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Anderson, Lynley Carol, and n/a. "Stress fractures : ethics and the provision of sports medicine at the elite level in New Zealand." University of Otago. Dunedin School of Medicine, 2005. http://adt.otago.ac.nz./public/adt-NZDU20060911.150036.
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The provision of medical care to top-level athletes in New Zealand comes with a number of challenging ethical issues. Some of these arise out of the commercial interest present in sport that links sporting success with funding, sponsorship deals and media interest. The requirement that athletes stay at peak physical function in order to be successful can, at times, be at odds with concepts of well-being and good health. The employment structure under which doctors are engaged by teams and the employment contracts which define these relationships can be the source of divided loyalty for doctors. For example, sharing health information beyond the doctor-athlete relationship may be in line with contractual obligations, but at odds with what the athlete requests. Divided loyalties also exist when athletes wish to participate in sport despite high risk of harm. Here there is a difference between what the doctor understands as the athlete�s best interest, and the athlete�s consideration of best interest.
This thesis adopts two strategies for examining the area of sports medicine in elite athletes in New Zealand. The first section utilizes qualitative research. Sixteen sports doctors were interviewed and the data analysed. The next section involves normative reflection. Here two issues (where a range of behaviours were exhibited by participants) selected from the data are considered and discussion is presented on how doctors should respond to these issues. An examination of the level of guidance offered to sports doctors from the Australasian College of Sports Physician�s Code of Ethics follows. The level of guidance offered is considered inadequate and the thesis ends with a call to attend to these concerns.
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Qualtere-Burcher, Paul. "The just distance : a new biomedical principle /." Connect to title online (Scholars' Bank), 2008. http://hdl.handle.net/1794/8687.
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Oh, Kirsten S. "The new ethics and its implications for the character and role of nursing." Theological Research Exchange Network (TREN), 1998. http://www.tren.com.
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Rind, Esther Christiane. "Investigating the spatial distribution of campylobacteriosis in New Zealand." Thesis, University of Canterbury. Geography, 2007. http://hdl.handle.net/10092/1464.
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Background Infection with Campylobacter is thought to account for about 5% - 14% of all food and waterborne diarrhoea cases worldwide. By international standards, New Zealand has extremely high rates of campylobacteriosis which are thought to be the highest reported rates worldwide. The incidence has been steadily increasing since 1980 (when the disease became notifiable), reaching a peak of cases in 2003 (396/100,000). Although different surveillance systems complicate international comparisons, New Zealand's particularly high rate still lacks a conclusive explanation. Aims This study investigates the geographical distribution of campylobacteriosis in New Zealand and the relative importance of factors assumed to be affecting the distribution of this disease, including those related to climate, landuse, water and food. The approach aims to explain why certain areas might increase the probability of becoming infected. Methodology A Geographical Information System (GIS) is used to visualise the disease rate, investigate potential disease clustering and identify outliers. Hierarchical regression, including the analysis of residuals, is applied to analyse the variables in their complex interrelation and to investigate whether there is statistical evidence explaining the geographical variation in campylobacteriosis. This study is undertaken at the territorial local authority level, as all required data are available at this spatial scale and covers the period 1997 to 2005. Results and conclusion There is a large geographical variation in campylobacteriosis across New Zealand, ranging from an average annual rate of 97/100,000 to 526/100,000 per territorial local authority (TLA). Generally, there is statistical evidence for global and local clustering of the disease rate. There are upper and lower outliers of campylobacteriosis in New Zealand; however, higher rates primarily appear in the South Island. The hierarchical modelling confirms statistical significance for some of the environmental and sociodemographic variables. The final model explains about 58% of the variation in campylobacteriosis, and the residuals reflect this variation relatively accurately in approximately 75% of all TLAs. Although the evaluation of the results is confronted with a number of challenges, it is concluded that socioeconomic and demographic factors are crucial factors in explaining the observed spatial patterns in the notification data.
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Crengle, Suzanne Marie. "The management of children's asthma in primary care : Are there ethnic differences in care?" Thesis, University of Auckland, 2008. http://hdl.handle.net/2292/4957.
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Whole document restricted until August 2010, see Access Instructions file below for details of how to access the print copy.<br>Abstract Background Asthma is a common problem in New Zealand, and is associated with significant morbidity and costs to children, their families, and wider society. Previously published New Zealand literature suggested that Māori and Pacific children were less likely than NZ European children to receive asthma medications and elements of asthma education, had poorer knowledge of asthma, and experienced greater morbidity and hospitalisations. However, none of the previous literature had been specifically designed to assess the nature of asthma care in the community, or to specifically answer whether there were ethnic disparities in care. A systematic review of studies published in the international literature that compared asthma management among different ethnic groups drawn from community-based samples was undertaken. The results of this review suggested that minority ethnic group children were less likely to receive elements of asthma medication use, asthma education and self-management (action) plans. Objectives The primary objectives of the study were to: • describe the use of medications, medication delivery systems, asthma education, and self-management plans in primary care for Māori, Pacific, and Other ethnic group children • ascertain whether there were any ethnic disparities in the use of medications, medication delivery systems, asthma education, and self-management plans in primary care after controlling for differences in socio-economic position and other potential confounders. Secondary objectives were to: • describe the asthma-related utilisation of GP, after hours medical care, emergency departments, and hospital admissions among Māori, Pacific, and Other ethnic group children with asthma • ascertain whether differences in medication use, the provision of asthma education, and the provision of self-management plans explained ethnic differences in health service utilisation. Methods A cross-sectional survey was conducted in Auckland, New Zealand. The caregivers of 647 children who were aged 2–14 years, had a diagnosis of asthma or experienced ‘wheeze or whistling in the chest’, and had experienced symptoms in the previous 12 months were identified using random residential address start points and door knocking. Ethnically stratified sampling ratios were used to ensure that approximately equal numbers of children of Māori, Pacific and Other ethnicity were enrolled into the study. A face-to-face interview was conducted with the caregivers of these children. Data was collected about: socio-demographic factors; asthma morbidity; asthma medications and delivery devices; exposure to, and experiences of, asthma education and asthma action plans; and asthma-related health services utilisation. Results In this study, the caregivers of 647 eligible children were invited to participate and 583 completed the interview, giving an overall completion rate of 90.1%. There were no ethnic differences in completion rates. The overall use of inhaled corticosteroid medications had increased since previous New Zealand research was published. Multivariable modelling that adjusted for potential confounders did not identify ethnic differences in the use of inhaled corticosteroids or oral steroids. Some findings about medication delivery mechanisms indicated that care was not consistent with guidelines. About 15% of participants reported they had not received asthma education from a primary care health professional. After adjusting for potential confounders there were no ethnic differences in the likelihood of having received asthma education from a health professional. Among those participants who had received education from a primary care health professional, significantly fewer Māori and Pacific caregivers reported receiving education about asthma triggers, pathophysiology and action plans. Lower proportions of Pacific (77.7%; 95% confidence interval (95%CI) 70.3, 85.1) and Māori (79.8%; 95% CI 73.6, 85.9) caregivers were given information about asthma triggers compared to Other caregivers (89.2%; 95% CI 84.9, 93.6; p=0.01). Fewer Māori (63.6%; 95% CI 55.7, 71.4) and Pacific (68.1%; 95% CI 60.1, 76.1) caregivers reported receiving information about pathophysiology (Other 75.9%; 95% CI 69.5, 82.3; p=0.05). Information about asthma action plans had been given to 22.7% (95% CI 15.5, 29.9) of Pacific and 32.9% (95% CI 25.3, 40.6) of Māori compared to Other participants (36.5%; 95% CI 28.6, 44.3; p=0.04). In addition, fewer Māori (64.2%; 95% CI 56.1, 72.3) and Pacific (68.5%; 95% CI 60.1, 77.0) reported that the information they received was clear and easy to understand (Other 77.9%; 95% CI 71.8, 84.1; p=0.03). About half of those who had received education from a health professional reported receiving further education and, after adjustment for potential confounders, Pacific caregivers were less likely to have been given further education (odds ratio 0.57; 95% confidence interval 0.33, 0.96). A minority of participants (35.3%) had heard about action plans and, after adjustment for potential confounders, Pacific caregivers were less likely to have heard about these plans (odds ratio 0.54; 95% confidence interval 0.33, 0.96). About 10% of the sample was considered to have a current action plan. The mean number of visits to a GP for acute and routine asthma care (excluding after-hours doctors and medical services) in the previous twelve months were significantly higher for Pacific (3.89; CI 3.28, 4.60) and Māori (3.56; CI 3.03, 4.16) children than Other ethnic group children (2.47; CI 2.11, 2.85; p<0.0001). Multivariable modelling of health service utilization outcomes (‘number of GP visits for acute and routine asthma care in the previous twelve months’, ‘high use of hospital emergency departments’, and ‘hospital admissions’) showed that adjustment for potential confounding and asthma management variables reduced, but did not fully explain, ethnic differences in these outcomes. Māori children experienced 22% more GP visits and Pacific children 28% more visits than Other children (p=0.05). Other variables that were significantly associated with a higher number of GP visits were: regular source of care they always used (regression coefficient (RC) 0.24; p<0.01); lower household income (RC 0.31; p=0.004) and having a current action plan (RC 0.38; p=0.006). Increasing age (RC -0.04; p=0.003), a lay source of asthma education (RC -0.41; p=0.001), and higher scores on asthma management scenario (RC -0.03; p=0.05) were all associated with a lower number of GP visits. Pacific (odds ratio (OR) 6.93; 95% CI 2.40, 19.98) and Māori (OR 2.60; 95% CI 0.87, 8.32) children were more likely to have used an emergency department for asthma care in the previous twelve months (p=0.0007). Other variables that had a significant effect on the use of EDs in the multivariable model were: not speaking English in the home (OR 3.72; 95% CI 1.52, 9.09; p=0.004), male sex (OR 2.43; 95% CI 1.15, 5.15; p=0.02), and having a current action plan (OR 7.85; 95% CI 3.49, 17.66; p<0.0001). Increasing age was associated with a reduced likelihood of using EDs (OR 0.90; 95% CI 0.81, 1.00; p=0.05). Hospitalisations were more likely in the Pacific (OR 8.94; 95% CI 2.25, 35.62) and Māori (OR 5.40; 95% CI 1.28, 23.06) ethnic groups (p=0.007). Four other variables had a significant effect on hospital admissions in the multivariable model. Participants who had a low income (OR 3.70; 95% CI 1.49, 9.18; p=0.005), and those who had a current action plan (OR 8.39; 95% CI 3.85, 18.30; p<0.0001) were more likely to have been admitted to hospital in the previous 12 months. Increasing age (OR 0.88; 95% CI 0.80, 0.98; p=0.02) and parental history of asthma (OR 0.39; 95% CI 0.18, 0.85; p=0.02) were associated with reduced likelihood of admission. Conclusions The study is a robust example of cross-sectional design and has high internal validity. The study population is representative of the population of children with asthma in the community. The three ethnic groups are also considered to be representative of those ethnic groups in the community. The study, therefore, has good representativeness and the findings of the study can be generalised to the wider population of children with asthma in the Auckland region. The results suggested that some aspects of pharmacological management were more consistent with guideline recommendations than in the past. However, given the higher burden of disease experienced by Māori and Pacific children, the lack of observed ethnic differences in the use of preventative medications may reflect under treatment relative to need. There are important ethnic differences in the provision of asthma education and action plans. Future approaches to improving care should focus on interventions to assist health professionals to implement guideline recommendations and to monitor ethnic disparities in their practice. Asthma education that is comprehensive, structured and delivered in ways that are effective for the people concerned is needed.
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White, Jill Fredryce. "The commodification of caring : a search for understanding of the impact of the New Zealand health reforms on nursing practice and the nursing profession : a journey of the heart /." Title page, table of contents and abstract only, 2004. http://web4.library.adelaide.edu.au/theses/09PH/09phw5822.pdf.
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Guy, Laurie. "Worlds in Collision: The Gay Debate in New Zealand 1960-86." Thesis, University of Auckland, 2000. http://hdl.handle.net/2292/2346.
