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1.
Health Commun ; 36(1): 109-115, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33222539

RESUMO

Aotearoa New Zealand's public health crisis communication approach amidst the COVID-19 pandemic effectively mobilized the nation into swift lockdown, significantly reducing community transmission. This communication approach has been applauded around the world. How did communities situated amongst the "margins of the margins" in Aotearoa New Zealand navigate through the existing structural barriers to health during the pandemic? In this study, we use a culture-centered analysis to foreground the structural context of disenfranchisement amidst the COVID-19 lockdown. Drawing on in-depth interviews with participants in a larger ethnographic project on poverty and health across three communities in Aotearoa New Zealand, we attend to the ways in which health is negotiated amidst the COVID-19 outbreak and lockdown response at the "margins of the margins." The narratives point out that health communication interventions to prevent COVID-19 in the context of Aotearoa New Zealand furthered the marginalization of communities at the margins, and community voices were largely erased from the enactment of interventions. With the extant structures failing to recognize these aspects of everyday struggles of health at the margins, the health and access challenges were further magnified during COVID-19. Our attention to communication situated in relationship to structures builds a register for health communication scholarship in the context of COVID-19 that is committed to disrupting the behaviorally based hegemonic health communication literature and transforming the unequal terrains of health experiences.


Assuntos
/etnologia , Controle de Doenças Transmissíveis/métodos , Pobreza/psicologia , Pobreza/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antropologia Cultural , Comunicação , Competência Cultural , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Negociação , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos , Pandemias , Fatores Socioeconômicos , Populações Vulneráveis , Adulto Jovem
2.
MMWR Morb Mortal Wkly Rep ; 69(48): 1807-1811, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33270609

RESUMO

By June 2020, Marshallese and Hispanic or Latino (Hispanic) persons in Benton and Washington counties of Arkansas had received a disproportionately high number of diagnoses of coronavirus disease 2019 (COVID-19). Despite representing approximately 19% of these counties' populations (1), Marshallese and Hispanic persons accounted for 64% of COVID-19 cases and 57% of COVID-19-associated deaths. Analyses of surveillance data, focus group discussions, and key-informant interviews were conducted to identify challenges and propose strategies for interrupting transmission of SARS-CoV-2, the virus that causes COVID-19. Challenges included limited native-language health messaging, high household occupancy, high employment rate in the poultry processing industry, mistrust of the medical system, and changing COVID-19 guidance. Reducing the COVID-19 incidence among communities that suffer disproportionately from COVID-19 requires strengthening the coordination of public health, health care, and community stakeholders to provide culturally and linguistically tailored public health education, community-based prevention activities, case management, care navigation, and service linkage.


Assuntos
/etnologia , Surtos de Doenças , Hispano-Americanos/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Arkansas/epidemiologia , Técnicas de Laboratório Clínico , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
4.
BMC Fam Pract ; 21(1): 269, 2020 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-33308161

RESUMO

BACKGROUND: During the first COVID-19 pandemic 'lockdown' in Aotearoa/New Zealand (March-May 2020, in which strict 'stay at home' measures were introduced), general practices were advised to use telephone and video consultations (telehealth) wherever possible instead of the usual in-person visits. This was a sudden change for most practices and patients. This research aimed to explore how patients accessed general practice during lockdown and evaluate their experiences with telehealth, to inform how telehealth could be most effectively used in the future. METHODS: Using a mixed-method approach, we undertook an online survey and in-depth interviews with adults (> 18 years) who had contact with practices during lockdown, recruited through social media and email lists. We present descriptive statistics from the survey data (n = 1010) and qualitative analysis of interview data (n = 38) and open-ended survey questions, using a framework of access to health care, from the patient's perspective. RESULTS: In general, patients reported high satisfaction with telehealth in general practice during lockdown. Telehealth was convenient and allowed patients to safely access health care without having to weigh-up the fear of COVID-19 infection against the need to be seen. Telehealth worked best for routine and familiar health issues and when rapport was established between patients and clinicians. This was easier with a pre-existing clinical relationship, but not impossible without one. Telehealth was less suitable when a physical examination was needed, when the diagnosis was unknown or for patients who had a strong preference to be seen in-person. CONCLUSIONS: Even in this disruptive lockdown period, that prompted an unexpected and rapid implementation of telehealth services in general practices, most patients had positive experiences with telehealth. In the future, patients want the choice of consultation type to match their needs, circumstances, and preferences. Technological issues and funding barriers may need to be addressed, and clear communication for both patients and clinicians is needed about key aspects of telehealth (e.g. cost, appropriateness, privacy). Maintaining telehealth as an option post-lockdown has the potential to increase timely and safe access to primary health care for many patients.


