Empowering Pacific Patients on the Weight Loss Surgery Pathway: A Co-designed Evaluation Study.

PURPOSE: Despite having the highest medical needs by population for weight loss treatment, Pacific patients in Aotearoa New Zealand face substantial levels of attrition in publicly funded weight loss surgery programs. In collaboration with the Auckland City Hospital bariatric surgery team, a Pacific-led preoperative weight loss surgery program was co-designed, delivered, and evaluated between 2020 and 2023. MATERIALS AND METHODS: This was a single-arm, prospective co-designed evaluation study that took place at Auckland City Hospital in Aotearoa New Zealand. Participants were Pacific patients (n = 14) referred to the weight loss surgery program. Survey and video diaries were analyzed to determine if the program had the potential to increase Pacific patient retention through the preoperative stage of weight loss surgery, increase surgery completion rates, and improve the quality of treatment experiences. RESULTS: Nine out of 14 participants attended all preoperative sessions. Six participants subsequently underwent weight loss surgery. Program components that had positive impacts on patient success and satisfaction were accessibility, information quality, having Pacific role models, cultural safety, and the group support system. The patients found the program to be culturally anchored and there was support for the implementation of the program going forward. CONCLUSION: This study demonstrated how a culturally anchored intervention can increase patient retention for those patients who may not respond to mainstream treatment. Adjusting existing preoperative weight loss surgery programs to integrate Pacific-led models of healthcare has the potential to increase Pacific patient resiliency to follow through with surgery.

Understanding suicidality in Pacific adolescents in New Zealand using network analysis.

INTRODUCTION: Pacific adolescents in New Zealand (NZ) are three to four times more likely than NZ European adolescents to report suicide attempts and have higher rates of suicidal plans. Suicidal thoughts, plans, and attempts, termed suicidality in this study, result from a complex dynamic interplay of factors, which emerging methodologies like network analysis aim to capture. METHODS: This study used cross-sectional network analysis to model the relationships between suicidality, self-harm, and individual depression symptoms, whilst conditioning on a multi-dimensional set of variables relevant to suicidality. A series of network models were fitted to data from a community sample of New Zealand-born Pacific adolescents (n = 550; 51% male; Mean age (SD) = 17 (0.35)). RESULTS: Self-harm and the depression symptom measuring pessimism had the strongest associations with suicidality, followed by symptoms related to having a negative self-image about looks and sadness. Nonsymptom risk factors for self-harm and suicidality differed markedly. CONCLUSIONS: Depression symptoms varied widely in terms of their contribution to suicidality, highlighting the valuable information gained from analysing depression at the symptom-item level. Reducing the sources of pessimism and building self-esteem presented as potential targets for alleviating suicidality amongst Pacific adolescents in New Zealand. Suicide prevention strategies need to include risk factors for self-harm.

Increased Effect Sizes in a Mindfulness- and Yoga-Based Intervention After Adjusting for Response Shift with Then-Test.

Objectives: Response shift refers to variations in self-reported evaluations at different times from changes in one's internal standards, values, and meanings. The current study explored the utility of the then-test to detect a potential mindfulness-based response shift occurrence during a mindfulness- and yoga-based intervention for student musicians, and to ascertain to what extent effect sizes could differ when adjusting for it. Method: Participants (n = 31) completed the Five Facet Mindfulness Questionnaire (FFMQ) halfway through the intervention (Time 1-FFMQ), post-intervention (Time 2-FFMQ), and immediately after Time 2-FFMQ with a then-test approach that asked participants to rate the FFMQ based on retrospective reflections on their mindfulness at Time 1 (then-test-FFMQ). Paired t-tests and Hedges' g effect sizes were computed to estimate three potential effects: response shift (Time 1-FFMQ minus then-test-FFMQ), the conventional intervention effect (Time 2-FFMQ minus Time 1-FFMQ), and the effect after adjusting for response shift (i.e., actual intervention effect = Time 2-FFMQ minus then-test-FFMQ). Results: Response shift was significant for the FFMQ Observe subscale (g = 0.41) and total scale (g = 0.37). The adjusted scores in all subscales (Observe, g = 0.47; Describe, g = 0.25; Act Aware, g = 0.40; Non-judge, g = 0.28; Non-react, g = 0.57) and total scale (g = 0.60) achieved significance and yielded larger effect sizes than the conventional results, for which only Act Aware (g = 0.28), Non-react (g = 0.36), and total scale (g = 0.28) were significant. Conclusions: Notwithstanding some methodological limitations, this study lends support to the utility of the then-test to quantify response shift. When adjusting for it, effect sizes from a mindfulness- and yoga-based intervention were generally amplified. Preregistration: This study was not preregistered.

