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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.
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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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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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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Withdrawn, Theodore Reremoana Farquharson. "Factors associated with cognitive ability in middle childhood". Thesis, University of Auckland, 2008. http://hdl.handle.net/2292/2378.

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There has been considerable debate among cognitive psychologists and epidemiologists regarding which determinants of children’s intelligence are most important. Factors such as children’s diet, maternal stress and social support are important for general health and wellbeing, but have received little research attention in longitudinal studies involving cognitive outcomes. Few studies have examined the determinants of intelligence in children born small-for-gestational age (SGA) at term even though these children may be particularly vulnerable to poorer postnatal environments. The aim of this study was to identify factors associated with cognitive ability in middle childhood in New Zealand (NZ) European children and children born SGA. The present research was conducted as part of the Auckland Birthweight Collaborative (ABC) study. Approximately half of the children in this study were born SGA (birthweight<10th percentile) and half were born appropriate-for-gestational age (AGA=birthweight>10th percentile). Information was collected from mothers and children on pregnancy, obstetric, socio-demographic, postnatal and dietary factors when the children were born (n=871), at one year (n=744), 3.5 years (n=550), and 7 years of age (n=591). Cognitive ability was assessed at 7 years using the Wechsler Intelligence Scale for Children – Third Edition. For the total sample, the analyses utilised weighting to allow for the disproportionate sampling of children born SGA. Results showed that SGA and AGA children did not differ in intelligence at 7 years. Factors associated with intelligence included maternal pregnancy factors (e.g. hypertension), socio-demographic factors (e.g. paternal education), and postnatal factors (e.g. maternal social support). In general, the effects of environmental factors did not differ significantly for SGA children compared with AGA children. A number of dietary factors were also found to be significantly and positively associated with intelligence measures including higher intakes of breads and cereals and weekly fish consumption. In contrast, daily margarine consumption was associated with significantly lower intelligence scores, particularly in SGA children, and this is the first study to report this association. iii Dietary and “environmental” factors were stronger predictors of children’s intelligence in middle childhood than “biological” factors, such as infant’s birthweight. Importantly, most of the factors associated with intelligence that were identified in this study are potentially modifiable. Further research is needed to examine whether these factors continue to be associated with cognitive ability in later childhood.

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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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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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Hartshorn, Nikki. "The impact of participating in an activity programme (10,000 steps @ work lite programme) on dietary change : a thesis presented in partial fulfillment of the requirements for the degree of Master of Science in Nutritional Science at Massey University, Palmerston North, New Zealand". Massey University, 2009. http://hdl.handle.net/10179/908.

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High levels of diet related chronic disease in New Zealand has lead to the development of health promotion programmes. The work place is an important venue to implement health promotion programmes to encourage staff to make healthy lifestyle choices. The aim of this research is to examine if a physical activity programme may be a ‘gateway’ to other positive behavioral changes such as healthy eating and/or cutting down smoking. This research introduces a health promotion programme to employees at a call centre. The intervention involved 3 groups: the health promotion group (HPG), which received both the physical activity programme (10,000 steps @ work ‘lite’ programme) plus nutritional information; the nutritional group (NG), which received only the nutritional information and the control group (CG), which did not take part in the intervention. The impact of the nutritional seminars with or without the exercise programme was measured by the participants’ reported fruit, vegetable, snack consumption and transtheoretical stages of change for exercise, fruit and vegetable intake, healthy snacking and smoking. A questionnaire was used to collect data retrospectively. The health promotion group (HPG) made positive changes in all behaviours unlike the nutritional group (NG) and the control group (CG). This provides some support for the hypothesis that physical exercise may act as a ‘gateway’ to other positive behavioural changes.

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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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Ihimaera, Louise. "He ara ki te ao mārama : a pathway to understanding the facilitation of taha wairua in mental health services : a thesis submitted in partial fulfilment of the requirements for a Masters of Arts, Massey University, Palmerston North, New Zealand". Massey University, 2004. http://hdl.handle.net/10179/990.

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This research is about the facilitation of taha wairua (spirituality) in mental health services. This research has been guided by kaupapa Maori frameworks and aimed to answer three questions: · Whether taha wairua, supported by matauranga Maori can be verified as a valid concept for use in mental health services · How Maori cultural and clinical workers facilitate taha wairua within a kaupapa Maori approach, and, · How the use and influence of taha wairua facilitates the inclusion of matauranga Maori. The increasing acceptability of alternative and holistic approaches to healing often with a spiritual component deserves serious consideration, especially within the area of mental health services. The literature shows that indigenous views of health and healing are valid and deserve recognition and acceptance in mental health services. The Treaty of Waitangi, the founding document of New Zealand, underpins Maori rights to the facilitation of taha wairua practices in Western health systems. Current New Zealand mental health policy and legislation provide strategies to progress the facilitation of Maori healing interventions in mental health services. It is noticeable, however, that these strategies are not built on the Treaty of Waitangi but are built on health disparities. The literature also supports the concept that there is a place in the recovery process for both spirituality and religious beliefs, and Western and cultural interventions. The data illustrate how tikanga Maori either practised solely in its natural form or within the framework of Maori models of health is beneficial to health outcomes for tangata whai ora and whanau when supported by the facilitation of taha wairua. The research data provided the foundation for components that can produce a framework for the facilitation of the concept of taha wairua within the scopes of practice of kaimahi Maori in mental health services. Some standards for best practice in supporting taha wairua within the cultural component of all Maori working in mental health have also been proposed. Maori do not have the critical mass to achieve all that has been raised in this research, and the principle of collective responsibility needs to be applied to provide the necessary resources and support to achieve implementation of Maori healing frameworks to facilitate taha wairua in mental health services. It is hoped the knowledge gained from this research will be useful to policy makers and managers in gaining insight into the benefits of healing for tangata whaiora, whanau and kaimahi Maori through the provision of appropriate cultural interventions and in providing an appropriate environment to enable physical and spiritual healing to take place. It is also hoped Maori too will find this research of benefit, particularly to inform scopes of practice, thereby providing potential for new ways to achieve best practice cultural and clinical practice.

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Wilson, Denise. "Ngā kairaranga oranga = The weavers of health and wellbeing : a grounded theory study : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, New Zealand". Massey University, 2004. http://hdl.handle.net/10179/992.

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Ngā Kairaranga Oranga – The Weavers of Health and Wellbeing is a theory about the health and wellbeing of Māori women. Health data about Māori women indicate that their health status is less than that of the non-Māori population despite the right to experience equality in health outcomes. Māori women’s health and wellbeing influences the nature of their health outcomes, varies across their lifetime. ‘What is happening for Māori women, their health and interactions with ‘mainstream’ health services?’ is the question that guided the research with Māori women. A grounded theory informed by a Māori centred approach was developed that utilised Mason Durie’s Māori-centred concepts of mana Māori (control), whakapiki tangata (enablement) and whakatuia (integration), and integrated Glaserian grounded theory to guide the collection and analysis of the data. Twenty-three women who identified as Māori within the Te Arawa rohe, and who were between the ages of 18 and 80 years were formally interviewed as either a group, pairs or individuals, with a further 15 informally interviewed during the process of theoretical sampling. Semi-structured interviews 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 Māori centred grounded theory. Three core categories were identified relating to the health and wellbeing of Māori women: (a) Mana Māori, which describes what is important for their health and wellbeing; (b) The Way It Is, which outlines the resigned acceptance they have of their reality and life circumstances, and the barriers and challenges that are encountered; and (c) Engaging with Health Services, which describes what they require from ‘mainstream’ health services to improve the access and use of these services. The basic social psychological process of ‘weaving health and wellbeing’ integrates these core categories. The interpretations Māori women have of health and wellbeing, and health-related actions are explained by the theory generated. This substantive grounded theory provides a model to guide the education and practice of health care providers working within ‘mainstream’ health services.

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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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Tsai, Midi. "The relationship between osteoporosis knowledge, beliefs and dietary calcium intake among South Asian women in Auckland : a thesis presented in partial fulfillment of the requirements for the degree of Master of Science in Human Nutrition at Massey University, Auckland, New Zealand". Massey University, 2008. http://hdl.handle.net/10179/855.

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Osteoporosis is a serious public health issue, which is growing in significance because of our aging population. It is estimated that one in three New Zealand women over the age of 50 years will suffer from an osteoporotic-related fracture. The risk of osteoporosis among South Asian women living in New Zealand is unknown. However, this is an important and growing population group. The purpose of this study was to determine osteoporosis knowledge, health beliefs and dietary calcium intake in a sample of South Asian women living in Auckland, New Zealand. Relationships between these variables and the predictors of dietary calcium intake were examined. A sample of 102 South Asian women (mean age of 41.6 years) completed an online questionnaire to assess osteoporosis knowledge and health beliefs using the validated Osteoporosis Knowledge Test (OKT) and Osteoporosis Health Belief Scale (OHBS), respectively. A four day food diary was used to assess dietary calcium and energy intake. In general, these South Asian women were lacking in osteoporosis knowledge, they did not perceive themselves to be susceptible to osteoporosis and did not consider osteoporosis to be a serious disease. They perceived many benefits of consuming a high calcium diet for the prevention of osteoporosis and did not identify many barriers to dietary calcium intake. In addition, these South Asian women were highly health motivated. Perceived barriers to dietary calcium intake (R=-0.32; P<0.01) and health motivation (R=0.30; P<0.01) were significantly correlated to dietary calcium intake. Health motivation, perceived barriers to dietary calcium intake and the use of a dietary supplement were significant predictors of dietary calcium intake and together explained 27% of the variance. These findings suggest that osteoporosis prevention interventions may need to increase awareness, overcome perceived barriers to dietary calcium intake as well as maintain health motivation among these South Asian women to achieve sufficient dietary calcium intake.

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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.

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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.

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14

McLaren, Stuart Joseph. "Noise in early childhood education centres: the effects on the children and their teachers : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy at Massey University, Wellington, New Zealand". Massey University, 2008. http://hdl.handle.net/10179/977.

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Although the effects of noise on children’s learning in school classrooms is well documented, there is very little on the effects of noise on preschool children. There are strict legal requirements for the daily noise exposure an adult worker can received in the workplace but nothing to control the noise children can receive in school and early education. There is also little or no data on how sound affects a child, compared to an adult. The early years of life are critical for the development of speech, hearing and auditory processes, as well as being the most vulnerable time for middle ear infections. This work sets out to determine the typical noise levels in early childhood centres and the effects on a range of children and their teachers. Reverberation times in most centres were found to well exceed the 0.6 seconds prescribed by the Australasian standard for schools and learning spaces. Very high levels of noise were recorded in a number of centres with a significant number of children and staff members, exceeding the maximum daily sound exposure of 100% permitted for workers in industry. A range of special needs children were identified as being particularly at-risk to noise, with the most adverse outcomes reported for those experiencing sensory integration disorder. Yet, even though high levels of noise were recorded, the majority of respondents in a survey of teachers rated the lack of sufficient space for the number of children present as the main issue, and inclement weather as the greatest environmental condition contributing to noise (by confining children indoors, especially over long periods of time). Hearing tests on the children were not permitted under the strict human ethics criteria to which this study had to conform, but simple hearing tests on a small group of teachers, revealed that hearing loss could be a serious occupational health issue. The legal issues of noise control and management in early childhood education have been addressed in this thesis, current legal frameworks reviewed, and recommendations presented for future consideration.

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15

von, Hurst Pamela Ruth. "The role of vitamin D in metabolism and bone health : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Nutritional Science at Massey University, Albany, New Zealand". Massey University, 2009. http://hdl.handle.net/10179/1148.

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Background Hypovitaminosis D is becoming recognised as an emerging threat to health, even in countries like New Zealand which enjoy plentiful sunshine. The evidence for a role for vitamin D deficiency in the aetiology of a plethora of diseases continues to accumulate, including type 2 diabetes, and the preceding insulin resistance. Objectives The primary objective of the Surya Study was to investigate the effect of improved vitamin D status (through supplementation) on insulin resistance. The secondary objectives were to investigate the vitamin D status and bone mineral density of South Asian women living in New Zealand, and to investigate the effect of vitamin D supplementation on bone turnover as measured by biochemical markers of bone resorption and formation. Method Women of South Asian origin, ≥20 years old, living in Auckland (n = 235) were recruited for the study. All were asked to complete a 4-day food diary, invited to have a bone scan, and were screened for entry into the intervention phase which required insulin resistance (HOMA-IR >1.93) and serum 25(OH)D < 50 nmol/L. Eighty-one completed a 6-month randomised controlled trial with 4000 IU vitamin D3 (n = 42) or placebo (n = 39). Primary endpoint measures included insulin resistance, insulin sensitivity (HOMA2%S), fasting C-peptide and markers of bone turnover, osteocalcin (OC) and collagen C-telopeptide (CTX). Ninety-one of the 239 had a bone scan and bone mineral density (BMD) was measured in the proximal femur and lumbar spine. Results Adequate serum 25(OH)D concentrations (>50 nmol/L) were observed in only 16% of subjects screened. Median (25th, 75th percentile) serum 25(OH)D increased significantly from 21 (11,40) to 75 (55,84) nmol/L with supplementation. Significant improvements were seen in insulin sensitivity and insulin resistance (P = 0·003, P = 0·02 respectively), and circulating serum insulin decreased (P = 0·02) with supplementation compared to placebo. There was no change in C-peptide with supplementation. Insulin resistance was most improved when endpoint serum 25(OH)D =80 nmol/L. In post-menopausal women OC and CTX levels increased in the placebo arm but CTX decreased from 0.39±0.15 to 0.36±0.17 (P = 0.012) with supplementation. Osteoporosis (T score <-2.5) was present in 32% of postmenopausal, and 3% of premenopausal women. Women 20 – 29 years (n=10) had very low BMD, calcium intake and serum 25(OH)D Conclusions Improving vitamin D status in insulin resistant women resulted in improved insulin resistance and sensitivity but no change in insulin secretion. Optimal 25(OH)D concentrations for reducing insulin resistance were shown to be ≥80 nmol/L. The prevalence of low 25(OH)D concentrations in this population was alarmingly high, especially in younger women. In post-menopausal women, vitamin D supplementation appeared to ameliorate increased bone turnover attributed to oestrogen deficiency.