Assuntos
Medicina Geral , Preferência do Paciente , Satisfação do Paciente , Telemedicina , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , Controle de Doenças Transmissíveis , Assistência à Saúde , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Grupo com Ancestrais Oceânicos , Pesquisa Qualitativa , Inquéritos e Questionários , Adulto Jovem
6.
Med J Aust ; 213 Suppl 10: S3-S31, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33190287

RESUMO

■The RHD Endgame Strategy: the blueprint to eliminate rheumatic heart disease in Australia by 2031 (the Endgame Strategy) is the blueprint to eliminate rheumatic heart disease (RHD) in Australia by 2031. Aboriginal and Torres Strait Islander people live with one of the highest per capita burdens of RHD in the world. ■The Endgame Strategy synthesises information compiled across the 5-year lifespan of the End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRE). Data and results from priority research projects across several disciplines of research complemented literature reviews, systematic reviews and narrative reviews. Further, the experiences of those working in acute rheumatic fever (ARF) and RHD control and those living with RHD to provide the technical evidence for eliminating RHD in Australia were included. ■The lived experience of RHD is a critical factor in health outcomes. All future strategies to address ARF and RHD must prioritise Aboriginal and Torres Strait Islander people's knowledge, perspectives and experiences and develop co-designed approaches to RHD elimination. The environmental, economic, social and political context of RHD in Australia is inexorably linked to ending the disease. ■Statistical modelling undertaken in 2019 looked at the economic and health impacts of implementing an indicative strategy to eliminate RHD by 2031. Beginning in 2019, the strategy would include: reducing household crowding, improving hygiene infrastructure, strengthening primary health care and improving secondary prophylaxis. It was estimated that the strategy would prevent 663 deaths and save the health care system $188 million. ■The Endgame Strategy provides the evidence for a new approach to RHD elimination. It proposes an implementation framework of five priority action areas. These focus on strategies to prevent new cases of ARF and RHD early in the causal pathway from Streptococcus pyogenes exposure to ARF, and strategies that address the critical systems and structural changes needed to support a comprehensive RHD elimination strategy.


Assuntos
Desenvolvimento de Programas/métodos , Febre Reumática/prevenção & controle , Cardiopatia Reumática/prevenção & controle , Adolescente , Adulto , Austrália/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Sistema de Registros , Febre Reumática/complicações , Febre Reumática/epidemiologia , Cardiopatia Reumática/epidemiologia , Cardiopatia Reumática/etiologia , Prevenção Secundária , Streptococcus pyogenes , Adulto Jovem
7.
Aust J Rural Health ; 28(6): 613-617, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33216416

RESUMO

The rapid response to the COVID-19 pandemic in Australia has highlighted the vulnerabilities of remote Aboriginal and Torres Strait Islander communities in terms of the high prevalence of complex chronic disease and socio-economic factors such as limited housing availability and overcrowding. The response has also illustrated the capability of Aboriginal and Torres Strait Islander leaders and the Aboriginal Community Controlled Health Services Sector, working with the government, to rapidly and effectively mitigate the threat of transmission into these vulnerable remote communities. The pandemic has exposed persistent workforce challenges faced by primary health care services in remote Australia. Specifically, remote health services have a heavy reliance on short-term or fly-in, fly-out/drive-in, drive-out staff, particularly remote area nurses. The easing of travel restrictions across the country brings the increased risk of transmission into remote areas and underscores the need to adequately plan and fund remote primary health care services and ensure the availability of an adequate, appropriately trained local workforce in all remote communities.


