Promoting Health and Well-being in Healthy People 2030.

Healthy People 2030 describes a vision and offers benchmarks that can be used to track progress toward the goal of all people in the United States achieving their full potential for health and well-being across the life span. This vision can be realized through evidence-based interventions and policies that address the economic, physical, and social environments in which people live, learn, work, and play. Securing health and well-being for all will benefit society as a whole. Gaining such benefits requires eliminating health disparities, achieving health equity, attaining health literacy, and strengthening the physical, social, and economic environments. Implementation of Healthy People 2030 will by strengthened by engaging users from many sectors and ensuring the effective use and alignment of resources. Promoting the nation's health and well-being is a shared responsibility-at the national, state, territorial, tribal, and community levels. It requires involving the public, private, and not-for-profit sectors.

Addressing Health Equity and Social Determinants of Health Through Healthy People 2030.

The evolution of Healthy People reflects growing awareness of health inequities over the life course. Each decade, the initiative has gained understanding of how the nation can achieve health and well-being. To inform Healthy People 2030's visionary goal of achieving health equity in the coming decade, the Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (Secretary's Advisory Committee) provided the US Department of Health and Human Services with guidance on key terms, frameworks, and measurement for health equity. Conditions in the environments in which people are born, live, learn, work, play, worship, and age influence health and well-being outcomes, functioning, and quality-of-life outcomes and risks and are mostly responsible for health inequities. No single individual, organization, community, or sector has sole ownership, accountability, or capacity to sustain the health and well-being of an entire population. The COVID-19 pandemic in the United States highlights underlying inequities and disparities in health and health care across segments of the population. Contributing factors that were known prior to the pandemic have led to major discrepancies in rates of infection and death. To reduce health disparities and advance health equity, systems approaches-designed to shift interconnected aspects of public health problems-are needed.

Law and Policy as Tools in Healthy People 2030.

Laws and policies are critical determinants of health and well-being. They can encourage positive behaviors and discourage harmful behaviors, and they can enhance or worsen health, health equity, health disparities, and health literacy. Recognizing their contribution to conditions in the environments in which people are born, live, learn, work, play, worship, and age, and people's experiences of these conditions, the US Department of Health and Human Services considered the roles of law and policy throughout its development of Healthy People 2030. Laws and policies often interrelate, but they have different purposes. A law is an established procedure, standard, or system of rules that members of a society must follow. A policy is a decision or set of decisions meant to address a long-term purpose or problem. Healthy People 2030 offers an opportunity for users in diverse sectors and at all levels to use laws and policies to support or inform the initiative's implementation, address health disparities and health inequities, and improve health and well-being in this decade. Introducing new laws and policies or rescinding existing ones to achieve Healthy People 2030 goals offers a chance to rigorously assess outcomes and weigh the balance of good outcomes against unintended consequences.

Healthy People 2030 Leading Health Indicators and Overall Health and Well-being Measures: Opportunities to Assess and Improve the Health and Well-being of the Nation.

CONTEXT: Released by the US Department of Health and Human Services (HHS) every decade since 1980, Healthy People identifies science-based objectives with targets to monitor progress and motivate and focus action. Healthy People 2030 is the current iteration of the Healthy People initiative. PROGRAM: Healthy People 2030 includes 3 sets of measures-Healthy People 2030 objectives, Leading Health Indicators (LHIs), and Overall Health and Well-being Measures (OHMs). Collectively, these components of Healthy People 2030 drive progress toward the initiative's vision of "a society in which all people can achieve their full potential for health and well-being across the life span." IMPLEMENTATION: The Healthy People 2030 LHIs and OHMs were developed with input from multiple subject matter experts and launched in December 2020. Designed as an entry point for users interested in improving the health of their communities and selected for their ability to improve health and well-being, the LHIs will be assessed annually. As broad, global outcome measures of overall health and well-being, the OHMs will be assessed at least 3 times before 2030. EVALUATION: The 23 LHIs are a subset of Healthy People 2030 core objectives that have been selected to drive action toward improved health and well-being. LHIs are intended to help organizations, communities, and states across the nation focus resources and efforts to improve the health and well-being of all people. The OHMs include 8 broad, global outcome measures of overall health and well-being that help assess progress toward the Healthy People 2030 vision. The Healthy People 2030 OHMs include the addition of a measure of overall well-being. DISCUSSION: Together with the Healthy People 2030 objectives, the LHIs and OHMs provide a plan of action to improve the health and well-being of the nation through a framework for assessing progress, addressing health disparities and social determinants of health, and advancing health equity.