Depression, anxiety and worry in young Pacific adults in New Zealand during the COVID-19 pandemic.

OBJECTIVE: To measure symptoms of anxiety, depression and hopelessness in a sample of young Pacific adults living in Auckland, New Zealand during the 2020/2021 COVID-19 pandemic and identify protective factors. METHODS: Participants were 267 Pacific adults (58% female) who completed a survey online. Analyses included descriptive statistics, correlations, linear regression and symptom network analysis. RESULTS: Around 25% of the sample scored in the range for moderate to severe anxiety and 10% for moderate to severe depression on standard measures. Almost 40% indicated that they found the first lockdown very stressful and 55% noted that some members of their family found it stressful. Only 16% worried about COVID-19 and their future quite a bit or constantly, while another 25% worried sometimes. Self-compassion and Pacific Identity had moderate, negative correlations, and Worry about COVID-19 had weak positive correlations, with anxiety, depression, hopelessness and perceived stress. CONCLUSION: These results suggest that, while the prevalence of depression and anxiety are quite high among this population, fostering ethnic identity and self-compassion in Pacific children and adolescents might protect against developing depression and anxiety.

Barriers to older Pacific peoples’ participation in the health-care system in Aotearoa New Zealand.

Introduction Participation in the health-care system is a key component of healthy ageing strategies. The number of Pacific people aged ≥65 years in Aotearoa New Zealand will increase significantly over the next decade. Addressing the considerable health inequities and unmet need for care Pacific Island people experience when compared to other ethnicities in Aotearoa New Zealand should be a priority. Aim To identify barriers to older Pacific people's participation in the health-care system in Aotearoa New Zealand. Methods A participatory action research design was utilised. In total, 104 Pacific co-researchers contributed to focus groups using Talanoa , a traditional method of conversational dialogue deeply rooted in Pacific Island culture. Data were collected in Pacific Island languages from storytelling and conversations shared within the focus groups. Data were translated into English and analysed using a collaborative approach. Results Three main themes captured older Pacific peoples' barriers to participation in the health-care system: accessing health care; relationships with health-care providers; and understanding the health-care system. Discussion Older Pacific people have the capacity to influence locally driven programmes to be more responsive to their needs and aspirations. Improving older Pacific peoples' participation in health care will require a commitment to partnership and inter-sectoral collaboration identified in recent ageing strategies. The findings will inform local communities, and policy and practice aimed at improving the health and wellbeing of Pacific peoples who are ageing in Aotearoa New Zealand.

Risk factors for depression in Pacific adolescents in New Zealand: A network analysis.

BACKGROUND: Network analysis provides opportunities to gain a greater understanding of the complex interplay of risk factors for depression and heterogeneous symptom presentations. This study used network analysis to discover risk factors associated with both depression severity and depression symptoms amongst Pacific adolescents in New Zealand. METHODS: Mixed graphical models with regularization were fitted to data from a community sample of New Zealand born, Pacific adolescents, (n = 561; 51% male; Mean age (SD) = 17 (0.35)) and associations between a wide range of potentially explanatory variables and depression severity and depression symptoms investigated. The associations identified were then tested for reliability, using resampling techniques and sensitivity analysis. RESULTS: In the networks, the explanatory variables associated with both depression severity and depression symptoms were those related to quality of the relationships with mother or friends, school connectedness, and self-assessed weight, but the symptoms they were associated with varied substantially. In the depression severity networks, impulsivity appeared to be a bridging node connecting depression severity with delinquency and negative peer influence. LIMITATIONS: The data were analysed cross-sectionally, so causal inferences about the directions of relationships could not be inferred and most of the data were self-reported. CONCLUSIONS: The results illustrate the varied way that adolescent depression can manifest itself in terms of symptoms and suggest specific items on the depression inventory that might be suitable targets for prevention strategies and interventions, based on the risk factor - depression symptom profiles of individuals or groups.

