Māori Health Review Issue 12

This study used the Demirjian method to assess dental maturation to compare development rates in children of three ethnic populations living in New Zealand (Mäori, Pacific Island, and European). Examinations of orthopantomographs of 1,343 children (623 females and 660 males) between the ages of 2.5 and 14 years indicated a dental age consistently lower than the children’s chronological age. According to regression analyses, the difference between dental and chronological age was significantly greater in Mäori than in European children (regression coefficient 0.414) and also significantly greater in Pacific Island children than in European children (regression coefficient 0.574). Further regression analyses revealed a significant difference between boys and girls for the 50th quantile maturity score (by 1.49) and a significant difference for the interaction of sex and age. Similarly, the maturity score was significantly higher for Mäori girls (1.28), although the age/interaction slopes were not significantly different between Mäori boys and girls.

This presentation discusses outcomes from an evaluation of the Health Sponsorship Council Smokefree Homes campaign, using information from five population surveys conducted annually since 2003. The overall goal of the campaign was to increase the number of parents and caregivers implementing and enforcing strategies to reduce exposure of children to second-hand smoke in homes and cars. Of between 2,000 and 2,500 adults surveyed each year, 500 to 1000 identified as Mäori. The survey data reveal greater responsiveness among Mäori parents and caregivers than people who do not identify as Mäori, with a large reduction in second-hand smoke exposure in Mäori caregivers’ homes.

These researchers aimed to determine whether parental smoking is a consistent risk factor for adolescent smoking, and whether maternal and paternal effects combine additively or multiplicatively, by examining data from annual national cross-sectional surveys (2002–2004 combined) with a multi-ethnic sample of 91,219 Year 10 students from New Zealand who answered a questionnaire on personal and parental smoking. The results showed that maternal smoking and paternal smoking were associated separately with an increased risk of daily adolescent smoking in all ethnic groups except paternal smoking in Asian youth. In each ethnic group, after adjusting for age and sex, the relative risk of adolescent daily smoking was significantly higher for maternal only smoking compared with paternal only smoking: Asians 5.50 (95% CI 3.55 to 8.52), Europeans 1.38 (1.26 to 1.52), Pacific Islanders 1.38 (1.10 to 1.73), and Mäori 1.10 (1.00 to 1.21). The excess maternal effect varied inversely with smoking prevalence. The net effects of maternal and parental smoking were additive for European, Mäori, and Pacific Island students, but multiplicative in Asian. Overall, about 40% of adolescent daily smokers could be attributed to parental smoking.

This study investigated how Mäori, Pacific Island, European, and Asian school students access cigarettes, with a special focus on their disposable income. Students aged 11–15 years were recruited through schools to participate in 12 focus groups taken by ethnically matched senior student facilitators and researchers. Students reported that cigarettes are easy for young people to buy from tobacco retailers, that they are affordable (50 cents for a roll-your-own) and available on an “I owe you” basis from friends and social suppliers, or given freely by family members or adults on the street. Students used money from family, and money that was earned, “scabbed”, and borrowed from friends. Students also reported spending small amounts on cigarettes, saved out of money provided by parents for lunches and other purposes. Students were open to parental advice on how to use money but felt they should have the final say.

This report is an overview of published population-based stroke incidence studies and other relevant research in the multi-ethnic New Zealand population, with a particular emphasis on Mäori and Pacific populations. The researchers highlight the fact that the stroke epidemiology data are skewed unfavourably towards Mäori and Pacific people and they call upon health providers to introduce effective measures and delivery systems with urgency, in order to reverse this trend and improve Mäori and Pacific people’s health.

These researchers examined data from 6,789 patients who had cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia at 369 hospitals participating in the National Registry of Cardiopulmonary Resuscitation, to determine the prevalence of delayed defibrillation (>2 minutes) in the US and its effect on survival. The overall median time to defibrillation was 1 minute; delayed defibrillation occurred in 2,045 patients (30.1%). Multivariate logistic regression analysis identified the following characteristics as being associated with delayed defibrillation; Black race, noncardiac admitting diagnosis, and occurrence of cardiac arrest at a hospital with <250 beds, in an unmonitored hospital unit, and during after-hours periods (5 p.m. to 8 a.m. or weekends). After adjusting for differences in patient and hospital characteristics, significantly fewer patients survived to hospital discharge when defibrillation was delayed than when it was not (22.2% vs 39.3%). In addition, a graded association was seen between increasing time to defibrillation and lower rates of survival to hospital discharge for each minute of delay (p for trend <0.001).

