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New Zealand introduced the quadrivalent human papillomavirus (4vHPV) vaccine (Gardasil®) on 1 September 2008 followed by the school-based arm of the vaccination programme from February 2009 and an initial catch-up programme through to the end of 2010, targeting women before they turned 20 years of age. This paper reports data on genital wart diagnoses among all new clients attending the Auckland Sexual Health Service (ASHS) from 1 January 2007 to 31 December 2013. Over the study period, 43,480 new clients were seen at ASHS and genital warts were diagnosed in 5,711 (13.1%). Of the 19,894 female new clients seen, ethnicity was recorded as: NZ European 39.5%, Māori 15.1%, Pacific Peoples 13.0%, Other 32.5%. There was a general decrease across time in the diagnoses of genital warts among all ethnic groups presenting to ASHS. For females, there was evidence of a difference in the rate of change over time in the proportion of genital warts diagnoses in the vaccine-eligible cohort compared to the vaccine-ineligible cohort (p=0.004). Whereas the proportion of females diagnosed with genital warts each year was fairly stable in the vaccine-eligible cohort pre-vaccine (RR=0.98), the risk of diagnosis decreased markedly over the 5 years after the introduction of the vaccine (RR=0.77). In comparison, there was only a small decrease in proportion of genital warts diagnoses among non-eligible females (pre-vaccine RR=0.87 vs post-vaccine RR=0.95). There was no such significant difference in rate change pre- to post-vaccine between younger and older men, eligible or not (p=0.53). Notably, Māori and Pacific young women had the largest decreases in genital warts diagnoses post-vaccine introduction (93.4% each) followed by NZ European (80.2%).
These researchers analysed responses from 15,822 participants in the 2014/15 New Zealand Attitudes and Values Study (NZAVS) longitudinal panel. Their analysis explored ethnic disparities in self-reported diagnosis of depression or an anxiety disorder by a doctor, relative to scores on the screening measure (the Kessler-6 scale) for these same forms of mental illness in a nationally representative sample of New Zealand adults. Māori, Pacific and Asian New Zealanders were more likely to score in the ‘at risk’ range of the Kessler-6 scale, indicating an increased likelihood of depression or anxiety, relative to European New Zealanders. However, the highest rate of actual diagnosis with depression or anxiety in the previous 5-year period was reported by European New Zealanders, rather than Māori, Pacific and Asian New Zealanders.
This paper reports on disparities in seclusion between Māori and non- Māori non-Pacific (nMnP) adults within New Zealand’s inpatient mental health facilities. Anonymised data were analysed from a New Zealand Ministry of Health dataset (PRIMHD) concerning 7,239 inpatient psychiatric admissions and 782 seclusion events for 9 district health boards (DHBs) (servicing 39% of the New Zealand population) from 1 July 2008 to 30 June 2010. Of all general adult psychiatric inpatient admissions for Māori, 15.2% included ≥1 seclusion event compared to 9.2% for nMnP admissions (p<0.001). Moreover, Māori male and female admissions to the inpatient unit were significantly more likely to be secluded than nMnP of the same gender. Of Māori male admissions, 16.7% were secluded compared with 10.7% of nMnP (p<0.001); 13.3% of Māori female admissions were secluded versus 7.6% of nMnP (p<0.001). Modelled seclusion event rate ratios for Māori compared to nMnP, sequentially adjusted for demographic and admission factors, revealed that Māori psychiatric inpatients are 39% more likely to experience a seclusion episode than nMnP adults in New Zealand. After fully adjusting for all sociodemographic variables (age, gender and NZDep06) and clinical characteristics (referral pathway, legal status and diagnosis on admission), the higher rate for Māori reduced slightly to 33%.
Outcomes are reported from an evaluation of the New Zealand Accident Compensation Corporation’s (ACC) ‘My Home is My Marae’ approach to injury prevention for whānau (families). Drawing from Māori models of health means that this approach is whānau inclusive (reflecting the hauora of the whānau), whānau empowering (improving knowledge and awareness of whānau to reduce, eliminate or isolate hazards in their whare), environmental (making changes in the home – te oa turoa) and physical (reducing the risk or incidence and/or severity of injury in the home – te taha tinana). From November 2013 to June 2014, 14 ‘My Home is My Marae’ trials were conducted across the South Auckland and Far North regions of New Zealand. All were delivered by local Māori providers of healthcare, education and social services. This evaluation team interviewed a purposive sample of 14 kaimahi (staff) from 6 of the provider organisations. A Kaupapa Māori theory-based methodology identified 5 key critical success factors in ‘My Home is My Marae’: mana tangata (reputation, respect and credibility); manākitanga (showing care for people); kānohi-ki-te-kānohi (face-to-face approach); capacity building for kaimahi, whānau and providers and ‘low or no cost’ solutions to hazards in the home. Data collected for the Far North area showed that 76% of the hazards identified could be resolved through ‘low or no cost’ solutions. No such data were available for South Auckland.
This paper details the efficiency and financial performance of New Zealand’s 20 DHBs in terms of achieving life expectancy (LE) gains for their Māori and European populations between 2006 and 2013. Data were analysed from period life tables produced by Statistics New Zealand for each ethnic group in each DHB using the 2006 and 2013 censuses. The data from these tables were combined with mortality data from the periods 2005–07 and 2012–14. The researchers found that the use of LE change is an effective indicator of managerial effectiveness. In all DHBs, LE improved for both Europeans and Māori, but at a greater rate for Māori. LE gains were unrelated to the proportion of Māori in the DHB in 2006 (correlation coefficient r=-0.16; p=0.49). Moreover, the change in Māori life expectancy was not associated with the initial LE in 2006 (r=0.19; p=0.42), suggesting that change was not limited at the upper end of the range. This was also true for Europeans (r=0.31; p=0.19). The efficiency of each DHB ranged from 79% to 100% and was significantly correlated with DHB financial performance.