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This thesis examines the public debate on homosexuality in New Zealand in the period 1960-86. Its focus is primarily on male homosexuality because the central issue was the continued criminalization of male same-sex sexual acts. The thesis notes irresolvable problems of definition of homosexuality involving discussions of behaviour, orientation and identity. Nevertheless, the debate proceeded on a binary basis, that homosexuals and heterosexuals were two clearly defined groups of people. The thesis begins by noting the repression and invisibility of homosexuals in the 1960s. It then explores the origins and significance of the New Zealand Homosexual Law Reform Society and the gay liberation movement. Because of the significance of religion in regard to the debate, a chapter is devoted to major change and cleavage that occurred within the churches relating to homosexuality in the period reviewed. Finally the intense fifteen months of debate that occurred prior to decriminalization of male homosexual activity in July 1986 is studied at depth. The thesis highlights the intensity of feeling that the debate engendered. This was the result of the clash of fundamentally different worldviews and value systems. Behind the particular issue lay the question of the moral and social status of homosexuals and homosexual acts. So fundamental was this division that from both sides the very future of society seemed to be at stake. Worlds were in collision.<br>Note: Thesis now published. Guy, L (2002). Worlds in collision : the gay debate in New Zealand, 1960-1986. Wellington [N.Z.]: Victoria University Press, 2002. ISBN 0864734387
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Poa, Nicola. "Molecular Genetics of Type 2 Diabetes in New Zealand Polynesians." Thesis, University of Auckland, 2004. http://hdl.handle.net/2292/692.
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The risk of developing type 2 diabetes is four fold higher in New Zealand(NZ) Polynesians compared to Caucasians. Hence diabetes is more prevalent in Maori (16.5% of the general population) and Pacific Island people (10.1%) compared to NZ Caucasians (9.3%). It is generally accepted that type 2 diabetes has major genetic determinants and heterozygous mutations in a number of genes have previously been identified in some subsets of type 2 diabetes and certain ethnic groups. The high prevalence of diabetes in NZ Polynesians, when compared with NZ Caucasians, after controlling for age, income and body mass index (BMI), suggest that genes may be important in this population. Therefore, the prevalence of allelic variations in the genes encoding amylin and insulin promoter factor-1 (IPF-1), and exon 2 of the hepatocyte nuclear factor-1α (HNF-1α) gene in NZ Polynesians with type 2 diabetes was determined. These genes are known to produce type 2 diabetes in other populations. The genes investigated were screened for mutations by PCR amplification and direct sequencing of promoter regions, exons and adjacent intronic sequences from genomic DNA. DNA was obtained from 146 NZ Polynesians (131 Maori and 15 Pacific Island) with type 2 diabetes and 387 NZ Polynesian non-diabetic control subjects (258 Maori and 129 Pacific Island). Sequences were compared to previously published sequences in the National Centre for Biotechnology Information database. Allelic variations in IPF-1 and exon 2 of the HNF-1α gene were not associated with type 2 diabetes in NZ Polynesians. However, in the amylin gene, two new and one previously described allele was identified in the Maori population including: two alleles in the promoter region (-132G>A and -215T>G), and a missense mutation in exon 3 (QlOR). The -215T>G allele was observed in 5.4% and l% of type 2 diabetic and non-diabetic Maori respectively, and predisposed the carrier to diabetes with a relative risk of 7.23. The -215T>G allele was inherited with a previously described amylin promoter polymorphism(-230A>C) in 3% of Maori with type 2 diabetes, which suggests linkage equilibrium exists between these two alleles. Both Q10R and -132G>A were observed in 0.76% of type 2 diabetic patients and were absent in non-diabetic subjects. Together these allelic variations may account for approximately 7% of type 2 diabetes in Maori. These results suggest that the amylin gene maybe an important candidate marker gene for type 2 diabetes in Maori.
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Rout, Matthew William. "To Define & Control: The Utility of Military Ethics in the New Zealand Army's Contemporary Operational Environment." Thesis, University of Canterbury. Social and Political Sciences, 2009. http://hdl.handle.net/10092/3048.
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Military ethics serve as a normative code of behaviour for the armed forces of a state, acting as a mechanism of definition and control within the force, between the force and its client, and between the force, its adversaries and the wider public. They have two, intrinsically linked, functions: a preventative function, which defines the moral and legal parameters of conduct, and a constructive function, which creates and maintains an effective and controllable force. Preceded by the code of chivalry, they were largely a creation of the era of conventional interstate warfare that was waged across the European continent from the Treaty of Westphalia through to the desolate end of the Second World War; yet, the operations upon which armed forces, and in particular, the New Zealand Army are deployed have changed, dramatically. Wars no longer, current operations are generally justified on moral principles and involve a multinational, joint and interagency deployment sent to intervene in an irregular, intrastate conflict occurring in an underdeveloped region and conducted under the intense glare of the media.
This disjuncture between the changing nature of operations and the context in which military ethics were formulated provides the fundamental question for the thesis: if the milieu in which military ethics developed has changed significantly, what is their current utility? Using the New Zealand Army as the frame of reference, first the contemporary operational environment and then the specific operational environment in Timor-Leste were examined to assess the current utility of military ethics. It was found that the preventative function has an increasing utility because it ensures conduct is within expected norms in an era where the perception of the adversary, the local populace and the domestic and international audience is key to operational success. Despite the reduction in conflict intensity, the constructive function has a remaining utility through its mediation and amelioration of the stressors engendered by the growing complexity of the operational environment. The retention of utility for the constructive function appears to have been facilitated by an adaptation of the warrior ethos, from a narrow traditional outlook to a broad and comprehensive modern interpretation.
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Goldie, John G. S. "A focused evaluation of ethics education in Glasgow University's new medical curriculum, 1996-2001." Thesis, University of Glasgow, 2005. http://theses.gla.ac.uk/5424/.
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The introduction of the new Glasgow medical curriculum provided an opportunity for evaluation of ethics education in the context of a modern curriculum. The constraints imposed prevented a comprehensive evaluation of ethics teaching in the new curriculum. Its focus had to be narrowed. This thesis builds on a dissertation submitted for a MMEd Degree at Dundee University, which covered the evaluation of ethics education in the first year of the new curriculum and produced the first three papers in the series being presented. It was decided to perform both process and outcome evaluation in year 1, where the largest proportion of formal curricular ethics sessions takes place. Outcome evaluation continued throughout the curriculum. The aims of the first year process evaluation were: 1) To judge the value of the curricular experiences provided for students in terms of: a) Acceptability to both students and tutors. b) Feasibility. c) Relevance of material to aims of teaching. 2) To judge the effectiveness of clinical tutors as facilitators of learning. The aim of the outcome evaluation was to test the following hypotheses: 1. Small group ethics teaching, in the first year of an integrated medical curriculum, will have a positive impact on students’ potential behaviour when facing ethical dilemmas. 2. The effect will be greater than that produced by a discrete lecture and large group teaching based course early in a traditional curriculum. 3. Students’ performance will be adversely affected as they progress through the medical curriculum. 4. The effect will be less pronounced in students undertaking the modern curriculum compared to those undertaking the traditional curriculum.
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Bourke, Catherine Therese. "Exploring the links between knowledge, power and silence in New Zealand’s discursive formation on therapeutic sexual exploitation." Thesis, University of Canterbury. Educational Studies and Human Development, 2010. http://hdl.handle.net/10092/5113.
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In this dissertation, Foucault’s methodologies, archaeology and genealogy, are used to explore the links between silence, knowledge and power in the area of therapeutic sexual exploitation. Underpinning this task is Foucault’s theoretical assumption that knowledge is not scientifically constructed through objective and rational methods. Knowledge, under Foucault’s theoretical framework, is influenced by the more obscure conditions of possibility which affect power relations and, therefore, power-knowledge. Therefore, New Zealand’s scientific discourse around therapeutic sexual exploitation is analysed by moving between the discursive and the extra-discursive. This is undertaken to highlight the more obscure conditions of possibility which may have affected the political construction of knowledge and its material effects in the area of therapeutic sexual exploitation.
New Zealand’s academic discourse on therapeutic sexual exploitation is examined with reference to the social conditions which have influenced the origins of counselling and psychotherapy in New Zealand. This includes an exploration of the links between counselling and psychotherapy to other New Zealand based psy-professions. In particular, an investigation is conducted as to how disciplinary procedures have been applied to those connected to, and affected by, therapeutic sexual exploitation. This, however, is studied by locating New Zealand’s discourse within an international discourse on therapeutic sexual exploitation. This wider lens shows how New Zealand’s discourse around therapeutic sexual exploitation, as other countries’ discourses on this matter, has developed in response to local social conditions and changing power relations.
Through this broader analysis of New Zealand’s discursive formation on therapeutic sexual exploitation one can see the interplay between silence, knowledge and power, and its material effects on the lives on people. This dissertation highlights not only what knowledge-power might be restricting, but also what it might be producing in the area of therapeutic sexual exploitation, the impacts of which, it will be argued, extends well beyond the particular domain under examination.
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Kerr, Karolyn. "The institutionalisation of data quality in the New Zealand health sector." Thesis, University of Auckland, 2006. http://hdl.handle.net/2292/1899.
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This research began a journey towards improved maturity around data quality management in New Zealand health care, where total data quality management is 'business as usual" institutionalised into the daily practices of all those who work in health care. The increasingly information intensive nature of health care demands a proactive and strategic approach to data quality to ensure the right information is available to the right person at the right time in the right format, all in consideration of the rights of the patient to have his/her health data protected and used in an ethical way. The work extends and tests principles to establish good practice and overcome practical barriers. This thesis explores the issues that define and control data quality in the national health data collections and the mechanisms and frameworks that can be developed to achieve and sustain good data quality. The research is interpretive, studying meaning within a social setting. The research provides the structure for learning and potential change through the utilisation of action research. Grounded theory provides the structure for the analysis of qualitative data through inductive coding and constant comparison in the analysis phase of the action research iterative cycle. Participatory observation provided considerable rich data as the researcher was a member of staff within the organisation. Data were also collected at workshops, focus groups, structured meetings and interviews. The development of a Data Quality Evaluation Framework and a national Data quality Improvement Strategy provides clear direction for a holistic and 'whole of health sector' way of viewing data quality, with the ability for organisations to develop and implement local innovations through locally developed strategies and data quality improvement programmes. The researcher utilised the theory of appreciative enquiry (Fry, 2002) to positively encourage change, and to encourage the utilisation of existing organisational knowledge. Simple rules, such as the TDQM process and the data quality dimensions guided the change, leaving room for innovation. The theory of 'complex systems of adjustment' (Champagne, 2002; Stacey, 1993) can be instilled in the organisation to encourage change through the constant interaction of people throughout the organisation.
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O'Leary, John A. "A theological critique of the development of the New Jersey Catholic advance healthcare directive." Theological Research Exchange Network (TREN), 1994. http://www.tren.com.
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Chatterton, Christopher. "Metabolic Syndrome : the construction of a 'new' medical problem and the socio-ethical consequences." Thesis, Cardiff University, 2014. http://orca.cf.ac.uk/58973/.
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The work presented here is a sociological and bioethical analysis of the medical condition known as Syndrome X/Metabolic Syndrome. The term is a recent name given to a group of cardiac/diabetic risk factors that include high cholesterol, insulin resistance, obesity, high blood pressure and high fat levels in the blood (Garber 2004). Interest in the topic was reawakened by Reaven (1988) who first coined the term ‘Syndrome X’ to describe a cluster of risk factors that he believed was linked to insulin resistance. In recent years the number of ‘new’ diseases that have been detected and identified by medicine has increased rapidly, with examples such as clinical obesity and infertility. Commentators have speculated as to why this may be happening and one suggestion is that our lives are becoming ever more medicalised (Moynihan and Smith 2002). The thesis consists of three main strands. The first strand is a sociological analysis of the Metabolic Syndrome concept and how it came to be constructed as a medical condition, with particular emphasis on whether the syndrome represents an example of the medicalisation of obesity. The second strand looks at the relationship between sociology and bioethics, and whether research from the former can help inform the ethical debate in the other. In this regard, I hope to show in this thesis that it is possible to conduct social and bioethical analyses side by side, and that these can be complementary and give you a richer understanding of a topic. The third strand is a discussion of the main ethical issues surrounding this ‘new’ diagnosis, with particular emphasis on the issue of blame and responsibility in relation to this condition.
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Horsburgh, Simon, and n/a. "A feasibility study of occupational exposure and acute injury outcome information collection methods for New Zealand agricultural workers." University of Otago. Dunedin School of Medicine, 2006. http://adt.otago.ac.nz./public/adt-NZDU20060831.110516.
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Background: Agricultural workers in New Zealand have high rates of occupational injury compared to most other occupational groups. They are also over-represented in work-related fatal injury statistics. While it is recognised that the personal and social costs of occupational injuries to agricultural workers are considerable, the ability to develop and evaluate evidence-based injury control strategies for this group has been limited by the lack of quality information on occupational exposures and injury events.