Assuntos
/epidemiologia , Serviços de Saúde do Indígena/organização & administração , Serviços de Saúde Rural/organização & administração , Austrália/epidemiologia , Humanos , Grupo com Ancestrais Oceânicos , Pandemias
8.
BMC Med Inform Decis Mak ; 20(1): 286, 2020 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-33143691

RESUMO

BACKGROUND: In Australia, health services are seeking innovative ways to utilize data stored in health information systems to report on, and improve, health care quality and health system performance for Aboriginal Australians. However, there is little research about the use of health information systems in the context of Aboriginal health promotion. In 2008, the Northern Territory's publicly funded healthcare system introduced the quality improvement program planning system (QIPPS) as the centralized online system for recording information about health promotion programs. The purpose of this study was to explore the potential for utilizing data stored in QIPPS to report on quality of Aboriginal health promotion, using chronic disease prevention programs as exemplars. We identify the potential benefits and limitations of health information systems for enhancing Aboriginal health promotion. METHODS: A retrospective audit was undertaken on a sample of health promotion projects delivered between 2013 and 2016. A validated, paper-based audit tool was used to extract information stored in the QIPPS online system and report on Aboriginal health promotion quality. Simple frequency counts were calculated for dichotomous and categorical items. Text was extracted and thematically analyzed to describe community participation processes and strategies used in Aboriginal health promotion. RESULTS: 39 Aboriginal health promotion projects were included in the analysis. 34/39 projects recorded information pertaining to the health promotion planning phases, such as statements of project goals, 'needs assessment' findings, and processes for consulting Aboriginal people in the community. Evaluation findings were reported in approximately one third of projects and mostly limited to a recording of numbers of participants. For almost half of the projects analyzed, community participation strategies were not recorded. CONCLUSION: This is the first Australian study to shed light on the feasibility of utilizing data stored in a purposefully designed health promotion information system. Data availability and quality were limiting factors for reporting on Aboriginal health promotion quality. Based on our learnings of QIPPS, strategies to improve the quality and accuracy of data entry together with the use of quality improvement approaches are needed to reap the potential benefits of future health promotion information systems.


Assuntos
Assistência à Saúde/normas , Sistemas de Informação em Saúde/organização & administração , Promoção da Saúde/normas , Serviços de Saúde do Indígena/normas , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Melhoria de Qualidade , Assistência à Saúde/organização & administração , Promoção da Saúde/organização & administração , Humanos , Informática Médica , Northern Territory , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos
10.
N Z Med J ; 133(1525): 62-73, 2020 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-33223549

RESUMO

Acute coronary syndrome (ACS) is one of the leading causes of mortality in the renal replacement therapy (RRT) population. We aimed to understand the characteristics, trends and outcomes of ACS in our local RRT population as a means to improve care and outcomes for this high-risk population. Using the ANZACS-QI database, we conducted a retrospective analysis of all ACS occurring in RRT patients between 1 January 2010-31 December 2019 managed at Waikato Hospital (n=135 at index ACS). In our cohort made up predominantly of Maori (55%) and European (34%) patients, 58% had diabetic nephropathy as their primary disease. Twenty-seven percent presented atypically and 65% had a delay of >72 hours from diagnosis to angiogram. There was a 49% mortality rate at one year post-index ACS. Factors associated with mortality at one year included: atypical presentation (chi-square statistic (X2) 7.250; p=0.0071), troponin delta >20% (X2 5.682; p=0.0171), peak troponin (point biserial correlation; r=0.2086; p=0.0473) and no revascularisation (X2 5.2419; p=0.0221). The findings in our cohort reiterate that patients on RRT are a vulnerable population who have poor outcomes associated with ACS, driven by multifactorial delays in diagnosis and treatment.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Nefropatias Diabéticas/epidemiologia , Terapia de Substituição Renal/estatística & dados numéricos , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Bases de Dados Factuais , Nefropatias Diabéticas/terapia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco
11.
N Z Med J ; 133(1525): 132-134, 2020 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-33223558

RESUMO

Clinician-scientist training most commonly refers to the concomitant undertaking of dual (medical and PhD) degrees by a medical student. While such training is relatively well-established in the US, Canada and many countries in Europe including the UK, uptake in Australasia has been slower and less successful. This brief piece explores this aspect, with some focus on the history of the intercalated programmes in New Zealand.