Mechanistic Investigation into DNA Modification by a RuII ,RhIII Bimetallic Complex.

Despite significant progress in the treatment of cancer, there remains an urgent need for more effective therapies that also have less impact on patient wellbeing. Photodynamic therapy employs targeted light activation of a photosensitizer in selected tissues, thereby reducing off-target toxicity. Our group previously reported a RuII ,RhIII bimetallic architecture that displays multifunctional covalent photomodification of DNA in the therapeutic window in an oxygen-independent manner, features that are essential for treating deep and hypoxic tumors. Herein, we explore the mechanism by which a new analogue, [(phen)2 Ru(dpp)Rh(phen)Cl2 ]3+ , or RuII -RhIII , interacts with DNA. We established that RuII -RhIII exhibits "light switch" behavior in the presence of DNA, undergoing strong electrostatic interactions that might involve groove binding. Furthermore, these noncovalent interactions play a major role in the covalent photobinding and photocleavage of DNA, which occur according to an oxygen-independent mechanism. Polymerase chain reaction (PCR) revealed that covalent modification of DNA by RuII -RhIII , especially photobinding, is critical to inhibiting amplification, thus suggesting that the complex could exert its toxic activity by interfering with DNA replication in cells. This new structural motif, with phenanthroline at all three terminal ligand positions, has a number of properties that are promising for the continued refinement of photodynamic-therapy strategies.

Tetra- and Heptametallic Ru(II),Rh(III) Supramolecular Hydrogen Production Photocatalysts.

Supramolecular mixed metal complexes combining the trimetallic chromophore [{(bpy)2Ru(dpp)}2Ru(dpp)]6+ (Ru3) with [Rh(bpy)Cl2]+ or [RhCl2]+ catalytic fragments to form [{(bpy)2Ru(dpp)}2Ru(dpp)RhCl2(bpy)](PF6)7 (Ru3Rh) or [{(bpy)2Ru(dpp)}2Ru(dpp)]2RhCl2(PF6)13 (Ru3RhRu3) (bpy = 2,2'-bipyridine and dpp = 2,3-bis(2-pyridyl)pyrazine) catalyze the photochemical reduction of protons to H2. This first example of a heptametallic Ru,Rh photocatalyst produces over 300 turnovers of H2 upon photolysis of a solution of acetonitrile, water, triflic acid, and N,N-dimethylaniline as an electron donor. In contrast, the tetrametallic Ru3Rh produces only 40 turnovers of H2 due to differences in the excited state properties and nature of the catalysts upon reduction as ascertained from electrochemical data, transient absorption spectroscopy, and flash-quench experiments. While the lowest unoccupied molecular orbital of Ru3Rh is localized on a bridging ligand, it is Rh-centered in Ru3RhRu3 facilitating electron collection at Rh in the excited state and reductively quenched state. The Ru → Rh charge separated state of Ru3RhRu3 is endergonic with respect to the emissive Ru → dpp 3MLCT excited and cannot be formed by static electron transfer quenching of the 3MLCT state. Instead, a mechanism of subnanosecond charge separation from high lying states is proposed. Multiple reductions of Ru3 and Ru3Rh using sodium amalgam were carried out to compare UV-vis absorption spectra of reduced species and to evaluate the stability of highly reduced complexes. The Ru3 and Ru3Rh can be reduced by 10 and 13 electrons, respectively, to final states with all bridging ligands doubly reduced and all bpy ligands singly reduced.

Enhancement of Solar Fuel Production Schemes by Using a Ru,Rh,Ru Supramolecular Photocatalyst Containing Hydroxide Labile Ligands.

Polyazine-bridged Ru(II)Rh(III)Ru(II) complexes with two halide ligands, Cl(-) or Br(-), bound to the catalytically active Rh center are efficient single-component photocatalysts for H2O reduction to H2 fuel, with the coordination environment on Rh impacting photocatalysis. Herein reported is a new, halide-free Ru(II)Rh(III)Ru(II) photocatalyst with OH(-) ligands bound to Rh, further enhancing the photocatalytic reactivity of the structural motif. H2 production experiments using the photocatalyst bearing OH(-) ligands at Rh relative to the analogues bearing halides at Rh in solvents of varying polarity (DMF, CH3CN, and H2O) suggest that ion pairing with halides deactivates photocatalyst function, representing an exciting phenomenon to exploit in the development of catalysts for solar H2 production schemes.

