Letteratura scientifica selezionata sul tema "Fields of Research – 320000 Medical and Health Sciences – 321200 Public Health and Health Services"

Purpose – The reform and opening up have triggered a “revival” of religious belief in rural China. The purpose of this paper is to explain why rural residents are increasingly becoming religious, by analysing the inherent relationship between their risks and religious choice, and conducts a preliminary investigation of the common characteristics of rural believers and the determinants of their religious choice. Design/methodology/approach – The authors applied a logit model to test the determinants of rural residents’ religious choice. The authors used sample survey data collected in 2008 from the rural area of Songxian County, Henan Province. Findings – The results suggest that age, sex, political status, health risks, and social security have a significant effect on rural residents’ religious choice. On this basis, the authors have discussed the inherent logic of “disease-related religious practice”. From these results, the paper points out that lack of basic public services such as medical care due to the government’s withdrawal from these fields has increased the health risks of rural residents, triggering a “revival” of religious belief in rural China. Originality/value – This paper has improved on previous research in two ways. First, it analyses the relationship between health risk and religious choice, shedding light on the underlying causes of the religious revival in rural China. Second, the methodology involves an analysis of household survey data, thus filling the gap created by less-rigorous quantitative analysis in rural China-based religious research.

ABSTRACT: Much needed services & resources for the progression of a business are presented by Business Incubation Centers (BIC) for beginner incubates. A successful business incubate would contribute positively in the region by forming original technologies and reducing unemployment(1, 2). The set up of Business Incubation Centers (BICs) is supported by Higher Education Commission (HEC) Pakistan which offers related services for young incubates, contributing to successful and freestanding companies in the country(3). The objectives is to encourage self-employment among the young, commercializing research originating from universities(4), creating alliance between Industry and Academia, & contributing to economic growth by employing & forming viable firms(2). HEC has established thirty business incubation centers in public sector universities of major cities in Pakistan. Among the thirty universities, BICs have been set up in two universities related to medicine and allied health sciences namely Khyber Medical University Peshawar and Dow University of Health Sciences Karachi. The focus of this paper is to highlight this under studied area and center of attention are the startup incubates from health industry. Many ground-breaking inventive projects enlisted on HEC’s website are available for commercialization of research, all originating from engineering and technology, none of which stems from medical universities. Although integrating medicine with technology would positively impact the society many fold yet it appears to be a ground unfamiliar by medical faculty(5) Assessing comments of medical faculty confirms their estrangement regarding BIC(2). There is a lack of knowledge among the faculty concerning BIC; much work has to be done in encouraging medical faculty which will result in positive contributions. Informal surveys and observations that we conducted further illustrate the aforementioned point and confirm inadequate knowledge of faculty and students regarding BICs, their objectives and purpose of formation. BIC in health industry appear to be a foreign ground passing unnoticed by faculty today. One can find many startups emerging in the field of health worldwide from internet sources.(6) In Pakistan many innovative business projects originating from the fields of IT, environmental sciences, agriculture, engineering technology etc have been registered by HEC and are ready for commercialization. Khyber Medical University Business Incubation Center KUBIC is providing an effective platform interconnecting commercial industries and investors inviting multiple incubates across the province to bring forth innovative ideas in the field of health. The future of business incubation appears bright as there are rich opportunities of research today despite the challenges they face as analyzed by past three decades of emerging practice. 5

Data are generated and employed for many ends, including governing societies, managing organisations, leveraging profit, and regulating places. In all these cases, data are key inputs into systems that paradoxically are implemented in the name of making societies more secure, safe, competitive, productive, efficient, transparent and accountable, yet do so through processes that monitor, discipline, repress, coerce, and exploit people. (Kitchin, 165) Introduction Provenance refers to the place of origin or earliest known history of a thing. It refers to the custodial history of objects. It is a term that is commonly used in the art-world but also has come into the language of other disciplines such as computer science. It has also been applied in reference to the transactional nature of objects in supply chains and circular economies. In an interview with Scotland’s Institute for Public Policy Research, Adam Greenfield suggests that provenance has a role to play in the “establishment of reliability” given that a “transaction or artifact has a specified provenance, then that assertion can be tested and verified to the satisfaction of all parities” (Lawrence). Recent debates on the unrecognised effects of digital media have convincingly argued that data is fully embroiled within capitalism, but it is necessary to remember that data is more than just a transactable commodity. One challenge in bringing processes of datafication into critical light is how we understand what happens to data from its point of acquisition to the point where it becomes instrumental in the production of outcomes that are of ethical concern. All data gather their meaning through relationality; whether acting as a representation of an exterior world or representing relations between other data points. Data objectifies relations, and despite any higher-order complexities, at its core, data is involved in factualising a relation into a binary. Assumptions like these about data shape reasoning, decision-making and evidence-based practice in private, personal and economic contexts. If processes of datafication are to be better