Assuntos
Pesquisa Biomédica , Educação de Pós-Graduação/métodos , Educação Médica Continuada/métodos , Escolha da Profissão , Educação de Pós-Graduação/tendências , Educação Médica Continuada/tendências , Humanos , Nova Zelândia , Grupo com Ancestrais Oceânicos
12.
BMC Public Health ; 20(1): 1752, 2020 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-33225914

RESUMO

BACKGROUND: A recent Royal Commission into the treatment of Australians living with disabilities has underscored the considerable exposure to violence and harm in this population. Yet, little is known about exposure to violence among Aboriginal and Torres Strait Islander people living with disabilities. The objective of this paper was to examine the prevalence, disability correlates and aspects of violence and threats reported by Aboriginal and Torres Strait Islander people living with disabilities. METHODS: Data from the 2014-15 National Aboriginal and Torres Strait Islander Social Survey were used to measure physical violence, violent threats and disability. Multivariable logistic and ordinal logistic regression models adjusted for complex survey design were used to examine the association between measures of disability and exposure to violence and violent threats. RESULTS: In 2014-15, 17% of Aboriginal and Torres Strait Islander people aged 15-64 with disability experienced an instance of physical violence compared with 13% of those with no disability. Approximately 22% of those with a profound or severe disability reported experiencing the threat of physical violence. After adjusting for a comprehensive set of confounding factors and accounting for complex survey design, presence of a disability was associated with a 1.5 odds increase in exposure to physical violence (OR = 1.54 p < 0.001), violence with harm (OR = 1.55 p < 0.001), more frequent experience of violence (OR = 1.55 p < 0.001) and a 2.1 odds increase (OR = 2.13 p < 0.001) in exposure to violent threats. Severity of disability, higher numbers of disabling conditions as well as specific disability types (e.g., psychological or intellectual) were associated with increased odds of both physical violence and threats beyond this level. Independent of these effects, removal from one's natural family was strongly associated with experiences of physical violence and violent threats. Aboriginal and Torres Strait Islander women, regardless of disability status, were more likely to report partner or family violence, whereas men were more likely to report violence from other known individuals. CONCLUSION: Aboriginal and Torres Strait Islander people with disability are at heightened risk of physical violence and threats compared to Aboriginal and Torres Strait Islander people without disability, with increased exposure for people with multiple, severe or specific disabilities.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Abuso Físico/etnologia , Adolescente , Adulto , Austrália/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Adulto Jovem
13.
PLoS One ; 15(10): e0239384, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002023

RESUMO

In recent decades, several studies have emphasized sense of personal control as a prominent aspect of Aboriginal health. However, one limitation is that instruments available to measure personal control were originally developed in western countries and validation for Aboriginal Australians has not been conducted. The aims of the current study were to evaluate whether the Sense of Personal Control Scale (SPCS) can be used to obtain culturally unbiased measurement of personal control across Aboriginal and non-Aboriginal Australians and to assess the psychometric properties of the SPCS for Aboriginal and non-Aboriginal Australian. METHODS: The current study utilized two Australian subsamples retrieved from the Teeth Talk Study (n = 317) and the National Survey of Adult Oral Health 2004-2006 (n = 3,857) in which the SPCS was included. Graphical Loglinear Rasch Models (GLLRM) were used to fulfill the aims of the study. RESULTS: The Perceived Constraints subscale fitted a GLLRM for Aboriginal Australians after the exclusion of three items, while fit to any Rasch model (RM) or GLLRM model could not be found in the non-Aboriginal sample. The Mastery subscale fitted a GLLRM in the non-Aboriginal sample after the exclusion of one item. In the Aboriginal sample, two items of the Mastery subscale fitted the RM, however, two items cannot be considered as a scale. CONCLUSION: In the present study, we showed that the development of new items is crucial before the revised SPCS might constitute a valid and reliable measure of sense of personal control in both Aboriginal and non-Aboriginal Australian populations, and it is possible to assess whether the SPCS can be measured without bias across these two populations.