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16

Espiner, Stephen. "The phenomenon of risk and its management in natural resource recreation and tourism settings : a case study of Fox and Franz Josef Glaciers, Westland National Park, New Zealand". Lincoln University, 2001. http://hdl.handle.net/10182/638.

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The significance of risk is growing in many Western societies, a phenomenon linked to increasing individualism, personal choice, and outcome uncertainty in multiple spheres of life. Despite being healthier and more physically protected from harm than any previous society, a serious concern for safety and risk control is emerging as a defining characteristic of modern social life. Within the context of a risk-averse society, this thesis investigates the nature and relevance of risk in natural resource recreation and tourism settings. Millions of people every day visit national parks and other protected areas around the world in which natural hazards inhere. Many visitors fail to recognise these hazards, creating moral, legal, and ethical issues for natural resource managers. People travel to national parks anticipating a degree of adventure, to escape routines, and to witness the grandeur of nature. Ironically, the very qualities that attract people to natural areas may also put them at risk. Managers of natural resource tourism and recreation areas in New Zealand are confronted with a paradox born out of visitor demand for nature experiences, a legal obligation to facilitate free access, and a growing social emphasis on health and safety. In particular, this study assesses the risk perceptions of visitors to the Fox and Franz Josef glaciers, popular tourist attractions on the West Coast of New Zealand's South Island, and explores the risk perceptions and beliefs of resource management agency staff. The study also investigates the issue of risk communication at these two sites, and the degree to which existing hazard messages are successful at encouraging appropriate visitor behaviour. Pictorial hazard warning signs are introduced to the sites and their effectiveness evaluated. The findings show that many visitors (especially international visitors) have relatively poor awareness of natural hazards, and behave in ways which potentially compromise physical safety. It is argued that perceptions and behaviour are a consequence of diverse individual and situational factors including limited knowledge of the sites, beliefs about management, poor comprehension of hazard warning signs, and freedom from the normative constraints of everyday life. In contrast to visitors, managers at the glacier sites consider the risks to be significant, and, potentially, severe. It is argued that managers' perceptions of risk are influenced by several important social and site-specific factors, including their own experiences of hazards at the glaciers, perceived legal and moral obligations, the organisational culture, and impressions of high societal expectation concerning safety. The situation is further complicated by the freedom of access principle in national parks, and increasing tourist demand for nature-based experiences. These factors governed beliefs about the subject of risk. This study identifies several dimensions of risk in nature-based recreation and tourism settings. Visitors are at risk of personal accident or injury at certain tourism attractions. Awareness of hazards is limited, visitor behaviour compromises safety, and existing communication strategies are only partially effective. Risk is also apparent in the agency responsible for management of outdoor recreation areas. Site managers perceive a risk in their failure to prevent visitors from harm, whereas senior managers identify risk as primarily financial, legal, and political. Collectively, these factors demonstrate that the phenomenon of risk is increasingly important in the tourism and recreation context, and has the potential to influence significantly both management and experience of protected natural areas in New Zealand.

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17

Abel, Sally. "Midwifery and maternity services in transition: An Examination of change following The Nurses Amendment Act 1990". Thesis, University of Auckland, 1997. http://hdl.handle.net/2292/1968.

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The Nurses Amendment Act 1990 enabled midwives in New Zealand/Aotearoa to care for women throughout normal childbirth on their own responsibility, without the supervision of a medical practitioner, as had previously been the case. The Act brought about significant changes to midwives' scope of practice, pay and status which had important implications for women's care, midwifery, the relationship between midwifery and medicine and the structure of maternity services. Three years after the passage of the Act, in July 1993, major restructuring of the health system along market principles began. From this time, consultation began for new maternity services arrangements, which fitted within the philosophy and structure of the new health system and which aimed to rectify some of the perceived problems resulting from the initial implementation of the 1990 Act. The consultation process was to take three years. This thesis describes and critically analyses changes to midwifery and maternity services, particularly in the greater Auckland region, in the six years from the passage of the Nurses Amendment Act in August 1990 until the official introduction of the new maternity structure in July 1996. This was a period in which midwifery was establishing itself in a medically-dominated domain while, simultaneously, a significant ideological shift was occurring in the philosophy and structure of the health system. Using an ethnographic approach, which included extensive key informant interviews and participant observation at a range of meetings over a period of three years I investigated in depth both the process of change and the relations of power between interest groups (consumer representatives, midwifery, medicine, hospital managers and regional health authorities) within local and national maternity services arenas. These findings were analysed using Foucault's later work on power and his concept of governmentality. A range of factors, including some of the trends occurring within the public sector, weakened the medical profession's control of normal childbirth and facilitated midwifery's entry as a competing provider of maternity care. Strategies used by midwifery representatives to maintain and develop the occupation's autonomous status were often effective, albeit constantly challenged. Despite ongoing conflict and some polarisation between medicine and midwifery, in general, relations of power between the various interest groups in both local and national settings were found to be complex and contestable with unstable alliances forming around particular issues. However, the fluidity of these power relations and the gains made by midwifery operated within constraints imposed by the influence of neo-liberal policies on the development of the new maternity structure. This gave the government's agents, the regional health authorities, the controlling influence on maternity services policy. Although the professed aim of the new structure was a more women-centred service, there were limits to consumer influence on maternity services policy and fiscal imperatives took precedence over some consumer interests. KEYWORDS: Midwifery; Maternity Services; Nurses Amendment Act 1990; Health Reforms; Power; Foucault; Professions; New Zealand; Aotearoa.

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18

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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19

Benipal, Jagpal Singh. "Analysis of trends and reasons for rising acute medical admissions in Auckland's public hospitals". 2008. http://hdl.handle.net/2292/2419.

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The main purpose of this study was to examine empirically the trends and reasons for rising acute adult medical admissions at two major public hospitals in Auckland from 1997 to 2004. According to recent national and international literature published on the topic, there has been unsustainable growth in the adult medical admissions both in NZ and most of the other developed countries. Overall, the causes of this increase have not been explored sufficiently in the literature reviewed. The NZ research has largely focused on the macro-analysis of hospital throughput data from health policy points of view. Methodology: A mixed methodology research design was applied to address the problem. Phase 1 quantitatively analysed adult medical hospital admission data (N = 277,416) obtained from the two hospitals (Middlemore and Auckland Public Hospitals), and phase 2 qualitatively explored the responses and views of the health professional expert panel (n = 16) in relation to the findings of phase 1 of the study. Findings: Overall, the crude number of admissions and age-standardised admission rates at both hospitals increased more rapidly than actual population increases. Approximately 1/3 of the patients accounted for 2/3 of the total admissions. Five major diagnostic categories accounted for 70%-80% of total acute admissions, with circulatory and respiratory system disorders being the leading causes of medical admissions. There was a strong relationship between age and increased admissions. MMH hospital overall, and its ethnic groups separately, had significantly higher admission rates than APH. Comparison of ethnic groups highlighted significant variations in the admission rates at the two hospitals despite adjusting for age, morbidity and deprivation. Conclusions: Overall the increase and variation in admission rates between the hospitals and ethnic groups was dependent on factors such as the characteristics of the population and patients, hospital admission and administration processes, availability of hospital beds, medical management at the hospital, and availability of primary and community care services. By making changes to those factors in the control of hospitals and District Health Boards, hospitals can potentially influence the trajectory of rising medical admissions. These factors include systems for managing patients with chronic illness, and pathways from community services to hospital. Finally, a number of future research areas, such as a large-scale study to explore the health service utilisation of the 55+ age groups, have been proposed.

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Prebble, Catherine Mary (Kate). "Ordinary Men and Uncommon Women : A History of Psychiatric Nursing in New Zealand Public Mental Hospitals, 1939-1972". 2007. http://hdl.handle.net/2292/1516.

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This social-cultural history explores the changing context, culture, and identity of psychiatric nurses working in New Zealand public mental hospitals between 1939 and 1972. Primary documentary sources and oral history interviews provided the data for analysis. The thesis is divided into two periods: 1939 to 1959 when asylum-type conditions shaped the culture of the institutional workforce, and 1960 to 1972 when mental health reform and nursing professionalisation challenged the isolation and distinct identity of mental hospital nurses. Between 1939 and 1959 the introduction of somatic treatments did not substantially change nursing practice in mental hospitals. Overcrowding, understaffing and poor resources necessitated the continuance of custodial care. The asylum-type institutions were dependent on a male attendant workforce to ensure the safety of disturbed male patients, and the maintenance of hospital farms, gardens, and buildings. Although female nurses provided all the care and domestic work on the female side, the belief that psychiatric nursing was physically demanding, potentially dangerous, and morally questionable, characterised the work as generally unsuitable for women. Introduction of psychiatric nursing registration which was a move toward professionalisation did little to change the dominance of a male, working-class culture. From 1960 to 1972 psychiatric nurses’ identity was contested. New therapeutic roles created the possibility of the nurses becoming health professionals. Their economic security and occupational power, however, was tied to an identity as unionised, male workers. As psychiatric nurses were drawn closer to the female-dominated nursing profession through health service changes and nursing education reform, both men and women acted to protect both their working conditions and their patients’ welfare. To achieve these ends, they employed working-class means of industrial action. By accepting the notion that psychiatric nurses’ identity was socially constructed, this thesis provides an interpretation that goes beyond the assumption that nursing is a woman’s profession. Instead, it presents psychiatric nursing as a changing phenomenon shaped by contested discourses of gender, class and professionalisation. Nursing in public mental hospitals attracted ordinary men and uncommon women whose collective identity was forged from the experience of working in a stigmatised role.

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21

Kampf, Antje. "'To map out the "venereal wilderness"' : a history of venereal diseases and public health in New Zealand, 1920-1980". 2005. http://hdl.handle.net/2292/2202.

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This thesis traces the public health debate about venereal disease in New Zealand from 1920, when the first venereal disease clinics were established, to 1980 before the first AIDS/HIV cases emerged. Studies of venereal disease in New Zealand have concentrated on issues of morality and on the political and social debates; this thesis focuses on treatment procedures and Health Department campaigns. The thesis explores the role of doctors in relation to venereal disease. While advancements in drug therapy benefited patients, medical authority was undermined by demanding and defaulting patients, inadequate medical education, and a low status of the profession. The medical profession developed epidemiological studies and defined 'at risk' groups in post-war decades. Despite claims to be 'scientific', the assessments were informed by stereotypes which had changed little over time. The thesis evaluates the scope of preventative health campaigns. Defined as a public health issue by the 1920s, venereal disease was seen as an individual responsibility by the 1960s. During this time the use of legislation declined, and education and contact tracing increased. The control of infection was limited owing to financial and administrative problems, defaulters and opposition from doctors. Those deemed most at risk were not reached by government educational campaigns, leaving much to the work of welfare groups and individual doctors. The health campaigns targeted groups like Maori and servicemen. The historiography has tended to overlook Maori, and, when military campaigns are discussed, to focus on females. This thesis attempts to redress the balance. Maori had, at least until the 1950s, different treatment experiences from non-Maori patients, although this did not necessarily imply discrimination. The military did attempt to control servicemen, though each Service had different experiences. This thesis stresses the complexity of the gender issue. There was a change from blaming females for infection in the early twentieth century to increasingly pointing to male responsibility. Despite these changes, even with the concept of individual risk pattern by the 1960s, and the understanding that men could be asymptomatic carriers, women were persistently seen as the 'reservoir'. A gender bias persisted.
Note: Thesis now published. (2007) Kampf, Antje. Mapping Out the Venereal Wilderness: Public Health and STD in New Zealand, 1920-1980. Berlin: Lit-Verlag. http://www.lit-verlag.de/isbn/3-8258-9765-9. Whole Document not available at the request of the author.

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22

Moy, Karen. "Physical activity and fitness measures in New Zealand : a study of validation and correlation with cardiovascular risk factors". 2005. http://hdl.handle.net/2292/305.

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The primary aim of the study was to validate the short and long form of the recently-created NZ physical activity questionnaires (NZPAQ-SF and NZPAQ-LF, respectively) in a multi-ethnic sample in Auckland. An international physical activity questionnaire (IPAQ-long) was also validated and compared to the NZ instruments. Objective PA measures were used to create a NZ compendium of PA intensities, providing baseline data for culturally-specific PAs. Secondary aims included an examination of the relationship between PA and CRF, and their associations with cross-sectional measures of cardiovascular (CV) risk factors. The study sample consisted of 186 apparently healthy males (n=90) and females (n=96) aged 19-86 yrs, classified as European/Other (n=60), Māori (n=61), and Pacific (n=65). Heart rate monitoring (HRM) with individual calibration was used to objectively measure the duration, frequency, and intensity of at least moderate-intensity PAs performed over 3 consecutive days. Type of PA and the context in which it was performed was simultaneously recorded by participants on daily PA logs. Correlations between HRM and self-reported levels of brisk walking, moderate-intensity, vigorousintensity, were poor for each questionnaire, and correlations were lower for Māori and Pacific ethnic groups than for European/Other. The NZPAQ-SF (r=0.3, p<0.001) and NZPAQ-LF (r=0.3, p<0.001) performed better than the IPAQ-long (r=0.1, p=0.37). The culturally-specific list of PA intensities showed strong correlation (R2=0.68) to an internationally-accepted compendium of PA intensities, and provided baseline energy cost data for 13 PAs performed by Māori and Pacific people in NZ. CRF levels were primarily influenced by gender, ethnicity, obesity, and performing at least 15 min/day of vigorous-intensity PA, and showed stronger associations with fasting blood lipids and glucose, while PA was more strongly related to SBP and DBP. The validated NZPAQs are acceptable for measuring population level PA prevalence in NZ adults, although accuracy is lower for Māori and Pacific people. However, the availability of a culturallyspecific list of PA intensities could potentially increase the accuracy of self-reported PA by Māori and Pacific people. Results from this study highlight the importance of vigorous-intensity PA for CV health, and identifies NZ Pacific people as high risk in terms of PA, obesity, and CRF.

