He Tuhononga Whaiaro: A Kaupapa Maori Approach to Mate Wareware (Dementia) and Cognitive Assessment of Older Maori.

AIM: The aim of this study is to investigate Maori (Indigenous peoples of Aotearoa New Zealand) understandings of dementia (mate wareware) and develop a framework to inform assessment of cognitive impairment. METHOD: Qualitative, kaupapa Maori (Maori approach) research with 241 older Maori (kaumatua) involving 17 focus groups across Aotearoa New Zealand (NZ) and eight families (whanau) from one region. We thematically analyzed transcribed data from audio-recorded interviews. RESULTS: Two overarching themes, namely, connection (Tuhononga) and self (Whaiaro), and eight subthemes in particular mind (hinengaro), spirit (wairua), body (tinana), family (whanau), social connection (whanaungatanga), identity and role (tuakiri), place (wahi), and ancestors (tupuna) emerged. Maori language (Te Reo Maori) was important for cognitive health. CONCLUSION: The findings embedded in cultural values improve understanding of dementia (mate wareware) in Maori. These themes can inform the assessment of older Maori with cognitive impairment. For those without cognitive impairment, the Tuhononga Whaiaro framework suggests factors potentially crucial for healthy aging in Maori.

What is communication assistance? Describing a new and emerging profession in the New Zealand youth justice system.

'Communication assistance' is a term that derives from section 80 of the Evidence Act 2006: a legislative provision that has given birth to a whole new profession in the New Zealand legal system. This legislative provision has been used to appoint a new role: that of the communication assistant to support complainants, witnesses and defendants of all ages with identified communication needs. This study focuses specifically on the provision of communication assistance for young people who offend in the New Zealand criminal justice system. It provides a qualitative analysis of professionals' descriptions (n = 28 participants) of communication assistance for this population in justice processes. The findings illustrate that communication assistance shares its core with a similar role in England and Wales, that of the intermediary, but that communication assistants in New Zealand have broader scope than their counterparts working in the area of youth justice.

Mate wareware: Understanding 'dementia' from a Maori perspective.

AIM: To investigate Maori (Indigenous people of Aotearoa New Zealand) understandings of dementia, its causes, and ways to manage a whanau (extended family) member with dementia. METHOD: We undertook kaupapa Maori research (Maori informed research) with 223 kaumatua (Maori elders) who participated in 17 focus groups across seven study regions throughout Aotearoa New Zealand and eight whanau from the Waikato region. We audio recorded all interviews, transcribed them and then coded and categorised the data into themes. RESULTS: Mate wareware (becoming forgetful and unwell) ('dementia') affects the wairua (spiritual dimension) of Maori. The findings elucidate Maori understandings of the causes of mate wareware, and the role of aroha (love, compassion) and manaakitanga (hospitality, kindness, generosity, support, caring) involved in caregiving for whanau living with mate wareware. Participants perceived cultural activities acted as protective factors that optimised a person's functioning within their whanau and community. CONCLUSION: Whanau are crucial for the care of a kaumatua with mate wareware, along with promoting healthy wairua for all. Whanau urgently need information to assist with their knowledge building and empowerment to meet the needs of a member affected by mate wareware. This requires collaborative healthcare practice and practitioners accessing the necessary matauranga Maori (Maori knowledge) to provide culturally appropriate and comprehensive care for whanau.

Factors Associated with Maori Performance on the WAIS-IV.

Neuropsychological tests are routinely used to assess Maori, the indigenous people of New Zealand, yet very few investigations of the psychometric properties of these tests with this population have been conducted. This paper focuses on factors that may impact performance of Maori adults on neuropsychological testing. The Wechsler Adult Intelligence Scale-IV (WAIS-IV) was administered to a sample of 284 Maori stratified for age (between 16 years and 90 years) and gender in order to establish a Maori normative data set. The sample who primarily spoke English as their first language were recruited from a range of urban, regional and rural areas in New Zealand to obtain representation of the main Maori Iwi (tribes). Analysis of test results suggests acculturation, education, income, and, "a culturally positive experience" may have accounted for some of the variance in test performance.

A pilot randomized controlled trial of on-line interventions to improve sleep quality in adults after mild or moderate traumatic brain injury.

OBJECTIVE: To explore feasibility and potential efficacy of on-line interventions for sleep quality following a traumatic brain injury (TBI). DESIGN: A two parallel-group, randomized controlled pilot study. SETTING: Community-based. SUBJECTS: In all, 24 participants (mean age: 35.9 ± 11.8 years) who reported experiencing sleep difficulties between 3 and 36 months after a mild or moderate TBI. INTERVENTIONS: Participants were randomized to receive either a cognitive behaviour therapy or an education intervention on-line. Both interventions were self-completed for 20-30 minutes per week over a six-week period. MAIN MEASURES: The Pittsburgh Sleep Quality Index assessed self-reported sleep quality with actigraphy used as an objective measure of sleep quality. The CNS Vital Signs on-line neuropsychological test assessed cognitive functioning and the Rivermead Post-concussion Symptoms and Quality of Life after Brain Injury questionnaires were completed pre and post intervention. RESULTS: Both programmes demonstrated feasibility for use post TBI, with 83.3% of participants completing the interventions. The cognitive behaviour therapy group experienced significant reductions ( F = 5.47, p = 0.04) in sleep disturbance (mean individual change = -4.00) in comparison to controls post intervention (mean individual change = -1.50) with a moderate effect size of 1.17. There were no significant group differences on objective sleep quality, cognitive functioning, post-concussion symptoms or quality of life. CONCLUSION: On-line programmes designed to improve sleep are feasible for use for adults following mild-to-moderate TBI. Based on the effect size identified in this pilot study, 128 people (64 per group) would be needed to determine clinical effectiveness.