Aim: The aim of this thesis was to develop and pilot a comprehensive occupational exposure and acute injury outcome data collection system for agricultural workers which will provide an evidence base for a public health approach to acute occupational injury control within the agricultural sector of New Zealand. The thesis objectives were therefore to:
* Develop study methods to collect occupational exposure and injury outcome information.
* Assess the likely validity of these study methods.
* Determine the feasibility of implementing the study methods.
* Suggest modifications to the study methods to enhance their validity and feasibility.
Methods: Pastoral farms in the Waitaki region of New Zealand were identified using a database of New Zealand farm owners. The owners and workers on these farms were contacted and asked to participate. Participants were required to complete an Initial Questionnaire which included items on farm and personal characteristics, the farm environment, training, safety perceptions and attitudes and safety behaviour. Participants were then monitored for six months. During the monitoring period each participant completed a monthly log of their work activities during the preceding week. Any work-related injuries to workers on participating farms were also recorded and reported monthly. Participants who were injured were followed up for an interview to obtain detailed injury event information. At the end of the monitoring period a second Questionnaire was administered to assess change during the study. Participants were asked about any occupational injury events during the study as part of one of the monthly logs and the second Questionnaire to provide a comparison measure to the monthly reports. A random third of participating farms were visited at the end of the study to assess the validity of participants� reports on the farm environment.
Results: Sixty-two farms were recruited into the study, a recruitment rate of 24%. This resulted in 82 study participants. Fifty-seven farms and 72 participants completed the study, resulting in retention rates of 92% and 88% respectively. Return of study items was high, with the lowest observed level of return being 92%. Levels of response error were low in most of the study items, with exceptions being the recording of the hours spent handling animals (37%) and total hours worked (22%). Most postal items (over 68%) were returned before a reminder call was made.
Participants� reports about the farm environment closely matched the observations made during the visits, with little evidence of significant misreporting. The validity of reported injury events during the study could not be determined, as the two methods of capturing injury events identified different events.
Conclusions: Within the limitations of the study, most of the study methods appeared to be feasible and have acceptable validity. The low recruitment rate and issues with validating the capture of injury events indicated that modifications to the study design were necessary to achieve acceptable validity and feasibility, however. Recommendations were made on how feasibility and validity might be improved.
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Miles, Mary Alice, and n/a. "A critical analysis of the relationships between nursing, medicine and the government in New Zealand 1984-2001." University of Otago. Faculty of Education, 2006. http://adt.otago.ac.nz./public/adt-NZDU20061024.145605.
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This thesis concerns an investigation of the tripartite arrangements between the government, the nursing and the medical sectors in New Zealand over the period 1984 to 2001 with a particular focus on primary health care. The start point is the commencement of the health reforms instituted by the Fourth New Zealand Labour Government of 1984. The thesis falls within a framework of critical inquiry, specifically, the methodology of depth hermeneutics (Thompson, 1990), a development of critical theory.
The effects of political and economic policies and the methodologies of neo-liberal market reform are examined together with the concept of collaboration as an ideological symbolic form, typical of enterprise culture.
The limitations of economic models such as public choice theory, agency theory and managerialism are examined from the point of view of government strategies and their effects on the relationships between the nursing and medical professions.
The influence of American health care policies and their partial introduction into primary health care in New Zealand is traversed in some detail, together with the experiences of health reform in several other countries.
Post election 1999, the thesis considers the effect of change of political direction consequent upon the election of a Labour Coalition government and concludes that the removal of the neo-liberal ethic by Labour may terminate entrepreneurial opportunities in the nursing profession. The thesis considers the effects of a change to Third Way political direction on national health care policy and on the medical and nursing professions. The data is derived from various texts and transcripts of interviews with 12 health professionals and health commentators.
The histories and current relationships between the nursing and medical professions are examined in relation to their claims to be scientific discourses and it is argued that the issue of lack of recognition as a scientific discourse is at the root of nursing�s perceived inferiority to medicine. This is further expanded in a discussion at the end of the thesis where the structure of the two professions is compared and critiqued. A conclusion is drawn that a potential for action exists to remedy the deficient structure of nursing. The thesis argues that this is the major issue which maintains nursing in the primary sector in a perceived position of inferiority to medicine.
The thesis also concludes that the role of government in this triangular relationship is one of manipulation to bring about necessary fundamental change in the delivery of health services at the lowest possible cost without materially strengthening the autonomy of the nursing or the medical professions.
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Yazdani, Anuschirawan. "The professional and personal impact of the Australian and New Zealand comprehensive gynaecological surgery training program on specialists in training and third-party stakeholders." Thesis, Queensland University of Technology, 2022. https://eprints.qut.edu.au/235134/1/Anuschirawan_Yazdani_Thesis.pdf.
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This research explores why specialists undertake further training in advanced gynaecological surgery, how and why such training pathways develop and how they are regulated.
This research advocated for the acceptance of alternative training pathways and shaped postgraduate medical education and workforce planning.
Through a mixed-methods approach, this thesis constructs a historical timeline as the foundation for a critical analysis of the professionalization of operative gynaecology and establishes the main reasons for advanced training as the development of surgical competency, recognition, certification, and involvement in academic activities, emphasizing the training unit, surgical case load, a structured curriculum and peer group.
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Villers, Trevor. "A thematic analysis of recent PHARMAC new medicines' subsidy decisions." Click here to access this resource online, 2008. http://hdl.handle.net/10292/386.
Full textAbstract:
PHARMAC, the Pharmaceutical Management Agency, manages the Pharmaceutical Schedule on behalf of the Government. The Agency is tasked with securing the best health outcomes that are reasonably achievable from pharmaceutical treatment and from within the amount of funding provided (§ 47 NZPHD Act, 2000). The Agency reports that it continues to improve New Zealanders’ access to funded medicines. In determining which pharmaceuticals to fund, PHARMAC’s Operating Policies and Procedures (OPPs) state that nine criteria guide its decision- making. The OPPs further state that PHARMAC can apply whatever weight it sees fit to the application of these criteria. I undertook a thematic analysis of 20 cases referred by PHARMAC’s principal medical advisory body, the Pharmacology and Therapeutic Advisory Committee (PTAC), to PHARMAC during the period February 2004 to November 2006 to determine whether these criteria were acknowledged in the official minutes of the respective bodies. PTAC is similarly required to take account of the abiding decision criteria. I also sought to determine whether other factors were apparent in guiding the decisions. There was evidence that PHARMAC consistently applied the decision criteria. PTAC was less assiduous in recording its application. In addition, I found that PHARMAC takes account of factors outside the stated criteria. I noted that PHARMAC takes particular account of the degree to which a decision might be publicly, politically or medically contentious in its decision-making. I also found evidence that consistency with prior decisions is another factor which PHARMAC takes into account, though does not apply routinely. This research indicates that PHARMAC does take account of its abiding decision criteria, applying health needs as well as fiscal criteria, though the weighting given each criterion is nowhere apparent in its official minutes. There remains an opportunity for evaluative research to determine whether fiscal considerations ‘outweigh’ needs considerations in PHARMACs decision-making.
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Al-Amer, Saleh Suliaman. "Nutritional and toxicological studies on New Zealand mutton bird meat (Puffinus griseus)." Lincoln University, 2009. http://hdl.handle.net/10182/1659.
Full textAbstract:
New Zealand mutton bird or tītī (Puffinus griseus and order procellariiformes) nest in New Zealand during the summer months, migrate to the northern hemisphere during May and return in September. Their eggs are laid during November and December and the chicks are hatched in the following January and February. Large numbers of them are harvested from April to May in New Zealand. They are wild seabirds annually harvested by Maori according to the customary rights agreement set by Treaty of Waitangi.NZ mutton birds also called Sooty Shearwaters are noted for their high proportion of body fat.These birds are interesting since its sole diet is based on krill and other small marine organisms that are potentially rich in n-3 fatty acids and other marine bioactive compounds. The proximate composition, fatty and amino acids and cholesterol content of mutton bird pectoral muscle were determined and compared with other common meat to explore the nutritional value of this New Zealand delicacy. The concentration of twenty two essential and toxic elements including silver (Ag), aluminium (Al), arsenic (As), cadmium (Cd), chromium (Cr), copper (Cu), mercury (Hg), manganese (Mn), lead (Pb), selenium (Se), potassium (K), calcium (Ca), magnesium (Mg), boron (B), iron (Fe), nickel (Ni), sulphur (S), sodium (Na) and cobalt (Co) and zinc (Zn) in mutton bird breast meat (Puffinus griseus) were measured over two years to evaluate its safety for human consumption. Persistent organochlorine, dichlorodiphenyltrichloroethane (DDT) and their metabolites, and aldrin and lindane were also measured.Twenty bird carcasses were purchased in both 2006 and 2007 from a local source. Meat samples from the pectoral muscle of two carcasses were pooled to generate 10 samples for each year. These were used for trace element analysis using inductively coupled plasma-mass spectrometry (ICP-MS). Trace elements were in the range of 0 to 1.09 mg/kg wet weight for Ag, 0 to 3.32 for Al, 0.17 to 0.79 for As, 0.01 to 0.07 for Cd, 0.03 to 0.15 for Cr, 3.56 to 4.88 for Cu, 0 to 0.15 for Hg, 0.22 to 0.50 for Mn, 0 to 0.09 for Pb, 0.66 to 1.18 for Se and 11.49 to 23.70 for Zn. In 2006, Ag, Al, Mn and Zn concentrations were significantly higher but Pb and Hg concentrations significantly lower compared to the 2007 samples (P < 0.05). Apart from one sample in 2006, all the samples were below the published maximum level for concern. However, our preliminary data indicated that the higher level of Cd and other metals in the skin of mutton bird may compromise the overall safety to humans consuming the skin of mutton birds. It is suggested that the evaluation of the metals in different parts and/or the whole mutton bird at different seasons is required to assure complete safety to the consumers.Furthermore, the nutritional value of mutton bird meat was studied over two harvesting seasons (2006 and 2007) to investigate the impact of seasonal variation. The moisture and carbohydrates contents ranged between 54.0 to 55.0 % and 2.8 to 3.0 %, respectively, and no seasonal effects were evident in these components. The values for fat and ash contents were higher and the protein content lower for birds harvested in 2007 compared with the 2006 values which ranged from 11.8 to 13.0, 10.3 to 11.7, and 20.3 to 18.5 % for fat, ash and protein content respectively. The major amino acids in mutton bird pectoral muscle were glutamate, aspartate, lysine, leucine, and arginine. Higher lysine concentrations and lower proline, cystein and methionine were found in mutton birds compared with the literature values for beef, lamb and pork. The essential amino acid content in mutton bird (43.8 and 44.9 % in 2006 and 2007, respectively) was slightly higher than those found in beef and lamb meats (42-43%).The major fatty acids detected were palmitic (C16:0), stearic (C18:0), oleic and isomers (C18:1), eicosenoic (C20:1), Docosahexaenoic acid (DHA) (C22:6), icosapentaenoic acid (EPA) (C 20:5) and these accounted for approximately 77% of the fatty acids. The 3/6 ratio of fats from pectoral muscle was 1.3. The cholesterol concentration varied slightly in the two years with 184.4±37.37and 134.4±25.55mg/100 g fresh weight for 2007 and 2008 respectively. Mutton bird was shown to contain significantly higher cholesterol content (134.4-184.4) than other common meat such as chicken (80.3-88.9), lamb (62.3), fish (52.79) and beef (51.97). Overall, the nutritional value of mutton bird muscle was similar to or superior to the traditionally protein sources such as seafood and red meat. Annual variations existed in the composition of Mutton bird pectoral muscle but this is not of nutritional consequence but might be a useful indicator for ecological events such as feed availability and other environmental issues. Mutton bird seems to be a good source of essential minerals, Zn and Fe compared with other traditional meats source. Mutton bird meat is nutritionally as good as the major sources of red or white meats. It may even have advantages over the other common meats (beef, lamb, fish and chicken) due to its high protein and monounsaturated fatty acids (omega n-3 and n-6) content. However, its high cholesterol content may represent a risk factor for some people.
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Le, Couteur Claire Elizabeth. "Dentist, Doctor, Dean : Professor Sir Charles Hercus and his record of fostering research at the Otago Medical School, 1921-1958." Thesis, University of Canterbury. History, 2014. http://hdl.handle.net/10092/9538.
Full textAbstract:
This thesis investigates the development of medical research at the Otago Medical School in Dunedin, New Zealand under Sir Charles Hercus, Dean from 1937-1958. It also explores his interest and participation in research from his student days and the years before becoming Dean, as well as the influence of the First World War on his career.