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23

Schaaf, David. "Cardiovascular disease risk factors in Pacific adolescents: the Auckland high school heart survey". 2005. http://hdl.handle.net/2292/1947.

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Cardiovascular disease is the leading cause of mortality in New Zealand. The most current evidence indicates that the burden of cardiovascular disease is greatest among Maori and Pacific peoples and Pacific peoples have the highest mortality rate for cerebrovascular disease [1]. There is substantial scientific evidence that cardiovascular disease has its origin early in life and that a person's risk of cardiovascular disease is determined by the synergistic effect of all the cardiovascular risk factors over time. The Auckland High School Heart Survey (AHHS) is an epidemiological survey designed to determine the prevalence of risk factors for cardiovascular disease in an adolescent high school population in New Zealand. It takes a 'lifecourse' and primary prevention approach to reducing the incidence of cardiovascular disease. The aims of the study were to determine cardiovascular risk factor levels in, and compare the cardiovascular and diabetes risk factor levels between, Pacific and European students and the main Pacific communities (Samoan, Cook Islands, Tongan, and Niuean). The AHHS was a school-based cross-sectional survey of 2,549 adolescent students, across 10 Auckland High Schools. A cluster sampling technique was used to obtain the target of 1000 Pacific participants, to enable Pacific ethnic-specific analysis. The study specifically aimed to determine ethnic-specific differences in lifestyle, intermediate and outcome variables that have been established as cardiovascular risks. Lifestyle variables included: smoking, alcohol consumption, leisure-time physical activity (LTPA), television exposure and sun exposure. The intermediate variables analysed included: body mass index (BMI), waist to hip ratio (WHR), percentage body fat (PBF) and physical work capacity 170 (PWC170). The outcome variables included: total cholesterol (TC), high density lipoprotein cholesterol (HDLC), ratio of total cholesterol to high density lipoprotein cholesterol (TC:HDLC), low density lipoprotein cholesterol (LDLC), triglycerides (TG), fasting blood glucose (FG), urinary micro albumin (UA), systolic and diastolic blood pressure (SBP & DPB). Demographic variables analysed included: sex, age, ethnic group, school, socio-economic status and growth development and maturation. The AHHS study results showed that demographic variables were strongly associated with both intermediate and outcome variables. The findings showed that there were significant ethnic variations between the four main ethnic groups (Pacific, Maori, Asian and European) in risk factors for cardiovascular disease. Pacific participants had the highest BMI and PBF. Pacific participants had the lowest levels of PWC170. With regard to outcome variables, Pacific adolescents had lower levels of TC, HDLC and LDLC compared to Europeans. However, Pacific participants had higher levels of TC:HDLC, FG, TG and DPB. To a lesser degree, lifestyle variables were also associated with other variables. However, the weaker association was likely due to measurement error. The findings of the AHHS study show that ethnic differences present in the adult population are already established among adolescents [2]. Some significant differences were also found between the Pacific ethnic groups (Samoan, Cook Islands, Tongan and Niuean). Among Pacific participants, Cook Islands participants also had the highest level of adjusted mean PWC170. With regard to outcome variables (lipids, fasting glucose and blood pressure), Tongan participants had lower TC, LDLC and TC:HDLC compared to Samoans. However, Tongan participants had significantly higher levels of TG compared to Samoans. For Pacific participants, Cook Islands participants significantly differed from Samoan in smoking, alcohol consumption and PWC170. Cook Islands participants were more likely to have tried smoking for the first time and at an earlier age. They were also more likely to smoke daily and to smoke higher amounts than the other Pacific ethnic groups. Cook Islands participants were more likely to have tried alcohol and at an earlier age. They were also more likely to be drinking alcohol weekly or more often when compared to Samoans. The AHHS study is one of the first pieces of epidemiological research undertaken in New Zealand that provides evidence that there are significant differences between Pacific ethnic groups for this age group. The AHHS study was also able to identify the determinant that explains ethnic differences in outcome variables. BMI was the most significant variable in determining the ethnic differences in outcome variables (lipids, blood pressure and fasting glucose). The AHHS study results showed that Pacific participants had the highest BMI levels of all the ethnic groups, followed by Maori. Television watching was the one lifestyle risk factor that was positively associated with BMI. The most effective variable in terms of decreasing mean difference in BMI was PWC170. PWC170 was significantly lower in Pacific, Asian, and Maori participants compared with European participants. Pacific participants had the lowest levels of PWC170 compared to all other ethnic groups. The AHHS findings support early interventions and programmes targeted to adolescents to reduce the incidence of cardiovascular disease. The findings which show that there are significant differences between Pacific ethnic groups for this age group, may warrant some specific public health initiatives being targeted directly to Pacific ethnic-specific groups. In addition, interventions and programmes that target reducing BMI and improving physical fitness should have an impact on a number of important cardiovascular risk factor outcome variables in adolescents, including: blood pressure, lipids and fasting glucose.

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24

Khin, Natalie R. "Mental disorders in general practice". 2004. http://hdl.handle.net/2292/1929.

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Background: There is a high rate of mental disorders among general practice attendees that is associated with substantial morbidity, disability and global burden. As a consequence GPs play a pivotal role in ensuring that patients with mental disorders are recognised and optimally treated. While there is little doubt of the role GPs play in managing mental illness in general practice the literature suggests a proportion of patients will go unrecognised or else be inadequately diagnosed and in some instances inadequately treated by their GP. The known problems of under diagnosis of mental disorders has been seen until recently to be a problem of GP knowledge and skill, which has led to the close scrutiny of GP performance in this field. In response to this close scrutiny has been the development of a wide range of physician education programs aimed to improving the clinical performance of GPs. However, more recently it has been acknowledged that reasons for low recognition and inadequate treatment of mental disorders in general practice is not only the GPs lack of skill and knowledge, but instead involves a complex interplay of GP, patient and systemic factors unique to GPs, their patients and the general practice setting. Therefore there is a growing interest in research to not only explore ways to improve the clinical performance of GPs, but to also gain a better understanding of the range of issues that GPs are confronted with when managing mental disorders in general practice. Aim: There were two aims of this research: 1) examine GP attitudes, reported confidence and behaviour pertaining to the detection, diagnosis and management of mental illness in general practice (Study One); and 2) describe the epidemiology of depression in general practice and investigate symptom attribution styles as it relates to depression (Study Two). Methodology: In Study One 800 randomly selected rural and urban GPs in the North Island were invited to complete the Attitudes, Reported Confidence and Behaviour Questionnaire Revised (ARCBQ-R). The ARCBQ-R had been previously piloted and reliability and validity issues addressed and published elsewhere. In Study Two, 15 general practices were randomly selected from a database of Auckland General Practices, of which 35 consecutive general care attendees were recruited from each of the 15 general practices. Consenting patients completed a self report questionnaire on mood and health and a computerised version of the Composite International Diagnostic Interview (CIDI) questionnaire (depression module only). Results: Study One: Four hundred and sixteen (52%) GPs completed the ARCBQ-R. GPs are confronted with a wide range of mental disorders in their day-to-day practice, with a predominance of depression and anxiety. GPs were most confident in detecting, diagnosing and treating depression and were most confident in prescribing antidepressants, particularly SSRIs for depression and anxiety. GP confidence in detection, diagnosis and treatment of mental illness was influenced by a number of GP factors such as: interest in mental health, previous mental health training, gender and exposure to mental disorders in their practice. Systemic and patients factors were also reported to influence the way in which GPs recognise and manage mental disorders in their practice. Only a small proportion of GPs reported to use solely DSM-IV or ICD-10 classifications when making a diagnosis, and the majority relied on informal ways to diagnose mental disorders in their patients, which raises questions about the appropriateness of formal diagnostic classifications in general practice. Training needs for this group of GPs involved both treatment and diagnostic issues pertaining to more complex disorders. GPs believed that shared care of mental disorders is the most effective way to provide optimal care for patients. However a number of issues pertaining to availability and assessibility of secondary mental health services along with structural issues such as cost, time and extended consultations in general practice must be addressed before this model of care can work to its full potential. Study Two: A total of 475 general practice attendees agreed to take part in this study. Approximately 20% of general practice attendees met DSM-IV criteria for major depression in the last 12 months and 12% for major depression with a recency of '1 month to less than 2 weeks'. Just under 5% of the sample met DSM-IV criteria for dysthymia, of which 80% had comorbid major depression. A greater proportion of participants who were divorced or separated, unemployed or looking for work, younger in age, of Maori ethnicity and had a history of mental illness met criteria for DSM-IV major depression. Compared to non-depressed participants, depressed participants in this study reported significantly more missed work or social activity in the last year due to emotional problems. With the aid of two screening questions for depression, GPs in this study accurately identified 75% of depressed general practice attendees. The most common attribution style amongst general practice attendees was a normalising attribution style. Patient attribution styles was not found to influence the level of depression detection by GPs, instead past and current illness profiles influenced GP detection rates of depression. Conclusion: The current research findings report figures and trends consistent with overseas studies, not only demonstrating the high prevalence of mental illness, particularly that of depression present in general practice attendees, but the many issues that shape mental health care in general practice. Inline with Klinkman's 'Competing Demands Model' GPs perform three important functions: 1) to identify mental disorders in the community; 2) directly provide mental health care to patients; and 3) a referral agent to secondary mental health services. Like Klinkman's model, results derived from the two studies suggest GPs attitudes towards mental health will shape the level of involvement across these three functions. Results derived from 'Study One' and 'Study Two' extends on Klinkman's model to incorporate 'shared care' as a potential model for managing more severe complex disorders. However, before such a model of 'shared care' can be implemented it is essential that accessibility and communication channels between primary and secondary sectors are improved, and structural funding arrangements including the appropriate remuneration for GPs time is addressed. In reality not all GPs will be interested in managing mental illness in their practice and therefore will not have the motivation to acquire and maintain a level of knowledge sufficient to work with patients with mental illness, whether it be in the capacity of 'shared care' or solely the responsibility of the GP. However, it is not unreasonable to expect GPs to have the necessary skills and ability to at least detect and diagnose mental illness in their patient population, and if necessary refer patients on to secondary mental health services. Prerequisite training in mental health, training in diagnostic classifications along with considerations around their appropriateness in general practice, a sound knowledge of patient risk factors for mental illnesses and established networks with secondary mental health services is necessary before GPs can successfully fulfill these roles.

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Tracey, Jocelyn Margaret. "The effect of reaccreditation on general practice in New Zealand". 1996. http://hdl.handle.net/2292/2246.

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The Reaccreditation Programme of the Royal New Zealand College of General Practitioners (RNZCGP) became compulsory for all members in 1994. Ongoing reaccreditation of medical specialists is a new, but rapidly growing trend on which little research has been done. The aim of this thesis is to investigate the effects of reaccreditation on general practice in New Zealand in the first three years of the programme. The history and current status of reaccreditation programmes throughout the world is summarised. The requirements of the RNZCGP Reaccreditation Programme are described and contrasted with the requirements of other programmes. A basic assumption of the Reaccreditation Programme that general practitioners can accurately identify their own areas of deficiency, is tested and found to be incorrect. A very low correlation between general practitioners' self assessments of knowledge on a given topic, and their results on a written objective test was found. The attitudes of general practitioners to the Reaccreditation programme, both shortly before it began and three years post-implementation are tested using a validated semantic differential questionnaire. Initial acceptance was reasonably high, but this decreased with time. Qualitative and quantitative studies of the ways in which general practitioners have altered their educational activities because of the programme showed improvements in the quality of the activities selected, but little increase in overall time spent. Analysis of the effects of the compulsory audit aspect of the Reaccreditation Programme showed that this activity has resulted in significant improvements to patient care. The effects of the programme on general practice are analysed in the light of current change theories and finally recommendations are made regarding the possible future development of the RNZCGP Reaccreditation Programme.

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26

Arroll, Bruce. "The Auckland blood pressure control study: a randomised controlled trial of physical activity and salt restriction in persons being treated with medication for hypertension". 1992. http://hdl.handle.net/2292/2245.