Optimising function and well-being in older adults: protocol for an integrated research programme in Aotearoa/New Zealand.

BACKGROUND: Maintaining independence is of key importance to older people. Ways to enable health strategies, strengthen and support whanau (family) at the community level are needed. The Ageing Well through Eating, Sleeping, Socialising and Mobility (AWESSOM) programme in Aotearoa/New Zealand (NZ) delivers five integrated studies across different ethnicities and ages to optimise well-being and to reverse the trajectory of functional decline and dependence associated with ageing. METHODS: Well-being, independence and the trajectory of dependence are constructs viewed differently according to ethnicity, age, and socio-cultural circumstance. For each AWESSoM study these constructs are defined and guide study development through collaboration with a wide range of stakeholders, and with reference to current evidence. The Compression of Functional Decline model (CFD) underpins aspects of the programme. Interventions vary to optimise engagement and include a co-developed whanau (family) centred initiative (Nga Pou o Rongo), the use of a novel LifeCurve™App to support behavioural change, development of health and social initiatives to support Pacific elders, and the use of a comprehensive oral health and cognitive stimulation programme for cohorts in aged residential care. Running parallel to these interventions is analysis of large data sets from primary care providers and national health databases to understand complex multi-morbidities and identify those at risk of adverse outcomes. Themes or target areas of sleep, physical activity, oral health, and social connectedness complement social capital and community integration in a balanced programme involving older people across the ability spectrum. DISCUSSION: AWESSoM delivers a programme of bespoke yet integrated studies. Outcomes and process analysis from this research will inform about novel approaches to implement relevant, socio-cultural interventions to optimise well-being and health, and to reverse the trajectory of decline experienced with age. TRIAL REGISTRATION: The At-risk cohort study was registered by the Australian New Zealand Clinical Trials registry on 08/12/2021 (Registration number ACTRN 12621001679875 ).

Stroke survivors' expectations and post-intervention perceptions of mindfulness training: A qualitative study.

Depression and anxiety are common sequelae of stroke, occurring in at least one-third of patients. This study evaluated the acceptability and feasibility of providing mindfulness training (MT) to stroke survivors with the aim of reducing depression and anxiety. Following a six-week one-on-one MT course, 17 participants were interviewed. The median age of participants was 71, and 10 participants were male. This paper focuses on participants' expectations of the MT and their views about its impact on their everyday lives. Conventional content analysis was used for coding and analysis. A single theme, Seizing rehabilitation opportunities, was captured in relation to expectations of MT, and four themes provided information relating to participants' perceived impact of the course: Calming the mind, Reduced reactivity, Remedying physical symptoms, and Not quite there yet.Most participants knew little about mindfulness before the MT and did not have specific goals in mind when volunteering to take part. The findings suggest that most participants considered MT beneficial through reducing stress and giving them additional skills to cope with their everyday lives. A tailored mindfulness intervention may be a useful adjunct to other rehabilitation therapies for stroke survivors.

Interpretability of Spatiotemporal Dynamics of the Brain Processes Followed by Mindfulness Intervention in a Brain-Inspired Spiking Neural Network Architecture.

Mindfulness training is associated with improvements in psychological wellbeing and cognition, yet the specific underlying neurophysiological mechanisms underpinning these changes are uncertain. This study uses a novel brain-inspired artificial neural network to investigate the effect of mindfulness training on electroencephalographic function. Participants completed a 4-tone auditory oddball task (that included targets and physically similar distractors) at three assessment time points. In Group A (n = 10), these tasks were given immediately prior to 6-week mindfulness training, immediately after training and at a 3-week follow-up; in Group B (n = 10), these were during an intervention waitlist period (3 weeks prior to training), pre-mindfulness training and post-mindfulness training. Using a spiking neural network (SNN) model, we evaluated concurrent neural patterns generated across space and time from features of electroencephalographic data capturing the neural dynamics associated with the event-related potential (ERP). This technique capitalises on the temporal dynamics of the shifts in polarity throughout the ERP and spatially across electrodes. Findings support anteriorisation of connection weights in response to distractors relative to target stimuli. Right frontal connection weights to distractors were associated with trait mindfulness (positively) and depression (inversely). Moreover, mindfulness training was associated with an increase in connection weights to targets (bilateral frontal, left frontocentral, and temporal regions only) and distractors. SNN models were superior to other machine learning methods in the classification of brain states as a function of mindfulness training. Findings suggest SNN models can provide useful information that differentiates brain states based on distinct task demands and stimuli, as well as changes in brain states as a function of psychological intervention.