The study draws upon unpublished material in New Zealand archives and a collection of student projects investigating public health issues. Hercus, as Professor of Public Health and Bacteriology incorporated these projects into the curriculum in the early 1920s. The thesis uses many original papers published in scientific and medical journals by Hercus and his colleagues at the School.
Building on a base of archival material including contemporary newspaper accounts, which have lately become available on the Papers Past website, this thesis draws together the individual disease studies undertaken by other thesis writers to give an account of Hercus’s achievements in fostering medical research.
A key finding of this thesis is that Hercus was instrumental in building up the research capability of the School. He accomplished this through his own investigations and by helping to establish the New Zealand Medical Research Council. The thesis illustrates the multitude of studies that Hercus undertook personally or facilitated others to pursue, beyond the elimination of endemic goitre, for which he perhaps is best known.
Another outcome of this study is an understanding of the difficult path that scientists faced in the early years of the twentieth century in New Zealand if they wished to carry out research. This thesis follows the origins of the Department of Scientific Research in the 1920s and the frequent collaboration Hercus made with scientists outside of the School. It will also demonstrate Hercus’s compassion and foresight in employing several Jewish refugee doctors as researchers at the School, who brought expertise into the research programmes.
The era was one of great interest in improving the health and wellbeing of a generation affected by wars and deprivation caused by them. A key finding of this thesis is that researchers at the School took steps to mitigate these through making New Zealand more self-sufficient in foodstuffs and to improve the national diet. As well, Hercus lobbied for the establishment of a School of Physical Education within the university to improve the physical fitness of the population.
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Verma, Rajiv, and n/a. "Clinical outcomes of dental implant treatment provided at the School of Dentistry, University of Otago from 1989 to 2005." University of Otago. School of Dentistry, 2008. http://adt.otago.ac.nz./public/adt-NZDU20081219.145402.
Full textAbstract:
Objective: The aim of the study was to evaluate the clinical outcomes of oral implant treatment provided at the School of Dentistry, University of Otago from 1989 to 2005.
Methods: Oral implant patients (n=320) with 586 implants were identified and invited to attend for a clinical examination. Implant demographics of all the patients were extracted from the files. Implant demographics of the examined and unexamined patients were compared to assess if the examined patients were representative of the total group. One hundred and three patients with 214 implants agreed to attend for an examination. In the clinical examination full mouth plaque scores, probing depths, bleeding on probing and suppuration were measured. In addition, around implants recession and width of keratinized gingiva were also recorded. For the radiographic examination, baseline radiographs and radiographs taken at the time of examination were digitized and compared to measure the amount of bone lost or gained around implants using NIH Image J software.
Results: There were equal numbers of males and females with a mean age of 46.3 � 15 years at the time of implant placement. The smoking history at the time of examination was recorded, 56% of the patients were non-smokers, 37% former smokers, and 7% were current smokers. More than half of the implants (56%) were placed in the anterior region. Based on the type of implant system, 79% were Branemark implants, 10% Straumann, 6% Southern implants and 4% were unknown. Most of the patients (64%) had implant-supported crowns, 19% had fixed denture prostheses, and 17% had implant-supported overdentures. The overall implant survival rate was 97.7% with five implants lost (2.3%) and 8 implants treated for peri-implantitis (3.8%). The mean PD around implants was 2.3mm (SD 0.6mm), mean recession was 0.5mm (SD 0.8mm) and mean attachment level of 2.8mm (SD 0.9mm). Probing depths [greater than or equal to] 4mm with BOP were recorded around implants in 8.9% of patients. The mean full mouth plaque score was 30% while mean plaque score around implants was 15.9%. The average bone loss around implants was 0.3mm (SD 0.8). Maximum bone loss observed was 2.9 mm.
Conclusion: The prevalence of peri-implant inflammation and implant survival rates in this group of patients appeared comparable to that reported in the literature. The prevalence of peri-implant lesions was low in the group of patients examined.
22
Goldstein, Daniel M. (Daniel Michael). "Medicine as practical wisdom : an old foundation for a new way of thinking in biomedical ethics." Thesis, McGill University, 1989. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=22372.
Full textAbstract:
This inquiry suggests a new epistemological foundation for understanding and discernment in biomedical ethics. This foundation, based on Aristotle's phronesis or practical wisdom, contains elements of the lived human experience which are seen as essential aspects of ethical, as well as medical, deliberation. The Aristotelian intellectual virtues of theoria and phronesis, used as "ideal types" of rationality, provide epistemological prejudices that structure two distinct ways of thinking. With this distinction, an alternative to certain dominant trends within biomedical ethics arises as phronesis provides more human centered prejudices for understanding. In conclusion, we shall see, using the doctrine of informed consent, that a phronetic rationality allows different, more humane meanings to come into being. Phronesis, it will be argued, provides a mode of rationality which promotes compassion and engagement in both ethics and medicine and consequently, is the more appropriate way of thinking in these important human practices.
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Gauld, Robin David Charles. "Policy processing in theory and practice : health reform in Hong Kong and New Zealand /." Thesis, Hong Kong : University of Hong Kong, 1996. http://sunzi.lib.hku.hk/hkuto/record.jsp?B17311664.
Full text
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Lessoway, Kamea. "Perception of quality of life for adults with hearing impairment in Aotearoa / New Zealand." Thesis, University of Canterbury. Department of Communication Disorders, 2014. http://hdl.handle.net/10092/9599.
Full textAbstract:
AIMS: This study investigated the perception of generic and disease-specific Health-Related
Quality of Life (HRQoL) for adults living with hearing impairment (HI) in Aotearoa/New
Zealand (NZ). This study aimed to answer three questions: (1) What is the perception of
HRQoL amongst adults with hearing impairment in NZ? (2) How do these perceptions
compare to adults with HI living in other countries for which we have data? (3) What are the
demographic and audiometric variables related to device ownership?
METHOD: HRQoL, demographic, and audiometric information was collected from 126 adults
in NZ. The following demographic information was collected: age, relationship length, hours
worked per week, income, ancestry, sex, level of education, city size, and sexual orientation.
The following audiologic information was also collected: ownership of hearing aids (HA),
ownership of hearing assistance technology (HAT), better-ear pure-tone average (BEPTA),
worse-ear pure-tone average (WEPTA), and signal-to-noise ratio loss (SNR loss). HRQoL
information was collected using the Medical Outcomes Study 36-Item Short-Form Health
Survey (SF-36; Ware & Sherbourne, 1992), and the Hearing Handicap Inventory (HHI) for
both elderly (HHIE) and adults (HHIA; Ventry & Weinstein, 1982; Newman, Weinstein,
Jacobson, & Hug, 1991). Variables discriminating HA and HAT owners from non-owners
were also analysed.
RESULTS: The relationship between demographic variables and HRQoL scores revealed that
only age and income were significant. Audiometric variables had significant relationships
with disease-specific HRQoL scores, as well as HA and HAT ownership. Finally, disease-specific
HRQoL scores and all audiometric variables differentiated HA owners from non-
owners, but demographic variables did not. Generic HRQoL scores and all audiometric
variables differentiated HAT owners from non-owners.
CONCLUSIONS: These results suggest that the negative impacts of HI on HRQoL as reported
overseas are also present in NZ, and that not only do audiometric variables including SNR
loss are related to HRQoL, but HRQoL is a significant predictor for HA and HAT ownership.
Further QoL research is warranted amongst the HI population in NZ to identify and
understand any causal relationships present amongst these variables. Furthermore, HRQoL
instruments and a test of speech understanding in noise have been shown to provide
additional meaningful information, and therefore clinicians might consider including them
during consultation.
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Muir, Lauretta, and n/a. "The impact of economic theory on the art of clinical practice : a study of science, meaning, and health." University of Otago. Dunedin School of Medicine, 2006. http://adt.otago.ac.nz./public/adt-NZDU20060911.160405.
Full textAbstract:
In being philosophically based this thesis is concerned with understanding the human condition with particular reference to matters of meaning and how these find expression in systems of government and social policy.
This study is based on the premise that concepts determine how the world is viewed and people use a variety of conceptual schemes to answer different classes of questions. Scientific endeavour is based in a scheme that enables questions about the material world to be answered. It cannot however answer classes of questions related to many features of human lives as its methods necessitate the development and use of abstractions and generalisations that are ill-equipped by design to determine what is important to people and what motivates and satisfies them. Therefore, the reality of any particular individual or group cannot be adequately understood in scientific terms.
The thesis examines the scientific conceptual framework and minimalist abstractions of the medical model and the quasi-scientific conceptual frameworks of economics and identifies their conceptual limits. It shows that if the medical model is assumed to provide a complete representation of realities in health and is uncritically used as the basis of medical practice it has the potential to overlook the patient as a person and distance medical practice from its social roots which can lead to adverse outcomes for both clinical practice and medicine itself. It also observes that the economic scheme has conceptual limits that create their own distorted representations of reality. A similar dislocation in the meaning of people�s lives occurs when abstractions are made by adopting concepts from other schemes based in science, such as the medical model, without any awareness of their conceptual limits. Further distortions occur when these other accounts are turned into economic ones. Not only is the patient as a person overlooked, so is the patient as an entity.
In light of these observations the thesis examines health reforms that have taken place in New Zealand, whereby the economic scheme has been given dominance in the development of public policy and set the parameters for rationality and what can acceptably be said. It shows that in not recognising features of meaning these parameters have led to health sector reforms that have had unintended and adverse consequences for clinical practice, as shown in the particular case of reforms of maternity services. Furthermore these reforms have severed the health sector from its social roots and moral frameworks and created barriers between it and government so that health sector problems that cannot be understood using economic parameters cannot be addressed in forums where public policy is developed.
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Biwer, Meagan. "The Case for Expanded Access to Investigational New Drugs." Scholarship @ Claremont, 2012. http://scholarship.claremont.edu/cmc_theses/414.
Full textAbstract:
Pharmaceuticals have benefitted countless lives. New therapies are being developed every day—many prove effective, but many do not. In order to ensure only safe and effective drugs enter the market, the United States' Food and Drug Administration (FDA) approves each treatment based on data garnered from clinical trials. Clinical trials take time, however, and investigational new drugs (INDs) can demonstrate signs of efficacy long before approval. These cases introduce a fundamental question: should the government limit patient access to a drug that has yet to be proven safe and effective? Or do patients have the right to freedom from governmental intervention in their medical decision-making?
In this paper, the history of IND regulation will be explored, followed by an examination of the freedom to access from constitutional, ethical, and infrastructural perspectives. Changes to the current system will then be proposed.
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Allies, Shaun Brandon. "Managed care ethics : the legitimacy of fairness of rationing new health technologies in the treatment of cancer in the private health care sector in South Africa." Thesis, Stellenbosch : Stellenbosch University, 2008. http://hdl.handle.net/10019.1/17470.
Full textAbstract:
Thesis (MBA)--Stellenbosch University, 2008.<br>ENGLISH ABSTRACT: The cost of medical care, in particular the cost of cancer care, has seen significant increases
globally in the last few years. These cost increases in part are a result of tremendous
advancements in new health technologies to diagnose, treat and care for cancer sufferers. The
development of these highly specialised treatment modalities is not expected to slow down in
the next few years, as potentially new treatments are already in the pipeline.
On the other hand, cancer is becoming more prevalent. affecting more people worldwide. The
condition remains life threatening, causing patients to become dependent and desperately
hopeful of their requested treatments. Managed care, which includes the processes of rationing,
has been implemented by medical aid schemes in the private health care industry in an effort to
curtail the escalating costs of health care. Currently medical aids in the country are under
immense pressure to comply with financially demanding legislation as well as to increase their
membership risk by keeping contributions low and subsequently improve access to private
health care in the country.
Notwithstanding the fact that rationing might be justified from an economic perspective, the
implications of transposing free market principles into an almost sacred health care environment
challenges current morals and ethics in this arena. The price consciousness in cancer care is
almost creating a scenario where clinical reasons are becoming subservient to fiscal reasons or,
put differently, it is placing a price tag on human lives.
In its true glory, the rationale of rationing is to challenge the individual patient needs against that
of the bigger medical aid society. The distributive justice principles of rationing are creating
immense conflict between the virtue-based, principle-based and contemporary ethics, which are
currently governing medical practice in the country. As a result rationing creates serious vexing
funding decisions with long-ranging effects.
Its against this background that the study further consider the implications of managed care and
rationing as it creates serious questions about the fairness, decision-making power and
authority of managed care organizations. The implication of this is that the treating physician
seems to have lost all autonomy and control in trying to treat and care for his cancer patient.