understood, then we need to seek out conceptual frameworks that are adequate to the way that data is used and understood by its users. Deborah Lupton suggests that often we give data “other vital capacities because they are about human life itself, have implications for human life opportunities and livelihoods, [and] can have recursive effects on human lives (shaping action and concepts of embodiment ... selfhood [and subjectivity]) and generate economic value”. But when data are afforded such capacities, the analysis of its politics also calls for us to “consider context” and “making the labour [of datafication] visible” (D’Ignazio and Klein). For Jenny L. Davis, getting beyond simply thinking about what data affords involves bringing to light how continually and dynamically to requests, demands, encourages, discourages, and refuses certain operations and interpretations. It is in this re-orientation of the question from what to how where “practical analytical tool[s]” (Davis) can be found. Davis writes: requests and demands are bids placed by technological objects, on user-subjects. Encourage, discourage and refuse are the ways technologies respond to bids user-subjects place upon them. Allow pertains equally to bids from technological objects and the object’s response to user-subjects. (Davis) Building on Lupton, Davis, and D’Ignazio and Klein, we see three principles that we consider crucial for work on data, darkness and light: data is not simply a technological object that exists within sociotechnical systems without having undergone any priming or processing, so as a consequence the data collecting entity imposes standards and way of imagining data before it comes into contact with user-subjects; data is not neutral and does not possess qualities that make it equivalent to the things that it comes to represent; data is partial, situated, and contingent on technical processes, but the outcomes of its use afford it properties beyond those that are purely informational. This article builds from these principles and traces a framework for investigating the complications arising when data moves from one context to another. We draw from the “data provenance” as it is applied in the computing and informational sciences where it is used to query the location and accuracy of data in databases. In developing “data provenance”, we adapt provenance from an approach that solely focuses on technical infrastructures and material processes that move data from one place to another and turn to sociotechnical, institutional, and discursive forces that bring about data acquisition, sharing, interpretation, and re-use. As data passes through open, opaque, and darkened spaces within sociotechnical systems, we argue that provenance can shed light on gaps and overlaps in technical, legal, ethical, and ideological forms of data governance. Whether data becomes exclusive by moving from light to dark (as has happened with the removal of many pages and links from Facebook around the Australian news revenue-sharing bill), or is publicised by shifting from dark to light (such as the Australian government releasing investigative journalist Andie Fox’s welfare history to the press), or even recontextualised from one dark space to another (as with genetic data shifting from medical to legal contexts, or the theft of personal financial data), there is still a process of transmission here that we can assess and critique through provenance. These different modalities, which guide data acquisition, sharing, interpretation, and re-use, cascade and influence different elements and apparatuses within data-driven sociotechnical systems to different extents depending on context. Attempts to illuminate and make sense of these complex forces, we argue, exposes data-driven practices as inherently political in terms of whose interests they serve. Provenance in Darkness and in Light When processes of data capture, sharing, interpretation, and re-use are obscured, it impacts on the extent to which we might retrospectively examine cases where malpractice in responsible data custodianship and stewardship has occurred, because it makes it difficult to see how things have been rendered real and knowable, changed over time, had causality ascribed to them, and to what degree of confidence a decision has been made based on a given dataset. To borrow from this issue’s concerns, the paradigm of dark spaces covers a range of different kinds of valences on the idea of private, secret, or exclusive contexts. We can parallel it with the idea of ‘light’ spaces, which equally holds a range of different concepts about what is open, public, or accessible. For instance, in the use of social data garnered from online platforms, the practices of academic researchers and analysts working in the private sector often fall within a grey zone when it comes to consent and transparency. Here the binary notion of public and private is complicated by the passage of data from light to dark (and back to light). Writing in a different context, Michael Warner complicates the notion of publicness. He observes that the idea of something being public is in and of itself always sectioned off, divorced from being fully generalisable, and it is “just whatever people in a given context think it is” (11). Michael Hardt and Antonio Negri argue that publicness is already shadowed by an idea of state ownership, leaving us in a situation where public and private already both sit on the same side of the propertied/commons divide as if the “only alternative to the private is the public, that is, what is managed and regulated by states and other governmental authorities” (vii). The same can be said about the way data is conceived as a public good or common asset. These ideas of light and dark are useful categorisations for deliberately moving past the tensions that arise when trying to qualify different subspecies of privacy and openness. The problem with specific linguistic dyads of private vs. public, or open vs. closed, and so on, is that they are embedded within legal, moral, technical, economic, or rhetorical distinctions that already involve normative judgements on whether such categories are appropriate or valid. Data may be located in a dark space for legal reasons that fall under the legal domain of ‘private’ or it may be dark because it has been stolen. It may simply be inaccessible, encrypted away behind a lost password on a forgotten external drive. Equally, there are distinctions around lightness that can be glossed – the openness of Open Data (see: theodi.org) is of an entirely separate category to the AACS encryption key, which was illegally but enthusiastically shared across the internet in 2007 to the