Electrocatalytic H2 Evolution by Supramolecular Ru(II)-Rh(III)-Ru(II) Complexes: Importance of Ligands as Electron Reservoirs and Speciation upon Reduction.

The supramolecular water reduction photocatalysts [{(Ph2phen)2Ru(dpp)}2RhX2](PF6)5 (Ph2phen = 4,7-diphenyl-1,10-phenanthroline, dpp =2,3-bis(2-pyridyl)pyrazine X = Cl, Br) are efficient electrocatalysts for the reduction of CF3SO3H, CF3CO2H, and CH3CO2H to H2 in DMF or DMF/H2O mixtures. The onset of catalytic current occurs at -0.82 V versus Ag/AgCl for CF3SO3H, -0.90 V for CF3CO2H, and -1.1 V for CH3CO2H with overpotentials of 0.61, 0.45, and 0.10 V, respectively. In each case, catalysis is triggered by the first dpp ligand reduction implicating the dpp as an electron reservoir in catalysis. A new species with Epc ∼ -0.75 V was observed in the presence of stoichiometric amounts of strong acid, and its identity is proposed as the Rh(H)(III/II) redox couple. H2 was produced in 72-85% Faradaic yields and 95-116 turnovers after 2 h and 435 turnovers after 10 h of bulk electrolysis. The identities of Rh(I) species upon reduction have been studied. In contrast to the expected dissociation of halides in the Rh(I) state, the halide loss depends on solvent and water content. In dry CH3CN, in which Cl(-) is poorly solvated, a [Ru] complex dissociates and [(Ph2phen)2Ru(dpp)Rh(I)Cl2](+) and [(Ph2phen)2Ru(dpp)](2+) are formed. In contrast, for X = Br(-), the major product of reduction is the intact trimetallic Rh(I) complex [{(Ph2phen)2Ru(dpp)}2Rh(I)](5+). Chloride loss in CH3CN is facilitated by addition of 3 M H2O. In DMF, the reduced species is [{(Ph2phen)2Ru(dpp)}2Rh(I)](5+) regardless of X = Cl(-) or Br(-).

Nonchromophoric halide ligand variation in polyazine-bridged Ru(II),Rh(III) bimetallic supramolecules offering new insight into photocatalytic hydrogen production from water.

The new bimetallic complex [(Ph2phen)2Ru(dpp)RhBr2(Ph2phen)](PF6)3 (1) (Ph2phen = 4,7-diphenyl-1,10-phenanthroline; dpp = 2,3-bis(2-pyridyl)pyrazine) was synthesized and characterized to compare with the Cl(-) analogue [(Ph2phen)2Ru(dpp)RhCl2(Ph2phen)](PF6)3 (2) in an effort to better understand the role of halide coordination at the Rh metal center in solar H2 production schemes. Electrochemical properties of complex 1 display a reversible Ru(II/III) oxidation, and cathodic scans indicate multiple electrochemical mechanisms exist to reduce Rh(III) by two electrons to Rh(I) followed by a quasi-reversible dpp(0/-) ligand reduction. The weaker σ-donating ability of Br(-) vs Cl(-) impacts the cathodic electrochemistry and provides insight into photocatalytic function by these bimetallic supramolecules. Complexes 1 and 2 exhibit identical light-absorbing properties with UV absorption dominated by intraligand (IL) π → π* transitions and visible absorption by metal-to-ligand charge transfer (MLCT) transitions to include a lowest energy Ru(dπ) → dpp(π*) (1)MLCT transition (λ(abs) = 514 nm; ε = 16 000 M(-1) cm(-1)). The relatively short-lived, weakly emissive Ru(dπ) → dpp(π*) (3)MLCT excited state (τ = 46 ns) for both bimetallic complexes is attributed to intramolecular electron transfer from the (3)MLCT excited state to populate a low-energy Ru(dπ) → Rh(dσ*) triplet metal-to-metal charge transfer ((3)MMCT) excited state that allows photoinitiated electron collection. Complex 1 outperforms the related Cl(-) bimetallic analogue 2 as a H2 photocatalyst despite identical light-absorbing and excited-state properties. Additional H2 experiments with added halide suggest ion pairing plays a role in catalyst deactivation and provides new insight into observed differences in H2 production upon halide variation in Ru(II),Rh(III) supramolecular architectures.