Hence the perception that managed care does not act in the best interest of the vulnerable and
desperate cancer suffering patient.
As a result of th is view of managed care it becomes important to ensure the fairness and or
legitimacy of managed care and rationing decisions. Therefore, the final section of the study
considers the fair and just rationing of medical care as well as setting limits that are morally and
ethically acceptable, in a cancer related setting. The studies of Daniels and Sabin are utilized
extensively in particular the suggested criteria required by managed care organisations to
ensure their rationing decisions are fair and legitimate. The implications of this and the
assurances to cancer sufferers in a medical scheme is that the decisions to fund new health
technologies are based on a process that is transparent and collaborative and that cost
consideration of treatment has merit if it is made within the confines of this process.<br>AFRIKAANSE OPSOMMING: Die koste van mediese sorg, en spesifiek die koste van kankersorg, het in die afgelope paar
jaar wereldwyd aansienlik toegeneem. Hierdie toename in koste is gedeeltelik die resultaat van
geweldige vooruitgang in nuwe gesondheidstegnologiee om kankerlyers te diagnoseer, te
behandel en vir hulle te sorgo Daar word nie verwag dat die ontwikkeling van hierdie hoogs
gespesialiseerde behandelingsmodaliteite oor die volgende paar jaar sal afneem nie, aangesien
nuwe behandelings steeds geregistreer word.
Aan die ander kant is die voorkomssyfer van kanker besig om toe te neem, en be"invloed dit
mense oor die hele wereld. Die toestand is steeds lewensbedreigend, en veroorsaak dat
pasiente afhanklik van en desperaat vol hoop is vir die nodige behandeling. Bestuurde sorg, wat
die proses van rantsoenering insluit, is deur mediesefondsskemas in die privaat
gesondheidsorgbedryf ge"lmplementeer in 'n poging om die stygende koste van mediese sorg te
verminder. Mediese fondse in die land is tans onder geweldige druk om aan finansieel
veeleisende wetgewing te voldoen en om hulle lidmaatskaprisiko te verhoog deur bydraes laag
te hou en gevolglik toegang tot privaat gesondheidsorg in die land te verbeter.
Ondanks die feit dat rantsoenering moontlik vanuit 'n ekonomiese perspektief geregverdig kan
word, daag die implikasies van die omsetting van vryemarkbeginsels in 'n amper heilige
gesondheidsorgomgewing huidige morele waardes en etiek in hierdie veld uit. Die
prysbewustheid in kankersorg skep amper 'n scenario waar kliniese redes ondergeskik aan
fiskale redes gestel word of, om dit anders te stel, dit plaas 'n prys op mense se lewens.
In sy volle glorie is die rasionaal van rantsoenering om die individuele pasient se behoeftes
teenoor die van die groter mediesefondssamelewing te stel. Die beginsels van verdelende
regverdigheid van rantsoenering skep enorme konflik tussen die deug..gebaseerde, beginselgebaseerde
en kontemporere etiek wat tans die mediese praktyk in die land beheer. Gevolglik
skep rantsoenering ernstige, moeilike befondsingsbesluite met effekte oor die lang termyn.
Oit is teen hierdie agtergrond dat die studie die verdere implikasies van bestuurde sorg en
rantsoenering moet oorweeg, aangesien dit ernstige vrae rondom die billikheid , besluitneming
en outoriteit van bestuurde sorg maatskappye lig. By implikasie beteken dit dat die geneesheer
wat die pasient behandel, feitlik aile beheer verloor het om die pasient vir aile praktiese
doeleindes optimaal te behandel. Oaarom die persepsie dat bestuurde sorg nie in die beste
belang van die kwesbare en desperaat kanker pasiente is nie.
As gevolg van die persepsie van bestuurde sorg, raak dit meer belangrik om die bilikheid en
regverdigheid van gesondheid sorg besluite te verseker. Met dit in ag genome, oorweeg die
finale deel van die studie die bilikheid en regverdigheid van mediese rantsoenering so-ook die
set van perke wat eties en moreel aanvaarbaar is, in 'n kanker verwante agtergrond. Die werke
van Daniels en Sabin word in aansienlike detail hersien in besonder hul voorgestelde kriteria
wat vereis word deur bestuurde sorg organisasies om te verseker hul besluite ten opsigte van
rantsoenering is redelik en regverdig. Die implikasies hiervan en die versekering tot kanker Iyers
in 'n mediese skema is dat die besluite om nuwe gesondheidstegnologiee te befonds, is
gebasseer op In deursigtige en samehorende proses en dat aile koste oorwegings vir
behandeling meriete het, indien dit is gemaak is binne die raamwerk van hierdie proses.
28
Bell, Avril. "Relating Maori and pakeha : the politics of indigenous and settler identities : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy at Massey University, Palmerston North, New Zealand." Massey University. School of Sociology, Social Policy and Social Work, 2004. http://hdl.handle.net/10179/267.
Full textAbstract:
Settler colonisation produced particular colonial subjects: indigene and settler. The specificity of the relationship between these subjects lies in the act of settlement; an act of colonial violence by which the settler physically and symbolically displaces the indigene, but never totally. While indigenes may be physically displaced from their territories, they continue to occupy a marginal location within the settler nation-state. Symbolically, as settlers set out to distinguish themselves from the metropolitan 'motherlands', indigenous cultures become a rich, 'native' source of cultural authenticity to ground settler nationalisms. The result is a complex of conflictual and ambivalent relations between settler and indigene.This thesis investigates the ongoing impact of this colonial relation on the contemporary identities and relations of Maori (indigene) and Pakeha (settlers) in Aotearoa New Zealand. It centres on the operation of discursive strategies used by both Maori and Pakeha in constructing their identities and the relationship between them. I analyse 'found' texts - non-fiction books, media and academic texts - to identify discourse 'at work', as New Zealanders make and reflect on their identity claims. This investigation has two aims. Firstly, I map the terrain of discursive strategies that bear the traces of colonial domination and resistance. Secondly, I seek to explore the possibilities for replacing colonial relations with non-dominating forms of relationship between Maori and Pakeha.The thesis is in two parts. Part I focuses on theories of identity, centring on essentialism and hybridity. I argue that both modes of theorising bear the traces of colonial relations and neither offers the means to 'escape' colonial relations. Part II focuses on theories of intersubjectivity, bringing relationality to the fore. I argue that epistemological relations (including identity relations) always involve a degree of violence and exclusion and that, consequently, these necessary relations must be held in tension with an awareness of the ethical dimension of intersubjective engagement. Utilising the ethics of Emmanuel Lévinas, I argue that a combination of an ethical orientation towards the other and a 'disappointed' orientation towards politics and epistemology, offers the means to developing non-dominating relations with the cultural other.
29
Gillies, Annemarie. "Kia taupunga te ngākau Māori : anchoring Māori health workforce potential : a thesis presented for the degree of Doctor of Philosophy, Māori Studies, Massey University, Palmerston North, New Zealand." Massey University, 2006. http://hdl.handle.net/10179/994.
Full textAbstract:
In New Zealand Māori are under-represented in the workforce across multiple sectors. This thesis explores this incongruity with regard to Māori health. A Māori perspective and philosophical foundation formed the basis of the methodological approach, utilising a case study research design to inform the study. This provided the opportunity to explore Māori health workforce development initiatives and their potential to contribute to improvements and gains in Māori health. It was important that this work take into account social and economic factors and their impact on health, as well as the varying political climates of market oriented reform and a fiscal policy focus, because it has not only challenged Māori health development but also provided opportunities for increased Māori involvement and participation in health and New Zealand society. Therefore the thesis, while focused on health takes cognisance of and, coincides with the capacity and capability building efforts that have been a feature of overall Māori development, progress and advancement. In the context of this thesis Māori health workers are seen as leaders within their whānau, hapū, iwi, and Māori communities. Consequently a potential workforce that is strong and powerful can lead to anticipated gains in Māori health alongside other Māori movements for advancement. The potential cannot be under-estimated. This thesis argues that there are critical success factors, specific determinants, influencing Māori health workforce potential, and that these success factors have wider application. Therefore, as this thesis suggests Māori workforce development, especially in relationship to the health workforce, is dependent on effective Māori leadership, the application of Māori values to workplace practices, levels of resourcing that are compatible with training and development, critical mass, and targeted policies and programmes.
30
Gang, Na-Hyun. "Action research: an exploration of a music therapy student's journey of establishing a therapeutic relationship with a child with autistic spectrum disorder in music therapy : a research dissertation presented in partial fulfilment of the requirements for the Master of Music Therapy at New Zealand School of Music, Wellington, New Zealand." Massey University, 2009. http://hdl.handle.net/10179/1155.
Full textAbstract:
This action research project examines the researcher’s journey of establishing a therapeutic relationship with a child with autism spectrum disorder during her practicum. Children with ASD present difficulty in communication and social relationship skills. As a student in training with a limited experience, the researcher had uncertainty and low confidence with regard to her clinical and professional skills which affected her work. In this project, the researcher has examined her own process of music therapy with a child with ASD and shows how she was able to improve her practice and therefore establish meaningful and effective therapeutic relationships with this client population and obtain valuable learning through the training. The study was conducted at a dedicated therapy centre in New Zealand where the researcher was in placement. A total of seven, thirty-minute weekly individual music therapy sessions and four supervision sessions were employed. This process was adapted into the design of action cycles which involved the repeated process of planning, action and evaluation. In-depth analysis of the researcher’s work was carried out throughout the cycles, using clinical notes, journal excerpts, supervision notes and video recordings of the sessions. The findings suggest that the researcher was able to improve her practice while attempting to build a therapeutic relationship with the client. Various clinical and personal issues arose such as uncertainty about improvisation, and lack of confidence in professional skills including communicating with parents, which led to disjunction and burnout symptoms. Discussions in supervision aided in in-depth reflection of the researcher’s work as well as emotional support. The researcher could ultimately develop ‘internal supervisor’ and was able to use independent strategies to help develop her work. Implications for training include making personal therapy a compulsory course requirement, providing training on professional skills, and student support groups. Future research may investigate the effectiveness of verbal input in music therapy and the emotional stages of parents.
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Caligiuri, Michael. "Traditional and New Enhancing Human Cybernetic and Nanotechnological Body Modification Technologies: A Comparative Study of Roman Catholic and Transhumanist Ethical Approaches." Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/26182.
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Advances in cybernetic and nanotechnological body modifications currently allow for enhancements to human physical and mental function which exceed human species-based norms. This thesis examines body modification and human enhancement from two perspectives—Roman Catholicism and Transhumanism— in order to contribute to bioethical deliberations regarding enhancement technologies. Roman Catholicism has a longstanding tradition of bioethical discourse, informing the healthcare directives of Roman Catholic institutions. Transhumanism is more recent movement that endorses body modifications and human enhancements as a means of individual betterment and social evolution. The thesis first considers definitions of human enhancement and levels of normalcy in connection to cybernetic and nanotechnological bionic implants, and outlines a series of criteria to assess a technology’s potential bioethical acceptability: implantability, permanency, power, and public interaction. The thesis then describes Roman Catholicism’s response to non-enhancing decorative body modifications (cosmetic surgeries, common decorative modifications such as tattoos and piercings, and uncommon modifications such as scarifications and brandings) in order to establish a basis for possible Roman Catholic responses to enhancing cybernetic and nanotechnological modifications. This is followed by an analysis from a Roman Catholic perspective of the major social issues brought forward by enhancement technologies: commodification, eugenics, vulnerability, and distributive justice. Turning to Transhumanism, the thesis describes the origins and philosophy of the movement, and then discusses the bioethical principles it advances with regard to human enhancement. The thesis concludes by locating points of convergence between Transhumanism and Roman Catholicism that could be the basis of more widely accepted ethical guidelines regarding modification technologies.
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Edwards, William John Werahiko. "Taupaenui : Maori positive ageing : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Palmerston North, New Zealand." Massey University, 2010. http://hdl.handle.net/10179/1331.