point where it is now accessible on Wikipedia. The language of light and dark spaces allows us to cut across these distinctions and discuss in deliberately loose terms the degree to which something is accessed, with any normative judgments reserved for the cases themselves. Data provenance, in this sense, can be used as a methodology to critique the way that data is recontextualised from light to dark, dark to light, and even within these distinctions. Data provenance critiques the way that data is presented as if it were “there for the taking”. This also suggests that when data is used for some or another secondary purpose – generally for value creation – some form of closure or darkening is to be expected. Data in the public domain is more than simply a specific informational thing: there is always context, and this contextual specificity, we argue, extends far beyond anything that can be captured in a metadata schema or a licensing model. Even the transfer of data from one open, public, or light context to another will evoke new degrees of openness and luminosity that should not be assumed to be straightforward. And with this a new set of relations between data-user-subjects and stewards emerges. The movement of data between public and private contexts by virtue of the growing amount of personal information that is generated through the traces left behind as people make use of increasingly digitised services going about their everyday lives means that data-motile processes are constantly occurring behind the scenes – in darkness – where it comes into the view, or possession, of third parties without obvious mechanisms of consent, disclosure, or justification. Given that there are “many hands” (D’Iganzio and Klein) involved in making data portable between light and dark spaces, equally there can be diversity in the approaches taken to generate critical literacies of these relations. There are two complexities that we argue are important for considering the ethics of data motility from light to dark, and this differs from the concerns that we might have when we think about other illuminating tactics such as open data publishing, freedom-of-information requests, or when data is anonymously leaked in the public interest. The first is that the terms of ethics must be communicable to individuals and groups whose data literacy may be low, effectively non-existent, or not oriented around the objective of upholding or generating data-luminosity as an element of a wider, more general form of responsible data stewardship. Historically, a productive approach to data literacy has been finding appropriate metaphors from adjacent fields that can help add depth – by way of analogy – to understanding data motility. Here we return to our earlier assertion that data is more than simply a transactable commodity. Consider the notion of “giving” and “taking” in the context of darkness and light. The analogy of giving and taking is deeply embedded into the notion of data acquisition and sharing by virtue of the etymology of the word data itself: in Latin, “things having been given”, whereby in French données, a natural gift, perhaps one that is given to those that attempt capture for the purposes of empiricism – representation in quantitative form is a quality that is given to phenomena being brought into the light. However, in the contemporary parlance of “analytics” data is “taken” in the form of recording, measuring, and tracking. Data is considered to be something valuable enough to give or take because of its capacity to stand in for real things. The empiricist’s preferred method is to take rather than to accept what is given (Kitchin, 2); the data-capitalist’s is to incentivise the act of giving or to take what is already given (or yet to be taken). Because data-motile processes are not simply passive forms of reading what is contained within a dataset, the materiality and subjectivity of data extraction and interpretation is something that should not be ignored. These processes represent the recontextualisation of data from one space to another and are expressed in the landmark case of Cambridge Analytica, where a private research company extracted data from Facebook and used it to engage in psychometric analysis of unknowing users. Data Capture Mechanism Characteristics and Approach to Data Stewardship Historical Information created, recorded, or gathered about people of things directly from the source or a delegate but accessed for secondary purposes. Observational Represents patterns and realities of everyday life, collected by subjects by their own choice and with some degree of discretion over the methods. Third parties access this data through reciprocal arrangement with the subject (e.g., in exchange for providing a digital service such as online shopping, banking, healthcare, or social networking). Purposeful Data gathered with a specific purpose in mind and collected with the objective to manipulate its analysis to achieve certain ends. Integrative Places less emphasis on specific data types but rather looks towards social and cultural factors that afford access to and facilitate the integration and linkage of disparate datasets Table 1: Mechanisms of Data Capture There are ethical challenges associated with data that has been sourced from pre-existing sets or that has been extracted from websites and online platforms through scraping data and then enriching it through cleaning, annotation, de-identification, aggregation, or linking to other data sources (tab. 1). As a way to address this challenge, our suggestion of “data provenance” can be defined as where a data point comes from, how it came into being, and how it became valuable for some or another purpose. In developing this idea, we borrow from both the computational and biological sciences (Buneman et al.) where provenance, as a form of qualitative inquiry into data-motile processes, centres around understanding the origin of a data point as part of a broader almost forensic analysis of quality and error-potential in datasets. Provenance is an evaluation of a priori computational inputs and outputs from the results of database queries and audits. Provenance can also be applied to other contexts where data passes through sociotechnical systems, such as behavioural analytics, targeted advertising, machine learning, and algorithmic decision-making. Conventionally, data provenance is based on understanding where data has come from and why it was collected. Both these questions are concerned with the evaluation of the nature of a data point within the wider context of a database that is itself situated within a larger sociotechnical system where the data is made available for use. In its