporting requirements. How do we capture the relevant yet often ignored benefits of Kaupapa Māori research?
Reference: Front Res Metr Anal. 2023;8:1212827.
Utility of big data to explore medication adherence in Māori and Non-Māori community-dwelling older adults with heart failure in Aotearoa New Zealand
A national cross-sectional study has highlighted significant disparity between Māori and non-Māori in medication adherence for heart failure. The study included 13,743 assessments for older community-dwelling adults with heart failure, including 1526 in Māori, between 2012 and 2019. Mean participant age was 74.5 years for Māori and 82.3 years for non-Māori. A total of 21.8% of those in the Māori cohort did not adhere fully to their medication regimen, compared with 12.8% of those in the non-Māori cohort. The adjusted prevalence ratio for medication non-adherence in Māori vs non-Māori was 1.53 (95% CI 1.36-1.73). The study authors noted that their results are transferable to other countries, allowing the identification of underserved ethnic groups for which culturally appropriate interventions can be targeted.
: I’m working with a team of Māori and Pacific researchers (https://www.manawafatu. org/) on hospital discharge ‘activities’ for Māori and Pacific people with heart failure. Preliminary results suggest it’s not so much an issue of being ‘appropriate’ as being clinically and culturally unsafe. Discharge letters are confusing and inconsistent, patients are told to see their GP but can’t afford/access GPs in time, management plans don’t suit peoples’ lives/contexts and people are becoming more unwell and dying as a result. Dr Sandra Hanchard is leading work to resolve this – please contact her if you are interested in knowing more.
Reference: Drugs Aging. 2023;40(9):847-855.
Childhood cancer incidence & survival in Aotearoa, New Zealand 2010-2019
While childhood cancer incidence and survival rates in New Zealand remain comparable with other high-income countries, 5-year survival is lower in Māori and Pacific peoples compared with nonMāori. This was the finding of a study involving 1522 children aged <15 years, diagnosed with cancer between 2010 and 2019. The age-standardised incidence of cancer was 169.1 (95% confidence interval [CI] 157.0-181.2) per million per year, and the overall 5-year survival rate was 85.6% (95% CI 83.7-87.3). When analysed according to ethnicity, 5-year survival rate was 80.9% (95% CI 76.5-84.6) for Māori, 82.6% (95% CI 75.6-87.7) for Pacific peoples and 87.8% (95% CI 85.6-89.7 for non-Māori. Differences in survival were most marked among children aged 1-14 years at diagnosis in both adjusted and unadjusted models.
The authors call for further research to “understand the survival differences” but I wonder if we already know enough about causes (differential exposure to the wider determinants of wellbeing including poverty, differences in access to and quality of care through health systems for tamariki and tai tamariki Māori) and should now focus on solutions. Some evidence-based and best-practice examples – more Māori doctors and health workers, cutting tobacco and vaping exposure, eliminating child poverty.
Reference: Cancer Epidemiol. 2023;86:102433.
The prescribing of cardioprotective medications and the impact on survival for patients with peripheral artery disease that undergo intervention
A study of cardioprotective medication prescribing in patients with peripheral artery disease (PAD) has highlighted areas of deficiency, namely for women and Māori men. The study assessed 2547 patients who had undergone PAD-related percutaneous and surgical intervention between 2010 and 2021 in the Midland region of New Zealand. Overall, 80.7% of patients received a prescription for antihypertensive medication, 77.4% for lipid-lowering medication and 89.9% for antithrombotic medication. Patients with concomitant ischaemic heart disease were more likely to be prescribed cardioprotective medication. Women were less likely to be prescribed lipid-lowering medication than men, while Māori men were less likely to be prescribed antiplatelet medication compared with non-Māori men. Lipid-lowering and antiplatelet medication showed a survival advantage on univariate analysis, while antihypertensive and anticoagulant medication did not. Best medical therapy was associated with better survival after adjustment for age, sex, end stage renal failure and presence of chronic limb-threatening ischaemia (hazard ratio 0.88, 95% CI 0.79-0.98).
So best practice medical treatment was associated with better survival, yet was not prescribed for Māori men over the last decade.
Reference: ANZ J Surg. 2023;93(10): 2376-2381.
Indigenous food sources as vectors of Escherichia coli and antibiotic resistance
There is a need to limit or reduce human pathogenic bacteria where wild food is gathered, with shellfish able to promote dissemination of antibiotic resistance. These were the findings of a survey of Escherichia coli (E. coli) and antibiotic resistance in aquatic foods and water in North Canterbury. Antibioticresistant bacteria were found on watercress (Nasturtium officinale) and cockles (Austrovenus stutchburyi). Greenshell/lip mussels (Perna canaliculus) kept in a tank with environmentally relevant concentrations of E. coli were colonised to levels considered unsafe for human consumption within 24 hours. Measurement of horizontal gene transfer between bacteria within the mussels showed that transmission frequency of plasmid RP4 was significantly higher in mussels than in water alone.