Tuning the Photophysical Properties of Ru(II) Monometallic and Ru(II),Rh(III) Bimetallic Supramolecular Complexes by Selective Ligand Deuteration.

A series of three new complexes of the design [(TL)2Ru(BL)](2+), two new complexes of the design [(TL)2Ru(BL)Ru(TL)2](4+), and three new complexes of the design [(TL)2Ru(BL)RhCl2(TL)](3+) (TL = bpy or d8-bpy; BL = dpp or d10-dpp; TL = terminal ligand; BL = bridging ligand; bpy = 2,2'-bipyridine; dpp = 2,3-bis(2-pyridyl)pyrazine) were synthesized and the (1)H NMR spectroscopy, electrochemistry, electronic absorbance spectroscopy, and photophysical properties studied. Incorporation of deuterated ligands into the molecular architecture simplifies the (1)H NMR spectra, allowing for complete (1)H assignment of [(d8-bpy)2Ru(dpp)](PF6)2 and partial assignment of [(bpy)2Ru(d10-dpp)](PF6)2. The electrochemistry for the deuterated and nondeuterated species showed nearly identical redox properties. Electronic absorption spectroscopy of the deuterated and nondeuterated complexes are superimposable with the lowest energy transition being Ru(dπ) → BL(π*) charge transfer in nature (BL = dpp or d10-dpp). Ligand deuteration impacts the excited-state properties with an observed increase in the quantum yield of emission (Φ(em)) and excited-state lifetime (τ) of the Ru(dπ) → d10-dpp(π*) triplet metal-to-ligand charge transfer ((3)MLCT) excited state when dpp is deuterated, and a decrease in the rate constant for nonradiative decay (knr). Choice of ligand deuteration between bpy and dpp strongly impacts the observed photophysical properties with BL = d10-dpp complexes showing an enhanced Φ(em) and τ, providing further support that the lowest electronic excited state populated via UV or visible excitation is the photoactive Ru(dπ) → dpp(π*) CT excited state. The Ru(II),Rh(III) complex incorporating the deuterated BL shows increased hydrogen production compared to the variants incorporating the protiated BL, while demonstrating identical dynamic quenching behaviors in the presence of sacrificial electron donor.

Increased Water Reduction Efficiency of Polyelectrolyte-Bound Trimetallic [Ru,Rh,Ru] Photocatalysts in Air-Saturated Aqueous Solutions.

The groundbreaking use of polyelectrolytes to increase the efficiency of supramolecular photocatalysts in solar H2 production schemes under aqueous aerobic conditions is reported. Supramolecular photocatalysts of the architecture [{(TL)2 Ru(BL)}2 RhX2 ](5+) (BL=bridging ligand, TL=terminal ligand, X=halide) demonstrate high efficiencies in deoxygenated organic solvents but do not function in air-saturated aqueous solution because of the quenching of the metal-to-ligand charge-transfer (MLCT) excited state under these conditions. The new photocatalytic system incorporates poly(4-styrenesulfonate) (PSS) into aqueous solutions containing [{(bpy)2 Ru(dpp)}2 RhCl2 ](5+) (bpy=2,2'-bipyridine, dpp=2,3-bis(2-pyridyl)pyrazine). PSS has a profound impact on the photocatalyst efficiency, increasing H2 production over three times that of deoxygenated aqueous solutions alone. H2 photocatalysis proceeds even under aerobic conditions for PSS-containing solutions, an exciting consequence for solar hydrogen-production research.

Mechanistic insight into the electronic influences imposed by substituent variation in polyazine-bridged ruthenium(II)/rhodium(III) supramolecules.

Unusual and unprecedented multipathway electrochemical mechanisms for a new class of supramolecular Ru/Rh bimetallic photocatalysts have been uncovered. The near isoenergetic Rh(dσ*) and bridging ligand(π*) molecular orbitals and a rate of halide loss that occurs on the cyclic voltammetry timescale provide a series of closely related complexes which display four different electrochemical mechanisms. A single complex displays two concurrent electrochemical pathways in marked contrast to all previously studied cis-[Rh(NN)(2)X(2)] motifs.

