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5.
BMC Public Health ; 21(1): 994, 2021 05 27.
Artículo en Inglés | MEDLINE | ID: mdl-34039334

RESUMEN

BACKGROUND: The mental health of Asian and Pacific Islander (API) undocumented young adults has been understudied, despite an increasingly restrictive immigration climate that would ostensibly raise mental health risks. This study examined the role of social ties and depression among API undocumented young adults. We distinguished between two types of social ties, bonding and bridging, and additionally considered the absence of ties (e.g. isolation). METHODS: We used primary data collected among 143 API undocumented young adults. We first identified correlates for each type of social tie and then examined the association for each measure with depression. RESULTS: Higher levels of bonding and bridging ties were associated with lower odds of a positive depression screen. In contrast, isolation was associated with higher odds of a positive depression screen. There were no significant associations between total social ties and depression. CONCLUSIONS: Our findings suggest that both bonding and bridging ties are important factors in the mental health of API undocumented young adults. Factors that facilitate these types of ties, such as DACA, can be effective interventions for improving mental health among this population.


Asunto(s)
Depresión , Emigración e Inmigración , Americanos Asiáticos , Grupo de Ascendencia Continental Asiática , Depresión/epidemiología , Humanos , Salud Mental , Grupo de Ascendencia Oceánica , Adulto Joven
6.
BMJ Open ; 11(5): e046143, 2021 05 03.
Artículo en Inglés | MEDLINE | ID: mdl-33941631

RESUMEN

INTRODUCTION: Aotearoa/New Zealand (NZ) is officially recognised as a bicultural country composed of Maori and non-Maori. Recent estimations have projected a threefold increase in dementia prevalence in NZ by 2050, with the greatest increase in non-NZ-Europeans. The NZ government will need to develop policies and plan services to meet the demands of the rapid rise in dementia cases. However, to date, there are no national data on dementia prevalence and overseas data are used to estimate the NZ dementia statistics. The overall aim of the Living with Dementia in Aotearoa study was to prepare the groundwork for a large full-scale NZ dementia prevalence study. METHODS AND ANALYSIS: The study has two phases. In phase I, we will adapt and translate the 10/66 dementia assessment protocol to be administered in Maori, Samoan, Tongan and Fijian-Indian elders. The diagnostic accuracy of the adapted 10/66 protocol will be tested in older people from these ethnic backgrounds who were assessed for dementia at a local memory service. In phase II, we will address the feasibility issues of conducting a population-based prevalence study by applying the adapted 10/66 protocol in South Auckland and will include NZ-European, Maori, Samoan, Tongan, Chinese and Fijian-Indian participants. The feasibility issues to be explored are as follows: (1) how do we sample to ensure we get accurate community representation? (2) how do we prepare a workforce to conduct the fieldwork and develop quality control? (3) how do we raise awareness of the study in the community to maximise recruitment? (4) how do we conduct door knocking to maximise recruitment? (5) how do we retain those we have recruited to remain in the study? (6) what is the acceptability of study recruitment and the 10/66 assessment process in different ethnic groups? ETHICS AND DISSEMINATION: The validity and feasibility studies were approved by the New Zealand Northern A Health and Disability Ethics Committee (numbers 17NTA234 and 18NTA176, respectively). The findings will be disseminated through peer-reviewed academic journals, national and international conferences, and public events. Data will be available on reasonable request from the corresponding author.


Asunto(s)
Demencia , Grupo de Ascendencia Oceánica , Anciano , Estudios Transversales , Demencia/epidemiología , Estudios de Factibilidad , Humanos , Nueva Zelanda/epidemiología
7.
BMJ Open ; 11(5): e042981, 2021 05 19.
Artículo en Inglés | MEDLINE | ID: mdl-34011581

RESUMEN

INTRODUCTION: Mainstream Australian mental health services are failing Aboriginal young people. Despite investing resources, improvements in well-being have not materialised. Culturally and age appropriate ways of working are needed to improve service access and responsiveness. This Aboriginal-led study brings Aboriginal Elders, young people and youth mental health service staff together to build relationships to co-design service models and evaluation tools. Currently, three Western Australian youth mental health services in the Perth metropolitan area and two regional services are working with local Elders and young people to improve their capacity for culturally and age appropriate services. Further Western Australian sites will be engaged as part of research translation. METHODS AND ANALYSIS: Relationships ground the study, which utilises Indigenous methodologies and participatory action research. This involves Elders, young people and service staff as co-researchers and the application of a decolonising, strengths-based framework to create the conditions for engagement. It foregrounds experiential learning and Aboriginal ways of working to establish relationships and deepen non-Aboriginal co-researchers' knowledge and understanding of local, place-based cultural practices. Once relationships are developed, co-design workshops occur at each site directed by local Elders and young people. Co-designed evaluation tools will assess any changes to community perceptions of youth mental health services and the enablers and barriers to service engagement. ETHICS AND DISSEMINATION: The study has approval from the Kimberley Aboriginal Health Planning Forum Kimberley Research Subcommittee, the Western Australian Aboriginal Health Ethics Committee, and the Curtin University Human Research Ethics Committee. Transferability of the outcomes across the youth mental health sector will be directed by the co-researchers and is supported through Aboriginal and non-Aboriginal organisations including youth mental health services, peak mental health bodies and consumer groups. Community reports and events, peer-reviewed journal articles, conference presentations and social and mainstream media will aid dissemination.