This paper describes risk factors associated with infectious disease (ID) hospitalisation in infancy within a cohort of 6,846 New Zealand children, born in 2009–2010. In multivariable logistic regression analyses involving all children, factors associated with ID hospitalisation in the first year of life included Māori (OR 1.49; 95% CI, 1.17 to 1.89) or Pacific (OR 2.51; 95% CI, 2.00 to 3.15) versus European maternal ethnicity, male gender (OR 1.32; 95% CI, 1.13 to 1.55), low birthweight (OR 1.94; 95% CI, 1.39 to 2.66), exclusive breastfeeding for <4 months (OR 1.22; 95% CI, 1.04 to 1.43), maternal experience of healthcare racism (OR 1.60; 95% CI, 1.19 to 2.12), household deprivation (most vs least deprived quintile of households; OR 1.50; 95% CI, 1.12 to 2.02), daycare attendance (OR 1.43; 95% CI, 1.12 to 1.81) and maternal smoking (OR 1.55; 95% CI, 1.26 to 1.91). In separate analyses of Māori and Pacific children, factors associated with ID hospitalisation of Māori infants were high household deprivation (OR 2.16; 95% CI, 1.06 to 5.02) and maternal smoking (OR 1.48; 95% CI, 1.02 to 2.14); for Pacific infants, the factors included delayed immunisation (OR 1.72; 95% CI, 1.23 to 2.38), maternal experience of healthcare racism (OR 2.20; 95% CI, 1.29 to 3.70) and maternal smoking (OR 1.59; 95% CI, 1.10 to 2.29).
This US investigation assessed physiological and psychosocial variables over a 9-month period of an experimental YMCA-based after-school care programme, “Youth Fit 4 Life” (YF4L), involving 9–12-year-olds. Outcomes are reported for 86 pupils on the YF4L programme and 55 who enrolled in a typical care group for 45 min/day. YF4L is based on social cognitive theory, emphasising mastery over physical activities and the development of self-management/selfregulatory skills to support healthy behaviours. At baseline, 28% of the entire cohort were overweight or obese. At the 3- and 9-month time points, compared with typical care, YF4L was associated with significantly greater improvements from baseline in body mass index (BMI), as well as measures of self-regulation, mood, self-efficacy, cardiovascular endurance and strength. Changes in self-regulation, mood and self-efficacy significantly mediated the treatment type–BMI relationship over both 3 months (R2 = 0.12; p=0.002) and 9 months (R2 = 0.13; p=0.001); change in self-regulation was a significant independent mediator. Changes in BMI and self-regulation reciprocally reinforced one another. Gender did not significantly moderate those relationships.
These researchers developed a culturally tailored text message-based maternal health programme (TextMATCH: Text for MATernal and Child Health) for Māori, Pacific, Asian, and South Asian families living in New Zealand. Over an 18-month period, TextMATCH enrolled 1,404 participants; 260 (18.52%) actively opted out at some point (after 0 to 17 months of messages). A total of 356 participants actively switched from the initial pregnancy programme to the baby programme after delivery. After 18 months of implementation, telephone interviews were conducted with 29 participants, including 6 who had withdrawn (duration of programme from 3 to 16 months). Only 2 participants reported that the programme was not useful; the remainder indicated that the messages were very useful (average rating of 4.24 out of a score of 5). All participants stated that the messages were relevant, culturally appropriate, and easy to understand. Most were happy with the specific advice and the language options provided.
This paper describes the development of a relationship model for biobanks, He Tangata Kei Tua, that will enable best practice by addressing Māori ethical concerns. This model is intended to guide culturally informed policy and practice for biobanks in relation to governance, operational, and community engagement activities. The model is derived from key issues of relevance to Māori, which were identified by the Te Mata Ira research project conducted in 2012–2015. Te Mata Ira identified Māori perspectives on biobanking and genetic research, and together with tikanga Māori, it developed cultural guidelines for ethical biobanking and genetic research involving biospecimens. The model draws on a foundation of mātauranga (Indigenous knowledge) and tikanga Māori (Māori protocols and practices).
These researchers recruited 295 patients with newly diagnosed gout disease (duration <10 years) from primary and secondary care settings and followed them for a mean 5.1 years (a total 1511 patient years accrued). At the time of censorship, 14.6% had died (standardised mortality ratio 1.96). A reduced Cox proportional hazards model revealed that the following factors were independently associated with an increased risk of all-cause death: older age (70–80 years: HR 9.96; 80–91 years: HR 9.39), Māori or Pacific ethnicity (HR 2.48), loop diuretic use (HR 3.99), serum creatinine (per 10 μmol/L change; HR 1.04), and the presence of subcutaneous tophi (HR 2.85). The presence of subcutaneous tophi was the only baseline variable independently associated with both cardiovascular (CV) cause of death (HR 3.13) and non-CV cause of death (HR 3.48).
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Tēnā koutou katoa Nau mai, haere mai ki a Arotake Hauora Māori. We aim to
Tēnā koutou katoa Nau mai, haere mai ki a Arotake Hauora Māori. We aim to
Tēnā koutou katoa Nau mai, haere mai ki a Arotake Hauora Māori. We aim to
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