conventional sense, provenance is a means of ensuring that a data point is maintained as a single source of truth (Buneman, 89), and by way of a reproducible mechanism which allows for its path through a set of technical processes, it affords the assessment of a how reliable a system’s output might be by sheer virtue of the ability for one to retrace the steps from point A to B. “Where” and “why” questions are illuminating because they offer an ends-and-means view of the relation between the origins and ultimate uses of a given data point or set. Provenance is interesting when studying data luminosity because means and ends have much to tell us about the origins and uses of data in ways that gesture towards a more accurate and structured research agenda for data ethics that takes the emphasis away from individual moral patients and reorients it towards practices that occur within information management environments. Provenance offers researchers seeking to study data-driven practices a similar heuristic to a journalist’s line of questioning who, what, when, where, why, and how? This last question of how is something that can be incorporated into conventional models of provenance that make it useful in data ethics. The question of how data comes into being extends questions of power, legality, literacy, permission-seeking, and harm in an entangled way and notes how these factors shape the nature of personal data as it moves between contexts. Forms of provenance accumulate from transaction to transaction, cascading along, as a dataset ‘picks up’ the types of provenance that have led to its creation. This may involve multiple forms of overlapping provenance – methodological and epistemological, legal and illegal – which modulate different elements and apparatuses. Provenance, we argue is an important methodological consideration for workers in the humanities and social sciences. Provenance provides a set of shared questions on which models of transparency, accountability, and trust may be established. It points us towards tactics that might help data-subjects understand privacy in a contextual manner (Nissenbaum) and even establish practices of obfuscation and “informational self-defence” against regimes of datafication (Brunton and Nissenbaum). Here provenance is not just a declaration of what means and ends of data capture, sharing, linkage, and analysis are. We sketch the outlines of a provenance model in table 2 below. Type Metaphorical frame Dark Light What? The epistemological structure of a database determines the accuracy of subsequent decisions. Data must be consistent. What data is asked of a person beyond what is strictly needed for service delivery. Data that is collected for a specific stated purpose with informed consent from the data-subject. How does the decision about what to collect disrupt existing polities and communities? What demands for conformity does the database make of its subjects? Where? The contents of a database is important for making informed decisions. Data must be represented. The parameters of inclusion/exclusion that create unjust risks or costs to people because of their inclusion or exclusion in a dataset. The parameters of inclusion or exclusion that afford individuals representation or acknowledgement by being included or excluded from a dataset. How are populations recruited into a dataset? What divides exist that systematically exclude individuals? Who? Who has access to data, and how privacy is framed is important for the security of data-subjects. Data access is political. Access to the data by parties not disclosed to the data-subject. Who has collected the data and who has or will access it? How is the data made available to those beyond the data subjects? How? Data is created with a purpose and is never neutral. Data is instrumental. How the data is used, to what ends, discursively, practically, instrumentally. Is it a private record, a source of value creation, the subject of extortion or blackmail? How the data was intended to be used at the time that it was collected. Why? Data is created by people who are shaped by ideological factors. Data has potential. The political rationality that shapes data governance with regard to technological innovation. The trade-offs that are made known to individuals when they contribute data into sociotechnical systems over which they have limited control. Table 2: Forms of Data Provenance Conclusion As an illuminating methodology, provenance offers a specific line of questioning practices that take information through darkness and light. The emphasis that it places on a narrative for data assets themselves (asking what when, who, how, and why) offers a mechanism for traceability and has potential for application across contexts and cases that allows us to see data malpractice as something that can be productively generalised and understood as a series of ideologically driven technical events with social and political consequences without being marred by perceptions of exceptionality of individual, localised cases of data harm or data violence. References Brunton, Finn, and Helen Nissenbaum. "Political and Ethical Perspectives on Data Obfuscation." Privacy, Due Process and the Computational Turn: The Philosophy of Law Meets the Philosophy of Technology. Eds. Mireille Hildebrandt and Katja de Vries. New York: Routledge, 2013. 171-195. Buneman, Peter, Sanjeev Khanna, and Wang-Chiew Tan. "Data Provenance: Some Basic Issues." International Conference on Foundations of Software Technology and Theoretical Computer Science. Berlin: Springer, 2000. Davis, Jenny L. How Artifacts Afford: The Power and Politics of Everyday Things. Cambridge: MIT Press, 2020. D'Ignazio, Catherine, and Lauren F. Klein. Data Feminism. Cambridge: MIT Press, 2020. Hardt, Michael, and Antonio Negri. Commonwealth. Cambridge: Harvard UP, 2009. Kitchin, Rob. "Big Data, New Epistemologies and Paradigm Shifts." Big Data & Society 1.1 (2014). Lawrence, Matthew. “Emerging Technology: An Interview with Adam Greenfield. ‘God Forbid That Anyone Stopped to Ask What Harm This Might Do to Us’. Institute for Public Policy Research, 13 Oct. 2017. <https://www.ippr.org/juncture-item/emerging-technology-an-interview-with-adam-greenfield-god-forbid-that-anyone-stopped-to-ask-what-harm-this-might-do-us>. Lupton, Deborah. "Vital Materialism and the Thing-Power of Lively Digital Data." Social Theory, Health and Education. Eds. Deana Leahy, Katie Fitzpatrick, and Jan Wright. London: Routledge, 2018. Nissenbaum, Helen F. Privacy in Context: Technology, Policy, and the Integrity of Social Life. Stanford: Stanford Law Books, 2020. Warner, Michael. "Publics and Counterpublics." Public Culture 14.1 (2002): 49-90.