Asunto(s)
Servicios de Salud del Indígena , Servicios de Salud Mental , Adolescente , Anciano , Australia , Humanos , Salud Mental , Grupo de Ascendencia Oceánica
10.
N Z Med J ; 134(1535): 17-24, 2021 05 21.
Artículo en Inglés | MEDLINE | ID: mdl-34012137

RESUMEN

AIM: This study aimed to explore Maori (the indigenous people of Aotearoa New Zealand) understandings of frailty. METHOD: Focus groups were held with older Maori in supported living, health professionals working with older Maori and a rural community. A qualitative thematic analysis was conducted. RESULTS: Two interlinked, overarching themes emerged: (1) Frailty is a multidimensional experience, not simply a physical one. (2) The experience of frailty is a balance between deficits and strengths. The Waikare o te Waka o Meihana model provided a useful framework for structuring the thematic results. CONCLUSIONS: Culturally appropriate and comprehensive support and care for older Maori with frailty will be facilitated by a rounded strength-based approach and listening skills.


Asunto(s)
Anciano Frágil , Fragilidad/etnología , Grupo de Ascendencia Oceánica/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Cultura , Femenino , Grupos Focales , Anciano Frágil/psicología , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Grupo de Ascendencia Oceánica/etnología , Adulto Joven
11.
N Z Med J ; 134(1535): 35-43, 2021 05 21.
Artículo en Inglés | MEDLINE | ID: mdl-34012139

RESUMEN

Within Aotearoa (New Zealand) there are systemic health inequities between Maori (the Indigenous people of Aotearoa) and other New Zealanders. These inequities are enabled in part by the failure of the health providers, policy and practitioners to fulfil treaty obligations to Maori as outlined in our foundational document, te Tiriti o Waitangi (te Tiriti). Regulated health professionals have the potential to play a central role in upholding te Tiriti and addressing inequities. Competency documents define health professionals' scope of practice and inform curriculum in health faculties. In this novel study, we critically examine 18 regulated health practitioners' competency documents, which were sourced from the websites of their respective professional bodies. The competencies were reviewed using an adapted criterion from Critical te Tiriti Analysis, a five-phase analysis process, to determine their compliance with te Tiriti. There was considerable variation in the quality of the competency documents reviewed. Most were not te Tiriti compliant. We identified a range of alternative competencies that could strengthen te Tiriti engagement. They focussed on (i) the importance of whanaungatanga (the active making of relationships with Maori), (ii) non-Maori consciously becoming an ally with Maori in the pursuit of racial justice and (iii) actively engaging in decolonisation or power-sharing. In the context of Aotearoa, competency documents need to be te Tiriti compliant to fulfil treaty obligations and policy expectations about health equity. An adapted version of Critical te Tiriti Analysis might be useful for those interested in racial justice who want to review health competencies in other colonial settings.


Asunto(s)
Competencia Clínica/legislación & jurisprudencia , Personal de Salud/legislación & jurisprudencia , Grupo de Ascendencia Oceánica , Documentación , Humanos , Nueva Zelanda , Grupo de Ascendencia Oceánica/etnología , Grupo de Ascendencia Oceánica/legislación & jurisprudencia
12.
N Z Med J ; 134(1535): 50-70, 2021 05 21.
Artículo en Inglés | MEDLINE | ID: mdl-34012140

RESUMEN

AIM: Older Maori have higher rates of self-reported disabling hearing loss in Aotearoa New Zealand (NZ). However, have greater unmet need for special equipment than non-Maori. This review aims to analyse current literature on the experiences of hearing loss and hearing services among older Maori and whanau. METHOD: This scoping review was undertaken using a Kaupapa Maori approach and PRISMA guidelines. Databases were explored to identify literature focused on older Maori and whanau experiences of hearing loss and hearing services. Inclusion criteria included: literature set in the NZ context; published between 1985 and 2020; English language; focus on hard-of-hearing Maori and whanau experiencing sensorineural hearing loss. RESULTS: A total of eight sources were identified. Hearing loss is a detriment to daily functioning, partaking in conversations and retaining Maori culture. Cost and poor patient-provider interactions created barriers to hearing services for Maori with hearing loss and whanau. CONCLUSION: The last analysis of literature regarding hearing loss and hearing services for Maori was written in 1989. Inequities in hearing loss and access to hearing services remain. Research that is Maori-led and uses a Kaupapa Maori approach is needed to further understand the realities of hearing loss and hearing services for older Maori and whanau.