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The global phenomenon of population ageing has major ramifications for societies and governments around the world. In New Zealand, efforts to address the impacts of population ageing have centred on the Government’s Positive Ageing Strategy. This is a thesis about positive ageing as viewed through Maori eyes. It has been informed by the memories and aspirations of older Maori who have lived through challenging times but have emerged with qualities that enable them to enjoy older age and to contribute to their own whanau, Te Ao Maori (the Maori world) and Te Ao Whanui (wider society). The thesis is philosophically located at the interface between Western science and matauranga Maori, an Indigenous inquiry paradigm. It is argued that Western science and matauranga Maori are relevant to research in the contemporary context, and reflect the realities of older Maori who live in both Te Ao Maori and Te Ao Whanui. The study used research techniques that draw on Western science (literature review), matauranga Maori (review of 42 Maori proverbs) and both inquiry paradigms simultaneously (qualitative study with 20 older Maori people). The research found that Maori positive ageing can be characterised by a two dimensional concept that incorporates a process dimension and an outcome dimension. The process dimension is consistent with a lifecourse perspective and therefore recognises that ageing is a life-long process where circumstances encountered during life may impact cumulatively and manifest in old age. The outcome dimension can be described in terms of complementary ‘universal’ and Maori specific outcome domains. The universal outcome domains are encapsulated in the New Zealand Positive Ageing Strategy and more recently are expressed in the Positive Ageing Indicators 2007 Report. The Maori-specific outcome domains identified in this Study are: kaitiakitanga – stewardship; whanaungatanga – connectedness; taketuku – transmission; takoha – contribution; takatu – adaptability; and, tino rangatiratanga – selfdetermination. The overarching outcome domain is taupaenui – realised potential.
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Clendon, Jillian Margaret. "Motherhood and the 'Plunket Book' : a social history : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Auckland, New Zealand." Massey University, 2009. http://hdl.handle.net/10179/826.
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The Well Child/Tamariki Ora Health Book (the Plunket book) is a small booklet given to New Zealand mothers on the birth of a child. It has been used by nurses as a tool to record growth and development from birth to five years since the 1920s. Although use of the book decreases over time, it is frequently kept within the family and handed on from mother to child. Utilising an oral history approach, this study has traced the development of the Plunket book over time and explored the experiences of a group of 34 women and one man who have reflected on their ownership of, or involvement with, Plunket books. The study found that the Plunket book remains an effective clinical tool for mothers and nurses. Mothers have used the book as a tool to link past with present, to maintain kinship ties across generations, to deal with change intergenerationally, and in a manner that contributes to their self-identity as woman and mother. Although mothers were able to use the book to affirm their own knowledge and that of their mothers, a medically dominated discourse persists in the book. The book has also played a role in facilitating the interaction between mother and nurse, providing an opportunity to explore the relationship in detail. The study found that the most successful relationships at any time were those that bordered the division between a professional relationship and a personal one: it was not the information that nurses offered but the interaction and resulting care they provided that was important to the mothers in the study. The study recommends that nurses and other health professionals continue to use the Plunket book as a clinical tool mindful of the fact that the book remains in use beyond the health professional’s immediate involvement with the mother and child, playing an important role in the context of the New Zealand family across generations. Future versions of the book should contain written reference to the strengths and abilities the mother holds as she cares for her child, reaffirming her role and identity as mother not only when her children are younger but as they grow and become parents themselves.
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Mpofu, Charles. "Immigrant medical practitioners' experience of seeking New Zealand registration a participatory study : a thesis submitted to Auckland University of Technology in partial fulfilment of the requirements of the degree of Master of Health Science, 2007." Click here to access this resource online, 2007. http://hdl.handle.net/10292/404.
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This qualitative modified participatory study underpinned by social critical theory explored the experiences of immigrant medical practitioners seeking registration in New Zealand. The occupational science notions of occupation, occupational deprivation and occupational apartheid were used to understand the experiences of the participants. The objective of the study was to understand the experiences of the participants and facilitate their self-empowerment through facilitated dialogue, affording them opportunities for collective action. Data was obtained through in-depth interviews and focus group discussions with eighteen immigrant medical practitioners who were doctors and dentists as well as two physiotherapists. The two physiotherapists were sampled out of necessity to explore diversity in findings. Transcripts were analysed using thematic analysis. This method included the processes of coding data into themes and then collapsing themes into major themes which were organised under categories. Four categories were created in the findings describing the experiences of immigrant practitioners and suggesting solutions. Firstly; findings revealed that immigrant medical practitioners had a potential worth being utilised in New Zealand. Secondly; it was found that these participants faced negative and disabling experiences in the process of being registered. Thirdly; the emotional consequences of the negative experiences were described in the study. Fourthly; there were collectively suggested solutions where the participants felt that their problems could be alleviated by support systems modelled in other Western English speaking countries that have hosted high numbers of immigrant medical practitioners from non-English speaking countries. This collective action was consistent with the emancipatory intent of participatory research informed by social critical theory. This study resulted in drawing conclusions about the implications of the participants’ experiences to well-being, occupational satisfaction as well as diverse workforce development initiatives. This study is also significant in policy making as it spelt out the specific problems faced by participants and made recommendations on what can be done to effectively utilise and benefit from the skills of immigrant medical practitioners. A multi-agency approach involving key stakeholders from the government departments, regulatory authorities, medical schools and immigrant practitioners themselves is suggested as a possible approach to solving the problems faced by these practitioners.
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Baker, Maria. "Te Arawhata o Aorua, Bridging two worlds: a grounded theory study : a thesis presented in partial fulfillment of the requirements for the degree of Masters of Philosophy in Nursing at Massey University (Albany), New Zealand." Massey University, 2008. http://hdl.handle.net/10179/1043.
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Te Arawhata o Aorua – Bridge of two worlds is a theory about Maori mental health nurses. The aim of this study was to explore what was occurring amongst Maori mental health nurses and dual competencies. A grounded theory informed by a Maori centred research approach was adopted and conducted with three focus groups of ten Maori mental health nurses situated in one metropolitan and two provincial cities. The research design was informed by Mason Durie?s Maori centred concepts of whakapiki tangata (enablement), whakatuia (integration) mana Maori (control) and integrated with grounded theory to guide the collection and analysis of the data. Audio taping and field notes were used to collect the data and the processes of constant comparative analysis, theoretical sampling and saturation were used to generate a middle range substantive Maori centred grounded theory. One core category was identified as two worlds which describes the main issue that they are grappling with. The basic social psychological process of bridging of tension explains how the two worlds are managed through two subcategories of going beyond and practising differently. Going beyond consists of two components, being Maori and enduring constant challenge that set the philosophical foundation to practice. Practising differently describes three key components as kaitiaki of wairua, it?s about whanau and connecting each are blended into each other and fused into nursing practice. The impressions of the Maori mental health nurses have been interpreted and explained by this theory. The substantive grounded theory provides a model to guide health services appreciation of Maori mental health nurses, for professional development of Maori mental health nurses and to policy writers.
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Wenn, Janice. "Kaupapa hauora Māori : ngā whakaaro whakahirahira o ngā kaumātua : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Māori Studies at Te Pumanawa Hauora Research Centre for Māori Health and Development, Massey University, Wellington, Aotearoa/New Zealand." Massey University, 2006. http://hdl.handle.net/10179/995.
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There is a requirement for all services within the New Zealand health system to be accredited with an established quality organisation and to demonstrate an ability to provide a measurable quality service to consumers. For Māori these requirements must make sense in Māori terms. This thesis is based on the view that, for Māori, the concept of health is more effectively expressed as hauora - optimal health and wellbeing for Māori. This thesis makes five contributions to Māori health and Māori health research. First, it identifies a responsive approach to engaging kaumātua effectively in the process of qualitative research. Second, it identifies a fundamental underlying conceptual framework – kaupapa hauora Māori as a means of understanding hauora – expressed in terms derived from kaumātua in Taranaki and Kahungunu. Third, it adapts this conceptual framework into an analytical research framework and then applies it to allow kaupapa hauora Māori (described in terms of worldview, values and ethics) to be identified from a range of data. Fourth, it critically analyses popular models of Māori health – Te Whare Tapa Whā, Te Wheke and Ngā Pou Mana. Finally, it proposes and details post-doctoral research that will translate kaupapa hauora Māori into a quality services framework/tool. “Kaupapa Hauora Māori” is a conceptual framework articulated by kaumātua, and has its origins in te ao Māori, from which the aronga or worldview is developed. The aronga is composed of the kaupapa or values and tikanga or ethics that provide kaumātua with the values base of hauora. These components have been identified by kaumātua and not only inform the concept of KHM but also inform the analytical research framework that is applied to the data. The values have been identified as a core set of values comprising whakapapa, wairua, whenua, whānau, tikanga te reo Māori, tinana, and hinengaro, and the associated tikanga is expressed as behaviour or ethics. These, together, influence the perception and understanding individuals have of their world and of hauora.
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Claas, Bianca Muriel. "Self-reported oral health and access to dental care among pregnant women in Wellington : a thesis presented in fulfilment of the requirements for the degree of Master of Public Health at Massey University, Wellington, New Zealand." Massey University, 2009. http://hdl.handle.net/10179/1205.
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Pregnancy can have important effects on oral health and pregnant women are a population group requiring special attention with regard to their oral health and their babies? health. International research shows that oral health care for pregnant women has been inadequate, especially in relation to education and health promotion and there is some evidence of disparities by SES and ethnicity. Improving oral health is one of the health priorities in the New Zealand Health Strategy (Ministry of Health, 2000) and the Ministry of Health (Ministry of Health, 2006a) has recently identified a need for more information on the oral health and behaviour of pre-natal women. The aims of this study were to gain an understanding of pregnant women?s oral health care practices, access to oral health care information and use of dental care services and to identify any difference by ethnicity and socio-economic position. A self-reported questionnaire was completed by 405 pregnant women (55% response rate) who attended antenatal classes in the Wellington region. The questionnaire was broadly divided into four parts: (1) care of the teeth when the woman was not pregnant; (2) care of the teeth and diet during the pregnancy; (3) sources of oral health information during pregnancy and; (4) demographic information . Data were analysed by age, ethnicity, education and income and odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using logistic regression. The majority of women in this survey were pakeha (80.2%), compared to 19.7% „Others? (8.8% Maori, 1.9% Pacific, 8.6% other). Most of the subjects were aged 31-35 years (34.5%), of high SES (household income and education level). Half of the women reported having regular visits to the dentist previous pregnancy while a significant percentage of women saw a dentist basically when they had problems. The usual dental hygiene habits were maintained during pregnancy. However, during pregnancy more than 60% of women reported bleeding gums. Just 32% of women went to see the dentist during pregnancy and less than half had access to oral health information related to pregnancy. „Others? (OR 0.38, 95% CI 0.15-0.91) and low income (OR 0.27, 95% CI 0.10-0.76) groups were significantly less likely to report access to oral health information compared to pakeha and high income groups (respectively). Women who went to see the dentist during pregnancy were more likely to receive information on dental health. However, low income women were more likely to report the need to see a dentist (OR 2.55, CI 1.08-5.99). Information on dental health and access to oral care should be prioritised to low income women, Maori, Pacific and other ethnic groups. Little attention has previously been given to oral health for pregnant women in New Zealand and there is a need to increase awareness of the importance of this area amongst health practitioners particularly Lead Maternity Carers and Plunket and tamariki ora nurses.
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Betteridge, Scott Sheng-yi. "Pseudoephedrine and its effect on performance : a thesis presented in partial fulfillment of the requirements for the degree of Master of Science in Sport and Exercise Science at Massey University, Palmerston North, New Zealand." Massey University, 2007. http://hdl.handle.net/10179/970.
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Pseudoephedrine is a mild stimulant which partially mimics the action of noradrenaline and adrenaline. Recently, pseudoephedrine has been removed from the World Anti Doping Agency (WADA) prohibited substances list. This occurred despite limited research in regards to its effects on sporting performance, and no studies on prolonged exercise performance (>2hrs). There is some evidence to suggest pseudoephedrine may have an ergogenic effect at dosages exceeding therapeutic levels, possibly by masking fatigue. This study investigated the possible ergogenic effects of pseudoephedrine on endurance cycling performance. Using a double blind, randomised cross over design, eight well-trained cyclists (VO2max 69 ± 2 ml×kg-1) performed two self- paced performance time trials at least 6 days apart. Ninety minutes prior to the trial, subjects consumed either placebo or pseudoephedrine (2.5 mg×kg-1) capsules. Diet and exercise were controlled for 48 hrs prior to each trial. The time trial required completion of a set amount of work, equivalent to riding at two and half hours at a power output calculated to elicit 70% VO2 max. Power output was measured using a Powertap system (Cycle Ops Power, Saris Cycling Group, USA). Venous blood samples were collected prior to capsule ingestion, just before starting the trial, and at every 20% increment in completed work until completion and were analysed for glucose and lactate. Heart rate was recorded throughout the trial. There was no significant effect of pseudoephedrine on average performance (p=0.235). Heart rate was significantly higher with pseudoephedrine consumption compared to placebo (p<0.05), but there was no significant difference in glucose or lactate between trials. Pseudoephedrine does not significantly improve self-paced endurance cycling performance, though the individual response was variable. However, exercising heart rate was significantly higher during exercise after ingestion of the stimulant.