Preoperative bariatric surgery programme barriers facing Pacific patients in Auckland, New Zealand as perceived by health sector professionals: a qualitative study.

Minority ethnic patient groups typically have the highest bariatric surgery preoperative attrition rates and lowest surgery utilisation worldwide. Eligible patients of Pacific Island ethnicity (Pacific patients) in New Zealand (NZ) follow this wider trend. OBJECTIVES: The present study explored structural barriers contributing to Pacific patients' disproportionately high preoperative attrition rates from publicly-funded bariatric surgery in Auckland, NZ. SETTING: Publicly-funded bariatric surgery programmes based in the wider Auckland area, NZ. DESIGN: Semi-structured interviews with health sector professionals (n=21) were conducted.Data were analysed using an inductive thematic approach. RESULTS: Two primary themes were identified: (1) Confidence negotiating the medical system, which included Emotional safety in clinical settings and Relating to non-Pacific health professionals and (2) Appropriate support to achieve preoperative goals, which included Cultural considerations, Practical support and Relating health information. Clinical environments and an under-representation of Pacific staff were considered to be barriers to developing emotional safety, trust and acceptance of the surgery process with patients and their families. Additionally, economic deprivation and lower health literacy impacted preoperative goals. CONCLUSIONS: Health professionals' accounts indicated that Pacific patients face substantial levels of disconnection in bariatric surgery programmes. Increasing representation of Pacific ethnicity by employing more Pacific health professionals in bariatric teams and finding novel solutions to implement preoperative programme components have the potential to reduce this disconnect. Addressing cultural competency of staff, increasing consultancy times and working in community settings may enable staff to better support Pacific patients and their families. Programme structures could be more accommodating to practical barriers of attending appointments, managing patients' preoperative health goals and improving patients' health literacy. Given that Pacific populations, and other patients from minority ethnic backgrounds living globally, also face high rates of obesity and barriers accessing bariatric surgery, our findings are likely to have broader applicability.

Factors associated with preoperative attrition in bariatric surgery: a protocol for a systematic review.

BACKGROUND: Bariatric surgery results in substantial medical and economic benefits; however, independent studies typically report high patient preoperative attrition rates. Studies have identified individual characteristics and sociodemographic variables of those who complete the surgery compared to those who do not. The aim of the present protocol is to outline a systematic review focussed on identifying the sociodemographic, medical, cultural, psychological, and patient-led factors affecting preoperative attrition in clients who were enrolled in bariatric surgery programmes. METHODS/DESIGN: The databases Scopus, CINAHL, PsycINFO, Web of Science, and MEDLINE will be searched for retrospective, prospective, and cross-sectional observational studies that have identified any sociodemographic, medical, cultural, psychological, and patient-led factors affecting preoperative attrition in clients who are enrolled in a bariatric surgery programme. English-language articles published between 1997 to 2020, inclusive of adults 18 years or older, will be included in the review. This protocol has been registered in PROSPERO, registration number; CRD42017068557. DISCUSSION: Presently, there are studies and reviews investigating population-based utilisation and access to bariatric surgery; however, there is a need to review the reasons behind preoperative bariatric surgery patient attrition once selected for bariatric surgery. The results of the review will highlight potential systematic disparities in patient attrition, where gaps in knowledge remain for further investigation, and suggest areas where countermeasures may be focussed for decreasing attrition rates. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017068557.

Associations between immunological function and memory recall in healthy adults.