In European Caucasian men, insulin sensitivity is negatively associated with intramyocellular lipid (IMCL) content, which may provide an early marker of diabetes risk. This study aimed to determine whether vastus lateralis IMCL content contributes to insulin sensitivity in 21 healthy Mäori men (mean age 28 years), all of whom had normal fasting blood glucose at baseline. According to multiple regression analysis incorporating the homeostasis model assessment of insulin resistance (HOMA-IR) as the dependent variable, increased body fatness and decreased aerobic capacity (per kg lean body mass) were significant predictors of insulin sensitivity as estimated by HOMAIR, and elevated vastus lateralis IMCL concentrations failed to predict insulin sensitivity.

This study reports recommendations developed by the US Society of General Internal Medicine Health Disparities Task Force, following a review and consensus process of health curricula. These recommendations specify that a curricula address 3 areas of racial and ethnic health disparities and focus on specific learning objectives:1) examining and understanding attitudes, such as mistrust, subconscious bias, and stereotyping, which practitioners and patients may bring to clinical encounters; 2) gaining knowledge of the existence and magnitude of health disparities, including the multifactorial causes of health disparities and the many solutions required to diminish or eliminate them; and 3) acquiring the skills to effectively communicate and negotiate across cultures, languages, and literacy levels, including the use of key tools to improve communication

These researchers surveyed 3,080 medical students at 5 US medical schools in 2006, using validated instruments to explore differences in the prevalence of burnout, depressive symptoms, and quality of life (QOL) among minority and nonminority medical students as well as the role that race/ethnicity plays in students’ training experiences. The response rate was 55%. Burnout was reported by 47% of students and depressive symptoms by 49%. Mental QOL scores were lower among students than among the age-matched general population (43.1 vs 47.2). While the prevalence of depressive symptoms was similar regardless of minority status, burnout was reported by significantly more nonminority students (39% vs 33%). They were more likely to report that their race/ethnicity had adversely affected their medical school experience (11% vs 2%) and cited racial discrimination, racial prejudice, feelings of isolation, and different cultural expectations as causes. Those minority students who reported such experiences were significantly more likely to experience burnout, depressive symptoms, and low mental QOL scores than were minority students without such experiences.

This report details the successful outcomes of a school-based rheumatic fever primary prevention programme set up in 2002 in Whangaroa, Northland, New Zealand. Prior to the intervention, rheumatic fever (RF) notifications in children aged 5–14 years in Whangaroa (424 per 100,000) exceeded those for all of Northland, New Zealand, and international notification rates. A hui held in Whangaroa in June 2001 agreed on the following approach: 3 times weekly swabbing of school children with sore throats; referral of positive cultures to the medical centre; oral amoxycillin for 10 days; education about the importance of sore throats (i.e. that infection with group A Streptococcus pyogenes can lead to the development of severe postinfectious sequelae such as RF and rheumatic heart disease); and a community-owned partnership approach. The intervention began on 25 February 2002; the last case of rheumatic fever was notified 8 days later.

These researchers sought to determine risk factors for lupus nephritis including clinical, laboratory, and ethnic factors in a cohort of lupus patients from two teaching hospitals in Auckland, New Zealand, after attending as either an inpatient, or a rheumatology outpatient between 2000 and 2005. 170 patients met American College of Rheumatology (ACR) systemic lupus erythematosus (SLE) classification criteria. Clinical, laboratory, and ethnic data were gathered from the patient notes. Twenty-four patients had lupus nephritis (LN) at diagnosis and 32 patients developed LN after diagnosis. Significant associations were observed between LN and the following variables; serositis, cutaneous vasculitis, anaemia, elevated CRP at >6 months after diagnosis, and hypocomplementaemia at >6 months after diagnosis. Patients with high doublestranded DNA (>5 x normal) were significantly more likely to develop type IV LN. Forty-one percent of patients were Caucasian, 12% Mäori, 23% Pacific People, 16% Asian, 6% Indian. The risk for developing LN was higher for Mäori patients with SLE (odds ratio [OR] 8.47), and Pacific People (OR 3.11). Independent risk factors for developing LN after SLE diagnosis included anaemia at presentation (hazard ratio [HR] 3.2) and a low complement at >6 months (HR 3.4).