Assuntos
Inquéritos Epidemiológicos , Grupo com Ancestrais Oceânicos/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/etnologia , Feminino , Serviços de Saúde do Indígena/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Adulto Jovem
14.
PLoS One ; 15(10): e0239765, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33119636

RESUMO

BACKGROUND: Aboriginal and Torres Strait Islander people experience a greater burden of disease and die younger than non-Indigenous Australians, with Aboriginal people living in remote areas of the Northern Territory of Australia having the lowest life expectancy estimates. Despite a high burden of chronic disease among Aboriginal and Torres Strait Islander people, access to specialist health services remains low and models of care that increase engagement, may improve health outcomes. METHODS: We describe client and staff perspectives of a model of clinical genetics services provided by the MJD Foundation (MJDF) in geographically and culturally complex contexts within the Northern Territory of Australia. We seek to understand the MJDF model's success in supporting Aboriginal families with the familial, neurodegenerative condition Machado-Joseph disease and how it could be applied in the provision of other specialist services. Thematic analysis was undertaken on semi-structured interviews with primary health care staff (n = 2), Non-Aboriginal MJDF Staff (n = 7) and Aboriginal MJDF Clients / Community workers (n = 13). RESULTS: Four key themes regarding the MJDF model of service delivery were identified with the service being; 1) client led 2) accepting of various understandings of genetic disease causation 3) focused on relationships, continuity and trust between the service provider and the clients, and 4) committed to incorporating an inclusive whole-of-family practice. The MJDF model takes a community-based, person-and family-centred approach to successfully deliver effective specialist genetic health services in remote community settings. We propose that these approaches have broad application in the future design and delivery of specialist health services particularly in culturally complex settings.


Assuntos
Doença Crônica/epidemiologia , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde do Indígena , Grupo com Ancestrais Oceânicos/genética , Adolescente , Competência Cultural , Feminino , Humanos , Masculino , Northern Territory/epidemiologia , Atenção Primária à Saúde/métodos , Relações Profissional-Paciente
15.
Women Birth ; 33(6): 520-525, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33092701

RESUMO

Persistent disparities in stillbirth risk and care are present in Australia. Eliminating these disparities is possible with a commitment to enhancing and scaling up models of culturally safe maternity care shown to be effective for Aboriginal and Torres Strait Islander women and those of migrant and refugee backgrounds. Campaigns to improve public awareness of stillbirth also play an important role in reducing stillbirth risk and consequences. To achieve reach and impact in communities at risk, messaging needs to be framed around the social and cultural context of women's lives. Here we describe important initiatives underway within the Stillbirth Centre of Research Excellence to develop a coordinated national approach to stillbirth prevention and care in communities that bear a disproportionate burden of stillbirth.


Assuntos
Assistência à Saúde Culturalmente Competente , Morte Fetal/prevenção & controle , Serviços de Saúde do Indígena/organização & administração , Disparidades em Assistência à Saúde , Serviços de Saúde Materna/organização & administração , Natimorto/etnologia , Austrália , Competência Cultural , Feminino , Acesso aos Serviços de Saúde , Humanos , Grupo com Ancestrais Oceânicos , Gravidez , Refugiados , Migrantes
16.
BMC Geriatr ; 20(1): 377, 2020 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008342