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Introduction This thesis describes two studies: The Auckland Heart Study Validation Project which validated the physical activity questionnaire from an earlier case-control study (known as the Auckland Heart Study); The Auckland Blood Pressure Control Study which was a factorial design randomised controlled trial of physical activity and salt restriction as a means of further lowering blood pressure in a community sample of patients treated with anti-hypertensive medication. This study used the physical activity questionnaire validated in the Auckland Heart Study Validation Project. Coronary heart disease is the leading cause of death and a major cause of morbidity in New Zealand. The Auckland Heart Study was a case-control study examining coronary heart disease and its risk factors and was conducted in Auckland from 1986 to 1988 (Jackson, 1989). This study incorporated a three month recall questionnaire on physical activity. The results showed that a high level of physical activity was associated with a low rate of coronary heart disease. For example the odds ratio for those with high levels of moderate leisure time physical activity was 0.78 for men and 0.39 for women. To assess the validity of the physical activity questionnaire, the Auckland Heart Study Validation Project was conducted in 1988. Both physical inactivity and hypertension are risk factors for coronary heart disease and physical activity is known to lower blood pressure. The Auckland Blood Pressure Control study was conducted during 1989-90 in order to assess the effectiveness of physical activity as a means of lowering blood pressure in a community setting. The physical activity questionnaire used in the Auckland Blood Pressure Control study was the same one validated in the Auckland Heart Study Validation Project. This thesis describes both the Auckland Heart Study Validation Project and the Auckland Blood Pressure Control study. The Auckland Heart Study Validation Project The 186 Participants for the Auckland Heart Study Validation Project were randomly selected from the control group of the Auckland Heart Study. Of those who could be contacted, 152 completed a seven day physical activity and food intake diary. The seven day diary was the gold standard for the three month physical activity recall questionnaire used in the Auckland Heart Study. The response rate for completing the seven day diary was 82%. The original control group had been randomly chosen from the community and hence the sub-sample of 152 participants represented a reasonable cross-section of the community. The correlations for the three month recall questionnaire compared with the seven day dairy, were 0.61, 0.49 and 0.86 for moderate, vigorous and total activity respectively. These findings were consistent with other validation studies in the literature. One of the strengths of the Auckland Heart Study Validation project was that it was undertaken in the community population for which it was intended. It was concluded that the three month physical activity recall measured physical activity in general and over the three recall period. Auckland Blood Pressure Control study Low levels of physical activity have been shown in observational studies to be associated with a high incidence of both coronary heart disease and hypertension. A concern with observational studies is that the findings may be due to confounding factors which are not able to be controlled, either in the design or the analysis. The best method of controlling for confounding is through the use of randomised controlled trials. The literature on physical activity as a means of lowering blood pressure contains many randomised trials and almost all have methodological weaknesses. Moreover, most of those studies have been conducted in laboratory settings; very few trials of physical activity and blood pressure have been conducted in community settings. The literature on salt restriction as a means of lowering blood pressure contains numerous well designed randomized controlled trials showing that salt restriction can lower blood pressure. While significant results have been achieved from salt restriction most of these studies have been involved intensive input from dietitians. None of the community based studies have demonstrated significant blood pressure reductions. The aim of the Auckland Blood Pressure Control study was to assess the effectiveness of physical activity and/or salt restriction as therapies to lower blood pressure in treated hypertensive patients in a community setting. The research design was a factorial design randomised controlled trial of physical activity and salt restriction as therapies for lowering blood pressure. Participants were recruited for the study from general practitioners and a variety of public advertisements. The study was conducted over six months and 181 of the baseline 208 participants completed the study. The two interventions were brisk walking for 40 minutes, three times a week and salt restriction advice. The main outcome measures were blinded blood pressures measured at three and six months. The average age of the participants was 55 years and there were approximately equal numbers of men and women. At the three month interview there was a statistically reduction in systolic blood pressure for salt restriction and physical activity as separate therapies, but not for the combination. There was no significant reduction in diastolic blood pressure at the three or six month assessment. Although the Auckland Heart Study three month recall questionnaire was valid for the case-control study there was concern that it was not sensitive enough for the randomised controlled trial. It was concluded that both physical activity and salt restriction lowered systolic blood pressure, at least in the short term, in persons with hypertension treated with medication in a community setting.

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27

Raymont, Antony. "General practice consultation and outcome: a social analysis of the patient practitioner encounter". 1992. http://hdl.handle.net/2292/2334.

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The thesis examines general medical practice with particular attention to patient outcomes. Sociological descriptions of healing are presented and compared with official views of medical institutions. A theoretical position is taken capable of interaction with the disciplines of both sociology and medicine. Definitions of health are reviewed and used to specify desirable outcomes to patient-practitioner encounters. The context of modern medical care is then discussed; the influence of the intellectual, social and economic environment on the development of medical care since 1800 are evaluated, and modern reformist pressure on medical practice is examined. From this discussion a list of qualities of interest in the sociological investigation of medical practice is developed. A research project, undertaken in New Zealand, is described which gathered information on a random sample of 9477 general practice patient-practitioner encounters. A survey methodology was used with data supplied by practitioners. In addition, a patient survey was carried out in a sub-sample of 763 visits. Data on practitioner, patient, problem presented, process of the encounter and outcome was recorded. Outcome was measured as empowerment at the visit and improvement after two weeks. The results of the project are presented and analyzed. It was found that most patients are satisfied with their consultation and that a majority have improved health state at two weeks. Much of the variation in improvement is explained by the severity of the problem and the age of the patient. Social variables make a small contribution to the prediction of good outcomes. In particular, empowerment at the consultation is related to improved subsequent health state. The influence of occupation, gender and ethnicity on problems presented to the practitioner and on outcome are discussed. A proportion of patients had delayed obtaining medical care for financial reasons. This was associated with more severe problems and poorer outcome. A psycho-social approach to problems was rare and patient counseling did not appear to contribute to a sense of empowerment. Practitioners reported highest rapport with simpler consultations and rapport was negatively related to empowerment. The significance of these findings is discussed. In a final section it is suggested that medical treatment and counseling may be antithetical skills and that both practitioner and patient may have vested interests in a materialistic view of the content of their interaction. The forms of social control implicit in the encounter are elaborated.

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Hoque, Mohammad Ekramul. "Epidemiology of Giardia infection in New Zealand and the risk in children". 2003. http://hdl.handle.net/2292/3127.

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Whole document restricted, see Access Instructions file below for details of how to access the print copy.
Background: Giardia is a leading cause of human gastrointestinal illnesses globally and is the most commonly notified waterborne disease in New Zealand. The national incidence rate of 46.6 per 100,000 is thought to be one of the highest among developed countries, peaking in the 1-4 and the 25-44 age groups. Risk factors for infection among vulnerable groups have not been explored systematically in New Zealand, although environmental factors and person-to-person transmission have been suspected. The true burden of Giardia infecion in the community has been difficult to estimate due to suspected under-notification of the disease. An important component of disease surveillance and the validation of disease incidence rates is an estimation of the degree of undercount. AIMS: To describe the epidemiological patterns of Giardia infection in the Auckland region and in New Zealand, compare them with local and international patterns of infection, and explore environmental links. To estimate the level of completeness of giardiasis notification in the Auckland adult population by using a simple capture-recapture method. To identify risk factors for giardiasis among Auckland children under 5 years of age. Methods: Analysis of Auckland data: Anonymised giardiasis notification data from Auckland Regional Public Health Services (ARPHS) for the period of July 1996 to June 2000 were analysed by person, place and time. Infection rates and relative risks were calculated and compared with national and international information. Analysis of New Zealand data: A study of national surveillance data utilised anonymised information for 7818 notified cases throughout New Zealand between July 1996 and June 2000. A weighted average of drinking water grades was estimated using the Community Drinking Register. Pearson's coefficient was used to measure the correlation between average drinking water grades and notified cases. Daily climate data were plotted against daily case notifications and modelled, using Poisson's regression, to predict any influence of climate on infection. Data were presented by age, gender, ethnicity and area using statistical and spatial methods. Estimation of under-notification: The capture-recapture technique is now being used in many countries to evaluate the completeness of disease ascertainment. Comparison of disease ascertainment involves two or more datasets. Two independent datasets of giardiasis cases aged 15 years or over were generated. Of them one was generated from the demographic information of cases recruited during the Auckland Giardiasis Study in 1998-99 and the other from giardiasis cases notified to the ARPHS for the same period of time. The area of residence of cases was geo-coded, mapped and overlaid by water distribution zones. Cases were matched and under-notification was estimated using a two-sample capture-recapture method. Case-control study: A case-control methodology was used to analyse the exposure history of 69 cases and 98 controls under 5 years of age in Auckland. Significant risks of infection were estimated and their attributable risks. Results: Giardiasis in Auckland: Auckland had a significantly higher rate of Giardia notification (58/100,000) than New Zealand (46/100,000) as a whole. Notification rates, which peaked during February-May, were significantly higher in Pakeha/Europeans and Asian/others, compared with Maori/Pacificans. Adjusted notification rates were higher for residents of North Shore and Auckland cities than for other areas of Auckland. The crude regional and national notification rates were almost 6 times the rate of laboratory identification of positive isolates in the UK and 4 times US reported rates. Giardiasis in New Zealand: At the national level, most cases occurred in the 1-4 year age group followed by the 25-44 year age group, and most cases were Pakeha/European. Ethnicity was not known for 18% of cases, affecting demographic calculations. Infection rates were high for a number of Health Districts (West Coast, Wanganui, Waikato and Tauranga) compared to the national average. Over 50% of the population received Aa-graded drinking water. No correlation between infection and the weighted average grades for water treatment plants (r = -0.12) or the reticulation systems (r = -0.11)) was found. A significant correlation with the mean daily maximum (r = 0.05) and minimum (r = 0.06) temperature was observed. Poisson's regression modelled minimum-temperature (chi2 = 5.40, p<0.05) and relative humidity (chi2 = 5.37, p<0.05) as predictors of a significant number of Giardia infections on a given day. Under-notification of giardiasis: The estimation of under-notification during the 12 month period, compared 413 cases who were notified to the ARPHS with 199 cases who had participated in a case-control study over the same period of time. North Auckland had slightly higher notification rates and also study participation rates. The giardiasis notification rate was higher in un-reticulated water zones (72.4/100,000 population). The capture-recapture calculation indicated that only 49% of cases were notified. Risk of giardiasis in children: In the case-control study, 95% of cases and 86% of controls used water from the Auckland Metropolitan Mains (AMM) supply for domestic purposes, 44 cases and 42 controls swam, and 59 cases and 54 controls wore nappies. Children wearing nappies were at significantly increased risk of the disease (OR=3.0, 95%CI 1.01-8.9), as were those from households which had more than one child wearing a nappy (OR=6.5, 1.8-23.4). The AMM water supply was associated with a reduced giardiasis risk compared to other drinking water sources. Significantly increased risks were associated with drinking water consumed away from home (OR=4.7, 2.2-10.1), swimming at least once a week (OR=2.4, 1.1-5.3) and travelling in side New Zealand (OR=2.5, 1.03-6.0). Conclusions: The higher rates of giardiasis observed in Auckland and New Zealand, in comparison with other developed countries, may be related to environmental or social factors. Missing ethnicity information precludes clear interpretation of variations in notification rate by ethnic group and suggests a need for improvement in data collection. There are opportunities to investigate the influence of risk factors on seasonal changes in notification rates both locally and nationally. Reported improvements in some areas could be due to local health measures or to random variation. Time-trend analysis suggests a seasonal pattern. The weighted average drinking water grading is a novel and readily available measure, and may not be truly representative of local supplies. Modelling of climate data showed an association with giardiasis but was inconclusive. Giardia notifications in Auckland are under-notified by half. This has obscured the true burden of Giardia infection. This has implications for estimates of the burden of disease in New Zealand. Notification rates vary inversely with socio-economic conditions and the presence of a reticulated water system. The case-control study identified vulnerable groups and modifiable risk factors for Giardia infection. Nappy-wearing was an independent risk factor for infection. Further study is advocated to ensure better protection of public health, especially for children. These studies identified vulnerable groups and major data-gaps. The risk of infection in children needs further attention for effective infection control measures to be developed for this disease. Recommendations for improvements in disease surveillance and data quality are discussed. GIS (Geographical Information System) is a useful tool for disease monitoring. Capture-recapture techniques are useful tools in evaluating the completeness of disease surveillance.

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Ameratunga, Shanthi Neranjana. "Disability following car crashes: an epidemiological investigation". 2005. http://hdl.handle.net/2292/3158.

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Background Road traffic injury is projected to rank as the third largest contributor to the global burden of disease by 2020. Disability is a significant component of the burden of disease ranking. Most published data on traffic crash outcomes, however, focus primarily on deaths and hospitalisations. Reliable estimates of post-crash disability and information on factors that modify the disabling process are essential to prioritise and allocate appropriate resources for road traffic injury prevention and interventions that reduce the risk of secondary disability. Aims To quantify the risk of disability associated with serious injury crashes in car drivers in a defined population; to explore the extent to which this risk is modified by chronic alcohol abuse; and to critically review methodological approaches that can redress the inadequate epidemiological attention to injury-related disability. Methods Systematic reviews were conducted to examine the available epidemiological evidence quantifying the association of car crashes with disability and the effect of alcohol on the risk of post-injury disability. Studies published or presented between January 1980 and April 2003 were reviewed. No language restriction was imposed. A population-based prospective cohort study conducted in the Auckland region of New Zealand recruited drivers exposed to serious injury crashes (identified through a surveillance system monitoring hospital admissions of injured car occupants). A representative sample of car drivers in the region was identified through roadside surveys (controls). The participants were interviewed at recruitment (to obtain pre-crash information from crash drivers and baseline data from controls) and re-interviewed at five and eighteen-months follow-up. Structured interviews on all three occasions included the Short Form-36, a global health change indicator, and the Alcohol Use Disorders Identification Test. Information on a range of potential confounders was sought at baseline through the interview, alcohol measurements and clinical records. Results Studies identified in the systematic reviews revealed that published estimates of the risk of post-crash disability ranged from 2% to 57%. The evidence regarding the effect of alcohol on post-injury disability is inconclusive largely because none examined this association directly. Most studies identified in the reviews were limited by several methodological problems including the absence of appropriate comparison groups, inadequate or no adjustment for confounding, significant potential for selection bias due to the study setting, high levels of loss to follow-up, and missing data. In the prospective cohort study, 215 crash drivers (75% follow-up) and 254 controls (69%) completed the 18-month interview. Overall, 40% of the drivers who were hospitalised, 20% of the crash drivers not hospitalised, and 7% of the controls reported deteriorated health at 18 months relative to their baseline health. This represents a tenfold excess risk of disability among hospitalised drivers and a three-fold excess risk among non-hospitalised crash drivers, relative to drivers in the general population. Among crash drivers reporting an overall decline in health, clinically important reductions in general and mental health were apparent over the follow-up period despite improving physical health and function. This trend was more evident among non-hospitalised than hospitalised crash drivers. Compared with drivers who were neither involved in a crash nor defined as hazardous drinkers, crash drivers who were hazardous drinkers had a seven-fold excess risk of a clinically significant (≥ 10%) decline in the SF-36 general health score (OR 6.85; 95% CI: 1.84-25.43). Crash drivers who were not hazardous drinkers had a three-fold risk (OR: 3.00; 95% CI: 1.14-7.89). The results indicated an important interaction between crash involvement and chronic alcohol abuse in potentiating the risk of disability. Conclusion Serious traffic crashes are associated with significant longer-term disability in a substantial proportion of survivors with an apparent worsening of mental health over time. Definitions of disability and estimates of the burden of disability following traffic injury remain highly variable in the published literature and it is timely for the international research community to develop a more systematic and consistent approach to this major and increasing component of the global burden of disease. By addressing the main methodological limitations of previous studies, this study revealed that chronic alcohol abuse potentiates the risk of post-crash disability. The findings suggest that measures for preventing road traffic crashes as well as efforts to identify problem drinkers among crash survivors should be intensified. The thesis highlights the need for robust indicators of non-fatal injury to monitor the impact of road safety programs and large-scale epidemiological studies to investigate the spectrum and determinants of post-injury disability.