Asunto(s)
Servicios de Salud del Indígena , Pérdida Auditiva/etnología , Grupo de Ascendencia Oceánica , Pérdida Auditiva/terapia , Humanos , Nueva Zelanda
13.
N Z Med J ; 134(1535): 71-77, 2021 05 21.
Artículo en Inglés | MEDLINE | ID: mdl-34012141

RESUMEN

The current New Zealand Bowel Screening Programme (BSP) is inequitable. At present, just over half of bowel cancers in Maori present before the age of 60 years (58% in females and 52% in males), whereas just under a third of bowel cancers in non-Maori are diagnosed before the same age (27% in females and 29% in males). The argument for extending the bowel screening age range down to 50 years for Maori is extremely simple-in comparison to non-Maori, a greater percentage of bowel cancers in Maori occur before the age of 60 years (when screening starts). Commencing the BSP at 50 years of age for Maori with high coverage will help fix this inequity. In this paper we review the current epidemiology of colorectal cancer with respect to the age range extension for Maori.


Asunto(s)
Neoplasias del Colon/prevención & control , Detección Precoz del Cáncer , Disparidades en Atención de Salud , Grupo de Ascendencia Oceánica , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/epidemiología , Neoplasias del Colon/etnología , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Disparidades en Atención de Salud/etnología , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Adulto Joven
14.
N Z Med J ; 134(1535): 91-92, 2021 05 21.
Artículo en Inglés | MEDLINE | ID: mdl-34012145

RESUMEN

This is an open letter to all medical professionals in Aotearoa/New Zealand in response to a recently publicised incident at a medical conference held in late 2020, where racist and offensive remarks were made about Maori to an audience of medical professionals and an invited Maori delegate. The incident brings to light cultural flaws in our profession that implicitly allow this type of behaviour to exist and negatively impact Maori patients. The challenge to our profession is to be honest, reflect on what we can learn from this incident, and bring about cultural change through personal reflection and collective action.


Asunto(s)
Grupo de Ascendencia Oceánica , Médicos , Racismo/prevención & control , Humanos , Nueva Zelanda , Médicos/psicología
16.
Med J Aust ; 214 Suppl 8: S5-S40, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33934362

RESUMEN

CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping individuals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide examples of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development.


Asunto(s)
Equidad en Salud/tendencias , Promoción de la Salud/tendencias , Australia , Comercio , Planificación en Salud Comunitaria/tendencias , Tecnología Digital/tendencias , Salud Ambiental/tendencias , Predicción , Servicios de Salud del Indígena/tendencias , Humanos , Grupo de Ascendencia Oceánica , Determinantes Sociales de la Salud/tendencias
17.
BMC Health Serv Res ; 21(1): 431, 2021 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-33957914

RESUMEN

BACKGROUND: Achieving quality improvement in primary care is a challenge worldwide, with substantial gaps between best practice and actual practice. Within the context of Australia, Aboriginal and Torres Strait Primary Health Care (PHC) services have great variation across settings, structures and context. Research has highlighted how these contextual differences can critically influence the success of Quality Improvement (QI) interventions and outcomes. Less understood is the interaction between local context and other factors, which may impact the implementation of QI interventions. This paper aims to explore the strengths and challenges in QI for Aboriginal and Torres Strait Islander PHC services and their priorities for improvement. METHODS: A multiple case study design was adopted, working with eight Aboriginal and Torres Strait Islander PHC services in Northern Territory, Queensland and Western Australia. Data were collected via a health service survey, semi-structured interviews with health service staff and service users and researcher observations, to explore QI and perceptions of care quality at the service level. Data reported here were analysed using an iterative thematic technique, within-case and across-case. RESULTS: A total of 135 interviews were conducted with health service staff, service users and community members. Participants emphasised the centrality of resilient community, committed workforce and valued Aboriginal and Torres Strait Islander team members in delivering care. A shared purpose around improving the health of community was a significant driver. Key challenges included staff turnover and shortages, a complex and overwhelming acute and chronic care workload, building relationships and trust between health services and the community. Service-suggested priority areas for improvement were categorised into five themes: i) cultural safety (community driving health and planning for culturally safe services); ii) community engagement (through clinical activities in the community); iii) shared ownership and a team approach around QI; iv) strengthening systems and consistent ways of doing things in the health service; and v) strengthening local workforce (and resources for a culturally safe workforce). CONCLUSIONS: These findings advance understandings of relational, community and cultural factors which are identified priorities for the delivery of quality care in Aboriginal and Torres Strait Islander PHC services across varied contexts.