When George Orwell encountered ideas of a technological utopia sixty-five years ago, he acted the grumpy middle-aged man Reading recently a batch of rather shallowly optimistic “progressive” books, I was struck by the automatic way in which people go on repeating certain phrases which were fashionable before 1914. Two great favourites are “the abolition of distance” and “the disappearance of frontiers”. I do not know how often I have met with the statements that “the aeroplane and the radio have abolished distance” and “all parts of the world are now interdependent” (1944). It is worth revisiting the old boy’s grumpiness, because the rhetoric he so niftily skewers continues in our own time. Facebook features “Peace on Facebook” and even claims that it can “decrease world conflict” through inter-cultural communication. Twitter has announced itself as “a triumph of humanity” (“A Cyber-House” 61). Queue George. In between Orwell and latter-day hoody cybertarians, a whole host of excitable public intellectuals announced the impending end of materiality through emergent media forms. Marshall McLuhan, Neil Postman, Daniel Bell, Ithiel de Sola Pool, George Gilder, Alvin Toffler—the list of 1960s futurists goes on and on. And this wasn’t just a matter of punditry: the OECD decreed the coming of the “information society” in 1975 and the European Union (EU) followed suit in 1979, while IBM merrily declared an “information age” in 1977. Bell theorized this technological utopia as post-ideological, because class would cease to matter (Mattelart). Polluting industries seemingly no longer represented the dynamic core of industrial capitalism; instead, market dynamism radiated from a networked, intellectual core of creative and informational activities. The new information and knowledge-based economies would rescue First World hegemony from an “insurgent world” that lurked within as well as beyond itself (Schiller). Orwell’s others and the Cold-War futurists propagated one of the most destructive myths shaping both public debate and scholarly studies of the media, culture, and communication. They convinced generations of analysts, activists, and arrivistes that the promises and problems of the media could be understood via metaphors of the environment, and that the media were weightless and virtual. The famous medium they wished us to see as the message —a substance as vital to our wellbeing as air, water, and soil—turned out to be no such thing. Today’s cybertarians inherit their anti-Marxist, anti-materialist positions, as a casual glance at any new media journal, culture-industry magazine, or bourgeois press outlet discloses. The media are undoubtedly important instruments of social cohesion and fragmentation, political power and dissent, democracy and demagoguery, and other fraught extensions of human consciousness. But talk of media systems as equivalent to physical ecosystems—fashionable among marketers and media scholars alike—is predicated on the notion that they are environmentally benign technologies. This has never been true, from the beginnings of print to today’s cloud-covered computing. Our new book Greening the Media focuses on the environmental impact of the media—the myriad ways that media technology consumes, despoils, and wastes natural resources. We introduce ideas, stories, and facts that have been marginal or absent from popular, academic, and professional histories of media technology. Throughout, ecological issues have been at the core of our work and we immodestly think the same should apply to media communications, and cultural studies more generally. We recognize that those fields have contributed valuable research and teaching that address environmental questions. For instance, there is an abundant literature on representations of the environment in cinema, how to communicate environmental messages successfully, and press coverage of climate change. That’s not enough. You may already know that media technologies contain toxic substances. You may have signed an on-line petition protesting the hazardous and oppressive conditions under which workers assemble cell phones and computers. But you may be startled, as we were, by the scale and pervasiveness of these environmental risks. They are present in and around every site where electronic and electric devices are manufactured, used, and thrown away, poisoning humans, animals, vegetation, soil, air and water. We are using the term “media” as a portmanteau word to cover a multitude of cultural and communications machines and processes—print, film, radio, television, information and communications technologies (ICT), and consumer electronics (CE). This is not only for analytical convenience, but because there is increasing overlap between the sectors. CE connect to ICT and vice versa; televisions resemble computers; books are read on telephones; newspapers are written through clouds; and so on. Cultural forms and gadgets that were once separate are now linked. The currently fashionable notion of convergence doesn’t quite capture the vastness of this integration, which includes any object with a circuit board, scores of accessories that plug into it, and a global nexus of labor and environmental inputs and effects that produce and flow from it. In 2007, a combination of ICT/CE and media production accounted for between 2 and 3 percent of all greenhouse gases emitted around the world (“Gartner Estimates,”; International Telecommunication Union; Malmodin et al.). Between twenty and fifty million tonnes of electronic waste (e-waste) are generated annually, much of it via discarded cell phones and computers, which affluent populations throw out regularly in order to buy replacements. (Presumably this fits the narcissism of small differences that distinguishes them from their own past.) E-waste is historically produced in the Global North—Australasia, Western Europe, Japan, and the US—and dumped in the Global South—Latin