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Wyllie, Allan. "Love the ads - love the beer: young people's responses to televised alcohol advertising". 1997. http://hdl.handle.net/2292/1960.

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This research was undertaken approximately 20 months after the introduction of alcohol brand advertising on New Zealand television, which resulted in a fourfold increase in televised alcohol advertising and a 42% increase in overall alcohol advertising. The primary aim of the research was to examine the nature of the relationships between young people's responses to televised alcohol advertising and drinking-related behaviours. The research was based on two surveys, one with l0 to 17 year olds and one with 18 to 29 year olds. The l0 to 17 survey involved 500 randomly selected face-to-face interviews in New Zealand's three largest urban areas. The 18 to 29 survey involved 1012 interviews. Respondents were randomly selected from throughout New Zealand and interviewed using a computer-assisted telephone interviewing (CATI) system. Both surveys asked about responses to specific alcohol advertisements, which were ones these age groups had been more exposed to. One of the two key response measures identified how frequently they recalled having seen the advertisement; this was labelled recalled exposure. Positive response to the advertising was measured by liking of the advertisement. Structural equation modelling (SEM) was used for the analyses, but this was preceded by correlation and regression analyses. On the basis of factor analyses that preceded the structural equation modelling, most of the modelling was based on the responses to the three beer advertisements in each study. 10 to 17 year old survey: The findings from the structural equation modelling were consistent with the hypothesis that positive responses to beer advertising (as measured by liking) were contributing to an increase in expected frequency of future drinking. The data were also consistent with the beer advertising contributing to an increased frequency of current drinking, although the relationship was just under the 0.05 level of significance. There was some limited evidence that recalled exposure may be associated with the drinking status of 10 to 13 year olds but, because of the small number of drinkers in this age group, this result needs to be interpreted with caution. The regression analyses indicated that recalled exposure was a predictor of 10 to 17 year olds' perceptions of how often their age/gender group drank and how accepting their friends were of drinking and occasional drunkenness. Other survey responses were also indicative of an influence of alcohol advertising on young people. Alcohol advertising was an important source of information about drinking, particularly for the 10 to 13 year old males. Almost half of these younger males accepted the portrayals in alcohol advertising as realistic and almost two thirds of them felt that alcohol advertising does encourage teenagers to drink. 18 to 29 year old survey: This study provided support for the hypothesis that more positive responses to televised beer advertisements resulted in larger quantities of alcohol being consumed on typical drinking occasions by 18 to 29 year old New Zealanders. It did not provide support for the hypothesis that drinking larger quantities of alcohol led to more positive responses to beer advertisements. The model showed that positive responses to beer advertisements had both a direct influence on quantity and an indirect influence, via its influence on positive beliefs. This study also provided support for the hypothesis that more positive responses to beer advertising were associated with increased alcohol-related problems. As with the 10 to 17 year olds, recalled exposure was related to perceptions of peer influence and behaviour. It was a significant predictor for female perceptions of peer quantities consumed and male and female perceptions relating to peer approval of drunkenness. The regression analyses also identified that recalled exposure was a predictor of males saying they were drinking more than the year before, however a SEM that specified reciprocal paths between these two variables found neither path to be significant. Discussion and implications This research has identified the importance of examining positive responses to alcohol advertisements. This acknowledges the active recipient of advertising who responds positively to advertising that offers valued outcomes. It also emphasises the importance of considering emotional/affective responses to advertising. However, the study also indicates that the weight of advertising is important, as reflected in the cognitive measure of recalled exposure. This appears to be having most influence on perceptions of what is normative behaviour. The results of the SEMs must be viewed as tentative, given the exploratory nature of the analyses and the limitations of cross-sectional surveys. However, as for all the previous studies, relationships have been identified between measures relating to alcohol advertising and those relating to alcohol consumption. While it is not possible to make definitive statements about directions of influence between these variables, these studies have all provided data that are consistent with the theory-based hypothesis that alcohol advertising does have an influence on alcohol consumption by young people.

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Mullin, Bernadette Therese. "Risk factors for motorcycle injury: the role of age, gender, experience, training and alcohol". 1997. http://hdl.handle.net/2292/2182.

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Introduction: Motorcyclists in New Zealand suffer a disproportionate number of road traffic crashes. In 1995, 2% of all registered vehicles in NZ were motorcycles, but 9% of reported injuries and 13% of all fatalities were in motorcycle riders. Generally there is a lack of good evidence about many postulated risk factors, with previous studies reporting inconsistent findings. Aim: To identify the role of age, gender, experience, training and alcohol consumption as risk factors for moderate to fatal injury resulting from a motorcycle crash. These factors were chosen because they are the subject of current policy debate in New Zealand. Methods: A population-based case-control study was conducted in the Auckland region over a three year period from Feb 1993. The study base was defined as motorcycles being ridden on non-residential public roads of the Auckland region over a three year period between the 15th of February 1993 and the 14th of February 1996 between 6am and midnight. A case was defined as a motorcycle crash occurring within the study base in which either or both the motorcycle driver or pillion passenger met the injury criteria: were admitted to a public hospital within Auckland; were treated in the Public Hospital Emergency Department in the region with an Injury Severity Score of 5 or greater; or died as a result of a motorcycle crash. The aim was to identify all cases using comprehensive case finding procedures included surveillance of emergency departments, the Coroner's office and injury crashes reported to the Police. Controls, or the sample of the study base, were identified from roadside surveys which were conducted at random times from 150 random sites chosen from non-residential roads. Each road was sampled in proportion to its total length. This produced a random sample of motorcycle riding from the study base. If possible, the motorcyclist was stopped at the survey site. If this was not possible, they were identified by following up their registration plate number. Interviewer-administered questionnaires were used, either face-to-face or by telephone, to obtain exposure data. Objective alcohol data were also obtained from blood and breathalyser tests. Results: Information was obtained on 477 cases and 1518 controls, with interviews completed for 94.5% of case drivers and 81.2% of control drivers. Motorcyclists aged 25 years and over had the lowest risk of moderate to fatal injury from a motorcycle crash when compared to drivers aged from 15 to 19 years (adjusted RR=0.45, 95%Cl=0.33-0.62); the risk for 20 to 24 year olds was intermediate (adjusted RR=0.72, 95%Cl=0.52-1.00). There was insufficient evidence from this study to assess whether there was a changing pattern of risk for motorcycle riders aged over 50 years. The population attributable risk for 15 to 16 year olds in this study was only 0.72%. There was no evidence of an association between gender and risk, indicating that most motorcycle injuries occur in males because most motorcycle riding is done by males. Motorcyclists with more than five years of regular on-road motorcycle riding experience were associated with some increased risk compared to those with less than two years (adjusted RR=1.57, 95%Cl=0.96-2.58), particularly among the 20 to 24 year age group. Motorcyclists who had ridden their motorcycle 10,000 kilometres or more had a lower risk compared to those who had ridden less than 1000 kilometres (adjusted RR=0.52, 95%Cl=0.35-0.79). There was no clear effect observed for other measures of experience including off-road motorcycle riding, other motor vehicle driving and familiarity with the road. There was some evidence that motorcyclists who had attended motorcycle training were at lower risk (adjusted RR=0.74, 95%Cl=0.49-1.14), but the precision of this estimate was poor. There was less clear evidence of an association with recent non-motorcycle training and risk. Motorcyclists who reported having consumed alcohol within 12 hours were at higher risk (adjusted RR=1.53, 95%Cl=1.05-2.23) with a population attributable risk of 11%. Discussion: The methods used in this study to identify and sample the study base by obtaining a random sample of motorcycle riding are likely to have provided a valid estimate of the risks associated with the exposures measured. However some limitations of the study design include the general reliance on self-reported measures of exposures, the lack of data collected on other motor vehicles on the road and the poor quality of data available on alcohol and other environmental factors. This study has identified the following groups of motorcyclists to be at increased risk of moderate to fatal injury: riders aged less than 20 years, riders with more than five years of riding, riders who have not undertaken a motorcycle training course, riders who have ridden less than 1000 kilometres on their current motorcycle and those who have recently consumed any alcohol. Given these results, combined with the information obtained from the systematic literature review, the provisions of the Graduated Drivers Licensing System should be reviewed. This should include consideration of basing restrictions for riding primarily on the age rather than the experience of the motorcyclist and the completion of specific motorcycle training courses only, rather than a training course for any motor vehicle. Further research should consider some of the shortcomings of this study that have been outlined above and also consider methods of increasing the proportion of female riders and older riders in research. The limited evidence of benefit from motorcycle training courses, while encouraging, indicates that further investigation of their benefit in controlled trials is required.

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Jackson, Rodney T. "The Auckland heart study: a case-control study of coronary heart disease". 1989. http://hdl.handle.net/2292/2184.

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Coronary heart disease is the leading cause of death and a major cause of morbidity in New Zealand. Although the mortality rates are now declining, they remain high by international standards and there is considerable scope for the prevention of coronary heart disease. There is a paucity of New Zealand data on the aetiology of this disease. The Auckland Heart Study is a case-control study of coronary heart disease which was designed to determine whether a range of variables including; smoking, passive smoking, hypertension, exercise, alcohol, serum lipids, and dietary and psychosocial factors, are related to coronary heart disease in New Zealand. Other factors examined included respiratory infection, sex hormones and serum vitamins. The study also documented the prevalence of the major risk factors in the Auckland adult population so as to examine trends in risk factors since the 1982 Auckland Risk Factor Study. The study was conducted between 1 March 1986 and 3 May 1988. There were two case groups: non fatal myocardial infarction cases and coronary death cases; and two control groups: myocardial infarction controls and coronary death controls. Participants were aged 25-64 years.

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Ellison-Loschmann, Elisabeth. "Asthma in Māori : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Epidemiology at Massey University, Wellington, New Zealand". 2004. http://hdl.handle.net/10179/1723.

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The research presented in this thesis arose out of work done by the Māori Asthma Review (Pomare et al, 1991). The Māori Asthma Review was undertaken because of concern regarding the excessive number of deaths and hospitalisations from asthma among Māori people, even though evidence at that time, was that asthma prevalence was similar between Māori and non-Māori children. One of the key findings from the review was that there were a combination of barriers for Māori when accessing asthma services, which were almost certainly reflected in more severe asthma and higher hospital admission rates. This thesis has involved conducting three pieces of new research: (i) a series of reviews and analyses of descriptive data on asthma prevalence, hospitalisations and mortality in Māori and non-Māori; (ii) analyses of the ethnicity data from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase III Wellington survey; and (iii) a follow-up study of Māori adolescents with asthma examining factors affecting asthma severity, access to health care and asthma quality of life in this adolescent population. The mortality analyses showed that Māori were disproportionately affected by the asthma epidemics during the 1960s and 1970s and that while the asthma mortality rates have declined now, they remain higher in Māori than in non-Māori. Asthma hospitalisation rates continue to be higher in Māori compared to non-Māori across all age groups. Hospital admission rates are generally higher in rural areas for Māori whereas those for non-Māori are higher in urban areas. Analyses of the ISAAC Phase III data show that Māori children are experiencing both greater asthma symptom prevalence and increased asthma severity compared with non-Māori children and that this is not explained by risk factors such as smoking. In the follow-up study of Māori adolescents, baseline asthma severity and frequency of wheeze were important determinants of subsequent morbidity. Having an asthma action plan, a peak flow meter and having routine visits to the general practitioner were all associated with small improvements in asthma quality of life during the one year follow-up. The only significant predictor of access problems during the one year follow-up was having had access problems at baseline. Cost was the most significant barrier to accessing care for these families. Asthma continues to be a significant health problem for Māori. The research conducted for this thesis supports and extends previous research indicating that asthma is more severe in Māori, because of problems of access to health care. It also indicates that differences in asthma prevalence between Māori and non-Māori are now being seen in children as well as adults, and that management and treatment issues underlie the emerging increase in asthma prevalence among Māori. Attention to access issues across mainstream health structures along with support for Māori provider organisations should continue. Additonally, active approaches to monitor differential treatment and barriers to effective interventions are needed.

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D'Souza, Wendyl Jude. "Epidemiology of epilepsy in Tasmania : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Epidemiology at Massey University, Wellington, New Zealand". 2008. http://hdl.handle.net/10179/1393.