Asunto(s)
Servicios de Salud del Indígena , Humanos , Northern Territory , Grupo de Ascendencia Oceánica , Atención Primaria de Salud , Mejoramiento de la Calidad , Queensland , Australia Occidental
18.
BMC Health Serv Res ; 21(1): 493, 2021 May 24.
Artículo en Inglés | MEDLINE | ID: mdl-34030670

RESUMEN

BACKGROUND: Improving health outcomes for Indigenous people by providing person-centred, culturally safe care is a crucial challenge for the health sector, both in Australia and internationally. Many cancer providers and support services are committed to providing high quality care, yet struggle with providing accessible, culturally safe cancer care to Indigenous Australians. Two Australian cancer services, one urban and one regional, were identified as particularly focused on providing culturally safe cancer care for Indigenous cancer patients and their families. The article explores the experiences of Indigenous cancer patients and their families within the cancer services and ascertains how their experiences of care matches with the cancer services' strategies to improve care. METHODS: Services were identified as part of a national study designed to identify and assess innovative services for Indigenous cancer patients and their families. Case studies were conducted with a small number of identified services. In-depth interviews were conducted with Indigenous people affected by cancer and hospital staff. The interviews from two services, which stood out as particularly high performing, were analysed through the lens of the patient experience. RESULTS: Eight Indigenous people affected by cancer and 23 hospital staff (Indigenous and non-Indigenous) were interviewed. Three experiences were shared by the majority of Indigenous cancer patients and family members interviewed in this study: a positive experience while receiving treatment at the cancer service; a challenging time between receiving diagnosis and reaching the cancer centre; and the importance of family support, while acknowledging the burden on family and carers. CONCLUSIONS: This article is significant because it demonstrates that with a culturally appropriate and person-centred approach, involving patients, family members, Indigenous and non-Indigenous staff, it is possible for Indigenous people to have positive experiences of cancer care in mainstream, tertiary health services. If we are to improve health outcomes for Indigenous people it is vital more cancer services and hospitals follow the lead of these two services and make a sustained and ongoing commitment to strengthening the cultural safety of their service.


Asunto(s)
Servicios de Salud del Indígena , Neoplasias , Australia , Hospitales , Humanos , Neoplasias/terapia , Grupo de Ascendencia Oceánica , Calidad de la Atención de Salud
19.
N Z Med J ; 134(1535): 25-35, 2021 05 21.
Artículo en Inglés | MEDLINE | ID: mdl-34012138

RESUMEN

AIM: This research examines the equity implications of the geographic distribution of COVID-19 vaccine delivery locations in Aotearoa New Zealand under five potential scenarios: (1) stadium mega-clinics; (2) Community Based Assessment Centres; (3) GP clinics; (4) community pharmacies; and (5) schools. METHOD: We mapped the distribution of Aotearoa New Zealand's population and the location of potential vaccine delivery facilities under each scenario. Geostatistical techniques identified population clusters for Maori, Pacific peoples and people aged 65 years and over. We calculated travel times between all potential facilities and each Statistical Area 1 in the country. Descriptive statistics indicate the size and proportion of populations that could face significant travel barriers when accessing COVID-19 vaccinations. RESULTS: Several areas with significant travel times to potential vaccine delivery sites were also communities identified as having an elevated risk of COVID-19 disease and severity. All potential scenarios for vaccine delivery, with the exception of schools, resulted in travel barriers for a substantial proportion of the population. Overall, these travel time barriers disproportionately burden Maori, older communities and people living in areas of high socioeconomic deprivation. CONCLUSION: The equitable delivery of COVID-19 vaccines is key to an elimination strategy. However, if current health services and facilities are used without well-designed and supported outreach services, then access to vaccination is likely to be inequitable.


Asunto(s)
Vacunas contra la COVID-19/provisión & distribución , COVID-19/prevención & control , Equidad en Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Salud Pública/métodos , Viaje/estadística & datos numéricos , Factores de Edad , Anciano , Mapeo Geográfico , Humanos , Nueva Zelanda , Grupo de Ascendencia Oceánica , Áreas de Pobreza , SARS-CoV-2 , Factores de Tiempo
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