America, Africa, Eastern Europe, Southern and Southeast Asia, and China. It takes the form of a thousand different, often deadly, materials for each electrical and electronic gadget. This trend is changing as India and China generate their own media detritus (Robinson; Herat). Enclosed hard drives, backlit screens, cathode ray tubes, wiring, capacitors, and heavy metals pose few risks while these materials remain encased. But once discarded and dismantled, ICT/CE have the potential to expose workers and ecosystems to a morass of toxic components. Theoretically, “outmoded” parts could be reused or swapped for newer parts to refurbish devices. But items that are defined as waste undergo further destruction in order to collect remaining parts and valuable metals, such as gold, silver, copper, and rare-earth elements. This process causes serious health risks to bones, brains, stomachs, lungs, and other vital organs, in addition to birth defects and disrupted biological development in children. Medical catastrophes can result from lead, cadmium, mercury, other heavy metals, poisonous fumes emitted in search of precious metals, and such carcinogenic compounds as polychlorinated biphenyls, dioxin, polyvinyl chloride, and flame retardants (Maxwell and Miller 13). The United States’ Environmental Protection Agency estimates that by 2007 US residents owned approximately three billion electronic devices, with an annual turnover rate of 400 million units, and well over half such purchases made by women. Overall CE ownership varied with age—adults under 45 typically boasted four gadgets; those over 65 made do with one. The Consumer Electronics Association (CEA) says US$145 billion was expended in the sector in 2006 in the US alone, up 13% on the previous year. The CEA refers joyously to a “consumer love affair with technology continuing at a healthy clip.” In the midst of a recession, 2009 saw $165 billion in sales, and households owned between fifteen and twenty-four gadgets on average. By 2010, US$233 billion was spent on electronic products, three-quarters of the population owned a computer, nearly half of all US adults owned an MP3 player, and 85% had a cell phone. By all measures, the amount of ICT/CE on the planet is staggering. As investigative science journalist, Elizabeth Grossman put it: “no industry pushes products into the global market on the scale that high-tech electronics does” (Maxwell and Miller 2). In 2007, “of the 2.25 million tons of TVs, cell phones and computer products ready for end-of-life management, 18% (414,000 tons) was collected for recycling and 82% (1.84 million tons) was disposed of, primarily in landfill” (Environmental Protection Agency 1). Twenty million computers fell obsolete across the US in 1998, and the rate was 130,000 a day by 2005. It has been estimated that the five hundred million personal computers discarded in the US between 1997 and 2007 contained 6.32 billion pounds of plastics, 1.58 billion pounds of lead, three million pounds of cadmium, 1.9 million pounds of chromium, and 632000 pounds of mercury (Environmental Protection Agency; Basel Action Network and Silicon Valley Toxics Coalition 6). The European Union is expected to generate upwards of twelve million tons annually by 2020 (Commission of the European Communities 17). While refrigerators and dangerous refrigerants account for the bulk of EU e-waste, about 44% of the most toxic e-waste measured in 2005 came from medium-to-small ICT/CE: computer monitors, TVs, printers, ink cartridges, telecommunications equipment, toys, tools, and anything with a circuit board (Commission of the European Communities 31-34). Understanding the enormity of the environmental problems caused by making, using, and disposing of media technologies should arrest our enthusiasm for them. But intellectual correctives to the “love affair” with technology, or technophilia, have come and gone without establishing much of a foothold against the breathtaking flood of gadgets and the propaganda that proclaims their awe-inspiring capabilities.[i] There is a peculiar enchantment with the seeming magic of wireless communication, touch-screen phones and tablets, flat-screen high-definition televisions, 3-D IMAX cinema, mobile computing, and so on—a totemic, quasi-sacred power that the historian of technology David Nye has named the technological sublime (Nye Technological Sublime 297).[ii] We demonstrate in our book why there is no place for the technological sublime in projects to green the media. But first we should explain why such symbolic power does not accrue to more mundane technologies; after all, for the time-strapped cook, a pressure cooker does truly magical things. Three important qualities endow ICT/CE with unique symbolic potency—virtuality, volume, and novelty. The technological sublime of media technology is reinforced by the “virtual nature of much of the industry’s content,” which “tends to obscure their responsibility for a vast proliferation of hardware, all with high levels of built-in obsolescence and decreasing levels of efficiency” (Boyce and Lewis 5). Planned obsolescence entered the lexicon as a new “ethics” for electrical engineering in the 1920s and ’30s, when marketers, eager to “habituate people to buying new products,” called for designs to become quickly obsolete “in efficiency, economy, style, or taste” (Grossman 7-8).