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Clayton-Smith, Bevan, and n/a. "He ratonga hauora Maori me nga ratonga rarau rongoa o Aotearoa e tirohanga, he tataritanga i nga mohio o tenei wa, i nga tumanako me etahi huarahi atu = Maori health providers and pharmacy services in New Zealand : a survey and analysis of current awareness, expectations and options." University of Otago. School of Pharmacy, 2005. http://adt.otago.ac.nz./public/adt-NZDU20070501.142338.
Full textAbstract:
This research aims to assess the existing relationship and characteristics between Maori health providers (MHPs) and pharmacy services in New Zealand and to provide future direction, pathways and strategies for collaboration, planning and improving health outcomes for Maori within the primary health care environment.
The characteristics of the relationship were identified and discussed before exploring strategies to strengthen the relationship and to improve Māori health outcomes. The assessment and analysis of the characteristics required an exploration of MHPs current knowledge of pharmacy services, the expectations of MHPs of pharmacy services and the current knowledge of pharmacists of MHP services and Maori health.
Themes identified that characterised the relationship were related to knowledge, health philosophies, interaction, service and capacity issues.
Knowledge issues incorporated themes of group dynamics, historical context, participant knowledge, pharmacy participant knowledge, MHP participant knowledge, solutions/ outcome knowledge, consideration of Maori.
Health philosophies related to themes of paradigms/worldviews, kaupapa Maori, capacity, culture and delivery of services, Treaty of Waitangi, knowledge of culture, communication and te reo, rongoa Maori, environmental culture, access, tino rangatiratanga.
Interaction issues discussed the themes of collaboration and communication, extent of collaboration, contact with Maori, community relationships, cost, benefits and opportunities.
The pharmacy environment, cost and health service delivery were identified as themes relating to service issues.
Capacity issues included themes of mana, direct workforce development (education, employment, promotion), indirect workforce development (education, environment, relationship building, funding), and the Maori Pharmacists Association.
This research attempted to follow kaupapa Maori qualitative research methodology, methods and the epistemology of kaupapa Maori throughout the research and design process. One to one semi-structured interviews were conducted with participants from each group. The sample size was established based on the purposeful sampling strategy of maximum variation sampling (7 MHP participants, 8 pharmacy participants.
Responses were directly related to differences in world-views and the historical context of the two health provider groups with respect to their roles in health. Variations within each group were related to knowledge, location and previous experience working with their counterparts.
Recommendations were associated with themes/issues of environment, knowledge, communication, cultural awareness, collaboration, services and the increased awareness of the roles and responsibilities with respect to each health provider group.
This dissertation also highlighted a number of key components that formed a collaborative, empowerment model of health created between organisations with different world-views, which can be adapted to a number of environments where there are different or opposing world-views within the overall same patient population.
It is anticipated that the results and outcomes from this research will help develop Maori responsive pharmacy services based on health promotion and wellness to Maori locally, regionally, nationally and have a positive impact on Maori health in collaboration with MHPs. Areas of pharmaceutical care are highlighted which may encourage projects or initiatives in collaboration with MHPs to enhance health gains for Maori, while increasing professional practice roles and scope for pharmacy.
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Mouatt, Joshua Roger. "The physiological effects of pseudoephedrine on endurance cycling : a thesis submitted in the partial fulfilment of the requirements for the degree of Master of Science in Sport and Exercise Science, Massey University (Palmerston North, New Zealand)." Massey University, 2008. http://hdl.handle.net/10179/1013.
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Background: Pseudoephedrine (PSE) is a mild central nervous system stimulant that when consumed at a high dosage has the potential to alter physiological and psychophysical responses. PSE is widely accessible as over-the-counter medication and despite limited research into PSE at high dosages or its effects on prolonged exercise (>2 hours) is no-longer on the World Anti-Doping Association’s banned substance list. Currently unrestricted in sport and with no real understanding of the abovementioned responses during endurance exercise there is a high potential for abuse in sport. A recent study performed in our laboratory found PSE to improve self-paced cycling performance in some individuals, however no physiological measurements were taken Purpose: The primary purpose of this study was to determine the physiological effects of PSE at a dosage previously shown to improve performance (2.5 mg/kg) in some individuals during prolonged cycling. A secondary purpose of this study was to assess the effect on endurance cycling performance. Methods: In a randomized, double-blind and counter-balanced design, ten welltrained cyclists participated in two trials, consisting of 120 min of fixed-intensity cycling at 65% VO2max followed by a set work, self-paced time-trial (TT) of ~30 min, following ingestion of either 2.5 mg/kg PSE or visual-matched glucose placebo. Venous blood samples were collected before and during exercise, along with body temperatures and heart rate. Perceived effort and expired gas samples were collected during exercise. Exercise and diet was controlled ~48-hours prior to the trials. Results: Mean heart rate was significantly higher with PSE (P = 0.028) during fixed-intensity exercise. Blood glucose concentrations were significantly lower with PSE (P <0.001) for the first 40 min of fixed-intensity exercise. Respiratory exchange ratio was lower in the final 20-min of fixed-intensity and TT with PSE. Blood lactate, perceived effort, ventilation, and body temperatures were not significantly different between conditions during exercise, nor was TT performance; however individual response was variable. Conclusions: PSE ingestion increased heart rate during endurance cycling and initially suppressed carbohydrate release into the bloodstream while increasing fat oxidation in the later stages of exercise. Despite individual responses, endurance cycling performance remained unchanged with PSE ingestion.
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Dodsworth, Caroline. "How can midlife nurses be supported to deliver bedside care in the acute clinical services until retirement? : a thesis presented in partial fulfilment of the degree of Master of Philosophy (Nursing), Massey University, Turitea, Palmerston North, New Zealand." Massey University, 2008. http://hdl.handle.net/10179/902.
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As the baby boomer generation move inexorably towards retirement and the requirement for health care services increases, the supply of nurses available to provide care at the patient bedside is forecast to fall significantly short of demand. This thesis has explored the perspectives of midlife nurses, asking what it would take to keep them in bedside practice until retirement. These nurses have provided insights which offer employers of valuable senior nurses, suggestions for maximising their potential. Through the use of questionnaires and focus groups nurses aged 45 years and over were asked what the employer can do to ensure that they are able to continue to work at the patient bedside until they reach the age of retirement. The results of this research demonstrate a workforce of nurses who are passionate and committed to their profession, but feeling disillusioned and disempowered. The nursing environment has changed over the span of their career and they find the increased workload, together with increasing professional demands, too hard to cope with. They feel they have no control over their workload, their shift patterns, or the expectations of their patients and colleagues. They want their experience to be recognized but they do not want to have to prove competency; they want to have a voice but they are unwilling to pursue postgraduate education to learn how to become visible and emancipated.
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Ryan, Helen Joanne. "The development of a reliable and valid netball intermittent activity test : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Sport and Exercise Science at Massey University, Auckland, New Zealand." Massey University, 2009. http://hdl.handle.net/10179/1130.
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The purpose of the present investigation was to identify the exercise intensity of netball match play in order to assist in the development of a Netball Intermittent Activity Test (NIAT). A further aim was to assess the criterion validity and the test-retest reliability of the NIAT. Eleven female netball players (21.4 ± 3.1 years, 1.73 ± 0.06 m, 69.3 ± 5.3 kg and 48.4 ± 4.9 ml•kg-1•min–1 mean ± SD, age, height, body mass and VO2max, respectively) volunteered to participate in the study. Heart rate data was recorded for all participants from at least two full 60 minute games during Premier Club competition. Individual maximum heart rate values were acquired for all subjects from the performance of the Multistage Fitness Test, and used to transform heart rate recordings into percent maximum heart rate (%HRmax). Patterns in %HRmax were used to indicate positional grouping when developing the NIAT from time motion analysis data. Subjects performed two trials of the NIAT separated by at least seven days. Physiological and performance markers were measured systematically throughout the NIAT. Exercise intensity as denoted by %HRmax significantly decreased from the first half of match play to the second half (90.4 ± 2.7% v 88.3 ± 2.8%; p<0.05). Significant differences (p<0.05) were observed between positional groups and led to the grouping of Defence (D), Centre Court (CC), and Attack (A) players for NIAT performance. Comparisons of %HRmax between match play and NIAT performance indicated that the NIAT had good criterion validity for D (match Mdn = 92.52% vs. NIAT Mdn = 86.27%, p>0.05) and A (match Mdn = 86.95% vs. NIAT Mdn = 82.93%, p>0.05) players, but that %HRmax during the NIAT (Mdn = 79.70%) was significantly lower than match play (Mdn = 89.70%) for CC group (p<0.05). Measures of 5 m sprint performance (1.27 ± 0.06 s v 1.25 ± 0.06 s; p>0.05; r=0.66, p<0.001), vertical jump height (29.12 ± 4.17 cm v 28.82 ± 3.60 cm; p>0.05; r=0.91, p<0.001), circuit time (107.49 ± 3.22 s v 107.89 ± 4.27 s; p>0.05; r=0.72, p>0.001) and %HRmax (82.56 ± 4.66% v 81.03 ± 4.13%; p>0.05; r=0.82, p<0.001) for NIAT1 vs. NIAT2 indicated good test-retest reliability. These data suggest that netball players experience a reduction in exercise intensity over the duration of a game, with exercise intensity being related to on-court position. Whilst the NIAT appears to be a repeatable activity pattern, it is not a good simulation of physiological strain for all positional groups. More work is required in order to create a netball simulation that is both reliable and valid for all players.
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LINDSAY, Lauren J. "A question about the genetic testing of children in New Zealand : the limitation of parental authority to consent on behalf of their child." Doctoral thesis, 2009. http://hdl.handle.net/1814/13557.
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Chalmers, Linda Maree. "Nurse managers' ethical conflict with their health care organizations : a New Zealand perspective : a thesis presented in partial fulfillment of the requirements for the degree of Master of Management in Health Service Management at Management at Massey University, Palmerston North, New Zealand." 2008. http://hdl.handle.net/10179/862.
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Immersed in a context of constrained health resources, nurse managers are at great risk of the experience and negative consequences of values clashes and ethical conflict, such as burnout and attrition. Replicating a qualitative descriptive study previously conducted in Canada (Gaudine & Beaton, 2002) this research is aimed at increasing knowledge of the experience of nurse managers’ ethical conflict with their health care organizations in New Zealand. Semi-structured interviews were used to gather data from eight nurse managers in New Zealand, which was analyzed using a general inductive approach to qualitative research. The experience of advocating for values that may be shared by both nursing and the health care organization, such as safety, teamwork and quality patient care, were revealed in the conceptual category of Nursing Management Advocacy. As with their Canadian study counterparts, Isolation was revealed as a key factor that made the experience of ethical conflict worse and involves the social experiences of silencing, employment barriers and invisibility. Support describes the factors that mitigated the experience of ethical conflict and involves personal, professional and organizational support, and are likewise similar to the experiences of Canadian nurse managers. The Bottom Line describes a focal point of the experience of ethical conflict where the health care organizations predominantly fiscal bottom line was confronted and challenged by nurse managers, and where the nurse manager might reach their own bottom line and choose to leave the organization. Being and Becoming Nursing Leaders describes the outcomes of ethical conflict for nurse managers who were not only transformed into nursing leaders, through learning, reflection, and growth but also counted the costs of nursing leadership. This study concludes that supportive colleagues, organizational structures and culture are essential to mitigating the experience of ethical conflict and isolation which nurse managers encounter. The study also concludes that reducing isolation and supporting nurse managers will ensure that nursing values are appropriately represented and articulated in the health care organization’s decision making systems and processes.
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Carter, Kristie Norah. "Trends and ethnic disparities in the incidence and outcome of stroke in Auckland, New Zealand over 20 years." 2007. http://hdl.handle.net/2292/2365.