Cross-cultural acceptability and utility of the strengths and difficulties questionnaire: views of families.

BACKGROUND: Screening children for behavioural difficulties requires the use of a tool that is culturally valid. We explored the cross-cultural acceptability and utility of the Strengths and Difficulties Questionnaire for pre-school children (aged 3-5) as perceived by families in New Zealand. METHODS: A qualitative interpretive descriptive study (focus groups and interviews) in which 65 participants from five key ethnic groups (New Zealand European, Maori, Pacific, Asian and other immigrant parents) took part. Thematic analysis using an inductive approach, in which the themes identified are strongly linked to the data, was employed. RESULTS: Many parents reported they were unclear about the purpose of the tool, affecting its perceived value. Participants reported not understanding the context in which they should consider the questions and had difficulty understanding some questions and response options. Maori parents generally did not support the questionnaire based approach, preferring face to face interaction. Parents from Maori, Pacific Island, Asian, and new immigrant groups reported the tool lacked explicit consideration of children in their cultural context. Parents discussed the importance of timing and multiple perspectives when interpreting scores from the tool. CONCLUSIONS: In summary, this study posed a number of challenges to the use of the Strengths and Difficulties Questionnaire in New Zealand. Further work is required to develop a tool that is culturally appropriate with good content validity.

Neuropsychological outcome and its correlates in the first year after adult mild traumatic brain injury: A population-based New Zealand study.

OBJECTIVE: The relationship between moderate/severe traumatic brain injury (TBI) and cognitive deficits is well known. The nature, duration and predictors of cognitive difficulties post-mild TBI remain unclear. This study examined cognitive, mood and post-concussion outcomes of mild TBI over 1-year post-injury. METHOD: Adults (>15 years) with mild TBI (n = 260) completed neuropsychological (CNS-Vital Signs, Behavioural Dyscontrol Scale), mood (Hospital Anxiety Depression Scale) and behavioural assessments (Cognitive Failures Questionnaire, Rivermead Post-Concussion Questionnaire) at baseline, 1-, 6- and 12-months post-injury. RESULTS: Over the 12-months post-injury self-reported cognition (p = 0.027), post-concussion symptoms (p < 0.001), depression (p < 0.001), anxiety (p < 0.001) and dyscontrol (p = 0.025) improved significantly. Assessments of memory, processing speed, executive function, psychomotor speed/reaction time, complex attention and flexibility also improved significantly. At baseline >20% of individuals produced very low scores on executive ability, complex attention and cognitive flexibility. At 1- and 6-month follow-ups >20% of participants were very low for complex attention, with 16.3% remaining so at 12-months. Executive abilities and speed were related to post-concussion symptoms, mood and self-reported cognition at 12-months. CONCLUSIONS: Whilst significant improvements were noted across measures over time, a significant proportion of individuals still perform poorly on neuropsychological measures 12-months after mild TBI; and these were linked to post-concussion symptoms, mood and self-reported cognitive outcomes. This implies a longer trajectory for recovery than has previously been suggested, which has implications for provision of assessment and rehabilitation services for more extended periods.

Kinetics of a chlorate-accumulating, perchlorate-reducing bacterium.

Kinetics parameters for perchlorate and chlorate reduction were determined for Dechlorosoma sp. HCAP-C, also known as Dechlorosoma sp. PCC, a novel perchlorate-reducing bacterium (PCRB) that accumulates significant amounts of chlorate during perchlorate reduction. This is the first report of such behavior, and we hypothesized the perchlorate reduction kinetics would be markedly different from other PCRB. In batch tests with initial perchlorate concentrations ranging from 200 to around 1400 mg/L, maximum chlorate accumulation ranged from 41 to 279 mg/L, and were consistently around 20% of the initial perchlorate concentration. For perchlorate, parameters were determined using a competitive inhibition model. The maximum specific substrate degradation rate qmaxP was 11.5mgClO4-/mgdry weight (DW)-d, and the half-maximum rate constant KP was 193 mgClO4-/L. For chlorate, the qmaxC was 8.3 mgClO3-/mgDW-d and the KC was 58.3 mgClO3-/L. The high KP values relative to conventional PCRB, values suggests that HCAP-C does not play a significant role at low perchlorate concentrations. However, the relatively high qmaxP, and the potential for syntrophic relationships with chlorate-reducing bacteria that relieve the effects of chlorate inhibition, suggest that HCAP-C could play a significant role at high perchlorate concentrations.

Post stroke fatigue--where is the evidence to guide practice?

A significant proportion of stroke survivors suffer from persistent and significant fatigue which is linked to reduced independence and case fatality. Despite its high prevalence and detrimental effects, studies of post-stroke fatigue (PSF) interventions are scarce. Only one randomised controlled trial of post-stroke fatigue treatment (i.e. fluoxetine) was identified, and though improving post-stroke emotional incontinence and depression in patients with fatigue this did not improve PSF itself. Despite there being no literature on its efficacy, patient and family education/counselling has been identified as an important rehabilitation intervention for the management of stroke-related fatigue, which has been found effective in other patient groups (i.e. cancer, multiple sclerosis, and those with traumatic brain injury). Factors contributing to the lack of evidence for PSF management are identified and it is concluded that there is a need to better differentiate those most likely to suffer PSF, to validate existing assessments of fatigue, and to evaluate the efficacy of fatigue management and treatment strategies in stroke survivors.