The use of interpretive description within Kaupapa Maori research.

Kaupapa Maori research (KMR) is an Indigenous research approach that is decolonizing and transformative. Interpretive description (ID) is a qualitative methodology used to generate knowledge relevant to the applied health disciplines. In this article, we discuss how we combined KMR and ID to investigate the experiences of Maori (the Indigenous peoples of New Zealand) with aphasia and their whanau (extended family). This is novel because it is the first time these two approaches have been combined. In the context of aphasia research, we discuss how they work together in theory, and the synergies that became apparent in practice. We conclude that the combination of KMR and ID enables clinicians and Maori with aphasia to learn from each other and work together, thereby generating knowledge that makes a difference for Maori with aphasia and their whanau.

Maori and Pacific families' experiences and perspectives of cardiovascular care; A qualitative study.

OBJECTIVE: This study aimed to understand the reasons behind evidence-practice gaps and inequities in cardiovascular care for Maori and Pacific people, as evidenced by the experiences and perspectives of patients and their families. METHODS: The research was guided by Maori and Pacific worldviews, incorporating Kaupapa Maori Theory and Pacific conceptual frameworks and research methodologies. Template analysis was used to analyse interview data from 61 Maori and Pacific people who had experienced a cardiovascular disease (CVD) risk assessment, acute coronary syndrome, and/or heart failure. RESULTS: The range of experiences relating to participants' heart health journeys are presented in five main themes: Context, Mana (maintaining control and dignity), Condition, People and Journey. CONCLUSIONS: Maori and Pacific people want to take charge of their heart health but face challenges. Participants described important obligations to family, community and tikanga (the culturally correct way of doing things). Participants described times when health care undermined existing responsibilities, their dignity and/or their mana, and they felt excluded from treatment as a result. IMPLICATIONS FOR PUBLIC HEALTH: Good reciprocal communication, stemming from a high-quality relationship is essential for successful outcomes. A workforce that is representative of the population it serves and is culturally safe lays the foundation for excellence in care.

New supramolecular structural motif coupling a ruthenium(II) polyazine light absorber to a rhodium(I) center.

Two new complexes, [(bpy)2Ru(dpp)Rh(I)(COD)](PF6)3 and [(Me2bpy)2Ru(dpp)Rh(I)(COD)](PF6)2(BF4) (bpy = 2,2'-bipyridine, Me2bpy = 4,4'-dimethyl-2,2'-bipyridine, dpp = 2,3-bis(2-pyridyl)pyrazine, and COD = 1,5-cyclooctadiene), representing a new Ru(II),Rh(I) structural motif, have been prepared and characterized by mass spectrometry, (1)H NMR spectroscopy, electrochemistry, electronic absorption spectroscopy, and emission spectroscopy. These two complexes represent a new type of supramolecular complex with a [(TL)2Ru(dpp)](2+) (TL = terminal ligand) light absorber (LA) coupled to a Rh(I) center and are models for Ru(II),Rh(I) intermediates in the photochemical reduction of water using dpp-bridged Ru(II),Rh(III) photocatalysts. Electrochemical study reveals overlapping reversible Ru(II/III) and irreversible Rh(I/II/III) oxidations and a quasi-reversible dpp(0/-) reduction, demonstrating that the lowest unoccupied molecular orbital (LUMO) is dpp(π*) based. The COD ligand is sterically bulky, displaying steric repulsions between hydrogen atoms on the alkene of COD and dpp about the square planar Rh(I) center. An interesting reactivity occurs in coordinating solvents such as CH3CN, where Rh(I) substitution leads to an equilibrium between the Ru(II),Rh(I) bimetallic and [(TL)2Ru(dpp)](2+) and [Rh(I)(COD)(solvent)2](+) monometallic species. The electronic absorption spectra of both complexes feature transitions at ca. 500 nm attributed to a Ru(dπ) → dpp(π*) metal-to-ligand charge transfer (MLCT) transition that is slightly red-shifted from the Ru synthon upon Rh(I) complexation. The methylation of TL on the Ru impacts the electrochemical and optical properties in a minor but predictable manner. The photophysical studies, by comparison with the model complex [{Ru(bpy)2}2(dpp)](PF6)4 and related Rh(III) complex [(bpy)2Ru(dpp)Rh(III)Cl2(phen)](PF6)3, reveal the expected absence of a Ru(dπ) → Rh(dσ*) (3)MMCT state (metal-to-metal charge transfer) in the title complexes, which is present in Rh(III) systems. The absence of this (3)MMCT state in Ru(II),Rh(I) complexes results in a longer lifetime and higher emission quantum yield for the Ru(dπ) → dpp(π*) (3)MLCT state than [(bpy)2Ru(dpp)Rh(III)Cl2(phen)](PF6)3. Both complexes display photocatalytic hydrogen production activity in the presence of water and a sacrificial electron donor, with the [(bpy)2Ru(dpp)Rh(I)(COD)](PF6)3 possessing a higher catalytic activity than the methyl analogue. Both display low activities, hypothesized to occur due to steric crowding about the Rh(I) site.