Canterbury researchers and Kai Tahu are leading the way in terms of protecting wai and for the wellbeing of people, and vice versa. Importantly they don’t blame the kai collection but instead focus on strategies to reduce harm to the water, the kai, matauranga Māori (traditional collection) and us.
Reference: Environ Pollut. 2023;334:122155.
Examining spatial variation for immunisation coverage in pregnant women
A nationwide study of all pregnant women who delivered between 2013 and 2020 found suboptimal maternal immunisation coverage, with significant spatio-temporal variation and clustering in coverage. The study determined receipt of the influenza or pertussis vaccine using any one of three relevant national databases (National Immunisation Register, Proclaims, Pharmaceutical collection) during the eligible pregnancy. Maximal maternal immunisation coverage was around 50% in the best performing regions, meaning approximately 183,737 pregnant women were not protected. The authors noted that their study was one of the first to examine spatial variation in maternal immunisation coverage in pregnant women at a national level over space and time, and provides tools to measure the impact of interventions aimed at improving immunisation coverage.
Reference: Soc Sci Med. 2023;335:116228.
Interventions to improve vaccine coverage of pregnant women in Aotearoa New Zealand
Healthcare professionals need to proactively engage with pregnant women regarding maternal immunisation and collaborate in service delivery, according to a survey of individuals from the vaccination workforce. Interview participants (n = 6) were involved in education, certification and supporting vaccinators, high-level strategising, and vaccination. They noted that interventions must emphasise the importance of maternal immunisation, promote collaboration and innovation, make interventions accessible, and empower Māori- and Pacific-driven avenues to vaccination. Participants identified the importance of building and maintaining trust, and affording women time and autonomy in vaccination.
Two great papers providing practical information for clinicians and services who aspire to protect hapu māmā equitably.
Reference: J Prim Health Care. 2023;15(3):230- 237.
“I haven’t even taken them to the doctors, because I have that fear of what to expect ”: a qualitative description study exploring perceptions and experiences of early childhood healthcare among ethnically diverse caregivers in Aotearoa New Zealand
Ensuring trusting relationships and positive health encounters for ethnically diverse caregivers of preschool children requires a non-judgemental, competent, and culturally sensitive approach by healthcare professionals and services. This was the finding of a qualitative study of 145 caregivers who identified as Māori, Pacific, Asian and/or European. Caregivers relied on multiple sources of health information, in particular trusting providers or other caregivers who had children. They were often disappointed that health providers did not build trusting relationships to support positive experiences. Caregivers often felt judged by providers when accessing care and felt pressure to conform. They were frustrated by slowness and fragmentation of the health system. Caregivers had to be proactive and assertive to ensure their child received care amidst numerous barriers, including discrimination and bias. Policies are required to alleviate the indirect costs of accessing healthcare, prioritising of whānau/family-centred car
An excellent piece of research from this team. Reading it reminded me of a nursing colleague’s experience with her child who had multiple health and disability hospital admissions. Her amazing ability to ‘navigate complexity’ was recorded as ‘over-demanding mother’ in the ‘Disease Classifications’ section.
Reference: Lancet Reg Health West Pac. 2023;40:100882.
A retrospective observational study of the management of non-traumatic dental presentations at a tertiary centre in New Zealand: a Choosing Wisely approach
Non-traumatic dental presentations (NTDPs) may receive suboptimal care in emergency departments (EDs), according to a study of presentations to the Christchurch Hospital ED in 2020. A total of 931 individuals with dental pain or dental abscesses were included, with over-representation of young adults, Māori, Pacific peoples and those living in high-deprivation areas. An orthopantomogram was performed in 37% of patients, and was considered low value in 24% of cases. Of patients managed by ED staff who were not referred to specialist dental services, 42% were prescribed antibiotics, of whom only half had facial swelling, and 71% were prescribed analgesia, including an opiate in 78% of cases. Definitive treatment was given in fewer than 20% of NTDPs. Continuing to provide care for NTDPs in the ED setting may increase healthcare costs and contribute to poor opioid and antimicrobial stewardship, the study authors concluded.
Further evidence to keep oral health (and disease prevention including smoking cessation) on the health agenda!
Reference: N Z Med J. 2023;136(1582):14-27.