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Background Better understanding of the demographic distribution of epilepsy and the prevalence of 'more specific forms of epilepsy' in community-based settings would improve our understanding of this disorder at the population level . Although we now have good estimates of epilepsy prevalence for most countries, we still lack knowledge on its demographic distribution by age, ethnicity, region, and socioeconomic status. In addition, no studies to date have reported the prevalence of epilepsy syndromes using patient interview outside a hospital setting. This thesis provides the first community-based estimates of the prevalence of the most common clinical group of epilepsies presumed to have a genetic basis - The Idiopathic Generalised Epilepsies (IGE) - by patient and witness interview. Methods This thesis has involved conducting five pieces of new research: (i) a series of reviews and analyses of descriptive data on epilepsy prevalence, particularly focusing on the critical methodological issues of ascertainment, diagnosis and classification of epilepsy for epidemiological purposes; (ii) the validation of a modified diagnostic epilepsy questionnaire adapted for administration in population studies; (iii) recruitment of a community-based cohort - The Tasmanian Epilepsy Register (TER) - through the Australian national prescription database; (iv) estimation of the overall prevalence and distribution of self-reported treated epilepsy in Tasmania by imputation methods; (v) estimation of the prevalence and distribution of IGE in Tasmania by telephone interviewing. Results My modified diagnostic questionnaire, administered by telephone interviewing and interpreted with standardized guidelines, demonstrated excellent agreement with an epilepsy specialist's clinical assessment in diagnosing the presence of epilepsy (K = 0.94), seizure-onset types (K = 0.84), simple or complex partial seizures (K=0. 87), any generalized non-convulsive seizure (K=0.82), and IGE (K = 0.82). A lthough stil l substantial, agreement was not as close for secondarily general ized seizures (K = 0.74), and generalized tonic-clonic seizures (K = 0.79). 7541 patients treated with antiepileptic drugs (AEDs) in the preceding year in Tasman ia were eligible for recruitment through the Australian national prescription database. After three mail contacts, 54.0% responded, with 43.6% who indicated treatment for epilepsy representing 86.0% of total possible epilepsy cases by imputation (n=2063) in Tasmania. 1180 agreed to participate in the TER, 90.0% of participants received their AEDs either exclusively from their general practitioner (70.9%) or in combination with a medical specialist (19.1%) in the preceding twelve months. The adjusted treated epilepsy prevalence was 4.36 per 1000 (95% CI 4.34, 4.39); this was: lower in women (prevalence ratio 0.92 (95% CI 0.84, 1.00); greater with increasing age (p< 0.001 ); similar in the three main geographical regions; and similar by categories of socioeconomic status based on postcode of residence. Following enrolment, 959/1083 (88.6%) eligible TER participants completed the diagnostic telephone interviewing, with partial epilepsy classified in two thirds, and generalised epilepsy in slightly more than one-fifth. IGE was observed in 20.3%, with tonic-clonic seizures (17.03%) and the absence epilepsies combined (11.01 %) being the most common IGE seizure types and syndromes respectively. The estimated prevalence of IGE was 0.89 per 1000; is highest between the ages of 20-39 years and in females, but was similar between Tasmanian regions and socio-economic groups. IGE prevalence beyond childhood related to refractory childhood or adolescent disease rather than olderonset cases, and was characterised by the presence of myoclonic and tonic-clonic seizures. Generalised seizures, but not IGE, were less prevalent in southern Tasmania. Conclusions Utilising the design approach described in this thesis may provide an alternative to neurological assessment, and when coupled with case ascertainment through prescription data, can provide a valid estimate of the prevalence of 'more specific forms of epilepsy' in countries with high access to health services. The observed pattern of high elderly epilepsy prevalence, is similar to patterns in recent studies in other developed countries, and has important implications for future planning of health services in these countries. IGE represents a considerable proportion of community-treated disease with important aetiological and prognostic determinants occurring at the seizure rather than syndrome level of classification.

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Chamusri, Somsaowanuch. "What underpins success in a health promoting school in Northeastern Thailand? : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University". 2008. http://hdl.handle.net/10179/817.

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A Health Promoting School (HPS) approach is now widely accepted internationally, with a focus on children’s health, the school curriculum, and whole school environment. In Thailand, the health and well-being of children is a fundamental value. HPS programmes have been implemented in schools as a strategy to focus on young people’s health. A number of barriers to successful HPS have been identified. While there is international evidence to show the steps and the key factors in creating successful HPS, little is known about successful HPS in the Thai context, in particular, in Northeastern Thailand which has been classified the poorest region. Ethnographic methods were used to examine what understanding of the meaning of HPS is necessary for a successful school, and how all those involved acted from the adoption of the HPS programmes by the local school until it achieved HPS status. A rural school which was successful in a HPS programme was selected, in Mahasarakham province, Northeastern Thailand. The data were obtained through participant observation, ethnographic interviews, and ethnographic records, and data analysis took place simultaneously with data collection. In this study, Lofland’s strategy for the analysis of the structure of human interaction was used. A variety of techniques for improving and documenting the credibility of the study such as prolonged engagement, persistent observation, and triangulation were used. This research revealed that the informants’ views reflected diverse understandings of the meaning of HPS. Those views were based on their experiences of HPS which differed according to the degree of participation, different levels of knowledge about HPS, and in the roles they played in the implementation of HPS in the school. Thai culture and school ethos influenced the success of HPS. Community participation was also crucial in supporting the school’s achievement. Key factors that underpinned success are identified. Implications of the findings for the HPS programme, health professionals, the school and community are discussed.

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Walton, Michaela C. "Berry fruit anthocyanins in human nutrition : bioavailability and antioxidant effects : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nutritional Science at Massey University, Palmerston North, New Zealand". 2006. http://hdl.handle.net/10179/1583.

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Anthocyanins (ACNs), which are responsible for the red and blue colours displayed by many vegetables and fruits (particularly berries), belong to secondary plant metabolites, and are a component of our daily diet. There is an increasing interest on their biological activities as they are claimed to enhance health by protecting against some chronic diseases. However, before ACNs can perform health-promoting effects in vivo, they must first be sufficiently absorbed, distributed within the human body, and reach target tissues in adequate concentrations. To date, all studies investigating ACN absorption and metabolism came to the conclusion that their bioavailability is extremely low. To benefit from the proposed health effects of ACNs, their bioavailability, including absorption, metabolism, and excretion must first be understood. The main objective of this thesis was to provide further knowledge on ACN absorption, including the absorption site and mechanism, and the influence of food and other flavonoids on ACN absorption, as well as the investigation of their antioxidant effects in vivo. In vitro experiments using Ussing chambers showed that a strong absorption of ACNs occurred from the jejunum in mice. This was supported with a further in vivo study, where the major absorption site for ACNs may be the jejunum in rats. The limitation of ACN absorption to mainly one part of the intestine suggested the participation of a particular transport mechanism. In a further Ussing chamber study it was shown that flavonols, another common flavonoid group present in many fruits and vegetables, strongly inhibit ACN absorption, indicating a specific transport mechanism, with preference for other flavonoid compounds. Further in vivo studies have shown that the simultaneous ingestion of food components, such as breakfast cereals, resulted in a delayed absorption profile in two animal species. However, the additional food did not influence the antioxidant effect of ACNs. During a human intervention study, several measures of oxidative stress improved, but this improvement occurred equally in the treatments and placebo control, and may have resulted from changes in lifestyle. The results of these studies aid to understand details of ACN absorption and help to formulate future recommendations for ACN intake with increased bioavailability in humans.

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Tupai-Firestone, Ridvan. "Obstructive sleep apnoea syndrome among taxi drivers : consequences and barriers to accessing health services : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Sleep/Wake Research Centre, Wellington Campus, New Zealand". 2006. http://hdl.handle.net/10179/1581.

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Irregular pagination - jumps from p. 168 to p. 170.
Untreated Obstructive Sleep Apnoea Syndrome (OSAS) increases the risk of motor vehicle accidents and morbidity. Its prevalence among taxi drivers is unknown. The goals of this thesis were to: (1) estimate the prevalence of OSAS symptoms and risk factors among taxi drivers; and (2) identify the barriers to accessing health care services for the diagnosis and treatment of OSAS. Between June and July 2004 questionnaires were mailed to 651 taxi drivers from two Wellington taxi companies (response rate 41.3%, n=241). Excessive daytime sleepiness (ESS>10) was reported by 18% of drivers. The estimated proportion with a pre-test risk of OSA (RDI≥ 15/hour) was 15%, according to a questionnaire-based screening tool. Pacific drivers were more likely to report OSAS symptoms than people of "other" (non-Māori) ethnicities. Logistic regression analyses identified the following independent risk factors for OSAS symptoms: increasing neck size, age groups: 46-53 years and 61-76 years, and self-reported snoring 'always'. Three focus groups were conducted in November 2004. Thematic analyses identified the following barriers to accessing health care: (1) sleepiness was not a perceived health problem; (2) personal demands; (3) industry demands; and (4) driver avoidance and dissatisfaction with general practitioner's services. Detailed examination of these themes indicated that drivers were deterred from seeking care by limited knowledge and awareness of OSAS, confusion about responsibility for health and safety, medical costs, and the risk of finding out about other health conditions. General practitioners reportedly failed to screen for OSAS symptoms and demonstrated little knowledge about sleep health. These barriers are a major cause for concern, and they are used to support the belief that earning a living is more important than personal health and safety. The key finding is that improving drivers' knowledge is unlikely to change their behaviour, without concurrent measures to address systemic issues in the taxi industry and in the health care system.

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Marshall, Nathaniel Stuart. "Positive airway pressure for obstructive sleep apnoea : systematic evaluation versus clinical and technological drift : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Wellington Campus, New Zealand". 2005. http://hdl.handle.net/10179/1668.

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Content removed due to copyright restrictions: Marshall, N. S., Neill, A. M., Campbell, A. J., & Sheppard, D. S. (2005). Randomised controlled crossover trial of humidified continuous positive airway pressure in mild obstructive sleep apnoea. Thorax, 60(5), 427-432. Marshall, N. S., Gander, P. H., & Neill, A. M. (2003). Obstructive sleep apnoea and risk of motor vehicle accident: A perspective. New Zealand Medical Journal, 116(1176)
The practice of sleep medicine is expanding and evolving rapidly, often ahead of the evidence base to support clinical practice. Obstructive Sleep Disordered Breathing (SDB) is a condition characterised by repetitive airway collapse causing harmful intermittent blood oxygen desaturations and fragmented sleep. When combined with daytime sleepiness it is known as Obstructive Sleep Apnoea Syndrome (OSAS). Continuous Positive Airway Pressure (CPAP) eliminates SDB by pneumatically splinting open the airway with positive air pressure applied through the nose and/or mouth. CPAP effectively reduces daytime sleepiness in patients with severe OSAS. However, doubt remains as to the effectiveness of CPAP in the majority of patients with mild-moderate OSAS. The effects of CPAP were compared to a placebo CPAP during a three week crossover Randomised Controlled Trial (RCT) that included 31 mild-moderate OSAS patients. CPAP effectively eliminated SDB (when worn) and moderately improved subjective sleepiness. But. it did not improve objective wakefulness, mood, psychomotor function, or quality of life. Patients who were extremely sleepy at baseline tended to gain the most placebo adjusted benefit from treatment. A systematic review and meta-analysis aimed to gather and objectively combine all relevant RCT studies to find our whether CPAP reduced sleepiness in patients with mild-moderate OSAS. Seven trials were combined and showed that both subjective sleepiness and objective wakefulness were slightly improved by CPAP therapy. Objective sleepiness was not improved by CPAP. It is not clear from these two studies that treating mild-moderate OSAS with CPAP is an effective use of resources. CPAP effectiveness might be limited by sub-optimal compliance. C-Flex aims to improve compliance by modulating pressure during exhalation. C-Flex was compared to CPAP during a pilot RCT that included 19 patients with severe OSAS. C-Flex was associated with a non-significant increase in compliance of 1.7 hours/night compared to CPAP. However, this increase in compliance was not associated with better daytime patient outcomes. Further experiments are proposed as a result of our pilot RCT. This thesis helps expand evidence-based sleep medicine. Practitioners need to be vigilant, ensuring that treatments are effective in the patients groups in which they are being used (clinical drift), and that new treatments are not adopted without superiority over existing treatments (technological drift).

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Pocknall, Helen. "Hide and seek : parents' perspectives on children's access to health care : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University, Wellington, New Zealand". 2009. http://hdl.handle.net/10179/1282.

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Children are often referred to as the 'hidden' generation, a powerless group who in infancy and childhood depend on their parents and families/whanau to ensure they receive everything in life required to enable them to grow into healthy young people and adults. Some are more disadvantaged than others due to the socioeconomic circumstances they grow up in. This can have lasting effects on their health in childhood with associated impacts later in life. In New Zealand the populations of children most disadvantaged are those from Maori, Pacific and other low income families/whanau. The disparities that exist between children from these populations and other groups whilst lessening, is still significant. The purpose of this study was to explore with Maori, Pacific and low income parents and caregivers why they choose to 'seek' health services for their children, or not as the case may be. Patterns of use are established early in life therefore it is important to understand children's health care use. The literature suggests that children's access to health care is influenced by predisposing factors such as their socioeconomic status, ethnicity, the availability of services, choice of providers, availability of school–based health services, outreach services, relationships between the community and health service providers and having a regular source of primary health care. A qualitative exploratory design was the methodology chosen for this research. A modified 'community as partner' model (Anderson, 2008) formed the conceptual framework for the research. Sixteen Maori, Pacific and Pakeha parents and caregivers participated in three focus groups to discuss their perceptions of children's access to health care. Thematic analysis was used to identify codes, categories, themes and sub themes from the data. The New Zealand Child Health Strategy (Ministry of Health, 1998) was used as a model to inform the discussion. The main themes were: reality of life, visibility, knowing you, knowing me and kids come first. The findings suggest that relationships with primary health care providers, the cost of health care for children over five years, awareness of services and a need to prioritise children's needs, enable or prevent children's access to health care. Decisions made regarding further service provision for children will be enhanced by health providers and practitioners having a clearer understanding of the enablers and barriers to access and the factors that influence parental choice of services.

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Muller, Diane P. "Children's sleep in the family environment : a pilot study using actigraphy with 6-8-year-old New Zealand children : a thesis presented in partial fulfilment of the requirements for the degree of Master of Public Health at Massey University, Wellington, New Zealand". 2010. http://hdl.handle.net/10179/1704.