Subunit variation to uncover properties of polyazine-bridged Ru(II), Pt(II) supramolecules with low lying charge separated states providing insight into the functioning as H2O reduction photocatalysts to produce H2.

Two new structurally diverse polyazine-bridged Ru(II),Pt(II) tetrametallic complexes, [{(Ph2phen)2Ru(dpp)}2Ru(dpp)PtCl2](PF6)6 (1a) and [{(Ph2phen)2Ru(dpp)}2Ru(dpq)PtCl2](PF6)6 (2a) (Ph2phen = 4,7-diphenyl-1,10-phenanthroline, dpp = 2,3-bis(2-pyridyl)pyrazine, dpq = 2,3-bis(2-pyridyl)quinoxaline), as well as their trimetallic precursors have been synthesized to provide a comparison for detailed analysis to elucidate component effects in the previously reported photocatalyst [{(phen)2Ru(dpp)}2Ru(dpq)PtCl2](PF6)6 (4a) (phen = 1,10-phenanthroline). Electrochemistry shows terminal Ru based highest occupied molecular orbitals (HOMOs) with remote BL' (BL' = bridging ligand coupling central Ru and cis-PtCl2 moiety) based lowest unoccupied molecular orbitals (LUMOs). Population of a lowest-lying charge separated ((3)CS) excited state with oxidized terminal Ru and reduced remote BL' via intramolecular electron transfer is predicted by electrochemical analysis and is observed through steady-state and time-resolved emission studies as well as emission excitation profiles which display unusual nonunity population of the lowest lying emissive Ru→dpp (3)MLCT (metal-to-ligand charge transfer) state. Each tetrametallic complex is an active photocatalyst for H2 production from H2O with 2a showing the highest activity (94 TON (turnover number) in 10 h, where TON = mol H2/mol catalyst). The nature of the bridging ligand coupling the trimetallic light absorber to the cis-PtCl2 moiety has a significant impact on the catalyst activity, correlated to the degree of population of the (3)CS excited state. The choice of terminal ligand affects visible light absorption and has a minor influence on photocatalytic H2 production from H2O. Evidence that an intact supramolecule functions as the photocatalyst includes a strong dependence of the photocatalysis on the identity of BL', an insensitivity to Hg(l), no detectable H2 production from the systems with the trimetallic synthons and cis-[PtCl2(DMSO)2] as well as spectroscopic analysis of the photocatalytic system.

How pharmacist-led health services are tailored to minoritized populations, their acceptability and effectiveness: A scoping literature review.

BACKGROUND: Worldwide, minoritized populations experience inequitable health risks and outcomes. The importance of offering tailored services to meet the specific needs of target populations should be addressed during service development. Within healthcare systems, pharmacists play a crucial role in supporting patients to manage their medicines and health conditions. OBJECTIVES: This scoping review aims to identify, collate and analyse literature describing pharmacist-led services tailored for minoritized populations in order to strengthen the knowledge base and support for achieving health equity. METHODS: A scoping review was guided by the PRISMA-ScR checklist and the five-stage process outlined by Arksey and O'Malley. Medline, EMBASE, Scopus, CINAHL Plus, International Pharmaceutical Abstracts, and Google Scholar databases, plus grey literature were searched to identify relevant studies published up to October 2022. Texts were included if they reported on a pharmacist-led health service tailored to meet the needs of a minoritized population. The review protocol was registered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/E8B7D). RESULTS: Of the 566 records initially identified, 16 full-text articles were assessed for eligibility and 9 articles describing 6 unique services met the criteria and were included in the review. Three services were non-health-condition-specific, 2 targeted type two diabetes and 1 focussed on opioid dependency disorders. Service acceptability was consistently explored, and all services ensured that pharmacists' views were considered. However, only 4 consulted with the people from the group that the service targeted. Where reported, the effectiveness was not comprehensively evaluated. CONCLUSION: There is limited literature in this area and a critical need for more evidence on the effectiveness of pharmacist-led services for minoritized populations. We need a better understanding of how pharmacists contribute to health equity pathways and how to expand this. Doing so will inform future services and contribute towards achieving equitable health outcomes.