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Aims: The aims of this thesis were to investigate trends and ethnic disparities in the incidence and outcome of stroke in Auckland, New Zealand between 1981 and 2003. Methods: Trends were assessed using information from the three Auckland Regional Community Stroke (ARCOS) studies, conducted in people (aged ≥15 years) in Auckland, during 12-month calendar periods in 1981-1982, 1991-1992, and 2001-2002. These studies used comparable definitions and case finding methods and have been shown to meet the stringent criteria for a population-based “ideal” stroke incidence study. Rates were calculated using Poisson distribution and are presented with 95% confidence intervals. Trends in survival were assessed using Cox Proportional hazards regression modelling. Results: Overall trends in the incidence and event rates of stroke declined across the study period. These declines were significant in males and for the ages 65 to 74 years only. However, growing disparities in the rates of stroke between the major ethnic groups in New Zealand were found, with significant declines in New Zealand Europeans and increases in Māori and Pacific populations. Dramatic improvements in survival over the study period were also found, with the greatest improvement in the acute period, within the first 28-days after stroke. Adjustments for patient or disease severity factors strengthened the survival model. However, adjustments for care/service factors nullified the survival model, thus explaining most of the improving trend. Conclusions: The small declines in the incidence of stroke, improvements in survival and the ageing of the New Zealand population will lead to data dramatic increases in the number of people living with the effects of stroke. To maintain stable numbers of strokes occurring, more intensive prevention strategies need to target high-risk populations and population-wide health education strategies are needed to improve the health of the general population, hence reducing the risk of stroke.<br>Health Research Council (HRC) of New Zealand Pacific Health PhD scholarship
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Grant, Cameron Charles. "The epidemiology of pertussis in New Zealand and risk factors for pertussis in New Zealand infants." 2004. http://hdl.handle.net/2292/3130.
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Literature review Pertussis mortality and morbidity Mass immunisation was associated with a decrease in pertussis mortality and a profound reduction in pertussis incidence. Despite this pertussis remains prevalent. Infants account for the majority of pertussis deaths and hospitalisations. Immunisation Pertussis vaccines protect against disease rather than infection. Despite immunisation pertussis remains endemic. The efficacy of different whole cell and acellular pertussis vaccines varies considerably. There has only been a small increase in immunisation coverage in New Zealand over the past 25 years. Currently between 80% and 90% of New Zealand children receive the primary immunisation series. Other epidemiological features Bordetella pertussis is a highly infectious organism. Neither infection nor immunisation results in lifelong immunity. Pertussis affects all age groups. It is more severe in females than in males. The incidence has always been highest in infants and children but the reported incidence in adults is increasing. Pertussis epidemics occur at four yearly intervals. The epidemic periodicity has not been changed by immunisation. Risk factors for pertussis Contemporary case control studies from the United States have shown that exposure to someone outside of the home with pertussis increases the risk of introduction of pertussis into the home and that infants of adolescent mothers and of mothers with a preceding coughing illness are at increased risk of pertussis. Small sample size and imprecise measurement of immunisation status have compromised these studies. Other factors associated with an increased risk of pertussis in infants include younger age, low birth weight, the infant's immunisation status and household crowding. Prior to this current case control study there was no knowledge on the effect of infant characteristics, infant immunisation status, parental and household characteristics, or socioeconomic factors on the risk of pertussis in infants. Methods The pertussis mortality and hospital discharge statistics and notification data from 1872 to 2000 were reviewed. The characteristics of children hospitalised with pertussis during the 1995 to 1997 epidemic were described. Risk factors for pertussis in infants were determined using a case control study with two different control groups. A matched case-control design was used to compare infants with pertussis with well control infants from the community. An unmatched design was used to compare infants hospitalised with pertussis to infants hospitalised with other acute respiratory illnesses. Results Historical review of pertussis epidemiology Immunisation was associated with a significant decline in pertussis mortality rates in New Zealand. Pertussis incidence rates in New Zealand are five and 10 times higher than in the United Kingdom or the United States. New Zealand pertussis hospital discharge rates increased from 1920 to 1950, decreased from 1950 to 1970 and have been increasing since then. The severity of disease among those hospitalised in New Zealand is comparable to other developed countries. Case control study of risk factors for pertussis in infants In the community control sample factors associated with incomplete immunisation included poverty and household crowding, advice from a doctor that immunisations be delayed and the caregiver not having a record of the infant's immunisations. Primary and secondary pertussis in case households occurred in all age groups. Over half of the primary cases were infants. Factors associated with an increased risk of pertussis included incomplete immunisation of the infant, children five to nine years of age living in the household, household members with pertussis during the preceding two months and the family doctor advising that an immunisation be delayed. Preschool attendance by a household member was associated with a decreased risk of pertussis. Infants of low birth weight and infants with younger mothers were not at increased risk of pertussis. In a multivariate analysis, non-immunisation of other children in the household and the presence of someone in the household with clinical pertussis were associated with an increased risk of pertussis in infants. The associations between household members with cough and the risk of pertussis varied with the age of the household members and imply an age dependent disease modifying effect of immunisation. For many of the children in the study households it seems unlikely that any health professional knew whether or not they were fully immunised. Conclusions Immunisation reduced pertussis mortality in New Zealand. Pertussis hospitalisation rates are increasing despite improvements in the immunisation schedule. Sustained sub-optimal immunisation coverage appears to be the dominant reason for New Zealand’s excessive pertussis disease burden. Primary school aged children are important in household pertussis transmission.
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Polkinghorne, Philip John. "Rhegmatogenous retinal detachment : a New Zealand perspective." 2007. http://hdl.handle.net/2292/5554.
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In New Zealand, rhegmatogenous retinal detachment (RRD) is recognised as a serious and potentially blinding disorder but little is known about the prevalence, risk factors, management and outcomes for treatment for our population. This thesis attempts to investigate these issues and part of that documentation involved a clinical review of those individuals presenting with RRD. That survey was performed over a 16 month interval enabling the annualised rate for individuals presenting with a new RRD to be determined. The prevalence was found to be 11.8 per 100,000. The risk was age-related with the incidence of RRD increasing for each decade up until the age of 70 years. Men had a slightly greater risk of RRD, and high myopes (greater than 6 dioptres) accounted for approximately 1/3 of the presentations. A history of cataract surgery was also noted to be a significant risk factor for RRD. A subsequent investigation documented in this thesis determined the rate of RRD following cataract surgery using phaco-emulsification techniques was 1%. The risk for pseudo-phakic patients was inversely related to age. The initial survey revealed approximately 2/3 of the patients presented with macula-off RRDs. While individually many of these patients did well, as a group the functional improvement following surgery was limited and less than 1/3 of eyes achieved LogMAR 0.3. It was not always apparent what factors negatively impacted on the functional prognosis but certainly those individuals requiring more than one surgery tended to fare worse. The impact of a poor visual outcome was not directly assessed in this thesis but it is likely those individuals do suffer in terms of visual functioning and quality of life issues. In New Zealand there are a number of agencies that care and support visually impaired persons but there is inadequate data to assess and benchmark treatment and rehabilitation. If this could be achieved for patients with RRD then those barriers which potentially restrict successful outcomes might provide useful insight for other individuals with visual impairment.
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White, Jill Fredryce. "The commodification of caring : a search for understanding of the impact of the New Zealand health reforms on nursing practice and the nursing profession : a journey of the heart / Jill Fredryce White." Thesis, 2004. http://hdl.handle.net/2440/22093.
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"April, 2004."<br>Includes bibliographical references.<br>2 v. : ill (some col.), photos ; 30 cm.<br>Seeks to make visible some of the effects on nursing practice and the nursing profession of the political and organisational changes in the New Zealand health reforms in 1995.<br>Thesis (Ph.D.)--University of Adelaide, Dept. of Clinical Nursing, 2004
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Patel, Hussain Y. "Analysis of eye banking and corneal transplantation in New Zealand." 2007. http://hdl.handle.net/2292/5553.
Full textAbstract:
The series of studies comprising this thesis was developed to answer a number of key inter-related questions in regard to eye banking and corneal transplantation in New Zealand. The source and management of donor tissue procured by the New Zealand National Eye Bank (NZNEB) was analysed. Significant trends were identified with respect to donor demographics, donor procurement source, improved donor tissue processing and storage, decreased biological contamination, and increased utilization of corneal tissue. Current trends and ethnicity differences in indications for penetrating keratoplasty (PKP) were investigated. Keratoconus was identified as the most common indication for PKP in New Zealand, accounting for a significantly higher proportion of PKPs than other published reports. Keratoconus was the most common indication for PKP throughout all ethnicity groups and was particularly common in the Maori and Polynesian populations. Significant trends were identified including an increase in the number of PKPs for regraft and Fuchs’ endothelial dystrophy and a decrease for aphakic or pseudophakic bullous keratopathy and viral keratitis. Survival and visual outcome following PKP in New Zealand was investigated using univariate and multivariate analysis. Several independent risk factors were identified that influenced outcome of PKP. Active inflammation at PKP, pre-existing vascularisation, pre-operative glaucoma, small or large graft size, intra-operative complications, episodes of reversible rejection and a pre-operative diagnosis of regraft, trauma or infection resulted in a significantly decreased survival rate. Advancing recipient age, active inflammation at the time of PKP, pre-existing vascularisation, pre-operative glaucoma, episodes of reversible rejection, bullous keratopathy, trauma and non-infective keratitis were associated with poor visual outcome. Patient characteristics, indications, surgical details, and outcome of paediatric keratoplasty were analysed. Acquired non-traumatic indications accounted for the majority of paediatric keratoplasties in New Zealand. This study highlighted keratoconus as a particularly common indication for paediatric keratoplasty when compared to other countries. Survival and visual outcome was better for acquired compared to congenital indications. The effects of corneal parameters on the measurement of endothelial cell density (ECD) in the normal eye were analysed. Corneal thickness appears to be negatively correlated to ECD in the normal cornea for all age groups. Corneal diameter is correlated to ECD measurement in children but not in adults. Corneal curvature was not significantly correlated to ECD measurement, but this needs further investigation. Confocal microscopy and slit scanning topography were used to analyze endothelial morphology and function in the short and long term following PKP. The results of this study are in concordance with other published reports that have identified an accelerated loss of endothelial cells and more rapid development of abnormal endothelial cells in transplanted corneas compared to normal corneas.
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Thompson, John Michael David. "The Epidemiology of birthweight and placental weight in New Zealand." 1997. http://hdl.handle.net/2292/3250.
Full textAbstract:
The introduction to this thesis is a literature review. Kramer, in a study commissioned by WHO, reviewed the literature prior to 1985 on low birthweight. This is extended, mainly in respect to infants who are small for gestational age with emphasis on important findings in relation to birthweight since that time. Work in New Zealand on birthweight is also summarised. The literature is also reviewed in respect to the mechanisms in the pathway between the placenta and the fetus, and in respect to recent work suggesting a link between birthweight and disease in adult life. This thesis examines factors that influence birthweight and placental weight. Birthweight for gestational age percentile curves for the New Zealand population were firstly defined. small for gestational age (SGA) infants could then be categorised. The thesis considers two sources of data, the first a cross-sectional sample of the New Zealand population from 1987 to 1990 (the control subjects of the New Zealand cot Death study, a national case-control study on sudden infant death syndrome), and the second a hospital population in Auckland (National Womens Hospital (l992)). These two datasets are investigated to determine factors that influence birthweight in a univariate situation and then in the multivariate situation. Independent variables are considered using a priori categorisations and where appropriate Quantile-Quantile (Q-Q) derived categorisations determined by producing plots of the quantiles of cases versus controls. A number of variables under the headings of socio-demographic, lifestyle, genetic, obstetric and nutrition are examined and found to be associated with the outcomes of interest at the univariate level. After controlling in multivariate analyses a number of variables are found to be no longer significant, however some show strong relationships. The variable relating to smoking in both datasets shows the greatest detrimental effect on the outcomes considered in respect to birthweight. This confirms that in New Zealand, as in other places in the world, smoking has significant consequences on birthweight. The data is also investigated for the timing of insult to the fetus from smoking, and is found to be most important during pregnancy. comparison of the results comparing those obtained using a binary outcome for SGA, and those obtained using birthweight continuously, show relatively consistent results. The odds ratios and the decreases in birthweight obtained from both datasets show a relatively linear relationship between the two. An examination into whether a distinct group of individuals exists in respect to having large placentae for birthweight, indentified an artefact in the dataset relating to recording of placental weight for twins. After removal of twins from the dataset, examination of factors that influence placental weight showed that the factors that influence placental weight are not the same as those that influence birthweight. In particular smoking is found not to influence placental weight, and haemoglobin, which has no influence on birthweight, is found to be inversely associated with placental weight. other factors such as parity are found to influence placental weight in the same proportion in which birthweight is affected. In conclusion this thesis shows that factors investigated in New Zealand are consistent with findings in the international literature in relation to birthweight. The results on factors that influence placental weight add to the international literature on a topic on which little work has been carried out. The results of this thesis point to areas where future research needs to be carried out, in particular in relation to maternal nutrition during pregnancy and maternal energy expenditure during pregnancy. There is also a need for further research into the relationships of factors on placental weight and the ratio of birthweight to placental weight, and how these relationships affect health outcomes in childhood and adult life.