[iii] This defines the short lifespan deliberately constructed for computer systems (drives, interfaces, operating systems, batteries, etc.) by making tiny improvements incompatible with existing hardware (Science and Technology Council of the American Academy of Motion Picture Arts and Sciences 33-50; Boyce and Lewis). With planned obsolescence leading to “dizzying new heights” of product replacement (Rogers 202), there is an overstated sense of the novelty and preeminence of “new” media—a “cult of the present” is particularly dazzled by the spread of electronic gadgets through globalization (Mattelart and Constantinou 22). References to the symbolic power of media technology can be found in hymnals across the internet and the halls of academe: technologies change us, the media will solve social problems or create new ones, ICTs transform work, monopoly ownership no longer matters, journalism is dead, social networking enables social revolution, and the media deliver a cleaner, post-industrial, capitalism. Here is a typical example from the twilight zone of the technological sublime (actually, the OECD): A major feature of the knowledge-based economy is the impact that ICTs have had on industrial structure, with a rapid growth of services and a relative decline of manufacturing. Services are typically less energy intensive and less polluting, so among those countries with a high and increasing share of services, we often see a declining energy intensity of production … with the emergence of the Knowledge Economy ending the old linear relationship between output and energy use (i.e. partially de-coupling growth and energy use) (Houghton 1) This statement mixes half-truths and nonsense. In reality, old-time, toxic manufacturing has moved to the Global South, where it is ascendant; pollution levels are rising worldwide; and energy consumption is accelerating in residential and institutional sectors, due almost entirely to ICT/CE usage, despite advances in energy conservation technology (a neat instance of the age-old Jevons Paradox). In our book we show how these are all outcomes of growth in ICT/CE, the foundation of the so-called knowledge-based economy. ICT/CE are misleadingly presented as having little or no material ecological impact. In the realm of everyday life, the sublime experience of electronic machinery conceals the physical work and material resources that go into them, while the technological sublime makes the idea that more-is-better palatable, axiomatic; even sexy. In this sense, the technological sublime relates to what Marx called “the Fetishism which attaches itself to the products of labour” once they are in the hands of the consumer, who lusts after them as if they were “independent beings” (77). There is a direct but unseen relationship between technology’s symbolic power and the scale of its environmental impact, which the economist Juliet Schor refers to as a “materiality paradox” —the greater the frenzy to buy goods for their transcendent or nonmaterial cultural meaning, the greater the use of material resources (40-41). We wrote Greening the Media knowing that a study of the media’s effect on the environment must work especially hard to break the enchantment that inflames popular and elite passions for media technologies. We understand that the mere mention of the political-economic arrangements that make shiny gadgets possible, or the environmental consequences of their appearance and disappearance, is bad medicine. It’s an unwelcome buzz kill—not a cool way to converse about cool stuff. But we didn’t write the book expecting to win many allies among high-tech enthusiasts and ICT/CE industry leaders. We do not dispute the importance of information and communication media in our lives and modern social systems. We are media people by profession and personal choice, and deeply immersed in the study and use of emerging media technologies. But we think it’s time for a balanced assessment with less hype and more practical understanding of the relationship of media technologies to the biosphere they inhabit. Media consumers, designers, producers, activists, researchers, and policy makers must find new and effective ways to move ICT/CE production and consumption toward ecologically sound practices. In the course of this project, we found in casual conversation, lecture halls, classroom discussions, and correspondence, consistent and increasing concern with the environmental impact of media technology, especially the deleterious effects of e-waste toxins on workers, air, water, and soil. We have learned that the grip of the technological sublime is not ironclad. Its instability provides a point of departure for investigating and criticizing the relationship between the media and the environment. The media are, and have been for a long time, intimate environmental participants. Media technologies are yesterday’s, today’s, and tomorrow’s news, but rarely in the way they should be. The prevailing myth is that the printing press, telegraph, phonograph, photograph, cinema, telephone, wireless radio, television, and internet changed the world without changing the Earth. In reality, each technology has emerged by despoiling ecosystems and exposing workers to harmful environments, a truth obscured by symbolic power and the power of moguls to set the terms by which such technologies are designed and deployed. Those who benefit from ideas of growth, progress, and convergence, who profit from high-tech innovation, monopoly, and state collusion—the military-industrial-entertainment-academic complex and multinational commandants of labor—have for too long ripped off the Earth and workers. As the current celebration of media technology inevitably winds down, perhaps it will become easier to comprehend that digital wonders come at the expense of employees and ecosystems. This will return us to Max Weber’s insistence that we understand technology in a mundane way as a “mode of processing material goods” (27). Further to understanding that ordinariness, we can turn to the pioneering conversation analyst Harvey Sacks, who noted three decades ago “the failures of technocratic dreams [:] that if only we introduced some fantastic new communication machine the world will be transformed.” Such fantasies derived from the very banality of these introductions—that every time they took place, one more “technical apparatus” was simply “being made at home with the rest of our world’ (548). Media studies can join in this repetitive banality. Or it can withdraw the welcome mat for media technologies that despoil the Earth and wreck the lives of those who make them. In our view, it’s time to green the media by greening media studies. References “A Cyber-House Divided.” Economist 4 Sep. 2010: 61-62. “Gartner Estimates ICT Industry Accounts for 2 Percent of Global CO2 Emissions.” Gartner press release. 