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Historically, children were considered to rarely experience sleep problems and daytime sleepiness in middle childhood (5 – 12-years of age), however more recent findings indicate this may have changed. Psychosocial and environmental factors, such as technology use and bedtime routines, have been associated with reduced sleep quantity and/or quality. Links have also emerged between shorter sleep duration in children, and an increased risk of obesity in childhood and adulthood. Although a number of studies have investigated children’s sleep internationally, data are limited on both average sleep duration and the stability of sleep patterns of New Zealand children. This study aimed to collect normative data on the sleep of 6 – 8-year-olds, living in New Zealand, across both school and non-school nights, identify modifiable factors that impact on children’s sleep within the family environment, explore the relationship between children’s sleep and BMI, and pilot methods for potential future research. Actigraphy and diaries were used for seven consecutive days and nights, as well as a questionnaire incorporating the Children’s Sleep Habits Questionnaire (CSHQ), with 52 families living in the Wellington region. Stable objectively measured sleep patterns were identified, consistent with findings of Nixon et al. (2008). School night sleep duration was found to be, on average, longer than non-school night sleep, and parents tended to over-estimate their children’s sleep duration. Mean school night sleep duration was 9.9 hours (SD = 0.5) and non-school night sleep duration was 9.5 hours (SD = 0.7). No differences were identified between boys’ and girls’ sleep, and the 14% of children categorised as being overweight did not exhibit significantly different sleep patterns from the rest of the sample. Modifiable factors of technology and caffeine use were associated with differences in children’s sleep, as were non-modifiable familial factors of shiftworking adults living in the home, childcare duration and finishing times, and younger children in the household. Recommendations for future research include increasing the size and diversity of the sample, extending actigraphic recording to at least 10 consecutive days and nights to incorporate two weekends, using PSG with a sub-sample of children, and implementing a longitudinal study.

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Foliaki, Sunia. "Epidemiology of asthma in selected Pacific countries : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Epidemiology at Massey University, Wellington, New Zealand". 2007. http://hdl.handle.net/10179/1565.

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In this thesis, I describe a series of studies of the prevalence, causes, and management of asthma in the Pacific. The core study of the thesis is Phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). The ISAAC study is the largest worldwide epidemiological study on asthma prevalence and was established partly in response to the increases in asthma prevalence in most parts of the world over the last two to three decades. The ISAAC Phase I study found large variations in asthma prevalence globally, but no Pacific countries were involved. Thus, the situation in the Pacific was relatively unknown due to lack of standardised studies on prevalence and time trends. The burden and impact of other non-communicable diseases such as cardiovascular and other metabolic disorder on the other hand have been the target of various studies in the Pacific for the past few decades The ISAAC Phase III study was therefore conducted in eight Pacific countries to address the above issues, as well as to enhance Pacific participation and contribution to international research on the causes and control of asthma. The collaboration also served the purpose of encouraging and strengthening health research capacity in the Pacific. The ISAAC Phase III study was followed by an asthma self-management intervention trial conducted in Tonga by the ISAAC Tonga study team. Methods The work presented in this thesis involved: (i) the conduct of the ISAAC Phase III study in the six Pacific islands of Tokelau, Samoa, Fiji Islands, Tonga, Niue and the Cook Islands, as well as the incorporation into the analysis of data that had already been collected in French Polynesia and New Caledonia; (ii) analysis of the data from an environmental asthma risk factor questionnaire which was included in the ISAAC survey in three countries (Samoa, Fiji and Tokelau); (iii) the conduct of the Tonga Asthma Self-management Study which was intended to assess whether the introduction of asthma education, including asthma self-management plans, would reduce morbidity from asthma. Results A total of 20,876 13-14 year olds, in the eight countries involved, participated in the ISAAC Phase III survey, with an overall response rate of 92%. The survey showed that there was considerable variation in the prevalence of asthma symptoms between the eight countries, ranging from 5.8% for current wheeze in Samoa to 16.2% in Tonga. Tokelau reported the highest prevalence (19.7%) for current wheeze, but the number of participants was relatively small. The prevalences of asthma symptoms among Pacific children in the Pacific were lower than those reported for Pacific, Māori and European children living in New Zealand from a previous study (ISAAC Phase I) conducted ten years earlier using the same methodology. The prevalence of 'asthma ever' in Pacific children living in the Pacific was also lower than that found among Pacific, Māaori and European children in New Zealand. The ISAAC Phase III environmental questionnaire data was collected in Samoa, Fiji and Tokelau. The analyses indicated that the major factors associated with current wheeze (across the three countries) were paracetamol use in the previous year (odds ratio (OR) = 1.36, 95% CI 1 15-1.61), the use of open fires for cooking (OR = 1.34,95% CI 1.13-1.58), lack of physical activity as indicated by television viewing more than 3 hours per day (OR = 1.24,95% CI 1.04-1.47), regular meat consumption (OR = 1.30,95% CI 1.09-1.54) and regular cereal consumption (OR = 1.29,95% CI 1.07-1.54). However, these risk factors were not particular strong, and did not account for a large proportion of asthma cases (i.e. they had relatively low population attributable risks). The asthma self-management plan intervention study resulted in significant improvements in asthma morbidity and the management of asthma among individuals and the service provision. The success of the introduction of the self-management plan, in the context of an asthma clinic, was reflected by improvement in measures of asthma morbidity, such as peak expiratory flow rates and nights woken with asthma or coughing. There was also a reduction in the requirement for acute medical treatment, indicated by a decrease in emergency department hospital visits for asthma and hospital admissions. The programme was so successful that the intervention study evolved into a full regular asthma clinic for the main island of Tonga. It is now intended that the asthma self-management programme will be extended throughout the rest of Tonga, through the primary health care system. Conclusions The ISAAC Phase IIII survey has shown that, although there is a significant level of morbidity, asthma prevalence in Pacific countries is lower than those among Pacific people in New Zealand. Together with the large variations in prevalence between the six Pacific countries that participated, this further lends support for the role of environmental risk factors in asthma. The availability of data on eight countries using a standardised methodology also provides useful information on the burden of asthma in the Pacific that is comparable to other countries regionally and internationally as well as forming a basis for ascertaining trends in the future. The crucial role of asthma self-management plans in asthma management is supported by the findings of the Tonga study, and its implementation is essential in the resource-scarce Pacific health setting. The collaborative nature of ISAAC in the Pacific has further raised awareness of the need for capacity building and creating networks and environments that enhance health research in areas other than asthma. The study has also nurtured an environment and network that encourages and strengthens the establishment of health research as one of the vital tools for achieving better health.

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Welsh, Barry Donald. "Co-production in health management : an evaluation of Knowing the People Planning : a thesis presented in partial fulfilment of the requirements for the dgree of Doctor of Philosophy in Management at Massey University, Palmerston North, New Zealand". 2010. http://hdl.handle.net/10179/1680.

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Treating chronic health conditions consumes a significant portion of the health care resource. Two–thirds of UK hospital admissions consist of people with chronic conditions (Singh, 2005). To date, health management has tended to focus on service redesign, rather than focusing on the patients, as a way to facilitate improved outcomes and control costs. Typically, these management approaches are premised on the patient as a consumer/end user. An alternative view to the patient being a consumer is that of the patient being a co–producer of the service. Co–production recognises the client (patient) as a resource, in that value cannot easily be created or delivered, unless the patient actively contributes to the service (Alford, 1998). Patients gain health value when they are well and are independent of the health care system and its costs. Health care organisations gain economic value, when chronic patients require less health care. This thesis examines co–production, in the context of contemporary patient involvement and heath services management. ‘Knowing the People Planning’ (KPP), an innovative health management method, is evaluated for its patient management co–production potential. KPP is based on ten key features of service provision. Four of the key features relate to the patient, whilst the remaining six features relate to the organisation. It is the management of these patient and organisation features that better facilitates chronic long-term mental health patients as co–producers. The empirical findings, from this evaluation of KPP provide evidence for the efficacy of co–productive health management theory and practice. Patient health value and health care organisation economic value are created, when both the organisation and the patient co–produce the health service. KPP was initially implemented by eight of New Zealand’s 21 District Health Boards. Socio-ecological action research methodology was used to evaluate KPP — by taking a ‘people-in-environments’ approach. The evaluation covers fourteen action research cycles for 2,021 chronic long-term patients over four years. Measurements include the amount of time these long-term patients spent in hospital and employment rates. The integration of the action research cycles, using the socio-ecological method supported the generation of (what I have called) ‘co–productive health management theory’. Analyses of secondary data, across organisational and patient domains, supplement the action research findings, in order to assess for confounding factors. The organisation outcomes relate to costs and staff turnover. Patient outcomes relate to service utilisation measures, for approximately 60,000 adult patients per year, who access New Zealand’s secondary mental health services. A pivotal finding of this research was that, as the rate of patients with treatment plans increased from 50% to 90%, inpatient bed use decreased by 26%. However, increased funding for mental health services had only a minor impact on decreasing inpatient bed use. Patient employment rates increased, whilst the number of patients who required access to general practitioners and changes to their housing situation, decreased. The patient management co–production view offers a significant opportunity for health care managers and researchers to significantly improve both patient and organisation value. Co–production views the patient as a resource, who contributes to her/his health outcome, rather than a person who simply consumes services. The better patients can co–produce their health outcome the better their health, and the lower their demand for health services.

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Cheer, Jennifer Ann. "The meaning of social inclusion to people with enduring mental health problems : a thesis presented in partial fulfilment of the requirement for the degree of Master of Arts in Nursing at Massey University, Auckland, New Zealand". 2009. http://hdl.handle.net/10179/1239.

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The purpose of this qualitative research project has been to explore what social inclusion means to people with an enduring mental health problem. A review of the general literature on social inclusion revealed that little research has been conducted in relation to mental health, particularly in New Zealand. Even fewer studies have investigated the meanings that people with severe and enduring mental health problems place on their experiences. A life story narrative approach was employed in order to explore the experience of social inclusion and enduring mental health problems. Data were collected by way of unstructured, individual interviews with five users of mental health services living in supported housing in a small rural New Zealand town. Thematic analysis was carried out on the narratives, identifying six major themes. The findings indicated that, for this group of service users, social inclusion means having someone to love, something to do and somewhere to live. They want relationships with family and friends, to engage in recreational or leisure activities, to be employed, to have financial security, and to have safe and comfortable housing. The major barriers to achieving these are stigma and discrimination. New Zealand’s mental health services have adopted a recovery approach to mental health. Whereas social inclusion has a broad political and social focus that places responsibility for reducing social exclusion on society, recovery focuses on individuals’ personal journeys towards mental health and well-being. Despite international recognition of the value of social inclusion, New Zealand’s mental health services have not yet embraced it, although policy advisory organisations such as the Mental Health Commission state its aims as desirable for services. However, the concept of recovery sits within the framework of social inclusion and is an integral part of it. Mental health nurses need to understand what social inclusion means to people who experience it, so that they are able to empower them to make a positive contribution to their community, as citizens, friends, family members, employees and neighbours.

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Sukboonyasatit, Duljira. "Prediction of peoples' intentions and actual consumption of functional foods in Palmerston North: a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Food Technology at Massey University, Palmerston North, New Zealand". 2009. http://hdl.handle.net/10179/1676.

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Functional foods are a growing category in the food market, but little is known about New Zealanders’ views or use of them. A study was carried out in Palmerston North over the period 2005-2006 to investigate determinants of functional food use. The study had two stages: firstly focus groups (5 focus groups, n=42) to understand more of the consumer’s perspective, and then a detailed consumer survey. The questionnaire was based on the theory of Planned Behaviour (TBP), the Health Belief Model (HBM) and information gathered from the focus groups. The results from the study showed that participants knew little about the functional food concept. There was also a strong indication of scepticism, with people concerned about adequate dosage and efficacy. Dietary supplements were seen as a way to achieve the benefit without some of the barriers associated with functional foods. Therefore, a significant proportion of the respondents (>30%) preferred to have the functional ingredients in pill form. Other respondents preferred to have functional ingredients delivered in a staple food that was consumed on a daily basis and the most preferred food vehicle was a drink. Nutrition and health were ranked highest as influencers of food choice, with taste and cost also ranked as important. Women were more likely than men to identify nutrition and health as their main influence. An ANOVA model was used to establish the relationships between socio-demographics, health condition and health behaviour and the five attitudes factors (from exploratory factor analysis). No single attitude factor was significantly correlated with all the sociodemographic variables: women had less positive attitudes towards functional foods in general, were more likely to be sceptical and had less belief in the efficacy of functional foods. While more educated respondents considered functional foods to have less personal benefit, and those with lower income had less confidence in their own ability to consume functional foods. Talking to others about functional foods was found to be significantly negatively correlated with all attitude dimensions and intentions indicating that when people talk to others that their views about functional foods become more negative. In addition, people who Prediction of peoples’ intentions and actual consumption of functional foods in Palmerston North currently used dietary supplements had less positive attitudes and lower intentions to consume functional foods in general. Those who had existing CHD or arthritis symptoms had lower intentions than others to consume functional foods directed towards these diseases. Exploratory factor analysis also identified two factors related to intention to consume functional foods; one for functional foods in general and another for disease (arthritis and CHD) functional foods. Women had less intention to consume functional foods in general, while older adults were more likely to intend to consumer disease specific functional foods. A series of models were evaluated by using structural equation modelling to see how well they could predict peoples’ intentions to purchase and their actual purchase of functional foods in general, as well as disease specific functional foods. The analysis showed that the TPB model (R2=57%) and a modified TPB (R2=61%) better predicted peoples’ intention to consume general functional foods than the theory of reasoned action model (R2=55%). However, a model that included the modified TPB model plus 2 constructs (perceived benefits, perceived barriers) from the health belief model was best of all (R2=72%) at predicting peoples’ intention to consume general functional foods. Perceived barriers were the most influential predictor of intention (barriers included uncertainty about efficacy and dose; surprisingly taste and cost were not significant predictors, but this was probably due to the fact these constructs were not explored as multi-dimensional constructs. The models were poor at predicting intentions to consume specific functional foods, but the addition of perceived susceptibility and perceived severity improved prediction of intentions towards anti-CHD functional foods (R2 = 43%). Perceived susceptibility, but not perceived severity, improved prediction of intention to consumer anti arthritis functional foods (R2=37%). The research suggests that attitudes towards the concept of functional foods are generally positive, but scepticism is evident. Functional foods are not necessarily seen as ‘healthy’, nor are they considered a way to treat existing conditions. Thus careful marketing will be required to target product and messages to relevant segments of the market.