Upholding te mana o te wa: Maori patients and their families' experiences of accessing care following an out-of-hospital cardiac event.

Objective: The purpose of this study was to explore the experiences of Maori patients and their families accessing care for an acute out-of-hospital cardiac event and to identify any barriers or enablers of timely access to care. Design: Eleven interviews with patients and their families were conducted either face-to-face or using online conferencing. Interviews were audio-recorded and transcribed for thematic analysis using Kaupapa Maori methodology. Results: Data analysis identified three themes: (1) me and the event, (2) the people (3) upholding te mana o te wa or self-determined heart wellbeing. Knowledge of symptoms and a desire to maintain personal dignity at the time of the event affected emergency medical service initiation. Participants described relationships with health professionals, the importance of good quality information, having family support, and drawing on cultural practices as vital for their health care journey. Conclusion: Systemic barriers including racism, discrimination, and inadequate resourcing exist for Maori journeying to and through care following an out of hospital cardiac event. Improving the cultural safety of health professionals, better access to community defibrillation, and improving understanding of the life-long impacts a cardiac event has on patients and whanau is recommended.

What are the gaps in cardiovascular risk assessment and management in primary care for Maori and Pacific people in Aotearoa New Zealand? Protocol for a systematic review.

INTRODUCTION: In New Zealand, significant inequities exist between Maori and Pacific peoples compared with non-Maori, non-Pacific peoples in cardiovascular disease (CVD) risk factors, hospitalisations and management rates. This review will quantify and qualify already-reported gaps in CVD risk assessment and management in primary care for Maori and Pacific peoples compared with non-Maori/non-Pacific peoples in New Zealand. METHODS AND ANALYSIS: We will conduct a systematic search of the following electronic databases and websites from 1 January 2000 to 31 December 2021: MEDLINE (OVID), EMBASE, Scopus, CINAHL Plus, NZresearch.org, National Library Catalogue (Te Puna), Index New Zealand (INNZ), Australia/New Zealand Reference Centre. In addition, we will search relevant websites such as the Ministry of Health and research organisations. Data sources will include published peer reviewed articles, reports and theses employing qualitative, quantitative and mixed methods.Two reviewers will independently screen the titles and abstracts of the citations and grade each as eligible, not eligible or might be eligible. Two reviewers will read each full report, with one medically qualified reviewer reading all reports and two other reviewers reading half each. The final list of included citations will be compiled from the results of the full report reading and agreed on by three reviewers. Data abstracted will include authors, title, year, study characteristics and participant characteristics. Data analysis and interpretation will involve critical inquiry and a strength-based approach that is inclusive of Maori and Pacific values. This means that critical appraisal includes an assessment of quality from an Indigenous perspective. ETHICS AND DISSEMINATION: Ethical approval is not required. The findings will be published in a peer-reviewed journal and shared with stakeholders. This review contributes to a larger project which creates a Quality-Improvement Equity Roadmap to reduce barriers to Maori and Pacific peoples accessing evidence-based CVD care.

Barriers to optimal stroke service care and solutions: a qualitative study engaging people with stroke and their whanau.

AIM: The aim of this study was to explore the perspectives of people with stroke and their whanau on barriers to accessing best practice care across Aotearoa, and to brainstorm potential solutions. METHOD: We conducted ten focus groups nationwide and completed a thematic analysis. RESULTS: Analysis of the data collected from the focus groups identified five themes: (1) inconsistencies in stroke care; (2) importance of effective communication; (3) the role of whanau support; (4) the need for more person rather than stroke centred processes; and (5) experienced inequities. Participants also identified potential solutions. CONCLUSION: Key recommendations include the need for improved access to stroke unit care for rural residents, improved post-discharge support and care coordination involving the whanau, improved communication across the patient journey, and a concerted effort to improve culturally safe care. Next step is to implement and monitor these recommendations.