6 April 2007. ‹http://www.gartner.com/it/page.jsp?id=503867›. Basel Action Network and Silicon Valley Toxics Coalition. Exporting Harm: The High-Tech Trashing of Asia. Seattle: Basel Action Network, 25 Feb. 2002. Benjamin, Walter. “Central Park.” Trans. Lloyd Spencer with Mark Harrington. New German Critique 34 (1985): 32-58. Biagioli, Mario. “Postdisciplinary Liaisons: Science Studies and the Humanities.” Critical Inquiry 35.4 (2009): 816-33. Boyce, Tammy and Justin Lewis, eds. Climate Change and the Media. New York: Peter Lang, 2009. Commission of the European Communities. “Impact Assessment.” Commission Staff Working Paper accompanying the Proposal for a Directive of the European Parliament and of the Council on Waste Electrical and Electronic Equipment (WEEE) (recast). COM (2008) 810 Final. Brussels: Commission of the European Communities, 3 Dec. 2008. Environmental Protection Agency. Management of Electronic Waste in the United States. Washington, DC: EPA, 2007 Environmental Protection Agency. Statistics on the Management of Used and End-of-Life Electronics. Washington, DC: EPA, 2008 Grossman, Elizabeth. Tackling High-Tech Trash: The E-Waste Explosion & What We Can Do about It. New York: Demos, 2008. ‹http://www.demos.org/pubs/e-waste_FINAL.pdf› Herat, Sunil. “Review: Sustainable Management of Electronic Waste (e-Waste).” Clean 35.4 (2007): 305-10. Houghton, J. “ICT and the Environment in Developing Countries: Opportunities and Developments.” Paper prepared for the Organization for Economic Cooperation and Development, 2009. International Telecommunication Union. ICTs for Environment: Guidelines for Developing Countries, with a Focus on Climate Change. Geneva: ICT Applications and Cybersecurity Division Policies and Strategies Department ITU Telecommunication Development Sector, 2008. Malmodin, Jens, Åsa Moberg, Dag Lundén, Göran Finnveden, and Nina Lövehagen. “Greenhouse Gas Emissions and Operational Electricity Use in the ICT and Entertainment & Media Sectors.” Journal of Industrial Ecology 14.5 (2010): 770-90. Marx, Karl. Capital: Vol. 1: A Critical Analysis of Capitalist Production, 3rd ed. Trans. Samuel Moore and Edward Aveling, Ed. Frederick Engels. New York: International Publishers, 1987. Mattelart, Armand and Costas M. Constantinou. “Communications/Excommunications: An Interview with Armand Mattelart.” Trans. Amandine Bled, Jacques Guot, and Costas Constantinou. Review of International Studies 34.1 (2008): 21-42. Mattelart, Armand. “Cómo nació el mito de Internet.” Trans. Yanina Guthman. El mito internet. Ed. Victor Hugo de la Fuente. Santiago: Editorial aún creemos en los sueños, 2002. 25-32. Maxwell, Richard and Toby Miller. Greening the Media. New York: Oxford University Press, 2012. Nye, David E. American Technological Sublime. Cambridge, Mass.: MIT Press, 1994. Nye, David E. Technology Matters: Questions to Live With. Cambridge, Mass.: MIT Press. 2007. Orwell, George. “As I Please.” Tribune. 12 May 1944. Richtel, Matt. “Consumers Hold on to Products Longer.” New York Times: B1, 26 Feb. 2011. Robinson, Brett H. “E-Waste: An Assessment of Global Production and Environmental Impacts.” Science of the Total Environment 408.2 (2009): 183-91. Rogers, Heather. Gone Tomorrow: The Hidden Life of Garbage. New York: New Press, 2005. Sacks, Harvey. Lectures on Conversation. Vols. I and II. Ed. Gail Jefferson. Malden: Blackwell, 1995. Schiller, Herbert I. Information and the Crisis Economy. Norwood: Ablex Publishing, 1984. Schor, Juliet B. Plenitude: The New Economics of True Wealth. New York: Penguin, 2010. Science and Technology Council of the American Academy of Motion Picture Arts and Sciences. The Digital Dilemma: Strategic Issues in Archiving and Accessing Digital Motion Picture Materials. Los Angeles: Academy Imprints, 2007. Weber, Max. “Remarks on Technology and Culture.” Trans. Beatrix Zumsteg and Thomas M. Kemple. Ed. Thomas M. Kemple. Theory, Culture [i] The global recession that began in 2007 has been the main reason for some declines in Global North energy consumption, slower turnover in gadget upgrades, and longer periods of consumer maintenance of electronic goods (Richtel). [ii] The emergence of the technological sublime has been attributed to the Western triumphs in the post-Second World War period, when technological power supposedly supplanted the power of nature to inspire fear and astonishment (Nye Technology Matters 28). Historian Mario Biagioli explains how the sublime permeates everyday life through technoscience: "If around 1950 the popular imaginary placed science close to the military and away from the home, today’s technoscience frames our everyday life at all levels, down to our notion of the self" (818). [iii] This compulsory repetition is seemingly undertaken each time as a novelty, governed by what German cultural critic Walter Benjamin called, in his awkward but occasionally illuminating prose, "the ever-always-the-same" of "mass-production" cloaked in "a hitherto unheard-of significance" (48).

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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.

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.

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.

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.

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.

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.

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.

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.

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.

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.