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45

Stuart, Keriata. "Trading off : a grounded theory on how Māori women negotiate drinking alcohol during pregnancy : a thesis presented in partial fulfilment of the requirements for the degree of Master of Public Health at Massey University, Wellington, New Zealand". 2009. http://hdl.handle.net/10179/1211.

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This study aimed to understand how Maori women negotiate decisions about alcohol and pregnancy. It was based in the recognition that Maori women?s decisions about drinking alcohol when pregnant are shaped by social and cultural expectations about gender roles, as well as their knowledge about alcohol and pregnancy. Maori attitudes to alcohol have also been influenced by colonisation and Maori responses to it. Alcohol use in pregnancy also exists in the context of potential impacts, including fetal alcohol spectrum disorder. There is little knowledge about how and why women may or may not drink during pregnancy. The research used grounded theory methods. Information was gathered through in-depth interviews with ten Maori women. The information they provided was analysed using constant comparative analysis, and a series of categories was generated. The grounded theory proposes that Maori women manage decisions about drinking alcohol when pregnant using a process of Trading off. Trading off is supported by three key processes: drawing on resources, rationalising, and taking control of the role. Maori women start by learning the rules about alcohol, get messages about alcohol and pregnancy, change their alcohol use while making role transitions, and use alcohol in the processes of fitting in where you are, releasing the pressure, and carrying on as normal. Trading off is an individual process, but exists in a complex social context. The process is fluid, conditional, and continues throughout pregnancy. The theory must be recognised as my interpretation, although I believe it is grounded in the data, accounts for the data, and offers a new, modifiable and potentially useful interpretation. While the body of theory that can be compared to the theory of Trading off is limited, the interpretation is consistent with several models of health behaviour, including Maori health models. This research has implications for future research, and for the development of programmes to support Maori women.

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Scuffham, Andrew Mark. "Musculoskeletal discomfort in veterinarians : a thesis presented in partial fulfilment of the requirements for the degree of Master of Ergonomics at Massey University, Palmerston North, New Zealand". 2009. http://hdl.handle.net/10179/1274.

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Content removed due to copyright restrictions: Appendix 6: Paper presented at the 15th New Zealand Ergonomics Society Conference: Ergonomics for the Ageing Population, Martinborough. Scuffham, A., Stevenson, M., Legg, S. & Firth, E. Prevalence of musculoskeletal discomfort in New Zealand small animal veterinarians. In: 15th New Zealand Ergonomics Society Conference: Ergonomics for the Ageing Population. Eds R. G. Adank & L. Gardner Wood. Martinborough, New Zealand Ergonomics Society. 27-28 May, 2009, [CD-ROM]. Appendix 7: Paper presented at the Society of Diary Cattle Veterinarians of the New Zealand Veterinary Association 26th annual conference, Rotorua. Scuffham, A., Firth, E., Stevenson, M., & Legg, S. Musculoskeletal discomfort in New Zealand large animal veterinarians. In: Proceedings of the Society of Dairy Cattle Veterinarians of the New Zealand Veterinary Association 26th annual conference. Ed. T. Parkinson. VetLearn, Palmerston North. 24-27 June 2009, pg 201-204. Appendix 8: Paper presented at the New Zealand Equine Veterinary Association Annual Conference, Taupo. Scuffham, A., Firth, E., Stevenson, M. & Legg, S. Musculoskeletal discomfort in New Zealand equine veterinarians. In: Proceedings of the New Zealand Equine Veterinary Association of the NZVA Annual Conference. Ed. M Leyland. VetLearn, Palmerston North. 24-27 June 2009, pg 163. Appendix 9: Paper presented at the 17th International Ergonomics Association World Congress on Ergonomics, Beijing. Musculoskeletal discomfort in New Zealand (non-clinical) veterinarians. Scuffham, A., Legg, S., Stevenson, M. & Firth, E. (9-14 August, 2009). [CD-ROM]
This thesis comprises three chapters about musculoskeletal discomfort (MSD) in veterinarians. Two of these chapters have been submitted to peer reviewed journals and one is in preparation for submission. The first chapter describes the prevalence and risk factors associated with MSD in New Zealand veterinarians. The second chapter is a paper on the tasks considered by veterinarians to cause MSD. The third chapter is a review of published literature on musculoskeletal problems (MSP) in veterinarians. The first chapter in this thesis describes a cross-sectional study of 867 New Zealand veterinarians. We used a modified Nordic musculoskeletal questionnaire to enquire about the presence or absence of MSD, whether this affected normal activities and if MSD necessitated absenteeism from work. Additional questions enquired about work activities, psychosocial factors and workload. The overall period prevalence of MSD was 96%. Normal activities were affected in 67% and 18% of participants reported that they had been absent from work due to MSD. Factors associated with the presence of MSD requiring time off work for clinical veterinarians included 10 year increases in age (odds ratio (OR) 1.26, 95% CI 1.05 - 1.52), work involving awkward grip and hand movements 100% of time (OR 12.91, 95% CI 3.46 – 84.21) and those who were dissatisfied with the level and difficulty of their work (OR 2.72, 95% CI 1.11 - 6.56). In the second chapter in this thesis, veterinarians were asked to indicate tasks that they considered ‘most likely to lead to musculoskeletal aches and pains’ and ‘why these tasks were likely to be the most risky’. They were also asked to suggest ‘any solutions that they applied or knew of’ to reduce musculoskeletal aches and pains. They identified the following tasks: lifting, surgery, rectal palpations and animal handling. Their reasons were primarily related to physical risk factors. Few identified psychosocial risk factors. The most common suggested solutions involved training and selection strategies rather than redesign of tasks, activities or facilities. These findings are consistent with a participatory ergonomics approach for reducing the risk of MSD, which aims to enhance personal well-being and improved system performance. The third chapter in this thesis - a review of the literature - focuses on the prevalence and nature (discomfort, pain, injury and disorders) of MSP amongst veterinarians. Veterinarians are exposed to a range of physical and psychosocial occupational hazards that have been well documented and associated with MSP. The range of reported prevalence estimates in this review was 50% to 96%. This range may reflect real differences among the veterinary populations studied, or more likely be due to differences in MSP definitions, study methodologies, and response rates. The magnitude of the reported prevalence justifies further research to triangulate data and determine other factors associated with MSD. Most of the studies in the review focused on physical risk factors. The lack of studies into psychosocial risk factors for MSP needs to be addressed.

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Boonphadh, Piyaporn. "The perceived effects of work on health of rubber farmers in southern Thailand : a dissertation presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing, Massey University, Palmerston North, New Zealand". 2008. http://hdl.handle.net/10179/766.

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This study was conducted in a rubber farming community in Southern Thailand with rubber farmers and their first-line public healthcare providers as the study informants. The study aims were to first, explore perceived effects of work exposures in rubber farming on rubber farmers’ health, second, identify decisions made in response to the effects of work exposures on health, and third, determine influencing factors on the construction of the perception and the process of decision making. Data were obtained using ethnographic research methods, underpinned by an interpretative paradigm. Unstructured interviews and participant observation were employed as the principal means of data collection. Together with the primary methods of data collection, note taking (fieldnotes, fieldwork personal journal, and photographs) and reviewing/analysing existing documents were employed. While data were being collected, initial data analysis was carried out to make sense of information gained and direct further steps of the data collection. After terminating the data collection, ethnographic data analysis suggested by Spradley (1979, 1980) was used to determine themes to meet the aims of the study. The study findings reveal that individual rubber farmers and healthcare providers construct perceptions of effects of rubber farming on rubber farmers’ health and decisions on the actions taken to manage the rubber farmers’ work-related health problems based on their own accounts of compounding factors. Among factors identified, discrepancies between health policy and its practice, coupled with the existence of a hierarchy of power-superior-inferior relationships among individual levels of health authority-emerge as the most powerful factors, inducing the emergence of other factors. Recommendations made as a result of this study draw attention mainly to the minimisation of the discrepancies between health policies and their implications, and the establishment of partnership status among authorised health agencies and between health agencies and rubber farmers in order to improve the quality of occupational safety and health services provided to the rubber farmers.

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48

Knoch, Bianca. "The effects of dietary eicosapentaenoic acid and arachidonic acid on gene expression changes in a mouse model of human inflammatory bowel diseases : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nutritional Science at Massey University, Palmerston North, New Zealand". 2010. http://hdl.handle.net/10179/1529.

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Nutrigenomics studies the genome-wide influence of nutrients to understand the association between nutrition and human health. Studies in animal models and humans have demonstrated that dietary n-3 polyunsaturated fatty acids (PUFA) from fish oil may be beneficial in inflammatory bowel diseases (IBD). This thesis aimed to test the hypothesis that dietary n-3 PUFA eicosapentaenoic acid (EPA) reduced and n-6 PUFA arachidonic acid (AA) increased colitis in the interleukin- 10 gene-deficient (Il10–/–) mouse model of IBD, and that these PUFA altered the intestinal bacteria community during colitis development using genome-wide expression and bacterial profiling. Using a combined transcriptomic and proteomic approach, the time-course study defined the onset and progression of colitis in Il10–/– mice. Histopathology, transcript and protein changes before and after colitis onset involved in innate and adaptive immune responses suggested delayed remodelling processes in colitic Il10–/– mice and 11 weeks of age as suitable time point to study the effects of dietary PUFA on colitis development. Comparing the transcriptome and proteome profiles associated with colon inflammation of mice fed with the AIN-76A or oleic acid (OA) diet showed that OA was an appropriate control for unsaturated fatty acids in multi-omic studies. The PUFA intervention study indicated that dietary EPA-induced lipid oxidation might have a potential anti-inflammatory effect on inflamed colon tissue partially mediated through activation of peroxisome proliferator-activated receptor alpha (PPARα). Unexpectedly, dietary AA decreased the expression of inflammatory and stress colonic genes in Il10–/– mice. Altered intestinal bacteria community observed in Il10–/– mice before and after colitis onset was associated with the lack of IL10 protein led to changes in intestinal metabolic and signalling processes. Interestingly, dietary EPA and AA seemed to change intestinal bacteria profiles during colitis development. The role of PPARα in the colon was further examined in a concluding study which identified vanin1 as a likely new PPARα-target gene which may also be involved in lipid metabolism. These findings using a state-of-the-art approach combining transcriptomics, proteomics and physiology provide a basis for future research on molecular mechanisms underlying the effects of dietary PUFA, and might contribute to the development of fortified foods that improve intestinal health and wellness.

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49

Kent, Bruce. "The role of hope in adjustment to acquired hearing loss : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Health Science, Massey University, Palmerston North, Aotearoa/New Zealand". 2005. http://hdl.handle.net/10179/1674.

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This study investigates the extent and nature of the relationship between individual and disability characteristics (age, sex, degree of hearing loss, age at onset of hearing loss, time since onset of hearing loss, use of technology, and use of services), and adjustment to acquired hearing loss, and the role hope has in that relationship. A sample of 114 adults with hearing loss who had accessed hearing therapy services participated in the study. It was hypothesised that hope would interact with the individual and disability characteristics and therefore function as a moderating variable. The second hypothesis was that hope may be related to individual and disability characteristics as well as adjustment but actually provides the only significant pathway to adjustment; more simply, hope may be a mediator of adjustment. The results indicate that the degree of loss was the only statistically significant individual and disability characteristic related to adjustment. The trait of hope did not produce an interaction effect of statistical significance in the moderation model. However, the study does provide support for the hypothesis that the trait of hope serves is a mechanism by which the degree of loss affects adjustment. Hearing loss affects hope which in turn affects adjustment. In other words, hope was found to act as a mediating variable. The extent of this mediating role was substantial as hope was found to account for 45% of the relationship between the degree of loss and adjustment. Additionally, the study found that self-efficacy and personal meaning may influence hope and despair dimensions in different ways. The perception of one's ability to influence events is a major contributor to hopefulness while the construction of meaning appears to be related to lower levels of despair. Current research in the area of positive psychology indicates that individual traits are modifiable and therefore hope finding, hope bonding, hope enhancement, and hope reminding can instil and increase hope. The implication of these findings is that hearing rehabilitation programmes need to consider the role of hope in intervention strategies. The study suggests possibilities for future research including the investigation of more complex mediational chains, refining individual and disability variables, and assessing the effect of hope-focussed intervention strategies.

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Carr, Rosemary Joy. "Factors influencing nutrition risk of older New Zealanders : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Human Nutrition at Massey University, Auckland, New Zealand". 2009. http://hdl.handle.net/10179/859.

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As the population ages it is increasingly important to understand the factors influencing dietary habits of older people. Social, biological and psychological factors influence food intake and affect nutrition risk among older people living in the community. The purpose of this study was to identify food-related behaviours that place older people at nutrition risk and to evaluate older peoples’ perceptions and experiences of various nutrition support options. Fifty-one community living people aged between 80 and 85 years were recruited in North Shore City. Food-related behaviours were explored with the use of three quantitative tools. Practitioner Assessment of Network Type (PANT) was used to evaluate social networks. Elderly Assessment System (EASY-Care) was used to evaluate physical and mental wellbeing. Seniors in the Community: Risk Evaluation for Eating and Nutrition Version II (SCREEN II) assessed nutrition risk. Five people participated in a qualitative interview about nutrition support they had received. A third of the participants (31 percent) were found to be at nutrition risk. Twothirds (67 percent) showed some evidence of disability and needed assistance with everyday tasks. Nearly half (47 percent) of these older people had supportive social networks including close relationships with local family, friends and neighbours. There was an inverse linear relationship between participants’ self-rated health and nutrition risk (p<.001). Those who perceived their health to be fair or poor were more likely to be at nutrition risk. The importance of social contact, a sense of gratitude, ‘getting a meal’, and ‘meeting the need’ were common themes that emerged from interviews with participants who received nutrition support. These findings indicate that nutrition risk may be prevalent among community living older people in New Zealand. Strategies and initiatives are needed to encourage independent living and to help older people with the procurement, preparation, cooking and sharing of enjoyable meals.

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Tesis sobre el tema "Fields of Research – 320000 Medical and Health Sciences – 321200 Public Health and Health Services"

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