RESUMO

BACKGROUND: The Aotearoa New Zealand population is ageing accompanied by health and social challenges including significant inequities that exist between Maori and non-Maori around poor ageing and health. Although historically kaumatua (elder Maori) faced a dominant society that failed to realise their full potential as they age, Maori culture has remained steadfast in upholding elders as cultural/community anchors. Yet, many of today's kaumatua have experienced 'cultural dissonance' as the result of a hegemonic dominant culture subjugating an Indigenous culture, leading to generations of Indigenous peoples compelled or forced to dissociate with their culture. The present research project, Kaumatua Mana Motuhake Poi (KMMP) comprises two interrelated projects that foreground dimensions of wellbeing within a holistic Te Ao Maori (Maori epistemology) view of wellbeing. Project 1 involves a tuakana-teina/peer educator model approach focused on increasing service access and utilisation to support kaumatua with the greatest health and social needs. Project 2 focuses on physical activity and cultural knowledge exchange (including te reo Maori--Maori language) through intergenerational models of learning. METHODS: Both projects have a consistent research design and common set of methods that coalesce around the emphasis on kaupapa kaumatua; research projects led by kaumatua and kaumatua providers that advance better life outcomes for kaumatua and their communities. The research design for each project is a mixed-methods, pre-test and two post-test, staggered design with 2-3 providers receiving the approach first and then 2-3 receiving it on a delayed basis. A pre-test (baseline) of all participants will be completed. The approach will then be implemented with the first providers. There will then be a follow-up data collection for all participants (post-test 1). The second providers will then implement the approach, which will be followed by a final data collection for all participants (post-test 2). DISCUSSION: Two specific outcomes are anticipated from this research; firstly, it is hoped that the research methodology provides a framework for how government agencies, researchers and relevant sector stakeholders can work with Maori communities. Secondly, the two individual projects will each produce a tangible approach that, it is anticipated, will be cost effective in enhancing kaumatua hauora and mana motuhake. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry ( ACTRN12620000316909 ). Registered 6 March 2020.


Assuntos
Envelhecimento/etnologia , Envelhecimento/psicologia , Promoção da Saúde/métodos , Relações Interpessoais , Idioma , Medicina Tradicional/métodos , Grupo com Ancestrais Oceânicos/educação , Idoso , Pesquisa Participativa Baseada na Comunidade , Características Culturais , Humanos , Nova Zelândia , Grupo com Ancestrais Oceânicos/etnologia , Grupo com Ancestrais Oceânicos/psicologia , Grupo Associado
17.
N Z Med J ; 133(1523): 87-95, 2020 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-33032306

RESUMO

Prostate cancer represents a significant health burden worldwide. The cancer incidence had substantially increased since the introduction of prostate specific antigen (PSA) in cancer screening. This had led to considerable debates among health professionals and epidemiologists, since PSA as a screening tool seemed to be far from perfect. In New Zealand, the controversy was quite prominent in the last three decades, with some advocating the benefits of screening, while others concerned regarding the risk of harms. With the absence of an organised screening programme and the appropriate monitoring and quality assurance procedures, the effects of the PSA testing debate had undoubtedly caused a variability in the opportunistic prostate cancer screening practices in the community. This, in addition to the recent rapid advancements in prostate cancer imaging, and updated results from randomised trials, have made it mandatory to question the validity of continuing with the current approach to prostate cancer screening. However, high-quality local data on these aspects had been lacking, which represents an ongoing challenge to developing robust and sound health policies.


Assuntos
Detecção Precoce de Câncer , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/epidemiologia , Adulto , Idoso , Grupo com Ancestrais do Continente Europeu , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos , Antígeno Prostático Específico/sangue
18.
Arch Pathol Lab Med ; 144(10): 1199-1203, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33002152