Studies in clinical and aging populations support associations between immunological function, cognition and mood, although these are not always in line with animal models. Moreover, very little is known about the relationship between immunological measures and cognition in healthy young adults. The present study tested associations between the state of immune system and memory recall in a group of relatively healthy adults. Immediate and delayed memory recall was assessed in 30 participants using the computerised cognitive battery. CD4, CD8 and CD69 subpopulations of lymphocytes, Interleukin-6 (IL-6) and cortisol were assessed with blood assays. Correlation analysis showed significant negative relationships between CD4 and the short and long delay memory measures. IL-6 showed a significant positive correlation with long-delay recall. Generalized linear models found associations between differences in all recall challenges and CD4. A multivariate generalized linear model including CD4 and IL-6 exhibited a stronger association. Results highlight the interactions between CD4 and IL-6 in relation to memory function. Further study is necessary to determine the underlying mechanisms of the associations between the state of immune system and cognitive performance.

Children's voices in public hospital healthcare delivery: intention as opposed to practice.

AIM: To determine the extent to which children have the opportunity to provide feedback on public hospital care in New Zealand. METHOD: A scan of the web sites of the Ministry of Health and the Health Quality and Safety Commission New Zealand (HQSC) together with a search of core District Health Board publications was conducted to identify existing or planned processes to capture the hospital experience of patients under 18 years. RESULTS: The importance of gathering patient feedback was recognised but, currently, ad hoc strategies are being used to put these good intentions into practice. Although some DHBs are introducing novel methods of gathering patient feedback, details of data collection methods and characteristics of participants are often not publicised. The HQSC has developed an adult Inpatient survey to provide a coherent means of assessing patient experience nationally but there is currently no children's survey available. CONCLUSIONS: Our analysis suggests a lack of opportunity for children's perspectives to be taken into account in secondary health service delivery. The current 'paternalistic' approach, based upon children being a vulnerable population, is contrary to the emerging recognition that children are individuals who can contribute to their own care and well-being.

Supervisors' responses to sickness certification for an episode of low back pain: employees' personal experiences.

PURPOSE: To understand how work supervisors respond to sickness certification for an episode of low back pain based on employees' reports of employer-employee interactions. METHOD: Thematic analysis of semi-structured in-depth interviews with 16 employees who were currently or had recently been off work with an episode of low back pain. RESULTS: Two types of initial supervisor response were identified: See you later and take your time and get it right. Both of these relied on the employee returning to work once they were able to do their normal work tasks. Three types of subsequent response were identified: proactive, apathetic and negative. Only the proactive response included actions to encourage and assist the employee to return to the workplace. CONCLUSIONS: The interactions described by participants suggest that employers and their representatives often postpone actioning to return to work interventions which potentially delays the rehabilitation of the employee.

Does the doctor or the patient control sick leave certification? A qualitative study interpreting patients' interview dialogue.

BACKGROUND: Sickness certification poses challenges and problems for the GP. Patient factors may influence the sick leave period. OBJECTIVE: To explore how sickness certification occurred based on patients' reports of medical consultations for a new episode of low back pain. METHODS: A qualitative study using semi-structured interviews with 16 employees who were currently or had recently been off work with an episode of low back pain. RESULTS: We present a preliminary typology of sickness certification responses by medical practitioners comprising four response types: 'process', 'cued', 'consultative' and 'laissez-faire'. All but the process response allows the patient some influence in the sickness certification decision. It is possible that certain types of response may occur at specific stages of recovery. CONCLUSIONS: Doctors may allow patients input into the sickness certification process for a number of reasons. As yet, we do not know if this helps or hinders the return to work process.

Reductions in driver speed using posted feedback of speeding information: social comparison or implied surveillance?

Reducing driver speed has an essential role to play in traffic safety. This study measured the effect of a roadside sign, in a 50 km/h zone, that consecutively displayed one of three messages: The average speed at the site: this message was designed to induce "social comparison" whereby drivers may reduce their speed in order to comply with the behaviour of the majority. A warning that drivers' speeds were being measured: this was intended to imply surveillance whereby drivers may reduce speed in order to avoid possible enforcement action. A combination of both messages, to see if both together would have a greater effect than either alone. The speed of drivers travelling along a busy urban road (11,500 cars daily in each direction) was measured using inductive loop detectors. The proportion of drivers travelling 60 km/h or less increased with all three messages, suggesting that both social comparison and implied surveillance are mechanisms by which driver speed may be reduced. However, the speed reductions were not as great as in previous studies of feedback signs. This may be due to differences in the existing safety culture.