Māori Health Review Issue 7

A CD-ROM-based tutorial Addressing Parents Concerns About Childhood Immunizations: A Tutorial for Primary Care Providers has been developed. The tutorial provides information which explains the nature and origins of parents concerns, discusses the potential clinical implications of reluctance to vaccinate, and the professional and ethical obligations of physicians toward both parents and children. The aim of this study was to test the effectiveness of the tutorial. Subjects were 122 paediatric and family medicine residents at 7 training programmes across 4 states. A 26-item pretest/posttest was used to assess knowledge and attitudes. Improvements in residents’ general knowledge, knowledge of adverse effects of immunisation and attitudinal measures were both statistically and clinically significant. The authors suggest that use of the tutorial may help to improve communications between parents and primary care health providers on this subject.

This paper explores how Mäori sexuality was experienced in the pre-European era. Reference sources included historical accounts including oral histories, archival material and depictions of Mäori sexuality from art forms such as carvings. This was supplemented by more recent information from the Mäori Sexuality Project. The authors describe a view of Mäori sexuality which is markedly different from the Western colonialist view, as promoted by many Christian churches. They suggest that traditionally Mäori embraced sexual diversity and difference and discuss the implications of these findings in relation to the sexual rights and health of Mäori.

The authors report on progress toward developing stronger Mäori participation in the New Zealand health and disability workforce over the last 15 years. They note that “substantial progress” has been made, and that this should ensure a good basis for continuing efforts in this area. Factors which have contributed to this success include Mäori leadership, mentorship and peer support, and comprehensive support within study programmes, and in the transitions between school, university and work. The authors suggest that these approaches may also be valuable for health workforce development for other indigenous peoples.

This systematic review of 41 studies examined the effectiveness of interventions to combat youth violence. Interventions were classed as primary (universally implemented in order to prevent violence), secondary (selectively targeted toward youths at risk for violent behaviour) or tertiary (directed toward those with existing violent behaviour). Interventions which were effective (statistically significant) comprised 49% of those assessed. Interventions at the tertiary level were more likely to be effective than primary or secondary level interventions. In conclusion “increasing effectiveness was reported as the level of intervention increased from primary to tertiary. Approaches to evaluate prevention interventions need to be clarified and standardized.”

The authors critique a paper titled Skin infections of the limbs of Polynesian children which was published in the New Zealand Medical Journal on 23 April 2004 (http://www.nzma.org.nz/journal/11 7-11 92/847/). A number of issues were identified. These included a lack of description of how ethnicity was determined; failure to identify New Zealand Mäori as a distinct ethnic group, instead using the blanket term ‘Polynesian’; an inadequate analysis of the results which did not consider potentially key factors such as socioeconomic status and differential access to healthcare; and a suggestion that genetic factors might affect infection rates in Polynesian children. The authors find that the article “falls well short of the standard required of publication in a peer-reviewed journal” and question the rigour of the peer-review process. They conclude by providing a positive example of how a more comprehensive approach can address the same issues, citing a collaboration between Capital & Coast DHB, Hutt Valley DHB and Regional Public Health.

This book documents the evidence for racial and ethnic disparities in healthcare. The authors explore how disparities arise, how they are experienced and their consequences for the quality of healthcare received. They also analyse the attitudes, expectations and behaviour of patients and providers. Recommendations for areas where disparities could be reduced are outlined, including medical care, financing, allocation of care, availability of language translation, and community-based care. Opportunities for using cross-cultural education are discussed, and recommendations for data collection and research initiatives are provided.

Subjects in this cross-sectional study were 4,718 women aged 18 to 44 years who were at risk for type 2 diabetes due to a history of gestational diabetes mellitus. Racial and ethnic variations in access to healthcare, use of particular healthcare services, presence of cardiovascular risk factors, and perceptions of health and impairment were assessed using a national, population-based, random sample telephone survey. Around 20% of those surveyed had no primary healthcare provider and no health insurance and reported cost barriers to access healthcare. Suboptimal outcomes were reported across racial and ethic groups. The most disadvantaged group were Latin Americans: 40% had no health insurance and no primary care provider, and 25% reported suboptimal perceptions of health. The most advantaged group (in terms of healthcare access, cholesterol and blood pressure elevation, and impaired physical health) were Asians and Pacific Islanders. Healthcare access and other covariates did not fully explain racial and ethnic variations in healthcare use and presence of risk factors.

The Mäori Health Research team from Health Research Council (HRC) is taking its roadshow around the country between August 27 and September 7 2007.

The purpose of the roadshow is to profile HRC funding opportunities for Mäori health research.

For more information about meetings in each region or to request a presentation from the HRC at your organisation, please contact Everdina Fuli at efuli@hrc.govt.nz

The authors aimed to provide an accurate estimate of the prevalence of iron deficiency (ID) in New Zealand children aged 6 to 23 months. Subjects were identified from a random, ethnically stratified sample. Children with 2 or more of the following abnormal values were considered to have ID: serum ferritin (< 10 μg/L); iron saturation (< 10%); mean cell volume (< 73 fl). Overall prevalence of ID was 14% (95% CI 9 to 17%). There were significant associations between ID and ethnicity (Mäori 20%, Pacific 17%, other 27%, New Zealand European 7%, p = 0.005). Social deprivation did not predict ID. Multivariate analysis found a correlation between ID and BMI > 18.5 kg/m2 (RR 4.34, 95% CI 1.08 to10.67) and with receiving no infant or follow-on formula (RR 3.60, 95% CI 1.56–6.49). Children at increased risk of ID include those with more rapid growth, and those who receive milk other than infant or follow-on formula. These results suggest that cultural practices may influence iron status.

This 12-week pilot study tested the design and methodology for a future randomised controlled trial of interventions to promote healthier food purchasing. Participants were customers of the participating supermarket (in Wellington) and were the main shoppers for their household. Each was randomised to 1 of 4 trial conditions comprising price discounts, nutritional education, a combination of both, or no intervention. Data on purchases were collected using the ‘Shop ’N Go’ electronic purchase system. The study found this method of electronic data collection was an effective way to measure the effects of the study interventions. Participant follow-up rate was 98%, and 85% of supermarket purchases were captured by the data collection system. However the authors noted difficulties recruiting sufficient numbers of Mäori, Pacific and low-income participants.