RESUMO

CONTEXT.­: The burden of chronic kidney disease in Indigenous Australians is 7.3 times higher than that of non-Indigenous Australians. If chronic kidney disease is detected early and managed, deterioration in kidney function can be reduced. Urine albumin to creatinine ratio is a key marker of early renal damage. OBJECTIVE.­: To report on 16 years of analytic quality of urine albumin to creatinine ratio testing on Siemens DCA devices enrolled in the national Quality Assurance for Aboriginal and Torres Strait Islander Medical Services point-of-care testing program. DESIGN.­: Quality Assurance for Aboriginal and Torres Strait Islander Medical Services participants are required to test 2 quality assurance samples each month across two 6-monthly testing cycles per year. Participants also test 2 quality control samples monthly. RESULTS.­: The percentage of urine albumin, creatinine, and albumin to creatinine ratio results for quality assurance point-of-care testing that were within assigned allowable limits of performance averaged 96.9%, 95.9%, and 97.5%, respectively. The percentage acceptable quality control results for urine albumin and creatinine averaged 93.5% and 86.8%. The median imprecision for urine albumin, creatinine, and albumin to creatinine ratio quality assurance testing averaged 5.5%, 4.1%, and 3.3%, respectively, and the median within-site imprecision for quality control testing averaged 5.4%, 4.3%, and 5.7%, respectively, for the low sample and 4.0%, 4.1%, and 4.5%, respectively, for the high sample. CONCLUSIONS.­: For 16 years the DCA system has proven to be reliable and robust and operators at Aboriginal medical services have demonstrated they are able to conduct point-of-care testing for urine albumin to creatinine ratio that consistently meets analytic performance standards.


Assuntos
Albuminúria/urina , Creatinina/urina , Testes Imediatos , Insuficiência Renal Crônica/diagnóstico , Austrália , Humanos , Grupo com Ancestrais Oceânicos , Garantia da Qualidade dos Cuidados de Saúde , Controle de Qualidade , Insuficiência Renal Crônica/urina , Urinálise
20.
N Z Med J ; 133(1524): 50-63, 2020 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-33119570

RESUMO

BACKGROUND: Most cervical cancers are associated with human papillomavirus (HPV) types 16 and 18. In 2008, New Zealand commenced a quadrivalent HPV (virus-like particles of types 6, 11, 16 and 18) vaccination programme. AIM: Document trends in number of colposcopy referrals and number and grade of cervical abnormalities diagnosed in women (20-24 years) referred to three large colposcopy clinics over time. METHOD: Retrospective analysis of colposcopy clinic data. RESULTS: The dataset included 5,012 episodes from 4,682 women. In Auckland (2013-2017), there was a 38% decrease in colposcopy referrals and 55% decrease in cervical intraepithelial neoplasia grade 2 (CIN2) or worse diagnoses. In Waikato (2011-2017), there was an 8% decrease in referrals and 22% reduction in CIN2 or worse diagnoses. In Canterbury (2011-2017), there was a 24% decrease in referrals and 49% reduction in CIN2 or worse diagnoses. Across all centres, the decrease in cervical intraepithelial neoplasia grade 3 (CIN3) or worse diagnoses was marked and more consistent than in CIN2 diagnoses. However, while the proportion of biopsies reported as CIN3 or worse decreased in non-Maori (24% in 2013 vs 16% in 2017, nptrend z=-4.24, p>|z| <.001), there was no change in Maori women (31% in 2013 vs 29% in 2017, nptrend z=-0.12, p>|z| =.90). CONCLUSIONS: We observed a decreased number of CIN diagnoses in young women over time, with a particularly large drop in the number of CIN3/AIS/CGIN diagnoses. However, compared to non-Maori, Maori women having biopsies are more likely to have CIN3 or worse and there was a smaller reduction in the total number of Maori women diagnosed with CIN2 or worse.


Assuntos
Neoplasia Intraepitelial Cervical/epidemiologia , Vacinas contra Papillomavirus , Neoplasias do Colo do Útero/epidemiologia , Biópsia , Neoplasia Intraepitelial Cervical/diagnóstico , Colposcopia/tendências , Feminino , Humanos , Povos Indígenas , Gradação de Tumores , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos , Infecções por Papillomavirus/prevenção & controle , Estudos Retrospectivos , Neoplasias do Colo do Útero/diagnóstico , Adulto Jovem
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